Rheumatology Flashcards
1
Q
Which joint is the most commonly affected by gout?
A
1st metatarsophalangeal joint (Big toe)
2
Q
Give 2 causes of increased urate production.
A
- Diet- red meat, alcohol, seafood
- Drugs- Cytotoxics, Warfarin
- Psoriasis
- Genetics
3
Q
Give 2 causes of decreased urate excretion.
A
- Drugs- aspirin, anti HTN drugs, diuretics
- CKD
- Male gender
- Elderly
- Metabolic syndrome
4
Q
Which treatments can be used for acute gout?
A
- RICE- rest ice compress elevate
- NSAIDs high dose
- Colchicine
- Steroids- oral, IM or intra articular
5
Q
Which treatments can be used to prevent gout/ as prophylaxis?
A
- Avoid triggers
- Allopurinol- start >3weeks after acute gout
(Febuoxstat if intolerant of Allopurinol)
6
Q
Which joint is most commonly affected by septic arthritis?
A
Knee
7
Q
Give 3 differential diagnoses for monoarthritis.
A
- Septic arthritis
- Osteoarthritis
- Crystal arthropathy: Gout/ pseudogout
- Trauma-haemarthrosis
8
Q
Is Colchicine typically used to prevent gout acutely or for prevention?
A
Acute
9
Q
Is Allopurinol typically used to prevent gout acutely or for prevention?
A
Prevention
10
Q
____________ involves widespread pain above and below the diaphragm, with 11 or more of 18 tender points.
A
Fibromyalgia
11
Q
Which hand joints are usually spared in rheumatoid arthritis?
A
DIPs
12
Q
Are pleural effusions in rheumatoid arthritis patients usually transudates or exudates?
A
Transudate
Low glucose
13
Q
What type of finger deformity has:
- DIP flexion
- PIP hyperextension
A
Swan neck
14
Q
What type of finger deformity has:
- PIP flexion
- DIP hyperextension
A
Boutonniere’s
15
Q
Rituximab is a biological therapy which works by targeting __ cells.
A
B cells
16
Q
Give 1 example of an Anti TNF alpha drugused for RA treatment.
A
- Infliximab
- Etanercept
- Golimumab
- Adalimumab
17
Q
Tocilizumab works as an antagonist for which receptors?
A
Il-6
18
Q
Give 3 or more examples of extra-articular features of RA.
A
- Rheumatoid nodules
- Pulmonary thickening, pulmonary effusion, nodules and fibrosis
- Anaemia of chronic disease
- Leg ulcers
- Eyes- scleritis, dry eyes
- Dry mouth
- Cervical spine inflammation leading to cord compression
- Vasculitis
19
Q
What is the name given to the group of conditions characterised by:
- HLA-B27 positive and RF negative
- Spinal inflammation
- Sacro-iliac joint involvement
- Enthesitis
A
Seronegative spondyloarthropathies
20
Q
Keratoderma Blennorrhagica is usually found in which seronegative spondyloarthropathy?
A
Reactive arthritis
21
Q
Adalimumab, Golimumab and Etanercept are all Anti _____ drugs.
A
Anti TNF alpha
22
Q
“Pencil in cup” deformity is seen radiologically in which type of arthritis?
A
Psoriatic arthritis
in particular arthritis multilans
23
Q
“Bamboo spine” is seen radiologically in which condition?
A
Ankylosing spondylitis
24
Q
Give 1 example of an organism causing a GI infection that can lead to reactive arthritis.
A
- Campylobacter
- Salmonella
- Shigella
- Neisseria
25
Reactive arthritis is considered to be chronic if it lasts for more than ____ months.
6 months
26
Reiter's Syndrome is a triad of symptoms (Arthritis + Urethritis + ___________) which can be found in reactive arthritis.
Conjunctivitis
27
Does the arthritis in reactive arthritis usually affect the upper or lower limbs?
Lower limbs
28
Anti centromere antibodies are found in which condition?
CREST- Limited systemic sclerosisfscl
29
Anti JO1 antibodies are found in which 2 conditions?
Polymyositis
| Dermatomyositis
30
Anti dsDNA antibodies are found in which condition?
SLE
31
Anti phospholipid antibodies are found in which conditions?
SLE
| Anti phospholipid syndrome
32
Anti CCP antibodies are found in which condition?
RA
33
Anti Scl70 antibodies are found in which condition?
Diffuse Systemic sclerosis
34
Name 2 or more autoantibodies that may be found in SLE patients.
1. ANA
2. Anti dsDNA
3. Anti phospholipid
4. Anti Smith
35
What happens to C3 and C4 (complement) levels in SLE patients?
C3 and C4 DECREASE
Due to consumption of complement
36
What happens to CRP and ESR levels in SLE?
ESR is raised
| CRP usully normal
37
First line treatment for ankylosing spondylitis is __________ and ________.
NSAIDs and exercise
38
Name as many of the 4 DMARDs used for RA as possible.
1. Methotrexate
2. Hydroxychloroquine
3. Sulfasalasinze
4. Leflunomide
39
Give 1 example of a side effect of Methotrexate.
1. Hepatotoxic/ cirrhosis
2. Bone marrow suppression
3. Hair loss
4. Sore mouth/ mouth ulcers
5. Nausea and diarrhoea
6. Pneumonitis/ pulmonary fibrosis
7. Teratogenic
40
Which DMARD is usually given first to patients with rheumatoid arthritis?
Methotrexate
41
Before starting Methotrexate, patients usually need to have bloods and a _________.
Chest X ray
42
Which DMARD has side effects including retinopathy and seiures?
Hydroxychloroquine
43
Name 3 or more risk factors for septic arthritis.
1. Diabetes
2. Joint disease (RA)
3. Immunosuppression
4. CKD
5. IVDU
6. Recent joint surgery/ prosthesis
44
Name 3 or more causes of secondary osteoporosis.
1. Hyperparathyroidism
2. Hyperthyroid
3. Coeliac disease
4. CKD
5. Liver disease
6. Cushing's disease
7. Drugs- Steroids, aromatase inhibitors
8. Autoimmune- RA
9. Malignancy eg. Myeloma, leukaemia, bone mets
45
Denosumab is a Rank-ligand inhibitor used to treat which condition?
Osteoporosis
46
Zoledronate, Risodronate and Alendronate are all ___________ drugs used for the treatment of osteoporosis.
Bisphosphonates
47
Out of the following immunosuppressants, which are NOT SAFE in pregnancy?
1. Hydroxychloroquine
2. Methotrexate
3. Sulfasalazine
4. Azathioprine
5. Cyclophosphamide
6. Leflunomide
7. Mycophenolate
Methotrexate
Mycophenolate
Cyclophosphamide
Leflunomide
48
Which category of drugs aim to slow damage to joints, reduce relapses, induce remission and allow tapering of glucocorticoids?
DMARDs
49
ANA, Anti centromere and Anti Scl-70 (Topoisomerase) autoantibodies are found in which connective tissue disorder?
Systemic sclerosis
50
Which anti hypertensives are used to prevent renal crises in Systemic Sclerosis?
ACEIs/ ARBs
51
Anti Ro and Anti La antibodies are found in which connective tissue disorder?
Sjorgens
52
Dry eyes, xerostomia and parotid swelling are features of which connective tissue disorder?
Sjorgens
53
Lymphocytic infiltration of exocrine tissue occurs in which connective tissue disorder?
Sjorgens
54
Myositis and dermatomyositis are rare conditions involving chronic inflammation of ________ muscle.
Striated
55
Giant cell arteritis affects which size blood vessel?
Large
56
Takayasu's arteritis affects which size blood vessel?
Large
57
Polyarteritis nodosa affects which size blood vessel?
Medium
58
Kawasaki disease (vasculitis) affects which size blood vessel?
Medium
59
Microscopic polyangitis affects which size blood vessel?
Small
60
Granulomatosis polyangitis (Wegener's) affects which size blood vessel?
Small
61
cANCA antibodies are found in which type of vasculitis?
Granulomatosis polyangitits (Wegener's)
62
pANCA antibodies are found in which type of vasculitis?
Microscopic polyangitis
63
Vasculitis is usually initially treated with steroids and which immunosuppressant?
Cyclophosphamide
64
Proximal muscle weakness, dysphagia, arthralgia, lung fibrosis and skin features are characteristic of which connective tissue disorder?
Dermatomyositis
65
What does ANCA stand for?
Anti-neutrophil cytoplasmic antibodies
66
Polyarteritis nodosa is often associated with which infection?
Hepatitis B
67
Oral and genital ulcers, uveitis, skin lesions and arthritis are features of which type of vasculitis?
Behcet's syndrome
68
Name 1 or more differential diagnoses for vasculitis.
1. Connective tissue diseases eg. SLE
2. Sarcoidosis
3. Chronic infection eg. TB, HIV, Hepatitis, Syphilis, Subacute bacterial endocarditis
4. Malignancy
5. Drug induced
69
Which age and gender of patients are most commonly affected by pseudogout?
Elderly
| Females
70
Give 1 or more risk factors for pseudogout.
1. Old age (females)
2. Hyperparathyroidism
3. Haemochromatosis
4. Hypophosphataemia
71
Balanitis, keratoderma blenorrhagica, uveitis, mouth ulcers and enthesitis are characteristic features of which type of arthritis?
Reactive arthritis.
72
The DAS28 is a measure of disease activity in which disease?
Rheumatoid arthritis
73
What 4 things are scored in the American College of Rheumatology (2010) Diagnostic criteria?
1. Joint involvement (more points for smaller joints and more joints)
2. Serology (RF or CCP)
3. Acute phase reactants (CRP or ESR)
4. Duration over 6 weeks
74
In osteoporosis, blood calcium. phosphate and ALP levels are usually ________.
Normal
75
Give 2 or more examples of drugs used in the management of osteoporosis.
1. Bisphosphonates eg. Zoledronate, Alendronic acid
2. Rank ligand inhibition eg. Denosumab
3. Calcium and Vit D
4. HRT
5. Recombinant PTH (Teraparatide)
6. Strontium
76
Oesophagitis, photosensitivity, jaw osteonecrosis and atypical fractures are potential side effects of ___________ which are used for osteoporosis.
Bisphosphonates
77
Which immunosuppressant can make patient's urine and tears yellow-orange, as well as causing photosensitivity, oligospermia and skin rashes?
Sulfasalazine
78
Which 2 drugs are typically used for INDUCTION treatment in hospital for SLE?
1. High dose steroid - IV methylprednisolone
| 2. IV Cyclophosphamide
79
Which 3 DMARDs may be used along with Hydroxychloroquine for MAINTENANCE treatment in SLE?
1. Methotrexate
2. Mycophenolate
3. Azathiaprine
80
Which ANCA vasculitis has mainly renal symptoms?
Microscopic polyangitis
81
Which type of vasculitis can present with respiratory symptoms (including nasal crusting, epistaxis, SOB, chest pain, pulmonary haemorrhages), glomerulonephritis or skin rashes?
Granulomatosis with polyangitis (Wegener's)
82
Gottron's papules, a heliotrope rash around the eyes and a "shawl sign" macular rash are features of which connective tissue disorder?
Dermatomyositis
83
Which types of cancer are linked with cancer associated dermatomyositis?
```
Lung
Pancreatic
Ovarian
Colorectal
NHL
```
84
For reactive arthritis, patients can be treated with joint splinting and NSAIDs. If the disease is chronic >6 months then the DMARDs __________ or __________ can be used.
Methotrexate
| Sulfasalazine
85
Polymyalgia rheumatica may be found in patients with which vasculitic condition?
Temporal arteritis (Giant Cell Arteritis)
86
In Polymyalgia Rheumatica, patients usually have _____ ESR results and ________ CK results.
Raised ESR
| Normal CK
87
Bisphosphonates are contraindicated in patients with an ____ of <35,
eGFR
88
First line treatment of osteoporosis is usually which bisphosphonate?
Alendronic acid
89
If a patient with osteoporosis can't tolerate Alendronic acid due to oesophagitis, which other drugs should they be offered?
Other bisphosphonate: Risedronate/ Etidronate
90
_____ disease involves increased but uncontrolled bone turnover due to osteoclast defect, and on Xray presents as a thickening of the skull calvarium.
Paget's
91
Azathioprine reacts with which gout medication to result in bone marrow suppression?
Allopurinol
92
In osteomalacia (adult ricket's) serum phosphate and calciuim levels are ____ and ALP levels are high.
LOW calcium and phosphate
93
Which condition is characterised by arterial/ venous thrombosis, miscarriage and livedo reticularis?
Anti phospholipid syndrome
94
Which condition may involve a tall patient with a high arched palate, pectus excavatum, pes planus, and hypermobility?
Marfan's syndrome
95
It is recommended that pregnant women take folic acid and which Vitamin during pregnancy?
Vitamin D
96
Marfan's syndrome is inherited in an autosomal _______ manner.
Dominant
97
Hyperparathyroidism is a risk factor for which type of arthritis?
Pseudogout
98
How long after stopping Methotrexate should women wait before trying to conceive?
6 months
99
Reduced lateral ______ of the lumbar spine is one of the earliest signs of Anyklosing Spondylitis.
Lateral flexion
100
Osteomalacia is normal bone amount but ___ mineral content.
Low
101
Give 2 or more causes of osteomalacia.
1. Liver failure
2. Renal failure
3. Vit D deficiency (low sunlight, absorption, poor diet)
4. Vit D resistance (inherited)
5. Drug induced (AEDs)
6. Tumour induced osteomalacia
102
What will the serum Calcium, phosphate and ALP be in a patient with osteomalacia?
Calcium and phosphate LOW
| ALP RAISED
103
Looser's zones/ pseudofractures on X-ray are suggestive of which condition?
Osteomalacia
104
Which condition involves increased but uncontrolled bone turnover, which is symptomatic in only 5% of patients?
Paget's disease of bone
105
What will the serum Calcium, phosphate and ALP be in a patient with Paget's disease of bone?
Calcium and phosphate NORMAL
| ALP RAISED
