Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals > Rheumatology Medicine 🩼✅ > Flashcards

Rheumatology Medicine 🩼✅ Flashcards

1
Q

AI polyendocrinopathy syndrome 1?? What is this

A

AIRE mutation. Chronic mucocandidiasis, hypoparathyroidism, Addison’s,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

AI polyendocrinopathy syndrome 2… what is it???

A

HLA DR3/4 associated. Addisons and thyroid AI. And more like pernicious anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How to diagnose and manage a Polyendocrinopathy case

A

Invx with the specific antibody (anti TPO, parietal cell, IF). Manage the specific disease (antifunal, B12) and immunosuppressant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why could primary adrenal insufficiency patients get hyponatremia

A

They get high ADH…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

addisons is associated with what acid base abnormality

A

Non AG met acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Initial test for addisons

A

Morning cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If suspect addisons, and done the morning cortisol test… comes back less than 3… what next

A

Do morning ACTH (this doesn’t confirm diagnosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to confirm Addison’s disease diagnosis

A

Synacten test (give ACTH, and see a failure of cortisol to rise). Should measure cortisol before, 30 mins and 60 mins after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A cortisol level of what post synacten is indicative of addisons

A

Less than 18-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the insulin tolerance test for Addison’s? CI for test?

A

Give insulin (usually lowers glucose which will increase ACTH and cortisol. Cortisol doesn’t increase in Addisons. CI’d in elderly and seizure patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the overnight metyrapone test for addisons

A

Give metyrapone (usually inhibits cortisol prod, increasing ACTH, and increasing 11(OH)cortisol. In addisons 11(OH)cortisol doesn’t increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What imaging is considered in primary adrenal insufficiency

A

CT/MRI abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Antibody to screen for in addisons (only positive some of the time)

A

Anti 21(OH) ase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment for addisons (consider three elements)

A

(Hydrocortisone or prednisolone =highest dose in morning) and (fludrocortisone =mineralcorticoid) and (DHEA =in females only who have depression/low libido)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is stress dose steroids in addisons

A

Steroid dose increased in Sx, illness to reduce risk of adrenal crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Discuss the invx and dx of adrenal crisis

A

Based at first on clinical suspicion (and basic labs). Can take random cortisol level (do before admin cortisone). Synacten only once patient stabilised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How to
Manage a patient with addisons crisis (consider 4 elements)

A

Hydrocortisone (prednisolone 2nd line). Fludrocortisone (got flu = sepsis) only if septic shock, or if patient receiving a non-hydrocortisone GC. 1L of isotonic saline in first hour. IV dextrose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When do we give fludrocortisone in addinsonian crisis?

A

Fludrocortisone only if septic shock, or if patient receiving a non-hydrocortisone GC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HLA for RA

A

HLA DR4 and DR1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the clinical diagnosis criteria (not that strict) for RA

A

Arthralgia and joint stiffness for 6 or more weeks in 3 or more joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Initial imaging for for RA

A

X ray (if both hands and feet). Good to get baseline too!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why do TFTs in RA patients?

A

AI thyroiditis is common in RA patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most specific AB marker for RA?

A

Anti CCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

HLA in RA?

A

HLA DR4 and DR1 (4 propellers 1 camera)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Late vs early findings of RA on X-RAY

A

Early: soft tissue swelling and osteopenia subchondrallu.
Late: joint space narrows, subchondral cysts, more generalised osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Use of US in RA Invx

A

Can detect early changes, likely signs of inflam (synovial hyperemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Use of MRI in RA?

A

Can detect early changes (inflam), and good to check for atlantiaxial subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Acute RA flare Tx

A

Lowest dose possible GCs (prednisone) for less than 3 months. NSAIDs can also be used instead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Long term therapy for RA (basic idea)

A

DMARDS are first line (like MTX), but need to bridge with NSAID, since they take time to work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When is hydroxychloroquine given in RA

A

Can be used as a chronic treatment, for low disease activity patients (not a 1st line)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

First line DMARD for RA

A

methotrexate! In all patients (except preg of course)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When is sulfalazine given in RA

A

In low activity RA, when MTX is contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When is leflunomide given in RA?

A

When all other DMARDS not able to be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

If patient with with RA has persistent moderate to severe symptoms, despite 3 months of DMARDs… give what?

A

Biologicals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How to investigate RA of the cervices spine?

A

Extension and flexion X-rays of the cervical spine. Or MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Before a RA patient undergoes general anaesthesia… need to check what?

A

Check for atlantoaxial subluxation (with X-RAY)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When do you do surgery in Atlanto axial subluxation

A

If there is instability or myelopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Felty is associated with which cancer?

A

NHL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which markers are elevated in RA arthritis patients

A

RF, Anti CCP (since it comes from RA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

First line and second line Tx for Felty syndrome

A

Methotrexate (cyclophosphamide 2nd)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

If patient with Felty has severe granulocytopenia, can give what?

A

GCSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Most common septic arthritis bacteria in < 2 year olds

A

Kingella Kingae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Most common septic arthritis bacteria in > 2 year olds

A

Staphylococcus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

If patient has prosthetic joint infx (septic arthritis) within 3 months of placement… what is the likely organism

A

Staphylococcus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

If patient has prosthetic joint infx (septic arthritis) between 3-12 months of placement… what is the likely organism

A

Staphylococcus epidermidis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

If patient has prosthetic joint infx (septic arthritis) over 12 months from time of placement… what is the likely organism

A

Staphylococcus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Gold standArd to diagnose septic arthritis

A

Arthrocentesis and culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Can you do an arthrocentesis on a patient with skin/subq infx

A

No. Big CI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Do you do blood cultures in septic arthritis patients…

A

Well… if there is acute onset and fever… which is most patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Preferred initial imaging for septic arthritis patients?

A

X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Treatment overview for septic arthritis

A

Arthrocentesis (drainage to dryness). Empiric Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Septic arthritis in prosthetic joint usually requires what surgery?

A

A surgery to remove pus from joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Empiric Abx for septic arthritis (gram +)

A

Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Empiric Abx for septic arthritis (gram - cocci)

A

Ceftriaxone (ceftriacocci)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Empiric Abx for septic arthritis (gram - bacilli)

A

Cefepime (Pime = bacilli)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Targeted Abx for septic arthritis MRSA and MSSA

A

MRSA: vancomycin
MSSA: naficillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Targeted Abx for septic arthritis (neisseria G)

A

Ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Osteoarthritis or RA… which has symmetrical involvement

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Radiological findings for OA

A

Joint space narrowing, subchondral sclerosis and cysts, osteophytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

First line treatment for OA

A

Exercise and weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Before oral NSAID, how else can we admin NSAIDs in OA

A

Topical NSAID patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Role of paracetamol/or intraarticular GC injections (in OA i think)

A

For short term relief when other medications are unsuitable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

When to refer OA patient for joint replacement

A

If QoL is severely impacted, or other options are ineffective/unsuitable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

First line for Juvenile idiopathic arthritis

A

NSAID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Some 2° causes of Pseudogout

A

Hyper parathyroidism, Hemochromatosis, chondrocalcinosis, joint damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Treatment for pseudo gout

A

NSAID, consider injection of cortisone. GCs oral, if no other option

67
Q

When do we give colchicine in pseudogout patients

A

As prophylaxis If patient had many flares! Can help prevent flares. Low dose only

68
Q

Can a gout attack occur if uric acid levels are normal

A

Yes

69
Q

When is a gout attack most likely to occur?

A

At night

70
Q

When is an Arthrocentesis done in the diagnostic workup for Gout (note: it’s not often done!)

A

If there is diagnostic uncertainty, or a higher probability of septic arthritis

71
Q

Lifestyle advise to a gout patient

A

No diet proven to help, but Limit alcohol, lose weight and avoid eating high fish and meat meals

72
Q

Within 24 hours of acute gout flare, Tx options

A

Oral prednisone or high dose naproxen or Colchicine (intraarticular injection if none above work, IL1 inhib last line/refer to Rheuma first)

73
Q

Chronic gout management (1st to 3rd line)

A

1st - allopurinol or febuxostat
2nd - probenecid
3rd - pegloticase

74
Q

Chronic gout treatment should be for who?

A

Recurrent gout attacks, renal insufficiency, tophi

75
Q

When giving a XOI for gout, give with?

A

Colchicine to reduce flare risk

76
Q

Use of peglitcase in gout? How to give it

A

For severe refractory gout (3rd line in chronic Mx). IV infusion every 2 weeks

77
Q

Use of rasburicase

A

Only in tumour lysis syndrome

78
Q

Diagnostic criteria for ankylosing spondylitis

A

Lower back pain > 3 months, <45 years old (+)
- sacrolititis on X-ray or MRI
Or/&
- HLA b 27

79
Q

Best initial Invx for ankylosing spondylitis (to Dx)

A

Sacroiliac joint PA X-ray

80
Q

Most sensitive method for early detection of ankylosing spondylitis

A

MRI

81
Q

First line treatment for ankylosing spondylitis, and the step up?

A

NSAID, then TNF alpha inhibitors

82
Q

Is Reiter syndrome usually oligo or poly arthritis? Migratory?

A

Oligo and migratory

83
Q

First line Tx for Reiter syndrome (and consider what else?)

A

NSAIDs. And treat any underlying infx

84
Q

Main difference between many of the seronegative arthritis and RA? I’m regards to the location of arthritis

A

Most seronegatives are asymmetrical. Unlike RA

85
Q

Tx for Psoriatic arthritis

A

NSAID (1st), DMARD (2nd)

86
Q

Fragility fracture most common location

A

Vertebral

87
Q

Diagnosis of osteoporosis

A

DXA (-2.5 means osteoporosis) and (-1means osteopenia)

88
Q

Calcium, phosphate and PTH in osteoporosis patients

A

Normal!

89
Q

When to treat osteoporosis

A

If had fragility fractures, and or if T score < -2.5

90
Q

First line for osteoporosis Tx

A

Bisphosphonates

91
Q

Aside from bisphosphonates, what are other treatments for osteoporosis

A

Teriperatide, tamoxifene, denosunab, calcitonin

92
Q

Calcium, phosphate, ALP and PTH levels in Pagets

A

Calcium normal , phosphate normal, ALP elevated and PTH levels normal

93
Q

First line treatment for Pagets

A

Bisphosphonate

94
Q

GCA suspect, management

A

High dose CSs first, then biopsy

95
Q

Usually diagnose Takayasu how?

A

Angiogram/arteriography (not biopsy)

96
Q

Treatment for takayasu

A

Corticosteroids are first line. Or there immunosuppressive Tx can be given. Bypass Sx or angioplasty given if severe

97
Q

Buergers disease Dx?

A

A clinical diagnosis.

98
Q

Advice and treatment for Buergers disease

A

Stop smoking. Consider CCB or iloprost

99
Q

Kawasaki disease treatment

A

IV immunoglobulin and aspirin

100
Q

Important invx in Kawasaki disease

A

Echo/CTA

101
Q

Treatment of polyarteritis nodosa

A

CSs, and cyclophosphamide

102
Q

HLA associated with Behcets

A

HLA B51

103
Q

Which two viruses can be seen to cause Behcets

A

HSV, parvovirus

104
Q

Treatment for Churg Strauss

A

GCs

105
Q

Wegeners treatment

A

CSs and ( rituximab or cyclophosphamide )

106
Q

HSP treatment

A

Supportive care, CSs/or NSAIDs, monitor BUN/Cr

107
Q

Goodpastures treatment

A

Plasmaphoresis and immunosuppressant

108
Q

Parvovirus in adult (arthritis). How to diagnose and treat

A

Check for anti ParvoV IgM. No need to treat

109
Q

Antibiotics given for Lymes-arthritis

A

Doxycycline, amoxicillin, or Ceftriaxone (doxy, foxy, amoxi)

110
Q

Gonococal septic arthritis. Treatment?

A

IV ceftriaxone and oral doxy in case chlamydia coinfx

111
Q

Do you need to biopsy muscles in polymyalgia Rheum?

A

No! Would be normal

112
Q

Treatment for polymyalgia rhematica

A

Low dose oral GCs.

113
Q

When does neonatal lupus occur

A

When mum has anti Ro and La crossing placenta to fetus. High in SLE, Sjr patients

114
Q

Who will have an abnormal strength test…. PMR or polymyositis patients

A

Polymyositis patients

115
Q

Main specific AB for poly/dermato myositis

A

Anti Jo (tRNA synthetase)

116
Q

Aside from antibody testing, what is the gold standard to Dx poly/dermato myositis

A

Muscle biopsy

117
Q

1st line Tx for poly/dermato myositis

A

GCs. MTX or Azathioprine 2nd

118
Q

Advice and first line treatment for fibromyalgia

A

Regular excersize , and TCAs

119
Q

Is symmetrically, and no ulceration in Raynauds, a sign of 1° or 2° cause

A

1°

120
Q

Is asymmetry, and ulceration in Raynauds, a sign of 1° or 2° cause

A

2°

121
Q

Medical therapy for raynauds

A

CCB

122
Q

CREST syndrome antibody

A

Anti centromere

123
Q

Diffuse Systemic sclerosis antibody

A

Anti scl 70 (topoisomerase I)

124
Q

Mixed connective tissue disease antibody

A

Anti U1 RNP

125
Q

If a patient has anti RNA polymerase III antibodies in diffuse S.S. What does this indicate?

A

High risk for renal crisis and more skin involvement

126
Q

Do immunosuppressants have a role in systemic sclerosis

A

No

127
Q

How to manage systemic sclerosis. For GI, raynauds, pulm HTN

A

PPI, CCB, usual pulmonary hypertension meds

128
Q

Treatment for scleroderma renal crisis

A

ACEi

129
Q

HLA associated with Sjogrens

A

HLA DR52 (Linn Sweden and Turkey)

130
Q

How to diagnose Sjogrens (is it clinical, AB, or both)

A

Both, need clinical (evidence of gland dysfunction) and antibodys

131
Q

What a few ways can prove gland dysfunction in Sjogren syndrome

A

Schimer test, scintigraphy, sialometry or labial gland biopsy

132
Q

Antibodies for Sjogrens

A

Anti Ro and La (RF and ANA usually + too)

133
Q

Sjogrens treatment (consider multiple elements)

A

Artificial tears and saliva. Muscarinic agonist, immunosuppressive. NSAID or hydroxychloroquine for arthralgia

134
Q

HLA associated with APLS

A

HLA DR7 (7 miscarriages)

135
Q

Most common cause of 2° anti phospholipid syndrome

A

SLE. Other causes are: RA, CA, HIV, Infx

136
Q

Diagnostic criteria for APLS

A

Sign of A or V thrombosis, recurrent miscarriage Hx, and at least 1 of the following antibodies:

Lupus anticoag
Anti cardiolipin
Anti B2 microglobulin

137
Q

Low risk APLS patient, Mx?

A

Low dose aspirin

138
Q

Long term APLS Mx?

A

PO Warfarin

139
Q

If pregnancy (or planning to get pregnant), what treatment should an APLS patient take ?

A

LMWH and aspirin

140
Q

HLA. Seen in SLE

A

HLA DR2 and DR3 (2, 3 SLE)

141
Q

DILE antibody

A

Anti histone

142
Q

Pregnancy advice for SLE

A

Don’t get pregnant until >= 6 months quiescent

143
Q

2 Specific antibody’s for SLE

A

Anti dsDNA and anti smith

144
Q

First line treatment that all SLE patients should be on

A

Hydroxychloroquine

145
Q

Mild to moderate SLE…. Tx?

A

Hydroxychloroquine plus oral glucocorticoids

146
Q

Severe SLE induction and maintenance treatment

A

IV GCs then hydroxychloroquine

147
Q

Best initial test for sarcoidosis

A

CXR

148
Q

Chronic lab markers for sarcoidosis are?

A

Calcium, ACE. Not inflammatory markers in chronic phase

149
Q

First line for sarcoidosis treatment

A

GCs (recall in resp the more complexed treatment plan)

150
Q

Antibody for primary biliary cholangitis

A

Anti mitochondrial

151
Q

HLA seen in graves

A

DR3 and B8 (Big 🦋)

152
Q

Best test for Graves suspicion

A

TSH.

153
Q

Specific marker for Graves

A

TSH receptor antibodies

154
Q

HLA in celiacs

A

DQ2 and DQ8. CeliaQs

155
Q

When to do arthroplasty for OA

A

If severe QoL impairment, and medical therapy not worked/suitable.

156
Q

Best Imaging for OA

A

Xray best (MRI can detect sooner)

157
Q

If suspect Ank spond, and Xray negative…. do what imaging?

A

MRI (can detect sooner)

158
Q

Before starting BPS’s, ensure what? (electrolyte wise)

A

Ca, PO4 are normal

159
Q

When to treat Osteoporosis patients?

A

Always. But treat osteopenia if fractures have occured

160
Q

Acute flare of APLS Tx?

A

CSs

161
Q

What is scleroderma renal disease? and how to Tx?

A

sudden oliguria and HTN. Usually with MAHA. Give ACEi

162
Q

JIA, and adult onset stills… do they have RF/ACCP?

A

no, they are seronegative

163
Q

before starting BPS for osteoporosis… what tests must be done?

A

Ca and Vit D

164
Q

Oral or IV antibiotics for osteomyelitis at first?

A

IV… then consider transition to oral if clinical improvement

Finals (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions