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Exam - M - MSK + Rheumatology Pathologies (Meg & Rach) > Rheumatology Passmed > Flashcards

Rheumatology Passmed Flashcards

1
Q

What blood results are seen in osteomalacia?

A

Low serum calcium
Low serum phosphate
Raised ALP
Raised PTH

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2
Q

what is osteomalacia?

A

Softening of the bones caused by severe vitamin D deficiency

Presents with:
Bone pain
Muscle weakness
Bone deformities

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3
Q

What are the blood results in osteoporosis?

A

ALL normal (PTH, ALP, Calcium, Phosphate)

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4
Q

What are the blood results in hyperparathyroidism?

A

High ALP
High PTH
High Calcium
Low phosphate

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5
Q

What is the first line treatment for ankylosing spondylitis?

A

Regular Exercise
Physiotherapy
NSAIDs

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6
Q

Which drugs should never be prescribed with methotrexate?

A

Trimethoprim (including co-trimoxasole) - causes bone marrow suppression and severe or fatal pancytopenia

High dose aspirin

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7
Q

What type of hypersensitivity reaction is allergic contact dermatitis?

A

Type IV (T cell-mediated)

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8
Q

what are the common features of psoriatic arthritis?

A

Pencil in cup X ray appearance
More likely to be asymmetrical
Dactylitis

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9
Q

When should patients be offered allopurinol?

A

After the first attack

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10
Q

What should be co-prescribed when starting allopurinol?

A

Colchicine

OR

NSAIDs

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11
Q

What type of hypersensitivity is SLE?

A

Type 3 (immune complex - free antigen and antibody combine)

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12
Q

What is the main difference in blood tests between PMR and polymyositis?

A

Polymyositis causes an increase in creatinine kinase, PMR is NOT associated with an increase in CK.

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13
Q

what are the ‘A’s in ankylosing spondylitis?

A

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
Any caudal equine syndrome
Peripheral arthritis

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14
Q

What complication can be seen in temporal arteritis?

A

Anterior ischaemic optic neuropathy (occlusion in a branch of the ophthalmic artery)

Fundoscopy - swollen pale disc and blurred margins

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15
Q

What are the signs and symptoms of temporal arteritis?

A

50% have PMR
Raised ESR
Sometimes raised CRP
CK and EMG NORMAL

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16
Q

What is the urgent treatment given in temporal arteritis?

A

No visual loss:
- High dose prednisolone

Visual loss:
- IV methylprednisolone given first before red

Urgent opththalmology review

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17
Q

What is Ewings sarcoma?

A

A malignant bone tumour affecting children.

Occurs mostly in pelvis and long bones - causes severe pain.

Onion skin appearance on X-ray.

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18
Q

what is an osteosarcoma?

A

MOST common primary malignant bone tumour

Seen mostly in children

Occurs mostly in the metaphysics of long bones prior to epiphyseal closure

Sunburst pattern on X-ray

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19
Q

what are the blood results in antiphospholipid syndrme?

A

Rise in APTT
Thrombocytopenia (low platelets)

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20
Q

What are the features of antiphospholipid syndrome?

A

Predisposition to VTE and arterial thrombosis
Recurrent foetal loss
Thrombocytopenia
Lived reticular
ASSOCIATED WITH SLE
Anticardiolipin antibodies

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21
Q

What are the features of antiphospholipid syndrome?

A

Predisposition to VTE and arterial thrombosis
Recurrent foetal loss
Thrombocytopenia
Lived reticular
ASSOCIATED WITH SLE
Anticardiolipin antibodies

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22
Q

what is the primary prophylaxis of antiphospholipid syndrome?

A

Low dose aspirin

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23
Q

What is the secondary prophylaxis of

A

Lifelong warfarin INR 2-3

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24
Q

what type of reaction is anaphylaxis?

A

Type I

Antigen reacts with IgE bound to mast cells

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25
Q

what crystals are seen in pseudogout

A

calcium pyrophosphate dehydrate crystals

Joint aspiration: Weakly-positive bifringent rhomboid shaped crystals

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26
Q

What is limited cutaneous systemic sclerosis?

A

Scleroderma which mainly affects the face, distal limbs

Anti-Centromere antibodies

CREST syndrome is a subtype

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27
Q

What is diffuse cutaneous systemic sclerosis?

A

scleroderma which affects the trunk and proximal limbs

Anti scl-70 antibodies

Organ involvement: Interstitial lung disease, renal disease, hypertension

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28
Q

What is scleroderma

A

Tightening and fibrosis of the skinWITHOUT organ involvement

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29
Q

what are the components of CREST syndrome?

A

Calcinosis
Raynauds
Oesophageal dysmotilit
Sclerodactyly
Tenalgiectasia

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30
Q

What are the seronegative spondyloarthropathies?

A

Positive HLA-B27
Rheumatoid factor negative

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis

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31
Q

What are the X-ray changes of osteoarthritis?

A

LOSS
- Loss of joint space
- Osteophytes forming at joint margins
- Subchondral sclrosis
- Subchondral cysts

32
Q

what are the signs and symptoms of SLE?

A

Malar rash
Photosensitivity
Raynaids
Lived reticular
Non scarring alopecia

Arthralgia
Non-erosive arthritis

Pericarditis
Myocarditis

Pleurisy
Fibrosing alveoliitis

Proteinuria
Llomerulonephritis
Anxiety and depression
Psychosis
Seizures

33
Q

What condition can patients undergoing chemotherapy be at a higher risk of?

A

Gout (due to increased rate levels)

34
Q

Which antibodies are positive in SLE?

A

99% Positive:
Antinuclear antibody ANA

Highly specific but not sensitive:
Anti dsDNA (usually the answer in SBA)
Anti smith
Anti - U1 RNP, Anti ro, Anti la

35
Q

What is the most common organism causing septic arthritis OVERALL?

A

staphylococcus aureus

36
Q

What is the most common organism causing septic arthritis in sexually active people?

A

Neisseria gonorrhoea

37
Q

what are the signs of septic arthritis

A

haematogenous spread
acute swollen joint
tarm to touch
fever
restricted movement

38
Q

What are the investigations that should be done in septic arthritis?

A

Synovial fluid sampling (done prior to abx, can be done under ultrasound guidance)
Blood cultures (haematogenous spread)
Joint imaging

39
Q

What is the management of septic arthritis?

A

Flucloxacillin

Clindamycin if penicillin allergic

*4-6 WEEKS of ABX

Patients switched to oral ABX after 2 weeks

needle aspiration to decompress the joint
arthroscopic lavage may be needed

40
Q

Regarding a DEXA scan, what is the T and Z score?

A

T score - your bone density compared to a 30 year old

Z score - your bone density adjusted to your age, General and ethicity

41
Q

What are the DEXA scan results?

A

> -1.0 = normal
- 1.0- -2.5 = osteopaenia
< -2.5 = osteoporosis

42
Q

what is the treatment for acute flares of rheumatoid arthritis?

A

Intramuscular or oral steroids:
methylprednisolone

43
Q

what is the treatment of Raynaud?

A

nifedipine

44
Q

what are the features of osteogenesis imperfect?

A

AKA - brittle bone disease

Presents in childhood
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections

ALP, PTH, calcium and phosphate usually NORMAL

45
Q

what are the blood results in poly myalgia rheumatic?

A

Raised ESR
raised CRP
Normal anti CCP
Normal CK

46
Q

what is reactive arthritis

A

A HLA-B27, seronegative arthritis.

It is an arthritis that develops following an infection where the organisms cannot be recovered from the joint

47
Q

what are the signs of reactive arthritis

A

urethritis
conjunctivitis
arthritis

often occurs post STI
caused by chlamydia trachoma’s

48
Q

what is the treatment for reactive arthritis

A

analgesia
NSAIDs
intra articular steroids

49
Q

Sensitive vs specific factors for SLE?

A

Sensitive - ANA
Specific - Anti dsDNA

50
Q

what is the complication of hydroxychloroquine

A

sight loss

51
Q

what are the adverse effects of methotrexate

A

mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
Interaction with trimethoprim or co-trimoxazole
interaction with aspirin (increases risk of methotrexate toxicity)
toxicity

52
Q

what is the guidance regarding methotrexate treatment and pregnancy

A

both women AND men should avoid pregnancy/use effective contraception for 6 months after stopping methotrexate

53
Q

what is the medication used to treat methotrexate toxicity

A

folonic acid

54
Q

what is polymyositis?

A

an inflammatory disorder causing symmetrical, proximal muscle weakness

it is associated with malignancy

55
Q

how is marfans syndrome passed on

A

autosomal dominant

56
Q

what are the blood results seen in pages disease?

A

Raised ALP
Normal calcium
Normal phosphate

57
Q

What is the first and second line imaging for ankylosing spondylitis?

A
  1. Plain x-ray of the sacroiliac joints
  2. MRI (if sacroiliac x-ray is negative but suspicion remains high)
58
Q

Who should take vitamin D supplementation

A
  • All pregnant women and breastfeeding women
  • Children 6 months - 5 years (if not drinking 500ml of formula milk a day)
  • Adults >65
  • Housebound patients
59
Q

Which antibody is a good rule out test for SLE?

A

ANA antibody
Because its positive in 99% of people with SLE

60
Q

What should be prescribed with methotrexate?

A

Folate - this reduces the risk of bone marrow suppression

61
Q

What is sjogrens syndrome?

A

An autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces.

Can be primary.

Can be secondary - develops around 10 years after rheumatoid arthritis or SLE.

62
Q

what are you at increased risk of if you have sjogrens?

A

Lymphoid malignancy (40-60 fold).

63
Q

what are the features of sjogrens syndrome?

A

dry eyes
dry mouth
vaginal dryness
arthralgia
raynauds
myalgia
sensory polyneuropathy
recurrent episodes of parotitis
renal tubular acidosis

64
Q

what are the tests done for sjogrens disease?

A

Antibody tests:
- Anti Ro = most associated with primary sjogrens
- anti-La

  • ANA
  • rheumatoid factor

Schirmers test - strip of paper left under the eyelid for 5 minutes (should travel 15mm). A result of <10mm is significant.

65
Q

What is the management of sjogrens syndrome?

A

Artificial tears
Artificial saliva
Vaginal lubricants
Hydroxychloroquine (to halt progression of the disease)
Pilocarpine - many stimulate saliva production

66
Q

What is dermatomyositis?

A

an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristics skin lesions

67
Q

What should be done when someone is diagnosed with dermatomyositis?

A

A malignancy screen

68
Q

What is the treatment for osteoarthritis?

A
  1. Weight loss, local muscle strengthening exercises and general fitness
  2. Paracetamol and Topical NSAIDs (topical NSAIDs for knee and hand only)
  3. Oral NSAIDs, opioids, capsaicin cream and intra-articular corticosteroids.
  4. joint replacement should be considered if conservation methods fail
69
Q

what should be prescribed in OA alongside NSAIDs and COX-2 inhibitors?

A

A PPI

70
Q

what is the treatment for fibromyalgia

A
  1. Aerobic exercise
  2. CBT
  3. Medication: Pregabalin, duloxetine, amitriptyline
71
Q

what blood test can be used to monitor disease activity in SLE?

A

Complement levels - usually go down in active flare

72
Q

when can hydroxochloroquine be used?

A

It CAN be used

73
Q

What x-ray changes are seen in pseudo gout

A

chonedrocalcinosis

74
Q

What is the treatment for raynauds?

A

Nifedipine

75
Q

What is the treatment for SLE?

A

Hydroxychloroquine

76
Q

what tests should be done if rheumatoid arthritis is suspected

A

rheumatoid factor
anti CCP (same sensitivity, higher specificity) - can be detected 10 years before RA develops
X-ray of hands and feet

77
Q

what is the treatment for antiphospholipid syndrome

A

primary prevention:
daily aspirin

Secondary prevention:
Lifelong warfarin INR target 2-3

Exam - M - MSK + Rheumatology Pathologies (Meg & Rach) (13 decks)

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