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Year 4 Final > Rhuematology > Flashcards

Rhuematology Flashcards

1
Q

Rheumatoid arthritis diagnostic antibodies?

A

Anti-CCP
Rheumatoid factor

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2
Q

To revise the mnemonic differentiating OA and RA:

A

==== OA ====
L loss of joint space
O osteophytes
S subchondral sclerosis
S subchondral cysts

==== RA ====
L loss of joint space
E erosions
S soft tissue swelling
S soft bones (osteopenia)
S Subluxation

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3
Q

What antibodies are associated with limited cutaneous systemic sclerosis

A

anti-centromere antibodies

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4
Q

What is azathioprine?

A

metabolised to the active compound mercaptopurine, a purine analogue that inhibits purine synthesis. A thiopurine methyltransferase (TPMT) test may be needed to look for individuals prone to azathioprine toxicity.

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5
Q

First line for osteoporosis?

A

Bisphosphonates- Alendronate
If can’t tolerate give riseronate or etidrone

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6
Q

What does raloxifen do?

A

selective oestrogen receptor modulator (SERM)
prevent bone loss and to reduce the risk of vertebral fractures, but has not yet been shown to reduce the risk of non-vertebral fractures

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7
Q

What is Strontium ranelate

A

‘dual action bone agent’ - increases deposition of new bone by osteoblasts (promotes differentiation of pre-osteoblast to osteoblast) and reduces the resorption of bone by inhibiting osteoclasts

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8
Q

What is denosumab?

A

human monoclonal antibody that inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts

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9
Q

X-ray findings in psoriatric arthritis?

A

often have the unusual combination of coexistence of erosive changes and new bone formation
periostitis
‘pencil-in-cup’ appearance

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10
Q

What rheumatoid arthritis factor has the highest specificity?

A

Anti-cyclic citrullinated peptide antibody

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11
Q

What kind of nodes suggest OA?

A

Herbeden’s nodes

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12
Q

X ray findings in ankylosing spondylitis?

A

sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus
chest x-ray: apical fibrosis

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13
Q

What is given in temporal arteritis if evolving visual losss?

A

IV methylprednisolone

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14
Q

Interactions of methotrexate?

A

avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia
high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion

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15
Q

Poor prognostic features of RA?

A

rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset

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16
Q

Mneumonic for SLE?

A

Serositis: pleurisy or pericarditis
Oral ulcers
Arthritis
Photosensitivity

Blood: anaemia, leukopenia, lymphopenia and thrombocytopenia
Renal disorder: lupus nephritis - minimal mesangial, mesangial proliferative, focal, diffuse, membranous and advanced sclerosis
Antinuclear antibody
Immunology: anti-Smith, anti-ds DNA and antiphospholipid antibody
Neurologic disorder: seizures or psychosis

Malar rash
Discoid rash

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17
Q

Features of Behcet’s?

A

1) oral ulcers 2) genital ulcers 3) anterior uveitis

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18
Q

Things metnioned in FRAX scoring tool?

A

history of glucocorticoid use
rheumatoid arthritis
alcohol excess
history of parental hip fracture
low body mass index
current smoking

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19
Q

Most common occular complication in temporal arteritis?

A

anterior ischemic optic neuropathy
results from occlusion of the posterior ciliary artery

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20
Q

In young adults with septic arthritis, what is the most common organism?

A

Neisseria gonorrhoea

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21
Q

Highly specific tests for SLE?

A

Anti dsDNA
Anti-smith

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22
Q

If a patient has diffuse cutaneous systemic sclerosis and renal disease what medication should they be started on?

A

Ace Inhibitor

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23
Q

What is hydroxychloroquine used in?

A

Management of rheumatoid arthritis and SLE

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24
Q

Mneumonic for Felty’s syndrome?

A

SANTA:
- Splenomegaly
- Anaemia
- Neutropenia
- Thrombocytopenia
- Arthritis

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25
First line for acute management of gout?
NSAIDs or colchicine are first-line If have a duodenal ulcer give colchicine
26
What is keratoderma blenorrhagica?
waxy yellow/brown papules on palms and soles
27
Investigations of polymyalgia rheumatica?
raised inflammatory markers e.g. ESR > 40 mm/hr note creatine kinase and EMG normal
28
Hyperparathyroidism effects on calcium and phsophate
calcium is high as PTH works to increase free calcium by increasing renal reabsorption, reducing phosphate reabsorption (hence phosphate is low) and increasing calcium reabsorption from the bones (hence ALP is raised
29
What antiboies are associated with diffuse cutaneous systemic sclerosis?
anti-scl-70
30
What antiboies are associated with limited cutaneous systemic sclerosis
anti-centromere antibodies
31
Most useful tool to assess hypermobility?
Beighton score
32
Adverse effect of hydroxycholoroquine?
bull's eye retinopathy - may result in severe and permanent visual loss
33
First line for polymyalgia rheumatica?
Oral predinsolone
34
X ray findings in pseudogout?
chondrocalcinosis in the knee this can be seen as linear calcifications of the meniscus and articular cartilage
35
Adverse effects of interferon-alpha?
flu-like symptoms and depression
36
Ankylosing spondylitis features - the 'A's
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis
37
What is CREST sundroke?
calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia
38
Features of polymyositits?
proximal muscle weakness +/- tenderness Raynaud's respiratory muscle weakness interstitial lung disease e.g. fibrosing alveolitis or organising pneumonia seen in around 20% of patients and indicates a poor prognosis dysphagia, dysphonia
39
around 30% of dermatomyosis patients have antibodies to aminoacyl-tRNA synthetases (anti-synthetase antibodies), including:
antibodies against histidine-tRNA ligase (also called Jo-1) antibodies to signal recognition particle (SRP) anti-Mi-2 antibodies
40
Next step in ankylosing spondylitis after oral NSAIDS?
TNF-alpha blockers
41
What needs to be checked when starting on azathioprine?
thiopurine methyltransferase (TPMT) test may be needed to look for individuals prone to azathioprine toxicity.
42
Pharmacologial treatment for Raynauds?
Nifedipine
43
Cautions of using sulfasalazine?
G6PD deficiency allergy to aspirin or sulphonamides (cross-sensitivity)
44
Joint aspiration in pseudogout?
weakly-positively birefringent rhomboid-shaped crystals
45
Why prescribe folate once a week in patients on methotrexate?
Reduce risk of bone marrow suppression
46
Management of flares of RA>
Oral or IM corticosteroids
47
If eGFR less than 30 what can be used to prevent pathological fractures in bony metastases?
Denosumab
48
What are Gottron's papules?
roughened red papules over extensor surfaces of fingers
49
Features of osteomalacia?
bone pain bone/muscle tenderness fractures: especially femoral neck proximal myopathy: may lead to a waddling gait
50
Who to start oral bisphosphaonates in without doing a DEXA scan?
1. Anyone with a BMD <-2.5 on DEXA 2. Anyone 75 or Over with a Fragility Fracture 3. Anyone on High Dose Corticosteroids (>7.5mg for >3months)
51
Type IV hypersensitvitiy reaction?
Delayed T cell mediated ones
52
Risk factors for pseudogout?
haemochromatosis hyperparathyroidism low magnesium, low phosphate acromegaly, Wilson's disease
53
Monitoring SLE?
inflammatory markers- ESR is generally used. during active disease the CRP may be normal - a raised CRP may indicate underlying infection complement levels (C3, C4) are low during active disease (formation of complexes leads to consumption of complement) anti-dsDNA titres can be used for disease monitoring (but note not present in all patients)
54
When to start TNF-Inhibitors in RA?
inadequate response to at least two DMARDs including methotrexate
55
What is osteomalacia caused by?
Softening of the bones due to severe vitamin D deficiency and can present with bone pain, muscle weakness or bone deformities.
56
Lab values in osteomalacia?
Calcium decrease Phosphate decreased ALP increased PTH increased
57
What must be done prior to starting a biologic?
chest X-ray to look for TB prior to starting biologics for rheumatoid arthritis as they can cause reactivation
58
What is dactylitis?
inflammation of a digit (finger or toe).
59
Causes of dactylitis?
spondyloarthritis: e.g. Psoriatic and reactive arthritis sickle-cell disease other rare causes include tuberculosis, sarcoidosis and syphilis
60
Antibodies in SLE?
61
Antibodies in systemic sclerosis?
Anti SCL 70 Anti centreomere
62
Antibodies in Sjorgren syndrome?
63
Antibodies in poltmosititis and dermatomyoisitits?
64
What is cANCA associated with?
Granulomatosis with polyangitis
65
What is pANCA associated with?
66
Is azithroprine safe in pregnancy?
Yes
67
What is osteogenesis imperfecta?
group of disorders of collagen metabolism resulting in bone fragility and fractures. The most common, and milder, form of osteogenesis imperfecta is type 1
68
BMD in osteopenia?
-1.0 to -2.5
69
What is an example of a urate lowering therapy?
Allopurinol
70
What is Behcet's syndrome?
complex multisystem disorder associated with presumed autoimmune-mediated inflammation of the arteries and veins
71
Drugs that cause drug induced lupus?
procainamide hydralazine isoniazid minocycline phenytoin
72
Adverse effects of sulfalazine?
oligospermia Stevens-Johnson syndrome pneumonitis / lung fibrosis myelosuppression, Heinz body anaemia, megaloblastic anaemia may colour tears → stained contact lenses
73
CXR finding in late stage ankylosing spondylitis?
Apical fibrosis
74
Complications. ofRA?
respiratory: pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, methotrexate pneumonitis, pleurisy ocular: keratoconjunctivitis sicca (most common), episcleritis, scleritis, corneal ulceration, keratitis, steroid-induced cataracts, chloroquine retinopathy osteoporosis ischaemic heart disease: RA carries a similar risk to type 2 diabetes mellitus increased risk of infections depression
75
in marfans there is a defect in which protein?
Fibrillin-1
76
If patients with osteoporosis can't tolerate alendronate what is next line?
Risedronate or etidronate
77
What is paget's disease treated with?
Bisphosphonates
78
What is polyarteritis nodosa
vasculitis affecting medium-sized arteries with necrotizing inflammation leading to aneurysm formation.
79
What are tyoe 3 immune reactions?
characterized by the recruitment of neutrophils and the stimulation of epithelial antimicrobial defenses at infection sites.
80
After inital thronboembolic event what should be managment of antiphospholipid syndrome?
lifelong warfarin with a target INR of 2-3
81
Treatment of choice for methotrexate toxocity?
Folinic acid
82
Osteomalacia bloods?
Calcium decreased Phosphate decreased ALP increased PTH increased
83
How to remeber bloods in osteomalacia?
I remember it as weak bone disease due to low calcium and vit D low Ca Low phosphate High PTH (due to low Ca) High ALP (why? Bcos bone is weak so osteoblast try to reconstruct the bone by secrete more ALP)
84
How to rember bloods in paget disease?
Classic sudden central bone pain in elderly with normal bone profile except ALP Normal Calcium Normal phosphate Normal PTH High ALP
85
Bloods in hypoparathyroidism?
Low PTH -> Low Calcium -> high Phosphate -> normal ALP(no problem with bone) Low serum calcium. High serum phosphate. Low PTH. Normal alkaline phosphatase.
86
What do bisphosphonates do?
suppressing elevated bone turnover
87
Sample of synovial fluid from the knee in reactive arthritis?
Develops after an infection where the organism cannot be recovered from the joint
88
Features of Behcet's syndrome?
classically: 1) oral ulcers 2) genital ulcers 3) anterior uveitis thrombophlebitis and deep vein thrombosis arthritis neurological involvement (e.g. aseptic meningitis) GI: abdo pain, diarrhoea, colitis erythema nodosum
89
Why is syndesmophytes seen in ankylosing spondylitis?
Due to ossification of outer fibers of annulus fibrosus
90
What should be prescribed with NSAIDs in all patients with osteoarthritis?
PPI
91
What causes gout?
High purine diet. Cheese and wine!
92
What causes gout?
Diuretics Chemotherapy- Tumour lysis syndrome. Get an increased in uric acid
93
Gout presentation
Pain Limping TOPHI- Large visible lumps of urate crystals Usually in large MTP joint, also in ankle and wrist
94
Crystals in gout?
Negatively befringed needle shape
95
Crystals in pseudogout
Positive befringed Rhomboid shaped
96
Second line for gout?
Febuxostat
97
What causes pseudogout?
Calcium deposition
98
Symptoms of polymyalgia rheumatica?
Mild pain, Aching Stiff Quick onset- A month ish Lethargy Low grade fever
99
Investigations for polymyalgia rheumatica?
High ESR Normal creatine kinase Electomyography normal
100
What is polymyalgia rheumatica linked with?
Temporal arteritis
101
What is rheumatoid arthritis?
Autoimmune condition affecting the joints
102
Investigations for rhuematoid arthritis?
Inflammatory markers- CRP, ESR Xray- LESS RF- Positive in 70-80% (also in 100% of Feltys) Anti CCP- 70% sensitivity, 95% specific
103
Signs of rheumatoid arthritis?
Boutiners derformity- finger is flexed at the proximal interphalangeal joint (PIP) and hyperextended at the distal interphalangeal joint (DIP) Ulnar deviation Squeeze across MCP joint and will be tender
104
What is Felty's syndrome
SANTA Splenomeglay Anaemia Neutropenia Thrombocytopnia RA
105
Management of RA?
NSAIDs PPI Referal to rheumatology DMARDs. If not luck with 2 different DMARDs give TNF alpha inhibitor Flaires- IM/oral corticosteroids
106
Extrarticular manifestations of RA?
Eye issues Rheumatoid nodules- Skin and lung (pulmonary fibrosis) Small vessel damage and destruction of the lungs
107
Signs of osteoarthritis?
Herbeden's nodes and bouchard's nodes Squaring of the thumb
108
SLE common presentation?
Young women Afro Caribbean origin
109
Diagnostic criteria in SLE features?
SOAP BRAIN Serostitis Oral ulcers Arthritis Photosensitivity Blood Renal- Portein ANA Immunologic- DS DNA Neurological
110
Bloods in SLE
ANA- 99% of cases it is positive Anti-DsDNA- Most useful
111
What is Sjorgen's syndrome?
Everything is dry Autoimmune disorder that destroys the salivary and lacrimal glands
112
Investigations for sjorgen's
Anti Ro and Anti La
113
Management of sjorgens
Lubricants Artifical tears/saliva Second line is pilocarpine
114
Most common cause of reactive arthritis?
Chlamydia
115
Management of psoriatric arthritis
NSAIDS Second line is monoclonal antibodies
116
* First line for spasicity in MS?
o Baclofen and gabapentin
117
* What are focal seizures?
o previously termed partial seizures o these start in a specific area, on one side of the brain o the level of awareness can vary in focal seizures. The terms focal aware (previously termed 'simple partial'), focal impaired awareness (previously termed 'complex partial') and awareness unknown are used to further describe focal seizures o further to this, focal seizures can be classified as being motor (e.g. Jacksonian march), non-motor (e.g. déjà vu, jamais vu; ) or having other features such as aura
118
* What is GBS?
o Immune mediated demyelination of the PNS often triggered by infection
119
* The characteristic features of Guillain-Barre syndrome is what?
o is progressive, symmetrical weakness of all the limbs. o the weakness is classically ascending i.e. the legs are affected first o reflexes are reduced or absent o sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs o " there may be a history of gastroenteritis o " respiratory muscle weakness o " cranial nerve involvement o diplopia o bilateral facial nerve palsy o oropharyngeal weakness is common o " autonomic involvement o urinary retention o diarrhoea
120
Mnagement for focal seizures
Lamotrigine or levetiracetam
121
Stroke or TIA driving regulation?
1 month off driving, may not need to inform DVLA if no residual neurological deficit
122
Features of juvenile myoclonic epilepsy?
* infrequent generalized seizures, often in morning//following sleep deprivation * daytime absences * sudden, shock-like myoclonic seizure (these may develop before seizures)
123
Treatment of juvenile mycolonic epilepsy?
Sodium valproate
124
* TACs features
* 1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg * 2. homonymous hemianopia * 3. higher cognitive dysfunction e.g. dysphasia
125
What does TACs involve
Middle and anterior cerebral arteries
126
Features of PACs
* involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery * Two of three of these * 1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg * 2. homonymous hemianopia * 3. higher cognitive dysfunction e.g. dysphasia
127
Features of lacunar infarcts?
* involves perforating arteries around the internal capsule, thalamus and basal ganglia * presents with 1 of the following: * 1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three. * 2. pure sensory stroke. * 3. ataxic hemiparesis
128
Features of posterior circulation infarcts?
* involves vertebrobasilar arteries * presents with 1 of the following: * 1. cerebellar or brainstem syndromes * 2. loss of consciousness * 3. isolated homonymous hemianopia

Year 4 Final (39 decks)

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