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RACP 2022 Written > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Which of the following is not useful in treatment of ankylosing spondylitis?

  1. Etanercept
  2. Adalimumab
  3. Secukinumab
  4. Abatacept
  5. Ixekizumab
A
  1. Abatacept

Principles of ank spond treatment:
1st line: physical therapy + NSAIDs
2nd line after failed x2 NSAIDs trialled for 2-4 weeks each: TNF alpha inhibitor (i.e. etanercept, adalimumab) OR IL-17 inhibitor (Ixekizumab, secukinumab)

3rd line: switch to IL-17 inhibitor OR trial a different TNF-alpha blocker (if inital response then failure)

Abatacept - T cell costimulator, evidence in RA and PsA but not Ank spond

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2
Q

What is the first line pharmacologic treatment for Raynaud’s?
What is the second line treatment?
Other than cold, what else can exacerbate Raynaud’s?

A
  1. Dihydropyrine ca channel blockers - amlodipine, nifedipine
  2. PDE5 inhibitors (i.e. sildenafil), topical nitrates (i.e. nitroglycerin ointment), some evidence for ARBs and fluoxetine
  3. Smoking, vasoconstricting drugs (i.e. tryptans)
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3
Q

Which of the following indicates the patient is more likely to have primary rather than secondary Raynaud’s?

  1. Signs of tissue ischemia
  2. Male gender
  3. Age >40
  4. Symmetry
  5. Positive nailfold capillaroscopy
A
  1. Symmetry is more common in primary Raynauds

Nailfold capillarascopy = scleroderma

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4
Q

Name 5 features of mixed connective tissue disease

A
  1. Pulmonary hypertension ( most common cause of death, associated with anti-cardiolipin IgG)
  2. Arthritis
  3. Antibodies - anti-U1-RNP (diagnostic), anti-SNRP
  4. Swollen hands
  5. Raynaud’s
  6. Esophageal dysmotility
  7. Myositis
  8. Acrosclerosis (stiff thick skin on distal fingers(
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5
Q

Which rheumatologic disorders are associated with anterior uvieitis?
Which is not?

A

Spondyloarthropathies - ank spond, psoriatic arthritis, reactive arthritis

JIA
Sjogren’s
Kawasaki’s
Sweet syndrome

AIN

Scleritis OR AU: SLE, Sarcoidosis, relapsing polychnditis, IBD

Anterior uveitis NOT associated with RA (scleritis/episcleritis is)

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6
Q

The following antibodies are associated with an increased risk of what in Scleroderma?

  • Anti-Scl-70 (topoisomerase I)
  • Anti-centremere
  • Anti-RNA polymerase III
A

Anti-Scl-70 (topoisomerase I) - pulmonary fibrosis, more common with diffuse scleroderma

Anti-RNA-polymerase III - diffuse scleroderma, increased skin disease and renal crisis.

Anti-centromore - pulmonary HTN + esophageal disease, more common with limited scleroderma. Protective against fibrosis.

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7
Q

Rheumatologic disorder strongly associated with anti-U1 RNP (U1 ribonucleoprotein) antibodies? ANA pattern

A

Mixed connective tissue disorder

Speckled ANA

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8
Q

Rheumatologic disorder strongly associated with anti-histone antibodies

ANA pattern?

A

Drug induced lupus

Homogenous ANA

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9
Q

Seronegative polyarthritis with fever, rash and high ferritin

A

Still’s disease

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10
Q

Rheumatologic disorder strongly associated with Anti-SS-B (anti-La) antibodies

A

Sjogren’s. Poor specificity. Anti-Ro = CHB in SLE.

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11
Q

Rheumatologic disorder strongly associated with anti-ribosomal P protein antibodies

A

SLE. Highly specific but poor sensitivity. Associated cutaneous manifestation

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12
Q

Role of IL-1B in OA?

A

Inhibits chondrocytes (along with TNF)
Inhibits aggrecanase and collagen II
Stimulates release of MMPs

End product = cartilage destruction

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13
Q

Features of DISH (dish diffuse idiopathic skeletal hyperostosis)

A

Older male age >50
Diabetes in 20%
Negative HLA-B27
Thoracic spine pain with loss off thoracic lateral flexion)

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14
Q

Which autoimmune disorders can cause RTA? Which type?

A

Distal (Type 1)

Sjögren’s syndrome
Autoimmune hepatitis/primary biliary cirrhosis
Systemic lupus erythematosus (also can generate hyperkalemic RTA)
Rheumatoid arthritis

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15
Q

HLA type associated with Behcets

A

HLA-B51

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16
Q

HLA type associated with hypersensitivity to allopurinol

A

HLA-B58*01

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17
Q

Dermatomyositis associated with mild/amyopathic muscle involvement and rapidly progressive ILD

A

anti-MDA5 antibodies

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18
Q

What is bimekizumab and what is it used for?

A

Anti-IL17

Plaque psoriasis

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19
Q

What is avacopan and what is it used for?

A

Anti-C5 receptor
ANCA vasculitis

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20
Q

Which of the following does not have a role in Scleroderma ILD?
A. Cyclophosphamide
B. MTX
C. Azathioprine
D. Tociluzimab
E. MMF

A

B - MTX

MMF 1st line, cyclo 2nd line

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21
Q

What is the “triad” of Felty syndrome

A

RA, Neutropenia, Splenomegaly.

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22
Q

5 factors associated with poor prognosis in RA

A

Smoking
Elevated CRP/ESR
High anti-CCP/RF titres
Erosions at baseline
HLA-DRB1*04 homozygosity
Older age

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23
Q

What is the major cause for premature death in RA?

A

CVD

24
Q

What percentage of patients with GCA will have vision loss?

A

15-20%

25
Q

Which autoimmune diseases are associated with hyposplenism?

A

Antiphospholipid syndrome
Goodpastures
GPA (PR3) cANCA
Hashimotos thyroiditis
PAN
RA
SLE
IBD
Celiac

Also sarcoid/amyloid

26
Q

Most common neurologic manifestation of RA

A

Carpal tunnel

27
Q

Cardiac manifestations of RA

A

Pericarditis (restrictive and granulomatous)
Myocarditis
Coronary artery disease
Heart failure
Atrial fibrillation
Asymptomatic myocardial disease

28
Q

HLA type associatd with RA

A

HLA DRB1

29
Q

What is the cause of GI hypomotility (oesophagus, stomach, and small/
large intestine) in scleroderma?

A

Autonomic nerve dysfunction of the GIT

Results in esophageal dysmotility, strictures, gastroparesis and psuedo-obstructive

30
Q

Infection commonly associated with PAN

A

Hepatitis B

31
Q

Key features of anti-synthetase syndrome

A

inflammatory myopathy
interstitial lung disease
“mechanic’s hands”
inflammatory arthritis,
Raynaud phenomenon
anti-Jo 1

32
Q

HLA associated with Behcets

A

HLA B51

33
Q

Factors increase risk of Leflunomide use

A

low weight, ETOH, pregnancy and concurrent use with methotrexate

34
Q

Pathognomonic + characteristic features of Dermatomyositis?

A

Path: Heliotorpe rash, GOttron papules
Char: Malar erythema, Shawl sign, periungual and cuticular changes

NOT raynauds

35
Q

Biolgoical agent useful in GCA?

A

Tocilizumab

36
Q

Describe Inclusion body myo9sitis?

A

old man, insidious onset (can be five years), painless muscle weakness often starts proximal (hard to get up from chair). Characteristic = weakness distal finger flexors (does not happen in polymyositis). On exam distal muscle groups asymmetric. normal CK (usually elevated in Polymyositis). Biopsy: endomysial inflammation. EMG neuropathic and myopathic features (only myopathic in poly)

37
Q

Describe Polymyositis?

A

AKA Anti-synthetase syndrome
Anti Jo+ ILD = anti-synthestase syndrome
Symmetric, progressive weakness.
fever, maliase, weight loss, Raynauds.
upper oesphages dysphagia
also can get conduction defects
Non-erosive arthritis
“mechanics hands”
Raised CK.

38
Q

Mandatory parts of PMR diagnosis

A

age >50, bilateral shoulder ache abnormal CRP/ESR

39
Q

Common feature of limited scleroderm, common feature of diffuse?

A

Limited: telangiectasia, diffuse - tendon friction rubs

40
Q

Common histo type fo ILD in systemic sclerosis?

A

NSIP and responds to cyclophosphamide

41
Q

Characterisics of scleroderma renal crisis? Mx?

A

Malignant HTN
Mild Protenuria
microangiopathinc anemia and RNA polyerase positivity

NOT GN

Treat with ACE -I

42
Q

Four categories of RA classicficaton

A

of Joints

Sero (RF and Anti - CCP)
CRP/ESR
Duration >6 weeks

43
Q

Clinical Triad of Felty? Complications?

A

RA, neutropenia and splenomegaly
recurrent infections, hyperspleen =aneamia and thrombocytopenia, lymphadenopathy, skin hyperpig and cutaneous ulceration.
Control underlying RA. +/- splecectomy

44
Q

Seronegative arthropathies

A

Ank Spon
Psoriatic
Rective
Enteropathic spon
Undifferentiated spondylo

45
Q

Which is not a TNF inhbitor SE?
Demyelinating disease
infusion reaction
Irreversible Lupus like syndrome
reactivate TB
Cardiac Failure

A

Irreversible lupus like syndrome
DOes but is REVersible lupus like syndrome ANA positive

46
Q

Mech of Action
Infliximab, Etanercept, Adalimumab

A

TNF inhbitor

47
Q

Target of action ANakinra

A

IL-1

48
Q

Classic Still’s Disease?

A

16-35 yo
arthralgia, high ferritin, salmon pink maculopaula rash, fever, lymphadenopathy
RF and ANA negative

49
Q

Clues to Behcet’s Disease

A

Erythema nodosum
Recurrent genital ulceraction
Recurrent oral ulcerations
elevated ESR
inflam eye diease
pred to involved organ.

50
Q

Broad classes that raise serum urate?

A

Diuretics (except Losartan), anti-TB, anti-virals, immunosupressives (except MMF) and chemo drugs

51
Q

Which organs are rarely effected in limited scleroderma? A which ab is and not assoicated

A

Cardiac and renal
Limited: Anti-Centromere Ab
Diffuse: Anti-top Ab (Scl-70)
Renal: Anti-RNA polymerase III

52
Q

radiograph features of RA

A

symmetirc, marginal erosieon, jiont space narrowing, DIP sparing, Juxta artiulcar op, periarticular soft tissue swelling

53
Q

WHich DMARD no evidence for slow progression of RA radiographically?

A

Hydroxychloroquine
DO: MTx, abatacept, sulfasalazine, pred

54
Q

Which RA drug causes eye problems?

A

MTX
maculopathy
vortex keratopathy

55
Q

IBD vs RA STAT4 and STAT3 which is which

A

IBD - STAT3
RA - STAT4, APDI, DR4 PTPN22

56
Q

Most Common organism in imunocomp Rhem patients?

A

staph

57
Q

What bone problem is phenytoin therapy linked with?

A

enchanced vit d metablism leading to osteomalacia
not osteoporsis,

RACP 2022 Written (21 decks)

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