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Yr 2 EOYS > LOCO EOYS3 > Flashcards

LOCO EOYS3 Flashcards

1
Q

Gottron sign is an indication of which disease? [1]

A

Dermatomyositis

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2
Q

Ankylosing spondylitis is most associated with which of the following?

Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation

A

Aortic regurgitation

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3
Q

State an autoimmune disease that can cause AVN block [1]

A

Ankylosing spondylitis

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4
Q

What is the name for this sign of dermatomyositis? [1]

A

Gottron sign: red, thickened, scaly skin over the knuckles

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5
Q

This rash is likely to be sign of:

Scleroderma
Ankylosing spondylitis
Dermatomyositis
SLE

A

Dermatomyositis: purple rash around eye lids and face

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6
Q

Describe the difference in pathology of calcinosis between scleroderma and dermatomyositis [1]

A

systemic sclerosis: vascular hypoxia
dermatomyositis: release of calcium from mitochondria in muscle cells damaged by myopathy

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7
Q

Inflammation of the middle layer of the eye is a complication of:

Scleroderma
Ankylosing spondylitis
Dermatomyositis
SLE

A

Ankylosing spondylitis: anterior uveitis

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8
Q

Why is AS referred to as a seronegative spondyloarthropathy? [2]

A

Lack of rheumatoid factor positivity
Abscence of specific antibodies

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9
Q

Describe the pathophysiology of Scleroderma [1]

A

Autoimmune inflammatory and fibrotic connective tissue disease: immune mediated damage to vascular stuctures and excessive synthesis and depostion of extracellular martrix like collagen.

Cause chronic fibrosis, scarring and damage to organs

Cause of condition unknown

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10
Q

What are the two main patterns of disease in scleroderma? [2]

A

Limited cutaneous systemic sclerosis / scleroderma: aka CREST syndrome
Diffuse cutaneous systemic sclerosis / scleroderma: progressive organ dysfunction due to fibrosis

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11
Q

Describe skin changes seen in scleroderma [8]

A

Pruritus (usually early)
‘Puffy’ appearance due to oedema (often seen in digits)
‘Salt and pepper’ appearance: due to hyperpigmentation and hypopigmentation
Loss of hair
Dryness
Changes to capillaries in nail bed: may only be seen with special dermatoscope (Capillaroscopy)
Atrophy of subcutaneous tissue
Ulcerations: may be seen over joints due to tight skin or on finger tips
Telangiectasia: abnormal dilation of capillary
Calcinosis: calcium deposits in the skin
Perioral skin tightening with decreased oral opening: gives rise to a ‘pursed-string’ appearance

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12
Q

Describe a phenomenon associated with scleroderma [1]

A

Raynaud phenomenon: skin colour changes that occur in the fingers and toes from vasospasm.

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13
Q

Desribe the characteristic features of CREST syndrome [5]

A

C - calcinosis: calcium deposits in the skin
R - Raynaud phenomenon
E - oEsophageal dysmotility: swallowing difficulty
S - sclerodactyly: skin thickening and hardening affecting the fingers and toes
T - telangiectasia: dilated capillaries. Usually appear on face, palms and mucous membranes

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14
Q

What is the key investigation for diagnosing dermatomyositis? [1]

A

Creatine kinase blood test: inflammation in the muscle cells (myositis) leads to release of creatine kinase.

Normal creatine kinase levels are 300 U/L; in dermatomyositis is usually over 1000 U/L

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15
Q

What are skin features of dermatoymyositis? [5]

A

Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees
Photosensitive erythematous rash on the back, shoulders and neck
Purple rash on the face and eyelids
Periorbital oedema (swelling around the eyes)
Subcutaneous calcinosis (calcium deposits in the subcutaneous tissue)

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16
Q

How do you treat AS?

A

Conventional analgesia / NSAIDs:
* Naproxen
* Ibuprofen
* Celecoxib

Convetional DMARDs: although not much evidence for
Sulphasalazine, methotrexate

Biological DMARDs

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17
Q

Describe extra-articular manifestations of AS [3]

A

Anterior uveitis: inflammation of the middle layer of the eye. Typically causes unilateral eye pain and redness
Aortitis: can lead to aortic regurg
Atrioventricular block

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18
Q

Articular features of reactive arthritis? [3]
Extra-articular associations of reactive arthritis? [3]

A

Articular features:
* Peripheral arthritis
* Axial arthritis: inflammatory back pain
* Enthesitis and/or dactylitis

Extra-articular associations
* Bilateral conjunctivitis (non-infective)
* Anterior uveitis
* Circinate balanitis is dermatitis of the head of the penis
* Triad: arthritis, urethritis and, conjunctivitis

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19
Q

Reactive arthritis has a triad of which 3 symptoms? [3]

A

Classic triad of urethritis, conjunctivitis and arthritis

‘Can’t see, pee or climb a tree’

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20
Q

Which disease is depicted?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

A

Scleroderma: Perioral skin tightening with decreased oral opening: gives rise to a ‘pursed-string’ appearance

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21
Q

Name this sign of scleroderma [1]

A

Telangiectasia: abnormal dilation of capillary

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22
Q

This lady presents with puffy eyes. What disease is she most likely to have?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

A

Dermatomyositis: Periorbital oedema (swelling around the eyes)

23
Q

Name this sign [1]

What is it a complication of? [1]

A

Circinate balanitis: due to reactive arthritis

24
Q

A 54-year-old woman, who is known to have systemic sclerosis, complains that her hands change colour in the cold. This is associated with severe pain. She asks if there is any medication you can prescribe.

Which of the following is a suitable first line option?

Amlodipine

Atenolol

Amitriptyline

Bisoprolol

Nifedipine

A

Nifedipine is a pharmacological option for Raynaud’s phenomenon

25
Q

Explain the peripheral mechanism of inflammation during tissue injury [4]

A

Release of inflammatory mediators (K+ H+ bradykinin, histamine, 5HT, nitric oxide): make membranes more unstable

Activation of arachidonic acid pathway: production of leukotrienes and prostanoids

Activation of peripheral nociception (pain enhanced in inflammation)

Modulation of primary afferents to subsequent stimulus

26
Q

Describe the pain pathways in neuropathic [4]

A

Pain is felt somewhere else, but pathology could be more proximal

Inflamamtion / mech. pressure causes the nerve to change behaviour: cell membrane becomes unstable and fires ectopic signals.:
* Alteration in ion channel expression
* Ectopic and spontaneous discharge
* Ephaptic conduction
* Collateral sprouting at primary afferents
* Sprouting of sympathetic neurones at DRG

27
Q

Saw tooth erosion is associated with which type of OA? [1]

A

Erosive OA

28
Q

Question 28 of 152
A 23-year-old woman suffers from recurrent anterior dislocations of her left shoulder. A CT scan reveals a Bankart lesion. This is a lesion of the anterior glenoid labrum. Which rotator cuff muscle tendon is found at the anterior aspect of the shoulder capsule?

Teres minor

Supraspinatus tendon

Teres major

Subscapularis tendon

Infraspinatus tendon

A

Subscapularis tendon

29
Q

A 34-year-old man presents to the emergency department complaining of pain in his right hand after a fall 5 days ago. The pain is on the dorsum of the hand, at the base of his thumb. He explains that he fell forwards whilst playing football but managed to catch himself with his right hand before his head hit the floor.

On examination, there is marked tenderness on palpation of the base of the first metacarpal on the dorsum of his hand. There is also swelling in this area.

What type of fracture is the patient most likely to have sustained?

Boxer’s fracture
Colles’ fracture
Galeazzi fracture
Scaphoid fracture
Smith’s fracture

A

Falling onto an outstretched hand (FOOSH) is the most common mechanism causing a scaphoid fracture

30
Q

A 61-year-old female presents to the rheumatology clinic with a new diagnosis of rheumatoid arthritis. She is started on a short course of steroids and a disease modifying anti-rheumatic drug. What type of joint is primarily affected in rheumatoid arthritis?

Synovial
Fibrous
Cartilaginous
Synostosis
Hyaline

A

Synovial

31
Q

A 52-year-old woman with muscle aches presents to the general practice. She has been experiencing this for well over a year and it affects her chest and back more so than her limbs. On questioning, she alludes to having bouts on average every 3 months of becoming short of breath. She lives a very healthy lifestyle remaining abstinent from drinking and smoking.

On examination, she has a flat erythematous rash on her torso and purple discolouration bilaterally around the eyelids which she explains she has had for a long time.

Which antibody is associated with the patient’s condition?

Anti-Jo-1

Anti-Scl-70

Anti-smooth muscle

Anti-histone

C-ANCA

A

Anti-Jo-1

Dermatomyositis is associated with the anti-Jo-1 antibody

32
Q

A 27-year-old male attends his general practitioner with lower back pain. He reports that the back pain has been present for the past year and has minimal improvement with oral ibuprofen and paracetamol. He has found that it is worse in the morning and swimming helps alleviate his symptoms. He has no history of trauma and works as a tax analyst, preferring to run for exercise than perform heavy lifting routines. He has no past medical history of note and no drug allergies.

What is the most likely radiological finding in this patient?

‘Pencil in cup’ deformity
Bamboo spine
Osteophytes
Sacroiliitis
Vertebral collapse

A

Sacroiliitis (Bamboo spine is a sign of late stage AS)

33
Q

RA

Methotrexate and Rituximab would be

First line treatment
Second line treatment
Third line treatment
Fourth line treatment

A

Third line treatment

34
Q

RA

Methotrexate & a TNF-inhibitor would be

First line treatment
Second line treatment
Third line treatment
Fourth line treatment

A

Second line treatment

35
Q

Methotrexate inhibits which enzyme? [1]

A

dihydrofolate reductase

36
Q

RA Treatment:

Hydroxychloroquine blocks:

TLR7
TLR8
TLR9
TLR10
TLR11

A

TLR9

37
Q

RA

Leflunomide inhibits which enzyme? [1]

What is the effect of this? [2]

A

Dihydroorotate dehydrogenase (DHODH): stops pyrimidine synthesis & therefore reduces pro-inflammatory cytokines: IL-1, TNF-A and IL-6; Blocks T cell proliferation

38
Q

Which treatment for RA reduces pyrimidine synthesis?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Leflunomide

39
Q

Which treatment for RA that targets TLR-9?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Hydroxychloroquine

40
Q

Which treatment for RA that reduces dendritic cell activation?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Hydroxychloroquine

41
Q

Which is a treatment for RA that inhibits dihydro-orotate dehydrogenase?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Leflunomide

42
Q

Which treatment for RA is a tumor necrosis factor-alpha (TNF-alpha) inhibitor?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Infliximab

43
Q

Which treatment for RA leads to decreased T-cell proliferation and cytokine production?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Abatacept

44
Q

Which treatment for RA is an IL-1 antagonist?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Anakinra

45
Q

Which treatment for RA targets IL-6?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Tolizumab

46
Q

Which treatment for RA targets upregulates CTLA-4, which switches T cell off?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Tolizumab

47
Q

A garden spade deformity arises from a

Hangman fracture
Colles fracture
Smith fracture
Wedge fracture

A

Smith fracture

48
Q

This shows what type of deformity? [1]

What type of fracture would this have arisen from? [1]

A

Garden spade; due to Smith fracture

49
Q

This shows a

Hangman fracture
Colles fracture
Smith fracture
Wedge fracture

A

Wedge fracture

50
Q

hyperflexion injuries to the vertebral body resulting from axial loading

This best describes a

Hangman fracture
Colles fracture
Smith fracture
Wedge fracture

A

Wedge fracture

51
Q

Dinner fork deformity arises from improper healing of a

Hangman fracture
Colles fracture
Smith fracture
Wedge fracture

A

Colles fracture

52
Q

What is the name for this type of fracture? [1]

A

Jefferson fracture

53
Q

What is impingement syndrome

Compression of the musculocutaneous nerve
Compression of the long thoracic nerve
Inflammation of the long head of the biceps brachii
Inflammation of the supraspinatus tendon
Compression of the axillary artery

A

Inflammation of the supraspinatus tendon

Yr 2 EOYS (58 decks)

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