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Year 6 - MBBS COPY > Passmed: Rheum > Flashcards

Passmed: Rheum Flashcards

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1
Q

Why may a pt w polymyalgia rheumatica appear weak?

A

Pain inhibition > true weakness of limb girdles

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2
Q

What are the Gell and Coombs classification of hypersensitivity?

A

I - Anaphylactic IgE
II - Cell Bound IgG/M
III - Immune Complex
IV - Delayed T Cell

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3
Q

What is the defect in Marfan’s syndrome?

A

FBN1 gene, chr15, fibrillin-1

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4
Q

What might dilation of the aortic sinuses lead to?

A

Aortic Aneurysm

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5
Q

What cardiac features can be found in Marfans pts?

A

Aortic aneurysm, dissection, regurg + mitral valve prolpase therefore require annual echo +/- meds

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6
Q

Inf MI + complete heart block tx

A

Consrv is asx and haem stable or w atropine if also chest pain, syncope, HF or shock

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7
Q

Ant MI + complete heart block tx

A

Pacing

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8
Q

Ix to rule out and confirm dx of SLE

A

Rule out: ANA has the highest sensitivity

Confirm dx: anti-dsDNA has the highest specificity

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9
Q

What should be screened for following dx of dermatomyositis?

A

Underlying malignancy typically ovarian, breast, lung

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10
Q

What are the skin features of dermatomyositis?

A

Photosensitive, heliotrope rash in periorbital region, Gottrons papules over dorsum of hands

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11
Q

cANCA vs pANCA

A

cANCA: targets PR3 + pos for GPA

pANCA: targets MPO + pos for eGPA, microscopic polyangiitis, UC/PSC

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12
Q

Mx of ANCA associated vasculitis

A

MDT: rheum, resp, renal

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13
Q

Ix + Mx for GCA

A

Ix: inflam markers + temporal artery biopsy

Tx: high dose pred + urgent same day ophthal review

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14
Q

Typical demographic of ank spond pt

A

Young Male

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15
Q

Ix + Mx for Ank Spond

A

Ix: inflam markers and HLA-B27, spirometry, imaging

Mx: encourage reg exercise, physio, NSAIDs, DMARDs if peripheral joint involvement, anti-TNF if persistently high disease activity despite conventional tx

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16
Q

What does the x-ray of sacroiliac joints show in ank spond pts?

A

May be normal early in disease

Sacroiliitis, sclerosis, subchondral erosions

Plus squaring of lumbar vertebrae, syndesmophytes, bamboo spine (late and uncommon)

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17
Q

What does MRI show in ank spond pts?

A

Done if neg x-ray but still high suspicion which will show signs of early inflam eg BM oedema

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18
Q

What is the dagger sign of a bamboo spine?

A

Single central radiodense line on x-ray related to ossification of supraspinous and interspinous ligaments

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19
Q

What causes syndesmophytes?

A

Ossification of outer fibres of annulus fibrosus

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20
Q

How long should either sex wait following methotrexate tx before conceiving?

A

6mnths

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21
Q

How often is methotrexate taken?

A

Wkly

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22
Q

What should be co-prescribed alongside methotrexate and when should it be take?

A

Once wkly folic acid 5mg taken >24hrs after each methotrexate dose

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23
Q

Which pts <60yrs get pseudogout?

A

Underlying risk factor: haemochromatosis, Wilson’s disease, acromegaly, hyperparathyroidism, low Mg, low phosphate

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24
Q

What is antisynthetase syndrome?

A

A subtype of dermatomyositis: myositis + ILD +/- hand sx

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25
Which abs are pos in antisynthetase syndrome?
Anti-Jo1
26
What are the bone profile blood tests results in pts w osteogenesis imperfecta?
Normal: Ca, PO4, PTH, ALP
27
What does hyperCa in the absence of elevated PTH suggest?
1° Malignancy or Sarcoidosis
28
What hx is suggestive of acute reactive arthritis?
Can’t see, pee or bend the knee
29
Def of reactive arthritis + most commonly associated organisms
Arthritis following an infection where the organism cannot be recovered from the joint Post-Dysenteric: shigella, salmonella, yersinia, campylobacter - M=F Post-STI: chlamydia trachomatis - M>F
30
How do renal comps of systemic sclerosis px + tx?
HTN + AKI +/- MAHA -> ACEi
31
What is labetalol commonly used for?
To acutely lower BP in haemorrhagic strokes
32
Preventing pathological fractures: bisphosphonates vs denosumab
Whilst alendronate is first line if eGFR <30 then denosumab is preferred
33
Denosumab: Dose + SEs
Dose: S/C 60mg 6mnthly or 120mg 4wkly to prevent skeletal-related events in adults w mets from solid tumours SEs: dyspnoea + diarrhoea
34
What markers are used to monitor SLE flares? (2)
Dec Complement + Inc ESR
35
How does anti-phospholipid syndrome px?
CLOTS: clots, livedo reticularis, obstetric comps, thrombocytopenia
36
What is the mx for antiphospholipid syndrome?
Based on EULAR guidelines: low dose aspirin or lifelong warfarin following a VTE
37
What does antiphospholipid syndrome cause a paradoxical rise of?
APTT
38
What are the blood results for polymyalgia rheumatica?
Raised WCC/CRP/ESR + Normal CK
39
Mx of Gout
Acute: any CIs? NSAIDs, colchicine, pred, continue the allopurinol throughout if already taking Chronic: started 2wks after initial attack (1) Allopurinol (2) Febuxostat Lifestyle Mods: lose weight, red high purine foods/alcohol, stop precipitating drugs
40
Which drugs classically cause drug induced lupus? (3)
Procainamide (antiarrhythmic), Hydralazine (tx high BP), Isoniazid (anti-TB)
41
How does drug induced lupus typically px?
Arthralgia, Myalgia, Skin/Pulmonary Involvement
42
Which abs are a/w drug induced lupus?
Antihistone
43
SLE vs DIL
SLE: young + female DIL: elderly + male
44
What is the adverse effect of hydroxychloroquine?
Bulls eye retinopathy which may result in visual loss, baseline ophthal exam, annual screening
45
Mx of OA
Consv: wt loss, encourage exercise, local muscle strengthening, braces, insoles Medical: para and topical NSAIDs if knee/hand, oral NSAIDs w PPI, opioids, capsaicin cream, steroid injections Surg: if above fail refer for joint replacement
46
Cardiac comps of Ehler-Danlos syndrome (3)
Aortic regurg, mitral valve prolapse, aortic dissection
47
Do you stop the pred if clinical suspicion of GCA but temporal biopsy is neg ?
No because skip lesions mean the result may show up as neg
48
What does systemic vasc sx + hep B signs - pulm signs suggest?
Polyarteritis Nodosa
49
What are the features of poor prognosis in RA? (7)
Insidious onset, poor functional status at px, extra articular features, erosions on x-ray <2yrs, HLA DR4, RF, anti-CCP abs
50
Outline bone protection for pts starting steroids >65yo / prev fragility # / will be >3mnths / DEXA >-1.5
Co-prescribe alendronate, calcium, vit D replete
51
Outline bone protection for pts starting steroids <65yo
Offer bone density scan w T score: >0 reassure + 0 to -1.5 repeat scan in 1-3yrs
52
What is the initial mx of RA?
DMARD monotherapy +/- short course of bridging prednisolone
53
What does hyperPTH put you at an inc risk of developing? (2)
Pseudogout + Renal Stones
54
What is the relationship b/w calcium and eye problems?
HypoCa - Cataracts HyperCa - Corneal Calcification
55
Frozen Shoulder vs Polymyalgia Rheumatica
FS: unilateral + pain then stiffness PR: bilateral + both sx together
56
Limited cutaneous systemic sclerosis abs
Anti-centromere abs
57
Diffuse cutaneous systemic sclerosis abs
Anti-Scl-70 abs
58
What are the 8A’s of ank spond?
Anterior Uveitis Apical Fibrosis Aortic Regurg AV Node Block Amyloidosis Achilles Tendonitis Arthritis Peripherally And Cauda Equina Syndrome
59
What are the clinical findings of ank spond?
Posture: loss of lumbar lordosis + accentuated thoracic kyphosis Examination: red lateral flexion, forward flexion, chest expansion
60
How is forward flexion tested?
Schober’s Test: a line is drawn 10cm above and 5cm below dimples of Venus and it should inc >5cm
61
What are the crystals from joint aspiration like in gout, pseudogout, RA and OA?
Gout: monosodium urate, needle shaped, neg birefringent Pseudo: ca pyrophosphate, rhomboid shaped, pos birefringent RA: cholesterol, rhomboid shaped, neg birefringent OA: ca phosphate, coffin lid shaped, no birefringence
62
What is first line mx for ank spond?
Physio + NSAIDs
63
What are the adverse effects of bisphosphonates? (5)
Acute phase response, oesophageal reactions, osteonecrosis of jaw, inc risk atypical stress #, hypoCa
64
What are the adverse effects esp w alendronate? (2)
Oesophageal ulcers + inc risk of atypical stress # of proximal femoral shaft
65
How should oral bisphosphonates be taken?
Taken on empty stomach >30mins before breakfast or another oral med + then remain sat/stood in that time
66
What do the bloods show in antiphospholipid syndrome?
Raised APTT, Normal PT, Thrombocytopenia
67
What is the main immunoglobulin found in breast milk?
IgA
68
What does low Ca and PO4 w raised ALP make you think of?
Osteomalacia
69
What are the possible eye signs of Marfan’s syndrome? (3)
Upwards lens dislocation, blue sclera, myopia
70
Do Marfan’s pts have learning difficulties?
No
71
What are chemo pts at an inc risk of?
Gout
72
Mx of Pseudogout
Aspiration of joint to exclude septic arthritis + then NSAIDs, colchicine, steroids
73
When should sulfasalazine be avoided? (2)
G6PD def + allergy to aspirin or sulphonamide
74
What are the adverse effects of sulfasalazine? (5)
Oligospermia, SJS, may colour tears Plus resp: pneumonitis + fibrosis Plus haem: myelosuppression, Heinz body anaemia, megaloblastic anaemia
75
Is sulfasalazine safe in preg + breastfeeding?
Yes
76
What should be checked before starting azathioprine? (2)
If the pt is on allopurinol + a TPMT test to assess risk of toxicity
77
What are the adverse effects of azathioprine? (4)
N+V, pancreatitis, BM depression, inc risk of non-melanoma skin cancer
78
Is azathioprine safe in preg + breastfeeding?
Yes in preg but use cautiously if breastfeeding
79
What does arthritis w nail and skin changes suggest?
Psoriatic Arthropathy
80
Which hand joint is predominantly affected in psoriatic arthropathy?
DIPs
81
What deformity is classically a/w psoriatic arthropathy?
‘Pencil-in-cup’
82
Ddx for HyperCa (3)
If high PTH: 1° or 3° hyperparathyroidism If low PTH: malignancy, XS calcium/vit D, paget’s, thyrotoxicosis, adrenal insufficiency Plus drug SEs: thiazide diuretics, lithium, vit A
83
How many NSAIDs must have failed before starting anti-TNFα inhibitor for ank spond?
Two + meets criteria for active disease on two occasions 12wks apart
84
Why colchicine>NSAIDs in elderly pt on warfarin w gout?
Risk of life threatening GI haemorrhage
85
Which score is useful for assessing hypermobility?
Beighton
86
What is used to tx acute flares of RA?
IM Steroids
87
What does the presence of chondrocalcinosis on x-ray point you towards?
Pseudogout > Gout
88
What is the z-score adjusted for?
Age, Gender, Ethnicity
89
What is the classic triad of Behcet’s syndrome?
Oral ulcers, genital ulcers, ant uveitis
90
What is the HLA association w Behcet’s?
HLA B51
91
What are the four spondyloarthropathies?
PEAR: psoriatic, enteropathic, ank spond, reactive
92
Would you find the organism in a joint aspirate of reactive arthritis?
No only in a septic joint
93
How regularly is methotrexate taken?
Wkly
94
What should be co prescribed alongside methotrexate?
Wkly Folic Acid 5mg
95
What interacts w methotrexate? (2)
High dose aspirin inc risk of toxicity by red excretion + trimethoprim inc risk of marrow aplasia
96
What clinical feature is most specific for inflammatory back pain?
Improvement w activity and not relieved by rest
97
What is caused by compression of the lateral cutaneous nerve of the thigh?
Meralgia Paraesthetica
98
What should you screen for before starting biologics?
TB, Hep B/C, HIV
99
What are the most commonly implicated bacteria preceding reactive arthritis?
Chlamydia Trachomatis Salmonella Enterica Campylobacter Jejuni

Year 6 - MBBS COPY (35 decks)

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