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1
Q

Cutaneous manifestations of dermatomyositis

A
  • Gottrons papuls
  • Red, violacious erythemas (V-sign, Shawl sign, Holster sign)
  • Mechanic’s hands
  • cutanous calcinosis
  • heliotrope rash
  • erythroderma
  • nailfold abnormalities
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2
Q

Causes of subcutaneous nodules

A
  • RA
  • Gout
  • Rheumatic fever
  • sarcoidosis
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3
Q

Causes of dactylitis

A
  • Ank spond
  • Psoriatic arthritis
  • IBD-related arthritis
  • reactive arthritis
  • undiff. spondyloarthrits
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4
Q

Hand deformities in RA

A
  • Ulnar deviation
  • subcutaneous nodules
  • Z deformity of thumb
  • Boutonniere’s deformity
  • Swan-neck deformity
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5
Q

Biological agents to treat RA

A
  • TNF inhibitors
  • IL-6 inhibitor
  • B-cell depletion
  • Co-stimulation modulation
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6
Q

DMARDS

A
  • methotrexate
  • sulfasalazine
  • chloroquine
  • lefluonomide
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7
Q

X-ray findings in RA

A
  • uniform joint space narrowing
  • periarticular osteopenia
  • juxta-articular bony erosions
  • sub-luxation and gross deformities
  • peri-articular soft tissue swelling
  • capsular erosions
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8
Q

X-ray findings in OA

A
  • joint space narrowing
  • osteophytes
  • subchondral cysts
  • subchondral sclerosis
  • fibrillated cartilage
  • early cartilage loss
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9
Q

Nail manifestations in psoriatsis

A
  • pitting
  • onycholysis
  • subungual hyperkeratosis
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10
Q

Differentials of OA

A
  • ank spond
  • avascular necrosis
  • RA
  • psoriatic arthritis
  • gout
  • psuedogout
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11
Q

Clinical features of diffuse systemic sclerosis

A
  • severe ILD
  • renal involvement
  • diffuse skin involvement
  • anti-topoisomerase Ab
  • short duration of Raynauds
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12
Q

Clinical features of limited systemic sclerosis

A
  • isolated pumonary hypertension
  • no renal involvement
  • limited skin involvement
  • anti-centromere Ab
  • long duration of Raynauds
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13
Q

Drug used for renal involvement of systemic sclerosis

A

ACE-inhibitor

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14
Q

Autoantibodies specific to systemic sclerosis

A
  • anti-centromere antibody SCL70

- anti-topoisomerase

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15
Q

6 types of systemic involvement of systemic sclerosis

A
  • GIT (oesoph dysmotility, microstomia)
  • Pulm (ILD, PHPT)
  • Cardiac (pericarditis)
  • renal (scleroderma renal crisis)
  • musculoskeletal (arthralgia)
  • vascular (Raynauds)
  • cutaneous (progressive skin fibrosis)
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16
Q

6 systemic manifestations of idiopathic inflammatory myositis

A
  • Constitutional
  • Skeletal (prox muscle weakness, pharyngeal weakness, weak neck flexors)
  • skin (DM)
  • lungs (ILD)
  • cardiac (carditis, CMO)
  • joints (arthritis)
  • GIT (GORD)
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17
Q

Differentials of proximal muscle weakness

A
  • genetic muscle disorders (muscular dystrophies)
  • congenital myopathies
  • neuropathies (SMA, MG, GBS)
  • metabolic (storage disease)
  • endocrine (thyroid)
  • infection
  • drugs (AZT, steroids)
  • granulomatous disease
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18
Q

Causes of Raynaud’s phenomenon

A
  • Idiopathic (primary)
  • scleroderma
  • SLE
  • Sjogrens
  • RA
  • dermatomyositis
  • drugs (Bblock, sulfasalazine)
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19
Q

Differentials for gout

A
  • CPPD
  • BCPC
  • septic arthritis
  • reactive arthritis
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20
Q

Bedside test for renal flare in SLE

A

Dipstix - proteinuria and haematureia

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21
Q

Clinical findings for APS

A
  • tendency to thrombosis, recurrent fetal loss, thrombocytopenia, false positive tests for syphilis
  • Ab: anti-cardiolipin, anti-glycoprotein1, anti glycoprotein B2, anti-lupus coag
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22
Q

Treatment of APS

A

long-term anticoagulation with Warfarin

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23
Q

Definition of osteoporosis

A

Generalised bone disease characerised by decreased bone mass and deterioration of bone micro-architecture, resulting in increased fracture risk

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24
Q

Primary OP

A

bone loss related to decline in gonadal function associated with aging

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25
Secondary OP
bone loss that results due to a variety of conditions that adversely impact bone metabolism
26
Causes of secondary OP
- endocrine - thyrotoxicosis, cushings - hypogonadal (anorexia, turners) - drugs (glucocorticoids) - haematological malignancy (MM, thalassemia) - GIT (IMB, malabsorption) - Neurological (Parkinsons) - other (RA, AS, SLE, CRF)
27
Radiographic diagnosis of OP
Dexa score of -2.5 and below or T-score of -1 and below
28
Treatment of OP
Non-pharm - prevention of falls Pharm - calcium and vit D supp - bisphosphonates - calcitonin - strontium ranalate - HRT - selective oestrogen receptor modulator
29
SLICC immunological criteria
- anti-dsDNA - anti-Sm - positive Coomb's test - anti-phospholipid antibody - ANA - low complement
30
SLICC clinical criteria
- acute lupus rash - chronic lupus rash - oral ulcers - arthritis - thrombocytopenia - haemolytic anaemia - leucopenia - serositis - lupus nephritis - non-scarring alopecia - neurological
31
Things to exclude for FMS
- hypothyroidism - hyperparathyroidism - polymyalgia rheumatica - early inflammatory arthritis - parkinsonism - myositis - malignancies
32
Treatment of FMS
Non-pharm - education - aerobics - CBT Pharm - TCAs - SSRIs - alpha 2 delta ligands - tramadol and paracetamol
33
Commonest non-articular rheumatism at elbow
- tennis elbow (lateral epicondylitis - pain on wrist flexion) - golfer's elbow (medial epicondylitis - pain on wrist extension)
34
Commonest non-articular rheumatism at knee
Pre-patellar bursitis (housemaid's knee)
35
New classification of JIA
- oligoarticular (persisten, extended) - polyarticular (RF pos, neg) - systemic - enthesitis related - psoriatic - unclassified
36
Causes of primary large artery vasculitis
- GCU | - Takayasu's
37
Causes of primary medium artery vasculitis
- classic PAN | - Kawasaki
38
Causes of secondary large artery vasculitis
- aortitis (RA) | - infection (syphilis, TB)
39
Treatment for primary vasculitis
- immunosuppression (steroids, MTX, biologicals) | - revascularisation
40
Acute treatment of gout
- NSAIDs - colchicine - if CI, steroids
41
Urate lowering therapies
- uricostatic (allopurinol) - uricosuric (probenecid) - uricolytic (pegloticase)
42
Prophylaxis of acute attacks during ULT
colchicine for 3-6 months | NSAIDS for 6-12 weeks
43
6 clinical syndromes of CPPD
- pseudogout - OA-like - RA-like - OA- like with discrete acute attacks - neuropathic type - asymptomatic chondrocalcinosis
44
Crystals in CPPD joint aspirate
Positively bifringemnt
45
Treatment of CPPD
- NSAIDs - IAI steroids - colchicine (pseudogout) - HCQ (chronic arthritis
46
Definition of Sjogrens
Chronic inflammatory disorder characterised by lymphocytic infiltrates in exocrine glands
47
Red flags for lower back pain
- age of onset <20 years or >50 years - recent history of violent trauma - constant progressive, non-mechanical pain - thoracic pain - past history of malignant tumour - prolonged use of corticosteroids - drug abuse, immunosuppression, HIV - systemically unwell - unexplained weight loss, night sweats - widespread neurological symptoms - structural deformity - fever
48
Criteria for Sjogrens
- ocular symptoms - oral symptoms - ocular signs - autoantibodies (ro, La) - alivary gland involvement - histopathology
49
What malignancy is Sjogrens associated with?
Non-Hodgkins lymphoma
50
Triad of Reiter's syndrome
- urethritis - conjunctivitis - oligo-arthritis
51
Extra-articular features of reactive arthritis
- mucocutaneous lesions - enthesitis - conjunctivitis - uveitis - urethritis - dactylitis - carditis
52
Treatment of reactive arthritis
- NSAIDS - IAI steroid - mod/high dose steroids - antibiotics if acute phase - chronic = sulfasalazine - physiotherapy
53
Side effects of long-term steroid use
- proximal myopathy - diabetes - cushings - osteoporosis - hypertension - glaucoma - cataracts
54
Side-effects of NSAIDs
- Reye's syndrome - sodium and water retention - PUD - interstitial nephritis - bronchospasm - transaminitis
55
Criteria for hypermobility syndrome
- hyperextension of knees >10 - thumb passively opposed to forearm - little MCP extends >90 degrees - elbow extension >10 - palms on floor
56
Causes of hypermobility syndrome
- hypermobility syndrome (AD) - Ehlers Danlos - Down's syndrome - osteogenesis imperfecta - Marfans - Marfanoid hypermobility syndrome
57
Gout X-ray findings
- preserved joint space - rat-bitten punched out erosions - overhanging sclerotic edges - tophi - no periarticular osteopenia
58
Spondyloarthritis disorders
- ankylosing spondyitis - psoriatic arthritis - reactive arthritis - IBD-related arthritis - undifferentiated spondyloarthritis
59
Axial features of spondyloarthritis
- inflammatory back pain - ankylosis of the spine, vertebro-costal and sterno-costal joints - abnormal posures - risk of fracture - sacroilitis - arthritis of hip and shoulder
60
Extra-articular features of spondyloarthritidies
- enthesitis - dactylitis - acute anterior uveitis - diarrhoea - psoriases - keratoderma blenorrhagicum
61
Treatment of axial spondyloarhtitis
- NSAIDs | - biologic DMARDs
62
Treatment of peripheral arthitis of spondyloarthritis
- NSAIDs - synthetic DMARD - biologic DMARDs
63
CASPAR criteria for psoriatic arthritis
An inflammatory articular disease with >3 of: - psoriasis (current, present, fam Hx) - typical nail dystrophy - negative RF - dactylitis - juxtaarticular new bone formation
64
Ophthalmic manifestations of RA
- keratoconjunctivitis sicca - scleritis and episcleritis - keratitis - retinal vasculitis - scleromalacia
65
Pulmonary manifestations of RA
- pulmonary nodules - interstitial lung disease - pleural effusions
66
Felty's syndrome
- neutropenia - splenomegaly - leg ulcers
67
Complications of RA
- accelerated atherosclerosis - lymphoma - FMS - medication-related
68
BCP crystals
- carbonate-substituted hydroxyapetite - tricalcium phosphate - otacalcium phosphate
69
Associations with BCP deposition disease
- Milwaukee shoulder syndrome - OA - calcific tenditiis - limited SS - dermatomyositis - mixed crystal deposition disease - chronic renal failure - hypercalcaemia
70
3 types of idiopathic inflammatory myopathy
- polymyositis - dermatomyositis - inclusion body myositis
71
Management of IIM
- corticosteroids - immunosuppressive agents - IVIG
72
Complications of Raynaud's phenomenon
- fingertip pits and digital ulcers - gangrene - osteomyelitis - digital amputation
73
Treatment of pulmonary arterial hypertension in systemic sclerosis
- calcium channel blockers - endothelin receptor antagonist (bosentan) - phosphodiesterase 5 inhibitor (sildenafil) - prostacyclin analogue inhalers

Rheumatology (6 decks)

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