Rheu Flashcards
(112 cards)
1
Q
Are Oral corticosteroids Dmards?
A
No they are not. Oral corticosteroids are not DMARDS
2
Q
Difference between Methylprednisolone and Prednisolone?
A
Essentially the same. Prednisolone is administered Orally. Methylprednisolone is administered IV.
3
Q
According to NICE guidelines, patient needs a DAS assessment
A
anti TNF therapy
4
Q
Pneumonitis is well recognized but uncommon complication
A
Methotrexate
5
Q
Inhibit both COX-1 and COX-II
A
NSAIDS
6
Q
All brands are parenteral
A
anti TNF therapy
7
Q
Causes profound B-Cell lymphocyte depletion
A
Rituximab
8
Q
Better G.I. safety than the older generation of these drugs
A
Cox II selective non-steroidals
9
Q
Can cause temporary azospermia in young men
A
Sulphasalazine
10
Q
Azoospermia meaning
A
The complete absence of sperm from the seminal fluid.
11
Q
Combination therapy may be more effective than monotherapy
A
DMARDs
12
Q
Increased risk of infection with intra-cellular pathogens
A
Anti TNF therapy
13
Q
Highly teratogenic and abortifacient
A
Methotrexate
14
Q
Efficacy is similar to the older generation of these drugs
A
Cox II selective non steroidals
15
Q
Closely related drugs are used to treat Crohn’s disease
A
Sulphasalazine
16
Q
Given as adjuvant to other drugs to treat osteoporosis
A
Calcium/Vitamin D
17
Q
Given early in disease to slow down progression
A
DMARDs
18
Q
Have cardiovascular risk similar to older generation of these drugs
A
Cox II Selective non steroidals
19
Q
Helpful for bone metastases induced hypercalcaemia
A
Bisphosphonates
20
Q
Also referred as ‘pulse’ therapy
A
Methylprednisolone
21
Q
Do not prescribe if allergic to aspirin
A
Sulphasalazine
22
Q
Very rapid influence on inflammatory arthritis SLE & vasculitis
A
Oral Corticosteroids
23
Q
Well recognised to cause infertility
A
Cyclophosphamide
24
Q
Many brands in chewable formulation
A
Calcium/vitamin d
25
Narrow therapeutic window
Paracetamol
26
Minimise fracture risk in people taking steroids
Bisphosphonates
27
Titrate dose to reduce serum urate level
Allopurinol
28
More side effects if TPMT enzyme deficient
Azathioprine
29
Most of them need regular blood monitoring
DMARDs
30
Osteoporosis with long term use
Oral Corticosteroids
31
Weight gain very common
Oral Corticosteroids
32
Drug interaction with allopurinol
Azathioprine
33
Risk of haemorrhagic cystitis
Cyclophosphamide
34
Risk of interstitial nephritis and fluid retention
NSAIDs
35
Risk of oesophagitis
Bisphosphonates
36
Risk of peptic ulcer
NSAIDs
37
Should not be stopped during an ‘attack’
Allopurinol
38
Key treatment for temporal arteritis (gca) and PMR
MethylPrednisolone
39
Often used as a ‘steroid sparing’ agent
Azathioprine
(I think othere DMARDs too, check...)
40
reduces hyperuricaemia
Allopurinol
41
Efficacy due to action on bone and muscle
Calcium/Vitamin D
42
Used for intra-articular and intravenous injections
Methylprednisolone
43
Licensed for treatment of lymphoma and rheumatoid arthritis
Rituximab
44
Weekly doses followed by folic acid
Methotrexate
45
Alkylating chemotherapeutic drug
Cyclophosphamide
46
Follow up infusions are not needed many months
Rituximab
47
Which anti microbial may cause cutaneous hypersensitivity vasculitis?
Penicillin
48
Do Diuretics decrease uric acid excretion?
Yes. Therefore risk factor for gout.
49
Which Class of antiarrhythmics can exacerbate Raynards symptoms
Beta Blockers.
50
The 4 common clinical features of Spondyloarthropathies
1. Sacroiliac/axial disease (back/buttock pain)
2. Inflammatory arthropathy of peripheral joints
3. Enthesitis (inflammation at tendon insertions)
4. Extra-articular features (skin/gut/eye)
51
Common signs and symptoms of SLE
S erositis (pleurisy, pericarditis)
O ral ulcers (usually painless; palate most specific)
A rthritis (small joints nonerosive)
P hotosensitivity (or malar or discoid rash)
B lood disorders (low wcc, lymphopenia, thrombocytopenia, hemolytic anemia)
R enal involvement (glomerulonephritis)
A utoantibodies (ANA positive in >90% of cases)
I mmunologic tests (e.g. low complements)
N eurologic disorders (seizures or psychosis)
52
Which conditions can have Raynauds Phenomenon as an extra articular sign?
SLE,
Sjorgrens's,
Systemic Sclerosis (Scleroderma)
Dermatomyositis + Polymyositis
53
Which drugs can induce Raynauds
Beta Blockers
54
Risk factors for septic arthritis
diabetes mellitus, pre existing joint disease (e.g. RA), recent joint surgery, immunosuppression, chronic renal failure, Alcoholism
55
Septic arthritis pathophysiology
Foreign microbe infection of the joint space (capsule) that is associated with rapid joint destruction within days if not adequately treated.
56
Is septic arthritis typically monoarticular or polyarticular?
Typically monoarticular. Can be polyarticular = very poor prognosis
57
Most common causative organisms of septic arthritis
Staph Aureus and Streptococci
58
IVDU can have septic arthritis in strange sites, where?
Axial Sites
59
In which joint is septic arthritis most commonly affected?
Knee
60
Gram -ve seen as causative organism for septic arthritis in elderly and IVDU, true or false?
True
61
In people under 40, what can be the causative organism for septic arthritis?
Gonococcal
62
Complications of septic arthritis
Degeneration of joint
Death
63
The 2 specific septic arthritis diagnostic investigations
Aspirate synovial fluid
Blood culture
64
Management of Septic Arthritis
Antibiotics and surgical washout
65
Features seen in Spondyloarthropathies (but in different degrees depending in the type of Spondyloarthropathy)
S ausage digits
P soriasis
I ritis (inflammation of the colored part of your eye)
N SAID response is good
E nthesitis (inflammation of sites of tendon to bone)
A rthritis/ arthralgia
C rohns (+other IBDs)
H LA-B27
E levated inflammatory vessels
66
Dactylitis (sausage digit) is associated with which forms of spondyloarthropathy?
**Psoriatic arthritis**
Ankylosing spondylitis
67
What are spondyloarthropathies?
Group of conditions that affect the spine and peripheral joints and are associated with the presence of HLA-B27
68
Name 4 clinical features that all Spondyloarthropathies tend to have:
Sacroiliac/axial disease (back/buttock pain)
Inflammatory arthropathy of peripheral joints
Enthesitis (inflammation at tendon insertions)
Extra articular features (skin/gut/eye)
69
Extra-articular manifestations of Ankylosing spondylitis (All the A's)
Anterior uveitis
AV block
Aortic incompetence
Apical lung fibrosis
Amyloidosis
70
I.PAIN (=features of inflammatory back pain) tell me them!
Insidious onset
Pain at rest and at night therefore
Age of onset is LESS THAN 40
Improvement with exercise
No improvement with rest
71
Talk Psoriatic Arthritis in terms of patterns of presentation
Nails can be affected
Can be seen as symmetrical arthritis (like RA)
Can be seen as monoarthritis
Can be seen as asymmetrical oligoarthritis with dactylitis
72
What xray appearance can be observed in Psoriatic Arthritis
Pencil in cup
73
Can you get costochondritis with Ankylosing spondylitis?
Yes
74
In Ankylosing Spondylitis name 3 features seen on the xray of the spine and the SI joint
1. Syndesmophytes (seen in ankylosing spondylitis)
2. Romanus lesion
3. SI joint erosions
(The sacroiliac joints are centrally involved in the SpA (spondyloarthropathy ), most clearly and pathognomonic in ankylosing spondylitis)
75
Before giving someone Methotrexate what two tests does the patient need
CXR and liver tests
76
Name two characteristic features of blood tests for someone with SLE?
low WCC and low platelets
(also raised PV with normal CRP)
77
Lupus urine test would show?
Lupus can attack the kidneys (lupus nephritis). Therefore, can have blood and protein in the urine. (Haematuria and Proteinuria)
78
Polymyalgia Rheumatica is associated with which other condition?
Giant cell Arteritis
79
Prednisolone is typically given daily in almost all PMR patients initially, at what dose though?
15mg
Then taper off slowly.
80
Can PMR patients expect the response to prednisolone to be dramatic or not?
Dramatic diagnostic response within 5 days of starting the medication
81
What symptom should patients with PMR be watchful for?
Headache (possible GCA)
82
If GCA is diagnosed what drug is given and at what dose?
60mg Prednisolone daily.
For at least 2 weeks, then taper off.
83
For acute onset GCA visual symptoms, what drug should be given?
Methylprednisolone IV pulse therapy (1-3 days)
84
GCA trumps PMR as it requires higher prednisolone. True or False?
True
85
In PMR prednisolone is given and which other drugs?
Many adverse effects of long term corticosteroid usage.
Calcium/ vit d (prevention of osteoporosis)
PPI (to reduce glucocorticoid risk of [weakly linked with] peptic ulceration and perforation)
86
Either a biopsy of the temporal artery or ........ can help to diagnose GCA
Ultrasound of the temporal artery
87
Which NSAID has least risk for cardiovascular adverse events?
Naproxen
88
Are Heberden's nodes on the PIPJs?
No they are on the DIPJs
(herbs sprinkling).
Seen in OA
89
Are Bouchard's nodes on the PIPJs?
Yes
Seen in OA
90
If a patient has really tight skin and as a result can no longer fully stretch their fingers, which condition are you thinking of?
Systemic Sclerosis
Sign is called sclerodactyly
91
Person presents with weird looking nails and DIPJs swelling, whats most likely diagnosis?
Psoriatic Arthritis
92
Which two tests can be used to diagnose carpal tunnel syndrome?
Tinel's and Phalen's
93
What condition?
Hallux Valgus
94
Which condition can have nail fold infarcts?
**RA**
SLE, Vasculitis
95
Schobers test is used in which Spondyloarthropathy?
Ankylosing Spondylitis
96
What is Schobers test?
Used to test if theres a decrease in lumbar spine flexion
97
Test yourself with cover and recall of rheumatology booklet
Look at written notes too
98
Test yourself with cover and recall of rheumatology booklet
99
Test yourself with cover and recall of rheumatology booklet
Look at written notes too
100
Test yourself with cover and recall of rheumatology booklet
Look at written notes too
101
Test yourself with cover and recall of rheumatology booklet
Look at written notes too
102
Test yourself with cover and recall of rheumatology booklet
103
Whats Tophi?
Urate deposits (seen in e.g. pinna, tendons, joints)
104
A patient has gout. They extract synovial fluid from the affected joint, describe what the urate crystals look like?
Needle-shaped monosodium urate crystals, displaying ***negative birefringence*** under polarised light
105
What conditions lead to saddle nose?
Trauma,
Cocaine abuse,
Relapsing polychondritis,
Vasculitis (e.g. Wegener's granulomatosis)
106
Name some forms of Vasculitis
Blood vessels affected:
Large: GCA
Medium: Kawasaki disease
Small: Wegener's granulomatosis (granulomatosis with polyangiitis)
Variable vessel vasculitis: Behcet's
From research PMR is and is not considered to be a true vasculitis
107
Whats arthralgia?
Joint pain (check)
108
Some tests required for Vasculitis:
ANCA (may be positive),
CRP (raised),
ESR (raised),
Mandated urinalysis: To identify if theres kidney involvement then look for proteinuria and haematuria (sign of glomerulonephritis)
"The presentation of vasculitis will depend on the organs affected"
109
Whats the most common cause of Thoracic kyphosis in men? In women?
In men Ankylosing Spondylitis
In women Osteoporosis.
110
Give examples of Hypermobility Spectrum Disorders:
Ehlers Danlos syndrome, Marfan syndrome
111
Whats Beighton Score
Beighton score is a popular screening technique for hypermobility
112
Dupuytren's contracture causes
Diabetes mellitus, Alcoholic liver disease, trauma, anti epilepsy drugs (e.g. Phenytoin)
