Rheum Flashcards
(79 cards)
1
Q
Important side effects of Rituximab
A
thrombocytopenia
peripheral neuropathy
2
Q
Maintenance dose of methotrexate in RA
A
7.5-15mg Once weekly
3
Q
What other drug should be prescribed along methotrexate in RA
A
Folic acid 5mg OD. Omit on meth day
4
Q
side effects of methotrexate
A
mucositis mouth ulcers pulmonary fibrosis leukopenia teratogenic
5
Q
Extra-articular diseases associated with Ra, or that may present along side
A
Pulmonary fibrosis + nodules
Bronchiolitis obliterates (inflam –> small airway destruction)
Felty’s syndrome - neutropenia + splenomegaly
Anemia
nodular disease
pericarditis/pericardial effusions
6
Q
systemic symptoms of RA
A
fatigue + weight loss
pericarditis
pleurisity
recurrent soft tissue disease
7
Q
Genes associated with RA
A
HLA-DR4
hla-dr1
8
Q
Antibodies associated with RA
A
Anti-CCP Cyclic citrullinated peptide antibodies rheumatoid factor (only in 70%)
9
Q
Inx in suspected RA
A
RBC, U/E - Norm anaemia, CRP and ESR up
Antibodies - ANTI-CCP
gene testing? - HLA-DR4/1
10
Q
Urgent referral criteria for RA
A
If hands and feet involved
multiple joints
>3 months of symptoms
11
Q
First line mx of RA (exc NSAIDS)
A
Methotrexate + folic acid, leflunomide, hydroxychloroquine,
12
Q
2nd line mx of RA
A
2 of Methotrexate + folic acid, leflunomide, hydroxychloroquine
13
Q
3rd line mx of RA
A
TNF inhibitors - eternacept, adalumimab,
14
Q
4th line mx of ra
A
methotrexate + rituximab
15
Q
Side effects of leflumonide
A
peripheral neuropathy
16
Q
Side effects of hydroxychlorquine
A
visual field defects
retinopathy
17
Q
Severe complication of RA involving cervical spine
A
Atlanta-axial sublimation
Inflammation and bursitis of the joint can cause spinal cord compression.
Medical emergency
18
Q
Psoriatic arthritis signs
A
Onychosis - nail splitting from bed
Nail pitting
bone shortening - telescoping fingers
19
Q
X-ray signs in Psoriatic A
A
periosteum inflammation, ankylosis, osteolysis
pencil in cup deformity
20
Q
Management of psoriatic a
A
NSAIDs
Methotrexate + ciclosporin
Eternacept
21
Q
How should steroids be delivered in psoriatic A
A
injection into joint space only - oral steroids may worsen skin lesions
22
Q
3 other features of reactive arthritis
A
Anterior uveitis
keratoderma blenorrhagia
Circinate balantis
Bilateral aseptic conjuctivitis
23
Q
Associated diseases with and spond
A
psoriatic arthritis reactive arthritis dactylics inflammatory bowel disease enthuses (archilis) heart block restrictive lung disease apical pulmonary fibrosis anaemia
24
Q
Gene associated with ank spond
A
HLA-B27
25
inx of ank spond
FBC, U/E
CRP and ESR raised
MRI - bone marrow oedema in early disease
XRAY - bamboo spine
Schobers test - <20cm increase in distance on back = suggestive of ank spond
26
Two clinical features of anti-phospholipid syndrome
Recurrent miscarriage
| VTEs
27
What other condition has strong links to giant cell arteritis
Polymyalgia rheumatica
28
Temporal arteritis sympoms
```
jaw claudication
Unilateral headache (temporal and forehead) and scalp tenderness
Visual changes
```
29
Positive blood results in GCA
raised ESR and CRP
30
How would you approach a patient with suspected GCA
Bloods + temporal artery biopsy
Start steroids before results arrive to avoid blindness/stroke.
Mx = 40-60mg of pred. Taper off slowly (over years)
Additional meds = aspirin 75mg (stroke protection). PPI. Bisphosphonates and vit d
31
Patient presents with bilateral weak arm pulses. Hypertension. Aortic valve regard.
Where are they from and what do they have?
Japan
Takayasu's vasculitis
Affected the aorta and renal artery most commonly
32
Symptoms of limited cutaneous systemic sclerosis
```
Calcinosis
Raynauds
Eosophogeal dysmotility
scleroderma
telangiectasia
```
33
Symptoms seen in diffuse systemic sclerosis on top of crest symptoms
cardiac: hypertension. CVD
Lung: pulmonary fibrosis. Pulmonary hypertension
Kidney: glomerulonephritis and scleroderma renal crisis
34
Auto-antibodies seen in Systemic sclerosis
ANA positive in most patients
Anti-centromere in cutaneous disease
Anti-scl70 - diffuse
35
What criteria are used to base diagnose of systemic sclerosis on
ACR and the EULAR
36
Symptoms of SLE: Joints, Kidneys and skin
Arthralgia with no clinical signs of disease
Butterly erythemous rash on face - photosensitive
Nephritis
37
Symptoms of SLE specific to eyes, GI, heart, lungs, lymphatic system
```
Conjuctivitis, optic neuritis, retinopathy
Ulcers, mesenteric vasculitis
Depression psychosis
Pericarditis effusions
Exudative effusions
Lymphadenopathy, splenomegaly
```
38
What is discoid lupus erythema
raised discoid plaques on the skin
| However the autoimmune condition is limited to the skin, no other organs involved
39
Positive bloods in SLE
ESR raised but CRP normal
urea and creat raised in renal involvement
Abds - anti-dsDNA, anti-ro, anti-la
normocytic anaemia
40
What blood results would indicate a flare up of SLE
```
raised ESR
raised antibodies (dsDNA)
Reduces C3
```
41
Mx of SLE
```
Skin - topical corticosteroids
joints - NSAIDs
Flares - short course of steroids
Flares involving renal or cerebral - high dose steroids
Hydroxychloroquine in mild disease
Rituximab and Balumamab
azathioprine
```
42
```
Patient has boney pain and these blood results
ALP raised
Ca low
PO4 low
PTH raised
```
osteomalacia
43
Blood results in osteomalacia
ALP raised
Ca low
PO4 low
PTH raised
44
Pagets disease blood results
ALP raised
| Ca and PO4 normal
45
X ray signs in pagets disease
woolly skull
v shaping of long bones
osteoporosis circumsscripta
46
gold standard test in osteoporosis
```
DEXA scan
0 = better than normal
-1 > normal
-2.5 > osteopenia
-2.5 > osteoporosis
```
47
Management of osteoporosis (FRAX and DEXA)
Those at risk - women >65 men >75 - offer FRAX score.
If risk low: measure and offer lifestyle advice
If risk intermediate - DEXA
If risk high - treat
DEXA scan results: either treat or offer lifestyle advice
Treatment = bisphosphonates (alendrolic acid 10mg OD) and calciferol.
48
What drug should be used to treat vitamin D deficiency in kidney disease
Alfacalcidol
49
Pulmonary condition associated with limited cutaneous Systemic sclerosis
Pulmonary arterial hypertension
50
Pulmonary condition associated with diffuse Systemic sclerosis
Interstitial lung disease
51
Antibodies in both types of systemic sclerosis
ANA positive
Anti-centromere in limited cutaneous
Anti-scl70 in diffuse
52
Diagnostic criteria/tool for ss
ACR and the EULAR
53
Management of ss
```
steroids and immunosuppressants
non-medical management
stop smoking
physio
emollients
```
54
57yo women presents with unilateral headache + scalp tenderness
1) Possible diagnosis
2) inx and results
3) Management and dosages
4) Severe complication
5) Associated rheum condition
1) Temporal arteritis
2) Raised ESR and CRP. Temporal artery biopsy would be diagnostic
3) Aspiriin 75mg. Pred 40mg (60mg if jaw claudication or vision changes)
4) Blindness
5) polymyalgia rheumatica
55
Japanese women has weak pulses and malignant hypertension
1) diagnosis
2) cause of hypertension
1) Takayasu's arteritis
| 2) renal artery stenosis causes RAAS.
56
mx of antiphospholipid syndrome
long term warfarin
| preggers --> LMWH + aspirin ?75mg
57
Definition of bachets disease
inflammatory condition - recurrent oral and genital ulcers
58
1) Skin signs in Bachets
2) MSK signs in bachets
3) GI
4) CNS
1) erythema nodosum, papules and pustules, vasculitis.
2) Arthalgia. morning stiffness. Oligoarthritis
3) Inflammation, ulceration
4) Memory decline, headaches, migranes, aseptic meningitis, mengioencephalitis
59
Management of bachets disease
topical steroids for mouth.
Systemic prednisolone
anaesthetic cream for genitals
cochicine nsaids
60
Key features of pagets disease
Disease of bone turnover
| On x-ray areas of osteolysis and areas of high densitiy (sclerosis)
61
X ray signs of pagets
osteoporosis circumscripta
cotton wool appearance of skull
v-shaped defects in long bone
62
Management of pagets disease
bisphosphonates
63
Key blood results seen in pagets disease
Raised ALP.
| Normal Ca and Normal Phosphate
64
1) Two possible causes for a patient with bilateral shoulder and pelvic girdle pain.
2) Which of the above is more likely to affect white women over the age of 50.
3) what percentage of these patients will suffer GCA as well?
1) Polymyalgia rheumatica and Polymyositis.
2) PR
3) 10%
65
1) Inx in patients with Polymyalgia rheumatica
| 2) Management of PR
1) Raised ESR, Raised CRP. Raised plasma viscosity.
LFTs. U&Es. FBC. Ca, TSH and CK to rule out other possible causes.
2) Prednisolone 2 year dose reducing cause.
66
HLA-B27 associated diseases and symptoms
Reactive arthritis
IBD - associated
Psoriatic
Ank Spon
Dactylitis, psoriasis, inflammatory back pain, improves with nsaids, enthesis, anterior uveitis, HLA-B27.
67
Test for spinal mobility in ank spon
Schöber test. Lumber sine length increases by 5cm in full flexion at the L5 level.
68
X ray signs in ank spond
Ossification of ligaments
Syndesmophytes
erosion and sclerosis
bamboo spine
69
Management of of all seronegative spondyloarthropathies
patient education, physiotherapy and stop smoking.
Methotrexate, luflunomide, sulfalazine.
Infliximab
Adalimumab
70
1) Infections that cause reactive arthritis
2) STI that cause septic arthritis
3) 3 associated symptoms with RA
3) Management and inx of reactive arthritis
1) Chlamydia. Gastroenteritis
2) Gonococcal septic arthritis
3) Ant uveitis. Circinate balantitis. Bilateral aseptic conjunctivitis.
3) Joint aspiration and cultures to rule out septic arthritis. Manage with NSAIDs
71
1) Patient demographic affected by GCA and related condition
2) 3 presenting symptoms for GCA
1) Old people >50 Polymyalgia Rheumatica
| 2) Jaw claudication. scalp tenderness, frontal headache
72
1) 4 small vessel vasculitis' - which ones are ANCA positive.
2) Differential for the three ANCA + diseases
3) General management of ANCA + small vessel vascultis
1) HSP, Eosinophilic GPA. GPA and microscopic polyangitis
2) EGPA - raised eosinophiles on blood count.
GPA - granulomas present (not seen on mPA)
3) Prednisolone, cyclophosphamide, rituximab.
73
Symptoms common in all anca + small vessel vasculitis
ENT - sinusitis. Rinorrhoea.
Pulmonary - fibrosis, effusions
Heart - pericarditis
renal - nephritic picture
74
Pathology of HSP
IgA nephropathy.
Affects children mostly
Causes nephritic syndrome
75
Presentation of HSP
haematuria
purpuric rash
joint pain and abdo pain may also be present
76
Antibodies in
1) Limited systemic sclerosis
2) Diffuse systemic sclerosis
1) Anti-centromere
| 2) Anti - scl70
77
Antibodies in
1) Polymyositis
2) Dermatomyositis
1) Anti-Jo 1
| 2) Anti-Mi 2 and ANA
78
1) Inx for polymyositis and dermatomyositis
2) Lesions seen on back of hands in dermatomyositis
3) Where is the pain commonly located in the above disease. what other disease shares this presentation
4) Facial symptoms/sign in above disease.
1) Creatinine kinase will be raised
2) Gattrons lesions (rash on knuckles)
3) Shoulder and pelvic girdle - polymyalgia rheumatica
4) Peri-orbital oedema
79
X ray signs in AS
Subchondral sclerosis
Syndesmophytes
Ossification of ligaments
Fusion of the facet at sciatic/lumbar
