Rheum Flashcards
(127 cards)
1
Q
Earliest radiological finding in ank spon?
A
Bone marrow oedema
2
Q
XR findings in ank spon?
A
Subchondral erosions
Sclerosis
Squaring of vertebrae
Syndesmophytes
3
Q
Early XR finding in RA?
A
Juxta-articular osteopaenia
4
Q
DIP swelling and dactylitis?
A
Psoriatic arthritis
5
Q
XR findings in RA
A
Marginal erosions, soft tissue swelling and periarticular osteoporosis/erosions,
Joint-subluxation is late
6
Q
Most common secondary cause of Raynaud’s?
A
Systemic sclerosis (scleroderma)
7
Q
Obstructive picture PFTs in RA?
A
Bronchiolitis Obliterans
8
Q
Pain on the radial side of the wrist/tenderness over the radial styloid process?
A
De Quervein’s Tensosynovitis
9
Q
Calcification of the triangular fibrocartilage?
A
Pseudogout (often flares with infection)
10
Q
Swelling at the DIP joints (Heberden’s nodes)?
A
OA
11
Q
Can anti-TNF alpha drugs slow radiological progression in ank spon?
A
No (contrary to their effects in RA)
12
Q
Can’t see/pee/bend the knee?
A
Reactive arthritis
13
Q
Waxy yellow rash on the feet in an arthritis?
A
Keratoderma blenorrhagica - i.e. reactive arthritis
14
Q
DMARDs safe in pregnancy
A
Sulfasalazine
Hydrochloroquine
15
Q
False positive VDRL test?
A
Antiphospholipid syndrome
16
Q
Paradoxicallly high APTT and low plateletes? (+/- emobuls) Rheum disease assoc?
A
Antiphospholipid, SLE
17
Q
Homogenous ANA staining?
A
SLE
18
Q
Speckled ANA staining?
A
MCTD
19
Q
Nucleolar ANA staining?
A
Scleroderma
20
Q
Centromere ANA staining?
A
Limited (central) systemic sclerosis, incl. CREST syndrome
21
Q
RA with +ve ANA?
A
Felty’s or Sjorgrens
22
Q
ANA against anti-dsDNA?
A
SLE
23
Q
ANA against anti-ssDNA?
A
Drug-induced lupus
24
Q
Anti-Ro
A
Sjogrens/congenital lupus/neonatal lupus syndrome
25
Anti-La
Primary sjogrens
26
Anti-Jo1
Polymyositis
27
Anti-Sm
SLE
28
Anti-RNP
MCTD
29
Anti-Scl70
Progressive systemic sclerosis
30
Treatment in antiphospholipid syndrome?
Primary prevention is low dose aspirin
Secondary prevention is life long warfarin INR 2-3 for first venous or arterial thrombus
Warfarin INR 3-4 for second thrombus/recurrence
31
Most sensitive vs most specific autoantibodies in SLE
ANA 99% sensitive
Anti-Sm, Anti-dsDNA 90% specific
32
Which complement levels low in SLE?
C4 (and C3)
33
3 culprit drugs in drug-induced lupus?
Hydralazine
Isoniazid
Procainamide
34
SLE - which hypersensitivity reaction?
Type III
35
HLA assoc in SLE?
HLA B8, DR2, DR3
36
Mainstay of treatment in SLE?
Hydroxychloroquine
37
Commonest form of lupus nephritis? Treatment?
Class IV - diffuse proliferative glomerulonephritis
Treat the HTN
Steroids + MMF OR cyclophosphamide
38
Skin findings in dermatomyositis?
Heliotrope rash around the eyes
Gottron's papules (scaly papules over MCP/PIP)
Mechanic's hands
39
Autoantibodies in dermatomyositis/polymtositis?
Anti-Jo1
ANA
Anti-Mi-2
40
Classes of systemic sclerosis?
Limited scleroderma with systemic involvement (includes CREST)
Diffuse scleroderma with limited involvement
Scleroderma without internal organ disease
41
Worst prognosis of the systemic sclerosis patterns?
Diffuse scleroderma with limited involvement
42
Autoantibody particularly assoc with diffuse scleroderma with limited involvement?
Anti-Scl-70
43
Autoantibody particularly assoc with limited scleroderma with systemic involvement?
Anti-centromere
44
Features of CREST syndrome?
Calcinosis
Raynauds
oEsophageal dysmotility
Sclerodactyly
Telangectasia
45
anti-RNP mnemonic
which condition?
R Raynoud
N swollen hands with No synovitis
P Pain in muscle and joints
Mixed connective tissue
46
Most likely organism in reactive arthritis aspirate?
None!
47
TNF primarily secreted by?
Macrophages
48
Second line for saliva lack in Sjogrens?
pilocarpine
49
Most likely organism in septic arthritis/discitis?
S aureus
50
Reactive arthritis HLA association?
HLA-B27
51
Azathioprine mechanism of action?
Inhibits purine synthesis
52
Antibiotic contraindicated with MTX?
Trimethoprim (or co-trim)
53
MMF mechanism?
Inosine-5'-monophosphate dehydrogenase inhibitor
54
Co-allergy with sulfasalazine?
Aspirin
55
Proximal myopathy in combination with mechanic hands?
Anti-synthetase syndrome
56
First and second-line Rx in primary Raynaud's?
1st: CCB - nifedipine
2nd: IV prostacyclin (epoprostenol) infusions:
57
Familial Mediterranean Fever features?
Attacks typically last 1-3 days
pyrexia
abdominal pain (due to peritonitis)
pleurisy
pericarditis
arthritis
erysipeloid rash on lower limbs
58
Familial Mediterranean Fever mode of inheritance
AR
59
Familial Mediterranean Fever who does it affect?
Turkish and Armenian
60
MTX mechanism?
Inhibition of dihydrofolate reductase
61
Dermatomyositis - most common and most specific?
Most common - ANA
Most specific - Anti-Mi-2
62
'Second-wind' phenomenon distal muscle cramping following exercise?
McArdle's disease
63
Tenderness over the radio-styloid process?
De Quervein's Tensosynovitis
64
Oral ulcers, genital ulcers, anterior uveitis?
Bechets
65
Bechets HLA association?
HLA B51
66
Marfans - defect in what?
Fibrillin-1
67
Alendronate most common side effect?
Dyspepsia (numerous oesophageal problems can occur)
68
Percentage of psoriasis patients who develop arthropathy?
10-20%
69
Large vessel vasculitidies?
GCA/temporal arteritis
Takayasus
70
Medium vessel vasculitidies?
PAN
Kawasaki
71
ANCA vasculitides?
Micro polyang.
Gran. with polyang. (Wegner's)
Eosin. gran. with polyang. (Churg-Strauss)
72
Drug unmasking Churg-Strauss?
Montelukast
73
Most common opthalmic pathology in GCA?
Anterior ischaemic optic neuropathy
74
GCA/PMR association?
50% GCA patients have PMR
15% PRM patients develop GCA
75
Systemic illness with claudication/absent pulses/bruits?
Takayasu (large vessel)
76
cANCA directed against what?
anti-PR3
77
pANCA directed against what?
anti-MPO
78
Type of ANCA in gran. with polyang?
cANCA (c comes first)
79
Type of ANCA in eosin. gran. with polyang?
pANCA (p comes second)
80
PAN assoc with?
Hep B
81
Livedo retiularis and mononeuritis multiplex, gen unwell?
PAN
82
As well as ear problems, may present with nasal chondritis, respiratory tract involvement and arthralgia?
Relapsing polychondritis - repeated attacks and degradation on/of cartilage
83
Treatment for uncomplicated vs complicated GCA?
Uncomplicated - oral pred
Complicated - IV methylpred
84
Marfan mode of inheritance?
AD
85
Cystals in pseudogout?
Weakly positively birefringent rhomboid-shaped crystals
86
Cystals in gout?
Negatively bifringent needle-shaped crystals
87
CK in PMR?
Normal (CRP and ESR raised)
88
Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test?
S1 lesion
89
Ottawa rules?
bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
inability to walk four weight bearing steps immediately after the injury and in the emergency department
90
Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?
Osteomalacia
91
Looser's zones on x-ray?
Osteomalacia
92
Osteogenesis imperfecta collagen type?
Type 1
93
Marfans occular manifestation?
Marfan's syndrome - upwards lens dislocation
94
RA HLA assoc?
HLA DR4 - especially BR1
95
Where is the fibrosis in asbestosis ?
LZs
96
CXR findings in asbestosis?
Reticulonodular shadowing of the lower zones
Hooneycombing
97
PFTs in asbestosis? Why?
Restrictive
It's fibrotic
98
Dust and small rounded upper zone opacities?
Coal workers pneumoconiosis
99
Breathlessness, progression and dry cough.
Eggshell calcification?
Silicosis
100
Occupational asthma mnemonic?
GIrlfriend works at a PEPSI factory and comes home with asthma symptoms every day
GF Glutaraldehyede. Flour
PEPSi :
Platinum salt
Epoxy resins
Proteiolytic enzymes
Soldering flux resins
Isocynayes
101
What is extrinsic allergic alveolitis?
(Hypersensitivity pneumonitis)
Farmers lung - mouldy hay - micropolyspora
Bird fanceris
Bagassosis - sugar cane - sacchari
Malt worker's - aspergillus clavatus
Mushroom workers lung - thermophilic actinomycetes
102
Acute breathlessness hours after dust exposure/allergen, flu like, resolve within 48 hours?
EAA
103
Fibrosis in EAA?
Upper zone
104
Diagnosis of EAA?
Clinical history
Restrictive PFTs (eventually)
Lung tissue histology - mononuclear cell infiltrate with NON-CASEATING GRANULOMAS
High WCC on BAL
Specific IgG precipitins
105
HRCT findings in EAA?
Reticular, nodular and ground-glass opacities
106
Hypersensitivity type in EAA?
Type III
107
Pulmonary eosinophilia causes?
Churg-Strauss syndrome
allergic bronchopulmonary aspergillosis (ABPA)
Loffler's syndrome
eosinophilic pneumonia
hypereosinophilic syndrome
tropical pulmonary eosinophilia
drugs: nitrofurantoin, sulphonamides
less common: Wegener's granulomatosis
NOT EAA!!!
108
Vasculitis sounding question presents with general upset plus acute abdominal pain?
PAN - can cause bowel ischaemia
109
Tramline pattern on XR?
Ank spon
110
Rash over buttocks and IgA deposition after recent viral infection?
HSP
111
Chronic fatigue treatment?
CBT
112
Blood marker in Still's?
Very high ferritin
113
Haemoptysis, saddle nose deformity, deafness?
GPA (Wegner's)
114
Renal disease in Churg strauss?
Necrotising crescentic glomerulonephritis
115
Onion peel appearance on paeds XR?
Ewings
116
Lytic lesion with sclerotic margins in the upper (e.g. tibial) metaphysis on child's XR?
Brodie's abscess
117
Soap-bubble appearance on bony film?
Osteoclastoma
118
Most likely blood abnormality in PAN?
Raised creatinine (and urea)
119
HLA for Felty's?
DRW4 (not just DR4 as in RA)
120
XR finding in osteomalacia?
Looser zone aka translucent bands aka pseudofractures
121
Swelling and tenderness of the forearms with skin induration/peau d'orange, carpal tunnel and eosinophilia?
Eosinophilic fasciitis
122
3 or 4 loose bodies in the knee, young men?
Osteochondritis dissecans
123
Burning foot pain/reduced sensation sole, severe pain on pressure applied behind the medial mal?
Tarsal tunnel syndrome - tibial nerve compression
124
First line for polymyositis?
Steroids
125
Most definitive diagnostic test for Sjogrens?
Labial gland biopsy
126
HIV positive and mentions on didanosine, gouty question. What can't you give?
Allopurinol
127
Pneumonia in an alcoholic? Previous aspiration?
Klebsiella
