Rheum/MSK Flashcards
(111 cards)
1
Q
HLA B27 associated with 3 conditions:
A
Ankylosing spondylitis
reactive arthritis
Enteropathic arthritis
2
Q
HLA-DR3 associated with 2 conditions
A
Sjogren’s syndrome and SLE
3
Q
Causes of Joint pain:
SOFTER TISSUE
A
Sepsis OA Fracture Tendon/muscle Epiphyseal Referred Tumour Ischaemia Seropositive arthritides Seronegative arthritides Urate (other crystals) Exa-articular rheumatism
4
Q
5 Seropositive arthritis:
A
RA, SLE, Scleroderma, Dermatomysitis, Sjogren’s
5
Q
4 Seronegative arthritis:
A
Ankylosing Spondylitis (Symm), Enteropathic arthritis (Symm), Reactive arthritis (ReA), psoriatic arthritis (PsA)
6
Q
2 handfindings on OA:
A
thumb squaring
herbeden’s nodes (DIP)
Bouchards nodes (PID)
7
Q
LOSS XRAY finding in OA:
A
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
8
Q
Symmetrical arthritis affecting the small joints. Morning stiffness
A
Rheumatoid arthritis
9
Q
Rash, Photosensitivity, arthritis, CNS, GN, Raynaud’s phenomonen
A
SLE
10
Q
Signs of Scleroderma?
A
CREST: Calcinosis Raynaud's phenomon Eosophageal Sclerodactyl (skin tightness) Telengactasia
11
Q
Heliotrope Rash (peri-orbital), Shawl sign, macular oedema over chest and shoulder, Proximal muscle weakness
A
Dermatomyositis
12
Q
CCB also increases _________ levels, possibly by a renal vasodilatory effect
A
uric acid
13
Q
Side effects include liver cirrhosis, pneumonitis and myelosuppression
A
Methotrexate
14
Q
Side effects include rashes, oligospermia, heinz body enzyme, interstital lung disease
A
Sulfasalazine
15
Q
Side effects include retiniopathy, corneal deposits
A
Hydroxychloroquine
16
Q
Side effects include Cushingoid features, Osteoporosis, Impaired glucose tolerance, hypertension, cataracts
A
Prednisolone
17
Q
Side effects of Gold treatment
A
proteinuria
18
Q
Side effects include Proteinuria and exacerbation of MG
A
Penicillamine
19
Q
Reactivation of TB can occur with _______
A
BIological agents
20
Q
NSAIDs cause _______ in asthmatics
A
Bronchospasma
21
Q
Reactive arthritis (With Reiter’s arthritis) which is associated with ____, ____ and also ____
A
Chlamydia, gonorrhea and Gastroenteritis
22
Q
Reactive arthritis is a HLAB27 Sero____ spondyloarthropathy.
A
Seronegative
23
Q
Reactive arthritis typically develops within _______ weeks of initial infection and lasts around _______. Arthritis is typically an assymetrical/symmetrical oligo/polyarthritis. Also associated with ______
A
Reactive arthritis typically develops within 4 weeks of initial infection and lasts around 4-6months. Arthritis is typically an assymetrical oligoarthritis. Also associated with dactylitis
24
Q
The combination of ______, ______ and _____ points to a diagnosis of psoriatic arthropathy
A
The combination of nail changes, skin changes and arthritis points to a diagnosis of psoriatic arthropathy
25
Does Psoriatic arthritis affect DIP or PIP?
DIP rather than PIP and MCP.
26
X-ray findings of Rheumatoid arthritis (LESS):
Los of joint space
Erosions
Soft tissue swelling
Soft bones - osteopenia
27
Xray findings of osteoarthritis (LOSS):
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
28
6 A's with Ankylosing spondylitis?
And one weird one but like totally related to back!
```
Apical Fibrosis
Anterior Uveitis
Aortic regurgitation
Archilles Tendonitis
AV Node block
Amyloidosis
```
and cauda equina
29
Patient with Ankylosing spondylitis present with reduced _____ and _____ flexion. Aswell as reduced chest expansion
Reduced lateral and forward flexion
30
Bamboo spine on XRAY
Ankylosing spondylitis
31
Typically a young man who presents with lower back pain and stiffness of insidious onset. Pain typically worse at night and stiffness in the morning that improves with exercise.
Ankylosing Spondylitis
32
Methotrexate, Sulfasaline, Leflunomide and Hydroxychloroquinone are all examples of _____
DMARDs
33
The current indication for a TNF-inhibitor is an inadequate response to ....
at least two DMARDs including methotrexate
34
anti-CD20 monoclonal antibody, results in B-cell depletion
Rituximab
35
anti-CD20 monoclonal antibody, results in B-cell depletion
Infliximab
36
To differentiate between polymyalgia rheumatica and statin-induced myopathy, _____ is usually measured
ESR
37
Histology shows vasculitis with giant cells, characteristically 'skips' certain sections of affected artery whilst damaging others - overlaps with temporal arteritis
Polymyalgia Rheumatica
38
Muscle bed arteries affected most in ________
polymyalgia rheumatica
39
Typically affecting > 60 yo, Usually rapid onset (less then one month, aching, morning stiffness in proximal limb muscles). Also get polyarthlagia
Polymyalgia Rheumatic
40
In Polymyalgia Rheumatica you get reduced CD__ T cells
CD8+ T cells
41
Multi-system vasculopathy manifested by recurrent thromboembolic events, spontaneous abortions and thrombocytopenia
Anti-Phospholipid syndrome
42
Laboratory investigations for APLA?
Lupus anticoagulant, Anti-cardiolipin Ab, Anti-b2 glycoprotein Ab
43
Mx of APLA? (Thrombosis, Recurrent Fetal loss and catastrophic APS)
Mx:
Thrombosis - life-long anti-coagulation with warfarin (target INR 2.0 - 3.0)
Recurrent fetal loss: heparin or LMWH +/- aspirin in pregnancy
Catastrophic APS
44
A non-inflammatory autoimmune disorder characterized by widespread small vessel vasculopathy and brosis
Scleroderma
45
Scleroderma: CREST syndrome:
Calcinosis: Calcium deposits on skin
Raynauds Phenomenon
Eosophageal dysfunction - acid reflux
Sclerodactyl: tightening of the skin on digits
Telengiectasia: superficial dilated blood vessels
46
```
Idiopathic vasculopathy (not vasculitis) leading to atrophy and fibrosis of tissues.
Intimal proliferation and media mucinus degeneration --> progressive obliteration of vessel lumeng --> fibrotic tissue
```
Scleroderma
47
Scleroderma can be __1__ or __2___. In 1 there is ____________ and affects. in 2 it is either Limited systemic (CREST) or diffuse systemic.
1. Localised or 2. Systemic
| In localised there is non involvement of internal organs
48
In Scleroderma, ______ is the most common cause of morbidity and mortality.
Lung disease
49
What bloodwork would you do for Scleroderma?
Anti-topoisomerase 1/anti-Scl-70: specific nut not sensitive for diffuse systemic sclerosis.
Anti-centromere: favours diagnosis of CREST
50
________ (blood test) favours diagnosis of CREST
Anto-centromere
51
What investigations would you order for scleroderma?
```
Blood work (FBE, Cr, ANA), anti-topoisomerase, antoicentromere
PFT, CXR, Echo?
```
52
Dry eyes (Keratoconjunctivitis/xerophthalmia) - foreign bod sensation, Dry Mouth (Xerostomia) - trouble swallowing and Arthritis (Small joints)
Sjogren's Syndrome
53
Inflammation secondary to pathological clotting, affects small and medium-sized vessels of distal extremities, may lead to distal claudication and gangrene, most important etiologic factor is cigarette smoking
Most common in young Asian males
Buerger's disease
54
Leukocytoclastic vasculitis, multi-system disorder presenting with ocular involvement (uveitis), recurrent oral and genital ulceration, venous thrombosis, skin and joint involvement, more common in Mediterranean and Asia, average age 30s, M>F
behcet's disease
55
Medium vessel vascultiis: (2):
Kawasaki and Polyarteritis Nodosa
56
“Pulseless disease”, unequal peripheral pulses, chronic inflammation, most often the aorta and its branches
Usually young adults of Asian descent, F>M; risk of aortic aneurysm
Takayasu's Arteritis
57
Two Large vessel vasculitides?
temporal Arteritis and takasayu's
58
c-ANCA associated small vessel vasculitis?
Granulomatosis with Polynagitis
59
50% ANCA positive - Granulomatous inflammation of vessels with hypereosinophilia, with frequent lung involvement (asthma, allergic rhinitis)
Churg-Strauss syndrome
60
Necrotizing granulomatous vasculitis of lower and upper respiratory tract + Focal segmental glomerulonephritis
Granulomatosis with Polyangiitis
61
There is an association between ______ and Polyarteritis Nodosa
Hep B surface antigen positivity
62
Consider ______ in a non-diabetic patient with mononeuritis multiplex.
Polyarteritis Nodosa
63
40 yo male, Weight loss, myalgia, Livedo Reticularis (mottled reticular pattern over skin), Neuropathy with testicular pain
Polyarteritis Nodosa
64
New onset temporal headache, with sudden, painless loss of vision and/or diplopia with tongue and jaw claudication
Temporal arteritis - needs urgent referral.
65
What are the four seronegative spndyloarthritis?
AS, Psoriatic, reactive and Enteropathic
66
Anti-CCP are present and highly specific for ____ in it's ____ stages.
RA in it's early stages
67
Anti-dsDNA is commonly seen in _____ with positive ____
SLE also with a positive ANA
68
Rheum Blood tests for SLE:
ANA - highly sensitive
RH - 20% pos
Anti-dsDNA (highly specific but not sensitive)
Anti-Smith Very specific but not that sensitive
Consider anti-Ro and Anti-La
C3, C4 are low during active disease
69
______ titres can be used for disease monitoring in SLE
Anti-dsDNA
70
Anti-Jo1 are highly associated iwth
Polymyositis and Dermatomyositis
71
How do you differentiate between Polymyositis and Polymyalgia Rheumatica?
Age group, Bloodwork?
Age - Polymyositis affects people between 40-60, PR affects peopel over 60.
Polymyositis has increased CK
72
In RA we use ______ to induce remission. And if that doesn't work you can add on either ______
Methotrexate with Folic acid. Can add on other DMARD's Hydroxychloroquine and/or Sulfalazine
73
In patients with RA, if remission hasnt been achieved by DMARDs and prednisolone you can try adding ____
Biological agents
74
How to mantain remission in RA?
Use low dose effective DMARDs?
75
It is caused by a defect in the fibrillin-1 gene on chromosome 15 and affects around 1 in 3,000 people.
Marfan's
76
T or F. Steroids do not cause osteonecrosis?
F - they do!
77
First line manage of Raynaud's ?
Nifedipine
78
For Osteoarthritis, second-line treatment is ...
Second-line treatment is oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids. A proton pump inhibitor should be co-prescribed with NSAIDs and COX-2 inhibitors. These drugs should be avoided if the patient takes aspirin
79
Side effects of Colchine?
Diarrhea, nausea, cramping, abdominal pain, and vomiting
80
A 68-year-old female presents with a two week history of intermittent headaches and lethargy. Blood tests show raised ESR
Temporal Arteritis
81
Mx of AS?
1. Exercise - swimming.
2. Paracetamol and NSAIds
2a. DMARDs only used if peripheral disease
3. Consider biologics in severe AS
82
Old man, bone pain, raised ALP
Paget's disease
83
disease of increased but uncontrolled bone turnover
Paget;s disease
84
What happens to calcium, phosphate and ALP in Paget's disease?
Elevated ALP, Normal Calcium and phosphate usually. Calcium can become raised if prolonged immbolisation
85
Complications of Paget's disease?
Deafness (cranial nerve entrapment), bone sarcome (1% affected for >10 years), Fracture, skull thickening
86
_______ can cause facial palsies, parotid enlargement, hypercalcaemia and ocular problems, as seen in this case.
Sarcoidosis
87
Erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia, hypercalcaemia, dyspnea, weight loss
Sarcoidosis
88
Which syndrome of Sarcoidosis?
| Bilateral Hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia.
Lofgren's Syndrome
89
In Mikulicz syndrome* there is enlargement of the _______ glands due to sarcoidosis, tuberculosis or lymphoma
Parotid and lacrimal gland enlargement
90
Heerfordt's syndrome (uveoparotid fever) there is_____, _____ and ____ secondary to sarcoidosis
Parotid enlargement, fever and uveitis
91
T-score:
0 --> -1 = _______
-1 --> -2.5 = _______
< -2.5 = _____
Normal, Osteopaenia, Osteoporosis
92
(paradoxically) prolonged APTT + low platelets
Phospholipid syndrome
93
______ is positive in 40% of people with RA who test negative for RF.
Anti-CCP
94
Pencil-in-cup deformity is the description given to one of the appearances on plain radiograph in______-
psoriatic arthritis
95
You review a 48-year-old woman who is taking methotrexate for rheumatoid arthritis. Concurrent prescription of which other medication should be avoided?
Trimethoprim - there is a risk of haematological toxicity
96
4 Clinical uses of bisphosphonates?
Prevention and treatment of Osteoporosis
Hypercalcaemia
Pain from Bone Metastases
Paget's diseas
97
Adverse effects with bisphosphonates:
1. Oesophageal reactions: Oesophagitis, oesophageal ulcers
2. Osteonecrosis of jaw
3. increased risk of atypucal stress fracture of proximal femoral shaft
98
Chondrocalcinosis is pathognomonic for ______
Pseudogout
99
Oral and genital ulcers - Arthritis, Skin Pathergy test to diagnose
Behcet's disease
100
Kid - with rash all over legs and butt, arthritis and abdo pain
Henoch Schonlein Purpura
101
Atopy + Eosinophilia + GN + P-Anca
Churg Strauss Syndrome
102
Headache, temporal tenderness, jaw claudication, amaurosis fugax, high ESR
Temporal Arteritis
103
Anti-CCP
RA
104
Anti-ro, Anti-LA
Sjogren's?
105
Anti-dsDNA and anti-Smith
SLE
106
C3/C4 increases/decreases as the disease progresses?
decreases
107
Anti-cardiolipin and Anti-Beta Ziploprotein
Anti-Phospholipid syndrome
108
Anti-Topiomerase 1 and Anti-Scl
Diffuse Scleroderma
109
Anti-centromere
CREST Scleroderma
110
Anti-Jo
Polymyositis
111
Anti-Mi2
Dermatomyositis
