Rheumat Ortho

Question 1

CYP3A4 inhibitors 4 examples

Answer 1

Erythromycin
Clarithromycin
Ketoconazole
Itraconazole

Question 2

P glycoprotein inhibitors

Answer 2

Amiodarone
Clarythromycin
Verapamil
Ciclosporin

Question 3

Kanavel sign
1.seen in
2.what are those?

Answer 3

Seen in infectious tenosynovitis
1.pain on passive extension of fingers
2.fusiform swelling of whole finger
3.tenderness
4.flexed resting position of finger

Question 4

Treatment of gout

Answer 4

1.NSAIDS -indomethacin or naproxen
If not available,
Colchicine 1.2mg stat f/b 0.6 mg after 6 hrs f/b 0.6 mg twice or thrice daily for 2 to 3 days
Given reduced dose if gfr less than 50ml/173m2 or in those taking cyl3a4 inh or p glycoprotein inh. Not given if gfr is less than 30
2.calecoxib ia given off -label if other nsaids C/I d/t gastric ulcer or intestinal bleeding or gastritis
3. If nsaids not working give iv or intralesional prednisolone
0.5 mg/kg given over 5-10 days. Tapered and stopped

Aspirin reduces urate excretion. So C/I
Allopurinol given as prophylaxis in high uric acid. Not given in acute setting. Dont change dose during acute flare up.

Question 5

Neonatal lupus erythomatosis casued by which all antibodies?

Answer 5

1. Anti-Ro( SSA) (m.imp >95%)
   2.Anti-La(SSB)
   3.U1-ribonucleoprotein (rare)

Anti- Cardiolipin and anti smith dont cause NLE

Question 6

Most common manifestation of NLE neonatal lupus?

Answer 6

> 65% has cardiac
Conduction and rhythm abnormality leading to congestive HF
Usually complete heart block 15-30% mostly in 18th-20 week of gestation
Seen mlre in child of mother with sjogrens than SLE

Question 7

SLE criteria

Answer 7

4 out of 11:

1.acute or subacute cutaneous lupus
2.chronic cutaneous lupus
3.scareing alopecia
4.mouth or nose ulcers
5.synovitis (2 or more joints)
6.serositis(pericarditis, pleuritis)
7.renal involvement
8.CNS involvement
9.hemolytic anemia
10. Leukopenia (<400) or lymphopenia(<1000)
11.thrombocytopenia(<1 lakh)

Lab
1.positive ANA (acute or subacute)
2.anti dsDNA(chronic cutaneous)
3.anti smith(oral or nose ulcers)
4.low complement(C3,C4.CH50) : non scarring alopecia
5.Positive direct cooms test(synovitis)
6.Anti phospholipid antibody(serositis)

Question 8

SLE management

Answer 8

1. Hydroxychloroquine
   2.steroids

For severe lupus( the ones except cutaneous, serositis, tenovitis)
Steroid sparing agents
HCQ
Cyclophosphamide
Mycophenolate
Methotrexate