Rheumatology 1 Flashcards by H JP

ANCA are associated with which type of disease?
Give three examples

Small vessel vasculitis
1. Granulomatosis with polyangitis (Wegener’s)
2. Eosinophilic granulomatosis with polyangitis (Churg-Strauss)
3. Microscopic polyangitis

How well did you know this?

Not at all

Perfectly

Type of ANCA
Granulomatosis with polyangitis/ Wegener’s?

cANCA

How well did you know this?

Not at all

Perfectly

Type of ANCA
Eosinophillic granulomatosis/ Churg Strauss?

pANCA

How well did you know this?

Not at all

Perfectly

Type of ANCA
Microscopic polyangitis?

pANCA

How well did you know this?

Not at all

Perfectly

Other pANCA conditions (4)

UC (70%)
PSC (70%)
AntiGBM (25%)
Crohn’s (20%)

How well did you know this?

Not at all

Perfectly

Ankylosing spondylitis HLA

HLA B27

How well did you know this?

Not at all

Perfectly

What is Schober’s test?

a line is drawn 10 cm above and 5 cm below the back dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible

How well did you know this?

Not at all

Perfectly

Features of ank spond (7)

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
Cauda equina

How well did you know this?

Not at all

Perfectly

Ank spond O/E: (3)

Reduced lateral flexion, forward flexion, chest expansion

How well did you know this?

Not at all

Perfectly

Ank spond Ix of choice
If negative then which Ix

Plan XR - sacroiliac joints
MR

How well did you know this?

Not at all

Perfectly

Findings on sacroiliac joint (4) and CXR (1) for ank spond
MR findings (1)

Bamboo spine
Sacroilitis
Subchondral erosions
Syndesmophytes

Apical fibrosis

Bone marrow oedema

How well did you know this?

Not at all

Perfectly

Ank spond Mx (4)

Exercise e.g swimming
NSAIDs
Physio
DMARDS if peripheral joint involvement

How well did you know this?

Not at all

Perfectly

Features of antiphospholipid syndrome (5)

Recurrent fetal loss
Recurret VTE/ arterial thrombosis
Thrombocytopenia
Prolonged APTT
Livedo reticularis (mottled skin)

How well did you know this?

Not at all

Perfectly

Antiphospholipid syndrome is associated with which condition?

SLE

How well did you know this?

Not at all

Perfectly

Antiphospholipid syndrome Mx
Primary thromboprophylaxis
Secondary
INR range
Recurrent VTE mx (2)

Primary thromboprophylaxis: Low dose aspirin
Secondary thromboprophylaxis:
Initial VTE or aterial: warfarin INR 2-3
Recurrent VTE INR 3-4 + aspirin

How well did you know this?

Not at all

Perfectly

Which test should be used to check for azathioprine toxicity?

TPMT test

How well did you know this?

Not at all

Perfectly

Triad of symptoms for Behcet’s syndrome?

Oral ulcers
Genital ulcers
Anterior uveitis

How well did you know this?

Not at all

Perfectly

Behcet’s
What is it?
Ethnicity
Gender
Age
HLA

Automimmune vasculitis all sizes large, medium and small vessel
Turkish
M>F
20-40yo
HLA B51

How well did you know this?

Not at all

Perfectly

What it the pathergy test?

Puncture site following needle prick becomes inflamed with small pustule forming/ ulcer formation = test for Behcet’s

How well did you know this?

Not at all

Perfectly

Bisphosphonates counselling

‘Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet’

How well did you know this?

Not at all

Perfectly

When do you stop bisphosphonates? (3)

Stopped after 5 years if:
Patient <75yo
Femoral neck T score >2.5
Low risk FRAX

How well did you know this?

Not at all

Perfectly

Osteoporosis
Ca
Phos
ALP
PTH

Ca normal
Phos normal
ALP normal
PTH normal

How well did you know this?

Not at all

Perfectly

Osteomalacia
Ca
Phos
ALP
PTH

Study These Flashcards

Ca low
Phos low
ALP normal
PTH normal

Primary hyperparathyroidism
Ca
Phos
ALP
PTH

Study These Flashcards

Ca high
Phos low
ALP high
PTH high

Secondary hyperparathyroidism (CKD) Ca Phos ALP PTH

Ca low Phos high ALP high PTH high

Paget's Ca Phos ALP PTH

Ca normal Phos normal ALP high PTH normal

Osteopetrosis Ca Phos ALP PTH

Ca normal Phos normal ALP normal PTH normal

XR double bubble/ soap bubble appearance is keeping with which benign tumour? What age group? Where does it commonly occur?

Giant cell tumour 20-40yo Epiphyses of long bones

Where does an osteoma commonly occur? Associated with which syndrome?

Skull Gardner's syndrome (variant of familial adenomatous polyposis)

What is the most common benign bone tumour? Gender Age

Osteochondroma -cartilage-capped bony projection on the external surface of a bone M>F Age <20yo

What is the most common primary malignant bone tumour? Where does it occur? Age range

Osteosarcoma Long bones - femur, tibia, humerus Children and adolesents

Osteosarcoma is associated which conditions (2)?

Retinoblastoma Paget's disease of the bone

What is the Codman triangle? Seen in which condition?

XR finding seen in osteosarcoma Sunburst appearance

Which type of bone malignancy would you see an onion skin appearance on XR?

Ewing's sarcoma

Which malignant bone tumour is most common in middle aged?

Chondrosarcoma (Malignant tumour of cartilage)

CFS Mx (5)

1. CBT 2. Graded exercise 3. Pacing 4. Low dose amitriptyline 5. Pain management clinic

Causes of dactylitis (6)

Psoariatic arthritis Reactive arthritis Sickle cell TB Sarcoidosis Syphillis

How often is denosumab given for treatment of osteoporosis?

SC 60mg every 6 months

Mx of osteoporosis (2)

1. Bisphosphonates - alendronate if not tolerated then alternative risedronate or etidronate 2. Raloxifene

What is dermatomyositis?

Inflammatory disorder causing symmetrical proximal muscle weakness and skin lesions Usually an underlying malignancy

What are Gottron's papules? Which condition are they found in?

Dermatomyositis Roughened red papules over extensor surfaces of fingers

Name five skin features of dermatomyositis

Macular papular rash across chest and back Heliotrope rash in periorbital region Gottron's papules Dry and scaly hands Photosensitivity

Dermatomyositis auto-antibody positive (3) 80% 30% 30%

ANA (80%) anti-Jo1 anti Mi-2 (30%)

Discoid lupus Gender Does it progress to SLE? Characterised by?

F>M Rarely progresses to SLE Follicular keratin plugs

Discoid lupus is commonly found where? Describe the lesion Healing lesions can cause?

Face, scalp, ears, neck Erythematous, raised rash, scaly Scarring alopecia and pigmentation

Discoid lupus Mx (3)

1. Topical steroid cream 2. Anti-malarials e.g hydroxychloroquine 3. Avoid sun exposure

Ehler Danlos AD or AR Affects which type of collagen? Associated with which conditions? (4)

AD Type III Aortic regurg, MV prolapse, aortic dissection, SAH

What drugs can cause drug induced lupus? (3)

Hydralazine Isoniazid Phenytoin

Mx fibromyalgia (3) Name three medications that can be used

Explanation Aerobic exercise CBT Pregabalin, duloxetine, amitriptyline

Gout synovial fluid analysis When do you check urate levels?

Negatively birefringent crystals 2 weeks after the acute attack

Gout radiological findings (5)

Joint effusion Punched out erosions Eccentric erosions Soft tissue tophi Preservation of joint space

Gout mx Acute (3) What should happen to allopurinol?

1. NSAIDs/ colchicine - until D2 post symptoms have resolved +/- PPI 2. Pred 15mg OD/ intra-articular steroid Continue allopurinol

When should you offer ULT? (urate lowering therapy e.g allopurinol) (5)

=>2 attacks in last year Tophi Renal disease Uric acid renal stones As prophylaxis if on diuretics or cytotoxics

How should allopurinol be titrated? What should you give with allopurinol?

100mg OD, up titrated every few weeks until serum uric acid <300 Colchine cover or NSAIDs --> may need to be continued for 6 months

What can you give if allopurinol is not tolerated?

Febuxostat (xanthine oxidase inhibitor)

Which drug can cause gout?

Thiazide diuretics

Rheumatology 1 Flashcards

(56 cards)