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Rheumatology Flashcards

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1
Q

MOA bisphosphonates

A

inhibits bone resorption by osteoclasts

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2
Q

What is Churg Strauss syndrome?

A

small- medium vessel vasculitis

asthma + eosinophilia

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3
Q

Criteria for Churg-Strauss syndrome

4+ of…

A 
asthma
eosinophilia
paranasal sinusitis
pulmonary infiltrates
vasculitis on histology
polyneuropathy or mononeuritis multiplex
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4
Q

Features hereditary haemochromatosis

A

high iron

Diabetes
CCF 
DCM (reversible with Rx)
Cirrhosis 
Hypogonadism
Pseudogout
Bronze/ Slate grey skin (reversible)
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5
Q

Inheritance hereditary haemochromatosis

A

AR

HFE gene mutation

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6
Q

Ix hereditary haemochromatosis

A

ferritin >1000

genetic testing

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7
Q

Features of PMR

A

pelvic and shoulder muscle stiffness
(DON’T get proximal muscle pain)
fever, anorexia, weight loss

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8
Q

Ix for PMR

A

normocytic anaemia
ESR can be >50
High CRP

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9
Q

Rx for PMR

A

Prednisolone

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10
Q

Condition seen in 30% PMR patients

A

GCA

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11
Q

Features GCA

A 
Visual disturbances
Headache
Temporal tenderness
Jaw claudication 
TIAs
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12
Q

Features of PCP pneumonia

Drug that is RF for PCP

A

post exertional hypoxia
dry cough, fever, weight loss

Drug RF = anti=TNF

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13
Q

Define Raynaud’s

A

Pallor digits

Then colour change (cyanosis, erythema)

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14
Q

MOA of Raynaud’s

A

vasospasm without endothelial damage

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15
Q

Types of Raynaud’s

A

primary

secondary

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16
Q

When to suspect secondary Raynaud’s e.g. connective tissue disease

A 
Onset >30 
Painful ASYMMETRICAL episodes
ANA positive
ulcers/gangrene/ischaemia digits
abnormal nail fold capillaries
episodes last > 1 hour
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17
Q

Drug that interacts w azathioprine (purine synthesis inhibitor)

A

Allopurinol (gout)

  • xanthine oxidase inhibitor
  • xanthine oxidase breaks down azathioprine
  • Azathioprine toxicity -> pancytopenia
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18
Q

Osteomalacia Ix

A

Low Ca
Low Phos
Low Vit D
High ALP (increased osteoblast activity, released f/ bone)

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19
Q

Most likely underlying metabolic cause gout

A

decrease renal excretion urate

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20
Q

Serum urate level that increases risk of gout

A

> 7

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21
Q

SLE Ab

A

ANA

anti ds-DNA

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22
Q

anti-centromere Ab

A

limited cutaneous systemic sclerosis (CREST)

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23
Q

Anti-Scl-70

A

diffuse cutaneous systemic sclerosis

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24
Q

Anti Ro and Anti La

A

Sjogrens

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25
Anti-Jo-1
Dermatomyositis
26
Anti histone Ab
Drug-induced lupus
27
Features Takayasu's arteritis
Large vessel vasculitis | Normally young Japanese women
28
Signs/Sx Takayasu's arteritis
Limb claudication on exertion CP Systemic Sx - weight loss, fatigue, fever, myalgia
29
Artery commonly affected in Takayasu's arteritis
Branches of aorta | Commonly subclavian artery
30
Rx Takayasu's arteritis
Glucocorticoids | Methotrexate and azathioprine
31
Tocolizumab MOA and indication
anti-IL6 monoclonal Ab Moderate- severe RA and not responded to DMARD/TNF antagonist
32
Atabacept MOA
cytotoxic T cell antigen 4 (CTLA 4) homologue
33
Examples anti TNF-alpha agents
``` infliximab adalimumab etanercept golimumab certolizumab ```
34
Indications anti-TNF alpha agents
``` RA psoriatic arthritis ankylosing spondylitis Crohn's juvenile idiopathic arthritis ```
35
Rituximab MOA and indication
Anti CD-20 | RA and haem malignancies
36
Anakinra MOA and indications
anti-IL 1 Ab | RA and adult onset still's disease
37
Risk acute lymphoblastic leukaemia and treatment of disease
avascular necrosis of femoral head
38
2 drugs associated w/drug induced lupus
Hydralazine Quinidine Procainamide
39
Risk with zolendronic acid (bisphosphonate)
jaw osteonecrosis
40
RA spinal complication
Atlanto-axial subluxation
41
Low C4 and rheumatoid factor positive
Cryoglobulinaemia
42
Rx for ankylosing spondylitis
NSAIDs and PT
43
Ab causing neonatal lupus (and complete HB)
Anti Ro
44
Anti Jo1 Ab
Dermatomyositis | Polymyositis
45
First line for prevention steroid induced osteoporosis
Bisphosphonate e.g. alendronic acid
46
Blood monitoring for methotrexate dose change
Every 2 weeks for 6 weeks | Then monthly until dose + disease stable for 1 year
47
Drug induced lupus features
Lower incidence nephritis No skin involvement Anti-histone Abs
48
Drugs causing drug induced lupus
Procainamide, hydralazine , minocycline | anti-TNF agents, statins
49
Conditions associated w/ iritis
Reiter’s Behcets Psoriatic arthropathy (20%) IBD
50
Proteinuria + diarrhoea in RA. What do you Ix for? What is Ix?
Secondary (AA) amyloidosis (complication of RA) -> nephropathy Ix = Biopsy (GI/ rectum) and histology
51
Blood that suggest polymyositis rather than PMR
Raised CK
52
Rx for <65 year old on steroids if osteoporotic/have fragility fracture
Bisphosphonates
53
Rx psoriatic arthritis
DMARD
54
MOA systemic sclerosis
Increased fibroblast activity + fibrosis in different organs | Chronic AI disease
55
GI problems in systemic sclerosis (limited and diffuse cutaneous)
Malabsorption + malnutrition Anywhere from mouth to anus Due to dysmotility because of infiltration of intestinal wall w/ fibrous tissue
56
Conditions associated w/ anterior uveitis
AS, reactive arthritis, IBD, sarcoidosis, Behcets
57
Malar rash seen in
SLE, pellagra (niacin), dermatomyositis
58
What is discitis? Features?
Inflammation vertebral disc space often due to infection | Insidious onset pain, locally tender worsening on activity (NOT STIFFNESS)
59
What is spondylolisthessis
Movement of vertebra due to instability Pain worse on activity (as with OA) May be associated w nerve root compression
60
PD drugs: Selegeline MOA
MAO inhibitor | stop DA breakdown in synapse
61
Pt with PD Starts drooling Mx?
glycopyrronium
62
Levodopa for PD Normally given with which drug?
carbidopa/ benserazide (decarboxylase inhibitor) stops peripheral metabolism to DA
63
SE of levodopa
``` dyskinesia on off effect dry mouth anorexia palpitations postural drop psychosis ```
64
PD drugs bromocriptine, cabergoline, ropinirole, apomorphine MOA?
dopamine receptor agonist
65
SE of dopamine receptor agonists e.g bromocriptine, cabergoline, ropinirole, apomorphine
fibrosis | cardiac, petroperitoneal, pulmonary
66
Rx for drug - induced parkinsonism
procyclidine, benzotropine, trihexyphenidyl (benzhexol) Antimuscarinics stop tremor + rigidity block cholinergic receptors

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