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Medicine Finals: HARD STUFF ONLY > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Which antibody is associated with diffuse systemic sclerosis?

A

Anti-Scl-70

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2
Q

Which antibody is associated with limited systemic sclerosis?

A

Anti-centromere

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3
Q

Which antibody is associated with Polymyositis?

A

Anti-Jo-1

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4
Q

Which antibody is associated with Dermatomyositis?

A

Anti-Mi-2

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5
Q

What x-ray signs are seen in rheumatoid arthritis?

A

LESS

Loss of joint space
Periarticular erosions
Sublaxation
Soft tissue swelliing

Also: Juxta-articular osteoporosis

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6
Q

What are extra-articular features of ankylosing spondylitis?

A 
Chest pain due to costrochondritis
Anterior uveitis
Plantar fasciitis
Inflammatory bowel disease
Pulmonary fibrosis
Achilles tendonitis
Amyloidosis
Aortic regurgitation
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7
Q

What are complications of SLE?

A 
Pericarditis/Myocarditis
Pulmonary fibrosis
CVD
Antiphospholpid syndrome
Anaemia
Lupus nephritis
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8
Q

How does Dermatomyositis present?

A

Weakness of shoulders and pelvic girdle

Gottron lesions, Photosensitive rash on back/shoulders/neck, periorbital oedema, purple rash around eyes

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9
Q

What is seen on XR in pseudo gout?

A

Chondrocalcinosis

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10
Q

How can you interpret a T score?

A

-1 to -2.5 = Osteopenia

Less than -2.5 = Osteoporosis

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11
Q

What are dermatological features of SLE?

A

Livedo reticularis
Photosensitive malar rash
Lichen planus

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12
Q

What is seen on CXR in ankylosing spondylitis?

A

Apical fibrosis

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13
Q

What kind of retinopathy does Hydroxychloroquine cause?

A

Bulls eye retinopathy - loss of central vision

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14
Q

Which bones are most commonly effected in Paget’s disease?

A

Skull
Spine + Pelvis
Femur + tibia

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15
Q

Which clotting marker is raised in antiphospholipid syndrome?

A

APTT

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16
Q

How does reactive arthritis present?

A

Acute monoarthritis
Cant see = Anterior uveitis, Conjuntivitis
Cant pee = balanitis
Cant climb a tree = dactylitis, Keratoderma blenorrhagica

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17
Q

What are features of SLE?

A

Arthrits/arthralgia
Myalgia
Butterfly malar rash (photosensitive)
Fatigue

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18
Q

What is discoid lupus erythematosus?

A

More in women with darker skin
Photosensitive lesions
Associated with scarring alopecia
Management= topical steroids

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19
Q

What drugs cause drug induced lupus?

A 
Hydralazine
Isoniazid
Phenytoin
Minocycline
Procainamide
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20
Q

What is seen on nailfold capillaroscopy in systemic sclerosis?

A

Avascular necrosis
Micro-haemorrhages
Abnormal capillaries

21
Q

What antibodies are raised in antiphospholipid syndrome?

A

Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein 1 antibodies

22
Q

How does Behcet’s disease present?

A

MAIN TRIAD OF

1) Recurrent oral ulcers
2) Recurrent genital ulcers
3) Recurrent anterior uveitis

Also:
Erythema nodosum
Morning stiffness + arthralgia
DVT, thrombophlebitis
Abdo pain, diarrhoea
23
Q

What is polyarteritis nodosa?

A

Medium vessel vasculitis

Fever, malaise, arthralgia
Mononeuritis multiplex 
Livedo reticularis
Haematuria
Renal failure
Necrotic ulcers
24
Q

What abnormal blood results are present in temporal atertis?

A

Raised ESR+CRP
Raised ALP
Normocytic anaemia
Raised platelets

25
Q

Which autoantibodies are present in Sjorgen’s syndrome?

A

Anti-Ro and Anti-La

26
Q

What are features of Marfan’s syndrome?

A 
Tall stature
High arched palate
Pectus excavatum
Pes planus
Scoliosis
Dilation of aortic sinuses —> Mitral regurg, aortic regurg, aortic dissection
Upwards lens dislocation
Repeated pneumothoraces
Dural ectasia (ballooning of the dural sac)
27
Q

What are features of Ehler-Danlos syndrome?

A 
Hypermobility
Stretchy elastic fragile skin
Easy bruising
Aortic regurg
Mitral valve prolapse
Aortic dissection
SAH
28
Q

What is Adult Still’s disease? How is it managed?

A 
Arthralgia
Raised serum ferritin
Salmon pink rash
Pyrexia
Lymphadenopathy

Management = NSAIDs

29
Q

What are examples of large vessel vasculitis?

A

Temporal arteritis

Takayasu’s arteritis

30
Q

What are examples of medium vessel vasculitis?

A

Polyarteritis nodosa

Kawasaki disease

31
Q

What are examples of a small vessel vasculitis?

A

ANCA associated - GPA, eGPA

Immune mediated - HSP, Anti-GBM

32
Q

How can you differentiate between polymyositis and polymyalgia rheumatica clinically?

A

Polymyalgia rheumatica = NO WEAKNESS

Polymyositis = WEAKNESS

33
Q

What to do if someone with polymyalgia rheumatic does not respond to steroids?

A

Consider alternative diagnosis - Polymyalgia rheumatica should respond really well to steroids

34
Q

When are bisphosphonates CI?

A

CKD 4 or 5

35
Q

What is an alternative to bisphosphonates if they are CI?

A

Denosumab - needs to be started in secondary care

36
Q

What is second line in someone who cannot tolerate the side effects of oral alendronate?

A

IV Risedronate

37
Q

What is seen on skull x-ray in Paget’s disease?

A 
Thickened vault
Osteoporosis circumscripta (Cotton-wool appearance)
38
Q

Which things are associated with HLA-b27?

A

Reactive arthritis
Ankylosing spondylitis
Anterior uveitis

39
Q

What EARLY x-ray findings are seen in RA?

A
  • loss of joint space
  • juxta-articular osteoporosis
  • soft-tissue swelling
40
Q

What LATE x-ray findings are seen in RA?

A
  • periarticular erosions

* subluxation

41
Q

What are poor prognostic features of RA?

A
  • rheumatoid factor positive
  • anti-CCP antibodies
  • poor functional status at presentation
  • X-ray: early erosions (e.g. after < 2 years)
  • extra articular features e.g. nodules
  • HLA DR4
  • insidious onset
42
Q

What does the joint aspirate in RA show?

A

Yellow cloudy fluid

high WCC

43
Q

What is Z score adjusted for?

A

Age, gender, ethnicity

44
Q

How to start allopurinol?

A

Always start allopurinol with either colchicine or NSAID for up to 6 months

45
Q

How is an acute flare of RA managed?

A

IM Methylprednisolone

46
Q

What shape are the crystals in gout and pseudo gout?

A 
Gout = rhomboid shaped
Pseudogout = needle shaped
47
Q

How do you manage a first episode of RA?

A

Methotrexate + short bridging course of oral prednisolone

48
Q

What are complications of Paget’s disease?

A 
Deafness
Bone sarcoma
Fractures
Skull thickening
High-output cardiac failure

Medicine Finals: HARD STUFF ONLY (23 decks)

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