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FLASH FINALS > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Conditions associated w/ pANCA

A

UC
PSC
Anti-GBM disease
Crohn’s disease

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2
Q

Other features of ankylosing spondylitis - the A’s

A 
Apical fibrosis 
Anterior uveitis 
Aortic regurgitation 
Achille's tendonitis 
AV node block 
Amyloidosis 
Cauda equina syndrome
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3
Q

If Ankylosing spondylitis suspicion high but no signs on X-ray what investigation should be done:

A

MRI

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4
Q

Management Ankylosing spondylitis:

A

Regular exercise encouraged
NSAIDs first line
Anti-TNF drugs given if persistently high disease activity
DMARDs

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5
Q

Anti-phospholipid syndrome blood results:

A

Paradoxical INCREASED aPTT and thrombocytopenia

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6
Q

APS is commonly associated w/ which other CTD

A

SLE

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7
Q

APS primary prophylaxis:

APS secondary prophylaxis

A

Low-dose aspirin

Lifelong WARFARIN

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8
Q

Anti-synthetase syndrome antibody:

A

Anti-Jo1

Also seen in dermatomyositis

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9
Q

Azathioprine MoA:

A

Inhibits purine synthesis

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10
Q

Azathioprine adverse effects: (4)

A

Pancreatitis
Nausea and vomiting
Bone marrow depression
Increased risk of non-melanoma skin cancer

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11
Q

Is Azathioprine safe in pregnancy?

A

YES

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12
Q

Behcet’s triad:

A

Oral ulcers
Genital ulcers
Anterior uveitis

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13
Q

Bisphosphonates MoA:

A

Inhibit osteoclasts

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14
Q

Bisphosphonates clinical uses:

A

Prevention and tx. of osteoporosis
Hypercalcaemia
Paget’s disease
Pain from bone mets

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15
Q

Bisphosphonates adverse effects:

A

Oesophageal reactions: Oesophagitis, ulcers
Osteonecrosis of jaw
Atypical stress fractures of femur

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16
Q

How should bisphosphonates be taken:

A

Taken while sitting or standing on an EMPTY stomach at least 30 minutes before breakfast or any other medication

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17
Q

What should be corrected prior to giving bisphosphonates

A

Hypocalcaemia/vitamin D deficiency

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18
Q

Benign bone tumours:

A

Osteoma
Osteochondroma
Giant cell tumour

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19
Q

Benign tumour affecting skull typically assoc. w/ Gardner’s syndrome:

A

Osteoma

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20
Q

Most common benign bone tumour:

A

Osteochondroma

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21
Q

Benign bone tumour w/ ‘double bubble’ or ‘soap bubble’ appearance:

A

Giant cell

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22
Q

Malignant bone tumours:

A

Osteosarcoma
Ewing’s sarcoma
Chrondrosarcoma

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23
Q

Most common primary malignant bone tumour:

Where is it commonly seen:

A

Osteosarcoma

Long bones

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24
Q

Malignant bone tumour w/ sunburst pattern:

A

Osteosarcoma

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25
Q

Small round blue cell tumour:

seen most frequently in:

A

Ewing’s sarcoma

Pelvis and long bones

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26
Q

Bone tumour showing ‘onion skin appearance on x-ray’

A

Ewing’s sarcoma

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27
Q

Malignant tumour of cartilage
Most commonly affects axial skeleton
Most common in middle age

A

Chrondrosarcoma

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28
Q

Mx. Chronic fatigue syndrome

A

CBT (very effective)

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29
Q

Other causes of dactylitis other than spondyloarthropathy

A

Sickle-cell disease
TB
Sarcoidosis
Syphilis

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30
Q

Drug-induced lupus which antibody is found:

A

Anti-HISTONE

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31
Q

Difference between SLE and drug-induced SLE

A

Renal and Neuro involvement unusual in drug-induced

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32
Q

Most common causes of drug-induced lupus

A

Hydralazine and procainamide

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33
Q

Describe dermatomyositis

A

An inflammatory disorder causing symmetrical proximal muscle weakness and characteristic skin lesions

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34
Q

Dermatomyositis w/out skin manifestations =

A

Polymyositis

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35
Q

Skin features of dermatomyositis: (4)

A 
Photosensitivity 
Macular rash over back and shoulder 
Heliotrope rash in peri-orbital region
Gottron's papules 
Mechanic's hands - dry and scaly hands w/ linear cracks on the palmar and lateral aspects of fingers
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36
Q

Muscle features in dermatomyositis:

A

Proximal muscle weakness

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37
Q

Cardiac problems in Ehlers-Danlos

A

Aortic regurgitation
Mitral valve prolapse
Aortic dissection

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38
Q

Urate levels in Gout:

When should these be checked:

A

May be high or normal or low during acute attacks

2 weeks after an attack

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39
Q

Radiological features of gout:

A

Joint effusions = early sign
‘Punched out’ erosions in juxta-articular distribution

NO PERIARTICULAR OSTEOPENIA in contrast to rheumatoid arthritis

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40
Q

Drug cause of gout:

A

DIURETICS - decreased excretion of uric acid

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41
Q

GOUT management:

A

NSAIDS or colchicine first line

Oral steroids considered if NSAIDs/Colchicine contraindicated

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42
Q

Urate lowering therapy:

A

Allopurinol

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43
Q

ULT: when should this be commenced:

A

After acute attack has settled down

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44
Q

Anti-hypertensive medication which may be of benefit to reduce gout in co-existent hypertension

A

LOSARTAN

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45
Q

Referred lumbar spine hip pain test:

A

Femoral stretch test - flexion of knee and hip pulls femoral nerve and will produce pain

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46
Q

HLA-DR4 conditions

A

T1DM

Rheumatoid arthritis

47
Q

HLA-DR3 conditions

A

Dermatitis herpetiformis
Sjogren’s syndrome
PBC

48
Q

HLA-DQ2/DQ8

A

Coeliac disease

49
Q

HLA-B51:

A

Behcet’s disease

50
Q

Can hydroxychloroquine be used in pregnancy:

A

YES

51
Q

Most abundant immunoglobulin in the body:

A

IgG

52
Q

Pentamer immunoglobulin

A

IgM - also first Ig produced in response to infection

53
Q

Ig which mediates type 1 hypersensitivity reaction

A

IgE

54
Q

Marfan’s syndrome cardio complications:

A

Dilation of aortic sinuses leading to aortic aneurysm
Aortic regurgitation
Aortic Dissection
Mitral valve prolapse

55
Q

Marfan’s ophthalmic complications:

A

Upward lens dislocation, blue sclera, myopia

56
Q

Marfan’s monitoring

A

Regular echocardiography

and BB/ACEi therapy

57
Q

Methotrexate adverse effects:

A 
Mucositis
Myelosuppression 
Pneumonitis 
Pulmonary fibrosis 
Liver fibrosis
58
Q

How often is Methotrexate taken:

A

Weekly rather than daily

59
Q

Methotrexate monitoring:

A

FBCs, U&Es, LFTs every 2-3 months

60
Q

What should be co-prescribed w/ Methotrexate

A

FOLIC acid 5 mg

MTX is a folic acid inhibitor

61
Q

Methotrexate: other medications to avoid while taking:

A

Trimethoprim or co-trimoxazole (marrow aplasia)

High dose aspirin increases risk of MTX toxicity secondary to reduced excretion

62
Q

Rheumatoid arthritis X-ray findings:

A

Loss of joint space
Juxta-articular osteoporosis
Peri-articular erosions
Subluxation

63
Q

OA first line medical mx.

A

Paracetamol and topical NSAIDs

64
Q

Topical NSAIDs are only indicated in OA of:

A

Knee or hand

65
Q

OA second line management:

A

ORAL NSAIDs/cox-2 inhibitors

66
Q

What should be co-prescribed w/ NSAIDs/COX-2 inhibitors

A

PPI

67
Q

Osteogenesis imperfecta Calcium,phosphate, PTH, ALP levels

A

ALL normal

68
Q

What is osteomalacia:

A

Softening of the bones secondary to low Vitamin D -> leads to decreased bone mineral content

69
Q

Fx of Osteomalacia:

A

Proximal myopathy - waddling gait
Bone pain
Bone/muscle tenderness
Fractures: especially in femoral neck

70
Q

X-ray features of osteomalacia:

A

Translucent bands - (Looser’s zones or pseudofractures)

71
Q

Tx. Osteomalacia ->

A

Vitamin D supplementation - loading dose often needed initially

72
Q

Any patient w/ fragility fracture and > 75 yrs should automatically receive:

A

Oral BISPHOSPHONATE

73
Q

Fragility fracture and pt. is <75 yrs:

A

Arrange DEXA scan ->

FRAX assessment

74
Q

Medications that may worsen osteoporosis:

A 
PPIs
SSRIs
Anti-epileptics 
Glitazones 
Long term heparin therapy
Aromatase inhibitors
75
Q

First-line tx. for Osteoporosis

A

ORAL Alendronate

Vitamin D and calcium should be offered to all women unless clinician confident they’re receiving enough in their diet

76
Q

How is Denosumab given:

A

Single SC injection once every 6 months

77
Q

Tx. Paget’s disease:

A

Bisphosphonate (oral risedronate or IV zoledronate

78
Q

Polyarteritis nodosa associated w/ which infection

A

Hepatitis B

79
Q

Polymyalgia rheumatica important negative finding:

A

Weakness - Not typically associated with PMR

80
Q

Polymyalgia rheumatica investigation findings: Bloods:

A

Raised inflammatory markers - ESR > 40 mm/hr
CK and EMG normal
NO INCREASE in CK

81
Q

Polymyositis: blood results -

A

Elevated CK

other muscle enzymes (LDH, AST, ALT are also elevated in 85-95% of pts.

82
Q

Polymyositis anti-bodies:

A

Anti-synthetase antibodies

Anti-Jo-1 antibodies

83
Q

Pseudogout crystals:

A

Calcium pyrophosphate crystals

weakly-positively birefringent rhomboid-shaped crystals

84
Q

Pseudogout most commonly affected joints:

A

Knee, wrist, shoulders

85
Q

Management of pseudogout:

A

Aspiration of joint fluid to exclude septic arthritis

86
Q

Drug mx. pseudogout:

A

NSAIDs or intra-articular, intra-muscular or oral steroids as for gout

87
Q

Treatment of psoriatic arthritis:

A

Similar to RA
Mild peripheral arthritis/mild axial disease may be treated with an NSAID rather than DMARD
MABs - Ustekinumab, secukinumab

88
Q

Periarticular disease in Psoriatic arthritis:

A

Tenosynovitis and soft tissue inflammation which results in:
Enthesitis
Tenosynovitis
Dactylitis

89
Q

Reactive arthritis Tx.

A

Symptomatic: analgesia, NSAIDs, intra-articular steroids

Sulfasalazine and methotrexate are sometimes used for persistent disease

90
Q

Most common complication of rheumatoid arthritis:

A

Keratoconjunctivitis sicca

91
Q

Felty’s syndrome triad:

A

RA
Splenomegaly
Low WCC

92
Q

Sulphasalazine side effects:

A

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

93
Q

Gold side effects:

A

Proteinuria

94
Q

What investigation is recommended for ALL pts. w/ suspected RA

A

X-rays of hands and feet

95
Q

Rheumatoid arthritis initial management:

A

DMARD monotherapy +/- course of bridging prednisolone

96
Q

Flares of Rheumatoid arthritis mx.

A

Oral or IM Corticosteroids

97
Q

TNF inhibitors major side-effect:

A

Reactivation of latent TB

98
Q

Poor prognostic factors in RA:

A 
RF and anti-ccp positive 
Poor functional status at presentation 
X-ray showing early erosions 
Extra-articular features - nodules 
HLA DR4 
Insidious on-set
99
Q

RA LATE x-ray findings:

A

Periarticular erosions

Subluxation

100
Q

Teres minor role:

A

Adducts and rotates arm laterally

101
Q

Septic arthritis m/c organism overall

A

Staphylococcus aureus

102
Q

Septic arthritis most common organism in young adults who are sexually active

A

Neisseria gonorrhoea

103
Q

Septic arthritis Ix.

A

Synovial fluid sampling is obligatory
Blood cultures
Joint imaging

104
Q

Mx. septic arthritis:

A

Flucloxacillin for 4-6 weeks

Clindamycin if allergic
Needle decompression may be needed to decompress the joint

105
Q

Seronegative arthritis: usually follows which pattern of arthritis:

A

Asymmetrical, peripheral

106
Q

Mx Sjogren’s:

A

Artificial saliva and tears

Pilocarpine may stimulate saliva production

107
Q

Sulfasalazine should be used with caution if patient has:

A

G6PD deficiency

Allergy to aspirin or sulphonamides

108
Q

SLE tests:

A

ANA - highly sensitive
Anti-dsDNA: highly specific
Anti-smith: highly specific
20% are rheumatoid factor positive

109
Q

Complement levels during SLE active disease:

A

LOW - consumption of complement

110
Q

SLE advice

tx.

A

NSAIDs
Wear sun-block

Hydroxychloroquine

111
Q

SLE tx. if internal organ involvement: (renal, neuro, eye)

A

Prednisolone

cyclophosphamide

112
Q

CREST syndrome:

A 
Calcinosis 
Raynauds 
oEsophageal dysmotility
Sclerodactyly 
Telangiectasia
113
Q

Key examination in pts. presenting w/ temporal arteritis

A

Vision testing

114
Q

Temporal arteritis tx.
Vision loss
No vision loss

A

Vision loss: IV methylprednisolone

No-vision loss: High dose oral prednisolone

FLASH FINALS (34 decks)

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