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BPT > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

4 main presentations of lupus

A

Discoid lupus - scarring, depigmentation, 80% above neck

Subcutaneous lupus (SCLE) - photosensitive, non-scarring rash, cape distribution

Systemic lupus - low risk: malar rash, patchy alopecia

Systemic lupus - high risk: more systemic involvement

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2
Q

Renal and CSN lupus ab

A

Anti-SM

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3
Q

3 specific SLE Abs

A

DsDNA

Anti-Sm

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4
Q

SLE - monitor disease activity

A

Anti-dsDNA - lupus nephritis
C3/C4
ESR

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5
Q

anti-Ro

A

Subacute cutaenous lupus, neonatal heart block

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6
Q

Anti-U1RNP

A

MCTD

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7
Q

Anti-dendritic cell biologic

A

Litifilimab

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8
Q

Anti-BAFF/BlyS (b cell activating/b lymphocyte)

A

Belimumab

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9
Q

Biologic blocking IFN 1 signalling

A

Anifrolumab

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10
Q

SLE treatment principals

A

All patients get hcq

Mild - usually hcq alone
Moderate - Pred, possibly aza or MTX as steroid sparing

Severe = renal and cns
- Induction - Pred and Cyclophosphamide/MMF
- Maintenance - MMF or AZA, biologics

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11
Q

Lupus nephritis Rx

A

Steroid pulse + MMF/Cyclo
Rescue Ritux

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12
Q

APLS anticoagulation in pregnancy

A

LMWH and aspirin

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13
Q

Anti-histone

A

Drug induce lupus

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14
Q

Common drugs causing lupus

A

Anti-TNF
Minocycline
PPIs
Hydralazine

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15
Q

Rheumatoid - HLA association

A

HLA-DRB1 04

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16
Q

Ab in < 1% autoimmune disease

A

Anti dfs70

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17
Q

Felty syndrome triad

A

RA + neutropenia + splenomegaly

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18
Q

RA - what cytokine causes erosions

A

TNF

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19
Q

Major cytokines in RA

A

Erosions - TNF
Inflammation - IL-1, IL-6, IL-17, TNF

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20
Q

Eye manifestations RA

A

Scleritis, episcleritis (whole or segmental), peripheral ulcerative keratitis

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21
Q

Common neuro finding of RA

A

CTS

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22
Q

Most common haem finding of RA

A

Anaemia

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23
Q

Diagnostic criteria for RA

A

Inflammatory arthritis (usually peripheral) > 3 joints
Positive RF and/or anti-CCP
Elevated ESR/CRP
Duration > 6 weeks
No other CTD

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24
Q

Poor prognostic features for RA

A

Early erosive XR changes
Extra-articular features
Sustained CRP elevation
CCP positivity

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25
Q

Which DMARD does not slow radiographical progression RA

A

HCQ

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26
Q

Treatment ladder RA

A

MTX 1st

Triple therapy 2nd - LFL,SLZ, MTX

Add biologics third

Add JAKi 4th

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27
Q

MTX A/E

A

Myelosuppression
Nephrotoxicity - need urinary alkalinisation and leucovorin rescue
Hepatotoxicity

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28
Q

A/E HCQ

A

Retinopathy

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29
Q

Leflunomide A/E

Antidote -

A

Myelosuppresion
Teratogenic

Antidote - cholestyramine

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30
Q

SZL A/E

A

Myelosuppression, high risk in G6PD
Sulfur drug - rash

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31
Q

TNFi A/E

A

reactiviation opportunistic infections
Cardiac failure
Reversible lupus

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32
Q

A/E of JAK inhibitors

A

Increased Zoster infection
Increased overall cancer risk
Increased CVS risk

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33
Q

IMS okay in pregnancy

A

PASH TNF
Pred, Aza, SZS, HCQ, TNF

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34
Q

Dose of pred associated with worse outcomes/mortality

A

Daily dose > 8mg (aim to wean below this as safely possible)

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35
Q

Most common eye sign of RA

A

Keratoconjunctivitis sicca

36
Q

Eye signs of ra in order of severity

A

Keratoconjunctivitis sicca -dry, gritty eyes

Episcleritis - red sclera

Scleritis - painful red sclera (can be scleromalacia perforans or peripehral ulcerative keratitis, needs opthal

37
Q

PR3

A

GPA

38
Q

MPO

A

EGPA 65%
MPA 80%

39
Q

ANCA vasculitis associated with RPGN

A

MPA

40
Q

ANCA vasculitis associated with trachela stenosis

A

GPA

41
Q

Management of ANCA vasculitis

A

GC + Cyclophosphamide

Ritux as salvage

42
Q

Urticaria > 72 hours

A

Antic1q Ab
Urticarial vasculitis

43
Q

Investigation of PAN

A

Biopsy - segmental necrotising vasculitis medium vessels

CT angiographa

44
Q

Features of Behcet’s

A

Oral ulcers

2 of
- genital ulcers
- SKin lesions
- Pathergy - skin sensitivity to trauma
- Ocular inflammation

45
Q

Visual symptoms and GCA Rx

A

Methylpred

46
Q

Complications of GCA

A

Vision loss

Aortic dissection

47
Q

Anti-topoisomerase - other name?

A

Anti-Scl70

48
Q

RNA polymerase III?

A

Diffuse SSc
- Renal
- malignancy

49
Q

Anti-centromere

A

Limited SSc
- Pulm HTN

50
Q

SSc renal crisis Rx

A

ACEi

51
Q

SSc ILD Rx

A

Cyclophosphamide

New evidence for nintedanib

52
Q

Resorption of terminal tuft

A

Acro-osteolysis = SSc (diffuse)

53
Q

Leading cause of death SSc

A

ILD

54
Q

Probenecid
- CI

A

Nephrolithiasis

55
Q

Non gout drugs with:
-ULT
- Urate elevating properites

A

Losartan - lowers urate

Aspirin - increases urate

56
Q

Anti-Jo

A

Anti-synthetase syndrome

57
Q

Anti Pl 7
Anti Pl 12

A

Anti synthetase syndrome

58
Q

Anti Mi

A

Dermaomyositis

59
Q

MDA-5

A

MDA-5 associated ILD

60
Q

Cancer associated Abs

A

Anti TIF1
Anti NXP2

61
Q

Anti Pm-Scl

A

Scleroderma overalp myositis

62
Q

Anti-Ku

A

Scleroderma overlap myositis

63
Q

Ro60 vs Ro52

A

Ro60 - Subacute lupus, Sjogren’s

Ro52 - scleroderma overlap

64
Q

Spontaneous activity in EMG
- Signs
- Significance

A

Fibrilliation, positive waves, complex repetitive discharges

Significance - chronic partial/full nerve lesions

65
Q

Motor unit recruitment on EM
- Amplitude
- Early recruitment?

A

Amplitude
- Low - primary muscle disease
- High - chronic partial dennervation with re-innervation

Early recruitment = primary muscle disease

66
Q

MND EMG findings

A

Spontaneous activity with chronic partial dennervation all 4 limbs

67
Q

Characteristic pathology of Sjogren’s

A

Lymphocyte infiltration of exocrine glands

68
Q

Muscle biopsy - necrosis but no inflammation

A

Necrotising myopathy - Immune/statin etc.

69
Q

Managemene of FMF

A

1st - colchicine

2nd line - Anakinra IL-1 inhibition

70
Q

Have U1RNP and Anti-Sm/Anti-dsDNA

A

Lupus - lupus trumps MCTD

71
Q

What is RF?

Found in

A

Antibody against Fc portion of IgG.

Found in Sjogren’s, MCTD, cryoglobuinaemia

72
Q

ANCA positive but with mismatch of pattern to antibody - cause?

A

Cocaine/levamisole

73
Q

Main lifestyle RF for RA

A

Smoking

74
Q

A/E of tocilizumab

A

LFT
Cholesterolaemia

75
Q

Staining pattern for ANA positive, dsDNA psotive but ENA negative

A

Homogenous (nucleus stains one colour)

76
Q

Most prevalent CNS complication lupus

A

Cognitive dysfunction = “brain fog”

77
Q

Difference between Jaccoud’s and RA

A

Jaccound (in SLE) shows no erosive arthritis

RA will show erosive arthritis

78
Q

Faber test for hip pathology

A

Flexion, external rotation and abduction

90% sensitive and specific

79
Q

Most common cause of coronary artery aneurysm

A

Kawasaki disease

80
Q

Negative birefringence
Needle shaped

A

Uric acid/gout

81
Q

Positive birefringence
Rhomboid

A

CPPD (Ca)

82
Q

Central necrosis surrounded by palisading macrophages

A

Rheumatoid nodule

83
Q

Cause of gout from increased uric acid synthesis.
- which enyme deficiency?

A

Hypoxanthine-guanine phosphoribosyl transferase (HGPRTase)

84
Q

Necrotising myopathy antibodies

A

Srp
Hmg coa reductase

85
Q

Ab most associated with myocarditis in myositis

A

SRP

86
Q

IgG antiC1nA

A

Inclusion body myositis

BPT (18 decks)

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