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MRCP Part 1 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Adhesive capsulitis (frozen shoulder) isassociated with

A

DM
up to 20% of diabetics may have an episode of frozen shoulder

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2
Q

In Adhesive capsulitis (frozen shoulder)

Which is effected more

1- Abduction or external or internal rotation ?

2- active or passive movement?

A
  1. external rotation is affected more than internal rotation or abduction
  2. both active and passive movementis affected
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3
Q

Treatment of Adhesive capsulitis (frozen shoulder)

A
  1. NSAIDs
  2. physiotherapy
  3. oral corticosteroids and
  4. intra-articular corticosteroids
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4
Q

Ankylosing spondylitis is associated with a HLA-…..?

A

HLA-B27

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5
Q

Features of Ankylosing spondylitis ( 7A,C)

A
  1. Apical fibrosis
  2. Anterior uveitis
  3. Aortic regurgitation
  4. Achilles tendonitis
  5. AV node block
  6. Amyloidosis
  7. Arthritis peripheral
  8. cauda equina syndrome
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6
Q

Treatment of Ankylosing spondylitis

A

encourage regular exercise such as swimming

physiotherapy

NSAIDs are the first-line treatment

the disease-modifying drugs which are used to treat rheumatoid arthritis are only really useful if there is peripheral joint involvement

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7
Q

Antiphospholipid syndrome is associated with

A

SLE

other autoimmune disorders

lymphoproliferative disorders

phenothiazines (rare)

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8
Q

Investigations of Antiphospholipid syndrome

A
  1. anticardiolipin antibodies
  2. anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
  3. lupus anticoagulant
  4. thrombocytopenia
  5. prolonged APTT
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9
Q

Management of antiphospholipid syndrome

A

lifelong warfarin with a target INR of 2-3

If recurrent VTE events: if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4

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10
Q

Causes of Avascular necrosis of the hip

A

long-term steroid use

chemotherapy

alcohol excess

trauma

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11
Q

What is the the investigation of choice in Avascular necrosis?

A

MRI

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12
Q

The classic triad of Behcet’s syndrome

A
  1. genital ulcers
  2. oral ulcers
  3. anterior uveitis

*Goa

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13
Q

Behcet’s syndrome is associated withHLA….?

A

HLA B51

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14
Q

Investigations of dermatomyositis

A
  • elevated CK
  • ANA
  • anti-Mi-2 antibodies
  • antibodies to signal recognition particle (SRP)
  • antibodies against histidine-tRNA ligase (also called Jo-1)
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15
Q

Treatment of dermatomyositis

A

prednisolone

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16
Q

Drug-induced lupus

A

Most common causes

procainamide
hydralazine

Less common causes

isoniazid
minocycline
phenytoin

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17
Q

Familial Mediterranean Fever (FMF) is an autosomal ….. disorder

A

autosomal recessive

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18
Q

Investigations of Polymyositis

A
  • elevated CK
  • LDH
  • anti-synthetase antibodies

anti-Jo-1 antibodies are seen in pattern of disease associated with lung involvement, Raynaud’s and fever

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19
Q

Management of Polymyositis

A

high-dose corticosteroids tapered as symptoms improve

azathioprine may be used as a steroid-sparing agent

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20
Q

Which condition is associated with HLA B8, DR2, DR3

A

SLE

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21
Q

SLE is atype ……?……. hypersensitivity reaction

A

SLE atype 3 hypersensitivity reaction

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22
Q

neonatal complications due to SLE include

A

congenital heart block

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23
Q

SLE management

A

Basics

NSAIDs

sun-block

Hydroxychloroquine

the treatment of choice for SLE

If internal organ involvement e.g. renal, neuro, eye then consider prednisolone, cyclophosphamide

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24
Q

Systemic lupus erythematosus: investigations

A

ANA

ANTI dsDNA
ANTI Smith
ANTI U1 RNP
ANTI RO (SS-A)
ANTI LA ( SS-B )

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25
Q

Discoid lupus erythematosus is characterised by

A

follicular keratin plugs

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26
Q

Management of Discoid lupus erythematosus

A

topical steroid cream

oral antimalarials may be used second-line e.g. hydroxychloroquine

avoid sun exposure

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27
Q

anti-Ro is specific for

A

Sjogren’s syndrome,

SLE,

congenital heart block

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28
Q

anti-La:specific for

A

Sjogren’s syndrome

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29
Q

anti-Jo 1: specific for

A

polymyositis

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30
Q

anti-scl-70 specific for

A

diffuse cutaneous systemic sclerosis

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31
Q

anti-centromere is specific for

A

limited cutaneous systemic sclerosis

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32
Q

Carpal tunnel syndrome is caused by compression of ……

A

compression of median nerve in the carpal tunnel.

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33
Q

Causes of carpal tunnel syndrome

A

idiopathic

pregnancy

oedema e.g. heart failure

lunate fracture

rheumatoid arthritis

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34
Q

Treatment of carpal tunnel syndrome

A
  1. 6-week trial of conservative treatments if the symptoms are mild-moderate
  • corticosteroid injection
  • wrist splints at night: particularly useful if transient factors present e.g.pregnancy
  1. if there are severe symptoms or symptoms persist with conservative management:
    - surgical decompression (flexor retinaculum division)
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35
Q

Cubital tunnel syndrome occurs due to compression of

A

the ulnar nerve as it passes through the cubital tunnel.

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36
Q

In Cubital tunnel syndrome

In which fingers Tingling and numbness occur ?

A

In the 4th and 5th finger

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37
Q

Treatment of Cubital tunnel syndrome

A

Avoid aggravating activity

Physiotherapy

Steroid injections

Surgery in resistant cases

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38
Q

Treatment of De Quervain’s tenosynovitis

A

analgesia

steroid injection

immobilisation with a thumb splint (spica) may be effective

surgical treatment is sometimes required

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39
Q

Ehler-Danlos syndrome is an autosomal …1…..connective tissue disorder that mostly affects type …..2… collagen

A
  1. autosomal dominant
  2. affects type III collagen
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40
Q
  1. elastic, fragile skin
  2. joint hypermobility: recurrent joint dislocation
  3. easy bruising
  4. aortic regurgitation, mitral valve prolapse and aortic dissection
  5. subarachnoid haemorrhage
  6. angioid retinal streaks

Features of which condition

A

Ehler-Danlos syndrome

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41
Q

Management of fibromyalgia

A

aerobic exercise: has the strongest evidence base

cognitive behavioural therapy

medication: pregabalin, duloxetine, amitriptyline

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42
Q

In which level of Uric acid is supporting a diagnosis of gout

A

uric acid level ≥ 360 umol/L

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43
Q

When do you repeat Uric acid level
If Uric acid level is not elevated during a flare and gout is strongly suspected ?

A

at least 2 weeks after the flare has settled

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44
Q

Drugs causing gout

A

aspirin

alcohol

pyrazinamide

ciclosporin

cytotoxic agents

diuretics:thiazides, furosemide

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45
Q

Causes of Increased production of uric acid

A

myeloproliferative/lymphoproliferative disorder

cytotoxic drugs

severe psoriasis

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46
Q

Indications for urate-lowering therapy (ULT)

A

if:

  1. > = 2 attacks in 12 months
  2. tophi
  3. renal disease
  4. uric acid renal stones
  5. prophylaxis if on cytotoxics or diuretics
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47
Q

colchicine inhibits…..

A

inhibits microtubule polymerization by binding to tubulin, interfering with mitosis. Also inhibits neutrophil motility and activity

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48
Q

Target of s. Uric acid

A
  1. < 360 µmol/L
  2. < 300 µmol/L IF may be considered for patients who have tophi, chronic gouty arthritis or continue to have ongoing frequent flares despite having a uric acid below 360 µmol/L
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49
Q

febuxostat ……………… inhibitor.

A

xanthine oxidase inhibitor)

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50
Q

Urate-lowering therapy
1. What is the first line ?

  1. Second line ?
  2. In refractory cases ?
A
  1. allopurinol
  2. febuxostat
  3. uricase or pegloticase
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51
Q

Which anti hypertensive drug has a specific uricosuric action?

A

losartan

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52
Q

Greater trochanteric pain syndromeis due to repeated movement of ………..

A

the fibroelastic iliotibial band

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53
Q

Features of Greater trochanteric pain syndrome

A

pain over the lateral side of hip/thigh

tenderness on palpation of the greater trochanter

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54
Q

Adverse effects of Hydroxychloroquine

A

bull’s eye retinopathy - may result in severe and permanent visual loss

  • baseline ophthalmological examinationand annual screening is generally recommened
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55
Q

Causes of iliopsoas abscess

A

Staphylococcus aureus: most common

Crohn’s (commonest cause in this category)

Diverticulitis, colorectal cancer

UTI, GU cancers

Vertebral osteomyelitis

Femoral catheter, lithotripsy

Endocarditis

intravenous drug use

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56
Q

tennis racket-shaped Birbeck granules on electromicroscopy

A

Langerhans cell histiocytosis

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57
Q

In Lateral epicondylitis

pain worse on …………….

A

wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended

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58
Q

Red flags for lower back pain

A

age < 20 years or > 50 years

history of previous malignancy

night pain

history of trauma

systemically unwell e.g. weight loss, fever

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59
Q

Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

Which Site of compression ?

A

L3 nerve root compression

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60
Q

Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

Which site of compression?

A

L4 nerve root compression

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61
Q

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

Which site of compression?

A

L5 nerve root compression

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62
Q

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

Which site of compression?

A

S1 nerve root compression

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63
Q

Marfan’s syndrome is anautosomal……1….

It is caused by a defect in the ……..2…… on chromosome …….3…. that codes for …….4…..

A
  1. autosomal dominant
  2. FBN1 gene
  3. chromosome 15
  4. the protein fibrillin-1
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64
Q

McArdle’s disease is autosomal …..1…. type ….2….. glycogen storage disease

A
  1. autosomal recessive type V glycogen storage disease
  2. Type V glycogen storage disease
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65
Q

McArdle’s disease

caused by ………1……. deficiency

this causes decreased ……..2….

A
  1. myophosphorylase deficiency
  2. muscle glycogenolysis
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66
Q

muscle pain and stiffness following exercise

muscle cramps

myoglobinuria

low lactate levels during exercise

Features of……?

A

McArdle’s disease

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67
Q

Heberden’s nodes at the DIP joints seen in

A

Osteoarthritis (OA) of the hands

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68
Q

Osteoarthritis: management

A
  1. weight loss
  2. muscle strengthening exercises
  3. topical NSAIDsare first-line analgesics ( KNEE & HANDS )
  4. second-line treatment is oral NSAIDs
  5. intra-articular steroid injections may be tried if standard pharmacological treatment is ineffective
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69
Q

Osteogenesis imperfecta is autosomal …….

  • abnormality in type ……. collagen.
A

autosomal dominant

abnormality in type 1 collagen

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70
Q

vertebral osteomyelitis is the most common form of ……. osteomyelitis in adults

A

haematogenous osteomyelitis

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71
Q

The most common cause of osteomyelitis

A

Staph. aureus

But Salmonellaspecies in patients with sickle-cell anaemia

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72
Q

Treatment of osteomyelitis

A

flucloxacillin for 6 weeks

clindamycin if penicillin-allergic

73
Q

Osteopetrosis is rare disorder of defective …..1…… resulting in failure of normal bone resorption.

  1. calcium, phosphate and ALP are ……
  2. Treatment
A
  1. defective osteoclast function
  2. calcium, phosphate and ALP are normal
  3. stem cell transplant and interferon-gamma
74
Q

Medications that may worsen osteoporosis

A
  1. glucocorticoids
  2. SSRIs
  3. antiepileptics
  4. PPi
  5. glitazones
  6. long term heparin therapy
  7. aromatase inhibitors e.g. anastrozole
75
Q

Management of patients at risk of corticosteroid-induced osteoporosis

If T score
1. > 0 ; ……..

  1. 0 to - 1.5 ; ……..
  2. < -1.5 ; ……..
A

If T score
1. > 0 ; Reassure

  1. 0 to - 1.5 ; Repeat bone density scan in 1-3 years
  2. < -1.5 ; Offer bone protection

The first-line treatment is alendronate. Patients should also be calcium and vitamin D replete.

76
Q

Denosumab human monoclonal antibody that inhibits ……?

A

human monoclonal antibody that inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts

77
Q

6 Risk factors of pseudogout

A

haemochromatosis

Wilson’s disease

hyperparathyroidism

low magnesium, low phosphate

acromegaly,

78
Q

joint aspiration in pseudogout

A

weakly-positively birefringent rhomboid-shaped crystals

79
Q

Pseudogout
X Ray finding

A

chondrocalcinosis

80
Q

Treatment of pseudogout

A

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

81
Q

Polymyalgia rheumatica is associated with

A

temporal arteritis

82
Q

Treatment of Polymyalgia rheumatica

A

prednisolone 15mg/od

patients typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis

83
Q

Predisposing factors of Paget’s disease

A
  1. increasing age
  2. male sex
  3. northern latitude
  4. family history
84
Q

the stereotypical presentation of Paget’s disease

A

older male with bone pain and an isolated raised ALP

85
Q

Management of Paget’s disease

indications for treatment include

A

indications for treatment
1. bone pain
2. skull or long bone deformity
3. fracture
4. periarticular Paget’s

bisphosphonate(either oral risedronate or IV zoledronate)

calcitonin is less commonly used now

86
Q

Complications of Paget’s disease

A

deafness (cranial nerve entrapment)

bone sarcoma (1% if affected for > 10 years)

fractures

skull thickening

high-output cardiac failure

87
Q

Pseudoxanthoma elasticum is an inherited condition usually autosomal ……..?

A

autosomal recessive

88
Q

Cardio features are associated with Pseudoxanthoma elasticum

A

Mitral valve prolapse

Risk of ischemic heart disease

89
Q

Mycophenolate mofetil inhibits ……………

A

Inhibits inosine monophosphate dehydrogenase, which is needed for purine synthesis

90
Q

Polyarteritis nodosa (PAN) is a vasculitis affecting ……….sized arteries with necrotizing inflammation leading to aneurysm formation.

A

medium sized arteries

91
Q

Polyarteritis nodosa (PAN)is associated with

A

Hepatitis B infection

92
Q

most common organism causing septic arthritis

A
  1. Staphylococcus aureus
  2. in young adults who are sexually active,Neisseria gonorrhoeaeis the most common organism
93
Q

Treatment of septic arthritis

A

flucloxacillin or clindamycin if penicillin allergic

antibiotic treatment is normally be given for several weeks (BNF states 4-6 weeks)

patients are typically switched to oral antibiotics after 2 weeks

94
Q

RF & ANA in stills disease

A

Negative

95
Q

Management of Still’s disease

A
  1. NSAIDS ; should be used first-lineto manage fever, joint pain and serositis
  2. Steroids
  3. if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered
96
Q

8 Poor prognostic features of RA

A
  1. Female
  2. insidious onset
  3. poor functional status at presentation
  4. extra articular features e.g. nodules
  5. rheumatoid factor positive
  6. anti-CCP antibodies
  7. HLA DR4
  8. X-ray: early erosions (e.g. after < 2 years)
97
Q

Rheumatoid arthritis: x-ray changes

A
  1. loss of joint space
  2. periarticular erosions
  3. juxta-articular osteoporosis
  4. subluxation
  5. soft-tissue swelling
98
Q

8 conditions associated with a positive RF

A
  1. RA
  2. Felty’s syndrome
  3. SLE
  4. systemic sclerosis
  5. Sjogren’s syndrome
  6. infective endocarditis
  7. Infections: TB, HBV, EBV, leprosy
  8. general population
99
Q

indication for a TNF-inhibitor in RA

A

an inadequate response to at least two DMARDs including methotrexate

100
Q

Side effects of etanercept

A

demyelination,

reactivation of tuberculosis

101
Q

Rheumatoid arthritis: management

A
  1. NICE recommendDMARDmonotherapy+/- a short-course of bridging prednisolone.
102
Q

choices for initial DMARD monotherapy in RA

A
  1. methotrexateis the most widely used DMARD.
  2. sulfasalazine
  3. leflunomide
  4. hydroxychloroquine
103
Q

Side effects of Adalimumab

A

Reactivation of tuberculosis

104
Q

Side effects of Methotrexate

A

Myelosuppression
Liver cirrhosis
Pneumonitis

105
Q

Side effects of Sulfasalazine

A

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease
Stevens-Johnson syndrome

106
Q

Side effects of Leflunomide

A

Liver impairment
Interstitial lung disease
Hypertension

107
Q

Side effects of Hydroxychloroquine

A

Retinopathy

Corneal deposits

108
Q

2 Side effects of Penicillamine

A

Proteinuria

Exacerbation of myasthenia gravis

109
Q

Which DMARD are safe in pregnancy

A

sulfasalazine and hydroxychloroquine are considered safe in pregnancy

110
Q

In Sjogren’s syndrome
There is a marked increased risk of …………?

A

lymphoid malignancy

111
Q

Management of Sjogren’s syndrome

A

artificial saliva and tears

pilocarpine may stimulate saliva production

112
Q

Rotator cuff muscles

A

SItS- small t for teres minor

Supraspinatus
Infraspinatus
teres minor
Subscapularis

113
Q

CREST syndrome is

A

subtype of limited systemic sclerosis
1. Calcinosis,
2. Raynaud’s phenomenon,
3. OEsophageal dysmotility,
4. Sclerodactyly,
5. Telangiectasia

114
Q

Which pattern of systemic sclerosis is associated withanti-centromere antibodies

A

Limited cutaneous systemic sclerosis

115
Q

Which is the first sign of Limited cutaneous systemic sclerosis?

A

Raynaud’s

116
Q

Which condition is associated withanti scl-70 antibodies ?

A

Diffuse cutaneous systemic sclerosis

117
Q

What is the most common cause of death in Diffuse cutaneous systemic sclerosis?

A

interstitial lung disease (ILD) and

pulmonary arterial hypertension (PAH)

118
Q

Patients with Diffuse cutaneous systemic sclerosis complicated by renal disease and hypertension, should be started on ……?

A

anACE inhibitor

119
Q

Which one is associated with poor prognosis
Limited or diffuse cutaneous systemic sclerosis?

A

Diffuse cutaneous systemic sclerosis

120
Q

Temporal arteritis affects …………sized vessels arteries.

A

medium and large-

121
Q

Treatment of Temporal arteritis

A

urgent high-dose glucocorticoids should be given as soon as the diagnosis is suspected

if there is no visual loss then high-dose prednisolone is used

if there isevolving visual loss IV methylprednisoloneis usually given prior to starting high-dose prednisolone

urgent ophthalmology review

122
Q

Secondary causes of Raynaud’s phenomenon

A
  1. scleroderma (most common)
  2. RA
  3. SLE
  4. Leukaemia
  5. type I cryoglobulinaemia, cold agglutinins
  6. cervical rib
  7. drugs: oral contraceptive pill, ergot
  8. use of vibrating tools
123
Q

Management of Raynaud’s

A

all patients with suspectedsecondary Raynaud’s phenomenon should be referred to secondary care

first-line: calcium channel blockers e.g.nifedipine

IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months

124
Q

Which is the most common part of the body affected in Relapsing polychondritis ?

A

the ears,

  • can affect other parts of the body such as the nose and joints.
125
Q

Treatment of Relapsing polychondritis

A

Induce remission: steroids

Maintenance: azathioprine, methotrexate, cyclosporin, cyclophosphamide

126
Q

Reactive arthritis is a triad of

A

urethritis, conjunctivitis and arthritis

127
Q

the organisms that are most commonly associated with reactive arthritis:

A

Post-STI form : Chlamydia trachomatis

Post-dysenteric form:
1. Shigella flexneri
2. Salmonella typhimurium
3. Salmonella enteritidis
4. Yersinia enterocolitica
5. Campylobacter

128
Q

Treatment of reactive arthritis

A

symptomatic: analgesia,NSAIDS, intra-articular steroids

sulfasalazine and methotrexate are sometimes used for persistent disease

129
Q

Treatment of Psoriatic arthropathy

A

treatment is similar to that of rheumatoid arthritis

130
Q

Methotrexate inhibits……….

A

dihydrofolate reductase, an enzyme essential for the synthesis of purines and pyrimidines

131
Q

Methotrexate & pregnancy

A

women should avoid pregnancy for at least 6 months after treatment has stopped

132
Q

Interactions of methotrexate with

A
  1. trimethoprim
  2. co-trimoxazole
  • increases risk of marrow aplasia
  1. high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion
133
Q

Treatment of Methotrexate toxicity

A

the treatment of choice is folinic acid

134
Q

Azathioprine increase risk of ………….cancer

A

risk of non-melanoma skin cancer

135
Q

Azathioprine in pregnancy

A

Safe to use

136
Q

4 Side effects of Azathioprine

A
  1. bone marrow depression
  2. pancreatitis
  3. nausea/vomiting
  4. increased risk of non-melanoma skin cancer
137
Q

Bisphosphonates inhibit ……..

A

osteoclastsby reducing recruitment and promoting apoptosis.

138
Q

Side effects of bisphosphonates

A
  1. oesophagitis
  2. osteonecrosis of the jaw
  3. hypocalcaemia
  4. acute phase response: fever, myalgia and arthralgia may occur following administration
139
Q

Denosumab Inhibits

A

RANKL

140
Q

the two most common side effects of denosumab

A

Dyspnoea and diarrhoea

141
Q

cANCA is found in which condition

A

Granulomatosis with polyangiitis

142
Q

pANCA is found in which conditions

A
  1. Eosinophilic granulomatosis with polyangiitis
  2. Microscopic polyangiitis
  3. Ulcerative colitis
  4. Primary sclerosing cholangitis
  5. Crohn’s disease
  6. Anti-GBM disease
143
Q

How to take Bisphosphonates to avoid oesophageal problems

A

Take at least 30 minutes before breakfast with plenty of water + sit-upright for 30 minutes following

  • 30 before & 30 after
144
Q

Azathioprine - check …………….. before treatment

A

thiopurine methyltransferase deficiency (TPMT)

145
Q

APTT and platelet in antiphospholipid syndrome

A

prolonged APTT and thrombocytopenia make antiphospholipid syndrome the most likely diagnosis

146
Q

Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of

A

psoriatic arthritis

147
Q

What indicates a poor prognosis In Polymyositis ?

A

interstitial lung disease

148
Q

SLE - antibodies associated with congenital heart block

A

anti-Ro

149
Q

Paget’s disease - increased serum and urine levels of

A

hydroxyproline

150
Q

Which cells secretes the majority of tumour necrosis factor in humans?

A

Macrophages

151
Q

HLA DRB1 has been implicated in ……?

A

SLE

152
Q

HLA DR4 is associated with

A

RA

153
Q

HLA DQ2 is associated with …..

A

coeliac disease

154
Q

HLA B51

A

Behcet’s disease

155
Q

Which autoantibody is most specific for dermatomyositis ?

A

Anti-Mi-2 antibodies

156
Q

Which autoantibody is most common +ve for dermatomyositis ?

A

ANA

157
Q

Approximately what percentage of patients with psoriasis develop an associated arthropathy?

A

10-20%

158
Q

4 signs associated with carpal tunnel syndrome?

A
  1. weakness of thumb abduction (abductor pollicis brevis)
  2. wasting of thenar eminence (NOT hypothenar)
  3. Tinel’s sign: tapping causes paraesthesia
  4. Phalen’s sign: flexion of wrist causes symptoms
159
Q

Bone pain, tenderness and proximal myopathy (→ waddling gait) seen in

A

osteomalacia

160
Q

What are the blood tests can be used for disease monitoring in SLE ?

A
  1. complement levels (C3, C4) are lowduring active disease
  2. anti-dsDNA titres can be used for disease monitoring (but note not present in all patients)
161
Q

Patients who are allergic to aspirin may also react to

A

sulfasalazine

162
Q

What should be monitored during treatment with Leflunomide ?

A

CBC
LFT
BP

163
Q

Rheumatoid factor is an Ig..?.. antibody against Ig..?..

A

Rheumatoid factor is an IgM antibody against IgG

164
Q

Which antibodies are most specific for systemic lupus erythematous?

A

anti-Sm & anti-dsDNA are 99% specific

165
Q

What is the most common cardiac defect seen in Marfan’s syndrome

A

dilation of the aortic sinuses which may predispose to aortic dissection

166
Q

Which connective tissue disease is most strongly associated with Raynaud’s phenomenon?

A

systemic sclerosis

167
Q

Patients with carpal tunnel syndrome often get relief from…

A

shaking their hands

168
Q

What is Heberden’s nodes?
Seen in which condition?

A
  • Painless nodes (bony swellings) at the DIP joints
  • osteoarthritis
169
Q

Looser’s zones x-ray are most characteristically associated with

A

Osteomalacia

170
Q

L5 lesion features

A

loss of foot dorsiflexion + sensory loss dorsum of the foot

171
Q

S1 lesion features

A

Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

172
Q

Diagnosis of ankylosing spondylitis can be best supported by ……….. on a pelvic X-ray

A

sacro-ilitis

173
Q

What is the greatest predictor of future thrombosis in patients with anti-phospholipid syndrome?

A

Lupus anticoagulant

174
Q

Which vasculitis is associated withhepatitis B infection ?

A

Polyarteritis nodosa

175
Q

Anti-Jo 1 antibodies are more commonly seen in ………. than …………

A

Anti-Jo 1 antibodies are more commonly seen in polymyositis than dermatomyositis

176
Q

Patients with Sjogren’s syndrome are at an increased risk of which malignancy?

A

Non-Hodgkin’s lymphoma

177
Q

Which drug is associated with an increased risk of atypical stress fractures of the proximal femoral shaft?

A

Alendronate

178
Q

TNF is key in pathophysiology of ……

A

RA

179
Q

Apremilast is

A

PDE4 inhibitor

MRCP Part 1 (15 decks)

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