Rheumatology Flashcards
(69 cards)
1
Q
Is SLE more F or M predominant
A
F
2
Q
Typical onset of SLE
A
15-50yrs
3
Q
Aetiology SLE
A
Exact cause unknown Genetics Sex hormone status Drugs UV light (can trigger attacks ) EBV exposure
4
Q
Who is SLE a disease of
A
Young females
5
Q
Which Autoantibodies are associated with SLE
A
ANA
Anti-dsANA
Anti-smith
Anti Ro
6
Q
What happens to serum compliment levels in SLE
A
Decreases
7
Q
Which organ does SLE affect
A
It is a multi system autoimmune disease
It affects many organs and many systems (systemic)
8
Q
Who should you suspect SLE in
A
Young females
9
Q
Face manifestations of SLE
A
Butterfly rash
Photosensitivity
Malar flush
10
Q
What types of disease is SLE
A
Autoimmune
11
Q
What is the main cause of SLE
A
Exact cause is unknown
12
Q
Chest manifestations of SLE
A
Pleurisy
Pleural effusion
Fibrosis
13
Q
Joint manifestation of SLE
A
Arthritis of small joints
Aseptic necrosis of hip
14
Q
Nervous system manifestations of SLE
A
Fits Hemiplegia Ataxia Peripheral neuropathy CN lesions
15
Q
Heart manifestations of SL
A
Pericarditis
Endocarditis
Aortic valve lesions
Cardiomyopathy
16
Q
GI manifestations SLE
A
Abdo. pain
mouth ulcers
17
Q
Blood manifestations of SLE
A
Anaemia
Leukopenia
Thrombocytopenia
18
Q
General manifestations of lupus
A
Fever Depression Fatigue Malaise Weight loss Lymphadenopathy
19
Q
What is a far more common cause of a face butterfly rash (compared to SLE)
A
Acne and rosacea
20
Q
Ix for SLE
A
FBC Anaemia Urine dipstick ESr CRP U&Es Urea Creatinine
21
Q
Ix autoantibodies for SLEP
A
Complement level ANA Anti-dsANA Anti-Smith Anti-Ro
22
Q
Imaging Ix for SLE
A
Skin and kidney biopsy
CT scans
CXR
23
Q
Rx for mild SLE
A
Hydroxychloroquine
High factor sunblock
NSAIDS
24
Q
Rx for moderate SLE
A
Azathioprine
Methotrexate
Mycophenolate
25
What type of pattern does SLE follow
Relapse and remitting
26
Name another disease apart from SLE which follows a relapse and remitting course
Multiple Sclerosis
27
Rx for severe SLE
Cyclophosphamide
Rituximab
High dose steroids
28
Why can methotrexate not be given in pregnancy
It is teratogenic
29
Are SLE exacerbations more or less common in pregnancy
More common
30
What are pregnant ladies with SLE more susceptible to
Pre-eclampsia
31
What are safe pregnancy drugs for SLE
Azathioprine
| Low dose oral steroids
32
Explain the SLE classification criteria
Any 4 or more criteria (1 clinical, 1 laboratory)
| Or biopsy proven lupus nephritis with +ve ANA or +ve anti-DNA
33
What are the 11 clinical criteria for SLE
1) Acute cutaneous lupus/Malar rash (butterfly rash)
2) Chronic cutaneous lupus/Discoid rash (raised, scarring, permanent marks, non scarring alopecia)
3) Non-scarring alopecia
4) Oral/Nasal ulcers
5) Synovitis (2 joints at least)
6) Serositis (pleurisy or pericarditis)
7) Urinalysis (presence of proteinuria or red cell casts)
8) Neurological (unexplained seizures or psychosis)
9) Haematological/ Haemolytic anaemia
10) Leucopenia
11) Thrombocytopenia
34
What is the laboratory criteria for SLE
```
+ve ANA
+ve Anti-dsANA
+ve Anti-Smith
+ve Anti-Phospholipi
Low Complement
+ve Direct Coombs Test
```
35
What is the most common systemic vasculitis
Giant Cell Arteritis
36
What is GCA
Inflammatory granulomatous arteritis of temporal arteries
37
Signs of GCA
```
Increased ESR
Temporal artery tenderness
Reduced pulsation
New headache
Jaw claudication
Beaded appearance
```
38
What is the most feared manifestation of GCA
Sudden painless temporary vision loess in one eye
39
What is vision loss caused by in GCA
Involvement of ophthalmic artery
40
What is the Dx for GCA
Temporal artery biopsy
41
Rx GCA
High dose prednisone
42
What is GCS associated with in 50%
Polymyalgia Rheumatica
43
What is Polymyositis characterised by
Insidious onset of progressive symmetrical proximal muscles weakness and autoimmune mediated striated muscle inflammation
44
What is dermatomyositis
When there is polymyositis with skin involvement
45
Signs of polymyositis
Proximal weakness of muscles
| Muscle wasting
46
Skin signs of Dermatomyositis
Gottron's Papules
Helitrope Rash
Macular rash
47
What is Shawl sign
Shawl sign is +ve if there is a muscular rash all over the back and shoulders
48
where does a heliotrope rash affect
The eyelids
49
Main symptoms of Polymyositis
Proximal muscle weakness
50
Which enzyme is elevated in polymyositis
Creatinine
51
Ix polymyositis
Creatinine
EMG
Muscle biopsy
52
Rx for polymyositis
Prednisolone (steroids)
Immunosuppression:
Methotrexate
To treat rashes:
Hydroxychloroquine
Topical Tacrolimus
53
What is the diagnosis
45 Y female presents with 3/7 Hx difficulty breathing and right sided chest pain worse with deep inspiration. Her CXR confirms right pleural effusion. Treatment with antibiotics makes no difference. Her FBC showed persistently low WCC of 3.0 then 3.2 and low platelets of 100. In the last year she has been experiencing intermittent pain and swelling in her joints and recurrent facial rash after sun exposure .
SLE
54
Complications polymyositis
Increased malignancy risk
| Increased interstitial lung disease risk
55
Which gender does Sjogren's much more commonly affect
Females
56
What are the primary symptoms of Sjogren;s
```
Dry eyes
Dry mouth
Dry skin
Parotid gland enlargement
Vaginal sryness
```
57
Ix for Sjogren's
```
FBC
RF
ANA antibodies
Anti-Ro
Anti-La
```
Schirmer Tear Test
Rose Bengal staining
Biopsies
58
Rx for Sjogren's
Artificial tears and saliva replacement solutions
Lubricants
Hydroxychloroquine
59
Complications of Sjogren's
```
Lymphoma
Non-Hodgkin’s B Cell Lymphoma
Neuropathy
Purpura
Interstitial lung disease
Renal tubular acidosis
```
60
Which disease does polymyalgia rheumatic have a close connection with
Giant cell arteritis
61
what is polymyalgia
Polymyalgia rheumatica (PMR) is an inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years.
62
What is the pathogenesis of polymyalgia rheumatica
Unknown
63
What is the most common presentation of polymyalgia rheumatica
Pain and stiffness in the neck, shoulder girdle +/- pelvic girdle
64
Rx of polymyalgia rheumatica
Corticosteroid (prednisolone)
65
Which medication should there be a dramatic response to in polymyalgia rheumatica
Corticosteroids
66
which criteria would indicate a positive diagnosis of Polymyalgia Rheumatica
Age >50yrs
Pain in shoulders or hips
Stiffness in the morning that persists >45 mins
Symptoms have lasted >2 weeks
Blood tests should increased ESR andCRP
Dramatic response to Prednisolone (corticosteroids)
67
what is a 2nd line rx for polymyalgia rheumatica
Methotrexate (DMARD)
68
Ix for Polymyalgia Rheumatcia
NO specific Ix or Test
Bloods:
CRP
ESR
RF (to rule out RA)
Strong suggestive diagnostic factors
69
Which gender is polymyalgia rheumatic more common in
Females
