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Exam - M - MSK + Rheumatology Pathologies (Meg & Rach) > Rheumatology Passmed > Flashcards

Rheumatology Passmed Flashcards

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1
Q

What blood results are seen in osteomalacia?

A

Low serum calcium
Low serum phosphate
Raised ALP
Raised PTH

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2
Q

what is osteomalacia?

A

Softening of the bones caused by severe vitamin D deficiency

Presents with:
Bone pain
Muscle weakness
Bone deformities

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3
Q

What are the blood results in osteoporosis?

A

ALL normal (PTH, ALP, Calcium, Phosphate)

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4
Q

What are the blood results in hyperparathyroidism?

A

High ALP
High PTH
High Calcium
Low phosphate

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5
Q

What is the first line treatment for ankylosing spondylitis?

A

Regular Exercise
Physiotherapy
NSAIDs

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6
Q

Which drugs should never be prescribed with methotrexate?

A

Trimethoprim (including co-trimoxasole) - causes bone marrow suppression and severe or fatal pancytopenia

High dose aspirin

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7
Q

What type of hypersensitivity reaction is allergic contact dermatitis?

A

Type IV (T cell-mediated)

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8
Q

what are the common features of psoriatic arthritis?

A

Pencil in cup X ray appearance
More likely to be asymmetrical
Dactylitis

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9
Q

When should patients be offered allopurinol?

A

After the first attack

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10
Q

What should be co-prescribed when starting allopurinol?

A

Colchicine

OR

NSAIDs

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11
Q

What type of hypersensitivity is SLE?

A

Type 3 (immune complex - free antigen and antibody combine)

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12
Q

What is the main difference in blood tests between PMR and polymyositis?

A

Polymyositis causes an increase in creatinine kinase, PMR is NOT associated with an increase in CK.

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13
Q

what are the ‘A’s in ankylosing spondylitis?

A

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
Any caudal equine syndrome
Peripheral arthritis

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14
Q

What complication can be seen in temporal arteritis?

A

Anterior ischaemic optic neuropathy (occlusion in a branch of the ophthalmic artery)

Fundoscopy - swollen pale disc and blurred margins

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15
Q

What are the signs and symptoms of temporal arteritis?

A

50% have PMR
Raised ESR
Sometimes raised CRP
CK and EMG NORMAL

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16
Q

What is the urgent treatment given in temporal arteritis?

A

No visual loss:
- High dose prednisolone

Visual loss:
- IV methylprednisolone given first before red

Urgent opththalmology review

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17
Q

What is Ewings sarcoma?

A

A malignant bone tumour affecting children.

Occurs mostly in pelvis and long bones - causes severe pain.

Onion skin appearance on X-ray.

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18
Q

what is an osteosarcoma?

A

MOST common primary malignant bone tumour

Seen mostly in children

Occurs mostly in the metaphysics of long bones prior to epiphyseal closure

Sunburst pattern on X-ray

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19
Q

what are the blood results in antiphospholipid syndrme?

A

Rise in APTT
Thrombocytopenia (low platelets)

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20
Q

What are the features of antiphospholipid syndrome?

A

Predisposition to VTE and arterial thrombosis
Recurrent foetal loss
Thrombocytopenia
Lived reticular
ASSOCIATED WITH SLE
Anticardiolipin antibodies

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21
Q

What are the features of antiphospholipid syndrome?

A

Predisposition to VTE and arterial thrombosis
Recurrent foetal loss
Thrombocytopenia
Lived reticular
ASSOCIATED WITH SLE
Anticardiolipin antibodies

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22
Q

what is the primary prophylaxis of antiphospholipid syndrome?

A

Low dose aspirin

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23
Q

What is the secondary prophylaxis of

A

Lifelong warfarin INR 2-3

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24
Q

what type of reaction is anaphylaxis?

A

Type I

Antigen reacts with IgE bound to mast cells

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25
what crystals are seen in pseudogout
calcium pyrophosphate dehydrate crystals Joint aspiration: Weakly-positive bifringent rhomboid shaped crystals
26
What is limited cutaneous systemic sclerosis?
Scleroderma which mainly affects the face, distal limbs Anti-Centromere antibodies CREST syndrome is a subtype
27
What is diffuse cutaneous systemic sclerosis?
scleroderma which affects the trunk and proximal limbs Anti scl-70 antibodies Organ involvement: Interstitial lung disease, renal disease, hypertension
28
What is scleroderma
Tightening and fibrosis of the skinWITHOUT organ involvement
29
what are the components of CREST syndrome?
Calcinosis Raynauds Oesophageal dysmotilit Sclerodactyly Tenalgiectasia
30
What are the seronegative spondyloarthropathies?
Positive HLA-B27 Rheumatoid factor negative Ankylosing spondylitis Psoriatic arthritis Reactive arthritis Enteropathic arthritis
31
What are the X-ray changes of osteoarthritis?
LOSS - Loss of joint space - Osteophytes forming at joint margins - Subchondral sclrosis - Subchondral cysts
32
what are the signs and symptoms of SLE?
Malar rash Photosensitivity Raynaids Lived reticular Non scarring alopecia Arthralgia Non-erosive arthritis Pericarditis Myocarditis Pleurisy Fibrosing alveoliitis Proteinuria Llomerulonephritis Anxiety and depression Psychosis Seizures
33
What condition can patients undergoing chemotherapy be at a higher risk of?
Gout (due to increased rate levels)
34
Which antibodies are positive in SLE?
99% Positive: Antinuclear antibody ANA Highly specific but not sensitive: Anti dsDNA (usually the answer in SBA) Anti smith Anti - U1 RNP, Anti ro, Anti la
35
What is the most common organism causing septic arthritis OVERALL?
staphylococcus aureus
36
What is the most common organism causing septic arthritis in sexually active people?
Neisseria gonorrhoea
37
what are the signs of septic arthritis
haematogenous spread acute swollen joint tarm to touch fever restricted movement
38
What are the investigations that should be done in septic arthritis?
Synovial fluid sampling (done prior to abx, can be done under ultrasound guidance) Blood cultures (haematogenous spread) Joint imaging
39
What is the management of septic arthritis?
Flucloxacillin Clindamycin if penicillin allergic ***4-6 WEEKS of ABX** Patients switched to oral ABX after 2 weeks needle aspiration to decompress the joint arthroscopic lavage may be needed
40
Regarding a DEXA scan, what is the T and Z score?
T score - your bone density compared to a 30 year old Z score - your bone density adjusted to your age, General and ethicity
41
What are the DEXA scan results?
> -1.0 = normal - 1.0- -2.5 = osteopaenia < -2.5 = osteoporosis
42
what is the treatment for acute flares of rheumatoid arthritis?
Intramuscular or oral steroids: methylprednisolone
43
what is the treatment of Raynaud?
nifedipine
44
what are the features of osteogenesis imperfect?
AKA - brittle bone disease Presents in childhood fractures following minor trauma blue sclera deafness secondary to otosclerosis dental imperfections ALP, PTH, calcium and phosphate usually NORMAL
45
what are the blood results in poly myalgia rheumatic?
Raised ESR raised CRP Normal anti CCP Normal CK
46
what is reactive arthritis
A HLA-B27, seronegative arthritis. It is an arthritis that develops following an infection where the organisms cannot be recovered from the joint
47
what are the signs of reactive arthritis
urethritis conjunctivitis arthritis often occurs post STI caused by chlamydia trachoma's
48
what is the treatment for reactive arthritis
analgesia NSAIDs intra articular steroids
49
Sensitive vs specific factors for SLE?
Sensitive - ANA Specific - Anti dsDNA
50
what is the complication of hydroxychloroquine
sight loss
51
what are the adverse effects of methotrexate
mucositis myelosuppression pneumonitis pulmonary fibrosis liver fibrosis Interaction with trimethoprim or co-trimoxazole interaction with aspirin (increases risk of methotrexate toxicity) toxicity
52
what is the guidance regarding methotrexate treatment and pregnancy
both women AND men should avoid pregnancy/use effective contraception for 6 months after stopping methotrexate
53
what is the medication used to treat methotrexate toxicity
folonic acid
54
what is polymyositis?
an inflammatory disorder causing symmetrical, proximal muscle weakness it is associated with malignancy
55
how is marfans syndrome passed on
autosomal dominant
56
what are the blood results seen in pages disease?
Raised ALP Normal calcium Normal phosphate
57
What is the first and second line imaging for ankylosing spondylitis?
1. Plain x-ray of the sacroiliac joints 2. MRI (if sacroiliac x-ray is negative but suspicion remains high)
58
Who should take vitamin D supplementation
- All pregnant women and breastfeeding women - Children 6 months - 5 years (if not drinking 500ml of formula milk a day) - Adults >65 - Housebound patients
59
Which antibody is a good rule out test for SLE?
ANA antibody Because its positive in 99% of people with SLE
60
What should be prescribed with methotrexate?
Folate - this reduces the risk of bone marrow suppression
61
What is sjogrens syndrome?
An autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces. Can be primary. Can be secondary - develops around 10 years after rheumatoid arthritis or SLE.
62
what are you at increased risk of if you have sjogrens?
Lymphoid malignancy (40-60 fold).
63
what are the features of sjogrens syndrome?
dry eyes dry mouth vaginal dryness arthralgia raynauds myalgia sensory polyneuropathy recurrent episodes of parotitis renal tubular acidosis
64
what are the tests done for sjogrens disease?
Antibody tests: - Anti Ro = most associated with primary sjogrens - anti-La - ANA - rheumatoid factor Schirmers test - strip of paper left under the eyelid for 5 minutes (should travel 15mm). A result of <10mm is significant.
65
What is the management of sjogrens syndrome?
Artificial tears Artificial saliva Vaginal lubricants Hydroxychloroquine (to halt progression of the disease) Pilocarpine - many stimulate saliva production
66
What is dermatomyositis?
an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristics skin lesions
67
What should be done when someone is diagnosed with dermatomyositis?
A malignancy screen
68
What is the treatment for osteoarthritis?
1. Weight loss, local muscle strengthening exercises and general fitness 2. Paracetamol and Topical NSAIDs (topical NSAIDs for knee and hand only) 3. Oral NSAIDs, opioids, capsaicin cream and intra-articular corticosteroids. 4. joint replacement should be considered if conservation methods fail
69
what should be prescribed in OA alongside NSAIDs and COX-2 inhibitors?
A PPI
70
what is the treatment for fibromyalgia
1. Aerobic exercise 2. CBT 3. Medication: Pregabalin, duloxetine, amitriptyline
71
what blood test can be used to monitor disease activity in SLE?
Complement levels - usually go down in active flare
72
when can hydroxochloroquine be used?
It CAN be used
73
What x-ray changes are seen in pseudo gout
chonedrocalcinosis
74
What is the treatment for raynauds?
Nifedipine
75
What is the treatment for SLE?
Hydroxychloroquine
76
what tests should be done if rheumatoid arthritis is suspected
rheumatoid factor anti CCP (same sensitivity, higher specificity) - can be detected 10 years before RA develops X-ray of hands and feet
77
what is the treatment for antiphospholipid syndrome
primary prevention: daily aspirin Secondary prevention: Lifelong warfarin INR target 2-3

Exam - M - MSK + Rheumatology Pathologies (Meg & Rach) (13 decks)

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