Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MBBS - Year 1 > Clinical skills - Infl Arthritis > Flashcards

Clinical skills - Infl Arthritis Flashcards

1
Q

Polyarticular pain

A

Pain in at least 4 joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Arthralgia

A

Aching in joints without swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Characteristics of infl arthritis

A

Early morning and inactivity stiffness - generally >1 hr, averages 3 hrs in RhA and parallels degree of joint infl
Systemic symptoms e.g lethargy, wt loss, pyrexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why we distinguish between infl and non-infl

A

Infl is potentially more serious
Many forms have systemic manifestations
Early recognition & intervention improves outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Common types of arthritis

A

Acute (self-limiting) infl

Chronic infl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute (self-limiting) infl arthritis

A

Infection related, viral e.g Rubella, Hep B, Streptococcus

Goes away by itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does acute infl arthritis present with

A

Sudden onset
Fever and systemic upset
Variable severity
6-12 weeks duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of chronic infl arthritis

A 
RhA (lasts more than 6 weeks)
SpA - psoriatic, axial SpA
Crystal arthritis - Gout, CPPD
Connective tissue disease e.g. SLE, polymyostis
Others e.g sarcoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

OA aetiology - secondary

A 
Trauma 
Congenital disorders 
Metabolic 
Endocrine 
Neuropathic 
Paget's 
Infl arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical features of OA

A 
Pain - activity related 
Transient morning/ inactivity stiffness 
Joint enlargement 
Limitation of movement 
Muscle atrophy 
Crepitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

OA distribution

A 
DIP > PIP > MCP (v common)
CMC thumb - squaring 
AC shoulder 
Hips 
Knees 
MTP Feet 
Facet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Classification criteria for RhA

A

4/7 criteria = RhA

Morning stiffness > 1hr
Arthritis of >3 joint areas 
Hand involvement 
Symmetry 
Nodules 
Radiographic erosions 
RhF +ve

First 4 need to have been for 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical features of spondylarthrosis

A 
Uveitis 
Psoriasis 
Hip arthritis 
Peripheral arthritis 
Dactylitis 
Enthesitis 
Psoriatic nail changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Epidemiology of SpA

A

Slightly less common than RhA
Prevalence 0.5-1%
Caucasion > Asian > Afro-Caribbean

Proportional to freq of HLA-B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Psoriatic arthritis

A

Arthritis usually follows but may precede psoriasis
Severity of joint and skin disease independent
Nail involvment in 80% and only 20% of psoriasis alone
Good prognosis esp in pauciarticular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clinical subsets of arthritis

A 
Monoarthritis/ oligoarthritis 
Asymmetrical polynarthritis (DIP predominant)
'Rheumatoid' polyarthritis 
Psoriatic spondylitis 
Arthritis mutilans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hx in polyarthritis

A 
Age 
Sex 
Mode of onset 
Severity of joint infl - intensity and no. swollen joints 
Temporal pattern of joint involvement 
Distribution of joint involvement
Rheumatology hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Distribution of joint involvement in polyarthritis

A

Small joint: MCP - RhA, DIP and PIP - OA

Large joint: Hip and foot - SpA or crystal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lab investigations in polyarthritis

A 
FBC 
ESR and CRP 
RhF, ANA, anti-CCP, HLA-B27
Uric acid 
Synovial fluid analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Radiology for polyarthritis

A

X-ray
Ultrasound
MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Classification of spondylarthrosis

A 
Axial SpA
Reactive arthritis 
Psoriatic arthritis
Enteropathic arthritis
Undifferentiated spondylarthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Concepts of familial disease in poly arthritis

A

Most of the arthritis “run in families”
Very few directly inherited
Many associated w/ HLA e.g. DR4 - RA, GCA & B27 - AS, spondyloarthritidies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

HLA-B27 associated SpA’s

A 
Ankylosing spondylitis 
Psoriatic arthritis 
Juvenile SpA
Arthritis associated w/ IBD
Reactive arthritis 
Undifferntiated SpA
Acute Anterior Uveitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Criteria for ankylosing spondylitis/ Axial SpA

A

Sacroilitis at least grade 2 bilaterally or grades 3/4 unilaterally
Low back pain and stiffness for <3 months that improves w/ exercise but isn’t relieved by rest
Limitation of motion of the lumbar spine in both the sagittal and frontal planes
Limitation of chest expansion relative to normal values correlated for age and sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Infl back pain (spondylitis) clinical features
``` Gradual onset Early morning/ rest stiffness Better w/ movement No radical signs Usually at young(er) age Good response to NSAID ```
26
Long term features and complications of ankylosing spondylitis
Lung, heart, renal complications and osteoporosis usually late (>20yrs) Slowly evolving, progressive spinal stiffness causing functional difficulties
27
Constitutional symptoms of ankylosing spondylitis
``` Fatigue Pyrexia Wt loss Anaemia Increased ESR (20%) ```
28
Pathogenesis and radiology findings of SpA
Infl - bone marrow, oedema, erosions | New bone: shiny corners, fusion by syndesmophytes, ossification
29
Ossification
Natural process of bone formation
30
Investigations of ankylosing spondylitis
FBC, ESR/CRP X-ray of SI joint MRI
31
Treatments of ankylosing spondylitis
Diagnosis and monitoring disease activity to prevent development of deformities Patient + physiotherapist to treat NSAIDs biologic DMARDs for peripheral joints only
32
Axial SpA treatment
``` NSAIDs Exercise Limited DMARD use Anti-TNF Secukinumab AS only BASDAI, BASMI, BASFI ```
33
BASDAI
Determines effectiveness of drug being used to treat
34
BASMI
Assesses spinal mobility
35
BASFI
Assesses functional limitations
36
ReA
Reactive arthritis - a sterile joint infl that develops after a distant infection Systemic Triggering infections usually in throat, urogenital or GI tracts May be no preceding infection
37
Clinical features of ReA
Hx of infection up to 2 weeks prior Family Hx Infections
38
Infections seen in ReA
GI Urogenital Others e.g. meningococci, streptococci, staph
39
GI infections seen in ReA
Salmonella Shigella Yersinia Campylobacter
40
Urogenital infections seen in ReA
Chlamydia | Neisseria
41
Systemic symptoms of ReA
Malaise Fatigue Pyrexia
42
Joint and muscle symptoms of ReA
Arthralgia --> disabling polyarthritis Asymmetric Mono/ oligo arthritis (in 85% of pts) Large joints
43
Extra-articular MSK manifestations of ReA
Tenosynovitis Enthesopathy Plantar fasciitis Achilles tendinitis
44
Examination of joints in ReA
Red and warm Shifting pattern Dactylitis Low back pain in chronic disease
45
Investigations of ReA
``` FBC Urea and electrolytes (U&E) Liver function tests (LFT) CRP ESR RhF Urinalysis Blood cultures ```
46
Investigation of synovial fluid in ReA
Gram stain Polarised light microscopy Culture PCR
47
GI symptoms in ReA
Abdo pain | Diarrhoea
48
Management of acute ReA
``` Analgesia NSAIDs Steroids Abx? Rest Splinting Rehab ```
49
Management of chronic ReA
Arthralgia - NSAIDs Physio DMARDs
50
Differential diagnosis of ReA
Septic arthritis Crystal arthritis Psoriatic spondyloarthropathies
51
Psoriatic arthropathy presentation
``` Asymmetrical oligoarthritic: 30-40% Symmetrical polyarthritis: 30% DIP joint predominant: 10-15% Spondoarthritis: 10-20% Mutilans: <10% ```
52
Treatment of psoriatic arthritis
NSAIDs SZP, MTX, LFN, CyA, apremilast Biologics incl anti TNF, use kunumab Physio/ OT/ Education In some patients skin activity mirrors joint activity, therefore treat skin, joints improve
53
Enteropathic arthritis
Mainly ulcerative colitis and Crohn's disease Often arthritis and gut symptoms linked Associated w/ extra-intestinal manifestations of iBD
54
Lab tests for RhA
FBC ESR, CRP RhF - found in 80% Anti-CCP
55
Predictive variables for erosions in RhA
RhF 2 or more swollen large joints Disease duration > 90 days
56
Risk factors for development of RhA
``` Cigarette smoking Obesity Immunisation Blood transfusion Previous termination of pregnancy ```
57
Treatment of mild RhA
NSAIDs
58
Treatment of moderate RhA
DMARDs
59
Treatment of severe RhA
Combination therapy
60
Effective DMARDS
``` Methotrexate Salazopyrine (SZP) Hydoxychloroquinone Leflunomide Corticosteroids Ciclosporin Gold Azathioprine Cyclophophamide ```
61
Predictors of a poor prognosis in RhA
``` RhF Anti-CCP Baseline radiological score Nodules Acute phase proteins HAQ score Grip strength Swollen joint count ```
62
Biologics used to treat RhA
``` Anti - TNF Rituximab Abatacept Tocilizumab JAK inhibitors ```
63
When will you be eligible for biologic treatment for RhA
2 or more DMARDs incl methotrexate must be proven inadequate
64
Surgeries to treat RhA
``` Arthroplasty Synovectomy Tendon rupture Entrapment neuropathy Cervical decompression for myelopathy ```
65
DMARDS for spondyloarthropies
Effectivity has only been proven in the legs - not for use in the spine of sacroiliac joints
66
Examples of TNF Alpha blockers
Infliximab Etanercept Adalimumab Certolizumab peg
67
Dosage of inflliximab
5mg/Kg Iv for 6-8 weeks
68
Dosage of Etanecerpt
25mg subcutaneously 2x a week
69
Dosage of Adalimumab
40 mg via injections every 2 weeks
70
Surgeries used to spondyloarthropies
Total hip replacement Surgical spine fusion Correction of spine deformities
71
Physical therapies used to treat spondyloarthropies
``` Physio Flexibility training Spa - exercise Swimming Walking ```
72
Causes of chronic infl
Persistent infections Hypersensitivity diseases Exposure to toxic agents Primary granulomatous disease
73
Cell mediators involved in chronic infl
``` Histamine Serotonin Prostaglandin Leukotrienes Platelet-activating factor ROS Nitric oxide Cytokines Chemokines ```
74
Histamine in chronic infl
Vasodilation Increased vascular permeability Endothelial activation
75
Serotonin in chronic infl
Vasoconstriction
76
Prostaglandins in chronic infl
Vasodilation Pain Fever
77
Examples of growth factors
``` EGF TGF - alpha and beta PDGF FGF ILGF TNF ```
78
EGF
Epidermal growth factor | Regenberation of epithelial cells
79
TGF - alpha
Transforming growth factor - alpha | Regeneration of epithelial cells
80
TGF - beta
Transforming growth factor - beta Stimulates fibroblast proliferation and collagen synthesis Controls epithelial regeneration
81
PDGF
Platelet derived growth factor | Mitogenic and chemotactic for fibroblasts and smooth muscle cells
82
FGF
Fibroblast growth factor Stimulates fibroblast proliferation Angiogenesis Epithelial cel regeneration
83
ILGF
Insulin like growth factor | Synergistic effect with other growth factors
84
TNF
Tumour necrosis factor | Stimulates angiogenesis
85
Granulomas
Multinucleate giant cell | Macrophages and lymphocytes combined
86
Types of granulomas
Immune granulomas | Foreign body granulomas
87
Immune granulomas
Produced when the agent can't be readily eliminated | Macrophages active T cell cells to produce IL2 and interferon gamma
88
Foreign body granulomas
Response to foreign bodies without T-cell mediated immune response Form around materials e.g. sutures, fibres Giant cells attach to the surface of the foreign body
89
Reiter's syndrome
Conjunctivitis, uveitis and arthritis | Presents in ReA
90
Enthesitis
An infl of the ligament, tendon, joint capsule or fascia insertion site into the bone Hallmark of SpA
91
What does enthestis cause
Heel pain Metatarsalgia Iliac spine pain
92
Dactylitis
'Sausage fingers and toes' | Caused by arthritis, ethesitis and tendinitis
93
Circulate balanitis
Painless, ulceration of the glans penis which rupture to form superficial erosions - some w/ circular patterns Can accompany uveitis
94
Keratoderma blennorrhagia
Psoriasform lesions occurring on the palms of the hands and soles of feet
95
X rays in ReA
Fluffy periostitis Plantar spurs Periarticular osteoporosis
96
Examples of corticosteroids
Prednisolone | Methylpredisolone
97
Cautions when taking corticosteroids
Blurry vision | Suppression of immune system
98
How can methotrexate be administered
Orally or via a subcutaneous injection
99
Prescription of methotrexate
Fixed once weekly dose of 7.5mg and can be increased to 20mg
100
What is prescribed alongside methotrexate
Folic acid - don't take on same days | Counteracts strong effects of MTX - reduced absorption of vit B
101
What has to be reduced when taking methotrexate
Alcohol intake | Both are processed in the liver --> overworking
102
Side effects of methotrexate
``` Myelosuppression GI problems e.g nausea, vomiting, diarrhoea Pneumonitis Mucositis Affects liver function (carry out LFT) Pulmonary fibrosis ```
103
Sulfasalazine dosage
Start with one tablet 500mg daily ---> increase 500mg each week until 2-3g daily is reached (2-4 weeks)
104
Half life of SSZ
Relatively short, 4-5 hrs | Doesn't cause large immunosuppressive response and can be used perioperatively
105
SSZ facts
Can be found in liquid and tablet form (enteric coated) Often prescribed alongside MTX in combination therapy 6-8 weeks to notice effects of drug Can be used during pregnancy, unlike MTX Monthly blood tests and LFT's required
106
Side effects of SSZ
``` Hypersensitivity GI problems * Nausea * Proteinuria Skin rash Headaches Reduced sperm count Can cause orange staining of contact lenses ```
107
Proteinuria
Bright, orange urine
108
Prodrug
Remains inactive until its taken e.g leflunomide
109
Mechanism of LEF
Affects the rate limiting step in the synthesis of pyrimidines preventing activate lymphocytes progressing from the G1 to S phase in cell division ---> cell apoptosis
110
Initial prescription of LEF
10-20mg daily Take 4-6 weeks to have effect Requires FBC every 2 weeks
111
Side effects of LEF
``` Diarrhoea Increased liver enzymes Increased bp Shortness of breath Skin reactions ```
112
Pros of biologics
Treatments specialised to a spp drug target
113
Cons of biologics
V expensive
114
Biologics
Protein-formed drugs which have the ability to block the activity of certain mediators involved in infl Administered via subcutaneous or iv methods (increases risk of infection)
115
Eligibility for biologics
Patient must score 5.1 or higher using DAS 28 | Two DMARD treatments must have failed
116
Side effects of biologics
Headaches Abdo pain Nausea Adverse skin reactions at site of injection
117
JAK inhibitors
Synthetic DMARDS which target tyrosine kinase (TK) --> reduces infl
118
Tyrosine kinase
Important mediator of pro-infl cytokines
119
Examples of JAK inhibitors used to treat RhA
Tofacitinab | Baricitinib
120
Examples of Anti-TNF drugs
Adalimumab Etanecerpt Infliximab Golimumab
121
Extra-articular features of RhA
Rh nodules Tensoynovitis and Bursitis Carpal Tunnel syndrome Muscle wasting
122
Rheumatoid nodules
Firm subcutaneous nodules found in around 20% of patients with RhA
123
Tenosynovitis and Bursitis
Tendon sheaths and bursae are lined with synovium and can therefore become inflamed in RhA
124
Lyme disease
Vector-borne disease | Example of zoonosis: pathogen moved from animal to human
125
Cause of lyme disease
Bacterial infection (Borrellia) from the bite of an infected tick that has infected another animal
126
Presentation of typical tick bite
Red rash | Bullseye appearance
127
Symptoms of Lyme disease
``` Flu like symptoms Pain/ swelling around tick bite mark Headaches Lethargy Muscle pain/ feeling of weakness Articular pain ```
128
Late manifestation of Lyme disease
Lyme arthritis - similar to OA and affects large joints
129
Treatment of Lyme disease
Doxycycline 200mg daily but can also give amoxicillin and ceftriaxone
130
Where do Rh nodules develop in
Areas affected by pressure or friction, such as the DIP, PIP elbows and Achilles tendon and tend to suggest more severe disease.
131
5 common fracture cases
``` Wrist fracture Proximal humerus Clavicle Ankle fracture NOF ```
132
Colles' fracture
Distal radius fracture Result of FOOSH Bone points upward to thumb Hand points up
133
Smith's fracture
Hand points down Fracture of distal radius Forced pronation
134
Jones' fracture
Fracture to base of 5th metatarsal
135
Examination findings of RhA
Swelling of 3 or more joint - specificity of 73% Tenderness largely along the joint line Synovitis +ve squeeze test
136
What does synovitis produce
A 'boggy' or 'doughy' swelling which may be subtle
137
Squeeze test
Pain on gently squeezing the MCP or MTP joints together
138
What are we aiming for in RhA management
``` Minimising joint pain and swelling Preventing deformity (e.g. ulnar deviation) and radiographic damage (e.g. erosions) Maintaining quality of life (personal and work) Controlling extra-articular manifestations ```
139
Examples of immunosuppressive therapy
``` Azathioprine Cyclophosphamide Ciclosporin Mycophenate mofetil Tacrolimus ```
140
Features of immunosuprresive therapy
Also suppresses arthritis organ involvement in SLE and vasculitis Many have steroid sparing effects Musts be taken in pregnancy
141
Role of TNF in RhA
Mediates pathologic infl Mediates joint destruction Mediates systemic, extra-articular symptoms of infl Regulates levels of adhesion molecules responsible for leukocyte migration
142
Intra articular injection
Combination of corticosteroids and local anaesthesia Diagnostic and therapeutic as will show pain in knee is caused by hip arthritis Can last few weeks to few months
143
Screening for infl spine disease
Ask about ems >30 mins Relieved w/ exercise and NOT rest Alternating buttock pain 2 sero-ve clues and HLA-B27 +ve
144
Age of onset in infl back pain vs mechanical
<40 vs any age
145
Symptom duration of infl back pain vs mechanical
>3 months vs <4 weeks
146
Ems in infl back pain vs mechanical
>60 mins vs <30 mins
147
Nocturnal pain in infl back pain vs mechanical
Frequent vs infrequent
148
Sacroiliac joint tenderness in infl back pain vs mechanical
Frequent vs absent
149
Exercise improvement in infl back pain vs mechanical
Improvement vs NO improvement
150
Examination for infl spinal disease - Look
Inspection from back - swelling, deformity (scoliosis/ curvature), muscle wasting (spine of scapula becomes v prominent, intercostal muscles), symmetry of chest wall Inspection from side - curvature of the spine (scoliosis, kyphosis, lordosis)
151
Examination for infl spinal disease - Feel
Tenderness in spine Sacroiliac joint - dimples of Venus (posterior superior iliac spine) Palpate paraspinal muscles
152
Examination for infl spinal disease - Move
Forward flexion of upper thoracic spine and neck Extension of upper thoracic spine Lateral flexion Flexion of neck Lateral rotation of neck Lateral rotation of spine (done at end of measurements)
153
Testing extension in infl spinal disease
Stand behind patient and fix the pelvis with one hand and the other on shoulder Patient leans backwards
154
Testing lateral flexion in infl spinal disease
Bending with hands by sides, as if trying to touch floor
155
Testing flexion of neck
Looking up and down
156
Testing lateral rotation of neck
Touching ear to shoulder
157
Testing lateral rotation of spine
Patient sitting in the chair with arms in an X-formation and hold them from the shoulders
158
Examination for testing for infl spine disease - Measurements
Occipital bone to wall distance Tragus to wall distance Chest expansion Lateral flexion
159
What should the occipital bone to wall distance be
0 | Higher in those w/ AS
160
What should the tragus to wall distance be
<15 cm
161
Measuring chest expansion
Find 4th intercostal space (usually at nipple) Measure circumference of chest before and after patient takes a deep breath Take 3 measurements and find avg of the differences
162
Measuring lateral flexion
From middle finger to floor, normal and flexed | Difference should be >10 cm
163
Schober's test
Tests for lumbar flexion: should be >5 to get -ve result Place finger at level of posterior iliac spine (approx. L5) and mark 5cm below and 10cm below Ask patient to bend over and measure difference between two markings
164
Intermallelolar distance
Patient stands with legs spread as wide as possible | Distance between both medial malleoli should be >100 cm
165
Main extraskeletal manifestation of AS
Aortic insufficiency, ascending aortitis, conduction abnormalities Pulmonary – upper lobe fibrosis, restrictive changes Ocular – anterior uveitis
166
Indications of methotrexate
Infl arthritis Psoriasis Some chemo acute lymphoblastic leukemia
167
Monitoring of methotrexate
FBI, U&E and LFTs weekly until therapy stabilised and then every 2-3 months
168
Interactions w/ methotrexate
Avoid trimethoprim or co-trimaxozele | High dose aspirin increases the risk of toxicity
169
Myelosuppression
Decrease in red blood cells, platelets and white cell (pancytopaenia) and results in myelosuppression Commonly caused by methotrexate
170
Thrombocytopenia
Low levels of platelets
171
Agranulocytosis
Reduction in the granulocytes
172
Granulocytes
Neutrophils Eosinophils Basophils
173
Mechanism of NSAIDs
Inhibiting cyclo-oxygenase enzymes thus reducing the production of key mediators of infl (prostaglandins) Antipyretic action as PGE2 is involved in the thermoregulation centre in the hypothalamus
174
Important and common side-effects of NSAIDs
Peptic ulceration | Exacerbation of asthma
175
COX-2 selective NSAIDs
Celecoxib | Etoricoxib
176
Aspirin
Non-reversible COX 1 and 2 inhibitor
177
Tests helping choose ddx for infl joint pain
Anti-CCP antibody – if elevated will increase chance of rheumatoid arthritis Serum urate/uric acid – if elevated will increase chance of gout Synovial fluid aspirate for uric acid crystals – if present will confirm diagnosis of gout Pain radiographs of hands or feet – presence and pattern of erosions may support RA, psoriatic arthritis or gout. Swabs or blood cultures or stool cultures – to support active distant infection
178
X-rays for ankylosing spondylitis
Loss of cortical margins (blurring of vertebral rims at thoracolumbar junction), widening of the joint space, sclerosis, ‘squaring’ of vertebrae, syndemsophytes
179
MRI in ankylosing spondylitis
Sclerosis Ankylosis Bone marrow oedema (shows active infl)
180
Features of spondyloarthritides
Seronegativity; -ve RhF HLA B27 association ‘Axial arthritis’ Asymmetrical large-joint oligoarthritis (<5 joints) or monoarthrits Enthesitis Dactylitis
181
Examples of enthesitis seen in spondyloarthritides
Plantar fasciitis Achilles tendonitis Costochondritis
182
Cause of dactylitis
Soft tissue oedema and tenosynovial and joint infl
183
Squaring of spine - AS
Bamboo spine, calcification of ligaments w/ ankylosis
184
Syndesmophytes - AS
Bony proliferations due to enthesitis between ligaments and vertebral bodies
185
Disease progression of AS
Variable: Kyphosis Neck hyperextension (question mark posture) Spina-cranial ankylosis
186
Prognosis of AS
Bad if onset is after 16yrs, early hip involvement or poor response to NSAIDs
187
'Axial arthritis'
Spine and SI joints
188
X-ray features of RhA
Juxta-articular osteopenia Soft tissue swelling Joint deformity Loss of joint space
189
X-ray features of gout
Periarticular erosions Normal joint space Soft tissue swelling
190
Likely causes for back pain in 15-30 age group
``` Prolapsed disc Trauma Fractures Ankylosing spondylitis Pregnancy ```
191
Likely causes for back pain in 30-50 yrs age group
Degenerative spinal disease Prolapsed disc Malignancy (1’ or 2’ from big 5)
192
Likely causes for back pain in those 50+
``` Degenerative Osteoporotic vertebral collapse Paget’s Malignancy Spinal stenosis Myeloma ```
193
Spinal stenosis
Narrowing of the spine one or more of three parts:  The space at the centre of the spine.  The areas where nerves branch out from the spine to other areas of the body.  The space between the bones of the spin
194
What is spinal stenosis often caused by
OA
195
Main symptoms of spinal stenosis
Pain Numbness Weakness Tingling sensation in one or both legs - can make walking difficult and painful
196
Abx for septic arthritis
Given by IV for 2 week and followed by 4-6 weeks of oral
197
Haemarthrosis
Bleeding into joint spaces Can happen very soon after joint replacement Presents as warm and erythematous
198
RhA presentation in feet
Loss of the longitudinal arch, together with pes planus (caused by valgus deformity of the subtalar joints)
199
Rheumatoid hand
``` Boutonnieres Ulnar deviation of fingers Radial deviation of MCPs Swan neck deformity Dorsal subluxation in distal ulnar Muscular atrophy ```
200
Causes of high RhF
``` SLE Sjrogens Chromic active hepatitis Bacterial endocarditis Lymohoma TB Malaria Myeloma ```
201
Side effect of long term prednisolone
Avascular necrosis of femoral head
202
By how much does RhA decrease leg expectancy
~ 8-15 yrs
203
When must biologics be stopped
Before surgery | Do not restart until off of abx
204
What causes telescoping
Arthritis mutilans | PsA
205
Felty’s syndrome
Seen in RhA | Splenomegaly and neutropenia
206
Side effects of ciclosporin
HTN Tremulousness Gingival hypertrophy

MBBS - Year 1 (93 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions