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JL Musculoskeletal > Cortext Week 2 > Flashcards

Cortext Week 2 Flashcards

1
Q

What are these features suggestive of - joint pain with associated swelling, morning stiffness, improvement with excersise, synovitis on examination, raised CRP and PV and extra-articular symptoms?

A

Inflammatory arthritis

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2
Q

In RA are women or men more commonly affected?

A

Women by 2-3 times more

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3
Q

In the pathogenesis of RA - what is the immune response initiated against?

A

Synovium

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4
Q

Name 3 triggers of RA?

A

Smoking, infection and trauma

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5
Q

What joints are not affected in RA?

A

DIP

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6
Q

Over time in RA the cervical spine can be affected and can cause cervical cord compression - what causes this?

A

Atlanto-axial subluxation

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7
Q

Name 4 categories of extra-articular features in RA?

A

Rheumatoid nodules
Lung involvement - pleural effusions, interstitial fibrosis and pulmonary nodules
Cardiovascular morbidity
Ocular involvement - keratoconjunctivitis sicca, episcleritis, uveitis and nodular scleritis that may lead to scleromalacia

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8
Q

What two autoantibodies can be measured in RA?

A

Rheumatoid factor

Anti-CCP - more specific!

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9
Q

What is the timeframe for starting DMARD therapy in RA?

A

3 months

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10
Q

What DMARD is usually first line in RA?

A

Methotrexate

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11
Q

What are patients with seronegative diseases usually positive with?

A

HLA-B27

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12
Q

In AS what gender is more commonly affected?

A

Males by 3:1 (age of onset 20-40)

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13
Q

Over time with AS what shape does the spine form?

A

Question mark - loss of lumbar lordosis and increased thoracic kyphosis

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14
Q

Name four associated conditions to AS? (A disease)

A

Anterior uveitis, aortitis, pulmonary fibrosis and amyloidosis

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15
Q

What class of drugs is not used in AS?

A

DMARDS - instead NSAIDs, anti-TNF inhibitors

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16
Q

Name two psoriatic nail changes?

A

Pitting and oncholysis

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17
Q

How is psoriatic arthritis treated

A

With DMARDS

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18
Q

What kind of infections most commonly cause reactive arthritis?

A

Genitourinary infections (Chlamydia and Neisseria) - joints become affectedc 1-3 weeks after the infection

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19
Q

What four conditions make up Reiters syndrome?

A

Uveitis, urethritis or conjuctivitis and arthritis

Cant see, cant pee, cant bend the knee

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20
Q

In what type of people is the prevelance of SLE high?

A

Black people

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21
Q

What is the genetic predisposition of SLE supported by?

A

40% concordance in monoxygotic twins

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22
Q

More than 90% of cases of SLE occur in which gender?

A

Women 11:1 during childbearing years. Onset is usually 20-30

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23
Q

List the presenting features of SLE. NO MAPID RASH

A 
Neurological symptoms
Oral ulcers
Malar rash
ANA positive (95% of patients but not specific)
Photo sensitivity
Immunodeficiency
Discoid rash
Renal problems
Arthritis
Serositis
Haemoglobin low
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24
Q

Name the antibody specific to SLE and varies with disease activity?

A

Anti-dsDNA

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25
Q

Name the antibody in SLE with low sensitivity but specific?

A

Anti-Sm

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26
Q

When SLE is active what are the complement C3/4 levels?

A

Low

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27
Q

What test must be done when diagnosing SLE?

A

Urinalysis for evidence of glomerulonephritis

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28
Q

For skin disease and arthralgia in SLE what drugs are commonly used?

A

Hydroxychloroquine, topical steroids and NSAIDs

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29
Q

What conditions affecting the lungs and heart can SLE cause?

A

Pericardial effusion and interstitial lung disease - azathioprine may be required

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30
Q

For severe disease of SLE involving lupus nephritis or CNS lupus what treatment is given?

A

IV steroids and Cyclophosphamide

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31
Q

What disease presents with dryness of eyes and mouth, arhtralgia, fatigue, vaginal dryness and parotid gland swelling?

A

Sjogrens

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32
Q

What is there an increased risk of with Sjogrens?

A

Lymphoma

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33
Q

How is the diagnosis of Sjogrens confirmed?

A

Ocular dryness (Schirmers test), anti-Ro, anti-La and typical features on lip gland biopsy

34
Q

Pilocarpine is a drug used in Sjogrens - what does it do and name a side effect?

A

Stimulates saliva production but can cause flushing

35
Q

Pulmonary hypertension, Raynauds and fibrosis occur in what connective tissue disease?

A

Systemic sclerosis

36
Q

Name the components of CREST?

A

Calcinosis, raynauds, esophageal dysmotility, sclerodactyly and telangactasia + pulmonary hypertension

CREST syndrome is seen in systemic sclerosis

37
Q

What happens to the nose in systemic sclerosis?

A

Beaking

38
Q

What antibody is associated with limited systemic sclerosis?

A

Anti-centromere

39
Q

What antibody is associated with diffuse systemic sclerosis?

A

Anti-Scl-70

40
Q

How is Raynauds treated?

A

Calcium channel blockers, bosentan

41
Q

How is renal involvement in systemic sclerosis treated?

A

With ACE inhbitiors

42
Q

What are anti-RNP antibodies associated with?

A

Mixed connective tissue disease

43
Q

What does anti-phospholipid syndrome manifest clinically as?

A

Recurrent venous or arterial thrombosis and/or foetal loss (late, spontaneous, second or third trimester, although can occur anytime)

44
Q

What cardiovascular condition is seen in APS?

A

Libman-Sacks sterile endocarditis

45
Q

What neurological symptom is seen in APS?

A

Migraine

46
Q

What cutaneous finding is seen in APS?

A

Livedo reticularis

47
Q

What condition can there be thrombocytopenia, lupus anticoagulant, anti-cardiolipin antibodies and anti0beta 2 glycoprotein positive?

A

Anti-phospholipid syndrome

48
Q

How is APS managed?

A

Anti-coagulation (LMWH used in pregnancy)

49
Q

What are gouty tophi?

A

Painless white accumulations of uric acid which occur in soft tissues and erupt throuh skin

50
Q

What condition occurs in the elderly, involves proximal myalgia of the hip and shoulder girdle, morning stiffness lasting over 1 hour and symptoms improve as day goes on?

A

Polymyalgia rheumatica

51
Q

What do 15% of patients with polymyalgia rheumatica develop?

A

Giant cell arteritis - 40/50% of patients with GCA have associated PMR

52
Q

What do symptoms of PMR respond dramatically to?

A

Low dose steroids - prednisolone 15mg, reduced over 18 months until condition resolved

53
Q

What condition involves visual disturbances, headache, jaw claudication and scalp tenderness?

A

GCA

54
Q

What is raised in GCA?

A

PV, CRP and ESR

55
Q

In GCA - what is jaw claudication a result of?

A

Ischaemia in maxillary artery

56
Q

What is the definitive test for GCA?

A

Temporal artery biopsy

57
Q

What is the treatment for GCA?

A

Prednisolone 40mg if no visual impairment but 60mg if visual symptoms. Give for 2 years until resolved.

58
Q

What antibody is unique to dermatomyositis and polymyositis (symmetrical, proximal muscle weakness, more common in women)?

A

Anti-Jo-1

Also ANA, anti-SRP

59
Q

Other than inflammatory markers, what else is raised in polymyositis and dermatomyositis?

A

CK

60
Q

When testing for polymyositis - what test findings are abnormal in 90% of patients?

A

Electromyographic EMG

Muscle biopsy is also good to do

61
Q

How is polymyositis managed?

A

Prednisolone 40mg with methotrexate or azathioprine

62
Q

Give three clinical feature of dermatomyositis?

A

Vshaped rash over chest
Gottrons papules
Heliotropic rash

63
Q

What three conditions are associated with fibromyalgia?

A

Depression
IBS
Migraine

64
Q

Name two large vessel vasculitis?

A

Takayasu arteritis in under 50s usually young women

Giant cell arterirtis in over 50s

65
Q

How is large vessel vasculitis managed?

A

Prednisolone 40-60mg and gradually reducing.

66
Q

Name two medium vessel vasculitis

A

Polyarteritis nodosa

Kawasaki disease

67
Q

Name three ANCA associated small vessel vasculitis

A
  1. Wegeners granulomatosis (GPA)
  2. Microscopic polyangitis
  3. Churg-Strauss syndrome
68
Q

If the vasculitis is ANCA associated with no granulomas present what is the diagnosis?

A

Microscopic polyangitis

69
Q

If the vasculitis is ANCA associated with granulomas and asthma and eosinophils present - what is the diagnosis?

A

Churg-Strauss syndrome

70
Q

If the vasculitis is nonANCA associated and IgA dominant immune deposition what is the diagnosis?

A

Henoch=-Schonlein Purpura

71
Q

If the vasculitis is non-ANCA associated and not IgA dominatn immune deposition present, also serum cryoglobulin present - what is the diagnosis?

A

Cryoglobulinemic vasculitis

72
Q

Name some features of small vessel vasculitis?

A

Fever, weight loss, a raised non-blanching purpuric rash, arthralgia, mononeuritis multiplex, glomerulonephritis and lung opacities

73
Q

What symptoms are common in GPA?

A

ENT - nose bleeds, deafness, recurrent sinusitis and nasal crusting

74
Q

What two associations does GPA have?

A

cANCA and PR3

75
Q

What is the most important complication of microscopic polyangitis?

A

Glomerulonephritis

76
Q

How are most cases of ANCA associated vasculiris treated?

A

IV steroids and cyclophosphamide

77
Q

Who does Henoch Schonlein purpura affect?

A

Commonly children

78
Q

In henoch schonlein purpura - what commonly precedes the symptoms?

A

URTI

79
Q

What causes purpuric rash over the buttocks and lower limbs, abdo pain, vomiting and joint pain in choldren?

A

Henoch schonlein purpura

80
Q

How is henoch schonlein purpura treated?

A

It is self limiting

JL Musculoskeletal (35 decks)

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