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Rheum > Estras > Flashcards

Estras Flashcards

1
Q

Which vasculitides have granulomas

A

GCA
Takayasu
Wegners
Churg strauss

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2
Q

purpura in vasculitis points to

A

medium vessel

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3
Q

predom cell infiltrate in GCA is

A

CD4 positive T cells!!!!

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4
Q

Purpura on legs and no renal involvement

A

leukocytoclastic vasculitis from drugs often eg diuretics, penicillins

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5
Q

In GCA how treat

A

steroids

and ASPIRIN FOR ALL!!!

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6
Q

How do ANCA cause disease

A

Cause neutrophil self activation via Kurlander phenomenon
Prevents alpha 1 AT mopping up PR3
ACtivate endothelium

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7
Q

Link between alpha 1 AT and wegners

A

Normally alpha 1 will inhibit PR3- if not enought then uninhibited

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8
Q

Why IV over oral cyclo

A

less toxic

more likely to relapse but no survival difference

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9
Q

CF and ANCA

A

90% positive

correlates with vasculitic phenom, worse lung disease, pseudomonas

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10
Q

specific ank spond back pain

A

alternating buttock pain

wake in second half of night

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11
Q

what is mecahnism of dactylitis

A

inflamed FLEXOR TENDON SHEATH of digit

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12
Q

Episcleritis vs uveitis

A

epi- painless, localised redness over bit of white, blanche vessels with phenyephrine

uveitis- painful, whole eye red, photophobia, blurred vision

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13
Q

Skin in seroneg

A

keratoderma blennorhagicum- gross skin peeling soles

circumnate balanitis

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14
Q

sI joint grading

A 
0-none
1-suspicious early
2-joint space narrowing with sclerosis minor
3. joint space widening
4 advanced alkylosis
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15
Q

Multip with bilateral areas of dense sclerosis on iliac side of SI joint bottom wihtout actual joint change

A

osteitis condensans ilii

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16
Q

On MRI, what do the ank spond bits look like

A

bone oedema looks white on STIR- TNF alphas reverse this

On T1 look black

17
Q

what is best for structural changes in ank spond

A

X ray and CT more sens than MRI

18
Q

ddx syndesmophytes in a man over 30 with diabetes on HLA negative

A 
DISH
diffuse isiopathic skeletal hyperostosis
ossification of the ALL
treat with simple analgesia and NSAIDS
osteophytes come out of the sides, actual corners are clear
19
Q

If young person with inflamm back pain and HLAB27 positive then how many have ank spond

A

1/3

20
Q

If dad is known HLA b27 pos with AS, what is risk of child getting it?

A

50% chance will pass to child
20% chance if get that will develop
So actually only 10%

21
Q

strongest predictor of worse outcome in AS

A

hip arthritis’

also smoking
young at onset
poor supports
no NSAID response
dactylitis, oligoarthtiris
22
Q

In AS what is the first objective sign spine involvement

A

reduced lateral spine flexion

23
Q

Are NSAIDS disease modifying in AS

A

yes, both axial and peripheral- better if take regularly and in comb with PT

TNF next line for axial disease if not enough NSAID response - no evidence that slow rad progression though, but improve spinal mobility, QOL, function
NOT DMARDS for axial

Peripheral disease local CS or TNF alpha blockers or sulfasalazine

24
Q

EA features of AS- what works?

A

No NSAID effect, but TNF good (dont use ertanacept in IBD)

25
Q

What is arthritis mutilans

A

in psoriatic, where shortening of the digits due to bony lysis

26
Q

difference between ank spond and psoriatic spondyloarthropathy

A

more asymmetric
syndesmophytes less common, unilaterl, comma shaped
C spine much more commonly involved

if give TNF blocker, def radiological reduction in errosive changes

27
Q

Triad for reactive arthritis coming on 1-4 weeks post

A

conjunctivitis
urethritis
arthritis

WCC in fluid can be VERY high

treat with rest, nsiads, LONG course for chlamydia treatment

28
Q

what are the two syndromes for gonococcal arthritis

A

septic arthritis

triad of polyarthralgia, florid tenosynovitis and purulent vesicles palms- dermatitis
pos blood cultures but hard to culture

29
Q

what effect will total proctocolectomy give in UC or Crohns disease on arthritis

A

UC will give remission

Crohns not

30
Q

What is the paradoxical effect of the TNF blockers

A

Treat RA but get psoriasis or flare IBD

lowest risk inflix

31
Q

Where do you get pain in hip OA

A

groin

can also be referred to knee

32
Q

trochanteric pain think

A

gluteal muscle tendinopathy or trochanteric bursitis

33
Q

What is the most heritable type of OA

A

lumbar and C spine

34
Q

Explain trendelenberg

A

when stand on bad leg, glut medius cannot contract to keep level so good side dips down

35
Q

Heberdens

A

DIP

36
Q

Bouchards

A

PIP

37
Q

What imaging to assess spine OA

A

x ray or MRI

CT not useful

38
Q

Which joints are biggest problem in charcot joint?

A

mid tarsal

39
Q

Joint disease in a dialysis patients

A

thing beta 2 micro amyloidosis

Rheum (12 decks)

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