Exam Flashcards
What is the main investigation in an acute attack of gout?
Aspiration and microscopy of synovial fluid- negatively birefringent needle-shaped crystals
How is gout treated a) acutely and b) prophylactically?
a) NSAIDs, colchicine, intra-articular steroids
b) allopurinol (2-4 weeks after acute attack), feubuxostat
What causes pseudogout?
Deposition of calcium pyrophosphate crystals
Symptoms of osteoarthritis (3)
Pain on activity relieved by rest
Morning stiffness
Inactivity “gelling”
Radiological signs of osteoarthritis (LOSS)
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
Conservative management of osteoarthritis
Analgesia, physio, OT, tricyclics
Surgical management of osteo
Joint replacement, washout, osteophyte removal
Symptoms of polymyalgia rheumatica (2)
Severe symmetrical pain across the neck and shoulder girdle and pelvis
morning stiffness
Investigations in PMR (3)
Raised inflammatory markers
CK normal
Skip lesions on temporal artery biopsy
Management of PMR (2)
Corticosteroids
High dose prednisolone if temporal arteritis
Immunopathology of lupus
Immune complex deposition in small vessels
Most sensitive lupus antibody
ANA
Most specific lupus antibody
Anti-Sm
Most clinically useful lupus antibody
Anti-dsDNA
Monitoring of lupus (3)
C3/C4
ESR
dsDNA
Management of lupus (3)
Steroids
Hydroxychloroquine
Immunosuppressants e.g. MTX, AZT
Cause of Sjogren’s syndrome
Lymphocytic infiltration of exocrine glands
Symptoms of Sjogren’s (6)
Dry eyes Dry mouth Dry cough Dry vagina Dysphagia Raynaud's
Tests for Sjogren’s (3)
Schirmer’s test
Gland biopsy
Autoantibodies- rheumatoid factor, ANA, Ro/lA
Limited cutaneous scleroderma symptoms (CREST)
Calcinosis Raynauds Esophageal dysmotility Sclerodoctyly Telangiectasia
Distinguishing features of diffuse cutaneous scleroderma
Rapid onset of skin symptoms following Raynaud’s;
early organ involvement
Anti-centromere antibody
Limited scleroderma
Treatment for Raynauds
Nifedipine
Treatment of pulmonary hypertension (2)
Sildenafil, Bosentan
Presentation of rheumatoid arthritis
Symmetrical stiff, swollen joints (MCP, PIP, wrist, feet) and non-specific symptoms
Best antibodies for rheumatoid arthritis
Anti-ccp and rheumatoid factor
Radiological signs in RA (5)
Osteopenia Erosions Loss of joint space Periarticular swelling Deformity
Management of RA
Steroids for lag phase and flare-ups
MTX + other DMARD
Analgesia for symptomatic relief
Main feature of polymyositis/dermatomyositis
Symmetrical proximal progressive muscle weakness
Skin signs in dermatomyositis
Gottron’s papules
Shawl sign
Heliotrope rash
CK in polymyositis/dermatomyositis
Elevated
Jo-1
Polymyositis
Mi-2
Dermatomyositis
Treatment of poly/dermatomyositis (3)
High dose prednisolone
DMARDs
Skin therapeutics
Inclusion body myositis
More distal, more progressive, more often in men
The four main seronegative arthritides
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis
HLA in the sernonegative arthritides
HLA-B27
1-4 weeks after dysentery/urethritis
Reactive arthritis
Reiter’s syndrome
Conjunctivitis, urethritis, arthritis
Skin lesions in reactive arthritis (3)
Keratoderma blenorrhagica
Oral ulcers
Hyperkeratotic nails
