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Rheumatology > General > Flashcards

General Flashcards

1
Q

tell me the 5 seronegative spondyloarthropathies

A 
reactive
psoriatic
ank spond
enteropathic
JIA
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2
Q

what makes seronegative spondyloarthropathies themselves?

A 
negative rheumatoid factor
spinal & sacroiliac joints affected
HLA B27
asymmetric 
enthesitis
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3
Q

what allele are seronegative spondyloarthropathies

A

HLA B27

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4
Q

keratoderma blenorrhagica is rash on feet in what

A

reactive arthritis

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5
Q

does psoriasis usually precede psoriatic arthritis?

A

yes by a few years usually

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6
Q

which joints are affected in psoriatic arthritis?

A

DIP

pencil in cup erosions on X ray

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7
Q

what are the nail changes in psoriatic arthritis?

A

onycholysis

dactylitis

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8
Q

name some symptoms of ank spond

A

back pain + stiffness
infl of other joints e.g. knee
fatigue

kyphosis, loss of lumbar lordosis

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9
Q

give me an example of a medium vessel vasculitis

A

polyarteritis nodosa

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10
Q

name 3 conditions that can cause secondary vasculitis

A

RA
SLE
Hep B/C

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11
Q

which small vessel vasculitis causes adult onset asthma but uncommonly affects kidneys (unlike the others which affect kidaz and lungs)

A

churg strauss

eosinophilic granulamatous polyangitis

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12
Q

monosodium urate crystals deposition causes joint infl whats this?

A

gout

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13
Q

age, alcohol, obesity, venison and male are risk factors for gout. name 2 more.

A

diabetes

thiazide diuretics

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14
Q

what investigation for gout?

A

diagnosis clinical if typical.
if not,
joint aspiration

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15
Q

what does microscopy of synovial fluid on joint aspiration of GOUT show?

A

negative birefringent needle shaped crystals

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16
Q

what does microscopy of synovial fluid on joint aspiration of PSEUDOGOUT show?

A

positively birefringent diamond shaped crystals

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17
Q

why test glucose and lipids when diagnosing gout?

A

assoc w metabolic syndrome

and diabetes

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18
Q

what is the management of acute gout ?

A

RICE
NSAIDs
colchicine

corticosteroids if bad

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19
Q

what is the management of chronic gout.

A

lifestyle
allopurinol / febuxostat

(xanthine oxidase inhibitors)
(if >2 attacks a year)

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20
Q

how long do acute attacks of gout take to recur?

A

3-10days

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21
Q

an acute attack of gout reaches its peak within

A

24hrs!

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22
Q

deposition of calcium pyrophosphate crystals causing joint infl. whats this

A

pseudogout

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23
Q

what are the pseudogout crystals

A

calcium pyrophosphate

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24
Q

what is the management of pseudogout?

A

RICE
NSAIDs
IA steroids

acute attacks usually resolve in 10ds
elderly - dehydration, intercurrent illness

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25
Q

what is the triad of pagets

A

pain
fracture
deformity

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26
Q

high bone turnover, osteoclasts go crazy and we dont know why. osteoblasts cant keep up so make rubbish woven + lamelllar bone.

A

paget’s

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27
Q

what is paget’s?

A

high bone turnover, osteoclasts go crazy and we don’t know why. poor osteoblasts cant keep up so make rubbish mosaic of woven + lamellar bone.

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28
Q

is most paget’s asymptomatic?

A

yes - radiologically common but minority are symptomatic.

got a spot of paget’s on your x ray hun

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29
Q

which bones can paget’s affect?

A

pelvis
lumbar spine
skull
femur , tibia

i havent got any leg bones

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30
Q

what investigations for paget’s

A

plain X ray
alk phos - high
isotope scan

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31
Q

why is alk phos high in paget’s

A

high bone turnover

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32
Q

bones messy and fluffy on x ray (cortical thickening, abnormal texture)

A

paget’s

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33
Q

what is the treatment for paget’s ???

A

BISPHOSPHONATES
they disable osteoclasts
only treat if symptomatic

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34
Q

pain
fracture
deformity

= triad for what?

A

paget’s

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35
Q

low bone mass and microarchitectural destruction of bone –> increase in bone fragility and susceptibility to fracture
what’s this?

A

osteoporosis

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36
Q

name the 3 osteoporosis fragility fractures that happen

A

colles
NOF
vertebral

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37
Q

what questions are in FRAX

A 
age height weight
previous fractures
parental hip fracture
RA
glucocorticoids
smoker/alcohol
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38
Q

what does FRAX tell us

A

10yr fracture risk for untreated 40-90 yr olds

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39
Q

what does DEXA stand for

A

dual energy x ray absorptiometry

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40
Q

what does DEXA tell us

A

bone mineral density!!!

then calcs into T score

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41
Q

what does T score tell us

A

how much bone have you lost since young adult peak bone mass

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42
Q

how is Z score different to T score

A 
Z = compared to pts same age
T = compared to peak bone mass
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43
Q

-1 T score =

A

osteopenia

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44
Q

-2.5 T score =

A

osteoporosis

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45
Q

investigations for osteoporosis?

A

FRAX
DEXA scan - T score
vertebral fracture assessment (dexa of whole spine)

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46
Q

why do a vertebral fracture assessment?

A

these often go undiagnosed and are big risk factor

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47
Q

in osteoporosis thats not caused by endocrine, whats Ca PTH and vit D levels?

A

normal

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48
Q

if someones a rlly bad bone mineral density and youre suspicious, what other investigations might you do?

A

Ca, PTH, vit D - hyperPTH
TSH - hyperthyroid
coeliac antibodies
sex hormones (hypogonadism)

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49
Q

what 4 bits of lifestyle advice can you give to someone w osteoporosis?

A

less smoking/alcohol
more exercise
dietary calcium
vit D supplements

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50
Q

shout out the drug management of osteoporosis

A

bisphosphonates
HRT
denosumab
teriparatide

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51
Q

how often is IV zolendronate given?

A

annually!

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52
Q

how often are oral alendronate and risedronate given?

A

weekly

risedronate!

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53
Q

rare but bad SEs of bisphosphonates?

A

atypical femoral fractures

osteonecrosis of jaw

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54
Q

common SE of bisphosphonates?

A

oesophagitis

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55
Q

instructions for taking bisphosphonates?

A

first thing in morn empty stomach big glass of H2o , nothing else for 30 mins after dont lie down

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56
Q

“if youre vitamin D deficient, you can drink as much milk as you want but…

A

you’re not gonna absorb the calcium”

you need vit D to absorb ca from gut

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57
Q

what is the pathophys of osteomalacia?

A

low vit D - less Ca from gut - increased PTH - increased bone turnover + less mineralisation

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58
Q

what is the difference between osteporosis and osteomalacia?

A

porosis = low BD w lone bone mass. you’ve lost bone.

malacia = low BMD w normal amount of osteoid but softer cos less calcium.

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59
Q

what level of vit D counts as deficient?

A

<25

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60
Q

25 - 50 vit D =

A

insufficient

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61
Q

> 50 vit D =

A

sufficient

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62
Q

pt presents w bone pain, muscle aches, proximal muscle weakness. vit D level is 15.

A

osteomalacia and vit D def

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63
Q

osteomalacia :
alk phos
ca/phos
PTH

A

alk phos high (bone turnover)
PTH high (tryna increase ca)
Ca low (cant absorb)
vit D low

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64
Q

name some RFs for vit D def and osteomalacia

A 
dark skin
housebound
body covering
alcoholism
vegetarian
poverty
obesity
EBG >6 months 
LATE CKD
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65
Q

severe severe vit D def can cause

A

hypo Ca tetany seizures

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66
Q

plain X ray leg of someone with osteomalacia. what does it show?

A

cortical bone lucency
Looser’s zones
(strips of low density)

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67
Q

Loosers zones?

A

strips of low density on X ray of someone w osteomalacia

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68
Q

bone profile blood test involves what?

A

total protein
albumin
adjusted calcium
alk phos

(can add on phosphate)

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69
Q

osteomalacia investigations?

A

serum vit D
alk phos, ca/phos, PTH
plain x ray
dexa

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70
Q

treatment for osteomalacia

A

high dose vit D - CHOLECALCIFEROL 20,000 units for 12wks
+ Ca supplements

then continue low dose supplementation long term

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71
Q

why give Ca supplements alongside high dose vit D in treatment of osteomalacia?

A

help bone remineralise

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72
Q

what is AdCalD3

A

combined low dose vit D and calcium supplement

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73
Q

pt with end stage CKD has vit D def. how to treat?

A

CALCITRIOL (activated vit D)

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74
Q

what is cholecalciferol?

what is calcitriol?

A 
cholecalciferol = skin vit D
calcitriol = activated vit D (only give for renal pts)
75
Q

autoimmune disease where there is too much fibroblast activity causing vascular damage and fibrosis of organs. what’s this?

A

systemic sclerosis aka scleroderma

76
Q

what are the two types of systemic sclerosis

A

limited cutaneous and diffuse cutaneous (whole body skin involvement)

77
Q

limited cutaneous sclerosis aka

A

CREST syndrome

78
Q

what does CREST syndrome stand for

A 
Calcinosis
Raynaud's - nailfold capillaroscopy
Esophageal dysmotility
Sclerodactly 
Telangiectasia
79
Q

WHAT ACTUALLY is systemic sclerosis

A

autoimmune
too much fibroblast activity
FIBROSIS OF ORGANS AND VESSELS

80
Q

what ACTUALLY is polymyositis and dermatomyositis

A

autoimmune
INFLAMMATION OF MUSCLES
derm has skin involvement

81
Q

proximal myopathy, hard to hold your head high. plus heliotrope eyelids and purple rash. can progres to interstit lung disease.

A

polymyositis and dermatomyositis

infl of muscles! proximal myopathy. skin involve.

82
Q

middle aged woman presents struggling to comb her hair or even hold her head high. she has a purpley rash on her face.

A

polymyositis + dermatomyositis

83
Q

investigations for polymyositis and dermatomyositis

A

high creatine kinase!

anti-Mi (derm)
anti-Jo (poly)
anti-ANA
EMG

diagnostic = muscle biopsy

84
Q

which investigation is diagnostic for polymyositis and dermatomyositis?

A

muscle biopsy

85
Q

polymyositis and dermatomyositis can be assoc w what

A

MALIGNANCY
PARANEOPLASTIC for breast gastric lung

also other autoimmune - hashimotos

86
Q

treatment for polymyositis and dermatomyositis

A

prednisolone

87
Q

what actually is lupus / SLE?

A

multisystem autoimmune conn tiss body attacks lots of its healthy tissues
complex

88
Q

RFs for SLE

A

afro-caribbean women >40
HLA-DR2, 3
UV, EBV

89
Q

ESR raised and CRP normal makes u think

A

SLE , lupus!

90
Q

why is SLE called lupus?

A

rash looks like a wolf bite

91
Q

shoot me some symptoms of SLE

A 
photosensitive butterfly rash (naso-labial sparing)
oral ulcers
dry eye/mouth
fatigue
fever
splenomegaly
lymphadenopathy
arthralgia
pleuritic pain / pericarditis 
Raynaud's 
psychosis 
nephritic / nephrotic syndrome
92
Q

is there increased CVD risk in lupus?

A

yes

93
Q

photosensitive skin eruption w/o systemic symps =

A

discoid lupus

94
Q

what are the KEY investigations for SLE

A

anti-dsDNA
ant-Sm
low C3/4

95
Q

why test antiphospholipid antibodies in SLE?

A

antiphospholipid syndrome assoc w SLE

96
Q

some investigations for SLE

A 
FBC, ESR, CRP 
anti-ANA
anti-dsDNA
anti-Sm
low C3/4
antisphospolipid antibodies
97
Q

what might FBC show in lupus

A

haemolytic anaemia, low plts

98
Q

is there a cure for SLE?

A

no. just reducing flares.

people die much younger :(

99
Q

what is the management of SLE?

A

NSAIDS, prednisolone
HYDROXYCHLOROQUINE
immunosuppressants -azathioprine

100
Q

dry mouth and dry eyes and enlarged parotids. positive rheumatoid factor. in middle aged woman.

A

sjorgens syndrome

she needs artificial tears and saliva

101
Q

sjorgens syndrome can be primary or secondary to?

A

RA, SLE

102
Q

treatment for sjorgens syndrome?

A

artificial tears and saliva

103
Q

hypercoagulable , autoimmune. causing thrombosis and adverse preg outcomes. what this

A

antiphospholipid syndrome

104
Q

antiphospholipid assoc w what disease?

A

SLE

105
Q

treatment for antiphospholipid syndrome?

A

long term warfarin

in preg : LMWH and low dose aspirin

106
Q

localised loss of cartilage, remodelling of adjacent bone, infl. triggered by trauma and need for joint to repair itself. what’s this?

A

osteoarthritis

wear and tear

107
Q

name some RFs for osteoarthritis

A 
FHx
ageing
female
obesity 
joint injury / occupational stresses on joint
108
Q

which joints does OA effect?

A

hip
knee
hand

109
Q

hip pain, worse w exercise relieved by rest , morning stiffness <30 mins . what might you find on examination?

A

reduced ROM
crepitus
swelling/warmth
bony swelling e.g. Bouchards Heberdens nodes

= OA

110
Q

heberdens nodes are

A

DIP

111
Q

bouchards nodes are

A

PIP

112
Q

when can a clinical diagnosis of osteoarthritis be made

A

> 45 + activity related + stiffness <30mins

113
Q

OA plain X ray signs

A

Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis

114
Q

talk to me about non pharma management of OA

A 
exercise
weight loss
physio
walking aids
supportive footwear
115
Q

talk to me about pharma management of OA

A 
paracetamol
topical NSAIDs
oral NSAID
IA corticosteroids
knee/hip replacement
116
Q

autoimmune infl of synovial lining of joints, tendon sheaths and bursa. what’s this?

A

rheumatoid arthritis

a symmetrical polyarthritis

117
Q

what allele is rheumatoid arthritis?

A

HLA DR4 /1

118
Q

what antibodies for rheumatoid arthritis

A

rheumatoid factor

anti-CCP

119
Q

two RFs for RA

A

woman

HLA DR4 /1

120
Q

what do rheumatoid arthritis swellings feel like?

A

boggy, soft

as opposed to bony swellings in OA

121
Q

atlanto-axial subluxation in

A

rheumatoid arthritis

when it affects C spine
risk of cord compression

122
Q

which joints does RA tend to affect?

A

wrist, ankle, MCP, PIP

sometimes c spine, hips, knees

123
Q

tell me about the onset of RA

A

can be overnight or gradual

124
Q

name 5 things you might see on hand examination with rheumatoid arthritis

A 
ulnar deviation
boutonniere
swan neck
Z thumb
elbow nodules
125
Q

is rheumatoid arthritis a symmetrical polyarthritis ?

A

yeah

126
Q

name some symptoms of rheumatoid arthritis

A

pain swelling stiffness in small joints of hands and feet
worse in morn
stiffness >30mins
improves with activity

127
Q

does rheumatoid improve with activity?

A

yes

128
Q

does osteoarthritis improve with ativity?

A

no - gets worse w activity

129
Q

is DIP affected in RA?

A

NEVER

130
Q

which joint is NEVER affected in RA?

A

DIP

131
Q

what is caplan’s

A

pulmonary fibrosis in RA

132
Q

extra-articular RA - lung: ?

A

pulmonary fibrosis

bronchiolitis obliterans

133
Q

extra-articular RA - eye: ?

A

sjorgens sclerosis

keratoconjunctivitis sicca

134
Q

extra-articular RA - cardiovascular: ?

A

pericardial effusion
vasculitis
accelerated atherosclerosis
anaemia of chronic disease

135
Q

what is Felty’s syndrome

A

RA + splenomegaly + neutropenia

136
Q

what organ does Felty’s syndrome affect in RA?

A

spleen

137
Q

extra-articular RA - wrist: ?

A

carpal tunnel

138
Q

what might FBC show in RA?

A

normocytic anaemia of chronic disease

139
Q

what scan can show synovitis

A

Ultrasound

140
Q

what does X ray show in RA

A

soft tissue swelling

joint destruction

141
Q

main drugs for rheumatoid arthritis?

A

DMARDS

biologics

142
Q

which DMARDs for rheumatoid arthritis?

A

methotrexate
leflunomide
sulfasalazine

*hydroxychloroquine if mild

143
Q

what biologics for rheumatoid arthritis?

A

TNF blockers

rituximab

144
Q

name 3 TNF blockers

A

adalimumab
infliximab
etanercept

145
Q

complications of taking biologics for rheumatoid arthritis?

A

immunosuppression

reactivation of Hep B /C

146
Q

apart from DMARDs and biologics, what else is the management of rheumatoid arthritis ?

A 
MDT
IM/IA steroids for flare ups
NSAIDs + PPIs
physio + OT
manage CV risk and stop smoking
147
Q

side effect of methotrexate?

A

pulmonary fibrosis

148
Q

side effect of leflunomide?

A

peripheral neuropathy

149
Q

side effect of sulfasalazine?

A

low sperm count

sulfasalazine sperm

150
Q

3 general side effects of all DMARDs

A

mouth ulcers
bone marrow suppression
teratogenic

151
Q

what actually is sarcoma

A

malignancy of mesenchymal origin
i.e. anything thats not carcinoma (epithelial)

e.g. leiomyo, rhabdomyo, lipo, fibro, angio, osteo, chondro

152
Q

malignancy of mesenchymal origin = ?

A

sarcoma

153
Q

4 SIGNS OF SARCOMA

A

lump >5cm
lump increasing in size
lump deep to fascia
pain

154
Q

lump >5cm
lump increasing in size
lump deep to fascia
pain

=?

A

= sarcoma

155
Q

why CT thorax in all sarcomes?

A

common met is lung

156
Q

which 5 cancers most commonly spread to bone

A

PB-KTL

prostate
breast
kidney
thyroid
lung
157
Q

in adults, what bones does osteomyelitis affect? and in kids?

A

in kids - long bones
adults- vertebrae
(these are well vascularised ones)

158
Q

symptoms of osteomyelitis?

A

dull pain
fever/rigors
swelling/erythema

159
Q

what are the three ways infection can get to the bone for osteomyelitis

A

direct e.g. open fracture
adjacent soft tissues e.g. DM ulcer
haematogeneous e.g. TB bacteraemia

160
Q

investigations for osteomyleitis?

A

MRI
blood cultures
bone biopsy w culture

161
Q

treatment for osteomyleitis?

A

surgical debridement

IV Abx

162
Q

is septic arthritis a M E D I C A L E M E R G E N C Y?

A

Yes
mortality
joint destruction in 24hrs

163
Q

which organism tends to cause septic arthritis / osteomyelitis in intravenous drug users

A

pseudomonas

164
Q

investigation for septic arthritis?

A

URGENT JOINT ASPIRATION

microscopy and culture of synovial fluid

165
Q

name 3 differentials for septic arthritis

A

gout
pseudogout
reactive arthritis

166
Q

what is treatment for septic arthritis?

A

IV Abx
3-6wks
e.g. fluclox + rifampicin
may need washout + immobilise

167
Q

how do you prevent prosthetic joint infection?

A

peri op Abx and Abx cement in prosthesis

if bad might need exchange arthroplasty

168
Q

which 4 muscles make up the rotator cuff?

A

supraspinatus, infraspinatus, teres minor, subscapularis

169
Q

what are the commonest 4 causes of shoulder pain?

A

1) rotator cuff disorders
2) glenohumeral disorders
3) acromioclavicular disorders
4) referred neck pain!!

170
Q

what causes glenohumeral disorders?

A 
adhesive capsulitis (aka forzen shoulder)
osteoarthritis of shoulder
171
Q

what causes rotator cuff disorders?

A

subacromial impingement

rotator cuff tear

172
Q

what causes acromioclavicular disorders?

A

trauma

osteoarthritis

173
Q

pain on external rotation =

A

frozen shoulder aka adhesive capsulitis

174
Q

adhesive capsulitis aka

A

frozen shoulder

175
Q

scarf test =

A

acromioclavicular disorder

pain on cross body adduction

176
Q

painful arc=

A

subacromial impingement (rotator cuff tendonitis)

177
Q

can’t put on your jacket, impaired external rotation. what shoulder pathology?

A

adhesive capsulitis aka frozen shoulder

178
Q

rotator cuff TEAR is usually who

A

young ppl w trauma

179
Q

painful arc is what

A

70-120 of abduction
then deltoid takes over (not rotator cuff muscles)
–> SUBACROMIAL IMPINGEMENT

180
Q

more worrying causes of shoulder pain that arent rotator cuff, glenohumeral, acromioclavicular or referred neck pain include…

A

MI
gallbladder / subphrenic abscess
apical lung cancer
polymyalgia rheumatica (friend of giant cell)

181
Q

what scan is best for shoulder?

A

ultrasound!!

x ray only if suspect arthritis / dislocation

182
Q

if you suspect referred neck pain causing shoulder pain, what scan

A

x ray c spine

183
Q

when you dislocate your shoulder which joint is it

A

glenohumeral joint

Rheumatology (1 decks)

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