Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheumatology > Introduction > Flashcards

Introduction Flashcards

1
Q

Common rheumatology presentations

A

-Joint pain
-Back pain
-Muscle pain
-Headache
-Regional or generalised pain
-Systemic illness (fever, rash,
muscle/joint pain ++)

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

Non-inflammatory arthritis presentation

A

-Short lived morning stiffness
-Symptoms exacerbated by use, specific movements

=Symptomatic treatment

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

Inflammatory arthritis presentation

A

-Early morning stiffness > 1 hour
and post-inactivity gelling
-Joint swelling (tender, soft tissue
swelling) and warmth
-Erythema suggests septic joint (or
crystal arthritis)
-Improves with exercise, NSAIDs

=Symptomatic and disease modifying treatment

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

Examples of soft tissue pathology

A

-Tennis elbow
-Rotator cuff injury
-Trochanteric bursa

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

Examples of radicular pain causes

A

-Sciatica
-Cervical root irritation

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

Examples of localised, persistent pain causes

A

-Paget’s disease
-Fracture
-Metastases

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

Additional features in history taking

A

-Systemic enquiry
=Photosensitive rash, Raynauds, sicca symptoms, mouth ulcers,
serositis in CTD
=Fever, purpuric rash, multisystem disease in Vasculitis

-Environment
=Smoking a key risk factor for RA
= Alcohol, Sugary drink for Gout

-Past medical history
=Uveitis/Psoriasis/IBD suggestive of Spondyloarthritis
=Metabolic syndrome commonly seen in gout.
=Latent infection TB, HIV relevant prior to immunosuppression

-Family History - relevant across all presentations

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

How does distribution of joint involvement suggest differential diagnosis of inflammatory arthritis?

A

-Monoarthritis= septic arthritis/ gout
-Oligoarthritis (2-4)= spondylo-arthritis
-Polyarthritis (>-5)= RA, Psoriatic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Taking a history for monoarthritis

A

– Gout typically acute onset (<24 hours) of
severe pain with intermittent attacks
– Septic arthritis key differential (consider
recent infection, systemic upset)
– Pseudogout may complicate existing OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Examination of monoarthritis

A

– Hot, red and swollen
– Intensely painful, restricted joint
movements
– Tophi in advanced gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Taking a history in oligoarthritis

A

– Identify prior psoriasis, uveitis, IBD
– Consider recent GI/GU infection in
Reactive arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Examination in oligoarthritis

A

– Search for psoriasis and examine spine
– Dactylitis, enthesitis
– Psoriatic arthritis typically
asymmetrical oligoarthritis, but other
typical patterns include extensive nail
and DIPJ involvement

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

Taking a history in polyarthritis

A

– Gradual onset of inflammatory arthritis
– May have relapsing remitting course
– Acute onset consider viral polyarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Examination in polyarthritis

A

– Joint tenderness, warmth
– Boggy synovial swelling (like a sponge)
– Poor grip strength
– Typically small joint symmetrical involvement
– Characteristic deformities now uncommon

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

Inflammatory features in back pain

A

-Early morning stiffness > 1 hour
-Alternating buttock pain suggests
sacro-ileitis
-Improves with exercise, NSAIDs
-Persistent for >3 months

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

Non-inflammatory features in back pain

A

-Short lived morning stiffness
-Symptoms exacerbated by
use, specific movements

17
Q

Red flag symptoms in non-inflammatory back pain

A

-Weight loss
-History of cancer, neurological symptoms, fever,
night time pain, persistence> 6 week

18
Q

Distribution of back pain differentials

A

-Spinal stiffness, buttock pain= ankylosing spondylitis
-Localised= Paget’s, Vert compression, Metastatic disease, Infection

19
Q

Inflammatory features in myalgia/ muscle pain

A

-Symmetrical pain and stiffness in
shoulder/pelvic girdle
-Early morning stiffness > 45min
-Difficulty rising from bed/chair
-Age greater than 50

20
Q

Non-inflammatory features in muscle pain

A

-Short lived morning stiffness
-Symptoms exacerbated by
use, specific movements
-Diffuse tenderness, fatigue,
sleep disturbance, depression

21
Q

Features of inflammatory myopathy

A

-Proximal muscle weakness
-Skin rash

22
Q

Distribution of myalgia symptoms differentials

A

-Limb girdle stiffness/ pain= polymyalgia
-Generalised myalgia, arthralgia, fatigue (multiple tender points)= fibromyalgia

23
Q

Characteristics of PMR

A
  • Age > 50 yrs
    – Duration > 2weeks
    – Acute phase response
    – Morning stiffness >45min
    – Bilateral shoulder, or pelvic
    girdle aching, or both
    – Exclusion of other diagnoses
    – Rapid response to steroid
24
Q

When should GCA be considered in association with PMR?

A

-New onset headache
-Abnormal/tender temporal artery
-Visual disturbance
-Jaw claudication

25
Q

Investigations in rheumatology

A

-Inflammatory markers
=ESR/CRP

-Radiographs
=Erosions, periarticular osteopenia
=MSK USS/MRI more sensitive
=Sacro-ileitis in SpA

-Immunology
=RF/ANA – many false positives
=CCP/dsDNA more specific

Rheumatology (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions