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MIca week 8 Flashcards

1
Q

What is this rash?

A

butterfly

SLE

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2
Q

What is the antibody in SLE

A

Anti nuclear

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3
Q

IN what demographic is SLE?

A

chcinese, asian, afrocaribean

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4
Q

What are characteristics of SLE

A

Serositis

Oral ulcers
Arthritis
Photosensitivuty
Blood
Renal

ANA
Immune
Neurologoic
Malar
Discoid

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5
Q

What are tests yo woudl like to do

A

FBC normochromic normocytic anaemia, ESR, ANA,anti-dsDNA

Auto antibodies- anti-SM, anti dsDNA,

complement

CXR

renal biopsy

MRI/CT

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6
Q

What conditions that are associated with SLE

A

Autoimmune: scleroderma, polymyositis, Rheumatoid, Sjogren

anti phospholipid syndrome

CVD, HTN, OSteoporosis, Non Hodkiin Lymphoma

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7
Q

What is the mangement of SLE

A

carful counselling

lifestyle- diet exercise, mentalwellbeing, flu jab, family planning

symptomatic- pain control, NSAIDS, analgesia, physiottherapy

Specialist- steroid, hydroxychlorouiune,cyclophosphamide,mycophenolate, azathioprine, boilogics

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8
Q

what is a poor indication in SLE?

A

renal involvement

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9
Q

What is Sjogren disease?

What are the types

A

lymphocytic infiltration of exocrine glands

primary

secondary: rheumatoid artrithis,SLE, systemic, sclerosis

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10
Q

What are the symptoms of Sjogrens?

A

raynauds

dysparunia

eye dry

dry mouth - drink a lot

dry skin

fatigue

PArotid or submandibular swelling

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11
Q

What do you do in examination of Sjogrens?

A

Schirmer’s test- filter paper put in lower conjuctiva

drool test

submandibular or parotid swelling, lymphadenopathy

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12
Q
A
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13
Q

What investigation would you do for Sjogrens

A

anti Ro, Anti La antibodies

FBC- anaemia of chronic disease

U&E

ESR - high

LFT’s
immunoglobulin (RhF +, ANA+, anti Ro/ La ab +)

USS of salivary gland

biopsy and immunohistology

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14
Q
A
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15
Q

What is the managementof Sjogren’s

A

mouth- artificial saliva, good dental hygien, hugh fluoride

  1. Eyes- artificial tears, ophtalmology- puntal plug, cyclosporin eue drops
  2. Other symtoms- analgesia for arthralgia, emolient for skin, raynauds specific

4,- systemeci therapy - Hydroxychloroquine

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16
Q

WHat are patietns with Sjoegren at higher risk of getting?

A

non Hodgekin Lymphoma

17
Q

What are distinguishing feature between OA and RA

A

OA: unilateral, worse at night, weight baring joints (heberden adn bouchards)
RA: symmetrical, better in the morning, (swann neck deformity, boutonniere, z thumb, ulnar deviation), poly

18
Q
A
19
Q
A

loss of joint space

subchondral cyst

osteophyte

20
Q

What does the trendelenberg test and what condition does it show

A

stand but one leg up

look at the hip adductors

missalignement

DAMAGED in osteoarthritis

21
Q

What is the thomas test

A

ask patient to bring knee to the chest when lying down

Can not keep the other leg hanging down

SIGN OF osteoarthritis

22
Q

What is polymyalgia rheumatica

A

inflammatory condition

with severe bilateral pain and stiffness in the morning

Hip and shoulder and neck

23
Q

in what demographic do you find patients with polymyalgia rheumatica?

A

old lady

24
Q

what does polymyositis present with?

A

weakness

NOT really pain

25
Q
A
26
Q

What is the treatment for patients with polyathraliga rheumatica

A

RISk of diabetes melitus

prednisolilone 3 weeks and wean them down

treatment for 1-2 year

Bisphophonates, Vit D3

Diet exercise

PPI

lipid and BP

27
Q

in polymyaligia rheumatica what are the marker you use to identify if your treatemnt is working?

A

ESR

symptoms

28
Q

What are symtpoms of Giant cell arteritis

A

unilateral headache

vision changes- shades, blurred, double vision, visual loss

jaw claudication

scalp tenderness

PMR

29
Q

How do you manage a patient with GCA

A

no visual sympoms- 40-60 mg prednisolone , PPI and arrange bloods if possible - refere urgently to rheumatology within 3 days- may arrange biopsy

if visual symptoms- start prednisolone 60-100mg, PPI cover and same day assesment with ophtalmology

30
Q

reactive arthrits

A

seronegative clinically associatedwith inflammationback pain

31
Q

What are symptoms seen in reactive arthritis

A

FEVER,

Malaise

GU/GI

lower back pain

heel pain - achilles tendonitis

erythema nodosum

uvitis

urethritis

arthritis

can’t see, can’t pee and climb a tree

32
Q
A
33
Q

WHat are investigations for a monoarthritis

A

Esrr/ CRP

FBC

HLA B27

Joint aspiration

underlying GI/GU

34
Q

What are management

A

treat infection

phy

35
Q

What are bloods to monitor paitients on methotrexate

A

FBC

U&E- look at creatinine

LFT

36
Q

What are drugs you can not give patientts on methotrexate

A

trimethoprim

37
Q

What areside effect

A

photosensitivity

agranuloysitossi

liver imparement

lung fibrosis

38
Q

What areinvestigations for GOUT

A

exclude: septic arthritis, pseudo gout adn RA or OA

serum urate

39
Q

What is the management for gout

A

RICE: rest, ice, compression and elevation
NSAIDS,colchicine, steroids think of PPI

Allopurinol for prevention but not in acute episode because precipitates symptome

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