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Phase 2A (HV) > Miscellaneous- Rheum > Flashcards

Miscellaneous- Rheum Flashcards

1
Q

What is OA

A

Is a non inflammatory degenerative joint pain characterised by the deterioration of articulate cartilage and new bone formation

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2
Q

List 5 symptoms of OA

A 
Joint stiffness 
Joint pain - associated w/ activity 
Bone enlargements 
Crepitus 
Restricted range of motion
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3
Q

What joints are affected in OA

A

PIP
DIP
Carpometacarpal joint

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4
Q

What signs of OA

A

Heberdens nodes- DIP
Bouchard nodes- Pip
squaring of carpometacarpal oint

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5
Q

Signs on X-ray in OA

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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6
Q

Tx for OA

A

Cx- lose weight, exercise, braces, physio/occupational therapy

Rx- oral paracetamol/topical NSAIDs— NSAIDS

Sx- osteotomy, arthroplasty, arthroscopy, fusion of joints

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7
Q

What is RA

A

Inflammatory autoimmune condition of synovial joints

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8
Q

What joints affected in RA

A

MTP
MCP
PIP

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9
Q

What scoring system is used to assess for the severity of RA

A

DAS28

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10
Q

What are the signs/Sx of RA

A 
Early morning stiffness 
Pain eases with use 
Fatigue 
Extra-articular involvement- nodules, pleural effusions, episcleritis, amyloidosis, carpal tunnel 
Symmetrical, deforming polyartropathy
Joint swelling
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11
Q

What signs of RA can be seen on X-ray

A

Loss of joint space
Erosions (periatricular)
Soft tissue swelling
Soft bones (osteopenia)

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12
Q

What is RF

A

Ab against the FC potion of IgG

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13
Q

What is the tx for RA

A 
Regular NSAIDs
During flares- corticosteroids 
Remission- 1st line- DMARD monotherapy
			   2nd line- dual DMARD
				3rd line- methotrexate + TNF inhibitor 
4th- methotrexate and rituximab
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14
Q

What are the signs seen on hands of RA

A

Boutonnières deformity
Swan neck (he pip, flexed dip)
Z thumb
Ulnar deviation

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15
Q

Se of methotrexate

A

Pulmonary fibrosis

Teratogenic

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16
Q

What drug inhibits xanthine oxidase

A

Allopurinolol

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17
Q

List 3 causes of gout

A

Increase consumption of purines- shellfish, anchovies, red meat
Increased production of purines- high fructose syrup contains beverages
Decrease uric acid clearance- CKD
Increased production of uric acid- drugs
Tumour lysis syndrome

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18
Q

What is the cycle to form mono sodium urate

A

Hypoxanthine- xanthine- uric acid- mono sodium urate

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19
Q

Sx and signs of gout

A

Acute swollen hot painful joint
Tophi- on ear, dip elbows, toe
Joints stiffness

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20
Q

Tx for acute flare of gout

A

NSAIDs or colchicine

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21
Q

Tx for lowering urate

A

Allopurinolol + lifestyle changes

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22
Q

Rf for OA

A 
Female
Increasing age
Trauma bone 
Early menopause
FHx 
Obesity
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23
Q

Rf for gout

A 
Male
Obesity
High purine diet
FHx 
Diuretics
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24
Q

Ix for gout

A

Joint aspirate with fluid analysis- needle shaped mono sodium urate crystals negatively birefringent under polarised light

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25
Q

What changes may be seen on X-ray in person suffering form pseudo gout

A

Chondrocalcinosis

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26
Q

What joints mostly affected in pseudo gout

A

Knee
Shoulder
Wrist

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27
Q

Tx for pseudo gout

A

NSAIDS

Or intramuscular/intrartiuclr/ oral steroids

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28
Q

What diseases is pseudo gout associated with

A

Haemochromotosis
Hyperparathyroidism
Wilson’s
Low magnesium and low phosphate

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29
Q

What is osteoporosis

A

A systemic skeletal disease characterised by low bone mass and microarchitectural deterioration therefore increase in bone fragility and susceptibility to fractures

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30
Q

List three endocrine disease that contribute to osteoporosis

A

Cushings
Hyperthyroidism
Hyperparathyroidism
Male hypogonadism

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31
Q

Rf for osteoporosis

A 
Increase age 
Previous fracture 
Corticosteroid use
Smoking 
Excess alcohol 
FHx
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32
Q

What abnormal finding can be found in cross section of bone in osteoporosis

A

Fewer trabecular in spongy bone
Thinning of cortical bone
Widening Haversian canals

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33
Q

Gs Ix for osteoporosis and results

A

Dexa scan- t score of -2.5 or less

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34
Q

What 2 areas are commonly affected in osteoporosis that the dexa scan focuses on

A

Lumbar spine

Hip

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35
Q

What is a t score

A

Standard deviation that is compared to gender matched young adult mean

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36
Q

What criteria are listed in the FRAX assessment tool

A 
Sex 
Weight 
Height 
Previous fracture
Corticosteroid use 
Current smoking 
Parent fractured hip 
Alcohol
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37
Q

Other than dexa scan what other Ix can be done in osteoporosis

A 
X-ray of wrist, spine, hip- of fracture suspected 
MRI spine 
Bone profile- calcium, phosphate, alp 
Vit d levels 
TFTs
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38
Q

Tx for osteoporosis

A

Rx- lifestyle advise (stop smoking, diet, regular exercise)
1st line Rx- bisphosphoneates + vit d and calcium
Desonumab
HRT
Teriparatide

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39
Q

5 sx of a ankylosing spondylitis

A 
Back pain 
Buttock pain 
Uveitis
Enthesis 
Weight loss
Fatigue 
Lower back stiffness
Sleep disturbances
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40
Q

What clinical test can be done to aid diagnosis of ank spon

A

Schrobers test- <20cms

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41
Q

1st line Ix in ank spon

A

Pelvic/back X-ray

Other- Inflamma markers/Hal b27/ mri

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42
Q

What X-ray changes can be seen in ank spon

A

Syndesmophytes (bamboo spine)

Sacroilitis

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43
Q

Tx for ank spon

A

Encourage exercise
1st line- NSAIDs
Intra-articulate corticosteroid injection
DMARDs

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44
Q

Sx and signs of psoriatic arthritis

A

Symmetrical
Dactylitis
History of Psoriasis- pink scaly patches
Onycholisis/ nail pitting
Pain swelling and stiffness of affected joints

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45
Q

What joint is mostly affected in psoriatic arthritis

A

Dip

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46
Q

What X-ray sing is seen in psoriatic arthritis

A

Pencil in cup

47
Q

Tx for psoriatic arthritis

A

Mild- NSAIDs
Severe cases- DMARDS
anti TNF
Ustekinumab and seckinimab

48
Q

What is reactive arthritis

A

An inflammatory seronegative spondylarthropathy that occurs after exposure to GI or GU infections

49
Q

What GU and GI infections are commonly associated with reactive arthritis

A

GU- chlamydia

GI- salmonella, shigella

50
Q

What triad of Sx is seen in reactive arthritis

A

Conjunctivitis
Urethritis
Arthritis

51
Q

What rash is commonly associated with reactive arthritis

A

Keratoderma blennorhagia- waxy Paiutes on palms and soles

52
Q

1st line tx for reactive arthritis

A

NSAIDs
2nd line- corticosteroids
Recurrent cases- DMARDs

53
Q

What is septic arthritis

A

Infection of 1 or more joints

54
Q

What is the most common organism in septic arthritis in following groups
A- young sexually actively adults
B- prosthetic joints
C- IVDU

A

A- neisseria gonorrhoea
B- staph epidermisdis
C- pseudomonas aureginosa

55
Q

Ix for septic arthritis

A

Joint aspiration and synovial fluid analysis
Or
Blood cultures
Joint imaging

56
Q

Tx for septic arthritis

A

IV antibiotics- usually flucloxacillin or clindamycin
Joint washout
Analgesia

57
Q

Which way can osteomyelitis infection occur

A

Through hamategenous spread

Or contagious spread (nearby tissue, trauma, surgical induction)

58
Q

What is osteomyelitis and what joints are affected in
A- children
B- older adults

A

Osteomyelitis is infection of bone +/- bone marrow

A- long bones
B- vertebrae

59
Q

What investigations would occur in osteomyelitis

A

Blood tests- high wccc and high inflammatory markers
Bone biopsy
X-ray- changes seen 2 weeks after contracting osteomyelitis

60
Q

Tx for osteomyelitis

A

Abx- flucloxacillin

Surgical debriedment

61
Q

List 5 Sx of SLE

A 
Photosensitive malar rash sparing nasolabial folds 
Fever 
Oral ulcers
Raynauds 
Arthralgia
Fatigue
62
Q

Name extra manifestations of SLE

A

Pericarditis
Glomerulonephritis
Arthralgia
Anxiety depression

63
Q

What antibody is most sensitive in SLE

A

ANA

64
Q

What Ab is most specific to SLE

A

Anti dsDNA

65
Q

Triggers for flares in SLE

A

Oestrogen containing contraception
Overexposure to sunlight
Stress
Infections

66
Q

Tx for SLE

A

NSAIDs and hydroxychloroquine are the mainstay of SLE treatment and may be sufficient for mild disease alone ± short courses of corticosteroids for flares.

More prominent organ involvement may require long-term corticosteroids, usually in combination with a DMARD as a ‘steroid sparing agent’ to reduce the steroid dose.

Severe flares causing serious renal, neurological or haematological effects may require high dose corticosteroids in combination with immunosuppressants. Cyclophosphamide is effective and is the usual choice.

67
Q

Epidemiology SLE

A 
Affects women (9:1)
Moser common in Afro Caribbean and Asian communities
68
Q

What Ab are associated with anti-phospholipid syndrome

A 
Anti cardiolipin (also present in syphylis- can cause false positive for syph)
Anti beta2 glycoprotein 1 Ab
69
Q

1st line tx for antiphospholipid syndrome

A

Lmwh- dalteparin

70
Q

List 5 sx of dermatomyositis

A 
Groton lesions- scaly patches on knuckles, elbows, knees
Periorbital oedema
Heliotrope rash 
Photosensitive malar rash- shawl like 
Malar rash on face 
Bilateral muscle weakness 
Dyspnoea
71
Q

What investigations would you do in dematomyositis

A

Serum creatinine kinase
EMG
Serum aldolase
Autoantibodies

Muscle biopsy- gold standard

72
Q

What antibodies associate with
A) dermatomyositis
B) polymyositis

A

A) anti- mi2 antibodies and anti jo-1 and ANA

B)anti jo-1

73
Q

1st line tx for dermatomyositis

A

Corticosteroids (methyprednisalone)+
IVIG
immunosuppressants- azathioprine
Rituximab

74
Q

What antibodies associate with limited scleroderma

A

Anti centromere

75
Q

What autoantibodies associated with diffuse scleroderma

A

Anti scl-70

76
Q

Features of limited systemic sclerosis

A 
Cakcinosis 
Raynaud’s phenomenon
Esophageal dysmotility- GORD
sclerodactyly- bright shiny skin on hands and feet 
Telangiecstasia

Skin fibrosis limited to hands, forearms feet and legs, head and neck

77
Q

Features of diffuse systemic sclerosis

A 
Loss of normal skin creases
Restricted mouth opening 
Arthralgia 
Features in history and examination
Family history of systemic sclerosis
Raynaud's phenomenon
Digital pits or ulcers that can be painful and lead to functional disability
Skin thickening, sclerodactyly and loss of function of the hands
Telangiectasia
78
Q

What is the treatment for raynauds

A

Nifedipine- Ccb

79
Q

What medication is contraindicated in raynauds

A

Beta blockers

80
Q

What is the most common benign tumour of the bone

A

Osteochondroma

81
Q

What cells does an osteosarcoma arise from and who is it most common in

A

Osteoblasts

Adolescents

82
Q

What bone b]cancer most commonly involves chromosomes translocation t(11:22)

A

Ewing’s sarcoma (Onion skin like on X-ray)

83
Q

What bone cancer affects the elderly

A

Chondrosarcoma

84
Q

Tx for fibromyalgia

A

Medicine, such as antidepressants and painkillers

Talking therapies, such as cognitive behavioural therapy (CBT) and counselling

Lifestyle changes, such as exercise programmes and relaxation techniques

85
Q

What is sicca syndrome

A

When sjorgen syndrome occurs primarily

86
Q

Sx for sjorgens

A 
Dry eyes
Dry mouth
Vaginal dryness
Burning mouth
Arthralgia 
Raynauds
87
Q

What antibodies associated with sjorgen

A

Anti ro and anti la

88
Q

What drug is used to halt the disease progression in sjorgens

A

Hydroxychloroquine

89
Q

What is GCA

A

A granulomatous vasculitis of large and medium sized arteries

90
Q

Sx of gca

A 
Scalp tenderness
Headaches 
Vision loss
Malaise 
jaw claudictaion
91
Q

1st line Ix for gca

A

Raised esr

92
Q

Tx for gca

A

Corticosteroids

93
Q

What is Wegners granulamatosis

A

A vasculitis affecting the small vessels typically resp tract and kidneys

94
Q

Sx and signs of GPA

A 
Saddle Shaped nose
Nose bleeds
Sinusitis 
Haemotysis 
Cough 
Glomerulonephritis 
Low urine production 
B symptoms
95
Q

Is gpa canca and panca

A

CANCA

96
Q

Tx for wegners

A

COticosteroids + cyclophosphamide

97
Q

What is poyarteritis nodosa associated with

A

Hep b

98
Q

What is osteomalacia

A

A metabolic bone disease characterised by incomplete mineralisation of osteoid following growth

99
Q

Sx of osteomalacia

A 
Waddling gait 
Bone pain
Knock knees
Bowing of legs 
Skull softening
100
Q

List 5 causes of osteomalacia

A 
Vit d deficiency 
Malabsorbtion
CKD
Renal tubular acidosis 
Drugs- phenytoin or carbamazepine 
Cadmium positioning
101
Q

What are the biochemical and radiological finding so osteomalacia

A

Low calcium
Low phosphate
High alp
High pth

X-ray- looser lines whic are lucines going part way through bone

102
Q

What is Padgett disease of bone

A

Disorder characterised by focal areas of increased bone remodelling resulting in poorly organised bone

103
Q

Sx of Padgett

A 
Bowing of femur or tibia 
Bone fractures
Hearing loss
Frontal bossing
Facial pain
104
Q

Skull X-ray in Padgett

A

Cotton wool appearance

105
Q

Chemical finding in Padgett

A

High alp

Normal calcium and phosphate

106
Q

Tx for Padgett

A

Bisphosphonates + calcium and vit d

And analgesia

107
Q

Mutation present in marfans

A

Defect in fibrillin 1 protein

108
Q

How does fibrillin regulate growth

A

Fibrillin sequesters TGF-BETA which stimulates growth

109
Q

What defect causes Ehlers danlos

A

Affects type 3 collagen (found in liver, bone marrow, spleen, arteries and uterus)

110
Q

What is the mode of inheritance in marfans and Ed

A

Autosomal dominant

111
Q

What is feltys syndrome

A

Rare variant of RA
Triad of RA, Splenomegaly and neutropenia

Management is DMARD + corticosteroids (+anti TNF)
Should be vaccinated against influenza and pneumococcus

112
Q

What is Behçet’s disease

A

Uveitis
Erythema nodosum
Recurrent mouth and genital ulcers

113
Q

What is takayasu arteritis

A

Takayasu’s arteritis is a chronic granulomatous vasculitis affecting large arteries: primarily the aorta and its main branches.

Phase 2A (HV) (13 decks)

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