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SAQ style flashcards > MSK AND RHEUM - SAQ high yield topics > Flashcards

MSK AND RHEUM - SAQ high yield topics Flashcards

1
Q

what are the typical features of rheumatoid arthritis ?

A

Swollen painful joints in the hands and feet.
Pain that worsens with rest and improves with activity.
Stiffness that is worse in the morning lasting > 30 minutes
symmetrical joint swelling

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2
Q

which joints are most commonly affected by RA

A

MCP
PIP
wrist
MTP

  • DIP joint is very rarely affected and more likely to represent OA.
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3
Q

What hand signs exist in RA?

A

Z shaped deformity ( thumb)
Swan neck deformity
Boutonniere deformity
Ulnar deviation

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4
Q

what systemic symptoms are present in RA

A

Low grade fever
weight loss
general malaise

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5
Q

what extra-articular manifestations can occur in RA

A

Pulmonary fibrosis
Felty’s syndrome
Sjogren syndrome
AOCD
Eye manifestations such scleritis, episcleritis, keratitis
rheumatoid nodules
carpal tunnel syndrome
bronchiolitis obliterans
amyloidosis

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6
Q

how is rheumatoid arthritis diagnosed

A

RF, Anti-CCP antibodies
CRP/ESR
X-ray

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7
Q

what xray features are present in RA?

A

LESS

loss of joint space
erosions
Soft tissue swelling
subluxation
Juxta-articular osteoporosis

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8
Q

how is rheumatoid arthritis ?

A

DMARD monotherapy +/- a short course of bridging prednisolone.

Methotrexate / Sulfasalazine

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9
Q

how are flares of rheumatoid arthritis managed ?

A

corticosteroids - oral or IM

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10
Q

what is the most common ocularmanifestation of RA ?

A

Keratoconjunctivitis

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11
Q

what score is used to monitor disease activity in RA

A

DAS28

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12
Q

which are the safest DMARDs to use in pregnancy ?

A

Hydroxychloroquine / Sulfasalazine

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13
Q

what are the key xray changes seen in osteoarthritis ?

A

LOSS
Loss of joint space
Osteophytes
Sub-articular sclerosis
Sub-chondral cysts

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14
Q

which joints are commonly affected in Osteoarthritis

A

Knee - most common
Hip - 2nd most common
DIP joint
lumbar and cervical spine

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15
Q

what are the symptoms of osteoarthritis

A

Bulky, bony enlargement of the joint
restricted range of motion
crepitus on movement
joint effusion

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16
Q

what are the signs of osteoarthritis

A

Heberden’s nodes - DIP
Bouchard’s nodes - PIP
Squaring at the base of the thumb

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17
Q

what is the criteria for diagnosis of osteoarthritis

A

patient > 45
typical pain associated with activity
no morning stiffness

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18
Q

what is the non-pharmacological and pharmacological management of OA

A

patient education + lifestyle changes
exercise + Weight loss

topical NSAIDs, oral NSAIDs
Intra-articular joint injections

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19
Q

which medications should be avoided / only used for short-term use in OA?

A

Paracetamol / weak opioids

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20
Q

what conditions are the ANCA antibodies associated with

A

Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis
Microscopic polyangiitis

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21
Q

which conditions are associated with p-anca ?

A

microscoPic polyangiitis = P-anca
Eosinophilic Granulomatosis with Polyangiitis = P-anca EEPY

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22
Q

what conditions are associated with c-anca?

A

granulomatosis with polyangiitis

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23
Q

what are the small cell vasculitis?

A

HSP
Microscopic polyangiitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with Polyangiitis

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24
Q

what are the medium cell vasculitis ?

A

Polyarteritis nodosa
Kawasaki disease

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25
Q

What are the large cell vasculitis ?

A

GCA
Takayasu’s arteritis

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26
Q

what are the features of

  1. Microscopic polyangiitis
  2. Granulomatosis with Polyangiitis
  3. Eosinophilic Granulomatosis with Polyangiitis
A
  1. Glomerulonephritis, diffuse alveolar haemorrhage.
  2. Nasal symptoms, respiratory symptoms, glomerulonephritis.
  3. late onset asthma, sinusitis and rhinitis
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27
Q

How does polyarteritis nodosa present?

A

Renal impairment

Hypertension

Cardiovascular events

Tender skin nodules

28
Q

How does Kawasaki disease present ?

A

High fever (more than 5 days)

Widespread rash

Bilateral conjunctivitis

Strawberry tongue

Coronary artery aneurysms

29
Q

how does Takayasu’s arteritis present

A

Aortic arch affected

“Pulseless” disease

30
Q

what are the 4 classic features of HSP ?

A

Purpura (100%),
Joint pain (75%),
Abdominal pain (50%)
Renal involvement (IgA nephritis) (50%)

31
Q

what is a classical sign of granulomatosis with polyangiitis

A

Saddle shaped nose

32
Q

what is a characteristic finding on FBC in Eosinophilic granulomatosis

A

Raised eosinophils

33
Q

what infection can cause polyarteritis nodosa

A

Hep B

34
Q

what conditions is dermatomyositis associated with?

A

Connective tissue disorders
Underlying malignancy : Ovarian, breast and lung cancer

35
Q

what are the skin features of dermatomyositis ?

A

Gottron’s papules : roughened red papules over extensor surfaces of fingers
Heliotrope rash in the periorbital region
Mechanic’s hands : dry and very scaly hands with linear cracks

36
Q

what antibodies are present in dermatomyositis?

A

ANA
Anti-Jo

37
Q

what are the non skin features of dermatomyositis ?

A

muscle weakness
Raynaud’s
respiratory muscle weakness
Interstitial lung disease
dysphagia and dysphonia

38
Q

what are the patterns of disease of systemic sclerosis ?

A

Limited cutaneous systemic sclerosis
Diffuse cutaneous systemic sclerosis
Scleroderma

39
Q

what are the signs and symptoms of limited cutaneous systemic sclerosis ? What antibodies is it associated with?

A

Raynaud’s disease
Affecting face and distal limbs
CREST
Calcinosis
Raynaud’s phenomenon
oEsophageal dysmotility
Sclerodactyly
telangiectasia

Anti-centromere antibodies

40
Q

what are the symptoms of diffuse cutaneous systemic sclerosis ? what antibodies is it associated with?

A

affects trunk and proximal limbs predominantly
respiratory involvement ( ILD, PAH)
renal disease and HTN

Associated with anti scl-70 antibodies

41
Q

what are the symptoms of scleroderma

A

tightening and fibrosis of skin
manifests as plaques or linear

42
Q

what are the causes of gout

A

chronic hyperuricemia caused due to :
drugs - diuretics
CKD
cytotoxic drugs
myeloproliferative drugs
lead toxicity

43
Q

what are the features of gout ? Where does it commonly affect ?

A

pain, swelling and erythema

main joints affected :
MTP
Ankle
wrist
Knee

44
Q

what investigations are performed in gout?

A

Uric acid measurement in acute setting
synovial fluid sampling : needle shaped negatively birefringent monosodium urate crystals under polarised light

45
Q

how is gout managed ?

A

NSAIDs / colchicine
start allopurinol 2 weeks after initial attack

46
Q

what are the risk factors for pseudogout

A

haemochromatosis
hyperparathyroidism
low magnesium and phosphate
acromegaly and Wilson’s disease

46
Q

what is pseudogout caused by?

A

Deposition of calcium pyrophosphate dihydrate crystals in the synovium

47
Q

what joints are most commonly affected in pseudogout? What does joint aspiration show

A

knee, wrist and shoulders
Joint aspiration shows weakly positive birefringent rhomboid shaped crystals.

48
Q

what does xray show in pseudogout

A

chondrocalcinosis

49
Q

how is pseudogout managed

A

aspiration of joint fluid
NSAIDs, intramuscular / oral steroids

50
Q

causes of mononeuritis multiplex

A

HIV /AIDS , rheumatoid arthritis, diabetes, sarcoidosis,
polyarteritis nodosa, leprosy, carcinomatosis.

51
Q

what conditions present with vasculitis as a feature

A

Infective endocarditis, rheumatoid arthritis, B ehçet’s, SLE,
inflammatory bowel disease, scleroderma, hepatitis В and C,
polymyositis, dermatomyositis.

52
Q

what are the general features of SLE

A

Fatigue
Fever
mouth ulcers
lymphadenopathy

53
Q

what are the dermatological features of SLE?

A

Malar ( butterfly) rash ( sparing nasolabial folds)
Discoid rash
photosensitivity
Raynaud’s phenomenon
livedo reticularis

54
Q

what are the other features of SLE?

A

MSK - arthralgia, non erosive SLE
CV- Pericarditis, myocarditis
Resp- pleurisy, fibrosing alveolitis
Renal - proteinuria, glomerulonephritis
Neuro-psychiatric - anxiety, psychosis, seizures

55
Q

what are the investigations performed for SLE ?

A

ANA positive - highly sensitive
anti-dsDNA and anti-Smith : highly specific

low levels of C3, C4

56
Q

what is the management of ALP syndrome?

A

primary thromboprophylaxis : Low dose aspirin
Secondary thromboprophylaxis : lifelong warfarin

57
Q

what are the causes of reactive arthritis

A

Post STI : Chlamydia trachomatis
Post dysentery : Shigella, Salmonella, campylobacter, yersinia

58
Q

what are the features of reactive arthritis ?

A

urethritis
conjunctivitis
arthritis

59
Q

what are the dermatological features of reactive arthritis

A

circinate balanitis
keratoderma blennorrhagica

60
Q

what is the presentation of psoriatic arthritis ?

A

symmetrical polyarthritis
asymmetrical oligoarthritis typically affecting hands and feet
DIP joint disease
sarcoiliitis

61
Q

what is the most severe features of psoriatic arthropathy

A

arthritis mutilans ( severe deformity fingers / hand and ‘telescoping fingers)

62
Q

what are the nail changes seen in psoriatic arthropathy

A

Pitting and onycholysis

63
Q

what xray changes are seen in psoriatic arthropathy ?

A

'’pencil in cup’’ appearance

64
Q

what is the management of psoriatic arthritis?

A

NSAIDs
methotrexate

65
Q
A

SAQ style flashcards (4 decks)

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