Presentations Flashcards
1
Q
Ankylosing Spondylitis (5)
A
Young Man with:
1. Lower back stiffness +/- Pain
2. Better after activity (morning stiffness)
3. Pain at night which is better when they get out of bed
4. The 8 A’s
5. Lumbar Spine and Sacro-ilieal joint involvment
2
Q
List the 8 A’s of Ankylosing Spondylitis (8)
A
- Anterior Uveitis
- AV Node Block
- Aortic Regurgitation
- Arthritis (peripheral) 25% - more common if female
- Apical Lung Fibrosis
- Achilles Tendonitis
- Amyloidosis
- And Cauda EquinA syndrome
3
Q
APS (Antiphospholipid Syndrome) (6)
A
- Venous & Arterial Thromboses
- Recurrent early Miscarriages
- Livedo Reticularis - web-like purple leg veiny discolouration
- Pre-eclampsia
- Pulmonary HTN
- +/- SLE - 30% of SLE patients have APS
4
Q
Antisynthetase Syndrome (4)
A
- Myositis
- ILD - Interstitial Lung Disease
- Thickened and cracked skin on hands
- Raynaud’s
5
Q
Behcet’s Disease (8)
A
TRIAD:
1. Mouth Ulcers
- Genital Ulcers
- Anterior Uveitis
- Arthritis
- DVT or Thrombophlebitis
- GI: abdo pain, diarrhoea
- Erythema nodosum
- Aseptic Meningitis
6
Q
Dermatomyositis and Polymyositis (8)
A
SYMMETRICAL SYMPTOMS
- Photosensitive skin leading to macular rash over neck and shoulders (as exposed to sun)
- Helitrope rash around eyes
- Gottron’s papules - symmetrical red rough papules over extensor surfaces of joints - fingers and elbows
- Thick cracked skin on hands
- Proximal muscle weakness
- Reynaud’s
7 ILD
- 25% are paraneoplastic syndromes
7
Q
Discoid Lupus Erythematous (3)
A
- Erythematous, raised, red, scaly lesions on the head, face, neck, scalp, ears
- May be photosensitive
- Atrophy heals lesions causing alopecia or pigmentation
8
Q
Drug-Induced Lupus (8)
A
- Arthralgia
- Myalgia
- Malar rash
- Pleurisy
- ANA + in 100%, ds-DNA negative
- Anti-Histone antibodies
- Anti-Ro / Anti-smith
- On Proclainamide or Hydralazine + other drugs - see pharmacy section
9
Q
Ehler-Danlos Syndrome (7)
A
- Hyper mobility form type 3 collagen disorder
- Elastic, fragile skin
- Joint hypermobility - recurrent dislocations
- Easy bruising
- Aortic regurgitation - mitral valve prolapse and aortic dissection
- SAH
- Angioid retinal streaks
10
Q
List the 8 Rheumatological DDxs for Adult Hip Pain and summarise each presentation: (8)
A
- Osteoarthritis - worse with exercise, loss of int. rot. first. Age and obesity
- Inflammatory Arthritis - Morning stiffness, systemic features, Raised ESR/CRP
- Meralgia Parasthetica - Compression of lateral cutaneous nerve - burning in antero-lateral thigh
- Referred Lumbar Spine pain - trapped femoral nerve. Leg extension + knee flexion = pain / tingling
- Greater trochanteric Pain Syndrome - Pain and tenderness over greater trochanter
- Avascular Necrosis Femoral Head - gradual or sudden onset - may follow steroids course or # or dislocation
- Pubic Symphisis Dysfunction - Pregnancy, waddling gait, laxity in ligaments refers pain medial groin and medial thigh/hip
- Transient Idiopathic Osteoporosis - Pregnancy, rare, 3rd trimester, limited ROM of hip + groin pain +/- unable to weight bare
11
Q
Paget’s Disease of Bone (5)
A
- Old man
- Bone Pain
- Raised ALP
- Sensory-Neural Hearing Loss
- Skull thickening
12
Q
Rheumatoid Arthritis (6)
A
- Swollen painful hands and feet joints
- > 60 minutes Morning Stiffnes
- Insidious onset
- Fatigue
- > 3 joints
- Positive metacarpal squeeze pain
13
Q
Psoriatic Arthritis (8)
A
- Asymmetrical swelling of hands
- Nail chenges - pitting
- Dactylitis
- Systemic polyarthritis like RA
- Sacroilieitis - confuses you with Ank Spond
- Does NOT spare the DIP - infact, a common site of inflammation
- +/- known or newly seen psoriasis -this often preceeds the plaques though
- Achilies tendonitis
