r h e m concise Flashcards

Question

where are nodules in RA seen?

Answer 1

seen in elbows and fingers - firm, non tender mobile or fixed

Answer 2

pericarditis, pericardial effusion fibrosing alveolitis, exudative pleural effusions

Answer 3

episcleritis | secondary sjogren's syndrome

Answer 4

RA with splenomegaly and neutropenania Thrombocytopenia anaemia

Answer 5

4/7 of 1. Morning stiffness >1h (lasting >6wks) 2. Arthritis ≥3 joints 3. Arthritis of hand joints 4. Symmetrical 5. RA nodules 6. positive RF 7. radiographic changes

Answer 6

LESS loss of joint space or narrowing boney erosions soft bones - osteopenia soft tissue swelling

Answer 7

bloods =FBC - feltys syndrome - anaemia, thrombocytopenia, neutropenia CRP/ESR RF, anti CCP = specific, ANA X-ray

Answer 8

psoariatic arthritis = nail changes and plaques chronic crystal arthritis jaccoud's arthritis

Answer 9

conservative = regalar exercise, PT, OT = aids, splints medical = DAS28 assessment to monitor disease activity, DMARDS and biologicals early steroids IM PO or intra articular for exacerbations NSAIDs for sx relied manage CVS risk = RA accelerates atheresclosis prevent osteoporosis and gastric ulcers

Answer 10

cause myelosuppression = pancytopenia methotrexate = hepatotoxic, pulmonary fibrosis sulfalazine = hepatotoxic, reduced sperm count hydrochloroquine = retinopathy, seizures

Answer 11

deposition of monosodium rate crystals in and around joints

Answer 12

acute monoarthrits with severe joint inflammation greater toe MTP = podagra can also present as asymmetric oligoathrits, deposition of rate in pinna and tendons = tophi renal disease = radiolucent stones and interstitial nephritis

Answer 13

SA pseudogout haemoarthritis

Answer 14

1. hereditary 2. drugs = diuretics, NSAIDs 3. reduced renal excretion = renal impairment

Answer 15

polarised light microscopy = negatively birefringent needle shaped crystals increased serum rate

Answer 16

NSAID's - diclofenac colchicine use steroids if NSAID's are contraindicated

Answer 17

conservative = weight loss, avoid EtOH excess allopurinol = xanthine oxidase inhibitors

Answer 18

group of inflammatory conditions affecting spine and peripheral joints without production of RFs, associated with HLA B27 allele AS psoriatic arhtris reactive arthritis

Answer 19

chronic disease characterised by stiffening and inflammation of spine and sacroiliac joints gradual onset back pain progressive loss of all spinal movements costocondritis

Answer 20

Schober's test , less than 5cm some pt with question mark posture = thoracic kyphosis and neck hyperextension

Answer 21

osteoporosis acute iritis or anterior uveitis apical pulmonary fibrosis

Answer 22

clinical dx sacroiliitis - ireegularitis, sclerosis, erosions bamboo spine - calcification of ligaments and periostea bone calcification FBC anemia, increased ESR/CRP, HLA B27 DEXA scan and CXR

Answer 23

conservative - exercise, physio medical - NSAID's, anti TNF if severe, local steroid injections, bisphosphonates hip replacement to reduce pain and increase mobility

Answer 24

pencil in cup deformity = erosion

Answer 25

NSAIDs, sulfasalazine, methotrexate, ciclosporin, anti TNF

Answer 26

sterile arhtris 1=4 weeks after urethritis or dysentry Urethritis: chlamydia, ureaplasma  Dysentery: campy, salmonella, shigella, yersinia

Answer 27

increased cap, ESR stool culture if diarrhoea urine chlamydia PCR

Answer 28

NSAID's and local steroids

Answer 29

inflammation of medium to large sized vessels, arteries associated with PMR

Answer 30

``` systemic = fever, malaise, fatigue headache - unilateral temporal artery and scalp tenderness jaw claudication amarosis fugax prominent temporal arteries, pulsation ```

Answer 31

``` do ESR and starrt red 40-69mg/d PO increase ESR, CRP increased ALP reduced Hb, increased Plts temporal artery biopsy ``` PPI and alendronate cover = steroids risk

Answer 32

severe pain and stiffness i shoulders, neck and hips, symmetrical, worse in morning, no weakness carpal tunnel systemic sx = fever. fatigue, weight loss GCA association

Answer 33

increased ESR, CRP, increased ALP normal CK rx = pred tapering course add PPI and alendronate cover

Answer 34

condition of central pain processing characterized by chronic widespread pain in all 4 quadrants of the body sleep deprivation

Answer 35

neurosis = depression, anxiety, stress low income divorce

Answer 36

chronic widespread MSK and tenderness ``` morning stiffness fatigue poor concentration sleep disturbance low mood ``` Lx all normal

Answer 37

educate pt CBT graded exercise programs amitriptyline or pregabalin

Answer 38

multi systemic autoimmune inflammatory disease | which autoAbs to a variety of autoantigens result in the formation and deposition of immune complexe

Answer 39

relapsing and remitting history constitutional sx = fatigue, weight loss, fever and myalgia SOAP BRAIN

Answer 40

S erositis - Pleurisy, pericarditis  O ral ulcers - usually painless; palate is most specific  A rthritis – small joints nonerosive  P hotosensitivity – or malar or discoid rash  B lood disorders – low WCC, lymphopenia, thrombocytopenia, hemolytic anemia  R enal involvement -glomerulonephritis  A utoantibodies (ANA positive in >90% cases)  I mmunologic tests e.g. low complements  N eurologic disorder - Seizures or psychosis

Answer 41

ANA Anti Ro, Anti La Anti dsDNA Antiphospholipid - increase risk of pregnancy loss and thrombosis

Answer 42

sun protection - SPF reduce CVS risk hydrochloroquine = rash and arthralgia short courses of prednisolone for flares mycophenolate mofetil, azathioprine commonly used

Answer 43

multisystem autoimmune disease increased fibroblast activity result in abnormal growth of connective tissue leading to vascular damage and fibrosis limited SS (70%) vs diffuse SS

Answer 44

limited SSc CREST ``` calconosis cutis raynaud's oesophageal and gut dismotility scelrodactyly telangiectasia skin involvelemt = beak nose, microstomia pulmonary HTN ```

Answer 45

no cure pre for acute attacks  Raynaud’s: CCBs, ACEi, IV prostacyclin  Renal: intensive BP control – ACEi 1st line  Oesophageal: PPIs, prokinetics (metoclopramide)  PHT: sildenafil,

Answer 46

FBC - anaemia, UE renal impairment ANA positive Abs - centromere in limited, ``` Scl 70 and RNA polymerase III in diffus e X-ray hands- calcinosis CXR, HRCT, PFT- pulmonary disease ECG & ECHO - PA hypertension, heart failure, myocraditis and arrhythmias, ```

Answer 47

``` mnemonic –madfred! Myalgia Arthralgia Dry Mouth Fatigue Raynaud’s phenomenon Enlarged parotids Dry eyes ```

Answer 48

Anti Ro and Anti La Antibodies – 90% of patients RF & anti ds-DNA salivary gland biopsy may be needed treatment is symptomatic Avoid dry or smoky atmospheres Dry eyes--artificial tears Dry mouth -artificial saliva, sugar free gum/pastilles Skin emollients, vaginal lubricants

Answer 49

A skeletal condition characterized by low bone mass, deterioration of bone tissue, and disruption of bone architecture that leads to compromised bone strength and an increased risk of fractur

Answer 50

Non-modifiable - Advanced age (>65 years) - Female gender - Caucasian or south Asians - Family history of osteoporosis-genetic - History of low trauma fracture (fall from standing height or less, at walking speed or less. Modifiable - Low body weight (58 kg or body mass index [BMI] <21) - Premature menopause (age<45) - Calcium/vitamin D deficiency - Inadequate physical activity - Cigarette smoking - Excessive alcohol intake (>3 drinks/day) - Iatrogenic: e.g. corticosteroids, aromatase inhibitors

Answer 51

DEXA) of the lumbar spine and hip

Answer 52

- T-score is the number of SDs from the mean bone density of persons of same gender at age of peak density (25 years) - T-score minus 2.5 or less = osteoporosis - Normal BMD = T-score ≥ −1 - Osteopenia = T-score between −1 and −2.

Answer 53

The Z-score is a comparison of the patient’s BMD with an age- & gender-matched population -A Z-score

Answer 54

osteopenia = weight-bearing exercise, vitamin D3 supplementation (800-2000 IU/day), limiting alcohol, and smoking cessation. Dietary advice regarding calcium intake; supplements if needed. osteoporosis = Vitamin D ± calcium supplementation plus: 1st line: Oral bisphosphonates, or IV if oral not tolerated. 2nd line: Denosumab or teriparatide

Answer 55

due to vasospasm of the digits. It is painful and is characterized by a typical sequence of colour changes in response to a cold stimulus. It is often also precipitated by stress. white- inadequate blood flow blue -venous stasis red -re-warming hyperaemia.

Answer 56

SSc SLE Sjogrens syndrome use of heavy vibrating tools cervical rib beta blockers

Answer 57

keep warm avoid smoking. Calcium-channel blockers are the first-line. Phosphodiesterase-5 inhibitors, and prostacyclins are usually effective.

Answer 58

digital ulcers, severe digital ischaemia and infection.

Answer 59

steomalacia describes softening of the bones secondary to low vitamin D levels that in turn lead to decreased bone mineral content. rickets in children

Answer 60

``` vitamin D deficiency malabsorption lack of sunlight diet chronic kidney disease drug induced e.g. anticonvulsants inherited: hypophosphatemic rickets (previously called vitamin D-resistant rickets) liver disease: e.g. cirrhosis ```

Answer 61

bone pain bone/muscle tenderness fractures: especially femoral neck proximal myopathy: may lead to a waddling gait

Answer 62

bloods low vitamin D levels low calcium, phosphate (in around 30%) raised alkaline phosphatase (in 95-100% of patients) x-ray translucent bands (Looser's zones or pseudofractures)

Answer 63

vitamin D supplmentation a loading dose is often needed initially calcium supplementation if dietary calcium is inadequate