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Y6 Senior Med > Rheum > Flashcards

Rheum Flashcards

1
Q

What are red flags forr back pain

A 
Age (<20 or >55) 
Sphincter disturbance 
Recet / current infection 
Malignancy 
Morning stiffness 
COnstant or progressive pain 
Neuro disturbance 
Bilareral / alternating leg pain 
FLAWS 
Thoracic back pain 
Nocrturnal pain
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2
Q

Ix for lower back pain

A

MRI only if suspected malignancy / fracture, infection, ask spond

NEVER XR

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3
Q

how do you manage lower back pain

A
  1. conservative: physical acrivity and exercise
  2. medical: NSAID + PPI

consider group exercise programme, manual therapy, radiofrequency denervation, epidural injections

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4
Q

What is RA

A

chronic inflammatory disease characterised by SIMMETRICAL DEFORMING POLYARTHRITIS

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5
Q

What is epidemiology like in RA

A

smokers
F>M
middle aged

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6
Q

sx of RA

A

swollen painful small joints in hands and feet
ulnar deviation of MCPs and radial deviation at wrist
Morning stiffness, better with exercise

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7
Q

late fts of RA (pathomnemonic=

A

Swan neck
Boutonierre
Z thumb
Ulnar deviation at MCP

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8
Q

What is a boutonniere deformity

A

PIP is flexed

DIP is hyperextended

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9
Q

What is a swan necjk deformity

A

PIP is hyperextended

DIP is flexed

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10
Q

What are bedside Ix for RA

A 
DAS 28 (disease activity score 28) 
Squeeze test postive
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11
Q

why is the DAS 28 called that?

A

because there are 28 bones in the hand

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12
Q

what is thhr squeeze test

A

discomfort squeezing across the MCPJ or MTPJ

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13
Q

Bloods for RA

A 
FBC(anaemia, low PMN, high platelets) 
Raised ESR, CRP 
RhF +
anti-CCP +
ANA +
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14
Q

which is the most specific and sentitive antibody for RA

A

anti-CCP

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15
Q

What antibody correlates severe progressive diseasse?

A

RhF

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16
Q

what imaging should you get for RA

A

XR
USS (synovitis)
MRI
CXR

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17
Q

What do you need to monitor in RA

A

CRP
DAS28
Tender and swollen Joint Count

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18
Q

How do you manage RA

A

DMARD monotherapy + bridging prednisolone short course

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19
Q

What are DMARDD medication examples

A

methotrexate, sulfasalazone

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20
Q

what investigations should you get often if on methotrex

A

regular FBC and LFT (risk of myelosuppression and liver cirrhosis)=

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21
Q

how do you treat RA flare

A

CORTICOSTEROD + NSAID

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22
Q

what is driving process behind RA

A

Autoinflamm!

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23
Q

What are RA findings on radiographh

A 
LESS
loss of joint space 
Erosions (periarticular) 
soft tissue deformity 
sublazation and deformity
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24
Q

Whhat is driving process behind OA

A

mechanical wear and tear

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25
Q

what age group is OA most common

A

elderlhy

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26
Q

what joints are affecte in OA

A 
weightberaring joints (knee, hip) 
Hands: CMC, DIP, PIP
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27
Q

what joints are affected in RA

A

Hands (MCP, PIP)

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28
Q

What is pain like in OA

A

pain following use (because this is mechanical wear!!)
pain improves with rest
unilateral
systemically well

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29
Q

what is pain like in RA

A

morning stiffness
pain improves with use
bilateral
systemic unwell

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30
Q

what are XR findings in OA

A 
LOSS 
loss of joint space 
osteophytes 
subchondral sclerosis 
subchondral cysts
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31
Q

what is the aetiology of gout

A 
monosodium urate (MSU) crystal deposition in and around the joints 
this causes erosive arthritis
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32
Q

what can precipitate a gout attack

A

surgery
infection
fasting
diuretics

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33
Q

who is gout common in

A

men

with HTN, IHD, metabolic syndrome

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34
Q

what are causes of gout

A

drugs (diuretics, aspirin, cytotoxics)
decreased urate extretion (renal impairment)
increased cell turnover (lymphoma, leukaemia, psoriasis, haemolysis)
Alcohol excess
Purine-rich food (beef, llamb, pork, seafood)

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35
Q

S/S gout

A

MONOARTHRITIS
(usually on first MTP)

Tophi (urate in pinna and tendons)
radiolucent kidney stones
iinterstitial nephritis

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36
Q

what ix should you get in gout

A 
serum urate (high or normal) 
XR (shows late findings of punched out erosions "RAT BITES" and reduced joint space) 
Fine needle aspiration and polarised light microscopy (negatively birefringent, needle shaped crystals)
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37
Q

how do you manage gout ACUTE ATTACK

A

ACUTE attack: Colchine, NSAID

if renal impairment: steroids

follow up in 4-6 weks

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38
Q

what are contreaindications of NSAIDS

A

warfarin
PUD
HF
CRF

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39
Q

How do you manage CHRONIC gout

A

Conservative: WL, avoid alcohol

Urate lowering therapy: allopurinol (xanthine oxidase inhibitor)

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40
Q

what is psudogout caused by

A

calcium pyrophosphate crystals

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41
Q

what joints ar affected by pseudogout

A

BIGGER joints (knee, wrist, hip)

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42
Q

What will needle aspiration show for pseudogout

A

positively birefringent, needle shaped crystals

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43
Q

how do you manage pseudogout

A

analgesia
NSAIDS
steroids

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44
Q

what are the four seronegative spondyloarthropathies

A

psoriatic arthritis
enteropathic arthritis
alkylosing spondylitis
reactive arthritis

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45
Q

what are seronegative spondyloarthropathies

A

inflammatory arthritis affecting spine and peripheral joints
with NO RhF production
HLA B27 assdociation

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46
Q

What is alk spond sx

A 
back pain, relieved by exercise 
morning stiffness 
costochondritis (anterior chest pain) 
SOB (pulm fibrosis)
eye pain 
osteoporosis
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47
Q

what is alk spond associated with

A 
AAAAAA 
Anterior uveitis 
Apical lung fibrosis 
aortic regurg 
AV node block 
Achilles tendonitis 
Amyloidosis
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48
Q

who will alk spond occur in

A

YOUNG MEN

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49
Q

what exam can you do for alk spond

A

Schober’s test - mark L5, place a finger 5cm above and 5 cm below the mark, get them to bend over

if there is less than a 5cm increase >POSITIVE for AlkSpond

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50
Q

What ix can you get for ALkSpond

A

XR
MRI
HLA-B27 testing
ESR, CRP (non specific)

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51
Q

what changes do you see on XR / MRI spine for alkspond

A

sacroilitis
sclerosis
ankylosis (fusion)
bamboo spine (squaring of lumbar vertebrae)

52
Q

how do you manage alkspond

A

conservative (exerciis / physio)
medical (NSAID > anti-TNFa)
surgical (hip replacement to decrease pain and increase mobility

53
Q

what is psoriatic arthritiis

A 
Psoriasis 
Nail changes - pitting, onycholysis, subungal hyperkeratosis 
Enthesitis 
Dactylitis (swollen sausage finger) 
Arthritis (usually of DIPJ)
54
Q

mx psoriatic arthritis

A

NSAID > methotrex

55
Q

what is Reiter’s / Reactive arthritis

A

sterile arthrisis 1-4 weeis after urethritis (chlamydia) or dysentry (campylobacter)

56
Q

sx of reactive arthritis

A

can’t see
can’t pee
can’t cliimb a tree

so: conjunctivitis, urethritis, oligoarthritis in LL
also circinate balanitis, keratoderma blenorrhagicum

57
Q

ix Reactive arthritis

A

raised ESR, CRP
stool culture if diarrhoea
urine test chlamydiia

58
Q

mx Reactive arthritis

A

NSAIDS

PO steroids

59
Q

Behcet’s disease in whom

A

mediterranean, turkish, japanese

60
Q

S/S behcet disease

A

recurrent oral and genital ulceration, uveitis, erythema nodosum, VTE

61
Q

Sjogren syndrome sx

A

dry eyes
bilateral parotid swelling
decreased salivation, xerostomia
vaginal dryness

62
Q

ix for Sjogrens

A

Schirmer’s test

Antibodies (anti Ro, anti La, RhF)

63
Q

Mx sjogrens

A

artificial tears, saliva replacement

NSAID/hydroxychloroquine

64
Q

SLE symptoms

A 
SOAP BRAIN MD 
seroritis 
oral ulcers 
arthritis 
photosnsitivity 
blood counts all low 
renal damage (proteinuria, haematuria) 
ANA high 
immunological (anti dsDNA, AIHA) 
neurological (psych sx, seizures)
65
Q

what condition does antiphospholipid syndrome often occur with

A

occurs with SLE in 30% of cases

66
Q

How does APS present

A

Thrombi
Thrombocytopoenia
Antibodies

Also:
livedo reticularis
recurrent miscarriage

67
Q

how do you manage APS

A

low dose aspirin if no prior VTE

warfarin if prior VTE

68
Q

what antibodies are raised in APS

A

anti-cardiolipin

lupus anticoagulant

69
Q

what antibodies ix must you do if suspecting lupus

A

ANA (most sensitive, poorly specific)
anti-dsDNA
anti-smith
RhF

70
Q

how do you monitor SLE disease

A

anti-dsDNA titers (marker of disease activity)
C4 reduction (moderate activity) > C3 wrduction (very active lupus)
ESR lvels

71
Q

how do you mansage SSLE

A

FLARES: prednisolone + IV cyclophosphamide

MAINTAINANCE: hydroxychloroquine + DMARD

72
Q

what are the five fts of limited systemic sclerosis

A 
CREST 
calcinoosis 
raynauds 
oesophageal dysmotility 
sclerodacyly
telangectasia
73
Q

what are fts of diffuse scleroderma

A

diffuse skin involvement beyond wrists, up the arms
diffuse organ fibrosis:
- GI (GOR, aspiration, dysphagia, anal incontinence)
- Lung (fibrosis, pul HTN)
- cardiac (arrythmia)
- renal (acute HTN crisis)

74
Q

antibodies for systemic sclelrosis

A

Limited: anti-centromere
Diffuse: anti-SCL70, anti topoisomerase

75
Q

what is polymyositis

A

inflammation of skeletal muscle

76
Q

polymyositis sx

A

progressive proximal muscle weakness
with myalgia and arthralgia
wasting of shoulder and pelvic girdle
dysphagia, dysphonia, resp weakness

77
Q

what can trigger polymyositis

A

paraneoplastic tumour

78
Q

whhat is dermatomyositis

A

polymyositis + skin signs

79
Q

what skin signs do you get with dermatomyositis

A

priorbital heliotrope rash (worse in sunlight)
gottron’s papules
mechanic hands (painful rough skin)

80
Q

what ix do you gt for myositis

A 
RAISED CK (1000s) 
AST, ALT, LDH raised 
EMG 
Biopsy (definitive) 
Antibodies (anti-Jo1, Anti-Mi2, anti-SRP) 
MALIGNANCY screen
81
Q

give examples of two large vessel vasculitis

A

GCA

Takayasu

82
Q

give examples of two medium vessel vasculitis

A

Polyarteritis nodosa

Kawasaki disease

83
Q

give examples of two small vessel vasculitis

A

Churg strauss
Wegeeners granulomatosis
HSP, goodpastures

84
Q

What antibody with Churg Strauss?

A

pANCA

85
Q

what antibody with Wegeners

A

cANCA

86
Q

sx of GCA

A

scalp tenderness
jaw cladication
headache
amarosis fugax (ischaemic optic neuropathy)

87
Q

ix GCA

A

USS temporal artery (halo sign)
if USS negativem, get a temporal artery biopsy

Raised ESR

88
Q

how do you manage GCA

A

PO prednisolate immediately (before ix)

89
Q

what do you give for GCA if visual sx

A

IM methylpred

90
Q

how does takayasu arteritis present

A 
Asian females 
20-40yo 
weak/unequal limb pulses 
HTN 
large vessel blockage
91
Q

how does Polyarteritis nodosa present

A 
young male adult 
systemic symptoms 
rash 
melaena, abdo pain 
renal: HTN 
liver dysfunction (HBV)
92
Q

How do you manage polyarteritis nodosa

A

prednisolone + cyclophosphamide

93
Q

How does Wegeners prsent

A

URT: rhinitis, epistaxis, saddle nose
LRT: haeemoptysis, cough
renal: RPGN, nephritic syndorme

94
Q

Chung strauss sx

A

eosiniophilia
asthma
vascultisi

95
Q

what meds can you give for chronic pain

A

All diabetics get peripheral (neuropathy)

amytryptiline
duloxetine
gabapentine
pregabalin

96
Q

first line mx for neuropathic pain

A

amytriptyline and pregabalin

97
Q

first line mx diabetic neuropathy

A

duloxetine

98
Q

first line trigeminal neuralgia c

A

carbamazepine

99
Q

what is stills disease

+ what are its findings on blood test

A

type of inflammatory arthritis presenting with FAR:

Fever (SPIKES in the evenings)
arthralgia
Rash (salmon pink maculopapular)

negative RF, ANA
high ferritin

100
Q

mx stills diseae

A

NSAID

add srteroid after one week

101
Q

How does pseudogout present on X ray?

A

CHONDROCALCINOSIS (deposits of calcium along joint line)

otherwise may mimic OA

102
Q

what are heberden and bouchard nodes

A 
Heberden = swollen DIP 
Bouchard = swollen pip

in Osteoarthrtis

103
Q

what is cervical spondylosis

A

degeneraton of cervical spine
impinges onto spinal cord > compresses nerve root and anterior spinal cord
causes DEGENERATIVE CERVICAL MYELOPATHY

104
Q

sx DEGENERATIVE CERVICAL MYELOPATHY

A

pain in neck and arms
numbness in neck and arms
loss of motor function (digital dexterity)

105
Q

signs DEGENERATIVE CERVICAL MYELOPATHY

A

LMN in upper limbs

UMN in LL (including autonomic dysfunction)

106
Q

what sign is POSITIVE In DEGENERATIVE CERVICAL MYELOPATHY

A

Hoffman

107
Q

management of DEGENERATIVE CERVICAL MYELOPATHY

A

urgent neurosurgery referral

needs IV methylpred + decompression

108
Q

what will you find when examining a patient with GCA

A

swelling and erythema over temporal artery
thickened, non pulsatile temporal artery
reduction in visual acuity

109
Q

what are the two types of gout

A

PODAGRA = acute attack, excruciating pain swelling and hot 1st MTP

Chronic TOPHACEOUS GOUT = chronic disease, depositon of TOPHI in joints, tendons, pinna

110
Q

whhat dietary advice should you gve to someone with gout

A

avoid meat, alcohol, prolonged fasting

lose weight

111
Q

what does XR show in gout

A

punched out erosions “RAT BITES” and reduced joint space

112
Q

classic presentation of POLYMYALGIA RHEUMATICA

A

PAIN and STIFFNESS in shoulders, neck, hips (NO weakness)
» pain worse on walking
» stiffness worse in morning, resolves during the day

OVER 50s

Min 2 weeks of sx

113
Q

what are blood markers like in POLYMYALGIA RHEUMATICA

A

raised ESR, CRP

normal CK

114
Q

how do you manage POLYMYALGIA RHEUMATICA

A

PO prednisolon

115
Q

descriibe pattern of muscle weakness in polymyositis

A

PROXIMAL FIRST (distal is much later)

Difficulty getting up from chair, lifting objects, brushnig hair

fine motor coord is usually spared until later

116
Q

what does the face look like in scleroderma

A

beak nose

microstomia (puckered mouth)

117
Q

describe presentation of polyarteritis nodosa

A 
systemically unwell 
skin rash 
GI melaena, abdo pain 
renal HTN 
liver  involvement HBV
118
Q

what is classiical 2 signs to distinguissh polyarteriitis nodos

A
  • ROSARY BEAD SIGN on renal angio

- HBV

119
Q

What antibody is characteristic of goodpastures

A

anti GBM

120
Q

what meds can cause DRUG INDUCED LUPUS

A

Hydralazine PIMP

Hydralazine 
Procainamide 
Isoniazid 
Minocycline 
Phenytoin
121
Q

which antibody is present in virtually 100% of pts with driug induced lupus

A

aanti-histone antibody

122
Q

when must you reassess the necessity or oral biphosphinates

A

assess after five years

123
Q

how do you reassess the need for biphosphonates

A

FRAX score and DEXA scan

124
Q

what conditions would you stop biphosphonates for

A

if T score >-2.5
low risk

BUT REVIEW IN 2 YEARS

125
Q

how do you manage paget’s disease

A

bisphosphonate (either oral risedronate or IV zoledronate)

126
Q

what does joint aspirate show in RA

A 
yellow cloudy fluid 
high WCC (PMN)

Y6 Senior Med (29 decks)

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