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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
what age group is OA most common
elderlhy
26
what joints are affecte in OA
``` weightberaring joints (knee, hip) Hands: CMC, DIP, PIP ```
27
what joints are affected in RA
Hands (MCP, PIP)
28
What is pain like in OA
pain following use (because this is mechanical wear!!) pain improves with rest unilateral systemically well
29
what is pain like in RA
morning stiffness pain improves with use bilateral systemic unwell
30
what are XR findings in OA
``` LOSS loss of joint space osteophytes subchondral sclerosis subchondral cysts ```
31
what is the aetiology of gout
``` monosodium urate (MSU) crystal deposition in and around the joints this causes erosive arthritis ```
32
what can precipitate a gout attack
surgery infection fasting diuretics
33
who is gout common in
men | with HTN, IHD, metabolic syndrome
34
what are causes of gout
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)
35
S/S gout
MONOARTHRITIS (usually on first MTP) Tophi (urate in pinna and tendons) radiolucent kidney stones iinterstitial nephritis
36
what ix should you get in gout
``` 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) ```
37
how do you manage gout ACUTE ATTACK
ACUTE attack: Colchine, NSAID if renal impairment: steroids follow up in 4-6 weks
38
what are contreaindications of NSAIDS
warfarin PUD HF CRF
39
How do you manage CHRONIC gout
Conservative: WL, avoid alcohol | Urate lowering therapy: allopurinol (xanthine oxidase inhibitor)
40
what is psudogout caused by
calcium pyrophosphate crystals
41
what joints ar affected by pseudogout
BIGGER joints (knee, wrist, hip)
42
What will needle aspiration show for pseudogout
positively birefringent, needle shaped crystals
43
how do you manage pseudogout
analgesia NSAIDS steroids
44
what are the four seronegative spondyloarthropathies
psoriatic arthritis enteropathic arthritis alkylosing spondylitis reactive arthritis
45
what are seronegative spondyloarthropathies
inflammatory arthritis affecting spine and peripheral joints with NO RhF production HLA B27 assdociation
46
What is alk spond sx
``` back pain, relieved by exercise morning stiffness costochondritis (anterior chest pain) SOB (pulm fibrosis) eye pain osteoporosis ```
47
what is alk spond associated with
``` AAAAAA Anterior uveitis Apical lung fibrosis aortic regurg AV node block Achilles tendonitis Amyloidosis ```
48
who will alk spond occur in
YOUNG MEN
49
what exam can you do for alk spond
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
50
What ix can you get for ALkSpond
XR MRI HLA-B27 testing ESR, CRP (non specific)
51
what changes do you see on XR / MRI spine for alkspond
sacroilitis sclerosis ankylosis (fusion) bamboo spine (squaring of lumbar vertebrae)
52
how do you manage alkspond
conservative (exerciis / physio) medical (NSAID > anti-TNFa) surgical (hip replacement to decrease pain and increase mobility
53
what is psoriatic arthritiis
``` Psoriasis Nail changes - pitting, onycholysis, subungal hyperkeratosis Enthesitis Dactylitis (swollen sausage finger) Arthritis (usually of DIPJ) ```
54
mx psoriatic arthritis
NSAID > methotrex
55
what is Reiter's / Reactive arthritis
sterile arthrisis 1-4 weeis after urethritis (chlamydia) or dysentry (campylobacter)
56
sx of reactive arthritis
can't see can't pee can't cliimb a tree so: conjunctivitis, urethritis, oligoarthritis in LL also circinate balanitis, keratoderma blenorrhagicum
57
ix Reactive arthritis
raised ESR, CRP stool culture if diarrhoea urine test chlamydiia
58
mx Reactive arthritis
NSAIDS | PO steroids
59
Behcet's disease in whom
mediterranean, turkish, japanese
60
S/S behcet disease
recurrent oral and genital ulceration, uveitis, erythema nodosum, VTE
61
Sjogren syndrome sx
dry eyes bilateral parotid swelling decreased salivation, xerostomia vaginal dryness
62
ix for Sjogrens
Schirmer's test | Antibodies (anti Ro, anti La, RhF)
63
Mx sjogrens
artificial tears, saliva replacement | NSAID/hydroxychloroquine
64
SLE symptoms
``` 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
what condition does antiphospholipid syndrome often occur with
occurs with SLE in 30% of cases
66
How does APS present
Thrombi Thrombocytopoenia Antibodies Also: livedo reticularis recurrent miscarriage
67
how do you manage APS
low dose aspirin if no prior VTE | warfarin if prior VTE
68
what antibodies are raised in APS
anti-cardiolipin | lupus anticoagulant
69
what antibodies ix must you do if suspecting lupus
ANA (most sensitive, poorly specific) anti-dsDNA anti-smith RhF
70
how do you monitor SLE disease
anti-dsDNA titers (marker of disease activity) C4 reduction (moderate activity) > C3 wrduction (very active lupus) ESR lvels
71
how do you mansage SSLE
FLARES: prednisolone + IV cyclophosphamide MAINTAINANCE: hydroxychloroquine + DMARD
72
what are the five fts of limited systemic sclerosis
``` CREST calcinoosis raynauds oesophageal dysmotility sclerodacyly telangectasia ```
73
what are fts of diffuse scleroderma
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
antibodies for systemic sclelrosis
Limited: anti-centromere Diffuse: anti-SCL70, anti topoisomerase
75
what is polymyositis
inflammation of skeletal muscle
76
polymyositis sx
progressive proximal muscle weakness with myalgia and arthralgia wasting of shoulder and pelvic girdle dysphagia, dysphonia, resp weakness
77
what can trigger polymyositis
paraneoplastic tumour
78
whhat is dermatomyositis
polymyositis + skin signs
79
what skin signs do you get with dermatomyositis
priorbital heliotrope rash (worse in sunlight) gottron's papules mechanic hands (painful rough skin)
80
what ix do you gt for myositis
``` RAISED CK (1000s) AST, ALT, LDH raised EMG Biopsy (definitive) Antibodies (anti-Jo1, Anti-Mi2, anti-SRP) MALIGNANCY screen ```
81
give examples of two large vessel vasculitis
GCA | Takayasu
82
give examples of two medium vessel vasculitis
Polyarteritis nodosa | Kawasaki disease
83
give examples of two small vessel vasculitis
Churg strauss Wegeeners granulomatosis HSP, goodpastures
84
What antibody with Churg Strauss?
pANCA
85
what antibody with Wegeners
cANCA
86
sx of GCA
scalp tenderness jaw cladication headache amarosis fugax (ischaemic optic neuropathy)
87
ix GCA
USS temporal artery (halo sign) if USS negativem, get a temporal artery biopsy Raised ESR
88
how do you manage GCA
PO prednisolate immediately (before ix)
89
what do you give for GCA if visual sx
IM methylpred
90
how does takayasu arteritis present
``` Asian females 20-40yo weak/unequal limb pulses HTN large vessel blockage ```
91
how does Polyarteritis nodosa present
``` young male adult systemic symptoms rash melaena, abdo pain renal: HTN liver dysfunction (HBV) ```
92
How do you manage polyarteritis nodosa
prednisolone + cyclophosphamide
93
How does Wegeners prsent
URT: rhinitis, epistaxis, saddle nose LRT: haeemoptysis, cough renal: RPGN, nephritic syndorme
94
Chung strauss sx
eosiniophilia asthma vascultisi
95
what meds can you give for chronic pain
All diabetics get peripheral (neuropathy) amytryptiline duloxetine gabapentine pregabalin
96
first line mx for neuropathic pain
amytriptyline and pregabalin
97
first line mx diabetic neuropathy
duloxetine
98
first line trigeminal neuralgia c
carbamazepine
99
what is stills disease | + what are its findings on blood test
type of inflammatory arthritis presenting with FAR: Fever (SPIKES in the evenings) arthralgia Rash (salmon pink maculopapular) negative RF, ANA high ferritin
100
mx stills diseae
NSAID | add srteroid after one week
101
How does pseudogout present on X ray?
CHONDROCALCINOSIS (deposits of calcium along joint line) | otherwise may mimic OA
102
what are heberden and bouchard nodes
``` Heberden = swollen DIP Bouchard = swollen pip ``` in Osteoarthrtis
103
what is cervical spondylosis
degeneraton of cervical spine impinges onto spinal cord > compresses nerve root and anterior spinal cord causes DEGENERATIVE CERVICAL MYELOPATHY
104
sx DEGENERATIVE CERVICAL MYELOPATHY
pain in neck and arms numbness in neck and arms loss of motor function (digital dexterity)
105
signs DEGENERATIVE CERVICAL MYELOPATHY
LMN in upper limbs | UMN in LL (including autonomic dysfunction)
106
what sign is POSITIVE In DEGENERATIVE CERVICAL MYELOPATHY
Hoffman
107
management of DEGENERATIVE CERVICAL MYELOPATHY
urgent neurosurgery referral | needs IV methylpred + decompression
108
what will you find when examining a patient with GCA
swelling and erythema over temporal artery thickened, non pulsatile temporal artery reduction in visual acuity
109
what are the two types of gout
PODAGRA = acute attack, excruciating pain swelling and hot 1st MTP Chronic TOPHACEOUS GOUT = chronic disease, depositon of TOPHI in joints, tendons, pinna
110
whhat dietary advice should you gve to someone with gout
avoid meat, alcohol, prolonged fasting | lose weight
111
what does XR show in gout
punched out erosions "RAT BITES" and reduced joint space
112
classic presentation of POLYMYALGIA RHEUMATICA
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
what are blood markers like in POLYMYALGIA RHEUMATICA
raised ESR, CRP | normal CK
114
how do you manage POLYMYALGIA RHEUMATICA
PO prednisolon
115
descriibe pattern of muscle weakness in polymyositis
PROXIMAL FIRST (distal is much later) Difficulty getting up from chair, lifting objects, brushnig hair fine motor coord is usually spared until later
116
what does the face look like in scleroderma
beak nose | microstomia (puckered mouth)
117
describe presentation of polyarteritis nodosa
``` systemically unwell skin rash GI melaena, abdo pain renal HTN liver involvement HBV ```
118
what is classiical 2 signs to distinguissh polyarteriitis nodos
- ROSARY BEAD SIGN on renal angio | - HBV
119
What antibody is characteristic of goodpastures
anti GBM
120
what meds can cause DRUG INDUCED LUPUS
Hydralazine PIMP ``` Hydralazine Procainamide Isoniazid Minocycline Phenytoin ```
121
which antibody is present in virtually 100% of pts with driug induced lupus
aanti-histone antibody
122
when must you reassess the necessity or oral biphosphinates
assess after five years
123
how do you reassess the need for biphosphonates
FRAX score and DEXA scan
124
what conditions would you stop biphosphonates for
if T score >-2.5 low risk BUT REVIEW IN 2 YEARS
125
how do you manage paget's disease
bisphosphonate (either oral risedronate or IV zoledronate)
126
what does joint aspirate show in RA
``` yellow cloudy fluid high WCC (PMN) ```

Y6 Senior Med (29 decks)

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