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Year 6 > Rheum > Flashcards

Rheum Flashcards

1
Q

Ix for rheumatoid arthritis

A

Nodules
Abdo exam- organomegaly
Lower extremities- ulcers
Anti CCP
X ray

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2
Q

Treatment of RhA

A

If evidence of RhA

Start on DMARD (hydroxy, methotrexate, sulfalazine)
+/- short prednisolone

Flares- CS - pred

If DAS >5.10- consider stepping up management

Refer early arthritis clinic

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3
Q

Side effects of tx of RhA

A

Meth- hair loss, PF
HC- bull eye lesions
Sulf- oospermia

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4
Q

Order of tx in RhA

A

2 DMARDs then biologics

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5
Q

What do you need to check for when giving infliximab, etanercept and adalilumab

A

Screen TB
Chest X ray

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6
Q

Ix needed when on methotrexate

A

FBC, U&Es, LFT every 4 months

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7
Q

Signs and symptoms of psoriatic arthritis

A

Asymmetrical polyarthritis
Can affect spine

Nail changes
DIP affected
Can have skin changes but not always

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8
Q

Tx of psoriatic arthritis

A

Methotrexate

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9
Q

Sx of reactive arthritis

A

Anterior Uveitis
Urethritis
Arthritis
Kertoderma blenorragia
After STI or GI infection

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10
Q

Tx of reactive arthritis

A

NSAIDs, refer to rheum

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11
Q

Signs and symptoms of AS

A

Morning stiffness
Gradual onset
Pain at night
Sacroiliitis
Squaring of lumbar vertebrae

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

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12
Q

What hand sign do Seronegative arthritis have

A

Dactylitis

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13
Q

Sx of RhA

A

DIP spared- mainly MCP, PIP, wrist, knee
Nodules
Carpal tunnel
Ulcers, organomegaly

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14
Q

Sx of PR

A

Shoulder and hips- high ESR
Worse in mornings
Sore muscles
carpal tunnel
GCA

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15
Q

Tx of PR

A

Prednisilone 15mg OD
Continue until sx gone then tamper

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16
Q

What can temporal arteritis cause

A

Anterior Ischaemia optic neuropathy
White swollen optic disc

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17
Q

Tx of GCA

A

40-60mg pred, daily for 4 weeks, tapered over 6m- 1year

Methylprednisilone if eye affected

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18
Q

Sx of takayasu arteritis

A

Systemic features of a vasculitis e.g. malaise, headache
Unequal blood pressure in the upper limbs
carotid bruit and tenderness
absent or weak peripheral pulses
upper and lower limb claudication on exertion
aortic regurgitation (around 20%)

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19
Q

Ix and Tx of Takayasu Arteritis

A

MRA or CTA
Steroids

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20
Q

Sx of microscopic poly

A

pANCA
Fever
Muscle aches
Lung involvement
Renal
Skin lesions

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21
Q

ANCA positive vasculitides and sx

A

GPA- saddle shape nose, rhinos, epistaxis, LRT- haemoptysis, renal- nephritis
EGPA- asthma, RPGN
MP- pANCA, haemoptysis- Hep B

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22
Q

ANCA negative vasculitidies and sx

A

HSP- IgA vasculitis- rash, arthralgia, glomerulnephrtiis

Goodpastures- renal and lung involvement

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23
Q

Sx of dermatomyositis

A

From PNP syndrome
Gottrons papules over knuckles
Heliotrope on eyelids
Proximal Muscle weakness
ANA +- anti Jo

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24
Q

Sx of polymyositis

A

Proximal muscle weakness
Malignancy
May have raynauds and dysphagia

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25
Q

Ix of polymyositis

A

Raised CK 1000s
ALT and AST also raised
EMG
Anti-Jo
Muscle biopsy

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26
Q

Diffuse Scleroderma sx

A

Scleroderma affects limbs and trunk
Pulmonary fibrosis
Scl70 +

Hardening of the skin
Cold peripheries

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27
Q

Limited Scl sx

A

CREST
Pulmonary HTN- echo and ecg

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28
Q

Tx of diffuse sclerosis

A

Immunosuppression
PPI for regurg
ACEi for renal failure

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29
Q

Sx of behcets

A

Oral and genital Ulcers
Anterior uveitis
Mediterranean

Increased risk of VTE

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30
Q

Sx of Sjogrens

A

Inflammmed parotids
Dry
Painful sex
Arthralgia

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31
Q

Tx of sjogrens

A

Artificial tears
Hydroxy- arthralgia

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32
Q

Tx of SLE

A

Hydroxychloroquinine- maintenance

Falres- Prednisolone + Cyclophosphamide
ACE if proteinuria

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33
Q

Ix of SLE

A

ANA- sensitive
dsDNA- specific
C3 and 4 low- during active disease

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34
Q

Ix of gout

A

Negative needle on aspiration
Measure rate 2-4w after inflammation settles

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35
Q

Tx of gout

A

Acute- NSAIDs, colchicine- if low GFR- can cause diarrhoea

Long term- allopurinol

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36
Q

Sx of pseudo gout

A

Larger joints
Chondrocalcinosis
Positive rhomboid

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37
Q

Osteoporosis Tx

A

Vit D and calcium
Alendronate- weekly

risedronate or etidronate if cannot tolerate alendronate

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38
Q

When to give bisphosphonates

A

T > -2.5
T > -1.5 and on steroids

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39
Q

Tx of polymyalgia rheumatic

A

Tx with steroids for 3 weeks
If no improvement- consider alternate diagnosis

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40
Q

Tx of ankylosing spondylitis

A

Physio and NSAIDs whilst referred to rheum

Then DMARDs such as sulphasalazine

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41
Q

OA vs psoriatic arthritis feel

A

Bony vs boggy

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42
Q

Antibody in limited sclerosis

A

Anti-centromere

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43
Q

Antibody in diffuse sclerosis

A

Anti-scl70

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44
Q

First line Ix of AS

A

X ray spine and pelvis

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45
Q

Sjogren syndrome sx

A

Enlarged parotids
Dry mouth
Dry eyes

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46
Q

Sjogren syndrome dx

A

ANA +
Rh factor +
Schirmers +

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47
Q

Gout vs pseudo gout

A

Gout- toe- negative needles
Pseudo- positive rhomboids

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48
Q

Gout vs pseudo tx

A

Gout- NSAIDs, colchicine, pred if renal impair

Pseudo- NSAIDS

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49
Q

APS features

A

Clots,
livedo reticularis- lace like on skin of legs, miscarriage, low plt

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50
Q

APS dx

A

+ve blood test 2 occasions 12 weeks apart
Anti cardiolipin, lupus anticoagulant

APTT- wrongly prolonged in lab results
Plt low

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51
Q

Prosthetic with extreme pain ix

A

Synovial aspiration for septic arthritis

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52
Q

Polyartiritis nodosa sx

A

Ulcerating skin
Orchitis
Renal failure
Abdo pain
Arthritis

Hep B

No lung
No ANCA

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53
Q

Dx of polyartiritis nodosa

A

Biopsy of affected area

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54
Q

Dx of PR

A

ESR

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55
Q

PR vs myositis

A

Myositis causes weakness
PR- pain and stiff

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56
Q

Tx of GCA

A

60mg pred
Tapered over 1-2 years due to relapse

57
Q

Disease RF for pseudogout

A

Haemachromatosis
Wilsons
Hyperparathyroid
Acromegaly
Low Mg, P

58
Q

ECG changes in GPA

A

St elevation
Myositis

59
Q

Tx of raynauds

A

CCB

60
Q

DAS scoring of RA

A

2.6- 3.2 low
3.2-5.1 moderate
>5.1 high

61
Q

Stool problems, painful lesions on shins and arthritis

A

Enteropathic arthritis

62
Q

Seronegative arthropathies

A

PARE
Psoriatic
AS
Reactive
Enteropathic

63
Q

RA features

A

MCP and wrist subluxation
Swan neck deformity
Boutonniere
Ulnar deviation
Z shaped thumb

Atlanto-axial joint subluxation
Carpal tunnel
Tenosynovitis

Anaemia
Amyloidosis
Nodules
Raynauds

Pneumonitis

64
Q

Tx of non specific back pain

A

NSAIDs and PPI

65
Q

Septic arthritis order of mx

A

Aspirate an culture
Then iv abx

66
Q

Myositis Ix

A

CK
Then EMG
Then muscle biopsy definitive diagnosis

67
Q

pANCA and cANCA positive

A

Subactute bacterial endocarditis

68
Q

Dx of herniated disc

A

Straight leg raise

69
Q

Other SE of steroids

A

glaucoma
Hyperglycaemia
Insomnia
Weight gain

70
Q

Order of tests in GCA

A

ESR
Biopsy

71
Q

Gene of AS

A

HLA B27

72
Q

Most important test to monitor with scleroderma

A

Renal function tests

73
Q

SLE presentation

A

Fever
Myalgia
Arthritis
Photosensitivty
Discoid rash
Raynauds
Renal
Neuro
Ulcers
Malar rash- spares nasolabial folds

74
Q

Dx of SLE

A

ANA
dsDNA
Low complement

75
Q

Headache, psychosis or fits in SLE and tx

A

Cerebral lupus
Steroids and cycle/aza

76
Q

Lupus GLN tx

A

Protein uria- ACEi

Steroids and myco/cyclo
usually nephrotic

77
Q

Nerve roots weaknesses

A

L2- hip flexion
L3- knee extension
L4- knee extension, inversion, dorsiflexion
L5- inversion, dorsiflexion
S1- eversion, knee flexion

78
Q

Behcets HLA

A

HLA B51

79
Q

Felty syndrome

A

RA
Splenomegaly
Neutropaenia

80
Q

What are patent with sjogrens predipososed to

A

Lymphoma

80
Q

What are patent with sjogrens predipososed to

A

Lymphoma

81
Q

Allopurinol in acute gout

A

If already on continue to take

82
Q

Marfans defect

A

Fibrillin

83
Q

If starting on long term steroids what do you do

A

Bisphosphonate, Vit D, calcium suppliments

84
Q

X ray features of psoriatic arthritis

A

Pencil and cup
Plantar spur

Periarticular erosions with bone resorption

85
Q

If GCA with evolving visual loss mx

A

IV methylprednisolone

86
Q

Hydroxychoroquien SE

A

Retinopathy- bulls eye ring

87
Q

Enteropathic arthritis HLA

A

HLA B27

88
Q

Patients allergic to aspirin/cotrimox are usually allergic to

A

Sulfalazine

89
Q

Sx of AS

A

Reduced chest expansion, lateral and forward flexion
Uveitis- painful
Achilles tendonitis

90
Q

Schober test

A

AS if <5cm

91
Q

Meralgia parasthetica nerve and sx

A

Lateral cutaneous nerve compression
Parasthesia
Less sensation

92
Q

Still disease

A

Pyrexia - arises in afternoon
Arthralgia
Salmon pink rash
Lymphadenopathy
Hypotensive- can mimic sepsis

Can have high ferritin and LFTs

93
Q

When to give bone protection for steroids

A

If on >7.5 a day >3 months

94
Q

If on methotrexate and in contact with varicella tx

A

Test AB, if neg VZIG

95
Q

Diffuse vs limited sclerosis

A

Diffuse- proximal limb, trunk
ILD- fibrosis, Pul HTN

Limited- distal limb

96
Q

APLS tx

A

Before VTE- aspirin
After first VTE- Lifelong warfarin

97
Q

Affects of tamoxifen on bones

A

Protective since agonist in the bones

98
Q

RF of osteoporosis

A

Steroids, PPI, levothyroxine
RhA
Low BMI
Smoking

CKD

99
Q

Osteoporosis of the hand sx

A

DIP affected
Bouchards- proximal
Herberdens- distal

Squaring of thumbs

100
Q

OA of hands tx

A

para and Topical NSAIDs first

Oral NSAIDs, opioids, capsaicin cream and IA steroids next

101
Q

Methotrexate SE

A

Mucositis
Myelosuppression
Pneumonitis- reticular shadowing on CXR
Pul fibrosis
Liver fibrosis

102
Q

Methotrexate pneumonitis presentation

A

New dry cough, dyspnoea, fever
reticular shadowing on CXr

103
Q

Tx of RhA in pregnancy

A

Hydroxychloroquine

104
Q

Causes of Raynauds

A

Vibrating tools
Scleroderma
RhA
SLE
Primary cause - bilateral

105
Q

What predisposes you to azathioprine deficiency

A

TMPT deficiency

106
Q

X ray of different arthritis

A

Septic- effusion

Psoritatic- periarticular erosions and bone resorption

OA- LOSS

RhA- LESS- proximal joints
Erosions, subluxation, soft tissue swelling

107
Q

Medication for all housebound patients

A

Vit D

108
Q

Pseudogout knee x ray

A

Chondrocalcinosis
Visible cartilage on edges

109
Q

Antibodies for demote/polymyositis

A

Anti Jo

110
Q

Antibodies for sjorgrens

A

Anti Ro/La

111
Q

If someone with SLE has high WCC, raised CRP and normal kidney function

A

Underlying infection

As CRP usually normal in SLE, kidney function oddly derange too

112
Q

Chronic fatigue syndrome Dx

A

Normal tests- FBC, ESR, U+E
Sx persistent for 3 months

113
Q

Presentation of osteomalacia

A

Bone pain
proximal myopathy
Waddling gait
Low Vit D

114
Q

X ray of AS

A

Subchondral erosions
Sclerosis
Squaring of vertebrae
Syndesmophytes
Ossification of supraspinous ligament

115
Q

Signs of Pagets on X ray

A

Osteolysis in early disease → mixed lytic/sclerotic lesions later
skull x-ray: thickened vault, osteoporosis circumscripta

116
Q

Tx of Pagets

A

Bisphosphonates
Oral risedronate

117
Q

Signs of psoas abcess

A

Hip extension
Fever

118
Q

Meds you can take for SLE in pregnancy

A

Azathioprine

119
Q

Poor prognosis of RhA

A

RhF or anti CCP positive
Early erosions
Nodules
Insidious onset

120
Q

When to give Anti TNFa for AS

A

After failed 2 NSAIDs and has active disease on 2 occasions 12 weeks apart

121
Q

What should you correct before giving BP

A

Vit D and calcium

122
Q

What suggests primary raynauds rather than secondary

A

<40
Bilateral

123
Q

Infective flexor tenosynovitis sx

A

Fixed flexion, tenderness, pain on passsive extension

124
Q

If IVDU presents with discitis what other ix should you do

A

Echo- since IE can cause discitis

125
Q

Rheumatoid arthritis joint aspiration

A

Yellow
High PMN
No crystals

126
Q

Extra articular sx of RhA

A

Multisystemic effect- unwell, fevers, fatigue

Haem- anaemia, splenomegaly- felty , amyloid- kidneys

Derm- nodules

Opthalmic- dry eyes (keratoconjunctivitis sicc)

Pleural- nodules, fibrosis

Pericardial- IHD

Increased risk of neck breaks- due to Atlanto-axial subluxation

127
Q

Drug induced lupus causes

A

Hydralazine PIMP

Procainimide
Isoniazid
Minocycline
Phenytoin

128
Q

Tx of Stills disease

A

NSAIDs
After 1 week no improvement- steroids

129
Q

What should you monitor with HSP

A

BP and urine dipstick

130
Q

OP and osteopenia on DEXA

A

-1 to -2.5 is osteopenia
OP >-2.5

131
Q

Type of deposits in pseudo gout

A

calcium pyrophosphate dihydrate crystals

132
Q

Osteoarthritis tx

A

Oral paracetamol or topical NSAID (only for hands or knee)

Then oral NSAIDs with PPI

133
Q

Azathioprine SE

A

BM suppression
N+V
Pancreatitis

134
Q

What should you co prescribe with methotrexate

A

Folate for myelosuppression

135
Q

Organism of septic arthritis in young sexually active people

A

Gonorrheoa

136
Q

X ray of AS

A

Subchondral erosions
Sclerosis
Squaring of lumbar vertebrae

137
Q

Immune hypersensitivity reactions

A

1- immediate
2- AB against antigen- graves
3- deposition- SLE
4- delayed

138
Q

What do you need to do before surgery for RHA patietn

A

AP and lateral neck X rays

Year 6 (28 decks)

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