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Rheum Flashcards

1
Q

Rheumatoid Ix

A 
Anti CCP (increased sensitivity) 
Rh factor 
X Ray - dons
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2
Q

X Ray features of rheumatoid

A 
DONS 
joint Deformity
juxta articular Osteopenia 
joint space Narrowing 
Soft tissue swelling
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3
Q

Tx for RhA

A
  1. DMARDs (methotrexate with folic acid)
  2. Corticosteroids
  3. NSAIDs
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4
Q

RhA is associated with what condition

A

Feltys syndrome

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5
Q

What is feltys

A 
SANTA
Splenomegaly 
Arthritis 
Neutropenia 
Thrombocytopenia 
Anaemia
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6
Q

Osteoarthritis symmetrical or asymmetrical?

A

Asymmetrical

Hate heberdens –> further away

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7
Q

Travelling businessman, pt with prosthetic limb, IVDU, immunosuppressive

A

Infective/septic arthritis usually in knee

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8
Q

Monosodium urate

A

Gout

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9
Q

Calcium pyrophosphate

A

Pseudogout

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10
Q

Needle shaped

A

Gout

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11
Q

What shape is pseudo gout?

A

Rhomboid

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12
Q

Polarised light

  1. Negative
  2. Positive
A
  1. Gout

2. Puseudogout is positive

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13
Q

When is pseudo gout normally?

A

Knee

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14
Q

RFs for pseudo gout

A

HyperPTH
Hypophosphataemia
Harmochromatosis

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15
Q

Spondyloaryhropathies

A 
PEAR
Psoriatic
Enteropathic
Ankylosing spondylitis 
Reactive arthritis
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16
Q

HLA B27
Axial arthritis
Extra articular manifestations: uveitis, psoriatic rash, IBD, ulcers

A

Spondyloaryhropathies

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17
Q

Arthritis 2 weeks post GU or GI infection +/- articular manifestations
Joint: lower limb

A

Reactive arthritis (sterile)

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18
Q

Reiter’s syndrome

A

Can’t see, can’t pee, can’t climb a tree

Conjunctivitis, urethritis, reactive arthritis

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19
Q

SLE Dx

A

SOAP BRAIN MD >4 = SLE

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20
Q

SLE antibodies

A

Most sensitive ANA

Most specific ANTI dsDNA

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21
Q

ANA antibody

A

Sensitive antibody in SLE

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22
Q

Anti dsDNA

A

Most specific antibody in SLE

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23
Q

Antiphospholipid syndrome is associated with what

A

SLE

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24
Q

Px anti phospholipid syndrome

A 
CLOT
Clots
Livedo reticularis 
Obstetric complications 
Thrombocytopenia
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25
Q

Antibodies in antiphospholip syndrome

A

Antiphospholipid AB
Lupus anticoagulant
Anticardiolipin

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26
Q

Anti rho and anti la

A

Sjögren’s syndrome

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27
Q

Sjögren’s syndrome Px

A

Dry eyes, dry mouth
+/- raynauds
+/- parotitis

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28
Q

AL amyloid

A

Primary amyloidosis

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29
Q

AA amyloid

A

Secondary amyloidosis

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30
Q

IgG light chain

A

Primary amyloidosis

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31
Q

Serum amyloid A

A

Secondary amyloidosis

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32
Q

Primary amyloidosis is associated with what condition?

A

Multiple myeloma

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33
Q

Secondary amyloidosis is associated with that

A

Chronic infection or inflammation RhA or RB

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34
Q

Periorbital pupura

A

Primary amyloidosis

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35
Q

Grottens papules
Heliotrope rash
Shawl sign
Periungal telangiectasia

A

Dermatomyositis

36
Q

Scleroderma/systemic sclerosis Px

A 
CREST
calcinosis
Raynauds
Oesophageal dis motility 
Sclerodactyly
Telangiectasia
37
Q

Anti centromere antibody

A

Limited systemic sclerosis

38
Q

Anyitropoisomerase antibody

A

Diffuse systemic sclerosis

39
Q

Goodpastures triad

A
  1. Glomerulonephritis
  2. Pulmonary damage = haemorrhage
  3. Anti GBM antibodies
40
Q

Behçet’s disease

A
  1. Oral ulcers
  2. Genital ulcers
  3. Uveitis, vision lost
    HLA B51 association
41
Q

Small vessel immune mediated disease

A

HSP
Behçet’s disease
GoodpAstures syndrome

42
Q

Small vessel disease ANCA associated

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis) = c. ANCA
Microscopic polangitis = p. ANCA
Churg strauss syndrome (esinophillic granulomatosis with polyangitis) = p. ANCA

43
Q

Kawasaki disease - medium vessel Px

A 
CRASH AND BURN
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hand and feet swelling
And burn = fever
44
Q

Rosary sign on angiogram

A

Polyarteritis nodosa

45
Q

PMH in Polyarteritis nodosa

A

HepB

46
Q

Medium vessel disease

A

Kawasaki

Polyarteritis nodosa

47
Q

Attacks branches of aortic arch

A

Takyasu Arteritis

48
Q

Lasegues sign

A

Tests for disc Herniation in sciatica. Raising straight leg –> If the patient experiences sciatic pain when the straight leg is at an angle of between 30 and 70 degrees, then the test is positive and a herniated disc a possible cause of the pain.[3] A negative test suggests a likely different cause for back pain

49
Q

Ix for polymyositits and dermatonyositis

A

CK, alodase, LDH, transaminase, myoglobin –> all raised.
EMG
Muscle biopsy

50
Q

Ankylosing spondylitis pain

A

Worse at night

Spinal morning stiffness relieved by exercise and rest

51
Q

Ix for ankylosing spondylitis

A

Pelvic X RAY looking for sacroilits

Schnobers test –> forward flexion distance less than 5cm between posterior illiac spines

52
Q

Carpal tunnel causes

A

MEDIAN TRAPS

  • myxodema
  • enforced flexion eg Coles splint
  • diabetic neuropathy
  • acromegaly
  • neoplasms eg myeloma
  • tumours (benign) lipoma
  • RhA
  • amyloidosis
  • pregnancy and premenstural odema
  • sarcoidosis
53
Q

Tests for Carpal tunnel

A 
Tinels test (tapping on carpal tunnel produces symptoms) 
Phalans test (maximal flexion of the wrist for >1mm may cause symptoms)
54
Q

What is cervical spondylitis and what may the patient complain of?

A

Osteoarthritis of the spine causing degeneration of the vertebral bodies

Px. Neck stiffness, crepitus on moving neck, stabbing or dull arm pain, forearm/wrist pain

Signs of chord compression. Spastic leg weakness (often more in one leg that the other)
numbness in hands.
Heavy legs, foot drop/walking poorly
incontinece, hesitancy and urgency are often late

55
Q

Lhermitte’s sign

A

Neck flexion produces crepitus or parasthesis a down the spine –> MS And other conditions

56
Q

Complications of giant cell and management

A

Carotid or aortic artery embolism
Glucocorticoid related adverse effects

-visual impairment: IV methylpred
-no visual impairment: oral prednisolone
Always also give aspirin and bisphosphosphonates
Consider methotrexate

57
Q

Progressive painless PROXIMAL muscle weakness

A

Polymyositits and dermatonyositis

58
Q

Osteomyelitis Px and Ix

A

Px: painful immobile limb, fever, swelling and tenseness, erythema, localised odema

Ix: wBC, X-RAY of infected area: dark, tissue swelling, periosteal thickening, ESR CRP,cultures

59
Q

Severe bilateral pain and morning stiffness of shoulder, neck and pelvic girdle

A

Polymyalgia Rheumatica

Similar management to giant cell arteritis

60
Q

Circinate balantitis

Keratoderma blenorrhagia

A

Reactive arthritis

61
Q

Which arthritis is sterile

A

Reactive arthritis

62
Q

Accumulation of lymphocytes and macrophages in the body

A

Sarcodosis

63
Q

Small blood vessel damage and fibrosis

A

Systemic sclerosis

64
Q

Ix of systemic sclerosis

A 
Abnormal prayer sign -->swelling and fibrosis of tendons and contractures
ANA positive 
Raised ESR
Echo - R heart enlargement 
Pulmonary function tests - decreased FVC
65
Q

Asthma and esinophillia

A

Churg Strauss syndrome

66
Q

Constitutional upset, head and neck pain, tenderness over arteries,

Dizziness, fainting and decreased peripheral pulses

A

Takayasus aortitis

67
Q

Polyarthritis nodosa triad

A
  1. Skin: skin rashes and punches out ulcers
  2. Renal: increased bp and renal failure
  3. Mesenteric: abdominal pain and GI bleeding
68
Q

Wengers

  • what time of arteritis
  • involvement
A
  • small cell, c. ANCA positive
  • upper airway: saddle shaped nose, sinusitis, nasal ulcers
  • lower airway: cough, haemoptosis
  • renal: glomerulonephritis
69
Q

Rapidly progressing glomerulonephritis with pulmonary haemorrhage

A

Microscopic polyangitis

p. ANCA positive

70
Q

Polymyalgia Rheumatic is HLA what

A

HLA-DR4

71
Q

How are NSAIDS given in polymyalgia rheumatica

A

Given in combination with corticosteroids (10-20mg oral prednisolone)

72
Q

O/e giant cell arteritis

A

Prominent temporal arteries without pulsation and temporal tenderness. Fundoscopy may show ischaemia

73
Q

Takayasu’s Arteritis

A

Systemic symptoms of fever, malaise, night sweats, arthralgiaUpper limb claudication – subclavian artery involvementHypertension – renal artery stenosisNeurological manifestations – carotid artery involvement

74
Q

Kawasaki Disease

A

Treatment is with high dose IVIG and aspirin

75
Q

Granulomatosis with polyangitis

A

Wenger’s granulomatosis

76
Q

Esniophillic granulomatosis with polyangitis

A

Churg Strauss Syndrome

77
Q

Wegners Ix

A

Diagnosis – presence of C-ANCA is not conclusive! Histopathology – biopsy shows granulomatous infiltration in the arterial wall or perivascular area.

78
Q

Churg Strauss Syndrome

A

Presence of P-ANCA antibodies, eosinophils and granulomas all aid diagnosis

Condition exists in 3 stages

  1. Allergic Stage: asthma/allergic rhinitis experienced by almost all patients. May be a worsening of existing asthma or a new development
  2. Eosinophilic Stage: abnormally high eosinophil count in blood and tissues. May present with fever, malaise, WL, night sweats
  3. Vasculitic Stage: inflammation of vessels and reduced blood flow to organs (particularly in the abdomen). Inflammation of the myocardium/reduced blood flow to the heart is the most serious complication and most common cause of death
79
Q

Microscopic Polyangitis Ix:

A

Multisystem small vessel vasculitis associated with P-ANCA antibodies without evidence of granulomatous disease

80
Q

Tensilon Test

A

Myashthenia Gravis (however can be positive in lambert eton syndrome aswell)

81
Q

Rimmed Vacuoles

A

Myositis

82
Q

First change seen on X ray in anklyosisng spondylitis

A

Sacroilitis

Fusion of joint and lumbar vertebrae happen only after prolonged inflammation

83
Q

How is Torsades de pointes induced?

A

Torsades de pointes induced by anti-depressant
overdose (e.g. selective serotonin reuptake inhibitors) is treated with
intravenous magnesium sulphate.

84
Q

Anti centromere antibody
Pulmonary hypertension
CREST features

A

limited cutaenous scleroderma =
connective tissue disorder characterised by
thickening and fibrosis of the skin (scleroderma) with involvement
of internal organs.

85
Q

Renal Crises
Anti topoisomerase antibody
Anti SCL-70 antibody

A

diffuse cutaenous scleroderma

86
Q

Tx of cutaenous scleroderma

A

The treatment of systemic
sclerosis is with steroids and immunosuppressives. Penicillamine slows skin
disease (steroids do not help the skin). Lung fibrosis is the main cause of death, followed by renal disease.

87
Q

HLA B51

A

Behcets

Resp (13 decks)

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