Rheum Flashcards
1
Q
Rheumatoid Ix
A
Anti CCP (increased sensitivity) Rh factor X Ray - dons
2
Q
X Ray features of rheumatoid
A
DONS joint Deformity juxta articular Osteopenia joint space Narrowing Soft tissue swelling
3
Q
Tx for RhA
A
- DMARDs (methotrexate with folic acid)
- Corticosteroids
- NSAIDs
4
Q
RhA is associated with what condition
A
Feltys syndrome
5
Q
What is feltys
A
SANTA Splenomegaly Arthritis Neutropenia Thrombocytopenia Anaemia
6
Q
Osteoarthritis symmetrical or asymmetrical?
A
Asymmetrical
Hate heberdens –> further away
7
Q
Travelling businessman, pt with prosthetic limb, IVDU, immunosuppressive
A
Infective/septic arthritis usually in knee
8
Q
Monosodium urate
A
Gout
9
Q
Calcium pyrophosphate
A
Pseudogout
10
Q
Needle shaped
A
Gout
11
Q
What shape is pseudo gout?
A
Rhomboid
12
Q
Polarised light
- Negative
- Positive
A
- Gout
2. Puseudogout is positive
13
Q
When is pseudo gout normally?
A
Knee
14
Q
RFs for pseudo gout
A
HyperPTH
Hypophosphataemia
Harmochromatosis
15
Q
Spondyloaryhropathies
A
PEAR Psoriatic Enteropathic Ankylosing spondylitis Reactive arthritis
16
Q
HLA B27
Axial arthritis
Extra articular manifestations: uveitis, psoriatic rash, IBD, ulcers
A
Spondyloaryhropathies
17
Q
Arthritis 2 weeks post GU or GI infection +/- articular manifestations
Joint: lower limb
A
Reactive arthritis (sterile)
18
Q
Reiter’s syndrome
A
Can’t see, can’t pee, can’t climb a tree
Conjunctivitis, urethritis, reactive arthritis
19
Q
SLE Dx
A
SOAP BRAIN MD >4 = SLE
20
Q
SLE antibodies
A
Most sensitive ANA
Most specific ANTI dsDNA
21
Q
ANA antibody
A
Sensitive antibody in SLE
22
Q
Anti dsDNA
A
Most specific antibody in SLE
23
Q
Antiphospholipid syndrome is associated with what
A
SLE
24
Q
Px anti phospholipid syndrome
A
CLOT Clots Livedo reticularis Obstetric complications Thrombocytopenia
25
Antibodies in antiphospholip syndrome
Antiphospholipid AB
Lupus anticoagulant
Anticardiolipin
26
Anti rho and anti la
Sjögren's syndrome
27
Sjögren's syndrome Px
Dry eyes, dry mouth
+/- raynauds
+/- parotitis
28
AL amyloid
Primary amyloidosis
29
AA amyloid
Secondary amyloidosis
30
IgG light chain
Primary amyloidosis
31
Serum amyloid A
Secondary amyloidosis
32
Primary amyloidosis is associated with what condition?
Multiple myeloma
33
Secondary amyloidosis is associated with that
Chronic infection or inflammation RhA or RB
34
Periorbital pupura
Primary amyloidosis
35
Grottens papules
Heliotrope rash
Shawl sign
Periungal telangiectasia
Dermatomyositis
36
Scleroderma/systemic sclerosis Px
```
CREST
calcinosis
Raynauds
Oesophageal dis motility
Sclerodactyly
Telangiectasia
```
37
Anti centromere antibody
Limited systemic sclerosis
38
Anyitropoisomerase antibody
Diffuse systemic sclerosis
39
Goodpastures triad
1. Glomerulonephritis
2. Pulmonary damage = haemorrhage
3. Anti GBM antibodies
40
Behçet's disease
1. Oral ulcers
2. Genital ulcers
3. Uveitis, vision lost
HLA B51 association
41
Small vessel immune mediated disease
HSP
Behçet's disease
GoodpAstures syndrome
42
Small vessel disease ANCA associated
Granulomatosis with polyangiitis (Wegener's granulomatosis) = c. ANCA
Microscopic polangitis = p. ANCA
Churg strauss syndrome (esinophillic granulomatosis with polyangitis) = p. ANCA
43
Kawasaki disease - medium vessel Px
```
CRASH AND BURN
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hand and feet swelling
And burn = fever
```
44
Rosary sign on angiogram
Polyarteritis nodosa
45
PMH in Polyarteritis nodosa
HepB
46
Medium vessel disease
Kawasaki
| Polyarteritis nodosa
47
Attacks branches of aortic arch
Takyasu Arteritis
48
Lasegues sign
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
Ix for polymyositits and dermatonyositis
CK, alodase, LDH, transaminase, myoglobin --> all raised.
EMG
Muscle biopsy
50
Ankylosing spondylitis pain
Worse at night
| Spinal morning stiffness relieved by exercise and rest
51
Ix for ankylosing spondylitis
Pelvic X RAY looking for sacroilits
| Schnobers test --> forward flexion distance less than 5cm between posterior illiac spines
52
Carpal tunnel causes
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
Tests for Carpal tunnel
```
Tinels test (tapping on carpal tunnel produces symptoms)
Phalans test (maximal flexion of the wrist for >1mm may cause symptoms)
```
54
What is cervical spondylitis and what may the patient complain of?
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
Lhermitte's sign
Neck flexion produces crepitus or parasthesis a down the spine --> MS And other conditions
56
Complications of giant cell and management
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
Progressive painless PROXIMAL muscle weakness
Polymyositits and dermatonyositis
58
Osteomyelitis Px and Ix
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
Severe bilateral pain and morning stiffness of shoulder, neck and pelvic girdle
Polymyalgia Rheumatica
| Similar management to giant cell arteritis
60
Circinate balantitis
| Keratoderma blenorrhagia
Reactive arthritis
61
Which arthritis is sterile
Reactive arthritis
62
Accumulation of lymphocytes and macrophages in the body
Sarcodosis
63
Small blood vessel damage and fibrosis
Systemic sclerosis
64
Ix of systemic sclerosis
```
Abnormal prayer sign -->swelling and fibrosis of tendons and contractures
ANA positive
Raised ESR
Echo - R heart enlargement
Pulmonary function tests - decreased FVC
```
65
Asthma and esinophillia
Churg Strauss syndrome
66
Constitutional upset, head and neck pain, tenderness over arteries,
Dizziness, fainting and decreased peripheral pulses
Takayasus aortitis
67
Polyarthritis nodosa triad
1. Skin: skin rashes and punches out ulcers
2. Renal: increased bp and renal failure
3. Mesenteric: abdominal pain and GI bleeding
68
Wengers
- what time of arteritis
- involvement
- small cell, c. ANCA positive
- upper airway: saddle shaped nose, sinusitis, nasal ulcers
- lower airway: cough, haemoptosis
- renal: glomerulonephritis
69
Rapidly progressing glomerulonephritis with pulmonary haemorrhage
Microscopic polyangitis
| p. ANCA positive
70
Polymyalgia Rheumatic is HLA what
HLA-DR4
71
How are NSAIDS given in polymyalgia rheumatica
Given in combination with corticosteroids (10-20mg oral prednisolone)
72
O/e giant cell arteritis
Prominent temporal arteries without pulsation and temporal tenderness. Fundoscopy may show ischaemia
73
Takayasu’s Arteritis
Systemic symptoms of fever, malaise, night sweats, arthralgiaUpper limb claudication – subclavian artery involvementHypertension – renal artery stenosisNeurological manifestations – carotid artery involvement
74
Kawasaki Disease
Treatment is with high dose IVIG and aspirin
75
Granulomatosis with polyangitis
Wenger's granulomatosis
76
Esniophillic granulomatosis with polyangitis
Churg Strauss Syndrome
77
Wegners Ix
Diagnosis – presence of C-ANCA is not conclusive! Histopathology – biopsy shows granulomatous infiltration in the arterial wall or perivascular area.
78
Churg Strauss Syndrome
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
Microscopic Polyangitis Ix:
Multisystem small vessel vasculitis associated with P-ANCA antibodies without evidence of granulomatous disease
80
Tensilon Test
Myashthenia Gravis (however can be positive in lambert eton syndrome aswell)
81
Rimmed Vacuoles
Myositis
82
First change seen on X ray in anklyosisng spondylitis
Sacroilitis
| Fusion of joint and lumbar vertebrae happen only after prolonged inflammation
83
How is Torsades de pointes induced?
Torsades de pointes induced by anti-depressant
overdose (e.g. selective serotonin reuptake inhibitors) is treated with
intravenous magnesium sulphate.
84
Anti centromere antibody
Pulmonary hypertension
CREST features
limited cutaenous scleroderma =
connective tissue disorder characterised by
thickening and fibrosis of the skin (scleroderma) with involvement
of internal organs.
85
Renal Crises
Anti topoisomerase antibody
Anti SCL-70 antibody
diffuse cutaenous scleroderma
86
Tx of cutaenous scleroderma
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
HLA B51
Behcets
