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GI > Rheuma > Flashcards

Rheuma Flashcards

1
Q

What is systemic sclerosis and how may it present ?

A

Chronic abnormal diffuse of connective tissue
Can be diffuse or limited

Thickening of skin / hardening
Loss of face expression
Joint pain
Can fange heart lung kidneys ( lifetreathening )

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2
Q

What is limited systemic sclerosis associated with ?

A 
CREST syndrome 
Calcinosis cutis
Raynods phenomenon 
Esophageal dysmotility
Sclerodacyly
Telangiectasia
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3
Q

Name 3 autoimmune and 3 inherited connective tissue disorders

A 
Rheumatoid arthritis 
SLE
Sjörgen syndrome 
Systemic sclerosis 
Inflammatory myositis

Marfan syndrome
Alport syndrome
Ehlers Danos
Osteogenesis imperfecta

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4
Q

Which antibodies can be found in patients with vascultits ?

A

ANCA

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5
Q

A patient presents with sudden blurred vision on one eye , headaches , jaw claudification and a tender scalp. On examination he shows an RAPD and and a pale and swollen optic disk. ESR and CRP are raised . What’s the diagnosis and treatment ?

A

Temporal arteritis

IV steroids

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6
Q

In a patient with polymyalgia rheumatica, what do you have to examine to exclude an associated condition ?

A

Temporal arthritis

Eyes

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7
Q

A patient presents with tender points and chronic pain. What condition would you think of ?

A

Fibromyalgia

  • neurosensory disorder
    Treat with exercise and antidepressants
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8
Q

A patient presents with dry eyes and mouth . Which test would you perform ? What’s this condition called ?

A

Schirmers test for tear production

Sjörgen syndrome - sicca syndrome

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9
Q

What is secondary sjörgen syndrome associated with?

Which markers would you find in the blood ?

A

RA,SLE

ANA and anti-SSA/Ro

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10
Q

A patient with sjörgen syndrome is at risk of developing which condition?

A

B cell lymphoma and MALT lymphoma

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11
Q

A patient suffered a group A streptococcus tonsillitis 2 weeks ago.
He know presents with fever, joint pain that was in his feet first and now moved to the hips and skins nodules.
What’s the diagnosis ?

A

Rheumatic fever

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12
Q

In rheumatic fever , which organs might be affected ?

A

Heart - mitral / aortic valve and pancarditis
Skin nodules, erythema marginatum
Migratory polyarthritis

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13
Q

14 year old patient presents with joint inflammation and morning stiffness . What’s the diagnosis ?

A

Juvenile idiopathic arthritis

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14
Q

What is Gout?

A

Inflammatory , mono articular athropathy

Causes by increase levels of urea leading to deposition of Uric acid crystals in joints

Chronic: repeated attacks & giant cell accumulation

Causes
Genetic
Drugs, kidney disease , ketoacidosis
Leukaemia, psoriasis ,

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15
Q

What can trigger an episode of gout?

A

Alcohol

Purin rich food: meat , fish

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16
Q

In gout , which joint is commonly affected ?

A

MTP joint

Most common big toe = podagra

17
Q

In gout , which finding would you make in a synovial fluid sample (arthrocentesis )?

A

Crystals in shape of needle

18
Q

What is pseudogout?

A

Deposition of calcium

Crystals causing inflammation in a joint

19
Q

Name the 4 seronegative inflammatory arthritis .

What do they all have in common?

A

Psoriasis arthritis
Enterohepatic arthritis
Reactive arthritis
Ankylosing spondylitis

HLA-B27 genetic predisposition

20
Q

In seronegatives arthritis , what are characteristic symptoms ?

A

They all have a negative rheumatoid factor !

Asymmetrical involvement of joints

Predominant : spine 
Non-musculoskeletal symptoms 
Anterior uveitis 
Skin nails 
Conjunctivitis 
Nephritis 
Gut inflammation
21
Q

In Reiters Syndrome , there are 3 characteristic clinical features

A

=reactive arthritis

Urethritis
Conjunctivitis
Arthritis

“Can’t see , pee or climb a tree “

22
Q

What is psoriatic arthritis ?

A

Inflammation of joints like hand . Spine , feet that occur in patients with psoriasis

23
Q

Inflammatory rheumatic disease can affect one joint (monoarricular) or several (polyarticular ). Give examples

A

Mono

  • gout
  • infection / trauma

Poly

  • polyarthritis :RA, SLE, scleroderma,
  • spondyloarthritis: Reiters , psoriatic, ankylosing spondylitis
  • post infectious : rheumatic fever , Lyme
24
Q

What are the differences of osteoarthritis and rheumatoid arthritis ?

A 
RA
- synovial disease 
- MCP, PIP
- early morning stiffness >30
Min
- pain on decreased exercise 
- high inflammatory markers 
-extraarticular manifestations 
- bone erosions

OA:

  • cartilage disease
  • DIPs and 1st CMCJs
  • morning stiffness <30 min
  • pain worse at night / resting
  • no other manifestations
  • osteophytes
25
Q

Explain the typical symptoms in a patient with RA

A 
Symmetrical 
Hands , wrist , feet 
Inflammation
Morning stiffness 
General unwell "flu like" malaise fever 
Pain on rest 
PIP and MCP joints ( never DIP)
Rheumatoid nodules
26
Q

Give 5 organic manifestations of patients with RA

A
  • bursitis
  • Carpal tunnel syndrome
  • rheumatic nodules
  • sjörgen syndrome
  • scleritis
    -episcleritis
    Feltys syndrome
27
Q

What can be seen on an X-ray in patients with RA?

A

Joint space narrowing
Bone erosions
Cysts
Peri-auricular osteoporosis

28
Q

What are classical features of a rheumatoid hand ?

A 
Ulnar deviation 
Swan neck
Atrophy  of muscles 
Boutonnière deformity 
Hitchhiker thumb
29
Q

Classical blood parameters of rheumatoid arthritis

A

Rheumatoid factor
ANA
Anti CCP ( ACPA)

High esr, crp

30
Q

Explain treatment of rheumatoid arthritis

A

General
- resting during acute attack
- exercise to strengthen muscles
Weight loos and good foot wear

Pain
Paracetamol , NSAIDs

Immunosuppression
MTX

31
Q

Risk factors for osteoarthritis

A 
Age 
Female gender
Family history 
Occupation 
Overweight
32
Q

Pathophysiology of osteoarthritis

A 
Degenerative break down of cartilage
( and secondary inflammation )
Leading to remodelling processes 
- subchondral sclerosis 
- osteophytes
- crystal deposition
33
Q

Describe typical symptoms of osteoarthritis

A 
Pain 
Crepitus 
Morning stiffness <30
Min
Restricted movement 
Drumstick fingers
34
Q

Classic features of osteoarthritis in the hands

A 
Drumstick fingers 
DIP affected ( knuckles normal) 
Bourchards nodes
35
Q

The X-ray of a joint of a patient with osteoarthritis shows ?

A 
Irregular joint space narrowing
Osteophytes
Subchondral sclerosis &amp; cysts 
Malalignement 
Chondrocalcinosis
36
Q

I blood test of a patient with osteoarthritis shows ?

A

Nothing
Low ESR and CRP
No Rheumatoid factor

Synovial fluid shows no inflammation

37
Q

Treatment of osteoarthritis

A 
Huge impact on life !!  Stay low on medication as they Will be forever 
Education 
Advice 
Strengthen exercise
Weight loss 
Paracetamol
 topical NSAIDs 
Capsacain
Oral NSAIDs
Local heat and cold 
Support and braves 
Shoes
Manual therapy

GI (7 decks)

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