Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Station 5 > rheumatoid hands/rheumatology > Flashcards

rheumatoid hands/rheumatology Flashcards

1
Q

EULAR criteria for RA

A

score 6+ = RA

Symptom Duration (as reported by patient) Points

< 6 weeks 0
> 6 weeks 1

Joint Distribution Points

1 large joint 0
2-10 large joints 1
1-3 small joints (with or without involvement of large joints) 2
4-10 small joints (with or without involvement of large joints) 3
> 10 joints (at least 1 small joint) 5

Serology Points

RF- and CCP- 0
Low RF+ or CCP+ 2
High RF+ or CCP+ 3

Acute Phase Reactants Points

Normal ESR or CRP 0
Abnormal ESR or CRP 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hand signs of RA

A 
symmetrical deforming polyarthritis - small joints hands, wrists, elbows, DIP sparing.
MCP ulnar deviation
Boutonniere's/swan necking
Z thumb
piano key sign
rheumatoid nodules
Surgical scars
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Extra-articular manifestations of RA

A

haematological: Felty’s syndrome
skin: nodules, vasculitis, pyoderma gangrenosum
eye: scleritis, episcleritis
CVD: valvular disease, pericardial effusion, myocarditis, heart failure
Resp: pulmonary fibrosis, pleural effusion, bronchiolitis
Renal: amyloidosis
Neurology: peripheral neuropathy, mononeuritis multiplex
Compression neuropathies: carpal tunnel, atlanto-axial subluxation,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Investigation of suspected RA

A

FBC - anaemia chronic dis, felty’s
CRP/ESR
RhF - 5-10% in normal population 80% of RA
CCP - TB false positive
XR - joints - osteopenia, erosions, joint space narrowing, deformity
CXR - fibrosis or nodules
Lung function tests - restrictive defects
HRCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of RA - options

A

Conservative: exercise, PT/OT - home and lifestyle modification
NSAIDS
DMARDS - methotrexate, sulphasalazine, leflunomide, hydroxychloroquine
Glucocorticoids
OLD - gold, pencillamine
Biologics
Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Initial management of RA - NICE

A

new diagnosis: 2 DMARDS inc methotrexate and short-term glucocorticoids.
If disease not responding or disease severity score DAS28 is high - 5.1+
Can give Adalimumab, etanercept, certolizumab pegol or tocilizumab as monotherapy or certolizumab pegol, golimumab, abatacept and tocilizumab with methotrexate if tolerated.
Can continue biologics if there is response
If no response, rituximab and methotrexate in combination
If rituximab contra-indicated/adverse effect - Adalimumab, etanercept, infliximab and abatacept
When stable, reduce as able.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How would you monitor a patient on DMARD/TNF

A

SPECIALIST REVIEW
clinical - regular review - hx and exam, evidence of infection or complications TB reactivation, pulmonary fibrosis
Bloods - FBC, U&E, LFT - monthly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the side effects of methotrexate and how would one treat methotrexate toxicity?

A 
hepatitis
alveolitis
stomatitis
bone marrow suppression/pancytopenia
infections due to immunosuppression

Folinic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you manage a patient in A+E who presents with cellulitis who is taking anti-TNF therapy

A

admit
stop biologic
IV antibiotics
specialist advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of anaemia in RA

A 
chronic disease
NSAIDS/steroids - causing GI bleeding
Felty's
renal amyloid
myelosuppression secondary to drugs
autoimmune haemolytic anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you distinguish active from inactive arthritis?

A

Symptoms - increased pain, fatigue, swelling, joint tenderness, joint temperature, raised ESR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Psoriatic arthritis history

A 
Inflammatory back pain
iritis
symptoms of IBD
enthesitis
plantar fasciitis
joint distribution - asymmetry
?response to exercise and NSAIDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Psoriatic arthritis examination

A

Nails: pitting, onycholysis, transverse ridging, hyperkeratosis, yellowing
Skin: psoriasis - elbows, knees, hairline, back of neck, umbilicus, koebners
Sacroiliitis
Aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Psoriatic arthritis differentials

A

DIP involvement - OA
Rheumatoid pattern - RA
ank spond, reactive arthritis, IBD related arthropathy
oligoarthropathy - reactive arthritis, gout, sarcoidosis
dactylitis - gout, reactive, sarcoidosis
If severe and rapid - consider HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations psoriatic arthropathy

A

Plain films
US if radiographs inconclusive
Bloods - fbc anaemia, renal function, CRP and ESR (can be normal in PsA)
HLA-B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treating psoriatic arthropathy

A

conservative: OT/PT
medical: NSAIDS in mild, non erosive disease
DMARDS - sulfasalazine - arthritis
methotrexate - arthritis and skin
leflunomide arthritis > skin
hydroxychloroquine - exacerbates skin disease
Steroids: caution as withdrawal can worsen disease
Local cortisone injections
anti-TNF

will remain on medication indefinitely to control arthritis

17
Q

How to differentiate between RA and PsA

A

Asymmetry
nail changes
dactylitis

family hx of psoriasis

negative RhF and CCP

18
Q

Causes of breathlessness in SLE/connective tissue disorders

A 
PE
Pleural effusion
pneumonia - (can be due to immunosuppression)
pulmonary fibrosis
reaction to biologic therapy - ARDS mimic
Pericardial effusion
Acute MI 
cardiomyopathy
renal failure causing pulmonary oedema
myositis/GBS
19
Q

SLE history

A

Arthritis - non deforming
Mucocutaneous lesions - butterfly pattern rash, light sensitive, alopecia, mouth ulcers
Cardioresp. involvement - SOB, CP, syncope, haemoptysis
Renal disease - oedema, renal biopsies, RRT
Myositis
Neuropsychiatric
Haematological - thrombotic events - antiphospholipid syndrome
Obstetric - recurrent miscarriage, pre-eclampsia

20
Q

ACR SLE diagnostic criteria

A

4 of
Malar Rash
discoid rash
photosensitivity
oral ulcers
non erosive arthritis
serositis - pleuritis, pleural effusion or percarditis
renal disorder - proteinura, cellular casts
neurological disorder - seizures, psychosis, transverse myelitis
haematological disorder - haemolytic anaemia, leucopenia, lymphopenia, thrombocytopenia
anti-nuclear antibodies
other autoantibodies - antiphospholipid syndrome, anti SM, anti dsDNA

21
Q

SLE examination

A

lymphadenopathy or fever
arthritis
mucocutaneous - discoid rash, malar rash, mouth ulcers, vasculitis, alopecia,
cardiac involvement - AR or MR
respiratory - fibrosis, pleural effusions, consolidation
Hypertension
urinalysis - nephritic picture
renal disease - oedematous, nephrotic syndrome, RRt, AV fistula, renal transplant
Evidence of thrombotic events
Iatrogenic - cushingoid appearance
Neurological

22
Q

Sjogrens - hx, exam, ix

A

Seen in combination with RA or SLE
dry eyes, dry mouth
bilateral enlarged parotid glands
schirmer’s test - filter paper, measure distance of moisture spread

anti Ro and anti La, may be seen in RhF and anti CCP positive, if antibodies -ve - parotid biopsy
High risk of lymphoma - 40x

23
Q

SLE investigations

A

Determined by disease pattern
urine cytology - cell casts
elevated ESR, sometimes elevated CRP due to acute process
FBC - haemolytic anaemia, thrombocytopenia, lymphopenia
Immunological tests
ANA - positive in 95%
dsDNA usually positive
anti ro and la
low C4 and low C3
antiphospholipid antibodies
CK - myositis
Pulse oximetry +/- ABG CXR - effusions, fibrosis, cardiomegaly (can be sign of pericardial effusion)
CTPA - ?PE
Echo - if valvular lesion - incompetence, vegetations, pericardial effusion
renal biopsy

24
Q

Treating SLE - medication

A 
Steroids - pred - long term
antimalarials
immunosuppressants - azathioprine, cyclophosphamide, MMF, methotrexate
biologics - rituximab
IVIg
plasmapheresis

SLE - anticoagulation

25
Q

Risks of cyclophosphamide

A

Infection:
reactivation of previous infection - Hep B, Hep C, TB and HIV screen prior
myelosuppression
immunosuppression - PCP prophylaxis given
haemorrhagic cystitis - MESNA
Malignancy - all forms assoc with increased doses
Infertility

Oral cyclophosphamide has a higher risk than puled IV equivalent

26
Q

Tell me about systemic sclerosis

A

systemic sclerosis is a CTD causing thickening and fibrosis in the skin with heterogenous other organ involvement. It is 3x more common in women. No ethnic bias.

27
Q

Tell me about the scleroderma spectrum

A

This increases in severity from Reynaud’s phenomenon, localised scleroderma, limited cutaneous systemic sclerosis (CREST) scleroderma distal to elbows), diffuse cutaneous (proximal to elbows)

28
Q

This patient has reynaud’s phenomenon, what are the causes and the differentiating features

A

SYSTEMIC SCLEROSIS
Scleroderma
SOB leading to Pulmonary fibrosis or PAH
Dysphagia, dyspepsia, diarrhoea

SLE
malar rash/photosensitivity/scarring alopecia
Jaccoud’s arthropathy
Oral ulceration

DERMATOMYOSITIS
Heliotrope rash
Proximal rash

MIXED CONNECTIVE TISSUE DISEASE
features of SLE
features of scleroderma
features of polymyositis

SJOGREN’S SYNDROME
Xerophthalmia
Fatigue
Non-erosive small joint polarthropathy

29
Q

Examination features of connective tissue disorders - ?CREST

A 
HANDS
sclerodatyly
arthritis
jaccoud's arthropathy (severe rheumatoid appearance)
digital ulcers
subcutaneous calcinosis
cutaneous vasculitis
periungal erythema
gottrons papules

FACE
telangiectasia
microstomia

Cardiorespiratory
fibrosis
PAH
(pulmonary causes are largest cause of mortality)

30
Q

Investigations of Reynauds/systemic sclerosis and management

A 
Positive ANA - 90%
Scl70 dcSSc
anticentromere lcSSc
nailfold capillaroscopy
lung function tests 
HRCT
Echo

Treatment
calcium antagonists and iloprost - Reynauds
methotrexate, MMF - skin
cyclophosphamide - skin and lungs

31
Q

Gout triggers

A 
alcohol
purine ingestion
haemorrhage
infection
trauma
surgery
radiotherapy
dehydration
32
Q

Gout precipitating conditions

A 
Renal impairment
hypothyroidism
myelo/lympho-proliferative conditions
PCV
hyperparathyroidism
diabetes mellitus
diabetes insipidus
barter's syndrome
sarcoidosis
psoriasis
hyperlipidaemia
obesity
33
Q

Drugs that increase urate level

A 
thiazide diuretics
aspirin
theophylline
ciclosporin
levodopa
ethambutol

Note losartan and fenofibrate reduce levels.

34
Q

Investigations in gout

A

Bedside - blood pressure (HTN due to renal impairment)
obs - low grade pyrexia

Lab
urate, lipids, thyroid and renal dysfunction

Imaging
plain films - punched out erosions
joint space preservation
no osteopenia

Station 5 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions