Rheumatolgy Flashcards
Painful red swollen knee. Differentials?
Septic arthritis- often post joint injectin
Reactive arthritis- GI or sex infection
Gout- needle shaped -vely birefringent
Pseudogout- rhomboid crystals +vely birefringent
Examples of ESBLs? And abx that usually treats them
E.coli
Klebsiella
Usually cause UTIs but can cause pneumonia
Tx: meropenam or imipenem
AIDS defining illnesses?
Kaposi’s sarcoma
PCP- pneumocystis jirovecii pneumonia
CMV
Candidiasis- oesophageal or bronchial
Lymphomas - excluding Hodkins
TB
Examples of cephlosporins?
Ceftriaxone, cefotaxime
All the cephs….
What medication class can cause atheroscleosis?
Atypical antipsychotics- e.g. olanzapine, risperidone, clozapine, quitiapine
As can cause hyperlipidaemia
Two types of systemic sclerosis?
Diffuse cutaneous systemic sclerosis
Limited cutaneous systemic sclerosis
Scleroderma- w/o organ involvement
Diffuse- affects trunk and limbs mostly. Poor prognosis due to resp involvement in 80% interstitial lung disease and pulmonary arterial hypertension
Most specific antibody for diffuse cutaneous systemic sclerosis
Anti-Scl-70 abx
Which antibody is most specific for limited cutenous systemic sclerosis?
Subtype of limited systemic sclerosis?
Anti centromere antibodies
CREST syndrome: Calcinosis, Raynaud’s phenomenon, oEsophageal dysmobility, Sclerodactyly, Telangiectasia
Which anti body is associated with Sjögren’s syndrome?
Anti-Ro in 70%
Anti-La in 30%
RF +ve in 50%
ANA +ve in 70%
Autoimmune disorder affecting exocrine glands, ,ears to dry mucosal surfaces e.g. dry mouth, eyes, vagina
Immunologicical +ve findings in RA?
Rheumatoid factor
Anti-CCP (anti- cycling citrullinated protein)
Hand findings in RA?
Swollen joints
Ulnar deviation in fingers
Boutonnière deformity- flexion at PIP, hyperextention at DIP
Swan neck deformity- hyper extension at PIP, flexion at DIP
Z-shaped deformity if thumb
Wrist subluxation
Rupture of extensor tendon
Muscle wasting
X ray findings of RA hands?
Loss of joint space
Soft tissue swelling
Jutta-articulate osteopenia
Bkny erosions
Extra articulate features in RA?
Key ones
Pulmonary fibrosis w/ nodules- Caplans syndrome
Bronchiolitis obliterans- small airway destruction
Felty’s syndrome- RA, neutropenia, splenomegaly
Others:
Scleritis
Episcleritis
Lymphadenopathy
Pleural effusion
Pericardial effusion
Rheumatoid nodules e.g. elbow, pleura
Amyloidosis
Vasculitis
Raynaud’s phenomenon
Carpal tunnel syndrome
X-ray of a joint with gout findings?
Normal joint space
Soft tissue swelling
Erosion of periarticular bone
Light microscopy findings in gout and pseudogout?
Gout- negatively birefringent needle shaped crystals (made out of urate crystals)
Pseudo gout- positively birefringent rhomboid shaped crystals (made out of calcium pyrophosphate crystals)
X-ray findings in OA?
LOSS
loss of joint space
Osterphytes
Subchondral sclerosis
Subchondral cysts
Why might someone with SLE suffer from recurrent miscarriages?
20%+ of patients with SLE also have antiphospholipid syndrome, a condition that increases the risk of both arterial and venous clotting and recurrent miscarriages
4 most common features of antiphospholipid syndrome?
‘CLOT’
Coagulation defect- clots!
Livedo reticularis
Obstetric- recurrent miscarriage
Thrombocytopenia
What is Raynaud’s phenomenon?
Peripheral digital Ischaemic caused by vasospasm which is precipitated by cold or emotion
What can cause Raynaud’s phenomenon?
Raynaud’s disease-
SLE
RA
Dermatomyositis/polymyositis
Beta blockers
Polycythaemia rubra vera
Occupations e.g. vibrating tools
Hypothyroidism
Atherosclerosis
Beugers disease
39yo patient comes in with recent fatigue, aches and pains in shoulders and legs and a rash on eyes and hands, what is it? And the features of this?
Dermatomyositis
An autoimmune disease causing inflammation of the muscles and skin
(Polymyositis is same but without skin involvement)
Features
Muscle pain, most commonly shoulder and girdle bilaterally ie PROXIMAL
Fatigue and weakness
Skin features:
- Gottron lesions- scaly erythematous rash on knuckles, elbows and knees
- Heliotrope- purple rash over eyelids
- a photosensitive erythematous rash across back, shoulders and neck
- Subcutaneous calcinosis- calcium in sucut tissue
Suspecting Dermatomyositis, what first commonly done test would indicate this?
Raised CK
Extraarticular associations of anklylosing spondylitis?
Aortic regurg- early diastolic murmur
Pulmonary fibrosis
Anterior uveitis
Amyloidosis
