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RW FY1 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Anti-dsDNA

Anti-Ro

Anti-La

Anti-Sm

Anti-U1-RNP

Anti-Scl-70

Anti-centromere

Anti-Jo-1

Anti-Mi-2

A
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2
Q

Ocular manifesations of Rheumatoid arthritis

A

Keratoconjuncitivitis sicca (most common)

Sjögren’s syndrome (dryness, parotid enlargement)

Episcleritis (erythema)

Scleritis (erythema + pain + swollen)

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3
Q

Felty’s syndrome

A

Felty’s syndrome

SANTA

Splenomegaly | Arthritis (Rheumatoid) | Neutropaenia | Thrombocytopaenia | Anaemia

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4
Q

Ix for RhA

A

1st line = Rheumatoid factor (+ve in 70%)

Anti-CCP (high specificity) (+ve in 60%)

These are also poor prognostic factors

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5
Q

X ray changes in RhA

A

Tip: LESS

  • Loss of joint space
  • Erosions (justa-articular osteopenia) [often 1st sign]
  • Soft tissue swelling
  • Soft bones (Osteopenia)
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6
Q

Tx of RhA

S/E of Tx

A

Acute

  • Corticosteroids

Chronic

  • (1) DMARD + Bridging Prednisolone
    • ​Methotrexate
        • Folate
      • S/E: Hepatotoxic, Agranulocytosis (stop if infection!)
    • Azathioprine
      • ​Check TPMT deficiency beforehand
    • Sulfasalzine
      • ​Safe in pregnancy + breastfeeding
    • Hydroxychlorquine
      • ​Safe in pregnancy + breastfeeding
      • *​S/E*: Retinopathy
  • If refractory –> (2) Biologics
    • Anti-TNF (Infliximab, Etanercept, Adalimumab)
    • Anti-B cell (Rituximab)
    • S/E: Opportunistic infections, reactivation of latent TB
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7
Q

Tx of OA

A

Tx of OA

1st line

  • (1) Oral Paracetamol
  • or (1) Topical NSAIDs
    • Topical NSAIDs are only indicated in Hand OA or Knee OA

2nd line

  • (2) Oral NSAID (+ PPI)
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8
Q

Cause of septic arthritis

A

< 30 years –> N. gonorrhoea

> 30 years –> S. aureus

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9
Q

Ix + Tx for septic arthritis

A

Investigations

  • Blood culture [1st Ix under new guidelines]
  • URGENT joint aspiration –> synovial fluid MC&S

Management

  • IV Flucloxacillin
  • If pencillin allergic –> IV Clindamycin
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10
Q

Ix for Gout

A

Ix for Gout

Arthrocentesis with synovial fluid analysis

  • -ve birefringent needle-shaped crystals under polarised light [DIAGNOSTIC]

N.B. Urate is normal in 25% of Gout

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11
Q

X-ray (affected joint):

  • Periarticular erosions
  • Overhanging sclerotic margins / edges
  • Well-defined punched out bone lesions
  • Soft tissue tophi

Diagnosis?

A

Gout

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12
Q

Tx for Gout

A

Acute

  • (1) NSAID (C/I in CKD) or Colchicine
  • (2) Corticosteroids

Once acute gout resolved

  • Urate lowering therapy
    • Xanthine oxidase inhibitor –> Allopurinol
    • Uricosuric agents –> Probenecid
  • + Colchicine as bridging therapy

Low purine diet (avoid meat + seafood + oily fish)

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13
Q

X-ray Joint: Chondrocalcinosis

Diagnosis?

Ix?

Treatment?

A

Pseudogout (calcium pyrophosphate crystals)

Arthrocentesis + synovial fluid analysis: +ve birefringent, Rhomboid-shaped crystals

Tx: NSAIDs or Colchicine

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14
Q

DIP swelling + dactylitis

Diagnosis?

A

Psoriatic arthritis

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15
Q
A
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16
Q

Early morning gack pain, improves with exercise

Eye pain

Loss of lateral flexion of lumbar spine (1st sign)

Shober’s test +ve

Diagnosis? Ix? X ray changes? Tx?

A

Ankylosing spondylitis

1st line = X-ray (Pelvis) to look for sacroillitis

X-ray spine –> syndesmophytes, bamboo spine, squaring of vertebra

If X-ray negative –> MRI

Tx: (1) NSAIDs, (2) Biologics

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17
Q

Causes of reactive arthritis

A

After GI infection –> Post-dysentery

  • Salmonella | Campylobacter | Shigella | Yersinia species

After GU infection (Post-STI)–> Urethritis (typically 1-4 weeks after)

  • Chlamydia [most common]
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18
Q

Triad of reactive arthritis

A

Classic triad ==> “can’t see, can’t pee, can’t climb a tree”

  • Conjunctivitis
  • Urethritis (non-gonococcal)
  • Arthritis (post-infectious)
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19
Q

Fever

Arthritis

Salmon-pink rash

Lymphadenopathy

Hepatosplenomegaly

Diagnosis? Ix?

A

Adult onset Still’s disease

Ferritin: ↑↑↑ (e.g. Ferritin = 4000, NR 15-300)

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20
Q

Amyloidosis

Types + Protein involved

Causes

Presentation

A
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21
Q

Clot + Thrombocytopenia

Diagnosis?

Features?

Tx?

A

Antiphospholipid syndrome

  • Anticardiolipin antibodies: +ve on 2 occasions (12 weeks apart)
  • Anti-β2-GPI antibodies: +ve on 2 occasions (12 weeks apart)
  • Lupus anticoagulant: +ve on 2 occasions (12 weeks apart)

CLOT

  • Clots (arterial + venous)
  • Livedo reticularis (mottled rash)
  • Obstetric complications (recurrent miscarriage)
  • Thrombocytopaenia

Tx: Warfarin (INR 2-3) +/- Aspirin

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22
Q

Shoulder weakness

Raynaud’s phenomenon

Raised CK

Diagnosis?

A

Polymyositis

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23
Q

Shoulder weakness

Raynaud’s phenomenon

Gottren’s papules

Heloiotrope rash

Shawl sign

Raised CK

Diagnosis?

A

Dermatomyositis

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24
Q

Definitive diagnosis for dermatomyositis / polymyositis

A

Muscle biopsy

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25
Tx for dermatomyositis / polymyositis
(1) IV/PO **Corticosteroids** (2) IVIG **+ Screen for underlying malingnacy**
26
**Joint hypermobility** **Elastic + fragile skin** Diagnosis? Cause?
**Ehlers Danlos syndrome** **Mutation in Type III collagen** Tip: **_3_**hler's Danlos syndrome (affects Type III Collagen)
27
**Tall** **Wrist sign and Thumb sign +ve** **High arched palate** **Superotemporal ectopia lentis** **Aortic regurtation + Mitral regurgitation** **Aortic dissection** **Pneumothorax** Diagnosis? Cause?
**Marfan's syndrome** **Autosomal dominant** Mutations in **Fibrillin-1 gene**
28
**"Plucked chicken skin" appearance** **Retinal angioid streaks** **GI Bleeding** **Mitral valve prolapse** Diagnosis? Cause? Complications?
**Pseudoxanthoma elasticum** **Autosomal recessive** ↑ risk of **ischaemic heart disease**
29
**Dry, scaly, erythematous plaques** **Follicular keratin plugs [characteristic]** Diagnosis?
**Cutaneous discoid lupus erythematosus (DLE) = discoid lupus**
30
Causes of drug-induced lupus
Drugs associated with SLE * Most common * **Procainamide** * **Hydralazine** * Uncommon * **Isoniazid** * **Phenytoin**
31
Ix for drug-induced lupus
**drug-induced lupus** ## Footnote ANA +ve (100%) **Anti-histone _antibodies +v_**_e_ (90%) **Anti-dsDNA _NEGATIVE_** (usually +ve in SLE)
32
Causes of Neonatal lupus erythematosus Presentation
**Neonatal lupus erythematosus** **Anti-Ro antibodies** Congenital heart block
33
Tx for SLE
Acute SLE * **High-dose Prednisolone** * **IV Cyclophosphamide** Chornic SLE * Skin symptoms --\> **Hydroxchlorquine** * Joint symptoms --\> **NSAIDs**
34
Monitoring for SLE
Monitoring for SLE * **ESR** * **Anti-dsDNA Ab titres** * However, these are not present in all SLE (only present in 70%) * **C3/C4 levels** * ↓ during active disease as formation of complexes consumes complement
35
Most common renal manifesation of SLEdiffuse proliferative glomerulonephritis
SLE --\> **diffuse proliferative glomerulonephritis**
36
**Mixed connective tissue disease** What antibody?
**Mixed connective tissue disease** **Anti-U1-RNP antibodies** Anti-U1 ribonucleoprotein (RNP) antibodies / Anti-RNP: +ve
37
**Sjogren's syndrome** Antibodies Presentation Associations
**Sjogren's syndrome** Anti-Ro + Anti-La Dry eyes + Dry mouth **Sjogren's syndrome** is associated with * **Primary biliary cirrhosis** (70%) * **Rheumatoid arthritis**
38
**CREST syndrome** Involves
CREST * **Calcinosis** = tender white nodules over extensor surface * **Raynaud’s phenomenon** * **oEsophageal dysmotility** * **Sclerodactyl** = tightening and thickening of skin * **Telangiectasia** = blanchable red patches of small vessels
39
Limited vs Diffuse systemic sclerosis
40
Bacterial overgrowth syndrome Investigation? Associated with?
**Systemic sclerosis** Due to reduced peristalsis Ix: **Hydrogen breath test**
41
Most common cause of death in systemic sclerosis
Most common cause of death in systemic sclerosis Respiratory involvement * **Pulmonary fibrosis** * **Pulmonary hypertension**
42
Tx for Raynaud's phenomenon
CCB (**Nifedipine**)
43
Types of vasculitis
44
**Visual symptoms** **Jaw claudication** **Headache** **Scalp tenderness** **Polymyalgia rheumatica** Diagnosis? Tx? Complications?
**Temporal arteritis / Giant cell arteritis** ## Footnote Tx: **High dose corticosteroids** Complications: **anterior ischaemic optic neuropathy** --\> Blindness
45
**Asian female** **Weak/Absent pulses** **L + R BP differential** **Claudication** **Hypertension** **Chest pain** Diagnosis? Ix? Tx?
**Takayasu arteritis** (branches of aortic arch) Ix: **CT angiography** Tx: **Corticosteroids**
46
Features of Kawasaki Ix? Tx?
**Kawasaki's disease** (affects coronary arteries) * **Conjunctivitis** * **Rash (maculopapular)** * **Adenopathy (cervical lymphadenopathy)** * **Strawberry tongue** * **Hands and feet (erythema and swollen)** * **Fever \> 5 days** Ix: TTE to look at coronary arteries Tx: IVIG + Aspirin
47
**Hepatitis B** **Mononeuritis multiplex** **Livedo reticularis** **Haematuria** **Renal failure** **Hypertension** Diagnosis? Ix? Tx?
**Polyarteritis nodosa** (affects skin, renal, mesenteric arteries) Associated with **Hepatitis B** Ix: Angiography (**string of beads** = Rosary sign) Tx: Corticosteroids
48
**Smoking** **Absence of distal pulses** **Rest pain** **Raynaud's phenomenon** Diagnosis? Ix? Tx?
**Buerger's disease** (thromboangiitis obliterans) Associated with **smoking** Is: **Arterial Doppler + Angiography** Tx: **CCB (Nifedipine)**
49
**Wegener vs Churg Strauss** What are the new names
Tip: Longer one is for the longer one ## Footnote **Wegener = Granulomatosis with polyangiitis** **Churg-Strauss = Eosinophilic granulomatosis with polyangiitis**
50
**cANCA vs pANCA** Associations Targets
Tip: C3PO * **C-ANCA --\> PR3** * Wegener's * **P-ANCA --\> MPO** * ​Churg-Strauss
51
**Asthma symptoms** **Started Montelukast** **Mononeuritis multiplex** Diagnosis? Ix? Tx?
**Eosinophilic Granulomatosis with Polyangitis** = (Churg-Strauss syndrome) * pANCA * Eosinophilia Tx: Corticosteroids + Cyclophosphamide
52
**Upper respiratory tract involvement** (Saddle nose, Sinsitus, Nosebleeds) **Lower respiratory tract involvement** (Haemoptysis) Pauci-immune **(rapidly progressive) glomerulonephritis** Diagnosis? Ix? Tx?
**Granulomatosis with Polyangiitis** (GPA) = (Wegener’s Granulomatosis) * c-ANCA * Biopsy: Crescentic glomerulonephritis Tx: Corticosteroids + Cyclophosphamide
53
**p-ANCA antibodies without evidence of granulomatous disease** **Lung + Kidney involvement** **No nasopharynx involvement** (key difference!) Diagnosis?
**Microscopic polyangiitis**
54
Features of Henon-Schonlein purpura Renal biopsy findings
+/- Preceding URTI **Palpable purpuric rash** (on buttocks and extensor surfaces of arms and legs) **Arthralgia / Arthritis** **Abdominal pain** **Glomerulonephritis** (Haematuria or Proteinuria) **(Peri-articular oedema)** Renal biopsy: mesangial IgA deposition
55
Behcet's disease - features - complications?
Behcet's disease * Triad * **Oral ulcers** * **Genital ulcers** * **Uveitis** * Erythema nodosum Complications * VTE * Aseptic meningitis
56
DDx: Wegener's granulomatosis vs Goodpasture's syndrome
57
**Cryoglobulinaemia** Triad
**Cryoglobulinaemia** * **Triad (**PAW) * **​Purpura** * **Arthralgia** * **Weakness**
58
**Cryoglobulinaemia** Types + Associations
59
Acute onset Shoulder/Hip stiffness or pain Normal power Rapid response to corticosteroids Raised ESR Diagnosis? Tx? Associations?
**Polymyalgia rheumatica** Associated with temporal arteritis / giant cell arteritis Tx: Corticosteroids
60
**Polymyalgia rhuematica** vs **Fibromyalgia** vs **Stain-induced myopathy**
61
Continuous regional pain out of proportion to the severity of the inciting event and beyond the normal time frame expected following the event Diagnosis? Tx?
**Complex Regional Pain Syndrome** Tx: Physiotherapy
62
Causes + Ix + Tx for osteomyelitis
**Osteomyelitis** Causes * **Staph aureus** (most common) * **Salmonella spp** (most common in sickle cell patients) Ix: **MRI (Bone)** Tx: IV Flucloxacillin +/- Surgical debridgement
63
**Lupus pernio** = Red/Purple raised hard skin lesions on nose, ears, cheeks Diagnosis? Ix? CXR changes? Prognosis?
**_Sarcoidosis_** Biopsy = **Non-caseating granuloma** (diagnostic) **Serum ACE +ve** CXR: **bilateral hilar lymphadenopathy** Good prognosis as majority self resolve spontaneously

RW FY1 (15 decks)

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