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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
Q

Tx for dermatomyositis / polymyositis

A

(1) IV/PO Corticosteroids
(2) IVIG

+ Screen for underlying malingnacy

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26
Q

Joint hypermobility

Elastic + fragile skin

Diagnosis? Cause?

A

Ehlers Danlos syndrome

Mutation in Type III collagen

Tip: 3hler’s Danlos syndrome (affects Type III Collagen)

27
Q

Tall

Wrist sign and Thumb sign +ve

High arched palate

Superotemporal ectopia lentis

Aortic regurtation + Mitral regurgitation

Aortic dissection

Pneumothorax

Diagnosis? Cause?

A

Marfan’s syndrome

Autosomal dominant

Mutations in Fibrillin-1 gene

28
Q

“Plucked chicken skin” appearance

Retinal angioid streaks

GI Bleeding

Mitral valve prolapse

Diagnosis? Cause? Complications?

A

Pseudoxanthoma elasticum

Autosomal recessive

↑ risk of ischaemic heart disease

29
Q

Dry, scaly, erythematous plaques

Follicular keratin plugs [characteristic]

Diagnosis?

A

Cutaneous discoid lupus erythematosus (DLE) = discoid lupus

30
Q

Causes of drug-induced lupus

A

Drugs associated with SLE

  • Most common
    • Procainamide
    • Hydralazine
  • Uncommon
    • Isoniazid
    • Phenytoin
31
Q

Ix for drug-induced lupus

A

drug-induced lupus

ANA +ve (100%)

Anti-histone antibodies +ve (90%)

Anti-dsDNA NEGATIVE (usually +ve in SLE)

32
Q

Causes of Neonatal lupus erythematosus

Presentation

A

Neonatal lupus erythematosus

Anti-Ro antibodies

Congenital heart block

33
Q

Tx for SLE

A

Acute SLE

  • High-dose Prednisolone
  • IV Cyclophosphamide

Chornic SLE

  • Skin symptoms –> Hydroxchlorquine
  • Joint symptoms –> NSAIDs
34
Q

Monitoring for SLE

A

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
Q

Most common renal manifesation of SLEdiffuse proliferative glomerulonephritis

A

SLE –> diffuse proliferative glomerulonephritis

36
Q

Mixed connective tissue disease

What antibody?

A

Mixed connective tissue disease

Anti-U1-RNP antibodies

Anti-U1 ribonucleoprotein (RNP) antibodies / Anti-RNP: +ve

37
Q

Sjogren’s syndrome

Antibodies

Presentation

Associations

A

Sjogren’s syndrome

Anti-Ro + Anti-La

Dry eyes + Dry mouth

Sjogren’s syndrome is associated with

  • Primary biliary cirrhosis (70%)
  • Rheumatoid arthritis
38
Q

CREST syndrome

Involves

A

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
Q

Limited vs Diffuse systemic sclerosis

A
40
Q

Bacterial overgrowth syndrome

Investigation?

Associated with?

A

Systemic sclerosis

Due to reduced peristalsis

Ix: Hydrogen breath test

41
Q

Most common cause of death in systemic sclerosis

A

Most common cause of death in systemic sclerosis

Respiratory involvement

  • Pulmonary fibrosis
  • Pulmonary hypertension
42
Q

Tx for Raynaud’s phenomenon

A

CCB (Nifedipine)

43
Q

Types of vasculitis

A
44
Q

Visual symptoms

Jaw claudication

Headache

Scalp tenderness

Polymyalgia rheumatica

Diagnosis? Tx? Complications?

A

Temporal arteritis / Giant cell arteritis

Tx: High dose corticosteroids

Complications: anterior ischaemic optic neuropathy –> Blindness

45
Q

Asian female

Weak/Absent pulses

L + R BP differential

Claudication

Hypertension

Chest pain

Diagnosis? Ix? Tx?

A

Takayasu arteritis (branches of aortic arch)

Ix: CT angiography

Tx: Corticosteroids

46
Q

Features of Kawasaki

Ix?

Tx?

A

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
Q

Hepatitis B

Mononeuritis multiplex

Livedo reticularis

Haematuria

Renal failure

Hypertension

Diagnosis? Ix? Tx?

A

Polyarteritis nodosa (affects skin, renal, mesenteric arteries)

Associated with Hepatitis B

Ix: Angiography (string of beads = Rosary sign)

Tx: Corticosteroids

48
Q

Smoking

Absence of distal pulses

Rest pain

Raynaud’s phenomenon

Diagnosis? Ix? Tx?

A

Buerger’s disease (thromboangiitis obliterans)

Associated with smoking

Is: Arterial Doppler + Angiography

Tx: CCB (Nifedipine)

49
Q

Wegener vs Churg Strauss

What are the new names

A

Tip: Longer one is for the longer one

Wegener = Granulomatosis with polyangiitis

Churg-Strauss = Eosinophilic granulomatosis with polyangiitis

50
Q

cANCA vs pANCA

Associations

Targets

A

Tip: C3PO

  • C-ANCA –> PR3
    • Wegener’s
  • P-ANCA –> MPO
    • ​Churg-Strauss
51
Q

Asthma symptoms

Started Montelukast

Mononeuritis multiplex

Diagnosis? Ix? Tx?

A

Eosinophilic Granulomatosis with Polyangitis = (Churg-Strauss syndrome)

  • pANCA
  • Eosinophilia

Tx: Corticosteroids + Cyclophosphamide

52
Q

Upper respiratory tract involvement (Saddle nose, Sinsitus, Nosebleeds)

Lower respiratory tract involvement (Haemoptysis)

Pauci-immune (rapidly progressive) glomerulonephritis

Diagnosis? Ix? Tx?

A

Granulomatosis with Polyangiitis (GPA) = (Wegener’s Granulomatosis)

  • c-ANCA
  • Biopsy: Crescentic glomerulonephritis

Tx: Corticosteroids + Cyclophosphamide

53
Q

p-ANCA antibodies without evidence of granulomatous disease

Lung + Kidney involvement

No nasopharynx involvement (key difference!)

Diagnosis?

A

Microscopic polyangiitis

54
Q

Features of Henon-Schonlein purpura

Renal biopsy findings

A

+/- 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
Q

Behcet’s disease

  • features
  • complications?
A

Behcet’s disease

  • Triad
    • Oral ulcers
    • Genital ulcers
    • Uveitis
  • Erythema nodosum

Complications

  • VTE
  • Aseptic meningitis
56
Q

DDx: Wegener’s granulomatosis vs Goodpasture’s syndrome

A
57
Q

Cryoglobulinaemia

Triad

A

Cryoglobulinaemia

  • Triad (PAW)
    • ​Purpura
    • Arthralgia
    • Weakness
58
Q

Cryoglobulinaemia

Types + Associations

A
59
Q

Acute onset

Shoulder/Hip stiffness or pain

Normal power

Rapid response to corticosteroids

Raised ESR

Diagnosis? Tx? Associations?

A

Polymyalgia rheumatica

Associated with temporal arteritis / giant cell arteritis

Tx: Corticosteroids

60
Q

Polymyalgia rhuematica vs Fibromyalgia vs Stain-induced myopathy

A
61
Q

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?

A

Complex Regional Pain Syndrome

Tx: Physiotherapy

62
Q

Causes + Ix + Tx for osteomyelitis

A

Osteomyelitis

Causes

  • Staph aureus (most common)
  • Salmonella spp (most common in sickle cell patients)

Ix: MRI (Bone)

Tx: IV Flucloxacillin +/- Surgical debridgement

63
Q

Lupus pernio

= Red/Purple raised hard skin lesions on nose, ears, cheeks

Diagnosis? Ix? CXR changes?

Prognosis?

A

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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