Rheumatology Flashcards
Osteopetrosis is a disorder of…
Osteoclast function
Osteopetrosis: features
Dense, thick bones prone to fractures
Osteopetrosis: bloods
Normal calcium, phosphate and ALP
Osteomalacia: causes (5)
Vitamin D deficiency CKD Drug induced Inherited Liver cirrhosis
Osteomalacia: features
Bone pain
Fractures
Proximal myopathy
Osteomalacia: bloods
Low vitamin D
Low calcium and phosphate
Raised ALP
Osteomalacia: x-ray
Translucent bands
Looser’s zones
Limited cutaneous systemic sclerosis: assoications
Anti-centromere antibodies
CREST syndrome
Calcinosis Raynaud's Oesophageal dysmotility Sclerodactyly Telangiectasia
Diffuse cutaenous systemic sclerosis: associations
scl-70 antibodies
Scleroderma: features
tightening and fibrosis of skin
Scleroderma: features
ANA positive in 90%
Reactive arthritis: post dysentry
Shigella, Salmonella, Yersinia, Campylobacter
Reactive arthritis: post STI
Chlamydia
T score >-1.0
Normal
T score -1.0 to -2.5
Osteopenia
T score
Osteoporosis
Psoriatic arthritis: features
Symmetric polyarthritis
Asymmetrical oligoarthritis
DIP joint disease
Pseudogout: associations
Haemochromatosis Hyperparathyroid Low Mg and PO4 Acromegaly Wilson's
Pseudogout: aspiration
weakly positive birefringment rhomboid shaped crystals
Adhesive capsulitis: features
Weakened external rotation
Causes of AVN
Steroids
Chemo
Alcohol
Trauma
Collagen affected in osteogenesis imperfecta
type 1
Osteogenesis Imperfecta: features
Childhood
Fractures
Blue sclera
Deafness
Pain worse on wrist extension is..
Lateral epicondylitis
Pain worse on wrist flexion is…
Medial epicondylitis
De Quervain’s: what?
Inflammation of sheath containing extensor pollicis brevis and abductor pollicis longus
De Quervain’s: features
Pain on radial side of wrist
Tenderness over radial styloid process
Abduction of thumb is painful
Rheumatoid arthritis: antibodies
Rheumatoid factor
ACPA
Dermatomyositis: what?
Inflammatory disorder causing symmetrical, proximal muscle weakness and skin lesions
Dermatomyositis: skin features
Photosensitive rash Macular rash over back and shoulder Helitrop rash in periorbital region Gottron's papules Mechanis hands
Dermatomyositis: Ix
Elevated CK
EMG
ANA positive
anti-Mi 2 (specific)
SLE: antibodies
ANA (99% positive)
anti-dsDNA
anti-Smith
RA: X ray changes
Loss of joint space
Juxta-articular OP
Soft tissue swelling
Paget’s: features
Bone pain
Isolated ALP raise
Paget’s: Mx
Bisphosphonate
Calcitonin
Polymyositis: what?
Inflammatory disorder causing symmetrical, proximal muscle weakness
Polymyositis: features
Proximal muscle weakness Raynaud's Respiratory muscle weakness ILD Dysphagia
Antiphospholipid Sx: features
VTE Recurrent miscarraige Livedo reticularis Thrombocytopenia Prolonged APTT
Antibodies: RA
RhF
Anti-CCP
Antibodies: SLE
ANA
dsDNA
Antibodies: Dermatomysoitis/Polymyositis
Anti-Jo
Antibodies: Limited scleroderma
anti-centromere
Antibodies: Diffuse scleroderma
anti scl-70
Antibodies: Sjogren’s Sx
Anto Ro
ANA
RhF
Antibodies: microscopic polyangiitis
pANCA
Antibodies: Wegner’s granulomatosis
cANCA
New diagnosis of dermatomyositis requires investigation of…
cancer
Langerhans cell histocytosis: features
bone pain
cutaneous nodules
recurrent otitis media
tennis racket-shaped Birbeck granules
Leflunomide: contraception
2 years following cessation
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L3 palsy
Sensory loss of anterior knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
L4 palsy
Sensory loss on dorsum foot
Weakness in foot and hallux dorsiflexion
Relfexes in tact
Positive sciatic nerve stretch test
L5 palsy
Sensory loss posterolateral aspect of leg and lateral foot
Weakness in plantar flexion
Reduced ankle reflex
Positive sciatic nerve stretch test
S1 palsy
Meralgia paraesthetica: lesions
Lateral femoral cutaneous nerve
Raloxifene: MoA
Selective oestrogen receptor modulator
Strontium ranelate: MoA
Increases deposition of new bone by osteoblasts
Reduces resorption of bone by inhibiting osteoclasts
Denosumab
Human monoclonal antibody that inhibits RANK ligand
Paget’s disease: features
Older male with bone pain and isolated raised ALP
Polyarteritis nodosa: features
Fever, malaise, arthralgia Weight loss HTN Mononeuritis multiplex Livedo reticularis
cANCA target
Serine proteinase 3
cANCA indicates
Granulomatosis with polyangiitis
pANCA target
myeloperoxidase
pANCA associations
UC, PSC, anti-GBM, Crohn’s
Drug induced Lupus: causes
Procainamide Hydralazine Isonazid Minocycline Phenytoin
Iliopsoas abscess: tests
Pain on hyperextension of hip
Marfan’s: features
Tall High arched palate Arachnodactyly Pectus excavatum Pes planus Scoliosis Aortic sinus dilatation MV proplapse Pneumothoraces Upwards lens dislocation Blue sclera Dural ectasia
McArdle’s disease
AR type V glycogen storage disease
McArdle’s disease: features
Muscle pain and stiffness following exercise
Cramps
Myoglobinuria
Low lactate during exercise
Pseudogout: RF
Haemochromatosis
Hyperparathyroid
Low Mg, low PO4
Acromegaly, Wilson’s
Pseudoxanthoma elasticum: features
Retinal angioid streaks
Plucked chicken skin appearance
MV prolpase
GI haemorrhage
Relapsing polychondritis: what?
Repeated episodes of inflammation and deterioration of cartilage
Relapsing polychrondritis: features
Aurricular chondritis, hearing loss, vertigo Saddle nose deformity Hoarseness, aphonia, wheezing, stridor Episcleritis, scleritis Arthralgia
Etanercept, infliximab, adalimumab
TNF inhibitors
Rituximab
Anti-CD20
Still’s disease in adults: features
Arthralgia, elevated ferritin, salmon pink macular-papular rash, pyrexia, LN
Rf and ANA negative
SLE: pregnancy
Congential heart block
Associated with anti-RO antibodies