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Leeds MBCHB Year 4 Peads > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

3 key features of inflammatory arthritis

A

Joint pain, swelling and stiffness

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2
Q

Key feature of systemic juvenile idiopathic arthritis

A

Salmon pink rash

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3
Q

Systemic juvenile idiopathic arthritis common name

A

Stills disease

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4
Q

Typical features of systemic juvenile idiopathic arthritis

A

Salmon pink rash

Fevers, lymph nodes, weight loss, join pain and inflammation, splenomegaly, muscle pain, pleuritis

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5
Q

Blood tests for systemic juvenile idiopathic arthritis

A

AMA and RF normally negative

Raised inflammatory markers - CRP, ESR, platelets, ferritin

ESR low if macrophage activation syndrome

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6
Q

Key complication of systemic juvenile idiopathic arthritis

A

Macrophage activation syndrome

Overactivation of immune system -> DIC -> non blanching rash/ anaemia, thrombocytopenia

LOW ESR

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7
Q

Key differentials for children with fevers for more than 5 days (non infective)? (4)

A

Kawasaki disease, stills disease, rheumatic fever, leukaemia

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8
Q

5 types of juvenile idiopathic arthritis

A

Systemic, polyarticular, oligoarticular, enthesitis related, juvenile psoriatic

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9
Q

How many joints does polyarticular and oligoarticular juvenile idiopathic arthritis effect

A

Polyarticular 5 or more

Oligoarticular 4 or less

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10
Q

Signs and symptoms in polyarticular juvenile idopathic arthritis

A

5 or more joints with symmetrical arthritis.

Mild fever, anaemia, reduced growth

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11
Q

RA in children name

A

Polyarticular juvenile idiopathic arthritis

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12
Q

Condition associated with oligoarticular juvenile idiopathic arthritis

A

Anterior uveitis

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13
Q

Oligoarticular JIA presentation

A

Commonly only effects 1 joint

Girls under 6 years

Anterior uveitis association

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14
Q

Enthesis definition

A

Point at which tendon inserts onto bone

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15
Q

What is the name of the group of conditions: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, IBD.

A

Seronegative spondyloarthropathy

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16
Q

Gene mutation in majority of enthesitis related juvenile idiopathic arthritis

A

HLA B27

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17
Q

How will patients with enthesitis related arthritis present

A

Tender palpation of entheses

Psoriasis, IBD, anterior uveitis

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18
Q

Seronegative meaning

A

RF test negative

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19
Q

4 types of management of juvenile idiopathic arthritis

A

NSAIDS
Steroids
DMARDS
Biologicals (tumour necrosis factor inhibitors)

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20
Q

Ehlers-danlos syndrome cause

A

Genetic defect in collagen

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21
Q

4 types of EDS

A

Hypermobile (most common) - soft stretchy skin
Classical - remarkably stretchy skin, very smooth. Hernias, prolapses, MR, aortic root dilatation
Vascular - thin translucent skin. Vessels prone to rupture
Kyphoscoliotic - hypotonia and kyphoscoliosis

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22
Q

Inheritance type of EDL

A

Autosomal dominant

Hypermobile (most common) is genetic but unknown

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23
Q

Scoring system for hyper mobility

A

Beighton score

Max of 9

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24
Q

Hypermobile EDS symptoms other than joint pain and hypermobility

A

Soft skin, easy brushing, GORD, IBS, PROM, incontinence, bleeding, autonomic dysfunction

POTS

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25
Q

Other common genetic condition that causes hypermobility

A

Marfan syndrome - high arch palate, arachnodactyly and long arm span

26
Q

Management of EDS

A

No cure

Physio, good posture, moderate exercise

27
Q

Rheumatology condition associated with POTS

A

EDS

28
Q

Henoch Schonlein Purpura cause

A

IgA vasculitis

Inflammation of skin, kidneys, and GIT from IgA deposits in blood vessels

29
Q

Henoch Schonlein Purpura 4 features

A

Purpura
Joint pain
Abdominal pain
Renal involvement

30
Q

Child presents with purpura rash, joint pain, abdominal pain and deranged U&Es - DX?

A

Henoch Schonelin Purpura

31
Q

5 differentials of non blanching rash

A 
Menigococcal sepsis
Henoch Schonlein Pupura
Idiopathic thrombocytopenic purpura
Haemolytic uraemia syndrome (E Coli 0157)
Leukaemia
32
Q

Important test to do in children with hence schonlein purpura

A

Dipstick urine - 50% have renal involvement (IgA nephritis)

2+ protein -> nephrotic syndrome

33
Q

Criteria for hence schonlein purpura diagnosis

A

EULAR/PRINTO/PRES criteria

Pupura and one of:
Abdominal pain, arthritis, IgA deposits, proteinuria

34
Q

Kawasaki type of disease

A

Mucocutaneous lymph node syndrome

Vasculitis

35
Q

Kawasaki epidemiology

A

Boys under 5

Asian, Japanese and Korean children

36
Q

Kawasaki disease key complication

A

Coronary artery aneurysm

37
Q

Key features of Kawasaki disease

A

High fever for more than 5 days
Widespread maculopapular rash and desquamation (skin peeling)

Strawberry tongue, cracked lips, cervical lymphadenopathy, bilateral conjunctivitis

38
Q

Key features of Kawasaki disease

A

High fever for more than 5 days
Widespread maculopapular rash and desquamation (skin peeling)

Strawberry tongue, cracked lips, cervical lymphadenopathy, bilateral conjunctivitis

39
Q

What is desquamation and what Peads disease is it associated with

A

Peeling skin

Kawasakis disease

40
Q

Investigations in Kawasaki disease

A

FBC - anaemia, leukocytosis and thrombocytosis
LFT - hypoalbuminemia and elevated LFTs
Inflammatory markers (ESR) - raised
Urinalysis - white cells without infection
Echo - check for coronary artery pathology

41
Q

3 phases to Kawasaki disease

A

Acute - 1 to 2 weeks child most unwell
Subacute - 2 to 4 weeks desquamation and arthralgia. Risk of coronary artery pathology
Convalescent - 2 to 4 weeks symptoms settle

42
Q

Management of Kawasakis disease

A

High dose aspirin - reduce risk of thrombosis

IV immunoglobulins - reduce risk of coronary artery aneurysms

43
Q

Why is aspirin not normally given to children

A

Risk of Reyes syndrome

44
Q

Rheumatic fever type of disease

A

Autoimmune condition triggered by streptococcus bacteria.

Antibodies against strep also target body tissues

45
Q

Why is rheumatic fever uncommon in UK

A

Early treatment of streptococcus (group A beta-haemolytic - commonly pyogenes) that causes tonsillitis with antibiotics.

46
Q

Most common bacteria to cause RF

A

Group A beta-haemolytic streptococcus

Streptococcus pyogenes

47
Q

Type of reaction in RF

A

Type 2 hypersensitivity

48
Q

Timing between streptococcus infection and RF

A

2- 4 weeks

49
Q

Most common infection 2-4 weeks before RF

A

Tonsilitis (strep pyogenes)

50
Q

5 groups of symptoms in RF

A

Joint involvement - migratory arthritis (hot swollen large joints that move from one joint to another)

Heart involvement - carditis (pericarditis, myocarditis, endocarditis), mitral valve disease, pericardial rub

Skin involvement - subcutaneous nodules, erythema marginatum rash

Firm painless nodules on extensor surfaces

Nervous system - chorea (irregular, uncontrolled rapid movements on limbs)

51
Q

Rash in RF

A

Erythema marginatum

52
Q

Type of nervous system symptom in RF

A

Chorea - rapid, uncontrolled random movements on limbs

53
Q

Type of joint problems in RF

A

Migratory arthritis - swelling in large joints moves from one to another

54
Q

Are subcutaneous nodules painful in RF

A

NO

55
Q

3 key investigations for RF

A

Throat swap for group A streptococcus
ASO antibody
ECG/ echo/ CXR for carditis

56
Q

Criteria to diagnose RF

A

Jones criteria

57
Q

Treatment of tonsillitis caused by streptococcus bacteria

A

Phenoxymethylpenicillin for 10 days

58
Q

Management of RF

A

NSAIDS - arthritis
Aspirin and steroids - carditis
Prophylactic abx - prevent further strep infections

59
Q

Why do RF patients need abx prophylaxis

A

Further exposure -> ab production -> reoccurrence of RF

60
Q

Complication of RF

A

Reoccurrence
Mitral stenosis
Chronic heart failure

Leeds MBCHB Year 4 Peads (21 decks)

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