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Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

HSP

A

IgA vasculitis
small vessel
triggered by an upper airway infection (e.g. tonsillitis) or a gastroenteritis.

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2
Q

HSP epidemiology

A

It is most common in children under the age of 10 years.

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3
Q

Granulomatosis with polyangiitis (GPS) (Wegener’s granulomatosis) clinical presentation

A 
nosebleeds
crusty nasal secretions
hearing loss
sinusitis.
saddle shaped nose 
lungs:cough, wheeze and haemoptysis.
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4
Q

Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome) clinical presentation

A

elevated eosinophil , shortness of breath

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5
Q

Which types of vasculitis are medium vessel

A

Polyarteritis nodosa
Kawasaki Disease
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome)

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6
Q

Which types of vasculitis are small vessel

A

Henoch-Schonlein purpura
Granulomatosis with polyangiitis (GPS/GPA) (Wegener’s granulomatosis)
Eosinophilic granulomatosis with polyangitis ( EGPA) (Churg-Strauss syndrome)
Microscopic polyangiitis
Anti-GBM
AntiC1q ( urticarial vasculitis)
Cryoglobinaemia

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7
Q

Which types of vasculitis are large vessel vasculitis

A

Polymyalgia rheumatica
Giant cell arteritis
Takayasu’s arteritis

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8
Q

Polyarteritis Nodosa epidemiology

A

men aged 40-60.

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9
Q

Polyarteritis Nodosa associations

A

most associated with hepatitis but can also occur without a clear cause or with hepatitis C and HIV.

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10
Q

Polyarteritis Nodosa clinical presentation

A

~~~
renal impairment, strokes and myocardial infarction.
rash called livedo reticularis
inflamed gallbladder
testicular pain
abdominal angian
neuro
chest
Aneurysms is a late finding

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11
Q

Polymyalgia Rheumatica epidemiology

A

above 50 years, women, caucasians

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12
Q

Polymyalgia Rheumatica key features

A

Bilateral shoulder pain that may radiate to the elbow
Bilateral pelvic girdle pain
Worse with movement
Interferes with sleep
Stiffness for at least 45 minutes in the morning
Systemic symptoms such as weight loss, fatigue, low grade fever and low mood
Upper arm tenderness
Carpel tunnel syndrome
Pitting oedema

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13
Q

Treatment of

Polymyalgia Rheumatica

A

prednisolone

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14
Q

Giant cell arteritis GCA (also known as temporal arteritis)

A

presents with symptoms affecting the temporal arteries .There is a strong link with polymyalgia rheumatica.

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15
Q

Giant cell arteritis GCA (also known as temporal arteritis) features

key features

A 
headache - unilateral, forehead/temple
Jaw claudication
tongue pain 
eye symptoms
Fever
Muscle aches
Fatigue
Weight loss
Loss of appetite
Peripheral oedema
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16
Q

Diagnosis of Giant cell arteritis

A

Multinucleated giant cells are found on the temporal artery biopsy.

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17
Q

Management of Giant cell arteritis

A

Start steroids immediately before confirming the diagnosis to reduce the risk of permanent sight loss
Aspirin 75mg daily decreases visual loss and strokes
Proton pump inhibitor (e.g. omeprazole) for gastric prevention while on steroids

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18
Q

Takayasu’s arteritis

A

Mainly affects aorta, usually presents before the age of 40 years with non-specific systemic symptoms, such as fever, malaise and muscle aches, or with more specific symptoms of arm claudication or syncope

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19
Q

Scleroderma /( Systemic sclerosis)

A

Systemic sclerosis is an autoimmune inflammatory and fibrotic connective tissue disease.most notably affects the skin in all areas but it also affects the internal organs.Scleroderma translates directly to hardening of the skin.

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20
Q

Scleroderma - Limited cutaneous systemic sclerosis clinical presentation

A

CREST

  • Calcinosis
  • Raynauds
  • Oesophageal dysmotility
  • Sclerodactyly
  • Telangectasia
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21
Q

Diffuse cutaneous systemic sclerosis features

A

Sclerodactyly
Telangiectasia
Calcinosis
Raynaud’s phenomenon
​​Oesophageal dysmotility
Systemic and pulmonary hypertension
Pulmonary fibrosis
Scleroderma renal crisis

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22
Q

Scleroderma - diffuse cutaneous systemic sclerosis autoantibodies

A

Anti-Scl-70

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23
Q

limited cutaneous systemic sclerosis autoantibodies

A

Anti-centromere antibodies

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24
Q

systemic sclerosis autoantibodies

A

Antinuclear antibodies ANA

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25
Q

what does nail fold capillaroscopy show in systemic sclerosis

A

Abnormal capillaries, avascular areas and micro-haemorrhages

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26
Q

Myositis epidemiology

A

40-60 year olds, more common in females

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27
Q

Polymyositis

A

chronic inflammation of muscles

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28
Q

Clinical presentation of polymyositis

A 
Weakness predominant: proximal
Trunk weakness a poor prognostic sign
Muscle pain, fatigue and weakness 
Occurs bilaterally 
Mostly affects the shoulder and pelvic girdle
Develops over weeks
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29
Q

Dermatomyositis

A

connective tissue disorder where there is chronic inflammation of the skin and muscles. can be associated with malignancy

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30
Q

Dermatomyositis Skin Features:

A

muscular features of polymyositis with additional skin rashes
Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees
Photosensitive erythematous rash on the back, shoulders and neck
Purple rash on the face and eyelids
Periorbital oedema
Subcutaneous calcinosis

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31
Q

Myositis investigations

A

CK>1000
Autoantibodies
Electromyography (EMG)
Muscle biopsy
Blood tests that are elevated include lactate dehydrogenase, aldolase, ALT and AST.

32
Q

polymyositis autoantibodies

A

•Anti-Jo-1 antibodies: polymyositis (but often present in dermatomyositis)

33
Q

dermatomyositis autoantibodies

A

Anti-Mi-2 antibodies

Anti-nuclear antibodies

34
Q

Mx myositis

A

Corticosteroids
Immunosuppressants (such as azathioprine)
IV immunoglobulins
Biological therapy (such as infliximab or etanercept)
Hydroxychloroquine occasionally helps with skin disease in dermatomyositis.
As well as pharmacological therapy, physiotherapy is essential to rehabilitate patients.

35
Q

Ehlers danlos

A

group of genetic conditions that cause defects in collagen, resulting in hypermobility of the patient’s joints and abnormalities in connective tissue such as the skin, bones, blood vessels and organs
Inheritance is autosomal dominant.

36
Q

Ehlers danlos features

A

soft and stretchy skin
severe joint hypermobility, joint pain and abnormal wound healing
prone to hernias, prolapses, mitral regurgitation and aortic root dilatation.

37
Q

Sjogren’s syndrome

A

autoimmune disorder characterised by decreased lacrimal and salivary gland secretion, which manifests as dry eyes and dry mouth.

38
Q

Extraglandular features of Sjogrens syndrome

A

Systemic upset such as fever, myalgia, malaise or fatigue.
Arthritis
Raynaud’s
Cutaneous vasculitis which manifests as purpura and skin ulcers.
interstitial lung disease, renal disease and neurological disease including seizures

39
Q

Sjogren autoantibodies

A

Most patients are ANA positive but this is not specific for Sjogren’s syndrome.
Anti-Ro and Anti-La Autoantibodies are both specific for Sjogren’s syndrome.

40
Q

Schirmer’s test

A

this demonstrates reduced tear production using a strip of filter paper on the lower eyelid: wetting of <5mm is positive for shorten

41
Q

Rose bengal staining

A

his demonstrates keratitis due to conjunctivitis sicca when using a slit-lamp used for sjorgrens

42
Q

Sjogrens syndrome Mx

A

artificial tears such as hypromellose.
artificial saliva
Vaginal dryness can be treated with topical lubrication.
Arthritis can be treated with hydroxychloroquine ± NSAIDs.
corticosteroids for complications such as vasculitis and pulmonary, renal or neurological disease

43
Q

SLE epidemiology

A

more common in females (F:M = 9:1)
more common in Afro-Caribbeans and Asian communities
onset is usually 20-40 years
incidence has risen

44
Q

SLE skin signs

A

malar (butterfly) rash: across the nose and cheek bones that gets worse with sunlight.
discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas. Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic
photosensitivity
Raynaud’s phenomenon
livedo reticularis
non-scarring alopecia

45
Q

Anti-Smith

A

(highly specific to SLE but not very sensitive)

46
Q

Mx SLE

A

NSAIDs for joint stiffness, MSK pain
Steroids (prednisolone) to suppress immune response
Hydroxychloroquine (first line for mild SLE,reduce constitutional & MSK Sx & mucocutaneous manifestations)
Suncream and sun avoidance for the photosensitive the malar rash
Biological therapies are considered for patients with severe disease eg rituximab

47
Q

OA xray changes

A

L – Loss of joint space
O –Osteophytes
S – Subarticular sclerosis
S – Subchondral cysts

48
Q

Gout aspirated fluid shows

A

No bacterial growth
Needle shaped crystals
Negatively birefringent of polarised light
Monosodium urate crystals

49
Q

pseudo gout Aspirated fluid will show

A

No bacterial growth
Calcium pyrophosphate crystals
Rhomboid shaped crystals
Positive birefringent of polarised light

50
Q

Gout xray shows

A

Typically the space between the joint is maintained
Lytic lesions in the bone
Punched out erosions
Erosions can have sclerotic borders with overhanging edges

51
Q

classic xray change in pseudogout

A

Chondrocalcinosis- thin white line in the middle of the joint space caused by the calcium deposition.

52
Q

Clinical presentation of Sjogren’s syndrome

A 
dry eyes and dry mouth.
Systemic upset
Arthritis
Raynaud's
Cutaneous vasculitis
53
Q

OA risk factors can be remembered by the mnemonic SHATTERED FAMILY:

A 
S – Steroid use
H – Hyperthyroidism, hyperparathyroidism
A – Alcohol and smoking
T – Thin (BMI<22)
T – Testosterone deficiency
E – Early menopause
R – Renal/liver failure
E – Erosive/inflammatory bone disease
D – Diabetes
FAMILY HISTORY

Age (>50 for women and >65 for men)
Female sex

54
Q

Clinical presentation pagets disease

A

Elderly, bone pain, deformity, pathological fractures, hearing loss

55
Q

Pagets disease features on Xray

A

well defined osteolytic lesion on X-ray = osteoporosis circumscripta
skull xray appearance= cotton wool appearance

56
Q

Ankylosing spondylitis epidemiology

A

20-30 years old.. M>F, strong family history

57
Q

Clinical presentation Ankylosing spondylitis

A

Symptoms develop over more than 3 months.
lower back pain and stiffness and sacroiliac pain in the buttock region.
pain in the buttocks can alternate from left to right.
The pain and stiffness is worse with rest and improves with movement.
The pain is worse at night and in the morning and may wake them from sleep.
can affect other organ systems

58
Q

Management of ankylosing spondylitis

A

NSAIDs
Steroids can be use during flares
Anti-TNF medications
Secukinumab is a monoclonal antibody against interleukin-17. It is recommended by NICE if the response to NSAIDS and TNF inhibitors is inadequate.

59
Q

Clinical presentation Reactive arthritis

A

Classic triad: cant see , pee or climb a tree (triad of urethritis, conjunctivitis and arthritis)

60
Q

Clinical presentation Antiphospholipid syndrome

A

Clots - Usually venous thromboembolism (eg. deep venous thrombosis or pulmonary embolism), but arterial embolism (eg. myocardial infarction or stroke) can also occur.
Livedo reticularis - A mottled, lace-like appearance of the skin on the lower limbs.
Obstetric loss - Recurrent miscarriages, pre-eclampsia and premature births can occur.
Thrombocytopenia.
In addition cardiac valve disease can occur, usually aortic and mitral regurgitation ± stenosis.

61
Q

Antiphospholipid blood tests

A

One or more of the following positive blood tests are needed on 2 occasions, 12-weeks apart to diagnose APS:
Anti-cardiolipin antibodies.
Anti-beta2-GPI antibodies.
Positive lupus anticoagulant assay.

62
Q

Anti-dsDNA

A

highly specific test for lupus (SLE)

63
Q

Felty’s syndrome

A

RA, splenomegaly and low white cell count
Felty syndrome is a long-term complication of rheumatoid arthritis. It presents with a combination of splenomegaly and low WCC. In this case, mild thrombocytopenia is caused by splenomegaly.

64
Q

location of herberden and bouchards nodes

A

Heberden’s nodes (in the DIP joints)

Bouchard’s nodes (in the PIP joints)

65
Q

Seronegative arthropathies

A

associated with HLA-B27

66
Q

Rheumatoid xray features

A 
Loss of joint space
Erosions
Soft tissue swelling
Soft bones osteopenia
Subluxation
67
Q

Behcet’s syndrome

A

complex multisystem disorder associated with presumed autoimmune-mediated inflammation of the arteries and veins.

68
Q

Behcet’s syndrome epidemiology

A

eastern Mediterranean (e.g. Turkey)
Men
20-40y old
fhx

69
Q

Behcet’s syndrome features

A

1) oral ulcers 2) genital ulcers 3) anterior uveitis

thrombophlebitis and deep vein thrombosis
arthritis
neurological involvement (e.g. aseptic meningitis)
GI: abdo pain, diarrhoea, colitis
erythema nodosum
Pericarditis

70
Q

Rheumatoid arthritis

A

autoimmune condition that causes chronic inflammation of of the joints
symmetrical polyarthritis.

71
Q

Rheumatoid arthritis epidemiology

A

3x more common in women
peak onset is in 40-60 year olds
More common in smokers

72
Q

Antibodies in rheumatoid arthritis

A

Rheumatoid Factor (RF)
Cyclic citrullinated peptide antibodies (anti-CCP antibodies) are autoantibodies that are more sensitive and specific to rheumatoid arthritis

73
Q

Clinical Presentation RA

A

Pain - worse after rest but improves with activity
Swelling
Stiffness
systemic symptoms: Fatigue, Weight loss, Flu like illness, Muscles aches and weakness

74
Q

RA signs in hands

A

Z shaped deformity to the thumb
Swan neck deformity- flexed DIP
Boutonnieres deformity -hyperextended DIP

75
Q

RA Mx

A

short course of steroids at first presentation and during flare ups
NSAIDS with ppl
DMARD
biological therapy

Medicine (72 decks)

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