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FINALS > rheumatology > Flashcards

rheumatology Flashcards

1
Q

in OA, where would you find Heberdens nodes?

A

DIP joint

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2
Q

in OA, where would you find Bouchards nodes?

A

PIP joint

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3
Q

what are the x-ray findings in OA?

A

loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts

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4
Q

what would be the treatment for OA in the knee and hip?

A

arthroplasty

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5
Q

what would be the treatment for OA in the MTP, wrist and ankles?

A

arthrodesis (fusion of bones together)

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6
Q

what mediates RA?

A

HLA-DR4

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7
Q

what are some triggers of RA?

A

smoking
infection
stress

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8
Q

what joints does RA mainly affect?

A

small joints of hands and feet - MCP and PIP
typically spares DIP joints
wrist and ankle

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9
Q

what are some later deformities seen with RA?

A

joint subluxation of the cervical spine
swan neck - PIP joint hyperextension, DIP joint flexion
boutonieres - PIP joint flexion, DIP joint hyperextension
z thumb

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10
Q

when are extra articular features present in RA?

A 
when serology is positive and include:
lung fibrosis (lower lungs) 
keratoconjunctivitis sicca 
vasculitis
osteoporosis
scleritis
neutropenia 
Raynauds 
Carpal tunnel 
pericarditis
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11
Q

what is felty’s syndrome?

A

RA + splenomegaly + neutropenia

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12
Q

what x ray findings are seen in RA?

A

loss of joint space
peri-articular erosions
subluxations
junta-articular osteoporosis

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13
Q

what is seen on serology in RA?

A

raised RF
raised anti-CCP
raised ESR and CRP

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14
Q

how is a diagnosis made in RA?

A

clinical diagnosis

serology not completely sensitive

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15
Q

what is the 1st line treatment for RA?

A

DMARD (methotrexate) +/- short course of prednisolone

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16
Q

how is disease monitored in RA?

A

using CRP and DAS28

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17
Q

how is a flare up of RA treated?

A

using corticosteroids (oral or IM)

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18
Q

what needs to be done and why before starting methotrexate?

A

FBC - agranulocytosis

LFTs - hepatotoxicity (cirrhosis)

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19
Q

what are names of DMARDs apart from methotrexate?

A

leflunomide
sulfasalazine
hydroxychloroquine

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20
Q

when are steroids used in RA?

A

for remission induction in flares

as filler while other drugs start to work

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21
Q

when can anti-TNF therapy be used in RA?

A

after inadequate response to 2 DMARDs (one being methotrexate)

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22
Q

name anti-TNF therapy

A

etanercept

infliximab

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23
Q

what are biologics co-prescribed with?

A

methotrexate

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24
Q

what is the DAS28 score?

A

<2.6 remission
2.6-3.2 low disease activity
3.2-5.1 moderate disease activity
>5.1 active disease

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25
Q

what features do spondyloarthritides share?

A

seronegative - negative for RF
positive for HLA-B27 mutation
arthritis of spine and SI joints
involves less then 5 lower limb joints
dactylitis (sausage fingers)
enthesitis (inflammation of tendon and ligament insertion)
extra articular features - anterior uveitis, rash, IBD and aortic valve incompetence

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26
Q

what pathophysiology is seen with AS?

A

widening and subchondral sclerosis of SIJ (eventual fusion of SIJ joint)
formation of syndesmophytes that fuse together causing stiffness and immobility
calcification of vertebral ligaments

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27
Q

what are calcified vertebral ligaments described as on x-ray in AS?

A

bamboo spine

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28
Q

what additional symptoms are associated with AS?

A 
fatigue
anterior uveitis 
painful heel and feet (Achilles tendonitis, plantar fasciitis)
SOB - atypical upper zone fibrosis 
aortic regurgitation 
amyloidosis 
IgA nephropathy
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29
Q

what spinal posture is seen in advanced AS?

A

questions mark posture

  • thoracic kyphosis
  • cervical spine hyperextension
30
Q

what is seen on examination for AS?

A

tender SIJ
Schobers test positive (reduced lunar flexion)
reduced chest expansion

31
Q

what is schobers test?

A

when patient flexes lumbar spine, should increase from 15cm to greater than 20cm but in AS reduced lumbar flexion

32
Q

how is a diagnosis made in AS?

A

clinically due to late radiographic changes

33
Q

what imaging can be used in AS?

A

MRI of spine and SIJ

34
Q

what is the first line management of AS?

A

NSAIDs, physio, encourage exercise

35
Q

what treatment can be used to help enthesitis?

A

intra-articular steroids

36
Q

what treatment can be used to help peripheral joint disease?

A

sulfasalazine

mainly of the hip joint

37
Q

if there is non responsive pain and stiffness in AS what treatment can be used?

A

anti-TNF

38
Q

what develops first in PA, the arthritis or the psoriasis?

A

psoriasis

39
Q

what joints does PA affect most commonly?

A

DIP of hands and feet

40
Q

what other joint patterns can PA affect?

A

symmetrical polyarthritis

unilateral sacroilitis

41
Q

what other presentations are seen with PA?

A

psoriatic rash

nail changes - pitting, onycholysis, subungual hyperkeratosis

42
Q

what is seen on x-ray with PA?

A

pencil in dup deformity (due to osteolysis)

43
Q

how is PA treated?

A

1st line - NSAIDs and physio

progressive disease - methotrexate or anti-TNF

44
Q

what is reactive arthritis?

A

sterile synovitis occuring 1-4 weeks after infection

45
Q

what infections are commonly associated with reactive arthritis?

A

GI - salmonella

STI - chlamydia

46
Q

what is another name for reactive arthritis?

A

Reiter’s syndrome

47
Q

what is Reiter’s syndrome? and what phrase can help remember it?

A

uveitis, urethritis, arthritis

–> can’t see, can’t pee, can’t bend the knee

48
Q

what symptoms are associated with reactive arthritis?

A 
asymmetrical lower limb pain (knee common)
red eye, blurred vision
pain on urination
mouth ulcers
rash on soles of feet and palms of hands
49
Q

what is the rash on hands and feet seen with reactive arthritis?

A

keratoderma blennorhagica (painful, brown, raised lesion)

50
Q

what investigations are done for reactive arthritis?

A

joint aspiration to rule out septic arthritis

urine sample for chlamydia

51
Q

what is the treatment for reactive arthritis?

A

rest and NSAIDs

if recurring, potentially DMARD treatment started

52
Q

what is enteropathic arthritis?

A

arthritis associated with IBD or post gastric bypass surgery

53
Q

what are associated symptoms of enteropathic arthritis?

A

GI symptoms

erythema nodosum

54
Q

what investigations are done for enteropathic arthritis?

A

stool sample
FBC, LFTs
colonoscopy or upper GI endoscopy

55
Q

what is the treatment for enteropathic arthritis?

A

treat underlying IBD
NSAIDs
intra articular steroids

56
Q

what can cause gout?

A

increased urate production:

  • alcohol
  • red meat and fish
  • haemolytic diseases

decreased excretion:

  • CKD
  • hypothyroidism
  • drugs (diuretics, chemotherapies)
57
Q

what is acute gout?

A

mono arthritis that typically presents in 1st MCP, ankle or knee joint
lasts 3-10 days

58
Q

what is chronic gout?

A

multiple acute attacks that cause tophi to develop in joints
(large, painless white deposits of sodium urate)

59
Q

what are the investigations for gout?

A

blood - urate levels

joint aspiration - needle shaped, negatively birefringent crystals

60
Q

what is the treatment for acute gout?

A

1st line: NSAIDs and PPI
2nd line: cochicine
3rd line: steroids
(around 2 weeks for acute attack)

61
Q

why would a patient be put on colchicine instead of NSAIDs in gout? what should you warn patients off with colchicine?

A

peptic ulcer disease

D & V

62
Q

when is chronic treatment started for gout?

A

after 1st attack of gout

63
Q

what is the treatment for chronic gout?

A

1st: allopurinol
2nd: febuxosat

64
Q

when should chronic gout treatment be started?

A

2 to 4 weeks after attack

not to be started during attack

65
Q

what extra treatment should patients be given when starting chronic gout treatment and why?

A

cover with acute drug (colchicine)

can potentially precipitate an attack

66
Q

what is deposited in the joints in pseudogout?

A

calcium pyrophosphate crystals

67
Q

what is deposited in the joints in gout?

A

sodium urate crystals

68
Q

what is the difference between the crystals in gout and pseudogout?

A

gout - needle shaped negatively birefringent pseudogout - rhomboid shaped weakly positive birefringent

69
Q

what conditions are associated with psuedogout?

A

metabolic ones - diabetes, haemochromatosis, hyperparathyroidism
ageing
injury

70
Q

what joints are affected in pseudo gout?

A

knee, wrist and shoulder

71
Q

what is the treatment for pseudogout?

A

1st line: NSAIDs +/- intra articular steroids
2nd line: colchicine
(no prophylactic treatment)

FINALS (25 decks)

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