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Year 3 - Medical Block Workbooks > Rheumatology > Flashcards

Rheumatology Flashcards

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USMLE® Step 1 flashcards
1
Q

Gout

  1. Acute Treatments and Mechanisms
  2. Chronic Treatments
A

Chronic

  1. Allopurinol or FebuXOstat
    • Xanthine Oxidase inhibitor
      - reduce urate production

Acute

  1. NSAIDs
  2. Steroid
    • PLP ase
  3. Colchicine
    - Plant alkaloid
    - Accumulates in WBCs
  4. Canakinumab
    • Interleukin-1 inhibitor
  5. Rasburicase
    - In malignancy
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2
Q

Nocturnal pain

- Aetiologies

A

Nocturnal pains
- Destruction

  1. Inflammation
  2. Cancer
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3
Q

Ankle, Elbow, and Wrist pain

  • Periarticular causes
A

Ankle pains

  1. RA: Tenosynovitis
  2. PsA:
    - Achilles tendinitis
    - Lateral epicondylitis
  3. De Quervain’s
    - Anatomical snuffbox
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4
Q

Patterns of pain

  1. Proximal joints only
  2. Small joint only
  3. Large joint only
  4. Large and small joints
  5. Symmetrical pattern
  6. Spinal involvement
A

Pain patterns

  1. Proximal joints
    - PMR
  2. Small joints
    - Early RA
  3. Large joints only
    - OA
  4. Large and small joints
    - RA
  5. Symmetrical
    - RA
  6. Spinal
    - AS
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5
Q

Monoarthritis

- First DDx

A

Monoarthritis

  • Septic till proven otherwise
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6
Q

Gout vs pseudogout

  • Presentation
A
  1. Gout
    - Men
  2. Pseudogout
    - Elderly women
    - Severe OA
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7
Q

Chronic monoarthritis

- Infectious cause

A

Chronic infective monoarthritis

- TB

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8
Q

Chronic monoarthritis

- Non-inflammatory cause

A

Chronic monoarthritises

  1. OA
  2. Traumatic eg. meniscus
  3. Osteonecrosis
    - Prednisolone use
  4. Neuropathic
    eg. Charcot’s
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9
Q

DIP Arthritises

A

DIP Arthritises

  1. PsA
    - Nail dystrophy
  2. OA
    - Herbeden’s nodes
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10
Q

Gout

- Speed of swelling

A

Gout

  1. Swelling is very fast onset
  2. Around 1 hour
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11
Q

Fingers

- Bony Swellings?

A

Bony swellings

  1. Herbeden’s nodes
  2. Bouchard’s nodes
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12
Q

Mechanical AM stiffness

  1. Length
  2. Activity/rest effect
  3. Fatigue
  4. Systemic involvement
A

Mechanical AM stiffness

  1. <30 minutes
  2. Relieved on rest
  3. Minimal fatigue
  4. No systemic involvement
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13
Q

Inflammatory AM stiffness

  1. Length
  2. Activity/rest
  3. Fatigue
  4. Systemic involvement
A

Inflammatory AM stiffness

  1. > 1hour
  2. Better on activity
  3. Significant fatigue
  4. Systemic involvement
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14
Q

Rheumatology exam

- Face signs

A

Rheum Face Ex

  1. Dry mouth/Eyes
    - RA + Sjogren’s
  2. Mouth ulcers
    - SLE + IBD + Reactive a.
  3. Iritis
    - Spondyloarthropath
  4. Scleritis
    - RA, GPA
  5. Visual disurbance
    - SLE (retinal vasc.) + GCA
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15
Q

Rheumatology exam

- Skin signs

A

Rheum Exam - Skin

  1. PsA
    - Plaques, dystrophic nail
  2. SLE
    - Raynauds, Digital ulcers, Malar rash, photosensitivity, Livedo r., alopecia
  3. Systemic sclerosis
    - Raynaud’s
    - Telangiectasia, calcinosis
    - Digital ulcers, sclerodactyly
  4. Acute sarcoid
    - Erythema nodosum
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16
Q

Rheumatology exam

- GU signs

A

Rheum Exam - GU

  1. SLE
    - HTN, eGFR,
    - N-VH, frothy, miscarriage
  2. Vasculitis
    - HTN, eGFR, N-VH, frothy
  3. Gout
    - Renal stones
  4. Reactive a.
    - Vaginal/urethral discharge
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17
Q

SLE

- Neurologic signs

A

SLE Neurology

  1. Headache
  2. Seizures
  3. Psychosis
  4. TIA/CVA
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18
Q

SLE

- Cardio-resp effects

A

SLE Cardioresp

  1. SoB
    - Pleural effusion
    - Pericardial effusion
    - Alveolitis
  2. Chest pain
    - Pleuritic
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19
Q

GPA

- Cardio-resp effects

A

Granulomatosis with poly ang.
- Cardio resp

  1. Pulmonary infiltrates
  2. Haemoptysis
  3. Sinusitis
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20
Q

RA

- Cardio-resp effects

A

RA Cardio Resp

  1. Pleural effusion
  2. Alveolitis
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21
Q

Rheumatological conditions

  1. Recurrent VTE
  2. Recurrent cytopenia
A

Rheumatological conditions

  1. Anti-phospholipid syndrome
    - VTE
  2. SLE
    - Recurrent cytopenia
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22
Q

Anti-phospholipid syndrome

- CLOTs

A

APS (Hughes)

C lots

C oagulation defects
L ivedo reticularis
 - Red/blue 'net'
O bstetric (miscarriage)
T hrombocytopenia
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23
Q

GALS Assessment

- Components

A

GALS Assessment

  1. Gait
  2. Arms
  3. Legs
  4. Spine
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24
Q

Full Rheum Exam

- Shoulder sign

A

Rheum Shoulder Sign

  • Reduced External rotation
  • Earliest LoF
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25
Q

Full Rheum Exam

- Early hip signs

A

Rheum hip signs

  1. Reduced vastus medialis
  2. Reduced internal rotation
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26
Q

Rheum exam

- Causes of kyphosis

A

Rhuem kyphoses

  1. Long standing AS
    - And loss of lumbar lordosis
  2. Osteoporosis
    - Fractures
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27
Q

GALS

- Arms (5)

A

GALS Arm

  1. Inspect palm and dorsum
  2. Pincer and power grip
  3. MCPJ Squeeze
  4. Forearm movements

5 Shoulder movements

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28
Q

GALS

- Legs (6)

A

GALS Legs

  1. Inspect legs
  2. Hip rotation
  3. Knee effusion
  4. Knee movement
  5. Inspect feet
  6. MTPJ squeeze
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29
Q

GALS

- Spine (4)

A

GALS Spine

  1. Inspect
  2. Palpate supraspinatus
  3. Cervical lateral flexion
  4. Lumbar flexion
  5. Hip flexion
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30
Q

Two ataxic gaits

A

Ataxic gaits

  1. Cerebellar
    - Wide staggering
    - Arms out for balance
  2. Sensory
    - Wide stamping
    - Ear and eyes used
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31
Q

Gaits

  • Festinant/projectile
  • Waddling
A

Gaits

  1. Festinant/projectile
    - Difficulty intiating
    - Shuffling run (festinare)
    - Reduced arm swing
  2. Waddling
    - Duck-like
    - Bilateral muscle weakness
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32
Q

Rheum Exam

- Skin signs

A

Rheum Skin Exam

  1. Calcinosis
    - SLE
    - Systemic sclerosis (s.derma)
  2. Telangiectasia
    - Scleroderma
    - SLE
    - Dermatomysositis
  3. Psoriasis
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33
Q

ANA Association

SLE

A

SLE ANA

  • dsDNA
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34
Q

ANA Association

  • SLE and Sjogren’s
A

SLE and Sjogren’s ANAs

  1. Anti RO
  2. Anti-LA
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35
Q

ANA Association

  • Systemic sclerosis
A

Systemic sclerosis ANAs

  1. Anti-centromere
  2. Anti-Scl70
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36
Q

ANA Association

  • Polymyositis
A

Polymyositis ANA

  • Anti Jo-1
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37
Q

ANCAs

  • C ANCA
A

C ANCA

  1. GPA
    (Granulomatosis w/ PA)
  2. Infection
  3. Neoplasia
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38
Q

P ANCA

- Association

A

P ANCA

  1. MPA
    (Microscopic PA)
  2. . Infection
  3. Neoplasia
39
Q

HLA association

  • B27
A

HLA B27

  1. 10% of white people
  2. AS
    - 90% of white people
  3. Iritis
  4. Juvenile arthritis
40
Q

Rheum Investigations

- SLE and Vasculitis

A

SLE & Vasculitis Ix

  • Urine dip (protein/blood)
41
Q

Methotrexate

- 5 ADRs

A

Methotrexate ADRs

  1. Nausea
  2. Oral ulcers, hair thinning
  3. Hepatitis, cirrhosis
  4. Pneumonitis
  5. Bone marrow suppression
42
Q

Hydroxychloroquine

- 2 ADRs

A

Hydroxychloroquine ADRs

  1. GI
  2. Vision
    - Retinal pigmentation
43
Q

Sulfasalazine

- 4 ADRs

A

Sulfasalazine ADRs

  1. GI
  2. Rash
  3. Hepatitis
  4. Bone marros
44
Q

Cylophosphamide

- 3 ADRs

A

Cyclophosphamide ADRs

  1. Marrow suppression
  2. Infertility
  3. Cancer risk
45
Q

Azathioprine

- 2 ADRs

A

Azathioprine ADRs

  1. GI
  2. Marrow supression
46
Q

Ciclosporin

- 2 ADRs

A

Ciclosporin ADRs

  1. Renal impairment
  2. HTN
47
Q

RA

- Pathogenesis

A

RA Pathogensis

  1. T&B cell anti-bodies
    - to Fc of IgG (RF)
    - to Citrullinated cyclic p.
  2. Macrophage TNFa
  3. Synoviocytes
48
Q

RA Mx

  1. Chronic
  2. Acute
A

RA Mx

  1. Chronic monotherapy
    - Methotrexate
  2. Chronic combination
    + Leflunomide
    + Hydroxychloroquine
    + Sulfasalazine
  3. Acute Steroids
    - PO
    - IM
    - I-art
  4. NSAIDs
    - for symptoms
    - + PPI
    - If not CI’d
49
Q

RA

- LESS

A

RA LESS

L oss of joint space
E rosions (periarticular)
S oft tissue swelling
S ubluxation

50
Q

GCA

- Pathogenesis

A

GCA
- HLA II Granulomatous vasculitis

  1. Over 50yrs (72 median)
  2. Chronic vaculitis
    - Large vessels
    - Medium vessels
  3. AION
    - Anterior ischemic optic neuropathy
    - Opthalmic emergency
51
Q

GCA

- RFs

A

GCA RFs

  1. Age
  2. Female
  3. PMR (50%)
52
Q

GCA

- Presentation

A

GCA S&S

  1. Headache (70%)
    - Localised
    - Unilateral
    - Boring/lancinating
    - Jaw claudication
  2. Constitutional symptoms
    - Aching
  3. Scalp tenderness
  4. Visual disturbance/loss
53
Q

GCA

- Dx

A

GCA Dx

  1. New headache/tenderness
  2. ESR, CRP, PV
  3. Visual symptoms
  4. Biopsy
54
Q

GCA

- Mx

A

GCA Mx

  1. Prednisolone
    - PO, OD
    - Taper after two weeks
  2. Acute visual
    - IV Methylprednisolone
    - 1-3 days
  3. Low dose aspirin
55
Q

PMR

- Presentaton

A

PMR Pres

  1. <60 yo
  2. Proximal limb pain/stiffness
    - Neck & shoulders
    - Hips
  3. Night time pain
  4. Systemic (25%)
56
Q

PMR

- Mx

A

PMR Mx

  1. Prednisolone
    - PO, OD
    - Fast response & slow taper
  2. Methotrexate
    - Steroid sparing
57
Q

Spondyloarthropathies

- Group of 4

A

Spondyloarthropathies

  1. AS
  2. PsA
  3. Reactive A.
  4. Enteropathic A.
58
Q

Ankylosing Spondylitis

- Presentation

A

AS Pres

  1. Young men
    - Teens-mid-thirties
  2. Pain
    - Buttock, chest
  3. Later changes
    - Positive Schober’s
    - Reduced chest expansion
59
Q

Ankylosing spondylitis

- Mx

A

AS Mx

  1. NSAIDs and physio
  2. TNF inhibitors
    - Infliximab/adalimumab/Etanercept
  3. IL-17 inhibitors
    - Secukinumab
60
Q

PsA

- Presentation

A

PsA Pres

  1. 10% with Psoriasis
  2. Oligo-arthrtis
    - Symmetrical or mono
  3. Dactylitis
  4. Pencil-in-cup x-ray
61
Q

PsA

- Mx

A

PsA Mx

  1. NSAIDs
  2. DMARDs
    - Methotrexate
    - Ciclosporin
  3. TNFi
    - Etanercept
    - Infliximab
  4. IL inhibitors
    - 17 Secukinumab
    - 12/23 Ustekinumab
62
Q

Reactive arthritis

- Pathogenesis

A

Reactive arthritis pathogenesis

  1. Distant infection
    - Post dystentery
    (Salmonella/shigella/camp.)
    - Post urethritis
  2. Acute arthritis
    - Lower limb
    - Asymmetrical
63
Q

Reactive arthritis

- Pres

A

Reactive Arthritis

  1. Post-infective
    - Days - 2 weeks
  2. Acute arthritis
    - Lower limb
    - Asmmetrical
  3. Can’t see, can’t wee
  • Circinate balanitis
  • Conjunctivitis
  • Uveitis
  1. Enthesitis
    - Tendon joining bone
64
Q

Reactive arthritis

- Mx

A

Reactive arthritis Mx

  1. Treat infection
  2. NSAIDs
  3. Joint injections
  4. Resolve within 2 years
  5. Refractory (HLA-B27+)
    - DMARDs
    - Sulfasalazine
65
Q

Enteropathic arthritis

- Pathophysiology

A

Enteropathic arthritis

  1. IBD 10-20%
    - 2/3 peripheral
    - 1/3 axial
  2. Peripheral Type 1
    - Correlates with flares
    - Oligoarticular
    - Asymmetric
  3. Peripheral Type 2
    - Correlates less with flares
    - Polyarticular
    - Symetrical
66
Q

Enteropathic arthritis

- Mx

A

Enteropathic Arthritis Mx

  1. NSAIDs
    - May flare IBD
  2. DMARDs
  3. TNFi
67
Q

Ankylosing spondylitis

- 5As

A

Ankylosing spondylitis

  1. Anterior uveitis
  2. Aortic incompetence
  3. AV Block
  4. Apical lung fibrosis
  5. Amyloidosis
68
Q

SLE

- SOAP BRAIN MD

A

SLE

S erositis
O ral ulcer
A rthritis
P hotosensitivity

B loods low
R enal compromise
A NA +ve
I mmunologic
N eurology (seize/psych)

M alar Rash
D iscoid Rash

69
Q

SLE

- Mx

A

SLE Mx

  1. Lifestyle
    - CVS
    - Sun protection
  2. Meds
    - Hydroxychloroquine
    - Prednisolone flares
    - Mycophenolate/aza/ritux
70
Q

Raynaud’s

- Colour changes

A

Raynaud’s colours

  1. White
    - Low flow
  2. Blue
    - Venous stasis
  3. Red
    - Hyperaemia
71
Q

Raynaud’s features

- Incidental Rheumatoid Findings

A

Rheumatoid Raynaud’s

  1. Nail-fold capillaries
    - Systemic sclerositis
    - Dermatomyositis (DM)
  2. Puffy fingers
  3. Photosensitivity
72
Q

Raynaud’s

- Rheumatoid associations

A

Rheumatoid Raynaud’s

  1. Scleroderma
  2. SLE
  3. Dermato/polymyositis
  4. Sjogren’s
73
Q

Raynaud’s

- Mechanical causes

A

Mechanical Raynaud’s

  1. Vibrating tools
  2. Cervical rib
    Thoracic outlet syndrome
  3. Cryoglobulinaemia
    - Sticky blood
  4. Beta-blockers
74
Q

Raynaud’s

- Management

A

Raynaud’s Mx

Conservative

  1. Keep warm
  2. Smoking cessation

Medical

  1. CCB
  2. PDE-5 and prostacyclins
    - Sildenaphil
    - Iloprost
75
Q

Vasculitis

- Four small vessel disease

A

Small Vessel Disease

  1. MPA
  2. GPA
    - Wegener’s
  3. EGPA
    - Churg-Strauss
  4. IgA
    - Henoch-Schonlein Purpura
76
Q

Vasculitis

- Two medium vessel diseases

A

Medium vessel disase

  1. PAN
    - Polyarteritis nodosa
  2. KD
    - Kawasaki disease
77
Q

Vasculitis

- Two large vessel disease

A

Large vessel disease

  1. GCA
  2. TAK
    - Takayasu arteritis
78
Q

Vasculitis

- Commonest aetiology

A

Vasculitis
- Commonly Secondary

  1. Infection
  2. Drugs
  3. Malignancy
  4. Ct disease
79
Q

Vasculitis

- Mx

A

Vasculitis Mx

Secondary

  1. R/O infection
  2. Stop drugs

Medical
3. CSTs

  1. Second line
    - Cytotoxic
    - Immunomodulatory
    - Biologics
80
Q

Myositis
- Presentation

  1. DM
  2. PM
A

DM and PM Pres

  1. 40-50
  2. Proximal muscle weakness
  3. Painless
  4. SoB
  5. Rash
    - Dorsal hand (Gottron’s)
    - Pigmentation change
  6. Mechanic’s Hands
    - Cracked palms
    - Cracked fingers
  7. Raynaud’s
81
Q

Myositis

- Mx

A

DM and PM Mx

Lifestyle
1. Sun protection

Medical
2. CSTs

  1. DMARDs long-term
    - Methotrexate
    - Azathioprine
    - HCQ for rash
  2. Second line
    - Rituximab
    - IVIG
82
Q

Systemic Sclerosis
(Scleroderma)

CREST

A

Scleroderma CREST

C alcinosis cutis
R aynaud's
E osophageal dysmotility
S clerodactyly
T elangiectasia
83
Q

Systemic Sclerosis
(Scleroderma)

  • Mx
A

Systemic sclerosis Mx

  1. No ‘cure’

Conservative
1. Psychological support

Medical
2. Raynaud’s management

  1. Skin thickening
    - Methotrexate
    - Mycophenolate
  2. HTN
    - ACEi
  3. Flares
    - Short prednisolone
  4. GI
    - PPI
84
Q

Sjogren’s

- MAD FRED

A

Sjogren’s MAD FRED

M yalgia
A rthralgia
D ry mouth

F atigue
R aynaud’s
E nlarged parotids
D ry eyes

85
Q

Sjogren’s

- Mx

A

Sjogren’s Mx

Conservative
1. Avoid dry/smoky areas

Medical
2. Artificial tears

  1. Artificial saliva
  2. Gum/pastilles
    - Sugar free
  3. Emolients
    - Skin
    - Lubrication
  4. Rarely Immuno/steroids
86
Q

Sjogren’s

- Associations

A

Sjogren’s Associations

  1. RA and SLE
  2. Coeliac, PBC, Thyroid
  3. 5-10% Lymphoma risk
  4. Fetal
    - Loss
    - Heartblock
    - Lupus syndrome
87
Q

Hypermobility spectrum

- S&S

A

HSD S&S

  1. Soft tissue rheumatism
    - Epicondylitis
  2. Skin
    - Thin, striated
    - Papyraceous
    - Hyperextensible
  3. Marfanoid
  4. Myopia, drooping lids
  5. Hernias and prolapses
88
Q

Hypermobility

- Management

A

Hypermobility Mx

  1. Strengthening exercises
    - Subluxation
  2. Specialist pain mx
  3. Splinting/surgery
89
Q

Fibromyalgia

- S&S

A

Fibromyalgia S&S

  1. Stiffness
  2. Profound fatigue
  3. Numbness
  4. Headaches
  5. IBS
  6. Depression and anxiety
  7. ‘Fibrofog’
90
Q

Fibromyalgia

- Mx

A

Fibromyalgia Mx

  1. Pain
    - Amitryptyline
    - Pregabalin
  2. CBT
91
Q

Osteoporosis

- Ix

A

OP Ix

  1. DEXA
    - Dual energy absorbiometry
  2. T-score from age range
    - OP is >2.5 SDs
    - Osteopenia is 1-2.5 SDs
  3. Z-Score age and gender
92
Q

Osteopenia

- Mx

A

Osteopenia Mx

Conservative

  1. Weight-bearing exercise
  2. Alcohol and smoking
  3. Dietary calcium

Medical
2. Vit D3

93
Q

Osteoporosis

- Mx

A

Osteoporosis Mx

  1. Vit D
  2. Oral bisphosphonate
    - Or IV
  3. Second line
    - Denosumab
    - Teriparatide (PTH)

Year 3 - Medical Block Workbooks (7 decks)

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