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2a > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Extra articular manifestations of RA

A

rheumatoid nodules, episcleritis, peripheral sensory neuropathy, pericardial effusion (exudate)

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2
Q

RA XR

A

LOES: loss of joint space, osteopenia, erosion of bone, swelling of soft tissue

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3
Q

FBC & autoantibodies for RA

A

CRP raised +/- ESR. RF (often false positive) & cyclic citrullinated peptide (CCP - rarely false positive, indicates severe disease)

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4
Q

how long do DMARDs take to work

A

up to 6 weeks

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5
Q

Methotrexate SE

A

given with folate.

nausea, mouth ulcers, diarrhoea, abnormal LFTs, neutropenia, thrombocytopaenia, renal impairment

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6
Q

Sulfasalazine SE

A

used in young people & women

drug induced lupus in ANA positive pts

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7
Q

hydroxychloroquine SE

A

irreversible retinopathy

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8
Q

what does leflunomide do

A

blocks T cell proliferation

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9
Q

examples of TNFa blockers

A

infliximab, etanercept, adalimumab

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10
Q

why are B cell inhibitors useful in RA

A

they produce RF

e.g. rituximab

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11
Q

tissue type that everyone with seronegative arthritis has

A

HLAB27 (chromosome 6)

not everyone with HLAB27 has disease

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12
Q

what is enthesitis

A

swelling of bone & tendons

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13
Q

seronegative/spondylarthritis mneumonic

A 
SPINEACHE
Sausage Digits (dactylitis); Psoriasis; Inflammatory back pain; NSAID (works well); Enthesitis (heel); Arthritis; Crohn's/Collitis/elevated CRP; Hlab27; Eye (uveitis)
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14
Q

what nail involvement predicts arthritis in patients with psoriasis

A

pitting, onycholysis (white nails lifting off), subungual hyperkeratosis, ridging, thickening, crumbling, colour changes

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15
Q

Different presentations in psoriatic arthritis

A

mostly peripheral, DIP & PIP, arthritis mutilans (deforming -> telescoping fingers), dactylitis, asymmetrical large joints; spine; psoriasis

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16
Q

bloods in psoriatic a

A

CRP not significantly raised

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17
Q

alternative name for reactive arthritis

A

Reiters Disease

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18
Q

what infections cause reactive arthritis

A

STIs: chlamydia, gonorrhoea
GI: Salmonella enteritidis, Shigella flexneri, and S. disenteriae, Yersinia enterocolitica, Campylobacter jejuni, Clostridium difficile

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19
Q

how long after infection does reactive arthritis peak

A

2-3 weeks (can start 2 days after)

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20
Q

what are joints like in reactive arthritis

A

sterile

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21
Q

classical presentation for reactive arthritis

A

triad of arthritis, conjunctivitis & sterile urethritis

can also have keratoderma blennorrhagia (brown scaley rash on feet) & circinate balanitis (genital inflamation)

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22
Q

what do you get in ankylosing/axial spondylitis

A

syndesmophytes

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23
Q

ankylosing/axial treatment

A

anti TNF drugs, IL17 blockers, JAK inhibitors

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24
Q

who gets enteropathic arthritis

A

20% IBD pts

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25
Q

presentation of enteropathic arthritis

A

assymetric lower limb, usually reflects bowel activity, typically not erosive

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26
Q

joints effected in gout

A

in order: big toe (1st MTPJ), feet, ankles, knees, elbows, hands. Doesnt effect: shoulders, hips, spine

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27
Q

how do urate crystals form

A

purines -> hypoxanthine -> xanthine -> uric acid -> excreted by kidneys OR monosodium urate crystals.
Xanthine oxidase

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28
Q

causes of gout

A

too high intake (alcohol, fructose, excess meat, shellfish, offal, yeast, or myeloproliferative disease, psoriasis, tumour lysis syndrome etc.
or too low excretion: renal impairment, thiazide diuretics, aspirin, certain drugs

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29
Q

why does alcohol increase gout

A

alcohol competes with uric acid for excretion

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30
Q

gout on microscopy

A

negatively birefringent needle shaped crystals

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31
Q

chronic gout prevention

A

allopurinol (xanthine oxidase inhibitor) or febuxostat. increases gout initially so coprescribe with NSAIDs/cochicine (SE: diarrhoea) for 6 months)

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32
Q

crystal in pseudogout

A

pyrophosphate

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33
Q

joints in pseudogout

A

knees > wrists > shoulders > ankle > elbows

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34
Q

risk factors pseudogout

A

haemochromotosis, hyperparathyroidism, hypophosphatasia, hypomagnesaemia, hypothyroidism, acromegaly

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35
Q

microscopy for pseudogout

A

weakly positive birefringent rhomboid shaped crystals

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36
Q

antibody in connective tissue diseases

A

ANA

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37
Q

bloods in SLE

A

ESR raised, CRP not. CRP only goes up if interpretive infection
blood counts tend to be low

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38
Q

antibodies in SLE

A

ANA (sensitive), dsDNA (specific but not present in all)

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39
Q

SLE complication

A

lupus nephritis (nephrotic syndrome & renal failure

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40
Q

radiological signs of osteoarthritis

A

JOSSA
Joint space narrowing, osteophytes, subchondral (& periarticular) sclerosis, subchondral cysts; abnormalities of bone contour

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41
Q

signs of osteoarthritis on hands

A

Heberden’s nodes (DIP) & bouchards nodes (PIP)

42
Q

what changes do you see in bone structure with age

A

decreased trabecular thickness, decrease in connections between horizontal trabeculae, decrease in trabecular strength, remodelling frequency increases

43
Q

why is Cushing’s a risk factor for osteoporosis

A

cortisol increases resorption & osteoblast apoptosis

44
Q

antiresorbative treatment for osteoporosis

A

bisphosphonates (inactivate osteoclasts) e.g. alendronate, zoledronate
Denosumab - monoclonal antibody that inhibits RANKL

45
Q

anabolic osteoporosis treatments

A

increase osteoblast activity & formation

teriparatide (PTH analogue). 2nd line, expensive

46
Q

where is haematogenous seeding most common in children vs adults

A

children: long bones
adults: vertebra

47
Q

why is haematogenous seeding most common in the metaphesis (when in long bones)

A

blood is slower, absent basement membrane, lacking/inactive phagocytic lining.
even more blood flow in children (with age, vertebra get more blood flow too)

48
Q

most common causative organism for spine infection (osteomyelitis)

A

staph aureus (can survive inside macrophages)

49
Q

common osteomyelitis causative organisms in healthy people

A

staph aureus, coagulase negative staph, aerobic gram negative bacilli

50
Q

osteomyelitis causative organism in sickle cell

A

salmonella

51
Q

osteomyelitis causative organisms in IVDU

A

P. aeruginosa & serratia marcescens

52
Q

XR signs of osteomyelitis

A

bony destruction, abnormal bone density, digital vascular calcification, cortical erosion, periosteal reaction, mixed lucency, sclerosis, sequestera, soft tissue swelling
On MRI - increased white signal = inflammation

53
Q

septic arthritis common organisms

A

same as osteomyelitis. used to be haemophilus influenza in children under 2, now vaccinated

54
Q

common joints for septic arthritis

A

knee>hip>shoulder. 90% monoarthritis

55
Q

antibiotics for staph aureus

A

flucloxacillin, erythromycin, doxy/tetracycline

56
Q

most common bacteria in prosthetic joint infection

A

coagulase negative staph, staph aureus

57
Q

where does osteosarcoma occur

A

metaphysis of long bones (often knee, proximal humerus)

58
Q

where does osteosarcoma metastasize to

A

lung

59
Q

what staging system do primary bone tumours use

A

Enneking System

60
Q

what staging system do primary bone tumours use

A

Enneking System (IA-> III)

61
Q

what does Mirel’s scoring system show

A

chance of periprosthetic fracture within 12 months

62
Q

what is osteomalacia

A

weak bones, due to defective mineralisation of newly formed bone matrix (osteoid) usually due to vitamin D deficiency

63
Q

Diagnostic criteria for RA

A

RF RISES
Rheumatoid factor positive; Finger/hand/wrist involvement; Rheumatoid nodules present; Involvement of >3 joints; Stiffness in morning for >1hr; Erosions on XR; Symmetrical involvement.
Need >4 of above for >6 weeks

64
Q

Sensitivity vs specificity

A

Sensitivity: ability of a test to correctly identify those with a disease
Specificity: ability of a test to correctly identify those without a disease
(In context: hightly sensitive: few false negatives highly specific: few false positives)

65
Q

What is felty syndrome

A

Rheumatoid arthritis + splenomegsly & granulocytopenia

Treat RA and it will help the rest of the triad

66
Q

Bisphosphonates side effects

A

Oesophagitis, jaw necrosis

Give meds in morning then stand up straight to make sure goes into stomach

67
Q

Advantage of zoledronate over alendronate

A

Zol can be given once a year as an injection

68
Q

What type of hypersensitivity is SLE

A

Type 3

69
Q

What is antiphospholipid syndrome

A

Antibody mediated acquired thrombopholia characterised by thrombosis and or recurrent miscarriages.
Associated with SLE in 20-30%

70
Q

Antiphospholipid syndrome s&s

A

Coagulation defects - dvt, MI etc
Livedo reticularis - discolourisation of leg
Obstetric issues
Thrombocytopenia

71
Q

Antiphospholipid diagnosis

A 
1 clinical (vascular event, pregnancy morbidity)
1 lab (anticardiolipin, lupus anticoagulant, anti beta 2 glycoproteins 1 antibody)
72
Q

Antiphospholipid treatment

A

Lifestyle - no smoking etc
Warfarin long term
Manage clots etc

73
Q

S&s sjogrens

A

Dry eyes, parotid gland enlargement, joint pain, raynauds, systemic features

74
Q

Sjogrens diagnosis

A

Schirmer tear test, rose Bengal staining & slit lamp exam. Rheumatoid factors, ANA, anti Ro, anti La

75
Q

What is systemic sclerosis

A

Autoimmune disease with increased fibroblast activity (increased collagen deposition) resulting in abnormal growth of connective tissue. High mortality

76
Q

Systemic sclerosis s&s

A

Limited: skin involvement - hands, face, feet, forearms; beak like nose, small mouth, microstomoa
& diffuse: widespread skin changed, raynauds, gi, renal, lung involvement

77
Q

Polymyositis

A

Rare muscle disorder with inflammation and necrosis of skeletal muscle. Defmatomyositis get skin involvement too

78
Q

Polymyositis signs

A

Proximal muscles of shoulder and pelvic girdle effected, pain & tenderness uncommon. Can lead to resp failure if respiratory muscles involved

79
Q

Dermatomyositis sigsn

A

Heliotrope (purple) discolouration of eyelids. Scaly erythematous plaques over knuckles (gottron lesions)

80
Q

Polymyositis diagnosis

A

Serum creatinine kinase etc

ANA, ant jo1, anti mi2

81
Q

Pagets

A

Localised disorder of bone remodelling - increased resorption and increased formation of weaker bone. Rare Under 40

82
Q

Pagets signs

A

Bowed tibia
Skull changes (can cause deafness & hydrocephalus)
(Bone pain etc)

83
Q

Pagets diagnosis

A

Increased ALP, urinary hydroxyproline

84
Q

Pagets treatment

A

Bisphosphonates

Nsaids

85
Q

Hyperuricaemia definition (values)

A

> 420umol/l in men

> 360umol/l in women

86
Q

1st line investigation for gout

A

Bloods

87
Q

Gold standard investigation for gout

A

Joint aspiration (incase of septic arthritis)

88
Q

First line treatment for gout

A

Colchicine & nsaids

89
Q

What is osteomyelitis

A

Infection of bone marrow

90
Q

Joint effected in ank spon

A

Sacroiliac joint

91
Q

Reactive arthritis mnemonic

A

Can’t see (uveitis)
Can’t pee (urethritis)
Can’t climb a tree (enthesitis)

92
Q

Psoriatic arthritis xr sign of telescope fingers

A

Pencil in cup

93
Q

Treatment for all hlab27

A 
Pain management (very responsive to nsaids) or corticosteroids 
Biological therapy - infliximab
94
Q

Neuropathic pain relief drugs

A

TCA, gabapentin, pregabalin

95
Q

What cancer do you see onion skin in

A

Ewing’s sarcoma

96
Q

Secondary bone tumours

A 
Lead kettle (PBKTL)
Prostate, breast, kidneys, thyroid, lungs
97
Q

Wegeners granulomatosos

A 
cANCA positive 
Hearing loss, sinusitis, nose bleeds
Saddle shaped nose 
Treated with steroids and immunosuppressants
Aka granulomatosis with polyangitis
98
Q

SLE complications

A

CVD, infection, anaemia, pericarditis, pleuritic, ILD, lupus nephritis, neuropsychiatric SLE, recurrent miscarriage, VTE

99
Q

Skull appearance on XR in pagets

A

Cotton wool appearance

100
Q

RA treatment 1st - 4th line

A
  1. DMARD
  2. 2 dmards
    • biologic (usually anti tnf)
  4. Rituximab
101
Q

Polymyalgia rheumatica

A

Inflammatory disorder causing pain stiffness and inflammation in the shoulders, neck and hip muscles

102
Q

Causes of raises creatinine kinase

A 
Dermato/polymyositis 
Rhabdomyolysis
AKI
MI
Statins
Strenuous exercise

2a (10 decks)

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