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Rheumatology Flashcards

1
Q

Osteoarthritis Xray findings

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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2
Q

Osteoarthritis presentation

A

Large, weight-bearing joints affected
Pain is worse on movement
Stiffness on rest
Bone swellings in fingers

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3
Q

Osteoarthritis hand joints affected

A

Proximal interphalangeal joint: Bouchard’s nodes
Distal interphalangeal joint: Heberden’s nodes

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4
Q

Management of osteoarthritis

A

1st: Analgesia
Paracetamol/topical NSAIDs
Codeine/oral NSAIDs (+PPI)

2nd: Corticosteroid injections injections

Joint replacement

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5
Q

Rheumatoid arthritis Xray findings

A

Loss of join space
Erosion of bone
Soft tissue swelling
Soft bones (osteopenia)

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6
Q

Rheumatoid arthritis presentation

A

Symmetrical, deforming, peripheral polyarthris
Pain improves with use

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7
Q

Rheumatoid arthritis hand deformities

A

Ulnar deviation
Swan neck
Boutenniere deformity

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8
Q

Rheumatoid arthritis: which hand joints are affected?

A

MCP
PIP
Wrist

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9
Q

Rheumatoid arthritis systemic presentations

A

Scleritis
Pleural effusions
Pericarditis

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10
Q

Rheumatoid arthritis blood results

A

RF (highly sensitive)
Anti-CCP (more specific)
ESR

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11
Q

Rheumatoid arthritis management

A

1st: DMARDS
Methotrexate (+folic acid), leflunomide, sulfasalazine (pregnancy)
+ short term bridging prednisolone until DMARD can take effect

Steroids for flareups

Biologics
TNF a blockers: Infliximab
B cell inhibitors: Rituximab

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12
Q

Felty syndrome triad

A

Rheumatoid arthritis
Splenomegaly
Neutropenia

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13
Q

Osteoporosis pathophysiology

A

↓ bone mass/density and micro-architectural deterioration
↑ in bone fragility and susceptibility in fracture

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14
Q

Osteoporosis DEXA T-score

A

< -2.5

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15
Q

Osteoporosis management

A

1st: AdCal-D3 + bisphosphonates (oral alendronate/ risedronate)
2nd: Denosumab

Teriparatide
HRT

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16
Q

Osteoporosis risk assessment

A

FRAX
Qfracture

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17
Q

Osteoporosis aetiology

A

Steroid use
Hyperthyroidism and hyperparathyroidism
Alcohol and tobacco
Thin – low BMI
Testosterone decrease leads to increased bone turnover
Early menopause
Renal or liver failure
Erosive/inflammatory bone disease
Dietary calcium decrease/Diabetes mellitus type 1

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18
Q

Pseudogout joint aspiration findings

A

Positively birefringent rhomboid crystals
Calcium Pyrophosphate

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19
Q

Gout joint aspiration findings

A

Negatively birefringent needle crystals
Monosodium urate

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20
Q

Pseudogout joints affected

A

Ankle
Knee
Wrist

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21
Q

Gout joints affected

A

Big toe most common

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22
Q

Investigations for crystal arthritis

A

1st: Bloods - U&Es + eGFR, hyperuricaemia (4-6 weeks later)
Gold standard: Joint aspiration

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23
Q

Allopurinol mechanism of action

A

Inhibits Xanthine Oxidase

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24
Q

Management of gout

A

Acute:
1st: NSAIDs/colchicine
2nd: Intra articular steroids

Long term:
1st: Allopurinol
2nd: Febuxostat

Lifestyle advice

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25
SLE hypersensitivity reaction
Type III hypersensitivity
26
SLE inflammatory markers + antibodies
Raised ESR, normal CRP ANA – 99% of cases Anti-dsDNA – only 60% of cases
27
Drug induced SLE causes
Hydralazine Isoniazid Procainamide
28
SLE presentation
Joint pain Skin - malar rash, discoid rash, photosensitive butterfly rash Serositis - scleritis, pericarditis, pleuritis, oral ulcers Kidneys - glomerulonephritis with proteinuria CNS - depressions, psychosis
29
SLE management
Hydroxychloroquine Steroids Methotrexate UV protection
30
Antiphospholipid syndrome features
Coagulation defects Recurrent miscarriage Livedo reticularis Thrombocytopaenia
31
Antiphospholipid syndrome management
Warfarin LMWH + aspirin in pregnancy
32
Antiphospholipid syndrome lab criteria for diagnosis
1 of the following (+ 1 clinical): Anti-cardiolipin antibody Lupus anticoagulant Anti-Beta 2 Glycoprotein 1 antibody
33
Sjogren's syndrome features
Dry eyes, mouth Parotid gland enlargement Raynaud's Joint pain
34
Sjogren's syndrome antibodies
Anti-RO – 70% Anti-LA – 30% - but most sensitive ANA – 70% RF – 50%
35
Sjogren's investigations
Schirmer tear test Rose Bengal staining and slit lamp exam Antibodies Salivary gland biopsy is 100% confirmatory but not needed for diagnosis
36
Sjogren's management
Lifestyle - Humidifier, Eye drops, Mouth wash Medications - NSAID, Hydroxychloroquine M3 agonist - pilocarpine
37
Raynaud's phenomenon aetiology
Other autoimmune conditions Vibrational tools Smoking Use of beta blockers
38
Raynaud's management
Lifestyle Calcium channel blockers
39
Systemic sclerosis pathophysiology
Increased fibroblast activity (↑ collagen deposition) Results in abnormal growth of connective tissue
40
Systemic sclerosis presentation
Pulmonary: pulmonary HTN, pulmonary fibrosis Cardio: Raynaud’s, CAD, pericarditis, arrhythmias GI: GORD, oesophageal scarring, reduced small bowel motility MSK: sclerodactyly, calcinosis, arthralgia, myalgia, skin thickening Distal to elbows and knees in limited Proximally in diffuse
41
Systemic sclerosis antibodies
90% have ANA Limited: Anti-centromere Diffuse: Anti-RNA polymerase III
42
ESR in systemic sclerosis
Normal
43
Systemic sclerosis management
Lifestyle - avoid smoking, handwarmers Renal: ACEi GI - PPIs, Antibiotics Pulmonary fibrosis - IV cyclophosphamide
44
CREST syndrome
Limited cutaneous systemic sclerosis Calcinosis Raynaud's oEsophageal dysmotility Sclerodactyly Telangiectasia
45
Myositis (poly/dermato) presentation
Progressive muscle weakness of shoulder and pelvic girdle Dermato additional symptoms include: Heliotrope (purple) discoloration of eyelids Scaly erythematous plaques over the knuckles
46
Myositis antibodies
ANA, Anti jo1, anti mi2
47
Myositis blood results
Increase in: CK Aminotransferases Lactate dehydrogenase Aldolase
48
Myositis management
Oral prednisolone IVIG in severe disease
49
Paget's disease pathophysiology
↑ osteoclastic bone resorption followed by ↑ formation of weaker bone Leads to structurally disorganized mosaic of bone (woven bone)
50
Paget's disease presentation
60-80% are asymptomatic Bone pain Joint pain Deformities: Bowed tibia Skull changes Kyphosis Neuro complications: CN VIII compression - deafness Blockage of aqueduct of sylvius causing hydrocephalus
51
Paget's disease diagnosis
Bloods - Increased ALP, normal calcium and phosphate Urinary hydroxyproline increase X-rays - osteoarthritis findings
52
Paget's disease management
Bisphosphonates NSAIDS
53
Paget's disease complications
Heart failure - heart must work harder to compensate for increased blood flow to bones
54
Osteomalacia pathophysiology
Defective mineralization of newly formed bone matrix or osteoid in adults, due to inadequate phosphate or calcium, or due to ↑ bone resorption (hyperPTH) Most commonly due to Vit D deficiency
55
Osteomalacia causes
Malnutrition (most common) Drug induced Defective 1-alpha hydroxylation Liver disease
56
Osteomalacia presentation
Widespread bone pain and tenderness Gradual onset and persistent fatigue Muscle weakness, parasthesia, waddling gait Fractures
57
Osteomalacia investigation results
↓ calcium, ↓ phosphate, ↑ ALP, ↑ PTH X ray: Defective mineralisation
58
Osteomalacia management
Lifestyle - nutrition, sunlight Medications - Vit D replacement Malabsorption/Renal disease - IM calcitriol
59
Septic arthritis management
Admister O2 Take blood cultures/joint aspiration Give IV antibiotics Give IV fluids Check lactase Measure urine output
60
Septic arthritis risk factors
IVDU Immunocompromised Intra-articular injections Prosthetic joints
61
Septic arthritis causative organisms
S aureus N gonorrhoea S epidermis (prosthetics)
62
Septic arthritis antibiotics
4-6 weeks 1st: Flucloxacillin 2nd: Clindamycin If MRSA suspected: vancomycin/teicoplanin If gonococcal: cefotaxime/ceftriaxone
63
Osteomyelitis methods of infection
Direct inoculation Contiguous spread Haematogenous seeding
64
5 stages of osteomyelitis
Acute inflammation Subperiosteal abscess Sequestrum - necrotic bone within the pus Involcrum – new bone surrounding sequestrum Cloacae - opening to allow dead bone and pus to come out
65
Investigating osteomyelitis
Bone biopsy is best Raised WCC, ESR and CRP
66
Seronegative spondyloarthropathies
HLAB27 Ankylosing spondylitis Psoriatic arthritis Reactive arthritis
67
Ankylosing spondylitis aetiology + Xray findings
Inflammation of sacroiliac joints Loss of spinal movements Bamboo spine due to vertebral fusion Bone spurs - syndesmophytes Eroded & sclerotic sacroiliac joints
68
Reactive arthritis triad
Conjunctivitis Urethritis Enthesitis
69
Keratoma blenorrhagica
Associated with reactive arthritis Feet ulceration
70
Circinate balanitis
Associated with reactive arthritis
71
Management of HLAB27 spondyloarthropathies
1st line: physiotherapy + NSAIDs TNF-alpha inhibitors (infliximab) Steroid injections Surgery
72
Xray findings psoriatic arthritis
Pencil in cup deformity
73
Which joint is most commonly affected in psoriatic arthritis?
Distal interphalangeal joint
74
Xray findings in osteochondroma
Exostosis
75
Xray findings in Ewing's sarcoma
Onion skin changes
76
Xray findings in osteosarcoma
Sunburst appearance
77
Most likely secondary bone tumours
PBKTL (lead kettle) Prostate Breast Kidneys Thyroid Lungs

Medicine (13 decks)

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