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Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

how are flares of rheumatoid arthritis usually managed?

A

corticosteroids - oral or intramuscular

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2
Q

What are the features of osteoarthritis?

A

usually bilateral
one joint at a time is affected over a period of several years
the carpometacarpal joints and distal interphalangeal joints are affected most
painless nodes:
herbeden’s nodes at the DIP joints
bouchard’s nodes at the PIP joints
squaring of the thumbs

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3
Q

What are the features of takayusu’s arteritis?

A

systemic features of vasculitis e.g. malaise, headache
unequal blood pressure in upper libs
carotid bruit and tenderness
absent or weak peripheral pulses
upper and lower limb claudication on exertion
Aortic regurgitation

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4
Q

what is the management of a displaced hip fracture?

A

total hip replacement or hemiarthroplasty
total hip replacement is favoured to hemi if patients:
- were able to walk independently outdoors with no more than the use of a stick and
- are not cognitively impaired and
- are medically fit for anaesthesia and the procedure

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5
Q

What is the management of ankylosing spondylitis?

A

NSAIDS
tnf-alpha blockers e.g. infliximab, etanercept

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6
Q

what antibodies are associated with limited (central) cutaneous systemic sclerosis?

A

anti-centromere antibodies

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7
Q

what antibodies are associated with diffuse cutaneous systemic sclerosis?

A

anti-scl 70 antibodies

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8
Q

When should people with ank. spond be considered anti-tnf therapy\?

A

in axial ank spond that has failed on 2 different NSAIDs and meets criteria for active disease on 2 occasions 12 weeks apart

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9
Q

what is the management of perthes disease?

A
  • keep femoral head within acetabulum - cast, braces
  • if less than 6 years: observe
  • older: surgical management with moderate results
  • operate on severe deformities
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10
Q

What are the features of hypercalcaemia?

A
  • bones, stones, groans and psychic moans
  • corneal calcification
  • shortened qt interval on ECG
  • hypertension
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11
Q

What is myasthenia gravis associated with?

A

thymomas in 15%
autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE
thymic hyperplasia in 50-70%

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12
Q

what is seen on synovial fluid analysis in gout?

A

needle shaped negatively birefringent monosodium urate crystals under polarised light

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13
Q

How high would the CK be in rhabdomyolysis?

A

> 10,000

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14
Q

what are the features of drug-induced lupus?

A

arthralgia
myalgia
skin - malar rash and pleurisy are common
ANA positive in 100%
anti-histone antibodies are found in 80-90%
Anti-Ro, anti-Smith positive in 5%

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15
Q

what medication can make Raynaud’s worse?

A

propranolol

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16
Q

what are the features of limited cutaneous systemic sclerosis?

A

skin fibrosis is limited to the hands and forearms, feet and legs, and head and neck
also called CREST syndrome:
Calcinosis
Raynauds
Eosophageal dysmotility - GORD/dysphagia
Sclerodactyly - bright shiny skin of hands and feet
Telangiectasia

17
Q

what are the features of diffuse cutaneous systemic sclerosis?

A

multi-system autoimmune disease - key features are abnormalities of blood vessels and fibrosis of the skin and internal organs
skin involvement is over widespread areas at onset and is characterised by early visceral involvement
features:
- family history of systemic sclerosis
- raynauds phenomenon
- digital pits or ulcers that can be painful and lead to functional disability
- skin thickening, sclerodactyly and loss of function of the hands
- telangiectasia

18
Q

What are the features of still’s disease?

A

arthralgia
elevated serum ferritin
rash: salmon pink, maculopapular
pyrexia: typically rises in late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
lymphadenopathy
rheumatoid factor and anti-nuclear antibody negative
has a bimodal age distribution 15-25 years and 35-46 years

19
Q

what is the general prognosis of sarcoidosis?

A

it remits without treatment in approximately 2/3 of people

20
Q

what are poor prognostic factors of sarcoidosis?

A

insidious onset, symptoms > 6 months
absence of erythema nodosum
extrapulmonary manifestations
CXR: stage III-IV features
Black people

21
Q

What is the management of osteoporosis?

A

treatment is indicated following osteoporotic fragility fractures in post-menopausal women who are confirmed to have osteoporosis
vit D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake
alendronate is first line

22
Q

What are the features of ank. spond on x-ray?

A

radiographs may be normal in early disease, later changes include:
- sacroiliitis: subchondral erosions, sclerosis
- squaring of lumbar vertebrae
- bamboo spine - late and uncommon sign
- syndesmophytes

23
Q

what should be done before starting biologic therapy in people with RA?

A

chest X-ray to look for tb prior to srtarting

24
Q

what is dermatomyositis?

A

inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions
may be idiopathic or may be associated with connective tissue disorders or underlying malignancy - typically breast and lung - screening for an underlying malignancy is usually performed following a diagnosis of dermatomyositis
polymyositis is a variant of the disease where skin manifestations are not present

25
Q

what are the features of dermatomyositis?

A

skin features: photosensitive, macular rash over back and shoulder, heliotrope rash in periorbital region, Gottron’s papules - roughened red papules over extensor surfaces of fingers, ‘mechanic hands’ - extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers, nail fold capillary dilatation
other features: proximal muscle weakness +/- tenderness, raynauds, resp muscle weakness, ILD, dysphagia, dysphonia

26
Q

what antibodies are positive in dermatomyositis?

A

80% are ANA positive
30% have Jo-1/anti-mi-2

27
Q

what is felty’s syndrome?

A

Rheumatoid arthritis
splenomegaly
low white cell count

28
Q

what percentage of ppl with psoriasis develop psoriatic arthritis and when does it usually occur?

A

occurs in 10-20% of patients with psoriasis and usually occurs within 10 years of developing skin changes - typically affects people in middle age but can occur at any age

29
Q

what are the patterns of joint involvement in psoriatic arthritis?

A

there are several recognized patterns of joint involvement:
- symmetrical polyarthritis: presents similarly to rheumatoid and is more common in women - hands, wrists, ankles and DIP joints are affected
- asymmetrical pauciarthritis: affects mainly digits - fingers and toes and the feet - pauciarthritis describes when arthritis only affects a few joints
- spondylitic pattern: more common in men - presents with: back stiffness, sacroiliitis, atlanto-axial joint involvement

30
Q

what are signs of psoriatic arthritis?

A

onycholysis - separation of nail from nail bed
dactylitis - inflammation of full finger
Enthesitis - inflammation of entheses - points of insertion of tendons into bone

31
Q

what is the PEST tool

A

psoriasis epidemiological screening tool -
Nice recommend patients with psoriasis complete the PEST tool to screen for psoriatic arthritis
This involves several questions asking abt joint pain, swelling, a history of arthritis and nail pitting
A high score triggers referral to rheumatology

32
Q

what are x-ray changes seen in psoriatic arthritis?

A

periostitis - inflammation of periosteum causing thickened and irregular outline of bone
ankylosis - where bone joining together causes joint stiffening
osteolysis - destruction of bone
dactylitis - inflammation of whole digit and appears on x-ray as soft tissue swelling
pencil in cup appearance - classic appearance

33
Q

what is arthritis mutilans?

A

most severe form of psoriatic arthritis - occurs in the phalanxes - osteolysis of bones around joints and digits - leads to progressive shortening of digit - skin then folds as digit shortens giving an appearance that is often called a “telescopic finger”

34
Q

what is the treatment of psoriatic arthritis?

A

treatment is coordinated by derm and rheum
depending on severity they may require:
- NSAIDs
- DMARDs - leflunomide, methotrexate, sulfasalazine
- anti-tnf meds
- ustekinumab is last-line

35
Q

what are the associations with psoriatic arthritis?

A
  • conjunctivitis/anterior uveitis
  • amyloidosis
    -aortitis
36
Q

x-ray changes seen in RA?

A

Joint destruction and deformity
Soft tissue swelling
Periarticular osteopenia
Bony erosions

37
Q

what are the general features of sle?

A

fatigue
fever
mouth ulcers
lymphadenopathy

Medicine (20 decks)

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