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Med School Finals > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Classification of arthritis by number of joints affected?

A

Monoarthritis = 1
Oligoarthritis = 2-4
Polyarthritis = > 4

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2
Q

Seronegative arthritis feature and examples?

A

All linked to HLA-B27:
→ ankylosing spondylitis
→ reactive arthritis (Reiter’s)
→ psoriatic arthritis
→ IBD-related arthritis
→ juvenile idiopathic arthritis

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3
Q

Seropositive arthritis feature and examples?

A

All RF +ve or antibody +ve:
→ rheumatoid arthritis
→ SLE
→ sjogren’s
→ scleroderma
→ vasculitis

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4
Q

Features of rheumatoid arthritis?

A

Symmetrical arthritis
Main joints are MCPs/PIPs
Morning stiffness improves with activity

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5
Q

Antibodies in rheumatoid arthritis?

A

Rheumatoid factor
Anti-CCP

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6
Q

X-ray features of rheumatoid arthritis?

A

Loss of joint space
Juxta-articular osteoporosis
Periarticular erosions
Subluxation

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7
Q

Swan neck vs Boutonniere deformity?

A

Swan neck = PIP hyperextension, DIP hyperflexion
Boutonniere = PIP hyperflexion, DIP hyperextension

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8
Q

Management of rheumatoid arthritis?

A

1st line = DMARD +/- short course of prednisolone
2nd line = other DMARD
3rd line = TNF-inhibitor

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9
Q

Felty’s syndrome?

A

Rheumatoid arthritis + splenomegaly + low WCC

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10
Q

Treatment response monitoring for arthritis?

A

CRP + DAS28 score

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11
Q

Examples of DMARDs?

A

Methotrexate
Sulfasalazine
Leflunomide
Azathioprine
Ciclosporin
Hydroxychloroquine

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12
Q

DMARDs unsafe in pregnancy and breastfeeding?

A

Methotrexate
Leflunomide

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13
Q

Examples of TNF-inhibitors?

A

Etanercept
Infliximab
Adalimumab

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14
Q

Methotrexate mechanism of action and side effects?

A

Dihydrofolate reductase inhibitor
Side effects = mucositis, myelosuppresion, pneumonitis, pulmonary fibrosis, liver fibrosis

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15
Q

Methotrexate monitoring requirements?

A

FBC, U&Es, LFTs weekly until medication stabilised
→ then monitor every 2-3 months

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16
Q

Advice regarding sex and methotrexate?

A

Women = avoid pregnancy until 6 months post-therapy
Men = use condoms until 6 months post-therapy

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17
Q

What should be co-prescribed with methotrexate?

A

Folic acid 5mg

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18
Q

Features and management of psoriatic arthritis?

A

Symmetrical or asymmetrical arthritis
Morning stiffness improves with activity
Psoriatic changes e.g. plaques, nail disease
Management = same as RA, NSAID for mild disease

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19
Q

X-ray features of psoriatic arthritis?

A

Erosions
New bone formation
“Pencil in cup” appearance

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20
Q

Features and management of reactive arthritis?

A

Assymetrical arthritis
Within 4 weeks of infection e.g. chlamydia
Urethritis, circinate balanitis, eye disease
Management = NSAID, DMARD for persistent disease

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21
Q

Most common organism and location of septic arthritis?

A

Organism = staphylococcus aureus
Location = knee

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22
Q

Features, investigation and management of septic arthritis?

A

Generally unwell e.g. fever
Acute monoarthritis
Investigation = joint aspiration
Management = IV flucloxacillin

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23
Q

Features and management of osteoarthritis?

A

Asymmetrical arthritis
Main joints are DIPs/PIPs, large joints
Pain worsens upon activity
Management = paracetamol, topical NSAID (knee or hand OA), joint replacement

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24
Q

Features of hand OA?

A

Herbeden’s nodes (DIPs)
Bouchard’s nodes (PIPs)
Squaring of the thumbs

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25
Q

X-ray features of osteoarthritis?

A

LOSS:
→ loss of joint space
→ osteophytes
→ subchondral sclerosis
→ subchondral cysts

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26
Q

Osteoporosis vs osteopenia vs osteomalacia?

A

Osteopenia = low BMD
Osteoporosis = low BMD and structural change
Osteomalacia = low BMD secondary to low vitamin D

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27
Q

Definition of osteoporosis?

A

Bone mineral density (BMD) < 2.5 standard deviations below the young adult mean density

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28
Q

Who should be screened for osteoporosis and investigations?

A

Women ≥ 65 and men ≥ 75:
→ FRAX or QFracture score
→ DEXA scan

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29
Q

Management of patients after a fragility fracture?

A

≥ 75 = oral bisphosphonate, DEXA scan not required
< 75 = DEXA scan

30
Q

DEXA scan T scores?

A

> -1.0 = normal
-1.5 to -2.5 = osteopaenia
< -2.5 = osteoporosis

31
Q

Management of osteoporosis?

A

1st line = alendronate
2nd line = risedronate, etidronate
3rd line = denosumab, raloxifene etc.
N.B. all should be offered calcium + vitamin D

32
Q

Bisphosphonate examples, mechanism of action and side effects?

A

Examples = alendronate, risedronate, etidronate
Mechanism of action = inhibits osteoclasts
Side effects = GI upset, jaw osteonecrosis, atypical stress fractures

33
Q

Advice for taking bisphosphonates?

A
  • Correct calcium or vitamin D deficiency first
  • Take on empty stomach 30 mins before meal
  • Stand or sit for 30 mins after ingestion
34
Q

Calcium, phosphate, ALP and PTH values for osteoporosis, osteomalacia, CKD and Paget’s?

A

Osteoporosis = all normal
Osteomalacia = decreased calcium and phosphate, increased ALP and PTH
CKD = decreased calcium, increased phosphate and ALP and PTH
Paget’s = normal calcium and phosphate and PTH, increased ALP

35
Q

Features and management of ankylosing spondylitis?

A

Lower back pain
Sacroiliac joint tenderness
Reduced lateral and forward flexion
Morning stiffness improves with activity
Enthesitis, anterior uveitis, pulmonary fibrosis
Management = exercise, NSAID, DMARD

36
Q

X-ray features of ankylosing spondylitis?

A

Sacroiliitis
Squaring of lumbar vertebrae
“Bamboo spine” appearance

37
Q

Features and management of SLE?

A

Multisystem manifestations
→ general e.g. fatigue
→ msk e.g. arthritis
→ skin e.g. malar rash
→ kidneys e.g. GN
→ heart e.g. pericarditis
→ lungs e.g. pleurisy
Management = hydroxychloroquine (1st line), prednisolone (2nd line), cyclophosphamide (3rd line)

38
Q

Antibodies in SLE vs drug-induced SLE?

A

SLE = ANA, anti-dsDNA, anti-smith
Drug-induced = anti-histone

39
Q

Monitoring markers for SLE?

A

Anti-dsDNA
ESR
C3 and C4 (low in active disease)

40
Q

Features and management of Sjögren’s syndrome?

A

Keratoconjunctivitis sicca
Dry mouth
Vaginal dryness
Arthralgia
Management = artificial tears/saliva, pilocarpine

41
Q

Antibodies in Sjögren’s syndrome?

A

ANA
Anti-Ro
Anti-La

42
Q

Complication of Sjögren’s syndrome?

A

40-60 fold increased risk of lymphoid malignancy

43
Q

Features of gout?

A

Painful, swollen joint
Localised erythema
Typically affects 1st MTP

44
Q

Synovial fluid feature of gout?

A

Needle shaped negatively birefringent monosodium urate crystals

45
Q

When should uric be measured after a gout attack and why?

A

After episodes has settled (around 2 weeks)
→ may be low, normal or high during attack

46
Q

Acute vs long-term management of gout?

A

Acute = NSAID or colchicine (1st line), prednisolone (2nd line)
Long-term = allopurinol (1st line), febuxostat (2nd line)

47
Q

Conditions associated with pseudogout?

A

Haemochromatosis
Hyperparathyroidism
Wilson’s disease
Acromegaly

48
Q

Synovial fluid feature of pseudogout?

A

Rhomboid shaped positively birefringent crystals

49
Q

List examples of small vs medium vs large vessel vasculitides?

A

Small = wegener’s, churg-strauss, microscopic polyangiitis, HSP, goodpasture’s
Medium = kawasaki, polyarteritis nodosa
Large = giant cell (temporal), takayasu’s

50
Q

ANCA associated vasculitides and antibody sub-type?

A

Granulomatosis with polyangiitis (cANCA)
Eosinophillic granulomatosis with polyangiitis (pANCA)
Microscopic polyangiitis (pANCA)

51
Q

Features and management of ANCA associated vasculitis?

A

Generally unwell e.g. fever
Glomerulonephritis
Respiratory disease
Sinusitis
Vasculitis rash (minority)
Management = immunosuppressants

52
Q

Features and management of temporal (giant cell) arteritis?

A

Headache
Jaw claudication
Visual disturbance
Tender temple region
PMH polymyalgia rheumatica
Management = oral prednisolone (no visual loss), IV methylprednisolone (visual loss)

53
Q

Investigation for temporal arteritis and feature?

A

Temporal artery biopsy
Skip lesions

54
Q

Most common optic manifestation of temporal arteritis and fundoscopy features?

A

Anterior ischaemic optic neuropathy
Fundoscopy = pale disc and blurred margins

55
Q

Features and management of polymyalgia rheumatica?

A

Achy, stiff proximal limb muscles
NO weakness!
Polyarthralgia
Fatigue
Raised ESR
Management = prednisolone

56
Q

Features and management of fibromyalgia?

A

Chronic pain at specific points
Brain fog
Fatigue
Management = exercise, pain management

57
Q

Polymyalgia vs fibromyalgia?

A

Polymyalgia = > 60, raised ESR, morning stiffness, no tender points
Fibromyalgia = 30-50, normal ESR, no morning stiffness, tender points e.g. shoulders

58
Q

Timescale for chronic fatigue syndrome?

A

Symptoms must be present for at least 3 months to be referred to CFS specialist

59
Q

Features and management of polymyositis?

A

Proximal muscle weakness
Raynaud’s
Interstitial lung disease
Management = prednisolone

60
Q

Features and management of dermatomyositis?

A

Proximal muscle weakness
Raynaud’s
Interstitial lung disease
Heliotrope rash
Shawl sign
Gottron’s papules
Management = prednisolone

61
Q

Investigations for polymyositis and dermatomyositis?

A

Creatine kinase (CK)
EMG
Muscle biopsy

62
Q

Antibody in polymyositis and dermatomyositis?

A

Anti-Jo-1

63
Q

Additional screening test for polymyositis and dermatomyositis?

A

Check for underlying malignancy
Most commonly breast, ovarian or lung

64
Q

Disease patterns of systemic sclerosis?

A

Limited cutaneous systemic sclerosis
Diffuse cutaneous systemic sclerosis
Scleroderma (no internal organ involvement)

65
Q

CREST syndrome and features?

A

Sub-type of limited cutaneous systemic sclerosis:
→ calcinosis
→ raynaud’s
→ oesophageal dysmotility
→ scerlodactyly
→ telangiectasia

66
Q

Antibody in limited vs diffuse systemic sclerosis?

A

Limited = anti-centromere
Diffuse = anti-scl-70

67
Q

Features and management of antiphospholipid syndrome?

A

Venous/arterial thrombosis
Recurrent miscarriages
Pre-eclampsia
Levido reticularis
Management = low-dose aspirin, lifelong warfarin (if PMH thrombotic event)

68
Q

Blood test features of antiphospholipid syndrome?

A

Thrombocytopaenia
Prolonged APTT
Anti-cardolipin antibodies

69
Q

Features of Behcet’s syndrome?

A

Triad of:
→ oral ulcers
→ genital ulcers
→ anterior uveitis

70
Q

Arthritis with a salmon-pink rash?

A

Still’s disease

Med School Finals (18 decks)

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