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Z2F/Comprehensive Flashcards > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

lumps on fingers in osteoarthritis

A

Herbedens nodes = DIP joints

Bouchard’s nodes = PIP joints

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2
Q

management of osteoarthritis:
1. Non-medical options (2)
2. Medical/surgical options

A
  1. Weight loss (if overweight)
    Physiotherapy

2.Medical/surgical options
Analgesia (first line= paracetamol or topical NSAIDs)
Intra-articular steroid injections
joint replacement surgery

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3
Q

antibodies associated with rheumatoid arthritis (2)

A
  1. Anti-CCP antibodies- sensitivity 70%, specificity 90-95%
  2. Rheumatoid Factor- sensitivity 70%, lower specificity
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4
Q

Hand deformities associated with Rheumatoid Arthritis (4)

A
  1. z-shaped deformity (thumb)
  2. Swan-neck deformity
  3. Boutonniere’s deformity
  4. Ulnar deviation at the MCP joints
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5
Q

Rheumatoid Arthritis:
1. investigations for synovitis
2. scoring system
3. First line options for management
4. Initial type of biologic

A
  1. Ultrasound of joints
  2. DAS28
  3. Methotrexate, Leflunomide, Sulfasalazine
  4. TNF inhibitor
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6
Q

35yF with asymmetric pain and stiffness in the fingers, skin rash and nail changes
1. Diagnosis?
2. Nail changes?
3. Name for inflammation of an entire digit?
4. Screening tool?
5. most severe form with osteolysis and telescoping of the digits?

A
  1. Psoriatic arthritis
  2. Nail changes: nail pitting + oncholysis (separation of the nail from the nailbed)
  3. Dactylitis
  4. Psoriasis epidemiological screening tool (PEST)
  5. Arthritis Mutilans
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7
Q

42yM with knee pain and swelling two weeks after having gastroenteritis
1. Diagnosis?
2. Classic triad of features?
3. Associated gene?
4. most important differential?
5. most common triggers?
6. Investigation to exclude other causes?

A
  1. Reactive arthritis
  2. Arthritis + conjunctivitis + urethritis/balanitis
  3. HLA B27
  4. Septic Arthritis- would usually have a fever with this
  5. Gastroenteritis and sexually transmitted infection (chlamydia)
  6. Joint Aspiration
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8
Q

Ankylosing spondylitis:
1. Associated gene ?
2. Main symptoms in the back?
3. Worse morning/evening or movement/rest?
4. Name the test
5. XRay findings in late disease?
6. MRI finding in early disease?

A
  1. HLA B27
  2. pain and stiffness
  3. Worse in the morning, worse after rest
  4. Schober’s test
  5. Bamboo spine
  6. Bone Marrow Oedema
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9
Q

SLE:
1. presenting features can include (7)
2. Initial antibody test?
3. Specific antibody tests?
4. first line in mild disease?
5. biologic used in severe disease, targeting B cells?

A
  1. malar rush which spares nasolabial folds and is worse with sunlight, hair loss, joint pain, splenomegaly, hair loss, SOB, lymphadenopathy, myalgia
  2. initial antibody test= Anti nuclear antibodies
  3. Specific antibody tests: Anti-Double stranded DNA + Anti-Smith
  4. first line in mild disease= Hydroxychloroquine
  5. Biologic used in severe disease= Rituximab
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10
Q

30yF with skin lesions on her face and patches of hair loss. Symptoms are worse with sunlight

  1. Diagnosis
  2. diagnostic investigation?
  3. Treatment options? (4)
  4. Rarely lesions can become which cancer?
A
  1. Discoid Lupus erythematous
  2. Skin biopsy
  3. management:
    1- sun protection
    2- topical steroids
    3- intralesion steroid injections
    4- hydroxychloroquine
  4. Squamous Cell Carcinoma
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11
Q

Reynaud’s phenomenon:
1. 3 stages of colour changes?
2. what % have an underlying disease?
3. most associated connective disease?
4. screening blood test for connective tissue disease?
5. test to examine the small blood vessels in the fingers?
6. medical management?

A
  1. White -> blue -> red
  2. 10-20%
  3. associated connective tissue disease= Systemic sclerosis
  4. screening blood test for connective tissue disease= Antinuclear Antibodies
  5. Nailfold capillaroscopy
  6. Prophylactic nifedipine
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12
Q

CREST syndrome:
1. abbreviations?
2. which antibodies are checked initially in suspected connective tissue disease?
3. antibodies in limited cutaneous systemic sclerosis?
4. antibodies in diffuse cutaneous systemic sclerosis?

A
  1. Calcinosis, Reynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasia
  2. Antinuclear antibodies (ANA) are checked initially in suspected connective tissue disease
  3. anti-centromere antibodies= antibodies in limited cutaneous systemic sclerosis
  4. anti-scl-70 antibodies= antibodies in diffuse cutaneous systemic sclerosis
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13
Q

65yF with one month of shoulder and pelvic girdle pain and stiffness, worse in the morning
1. diagnosis?
2. abnormal blood tests?
3. treatment?
4. additional medications to protect against the side effects of treatment?

A
  1. Polymyalgia rheumatica
  2. Abnormal bloods: raised CRP, raised ESR, raised plasma viscosity
  3. initial treatment= Prednisolone 15mg OD
  4. additional medications to protect against the side effects of treatment:
    - bisphosphonates
    - calcium and vit D
    - proton pump inhibitors
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14
Q

72yo with right sided temporal headache with scalp tenderness and aching in his jaw whilst chewing

  1. Diagnosis
  2. associated condition?
  3. key complication?
  4. key blood test?
  5. definitive test?
  6. initial treatment?
A
  1. giant cell arteritis (temporal arteritis)
  2. associated condition= polymyalgia rheumatica
  3. key complication= loss of vision
  4. key blood test= ESR (usually >50mm/hour)
  5. definitive test= temporal artery biopsy
  6. high dose prednisolone (40-60mg/day)
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15
Q

52yF with pain and weakness in the thighs, shoulders and upper arms. There is a purplish rash on the eyelids
1. Diagnosis?
2. Rash on the hands?
3. Similar diagnosis without skin changes?
4. Initial blood test?
5. Antibodies (3)
6. definitive investigation?
7. What else to consider in new cases?
8. first line treatment?

A
  1. dermatomyositis
  2. Gottron lesions
  3. Polymyositis
  4. Creatine Kinase
  5. Antibodies:
    Anti-jo-1 antibodies (polymyositis)
    anti-mi-2 antibodies (dermatomyositis)
    antinuclear antibodies
  6. muscle biopsy
  7. Possible underlying cancer
  8. Corticosteroids
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16
Q

Sjogren’s:
1. affected structures
2. may be secondary to? (2)
3. associated antibodies? (2)
4. test for dry eyes?
5. treatment to halt disease progression?

A
  1. Exocrine glands
  2. systemic lupus erythematous or rheumatoid arthritis
  3. Antibodies: Anti-Ro, Anti-La
  4. Schirmer test
  5. Hydroxychloroquine
17
Q

Saddle-shaped nose, nose bleeds, sinusitis, cough/wheeze/haemoptysis, glomerulonephritis
1. Diagnosis
2. type of disease?
3. blood test for this type of disease?
4. general treatments? (2)

A
  1. GPA (Wegener’s granulomatosis)
  2. Vasculitis (small/medium-sized)
  3. Anti-nuclear cytoplasm antibodies (ANCA)
  4. general treatments: Steroids + immunosuppressants
18
Q

Behcet’s disease:
1. presentation
2. associated gene?
3. special test?
4. Disease pattern?
5. topical treatment for mouth ulcers?
6. other causes of mouth ulcers? (7)

A
  1. recurrent episodes of oral and genital ulcers and episodes of knee pain and swelling
  2. HLA B51
  3. Pathergy test
  4. relapsing-remitting disease pattern
  5. Steroids (soluble betamethasone tablets)
  6. other causes of mouth ulcers:
    simple aphthous ulcers (common)
    IBD (Crohn’s)
    Coeliac disease
    vitamin deficiency (B12, folate, iron)
    Herpes simplex virus
    hand, foot and mouth
    squamous cell carcinoma
19
Q

gout:
1. What blood test is raised?
2. what is seen on aspirated fluid?
3. first line for acute flare?
4. tx in renal impairment? main side effect?
5. prophylactic treatment?

A
  1. uric acid is raised in gout
  2. monosodium urate crystals (needle shaped) negatively biferingent of polarised light
  3. NSAIDs are first line e.g. ibuprofen or naproxen
  4. colchicine in renal impairment, main side effect is diarrhoea
  5. prophylactic tx= Allopurinol
20
Q

70yo with a hot, swollen, stiff and painful knee

  1. Diagnosis?
  2. differential to exclude?
  3. what is in the joint?
  4. appearance of joint fluid microscopy?
  5. first line medication?
A
  1. Pseudogout
  2. septic arthritis
  3. calcium pyrophosphate crystals
  4. rhomboid shaped crystals that are positively bifringent of polarised light
  5. NSAIDs
21
Q

Osteoporosis:
1. risk assessment tool?
2. investigation?
3. T score for diagnosis?
4. guidelines for deciding whether to treat?
5. first-line treatment?
6. monoclonal antibody option?

A
  1. FRAX tool
  2. DEXA scan
  3. < -2.5
  4. NOGG guidelines
  5. Bisphosphonates= first line. vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
  6. Denosumab
22
Q

osteomalacia:
1. cause?
2. abnormal electrolytes?
3. abnormal liver test?
4. abnormal hormone?
5. treatment?

A
  1. vitamin D deficiency
  2. low serum calcium + low serum phosphate
  3. raised ALP
  4. raised parathyroid hormone (PTH)
  5. treatment dose vitamin D
23
Q

68yM with bone pain, deformity, pathological fractures and hearing loss

  1. Diagnosis
  2. name for well-defined osteolytic lesions on XR?
  3. classical skull XR?
  4. key abnormal blood test?
  5. main treatment?
A
  1. Paget’s disease of the bome
  2. Osteoporosis circumscripta
  3. ‘cotton wool’ appearance
  4. raised ALP
  5. Bisphosphonates
24
Q

examples of medium vessel vasculitis

A

Buerger’s disease
Kawasaki disease
Polyarteritis nodosa

25
Q

examples of large vessel vasculitis

A

giant cell arteritis
Takayasu’s arteritis

26
Q

examples of small vessel vasculitis

A

Wegener’s granulomatosis (GPA)
Henoch-Schonlein Purpura
Churg-Strauss disease

27
Q

what types of vasculitis present with skin findings?

A

medium and small vessel disease

28
Q

management of Buerger’s disease

A

Management is with smoking cessation ± vasoactive medication (such as nifedipine).

If there is critical ischaemia the patient requires hospital admission, vasoactive medication and debridement of gangrenous tissue.

29
Q

Trochanteric bursitis (greater trochanteric pain syndrome)
1. Presentation
2. Management

A
  1. pain over lateral side of hip/thigh, tenderness of palpation of the greater trochanter
  2. The management is mostly conservative and involves adequate analgesia. This may involve steroid injections.

Physiotherapy is useful for stretching and strengthening exercises.

Only as a last resort and in selected cases is bursectomy (removal of the inflamed bursa) considered.

30
Q

Ostemyelitis:
1. most likely causative organisms
2. imaging modality of choice
3. Management

A
  1. Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate
  2. MRI is the imaging modality of choice, with a sensitivity of 90-100%
  3. management:
    flucloxacillin for 6 weeks
    clindamycin if penicillin-allergic
31
Q
  1. what are the seronegative spondyloarthropathies?
  2. what antibody is associated with them?
A
  1. ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis (associated with IBD)
  2. HLA B27

Z2F/Comprehensive Flashcards (7 decks)

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