rheumatology Flashcards
Which rheumatological condition has only pain and stiffness but no weakness
polymylagia rheumatica
Which rheumatological condition can lead to carpal tunnel syndrome
polymyalgia rheumatica
Which rheumatological condition is associated with polymyalgia rheumatica
giant cell arteritis
Which condition is a medical emergency
giant cell arteritis
which are the 5 features of GCA
bitemporal sudden onset headache, vision: amaurosis fugax, vision loss, scalp tenderness, intermittent jaw claudication
What condition shows a optic disc that is chalky white and swollen optic disc
GCA
Which condition has a diagnosis using a biopsy
GCA
Treatment of GCA
oral prednisolone
What is the main mechanism of vision loss in GCA
anterior ischaemic optic neuropathy
What do you see in the blood film of someone with GCA
normochormic normocytic anaemia
what type of aneurysm is GCA associated with
aortic aneurysm
Which joints in the hands is osteoarthritis common
interphalangeal joints
what is the most common joint disease in the uk
osteoarthritis
which condition are heberdens and bouchards nodes seen
osteoarthritis
features on the x-ray in osteoarthritis
L: loss of joint space O: osteophytes S: subarticular sclerosis S: subchondral cysts
What three features are needed for the diagnosis of osteoarthritis
aged over 45 and morning stiffness less than 30min and movement related joint space
What is the first line management of osteoarthritis but then in the knee and hand
paracetamol, nsaids but for the knee and hand it is topical nsaids
Difference between ankylosing spondylitis and arthritis of the lumbar spine
ankylosing spondylitis is an inflammatory condition and more stiffness in the morning
What are the risk factors of osteoporosis
S: steroids H: hyperparathyroidism A: alcohol and smoking T:thin T: low testosterone E: erosive bone disease R: poor renal function E: early menopause D: diabetes
What is the first step before doing a dexa scan
do q risk score, if it is more than 10% do a dexa scan
What is the t score
this is comparing the bone density to young adults of the same sex.
What is the z score
comparing the bone density to adults of the same age and sex
What score indicates osteopenia
T score is -1 to -2.5 less than the mean
What score indicates osteoporosis
Z score less than 2 SD of the mean
What is the first line treatment for osteoporosis
bisphosphonates, like alendronic acid
What is the mechanism of action of desonumab
causes the maturation of osteoclasts
What is the mechanism of action of raloxifene
binds to ER
In which bone condition is the bone mineral: bone matrix reduced
osteomalacia
In which condition is the serum calcium increased: osteomalacia, pagets, osteitis fibrosa cystica
Osteitis fibrosa cystica
In which condition is the serum calcium decreased: osteomalacia, pagets, osteitis fibrosa cystica
osteomalacia
In which condition is the serum calcium normal: osteomalacia, pagets, osteitis fibrosa cystica
pagets
What is osteomalacia
deficiency in vitamin D or calcium or phosphate which results in a failure to mineralize bone
bowing of legs, knock knees, costochondral swelling, skull softening and proximal muscle weakness are features of which condition
osteomalacia
What is characterised a vitamin D deficiency
less than 25nmol/L of vitamin D
radiolucent bones in a xray suggest what
osteomalacia
What is the maintainence dose of vitamin D
800 IU
How would you treat vitamin D deficiency
50000IU for 6 weeks, 20000 for 7 weeks, 4000IU for 10 weeks and then the maintenance dose of 800IU
How would you treat vitamin D insufficiency
800IU maintenance dose
Which arthritis affects the PIP joints and MCP joints
RA
Which arthritis has a neutropenia and painful DIP and PIP joints
Psoriatic arthritis
boutinnere’s deformity, wrist sublaxation, swan neck deformity and z shaped thumb suggest what
RA
juxta-articular osteopenia and loss of joint space and on xray
RA
What are the categories of DS28
less than 1.6: mild
16-3.2: moderate
3.2-5.1: severe if over 5.2 start DMARD treatment
Examples of three DMARDS
methotrexate, hydrochloroquine and sulfaszine
side effects of methotrexate
cough, dysponea and fever (pneumonitis)
Which condition has an occult rash on the umbilicus, scalp and behind the ear and a pencil in cup deformity in the achilles tendon
psoriatic arthritis
which condition presents with extra-rheumatological features like raynaud’s phenomenon, pleural effusions, seizures and hepatosplenomegaly
SLE
which condition shows joint widening on a x-ray
rickets
treatment of acute flares in RA
IV methylprednisolone
hip pain with fever
transient synovitis same day referral
ANA and anti-dsDNA specificity and senstivity for SLE
ANA: more sensitive anti-dsDNA: more specific
which drug with aziathioprine has a severe interaction and can cause bone marrow suppression and agranulocytosis
allopurinol
anti jo-1
dermatomyositis: purple rash on face
anti-scl-70
diffuse systemic sclerosis: thickening of the skin
what is marfans syndrome associated with
recurrent pneumothoraces
what should be done before giving bisphosphonates
correct calcium and vitamin D level
treatment for sjorgens
hypromellose
aortic problems, young female which causes limb claudication
takayasu’s arteritis
distinguishing factor for pagets disease
isolated raised ALP
leg may be observed to be flexed at the hip, internally rotated and adducted.
posterior dislocation
, the leg can be positioned as externally rotated, but this is usually accompanied by significant abduction,
anterior dislocation
urethritis, arthritis and infective illness
reactive arthritis
joint aspirate is yellow and cloudy with the absence of crystals
RA
difference between pseudogout and gout
chondrocalcinosis
Bisphosphonates and denosumab can be used to prevent pathological fractures in bone metastases. If the eGFR < 30, denosumab is preferred
treatment for pagets disease
bisphosphonates
first line treatment for gout
nsaids and colchine
