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Rheumatology > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the hand findings in scleroderma?

A

Sclerodactyly
Raynaud’s phenomenon
Soft tissue atrophy
Calcinosis cutis
Nail dystrophy
Ulceration
Gangrene
Flexion deformities
Oedema
Telangiectasia
Vitiligo
Morphoea
Pigmentation
Pruritis

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2
Q

What are the musculoskeletal findings in scleroderma?

A

Arthritis
Myositis and myopathy
Intra-articular calcification
Osteopaenia

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3
Q

What are the gastrointestinal findings of scleroderma?

A

Dysphagia
GORD
Steatorrhoea and malabsorption due to SIBO
Pneumatosis coli
Diverticulosis
Primary biliary cirrhosis
Bowel obstruction

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4
Q

What are the renal findings of scleroderma?

A

Malignant hypertension
Glomerulonephritis
Scleroderma renal crisis

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5
Q

What are the respiratory findings of scleroderma?

A

Interstitial lung disease with basal predominance
Restrictive lung defects
Pleural effusions
Atelectasis

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6
Q

What are the cardiovascular findings of scleroderma?

A

Restrictive cardiomyopathy
Pericarditis
Pericardial effusion
Pulmonary hypertension
Conduction defects

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7
Q

What two arthropathies are typically DIP sparing?

A

Rheumatoid arthritis and SLE

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8
Q

What are the three eponymous deformities seen in rheumatic hands?

A

Swan neck - PIP hyperflexion with MCP/DIP extension
Boutonniere’s - PIP hyperextension with MCP/DIP flexion
Z deformity - Thumb IP joint flexion and MCP hyperextension

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9
Q

What are the differentials for rheumatoid nodules?

A

Gouty tophi
Cutaneous sarcoidosis
Granuloma annulare
Tendon xanthomata

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10
Q

What are the other manifestations of RA?

A

Shoulder, elbow, knee and foot involvement
Atlanto-axial subluxation leading to cervical myelopathy
Episcleritis, scleritis, cataracts, Sjogren’s syndrome, scleromalacia perforans
Anaemia
Pleural effusions, pulmonary fibrosis, bronchiectasis, Caplan’s syndrome
Pericarditis
Pyoderma gangrenosum
Felty’s syndrome, hepatosplenomegaly from secondary amyloidosis
Nephrotic syndrome
Mononeuritis multiplex, polyneuropathy

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11
Q

What are the diagnostic criteria for RA?

A

Morning stiffness >1 hour
Symmetrical joint involvement
>/3 joints affected
Involvement of the small joints of the hand
Positive rheumatoid factor
Rheumatoid nodules
Radiographic evidence

Where eligible, present for at least 6 weeks. At least four of the above needed.

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12
Q

What is rheumatoid factor?

A

IgM targeted against the Fc portion of IgG in 75% of RA patients
Also present in SLE and Sjogren’s, malignancy, chronic infection and 5% of the population
Seropositive RA is more aggressive with more extra-articular manifestations

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13
Q

What are the poor prognostic markers in RA?

A

Positive serology (anti-CCP or RF)
Early radiographic evidence of erosive disease
Impaired functional status
Persistently active synovitis

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14
Q

What are the general treatment principles in RA?

A

Patient education
Physiotherapy
Bone protection
Vaccination
Corticosteroids to induce remission
DMARDs (MTX first line for all RA)
Biologics (more rapid onset but higher cost, risk of TV and hepatosplenic T-cell lymphoma)

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15
Q

What are the five patterns of psoriatic arthritis?

A

Asymmetrical oligoarthritis with DIP predominance
Symmetrical polyarthritis with PIP/MCP predominance and DIP sparing (similar to RA)
DIP arthritis
Arthritis mutilans
Spondylitis +/- sacroiliitis

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16
Q

What are the three typical nail findings in psoriatic arthritis?

A

Nail pitting (correlates with disease activity)
Onycholysis
Transverse ridging

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17
Q

What are some examples of anti-TNFa therapy?

A

Infliximab, etanercept, adalimumab

18
Q

What are the hallmark findings of ankylosing spondylitis?

A

Protuberant abdomen
Increased kyphosis
Decreased cervical movement
Decreased spinal movement with increased occiput to wall distance
Positive modified Schober’s test
Decreased chest expansion

19
Q

What features are associated with ankylosing spondylitis?

A

Anterior uveitis
Aortic regurgitation and MVP
Atrioventricular conduction defects
Apical pulmonary fibrosis
Atlanto-axial subluxation
Achilles tendonitis
Amyloidosis

20
Q

What are the sacroiliac joint changes in ankylosing spondylitis?

A

Loss of cortical outline
Juxta-articular osteosclerosis
Erosions
Joint ankylosis

21
Q

What are the lumbar spine changes in ankylosing spondylitis?

A

Loss of lumbar lordosis
Vertebral squaring
Thoracolumbar syndesmophytes
Bamboo spine
Osteoporosis
Apophyseal joint fusion

22
Q

What features suggest a mixed connective tissue disease?

A

Overlap features of rheumatoid arthritis, systemic sclerosis, dermatomyositis and SLE

23
Q

What skin involvement is seen with SLE?

A

Butterfly rash with nasolabial sparing
Photosensitivity
Palmar erythema
Vasculitic lesions
Purpura
Urticaria
Livedo reticularis
Telangiectasia
Alopecia
Subcutaneous nodules
Raynaud’s phenomenon

24
Q

What musculoskeletal involvement is seen with SLE?

A

Non-erosive polyarthritis of the MCPs, PIPs, wrists and knees
Jacoud’s arthropathy - Deforming non-erosive arthropathy of the MCPs due to subluxation
Splinter haemorrhages
Nailfold capillaries
Periungual infarcts
Avascular necrosis

25
Q

What respiratory involvement is seen with SLE?

A

Restrictive lung defect with basal fibrosis
Pleural effusions
Pleurisy

26
Q

What cardiovascular involvement is seen with SLE?

A

Myopericarditis
Heart failure
Libman-Sacks endocarditis
Accelerted coronary atherosclerosis

27
Q

What neurological involvement is seen with SLE?

A

Seizures
Hemiparesis
Ataxia
Cranial nerve lesions
Aseptic meningitis
Chorea
Mononeuritis multiplex
Polyneuropathy
Neurosis

28
Q

What haematological involvement is seen with SLE?

A

Normochromic, normocytic anaemia
Haemolytic anaemia
Leucopaenia
Thrombocytopaenia
Pancytopaenia
Lymphadenopathy
Splenomegaly

29
Q

What renal involvement is seen with SLE?

A

Lupus nephritis

30
Q

What ocular involvement is seen with SLE?

A

Sjogren’s syndrome
Retinal infarcts
Roth spots
Papilloedema

31
Q

What are the diagnostic criteria for SLE?

A

Four of the following 11 criteria:

Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
Renal involvement
Neurological involvement
Haematological involvement
Immunological disorder
Positive ANA

32
Q

What are the causes of drug-induced SLE?

A

Procainamide
Hydralazine
Isoniazid
Quinidine
Chlorpromazine
Methyldopa
Phenytoin
Carbamazepine
Sulphonamides
OCP
Tetracycline

33
Q

What autoantibodies are seen in SLE?

A

ANA
Anti-dsDNA
Anti-histone
Anti-Sm
Anti-Ro and anti-La for ANA-negative subacute cutaneous lupus
Antiphospholipid antibodies

34
Q

What are the non-pharmacological management options for SLE?

A

Sunscreen and avoidance of sunlight
Low-dose oestrogen or progesterone only for contraception
Remove offending drugs
Smoking cessation and primary CV risk management

35
Q

What are the non-pharmacological management options for SLE?

A

Sunscreen and avoidance of sunlight
Low-dose oestrogen or progesterone only for contraception
Remove offending drugs
Smoking cessation and primary CV risk management

36
Q

What are the pharmacological management options for SLE?

A

NSAIDs
Hydroxychloroquine
Corticosteroids
Cytotoxics
Plasma exchange for severe disease

37
Q

What are the X-ray findings for RA?

A

Marginal erosions over the radial side of the MCPs
Soft tissue swelling
Subluxation
Juxta-articular osteoporosis
Joint space narrowing

38
Q

What are the X-ray findings of psoriatic arthritis?

A

Distal-predominant erosions with bone formation
Periostitis
Pencil-in-cup appearance
Dactylitis
Acro-osteolysis

39
Q

What are the X-ray findings of scleroderma?

A

Acro-osteolysis
Periarticular osteopaenia
Pencil-in-cup deformity
Soft tissue atrophy and calcinosis

40
Q

What are the X-ray findings of osteoarthritis?

A

Joint space narrowing
Osteophyte formation
Subchondral cysts

41
Q

What are the X-ray findings of gout?

A

Gouty tophi
Punched out lytic lesions
Overhanging of sclerotic margins

Rheumatology (1 decks)

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