Rheumatology Flashcards
Lupus - rash type, common organs affected, initial blood screen significance. 1st line mx.
Transiet erythematous patches, butterfly rash. Any organ affect - haem (leukpaenia, haemolysis), neuropsych (seizures), oral ulcers, serosa - pleural effusion, pericarditis, arthritis, nephritis. ANA non specific inital, later do complement and phospholipid and AntiDsDNA. Hydroxychloroquine.
Systemic sclerosis: limited features and other complications. Annual screening.
Calcinosis, raynauds, oesophageal dysmotility, slcerodactyly, telangiectasia. Risk: pulm HTN, ILD, digital ulcers, watermelon stomach (vascular ectasia), GI bleeding, decreased mouth opening. Annual echo and lung fx tests, do HRCT if symptoms.
What are 3 common features of polymyalgia rheumatica and 3 fx that are supportive of diagnosis? How is it treated?
Age >50, bilateral shoulder ache, elevated ESR or CRP. Morning stiffness >45min, only hips/shoulders involved, no RF or Anti-CCP. Rare in under 50. Long term steroids -15mg daily initially, wean over a year.
Rheumatoid arthritis - which hand joints affected, 2 hx features, 3 exam features and 4 xray features.
MCP + PIP. Morning stiffness >30min, Fhx. Symmetrical effect, 3+ tender/swollen joints, positive squeeze test at MCP/MTP. Xray: cysts, joint destruction, subluxation, erosion of joint margins.
What tests are done in suspect RA? When is referral indicated? What are early signs of poor prognosis?
RF - 70% once establish, Anti-CCP 96% specific and seen early. Refer immediate if multiple or tests positive, otherwise 6 weeks of unexplained swelling. PP: smoker, swelling in >20 joints, high RF titre, sustained raised inflam markers, impaired function early, bony erosions on xray early.
What are the 3 factors of RA remission? What are 5 principles of management? 4 1st line management.
Symptom relief, normal inflam markers, no joint swelling. Symptom monitoring (aim for remission), adherence to meds, vaccinations, manage CVD risk, check drug interactions. Panadol, NSAIDs, omega 3 supplements, DMARDs, steroids.
Methotrexate - 5 side effects, what monitoring required, and supplement needed.
Teratogenic, hepatotoxic w alcohol, photosensitivity, alopecia, stomatitis. Monitor FBE, UEC, LFTs monthly then 3mo. Need folic acid.
How is juvenile idiopathic arthritis defined? What are 3 differentials?
Inflammatory arthritis under age 16 for 6 weeks with no cause. DDx: rheumatic fever, leukaemia, reactive arthritis.
What are 5 risk factors for gout? What are 6 precipitants?
HTN, CKD, diabetes, obesity, dyslipidaemia. P: alcohol, seafood/meat/yeast, fructose sweetened drinks, dehydration, diuretics, fasting/dieting.
What are three 1st line options for acute gout pain? 2nd line?
Local steroid injection, oral NSAID 3-5d, prednisolone 15-30mg 3-5d. 2ndline: colchicine 1mg then 500micorg 1hr later.
How is allopurinol used in gout? SE and 2nd line options. Target.
Recommended for all gout, ok in renal impairment. Flare prophylaxis w colchicine. Avoid dose changes during attack. Hypersensitivity syndrome - rash, fever, hepatitis. 2nd line: ADD probenecid (avoid if kidney stone). Febuxostat. Aim uric acid < 0.36 or 0.30 if tophi.
What is sjogren syndrome? What causes it? Mx?
Autoimmune lymphoid infiltration into exocrine glands. Primary or 2nd to SLE, RA, sclerosis. Benign. Sx management: glasses outdoors (wind), avoid anticholinergics, regular dental review, artificial saliva, chew gum, eye gels/ointments.
Polymyositis - presentation, age, features and assoc condition.
Symmetrical muscle weakness/wasting, less pain. Age 40-60, elevated CK. May get heliotrope rash on eyelids in dermatomyositis.
Diagnostic features of temporal arteritis, Ix.
3 of: age >50, new local headache, temporal artery tenderness or reduced pulse, ESR >50, abnormal biopsy. Need biopsy within 1 week but may be false negative.
Acute and long term treatment of temporal arteritis. 4 Fx of long term mx.
Urgent specialist, IV methylpred if visual change or oral pred for 4 weeks + aspirin 100mg. Treat for 18mo, monitor symptoms, SE of steroids, chance of PMR, ongoing visual risk.
