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.
Ankylosing spondylitis - age, 5 features, test.
< 40yo, may get peripheral joints first. Pain for 3mo, morning stiffness >30 mins, awake or pain in 2nd half of night, improves w exercise, reduced lumbar flexion. HLA-B27 helpful
Features of psoriatic arthritis
Can be similar to ank spond or RA. Can be monoarthritis or DIP affected. Can cause sacroilitis and occur before psoriasis itself.
What is raynauds? 4 features of Mx. What are chillblains - symptoms, 4 fx of mx.
Vasospasm from cold/stress. Avoid cold, use gloves, avoid smoking, DH CCBS if needed (amlo, nifedipine). C: inflammation of small vessels in cold, itchy/tender red/purple bumps. Warm gradually (avoid heat/ice), potent topical steroid 1st line +/- dressing. Can add CCBs and topical GTN.
What are 3 possible causes of reactive arthritis? Symptoms and management.
Chlamydia, strep, GIT (salmonella, campylobacter). Arthritis, conjunctivitis, urethritis. Resolves in 6mo, NSAIDs for pain, treat infection if present.
