Rheumatology Flashcards
Describe the most important findings in an x-ray of a patient with osteoarthritis.
Narrow joint space and osteophytes.
What is the most common risk factor for osteoarthritis?
Obesity.
How should a patient with osteoarthritis approach lifestyle changes?
By losing weight.
Define the sequence of treatment in osteoarthritis starting with the first line.
Paracetamol.
What is the next step in treatment if paracetamol fails in osteoarthritis?
NSAIDs.
What is the recommended treatment if NSAIDs fail in osteoarthritis?
Opioids.
What is the subsequent step if opioids fail in treating osteoarthritis?
Intraarticular steroid injection.
Do you replace the joint in cases of marked impairment of daily activities due to osteoarthritis?
Yes.
Where should a patient hold the stick when walking with the diseased leg on the ground?
On the opposite side.
Describe the laboratory findings in osteoarthritis.
All labs are normal.
What condition is characterized by an old patient with chronic neck pain and sensory deficit?
Cervical spondylosis.
What are the X-ray findings in cervical spondylosis?
Bony spurs and sclerotic facet joints.
What is the first-line treatment for acute gouty arthritis (podagra)?
NSAIDS
Colchicine
glucocorticoids prednisolone - if above two are contraindicated
What is the most important test in diagnosing acute gouty arthritis?
Synovial fluid analysis (arthrocentesis).
Describe the findings in arthrocentesis for acute gouty arthritis.
WBCs 2000-50000, needle-shaped, negatively birefringent crystals, negative gram stain & culture.
What are the X-ray findings in gout?
Punched out erosions.
What is the main lifestyle modification to prevent gout?
Stop alcohol consumption.
What is the first-line treatment for an acute gout attack excluding patients with renal failure or gastrointestinal bleeding?
Indomethacin.
What is the second-line treatment for an acute gout attack?
Colchicine.
What is the recommended treatment for tophaceous gout?
Allopurinol.
What is the main side effect of colchicine?
Diarrhea.
What is the main side effect of allopurinol?
Rash.
What should be done if an acute gout attack occurs while a patient is on allopurinol?
Administer indomethacin and continue allopurinol.
What is the most common drug causing gout attacks?
Thiazide diuretics.
What is the main indication for long-term medication use in gout?
Renal failure.
What is the starting dose of allopurinol?
50-100 mg.
Describe the side effects of thiazide diuretics.
Hyponatremia, hypokalemia, hyperglycemia (induces diabetes mellitus), hyperuricemia (contraindicated in gout), hypercalcemia (hypocalciuria, prophylaxis against renal stones), hyperlipidemia.
What is the diagnosis for an old patient with hypercalcemia developing acute knee joint pain?
Pseudo-gout.
What are the crystal characteristics in arthrocentesis for pseudo-gout?
Rhomboid-shaped crystals, positive birefringent.
What is the first-line treatment for pseudo-gout?
NSAIDs.
Describe the treatment for a patient with low back pain not radiating to the lower limb and examination showing paravertebral muscle spasm.
Treatment involves analgesics and activity, with no bed rest.
What is the diagnosis for a patient with low back pain radiating to the lower limb and a positive straight leg test on examination?
The diagnosis is a herniated disc.
Define the term ‘Cauda Equina’ in the context of severe radicular lower limb pain, lower motor neuron lesion, and urine and stool incontinence.
Cauda Equina refers to a collection of nerve roots at the lower end of the spinal cord.
How is spinal stenosis diagnosed and treated in a patient with low back pain that worsens with leaning forward and walking uphill?
Diagnosis is done through MRI, and treatment of choice is surgery.
Describe the management approach for a post-menopausal patient with severe localized back pain and tenderness to one vertebra.
Initial investigation involves X-ray, and if no fracture appears, a DEXA scan is recommended.
What is the important laboratory finding in Ankylosing Spondylitis (AS) and how is it managed?
An important finding is a positive HLA-B27 and negative RF. Management includes NSAIDs as first-line, infliximab as second-line, and sulphasalazine as third-line treatment.
Define the term ‘Anterior uveitis’ in the context of Ankylosing Spondylitis (AS).
Anterior uveitis refers to inflammation of the uvea in the front of the eye, commonly associated with AS.
How is acute pancreatitis investigated and treated?
Investigations include amylase and lipase levels, ultrasound, and CT scans. Treatment involves analgesics, intravenous fluids, and NPO (nothing by mouth).
Describe the management of acute cholecystitis in a female patient with severe right upper quadrant pain.
Initial investigation is done through ultrasound to identify stones at the cystic duct. Treatment starts conservatively and may progress to scheduled cholecystectomy.
What are the diseases that can cause pain referred to the back?
Diseases include perforated peptic ulcer, acute pancreatitis, aorta dissection or rupture, acute cholecystitis, renal colic, and pyelonephritis.
Describe the differential diagnosis of shoulder pain.
Differential diagnosis of shoulder pain includes rotator cuff tendonitis, rotator cuff tear, adhesive capsulitis, sub-acromial bursitis.
What is the treatment of choice for rotator cuff tendonitis?
NSAIDs.
Define fibromyalgia.
Fibromyalgia is a condition characterized by generalized musculoskeletal pain, disturbed sleep, and normal lab results.
How is polymyalgia rheumatica (PMR) diagnosed and treated?
Diagnosed by symptoms of pain at shoulder & pelvic girdle with morning stiffness >1h, treated with low-dose steroids. If associated with giant cell arteritis, high-dose steroids are given.
Describe the diagnosis and treatment of polymyositis.
Diagnosed by muscle weakness, elevated CK & aldolase, treated with muscle biopsy and cortisone.
What is the diagnosis and treatment for dermatomyositis?
Diagnosis is muscle weakness, elevated CK & aldolase, heliotrope rash, and gottron papule. Treatment involves cortisone.
Define Sjogren’s syndrome.
Sjogren’s syndrome is a condition characterized by keratoconjunctivitis, difficult swallowing, dyspareunia, and enlarged parotid gland.
What are the important investigations for Sjogren’s syndrome?
Anti-SSA (RO) and anti-SSB (LA) antibodies are crucial. Biopsy of enlarged parotid gland may be needed.
Describe the diagnosis and treatment of polymyalgia rheumatica (PMR) associated with giant cell arteritis.
Diagnosed by symptoms of PMR with high ESR. Treatment involves high-dose steroids and temporal artery biopsy for confirmation.
What is the diagnosis and treatment ) in a young female with rash over face and arthralgia?
Diagnosis is SLE, and
First Ana
Diagnosis - anti D
More accurate anti Smith
treatment involves anti-DNA or anti-Smith antibodies.
Hydroxychloroquine is important for mild joint affection or skin manifestations.
Describe the presentation of a patient with sarcoidosis.
Young female with chronic dry cough, bilateral hilar lymphadenopathy, increased Ca level, and elevated ACE.
What is the treatment of choice for sarcoidosis?
Oral steroids.
What is the immediate management for a patient with suspected septic arthritis?
Immediate joint aspiration.
Define a Baker’s cyst and its potential complication.
Swelling at the back of the knee; if ruptured, can cause severe pain at the calf.
How can septic arthritis be differentiated from other causes of knee swelling?
Immediate aspiration is needed to confirm the diagnosis, with Staph aureus being the most common organism.
Describe the next step in management for an elderly female with rheumatoid arthritis presenting with severe knee pain.
Aspiration to exclude septic arthritis.
What is the most common organism causing septic arthritis?
Staphylococcus aureus.
Describe the presentation of a patient with rheumatoid arthritis.
Joint pain, morning stiffness that improves with activity.
What is the most important investigation before considering surgery for a rheumatoid arthritis patient?
X-ray of the cervical vertebrae to exclude C1-C2 involvement.
Describe the presentation of Felty’s syndrome.
Rheumatoid arthritis, splenomegaly, and neutropenia.
What is the most common cause of death in patients with rheumatoid arthritis?
Cardiovascular disease.
What is the preferred drug for treating rheumatoid arthritis?
Methotrexate.
Describe the characteristics of limited scleroderma (CREST syndrome).
Calcinosis cutis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia, positive Anti-Centromere antibody.
What is the most common cause of death in scleroderma patients?
Pulmonary hypertension.
What is the treatment of choice for renal crisis in scleroderma?
ACE inhibitors.
What test should be performed before initiating azathioprine therapy?
Thiopurine methyltransferase genotype.
Describe the presentation of a patient with scleroderma.
Basal crepitations over the back, colored fingers, some fingers amputated, and difficulty swallowing.
What is the management for avascular necrosis in a patient on high-dose cortisone?
MRI is the imaging modality of choice.
Describe the presentation of a patient with scleroderma in CREST syndrome.
Calcinosis cutis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia, positive Anti-Centromere antibody.
Describe the treatment for Rheumatoid Arthritis.
Methotrexate is usually the first line agent in the management of rheumatoid arthritis but simple analgesia and nonsteroidal anti-inflammatory drugs are also important for symptom control. Rheumatoid arthritis (RA) is a chronic disease with significant cost to both the individual and the community.
https://www.racgp.org.au › …PDF
Rheumatoid arthritis - RACGP
What is the drug of choice for Gout prevention of new attacks?
Allopurinol.
How is Fibromyalgia treated?
Amitriptyline.
Define the drug of choice for Polymyositis.
High dose steroids.
Do you immobilize a Charcot joint?
Yes, the next step is cast and immobilization.
What is the initial treatment for an acute Gout attack?
NSAIDs, Indomethacin.
Describe the treatment for Epidural abscess.
Vancomycin.
What is the management for Cord compression?
Steroids.
How is Spinal stenosis managed?
Weight loss & Steroid injection.
Define the treatment for Temporal Giant cell arteritis.
High dose steroids.
What is the drug of choice for Ankylosing Spondylitis?
NSAIDs.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy and recent studies suggest that regular use among patients with AS slows radiographic progression.
https://www.racgp.org.au › …PDF
Ankylosing spondylitis: an update - RACGP
Describe the treatment for Reactive arthritis (Reiter’s syndrome).
NSAIDs.
Reactive arthritis
Reactive arthritis, although not a form of juvenile idiopathic arthritis, can present in adolescence, and like ERA, has an association with HLA-B27 positivity. The classic triad of arthritis, conjunctivitis and urethritis is not present in all cases. Enteric or genitourinary infections, including sexually transmissible infections (STIs; eg chlamydia), are typical triggers and should be considered in adolescents presenting with arthritis and relevant symptoms on systems review.14 The pattern of arthritis is variable; however, it most commonly involves the lower limbs, and prominent pain and erythema are classically described. Differentiating reactive arthritis from juvenile idiopathic arthritis can be challenging; however, reactive arthritis is generally self‑limited, requiring treatment with NSAIDs only. RACGP
What antibiotics are used in Septic arthritis?
Ceftriaxone & Vancomycin.
How is Polymyalgia Rheumatica treated?
Low dose steroids.
Do you use wrist splint and NSAIDs for Carpal Tunnel syndrome?
Yes.
What is the treatment for SLE (Systemic Lupus Erythematosus)?
High dose steroids.
hydroxychloroquine
Describe the treatment for Psoriatic arthritis.
NSAIDs.
Arthritis Australia
https://arthritisaustralia.com.au › Types of Arthritis
What treatments are there for psoriatic arthritis? · non-steroidal anti-inflammatory drugs (NSAIDs) · disease-modifying anti-rheumatic drugs (DMARDs) · biological …
What is the treatment for Gonococcal arthritis?
Ceftriaxone or cefotaxime.
How is Scleroderma investigation ?
Anti-topoisomerase (Scl 70).
Define the antibodies associated with Wegener’s granulomatosis.
Anti-neutrophil cytoplasmic Antibody (C-ANCA).
What antibodies are linked to Churg-Strauss syndrome?
Anti-myeloperoxidase antibody (P-ANCA).
