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13-19-18-1 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the XR finds of OA?

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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2
Q

What is the criteria for a clinical diagnosis of OA?

A

> 45 years old
Pain w/ activity
No AM stiffness

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3
Q

What is the 1st line Tx for OA?

A

Topical NSAIDs

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4
Q

What conservative management options are available in OA?

A

Education, OT/PT, Weight loss
NSAIDs
Paracetamol (short term)
IA Steroid (<10 weeks)

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5
Q

What are the key diagnostic criteria for RA?

A

Arthralgia >6 weeks
AM stiffness
Joint swelling

Swan-neck (DIP hyperflex, PIP hyperext.)
Boutonniere’s (DIP hyperext, PIP hyperflex.)
Rheumatoid nodules

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6
Q

What metric for grading RA severity can be used?

A

DAS

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7
Q

What investigations may be useful in ?RA?

A

RF (60%)
Anti-CCP (70%)
XR
US

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8
Q

What is the gold-standard investigation for RA?

A

Anti-CCP (positive even when RF is negative)

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9
Q

What is the standard treatment for RA?

A

DMARDs

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10
Q

What is the standard treatment for RA if pregnant?

A

Corticosteroids

Sulfasalazine and Hydroxychloroquine safe in pregnancy

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11
Q

What blood tests should be done when starting starting DMARDs?

A

TPMT activity
HepB Hep C
FBC
LFTs

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12
Q

What supplementation should be given when commencing DMARDs

A

Folic acid

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13
Q

What pre-operative imaging may be warranted in a patient with RA and why?

A

MRI to rule out risk of atlantoaxial subluxation of the cervical spine - damage to ligaments around odontoid peg of axis (C2) thus shifting within the atlas (C1)

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14
Q

The combination of RA, low neutrophils and an enlarged spleen is termed?

A

Felty’s syndrome
= RA + Neutropenia + Splenomegaly)

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15
Q

What are the side effects of MTX?

A

Mouth ulcers/mucositis
Liver toxicity
BM suppression and leukopenia
Teratogenic

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16
Q

What are the potential side effects of sulfasalazine?

A

Orange urine
BM suppression
Male infertility

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17
Q

What are the potential side effects of hydroxychloroquine?

A

Retinal toxicity
Blue-grey skin pigmentation
Hair bleaching

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18
Q

What are the features of psoriatic arthritis?

A

Onycholysis
Dactylitis
Skin plaques
Enthesitis
Arthritis

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19
Q

What are some of the radiological findings of Psoriatic arthritis?

A

Erosions
Periostitis
Osteolysis
Ankylosis
Dactylitis

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20
Q

What are the treatment options for Psoriatic arthritis?

A

DMARD / NSAID / IA Steroid

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21
Q

What genetic link does reactive arthritis have?

A

HLA B27

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22
Q

What are the associations of reactive arthritis?

A

Arthritis
Bilateral conjunctivitis/uveitis
Urethritis

‘Can’t see, pee or climb a tree’

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23
Q

How do you manage a reactive arthritis?

A

Tx cause + NSAID

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24
Q

What gene is strongly linked to Ankylosing spondylitis?

A

HLA B27

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25
Q

What are the associated conditions with Ankylosing spondylitis?

A

Anterior uveitis
AV block
Aortic regurgitation
Apical lung fibrosis
Anaemia of chronic disease

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26
Q

What Ab markers are suggestive of SLE?

A

ANA
dsDNA **

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27
Q

What rash is characteristic of SLE?

A

Malar ‘butterfly’ rash

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28
Q

What examination should be conducted prior to commencing Hydroxychloroquine?

A

Eye - risk of retinitis

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29
Q

What is the characteristic feature of discoid erythematous lupus?

A

Photosensitive plaques

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30
Q

What are the treatment options for discoid erythematous lupus?

A

Topical/intralesional steroids

Hydroxychloroquine

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31
Q

What are the features of Limited systemic sclerosis?

A

CREST

32
Q

What are the autoantibodies implicated in systemic sclerosis?

A

Limited = anti-centromere

Diffuse = anti-Scl70

33
Q

What blood test is suggestive of PMR?

A

Raised ESR

34
Q

What is the management of PMR?

A

Oral steroids - Prednisolone 15mg/day
FU in 1 week

35
Q

When do you FU in a suspected PMR diagnosis and why?

A

1 week - usually a quick response to steroids.
If not, consider another diagnosis

36
Q

What is the primary method of diagnosing GCA?

A

Clinical

37
Q

What is the gold standard for a definitive diagnosis of GCA?

A

Temporal artery biopsy

38
Q

What is the management of GCA?

A

Steroids

If visual symptoms, Urgent Ophthalmology review and IV Steroids

39
Q

What are the key features of Polymyositis/Dermatomyositis?

A

Heliotrope rash
Gottron’s papules
Proximal muscle weakness
Periorbital oedema

40
Q

What are the autoantibodies associated with polymyositis/dermatomyositis?

A

Anti-Jo1

41
Q

What is the autoantibody for Antiphospholipid syndrome?

A

Anti-cardiolipin
Lupus anticoagulant

42
Q

What is the management of antiphospholipid syndrome?

A

Life-long warfarin or LMWH

43
Q

What is the management of antiphospholipid syndrome in pregnancy?

A

LMWH

Warfarin is teratogenic

44
Q

Which autoantibodies are suggestive of Sjogren’s syndrome?

A

Anti-Ro and Anti-La

45
Q

What malignancy is Sjogren’s linked to?

A

NHL

46
Q

What are the clinical features of Sjogren’s syndrome?

A

Sicca symptoms
Dry eyes
Dry mouth
Dry mucous membranesWh

47
Q

What are the autoantibodies present in Sjogren’s syndrome?

A

Anti-Ro
Anti-La

48
Q

Which gene is linked to Behcet’s disease?

A

HLA B51

49
Q

What is the management of EDS?

A

Supportive

50
Q

What is the inheritance of EDS?

A

Autosomal dominant

51
Q

How may vasculitis be categorised?

A

Vessel size
ANCA positive

52
Q

Wegener’s granulomatosis is which type of ANCA positive vasculitis?

What are its features?

A

cANCA

Lung and renal

53
Q

Churg-Strauss is which type of ANCA positive vasculitis?

What are its features?

A

pANCA
Raised eosinophils

Late-onset asthma
Rhinosinusitis

54
Q

Positive birefringence under polarised light is suggestive of which crystal arthropathy?

A

Pseudogout

55
Q

What XR findings may be suggestive of Pseudogout?

A

Chondrocalcinosis

56
Q

Which joints are commonly affected in gout?

A

MTP
CMC
Wrist

57
Q

What would show negatively birefringence of polarised

A

Gout

58
Q

What would monosodium urate crystals upon knee aspiration suggest?

A

Gout

59
Q

What is the Management steps for Gout?

A

NSAIDs + PPI
Then Colchicine

60
Q

If initiating allopurinol, what should you wait for?

A

Acute flare to resolve

61
Q

What is the primary side effect of Colchicine?

A

Abdominal Sx
Diarrhoea

62
Q

How does allopurinol work?

A

Inhibits xanthine oxidase thus lowers uric acid level

63
Q

How does T score vary from Z score?

A

T score is SD from young, healthy adults

Z score is SD from average for their age, sex and ethnicity

64
Q

What tool can be used to calculate 10-year risk of OP fracture?

A

QFracture

FRAX

65
Q

Which two groups of people do not need a DEXA prior to commencing Tx?

A

> 50 y/o and Fragility Fx

Vertebral Fx

66
Q

What is the primary therapeutic treatment of Osteoporosis?

A

Bisphosphonates

Calcium
Vitamin D

67
Q

What are the common side effects of Bisphosphonates?

A

GORD
Atypical Fx
ONJ
Osteonecrosis of external auditory canal

68
Q

How should you take oral bisphosphonates?

A

Empty stomach, glass of water, sit up for 30 minutes

69
Q

What is the order of treatment in OP?

A

Bisphosphonate

Change Bisphosphonate (strontium)

Denosumab/Teriparatide/Raloxifene

70
Q

What risks are increased with strontium ranelate?

A

VTE
MI

71
Q

When should treatment be re-assessed once stable on Bisphosphonates?

A

3-5 years, stop if T-score is more than -2.5

Repeat DEXA

72
Q

What may be seen on XR in Osteomalacia?

A

Incomplete fractures called Looser Zones

73
Q

What are the derangements observed in Osteomalacia?

A

(low Vitamin D)
Low Ca2+
Low Pi
High PTH
High ALP

74
Q

What is Paget’s disease of the bone?

A

Excessive bone turnover with osteoclast vs osteoblast activity - poorly coordinated

75
Q

What biochemical marker is deranged in Paget’s disease of bone?

A

ALP

76
Q

What XR findings may be identified in Paget’s disease of the bone?

A

Osteolytic defects
Bone enlargement (sclerosis)

13-19-18-1 (6 decks)

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