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Z MD 2 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

which drugs are classically associated with Raynauds

A

B-blockers

ergotamine

Bleomycin

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2
Q

What is osteoporosis

A

disease of low bone mineral density and microarchitectural deterioration of bone leading to fragility fractures

  • T score >-2.5
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3
Q

special tests for back pain

A

Scober’s test

Straight leg Raising test

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4
Q

what is rotator cuff tendonitis

A

inflammation of the tendons of the rotator cuff

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5
Q

what is Wegner’s vasculitis

A

granulomatosis with polynagitis (small vessel vasculitis) - granulomatous inflammation of the vessels of the respiratory tract and kidneys

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6
Q

Xray changes seen in OA joint

A

(LOSS)

Loss of joint space - uneven cartilage degeneration

osteophytes

subchondral sclerosis

subchondral cysts

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7
Q

what are the seronegative spondyloarthopathies

A

ankylosing spondyloarthritis

reiter syndrome

enteritis-associated arthritis

psoriatic arthritis

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8
Q

Xray changes seen in RA joint

A

soft tissue swelling

junxtra-articular osteoporosis

symmetrical joint space narrowing

erosion of the bone

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9
Q

what skin rash is associated with vasculitis

A

livedo reticularis

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10
Q

mainstay longterm treatment for gout

A

allopurinol - titrate dose to get serum urate conc less than 0.4mmol/L, aim for less than 0.3mmol/L

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11
Q

how long is the corticosteroid treatment of giant cell arteritis

A

1-2 years - depending on the Sx and acute phase reactants

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12
Q

what is the difference (scores) between osteopaenia and osteoporosis

A

Osteopaenia - T score between -1 and -2.5

osteoporosis - T score greater than -2.5

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13
Q

presentation of giant cell arteritis

A
  • age at onset >50
  • new onset headache - often temporal
  • tenderness overy the scalp
  • jaw/tongue claudication
  • sudden painless loss of vision and/or diplopia
  • polymyalgia rheumatica
  • aortic arch syndrome
  • weight loss
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14
Q

what is the first line drug therapy for osteoporosis

A

bisphosphonates

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15
Q

where is bone mineral density measured for the spine

A

L1-4 or L2-4

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16
Q

what are the large vessel vasculitides

A

giant cell arteritis

Takayasu’s arteritis

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17
Q

how do you diagnose polymyositis

A

muscle biopsy! CK level very high

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18
Q

what other pharmacological treatments are there for osteoporosis other than bisphosphonates

A

SERMS

RANKL inhibitors

PTH (intermittent)

Calcium supplement

Vit D supplement

HRT

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19
Q

special tests for hip exam

A

Tredelenbergs

Thomas test

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20
Q

what does the thomas test test for

A

fixed flexion hip deformity - opposite leg will raise on flexion of the hip

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21
Q

if one leg is shorter than the other, what does it suggest

A

neck of femur fracture –> external rotation

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22
Q

What are the nodes associated with osteoarthritis called

A

Heberdens noes = DIP

Bouchards nodes = PIP

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23
Q

signs associated with sciatica

A

reduced tone

reduced reflexes

reduced strength

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24
Q

which joints of the hand are typically involved in OA

A

PIP, DIP, MCP (especially base of thumb)

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25
what is polyarteritis nodosa
necrotising vasculitis causing aneurysm and thrombosis in medium seized arteries causing end organ infarction
26
what does Lachman's test test for
ACL pathology
27
function of PTH
- increases bone resorption --\> increased Ca and P in the blood - increases kidney Ca reabsorption and P excretion - increased kidney conversion of VitD2--\>D3 --\> increased Ca absorption
28
how do urate crystals cause inflammation
ingested by phagocytes --\> opsonized --\> activation of the innate immune system by TOL-R --\> inflammasome --\> neutrophilic inflammation
29
action of bisphosphonates
inhibit OC recruitment and differentiation
30
treatment of acute gout
NSAIDs - high doses for 3-4 days, and then wean for 6 weeks (colchicine if NSAIDs contraindicated) (steroids if NSAIDs contraindicated)
31
overall effect of calcitonin
decreases plasma calcium
32
overall effect of PTH
increases plasma calcium and decreases plasma phosphate
33
diagnosis of giant cell arteritis
- ESR \>100 mm/hour - biopsy of temporal artery
34
which CTD is associated with pancytopaenia
SLE
35
explain the local inspection for a hand examination
Alignment bony deformity colour disuse/wasting evidence of scars/nodules/swelling fingernail changes
36
where is bone mineral density measured for the hip
femoral neck total hip - best predictor trochanteric Wards triangle
37
what is polymyositis
inflammation of the skeletal muscle
38
what is kawasaki disease
childhood variant of polyarteritis nodosa
39
major side effect of allopurinol
T1 HS SJS (can be fatal)
40
what are some features of a patients Raynauds that would suggest underlying CTD
asymmetrical new onset fingertip ulceration abnormal nail fold capillaries ANA positive
41
Treatment of vasculitis
remove the cause (if you can) high dose steroids and cytotoxic drugs
42
explain the power tests for the hand examination
grip strength (around two fingers) pinch grip
43
explain the clinical presentation of osteoporosis
commonly asymptomatic height loss fractures - most commonly hip, vertebrae, humerus and wrist (fragility fractures) dowager hump - collapse fracture of vertebral bodies pain - especially backache
44
what are the medium vessel vasculitides
Polyarteritis nodosa Kawasaki's
45
what does the straight leg test show
confirms possible sciatica --\> reproduction of symptoms when raising the legs
46
explain the movements you need to do when testing ROM for the hand examination
make fist oppose thumb and fingers extend and flex wrist pronate and supinate hand
47
typical pattern of involvement of the joints in RA
MCP, PIP, wrist involvement symmetrical nodules
48
treatment of giant cell arteritis
prednisolone for 4 weeks and then taper according to ESR/Sx provide fracture prevention therapy
49
typical gonococcal arthritis presentation
migratory polyarticular arthritis upper limbs\>lower limbs
50
which CTDs are associated with thrombo-embolic phenomena
SLE vasculitis
51
what does McMurrays test test for
tear in the meniscus of the knee joint
52
what does tredelenbergs test test for
pathology of the ilio-tibial tract --\> will show pelvis tilt on opposite side
53
what is the urate conc where physiological saturation occurs
more than 0.4mmol/L
54
what are the effects of inadequate Vitamin D levels
decreased calcium absorption from the intestines: - secondary hyperparathyroidism - increased bone turnover - decreased BMD - increased risk of fracture - decreased neuromuscular function
55
what is Takayasu's arteritis
granulomatous inflammation of the aorta and major branches causing stenosis, thrombosis and aneurysms
56
most common cause of bone and joint infection
staph aureus (followed by strep pyogenes)
57
what are the special tests for the knee
Lachman's test McMurrays test
58
what are the dermatological signs of polymyositis/dermatomyositis
heliotrope, peri-orbital oedema, shawl sign, cuticle overgrowth, mechanics hands, Gottrons sign
59
key antibody for rheumatoid arthritis
Anti-CCP
60
what is the major predictor for serum urate levels
renal clearance of uric acid
61
which features of gout make it virtually indistinguishable from septic arthritis
pain, fever, high ESR, leukocytosis, redness, swelling that extends past joint
62
function of RANK-L and osteoprotegrin
RANK-L - stimulates osteoclasts to break down bone osteoprotegin - decoy receptor produced by OB that prevent RANK-L from binding --\> pro bone making
63
which drug interaction do you have to be extra careful with when prescribing allopurinol
azathioprine - metabolized by xanthine oxidase
64
What are sicca symptoms
excessively dry eyes and dry mouth
65
What is the typical pattern of psoriatic arthritis
DIP joint asymmetrical joint involvement often involves iliosacral joints may have dactylitis (sausage digit)
66
potential side effects of long term bisphosphonate use
Osteonecrosis of the jaw atypical femoral shaft fracture
67
how do you diagnose gout
aspiration of fluid --\> urate crystals within neutrophils
68
What does Schober's test show
ROM of flexion of the lumbar spine
69
what are the 3 organs and 2 hormones that regulate Calcium homeostasis
organs - gut, lungs, kidney hormones - Parathyroid hormone, Vitamin D3
70
which endocrine problem is associated with Raynauds
hypothyroidism
71
what is Charcot joint
neuropathy leads to loss of protective mechanisms of the joint --\> extreme traumatic damage
72
acute gout is often triggered by
acute fluctuations (either up or down) of serum urate concentration
73
what is the difference between a T score and a Z score for BMD
T score - the number of SDs of the patients BMD away from the mean of the young normal mean Z score - the number of SDs of the patients BMD away from the mean in an aged matched population
74
action of denusomab
monoclonal Ab against RANK-L --\> stops activation of OC
75
what is scleroderma
multi system connective tissue disease characterised by asymmetrical Raynauds and sclerodactyly
76
which group of patients with psoriasis are more likely to have joint involvement
those with nail changes

Z MD 2 (15 decks)

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