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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
Q

what is polyarteritis nodosa

A

necrotising vasculitis causing aneurysm and thrombosis in medium seized arteries causing end organ infarction

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26
Q

what does Lachman’s test test for

A

ACL pathology

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27
Q

function of PTH

A
  • 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
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28
Q

how do urate crystals cause inflammation

A

ingested by phagocytes –> opsonized –> activation of the innate immune system by TOL-R –> inflammasome –> neutrophilic inflammation

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29
Q

action of bisphosphonates

A

inhibit OC recruitment and differentiation

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30
Q

treatment of acute gout

A

NSAIDs - high doses for 3-4 days, and then wean for 6 weeks (colchicine if NSAIDs contraindicated) (steroids if NSAIDs contraindicated)

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31
Q

overall effect of calcitonin

A

decreases plasma calcium

32
Q

overall effect of PTH

A

increases plasma calcium and decreases plasma phosphate

33
Q

diagnosis of giant cell arteritis

A
  • ESR >100 mm/hour
  • biopsy of temporal artery
34
Q

which CTD is associated with pancytopaenia

A

SLE

35
Q

explain the local inspection for a hand examination

A

Alignment

bony deformity

colour

disuse/wasting

evidence of scars/nodules/swelling

fingernail changes

36
Q

where is bone mineral density measured for the hip

A

femoral neck total hip - best predictor

trochanteric Wards triangle

37
Q

what is polymyositis

A

inflammation of the skeletal muscle

38
Q

what is kawasaki disease

A

childhood variant of polyarteritis nodosa

39
Q

major side effect of allopurinol

A

T1 HS SJS (can be fatal)

40
Q

what are some features of a patients Raynauds that would suggest underlying CTD

A

asymmetrical

new onset

fingertip ulceration

abnormal nail fold capillaries

ANA positive

41
Q

Treatment of vasculitis

A

remove the cause (if you can)

high dose steroids and cytotoxic drugs

42
Q

explain the power tests for the hand examination

A

grip strength (around two fingers)

pinch grip

43
Q

explain the clinical presentation of osteoporosis

A

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
Q

what are the medium vessel vasculitides

A

Polyarteritis nodosa

Kawasaki’s

45
Q

what does the straight leg test show

A

confirms possible sciatica –> reproduction of symptoms when raising the legs

46
Q

explain the movements you need to do when testing ROM for the hand examination

A

make fist

oppose thumb and fingers

extend and flex wrist

pronate and supinate hand

47
Q

typical pattern of involvement of the joints in RA

A

MCP, PIP, wrist involvement symmetrical nodules

48
Q

treatment of giant cell arteritis

A

prednisolone for 4 weeks and then taper according to ESR/Sx

provide fracture prevention therapy

49
Q

typical gonococcal arthritis presentation

A

migratory polyarticular arthritis

upper limbs>lower limbs

50
Q

which CTDs are associated with thrombo-embolic phenomena

A

SLE

vasculitis

51
Q

what does McMurrays test test for

A

tear in the meniscus of the knee joint

52
Q

what does tredelenbergs test test for

A

pathology of the ilio-tibial tract –> will show pelvis tilt on opposite side

53
Q

what is the urate conc where physiological saturation occurs

A

more than 0.4mmol/L

54
Q

what are the effects of inadequate Vitamin D levels

A

decreased calcium absorption from the intestines:

  • secondary hyperparathyroidism
  • increased bone turnover
  • decreased BMD
  • increased risk of fracture
  • decreased neuromuscular function
55
Q

what is Takayasu’s arteritis

A

granulomatous inflammation of the aorta and major branches causing stenosis, thrombosis and aneurysms

56
Q

most common cause of bone and joint infection

A

staph aureus (followed by strep pyogenes)

57
Q

what are the special tests for the knee

A

Lachman’s test

McMurrays test

58
Q

what are the dermatological signs of polymyositis/dermatomyositis

A

heliotrope, peri-orbital oedema, shawl sign, cuticle overgrowth, mechanics hands, Gottrons sign

59
Q

key antibody for rheumatoid arthritis

A

Anti-CCP

60
Q

what is the major predictor for serum urate levels

A

renal clearance of uric acid

61
Q

which features of gout make it virtually indistinguishable from septic arthritis

A

pain, fever, high ESR, leukocytosis, redness, swelling that extends past joint

62
Q

function of RANK-L and osteoprotegrin

A

RANK-L - stimulates osteoclasts to break down bone

osteoprotegin - decoy receptor produced by OB that prevent RANK-L from binding –> pro bone making

63
Q

which drug interaction do you have to be extra careful with when prescribing allopurinol

A

azathioprine - metabolized by xanthine oxidase

64
Q

What are sicca symptoms

A

excessively dry eyes and dry mouth

65
Q

What is the typical pattern of psoriatic arthritis

A

DIP joint

asymmetrical

joint involvement often involves iliosacral joints

may have dactylitis (sausage digit)

66
Q

potential side effects of long term bisphosphonate use

A

Osteonecrosis of the jaw

atypical femoral shaft fracture

67
Q

how do you diagnose gout

A

aspiration of fluid –> urate crystals within neutrophils

68
Q

What does Schober’s test show

A

ROM of flexion of the lumbar spine

69
Q

what are the 3 organs and 2 hormones that regulate Calcium homeostasis

A

organs - gut, lungs, kidney

hormones - Parathyroid hormone, Vitamin D3

70
Q

which endocrine problem is associated with Raynauds

A

hypothyroidism

71
Q

what is Charcot joint

A

neuropathy leads to loss of protective mechanisms of the joint –> extreme traumatic damage

72
Q

acute gout is often triggered by

A

acute fluctuations (either up or down) of serum urate concentration

73
Q

what is the difference between a T score and a Z score for BMD

A

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
Q

action of denusomab

A

monoclonal Ab against RANK-L –> stops activation of OC

75
Q

what is scleroderma

A

multi system connective tissue disease characterised by asymmetrical Raynauds and sclerodactyly

76
Q

which group of patients with psoriasis are more likely to have joint involvement

A

those with nail changes

Z MD 2 (15 decks)

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