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IPE > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the general assessment method for rheumatological complaints?

A

Gait Arms Legs Spine

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2
Q

What should be examined when a patient with back pain presents?

A

Look at back statically and with AP and lat flexion and extension Push on spine and sacroilliac joints Neuro exam of lower limbs (sensation, reflexes, power) Consider PR for tone Examine nerve root pain (straight leg test) Signs of generalised disease and abdo exam

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3
Q

What investigations could be considered in back pain and why?

A

MRI (prolapse, cord compression, inflammation, tumour) FBC, ESR, CRP (infection, tumour, myeloma) Serum/urine electorphoresis (myeloma) PSA (tumour) U+E and ALP (pagets)

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4
Q

In what different ways can RA present with joint pains?

A

Typical - small joint swelling, stiffness and pain sparing DIP, worse in the morning Sudden onset widespread Palindromic - moving around various joints either polyarthritis or monoarthritis Persistent monoarthritis

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5
Q

What systemic features can be present in RA?

A

Lung and elbow nodules Fatigue Fever Weight loss Pericarditis Pleurisy Lymphadenopathy Fibrosing alveolitis Raynauds Carpel tunnel syndrome Peripheral neuropathy Episcleritis Scleritis Keritoconjuctivits sicca

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6
Q

What are the typical hand deformities of RA? Where else may they occur?

A

Ulnar deviation Boutonnieres Swan neck deformities

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7
Q

What is the eponomous conditions associated with RA?

A

Feltys syndrome - RA + splenomegally + neutropenia Caplans syndrome - RA lung nodules + coal workers pneumoconiosis

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8
Q

What blood tests are used in RA? Which is sensitive and which is specific?

A

RF - 70% sensitivity Anti CCP - 98% specificity

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9
Q

What do xrays show on RA?

A

Loss of joint space Juxta-articular osteopenia Marginal erosions Soft tissue swelling

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10
Q

What scale is used to monitor progress in RA? What is the aim?

A

Disease Activity Score 28 Swelling or tenderness at 28 joints including PIP, MCP, knees, shoulders, elbows and wrists. ESR and patients reported severity as,so considered. Aim is a score of

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11
Q

Acute treatment options for RA

A

NSAIDs Steroids - IM, oral, interarticular

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12
Q

What disease modifying treatments are appropriate for RA?

A

Methotrexate Hydroxychloroquinine Sulfasalazine

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13
Q

When should biological agents be used in RA? Which can be used?

A

Failure to respond to dmards with DAS28 >5.1 1st line - TNFalpha inhibitors - infliximab 2nd line - B cell depletors - rituximab 3rd line - IL1/IL6 inhibition - tocilizumab OR tcell disruptors - acatacept

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14
Q

Side effects of methotrexate

A

Hepatic failure Pneumonitis Oral ulcers

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15
Q

Side effects of sulfasalazine

A

Rash Decreased sperm count Oral ulcers

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16
Q

Side effects of hydroxychloroquinine

A

Irreversible retinopathy with blindness

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17
Q

What other autoimmune condition often occurs secondary to rheumatoid arthritis?

A

Sjogrens syndrome

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18
Q

What is sjogrens syndrome?

A

Autoimmune reaction against glands

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19
Q

Symptoms of sjogrens?

A

Dry eyes (keratoconjunctivitis sicca) Corneal ulceration Dry mouth Dental caries Dry vagina Dry skin Raynauds Arthralgia Fatigue

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20
Q

What test is used for keratoconjunctivitis sicca?

A

Schirmers tear test

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21
Q

What autoantibodies are raised in sjogrens?

A

ANA Anti ro Anti la

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22
Q

Treatment options for sjogrens?

A

Artificial tears Saliva replacement Hydroxychloroquinine for arthralgia or fatigue Corticosteroids for severe exacerbations

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23
Q

What is antiphospholipid syndrome?

A

Autoantibodies against phospholipids on apoptotic bodies

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24
Q

Signs and symptoms of antiphospholipid syndrome

A

Arterial and venous thrombi Recurrent miscarriage

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25
Q

Positive blood tests in antiphospholipid syndrome

A

Lupus anticoagulant test persistantly positive

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26
Q

Treatment options for antiphospholipid syndrome

A

If thrombus formation warfarin When pregnant aspirin and sc heparin

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27
Q

Signs and symptoms of fibromyalgia

A

Constant pain above and below waist Aching Tender trigger points Fatigue Depression Sleep disturbance Associated IBS Headaches

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28
Q

Treatment of fibromyalgia

A

Reassurance Exercise Depression treatment Pain relief

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29
Q

Good pain relief meds in fibromyalgia

A

Amitriptyline Gabapentin Nsaids

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30
Q

What is the pathological mechanism of gout?

A

Hyperuricaemia leads to intra articular sodium urate crystals in cartilage. Stress (dehydration, surgery, alcohol) triggers shedding of crystals into joint resulting in inflammation,

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31
Q

Broad categories of causes of hyperuracemia. Which is a more common cause of gout?

A

Impaired excretion (90%) Increased production

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32
Q

Causes of impaired excretion of uric acid causing hyperuricaemia and gout

A

CKD Thiazides Aspirin Lead toxicity Htn Dehydration

33
Q

Causes of hyperuricaemia due to increased urate produciton

A

High protein diet Age Lactic acid (alcohol, exercise) Obesity Cell turnover (polycythaemia vera, leukaemia, tumour lysis, psoriasis)

34
Q

Acute presentation of gout? Commonly effected joints?

A

Monoarthropaty, sudden agonising pain swelling and redness Usually lasting one week 1st MTPJ, ankle, wrist, finger, knee

35
Q

Chronic presentation of gout

A

Tophi Chronic joint pain Kidney stones

36
Q

Investigations in gout

A

Xray Serum urate Joint fluid asperation

37
Q

What are tophi?

A

In gout Smooth red tender lumps filled with white fluid Found on joints, ears and achilles tendon

38
Q

Treatment of acute gout attack

A

NSAIDs Colchicine Intraarticular corticosteroids

39
Q

Big side effect of colchincine

A

Diarrheoa

40
Q

Chronic treatment of gout

A

Dietary advice (decrease alcohol, cholesterol and spinach) Allopurinol if >3 attacks per year, tophi or renal calculi

41
Q

Mechanism of allopurinol? What should be considered?

A

Blocks xanthine oxidase May induce acute attack so cover with colchicine

42
Q

Risk factors for septic arthrits

A

Pre existing joint disease Diabetes Immunocompramised Joint replacement Ivdu

43
Q

Typical organisms for septic arthritis

A

Staph aureus Neisseria gonorrheoa

44
Q

Presentation of septic arthritis

A

Single joint Acute swelling redness and pain Systemic symptoms in about 50%

45
Q

Tests in septic arthritis?

A

Aspiration with ms and c Fbc Blood cultures

46
Q

Treatment of septic arthritis

A

Iv abx

47
Q

Definition of chronic kidney disease”

A

Impaired renal function for more than three months based on abnormal structure or function OR GFR

48
Q

Stages of CKD

A

1 - normal gfr, evidence of damage 2 - gfr 60-89, evidence of damage 3 - gfr 30-59 with or without damage 4 - gfr 15-29 with of without damage 5 - gfr

49
Q

What is renal failure?

A

GFR

50
Q

What is evidence of damage when assessing ckd?

A

Proteinuria Haematuria Abnormal anatomy Systemic disease

51
Q

Causes of CKD

A

DM HTN Idiopathic Glomerulonephritis Pyleonephritis Adult polycystic kidney disease Renovascualr disease

52
Q

What should be tested on a patient with suspected ckd?

A

Dipstick for urine Diabetes Htn Cvd Recurrent UTI For multi system disorders For structural disease

53
Q

What element of history is important in a patient with a chronic kidney disease?

A

FHx

54
Q

What symptoms may a ckd patient present with?

A

Uremia Ankle swelling Dysponea Oligourea Amenorrhea and impotance

55
Q

Signs of ckd

A

Htn Fluid overload Purporia Ballotable kidney

56
Q

Signs and symptoms of uremia

A

Anorexia Pruritus Uremic frost Vomiting Restless leg Fatigue Yellow tinged skin Pericarditis

57
Q

Blood tests to run in a ckd patient

A

Glucose Fbc - anaemia U+es

58
Q

What would a kidney with ckd usually look like on uss? What may cause them to be the opposite?

A

Usually small Infiltrative disorders like amyloidosis or myleoma

59
Q

What tests should be done on urine with ckd?

A

Dipstick, ms and c, acr / pcr

60
Q

When should a ckd patient have a biopsy?

A

Rapidly progressive or unclear cause in a large kidney

61
Q

Complications of ckd

A

Cvd Anaemia Acidosis Bone mineral disorders Non bone calcifications Secondary and tertiary hyperparathyroidism

62
Q

What bone mineral disorders occur with ckd?

A

Low calcium Osteomalacia Osteitis fibrosa cystica

63
Q

What is osteitis fibrosis cystica

A

Low vit d so high pth so low calcium so bone reabsorption and cyst formation (2ndry hyperparathyroidism complication)

64
Q

Treatment options in ckd?

A

Treat reversible cause Limit progression Symptom control Renal replacement therapy

65
Q

How may reversible causes be treated in ckd?

A

Stop nephrotoxic drugs Control dm Relieve obstruction

66
Q

How can ckd progression be slowed?

A

Lower bp Treat proteinuria with acei Prevent renal bone disease with calicum supplementation and vit d analoges Modify cvd risk with aspirin and statins

67
Q

What treatment options are available for ckd anaemia?

A

Iron, b12 folate Epo

68
Q

What treatment options are available for ckd oedema ?

A

Frusemide Fluid reatriction

69
Q

When should renal replacement therapy be considered?

A

Symptomatic (pericaridits, encephalopathy, volume overload) Biochemical disturbance (acidosis, hyperkalaemia)

70
Q

Why should preparation occur for rrt in ckd? When?

A

Mrtality higher if not preplanned When egfr

71
Q

Types of rrt in ckd

A

Haemodialysis Haemofiltration Peritoneal dialysis Transplantation

72
Q

Different between haemodialysis and haemofiltration

A

Heamodialysis - diffusion over semi permiable membrane Haemofiltration - pressure driven

73
Q

Benefits of haemodialysis

A

Days off Low reposibility See others

74
Q

Problems with haemodialysis

A

Hypotension, Time consuming Many meds Fistual issues

75
Q

Benefits of peritoneal dialysis

A

Perform overnight Perform at home Better initial preservation of kidneys Less fluid and food restrictions

76
Q

Problems with peritoneal dialysis

A

Peritonitis Adhesions Infections Eventually degraeds Leaks into scrotum Herniation

77
Q

Benefit of haemofiltration

A

Fluids replaced so more haemo dynamically stable thus good on itu

78
Q

Problems with kidney transplantation

A

Immunosupression Rejection Surgical problems

IPE (17 decks)

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