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Musculoskeletal KMcG > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Define arthropathy

A

disease of the joint

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2
Q

define arthritis

A

inflammation of the joint

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3
Q

arthralgia

A

pain in the joint

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4
Q

two main categories of arthritis

A

non-inflammatory and inflammatory

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5
Q

what are the subtypes of inflammatory arthritis

A

seropositive, seronegative, infectious and crystal induced

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6
Q

Give an example of a seropositive arthritis (5)

A

rheumatoid, lupus, scleroderma, vasculitis and Sjogrens

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7
Q

give an example of a seronegative arthritis

A

ankylosing spondylitis, psoriatic arthritis, reactive arthritis and IBD arthritis

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8
Q

Anti CCP associated with

A

Rheumatoid arthritis

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9
Q

Anti-nuclear antibody (ANA) associated with

A

SLE, Sjogrens, systemic sclerosis, MCTD, autoimmune liver disease

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10
Q

Anti-double stranded DNA antibody (dsDNA) associated with

A

SLE

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11
Q

Anti Sm associated with

A

SLE

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12
Q

Anti-Ro associated with

A

SLE, Sjogrens syndrome

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13
Q

Anti-centromere antibody

A

systemic sclerosis (limited)

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14
Q

Anti-Scl-70 antibody

A

systemic sclerosis (diffuse)

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15
Q

anti RNP antibody associated with

A

SLE, MCTD

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16
Q

Anti-cardiolipin antibody and lupus anti-coagulant

A

Anti-phospholipid syndrome

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17
Q

Anti-neutrophil cytoplasmic antibody (ANCA)

A

small vessel vasculitis

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18
Q

does osteoarthritis follow Mendelian inheritance

A

No, no pattern observed and no genetic mutation identified

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19
Q

what name is given to osteoarthritis of no known cause

A

primary OA

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20
Q

mnemonic for OA x-ray

A

LOSS = Loss of joint space, Osteophytes, Sclerosis, Subchondral cysts

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21
Q

Typical management of OA

A

Simple analgesia and mild opiates, physiotherapy.

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22
Q

what is the most prevelant seropositive inflammatory arthropathy

A

rheumatoid arthritis

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23
Q

what sex is more likely to develop RA

A

women

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24
Q

In RA the immune response is initiated against what structure

A

the synovium

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25
Q

Lung symptoms of RA

A

pleural effusions, interstitial fibrosis and pulmonary nodules

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26
Q

Ocular involvement of RA

A

keratoconjunctivitis, sicca, episcleritis, uveitis and nodular scleritis

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27
Q

Auto antibody investigations for RA

A

Rheumatoid factor, anti-CCP

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28
Q

are all RA patients seropositive

A

no, 15-20% are seronegative

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29
Q

CRP, ESR and plasma viscosity in RA are usually ..

A

raised

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30
Q

in RA an xray taken at the onset of symptoms will show

A

no joint abnormalities

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31
Q

early features of RA on xray are

A

peri-articular osteopenia

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32
Q

Late stage disease RA will show what on xray?

A

peri-articular erosions

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33
Q

why is ultrasound useful in RA?

A

detecting synovial inflammation , particularly useful if there is clinical uncertainty about RA as a diagnosis

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34
Q

what group of drugs are recommended for RA within 3 months of onset of symptoms

A

DMARDs

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35
Q

short term symptom relief of RA involves:

A

simple analgesics, NSAIDs and intramuscular/intraarticular or oral steroids

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36
Q

first line DMARD for RA

A

methotrexate

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37
Q

other DMARD examples:

A

sulphasalazine, hydroxychloroquine and leflunamide

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38
Q

what are the risks of using DMARDs

A

immunosuppression, risk of infection and bone marrow surpression

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39
Q

If RA does not respond to regular DMARD therapy the patient may be eligible for what therapy next, what is an example?

A

biologic agents, anti-TNF alpha drugs are first line

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40
Q

ankylosing spondylitis effects what joints

A

spine and sacro-iliac joints

41
Q

typical presentation of AS

A

male, 20-40yo, spinal pain, loss of lumbar lordosis and increased thoracic kyphosis

42
Q

describe schobers test

A

testing lumbar spine flexion: measure 10cm above and 5 cm below the posterior superior iliac crests

43
Q

are all AS sufferers HLA-B27 positive

A

no, only 90% are

44
Q

psoriatic arthritis occurs in all people with psoriasis

A

no. it only occurs in 30% of patients with psoriasis

45
Q

treatment of psoriatic arthritis

A

DMARDs (methotrexate), Anti TNF therapy, joint replacement for larger joints

46
Q

Enteropathic arthritis usually effects the

A

peripheral joints, sometimes spine.

47
Q

what is reactive arthritis

A

arthritis is response to an infection in another part of the body, usually 1-3 weeks after infection

48
Q

What is the triad of Reiters syndrome

A

urethritis, uveitis/conjunctivitis and arthritis

49
Q

what would you expect to see from an FBC looking for SLE

A

anaemia, leucopenia and thrombocytopenia

50
Q

what antibody is checked regularly in patients with SLE and why?

A

anti-dsDNA and complement, these vary with disease activity and usually point to disease flares

51
Q

why do we request urinalysis for patients with SLE?

A

to check for presence of blood or protein which may indicated glomerulonephritis

52
Q

what is Sjogrens syndrome

A

an autoimmune condition characterised by lymphocyctic infiltrates in exocrine organs

53
Q

how can we diagnose Sjogrens

A

Schirmers test (ocular dryness), positive anti-RO and anti-La

54
Q

what are the typical characterisitics of systemic sclerosis

A

Raynauds, fibrosis and atrophy of the skin and subcutaneous tissue

55
Q

what are the 3 phases of cutaneous involvement within SSc

A

oesmatous, indurative and atrophic

56
Q

describe major SSc

A

centrally located skin sclerosis that affects the arms, face/neck

57
Q

describe minor SSc

A

included sclerodactyly, atrophy of the fingertips and bilateral lung fibrosis

58
Q

what criteria needs to be met to diagnose a patient with SSc

A

patient must have 1 major and 2 minor features

59
Q

what is limited systemic sclerosis

A

skin involvement is confined to face, hands/feet and forearms, Anti-centromere antibody presence. Organ involvement occurs later

60
Q

what is diffuse systemic sclerosis

A

skin changes develop more rapidly and may involve the trunk, early organ involvement. ANti-Scl-70 antibody involvement

61
Q

how does Anti-phospholipid syndrome manifest clinically

A

recurrent venous/arterial thrombosis and/or foetal loss

62
Q

what is gout caused by

A

deposition of urate crystals within a joint due to high serum uric acid levels

63
Q

where is classic site of gout?

A

first MTP joint (Podagra), ankle and knee

64
Q

how do we diagnose gout?

A

sample synovial fluid with polarised microscopy

65
Q

what is pseudogout

A

like gout but caused by calcium pyrophosphate crystals

66
Q

what is chondrocalcinosis

A

when calcium pyrophosphate deposition occurs in cartilage and other soft tissues without inflammation

67
Q

what is polymyalgia rhematica

A

proximal myalgia of the hip and shoulder girdles with morning stiffness that lasts more than 1 hour

68
Q

giant cell arteritis effects what layer of the blood vessels

A

intima media and adventitia

69
Q

what diagnostic test is used to diagnose GCA

A

temporal artery biopsy

70
Q

what is polymyositis

A

an idiopathic inflammatory myopathy, causes symmetrical, proximal muscle weakness

71
Q

what is dermatomyositis

A

clinically similar to polymyositis but also has cutaneous involvement

72
Q

what cells are involved in polymyositis

A

T-cells, CD8 cells and macrophages

73
Q

investigations into suspected polymyositis

A

inflammatory markers, serum creatine kinase, ANA, Anti-Jo-1 and anti-SRP, MRI scan, EMG, muscle biopsy

74
Q

is dermatomyositis pre-malignant?

A

yes, malignancy should be screened for at the time of diagnosis

75
Q

small/medium vasculitis can be further divided into what two groups

A

ANCA positive and negative conditions

76
Q

what are the types of ANCA positive vasculitis

A

Granulomatosis with polyangitis, microscopic polyangitis, renal limited vasculitis, Churg-strauss syndrome

77
Q

what is Henoch-Schonlein purpura

A

an acute IGA mediated disorder involving generalised vasculitis, common in children. usually presents 3 weeks after an upper RTI and follows with a purpuric rash over the buttocks, limbs. abdominal pain, vomiting and joint pain

78
Q

which sex is RA more common in

A

females

79
Q

which age group is RA most common in

A

30-50yo

80
Q

what is feltys syndrome

A

RA, neutropenia (Low WCC) and splenomegaly

81
Q

is someone who smokes more or less likely to respond to treatment

A

less likely

82
Q

describe the distribution of RA

A

symmetrical polyarthritis

83
Q

patients with OA have an increase in what immunological cells

A

cytokines; IL-1, TNF and metalloproteins, prostaglandins

84
Q

what are the names of the bony enlargements seen at the DIPs

A

Heberdens nodes

85
Q

what are the bony enlargements at the PIPs

A

Bouchards nodes

86
Q

what name is given to a fluid filled cyst in the popliteal fossa

A

Bakers cyst

87
Q

how is OA graded

A

Kellgren-lawrence grading scale

88
Q

what is Milwaukee shoulder

A

Hydroxyapatite

89
Q

how does Milwaukee shoulder happen?

A

Hydroxyapatite crystal deposition in or around the joint

90
Q

are males or females more likely to have AS

A

males

91
Q

clinical findings in AK

A

loss of lumbar lordosis and increased thoracic kyphosis

92
Q

explain the treatment plan of AK

A

physio, NSAIDs and anti-TNFs

93
Q

treatment for psoriatic arthritis

A

DMARDs

94
Q

describe the rash seen in SLE

A

butterfly rash

95
Q

hair symptoms in SLE

A

alopecia

96
Q

hand symptoms in SLE

A

Raynauds

97
Q

microbiology of synovial fluid in gout appearance

A

needle shaped, negative birefringence, change from yellow to blue when lined across the direction of polarisation

98
Q

giant cell arteritis is most commonly associated with

A

polymyalgia rheumatica

99
Q

what condition is a hellotrope rash seen in? describe the rash

A

dermatomyotosis, like a butterfly flash but covers the eyelids

Musculoskeletal KMcG (13 decks)

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