Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPE > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Describe the signs/symptoms in the joints of rheumatoid arthritis

A
  • Swollen, painful, stiff joints
    • Small joints of hand, wrist, feet and cervical spine
    • Symmetrical
    • Worse in the morning or after prolonged inactivity
  • Digital ulnar deviation
  • Dorsal wrist subluxation (radial)
  • Loss of knuckle guttering
  • Finger deformities
    • Swan neck (PIPJ extention, DIPJ flexion)
    • Boutonniere (PIPJ flexion, DIPJ extension)
    • Z deformity of thumb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name some extra-articular signs of rheumatoid arthritis

A
  • Skin - rheumatoid nodules, vasculitis, Raynauds
  • Lungs - fibrosis, pleural effusion, nodules
  • Kidneys - amyloid, immune-complexes
  • Liver - hepatomegaly
  • Blood - normocytic anaemia, neutropenia
  • Neuro - peripheral neuropathy
  • Atherosclerosis
  • Eyes - episcleritis/scleritis, dryness
  • Carpal tunnel syndrome
  • Osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the diagnostic criteria of RA

A

At least 4 criteria for 6 weeks:

  • Morning stiffness > 1 hour
  • Involvement of hand joints
  • Arthritis >/= 3 joints
  • Symmetrical arthritis
  • Rheumatoid nodules
  • Serum rheumatoid factor
  • X-ray changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name some investigations into RA

A
  • Bloods - inc ESR/CRP, dec Hb, dec WCC, inc platelets, inc LFTs (ALP), dec albumin
  • Rheumatoid factor (70%)
  • Anti-CCP antibody (95%)
  • X-ray
    • Soft tissue swelling
    • Loss of joint space
    • Erosions
    • Subluxation
    • Carpal destruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is RA managed?

A
  • Regular exercise
  • Physiotherapy
  • Wrist splints
  • NSAIDs (ibuprofen 400mg/8hr) + PPI
  • Steroid injection
  • Glucocorticoids for acute flare ups (prednisolone 7.5mg/d)
  • DMARDs ASAP (methotrexate)
  • Anti-TNF (infliximab)
  • Surgery - joint replacement, tenosynovectomy, carpal tunnel decompression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name the common DMARDs, their mechanism of action and their side effects

A
  • Hydroxychloroquine - eye exam (ocular toxicity)
  • Methotrexate/anti-tnf - CXR (pulmonary fibrosis)
  • Ciclosporin/mycophenolate - urinanalysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What advice should be given when prescribing NSAIDs?

A
  • Not to asthmatics, peptic ulcer
  • For relief of symptoms only - not needed all the time
  • Side effects - GI bleeding, headaches/dizziness, hypertension, fluid retention allergic reaction, constipation, diarrhoea
  • Stop taking if experiencing abdo pain or black stools and report to doctor
  • Don’t supplement with other NSAIDs over the counter
  • Smoking and alcohol increase side effect risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the Disease Activity Score?

A

DAS28: A tool used to measure the activity or control of RA. Questions include:

  • Number of swollen joints (/28)
  • Number of tender joints (/28)
  • ESR/CRP value
  • Patient global health score (/10)

Number between 0-10 based on severity of disease activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the signs/symptoms of psoriatic arthritis

A
  • Asymmetrical oligoarthritis (inflammation affecting 1-4 joints during 1st 6 months)
    • Mainly DIPs
    • Pain, swelling, stiffness, redness, warmth
  • Dactylitis (sausage finger)
  • Nail pitting / oncholysis (nail separation)
  • Enthesitis (inflammation of tendon insertion)
  • Spondylitis (back)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the x-ray features of psoriatic arthritis

A
  • Asymmetrical
  • Osteolysis (pencil in a cup appearance)
  • Proliferative erosions
  • Periosteal reaction
  • DIP disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is psoriatic arthritis investigated?

A
  • Bloods - U+Es, LFTs
    • NO rheumatoid factor
  • Hands and feet x-ray
  • US/MRI of achilles tendon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is psoriatic arthritis treated?

A
  • Physiotherapy
  • Refer to dermatology for psoriasis
  • NSAIDs
  • DMARDs - methotrexate, leflunomide, ciclosporin, azathioprine
  • Anti-TNF (infliximab)
  • Intra-articular steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is reactive arthritis?

A

A sterile inflammatory arthritis precipitated by a distant infection (HLA-B27 associated)

  • Urethritis
  • Acute diarrhoea
  • Chlamydia trachomatis
  • Campylobacter
  • Shigella
  • Salmonella
  • Rubella
  • HIV
  • Hep B/C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name some signs/symptoms of reactive arthritis

A
  • Reiter’s syndrome = arthropathy (knee, SI joint), conjunctivitis + urethritis/cervicitis
    • ‘Can’t wee, can’t see, can’t climb up a tree’
  • GI - ileitis/colitis
  • Mucocutaenous - oral ulcers, keratoderma blenorrhagium (small hard nodules on soles of feet)
  • General - malaise, fatigue, weight loss
  • Enthesopathy (attachment of tendon/ligament)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is reactive arthritis investigated?

A
  • Bloods - FBC, U+Es, LFTs, CRP/ESR
  • Aspirate knee - M, C + S
  • Stool culture
  • urethral swabs
  • PCR of early morning urine (chlamydia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is reactive arthritis treated?

A
  • Antibiotics
  • NSAIDs
  • Intra-articular corticosteroid injection
  • DMARDs if no improvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is ankylosing spondylitis?

A

Autoimmune inflammation of the axial skeleton, typically the SI joint.

  • HLA-B27 associated
  • Predominantly affects males
  • Between 15-40
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the signs and symptoms of ankylosing spondylitis?

A
  • Chronic dull pain in lower back/gluteal region
    • Worse in the morning
    • Better with exercise
  • Insertional tendonitis (Achilles, intercostal, plantar fascia etc)
  • Synovitis (hip/knee)
  • Uveitis (inflammation of anterior eye chamber)
  • Systemic - weight loss, fatigue, fever
  • Question mark posture in late disease
  • CVS - Aortic regurgitation, cardiomegaly, aortic valve disease
  • Respiratory - upper lobe, bilateral pulmonary fibrosis

Additional features (As) = arthitis, anterior uveitis, aortic regurgitation, AV node block, achilles tendonitis, apical pulmonary fibrosis, amyloidosis and cauda equina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is ankylosing spondylitis investigated?

A
  • Schober’s test - flexion of lumbar spine (abnormal if < 5cm)
  • Wall-tragus measurement (kyphosis)
  • Bloods - HLA-B27, anaemia, raised inflammatory markers
  • MRI of sarco-iliac joints
    • Erosions
    • Sclerosis
  • X-ray of spine = squaring and ossification
    • Syndesmophyte = longitudinal fibrous band
    • Symmetrical SIJ changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is ankylosing spondylitis treated?

A
  • Education - sleeping flat on a firm mattress
  • Exercise and physiotherapy
  • Hydrotherapy
  • Stop smoking
  • NSAIDs / opioids
  • DMARDs
    • Sulfasalazine
  • TNF-alpha blocker (infliximab)
  • Acute flare ups - intra-articular steroid injection
  • Steroid eye drops for uveitis
  • Surgery
    • Joint replacement (hip)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is SLE?

A

Autoimmune-mediated, systemic inflammation/connective tissue disorder that can affect multiple organs

  • Classically affects women aged 20-40
  • More common in non-white communities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name some signs and symptoms of SLE

A
  • Rashes
    • Malar - spares nasolabial folds
    • Discoid - erythematous papules with scaling on head/neck
    • Photosensitive
  • Raynauds
  • Oral/nasopharyngeal ulcers (painless)
  • Arthritis > 2 joints (non-erosive)
  • Serositis - pleural / pericardial / peritoneal
  • Renal disease
  • Cardiovascular disease
  • CNS - seizures, psychosis, headache
  • Haematological - haemolytic anaemia, leucopenia, lymphopenia
  • Systemic - weight loss, maliase, fever, myalgia, alopecia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the criteria for diagnosing ankylosing spondylitis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the criteria for diagnosing SLE

A

SOAP BRAIN MD

  • Serositis (pleurits, pericarditis)
  • Oral ulcers
  • Arthritis
  • Photosensitivity
  • Blood - anaemia, leukopenia, thrombocytopenia
  • Renal - protein
  • ANA
  • Immunology - dsDNA
  • Neurology - psych, seizures
  • Malar rash
  • Discoid rash
25
Q

How is SLE investigated?

A
  • Bloods
    • ANA / ENA / ds DNA antibody
    • FBC - dec neutrophils, dec lymphocytes, inc ESR, dec C3/C4
    • NB: not necessarily raised CRP
  • Urine dip - inc urea, inc creatinine, protein
26
Q

What is anti-phospholipid syndrome?

A

A hypercoagulable state caused by antiphospholipid antibodies

  • Can be secondary to SLE
  • Causes thrombosis and obstetrical complications
    • Miscarriage, pre-eclampsia, congenital heart block
  • Treated with hydroxychloroquine
27
Q

What advice should be given to someone with SLE?

A
  • Rest as appropriate
  • Avoid over-exposure to sunlight
  • Wear sun cream (> SPF 30)
  • CVS risk factors
    • BMI
    • Smoking / alcohol
    • Exercise
  • Take calcium / vit D supplements to maintain bone health
  • Avoid oestrogen pill
28
Q

What pharmacological treatment is recommended for SLE?

A
  • NSAIDs
  • Hydroxychloroquine (if uncontrolled by NSAIDs)
    • Risk of retinopathy (need annual opthalmology check)
  • Prednisolone for severe episodes
  • Azathioprine, methotrexate, ciclopsorin if not controlled by HCQ
  • Rituximab
29
Q

What is Wegener’s Granulomatosis / GPA?

A

A systemic vasculitis that affects small and medium sized blood vessels. This typically affects the lungs, kidneys and ENT.

30
Q

Name some clinical features of Wegeners

A
  • Kidneys - glomerulonephritis
  • Nose - saddle-nose, pain, stuffiness, nosebleeds
  • Ears - conductive/sensorineural hearing loss
  • Oral cavity -ulcers, strawberry gingivitis
  • Eyes - scleritis, conjunctivits, uveitis
  • Lungs - nodules, cavitis. infiltrate, haemorrhage
  • Arthritis
  • Chronic sinusitis
31
Q

How is Wegeners investigated?

A
  • CXR - nodules, cavities, infiltrate
  • Urine dip - microscopic haematuria, red cell casts
  • Biopsy of kidney/sinus - granulomatous inflammation of arterial walls
  • Nasal/oral inflammaion
  • Bloods
    • ANCA
    • FBC
    • CRP/ESR
32
Q

What is the criteria for diagnosing Wegeners?

A
33
Q

How is Wegeners treated?

A
  • Cyclophosphamide for induction
  • Azathioprine, methotrexate, trimethoprim for remission maintenance
  • Rituximab
  • Prednisolone for acute flare ups
34
Q

What are the signs and symptoms of dermatomyositis/polymyositis?

A
  • Muscle weakness
    • Symmetrical
    • Diffuse
    • Starts proximally
  • Breathlessness (diaphragmatic weakness)
  • Skin
    • Gottron’s papules = erythematous papules over MC/IPJ
    • Macular rash over back (shawl sign)
    • Heliotrope / lilac rash over eyelids
    • Telangiectasia (spider veins)
  • Mechanics hands
  • Raynauds
35
Q

What is dermatomyositis?

A

Inflammation of the skin and muscles that can also affect the joints, oesophagus, lungs and heart

36
Q

How is dermatomyositis/polymyositis investigated?

A
  • Inc creatine kinase / ALP
  • Alteration in electromyograph activity
  • Muscle biopsy / skin biopsy
  • Malignancy markers - FBC, CXR, CRP, abdo US, PSA
  • Anti-Mi-2 antibodies
37
Q

Describe the signs and symptoms of polymyalgia rheumatica

A
  • Symmetrical aching and morning stiffness in shoulders and proximal limb muscles for > 1 month
  • Polyarthritis
  • Tenosynovitis (carpal tunnel)
  • Depression
  • Fatigue
  • Fever
  • Weight loss
38
Q

How is PMR investigated?

A
  • Inc ALP
  • Inc ESR
39
Q

How is PMR treated?

A
  • Prednisolone
    • Decrease dose slowly
  • Bisphosphonates
40
Q

Name some signs and symptoms of Giant Cell Arteritis/temporal arteritis?

A
  • Headache
    • Worse with chewing/brushing hair
  • Scalp and temporal artery tenderness
  • Jaw claudication
  • Sudden blindness in one eye
  • Prominent/pulsatile temporal artery
41
Q

How is GCA investigated?

A
  • Inc ESR/CRP
  • Inc platelets
  • Inc ALP
  • Dec Hb
  • Temporal artery biopsy
  • Fundoscopy - pale swollen optic disc
  • Visual acuity
42
Q

Name some causes of gout

A
  • Diuretics - reduced renal excretion
  • Obesity / hyperlipidaemia
  • Hyperparathyroidism
  • High purine intake
    • Red meat, beer, offal
  • Ischaemic heart disease
  • Renal impairment
  • Hypothyroidism
  • Drugs - pyrazinamide / ethanol
43
Q

Name some precipitants of gout

A
  • Trauma
  • Starvation
  • Alcohol
  • Surgery
  • Infection
44
Q

Describe some clinical signs and symptoms of gout

A

Urate crystals deposited in synovium, connective tissues and kidneys

  • Pain, redness and swelling of the joint
    • MTP of big toe
    • Knee
    • Elbow
    • Ankle
  • Olecranon bursitis
  • Tophus deposits in digits, ear, bursae, tendon sheaths
  • Nephropathy
  • Uric acid stones in urinary tract
45
Q

How is gout diagnosed?

A
  • Synovial fluid analysis
    • Polarised light microscopy
    • Gram stain / culture (exclude infection)
  • Serum urate (not always inc)
  • CRP/ESR, FBC
  • X-ray
    • Soft tissue swelling
    • Opacities
    • Erosions
46
Q

How is gout managed?

A
  • NSAIDs (CI in renal disease)
  • Corticosteroids
  • Lifestyle changes
    • Avoid fasting
    • Reduce alcohol intake
    • Reduce food high in purines
    • Lose weight
    • Avoid aspirin
  • Allopurinol (3 weeks after attack) 100-300 mg/day
    • Adjust with urate levels
47
Q

What is Sjogrens syndrome?

A

Chronic autoimmune disorder, characterised by lymphocytic infiltration exocrine glands resulting in dry mucous membranes

  • More common in females
  • Between 30-60 years
  • Can be secondary to RA or SLE
48
Q

What are the clinical features of Sjogrens

A
  • Dry mucous membranes - mouth, eyes, vagina, resiratory tract
    • Mouth - difficulty eating, dental caries, candidal infections
    • Repiratory tract - hoarseness, infections
    • Dry skin
    • Eyes - corneal ulcers, keratoconjunctivitis
  • Signs and symptoms of a secondary cause
  • Arthralgia
  • Parotid gland swelling
  • Raynauds
  • Lymphadenopathy
49
Q

How is Sjogrens investigated?

A
  • Routine bloods tests - anaemia
    • Inc amylase and inflammatory markers
    • +ve ANA and RF
    • +ve anti-Ro and anti-La
  • Schirmer test (strips of filter paper) - dry eyes
  • Can perform biopsy of salivary gland or lower lip
50
Q

How is Sjogrens managed?

A
  • Education
    • Promotion of oral hygiene
  • Artifical tears/lubricating gels
  • Artifical saliva sprays/mouthwashes
  • Pilocarpine - stimulate saliva and tear production
  • Hydroxychloroquine if skin/joint problems
  • Analgesia
  • Emollients for dry skin
51
Q

Name the important immunological blood tests and what they diagnose

A
  • Rheumatoid factor (IgM) - 70% RA, 90% Sjogrens
  • Anti-CCP antibody - RA
  • ANA - SLE, 75% Sjogrens
  • Anti-ds DNA - SLE
  • Extractable Nuclear Antigens
    • Anti-Ro - Sjogrens
    • Anti-La - Sjogrens
    • Anti-Jo1 - polymyositis
  • ANCA - vasculitis
  • ACLA - anti-phospholipid syndrome
52
Q

Name some examples of seronegative arthropathies

A
  • Reactive arthritis
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Enteropathic arthritis
53
Q

What test may be useful before starting azathioprine/mecaptocurine?

A

Serum TPMT - enzyme that is involved in the metabolism of azathioprine

  • If deficient - can develop severe and life-threatening bone marrow toxicity
54
Q

What is GCA/temporal arteritis?

A
  • Large vessel vasculitis
  • Segmental granulomatous inflammation of external carotid artery and branches
    • Superficial temporal
    • Opthalmic
    • Maxillary
  • Pain over thickened, tender, non-pulsatile temporal arteries
  • Visual loss / amaurosis fugax (25%)
  • Jaw claudication
  • Associated with PMR
55
Q

What are the main 4 features of anti-phospholipid syndrome?

A

CLOT

  • Clotting disorder (thrombosis)
  • Livedo reticularis
  • Obstetric complications
    • Recurrent 1st trimester miscarriage
  • Thrombocytopenia

30% of SLE

56
Q

Describe the difference between RA and OA in terms of:

  • Symmetry
  • Morning stiffness
  • Agrravating and relieving factors
  • Age of onset
  • Speed of deterioration
  • Systemic involvement
A
57
Q

How is GCA diagnosed?

A
  • Raised ESR
  • Temporal artery biopsy
58
Q

How is GCA managed?

A

Prednisolone 60mg/day until ESR decreases

IPE (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions