Brainscape's Knowledge GenomeTM

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


See full index

Finals Bible: Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is rheumatoid arthritis?

A

Chronic systemic inflammatory disorder of unknown cause with characteristic joint involvement

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

Diagnostic criteria for rheumatoid arthritis?

A

4/7 of:

morning stiffness >1 hour
Arthritis of 3 or more joints
Arthritis of hand joints
Symmetrical arthritis
Rheumatoid nodules
Rheumatoid factor positive
X-ray changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical features of rheumatoid arthritis - hands?

A

Symmetrical poly arthritis sparing the DIPS

Ulnar deviation and prominent ulnar styloid
Swan neck deformity
Boutonniere deformity
Z-thumb
Subluxation at MCP's and wrist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical features of rheumatoid - not hands?

A

Atlanto-axial instability due to weakening of transverse ligament holding odontoid of C2 against arch of C1
- diagnosed when odontoid > 3mm from anterior arch

Anaemia of chronic disease

Scleritis

Interstitial fibrosis, pulmonary nodules

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

X-ray changes in rheumatoid?

A

BENJ

Bone cysts
Erosions
Narrowing of joint space
Juxta-articular osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What markers should you look for in rheumatoid arthritis?

A

Rheumatoid factor = 70%
- IgM to Fc of IgG

Anti-CCP, much more specific but less sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of Rheumatoid arthritis?

A

Conservative = info/counselling, OT.

Medical:
Analgesics and NSAIDs

1st line = Methotrexate 7.5mg PO once weekly + 1 other DMARD e.g. Sulfasalazine

2nd line = biologicals, only if you have tried two DMARDs one being methotrexate, and DAS score >5.1 twice

Steroids used for bridging when starting DMARDs + for systemic flair ups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Examples of DMARDs and their SE’s in rheumatoid arhtirits?

A

Methotrexate = Pulmonary fibrosis, BM suppression

Sulfasalzine = reduced sperm, Heinz body anaemia, BM supression

Leflunomide = HTN and interstitial lung disease

Hydroxychloroquinine = Rash, retinopathy

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

Examples of biologicals and their SE’s in rheumatoid arthritis?

A

Anti-TNF e.g. Etanercept and infliximab = BM suppression and hair loss

Anti-B cell e.g. Rituximab = Cytokine release syndrome, infusion reaction

Anti-IL6 e.g. tocilizumab = BM suppression and mouth ulcers

CTLA4-Ig fusion e.g. Abatacept = GI and BM suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Monitoring in rheumatoid?

A

LFT’s and FBCs every 1-2 months early doors then every 3-4 months once stable

DAS score = disease activity score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is osteoarthritis?

A

The degenerative loss of articular cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features of osteoarthritis?

A

Pain on activity and worse at end of day / night

morning stiffness <45 minutes

Functional limitation

Affects weight bearing joints = knees, hips

Hands DIP

Spine lumbar affected most

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

X-ray changes in OA?

A

Loss of joint spaces
Osteophytes
Subchondral cysts
Sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of osteoarthritis?

A

Conservative = weight control, exercise and appropriate orthotics

Medical = analgesia:
1st line = paracetamol
Then NSAIDs
Then Opioids

Intra-articular steroid injections

Surgery = Replace joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is septic arthritis?

A

Inflammation of the joint due to the presence an MO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Common MO’s in septic arthritis?

A

Staph aureus = 60%
S. Pyogenes = 15%
N. Gonnorhoea in sexually active patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diagnosis of septic arthritis?

A

Joint aspiration prior to antibiotics:
Gram stain
WCC > 50,000/mm3
+ve culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of septic arthritis?

A

Local guidelines = IV for two weeks or until improvement then four weeks orally

No RF’s for atypical = Vancomycin 1g IV BD for two weeks, then clindamycin

If high risk G-ve in elderly / UTI / recent abdo surgery = Ceftriaxone 2g IV OD for 2 weeks, then cefalexin

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

What is gout?

A

Disorder of purine metabolism, characterised by hyperuricaemia and the deposition of monosodium rate crystals in joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Precipitating factors for acute gout?

A

Starvation or alcohol excess

Surgery

drugs = Thiazides, furosemide, high dose salicylates

Reduced excretion in renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does synovial fluid show in gout?

A

-vely birefringent needle shaped crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of acute gout?

A

NSAIDS e.g.naproxen 500mg PO BD 2 weeks

2nd line = prednisolone

3rd line = colchicine
- useful if contraindication to NSAIDS e.g. GI bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Prophylaxis for gout?

A

Conservative = weight loss, dietary modifications and avoid alcohol

Medical prophylaxis if recurrent attacks, tophi and erosive disease

Xanthine oxidase inhibitor = allopurinol 100mg PO OD
- don’t start within 2 weeks of attack

2nd line = Probenecid = increased renal excretion

Refractory = pegolticase

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

What is pseudogout?

A

Deposition of calcium pyrophosphate crystals in joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pseudogout associations?

A

4 H’s

Hypoparathyroid
Haemochromatosis
Hypomagnesaemia
Hypophosphatia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Synovial fluid findings in pseudogout?

A

+vely birefringent rhomboid crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

X-ray change in gout vs pseudogout?

A

Gout = punched out erosions

Pseudogout = linear calcium deposition in cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Management of pseudogout?

A

Accessible joints = IA corticosteroids

Inaccessible = Colchicine + NSAIDs

If refractory = systemic corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is a seronegative spondyloarthritis

A

Any joint disease of the vertebral column that is seronegative i.e. RF -ve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Types of seronegative spondyloarthritis?

A

Anyklosing spondylitis = HLA-B27

Psoriatic arthritis

Reactive arthritis

Enteropathic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is ankylosing spondylitis?

A

Chronic inflammation of the spine, sacra-iliac joint and axial joints

Strongly HLA-B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Clinical features of ank spond?

A

Insidious back pain > 3 months
Early morning stiffness, and bad at night
Relived by exercise

Enthesitis is common = heel and knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Extra articular signs of ank spond?

A

AAAA

Anterior uveitis
Aorititis = aortic regurgitation
Amylodosis
Apical lung fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

X-ray findings in ankylosing spondylitis?

A

Sacra-Iliac fusion

Squaring of vertebral bodies
Bamboo spine
Syndesmophytes = Ossification of annulus fibrosis (the tough circular exterior of the intervertebral disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Management of ankylosing spondylitis?

A

Conservative = educate and physio

Medical = NSAIDs for pain
IA injection of intra-articular disease / entheisits

Peripheral joint involvement = sulfasalazine

If refractory:

  • continue NSAIDs
  • TNF alpha inhibitor e.g. Adalimumab or Etanercept
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is psoriatic arthritis?

A

Inflammatory arthritis in association with psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Clinical features of psoriatic arthritis?

A

Psoriasis generally precedes arthritis
Some may have nail dystrophy = pitting and onycholysis

Can have multiple patterns, but most common is polyarthritis mimicking RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

X-ray changes in psoriatic arthritis?

A

May see axial changes like in ankylosing spondylitis

Pencil cup deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Management of psoriatic arthritis?

A

If limited peripheral joint disease = Naproxen 500mg PO BD + physio ± steroid injections

Progressive peripheral joint disease:
Methotrexate

2nd line = Etanercept or adalimumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is enteropathic arthritis?

A

Arthropathy associated with pathology in large / small bowel e.g. IBD, coeliacs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Clinical features of enteropathic arthritis?

A

May only have arthralgia
Asymmetrical oligoarticular disease

May see associated skin lesions e.g. pyoderma gangrenous and erythema nodosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Management of enteropathic arthritis?

A

Treat the IBD
Symptomatic = NSAIDsand steroids for flares

Sulfasalazine as treats the joints and the IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is reactive arthritis?

A

Sterile inflammation of joint, initiated by infection e.g. Salmonella / shigella / yersinia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Classic triad of reactive arthritis?

A

Arthritis
Conjuctivitis
Urethritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Clinical features of reactive arthritis?

A

Arthritis weeks after urethritis / dysentry

Often self limiting

Associated:

  • Conjunctivitis
  • Uveitis
  • Oral ulcers
  • Keratoderma blennorhagica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Management of reactive arthritis?

A

NSAIDs and steroids acutely

Ongoing = sulfasalazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is osteoporosis?

A

Predisposition to fractures due to low bone mass and micro-architectural deterioration of bone tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the bone mineral density of osteoporosis and osteopenia?

A

Osteoporosis is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

RF’s for osteoporosis?

A 
Post-menopause
Previous #
Steroids
Low BMI
Malabsorption
Alcoholic / smoker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Pathology of osteoporosis?

A

Increased osteoclast activity = reduced density

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Investigations for osteoporosis?

A

FRAX tool for 10 year fracture risk - used in all women >65, men >75
Younger if RF’s

Bloods NORMAL

DEXA scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How does FRAX score affect management?

A

Low risk = conservative

Intermediate = DEXA

High risk = Medical therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Management of osteoporosis?

A

Conservative = manage RF’s, dietary advice, exercise, falls prevention with OT and physio.

Medical = Calcium and vitamin D

Anti-resorptive agents = bisphosphonates e.g. alendronate 10mg PO OD

OR

RANK-L antibodies = Denosumab 60mg SC twice yearly

54
Q

What is osteomalacia?

A

Inadequate bone mineralisation due to vitamin D deficiency.

Can be due to poor absorption or poor metabolism

55
Q

Biochem of osteomalacia?

X-ray signs?

A

Low vitamin D

Low calcium and phosphate = PTH raised = secondary hyperPTH

High alkaline phosphatase

Loosers zones

56
Q

Management of osteomalacia?

A

Vitamin D supplementation

57
Q

Anti-Scl 70?

A

Systemic sclerosis

58
Q

Anti-centromere?

A

CREST

59
Q

Anti-jo 1?

A

Polymyositis

60
Q

C-ANCA?

A

GPA / Wegeners

61
Q

P-ANCA?

A

Microscopic polyangitis and EGPA/Churg Strauss

62
Q

Anti-ro/la?

A

Sjogrens

63
Q

Anti-CCP?

A

RA

64
Q

Anti dsDNA or Anti-Sm?

A

SLE

65
Q

Clinical features of SLE?

A 
Skin features: MALAR (rash)
Mouth ulcers
Alopecia
Livedo reticularis
Abnormal sensitivity to light
Raynauds

Arthritis

Pericarditis, pneumonitis, nephritis

Blood disorders e.g. anaemia, leucopenia, thrombocytopaenia

66
Q

Diagnostic criteria for SLE?

A

4 of: BD PANORAMAS….

Blood disorder
Discoid rash

Photosensitive
Arthritis
Neuro disease
Oral ulcers
Renal disease
ANA = 99% +ve
Malar rash
Autoantibodies to dsDNA or Sm = very specific but not that sensitive
Serositis
67
Q

Management of SLE?

A

Conservative = avoid sun, stop smoking, healthy

Medical:

Mucocutaneous = eye drops and sunscreen

Joints = Naproxen 500mg BD
+ hydroxychloroquinine if severe
Steroids if refractory and severe

If nephritis may need immunosuppressants e.g. cyclophosphamide

68
Q

What is drug induced lupus?

Clinical signs?

A

Variant on SLE that resolves within days to months on drug withdrawal

Mostly skin and lung signs

69
Q

Most common drugs causing drug induced lupus?

A

Anti-hypertensives = Hydralazine

Anti-arrhythmic = Procainamide

Antibiotics = Minocycline and isoniazid

70
Q

What are the antibodies for drug induced lupus?

A

ANA+ve 100%, anti-histone 95%

71
Q

what is anti-phospholipid syndrome?

A

Due to anti-phospholipid antibodies against anti-cardiolipin and lupus anticoagulant.

mainly primary, but can be secondary due to SLE

72
Q

Diagnostic criteria for antiphospholipid syndrome?

A

Vascular thrombosis in any organ OR a pregnancy event
+
Persistently positive for antibodies

73
Q

Clinical features of antiphospholipid syndrome?

A

Clotting
Miscarriage
Livedo reticularis
Cardiac valve lesions

If due to lupus anticoagulant = prolonged APTT

74
Q

Management of antiphospholipid syndrome?

A

Initially LMWH e.g. Dalteparin

Then lifelong warfarin INR 2-3

If pregnant LMWH only

75
Q

What is systemic sclerosis?

A

Disease of unknown aetiology characterised by fibrosis of skin, vessels and internal organs

76
Q

Classification of systemic sclerosis?

A

Diffuse = 30% = early and severe organ involvement

Limited = 70% = CREST, skin limited to face, hands and feet.

77
Q

Clinical features of limited vs diffuse sclerosis?

A

Limited = CREST + 15% have pulmonary HTN

Calcinosis
Raynauds
oEsophageal dismotility
Sclerodactyly
Telangiectasia 
Diffuse:
Widespread skin involvement
Organ fibrosis:
GI = GORD, aspiration and incontinence
Lung fibrosis
Cardiac = arrhythmias
Renal = acute HTN crisis
78
Q

Management in systemic sclerosis?

A

Conservative = exercise, stop smoking, skin emollients
Hand warmers for Raynauds

Medical = immunosuppressants e.g. methotrexate or mycophenolate

then treat symptomatically…..

Calcinosis = excision
Raynauds = Nifedipine 10mg PO TDS
GORD = PPI's

Renal crisis = ACEI Captopril 12.5mg PO OD

79
Q

What is Sjogrens?

A

Autoimmune condition characterised by inflammation and destruction of the exocrine glands

80
Q

Clinical features of sjogrens - glandular?

A

Dry itchy eyes = Keratoconjunctivitis sick and dry mouth

Other glands = dry skin, otitis media, chest infection and pancreatic insufficiency

81
Q

Clinical features of sjogrens - extra glandular?

A 
Fatigue and arthralgia
Peripheral neuropathy
RTA
Vasculitis
LN's and hepatosplenomegaly
82
Q

Serology for sjogrens?

A

RF+ve
ANA speckled +ve

Antibodies to ro and la

83
Q

Management of sjogrens?

A

Dry eyes = artificial tears, ophthalmic ciclosporin

Dry mouth = artificial saliva

Arthritis = Naproxen
2nd line = hydroxychloroquinine

Vascultitis = corticosteroids

84
Q

What is myositis?

A

Group of disorders with immune mediated muscle injury causing proximal muscle weakness

85
Q

four types of myositis?

A

Polymyositis
Dermatomysositis
Inclusion body myositis
Necrotising myopathy

86
Q

Women aged 50-70, symmetrical proximal muscle weakness, dysphagia, systemic upset and arthralgia

A

Myositis

87
Q

What is dermatomyositis?

A

Myositis + skin signs

88
Q

Dermatomyositis skin signs?

A

FACE:
Heliotrope rash = lilac rash affecting eyelids and nasolabial folds

HANDS:
Gottrons papules = purple erythematous flat lesions over interphalangeal region of fingers

Mechanic hands = cracking and fissuring over skin pads

Nailfold abnormalities = periungual erythema, dilated capillary loops

BODY:
V-sign rash = Confluent erythematous rash over anterior chest and neck

Macular rash = shawl like erythematous over shoulders

89
Q

Who does anti-synthetase syndrome affect?

A

30% of patients with polymyositis and dermatomyositis

90
Q

What are the features of anti-sdnthetase syndrome?

A

MARIMBA

Myositis
Acute onset
Raynauds
Interstitial lung disease
Mechanic hands
B-symptoms
Arthritis
91
Q

CK raised, anti-jo1 and EMG characteristic findings

A

Myositis

92
Q

Management of myositis?

A

Physio and rehab

Medical = immunosuppression

High dose steroids for 1 week then taper

2nd line = azathioprine / methotrexate

93
Q

What is polymyalgia rheumatica?

A

Clinical syndrome of proximal limb girdle pain and stiffness, associated with rapid response to steroids

70 years old female

94
Q

Clinical features of polymyalgia rheumatica?

A

Acute onset, bilateral proximal muscle pain = Neck, shoulder and hip

Early morning stiffness

Normal muscle strength but hard to assess due to pain

95
Q

Investigations In polymyalgia rheumatica?

Management?

A

CRP and ESR raised
USS for bursitis and effusions = commonly trochanteric

Prednisiolone high dose then taper to response
Will see rapid response in 48 hours
Usually on low dose for prednisolone for a year

96
Q

What is a vasculitis?

A

Inflammation of the blood vessels with narrowing / occlusion = tissue ischaemia or necrosis

97
Q

What is the Chapel-Hill Classification of vasculitides?

A

By size:

Large = Giant cell arteritis and Takayasu’s

Medium = Polyarteritis nodosa and Kawasakis

Small = GPA, EGPA and microscopic polyangitis
HSP

98
Q

What is giant cell arteritis associated with?

A

Polymyalgia rheumatica

99
Q

Clinical features of GCA?

A

Commonly affects temporal and ophthalmic = unilateral headache, temporal
Scalp tenderness and jaw claudication
Visual phenomenon

May have proximal weakness due to PMR

100
Q

Investigations for GCA?

A

Raised CRP

Gold standard = temporal artery biopsy

101
Q

Management of GCA?

A

Do not delay steroids as blindness risk
High dose 60mg PO OD for 4 weeks then taper down

IV steroids if impending visual loss

Aspirin 75mg + GI and bone protection

102
Q

What is takayasus arteritis?

A

Granulomatous panarteritis of the aorta and great vessels causing stenosis / occlusion / aneurysm

Affects young Asian females

103
Q

Clinical features of takayasus - systemic stage?

A

Systemic stage = fever, fatigue, weight loss and arthralgia

104
Q

Clinical features of Takayasus - Occlusive stage?

A

Vascular = claudication, HTN and ABSENT PERIPHERAL PULSES
Neuro = Syncope, TIAs
Cardiac = Angina and dyspnoea
- aortic regurgitation secondary to root dilation

105
Q

Investigations for Takayasus?

A

Bloods = inflammatory markers raised

Non-invasive angiography e.g. MRA CTA

106
Q

Management of Takayasus?

A

Medical = Steroids, Aspirin and GI and bone protection

If cannot tolerate steroids = methotrexate

May need surgical intervention if significant limb ischaemia - immunosuppress prior to revascularisation

107
Q

What is polyarteritis nodes (PAN)

A

Vasculitis of medium sized vessels with aneurysm formation

Often middle aged men with Hep B

108
Q

Clinical features of PAN?

A

Fever and weight loss, arthralgia

GI = perforation / haemorrhage

Renal = Haematuria, HTN

Testes = pain

109
Q

Investigations for PAN?

A

Angiography, biopsy affected organs

110
Q

Management of PAN?

A

Non-hepatitis:
Poor prognosis = Prednisolone, cyclophosphamide and azathioprine

Good prognosis = Prednisolone

Hepatitis related:
Prednisolone

111
Q

What is Kawasakis?

A

An acute febrile self limiting vasculitis of medium vessels

Asian children

112
Q

Clinical features of Kawasaki’s?

A

Fever > 5 days plus 4 of:

  • Bilateral conjucntivitis
  • Cervical lymophadenopathy
  • Oral mucositis = strawberry tongue
  • Hand/ feet erythema followed by desquamation
  • Blotchy red rash

20% will develop coronary vasculitis / aneurysm

113
Q

Management of Kawasakis?

A

IVIG 2g/kg as single dose

The aspiring 80mg/kg / day

114
Q

What is GPA?

A

Granulomatosis with polyangitis

Necrotising granulomatous vasculitis of small vessels

115
Q

Whats the classic triad of GPA?

A

URT, LRT and glomerulonephritis

116
Q

Clinical features of gPA?

A

ENT = rhinorrhoea, sinusitis, saddle nose due to nasal ulceration, otitis media

LRT = cough and haemoptysis

Renal = Glomerulonephritis

117
Q

Investigations forn GPA?

A

cANCA +ve
Urinalysis
CXR

Biopsy affected tissue = necrotising granulomas

118
Q

Management of GPA?

A

Organ threatening = Methylprednisolone IV, followed by oral + cyclophosphamide

Non-Organ threatening = steroids and methotrexate

Maintenance of remission = Steroids and methotrexate

119
Q

What is eGPA?

A

Also a necrotising granulomatous vasculitis

Rare, but prevalent in ASTHMATICS

120
Q

Classic triad of eGPA?

A

Eosinophilia, granulomatous inflammation and vasculitis

121
Q

Clinical features of eGPA?

A

Lungs = Asthma, rhinitis or sinusitis

Skin = nodules and purpura

Neuro = neuropathy

122
Q

Investigations eGPA?

A

pANCA +ve
CXR = infiltrates

Biopsy = eosinophilic necrotising granulomas

123
Q

Management of eGPA?

A

Prednisolone

If steroids not sufficient = Methotrexate

Severe = Cyclophosphamide and rituximab

124
Q

Clinical features of microscopic polyangitis?

A

Fever and malaise

Lung = pulmonary infiltrates

Renal = Glomerulonephritis

Neuropathy

125
Q

Investigations for MPA?

A

pANCA

biopsy = necrotising granulomas

126
Q

Management of MPA?

A

Steroids and methotrexate

Cyclophosphamide if more severe

127
Q

What is HSP?

A

IgA mediated autoimmune hypersensitivity vasculitis

Most common vasculitis of childhood. Males

128
Q

Clinical features of HSP?

A

Hx of URTI

Palpable non blanching rash over lower limb extensor surfaces

Symmetrical large joint arthralgia / arthritis = Knees and ankles

Glomerulonepgirits (IgA nephropathy )

129
Q

Investigations for HSP?

A

Urinalysis = RBC’s, casts and protein
Elevated IgA in serum

biopsy = Immunofluorescence show IgA and C3

130
Q

Management of HSP?

A

Steroids

If severe add in cyclophosphamide

Prognosis excellent, 1 in3 have relapses

131
Q

Pain all over, with multiple trigger points. Normal joints…

A

Fibromyalgia

132
Q

Management of fibromyalgia?

A

Information and self care
Analgesia = Pregabalin or duloxetine
Physio, accupuncture
CBT

Assess for psychiatric disturbances

Finals Bible: Medicine (6 decks)

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