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Acute Care > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Swan neck = hyperextension at PIP and flexion and DIP

A

Boutonnière = flexion at PIP and hyperextension at DIP

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2
Q

For RA diagnosis you need 4/7 of RF RISES?

A

R - rheumatoid factor
F -finger/ hand joint involvement

R - rheumatoid nodules
I - Involvement of 3 + joints 
S - Stiffness (early morning) 
E - Erosions/ decalcification of x-rayI
S- Symmetrical
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3
Q

Which bloods should you do in RA?

A 
WBC
ESR/ CRP
Auto- antibodies (Rh/ CCP)
Albumin (low = increasing disease severity)
Neutropenia is seen in Felty’s syndrome)
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4
Q

What are the 3 types of biological drugs used in RA?

A

IL-1 receptor antagonists e.g. Anakinra
TNF alpha antagonists e.g. etanercept
Cytotoxic e.g. azathioprine

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5
Q

Extra-articular RA

A 
Eyes = kerato-conjunctivitis sicca, episcleritis, scleritis
CVS = endocarditis, pericarditis, myocarditis
CNS = carpal tunnel, peripheral neuropathies
Respiratory = pulmonary nodules, bronchiolitis obliterates , pleural effusions
Skin = rheumatoid nodules
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6
Q

X-ray features of RA

A

Soft tissue swelling e.g. joint effusion, oedema, tenosynovitis
Osteoporosis
Joint space narrrowing
Erosions

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7
Q

Reiters syndrome = triad of…

A

Seronegative asymmetrical arthritis

Conjunctivitis

Urethritis

Treat with bed-rest, intra-articulation steroids and NSAIDs

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8
Q

To be diagnosed with lupus you need 4/7 of

ORDER HER ANA

A 
O - Oral ulcers 
R - rash (malar)
D - disorder rash
E - exaggerated photosensitivty
R - renal disease and raynauds

H - haematological abnormality (low lymphocytes, platelets and neutrophils)
I - immunological abnormality (low C3/ C4,
S - serositis

A - ANA (Anti- dsDNA, anti- Ro/ La)
N - neurological
A - arthralgia

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9
Q

Minor SLE = NSAIDs, hydroxychloroquine and low dose steroids

A

Major SLE = high dose steroids and immunosuppressants

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10
Q

What is Libyan-Sacks endocarditis?

A

A non-bacterial form of endocarditis which typically affects this mitral valve

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11
Q

APTT is increased in anti-phospholipid syndrome

Platelets may be low

A

Initially treated with aspirin

STart warfarin in VTE develops

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12
Q

Anti-centromere antibody

A

Limited systemic sclerosis

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13
Q

Anti-Scl70

A

Diffuse cutaneous systemic sclerosis

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14
Q

Systemic sclerosis is also called CREST syndrome - what are the features?

A 
C = calcinosis 
R = raynauds
E = oesophageal dysmotility 
S = sclerodactyly (thickening of skin on finders and hands)
T = telangiectasia
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15
Q

Early stage systemic sclerosis = treat with immunosuppressants

A

Late stage = treat with anti-fibrotics e.g. penicillamine

Don’t forget CCB e.g. nifidepine for raynauds

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16
Q

Psoriatic arthritis usually causes an asymmetrical arthritis with prominent axial skeleton involvement

A

DIP joints are often affected - unlike in RA

Rh and ANA -ve

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17
Q

Extra-spinal features of ank spon?

A

Anterior uveitis
Enthesitis - tendon involvement
Aortic regurgitation
Apical pulmonary fibrosis

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18
Q

Skin features of dermatomyositis

A

Helitrope rash
Periorbital oedema
Gottron’s papule (red, scaly patches on dorsum of hand) and periungul telangiectasia
Shawl sing

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19
Q

Immunology of dermatomyositis

A

High CK and ANA

Anti-Jo +ve

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20
Q

Sjogrens is associated with RhF, ANA, anti-Ro and anti-La. What are the complications?

A 
Pancreatitis
Nephrogenic DI
Renal tubular acidosis
Glomerulonephritis
Neuropathy
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21
Q

What is polyarteritis nodosa?

A
  • Necrotizing vasculitis of small and medium blood vessels
  • Rapid renal failure can occur, as well as weight loss, fever, malaise, myalgia, polyarthritis
  • livedo reticularis is common
  • Arteriography will show multiple small aneurysms
  • associated with HBV, HIV, CMV etc
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22
Q

PMR = proximal stiffness, ESR raised but power normal and CK normal

A

Unlike polymyositis which causes high CK

23
Q

Wegners granulomatosis

A
  • necrotizing granulomas in respiratory tract + kidneys
  • purpura, cough, bloody nasal discharge, haematuria
  • cANCA
24
Q

Young female with systemic illness and tenderness over palpable arteries + bruits. May be claudication pain….

A

Takayasu arteritis
Large vessel vasculitis
Treat with steroids +/- immunosuppressant
Beware renovascular hypertension

25
Q

Behçet’s disease is more common in Turkey. What are the features?

A 
Recurrent aphthous stomatitis
Sterile pustules at site of trauma
Genital ulceration
Large joint arthritis
Intestinal ulceration 
Epididymitis 
Uveitis

Treat with steroids/ ciclosporin

26
Q

Podagra

A

1st MCP - most commonly affected in gout

27
Q

Don’t forget gouty tophi on the pinnae and hands and arthritis can be a feature of chronic gout

A

Treat with NSAID/ colchicine

Allopurinol to reduce recurrence

28
Q

Positively bifringent crystals

A

Pseudogout
Calcium pyrophospahte crystals

Diabetes, hyperparathyroidism, haemochromatosis, hypothyroid etc are RF

29
Q

Pagets typically affects the pelvis, lumbar spine, femur and skull. Pain, fractures and nerve compression

A

ALP is raised but Ca normal

Treat with bisphosphonate such as aledronate for active disease and calcitonin for pain

30
Q

Osteomalacia is defective bone mineralisation. It presents with bone pain and deformity + proximal myopathy. Bloods show Low Ca, phosphate and vit D with high ALP and PTH. Give some causes

A

Poor diet
Malabsorption
Chronic pancreatitis
Chronic renal failure

‘Looser’s zone’ on bones e.g. femur

31
Q

Marfan’s associated with dilated aortic sinuses or mitral valve prolapse. Pectus excavatim and arachnodactlyl. Which protein is mutated?

A

Fibrillation

Arachnodactyly means fingers and long and spider like

32
Q

Osteopenia = T score -1 to -2.5

A

Osteoporosis T score

< -2.5

33
Q

Think Still’s disease in a patient with a fever which worsens in the afternoon/ evening then improves each morning

A

There is usually gradually worsening joint pain and a rash (typically salmon pink)
NSAIDs are mainstay of treatment

34
Q

Remember there should be a dramatic response with steroids when treating PMR.

A

If there is not a sudden improvement then the diagnosis is probably not correct

35
Q

What is the cause of visual loss in temporal arteritis?

A

Anterior ischaemic optic neuropathy

Typically described as ‘large, dark shadow coming down’

36
Q

1st line management of OA

A

Lifestyle

Paracetemol +/- topical NSAID (if hands/ knee affected)

37
Q

Remember limited (central) systemic sclerosis = anti-centromere

A

Diffuse (spread) systemic sclerosis = Anto-Scl70

38
Q

High impact exercise, Black ethnicity and late menopause are all protective against osteoporosis

A

Having RA is a risk factor, included in the FRAX tool

39
Q

Sjogrens may be primary or secondary to RA/ SLE etc. What important complication should you be aware of?

A

Vastly increased risk of lymphoma

40
Q

Offer allopurinol to all patient who present with acute gout

A

It should be started at least 2 week after gout has settles as if started to early it can precipitate other atacks

BUT if patients are already taking allopurinol they should continue to take it - even if they have an acute attack

41
Q

Bone protection for patient started on long -term steroids?

A

> 65 or previous fragility # = start aledronate + ensure adequate Ca/ Vit D

<65 = do bone density scan and act accordingly

42
Q

Bisphosphonates are associated with osteonecrosis of the jaw and atypical femoral shaft #

A

Also risk of oesophageal reactions such as ulcers

43
Q

Management of Ank Spon?

A

Regular exercise therapy e.g. swimming
Physio
NSAIDs

44
Q

5key features of anti-phospholipid syndrome

A

1) Prolonged APTT
2) Thrombocytopenia
3) Recurrent arterial/ venous thrombosis
4) Recurrent pregnancy loss
5) Livedo reticularis

45
Q

Ank spon = all the A’s

A 
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendinitis
AV node block
Amyloidosis
46
Q

Patient on leflonumide need their FBC, LFT and BP measure. Myelosupression and pneumonitis are important side effects

A

Very long half-life so women need effective contraception for at least 2years after treatment

47
Q

Who is the classic patient affected by Takayasau vasculitis?

A

Large vessel vasculitis which affects Asian women aged <40

Affects brachial of the arch of aorta
—> head/ arms pain/ symptoms

48
Q

What is the commonest type of vasculitis?

A

Kawasaki

49
Q

Fibrinoid necrosis and ‘string of beads’ on angiogram?

A

Polyarteritis nodosa

Symptoms depend on location:
Renal —> HT
Mesenteric —> mesenteric Ischaemia etc

50
Q

Buerger’s disease is notorious for causing…

A

Clots in the vessels supplying the fingers and toes —> ulcers and necrosis

Usually young men who smoke

51
Q

How do you differentiate between granulomatosis with polyangitis (Wegners) and microscopic polyangitis?

A

Microscopic polyangitis affects lungs and kidneys only (NOT NOSE). There are NO granuloma and it is p-ANCA

Wegner’s is cANCA

52
Q

p-ANCA

A

Churg Strauss or microscopic polyangitis was

53
Q

What are the different types of psoriatic arthritis?

A
  • distal psoriatic arthritis
  • psoriatic spondylitis
  • rheumatoid-like
  • arthritis mutilans
  • asymmetrical oligoarthritis
54
Q

The lung has a dual blood supply from the:

A
  • pulmonary arteries

- bronchial arteries

Acute Care (4 decks)

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