Brainscape's Knowledge GenomeTM

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


See full index

EOY3 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Rheumatoid arthritis

A

symmetrical, painful swollen joints in the hands and feet (DIPJ not affected)
morning stiffness lasting >30 minutes
positive squeeze test
rheumatoid nodules - lungs, elbow and knuckles

anti-CCP

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

extra-articular manifestations of RA

A

ocular: keratoconjuctivitis, episcleritis, scleritis, corneal ulceration
respiratory: pulmonary fibrosis/nodules, pleural effusion, infection secondary to immunosuppression, methotrexate pneumonitis
CVS: pericarditis, vasculitis, peripheral neuropathy
systemic: fatigue, fever, lymphadenopathy, weight loss, PO, depression

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

X-ray changes in RA

A

early: loss of joint space, juxta-articular OP, soft tissue swelling
late: periarticular erosions and subluxations

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

poor prognostic features in RA

A

positive RF, poor functional status at presentation, anti-CCP, HLA DR4, X-ray showing early erosions (<2years), insidious onset, rheumatoid nodules, being female

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

management of RA

A 
2 DMARDs (one of which is methotrexate) and a short-term glucocorticoid 
e.g. methotrexate + sulfasalazine + prednisolone

TBF-inhibitors e.g. infliximab used if that inefficient

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

Reactive arthritis

A

aka Reiter’s syndrome
HLA-B27 associated seronegative spondyloarthropathy
typically develops <4 weeks post (sexually transmitted) infection
no organism can be retrieved from joint aspiration
classical triad: urethritis, conjunctivitis and arthritis
Rx: analgesia, NSAIDs, intra-articular steroids
sulfasalazine and methotrexate if persistent disease (symptoms rarely last more than 12 months)

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

Gout

A

caused by chronic hyperuricaemia
risk factors include CKD, DM, obesity, thiazide diuretics, furosemide, alcohol and Lesch-Nylan syndrome

affects small joints
causes needle-like uric acid crystals that are negatively birefringent

Rx: NSAIDs, colchicine (causes diarrhoea) and allopurinol prophylaxis

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

Pseudo-gout

A

risk factors include hyperparathyroidism, hypothyroidism, haemochromatosis, acromegaly, Wilson’s Disease

affects larger joints
causes rhomboid calcium phosphate crystals that are weakly positively birefringent, chondrocalcinosis on X-ray

Rx: aspirate to exclude septic arthritis, NSAIDs and steroids

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

use of allopurinol as gout prophylaxis

A

inhibits xanthine oxidase
started 2 weeks after an acute attack has settled (if already taking, continue throughout attack). initial dose of 100mg OD is then titrated every few weeks to aim for a serum uric acid <300micromol/L

INTERACTS WITH CYCLOPHOSPHAMIDE

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

Systemic Lupus Erythematous features

A

“A CHRONIC RASH”
ANA positive in 99%
CVS - pericarditis, myocarditis, HTN
Respiratory - pleurisy, fibrosing alveolitis
Others - fever, fatigue, lymohadenopathy, oral ulcers, weight loss
Nuropsychiatric - anxiety, depression, psychosis and seizures
Immunological - anti-dsDNA, antiphospholipid syndrome, anti-Smith
Compliment levels (C3 and C4) decrease during active disease
Renal - glomerulonephritis, proteinurea, lupus nephritis (a severe complication)
Arthritis - 2 or more joints (non-erosive) and arthralgia
Skin - malar (butterfly) rash, photosensitivity, discoid rash and livedo reticularis (lace like rash)
Haematology - neutropenia, thrombocytopenia, lymphopenia, increased ESR but CRP is normal

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

SLE presentation

A

glove and sweater

gloves: raynauds, joint pain and swelling, hand rash
sweater: proximal muscle weakness, hair loss, mouth ulcers, pleuritic/ pericardial pain, truncal rash, uveitis

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

SLE management

A 
high factor sunblock 
hydroxychloroquine (decreases disease activity and increases survival)
NSAIDs (unless has renal disease) 
azathioprine/methotrexate/mycophenolate 
belimimab (monoclonal antibody)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is discoid lupus?

A

lupus that only affects the skin

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

drug induced lupus

A

renal and NS involvement is rare
usually resolves when drug is stopped
features: arthralgia, myalgia, malar rash, pleurisy, ANA positive, ds-DNA negative, upto 90% have anti-histone antibodies

offending drugs –> procainamide, hydralazine, isoniazid and phenytoin

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

antiphospholipid syndrome

A 
features: "CLOTS" 
coagulation defect
livedo reticularis
obstetric (recurrent miscarriages) 
thrombocytopenia 
persistent aniphospholipid antibodies (anti-cl and LA antibodies)
Rx: anticoagulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sjogren’s syndrome

A 
autoimmune disorder affecting exocrine grands (gives dry mucosal surfaces)
RF positive (100%), ANA positive (70%), anti-RO and anti-LA (most classical)

Rx: artificial tears and saliva, lubricant, hydroxychloroquine to reduce arthralgia and skin symptoms

17
Q

fibromyalgia

A

widespread pain and fatigue (tender in >11/18 locations)

Rx: education, CBT, pregabalin, duloxetine and amitriptyline

18
Q

ankylosing spondylitis

A

HLA-B27 associated spondyloarthropathy
commonly in males 20-30y/o
lower back pain and stiffness (worse in morning and improves with exercise) of insidious onset
other features (the A’s): apical fibrosis, anterior uveitis, aortic regurgitation, achilles tendonitis, AV node block, amyloidosis
x-ray: sacroiliitis, squaring of lumbar vertebrae, “bamboo spine” in late stages
Rx: exercise and NSAIDS +/- bisphosphonates
then tnf alpha blockers e.g. etanercept

19
Q

Psoriatic arthritis

A

features: “ROADS”
rheumatoid like pattern (does affect DIPJ), (asymmetrical) oligoarthritis, arthritis mutilans, DIPJ involvement, spondylitis or sacroiliitis
RF negative, increase IgA
x-ray: pencil cup deformity of distal phalanx
Rx: topical treatment for rash, oral prednisolone or local injection of methylprednisolone during flare
+/- NSAIDs and COX2 inhibitors
tnf-alpha inhibitors (infliximab) for active enthesis and dactylitis

20
Q

scleroderma

A

aka systemic sclerosis
ANA positive in 90%

  • limited cutaneous sclerosis (~70%) - face and distal limbs, associated with anti-centromere antibodies. crest is a subtype: calcinosis, Raynaud’s phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia
  • diffuse cutaneous systemic sclerosis (~30%) - trunk and proximal limbs, associated with scl-70/anti-RNA polymerase-3 antibodies, HTN, lung fibrosis and renal involvement - poor prognosis

—> pulmonary fibrosis, malabsorption, reduced SB motility leading to infections, intestinal obstruction, cardiac tamponade, renal crisis due to accelerated HTN

Rx: immunosuppression

  • prednisolone/methotrexate/ciclosporin/azathioprine
  • cyclophosphamide/mycophenolate for pulmonary involvement
  • cyclical ABx for gut bacterial overgrowth
  • PPIs
  • ACEi to control BP
  • pt education and PT
21
Q

polymyalgia rheumatica

A

frequently occurs with giant cell arthritis
typically >60y/o, rapid onset, aching morning stiffness and proximal limb muscles, polyarthralgia, lethargy, depression, low-grade fever, anorexia and night sweats

ESR is used to monitor response to treatment (along with symptoms)
Rx: prednisolone (gives a dramatic response, if doesn’t work consider a new diagnosis)
calcium and vitamin d supplements and bisphosphonates

22
Q

vasculitis types

A 
large vessel (giant cell, takaydasu's arteritis) Rx: steroids 
medium vessel (polyarteritis nodosa, Kawasaki disease) Rx: immunosuppression 
small vessel (wegner's - cANCA, churg-strauss - pANCA, microscopic polyangiitis, Goodpasture's, IgA vasculitis) Rx: immunosuppression 
variable (behcet's and corgan's syndrome)

smoking cessation helps all

23
Q

Giant cell arteritis

A

headache, temporal artery and scalp tenderness (when
brushing hair), jaw claudication, amaurosis fugax
Rx: prednisolone STAT or IV methylprednisolone if visual symptom history

typically lasts two years and then has complete remission

24
Q

Behcet’s syndrome

A

oral ulcers, genital ulcers and anterior uveitis
HLA B51 and MICA6 allele associated
Rx: azathioprine (if eye/vasculitis)
TNF-alpha inhibitors (if CNS involvement)
topical corticosteroids (for ulcerations)
NSAIDs (for joint involvement and muscle pain)
surgery - aneurysm repair, repair of GI perforations glaucoma, cataracts or retinal detachment

25
Q

Takyasu’s arteritis

A

affects aorta and its branches
upper limb claudication with diminished or absent pulses
raised ESR in acute phase

26
Q

Buergers disease

A

thrombotic occlusions of small and medium vessels in the lower limb, common in young male smokers
proximal pulses are present but pedal pulses are lost, tortuous corkscrew shaped collateral vessels are seen on angiography

27
Q

Polyarteritis nodosa

A

systemic necrotising vasculitis affecting small and medium muscular arteries
common in populations with a high Hep B prevalence
renal disease in 70%
angiography shows saccular/fusiform aneurysms

28
Q

Wegners granulomatosis

A

c-ANCA

ulceration, nodules and purpura may be seen

29
Q

methotrexate

A

DMARD
dihydrofolate reductase inhibitor (prevents DNA synthesis by preventing folate conversion to purines and thymidylate)
ADR:
-myelosuppression (FBC monitoring)
-liver cirrhosis (LFT monitoring)
-pneumonitis
-teratogenic (not taken in pregnancy, must be stopped 3 months before conception in females AND males)

TAKEN ONCE A WEEK
NEVER WITH TRIMETHOPRIM

30
Q

sulfasalazine

A 
DMARD
5-aminosalicylate, possibly inhibits T cell proliferation, IL-2 production, neutrophil, chemotaxis and degranulation 
ADR:
-rashes
-oligospermia
-Heinz body anaemia
-interstitial lung disease 
- if allergic to aspirin then may be allergic 
-safe in pregnancy
31
Q

leflunomide

A 
DMARD 
ADR: 
-liver impairment 
-ILD
-HTN
-not safe in pregnancy
32
Q

hydroxychloroquine

A 
DMARD 
reduces activation of dendritic cells 
ADR:
-retinopathy (needs a baseline ophthalmic examination)
-corneal deposits 
-safe in pregnancy
33
Q

prednisolone

A 
glucocorticoid
ADR:
-cushingoid features
-OP
-impaired glucose tolerance 
-HTN
-catarcts
34
Q

etanercept

A

TNF-alpha inhibitor (recombinant human protein)
ADR:
-demyelination
-reactivation of TB

given SC

35
Q

infliximab

A

TNF-alpha inhibitor (monoclonal antibody - reduces cytokine cascade, reduces inflammation, reduces angiogenesis and reduces joint destruction)
ADR: reactivation of TN

given IV

36
Q

adalimumab

A

TNF-alpha inhibitor (monoclonal antibody - reduces cytokine cascade, reduces inflammation, reduces angiogenesis and reduces joint destruction)
ADR: reactivation of TB

given SC

37
Q

rituximab

A

anti-CD20 monoclonal antibody, causing B-cell depletion

ADR: infusion reactions are common

38
Q

NSAIDs

A

nonselective COX inhibitors
can be taken up to 32 weeks in pregnancy
ADR: bronchospasm in asthmatics, dyspepsia/peptic ulceration (co-prescribe a PPI)

39
Q

Allopurinol

A

Xanthine Oxidase inhibitor (prevents purine metabolism)

ADR: can cause steven-johnson syndrome

EOY3 (20 decks)

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