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MS4 - MDEMO > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Diagnosis of gout

A

Hx

Joint aspiration

Raised urate and CRP

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2
Q

Common organisms causing acute septic arthritis

A

Staph aureus

H influenza

Streptococci

Gonococci (in US)

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3
Q

Organisms associated with chronic septic arthritis

A

TB

Fungi

Brucella

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4
Q

Diagnosis of septic arthritis

A

Clinical Hx

Synovial fluid culture / microscopy

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5
Q

Sx of septic arthritis

A

Night sweats

Fever

Raised WCC

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6
Q

Types of arthritis

A

Osteoarthritis (OA)

Rheumatoid arthritis (RA)

Ankylosing spondylitis

Gout

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7
Q

OA

Age

F:M

Affected part

A

> 50

F > M

Cartilage

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8
Q

RA

Age

F:M

Affected part

A

30 - 50

F>M

Synovium

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9
Q

Ankylosing spondilitis

Age

F:M

Affected part

A

15 - 30

M >> F

Enthesis

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10
Q

Gout

Age

F:M

Affected part

A

> 40

M > F

Crystals

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11
Q

OA radiograph changes

A

JOBS

Joint space narrowing

Osteophytes

Sclerosis

Subchondral cysts

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12
Q

RA radiograph changes

A

Joint space narrowing

Juxta-articular osteoporosis

Erosions

Deformities

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13
Q

Mx of Sjogren’s syndrome

A

Dry eyes - artificial tears
Xerostomia - artificial saliva, lozenges, pilocarpine
Dyspareunia - lubricant jelly
Major organ involvement - glucocorticoids

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14
Q

Diagnosis of polyarteritis nodosa

A

3+ of following 10 criteria:

Weight loss > 4 kg
Livedo reticularis
Testicular pain or tenderness
Myalgias or weakness
Neuropathy
Diastolic BP > 90
Elevated urea or creatinine
Hep B virus
Arteriographic abnormality
Biopsy of small or medium size artery showing neutrophils

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15
Q

Management of systemic sclerosis

A

Supportive

Stop smoking - lung involvement
Keep hands warm
ACE inhibitors
IV prostacyclin if severe

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16
Q

Use of ACEi in systemic sclerosis

A

Prevent accelerated hypertension

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17
Q

Medication to avoid in systemic sclerosis

A

Beta blocker

Vasoconstriction

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18
Q

Radiological findings of psoriatic arthritis

A

Pencil and cup sign
Hazy joints

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19
Q

Clinical presentations of gout

A

Asymptomatic hyperuricaemia
Acute gout
Atypical gout
Intercritical gout
Chronic tophaceous gout

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20
Q

Atypical gout

A

Bursitis

Cellulitis

Tenosynovitis

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21
Q

Intercritical gout definition

A

Recurrent acute attacks

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22
Q

Chronic tophaceous gout definition

A

Progressive erosive joint destruction

Tophi

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23
Q

Common locations of tophi

A

Ear

Hands

Extensor surfaces

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24
Q

Radiograph findings of Ankylosing Spondylitis

A

Loss of joint space
Sclerosis
Syndesmophyte formation / bamboo spine
Sacroiliac joint involvement

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25
Q

Extra-articular manifestations of ank spond

A

Anterior uveitis

Apical lung fibrosis

Achilles tendonitis

Aortic regurgitation

Amyloidosis

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26
Q

RFs for gout

A

Obesity
Alcohol
Renal failure
Diuretic use

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27
Q

Reason for diuretics increasing risk of gout

A

Impaired urate excretion

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28
Q

Gout crystal definition

A

Urate crystals
Needle shaped
Negatively birefringent

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29
Q

Pseudogout crystal definition

A

Calcium pyrophosphate crystals
Rhomboid shaped
Positively birefringent

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30
Q

Psoriatic arthritis age

A

25-40

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31
Q

Psoriatic arthritis definition

A

Asymmetrical inflammatory oligoarthritis
Seronegative

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32
Q

Serious complication of psoriatic arthritis

A

Arthritis mutilans

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33
Q

Main joints affected by psoriatic arthritis

A

DIP joints

Predominantly hands and feet

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34
Q

Post infection

Reactive arthritis definition

A

Inflammatory oligoarthritis

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35
Q

Organisms causing reactive arthritis

A

Chlamydia

Gonnorhoea

Campylobacter

Salmonella

Shigella

Yersinia

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36
Q

Nail changes in psoriatic arthritis

A

Nail pitting

Onycholysis

Subungal keratosis

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37
Q

Early radiograph changes in septic arthritis

A

Soft tissue swelling

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38
Q

Radiograph changes in septic arthritis 10-14 days

A

Joint space narrowing

Erosions

Osteomyelitis

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39
Q

Late radiograph changes in septic arthritis

A

Destruction of surrounding bone

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40
Q

Constitutional B symptoms

A

Eg.

Fatigue

Malaise

Weight loss

Low grade pyrexia

Night sweats

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41
Q

Oligoarthritis definition

A

< 5 joints affected

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42
Q

Polyarthritis definition

A

5+ joints affected

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43
Q

Causes of haemarthrosis

A

Haemophilia
Bleeding disorders
Anticoagulant therapy
Trauma

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44
Q

Management of haemarthrosis

A

Correct bleeding disorder first
Physio

Only aspirate if diagnostic uncertainty - not until corrected bleeding disorder

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45
Q

Clinical features of Sjogren’s syndrome

A

Dry eyes
Dry mouth
Dry vagina

Raynaud’s
Organ and glandular involvement

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46
Q

Xerostomia

A

Dry mouth

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47
Q

Systemic Lupus Erythematosus (SLE) antibodies

A

Anti-dsDNA
Anti-Ro and Anti-La

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48
Q

Enteropathic arthritis definition

A

Associated with IBD

Arthritis exacerbations often simultaneous with IBD flare ups

Acute onset

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49
Q

Main joints affected by enteropathic arthritis

A

Typically large joints of lower limb

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50
Q

Systemic sclerosis antibodies

A

ANA

Anti-centromere or Anti-Scl-70

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51
Q

Other Ix for systemic sclerosis

A

Normocytic anaemia

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52
Q

Causes of mechanical back pain

A

Damage to:

  • Vertebrae
  • Intervertebral discs
  • Facet joints
  • Sacroiliac joints
  • Spinal cord
  • Nerves
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53
Q

Fibromyalgia definition

A

Chronic

Widespread joint involvment

F > M

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54
Q

Sx of fibromyalgia

A

Poor sleep

Tender trigger points

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55
Q

Sjogren’s syndrome definition

A

Autoimmune

Primary Sjogren’s - occurs alone

Secondary Sjogren’s - associated with other autoimmune rheumatic diseases

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56
Q

Sjogren’s syndrome Ix

A

Schirmer’s test helpful (leave 5 mins)

Antibodies

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57
Q

Sjogren’s syndrome antibodies

A

Anti-Ro and Anti-La

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58
Q

Risk with Sjogren’s syndrome

A

Increased lymphoid malignancy risk

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59
Q

Types of seronegative spondyloarthropathy

A

Psoriatic arthritis

Enteropathic arthritis

Ankylosing spondylitis

Reactive arthritis

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60
Q

Axial skeleton

A

Bones of head, trunk and spine

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61
Q

Inflammatory back pain description

A

Chronic onset > 3 months
Relieved by activity
Worsened by rest or sleep

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62
Q

Inflammatory back pain age

A

Usually age < 40

63
Q

Gout vs Pseudogout pain

A

Gout more painful than pseudogout

64
Q

Vasculitis definition

A

Inflammation of blood vessels

Large vessel

Medium vessel

Small vessel

Arteries and veins

65
Q

Large vessel vasculitis example

A

Giant cell (temporal) arteritis

66
Q

Medium vessel vasculitis example

A

Polyarteritis nodosa

67
Q

Small vessel vasculitis example

A

Wegener’s granulomatosis

68
Q

Arteries and veins vasculitis example

A

Behcet’s syndrome

69
Q

Course of CTDs

A

Chronic
Relapsing/remitting

70
Q

Common clinical features of connective tissue disorders (CTDs)

A

Constitutional symptoms
Raynaud’s
Mouth ulceration
Rashes
Alopecia

71
Q

Ix for reactive arthritis

A

Joint aspirate

Chlamydia test - often asymptomatic

72
Q

Differentials for red hot swollen joint

A

Septic arthritis

Gout

Reactive arthritis

Haemarthrosis

(Cellulitis)

73
Q

Gold standard Ix for seronegative spondyloarthropathy

A

MRI

74
Q

Mx of septic arthritis

A

Urgent joint aspiration

IV broad spectrum abx

More appropriate abx after culture

75
Q

Characteristic joint aspirate description of septic arthritis

A

Fluid characteristically thick and purulent

76
Q

Diagnosis of pseudogout

A

Synovial fluid analysis
Fluid often blood stained or turbid
X-ray may show chondrocalcinosis

77
Q

Polymyositis/Dermatomyositis definition

A

Autoimmune

Inflammation of striated muscle +/- dermatological features

Organ involvement - eg. lungs

Can have malignant cause

78
Q

Seronegative spondyloarthropathy definition

A

Collection of Sx / signs

Extrasynovial inflammation of axial skeleton, entheses and cartilaginous joints

Untreated leads to spinal fusion and disfigurement

79
Q

Genetics of seronegative spondyloarthropathies

A

Associated with HLA-B27

80
Q

Conditions associated with HLA-B27

A

PUBCAR

Psoriatic arthritis

UC

Behcet’s

Crohns

Ank spond

Reactive arthritis

81
Q

Peripheral presentation of spondyloarthropathy

A

Silimar to RA but asymmetrical and less severe

82
Q

Association of Giant cell (temporal) arteritis

A

Polymyalgia Rheumatica

83
Q

Giant cell (temporal) arteritis definition

A

Granulomatous arteritis of aorta and large blood vessels

84
Q

Sx of giant cell arteritis

A

Headaches/scalp tenderness
Jaw claudication
Visual disturbances - CRAO

85
Q

CRAO

A

Central retinal artery occlusion

86
Q

Mx of giant cell arteritis

A

Prednisolone

87
Q

Giant cell arteritis

Age

ESR

Rx

A

Age > 60

ESR > 60

Prednisolone 60 mg

88
Q

Pathogenesis of Ankylosing Spondylitis

A

Chronic inflammation of entheses and cartilagenous joints
Leads to fibrosis with calcification

Syndesmophyte formation

Usually starts with sacroilliac joints

89
Q

Sexually acquired reactive arthritis (Reiter’s syndrome)

A

Reactive arthritis

Urethritis

Conjunctivitis

90
Q

Features common in vasculitis

A

Pyrexia + normal cultures

Weight loss

Rashes

Sensory / motor loss

91
Q

Systemic sclerosis / scleroderma definition

A

Fibrosis and microvascular damage

92
Q

Sx of systemic sclerosis / scleroderma

A

CREST:

Calcinosis
Raynaud’s
Oesophageal dysmotility
Scleradactyly
Telangiectasia

Organ involvement - lungs, GI

93
Q

Clinical features of polymyositis / dermatomyositis

A

Painless proximal muscle weakness
Joint pains
Heliotrope rash
Interstitial lung disease
Dysphagia

94
Q

Heliotrope rash

A

Purple-ish rash on eyelids

95
Q

Rheumatism definition (vs arthritis)

A

Pain and stiffness from structures outside joints

96
Q

Management of spondyloarthropathy

A

Physio
NSAIDs
Anti-TNF
DMARDs (no effect for axial symptoms)

97
Q

Anti-TNF drug examples

A

Infliximab

Etanercept

98
Q

DMARDs examples

A

Methotrexate

Sulfasalazine

99
Q

Management of polymyositis/dermatomyositis

A

Oral prednisolone
Immunosuppression
Bisphosphonates - prevent glucocorticoid induced osteoporosis

100
Q

Immunosuppression drugs used for polymyositis / dermatomyositis

A

Azathioprine

Methotrexate

101
Q

Indications for allopurinol therapy for gout

A

Recurrent attacks
Tophi
Bony damage
Coexistent renal disease
Very high uric acid levels

102
Q

Diagnosis of SLE

IM DAMN SHARP

A

4 out of 11 criteria:

Immunological disorder

Malar rash

Discoid rash

Arthritis

Mouth ulcers

Neurological disease

Serositis

Haematological disorder

Alopecia

Raynaud’s

Photosensitivity

103
Q

Serositis for SLE diagnosis

A

Pleurisy

Pericarditis

104
Q

Renal disease for SLE diagnosis

A

Nephrotic syndrome

Glomerulonephritis

105
Q

Haematological disorders for SLE diagnosis

A

Anaemia

Leukopenia

Thrombocytopenia

106
Q

Neurological disease for SLE diagnosis

A

Seizures

Psychosis

107
Q

Immunological disorder for SLE diagnosis

A

anti-dsDNA

ANA

108
Q

Allopurinol drug interactions

A

Warfarin
Azathioprine

109
Q

Presentation of reactive arthritis

A

Acute
Asymmetrical inflammatory oligoarthritis
Predominantly lower limb

110
Q

Prognosis of reactive arthritis

A

First presentation usually self limiting 2-4 months
Often recurrs

111
Q

Mechanical back pain features

A

Acute onset
Age usually 20-55
Worsened by movement
Relieved by rest

112
Q

Polyarteritis nodosa definition

A

Necrotising inflammation of medium sized arteries
Leads to aneurysms
Organ infarction if untreated

113
Q

Association of polyarteritis nodosa

A

Previous Hep B infection

114
Q

Mx of polyarteritis nodosa

A

High dose glucocorticoids

Eg. cyclophosphamide

115
Q

Association of Polymyalgia Rheumatica

A

Giant cell (temporal) arteritis

116
Q

Sx of Polymyalgia Rheumatica

A

Pain and stiffness around shoulder and hip girdles
No obvious synovitis
Constitutional symptoms

117
Q

Mx of polymyalgia rheumatica

A

Moderate dose glucocorticoids

Eg. prednisolone

118
Q

Mx of SLE

A

Hydroxychloroquine +/- glucocorticoids
Immunosuppressants
Depends on organ involvement

119
Q

Immunosuppressants used for SLE

A

Azathioprine

Methotrexate

120
Q

Connective Tissue Diseases (CTDs) definition

A

Group of non-organ specific autoimmune diseases

121
Q

Mx of gout

A

High fluid intake
NSAIDs
Colchicine
Allopurinol

122
Q

Colchicine SEs and use

A

GI side effects

Used when NSAIDs not tolerated

123
Q

Allopurinol

A

Xanthine oxidase inhibitor

Lowers uric acid

124
Q

Behcet’s syndrome defintion

A

Systemic vasculitis

125
Q

Sx of Behcet’s syndrome

A

Eye, oral and genital ulcers

126
Q

Genetic associations of Behcet’s syndrome

A

HLA-B51 or HLA-B27

127
Q

Ethnic group Behcet’s syndrome more common in

A

Mediterranean, Middle Eastern and Far Eastern

128
Q

Mx of Behcet’s syndrome

A

Colchicine for ulceration
Glucocorticoids +/- immunosuppressants (azathioprine)

129
Q

Management of pseudogout

A

Joint aspirations may relieve symptoms
Intra-articular steroid injection shortens attack
NSAIDs
COX-2 selective agents

130
Q

Polymyositis / dermatomyositis antibodies and Ix

A

Anti-Jo-1

Raised CK

131
Q

Antiphospholipid syndrome Sx

A

Venous/arterial thrombosis
Thrombocytopenia
Recurrent miscarriages
Cerebral disease
Livedo reticularis

132
Q

Mx of antiphospholipid syndrome

A

Anticoagulation

Aspirin, warfarin

133
Q

Examples of CTDs

A

SLE

Sjogren’s

Systemic sclerosis

134
Q

SE of methotrexate

A

Folate depletion

135
Q

Heberden’s nodes

A

Bony prominence DIP

136
Q

Bouchard’s nodes

A

Bony prominence PIP

137
Q

Palindromic arthritis definition

A

Stiffness and Sx come and go

138
Q

Modified mankin score use

A

Shows degree of cartilage breakdown

139
Q

Examination findings for OA

A

Varus knees

Herberden’s nodes

Bouchard’s nodes

Baker’s cyst

140
Q

Mx of OA

A

Analgesia (NSAIDs)

Intra-articular steroid injection

Sugery / replacement

141
Q

Enthesis definition

A

Where tendon, ligament or capsule inserts on bone

142
Q

Psoriatic arthritis definition

A

Associated with psoriasis

143
Q

Mx of psoriatic arthritis

A

DMARDs

Anti-TNF biologics

Immunosuppressants

144
Q

SEs of bisphosphonates

A

TMJ necrosis

Atypical femoral fracture

145
Q

When and how to take bisphosphonates

A

Before breakfast

Standing / sitting up for 30 mins

146
Q

Paget’s disease definition

A

Abnormal bone remodelling

147
Q

Mx of Paget’s disease

A

Bisphosphonates

148
Q

Wegener’s granulomatosis other name

A

GPA

Granulomatosis with polyarteritis

149
Q

Wegener’s granulomatosis definition

A

Medium vessel vasculitis

Characteristic saddle-nose deformity due to perforated septum

150
Q

Sx of Wegener’s granulomatosis

A

Affects ears, nose, kidneys, lungs

Constitutional sx

SOB, cough

Haematuria

151
Q
A
152
Q

RA aetiology

A

Associated with HLA-DR4 inheritance (Human Leukocyte Antigen genes)

T-lymphocytes target normal tissue

153
Q

RA deformities

A

Ulnar deviation of fingers

Swan neck deformity

Boutanierre deformity

Z thumbs

MS4 - MDEMO (4 decks)

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