Rheumatology Flashcards
1
Q
Diagnosis of gout
A
Hx
Joint aspiration
Raised urate and CRP
2
Q
Common organisms causing acute septic arthritis
A
Staph aureus
H influenza
Streptococci
Gonococci (in US)
3
Q
Organisms associated with chronic septic arthritis
A
TB
Fungi
Brucella
4
Q
Diagnosis of septic arthritis
A
Clinical Hx
Synovial fluid culture / microscopy
5
Q
Sx of septic arthritis
A
Night sweats
Fever
Raised WCC
6
Q
Types of arthritis
A
Osteoarthritis (OA)
Rheumatoid arthritis (RA)
Ankylosing spondylitis
Gout
7
Q
OA
Age
F:M
Affected part
A
> 50
F > M
Cartilage
8
Q
RA
Age
F:M
Affected part
A
30 - 50
F>M
Synovium
9
Q
Ankylosing spondilitis
Age
F:M
Affected part
A
15 - 30
M >> F
Enthesis
10
Q
Gout
Age
F:M
Affected part
A
> 40
M > F
Crystals
11
Q
OA radiograph changes
A
JOBS
Joint space narrowing
Osteophytes
Sclerosis
Subchondral cysts
12
Q
RA radiograph changes
A
Joint space narrowing
Juxta-articular osteoporosis
Erosions
Deformities
13
Q
Mx of Sjogren’s syndrome
A
Dry eyes - artificial tears
Xerostomia - artificial saliva, lozenges, pilocarpine
Dyspareunia - lubricant jelly
Major organ involvement - glucocorticoids
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
15
Q
Management of systemic sclerosis
A
Supportive
Stop smoking - lung involvement
Keep hands warm
ACE inhibitors
IV prostacyclin if severe
16
Q
Use of ACEi in systemic sclerosis
A
Prevent accelerated hypertension
17
Q
Medication to avoid in systemic sclerosis
A
Beta blocker
Vasoconstriction
18
Q
Radiological findings of psoriatic arthritis
A
Pencil and cup sign
Hazy joints
19
Q
Clinical presentations of gout
A
Asymptomatic hyperuricaemia
Acute gout
Atypical gout
Intercritical gout
Chronic tophaceous gout
20
Q
Atypical gout
A
Bursitis
Cellulitis
Tenosynovitis
21
Q
Intercritical gout definition
A
Recurrent acute attacks
22
Q
Chronic tophaceous gout definition
A
Progressive erosive joint destruction
Tophi
23
Q
Common locations of tophi
A
Ear
Hands
Extensor surfaces
24
Q
Radiograph findings of Ankylosing Spondylitis
A
Loss of joint space
Sclerosis
Syndesmophyte formation / bamboo spine
Sacroiliac joint involvement
25
Extra-articular manifestations of ank spond
Anterior uveitis
Apical lung fibrosis
Achilles tendonitis
Aortic regurgitation
Amyloidosis
26
RFs for gout
Obesity
Alcohol
Renal failure
Diuretic use
27
Reason for diuretics increasing risk of gout
Impaired urate excretion
28
Gout crystal definition
Urate crystals
Needle shaped
Negatively birefringent
29
Pseudogout crystal definition
Calcium pyrophosphate crystals
Rhomboid shaped
Positively birefringent
30
Psoriatic arthritis age
25-40
31
Psoriatic arthritis definition
Asymmetrical inflammatory oligoarthritis
Seronegative
32
Serious complication of psoriatic arthritis
Arthritis mutilans
33
Main joints affected by psoriatic arthritis
DIP joints
Predominantly hands and feet
34
Post infection
Reactive arthritis definition
Inflammatory oligoarthritis
35
Organisms causing reactive arthritis
Chlamydia
Gonnorhoea
Campylobacter
Salmonella
Shigella
Yersinia
36
Nail changes in psoriatic arthritis
Nail pitting
Onycholysis
Subungal keratosis
37
Early radiograph changes in septic arthritis
Soft tissue swelling
38
Radiograph changes in septic arthritis 10-14 days
Joint space narrowing
Erosions
Osteomyelitis
39
Late radiograph changes in septic arthritis
Destruction of surrounding bone
40
Constitutional B symptoms
Eg.
Fatigue
Malaise
Weight loss
Low grade pyrexia
Night sweats
41
Oligoarthritis definition
\< 5 joints affected
42
Polyarthritis definition
5+ joints affected
43
Causes of haemarthrosis
Haemophilia
Bleeding disorders
Anticoagulant therapy
Trauma
44
Management of haemarthrosis
Correct bleeding disorder first
Physio
Only aspirate if diagnostic uncertainty - not until corrected bleeding disorder
45
Clinical features of Sjogren's syndrome
Dry eyes
Dry mouth
Dry vagina
Raynaud's
Organ and glandular involvement
46
Xerostomia
Dry mouth
47
Systemic Lupus Erythematosus (SLE) antibodies
Anti-dsDNA
Anti-Ro and Anti-La
48
Enteropathic arthritis definition
Associated with IBD
Arthritis exacerbations often simultaneous with IBD flare ups
Acute onset
49
Main joints affected by enteropathic arthritis
Typically large joints of lower limb
50
Systemic sclerosis antibodies
ANA
Anti-centromere or Anti-Scl-70
51
Other Ix for systemic sclerosis
Normocytic anaemia
52
Causes of mechanical back pain
Damage to:
- Vertebrae
- Intervertebral discs
- Facet joints
- Sacroiliac joints
- Spinal cord
- Nerves
53
Fibromyalgia definition
Chronic
Widespread joint involvment
F \> M
54
Sx of fibromyalgia
Poor sleep
Tender trigger points
55
Sjogren's syndrome definition
Autoimmune
Primary Sjogren's - occurs alone
Secondary Sjogren's - associated with other autoimmune rheumatic diseases
56
Sjogren's syndrome Ix
Schirmer's test helpful (leave 5 mins)
Antibodies
57
Sjogren's syndrome antibodies
Anti-Ro and Anti-La
58
Risk with Sjogren's syndrome
Increased lymphoid malignancy risk
59
Types of seronegative spondyloarthropathy
Psoriatic arthritis
Enteropathic arthritis
Ankylosing spondylitis
Reactive arthritis
60
Axial skeleton
Bones of head, trunk and spine
61
Inflammatory back pain description
Chronic onset \> 3 months
Relieved by activity
Worsened by rest or sleep
62
Inflammatory back pain age
Usually age \< 40
63
Gout vs Pseudogout pain
Gout more painful than pseudogout
64
Vasculitis definition
Inflammation of blood vessels
Large vessel
Medium vessel
Small vessel
Arteries and veins
65
Large vessel vasculitis example
Giant cell (temporal) arteritis
66
Medium vessel vasculitis example
Polyarteritis nodosa
67
Small vessel vasculitis example
Wegener's granulomatosis
68
Arteries and veins vasculitis example
Behcet's syndrome
69
Course of CTDs
Chronic
Relapsing/remitting
70
Common clinical features of connective tissue disorders (CTDs)
Constitutional symptoms
Raynaud's
Mouth ulceration
Rashes
Alopecia
71
Ix for reactive arthritis
Joint aspirate
Chlamydia test - often asymptomatic
72
Differentials for red hot swollen joint
Septic arthritis
Gout
Reactive arthritis
Haemarthrosis
(Cellulitis)
73
Gold standard Ix for seronegative spondyloarthropathy
MRI
74
Mx of septic arthritis
Urgent joint aspiration
IV broad spectrum abx
More appropriate abx after culture
75
Characteristic joint aspirate description of septic arthritis
Fluid characteristically thick and purulent
76
Diagnosis of pseudogout
Synovial fluid analysis
Fluid often blood stained or turbid
X-ray may show chondrocalcinosis
77
Polymyositis/Dermatomyositis definition
Autoimmune
Inflammation of striated muscle +/- dermatological features
Organ involvement - eg. lungs
Can have malignant cause
78
Seronegative spondyloarthropathy definition
Collection of Sx / signs
Extrasynovial inflammation of axial skeleton, entheses and cartilaginous joints
Untreated leads to spinal fusion and disfigurement
79
Genetics of seronegative spondyloarthropathies
Associated with HLA-B27
80
Conditions associated with HLA-B27
PUBCAR
Psoriatic arthritis
UC
Behcet's
Crohns
Ank spond
Reactive arthritis
81
Peripheral presentation of spondyloarthropathy
Silimar to RA but asymmetrical and less severe
82
Association of Giant cell (temporal) arteritis
Polymyalgia Rheumatica
83
Giant cell (temporal) arteritis definition
Granulomatous arteritis of aorta and large blood vessels
84
Sx of giant cell arteritis
Headaches/scalp tenderness
Jaw claudication
Visual disturbances - CRAO
85
CRAO
Central retinal artery occlusion
86
Mx of giant cell arteritis
Prednisolone
87
Giant cell arteritis
Age
ESR
Rx
Age \> 60
ESR \> 60
Prednisolone 60 mg
88
Pathogenesis of Ankylosing Spondylitis
Chronic inflammation of entheses and cartilagenous joints
Leads to fibrosis with calcification
Syndesmophyte formation
Usually starts with sacroilliac joints
89
Sexually acquired reactive arthritis (Reiter's syndrome)
Reactive arthritis
Urethritis
Conjunctivitis
90
Features common in vasculitis
Pyrexia + normal cultures
Weight loss
Rashes
Sensory / motor loss
91
Systemic sclerosis / scleroderma definition
Fibrosis and microvascular damage
92
Sx of systemic sclerosis / scleroderma
CREST:
Calcinosis
Raynaud's
Oesophageal dysmotility
Scleradactyly
Telangiectasia
Organ involvement - lungs, GI
93
Clinical features of polymyositis / dermatomyositis
Painless proximal muscle weakness
Joint pains
Heliotrope rash
Interstitial lung disease
Dysphagia
94
Heliotrope rash
Purple-ish rash on eyelids
95
Rheumatism definition (vs arthritis)
Pain and stiffness from structures outside joints
96
Management of spondyloarthropathy
Physio
NSAIDs
Anti-TNF
DMARDs (no effect for axial symptoms)
97
Anti-TNF drug examples
Infliximab
Etanercept
98
DMARDs examples
Methotrexate
Sulfasalazine
99
Management of polymyositis/dermatomyositis
Oral prednisolone
Immunosuppression
Bisphosphonates - prevent glucocorticoid induced osteoporosis
100
Immunosuppression drugs used for polymyositis / dermatomyositis
Azathioprine
Methotrexate
101
Indications for allopurinol therapy for gout
Recurrent attacks
Tophi
Bony damage
Coexistent renal disease
Very high uric acid levels
102
Diagnosis of SLE
IM DAMN SHARP
4 out of 11 criteria:
Immunological disorder
Malar rash
Discoid rash
Arthritis
Mouth ulcers
Neurological disease
Serositis
Haematological disorder
Alopecia
Raynaud's
Photosensitivity
103
Serositis for SLE diagnosis
Pleurisy
Pericarditis
104
Renal disease for SLE diagnosis
Nephrotic syndrome
Glomerulonephritis
105
Haematological disorders for SLE diagnosis
Anaemia
Leukopenia
Thrombocytopenia
106
Neurological disease for SLE diagnosis
Seizures
Psychosis
107
Immunological disorder for SLE diagnosis
anti-dsDNA
ANA
108
Allopurinol drug interactions
Warfarin
Azathioprine
109
Presentation of reactive arthritis
Acute
Asymmetrical inflammatory oligoarthritis
Predominantly lower limb
110
Prognosis of reactive arthritis
First presentation usually self limiting 2-4 months
Often recurrs
111
Mechanical back pain features
Acute onset
Age usually 20-55
Worsened by movement
Relieved by rest
112
Polyarteritis nodosa definition
Necrotising inflammation of medium sized arteries
Leads to aneurysms
Organ infarction if untreated
113
Association of polyarteritis nodosa
Previous Hep B infection
114
Mx of polyarteritis nodosa
High dose glucocorticoids
Eg. cyclophosphamide
115
Association of Polymyalgia Rheumatica
Giant cell (temporal) arteritis
116
Sx of Polymyalgia Rheumatica
Pain and stiffness around shoulder and hip girdles
No obvious synovitis
Constitutional symptoms
117
Mx of polymyalgia rheumatica
Moderate dose glucocorticoids
Eg. prednisolone
118
Mx of SLE
Hydroxychloroquine +/- glucocorticoids
Immunosuppressants
Depends on organ involvement
119
Immunosuppressants used for SLE
Azathioprine
Methotrexate
120
Connective Tissue Diseases (CTDs) definition
Group of non-organ specific autoimmune diseases
121
Mx of gout
High fluid intake
NSAIDs
Colchicine
Allopurinol
122
Colchicine SEs and use
GI side effects
Used when NSAIDs not tolerated
123
Allopurinol
Xanthine oxidase inhibitor
Lowers uric acid
124
Behcet's syndrome defintion
Systemic vasculitis
125
Sx of Behcet's syndrome
Eye, oral and genital ulcers
126
Genetic associations of Behcet's syndrome
HLA-B51 or HLA-B27
127
Ethnic group Behcet's syndrome more common in
Mediterranean, Middle Eastern and Far Eastern
128
Mx of Behcet's syndrome
Colchicine for ulceration
Glucocorticoids +/- immunosuppressants (azathioprine)
129
Management of pseudogout
Joint aspirations may relieve symptoms
Intra-articular steroid injection shortens attack
NSAIDs
COX-2 selective agents
130
Polymyositis / dermatomyositis antibodies and Ix
Anti-Jo-1
Raised CK
131
Antiphospholipid syndrome Sx
Venous/arterial thrombosis
Thrombocytopenia
Recurrent miscarriages
Cerebral disease
Livedo reticularis
132
Mx of antiphospholipid syndrome
Anticoagulation
Aspirin, warfarin
133
Examples of CTDs
SLE
Sjogren's
Systemic sclerosis
134
SE of methotrexate
Folate depletion
135
Heberden's nodes
Bony prominence DIP
136
Bouchard's nodes
Bony prominence PIP
137
Palindromic arthritis definition
Stiffness and Sx come and go
138
Modified mankin score use
Shows degree of cartilage breakdown
139
Examination findings for OA
Varus knees
Herberden's nodes
Bouchard's nodes
Baker's cyst
140
Mx of OA
Analgesia (NSAIDs)
Intra-articular steroid injection
Sugery / replacement
141
Enthesis definition
Where tendon, ligament or capsule inserts on bone
142
Psoriatic arthritis definition
Associated with psoriasis
143
Mx of psoriatic arthritis
DMARDs
Anti-TNF biologics
Immunosuppressants
144
SEs of bisphosphonates
TMJ necrosis
Atypical femoral fracture
145
When and how to take bisphosphonates
Before breakfast
Standing / sitting up for 30 mins
146
Paget's disease definition
Abnormal bone remodelling
147
Mx of Paget's disease
Bisphosphonates
148
Wegener's granulomatosis other name
GPA
Granulomatosis with polyarteritis
149
Wegener's granulomatosis definition
Medium vessel vasculitis
Characteristic saddle-nose deformity due to perforated septum
150
Sx of Wegener's granulomatosis
Affects ears, nose, kidneys, lungs
Constitutional sx
SOB, cough
Haematuria
151
152
RA aetiology
Associated with HLA-DR4 inheritance (Human Leukocyte Antigen genes)
T-lymphocytes target normal tissue
153
RA deformities
Ulnar deviation of fingers
Swan neck deformity
Boutanierre deformity
Z thumbs
