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FINALS > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are some causes of symmetrical polyarthritis?

A

Rheumatoid

Osteoarthritis

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2
Q

What are some causes of asymmetrical polyarthritis?

A

Reactive

Psoriatic

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3
Q

What are the x-ray findings of osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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4
Q

What are some risk factors for osteoarthritis?

A 
Age
High BMI
Female
FH 
Overuse 
Previous surgery
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5
Q

What should be done for suspected septic arthritis?

A

Joint aspiration, blood cultures

Ortho referral, IV antibiotics, joint washout

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6
Q

What are the categories for diagnostic criteria in RA?

A 
Number of joints involved 
Serology 
Acute phase reactants
Duration of 6 weeks 
Over 6 = diagnostic
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7
Q

What are the serology diagnostic criteria in RA?

A

RF and anti-CCP
Negative = 0
Low positive = 2
High positive = 3

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8
Q

What are the acute phase reactants diagnostic criteria in RA?

A

CRP and ESR
Normal = 0
High = 1

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9
Q

What are the joint involvement diagnostic criteria in RA?

A 
1 large = 0 
2-10 large = 1
1-3 small = 2
4-10 small = 3
Over 10 = 5
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10
Q

What is the initial management of RA?

A
  1. Urgent referral to rheumatology
  2. High dose NSAID + PPI
  3. Do DAS28 to measure severity
  4. 2 x DMARD
  5. Physio and OT
  6. Control CVS risk factors
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11
Q

What are some extra-articular features of RA?

A 
Felty's syndrome 
Atlanto-axial subluxation
Caplan's syndrome (pulmonary nodules)
Effusions 
Blood - normocytic anaemia 
Olecranon bursitis 
Oral dryness 
Kidneys - amyloid 
Sensory neuropathy
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12
Q

What are some risk factors for gout?

A

Male, alcohol, high purine intake, metabolic syndrome, diuretics, CKD

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13
Q

What investigations should be done for suspected gout?

A

FBC, CRP, ESR
Joint aspiration and synovial fluid analysis
UEs, LFTs

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14
Q

When should gout prophylaxis be considered?

A

Over 2 attacks in a year
Tophi
CKD II
Urolithiasis

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15
Q

What are some features of gout prophylaxis?

A

Introduce 2-4 weeks after acute attack
Cover with NSAIDs for 6 months
Aim urate <300 micromoles/L
Alternative = febuxostat

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16
Q

What is pseudo gout?

A

Calcium pyrophosphate deposition
Acute monoarthropathy - usually large joints
Rhomboid crystals on light microscopy

17
Q

What are some features of ankylosing spondylitis?

A

Disease of spine and SI joints
Typically men under 30
Gradual onset low back pain and stiffness
Neck hyperextension and kyphosis

18
Q

What are the x-ray findings in ankylosing spondylitis?

A

SI narrowing
Sclerosis
Erosions
Fusion

19
Q

What is Reiter’s?

A

Urethritis
Arthritis
Conjunctivitis

20
Q

What is the triad of systemic sclerosis?

A
  1. Scleroderma - skin fibrosis
  2. Internal organ fibrosis
  3. Microvascular abnormalities
21
Q

What antibodies should be done for systemic sclerosis?

A

ANA, anti-Scl 70 (diffuse)

Anti-centromere (limited)

22
Q

What are limited and diffuse systemic sclerosis?

A

Limited - face, hands and feet, pulmonary hypertension

Diffuse - can involve whole body, control BP, annual echo and spirometry

23
Q

What is myositis?

A

Inflammation of muscles
Insidious onset
Progressive symmetrical proximal muscle weakness
Can be secondary to malignancy

24
Q

What antibodies are associated with myositis?

A

JO1, anti Mi2

CK

25
Q

What is Sjogren’s syndrome?

A

Often secondary to CTD
Dry eyes and dry mouth
Ro and La antibodies

26
Q

What is SLE?

A

Multisystemic autoimmune disease
Formation of immune complexes
Inadequate clearance, immune response, tissue inflammation & damage

27
Q

What are the 11 diagnostic criteria for SLE? (need over 4)

A
  1. Malar rash
  2. Discoid rash
  3. Photosensitivity
  4. Oral ulcers
  5. Arthritis
  6. Serositis - pleuritis or pericarditis
  7. Renal disorder
  8. Neurological disorder
  9. Haematological disorder
  10. Immunologic disorder
  11. ANA
28
Q

What antibodies are associated with SLE?

A

Anti-DNA
Anti-Smith
Antiphospholipid
ANA

29
Q

What is the treatment for SLE?

A 
Avoid sunlight 
Hydroxychloroquine 
NSAIDs
Lupus nephritis - azathioprine + steroid 
Pregnancy planning
30
Q

What is the anatomy of the boutonniere deformity?

A

Rupture of central slip of extensor expansion
Button hole formed by intact lateral slips
Rheumatoid tenosynovitis

31
Q

What is rheumatoid factor?

A

IgM against your own IgG

32
Q

What signifies active disease in RA?

A

Active synovitis

Red and swollen joints

33
Q

What are some side effects of methotrexate?

A

Bone marrow suppression - neutropenia
Liver and renal toxicity
Pneumonitis/pulmonary fibrosis
FBC, LFTs, UEs every 4-6 weeks

34
Q

What is the cause of atlanto-axial subluxation?

A

Weakened cervical spine tendons
Odontoid peg of axis subluxes backwards
Can compress upper cervical cord

35
Q

What are the x-ray findings in RA?

A 
Soft tissue swelling 
Peri-articular osteoporosis 
Absent osteophytes
Deformity 
Erosions 
Subluxation
36
Q

What is CREST syndrome?

A

Calcinosis, Raynaud’s, (o)esophageal involvement, sclerodactyly, telangiectasia

37
Q

What are the blood findings in osteomalacia?

A

Raised ALP, raised PTH, low vitamin D, low calcium, low phosphate

FINALS (19 decks)

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