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Musculoskeletal > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Is SLE more F or M predominant

A

F

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2
Q

Typical onset of SLE

A

15-50yrs

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3
Q

Aetiology SLE

A 
Exact cause unknown 
Genetics 
Sex hormone status 
Drugs 
UV light (can trigger attacks )
EBV exposure
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4
Q

Who is SLE a disease of

A

Young females

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5
Q

Which Autoantibodies are associated with SLE

A

ANA
Anti-dsANA
Anti-smith
Anti Ro

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6
Q

What happens to serum compliment levels in SLE

A

Decreases

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7
Q

Which organ does SLE affect

A

It is a multi system autoimmune disease

It affects many organs and many systems (systemic)

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8
Q

Who should you suspect SLE in

A

Young females

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9
Q

Face manifestations of SLE

A

Butterfly rash
Photosensitivity
Malar flush

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10
Q

What types of disease is SLE

A

Autoimmune

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11
Q

What is the main cause of SLE

A

Exact cause is unknown

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12
Q

Chest manifestations of SLE

A

Pleurisy
Pleural effusion
Fibrosis

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13
Q

Joint manifestation of SLE

A

Arthritis of small joints

Aseptic necrosis of hip

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14
Q

Nervous system manifestations of SLE

A 
Fits 
Hemiplegia 
Ataxia 
Peripheral neuropathy 
CN lesions
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15
Q

Heart manifestations of SL

A

Pericarditis
Endocarditis
Aortic valve lesions
Cardiomyopathy

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16
Q

GI manifestations SLE

A

Abdo. pain

mouth ulcers

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17
Q

Blood manifestations of SLE

A

Anaemia
Leukopenia
Thrombocytopenia

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18
Q

General manifestations of lupus

A 
Fever 
Depression 
Fatigue 
Malaise 
Weight loss 
Lymphadenopathy
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19
Q

What is a far more common cause of a face butterfly rash (compared to SLE)

A

Acne and rosacea

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20
Q

Ix for SLE

A 
FBC 
Anaemia 
Urine dipstick 
ESr 
CRP 
U&Es 
Urea 
Creatinine
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21
Q

Ix autoantibodies for SLEP

A 
Complement level 
ANA 
Anti-dsANA 
Anti-Smith 
Anti-Ro
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22
Q

Imaging Ix for SLE

A

Skin and kidney biopsy
CT scans
CXR

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23
Q

Rx for mild SLE

A

Hydroxychloroquine
High factor sunblock
NSAIDS

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24
Q

Rx for moderate SLE

A

Azathioprine
Methotrexate
Mycophenolate

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25
Q

What type of pattern does SLE follow

A

Relapse and remitting

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26
Q

Name another disease apart from SLE which follows a relapse and remitting course

A

Multiple Sclerosis

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27
Q

Rx for severe SLE

A

Cyclophosphamide
Rituximab
High dose steroids

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28
Q

Why can methotrexate not be given in pregnancy

A

It is teratogenic

29
Q

Are SLE exacerbations more or less common in pregnancy

A

More common

30
Q

What are pregnant ladies with SLE more susceptible to

A

Pre-eclampsia

31
Q

What are safe pregnancy drugs for SLE

A

Azathioprine

Low dose oral steroids

32
Q

Explain the SLE classification criteria

A

Any 4 or more criteria (1 clinical, 1 laboratory)

Or biopsy proven lupus nephritis with +ve ANA or +ve anti-DNA

33
Q

What are the 11 clinical criteria for SLE

A

1) Acute cutaneous lupus/Malar rash (butterfly rash)
2) Chronic cutaneous lupus/Discoid rash (raised, scarring, permanent marks, non scarring alopecia)
3) Non-scarring alopecia
4) Oral/Nasal ulcers
5) Synovitis (2 joints at least)
6) Serositis (pleurisy or pericarditis)
7) Urinalysis (presence of proteinuria or red cell casts)
8) Neurological (unexplained seizures or psychosis)
9) Haematological/ Haemolytic anaemia
10) Leucopenia
11) Thrombocytopenia

34
Q

What is the laboratory criteria for SLE

A 
\+ve ANA 
\+ve Anti-dsANA 
\+ve Anti-Smith 
\+ve Anti-Phospholipi 
Low Complement 
\+ve Direct Coombs Test
35
Q

What is the most common systemic vasculitis

A

Giant Cell Arteritis

36
Q

What is GCA

A

Inflammatory granulomatous arteritis of temporal arteries

37
Q

Signs of GCA

A 
Increased ESR 
Temporal artery tenderness 
Reduced pulsation 
New headache
Jaw claudication 
Beaded appearance
38
Q

What is the most feared manifestation of GCA

A

Sudden painless temporary vision loess in one eye

39
Q

What is vision loss caused by in GCA

A

Involvement of ophthalmic artery

40
Q

What is the Dx for GCA

A

Temporal artery biopsy

41
Q

Rx GCA

A

High dose prednisone

42
Q

What is GCS associated with in 50%

A

Polymyalgia Rheumatica

43
Q

What is Polymyositis characterised by

A

Insidious onset of progressive symmetrical proximal muscles weakness and autoimmune mediated striated muscle inflammation

44
Q

What is dermatomyositis

A

When there is polymyositis with skin involvement

45
Q

Signs of polymyositis

A

Proximal weakness of muscles

Muscle wasting

46
Q

Skin signs of Dermatomyositis

A

Gottron’s Papules
Helitrope Rash
Macular rash

47
Q

What is Shawl sign

A

Shawl sign is +ve if there is a muscular rash all over the back and shoulders

48
Q

where does a heliotrope rash affect

A

The eyelids

49
Q

Main symptoms of Polymyositis

A

Proximal muscle weakness

50
Q

Which enzyme is elevated in polymyositis

A

Creatinine

51
Q

Ix polymyositis

A

Creatinine
EMG
Muscle biopsy

52
Q

Rx for polymyositis

A

Prednisolone (steroids)

Immunosuppression:
Methotrexate

To treat rashes:
Hydroxychloroquine
Topical Tacrolimus

53
Q

What is the diagnosis
45 Y female presents with 3/7 Hx difficulty breathing and right sided chest pain worse with deep inspiration. Her CXR confirms right pleural effusion. Treatment with antibiotics makes no difference. Her FBC showed persistently low WCC of 3.0 then 3.2 and low platelets of 100. In the last year she has been experiencing intermittent pain and swelling in her joints and recurrent facial rash after sun exposure .

A

SLE

54
Q

Complications polymyositis

A

Increased malignancy risk

Increased interstitial lung disease risk

55
Q

Which gender does Sjogren’s much more commonly affect

A

Females

56
Q

What are the primary symptoms of Sjogren;s

A 
Dry eyes
Dry mouth 
Dry skin 
Parotid gland enlargement
Vaginal sryness
57
Q

Ix for Sjogren’s

A 
FBC 
RF 
ANA antibodies 
Anti-Ro 
Anti-La

Schirmer Tear Test
Rose Bengal staining
Biopsies

58
Q

Rx for Sjogren’s

A

Artificial tears and saliva replacement solutions
Lubricants

Hydroxychloroquine

59
Q

Complications of Sjogren’s

A 
Lymphoma 
Non-Hodgkin’s B Cell Lymphoma
Neuropathy 
Purpura 
Interstitial lung disease
Renal tubular acidosis
60
Q

Which disease does polymyalgia rheumatic have a close connection with

A

Giant cell arteritis

61
Q

what is polymyalgia

A

Polymyalgia rheumatica (PMR) is an inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years.

62
Q

What is the pathogenesis of polymyalgia rheumatica

A

Unknown

63
Q

What is the most common presentation of polymyalgia rheumatica

A

Pain and stiffness in the neck, shoulder girdle +/- pelvic girdle

64
Q

Rx of polymyalgia rheumatica

A

Corticosteroid (prednisolone)

65
Q

Which medication should there be a dramatic response to in polymyalgia rheumatica

A

Corticosteroids

66
Q

which criteria would indicate a positive diagnosis of Polymyalgia Rheumatica

A

Age >50yrs
Pain in shoulders or hips
Stiffness in the morning that persists >45 mins
Symptoms have lasted >2 weeks
Blood tests should increased ESR andCRP
Dramatic response to Prednisolone (corticosteroids)

67
Q

what is a 2nd line rx for polymyalgia rheumatica

A

Methotrexate (DMARD)

68
Q

Ix for Polymyalgia Rheumatcia

A

NO specific Ix or Test

Bloods:
CRP
ESR
RF (to rule out RA)

Strong suggestive diagnostic factors

69
Q

Which gender is polymyalgia rheumatic more common in

A

Females

Musculoskeletal (13 decks)

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