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Finals > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

pain in first 15 degrees of arm abduction?

A

supraspinatus

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2
Q

pain in 60-120 degrees of arm abduction

A

glenohumeral joint , deltoid

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3
Q

pain in final 10 degrees of arm abduction?

A

ACJ

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4
Q

what joints are commonly affected in OA

A 
DIP (heberdens nodes), 1st MCP (thumb base), knees
also PIP (bouchards nodes)
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5
Q

cardinal signs of arthritis (5)

A

pain, stiffness, swelling, deformity, loss of function

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6
Q

x ray features of OA

A

osteophytes, loss of joint space, sub articular sclerosis (dense lesion), subchondral cysts (lucent lesions)

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7
Q

describe the presentation of RA

A

symetrical small joints
morning stiffness lasting over 1 hour
spares DIP

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8
Q

which joints does RA commonly affect

A

MCP and PIP
wrist
MPJ (base of big toes) and ankle

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9
Q

PIP flexion with DIP hyperextension - what deformity?

A

Boutonniere

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10
Q

PIP extension with DIP flexion - what deformity?

A

swan neck

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11
Q

list extra articular features of RA (by system)

A

neuro: radiculopathies, CTS
resp: nodules, fibrosis, effusions
cardio: pericarditis, myocarditis, valve disease, increased risk of CVD
Derm: rheumatoid nodules, palmar erythema
heam: felty’s (neutropenia, anaemia, splenomegaly), pernicious anaemia, anaemia of chronic disease, iron deficiency, haemolytic, microscytic, vasculitis (and raynaud’s)
opthal: sjogren’s, keratoconjunctivitis, episcleritis, keratitis, uveitis

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12
Q

investigations in RA and imaging findings

A

ESR, CRP, platelets, ferritin, anti-ccp, RF (all raised)

x ray: soft tissue swelling, sub articular osteopenia (lucency), subluxation, joint space narrowing

MRI and USS - synovitis and erosions

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13
Q

how can you measure RA progression

A 
DAS 28 (disease activity score)
>5.1 = active and <3.2 = controlled
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14
Q

management of RA

A

DMARD (methotrexate) within 3 months of sx
- needs PFT’s, LFTs and FBC monitoring and folic acid

2nd line - infliximab (TNF alpha), rituximab (B cell)
- need infection screen and contraception

corticosteroids in acute flares

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15
Q

what disease are people with RA more prone to

A

lymphoma and CVD (atherosclerosis)

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16
Q

what joints does gout commonly affect?

A 
1st MTP (base of thumb)
knee, elbow, wrist
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17
Q

where do tophi commonly form in gout?

A

pinna (ear)

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18
Q

what does thenar wasting suggest?

A

median nerve pathology

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19
Q

what does hypothenar wasting suggest?

A

ulnar nerve pathology (ulnar claw)

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20
Q

investigations in gout

A

needle aspiriation of synovial fluid- negatively bifrimget needle shaped crystals
gram stain and culture
uric acid
xray

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21
Q

management of gout

A

NSAIDs (colchicine if cant have nsaids)

allopurinol Px

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22
Q

risk factors for pseudogout

A

elderly, illness, dehydration, surgery, steroid use

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23
Q

investigations in pseudogout

A

synovial fluid aspiration - positively bifringent rhomboid shaped crystals and neutrophils
chondrocalcinosis on x ray and linear opacification of articular cartilage

24
Q

what clinical presentation os specific to seronegative arthropathy?

A

dactylitis

25
Q

presentation and signs in ank spond

A

enthesitis and synovitis (esp achilles tendon), morning stiffness, reduced forward lumbar flexion (Schober’s test <5cm), tender sacroiliac joints, reduced chest expansion, anterior uveitis, IBD (UC), aortic regurge

26
Q

investigations in ank spond

A

HLA b27 testing
MRI
Xray: sacroiliitis, erosions, sclerosis, vertebral syndesmophytes, bamboo spine
absence of ANA and RF

27
Q

what drug may help in ank spond

A

TNF alpha blockers - enteracept

28
Q

what joints does psoriatic arthritis affect and what does imaging show

A

DIP

erosions and pencil in a cup appearance on x ray (Mutilans)

29
Q

what is reiters syndrome

A

conjunctivitis, urethritis, arthritis

30
Q

what is reactive arthritis

A

sterile mono/oligoarthritis 1-4 weeks following STI/GI infection

31
Q

what must you do to rule out septic arthitis

A

aspitiation and culture

32
Q

what signs are highly predictive of a connective tissue diease

A

mouth ulcers

raynauds

33
Q

list the signs and symptoms of SLE

A 
SOAP BRAIN MD
Serositis (pleuritis/pericarditis)
Oral ulcers
Arthritis - non erosive, >2 peripheral joints
Photosensitivity
Blood - anaemia, leucocytopenia, thrombocytopenia
Renal - proteinuria
ANA +ve 
Immunological (anti DNA, anti sm, anti phospholipid, low complement)
Neuro - seizures, psychosis, depression
Malar rash (in acute cutaneous)
Discoid rash (chronic cutaneous)

systemically unwell, raynauds, thrombosis

34
Q

list the drugs which cause SLE

A

isoniazid, hydralazine, chlorpromazine, phenytoin, methyl dopa

35
Q

management of acute and chronic SLE

A

IV cyclophosphamide and prednisolone

hydroxychloroquine an steroids for maintenance

36
Q

diagnosis of antiphospholipid syndrome

A

CLOT
Coagulation - thrombosis (cerebral and renal)
Livedo reticularis
Obstetric complications
Thrombocytopenia (low platelets, raised APTT)

antibodies (anti cardiolipin, lupus anticoagulant) present 12 weeks apart

37
Q

what antibodies are present in sjogren’s (implications for fetus)

A

ANA, RF (very high), ESR, anti ro and anti la cause fetal heart block

38
Q

investigations in sjrogrens

A

antibodies (RF, ANA, anti ro and anti la)
schirmer’s test, sialometry, salivary gland biopsy
ESR

39
Q

management of sjogren’s and review

A

annual - risk of lymphoma and vasculitis
dental review
artificial tears and saliva

40
Q

describe the limited cutaneous form of systemic sclerosis

A

CREST - subcutaneous calcinosis, raynauds, oesophageal and gut dysmotility, Sclerodactyly (face and hands only), telangiectasia
organ fibrosis - pulmonary HTN
anti centromere Abs

41
Q

describe the diffuse cutaneous form of systemic sclerosis

A

scleroderma on arms face legs and trunk
fibrosis of organs
renal crisis: accelerated HTN, headache, oliguria

42
Q

describe polymyositis and investigations

A

pelvic girdle weakness (cant get out of chair)
dysphagia - pharyngeal weakness
interstitial lung disease

muscle breakdown: CK, ALT, AST, LDH, biopsy
Anti Jo

43
Q

describe dermatomyositis and investigations

A

Rash over neck and back - shawl sign
gottron’s papules over MCP
systemic symptoms
anti Mi2 and muscle biopsy

44
Q

what is behcet’s disease and management

A

oral and genital ulcers
non erosive arthritis
eye and skin lesions
1-2 years steroids

45
Q

example of large vessel vasculitis

A

Giant cell arteritis, takyasus

46
Q

example of medium vessel arteritis

A

polyarteritis nodosa, kawasakis

47
Q

example of small vessel vasculitis (and descriptions)

A

ANCA positive:
polyangiitis (glomerulonephritis and pulmonary hemorrhage
Churg strauss (eosinophilia, granulomatous inflammation, vasculitis - asthma, sinusitis, mononeuritis multiplex, haemoptysis, haematuria)
granulomatosis polyangiitis (ENT, lungs, kidneys - C-ANCA P3)

ANCA negative:
cryoglobulinemia
HSP - abdo pain, rash, arthritis, nephrotic syndrome
goodpasture’s - glomerulonephritis and pulmonary hemorrhage

48
Q

what is polymyalgia rheumatica associated with?

A

GCA

49
Q

presentation of PMR

A

bilateral pain and stiffness in arms and legs

cant brush hair/ get out of chair

50
Q

where does GCA affect

A

aorta, cerebral arteries, temporal artery

51
Q

investigations in GCA

A

ESR and biopsy

ANCA , C3, C4

52
Q

what is takayasu’s arteritis and how does it present

A 
granulomatous inflammation of aorta and its branches
in asian women under 40
stenosis, occlusion, aneurysm, stroke
unequal BP/absent pulses = occlusion
need CT angiography
53
Q

what is polyarteritis nodosa and presentation

A

vasculitis causing tissue ischaemia

associated with hepatitis B

54
Q

what must you screen regularly is on hydroxyxhloyquine

A

eyes - maculopathy

55
Q

what is fibromyalgia associated with and how can you assess it

A

hypermobility
beighton score /9
- knees, elbows, finger, thumb, trunk

56
Q

diagnosis of fibromyalgia

A

11/18 tender points

Finals (18 decks)

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