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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
presentation and signs in ank spond
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
investigations in ank spond
HLA b27 testing MRI Xray: sacroiliitis, erosions, sclerosis, vertebral syndesmophytes, bamboo spine absence of ANA and RF
27
what drug may help in ank spond
TNF alpha blockers - enteracept
28
what joints does psoriatic arthritis affect and what does imaging show
DIP | erosions and pencil in a cup appearance on x ray (Mutilans)
29
what is reiters syndrome
conjunctivitis, urethritis, arthritis
30
what is reactive arthritis
sterile mono/oligoarthritis 1-4 weeks following STI/GI infection
31
what must you do to rule out septic arthitis
aspitiation and culture
32
what signs are highly predictive of a connective tissue diease
mouth ulcers | raynauds
33
list the signs and symptoms of SLE
``` 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
list the drugs which cause SLE
isoniazid, hydralazine, chlorpromazine, phenytoin, methyl dopa
35
management of acute and chronic SLE
IV cyclophosphamide and prednisolone | hydroxychloroquine an steroids for maintenance
36
diagnosis of antiphospholipid syndrome
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
what antibodies are present in sjogren's (implications for fetus)
ANA, RF (very high), ESR, anti ro and anti la cause fetal heart block
38
investigations in sjrogrens
antibodies (RF, ANA, anti ro and anti la) schirmer's test, sialometry, salivary gland biopsy ESR
39
management of sjogren's and review
annual - risk of lymphoma and vasculitis dental review artificial tears and saliva
40
describe the limited cutaneous form of systemic sclerosis
CREST - subcutaneous calcinosis, raynauds, oesophageal and gut dysmotility, Sclerodactyly (face and hands only), telangiectasia organ fibrosis - pulmonary HTN anti centromere Abs
41
describe the diffuse cutaneous form of systemic sclerosis
scleroderma on arms face legs and trunk fibrosis of organs renal crisis: accelerated HTN, headache, oliguria
42
describe polymyositis and investigations
pelvic girdle weakness (cant get out of chair) dysphagia - pharyngeal weakness interstitial lung disease muscle breakdown: CK, ALT, AST, LDH, biopsy Anti Jo
43
describe dermatomyositis and investigations
Rash over neck and back - shawl sign gottron's papules over MCP systemic symptoms anti Mi2 and muscle biopsy
44
what is behcet's disease and management
oral and genital ulcers non erosive arthritis eye and skin lesions 1-2 years steroids
45
example of large vessel vasculitis
Giant cell arteritis, takyasus
46
example of medium vessel arteritis
polyarteritis nodosa, kawasakis
47
example of small vessel vasculitis (and descriptions)
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
what is polymyalgia rheumatica associated with?
GCA
49
presentation of PMR
bilateral pain and stiffness in arms and legs | cant brush hair/ get out of chair
50
where does GCA affect
aorta, cerebral arteries, temporal artery
51
investigations in GCA
ESR and biopsy | ANCA , C3, C4
52
what is takayasu's arteritis and how does it present
``` 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
what is polyarteritis nodosa and presentation
vasculitis causing tissue ischaemia | associated with hepatitis B
54
what must you screen regularly is on hydroxyxhloyquine
eyes - maculopathy
55
what is fibromyalgia associated with and how can you assess it
hypermobility beighton score /9 - knees, elbows, finger, thumb, trunk
56
diagnosis of fibromyalgia
11/18 tender points

Finals (18 decks)

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