Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

500 SBA's > RHEUMATOLOGY > Flashcards

RHEUMATOLOGY Flashcards

1
Q

What is rheumatoid arthritis?

A 
An autoimmune 
systemic inflammatory disorder 
affecting mainly the joints of the hand 
but also associated with extra-articular features. 
Symmetrical deforming polyarthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the HLA associations of Rh A?

A

HLA DR1

HLA DR4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the epidemiology of Rh A?

A

Females

30-50yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the PC of RhA?

A

Gradual joint pain, swelling
Worst in the mornings
Impairs function and movement

+ systemic symptoms: weight loss, fever, fatigue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Early signs on OE for RhA

A

SYMMETRICAL swelling of joints
Warm + Tender joints
MCP, PIP commonly affected
Decrease in range of movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Late signs on OE for RhA

A 
SYMMETRICAL deformed arhtopathy
Ulnar deviation of finger
Radial deviation of wrist
"swan neck"
"boutoinnere"
"z" of thumb
Rheumatoid nodules - hard, firm SC nodules found commonly on elbows and palms (associated with RhF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What investigations do you carry out for RhA?

A 
RhF + 
Anti-CCP + (500 SBA book says this is the most sensitive specific investigation for RhA)
ANA +
Bloods: low HB, high Plt
High ESR + CRP

Joint aspiration to exclude septic arthritis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do you expect to see on Xray for RhA

A

“DONS”

Deformity
Osteopenia
Narrowing of joint space
Swelling of soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which joints are usually spared on new onset RhA?

A

DIP

500 SBA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define psoriasis

A

• A chronic inflammatory skin disease, which has characteristic lesions and may be complicated by arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Recognise ALL the signs/symptoms of psoriasis

A
  • Itching and occasionally tender skin
  • Pinpoint bleeding with removing scales (Auspitz phenomenon)
  • Skin lesions may develop at sites of trauma/scars (Koebner phenomenon)
  • Discoid/Nummular psoriasis - symmetrical, well-demarcated erythematous plaques with silvery scales over extensor surfaces (knee, elbows, scalp, sacrum)
  • Flexural psoriasis - less scaly plaques in axilla, groins, perianal and genital skin
  • Guttate psoriasis - small drop-like lesions over trunk and limbs
  • Palmoplantar psoriasis - erythematous plaques with pustules on palms and soles
  • Generalised pustular psoriasis - pustules distributed over limbs and torso

Nail signs:
o Pitting
o Onycholysis
o Subungual hyperkeratosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Signs of psoriatic arthritis

A 
o  Asymmetrical oligoarthritis  
o  Symmetrical polyarthritis  
o  Distal interphalangeal joint predominance  
o  Arthritis mutilans  
o  Psoriatic spondylitis

Mostly affects DIP and is assymetrical (5% of psoriasis pts will develop psoriatic arthritis) - from 500 SBA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define osteoarthritis

A

• Age-related degenerative joint disease when cartilage destruction exceeds repair, causing pain and disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Recognise the presenting symptoms of osteoarthritis

A
  • Joint pain and discomfort - Use-related *
  • Stiffness or gelling after inactivity
  • Difficulty with certain movements *
  • Feelings of instability
  • Restriction walking, climbing stairs and doing manual tasks

• Systemic features are usually absent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Recognise the signs of osteoarthritis on physical examination

A

• Local joint tenderness
• Bony swellings along joint margins
o Heberden’s Nodes - DISTAL interphalangeal joint
o Bouchard’s Nodes - PROXIMAL interphalangeal joint
• Crepitus and pain during joint movement
• Joint effusion
• Restriction of range of joint movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the classic OA signs on joint xray?

A 
FOUR classic features: 
o  Loss of joint space (narrowing)  
o  Osteophytes  
o  Subchondral cysts  
o  Subchondral sclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Explain the aetiology/risk factors of infective arthritis

A
  • May be idiopathic
  • In most cases there is RECENT systemic infection ** allowing for haematogenous spread
•  Risk Factors 
o  Recent orthopaedic procedures   
o  Osteomyelitis 
o  Diabetes  
o  Immunosuppression 
o  Alcoholism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Common causative organisms of septic arthritis

A

Neisseria gonorrhoeae

o  Viruses 
•  Rubella  
•  Mumps  
•  Hepatitis B 
•  Parvovirus B19

o Fungi
• Candida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Recognise the presenting symptoms of infective arthritis

A

• Fever
• Excruciating joint pain
• Joint redness, swelling and loss of joint function
• Usually a monoarthropathy (usually affecting one large joint)
o NOTE: it may cause a polyarthropathy in the immunosuppressed

• Tuberculous arthritis develops more slowly and is more chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Recognise the signs of infective arthritis on physical examination

A
  • Painful, hot, swollen
  • Immobile joint
  • Erythema
  • Severe pain prevents passive movement
  • Pyrexia
  • Look for signs of aetiology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Identify appropriate investigations for septic arthritis

A

• Joint Aspiration (IMPORTANT)
o In infective arthritis, the aspirate will be grossly purulent **
o Send synovial fluid for MC&S

• Microscopy - rule out crystal arthritis
o PCR may be used if a viral cause is suspected

•  Bloods 
o  FBC - high WCC, high neutrophils  
o  High CRP and ESR  
o  Blood cultures M MC&S 
o  Viral serology may be useful

• Plain Joint Radiographs
o Affected joint may look normal initially
o Can show signs of damage following the infection

• MRI Scan
o Useful for detecting osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Define reactive arthritis

A

• Characterised by a sterile arthritis occurring after an extra-articular infection (commonly GI or urogenital).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Reiter’s syndrome

A

Reiter’s Syndrome is defined as a TRIAD of:
o Reactive arthritis
o Urethritis
o Conjunctivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Explain the aetiology/risk factors for reactive arthritis

A 
•  Associated with infections:  
o  GI 
•  Salmonella 
•  Shigella  
•  Yersinia 
•  Campylobacter

o Urogenital
• Chlamydia trachomatis (60%)*

• It is thought that initial activation of the immune system by a microbial antigen is followed by an autoimmune reaction that involves the skin, eyes and joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which HLA is associated with Reactive arthritis

A

• HLA-B27 allele is identified in 70-80% of patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Recognise the presenting symptoms of reactive arthritis

A
  • Symptoms can develop 3-30 days after infection
  • Burning or stinging when passing urine (due to urethritis)
  • Arthritis
  • Low back pain (due to sacroiliitis)
  • Painful heels (due to enthesitis and plantar fasciitis)
  • Conjunctivitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Recognise the signs of reactive arthritis on physical examination

A

• Signs of Arthritis
o Asymmetrical oligoarthritis
o Often affects the lower extremities
o SausageMshaped digits

• Signs of Conjunctivitis
o Anterior uveitis M painful red eye

• Oral Ulceration

• Circinate Balanitis
o Scaling red patches on the glans

•  Keratoderma Blenorrhagica 
o  BrownishMred macules  
o  Vesicopustules  
o  Yellowish-brown scales  
o  Found on the SOLES and PALMS

• Others
o Nail dystrophy
o Hyperkeratosis
o Onycholysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Identify appropriate investigations for reactive arthritis

A

• Bloods
o FBC
o High ESR and CRP
o HLA-B27 testing

• Stool or Urethral Swabs and Cultures
o May be negative by the time the arthritis develops (because the arthritis occurs post-infection)

• Urine
o Screen for Chlamydia trachomatis

• Plain X-Rays
o Useful in chronic cases
o Erosions seen at the entheses (insertion of tendons into bone)

• Joint Aspiration
o To exclude septic or crystal arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which crystals deposit in the joints in pseudogout?

A

Calcium pyrophosphate dihydrate

near the surface of chondrocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What diseases are RF for gout?

A

Haemochromatosis, Wilson’s, Hyperparathyroidism, Acromegaly, Hypophosphotemia, Hypomagnesemia

(you would expect to find pseudgout in a young patient if they have one of these diseases)

31
Q

In which demographic group is pseudogout mostly found?

A

Elderly females (x2)

32
Q

How does pseudogout present?

A

Acute painful swollen joint knee/wrist (ankle, shoulder)

33
Q

What are the signs OE of pseudogout

A

Red, hot, swollen, tender, resticted range of movement

34
Q

What investigations do you carry out for pseudogout?

A

Bloods: raised WCC, raised ESR, (Mg2+, PTH, Pho)
Blood and joint aspirate culture: to exclude septic arthritis
Joint aspirate -
Xray

35
Q

What would the joint aspirate under polarised light

A

Positive birefringence - rhomboid/brick shaped crystals

36
Q

What is a key feature on Xray for pseudogout?

A

CHONDROCALCINOSIS !!!

It will differentiate it from other things like: gout, OA, septic arhritis as there is some overlap in presentation and signs between them.

37
Q

Define ankylosing spondylitis

A

• Seronegative inflammatory arthropathy affecting preferentially the axial skeletal and large proximal joints

38
Q

Which joints are mainly affected in AS?

A

axial skeletal and large proximal joints

39
Q

What is the HLA associated with AS?

A

HLA-B27

40
Q

What’s the pathophysioogy o

A

o Inflammation starts at the ENTHESES* (where ligaments attach to vertebral bodies)
o Persistent inflammation leads to reactive new bone formation*
o Changes begin in the lumbar vertebrae and progress superiorly
o Vertebral bodies become more square
o Syndesmophytes* (vertical ossifications bridging the
margins between adjacent vertebrae)
o Fusion of syndesmophytes and facet joints
o Calcification of anterior and lateral spinal ligaments

41
Q

What is the classic demographic of an AS pt?

A

Young male

42
Q

Recognise the presenting symptoms of ankylosing spondylitis

A

• Lower back and sacroiliac pain **

• Pain pattern
o Worse in the morning **
o Better with activity **
o Worse when resting **

  • Disturbed sleep
  • Progressive loss of spinal movement
  • Symptoms of asymmetrical peripheral arthritis
  • Pleuritic chest pain (due to costovertebral joint involvement)
  • Heel pain (due to plantar fasciitis)
  • NonMspecific symptoms (e.g. malaise, fatigue)
43
Q

Recognise the signs of ankylosing spondylitis on physical examination

A
  • Reduced range of spinal movement (particularly hip rotation)
  • Reduced lateral spinal flexion
  • Schober’s Test
  • Tenderness over the sacroiliac joints
44
Q

What is Schober’s test

A

o Two fingers are placed on the patients back about 10 cm apart
o The patient is asked to bend over
o The distance between the two fingers should increase by > 5 cm on forward
flexion
o Reduced movement would suggest ankylosing spondylitis - AS is a clinical diagnosis !!!!

45
Q

What are the signs OE for later stages of AS?

A

• LATER STAGES:
o Thoracic kyphosis
o Spinal fusion
o Question mark posture

46
Q

What are the signs of exrta-articular disease of AS?

A 
•  Signs of Extra-Articular Disease: 5 As  
o  Anterior uveitis  
o  Apical lung fibrosis   
o  Achilles tendinitis   
o  Amyloidosis 
o  Aortic regurgitation
47
Q

Identify appropriate investigations for ankylosing spondylitis

A

• Bloods
o FBC - anaemia of chronic disease
o Rheumatoid factor - negative *
o ESR/CRP - high *

• Radiographs
o Anteroposterior and lateral radiographs of the spine
• May show Bamboo spine*

o Anteroposterior radiograph of sacroiliac joints
• Shows symmetrical blurring of joint margins

o LATER STAGES on XRAY:
• Erosions
• Sclerosis
• Sacroiliac joint fusion

o CXR - check for apical lung fibrosis

• Lung Function Tests
o Assess mechanical ventilatory impairment due to kyphosis

48
Q

Generate a management plan for giant cell arteritis

A
  • High dose oral prednisolone IMMEDIATELY to prevent visual loss
  • Reduce the dose of prednisolone gradually
  • Many patients will need to be kept on a maintenance dose of prednisolone for 1-2 yrs
  • Low dose aspirin (with PPIs and gastroprotection) - reduces risk of visual loss, TIAs and stroke
  • Annual CXR for up to 10 yrs to look for thoracic aortic aneurysms
49
Q

What is polymyositis ?

A

Connective tissue disease characterised by inflammation of muscles

50
Q

What causes polymyositis?

A

Autoimmune

Possible viral triggerQ

51
Q

What is the epidemiology of polymyositis?

A

30-60yo Female

52
Q

How does one present with polymyositis

A

Progressive muscle weaknes gradually getting worst over the past few months
(NO RASH)

53
Q

How does a dermatomyositis rash look like?

A

• Blue-purple discolouration of the upper eyelids with periorbital oedema
• Flat red rash involving the face and upper trunk
• Raised purple-red scaly patches over the extensor surfaces of joints and fingers
o Rash may affect knees, shoulders, back and upper arms
o Rash may be exacerbated by sunlight
o Proximal myopathy
o Muscle pain and tenderness in early disease

54
Q

What are the IX for polymyositis

A

CK is raise (50% more)
EMG
Musclebx - defnitive diagnostic test

55
Q

Which auto-ab are related to polymyositis

A

Anti-Jo1

Myosite specific Ab

56
Q

Which auto-ab are related to dermatomyositis

A

Anti-Mi2

ANA

57
Q

Define SLE

A

• Multi-system inflammatory autoimmune disorder

58
Q

What are the American College of Rheumatology criteria

A

• 4/11 of the diagnostic criteria of the American College of Rheumatology provides high sensitivity and specificity for the diagnosis of SLE:
SOAP BRAIN MD

o Serositis
o Oral ulcers
o Arthritis (non-erosive)
o Photosensitivity
o Bloods (haemolytic anaemia/ leukopaenia/ thrombocytopaenia)
o Renal disease (urine casts/proteinuria)
o ANA
o Immunological disorder (anti-dsDNA /anti-Sm /anti-phospholipid)
o Neurological disease (psychosis/seizures)
o Malar rash
o Discoid rash

59
Q

Recognise the presenting symptoms and signs of SLE

A 
•  General Symptoms 
o  Fever  
o  Fatigue  
o  Weight loss  
o  Lymphadenopathy  
o  Splenomegaly
  • Raynaud’s phenomenon
  • Oral ulcers

• Skin Rash
o Malar rash
o Discoid lupus (red scaly patches)
o Atypical rashes (e.g. photosensitivity, vasculitis, urticaria, purpura)

• Systemic Involvement
o Musculoskeletal - arthritis, tendonitis, myopathy
o Heart - pericarditis, myocarditis, arrhythmias, Libman-Sacks endocarditis
o Lung - pleurisy, pleural effusion, basal atelectasis, restrictive lung defects
o Neurological - headache, stroke, cranial nerve palsies, confusion, chorea
o Psychiatric - depression, psychosis
o Renal - glomerulonephritis

60
Q

Identify appropriate investigations for SLE

A 
•  Bloods 
o  FBC 
o  U&E 
o  LFT  
o  Raised ESR   *
o  Raised/Normal CRP  *
o  Clotting  
o  Complement
  • Urine M haematuria, proteinuria, red cell casts
  • Joints M plain radiographs
  • Heart and Lungs M CXR, ECG, echocardiogram, CT
  • Kidneys M renal biopsy (if glomerulonephritis suspected) • CNS M MRI scan, lumbar puncture
61
Q

State the autoantibodies associated with SLE

A 
•  Autoantibodies 
o  Anti-dsDNA (60%) 
o  Rheumatoid factor (30M50%)  
o  Anti-ENA 
o  Anti-RNP 
o  Anti-SM 
o  Anti-Ro 
o  Anti-La 
o  Anti-histone 
o  Anti-cardiolipin
62
Q

a 55yo female presetns with dry cough and SOB which have been present and have progressed the past few months.
PMH: rheumatoid arthritis
OE: Bilateral fine inspiratory crackles

What is this

A

Pulmonary fibrosis
Is an extra-articular manifestation of RhA
Is also a side effect of methotrexate (a disease-modifying anti rheumatic drug) a drug used in RhA

63
Q

Define anti-phospholipid syndrome

A

• Characterised by the presence of antiphospholipid antibodies (APL) in the plasma, venous and arterial thrombosis, recurrent foetal loss and thrombocytopaenia

64
Q

Explain the aetiology/risk factors of anti-phospholipid syndrome

A
  • Antiphospholipid antibodies (APL) are directed against plasma proteins bound to phospholipids
  • APL may develop in susceptible individuals following exposure to infectious agents
  • Once APL are present, a second event is needed for the syndrome to develop
  • APL has effects on a number of coagulation factors (e.g. protein C, annexin V, platelets, fibrinolysis)
  • Complement activation by APL is critical for the complications
65
Q

Summarise the epidemiology of antiJphospholipid syndrome

A
  • More common in YOUNG WOMEN
  • Accounts for 20% of strokes in < 45 yrs
  • Accounts for 27% of women with > 2 miscarriages
66
Q

Recognise the presenting symptoms of antiJphospholipid syndrome

A 
•  RECURRENT MISCARRIAGES   *
•  History of: 
o  Arterial thromboses (stroke) 
o  Venous thromboses (DVT, PE)  * 
•  Headaches (migraine) 
•  Chorea  
•  Epilepsy

(at a young age)

67
Q

Recognise the signs of antiJphospholipid syndrome on physical examination

A

• Livedo reticularis = A skin finding consisting of a mottled reticulated vascular pattern that appears as a lace-like purplish discolouration of the skin

  • Signs of SLE (e.g. malar rash, discoid lesions)
  • Signs of valvular heart disease
68
Q

Identify appropriate investigations for antiJphospholipid syndrome

A

• FBC - low platelets
• ESR - usually normal
• U&Es - can get APL nephropathy
• Clotting screen - high APTT
• Presence of antiphospholipid antibodies may be demonstrated by:
o ELISA testing for anticardiolipin antibodies
o Lupus anticoagulant assays

69
Q

Which auto-ab are associated with Sjrogens

A

• Autoantibodies
o Rheumatoid factor
o ANA
o AntiMENA (extractable nuclear antigens)

70
Q

What is Sjorgens

A

Characterised by inflammation and destruction of exocrine glands (usually salivary and
lacrimal glands).
o NOTE: when associated with other autoimmune diseases, Sjogren’s syndrome is
termed secondary

71
Q

How does sjogrens present

A
  • Dry eyes (keratoconjunctivitis sicca) - they will be gritty and sore
  • Dry mouth - leads to secondary dysphagia
  • Dry upper airways M leads to a dry cough and recurrent sinusitis
  • Fatigue
  • Fever
  • Weight loss
  • Depression
  • Dry skin or hair
  • Dry vagina - may cause dyspareunia
  • Reduced GI mucus secretions leads to reflux oesophagitis, gastritis and constipation
72
Q

What is Schirmer’s Test

A

o A strip of filter paper is placed under the eyelid

o Positive for Sjogren’s syndrome if < 10 mm of the strip is wet after 5 mins

73
Q

What is Henoch-Schonlein purpura

A

A small vessel vasculitis which usually occurs in children after an upper respiratory tract infection.
purpura, arthritis, gut symptoms, glomerulonephritis, IgA deposition

500 SBA's (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions