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Phase 2a Questions > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Systemic lupus erythematosus - Autoantibodies

A
  1. Anti-nuclear antibodies
  2. Raised anti-dsDNA antibody (v specific)
  3. Anti-Ro
  4. Anti-Sm
  5. Anti-a
  6. Rheumatoid factor (40%)
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2
Q

Vasculitis - ANCA

A
  1. Anti- neutrophil cytoplasmic antibodies
  2. Small vessel usually +ve
  3. Large vessel -ve
  4. Medium vessel -ve
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3
Q

Rheumatoid Arthritis - Bloods

A
  1. Positive Rheumatoid Factor
  2. Positive anti-cyclic citrullinated peptide (Anti-CCP)
  3. Normochromic normocytic anaemia
  4. ESR +/or CRP raised
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4
Q

Osteoarthritis - Clinical presentation

A
  1. Joints pain (worse on movement)
    - Distal interphalangeal joints
    - 1st carpometacarpal joint (base of thumb)
    - 1st metatarsophalangeal joint of foot
    - Weight bearing joints
  2. Transient morning stiffness (<30mins)
  3. Crepitus (grating)
  4. Heberden’s nodes at DIPJs
  5. Bouchard’s at PIJPs
    B before H –> more proximal

Unsymmetrical!

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5
Q

Rheumatoid Arthritis - Extra-articular manifestations LUNG

A
  1. Pleural effusions
  2. Fibrosing alveolitits
  3. Pneumoconiosis
  4. Interstitial lung disease
  5. Bronchiectasis
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6
Q

RA - Extra-articular manifestations HEART

A
  1. Pericarditis
  2. Pericardial rub
  3. Raynauds
  4. Pericardial effusion
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7
Q

RA - Extra-articular manifestations NEURO

A
  1. Peripheral sensory neuropathies
  2. Compression/entrapment neuropathies
  3. Cord compression
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8
Q

RA - Extra-articular manifestations KIDNEY

A
  1. Amyloidosis
  2. Nephrotic syndrome
  3. CKD
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9
Q

RA - Extra-articular manifestations SKIN

A

SC nodules

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10
Q

RA - X ray

A
  1. Soft tissue swelling (early)
  2. Joint space narrowing (late)
  3. Peri-articular erosions
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11
Q

Mechanical lower back pain - Treatment

A
  1. Analgesia
  2. Physio
  3. Avoid excessive rest
  4. Re-education in lifting
  5. Comfortable sleeping position
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12
Q

Bone tumour - X ray

A
  1. Mets as osteolytic A w bony destruction
    - Visible = <60% bone density
  2. Osteosclerotic (increased bone density) mets -> prostatic carcinoma
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13
Q

Gout - risk facotrs

A
  1. Purine rich foods
  2. High alcohol intake
  3. High fructose intake
  4. High sat fat
  5. Drugs –> low dose aspirin
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14
Q

Systemic lupus erythematous - Treatment

A
  1. IV cyclophosphamide + high dose prednisolone
  2. NSAIDs
  3. Anti-malarials
    - Chloroquine or hydroxychloroquine
  4. Immunosuppressives
    - Oral azathioprine / methotrexate
  5. Biologicals
    - Rituximab (anti-CD20)
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15
Q

Giant cell arteritis - Clinical presentation

A
  1. Severe headache
  2. Scalp/temple tenderness
  3. Claudication of jaw
  4. Sudden painless vision loss = emergency
  5. Unequal/weak pulses
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16
Q

Bone/joint infection - causative organisms

A
  1. Staph aureus
  2. H. influenzae (vaccine)
  3. Neisseria gonorrhoea
  4. Streptococci
  5. Gram -ve bacteria
17
Q

Prosthetic joint infection - causative organisms

A
  1. Staph aureus
  2. Coagulase -ve staph
    - hip replacement
  3. Gram +ves
18
Q

Joint pain- types

A
  1. Inflammatory
    - RA
    - Septic arthritis
    - Spondyloarthropathies
    - CT disease
  2. Non-inflammatory
    - OA (degenerative)
    - Fibromyalgia (non-degenerative)
19
Q

RA - Clinical presentation

A
  1. Symmetrical peripheral polyarthritis
  2. DIJPs spared
  3. Ulnar deviation
  4. Swann neck/Z thumb
  5. Swollen, tender and warm
20
Q

HLA-B27

A

Seronegative spondyloarthropathies

  1. Ankylosing spondylitis
  2. Reactive arthritis
  3. Psoriatic arthritis
21
Q

Osteoporosis - Treatment

A
  1. Biphosphonates (oral alendronate) –> slow osteoclasts –> less bone turnover
  2. Denosumab
    (inhibits RANK –> less osteoclast activation)
  3. Strontium renlate (less fractures)
  4. HRT –> menopausal women
  5. Raloxifene –>activate oestrogen receptor on bone
22
Q

Septic arthritis - Definition

A

Medical emergency - acutely inflamed joint

23
Q

Septic arthritis - Diagnosis

A
  1. Urgent joint aspiration of synovial fluid
    - MC+S
    - Before antibiotics
24
Q

Carpal tunnel syndrome - Definition

A

Compression of median N by flexor tendons

25
Q

Carpal tunnel syndrome - Presentation

A
  1. Pain
  2. Numbness
  3. Tingling
  4. Weakness
  5. Wasting of M supplied by median N
26
Q

Fracture - Classification

A 
Salter-Harris fracture classification
1. If involving physis (growth plate)
2, Higher = more damage
3. Epiphysis and metaphysis
4. Growth arrest
27
Q

Osteoporosis - DEXA scan

A 
Dual energy X-ray absorptiometry (DEXA)
1. Gold standard
2. T score --> SD score compared to gender matched 25yr old average
-1 to -2.5 = osteopenia
 matched to same age
28
Q

FRAX score

A

Risk of fracture in next 10 yrs

29
Q

Allopurinol action

A

Inhibits xanthine oxidase –> less uric acid production –> less monoNa urate production

  • Gout (can trigger it)
  • Kidney stones
  • Hyperuricaemia
30
Q

Giant cell arteritis - Treatment

A
  1. High dose prednisolone
    - Stop vision loss
    - LT
  2. GI and bone protection
    - Lansoprazole
    - Alendronate
    - Ca2+
    - Vit D
31
Q

RA - Treatment DMARDs

A

Disease Modifying Anti-Rheumatic drugs

  • Methotrexate
  • Sulfasalazine
  • Leflunomide
32
Q

RA - Treatment biological

A
  1. TNF-alpha blocker
    - IV infliximab
    - SC etanercept
    - SC adalimumab
  2. B cell inhibitors
    - Rituximab
  3. IL blockers
    - Tocilzumab
  4. T cell activation blocker
    - Abatacept
33
Q

Pseudogout - Joint fluid aspiration + microscopy

A

Ca pyrophosphate crystals
(+ve bifringent crystals under polarised light - rhomboid)
Pseudo = Pos

Culture - septic arteritis

34
Q

Gout - Joint fluid aspiration + microscopy

A

Long needle shaped monosoduim urate crystals

-ve bifringent under bipolarised light

Phase 2a Questions (14 decks)

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