Rheumatology Flashcards
1
Q
Systemic lupus erythematosus - Autoantibodies
A
- Anti-nuclear antibodies
- Raised anti-dsDNA antibody (v specific)
- Anti-Ro
- Anti-Sm
- Anti-a
- Rheumatoid factor (40%)
2
Q
Vasculitis - ANCA
A
- Anti- neutrophil cytoplasmic antibodies
- Small vessel usually +ve
- Large vessel -ve
- Medium vessel -ve
3
Q
Rheumatoid Arthritis - Bloods
A
- Positive Rheumatoid Factor
- Positive anti-cyclic citrullinated peptide (Anti-CCP)
- Normochromic normocytic anaemia
- ESR +/or CRP raised
4
Q
Osteoarthritis - Clinical presentation
A
- Joints pain (worse on movement)
- Distal interphalangeal joints
- 1st carpometacarpal joint (base of thumb)
- 1st metatarsophalangeal joint of foot
- Weight bearing joints - Transient morning stiffness (<30mins)
- Crepitus (grating)
- Heberden’s nodes at DIPJs
- Bouchard’s at PIJPs
B before H –> more proximal
Unsymmetrical!
5
Q
Rheumatoid Arthritis - Extra-articular manifestations LUNG
A
- Pleural effusions
- Fibrosing alveolitits
- Pneumoconiosis
- Interstitial lung disease
- Bronchiectasis
6
Q
RA - Extra-articular manifestations HEART
A
- Pericarditis
- Pericardial rub
- Raynauds
- Pericardial effusion
7
Q
RA - Extra-articular manifestations NEURO
A
- Peripheral sensory neuropathies
- Compression/entrapment neuropathies
- Cord compression
8
Q
RA - Extra-articular manifestations KIDNEY
A
- Amyloidosis
- Nephrotic syndrome
- CKD
9
Q
RA - Extra-articular manifestations SKIN
A
SC nodules
10
Q
RA - X ray
A
- Soft tissue swelling (early)
- Joint space narrowing (late)
- Peri-articular erosions
11
Q
Mechanical lower back pain - Treatment
A
- Analgesia
- Physio
- Avoid excessive rest
- Re-education in lifting
- Comfortable sleeping position
12
Q
Bone tumour - X ray
A
- Mets as osteolytic A w bony destruction
- Visible = <60% bone density - Osteosclerotic (increased bone density) mets -> prostatic carcinoma
13
Q
Gout - risk facotrs
A
- Purine rich foods
- High alcohol intake
- High fructose intake
- High sat fat
- Drugs –> low dose aspirin
14
Q
Systemic lupus erythematous - Treatment
A
- IV cyclophosphamide + high dose prednisolone
- NSAIDs
- Anti-malarials
- Chloroquine or hydroxychloroquine - Immunosuppressives
- Oral azathioprine / methotrexate - Biologicals
- Rituximab (anti-CD20)
15
Q
Giant cell arteritis - Clinical presentation
A
- Severe headache
- Scalp/temple tenderness
- Claudication of jaw
- Sudden painless vision loss = emergency
- Unequal/weak pulses
16
Q
Bone/joint infection - causative organisms
A
- Staph aureus
- H. influenzae (vaccine)
- Neisseria gonorrhoea
- Streptococci
- Gram -ve bacteria
17
Q
Prosthetic joint infection - causative organisms
A
- Staph aureus
- Coagulase -ve staph
- hip replacement - Gram +ves
18
Q
Joint pain- types
A
- Inflammatory
- RA
- Septic arthritis
- Spondyloarthropathies
- CT disease - Non-inflammatory
- OA (degenerative)
- Fibromyalgia (non-degenerative)
19
Q
RA - Clinical presentation
A
- Symmetrical peripheral polyarthritis
- DIJPs spared
- Ulnar deviation
- Swann neck/Z thumb
- Swollen, tender and warm
20
Q
HLA-B27
A
Seronegative spondyloarthropathies
- Ankylosing spondylitis
- Reactive arthritis
- Psoriatic arthritis
21
Q
Osteoporosis - Treatment
A
- Biphosphonates (oral alendronate) –> slow osteoclasts –> less bone turnover
- Denosumab
(inhibits RANK –> less osteoclast activation) - Strontium renlate (less fractures)
- HRT –> menopausal women
- Raloxifene –>activate oestrogen receptor on bone
22
Q
Septic arthritis - Definition
A
Medical emergency - acutely inflamed joint
23
Q
Septic arthritis - Diagnosis
A
- 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
Carpal tunnel syndrome - Presentation
1. Pain
2. Numbness
3. Tingling
4. Weakness
5. Wasting of M supplied by median N
26
Fracture - Classification
```
Salter-Harris fracture classification
1. If involving physis (growth plate)
2, Higher = more damage
3. Epiphysis and metaphysis
4. Growth arrest
```
27
Osteoporosis - DEXA scan
```
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
FRAX score
Risk of fracture in next 10 yrs
29
Allopurinol action
Inhibits xanthine oxidase --> less uric acid production --> less monoNa urate production
- Gout (can trigger it)
- Kidney stones
- Hyperuricaemia
30
Giant cell arteritis - Treatment
1. High dose prednisolone
- Stop vision loss
- LT
2. GI and bone protection
- Lansoprazole
- Alendronate
- Ca2+
- Vit D
31
RA - Treatment DMARDs
Disease Modifying Anti-Rheumatic drugs
- Methotrexate
- Sulfasalazine
- Leflunomide
32
RA - Treatment biological
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
Pseudogout - Joint fluid aspiration + microscopy
Ca pyrophosphate crystals
(+ve bifringent crystals under polarised light - rhomboid)
Pseudo = Pos
Culture - septic arteritis
34
Gout - Joint fluid aspiration + microscopy
Long needle shaped monosoduim urate crystals
| -ve bifringent under bipolarised light
