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MBBS / MBChB finals > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Features of Reiter’s syndrome

A

Triad of:
Urethritis
Conjunctivitis
Arthralgia

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2
Q

Features of ankylosing spondylitis

A

Young male
Buttock / sacroiliac pain
Worse in the morning
Relieved by exercise

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3
Q

X-ray Features of ankylosing spondylitis

A

Syndesmophytes

Bamboo spine

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4
Q

Associated conditions of ankylosing spondylitis

A

Arthritis
Anterior uveitis
Apical lung fibrosis
Aortic regurgitation

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5
Q

What is meant by ‘seronegative arthritis’

A

Arthritis not associated with rheumatoid factor production.

E.g. Reiter’s syndrome, ankylosing spondylitis, psoriatic arthritis, enteropathic arthropathy

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6
Q

Features of Raynaud’s phenomenon

A

Usually F
cold, cyanosed fingers
Normal –> white –> blue –> pink

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7
Q

Features of systemic sclerosis

A 
Calcinosis
Raynaud's is common
Oesophageal dysmotillity
Sclerodactly
Telengiectasia
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8
Q

Features of Bechets disease

A 
More common in Turkish/Iranian patients
Oro-genital ulceration
Uveitis
Arthritis
Pathergy reaction = pathognomonic
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9
Q

Features of polymyositis

A

Proximal muscle weakness
Pain and tenderness
Raised CK

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10
Q

Features of dematomyositis

A

Proximal muscle weakness
Pain and tenderness
Raised CK
Heliotrope (purple) rash

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11
Q

Features of Sjögren’s syndrome

A

Dry eyes
Dry mouth
Positive schirmers test

Corneal ulcers
Oral candida
Vaginal dryness
Dyspareunia 
Respiratory hoarseness
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12
Q

What is anti-double stranded DNA antibody most commonly s associated with?

A

SLE

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13
Q

What are anti-Jo antibodies most commonly associated with?

A

Polymyositis

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14
Q

What are anti-centromere antibodies most commonly associated with?

A

Limited systemic sclerosis

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15
Q

What are anti-topoisomerase antibodies most commonly associated with?

A

Diffuse systemic scerosis

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16
Q

What are cANCA and anti-PR3 antibodies most commonly associated with?

A

Wergener’s granulomatosis

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17
Q

What is alpha-endomysial antibody most commonly associated with?

A

Coeliac

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18
Q

What are anti-cyclic citrunillated peptide antibodies most commonly associated with?

A

Rheumatoid arthritis

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19
Q

What is feltys syndrome

A

Splenomegally
Neutropenia
In a pt with RA

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20
Q

Clinical features of pseudogout

A

acute monoarticular or oligoarticular arthritis.
Commonly knees - or wrists, shoulders, ankles, hands and feet.
Acute joint pain and swelling.
Effusion, warmth, tenderness and pain on movement.

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21
Q

Positively birefringent crystals occur when….

A

Pseudogout

Rhomboid shaped crystals

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22
Q

Negatively birefringent crystals occur in….

A

Gout

Needle shaped crystals

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23
Q

Features of psoriatic arthritis

A

DIPJ involvement
Dactylitis

(Arthritis mutilans = severe form)

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24
Q

Features of a septic arthritis

A 
Hot 
swollen 
tender joint
Unwell patient 
restricted range of movement
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25
Most common cause of a septic arthritis
Staph aureus
26
Risk factors for septic arthritis
``` Old very young IVDU diabetes Pre-existing joint condition ```
27
Management of septic arthritis
Surgical washout IV flucloxacillin and benzylpenicillin Few weeks oral antibiotics
28
Complications of septic arthritis
Joint destruction osteomyelitis bony fusion across to joint (ankylosis)
29
Features of Reiter's syndrome
Arthritis urethritis iritis
30
What causes osteoarthritis
Wear and tear of articular surfaces of the joint
31
Risk factors osteoarthritis
``` Female obesity Hyper mobility trauma Repetitive use ```
32
Clinical presentation of osteoarthritis
``` Joint pain worse with movement relieved by rest stiffness joint instability deformity ```
33
Examination findings in osteoarthritis
Bony swellings Joint effusion crepitus
34
Where do heberdens nodes occur
DIPJ
35
Where do Bouchards nodes occur
PIPJ
36
Management of osteoarthritis
``` Weight loss physiotherapy NSAID intra-articular steroid injection arthrodesis joint replacement ```
37
What is tennis elbow
Inflammation of the insertion of the tendon into the lateral epicondyle of the elbow Usually due to repetitive strain Exacerbated by wrist extension
38
What is golfers elbow
Inflammation of the insertion of the tendon into the medial epicondyle of the elbow Usually due to repetitive strain Exacerbated by wrist flexion
39
Typical patient with gout
``` Male Older Obese Drinks alcohol Hypertension Ischaemic heart disease Diabetes ```
40
Presentation of acute gout
Sudden pain, swelling and redness of joint (commonly 1st metatarso-phalangeal)
41
Management of acute gout
NSAIDS - indometacin or diclofenac
42
Prophylaxis for gout
Allopurinol (xanthine oxidase inhibitor) Do not prescribe during or within 1 month of an acute attack. It can precipitate and acute attack initially
43
What is chronic tophaceous gout
Where the urate crystals accumulate in cartilage - often in the ear and Achilles' tendon
44
What is gout nephropathy
Urate deposition in the kidney causing acute renal failure and urate stones
45
Symptoms of ankylosing spondylitis
Insidious onset low back pain Stiffness worse in morning - better with exercise Poor spinal flexion Question mark posture + extra articular features = apical lung fibrosis, anterior uveitis, Achilles tendinitis, plantar fasciitis, aortic regurgitation, amyloidosis
46
Management of ankylosing spondylitis
Physiotherapy Exercise Slow release NSAIDs
47
Presentation of enteropathic arthritis
Asymmetrical oligoarthrits Mostly affects large joints of lower limb Occurs with IBD Management = treat IBD
48
Classical presentation of RA
Symmetrical arthritis of small joints of the hand Worse in the morning Boggy swelling
49
Common deformities in RA
``` Swan neck Boutonnières deformity Z thumb Atlanto-axial subluxation Spindling of fingers Ulnar deviation ```
50
Features of juvenile idiopathic arthritis
Joint inflammation >6 weeks | Onset <16yo
51
Types of juvenile idiopathic arthritis
Mono articular = single joint Pauciartiular = 4 or less joints Polyarticular = > 4 joints
52
Complications of juvenile idiopathic arthritis
Chronic anterior uveitis Flexion contraction of joints Amyloidosis
53
Management of juvenile idiopathic arthritis
Physiotherapy NSAIDs Intra-articular steroids DMARDs
54
What is stills disease
A systemic form of juvenile idiopathic arthritis - autoimmune. ``` Intermittent high pyrexia Salmon pink rash Arthralgia Myalgia Hepatosplenomegally Lymphadenopathy Pericarditis ```
55
Diagnosis of Polymyositis
Serum raised creatinine kinase | Muscle biopsy demonstrates information and necrosis
56
What is polymyositis
Rare inflammatory disorder of skeletal muscle Associated with underlying malignancy
57
What is the name given to features of dermatomyositis without muscle weakness
Amyopathic Dermatomyositis
58
Symptoms of antiphospholipid syndrome
``` Recurrent arterial venous thrombosis PE DVT stroke Recurrent miscarriage thrombocytopenia ```
59
Antibodies in antiphospholipid syndrome
Anti-cardiolipin antibodies
60
Management of antiphospholipid syndrome
Avoid smoking / COCP Treat hypertension treat hyperlipidaemia treat diabetes After thrombosis a lifelong warfarin - INR 2.5 Substitute s/c heparin if planning pregnancy
61
Features of limited cutaneous scleroderma
Scleroderma limited to distal limbs Beaked nose small furrowed mouth (Microstomia) CREST Syndrome
62
Features of diffuse cutaneous scleroderma
Involved skin of whole-body Involvement of internal organs (Renal impairment, lung fibrosis) Worse prognosis
63
Antibodies associated with Sjögren's syndrome
Anti-Ro | anti-La
64
Treatment of Sjögren's syndrome
Artificial tears | artificial saliva
65
Diagnosis of SLE
``` Four or more of: Arthralgia renal disease - Nephrotic syndrome antinuclear Ab Serostitis - Pleurisy, pleural effusion, pericarditis Haematological disorder - Pancytopenia photosensitivity Oral ulcer immunology - Anti-dsDNA, Anti-Smith Neurological problems- depression, psychosis Malar rash Discoid rash ```
66
Management of SLE
Analgesia, steroids, immuno-suppression
67
What are overlap syndromes
Cases in which patient have more than one connective-tissue disease simultaneously
68
What drugs can induce lupus
Isoniazid | penicillamine
69
What is the 1st line DMARD in the UK
Sulfasalazine
70
Why should patients with rheumatoid arthritis with rheumatoid nodules NOT receive methotrexate
Causes accelerated nodule growth
71
Management of anti phospholipid syndrome
Not suffered thrombosis yet - daily low dose aspirin Previous thromboses - warfarin Previous thromboses + pregnancy - enoxaparin
72
Diagnostic test for dematomyositis
Muscle biopsy | Demonstrates inflammation and necrosis
73
Osteoporosis prophylaxis for patients on steroids
Lifestyle - Stop smoking, limit alcohol and exercise Calcium and vitamin D supplements Oral bisphosphonates
74
Antibodies most commonly seen in SLE
Anti-dsDNA

MBBS / MBChB finals (25 decks)

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