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General Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

0
Q

Features of Reiter’s syndrome

A

Triad of:
Urethritis
Conjunctivitis
Arthralgia

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1
Q

Antibodies most commonly seen in SLE

A

Anti-dsDNA

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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
Q

Most common cause of a septic arthritis

A

Staph aureus

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26
Q

Risk factors for septic arthritis

A 
Old 
very young 
IVDU 
diabetes
Pre-existing joint condition
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27
Q

Management of septic arthritis

A

Surgical washout
IV flucloxacillin and benzylpenicillin
Few weeks oral antibiotics

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28
Q

Complications of septic arthritis

A

Joint destruction
osteomyelitis
bony fusion across to joint (ankylosis)

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29
Q

Features of Reiter’s syndrome

A

Arthritis
urethritis
iritis

30
Q

What causes osteoarthritis

A

Wear and tear of articular surfaces of the joint

31
Q

Risk factors osteoarthritis

A 
Female 
obesity 
Hyper mobility 
 trauma 
Repetitive use
32
Q

Clinical presentation of osteoarthritis

A 
Joint pain worse with movement 
relieved by rest 
stiffness 
joint instability 
deformity
33
Q

Examination findings in osteoarthritis

A

Bony swellings
Joint effusion
crepitus

34
Q

Where do heberdens nodes occur

A

DIPJ

35
Q

Where do Bouchards nodes occur

A

PIPJ

36
Q

Management of osteoarthritis

A 
Weight loss 
physiotherapy 
NSAID
intra-articular steroid injection 
arthrodesis 
joint replacement
37
Q

What is tennis elbow

A

Inflammation of the insertion of the tendon into the lateral epicondyle of the elbow
Usually due to repetitive strain
Exacerbated by wrist extension

38
Q

What is golfers elbow

A

Inflammation of the insertion of the tendon into the medial epicondyle of the elbow
Usually due to repetitive strain
Exacerbated by wrist flexion

39
Q

Typical patient with gout

A 
Male
Older
Obese
Drinks alcohol 
Hypertension
Ischaemic heart disease
Diabetes
40
Q

Presentation of acute gout

A

Sudden pain, swelling and redness of joint (commonly 1st metatarso-phalangeal)

41
Q

Management of acute gout

A

NSAIDS - indometacin or diclofenac

42
Q

Prophylaxis for gout

A

Allopurinol (xanthine oxidase inhibitor)
Do not prescribe during or within 1 month of an acute attack.
It can precipitate and acute attack initially

43
Q

What is chronic tophaceous gout

A

Where the urate crystals accumulate in cartilage - often in the ear and Achilles’ tendon

44
Q

What is gout nephropathy

A

Urate deposition in the kidney causing acute renal failure and urate stones

45
Q

Symptoms of ankylosing spondylitis

A

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
Q

Management of ankylosing spondylitis

A

Physiotherapy
Exercise
Slow release NSAIDs

47
Q

Presentation of enteropathic arthritis

A

Asymmetrical oligoarthrits
Mostly affects large joints of lower limb
Occurs with IBD

Management = treat IBD

48
Q

Classical presentation of RA

A

Symmetrical arthritis of small joints of the hand
Worse in the morning
Boggy swelling

49
Q

Common deformities in RA

A 
Swan neck
Boutonnières deformity
Z thumb 
Atlanto-axial subluxation 
Spindling of fingers
Ulnar deviation
50
Q

Features of juvenile idiopathic arthritis

A

Joint inflammation >6 weeks

Onset <16yo

51
Q

Types of juvenile idiopathic arthritis

A

Mono articular = single joint
Pauciartiular = 4 or less joints
Polyarticular = > 4 joints

52
Q

Complications of juvenile idiopathic arthritis

A

Chronic anterior uveitis
Flexion contraction of joints
Amyloidosis

53
Q

Management of juvenile idiopathic arthritis

A

Physiotherapy
NSAIDs
Intra-articular steroids
DMARDs

54
Q

What is stills disease

A

A systemic form of juvenile idiopathic arthritis - autoimmune.

Intermittent high pyrexia
Salmon pink rash
Arthralgia 
Myalgia
Hepatosplenomegally
Lymphadenopathy 
Pericarditis
55
Q

Diagnosis of Polymyositis

A

Serum raised creatinine kinase

Muscle biopsy demonstrates information and necrosis

56
Q

What is polymyositis

A

Rare
inflammatory disorder of skeletal muscle
Associated with underlying malignancy

57
Q

What is the name given to features of dermatomyositis without muscle weakness

A

Amyopathic Dermatomyositis

58
Q

Symptoms of antiphospholipid syndrome

A 
Recurrent arterial venous thrombosis 
PE
DVT
stroke
Recurrent miscarriage 
thrombocytopenia
59
Q

Antibodies in antiphospholipid syndrome

A

Anti-cardiolipin antibodies

60
Q

Management of antiphospholipid syndrome

A

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
Q

Features of limited cutaneous scleroderma

A

Scleroderma limited to distal limbs
Beaked nose
small furrowed mouth (Microstomia)
CREST Syndrome

62
Q

Features of diffuse cutaneous scleroderma

A

Involved skin of whole-body
Involvement of internal organs (Renal impairment, lung fibrosis)
Worse prognosis

63
Q

Antibodies associated with Sjögren’s syndrome

A

Anti-Ro

anti-La

64
Q

Treatment of Sjögren’s syndrome

A

Artificial tears

artificial saliva

65
Q

Diagnosis of SLE

A 
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
Q

Management of SLE

A

Analgesia, steroids, immuno-suppression

67
Q

What are overlap syndromes

A

Cases in which patient have more than one connective-tissue disease simultaneously

68
Q

What drugs can induce lupus

A

Isoniazid

penicillamine

69
Q

What is the 1st line DMARD in the UK

A

Sulfasalazine

70
Q

Why should patients with rheumatoid arthritis with rheumatoid nodules NOT receive methotrexate

A

Causes accelerated nodule growth

71
Q

Management of anti phospholipid syndrome

A

Not suffered thrombosis yet - daily low dose aspirin
Previous thromboses - warfarin
Previous thromboses + pregnancy - enoxaparin

72
Q

Diagnostic test for dematomyositis

A

Muscle biopsy

Demonstrates inflammation and necrosis

73
Q

Osteoporosis prophylaxis for patients on steroids

A

Lifestyle - Stop smoking, limit alcohol and exercise
Calcium and vitamin D supplements
Oral bisphosphonates

General Medicine (25 decks)

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