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Nephrology > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Monoarthritis

A

SA, gout, CPPD, OA, trauma (haemarthrosis)

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2
Q

Polyarthritis

A

Symmetrical - RA, OA, viruses (hep ABC, mumps) systemic conditions
Asymmetrical - reactive, psosriatic

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3
Q

Heberdens nodes

Bouchards nodes

A

B proximal

H distal

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4
Q

Felty’s syndrome

A

RA + splenomegaly + neutropenia

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5
Q

DMARDS, tx RA

A

a combination of
methotrexate (pneumonitis (get urgent respiratory help), oral ulcers,hepatotoxicity)
sulfasalazine (rash, sperm count, oral ulcers) hydroxychloroquine (irreversible
retinopathy (request annual ophthalmology review))

Then biological agents - SE - Serious infection, including reactivation of TB (screen and consider prophylaxis) and hep B; worsening HF etc

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6
Q

Ankylosing Spondylitis

A

HLA B27 +ve

progressive loss of spinal movement (all
directions)—hence reduced thoracic expansion.
kyphosis, neck hyperextension
(question-mark posture)
spino-cranial ankylosis.
enthesitis- esp Achilles tendonitis, plantar fasciitis,
at the tibial and ischial tuberosities, and at the iliac crests.
Anterior mechanical chest pain due to costochondritis and fatigue may feature
Acute iritis occurs in~⅓ of patients and may lead to blindness if untreated
osteoporosis (up to 60%)
aortic valve incompetence (<3%)
pulmonary apical fibrosis.

Sacroiliitis is the earliest X-ray feature

Tx - exercise, NSAIDs, bisphosphonates, TNFa blockers

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7
Q

Spondylarthritidies

A

AS
Enteric arthropathy - IBD, coeliac, GI bypass, Whipples – improves w tx of bowel
Psoriatic Arthritis - symmetrical, NSAIDS,
sulfasalazine, methotrexate and ciclosporin
Reactive arthritis - sterile, affects lower limbs 1-4 weeks after urethritis/ dysentery,

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8
Q

Autoimmune connective tissue diseases

A 
systemic sclerosis
primary Sjögren’s
syndrome , idiopathic inflammatory myopathies (myositis), 
mixed connective tissue disease
relapsing polychondritis
Behçet’s disease
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9
Q

Systemic sclerosis

A

Scleroderma/vascular disease
Two types:
Limited cutaneous
Diffuse cutaneous

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10
Q

Polymyositis Tests
Screening
Treatment

A

Muscle enzymes (ALT, AST, LDH, CK & aldolase) in plasma
EMG - fibrillation potentials
**muscle biopsy
MRI muscle oedema in acute
anti-Mi2, anti-Jo1—associated with a syndrome
of acute onset and interstitial lung fibrosis that should be treated aggressively.

SCREEN MALIGNANCY
Steroids
Immunosuppressives

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11
Q

Dermatomyositis

A

Macular rash (shawl sign)
Lilac-purple (heliotrope) rash on eyelids often
with oedema
Nailfold erythema (dilated capillary loops)
Gottron’s papules: Roughened red papules over the knuckles, also seen on elbows and knees
(pathognomonic if CK high + muscle weakness);
Subcutaneous calcifications

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12
Q

Anti-La, anti Ro

A

Sjögren’s

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13
Q

Anti-Smith

A

SLE

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14
Q

Anti Jo-1; Anti-Mi-2

A

Polymyositis, dermatomyositis.

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15
Q

Anti-Scl70

A

Diffuse systemic sclerosis.

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16
Q

Antimitochondrial Ab

A

Primary biliary cirrhosis (>95%), autoimmune hepatitis

30%), idiopathic cirrhosis (25–30%

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17
Q

Anti-smooth muscle Ab (SMA)

A 
Autoimmune hepatitis (70%), primary biliary cirrhosis
(50%), idiopathic cirrhosis (25–30%)
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18
Q

Coeliac disease ab

A

a gliadin Ab, antitissue transglutaminase, anti-endomysial Ab

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19
Q

C ANCA

A

Granulomatosis + polyangiitis

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20
Q

Perinuclear (p-ANCA), MPO +ve

A

Microscopic polyangiitis

(45%), Churg–Strauss,

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21
Q

Anti-voltage-gated Ca2+-channel Ab:

A

Lambert Eaton Syndrome

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22
Q

Anti-aquaporin 4:

A

Devic’s disease - neuromyelitis optica

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23
Q

Anti-double-stranded DNA

24
Q

Antihistone Ab

A

drug induced SLE

25
Q

Anticentromere ab

A

Limited SS

26
Q

ANA

A

SLE, autoimmune hep, sjogrens

27
Q

SLE- Pathology

A

autoantibodies are made against a variety of autoantigens
polyclonal
B-cell secretion of pathogenic auto anti bodies causing tissue damage > immune complexes, complement activation

28
Q

SLE-Diagnosis

A 
Malar Rash
Photosensitivity
Discoid Rash
Renal - proteinuria
CNS disorders
Serositis -Pleura/ pericarditis
Arthritis - non erosive
Oral ulcers
Haem -Low counts - anaemia (haemolytic)
Ab prescence
ANA +ve
29
Q

SLE treatment

A

IV cyclophosphamide + high-dose prednisolone

maintence - NSAIDs, hydroxychloroquine, steroids

30
Q

APLS

A

Coagulation defect, Livedo reticularis, Obstetric
(recurrent miscarriage), Thrombocytopenia
Tx - low dose aspirin

31
Q

Vasculitis Large

A

Giant cell arteritis, Takayasu’s arteritis

32
Q

Medium Vasculitis

A

Polyarteritis nodosa, Kawasaki disease

33
Q

Small Vasculitis

A

ANCA +ve -predilection for respiratory tract and kidneys.
p-ANCA associated microscopic polyangiitis, lomerulonephritis and Churg–Strauss syndrome and c-ANCA associated Wegener’s granulomatosis

ANCA –ve -HSP, goodpasture’s syndrome, cryoglobulinaemia.

34
Q

Polymyalgia rheumatica

A

CRP high, ESR typically >40 (but may be normal); ALP is high in 30%. Note CK levels are normal (helping to distinguish from myositis/myopathies
Prednisolone

35
Q

Pseudogout patho

A

deposition of calcium pyrophosphate dihydrate crystals in the synovium.

36
Q

Pseudogout XR findings

A

chondrocalcinosis

37
Q

Pseudogout aspiration

A

joint aspiration: weakly-positively birefringent rhomboid-shaped crystals

38
Q

Pseudogout RF

A 
haemochromatosis
hyperparathyroidism
acromegaly
low magnesium, low phosphate
Wilson's disease
39
Q

What is gout?

A

deposition of monosodium urate monohydrate in the synovium

40
Q

Risk factors for gout

A

thiazides, drugs, alcohol, poor eGFR, red meat, CVD, myeloproliferative disorders, cytotoxic drugs, psoriasis, Lesch Nyhan syndrome

41
Q

What to do on gout follow up

A

Check urate, BP, CVD risks
Council re ULT
Advance px

42
Q

Acute mx of gout

A 
colchicine - diarrhoea
NSAIDS high dose - 2 days post sx
Pred 15mg 
Steroid injections
Cont allopurinol
43
Q

Aim of urate lowering therapy

44
Q

SLE antibodies

A 
Anti ANA (sens, not spec)
Anti Smith (specific)
Anti DsDNA
45
Q

APLS findings

A

CLOT - coagulation, livedo reticularis, obs issues,

Prolonged APTT

46
Q

APLS management

A

Lifelong aspirin
If VTE/ arterial clot - lifelong warfarin.
Target 2-3
If clot on warfarin - 3-4

47
Q

APLS management in pregnancy

A

Low dose aspirin

Then LMWH once fetal heartbeat > 34 weeks.

48
Q

Raynauds management

A 
Nifedipine
IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months
49
Q

Large vessel vasculitis

A

GCA, Takayasus arteritis

50
Q

Medium vessel vasculitis

A

Polyarteritis nodosa, Kawasakis

51
Q

Small vessel vasculitis

A

P anca - microscopic polyangitis

C anca - wegeners

52
Q

Takayasus arteritis

A 
Aorta
Woman, asian
absent limb pulse, different BPs
Systemic sx - malaise, headache
Steroids
53
Q

Polyarteritis Nodosa

A

Men
medium sized vessels, necrotising inflammation > aneurysms
Ass w Hep B

54
Q

Diffuse cutaneous systemic sclerosis

A 
whole body
organ fibrosis - all
Antitopoisomerase-1 antibodies (Anti-Scl70) - 40%
Anti RNA polymerase 20%
Control BP, annual ECHO, spiro

Tx - IV cyclophosphamide
BP
ACE - prevent renal crisis

55
Q

Limited cutaneous Systemic Sclerosis

A 
Calcinosis, Raynauds, Eesophageal/ gut dysmotility, Sclerodacytly, Telangectasia
Hands, feet, face
Pulmonary HTN
Anti centromere - 80%
Tx - sildenafil, bosentan (pulm HTN)
56
Q

Behcets Disease

A

Classic triad:
oral ulcers
genital ulcers
anterior uveitis

HLA B51

Nephrology (26 decks)

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