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phase 3b > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Presentation of OA

A

pain ± stiffness

Thumb base, hip, knee

random exacerbations for weeks/months

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2
Q

what would you find on examination for OA

A

Heberdens nodes - DIP
Bouchards nodes - PIPs
synovial thickening
deformity effusion
crepitus
decreased function
muscle weakness and wasting

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3
Q

X-ray findings for OA

A
  1. decreased joint space
  2. osteophytes
  3. subchondral sclerosis
  4. subchondral cysts
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4
Q

management of OA

A

regular review

pain relief: para/NSAIDS -> opioid/cox2 inhib

IA steriod injections

joint replacement

lifestyle: weight, physio

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5
Q

What is the pathology of Rheumatoid arthritis?

A

synovial inflammation -> synovial proliferation -> pannus -> art cart destruction -> bony erosions

RF by B cells locally
Inflam caused by factors produced by T cells, macrophages, mast cells and fibroblasts

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6
Q

Presentation of RA

A

joint pain and stiffness (>30m in morning)

PIPJs small joints in hands/wrists/feet

General fatigue and malaise

+systemic features

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7
Q

Examination findings for RA

A

symmetrical joint inflam
muscle wasting

ulnar deviation
swam neck
boutonnieres
Z deformity

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8
Q

Systemic features of RA

A

eyes: Sjorens syndrome
Skin: ulcers rashes
Rheumatoid nodules: eyes, subcut, lungs, heart
Neuro: peripheral nerve entrapment
resp: pulmonary fibrosis
Cardio: MI
Liver: hepatomegaly

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9
Q

RA investigations

A

Rheumatoid factor

Anti CCP (cyclic citrullinated peptide)

X-ray

  1. soft tissue swelling
  2. periarticular osteopenia
  3. loss of joint space
  4. erosions
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10
Q

RA management

A

NSAIDS and Cox 2 inhib
Corticosteriods - PO/ injection, symptomatic

2 X DMARD - methotrexate, sulfasalazine, leflunomide, hydroxychloroquinine

TNF inhib - infliximab

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11
Q

Septic arthritis causative organsisms

A

STAPH AUREUS

Strep

neisseria (young person, sexual history)

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12
Q

Septic arthritis risk factors

A

IVDU

immunosuppressed

prosthetic (prior joint damage)

Diabetes

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13
Q

Septic arthritis presentation

A

acute painful red swollen monoarthritis with fever

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14
Q

Septic arthritis management

A

Start broad spec ABx
X-ray
Aspirate (gram stain m C&S, crystal analysis)
fluclox 6 weeks clindamycin if allergic

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15
Q

Gout crystal

A

sodium urate

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16
Q

gout presentation

A

acute painful red swollen joint

MPJ, ankle, knee, elbow, wrist, fingers

tophi (chalk appearance under skin, asymmetrical)

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17
Q

gout diagnosis

A

clinical

serum urate >360
aspiration: needle shaped crystals

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18
Q

Gout management

A

NSAIDS (diclofenac, naproxen, indometacin)

Colchicine (4-6 daily until symptoms resolve)

Pred

Canankinumab

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19
Q

Gout triggers

A

red meat

alcohol

dehydration

diuretics

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20
Q

Gout prophylaxis

A

allopurinol (after symtoms settle)

lifestyle

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21
Q

Pseudogout crystals

A

calcium pyrophosphate

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22
Q

pseudogout presentation

A

acute painful red swollen joint (milder than gout)

Knee, ankle, wrist, feet, shoulder

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23
Q

Pseudogout diagnosis

A

X-ray Chondrocalcinosis

aspiration: rhomboid shaped crystals

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24
Q

Sign and condition

A

Chondrocalcinosis

pseudogout

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25
Q

Management of pseudogout

A

NSAIDS

colchicine

steriod injection

treat any primary conditions

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26
Q

triggers for pseudogout

A

illness: flu, chest infection, fever

hyperparathyroid, hypothyroid, hypomagnesaemia

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27
Q

Causes of Reactive arthritis

A

post enteric: campylobacter, salmonella

post veneral: gonorrhea, chlamydia

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28
Q

Reactive arthritis presentation

A

1-6 weeks post infectious

  • asymmetrical lower extremity oligoarthritis
  • commonly pain lower back
    • conjunctivitis, urethritis, arthritis,
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29
Q

reactive arthritis investigations

A

Aspirate: increased WCC

RBC: increased ESR/CRP

Stool sample cultures: causative organism

serology: gono or chlamydia

HLA-B27 antigen +Ve

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30
Q

What is this and in which condition is it seen

A

Keratoderma blenorrhagicum - reactive arthritis

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31
Q

how is reactive arthritis managed

A

self limiting, symptoms resolve 3-12 months

  • rest and aspirate
  • physio
  • NSAIDS
  • corticosteriods (PO/inject)
  • Abx
32
Q

what is perthes and who gets it

A

self limiting hip disorder caused by ischaemia -> necrosis of femoral head

males 4-8 with delayed skeletal maturity

33
Q

How does perthes present?

A

hip/knee pain -> limp

decreased ROM

34
Q

Perthes investigations

A

FBC, ESR, X-ray

X ray shows widening joint space and remodelling deformities

35
Q

Perthes management

A

if <50% of fem head affected then bed rest and NSAIDS

If >50% fem head affected then plaster cast and surgery

36
Q

Perthes X ray findings

A

Widening joint space

decreased size of nuclear femoral head with patchy density

collapse and deformity of femoral head

37
Q

what is pagets

A

bone remodelling disorder with increased osteoclast -> increased osteoblasts -> weak and disorganised bone

38
Q

pagets presentation

A
  • axial skeleton
  • normally asymptomatic picked up incidentally
  • bone pain
39
Q

Pagets investigations

A
  • Bone specifc alkaline phosphatase levels increased
  • X-ray
  • isotope scan
40
Q

Pagets management

A

NSAIDS

IV/PO bisphosphonates (zoledronate) + calcium and vit D

41
Q

what is charcots?

A

neuropathic joints caused by decreased sensation leading to damage

42
Q

causes of charcots

A

Developed countries: diabetes, diabetic neuropathy

developing: leprosy

43
Q

charcots presentation

A

redness, warmth, swelling, deformity., loss of function

pain non proportional to state of joint

44
Q

charcots investigations

A

x-ray, early OA changes, disruption later

HbA1c to assess db control

45
Q

charcots management

A

education and treatment of underlying disease

immbolisation, cast changed weekly for 3-6 months

podiatry referral

bisphosphonates can help heal bone in acute phase

surgery in chronic - amputation

46
Q

Pagets complications

A

Triad: Pain, deformity, fractures

Deafness, osteosarcoma

47
Q

Symptoms of antiphospholipid syndrome

A

Venous/arterial thrombosis
recurrent mis
Pre-E
Mottled skin - livedo reticularis
thrombocyopenia

48
Q

How do u confirm antiphospholipid syndrome?

A

anti-cardiolipin antibodies

49
Q

how do u manage antiphospholipid syndrome?

What is it associated with?

A

Warafin 6m or lifelong if recurrent

SLE

50
Q

What is systemic scleorsis?

A

hardened sclerotic skin and other connective tissues

51
Q

What factor results would u get in systemic sclerosis?

A

ANA +ve
RF +ve
Anti-scl-70: diffuse cutatneous systemic
Anti-centromere: limited cutaneous systemic

52
Q

Symptoms of limited cutaneous systmic sclerosis?

A

CREST

Calcinosis (white deposits)
Raynauds
oEsophageal (dysphagia)
Sclerodactyly
Telangiectasis (spider naevia)

53
Q

Management of systemic sclerosis

A

Raynaurds: nifedipine

consider Methotrexate

54
Q

what is polymyalgia rheumatica?

A

giant cell vasculitis

55
Q

How does PMR present?

A

pt >60 onset <1m
morning aches and stiffness in prox limbs, lethary, depression, low grade fever, anorexia, night sweats

56
Q

PMR Ix and Mx

A

Increased ESR (diagnosis of exclusion)

Pred

57
Q

What causes Marfans?

A

Autosomal dominant condition causes decreased fibrin

58
Q

Features of Marfans

A

Tall
pectus excavatum
scoliosis
archnodactyly

59
Q

Heart things in Marfans

A

dilated aortic sinus

increased risk of aneurysms, dissection and regurg

60
Q

Mx of Marfans

A

Echo

BB and ACE-I

61
Q

What is SLE

A

autoimmune type 3 hypersensitiviy reaction

62
Q

Symptoms of SLE

A

General: fatigue, mouth ulcers
Skin: photosensitive rash, malar rash which comes and goes, alopecia
CV: pericarditis
Renal: Lupus nephritis (test urine, deadly)
Haem: pancytopenia

63
Q

Causes of pancytopenia in SLE and how to differentiate between

A

Treatment: hypoplastic
conditon: hyperplastic

64
Q

Investigations in SLE

A

Anti dsDNA and anti Smith +Ve

Low C3 and C4

ANA +Ve
RF: either

65
Q

Management of SLE

A

Education and support
NSAIDS: joint pain
hydroxycholoroquinine: skin lesions, malasia, myalgia
steriods reserved for life threatening

66
Q

What is dermatomyosis

A

Inflam disorder causing symmetrical proximal weakness and skin lesions

67
Q

Causes of dermatomyosis

A

Idiopathic

68
Q

symptoms of dermatomyosis

A

photosensitive, back/shoulders red papules over extensor surfaces of fingers

Raynaurds, muscle weakness and tenderness

69
Q

Ix and management for dermatomyositis

A

ANA +ve

Sun block

steriods

azathioprine

70
Q

Presentation of ank spon

A

young male with lower back pain and stiffness worse in morning better with exercise

71
Q

OE ank spond

A

decreased lat and forward flex

decreased chest expansion

72
Q

Ix for ank spon

A

X-ray: sacroiliitis, lumbar sparing, bamboo spine

73
Q

management of ank spon

A

NSAIDs

sulphasalazine

74
Q

what is Sjorgrens syndrome

A

autoimmune disorder affecting exocrine glands

75
Q

How does Sjogrens present?

A

dry: eyes, mouth vagina
arthralgia, Raynaurds, myalgia

76
Q

Investigations of Sjorgrens

A

RF +ve

ANA +ve

Anti Ro and La

77
Q

Management of Sjorgrens

A

artificial tears

pilocarpine

phase 3b (15 decks)

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