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Phase 4 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Name the type of vasculitis’s there are:

A

Large:

  • Temporal/ Giant
  • Takayasu arteritis

Medium:

  • Kawasaki
  • Polyarteritis nodosa
  • Buerger’s disease

Small:

  • Henock Scholien
  • Granulomatosis with polyangiitis
  • Eosinophilic Granulomatosis with polyangiitis (Chaurg Straus)
  • Microscopic polyangiitis
  • Cryoglobulinemia
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2
Q

What should make one think this may be vasculitis?

A

When there is multisystem involvement

Rashes

Raised inflammatory markers - especially ESR

Abnormal urinalysis

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3
Q

What are the symptoms of Kawaski disease?

A 
CRASH 
- Conjunctivitis 
- Rash 
- Adenopathy (lymphadenopathy) 
- Strawberry tongue 
- Hand/ feet rash - on palsm 
\+ 
- Fever
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4
Q

How can Henock - Scholein be differentiated from other syndromes that cause purpuric rashes such as ITP and TTP?

A

The platelet count will remain normal to high in Henock, where as the others cause thrombocytopenia

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5
Q

What is Felty’s syndrome?

A

Where in RA there is splenomegaly and Neutropenia

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6
Q

What investigations should be done in suspected vasculitis?

A

^ESR/ CRP

ANCA test - immunofluorescence followed by ELISA

Renal Status - creatinine, urea

Urine analysis - RBC casts, proteinuria

Angiography

Biopsy

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7
Q

Which vessels do giant cell vasculitis tend to affect?

A

Temporal
Ophthalmic
External carotid

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8
Q

What vasculitis is hepatitis associated with?

A

Polyarteritis nodosa

- associated with Hep B* major risk factor

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9
Q

How is polyarteritis nodosa diagnosed?

A

Angiography
and
Biopsy

Angiography will show the Rosary sign
- skipping of lesions causing a bead like appearance

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10
Q

At diagnosis of Kawasaki disease, what must be done?

A

Echocardiogram to assess for any damage to the heart

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11
Q

What is needed to diagnose granulomatosis polyangiitis?

A

c- ANCA levels
+
Biopsy from affected site

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12
Q

Which vasculitis are typically treated with steroids?

A

Giant cell
Takayasu
polyarteritis nodosa

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13
Q

What is the treatment of ANCA+ and Cryoglobulinemic type vasculitis?

A

Immunosuppressive medication (such as cyclophosphamide)
+
Steroids

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14
Q

How should Kawasaki vasculitis be treated?

A

IV immunoglobulins
- within the 1st 10 days

+

Aspirin
- prevent clots

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15
Q

What type of vasculitis is p-ANCA positive? and what are some symptoms of it?

A

Eosinophilic granulomatosis with polyangiitis

  • chronic sinusitis
  • asthma
  • blood eosinophilia
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16
Q

What is a highly suggestive feature of Lupus?

A

Multisystem involvement with increased ESR but normal CRP

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17
Q

What disease is associated with Anti- centromere antibodies?

A

Systemic Sclerosis - limited (CREST) type

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18
Q

What are the symptoms of CREST?

A 
Calcinosis 
Raynaud's 
Oespahgeal dysmotility
Sclerodactyly 
Telectangasia
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19
Q

What is a distinguishing feature of polymyalgia rheumatica that helps distinguish it form other muscle diseases?

A

Normal Creatine kinase

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20
Q

Which drugs can be taken for RA during pregnancy?

A

Sulfasalazine

Hydroxychloroquine

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21
Q

What is the different areas of diagnostic criteria for RA?

A

Number of joints affected

Serology markers

Duration of symptoms

Acute reactant proteins. ESR. CRP

Scores of >6 are diagnostic

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22
Q

What are the symptoms of polymyalgia rheumatica?

A

Subacute <2 weeks pain onset

  • bilateral
  • should pain
  • limb girdle pain
  • fatigue
  • weight loss
  • depression
  • Carpel tunnel syndrome
  • temporal arteritis
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23
Q

How is the diagnosis of polymyalgia rheumatica made?

A 
Clinical symptoms 
\+ 
Response to steroids 
\+ 
Ruling out other conditions
\+ 
Rapid onset <2 weeks
  • ESR >40
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24
Q

What advice/ additional interventions should be given to anyone on steroids?

A

STOP

  • sick day rules - double
  • Ticket - to say steroid dependent
  • Osteoporosis treatment
  • PPIs
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25
Q

What autoimmune antibodies are associated with Dermatomyositis?

A

Anti - Jo

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26
Q

What are the skin lesions typically seen with dermatomyositis?

A

Photosensitivity
Maculopapular rash
Gottron’s papules - on knuckles
Lilac purple rash across eyelids ** very characteristic

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27
Q

Dermatomyositis and Myositis may be due to what serious conditions?

A

Paraneoplastic effects from:

  • lung
  • ovarian
  • pancreatic cancer
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28
Q

what investigations should be done into suspected dermatomyositis and how is it treated?

A

Muscle biopsy - diagnostic
- MRI can help identify areas of abnormal muscle for biopsy

CK levels - useful for measuring disease activity

Anti- Jo

CXR/ Spirometry

  • *screening for malignancy
  • CT chest/Abdo/ Pelvis

Management:

  • exercise programme
  • prednisolone

Azathioprine/ methotrexate 2nd line

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29
Q

What are the diagnostic tests into Sjogren’s syndrome?

A

Schirmer tear testing
- 5 mins analysis of amount of tear production

Salivary gland biopsy

Auto antibodies

  • RF
  • ANA
  • Anti - Ro
  • Anti - La
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30
Q

Which antibodies are associated with CREST syndrome?

A

Anti - Centromere

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31
Q

Which antibodies are associated with Diffuse systemic sclerosis?

A

DNA SCL-70 antibodies

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32
Q

What is the treatment for systemic sclerosis?

A

Non Medical:

  • Stop smoking
  • skin stretching
  • avoidance of cold
  • Physiotherapy

Medical

  • nifedipine
  • Metoclopramide - motility
  • PPIs - gastric reflux
  • Analgesia - joint pain

Diffuse disease:

  • ACE inhibitors (kidney damage can occur)
  • IV cyclophosphamide
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33
Q

What are the diagnostic tests for Sjogrens syndrome?

A

Schrimer Test

Biopsy of salivary gland

Anti Ro and Anti La antibodies

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34
Q

How does Takayusa present, how is it diagnosed and what is the treatment?

A

Claudication
Fever
Weight loss
Loss of radial pulses

Angiogram
ESR

treatment:
- High dose steroids

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35
Q

What are the symptoms / clinical features of temporal arteritis?

A

Headache

  • temporal headache
  • occipital region pain

Scalp tenderness

Jaw Pain
- brought on by chewing

Amaurosis Fugax

Sudden loss of vision

TIAs

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36
Q

What investigation should be done into temporal arteritis?

A

Bloods:

  • FBC : anaemia, high platelets, WCC
  • ESR
  • LFTs - often albumin is low

X-rays:

  • Ultrasound of temporal artery
  • Angiography

Biopsy of temporal artery

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37
Q

What would you see on biopsy of the temporal artery in giant cell arteritis?

A

Fragmentation of the internal elastic lamina with necrosis of the media
+
Inflammatory infiltrate

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38
Q

What are some differentials for temporal arteritis?

A

PMR

Amyloidosis

Haematological malignancies

Takayasu’s arteritis

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39
Q

What deformity can occur in granulomatosis polyangiitis?

A

Saddle nose deformity

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40
Q

List some features found clinically on RA:

A

Sausage shaped fingers
Synovitis
Prominent radius head
Z-shaped deformity of thumb

*then usually stuff remember symmetry

41
Q

What are some side effects of methotrexate:

How often is it given and what should be given with it?

A

Pancytopenia
Pneumonitis
Liver toxicity - need regular LFTs
Stomastiis

Once weekly.

Folic acid
- sub cut

42
Q

What score is used to monitor disease progress in RA?

A

Disease Activity Score of 28 joints - DAS28

  • joints
  • ESR
  • General health

<0.6 is poor prognosis

*ultrasound is also usually used

43
Q

What are some features of poor prognosis indicators in RA?

A 
Multiple joint involvement 
HLA DR4 positive 
RF positive 
Early -x-ray changes 
Extra-articular features
44
Q

What investigations do you want to do into Lupus?

A

Bloods:

  • FBC - leukopenia/ thrombocytopenia
  • ESR
  • U&Es - renal nephritis
  • Complement studies - Low C3, C$
  • ANA, ds DNA

Orifices:
- Urine analysis

X-rays:

  • CXR - pleural effusion
  • Joint x-rays - non erosive

ECG
- pericarditis

Special tests:

45
Q

What is it called when lupus affects the kidneys and how is confirmed?

A

Lupus nephritis

Renal biopsy

46
Q

How can infection and Lupus be differentiated?

A

CRP levels

47
Q

What are some complications that can occur in birth with lupus?

A

Miscarriage - PLS

Pre-eclampsia

Worsening of symptoms

Preterm

Neonatal lupus
- transcient discoid rash

48
Q

What is the diagnostic criteria for RA?

A

Joints affected

Serology

  • Rh Factor
  • Anti - CCP

Duration of symptoms
>6 weeks

Acute phase reactant proteins

  • ESR
  • CRP
49
Q

What surgical operations may be indicated for RA?

A

Synovectomy
- finger tendon sheath to reduce contractures

Joint arthroplasty

50
Q

What is psoriatic arthritis associated with?

A

nail changes

  • Pitting nails
  • Onycholysis
  • Subungual Hyperkeratosis
  • Onychauxis
  • colour changes

Synovitis

palmo-pustular changes

Metabolic syndrome

51
Q

What are the different types of Psoriatic arthritis and how do they present?

A

Asymmetrical Oligoarthritis

  • synovitis
  • enthesitis
  • dactylitis

Symmetrical Polyarthritis
- symptoms of RA without extra articular

DIPJ arthritis

  • Periarticular swelling
  • Nail dystrophy

AS arthritis
- resembles AS

Mutlins

  • Telescoping of the digits
  • shortening and destruction
  • opera glass hand
52
Q

What is the diagnostic criteria and disease monitoring scoring system used for psoriatic arthritis?

A

Diagnostic criteria: CASPAR

  • evidence of psoriasis / family history
  • dactylitis / of previously
  • Negative Rh
  • Radiological keeping
  • Nail changes

Disease monitoring: DAPSA-64
- >28 is severe

53
Q

Which bones are most likely to be affected in paget’s disease?

A

Skull, spine, pelvic bone

54
Q

Where does a malar rash spare?

A

Nasal labia folds

55
Q

What are the specific antibodies towards lupus?

A

dsDNA

Anti-smith

56
Q

What gene is linked to anti-phospholipid syndrome?

A

HLA DR7

57
Q

What investigations should be done into lupus?

A

Bloods:

  • FBC - anaemia
  • U&Es - kidney involvement
  • ESR
  • Complement studies - C3, C4 will be low
  • Ant- ANA
  • Anti - dsDNA
  • Anti Smith

Orifices:
- Urine analysis - protein, blood (lupus nephritis)

X-rays:
- Joint’s

ECG:
- pericarditis

Special tests:
- Kidney biopsy

58
Q

What is the general management of Lupus and what is the scoring system used?

A

SELENA SLEDIA - scoring system used

Avoid sun exposure

Mild:

  • NSAIDS
  • hydroxychloroquine

Moderate:

  • Hydroxychloroquine
  • Steroids
  • Belimumab

Severe:

  • Cyclophosphamide
  • Plasmapheresis
59
Q

Differentials for Lupus?

A

RA
Phospholipid syndrome
Systemic Sclerosis

60
Q

What is the medical management of SA?

A

1st line:

  • NSAIDs
  • Steroid injection

2nd line:

  • Infliximab
  • Etanercept

3rd line:
- Secukinumab = IL-17 Inhibitor

Cardiovascular management

61
Q

What are the manifestations of Reactive arthritis?

A

Asymmetrical arthritis
- usually follows a few weeks after infection

Sterile conjunctivitis or anterior uveitis

Urethritis

Dactylitis

Enthesitis

Skin:
- Keratoderma Blennorrhagica

**usually develops within 4 weeks of the infection

62
Q

What are the risk factors for systemic scleroderma?

A

Bleomycin
Vinyl chloride

Female - 30 -50 years old

63
Q

What are the features of limited scleroderma?

A

Calcinosis

Raynaud’s

Esophageal dysmotility

Sclerodactyly - intense tight fibrosis tissue around hands

Telectangasia

64
Q

What are the symptoms of diffuse scleroderma?

A

edematous onset followed by raynaud’s.
Extensive skin thickening

  • Heart burn
  • Malabsorption for G.I track
  • Acute hypertensive renal crisis
  • Lung fibrosis
  • Myocardial fibrosis
65
Q

What are the specific antibodies related to scleroderma?

A

CREST syndrome: anti- centromere

Diffuse:
Anti - SCL-70

66
Q

What investigations should be done into Scleroderma?

A

Bloods:

  • FBC
  • U&Es - kidney involvement
  • Antibodies
  • Rh factor

Orifices:

  • urine microscopy
  • Protein: creatinine ratio

X-rays:

  • High resolution CT for fibrosis of lung
  • Barium swallow

ECG:
- Heart block/ fibrosis

67
Q

What is the classical onset of polymyalgia rheumatica?

A 
50 year old woman, sudden onset pain and stiffness in: 
- neck 
- shoulders 
- pelvis 
last for >30 mins
68
Q

What is Behcet’s disease, where is it common, what is the genetic factor and what is diagnostic test?

A

Multisystem inflammatory condition characterised by:

  • Oral ulcers
  • genital ulcers
  • also affects many other organs:
  • Iran
  • Japan
  • Turkey

HLA B51

Pathergy test.

69
Q

What would you see on a FBC of someone with phospholipid syndrome?

A

Thrombocytosis

70
Q

What is the recommended treatment for fibromyalgia?

A

CBT

71
Q

What are some common drugs that cause lupus?

A

Procainamide
hydralazine
Isoniazid

72
Q

What will the optic disc look like in temporal arteritis?

A

Pale and oedematous

73
Q

What antibodies are associated with drug induced lupus?

A

Anti-histone body

74
Q

What are the risk factors for lupus?

A

Family history

Genetics
- HLA DR3

Sex hormone status

Drugs

  • hydralazine
  • Isoniazid
  • Procainamide
  • Penicillamine
75
Q

What are some skin manifestations of lupus?

A

Malar rash
Discoid rash
Livedo Reticularis
Alopecia

76
Q

What defects can occur in the heart due to lupus?

A

Pericarditis
Aortic valve lesions
Non - infective endocarditis

77
Q

What will the FBC results of lupus show?

A

Anaemia - anemia of chronic disease + Haemolytic anaemia
Leukopenia
Lymphopenia
Thrombocytopenia

Type II hypersensitivity reaction can destroy the blood cells

78
Q

What is another name for Scl - 70?

A

Topoisomerase - 1

79
Q

Name two tests to look for antiphospholipid syndrome:

A

Anticardiolipin test
- detects IgG that bind to negatively charged phospholipids

Lupus anticoagulant test
- despite being called lupus it is for APL

80
Q

What is the core triad of lupus?

A

Fever
Arthralgia
Rash

81
Q

What is the key radiological featured needed on x-ray to confirm a diagnosis of AS?

A

Sacroiliitis

82
Q

Patient is on warfarin and develops gout, what is 1st line medication?

A

Colchicine

**NSAIDS contraindicated with warfarin

83
Q

What is the histological changes seen in RA?

A

Increased villous hyperplasia

Synovial thickness

Lymphocyte and plasma cell infiltration

84
Q

Name two creams used in psoriasis which have vitamin D analogues in them:

A

Dovobet

Enstilar

85
Q

How is Psoriatic arthritis differentiated from RA?

A

Absence of Anti - CCP

Dactylitis

86
Q

What are the radiological findings of psoriatic arthritis?

A

Pencil in Cup deformity

Dactylitis

Fluffy periostitis

Distal joint erosion

87
Q

What is the treatment for psoriatic arthritis?

A

1st line:
NSAIDs
Physiotherapy

2nd Line:
- DMARDS

3rd:
- Biologics
- Infliximab
- Apremilast

88
Q

What findings may be present in psoriatic arthritis?

A 
Dactylitis
Reduced ROM 
Painful 
Deformity 
Sacroiliac involvement 
Psoriasis 
Nail changes
Predominantly distal involvement
89
Q

What x-ray features are seen with psoriatic arthritis?

A

Fluffy periostitis

Dactylitis

Distal phalangeal erosion

Pencil in cup deformity

90
Q

What are the symptoms of AS?

A

Sacroiliac pain

Morning stiffness

Breathlessness
- apical pulmonary fibrosis

Reduced exercise capacity
- aortic regurgitation

Blurring of vision
- anterior uveitis

Plantar fasciitis

Weight loss

Fever

91
Q

What are some clinical findings of AS?

A

Schober’s test positive
- reduced lumbar movement when bending forward

Enthesitis

Diastolic murmur heard left sternal edge
- aortic regurgitation

Hyperextension of the neck
- compensatory mechanism

Loss of lumbar lordosis

Kyphosis

92
Q

What is the diagnostic criteria for AS?

A

<50 years

Worse on rest

Improvement with movement

Insidious onset

93
Q

What is a common bursitis found with polymyalgia rheumatica?

A

Trochanteric Bursitis

- diagnosed via US

94
Q

What are the differentials for polymyalgia rheumatica?

A

Polymyositis

SLE

Fibromyalgia

Hypothyroidism

RA

95
Q

How is polymyalgia monitored?

A

ESR and CRP levels

96
Q

In the treatment of Polymyalgia, what occurs at 4 weeks?

A

Reassessment

- and started on reducing regime

97
Q

What investigations are wanted into giant cell arteritis?

A 
FBC 
ESR 
CRP 
CK level 
Rh factors

Ultrasound of temporal with biopsy
Fundoscopy

98
Q

What is an adverse effect of hydroxychloroquine?

A

Retinopathy

99
Q

Which drug is sulfasalazine similar to and as such if there is a allergic reaction should also be avoided?

A

Aspirin

Mesalazine

Both are salicylic acid based

Phase 4 (49 decks)

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