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Medical Finals 2020 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the pattern of disease in osteoarthritis?

A

Symmetrical, usually large joints such as knees, hips and spine

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2
Q

What are 5 things you will see on x-ray of someone with osteoarthritis?

A
  • Narrowing of joint spaces
  • Osteophyte formation
  • Abnormal bone contour
  • Sub-chondral cyst
  • sub-articular sclerosis
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3
Q

What is a bamboo spine indicative of?

A

Ankylosing Spondylitis - on x-ray there are syndesmophytes present (bony growths in spinal ligaments) and slow fusion of the vertebrae

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4
Q

Give 5 factors that predispose to osteoarthritis?

A

Obesity, Gender (F>M), Paget’s Disease, Previous fractures, Occupation, Hereditary, Hypermobility

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5
Q

What investigations would you do for Spondyloarthritis and what would you see?

A

HLA-B27 - positive
Inflammatory Markers - raised ESR/CRP
X-Ray changes

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6
Q

What types of arthritis are believed to be caused by HLA-B27?

A

Psoriatic, AS, Reactive, Enteropathic

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7
Q

Give some adverse effects of bisphosphanates (5)

A 
Oesophageal reactions
Osteonecrosis of the jaw
Atypical stress # (proximal femoral shaft)
Acute fever, myalgia, arthralgia
Hypocalcaemia
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8
Q

Give some differentials of hip pain

A 
OA
Trochanteric bursitis
Femoral neck #
Avascular necrosis
Polymyalgia rheumatica
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9
Q

Name 3 biologics used in inflammatory arthritis.

A

Etanercept - increased infection risk
Infliximab (give with methotrexate), flu-like SE
Adalimumab

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10
Q

Give 3 DMARDs and common SE

A

Methotrexate - SE contraindicated in pregnancy, hepatotoxicity
Sulfasalazine - SE neutropenia, rash, oral ulcers, low sperm count
Leflunomide - GI SE, teratogenic, hepatotoxicy

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11
Q

What associated conditions may give the impression of fibromyalgia

A

Sleep problems, IBS, tension headaches, no neuro or MSK pattern

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12
Q

What is ME?

A

Myalgic Encephalopmyelitis - Chronic Fatigue Syndrome

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13
Q

What are the things you MUST screen for in back pain?

A

Cauda Equina, Bone Mets to the spine, Myeloma

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14
Q

What are risk factors for osteoarthritis?

A

Age, previous trauma, obesity, post-menopausal woman

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15
Q

What is the first line treatment of osteoarthritis?

A 
Lifestyle management
Paracetamol
NSAIDs - topical or oral
Intra-articular steroids
Surgical replacement of affected joint
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16
Q

What antibodies can be found in SLE?

A 
Anti-double stranded DNA
Anti-Ro
Anti-La
Antiphospholipid
ASMA (Anti-smooth muscle antibodies)
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17
Q

What antibodies are specific to systemic sclerosis (limited and diffuse)?

A

Limited - anticentromere antibody

Diffuse - anti-Scl 70

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18
Q

What is palindromic rheumatism?

A

Rheumatoid arthritis when patients suffer from flare ups and not regular disease, treat with methotrexate and hydroxychloroquine

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19
Q

What are the key clinical features of rheumatoid arthritis? (5)

A

Symmetrical, polyarthritis, synovial joints
Seropositive (RF +ve)
Early morning stiffness lasting >1hr
Rheumatoid nodules may form
Subluxation of tendons and muscle wasting

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20
Q

What are 8 extra-articular features of rheumatoid arthritis?

A

Lungs - rheumatoid nodules, Caplan’s syndrome, pleural effusions
Heart - pericardial rub, pericardial effusion, pericarditis
GI - diarrhoea, reduced motility
Skin - vasculitis, Sjogren’s syndrome, sceritis
Kidneys - amyloidosis
Neuro - polyneuropathy, peripheral nerve entanglement

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21
Q

What are 5 hand signs of rheumatoid arthritis?

A 
Swan-neck deformity
Ulnar deviation
Z-thumb
Boutonierre's deformity
Piano key deformity of the wrist
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22
Q

What treatments can you use for rheumatoid arthritis?

A

DMARDs (methotrexate, sulfasalazine, hydroxychloroquine)
NSAIDs
Corticosteroids
TNF inhibitors

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23
Q

What are your differentials for a warm, swollen joint?

A

Gout

Septic Arthritis

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24
Q

Give 3 differences between gout and pseudogout on microscopy

A

Gout - urate crystals, needle-shape, -ve bifringent

Pseudogout - calcium phosphate crystal, rhomboid-shape, +ve bifringent

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25
Give three mechanisms that can result in purine increase?
``` Increased intake (beer, red meat, alcohol) Reduced excretion (renal problems, diuretics) Secondary gout (family history, chronic renal failure) ```
26
An x-ray of someone's foot shows 'punched out erosions'. What does this show?
Gout, known as 'rat bites', caused by tophi (aggregates on inflammatory cells)
27
What is colchicine used for?
Acute gout
28
What is used in the acute management of gout?
Colchicine NSAIDs (not as effective in pseudo gout) Steroids Lifestyle changes (alcohol, lose weight)
29
What is used in the chronic management of gout?
Allopurinol | Febuxostat
30
What are the associations of HLA-B27
``` Psoriatic arthritis Enteropathic arthritis Ankylosing Spondylitis Reactive arthritis UC Crohn's ```
31
What are some typical clinical features of Ank Spond?
Inflammation of the sacroiliac joints Pain relieved by exercise, worse in mornng Spinal fusion - bamboo spine
32
What are some extra-articular features of ank spond?
Anterior uveatis Cutaneous lesions IBD
33
What are the management options for Ank Spond?
Infliximab infusions NSAIDs Exercise Other TNF-alpha blockers (etanercept, adalimumab, golimumab)
34
What is 'pencil in a cup' a sign of, and what other signs may be seen on x-ray in this condition?
Psoriatic arthritis | 'Telescopic' fingers, bone shortening, loss of joint line
35
What does dactylitis mean and in what conditions is it seen?
Sausage shaped fingers | Seen in psoriatic arthritis, seronegative arthritis
36
How do you treat psoriatic arthritis?
NSAIDs and DMARDs | Can use ciprofloxacin or anti-TNF alpha agents
37
What infections proceed reactive arthritis?
STI (chlamydia), enteric (salmonella, shigella, campylobacter, yersinia).
38
What is Reiter's Syndrome?
Conjunctivitis Urethritis Acute Arthritis Seen in sexually acquired infections
39
What is enthesitis?
Inflammation at a tendon or ligament insertion
40
What are some general systemic features of connective tissue disease?
Mouth ulcers, dry eyes, dry mouth, hair loss, leg ulcers
41
What does the acronym SOAP BRAIN stand for and what condition is it used for?
``` SLE Serositis Oral ulcers Arthritis Photosensitivity Blood - anaemia (all low) Renal disease - hypertension, proteinuria ANA Immunological - anti ds DNA Neurological - psychosis ```
42
What are the rashes associated with SLE?
Malar rash - butterfly rash across nose and cheeks | Discoid rash - plaques
43
What medical management can be used for SLE?
NSAIDs, Prednisolone | Hydroxychloroquine, Rituximab, Cyclophosphamide
44
What are they two types of systemic sclerosis?
Limited - CREST (calcinosis, raynaud's, eosophageal, scerodacyly, telangiectasia) Diffuse - more progressive, severe, systemic involvement SS is a loss of elasticity of the skin
45
What investigations do you do in systemic sclerosis?
ANA, FBC, U&E CXR, ECG, ECHO - screen for pulmonary hypertension Anti-Scl Ab Anti-centromere Ab
46
How do you manage systemic sclerosis?
Skin lubricants, PPI Illoprost Regular ECHO and PFT
47
What is Schirmer tear test used for?
To test for defective tear production in Sjogren's Sydrome.
48
Sjogrens occurs with which diseases?
Rheumatoid, Sceroderma (systemic sclerosis), SLE
49
How do you manage Raynaud's?
Calcium channel blockers (nifedipide)
50
What is polymyositis?
Inflammation of striated muscle | If skin involvement: dermatomyositis
51
What are some features of polymyositis?
Proximal muscle weakness Rash (Gottron's papules over knuckles) Muscle wasting Risk of pulmonary fibrosis
52
What investigations are done in polymyositis and how is it treated?
Muscle and skin biopsy ANA ESR/CRP Serum creatinine kinase Treated with prednisolone
53
What are other organ involvements with Marfan's Syndrome?
Heart - aortic aneurysm, aortic dissection, mitral valve prolapse Tall, thin body, long arms Retinal detachment, dislocated lens
54
Is Marfan's Syndrome autosomal dominant or recessive?
Autosomal Dominant
55
What is Ehler Danlos Syndrome?
Collagen disorders with an effect on skin fragility, hyperextensibility and joint hypermobility.
56
What types of vasculitis are ANCA positive?
Wegener's Granuloma (Gramulomatosis with polyangiitis) | Churg-Strauss Granulomatosis
57
What is the treatment for PMR?
Prednisolone 10-15mg | GCA treat with 60-100mg
58
What is the management for Kawasaki Disease?
High dose IV immunoglobulins, aspirin 200-300mg OD
59
What is seen on investigations for vasculitis?
Raised ESR | ANCA (Anti-neutrophil cytoplasma antibodies)
60
What are some associated symptoms of GCA?
Visual loss Jaw claudication Headache, scalp tenderness
61
What is the diagnostic investigation for GCA?
Temporal artery biopsy | Not done often but temporal artery ultrasound would show a halo sign
62
What is the biggest worry with GCA?
Visual loss due to Anterior Ischaemic Optic Neuropathy (AION)
63
What is Behcet's Syndrome?
Inflammatory vasculitis with systemic inflammation, mouth sores, eye inflammation, headache, muscle and joint pain, genital sores. Associated with Turkish population
64
What are the systemic symptoms of Granulomatosis with Polyangiitis?
Resp: sinusitis pain, breathlessness, pulmonary haemorrhage Renal: proteinuria, haematuria Skin: vasculitis rash, ulcers
65
How is Wegener's treated?
Steroids | Methotrexate/Azathioprine
66
Is there proximal muscle weakness in polymyalgia?
No, just proximal muscle stiffness
67
What is antiphospholipid syndrome?
Predisposition to both venous and arterial thromboses, foetal loss and thrombocytopaenia Anti-cardiolipin antibody
68
What supplements are advised during pregnancy?
Folic acid pre-conception until 12 weeks gestation, vitamin D supplements throughout the whole of pregnancy
69
What features might you see in antiphospholipid syndrome?
``` Venous/arterial thrombosis Recurrent miscarriages Thrombocytopenia Livedo reticularis - mottled skin discolouration, lace-like Prolonged APTT ```
70
What are the 6 'A's of ankylosing spondylitis?
``` Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis ```
71
HLA-B27 is positive in what percentage of patients?
90%

Medical Finals 2020 (25 decks)

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