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Medical Finals 2020 > Rheumatology > Flashcards

Rheumatology Flashcards

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USMLE® Step 1 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
Q

Give three mechanisms that can result in purine increase?

A 
Increased intake (beer, red meat, alcohol)
Reduced excretion (renal problems, diuretics)
Secondary gout (family history, chronic renal failure)
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26
Q

An x-ray of someone’s foot shows ‘punched out erosions’. What does this show?

A

Gout, known as ‘rat bites’, caused by tophi (aggregates on inflammatory cells)

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27
Q

What is colchicine used for?

A

Acute gout

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28
Q

What is used in the acute management of gout?

A

Colchicine
NSAIDs (not as effective in pseudo gout)
Steroids
Lifestyle changes (alcohol, lose weight)

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29
Q

What is used in the chronic management of gout?

A

Allopurinol

Febuxostat

30
Q

What are the associations of HLA-B27

A 
Psoriatic arthritis
Enteropathic arthritis
Ankylosing Spondylitis
Reactive arthritis
UC
Crohn's
31
Q

What are some typical clinical features of Ank Spond?

A

Inflammation of the sacroiliac joints
Pain relieved by exercise, worse in mornng
Spinal fusion - bamboo spine

32
Q

What are some extra-articular features of ank spond?

A

Anterior uveatis
Cutaneous lesions
IBD

33
Q

What are the management options for Ank Spond?

A

Infliximab infusions
NSAIDs
Exercise
Other TNF-alpha blockers (etanercept, adalimumab, golimumab)

34
Q

What is ‘pencil in a cup’ a sign of, and what other signs may be seen on x-ray in this condition?

A

Psoriatic arthritis

‘Telescopic’ fingers, bone shortening, loss of joint line

35
Q

What does dactylitis mean and in what conditions is it seen?

A

Sausage shaped fingers

Seen in psoriatic arthritis, seronegative arthritis

36
Q

How do you treat psoriatic arthritis?

A

NSAIDs and DMARDs

Can use ciprofloxacin or anti-TNF alpha agents

37
Q

What infections proceed reactive arthritis?

A

STI (chlamydia), enteric (salmonella, shigella, campylobacter, yersinia).

38
Q

What is Reiter’s Syndrome?

A

Conjunctivitis
Urethritis
Acute Arthritis
Seen in sexually acquired infections

39
Q

What is enthesitis?

A

Inflammation at a tendon or ligament insertion

40
Q

What are some general systemic features of connective tissue disease?

A

Mouth ulcers, dry eyes, dry mouth, hair loss, leg ulcers

41
Q

What does the acronym SOAP BRAIN stand for and what condition is it used for?

A 
SLE
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood - anaemia (all low)
Renal disease - hypertension, proteinuria
ANA
Immunological - anti ds DNA
Neurological - psychosis
42
Q

What are the rashes associated with SLE?

A

Malar rash - butterfly rash across nose and cheeks

Discoid rash - plaques

43
Q

What medical management can be used for SLE?

A

NSAIDs, Prednisolone

Hydroxychloroquine, Rituximab, Cyclophosphamide

44
Q

What are they two types of systemic sclerosis?

A

Limited - CREST (calcinosis, raynaud’s, eosophageal, scerodacyly, telangiectasia)
Diffuse - more progressive, severe, systemic involvement

SS is a loss of elasticity of the skin

45
Q

What investigations do you do in systemic sclerosis?

A

ANA, FBC, U&E
CXR, ECG, ECHO - screen for pulmonary hypertension
Anti-Scl Ab
Anti-centromere Ab

46
Q

How do you manage systemic sclerosis?

A

Skin lubricants, PPI
Illoprost
Regular ECHO and PFT

47
Q

What is Schirmer tear test used for?

A

To test for defective tear production in Sjogren’s Sydrome.

48
Q

Sjogrens occurs with which diseases?

A

Rheumatoid, Sceroderma (systemic sclerosis), SLE

49
Q

How do you manage Raynaud’s?

A

Calcium channel blockers (nifedipide)

50
Q

What is polymyositis?

A

Inflammation of striated muscle

If skin involvement: dermatomyositis

51
Q

What are some features of polymyositis?

A

Proximal muscle weakness
Rash (Gottron’s papules over knuckles)
Muscle wasting
Risk of pulmonary fibrosis

52
Q

What investigations are done in polymyositis and how is it treated?

A

Muscle and skin biopsy
ANA
ESR/CRP
Serum creatinine kinase

Treated with prednisolone

53
Q

What are other organ involvements with Marfan’s Syndrome?

A

Heart - aortic aneurysm, aortic dissection, mitral valve prolapse
Tall, thin body, long arms
Retinal detachment, dislocated lens

54
Q

Is Marfan’s Syndrome autosomal dominant or recessive?

A

Autosomal Dominant

55
Q

What is Ehler Danlos Syndrome?

A

Collagen disorders with an effect on skin fragility, hyperextensibility and joint hypermobility.

56
Q

What types of vasculitis are ANCA positive?

A

Wegener’s Granuloma (Gramulomatosis with polyangiitis)

Churg-Strauss Granulomatosis

57
Q

What is the treatment for PMR?

A

Prednisolone 10-15mg

GCA treat with 60-100mg

58
Q

What is the management for Kawasaki Disease?

A

High dose IV immunoglobulins, aspirin 200-300mg OD

59
Q

What is seen on investigations for vasculitis?

A

Raised ESR

ANCA (Anti-neutrophil cytoplasma antibodies)

60
Q

What are some associated symptoms of GCA?

A

Visual loss
Jaw claudication
Headache, scalp tenderness

61
Q

What is the diagnostic investigation for GCA?

A

Temporal artery biopsy

Not done often but temporal artery ultrasound would show a halo sign

62
Q

What is the biggest worry with GCA?

A

Visual loss due to Anterior Ischaemic Optic Neuropathy (AION)

63
Q

What is Behcet’s Syndrome?

A

Inflammatory vasculitis with systemic inflammation, mouth sores, eye inflammation, headache, muscle and joint pain, genital sores.
Associated with Turkish population

64
Q

What are the systemic symptoms of Granulomatosis with Polyangiitis?

A

Resp: sinusitis pain, breathlessness, pulmonary haemorrhage
Renal: proteinuria, haematuria
Skin: vasculitis rash, ulcers

65
Q

How is Wegener’s treated?

A

Steroids

Methotrexate/Azathioprine

66
Q

Is there proximal muscle weakness in polymyalgia?

A

No, just proximal muscle stiffness

67
Q

What is antiphospholipid syndrome?

A

Predisposition to both venous and arterial thromboses, foetal loss and thrombocytopaenia
Anti-cardiolipin antibody

68
Q

What supplements are advised during pregnancy?

A

Folic acid pre-conception until 12 weeks gestation, vitamin D supplements throughout the whole of pregnancy

69
Q

What features might you see in antiphospholipid syndrome?

A 
Venous/arterial thrombosis
Recurrent miscarriages
Thrombocytopenia
Livedo reticularis - mottled skin discolouration, lace-like
Prolonged APTT
70
Q

What are the 6 ‘A’s of ankylosing spondylitis?

A 
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
71
Q

HLA-B27 is positive in what percentage of patients?

A

90%

Medical Finals 2020 (25 decks)

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