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Long Case > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Presentation of osteoarthritis

A

Pain and stiffness worst at the end of the day
Pain on movement
Crepitus

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2
Q

Features to look for on exam for osteoarthritis

A

DIP Heberden’s nodes
PIP Bouchard’s nodes
Pain in stiffness in thumbs, MCP, knees
Limited ROM

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3
Q

Findings on XRay for osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis

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4
Q

Management of osteoarthritis

A 
Weight loss
Exercise/physio/walking aids
Topical NSAIDs
Corticosteroid/hyaluronic acid injections
Surgical joint replacement
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5
Q

Presentation of rheumatoid arthritis

A 
Pain/swelling
Morning stiffness
Deformity
Raynaud's/nodules
Dyspnoea
Peripheral neuropathy
Anaemia symptoms
Fatigue
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6
Q

Targeted examination for rheumatoid arthritis

A 
Wrist swelling/deviation
MCP swelling
Ulnar deviation/subluxation
Swan neck/boutonnaire's/Z-thumb
Palmar erythema
Fixed flexion
Nodules
Temperature
Grip strength and functional tests
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7
Q

Diagnosis of rheumatoid arthritis

A 
4 or more
Arthritis of 3 or more joints
Rheumatoid nodules
Morning stiffness
Radiographic changes
Arthritis of hand joints
Positive rheumatoid factor
Symmetrical arthritis
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8
Q

Blood findings in rheumatoid arthritis

A

Low Hb High ESR Rheumatoid factor and anti-CCP antibodies

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9
Q

Which score is used to monitor rheumatoid arthritis?

A

DAS28

Includes ESR and number of tender and swollen joints

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10
Q

Management of rheumatoid arthritis

A 
PT and OT
NSAIDs
Methotrexate, sulfasalazine and hydroxychloroquine
Infliximab
Steroids in acute flares
Surgical joint replacement
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11
Q

Side effects of rheumatoid arthritis medication

A

Methotrexate: pneumonitis, hepatoxicity, oral ulcers
Sulfasalazine: rash, oligospermia, oral ulcers
Hydroxychloroquine: retinopathy
Infliximab: infections

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12
Q

Presentation of ankylosing spondyloarthritis

A 
Young male
Low back pain worse at night, morning stiffness relieved by exercise
Loss of spinal movements
Tendon inflammation and uveitis
HLA-B27
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13
Q

Investigations for ank spond

A

Bloods:ESR, HLA-B27

MRI

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14
Q

Management of ank spond

A

Exercise
NSAIDs
ANti TNF-a blockers if severe (humira/adalimumab)
Local steroid injections for short term relief

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15
Q

Presentation of psoriatic arthritis

A

Affects 10-40% of those with psoriasis
Symmetrical polyarthropathy or asymmetrical oligoarthropathy
Skin and nail changes
Onycholysis and dactylitis

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16
Q

Management of psoriatic arthritis

A

NSAIDs
Methotrexate/sulfsalazine/ciclosporin
Anti TNF-a if severe

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17
Q

Presentation of reactive arthritis

A

1-4 weeks following urethritis or dysentery

Reiter’s syndrome: urethritis, conjunctivitis, arthritis

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18
Q

Management of reactive arthritis

A

Rest and splint affected joints
NSAIDs/local steroid injection
Consider methotrexate

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19
Q

Define SLE

A

Multisystem autoimmune disease characterised by B-cell secretion of autoantibodies to a variety of autoantigens which form immune complexes. More common in females

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20
Q

Syndromes commonly associated with SLE

A

Sjogrens
Antiphospholipid
Autoimmune thyroid disease

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21
Q

Features of SLE (4 required for diagnosis)

A 
Discoid rash
Lupus nephritis
Arthritis
Malar rash
ANA +ve
Serotitis (pleuritis/ pericarditis)
Immunological (antidsDNA/ Anti-SM)
Photosensitivity
Haemolytic anemia/leukopenia
Oral ulcers
Neurological (seizures/psychosis)
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22
Q

Which drugs can induce SLE

A

Procainamide
Hydralazine
Diltiazem
Isoniazid

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23
Q

Haematological findings in SLE

A 
Normocytic anaemia or haemolytic anaemia
High ESR but normal CRP
Low platelets and WBC
ANA +ve 
Anti-dsDNA +ve
Anti SM +ve
Low C3 and C4
24
Q

Management of SLE

A

Acute flares: IV cyclophosphamide and high dose prednisolone
Maintenance: NSAIDs, steroids, methotrexate or azathioprine, warfarin for hypercoagulability
Sunscreen

25
Q

Presentation of anti-phospholipid syndrome

A

Coagulation defect
Livedo reticularis
Obstetric (recurrent miscarriage)
Thrombocytopenia

26
Q

What is psoriasis characterised by

A

Epidermal proliferation

Inflammatory infiltration of the dermis and epidermis by TNF-alpha, activated T-cells, macrophages and dendritic cells

27
Q

Risk factors psoriasis

A 
Stress
Skin trauma
Drugs (lithium, NSAIDs)
Alcohol/smoking
Obesity
Family history
28
Q

Other diseases associated with psoriasis

A 
Inflammatory arthritis
Inflammatory bowel disease
Uveitis
Coeliac disease
Metabolic syndrome
29
Q

Management of psoriasis

A

Remove triggers-discuss control not cure
Mild: calcipotriol and betamethasone cream
Emolliants
Salicyclic acid
Moderate/severe: phototherapy or methotrexate
Biologics if no improvement

30
Q

Difference between scleroderma and systemic sclerosis

A

Scleroderma: autoimmune skin fibrosis

Systemic sclerosis: scleroderma + vasculitis

31
Q

Types of systemic sclerosis

A

Limited cutaneous systemic sclerosis (CREST): anti-centromere, limited to face hands and feet
Diffuse cutaneous systemic sclerosis: anti-topoisomerase

32
Q

Presentation of CREST syndrome

A 
Thickening of fingers, tight skin (prayer sign)
Telangiectasia
Raynaud's
GORD
Calcinosis on extensor surfaces
33
Q

Investigations for systemic sclerosis

A

Bloods
Renal function
Echo
Pulmonary function tests (for interstitial lung disease)

34
Q

Management of systemic sclerosis

A 
Smoking cessation
Methotrexate/mycophenylate
Sildenafil for raynauds
Prednisone
Monitor FBC, renal function and echo
35
Q

Risk factors for Sjogren’s syndrome

A

Female, 20s, scleroderma, RA, SLE

36
Q

Presentation of sjogren’s syndrome

A 
Kerratoconjunctivitis
Altered swallow/taste
Decreased salivation
Parotid swelling
Arthralgia
37
Q

Investigations for Sjogren’s

A

Schimer’s Test
Test of conjunctival dryness (<5mm in 5 mins)
Check RF ANA anti-RO
Salivary gland biopsy

38
Q

Management of Sjogren’s

A 
Treat symptoms (eye drops, lozenges, gum, pilocarpine)
Treat vasculitis with prednisone or IV IG
Avoid dentures over night, avoid anti-cholinergics and anti-histamines
39
Q

What is polymyositis/dermatomyositits?

A

Polymyositis is immune-mediated striated muscle inflammation

Dermatomyositis is polymyositis plus cutaneous involvement

40
Q

Presentation of polymyositis/dermatomyositis

A

Symmetric progressive proximal muscle weakness
Gottron papules
Shawl sign (rash over shoulders, chest and back)
Heliotrope rash (dusky red periorbital rash)

41
Q

Investigations for polymyositis/derm

A

Raised serum creatinine kinase and anti-Jo antibodies
Electromyography
Muscle biopsy
MRI for muscle oedema/fibrosis and checking for malignancy

42
Q

Management of poly/derm

A

Screen for malignancy
High dose prednisone for acute flares
Derm manifestations just moisturiser/sunscreen
Azathioprine Methotrexate
IVIG in severe cases
Follow up with rheum and regular assessment of pulmonary and cardiac involvement

43
Q

Risk factors for gout

A

Seafood, meat, beer, obesity, diuretics, dehydration

44
Q

Presentation of gout

A

Rapid onset pain
50% 1st MTP
Red, hot, swollen, tender
Can be mono or oligo

45
Q

Investigations for gout

A

Arthrocentesis (negative birefringent needles)
Raised WBC and serum urate
Xray

46
Q

Criteria for diagnosis of gout

A 
Monosodium urate crystals in joint fluid and
developed within one day
Monoarthritis with redness
1st MTP involved
Tophi
Abnormal swelling on xray
47
Q

Management of gout

A

Acute flare: naproxen/colchine/prednisone
Prevention: allopurinol
Lose weight and improve diet

48
Q

Presentation of polymyalgia rheumatica

A

Bilateral morning stiffness in neck/shoulders/pelvis
Low grade fever and fatigue
Response to steroids
Associated with giant cell arteritis

49
Q

Investigations for polymyalgia rheumatica

A

CRP, ESR, serum electrophoresis (rule out myeloma)

Normal CK

50
Q

Management of polymyalgia rheumatica

A 
Prednisone
Colecalciferol
Alendronate
Warn patient of GCA symptoms
Monitor monthly
51
Q

Presentation of giant cell arteritis

A

Headache
Scalp tenderness
Jaw claudication
Monocular blindness

52
Q

Investigations for GCA

A

ESR
FBC
Temporal artery biopsy-treat first

53
Q

Management of GCA

A

Start prednisone 1mg/kg first if high suspicion of GCA
Begin aspirin 75mg OD when confirmed
Monitor because increased aneurysm risk

54
Q

Presentation of fibromyalgia

A

Chronic diffuse pain
Chronic fatigue
Cognitive dysfunction
Sleep and mood disturbance

55
Q

How to diagnose fibromyalgia/investigate

A

Diagnosis of exclusion all bloods normal

Tender in 11/18 spots

56
Q

Management of fibromylagia

A 
Amitriptyline
Gabapentin
CBT
Exercise
Education

Long Case (11 decks)

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