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Rheumatology and Orthopaedics > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is Perthe’s disease?

A

Avascular necrosis of capital femoral epiphysis due to interuption of blood supply, followed by revascularisation and reossification over 18-36 months

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2
Q

What are the symptoms of Perthe’s disease?

A 
gradual onset
PAINLESS limp
Intermittent hip, knee, groin and thigh pain
Trendelenburg 
hip stiff, leg discrepency
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3
Q

How would you treat Perthe’s disease?

A

NSAIDs, traction, crutches, physio
Muscle lengthening, osteotomy

Self-limiting

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4
Q

Who commonly presents with Perthe’s disease?

A

4-8 year olds, males>females

- 50% develop premature OA

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5
Q

What are risk factors for osteomyelitis?

A

behavioural - trauma, IVDU
vascular - DM, sickle cell
pre-existing bone problems
immune deficiency

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6
Q

What are the signs of osteomyelitis?

A

dull pain worse on movement
acue - tenderness, warmth, swelling
chronic - tenderness, warmth, swelling, ulcers, non-healing fractures

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7
Q

How would you treat osteomyelitis?

A

IV antibiotics for 6-10 weeks (e.g. flucloxicillin)
Surgical debridement
Immobilization

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8
Q

What are the signs and symptoms of septic arthritis?

A

red, hot, swollen joint

muscle spasms

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9
Q

How would you test for septic arthritis?

A

need surgeon to aspirate and culture
blood cultures
RBC
swabs

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10
Q

What are some red flag symptoms of bone pain and what would you suspect?

A

pain at rest and at night

- tumour, infection, fracture

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11
Q

What are some red flag symptoms of inflammatory joint pain and what would you suspect?

A

pain and stiffness in joint in morning, at rest and with use
- inflammatory, infective

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12
Q

How do inflammatory joint problems present?

A 
pain eases with use
significant stiffness (>60mins, early morning, at rest)
swelling 
hot and red
young patients, psoriasis, fam history
hand and feet 
responds to NSAIDs
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13
Q

How do degenerative joint problems present?

A 
pain increases with use 
stiffness is not prolonged (<30 mins, morning and evening)
not inflamed or swollen
1st CMCJ, DIPJ, knees 
not as responsive to NSAIDs
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14
Q

What are some systemic symptoms of RA?

A 
fibrosis/interstial lung disease 
cardiomegaly/pericardial effusion 
plueral effusion 
pitting oedema e.g. kidney inflammation
digital vasculitis
gastric ulcers
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15
Q

What are some red flag features of back pain?

A

if <16 or >50 and new back pain

  • history of cancer, weight loss or fever
  • recent serious illness or infection
  • bladder/bowel symptoms/saddle anaesthesia
  • neuro issues e.g. foot drop
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16
Q

How do you monitor people on methotrexate?

A

bloods every 3 months

- FBC, LFT, renal function

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17
Q

What are the complications to look out for with methotrexate?

A

get bone marrow failure, methotrexate toxicity if they have AKI, induces miscarriage

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18
Q

Which antibiotics do you not prescribe to patients on methotrexate?

A

trimethoprim and septrin

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19
Q

What drug do you need to give alongside methotrexate?

A

folic acid

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20
Q

What is the best test to exclude/confirm RA?

A

Anti-cyclic citrullinated ceptide - CCP

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21
Q

What is the first line disease modifying treatment for RA?

A

methotrexate 1 milligrams

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22
Q

What is a complication of methotrexate?

A

first 6 months - pneumonitis

dry cough, low grade fever, SOB

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23
Q

Which bone disease is giant cell arteritis linked to?

A

RA

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24
Q

How would you treat giant cell arteritis?

A

prednisilone - 60mg

ASAP

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25
What is most common cause of bone and joint infection?
Staph aureus
26
Which test should everyone with inflammatory disease have?
Bone density scan
27
What are the mechanisms by which osteomyelitis occurs?
direct inoculation continuous spread of infection to bone haematogenous seeding
28
What are the symptoms in autoimmune connective tissue disease?
CREST Calcinosis, Raynaud's, Eosophageal dysmobility, Sclerodactyl (thickening of skin on digits), Telangiectasia (dilated veins on skin)
29
What is an example of large vessel vasculitis and how you would treat it?
giant cell artertitis | treat with corticosteroids, long term steroid treatment
30
What is fibromyalgia and how would you diagnose it?
widespread MSK pain for at least 3 months - all other causes excluded pain on at least 11/18 tender points, skinfold tenderness
31
What are some symptoms of anti-phospholipid syndrome?
arterial and venous thrombosis recurrent miscarriages thrombocytopenia
32
How do you treat anti-phospholipid syndrome?
low dose aspirin | warfarin if recurrent thrombosis
33
Which rheumatology conditions is antiphospholipid syndrome associated with?
SLE | other rheumatic or autoimmune conditions
34
What is ANCA?
anti-neutrophil cytoplasmic antibodies | a type of vasculitis
35
What is polymyositis/dermatomyositis and how would you test for it?
``` inflammation of striated muscle = proximal muscle weakness TEST - autoimmune antibodies (JO-1, PM=Scl, Mi-2) EMG, MRI, needle biopsy ```
36
How would you treat Raynaud's?
keep warm stop smoking vasodilators sympathectomy
37
What is Raynaud's syndrome/disease?
peripheral digital ischaemia due to spasm of digital arteries, percipitated by cold or emotion
38
What are some symptoms of spondylitis?
SPINEACHE sausage digits, psoriasis, inflammatory back pain, NSAIDs, enthesitis, arthritic, Crohn's/colitis/CRP HLA-B27 Eye -uveitis
39
What is spondylitis?
inflammation of vertebrae
40
What is the pathology of SLE?
apoptosis leads to release of nuclear antigen | genes react and form anti-nuclear antigens which deposit in tissues and cause tissue damage
41
How would you treat systemic sclerosis?
Raynaud's - vasodilators sympathectomy Reflux - PPI Ace-i to prevent renal crisis skin oedema - cytotoxic drugs
42
What are the symptoms of Sjogren's sydrome?
``` DRY sicca complex (dry eyes and mouth, enlarged salivary glands) inflammatory arthritis lymphadenopathy fatigue vasculitis dry cough, dysphagia ```
43
What is scleroderma?
autoimmune connective tissue disorder esp. on hands, arms and face life threatening when pulmonary involvement
44
What is the difference between gout and pseudogout?
gout - monosodium urate crystals | pseudogout - calcium pyrophosphate crystals
45
How would you treat SLE?
``` UV protection assess organ damage and activity topical sunscreen, steroids, cytotoxic NSAIDs, antimalarials, anticoagulants rituximab ```
46
How do you treat Sjorgren's syndrome?
artifiical tears and saliva | immunosuppression e.g. ritiximab
47
What is the diagnostic conditions for SLE?
``` renal, neuro, haem disorders antinuclear antibodies, antiphospholipid, anti-smith, anti-dyDNA butterfly/malar rash, photosensitivity discoid ulcers in mouth/nose scleritis (plueirits, pericarditis) arthritis ```
48
What is the treatment of osteoarthritis?
non-medical e.g. physio topical NSAIDs, analgesia arthroscopy arthroplasty
49
What are the main extra-articular symptoms of rheumatoid arthritis?
``` carpal tunnel syndrome tenosynovitis scleritis pulmonary fibrosis pericarditis vasculitis ```
50
What are some symptoms of rheumatoid arthritis?
``` early morning stiffness pain loss of function deformity, damage swelling symmetrical extra-articular ```
51
What disease is enteropathic arthritis associated with?
IBD - 20% have IBD
52
What are the differences between OA and RA?
``` RA = autoimmune, joints and organs, symmetrical, any age, faster worsening OA = degenerative joints, old age ```
53
How do you treat spondyloarthritis?
physio anti-inflammatories anti-TNF
54
What is the antigen associated with spondyloarthritis?
HLA-B27
55
What are some symptoms of psoriatic arthritis?
affects distal interpharyngeal joints assymetricla oligarthritis onycholysis
56
How would you treat rheuamtoid arthritis?
``` analgesia steroids DMARDs anti-TNF exercise, physio, manage rf ```
57
What on XR indicates OA?
``` joint space narrowing osteophyte formation subcondral sclerosis subchondral cysts abnormalities of bone contour ```
58
What causes reactive arthritis?
triggered 2days - 2 weeks after infection (especially UTI) | sterile inflammation of synovial membrane, tendons and fascia
59
How do you test for gout?
polarized light microscopy of synovial fluid XR - early shows soft tissue swelling, late shows periarticular erosion Bloods - serum urate
60
How do you treat crystal arthritis?
steroids colchicine, allopurinol NSAIDs
61
What are some signs of Duchenne's muscular dysrophy?
Proximal muscle weakness = pseudohypertrophy of calves | Gower's sign
62
What is the genetic disease that causes DMD and how can it vary?
X-linked dystrphin destruction | Becker's
63
What is the most common muscular dystrophy and it's symptoms?
myotonic MD facial, limb girdle and proximal limb wasting GI disturbance, diabetes, myotonia
64
What are some examples of large vessel vasculitis?
giant cell arteritis polymyalgia rheumatica Kawasaki's Tachyau's arteritis
65
How quickly do you need to do a biopsy in giant cell arteritis? Why could there be a false negative?
within 2 weeks of starting steroids | - can be false - as inflammation has skip lesions
66
How do you treat giant cell arteritis?
IV methylprednisolone if visual disturbance | oral prednisilone if no visual disturbance
67
What other condition is associated with giant cell arteritis that you need to include in a history?
polymyalgia rheumatica - ask about back pain
68
What are some symptoms of Tachyau's arteritis?
aneurysms, pulseless limbs, radio-radial delay, blood pressure differences
69
What are some medium vessel vasculitis conditions?
``` polyarteritis nodosa (Hep B, scrotal disease, peripheral neuropathy) Behcet's (mouth and genital ulcers) ```
70
What are some examples of small vessel vasculitis?
``` granulomatosis with polyangiitis microscopic polyangitis Churg strauss Good-pastures IgA vasculitis ```

Rheumatology and Orthopaedics (5 decks)

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