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Phase 4 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the RFs for sciatica?

A

Age 40-65
Smoking
Tall
Occupation - strenuous job, vibrations

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2
Q

Causes of sciatica?

A

90% d/t disc herniation
Malignancy
Infection
Rarely due to a sciatic nerve disorder

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3
Q

What are the S+S in sciatica?

A

Pain in the distribution of the sciatic nerve in the thigh and below the knee (if not felt below the knee, it’s not sciatica)
Often accompanied by numbness and paraesthesia
Pain is exacerbated by coughing, straining, sneezing, laughing

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4
Q

Treatment of sciatica?

A

See notes

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5
Q

What are the two pain symptoms of Anky Spon?

A

Back pain and stiffness

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6
Q

What are the signs on clinical exam of Ank Spon?

A

Schobers test positive
Reduced lateral flexion
Reduced chest expansion

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7
Q

What is the Tx of Ank Spon?

A 
Medical:
NSAIDs (diclofenac/naproxen)
Steroids (for surrounding disease)
Anti-TNF (infliximab, etanercept)
DO NOT USE DMARDS

Physio/hydrotherapy
Stop smoking
Support groups
Encourage exercise

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8
Q

What are the extra-articular symptoms of RA?

A

See notes

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9
Q

Other than RA, what disease is RF positive in?

A

SLE
Sjogrens
Hep C
Acute viruses/infections

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10
Q

What supplement need to be taken with DMARDs?

A

Folic acid

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11
Q

How to treat reactive arthritis?

A

No cure
Splint joint
NSAIDs/IA steroid injections
Consider DMARDs if >6 months

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12
Q

What are the nail changes in psoriatic arthritis?

A

Pitting, yellowing, onycholysis

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13
Q

What is seen on X-ray in psoriatic arthritis?

A

Pencil in cup deformity

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14
Q

How to treat psoriatic arthritis?

A

NSAIDs
Steroids
DMARDs
TNF-alpha

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15
Q

How long to wait after gout attack to start allopurinol? What is the alternative?

A

3 weeks

Febuxostat (more expensive)

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16
Q

What precipitates a gout flare up?

A

Infection, trauma, surgery, starvation, diuretics

17
Q

Gout RFs

A

Male, meat + seafood (high in purines), alcohol, diuretics, obesity, HTN, coronary heart disease, DM, CKD, heart failure

18
Q

Which blood is raised in pseudogout?

A

Neutrophils

19
Q

Things that precipitate pseudogout attack?

A

dehydration, intercurrent illness, haemochromatosis (high iron), hyperparathyroidism, long-term steroids

20
Q

Which Ca is more common in Sjogrens?

A

non-hodgkins lymphoma

21
Q

Which Abs are positive in Sjogrens?

A

ANA, RF, Ro, La

22
Q

Ix for Sjogrens?

A

Salivary gland USS

Schirmer’s test

23
Q

Management of Sjogrens?

A

Tear and saliva replacement
Hydrochloroquine for fatigue, myalgia, arthralgia, rashes
Corticosteroids/immunosuppressants for organ-threatening extra-glandular disease
Biological therapies

24
Q

Which immunosuppressant drug is given for systemic sclerosis?

A

IV cyclophosphamide

25
Q

What is the pathophysiology of dermatomyositis?

A

Capillary obliteration cause ischamia and muscle infarction

26
Q

What are the Ix for dermato/polymyositis?

A 
Check autoantibodies
o	Anti-Jo1 (poly), anti-Mi-2 (derm), ANA
Raised serum muscle enzymes – CK, aldolase
Muscle biopsy
Screen for malignancy
27
Q

What is the Tx for dermato/polymyositis?

A

Steroids

Methotrexate

28
Q

What is the Tx of SLE?

A

To treat flares -> cyclophosphamide + steroids
Maintenance -> NSAIDs + hydroxychloroquine
Biologics -> rituximab
Suncream, topical steroids

29
Q

Investigations for GCA?

A 
Raised CRP/ESP
Raised ALP (inflammatory marker)
Low Hb
Temp art biopsy
Temp art USS - halo sign
30
Q

How long for steroids in GCA?

A

Minimal - 1 year, usually 2

31
Q

What are the blood results like for PMR?

A

Raised CRP
Raised/normal ESR
Raised ALP
CK is normal

32
Q

Characteristic presentation in PMR?

A

Tenderness + morning stiffness in the shoulders and proximal limb muscles (no weakness)

33
Q

What type of cells can be seen on a blood film in myeloma?

A

Rouleaux cells (RBC stacking)

Phase 4 (13 decks)

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