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Medical School > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Rheumatoid arthritis - general

  1. Which cells target normal tissue
  2. Higher risk if do what
  3. Classic presentation
  4. Symptom onset - time frame
  5. X-ray findings (4)
  6. Blood protein in 70%
  7. Highly specific antibody
  8. Other bloods
A
  1. T cells
  2. Smoke
  3. Symmetrical swollen/painful/stiff small joints, worse in morning, long duration (>6 weeks)
  4. Over weeks/months
  5. Soft tissue swelling, loss of joint space, joint deformity, juxta-articular osteopaenia
  6. Rheumatoid factor - associated with more severe
  7. Anti-CCP
  8. Normo/microcytic anaemia, high platelets/ESR/CRP
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2
Q

Rheumatoid arthritis - management

  1. Assess disease activity with
  2. General management - 1st line (+ monitoring)
  3. Others
  4. Side effects
  5. TNF-inhibitors if
  6. Hydroxychloroquine - what must be checked regularly
  7. Flare - 1st line
  8. Analgesia - most useful
A
  1. DAS28 + CRP monitoring
  2. DMARD monotherapy - methotrexate* (LFT, FBC)
  3. Sulfasalazine, hydroxychloroquine,
  4. GI upset, raised liver enzymes, bone marrow suppression, oral ulcers, pneumonitis
  5. 2 DMARDs didn’t work
  6. Retinal damage
  7. IM methylprednisolone
  8. NSAIDs
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3
Q

Rheumatoid arthritis - examination

  1. Joints affected
  2. Typical distribution
  3. Joint - pathological processes (4)
  4. Boutonniere deformity =
  5. Swan neck deformity =
  6. Other hand/wrist signs
  7. Extra-articular manifestations - nodule location (6)
  8. Lungs (4)
  9. Cardiovascular
  10. Other
  11. Felty syndrome - 2 additional features
A
  1. Small-medium (MCP, PIP, wrist, MTP)
  2. Symmetrical
  3. Tenosynovitis, bursitis, thickened capsule, bone erosion, cartilage destruction
  4. PIP flexion, DIP hyperextension
  5. MCP flexion, PIP hyperextension, DIP flexion
  6. Ulnar deviation, wrist/finger subluxation (radiocarpal), ulnar claw (MCP extension, PIP flexion)
  7. Elbows, lungs, cardiac, CNS, lymphadenopathy, vasculitis
  8. Pleural disease, interstitial fibrosis, bronchiolitis obliterans, organising pneumonia
  9. IHD, pericarditis, pericardial effusion
  10. Anaemia, carpal tunnel, peripheral neuropathy, splenomegaly
  11. RA with splenomegaly + leukopaenia
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4
Q

Spondyloarthropathies - general

  1. Types (4)
  2. Common features
  3. Enthesitis - definition, examples (3)
  4. Pathology - step 1
  5. Pathology - step 2
  6. Enteric arthropathy - associations
  7. Management
  8. Psoriatic arthritis - joint patterns (5)
  9. Examination
  10. Radiology
  11. Management
  12. Other HLA-B27-associated disease
A
  1. Ankylosing spondylitis, enteric arthropathy, psoriatic arthritis, reactive arthritis
  2. Seronegative (RhF -), HLA B27 associated, ‘axial’, asymmetrical, large joint, mono/oligo pattern, dactylitis
  3. Inflammation at insertion of a tendon, ligament or capsule in a bone (plantar fasciitis, achilles tendonitis, chostrochondritis)
  4. Initial inflammation + erosions
  5. Fibrosis + ossification
  6. IBD, GI bypass, Whipple’s disease, coeliac disease
  7. Arthropathy improves if treat bowel, DMARD if resistant
  8. Symmetrical poly, DIP only, asymmetrical oligo, spinal, mutilans
  9. Nail changes, dactylitis, aceneiform rash, palmo-plantar pustulosis
  10. Erosive, ‘pencil in cup’ if severe,
  11. NSAIDs, sulfasalazine, methotrexate
  12. Acute anterior uveitis
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5
Q

Ankylosing spondylitis

  1. Classic patient
  2. Main joints affected (2)
  3. Extra-skeletal features
  4. Associated diseases
  5. Examination
  6. Diagnosis
  7. Imaging findings
  8. Bloods
  9. Management
A
  1. Young male - back pain worse at night with early morning stiffness >30 minutes (relieved by exercise)
  2. Spine, sacroiliac
  3. Apical fibrosis, anterior uveitis, aortic regurgitation, AV node block achilles tendonitis, amyloidosis, cauda equina, peripheral arthritis (25%, commoner if female)
  4. Crohn’s/UC
  5. Progressive loss of spine ROM in all directions, reduced thoracic expansion, sometimes progress to kyphosis + neck hyperextension
  6. MRI spine + sacroiliac joints
  7. MRI - marrow oedema (active inflammation), destructive changes (sclerosis, erosions, anklyosis).
    CXR can also show sacroiliac joint space narrow/wider, T11-L1 syndesmophytes, causing fusion
  8. Normocytic anaemia, high ESR/CRP
  9. NSAIDs, TNF inhibitors, exercise (physio imput)
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6
Q

Osteoarthritis

  1. Risk factors
  2. Secondary predisposing factors (3)
  3. Classic joint presentation (4)
  4. Classic history
  5. Common joints (4)
  6. Examination - general
  7. Bouchards nodes - location
  8. Herberdens nodes - location
  9. X-ray changes (4)
  10. Bone screen - 3 components
  11. Management
A
  1. Age, obesity, female, occupation, muscle weakness, gout
  2. Trauma, congenital/developmental, metabolic disease
  3. Pain/crepitus, stiffness, swelling, deformity
  4. Pain/crepitus worse on moving, background ache at rest, stiffness post-rest, perceived power loss from pain
  5. Knee, hip, DIP + thumb CMC
  6. Joint tenderness, derangement, bony swelling, mild sinovitis, reduced ROM
  7. PIPJs
  8. DIPJs
  9. Loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts
  10. ALP, Ca2+, phosphate
  11. Exercise, weight loss, analgesia (regular paracetamol + topical NSAIDs, short course PO + codeine if not enough), hot/cold packs, physio, joint replacement
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7
Q

Methotrexate - counselling

  1. Action
  2. Timeline
  3. How to take
  4. Length of treatment
  5. Effects - time before
  6. Tests (+ when)
  7. Important side effects
  8. Complications (+ symptoms)
  9. Contraindications
  10. Supplementary advice - when to get help
  11. What else to do to avoid infection
  12. Avoid/limit what
  13. When not to take
  14. IMPORTANT LIFESTYLE ADVICE
A
  1. Disease modifier, reduced inflammation, improves symptoms
  2. Once weekly with folic acid at another time
  3. Tablet usually, sometimes injection
  4. Long-term
  5. 4-6 months
  6. FBC, U+E, LFT (at start, then every 2 weeks until stable, then every 3 months)
  7. Alopecia, headaches, GI upset (mucosal damage)
  8. Myelosuppression (infection, anaemia, unexplained bleed/bruise), hypersensitive (hepatitis/pneumonitis/rash)
  9. Trying for baby (M/F), pregnant, active infection, liver / renal failure, breastfeeding, immunodeficiency.
  10. Go to ED if myelosuppression or respiratory signs
  11. Get pneumococcal vaccine before + yearly flu jab
  12. Limit careful alcohol, no NSAIDs / aspirin / penicillin
  13. If have infection
  14. Contraception (M+F) whilst using + 3 months after
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8
Q

Vasculitis - general

  1. Classified using what
  2. Can be primary, or secondary to what (6)
  3. General symptoms/test result
  4. Large vessel - types (3)
  5. Polymyalgia rheumatica -features
  6. Investigations
  7. Differentials (4)
  8. Management
  9. Takayasu arteritis - classic presentation
  10. Other signs
  11. Association
  12. Management
A
  1. Modified Chapel Hill Criteria
  2. SLE, RA, Hep B/C, HIV, malignancy
  3. Overwhelming fatigue, raised ESR/CRP, maybe ANCA
  4. Giant cell, polymyalgia rheumatica, takayasu arteritis
  5. > 50, F, subacute onset of fatigue, bilateral aching, tenderness, morning stiffness in shoulders, hips, proximal limbs, weight loss, anorexia, depression. Associated mild polyarthritis, tenosynovitis, carpal tunnel. NO weakness.
  6. CRP up, ESR >40/normal, ALP up in 30%, CK normal
  7. RA, polymyositis, hypothyroidism, cervical spondylosis
  8. Prednisolone 15mg PO (much better within 7 days)
  9. Female, asian, aorta occlusion, absent limb pulse
  10. Intermittent claudication, malaise, headache, carotid bruit
  11. Renal artery stenosis
  12. High dose prednisolone
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9
Q

Medium vessel vasculitis - general

  1. Types (2)
  2. PAN - what is it
  3. Associated with what
  4. Features
  5. Commonest cause of death
  6. Diagnostic
  7. Management
  8. Kawasaki disease - features (6)
  9. Management
  10. Complications
A
  1. Polyarteritis nodosa (PAN), kawasaki disease
  2. Necrotising vasculitis, thrombosis/aneurysms
  3. Hep B, middle-aged men
  4. Fever, malaise, arthralgia, haematuria, renal failure
  5. Renal artery stenosis, glomerular ischaemia, HTN
  6. Renal/mesenteric angiography, renal biopsy
  7. Control BP, steroids if mild, steroid-sparing if severe
  8. High fever >5 days, conjunctival injection, cracked lips, strawberry tongue, cervical lymphadenopathy, red palms/soles of feet (peel)
  9. High dose aspirin, IVIG, echo
  10. Coronary artery aneurysm
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10
Q

Small vessel vasculitis - general

  1. Types (3)
  2. Which associated with c-ANCA (targets PR3)
  3. Which associated with p-ANCA (targets MPO)
  4. Microscopic - signs
  5. eGPA (Churg-Strauss) - other features
  6. GPA (Wegener’s) - other features
  7. Management - to go into remission
  8. What to add if vital organ/life-threatening
  9. Maintenance therapy
A
  1. Eosinophilic granulomatosis with polyangiitis, granulomatosis with polyangiitis, microscopic polyangitis
  2. GPA, sometimes microscopic
  3. EGPA, microscopic polyangitis
  4. Rapidly progressing glomerulonephritis, pulmonary haemorrhage
  5. Asthma, sinusitis, mononeuritis multiplex, p-ANCA
  6. URT (epistaxis, sinusitis, nasal crusting), LRT (dyspnoea, haemoptysis), vasculitis rash, eyes involved, pauci-immune glomerulonephritis, c-ANCA
  7. IV cyclophosphamide/ rituximab, glucocorticoid
  8. Plasma exchange
  9. Methotrexate / azathioprine / rituximab, + taper glucocorticoids
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11
Q

High-dose steroids

  1. Things to check before starting
A
  1. GI protection, bone protection, screen for DM, monitor BP/weight
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12
Q

Antiphospholipid syndrome

  1. Associated with (20-30%)
  2. Characteristics - ‘CLOTS’
  3. Main antibodies (2)
  4. Management
A
  1. SLE
  2. Coagulation defect (arterial/venous)
    Livedo reticularis
    Obstetric (recurrent miscarriage)
    Thrombocytopaenia (cerebral, renal)
  3. Anti-phospholipid (lupus anticoagulant, cardiolipin)
  4. Anticoagulation, pregnancy counselling
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13
Q

Systemic lupus erythematosus (SLE)

  1. Autoantibody production against
  2. Drugs that induce (3)
  3. Type of arthritis
  4. Dermatological features (4)
  5. Cardiovascular features (3)
  6. Non-infective endocarditis - type, valve affected
  7. Respiratory features (3)
  8. Haematological features (4)
  9. Commonest cause of lupus-related death
  10. Main serological test
  11. Antibodies present
  12. Other bloods
  13. Management - mild
  14. Moderate
  15. Severe
A
  1. Nuclear material (ANA, homogenous)
  2. Minocycline, oral contraceptive, hydralazine
  3. Non-erosive
  4. Photosensitivity, butterfly rash, hair loss, mucosal ulceration
  5. Pericarditis, myocarditis, raynaud phenomenon
  6. Libman-sacks endocarditis, mitral valve
  7. Pleurisy, pleural effusions, pneumonitis
  8. Lymphopaenia, neutropaenia, anaemia, antiphosphalipid syndrome
  9. Glomerulonephritis
  10. ANA (95%)
  11. anti-dsDNA (60%), RF (40%), ENA in 20% (Ro, La, Sm, RNP), antiphospholipid (cardiolipin/Lupus anticoagulant)
  12. Low complement (C3/4/50), positive direct coombs
  13. NSAIDS / hydroxychloroquinine
  14. Corticosteroids / azathiprine / methotrexate
  15. Corticosteroids + cyclophosphamide / tacrolimus
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14
Q

Sjogren’s syndrome

  1. Which glands affected, consequence
  2. Cause
  3. Commoner in
  4. Increased risk of
  5. Features
  6. Name for dry eyes
  7. Associated renal disease
  8. Type of neuropathy
  9. Investigations - what present in nearly all patients
  10. What positive in 70%
  11. What positive in 30%
  12. Test to measure tear formation
  13. Histology
  14. Other bloods - significant results (2)
A
  1. Exocrine, so dry mucosal surfaces
  2. Primary, or secondary to RA/other CTDs
  3. Women
  4. Lymphoid malignancy
  5. Dryness (eyes, mouth, vagina), joints (arthralgia, raynaud’s, myalgia,
  6. Keratoconjunctivitis sicca
  7. Renal tubular acidosis
  8. Sensory polyneuropathy
  9. Rheumatoid factor
  10. ANA, Anti-Ro (if primary)
  11. Anti-La
  12. Schirmer’s test: filter paper near conjunctival sac
  13. Focal lymphocytic infiltration
  14. Hypergammaglobulinaemia, low C4
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15
Q

Raynaud’s syndrome

  1. Management - 1st line
A
  1. Nifedipine
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16
Q

Fibromyalgia

  1. Risk factors (3)
  2. Associated symptoms (7)
  3. Investigations to rule out other diseases
  4. Diagnostic requirements
  5. Main pharmalogical treatment
  6. What not to use
  7. Chronic fatigue syndrome (myalgic encephalomyelitis)
    - definition
A
  1. Female, middle age, stress
  2. Depression, fatigue, poor concentration, sleep disturbance, headache, paraesthesia, anxiety
  3. TSH, vit D, B12, iron studies, magnesium, ESR/ CRP
  4. Chronic (> 3 months), widespread (L/R, upper/lower)
  5. Amitriptyline
  6. NSAIDs
  7. Persistent disabling fatigue >6 months, present >50% of the time + 4 of: myalgia, polyarthralgia, worse memory, unrefreshing sleep, exertional fatigue >24 hours, sore throat, tender lymph nodes
17
Q

Gout

  1. Type of crystals
  2. Deposited where (3)
  3. Symptoms/signs - ‘G O U T’
  4. Urate high - threshold
  5. Primary - causes
    Secondary gout
  6. Over-production of uric acid - causes (4)
  7. Under-excretion of uric acid - causes (4)
  8. Bloods (2)
  9. Aspiration - findings
  10. X-ray - early
  11. Late
A
  1. Urate
  2. Joints, kidneys, soft tissues
  3. Great toe (MTP), One joint, Uric acid raised, Tophi
  4. > 0.4 mmol/L
  5. Uricaemia inherited disorder, hypothyrodism
  6. Psoriasis, polycythaemia rubra vera, leukaemia, primary hyperparathyroidis, diet (alcohol, red meat, sweeteners\0
  7. HTN, renal disease, alcohol, elderly, diuretics
  8. Urate, U+Es
  9. Needle shaped crystals, negatively birefringent
  10. Soft tissue swelling
  11. Periarticular erosion + disruption, NORMAL joint space
18
Q

Pseudogout (CPPD)

  1. Risk factors (4)
  2. Joints affected
  3. Acute - pattern
  4. Chronic - pattern
  5. Aspiration - findings
  6. X-ray - finding
  7. Management - acute
  8. Prophylaxis
  9. Complications
A
  1. Arthritis, DM, hyperparathyroidism, haemochromatosis, low phosphate
  2. Knees, wrists, hips
  3. Large joint mononeuropathy post illness/surgery/trauma
  4. Inflammatory, symmetrical, polyarthritis/sinovitis
  5. Oval / rhomboid crystals, weakly positively birefringent
  6. Chondrocalcinosis (soft tissue calcium deposits)
  7. Usually self limiting, rest, NSAIDs, cool packs, intra-articular steroids
  8. NSAIDs (+ PPI) + colchicine
  9. Secondary osteoarthritis
19
Q

Gout - management

  1. Conservative
  2. Avoid what
  3. Acute flare
  4. Long-term prophylaxis - what
  5. Indication
  6. How long to wait before starting post-flare
  7. Titration
  8. Other indications (2)
  9. Side effects
  10. Give what alongside when starting
  11. What happens in next flare
  12. Alternative if contraindicated (+ side effect)
A
  1. Weight loss
  2. Purine rich food, alcohol excess, aspirin, diuretics
  3. NSAIDs / Colchicine / Steroids (if renal impairment so can’t have other two), rest/elevate, ice packs
  4. Allopurinol
  5. > 1 flare in 12 months, but especially if >2 flares, renal disease, uric acid renal stones, tophi
  6. Wait until inflammation reduced (3 weeks)
  7. 100mg a day, increase every 4 weeks until plasma urate < 0.3.
  8. Cytotoxics, diuretics
  9. Rash, fever, low WCC, can preciptate flare
  10. NSAID (6 weeks) / colchicine 0.5mg bd 6 months
  11. Don’t stop allopurinol
  12. Febuxostat (deranged LFTs)
20
Q

Antibodies/protein markers present

  1. Rheumatoid arthritis (2)
  2. SLE (5)
  3. Drug-induced SLE
  4. Sjogren’s (4)
  5. Anti-phospholipid syndrome (2)
  6. Polymyositis / dermatomyositis (2)
  7. Limited cutaneous systemic sclerosis
  8. Diffuse systemic sclerosis
  9. Which can cross placenta in pregnancy
A
  1. Rheumatoid factor, anti-CCP
  2. ANA (95%) anti-dsDNA (60%), RF (40%), ENA in 20% (Ro, La, Sm, RNP), antiphospholipid (cardiolipin/Lupus anticoagulant)
  3. Anti-histone
  4. ENA (Ro, La), ANA, rheumatoid factor, anti-CCP
  5. Anti-phospholipid (cardiolipin, lupus anticoagulant)
  6. Anti-Jo, ANA
  7. Anti-centromere, ANA
  8. Anti-Scl70
  9. Anti-Ro, anti-La
21
Q

Rheumatology history - general

  1. Screening questions (3)
  2. Presenting symptoms
  3. Extra-articular features
  4. Related diseases
  5. Current/past drugs
  6. Family history
  7. Social history
A
  1. Free from pain/stiffness in joints/muscle/back, dress self, walk up/down stairs
  2. Pattern, symmetry, morning stiffness >30 minutes, pain, swelling, loss of function, erythema, warmth
  3. Rash/photosensitivity, Raynaud’s, nodules/nodes, ulcers (mouth/genitals), dry eyes/mouth, anterior uveitis, diarrhoea/urethritis, weight loss
  4. Crohn’s/UC, preceding infections, psoriasis
  5. NSAIDs, DMARDs, biological agents
  6. Arthritis, psoriasis, autoimmune disease
  7. Age, occupation, sexual history, smoking (may worsen RA), home help
22
Q

Arthritides - differentials

  1. Monoarthritis (4)
  2. Oligoarthritis (5)
  3. Symmetrical polyarthritis (4)
  4. Asymmetrical polyarthritis (3)
A
  1. Septic, crystal, osteorthritis, trauma (haemarthrosis)
  2. Crystal, psoriatic, reactive, ankylosing spondylitis, osteoarthritis
  3. Rheumatoid, osteoarthritis, viruses (Hep A/B/C, mumps), systemic conditions
  4. Reactive, psoriatic, systemic
23
Q

Reactive arthritis

  1. Joint pattern
  2. Causative organisms (broad areas)
  3. Other clinical features
  4. Reiter’s syndrome - triad
  5. Investigations - investigate reactive cause
  6. Management
A
  1. Oligoarthritis, asymmetrical
  2. GI (salmonella, campylobacter, yersinia), GU (chlamydia)
  3. Iritis, keratoderma blenorrhagia (raised brown plaques on soles/palms), circinate balanitis (painless penile ulceration from chlamydia), mouth ulcers, enthesitis
  4. Arthritis, urethritis, conjunctivitis
  5. ESR, CRP, stool culture if diarrhoea, sexual health review, viral serology
  6. No specific cure; splint joints, NSAIDs, local steroid injections
24
Q

Synovial fluid (appearance, viscosity, WBC, neutrophils)

  1. Normal
  2. Osteoarthritis
  3. Haemorrhagic
  4. Rheumatoid arthritis
  5. Crystal arthritis (gout/CPPD)
  6. Septic arthritis
  7. Bloods - general
A
  1. Clear, normal V, WBC <200, neuts 0
  2. Clear/straw, high V, WBC <1000, neuts <50%
  3. Xanthochromic, varied V, WBC <10000, neuts <50%
  4. Turbid/yellow, low V, WBC 1-50,000, neuts varied
  5. Turbid/yellow, low V, WBC 5-50,000, neuts 80%
  6. Turbid/yellow, low V, WBC 10-100,000, neuts >90%
  7. FBC, ESR, urate, U+E, CRP, culture if ? septic
25
Q

NSAIDs - side effects and how to manage

  1. GI
    Avoid concomitant prescription of
  2. CV
    NSAID with lowest CV risk
  3. Renal
    Higher risk if
  4. Counselling - important points
A
  1. Bleeding/ulcers/perforation; prescribe PPI if >45 or other bleeding risk
    Anticoagulants, antiplatelets, SSRI, spironolactone, steroids, bisphosphonates
  2. MI/stroke
    Naproxen
  3. Failure
    Diuretics, ACE-i, ARBs, elderly, HTN, T2DM
  4. Only take when need, stop + get help immediately if new abdominal pain / any signs of GI bleeding (black stool, fainting), no mixing NSAID types, smoking/alcohol increase risk
26
Q

Systemic sclerosis

  1. Features
  2. Limited cutaneous (CREST) - location, association
  3. Antibodies (2)
  4. Diffuse - antibodies (2)
A
  1. Scleroderma, internal organ fibrosis, microvascular abnormality
  2. Face, hands, feet; subclinical pulmonary HTN (sildenafil)
  3. ANA (anti-centromere)
  4. Anti-SCL-70, anti-nucleolar, anti-CCP, anti-RNAP (20%)
27
Q

Myositis

  1. Definition
  2. Polymyositis - definition
  3. Associated muscular symptoms
  4. Extra-muscular signs
  5. Dermatomyositis - skin signs
  6. Associated malignancies
  7. Bloods
  8. Diagnostic test
  9. Other tests + findings (2)
  10. Antibodies
  11. Management - general
  12. Skin
A
  1. Autoimmune striated muscle inflammation
  2. Insidious progressive symmetrical proximal muscle weakness
  3. Myalgia, dysphagia, dyphonia, respiratory weakness
  4. Fever, arthralgia, Raynaud’s, interstitial lung fibrosis, myocarditis, aryythmias
  5. Gottron’s papules (rough/red, knuckle/elbow/knee), macular rash (‘shawl sign’ if on shoulders), eyelid heliotrope + oedema, nailfold erythema
  6. Lung, pancreas, ovary, bowel
  7. Raised muscle enzymes (e.g. CK, ALT, AST, LDH)
  8. Muscle biopsy
  9. EMG (fibrillation potentials), MRI (muscle oedema
  10. Anti-Mi2, anti-Jo1
  11. Prednisolone, immunosuppressant/cytotoxic if resistant
  12. Hydroxychloroquine / topical tacrolimus
28
Q

Vasculitis - variable vessel size

  1. Behcet’s syndrome - triad
  2. Associated with which HLA
  3. Classic patient
  4. Other symptoms
  5. Test suggestive of diagnosis
  6. Cogan syndrome - inflamed where
  7. Other features
A
  1. Oral ulcers, genital ulcers, anterior uveitis
  2. B51
  3. Young middle eastern men, positive FH
  4. Thrombophebitis, DVT, arthritis, aseptic meningitis, erythema nodosum, GI (abdominal pain, diarrhoea, colitis)
  5. Positive pathergy test (puncture site following needle prick becomes inflamed with small pustule forming)
  6. Cornea
  7. Fever, fatigue, weight/hearing loss, vertigo, tinnitus
29
Q

Systemic disease + skin - description, causes

  1. Erythema nodosum
  2. Erythema multiforme
  3. Erythema migrans
  4. Erythema marginatum
A
  1. Painful, blue-red, raised, on shins. Sarcoid, drugs (sulphonamides, OCP), streptococcal infection, Crohn’s
  2. ‘Target’ lesions (symmetrical/central blister, on limbs, palms/soles. Stevens-Johnson syndrome post-drugs, or collagen disorder
  3. Small papule at site of tick bite, forming large erythematous ring with central fading (‘bullseye’). Lyme
  4. Transient trunk pink coalescent rings. Rheumatic fever
30
Q

Methotrexate - general (non-counselling)

  1. Prevents which cellular function
  2. Used in what (3)
  3. Long-term use - complications (2)
A
  1. Cellular replication
  2. DMARD for RA, chemotherapy, severe psoriasis
  3. Hepatic cirrhosis, pulmonary fibrosis
31
Q

Juvenile idiopathic arthritis

  1. Definition
  2. Stills disease - features
  3. Polyarticular - specific features
  4. Pauci-articular (oligo) - specific features
A
  1. Arthritis without any other cause, lasting more than 6 weeks in patients under the age of 16
  2. Salmon-pink rash, swinging fever, lymphadenopathy, splenomegaly, joint pain, ANA/RF negative
  3. 4+ joints, symmetrical, RF negative
  4. <4, larger joints (but not hips), uveitis, positive ANA

Medical School (28 decks)

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