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FINALS revision - @medicbotanist > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

How would you manage a high calcium?

A

IV fluids
IV bisphosphonates

if needed give Denosumab and steroid use

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2
Q

What two assessment scales can you do on a patient with suspected osteoporosis?

Which one is said to be better?

A

DEXA scan

Vertebral fracture assessment

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3
Q

What pathway do bisphosphonates work via?

A

HMG-CoA pathway

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4
Q

Explain the pharmacology of bisphosphonates?

A
  1. Bisphosphonates haven a high affinity for hydroxyapatite so head straight to the bone.
  2. Osteoclasts when they resorb bone also take up some bisphosphonates.
  3. The bisphosphonates disable the osteoclast activity. Causes apoptosis and thus reduces bone absorption
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5
Q

Give two significant SE of bisphosphonates?

A

Oesphagitis

Avascular necrosis of the jaw (happens after months of treatment)

AF

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6
Q

How will high calcium appear on ECG?

A

Short QT

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7
Q

How will low calcium present on ECG?

A

Long QT

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8
Q

What will the PTH levels look like in

A. Malignancy
B. Primary PTH

A

A. Low or normal

B. High

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9
Q

What does having a low Vit D do to the PTH levels?

A

Increases secondary PTH levels

Leading to increased bone resorption and thus significant risk of osteoporosis

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10
Q

What happens to blood test marker would go up in increased bone turnover?

A

Alkaline Phosphatase

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11
Q

What is seen on X Ray with someone with Ewing’s sarcoma?

A

Onion skin appearance

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12
Q

What is seen on X Ray with osteosarcoma ?

A

Sun burst appearance

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13
Q

What joint deformities will you get in osteoarthritis?

A

You will get Heberdens (distal) and Bouchard (proximal) nodes

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14
Q

What limb deformities will you get with rheumatoid arthritis?

A

Boutonnière deformity

Swan Neck deformity

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15
Q

What are two antibodies you will be looking for in the blood of a patient with Rheumatoid arthritis?

A
  1. anti CCP

2. RF

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16
Q

What are some of the extra articular joint manifestations of rheumatoid arthritis?

A
  1. Subcutaneous skin nodules
  2. Pleural effusions
  3. Pericarditis
  4. Cord compression
  5. Carpal Tunnel;
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17
Q

What is the first and then the second line treatment for rheumatoid arthritis?

A

1st line: pain relief + NSAIDs + methotrexate + folic acid

2nd line: biological agent such as infliximab or rituximab

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18
Q

What is a normal T score for a person?

A

T Score of > -1.0

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19
Q

What is osteomalacia?

A

The poor mineralisation of bone secondary to Vit D deficiency

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20
Q

What will the levels of calcium and phosphate be like in a patient with osteomalacia?

A

They will both be low- as in phosphate LOW and calcium LOW

Also increased Alk Phosph and also increased PTH

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21
Q

What is the treatment for osteomalacia?

A

Adcal

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22
Q

What are the crystals you get in a gout sample?

A

Monosodium urate crystals

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23
Q

What type of crystals do you get in a pseudo gout sample?

A

You get calcium pyrophosphate

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24
Q

What is tophaceous gout?

A

This is when you get monsodium urate crystal deposits in the peripheral joints such as the hands and toes.

These crystals release proteolytic enzymes that break down bone and lead to a punched out appearance to the bone.

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25
Q

What is the management of an acute flare of gout?

A

Give a steroid injection and an NSAID like colchicine

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26
Q

What are two conditions associated with pseudo gout?

A

Haemochromatois
Hyper parathyroidism
Diabetes

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27
Q

How do you manage a patient that has a pseudo gout episode?

A

SAME AS Gout!!

Give steroid injections and also give the patient colchicine

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28
Q

What will an x ray of a pseudo gout joint show?

A

Chondrocalcinosis

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29
Q

What is the management for Paget’s disease of the bone?

A

NSAIDs for pain relief

Bisphosphonates

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30
Q

What are 4 Red Flags in a patient with lower back pain?

A

Younger than 20 or older than 55

Acute onset backache in elderly

Nocturnal pain

History of malignancy

Neuro signs

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31
Q

Is mechanical back pain typically unilateral or bilateral?

A

Unilateral

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32
Q

How would a mechanical lower back pain present?

A

Sudden onset

Unilateral

Stiff back and the muscles continuously are spasming

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33
Q

What is lumbar spondylitis?

A

It is a lesion in the intervertebral disc. This leads to it rotating, shrinking and bending.

Recognised on X Rays as dehydration

Likely for osteophyte formation.

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34
Q

What is the aetiology of polymyositis or dermatomyositis?

A

Unknown

Just know that dermatomyositis affects the skin

Polymyositis affects the muscle

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35
Q

What is the clinical presentation of polymyositis?

A

Symmetrical muscle weakness and wasting of the pelvis and the shoulder muscles

Struggles to walk and raise from a chair can eventually involve the respiratory system.

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36
Q

How does dermatomyositis present?

A

You get characteristic skin changes

Discolouration on the eyelids
Erythematous plaques on the knuckles

Common to get Raynauds, arthralgia and dysphagia

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37
Q

What are some general symptoms of dermatomyositis and polymyositis?

A 
Fatigue 
Myalgia 
Joint pain and stiffness 
Skin changes 
Problems catching breath
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38
Q

How would you diagnose dermatomyositis or polymyositis?

A

Muscle Biopsy

Muscle enzymes: aminotransferase and creatinine kinase will all be raised

ANA and Myositis Specific ANtibodies (MSA) will all be positive

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39
Q

What is the treatment for polymyositis or dermatomyositis ?

A

Bed rest + prednisolone in flares

Immunosupression via cyclophosphamide in the meantime

40
Q

What type of hypersensitivity reaction is SLE?

A

Type 3

41
Q

What is the pathophysiology of SLE?

A

Well you get the cells damaged by immune complexes. These cells then undergo apoptosis. Remnants appear on the surface as self antigens containing DNA and histones

Presents theirselves to T cells and B cells and autoantibodies are made.

42
Q

What are 5 symptoms/signs of SLE?

A

Fatigue + Fever
Arthralgia (symmetrical and small joints)
Skin: malar and discoid rash, raynauds + photosensitivity
Lungs: recurrent pleural effusions
Heart: pericardial effusions and pericarditis
Kidneys: glomerularnephritis
CNS: psychosis, depression and seizures

43
Q

Give me 5 things you will see in a patient with SLE’s blood?

A

ESR raised but CRP normal

Low C3 and C4
ANA positive
anti-dsDNA positive
Anaemia of chronic disease

44
Q

How would you manage SLE?

A

High dose steroid + DMARD cyclophosphamide

Use of anti-malarial hydrochloroquine for skin disease and fatigue

45
Q

What does CLOT stand for in relation to antiphospholipid syndrome?

A

Coagulation defect (likely clots)
Livedo Reticularis (purple like discolouration of the skin)
Obstetric issues: recurrent miscarriage
Thrombocytopenia

46
Q

How does APS typically present?

A

Recurrent DVT or PE or strokes

Miscarriages

Skin abnormalities

Low platelets: and problems relating to this.

47
Q

What are the 3 blood tests you would like to do on a patient with suspected APS?

A

Anti-cardiolipin test

Lupus anticoagulant

Anti-B2 glycoprotein test

Need positive test 12 weeks apart x 2

48
Q

What is the treatment of APS for

  1. Non pregnant women
  2. Pregnant women
A
  1. long term warfarin - aspirin and clopidogrel can be added

2. LMWH and aspirin

49
Q

What is the treatment for Raynaud’s disease?

A

Nifedipine

50
Q

What is the difference between

Raynaud’s Disease

Raynaud’s Phenomenon?

A

Raynaud’s Disease: no underlying cause

Raynaud’s phenomenon: underlying cause

51
Q

What are the two types of systemic sclerosis?

Broadly what are the two ways to categories they’re difference?

A
  1. Limited cutaneous scleroderma (CREST) localised to skin
  2. Diffuse cutaneous scleroderma (DcSSc): skin changes + internal organs. Note the patient will have more progressive condition with this
52
Q

What symptoms would you expect to see in a patient with Limited cutaneous scleroderma (CREST)?

A

Calcinosis

Raynauds

Oesphageal Dysmotility

Sclerodactly: thickening of skin at fingers and toes

Telenagiectasis: spider veins

53
Q

What are the symptoms of Diffuse Cutaneous Scleroderma?

A

You get CREST + organ involvement

HTN
Nephritis
Pulmonary fibrosis

54
Q

What antibody will you see in CREST or limited scleroderma?

A

Anti-centromere antibodies

55
Q

What antibodies will you see in diffuse scleroderma?

A

anti RNA polymerase and anti topoisomerase 1 antibodies

56
Q

If a patient with scleroderma has kidney disease too. What might you see?

A
  1. Microangiopathic haemolytic anaemia + protein urine
57
Q

What can you use nail fold capillaroscopy on? What will it show ?

A

Scleroderma

Haemorrhages and avascular areas

58
Q

What antibodies will be positive in Sjogren’s Syndrome?

A

Anti RO

Anti La

59
Q

What will be seen in the glands of someone with Sjögren’s syndrome?

A

Lymphocytic infilitrates

60
Q

What is the staining method used for Sjögren’s syndrome?

A
  1. Rose Bengal staining
61
Q

What is a good medication to use to combat fatigue and arthralgia?

A

Hydroxychloroquine

62
Q

Is large vessel vasculitis - ANCA positive or negative?

A

ANCA negative

63
Q

What classification system do you use for patient with large cell vasculitis?

A

Chapel Hill classification

64
Q

Give an example of a large cell vasculitis?

A

Giant Cell Arteritis

65
Q

Are small vessel vasculitis positive or negative for ANCA

A

YES positive for c-ANCA generally

66
Q

Is small vessel vasculitis more common in men or women?

Give an example of a type?

A

Men

Wegners , Kawasaki and Henoch Schonelin purpura

67
Q

What is the management for someone with

A. Large vessel vasculitis

B. Small vessel vasculitis

A

A. Large Vessel: Steroids

B. Small Vessel: steroids and cyclophosphamide

68
Q

What are 3 RF for osteomyelitis ?

A

Sickle Cell anaemia

Diabetes

Peripheral Vascular Disease

69
Q

What is the method of spread in DM and PVD in relation to osteomyelitis?

A

Contagious Spread

70
Q

What is the method of osteomyelitis spread in a patient who has sickle cell ?

A

Haematogenous

71
Q

What are 3 causative organisms of osteomyelitis?

A

Staph Aureus
Staph Epidermidis
Pseudomonas

72
Q

What investigations would you want to do in someone with suspected osteomyelitis?

A

Bone Biopsy

Blood Cultures +CRP and WCC

MRI or CT immediately

73
Q

What are 2 complications of osteomyelitis?

A

Emphyema

Pericarditis

74
Q

What two abx would you use to treat osteomyelitis?

A

IV clindamycin and Ciprofloxacin

75
Q

What are 3 main causes of septic arthritis?

A

S Aureus

E.coli

Strep pneumoniae

N gonorrhoea

76
Q

How long do you have to have symptoms to be diagnosed with CFS?

A

More than 6 months

77
Q

Alongside persistent fatigue for more than 6 months. What other 4 criteria do you need to satisfy to get get a diagnosis of CFS?

A

Swollen lymph nodes

Persistent sore throat

Muscle ache

Brain fog

Polyarthralgia

Post extertional fatigue

78
Q

Using the American College of Rheumatology Guidelines. How many pain sites need to be satisfied to diagnose fibromyalgia?

A

11 out of 18

Management: CBT and anti depressants, physio and pain relief

79
Q

What 6 conditions are associated with the term ankylosing spondylitis?

A

Juvenile arthritis

Psoriatic Arthritis

Enteripathic arthritis

Reactive arthritis

Anklyosing Spondylitis

Anterior Uveitis

80
Q

What are some general symptoms of all Ank Spond conditions?

A

Use the mneumonic SPINECHE

Sausage digits 
Psoriasis
Inflammatory back pain 
NSAIDs good response 
Enthestitis 
Crohns 
HLA B27 
Eye uveitis
81
Q

What are the two types of bone?

A

Cortical (hard)

Trabecular (spongy and soft)

82
Q

What is bone made up of?

A

Hydroxyapatite

Water

Type 1 collagen

83
Q

What is a joint’s function?

A

Weight bear

Move in 3 dimensions

Transfer weight evenly

84
Q

Give an example of a fibrous joint?

A

Teeth

85
Q

Give an example of a cartilagenous joint?

A

Ribs

86
Q

Give an example of a synovial joint?

A

Knee

87
Q

What are the 4 stages of a fracture?

A
  1. Haematoma
  2. Inflammation + neovascularisation
  3. Repair
  4. Remodelling
88
Q

What investigation would you do in ank spond?

What would you see?

A

Bamboo spine (synedesmophytes)

Inflammation of sacroiliac joints

Enthestitis

89
Q

What name is given to the test to determine the flexibility of a patient’s spine. Commonly used in ank spond ?

A

Scober’s Test

90
Q

In Ank Spond what will the pattern of pain be?

A

Radiates to the buttock and hip

91
Q

Do you get symmetrical or as symmetrical joint involvement in ank spond ?

A

Assymetrical

92
Q

What part of the hands are involved in psoriatic arthritis?

A

DIPJ

93
Q

What condition causes telescoping of the fingers?

A

arthritis mutilans

94
Q

How do you treat psoriatic arthritis?

A
  1. Methotrexate
  2. Methotrexate + ciclosporin
  3. Methotrexate + ciclosporin + anti TNF entancerpt
95
Q

What is the management of reactive arthritis?

A
  1. NSAIDs and steroid injections
  2. Treat infection with abx
  3. Not remitting give methotrexate or sulfalazine
  4. TNF drug etancerpt (same as psoriatic)

FINALS revision - @medicbotanist (20 decks)

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