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rheumatology Flashcards

1
Q

signs of rheumatoid arthritis

A 
limited ROM
ulnar deviation
swan neck
boutonniere
z thumb
rheumatoid nodules
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2
Q

presentation of RA

A

red hot swollen painful joint with EMS
normally affects symmetrically, the small joints before large
extraarticular
scleritis, episcleritis, sjogren’s
pulmonary effusions, pulmonary fibrosis, pericarditis
splenomegaly, anaemia, amylodosis

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3
Q

investigations for RA

A

CRP, ESR
RF, anti CCP
x ray (JS narrowing, soft tissue swelling, erosions, periarticular osteopenia)
US for synovitis

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4
Q

management of RA

A

1st line: methotrexate + infliximab combination therapy
2nd line: triple therapy (methotrexate, hydrochloroquine, sulfasalazine)
adjucts: NSAIDs, corticosteroids

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5
Q

side effects of methotrexate

A

GI upset, alopecia, risk of infection, nephrotoxic, hepatotoxic

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6
Q

side effects of infliximab

A 
flu like symptoms
immune deficiency (risk of legionella and listeria infection)
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7
Q

cause of gout

A

primary: lesch nyhan syndrome
secondary: renal fairue, thiazide diuretic use, high intake, luekemia

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8
Q

presentation of gout

A

most commonly the MTP, knee
severe pain, sudden onset
red, hot swollen

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9
Q

investigations for gout

A

aspirate - negatively birefringent needle shape crystals
serum urate
U&Es
rule out other causes: ANA, RF, antiCCP, x ray

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10
Q

causes of psuedogout

A

hypo/hyper thyroidism
hyperparathyroidism
hemochromatosis
renal impairment

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11
Q

presentation of pseudogout

A

commonly knees, wrists, elbows

acute, red, swollen painful joint

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12
Q

investigations for pseudogout

A 
aspirate - positively birefringent rhomboid shaped crystals
bone profile (vit D, Ca, PTH)
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13
Q

management of gout

A

acute: NSAIDs or colchicine (also corticosteroids, anti IL1 biologics)
chronic: lifestyle changes, allopurinol

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14
Q

management of pseudogout

A

NSAIDs
colchicine
intraarticular dexamethasone

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15
Q

causes of reactive arthritis

A

virus: rubella, EBV, mumps
GI: salmonella, shigella, campylobacter
chlamydia trachomatis

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16
Q

presentation of reactive arthritis

A

usually acute symmetrical lower limb
classic trial: arthritis, conjunctivitis, urethritis
keratoderma blennorrhagia
following a diarrhoeal/urinary infection

can cause cardiac complications: aortic regurgitation, aortitis

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17
Q

investigations for reactive arthritis

A

CRP, ESR, WCC
urinary NAAT, rectal/throat swabs
stool cultures
rule out other causes: RF, ANA, joint aspirate, XRay

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18
Q

management of reactive arthritis

A

NSAIDs
intraarticular steroids
no evidence for treating underlying infection
self limiting but can be up to 6 months

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19
Q

presentation of inflammatory back pain

A 
age < 40
insidious onset
improves with exercise
no improvement with rest
pain > 3 months
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20
Q

presentation of ankylosing spondylitis

A 
inflammatory back pain
uveitis, enthesitis
loss of lumbar lordosis
reduced flexion (schobers test <5cm)
associated with IBD and psoriasis
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21
Q

investigations for ankylosing spondylitis

A

HLA B27 positive

x ray
spine - vertebral squaring, bamboo spine
pelvis - sacroiliitis

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22
Q

management of ankylosing spondylitis

A

NSAIDs
TNFa blocker - infliximab
sulphasalazine for peripheral joint involvement

23
Q

presentation of psoriatic arthritis

A

asymmetric, common in hands (DIP)
skin changes (scalp lesions, nail dystrophy, psoriatic lesions)
uveitis

24
Q

investigations for psoriatic arthritis

A

HLA Cw6

     x ray hands
DIP erosions
lysis of terminal phalanges
asymmetry
pencil in a cup deformity
25
what is the CASPAR diagnostic criteria used for
psoriatic arthritis
26
management of psoriatic arthritis
NSAIDs intraarticular steroids infliximab topical steroids for skin and nails
27
presentation of enteropathic arthritis
typically knee abdo pain, diarrhoea, fever, LGI bleed, weight loss bilateral posterior uveitis
28
investigations for enteropathy arthritis
HLA B27 CRP, ESR colonoscopy and faecal calprotectin
29
presentation of SLE
fever, malaise, fatigue, myalgia malar rash, discoid rash, photosensitivity, oral ulcers renal disease (nephritis/ESRF) CNS disease (headaches, seizures, anxiety) haemotalogical disease: anaemia, TTP serositis: pluerisity, pleural effusions, pericarditis arthritis
30
investigations for SLE
ANA, anti dsDNA, anti SM, antiphospholipid, anti Ro, anti La, anti RNP high ESR but normal CRP complement decreased urinalysis, serum creatinine, urine PCR, renal biopsy x ray joints(arthritis), chest (serositis)
31
management of SLE
``` smoking cessation topical steroids/sunblock for skin NSAIDs methotrexate cyclophosphamide rituximab ```
32
presentation of Giant cell arteritis
``` temporal headache amaurosis fugax jaw claudication polymyalgia rheumatica malaise, fatigue, fever ```
33
investigations for temporal arteritis
raised CRP and ESR temporal artery USSS - halo temporal artery biopsy
34
management of temporal arteritis
prednisolone methotrexate tocilizumab
35
presentation of polymyalgia rheumatica
shoulder/hip pain - worse in morning, symmetrical morning stiffness lasting >1hr fatigue, wt loss, fever
36
management of polymyalgia rheumatica
prednisolone
37
what is takayasu arteritis
``` a large cell arteritis affecting the aorta and its major branches can result in aortic regurgitation stenosis aneurysm formation hypertension ```
38
presentation of henoch schonlein purpura
purpuric rash commonly on the thigh and buttocks, associated with other skin changes (urticarial rash, confluent petechiae, ecchymoses) arthralgia/arthritis GI - abdo pain, bleeds, diarrhoea, intussusception
39
small vessel arteritis and their ANCA association
granulomatosis with polyangitis - cANCA and PR3 microscopic polyangitis - pANCA and MPO HSP - ANCA negative
40
presentation of GPA
URT: rhinitis, sinusitis, septal perforation LRT: dyspnoea, haemoptysis renal: RPGN (haematuria, oliguria, hypertension) constitutional: fatigue, fever, myalgia
41
presentation of MPA
necrotising vasculitis resulting in RPGN and pulmonary haemorrhage
42
Presentation of scleroderma
limited cutaneous = CREST + mainly distal extremties, later onset of visceral involvement diffuse cutaneous = distal, proximal, trunk, face, early visceral involvement
43
CREST syndrome
``` calcinosis raynaud's eosophageal involvement sclerodactyly telangiectasia ```
44
visceral involvement of scleroderma
vascular: raynaud's skin: digital ulceration, oedematous MSK: polyarthritis GI: reflux, malabsorbtion and wt loss, constipation resp: interstitial fibrosis, pulmonary hypertension cardiac: pericarditis, HF, arrhythmias Renal: glomerulosclerosis
45
investigations for scleroderma
``` FBC, ESR, U&Es urinalysis ANA anti Scl 70 (diffuse) anticentromere (limited) ```
46
management of scleroderma
raynauds - amlodipine digital ulcers: phosphodiesterase 5 inhibitor oesophageal involvement: PPI arthritis: methotrexate
47
presentation of polymyositis
``` Proximal muscle weakness Muscle atrophy dysphagia dyspnoea In dermatomyositis, characteristic heliotrope rash and gottron's papules ```
48
investigations for polymyositis
``` elevated CK, LDH, adolase ESR ANA, anti Jo 1 (associated with interstitial lung disease) MRI EMG muscle biopsy ```
49
management of polymyositis
prednisolone methotrexate/azathioprine IVIG, plasmapheresis, biologics
50
risk of pregnancy and CTD
anti Ro/anti La - neonatal lupus syndrome anti Ro - congenital heart block antiphospholipid antibodies - miscarriage SLE - pre-eclampsia, feotal growth retardation, prematurity
51
presentation of sjogren's
``` dry eyes (itchy, FB sensation) dry mouth (swallowing difficulty, decreased taste) fatigue ``` Less common (dry skin, vaginal dryness, arthralgia, myalgia)
52
investigations for sjogrens
schirmer test | Anti Ro, anti La
53
management of sjogrens
``` artificial tears salivary substitutes ciclosporin eye drops pilocarpine NSAIDs for MSK pain ```

finals (13 decks)

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