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finals > rheumatology > Flashcards

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
Q

what is the CASPAR diagnostic criteria used for

A

psoriatic arthritis

26
Q

management of psoriatic arthritis

A

NSAIDs
intraarticular steroids
infliximab
topical steroids for skin and nails

27
Q

presentation of enteropathic arthritis

A

typically knee
abdo pain, diarrhoea, fever, LGI bleed, weight loss
bilateral posterior uveitis

28
Q

investigations for enteropathy arthritis

A

HLA B27
CRP, ESR
colonoscopy and faecal calprotectin

29
Q

presentation of SLE

A

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
Q

investigations for SLE

A

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
Q

management of SLE

A 
smoking cessation
topical steroids/sunblock for skin
NSAIDs
methotrexate
cyclophosphamide
rituximab
32
Q

presentation of Giant cell arteritis

A 
temporal headache
amaurosis fugax
jaw claudication
polymyalgia rheumatica
malaise, fatigue, fever
33
Q

investigations for temporal arteritis

A

raised CRP and ESR
temporal artery USSS - halo
temporal artery biopsy

34
Q

management of temporal arteritis

A

prednisolone
methotrexate
tocilizumab

35
Q

presentation of polymyalgia rheumatica

A

shoulder/hip pain - worse in morning, symmetrical
morning stiffness lasting >1hr
fatigue, wt loss, fever

36
Q

management of polymyalgia rheumatica

A

prednisolone

37
Q

what is takayasu arteritis

A 
a large cell arteritis affecting the aorta and its major branches
can result in 
aortic regurgitation
stenosis
aneurysm formation
hypertension
38
Q

presentation of henoch schonlein purpura

A

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
Q

small vessel arteritis and their ANCA association

A

granulomatosis with polyangitis - cANCA and PR3
microscopic polyangitis - pANCA and MPO
HSP - ANCA negative

40
Q

presentation of GPA

A

URT: rhinitis, sinusitis, septal perforation
LRT: dyspnoea, haemoptysis
renal: RPGN (haematuria, oliguria, hypertension)
constitutional: fatigue, fever, myalgia

41
Q

presentation of MPA

A

necrotising vasculitis resulting in RPGN and pulmonary haemorrhage

42
Q

Presentation of scleroderma

A

limited cutaneous = CREST + mainly distal extremties, later onset of visceral involvement

diffuse cutaneous = distal, proximal, trunk, face, early visceral involvement

43
Q

CREST syndrome

A 
calcinosis
raynaud's
eosophageal involvement
sclerodactyly
telangiectasia
44
Q

visceral involvement of scleroderma

A

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
Q

investigations for scleroderma

A 
FBC, ESR, U&Es
urinalysis
ANA
anti Scl 70 (diffuse)
anticentromere (limited)
46
Q

management of scleroderma

A

raynauds - amlodipine
digital ulcers: phosphodiesterase 5 inhibitor
oesophageal involvement: PPI
arthritis: methotrexate

47
Q

presentation of polymyositis

A 
Proximal muscle weakness
Muscle atrophy
dysphagia
dyspnoea
In dermatomyositis, characteristic
heliotrope rash and gottron's papules
48
Q

investigations for polymyositis

A 
elevated CK, LDH, adolase
ESR
ANA, anti Jo 1 (associated with interstitial lung disease)
MRI
EMG
muscle biopsy
49
Q

management of polymyositis

A

prednisolone
methotrexate/azathioprine
IVIG, plasmapheresis, biologics

50
Q

risk of pregnancy and CTD

A

anti Ro/anti La - neonatal lupus syndrome
anti Ro - congenital heart block
antiphospholipid antibodies - miscarriage
SLE - pre-eclampsia, feotal growth retardation, prematurity

51
Q

presentation of sjogren’s

A 
dry eyes (itchy, FB sensation)
dry mouth (swallowing difficulty, decreased taste)
fatigue

Less common (dry skin, vaginal dryness, arthralgia, myalgia)

52
Q

investigations for sjogrens

A

schirmer test

Anti Ro, anti La

53
Q

management of sjogrens

A 
artificial tears
salivary substitutes
ciclosporin eye drops
pilocarpine
NSAIDs for MSK pain

finals (13 decks)

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