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3rd year medicine > Rheumatology Guidelines > Flashcards

Rheumatology Guidelines Flashcards

1
Q

schobers test and ank spond

A

<5cm is postiive

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2
Q

most useful 1st test for ank spond gold standard Ix

A

Xray sacroiliacs MRI is gold standard

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3
Q

ESR and CRP in ank spond

A

both up

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4
Q

1st line ank spond

A

NSAIDs and exercise

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5
Q

DMARD in ank spond

A

only if peripheral involvemtn (mor ein woman)

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6
Q

When do you do biologic in ank spond

A

if failed 2 NSAIDs

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7
Q

antiphospholipid syndrome aPTT

A

paradoxically up

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8
Q

antiphospholipid Mx

A

warfarin - first VTE = 6m at 2-3 - recurrent VTE if second one during warfarin = lifelong at 3-4 - arterial thrombosis = lifelong 2-3

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9
Q

behcets Ix

A

pathergy test

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10
Q

CFS 1st line

A

CBT

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11
Q

dermatomyositis definitive ix

A

muscle biopsy

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12
Q

CK in dermatomyositis

A

up

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13
Q

EMG in dermatomyositis

A

fibrillations

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14
Q

1st line dermatmyositisi

A

steroids

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15
Q

diagnosis of fibromyalgia

A

need t be tender at 11+ out of 18 points

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16
Q

best evidence Tx for firbomyalgia

A

aerobic exercise

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17
Q

gout acute 1st line

A

NSAIDs (max dose for 1-2d after Sx stop) or colchicine

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18
Q

when can you not use NSAIDs in gout

A

any CKD

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19
Q

when can you not use colchicine in gout and what do you then use

A

ESKD, use prednisolone

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20
Q

serum urate aim for when on allopuronol

A

less than 300

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21
Q

2nd line urate lowering drug

A

febuxostat

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22
Q

diet for gout?

A

increase vit C

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23
Q

diuretics for gout?

A

stop thiazides. ARB help

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24
Q

xray findgins in rickets

A

cupped ragged metaphysis

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25
Q

adults osteomalacia xray finding

A

pseudofracture/loosers zone

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26
Q

skull problem in pagets

A

frontal bossing osteoporosis circumscipta (patches of osteoporosis)

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27
Q

polyarteritis nodosa association

A

man with hep B

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28
Q

PAN definitive biopsy (2)

A

renal or mesenteric angiogram biopsy with microaneursysm

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29
Q

PAN Mx

A

control BP steroids a cyclophosphamide

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30
Q

PAN blood test - crp, esr, wcc, hb

A

crp esr wcc up anaemia

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31
Q

PMR Ix - esr, ck, alp, emg

A

esr up alp up ck and EMG

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32
Q

PMR Mx

A

prednisolone (methylpred if eye involvement)

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33
Q

pseudogout Mx

A

NSAIDs or steroids

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34
Q

psoriatic arthroapthy : systemic steroids?

A

makes rash worse

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35
Q

joint aspirate in reactive arthtis

A

negative

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36
Q

Mx for reactive arthtiris

A

4w to start 4m to leave self limiting so don’t have to do anytihgn, can use MTX is lasting more than 6m

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37
Q

how do you detect RF

A

rose waaler test - sheep red cell agglutination less specific Latex aggluniation test

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38
Q

how do you diagnose RA

A

need 6/10 score of American thingy: - abnormal ESR + CRP, >6w, joints involved (more joints= more points), serology (RF + ACPA)

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39
Q

1st line RA Tx in flare first time

A

single DMARD (methotrexate) +/- short course of bridging pred

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40
Q

disease monitoring in RA

A

DAS28 + CRP

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41
Q

TNFa-i indication in RA

A

failed 2 DMARDS including MTX

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42
Q

definitive test for sjogrens

A

biopsy shows lymphocytic infiltration

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43
Q

other weird blood test for sjogrens

A

IgG high and C4 low

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44
Q

Mx for sjogrens

A

articificla tears and saliva pilocarpine may stimulate excretions DMARDs- hydroxychoroquine

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45
Q

SLE diagnsitic critera

A

Need 4 or more of: dicoid rash, malar rash, photosensitivity, oral ulcer, arthritis, serositis, renal disorder, CNS disorder, haem disorder, immunological disrde, ANA

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46
Q

SLE blood during flare - CRP/ESR - complemenyts?

A

Crp normal but ESR raised low C3 and C4

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47
Q

disease monitoing for SLE

A

dsDNA

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48
Q

severe flare SLE Mx

A

IV cyclophosphamide + high dose pred

49
Q

signs on X-ray for osteoarthritis

A

LOSS loss of joint space osteophytes subchondral sclerosis subchondral cyst

50
Q

risk factors for osteoarthritis

A

most common place is knee then hip risk factors: - increasing age - female - obesity - developmental dysplasia of hip

51
Q

is RA/OA pain relived by rest or exercise

A

RA pain relieved by exercise OA pain relieved by rest

52
Q

first line investigation for OA

A

X-ray clinical diagnosis can be made if features typical

53
Q

Mx of OA

A

analgesia: - first line: paracetamol and topical NSAIDs second line: oral NSAIDs/ COX2 inhibitors, opioids, intra-articular corticosteroids PPI co-prescribed with NSAIDs and COX-2 inhibitors joint replacement - definitive treatment

54
Q

reasons for revision of total hip replacement

A
  • aseptic loosening (most common reason) - pain - dislocation - infection
55
Q

anticoagulation after hip operation

A

LMWH for 4 wks after hip replacement

56
Q

what is a bakers cyst

A

popliteal cyst (back of knee) swelling in popliteal fossa if underlying pathology no treatment needed if underling cause - treat

57
Q

Mx for flare of RA

A

corticosteroids - oral or intramuscular

58
Q

monitoring for methotrexate

A

monitoring of FBC and LFTs - risk of myelosuppression and liver cirrhosis

59
Q

what type of vasculitis is temporal arteritis

A

giant cell arteritis

60
Q

main treatment for vaculitides

A

immunosuppression

61
Q

most likely vasculitis in young male smokers

A

Buergers disease helped by smoking cessation

62
Q

what population is polyarteritis nodosa most common in

A

in populations with high prevalence of hep B

63
Q

head pain in temporal region jaw claudication vision problems diagnosis

A

temporal arteritis

64
Q

what condition is giant cell arteritis linked to

A

polymyalgia rheumatica

65
Q

risk factors for osteoporosis

A

corticosteroid use smoking alcohol low BMI FHx

66
Q

first line Mx for osteoporosis

A

alendronate post menopausal women to be offered Vit D and calcium supplements

67
Q

administration of bisphosphonates

A

tablets swallowed with plenty of water while sitting or standing on empty stomach for at least 30mins before breakfast sit stand for at least 30mins after tablet to reduce chances of oesophageal ulcers

68
Q

assessing risk of osteoporosis

A

all women >65 + all men >75 assessed + people with risk factors FRAX score- 10yr risk of fragility fracture (patients 40-90) DEXA scan if FRAX intermediate result

69
Q

when should you straight DEXA someone

A
  • before starting treatment affecting bone density (sex hormone deprivation for breast/prostate cancer) - <40yrs with major risk factors
70
Q

management according to FRAX score

A

FRAX low risk: reassure + lifestyle advice intermediate risk: offer BMD (DEXA) high risk: offer bone protection treatment

71
Q

T score interpretation for DEXA scan

A

>-1.0 = normal -1.0 to -2.5 = osteopenia

72
Q

rheumatoid arthritis xray changes

A

early findings: - loss of joint space - junta-articular osteoporosis - soft-tissue swelling late x-ray findings: - periarticular erosions - subluxation

73
Q

epidemiology of SLE

A
  • females - afro-caribbeans and asians - onset 20-40yrs -
74
Q

SLE HLA?

A

HLA B8, DR2, DR3

75
Q

what crystals are in pseudo gout

A

deposition of calcium pyrophosphate dehydrate crystals in synovial

76
Q

what distinguishes gout from pseudogout on XR

A

pseudogout has chonedrocalcinosis on XR (can bee seen in knee as calcification of meniscus and articular cartilage)

77
Q

Mx of pseudogout

A

knee, wrist, shoulders most commonly affected MX: - aspiration of joint to exclude septic arthritis NSAIDs or intra-articular or intra-muscular or oral steroids as for gout

78
Q

what type of immune reaction is SLE

A

type 3 hypersensitivity reaction

79
Q

dermatomyositis features

A

skin lesions and proximal muscle weakness - violet periorbital rash - red papules over back of fingers (gottrons papules) (by joints)

80
Q

management for chronic gout to prevent recurrent attacks

A

allopurinol

81
Q

chemotherapy increases the risk of gout due to what?

A

increased urate production

82
Q

weeks after infection can’t pee can’t see can’t climb a tree diagnosis

A

reactive arthritis GI: salmonella GUS: chlamydia UTI conjunctivitis joint pain and swelling

83
Q

gout Vs pseudogout on joint aspirate

A

crystals: - gout: negative needles, urate crystals - pseudogout: positive rhomboid, calcium pyrophosphate crystals

84
Q

turbid grey coloured joint aspirate

A

septic joint

85
Q

symptoms of antiphospholipid syndrome

A

CLOT symptoms: - Clot - Lived reticular - Obstetrics - recurrent miscarriages - Thrombocytopaenia

86
Q

limited systemic sclerosis (scleroderma) symptoms

A

CREST symptoms: - Calcinosis - Raynauds phenomenon (may be first sign) - Esophageal dysmotility - Sclerodactylyl (stiff fingers) - Telangiectasia

87
Q

osteomalacia what is it Mx

A

low calcium and phosphate high ALP treat with Calcium (cholecalciferol) with Vit D tablets

88
Q

Pagets levels in blood

A

calcium and phosphate normal ALP high

89
Q

Kocher’s criteria

A

septic arthritis asses prob of SA in children non-weight bearing - 1 point Fever > 38.5 - 1 point WCC > 12 - 1 point ESR > 40 - 1 point 1= 3% 2= 40% 3= 93% 4= 99%

90
Q

bacteria causing septic arthritis in young sexually active adults

A

neisseria gonorrhoea

91
Q

Mx of septic arthritis

A
  • Synovial fluid obtained before starting treatment - IV Abx – flucloxacillin 6-12 weeks or clindamycin if penicillin allergic - Needle aspiration - Arthroscopic lavage may be required
92
Q

presentation of juvenile idiopathic arthritis

A

occurs in <16yrs lasts > 6 wks polyarticular presentation (multiple joints) systemic features: - fever - rash ANA +ve RF -ve

93
Q

sjogrens presentation

A

‘D’ factor: - dry eyes - dry mouth - dry cough - dysphagia - dry vagina - dyspareunia (pain during sex) generalised arthralgia and fatigue

94
Q

tests for sjogrens

A

Schirmers test: - filter paper in eyes - <5mm of moister over 5 mins = positive schimers Lissamine green test and rose bengal staining (ocular surface staining to look for damage)

95
Q

blue sclera

A

osteogenesis imperfecta

96
Q

Marfans disorder

A

connective tissue disorder tall stature high arched palate pacts excavatum scoliosis aortic dissection and cardiac problems Mx: - echo monitoring - BB/ ACEi

97
Q

which antibodies for myositis

A

anti-Jo antibodies

98
Q

how long after finishing methotrexate should you continue contraception

A

contraception 6months after stopping methotrexate

99
Q

what is co-prescribed with methotrexate

A

folic acid both taken once weekly

100
Q

treatment for methotrexate toxicity

A

folinic acid

101
Q

most common cause of hip pain in children

A

transient synovitis acute hip pain associated with viral infection well or mild fever 2-10yrs

102
Q

nail changed + skin changes + arthritis

A

psoriatic arthropathy

103
Q

marker for most likely position of gout

A

marker E - first metatarsophalangeal joint

104
Q

what should patients be put on after first attack of gout

A

allopurinol - started 2 weeks after attack

colchicine should be considered when starting allopurinol

105
Q

what should be done to allopurinol during gout attack

A

remain on it if already on it

106
Q

rheumatoid arthritis + splenomegaly + low WCC

A

Felty’s syndrome

107
Q

most common type of anaemia in inflammatory conditions

A

microcytic anaemia - due to iron deficiency

can be due to NSAID and lack of iron intake

108
Q

what type of anaemia can be caused by methotrexate

A

macrocystic anaemia - due to folic acid deficiency

need to take folate when taking methotrexate

109
Q

prognostic indicator of RA

A

RF

if they have rheumatoid arthritis, more likely to have extra-articular features

110
Q

anti JO-1 in SLE patient

A

indicates the person is more likely to develop interstitial lung disease

need high resolution CT of lungs

111
Q

serum uric acid level during gout attack

A

low during acute attack

once attack has gone then its high

112
Q

level up from methotrexate if not working

A

sulfasalazine

then anti-TNF

113
Q

how do you deliver steroids in acute attack of RA

A

IM steriods into buttock

114
Q

first two treatments for ank spond

A

first line: physiotherapy

NSAIDs for 3 months

if not working then different NSAIDs

if not then biologics

dont give DMARDs unless peripheral involvement

115
Q

mx for acute flare of ank spond

A

steroids + NSAIDs

116
Q

side effect of colchicine

A

diarrhoea

117
Q

if giving allopurinol during acute attack what should yu give in addition

A

give NSAIDs to stop gout attack from the allopurinol

118
Q

treatment for fibromyalgia

A

due to trauma

focus on sleep, fatigue, anxiety/depression, unresolved psychological issues

3rd year medicine (31 decks)

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