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MSK > Rheumatology History taking and Pharmacology > Flashcards

Rheumatology History taking and Pharmacology Flashcards

1
Q

name three inflammatory arthrides that start acutely

A

crystal arthropathies
infectious athritis
reactive arthritis

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2
Q

what is the additive pattern

A

one which more and more joints are affected over time

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3
Q

what arthritis involves the MCPs, wrists, elbows, shoulder, ankles or second to fifth MTPs

A

secondary arthritis (previous trauma or infection) or inflammatory arthritis

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4
Q

what type of arthritis begins as monoarthritis

A

oestoarthritis- one weight bearing joint

can also be inflammatory

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5
Q

what is oligoarthritis

A

involving 1-4 joints

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6
Q

what is polyarthritis usually associated with

A

inflammatory arthritis

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7
Q

is psoriatic arthritis symmetrical or asymmetrical

A

asymmetrical

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8
Q

how does anklylosing spondylitis affects the joint

A

affects axial skeleton and large peripheral joints in an asymmetrical fashion

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9
Q

what joints does osteoarhritis affect

A

DIP, base of thumb, knees, hips, lumbar and cervical spine

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10
Q

what type of arthritis commonly doesn’t affect other joints- just the one affected

A

degenerative- primary osteoarthritis

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11
Q

what type of arthritis spreads to other joints (additive)

A

inflammatory- rheumatoid

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12
Q

what is palindromic pattern of joint involvement

A

The begins with a joint becoming involved and reaching peak intensity over 24 hours and then resolving just as quickly as it came on

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13
Q

what type of arthritis has an intermittent pattern (on and off)

A

inflammatory

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14
Q

what are the inflammatory features of arthritis

A

joint swelling
redness (septic, gout, reactive arthritis, psoriatic)
morning stiffness (longer than 30mins)
gets better with movement (no inactivity gelling like in osteo)
disturbed sleep
fever (septic arthritis, gout, vasculitis, SLE)
weight loss (vasculitis, inflam arthritis, CTD)

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15
Q

how does smoking affect arthitis

A

less likely to respond to medications
more progressive disease in RA
increased risk of cardiovascular disease

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16
Q

how does alcohol affect arthritis

A

reacts badly with drugs e.g. methotrexate

can cause gout

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17
Q

what suggests a bacterial infectious arthritis

A

monoarticular- very red and warm
associated with fevers and chills
portal of entry
prior underlying joint abnormality (prosthetic, arthritis)

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18
Q

what suggests a viral infectious arthritis

A 
acute polyarticular onset 
may have associated  rash (parovirus)
duration less than 6 weeks 
other people sick at home 
hepatitis and HIV
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19
Q

what associated symptoms would suggest rheumatoid arthritis

A 
rheumatoid nodules 
sicca features (dry eyes and mouth)
raynauds phenomenon 
occular inflammation 
pulmonary involvement (dry cough, SOB)
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20
Q

what associated mucocutaneous symptoms would suggest a CTD

A 
alopecia, 
oral/ nasal ulceration, 
nosebleeds, 
chronic sinusitis, 
malar rash, 
photosensitivity, 
subcutaneous lupus, 
urticaria, 
dry mouth, sclerodactyly (systemic sclerosis)
21
Q

what associated occular symptoms would suggest a CTD

A 
sicca symptoms (sjogrens)
red, inflamed eye
22
Q

what associated pulmonary symptoms would suggest a CTD

A

pleuritic chest pain
SOB
cough

23
Q

what associated cardio symptoms would suggest a CTD

A

pericardial chest pain

raynauds syndrome

24
Q

what associated CNS symptoms would suggest a CTD

A 
headaches and migrarines
psychiatric illness
peripheral neuropathy 
mononeuritis mulitplex 
seizures
25
what associated lymph symptoms would suggest a CTD
lymphadenopathy
26
what associated renal symptoms would suggest a CTD
new onset hypertension haematuria proteinuria
27
what would suggest ant-phospholipid syndrome
``` recurrent miscarriages blood clots (arterial or venous) ```
28
what symptoms would suggest a vasculitis
ENT problems (nasal stuffiness/sinusitis, crusting, nose bleeds, acute hearing loss) non blanching rash CNS problems (acute nerve palsy, acute temporal headache with scalp tenderness (GCA)) occular problems- red inflamed eye, sudden vision loss (GCA) pulmonary problems (asthma (EGPA), polyangitis (churg strauss), cough, SOB, haemoptysis renal problems- new onset hypertension, haematuria, proteinuria
29
what symptoms would suggest seronegative spondyloarthritides
``` psorias symptoms/ FH of psoriasis FH of spin problems (AS) recent STI/ urethral discharge recent gastroenteitis IBD symptoms enthesitis dactylitis eye inflammation ```
30
what drug can cause gout
diuretic use
31
what medical conditions is gout associated with
hypertension, obesity, insulin resistance, hypercholesterolemia
32
why might peptic ulcer disease be a problem
risk is higher in RA, concurrent use of anticoagulants (GI bleed)
33
why might liver or kidney disease be a problem
many rheumatological medications hepatoxic (methotrexate) or nephrotoxic or metabolised in the liver
34
why might pulmonary disease be a problem
Some rheumatological medications may cause pneumonitis (eg methotrexate and anti-TNF drugs) and pre-existing lung disease might affect choice of treatment. NSAIDs are contraindicated in patients with NSAID / aspirin sensitive asthma
35
what rheumatological drugs do you not give in pregnancy
methotrexate and leflunomide
36
what are bouchards nodes
swelling of PIPs- seen in osteoarthritis
37
what is the most specific inflammatory marker
CRP
38
what can be seen in x rays of rheumatoid arthritis
loss of joint space, erosions, osteopenia
39
what happens to the pannus during inflammation
become hypervascular and/ or hypertrophic
40
what can show a hypertrophic or hypervascular pannus
MRI
41
what joints does psoriatic arthritis affect in hand
DIPs and PIPs
42
what is the dosage of methotrexate
starts 15 mg then increased to 20mg weekly
43
what must methotrexate be prescribed in combination with and why
folic acid (taken everyday)- as methotrexate is a folate antagonist, if not will get: nausea, alopecia, mouth ulcers
44
what condition is monitored by the DAS28 score
RA only
45
what is the lowest titre of serum ANA
1:80
46
why is creatine raised in renal conditions
as is excreted through the kidneys
47
what does protein in the urine show
kidneys not working
48
in systemic sclerosis what organs can be affected and how
lung and kidneys pulmonary artery hypertension interstitial lung disease
49
what imaging for pulmonary artery hypertension
transthoracic echocardiogram- shows tricuspid valve to see if back pressure causing regurgitation and how strong ejection is

MSK (71 decks)

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