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4th Year Exam > Rheumatology ILOs > Flashcards

Rheumatology ILOs Flashcards

1
Q

Which gene is associated strongly with rheumatoid arthritis?

A

HLA-DR4

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2
Q

Give 4 deformities seen in RA

A

Swan neck
Boutonnière
Z-thumb
Ulnar deviation

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3
Q

Give 3 symptoms of RA

A

Pain
Stiffness (morning >1 hour)
Small joint affected

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4
Q

Outline the pathophysiology of RA

A

Synovial lining becomes hyperplastic, infiltrates synovium causing erosions

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5
Q

Give 2 blood test used specifically to assess RA

A

Rheumatoid factor (IgM antibody)

Anti CCP antibody

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6
Q

Give 3 signs seen on X-ray in RA

A

Peri-articular osteopenia
Erosions
Subluxation

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7
Q

Give 3 classes of drug treatment for RA

A

Analgesia
DMARDs
bDMARDs

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8
Q

Give 3 examples of DMARDs

A

Methotrexate (folate antagonist)

Hydroxychloroquine

Sulfasalazine

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9
Q

Define the 2 types of OA and give 2 symptoms

A

Primary and Secondary (due to other cause like Paget’s)

  • Pain worse on movement
  • Stiffness after inactivity
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10
Q

Give 4 signs seen on an OA X-Ray

A

Subchondral cysts
Subchondral sclerosis
Joint space narrowing
Osteophytes

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11
Q

Give 2 microscopic changes seen in OA

A

Fissuring cartilage

Nodules of reactive bone

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12
Q

What will Rheumatoid factor and Anti-CCP antibody show in OA?

A

Negative

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13
Q

Give 3 management options in OA

A

Analgesia
Physiotherapy
Surgery

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14
Q

Define psoriatic arthritis and which gene it is associated with

A

Seronegative inflammatory arthritis with 3 or more swollen joints asymmetrically

HLA-B27

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15
Q

Give 3 symptoms of psoriatic arthritis

A
  • Morning pain >30 mins
  • Dactylitis
  • Psoriasis
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16
Q

Outline the pathophysiology of psoriatic arthritis

A

CD8+ cells cause hypervascularity in synovium

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17
Q

How is psoriatic arthritis differentiated from RA?

A

DIP involvement and dactylics in psoriatic arthritis but not RA

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18
Q

Give 2 X-ray signs seen in psoriatic arthritis

A

Erosions

Osteolysis (pencil in cup)

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19
Q

Give 3 drug treatments for psoriatic arthritis

A

NSAIDs
Steroids in flare
DMARDs

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20
Q

Give 3 features of septic arthritis affecting one joint

A
  • Cardinal inflammation features
  • Fever
  • Leukocytosis/raised CRP
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21
Q

How many joints are usually affected in polyarticular septic arthritis and name 2 common organisms

A
  • 4 joint average

Strep and Staph

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22
Q

Give 3 risks of septic arthritis

A
  • Previous arthritis
  • Trauma
  • Diabetes
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23
Q

What is gold standard Dx for septic arthritis?

A

Joint aspirate

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24
Q

Define gout and give common clinical features

A

Hyperuricaemia and deposition of urate crystals causing attacks of acute inflammatory arthritis

Severe acute pain, commonly feet

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25
Q

Give 3 risks of gout

A
  • Age
  • Male
  • Obesity
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26
Q

How do gout crystals appear compared to pseudo-gout?

A

Gout: needle shaped, negatively birefringent

PG: rhomboid crystals, weakly positively birefringent

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27
Q

Give 2 management options for gout

A

NSAIDs

Allopurinol

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28
Q

Define pseudo-gout and give 2 risks

A

Calcium pyrophosphate deposition associated with acute and chronic arthritis

  • Age
  • Hyperparathyroidism
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29
Q

Give 2 management options for pseudo-gout

A

NSAIDs

Colchicine

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30
Q

Define temporal arteritis

A

Granulomatous vasculitis of large and medium sized arteries, affecting branches of external carotid artery commonly

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31
Q

Give 3 symptoms of temporal arteritis and which condition it is associated with

A
  • Headache
  • Jaw claudication
  • Loss of vision

Polymyalgia Rheumatica

32
Q

Give 2 risks of Temporal arteritis

A
  • Female

- Caucasian

33
Q

What is gold standard Dx for Temporal arteritis and what is the main form of treatment?

A

Temporal artery biopsy

Prednisolone

34
Q

Define Polymyalgia Rheumatica

A

Inflammatory syndrome causing pain and morning stiffness in neck, shoulder and or pelvic girdle in those over 50, unclear cause

35
Q

Which Interleukin is thought to be associated with Polymyalgia Rheumatica?

A

IL-6

36
Q

Give 3 management options for Polymyalgia Rheumatica

A

Prednisolone
NSAIDs
Calcium

37
Q

Define osteoporosis and give 1 risk

A

Skeletal disorder characterised by compromised bone strength, porous bone, often leads to fragility fractures

Early menopause (<45)

38
Q

Outline the pathology of osteoporosis

A

Imbalance of bone formation and resorption leads to decreased bone mass and higher fracture risk

39
Q

How is osteoporosis diagnosed?

A

DEXA scan (T < -2.5)

40
Q

How is 10 year fracture risk assessed for osteoporosis?

A

FRAX/Qfracture score

41
Q

Give 2 drug treatments for osteoporosis

A

Adcal D3

Bisphosphonate

42
Q

Define Ankylosing Spondylitis and which gene it is commonly associated with

A

Progressive inflammatory arthropathy affecting sacroiliac joints and axial spine
HLA B27

43
Q

Give 2 symptoms and 2 risks for Ankylosing Spondylitis

A

Back pain + Enthesitis

Male + late teens/early 20s

44
Q

Briefly outline the pathophysiology of Ankylosing Spondylitis

A

Increased osteoclasts cause inflammation and cartilage erosion

45
Q

Give 2 signs which may be seen on spinal imaging in Ankylosing Spondylitis

A

Vertebral body squaring

Peripheral large joint arthritis

46
Q

Give 2 treatments for Ankylosing Spondylitis

A

NSAIDs

Sulfasalazine

47
Q

Give the 5 most common primary cancers to cause secondary bony mets

A 
Prostate 
Breast
Follicular thyroid
Renal
Bronchi
48
Q

Name a benign primary bone tumour

A

Osteoid Osteoma

49
Q

Define osteosarcoma

A

Tumour whose cells form bone, commonly in young males

50
Q

Give an example of a benign and malignant cartilage tumour

A

B: Enchondroma

M: Chondrosarcoma

51
Q

Who does Ewing’s sarcoma usually occur in and what chromosome translocation is commonly seen?

A

5-15 y/o in long flat bones

11/22 translocation

52
Q

Define SLE and give 3 features

A

AI chronic multi-system disorder commonly affecting women in reproductive years

  • Photosensitive rash
  • Malar rash
  • Raynaud’s
53
Q

Give 3 investigations for SLE

A
  • ESR
  • ANA
  • APTT (prolonged)
54
Q

Give 3 drug treatments for SLE

A

Steroids
DMARDs
Rituximab

55
Q

Define Sjogren syndrome and give 2 risks

A

AI disease characterised by dry eyes and dry mouth due to lymphocytic invasion of lacrimal and salivary glands

  • Female
  • SLE
56
Q

Define Polymyositis

A

Inflammatory myopathy affecting skeletal muscle affecting adults commonly between 30-60

57
Q

Give 2 investigations for Polymyositis

A

CK (elevated)

Muscle biopsy

58
Q

Define dermatomyositis and give 2 skin features

A

Idiopathic inflammatory myopathy characterised by skin manifestations

  • Gottron’s papules
  • Heliotrope rash
59
Q

Define vasculitis

A

AI condition causing inflammation of blood vessels in any location e.g. skin, ENT, nerves…

60
Q

Define Henoch-Schölein Purpura and give 2 symptoms

A

Small vessel vasculitis common in 2-11y/o

  • Purpuric rash
  • Ulcers
61
Q

What are the 3 types of ANCA-associated small vessel vasculitis?

A
  1. Microscopic polyangitis
  2. Granulomatosis with polyangiitis (GPA)
  3. Eosinophilic granulomatosis with polyangiitis (EGPA)
62
Q

Which 2 antibody tests can be done in suspected vasculitis?

A

cANCA

pANCA

63
Q

Give 3 drugs to induce remission in vasculitis

A

Prednisolone
Rituximab
Methotrexate

64
Q

Define reactive arthritis

A

Bacteria cannot be aspirated from the joint to culture, infection instead occurs due to another infection in the body e.g. Chlamydia

65
Q

Give 2 risks of reactive arthritis

A

HLA B27

Male

66
Q

What is the triad in reactive arthritis?

A

Arthritis
Conjunctivitis
Urethritis

67
Q

Give 2 investigations for reactive arthritis

A

Joint aspirate to exclude sepsis

Urethral/cervical swab

68
Q

Define Paget’s disease of the bone and give 3 common sites

A

Chronic bone disorder that is characterised by focal areas of increased bone remodelling, resulting in overgrowth of poorly organised bone

  • Pelvis, femur, skull
69
Q

Which LFT may be elevated in Paget’s and give 2 signs seen on bone scan

A

ALP

Cortical thickening + sclerosis

70
Q

Give 2 risks of Paget’s

A

> 55y/o

Temperate climate

71
Q

Name 6 things to look for on inspection of hands (DREAMS)

A 
Deformity 
Rashes
Erythema
Asymmetry 
Muscle wasting 
Swelling/skin changes
72
Q

What nodes are commonly seen in OA and where do they occur?

A

Heberden’s nodes in DIPs

73
Q

Where does a Bouchard node commonly affect?

A

Proximal interpharyngeal joints

74
Q

What can be seen on an X-ray of gout and pseudo-gout respectively?

A

G: Tophi
PG: Chondrocalcinosis

75
Q

Define the symptoms of scleroderma using CREST

A 
Calcinosis 
Raynaud's
Esophageal dysfunction
Sclerodactyly (thick and tight skin on fingers)
Telangectasia

4th Year Exam (20 decks)

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