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Year 3 - Medicine > Rheumatology - Introduction > Flashcards

Rheumatology - Introduction Flashcards

1
Q

What are the main rheumatological symptoms?

A
  • pain
  • swelling
  • stiffness
  • fatigue
  • weakness

Systemic symptoms may also be a feature

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2
Q

How do patients usually describe neuralgic pain?

A

‘Burning’ or ‘pins and needles’

Note the description of pain is highly variable and not always useful in terms of making a diagnosis.

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3
Q

What are the features of inflammatory pain?

A
  • nocturnal pain
  • aggravated by rest
  • better with NSAIDs / steroids
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4
Q

How many joints are affected in:

a) monoarticular pathology

b) oligoarticular pathology

c) polyarticular pathology

A

a) 1 joint

b) 2-4 joints

c) >4 joints

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5
Q

Give some causes of acute monoarthritis.

A

This is septic arthritis until proven otherwise.

Other differentials:
- gout
- pseudogout
- haemarthrosis

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6
Q

Give some causes of chronic monoarthritis.

A
  • tuberculosis
  • psosriatic arthritis (PsA)
  • reactive arthritis
  • osteoarthritis (OA)
  • tumours (rare)
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7
Q

Give some causes of acute polyarthritis.

A
  • reactive arthritis
  • rheumatoid arthritis
  • psoriatic arthritis
  • systemic lupus erythematous
  • vasculitis
  • HIV
  • uncontrolled gout
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8
Q

Give some causes of chronic polyarthritis.

A
  • reactive arthritis
  • psoriatic arthritis
  • rheumatoid arthritis
  • systemic lupus erythematous
  • vasculitis
  • uncontrolled gout
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9
Q

What is stiffness?

A

Difficulty moving a joint.

Stiffness worse in the morning and lasting longer than 30 minutes is suggestive of inflammatory arthritis (e.g. RA or PsA).

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10
Q

What are the causes of weakness in rheumatological disease?

A
  • joint pain on movement causing restriction of movement
  • neurogenic (e.g. foot drop in S1 root compression)
  • muscular (e.g. proximal weakness in polymyositis)
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11
Q

What are the features of inflammatory disease?

a) morning stiffness

b) effect of activity

c) effect of resting

d) fatigue

e) systemic involvement

A

a) >1 hour

b) better

c) worse

d) significant

e) yes

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12
Q

What are the features of mechanical disease?

a) morning stiffness

b) effect of activity

c) effect of resting

d) fatigue

e) systemic involvement

A

a) <30 minutes

b) worse

c) better

d) minimal

e) no

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13
Q

How is a rheumatological patient examined?

A

GALS screen, followed by regional examination of the MSK system.

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14
Q

What is the GALS screen?

A

Gait, arms, legs and spine assessment to detect most MSK abnormalities, which will then prompt further examination in more detail.

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15
Q

Outline how to assess

gait

in the GALS screening assessment.

A

Observe and interpret gait

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16
Q

Outline how to assess

arms

in the GALS screening assessment.

A
  • inspect hands
  • assess pincer grip / power grip
  • squeezes MCPJ for tenderness
  • active elbow flexion / extension / supination / pronation
  • active shoulder external rotation
17
Q

Outline how to assess

legs

in the GALS screening assessment.

A
  • inspects legs
  • examine for knee joint effusion
  • passive knee flexion / extension
  • hip flexion / internal rotation
  • inspect feet
  • perform MTPJ squeeze test for tenderness
18
Q

Outline how to assess

spine

in the GALS screening assessment.

A
  • inspects spine
  • palpates over supraspinatus
  • tests cervical spine lateral flexion
  • tests hip and lumbar spine flexion
19
Q
A
20
Q

How can you test the motor function of

a) radial nerve?

b) ulnar nerve?

c) median nerve?

A

a) wrist / finger extension against resistance

b) index finger abduction against resistance

c) thumb abduction against resistance

21
Q

What is the significance of Hb interpretation in rheumatological disease?

A
  • anaemia of chronic disease in RA
  • NSAIDs can cause Fe deficiency
22
Q

What is the significance of platelet interpretation in rheumatological disease?

A
  • rises with inflammation or bleeding
  • falls in SLE
23
Q

What is the significance of neutrophil interpretation in rheumatological disease?

A
  • rises with inflammation, sepsis and prednisolone usage
  • falls with SLE and DMARD toxicity
24
Q

What is the significance of lymphocyte interpretation in rheumatological disease?

A
  • falls in SLE and DMARD toxicity
25
Q

What is the significance of U&Es interpretation in rheumatological disease?

A
  • rise due to NSAIDs and renal disease
26
Q

What is the significance of uric acid interpretation in rheumatological disease?

A
  • elevated in gout
  • falls in inflammation
27
Q

What is the significance of LFTs interpretation in rheumatological disease?

A
  • hepatitic rise due to DMARD toxicity
28
Q

What is the significance of CK, ALT and LDH interpretation in rheumatological disease?

A

Rise in myositis

Year 3 - Medicine (33 decks)

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