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Y 3 Medicine > Rheumatology workbook > Flashcards

Rheumatology workbook Flashcards

1
Q

Which features support a diagnosis of RA

A

MCPs/PIPs, symmetrical, FH, (bully in a playground)

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2
Q

Can you see gout on x ray

A

No

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3
Q

Which joint is usually spared in RA and more indicated in OA

A

CMC spared (thumb)

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4
Q

Which joints apart from hands are routinely affected in RA

A

Feet - MTP
Wrist
Elbows
(Knees and shoulders less common)

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5
Q

Classical examination findings in RA

A

Ulnar deviation, soft tissue swelling and tenderness

Rheumatoid nodules, swan neck and boutonnière deformity,

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6
Q

Multisystem problems in RA

A

CAPS
Carpel tunnel syndrome
Anaemia/amyloidosis/Atlanta-axial involvement
Pleurisy/pleural effusion/pulmonary nodules/fibrosis/progressive broncholitis obliterans
Sjogren’s syndrome

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7
Q

Which investigations would further help with RA diagnosis

A

Rheumatoid factor anti-CCP
USS/MRI

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8
Q

Radiological features of RA vs OA

A

RA:
Loss of joint space
Erosions (Periarticular)
Soft tissue swelling
Subluxation/see through bones

OA:
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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9
Q

Treatment options for RA

A

DMARD monotherapy
TNF inhibitors (infliximab)
CD20 inhibitors (Rituximab)
JAK inhibitors/CTLA inhibitors

Steroids (prednisolone) and symptoms control with NSAIDS

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10
Q

Which monitoring is required when using RA treatments long term

A

Check FBC for anaemia, and liver function tests

EGFR

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11
Q

Which features distinguish RA from other arthritidies

A

Stiffness in the morning for over 30 minutes
Systemic symptoms
Symmetrical
FH strong

(Starts in small joints, insidious onset, better with NSAIDs)

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12
Q

Pattern of stiffness in OA

A

Less than 5 mins

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13
Q

Acronym for lupus

A
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14
Q

Investigations for lupus

A

Raised ESR, ANA positive (ro or la), C3 and C4 fall, urinalysis, skin biopsy, thrombocytopenia FBC

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15
Q

Treatment options for SLE

A

Short courses of prednisolone for flare ups
Hydroxychloroquine for rash and arthalgia

Mycophenolate mofetil, Rituximab, and cyclophosphamide induces remission

Azathioprine

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16
Q

What type of disease is ankylosing spondylitis

A

Seronegative spondyloarthropathy

(RF negative)

17
Q

Pattern of back pain in ankylosing spondylitis

A

Inflammatory back pain (worse at rest)

18
Q

SPINE ACHE what is it

A

Pneumonic for seronegative spondyloarthropathy

19
Q

What does SPINE ACHE stand for

A

Sausage digits (dactilytis)
Psoriasis
Iritis
NSAIDs help
Enthesitis (inflammation where ligaments join bone)

Arthralgia
Crohns
H
Elevated inflammatory markers

20
Q

Why do you get reduced chest expansion in ankylosing spondylitis

A

Costochondritis

21
Q

Typical presentation and examination of ankylosing spondylitis

A

Mid thirties male, loss of lumbar lordosis, reduced chest expansion

Positive Schober’s test

22
Q

What is Schobers test

A

Draw a horizontal line 10cm above and 5cm below PSIS

Measures degree of lumbar forward flexion as you bend forward and is positive if limited motion (distance increase over 20cm)

23
Q

Types of SS

A

SPEAR

Spondyloarthropathy in juveniles
Psoriatic arthritis
Enteropathogenic arthritis
Ank spond
Reactive arthritis

24
Q

Reactive arthritis features

A

Cant see, can’t pee, can’t climb a tree

uveitis, urethritis, arthritis

25
Q

Examination findings in SS

A

reduced neck movement
Positive FABERs

26
Q

What is FABERs

A

Tests for flexion, abduction and external rotation

27
Q

What investigations would further help with diagnosing Ankylosing Spondylitis

A

MRI spine and sacroiliac joints
X-ray of sacroiliac joints (check for pelvic narrowing)

28
Q

Genetics with ankylosing spondylitis

A

HLA-B27 gene variant

29
Q

Complications of ankylosing spondylitis

A

Anterior uveitis/(apical fibrosis/aortic incompetence)/abdominal colitis/Atlanta-axial involvement

1/2 patients have substantial colitis (IBD)

Spine fusion causing kyphosis, joint damage and reduced flexibility, osteoporosis and spinal fractures

Heart disease and stroke

Psoriasis

30
Q

What treatments are available for Ankylosing spondylitis

A

NSAIDs first line for pain management
Physiotherapy to improve mobility
TNF inhibitors and IL-17 inhibitors
JAK inhibitors

31
Q

What features support a diagnosis of gout

A

Male over 40, pain, redness

32
Q

Clinical findings in gout

A

Fever, joint swelling/warmth/redness, tophi, ocular findings include MSU crystal deposition,

33
Q

Common causes and associations of gout

A

Increased purine uptake/alcohol/high fructose intake/energy drinks

Obesity/congestive heart failure/coronary artery disease/smoking/DM/diuretics

34
Q

Key points in gout

A
35
Q

Which investigations help with making a diagnosis of gout

A

MSU crystals found in synovial fluid aspirate
Blood test to measure uric acid levels
X-ray to exclude other things

36
Q

Which treatment options are available for patients with gout

A

Acute: NSAIDs, steroids, colchicine
Chronic: ULT (allopurinol and febuxostat)(xanthine oxidase inhibitors)

37
Q

Joint pain schematic

A

Y 3 Medicine (6 decks)

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