SBAs: Rheumatology Flashcards

1
Q

Why does gout so often present in the big toe?

A

Last place blood reaches from aorta, poor venous return, uric acid able to accumulate

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2
Q

Describe the symptoms of gout

A

Erosive arthritis: warm, swollen, tender and very painful

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3
Q

Recall a sign of gout away from the monoarthropathy

A

Tophi (lumps of uric acid) in ears and on elbows

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4
Q

What is the dietary component that causes gout in excess, and in what sort of foods is it found?

A

Purines: port, red wine, cheese

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5
Q

Recall 3 causes of gout

A
  1. Purine-rich diet
  2. Kidney failure
  3. Leukaemia/ lymphoma
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6
Q

How does leukaemia lead to gout?

A

Tumour lysis syndrome

Very high levels of urate released following chemotherapy

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7
Q

What urate level is diagnostic of gout?

A

> 450

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8
Q

Describe the shape of the crystals in gout

A

Negative birefringent needle-shaped crystals

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9
Q

How can you examine crystal shape in gout?

A

Do a needle biopsy

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10
Q

Describe the shape of the crystals in pseudogout

A

Positive birefringent rhomboid-shaped crystals

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11
Q

What tests must be done when gout is suspected?

A

Needle biopsy

X ray of joint

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12
Q

What is the management of acute gout, and what must you be particularly careful about?

A

NSAIDs and steroids

Cannot give NSAIDs to renal failure patients

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13
Q

What is the management of chronic gout?

A

Allopurinol

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14
Q

What is the mechanism of action of allopurinol?

A

Xanthine oxidase inhibitor

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15
Q

How can patients with tumour lysis syndrome be protected from gout?

A

Giving prophylacted IV rasburicase: it is a recombinant urate oxidase

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16
Q

What sort of nodes do you see in osteoarthritis?

A

Heberden’s (distal)

Bouchard’s (proximal)

17
Q

Recall the mnemonic for and the X ray features of osteoarthritis

A
LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
18
Q

When is rheumatoid arthritis pain worst?

A

Morning

19
Q

Which joints are most commonly affected by rheumatoid arthritis?

A

MCP and PIP

20
Q

Recall 3 features of rheumatoid arthritis on the hands

A

Swan-necking
Boutoniere
Ulnar deviation

21
Q

Which is the most specific immunoglobulin to rheumatoid arthritis?

A

Anti-CCP

22
Q

What score is used to grade the severity of rheumatoid arthritis?

A

DAS28

23
Q

Recall the medical management of rheumatoid arthritis

A

DMARDs

24
Q

Recall an example of a DMARD drug

A

Methotrexate

25
Q

What is the mechanism of action of methotrexate?

A

Anti-folate - interferes with DNA replication

26
Q

Describe the appearance of psoriatic arthritis on the hands

A

Brown mail discolouration

Oncholysis

27
Q

Which joints tend to be affected by psoriatic arthritis?

A

DIPs

28
Q

How is psoriatic arthritis treated?

A

Similarly to rheumatoid arthritis with DMARDs