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BPT > Summary Book Rheumatology > Flashcards

Summary Book Rheumatology Flashcards

1
Q

Movements initiated by radial nerve. Associate with C6 and 7.

A

C6 - elbow flexion and brachioradialis. C6/7 - wrist extension. C7 - triceps, elbow extension and finger extension.

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2
Q

Movements initiated by median nerve. Associate with C8 and T1.

A

C8 - 1st and 2nd DIP flexion, and thumb flexion. T1 - thumb abduction.

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3
Q

Movements initiated by ulnar nerve. Associate with C8 and T1.

A

C8 - 3rd and 4th finger flexion. C8 and T1 - finger 4 abduction. T1 - 1st finger abduction and finger adduction.

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4
Q

Compare crystals of gout and pseudogout

A

Gout - monosodium urate, needle shaped, negative birefringence. Pseudogout - calcium pyrophosphate, rhomboid shaped, positive birefringence.

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5
Q

Compare xray findings of gout and pseudogout

A

Gout - erosive arthritis with soft tissue swelling. Pseudogout - chondrocalcinosis. Both are asymmetrical deforming peripheral oligoarthritis

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6
Q

Management of gout. Acute, prophylaxis and urate lowering.

A

Acute: 1. NSAID or colchicine. 2. Prednisolone - aim uric acid level <0.4. Prophylaxis: colchicine, weight loss, diet modification. Urate Lowering: allopurinol (xanthine oxidase inhibitor) or IL-1 blocker for refractory gout (anakinm).

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7
Q

Systems involved in rheumatoid arthritis

A

Cushingoid, joints, eyes, cardio, resp, splenomegaly, vasculitis

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8
Q

Describe key features of rheumatoid arthritis

A

Symmetrical deforming, small joint predominant peripheral arthropathy; with morning stiffness, joint pain/swelling, fatigue and possible paraesthesia.

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9
Q

Signs of rheumatoid arthritis

A

elbow subcutaneous nodules, sicca, ILD, pleural effusion, possible anaemia, peripheral neuropathy, splenomegaly, pericarditis, raynauds

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10
Q

Risk factors for rheumatoid arthritis

A

smoking, FHx (HLA-DR4)

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11
Q

Poor prognostic factors for rheumatoid arthritis

A

increased number of joints, extra-articular involvement, high rheumatoid factor and anti-ccp, erosions on xray, HLA-DR4 positive

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12
Q

Serum findings for rheumatoid arthritis

A

rheumatoid factor sensitive, anti-ccp specific and bad prognosis, FBC - anaemia, CRP

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13
Q

5 xray findings for rheumatoid arthritis

A
  1. marginal subchondral erosions. 2. symmetrical narrowing of joint space. 3. juxta-articular osteopenia. 4. periarticular soft tissue swelling. 5. deformities.
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14
Q

MRI findings for rheumatoid arthritis

A

synovitis, effusions, oedema

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15
Q

Management of rheumatoid arthritis

A

Non-pharmacological: exercise, braces, smoking cessation, OT/PT. Pharmacological: NSAID, steroids to bridge, DMARD (start early = 1. methotrexate, 2. leflunomide / sulfasalazine / hydroxychloroquine), biologic - anti TNF alpha (if methotrexate and DMARD fail after 6 months). Also manage cardiovascular and osteoporosis risk factors.

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16
Q

Risk factors of osteoarthritis

A

obesity, family history, joint trauma

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17
Q

Describe osteoarthritis

A

asymmetrical deforming peripheral oligoarthritis (knees, DIP (heberden), PIP (bouchard) and 1st CMC). With joint effusions, bony swelling, not warm, tender, crepitations and decreased ROM. Involves progressive loss of synovial cartilage.

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18
Q

Serum findings of osteoarthritis

A

normal inflammatory markers, negative RF/anti-ccp to exclude RA

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19
Q

Synovial findings of osteoarthritis

A

yellow, increased viscous, decreased cell count

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20
Q

4 xray findings of osteoarthritis

A
  1. joint space narrowing. 2. osteophytes. 3. subchondral sclerosis. 4. subchondral cysts
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21
Q

Management of osteoarthritis

A

exercise, weight loss, NSAIDs, intra-articular corticosteroids, surgery

22
Q

Examination of psoriatic arthritis (HLA B27)

A

hands and cardio

23
Q

Signs of psoriatic arthritis

A

Dactylitis, enthesitis, nail changes (pitting, onycholysis, ridging), functional limitation, anterior uveitis, aortic regurgitation, apical lung fibrosis, psoriatic skin disease (limb extensor, behind the ears, scalp line)

24
Q

Serum findings for psoriatic arthritis

A

CRP, negative autoantibody

25
Q

4 xray findings of psoriatic arthritis

A
  1. erosive arthropathy. 2. pencil in cup. 3. rays not rows. 4. juxta-articular new bone
26
Q

Management of psoriatic arthritis

A

exercise, UV for skin, NSAIDs and intra-articular steroids, methotrexate, anti-TNF alpha (infliximab)

27
Q

Presentation and management of giant cell arteritis

A

Headache, loss of vision, jaw claudication. Steroids.

28
Q

Associations of polyarteritis nodosa

A

peripheral neuropathy, mononeuritis multiplex and clots (chest or abdo pain)

29
Q

Organ involvement and management of microscopic polyangiitis

A

Lung and cyclophosphamide

30
Q

Organ involvement and management of granulomatosis with polyangiitis

A

Lung (dyspnoea, haemoptysis, cough, congestion) and renal. Rituximab, possibly cyclophosphamide or MMF.

31
Q

Organ involvement and management of eosinophilic granulomatosis with polyangiitis.

A

Renal, atopic conditions, mononeuritis multiplex and peripheral neuropathy. Cyclophosphamide vs mycophenolate.

32
Q

For management of renal and / or respiratory involvement of vasculitis which agents should be considered

A

Cyclophosphamide for lung or renal. MMF for renal.

33
Q

Investigations for vasculitis

A

ANCA, ESR, UEC, LFT, renal biopsy, imaging

34
Q

Risk factors for vasculitis

A

Other autoimmune conditions, drug reaction (hydralazine, allopurinol, propylthiouracil), leukaemia / lymphoma, hep B/C

35
Q

Presentation for mixed cryoglobulinemia

A

raynauds, arthrtis, Hep C

36
Q

Which organ is associated with microscopic polyangiitis

A

lung

37
Q

General presentation symptoms for vasculitis

A

fatigue, myalgia, arthralgia, rash

38
Q

Good questions for steroid and opioid use

A

Exposure over time, changes in dose, complications, weaning

39
Q

What to examine when determining activity of disease for a rheumatological condition

A

Nodules, eyes, anaemia, fibrosis, skin

40
Q

Administration of methotrexate

A

Weekly, monitor for toxicity, give folic acid

41
Q

Potential risk factors of methotrexate

A

Lung fibrosis, liver cirrhosis, skin malignancy, teratogenicity, infection, mouth ulcers, alopecia, pneumonitis

42
Q

Potential risk factors of leflunomide

A

Lung fibrosis, liver cirrhosis, skin malignancy, teratogenicity, infection, mouth ulcers, alopecia, pneumonitis, neuropathy

43
Q

What should be monitored for plaquenil (hydroxychloroquine)

A

Eyes and skin pigmentation

44
Q

Risk factors of sulfasalazine

A

Neutropenia and rash

45
Q

Risk factors of TNF inhibitors

A

TB, infection, skin malignancy, drug induced lupus, MS

46
Q

Give two examples of a JAK Kinase Inhibitor

A

Tofacitinib and Ruxolitinib

47
Q

Risk factors of JAK kinase inhibitors

A

Lipid dysfunction, CVS event, bowel perforation, diverticulitis, clots, shingles, skin malignancy

48
Q

Name a IL 6 drug

A

Tocilizumab

49
Q

Risk factors of IL 6 drugs

A

Bowel perforation, diverticulitis, lipid dysfunction, cytoplasm

50
Q

Important management when taking Rituximab

A

Vaccination against COVID and strep.

BPT (11 decks)

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