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Y3 Charis > Rheumatology - general > Flashcards

Rheumatology - general Flashcards

1
Q

Which is more common?

RA or OA?

A

OA

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2
Q

Pathophysiology of OA

A

Imbalance between cartilage degeneration and bone remodelling

Chronic slowly progressive disorder due to failure of articular cartilage (wear + tear)

Non-inflammatory degenerative process
Localised loss of cartilage
Remodelling of adjacent bone
Associated inflammation

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3
Q

Pathophysiology of RA

A

Active symmetrical arthritis lasting >6 weeks
Chronic (>6 weeks) autoimmune disease characterised by
Symmetrical deforming polyarthritis (>4 joints)
Extra-articular manifestaions

Site of inflammation - synovium

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4
Q

HLA associations in RA

A

HLA-DR1

HLA-DR4

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5
Q

Difference of primary vs secondary amyloidosis

A

Primary amyloidosis - AL amyloidosis
– Deposition of immunoglobulin light chain
- Plasma cell disorders e.g. MM

Secondary amyloidosis - AA amyloidosis
– Deposition of serum amyloid A
- Chronic inflammation e.g. RA, IBD, chronic infection

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6
Q

Seronegative spondyloarthritis = PEAR HEADS

A

Psoriatic arthritis
Enteropathic arhtirits
Ankylosing spondylitis
Reactive arthritis

HLA B27
Enthesitis 
Assymetrical oligoarthritis + axial involvement + extra-articular involvement 
Dactylitis 
Seronegative
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7
Q

Pathophysiology of ankylosing spondylitis

A
  • Autoimmune chronic progressive inflammatory disease
  • Destruction of interverbral joints, facet joints, sacroiliac joint
  • Fibroblasts replace destroyed joint with fibrin
  • Fibrous bands around joint limit range of motion
  • Ossification
  • HLA-B27
  • Peak onset 20-30
  • M>F
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8
Q

Define reactive arthritis

A

Sterile inflammation in joints 2 weeks after extra-articular infection

Urogenital (chlamydia, HIV, c.trichomatis, gonorrhoea) 
GI infections (salmonella, shigella, campylobacter, c difficile, giardia lamblia)
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9
Q

Define septic arthritis

A

Infection causing inflammation in a native or prosthetic joint

Most common pathogen
children - haemophilus influenzae
<30 years - N. gonorrhoea
>30 years - Staph aureus

surgical emergency! (joint destruction <24h)

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10
Q

Composition of crystals in gout vs pseudogout

A

Gout - monosodium urate crystals
Gout - excessive production of uric acid

Pseudogout - calcium pyrophosphate crystals
pseudogout - excessive production of pyrophosphate

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11
Q

When do acute gout attacks usually happen?

A

Tend to happen after

  • a large meal with foods rich in purines (shellfish, anchiovies, red meat)
  • alcohol consumption
  • dehydration
  • diuresis
  • surgery
  • trauma
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12
Q

RF for pseudogout

A
  • Hyperparathyroidism
  • Hypothyroidism
  • Hypomagnesemia
  • Hypophosphatesia
  • Haemochromatosis
  • Acromegaly
  • Wilson’s disease

Elderly women

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13
Q

RF for gout

A
  • Chemo/radiation (tumour lysis syndrome)
  • Obesity, DM, HTN, dyslipidaemia
  • Consumption of purine rich foods (shellfinsh, anchiovies, red meat), alcohol
  • Underexcretion of uric acid by the kidney (renal failure, thiazide + loop diuretics, aspirin, pyrazinamide, cyclosporin)

Obese middle aged men

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14
Q

Definition of osteomyelitis

A

Infection of the bone marrow which can spread to the bone cortex + periosteum via the Haversian canals

Results in an inflammatory destruction of the bone and if the periosteum becomes involved it can result in necrosis

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15
Q

What is a sequestrum and an involucrum?

A

Processes that happen during chronic osteomyelitis

  • Sequestrum - Necrotic bone separates from healthy part of bone
  • Involucrum - osteoblasts (originate from periosteum) may form new bone that wraps the sequestrum in place
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16
Q

Most common organisms that cause osteomyelitis in

a) most common
b) sickle cell disease
c) cat/dog bite, scratch

A

a) staph aureus
b) staph aureus + salmonella
c) pasturella multocida

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17
Q

Way in which osteomyelitis can spread

A

• Hematogenous spread (most common)
(Immunocompromised, DM, IVDU, Haemodialysis, Dental extraction of infected tooth)

  • Contiguous spread (cellulitis, localised infection, neuropathic ulcer)
  • Direct/Trauma (Penetrating injuries)
  • Surgery
18
Q

Most common site of osteomyelitis in adults vs children

A

Adults – cancellous bone, vertebrae (affects the 2 vertebrae + the intervertebral disc in between them, can result in vertebral abscess causing neural compression + spinal instability)

Children – metaphysis of long bones (femur, proximal tibia)

Feet commonly affected in diabetics (neuropathic ulcers get infected –> contiguous spread)

19
Q

Definition of idiopathic inflammatory myopathies

A
  • Autoimmune disorders that cause muscle inflammation –> muscle weakness –> wasting
  • Therefore in individuals with gradually progressive muscle weakness, suspect inflammatory myopathy

refers to a group of 3 disorders – polymyositis, dermatomyositis, inclusion body myositis

Polymyositis typically affects adults (F>M)
Dermtomyositis mainly affects children (F>M)
Inclusion body myositis - the most common inflammatory myositis in individuals >50 years (M>F)

20
Q

Sarcoidosis definition

A

multisystem chronic granulomatous inflammatory condition characterised by the formation of non-caseating granulomata at various sites in the body
• Commonly affect lungs, skin, eyes
• Accumulation of lymphocytes + macrophages - formation of non-caseating granulomas in the lungs and other organs

RF
• FHx
• Prior infection with M tuberculosis + Borrelia burgdorferi
• Bimodal distribution – peaks in 30s and 50s
• African-Americans
• F>M

21
Q

SLE pathophysiology

A

inflammatory, multisystem, autoimmune disease

DR2
DR3

Immune system recognizes nuclear antigens as foreign and tries to attack them

Type III hypersensitivity rxn - Ag-Ab complexes are deposited in vessels in various organs
Type II hypersensitivity rxn - ab targeting RBC, WBC, plt –> pancytopenia

22
Q

What is scleroderma +

Which are the 2 types of scleroderma and what is their difference?

A
  • Rare multisystem autoimmune disorder
  • Increased fibroblast activity –> abnormal growth of connective tissue –> fibrosis of organs + vasculature

Limited cutaneous scleroderma/CREST syndrome
• More common type
• Slower progression
• No sign of internal organ involvement
• Limited to face, distal limbs (blow the elbow + knees)

Diffuse cutaneous scleroderma
• Faster progression
• Internal organ involvement
• Can affect the entire body

23
Q

What does fundoscopy show on a pt w GCA?

A
  • Pallor
  • Oedema of the optc disc
  • Cotton wool spots
  • Small haemorrhages
  • Cherry spot on macula (if there is retinal artery thrombosis)
24
Q

What is not a symptom of polyarteritis nodosa?

A

No glomerulonephritis

Pulmonary arteries spared

25
Q

SLE ddx

A

• Skin
o Dermatomyositis – heliotrope or lilac rash extends beyond the nasolabial folds
o Skin cancer, psoriasis, sarcoidosis, syphilis – discoid rash, need skin biopsy showing ab deposition

• Lupus vs RA
o Joint deformities in lupus are usually non-erosive
o Anti-cyclic citrullinated peptide antibodies – more supportive of the dx of RA

• Sjogren’s syndrome
o Same extraglandular manifestations in lupus (lymphocytic infiltration of exocrine glands) - keratoconjunctivitis, xerostomia
o Ro + La antibodies in Sjogren’s syndrome

• Anti-cardiolipin antibodies also present in syphilis
o Treponemal antibody testing is negative in lupus

26
Q

What are the RF for polyarteritis nodosa?

A

Assosciated with HBV + HCV infection

27
Q

Which conditions is oesinophilic granulomatosis with polyangiitis (Churg Strauss syndrome) assosciated with?

A
  • Asthma
  • Oesinophilia

RF
Hx of asthma, allergic rhinitis, sinusitis

28
Q

RF for Bechets disease

A
  • 20-30
  • M>F
  • Mediterraneans
  • HLA-B51
  • HSV + parvovirus 19 infection
  • FHx
29
Q

RF for microscopic polyangiitis

A

• Ppt my medication (esp Abx e.g. penicillin)

30
Q

Differeence bn granulomatosis with polyangiitis + microscopic polyangiitis

A

Granulomatosis with polyangiitis

  • LRT, URT, glomerulonephritis
  • Histology shows non-caseating granulomata
  • c-ANCA

Microscopic polyangiitis

  • LRT, glomerulonephritis
  • No granulomata on histology
  • p-ANCA
31
Q

What does Takayasu vasculitis affect?

A

Large vessel vasculitis

Primarily affects aorta + its branches

Causes stenosis, occlusion, dilation, aneurysm formation

32
Q

Epidemiology of Takayasu arteritis

A
  • F>M
  • <40
  • Asian ethnicity
33
Q

What is mononeuritis multiplex?

A

Symptom of vasculitides

Ischaemia to multiple peripheral nerves
Painful, asymmetrical, asynchronous sensory + motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas
As the condition worsens, it becomes less multifocal + more symmetrical

34
Q

What is renal osteodystrophy caused by?

Radiological signs?

A

renal ostedystrophy = alteration of one morphology in pt w CKD - noabsorption of Ca, low Vitamin D

  • Osteopenia
  • Salt + pepper skull
  • Subperiosteal erosions
  • Brown tumours
  • pseudofractures
  • Rugger jersey spine
35
Q

Why is there a cherry red spot on fundoscopy in GCA?

A

Occlusion of ciliary and retinal arteries due to inflammation –> pale retina

Macula receives blood supply from choroid (supplied by the posterior ciliary arteries)

36
Q

Complications of septic arthritis

A

Rapid joint destruction
Osteomyelitis
Sepsis
Death

37
Q

Staging of sarcoidosis

A

1 bilateral hilar lymphadenopathy
2 bilateral hilar lymphadenopathy + lung involvement
3 lung involvement only
4 lung fibrosis

38
Q

Commonest extra-articular manifestation of RA

A

Anaemia

39
Q

What is

Chronic tophaceous gout
Gout nephropathy

A

Chronic tophaceous gout – accumulation of urate in cartilage (often ear + Achilles tendon)

Gout nephropathy – urate deposition in the kidneys (AKI + formation of urate stones)

40
Q

American Rheumatism Association criteria

A 
Dx of RA requires 4/7 
1 Morning stiffness >1h for >6w
2 Arthritis of hand joints (PIP, MCP, wrist) for >6w
3 Arthritis of >3 joint areas for >6w
4 Symmetric arthritis for >6w
5 Rheumatoid nodules
6 Characteristic XR findings*
7 Positive rheumatoid factor

*joint space narrowing, soft tissue swelling, juxta-articular erosions, joint subluxation

41
Q

Which 3 small vessel vasculitides cause nephritic syndrome?

A

Granulomatosis with polyangiitis (Wegener’s)
Eosinophilic Granulomatosis with polyangiitis (Churg Strauss)
Microscopic polyangiitis

Y3 Charis (35 decks)

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