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Rheumatoidal and orthopods > amk day > Flashcards

amk day Flashcards

1
Q

RA leads to inflation of the synovium and affects women more.
what are the features

A

swollen painful joints in hands and fit
stiffer in the morning -due to cortisol levels as higher in the morning so reflects progression of stiffening - cortisol glucticocord ( management)
ulnar deviation

swan neck deformity - DIP flexion and PIP hyperextension

boutonniere deformity ( PIP flexion and DIP hyperextension)

PIP and MCP swelling and DIP sparing

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2
Q

what finger joints does RA affect

A

PIP and MCP

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3
Q

investigations for RA

A

Rheumatoid factor - can be found in other though

Anti-CCP - detected 10 years before

x-rays of hands and feet

diagnosis made off one joint with an ifnammed synovitis
use DAS28 score specific for rheumatoid arhtiris

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4
Q

scoring system for RA

A

DAS28

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5
Q

what do you treat fro RA

A

DMARDs
methotrexate

also use prednisone

and TNF inhibitors as a biologic if no response to DMARD

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6
Q

methotrexate problems

A

antifolaxe - need to give folate acid

myelosuppreion

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7
Q

how to monitor RA and what for flair ups

A

DAS28 and CRP

corticosteriods

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8
Q

OA is a disorder fo synovial joint due to excessive stress and loading - gradual loss of cartilage

what are the features

A

pain worse on movement and better at the end of day

improved with rest
morning stiffness not prolonged - major diffence with RA

muscle wasting

nodules on PIP and DIP

c-ray features -LOSS 
loss of joint space 
osteophytes 
subchrnial cysts 
subchrodral sclerosis
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9
Q

investigate OA

A

xray - LOSS

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10
Q

manaagmetn of OA

A

los weight if big

1st line is NSAIDs and paracetamol
then cox-2 inhibitors if not working

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11
Q

psoriatic arthritis is an infalmmotry arthritis with psoriasis features are

A

symmetric poly arthritis
psoriatic lesion - itchy

DIP involvement - (again not rheumatoid )

ifnalmmtion of insertion point of tendons and ligaments)

dactyltiis - sausage fingers

nail changes - pitting , onycholysis( elevation of the nail) and nail colour and ridges

pencil in cup appearance - serve

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12
Q

how do you management PA

A

DMARD plus a steroid

pain relief

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13
Q

reactive arthritiss is a HLA-B27 seronegative onset with other infection such as
STI and gastroenteritis

classi triad of symptoms

A

urethritis
conjuctivitis
arthriits
can’t see can’t pee can climb a tree

treat with pain relief and if persists DMARD

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14
Q

septic arthritis is infection of synvoium most common organism

A

staph aureus

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15
Q

features of septic arthritis

A

acute, inflamed, tender joint , reduced range of movement , systemically unwell

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16
Q

test for septic arthritis

A

join aspiration and blood tests

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17
Q

gout is a microcrystal synovitis caused by deposition of monosodium urate in the synvoium caused by hperuricaemia

RF

A

increased uric acid production - myeloprolfieration
cytoctociv drugs
severe psoriasis

18
Q

what decrease uric acid excretion

A

diuretics
CKD
lead toxicity

19
Q

features of gout

A 
MTP generally affected 
pain 
swellign 
episdoes 
eryhtmea 
pockets of uric acid

X-ray looked punched off erosion appearance
joint space reduction

20
Q

manaagmetn of gout

A

Nsadi or colchine

2nd - oral steroid

21
Q

pseudo gout is caused by calcium pyrophosphate and affects the knee most commonly
what are the crystal shape

A

rhomboid

needle in gout

22
Q

analysing spondylitis associated with what HLA

A

HLA-B27

23
Q

features of ankylosing spondylitis

A

inflammatory back pain

affects sacroiliac joint

Achilles tendontisi
plantar fasciitis
extra articular features include anterior uveitis and pulmonary fibrosis

looked crouched and question mark back
bad posture

24
Q

HLA-B27 associations

A

anterior uveitis - common eye problem
reactive arthritis
enteric arthipathy
sporadic arthtiris

25
Q

management of AS

A

NSaids
DMard
local steriods

26
Q

difference between dermatomyositis and polymyositis

A

dermatomyositis has skin involvement

27
Q

what is myositis

A

inflammation of muscles and bilateral muscle weakness and myalgia and tenderness

systemic upset - fever
raynauds - vasospasm of arterioles decreasing blood flow to the skin - treated with CCB
interstitial lung disease

28
Q

what antibodies indicate myositis

A

anti-jo1 and Mi2
creatine kinase
serum enzymes

29
Q

Polymyalgia reumatica PMR
is inflammatory conditions only affecting over 50

features are

A

shoulder and hip girdle structures usually in morning
fever and weight loss

investigation include ESR and CRP and FBC and bone profile

30
Q

management of PMR

A

steroids
- frax scan ( fracture risk for osteoporosis whilst using steroids)
screen for other complications of steroids such as diabetes and mental health

31
Q

how to differeniate between myosotis and PMR

A

myositis - bilateral muscle weakness - patients struggle to move
PR - no muscle weakness - can still do tasks like vacuuming

32
Q

giant cell arthritis is temporal arteritis - inflammation of vessel present with skip lesions

features

A 
temporal headache 
jaw claudication 
monocular blindness 
thickened temporal artery 
scalp tenderness 
can also have signs of PMR
33
Q

management of giant cell arteritis

A

high dose steroids to reduce risk of strokes and blindness

also give bsphosphoante and PPI -associated symptoms

34
Q

enteropathic arthritis

if very specific gastro problems

A

umbrella term to describe various arthritis’s

35
Q

how do you test for gout - most appropriate

A

joint aspiration

then microscopic analysis looking for uric acid crystals

36
Q

myositis - what investigation would reveal this

A

muscle biopsy

37
Q

what in examination is specific of psoriatic arthritis

A

onchlyosis

38
Q

perthes disease is associated with a

A

painless limp

39
Q

reactive arthritis commonly occurs after a

A

STI or gastro infection

40
Q

septic arthritic patients are

A

reluctant

41
Q

Slipped capital femoral epiphysis

obese

A

most common hip disorder in the adolescent age group. It occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis. Weakness in the growth plate can be caused by a variety of factors, including stress on the growth plate due to obesity, and endocrine disorders such as panhypopituitarism, hypothyroidism, and renal osteodystrophy.

42
Q

dermatomyositis what autoantibodies

A

antibodies against histidine-tRNA ligase (also called Jo-1)
antibodies to signal recognition particle (SRP)
anti-Mi-2 antibodies

Rheumatoidal and orthopods (3 decks)

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