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Conditions Flashcards

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1
Q

Symptoms of scleroderma

A

CREST
Calcinosis: calcium deposit in skin

Raynaud’s Phenomenon: spasms of blood vessels in response to cold/stress

Esophageal dysfunction: reflux, decreased motility

Sclerodactyly: thickening/tightening of skin of fingers/hands

Telangiectasia: dilation of capillaries causing red marks on skin

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2
Q

Examination findings of scleroderma

A

Abnormal nail fold capillaries/torn nails
Palmar erythema
Digital ulcers / pitted scars
Calcinosis
Telangiectasia
Perioral skin tightening
Joint crepitus (wrist/ankle)

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3
Q

Pulmonary complications of scleroderma

A

Pulmonary HTN
Interstitial lung disease
Pleural effusion
Lung cancer

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4
Q

Acute onset monoarthritis workup

A

FBC
LFT
Calcium
U+E
Urate
RF
Anti-CCP
ANA
CRP
XR

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5
Q

Poor prognostic features of RA

A

RF positive
anti-CCP positive
>20 joints swollen at presentation
Early functional impairment
Early age of onset
Smoking

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6
Q

Measures of disease activity in RA

A

ESR/CRP
Number of tender/swollen joints
Duration of early morning stiffness
Functional assessment
Visual analogue scale for patient reported global assessment

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7
Q

Ix for RA

A

RF
anti-CCP - most sens 94%
ESR/CRP
Normal Ix does not rule out RA!!

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8
Q

RA XR findings

A

Involve Thumb IPJ and all MCPJ
MC head erosions
MCPJ osteopaenia
Joint space narrowing
Carpal erosions

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9
Q

Diagnostic features of RA

A

Fhx
Early morning stiffness > 1hr
Swelling in >=5 joints
Symmetrical
RF/ anti-CCP positive
sx > 6/12
Raised ESR/CRP
Bony erosions on XR

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10
Q

RA mx

A

Simple analgesics
Omega-3 supplements
DMARDS
Steroids
Weight loss
Exercise
Psychosocial support
Sleep promotion
Vaccination

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11
Q

Maintaining remission of RA

A

Methotrexate 10mg weekly PLUS folic acid 5mg weekly (separate day)
PO pred 5-15mg and slow taper

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12
Q

MTX patient education

A

EtOH 2std max 2x per week
Contraception
Drug interactions w/ folate antagonists e.g. trimethoprim
Vaccination; pneumococcal, influenza
Avoid live vaccines
Regular LFT/renal monitoring
Weekly folic acid
Sun protection

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13
Q

MTX ADRs

A

Stomatitis
Alopecia
N/v
diarrhoea
myelosuppression
hepatotoxicity
Infections

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14
Q

MTX monitoring

A

4 weekly
- Efficacy, ADR
- Bloods; FBC/LFT/albumin/Cr for 3/12 or after increasing dose -> then 8 weeks for 6 months -> then 12 weekly

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15
Q

Long term health monitoring RA

A
  • Joint effects – number, tenderness, function
    • Extra-articular involvement; nodules, rash
    • CVD: BP, renal function
    • Risk of infection on immunomodulators
    • Toxicity; monitor for toxicity (skin, lungs, GIT, heart)
    • Lifestyle – smoking, BMI
    • ADLS; function, sleep, mood, fatigue
    • Annual foot review
    • Medication adherence
    • Steroids – osteoporosis risk, BP, lipids, cataracts
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16
Q

Osteoporosis risk factors

A

Female
Low body weight
Caucasian/Asian
Prev minimal trauma #
Hx of falls
Fhx
Premature menopause
RA
Hyperthyroidism
Malabsorption disease - coeliac
Smoking/ETOH
Physical inactivity
Lack of sunlight
Long term steroid use
PPI
SSRI

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17
Q

Major osteoporosis risk factors for MBS BMD

A

Parental hx #
Premature menopause
Low body weight
Immobility
Smoking
Alcohol > 2 std per day
RA
Hyperthyroid/hyperparathyroid
CKD
Coealic
DM
Depression
Steroids > 3/12 >=7.5mg / day
SSRI/PPIs

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18
Q

Minimal trauma # flow chart for postmenopausal women and men >50yo

Study These Flashcards
A

Hip/vertebral -> straight to antiresorptives (can do baseline BMD but not essential)
Any other site -> BMD
-> if T score <=-1.5 -> antiresorptive
-> if T score > -1.5 -> specialist review

19
Q

BMD screening flow chart

Study These Flashcards
A

Age >=70yo or Major risk factors do BMD
if T score <= -2.5 -> antiresorptives
if T score >-2.5 -> Garvan fracture risk
Garvan # risk;
- Hip fracture >3%, any fracture >20% then tx antiresorptives
- if low risk - implement lifestyle changes

After tx - screen 2 yearly

20
Q

Osteoporosis lifestyle mx

Study These Flashcards
A

Falls prevention; home hazard removal, good footwear
Exercise; weight-bearing and balance training
Diet
- Calcium 1300mg / day
Sun exposure
Reduce alcohol/smoking
Weight loss

21
Q

Bisphosphonate therapy for osteoporosis

Study These Flashcards
A

Prior to prescribing
- Baseline renal, Ca, vitamin D (ensure replete >50)
Alendronate 70mg PO weekly
- Empty stomach, 2hrs from Ca/Iron/antacids
- Remain upright 60min
IV Zolendronic acid IV to avoid GIT ADR
ADR
- Myalgia, hypocalcaemia, AKI, osteonecrosis of jaw, oesophagitis
Duration
- 5 years oral, 3 years IV, if high risk (10 years oral, 6 years IV)
- After stop - BMD 2 years later

22
Q

RANKL inhibitor for osteoporosis

Study These Flashcards
A

Denosumab 60mg subcut every 6/12
- Ensure vitamin D replete and sufficient Ca intake
- Can be used in CKD IV
- Crucial compliance - high risk fracture if late
- Duration; indefinite or replace with bisphosphonates
- Avoids GIT ADR

23
Q

SERM for osteoporosis

Study These Flashcards
A

Raloxifene 60mg daily
<60 yo and menopausal
Best if spinal osteoporosis
Reduces risk of breast Ca - but increase VTE/CVA

24
Q

Tibolone for osteoporosis

Study These Flashcards
A

Tibolone 2.5mg daily
<60yo, menopausal sx
Increase risk breast Ca/CVA

25
Gout risk factors
Purine-rich diet; meat, seafood ETOH Diuretics CKD T2DM Obesity Dehydration
26
Gout acute flare mx
1st line; NSAID 5/7 OR prednisolone 15-30mg 5/7 2nd; colchicine 1mg stat then 0.5mg 1hr later Local steroid injection Allopurinol 50mg and titrate every 2/52 based on serum urate level
27
Flare prophylaxis when starting urate-lowering drug
Naproxen 250mg BD or 0.5-1mg colchicine daily Duration; 6/12 or 3/12 after reaching target urate (w/o tophi) or 6/12 after reaching target urate (w/ tophi)
28
Urate lowering therapy
Allopurinol 50mg and titrate 4/52 until target (max 900mg daily) Add on Probenecid 250mg BD Target urate - w/o tophi; <0.36mmol/L - with tophi; <0.30 mmol/L
29
Ankylosing spondylitis clinical features
HLA-B27 Enthesitis; achilles tendonitis, plantar fasciitis Dactylitis Uveitis Schober test <5cm Fusion of SIJ, bamboo spine, Dagger sign
30
Reactive arthritis features
Post genitourinary infection in male 20-40 - chlamydia is common cause Post GIT infection; salmonella, shigella etc Triad; conjunctivitis, arthritis, urethritis Tx - NSAID - PO pred - If suspect chlamydia - tx doxy 100mg BD 7/7
31
Polymyalgia rheumatica
Ache/stiff shoulder/hip girdle area Morning stiffness, improves with hot shower/activity Usually >50yo and women Ix; elevated ESR/CRP (some are normal tho) Tx - Pred 15mg 4/52 then taper by 2.5mg every 4/52 - don't reduce dose if signs of active disease - tx usually for 12/12 - Monitor inflamm markers as you taper
32
GCA clinical features
Headache Jaw claudication Polymyalgia rheumatica Visual; diplopia, visual loss Tender pulsatile enlarged temporal arteries Raised ESR/CRP
33
Mx of GCA
Urgent referral rheumatologist Urgent referral surgeon for temporal artery biopsy Pred 40-60mg in two doses for 4/52 or until inflamm markers resolve -> reduce by 10mg every 2/52 until 20mg -> reduce by 2.5mg every 2/52 until 10mg -> reduce 1mg every 4/52 MTX 10mg PO + FA Aspirin 100mg to reduce ischaemic events Monitor visual sx/acuity -> if worsening then IV methylpred Monitor ESR/CRP monthly
34
Viral polyarthritis causes
Ross River, Barmah Fores Dengue Yellow fever Parvovirus B19 Rubella Hep B/C HIV EBV
35
Juvenile idiopathic arthritis
Inflammatory arthritis <16yo and lasting 6/52 without any other cause Features - Joint pain/swelling - Stiff after rest/sleep - Fever, rash - Fhx RA/autoimmune Ix; always do FBC/ESR/CRP Mx - Refer rheum - NSAID - Panadol - Weak opioids like codeine - DMARDs - Dietary calcium + vitamin D intake - Land + aquatic exercise - Orthotics for foot - Psychosocial support
36
Diagnosis of SLE
4/11 of; - Malar rash - Discoid rash - Photosensitivity - Oral ulcers - Arthritis - Serositis; pleurisy, pericarditis - Renal features; proteinuria, casts - Neurological/psych; seizures, psychosis - Haematological; haemolysis, lymphopenia, thrombocytopenia - Immune; positive anti-dsDNA, anti-Smith, antiphospholipid Abx - ANA positive
36
Sjogren syndrome
Chronic autoimmune lymphoid infiltration of exocrine glands (saliva, lacrimal) -> gland dysfunction and severe sicca sx Cause; primary, secondary (RA, SLE, scleroderma) Sx - Fatigue - Arthralgia - Arthritis - Raynaud - Dry cough - Rare - lymphoid malignancy Dx - Significant and severe sicca (severe dry eyes), polyclonal hypergammglobulinaemia, positive ANA, RO and La antibodies
37
Mx sicca sx
Sunglasses outdoors Avoid dry/heated air/cigarette smoke/TCA Oral hydration Good dental hygiene Artificial salivary products (bicarb mouthwash) Chewing gum to stimulate saliva Ocular lubricants
38
Clinical features of Marfan syndrome
Aortic regurg/dissection MV prolapse Arachnodactyly Abnormal arm span Marfan wrist sign Marfan thumb sign Eye; dislocated lens (ectopia lentis)
39
Raynaud syndrome
Digit vasospasms due to cold/stress Cause; primary, secondary (scleroderma, etc) tx - DHP CCB (amlodipine 5-10mg daily)
40
Henoch-Schonlein purpura (HSP)
IgA vasculitis of childhood, 2-8yo, post strep A URTI Sx - Triad; purpura, large joint arthritis, abdominal pain - Nephritis; haematuria, proteinuria, HTN Ix - BP - Urinalysis - only Ix needed - If HTN , macroscopic haematuria or proteinuria -> formal UMCS, UACR, UEC, ALBUMIN and consult paeds Mx - Assess for testes involvement, resp/neuro features -> paeds - Panadol/ NSAID - Severe pain; pred 1mg/kg F/u - Urinalysis/BP weekly for 4/52 -> 2 weekly for next 2/12 -> then 6 month review and 12 month review
41
Kawasaki disease
Ddx; Scarlet fever, ARF, EBV, JIA, Stevens-Johnson syndrome, drug reaction, sepsis Diagnostic criteria - Fever for >=5 days and 4/5 of following - Bilat conjunctival injection - Cervical LN - Oral mucous membrane changes - Erythema/oedema/desquamation of hands/feet - Polymorphous rash Ix; raised ESR/CRP, high neutrophils, abnormal LFT Mx - IV immunoglobulin 2g/kg single infusion over 12hrs - IV methylpred 30mg/kg over 1hr up to 3/7; if fever persists after second dose IVIg - Aspirin 3-5mg/kg until f/u TTE 6/12 post fever - Defer any childhood immunisations for 11/12 post IgIG
42
Fibromyalgia mx
Regular graded exercise CBT Sleep hygiene Reassurance and education; nil tissue damage, not progressive 1st line; amitriptyline 10mg 2nd line; Pregabalin 25-75mg
43
Paget's disease of bone mx
Asymp - nil Indications for tx; symp, risk of disease progression (<50yo, lesion at critical site like skull/vertebrae, active disease, neuro sx, hypercalcaemia) Bisphosphonates - Risendronate 30mg 2/12 - IV zolendronic acid 5mg stat dose Monitor ALP 3/12 after dose When in remission - ALP every 2 years

Rheumatology (1 decks)

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