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1
Q

tell me the 5 seronegative spondyloarthropathies

A 
reactive
psoriatic
ank spond
enteropathic
JIA
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2
Q

what makes seronegative spondyloarthropathies themselves?

A 
negative rheumatoid factor
spinal & sacroiliac joints affected
HLA B27
asymmetric 
enthesitis
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3
Q

what allele are seronegative spondyloarthropathies

A

HLA B27

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4
Q

keratoderma blenorrhagica is rash on feet in what

A

reactive arthritis

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5
Q

does psoriasis usually precede psoriatic arthritis?

A

yes by a few years usually

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6
Q

which joints are affected in psoriatic arthritis?

A

DIP

pencil in cup erosions on X ray

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7
Q

what are the nail changes in psoriatic arthritis?

A

onycholysis

dactylitis

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8
Q

name some symptoms of ank spond

A

back pain + stiffness
infl of other joints e.g. knee
fatigue

kyphosis, loss of lumbar lordosis

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9
Q

give me an example of a medium vessel vasculitis

A

polyarteritis nodosa

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10
Q

name 3 conditions that can cause secondary vasculitis

A

RA
SLE
Hep B/C

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11
Q

which small vessel vasculitis causes adult onset asthma but uncommonly affects kidneys (unlike the others which affect kidaz and lungs)

A

churg strauss

eosinophilic granulamatous polyangitis

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12
Q

monosodium urate crystals deposition causes joint infl whats this?

A

gout

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13
Q

age, alcohol, obesity, venison and male are risk factors for gout. name 2 more.

A

diabetes

thiazide diuretics

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14
Q

what investigation for gout?

A

diagnosis clinical if typical.
if not,
joint aspiration

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15
Q

what does microscopy of synovial fluid on joint aspiration of GOUT show?

A

negative birefringent needle shaped crystals

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16
Q

what does microscopy of synovial fluid on joint aspiration of PSEUDOGOUT show?

A

positively birefringent diamond shaped crystals

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17
Q

why test glucose and lipids when diagnosing gout?

A

assoc w metabolic syndrome

and diabetes

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18
Q

what is the management of acute gout ?

A

RICE
NSAIDs
colchicine

corticosteroids if bad

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19
Q

what is the management of chronic gout.

A

lifestyle
allopurinol / febuxostat

(xanthine oxidase inhibitors)
(if >2 attacks a year)

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20
Q

how long do acute attacks of gout take to recur?

A

3-10days

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21
Q

an acute attack of gout reaches its peak within

A

24hrs!

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22
Q

deposition of calcium pyrophosphate crystals causing joint infl. whats this

A

pseudogout

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23
Q

what are the pseudogout crystals

A

calcium pyrophosphate

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24
Q

what is the management of pseudogout?

A

RICE
NSAIDs
IA steroids

acute attacks usually resolve in 10ds
elderly - dehydration, intercurrent illness

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25
what is the triad of pagets
pain fracture deformity
26
high bone turnover, osteoclasts go crazy and we dont know why. osteoblasts cant keep up so make rubbish woven + lamelllar bone.
paget's
27
what is paget's?
high bone turnover, osteoclasts go crazy and we don't know why. poor osteoblasts cant keep up so make rubbish mosaic of woven + lamellar bone.
28
is most paget's asymptomatic?
yes - radiologically common but minority are symptomatic. | got a spot of paget's on your x ray hun
29
which bones can paget's affect?
pelvis lumbar spine skull femur , tibia i havent got any leg bones
30
what investigations for paget's
plain X ray alk phos - high isotope scan
31
why is alk phos high in paget's
high bone turnover
32
bones messy and fluffy on x ray (cortical thickening, abnormal texture)
paget's
33
what is the treatment for paget's ???
BISPHOSPHONATES they disable osteoclasts only treat if symptomatic
34
pain fracture deformity = triad for what?
paget's
35
low bone mass and microarchitectural destruction of bone --> increase in bone fragility and susceptibility to fracture what's this?
osteoporosis
36
name the 3 osteoporosis fragility fractures that happen
colles NOF vertebral
37
what questions are in FRAX
``` age height weight previous fractures parental hip fracture RA glucocorticoids smoker/alcohol ```
38
what does FRAX tell us
10yr fracture risk for untreated 40-90 yr olds
39
what does DEXA stand for
dual energy x ray absorptiometry
40
what does DEXA tell us
bone mineral density!!! | then calcs into T score
41
what does T score tell us
how much bone have you lost since young adult peak bone mass
42
how is Z score different to T score
``` Z = compared to pts same age T = compared to peak bone mass ```
43
-1 T score =
osteopenia
44
-2.5 T score =
osteoporosis
45
investigations for osteoporosis?
FRAX DEXA scan - T score vertebral fracture assessment (dexa of whole spine)
46
why do a vertebral fracture assessment?
these often go undiagnosed and are big risk factor
47
in osteoporosis thats not caused by endocrine, whats Ca PTH and vit D levels?
normal
48
if someones a rlly bad bone mineral density and youre suspicious, what other investigations might you do?
Ca, PTH, vit D - hyperPTH TSH - hyperthyroid coeliac antibodies sex hormones (hypogonadism)
49
what 4 bits of lifestyle advice can you give to someone w osteoporosis?
less smoking/alcohol more exercise dietary calcium vit D supplements
50
shout out the drug management of osteoporosis
bisphosphonates HRT denosumab teriparatide
51
how often is IV zolendronate given?
annually!
52
how often are oral alendronate and risedronate given?
weekly | risedronate!
53
rare but bad SEs of bisphosphonates?
atypical femoral fractures | osteonecrosis of jaw
54
common SE of bisphosphonates?
oesophagitis
55
instructions for taking bisphosphonates?
first thing in morn empty stomach big glass of H2o , nothing else for 30 mins after dont lie down
56
"if youre vitamin D deficient, you can drink as much milk as you want but...
you're not gonna absorb the calcium" you need vit D to absorb ca from gut
57
what is the pathophys of osteomalacia?
low vit D - less Ca from gut - increased PTH - increased bone turnover + less mineralisation
58
what is the difference between osteporosis and osteomalacia?
porosis = low BD w lone bone mass. you've lost bone. malacia = low BMD w normal amount of osteoid but softer cos less calcium.
59
what level of vit D counts as deficient?
<25
60
25 - 50 vit D =
insufficient
61
>50 vit D =
sufficient
62
pt presents w bone pain, muscle aches, proximal muscle weakness. vit D level is 15.
osteomalacia and vit D def
63
osteomalacia : alk phos ca/phos PTH
alk phos high (bone turnover) PTH high (tryna increase ca) Ca low (cant absorb) vit D low
64
name some RFs for vit D def and osteomalacia
``` dark skin housebound body covering alcoholism vegetarian poverty obesity EBG >6 months LATE CKD ```
65
severe severe vit D def can cause
hypo Ca tetany seizures
66
plain X ray leg of someone with osteomalacia. what does it show?
cortical bone lucency Looser's zones (strips of low density)
67
Loosers zones?
strips of low density on X ray of someone w osteomalacia
68
bone profile blood test involves what?
total protein albumin adjusted calcium alk phos (can add on phosphate)
69
osteomalacia investigations?
serum vit D alk phos, ca/phos, PTH plain x ray dexa
70
treatment for osteomalacia
high dose vit D - CHOLECALCIFEROL 20,000 units for 12wks + Ca supplements then continue low dose supplementation long term
71
why give Ca supplements alongside high dose vit D in treatment of osteomalacia?
help bone remineralise
72
what is AdCalD3
combined low dose vit D and calcium supplement
73
pt with end stage CKD has vit D def. how to treat?
CALCITRIOL (activated vit D)
74
what is cholecalciferol? | what is calcitriol?
``` cholecalciferol = skin vit D calcitriol = activated vit D (only give for renal pts) ```
75
autoimmune disease where there is too much fibroblast activity causing vascular damage and fibrosis of organs. what's this?
systemic sclerosis aka scleroderma
76
what are the two types of systemic sclerosis
limited cutaneous and diffuse cutaneous (whole body skin involvement)
77
limited cutaneous sclerosis aka
CREST syndrome
78
what does CREST syndrome stand for
``` Calcinosis Raynaud's - nailfold capillaroscopy Esophageal dysmotility Sclerodactly Telangiectasia ```
79
WHAT ACTUALLY is systemic sclerosis
autoimmune too much fibroblast activity FIBROSIS OF ORGANS AND VESSELS
80
what ACTUALLY is polymyositis and dermatomyositis
autoimmune INFLAMMATION OF MUSCLES derm has skin involvement
81
proximal myopathy, hard to hold your head high. plus heliotrope eyelids and purple rash. can progres to interstit lung disease.
polymyositis and dermatomyositis infl of muscles! proximal myopathy. skin involve.
82
middle aged woman presents struggling to comb her hair or even hold her head high. she has a purpley rash on her face.
polymyositis + dermatomyositis
83
investigations for polymyositis and dermatomyositis
high creatine kinase! anti-Mi (derm) anti-Jo (poly) anti-ANA EMG diagnostic = muscle biopsy
84
which investigation is diagnostic for polymyositis and dermatomyositis?
muscle biopsy
85
polymyositis and dermatomyositis can be assoc w what
MALIGNANCY PARANEOPLASTIC for breast gastric lung also other autoimmune - hashimotos
86
treatment for polymyositis and dermatomyositis
prednisolone
87
what actually is lupus / SLE?
multisystem autoimmune conn tiss body attacks lots of its healthy tissues complex
88
RFs for SLE
afro-caribbean women >40 HLA-DR2, 3 UV, EBV
89
ESR raised and CRP normal makes u think
SLE , lupus!
90
why is SLE called lupus?
rash looks like a wolf bite
91
shoot me some symptoms of SLE
``` photosensitive butterfly rash (naso-labial sparing) oral ulcers dry eye/mouth fatigue fever splenomegaly lymphadenopathy arthralgia pleuritic pain / pericarditis Raynaud's psychosis nephritic / nephrotic syndrome ```
92
is there increased CVD risk in lupus?
yes
93
photosensitive skin eruption w/o systemic symps =
discoid lupus
94
what are the KEY investigations for SLE
anti-dsDNA ant-Sm low C3/4
95
why test antiphospholipid antibodies in SLE?
antiphospholipid syndrome assoc w SLE
96
some investigations for SLE
``` FBC, ESR, CRP anti-ANA anti-dsDNA anti-Sm low C3/4 antisphospolipid antibodies ```
97
what might FBC show in lupus
haemolytic anaemia, low plts
98
is there a cure for SLE?
no. just reducing flares. | people die much younger :(
99
what is the management of SLE?
NSAIDS, prednisolone HYDROXYCHLOROQUINE immunosuppressants -azathioprine
100
dry mouth and dry eyes and enlarged parotids. positive rheumatoid factor. in middle aged woman.
sjorgens syndrome she needs artificial tears and saliva
101
sjorgens syndrome can be primary or secondary to?
RA, SLE
102
treatment for sjorgens syndrome?
artificial tears and saliva
103
hypercoagulable , autoimmune. causing thrombosis and adverse preg outcomes. what this
antiphospholipid syndrome
104
antiphospholipid assoc w what disease?
SLE
105
treatment for antiphospholipid syndrome?
long term warfarin in preg : LMWH and low dose aspirin
106
localised loss of cartilage, remodelling of adjacent bone, infl. triggered by trauma and need for joint to repair itself. what's this?
osteoarthritis | wear and tear
107
name some RFs for osteoarthritis
``` FHx ageing female obesity joint injury / occupational stresses on joint ```
108
which joints does OA effect?
hip knee hand
109
hip pain, worse w exercise relieved by rest , morning stiffness <30 mins . what might you find on examination?
reduced ROM crepitus swelling/warmth bony swelling e.g. Bouchards Heberdens nodes = OA
110
heberdens nodes are
DIP
111
bouchards nodes are
PIP
112
when can a clinical diagnosis of osteoarthritis be made
>45 + activity related + stiffness <30mins
113
OA plain X ray signs
Loss of joint space Osteophytes Subchondral cysts Subarticular sclerosis
114
talk to me about non pharma management of OA
``` exercise weight loss physio walking aids supportive footwear ```
115
talk to me about pharma management of OA
``` paracetamol topical NSAIDs oral NSAID IA corticosteroids knee/hip replacement ```
116
autoimmune infl of synovial lining of joints, tendon sheaths and bursa. what's this?
rheumatoid arthritis a symmetrical polyarthritis
117
what allele is rheumatoid arthritis?
HLA DR4 /1
118
what antibodies for rheumatoid arthritis
rheumatoid factor | anti-CCP
119
two RFs for RA
woman | HLA DR4 /1
120
what do rheumatoid arthritis swellings feel like?
boggy, soft | as opposed to bony swellings in OA
121
atlanto-axial subluxation in
rheumatoid arthritis when it affects C spine risk of cord compression
122
which joints does RA tend to affect?
wrist, ankle, MCP, PIP sometimes c spine, hips, knees
123
tell me about the onset of RA
can be overnight or gradual
124
name 5 things you might see on hand examination with rheumatoid arthritis
``` ulnar deviation boutonniere swan neck Z thumb elbow nodules ```
125
is rheumatoid arthritis a symmetrical polyarthritis ?
yeah
126
name some symptoms of rheumatoid arthritis
pain swelling stiffness in small joints of hands and feet worse in morn stiffness >30mins improves with activity
127
does rheumatoid improve with activity?
yes
128
does osteoarthritis improve with ativity?
no - gets worse w activity
129
is DIP affected in RA?
NEVER
130
which joint is NEVER affected in RA?
DIP
131
what is caplan's
pulmonary fibrosis in RA
132
extra-articular RA - lung: ?
pulmonary fibrosis | bronchiolitis obliterans
133
extra-articular RA - eye: ?
sjorgens sclerosis | keratoconjunctivitis sicca
134
extra-articular RA - cardiovascular: ?
pericardial effusion vasculitis accelerated atherosclerosis anaemia of chronic disease
135
what is Felty's syndrome
RA + splenomegaly + neutropenia
136
what organ does Felty's syndrome affect in RA?
spleen
137
extra-articular RA - wrist: ?
carpal tunnel
138
what might FBC show in RA?
normocytic anaemia of chronic disease
139
what scan can show synovitis
Ultrasound
140
what does X ray show in RA
soft tissue swelling | joint destruction
141
main drugs for rheumatoid arthritis?
DMARDS | biologics
142
which DMARDs for rheumatoid arthritis?
methotrexate leflunomide sulfasalazine *hydroxychloroquine if mild
143
what biologics for rheumatoid arthritis?
TNF blockers | rituximab
144
name 3 TNF blockers
adalimumab infliximab etanercept
145
complications of taking biologics for rheumatoid arthritis?
immunosuppression | reactivation of Hep B /C
146
apart from DMARDs and biologics, what else is the management of rheumatoid arthritis ?
``` MDT IM/IA steroids for flare ups NSAIDs + PPIs physio + OT manage CV risk and stop smoking ```
147
side effect of methotrexate?
pulmonary fibrosis
148
side effect of leflunomide?
peripheral neuropathy
149
side effect of sulfasalazine?
low sperm count | sulfasalazine sperm
150
3 general side effects of all DMARDs
mouth ulcers bone marrow suppression teratogenic
151
what actually is sarcoma
malignancy of mesenchymal origin i.e. anything thats not carcinoma (epithelial) e.g. leiomyo, rhabdomyo, lipo, fibro, angio, osteo, chondro
152
malignancy of mesenchymal origin = ?
sarcoma
153
4 SIGNS OF SARCOMA
lump >5cm lump increasing in size lump deep to fascia pain
154
lump >5cm lump increasing in size lump deep to fascia pain =?
= sarcoma
155
why CT thorax in all sarcomes?
common met is lung
156
which 5 cancers most commonly spread to bone
PB-KTL ``` prostate breast kidney thyroid lung ```
157
in adults, what bones does osteomyelitis affect? and in kids?
in kids - long bones adults- vertebrae (these are well vascularised ones)
158
symptoms of osteomyelitis?
dull pain fever/rigors swelling/erythema
159
what are the three ways infection can get to the bone for osteomyelitis
direct e.g. open fracture adjacent soft tissues e.g. DM ulcer haematogeneous e.g. TB bacteraemia
160
investigations for osteomyleitis?
MRI blood cultures bone biopsy w culture
161
treatment for osteomyleitis?
surgical debridement | IV Abx
162
is septic arthritis a M E D I C A L E M E R G E N C Y?
Yes mortality joint destruction in 24hrs
163
which organism tends to cause septic arthritis / osteomyelitis in intravenous drug users
pseudomonas
164
investigation for septic arthritis?
URGENT JOINT ASPIRATION | microscopy and culture of synovial fluid
165
name 3 differentials for septic arthritis
gout pseudogout reactive arthritis
166
what is treatment for septic arthritis?
IV Abx 3-6wks e.g. fluclox + rifampicin may need washout + immobilise
167
how do you prevent prosthetic joint infection?
peri op Abx and Abx cement in prosthesis | if bad might need exchange arthroplasty
168
which 4 muscles make up the rotator cuff?
supraspinatus, infraspinatus, teres minor, subscapularis
169
what are the commonest 4 causes of shoulder pain?
1) rotator cuff disorders 2) glenohumeral disorders 3) acromioclavicular disorders 4) referred neck pain!!
170
what causes glenohumeral disorders?
``` adhesive capsulitis (aka forzen shoulder) osteoarthritis of shoulder ```
171
what causes rotator cuff disorders?
subacromial impingement | rotator cuff tear
172
what causes acromioclavicular disorders?
trauma | osteoarthritis
173
pain on external rotation =
frozen shoulder aka adhesive capsulitis
174
adhesive capsulitis aka
frozen shoulder
175
scarf test =
acromioclavicular disorder | pain on cross body adduction
176
painful arc=
subacromial impingement (rotator cuff tendonitis)
177
can't put on your jacket, impaired external rotation. what shoulder pathology?
adhesive capsulitis aka frozen shoulder
178
rotator cuff TEAR is usually who
young ppl w trauma
179
painful arc is what
70-120 of abduction then deltoid takes over (not rotator cuff muscles) --> SUBACROMIAL IMPINGEMENT
180
more worrying causes of shoulder pain that arent rotator cuff, glenohumeral, acromioclavicular or referred neck pain include...
MI gallbladder / subphrenic abscess apical lung cancer polymyalgia rheumatica (friend of giant cell)
181
what scan is best for shoulder?
ultrasound!! x ray only if suspect arthritis / dislocation
182
if you suspect referred neck pain causing shoulder pain, what scan
x ray c spine
183
when you dislocate your shoulder which joint is it
glenohumeral joint

Rheumatology (1 decks)

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