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Phase 2A (HV) > Miscellaneous- Rheum > Flashcards

Miscellaneous- Rheum Flashcards

(113 cards)

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1
Q

What is OA

A

Is a non inflammatory degenerative joint pain characterised by the deterioration of articulate cartilage and new bone formation

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2
Q

List 5 symptoms of OA

A 
Joint stiffness 
Joint pain - associated w/ activity 
Bone enlargements 
Crepitus 
Restricted range of motion
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3
Q

What joints are affected in OA

A

PIP
DIP
Carpometacarpal joint

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4
Q

What signs of OA

A

Heberdens nodes- DIP
Bouchard nodes- Pip
squaring of carpometacarpal oint

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5
Q

Signs on X-ray in OA

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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6
Q

Tx for OA

A

Cx- lose weight, exercise, braces, physio/occupational therapy

Rx- oral paracetamol/topical NSAIDs— NSAIDS

Sx- osteotomy, arthroplasty, arthroscopy, fusion of joints

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7
Q

What is RA

A

Inflammatory autoimmune condition of synovial joints

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8
Q

What joints affected in RA

A

MTP
MCP
PIP

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9
Q

What scoring system is used to assess for the severity of RA

A

DAS28

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10
Q

What are the signs/Sx of RA

A 
Early morning stiffness 
Pain eases with use 
Fatigue 
Extra-articular involvement- nodules, pleural effusions, episcleritis, amyloidosis, carpal tunnel 
Symmetrical, deforming polyartropathy
Joint swelling
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11
Q

What signs of RA can be seen on X-ray

A

Loss of joint space
Erosions (periatricular)
Soft tissue swelling
Soft bones (osteopenia)

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12
Q

What is RF

A

Ab against the FC potion of IgG

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13
Q

What is the tx for RA

A 
Regular NSAIDs
During flares- corticosteroids 
Remission- 1st line- DMARD monotherapy
			   2nd line- dual DMARD
				3rd line- methotrexate + TNF inhibitor 
4th- methotrexate and rituximab
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14
Q

What are the signs seen on hands of RA

A

Boutonnières deformity
Swan neck (he pip, flexed dip)
Z thumb
Ulnar deviation

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15
Q

Se of methotrexate

A

Pulmonary fibrosis

Teratogenic

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16
Q

What drug inhibits xanthine oxidase

A

Allopurinolol

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17
Q

List 3 causes of gout

A

Increase consumption of purines- shellfish, anchovies, red meat
Increased production of purines- high fructose syrup contains beverages
Decrease uric acid clearance- CKD
Increased production of uric acid- drugs
Tumour lysis syndrome

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18
Q

What is the cycle to form mono sodium urate

A

Hypoxanthine- xanthine- uric acid- mono sodium urate

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19
Q

Sx and signs of gout

A

Acute swollen hot painful joint
Tophi- on ear, dip elbows, toe
Joints stiffness

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20
Q

Tx for acute flare of gout

A

NSAIDs or colchicine

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21
Q

Tx for lowering urate

A

Allopurinolol + lifestyle changes

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22
Q

Rf for OA

A 
Female
Increasing age
Trauma bone 
Early menopause
FHx 
Obesity
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23
Q

Rf for gout

A 
Male
Obesity
High purine diet
FHx 
Diuretics
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24
Q

Ix for gout

A

Joint aspirate with fluid analysis- needle shaped mono sodium urate crystals negatively birefringent under polarised light

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25
What changes may be seen on X-ray in person suffering form pseudo gout
Chondrocalcinosis
26
What joints mostly affected in pseudo gout
Knee Shoulder Wrist
27
Tx for pseudo gout
NSAIDS | Or intramuscular/intrartiuclr/ oral steroids
28
What diseases is pseudo gout associated with
Haemochromotosis Hyperparathyroidism Wilson’s Low magnesium and low phosphate
29
What is osteoporosis
A systemic skeletal disease characterised by low bone mass and microarchitectural deterioration therefore increase in bone fragility and susceptibility to fractures
30
List three endocrine disease that contribute to osteoporosis
Cushings Hyperthyroidism Hyperparathyroidism Male hypogonadism
31
Rf for osteoporosis
``` Increase age Previous fracture Corticosteroid use Smoking Excess alcohol FHx ```
32
What abnormal finding can be found in cross section of bone in osteoporosis
Fewer trabecular in spongy bone Thinning of cortical bone Widening Haversian canals
33
Gs Ix for osteoporosis and results
Dexa scan- t score of -2.5 or less
34
What 2 areas are commonly affected in osteoporosis that the dexa scan focuses on
Lumbar spine | Hip
35
What is a t score
Standard deviation that is compared to gender matched young adult mean
36
What criteria are listed in the FRAX assessment tool
``` Sex Weight Height Previous fracture Corticosteroid use Current smoking Parent fractured hip Alcohol ```
37
Other than dexa scan what other Ix can be done in osteoporosis
``` X-ray of wrist, spine, hip- of fracture suspected MRI spine Bone profile- calcium, phosphate, alp Vit d levels TFTs ```
38
Tx for osteoporosis
Rx- lifestyle advise (stop smoking, diet, regular exercise) 1st line Rx- bisphosphoneates + vit d and calcium Desonumab HRT Teriparatide
39
5 sx of a ankylosing spondylitis
``` Back pain Buttock pain Uveitis Enthesis Weight loss Fatigue Lower back stiffness Sleep disturbances ```
40
What clinical test can be done to aid diagnosis of ank spon
Schrobers test- <20cms
41
1st line Ix in ank spon
Pelvic/back X-ray Other- Inflamma markers/Hal b27/ mri
42
What X-ray changes can be seen in ank spon
Syndesmophytes (bamboo spine) | Sacroilitis
43
Tx for ank spon
Encourage exercise 1st line- NSAIDs Intra-articulate corticosteroid injection DMARDs
44
Sx and signs of psoriatic arthritis
Symmetrical Dactylitis History of Psoriasis- pink scaly patches Onycholisis/ nail pitting Pain swelling and stiffness of affected joints
45
What joint is mostly affected in psoriatic arthritis
Dip
46
What X-ray sing is seen in psoriatic arthritis
Pencil in cup
47
Tx for psoriatic arthritis
Mild- NSAIDs Severe cases- DMARDS anti TNF Ustekinumab and seckinimab
48
What is reactive arthritis
An inflammatory seronegative spondylarthropathy that occurs after exposure to GI or GU infections
49
What GU and GI infections are commonly associated with reactive arthritis
GU- chlamydia | GI- salmonella, shigella
50
What triad of Sx is seen in reactive arthritis
Conjunctivitis Urethritis Arthritis
51
What rash is commonly associated with reactive arthritis
Keratoderma blennorhagia- waxy Paiutes on palms and soles
52
1st line tx for reactive arthritis
NSAIDs 2nd line- corticosteroids Recurrent cases- DMARDs
53
What is septic arthritis
Infection of 1 or more joints
54
What is the most common organism in septic arthritis in following groups A- young sexually actively adults B- prosthetic joints C- IVDU
A- neisseria gonorrhoea B- staph epidermisdis C- pseudomonas aureginosa
55
Ix for septic arthritis
Joint aspiration and synovial fluid analysis Or Blood cultures Joint imaging
56
Tx for septic arthritis
IV antibiotics- usually flucloxacillin or clindamycin Joint washout Analgesia
57
Which way can osteomyelitis infection occur
Through hamategenous spread | Or contagious spread (nearby tissue, trauma, surgical induction)
58
What is osteomyelitis and what joints are affected in A- children B- older adults
Osteomyelitis is infection of bone +/- bone marrow A- long bones B- vertebrae
59
What investigations would occur in osteomyelitis
Blood tests- high wccc and high inflammatory markers Bone biopsy X-ray- changes seen 2 weeks after contracting osteomyelitis
60
Tx for osteomyelitis
Abx- flucloxacillin | Surgical debriedment
61
List 5 Sx of SLE
``` Photosensitive malar rash sparing nasolabial folds Fever Oral ulcers Raynauds Arthralgia Fatigue ```
62
Name extra manifestations of SLE
Pericarditis Glomerulonephritis Arthralgia Anxiety depression
63
What antibody is most sensitive in SLE
ANA
64
What Ab is most specific to SLE
Anti dsDNA
65
Triggers for flares in SLE
Oestrogen containing contraception Overexposure to sunlight Stress Infections
66
Tx for SLE
NSAIDs and hydroxychloroquine are the mainstay of SLE treatment and may be sufficient for mild disease alone ± short courses of corticosteroids for flares. More prominent organ involvement may require long-term corticosteroids, usually in combination with a DMARD as a 'steroid sparing agent' to reduce the steroid dose. Severe flares causing serious renal, neurological or haematological effects may require high dose corticosteroids in combination with immunosuppressants. Cyclophosphamide is effective and is the usual choice.
67
Epidemiology SLE
``` Affects women (9:1) Moser common in Afro Caribbean and Asian communities ```
68
What Ab are associated with anti-phospholipid syndrome
``` Anti cardiolipin (also present in syphylis- can cause false positive for syph) Anti beta2 glycoprotein 1 Ab ```
69
1st line tx for antiphospholipid syndrome
Lmwh- dalteparin
70
List 5 sx of dermatomyositis
``` Groton lesions- scaly patches on knuckles, elbows, knees Periorbital oedema Heliotrope rash Photosensitive malar rash- shawl like Malar rash on face Bilateral muscle weakness Dyspnoea ```
71
What investigations would you do in dematomyositis
Serum creatinine kinase EMG Serum aldolase Autoantibodies Muscle biopsy- gold standard
72
What antibodies associate with A) dermatomyositis B) polymyositis
A) anti- mi2 antibodies and anti jo-1 and ANA | B)anti jo-1
73
1st line tx for dermatomyositis
Corticosteroids (methyprednisalone)+ IVIG immunosuppressants- azathioprine Rituximab
74
What antibodies associate with limited scleroderma
Anti centromere
75
What autoantibodies associated with diffuse scleroderma
Anti scl-70
76
Features of limited systemic sclerosis
``` Cakcinosis Raynaud’s phenomenon Esophageal dysmotility- GORD sclerodactyly- bright shiny skin on hands and feet Telangiecstasia ``` Skin fibrosis limited to hands, forearms feet and legs, head and neck
77
Features of diffuse systemic sclerosis
``` Loss of normal skin creases Restricted mouth opening Arthralgia Features in history and examination Family history of systemic sclerosis Raynaud's phenomenon Digital pits or ulcers that can be painful and lead to functional disability Skin thickening, sclerodactyly and loss of function of the hands Telangiectasia ```
78
What is the treatment for raynauds
Nifedipine- Ccb
79
What medication is contraindicated in raynauds
Beta blockers
80
What is the most common benign tumour of the bone
Osteochondroma
81
What cells does an osteosarcoma arise from and who is it most common in
Osteoblasts Adolescents
82
What bone b]cancer most commonly involves chromosomes translocation t(11:22)
Ewing’s sarcoma (Onion skin like on X-ray)
83
What bone cancer affects the elderly
Chondrosarcoma
84
Tx for fibromyalgia
Medicine, such as antidepressants and painkillers Talking therapies, such as cognitive behavioural therapy (CBT) and counselling Lifestyle changes, such as exercise programmes and relaxation techniques
85
What is sicca syndrome
When sjorgen syndrome occurs primarily
86
Sx for sjorgens
``` Dry eyes Dry mouth Vaginal dryness Burning mouth Arthralgia Raynauds ```
87
What antibodies associated with sjorgen
Anti ro and anti la
88
What drug is used to halt the disease progression in sjorgens
Hydroxychloroquine
89
What is GCA
A granulomatous vasculitis of large and medium sized arteries
90
Sx of gca
``` Scalp tenderness Headaches Vision loss Malaise jaw claudictaion ```
91
1st line Ix for gca
Raised esr
92
Tx for gca
Corticosteroids
93
What is Wegners granulamatosis
A vasculitis affecting the small vessels typically resp tract and kidneys
94
Sx and signs of GPA
``` Saddle Shaped nose Nose bleeds Sinusitis Haemotysis Cough Glomerulonephritis Low urine production B symptoms ```
95
Is gpa canca and panca
CANCA
96
Tx for wegners
COticosteroids + cyclophosphamide
97
What is poyarteritis nodosa associated with
Hep b
98
What is osteomalacia
A metabolic bone disease characterised by incomplete mineralisation of osteoid following growth
99
Sx of osteomalacia
``` Waddling gait Bone pain Knock knees Bowing of legs Skull softening ```
100
List 5 causes of osteomalacia
``` Vit d deficiency Malabsorbtion CKD Renal tubular acidosis Drugs- phenytoin or carbamazepine Cadmium positioning ```
101
What are the biochemical and radiological finding so osteomalacia
Low calcium Low phosphate High alp High pth X-ray- looser lines whic are lucines going part way through bone
102
What is Padgett disease of bone
Disorder characterised by focal areas of increased bone remodelling resulting in poorly organised bone
103
Sx of Padgett
``` Bowing of femur or tibia Bone fractures Hearing loss Frontal bossing Facial pain ```
104
Skull X-ray in Padgett
Cotton wool appearance
105
Chemical finding in Padgett
High alp | Normal calcium and phosphate
106
Tx for Padgett
Bisphosphonates + calcium and vit d And analgesia
107
Mutation present in marfans
Defect in fibrillin 1 protein
108
How does fibrillin regulate growth
Fibrillin sequesters TGF-BETA which stimulates growth
109
What defect causes Ehlers danlos
Affects type 3 collagen (found in liver, bone marrow, spleen, arteries and uterus)
110
What is the mode of inheritance in marfans and Ed
Autosomal dominant
111
What is feltys syndrome
Rare variant of RA Triad of RA, Splenomegaly and neutropenia Management is DMARD + corticosteroids (+anti TNF) Should be vaccinated against influenza and pneumococcus
112
What is Behçet’s disease
Uveitis Erythema nodosum Recurrent mouth and genital ulcers
113
What is takayasu arteritis
Takayasu's arteritis is a chronic granulomatous vasculitis affecting large arteries: primarily the aorta and its main branches.

Phase 2A (HV) (13 decks)

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