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Year 6 > Rheum > Flashcards

Rheum Flashcards

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1
Q

Ix for rheumatoid arthritis

A

Nodules
Abdo exam- organomegaly
Lower extremities- ulcers
Anti CCP
X ray

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2
Q

Treatment of RhA

A

If evidence of RhA

Start on DMARD (hydroxy, methotrexate, sulfalazine)
+/- short prednisolone

Flares- CS - pred

If DAS >5.10- consider stepping up management

Refer early arthritis clinic

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3
Q

Side effects of tx of RhA

A

Meth- hair loss, PF
HC- bull eye lesions
Sulf- oospermia

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4
Q

Order of tx in RhA

A

2 DMARDs then biologics

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5
Q

What do you need to check for when giving infliximab, etanercept and adalilumab

A

Screen TB
Chest X ray

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6
Q

Ix needed when on methotrexate

A

FBC, U&Es, LFT every 4 months

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7
Q

Signs and symptoms of psoriatic arthritis

A

Asymmetrical polyarthritis
Can affect spine

Nail changes
DIP affected
Can have skin changes but not always

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8
Q

Tx of psoriatic arthritis

A

Methotrexate

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9
Q

Sx of reactive arthritis

A

Anterior Uveitis
Urethritis
Arthritis
Kertoderma blenorragia
After STI or GI infection

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10
Q

Tx of reactive arthritis

A

NSAIDs, refer to rheum

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11
Q

Signs and symptoms of AS

A

Morning stiffness
Gradual onset
Pain at night
Sacroiliitis
Squaring of lumbar vertebrae

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

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12
Q

What hand sign do Seronegative arthritis have

A

Dactylitis

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13
Q

Sx of RhA

A

DIP spared- mainly MCP, PIP, wrist, knee
Nodules
Carpal tunnel
Ulcers, organomegaly

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14
Q

Sx of PR

A

Shoulder and hips- high ESR
Worse in mornings
Sore muscles
carpal tunnel
GCA

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15
Q

Tx of PR

A

Prednisilone 15mg OD
Continue until sx gone then tamper

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16
Q

What can temporal arteritis cause

A

Anterior Ischaemia optic neuropathy
White swollen optic disc

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17
Q

Tx of GCA

A

40-60mg pred, daily for 4 weeks, tapered over 6m- 1year

Methylprednisilone if eye affected

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18
Q

Sx of takayasu arteritis

A

Systemic features of a vasculitis e.g. malaise, headache
Unequal blood pressure in the upper limbs
carotid bruit and tenderness
absent or weak peripheral pulses
upper and lower limb claudication on exertion
aortic regurgitation (around 20%)

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19
Q

Ix and Tx of Takayasu Arteritis

A

MRA or CTA
Steroids

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20
Q

Sx of microscopic poly

A

pANCA
Fever
Muscle aches
Lung involvement
Renal
Skin lesions

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21
Q

ANCA positive vasculitides and sx

A

GPA- saddle shape nose, rhinos, epistaxis, LRT- haemoptysis, renal- nephritis
EGPA- asthma, RPGN
MP- pANCA, haemoptysis- Hep B

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22
Q

ANCA negative vasculitidies and sx

A

HSP- IgA vasculitis- rash, arthralgia, glomerulnephrtiis

Goodpastures- renal and lung involvement

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23
Q

Sx of dermatomyositis

A

From PNP syndrome
Gottrons papules over knuckles
Heliotrope on eyelids
Proximal Muscle weakness
ANA +- anti Jo

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24
Q

Sx of polymyositis

A

Proximal muscle weakness
Malignancy
May have raynauds and dysphagia

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25
Ix of polymyositis
Raised CK 1000s ALT and AST also raised EMG Anti-Jo Muscle biopsy
26
Diffuse Scleroderma sx
Scleroderma affects limbs and trunk Pulmonary fibrosis Scl70 + Hardening of the skin Cold peripheries
27
Limited Scl sx
CREST Pulmonary HTN- echo and ecg
28
Tx of diffuse sclerosis
Immunosuppression PPI for regurg ACEi for renal failure
29
Sx of behcets
Oral and genital Ulcers Anterior uveitis Mediterranean Increased risk of VTE
30
Sx of Sjogrens
Inflammmed parotids Dry Painful sex Arthralgia
31
Tx of sjogrens
Artificial tears Hydroxy- arthralgia
32
Tx of SLE
Hydroxychloroquinine- maintenance Falres- Prednisolone + Cyclophosphamide ACE if proteinuria
33
Ix of SLE
ANA- sensitive dsDNA- specific C3 and 4 low- during active disease
34
Ix of gout
Negative needle on aspiration Measure rate 2-4w after inflammation settles
35
Tx of gout
Acute- NSAIDs, colchicine- if low GFR- can cause diarrhoea Long term- allopurinol
36
Sx of pseudo gout
Larger joints Chondrocalcinosis Positive rhomboid
37
Osteoporosis Tx
Vit D and calcium Alendronate- weekly risedronate or etidronate if cannot tolerate alendronate
38
When to give bisphosphonates
T > -2.5 T > -1.5 and on steroids
39
Tx of polymyalgia rheumatic
Tx with steroids for 3 weeks If no improvement- consider alternate diagnosis
40
Tx of ankylosing spondylitis
Physio and NSAIDs whilst referred to rheum Then DMARDs such as sulphasalazine
41
OA vs psoriatic arthritis feel
Bony vs boggy
42
Antibody in limited sclerosis
Anti-centromere
43
Antibody in diffuse sclerosis
Anti-scl70
44
First line Ix of AS
X ray spine and pelvis
45
Sjogren syndrome sx
Enlarged parotids Dry mouth Dry eyes
46
Sjogren syndrome dx
ANA + Rh factor + Schirmers +
47
Gout vs pseudo gout
Gout- toe- negative needles Pseudo- positive rhomboids
48
Gout vs pseudo tx
Gout- NSAIDs, colchicine, pred if renal impair Pseudo- NSAIDS
49
APS features
Clots, livedo reticularis- lace like on skin of legs, miscarriage, low plt
50
APS dx
+ve blood test 2 occasions 12 weeks apart Anti cardiolipin, lupus anticoagulant APTT- wrongly prolonged in lab results Plt low
51
Prosthetic with extreme pain ix
Synovial aspiration for septic arthritis
52
Polyartiritis nodosa sx
Ulcerating skin Orchitis Renal failure Abdo pain Arthritis Hep B No lung No ANCA
53
Dx of polyartiritis nodosa
Biopsy of affected area
54
Dx of PR
ESR
55
PR vs myositis
Myositis causes weakness PR- pain and stiff
56
Tx of GCA
60mg pred Tapered over 1-2 years due to relapse
57
Disease RF for pseudogout
Haemachromatosis Wilsons Hyperparathyroid Acromegaly Low Mg, P
58
ECG changes in GPA
St elevation Myositis
59
Tx of raynauds
CCB
60
DAS scoring of RA
2.6- 3.2 low 3.2-5.1 moderate >5.1 high
61
Stool problems, painful lesions on shins and arthritis
Enteropathic arthritis
62
Seronegative arthropathies
PARE Psoriatic AS Reactive Enteropathic
63
RA features
MCP and wrist subluxation Swan neck deformity Boutonniere Ulnar deviation Z shaped thumb Atlanto-axial joint subluxation Carpal tunnel Tenosynovitis Anaemia Amyloidosis Nodules Raynauds Pneumonitis
64
Tx of non specific back pain
NSAIDs and PPI
65
Septic arthritis order of mx
Aspirate an culture Then iv abx
66
Myositis Ix
CK Then EMG Then muscle biopsy definitive diagnosis
67
pANCA and cANCA positive
Subactute bacterial endocarditis
68
Dx of herniated disc
Straight leg raise
69
Other SE of steroids
glaucoma Hyperglycaemia Insomnia Weight gain
70
Order of tests in GCA
ESR Biopsy
71
Gene of AS
HLA B27
72
Most important test to monitor with scleroderma
Renal function tests
73
SLE presentation
Fever Myalgia Arthritis Photosensitivty Discoid rash Raynauds Renal Neuro Ulcers Malar rash- spares nasolabial folds
74
Dx of SLE
ANA dsDNA Low complement
75
Headache, psychosis or fits in SLE and tx
Cerebral lupus Steroids and cycle/aza
76
Lupus GLN tx
Protein uria- ACEi Steroids and myco/cyclo usually nephrotic
77
Nerve roots weaknesses
L2- hip flexion L3- knee extension L4- knee extension, inversion, dorsiflexion L5- inversion, dorsiflexion S1- eversion, knee flexion
78
Behcets HLA
HLA B51
79
Felty syndrome
RA Splenomegaly Neutropaenia
80
What are patent with sjogrens predipososed to
Lymphoma
80
What are patent with sjogrens predipososed to
Lymphoma
81
Allopurinol in acute gout
If already on continue to take
82
Marfans defect
Fibrillin
83
If starting on long term steroids what do you do
Bisphosphonate, Vit D, calcium suppliments
84
X ray features of psoriatic arthritis
Pencil and cup Plantar spur Periarticular erosions with bone resorption
85
If GCA with evolving visual loss mx
IV methylprednisolone
86
Hydroxychoroquien SE
Retinopathy- bulls eye ring
87
Enteropathic arthritis HLA
HLA B27
88
Patients allergic to aspirin/cotrimox are usually allergic to
Sulfalazine
89
Sx of AS
Reduced chest expansion, lateral and forward flexion Uveitis- painful Achilles tendonitis
90
Schober test
AS if <5cm
91
Meralgia parasthetica nerve and sx
Lateral cutaneous nerve compression Parasthesia Less sensation
92
Still disease
Pyrexia - arises in afternoon Arthralgia Salmon pink rash Lymphadenopathy Hypotensive- can mimic sepsis Can have high ferritin and LFTs
93
When to give bone protection for steroids
If on >7.5 a day >3 months
94
If on methotrexate and in contact with varicella tx
Test AB, if neg VZIG
95
Diffuse vs limited sclerosis
Diffuse- proximal limb, trunk ILD- fibrosis, Pul HTN Limited- distal limb
96
APLS tx
Before VTE- aspirin After first VTE- Lifelong warfarin
97
Affects of tamoxifen on bones
Protective since agonist in the bones
98
RF of osteoporosis
Steroids, PPI, levothyroxine RhA Low BMI Smoking CKD
99
Osteoporosis of the hand sx
DIP affected Bouchards- proximal Herberdens- distal Squaring of thumbs
100
OA of hands tx
para and Topical NSAIDs first Oral NSAIDs, opioids, capsaicin cream and IA steroids next
101
Methotrexate SE
Mucositis Myelosuppression Pneumonitis- reticular shadowing on CXR Pul fibrosis Liver fibrosis
102
Methotrexate pneumonitis presentation
New dry cough, dyspnoea, fever reticular shadowing on CXr
103
Tx of RhA in pregnancy
Hydroxychloroquine
104
Causes of Raynauds
Vibrating tools Scleroderma RhA SLE Primary cause - bilateral
105
What predisposes you to azathioprine deficiency
TMPT deficiency
106
X ray of different arthritis
Septic- effusion Psoritatic- periarticular erosions and bone resorption OA- LOSS RhA- LESS- proximal joints Erosions, subluxation, soft tissue swelling
107
Medication for all housebound patients
Vit D
108
Pseudogout knee x ray
Chondrocalcinosis Visible cartilage on edges
109
Antibodies for demote/polymyositis
Anti Jo
110
Antibodies for sjorgrens
Anti Ro/La
111
If someone with SLE has high WCC, raised CRP and normal kidney function
Underlying infection As CRP usually normal in SLE, kidney function oddly derange too
112
Chronic fatigue syndrome Dx
Normal tests- FBC, ESR, U+E Sx persistent for 3 months
113
Presentation of osteomalacia
Bone pain proximal myopathy Waddling gait Low Vit D
114
X ray of AS
Subchondral erosions Sclerosis Squaring of vertebrae Syndesmophytes Ossification of supraspinous ligament
115
Signs of Pagets on X ray
Osteolysis in early disease → mixed lytic/sclerotic lesions later skull x-ray: thickened vault, osteoporosis circumscripta
116
Tx of Pagets
Bisphosphonates Oral risedronate
117
Signs of psoas abcess
Hip extension Fever
118
Meds you can take for SLE in pregnancy
Azathioprine
119
Poor prognosis of RhA
RhF or anti CCP positive Early erosions Nodules Insidious onset
120
When to give Anti TNFa for AS
After failed 2 NSAIDs and has active disease on 2 occasions 12 weeks apart
121
What should you correct before giving BP
Vit D and calcium
122
What suggests primary raynauds rather than secondary
<40 Bilateral
123
Infective flexor tenosynovitis sx
Fixed flexion, tenderness, pain on passsive extension
124
If IVDU presents with discitis what other ix should you do
Echo- since IE can cause discitis
125
Rheumatoid arthritis joint aspiration
Yellow High PMN No crystals
126
Extra articular sx of RhA
Multisystemic effect- unwell, fevers, fatigue Haem- anaemia, splenomegaly- felty , amyloid- kidneys Derm- nodules Opthalmic- dry eyes (keratoconjunctivitis sicc) Pleural- nodules, fibrosis Pericardial- IHD Increased risk of neck breaks- due to Atlanto-axial subluxation
127
Drug induced lupus causes
Hydralazine PIMP Procainimide Isoniazid Minocycline Phenytoin
128
Tx of Stills disease
NSAIDs After 1 week no improvement- steroids
129
What should you monitor with HSP
BP and urine dipstick
130
OP and osteopenia on DEXA
-1 to -2.5 is osteopenia OP >-2.5
131
Type of deposits in pseudo gout
calcium pyrophosphate dihydrate crystals
132
Osteoarthritis tx
Oral paracetamol or topical NSAID (only for hands or knee) Then oral NSAIDs with PPI
133
Azathioprine SE
BM suppression N+V Pancreatitis
134
What should you co prescribe with methotrexate
Folate for myelosuppression
135
Organism of septic arthritis in young sexually active people
Gonorrheoa
136
X ray of AS
Subchondral erosions Sclerosis Squaring of lumbar vertebrae
137
Immune hypersensitivity reactions
1- immediate 2- AB against antigen- graves 3- deposition- SLE 4- delayed
138
What do you need to do before surgery for RHA patietn
AP and lateral neck X rays

Year 6 (28 decks)

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