Rheum Flashcards
(216 cards)
1
Q
general ix for vasculitis
A
urinalysi for hameturia and proteinuria
urea and creatinien for renal impairment
ANCA testing,
CXR
2
Q
cANCA target
A
serine proteinase
3
Q
pANCA target
A
myeloperoxidase
4
Q
pANCA associatd with
A
UC
5
Q
ANCA vascultiis think
A
renal impairment
resp symptoms
systemic symptooms
rash (only in minority )
ENT
6
Q
the 8 A’s of ank spond
A
apical fibrosis
anterior uveitis
aortic regurg
achiles tendonitis
AV node block
amyloidosis
ANd cauda equina
peripheral Arthritis (25% more common if femlae)
7
Q
ix in ank spond
A
inflammatory amrkers 0 although normal levesl do not exclude
HLA- B27 little use in making dx
xray - most useful
8
Q
xray in ank spond show
A
sacroilitis - subchondral erosions,slerosis
squaring of lumbar vertebrae
syndesmophytes of annulus fibrosus
cxr - apical fibrosis
9
Q
if xray is neg for ank spond but suspicition remains high do
A
MRI
10
Q
MRI would show bone marrow oedema at sacroiliac joints
A
11
Q
mx of ank spomd
A
exercise and NSAIDS
phsio
DMARDS are only useful if there is peropheral arthritis
ANTI tnf
12
Q
anti phodpholipid syndrome has a strong association with
A
SLE
13
Q
skin change in anti phospholipid
A
livedo reticualris
14
Q
anti phospholipid antibody
A
anticardiolipin
15
Q
paradoxically anti phospholipid syndrome causes
A
thrombocytopenia & prolonged APTT
16
Q
mx of antiphosplipid syndrome
A
not had a thrombosis = aspirin
had a thrombosis = lifelong warfarin with INR 2-3. if had recurrent events then INR = 3-4
preg or planning preg= low dose aspriin +LMWH
17
Q
DOACS for antiphosplipid sydnrome
A
NO^
18
Q
antisynthetase syndroeme
A
anti jo 1
myositis (muscle weakness of proximal muscles)
Interstitial lung diase
thickend hands
raynauds
19
Q
what test do before azathioprine
A
TPMT test (thiopurine methyltransferase)
20
Q
azathioprine & what have a significant interaction causing bone marrow suppresion
A
allopurinol
21
Q
is azathioprine safe in preg
A
yeah
22
Q
adverse affects of azathioprine
A
bone marrow suppression
pancreatitis
23
Q
classic triad of behcets
A
oral ulcers, genital ulcers, anterior uveitis
24
Q
behcets is inflammation of
A
arteries and veins
25
dx of behcets no definitive but pathergy test is suggestvie which is when you
puncture site follwoing needle prick becomes inflamed with smal pustule forming
26
adverse effects of bispohsphoantes
oesophagitis or ulcers (particualry alendroante)
osteonecrosis of jaw (substanially increased risk if IV for cancer mx)
poor dental hygiene is a rf for osteonecrosis of jaw so all cancer pts hsould be dental check up before biphosphoante therapy to assess osteonecrosis of jaw
increased risk of atypical stress fracture of proximal femoral shaft if taking aldendroante
hyocalcaemia ( usually clinically important)
27
taking bisphonate
sit or stand upright for 30mins after taking
28
Hypocalcemia/vitamin D deficiency should be corrected before giving bisphosphonates. However, when starting bisphosphonate treatment for osteoporosis, calcium should only be prescribed if dietary intake is inadequate. Vitamin D supplements are normally given.
29
most common benign bone tumour
osteochondroma, ( not osetoma!)
30
boney projesction on externa surface of a bone
osteochondroma
31
giant cell tumour of bone is a benign condition
epiphysis and xray shows double bubble or soap bubble appearance
32
osteoma most commonly occurs on
skull
33
osteosarcoma most commonly occur where
metaphyseal region of long bones prior to epiphyseal closure
34
xray of osteosarcoma
Codman triangle from periosteal elevation & sunburst pattern
35
mutation of what significantly increases risk of osteosarcoma
Rb gene hence association with retinoblastoma
36
blue cell tumour that xray shows onion skin appearnace
ewings sarcoma
37
chronic fatigue syndrome how long gone on for
3 months
38
what has dactylitis
psoriatic and reactive arthritis
39
denosumab can prevent what
pathological fractuers in adults with bone metastases
- it is a subcut injection
40
first line for osteoporosis
oral biphosphoantes, alendroante is first line
41
screenign for what if diangosed with dermatomyositis
malignancy
42
dermatomysoitis
photosenstivie
rash over abck and shoulder and heliotrope rash on face
gottrons papules- roungened red papules over extensor surfaces of fingers
extrememly dry and scaling hands
43
antibody associated with dermatomysoits
anti Jo 1
44
discoid lupus presents with
red raised rash that is sometimes scaly
mx is topcail steriod cream
45
does discoid lupus progress to SLE
rarely <5%
46
drug induced lupus what is ususally not seen
renal and nervous syem involvemet
47
what antibody is common in drug induced lupus
anti histone
48
drug induced lupus would have symptoms of
arthralgia, malar rash, pleurisy
49
cuases of drug induced lupus
procainamide
hydralazine
isoniazid
50
syyndrome that results in tissue being more elastic and joint hypermobility and increased elasticity of the skin
Ehlers danlos
51
ehlers danlos aminly affects what collagen
type3
52
elastic fragile skin and joint hypermobility
Ehlers danlos
53
fibrmyalgia tender at
11/18 points
54
gout flares
typically develop amximum intesity with 12hrs
55
if suspect gout
measure uric acid levels >360 supports dx if under then repeat in 2 weeks
56
what test do you do to see needle shaped negatively birefringent monosodium urate crystals under polarised light
synovial fluid analysis
57
radiological features of gout
joint efffusion is ealry sign
well defiend punched out erosion with sclertic margins
58
acute mx of gout
NSaids or colchicine +PPI
59
when should max dose of NSAIDS be prescribed
1-2 days after symptoms haev settled to prevent recurrence
60
main s/e with colchicine
diarrhoea.
it inhibits tubulin
slower osnet of action
61
mx of gout if nsaids/ colchicine not suffient
steriods or sterod injections
62
what to do with allopurinol if having gout attack
continue taking it
63
commence urate lwoerign therapy should be done when pt not in pain
Nsaids or colchcine should be started as cover when starting allopurinol
64
2nd line to allopurinol
febuxostat
65
lifestyle for gout
reduce alchol and avoid it during an attack
losw weight
avoid high purien foods
consider stopping thiazide
losartan may be good
increase vit C
66
Lesch Nyhan syndrome
only seen in boys with gout and other features eg renal or neurological stuff
67
HLA DQ2/8
coeliac
68
HLA DR4
type 1 diabetes and RA
69
why do you do bselin optho exam and annual screening if on hydroxychloroquine
bulls eye retinopathy can led to severe and permanent vision loss
70
hydroxycholorquine cna be used
if preg
71
atopy so asthma, eczema and hayfever as what hypersenstiivty
type 1
72
type 2
pernciious anaemia
rheuamti fever
73
post strep glomerulonephritis
type 3
74
type 4
tb, allergic contact dermatiis
MS
75
most common immunoglobulim
igG
76
immunoglubin predominat in breats milk
igA
77
IgE binds to
Fc receptors of mast cells and basophils
78
interderons respond to
viral infections and neoplasia
79
interderon beta
reduces freq of exacerbation in relapsing remitting MS
80
langerhan cells are specialsied
dendritic cells
81
tennis racket shaped Birceck granules
Langerhans cell histiocytosis
82
tennis elbow goes on for
6 month s-- 2years
83
mx of tennis elbow
avoid muscle laoding
simplae anagelsia
physio
steriod injection
84
defect in protein fibrillin 1
marfans
85
pectus excavatum (chest going inwards )
marfans and can get pes planus
86
heart issues in marfans
dialtion of aortic sinuses predisposes to aortic dissection
mitral valve prolapse
87
other s/e of marfans
pneumothoraces
lens dislcoation
dural ectasia
88
leading cause of death in marfans
aortic dissection
89
marfans need
regular echo to sceen for aortic disection adn beta blocker/acei therpay
90
Mcardles disase
msucle pain and stiffness following exercise
second wind phenomenon
occurs when patients experience an improvement in exercise tolerance after a brief rest or reduction in intensity
91
methotrexate inhibits
dihydroflate reductase
92
s/e of methotrexate
mucositis
myelosuppression
liver fibrosis - momitor LFTS
93
most common pulmonary manifestation from methotrexate
pneumonitis
94
woemn should avoid preg how long after stopping methotrexate
6 months and men use effective contraception for at least 6 months after treatment
95
methotrexate is taken how often
weekly
96
methotrextae should check FBC, U&Es and LFTs weekly until stabilised and then can monitor every 2-3 months
97
folic acid should be co prescribed with methotrexate but but should be taken
more than 24hrs after methotexate dose
98
99
avoid prescribing what with methotexate
trimethroprim or co trimoxazole and icnrease risk of marrow aplasia
100
what drug increases the risk of methotrextae toxicity
aspirin
101
treatment for methotrexate toxicity
folinic acid
102
RA typcially has
bilateral symptoms and systemic symptoms
103
xray findings in RA
Juxta articualr osteoporosis
Periarticualr erosions
Subluxation
(loss of joint space)
104
OA mx
strengthening exercise and general aerobic fitness
TOPICAL NSAIDS ARE FIRST LINE ANALGESICS
ORAL NSAIDS +PPI
steriod injections
105
con of steriod injection
only provide short term relief (2-10 weeks)
106
the other S in LOSS for OA
subchondral cyst
107
what is known as brittle bone disease
osteonegensis imperfecta
108
presents in childhood, fractures following minor trauma, blue scelra, deafness secodnary to otosclerosis
osteogenesis imperfecta
109
ca, phosphate, pth, ALP
usualy normal in ostenogensis imperfecta
110
bone pain and tenderness especially at femoral neck and proximal myoapthy may lead to a waddling gait
everyhting low but ALP &pTH raised
111
xray of ostemolacia shows
tanslucent bands
112
mx of osteomalacia
Vit D - laoding dose is often needed intiialy
113
if >75 and have fragility fracture presuemd to have osteoporosis so can start on biphosphoante without need for a DEXa
if <75 should get DEXA
use the results to do a FRAX assessment
114
Ra is a rf for
osteoproosis
115
osteoporosis in a man
check testosterone as deficiency can be a rf
116
full blood count
urea and electrolytes
liver function tests
bone profile
CRP
thyroid function tests
osteoporsis - may do myeloma screen
117
T score for DEXA is based on bone mass of young reference population
Z score is adjusted for
age gender and ethnic factos
118
T score of what suggests osteoporosis
<-2.5
-1-2.5 = osteopaenia
>-1 = normal
119
if getting steriods for a long time eg more than 3 months eg in polymyalgia rheuamtica
give bone proteiction straight away
120
mx of giving biphosphonate for if on steriods
> 65 and had frgility fracture yes
<65 do dexa - if less than 1.5 give it . if between 0-1.5 repeat scan in a couple years
121
general mx of osteoporosis
diet, alcohol, smoke, cal& vit D
121
what in women may be contributing to osteoporosis
HRT
122
what is first line treatmetn follwing a hip fracture
IV zoledronate yearly
123
what is generally used as a 2nd lien after biphosphonates
denosumab
124
post menopuasal women with symptoamtic fracture
no dexa just treat
125
prescribe biphosphonares for how long before reasessing fracture risk
5 yers
126
Denosumab
human monoclonal antibody that inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts
also used for cancer patients with bone metastases to reduce skeletal-related events.
given as a single subcutaneous injection every 6 months
127
FRAX assess
10 year risk of fragility fracture
128
dexa scan looks at
hip and lumbar spine
129
stereotypcial presentation of Pagets is
older amle with bone pain and isolated raised ALP
130
xray of Pagets show
osteolysis in early disease, mixed lytic/sclerotic later
skull + thickened vault, osteoporosis circumscripta
131
pagets disease terateed with
biphosphonate
132
The skull, spine/pelvis, and long bones of the lower extremities are most commonly affected.
pagets
133
what is associated with Hep B infection
polyartertis nodosa
134
polyarthtiris refers to
ifnlaammtion of 5 or more joints simultaneously within first 6 weeks of onset
135
tb can cause a
polyarthritis
136
polymyagia rheuamtica
muscle stiffness and raised inflammatory markers
137
PMR
rapid onset <1 month
weakness not consdiered a. symotom just stiffness
CK is normal
should respond dramatically to steriods
138
polymysosits
proximal muscle weakness associated with malignancy
139
ix for polymositis show
raised CK
raised LDH, ALt. AST
Anti Jo 1
140
mx of polymositis is high steriods that can be taperd but what may be used as a steriod sparing agent
azathioprine
141
calcium pyrophosphate dihydrate crystals
pseudogout
142
pseudo gout under 60 think
haemochromatosis, hyperparathyroidism,acromegaly
143
most commonly affected joints in pseduogout
knee, wrist adn shoulders
144
joint aspiration in pseudo gout
weakly pos rhomboid shaped crystals
145
xray of pseudo gout shoes
CHONDROCALCINOSIS (in knee can be seen as liner calcifications )
146
mx of pseduogout
aspirate joint fluid to exclude septic arthrit s
147
mx of pseudo gout
NSAids or steriods
148
in psoriatci arthrtiis what comes first arthritis or rash
arthirtis
149
what suggests psoriatic arthrits over RA
psoratic - DIP invovement
150
arthritis mutilans in psoaritic arthritis is
severe form of telescoping with fingers
151
psoriatic arthrtis also has
enthesitis, nail chnages eg pitting and onycholysis
152
xray in psoriatc arthritis can show
combo of erosions and new bone formation
pencil in cup
153
mx of psoriatic similar to RA
mild - nsaids
mode- seveee- methotrexate
biologics
154
sero pos menas it has
anti ccp and rheumatoid factor
155
most common secodnary cause of raynauds
scleroderma
156
all pts with suspected raynauds shold be
referred to secondary care
157
first lien CCB for raynauds
nifedipine
158
mx of reactive arthritis
NSAids, steriod injection
symptoms rarely last more than 12 months
159
reactive arthritis
cant pee
cant see
cant climb a tree
160
reactive arthrtis symptoms develop
within 4 weeks of inital infection and last around 4-6months
161
circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
reactive arthris
162
most common ocular complciation of RA
keratoconjucitivits sicca
163
RA + splenomegaly + low white cell count
Feltys
164
rheumatoid factor
IgM reacts with Fc of pts own IgG
165
what is the best test for detectign rhematoid facror
rose waaler test ( sheep red cell agglutination)
166
RF not a mrker of disease activity
167
anti CCP can be detectable up to
10 yers before development of RA
168
all pts with RA should get
xrays of hands and feet
169
initial mx of RA
methotexate +/- short course of bridging prednisolone
170
bloods need to do for methotrexate due to the risk of myelosupression and lvier cirrhosis
FBC & Lfts
171
hydroxychloroquine: should only be considered for initial therapy if mild or palindromic disease
172
DAS 28 for response to treatmetn
short course of bridging pred may be given initialy fro RA as DMARDS can take weeks to months to start
173
flares of RA mx
steriods
174
when do you start on TNF inhinitor for RA
inadequate resposne to at least 2 DMARDS including methoterxate
175
etanercept is an anti tnf but risk of
reactivation of TB
176
swan neck and boutonniere deformity are
late features of RA
177
relapsing/remitting monoarthritis of different large joints (palindromic rheumatism)
178
poor prognostic feature of RA
Anti CCP
179
Early x-ray findings
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation
RA
180
4 rotator cuff
supraspinatus
infraspinatus
subscarpulr
teres MINOR
181
which rotator cuff is most commonly injured
supraspinatus
182
most common organism overall is Staphylococcus aureus
in young adults who are sexually active, Neisseria gonorrhoeae is the most common organism (disseminated gonococcal infection)the most common cause is hematogenous spread
this may be from distant bacterial infections e.g. abscesses
in adults, the most common location is the knee
septic arthritis
183
synovial fluid of septic arthritis shows
leucocytosis with neutrophil predominance
184
do blod cultures in septic arthritis as the msot common cuase of septic arthritis is
haematogenous spread
185
septic arthrtisi fluxo for
4-6 weeks. typically switched to oral after 2 weeks
needle aspiration to decompress joint
lavage may be required
186
seroneg if
rhematoid factor neg
187
seroneg
ank spond
psoriatic arthrtiis
reactive arthrits
enteropathic arthrits (associated with IBD)
188
sjogrens affects
exocrine glands
189
pts with sjogrens have a marked increase risk of
lymphoid malignancy
190
anti ro and LA
sjogrens
191
schirmers test test tear foramtion in
sjogrens
192
mx of sjogrens
artificial saliva and teats
pilocarpine amy be helpful to stimulate saliva productoin
193
elevated serum ferritin, arthralgia
pink maculopapular rash = stills disease - nsaids
194
dont give sulfasalazine if
allergic to aspirin
can also reduce sperm count
195
In contrast to other DMARDs, sulfasalazine is considered safe to use in both pregnancy and breastfeeding.
196
SLE has what type sensitivity reaction
type 3
197
SLE
fever
mouth ulcers
malar rash spares naslobaila folds
discoid rash
arthraliga
resp, renal
198
msot common renal manifestation in SLE
diffuse proliferative glomerulonephritis
199
most common cardiac manifestation in SLE
pericardiit s
200
99% of SLE has ANA (low specificiy) what is highly specfici
anti dsDNA
201
Lymphopenia is common in SLE
202
what inflamamtory marker geenrally used for SLE
ESR, crp may be normal so riased CRP may indicate an underlying infection
C3,4 are low during active disease
anti dsDNA can be used for disease monitoring not note not present in all pts
203
mx of SLE
NSaids and suncream
Hydroxychloroquine is treatment of choice
if renal, neuro eye involved consider prednisolone
204
limited systemic sclerosis
raynauds may be first sin
affects face and distal limb smost
associated with anti centromere antibodies
subtype is CREST Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
205
diffuse scleroderma main affects
trunks and proximal limbs - anti scl-70 antibody
206
most common cuase of death in diffuse cutaneous sytemic sclerosis
resp involement
if got renal disase- acei - catopril is typically used
207
scleroderma
tighterning and fibrosis of skin
208
anti-scl-70 antibodies associated with diffuse cutaneous systemic sclerosis
associated with a higher risk of severe interstitial lung disease
209
headahce, jaw claudication
temporal arteriris
210
anterior ischemic optic neuropathy accounts for the majority of ocular complications. It results from occlusion of the posterior ciliary artery (a branch of the ophthalmic artery) → ischaemia of the optic nerve head. Fundoscopy typically shows a swollen pale disc and blurred margins
temporal arteriris
211
ix of temproal arteriis
inflammtory markers
temporal artery biopsy
CK normal
212
mx of temproal arteiris
steriods before temporal artery biopsy
213
if there is no visual loss then high-dose prednisolone is used
if there is evolving visual loss IV methylprednisolone is usually given prior to starting high-dose prednisolone
there should be a dramatic response, if not the diagnosis should be reconsidered
temporal arteritis
214
babies with formualr mulk dont need to take vit D
as forumla milk has it.
6months - 5 years should take vit D
215
