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1. 4th year > Rheumatology > Flashcards

Rheumatology Flashcards

(150 cards)

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1
Q

pain pattern of osteoarthritis

A

worse on activity
worse at the end of the day
relieved by rest
morning stiffness <30 mins and inactivity gelling

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2
Q

ix osteoarthritis

A

Xray

  • loss of joint space
  • osteophytes
  • subchondral sclerosis
  • subchondral cysts
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3
Q

non pharm treatment osteoarthritis

A

weight loss
exercise
physio
walking aids

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4
Q

1st line treatment osteoarthritis

A

1st line paracetamol + topical NSAID

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5
Q

2nd line treatment osteoarthritis

A 
oral NSAID + PPI
opioids
capsaicin cream
intra-articular steroid
arthroplasty
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6
Q

is rheumatoid arthritis symmetrical or asymmetrical

A

symmetrical

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7
Q

pain pattern of rheumatoid arthritis

A

pain worse in the morning
pain better with activity and worse with rest
substantial morning stiffness, lasting hours, wears off with movement

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8
Q

main joints affected in rheumatoid arthritis

A

small joints of hands and feet - MCP and PIP

NOT DIP

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9
Q

what is felty’s syndrome

A

rheumatoid arthritis
splenomegaly
neutropenia

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10
Q

ix rheumatoid arthritis

A

xray
serology
usually clinical diagnosis

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11
Q

xray of rheumatoid arthritis

A

periarticular osteopenia
soft tissue swelling
reduced joint space
periarticular erosions

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12
Q

serology of rheumatoid arthritis

A

RF
more specific - Anti CCP (anti-cyclic cirtullinated peptide antibody)
thrombocytosis and moderate neurotrophilia

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13
Q

1st line ix for rheumatoid arthritis

A

RF

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14
Q

1st line treatment rheumatoid arthritis

A

DMARD monotherapy +/- short course of prednisolone

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15
Q

first line DMARD in rheumatoid arthritis

A

methotrexate

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16
Q

what needs to be monitored regularly with methotrexate

A

LFTs
FBC
U+E

before treatment and every 2-3 months

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17
Q

treatment of rheumatoid arthritis if inadequate response to 2 DMARDs, one of which was methotrexate. and a high DAS28 > 5.1

A

anti-TNF e.g. etanercept, infliximab, adalimumab

co-prescribed with methotrexate

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18
Q

tx flare of rheumatoid arthritis

A

steroids

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19
Q

monitoring rheumatoid arthritis

A

DAS28 and CRP

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20
Q

tx palindromic rheumatoid arthritis

A

hydroxychloroquine

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21
Q

important side effect of hydroxychloroquine

A

retinopathy - baseline ophthalmology examination and annual screening required

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22
Q

pain pattern of ank spond

A

progressive lower back pain
radiates to bum
marked morning stiffness and improves with exercise, better throughout the day
pain at night

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23
Q

1st line ix in ank spond

A

plain X ray of SI joints

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24
Q

ix if xray negative for ank spond but high suspicion

A

MRI

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25
1st line tx ank spond
NSAIDs | encourage regular exercise e.g. swimming
26
tx peripheral joint disease in ank spond
sulfasalazine
27
tx non-responsive pain and stiffness in ank spond
anti-TNF
28
nail changes seen in psoriatic arthritis
pitting onycholysis subungal hyperkeratosis
29
ix psoriatic arthritis
Xray | - pencil in cup
30
tx mild peripheral psoriatic arthritis
NSAIDs
31
tx progressive psoriatic arthritis
methotrexate anti-TNF if no response ustekinumab, secukinumab
32
when is reactive arthritis seen
1-4 weeks after infection usually gastroenteritis or STI
33
most common site of reactive arthritis
knee
34
ix reactive arthritis
joint aspirate to rule out septic arthritis | STI test
35
tx reactive arthritis
self limiting rest and NSAIDs steroids if needed
36
lifestyle factors that increase change of gout
alcohol red meat, kidney liver oily fish lose weight stop thiazides
37
most common joint in gout
1st MTP
38
ix for gout
blood urate levels checked once episode has settled joint aspiration with polarised light microscopy - needle shaped negatively birefringent crystals (also checked for septic arthritis) Xray
39
tx acute gout 1st line
NSAID
40
2nd line acute gout treatment if NSAID not tolerated
colchicine
41
3rd line acute gout treatment
steroids
42
1st line urate lowering therapy after 1st attack of gout
allopurinol - don't start during acute flare but if already taking then continue through flare
43
2nd line urate lowering therapy gout
febuxostat
44
precribing urate lowering therapy key points
start 2-4 weeks after acute attack | when starting, give cover with colchicine as risk of acute attack
45
what drug can allopurinol not be given with
azathioprine
46
joint aspirate of pseudogout
positively birefringent rhomboid shaped crystals
47
joints often affected in pseudogout
knee wrist shoulder
48
xray of pseudogout
chondrocalcinosis
49
tx pseudogout
1st line - NSAIDs +/- steroids 2nd line - colchicine 3rd - steroids no prophylactic treatment
50
type of hypersensitivity in SLE
3
51
rash of SLE
malar rash that spares the nasolabial folds | photosensitivity
52
ix SLE
urinalysis - look for glomerulonephritis bloods - FBC, U+E, ESR immunology BP and cholesterol (CVD risk)
53
immunology of SLE
Anti-ANA (sensitive not specific) RF Anti-dsDNA (specific) Anti-smith (Sm) (specific) (can also see anti-Ro, Anti-La and anti-RNP)
54
markers of disease activity of SLE
anti-DsDNA complement - inversely
55
tx SLE mild skin disease and arthralgia
hydroxychloroquine Nsaids, topical steroids
56
tx moderate SLE
immunosuppression - methotrexate, azathoiprine, mycophenolate oral steroids
57
tx SLE severe organ disease
IV prednisolone and cyclophosphamide
58
tx SLE unresponsive cases
IV immunoglobulin and rituximab
59
flare of SLE
steroids
60
most common cause of drug induced lupus
hydralazine
61
thrombocytopenia is seen in most connective tissue diseases except _____ which shows thrombocytosis
thrombocytopenia seen in most e.g. SLE, APLS thrombocytosis seen in rheumatoid arthritis
62
platelet count and APTT in anti-phospholipid syndrome
thrombocytopenia | rise in APTT
63
diagnosis of anti-phospholipid syndrome
positive immunology on 2 occasions 12 weeks apart
64
immunology of anti-phospholipid syndrome
anti-cardiolipin lupus anticoagulation test anti-beta-2 glycoprotein
65
primary prophylaxis in anti-phospholipid syndrome
low dose aspirin | - if aspirin CI then clopidogrel
66
tx anti-phospholipid syndrome after a VTE or arterial thrombosis
life long warfarin
67
tx of anti-phospholipid syndrome if VTE happens while already on warfarin
warfarin + low dose aspirin
68
tx anti-phospholipid syndrome between pregnancy/planning pregnancy
aspirin
69
tx anti-phospholipid syndrome during pregnancy
aspirin when confirmed on urine test | LMWH when FHB detected
70
cancer associated with sjogrens
lymphoma
71
dx sjogrens
schirmer's immunology gland biopssy - focal lymphocytic infiltration
72
immunology of sjogrens
``` Anti Ro Anti La hypergammaglobulinaemia low C4 RF ANA ```
73
tx sjogrens
eye drops artificial saliva pilocarpine arthralgia and fatigue - hydroxychloroquine, NSAID
74
what should be considered in any middle-aged patient presenting with new onset raynauds
systemic sclerosis
75
immunology of systemic sclerosis
ANA RF limited - anti-centromere diffuse - anti-SCL 70
76
s/s limited systemic sclerosis
CREST + P ``` calcinosis raynauds esophageal dysmotility sclerodactyly - face and distal limbs telangiectasia ```
77
s/s diffuse systemic sclerosis
same as limited but with involvement of organs and skin involves trunk and proximal limbs
78
tx systemic sclerosis
``` PHTN - bosentan raynauds - CCB, iloprost, bosentan renal - ACEI GI - PPI ILD - cyclophosphamide ```
79
monitoring in systemic sclerosis
annual ECHO chest CT BP control
80
what is mixed connective tissue disease
features of SLE, systemic sclerosis and polymyositis
81
immunology of mixed connective tissue disease
anti RNP
82
tx mixed connective tissue disease
significant disease - immunosuppression raynauds - CCB annual echo and PFTs
83
presentation of polymyosistis/dermatomyosis
symmetrical proximal muscle weakness usually of girdles that presents with difficulties of ADL dermatomyositis has skin involvement
84
3 skin manifestations of dermatomyositis
gottrons - scaly rough pink papules over knuckles heliotropic rash - lilac rash around eyes shawl sign - macular rash over back and shoulders
85
most common systemic manifestation of polymyosistis
interstitial lung disease - SOB
86
what cancers are at an increased risk in polymyosistis/dermato
``` breast ovarian lung bladder bowel ```
87
bloods of polymyosistis/dermatomyositis
``` very elevated CK anti jo1 anti SRP ANA anti-RNP ```
88
ix of polymyosistis/dermatomyositis
CK immunology EMG - abnormal biopsy - diagnostic
89
muscle biopsy of polymyosistis/dermatomyositis
perivascular inflammation and muscle necrosis
90
tx polymyosistis/dermatomyositis
malignancy screening prednisolone (initially 40mg) + immunosuppresion e.g. azathioprine/methotrexate
91
disease similar to polymyosistis/dermatomyositis but more common in men and weakness tends to be asymmetrical and affect distal or proximal muscle groups
inclusion body myositis
92
presentation of PMR
proximal myalgia of hip and shoulder girdles | morning stiffness > 1 hour, symptoms improve as day goes on
93
key difference in PMR and polymyositis
PMR - pain predominant | polymyositis - weakness predominant
94
CK and EMG of PMR
both normal
95
bloods of PMR
raised CRP and ESR | ESR
96
tx PMR
15mg oral prednisolone and gradually reduce over 18 months
97
tx PMR if associated with GCA
40-60mg prednisolone
98
what investigation is key in PMR
vision testing
99
key features of GCA
``` rapid onset visual disturbance headache jaw claudication scalp tenderness ```
100
diagnostic test of GCA
temporal artery biopsy ASAP - 100% specificity if positive but not very sensitive due to patchy involvement
101
tx GCA with visual involvement
60mg
102
tx GCA if no visual involvement
40mg
103
when should treatment of GCA be started
as soon as suspected, do not wait for biopsy | taper off over 2 years
104
key ix in vasculitis
urinalysis
105
2 examples of large vessel vasculitis
GCA | Takayasu
106
2 examples of medium vessel vasculitis
polyarteritis nodosa | kawasaki
107
3 examples of small vessel vasculitis
GPA eGPA microscopic polyangitis
108
Anti PR3
GPA
109
anti MPO
eGPA
110
ESR and CRP in vasculitis
raised
111
tx large vessel vasculitis
40-60mg prednisolone and gradually reduce | may + methotrexate, azathoprine
112
necrotising inflammation leading to aneurysm formation that occurs in middle aged med and is associated with Hep B
polyarteritis nodosa
113
s/s kawasaki
children high grade fever resistant to antipyretics conjunctival injection bright red cracked lips strawberry tongue red palms of hands and soles which later peel
114
tx kawasaki
high dose aspirin + IV immunoglobulin
115
screening in kawasaki
Echo - coronary artery aneurysms
116
where does GPA affect
upper and lower resp tract | kidneys
117
s/s GPA
chronic sinusitis, nasal crusting, saddle nose nose bleeds cough and haemoptysis, SOB, cavitating opacities on XR deaf, rash, joint pain haematuria and proteinuria
118
what kind of kidney disease does GPA cause
Rapidly progressive glomerulonephritis - nephritic syndrome
119
immunology of GPA
cANCA | PR3
120
urinalysis and renal biopsy of GPA
nephritic syndrome | epithelial crescents in Bowman's capsule
121
tx GPA initially
high dose steroids which are tapered off while other drugs start to work
122
tx GPA major organ involvment
cyclophosphamide - once remission induced by this treatment can be maintained with methotrexate or azathioprine
123
tx GPA mild disease
methotrexate / azathioprine - less toxic than cyclophosphamide rituximab
124
s/s EGPA
late onset asthma | sinusitis
125
bloods of EGPA
eosinophilia pANCA MPO
126
immunology of MPA
pANCO | MPO
127
what kind of kidney disease does MPA cause
rapidly progressive glomerulonephritis
128
vasculitis general mangement - localised disease. early systemic
steroids + methotrexate/azathioprine
129
vasculitis general mangement generalised
cyclophosphamide + steroids plasma exchange then azathioprine
130
vasculitis general mangement refractory
rituximab | IV immunoglobulin
131
vasculitis general mangement aggressive disease course
IV steroids and cyclophosphamide
132
is azathioprine safe in pregnancy
yes
133
what needs checked before starting azathioprine
TMPT levels
134
describe HSP
child with joint pain and purpuric rash over buttocks and lower limbs a few weeks after an URTI
135
immunology of HSP
IgA mediated
136
what needs monitored following HSP
BP and urinalysis
137
triad of behcets
oral ulcers genital ulcers anterior uveitis
138
dx of behcets
clinical | Pathergy test
139
tx behcets
steroids or DMARD or rituximab
140
tx raynauds
CCB - nifedipine 1st line IV prostacyclin
141
tx chronic fatigue / fibromyalgia
CBT | graded exercise programme
142
inheritance ehlers danlos
AD
143
inheritance marfans
AD
144
how often is methotrexate taken
weekly
145
what should be coprescirbed with methotrexate
folic acid 5mg once weekly take > 24 hours after methotrexate dose
146
what drugs should never be prescribed with methotrexate
trimethoprim | co-trimoxazole
147
can hydroxychloroquine be used in pregnancy
yes
148
ix if bleeding / infection occurs in someone taking azathioprine
FBC
149
is sulfasalazine safe in pregnancy
yes and in breast feeding
150
when are NSAIDs CI in pregnancy
3rd trimester --> cardiac malformation

1. 4th year (23 decks)

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