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Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Osteoarthritis Xray findings

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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2
Q

Osteoarthritis presentation

A

Large, weight-bearing joints affected
Pain is worse on movement
Stiffness on rest
Bone swellings in fingers

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3
Q

Osteoarthritis hand joints affected

A

Proximal interphalangeal joint: Bouchard’s nodes
Distal interphalangeal joint: Heberden’s nodes

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4
Q

Management of osteoarthritis

A

1st: Analgesia
Paracetamol/topical NSAIDs
Codeine/oral NSAIDs (+PPI)

2nd: Corticosteroid injections injections

Joint replacement

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5
Q

Rheumatoid arthritis Xray findings

A

Loss of join space
Erosion of bone
Soft tissue swelling
Soft bones (osteopenia)

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6
Q

Rheumatoid arthritis presentation

A

Symmetrical, deforming, peripheral polyarthris
Pain improves with use

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7
Q

Rheumatoid arthritis hand deformities

A

Ulnar deviation
Swan neck
Boutenniere deformity

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8
Q

Rheumatoid arthritis: which hand joints are affected?

A

MCP
PIP
Wrist

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9
Q

Rheumatoid arthritis systemic presentations

A

Scleritis
Pleural effusions
Pericarditis

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10
Q

Rheumatoid arthritis blood results

A

RF (highly sensitive)
Anti-CCP (more specific)
ESR

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11
Q

Rheumatoid arthritis management

A

1st: DMARDS
Methotrexate (+folic acid), leflunomide, sulfasalazine (pregnancy)
+ short term bridging prednisolone until DMARD can take effect

Steroids for flareups

Biologics
TNF a blockers: Infliximab
B cell inhibitors: Rituximab

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12
Q

Felty syndrome triad

A

Rheumatoid arthritis
Splenomegaly
Neutropenia

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13
Q

Osteoporosis pathophysiology

A

↓ bone mass/density and micro-architectural deterioration
↑ in bone fragility and susceptibility in fracture

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14
Q

Osteoporosis DEXA T-score

A

< -2.5

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15
Q

Osteoporosis management

A

1st: AdCal-D3 + bisphosphonates (oral alendronate/ risedronate)
2nd: Denosumab

Teriparatide
HRT

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16
Q

Osteoporosis risk assessment

A

FRAX
Qfracture

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17
Q

Osteoporosis aetiology

A

Steroid use
Hyperthyroidism and hyperparathyroidism
Alcohol and tobacco
Thin – low BMI
Testosterone decrease leads to increased bone turnover
Early menopause
Renal or liver failure
Erosive/inflammatory bone disease
Dietary calcium decrease/Diabetes mellitus type 1

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18
Q

Pseudogout joint aspiration findings

A

Positively birefringent rhomboid crystals
Calcium Pyrophosphate

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19
Q

Gout joint aspiration findings

A

Negatively birefringent needle crystals
Monosodium urate

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20
Q

Pseudogout joints affected

A

Ankle
Knee
Wrist

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21
Q

Gout joints affected

A

Big toe most common

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22
Q

Investigations for crystal arthritis

A

1st: Bloods - U&Es + eGFR, hyperuricaemia (4-6 weeks later)
Gold standard: Joint aspiration

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23
Q

Allopurinol mechanism of action

A

Inhibits Xanthine Oxidase

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24
Q

Management of gout

A

Acute:
1st: NSAIDs/colchicine
2nd: Intra articular steroids

Long term:
1st: Allopurinol
2nd: Febuxostat

Lifestyle advice

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25
Q

SLE hypersensitivity reaction

A

Type III hypersensitivity

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26
Q

SLE inflammatory markers + antibodies

A

Raised ESR, normal CRP
ANA – 99% of cases
Anti-dsDNA – only 60% of cases

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27
Q

Drug induced SLE causes

A

Hydralazine
Isoniazid
Procainamide

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28
Q

SLE presentation

A

Joint pain
Skin - malar rash, discoid rash, photosensitive butterfly rash
Serositis - scleritis, pericarditis, pleuritis, oral ulcers
Kidneys - glomerulonephritis with proteinuria
CNS - depressions, psychosis

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29
Q

SLE management

A

Hydroxychloroquine
Steroids
Methotrexate

UV protection

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30
Q

Antiphospholipid syndrome features

A

Coagulation defects
Recurrent miscarriage
Livedo reticularis
Thrombocytopaenia

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31
Q

Antiphospholipid syndrome management

A

Warfarin

LMWH + aspirin in pregnancy

32
Q

Antiphospholipid syndrome lab criteria for diagnosis

A

1 of the following (+ 1 clinical):
Anti-cardiolipin antibody
Lupus anticoagulant
Anti-Beta 2 Glycoprotein 1 antibody

33
Q

Sjogren’s syndrome features

A

Dry eyes, mouth
Parotid gland enlargement
Raynaud’s
Joint pain

34
Q

Sjogren’s syndrome antibodies

A

Anti-RO – 70%
Anti-LA – 30% - but most sensitive
ANA – 70%
RF – 50%

35
Q

Sjogren’s investigations

A

Schirmer tear test
Rose Bengal staining and slit lamp exam
Antibodies
Salivary gland biopsy is 100% confirmatory but not needed for diagnosis

36
Q

Sjogren’s management

A

Lifestyle - Humidifier, Eye drops, Mouth wash
Medications - NSAID, Hydroxychloroquine
M3 agonist - pilocarpine

37
Q

Raynaud’s phenomenon aetiology

A

Other autoimmune conditions
Vibrational tools
Smoking
Use of beta blockers

38
Q

Raynaud’s management

A

Lifestyle
Calcium channel blockers

39
Q

Systemic sclerosis pathophysiology

A

Increased fibroblast activity (↑ collagen deposition)
Results in abnormal growth of connective tissue

40
Q

Systemic sclerosis presentation

A

Pulmonary: pulmonary HTN, pulmonary fibrosis
Cardio: Raynaud’s, CAD, pericarditis, arrhythmias
GI: GORD, oesophageal scarring, reduced small bowel motility
MSK: sclerodactyly, calcinosis, arthralgia, myalgia, skin thickening
Distal to elbows and knees in limited
Proximally in diffuse

41
Q

Systemic sclerosis antibodies

A

90% have ANA

Limited: Anti-centromere
Diffuse: Anti-RNA polymerase III

42
Q

ESR in systemic sclerosis

A

Normal

43
Q

Systemic sclerosis management

A

Lifestyle - avoid smoking, handwarmers

Renal: ACEi
GI - PPIs, Antibiotics
Pulmonary fibrosis - IV cyclophosphamide

44
Q

CREST syndrome

A

Limited cutaneous systemic sclerosis

Calcinosis
Raynaud’s
oEsophageal dysmotility
Sclerodactyly
Telangiectasia

45
Q

Myositis (poly/dermato) presentation

A

Progressive muscle weakness of shoulder and pelvic girdle

Dermato additional symptoms include:
Heliotrope (purple) discoloration of eyelids
Scaly erythematous plaques over the knuckles

46
Q

Myositis antibodies

A

ANA, Anti jo1, anti mi2

47
Q

Myositis blood results

A

Increase in:
CK
Aminotransferases
Lactate dehydrogenase
Aldolase

48
Q

Myositis management

A

Oral prednisolone
IVIG in severe disease

49
Q

Paget’s disease pathophysiology

A

↑ osteoclastic bone resorption followed by ↑ formation of weaker bone
Leads to structurally disorganized mosaic of bone (woven bone)

50
Q

Paget’s disease presentation

A

60-80% are asymptomatic

Bone pain
Joint pain

Deformities:
Bowed tibia
Skull changes
Kyphosis

Neuro complications:
CN VIII compression - deafness
Blockage of aqueduct of sylvius causing hydrocephalus

51
Q

Paget’s disease diagnosis

A

Bloods - Increased ALP, normal calcium and phosphate
Urinary hydroxyproline increase
X-rays - osteoarthritis findings

52
Q

Paget’s disease management

A

Bisphosphonates
NSAIDS

53
Q

Paget’s disease complications

A

Heart failure - heart must work harder to compensate for increased blood flow to bones

54
Q

Osteomalacia pathophysiology

A

Defective mineralization of newly formed bone matrix or osteoid in adults, due to inadequate phosphate or calcium, or due to ↑ bone resorption (hyperPTH)

Most commonly due to Vit D deficiency

55
Q

Osteomalacia causes

A

Malnutrition (most common)
Drug induced
Defective 1-alpha hydroxylation
Liver disease

56
Q

Osteomalacia presentation

A

Widespread bone pain and tenderness
Gradual onset and persistent fatigue
Muscle weakness, parasthesia, waddling gait
Fractures

57
Q

Osteomalacia investigation results

A

↓ calcium, ↓ phosphate, ↑ ALP, ↑ PTH
X ray: Defective mineralisation

58
Q

Osteomalacia management

A

Lifestyle - nutrition, sunlight
Medications - Vit D replacement
Malabsorption/Renal disease - IM calcitriol

59
Q

Septic arthritis management

A

Admister O2
Take blood cultures/joint aspiration
Give IV antibiotics
Give IV fluids
Check lactase
Measure urine output

60
Q

Septic arthritis risk factors

A

IVDU
Immunocompromised
Intra-articular injections
Prosthetic joints

61
Q

Septic arthritis causative organisms

A

S aureus
N gonorrhoea
S epidermis (prosthetics)

62
Q

Septic arthritis antibiotics

A

4-6 weeks
1st: Flucloxacillin
2nd: Clindamycin

If MRSA suspected: vancomycin/teicoplanin
If gonococcal: cefotaxime/ceftriaxone

63
Q

Osteomyelitis methods of infection

A

Direct inoculation
Contiguous spread
Haematogenous seeding

64
Q

5 stages of osteomyelitis

A

Acute inflammation
Subperiosteal abscess
Sequestrum - necrotic bone within the pus
Involcrum – new bone surrounding sequestrum
Cloacae - opening to allow dead bone and pus to come out

65
Q

Investigating osteomyelitis

A

Bone biopsy is best
Raised WCC, ESR and CRP

66
Q

Seronegative spondyloarthropathies

A

HLAB27
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis

67
Q

Ankylosing spondylitis aetiology + Xray findings

A

Inflammation of sacroiliac joints
Loss of spinal movements

Bamboo spine due to vertebral fusion
Bone spurs - syndesmophytes
Eroded & sclerotic sacroiliac joints

68
Q

Reactive arthritis triad

A

Conjunctivitis
Urethritis
Enthesitis

69
Q

Keratoma blenorrhagica

A

Associated with reactive arthritis
Feet ulceration

70
Q

Circinate balanitis

A

Associated with reactive arthritis

71
Q

Management of HLAB27 spondyloarthropathies

A

1st line: physiotherapy + NSAIDs
TNF-alpha inhibitors (infliximab)
Steroid injections
Surgery

72
Q

Xray findings psoriatic arthritis

A

Pencil in cup deformity

73
Q

Which joint is most commonly affected in psoriatic arthritis?

A

Distal interphalangeal joint

74
Q

Xray findings in osteochondroma

A

Exostosis

75
Q

Xray findings in Ewing’s sarcoma

A

Onion skin changes

76
Q

Xray findings in osteosarcoma

A

Sunburst appearance

77
Q

Most likely secondary bone tumours

A

PBKTL (lead kettle)
Prostate
Breast
Kidneys
Thyroid
Lungs

Medicine (13 decks)

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