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Med School Finals > Rheumatology > Flashcards

Rheumatology Flashcards

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1
Q

Classification of arthritis by number of joints affected?

A

Monoarthritis = 1
Oligoarthritis = 2-4
Polyarthritis = > 4

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2
Q

Seronegative arthritis feature and examples?

A

All linked to HLA-B27:
→ ankylosing spondylitis
→ reactive arthritis (Reiter’s)
→ psoriatic arthritis
→ IBD-related arthritis
→ juvenile idiopathic arthritis

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3
Q

Seropositive arthritis feature and examples?

A

All RF +ve or antibody +ve:
→ rheumatoid arthritis
→ SLE
→ sjogren’s
→ scleroderma
→ vasculitis

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4
Q

Features of rheumatoid arthritis?

A

Symmetrical arthritis
Main joints are MCPs/PIPs
Morning stiffness improves with activity

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5
Q

Antibodies in rheumatoid arthritis?

A

Rheumatoid factor
Anti-CCP

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6
Q

X-ray features of rheumatoid arthritis?

A

Loss of joint space
Juxta-articular osteoporosis
Periarticular erosions
Subluxation

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7
Q

Swan neck vs Boutonniere deformity?

A

Swan neck = PIP hyperextension, DIP hyperflexion
Boutonniere = PIP hyperflexion, DIP hyperextension

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8
Q

Management of rheumatoid arthritis?

A

1st line = DMARD +/- short course of prednisolone
2nd line = other DMARD
3rd line = TNF-inhibitor

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9
Q

Felty’s syndrome?

A

Rheumatoid arthritis + splenomegaly + low WCC

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10
Q

Treatment response monitoring for arthritis?

A

CRP + DAS28 score

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11
Q

Examples of DMARDs?

A

Methotrexate
Sulfasalazine
Leflunomide
Azathioprine
Ciclosporin
Hydroxychloroquine

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12
Q

DMARDs unsafe in pregnancy and breastfeeding?

A

Methotrexate
Leflunomide

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13
Q

Examples of TNF-inhibitors?

A

Etanercept
Infliximab
Adalimumab

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14
Q

Methotrexate mechanism of action and side effects?

A

Dihydrofolate reductase inhibitor
Side effects = mucositis, myelosuppresion, pneumonitis, pulmonary fibrosis, liver fibrosis

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15
Q

Methotrexate monitoring requirements?

A

FBC, U&Es, LFTs weekly until medication stabilised
→ then monitor every 2-3 months

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16
Q

Advice regarding sex and methotrexate?

A

Women = avoid pregnancy until 6 months post-therapy
Men = use condoms until 6 months post-therapy

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17
Q

What should be co-prescribed with methotrexate?

A

Folic acid 5mg

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18
Q

Features and management of psoriatic arthritis?

A

Symmetrical or asymmetrical arthritis
Morning stiffness improves with activity
Psoriatic changes e.g. plaques, nail disease
Management = same as RA, NSAID for mild disease

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19
Q

X-ray features of psoriatic arthritis?

A

Erosions
New bone formation
“Pencil in cup” appearance

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20
Q

Features and management of reactive arthritis?

A

Assymetrical arthritis
Within 4 weeks of infection e.g. chlamydia
Urethritis, circinate balanitis, eye disease
Management = NSAID, DMARD for persistent disease

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21
Q

Most common organism and location of septic arthritis?

A

Organism = staphylococcus aureus
Location = knee

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22
Q

Features, investigation and management of septic arthritis?

A

Generally unwell e.g. fever
Acute monoarthritis
Investigation = joint aspiration
Management = IV flucloxacillin

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23
Q

Features and management of osteoarthritis?

A

Asymmetrical arthritis
Main joints are DIPs/PIPs, large joints
Pain worsens upon activity
Management = paracetamol, topical NSAID (knee or hand OA), joint replacement

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24
Q

Features of hand OA?

A

Herbeden’s nodes (DIPs)
Bouchard’s nodes (PIPs)
Squaring of the thumbs

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25
X-ray features of osteoarthritis?
LOSS: → loss of joint space → osteophytes → subchondral sclerosis → subchondral cysts
26
Osteoporosis vs osteopenia vs osteomalacia?
Osteopenia = low BMD Osteoporosis = low BMD and structural change Osteomalacia = low BMD secondary to low vitamin D
27
Definition of osteoporosis?
Bone mineral density (BMD) < 2.5 standard deviations below the young adult mean density
28
Who should be screened for osteoporosis and investigations?
Women ≥ 65 and men ≥ 75: → FRAX or QFracture score → DEXA scan
29
Management of patients after a fragility fracture?
≥ 75 = oral bisphosphonate, DEXA scan not required < 75 = DEXA scan
30
DEXA scan T scores?
> -1.0 = normal -1.5 to -2.5 = osteopaenia < -2.5 = osteoporosis
31
Management of osteoporosis?
1st line = alendronate 2nd line = risedronate, etidronate 3rd line = denosumab, raloxifene etc. N.B. all should be offered calcium + vitamin D
32
Bisphosphonate examples, mechanism of action and side effects?
Examples = alendronate, risedronate, etidronate Mechanism of action = inhibits osteoclasts Side effects = GI upset, jaw osteonecrosis, atypical stress fractures
33
Advice for taking bisphosphonates?
- Correct calcium or vitamin D deficiency first - Take on empty stomach 30 mins before meal - Stand or sit for 30 mins after ingestion
34
Calcium, phosphate, ALP and PTH values for osteoporosis, osteomalacia, CKD and Paget's?
Osteoporosis = all normal Osteomalacia = decreased calcium and phosphate, increased ALP and PTH CKD = decreased calcium, increased phosphate and ALP and PTH Paget's = normal calcium and phosphate and PTH, increased ALP
35
Features and management of ankylosing spondylitis?
Lower back pain Sacroiliac joint tenderness Reduced lateral and forward flexion Morning stiffness improves with activity Enthesitis, anterior uveitis, pulmonary fibrosis Management = exercise, NSAID, DMARD
36
X-ray features of ankylosing spondylitis?
Sacroiliitis Squaring of lumbar vertebrae "Bamboo spine" appearance
37
Features and management of SLE?
Multisystem manifestations → general e.g. fatigue → msk e.g. arthritis → skin e.g. malar rash → kidneys e.g. GN → heart e.g. pericarditis → lungs e.g. pleurisy Management = hydroxychloroquine (1st line), prednisolone (2nd line), cyclophosphamide (3rd line)
38
Antibodies in SLE vs drug-induced SLE?
SLE = ANA, anti-dsDNA, anti-smith Drug-induced = anti-histone
39
Monitoring markers for SLE?
Anti-dsDNA ESR C3 and C4 (low in active disease)
40
Features and management of Sjögren's syndrome?
Keratoconjunctivitis sicca Dry mouth Vaginal dryness Arthralgia Management = artificial tears/saliva, pilocarpine
41
Antibodies in Sjögren's syndrome?
ANA Anti-Ro Anti-La
42
Complication of Sjögren's syndrome?
40-60 fold increased risk of lymphoid malignancy
43
Features of gout?
Painful, swollen joint Localised erythema Typically affects 1st MTP
44
Synovial fluid feature of gout?
Needle shaped negatively birefringent monosodium urate crystals
45
When should uric be measured after a gout attack and why?
After episodes has settled (around 2 weeks) → may be low, normal or high during attack
46
Acute vs long-term management of gout?
Acute = NSAID or colchicine (1st line), prednisolone (2nd line) Long-term = allopurinol (1st line), febuxostat (2nd line)
47
Conditions associated with pseudogout?
Haemochromatosis Hyperparathyroidism Wilson's disease Acromegaly
48
Synovial fluid feature of pseudogout?
Rhomboid shaped positively birefringent crystals
49
List examples of small vs medium vs large vessel vasculitides?
Small = wegener's, churg-strauss, microscopic polyangiitis, HSP, goodpasture's Medium = kawasaki, polyarteritis nodosa Large = giant cell (temporal), takayasu's
50
ANCA associated vasculitides and antibody sub-type?
Granulomatosis with polyangiitis (cANCA) Eosinophillic granulomatosis with polyangiitis (pANCA) Microscopic polyangiitis (pANCA)
51
Features and management of ANCA associated vasculitis?
Generally unwell e.g. fever Glomerulonephritis Respiratory disease Sinusitis Vasculitis rash (minority) Management = immunosuppressants
52
Features and management of temporal (giant cell) arteritis?
Headache Jaw claudication Visual disturbance Tender temple region PMH polymyalgia rheumatica Management = oral prednisolone (no visual loss), IV methylprednisolone (visual loss)
53
Investigation for temporal arteritis and feature?
Temporal artery biopsy Skip lesions
54
Most common optic manifestation of temporal arteritis and fundoscopy features?
Anterior ischaemic optic neuropathy Fundoscopy = pale disc and blurred margins
55
Features and management of polymyalgia rheumatica?
Achy, stiff proximal limb muscles NO weakness! Polyarthralgia Fatigue Raised ESR Management = prednisolone
56
Features and management of fibromyalgia?
Chronic pain at specific points Brain fog Fatigue Management = exercise, pain management
57
Polymyalgia vs fibromyalgia?
Polymyalgia = > 60, raised ESR, morning stiffness, no tender points Fibromyalgia = 30-50, normal ESR, no morning stiffness, tender points e.g. shoulders
58
Timescale for chronic fatigue syndrome?
Symptoms must be present for at least 3 months to be referred to CFS specialist
59
Features and management of polymyositis?
Proximal muscle weakness Raynaud's Interstitial lung disease Management = prednisolone
60
Features and management of dermatomyositis?
Proximal muscle weakness Raynaud's Interstitial lung disease Heliotrope rash Shawl sign Gottron's papules Management = prednisolone
61
Investigations for polymyositis and dermatomyositis?
Creatine kinase (CK) EMG Muscle biopsy
62
Antibody in polymyositis and dermatomyositis?
Anti-Jo-1
63
Additional screening test for polymyositis and dermatomyositis?
Check for underlying malignancy Most commonly breast, ovarian or lung
64
Disease patterns of systemic sclerosis?
Limited cutaneous systemic sclerosis Diffuse cutaneous systemic sclerosis Scleroderma (no internal organ involvement)
65
CREST syndrome and features?
Sub-type of limited cutaneous systemic sclerosis: → calcinosis → raynaud's → oesophageal dysmotility → scerlodactyly → telangiectasia
66
Antibody in limited vs diffuse systemic sclerosis?
Limited = anti-centromere Diffuse = anti-scl-70
67
Features and management of antiphospholipid syndrome?
Venous/arterial thrombosis Recurrent miscarriages Pre-eclampsia Levido reticularis Management = low-dose aspirin, lifelong warfarin (if PMH thrombotic event)
68
Blood test features of antiphospholipid syndrome?
Thrombocytopaenia Prolonged APTT Anti-cardolipin antibodies
69
Features of Behcet's syndrome?
Triad of: → oral ulcers → genital ulcers → anterior uveitis
70
Arthritis with a salmon-pink rash?
Still's disease

Med School Finals (18 decks)

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