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BPT Clinical Exam Prep > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is MCP subluxation towards the palm referred to as?

A

Volar subluxation

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2
Q

What’s this?

A

Swan neck deformity

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3
Q

What’s this?

A

Boutenniere’s deformity

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4
Q

What’s this?

A

Z thumb deformity

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5
Q

What’s this?

A

Sclerodactyly

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6
Q

What are distal interphalangeal joint osteroarthritic nodules called?

A

Heberden’s node

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7
Q

What are proximal interphalangeal joint osteroarthritic nodules called?

A

Bouchard’s nodes

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8
Q

What two causes of arthritis typically cause symmetrical polyarthropathy with DIP sparing?

A

Rheumatoid arthritis and SLE arthropathy

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9
Q

What abnormality is seen in this XR?

A

Erosions of the MCPs and the ulnar styloid

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10
Q

What are the abnormalities in this XR?

A

Pencil in cup at the DIPs

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11
Q

What are these deformities typical of?

A

Osteoarthritis

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12
Q

What are the lumber spine findings in patients with ankylosing spondylitis?

A

Loss of lumber lordosis
Squaring of vertebrae
Syndesmophytes
Bamboo spine
Apophyseal (facet/intervertenral) joint fustion

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13
Q

What is a syndesmophyte?

A

Annulus fibrosus and ligamentous ossficiation at the junction of adjacent vertebral bodies.
Syndesmophytes originate from the connective tissue, osteophytes (though appearing similar radiographically) originate from the bone.

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14
Q

What is meant by facet joint fusion?

A

Literal fusion of the vertebral bodies.

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15
Q

What are the extraaxial joint manifestations of anklyosing spondylitis?

A

Arthritis: ankles, hips, knees, shoulders, and sternoclavicular joint.s
Enthesitis: especially at the achilles tendon
Dactylitis - diffuse swelling of toes or fingers

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16
Q

What the extraarticular manifestations of ankylosing spondylitis?

A

Acute anterior uveitis
Inflammatory bowel disease
Psoriasis
Apical lung fibrosis
Aortitis and aortic valve disease

17
Q

What is the differential for Jaccoud’s arthropathy?

A

Rheumatic fever
SLE
Parkinson’s disease
Hypocomplementemic vasculitis
HIV

18
Q

What is the significance of an anti-smith antibody?

A

Most specific SLE antibody, but not the most common. Also seen in mixed connective tissue diseae however.

19
Q

What antibody is typically seen in drug-induced lupus?

A

Anti-histone antiboides.

20
Q

Most common causes of drug induced lupus?

A

Procainamide, hydralazine, isoniazid, quinidine, chlorpromazine, methyldopa, pheytoin, carbamazepine, sulphonamides, OCP, tetracycline

21
Q

What type of heart disease is associated with lupus?

A

Libman-Sacks endocarditis - non-infective vegetations form heart valves. Most commonly the aortic and mitral valves. Often see diffuse thickenings on the vavles. Can cause stenosis or regurgitatant murmurs, which can eventuate in cardiac failure. These non-infective lesions can also embolise.

22
Q

What are the features seen in anti-centromere ANA pattern scleroderma?

A

Limited systemic sclerosis
Pulmonary arterial hypertension

23
Q

What are the features seen in anti-RNA polymerase III antibody sceleroderma?

A

ANA nucleolar pattern
Diffuse systemic sclerosis
Hand disability
Renal crisis with higher blood pressure

24
Q

What the features seen in anti-Scl70 autoantibody scleroderma?

A

Fine speckled ANA
Diffuse systemic sclerosis
Progressive lung fibrosis
Digital ulcers
Hand disability

25
Q

What is the thing about anti-Ro60 and SLE?

A

It’s the pathogenic antibody in a significant number of ‘ANA negative’ lupus presentations. It has to be tested for seperate to ANA. Also crosses the placenta like Ro52 and causes neonatal lupus.

26
Q

What are the clinical features of antisynthetase syndrome?

A

Acute onset
Myositis
Reynaud’s phenomenon
Non-erosive arthritis
‘Mechanics hands’ - thickened finger tips
Interstitial lung disease
Anti-Jo1 positive

27
Q

What’s the thing about antiribosomal P antibody and SLE?

A

Also a cytoplasmic antibody associated with SLE that, like Ro60, is not readily seen on ANA/ENA.
Has been associated with neuropsychiatric SLE in more cases than other abs.

28
Q

What is anti-Jo1 ab associated with?

A

Anti-synthetase syndrome

29
Q

What are the antibodies that are associated with dermatomyositis? What is each myositis phenotype

A

Anti-MDA5 (amyopathic dermatomyositis)
Anti-TIF1 gamma (malignancy associated, red on white patches, ovoid palatal patch, hyperkeratotic palmar patches)
Anti-Mi-2 (rapid onset, low risk of associated malignancy)
Anti- SRP (necrotising rapidly progressive myopathy with minimal inflammation)
Anti-Jo1 (antisynthetase syndrome)
Anti-NXP-2 (young onset disease, calcinosis and dysphagia prominant features)
Anti-SAE - (dysphagia heavy)
Anti-HMGCR (immune mediated necortising myositis, 50% have used statins previously)

30
Q

What does anti-MDA5 dermatomyositis look like?

A

Amyopathic! No muscle involvement. Rapidly progressive ILD however, arthritis, and skin involvement. This includes Gottron papules, shawl sign, painful palmar papules and macules, oral ulcerations and non-scaring alopecia.

31
Q

What antibody is often seen in patients with inclusion body myositis?

A

anti-NT5C1A

32
Q

What are the clinical features of inclusion body myositis?

A

Insidious onset of weakness (over about 5 years)
Old > young
Males > female
Proximal > distal leg weakness
Distal upper limb weakness - particularly flexor muscles
Facial muscle (especially obicularis occulis)
Globally decreased reflexes
Dysphagia

33
Q

What is the autoantibody seen in all patients with mixed connective tissue disease?

A

Anti-U1RNP

34
Q

What is the combination of features that make MCTD the most likely diagnosis compared with SLE or SSc?

A

Raynaud phenoenon AND dactylitis
The absence of severe kidney or CNS disease
Severe arthritis
Insidious onset pulmonary hypertension without ILD
Anti-U1 RNP ab positive

35
Q

List all the autoantibodies associated with SLE

A

Anti-DS DNA
Anti-Sm (smith)
Anti-ribosomal P
Anti-Ro52/60 (SSA)

36
Q

What type of myopathy has this patient most likely got?

A

Inclusion body myositis. Note the classic finding of forearm muscle wasting.

BPT Clinical Exam Prep (8 decks)

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