Rheumatology Flashcards
(223 cards)
1
Q
What are the clinical findings of ankylosing spondylitis?
A
reduced chest expansion, reduced lateral flexion and reduced forward flexion (Schober’s test)
2
Q
Sulfasalazine can cause what?
A
Reduced sperm count -> usually returns to normal upon stopping the medication
3
Q
What would joint aspiration of rheumatoid arthritis show?
A
- High WBC
- Polymorph neutrophils
- Cloudy/Yellow appearance
4
Q
What is previous chemo a big risk factor for?
A
Avascular necrosis
5
Q
Methotrexate plus trimethoprim can cause what?
A
Bone marrow suppression and panycytopenia
6
Q
DIP swelling and dactylitis with arthritis suggests what?
A
Psoriatic arthritis
7
Q
Which antibody is specific for anti-phospholipid syndrome?
A
Anticardiolipin antibody
8
Q
What are the smoking cessation drugs?
A
- Nicotine replacement (causes N+V, headaches, flu symptoms)
- Varenicline (causes nausea and C/I in pregnancy/BF)
- Bupropion (reduces seizure threshold)
9
Q
What type of shock does tension pneumothorax cause?
A
Obstructive
10
Q
Which lung cancer is gynaecomastia associated with?
A
Adenocarcinoma of the lung
11
Q
What does an isolated rise in ALP suggest?
A
Pagets disease of the bones
12
Q
subchondral erosions, sclerosis
and squaring of lumbar vertebrae
A
Anklyosing spondylitis
13
Q
What is the most common site of metatarsal stress fractures?
A
2nd metatarsal
14
Q
hyperpigmentation of the palmar creases indicates what?
A
Addisons
15
Q
How should proximal scaphoid pole fracture be managed?
A
Refer to orthopaedics for surgical fixation
16
Q
Features of a acetabular labral tear?
A
- Following trauma
- Hip/groin pain
- Snapping sensation
17
Q
Features of a femoroacetabular impingement?
A
- More chronic history
18
Q
Long term steroid use/chemo therapy + someone with hip pain suggests?
A
Avascular necrosis of the hip
19
Q
Pain following tibial surgery?
A
Compartment syndrome
20
Q
What is the management of AVN?
A
If displaced: total hip replacement for anyone who is mobile, no co-morbidities etc otherwise hemiarthroplasty
If not displaced: internal fixation
21
Q
Rheumatic vs psoriatic arthritis?
A
Psoriatic will be asymmetrical
22
Q
When should uric acid levels be measured again with gout?
A
2 weeks after the flare has settled
23
Q
X-ray findings for rheumatoid arthritis
A
L – loss of joint space
E – erosions
S – soft tissue swelling
S – soft bones (periarticular osteopenia)
+ juxta-articular osteoporosis
subluxation
24
Q
Extra-articular manifestations of RA?
A
Nodules, scleritis, episcleritis, pleural effusion, Felty, anaemia, Raynaud’s, carpal tunnel
25
RA, Splenomegaly and neutropenia?
Felty
26
Antibody of choice for RA
Anti-ccp
27
Hand signs for RA
- Ulnar deviation
- Swan neck deformity
- Z neck thumb
- Muscle wasting
- Wrist subluxation
28
What organism can cause septic arthritis with metal joint?
Early stages after surgery - staph aureus
Later onset - staph epidermidis
29
What are risk factors for septic arthritis?
RA, DM, Immunosuppression, Penetrating injury, infection elsewhere
30
What are the rotator cuff muscles?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
31
What muscles are responsible for shoulder abduction?
0-15 degrees: supraspinatus
15 - 90 degrees: deltoid
90 degrees+: Trapezius and serratus anterior
32
Which muscles does the accessory nerve innervate?
Deltoid and teres minor
33
Investigations to assess for supraspinatus impingement?
US and MRI
34
Proximal muscle weakness + raised CK + no rash
Polymyositis
35
Dermatomyositis vs polymyositis
Dermatomyositis would have a rash
36
What would be seen on X-ray to support a diagnosis of ankylosing spondylitis?
Sacro-ilitis
37
What should be given to women >75 with a fragility fracture?
Bisphosphonates
38
When should a referral for sciatica be considered?
4-6 weeks after analgesia + physio treatment
39
What are the features of ankylosing spondylitis?
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
40
Pain worse on walking on tip toes?
Plantar fasciitis
41
Fever + back pain + IVDU
Iliopsoas abscess
42
What is the treatment for psoas abscess?
Abx + percutaneous drainage
43
muscle wasting of the hands, numbness and tingling and possibly autonomic symptoms
Neurogenic thoracic outlet syndrome
44
What is osteomalacia?
Softening of the bones secondary to vit D deficiency
45
How does osteomalacia present?
- Bone pain/tenderness
- Fractures e.g NOF
- Proximal myopathy: waddling gait
46
How would osteomalavcia present on investigations?
- Low Vit D
- Low calcium and phosphate
- Raised ALP
- Translucent bands over the X-ray
47
Management of NOF fractures
Non-displaced + intracapsular: cannulated screw fixation
Stable + extra capsular: dynamic hip screw
Displaced + Intacapsular if not very mobile older patient: Hemiarthroplaty
Displaced + intracapsular if young/mobile older patient: Total hip arthroplasty
48
flexion deformities of his 4th and 5th digit which cannot be passively corrected
Duputrynes contracture
49
What is often the earliest sign of Dupuytrens?
Firm, thickened palmar nodule over the metacarpal head
50
What are risk factors for Dupuytrens?
- Diabetes
- Alcohol
- FH
- AIDS
51
Limited vs diffuse cutaneous systemic sclerosis
Diffuse will have widespread skin and organ involvement (lungs and kidneys)
52
What is fat embolism?
A syndrome secondary to trauma/fractures/orthopaedic surgery
53
How does fat embolism present?
Pulmonary: PE like symptoms
Neuro: altered mental status, seizures, coma
Derm: petechial rash on upper body
Managed with supportive treatment/prophylaxis
54
What are common precipitants of gout?
- Surgery
- Dehydration
- Alcohol
- Trauma
- Infection
- Foods rich in purines
55
What are x-ray findings of gout?
- Normal joint space
- Soft tissue swelling
- Periarticular erosions
56
What can be some examination findings of osteoarthritis?
- Antalgic gait
- Joint swelling
- Joint tenderness
- Pain on movement
- Crepitus
- Reduced ROM
57
purple discolouration of eyelids in dermatomyositis?
Heliotrope
58
What are Gottron's papules?
Rough, red papules over the knuckles -> dermatomyositis
59
What antibodies are associated with dermatomyositis?
Anti-Jo, Anti-MI, RF, ANA
60
What is Raynauds phenomenon?
Peripheral digital ischaemic caused by vasospasm which is precipitated by cold/emotion
61
What are some causes of Raynauds phenomenon?
- SLE
- Raynaud's disease
- RA
- Ehler-Danlos
- Beta blockers
- Atherosclerosis
62
What are the features of CREST?
Calcinosis
Raynaud's
Oesophageal dysmotility
Sclerodactyly
Telangiectasia
63
What respiratory condition is associated with AS?
Pulmonary fibrosis
64
What is mononeuritis multiplex?
Damage to 2+ peripheral nerves
65
What are causes of mononeuritis multiplex?
- HIV/AIDS
- Diabetes
- RA
- Sarcoidosis
66
What is the definitive investigation for Sjogrens?
Salivary gland biopsy
67
What is the most common cause of cauda equina syndrome?
Lumbar disc herniation at L4/L5/ or L5/S1
68
Pseudogout is strongly associated with what?
Haemochromatosis
69
What are the most specific markers for SLE?
anti-dsDNA and anti-SM
ANA - most sensitive
70
Erb's palsy has injury to which myotomes?
C5 and C6 (11 erbs and spices)
71
How does Erb's palsy present?
Imparied wrist extension and elbow flexion - waiters tip
72
Carbamazepine increases risk of what?
Osteoporosis
73
Back pain red flags?
- Thoracic or cervical spine pain
- Progressive pain not relieved by rest
- Fevers, chills, weight loss
- Early morning stiffness > 30 mins
- Bowel/bladder/neuro dysfunction
74
What should be given for cord compression secondary to bone metastases?
Dexamethasone
75
Osteoporosis risk factors?
Steroids
Hyperthyroidism/Hyperparathyroidism
Alcohol/Smoking
Thin
Testosterone deficiency
Early menopause
Renal failure
Erosive bone disease
Diabetes
76
What is a Colles fracture?
Fracture of the distal radium with dorsal angulation of the distal fracture fragments
77
Septic Arthritis in a prosthetic joint?
Admit patient and arrange ortho review
78
pain and swelling at the base of the thumb and along the radial aspect of the wrist, often worsened by thumb movement or grasping in a YOUNG person
De Quervain;s tenosynovitis
79
What should take place before starting anyone on biologics?
Quantiferon test - assess for TB as biologics can reactivate latent TB
80
Abx regiment for septic arthritis?
2 weeks of IV plus 4 weeks of orals
81
Which antibodies are specific for anti phospholipid
Anti-beta-2-glycoprotein I antibody
82
What is a common early finding in professional players who have had trauma?
Osteoarthritis
83
What cover should be given to those receiving allopurinol?
NSAIDs cover for 3 months as allopurinol can acutely raise urate levels
84
'rain-drop skull'
Myeloma
85
'pepper pot skull'
Hyperparathyroidism
86
What are the most common side effects of colchicine?
Diarrhoea, nausea + vomiting
87
What scoring system can be for RA and what does it indicate?
Disease-activity score
<2.6 - remission
>5.1 - high disease activity
88
What is the dose for steroids in GCA?
60mg of prednisolone
89
How would lumbar spondylosis present?
- Arthritis like pain which gets worse throughout the day in older patients
90
What is recommended in patients with GCA with CVD risk factors/IHD?
Aspirin 75mg as prophylaxis
91
What is the inheritance of Marfans?
Autosomal dominant
92
How should methotrexate be monitored?
FBC, Renal function and LFTs weekly until established then every 2-3 months
93
What can patients with limited systemic sclerosis develop as a late manifestation?
Interstitial lung disease
94
What investigation should be done for women with polymyalgia due to steroid use?
DEXA
95
What are the 4 features of antiphospholipid syndrome?
Clots - VTE/PE
Livedo reticularis
Obstetric loss
Thrombocytopenia
96
c-ANCA positive?
Granulomatosis with polyangiitis
97
What are features of granulomatosis with polyangiitis?
- Resp involvement
- Kidney involvement: glomerulonephritis
- Systemic symptoms
- Ocular manifestations e.g. scleritis
98
How is granulomatosis with polyangiitis managed?
- Cyclophosphamide/rituximab in acute
- Azathioprine/Methotrexate during remission
99
asthma, nasal polyps and a mononeuritis multiplex
Eosinophilic granulomatosis with polyangiitis
100
Recurrent oral and genital ulcers with uveitis and erythema nodosum?
Behcet's disease- HLA B51
101
Common sites where osteoporotic fragility fractures occur?
- Pubic ramus
- Hip
- Distal radium
- Proximal humerus
102
What are side effects of bisphosphonates?
- Abdominal pain
- Dyspepsia
- Nausea
- Abdominal distension
- Oesophageal ulceration
103
What is the first line imaging in myeloma?
MRI
104
Acute back pain in a patient with osteoporosis?
Think osteoporotic verterbral fracture -> X-ray needed
105
What is the Z score adjusted for in patients with DEXA scans?
Age, gender and ethnic factors
106
What antibodies are found in CREST syndrome?
Anti-centromere
107
What is Behcet's syndrome?
- Common in young Turkish men
- Oral ulcers, genital ulcers and anterior uveitis
- Erythema nodosum also present
108
Which DMARD is associated with retinopathy?
Hydroxychloroquine
109
What is Caplan syndrome?
Massive fibrosis in patients with RA and pneumoconiosis
110
What is polyarteritis nodosa?
Medium vessel vasculitis common in middle aged men with Hep B
Can cause testicular pain, weight loss, HTN, renal failure
PANCA positive
111
Ejection systolic murmur with SLE?
Libman-Sacks endocarditis
112
What are some skin changes with dermatomyositis?
- Heliotrope rash of eyelids
- Periorbital oedema
- Dilated capillary loops under the fingernails
113
What are some symptoms of dermatomyositis?
- Muscle swelling
- Muscle tenderness
- Arthralgia
- Fatigue
- Weakness
114
What are some symptoms of fibromyalgia?
- Pain
- Sleep disturbance
- Paraesthesia
- Memory disturbance
- Headaches
- Dizziness
115
What are some skin changes with Reiters?
- Mouth ulcers
- Erythema nodosum
- Keratoderma blennorrhagica (yellow/brown papules on soles of feet)
116
What are some cardiac complications of Reiters?
- Pericarditis
- Aortic regurg
- Aortitis
117
What is there not in someone with polymyalgia?
True weakness of muscles -> normal power
118
Management of a prolapsed disc?
Analgesia + Physio
119
Painful click on McMurrays test?
Think twisted knee injury - meniscal tear
120
What is a Galeazzi fracture?
Dislocation of the distal radioulnar joint with an associated fracture of the radius
121
tenderness in the anatomic snuffbox dorsally
Scaphoid fracture
122
What should be corrected before giving bisphosphonates?
Calcium level / Vit D deficiency
123
Pain on the radial side of the wrist/tenderness over the radial styloid process in a young women?
De Quervain's tenosynovitis
124
What does co-trimoxazole contain?
Trimethoprim -> think about methotrexate
125
Most likely places for bone mets?
Women - breast
Men - prostate
126
What are major risk factors for osteoporosis?
- Steroid use
- RA
- Alcohol excess
- Low BMI
- Smoking
127
What will the blood test values be with osteoporosis?
Everything normal
128
Imaging of choice for osteomyelitis?
MRI
129
lead pipe appearance of the colon
Ulcerative colitis
130
popping sensation, immediate swelling and immediate unable to weight-bear
ACL injury - Lachmans test
131
Knee locking and giving-way
Meniscal lesions
132
What is the management of newly diagnosed RA?
Methotrexate and oral steroids
133
Z score is helpful for what?
Diagnosing secondary osteoporosis
134
Compartment syndrome produces what?
Pain on passive stretch
135
What is the management of flares of rheumatoid arthritis?
Steroids oral or IM
136
When can reactive arthritis present and how long do symptoms last?
- Can develop upto 4 weeks after initial infection
- Symptoms last around 4-6 months
137
dull shoulder pain, that often disturbs sleep, followed by
stiffness and loss of shoulder mobility
Frozen shoulder - Adhesive capsulitis
138
Management of undisplaced scaphoid fractures?
Cast for 6-8 weeks
139
What are some hand signs of psoriatic arthritis?
- Dactylitis
- Nail pitting
- Onchylosis
- Nail discolouration
140
What are some X-ray findings of psoriatic arthritis?
- Soft tissue swelling
- Bony erosions
- Pencil in cup deformity
- Loss of joint space
141
What is the most severe form of psoriatic arthritis?
Arthritis mutilans
142
What is the treatment of psoriatic arthritis?
- NSAIDs if mild
- Methotrexate
- anti-TNF biologics
143
Chalky nodules in someone with gout?
Gouty tophi
144
What HLA type is rheumatoid?
HLA-DR4 / HLA-DR1
145
Risk factors for pseudogout?
- Steroid use
- Hyperparathyroidism
- Haemochromatosis
- Wilson's
- Acromegaly
146
What is the prognosis of pseudogout?
Resolves within 10 days
147
What are some complications of eosinophilic granulomatosis with polyangiitis?
- HF
- Myocarditis
- HTN
- Stroke
- Bowel ischaemia
- Pancreatitis
148
Prophylactic bisphosphonates should be offered to who?
Those with T score <1.5 if they are on steroids for more than 3 months
149
What should alendronate be changed to if patients are experiencing bad GI side effects?
Risedronate
150
SGLT-2 inhibitors can increase the risk of what?
Ulcers or infection -> increased risk of amputation
151
Which organism causes osteomyelitis in sickle cell?
Salmonella
152
anti-histone antibodies can be a sign of what?
Drug induced lupus - common causes include isoniazid, phenytoin
153
Lace like rash on shins is a sign of what?
Livedo reticularis -> associated with anti-phospholipid syndrome
154
raised CRP in a patient with known SLE
Can suggest underlying infection
155
What is an early x ray finding of rheumatoid arthritis?
Juxta-articular osteopenia
156
What is a fragility fracture?
A fracture from a fall from standing height or less
157
What are examples of fragility fracture?
- Vertebral compression fractures
- Hip
- Distal radium
- Proximal humerus fracture
158
Nerve and which fracture they are associated with?
Radial - fracture of shaft of humerus (wrist drop)
Ulnar - supracondylar fracture of humerus
Axillary - fracture of proximal humerus
159
Bilateral carpal tunnel?
Rheumatoid
160
Lateral knee pain in a runner?
Iliotibial band syndrome -> treat with stretches
161
Lateral epicondylitis causes what?
- Pain worse on supination of the wrist
- Pain worse on wrist extension against resistance
162
What is the main structure which is damaged in scaphoid fractures?
dorsal carpal branch of the radial artery
163
dislocation of the proximal radioulnar joint in association with an ulnar fracture
Monteggia fracture
164
Most common sites of osteomyelitis in children and adults?
Children - Metaphysis
Adults - Epiphysis
165
What are different management options for carpal tunnel?
- Night splints
- Intraarticular steroid injections
- Carpal tunnel decompression
166
Bruised, swollen, deformed and painful elbow?
Think supracondylar fracture
167
What would Perthes disease x-ray show?
- Widening of joint space
- Decreased femoral head size
- Flattening
168
What are surgical management options for osteoarthritis?
- Osteotomies
- Arthroplasty
169
What is duputryens?
Thickening of the palmar fascia which eventually causes a fixed flexion deformity
170
What is the most common type of shoulder dislocation?
Anterior dislocation
171
What is the weight bearing status after NOF surgeries?
Cannulated screws - less than full initially
Everything else - full weight bearing
172
Radiculopathy vs myelopathy
Radiculopathy - compression of a single nerve root which has exited the spinal cord
Myelopathy - pain due to compression of the spinal cord
173
Which nerve roots correspond to reflexes?
Ankle - S1/2
Knee - L3/L4
Bicep - C5/C6
Tricep - C7/C8
174
Simmonds test - calf squeeze
Achilles tendon rupture
175
Which knee compartment is most commonly affected in osteoarthritis?
Medial
176
Open tibial fractures should be covered with what?
Sterile saline gauze
177
Which muscle is responsible for the weakness in thumb abduction in carpal tunnel?
Abductor pollicis brevis
178
Haematogenous vs direct contamination?
Haematogenous - infection reaches bone through bloodstream
Direct contamination - infection spreads directly from adjacent tissues/structures to the bone
179
Bakers cysts occur secondary to what?
Degeneration
180
Imaging for achilles tendon rupture?
US
181
What is the test of choice for Duputryen's?
Table top test
182
Which arteries are at risk in NOF?
Circumflex arteries
183
Soft, non-tender swelling near joints or tendons, containing clear,
viscous fluid
Ganglionic cyst
184
Sciatic nerve originates from?
L4-S3
185
What is RICE mnemonic for soft tissue injuries?
Rest, ice, compression, elevation
186
Synovial fluid aspiration in someone with reactive arthritis?
No organisms will be recovered + cloudy/yellow colour
187
What is the most common mechanism of ankle sprains?
Inversion
188
Any MSK pain/Osteoarthritis first line treatment?
Topical NSAIDs/Oral NSAIDs
189
What is spondylolisthesis?
One vertebra slips out of line with one above it, usually in the lumbar spine
190
Pain on painful arc with normal X ray?
Painful arc syndrome / subacromial bursitis / impingement syndrome
191
Trigger finger management?
1. Rest and splint
2. NSAIDs
3. Steroid injections
192
What are examination findings of NOF?
Affected side shortened
Externally rotated
Abducted
193
S/E of bisphosphonates
- Oesophageal erosions
- Osteonecrosis of jaw
- Atypical fractures
194
CREST antibodies?
- Anti-centromere
- Anti-Scl70
195
What are pulmonary complications of CREST?
- Pulmonary fibrosis
- Pulmonary HTN
196
What are causes of sciatica?
- Spinal stenosis
- Disc herniation
- Pelvic tumours
197
Greenstick fractures are unique to who?
Children - usually under 10s
198
3rd line management for acute gout in renal disease?
Steroids
199
What is the investigation of choice for Takayasu's arteritis?
CT angio
200
What is Caplan syndrome?
RA plus pulmonary nodules
201
What is the diagnostic test for Behcet's disease?
Pathergy test
202
Diabetics are susceptible to what infections?
Staphylococcal
203
diffuse thickening of the pancreatic body and tail
Sausage pancreas sign -> autoimmune pancreatitis
204
Antiphospholipid causes prolonged what?
APTT
205
What drug makes Raynaud's worse?
Propranolol
206
RA spares which joint?
DIP
207
Progressive shoulder pain with reduced ROM in middle aged?
Frozen shoulder
208
Management of achilles tendonitis?
Rest, NSAIDs and physio if symptoms persistent beyond 7 days
209
What is Simmonds triad?
- palpation
- examining the angle of declination at rest
- squeeze test
210
Investigation for suspected hip fracture if X-ray is normal?
MRI
211
What can be done for NOF fractures?
Iliofascial nerve block
212
What is the most common reason for revising a total hip replacement?
Asceptic loosening of the implant
213
Joint aspirate with high WBC count, mainly neutrophils with well patient?
Rheumatoid
214
Gold standard diagnostic investigation for Ankylosing spondyliitis?
MRI of sacroiliac joints
215
Methotrexate can cause what when not given folate alongside?
Macrocytic anaemia due to folate deficiency
216
What is the treatment for reactive arthritis?
NSAIDs
217
Management of patients who do not respond to steroids in poly myalgia?
Refer to specialist
218
Compartment syndrome can cause what?
Rhabdomyolysis
219
Management of undisplaced patella fracture with intact extensors?
Conservative with knee immobilisation
220
Management of renal hypertensive crises in systemic sclerosis?
ACE inhibitors
221
What are S/E of leflunomide?
Raised BP and peripheral neuropathy
222
What is the anticoagulant of choice in antiphospholipid?
Warfarin
223
Kids born to mums with SLE/Sjogrens can get what?
Congenital heart block -> neonatal lupus syndrome
