Rheumatology Flashcards

Question

Criteria to diagnose APS?

Answer 1

Sapporo criteria Vascular thrombosis At least 1 episode of venous/arterial/small vessel thrombosis Not including superficial thrombophlebitis This should be unprovoked or provoked by a minor risk factor only Pregnancy morbidity with any of: 3 miscarriages < 10 weeks 1 miscarriage _<_10 weeks Premature birth < 34 weeks Laboratory criteria: On at least 2 occasions at least 12 weeks apart, any of the following are positive: Anticardiolipin antibodies Anti-beta2-glycoprotein I antibodies Lupus anticoagulant

Answer 2

Cerebral; stroke, central venous sinus thrombosis Rashes Lung; PE, PHTN Cardiac; MI, mitral regurgitation Thrombosis in peripheral arteries DVT Obstetric complications; recurrent miscarriage, still birth, PET, IUGR Retinal thrombosis Adrenal infarction Budd- chiari syndrome Mesenteric ischaemia Avascular necrosis Nephropathy

Answer 3

Factor V leiden Protein C or S deficiency Antithrombin III deficiency Malignancy Polycythaemia Multiple sclerosis

Answer 4

Urine dip; proteinuria Patients need to have at least one of the following antiphospholipid antibodies present on testing on two occasions at least 12 weeks apart: Lupus anticoagulant Anticardiolipin antibody Anti-beta2-glycoprotein I antibody FBC, Clotting, U+E, anti-dsDNA, anti-smith Doppler USS, CT/ MRI , TTE

Answer 5

Conservative; Smoking cessation Regular exercise Avoid alcohol Manage co-morbidities Medical; Warfarin; target 2-3, if recurrent thrombosis then 3-4 Consider adding aspirin, hydroxychloroquine

Answer 6

Catastrophic APS with rapid onset widespread small vessel thrombosis Vascular dementia Chronic PE/ pulmonary hypertension Renal failure

Answer 7

Prognosis of APS varies widely Overall survival is good - approximately 90-94% over 10 years However, significant disability may result from complications such as stroke and pulmonary hypertension With treatment, pregnant women have an 80% chance of a successful birth Catastrophic APS occurs in only 1% of patients, however mortality is approximately 50%

Answer 8

Treatment dose heparin High dose steroids IVIG or plasma exchange

Answer 9

Dull or sharp pain in the area between the lower ribs and the buttocks, which can lead to: Restricted movement and difficulty mobilising Sleep disturbance Distress and low mood Associated symptoms include: Stiffness Muscle spasms Sciatica (leg pain which may be accompanied by weakness, numbness or paraesthesias)

Answer 10

The majority of people have had an episode of low back pain (over 80% of the population) Approximately 90% of these cases are non-specific Incidence peaks at 50-55 years, although prevalence and disability is greatest in people aged 80-85 Worldwide, it is the leading cause of disability

Answer 11

Physical work especially involving heavy lifting, bending or twisting movements Sedentary lifestyle with lack of physical activity Obesity Smoking Depression and/or anxiety Stressful life events including physical or emotional trauma

Answer 12

Disturbed sleep Impacts on daily functioning including chores, work and leisure Depression and anxiety Decreased mobility and increased falls risk especially in older people Acute low back pain may become chronic

Answer 13

Multisystem inflammatory disease causing mouth and genital ulceration, skin lesions, uveitis and arthralgia

Answer 14

Most common in turkish people Men and women are equally likely to develop Behcet's disease, but men tend to be more severely affected HLA-B51 is the most strongly associated genetic risk factor Age of onset is usually in the 20s or 30s, although around 20% of cases present in childhood

Answer 15

Systemic symptoms; Fatigue Malaise Myalgia Low-grade fevers Headaches Arthralgia (an inflammatory arthritis may also occur) Mucocutaneous; Recurrent oral ulceration Mouth ulcers- heal within 7-21 days Genital ulcers Skin lesions Erythema nodosum Acne like papulopustular lesions Superficial thrombophlebitis Ocular; Uveitis; red, painful, photophobia, vision loss, retinal vasculitis Pulmonary; Pulmonary artery aneurysm Dyspnoea, chest pain, cough Rupture can lead to haemoptysis, syncope, cardiogenic shock CNS; Headaches Personality changes Cerebellar signs Dysarthria Sensory changes Memory loss Meningoencephalitis Cerebral vein thrombosis Presents with headache, decreased consciousness, visual loss and nausea and vomiting Signs include papilloedema, focal neurological deficits, seizures and cranial nerve palsies Gastro-intestinal; GI bleeding and perforation Cardiovascular; DVT Pericarditis Vasculitis Coronary artery aneurysm Cardiomyopathy

Answer 16

HSV Sarcoidosis Reactive arthritis Crohn's disease SLE

Answer 17

Wound swabs Urinalysis FBC, CRP, ESR, HLA-B51, RF, ANA, ANCA Syphilis serology U+E, LFT MRI head, MR venography, angiography, CT chest

Answer 18

Visual loss GI bleeding GI perforation Acute ischaemia of limbs or organs due to vasculitis or thrombosis Acute coronary syndrome Aneurysm rupture (e.g. in the lungs or the brain) Seizures Cognitive impairment is common especially in neuro-Behcets Psychological distress including depression and anxiety

Answer 19

The typical disease course is with flares of disease with intervening periods of remission The disease often becomes less active over time Mortality is generally low but is higher in men and patients with an early age of onset However death may occur due to neurological, GI or cardiovascular involvement Immunosuppressive treatments are also associated with significant risks e.g. of infection

Answer 20

Articular and periarticular calcium pyrophosphate deposition (CPPD) causes a spectrum of disease, ranging from asymptomatic radiographic changes, to acute arthritis (also known as "pseudogout") as well as a chronic inflammatory arthritis.

Answer 21

Previous joint injury or surgery Hyperparathyroidism Haemochromatosis Hypomagnesaemia Hypothyroidism Family history (ANK human gene mutations may be present)

Answer 22

All forms of CPPD disease are most common in older patients 50% of people will have radiographic changes of CPPD by the age of 80 Men and women are equally affected

Answer 23

Typically presents with an acute monoarthritis (rarely, an oligoarthritis) The knee, wrist, shoulder and elbow are the most commonly affected joints The affected joint is swollen, erythematous, warm and tender with an effusion on examination Systemic symptoms include fever and malaise

Answer 24

Usually a polyarticular arthritis affecting the small joints of the upper and lower limbs May present similarly to osteoarthritis with knee involvement, but inflammatory flares and severe articular damage can differentiate May resemble rheumatoid arthritis with wrists and metacarpophalangeal joint involvement Symptoms and signs are of chronic intermittent swelling and pain of affected joints

Answer 25

Gout Septic arthritis Osteoarthritis Rheumatoid arthritis

Answer 26

Microscopy of synovial fluid; Positively birefringent rhomboid-shaped calcium pyrophosphate crystals Culture of fluid X-ray; chondrocalcinosis Calcium, PTH, ferritin, TFT, Magnesium

Answer 27

NSAIDs, colchicine, steroids Joint aspiration

Answer 28

Acute CPP arthritis usually resolves within days to short weeks, although some flares may last months Chronic CPP arthritis can cause significant joint damage with subsequent disability In some cases of refractory chronic disease, biologic agents have been trialled (e.g. anakinra)

Answer 29

Enteropathic arthritis is an inflammatory arthritis associated with inflammatory bowel diseases (IBD) such as Crohn's disease or ulcerative colitis. Arthritis is the most common extraintestinal manifestation of IBD, affecting approximately 20-40% of patients.

Answer 30

Axial spondyloarthritis; Gradual onset of lower back pain and stiffness Symptoms are worse in the morning and improve with exercise Buttock pain is also common Examination findings include restricted spinal movements, sacroiliac joint tenderness and reduced chest expansion Type 1 peripheral arthritis; Oligoarticular arthritis of the large joints (i.e. fewer than 5 joints are affected) Usually asymmetrical; may affect only one joint (a monoarthritis) Knees and ankles are affected more commonly than the hips and shoulders Inflammation is often transient and migratory episodes are self-limiting in 90% of cases without permanent damage Strongly associated with flares of IBD and with extra-articular manifestations (e.g. uveitis and erythema nodosum) Often associated with enthesitis, tenosynovitis or dactylitis Type 2 peripheral arthritis; Polyarticular (i.e. 5 or more joints are involved) inflammation of primarily the small joints Metacarpophalangeal joints, knees and ankles are commonly involved Arthritis is usually symmetrical Joint inflammation is typically independent of IBD activity and is often chronic and migratory, causing damage to affected joints Other important symptoms and signs; Enthesitis is characterised by pain and inflammation at sites of tendon insertion (eg. Achilles tendinopathy, patellar tendinopathy, plantar fasciitis) Dactylitis - inflammation of a whole finger or toe Gastrointestinal symptoms including abdominal pain or cramping, diarrhoea, blood/mucus in faeces Systemic symptoms such as weight loss and fevers Dermatological manifestations such as pyoderma gangrenosum or erythema nodosum Aphthous ulcers in the mouth Anterior uveitis (pain and erythema of the eye with blurring of vision)

Answer 31

Whipples disease Reactive arthritis Coeliac disease

Answer 32

Faecal calprotectin Stool microscopy and culture Arthrocentesis for synovial fluid analysis FBC, CRP, ESR, anti-TTG, RF, p-ANCA X-ray of affected joint MRI spine and sacroiliac joint Colonoscopy +/- OGD

Answer 33

Local steroid injection DMARD; methotrexate, sulfasalazine NSAIDs, oral steroids Anti-TNF

Answer 34

rare granulomatous small and medium-vessel vasculitis associated with asthma and tissue eosinophilia. AKA churg- strauss syndrome

Answer 35

EGPA is rare, with a prevalence of approximately 10-14 cases per million people worldwide Men and women are equally affected Mean age at diagnosis is 50 years old Approximately 40% of patients are ANCA positive, usually anti-MPO (p-ANCA)

Answer 36

Adult onset asthma Chronic sinusitis Fevers, malaise, myalgia, arthralgia, fatigue Skin lesions; palpable purpura, skin nodules and petechiae Peripheral nerve involvement GI involvement Glomerulonephritis Cardiac involvement; myocarditis, coronary arteritis, heart failure

Rheumatology Flashcards

(61 cards)