Rheumatology Flashcards Preview

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Flashcards in Rheumatology Deck (108)
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1

Describe normal synovial fluid, commenting on appearance, viscosity, white cell count and neutrophils

Clear
Normal consistency
WCC less than 200
No neutrophils

2

Describe osteoarthritic synovial fluid, commenting on appearance, viscosity, white cell count and neutrophils

Clear
Increased viscosity
WCC less than 1000
Less than 50% neutrophils

3

Describe bloody synovial fluid, commenting on appearance, viscosity, white cell count and neutrophils

Red/dark brown
Varied viscosity
WCC less than 10 000
Neutrophils less than 50%

4

Describe inflammatory synovial fluid, commenting on appearance, viscosity, white cell count and neutrophils

Yellow/turbid
Reduced viscosity
WCC less than 50 000
Neutrophils vary, should be less than 80%

5

List the main seropositive inflammatory arthropathies

Rheumatoid
SLE
Scleroderma
Vasculitis
Sjogren's syndrome

6

List the main seronegative inflammatory arthropathies

Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
Enteropathic arthritis

7

List likely aetiology/risk factors for back pain in 15-30 yo

Prolapsed disc
Trauma
Fractures
Ank spond
Spondylolisthesis
Pregnancy

8

List likely aetiology/risk factors for back pain in 30-50 yo

Degenerative spine
Prolapsed disc
Malignancy

9

List likely aetiology/risk factors for back pain in over 50 yo

Degenerative spine
Osteoporosis
Paget's disease
Malignancy
Spinal stenosis

10

List red flags for back pain

Age less than 20 or over 55
New onset
Constant, progressive
Worse at night, lying down
Systemic upset
History of cancer
Cauda equina features
Neuro dysfunction

11

What is osteoarthritis?

Wear-and-tear degeneration of bones and joint

12

List aetiology/risk factors for osteoarthritis

Environment (hobbies, occupation, obesity)
Previous injuries/fractures
Genetics/familial
Secondary to disease (Perthes, DDH, arthropathies, malalignment)

13

List clinical features of osteoarthritis

Pain on movement/worse at end of day
"Background" joint pain
Joint stiffness on waking ~ 30 mins
Instability
Heberden's nodes (DIPJ)
Bouchard's nodes (PIPJ)
Bony tenderness

14

List XR findings of osteoarthritis

Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cysts

15

Outline management of osteoarthritis

Exercise to improve muscles and instability
Weight loss
Paracetamol + NSAID
Codeine
IA steroid temporary relief
Joint replacement for pain

16

List conditions associated with anti CCP antibody

Rheumatoid arthritis

17

List conditions associated with Rheumatoid factor

Rheumatoid arthritis
Sjogren's syndrome
Felty's syndrome
Mixed CTD
SLE

18

List conditions associated with anti ds DNA antibody

SLE

19

List conditions associated with anti Sm antibody

SLE

20

List conditions associated with anti Ro antibody

Sjogren's syndrome
SLE
Systemic sclerosis
Congenital heart block (placental transfer)

21

List conditions associated with anti La antibody

Sjogren's syndrome
SLE

22

List conditions associated with anti-centromere antibody

Limited systemic sclerosis

23

List conditions associated with anti Scl 70 antibody

Diffuse systemic sclerosis

24

List conditions associated with anti RNP antibody

Mixed CTD
SLE

25

List conditions associated with anti Jo 1 antibody

Polymyositis

26

List conditions associated with anti Mi2 antibody

Dermatomyositis

27

What is rheumatoid arthritis?

Chronic seropositive inflammatory arthritis caused by antibodies to Fc fragment of IgG and synovial fluid, resulting in a symmetrical deforming polyarthritis

28

List aetiology/risk factors for rheumatoid arthritis

Women
Smoking
Age 35-50 yo
Genetics, familial
Trauma
Autoimmune conditions

29

List clinical features of rheumatoid arthritis

Symmetrical swollen painful joints
Usually MCP and PIP / small joints
Early morning stiffness
Pain/stiffness eases with exercise
Tenosynovitis, bursitis
Extensor tendon rupture
Rheumatoid nodules
Boutonniere deformity (PIPJ flexion, DIPJ extension)
Swan-neck deformity (PIPJ extension, DIPJ flexion)
Ulnar deviation of fingers
Z thumb
Lymphadenopathy
Systemic upset

30

What investigations would you do for rheumatoid arthritis?

XR may be normal or show peri-articular osteopenia and erosions
Raised CRP ESR PV
Antibodies (RhF, CCP)