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Year 3 Buzzwords > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Giant cell arteritis

A 
Granulomatous inflammation
External carotid artery
HLA-DR4
HLA-DRB1
Polymyalgia rhuematica
Headaches, claudication, visual disturbances
Systemic features
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2
Q

Giant cell arteritis ix

A

1st: ESR levels
G: temporal artery biopsy with 48hrs of steroids (multiple locations as can be skip lesions)

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3
Q

Giant cell arteritis rx

A

1st: high dose oral prednisolone (40-60mg/day) immediately
G: titrate prednisolone

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4
Q

Takayasu’s aortitis

A 
Young Japanese females
Constitutional upset
Head or neck pain
Reduced/absent peripheral pulses
Hypertension
Arm claudication on repetition
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5
Q

Polyarteritis nodosa

A 
Hepatitis B
Any age
M>F
High incidence of aneurysms, thrombosis, embolism
Rosary sign (kidney arteries)
Thrombosis
Infarctions (GI perforations)
Hypertension
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6
Q

Kawasaki’s disease

A 
Children
Persistent fever >5/7
Fissured lips
Swollen hands/feet then desquamation
Skin rash
Lymphadenopathy
'Strawberry' tongue
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7
Q

Granulomatosis with polyangiitis

A

cANCA
Triad: upper respiratory, lower respiratory, glomerulonephritis
Saddle shaped nose

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8
Q

Eosinophilic granulomatosis with polyangiitis

A 
pANCA
Refractory asthma
Eosinophilia
Lower respiratory tract (cavitating lesions, haemoptysis)
Glomerulonephritis
Rash
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9
Q

Microscopic polyangiitis

A

pANCA
Non-specific with multiple organs affected
Glomerulonephritis (no glomerular Ig deposits)

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10
Q

Henoch-Schönlein Purpura

A

Purpura on legs and buttocks
Arthritis
Gut symptoms (abdo pain)
Glomerulonephritis with IgA deposition

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11
Q

Mixed essential cryoglobulinaemic vasculitis

A 
Hepatitis C
Arthritis
Splenomegaly
Skin vasculitis
Renal disease
Cryoglobulins (IgG and IgM mix)
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12
Q

Behçet’s disease

A 
HLA-B51
Triad: recurrent oral ulcers, genital ulcers, uveitis
Rash (erythema nodosum)
Arthritis
Pericarditis
Pathergy test
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13
Q

Anti-phospholipid syndrome

A

Triad: DVT/PE, obstetrics complications, thrombocytopaenia
Anti-cardiolupin
Lupus anticoagulant

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14
Q

Rheumatoid arthritis

A 
HLA-DR1
HLA-DR4
Rheumatoid factor (70%)
Anti-CCP (more specific)
Cytokines: IL-1, IL-6, TNF-alpha
DIP sparing
Swan neck deformity (MCP/DIP fixed, PIP extension)
Boutonniere deformity (MCP/DIP extension, PIP flexion)
Better with movement
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15
Q

Felty’s syndrome

A

Rheumatoid arthritis
Splenomegaly
Neutropaenia

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16
Q

Osteoarthritis

A

Heberden’s nodes (DIP)
Bouchard’s nodes (PIP)
X-ray: loss of joint space, osteophytes, subchondral cysts, subarticular sclerosis
Worse with movement

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17
Q

Septic arthritis

A

Joint aspiration

Acute infection of large joint

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18
Q

Reactive arthritis

A

Seronegative spondyloarthropathies (HLA-B27)
GI infections (salmonella, shigella, yersinia, campylobacter)
Circinate balanitis
Keratoderma blenorrhagica
Nail dystrophy, hyperkeratosis, onycholysis

19
Q

Reiter’s syndrome

A

Reactive arthritis
Urethritis
Conjunctivitis

20
Q

Gout

A

Negatively birefringent needle shaped
Uraemic acid increase (increased intake, decreased renal excretion)
Monosodium urate
RF: diuretics, salicylate

21
Q

Pseudogout

A

Positively birefringent rhomboid-shaped crystals
Calcium pyraphosphate deposition
RF: age, family history, joint damage, metabolic disturbance
Joint x-ray: linear, radio-opaque deposits in cartilage of joints

22
Q

Ankylosing spondylitis

A 
Seronegative spondyloarthropathies (HLA-B27)
Early morning back stiffness
Improves with exercise
Psoriasis
Iritis & uveitis
Enthesis > syndesmophytes > bamboo spine
23
Q

Schober’s test

A

Mark at iliac crest level
2nd mark 10cm above
Distance between two marks should increase by >5cm
<5cm = positive

24
Q

Cervical spondylosis

A

Osteophyte formation
Radiculopathy and myelopathy
+ve Lhermitte’s sign (crepitus +/- parasthesia down the spine on neck flexion)

25
Q

SLE

A

SOAP BRAIN MD: serositis, oral ulcers, arthritis, photosensitivity, blood (haem disorders), renal (proteinuria, urine casts), ANA, immune (anti-dsDNA, anti-Sm, anti-phospholipid), neurological (seizures, psychosis), malar/discoid rash (4/11 = ACR criteria)

26
Q

SLE antibodies

A 
ANA
Anti-dsDNA 60%
Anti-Sm 30%
Anti-Ro 30%
Anti-La 15%
27
Q

SLE investigations

A

Skin biopsy: immune deposits at dermal-epidermal junction
Renal biopsy: glomerulonephritis
FBC: anaemia, thrombocytopaenia, leukopaenia/lymphopaenia
Monitoring: complement and ESR

28
Q

Sjogren’s syndrome

A 
HLA-B8
HLA-DR3
F>M 15-65 yrs
Keratoconjunctiva sicca
Xerostomia
\+/- arthritis, arthralgia, myalgia
29
Q

Sjogren’s syndrome investigations

A

Autoantibodies: rheumatoid factor, ANA 60%, anti-La/Ro
Schirmer’s test: +ve <10mm wet in 5mins
Rose Bengal/Fluorescein stain: punctate or filamentary keratitis (cornea)

30
Q

Pre-scleroderma

A

Raynaud’s phenomenon, nail-fold capillary changes and ANA

31
Q

Scleroderma sine scleroderma

A

1%

Internal organ disease w/o skin changes

32
Q

Diffuse cutaneous systemic sclerosis

A

Raynaud’s phenomenon
Skin changes (truncal) and organ involvement (renal, lung, heart, GI)
Anti-scl70/topoisomerase
Anti-RNA polymerase III

33
Q

Limited cutaneous systemic sclerosis

A

CREST: calcinosis (deposits), Raynaud/s phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia)
Anti-centromere antibodies

34
Q

Antiphospholipid syndrome

A

Women, multiple miscarriages, young
Triad: obstetric complications, thromboembolic events, thrombocytopaenia
Autoantibodies: lupus anticoagulant, anticardiolupin
CLOT: clotting disorders, livedo reticularis, obstetric complications, thrombocytopaenia

35
Q

Fibromyalgia

A

At least 3 months
11 out of 18 points (9 pairs) tenderness immediately elicited: suboccipital muscle insertions, anterior aspects of C5-7, midpoint of upper border trapezius, origin of supraspinatous, 2nd CC, lateral humeral epicondyle, upper outer gluteal quadrant, greater trochanter, knee
Allodynia + hyperesthaesia

36
Q

Polymyositis

A

Endomysial inflammation
Preservation of fine motor movements
Proximal weakness (climbing stairs, getting out of chair)
Anti-Jo1
Muscle biopsy: beta-amyloid (Congo red staining)

37
Q

Dermatomyositis

A

Petimysial inflammation
Polymyositis + skin changes
Heliotrope rash (eyes), Gottron’s papules (knuckles), shawl sign (shoulders), calcinosis
Anti-Mi2
Muscle biopsy: beta-amyloid (Congo red staining)

38
Q

Polymyalgia rheumatica

A

Limited active movement shoulders/hips in the morning (improves throughout day)
No weakness
Tenosynovitis
Ix: ESR (elevated), USS/MRI (joint effusion)

39
Q

Polymyalgia rheumatica management

A

Prednisolone + taper down
Osteoporosis prophylaxis: vitamin D, calcium, bisphosphonates
Methotrexate/steroid sparing agents
NSAIDs

40
Q

Carpal tunnel syndrome

A

Idiopathic
Secondary ot tenosynovitis, bone, fluid retention, obesity, menopause, diabetes, renal disease
Intermittent hand numbness, difficulty extending the fingers

41
Q

Carpal tunnel syndrome investigations

A

Tinel’s test: tap = provokes symptoms

Phalen’s test: flexion of wrist 1min causes symptoms

42
Q

Osteomyelitis

A

Infection of bone (s. aureus and s. pygogenes/group A strep)

Young children w/ low grade fever, non specific pain, redness/swelling

43
Q

Sarcoidosis

A 
Diagnostic: non-caseating granuloms with multi-nucleated Langhans cells, activated epithelioid cells and mononuclear cells
Dry, unproductive cough
Lupus pernio (red-blue infiltration of cheeks)
Erythema nodosum
44
Q

Lofgren syndrome

A 
Acute sarcoidosis (self-resolving)
Fever
Erythema nodosum
Polyarthralgia/polyarthiritis
Bilateral hilar lymphadenopathy

Year 3 Buzzwords (6 decks)

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