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phase 3b > Rheumatology > Flashcards

Rheumatology Flashcards

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1
Q

Presentation of OA

A

pain ± stiffness

Thumb base, hip, knee

random exacerbations for weeks/months

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2
Q

what would you find on examination for OA

A

Heberdens nodes - DIP
Bouchards nodes - PIPs
synovial thickening
deformity effusion
crepitus
decreased function
muscle weakness and wasting

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3
Q

X-ray findings for OA

A
  1. decreased joint space
  2. osteophytes
  3. subchondral sclerosis
  4. subchondral cysts
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4
Q

management of OA

A

regular review

pain relief: para/NSAIDS -> opioid/cox2 inhib

IA steriod injections

joint replacement

lifestyle: weight, physio

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5
Q

What is the pathology of Rheumatoid arthritis?

A

synovial inflammation -> synovial proliferation -> pannus -> art cart destruction -> bony erosions

RF by B cells locally
Inflam caused by factors produced by T cells, macrophages, mast cells and fibroblasts

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6
Q

Presentation of RA

A

joint pain and stiffness (>30m in morning)

PIPJs small joints in hands/wrists/feet

General fatigue and malaise

+systemic features

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7
Q

Examination findings for RA

A

symmetrical joint inflam
muscle wasting

ulnar deviation
swam neck
boutonnieres
Z deformity

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8
Q

Systemic features of RA

A

eyes: Sjorens syndrome
Skin: ulcers rashes
Rheumatoid nodules: eyes, subcut, lungs, heart
Neuro: peripheral nerve entrapment
resp: pulmonary fibrosis
Cardio: MI
Liver: hepatomegaly

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9
Q

RA investigations

A

Rheumatoid factor

Anti CCP (cyclic citrullinated peptide)

X-ray

  1. soft tissue swelling
  2. periarticular osteopenia
  3. loss of joint space
  4. erosions
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10
Q

RA management

A

NSAIDS and Cox 2 inhib
Corticosteriods - PO/ injection, symptomatic

2 X DMARD - methotrexate, sulfasalazine, leflunomide, hydroxychloroquinine

TNF inhib - infliximab

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11
Q

Septic arthritis causative organsisms

A

STAPH AUREUS

Strep

neisseria (young person, sexual history)

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12
Q

Septic arthritis risk factors

A

IVDU

immunosuppressed

prosthetic (prior joint damage)

Diabetes

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13
Q

Septic arthritis presentation

A

acute painful red swollen monoarthritis with fever

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14
Q

Septic arthritis management

A

Start broad spec ABx
X-ray
Aspirate (gram stain m C&S, crystal analysis)
fluclox 6 weeks clindamycin if allergic

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15
Q

Gout crystal

A

sodium urate

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16
Q

gout presentation

A

acute painful red swollen joint

MPJ, ankle, knee, elbow, wrist, fingers

tophi (chalk appearance under skin, asymmetrical)

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17
Q

gout diagnosis

A

clinical

serum urate >360
aspiration: needle shaped crystals

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18
Q

Gout management

A

NSAIDS (diclofenac, naproxen, indometacin)

Colchicine (4-6 daily until symptoms resolve)

Pred

Canankinumab

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19
Q

Gout triggers

A

red meat

alcohol

dehydration

diuretics

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20
Q

Gout prophylaxis

A

allopurinol (after symtoms settle)

lifestyle

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21
Q

Pseudogout crystals

A

calcium pyrophosphate

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22
Q

pseudogout presentation

A

acute painful red swollen joint (milder than gout)

Knee, ankle, wrist, feet, shoulder

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23
Q

Pseudogout diagnosis

A

X-ray Chondrocalcinosis

aspiration: rhomboid shaped crystals

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24
Q

Sign and condition

A

Chondrocalcinosis

pseudogout

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25
Management of pseudogout
NSAIDS colchicine steriod injection treat any primary conditions
26
triggers for pseudogout
illness: flu, chest infection, fever hyperparathyroid, hypothyroid, hypomagnesaemia
27
Causes of Reactive arthritis
post enteric: **campylobacter,** salmonella post veneral: **gonorrhea,** chlamydia
28
Reactive arthritis presentation
1-6 weeks post infectious * asymmetrical lower extremity oligoarthritis * commonly pain lower back * conjunctivitis, urethritis, arthritis,
29
reactive arthritis investigations
Aspirate: increased WCC RBC: increased ESR/CRP Stool sample cultures: causative organism serology: gono or chlamydia HLA-B27 antigen +Ve
30
What is this and in which condition is it seen
Keratoderma blenorrhagicum - reactive arthritis
31
how is reactive arthritis managed
self limiting, symptoms resolve 3-12 months * rest and aspirate * physio * NSAIDS * corticosteriods (PO/inject) * Abx
32
what is perthes and who gets it
self limiting hip disorder caused by ischaemia -\> necrosis of femoral head males 4-8 with delayed skeletal maturity
33
How does perthes present?
hip/knee pain -\> limp decreased ROM
34
Perthes investigations
FBC, ESR, X-ray X ray shows widening joint space and remodelling deformities
35
Perthes management
if \<50% of fem head affected then bed rest and NSAIDS If \>50% fem head affected then plaster cast and surgery
36
Perthes X ray findings
Widening joint space decreased size of nuclear femoral head with patchy density collapse and deformity of femoral head
37
what is pagets
bone remodelling disorder with increased osteoclast -\> increased osteoblasts -\> weak and disorganised bone
38
pagets presentation
* axial skeleton * normally asymptomatic picked up incidentally * bone pain
39
Pagets investigations
* Bone specifc alkaline phosphatase levels increased * X-ray * isotope scan
40
Pagets management
NSAIDS IV/PO bisphosphonates (zoledronate) + calcium and vit D
41
what is charcots?
neuropathic joints caused by decreased sensation leading to damage
42
causes of charcots
Developed countries: diabetes, diabetic neuropathy developing: leprosy
43
charcots presentation
redness, warmth, swelling, deformity., loss of function _pain non proportional to state of joint_
44
charcots investigations
x-ray, early OA changes, disruption later HbA1c to assess db control
45
charcots management
education and treatment of underlying disease immbolisation, cast changed weekly for 3-6 months podiatry referral bisphosphonates can help heal bone in acute phase surgery in chronic - amputation
46
Pagets complications
Triad: Pain, deformity, fractures Deafness, osteosarcoma
47
Symptoms of antiphospholipid syndrome
Venous/arterial thrombosis recurrent mis Pre-E Mottled skin - livedo reticularis thrombocyopenia
48
How do u confirm antiphospholipid syndrome?
anti-cardiolipin antibodies
49
how do u manage antiphospholipid syndrome? What is it associated with?
Warafin 6m or lifelong if recurrent SLE
50
What is systemic scleorsis?
hardened sclerotic skin and other connective tissues
51
What factor results would u get in systemic sclerosis?
ANA +ve RF +ve Anti-scl-70: diffuse cutatneous systemic Anti-centromere: limited cutaneous systemic
52
Symptoms of limited cutaneous systmic sclerosis?
**_CREST_** **C**alcinosis (white deposits) **R**aynauds o**E**sophageal (dysphagia) **S**clerodactyly **T**elangiectasis (spider naevia)
53
Management of systemic sclerosis
Raynaurds: nifedipine consider Methotrexate
54
what is polymyalgia rheumatica?
giant cell vasculitis
55
How does PMR present?
pt \>60 onset \<1m morning aches and stiffness in prox limbs, lethary, depression, low grade fever, anorexia, night sweats
56
PMR Ix and Mx
Increased ESR (diagnosis of exclusion) Pred
57
What causes Marfans?
Autosomal dominant condition causes decreased fibrin
58
Features of Marfans
Tall pectus excavatum scoliosis archnodactyly
59
Heart things in Marfans
dilated aortic sinus increased risk of aneurysms, dissection and regurg
60
Mx of Marfans
Echo BB and ACE-I
61
What is SLE
autoimmune type 3 hypersensitiviy reaction
62
Symptoms of SLE
General: fatigue, mouth ulcers Skin: photosensitive rash, malar rash which comes and goes, alopecia CV: pericarditis Renal: Lupus nephritis (test urine, deadly) Haem: pancytopenia
63
Causes of pancytopenia in SLE and how to differentiate between
Treatment: hypoplastic conditon: hyperplastic
64
Investigations in SLE
**Anti dsDNA and anti Smith +Ve** **Low C3 and C4** ANA +Ve RF: either
65
Management of SLE
Education and support NSAIDS: joint pain hydroxycholoroquinine: skin lesions, malasia, myalgia steriods reserved for life threatening
66
What is dermatomyosis
Inflam disorder causing symmetrical proximal weakness and skin lesions
67
Causes of dermatomyosis
Idiopathic
68
symptoms of dermatomyosis
photosensitive, back/shoulders red papules over extensor surfaces of fingers Raynaurds, muscle weakness and tenderness
69
Ix and management for dermatomyositis
ANA +ve Sun block steriods azathioprine
70
Presentation of ank spon
young male with lower back pain and stiffness worse in morning better with exercise
71
OE ank spond
decreased lat and forward flex decreased chest expansion
72
Ix for ank spon
X-ray: sacroiliitis, lumbar sparing, bamboo spine
73
management of ank spon
NSAIDs sulphasalazine
74
what is Sjorgrens syndrome
autoimmune disorder affecting exocrine glands
75
How does Sjogrens present?
dry: eyes, mouth vagina arthralgia, Raynaurds, myalgia
76
Investigations of Sjorgrens
RF +ve ANA +ve Anti Ro and La
77
Management of Sjorgrens
artificial tears pilocarpine

phase 3b (15 decks)

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