Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 2a > Rheumatology > Flashcards

Rheumatology Flashcards

(113 cards)

Start Studying
1
Q

what is inflammation

A

reaction of microcirculation
movement of fluid and WBC into extra-vascular tissues
pro-inflammatory cytokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 4 pillars of inflammation

A 
rubor = red
dolor = painful
calor = heat
tumour = swollen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how may inflammation present

A

4 pillars +
stiffness
poor mobility/function
deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how may inflammatory joint pain progress

A

eases with use of joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how may degenerative pain progress

A

pain increases with use = clicks/clunks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

describe the difference in presentation of inflammatory and degenerative joint pain

A
  1. inflammatory = >60 mins vs <30 mins for degenerative
  2. degenerative = not clinically inflamed (hot and red)
  3. inflammatory responds to NSAIDs, degenerative not so much
  4. inflamm = hands and feet, degenerative = CMC, DIP joints (NOT AS A RULE)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the demographic for inflammatory pain

A

young
psoriasis
family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the demographic for degenerative joint pain

A

older

prior occupation/sport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does PRISMS stand for

A 
Pain
Rash/skin lesions
Immune
Stiffness
Malignancy
Swelling/sweats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what acronym can be used for history taking of rheumatological complaint

A

PRISMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is dactylitis

A

inflammation of a digit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is enthesitis

A

inflammation of the entheses = site where tendon or ligament insert into bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe how ESR is measured

A
  1. blood sample is centrifuged
  2. time taken for RBC to fall is measured
  3. increased fibrinogen in inflammation = stick to RBC = makes them heavier = fall faster
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is an ESR

A

erythrocyte sedimentation rate = increases in inflammation/infection
takes weeks to change relative to inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is CRP

A

C-reactive protein
increases in inflammation
rises and falls rapidly = good indicator of current inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are auto-antibodies

A 
immunoglobulins that bind to self
most commonly looked for:  IgM
IgG
CCP
ANA
anti-dsDNA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what auto-antibodies are found in rheumatoid arthritis

A 
RF = rheumatoid factor
CCP = cyclic citrullinated peptide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what auto-antibodies are found in systemic lupus erythematosus

A 
ANA = antinuclear antibody = binds to antigens in cell nucleus
dsDNA = double stranded DNA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is spondyloarthritis (SpA)

A 
umbrella term for group of conditions with inflammatory joint changes
1. ankylosing spondylitis AS
2. psoriatic arthritis PsA
3. enteropathic arthritis
4. reactive arthritis
= associated with HLA-B27 gene
= seronegative so no RF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is HLA B27

A

human leucocyte antigen B27
= a tissue type that plays a role in antigen presenting in immune system
a person is either HLAB27 positive or negative = +ve does not mean you will get AS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

where is CRP produced

A

produced by liver in response to IL-6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

name the 3 hypothesis of how HLAB27 is linked with disease

A
  1. molecular mimicry
  2. mis-folding theory
  3. HLA B27 heavy chain homodimer hypothesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

SPINEACHE to describe features of SpA

A 
Sausage digit
tabiasis
Inflammatory back pain
NSAID good response
Enthesitis (heel)
Arthritis
Crohns/Colitis/CRP elevated
HLA B27
Eye uveitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is particular in diagnosis of alkylosing spondylitis

A

can have normal CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is syndesmophytes
new bone formation and vertical growth from anterior vertebral corners
26
what is sacroiliitis
``` sclerosis erosions loss of space fusion = of sacroiliac joint ```
27
what is delayed damage theory
once inflammation has occurred = new bone formation is inevitable
28
what factors would differentiate inflammatory back pain IBP from general back pain
``` age of onset below 40 insidious onset improvement with exercise pain at night no improvement with rest ```
29
how is axial spondyloarthritis diagnosed using the ASAS classification criteria
1. sacroiliitis on imaging plus 1+ SpA feature (SPINAECHE) | 2. HLA B27 plus 2+ SpA features
30
what is osteoporosis
systemic skeletal disease low bone mass microarchitectural deterioration of bone tissue increase in bone fragility and susceptibility to fracture = bone not weaker, just less of it there
31
describe the changes in trabecular architecture with ageing
decrease trabecular thickness decrease in connections between horizontal trabeculae decrease in trabecular strength
32
why does osteoporosis increase in women
menopause = loss of restraining effects of oestrogen on bone turnover high bone turnover = more resorption than formation cancellous bone loss michroarchitectural disruption
33
what is DEXA
dual energy Xray absorptiometry = low radiation = measures important fracture sites
34
what is a T score
standard deviation score = compared with gender matched young adult average of peak bone mass (??)
35
why is Cushing's syndrome a risk factor for osteoporosis
cortisol increases bone resorption and induces osteoblast apoptosis
36
what is osteomalacia
metabolic bone disorder = low mineral bone content and vitamin D deficiency = soft bones but normal amount
37
what causes osteomalacia
``` vit D deficiency resistance to vit D liver disease tumour induced osteodystrophy ```
38
what are the signs/symptoms of osteomalacia
bone pain myalgia pathological fracture
39
how does osteomalacia present in children
= rickets | = bowed legs and knocked knees
40
how is osteopenia diagnosed
DEXA scanning = score of -1 to -2.5 = osteopenia
41
how is osteoporosis diagnosed
DEXA scanning = score -2.5 or worse = osteoporosis
42
how is osteomalacia treated
increase Vit D and calcium dietary intake | Vit D and calcium supplements = cholecalciferol or calcitriol
43
what is vasculitis
inflammation of blood vessel walls with subsequent impaired blood flow = vessel wall destruction = perforation = haemorrhage into tissues also causes endothelial injury = thrombosis and ischaemia/infarction of tissues
44
how is vasculitis classified
primary/secondary = if due to pre-existing condition or random vessel size = small/large ANCA = positive or negative target organ affected
45
what are ANCA
anti- nuclear cytoplasmic antibody = specific antibodies for antigens in cytoplasmic granules of neutrophils and monocyte lysosomes
46
name the main large vessel vasculitis
giant cell arteritis (temporal arteritis) = primary Takayasu's arteritis = primary aortitis in RA = secondary
47
name the main small vessel vasculitis
granulomatosis with polyangiitis (GPA) = primary Churg Strauss = primary microscopic polyangiitis = primary vasculitis secondary to autoimmune disease = secondary
48
what is the name of vasculitis classification
Chapel Hill
49
what is the most common condition affecting the synovial joints
osteoarthritis
50
what is osteoarthritis
a degenerative arthritis which affects synovial joints and characterised by articular cartilage degeneration
51
what tissues of the joint are involved in osteoarthritis
all tissues are involved but articular cartilage is most affected
52
describe the process of osteoarthritis
``` metabolically active and dynamic process = mediated by cytokines including: IL1 TNFalpha NO as well as driven by mechanical forces ```
53
what are the main pathological features of osteoarthritis
loss of cartilage | disordered bone repair
54
what joints does OA affect
``` knees = medially spreading laterally through patellofemoral compartment hips big toe spine hands = DIP, PIP, CMC joints ```
55
what is an arthroscopy
removal of loose bodies = prevents joint locking
56
what is an osteotomy
realignment of the knee by removing section of bone
57
what is fusion surgery
done in complex joints where replacement cant be done = fuse joints
58
what joints are affected in OA of the hands
distal interphalangeal joint carpometacarpal joint
59
where is the CMC joint
connecting trapezium of thumb to first metacarpal of the thumb
60
what compartment of the knee is most affected by osteoarthritis
medial
61
what is erosive/inflammatory OA
subset of OA strong inflammatory component can be treated with DMARDs
62
what is a loose body
bone or cartilage fragment leads to locking of joint
63
what is a discoid rash
red patches of skin associated with scaling and plugging of hair folicles
64
what is a butterfly rash
fixed red patches over cheeks
65
what is marfans syndrome
inherited autosomal dominant condition causes lack of fibrillin caused by mutation in FBN1 gene not curable = genetic counselling, surgical management
66
what are the signs/symptoms of marfans
aortic aneurism (root) aortic dissection coarctation of aorta tall, long arms dislocation of lens high arched pallet
67
what is EDS
Ehlers-Danlos syndrome autosomal dominant condition causes defective type 1 and 2 collagen production no treatment = manage complications
68
what are the signs/symptoms of EDS
hyper elastic skin hypermobile joints joint deformities early onset osteoarthritis easy bruising anal prolapse valvular heart disease
69
what population groups are more commonly affected by SLE
afro-Caribbean/asian
70
what test are done to diagnose SLE and which is specific for SLE
anti-nuclear antibody | double stranded DNA antibody = specific
71
what diseases can Raynauds be seen as a secondary condition to
systemic sclerosis mixed connective tissue disease SLE
72
what are the vascular damage causes of raynauds
atherosclerosis frost bite vibrating tools
73
what is Raynauds phenomenon
lack of blood flow in the microvasculature circulation causing cold and cyanosed fingers in the cold and increased blood flow in the warm = red/purple hands
74
what is the difference between scleroderma and systemic sclerosis
scleroderma only affects skin/underlying soft issue | systemic sclerosis affects internal organs
75
how is localised scleroderma divided
``` morphea = discoloured oval patches, itchy and hairless linear = thick skin along face, scalp, legs, arms ```
76
how is systemic scleroderma divided
``` limited = milder form, mostly affecting skin diffuse = affects whole body/ internal organs ```
77
what is dermatomyositis
inflammation of muscles with a skin rash | more common in women
78
what is polymyositis
inflammation of muscles which affects many different muscles particularly shoulders hips and thighs more common in women
79
what organ can be affected in dermatomyositis/polymyositis
lungs = interstitial lung disease
80
what is the treatment of dermatomyositis/polymyositis
steroids | immunosuppressant drugs
81
how is osteomalacia diagnosed
low calcium low phosphate high alkaline phosphatase biopsy shows incomplete mineralisation
82
what does SHATTERED stand for (Presentation of osteoporosis)
``` Steroid use >5mg/day Hyperthyroidism/parathyroidism/calciuria Alcohol and tobacco Thin Testosterone low Early menopause Renal/liver failure Erosive/inflammatory bone disease Dietary calcium low/DMT1 + Family history ```
83
explain SOAP BRAIN MD in the presentation of SLE
``` Serositis = pleurisy/pericarditis Oral ulcers Arthritis Photosensitivity Blood cytopenias Renal involvement Antinuclear antibodies Immunological phenomena (dsDNA) Neurological = psychosis/seizures Malar rash Discoid rash ```
84
what does CREST stand for and what disease does it describe
``` systemic sclerosis: Calcinosis = Ca skin deposits Raynauds Esophageal stricture/reflux Sclerodactyly = thick skin fingers/toes Telangiectasia = dilated facial spider veins ```
85
what is the treatment progression for osteoporosis
alendronice acid --> denosumab --> teriparatide | denusomab can be used if alendronic acid is CI or not tolerated
86
what drugs can cause osteoporosis
``` steroids alcohol anti-epileptics lithium cyclosporin PPI ```
87
what DMARDs can precipitate gout
methotrexate | sulfasalazine
88
what is polymalgia rheumatica
common old people muscle stiffness raised inflamm markers ESR >40mm/hr
89
how does polymyalgia rheumatica present
>60 rapid onset morning stiffness in proximal limbs mild polyarthralgia, lethergy, low-grade fever
90
how is polymyalgia rheumatica managed
prednisolon 15mg/OD usually dramatic response
91
what is polyarteritis nodosa (PAN)
vasculitis affects medium arteries necrotising inflammation leading to aneursym formation
92
what are the features of polyarteritis nodosa
middle age men + hep B fever, malaise, WL hypertension testicular pain haematuria ANCA in 20% hep B +ve in 30%
93
what is systemic sclerosis
unknown aetiology 4x more in females hardened sclerotic skin and other connective tissues 3 patterns: 1. limited cutaneous systemic sclerosis (incl CREST) 2. diffuse cutaneous systemic sclerosis 3. scleroderma
94
describe limited cutaneous systemic sclerosis
raynauds scleroderma affecting face + distal limbs anti-centromere antibodies CREST is a subtype
95
describe diffuse cutaneous systemic sclerosis
scleroderma affecting trunk + proximal limbs anti-scl-70 antibodies interstitial lung disease + pulmonary hypertension = mortality +++ renal disease poor prognosis
96
describe the antibodies found in systemic scleroderma
ANA Ab in 90% RF +ve in 30% antiscl-70 in diffuse anticentromere in limited
97
describe the findings of joint aspiration in gout
monosodium needle shaped crystals negatively befringent
98
what is raised in gout and what is first line and second line treatment
uric acid 1. nsaids 2. colchicine (in renal impairment)
99
what is the treatment for polymyalgia rheumatica and what should you co-prescribe
15mg prednisolone OD + PPI + bisphosphonates + Ca + VitD
100
triad of reactive arthritis
1. conjunctivitis 2. urethritis 3. arthritis
101
describe the management for SLE + what can discoid LE rarely progress to
sun protection hydroxychloroquine topical steroids injected steroids squamous cell carcinoma
102
what is the management of GCA
40-60mg OD prednisolone 500-1000mg OD methylprednisolone if vision loss or jaw claudication
103
what is henoch schonlein purpura caused by and what are the 4 main features
IgA immunoglobulin 1. joint pain 2. abdo pain 3. renal involvement 4. purpura
104
55 year old with pain and weakness in thighs, shoulders, upper arms purplish rash on eyelids rash over interphalangeal joints on hands
dermatomyositis raised creatinine kinase anti MI 2 + ANA antibodies muscle biopsy is definitive treat with corticosteroids
105
what is behcets disease? how does it present? what gene is it associated with? how is it treated?
oral and genital ulcers joint pain and swelling HLA B51 treat with topical steroids
106
medicine to treat raynauds
prophylactic nifedipine
107
what is the problem in sjogrens? what conditions can it be secondary to? what antibodies? treatment?
exocrine glands RA and SLE anti RO + anti LA hydroxychloroquine can halt progression
108
what investigations for synovitis and what is the scoring system for RA
USS DAS28
109
first line treatments for RA
methotrexate sulfasalazine leflunamide (with a bridging dose prednisolone) 2. TNF inhibitors
110
what investigations must you do when starting a TNF inhibitor and why
chest XR can reactivate TB
111
what cancers cause erythema nodosum EN? what infections cause EN? what medications cause EN?
leukemia lymphoma strep throat TB mycoplasma pneumonia GE COCP NSAIDs
112
what is the screening tool for psoriasis and what is an extreme form
psoriasis epidemiological screening tool arthritis mutilans
113
what is buergers disease
thromboangiitis obliterans smoker with blue fingers = ulcers, gangrene, amputation corkscrew collaterals on angiography STOP SMOKING COMPLETELY

Phase 2a (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions