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4th Year Exam > Rheumatology ILOs > Flashcards

Rheumatology ILOs Flashcards

(75 cards)

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1
Q

Which gene is associated strongly with rheumatoid arthritis?

A

HLA-DR4

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2
Q

Give 4 deformities seen in RA

A

Swan neck
Boutonnière
Z-thumb
Ulnar deviation

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3
Q

Give 3 symptoms of RA

A

Pain
Stiffness (morning >1 hour)
Small joint affected

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4
Q

Outline the pathophysiology of RA

A

Synovial lining becomes hyperplastic, infiltrates synovium causing erosions

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5
Q

Give 2 blood test used specifically to assess RA

A

Rheumatoid factor (IgM antibody)

Anti CCP antibody

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6
Q

Give 3 signs seen on X-ray in RA

A

Peri-articular osteopenia
Erosions
Subluxation

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7
Q

Give 3 classes of drug treatment for RA

A

Analgesia
DMARDs
bDMARDs

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8
Q

Give 3 examples of DMARDs

A

Methotrexate (folate antagonist)

Hydroxychloroquine

Sulfasalazine

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9
Q

Define the 2 types of OA and give 2 symptoms

A

Primary and Secondary (due to other cause like Paget’s)

  • Pain worse on movement
  • Stiffness after inactivity
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10
Q

Give 4 signs seen on an OA X-Ray

A

Subchondral cysts
Subchondral sclerosis
Joint space narrowing
Osteophytes

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11
Q

Give 2 microscopic changes seen in OA

A

Fissuring cartilage

Nodules of reactive bone

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12
Q

What will Rheumatoid factor and Anti-CCP antibody show in OA?

A

Negative

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13
Q

Give 3 management options in OA

A

Analgesia
Physiotherapy
Surgery

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14
Q

Define psoriatic arthritis and which gene it is associated with

A

Seronegative inflammatory arthritis with 3 or more swollen joints asymmetrically

HLA-B27

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15
Q

Give 3 symptoms of psoriatic arthritis

A
  • Morning pain >30 mins
  • Dactylitis
  • Psoriasis
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16
Q

Outline the pathophysiology of psoriatic arthritis

A

CD8+ cells cause hypervascularity in synovium

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17
Q

How is psoriatic arthritis differentiated from RA?

A

DIP involvement and dactylics in psoriatic arthritis but not RA

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18
Q

Give 2 X-ray signs seen in psoriatic arthritis

A

Erosions

Osteolysis (pencil in cup)

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19
Q

Give 3 drug treatments for psoriatic arthritis

A

NSAIDs
Steroids in flare
DMARDs

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20
Q

Give 3 features of septic arthritis affecting one joint

A
  • Cardinal inflammation features
  • Fever
  • Leukocytosis/raised CRP
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21
Q

How many joints are usually affected in polyarticular septic arthritis and name 2 common organisms

A
  • 4 joint average

Strep and Staph

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22
Q

Give 3 risks of septic arthritis

A
  • Previous arthritis
  • Trauma
  • Diabetes
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23
Q

What is gold standard Dx for septic arthritis?

A

Joint aspirate

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24
Q

Define gout and give common clinical features

A

Hyperuricaemia and deposition of urate crystals causing attacks of acute inflammatory arthritis

Severe acute pain, commonly feet

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25
Give 3 risks of gout
- Age - Male - Obesity
26
How do gout crystals appear compared to pseudo-gout?
Gout: needle shaped, negatively birefringent PG: rhomboid crystals, weakly positively birefringent
27
Give 2 management options for gout
NSAIDs | Allopurinol
28
Define pseudo-gout and give 2 risks
Calcium pyrophosphate deposition associated with acute and chronic arthritis - Age - Hyperparathyroidism
29
Give 2 management options for pseudo-gout
NSAIDs | Colchicine
30
Define temporal arteritis
Granulomatous vasculitis of large and medium sized arteries, affecting branches of external carotid artery commonly
31
Give 3 symptoms of temporal arteritis and which condition it is associated with
- Headache - Jaw claudication - Loss of vision Polymyalgia Rheumatica
32
Give 2 risks of Temporal arteritis
- Female | - Caucasian
33
What is gold standard Dx for Temporal arteritis and what is the main form of treatment?
Temporal artery biopsy Prednisolone
34
Define Polymyalgia Rheumatica
Inflammatory syndrome causing pain and morning stiffness in neck, shoulder and or pelvic girdle in those over 50, unclear cause
35
Which Interleukin is thought to be associated with Polymyalgia Rheumatica?
IL-6
36
Give 3 management options for Polymyalgia Rheumatica
Prednisolone NSAIDs Calcium
37
Define osteoporosis and give 1 risk
Skeletal disorder characterised by compromised bone strength, porous bone, often leads to fragility fractures Early menopause (<45)
38
Outline the pathology of osteoporosis
Imbalance of bone formation and resorption leads to decreased bone mass and higher fracture risk
39
How is osteoporosis diagnosed?
DEXA scan (T < -2.5)
40
How is 10 year fracture risk assessed for osteoporosis?
FRAX/Qfracture score
41
Give 2 drug treatments for osteoporosis
Adcal D3 | Bisphosphonate
42
Define Ankylosing Spondylitis and which gene it is commonly associated with
Progressive inflammatory arthropathy affecting sacroiliac joints and axial spine HLA B27
43
Give 2 symptoms and 2 risks for Ankylosing Spondylitis
Back pain + Enthesitis Male + late teens/early 20s
44
Briefly outline the pathophysiology of Ankylosing Spondylitis
Increased osteoclasts cause inflammation and cartilage erosion
45
Give 2 signs which may be seen on spinal imaging in Ankylosing Spondylitis
Vertebral body squaring | Peripheral large joint arthritis
46
Give 2 treatments for Ankylosing Spondylitis
NSAIDs | Sulfasalazine
47
Give the 5 most common primary cancers to cause secondary bony mets
``` Prostate Breast Follicular thyroid Renal Bronchi ```
48
Name a benign primary bone tumour
Osteoid Osteoma
49
Define osteosarcoma
Tumour whose cells form bone, commonly in young males
50
Give an example of a benign and malignant cartilage tumour
B: Enchondroma M: Chondrosarcoma
51
Who does Ewing's sarcoma usually occur in and what chromosome translocation is commonly seen?
5-15 y/o in long flat bones 11/22 translocation
52
Define SLE and give 3 features
AI chronic multi-system disorder commonly affecting women in reproductive years - Photosensitive rash - Malar rash - Raynaud's
53
Give 3 investigations for SLE
- ESR - ANA - APTT (prolonged)
54
Give 3 drug treatments for SLE
Steroids DMARDs Rituximab
55
Define Sjogren syndrome and give 2 risks
AI disease characterised by dry eyes and dry mouth due to lymphocytic invasion of lacrimal and salivary glands - Female - SLE
56
Define Polymyositis
Inflammatory myopathy affecting skeletal muscle affecting adults commonly between 30-60
57
Give 2 investigations for Polymyositis
CK (elevated) | Muscle biopsy
58
Define dermatomyositis and give 2 skin features
Idiopathic inflammatory myopathy characterised by skin manifestations - Gottron’s papules - Heliotrope rash
59
Define vasculitis
AI condition causing inflammation of blood vessels in any location e.g. skin, ENT, nerves…
60
Define Henoch-Schölein Purpura and give 2 symptoms
Small vessel vasculitis common in 2-11y/o - Purpuric rash - Ulcers
61
What are the 3 types of ANCA-associated small vessel vasculitis?
1. Microscopic polyangitis 2. Granulomatosis with polyangiitis (GPA) 3. Eosinophilic granulomatosis with polyangiitis (EGPA)
62
Which 2 antibody tests can be done in suspected vasculitis?
cANCA | pANCA
63
Give 3 drugs to induce remission in vasculitis
Prednisolone Rituximab Methotrexate
64
Define reactive arthritis
Bacteria cannot be aspirated from the joint to culture, infection instead occurs due to another infection in the body e.g. Chlamydia
65
Give 2 risks of reactive arthritis
HLA B27 | Male
66
What is the triad in reactive arthritis?
Arthritis Conjunctivitis Urethritis
67
Give 2 investigations for reactive arthritis
Joint aspirate to exclude sepsis Urethral/cervical swab
68
Define Paget's disease of the bone and give 3 common sites
Chronic bone disorder that is characterised by focal areas of increased bone remodelling, resulting in overgrowth of poorly organised bone - Pelvis, femur, skull
69
Which LFT may be elevated in Paget's and give 2 signs seen on bone scan
ALP Cortical thickening + sclerosis
70
Give 2 risks of Paget's
>55y/o | Temperate climate
71
Name 6 things to look for on inspection of hands (DREAMS)
``` Deformity Rashes Erythema Asymmetry Muscle wasting Swelling/skin changes ```
72
What nodes are commonly seen in OA and where do they occur?
Heberden's nodes in DIPs
73
Where does a Bouchard node commonly affect?
Proximal interpharyngeal joints
74
What can be seen on an X-ray of gout and pseudo-gout respectively?
G: Tophi PG: Chondrocalcinosis
75
Define the symptoms of scleroderma using CREST
``` Calcinosis Raynaud's Esophageal dysfunction Sclerodactyly (thick and tight skin on fingers) Telangectasia ```

4th Year Exam (20 decks)

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