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Year 3 St Peter's Hospital Tutorials > SBAs: Rheumatology > Flashcards

Flashcards in SBAs: Rheumatology Deck (28)
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1

Why does gout so often present in the big toe?

Last place blood reaches from aorta, poor venous return, uric acid able to accumulate

2

Describe the symptoms of gout

Erosive arthritis: warm, swollen, tender and very painful

3

Recall a sign of gout away from the monoarthropathy

Tophi (lumps of uric acid) in ears and on elbows

4

What is the dietary component that causes gout in excess, and in what sort of foods is it found?

Purines: port, red wine, cheese

5

Recall 3 causes of gout

1. Purine-rich diet
2. Kidney failure
3. Leukaemia/ lymphoma

6

How does leukaemia lead to gout?

Tumour lysis syndrome
Very high levels of urate released following chemotherapy

7

What urate level is diagnostic of gout?

>450

8

Describe the shape of the crystals in gout

Negative birefringent needle-shaped crystals

9

How can you examine crystal shape in gout?

Do a needle biopsy

10

Describe the shape of the crystals in pseudogout

Positive birefringent rhomboid-shaped crystals

11

What tests must be done when gout is suspected?

Needle biopsy
X ray of joint

12

What is the management of acute gout, and what must you be particularly careful about?

NSAIDs and steroids
Cannot give NSAIDs to renal failure patients

13

What is the management of chronic gout?

Allopurinol

14

What is the mechanism of action of allopurinol?

Xanthine oxidase inhibitor

15

How can patients with tumour lysis syndrome be protected from gout?

Giving prophylacted IV rasburicase: it is a recombinant urate oxidase

16

What sort of nodes do you see in osteoarthritis?

Heberden's (distal)
Bouchard's (proximal)

17

Recall the mnemonic for and the X ray features of osteoarthritis

LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

18

When is rheumatoid arthritis pain worst?

Morning

19

Which joints are most commonly affected by rheumatoid arthritis?

MCP and PIP

20

Recall 3 features of rheumatoid arthritis on the hands

Swan-necking
Boutoniere
Ulnar deviation

21

Which is the most specific immunoglobulin to rheumatoid arthritis?

Anti-CCP

22

What score is used to grade the severity of rheumatoid arthritis?

DAS28

23

Recall the medical management of rheumatoid arthritis

DMARDs

24

Recall an example of a DMARD drug

Methotrexate

25

What is the mechanism of action of methotrexate?

Anti-folate - interferes with DNA replication

26

Describe the appearance of psoriatic arthritis on the hands

Brown mail discolouration
Oncholysis

27

Which joints tend to be affected by psoriatic arthritis?

DIPs

28

How is psoriatic arthritis treated?

Similarly to rheumatoid arthritis with DMARDs