Term
| < 5 joint involvement is known as? |
|
Definition
oligoarthritis
>5 joint is polyarthritis |
|
|
Term
| examples of monoarthritis? |
|
Definition
septic
crystal
OA
trauma e.g haemarthroses |
|
|
Term
| examples of polyarthritis? |
|
Definition
RA
OA
viral e.g hep A/B/C and mumps
reactive and psoriatic arthritis |
|
|
Term
| examples of oligoarthritis? |
|
Definition
ank spond
reactive
psoriatic
crystal
OA |
|
|
Term
if you were aspirating a joint what would you ix for?
could you aspirate through a psoriatic plaque? |
|
Definition
WCC
culture
gram stain
polarised light
no you should aspirate through inflamed skin such as a psoriatic plaque |
|
|
Term
features of OA on xray
LOSS
subarticular sclerosis) hard one to remember |
|
Definition
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis |
|
|
Term
features of RA on xray
remember: Just JLS |
|
Definition
Juxta articular osteopenia
Loss of joint space
Soft tissue swelling
Joint deformity |
|
|
Term
features of gout on XRAY?
PNS |
|
Definition
periarticular erosions
normal joint space
soft tissue swelling |
|
|
Term
which one out of the following 3 has normal joint space on xray?
OA
RA
gout? |
|
Definition
gout
features are:-
periarticular erosions
normal joint space
soft tissue swelling |
|
|
Term
| what features on xray would you see in psuedogout? |
|
Definition
|
|
Term
|
Definition
exercise to improve muscle strength
weight loss if obese
paracetamol and topical NSAIDs: if ineffective use codeine short term or PO NSAID + PPI
topical capsaisin
severe: intra articular steroid
non pharmacological: physio, heat/cold packs, walking aids, stretching, manipulation, TENS |
|
|
Term
| definitive way to manage OA? |
|
Definition
| surgery and joint replacement |
|
|
Term
| if pt takes aspirin and has OA which drugs should be avoided? |
|
Definition
| PO NSAIDs and COX 2 inhibitors |
|
|
Term
| which is the most common surgical procedure for OA of hip? |
|
Definition
|
|
Term
| post advice for pts undergoing hip surgery for OA |
|
Definition
sleep on back for 1st 6 weeks
do not cross legs
avoid low chairs
avoid felxing hip > 90 degrees |
|
|
Term
| how long should you take LMWH after a hip op? |
|
Definition
|
|
Term
| what happens to pain stiffness with use of muscles in OA and RA? |
|
Definition
in OA rest improves pain
in RA stiffness improves on movement. |
|
|
Term
| which joint is affected in more than 50% cases of septic arthritis? |
|
Definition
|
|
Term
| risk factors for septic arthritis |
|
Definition
immunocompromised
DM
age > 80
prosthetic joints
pre existing joint disease
recent joint surgery
IVDU |
|
|
Term
| treat for septic arthritis caused by staph aureus? |
|
Definition
Flucoxicillin 1g/6hours IV
if allergic to penicillin then give
Clindamycin |
|
|
Term
| pt has septic arthritis and hx of MRSA. Which ABx would you give? |
|
Definition
|
|
Term
| which antibx in gonoccocal or gram neg septic arthritis? |
|
Definition
|
|
Term
| which HLAs are involved in RA? |
|
Definition
HLA DR4 and HLA DR1
whats the 41? |
|
|
Term
| frozen shoulder, carpal tunnel and de quervains tenosynotvitis are soft tissue problems associated with which disease? OA or RA? |
|
Definition
|
|
Term
| ulnar deviation of fingers is a late sing in which condition? |
|
Definition
|
|
Term
| where are Heberdons nodes found? |
|
Definition
|
|
Term
seen in RA, this syndrome is characterised by
splenomegaly
neutropenia and
RA
what is it? |
|
Definition
|
|
Term
| which scans are better at detecting synovitis, effusions than conventional exrays? |
|
Definition
|
|
Term
| how is disease activity measured in RA? |
|
Definition
DAS28 score.
the aim is to keep the score < 3 |
|
|
Term
| what is accelerated in RA that results in increased risk of CVS and CVA? |
|
Definition
atherosclerosis
also smoking increases symptoms of RA |
|
|
Term
| what name is given when gout affects big toe? |
|
Definition
|
|
Term
| you see needle shaped negative bifringent urate crystals under polarised light. what are you thinking? |
|
Definition
|
|
Term
|
Definition
high dose NSAIDS or COXIBS should subside symptoms in 3-5 days
if these are CI e.g HF, peptic ulcer, anticoagulation use colchicine |
|
|
Term
in acute mx of gout why might NSAIDS or COXIBS be CI?
what should be used instead? |
|
Definition
CI in HF, peptic ulcer or anticoagulation
use colchicine instead |
|
|
Term
| what is problematic in renal failure and gout? |
|
Definition
use of NSAIDS and colchicine. in this case steroids may be used.
rest and elevation also advised +/- ice packs |
|
|
Term
| when would you start prophylaxis rx with allopurinol? |
|
Definition
if the pt has had >1 attack of gout in 12 months
do not use in acute attacks but 3 weeks after you may start |
|
|
Term
| when might Febuxostat be used? |
|
Definition
prophylaxis of Gout when allopurinol is CI or not tolerated
SE: increased LFTs |
|
|
Term
| features and mx of psuedogout |
|
Definition
risk factors: old age, hyperparathyroid, hypophosphatemia, haemochormotosis
mx: ice pack, rest, intra articular steroids, cochicine nsaids in acute
chornic mx: MTX and hydroxychloroquine have a role
XRAY: soft tissue calcium deposition
tests: positively bifringement rhomboid shaped |
|
|
Term
| features of spondyloarthropathies |
|
Definition
seronegative
rf negative
HLA B27
axial arthritis
extra articular manifestations |
|
|
Term
| earliest xray feature of ank spond? |
|
Definition
sacroilliitis
bamboo spine is a late sign |
|
|
Term
|
Definition
vigourous exercise, not rest. plus physio for posture
NSAIDs if not CI
severe activie disease: TNF alpha blockers
local steroid injections
surgery e.g. hip replacement
consider bisphosphonates due to risk of osteoporotic spinal fractures. |
|
|
Term
| signs of worse prognosis in ankylosing spondylitis? |
|
Definition
ESR > 30
onset < 16 years
early hip involvement
poor response to NSAIDs |
|
|
Term
| in which type of arthritis may you see pencil in cup deformity? |
|
Definition
|
|
Term
| mx of psoriatic arthritis? |
|
Definition
NSAIDS
sulfasalazine
MTX
ciclosporin
anti TNF agents |
|
|
Term
| associated features of reactive arthritis? |
|
Definition
iritis
keratoderma blenorrhagica
circinate balanitis
mouth ulcers
enthesitis |
|
|
Term
| mx of reactive arthritis? |
|
Definition
no cure
splint affected joints
rx NSAIDs or local steroid injections
if symptoms >6 months consider sulfasalazine or MTX |
|
|
Term
| anticentromere Antibodies found in diffuse cutaneous disease? |
|
Definition
FALSE!!
found in limited cutaneous disease
in diffuse cutaneous disease it is SCL-70 antibodies |
|
|
Term
| in CREST syndrome where may HTN present sub clinically? |
|
Definition
|
|
Term
| shawl sign is a rash ove rthe back and should found in which condition? |
|
Definition
dermatomyositis
also Gottrons papules, these are roughened papules over the knuckles |
|
|
Term
| pathognomonic signs of dermatomyositis? |
|
Definition
shawl sign positive
Gottrons papules along with raised CK |
|
|
Term
| which Antibodies seen in SLE? |
|
Definition
anti nuclear antibodies
anti dsDNA antibodies highly specific and indicate disease severity |
|
|
Term
| Libman Sacks syndrome is a non infective endocarditis associated with which AI condition? |
|
Definition
|
|
Term
| anti-Jo antibodies associated with? |
|
Definition
|
|
Term
|
Definition
if 4 out of 11 are present
malar rash
discoid rash
photosensitivity
oral ulcers
non erosive arthritis
serositis
renal disorder
CNS disorder
haematological disorder
immunological disorder |
|
|
Term
| 3 things to monitor in SLE? |
|
Definition
Anti dsDNA antibodies
complement levels of C3/4
ESR |
|
|
Term
| which antibodies are found in ~100% of drug induced lupus? |
|
Definition
|
|
Term
what antibodies sene in antiphospholipid syndrome?
what is management?
what are features? |
|
Definition
antibodies seen: antiphospholipid, anticardiolipi, lupus anticoagulant
mx: low dose aspirin or warfarin
features: CLOT
Coagulation defect
Livedo reticularis
Obstretric problems
Thrombocytopenia |
|
|
Term
| ANCA positives tend to affect which part of the body? |
|
Definition
| respiratory tract and kidneys |
|
|
Term
henoch schonlein purpura
Goodpastures
Cryoglobulineamia are all what? |
|
Definition
|
|
Term
| mx of large vessel vasculitis? |
|
Definition
|
|
Term
| mx of medium/small vessel vasculitis? |
|
Definition
| steroids and IV cyclophosphamide 15mg/kg |
|
|
Term
|
Definition
60mg prednisolong daily PO
usually on steroids for 2 years
give PPI and bisphosphonates. |
|
|
Term
| which medium vessel vasculitis is associated with Hep B? |
|
Definition
| Polyarteritis Nodosa (PAN) |
|
|
Term
|
Definition
15mg pred PO daily.
there shold be a dramatic response in 1 week. if not then reconsider diagnoses
decrease dose 1mg per month
usually on steroids for 2 years |
|
|
Term
| which rash is seen in rheumatic fever? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| sarcoidosis may present with nodules on shin these AKA? |
|
Definition
|
|
Term
| what can you treat the itchy rash of dermatitis herpetiformis? |
|
Definition
|
|
Term
| anti Jo-1 anti Mi-2 seen in? |
|
Definition
|
|
Term
| which colour does sulfasalazine turn your urine? |
|
Definition
orange
it can also affect blood count and reduce sperm count |
|
|
Term
|
Definition
tablets come in 2.5mg and 10mg but for safety and to avoid confusion only 2.5mg is used.
starting dose 7.5 -15mg. max dose 25mg
take folic acid 5mg on a day that MTX isn't taken.
MTX taken once a week
meds to avoid whilst on MTX: trimethoprim and septrin
also avoid live vaccines |
|
|
Term
| how long should you used contraception for after stopping MTX? |
|
Definition
|
|
Term
| women on leflunamide who want a baby are asked to stop the drug and get a wash out treatment. if they do not want a wash out rx how long should they avoid not getting pregnant for? |
|
Definition
|
|
Term
| how is washout of leflunomide done? |
|
Definition
| taking cholestyrammine for 11 days |
|
|
Term
| what are differences in onset of action between DMARDs and biologics? |
|
Definition
| DMARDS take a lot longer to show an effect compared to biologics that exert their effect within days to weeks. |
|
|
Term
| with TNA alpha inhibitors there is an increased risk for reactivation of which disease? |
|
Definition
|
|
Term
| my MOA is by interacting with p55 and p75 cell surface TNF receptors. People who use me shold carry a special alert card. which drug am I? |
|
Definition
|
|
Term
| aged 30-99 year olds can used which score to asses 10 year risk of fracture? |
|
Definition
qfracture
FRAX is for 40-90 year olds |
|
|
Term
| what term is used when there is normal bony tissue but decreased mineral content in adults? |
|
Definition
osteomalacia
rickets in children
the difference is fusion of the epiphysis. |
|
|
Term
| imaging modality of choice for osteomyelitis? |
|
Definition
MRI
mx: fluclox for 6 weeks or clindamycin if penicillin allergy |
|
|
Term
| Rf is usually an IgM antibody. which 2 test can be used to detect it? |
|
Definition
Rose-Waller test: sheep red cell
Latex agglutinin test: less specific |
|
|
Term
|
Definition
Anti-Ro
Anti-La
histology shows local lymphocytic infiltration |
|
|
Term
| how would you define kyphosis? |
|
Definition
a curvature in xs of 45 degrees
it is usually associated in adults with osteoporosis |
|
|
Term
| name of disease that is the commonest cause of kyphosis in adolescents? |
|
Definition
| Scheurmanns disease. osteochondrosis of the thoracic vertebral bodies. |
|
|
Term
| common causes of genu valgum (valgus knees) |
|
Definition
RA/OA
arthritis of knee
trauma
RA usually presents with valgus knees
OA can also present with this but varus knees is common. |
|
|
Term
| mx for Dupuytrens contracture |
|
Definition
injectable collagenase
radiotherapy
surgical: fasciectomy, fisciotomy
splinting and steroid injections are NOT recommended. |
|
|
Term
| which nerve provides secretomotor fibres to parotids? |
|
Definition
|
|
Term
| which CN innervates cricothyroid muscle? |
|
Definition
|
|
Term
| difference between myasthenia gravis and lambert eaton |
|
Definition
MG: antibodies to acetyl choline receptor, fatiguabily after repetition of activity, reflexes normal, normal conduction velocity of peripheral nerves
lamber eaton: paraneoplastic syndrome, antibodies to voltage gated calcium channels, gets more stronger with repetitive activity, reflexes absent |
|
|
Term
what is the 1st way to manage hyponatremia?
fluid restriction or fluid administration? |
|
Definition
| fluid restriction. this is to exclude dilutional hyponatremia |
|
|
Term
| signs of frontal lobe lesion? |
|
Definition
primitive reflexes
emotional lability
intellectual impairment
personality change
urinary incontinence
mono/hemi paresis |
|
|
Term
management of trigger finger
this commonly affects little, ring finger or thumb
more common in the right hand |
|
Definition
conservative: not treating is an option as 1 in 5 get better spontaneously with rest and analgesia
splinting may help some people
medical:steroid injections
surgical: trigger finger release |
|
|
Term
|
Definition
idiopathic
occupational: jobs using a lot of screw drivers or pressure on palms
disease: RA, diabetes, amyloidosis, carpal tunnel, people on dialysis |
|
|
Term
| which imaging modality gives the most information about the extent of a tendon rupture? |
|
Definition
|
|
Term
| which people are at increased risk of tendon rupture? |
|
Definition
people over 60
but young people may get these from sporting injuries |
|
|
Term
| which Abx has been reported to cause tendon rupture? |
|
Definition
|
|
Term
| proximal biceps tendon rupture management |
|
Definition
conservative: most become asymptomatic within 4-6 weeks, can use NSAIDs and physio
surgical: distal reattachment is an option. |
|
|
Term
biceps tendon rupture can be proximal or distal. proximal is more common.
what age group does distal tendon bicep rupture occur? |
|
Definition
middle aged active males
usually due to a single traumatic event caused by flexion against resistance. |
|
|
Term
| distal bicep tendon rupture management |
|
Definition
conservative: can result in persistant elbow weakness
surgical: surgery needs to be performed early to prevent scarring of biceps. with delayed rx biceps may be attached to brachioradialis |
|
|
Term
| presentation of distal bicep tendon rupture |
|
Definition
sharp tearing sensation
painful swollen elbow
weakness of flexion and supination |
|
|
Term
| in delayed surgical rx of biceps tendon rupture which muscle can it be attached to? |
|
Definition
|
|
Term
| complications of biceps tendon rupture? |
|
Definition
bicep tendonitis
median nerve compression |
|
|
Term
| which tendon maintains the arch of the foot and damage to it is a cause of acquired flat foot? |
|
Definition
| the posterior tibial tendon |
|
|
Term
| what causes mallet finger? |
|
Definition
damage to extensor tendons
leads to permanent flexion of the DIP
mx: splint worn day and night for 6-8 weeks cures the problem in most cases.
if the above fails then surgery is needed |
|
|
Term
|
Definition
conservative: improve work and lifestyle ergonomics, NSAIDs may help, splinting
when to consider surgery? no improvement, progressive palsy and evidence of muscle wasting and clawing
surgery options: decompression surgery, transposition of the nerve, medial epicondylectomy |
|
|
Term
|
Definition
conservative: try not to over use your wrist, if you are overweight weight loss can help, NSAIDs, not treating is also an option, wrist splint for a few weeks.
medical: steroid injection
surgical: cut flexor retinaculum. |
|
|
Term
| polydactyly is most common on which side of the hand? |
|
Definition
Ulnar side. AKA postaxial polydactyly
there are two types type A and type B
type A = can be functional
type B = varies from a nubbin to non functional finger
mx: don't cause an issue but surgically removed for cosmetic reasons |
|
|
Term
|
Definition
where two or digits are fused together
mx: surgery with skin graft |
|
|
Term
| features of mortons neuroma |
|
Definition
benign
affects intermetatarsal plantar nerve
more common In women
presents with pain in 3rd intermatatarsophalangeal space, more worse when walking
pts may feel they have a pebble in their shoe
mulders click: hold neuron between thumb and finger and using other hand squeeze metatarsals, you will hear a click due to the neuroma moving between metatarsal heads
mx: avoid heels, metatarsal pads, corticosteroid injection, surgical removal of neuroma and neurectomy of the interdigital nerve. |
|
|
Term
|
Definition
| when proximal part of big toe points laterally and the tip of big toe bends medially aka bunion toe |
|
|
Term
|
Definition
stiff big toe
degenerative condition due to bone spurs affecting MTP at base of hallux
mx: rest, NSAIDs, corticosteroids, surgery |
|
|
Term
| features and definition of hammer toe |
|
Definition
deformity of proximal interphalangeal joint leading to permanent bentness
mallet toe is deformity of the distal joint
causes: high heels, ill fitting shoes,
mx: conservative with physical therapy and brace and toe exercises
surgical in serious cases to correct deformity |
|
|
Term
|
Definition
this may occur in any tow except the big toe
toes contracted at the PIP and DIP joints |
|
|
Term
| which toe deformity often occurs with bunions? |
|
Definition
| hammer toe. this usually affects the second toe |
|
|
Term
| fancy word for flat foot? |
|
Definition
pes planus
pes cavus = high arched foot |
|
|
