Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AKT > Rheumatology 2 > Flashcards

Rheumatology 2 Flashcards

1
Q

Describe the femoral nerve stretch test

A

Lie the patient prone
Extend the hip joint with a straight leg
Then bend the knee
If there is pain = trapped femoral nerve

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

Pain and tenderness over lateral side of thigh
Most common in women aged 50-70

A

Greater trochanteric pain

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

High steroid therapy
Previous hip fracture/ dislocation
Gradual or sudden onset
Hip pain

A

Avascular necorosis

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

Seen in the third trimester of pregnancy
Groin pain
Limited range of movement of hip
May be unable to weight bear
ESR can be elevated

A

Transient idiopathic osteoporosis

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

Hypersensitivity types

A

I anaphylactic
II cell bound
III immune complex
IV delayed

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

Hypersensitivity Mechanism

A

I IgE
II IgG or IgM
III IgG or IgA
IV T cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hypersensitivity examples I (2)

A

I - anaphylaxis, atopy

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

Hypersensitivity examples II (7)

A

II - ITP, Goodpasture’s, pernicious anaemia, haemolytic anaemia, RhF, pemphigus/ pemphigoid

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

Hypersensitivity examples III (3)

A

III - SLE, post strep GN, extrinsic allergic alveolitis acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hypersensitivity examples IV (6)

A

IV - TB, graft versus host, allergic contact dermatitis, extrinsic allergic alveolitis chronic, scabies, Guillian Barre

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

What makes lateral epicondylitis worse? (movements)

A

Wrist extension with the elbow extended
Supination with the elbow extended

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

Lateral epicondylitis
How long do the sx last for?

A

6 months to 2 years
Acute pain 6-12 weeks

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

Lateral epicondylitis Mx (4)

A

Avoid muscle overload
Simple analgesia
Steroid injection
Physiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Marfans
AD or AR
Gene + chromosome

A

AD
FBN1 gene chromosome 15

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

Tall stature
Long fingers (arachnodactyly)
High arched palate
Pectus excavatum
Scoliosis

Heart: dilatation of aortic sinuses
Lungs: repeated pneumothoraces
Eyes: upward lens dislocation, blue sclera, myopia

A

Marfan’s

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

AR type V glycogen storage disease
Muscle pain and stiffness following exercise
Muscle cramps
Myoglobinuria
Low lactate levels during exercise

A

Mc Ardle’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MTX rules around pregnancy

A

men and women should avoid pregnancy for 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MTX - what should be taken with it?

A

5mg once weekly - at least 24 hours post MTX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MTX - which meds should be avoided? (3)

A

Trimethoprim
Co-trimoxazole
High dose aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mx MTX toxicity

A

Folinic acid

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

OA XR findings (4)

A

Loss of joint space
Subchrondral sclerosis
Subchondral cysts
Osteophytes

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

RA XR findings (4)

A

Loss of joint space
Juxta-articular oseteoporosis
Periarticular erosions
Subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

OA Mx
CHECK AGAINST NICE

A
  1. Paracetamol + topical NSAIDs (knee and hand for topical NSAIDs)
  2. PO NSAIDs/ COX2 inhib, opioids, capsaicin cream, intra-articular steroids + PPI
24
Q

Blue sclera
Deafness secondary to otosclerosis
Dental imperfections

A

Osteogenesis imperfecta

25
Q

What is osteomalacia?
Mx

A

Softening of the bones secondary to low vitamin D
Mx vitamin D supplementation

26
Q

Osteomalacia findings on XR

A

Translucent bands (Loosers zones or pseudofractures)

27
Q

How long does sciatica symptoms last for?

A

4-6 weeks

28
Q

What is temporal arteritis?
Characteristic histology

A

Large vessel vasculitis overlapping with PMR
Skip lesions

29
Q

Temporal arteritis
Age
Onset
Sx (5)

A

> 60yo
Rapid < 1 month
Headache
Jaw claudication
Tender, palpable temporal artery
Visual symptoms
50% have PMR
Other:
Lethargy, low grade fever, anorexia, night sweats, depression

30
Q

Temporal arteritis Ix
(3)

A

Raised ESR >50
CRP raised
Biopsy - skip lesions

31
Q

Temporal arteritis Mx (1)
If visual symptoms (2)

A

High dose PO pred if no visual symptoms
If visual symptoms IV methylprednisolone

Urgent ophthalmology review - same day
Bisphosphonates are required

32
Q

Mx of patient with fragility fractures
>=75yo
<75

A

=>75yo who have had a fragility fracture without DEXA can be started on bisphosphonates
If under 75, then arrange a DEXA and use FRAX assessment which determines whether someone should have a bisphosphonate

33
Q

Name 6 RF that the FRAX assessment tool uses

A

Alcohol
RA
Steroid use
FH of fracture
BMI
Smoking

34
Q

Name 6 medications that can worsen osteoporosis other than steroids

A

Aromatose inhibitors eg anastrazole
Heparin long term
Glitazones
PPIs
Antiepileptics
SSRIs

35
Q

What is the Z score on a DEXA scan?

A

Bone mass adjusted for age, gender and ethnicity

36
Q

T score interpretation

A

> -1 = normal
-1 to - 2.5 = osteopaenia
< - 2.5 = osteoporosis

37
Q

When does the risk of osteoporosis with steroid use rise significantly?

A

7.5mg/day for 3 months or more

38
Q

Mx of patient’s at risk of steroid induced osteoporosis
Who gets immediate bone protection (2) and who requires a DEXA? (1)

A

Bone protection if:
1. >65yo
2. Prev fragility fracture

DEXA
1. <65

39
Q

How to interpret a DEXA result with patients at risk of steroid induced osteoporosis

A

T score >0 - reassure
0 to -1.5 repeat scan in 1-3 years
> - 1.5 bone protection

40
Q

Osteoporosis management (5)

A

Vit D and calcium supplementation should be offered to all women unless replete

  1. Alendronate - common SE GI
  2. Risedronate or etidronate
  3. Strontium ranelate and raloxifene (if bisphosphonates are not tolerated)
  4. Denosumab
41
Q

Raloxifene
MOA
Can worsen what symptoms?
Increased risk of?
Decreased risk of?

A

selective oestrogen receptor modulator
can worsen menopausal symptoms
increased risk of VTE
decrease breast ca

42
Q

Strontium ranelate
Who can prescribe?
Increased risk of

A

Secondary care
Increased risk of CVD and VTE

43
Q

How often in denosumab given?

A

Every 6 months SC injection

44
Q

How often is ibandronate given?

A

Every month

45
Q

Name four RF for Paget’s disease of the bone

A

Male
Increasing age
Northern latitude
FH

46
Q

Stereotypical presentation for Paget’s disease of the bone

A

Older male with bone pain and isolated raised ALP

47
Q

Bowing of the tibia
Bossing of skull
Thickened vault
Early mixed lytic/sclerotic lesions later

A

Paget’s

48
Q

Blood results Paget’s
ALP, Ca, phos

A

ALP raised
Normal Ca + phos

49
Q

Mx Paget’s

A

Bisphosphonates - PO risdronate or IV zoledronate

50
Q

Paget’s complications (5)

A

Deafness
Sarcoma
Fractures
Skull thickening
High output cardiac failure

51
Q

Vasculitis
Affects medium sized arteries with necrotizing inflammation which can lead to aneurysms forming

A

polyarteritis nodosa (PAN)

52
Q

Polyarteritis nodosa
Gender
Age
Associated with which condition

A

Middle aged men
Hep B

53
Q

Polyarteritis nodosa
Features (9)
Antibodies
Associated with which condition

A

Fever, malaise arthralgia
Weight loss
HTN
Mononeuritis multiplex, sensorimotor polyneuropathy
Testicular pain
Livedo reticularis
Haematuria
Renal failure

ANCA 20% of pts
Hep B serology +ve in 30% of pts

54
Q

PMR
Age
Onset
Symptoms
Ix
Rx and dose

A

> 60
Rapid onset <1 month
Morning stiffness in proximal limb muscles
Low grade fever, anorexia, depression, mild polyarthralgia, night sweats
ESR >40
CK and EMG normal
Rx pred 15mg OD

55
Q

What is polymyositis?
Which type of cell is it mediated by?
Associations (1)
Gender and age

A

Inflammatory disorder causing symmetrical proximal muscle weakness.
T cell mediated
Associated with malignancy
Middle aged females

56
Q

Polymyositis features (6)

A

Proximal muscle weakness
Dysphagia
Dysphonia
Raynauds
Respiratory muscle weakness
Interstitial lung disease

57
Q

Polymyositis
Blood test (4)
Antibodies

A

Elevated CK, LDH, AST and ALT
Anti-Jo1

AKT (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions