15/5

Question 1

What is the only childhood rash not to be managed supportively?

Answer 1

Scarlet fever - with penicillin

Question 2

Where does needle go in tension pneumothorax?

Answer 2

5th intercostal space midaxillary

THIS IS ONLY IF TRAUMATIC

Should still be 2nd intercostal space if spontaneous

Question 3

VIVA for scaphoid fractures

Answer 3

What?
- fracture of the scaphoid bone - at high risk of AVN as blood supply goes from distal to proximal

Hx
FOOSH
Tenderness in hand

Invx
tenderness in snuffbox and on telescoping of thumb

Imaging = XR/MRI (if inconclusive) (if XR inconclusive but v suspicious treat as # and repeat scans in 7-10 days

Manage
Conservative = remind of scan, splint for 6-8weeks
Medical = analgesia PRN
Surgical = fixation required if displaced or proximal pole affected

Question 4

What is Felty’s syndrome?

Answer 4

RA + splenomegaly + neutropenia

Question 5

VIVA for RA

Answer 5

Autoimmune condition which causes swelling of the synovial lining and tendons and bursa

Sx
Youngish with FH
Symmetrical polyarthoprathy
SOCRATES
Autoimmune = all that stuff
Extra-articular features
- epi-/scleritis
- anaemia of chronic disease
- rheumatoid nodules
- pulmonary fibrosis

Invx
Bedside
- hand and wrist exam
- symmetrical polyarthropthy
- Z-shaped thumb
- swan neck deformity (PIP hyperextension + DIP flexion)
- Boutonniere deformity (opposite of above)
- Ulnar deviation

Bloods
- RF and anti-CCP
- FBC, U+E’s, LFTs
- Inflam markers e.g. CRP

Imaging
- XR
LESS
Loss of joint space
Erosions
Soft tissue swelling
Soft bones (periarticular osteopenia)

Manage
MDT - GP, rheumatologist, specialist nurses, podiatrists

Conservative
- Monitor with DAS28
- Physiotherapy
- Education and support groups

Medical
DMARDS - methotrexate but highly tetrogenic, hydroxycholorquine and sulfasalazine are okay during pregnancy
1. Monotherapy
2. Combination of multiple DMARDS
3. Biologic therapies

NSAIDS

Surgical
- no longer as needed due to improvement in medical

Question 6

How should pts be counselled on methotrexate for RA?

Answer 6

ATHLETICS

Action - reduces immune response
Timeline - once a week
How to take - as tablet MUST be taken with folic acid 5mg (once a week) on alternate day of week
Length of treatment - lifelong
Effects - reduces flareups and disease progression
Tests - FBC for anaemia and low WCC, LFTs for liver toxicity 1-2weekly until stabilised then every 3 months
Important side effects
- mouth ulcers
- liver toxicity
- bone marrow suppression + leukopenia
- TETROGENIC (must be off for at least 3 mnths before trying to get pregnant)
Contraindications - pregnant
Supplementary advice - folic acid and are now immunocomprised so may get more infections than before