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year 3 conditions > MSK > Flashcards

MSK Flashcards

1
Q

Ix and Tx for caudal equina

A

whole spine MRI
urgent surgical decompression

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2
Q

what kind of medication is aledronic acid

A

oral bisphosphonate

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3
Q

what is the main side effect of oral bisphosphonates

A

oesophageal reactions
including oesophagitis, ulcers, erosions and strictures
which can present as odynophagia, dysphagia, or new/worsening dyspepsia

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4
Q

what gene mutation causes marfans

A

fibrillar 1 gene mutation

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5
Q

what condition does a collagen gene mutation cause

A

Ehlers Danlos syndrome

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6
Q

what condition does Treponema pallidum particle agglutination assay (TPPA) positivity indicate

A

syphilis

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7
Q

how can methotrexate affect bone marrow and what does this cause

A

can suppress bone marrow
this causes
- thrombocytopenia
- leucopenia
- agranulocytosis
- anaemia

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8
Q

biggest risk factor of NSAIDs

A

GI ulceration and abdo pain
–> can cause melaena

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9
Q

what are high risk pts who are prescribed long term NSAIDs given to prevent GI ulceration

A

omeprazole

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10
Q

what enzyme do NSAIDs inhibit

A

cyclooxygenase

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11
Q

fusion of which joints is a characteristic feature of ankylosing spondylitis

A

fusion of sacroiliac joint

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12
Q

what is hydroxychloroquine

A

anti-malarial drug used for treatment of SLE/RA

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13
Q

most common side effect of hydroxycholorquine

A

ocular toxicity

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14
Q

what type of med is leflunomide

A

DMARD

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15
Q

leflunomide side effects

A

increased bp
deranged LFTs

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16
Q

what do pts starting on etanercept have to be screened for

A

screened for Hepatitis B, C, HIV and TB prior to starting biologics as it may cause reactivation

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17
Q

what type of med is etanercept

A

biologics

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18
Q

if a pt has back pain, what does a normal neurological exam tell you

A

most likely excludes a disk herniation or vertebral fracture

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19
Q

what is lumbar spondylosis

A

an age-related degeneration of the vertebrae and disks of the lower back
- osteoarthiritis and degenerative disk disease

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20
Q

what does a positive straight leg raise test indicate

A

irritation of the sciatic nerve

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21
Q

what does a positive tinels test indicate

A

compression of the median nerve at the carpal tunnel

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22
Q

what does a positive trendelburg’s test indicate

A

suggests contralateral hip abductor weakness

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23
Q

what skin condition is ankylosing spondylitis associated with

A

psoriasis

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24
Q

marfans effects on the eyes

A

superior lens dislocation

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25
Q

colchicine most common side effects

A

diarrhoea
nausea
vomiting

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26
Q

Tx for achilles tendonitis

A

rest, NSAIDs eg naproxen

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27
Q

what type of drug is allopurinol

A

xanthine oxidase inhibitor

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28
Q

what arthritis is caused by IBD

A

enteropathic arthritis

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29
Q

is enteropathic arthritis seronegative or positive

A

seronegative

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30
Q

serious skin side effect of allopurinol

A

stevens johnson syndrome

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31
Q

what is the likely diganosis of someone with G6PD deficiency and painful ankle and why

A

gout
G6Pd so RBC are getting killed or affected in some way -> more uric acid -> gout

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32
Q

which cancers commonly metastasise to the bone

A

BLT with a Kosher Pickle

Breast
Lung
Thryoid
Kidney
Prostate

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33
Q

likely diagnosis
- back pain
- fever/weight loss/night sweats
- immunosuppression
- IV drug use

A

discitis

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34
Q

signs of nerve root compression

A

unilateral symptoms
Burning/shooting pain down the leg
Positive sciatic stretch test
Dermatomal stretch test positive
Reduced reflexes

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35
Q

first-line pharmacological management for non-neuropathic lower back pain

A

NSAIDs

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36
Q

what sort of back pain is duloxetine used for

A

neuropathic pain eg sciatica

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37
Q

what sort of back pain is gabapentin used for

A

neuropathic pain eg sciatica

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38
Q

what condition is nail pitting a feature of

A

psoriatic arthritis

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39
Q

what is the sick day rule for prednisolone

A

if acutely unwell double the usual dose of prednisolone

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40
Q

dermatological effets of corticosteroids

A

Cushingoid appearance with central obesity, buffalo hump, moon face, acne, thinned skin with striae

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41
Q

endocrine side effects of corticosteroids

A

Hyperglycaemia.
Cushing’s disease - Hypokalaemic hypertension with fluid and Na+ retention.
Growth retardation in children.

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42
Q

MSK side effects of corticosteroids

A

muscle wasting

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43
Q

psychiatric side effects of corticosteroids

A

Mood swings.
Worsening of underlying psychiatric condition.
Can cause full steroid psychosis soon after administering.

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44
Q

GI side effects of corticosteroids

A

dyspepsia

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45
Q

ophthalmic side effects of corticosteroids

A

Glaucoma.
Cataracts.

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46
Q

haem side effects of corticosteroids

A

Raised WCC

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47
Q

how do you stop taking corticosteroids

A

If they are taken for less than 3 weeks steroids can be safely stopped abruptly.
If taken for longer than this, the steroids must be tapered down slowly.

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48
Q

how to adjust medication if taking prednisolone but are nil-by-mouth or vomiting prednisolone before it can be absorbed

A

convert the increased daily dose of prednisolone to the equivalent IV hydrocortisone.

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49
Q

which type of vaccines are C/I if taking corticosteroids

A

live vaccinations

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50
Q

effect of corticosteroids on immune system

A

Reactivation of latent infections (TB / Hepatitis B/C / Herpes viruses)
new opportunistic infections eg candida

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51
Q

most important side effect of steroids

A

adrenal gland suppression

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52
Q

which conditions is HLA-B27 associated with

A

PEAR conditions:

Psoriatic arthritis
Enteropathic
Anykylosing spondylitis
Reactive arthritis

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53
Q

what is the straight leg raise test used to diagnose

A

herniated discs

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54
Q

could a vertebral fracture cause neurological symptoms

A

yes, as it could compress on the nerve root

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55
Q

what type of med is etoricoxib

A

NSAID

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56
Q

which condition does a high arched palate indicate

A

marfans

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57
Q

what condition does a water hammer pulse indicate

A

marfans

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58
Q

what condition can a RET gene mutation cause

A

MEN 2B

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59
Q

what does pain when palpating the anatomical snuffbox suggest

A

scaphoid fracture

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60
Q

what test is this and what condition does it indicate
Tenderness elicited over the radial styloid upon ulnar flexion of the wrist (flex hand sideways towards pinky finger side) with thumb clasp in the palm

A

positive finkelsteins test
de quevain’s tenosynovitis

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61
Q

what test is this and what condition does it indicate
Numbness elicited upon passive extension of the wrist

A

positive prayer sign
carpal tunnel syndrome

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62
Q

what test is this and what condition does it indicate
Numbness elicited upon passive flexion of the wrist

A

positive Phalen sign
carpal tunnel syndrome

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63
Q

which muscles does de quervains tenosynovitis include

A

extensor pollicis brevis
and abductor pollicis longus

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64
Q

describe acute anterior uveitis

A

painful red eye
reduced acuity
constricted pupil

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65
Q

describe conjunctivitis and which idk condition can it occur in

A

discomfort
feels like a forge in body in eye
if bacterial can get pus/discharge
no visual impairment
can occur in reactive arthritis

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66
Q

pupil dilation rather
often associated with nausea, vomiting and haloes around light
diagnosis

A

acute angle closure glaucoma

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67
Q

describe episcleritis

A

localised area of redness rather than the whole sclera, and the pain is usually a mild ache, with no change in acuity or pupil size

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68
Q

hypermobile joints, easily bruised or stretchy skin, and be prone to dislocations and chronic pain
likely diagnosis

A

Ehlers danlos syndrome

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69
Q

which fracture often follows a fall on an outstretched hand

A

scaphoid fracture

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70
Q

likely diagnosis if pt experiences pain at base of thumb which is worsened by thumb abduction

A

de quervain’s tenosynovitis

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71
Q

what is the equivalent IV hydrocortisone dose of 5mg oral prednisolone

A

20mg IV hydrocortisone = 5mg oral prednisolone

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72
Q

which abx can rarely cause achilles tendinopathy and tendon rupture as side effect

A

ciprofloxacin

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73
Q

what tests should be done when starting a pt on methotrexate to get a baseline in the case of possible methotrexate toxicity

A

CXR - methotrexate can cause pneumonitis
LFTs
renal function test
FBC

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74
Q

arthritis of small joints of hands
pitting of finger nails
dactylitis
likely diagnosis?

A

Psoriatic arthritis

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75
Q

what is jumpers knee

A

patellar tendonitis - anterior knee pane at inferior pole of patella, often occurs in runners/jumpers

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76
Q

what is osteoid osteoma

A

a benign (non-cancerous), small tumour that usually grows in the long bones of a person’s lower extremities
no systemic features
no lump

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77
Q

what is an osteosarcoma and what does X-ray show

A

malignant tenor of bone in which there is proliferation of osteoblasts
X-ray shows periostea reaction with “sunburst appearance”

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78
Q

what is Ewings sarcoma and what does X-ray show

A

cancer that begins as a growth of cells in the bones and the soft tissue around the bones
most common in children/young adults
X-ray shows ill-defined lytic area with ‘onion-skin’ periosteal reaction

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79
Q

which malignancies of bones is most common in children

A

Ewings sarcoma
osteosarcoma

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80
Q

chondrosacroma xray

A

inside bone looking fluffy / like clouds
“moth-eaten” pattern of bone destruction

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81
Q

pt presents with swollen painful MTP
what med could have caused this

A

thiazide like diuretic - gout

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82
Q

what medication is a dihydrofolate reductase inhibitor

A

methotrexate

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83
Q

most common joints for septic athiritis

A

large joints
50% occur in knee
other places are ankles, hips, shoulders, wrists

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84
Q

deranged LFTs and joint pain
likely diagnosis

A

pseudo-gout secondary to haemachromatosis –> can cause liver damage

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84
Q

what medication is coprescribed with methotrexate, taken on a different day to it, to reduce ,methotrexate toxicity and side effects

A

folic acid

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85
Q

which bacteria is gram negative diplococci

A

neisseria species

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86
Q

which bacteria is gram positive cocci arranged in clusters

A

staphylococcus

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87
Q

most common causative agent of septic arthritis

A

staph aureus

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88
Q

what type of med is aldedronic acid

A

bisphosphonate

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89
Q

what effects can anti epileptics have on the bones

A

osteoporosis, osteomalacia, rickets

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90
Q

what sort of neuron signs do spinal cord lesions cause

A

upper motor neurone signs eg brisk reflexes

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91
Q

bone pain, low calcium, low phosphate, raised ALP, raised PTH
likely diagnosis

A

osteomalacia

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92
Q

osteomalacia calcium/phosphate/ALP/PTH levels

A

low calcium,
low phosphate,
raised ALP,
raised PTH

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93
Q

what is the antidote for methotrexate toxicity

A

IV folinic acid (Leucovorin)
NOT the same as FOLIC acid which is used to counter the anti folate effects of methotrexate
- is coprescribed with it to prevent side effects and toxicity

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94
Q

methotrexate side effects

A

Mucositis
Myelosuppression
Pulmonary fibrosis
Liver fibrosis
and
teratogenicity

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95
Q

if a pt is on methotrexate, takes trimethoprim and gets pancytopenia what does tis mean has happened and what needs to be given to pt to correct this

A

methotrexate and trimethoprim have reacted as they are both anti folate
caused methotrexate toxicity
resulted in bone marrow suppression
give IV folinic acid

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96
Q

acute joint pain, fever and lesions on hand in young sexually active pt
diagnosis

A

septic arthritis caused by neisseria gonorrhoea
(known to be associated with tender necrotic pustules on the extremities.)

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97
Q

joint pain
abdo pain, diarrhoea, steatorrhea
chronic cough
no skin manifestations
likely diagnosis

A

Whipple’s disease arthritis
(no skin manifestations. less likely to be enteropathic arthritis)

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98
Q

3 patterns of enteropathic arthritis

A

Axial arthritis: Gradual onset of lower back pain and stiffness, worse in the morning, improves with exercise.

Peripheral arthritis of IBD: Asymmetric, oligoarticular arthritis, predominantly of the lower limbs. Often transient and migratory joint inflammation

Enthesopathy of IBD: Severe localised pain in specific areas of tendon insertion. Achilles tendinopathy, patellar tendinopathy, plantar fasciitis

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98
Q

what is a viscus

A

an organ located inside of the body

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99
Q

if pt had an internal fixation of femur and now has red swollen painful joint
but has no fever and normal obs
what is most important thing to do

A

surgical removal of the internal fixation
(remove the forge in body causing the osteomyelitis) - abx is given if there is sepsis signs

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100
Q

what does mouth bleeding in a pt on methotrexate suggest

A

pancytopenia

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101
Q

what is the first line Tx for lower back pain

A

NSAIDs with PPI cover

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102
Q

which part of spine is pain most suggestive of malignancy

A

thoracic spine

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103
Q

what is arthrosis

A

another name for osteoarthritis

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104
Q

what does a positive grind test in hand suggest

A

osteoarthiritis
synovitis

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105
Q

in which 2 stages of CKD is the use of colchicine contraindicated

A
  • end stage renal disease
  • if pt is on dialysis
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106
Q

give examples of live vaccines, these shouldn’t be given to pts on methotrexate or steroids

A

MMR
varicella-zoster
yellow fever
rotavirus
BCG

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107
Q

what does defective type 1 collagen synthesis lead to

A

osteogenesis imperfecta

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108
Q

what condition does excessive osteoclast activity cause

A

osteoporosis

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109
Q

what condition does defective osteoclast activity cause

A

osteopetrosis - overly dense bones

110
Q

what condition does Mutated fibroblast growth factor receptor (FGFR) cause

A

achondroplasia

111
Q

septic arthritis vs osteomyelitis

A

Osteomyelitis is an infection of the bone.
Septic arthritis is inflammation in the surface of the cartilage that lines the joint and the synovial fluid that lubricates the joint that is caused by an infection

112
Q

osteomyelitis xray

A

Periosteal reaction,
focal cortical loss,
regional osteopenia

113
Q

what is a pot puffy tumour

A

Pott puffy tumor is a forehead swelling due to frontal bone osteomyelitis with associated subperiosteal abscess
can occur due to sinusitis or trauma

(non neoplastic)

114
Q

where does Sclerosing osteomyelitis of Garre usually present

A

mandible - due to chronic infection from dental caries

115
Q

which med do you prescribe for a pt with peptic ulcer disease and gout

A

colchicine

115
Q

what condition is pain in buttocks which alternates from left to right indicative of

A

ankylosing spondylitis

116
Q

what should given when starting urate lowering therapy such as allopurinol

A

NSAIDs or colchicine, until the effective allopurinol dose is achieved
because starting urate lowering therapy can cause acute flares of the gout

117
Q

how long before having a baby do you need to stop taking methotrexate

A

6 months before conception

117
Q

what is charcots foot

A

rare complication of diabetic neuropathy
- bones of the foot become very fragile and start to break /dislocate in response to very minor forces

118
Q

second line preventative Tx for gout when allopurinol is not tolerated

A

Febuxostat

119
Q

what is Pott’s disease / Pott’s spine

A

manifestation of TB in the spine

120
Q

what is sublaxation

A

partial dislocation

121
Q

loss of joint space
peri articular osteopenia
soft tissue swelling
sublaxation
what condition is this

A

rheumatoid arthiritis

122
Q

what is osteochondroma and how does it appear on X-ray

A

benign none tumour, asymptomatic
appears as small bony protusion on xray

123
Q

which gram positive cocci in grape like clusters cause septic arthritis

A

staph aureus

124
Q

which gram negative diplococci cause septic arthritis

A

neisseria Gonorrhoea

125
Q

which bacteria is a gram negative rod

A

e coli

126
Q

which bacteria is gram positive cocci in chains

A

strep pyogenes

127
Q

which bacteria is a gram negative diplococci

A

neisseria

128
Q

which bacteria is a gram negative cocobacili

A

haemophilus influenza

129
Q

which NSAID has a lower risk of GI bleeds

A

celecoxib

130
Q

usual methotrexate and folic acid dose

A

both once a week, but take on different days
folic acid can be increased and taken more times if needed

131
Q

what condition is alternating buttocks pain associated with

A

ankylosing spondylitis

132
Q

what is an antalgic gait

A

limping because of pain

133
Q

young child
antalgic gait
recent cold
likely diagnosis

A

transient synovitis of the hip

134
Q

what condition does history of diabetes bronze skin and gynacomastia indicate

A

hereditary haemochromatosis

135
Q

what is the female athletic triad

A

eating disorders
amenorrhoea
osteoporosis

136
Q

what type of pt is a Slipped upper femoral epiphysis (SUFE) seen in

A

obese adolescent boys of African-American descent

137
Q

what endocrine disorders are associated with pseudo gout

A

hyperparathyroidism
hypothyroidism

138
Q

likely diagnosis:
lower back pain
bilateral lower limb pain
normal peripheral pulses

A

spinal stenosis- due to claudication

139
Q

inheritance pattern of marfans

A

autosomal dominant

139
Q

progressive bone pain
osteolytic lesions
fatigue
weight loss
diagnosis

A

multiple myeloma

140
Q

is diabetes a risk factor for gout or pseudo gout

A

gout

141
Q

which condition is anti dsDNA associated with

A

SLE

142
Q

which condition is anti CCP associated with

A

rheumatoid arthiritis

143
Q

which condition are Scl70 (Anti-topoisomerase 1), anticentromere and anti-RNA polymerase III associated with

A

systemic sclerosis

144
Q

if pt had recent genitourinary infection and now has reactive arthritis what is likely causative agent

A

chlamydia

145
Q

which nerve is compressed in carpal tunnel

A

median

146
Q

what can happen to hand if Carpal tunnel is left untreated

A

atrophy of the thenar muscles of the hand causing grip strength to weaken

147
Q

what causes claw hand

A

Klumpke’s paralysis, an injury to the lower roots (C8/T1) of the brachial plexus
or from ulnar nerve injury
most common cause of these are traumatic vaginal delivery

148
Q

what condition is ulnar deviation (MCPs swell and cause fingers to all bend towards pinky finger) a sign of

A

rheumatoid arthiritis

149
Q

what condition is swan neck deformity (PIP joint hyperextension, DIP joint flexion) a sign of

A

rheumatoid arthritis

150
Q

what condition is Boutonniere’s deformity (PIP joint flexion, DIP joint hyperextension) a sign of

A

rheumatoid arthritis

151
Q

what does cozens test check for

A

epicondylitis aka tennis elbow (elbow pain in an individual with a history of repetitive strain)
- pain during resisted extension of wrist and digits

152
Q

what does history of scleroderma and severe hypertension raise suspicion of

A

scleroderma renal crisis

153
Q

what is needed for osteoarthritis diagnosis

A

Osteoarthritis can be diagnosed clinically if the following apply:

The patient is aged over 45 years
AND
The patient has activity-related joint pain
AND
The patient has no morning stiffness or the morning stiffness lasts less than 30 minutes

(dont need xray for diagnoses)

154
Q

why does tenderness over anatomical snuffbox that’s been going on for a couple weeks need urgent orthopaedic review

A

could be a scaphoid fracture
risk of vascular necrosis

155
Q

what is phalen’s test used for

A

carpal tunnel syndrome

156
Q

what is tinel’s sign

A

tingly feeling when doctor taps skin over the site of the damaged nerve

157
Q

management of carpal tunnel

A

1) wrist splint
2) steroid injections / NSAIDs
3) surgery

158
Q

what is limited cutaneous systemic sclerosis

A

aka CREST syndrome

Calcinosis.
Raynaud’s.
oEsophageal dysmotility.
Sclerodactyly.
Telangiectasia

159
Q

what is nail pitting characteristic of

A

psoriatic artritis

160
Q

effects of systemic sclerosis on lungs

A

pulmonary fibrosis

161
Q

what pulmonary pressure is classed as pulmonary arterial htn

A

> 20 mmHg

162
Q

what is a common osteoporotic fracture of the back

A

vertebral wedge fracture

163
Q

mech of action of bisphosphonates eg aledronrate in osteoporosis

A

inhibit osteoclasts

164
Q

likely fracture if fall on outstretched hand

A

scaphoid fracture

165
Q

what should you do if suspicion of scaphoid factor but cant see it on xray

A

plaster up the hand/wrist and repeat xray in 10 days

166
Q

first line tx for knee osteoarthirtis

A

topical NSAIDs

167
Q

denosumab mech of action

A

Inhibits the receptor activator of nuclear factor-kappa B ligand (RANKL)

168
Q

diffuse vs limited systemic sclerosis

A

limited = crest (Calcinosis
Raynaud’s phenomenon
Oesophageal dysmotility
Sclerodactyly
Telangiectasia)

diffuse = multisystem disorder, abnormlaotie of blood vessels and friborsis of skin and internal organs eg ILD, renal crisis, myocardial disease)

169
Q

what is golfers elbow

A

medial epicondylitis

170
Q

what is the triad of arthritis, urethritis and conjunctivitis characteristic of

A

reactive arthritis

171
Q

what is obligatory external rotation as you flex the pts hip a sign of

A

slipped capital femoral epiphysis aka slipped upper femoral epiphysis

172
Q

pt often prefers to sit in a chair with the affected leg crossed over the other - what is this characteristic of

A

slipped capital/upper femoral epiphysis

173
Q

tingling in hand, worse at night, can make the feeling go away after shaking his hand or hanging it over the bed at night
what condition is this characteristic of

A

carpal tunnel syndrome

174
Q

what should be regularly monitored in crest syndrome

A

renal function tests and bp

175
Q

which condition is anti centromere antibody associated with

A

limited systemic sclerosis

176
Q

where in the bone can avascular necrosis happen in a scaphoid fracture

A

proximal pole of the scaphoid

177
Q

best/most sensitive test for acl tear

A

lachman’s test (more sensitive than anterior draw test)

178
Q

what is dupuytren’s contracture

A

hand deformatity due to thickening of palmar fascia in digits 4 and 5

179
Q

dupuytrens contracture management

A

surgical fasciotomy
collagenase / corticosteroid injections

180
Q

what is the earliest sign of dupuytrens contracture

A

a firm, thickened palmar nodule over the metacarpal head at the level of the distal of the distal palmar crease

181
Q

which ligament is injured when you hear a pop when changing direction / performing pivoting movements

A

ACL

182
Q

how to treat asymptomatic vs symptomatic Baker’s cyst

A

asymptomatic = not tx required
symptomatic = NSAIDs, intrarticular corticosteroid injection, pyshio, last resort if v painful and not responding to meds = surgery

183
Q

describe the reflexes and muscle tone in cauda equina and why

A

hypotonia and decreased muscle tone
because cauda equina involves a LMN lesion

184
Q

what is conus medullaris syndrome

A

lesson around L2
involves LMN ad UMN effects

185
Q

cauda equina vs conus medullaris syndrome

A

cauda equina syndrome: lower motor neuron effects eg hyporeflexia
conus medullaris syndrome: combination of LMN and upper motor neuron (UMN) effects eg hyperreflexia, positive babinskis sign

186
Q

first lien Tx of scleroderma renal crisis

A

ACEi (ACEi’s are usually c/I in AKI except for in scleroderma renal crisis)

187
Q

which arthritis’ have bony erosions

A

inflammatory arthritis - esp rheumatoid and psoriatic arthritis

188
Q

what are the sites of tumours from which bony metastases can arise

A

breast
thyroid
prostate
kidney
bronchus (lung)

BLT with a Kosher Pickle

189
Q

hip: limited internal rotation and is externally rotated when flexed
likely diagnosis

A

SUFE

190
Q

how to treat SUFE

A

surgical fixation of the femoral head

191
Q

first line tx of septic arthritis

A

IV fluxocillin (after joint aspiration)
only in severe cases or after abx, do the joint washout

192
Q

which condition has Chondrocalcinosis in the joint space

A

pseudo gout

193
Q

which condition has abnormally dense bone with increased thickness throughout the bone

A

osteopetrosis

194
Q

which condition has bony erosions

A

RA

195
Q

which condition has bone sublaxation

A

RA (z appearance of fingers)

196
Q

what to do if septic joint doesn’t improve w antibiotics

A

orthopaedic review - infection may be coming from abscess within the joint so consider a joint wash out

197
Q

babinskis sign in UMN lesion

A

positive

198
Q

what is the suprapubic mass found on abdo exam in cauda equina

A

distended bladder (urien cant be released due to urinary retention)

199
Q

how to advise a pt to take aledronic acid for osteoporosis

A

To take the medicine with water on an empty stomach
first thing in the morning before breakfast
remain upright for at least 30 minutes after taking it

200
Q

what test should be done prior to starting inflimab / other biologics

A

Quantiferon test (TB test - biological can reactivate latent TB)

201
Q

what test should be done for a patient starting hydrocholorquine

A

eye check - can affect vision

202
Q

prior to starting which meds should Thiopurin methyltrasnferase (TPMT) test be done

A

should be done prior to starting thiopurines eg azathioprine

203
Q

joint pain after finishing TB Tx
what is diagnosis and which antibody is present

A

drug induced lupus
secondary to isoniazid therapy (TB tx)
anti histone antibodies

204
Q

what is pANCA associated with

A

Microscopic polyangiitis
eosinophilic granulomatosis with polyangiitis

205
Q

what is cANCA associated with

A

granulomatosis with polyangiitis

206
Q

what are myeloperoxidase (MPO) antibodies associated with

A

microscopic polyangiitis

207
Q

what does schemer’s test look for

A

sjogrens syndrome
(demonstrates reduced tear production using a strip of filter paper on the lower eyelid, with wetting of <5 mm being positive)

208
Q

sulfasalazine side effects

A

azoospermia,
Stevens-Johnson syndrome
hepatitis

209
Q

hydroxychloroquine side effects

A

seizures,
retinopathy
prolonged QT interval.

210
Q

what type of antibody is rheumatoid factor

A

IgM against IgG

211
Q

what is the most specific serological marker for RA

A

anti-CCP

212
Q

first line serological marker to test for in
RA

A

RF

213
Q

what is feltys syndrome

A

triad of
rheumatoid arthiritis
splenomegaly
neutropenia

214
Q

which nerve roots are for the knee reflex and ankle reflex

A

L3
L4
(3, 4 kick down the door)

S1
S2
(1, 2 buckle my shoe)

215
Q

which condition is anti Scl70 antibody associated with

A

diffuse cutaneous systemic sclerosis

216
Q

rough cracking of skin on fingers
bluiSh- black lesions over knuckles/elbows/knees (gottrons papules)
raynauds
myopathy
heliotrope rats and shawl sign
raised CK
like diagnosis

A

dermatomyositis

217
Q

which condition is anti JO1 antibody associated with

A

Poly/Dermatomyositis

218
Q

Asthma (usually adult onset)
Eosinophilia of >10% in peripheral blood
Paranasal sinusitis
Pulmonary infiltrates (patchy and shifting)
Histological confirmation of vasculitis with extravascular eosinophils
Mononeuritis multiplex or polyneuropathy
likely diagnosis

A

Churg-strauss syndrome (Eosinophilic granulomatosis with polyangiitis)

219
Q

contrast Granulomatosis with polyangiitis (Wegener’s granulomatosis) with Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

A

G with P:
affects lungs, sinuses, kidneys
can cause glomerulonephritis
c-ANCA

EG with P:
late onset asthma, sinusitis, eosinophilia
p-ANCA

220
Q

which condition is anti-topoisomerase ab associated with

A

diffuse systemic scleroderma

221
Q

which conditions is ANA associated with

A

SLE, scleroderma sjogrens, juvenile arthritis, polymyositis, dermatomyositis, type1 autoimmune hep, PSC

222
Q

Tx for raynauds

A

smoking cessation and wear gloves
if that doesn’t work, dihydropryidine calcium channel blockers

223
Q

likely cause of vision problem in an RA pt

A

hydroxycholorquine

224
Q

like cause of bradycardia in a baby who’s mum had SLE/sjogrens

A

congenital heart block (diet to antibodies passing to foetus)

225
Q

RA Tx

A

acute / first presentation:
(mild disease)
1st line - hydroxycholorquine
2nd line - sulfasalazine / methotrextae / leflunomide

(moderate/severe disease)
1st line - methotrexate
2nd line - sulfasalazine / leflunomide / hydroxycholorquine

ongoing / unresposnive:
1st line - methotrexate
2nd line - methotrexate + sulfasalazine + hydroxychloroquine

226
Q

colour change in raynauds

A

WBC - white, then blue, then crimson (red)
Initial vasoconstriction leads to pallor
Deoxygenated static blood leads to cyanosis
Reactive hyperaemia leads to rubor

226
Q

pregnant RA pt Tx

A

stop methotrexate
switch to sulfasalazine or hydroxycholorquine

227
Q

what marker should you look for in to with bilateral shoulder and hip girdle pain and stiffness

A

raise ESR –> polymyalgia rheumatica

228
Q

which antibody is positive
- adult consent asthma
- rashes
- eosinophilia

A

p-ANCA

229
Q

what is ulnar deviation associated with

A

RA

230
Q

dryness
bilateral enlargement of parotid glands
diagnosis

A

sjogrens syndrome

231
Q

what presents with rheumatoid like hands that are reducible in extension

A

Jaccoud’s arthropathy

232
Q

example of med which worsen raynauds

A

beta blockers

233
Q

cause of red scaly facial rash which spares nasolabial folds and is worse in summer

A

SLE

234
Q

pANCA positive but no asthmatic symptoms
diagnosis

A

microscpic polyangiitis
(pANCA is positive in ^ and esocinophlc granulomatosis with polangiitis aka charge strauss)

235
Q

what condition does a ‘Full house’ immunofluorescence pattern on kidney biopsy indicate

A

lupus nephritis

236
Q

what can you see on cxr for granulomatosis with polyangiitis

A

bilateral nodular and cavitating infiltrats

237
Q

what is arthritis mutilans a complication of

A

psoriatic arthritis

238
Q

what is dactylitis a complication of

A

psoriatic arthritis

239
Q

cause of dry mouth and eyes

A

sjogrens syndrome

240
Q

pt with lupus presents with psychotic features and severe headache
likely diagnosis

A

cerebral lupus

241
Q

main side effects of sulfasalazine

A

Myelosuppression
Nausea
Rash
Oral ulcers
Decreased sperm count

242
Q

what is charge strauss / eosinophilic granulomatosis with polyangiitis treated with

A

corticosteroids

243
Q

what are anti smith abs found in

A

SLE

244
Q

what is the most common pattern of psoriatic arthritis

A

assymetrical oligoarthiritis

245
Q

what does positive ENA antibody mean

A

it means you have autoantibodies

246
Q

which joint in hand is spared in RA

A

DIP

247
Q

contrast antibodies and skin effects in limited vs diffuse systemic sclerosis

A
  • limited sclerosis: anti centromere antibody, no skin changes other than face and lower arms
  • diffuse sclerosis: antibody to topoisomerase I (SCl-70), other areas of skin involement
248
Q

what condition is DAS-28 score used for

A

rheumatoid arthiritis

249
Q

tx for lupus nephritis

A

high dose corticosteroids in combination with a cytotixic drug - eg cyclophosphamide, tacrolimus, mycophenylate

250
Q

initial ab test for SLE

A

ANA
(then do anti dsDNA)

251
Q

which lymphoma are pts with sjogrens likely to develop

A

MALT lymphoma

252
Q

meds for hypertension in SLE

A

ACEi or ARB

253
Q

first line test and
diagnostic test for sgojrens

A

first line: schemers test and anti ro/la abs
diagnostic (if uncertainty): salivary gland biopsy - histopathologic study shows lymphocytic infiltrates around the duct.

254
Q

which 2 conditions are associated with anti Ro aka anti SSA antibodies

A

SLE
Sjogrens syndrome

255
Q

what is Beurgers disease

A

a type of secondary raynauds, due to smoking
classic presentation: young, male smoker who has been experiencing claudication and has signs of lower limb atherosclerosis with absent pedal pulses

256
Q

what is erythromelalgia

A

temperature induced colour changes of the extremities however it has the opposite presentation to Raynaud’s with red painful burning extremities usually provoked by heat. Thrombocytosis can be a cause

257
Q

most sensitive abs for SLE

A

ANA

258
Q

most specific abs for SLE

A

Anti-dsDA
anti smith

259
Q

biologic side effects

A

Immunosuppression
Reactivation of TB
Allergic reaction, reaction at infusion site

260
Q

what type of med is Leflunomide

A

DMARDs

261
Q

what is polyarteritis nodosa

A

Polyarteritis nodosa is medium- and small-vessel vasculitis, most commonly associated with fever, neurological symptoms (often mononeuritis multiplex), skin disease and renal disease. Pulmonary and upper respiratory tract symptoms are less common

262
Q

what is hypromellose used for in sjogrens

A

used as artificial tears to soothe dry eyes

263
Q

2 emergencies in lupus

A

lupus nephritis
cerebral lupus

264
Q

what is pencil in cup deformity

A

aka arthritis mutilans
- most severe form of psoriatic arthritis

265
Q

what test needs to be does before starting hydroxycholorquine

A

eye test

266
Q

what is livedo reticularis associated with

A

SLE,
systemic sclerosis,
Sjögren’s disease

267
Q

neurological symptoms and headache, with fever and raised inflammatory markers in pt on biologics
likely diagnosis

A

encephalitis

268
Q

common side effect of gold treatment for RA

A

skin pigmentation

269
Q

headache
feeling unwell
pain in scalp which is worse when eating
diagnosis

A

giant cell arteritis - temporal arteritis

270
Q

what does positive lupus anticoagulant mean

A

antiphospholipid syndrome

271
Q

recent thrombus eg DVT with no risk factors of developing it
no clotting abnormalities
miscarriages
likely diagnosis?

A

antiphospholipid syndrome

year 3 conditions (17 decks)

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