amk day

Question 1

RA leads to inflation of the synovium and affects women more.
what are the features

Answer 1

swollen painful joints in hands and fit
stiffer in the morning -due to cortisol levels as higher in the morning so reflects progression of stiffening - cortisol glucticocord ( management)
ulnar deviation

swan neck deformity - DIP flexion and PIP hyperextension

boutonniere deformity ( PIP flexion and DIP hyperextension)

PIP and MCP swelling and DIP sparing

Question 2

what finger joints does RA affect

Answer 2

PIP and MCP

Question 3

investigations for RA

Answer 3

Rheumatoid factor - can be found in other though

Anti-CCP - detected 10 years before

x-rays of hands and feet

diagnosis made off one joint with an ifnammed synovitis
use DAS28 score specific for rheumatoid arhtiris

Question 4

scoring system for RA

Answer 4

DAS28

Question 5

what do you treat fro RA

Answer 5

DMARDs
methotrexate

also use prednisone

and TNF inhibitors as a biologic if no response to DMARD

Question 6

methotrexate problems

Answer 6

antifolaxe - need to give folate acid

myelosuppreion

Question 7

how to monitor RA and what for flair ups

Answer 7

DAS28 and CRP

corticosteriods

Question 8

OA is a disorder fo synovial joint due to excessive stress and loading - gradual loss of cartilage

what are the features

Answer 8

pain worse on movement and better at the end of day

improved with rest
morning stiffness not prolonged - major diffence with RA

muscle wasting

nodules on PIP and DIP

c-ray features -LOSS 
loss of joint space 
osteophytes 
subchrnial cysts 
subchrodral sclerosis

Question 9

investigate OA

Answer 9

xray - LOSS

Question 10

manaagmetn of OA

Answer 10

los weight if big

1st line is NSAIDs and paracetamol
then cox-2 inhibitors if not working

Question 11

psoriatic arthritis is an infalmmotry arthritis with psoriasis features are

Answer 11

symmetric poly arthritis
psoriatic lesion - itchy

DIP involvement - (again not rheumatoid )

ifnalmmtion of insertion point of tendons and ligaments)

dactyltiis - sausage fingers

nail changes - pitting , onycholysis( elevation of the nail) and nail colour and ridges

pencil in cup appearance - serve

Question 12

how do you management PA

Answer 12

DMARD plus a steroid

pain relief

Question 13

reactive arthritiss is a HLA-B27 seronegative onset with other infection such as
STI and gastroenteritis

classi triad of symptoms

Answer 13

urethritis
conjuctivitis
arthriits
can’t see can’t pee can climb a tree

treat with pain relief and if persists DMARD

Question 14

septic arthritis is infection of synvoium most common organism

Answer 14

staph aureus

Question 15

features of septic arthritis

Answer 15

acute, inflamed, tender joint , reduced range of movement , systemically unwell

Question 16

test for septic arthritis

Answer 16

join aspiration and blood tests

Question 17

gout is a microcrystal synovitis caused by deposition of monosodium urate in the synvoium caused by hperuricaemia

RF

Answer 17

increased uric acid production - myeloprolfieration
cytoctociv drugs
severe psoriasis

Question 18

what decrease uric acid excretion

Answer 18

diuretics
CKD
lead toxicity

Question 19

features of gout

Answer 19

MTP generally affected 
pain 
swellign 
episdoes 
eryhtmea 
pockets of uric acid 

X-ray looked punched off erosion appearance
joint space reduction

Question 20

manaagmetn of gout

Answer 20

Nsadi or colchine

2nd - oral steroid

Question 21

pseudo gout is caused by calcium pyrophosphate and affects the knee most commonly
what are the crystal shape

Answer 21

rhomboid

needle in gout

Question 22

analysing spondylitis associated with what HLA

Answer 22

HLA-B27

Question 23

features of ankylosing spondylitis

Answer 23

inflammatory back pain

affects sacroiliac joint

Achilles tendontisi
plantar fasciitis
extra articular features include anterior uveitis and pulmonary fibrosis

looked crouched and question mark back
bad posture

Question 24

HLA-B27 associations

Answer 24

anterior uveitis - common eye problem
reactive arthritis
enteric arthipathy
sporadic arthtiris

Question 25

management of AS

Answer 25

NSaids DMard local steriods

Question 26

difference between dermatomyositis and polymyositis

Answer 26

dermatomyositis has skin involvement

Question 27

what is myositis

Answer 27

inflammation of muscles and bilateral muscle weakness and myalgia and tenderness systemic upset - fever raynauds - vasospasm of arterioles decreasing blood flow to the skin - treated with CCB interstitial lung disease

Question 28

what antibodies indicate myositis

Answer 28

anti-jo1 and Mi2 creatine kinase serum enzymes

Question 29

Polymyalgia reumatica PMR is inflammatory conditions only affecting over 50 features are

Answer 29

shoulder and hip girdle structures usually in morning fever and weight loss investigation include ESR and CRP and FBC and bone profile

Question 30

management of PMR

Answer 30

steroids - frax scan ( fracture risk for osteoporosis whilst using steroids) screen for other complications of steroids such as diabetes and mental health

Question 31

how to differeniate between myosotis and PMR

Answer 31

myositis - bilateral muscle weakness - patients struggle to move PR - no muscle weakness - can still do tasks like vacuuming

Question 32

giant cell arthritis is temporal arteritis - inflammation of vessel present with skip lesions features

Answer 32

``` temporal headache jaw claudication monocular blindness thickened temporal artery scalp tenderness can also have signs of PMR ```

Question 33

management of giant cell arteritis

Answer 33

high dose steroids to reduce risk of strokes and blindness also give bsphosphoante and PPI -associated symptoms

Question 34

enteropathic arthritis if very specific gastro problems

Answer 34

umbrella term to describe various arthritis's

Question 35

how do you test for gout - most appropriate

Answer 35

joint aspiration then microscopic analysis looking for uric acid crystals

Question 36

myositis - what investigation would reveal this

Answer 36

muscle biopsy

Question 37

what in examination is specific of psoriatic arthritis

Answer 37

onchlyosis

Question 38

perthes disease is associated with a

Answer 38

painless limp

Question 39

reactive arthritis commonly occurs after a

Answer 39

STI or gastro infection

Question 40

septic arthritic patients are

Answer 40

reluctant

Question 41

Slipped capital femoral epiphysis obese

Answer 41

most common hip disorder in the adolescent age group. It occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis. Weakness in the growth plate can be caused by a variety of factors, including stress on the growth plate due to obesity, and endocrine disorders such as panhypopituitarism, hypothyroidism, and renal osteodystrophy.

Question 42

dermatomyositis what autoantibodies

Answer 42

antibodies against histidine-tRNA ligase (also called Jo-1) antibodies to signal recognition particle (SRP) anti-Mi-2 antibodies