ext Flashcards
A 32 year old woman has a febrile illness and swelling of the small joints of her hands for 2 days. She is seen in the GP surgery. She has not travelled outside the UK. She has two young children.
She has a maculopapular rash and palpable, small cervical lymph nodes. The small joints of her feet, wrists and knees are swollen.
Which is the most likely diagnosis?
Psoriasis
Reactive arthritis
Rheumatoid arthritis
Sarcoidosis
Systemic lupus erythematosus
reactive arthritis
what are the ottawa ankle rules
If ankle pain is present and there is tenderness over the posterior 6 cm or tip of the lateral or medial malleolus, then ankle x-ray is indicated.
If midfoot pain is present and there is tenderness over the navicular or the base of the fifth metatarsal, then foot x-ray is indicated.
If there is ankle or midfoot pain and the patient is unable to take four steps both immediately and in the emergency department, then x-ray of the painful area is indicated.
MANAGEMENT
X-ray.
RICE plan (Rest, Ice, Compression, Elevation).
Splinting/crutches and pain medication, pending outcome
ligaments of the ankle
The Anterior TaloFibular Ligament (ATFL)
The anterior talofibular ligament (Figure 10) is the most commonly injured ligament when an ankle is sprained. The ATFL runs from the anterior aspect of the distal fibula (lateral malleolus) down and to the outer front portion of the ankle in order to connect to the neck of the talus. It stabilizes the ankle against inversion, especially when the ankle is plantar-flexed.
The CalcaneoFibular Ligament (CFL)
The calcaneofibular ligament (Figure 10) is also on the lateral side of the ankle. It starts at the tip of the fibula and runs along the lateral aspect of the ankle and into the calcaneus. It too resists inversion, but more when the ankle is dorsiflexed.
Posterior TaloFibular Ligament
The posterior talofibular ligament runs from the back lower part of the fibula and into the outer back portion of the calcaneus (Figure 10). This ligament functions to stabilize the ankle joint and subtalar joint.
Lisfranc Ligaments
The Lisfranc joint complex is a series of ligaments that stabilize the tarsometatarsal joints. These ligaments prevent the joints of the midfoot from moving much, and as such provide considerable stability to the arch of the foot. The plantar ligaments are stronger than those on the dorsal side (Figure 12 & 13). The Lisfranc ligament is a strong band of tissue that connects the medial cuneiform to the base of the second metatarsal.
The Deltoid Ligament
The deltoid ligament is a fan shaped band of connective tissue on the medial side of the ankle (Figure 11). It runs from the medial malleolus down into the talus and calcaneus. The deeper branch of the ligament is securely fastened in the talus, while the more superficial, broader aspect runs into the calcaneus. This ligament functions to resist eversion.
eating lots of protein bad for people with
gout
Dairy contains a high level of protein casein. This type of protein triggers inflammation and pain in the joints, and may even contribute to irritation around the joints. Some dairy products, such as butter, contain a high amount of saturated fat. This can also contribute to inflammation and joint pain.
what fizzy drink can lead to vit d deficiecnyc
There is phosphoric acid in cola drinks (both regular and diet) Having more than ~ 1 liter per day of colas provides more acid than the body can deal with. Increases acidity reduces the Calcium in the body – in bone and teeth. Vitamin D is consumed in the body in the process of trying to restore the lost Calcium.
what is Chondromalacia patella
Chondromalacia patella is the breakdown of cartilage on the underside of the kneecap (patella). When the kneecap rubs against the thigh bone, it hurts and swells. It is common among runners and other athletes and has been given the nickname “runner’s knee.”
if NSAIDs contraindicated then we use colchine - what is a side effect of this
diarrhoea
used in gout and OA
paracetamol not anti-infammatory why not first line
does osteoarthritis need xrya diagnosis
no
This is correct. 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
what is given to pregnant women with antiphospholipid syndrome to prevent thrombotic ocmplications and reduce the risk of foetal lost
Heparin in combination with low-dose aspirin is given throughout pregnancy and up to 8 weeks postpartum to pregnant women who have antiphospholipid syndrome.
what immunosupressant worsens psoriasis
Hydroxychloroquine
when do you need to measure methotrexate levels
Methotrexate monitoring requirements include full blood count (FBC), urea and electrolytes (U&Es) and liver function tests (LFTs) 1–2 weekly until therapy stabilised, and 3 monthly, thereafter.
Sulfasalazine also requires monitoring of the FBC, U&Es and LFTs. Leflunomide requires FBC, LFTs and blood pressure monitoring.
does a normal temporal biopsy exlcude GCA
no
what things can repicated ANCA
Dual positivity weakly (to both p- and c-ANCA) should raise suspicion of a false positive result.
Causes of dual positive results include:
subacute bacterial endocarditis (and other chronic infections)
haematological malignancy
inflammatory bowel disease
drug induced vasculitis (including cocaine induced vasculitis).
straight leg raise
disc herniation
what do you prescribe in GCA to reduce the risk of steriod induced side effects
bisphosphonates adn PPi forosteoporosi and peptic ulcers
