MSK

Question 1

How does temporal arteritis present?

Answer 1

Temporal arteritis: usually rapid onset unilateral headache with jaw claudication and raised ESR

Question 2

What is ankylosing spondylitis?

Answer 2

a HLA-B27-associated spondyloarthropathy typically presenting in men aged 20-30

Question 3

How do we manage ankylosing spondylitis?

Answer 3

First-line management involves the use of an NSAID, such as ibuprofen, along with extensive physiotherapy.

Question 4

How does ankylosing spondylitis present on XR?

Answer 4

X-ray of the pelvis is particularly useful as the sacroiliac joints are commonly affected, demonstrating subchondral erosions and sclerosis.

Question 5

Where do you see a positive Simmon’s sign?

Answer 5

Achilles tendon rupture

Question 6

How does De Quervain’s tenosynovitis present?

Answer 6

De Quervain’s tenosynovitis is an idiopathic pain syndrome involving the tendons of extensor pollicis brevis and abductor pollicis longus at the radial wrist.

Question 7

What is Finkelstein’s test?

Answer 7

Finkelstein’s test, which is performed by pulling the patient’s thumb with ulnar deviation and longitudinal traction, can aid the diagnosis of De Quervain’s tenosynovitis. Finkelstein’s test is positive if the manoeuvre reproduces pain.

Question 8

What is CREST syndrome?

Answer 8

This patient has Sclerodactyly and Raynaud’s phenomenon. Telangiectasia can also be seen on the hands. She therefore has the RST of CREST syndrome, or more accurately limited cutaneous systemic sclerosis.

Question 9

What is bamboo spine?

Answer 9

bamboo spine with a single central radiodense line related to ossification of supraspinous and interspinous ligaments which is called dagger sign. Ankylosing is detectable in both sacroiliac joints.

Question 10

What is the other name for tennis elbow?

Answer 10

lateral epicondylitis, also known as tennis elbow. This condition is characterized by pain and tenderness over the lateral epicondyle of the humerus, which is aggravated by wrist extension against resistance with the elbow extended.

Question 11

What is trochanteric bursitis?

Answer 11

Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years

Question 12

What are Gottron’s papules?

Answer 12

Gottron’s papules are roughened red papules over the extensor surfaces and are seen in dermatomyositis

Question 13

How can we treat Raynaud’s phenomenon pharmacologically?

Answer 13

Oral nifedipine

Question 14

Which movement temporarily causes the pain in lateral epicondylitis?

Answer 14

Lateral epicondylitis: worse on resisted wrist extension/suppination whilst elbow extended

Question 15

Which antibiotic is associated with achilles tendon rupture?

Answer 15

Cipro causes achilles tendon rupture

Cipro stops you from going pro

Question 16

How does reactive arthritis present?

Answer 16

Urethritis + arthritis +/- conjunctivitis = reactive arthritis

Question 17

What is the McMurray’s test?

Answer 17

A meniscal tear is usually caused by twisting of the knee and on examination, McMurrays test will be positive. To perform McMurrays test, the knee is held in one hand, which is placed along the joint line, and flexed while the sole of the foot is held with the other hand. One hand is placed on the medial side of the knee to pull the knee towards a varus position. The other hand is used to rotate the leg internally whilst extending the knee. If pain or a ‘click’ is felt, this constitutes a ‘positive McMurray test’.

Question 18

What is the most common reason THRs need revising?

Answer 18

Aseptic loosening is the most common reason for total hip replacement revision. This often presents with pain in the hip or groin region radiating down to the knee.

Question 19

How does PMR present?

Answer 19

Features
typically patient > 60 years old

The core symptoms are pain and stiffness of the:
Shoulders, potentially radiating to the upper arm and elbow
Pelvic girdle (around the hips), potentially radiating to the thighs
Neck

The characteristic features of the pain and stiffness are:

Worse in the morning
Worse after rest or inactivity
Interfere with sleep
Take at least 45 minutes to ease in the morning
Somewhat improve with activity

Question 20

What is olecranon bursitis?

Answer 20

Olecranon bursitis (‘student’s elbow’) is a common cause for elbow swelling and may be caused by prolonged pressure, trauma or rheumatoid arthritis

Question 21

Where would you see anti-Ro antigen?

Answer 21

Primary Sjogren’s syndrome is an autoimmune disorder characterised by lymphocytic infiltration of the exocrine glands, particularly the salivary and lacrimal glands, leading to symptoms such as dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca). Anti-Ro (also known as SS-A) autoantibodies are found in approximately 60-70% of patients with primary Sjogren’s syndrome, making it the most associated autoantibody for this condition.

Question 22

How does lateral epicondylitis present?

Answer 22

Sometimes referred to as ‘tennis’ elbow, but remember other activities can also trigger it.

Worse on resisted wrist extension/suppination whilst elbow extended

Question 23

How does medial epicondylitis present?

Answer 23

This condition is commonly referred to as ‘golfer’s’ elbow. The pain is aggravated by wrist flexion and pronation. Sometimes it is associated with ulnar nerve compression. The symptoms in the question do not suggest medial epicondylitis as the pain is worsened on resisted extension and there are no other associated features.

Question 24

Who must we refer to when starting hydroxychloroquine?

Answer 24

H-eye-droxychloroquine

Recent data suggest that retinopathy caused by hydroxychloroquine is more common than previously thought and the most recent RCOphth guidelines (March 2018) suggest colour retinal photography and spectral domain optical coherence tomography scanning of the macula for patients likely to be taking the drug for more than 5 years.

Question 25

Which nerve is most likely to be damaged in knee arthroplasty?

Answer 25

Common peroneal nerve

Question 26

How does SLE present?

Answer 26

The malar rash, arthralgia, lethargy and history of mental health points towards a diagnosis of SLE. Remember that the CRP (in contrast to the ESR) is typically normal in SLE.

Question 27

Name an important SE of alendronate

Answer 27

Bisphosphonates can cause a variety of oesophageal problems

Question 28

How should oral bisphosphonates be taken?

Answer 28

Oral bisphosphonates should be swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking

Question 29

Give a common SE of methotrexate

Answer 29

Methotrexate may cause pneumonitis - typically presents with cough, dyspnoea and fever

Question 30

How do we manage >75 years following a fragility fracture

Answer 30

Alendronate and then DEXA scan

Question 31

How do we treat acute reactive arthritis?

Answer 31

NSAIDs

Question 32

How do we interpret FRAX score?

Answer 32

FRAX a colour 'risk' is given by the calculator - green, orange or red patients in the orange zone should have a DEXA scan if not already done to further refine their 10-year risk patients in the red zone should also have a DEXA scan if not already done to act as a baseline and guide drug treatment

Question 33

A 59-year-old man with a history of gout presents with a swollen and painful first metatarsophalangeal joint. He currently takes allopurinol 400mg od as gout prophylaxis. What should happen to his allopurinol therapy?

Answer 33

Allopurinol is a xanthine oxidase inhibitor that reduces the production of uric acid, and it is used as a long-term management strategy for gout. According to the UK guidelines, during an acute attack of gout, existing urate-lowering therapy (like allopurinol) should not be discontinued or altered in dosage. This is because changes in serum urate levels can precipitate acute attacks. Therefore, continuing allopurinol at its current dose would be the most appropriate course of action.

Question 34

How does aspirin react with sulfasalazine?

Answer 34

Patients who are allergic to aspirin may also react to sulfasalazine`

Question 35

How does lumbar spinal stenosis present?

Answer 35

Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication. One of the main features that may help to differentiate it from true claudication in the history is the positional element to the pain. Sitting is better than standing and patients may find it easier to walk uphill rather than downhill.

Question 36

How does meniscal tear present?

Answer 36

Meniscal tears result in a variety of symptoms including pain (which is often intermittent), locking, catching, and the knee giving way. Swelling usually occurs but develops several hours after the injury. On examination, there is well-localised pain over the joint line (anteromedial or anterolateral), along with varying levels of swelling and reduced mobility.

Question 37

How do we diagnose meniscal tears?

Answer 37

MRI

Question 38

How do we manage intertrochanteric (extracapsular) proximal femoral fracture?

Answer 38

Dynamic hip screw

Question 39

What must we check before starting azathioprine?

Answer 39

Thiopurine methyltransferase is the enzyme required to metabolism azathioprine, a small proportion of the population had reduced activity or deficiency of this enzyme putting them at risk of azathioprine toxicity. Accordingly. levels should be tested prior to commencing the drug with cautious dosing or an alternate therapy used if TPMT is found. azaTHIOprine - THIOpurine easy to memorise

Question 40

How does L5 lesion present?

Answer 40

L5 lesion features = loss of foot dorsiflexion + sensory loss dorsum of the foot

Question 41

Give the red flags in back pain

Answer 41

Trauma/tenderness Unexplained weight loss Neurological findings Age > 50 years old or <20 Fever IVDU Steroids use History of cancer

Question 42

What is cubital tunnel syndrome?

Answer 42

Cubital tunnel syndrome is caused by compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger. Usually conservative management.

Question 43

What is a type 1 hypersensitivity reaction?

Answer 43

Anaphylaxis

Question 44

What is etanercept, and what is a risk factor of its use?

Answer 44

TNF-α inhibitors may reactivate TB Used in RA

Question 45

Hydroxychloroquine is used in the management of rheumatoid arthritis and systemic/discoid lupus erythematosus. What is the main SE to be aware of?

Answer 45

Importantly, there is a risk of retinopathy and so patients on hydroxychloroquine should be advised to look out for visual symptoms and should have their visual acuity assessed annually.

Question 46

How does psoriatic arthritis differ from RA?

Answer 46

An asymmetrical presentation suggests psoriatic arthritis rather than rheumatoid

Question 47

How does subacromial impingement present?

Answer 47

Subacromial impingement often presents with a painful arc of abduction

Question 48

How does a supraspinatus tear present?

Answer 48

A supraspinatus tear is the closest differential from these options for the cause of this man's presentation. Shoulder pain and acromial tenderness would both be expected but the pain would be limited to the initial 60 degrees of abduction rather than the midpoint indicating impingement as the more likely cause. Depending on the extent of the tear, abduction can also be limited due to difficulty initiating the movement.

Question 49

How does frozen shoulder present?

Answer 49

Active and passive movement limited + external rotation most affected. Frozen shoulder, also known as adhesive capsulitis, is characterised by pain and stiffness in the shoulder joint. It typically presents with both active and passive movement limitation due to fibrosis and inflammation of the joint capsule. External rotation is usually the most affected movement in frozen shoulder, followed by abduction and then internal rotation.

Question 50

How does dermatomyositis present?

Answer 50

Derma-to-myositis Derma-: Skin Symptoms first Gottron's papules, heliotrope and macular rash) to- : Followed by muscle symptoms myositis-: muscle weakness due to inflammation

Question 51

How does facet joint present?

Answer 51

May be acute or chronic Pain worse in the morning and on standing On examination there may be pain over the facets. The pain is typically worse on extension of the back

Question 52

How do we manage temporal arteritis?

Answer 52

Glucocorticoids (e.g. pred) should be given once a diagnosis of temporal arteritis is suspected - don't wait for the temporal artery biopsy etc

Question 53

What is Paget's disease?

Answer 53

Paget's disease is a disease of increased but uncontrolled bone turnover. It is thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by increased osteoblastic activity.

Question 54

How does Paget's disease present?

Answer 54

old man, bone pain, raised ALP

Question 55

How should you manage scaphoid fracture?

Answer 55

due to the risk of avascular necrosis due to the blood supply to the scaphoid bone, needs to be seen in an orthopaedic clinic - you may be able to refer directly or this may need to be via your local emergency department.

Question 56

Following a THR pts must avoid...

Answer 56

Crossing their legs

Question 57

How does PMR present?

Answer 57

Features typically patient > 60 years old usually rapid onset (e.g. < 1 month) aching, morning stiffness in proximal limb muscles weakness is not considered a symptom of polymyalgia rheumatica also mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats Investigations raised inflammatory markers e.g. ESR > 40 mm/hr note creatine kinase and EMG normal

Question 58

How do we treat PMR?

Answer 58

prednisolone e.g. 15mg/od patients typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis

Question 59

What does burning thigh pain suggest?

Answer 59

? meralgia paraesthetica - lateral cutaneous nerve of thigh compression

Question 60

Which medication in RA may cause ILD?

Answer 60

Sulfasalazine

Question 61

Give an eye complication of steroid use

Answer 61

Cataracts

Question 62

Where do you see anti-dsDNA antibodies?

Answer 62

SLE

Question 63

Where do you see anti-jo1 antibodies?

Answer 63

polymyo/dermatomyositis

Question 64

Where do you see anti-CCP antibodies?

Answer 64

RA

Question 65

Where do you see anti-ro/anti-la antibodies?

Answer 65

Sjogren's syndrome

Question 66

Which bones does Paget's disease usually affect?

Answer 66

Paget's disease of the bone generally affects the skull, spine/pelvis, and long bones of the lower extremities

Question 67

What is the cause of housemaid's knee?

Answer 67

The prepatellar bursa lies anterior to the patella, and inflammation can be caused by excessive skin/patella friction, e.g. by working on one's knees. For this reason, it has been known as 'Housemaid's knee'. Housemaid's PREP the house (PREPatellar)

Question 68

What is keratoderma blennorrhagica?

Answer 68

Keratoderma blennorrhagica is a skin condition that is associated with reactive arthritis, formerly known as Reiter's syndrome

Question 69

When must we be careful with sulfasalazine?

Answer 69

Cautions G6PD deficiency allergy to aspirin or sulphonamides (cross-sensitivity)

Question 70

There is a small left para-central L4/5 disc prolapse causing compression of the transiting L5 nerve root. There is no compression of the cauda equina with CSF visible around all nerve roots. All other discs are normal and there are no bony abnormalities visible. Mx?

Answer 70

A referral for sciatica is appropriate after 4-6 weeks of conservative treatment (analgesia and physiotherapy) has failed.

Question 71

Which condition is Sjogren's syndrome linked with?

Answer 71

RA

Question 72

How does hypocalcaemia present?

Answer 72

tingling sensations, muscle spasms and aches, and nausea and vomiting. Common with bisphosphonates

Question 73

How does antiphospholipid syndrome present on coag?

Answer 73

prolonged APTT + low platelets

Question 74

How does epidural abscess present?

Answer 74

Signs of systemic sepsis with changing lower limb neurology

Question 75

How does PMR present?

Answer 75

Polymyalgia rheumatic is characterised by abrupt onset of bilateral early morning stiffness in the over 60s

Question 76

How long do we give abx for in septic arthritis?

Answer 76

4-6/52

Question 77

What is the Ottawa rule?

Answer 77

The Ottawa ankle rules determine the need to perform an ankle x-ray for patients presenting with foot or ankle pain. If an ankle x-ray is not indicated by the Ottawa ankle rules the probability of a fracture is very low. The rules state an x-ray is only required if there is an inability to weight bear both immediately after the injury and on assessment, or there is tenderness along the distal 6cm of the posterior edge of the tibia or fibula or distal tip of either malleoli.

Question 78

What is the earliest sign of ankylosing spondylitis?

Answer 78

Reduced lateral flexion of the lumbar spine

Question 79

What is dactylitis?

Answer 79

Dactylitis describes the inflammation of a digit (finger or toe).

Question 80

What are the Ottowa rules?

Answer 80

An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings: bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular) bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia) -inability to walk four weight-bearing steps immediately after the injury and in the emergency department

Question 81

What is a Buckle fracture?

Answer 81

Buckle, or torus, fractures are incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They typically occur in children aged 5-10 years.

Question 82

How do S1 lesions present?

Answer 82

S1 lesion features = Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

Question 83

How do we manage displaced hip fracture?

Answer 83

Hemiarthroplasty or THR

Question 84

How do we manage achilles tendonitis?

Answer 84

Achilles tendonitis management: rest, NSAIDs, and physio if symptoms persist beyond 7 days

Question 85

Give three causes of carpal tunnel syndrome?

Answer 85

idiopathic pregnancy oedema e.g. heart failure lunate fracture rheumatoid arthritis

Question 86

What is a myxoid cyst?

Answer 86

Myxoid cysts, also known as digital mucous cysts, are benign lesions that typically occur on the fingers or toes, particularly around the nail bed. They are often associated with osteoarthritis and degenerative joint diseases, which fits with this patient's history. The presence of a swelling proximal to the nail bed in a 60-year-old woman with osteoarthritis strongly suggests a myxoid cyst.

Question 87

How does medial meniscus tear present?

Answer 87

Gradual swelling of the knee is suggestive of effusion which often occurs due to meniscal injury. Tenderness over the medial joint line suggests a medial meniscus tear.

Question 88

How do posterior hip dislocations present?

Answer 88

Posterior hip dislocations present with a shortened and internally rotated leg

Question 89

What is clubfoot, and how does it present?

Answer 89

Inverted + plantar flexed foot which is not passively correctable. Clubfoot, also known as talipes equinovarus, is a congenital deformity that is characterised by the foot being turned inwards (inverted) and downwards (plantar flexed). The key feature of this condition is that the foot cannot be easily or fully corrected into a neutral position passively - this means without active movement from the patient.

Question 90

How do we treat clubfoot?

Answer 90

This condition often requires treatment with methods such as the Ponseti method, which involves gentle manipulation and casting of the foot over several weeks to gradually correct its position.

Question 91

What is trigger finger?

Answer 91

a condition that makes it difficult to bend or straighten a finger or thumb. It occurs when a tendon or its sheath becomes swollen or inflamed, causing the tendon to get stuck in the sheath. Symptoms include: A catching or locking sensation in the finger A popping or clicking sound when moving the finger Tenderness in the palm at the base of the affected finger Stiffness, especially in the morning Pain when flexing the finger Palpable nodule

Question 92

What is the female athlete triad of excessive exercise?

Answer 92

Women with low calorie intake or menstrual irregularities who have started a new sport or increased their training are at particular risk of stress fractures

Question 93

How does femoroacetabular impingement (FAI) present?

Answer 93

It commonly presents with hip/groin pain worse on prolonged sitting and associated with snapping, clicking or locking of the hip. There is an association between FAI and prior hip pathology eg Perthes in childhood. It is caused by a variant in hip anatomy leading to abnormal contact between the femur and acetabulum rim.

Question 94

Which RA drug can cause demyelination?

Answer 94

Etanercept

Question 95

How do we manage flares of RA?

Answer 95

Steroids

Question 96

Which side-effect is it most important to warn pts taking colchicine about?

Answer 96

Diarrhoea

Question 97

How long much a pt be symptomatic for before diagnosing chronic fatigue syndrome?

Answer 97

3 months

Question 98

Which foods must people with gout avoid?

Answer 98

Foods to avoid include those high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products

Question 99

What are the clinical findings in ankylosing spondylitis?

Answer 99

Clinical findings in anylosing spondylitis include reduced chest expansion, reduced lateral flexion and reduced forward flexion (Schober's test)

Question 100

What is Schober's test?

Answer 100

a line is drawn 10 cm above and 5 cm below the back dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible

Question 101

What causes dermatomyositis?

Answer 101

Usually an autoimmune condition, being most common in women aged 50-70. However, it can also be a paraneoplastic disease, with ovarian, breast and lung tumours being the most common underlying cancers

Question 102

A 75-year-old female was recently started on alendronate for treatment of osteoporosis following a fragility fracture. She returns to your clinic as she has suffered troubling upper gastrointestinal side effects. What is the most appropriate next step in her management?

Answer 102

Change to risedronate

Question 103

As the patient will most likely be taking prednisolone for over 3 months, what is the most appropriate action regarding her increased risk of developing osteoporosis?

Answer 103

Bone protection (alendronate) for patients who are going to take long-term steroids should start immediately

Question 104

Which renal pathology is associated with osteoporosis?

Answer 104

Chronic kidney disease (CKD) is correct. Osteoporosis is twice as common in those with eGFR <60 than in those with eGFR >60. Abnormalities of calcium, phosphate, and vitamin D metabolism in CKD lead to abnormal bone turnover and mineralization.

Question 105

Why is obesity protective against osteoporosis?

Answer 105

This is because adipose tissue can convert androgens into oestrogen, which aids in maintaining bone density. Moreover, greater body weight puts more stress on bones, leading to increased bone density as a response.

Question 106

Which XR changes are seen in RA?

Answer 106

Loss of joint space Erosions Soft tissue swelling Soft bones (osteoporosis/ osteopenia)

Question 107

How does osteomalacia present?

Answer 107

A 65-year-old Asian female presents with generalised, tender bone pain and muscle weakness. Waddling gait. The low calcium and phosphate combined with the raised alkaline phosphatase point towards osteomalacia.

Question 108

What blood test results would you expect with osteoporosis?

Answer 108

Normal

Question 109

Which blood test is abnormal in Paget's disease?

Answer 109

Isolated raised ALP

Question 110

How does dactylitis present?

Answer 110

A 'sausage-shaped' digit is a classical description of dactylitis.

Question 111

Which condition is dactylitis linked to?

Answer 111

Psoriatic arthritis

Question 112

What does keratoderma blenorrhagica look like?

Answer 112

On the soles of both feet you notice a waxy yellow rash. Seen in reactive arhtritis

Question 113

What is associated with antiphospholipid syndrome?

Answer 113

Antiphospholipid syndrome Clots - veno/ arterial thrombus L - livido reticularis O - obstetric miscarriage T - thrombocytopenia

Question 114

Which RA drug can exacerbate myasthenia gravis?

Answer 114

Penicillamine

Question 115

Which RA drug can cause bronchospasm?

Answer 115

Naproxen

Question 116

Which RA drug can cause proteinuria?

Answer 116

Penicillamine, gold

Question 117

Which RA drug can cause oligospermia?

Answer 117

Sulfasalazine

Question 118

Which RA drug can cause re-activation of TB?

Answer 118

Infliximab (or any other biologics, must do CXR prior to starting to look for cavitating disease as well as a tuberculin skin test or interferon-gamma release assay)

Question 119

How does ankylosing spondylitis present?

Answer 119

Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis

Question 120

What causes gout, and what is seen on microscopy/.

Answer 120

Gout = moNosodium urate = Needle-shaped and Negatively birefringent

Question 121

How can we distinguish gout from pseudogout?

Answer 121

Arthrocentesis shows positively birefringent crystals. Importantly, calcium pyrophosphate deposition onto cartilaginous tissues manifests radiologically as chondrocalcinosis, making chondrocalcinosis the most specific finding for CPPD of the options available.

Question 122

What is radial tunnel syndrome?

Answer 122

To do

Question 123

Which type of hypersensitivity reaction is allergic contact dermatitis?

Answer 123

Type IV ACID Anaphlyaxis Cell mediated Immune complex deposition Delayed hypersensitivity

Question 124

How does Ewing's sarcoma present on XR?

Answer 124

'onion skin' appearance

Question 125

What is osteosarcoma, and how does it present?

Answer 125

the most common primary malignant bone tumour in children and adolescents which commonly affects the metaphyseal region of long bones. Radiographs classically show Codman triangle (a triangular area of new subperiosteal bone) with an associated sunburst appearance.

Question 126

How do we treat Paget's disease?

Answer 126

Paget's disease of the bone is treated with bisphosphonates

Question 127

How does Paget's disease present?

Answer 127

3-year history of progressively worsening hip and back pain. He reports the hip pain is worse on weight-bearing and improves with rest. On examination, you noticed frontal bossing and bowing of the legs.

Question 128

Which antibiotic must never be co-prescribed with methotrexate?

Answer 128

Co-trimoxazole contains trimethoprim and therefore should never be prescribed with methotrexate This patient is presenting with symptoms of bone marrow suppression such as sore throat, mouth ulcer, fever and feeling generally unwell. Additionally, her blood results show anaemia, thrombocytopenia and neutropenia, showing that her bone marrow is being suppressed. severe myelosuppression

Question 129

Which antibody is associated with drug-induced lupus?

Answer 129

Anti-histone antibody AntihiSTONED antibody - drug-induced lupus

Question 130

How can we distinguish gout from pseudogout on XR?

Answer 130

Chondrocalcinosis helps to distinguish pseudogout from gout

Question 131

How do we manage bisphosphonates long-term?

Answer 131

After a five year period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan. This guidance separates patients into high and low risk groups. To fall into the high risk group, one of the following must be true: Age >75 Glucocorticoid therapy Previous hip/vertebral fractures Further fractures on treatment High risk on FRAX scoring T score <-2.5 after treatment If any of the high risk criteria apply, treatment should be continued indefinitely, or until the criteria no longer apply. If they are in the low risk group however, treatment may be discontinued and re-assessed after two years, or if a further fracture occurs. In the case of this patient, she has no risk factors which put her into the high risk group, but we do not have a recent DEXA scan. The best option would therefore be to re-scan her now, and consider a two year break if her T score is >-2.5

Question 132

Which medications can cause drug-induced lupus?

Answer 132

lupus Makes My HIPS Extremely Painful: Methyldopa Minocycline Hydralazine Isoniazid Phenytoin