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1
Q

what test can help diagnose antiphospholipid syndrome?

A

anti-cardiolipin

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2
Q

what paradoxical test result is seen in antiphospholipid syndrome?

A

prolonged APTT

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3
Q

what else is reduced in antiphospholipid syndrome?

A

platelets - thrombocytopaenia

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4
Q

name 3 features of antiphospholipid syndrome (other than the clots)

A

livedo reticularis (mottled + red)
preeclampsia
pulmonary HTN

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5
Q

management of initial VTE in antiphospholipid syndrome

A

warfarin - target INR of 2-3 for 6mo

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6
Q

management of recurrent VTEs in antiphospholipid

A

lifelong warfarin

if already taking warfarin - increase target INR to 3-4

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7
Q

what treatment worsens compartment syndrome?

A

anticoagulation

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8
Q

what complication can occur after ischaemia reperfusion injury in vascular patients?

A

compartment syndrome - can occur after VTE

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9
Q

which 2 main fractures carry the risk of compartment syndrome?

A

supracondylar fractures and tibial shaft injuries

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10
Q

list 4 possible symptoms of compartment syndrome

A

pain (active + passive)
paraesthesia
pallor
paralysis of muscle group

4 Ps

arterial pulsation may still be felt as necrosis is due to microvascular compromise

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11
Q

how to diagnose compartment syndrome?

A

measure pressure inside compartment

> 20 - abnormal
40 - diagnostic

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12
Q

treatment of compartment syndrome

A

prompt + extensive fasciotomy

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13
Q

what complication can result from fasciotomy? how to manage?

A

myoglobinuria - can cause renal failure

give aggressive IV fluids (before or after found??)

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14
Q

how quickly can muscle groups die in compartment syndrome?

A

4-6h

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15
Q

pain on wrist EXTENSION against resistance (arm straight)

A

laTeral epicondylitis - Tennis elbow - pain on exTension

laTeral Tennis exTension

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16
Q

natural history of lateral epicondylitis (ie timing)

A

acute pain for 6-12 weeks

episodes last 6mo-2 years

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17
Q

management of lateral epicondylitis

A

physio
simple analgesia
avoid muscle overload
steroid injection

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18
Q

how would osteomalacia affect calcium, phosphate, vitamin D, ALP + PTH?

A

low calcium, phosphate, vitamin D

high ALP + PTH

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19
Q

what is the common type of osteomalacia?

3 causes

A

vitamin D deficiency - malabsorption, lack of sun, diet

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20
Q

how do you manage osteomalacia?

A

calcium with vitamin D tablets

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21
Q

how does osteoporosis affect bloods?

A

bloods are normal

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22
Q

what effect does myeloma have on calcaemia?

A

hypercalcaemia

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23
Q

what effect does primary hyperparathyroidism have on calcaemia?

Study These Flashcards
A

hypercalcaemia

24
Q

investigations for myeloma?

Study These Flashcards
A

serum electrophoresis

skeletal survey

25
other than vitamin D deficiency, what can cause osteomalacia?
renal or liver disease | drug induced eg anticonvulsants
26
features of osteomalacia
bone - pain + fractures | muscles - tenderness + proximal myopathy
27
features of compartment syndrome
pain, esp on active/passive movement paraesthesiae pallor local paralysis
28
what intracompartmental pressures indicate compartment syndrome?
>40 - diagnostic | >20 - abnormal
29
CREST syndrome - what is it + what are the features?
limited cutaneous form of SSc ``` calcinosis - skin deposits raynaud's - dysphagia esophageal dysmotility sclerodactyly telangiectasia ```
30
Elderly woman. 2wk hip + shoulder pain + early morning stiffness. Difficulty raising arms. Power normal. ESR raised, CK normal. Diagnosis?
Polymyalgia rheumatica
31
What is the key blood result in polymyositis?
Raised CK
32
What joints does OA tend to present in?
Weight bearing eg hips + knees
33
What crystal is involved in pseudogout?
Calcium pyrophosphate
34
Where does pseudogout most commonly affect?
Mono-articular; knees then hips
35
what does chondrocalcinosis indicate?
pseudogout
36
what is pseudogout like on aspiration?
weakly positively birefringent rhomboid shaped crystals
37
pseudogout - management
aspirate to exclude septic arthritis | NSAIDs or IA/IM/PO steroids
38
plantar fasciitis - presentation
heel pain worsened by tip toes, usually worse medially
39
plantar fasciitis - management
rest feet + stretches regular paracetamol + NSAIDs if painful arched + cushioned heels, insoles
40
what would you find on examination of temporal arteritis?
pulseless temporal artery | tenderness on palpation
41
systemic sclerosis - antibodies
anti-centromere or anti-scl (depends on type) | 90% - ANA
42
3 things that can cause carpal tunnel
rheum disorders pregnancy oedema eg HF
43
carpal tunnel - 2 symptoms + 2 signs
pain/paraesthesia in thumb, 1st + 2nd finger shaking hand (oft at night) relieves weak thumb abduction wasting thenar eminence
44
carpal tunnel - management
corticosteroid injection wrist splints at night surgery
45
what is a complication of scaphoid fracture? what is the problem with scaphoid fractures?
avascular necrosis | often not seen on xray
46
what is osteomalacia? what causes it?
softened bones due to inadequate phosphate, calcium + vitamin D
47
what is CK like in PMR?
normal
48
CREST syndrome - which antibody?
anti-centromere
49
what is the difference between limited cutaneous SSc and diffuse cutaneous SSc?
limited - "CREST syndrome" - anti-centromere, systemic involvement limited diffuse - "progressive/malignant scleroderma" - anti-scl, greatest chance of lung, gut, heart, renal involvement
50
how does diffuse cutaneous scleroderma present?
more extensive + internal organ involvement mask-like face, wrinkled skin around a small mouth tethering of skin over nose - beaking interstitial pulmonary fibrosis renal dysfunction + THN atonic oesophagus - reflux + aspiration
51
seronegative arthritis - types?
psoriatic, reactive, ank spond, enteropathic
52
seronegative arthritis - presentation?
``` asymmetrical oligoarthritis + sacroiliitis anterior uveitis (acute ivitis) ```
53
dupuytren's - what is it?
thickening of palmar aponeurosis, preventing flexor tendons working properly little + ring fingers most commonly affected
54
dupuytren's - presentation
oft - painless deformity in middle aged men starts as firm painless nodule ± palmar skin pitting ± knuckle pad thickening cord formation leads to FF contracture of MCPs ± PIPs
55
dupuytren's - RFs
?microtrauma FH alcohol, smoking, diabetes phenytoin
56
dupuytren's - treatment
no treatment if managing with ADLs segmental fasciectomy - so sig recurrence rate post op splinting + physio

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