MSK

Question 1

Osteoarthritis

Answer 1

Primary: Physiotherapy, weight loss + exercise
Secondary: Paracetamol + Ibuprofen OR Paracetamol + Dihydrocodeine
Oral Prednisololne + IM METHYLPREDNISOLONE (while DMARDs kick in)
DMARD: Methotraxate (Sulfasalazine if pregnant)

Question 2

RA

Answer 2

Primary: Methotrexate (Or sulfasalazine) + IM METHYLPREDNISOLONE
Secondary: TNF-Alpha blockers (Infliximab or Etanercept or Adalmumab) + Methotrexate
Tertiary: B-cell inhibitors - Rituximab (stop production of Rheumatoid Factors) + Methotrexate
4th Line: Tocilizumab (blocks IL-6) or Anakinra (IL-1 blocker) + Methotraxate
5th Line: Abatacept (T-cell inhibitor)

Question 3

Scleroderma

Answer 3

Raynauds: Hand warmers + Oral Nifedipine or Oral Bosentan
Oeosphagus: Lansoprazole
CKD: Ramipril
GI malabsorption: Supplements

Question 4

Polymyositis

Answer 4

Oral Prednisolone
Hydroxyhloroquine for skin
Bed Rest + Exercise

Question 5

Reactive Arthritis

Answer 5

Methotrexate (or Sulfasalazine)
NSAIDs
Treat infections with antibiotics

Question 6

AS

Answer 6

2. NSAIDs at night

3. METHOTREXATE (or sulfasalazine)

Question 7

Osteoporosis

Answer 7

Aldendronic acid
AdCal
Teriparatide

Question 8

Aps

Answer 8

1. WARFARIN

Pregnant: Oral Aspirin, SC Heparin

Prophylaxis: Aspirin or Clopidogrel

Question 9

SLE

Answer 9

Primary: NSAIDs/Paracetamol + Sunblock
Hydroxychloroquine
Maintenance: NSAIDs 
Hydroxychloroquine
Methotrexate or Azathioprine
Belimumab

Question 10

Sjogren’s

Answer 10

Saliva and tear replacement solutions

NSAIDs and Hydroxychloroquine

Question 11

Pseudo Gout

Answer 11

Ibuprofen/Aspirin
Colchicin (antibiotic) if NSAID not tolerated
Prednisolone

Question 12

Polymyalgia Rheumatica

Answer 12

ORAL prednisolone (+ Lansoprazole + Aldenronate to stop GI and osteoporosis)

Question 13

GCA

Answer 13

ORAL Prednisolone (+ Lansoprazole + Aldenronate to stop GI and osteoporosis)

Question 14

Acute Gout

Answer 14

NSAIDs or Aspirin
If NSAIDs not tolerated – Colchicine
IM Prednisolone

3 weeks later: WE GIVE ALLOPURINOL as it causes GOUT if given too early

Secondary Line: FEBUXOSTAT

Stop thiazide diuretics and give LOSARTAN (promotes uric acid excretion)

Question 15

Paget’s

Answer 15

1. Aldendronate

2. NSAIDs

Question 16

Fibromyalgia

Answer 16

1. Rest pain thermostat
2. Correct non-restorative sleep + improve aerobic fitness
3. Oral Amitryptaline (depression)
4. Oral Pregabalin (anticonvulsants)

Question 17

Osteomalacia

Answer 17

1. Vit D replacement
2. Oral Ergocalciferol or IM Calcitriol (for malabsorption or hepatic disease)
3. Alfacidol or IM Calcitriol (renal)

Question 18

Septic arthritis

Answer 18

1. Stop Methotrexate
2. Double Prednisolone
3. Mobilise joint
4. Double IV antibiotics (2 week course)
5. NSAIDs
6. Aspiration of joint or surgical washout

Question 19

Gonorrhoea arthritis

Answer 19

1. Ciprofloxacin

2. Doxycycline

Question 20

Osteomyelitis

Answer 20

1. IV Teclopanin (IV antibiotic for prophylaxis against Gram-Positive)
2. IV Flucloxaillin
3. Oral Fusidic Acid (topical antibiotic)
4. Remove dead sequestra