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Flashcards in MSK Deck (41)
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1

Rheumatoid Arthritis deformities

Boutonniere
Ulnar deviation
Swan-neck
Z thumb

2

Osteoarthritis deformities

Bouchard - (PIP)

3

Osteoporosis mx:

1L, 2L

1L: Alendronic acid (bisphosphonate) + AdCal (vitD + Ca)

2: DMARD - Denosumab (monoclonal Ab to RANK > inhibit osteoclasts)

4

Gout Mx

+ brief pharmacology

Flare-up: COLCHICINE

Prophylaxis: Allopurinol + Febuxostat

Allopurinol = xanthine-oxidase inhibitor)

5

Osteoarthritis X-ray px

LOSS

Loss joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

6

Rheumatoid arthritis X-ray

Bony erosions
Joint subluxation
Reduced joint space
Osteopenia
Soft tissue swelling

7

Bisphosphonate Pharmacology

Inhibit Farnesyl Pyrophosphate Synthase > inhibit osteoclasts

8

Denosumab Pharmacology

Monoclonal Ab to RANK Ligand > inhibit osteoclasts

9

Osteoporosis Mx + pharmacology

Include tx option for someone post-menopausal or on a glucocorticoid

1L] Bisphosphonate - Alendronate; inhibit cholesterol synthesis > slows osteoclasts

2L] Denosumab; RANK Ligand Ab > matures osteoclasts
(Deno DINO BONES + -mAB = Ab)

Raloxifene; (post-menopause/ on glucocorticoid) - binds estrogen receptor, inhibits osteoclasts

Teriparatide; PTH analogue

10

Side effects of Bisphosphonates

Oesopagheal ulcers

Take with big glass of water, once weekly. Sit upright for 30 minutes after.

11

What is a DEXA scan?

DEXA Scan - T-score; compares bone density to younger pt of same sex

Used to diagnose osteoporosis

12

Osteoarthritis joints affected + X-ray findings

Wt-bearing, DIP, PIP

Weight-bearing joints = knee, hip, lumbar spine.

DIP - Heberden's
PIP - Bouchard's

X-RAY:
Lost joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

13

Rheumatoid Arthritis joints affected + deformities + other presentations

Symmetrical. MCP, PIP

Swan-neck
Boutonniere
Ulnar deviation
Rheumatoid nodules + factor

Dry cough (pleural effusion/ fibrosis).
Neck pain. Splenomegaly.

14

Rheumatoid arthritis GOLD investigation

Anti-cyclic citrullinated peptide Ab (Anti-CCP/ ANCPA)

15

Rheumatoid arthritis management

DAS28 score.

NSAIDs, paracetamol

DMARDs - Methotrexate (Sulfasalazine/ hydroxychloroquine). Prednisolone.

TNF-a inhibitors - Infliximab

16

RA risk factors

F, HLA-DR4, 40-60, Rheumatoid Factor, smoking

17

Osteoarthritis management

Physio, wt loss, aerobics.

Paracetamol, NSAIDs.

Short-term intra-articular steroids.

Curative = joint replacement

18

Most common overall cause of osteomyelitis and septic arthritis

Staphylococcus aureus

19

Moat common cause of osteomyelitis in IVD users

Pseudomonas
E coli

20

Most common cause of osteomyelitis in Sickle Cell patients

Salmonella

21

Most common cause of osteomyelitis/ septic arthritis following a joint-replacement

Staphylococcus epidermis

22

Treatment of osteomyelitis

Flucloxacillin + Fusidic Acid

or

Vancomycin + Cefotaxime

23

Most common cause of septic arthritis in young sexually-active adults

Neisseria gonorrhoea

24

Most common cause of septic arthritis in IVD users

Pseudomonas aeruginosa

25

Treatment of septic arthritis

1. Drainage of joint
2. Remove prosthetic

3. EMPIRICAL - Flucloxacillin + Vancomycin

4. S. aureus - vancomycin
N. gonorrhoea - Ceftriaxone

26

Most common bacterial STI?

Second most common bacterial STI?

Investigations?

Most common: Chlamydia Trachomatis

Second most common:
Neisseria gonorrhoea

1L: NAAT

Gold: Microscopy:

N. gonorrhoea: Gram-negative diplococci with polymorphs

27

Management of Chlamydia Trachomatis

Avoid sex until course finished

Doxycycline/ azithromycin

Contact trace

28

Management of Neisseria gonorrhoea

Ceftriaxone + Azithromycin

29

Sjorgren syndrome investigations

Salivary Gland Biopsy -
ANA, Anti-Ro, Anti-La

Schirmer's Test, Rose Bengal Stain

30

Sjorgren syndrome shows a ____ __ _________ of minor glands

Type 4 Hypersensitivity