OA, SepticA and RA

Answer 1

LOSS

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

Answer 2

TOLD

Tissue swelling
Osteopenia (Juxta-articular)
Loss of joint space
Deformed joint

Answer 3

NET

Normal joint space
Erosions
Tissue swelling

Answer 4

20

55

Answer 5

Gelling (stiffness)

Answer 6

Herbedens nodes

Answer 7

Bouchards nodes

Answer 8

LOSS

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

Question 9

[OA}: Core treatments for OA involve 2 main lifestyle changes irrespective of age/co-morbidity. What are they?

Answer 9

Weight loss

Exercise

Question 10

[OA}: 1st line tX

Answer 10

Paracetamol (+- topical NSAIDs)

Question 11

[OA}: If 1st line tx is inneffective you use …. or ….

Answer 11

Codeine

short term ORAL nsaid (+PPI)

Question 12

[OA}: If severe what can you use to non-surgically tx the pt

Answer 12

Intra-articular steroid injections

Question 13

[OA}: If substantially decreased QOL what is indicated

Answer 13

Joint replacement

Question 14

[OA}: What is the pattern of morning stiffness

Answer 14

<30 mins

Answer 15

It can destroy a joint in <24hrs

Answer 16

RA

Answer 17

Infection is difficult to treat there.

Answer 18

Synovial fluid (via aspiration)

Answer 19

Straight after aspiration

Answer 20

Staph Aureus
Streptococci
Neisseria Gonnococcus
Gram -ve

Answer 21

Flucloxacillin

Answer 22

Clindamycin

Answer 23

Vancomycin

Answer 24

Cefotaxime

Question 25

[SepticA]: Normally presents with acutely hot inflamed joint, unless...

Answer 25

Pt is immunocomromised

Question 26

[RA]: What 2 genes are associated with increased severity

Answer 26

HLA DR4 | HLA DR1

Question 27

[RA]: RA is usually a symmetrical peripheral polyarthritis, what does palindromic RA refer to?

Answer 27

Recurring rapid attack of mono (poly) arthritis of various joints.

Question 28

[RA]: There are two places subluxation can occur. Name both and which one is dangerous.

Answer 28

Dorsal wrist | Atlanto-axial (! - threatens spinal cord)

Question 29

[RA]: ... may rupture in the upper limb, this can also happen in the lower limb

Answer 29

extensor tendons

Question 30

[RA]: Name the deformities of the thumb (1) and fingers (3)

Answer 30

Ulnar deviation Z-thumb Swan-neck Boutonierre

Question 31

[RA]: Only 1% of pts have Feltys syndrome, apart from RA what makes up the triad

Answer 31

RA splenomegaly Neutropenia

Question 32

[RA]: Where would you find nodules

Answer 32

elbows | lungs

Question 33

[RA]: In what 4 ways can the lung be involved

Answer 33

Fibrosing alveolitis obliterative bronchiolitis pleural effusion Lung nodules

Question 34

[RA]: ... is associated with more severe disease and extra-articulars. It is present in ...% of pts in Ix

Answer 34

RhF | 70

Question 35

[RA]: What is the most specific thing to Ix for

Answer 35

Anti-cyclic citrullinated peptide antibodies are abbreviated to anti-CCP/ACPA. (98%)

Question 36

[RA}: Why would RA cause decreased Hb

Answer 36

Anaemia of chronic disease

Question 37

[RA}: how is disease activity measured

Answer 37

DAS28

Question 38

[RA}: What DAS28 should you aim for

Answer 38

<3

Question 39

[RA}: What are the 4 criteria for diagnosing RA

Answer 39

Joint involvement Serology Acute Phase reactants Duration of symptoms

Question 40

[RA}: In the diagnostic criteria what does serology look at

Answer 40

RhF Anti-CCP (looking at absent, low or high levels)

Question 41

[RA}: In the diagnostic criteria what does APR look into

Answer 41

CRP | ESR

Question 42

[RA}: In the diagnostic criteria what are the duration of symptom cut offs

Answer 42

6 weeks

Question 43

[RA}: In the diagnostic criteria how do they differentiate between number of joints

Answer 43

``` 1 large joint = 0 2-10 large joints = 1 1-3 small = 2 4-10 small = 3 >10 (one has to be small) = 5 ```

Question 44

[RA}: 1st line tx is ... and .... and ...

Answer 44

Methotrexate Sulfasalazine Hydroxychloroquine

Question 45

[RA}: Why do DMARDs require frequent FBCs

Answer 45

Immunosuppresive leading to pancytopenia and neutropenic sepsis

Question 46

[RA}: When can you use the TNF-a inhibitor infliximab (+methotrexate)

Answer 46

After Tx with 2 DMARDs with a DAS28 of >5.1

Question 47

[RA}: If tx with DMARDs alone, and then with infliximab has failed what can you use

Answer 47

Rituximab (B cell depeletion) | +methotrexate

Question 48

[RA}: If tx with DMARDs alone, and then with infliximab and then rituximab has failed what can you use

Answer 48

Tocilizumab (IL-6 blocker) | +methotrexate

Question 49

[RA}: The major SE of DMARDs is reactivation of ... and ....

Answer 49

TB | Hepatitis C

Question 50

[RA}: What is 1st line in treating an acute flare of RA

Answer 50

Methylprednisolone IM depot

Question 51

[RA]: What are the 4 ocular manifestations of extra-articular RA

Answer 51

Scleritis Episcleritis Keratoconjuctivitis Sicca Scleromalacia

Question 52

[RA]: What are the SE of Methotrexate (3)

Answer 52

Pneumonitis Oral Ulcers hepatoxicity

Question 53

[RA]: What are the SE of Sulfasalazine (3)

Answer 53

Rash Sperm count decreased oral ulcers

Question 54

[RA]: What are the SE of Hydroxychloroquine (1)

Answer 54

Irreversible retinopathy