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Rheum Flashcards

1
Q

burning and pins and needles in the hand, wakes at night. Diagnosis?

A

carpal tunnel

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2
Q

OA management

A
  1. exercise to build muscle strength
  2. weight loss
  3. analgesia [PO+topical]
  4. intra-articular steroid injections
  5. PT/OT, heat/cold packs, walking aids
  6. surgery
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3
Q

which is more specific for rheumatoid arthritis, anti CCP or rheumatoid factor?

A

anti CCP

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4
Q

monitoring for DMARDs

A

3 monthly FBC & LFT

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5
Q

methotrexate for ank spond?

A

doesn’t work on spine so only for other affected joints

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6
Q

what is crest syndrome?

A

type of scleroderma - calcinosis, raynauds, oesophageal, sclerodactyly, telangectasia

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7
Q

osteoporosis Mx

A

bloods to rule out [vit D, Ca, TFT]
alendronic acid > risedronate > zolendronate
Adcal

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8
Q

how long would you continue a patient on a bisphos for osteoporosis?

A

5 yrs then break

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9
Q

what chest xray changes might you see in chronic sarcoidosis?

A

hilar lymph node enlargement

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10
Q

sarcoid Mx

A

steroids

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11
Q

does it matter is RA patient is rheumatoid factor +ve or -ve when considering a biologic?

A

yes - unlikely to start in a -ve patient as they dont respond well

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12
Q

what can you do if methotrex Pt having nausea

A

split dose [twice a week instead of once] and ^folic acid from weekly to daily (except on methotrex day)

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13
Q

why do methotrex patients take folic acid?

A

reduces SEs

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14
Q

DMARD side effects

A

nausea, reduced appetite, sore mouth, diarrhoea

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15
Q

ank spond patients suffer with what bowel prob?

A

crohns

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16
Q

why might you switch pt from methotrex PO to SC?

A

100% of injection absorbed

GI SEs

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17
Q

Risk factors for RA

A

Female
Smoking
Genetic

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18
Q

Management of hyper mob/ Ehler Danlos type 3

A

Pain relief

Physio

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19
Q

Complications/ serious manifestations of ehler danlos/ hypermob

A

Dislocated eye lenses

Cardiac - aneurysm, valvular

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20
Q

If patient presents with RA picture + also has psoriasis, how do you diagnose?

A

Rh +ve = RA

Rh -ve = psoriatic

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21
Q

calcium deposits in joint causing inflamm. Dx?

A

pseudogout

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22
Q

what type of drug is hydroxychloroquine?

A

DMARD

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23
Q

what is Takayasu’s arteritis and Tx?

A

large vessel vasculitis. steroids,methotrex

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24
Q

what hip problem is an associated complication of steroid use? and Ix

A

avascular necrosis

MRI (xray wont necessarily show)

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25
what is the clinical triad of wegener's granulomatosis? (3 areas affected)
upper resp tract lower resp tract kidneys
26
describe some Sx of wegeners gran
``` oral ulcers bloody nasal discharge nasal bridge collapse (saddle) sinusitis haematuria dyspnoea ```
27
Mx of fibromyalgia
meds - pain relief + anti dep pain clinic exercise CBT/ councelling
28
what effect does fluoxetine have on sleep
^ wakefulness
29
what WBC change might steroids induce on FBC
^neutrophils
30
what is the name of the deformity seen in RA patients where there is flexed PIP and extended DIP?
boutonniere
31
what is the name of the deformity seen in RA patients where there is flexed DIP and extended PIP?
swan neck
32
what blood results might indicate active RA/ inflamm?
anaemia ^platelets ^ESR/CRP
33
72 yr old 3 day Hx pain/swelling of 1 knee O/E apyrexial, knee warm/swollen w/ effusion Mx?
could be trauma/ RA/ OA, but aspirate and culture synovial fluid to rule out septic arthritis
34
46 yr old male, DM/ HTN/ hyperlipidaemia 2 day Hx cute onset pain/ swelling of 1 ankle, cant weightbear. Differetial diagnoses?
gout | septic arth
35
risk factors for septic arth
``` elderly malignancy imm supp prosthesis injection trauma chronic arthr ```
36
most common organism for septic arth
staph aureus
37
if septic arth suspected should you start Abx immediately or wait til after aspirate
wait - Abx could skew culture result / false neg
38
Ix for septic arth
blood culture inflamm markers joint aspirate + culture
39
usual Abx for septic arth | +other mx
fluclox | surgical washout
40
multiple hot swollen joints, spreading to other joints, moving. + skin lesions. Diagnosis?
gonoccocal arth
41
extraarticular features of RA
lung nodules scleritis/episcleritis vasculitis ^risk of IHD
42
Differential for temporal arteritis in scalp tenderness
Migraine
43
ESR and age criteria for temp arteritis diagnosis
Both >50
44
how does gout present
1 JOINT acute inflamed big toe metatarsophalangeal in >50%
45
common joints for gout other than big toe metatarsophalangeal (in >50%)
``` ankle foot small joints of hand wrist elbow knee ```
46
gout is caused by deposition of what
monosodium urate crystals
47
what factors could precipitate gout
``` trauma surgery starvation infection diuretics ```
48
other than gout, what may occur due to long term raised plasma urate?
tophi [deposits] in pinna, tendons, joints | renal disease [stones, interstitial nephritis]
49
differentials for gout
``` septic arth reactive arth haemarthrosis CPPD (pseudogout) palindromic RA ```
50
give 5 risk factors for gout
``` male age post-menopause women impaired renal Fn HTN metabolic syndrome diuretics, antihypertensives, aspirin, warfarin, diet [alcohol, red meat etc] genetic myelo/lymphoproliferative disorders psoriasis tumour-lysis syndrome ```
51
what will light microscopy of synovial fluid show in gout
-vely birefringent urate crystals [needle-shaped]
52
Ix in gout
joint aspirate and light microscopy of synovial fluid serum urate levels XR
53
what might XR of gout show
soft tissue swelling only in early stages | punched out erosions in juxta-articular bone
54
Mx of acute gout
``` high dose NSAID colchisine if NSAID contra-I beware renal impairment for both! steroid [PO/IA/IM] rest + elevate, bed cage, ice pack ```
55
gout prevention
``` weight loss avoid fasting avoid alcohol/meat excess avoid aspirin prophylaxis: allopurinol ```
56
when would you start someone on gout prophylaxis
>1 attack/yr tophi renal stones
57
precautions when starting allopurinol
it may trigger an attack, so wait 3 weeks after an episode, and cover with regular NSAID/colchicine for 6 weeks/6 months respectively
58
how does acute calcium pyrophosphate deposition present
large joint monoarthropathy acute in the elderly
59
how does chronic calcium pyrophosphate deposition present
inflammatory RA-like symmetrical polyarthritis + synovitis
60
what will light microscopy of synovial fluid show in calcium pyrophosphate deposition ? and on XR?
weakly positively birefringent crystals [rhomboid shaped] soft-tissue calcium deposition
61
Mx of calcium pyrophosphate deposition
``` cool packs, rest aspiration intra-articular steroids NSAIDs +/- colchisine chronic: methotrex, hydroxychloroquine ```
62
Sx of OA
``` pain crepitus ['crunching/creaking'] background ache at rest worse with prolonged activity brief stiffness after rest [10-15 mins] instability ['gives way'] reduced ROM (mild inflamm) boney swelling [heberbens dip/bouchards pip] KNEE, HIP, DIP/PIP/CMC ```
63
xr features OA
``` LOSS Loss of joint space Osteophytes Subarticular sclerosis Subchondral cysts ```
64
risk factors for septic arthritis
``` pre-existing joint disease [RA] DM imm.supp. chronic renal failure recent joint surg prosthetic joint IV drug abuse age >80 ```
65
Ix in septic arth
urgent joint aspiration M+C blood cultures XR may be normal CRP may be normal
66
main differential for septic arth
crystal arthropathies
67
common organisms for septic arthritis
staph aureus strep neisseria gonococcus gram -ve bacilli
68
Mx of sertic arthritis
Abx | arthrocentesis/surgical washout/debridement
69
risks of NSAIDs
GI bleed ^stroke/MI risk renal injury
70
the spondyloarthropathies are a group of related chronic inflamm conditions. They include:
ank spond enteric arthropathy psoriatic arth reactive arth
71
what are the shared clinical features of the spondyloarthropathies [these include Ix findings]
1. seronegative [RF-ve] 2. HLA B27 3. axial arthritis [spine+sacroiliac] 4. asymmetrical large joint oligo/mono 5. enthesitis [plantar fasc/Achilles tendonitis/costochon] 6. dactylitis 7. extra-articular [eyes/rash/oral ulcers/valve/IBD]
72
main joints effected in ank spond
spine | sacroiliac joints
73
typical presentation of ank spond. + other complications/ mainfestations
``` young man gradual onset low back pain worse at night morning stiffness sacroiliac joint pain > buttocks/hips reduced spinal movement in all directions enthesitis ``` acute iritis osteoporosis aortic valve incompetence pulm apical fibrosis
74
XR/ MRI findings in ank spond
SI joint space narrowing/widening ankylosis/fusion sclerosis erosions MRI: as above + active inflamm [bone marrow oedema]
75
what are syndesmophytes? they are pathognomic for what disease?
bony proliferations due to enthesitis between ligaments and vertebrae. ank spond
76
Mx of ank spond
``` exercise/ PT NSAIDs TNFa blockers [adalimumab/ etanercept] local steroid inj bisphos [osteoP risk] ``` hip replacement / (spinal osteotomy)
77
associations of enteric arthropathy
IBD GI bypass coeliac
78
Mx of psoriatic arthritis
IA steroid [in monoarthritis] methotrex/leflunomide/sulfasalazine [in poly/oligo/ persistent monoarthritis] NSAIDs apremilast etanercept/adalimumab/infliximab ustekinumab
79
clinical features of reactive arthritis
arthritis Sx of STI iritis keratoderma blenorrhagica [brown papules on soles and palms] circinate balanitis [Chlam penile ulceration] mouth ulcers enthesitis
80
what is the triad of reiter syndrome
urethritis arthritis conjunctivitis
81
what are the features of systemic sclerosis
scleroderma (skin fibrosis) internal organ fibrosis microvascular abnormalities
82
what antibody is present in 90% of systemic sclerosis patients?
ANA
83
in systemic sclerosis, skin disease is limited or diffuse. Which areas are affected in limited?
face, hands, feet [NB. both limited and diffuse can have organ fibrosis but it happens later in limited]
84
what condition of the lungs, that can be life threatening, is ass. w/ limited systemic sclerosis? How is it treated?
pulm HTN sildenafil
85
sjogrens syndrome can be primary or secondary to what?
SLE RA systemic sclerosis
86
give 4 features of sjogrens
reduced tears [dry eyes, keratoconjunctivitis sicca] reduced salivation [Xerostomia, caries] parotid swelling vaginal dryness, dyspareunia dry cough dysphagia polyarthritis, arthralgia, raynauds, lymphadenopathy, vasculitis, lung, liver, kidney, peripheral neuropathy, myositis, fatigue
87
what CA are sjogrens patients at ^ risk of
non-hodgkins lymphoma
88
Mx of sjogrens
``` artificial tears frequent drinks gum/pastilles NSAIDs, hydroxychloroquine for arthralgia severe: imm supp ```
89
give 5 conditions in which raynauds is seen
``` SLE systemic sclerosis RA dermato/polymyositis atheroma polycythaemia rubra vera hypothyroid ```
90
what causes raynauds
paroxysmal vasospasm
91
Mx of raynauds [drug + advice]
rule out an underlying disease keep warm smoking cessation nifedipine
92
features of polymyositis
``` progressive symmetrical proximal muscle weakness + muscle inflamm myalgia arthralgia dysphagia dysphonia resp weakness ``` fever, arthralgia, raynauds, initerstitial lung fibrosis, myocarditis, arrhythmia
93
dermatomyositis features
those of myositis [muscle inflamm + weakness] plus skin signs: macular rash (shawl), lilac purple rash with oedema on eyelids, nail fold erythema, gottrans papules (red over knuckles, elbows, knees) fever, arthralgia, raynauds, initerstitial lung fibrosis, myocarditis, arrhythmia
94
what enzymes might you see increased in the plasma in myositis [muscle inflamm/ breakdown]
CK LDH ALT/AST
95
50 yr old female presents with gradually worsening thigh weakness, difficult to stand from sitting without using arms. Her muscles and joints ache, she also has a red rash over her chest, upper back and shoulders. On examination you notice some red papules over her knuckles and elbows. Bloods show ^CK. EMG shows fibrillation potentials. Diagnosis? And how would you confirm the diagnosis?
dermatomyositis muscle biopsy
96
Mx of myositis
pred imm supp. cytotoxics hydroxycloroquine/topical tacrolismus for skin disease
97
diseases associated with rheumatoid factor
``` sjogrens RA felty's syndrome SLE systemic sclerosis ```
98
diseases associated with ANA
SLE systemic scleroiss autoimmune hepatitis sjogrens
99
anti ds DNA = what disesase
SLE
100
gastric parietal cell / intrinsic factor antibodies =
pernicious anaemia
101
alpha gliadin antibody, antitissue transglutaminase Ab .... what disease?
coeliac
102
thyroid peroxidase antibodies seen in what diseases?
hashimoto's thyroiditis | grave's
103
islet cell antibodies, glutamic acid decarboxylase ab see in....
DM type 1
104
glomerular basement membrane antibody = what disease
goodpastures
105
cANCA seen in what diseases
granulomatosis with polyangiitis [wegeners] microscopic polyangiitis polyarteritis nodosa
106
pANCA seen in...
microscopic polyangitis churg-strauss goodpastures
107
acetylcholine receptor antibody seen in ....
myasthenia gravis
108
pathology of SLE
multisystem autoimmune | autoantibodies > immune complexes > imflammation + damage
109
give 8 features of lupus [can be Sx, manifestations, Investigation findings]
``` malar/butterfly rash discoid rash alopecia oral/nasal ulcers synovitis serositis [pleurisy, pleural effusion, pleural rub/ pericardial pain, pericardial effusion, pericardial rub, pericarditis on ECG] lupus nephritis [proteinuria, RC casts] seizure, psychosis, mononeuritis multiplex, myelitis, neuropathy haemolytic anaemia leucopenia thrombocytopenia +ve ANA/ anti-dsDNA/low complement/^ESR ```
110
mX of SLE
``` hydroxychloroquine topical steroids for skin flares NSAIDs azathiop, methotrex, mycophenalate belimumab renal: control BP, ACEi/ARB, RRT, transplant ``` suncream
111
features of anti-phospholipid syndrome + Mx
``` antibodies cause CLOT: Coag defects [clots: arterial/venous, cerebral, renal] Livedo reticularis Obs [miscarriages] Thrombocytopenia ``` Mx = anticoagulants
112
give the types of large vessel and medium vessels vasculitides
large: GCA, takayasu med: polyarteritis nodosa, kawasaki
113
what is the pathology in takayasu's? What Sx does this produce? who does it affect?
vasculitis of aorta and its major branches granulomatous stenosis, thrombosis, aneurysms aortic arch: dizzy, weak arm pulses, visual change systemic: fever, weight loss, malaise renal artery stenosis: high BP women age 20-40, in japan
114
complications of takayasu's arteritis
``` renal artery stenosis aortic valve regurg aortic aneurysm, dissection ischaemic stroke IHD ```
115
Mx of takayasu's
pred (methotrex, cyclophos) BP Control angioplasty/stenting/bypass in stenosis
116
list the small vessel vasculitides
ANCA-ass: microscopic polyangiits granulomatosis with polyangiits [Weg] churg-strauss [eosinophilic GWP] immune complex: goodpastures cryoglobulinaemic vasculitis IgA vasculitis[HSP]
117
Mx of large/medium/small vessel vasculitis
large: steroids (+steroid sparing later) | med/small: steroid + e.g. cyclophos/methotrex/azathiop
118
Hx sounds like temporal arteritis but patient is under 55, what other vasculaitis would, you consdier?
takayasu's
119
histroy sounds like temporal arteritis but biopsy is normal. what's going on?
skip lesions, dont be put off by -ve biopsy
120
what would you give a patient with temporal arteritis on long term steroids to avoid risks of steroid treatment?
bisphos calcium with colecalciferol PPI
121
what does polyarteritis nodosa do
necrotizing vasculitis aneurysms and thrombosis > infarct medium vessels
122
features of microscopic polyangiitis
glom. neph. | pulm haemorrhage
123
systemic features of vasculitis
``` fever malaise weight loss arthralgia myalgia ```
124
GI features of vasculitis
pain infarct perf malabsorption
125
renal features of vasculitis
``` hypertension haematuria proteinura casts renal failure glom.neph infarcts ```
126
neuro + psych features of vasculitis
``` stroke fits chorea psychosis confusion impaired cognition altered mood mononeuritis multiplex, polyneuropathy ```
127
what condition does polymyalgia rheumatica often occur alongside?
GCA
128
features of polymyalgia rheumatica
<2 weeks onset aching, tender, morning stiffness in shoulders, hips, proximal muscles NOT WEAKNESS fatigue, fever, weight loss, anorexia, depression age>50 [carpal tunnel, tenosynovitis, polyarthritis]
129
what investigation could help you distinguish polymyalgia rheumatica from myositis/myopathy?
CK raised in myositis/myopathy not in PMR
130
polymyalgia rheumatica Mx
pred (+ bisphos) +/-methotrex
131
fibromyalgia Mx
GET CBT amitriptilline/ pregab duloxetine if alongside depression/anx
132
what causes sudden blindness in GCA
optic nerve ischaemia
133
features of hypertensive retinopathy on fundoscopy
"silver wiring" - shiny hardened arteries "AV nipping" cotton wool spots [retinal infarcts where narrowed arterioles have become blocked] hard exudates macular oedema papilloedema flame haemorrhages ^BP damages retinal vessels
134
"roth spots" (small retinal infarcts) occur in what condition?
infective endocarditis
135
difference in fundoscopy with central vein occlusion ad branch vein occlusion
``` central = stormy sunset branch = confined to wedge of retina ```
136
what eye changes might be seen in leukaemia
retinal haemorrhages
137
differentials of red eye: acute glauc, ant uveitis, conjunc, subconjunc.haem. What does the pupil look like in each
acute glauc - fixed dilated (oval) ant. uveitis - small, stuck to lens conjunct/subconjunc haem = normal
138
differentials of red eye: acute glauc, ant uveitis, conjunc, subconjunc.haem. which has a steamy/ hazy cornea?
acute glauc
139
differentials of red eye: acute glauc, ant uveitis, conjunc, subconjunc.haem. Tx for each
acute glauc: IV acetazolamide + pilocarpine ant uveitis: pred drops + cyclopentolate conjunc: nothing or chloramphenicol subconjunc. haem. : resolves spont
140
causes of erythema nodosum
sarcoidosis drugs [sulfasalazine for UC, COCP] strep infection less common: IBD, TB, viruses/fungi
141
describe what erythema multiforme looks like + location
'target lesions' symmetrical +/- central blister on palms/soles, limbs
142
erythema migrans [papule developing into a spreading large erythematous ring with central fading] is pathognomic of what disease?
lyme disease
143
pyoderma gangrenosum associations [10cm purulent necrotic ulcers on legs/abdo/face] sex predominance? Tx?
``` IBD autoimmune hepatitis granulomatosis with polyangiitis [Weg] myeloma neoplasia ``` female predominance PO steroids +/-ciclosporin
144
skin manifestations of crohns
perianal/vulval/oral ulcers erythema nodosum pyoderma gangrenosum
145
skin manifestations of dermatomyositis
gottron's papules shawls sign heliotrope rash on eyelids
146
skin manifestations of DM
ulcers necrobiosis lipoidica granuloma annulare acanthosis nigricans
147
skin manifestations of coeliac
dermatitis herpetiformis
148
skin manifestations of hyperthyroid
pretibial myxoedema | thyroid acropachy
149
skin manifestations of liver disease
``` palmar erythema spider naevi gynaecomastia decreased pubic hair jaundice bruising scratch marks ```
150
Tx for itch of dermatitis herpetiformis
dapsone
151
which rheumatological diseases include raynauds
systemic sclerosis SLE polymyositis dermatomyositis
152
differentials for monoarthritis
SA OA crystal [gout, CPPD] trauma [haemoarthrosis]
153
differentials for oligoarthritis [<5]
``` crystal psoriatic reactive ank spond OA ```
154
differentials for symmetrical polyarthritis[ >5]
RA OA viruses [hepABC, mumps] systemic conditions [SLE, malig, haemochrom etc]
155
differentials for asymmetrical polyarthritis [>5]
reactive psoriatic systemic [SLE, malig, haemochrom etc]
156
what do you send synovial fluid for following joint aspiration [ie what are you investigating for
WCC gram stain polarised light microscopy [crystals] culture
157
red flags for sinister causes of back pain [malig/infection/inflamm]
``` <20 or >55 acute in elderly thoracic morning stiffness constant/worsening bilat/alternating leg pain neuro disturbace incl sciatica nocturnal pain sphincter distrbance worse supine fever, night sweats, weight loss recent or current infection malignancy Hx imm supp [steroids/HIV] abdo mass leg claudication or exercise related leg weakness/numbness [spinal stenosis] ```
158
a) which nerve roots is straight leg raise? b) what = a positive test? c) pathology usually suggested
a) L4, L5, S1 b) raise straight leg = pain below knee, worse on dorsiflex c) irritation to sciatic nerve, most common is lumbar disc prolapse
159
sciatic nerve is formed from which spinal roots?
L4-S3
160
a) which nerve are you assessing in femoral stretch test? | b) what = +ve test
a) L2-L4 | b) patient prone, knee flexed. hip ext > pain in front of thigh on
161
list 4 most likely causes of back pain in 15-30 yr olds
``` prolapsed disc trauma fracture ank-spond spondylolisthesis pregnancy ```
162
give 3 most likely causes of back pain in 30-50 yr olds
prolapsed disc malig degenerative
163
give 4 most likely causes of back pain in >50s
``` osteoporosis wedge fracture malig degen pagets myeloma spinal stenosis ```
164
Ix in red flag back pain
``` MRI, XR FBC urine/serum electrophoresis ESR/CRP PSA U+E LFT [alp] ```
165
Mx of back pain
neuro deficit- urgent neurosurg r/v non-spec - advise exercise, analgesia, physio, acupuncture [surg]
166
features of cauda equine compression
alternating / bilat root pain in legs saddle parastheisa los o anal tone bladder/bowel incont
167
features of acute cord compression
bilateral pain LMN signs @ level of compression UMN + sensory loss below sphincter disturbance
168
causes of acute cord compression + cauda equina
``` bony mets large disc protrusion myeloma cord/paraspinal tumour TB abscess ```
169
where is the pain felt + which movements would demonstrate weakness in L2 nerve root lesion
pain across upper thigh hip flexion and adduction
170
L3 nerve root lesion a) where's the pain? [dermatome] b) weakness in what movements? c) reflex affected?
a) across lower thigh b) hip adduction, knee ext c) knee jerk
171
L4 nerve root lesion a) where's the pain? [dermatome] b) weakness in what movements? c) reflex affected?
a) across knee to medial malleolus b) knee ext, foot inversion, dorsiflex c) knee jerk
172
L5 nerve root lesion a) where's the pain? [dermatome] b) weakness in what movements? c) reflex affected?
a) lateral shin to dorsum of foot and big toe b) hip ext + abduction, knee flex, foot + big toes dorsiflex c) big toe jerk
173
S1 nerve root lesion a) where's the pain? [dermatome] b) weakness in what movements? c) reflex affected?
a) post calf to lateral foot + little toe b) knee flexion, foot and toe plantar flex, foot eversion c) ankle jerk
174
factors that ^risk or worsen RA
female smoking 50-60s HLA DR4/1
175
features of RA
symm swollen painful stiff small joints of the hands and feet worse in morn larger joints can be involved/ fluctuating/various presentations
176
extraart and systemic Sx in RA
``` fatigue fever weight loss pericarditis pleurisy ```
177
early exam signs in RA
``` inflamm swollen MCP, PIP, MTP symm tenosynovitis [inflamed tendon] bursitis ```
178
late exam signs in RA
ulnar deviation - wrists and fingers | boutonieres, swan neck, Z thumb
179
what rare complication of RA can threaten the cervical spinal cord
atlanto-axial joint subluxation
180
lung extra art manifestations of RA
nodules pleural interstitial fibroiss bornchiolitis obliterans
181
extra art manifestations of RA - cardiac
cardiac nodules IHD pericardiits percardial effusion
182
Ix findings in RA
RF +ve antiCCP FBC anaemia of chronic disease, ^platelets ^ESR/CRP XR - soft tissue swelling, osteopenia, red. joint space, erosions, sublux, carpal destruciton US/MRI - synovitis, erosions
183
RA Mx
``` DMARDs [metho, sulfa, hydrox] biologics [inflix/ritux] steroids [IM/IA/PO] nsaids PT/OT surg CV risks stop smoking ```
184
SEs of methotrex/ risks
``` infections pneumonitis oral ulcers nausea + V hepatotox teratogenic ```
185
what diseases should pt be screened for befroe starting dmards
TB hepB/C HIV
186
SEs of biologics
infection reactivation of TB worsening HF blood disorders
187
pathophysiology behind pagets disease of bone + resulting problems
^bone turnover [^osteoblasts + osteoclasts] | remodelling, bone enlargement, deformity, weakness
188
clinical features of pagets disease of bone
deep boring pain bony deformmity + enlargement pelvis, lumbar spine, skull, femur, tibia[sabre]
189
cpmplicaptions of pagets disease of bone
``` pathological fracures OA ca2+^ nerve compression from bone overgrowth: deafness, root CCF osetosarcoma ```
190
XR findings in pagets disease of bone
bone enlargement patchy cortical thickening with sclerosis, osteolysis, deformity axial/long bone/skull
191
bloods in pagets disease of bone
^Ca2+ normal PO43- ^^^alp
192
mx of pagets disease of bone
analgesia | bisphos

3B GH (16 decks)

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