RHEUMATOLOGY AND MSK Flashcards

Question

how does takayasu's arteritis appear on CT angiography and doppler USS?

Answer 1

-segmental narrowing or occlusion of vessels

Answer 2

- Offer prednisolone 1mg/kg/day orally - Offer aspirin 75 mg daily - Offer methotrexate and folic acid, azathioprine, mycophenolate mofetil or cyclophosphamide in patients with release during glucocorticoid tapering. - Offer infliximab if initial immunosuppression fails - Offer surgery or endovascular intervention for significant limb claudication or severe ischaemic organ dysfunction.

Answer 3

- Current smoking history. - Paraesthesia. - Rest pain. - Cold sensation - Cyanosis. - Plantar claudication - Absent pulses. - Gangrene of the distal phalanges. - Positive Allan test whereby both radial and ulnar arteries are occluded resulting in ischaemia.

Answer 4

- Non-atherosclerotic occluded vessels | - Corkscrew shaped collateral vessels (Martorell’s sign).

Answer 5

- Urgent smoking cessation - Offer nifedipine for critical ischaemia. - Offer intravenous antibiotic therapy (metronidazole and benzylpenicillin sodium) for infection or wet gangrene. - Offer tramadol for pain relief.

Answer 6

- Popliteal bulge - Knee pain - Leg swelling - Calf tenderness - A sudden pop with increased pain, redness and warmth may indicate dissection or rupture of the cyst

Answer 7

- Knee joint trauma - Underlying knee joint arthritis - Underlying knee joint infection - Increasing age

Answer 8

- If asymptomatic, no treatment is required - Consider simple analgesia and physiotherapy for pain management - Perform cyst aspiration and intra-cystic corticosteroid injection

Answer 9

- Arthralgia - Weakness - Purpura and leukocytoclastic vasculitis - Peripheral neuropathy - Lower extremity vascular purpura - Hypertension due to renal involvement - Hyperviscosity syndrome: diplopia, ataxia, headache, confusion and retinal haemorrhage/thrombosis - Acrocyanosis and Raynaud’s phenomenon

Answer 10

-fasting qualitative serum cryoglobulins: present

Answer 11

- Manage the underlying condition: antivirals for HCV - Offer immunosuppression with prednisolone, cyclophosphamide or azathioprine - Rituximab can be used if these treatments fail - Plasmapheresis should be used when patients have a life or organ threatening cryoglobulinaemia

Answer 12

- Nocturnal onset - Gatrocnemius, with or without, foot involvement - Duration <10 minutes - Unilateral - Precipitation by trivial movements and forceful contractions - Visible or palpable muscle knotting - Good response to passive or active stretching - Normal physical examination

Answer 13

- To alleviate an attack, advise stretching and massaging the affected muscle - To reduce the frequency of attacks, stretch the affected muscles 3 times a day - A trial of quinine 200-300mg at bedtime for 4 weeks

Answer 14

- Episodic pain in one or both buttocks and low back pain and stiffness, typically worse in the morning and relieved by exercise. - Retention of the lumbar lordosis during spinal flexion - Paraspinal muscle wasting - Uveitis/iritis - Costochondritis - Peripheral joint involvement is asymmetrical and affects a few, predominantly large joints. - Fatigue

Answer 15

-Modified New York

Answer 16

-some blurring of joint margins

Answer 17

-minimal sclerosis with some erosion

Answer 18

-definite sclerosis on both sides of the joint and severe erosions with widening of the joint space with or without ankylosis

Answer 19

-complete ankylosis (fixation of the joint)

Answer 20

- Active inflammatory lesions such as bone marrow oedema, synovitis, enthesitis and capsulitis - BMO/osteitis is essential for diagnosis of active sacroiliitis - Structural damage lesions such as sclerosis, erosions, fat deposition and ankylosis

Answer 21

- NSAIDs - Adalimumab, certolizumab pegol, etanercept, golimumab and infliximab are recommended, as options for treating severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, NSAIDs. - Secukinumab is recommended as an option for treating active ankylosing spondylitis in adults whose disease has responded inadequately to conventional therapy (NSAIDs or TNF alpha inhibitors).

Answer 22

- Pain - Stiffness on a morning lasting <30 minutes - Functional difficulties: knee locking or giving way - Bony deformities: Bouchard’s nodes (PIPJ), Heberden’s nodes (DIPJ) and squaring of the base of the thumb (CMCJ) - Limited range of motion and an antalgic gait - Tenderness - Crepitus - Effusion

Answer 23

-Diagnose osteoarthritis clinically without investigations if a person: is 45 or over and has activity-related joint pain and has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes. -Perform an x-ray of the affected joints: osteophytes (new bone formation); joint space narrowing; subchondral sclerosis; subchondral cysts

Answer 24

- appropriate footwear - exercise - alternative pain relief - topical NSAIDs and oral paracetamol - intra-articular corticosteroid - joint surgery

Answer 25

- Symmetrical and polyarticular arthritis - Severe myalgia and abdominal pain for the duration of quotidian fevers with the presence of evanescent erythematous rash - serositis - Dermographism between fevers - Leucocytosis with neutrophilia, high inflammatory markers and thombocytosis - Macrophage activation syndrome

Answer 26

- Arthritis affecting 1-4 joints during the first 6 months of disease. There are two subcategories: - Persistent oligoarthritis: affecting no more than 4 joints throughout the disease course - Extended oligoarthritis: affecting a total of more than 4 joints after the first 6 months - asymmetric in the lower limbs

Answer 27

- Arthritis affecting 5 or more joints during the first 6 months of disease. - Rheumatoid factor (RF) is positive - symmetrical

Answer 28

- Arthritis affecting 5 or more joints during the first 6 months of disease. - Rheumatoid factor (RF) is negative - Heterogenous disease group, with ANA positive and chronic anterior uveitis

Answer 29

- Arthritis and psoriasis - Dactylitis - Nail pitting or onycholysis - Psoriasis in a first degree relative - small joint polyarthritis in younger patient - oligoarticular in older patients

Answer 30

- Arthritis and enthesitis - The presence of or a history of sacroiliac joint tenderness and/or inflammatory lumbosacral pain - HLA-B27 antigen - Acute symptomatic anterior uveitis - History of ankylosing spondylitis, enthesitis related arthritis, sacroiliitis with inflammatory bowel disease, Reiter’s syndrome or acute anterior uveitis in a first degree relative

Answer 31

- NSAIDs - intra-articular corticosteroids - DMARDs: MTX, SSZ and LEF - Abatacept, adalimumab, etanercept or tocilizumab

Answer 32

- uveitis - MAS - joint erosion - disease flare - osteopenia

Answer 33

- Asymmetrical oligoarthritis is most typical, but polyarticular and monoarticular variants occur - Axial arthritis: non-specific low back pain or buttock pain and stiffness, particularly during times of inactivity - Fever, fatigue and weight loss - Enthesitis - Oral ulcers - Keratoderma blennorhagicum - Circinate balanitis - Conjunctivitis - Anterior uveitis

Answer 34

- NSAIDs - Prednisolone - intra-articular corticosteroids - SFZ, MTX and AZA are indicated where disabling symptoms persist for 3 or more months or there is erosive joint damage - short course Abx for causative organism

Answer 35

- Active, symmetrical arthritis lasting >6 weeks - Joint pain and swelling - Morning stiffness lasting >1 hour - Swan neck deformity: DIP hyperflexion with PIP hyperextension - Boutonniere’s deformity: PIP flexion with DIP hyperextension - Ulnar deviation - Rheumatoid nodules - Fatigue

Answer 36

-monoarticular attacks lasting 24-48 hours

Answer 37

- self-limiting - last less than 12 months and leaving no permanent joint damage - Usually seronegative for RF and ACCP

Answer 38

-a period of several years during which the arthritis is active, but then remits leaving minimal damage

Answer 39

- Relapsing and remitting course over many years | - Seropositive patients tend to develop greater joint damage

Answer 40

- The disease progresses remorselessly over a few years and leads rapidly to joint damage and disability - it is usually seropositive

Answer 41

- initially affects the wrists more often than the fingers and has a less symmetrical joint involvement - Negative for RF and ACCP

Answer 42

- soft tissue swelling - juxta-articular osteoporosis - joint space narrowing - subchondral cyst formation - subluxation of joints

Answer 43

- symptom control with NSAIDs - short term glucocorticoids for disease flares - MTX, LEF, SZS or HCQ alone or in combination - for severe disease, offer biologic therapy (high intensity DMARD therapy and DAS28 5.1) - offer rituximab if there is inadequate response

Answer 44

- Pre-existing joint disease - Joint prostheses - Intravenous drug misuse - Immunosuppressive medication - HIV infection - Alcohol use disorder - Diabetes - Previous intra-articular corticosteroid injection - Recent joint surgery - The presence of other infections including skin infections and cutaneous ulcers - Exposure to ticks (may indicate arthritis associated with Lyme disease).

Answer 45

- Hot, swollen, painful joint - Restricted movement - Joint is often held in a position that maximises the joint space fully: fully extended knee; hip abducted, flexed and externally rotated - Limitation of active and passive movement, with reluctance to move or allow movement - Fever - Large, single joint affected

Answer 46

-joint aspiration: bacteria in cloudy culture fluid

Answer 47

- Offer IV flucloxacillin, or clindamycin if penicillin allergic - If MRSA is suspected, give vancomycin or teicoplanin - If gonococcal arthritis or gram-negative infection is suspected, cefotaxime or ceftriaxone is recommended - Aspirate the joint to dryness as often as is needed

Answer 48

- Low back pain with no radiation - Absence of any red-flag features - No neurological symptoms - Dull, gnawing, tearing, burning or electric pain associated with muscle spasm - Lack of pain on flexion or relief on extension

Answer 49

- analgesia - benzodiazepine for muscle spasm - exercise therapy

Answer 50

- Sudden onset of pain in the hip following viral infection - Limp - No pain at rest, but the hip is typically held abducted and externally rotated - Decreased range of movement, particularly internal rotation (positive log roll) - The pain may be referred to the knee. - The child is afebrile or has a mild fever and does not appear ill.

Answer 51

- Rest and NSAIDs | - traction may be needed

Answer 52

- Raynaud’s phenomenon developing upto 15 years before - Skin involvement limited to the hands, feet, face and forearms - Flexion deformities of the fingers - Beak like nose - Microstomia - Painful digital ulcers - Well demarcated telangiectasia - Dilated nail fold capillaries - Digital ischaemia - Pulmonary hypertension and interstitial disease - Bright, shiny skin of hands and feet - Prayer sign, claw hand deformities, carpal tunnel syndrome and calcinosis

Answer 53

- Oedematous in onset with skin sclerosis and concomitant Raynaud’s phenomenon - Diffuse swelling and stiffness of the fingers is rapidly followed by extensive skin thickening which can involve most of the body - Atrophic skin with loss of hair - Lethargy, anorexia and weight loss - GORD and dysphagia - Anal incontinence - Malabsorption due to dilatation and atony of the small bowel - Renal involvement: active hypertensive renal crisis - Pulmonary fibrosis and hypertension - Myocardial fibrosis leading to arrhythmias and conduction defects - Pericarditis - Can occur without skin involvement (SSc sine Scleroderma)

Answer 54

- ANA - anti-Scl70 or anti-topoisomerase 1 or anti RNA polymerase positive in DcSSc. - Anti-centromere, speckeld or nucleolar antibodies occur in LcSSc

Answer 55

- CCB or ARB - SSRIs, alpha-blockers and statin therapy can also be considered - Phosphodiesterase type 5 inhibitors are increasingly used - IV prostanoid (Iloprost) and digital sympathectomy

Answer 56

- Optimise oral vasodilator therapy and analgesia - Sildenafil - In severe, active digital ulceration, patients should receive IV prostanoid - In patients with recurrent, refractory digital ulcers, a phosphodiesterase type 5 inhibitor or IV prostanoid and an endothelin receptor antagonist should be considered - Digital sympathectomy with or without botox should be considered for severe and/or refractory cases

Answer 57

-IV cyclophosphamide

Answer 58

- PPI and H2 receptor antagonists - Prokinetic dopamine antagonists - Parenteral nutrition for patients with severe weight loss refractory to enteral supplementation - Intermittent broad-spectrum antibiotics (ciprofloxacin) are recommended for intestinal overgrowth - Loperamide or laxatives used for symptomatic management of diarrhoea or constipation

Answer 59

- Consider immunosuppression with or without a pacemaker - Consider an implantable cardioverter defibrillator - ACE-I and carvedilol

Answer 60

-Diuretics, including spironolactone and furosemide

Answer 61

-Irregular discoloured and thickened patches of skin than can occur on the arms, legs or body

Answer 62

-Areas of skin involvement spread out along lines, with streaks of involved skin that appears most often on the hand or foot

Answer 63

-Linear scleroderma on the head and face, including formation a deep furrow along the scalp with tight, hard skin extending onto the forehead

Answer 64

- For mild morphea, topical treatment with calcipotriene cream is often sufficient - Linear scleroderma responds well to methotrexate - Severe cases of Parry Romberg Syndrome may require referral to a craniofacial surgeon

Answer 65

- Oral ulcers on the moist mucosal surfaces of the mouth - Painful genital ulcers - Uveitis - Acne - Erythema nodosum on the lower extremities - Superficial thrombophlebitis - Hypopyon: precipitation of inflammatory cells in the anterior chamber - Stroke - Memory loss - Headache, confusion and fever as a result of meningeal involvement - Haemoptysis, cough, SOB or chest pain with pulmonary involvement

Answer 66

-Perform a pathergy test: induration with or without the formation of a pustule within 48 hours

Answer 67

- Initial therapy: Oral colchicine 500mcg BD, Topical steroid mouthwash or spray or Topical NSAID mouthwash and antibiotics - Step-up therapy: Azathioprine 2.5mg/kg, Tacrolimus up to 4mg twice a day or Corticosteroid - If the step-up therapy is ineffective, offer infliximab 5mg/kg for 4 doses and then switch to adalimumab 40mg every other week or etanercept 50mg once a week

Answer 68

- Initial acute therapy: - --Topical, intraocular steroids - --1000mg IV methylprednisolone 3 times a year or oral prednisolone 1mg/kg/day - Maintenance therapy includes oral steroid, azathioprine 2mg/kg/day or ciclosporin 2.5-5mg/kg/day - If there is a flare, or this treatment is ineffective, offer infliximab 5mg/kg for 4 doses and then switch to adalimumab 40mg every other week or etanercept 50mg once a week - If this is ineffective, offer interferon alpha 30mcg once a week for 6 months or rituximab, one cycle of 2 infusions (1000mg/infusion)

Answer 69

- Initial therapy: IV steroid or azathioprine 2.5mg/kg/day - Step up therapy: Cyclophosphamide IV pulses of 10mg/kg at increasing intervals, every 2 weeks for 12 weeks - Biologic therapy: offer infliximab 5mg/kg for 4 doses and then switch to adalimumab 40mg every other week or etanercept 50mg once a week - If ineffective, offer rituximab, one cycle of 2 infusions (1000mg/infusion)

Answer 70

- Pain and tenderness at the site of a bursa - Decreased active range of movement - Swelling - Low grade temperature, erythema and warmth in septic bursitis - Painful arc on shoulder abduction if subacromial - Lateral hip pain if trochanteric

Answer 71

- Advise conservative measures such as rest, ice, reduced activity, compression bandaging and simple analgesia - Consider aspiration if the effusion is large and a corticosteroid injection into the bursa - If septic bursitis is suspected, aspirate the bursa and give flucloxacillin or clarithromycin if penicillin allergic. Erythromycin is preferred in pregnancy

Answer 72

-Calcium pyrophosphate deposition

Answer 73

- Painful and tender joints - Involvement of shoulders, wrists and MCPJ - Sudden worsening of OA - Red and swollen joints - Joint effusion and fluctuance

Answer 74

-intracellular or extracellular positively birefringent rhomboid shaped crystals under polarised light

Answer 75

- linear, stippled radio-opaque deposits in the fibro-cartilage or hyaline articular cartilage of joints - calcified tendons - subchondral cysts - progressive rapid joint degeneration or bony collapse - predominant involvement of the patellofemoral joint in the knee

Answer 76

- Advise conservative measures with cool packs and rest, with simple analgesia such as paracetamol and NSAIDs - Offer joint aspiration with intra-articular corticosteroid injection - If intra-articular steroids are refused or ineffective, offer systemic prednisolone 10-20mg orally once daily or colchicine if steroids and NSAIDs are contraindicated

Answer 77

- Offer oral NSAIDs with gastroprotection (PPI) or low dose colchicine if contraindicated - Offer low dose corticosteroid, methotrexate or hydroxychloroquine for prophylaxis of chronic disease

Answer 78

- History of asthma and rhinitis. - Focal numbness or weakness (typically mononeuritis multiplex) - Nasal discharge of stuffiness. - Palpable purpura and petechiae, skin nodules, leukocytoclastic angiitis with palpable purpura, livedo reticularis, urticaria, necrotic bullae and digital ischaemia - Wheeze. - Haemoptysis - Shortness of breath or cough. - Abdominal pain, bleeding, bowel ischaemia and perforation, appendicitis and pancreatitis - Sensory or motor deficits. - Tachypnoea. - Low grade chronic constitutional symptoms - Heart failure, myocarditis and myocardial infarction - Glomerulonephritis, hypertension and CKD

Answer 79

- non-organ threatening disease, offer methotrexate or mycophenolate mofetil with a glucocorticoid - organ or life threatening disease, offer cyclophosphamide or rituximab with a glucocorticoid - rapidly progressive renal failure or pulmonary haemorrhage, consider plasma exchange - Upon remission, offer azathioprine, methotrexate or rituximab and continue to taper glucocorticoids

Answer 80

- Chest pain, worse on movement of the chest wall, especially with inspiration - Chest wall tenderness - Chest wall swelling (Tietze’s Syndrome)

Answer 81

- Advise the use of NSAIDs with PPI gastroprotection | - If unresponsive, offer intra-articular corticosteroid injection

Answer 82

- Cyclical pain in myofascial pain and dysfunction, continuous pain in internal derangement - Joint clicking or crepitus - Abnormal mandibular movement - Masticatory muscle tenderness

Answer 83

- simple analgesia and conservative management - diazepam for acute severe pain - amitriptyline or gabapentin if chronic - refer for botox, intra-articular steroids or surgery

Answer 84

- Postural asymmetry - Absent or minimal pain - Normal neurology - Paraspinal prominences on forward bending - Scoliometer measurement of >5o at paraspinal prominence - Symmetrical abdominal reflexes - Shoulder, waist line, thoracic wall and breast asymmetry

Answer 85

- Clinical diagnosis - standing PA and lateral x-rays of spine: coronal plane spinal curvature >10°; hypo- or hyperkyphosis of the thoracic spine

Answer 86

- Advise regular exercise to build core strength - Perform observational monitoring x-rays - Offer spinal bracing - If there is evidence of associated complications, offer spinal arthrodesis

Answer 87

- Audible pop - Rapid knee swelling - Unable to continue activity - Sensation of knee instability or buckling - Pain - Positive Lachman’s test - Positive pivot shift manoeuvre

Answer 88

- ACL fibres appear disrupted | - blurry on T1-weighted images with abnormal high signal on T2 weighted images

Answer 89

- Offer protected weight bearing, rest, ice, compression, elevation and NSAIDs - Offer physiotherapy to allow return to normal activity - Offer surgical repair for highly active individuals

Answer 90

- Worsening limb pain over weeks to months, more severe at rest and at night - Pain is described as deep, dull, boring and relentless - Mass or swelling that is usually firm, tender and warm to touch - Limp - Overlying skin ulceration

Answer 91

- radiolucent lesion with areas of mottled radiodensity and ill-defined margins - neoplasm is usually located in the metaphysis of long bone - periosteal reaction in the form of Codman's triangle or a sunburst appearance is common - sometimes soft tissue mass can be appreciated on conventional radiographs

Answer 92

- Perform wide surgical resection and reconstruction - If disease is high grade at presentation, offer neoadjuvant and adjuvant chemotherapy with methotrexate, doxorubicin and cisplatin - Offer local radiotherapy if there is doubt over surgical clearance - Mifamurtide for the treatment of high-grade resectable non-metastatic osteosarcoma

Answer 93

- Male - Consumption of meat, seafood and alcohol - Use of diuretics - Use of ciclosporin, tacrolimus, pyrazinamide, aspirin - High cell turnover

Answer 94

- Rapid onset of severe pain - Morning joint stiffness - Mono or oligoarticular pattern - Swelling and joint effusion - Tophi over extensor surface joints - Erythema and warmth

Answer 95

- WBC >2x109 | - strongly negative birefringent needle shaped crystals under polarised light

Answer 96

- NSAIDs or coxibs - If NSAIDs are not tolerated or contraindicated, give colchicine 500micrograms BD-QDS or a corticosteroid - In patients with an acute illness and comorbidity, joint aspiration and intra-articular corticosteroid is the treatment of choice

Answer 97

- allopurinol - febuxostat - sulfinpyrazone or probenecid or benzbromarone

Answer 98

- Urate lowering therapy - If initial ULT fails, pegloticase IV every 2 weeks - rasburicase

Answer 99

- A firm and thickened palmar nodule over the metacarpal head at the level of the distal palmar crease, proximal to the MCP joint - Palmar skin changes, with skin thickening, tethering, puckering or pitting - Pretendinous cords - MCP or PIP joint contracture - Patient unable to lay hand flat on table (Hueston table-top test)

Answer 100

- none if no loss of function - surgical release of contracture - corticosteroid injection with painful nodules

Answer 101

- Periodic fever lasting 12 to 72 hours - Abdominal pain that precedes the fever and lasts longer - Altered bowel habit: usually constipation but may have diarrhoea - Acute monoarticular joint pain and swelling - Erysipelas-like skin lesions: tender, erythematous, raised and well demarcated, usually 10-15cm in diameter and found below the knee - Pleuritic chest pain - Acute myalgia - Hepatosplenomegaly

Answer 102

- For an acute attack, give paracetamol or NSAIDs and colchicine - When FMF is confirmed, treat with colchicine - If there is poor response to colchicine, offer treatment with anakinra, etanercept, tocilizumab, canakinumab or allogenic haematopoietic stem cell transplant

Answer 103

- Splenomegaly - Joint deformities and rheumatoid nodules - RA

Answer 104

- neutropenia - anaemia - thrombocytopenia - raised CRP - elevated ALP and transaminases - positive RF, anti-CCP and ANA

Answer 105

- MTX, with SFZ or LEF added on - rituximab - G-CSF with severe neutropenia - splenectomy

Answer 106

- Chronic pain - Diffuse tenderness on examination - Fatigue unrelieved by rest - Sleep and mood disturbance - Cognitive dysfunction - Headaches - Numbness and tingling sensations - Stiffness

Answer 107

- offer simple analgesia - Offer amitriptyline, duloxetine or pregabalin/gabapentin - Offer a short course of diazepam for muscle spasms - A tailored exercise programme may be beneficial - Offer CBT, psychotherapy and relaxation techniques

Answer 108

- Fever. - Weight loss. - Myalgia and arthralgia. - Mononeuritis multiplex. - Paraesthesia. - Muscle tenderness. - Abdominal pain. - Skin manifestation such as livedo reticularis (a net-like cyanotic discolouration around pale skin). - Testicular pain - High diastolic pressure.

Answer 109

- corticosteroid therapy - If patients relapse despite steroid therapy, add cyclophosphamide - Azathioprine can also be used as maintenance therapy - Intravenous immunoglobulin (IV-Ig) and aspirin are effective in childhood PAN but, in resistant cases, either steroid or infliximab has a role

Answer 110

- Sharp or burning pain superior to the lateral joint line - Positive Noble’s test - Positive Ober’s test - Positive modified Thomas’ test - Reduced hip abductor strength - Genu varum - Hind foot and forefoot varum - Pes cavus - Prominent lateral femoral epicondyle, tight iliotibial tract and tensor fascia lata - Weak gluteus medius, maximus and tensor fascia lata - Tightness and weakeness in the quadriceps, iliotibial tract and lateral retinaculum

Answer 111

- Offer short course NSAIDs and rest - Refer to physiotherapy - If the pain is unresponsive to NSAIDs, offer a corticosteroid injection

Answer 112

- Pain of the tibial tubercle, worsened by forceful extension of the knee - Localised tenderness - Activity limitation - Localised swelling or warmth - Prominence of the tibial tubercle - Pain at the tubercle with resisted knee extension

Answer 113

- Offer paracetamol or NSAIDs with intermittent ice packs - activity modification - physiotherapy

Answer 114

- Shortness of breath. - Haemoptysis. - Cough. - Haematuria - Reduced urine output. - Oedema.

Answer 115

- Offer oral prednisolone and cyclophosphamide. - Offer plasmapharesis until anti-GBM is undetectable. - Advise smoking cessation.

Answer 116

-Crescentic glomerulonephritis

Answer 117

- General malaise, weight loss and fever - proximal muscle weakness - shoulder and pelvic girdle muscles become wasted but are not usually tender. - Movements such as squatting and climbing stairs become difficult. - As the disease progresses, involvement of pharyngeal, laryngeal and respiratory muscles can lead to dysphonia and respiratory failure.

Answer 118

- Myalgia - Polyarthritis - Raynaud’s phenomenon - Rash affecting the eyelids, where heliotrope (purple) discoloration is accompanied by periorbital oedema - Gottron’s papules over the dorsal surface of the knuckles, wrists, elbows, knees and malleoli - Symmetrical violaceous erythematous macular rashes - Ulcerative vasculitis and calcinosis of the subcutaneous tissue - Muscle fibrosis - Joint contractures

Answer 119

- The typical rash of DM is usually accompanied by muscle weakness. - Muscle atrophy, subcutaneous calcification and contractures - Ulcerative skin vasculitis - recurrent abdominal pain due to vasculitis

Answer 120

- abnormal spontaneous activity (fibrillation and positive sharp waves) - abnormal voluntary activity (low amplitude, short duration polyphasic motor potentials)

Answer 121

- ANA - anti-Jo-1 - anti-Mi-2 - anti-SRP - Anti-PM-Scl positive

Answer 122

- Prednisolone 0.5–1.0 mg/kg body weight continued until at least 1 month after myositis has become clinically and enzymatically inactive. - Pulsed IV methylprednisolone for the treatment of refractory inflammatory myositis - Early intervention with steroid-sparing agents such as methotrexate, azathioprine, ciclosporin and cyclophosphamide is common, especially where there is clinical relapse or rise in CK as the dose of steroids is reduced. - IVIG and plasmapheresis can be used in refractory cases

Answer 123

- Tenderness over the common extensor tendon - Positive extensor carpi radialis brevis stretch (maximal passive wrist flexion with extended arm) - Pain during resisted wrist and digit extension - Elbow pain during or after flexion and extension - Exacerbation of pain with repetitive movement or occupational activity - Decreased grip strength - Pain in the lateral aspect of the elbow

Answer 124

- Pain at the medial aspect of the elbow - Tenderness approximately 5mm distal and lateral to the medial epicondyle - Increased pain with resisted forearm pronation or wrist flexion - Elbow pain during or after flexion and extension - Exacerbation of pain with repetitive movement or occupational activity - Decreased grip strength

Answer 125

- heat and ice - orthoses and rest - NSAIDs or paracetamol - physiotheraoy - surgery - extracorporeal shockwave therapy in refractory epicondylitis

Answer 126

- Fever - irritability - cervical adenitis - conjunctivitis - rash - mucosal erythema - painful erythema of the hands and feet - arthralgia or arthritis - possible myocarditis, and pericarditis.

Answer 127

- persistent irritability - poor appetite - conjunctival injection - desquamation of extremities - Cardiac abnormalities (coronary artery ectasia or aneurysms) may develop during this stage

Answer 128

- fever >5 days and four other features of: - bilateral conjunctivital injection - red mucous membranes - cervical lymphadenopathy (cluster of grapes) with node diameter >1.5 - diffuse, maculopapular erythematous rash - red and oedematous palms and soles or peeling of fingers and toes starting subungually

Answer 129

- IVIG in the first 10 days - Aspirin 80-100mg/kg - Infliximab, steroids, cyclophosphamide, ciclosporin, MTX or plasma exchange may be offered with persistent inflammation

Answer 130

- Fever - Weight loss - Lymphadenopathy

Answer 131

- Alopecia - Oral/nasal ulcers - Photosensitivity - Malar rash - Discoid rash - Raynaud’s phenomenon

Answer 132

- Arthritis/arthralgia | - Myalgia/myositis

Answer 133

- Pericarditis - Pleurisy - Pneumonitis - Myocarditis - Endocarditis

Answer 134

- Seizures - Psychosis - Chorea - Transverse myelitis

Answer 135

- Proteinuria - Nephrotic Syndrome - End stage renal disease

Answer 136

- Haemolytic anaemia - Leucopenia - Lymphopenia - Thrombocytopenia - Thrombosis

Answer 137

- ANA - anti-dsDNA - anti-Sm

Answer 138

- BILAG 2004 | - SELENA-SLEDAI

Answer 139

- Topical or oral prednisolone or IM or IA methylprednisolone - Hydroxychloroquine and/or methotrexate - NSAIDs for days to few weeks only - For maintenance, offer prednisolone <7.5mg/day, and hydroxychloroquine 200mg/day and/or methotrexate 10mg/week

Answer 140

- Offer prednisolone or 1-3 doses of IV methylprednisolone, or IM methylprednisolone - Offer azathioprine or methotrexate or mycophenolate mofetil or ciclosporin and hydroxychloroquine - For maintenance, offer prednisolone and azathioprine, or methotrexate or mycophenolate mofetil or ciclosporin and hydroxychloroquine - For refractory cases, consider belimumab or rituximab

Answer 141

- Offer prednisolone or 1-3 doses of IV methylprednisolone or prednisolone - offer azathioprine or mycophenolate mofetil or cyclophosphamide IV or ciclosporin and hydroxychloroquine - For maintenance, offer prednisolone and mycophenolate mofetil or azathioprine or ciclosporin and hydroxychloroquine - Offer belimumab or rituximab in refractory cases - IVIG and plasmapheresis may be considered in patients with refractory cytopaenias, TTP, rapidly deteriorating acute confusional state and the catastrophic variant of APS

Answer 142

- Fractures - Wormian bones in the skull, and the vault may overhang the base causing basilar compression - Rapid teeth erosion - Blue sclerae - Corneal arcus - Aortic regurgitation and mitral valve prolapse - Joint hypermobility, with flat feet, hyper-extensible large joints and dislocations - Hearing loss

Answer 143

- lethal - multiple fractures (frequently occurring in utero) -short limbs due to faulty conversion of normal mineralised cartilage to defective bone matrix.

Answer 144

- Born with fractures and the skull well ossified - Progressive deformity of skull, long bones, spine, chest and pelvis - The face appears triangular with a large vault, prominent eyes and a small jaw - Sclera is blue in infancy but normal in childhood - Patients rarely walk and have very short stature

Answer 145

- Fractures at birth - Bowing of legs or recurrent fractures on walking - Normal colour sclera - Reduced stature - Hyperplastic callus appearing as swollen, painful vascular swellings over long bones

Answer 146

- moderately deforming | - patients exhibit moderate-to-severe bone fragility of long bones and vertebral bodies

Answer 147

- accumulation of osteoid due to a mineralisation defect, in the absence of a disturbance of mineral metabolism - sclerae are white or faintly blue and DI is uniformly absent. - All patients have vertebral compression fractures.

Answer 148

- fractures at birth - bluish sclerae - early deformity of the lower extremities - coxa vara - osteopenia - Rhizomelia (proximal limb shortening)

Answer 149

- Multidisciplinary care including physiotherapy, rehabilitation, bracing and surgical interventions. - bisphosphonates: IV pamidronate

Answer 150

- Pain exacerbated by activity - Location of pain is the anteromedial aspect of the knee with knee flexed to 90 degrees, the lateral aspect of the elbow, or the posteromedial aspect of the dorsiflexed ankle, or the anterolateral aspect of plantar-flexed ankle - Effusion - Locking and catching of joint - Absence of history of trauma

Answer 151

- knee x-ray: osteochondral lesion; free intra-articular loose bodies; malalignment; arthrosis - lower limb extremity film: malalignment with weight bearing line passing through involved compartment

Answer 152

- paracetamol and NSAIDs - physiotherapy - surgery

Answer 153

- Digital pallor and pain - Arthritis or arthralgia - Swollen hands - Sclerodactyly - Dilated nail fold capillaries - Dyspnoea/cough - GORD and heartburn - Myalgias or myositis - Haematuria - Lymphadenopathy - Alopecia - Skin rashes: malar rash, discoid lesions, acrosclerosis with telangiectasias and calcinosis - Proximal muscle weakness - Trigeminal neuralgia - Headaches - Neuropsychiatric disease - Peripheral neuropathy - Fever

Answer 154

-Anti-U1 ribonucleoprotein

Answer 155

- NSAIDs to treat the pain and inflammation. - hydroxychloroquine. - in more severe cases systemic corticosteroids are used. - Adjuvant therapy with steroid-sparing agents such as cyclophosphamide and ciclosporin - Calcium-channel blocking agents such as nifedipine for Raynaud's. - Oesophageal dysfunction: PPI - Prostaglandins for secondary pulmonary hypertension. - phosphodiesterase inhibitors such as sildenafil for raynauds and SPH - Endothelin receptor antagonists such as bosentan for pulmonary hypertension

Answer 156

- Asymptomatic - Long bone or back pain - Pathological fractures - Bony deformities: frontal bossing, prognathism, bone bowing - Increased local temperature - Hearing loss (skull involvement)

Answer 157

- elevated ALP | - Normal calcium, phosphorus and PTH

Answer 158

- NSAIDs and paracetamol | - bisphosphonates, calcium and vitamin D

Answer 159

- Vitamin D deficiency - CKD: renal osteodystrophy - Hypophosphataemia - Type 2 renal tubular acidosis - Bisphosphonates, aluminium containing phosphate binders, prolonged TPN or dietary fluoride - Inborn errors of metabolism - Cystic fibrosis

Answer 160

- Fractures - Diffuse bone pain and tenderness - Proximal muscle weakness

Answer 161

- Growth retardation - Hypotonia - Knock knees and bowed legs - Widened epiphyses at the wrists - Hypocalcaemic tetany

Answer 162

- normal or low calcium - low vitamin D - low serum phosphate - High PTH - High ALP

Answer 163

- Offer calcium and vitamin D replacement with colecalciferol or ergocalciferol in malabsorption syndromes - In patients with x-linked hypophosphateaemic rickets, type 1 and 2 vitamin D dependent rickets, oncogenic osteomalacia and Fanconi’s syndrome, offer calcium, Vitamin D and phosphate

Answer 164

- Back pain - Kyphosis - Fractures

Answer 165

- Female - Older age - Low BMI - Postmenopause - Secondary amenorrhoea - Primary hypogonadism - Smoking and excessive alcohol use - Prolonged immobilisation - Low calcium intake - Vitamin D deficiciency - Steroids - PPIs

Answer 166

-DXA scan: T-score <2.5

Answer 167

- oral or IV bisphosphonates (risk >1%) - denosumab - raloxifene - teriparatide

Answer 168

- Acute back pain from atraumatic activities - Kyphosis - Loss of lumbar lordosis - Localised tenderness - Loss of standing height - Loss of sagittal balance

Answer 169

- lateral view shows wedging of anterior vertebral body and local kyphosis - AP may show interpedicular widening and/or spinous process malalignment suggesting posterior vertebral body involvement

Answer 170

- Fatigue - Recurrent sensation of sand/gravel, itch or burning in eyes. - Redness of the eyes and sensitivity to wind and light - Dry mouth - Vasculitic skin disease - Dental caries - Arthralgia and myalgia - Corneal ulceration - Enlarged salivary glands

Answer 171

- four out of six of dry eye symptoms - dry mouth symptoms - objective ocular dryness (Schirmer’s test ⩽5 mm in 5 min or van Bijsterveld score ⩾4) - objective oral dryness (unstimulated salivary flow rate ⩽0.1 ml/min or positive salivary scintigraphy and sialography) - positive anti-Ro/La antibodies - labial gland focus score ⩾1

Answer 172

- conservation of tears by humidification and avoidance of systemic medication that exacerbates dryness. - Recommend liposomal sprays - simple lubricating drops - Low dose steroid-containing eye drops - Ciclosporin-containing eye drops or ointments - Topical NSAIDs such as diclofenac and indomethacin - pilocarpine

Answer 173

- humidify the environment. - good oral hygiene - pilocarpine

Answer 174

- pilocarpine | - topical oestrogen

Answer 175

- Regular exercise and a graded exercise programme - HCQ - AZA, CYC - Rituximab - IVIG - colchicine - dapsone - topical tacrolimus

Answer 176

- Mass - Upper/lower GI bleed with GI stromal tumours - Erythematous or maculopapular lesion (haemangioma) - Purplish macular-papular lesions (Kaposi Sarcoma) - Dysfunctional uterine bleeding (leiomyosarcoma) - Increased abdominal girth - Weight loss and fatigue - Anorexia - Abdominal bloating, discomfort and pain

Answer 177

- Offer wide local excision of the tumour with adjunctive radiotherapy and chemotherapy with ifosfamide and mesna - For Ewing’s sarcoma, give vincristine, doxorubicin, cyclophosphamide, ifosfamide, etoposide and mesna - For rhabdomyosarcoma, give vincristine, dactinomycin and cyclophosphamide - Give imatinib for GIST - For high grade soft tissue sarcoma, give doxorubicin, ifosfamide and mesna - Trabectedin

Answer 178

- History of vascular thrombosis - History of 3 or more consecutive pregnancy losses at <10 weeks’ gestation or unexplained fetal death >10 weeks gestation - Features of thrombocytopenia - Arthralgia/arthritis - Livedo reticularis

Answer 179

- vascular thrombosis - pregnancy morbidity (preterm births or miscarriages) - Lupus anticoagulant, Anti-cardiolipin antibody and Anti-B2-glycoprotein I antibody, present on two or more occasions 12 weeks apart

Answer 180

- Offer vitamin k antagonists such as warfarin, with a target INR of 2.5 - For pregnant women with APS, offer heparin and low dose aspirin throughout pregnancy

Answer 181

- Acute onset of multi-organ failure as a result of massive microvascular thrombosis - Treatment includes anticoagulation with heparin and warfarin and immunomodulation with plasmapheresis, IVIG and corticosteroids - For refractory CAPS, offer rituximab

Answer 182

- Subcutaneous wrist mass - Aching discomfort - Increased mass size after activity - Transilluminating mass

Answer 183

- If there is no neurovascular compromise, advise observation of the cyst with analgesia - Cyst aspiration with an injection of corticosteroid can be given, but should be avoided with volar cysts due to the close association with the radial artery - If there is neurovascular compromise, offer surgical resection

Answer 184

- S aureus - Group B streptococci - Aerobic gram-negative bacilli (e.g., Escherichia coli) - Candida albicans.

Answer 185

- S aureus - Kingella kingae - Group A streptococcus - Streptococcus pneumoniae - Haemophilus influenzae - Pseudomonas (due to foot puncture wounds).

Answer 186

- S aureus | - Group A streptococcus.

Answer 187

- S aureus - Coagulase-negative staphylococci - Aerobic gram-negative bacteria - Anaerobic gram-positive Peptostreptococcus species.

Answer 188

-Gram-negative bacilli.

Answer 189

- S aureus | - Candida species.

Answer 190

- S aureus | - Pseudomonas aeruginosa.

Answer 191

- S aureus | - salmonella

Answer 192

- Limp or reluctance to weight-bear - Non-specific pain at the site of infection - Malaise and fatigue - Local back pain with associated systemic symptoms - Paravertebral muscle tenderness and spasm - Local inflammation, tenderness, erythema or swelling - Fever - Reduced range of movement - Wound drainage or sinuses in chronic osteomyelitis

Answer 193

- First line antibiotic therapy is flucloxacillin for 6 weeks - If penicillin allergic, give clindamycin for 6 weeks - If suspected MRSA, give vancomycin or teicoplanin for 6 weeks - consider adding fusidic acid or rifampicin in the initial 2 weeks - Surgical removal of bone sequestrum may be required

Answer 194

- Stabbing or knife like heel pain - pain relief with rest - Post static dyskinesia: pain with the first few steps after rising - Pain exacerbated by walking barefoot - Pain improves with NSAIDs - Positive dorsiflexion-eversion test - Pain with metatarsophalangeal joint extension (Windlass Test)

Answer 195

- self care advice - insoles - analgesia - corticosteroid injection - formal physiotherapy - extracorporeal shockwave therapy - surgery

Answer 196

- Positive Barlow test: Hip dislocates with posterior pressure - Positive Ortolani test: hip relocates with anterior pressure - Limited hip abduction - Abnormal positioning of the leg to delayed crawling/walking - Toe-walking - Asymmetrical thigh and skin folds

Answer 197

- Female sex - Positive family history - Breech presentation

Answer 198

- Perform hip USS in 6 week to 6 month olds with clinical features or risk factors: subluxation on provocative testing; abnormal relationship between femoral head and acetabulum - Perform hip x-rays: abnormal relationship between femoral head and acetabulum (assessed by acetabular index, Shenton’s line and ossification of femoral head)

Answer 199

- For children <6 months, offer a dynamic flexion-abduction orthosis (Pavlik Harness) - Offer surgery: closed reduction with adductor or psoas tenotomy, followed by 3-4 months in a plaster cast or brace - Over the age of 18-24 months, an additional pelvic or femoral osteotomy is required

Answer 200

- Bone pain and swelling - Papulosquamous rash that affects the scalp, skin folds and midline of the trunk - Single or multiple violaceous papulonodular and vesicular rash 0Polyuria and polydipsia due to DI secondary to craniofacial bone lesions and multi-system disease - Growth or sexual maturation failure - Vertebra plana: spondylitis with reduction of the vertebral body to a thin disc - Hepatosplenomegaly, jaundice and ascites - Cough, dyspnoea and chest pain - Orbital abnormalities including proptosis, periorbital swelling and erythema, diplopia or ophthalmoplegia

Answer 201

- limited cutaneous disease, offer topical steroids, topical nitrogen mustard or psoralen combined ultraviolet A therapy - localised bone lesions, surgical curettage, radiotherapy, intralesional steroids, bisphosphonates and early chemotherapy with vinblastine and prednisolone - CBS: cladribine or cytarabine/radiotheraoy - For lymphadenopathy, offer surgical excision of single nodes, systemic steroids for regional nodes and chemotherapy for nodes resistant to treatment - For pulmonary LCH, offer corticosteroids or chemotherapy with vinblastine, methotrexate, cyclophosphamide, etoposide and cladribine. Lung transplant can be given in advanced disease - For multi-system LCH, offer prednisolone and vinblastine with 6-mercaptopurine added after 6 weeks in children. Adults should be offer cladribine or cytarabine. Should this treatment fail, other options include vemurafenib and stem cell transplant

Answer 202

- Ill-defined ache localised to the anterior knee behind the patella - Pain aggravated by compressive force - Increased Q angle (angle between the line connecting the ASIL to the centre of the patella and the line connecting centre of patella to anterior tibial tuberosity - Pain on palpation of the patellar retinaculum - Lateral patellar tilt - Reduced patellar mobility - Decreased muscle flexibility and muscle weakness

Answer 203

- trochlear dysplasia with the sulcus angle - patellar displacement with the bisect off angle - patellar tilt with the lateral tilt angle

Answer 204

- Advise relative rest and application of ice packs - Offer NSAIDs and paracetamol for analgesia - If there is no improvement with 6 weeks of conservative management, offer physiotherapy

Answer 205

- Shoulder/hip girdle stiffness for >1 hour in the morning - Shoulder/hip girdle pain - Acute onset - Low grade fever - Anorexia - Weight loss - Malaise - Depression - Asthenia - Oligoarticular arthritis

Answer 206

- initial standardized dose of prednisolone 15 mg daily orally - Intramuscular methylprednisolone (i.m. depomedrone) may be used in milder cases and may reduce the risk of steroid-related complications - bone protection

Answer 207

- Inflammatory joint pain and stiffness - Peripheral arthritis - Dactylitis - Pain at the site of tendon attachment - Spinal stiffness (most severely cervical and lumbar) - Reduction of C-spine mobility

Answer 208

- erosion in the DIPJ joint and periarticular new bone formation resulting in an irregular fuzzy appearance - joint subluxation and interphalangeal ankylosis - ivory phalanx - osteolysis and pencil-in-cup deformity in advanced disease

Answer 209

- Offer NSAIDs and/or local intra-articular steroid injections - offer a DMARD (e.g. methotrexate), offering a second DMARD if this fails to control the disease - The choice of first line anti-TNF includes: etanercept, infliximab, adalimumab and golimumab - Second line biologics include: certolizumab pegol and secukinumab - For patients requiring rapid control of skin disease, infliximab or adalimumab are preferred

Answer 210

- Repetitive job or overhead activities - Pain, paraesthesias and circulatory changes in the arm, hands and fingers - Upper extremitiy fatigue - Motor weakness - Thenar eminence atrophy - Positive Adson’s test - Positive costoclavicular test - Decreased radial pulse with hyperabduction - Positive Roos’ test - Positive stretch test - Positive Wright's Manoeuvre

Answer 211

- Offer conservative management with analgesia and occupational/physiotherapy - Offer corticosteroid injection into trigger points and associated muscles - Offer surgical decompression of the thoracic outlet - If there is arterial or venous thrombosis, offer catheter directed thrombolysis and anticoagulants if there is residual ischaemia

Answer 212

- Shoulder pain - Shoulder weakness - Loss of active range of movement - Pain and weakness on resisted external rotation indicates infraspinatus tear - Pain and weakness of empty can test suggests supraspinatus tear - Deltoid fatigue - Pain and weakness on lift off test suggests subscapularis tear - Pain and weakness on belly-press test: subscapularis tear - Positive Neer impingement test - Positive Hawkins’ impingement test

Answer 213

- Offer analgesia with paracetamol and NSAIDs - Refer for physiotherapy - Consider a subacromial corticosteroid injection - Refer to orthopaedic surgeon if there is no improvement

Answer 214

- Insidious onset - Well-localised tenderness on palpation of the affected tendon - Pain during activity - Tendon thickening and nodularity - Crepitus

Answer 215

- thickened, blurred tendon | - possible hypoechoic foci within the tendon

Answer 216

- Advise rest, ice therapy to affected area and NSAIDs with paracetamol - Offer bracing or splinting of the affected area - Offer a corticosteroid injection around the affected area - Offer heal lifts with Achilles’ tendinopathy - If these methods fail, offer extracorporeal shock wave lithotripsy for calcific tendinitis

Answer 217

- Symptoms localised over and around a retinacular sheath - Pain increased with motion - Painful popping sensation with finger flexion and extension (trigger finger) - Palpable nodule at the level of the metacarpal head (trigger finger) - Pain, tenderness and swelling localised to the radial side of the wrist, aggravated by thumb movement and ulnar deviation while the thumb is clasped in the palm/Finkelstein test (de Quervain’s disease) - Pain and swelling 4cm proximal to the wrist joint, with redness and palpable crepitus (intersection syndrome) - Pain, swelling and tenderness at Lister’s tubercle (extensor pollicis longus tenosynovitis) - Ulnar sided wrist pain (extensor carpi ulnaris tenosynovitis) - Pain at palmar wrist crease over scaphoid tubercle and along the length of the tendon (flexor carpi radialis tenosynovitis)

Answer 218

- Advise the patient to rest, apply intermittent ice treatment and take regular paracetamol and NSAIDs - Offer a splint to ease rest during the day - Refer for physiotherapy - Offer a steroid injection into the area if this is ineffective

Answer 219

- Joint hypermobility established by the Beighton 9-point score - Joint or spine pain, exacerbated by unaccustomed physical activity - Motor delay in infancy - Chronic pain - Fatigue - Recurrent joint dislocation or subluxation - Muscle pain or spasm - Soft, silky skin texture, or semi-transparent skin - Thin and stretchy double fold of skin - Stretch marks - Easy bruising - Atrophic scars - Poor wound healing - Hernias or organ prolapse - Orthostatic hypotension or POTS - Blue sclera

Answer 220

- Offer pain management with analgesia - Refer for physiotherapy and occupational therapy to improve quality of life - Offer CBT for chronic, unremitting pain with deconditioning - Offer splints and orthotics to support movement

Answer 221

- Limp - Limited range of movement at the hip joint: flexion deformity initially, and with progression adduction in flexion, internal rotation and abduction in extension are limited - Short stature - Muscle wasting - Hyperactivity - Trendelenberg’s sign - Synovitis

Answer 222

- Perform AP and frog lateral view pelvic x-rays - femoral head collapse and fragmentation - subchondral fracture

Answer 223

- For children aged 2 to 6, active monitoring is required - Offer analgesia with paracetamol and NSAIDs, and advise limited activity while disease is active - Refer for physiotherapy - If there is a developing deformity, offer casting/bracing with a Petrie cast - Surgery may be required: osteotomy

Answer 224

- Foot is fixed equinus and cannot be dorsiflexed - Hindfoot in varus and adducted - Forefoot adducted

Answer 225

-parallelism between talus and calcaneus

Answer 226

- Offer the ponsetti casting method: stretching the foot, repositioning and then casting weekly, before performing Achilles tenotomy - Offer the French functional method: stretched and taped by specialist physiotherapist - Offer surgery: selective medial release and posteromedial release, with or without subtraction osteotomy

Answer 227

- Disc shaped, erythematous maculopapular scaly lesions, typically on the face, neck, scalp, ears and extensor surfaces of the arms - Telangiectasia, hyperpigmentation and hypopigmentation - Permanent scarring alopecia

Answer 228

- prominent hyperkeratosis - follicular plugging - vacuolar degeneration - thickened epidermal basement membrane - periappendageal inflammation

Answer 229

- Offer treatment with medium strength topical corticosteroids e.g. 0.1% triamcinolone for lesions on the body, or 0.5 to 2.5% hydrocortisone for lesions on the face and scalp - Consider intralesional triamcinolone acetonide - Offer hydroxychloroquine if there is no response to topical treatment - If disease is refractory, offer methotrexate, azathioprine or mycophenolate mofetil or topical tacrolimus - Surgical excision can be used to treat scarred lesions

Answer 230

- Gait with affected leg externally rotated - Groin or knee pain - Bilateral hip pain - Trendelenburg’s gait - Restricted range of movement

Answer 231

- Puberty - Obesity - Endocrine disorders - Male

Answer 232

- AP x-rays: Klein’s line does not intersect the femoral head - frog-leg lateral x-rays: Klein’s line does not intersect the femoral head and blurred or widened physis (Bloomberg’s sign)

Answer 233

- Activity restriction with analgesia | - SCFE is treated with centre-to-centre screw fixation across the growth plate or an open osteotomy of the femoral neck

RHEUMATOLOGY AND MSK Flashcards

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