Rheumatology/ ortho

Question 1

gout aspirate presents with?

Answer 1

needle shaped neg birefiregence

Question 2

xray findings? for Gout

Answer 2

1st MTP joint would have associated swelling and in later stages punched out erosion

Question 3

treatment of choice for acute gout
1st line?
if patient has pmhx of duodenal ulcer?

long term management?

Answer 3

NSAIDSs
oral Colchine

allopurinol reduces serum urate

Question 4

situations that can precipitate Gout?

Answer 4

renal failure
diuretic use
nsaid use

recent chest infection
recent surgery
fasting

polycythaemia

Question 5

Xray features of RA?

Answer 5

soft tissue swelling
joint space narrowing
periarticular osteopenia
erosive damage

Question 6

pseudogout aspirate?

Answer 6

+birefirengment crystals

CPPD

Question 7

what is the mainstay of therapy for ankylosing spondylitis?

what medication is best for AP- if it is axial?

Answer 7

exercise
dry land and hydrotherapy is the main stay and is well tolerated

if several peripheral joints affected then METHOTREXATE

its not indicated when axial disease

Question 8

clinical tests for AS?

Answer 8

schobers test
wall to tragus
chest expansion

Question 9

5 associations of AS

Answer 9

anterior uveitis
Apical fibrosis.
Aortic regurgitation.
Amyloidosis (renal) Achilles involvement (enthesitis)

IBD
skin psoriasis
cauda equina
sjogren syndrome

seronegative spondyloarthritis and as such is associated with anterior uveitis, mucosal and skin lesions, inflammatory bowel disease, psoriasis, and myocardial involvement including aoric regurgitation and cardiac conduction defects

Question 10

diagnostic investigation for AS

diagnostic criteria?

Answer 10

diagnostic criteria

Hx inflammatory back pain
HLA B27
Sacro-ilitis on x-ray

Question 11

acute compression of cauda equina?

examination signs?

Answer 11

sensory loss in a lumbosacral distribution and flaccid, weakened lower limbs with reduced reflexes

Sensory loss to light touch and pinprick is evident over calves, feet and buttocks

Question 12

presenting symptoms of cauda equina?

Answer 12

backpain
bilateral sciatica
sensory loss
micturition

Question 13

causes of cauda equina? and how to differentiate

Answer 13

systemic FLAWS - myeloma , bony mets, primary sacral tumor

infected - fever- epidural abscess, haemtoma

disc prolapse

malignancy trauma or sepsis

Question 14

which 2 LL neuro examination signs are imp to differentiate compression of cord to cauda equina?

Answer 14

cord compression : spastic paralysis and brisk reflex
hypertonia and hypereflexia

cauda equina compression: flaccid paralysis and arreflexia
hypotonia

Question 15

6 red flag for back pain?

Answer 15

perianal parasthesia
back pain
bilateral sciatica 
erectile dysf
gait disturbance 
ll weakness

Question 16

s1

Answer 16

sole of foot

Question 17

s3

Answer 17

buttock

Question 18

l4

Answer 18

calf

Question 19

ciclosporin - what type of drug?

ciclosporin toxicity?

Answer 19

DMARD
tremor 
gingival hypertrophy
htn
headache

Question 20

features of reactive arthritis?

triad

Answer 20

Uretheritis
conjunctivitis
sero negative arthritis

Question 21

felty syndrome?

Answer 21

complication of RA
splenomegaly
neutropenia

rheumatoid arthritis, a swollen spleen, decreased white blood cell count, and repeated infections. It is rare.

Question 22

clinical findings associated with RA?

Answer 22

PIP joint swelling

ulnar deviation w volar subluxation

atlanto axial subluxation

swan neck deformity

boutonniere

z deformity

rheumatoid nodule

Question 23

methotrexate side effects?

Answer 23

hepatitis

lung fibrosis

Question 24

initial treatment of PMR

Answer 24

oral prednisolone

Question 25

for temporal arteritis treatment ?

Answer 25

IV methylprednisolone and oral pred

Question 26

osteoporosis treatment

Answer 26

bisphosphonates
calcium and vit d
HRT

Question 27

risk factors for osteoporosis ?

Answer 27

chronic steroid use
inflammatory conditions
premature menopause
alcohol excess

Question 28

Erythema nodosum

most common ddx?

Answer 28

Erythema nodosum normally presents as tender red, often bilateral nodules most commonly presenting on the anterior lower legs and arms.

The lesions can be accompanied by fever and joint pain

sarcoidosis and TB

Question 29

what is the most important investigation in a suspected sarcoidosis? or pt with erythema nodosum

Answer 29

bilateral hilar lymphadenopathy shown on an chest xray

Question 30

what abnormal blood test findingw ith sarcoidosis?

Answer 30

ACE and vit D is increased

Question 31

complications w sarcoidosis

Answer 31

require steroids
breathlessness
hypercalcaemia especially if sunbathes

Question 32

what rash does lyme disease present with?

Answer 32

erythema chronicum migrans

Question 33

pt with SLE can develop antiphospholipid syndrome

true / false?

Answer 33

APS is associated with repeated miscarriages and fetal deaths. It is associated with SLE.

Question 34

management of SLE

Answer 34

steroids

azathioprine

Question 35

what is anti phospholipid syndrome

Answer 35

Antiphospholipid (AN-te-fos-fo-LIP-id) syndrome occurs when your immune system mistakenly creates antibodies that make your blood much more likely to clot. This can cause dangerous blood clots in the legs, kidneys, lungs and brain

Question 36

scleroderma most common cause of death?

Answer 36

cardio / pulmonary involvement

Question 37

what is best management for ascending cholangitis?

Answer 37

Urgent ERCP

ERCP is an effective technique, allows instrumentation and is the safest method of dealing with an obstructing stone causing ascending cholangitis.