18/10/21 Flashcards
Lab Tests in Ankylosing Spondylitis. (2 tests + 1 bonus)
- ESR and CRP → only elevated in 50-70% of patients
- HLA-B27 occurs in 85-90% of patients
- HLA-B27 occurs in 5-15% of the general population but only 5% of HLA-B27 positive people develop ankylosing spondylitis
- NOT a good screening test
Imaging in Ankylosing Spondylitis (2 test)
- X-Ray → reparative changes in response to earlier acute inflammation. Chronica Changes of Sacroilitis are better seen on plain X-Ray. Advanced Disease → Bamboo Spine. Not ideal for early disease.
- MRI → can be particularly helpful in early disease
Extra-Axial Features of Ankylosing Spondylitis
- Asymmetric Oligoarthritis (≤4 joints)
- Enthesitis or Inflammation at insertion points can present as Achilles tendinitis, plantar fasciitis and intercostal enthesitis
- Dactylitis (Sausage Digit) → diffuse swelling of a finger or toe cause by tenosynovitis of the digital flexor tendon
Extra-articular Features of Ankylosing Spondylitis (6 points)
- Uniocular anterior uveitis
- Mucosal inflammation on colonoscopy
- Symptomatic IBD
- Osteoporosis and Osteopenia
- Atypical Pulmonary Fibrosis
- Aortic Valve Incompetence
Management of Ankylosing Spondylitis (2 points)
- NSAIDS are first line in symptomatic patients
- DMARDs such as methotrexate and sulfasalazine have little effect on spinal disease but can be useful for associater peripheral arthritis.
When does granuloma annulare require treatment?
Usually resolve without treatment BUT treatment is required when:
- if lesions persist for months
- is unsightly or tender
- affects normal function (e.g on a finger)
What is the treatment of granuloma annulare?
Treatment is: betamethasone dipropionate 0.05% ointment BD for a minimum of 4-6 weeks
What does granuloma annulare look like?
Common inflammatory skin condition → annular, smooth, discoloured papules and plaques
What conditions is granuloma annulare associated with?
Associated with autoimmune thyroiditis, diabetes mellitis, hyperlipidaemia, rarely with lymphoma, HIV, solid tumours
Complications of BPH (4 points)
Complications of BPH → UTI, urinary retention, obstructive uropathy and incontinence
Voiding Symptoms (3 points) Storage Symptoms (3 points) assocaited with BPH
Voiding Symptoms:
- weak stream, hesitancy or intermittency of flow
Storage Symptoms:
- urgency, daytime frequency and nocturia
Conservative Management of mild LUTS in BPH.
- Mild LUTS → limiting evening fluid intake
- Behavioural Changes → reducing diuretics (caffiene, alchohol), bladder irritants (acidic, spicy foods), evening fluid intake and constipation
- Bladder training + Pelvic Floor Exercises → improve bladder capacity and reduce storage symptoms
First Line therapy of BPH (mechanism, examples)
- FIRST LINE: Selective Alpha Blockers → Tamsulosin or Silodosin (to minimise postural hypotension)
- first line esp if voiding symptoms predominate
- work by relaxing the smooth muscle in the prostate and bladder neck
- some may need to discontinue due to side effects → hypotension, dizziness, congestion or anejaculation
- non-selective alpha blockers (Prazosin) are on the PBS but selective alpha blockers require private script
Red Flags in Pneumonia -> for admission to hospital. (7 points)
- Tachypnoea → RR >22 resp/minute
- Heart Rate → HR >100bpm
- Hypotension → systolic BP <90mmHg
- Acute Onset Confusion
- O2<92% on RA
- Multilobar Involvement on CXR
- Blood Lactate Concentration >2mmol/L
Treatment of Low-Severity CAP (1 points + 1 bonus)
- Monotherapy is recommended for low-severity CAP
- amoxicillin 1g PO TDS
- Review patient in 48hours → in case modification of therapy is required
- If concerned re: atypical pathogens (e.g Mycoplasmae pnuemonia, chlaymdophila (chlamydia) pneumonia) based on clinical presentation → e.g young adult with non-productive cough for >5days and bilateral lower zone infiiltrates on CXR
- doxycycline 100mg orally, 12 hourly
- Duration of therapy:
- If patient has significantly improved after 2-3 days of ABx → treat for 5 days
- If clinical response is slow → treat for 7 days
Options for migraine prophylaxis (8 options)
Amitriptyline 10mg PO nocte → increase daily dose by 10mg up to maximum 75mg daily
Nortriptyline 10mg PO nocte → increase daily dose by 10mg up to maximum 75mg daily
Candesartan 4mg PO daily → increase daily dose by 4mg up to maximum 32mg
Pizotifen 0.5mg PO nocte → increase daily dose by 0.5mg up to maximum 1.5-3mg
Propanolol 20mg PO nocte → increase daily dose by 20mg up to maximum 160mg daily divided into 2-3 doses
Sodium Valproate 200mg PO nocte → increase daily dose by 200mg up to maximum 500mg BD
Topiramate 25mg PO nocte → increase daily dose by 25mg up to maximum 100mg BD
Verapamil Sustained Release 90mg PO daily → increased daily dose slowly over 3 weeks up to maximum 240mg daily
Reliable signs to differentiate between Septic Arthritis and Transient Synovitis.
temperature >38.5 and history of NWB are the most reliable clinical signs differentiating septic arthritis and transient synovitis
Investigations of Septic Arthritis
- FBE → WCC >12
- ESR → >40
- CRP → >20
- Blood Culture
- X-Ray → rule out fractures, OM or tumours
- Bone Scan - DO NOT delay bone scan
- U/S of affected joint → most sensitive test for detecting a joint effusion
- NOT fluid aspiration - this is to be conducted in the OT with general anaesthesia
Timeframe of Acute vs Chronic Back Pain?
Acute → <4 weeks
Chronic → >12 weeks
Benefits of exercises therapy for lower back pain? (3 points)
- can improve pain and function in patients
- can provide psychological benefits → reduction in stress, anxiety and depression
- can improve the perception of exercise self-efficacy in activity restricted individuals
Definition of Oppositional Defiant Disorder.
Defined as an ongoing pattern of anger-guided disobedience and hostile and defiant behaviour towards authority figures.
ODD should be considered when these behaviours are consistently displayed and are impacting the child’s social and educational functioning
Definiction and Characteristics of Conduct Disorder
When there is behaviour that violates the rights of others or societal norms
- aggression towards people, animals or property, often with a callous manner and lack of empathy
- deceitfulness or theft
- serious violations of rules
Risk Factors of Oral Cancer (5 points)
- Smoking
- Alcohol Consumption
- Poor Oral Health
- Infective Agents → HPV 16 or 18
- Inflammatory Disease → lichen planus
