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
