4th Year Additions Flashcards
management pathway of OA
PO paracetamol and topical NSAIDs oral NSAIDs (consider PPI) topical capsaicin (chilli pepper) intra-articular joint injections joint replacement
what is the action of drugs that end in -nib?
JAK inhibitors
what is mixed connective tissue disease?
condition which features symptoms from other CTDs
features of mixed connective tissue disease
Raynaud's arthralgia/ arthritis myositis sclerodactyly pulmonary hypertension interstitial lung disease
antibody in mixed connective tissue disease?
anti-RNP Ab
what should be done annually in mixed connective tissue disease and systemic sclerosis
echo for pulmonary hypertension
PFTs for interstitial lung disease
what is Libman-Sacks endocarditis?
growth on valves (commonly mitral) associated with APLS
blood results in APLS
thrombocytopenia
prolonged APTT
what is chondrocalcinosis?
calcium pyrophosphate deposits occur in cartilage and other soft tissues
what does calcium pyrophosphate deposition disease encompass?
chondrocalcinosis hyperparathyroidisim hypothyroidism renal osteodystrophy haemochromatosis Wilson's
side effects of methotrexate
teratogenic
pulmonary fibrosis
side effects of leflunomide
hypertension
peripheral neuropathy
side effects of sulfasalazine
male infertility
side effects of hydroxychloroquine
nightmares
reduced visual acuity
side effects of anti-TNF
reactivation of TB or hep B
side effects of rituximab
night sweats
thrombocytopenia
what is polyarteritis nodosa?
medium vessel necrotising vasculitis
what conditions is polyarteritis nodosa associated with?
HBV
HCV
CMV
HIV
presentation of polyarteritis nodosa
weight loss fever malaise myalgia polyarthritis hip BP abdo pain livedo recticularis renal failure
diagnosis of polyarteritis nodosa
arteriography shows multiple small aneurysms
urine
bloods
management of polyarteritis nodosa
steroids
cytotoxic drugs
which vessels does Takayasu affect?
aorta and pulmonary arteries
what is Takayasu also called?
pulseless disease
diagnosis fo Takayasu
doppler USS
CT
MR angiogrpahy
who gets Takayasu?
young females 15-35
management of Takayasu?
steroids +/- immunosuppressants, angioplasty/ surgical repair
what is Bechet’s disease?
complex inflammatory condition linked to HLA B51
where is Bechet’s more common?
turkey
iran
major criteria for Bechet’s
recurrent aphthous stomatitis
sterile pustules at site of skin trauma (pathergy test)
uveitis
genital ulceration
minor criteria for Bechet’s
inflammatory large joint arthritis intestinal ulceration meningoencephalitis epididymitis thrombophlebitis
what is the pathergy test?
sterile needle creates an abrasion in the forearm > weal progression of >5mm
which conditions is pathergy test positive in?
bechets
sweet’s syndrome
pyoderma gangrenosum
management of bechets
steroids
colchicine
topical anaesthetic e.g. lidocaine
immunosuppressants e.g. ciclosporin A and biologics
what to do if patients have a raised plasma viscosity?
myeloma screen
IgG antibodies screen
what is the FRAX tool?
assess risk of fragility fractures in OP over the next 10 years
who should you perform the FRAX tool on?
men >75 and women >65
what can be used as secondary prevention for OP in women?
raloxifene
HRT
action of raloxifene?
selective oestrogen receptor modulator that stimulates oestrogen in bone but blocks them in uterus and breast
what is the serum blood test for vitamin D?
25-hydroxyvitamin D
monitoring in Paget’s
ALP
two complications of paget’s
osteogenic sarcoma (osteosarcoma)
spinal stenosis/ compression
hearing loss
first line for Paget’s
pamidronate (can have flu-like reaction after first dose)
L2 nerve root lesion
pain across upper thigh
weak flexion and adduction
L3 nerve root lesion
pain across lower thigh
weak hip adduciton
weak knee extension
L4 nerve root lesion
pain across knee to medial malleolus
weak knee extension
foot inversion
dorsiflexion
L5 nerve root lesion
lateral shin to dorsum of foot and great toe
weak hip extension, abduction, knee flexion, foot and great toe dorsiflexion (foot drop)
S1 nerve root lesion
pain across posterior calf
weak knee flexion, foot plantar flexion and eversion
minor SLE symptom management
NSAIDs
hydroxychloroquine
low dose steroids
major SLE symptoms
steroids
immunosuppressants
