Arthritis, gout

Question 1

Pharmacodynamics of NSAIDs

Answer 1

COX-inhibitor, diminish prostaglandins

Question 2

Side effects of NSAIDs

Answer 2

"	Gastric ulcers & bleeding
"	Platelet dysfunction
"	Exacerbation of asthma
"	Increase blood pressure
"	Increased CVS risk

Question 3

Pharmacodynamics of glucocorticoids

Answer 3

Downregulate proinflammatory proteins

Question 4

Side effects of glucocorticoids

Answer 4

"	Adrenal suppression 
"	Osteoporosis
"	Skin thinning & bruising
"	Hypertension
"	CVS risk
"	Immunosuppression
"	Diabetes
"	Cataracts

Question 5

Pharmacodynamics of hydroxychloroquine

Answer 5

Anti-malarial (exact MoA not understood)

Question 6

Pharmacodynamics of methotrexate

Answer 6

Interferes with metabolism of folic acid

Question 7

Pharmacodynamics of leflunomide

Answer 7

Pyrimidine synthesis inhibitor, interrupts synthesis of DNA & RNA

Affects rapidly dividing cells eg lymphocytes

Question 8

Pharmacodynamics of biologics

Answer 8

Monoclonal antibodies

Target TNF-α or IL-6

Question 9

Side effects of biologics

Answer 9

” Increased infection risk (reactivation of TB)
“ Increased cancer risk (lymphoma)
“ Drop in blood counts
“ Demyelinating condition similar to MS

Question 10

Which DMARDs are safe for use during pregnancy

Answer 10

Hydroxychloroquine

Sulfasalazine

Question 11

What drug is used to wash out leflunomide

Answer 11

Cholestyramine

Question 12

General side effects of DMARDS

Answer 12

• GI upset
• Mouth ulcers
• Drop in blood counts

Question 13

Specific side effect of hydroxychloroquine

Answer 13

Ocular toxicity: Bullseye retinopathy

Question 14

Specific side effect of sulfasalazine

Answer 14

Orange tears/ urine

Question 15

How many compartments are there in the knee joint (that can be affected by arthritis

Answer 15

3 compartments

1. Patella-femoral
2. Medial tibial-femoral
3. Lateral tibial-femoral

Note: fibula does not articulate with femur

Question 16

Main blood supply to neck of femur

Answer 16

Mainly lateral circumflex artery.

Also medial circumflex artery.

Both originate from profunda femoris artery.

In childen, also get acetabular branch of obturator artery (from ligamentum teres femoris)

Question 17

What part of pulmonary function test to look at before starting patient on methotrexate

Answer 17

Transfer factor DCLO

Question 18

Type of antibiotic that causes tendonitis

Answer 18

Ciprofloxacin

and other fluoroquinolones

Question 19

Which muscle group in leg tends to waste away in knee osteoarthritis

Answer 19

Quads

rectus femoris, vastus medius, vastus intermedius, vastus lateralis

Question 20

Does the medial or lateral side of the knee joint tend to wear away faster in osteoarthritis

Answer 20

Medial

Question 21

What to look for in MSK examination

Answer 21

WADES

wasting
assymmetry
dysfunction
erythema
swelling

Question 22

Presentation of reactive arthritis (3 components)

Answer 22

1. inflammatory arthritis of large joints
2. conjunctuvitis/ uveitis
3. urethritis/ cervicitis

Question 23

Difference between reactive and septic arthritis

Answer 23

Cannot find infection in joint in reactive, can in septic

Question 24

Presentation of septic arthritis

Answer 24

• very limited range of movement due to pain (any movement is painful)
• purulent synovial fluid (compared to normal amber colour)
• may be afebrile

Question 25

Which joint does gout most commonly affect

Answer 25

Big toe

Question 26

Differentiating RA and polymyalgia rheumatica

Answer 26

• later onset (starts 50-60y)
• affects muscles more than joints
• sudden onset of symptoms (RA occurs more gradually)