Corrections Flashcards
What medication is recommended for all patients with SLE (if not contraindications)?
Hydroxychloroquine
What antibody may be present in UC (but -ve in Crohn’s)?
pANCA
What are the 2 most common causes of drug-induced SLE?
1) procainamide
2) hydralazine
Mx of acute reactive arthritis?
NSAIDs (as long as no contraindications)
What can sometimes be used for persistent disease in reactive arthritis?
sulfasalazine and methotrexate
ALP in 1ary hyperparathyroidism?
Raised
Mx of undisplaced scaphoid fracture?
Cast for 6-8 weeks
What is considered to be the ‘anchor drug’ for long term maintenance therapy of SLE ?
Hydroxychloroquine
What is meralgia paraesthetica?
Syndrome of paraesthesia or anaesthesia in the distribution of the lateral femoral cutaneous nerve (LFCN).
Typical presentation of meralgia paraesthetica?
Symptoms in the upper lateral aspect of the thigh:
- Burning, tingling, coldness, or shooting pain
- Numbness
- Deep muscle ache
- Symptoms are usually aggravated by standing, and relieved by sitting
Risk factors for meralgia paraesthetica?
Obesity
Pregnancy
Tense ascites
Trauma
Iatrogenic e.g. surgery
Mx of patients with APS:
a) who haven’t had a thrombosis
b) have had a thrombotic event
a) daily low dose aspirin
b) lifelong warfarin
What is Paget’s disease?
Increased but uncontrolled bone turnover.
Thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by increased osteoblastic activity.
What areas are most affected in Paget’s?
- skull
- spine/pelvis
- long bones of the lower extremities
Stereotypical presentation of paget’s disease?
Older male with bone pain and isolated raised ALP
Features of Paget’s disease of bone?
1) bone pain e.g. pelvis, lumbar spine, femur
2) bowing of tibia, bossing of skull (untreated features)
Calcium & phosphate in Paget’s?
Typically normal
Mx of suspected scaphoid fracture in A&E?
Immobilisation using a Futuro splint or standard below-elbow backslab before specialist review
What do the Ottawa ankle rules state?
An XR is only necessary if there is pain in the malleolar zone and:
1) Inability to weight bear for 4 steps
2) Tenderness over the distal tibia
3) Bone tenderness over the distal fibula
Mx of ankle fracture?
1) All ankle fractures should be promptly reduced to remove pressure on the overlying skin and subsequent necrosis
2) Young patients, with unstable, high velocity or proximal injuries will usually require surgical repair. Often using a compression plate.
What is a Baker’s cyst?
AKA a popliteal cyst
These are not true cysts but rather a distension of the gastrocnemius-semimembranosus bursa.
How do Baker’s cysts present?
Swellings in the popliteal fossa behind the knee.
Features of Baker’s cyst rupture?
Similar symptoms to DVT e.g. pain, redness and swelling in the calf.
Mx of Baker’s cysts in children?
Baker’s cysts in children typically resolve and do not require treatment.
What is osteogenesis imperfecta?
A group of disorders of collagen metabolism resulting in bone fragility and fractures.
What is the most common type of OI?
Type 1 (also milder)
Inheritance of OI?
Autosomal dominant
Cause of OI?
abnormality in type 1 collagen due to decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides
Features of OI?
- presents in childhood
- fractrures following minor trauma
- blue sclera
- deafness 2ary to otosclerosis
- dental imperfections
Calcium, phosphate, ALP & PTH in OI?
Usually normal
What is the oreferred surgical treatment for stable intertrochanteric (extracapsular) proximal femoral fractures?
Dynamic hip screw
How can coeliac disease affect the bones?
Can cause osteomalacia 2ary to vitamin D deficiency (and therefore hypocalcaemia).
What urgent investigation is needed in suspected dermatomyositis?
Malignancy screen
What is the best initial management in a displaced ankle fracture?
Reduce the fracture to prevent any skin damage resulting from the pressure on the overlying skin that can lead to skin necrosis.
What is the most significant and potentially serious side effect of hydroxychloroquine?
Retinopathy –> monitor visual acuity
Juxta-articular osteoporosis/osteopenia is an early XR feature of what condition?
RA
What are 2 conditions associated with sebhorreic dermatitis?
1) Parkinson’s
2) HIV
How does sebhorreic dermatitis present?
- eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
- otitis externa and blepharitis may develop
1st line mx of seborrhoeic dermatitis?
Ketoconazole 2% shampoo
What does inflammatory arthritis involving DIP swelling & dactylitis point to a diagnosis of?
Psoriatic arthritis
In children, where is the most common site where osteomyelitis occurs in a long bone?
Metaphysis –> as this is a highly vascular area
What is the most common source of infection for osteomyelitis in children?
Haematogenous spread into the long bone (hence highly vascular area of metaphysis is most common location).
What is the hallmark feature of myasthenia gravis?
Fatigueable, painless muscle weakness that IMPROVES with rest.
Most common cause of bilateral vs unilateral foot drop?
Bilateral - peripheral neuropathy
Unilateral - common peroneal nerve lesion
How can ankylosing spondylitis affect chest expansion?
Reduced chest expansion as it can lead to breathing discomfort & taking shallower breaths over time –> can lead to scarring and reduction in chest’s ability to expand fully.
What is De Quervain’s tenosynovitis?
A common condition containing extensor pollicis brevis & abductor pollicis longus tendons is inflamed.
‘texters thumb’
Features of De Quervain’s tenosynovitis?
- pain on radial side of wrist
- tenderness over radial styloid process
- abduction of the thumb against resistance is painful
What movement is painful in De Quervain’s tenosynovitis?
Abduction of thumb against resistance
Mx of De Quervain’s tenosynovitis?
analgesia
steroid injection
What are some risk factors for Dupuytren’s contracture?
- manual labour
- phenytoin
- alcoholic liver disease
- diabetes
- trauma to hand
What 3 movements are reduced in ankylosing spondylitis?
1) reduced lateral flexion
2) reduced forward flexion
3) reduced chest expansion
When are anti-TNF alpha inhibitors indicated in AS?
In axial AS that has failed on 2 different NSAIDs and meets criteria for active disease on 2 occasions 12 weeks apart.