Corrections Flashcards
(131 cards)
1
Q
What medication is recommended for all patients with SLE (if not contraindications)?
A
Hydroxychloroquine
2
Q
What antibody may be present in UC (but -ve in Crohn’s)?
A
pANCA
3
Q
What are the 2 most common causes of drug-induced SLE?
A
1) procainamide
2) hydralazine
4
Q
Mx of acute reactive arthritis?
A
NSAIDs (as long as no contraindications)
5
Q
What can sometimes be used for persistent disease in reactive arthritis?
A
sulfasalazine and methotrexate
6
Q
ALP in 1ary hyperparathyroidism?
A
Raised
7
Q
Mx of undisplaced scaphoid fracture?
A
Cast for 6-8 weeks
8
Q
What is considered to be the ‘anchor drug’ for long term maintenance therapy of SLE ?
A
Hydroxychloroquine
9
Q
What is meralgia paraesthetica?
A
Syndrome of paraesthesia or anaesthesia in the distribution of the lateral femoral cutaneous nerve (LFCN).
10
Q
Typical presentation of meralgia paraesthetica?
A
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
11
Q
Risk factors for meralgia paraesthetica?
A
Obesity
Pregnancy
Tense ascites
Trauma
Iatrogenic e.g. surgery
12
Q
Mx of patients with APS:
a) who haven’t had a thrombosis
b) have had a thrombotic event
A
a) daily low dose aspirin
b) lifelong warfarin
13
Q
What is Paget’s disease?
A
Increased but uncontrolled bone turnover.
Thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by increased osteoblastic activity.
14
Q
What areas are most affected in Paget’s?
A
- skull
- spine/pelvis
- long bones of the lower extremities
15
Q
Stereotypical presentation of paget’s disease?
A
Older male with bone pain and isolated raised ALP
16
Q
Features of Paget’s disease of bone?
A
1) bone pain e.g. pelvis, lumbar spine, femur
2) bowing of tibia, bossing of skull (untreated features)
17
Q
Calcium & phosphate in Paget’s?
A
Typically normal
18
Q
Mx of suspected scaphoid fracture in A&E?
A
Immobilisation using a Futuro splint or standard below-elbow backslab before specialist review
19
Q
What do the Ottawa ankle rules state?
A
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
20
Q
Mx of ankle fracture?
A
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.
21
Q
What is a Baker’s cyst?
A
AKA a popliteal cyst
These are not true cysts but rather a distension of the gastrocnemius-semimembranosus bursa.
22
Q
How do Baker’s cysts present?
A
Swellings in the popliteal fossa behind the knee.
23
Q
Features of Baker’s cyst rupture?
A
Similar symptoms to DVT e.g. pain, redness and swelling in the calf.
24
Q
Mx of Baker’s cysts in children?
A
Baker’s cysts in children typically resolve and do not require treatment.
25
What is osteogenesis imperfecta?
A group of disorders of collagen metabolism resulting in bone fragility and fractures.
26
What is the most common type of OI?
Type 1 (also milder)
27
Inheritance of OI?
Autosomal dominant
28
Cause of OI?
abnormality in type 1 collagen due to decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides
29
Features of OI?
- presents in childhood
- fractrures following minor trauma
- blue sclera
- deafness 2ary to otosclerosis
- dental imperfections
30
Calcium, phosphate, ALP & PTH in OI?
Usually normal
31
What is the oreferred surgical treatment for stable intertrochanteric (extracapsular) proximal femoral fractures?
Dynamic hip screw
32
How can coeliac disease affect the bones?
Can cause osteomalacia 2ary to vitamin D deficiency (and therefore hypocalcaemia).
33
What urgent investigation is needed in suspected dermatomyositis?
Malignancy screen
34
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.
35
What is the most significant and potentially serious side effect of hydroxychloroquine?
Retinopathy --> monitor visual acuity
36
Juxta-articular osteoporosis/osteopenia is an early XR feature of what condition?
RA
37
What are 2 conditions associated with sebhorreic dermatitis?
1) Parkinson's
2) HIV
38
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
39
1st line mx of seborrhoeic dermatitis?
Ketoconazole 2% shampoo
40
What does inflammatory arthritis involving DIP swelling & dactylitis point to a diagnosis of?
Psoriatic arthritis
41
In children, where is the most common site where osteomyelitis occurs in a long bone?
Metaphysis --> as this is a highly vascular area
42
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).
43
What is the hallmark feature of myasthenia gravis?
Fatigueable, painless muscle weakness that IMPROVES with rest.
44
Most common cause of bilateral vs unilateral foot drop?
Bilateral - peripheral neuropathy
Unilateral - common peroneal nerve lesion
45
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.
46
What is De Quervain's tenosynovitis?
A common condition containing extensor pollicis brevis & abductor pollicis longus tendons is inflamed.
'texters thumb'
47
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
48
What movement is painful in De Quervain's tenosynovitis?
Abduction of thumb against resistance
49
Mx of De Quervain's tenosynovitis?
analgesia
steroid injection
50
What are some risk factors for Dupuytren's contracture?
- manual labour
- phenytoin
- alcoholic liver disease
- diabetes
- trauma to hand
51
What 3 movements are reduced in ankylosing spondylitis?
1) reduced lateral flexion
2) reduced forward flexion
3) reduced chest expansion
52
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.
53
When is pain worse in AS?
- pain at night
- worse after rest/inactivity
- worse in morning
54
Features of adult-onset Still's disease?
- arthralgia
- rash: salmon-pink, maculopapular
- fever
- lymphadenopathy
55
What is elevated in adult onset Still's?
Serum ferritin
56
1st line mx of adult-onset Still's?
1st line --> NSAIDs
Can then consider adding steroids
57
What medication can cause Dupuytren's contracture?
Phenytoin
58
When should surgical mx of Dupuytren's contracture be considered?
When the metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table.
59
What are poor prognostic factors in RA?
1) RF +ve
2) Anti-CCP antibodies
3) poor functional status at presentation
4) X-ray: early erosions (e.g. after < 2 years)
5) extra articular features e.g. nodules
6) HLA DR4
7) insidious onset
60
What is the Z score adjusted for in a DEXA scan?
Age, gender & ethnicity
61
What is the most common cause of osteomyelitis in sickle cell patients?
Salmonella
62
Treatment of choice for SLE?
Hydroxychloroquine
63
What is the treatment of choice for ALL patients with a displaced hip fracture?
Hemiarthroplasty or total hip replacement
64
How to decide between hemiarthroplasty or total hip replacement in a displaced hip fracture?
Total hip replacement is favoured to hemiarthroplasty if patients:
1) were able to walk independently out of doors with no more than the use of a stick and
2) are not cognitively impaired and
3) are medically fit for anaesthesia and the procedure.
65
1st line for lower back pain?
Oral NSAIDs
66
What score can be used to guide the need for DEXA scanning?
FRAX/QFracture
67
What condition causes pain on the radial side of the wrist and tenderness over the radial styloid process?
De Quervain's tenosynovitis
68
What are the 2 types of intracapsular hip fractures?
1) undisplaced
2) displaced
69
Mx of a stable intertrochanteric fracture (extracapsular)?
dynamic hip screw
70
Mx of a everse oblique, transverse or subtrochanteric fracture (extracapsular)?
intramedullary device
71
What nerve innervates the triceps?
C7 (radial)
72
What abs are asspciated with drug induced lupus?
Anti-histone abs
73
Is reactive arthritis a cause of dactylitis?
Yes
74
3 clinical findings in AS?
1) reduced forward flexion
2) reduced lateral flexion
3) reduced chest expansion
75
Order of temporal biopsy vs steroids in temporal arteritis?
Steroids first !!!
Then organise biopsy
76
How does an acetabular labral tear present?
May occur following trauma (most commonly in younger adults) or as a result of degenerative change (typically in older adults).
Features:
- hip/groin pain
- snapping sensation around hip
- may be the sensation of locking
77
What is an important differential for back pain in IVDU?
Psoas abscess
78
What is an iliopsoas abscess?
a collection of pus in iliopsoas compartment (iliopsoas and iliacus).
79
most common organism causes an iliopsoas abscess?
Staph. aureus
80
1st line for lower back pain?
NSAIDs (not physio)
81
1st line mx of a intertrochanteric (extracapsular) proximal femoral fracture?
Dynamic hip screw
82
Mx of Achilles tendonitis?
1) rest, NSAIDs
2) physio if symptoms persist beyond 7 days
83
In discitis due to Staphylococcus, what investigation is needed?
Echo to look for endocarditis
84
What should you check before treatment with azathioprine?
Check for thiopurine methyltransferase (TPMT) deficiency --> predisposes to azathioprine related pancytopaenia
85
Why is co-administration of vitamin D is crucial with alendronate?
As it ensures adequate calcium absorption from the GI tract, optimising the effects of alendronate.
86
What is the strongest risk factor for pseudogout?
Increasing age (>60 y/o)
87
In younger patients with pseudogout (<60 y/o), there is normally an underlying risk factor.
What are some risk factors for pseudogout?
1) haemochromatosis
2) hyperparathyroidism
3) low Mg, low phosphate
4) acromegaly
5) Wilson's disease
88
What is Felty's syndrome?
A condition characterised by splenomegaly & neutropenia in a patient with RA.
Hypersplenism results in destruction of blood cells which classically results in neutropenia but can also cause pancytopenia.
89
What murmur is seen in anaemia?
Soft, systolic murmur
90
What is the most appropriate management option for a 30 year old man with a flexion deformity of the finger at the DIP joint and inability to actively extend his finger following an
injury?
A finger splint --> this can provide support and immobilise the finger, allowing the tendon to heal and the finger to regain its full range of motion.
91
A 34 year old man has pain in his right shoulder and upper arm for 6 weeks that worsens when elevating his arm above his head. He does not recall any injury.
There is no deformity, tenderness or reduced range of movement. There is pain on abduction of the right shoulder that is worse with the arm in internal rotation and when abduction is resisted.
He is treated with ibuprofen.
What is the dx?
R supraspinatus tendinopathy
92
Alendronic acid vs zolendronic acid in mx of osteoporosis?
1st line --> alendronic acid
Zolendronate is only administered IV and is reserved for those intolerant of an oral bisphosphonate.
93
Wasting of ALL of the intrinsic muscles of the hand indicates a lesion located where?
T1 root lesion (as both median and ulnar nerves are affected)
94
What nerves supply the intrinsic muscles of the hand?
Ulnar nerve & median nerve
95
What is a fat embolism?
When one or more droplet-like particles of fat enter your bloodstream and block circulation through some of your blood vessels.
96
What are fat emboli most common caused by?
Bone fractures
97
Resp features of fat emboli?
Following fracture(s):
- Early persistent tachycardia
- Tachypnoea, dyspnoea, hypoxia usually 72 hours following injury
- Pyrexia
98
Neuro features of fat emboli?
- Confusion and agitation
- Retinal haemorrhages and intra-arterial fat globules on fundoscopy
99
Mx of fat emboli?
1) Prompt fixation of long bone fractures
2) DVT prophylaxis
3) General supportive care
100
How to differ between PE and fat embolism?
PE doesn't cause neuro changes
101
Stepwise mx of osteoarthritis?
1st line --> topical NSAIDs
2nd line --> oral NSAIDs (+PPI)
102
When should oral NSAIDs be avoided in OA?
1) Contraindications e.g. peptic ulcer disease
2) If the patient is taking aspirin already
103
When can weak opioids be given in OA?
1) short-term pain relief
2) all other pharmacological treatments are contraindicated, not tolerated or ineffective
104
What is De Quervain's tenosynovitis?
A common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.
105
Clinical features of De Quervain's tenosynovitis?
- Pain on radial side of wrist
- Tenderness over radial styloid process
- Abduction of thumb against resistance is painful
106
What movement of the thumb is painful in De Quervain's tenosynovitis?
Abduction of the tumb against resistance
107
What is Finkelstein's test?
With the thumb is flexed across the palm of the hand, pain is reproduced by movement of the wrist into flexion and ulnar deviation --> indicates De Quervain's tenosynovitis
108
Mx of De Quervain's tenosynovitis?
1) analgesia
2) steroid injection
3) immobilisation with a thumb splint (spica) may be effective
4) surgical treatment is sometimes required
109
What is adhesive capsulitis (frozen shoulder)?
A common cause of shoulder pain. It is most common in middle-aged females
110
What conditions are thought to predispose individuals to inflammatory responses within the joint capsule? (i.e. in adhesive capsulitis)
Diabetes (particularly type 1), thyroid dysfunction, hyperlipidaemia
111
Clinical features of adhesive capsulitis?
1) external rotation is affected more than internal rotation or abduction
2) both active and passive movement are affected
3) patients typically have a painful freezing phase, an adhesive phase and a recovery phase
4) bilateral in up to 20% of patients
112
How long does an episode of adhesive capsulitis typically last?
6m - 2y
113
What movement is most affected in adhesive capsulitis?
External rotation
114
Is active or passive movement affected in adhesive capsulitis?
Both
115
Mx of adhesive capsulitis?
no single intervention has been shown to improve outcome in the long-term
treatment options include NSAIDs, physiotherapy, oral corticosteroids and intra-articular corticosteroids
116
What % of cases of adhesive capsulitis are bilateral?
20%
117
1st line investigation for a suspected osteoporotic vertebral fracture?
XR of lumbar spine
118
LFTs in biliary colic?
All normal, inflammatory markers will also be normal
119
Fundoscopy results in PMR w/ visual changes?
Engorged pale optic disc with blurred margins --> due to anterior ischemic optic neuropathy
This is thought to be due to the immune system damaging arteries supplying the optic nerve, leading to thrombus formation and occlusion, leading to the death of nerve fibres at the anterior aspect of the optic nerve.
The ischaemia in the optic nerve leads to optic disc pallor and swelling.
120
Mx of all proximal scaphoid pole fractures?
Require surgical fixation
121
1st line investigation in suspected sarcoidosis?
1st line --> CXR (looking for hilar lymphadenopathy).
Serum ACE may be elevated but has a high false negative and false positive rate.
122
Bone profile in osteomalacia?
Low calcium
Low phosphate
High ALP
123
Why is phosphate low in osteomalacia?
Due to low levels of vitamin D
Vitamin D is required for absorption of calcium & phosphate
124
What muscle group is affected in Trendelenburg's gait?
Hip abductors
125
What are the 2 nail changes seen in psoriatic arthritis?
1) pitting
2) onycholysis (spoon shaped nails)
126
Whatskin manifestation may be seen in reactive arthritis?
Keratoderma blennorrhagicum (yellow waxy plaques on sole of feet)
127
Which 2 features are specific to psoriatic arthritis?
Dactylitis & enthesitis
128
What to do if a patient presents with dactylitis?
Refer for rheumatological assessment
129
What imaging is indicated in psoriatic arthritis?
XR of hands and feet
130
What is a Colles fracture?
A fracture of the distal radius, most commonly caused by FOOSH.
It is the most common type of wrist fracture.
131
