Deck 1

Question 1

Name 4 conditions that present with Monoarthritic presentation

Answer 1

Septic arthritis
Crystal arthritis (gout cppd)
Osteoarthritis
Trauma (haemarthrosis)

Question 2

Name 5 conditions that present with Oligoarthritis presentation

Answer 2

Crystal arthritis
Psoriatic arthritis
Reactive arthritis (yersinia, salmonella, campylobacter)
Ankylosing spondylitis
Osteoarthritis

Question 3

Name 4 conditions that present with SYMMETRICAL polyarthritis presentation

Answer 3

Rheumatoid
Osteoarthritis
Viruses (hep a/b/c/mumps)
Systemic conditions

Question 4

Name 2 conditions that present with ASYMMETRICAL polyarthritis presentation

Answer 4

Reactive arthritis

Psoriatic arthritis

Question 5

How do u assess the locomotor system

Answer 5

Gait
Arms
Legs
Spine
Range of movement

Question 6

Name the Rheumatological Investigations

Answer 6

Joint aspiration (look for blood, pus, crystals)
FBC, ESR, CRP, U+E
Urate
Blood culture for septic arthritis
Radiology: US, MRI – effusions, synovitis, enthesitis, infection, erosions, calcifications, widening/loss of joint space, changes in underlying bone
CXR: RA, vasculitis, TB, sarcoid

Question 7

X-ray features of osteoarthritis

Answer 7

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

Question 8

X-ray ft of rheumatoid arthritis

Answer 8

Juxta-articular osteopenia
Soft tissue swelling
Joint deformity
Loss of joint space

Question 9

X-ray ft of gout

Answer 9

Periarticular erosions
Normal joint space
Soft tissue swelling

Question 10

Causes for 15-30yo

Answer 10

Prolapsed disc (MRI), trauma, fractures
Ankylosing spondylitis
Spondylolisthesis
Pregnancy

Question 11

Causes for 30-50yo

Answer 11

Degenerative spinal disease
Prolapsed disc (MRI)
Ca secondary from lung/breast/prostate/thyroid/kidney

Question 12

Causes of pain for >50yo

Answer 12

Degenerative
Osteoporotic vertebral collapse
Paget’s (ALP)
Ca (PSA)
Myeloma (serum/ urine electrophoresis)
Spinal stenosis

Question 13

Name 4 neurosurgical emergencies

Answer 13

Acute cauda equina compression
Acute cord compression
Immediate urgent treatment
Mets

Question 14

What is osteoarthritis

Answer 14

Most common joint condition

Usually primary, secondary to joint disease or other conditions

Question 15

Signs and symptoms of OA

Answer 15

Pain on movement, worse at end of day
Background pain at rest
Stiffness after rest
Joint tenderness/derangement

Question 16

Rx for OA

Answer 16

Exercise, wt loss if overweight
Regular paracetamol +/- topical NSAIDs
Codeine, short term oral NSAID +PPI
Intra-articular hyaluronic acid injfections
Physio/OT
Heat/cold packs at site of pain/walking aids

Question 17

Inv for Septic arthritis

Answer 17

Urgent joint aspiration for synovial fluid microscopy + culture
X-ray (may be normal)
CRP (may be normal)
Blood culture to guide ABx

Question 18

Rx of Septic arthritis

Answer 18

Empirical IV Abx after aspiration
Follow local guidelines for ABx choice
Flucloxacillin 1g/6h
Vancomycin if MRSA
Cefotaxime (gonococcal or Gram -ve)
Ortho for arthrocentesis, lavage and debridement

Question 19

Presentation of rheumatoid arthritis

Answer 19

Symmetrical deforming peripheral polyarthritis, swollen painful and stiff small joints of hands and feet – worse in morning
HLADR4/DR1 linked
Increased incidence in females + smokers

Question 20

Less common presentation of RA

Answer 20

Widespread sudden onset of arthritis
Recurring mono/polyarthritis of various joints
Systemic illness with extra-articular symptoms

Question 21

Signs of RA

Answer 21

Early
- swollen MCP, PIP, wrist or MTP joints (symmetrical)
- tenosynovitis or bursitis
Late
- joint damage + deformity
- boutonniere and swan-neck deformities of fingers
Extra-articular
- vasculitis, lymphadenopathy, fibrosing alveolitis
- pleural + pericardial effusion
- Raynauds
- carpal tunnel syndrome
- splenomegaly, episcleritis, scleritis

Question 22

INV for RA

Answer 22

Rheumatoid factor
Anticyclic citrullinated peptide bodies (ACPA / Anti-CCP)
Inc ESR
Inc CRP
Inc Platelets
X-ray: bony erosions, subluxation, carpal destruction
US + MRI: synovitis

Question 23

Rx for RA

Answer 23

Refer early to rheumatologist
DAS28 to measure disease activity (reduce score to <3)
DMARDs early use w/ biological agents
Steroids (methylprednisolone)
NSAIDs (paracet + codeine ineffective)
Atherosclerosis accelerate in RA thus manage risk factors + smoking

Question 24

Criteria for diagnosing RA

Answer 24

Joint involvement
Serology
Acute phase reactants
Duration of symptoms

Question 25

Biological agents and NICE guidance shows 4 approaches

Answer 25

TNFA-alpha inhibitors
B cell depletion
IL-1 and IL6 inhibition
Disruption of T-cell function

Question 26

How does gout present

Answer 26

severe acute monoarthropathy of the metatarsophalangeal joint of the big toe
polyarticular including: ankle, foot, small joints of hand, wrist elbow knee

Question 27

DD of gout

Answer 27

Haemarthrosis, cppd, palindromic RA

Question 28

Causes of gout

Answer 28

Inc dietary purines
Alcohol excess
Diuretics
Leukaemia
Cytotoxics

Question 29

Inv for gout

Answer 29

Polarised light microscopy of synovial fluid = urate crystals
Serum urate
X-rays: soft tissue swelling

Question 30

Rx for gout

Answer 30

NSAID or coxib
Colchicine
Steroids
Rest and elevate affected joint
Allopurinol to decrease attacks, inc dose every 2w, admin 3w after 1st attack
Febuxostat
Uricosuric durgs