final tutorial Flashcards
Septic
septic arthritis - one joint
gout -
Management of acute gout
NSAID - naproxen
Hx of alcohol disease, CVD, renal failure, peptic ulcer disease or if 65
If no NSAID possible
Colcichine - SE = diarrhoea, so don’t give elderly patient,
Steroids
What do you give for prevention of gout?
Allopurinol - xanthine oxidase inhibitor - give lifelong, but can trigger an attack of gout so give 3 months of colchicine
RA management - name four drugs. When would you use biologics>
Methotrexate - use double contraception
Sulfasalazine - reduces sperm count
Leflunamide
Hydroxychloroquine
If 2 of these don’t work over 6 months, consider a biologic add on and then reduce
What is azathioprine? What is it used for?
Azathioprine - steroid sparing agent - lupus and connective tissue diseases
Management of osteoporosis, side effects and how to use
Alendronic acid - SE - oesphageal/GI ulcers or GORD
Or give zolendronate infusion
Granulomatosis polyangiitis
Wegener’s
Middle aged/elederly men
Upper respitatory tract
Sinusitis
Saddle shaped nose
Lower respitaroty tract
CXR - pulmonary nodules
pulmonary haemorrahge
Granulomatosis polyangitis antibody
c-ANCA, proteinase 3
Churgs strause - MYPO - myeloperoxindase - p ANCA
HLA B27 features
Crohns, IBD, enthesitis, uveitis, dactylitis, psoriasis,
Most common organism for reactive arthritis
Chlamydia
When you would suspect gonorrhoea
Rash on hands and feet
Investigation work up for reactive arthritis picture
ESR/CRP
Serology RF, CCP, ANA
Urate level to exlude gout
Refer to GUM
Aspirate joint
Management of reactive arthritis
NSAIDs, rest, splinting
Steroid injection
DMARDs if more than 3 months
When does ESR go up?
ESR - infection, inflammation, malignancy, anaemia, renal failure, pregnancy
Ca - 2.84
High calcium, high ESR up, what might you see on x ray of spine
Vertebral compression fracture
Differentials for vertebral fracture
Multiple myeloma - send of bloods for electrophoresis, urine for
when do you give hydroxychloroquine
hydroxylchol - for connectiv tissue disaees
what do you give to treat ankylospondylitis
NSAIDs, if they don’t work, give biologics - anti-TNF, or anti-IL17 - secucinumab
give an example of anti-TNF
infliximab = anti-TNF
What is arthralgia
Pain and stiffness without swelling
First line drug for SLE
Hydroxychloroquine
Three key tests for SLE
dsDNA
ESR
c3/c4
What are the symptoms of SLE in mild, moderate and severe disease?
mild - rash, arthritis, lymphadenopathy
moderate - pleurisy, pericarditis, cytopenias
severe - CNS lupus, glomerulonephritis
SLE antibodies
Always ANA positive
Anti-SM specific for SLE
Ro antibody - pregnancy consequence
2 percent risk of neonatal heart block
Tx of SLE
Hydroxychloroquine for skin/joints
Prednisolone - for flares
Azathioprine - for long term
Mycophenolate
Rituximabl/cyclphosphamide for worse diseaes
how do you diagnose psoriatic arthritis
Psoriasis - not symmetrical
Dactylitis
Nail oncholysis
How much prednisolone do you give for steroids?
visual disturbance - give 60mg
no visual disturbance - give 40mg
GCA - large vessel vasculitis, systemic unwellness, fever, malaise, fatigue, myalgias etc
Over 50s,
Rare in asians, more in caucasians
associated PMR
Temporal artery biopsy
US temporal
CT PET scan to screen for other parts of the body
always do dexa scan and bisphonate alongside steroids
weight gain
cetnarl obesity
htn
diabetes
cataracts
poor wound healing
bruising
thin skin
weight gain
cetnarl obesity
htn
diabetes
cataracts
poor wound healing
bruising
thin skin
Which antibody should you never give with methotrexate and why?
Trimethorprim - never give with methotrexate as it depletes folate levels and causes a pancytopenia
Chest xray - to exlude pulmonary fibrosis, interstitutional pneumonitis
What symptoms does sacroiliitis cause
sacral
pain and stiffness
no numbness in leg, impingement etc
