investigations and treatment Flashcards
Treatment for Paget’s disease
Biphosphonates
Treatment for pseudogout
NSAIDs/painkiller
How to differentiate between gout and pseudogout
Pseudogout = positively birefringent crystals + chondrocalcinosis
Gout = negatively birefringent crystals
Triad of reactive arthritis
Urethritis
Arthritis
Conjunctivitis
First line for acute gout
Colchicine / NSAIDs (be careful for duodenal ulcers or anything contraindicated with NSAIDs tho)
Investigation for gout
Synovial fluid analysis = negatively birefringent crystals
Uric acid = checked once acute episode has settled (2 weeks later)
X-ray = joint effusion, ‘punched out’ erosions
Why should you check testosterone in a man with clinical suspicion of osteoporosis
Hypogonadism is a cause of osteoporosis in men
First line investigation for osteoporosis
Blood cell , CRP, calcium
TFTs, DEXA
Then more depending on underlying cause ie serum testosterone
Antibody investigation for Rheumatoid arthritis
Anti-ccp
What other investigation detect for rheumatoid arthritis
Rose-Waaler test = sheep red cell agglutination
Latex agglutination test
Also Rheumatoid factor - but not very specific
*pain/tenderness on radial side of wrist over the radial styloid process
De Quervain’s tenosynovitis
Management of De Quervain’s tenosynovitis
Analgesia
Steroid injection
Immobilisation
Sometimes surgery is required
Test for De Quervain’s tenosynovitis
Finklestein’s
(Pull the thumb in ulnar deviation and longitudinal traction = pain > + test)
What are the causes of gout - DART
D - DIURETICS
A - ALCOHOL
R - RENAL DISEASE
T - TRAUMA
What disease is commonly associated with adhesive capsulises (frozen shoulder)
T2DM
Management of adhesive capsulitis / frozen shoulder
No single intervention has shown to improve outcome in the long term
= NSAIDs, physio, oral corticosteroids etc
Which drug can cause ‘bull’s eye maculopathy’
Hydroxychloroquine
Can cause ocular toxicity - damage is irreversible
‘Hill-Sachs’ lesion
Glenohumeral discloation
*prominent clavicle and loss of shoulder contour
Acromioclavicular dislocation
What drugs cause agranulocytosis
Allopurinol
Azathioprine
Methotrexate
Carbimazole
When should a second drug be added in T2DM
If the HbA1c > 58mmol/mol
Management of Addisonian crisis / acute adrenal insufficiency
Hydrocortisone 100mg IV = 1st
1L normal saline infused over 30-60 minutes or with dextrose
Investigation for Graves
Anti-TSH
What is the test for diabetes insipidus
Water deprivation test
What does cranial diabetes looks like on a water deprivation test
What is the treatment for diabetes insipidus
Desmopressin
What does excess PTH excretion result in
Increased calcium and decreased phosphate
Management of a child with persistent glue ear
1st line = grommet insertion
Consider adenoidectomy if child has nasal symptoms
Best investigation for ligamentous tears (ie ACL rupture)
MRI
