investigations and treatment

Question 1

Treatment for Paget’s disease

Answer 1

Biphosphonates

Question 2

Treatment for pseudogout

Answer 2

NSAIDs/painkiller

Question 3

How to differentiate between gout and pseudogout

Answer 3

Pseudogout = positively birefringent crystals + chondrocalcinosis

Gout = negatively birefringent crystals

Question 4

Triad of reactive arthritis

Answer 4

Urethritis
Arthritis
Conjunctivitis

Question 5

First line for acute gout

Answer 5

Colchicine / NSAIDs (be careful for duodenal ulcers or anything contraindicated with NSAIDs tho)

Question 6

Investigation for gout

Answer 6

Synovial fluid analysis = negatively birefringent crystals

Uric acid = checked once acute episode has settled (2 weeks later)

X-ray = joint effusion, ‘punched out’ erosions

Question 7

Why should you check testosterone in a man with clinical suspicion of osteoporosis

Answer 7

Hypogonadism is a cause of osteoporosis in men

Question 8

First line investigation for osteoporosis

Answer 8

Blood cell , CRP, calcium

TFTs, DEXA

Then more depending on underlying cause ie serum testosterone

Question 9

Antibody investigation for Rheumatoid arthritis

Answer 9

Anti-ccp

Question 10

What other investigation detect for rheumatoid arthritis

Answer 10

Rose-Waaler test = sheep red cell agglutination
Latex agglutination test

Also Rheumatoid factor - but not very specific

Question 11

*pain/tenderness on radial side of wrist over the radial styloid process

Answer 11

De Quervain’s tenosynovitis

Question 12

Management of De Quervain’s tenosynovitis

Answer 12

Analgesia
Steroid injection
Immobilisation
Sometimes surgery is required

Question 13

Test for De Quervain’s tenosynovitis

Answer 13

Finklestein’s

(Pull the thumb in ulnar deviation and longitudinal traction = pain > + test)

Question 14

What are the causes of gout - DART

Answer 14

D - DIURETICS
A - ALCOHOL
R - RENAL DISEASE
T - TRAUMA

Question 15

What disease is commonly associated with adhesive capsulises (frozen shoulder)

Answer 15

T2DM

Question 16

Management of adhesive capsulitis / frozen shoulder

Answer 16

No single intervention has shown to improve outcome in the long term

= NSAIDs, physio, oral corticosteroids etc

Question 17

Which drug can cause ‘bull’s eye maculopathy’

Answer 17

Hydroxychloroquine

Can cause ocular toxicity - damage is irreversible

Question 18

‘Hill-Sachs’ lesion

Answer 18

Glenohumeral discloation

Question 19

*prominent clavicle and loss of shoulder contour

Answer 19

Acromioclavicular dislocation

Question 20

What drugs cause agranulocytosis

Answer 20

Allopurinol
Azathioprine
Methotrexate
Carbimazole

Question 21

When should a second drug be added in T2DM

Answer 21

If the HbA1c > 58mmol/mol

Question 22

Management of Addisonian crisis / acute adrenal insufficiency

Answer 22

Hydrocortisone 100mg IV = 1st

1L normal saline infused over 30-60 minutes or with dextrose

Question 23

Investigation for Graves

Answer 23

Anti-TSH

Question 24

What is the test for diabetes insipidus

Answer 24

Water deprivation test

Question 25

What does cranial diabetes looks like on a water deprivation test

Answer 25

Question 26

What is the treatment for diabetes insipidus

Answer 26

Desmopressin

Question 27

What does excess PTH excretion result in

Answer 27

Increased calcium and decreased phosphate

Question 28

Management of a child with persistent glue ear

Answer 28

1st line = grommet insertion

Consider adenoidectomy if child has nasal symptoms

Question 29

Best investigation for ligamentous tears (ie ACL rupture)

Answer 29

MRI