medicine Flashcards
What are investigations you would want to do in a monoarthritis?
urine dip- look for a UTI
Blood: inflammatory markers, blood cultures (sepsis)
Imagining- unlikely to help
JOINT ASPIRATE- microbiology; crystals
What would you see in gout and pseudo gout under polarizing light microscopy
Monosodium urate crystals (needles and negatively biofringent)
Calcium pyrophosphate (rhomboid and positive biefringent)
What is the name of an acute attack of gout in the first metatarsal joint
What are the extra articular feature of rheumatoid nodules
fatigue
anaemia
nodules
ocular- episcleritis and anterior uvitis
how do you designuish a gout tophz and a rheumatoid nodule
tohpi have little hard things
What is the first line disease modifying drug for rheumatoid arthritis
What are side effects
methotrexate
nausea
anaemia- folate supplemts
livertoxicity
pulmunary fibrosis
How would you check for rheumatoid arthritis
Anti CCP
rheumatoid factor
CRP, ESR
Haematology: nornochromic normocytic anaemia
What predisposes youto osteoarthritis
obesity trauma smoking and family ihstroy
metabolic problems eg diabetes
What is the management of osteoarthritis
physiotherapy, occuptional therapy
weight loss
simple analgesi, topical NSAIDs
surery - hip replacement
dude with diabetes
mildy deranged LFT’s
joint pain
What does he have?
Haemochromatosis
DON’t forget bronzed skin
What is the treatment for haemochromatosis
venesection
GIVE them also IV saline to replace blood
What are investigations for haemachromatosis
ferritin
TIBS
serum iron
if someone presents with a flexoral psoriasis what would you want to do to investigation?
swab to exclude candidiasis
What investigation would you like to do in someone that has arthralgia and psoriasis
Rheumatoid factor (negative)
radiographs (distal interphalangeal joints)
erosions,
periarticular osteoporosis,
pencil-in-cup
deformity (whittling and cupping of the phalanges)
sacroiliitis
