Misc

Question 1

what is Charcot’s arthropathy

Answer 1

progressive condition characterised by joint dislocations, pathologic fractures, and debilitating deformities
usually in diabetes (used to be syphilis)

can occur in any joint but mostly foot/ankle

Question 2

what is included in inflammatory arthritis

Answer 2

seropositive
RA

seronegative
psoriatic
ank spond
reactive
enteropathic

Question 3

what gene are the seronegative inflammatory arthritises associated with

Answer 3

HLA-B27

Question 4

what does antiphospholipid syndrome include

Answer 4

thrombosis and/or recurrent miscarriage

Question 5

what antibodies antiphospholipid syndrome

Answer 5

antiphospholipid

Question 6

rx antiphospholipid syndrome

Answer 6

if had a thrombosis -> warfarin

aspirin, subcut heparin to reduce chance of miscarriage

Question 7

what does the onset tell you about the cause of a hot swollen joint

Answer 7

explosive = gout (hours)
a little bit slower = septic arhtritis
slower again = RA

Question 8

risk factors for gout

Answer 8

CKD

tumour lysis syndrome (occurs when having chemo - pts prophylactically given allopurinol)

Question 9

triggers of gout

Answer 9

dehydration
alcohol binge
surgery
injury

Question 10

what is included in purine rich diet

Answer 10

beer
fizzy drinks
fish
pulses/nuts
meat

Question 11

erosions on xray of gout vs RA

Answer 11

gout = rat bite erosions (erosion away from joint)
RA = periarticular erosions

Question 12

short term drugs for gout

Answer 12

colchicine (kowl-chuch-cine) (SE diarrhoea “run before they can walk” run to toilet for diarrhoea before can walk bc of gout pain
NSAID cannot often give bc CKD
steroid injection

Question 13

class of drug of allopurinol (exam q!)

Answer 13

inhibitor of the enzyme xanthine oxidase

Question 14

crystals in gout vs pseudogout

Answer 14

gout = needle, negatively birefringent
pseudogout = rhomboidal, positively birefringent

Question 15

finding on examination in gout

Answer 15

tophi

Question 16

methotrexate SEs

Answer 16

bad N+V
tired on the day it is taken
macrocytosis
mouth ulcers
rash
hair loss

Question 17

onion skin lesion seen in

Answer 17

intrarenal vessles in patient with scleroderma who has had a renal crisis

Question 18

methotrexate monitoring

Answer 18

FBC (for low WBC/neutrophil/platelets or high MCV)
creatinine/eGFR (can cause renal impairment)
LFTs (can raise liver enzymes)

Question 19

what is coprescribed with methotrexate

Answer 19

folate (to counteract the anti-folate SEs)

Question 20

common complication of scaphoid fracture

Answer 20

avascular necrosis (death of bone tissue due to lack of blood) => gradual joint pain with limited ROM

Question 21

interesting fact about raynaud’s to do with thumb

Answer 21

if it includes the thumb it is more likely secondary to another disease

Question 22

what movement is difficult in OA hip

Answer 22

internal rotation

Question 23

what two drugs to give with steroids

Answer 23

PPI and bone protection e.g. bisphosphonates and calcium?

Question 24

is there uricacidaemia in acute flare of gout

Answer 24

sometimes but it is not usually helpful as all the uric acid is in the joint, not in the blood. more useful to measure in a chronic situation

Question 25

give 6 causes of a positive ANA

Answer 25

SLE
sjogren's
SSc
polymyositis and dermatomyositis
RA
vasculitis

Question 26

in what disease are osteophytes seen

Answer 26

OA! NOT RA!!

Question 27

what is the sail sign at elbow

Answer 27

elevation of the anterior fat pad to create a silhouette similar to a billowing spinnaker sail from a boat =
elbow effusion = likely fracture

Question 28

what medication can cause avascualr necrosis of femoral/humeral head

Answer 28

chemo

Question 29

new back pain in pt with ank spond

Answer 29

FRACTURE UNTIL PROVEN OTHERWISE!!!! don’t just rely on xray -> need CT to prove or disprove