mock questions Flashcards
what cancers metastisise to bone?
Breast, Lung, Thyroid, Kidney, Prostate → bone.
what are the x-ray signs of OA?
LOSS: Loss of joint space, Osteophytes, Subchondral sclerosis and Subchondral cysts.
what is pencil in cup?
describes the image seen in an X ray of arthritis mutilans, a severe form of psoriatic
arthritis
what is reiter’s triad?
conjunctivitis, urethritis and arthritis -reactive arthritis
what are the extra articular manifestations of ankalosing spondylitis?
anterior uveitis, autoimmune bowel disease, apical lung fibrosis, aortic regurgitation, amyloidosis
what is the test done to asses a patients spine mobility?
schober’s test
how is the schober’s test carried out?
Have the patient stand, locate L5 vertebrae, mark a point 10cm above and 5cm below this point. Ask the patient to bend over forwards as far as they can, and measure the distance between the two points. A distance of less than 20cm indicates reduced lumbar movement and will help support a diagnosis of Ank. Spon.
what would be seen on x-ray in ankalosing spondylitis?
Bamboo spine or calcification of all the ligaments of the spine, squaring of the vertebral bodies, subchondral sclerosis, syndesmophytes, ossification, fusion of joints (facet / sacroiliac / costovertebral)
what is given for osteoarthritis?
bisphosphonates, paracetamol, NSAIDs, opioids
what tests can be done for sjorgen’s syndrome?
antinuclear antibodies, anti Ro and anti La antibodies, rheumatoid factor, schirmer’s test
what disease would be cANCA positive?
granulomatosis with polyangitis
what type of arthritis is caused by sjorgen’s syndrome?
inflmmatory, chronic, systemic
how is sjorgen’s syndrome treated?
Artificial tears and saliva, corticosteroids for flare ups methotrexate, azathioprine, cyclophosphamide
what is the gold standard investigation for septic arthritis?
joint aspiration microscopy, culture and sensitivity
what are the signs of ewing’s sarcoma?
lytic bone lesions, onion skin appearance
what would the ESR and CRP blood tests show in active SLE?
raised ESR, normal CRP
what would the blood test be like in paget’s disease of the bone?
ALP = raised calcium = normal phosphate = normal
what blood test is the most sensitive for diagnosing SLE?
anti nuclear antibodies
what are the causes of osteomalacia?
decreased vit D, renal failure, liver disease, inherited
what are the signs of SLE?
Discoid rash, pleuritis, peritonitis, myocarditis, oral / mucosal ulcers, alopecia, lupus nephritis, photosensitivity, anaemia, lymphopenia/leukocytopenia, migraine, seizures, psychosis etc
how is SLE monitored?
ESR
how is SLE treated?
Hydroxychloroquine (+/- NSAIDs +/- corticosteroids)
what is the name for the blotchy skin appearance in antiphospholipid syndrome?
livedo reticularis
what antibodies are present in antiphospholipid syndrome?
Lupus anticoagulant, anti-cardiolipin, anti-beta2 GP1
what disease could antiphospholid syndrome give a false positive result for and why?
syphilis due to anti-cardiolipin antibodies
what age and gender would you expect someone with a new fibromyalgia diagnosis to be?
female, 30-60yrs
what are the red flag symptoms of back pain?
Any symptoms of CES (Bilateral, Leg neuropathy, New urinary or faecal retentions and/or incontinence, Perianal or Perineal Sensory Loss, Poor Anal Tone PR)
Any symptoms of Spinal Fracture (Sudden Onset, High Impact Trauma, Structural Deformity, Point Tenderness Over Vertebral Body)
Any Cancer Red Flags (>50, Gradual Onset of Symptoms, Severe Constant Pain, Weight loss, History of Cancer)
Any Symptoms of Infection (Fever, TB, Diabetes, History of IVDU, HIV Infection, Immunosuppressed)
what puts someone at risk of osteomalacia?
Decreased sun exposure – decreased sun exposure leads to less vit D activation Diet – decreased dietary vit D leads to less vit D available for bone mineralisation
what reflex would be lost if there was a nerve root lesion at S1?
ankle jerk
where are heberden’s nodes found?
DIP joints
where are bouchard’s nodes found?
PIP joints
what is used to treat acute attacks of gout?
Colchicine, NSAIDs, steroids
what are the 3 stages of paget’s disease of the bone?
Lytic: excessive osteoclastic resorption
Mixed: excessive resorption and disorganised bone formation
Blastic: (latent) Osteoblasts lay down excess disorganised weak bone.
how is paget’s disease of bone treated?
bisphosphonates
what is important initial treatment in giant cell temporal arteritis?
prednisolone to stop blindness
what are the diagnostic criteria for temporal arthritis?
> 50yrs
temporal artery abnormality (e.g. Tender, decreased pulsation)
abnormal temporal artery biopsy
elevated ESR (>50mm/hr)
what is a complication of temporal artheritis?
polymyalgia rheumatica
which test is the most specific for diagnosing SLE?
Anti-dsDNA
A 27 year old female presents to your GP clinic complaining of joint pain. She said it
currently affects both her hands and is worse in the morning. Movement of the joints
improves the pain.
Upon examination, there is bilateral tenderness over the right and left wrists and 2 of
the DIP joints in the left hand. She also reveals that occasionally the pain
surrounding the DIP joints is accompanied with swelling and inflammation of the
whole finger, to such an extent that she can no longer wear rings on them.
Psoriatic arthritis is the most likely, due to dactylitis (inflammatory condition associated with spondyloarthropathies) and DIPJ involvement. The patient themselves does not need to have psoriasis, as a 1st degree relative with psoriasis is sufficient for diagnosis.
what is the second line pharmacological treatment for OA?
oral NSAIDs + PPI (to protect stomach)
what is the most common cause of reactive arthritis outside of STIs?
Campylobacter jejuni
what is the most specific antibody for sjorgen’s syndrome?
Anti-La
what is saturday night palsy?
compresses the radial nerve within the groove of the humerus
wrist drop
what would be suggestive of severely osteoporotic?
DEXA scan <2.5 AND a known pathological fracture
give 3 inflammatory causes of joint pain
autoimmune, spondylopathies, infection
give 2 non-inflammatory causes of joint pain
degenerative = OA non-degenerative = fibromyalgia
What is the medical term given to a distal interphalangeal joint swelling in a patient with
Osteoarthritis?
heberden’s nodes
what is the classification system used in fractures involving the epiphyseal plate or growth plate of a bone, commonly found in children?
salter-harris classification
what is the T score on a DEXA scan?
T= Bone density score/standard deviations away from compared to a 25 year-old of the same gender
what is the Z score on a DEXA scan?
Z= bone density compared to the average for their age of the same gender
how does allopurinol work?
Xanthine Oxidase Inhibitor - Xanthine oxidase metabolism xanthine into uric acid - Therefore inhibiting XO lowers plasma uric acid and precipitation of uric acid in joints/kidneys
how is rheumatoid arthritis monitored?
ESR and CRP
what is the life threatening complication of RA?
felty’s syndrome (splenomegly, neutropenia, RA)
what are extra articular manifestations of RA?
Skin: Nodules, vasculitis (ulcers, splinter haemorrhages)
Ocular, Oral: Sjogren’s
Pulmonary: Pleuritis, effusions
Renal: Glomerulonephritis
Neuro: peripheral neuropathy (rare)
Haematology: deranged bloods
Cardiac: atherosclerosis, pericarditis, MI
what are side effects of bisphosphonates?
Oesophagitis, osteonecrosis of jaw, oesophageal ulcers
how are bisphosphonates taken?
Take first thing in the morning (1) on an empty stomach (1), with a
full glass of water (1), stand or sit upright for 30 minutes after taking them (1),
don’t eat for at least 30 minutes before eating food / drinking fluids, for up
to 2 hours.
what are the risk factors for osteoporosis?
S - Steroid (prednisolone) use - others; heparin, PPIs, SSRIs, GnRH
analogues (goserelin)
H - Hyperthyroidism / hypercalciuria / hyperparathyroidism + cushing’s
A - Alcohol and tobacco
T - Thin - BMI <18.5, T1DM
T - Testosterone low → leads to increased bone turnover,
hypogonasism /
Klinefelter’s
E - Early menopause - increased bone turnover, premature ovarian
failure
R - Renal / liver failure
E - Erosive / inflammatory bone disease - RA / Myeloma
D - Dietary calcium low / malabsorption / T1DM
what investigations need to be done when someone has gout symtptoms?
none needed if no other disease is suspected
which bones tend to be affected in paget’s disease of bone?
femur, skull, vertebrea, pelvis
