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Phase 2a > MSK > Flashcards

MSK Flashcards

1
Q

pattern of starting joint pain in osteoarthritis?

A

starts at base of thumb and usually not symetrical

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2
Q

predisposition to osteomyelitis?

A

DM
peripheral vascular disease

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3
Q

routes of OM?

A

direct inoculation (open wound) - trauma or surgery - anything microbe
contiguous spread - constant surrounding infection in tissues for long time (prosthetic joint + diabetes) - easy access to bones
haematogenous seeding - via blood stream

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4
Q

epidemology of haematogenous seeding osteomylitis?

A

in metaphysis of long bones in children
spinal vertebra in adults due to high blood supply
IV drug users
users of dialysis
sickle cells

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5
Q

bacteria in sickle cells patients with osteomylitis?

A

salmonella

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6
Q

ix for osteomylitis?

A

MRI is more specific for acute
XR can work for chronic
bone biopsy (open is better then needle)
blood cultures
FBC - raised CRP/ ESP

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7
Q

tx for septic arthritis?

A

staph aureus - flucloxacillin
analgiasia
prednisolone (from long term steroid use) - double dose if they have infections
splinting
joint wash out

1 septic joint

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8
Q

cp for gonococcal artheritis?

A

polyarticular infections
skin lesions

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9
Q

genetic predispo for osteoarthritis?

A

COL2A1

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10
Q

genetic predispo for RA?

A

HLA DR1 + HLA DR4

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11
Q

ENVIROMENTAL RF FOR RA?

A

smoking and preivous infection

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12
Q

pathophysiology for RA?

A

citrullination
arginine (found in T2 collagen and vimentin)
converted to citruline
HLA DR1/DR4 causes immune system to not recognise citrulline
relase t cells and plasma cells to cause inflammation in joints - synovial cells proliferation

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13
Q

pannus?

A

thick inflammaotry tissue build up in synovial joints - filled with fibroblast, myofibroblasts and inflammatory cells

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14
Q

important antibodies in RA?

A

Rheumatic factor
anti CCP

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15
Q

cp of RA?

A

SYMmetrical
common MCP, PIP of hands
MTP of feet - progresses to large joints
worse in mornings or after period of no movement
ulnar deviation of fingers
buttonhole fingers - flextion of pip
swan neck deformatiy - flexion of dip
bakers in back of knee

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16
Q

felty syndrome

A

triad of RA, splenomegaly, granocytopenia = life threatenting infections

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17
Q

scoring system for RA?

A

DAS28
no of swollen joints
no tender joints
measure CRP

> 5.1 high activty
<2.6 remission

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18
Q

biologic therpy for RA?

A

ANTI tnf ALPHA therapy

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19
Q

surgical options for RA?

A

synovectomy
joint fusion if very severe in wrist

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20
Q

xray with RA?

A

LESS
loss of joint space
eorsion of bone
soft tissue swelling
soft bones

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21
Q

tx for staph aureus osteomylitis?

A

fusidic acid + vancomysin

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22
Q

how to ix for tb osteomylitis?

A

bm biopsy with caseating granuloma +

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23
Q

abx for gonnorhea infection?

A

azithromycin and ceftriaxone

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24
Q

symptoms of bone tumours?

A

lumps
pressure on nerves
tendons - snapping
joints - limitations of movement
pain - NIGHT /rest
fracture - pathological
b symtpoms - weight loss + fatigue

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25
Q

ix for primary bone tumour ?

A

FBC - raised WCC + ALP
ESR + CRP
1 ST LINE - xray -
2nd line CT or MRI (chest, abdo, pelvis)
definitive -> biopsy - percutaneous

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26
Q

MSTS, enneking?

A

bone tumour staging
grade (g) - low grade G1+ high grade G2
tumour - T1 intracompartmental + extracimpartmental T2
m - M0 none metastasis or M1 metastasis

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27
Q

tx for osteochondroma?

A

excision

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28
Q

xray for osteochondroma?

A

codman’s triangle and a sunburst appearance.

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29
Q

most common bone tumour?

A

mulitple myeloma

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30
Q

secondary bone cancers that cause osteolysis?

A

breast and lung

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31
Q

cp of multible myeloma?

A

pain in ribs/ spine
fatigue

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32
Q

tests for multible myeloma?

A

serum protein elextrophoresis - diagnostic
urine sample - bence jones
biopsy - monoclonal plasma cells
rouleaux in blood film - paraproteinaemia
MRI

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33
Q

tx for multiple myeloma?

A

chemotherapy, stem cell transplant, ,dexamethosone

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34
Q

ix for secondary bone tumour

A

mri, ct , bloods, x rays

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35
Q

bisphosphonate ?

A

osteoclast inhibitors - general bone pain in cancer

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36
Q

lesions shown on xray in chrondo sarcoma?

A

moutheaten pattern of bone destruction

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37
Q

xray of ewings sarcoma?

A

onion like layers in long bones
ewww onions

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38
Q

mnemonic for sx of reactive arthritis?

A

cant pee, cant see, cant climb a tree, brown discoloration - keratoderma
urethritis/ balanitis, uveitis, arthritis

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39
Q

CP of enteropathic arthritis?

A

assymetric joint
large joints and peripheral joints
peripheral joint inflammation will go down with treatment of IBD
SPINEACHE

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40
Q

ANTIBODY TEST that is sensitive but not specific to SLE?

A

anti nuclear antibodies (ANA) anti dsDNA is specific

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41
Q

ESR and CRP in SLE ?

A

raised ESR and normal CRP

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42
Q

mutation in marfans syndrome?

A

chromosome 15 mutation on FBN 1 - fibrillin is less abdundant or dysfunctional - less tisue elasticty - effect all body
AUTOSOMAL dominant

excessive tgfbeta - more growth

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43
Q

what are features of marfans body habitus ?

A

tall and thin
Arachnodactyly - long fingers
pigeon breast
aortic complication - abnormal root dilation, AAA
downward slant to eyes
stretch marks

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44
Q

eyes and marfans syndrome?

A

retinol distachment
dislocation of lens upwards

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45
Q

tx for slow aortic dilation in marfans syndrome ?

A

beta blockers
losartan - reduces TGF beta presentation

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46
Q

ehlers danlos syndrome?

A

autosomal dominant effecting collagen of tissues

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47
Q

CP of ED syndrome?

A

hypermobility
stretchy skin
cardiac issues - AAA, mitral regurgitation
weak valves and weak vessels

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48
Q

complication of vasculitis?

A

increase blood coagulation by exposure of collagen and tissue factor - clots + organ ischeamia
wall vessle get weakened - aneurysms
thicker vessle wall with fibrin - reducing diameter of lumen

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49
Q

general symptoms of vasculitis?

A

generlaised symtpoms of inflammation - fever, weight loss, fatigue

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50
Q

GCA? epidemology ?

A

older and women
giant cell arteritis- form of large vessle vasculitis
effect carotid arteries

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51
Q

symptoms of GCA?

A

visual problems- blindless
headaches
pain when chewing food
high ESR

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52
Q

takaysu vs GCA ?

A

T- asian women under 40 yrs - weakened pulse in an arm or leg - more pain in arms and legs
but very similar to GCA

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53
Q

kawasaki disease?

A

med size vasculitis of cornary arteries

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54
Q

polyarteritis nodosa?

A

med size vasculitis
confused to hep B infection
necrosis and fibrosis of vascular walls - aneurysms
string of beads on vascular wall

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55
Q

symptoms of PN?

A

polyarteritis nodosa
abdominal pain - mesentaric ischeamia
htn
nuerological symptoms
skin lesions
prerenal AKI

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56
Q

buergers disease?
epidemology ? rf?

A

small and med vessel vasculitis
clots of fingers and toes - ulcers
men 20- 40 years
smoking!

NOT bergers disease - IgA nephropathy
nephritic syndrome

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57
Q

antibody in small vessel vasculitis?

A

ANCA
antinuetrophilic cytoplasmic antibodies

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58
Q

GPA? antibodies?

A

WEGENERS DISEASE
granulomatosis with polyangitis GPA
release of cANCA
CAUSE GLOMERULONEPHRITIS

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59
Q

EPIDEMOLOGY of GPA? SYmptoms?

A

middle aged men
bloody mucus -ulcers
saddle shaped nose
breathing difficulty
low urine output and htn

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60
Q

microscopic polyangitis vs GPA?

A

MP- doesnt effect nose - no saddle shape
no granuloma
no cANCA - pANCA INSTEAD!

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61
Q

CHURG STRAUSS SYNDROME? effects where is body ? antibodies? RF?

A

EGPA- similar to gpa
causes gi, skin, nerve + heart damage in addition to GPA
asthma is RF
p anca

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62
Q

antibodies in henloch schonlein?

A

IgA antibodies

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63
Q

symptoms of HS PURPURA?

A

PURPURA- palpable red discoloration on skin
abdo pain
heamaturia and IGA nephropathy

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64
Q

TX FOR vasculitis?

A

corticosteroids - prednisone
PPI for protection from long use
ace inhibitors for htn

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65
Q

ix for GCA?

A

raised esr
arterial biopsy - patchy lesion of granuloma

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66
Q

ix for PN?

A

ct angiogram - anal bead arteries
biopsy kidneys - necrosing vasculitis

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67
Q

What is the most common vasculitis in childhood?

A

hsp - Henoch-Schonlein purpura (HSP)

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68
Q

pathophysiology of osteoartehritis?

A

chorndocytes try to repair injury - catabolic are overpowered - lots of inflammation - degrades t2 cartilage - new bone formation (T1 CARTILAGE ) (osteophytes) and ligaments become weak

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69
Q

stages of asteoarthritis?

A

1 - 10% cartilagous loss
2 - osteophytes devlop - joint space narrowin
3 - gaps in cartilage
4 -

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70
Q

rf of osteoarthritis?

A

age over 50+ more common in women - after menopause
genetic - polyarticular
athletes
manuel labour
obesity - low grade inflammation
afrocarribean and asian uncommon for osteoarthritis in hip
LOCAL TRAUMA

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71
Q

signs of OA?

A

boney swelling
synovitis - erosive OA similar to RA
CREPITUS
tenderness
limited rom
RF and anti ccp negative

72
Q

indications for arthroplasty?

A

uncontrolled pain at night
signifcant reduced ROM

73
Q

why gout unusal in young women?

A

estrogen increases uric acid secretion

74
Q

uric acid where is it from?

A

diet
turnover of dna/ rna

75
Q

diet with purine?

A

alcohol - beer - cider is lower purine
offal - kidney, liver
shellfish
red meat
fructose

76
Q

medications that decrease uric acid excretion?

A

ketones
lactate
diuretics
aspiriin 75mg

77
Q

acute gout symptoms?

A

monoarthritis
1st MTPJ classical - podagra
low grade fever
nocturnal symptoms
malaise

78
Q

ix for gout?

A

joint aspiration and light microscopy - see crystals
serum uric acid decreases in acute gout - can appear normal
xrays normal in acute
gout and infection at same time

79
Q

tx for acute gout?

A

prednisolone
NSAIDS - COX2 INHIBITORS
colchicine
hydrated
ice
rest

80
Q

prevent hyperureacemia ?

A

dietary modification - alcohol reduction, loose weight, reduce purine foods

81
Q

urate lowering therapy

A

allopurinol
febuxostate 2nd line
colchicine - to prevent flare ups

82
Q

what proportion of women over 50 get fracture from osteoporsis?

A

50%

83
Q

what is a t score?

A

standard deviation compared to young adults bone density

84
Q

two proprtion of bone other than BMD which contribute to bone strength?

A

bone size
bone turnover
mineralisation

85
Q

commondrugs for osteoporosis?

A

bisphophinates

86
Q

osteoporosis ?

A

decreased bone density t<2.5
not mineralisation
fracture is end product

87
Q

complication of osteoporosis?

A

hip fracture
multible spinal fractures - vertbral compression fracture
wrist fractures

88
Q

what proportion of men over 50 will have a fracture due to osteoporosis?

A

20%

89
Q

rf for osteoporosis?

A

steroids
hyperthyroid/ hyperparathyroid
aalcohol and smoking
t hin low bmi
testerone decrease
e early menopause - low estrogen
renal failure/ liver failure
erosive inflmmation disease - RA, CROHNS
DMT1 malabsorption

90
Q

colle fracture

A

wrist fractures- women 60 years better reflexes

91
Q

resorption signalling? cells?

A

load on bone
microfractures from walking
osteoclasts break it down to get repaired

92
Q

low estrogen on bone?

A

more bone is resorbed by osteoclasts but not osteoblasts cant keep up and replace it - less bone density

93
Q

DEXA pros?

A

low dose radiation - can be done on children

94
Q

denosumab?

A

anti reabsorptive medication for osteoporosis
stop rank ligand from getting rank receptor
shuts off bone reabsorption

95
Q

teriparatide?

A

anabolic tx for osteoporosis
increase bone formation
expensive!!

96
Q

3 triad symptoms of sjogrens syndrome?

A

dry eyes
dry mouth
arthritis

palaple purpura

97
Q

epidemology of sjogrens syndrome?

A

f>m
40 - 50 yrs old

98
Q

primary sjorgrens synrome?

A

not associated with other conditions

99
Q

complication from sjorgens syndrome?

A

conjuctivits and blepharitis - staph infection
high incidence of dental caries
40 fold increased risk of non hodgkins lymphoma

100
Q

ix and antibodies associated with sjorgens syndrome?

A

anti - RO
anti - LA
positive RF and ANA

salivary gland biopsy - inflammation due to lymphocytic infiltration

keratoconjunctivitis sicca - dry eyes
schrimer test - tears travelling less than 10 mm

101
Q

tx for sjorgrens syndrome/

A

SYMTPOMS RELIEF
- articial tears, saliva and lubrication
some steroids

102
Q

Pain in the 1st carpo- metacarpal joints is typical of ?

A

osteoartritis

103
Q

extra articular features of RA?

A

Subcutaneous nodules
Episcleritis
Peripheral sensory neuropathy
Pericardial effusion

104
Q

periarticular erosions vs scleroissi?

A

erosions - breaking down = RA
sclerosis - hardening

105
Q

ehler danos syndrome autoimmune or inherited disease?

A

inherited

106
Q

platelet count in SLE?

A

thrombocytopeania
low platelet count

107
Q

tx for SLE ?

A

antimalarials particularly hydroxychloroquine), sulfasalazine and methotrexate.

108
Q

A 64 year old woman with type 2 diabetes mellitus has been struggling with
cellulitis of her right forefoot for 4 weeks. After making no progress with oral
antibiotics, she has now had 14 days of intravenous flucloxacillin and
co-amoxiclavulanic acid but the pain and erythema persist and her CRP has
only fallen to 47 from its peak of 91. What is the next most appropriate
investigation?

A

x ray of right foot = osteopenia
osteomylacia

109
Q

Which of the following is the most frequent infecting
organism after hip replacement?

A

coagulase negative staph
s. epidermis
staph. saprophiticus

110
Q

A 37 year old man with a 10 year history of back pain presents with a “flare”
of symptoms – pain in his lower back radiating out over his buttocks and
down the back of his thighs, and pain between the shoulder blades. Ibuprofen
has been helping significantly. He finds it very difficult to get moving in the
mornings.
Which of the following features would support a diagnosis of inflammatory
back pain?

A

Pain across the
costochondral joints

111
Q

consequences of falls in old people?

A

fracture
pain
loss of independace
pneumonia
death
hospitalisation

112
Q

3 phases of pagets disease?

A

Phase 1 - lytic phase
Osteoclasts which have up to 100 nuclei aggressively demineralise the bone (x20 more than normal).
Phase 2 - mixed phase (lytic and blastic)
Blastic phase - rapid, disorganised proliferation of new bone tissue by a large number of osteoblasts. Collagen deposited in a haphazard way.
Phase 3 - sclerotic phase
New bone formation exceeds bone resorption. The bone is structurally disorganised and weak.
Osteoblastic activity slows down leading to dormant phase - ‘burned out state’

113
Q

cp of pagets disease

A
  • Pain - due to bone impinging on nerves
    Growth of bones in skull can cause:
  • Leontiasis - lion like face
  • Hearing loss - narrow auditory foramen and impinge on auditor nerve
  • Vision loss - bony overgrowth impinges on optic nerve
  • Kyphosis - curved spine
  • Lower limb muscle weakness - due to compression of spinal cord
  • Pelvic asymmetry
  • Bone enlargement - particularly pelvis, lumbar spine, skull, femur and tibia
  • Bowlegs - if tibia and femur becomes too weak to support weight
114
Q

tx for paagets disease?

A

Pain relief
- NSAIDs
Anti-resorptive medication - Biphosphonates e.g. alendronic acid
- Along with calcium and vit D supplementation
- Surgery -
Correct bone deformities
Decompress impinged nerve
Decrease fracture risk

115
Q

blood markers for pagets disease?

A

ALP - raised
calcium - normal
phosphate - normal/ low
normal - vit d

116
Q

DMARD stands for

A

Disease-modifying antirheumatic drugs

117
Q

cognitive complications of SLE?

A

cerebral lupus- dillusional + unremitting headache

118
Q

ix for APS?

A

lupus anticoagulant
IgG/M + anticardiolipin antibodies
anti b2 glycoprotein antibodies

119
Q

tx for APS? IF pregnant?

A

1st line - wafarin !!
preg: aspriin + low molecular weight heparin
if no thrombosis - aspirin (preventative)

120
Q

main sx for APS

A

CLOTS
c - clots - dvt, pe, stroke,
l -Livedo reticularis - A mottled, lace-like appearance of the skin on the lower limbs
o - obs - reccurent misscarriages
t - thrombocytopenia - low platelet

121
Q

medication for gout pts with CKD?

A

colchicine becuase kidney damage casued by NSAIDS
The NSAID indomethacin is traditionally used first-line. For patients with a high risk of gastro-intestinal side effects, past medical history of chronic kidney disease or heart failure, colchicine may be used.

122
Q

IDE EFFCTS OF BISPHOSPHINATES?

A

oesphageal ulcers
Nausea
dyspepsia
hypocalceamia

123
Q

how is fibromyalgia different from polymyalgia reumatica?

A

PMR - raised ESR/ CRP - MAY HAVE NORMOCYTIC ANAEMIA
fibro - no rasied esr/ crp no serological markers

124
Q

tx for PMR?

A

polymyalgia reumatica -oral prednisolone

125
Q

psuedogout crystals vs gout crystals

A

CPPD crystals - rod or rhomboid and weak positive bifringence
uric acid crystals - needle sahped and stronge negative

126
Q

epidemology of scleroderma?

A

mostly females - middle aged
10-20 per 100,000

127
Q

CREST syndrome ?

A

for scleroderma
C - calcinosis
R - Reynauds
E- oesphageal dismobilty - GORD
S - skin sclerodactyly bright shiny skin of hands and feet consistent with sclerodactyl no prayer sign
T- Telangiectasia.- spider vessels near skin

128
Q

ix for scleroderma?

A

normal CRP raised ESR
Anti-centromere antibodies (ACA) more associated with limited sclerosis

Anri-Scl-70, anti-topoisomerase and anti RNA polymerase III is most associated with diffuse systemic sclerosis

clinical diagnosis

129
Q

antibodies in dermatomytosis and polymyotiss?

A

anti JO1 antibodies
anti Mi2 antibodies - only derma

130
Q

gottrons papules?

A

DERMATOMYOSITIS
scaly erythematous plaques over PIP/DIP joints
shawl distrubtion of rashes

131
Q

BLOOD ix for polymyositis?

A

CK raised + LDH
anti JO1 antibodies

132
Q

role of chief cells?

A

secretes pepsin

133
Q

rickets vs osteomalacia?

A

defective bone mineralisation before ephysieal plate = rickets
after = osteomalacia

134
Q

ix for polymyalgi rhuematica vs GCA?

A

both raised ESR, clinical features and steroid response
GCA - temporal arterial biopsy (necrosis of media and fragmentation of lamina) with ulstrasound guiding
normochronic anaemia

135
Q

If a patient over 60 develops new onset diabetes mellitus along with weightloss, what diagnosis should you consider?

A

pancreatic cancer

136
Q

sx for polymyalgia rheumatica?

A

fatigue
bilateral stiffness and pain in shoulder and pelvic girdle
night sweats
weakness + waisting is absent

137
Q

conditions that mimic polymyalgia rheumatica?

A

fibromyalgia - no inflammaotry markers or anything abnormal on bloods
hypothyroidism
RA - presence of anti CCP and RF
body myositis -raised CK abnormal muscle biopsy

138
Q

kawasaki vs takayasus disease?

A

kawasaki - vasculitis of coronary arteries
takayasu - granulomatous inflammation of the aorta, branches, abdominal aorta, pulomnary artery

139
Q

medication rf for gout ?

A

furosimide - loop diuretic - inhibits sodium reabsoprtion
aspirin - nsaids

140
Q

side effects of corticosteroids?

A

glaucoma
weight gain
hypertension
insomnia
bone denisty loss

141
Q

causes of osteomalacia ?

A

vit D defiency - gi malabsorption
hyper pth - too much Ca+ released from bone
Renal failure - no vit D synthesis (25hydroxyvit d -> 1,25 dihydroxyvit d)
liver failure cholecalciferol - 25 hydroxy vit D

142
Q

VIT D pathway?

A

VITAmin d3 (cholecalciferol) - > 25 hydroxy vit D - > kidneys - > 1,25 dihydroxyvit d (ACTIVE)

143
Q

diagnostic ix for osteomalacia ?

A

bone biopsy
hypocalcaemia
high pth
serum calcium
LOW 25 HYDROXY VIT d
LOOSER ZONES ON XR bones

144
Q

tx for osteomalacia?

A

vit D REPLACEMENT - calcitriol
d3 tablets
egg

145
Q

young man painless heamaturia and flank pain , high BP- physical examination is normal

A

PKD

146
Q

A 60-year-old man presents to his GP with blood in his stools. He has also been experiencing fatigue and
reports unintentional weight loss of a stone over the past month. The GP requests some blood tests,
obtaining the following results:
Hb 120 g/L (130-180)
WCC 14.9 x109
/L (3.6-11.0)
MCV 69 fL (80-100)
Ferritin 18 ng/mL (25-350)

A

iron defiency anaemia caused by colorectal cancer

147
Q

mechanism of methotrexate?

A

competetive inhibitor of DHFR essential for purine synthesis

148
Q

why folic acid with methotrexate ? can they given at same time?

A

Folic acid is required in the synthesis of thymidylate (a pyrimidine) and of purine nucleotides
and thus for DNA synthesis.
Giving the folic
acid on the same day as the Methotrexate would reduce the effectiveness of the Methotrexate

149
Q

GCA tx ?

A

IV Predisolone + pain management + PPI alongside steroids

150
Q

complication of steroid therapy ?

A

higher dose more side effects
ulcer
adrenal crisis
hyperglyceamia
diabetes
cushing syndrome
weight gain
osteoporosis
cataracts
thinning of skin
hypertension

151
Q

medication for prevention of gout?

A

Alopurinol, febuxostat

152
Q

dexa with osteopenia/?

A

-1.6 t score

153
Q

t score of osteoporos ?

A

t scor of -2.5 or below

154
Q

RAPD IN RIGHT EYE sign?

A

A relative afferent pupillary defect is when the affected and normal eye appears to dilate when light is shone on the affected eye

155
Q

4th nerve palsy symptoms?

A

eye deviated up and out
vertical diplopia

156
Q

Ipsilateral oculomotor palsy and contralateral weakness of the upper and lower extremity, where is the stroke?

A

posterior cerebral artery

157
Q

CP OF jia?

A

pain all over body
salmon pink rash
large lymph nodes
spenomegalyitis
uveitis!

158
Q

IX of JIA?

A

FBC - raised CRP, ESR, ferritin,
no RF and ANA in Stills disease
ANA in oligoarthritis

159
Q

ix of ehler danlos ?

A

beighton score
hyperextions of joints
easy bruising
abdo pain
gord
Prolapse

160
Q

organ problems in diffuse scleroderma?

A

cv - coronary artery disease, myocardial fibrosis
lung - pulmonary htn , pulmonary fibrosis (restrictive)
kidneys glomerulonephritis

161
Q

tx for scleroderma?

A

> Avoid cold triggers - Raynaud’s
Gentle skin stretching - maintain range of motion
Physiotherapy - maintain healthy joints
Occupational therapy - adaptations to daily living to cope with limitations

> Nifedipine (CCB) - Raynaud’s as it can cause vasodilation
Lansoprazole (PPI) - GI symptoms
Analgesia - joint pain
Ramipril (ACE-inhibitor) - hypertension

162
Q

antibodies in dermatomyositis?

A

anti JO 1
ANA
anti MI 2

163
Q

sx for dermatomyositis ?

A

symmetrical proximal weakness
shawl SIGN - shoulder, neck
v sign - chest and front of neck
rash
difficulties sitting up from chair and walking up stairs
muscle aches and pains
dysphagia - swallowing issues
skin - heliotrope rash - butterfly flash
Malor rash
gottron papules ON KNUCKLES! - PATHONUEMONIC FOR DERMATOMYOSITIS

164
Q

ix for dermatomyositis?

A

CK raised - equivalent to muscle necrosis
ANA
anti JO 1
anti NI 2
ALT/ AST raised
emg - fibrillation
muscle biopsy - inflammation and fibrosis

165
Q

stages of pagets disease?

A

lytic - excessive osteoclast resorption of bone
mixed - excessive resorption and idsorganised bone formation
blastic - excess osteoblast laying down disorganised bone formation

166
Q

ALP, CALCIUM and phosphate in pagets disease?

A

ALP high
calcium and phosphate normal

167
Q

tx of GCA visual symptoms?

A

iv methylpredisolone

168
Q

antibodies specific and senstive to SLE?

A

SPECIFIC - ds DNA
sensitive - ANA

169
Q

blotching pattern on skin in antiphospholipid syndrome

A

livido reticularis

170
Q

antibodies in antiphospholipid syndrome

A

anti cardiolipin antibody
anti beta 2 GP 1
LUPUS ANTICOAGULANT

171
Q

anti cardiolipin antibody positive for?

A

syphilis
antiphospholipid syndrome

172
Q

ankle vs knee jerk reflex level at spine?

A

ankle - S1
Knee - l2,3,4

173
Q

extra articular manifestations of RA?

A

Lung - pleuritis
heart - CHF
skin - ulcers and nodules (splinter haem)
GI - ischeamic bowel
Renal - glomerulonephritis
eyes - uveitis

174
Q

Most common cause of chest pain in adults

A

Costochondritis

175
Q

Symptoms of costochondritis

A

Worse on inhalation
Sharp chest pain
Pain on palpation
Pain on upper body excercise
Rule out serious chest pain causes !!

Phase 2a (9 decks)

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