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1
Q

What are the 4 key X-ray findings in osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral stenosis (increased density in bone along joint line)
subchondral cysts (fluid filled holes in bone)

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2
Q

What are the key presentations of osteoarthritis?

A

joint stiffness and pain, worsened with activity

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3
Q

What signs of osteoarthritis may be present on the hands?

A

heberdens nodes (DIPs)
bouchards nodes (PIPs)
squaring at the base of the thumb

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4
Q

What lifestyle factors may help symptoms of osteoporosis?

A

losing weight
physiotherapy

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5
Q

What oral medications can be used to control symptoms of osteoarthritis?

A

paracetamol - 1st line
NSAIDs + PPI - 2nd line

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6
Q

what are the other treatments for osteoarthritis?

A

intra-articular steroid injections
hip/knee replacement

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7
Q

What antibody is present in 70% of patients with RA?

A

rheumatoid factor (RF)

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8
Q

What antibody predates the development of RA and is more specific and sensitive to RA?

A

anti-CCP antibodies

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9
Q

What are the key presentations of RA?

A

symmetrical distal polyarthropathy
joint pain, stiffness and swelling

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10
Q

How does activity effect the pain from RA?

A

it improves it

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11
Q

What is palindromic rheumatism?

A

short episodes of inflammatory arthritis

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12
Q

Which joints are almost never effected in RA but are often effected in osteoarthritis?

A

distal interphalangeal joints

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13
Q

What are the X-ray findings of RA?

A

Loss of bone space
osteopenia
erosion of bone
swelling of soft tissue

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14
Q

What hand deformities are common with RA?

A

Z shaped thumb
swan neck deformity
boutonnieres deformity
ulnar deviation of fingers at the knuckle

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15
Q

What is swan neck deformity?

A

extension of the PIPs and flexion of the DIPs

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16
Q

What is boutonnieres deformity?

A

extension of the DIPs and flexion of the PIPs due to a tear in the central slip of the finger extensors

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17
Q

What are some of the extra-articular manifestations of rheumatoid arthritis?

A

pulmonary fibrosis
bronchiolitis obliterans
feltys syndrome
sjogrens syndrome

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18
Q

What blood tests can be used to diagnose RA?

A

anti-CCP antibodies and RF
ESR/CRP

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19
Q

What are the 4 diagnostic criteria for RA?

A
  1. number/size of joints affected
  2. serology (anti-CCP, RF)
  3. inflammation (CRP/ESR)
  4. duration of symptoms (</>6 weeks)
    score is added up
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20
Q

What score is used to monitor RA and response to treatment?

A

DAS28 score

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21
Q

What combination of medications can be used initially or with flare ups of RA?

A

NSAIDs/Cox-2i + PPIs

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22
Q

what is the 1st line treatments for RA?

A

monotherapy with either:
methotrexate, sulfasalazine or leflunomide

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23
Q

Give an example of an anti-TNF drug used to treat RA

A

infliximab, adalimumab

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24
Q

Give and example of an anti-CD20 drug used to treat RA

A

rituximab

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25
What is the action of methotrexate?
it interferes with folate metabolism and suppresses the immune system
26
What are the side effects of methrotrexate?
mouth ulcers and mucositis liver toxicity damages bone marrow - low WCC teratogenic (harmful in pregnancy)
27
What is the action of leflunomide?
it is an immunosuppressant that effects the production of pyrimidine (DNA synthesis)
28
What are the side effects of leflunomide?
hypertension peripheral neuropathy
29
How does sulfasalazine work?
not clear but seems to effect folate metabolism, is an immunosuppressant and anti-inflammatory
30
What are the side effects of sulfasalazine?
temporary male infertility can be used in pregnancy
31
What is action hydroxychloroquine?
interferes with toll-like receptors - immunosuppressant
32
What are the side effects of hydroxycholorquine?
nightmares reduced visual acuity
33
What is tumour necrosis factor (TNF)?
a cytokine involved in inflammation
34
What are some of the side effects of anti-TNF drugs?
vulnerability to sepsis and infection reactivation of TB or hep B
35
What are the main side effects of rituximab?
night sweats thrombocytopenia
36
What is the action of rituximab?
monoclonal antibody against B cells
37
What medications can be a risk factor for oeseoporosis?
long term corticosteroids SSRIs, PPIs anti-oestrogens anti-epileptic
38
what tool is used to assess the 10 year risk of fragility fracture?
FRAX tool
39
What is the first line treatment for osteoporosis?
bisphosphonates - alendronate, zoledronic acid
40
What are some of the side effects of bisphosphonates?
reflux and oesophageal erosions
41
What is the key sign of SLE?
malar rash that gets worse in the sunlight
42
What other symptoms/signs may be present in SLE?
hair loss SOB arthralgia myalgia hepatomegaly lymphadenopathy
43
What type of hypersensitivity is SLE?
type 3
44
What antibodies is SLE associated with?
anti-nuclear antibodies (ANA)
45
What antibody is highly specific to SLE?
anti-smith
46
What are the two criteria used for diagnosis of SLE?
SLICC or ACR criteria involves presence of ANA and certain symptoms
47
What are some of the complications of SLE?
cardiovascular disease infection lupus nephritis interstitial lung disease anaemia pericarditis (all related to inflammation)
48
What is the first line treatment for mild SLE?
hydroxychloroquine
49
What other initial medication may be used for SLE?
NSAIDs prednisolone
50
What medication may be used in more severe SLE?
methotrexate
51
What is antiphospholipid syndrome?
disorder associated with antiphospholipid antibodies that causes a hyper-coagulable state
52
What are the main associations with antiphospholipid syndrome?
venous thromboembolism (DVT) arterial thrombosis (stroke) miscarriage
53
What condition can cause antiphospholipid syndrome?
SLE
54
What antibodies in antiphospholipid syndrome associated with?
lupus anticoagulant anticardiolipin antibodies anti-beta-2 glycoprotein 1 antibodies
55
What is the diagnostic criteria for antiphospholipid syndrome?
at least on clinical characteristic and at least one antibody
56
What is the management for antiphospholipid syndrome?
warfarin
57
What is the management for antiphospholipid syndrome in pregnancy?
LMWH (warfarin contraindicated in preg) + aspirin to reduce chance of complications in pregnancy
58
What is Sjogrens sydnrome?
an autoimmune condition that effects the exocrine glands leading to dry mucous membranes
59
what are the typical symptoms of Sjorgens?
dry eyes, mouth, vagina
60
What is secondary Sjorgens syndrome?
Sjorgens related to SLE or RA
61
What antibodies is Sjorgens syndrome associated with?
anti-Ro, anti-La
62
What test can be used to assess the dryness of eyes?
schirmer tear test
63
What medication can be used to halt the progression of Sjogrens?
hydroxychloroquine
64
What is raynauds associated with?
SLE, RA, systemic sclerosis, dermatomyositis
65
What are the two main patterns of disease in systemic sclerosis?
limited cutaneous systemic sclerosis diffuse cutaneous systemic sclerosis
66
What are the features of limited cutaneous systemic sclerosis?
calcinosis raynauds oesophageal dysmotility sclerodactyly talengiectasia
67
What extra features does diffuse cutaneous systemic sclerosis have?
cardiovascular - hypertension/CAD pulmonary - hypertension/fibrosis renal - glomerulonephritis
68
What is scleroderma?
hardening of the skin
69
What is sclerodactyly
loss of range of motion in the hands
70
hat is talengiectasia
dilated blood vessels in the skin
71
What is calcinosis?
calcium deposits under the skin, often in the fingertips
72
What antibodies are positive in most patients with systemic sclerosis?
anti-nuclear antibodies
73
What examination can help diagnose systemic sclerosis?
nailfold capillaroscopy (looking at the capillaries under a microscope in the nail bed)
74
What lifestyle changes can help systemic sclerosis?
physio gentle skin stretching no smoking avoid cold triggers
75
What medications can be used for diffuse systemic sclerosis?
Steroids/immunosuppresants
76
What is poly/dermatomyositis?
autoimmune disorder when there is inflammation of the muscle/skin and muscles
77
What is the key investigation for mysositis?
raised serum creatine kinase
78
What can cause myositis?
cancers - lung, breast, ovarian, GI
79
What is the presentation of myositis?
bilateral muscle pain, weakness and fatigue normally proximal muscles effects shoulder and pelvic girdle occurs over several weeks
80
what are the main skin features of dermatomyositis
Gottron lesions - scaly red patches on knuckles of hand photosensitive erythematosus on back, shoulders and neck
81
What antibodies are present in myositis?
antinuclear, anit-Jo-1, anti-Mi-2
82
What is the first line treatment for poly/dermatomyositis?
corticosteroids - prednisone
83
What is paget's disease?
a disorder that results in increased bone turnover
84
what are the key presentations of pagets disease?
bone pain enlarged bone pain fractures hearing loss (bones in ear)
85
What is one of the key xray presentations of pagets disease?
cotton wool appearance - areas of sclerosis and lysis (dense and thin bone)
86
What may be seen in LFTs in pagets disease?
raised alkaline phosphatase
87
What is the main treatment for pagets disease?
bisphosphonates - alendronate
88
What are the two key complications of pagets disease?
osteogenic sarcoma (bone cancer) spinal stenosis
89
Name two conditions in which vit D deficiency is common
IBD, CKD
90
apart from osteomalacia, what can low Vit D lead to?
secondary hyperparathyroidism as parathyroid detects low calcium
91
What are the potential symptoms of osteomalacia?
bone pain fatigue muscle pain/weakness abnormal fractures
92
What blood test can be used to investigate potential osteomalacia?
25-hydroxyvitamin D will be low
93
How is osteomalacia treated?
colecalciferol (vit D supplementation)
94
What is septic arthritis?
infection in the joint - present with red, swollen joint
95
What is the management of septic arthritis?
septic six oxygen IV antibiotics IV fluids joint aspiration - culture check lactates and urine output
96
What is reactive arthritis?
synovitis as a reaction to an infective trigger without infection in the joint?
97
What 3 symptoms are associated with reactive arthritis?
cant see, pee or climb a tree bilateral conjunctivitis anterior uveitis circinate balanitis (dermatitis at the head of the penis)
98
What are gouty tophi?
subcutaneous deposits of uric acid
99
Which joints does gout most typically effect?
DIPs, base of thumb/big toe, wrist
100
What will joint aspirated fluid show in gout?
no infection needle shaped crystals negatively birefringent of polarised light monosodium urate crystals
101
What would be seen on an x ray of of a joint with gout?
joint space maintained punched out erosions lytic lesons overhanging edges
102
What would blood tests show in gout?
hyperuricaemia
103
What medications can increase the amount of uric acid?
thiazide like diuretics insulin
104
What dietary factors can increase purines and hence uric acid?
meat and seafood
105
What is the first line treatment in acute flair ups of gout?
NSAIDs
106
What can be used instead of NSAIDs to treat acute gout?
colchicine
107
What prophylactic treatment can be started after stabilisation of acute gout?
xanthine oxidase inhibitors - allopurinol
108
What is pseudogout?
crystal arthropathy caused by calcium pyrophosphate crystals
109
what will be shown on joint aspiration in pseudogout?
no bacteria calcium pyrophosphate crystals rhomboid shaped crystals positively birefringent of polarised light
110
What is a common x ray finding of pseudogout?
chondrocalcinosis, a thin white line in the joint caused by calcium deposition
111
What other condition does psuedogout present similarly to on x ray?
osteoarthritis Loss of joint space osteophytes subchondral cysts subarticular sclerosis
112
What is the management of pseudogout?
if symptomatic - NSAIDs/steroids
113
What is the most common route of infection in osteomyelitis?
haemotogenous osteomyelitis - through the blood
114
What might x rays show in osteomyelitis?
periosteal reaction destruction of bone localised osteopenia
115
What is the best imaging tool to diagnose osteomyelitis?
MRI
116
What surgical treatment is used for osteomyelitis?
surgical debridement (cleaning) of infected bone/tissue
117
What medications are used to treat osteomyelitis?
6 week course of flucloxacillin
118
What are the seronegative spondyloarthropathies?
ankylosing spondylitis reactive arthritis psoriatic arthritis inflammatory bowel disease arthritis
119
What gene are the seronegative spondyloarthropathies related to?
HLA B27 gene
120
What joints does ankylosing spondylitis mainly effect?
sacroiliac joints, vertebral column
121
How does ankylosing spondylitis effect joints?
causes inflammation - stiffness and pain eventually causes fusion
122
What are some of the other symptoms of ankylosing spondylitis?
anterior uveitis chest pain - costosternal inflammation weight loss, fatigue
123
What test is used to assess the flexibility of the spine and help diagnose AS?
schober's test
124
What other tests can be done for AS?
HLA B27 genetic testing CRP/ESR
125
What would be seen on x ray of a spine in AS?
bamboo spine squaring of vertebral bodies fusion
126
What medications can help with pain in AS?
NSAIDs
127
What medication can be used in flair ups of AS?
steroids
128
What other medications can be used in AS?
anti-TNF - infliximab
129
What are the signs/symptoms of reactive arthritis?
stiff, swollen and painful joints psoriatic plaques dactylitis
130
how is reactive arthritis treated?
NSAIDs, corticosteroids, anti-TNF
131
What is polymyalgia rheumatica?
an inflammatory condition mainly effecting the shoulder, neck and pelvic girdle
132
What are the typical presentations of polymyalgia rheumatica?
sleep disruption morning stiffness
133
What is giant cell arteritis?
inflammation of the medium and large arteries, typically the temporal arteries
134
what is the main complication of giant cell arteritis?
vision loss
135
What are the key presentations of giant cell arteritis?
sever unilateral headache around temple scalp tenderness jaw claudication blurred/double vision
136
How is giant cell arteritis diagnosed?
clinical manifestations raised CRP temporal artery biopsy
137
What is seen in temporal arterial biopsy in giant cell arteritis?
mutlinucleated giant cells
138
What is giant cell arteritis closely associated with?
polymyalgia rheumatica
139
How are both giant cell arteritis and polymyalgia rheumatica treated?
steroids - prednisone
140
What is fibromyalgia?
chronic pain syndrome - widespread over body
141
What is osteosarcoma?
primary bone malignancy in kids metaphysis of long bone
142
What is ewing sarcoma
very rare, arises for mesenchymal cells in the bone
143
What is osteochondroma?
benign overproduction of bone
144
What is Behçets's disease?
a complex inflammatory condition
145
What are the key presentations of Behçets's disease?
mouth and genital ulcers
146
What test can be used to diagnose Behçets?
pathergy test
147
How is Behçets treated?
prednisolone

medicine phase 2 a (10 decks)

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