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help with 2a > msk > Flashcards

msk Flashcards

1
Q

hidden places where psoriasis can be found

A

Behind the ear
Inside the ear
Nails (onoklysis)
Scalp
Umbilicus
Genitals
Soles of feet

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2
Q

(i) septic arthritis risk factors

(ii) and which condition shares these

A

(i)
Recent joint surgery
Age 80+
Pre-existing joint disease eg rheumatoid arthritis
DM
Immunosuppression
Prosthetic joint
Recent intra-articular steroid injections
Penetrating trauma

(ii) OSTEOMYELITIS

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3
Q

primary cancers that COMMONLY metastasise to bone

A

Kidney (renal cell carcinoma)
Prostate - MALE ONLY
Breast
LUNG
Thyroid

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4
Q

antibodies found in SLE

A

ANA (antinuclear antibodies) - approx 85% of patients with SLE will be positive for ANA. However, they are also found in other conditions eg. autoimmune hepatitis.

Anti-dsDNA - highly specific for SLE, but only found in approx 60% of patients.

Anti-Smith antibodies - highly specific, but not very sensitive (only found in 20-30% of patients with SLE).

ANA and anti-dsDNA antibodies are the main antibodies associated with SLE. Remember that anti-ANA antibodies are more sensitive than anti-dsDNA antibodies, but anti-dsDNA is more specific for SLE. This means that if a patient is found to have anti-dsDNA antibodies it is highly likely that they have SLE. Anti-Smith antibodies are also highly specific for SLE, but have very low sensitivity.

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5
Q

1st line drug for osteoporosis
(i) class
(ii) example
(iii) how to take this class

A

(i) bisphophonate

(ii) alendronate (alendronic acid), risedronate, zoledronate

(iii) taken once a week, on an empty stomach, and the patient should remaining upright for at least 30mins after taking

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6
Q

Heberden’s nodes

A

DIPs in osteoarthritis
(distal interphalangeal)

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7
Q

Bouchard’s nodes

A

PIPs in osteoarthritis
(proximal interphalangeal joints)

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8
Q

hand deformities in RA

A

Z-shaped deformity of the thumb / Hitchhikers thumb
Boutonniere deformity
Swan neck deformity
Ulnar deviation

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9
Q

gout treatment
(i) acute
(ii) preventative

A

(i) High dose NSAIDs, and corticosteroids. Then Colchicine.

(ii) Allopurinol

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10
Q

phases of Paget’s disease physiology

A

LYTIC = excessive osteoclast resorption
MIXED = excessive resorption and disorganised bone formation
BLASTIC (latent) = osteoblasts lay down excess disorganised weak bone

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11
Q

Paget’s blood results

A

HIGH ALP (alkaline phosphatase)
NORMAL calcium
NORMAL phosphate

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12
Q

complications of Paget’s

A

Fractures
Leontiasis ossea / skull thickening
Osteosarcoma
Tibial bowing
Deafness
High output cardiac failure

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13
Q

Paget’s first line treatment

A

Bisphosphonates

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14
Q

define most likely diagnosis? 56yo woman, 1m Hx deteriorating vision, R side headache. intermittent jaw pain on chewing and extreme fatigue. recent difficulty combing hair due to scalp and shoulder pain.

A

(GCA)
Chronic granulomatous large vessel vasculitis mainly affecting the carotid arteries and its branches e.g. Temporal artery

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15
Q

(GCA)
1st line of action and why

A

Urgent high dose corticosteroids e.g. prednisolone
Prevent blindness (due to lack of ophthalmic artery blood flow – causing AAION)

Arteritic anterior ischemic optic neuropathy

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16
Q

(GCA)
Diagnostic criteria

A
  1. > 50yrs
  2. temporal artery abnormality (e.g. Tender, decreased pulsation)
  3. abnormal temporal artery biopsy
  4. elevated ESR (>50mm/hr)
    • NEW HEADACHE
17
Q

(GCA)
associated condition causing shoulder pain

A

Polymyalgia rheumatica

18
Q

23yo woman with rash on cheeks and bridge of nose. non specific muscle arthralgia and extreme tiredness. what condition most concerned about?

A

Systemic lupus erythematosus

19
Q

(SLE)
type of hypersensitivity reaction

A

Type III (+ type II causing haematological signs eg. anaemia)

20
Q

(SLE)
most sensitive antibody and most specific

A

Specific = ds-DNA
Sensitive = ANA

21
Q

(SLE)
signs

A

Discoid rash
Pleuritis
Peritonitis
Myocarditis
Oral / mucosal ulcers
Alopecia
Lupus nephritis
Photosensitivity
Anaemia
Lymphopenia/leukocytopenia
Migraine
Seizures
Psychosis etc

22
Q

(SLE)
marker used to monitor

A

ESR

23
Q

(SLE)
treatment for arthralgia / skin symptoms associated

A

Hydroxychloroquine
+/- NSAIDs
+/- corticosteroids

24
Q

28yo woman 3rd miscarriage. Hx of recurrent DVT and 1 PE. blotchy skin pattern, prolonged APTT on bloods. top differential?

A

antiphospholipid syndrome

25
Q

(antiphospholipid syndrome)
blotchy pattern commonly called

A

Livedo reticularis

26
Q

(antiphospholipid syndrome)
antibodies associated

A

Lupus anticoagulant
Anti-cardiolipin
Anti-beta2 GP1

27
Q

(antiphospholipid syndrome)
what disease could this give a false positive result for

A

Syphilis (RPR) due to anti-cardiolipin Ab

28
Q

(antiphospholipid syndrome)
management

A

Low dose aspirin

29
Q

likely gender of fibromyalgia patient

A

Female
(5x more common in women)

30
Q

(fibromyalgia)
like age

A

30-60

31
Q

red flags for back pain

A

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)

32
Q

risks for osteomalacia

A

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

33
Q

reflex lost with S1 root lesion

A

Ankle jerk – this reflex is mediated by the S1 spinal segment of the spinal cord

help with 2a (2 decks)

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