msk Flashcards
hidden places where psoriasis can be found
Behind the ear
Inside the ear
Nails (onoklysis)
Scalp
Umbilicus
Genitals
Soles of feet
(i) septic arthritis risk factors
(ii) and which condition shares these
(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
primary cancers that COMMONLY metastasise to bone
Kidney (renal cell carcinoma)
Prostate - MALE ONLY
Breast
LUNG
Thyroid
antibodies found in SLE
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.
1st line drug for osteoporosis
(i) class
(ii) example
(iii) how to take this class
(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
Heberden’s nodes
DIPs in osteoarthritis
(distal interphalangeal)
Bouchard’s nodes
PIPs in osteoarthritis
(proximal interphalangeal joints)
hand deformities in RA
Z-shaped deformity of the thumb / Hitchhikers thumb
Boutonniere deformity
Swan neck deformity
Ulnar deviation
gout treatment
(i) acute
(ii) preventative
(i) High dose NSAIDs, and corticosteroids. Then Colchicine.
(ii) Allopurinol
phases of Paget’s disease physiology
LYTIC = excessive osteoclast resorption
MIXED = excessive resorption and disorganised bone formation
BLASTIC (latent) = osteoblasts lay down excess disorganised weak bone
Paget’s blood results
HIGH ALP (alkaline phosphatase)
NORMAL calcium
NORMAL phosphate
complications of Paget’s
Fractures
Leontiasis ossea / skull thickening
Osteosarcoma
Tibial bowing
Deafness
High output cardiac failure
Paget’s first line treatment
Bisphosphonates
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.
(GCA)
Chronic granulomatous large vessel vasculitis mainly affecting the carotid arteries and its branches e.g. Temporal artery
(GCA)
1st line of action and why
Urgent high dose corticosteroids e.g. prednisolone
Prevent blindness (due to lack of ophthalmic artery blood flow – causing AAION)
Arteritic anterior ischemic optic neuropathy
(GCA)
Diagnostic criteria
- > 50yrs
- temporal artery abnormality (e.g. Tender, decreased pulsation)
- abnormal temporal artery biopsy
- elevated ESR (>50mm/hr)
- NEW HEADACHE
(GCA)
associated condition causing shoulder pain
Polymyalgia rheumatica
23yo woman with rash on cheeks and bridge of nose. non specific muscle arthralgia and extreme tiredness. what condition most concerned about?
Systemic lupus erythematosus
(SLE)
type of hypersensitivity reaction
Type III (+ type II causing haematological signs eg. anaemia)
(SLE)
most sensitive antibody and most specific
Specific = ds-DNA
Sensitive = ANA
(SLE)
signs
Discoid rash
Pleuritis
Peritonitis
Myocarditis
Oral / mucosal ulcers
Alopecia
Lupus nephritis
Photosensitivity
Anaemia
Lymphopenia/leukocytopenia
Migraine
Seizures
Psychosis etc
(SLE)
marker used to monitor
ESR
(SLE)
treatment for arthralgia / skin symptoms associated
Hydroxychloroquine
+/- NSAIDs
+/- corticosteroids
28yo woman 3rd miscarriage. Hx of recurrent DVT and 1 PE. blotchy skin pattern, prolonged APTT on bloods. top differential?
antiphospholipid syndrome
