MSK

Question 1

what is ankylosing spondylitis?

Answer 1

an inflammatory condition affecting the axial skeleton esp the spine and sacroiliac joints

Question 2

what kind of disease is ankylosing spondylitis?

Answer 2

a seronegative spondylarthropathy

Question 3

~90% of ankylosing spondylitis have which gene?

Answer 3

HLA-B27

Question 4

is ankylosing spondylitis more common in men or women?

Answer 4

men

Question 5

what is the typical ankylosing spondylitis pt?

Answer 5

a young man in 20s

Question 6

what is the timeline for symptom development in ankylosing spondylitis?

Answer 6

symptoms develop gradually over at least 3 months

Question 7

what are the main presenting symptoms in ankylosing spondylitis?

Answer 7

pain and stiffness in lower back

Question 8

what is characterisitc about the pain and stiffness in ankylosing spondylitis?

Answer 8

it is worse w/ rest and improves w/ movement

worse at night

morning stiffness >30 mins

Question 9

what are the 5 conditions assoc w/ ankylosing spondylitis?

Answer 9

anterior uveitis
aortic regurg
atrioventricular block
apical lung fibrosis
anaemia of chronic disease

Question 10

what does schobers test assess?

Answer 10

spinal mobility

Question 11

how is the schobers test carried out?

Answer 11

the pt stands straight and L5 is located and a point is marked 10cm above and 5cm below L5

the pt then bends forward as much as possible and the distance between the 2 points is measured

Question 12

what result of schobers test supports a diagnosis of ankylosing spondylitis?

Answer 12

<20cm

Question 13

what are the investigations for ankylosing spondylitis?

Answer 13

HLA-B27 genetic testing

inflammatory markers (CRP and ESR)

spine XR - bamboo spine (fusion of sacroiliac and spinal joints)

Question 14

what is the first line management of ankylosing spondylitis?

Answer 14

NSAIDs

Question 15

what is the second line management of ankylosing spondylitis?

Answer 15

anti TNF (adalimumab, etanercept, infliximab)

Question 16

what are the two third line managements for ankylosing spondylitis?

Answer 16

monoclonal antibodies against IL-17 (secukinumab or ixekizumab)

JAK inhibitor (upadacitnib)

Question 17

what is the difference between polymyositis and polymyalgia rheumatica?

Answer 17

polymyalgia rheumatica causes pain and stiffness

polymyositis causes pain and weakness

Question 18

what is gout?

Answer 18

a type if crystal arthroparthy assoc w/ chronically high uric acid levels

Question 19

what is the typical presentation of gout?

Answer 19

a single hot swollen and painful joint

Question 20

what are the 3 joints most commonly affected by gout?

Answer 20

base of big toe
base of thumb
wrist

Question 21

what does aspirated fluid show in gout?

Answer 21

monosodium urate crystals

needle shaped and negatively bifringent of polarised light

Question 22

what does aspirated fluid in pseudo gout show?

Answer 22

calcium pyrophosphate crystals

rhomboid shaped and positively bifringent of polarised light

Question 23

what is the first line management of an acute flare of gout?

Answer 23

NSAIDs e.g. naproxen w/ PPI

Question 24

what is the second line management of an acute flare of gout?

Answer 24

colchicine

Question 25

what is used for gout prophylaxis?

Answer 25

xanthine oxidase inhibitors e.g. allopurinol

Question 26

when can gout prophylaxis be started after an acute attack?

Answer 26

wks after the acute attack

Question 27

is gout prophylaxis continued throughout acute attacks?

Answer 27

yes