MSK Flashcards
Ix and Tx for caudal equina
whole spine MRI
urgent surgical decompression
what kind of medication is aledronic acid
oral bisphosphonate
what is the main side effect of oral bisphosphonates
oesophageal reactions
including oesophagitis, ulcers, erosions and strictures
which can present as odynophagia, dysphagia, or new/worsening dyspepsia
what gene mutation causes marfans
fibrillar 1 gene mutation
what condition does a collagen gene mutation cause
Ehlers Danlos syndrome
what condition does Treponema pallidum particle agglutination assay (TPPA) positivity indicate
syphilis
how can methotrexate affect bone marrow and what does this cause
can suppress bone marrow
this causes
- thrombocytopenia
- leucopenia
- agranulocytosis
- anaemia
biggest risk factor of NSAIDs
GI ulceration and abdo pain
–> can cause melaena
what are high risk pts who are prescribed long term NSAIDs given to prevent GI ulceration
omeprazole
what enzyme do NSAIDs inhibit
cyclooxygenase
fusion of which joints is a characteristic feature of ankylosing spondylitis
fusion of sacroiliac joint
what is hydroxychloroquine
anti-malarial drug used for treatment of SLE/RA
most common side effect of hydroxycholorquine
ocular toxicity
what type of med is leflunomide
DMARD
leflunomide side effects
increased bp
deranged LFTs
what do pts starting on etanercept have to be screened for
screened for Hepatitis B, C, HIV and TB prior to starting biologics as it may cause reactivation
what type of med is etanercept
biologics
if a pt has back pain, what does a normal neurological exam tell you
most likely excludes a disk herniation or vertebral fracture
what is lumbar spondylosis
an age-related degeneration of the vertebrae and disks of the lower back
- osteoarthiritis and degenerative disk disease
what does a positive straight leg raise test indicate
irritation of the sciatic nerve
what does a positive tinels test indicate
compression of the median nerve at the carpal tunnel
what does a positive trendelburg’s test indicate
suggests contralateral hip abductor weakness
what skin condition is ankylosing spondylitis associated with
psoriasis
marfans effects on the eyes
superior lens dislocation
colchicine most common side effects
diarrhoea
nausea
vomiting
Tx for achilles tendonitis
rest, NSAIDs eg naproxen
what type of drug is allopurinol
xanthine oxidase inhibitor
what arthritis is caused by IBD
enteropathic arthritis
is enteropathic arthritis seronegative or positive
seronegative
serious skin side effect of allopurinol
stevens johnson syndrome
what is the likely diganosis of someone with G6PD deficiency and painful ankle and why
gout
G6Pd so RBC are getting killed or affected in some way -> more uric acid -> gout
which cancers commonly metastasise to the bone
BLT with a Kosher Pickle
Breast
Lung
Thryoid
Kidney
Prostate
likely diagnosis
- back pain
- fever/weight loss/night sweats
- immunosuppression
- IV drug use
discitis
signs of nerve root compression
unilateral symptoms
Burning/shooting pain down the leg
Positive sciatic stretch test
Dermatomal stretch test positive
Reduced reflexes
first-line pharmacological management for non-neuropathic lower back pain
NSAIDs
what sort of back pain is duloxetine used for
neuropathic pain eg sciatica
what sort of back pain is gabapentin used for
neuropathic pain eg sciatica
what condition is nail pitting a feature of
psoriatic arthritis
what is the sick day rule for prednisolone
if acutely unwell double the usual dose of prednisolone
dermatological effets of corticosteroids
Cushingoid appearance with central obesity, buffalo hump, moon face, acne, thinned skin with striae
endocrine side effects of corticosteroids
Hyperglycaemia.
Cushing’s disease - Hypokalaemic hypertension with fluid and Na+ retention.
Growth retardation in children.
MSK side effects of corticosteroids
muscle wasting
psychiatric side effects of corticosteroids
Mood swings.
Worsening of underlying psychiatric condition.
Can cause full steroid psychosis soon after administering.
GI side effects of corticosteroids
dyspepsia
ophthalmic side effects of corticosteroids
Glaucoma.
Cataracts.
haem side effects of corticosteroids
Raised WCC
how do you stop taking corticosteroids
If they are taken for less than 3 weeks steroids can be safely stopped abruptly.
If taken for longer than this, the steroids must be tapered down slowly.
how to adjust medication if taking prednisolone but are nil-by-mouth or vomiting prednisolone before it can be absorbed
convert the increased daily dose of prednisolone to the equivalent IV hydrocortisone.
which type of vaccines are C/I if taking corticosteroids
live vaccinations
effect of corticosteroids on immune system
Reactivation of latent infections (TB / Hepatitis B/C / Herpes viruses)
new opportunistic infections eg candida
most important side effect of steroids
adrenal gland suppression
which conditions is HLA-B27 associated with
PEAR conditions:
Psoriatic arthritis
Enteropathic
Anykylosing spondylitis
Reactive arthritis
what is the straight leg raise test used to diagnose
herniated discs
could a vertebral fracture cause neurological symptoms
yes, as it could compress on the nerve root
what type of med is etoricoxib
NSAID
which condition does a high arched palate indicate
marfans
what condition does a water hammer pulse indicate
marfans
what condition can a RET gene mutation cause
MEN 2B
what does pain when palpating the anatomical snuffbox suggest
scaphoid fracture
what test is this and what condition does it indicate
Tenderness elicited over the radial styloid upon ulnar flexion of the wrist (flex hand sideways towards pinky finger side) with thumb clasp in the palm
positive finkelsteins test
de quevain’s tenosynovitis
what test is this and what condition does it indicate
Numbness elicited upon passive extension of the wrist
positive prayer sign
carpal tunnel syndrome
what test is this and what condition does it indicate
Numbness elicited upon passive flexion of the wrist
positive Phalen sign
carpal tunnel syndrome
which muscles does de quervains tenosynovitis include
extensor pollicis brevis
and abductor pollicis longus
describe acute anterior uveitis
painful red eye
reduced acuity
constricted pupil
describe conjunctivitis and which idk condition can it occur in
discomfort
feels like a forge in body in eye
if bacterial can get pus/discharge
no visual impairment
can occur in reactive arthritis
pupil dilation rather
often associated with nausea, vomiting and haloes around light
diagnosis
acute angle closure glaucoma
describe episcleritis
localised area of redness rather than the whole sclera, and the pain is usually a mild ache, with no change in acuity or pupil size
hypermobile joints, easily bruised or stretchy skin, and be prone to dislocations and chronic pain
likely diagnosis
Ehlers danlos syndrome
which fracture often follows a fall on an outstretched hand
scaphoid fracture
likely diagnosis if pt experiences pain at base of thumb which is worsened by thumb abduction
de quervain’s tenosynovitis
what is the equivalent IV hydrocortisone dose of 5mg oral prednisolone
20mg IV hydrocortisone = 5mg oral prednisolone
which abx can rarely cause achilles tendinopathy and tendon rupture as side effect
ciprofloxacin
what tests should be done when starting a pt on methotrexate to get a baseline in the case of possible methotrexate toxicity
CXR - methotrexate can cause pneumonitis
LFTs
renal function test
FBC
arthritis of small joints of hands
pitting of finger nails
dactylitis
likely diagnosis?
Psoriatic arthritis
what is jumpers knee
patellar tendonitis - anterior knee pane at inferior pole of patella, often occurs in runners/jumpers
what is osteoid osteoma
a benign (non-cancerous), small tumour that usually grows in the long bones of a person’s lower extremities
no systemic features
no lump
what is an osteosarcoma and what does X-ray show
malignant tenor of bone in which there is proliferation of osteoblasts
X-ray shows periostea reaction with “sunburst appearance”
what is Ewings sarcoma and what does X-ray show
cancer that begins as a growth of cells in the bones and the soft tissue around the bones
most common in children/young adults
X-ray shows ill-defined lytic area with ‘onion-skin’ periosteal reaction
which malignancies of bones is most common in children
Ewings sarcoma
osteosarcoma
chondrosacroma xray
inside bone looking fluffy / like clouds
“moth-eaten” pattern of bone destruction
pt presents with swollen painful MTP
what med could have caused this
thiazide like diuretic - gout
what medication is a dihydrofolate reductase inhibitor
methotrexate
most common joints for septic athiritis
large joints
50% occur in knee
other places are ankles, hips, shoulders, wrists
deranged LFTs and joint pain
likely diagnosis
pseudo-gout secondary to haemachromatosis –> can cause liver damage
what medication is coprescribed with methotrexate, taken on a different day to it, to reduce ,methotrexate toxicity and side effects
folic acid
which bacteria is gram negative diplococci
neisseria species
which bacteria is gram positive cocci arranged in clusters
staphylococcus
most common causative agent of septic arthritis
staph aureus
what type of med is aldedronic acid
bisphosphonate
what effects can anti epileptics have on the bones
osteoporosis, osteomalacia, rickets
what sort of neuron signs do spinal cord lesions cause
upper motor neurone signs eg brisk reflexes
bone pain, low calcium, low phosphate, raised ALP, raised PTH
likely diagnosis
osteomalacia
osteomalacia calcium/phosphate/ALP/PTH levels
low calcium,
low phosphate,
raised ALP,
raised PTH
what is the antidote for methotrexate toxicity
IV folinic acid (Leucovorin)
NOT the same as FOLIC acid which is used to counter the anti folate effects of methotrexate
- is coprescribed with it to prevent side effects and toxicity
methotrexate side effects
Mucositis
Myelosuppression
Pulmonary fibrosis
Liver fibrosis
and
teratogenicity
if a pt is on methotrexate, takes trimethoprim and gets pancytopenia what does tis mean has happened and what needs to be given to pt to correct this
methotrexate and trimethoprim have reacted as they are both anti folate
caused methotrexate toxicity
resulted in bone marrow suppression
give IV folinic acid
acute joint pain, fever and lesions on hand in young sexually active pt
diagnosis
septic arthritis caused by neisseria gonorrhoea
(known to be associated with tender necrotic pustules on the extremities.)
joint pain
abdo pain, diarrhoea, steatorrhea
chronic cough
no skin manifestations
likely diagnosis
Whipple’s disease arthritis
(no skin manifestations. less likely to be enteropathic arthritis)
3 patterns of enteropathic arthritis
Axial arthritis: Gradual onset of lower back pain and stiffness, worse in the morning, improves with exercise.
Peripheral arthritis of IBD: Asymmetric, oligoarticular arthritis, predominantly of the lower limbs. Often transient and migratory joint inflammation
Enthesopathy of IBD: Severe localised pain in specific areas of tendon insertion. Achilles tendinopathy, patellar tendinopathy, plantar fasciitis
what is a viscus
an organ located inside of the body
if pt had an internal fixation of femur and now has red swollen painful joint
but has no fever and normal obs
what is most important thing to do
surgical removal of the internal fixation
(remove the forge in body causing the osteomyelitis) - abx is given if there is sepsis signs
what does mouth bleeding in a pt on methotrexate suggest
pancytopenia
what is the first line Tx for lower back pain
NSAIDs with PPI cover
which part of spine is pain most suggestive of malignancy
thoracic spine
what is arthrosis
another name for osteoarthritis
what does a positive grind test in hand suggest
osteoarthiritis
synovitis
in which 2 stages of CKD is the use of colchicine contraindicated
- end stage renal disease
- if pt is on dialysis
give examples of live vaccines, these shouldn’t be given to pts on methotrexate or steroids
MMR
varicella-zoster
yellow fever
rotavirus
BCG
what does defective type 1 collagen synthesis lead to
osteogenesis imperfecta
what condition does excessive osteoclast activity cause
osteoporosis
what condition does defective osteoclast activity cause
osteopetrosis - overly dense bones
what condition does Mutated fibroblast growth factor receptor (FGFR) cause
achondroplasia
septic arthritis vs osteomyelitis
Osteomyelitis is an infection of the bone.
Septic arthritis is inflammation in the surface of the cartilage that lines the joint and the synovial fluid that lubricates the joint that is caused by an infection
osteomyelitis xray
Periosteal reaction,
focal cortical loss,
regional osteopenia
what is a pot puffy tumour
Pott puffy tumor is a forehead swelling due to frontal bone osteomyelitis with associated subperiosteal abscess
can occur due to sinusitis or trauma
(non neoplastic)
where does Sclerosing osteomyelitis of Garre usually present
mandible - due to chronic infection from dental caries
which med do you prescribe for a pt with peptic ulcer disease and gout
colchicine
what condition is pain in buttocks which alternates from left to right indicative of
ankylosing spondylitis
what should given when starting urate lowering therapy such as allopurinol
NSAIDs or colchicine, until the effective allopurinol dose is achieved
because starting urate lowering therapy can cause acute flares of the gout
how long before having a baby do you need to stop taking methotrexate
6 months before conception
what is charcots foot
rare complication of diabetic neuropathy
- bones of the foot become very fragile and start to break /dislocate in response to very minor forces
second line preventative Tx for gout when allopurinol is not tolerated
Febuxostat
what is Pott’s disease / Pott’s spine
manifestation of TB in the spine
what is sublaxation
partial dislocation
loss of joint space
peri articular osteopenia
soft tissue swelling
sublaxation
what condition is this
rheumatoid arthiritis
what is osteochondroma and how does it appear on X-ray
benign none tumour, asymptomatic
appears as small bony protusion on xray
which gram positive cocci in grape like clusters cause septic arthritis
staph aureus
which gram negative diplococci cause septic arthritis
neisseria Gonorrhoea
which bacteria is a gram negative rod
e coli
which bacteria is gram positive cocci in chains
strep pyogenes
which bacteria is a gram negative diplococci
neisseria
which bacteria is a gram negative cocobacili
haemophilus influenza
which NSAID has a lower risk of GI bleeds
celecoxib
usual methotrexate and folic acid dose
both once a week, but take on different days
folic acid can be increased and taken more times if needed
what condition is alternating buttocks pain associated with
ankylosing spondylitis
what is an antalgic gait
limping because of pain
young child
antalgic gait
recent cold
likely diagnosis
transient synovitis of the hip
what condition does history of diabetes bronze skin and gynacomastia indicate
hereditary haemochromatosis
what is the female athletic triad
eating disorders
amenorrhoea
osteoporosis
what type of pt is a Slipped upper femoral epiphysis (SUFE) seen in
obese adolescent boys of African-American descent
what endocrine disorders are associated with pseudo gout
hyperparathyroidism
hypothyroidism
likely diagnosis:
lower back pain
bilateral lower limb pain
normal peripheral pulses
spinal stenosis- due to claudication
inheritance pattern of marfans
autosomal dominant
progressive bone pain
osteolytic lesions
fatigue
weight loss
diagnosis
multiple myeloma
is diabetes a risk factor for gout or pseudo gout
gout
which condition is anti dsDNA associated with
SLE
which condition is anti CCP associated with
rheumatoid arthiritis
which condition are Scl70 (Anti-topoisomerase 1), anticentromere and anti-RNA polymerase III associated with
systemic sclerosis
if pt had recent genitourinary infection and now has reactive arthritis what is likely causative agent
chlamydia
which nerve is compressed in carpal tunnel
median
what can happen to hand if Carpal tunnel is left untreated
atrophy of the thenar muscles of the hand causing grip strength to weaken
what causes claw hand
Klumpke’s paralysis, an injury to the lower roots (C8/T1) of the brachial plexus
or from ulnar nerve injury
most common cause of these are traumatic vaginal delivery
what condition is ulnar deviation (MCPs swell and cause fingers to all bend towards pinky finger) a sign of
rheumatoid arthiritis
what condition is swan neck deformity (PIP joint hyperextension, DIP joint flexion) a sign of
rheumatoid arthritis
what condition is Boutonniere’s deformity (PIP joint flexion, DIP joint hyperextension) a sign of
rheumatoid arthritis
what does cozens test check for
epicondylitis aka tennis elbow (elbow pain in an individual with a history of repetitive strain)
- pain during resisted extension of wrist and digits
what does history of scleroderma and severe hypertension raise suspicion of
scleroderma renal crisis
what is needed for osteoarthritis diagnosis
Osteoarthritis can be diagnosed clinically if the following apply:
The patient is aged over 45 years
AND
The patient has activity-related joint pain
AND
The patient has no morning stiffness or the morning stiffness lasts less than 30 minutes
(dont need xray for diagnoses)
why does tenderness over anatomical snuffbox that’s been going on for a couple weeks need urgent orthopaedic review
could be a scaphoid fracture
risk of vascular necrosis
what is phalen’s test used for
carpal tunnel syndrome
what is tinel’s sign
tingly feeling when doctor taps skin over the site of the damaged nerve
management of carpal tunnel
1) wrist splint
2) steroid injections / NSAIDs
3) surgery
what is limited cutaneous systemic sclerosis
aka CREST syndrome
Calcinosis.
Raynaud’s.
oEsophageal dysmotility.
Sclerodactyly.
Telangiectasia
what is nail pitting characteristic of
psoriatic artritis
effects of systemic sclerosis on lungs
pulmonary fibrosis
what pulmonary pressure is classed as pulmonary arterial htn
> 20 mmHg
what is a common osteoporotic fracture of the back
vertebral wedge fracture
mech of action of bisphosphonates eg aledronrate in osteoporosis
inhibit osteoclasts
likely fracture if fall on outstretched hand
scaphoid fracture
what should you do if suspicion of scaphoid factor but cant see it on xray
plaster up the hand/wrist and repeat xray in 10 days
first line tx for knee osteoarthirtis
topical NSAIDs
denosumab mech of action
Inhibits the receptor activator of nuclear factor-kappa B ligand (RANKL)
diffuse vs limited systemic sclerosis
limited = crest (Calcinosis
Raynaud’s phenomenon
Oesophageal dysmotility
Sclerodactyly
Telangiectasia)
diffuse = multisystem disorder, abnormlaotie of blood vessels and friborsis of skin and internal organs eg ILD, renal crisis, myocardial disease)
what is golfers elbow
medial epicondylitis
what is the triad of arthritis, urethritis and conjunctivitis characteristic of
reactive arthritis
what is obligatory external rotation as you flex the pts hip a sign of
slipped capital femoral epiphysis aka slipped upper femoral epiphysis
pt often prefers to sit in a chair with the affected leg crossed over the other - what is this characteristic of
slipped capital/upper femoral epiphysis
tingling in hand, worse at night, can make the feeling go away after shaking his hand or hanging it over the bed at night
what condition is this characteristic of
carpal tunnel syndrome
what should be regularly monitored in crest syndrome
renal function tests and bp
which condition is anti centromere antibody associated with
limited systemic sclerosis
where in the bone can avascular necrosis happen in a scaphoid fracture
proximal pole of the scaphoid
best/most sensitive test for acl tear
lachman’s test (more sensitive than anterior draw test)
what is dupuytren’s contracture
hand deformatity due to thickening of palmar fascia in digits 4 and 5
dupuytrens contracture management
surgical fasciotomy
collagenase / corticosteroid injections
what is the earliest sign of dupuytrens contracture
a firm, thickened palmar nodule over the metacarpal head at the level of the distal of the distal palmar crease
which ligament is injured when you hear a pop when changing direction / performing pivoting movements
ACL
how to treat asymptomatic vs symptomatic Baker’s cyst
asymptomatic = not tx required
symptomatic = NSAIDs, intrarticular corticosteroid injection, pyshio, last resort if v painful and not responding to meds = surgery
describe the reflexes and muscle tone in cauda equina and why
hypotonia and decreased muscle tone
because cauda equina involves a LMN lesion
what is conus medullaris syndrome
lesson around L2
involves LMN ad UMN effects
cauda equina vs conus medullaris syndrome
cauda equina syndrome: lower motor neuron effects eg hyporeflexia
conus medullaris syndrome: combination of LMN and upper motor neuron (UMN) effects eg hyperreflexia, positive babinskis sign
first lien Tx of scleroderma renal crisis
ACEi (ACEi’s are usually c/I in AKI except for in scleroderma renal crisis)
which arthritis’ have bony erosions
inflammatory arthritis - esp rheumatoid and psoriatic arthritis
what are the sites of tumours from which bony metastases can arise
breast
thyroid
prostate
kidney
bronchus (lung)
BLT with a Kosher Pickle
hip: limited internal rotation and is externally rotated when flexed
likely diagnosis
SUFE
how to treat SUFE
surgical fixation of the femoral head
first line tx of septic arthritis
IV fluxocillin (after joint aspiration)
only in severe cases or after abx, do the joint washout
which condition has Chondrocalcinosis in the joint space
pseudo gout
which condition has abnormally dense bone with increased thickness throughout the bone
osteopetrosis
which condition has bony erosions
RA
which condition has bone sublaxation
RA (z appearance of fingers)
what to do if septic joint doesn’t improve w antibiotics
orthopaedic review - infection may be coming from abscess within the joint so consider a joint wash out
babinskis sign in UMN lesion
positive
what is the suprapubic mass found on abdo exam in cauda equina
distended bladder (urien cant be released due to urinary retention)
how to advise a pt to take aledronic acid for osteoporosis
To take the medicine with water on an empty stomach
first thing in the morning before breakfast
remain upright for at least 30 minutes after taking it
what test should be done prior to starting inflimab / other biologics
Quantiferon test (TB test - biological can reactivate latent TB)
what test should be done for a patient starting hydrocholorquine
eye check - can affect vision
prior to starting which meds should Thiopurin methyltrasnferase (TPMT) test be done
should be done prior to starting thiopurines eg azathioprine
joint pain after finishing TB Tx
what is diagnosis and which antibody is present
drug induced lupus
secondary to isoniazid therapy (TB tx)
anti histone antibodies
what is pANCA associated with
Microscopic polyangiitis
eosinophilic granulomatosis with polyangiitis
what is cANCA associated with
granulomatosis with polyangiitis
what are myeloperoxidase (MPO) antibodies associated with
microscopic polyangiitis
what does schemer’s test look for
sjogrens syndrome
(demonstrates reduced tear production using a strip of filter paper on the lower eyelid, with wetting of <5 mm being positive)
sulfasalazine side effects
azoospermia,
Stevens-Johnson syndrome
hepatitis
hydroxychloroquine side effects
seizures,
retinopathy
prolonged QT interval.
what type of antibody is rheumatoid factor
IgM against IgG
what is the most specific serological marker for RA
anti-CCP
first line serological marker to test for in
RA
RF
what is feltys syndrome
triad of
rheumatoid arthiritis
splenomegaly
neutropenia
which nerve roots are for the knee reflex and ankle reflex
L3
L4
(3, 4 kick down the door)
S1
S2
(1, 2 buckle my shoe)
which condition is anti Scl70 antibody associated with
diffuse cutaneous systemic sclerosis
rough cracking of skin on fingers
bluiSh- black lesions over knuckles/elbows/knees (gottrons papules)
raynauds
myopathy
heliotrope rats and shawl sign
raised CK
like diagnosis
dermatomyositis
which condition is anti JO1 antibody associated with
Poly/Dermatomyositis
Asthma (usually adult onset)
Eosinophilia of >10% in peripheral blood
Paranasal sinusitis
Pulmonary infiltrates (patchy and shifting)
Histological confirmation of vasculitis with extravascular eosinophils
Mononeuritis multiplex or polyneuropathy
likely diagnosis
Churg-strauss syndrome (Eosinophilic granulomatosis with polyangiitis)
contrast Granulomatosis with polyangiitis (Wegener’s granulomatosis) with Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
G with P:
affects lungs, sinuses, kidneys
can cause glomerulonephritis
c-ANCA
EG with P:
late onset asthma, sinusitis, eosinophilia
p-ANCA
which condition is anti-topoisomerase ab associated with
diffuse systemic scleroderma
which conditions is ANA associated with
SLE, scleroderma sjogrens, juvenile arthritis, polymyositis, dermatomyositis, type1 autoimmune hep, PSC
Tx for raynauds
smoking cessation and wear gloves
if that doesn’t work, dihydropryidine calcium channel blockers
likely cause of vision problem in an RA pt
hydroxycholorquine
like cause of bradycardia in a baby who’s mum had SLE/sjogrens
congenital heart block (diet to antibodies passing to foetus)
RA Tx
acute / first presentation:
(mild disease)
1st line - hydroxycholorquine
2nd line - sulfasalazine / methotrextae / leflunomide
(moderate/severe disease)
1st line - methotrexate
2nd line - sulfasalazine / leflunomide / hydroxycholorquine
ongoing / unresposnive:
1st line - methotrexate
2nd line - methotrexate + sulfasalazine + hydroxychloroquine
colour change in raynauds
WBC - white, then blue, then crimson (red)
Initial vasoconstriction leads to pallor
Deoxygenated static blood leads to cyanosis
Reactive hyperaemia leads to rubor
pregnant RA pt Tx
stop methotrexate
switch to sulfasalazine or hydroxycholorquine
what marker should you look for in to with bilateral shoulder and hip girdle pain and stiffness
raise ESR –> polymyalgia rheumatica
which antibody is positive
- adult consent asthma
- rashes
- eosinophilia
p-ANCA
what is ulnar deviation associated with
RA
dryness
bilateral enlargement of parotid glands
diagnosis
sjogrens syndrome
what presents with rheumatoid like hands that are reducible in extension
Jaccoud’s arthropathy
example of med which worsen raynauds
beta blockers
cause of red scaly facial rash which spares nasolabial folds and is worse in summer
SLE
pANCA positive but no asthmatic symptoms
diagnosis
microscpic polyangiitis
(pANCA is positive in ^ and esocinophlc granulomatosis with polangiitis aka charge strauss)
what condition does a ‘Full house’ immunofluorescence pattern on kidney biopsy indicate
lupus nephritis
what can you see on cxr for granulomatosis with polyangiitis
bilateral nodular and cavitating infiltrats
what is arthritis mutilans a complication of
psoriatic arthritis
what is dactylitis a complication of
psoriatic arthritis
cause of dry mouth and eyes
sjogrens syndrome
pt with lupus presents with psychotic features and severe headache
likely diagnosis
cerebral lupus
main side effects of sulfasalazine
Myelosuppression
Nausea
Rash
Oral ulcers
Decreased sperm count
what is charge strauss / eosinophilic granulomatosis with polyangiitis treated with
corticosteroids
what are anti smith abs found in
SLE
what is the most common pattern of psoriatic arthritis
assymetrical oligoarthiritis
what does positive ENA antibody mean
it means you have autoantibodies
which joint in hand is spared in RA
DIP
contrast antibodies and skin effects in limited vs diffuse systemic sclerosis
- limited sclerosis: anti centromere antibody, no skin changes other than face and lower arms
- diffuse sclerosis: antibody to topoisomerase I (SCl-70), other areas of skin involement
what condition is DAS-28 score used for
rheumatoid arthiritis
tx for lupus nephritis
high dose corticosteroids in combination with a cytotixic drug - eg cyclophosphamide, tacrolimus, mycophenylate
initial ab test for SLE
ANA
(then do anti dsDNA)
which lymphoma are pts with sjogrens likely to develop
MALT lymphoma
meds for hypertension in SLE
ACEi or ARB
first line test and
diagnostic test for sgojrens
first line: schemers test and anti ro/la abs
diagnostic (if uncertainty): salivary gland biopsy - histopathologic study shows lymphocytic infiltrates around the duct.
which 2 conditions are associated with anti Ro aka anti SSA antibodies
SLE
Sjogrens syndrome
what is Beurgers disease
a type of secondary raynauds, due to smoking
classic presentation: young, male smoker who has been experiencing claudication and has signs of lower limb atherosclerosis with absent pedal pulses
what is erythromelalgia
temperature induced colour changes of the extremities however it has the opposite presentation to Raynaud’s with red painful burning extremities usually provoked by heat. Thrombocytosis can be a cause
most sensitive abs for SLE
ANA
most specific abs for SLE
Anti-dsDA
anti smith
biologic side effects
Immunosuppression
Reactivation of TB
Allergic reaction, reaction at infusion site
what type of med is Leflunomide
DMARDs
what is polyarteritis nodosa
Polyarteritis nodosa is medium- and small-vessel vasculitis, most commonly associated with fever, neurological symptoms (often mononeuritis multiplex), skin disease and renal disease. Pulmonary and upper respiratory tract symptoms are less common
what is hypromellose used for in sjogrens
used as artificial tears to soothe dry eyes
2 emergencies in lupus
lupus nephritis
cerebral lupus
what is pencil in cup deformity
aka arthritis mutilans
- most severe form of psoriatic arthritis
what test needs to be does before starting hydroxycholorquine
eye test
what is livedo reticularis associated with
SLE,
systemic sclerosis,
Sjögren’s disease
neurological symptoms and headache, with fever and raised inflammatory markers in pt on biologics
likely diagnosis
encephalitis
common side effect of gold treatment for RA
skin pigmentation
headache
feeling unwell
pain in scalp which is worse when eating
diagnosis
giant cell arteritis - temporal arteritis
what does positive lupus anticoagulant mean
antiphospholipid syndrome
recent thrombus eg DVT with no risk factors of developing it
no clotting abnormalities
miscarriages
likely diagnosis?
antiphospholipid syndrome
