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1
Q

mechanism of action of methotrexate

A

dihydrofolate reductase inhibitor leading to reduced DNA synthesis

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2
Q

side effects of methotrexate

A
  • agranulocytosis
  • stomatitis
  • bone marrow suppression -> pancytopenia
  • liver toxicity
  • alopecia
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3
Q

monitoring with methotrexate

A
  • FBC
  • LFT
  • renal function before starting
  • give with folic acid
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4
Q

mechanism of action of rituximab

A

targets CD20 on B cells

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5
Q

mechanism of action of anakinra

A

interleukin 1 receptor antagonist

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6
Q

mechanism of action of azathioprine

A

inhibits synthesis of purines

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7
Q

side effects of azathioprine

A
  • pancreatitis
  • anaemia
  • GI upset
  • leukopenia
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8
Q

side effect of ciclosporin

A

gingival hypertrophy

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9
Q

features of systemic JIA

A

2 weeks of fever and salmon pink rash.
symmetrical joint pain
+/- hepatosplenomegaly, pericarditis, peritonitis, pleuritis

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10
Q

features of oligoarticular arthritis

A

most common
<4 joints involved (usually lower joints)
+ uveitis (presents before arthritis, ANA +ve)

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11
Q

features of polyarticular arthritis

A

> 5 joints involved (usually smaller joints)
often girls
rheumatoid factor +ve (= poorer prognosis)

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12
Q

features of enthesitis arthritis

A

arthritis plus…
- sacro-iliac / lumbrosacral pain
- heel pain and lower limb pain
- acute anterior uveitis

HLA B27 +ve, boys

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13
Q

features of juvenile psoriatic arthritis

A
  • affects small and large joints asymetrically
  • dactylitis
  • nail pitting
  • oncholytis
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14
Q

investigations for JIA

A

clinical diagnosis …

  1. raised ESR
  2. ANA - if +ve, important in predicting uveitis and blindness (need regular slit lamp examinations)
  3. rheumatoid factor - +ve in polyarticular.
  4. USS joint
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15
Q

management of juvenile arthritis

A
  1. physiotherapy
  2. pain relief - NSAIDS (naproxen)
  3. steroids - intraarticular for oligoarticular
  4. methotrexate
  5. DMARDS
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16
Q

side effects of intra-articular arthritis

A
  • peri articular calcifciation
  • atrophy of site
  • hypopigmentation
  • crystal synovitis
  • avascular necrosis of femoral head
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17
Q

features of SLE/ diagnsosis

A

need >4/11 features of….

S - serositis e.g. pericarditis, myocarditis
O- oral ulcers
A - arthritis
P - photosensitivity

B - Blood disorder e.g. haemolytic anaemia, thrombocytopenia, leukopenia
R - renal e.g. lupus nephritis
A- ANA +ve
I - immunological e.g dsDNA +ve
N - neurological e.g. psychosis, seizures

M- malar rash - butterfly rash across face
D - discoid rash - sun exposed areas, scaling

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18
Q

management of SLE

A
  1. sun exposure, exercise
  2. NSAIDs
  3. steroids - pred gives rapid symptomatic relief
  4. immunosuppressive agents e.g. azathioprine, methotrexate
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19
Q

features of behcets disease

A

HLA B5
- uveitis
- erythema nodosum
- oral and genital ulcers
- thrombophlebitis

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20
Q

cause of reactive arthritis

A

HLA- B27

  1. diarrhoea e.g. campylobacter, salmonella
  2. gonorrhoea/ chlamydia
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21
Q

features of reactive arthritis

A
  1. arthritis
  2. conjunctivitis/ uveitis
  3. urethritis
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22
Q

risk factors for SUFE

A
  1. boys
  2. obesity
  3. adolescents
  4. previous radiation of hip
  5. endocrine disorders e.g. hypothyroid, GH deficiency, short stature
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23
Q

presentation of SUFE

A
  • pain in hip/ groin/ medial thigh on walking
  • limp
  • limited hip rotation
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24
Q

complications of SUFE

A
  • avascular necrosis of femoral head
  • osteoarthritis
  • osteonecrosis
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25
investigations for SUFE
anteroposterior and frog leg lateral x rays... - femoral head displacement - widened epiphyseal line - globular swelling of joint capsule
26
management of SUFE
1. rest 2. analgesia 3. surgery - screw fixation across growth plate
27
risk factors for perthes disease
- boys - 4 - 11 y/o
28
presentation of perthes disease
- pain and limitation on internal rotation and abduction of hip - afebrile
29
x ray of perthes disease
radiolucency of femoral head (= avascular necrosis_
30
management of perthes disease
abduction bracing +/- osteostomy (containment) put in a Petrie cast
31
presentation of osgood schlatter
- boys - playing sport - pain in knee
32
causes of osteomyelitis
NEONATES (Affects femur/ humerus) - GBS - s.aureus - e.coli INFANT (affects long bone metaphysis) - s. aureus ** - k. kingae (chronic) - salmonella (sickle cell)
33
risk factors for osteomeylitis
- trauma - sickle cell disease - previous surgery - diabetes - immunocompromised - blood stream infections
34
presentation of osteomyelitis
- fever unwell - localised bone pain/ swelling
35
what is brodies abscess
- localised deep abscess in bone - causes deep boring pain
36
investigations for osteomyelitis
1. bloods - raised CRP, raised ESR, raised WCC 2. blood cultures 3. x ray - radiolucent metaphyseal lesions, periosteal elevation 4. MRI - detects early changes
37
management of osteomyelitis
1. IV antibiotics for 4-6 weeks 2. analgesia
38
presentation of septic arthritis
1. red hot swollen painful joint 2. fever 3. unable to weight bear
39
management of septic arthritis
1. USS joint aspiration 2. FBC, CRP, cultures 3. IV antibiotics for 4-6 weeks
40
presentation of hypermobility
pain that worsens during course of the day and afetr exercise back pain poor posture
41
score for hypermobility and management
BEIGHTON SCORE >4/9 = hypermobile need physiotherapy
42
cause of ehlers danlos syndrome
autosomal dominant mutation in COL5A12 gene defective collagen V
43
presentation of ehlers danlos syndrome
- hyperextensilibity of skin - hypermobile - hypotonia - developmental delay - poor wound healing - blue sclera - aortic regurg + aortic dissection
44
cause of ankylosing spondylitis
HLA B27 autoimmune common in adolescent boys
45
presentation of anylosing spondylitis
1. back pain - and radiates to back of legs 2. stiffness - worse in morning, relieved by exercise 3. aortic regurg 4. pulmonary fibrosis 5. iBD 6. nephrotic syndrome
46
x ray signs of ankylosing spondylitis
- 1st sign = loss of costal margins, blurring of vertebral junction - widening of joint space - anterior squaring of vertebra - late sign = marginal sclerosis, narrowing and fusion
47
cause of rickets
1. nutritional deficiency - low calcium and low vit D intake, risk if vegetarian/ vegan/ prolonged breastfeeding 2. malabsorption e.g. coeliac, cystic fibrosis 3. lack of sunlight 4. liver disease 5. renal tubular loss e.g x linked dominant hypophosphataemia. fanconi, cystnosis
48
presentation of rickets
- tender swollen joints - genu varum + valgum - delayed walking - skull bossing - delayed formation of teeth , enamel hypoplasia
49
x ray in rickets
- cupping, splaying and fraying of metaphysis - costochondral swelling - loosers zone
50
bloods of vit D deficient rickets
1. low vit D 2. low or normal calcium 3. high ALP 4. high PTH 5. low phosphate
51
bloods of hypophosphataemic rickets
1. normal vit D 2. normal calcium 3. high ALP 4. low phosphate 5. normal/ high/ low pTH
52
complications of rickets
1. cardiomyopathy 2. hypocalcaemic seizures 3. delayed gross motor delay 4. faltering growth
53
features of type 1 osteogeneis imperfecta
autosomal dominant blue scleria easy bruising fractures hearing loss
54
cause of hSP
systemic vasculitis - IgA mediated of small blood vessels
55
presentation of HSP
1. skin rash - blanching maculopapular rash -> petechie, purpura 2. abdominal pain, diarrhoea 3. arthritis - with swelling/ oedema 4. nephritis - proteinuria/ haematuria / AKI
56
management of HSP
1. rule out other conditions e.g. FBC, U&E, CRP clotting 2. may need renal biopsy if kideny issues - IgA deposits 3. BP and urinanalysis at day 7, 14 and then 1, 3, 6 and 12 months
57
different rashes in dermatomyositis
1. gottrons papules 2. shawl rash - sun exposed areas 3. heliotrope rash - blue/ purple discolouration of eyelids 4. mechanic hands
58
features of dermatomyositis
1. 1st sign = rashes 2. muscle weakness - proximal muscles (shoulders/ neck) 3. dysphagia, dysphonoa 4. muscle atrophy and tenderness 5. restrictive pulmonary disease 6. fatigue
59
diagnosis of dermatomyositis
diagnosis = muscle biopsy + MRI lower limbs - raised cK - raised ALT (1st to rise), raised LDH, raised aldolase - ANA +ve 80% - myotis specific antibodies e.g. anti Jo-1, anti Mi2
60
management of dermatomyositis
1. corticosteroids 2. methotrexate/ hydroxychloroquine
61
criteria for kawasakis disease
C - conjunctivitis - bilateral, non purulent R - rash - polymorphous rash A - adenopathy - cervical lympahdenopathy, non tender, unilateral or b/l S - strawberry tongue, dry lips H - hands - desquamation of hands and feeds +BURN for >5 days
62
features of polyarteritis nodosa
1. livedo reticularis 2. hypertension 3. weight loss 4. fever 5. aneurysm nodules 6. leg/ arm weakness, fatigue
63
what is polyarteritis nodosa
autoimmune dosease small + medium size vessel vasculitis -> causes transmural fibrinoid necrosis

AKP (12 decks)

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