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1
Q

Bouchard’s and Heberden’s, which joints do they affect? Which disease condition do you find them in?

A

Osteoarthritis

Bouchard’s - Proximal Interphalangeal Joints
Heberden’s - Distal Interphalangeal Joints

[B before H in alphabet]

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2
Q

Give two signs on X-ray of osteoarthritis

A

Loss of joint space
Osteophytes
Subaticular sclerosis
Subchondral cysts

[LOSS]

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3
Q

Name two diagnostic tests for rheumatoid arthritis

A

Anti-Cyclic Citrullinated Peptide Antibody (ACCP) - Most specific test

Rheumatoid factor

Anti Nuclear Antibodies

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4
Q

Name two DMARDs

A

Methotrexate
Hydroxychloroquine
Sulphasalazine
Azathioprine

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5
Q

Give two clinical signs of rhumatoid arthritis

A

Pain worse in morning (lasting >30mins)

Tends to affect proximal interphalangeal joints + writsts.

Swan neck deformity

Responds to NSAIDs

Ulnar Deviation

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6
Q

Give two extra-articular complications of rheumatoid arthritis

A

Pericarditis

Pulmonary fibrosis (esp in smokers)

Scleritis

Amyloidosis

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7
Q

Which is more specific for rheumatoid arthritis, ACCP or RF?

A

ACCP is more specific than RF.

[RF is +ve in about 80% of patients. Having a negative RF doesn’t mean you don’t have RA]

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8
Q

What is Felty Syndrome?

A

Triad of:

1) Rheumatoid Arthritis
2) Splenomegaly
3) Neutropenia

[AKA Super Rheumatoid]

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9
Q

What is the most common causative organism of septic arthritis?

A

Staph aureus (G+)

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10
Q

What is the first line treatment for septic arthritis?

A

Empirical antibiotics:
Vancomycin (G+)
Ceftriaxone (G-)
Debridement

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11
Q

True or false methotrexate is safe in pregnancy or breast feeding?

A

False. It is teratogenic.

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12
Q

True or false, it is safe to give methotrexate and trimethoprim together?

A

False. Both impair folate metabolism.

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13
Q

Name two biological DMARDs

A

Anti-TNF (infliximab, golimumab) - most common

B-cell inhibitors: Rituximab
T-cell inhibitors: Abatacept
IL6 inhibitos: Tocilizumab
JAK inhibitors: Baricitinib

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14
Q

True or false, DMARDs must be stopped when a patient is acutely unwell, has an infection or is going into surgery?

A

True.

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15
Q

True or false, biological DMARDs like rituximab increase the risk of organ cancers?

A

False. No evidence of this.

They do increase the risk of non-melanoma skin cancers.

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16
Q

What is the treatment of MRSA?

A

Vancomycin or Clindamycin

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17
Q

How does De Quervain Tendinopathy present?

A

Pain on the radial side of the wrist which radiates up the arm and is worse on use.

Caused by repetitive movements and caused by inflammation of the tendon sheaths of the thumb.

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18
Q

Give two risk factors for trigger finger (stenosing tenosynovitis)

A 
Diabetes type 2
Thyroid disease
Inflammation 
Renal disease
Injury
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19
Q

Why is trigger finger called that? How does trigger finger differ from Dupuytren’s contracture?

A

The tendon makes a popping sound on extension.

Trigger finger is painful on flexion.

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20
Q

Lateral epicondylitis and Medial epicondylitis are also known as?

A

Tennis elbow (BaboLateral!)

Golfer’s elbow

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21
Q

What are tophi?

A

Uric acid crystals deposited in joints in gout

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22
Q

What is the first line treatment for acute gout?

A

NSAIDs (1st)
Colchicine
Steroids

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23
Q

What is the treatment for chronic gout?

A

Allopurinol

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24
Q

What enzyme is blocked by allopurinol?

A

xanthine oxidase - reduces uric acid production

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25
True or false, NSAIDs are contraindicated in patients with peptic ulcers?
True
26
Give two lifestyle changes for gout
Exercise Reduce purine rich foods Avoid alcohol
27
What do you find on birefringence in gout following synovial aspirate?
Negative birefringence | Spindles
28
What crystals cause pseudo-gout?
Calcium pyrophosphate
29
What do pseudo-gout crystals look like under microscope/polarised light?
Postive birefringence | Rhomboid shape
30
True or false, hypothyroidism is a risk factor for pseudo-gout?
True
31
Give two signs of ankylosing spondylitis
[SPINE ACHE] ``` Sausage digits Psoriasis Inflammatory back pain NSAID responsive Enthesitis (esp heel) ``` Arthritis CRP raised HLAB27 Eyes (uveitis)
32
What sign of ankylosing spondylitis would you expect to see on a spinal X-ray?
Bamboo spine (calcification of the spinous ligaments)
33
What is the cause of ankylosing spondylitis?
Human Leukocyte Antigen B27 - 90% of cases.
34
True or false, ankylosing spondylitis is a seronegative condition?
True. RF negative
35
What level of T-score is diagnostic of osteoporosis?
-2.5 SD
36
What causes osteoporosis?
Increased osteoclast activity vs osteoblast activity.
37
Give two risk factors for osteoporosis
``` Steroid use Alcohol Early menopause Rheumatoid arthritis Malnutrition ```
38
Give two treatments for osteoporosis
Bisphosphonates Vit D + Calcium HRT Exercise
39
What is the FRAX score?
10 year risk of a fracture ``` Age Sex BMI Previous fracture Parent hip fracture Smoker Steroids RA Secondary osteoporosis Alcohol >3U/d Femoral neck BMD ```
40
What is osteomalacia?
Softening of bone due to reduced mineral content
41
What investigations would you carry out to investigate osteomalacia?
X-ray Blood calcium Vit D Phosphate levels
42
What is the difference between raynaud's syndrome and phenomenon?
Syndrome - idiopathic | Phenomenon - induced by a stressor e.g. cold, stress.
43
What is Reiter's syndrome? What is the triad of symptoms?
Secondary inflammation caused by an infection e.g. chlamydia or salmonella causing arthritis. Can't see (Conjunctivitis) Can't pee (Urethritis) Can't climb a tree (Arthritis)
44
What is the gold standard investigation for Giant Cell Arteritis?
Biopsy
45
What is the treatment for giant cell arteritis?
Steroids (prednisone) Bisphosphonates PPI
46
What type if vasculitis are Antineutrophil Cytoplasm Antibodies (ANCA) associated with?
Small vessel - Granulomatosis with polyangiitis (Wegener's) - Microscopic polyangiitis
47
What vasculitis is commonly associated with a saddle nose?
Granulomatosis with Polyangiitis (Wegener's) - Caused by granulomas
48
Name a medium vessel vasculitis
Polyarteritis Nodosa (PAN)
49
What type of hypersensitivity reaction is Lupus?
Type 3 (complement)
50
Give two signs of Lupus
``` Malar rash Photosensitivity Discoid eczema Arthralgia ESR raised CRP normal ```
51
True or false, women in childbirth are 10x more likely to get lupus?
True
52
What inheritance pattern does Marfan's follow?
AD
53
What mutation is responsible for Marfan's?
FBN1 | Changes fibrillin
54
Give three signs of marfans
``` Tall stature Pectus excavatum/carinatum Flexible joints Mitral valve prolapse AAA High palate ```
55
What diagnostic criteria are used to diagnose marfans?
Ghent criteria
56
What treatment would you give a patient with marfan's?
BBlocker / CCB | + ACEi
57
What treatment would you offer a patient with fibromyalgia?
Pregabalin Amitriptyline Duloxetine
58
True or false, cauda equina requires a same day surgical referral?
True
59
Give two sigsn of cauda equina syndrome
``` Bilateral sciatica-like pain Saddle anaethesia Bladder / Bowel incontinence Sexual dysfunction Reduced reflexes Loss of tone/power ```
60
How do reflexes differ in cauda equina syndrome vs cord compression?
Cauda equina = reduced reflexes Compression = Brisk reflexes.

MSK (P4) (1 decks)

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