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Phase 2a mocks > MSK / Rheum > Flashcards

MSK / Rheum Flashcards

1
Q

Which is the genetic component most associated with ankylosing spondylitis?

A

HLA-B27

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2
Q

88M. Severe pain in lower legs, lasting many months. Bowing of the tibia laterally seen on examination

The suspected diagnosis is Paget’s disease, what blood test results would support this (ALP, PTH, Calcium, phosphate, 25-hydroxyvitamin D)

A

Elevated ALP, normal PTH, normal calcium, normal phosphate, normal 25-hydroxyvitamin D

EVERYTHING NORMAL EXCEPT ALP

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3
Q

Loss of knee jerk is is caused is caused by vertebral disc prolapse at what level?

A

L4

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4
Q

An 18 year old male presents at your GP surgery complaining of acute knee pain. The joint is hot, swollen, and tender. He has no other joint symptoms although does complain of some eye pain and painful urination. He undergoes joint aspiration which excludes septic arthritis, and so you suspect reactive arthritis.
Which of the following infections is most likely in this case?
A. Epstein Barr virus
B. Chlamydia
C. Gonorrhoea
D. E.Coli
E. Staphylococcus aureus

A

B. Chlamydia

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5
Q

19F, IVDU with septic arthritis.
A joint aspiration and culture reveals gram negative rod-shaped microorganisms are present within the synovial fluid.
What is the causative agent?
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Neisseria gonorrhoeae
D. Haemophilus influenzae
E. Streptococcus agalactiae

A

A. Pseudomonas aeruginosa

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6
Q

27F. Joint pain affecting both hands, worse in the morning. Movement improves the pain.
Bilateral tenderness over both wrists and 2 DIP joints in the left hand. Occasionally the pain surrounding the DIP joints is accompanied with swelling and inflammation of the whole finger, to such an extent that she can no longer wear rings on them.

Most likely diagnosis?

A

Psoriatic arthritis

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7
Q

59F presents to A&E with transient unilateral loss of vision occurring multiple times in the last 4 hours. She also notes generalised aching in her body that she has just put down to aging, and pain when brushing her hair.

What is the most likely diagnosis? What should be the immediate treatment?

A

Giant cell arteritis

Prednisolone (immediate IV steroids)

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8
Q

74M. Acute shoulder pain for 2 days. Severe with limited mobility due to swelling.

Joint aspiration shows positively birefringent rhomboid crystals under polarised light.
Based on this, what is the likely diagnosis and another likely feature to be seen on XR?

A

Pseudogout

Calcification parallel to articular surfaces

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9
Q

‘you squeeze her metacarpophalangeal joints and she winces in pain’

No rash / skin change.

Most likely diagnosis?

A

Rheumatoid arthritis

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10
Q

Causative organism of reactive arthritis if presenting with urinary symptoms

A

Chlamydia

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11
Q

Causative organism of reactive arthritis if also presenting with GI symptoms (from up to 2wks before onset of joint pain)

A

E.Coli

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12
Q

Causative organism of reactive arthritis if also presenting with glandular fever symptoms

A

EBV

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13
Q

Causative organism reactive arthritis with eye irritation, recent upset stomach.

A

Campylobacter jejuni

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14
Q

Which antibody in the typical screen used in the diagnosis of Sjogren’s syndrome is most specific?

A

Anti-La

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15
Q

Give 2 surgical treatment options for osteoarthritis

A
  • arthroscopy
  • arthroplasty
  • osteostomy
  • fusion
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16
Q

Name 2 ‘hidden’ places where psoriasis can be found

A
  • behind the ear
  • inside the ear
  • nails
  • scalp
  • genitals
  • soles of feet
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17
Q

Give 5 RFs for septic arthritis / osteomyelitis

A
  • IVDU
  • age over 80
  • pre existing joint disease e.g. rheumatoid arthritis
  • diabetes mellitus
  • immunosuppression
  • recent joint surgery
  • prosthetic joint
  • recent intra articular steroid injections
  • penetrating trauma
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18
Q

Name 2 antibodies that many be found in a pt with SLE

A
  • antinuclear antibodies (ANA) - highly sensitive
  • anti double stranded DNA antibodies (anti-dsDNA) - specific
  • anti smith antibodies (anti Sm) - most specific, least sensitive
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19
Q

State the class of drugs which is first line in osteoporosis
Give an example
Give brief instruction for how it should be taken

A

Bisphosphonates e.g. Alendronic Acid
Taken once a week, on an empty stomach

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20
Q

Name 3 characteristic deformities of the hands in rheumatoid arthritis.

A
  • Swan neck deformity
  • Z thumb deformity
  • Boutonnière deformity
  • Ulner deviation
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21
Q

What is the mechanism of Allopurinal?

A

Inhibition of xanthine oxidase, therefore preventing the conversion of hypoxanthine to xanthine to uric acid

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22
Q

What is Allopurinol used for?

A

To treat gout

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23
Q

What is the treatment for acute gout?

A

Colchicine and high dose NSAIDs

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24
Q

What is prescribed to prevent future bouts of gout?

A

Allopurinol

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25
Q

Describe the 3 phases of the Pathophysiology of Pagets

A
  1. Lytic phase: excessive osteoclastic reabsorption
  2. Mixed phase: excessive reabsorption and disorganised bone formation
  3. Blastic/latent: disorganised osteoclastic bone formation, causing weak bone
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26
Q

Give 2 complications of Paget’s

A
  • osteosarcoma
  • fractures
  • tibial bowing
  • deafness
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27
Q

What is the first line treatment in Pagets

A

Bisphosphonates

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28
Q

Define GCA

A

Chronic granulomatous large vessel vasculitis, mainly affecting the carotid arteries and its branched e.g. the temporal artery.

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29
Q

What is the acute management of GCA and why?

A

High dose corticosteroids e.g. Prednisolone
Prevent blindness

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30
Q

Describe the diagnostic criteria for GCA

A
  • > 50 yrs old
  • temporal artery abnormality e.g. tenderness
  • abnormal temporal artery biopsy
  • elevated ESR
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31
Q

What condition that causes shoulder pain is associated with GCA?

A

Polymyalgia rheumatica

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32
Q

What type of hypersensitivity is SLE?

A

Type III

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33
Q

Give 3 signs of SLE

A
  • malar rash
  • fatigue
  • muscle pain
  • lymphadenopathy
  • arthralgia
  • mouth ulcers
  • alopecia
  • lupus nephritis
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34
Q

What marker is used to monitor SLE?

A

ESR

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35
Q

How do you treat arthralgia / skin symptoms associated with SLE?

A

Hydroxychloroquine

36
Q

A 28 year old woman presents to her with her 3rd recurrent miscarriage. She has a history of recurrent DVTs and one pulmonary embolism. On examination you identify a blotchy pattern on her skin. On investigation, her blood results show a prolonged APTT.
Most likely diagnosis?

A

Anti phospholipid syndrome

37
Q

What is the name of the rash seen in anti phospholipid syndrome?

A

Livedo Reticularis

38
Q

What 3 antibodies are associated with anti phospholipid syndrome?

A
  • Lupus anticoagulant
  • Anti-cardiolipin
  • Anti-beta2 GP1
39
Q

What is the main group affected my fibromyalgia?

A

Female, age 30-60

40
Q

List 2 RFs for osteomalacia

A
  • lack of sun exposure
  • lack of dietary intake of vitamin D
41
Q

Which reflex is lost with a nerve root lesion at S1?

A

Ankle jerk

42
Q

What is the clinical test used in Ankylosing SPondilitis to examine spine mobility?

A

Schober’s test

Ask pt tho stand up straight, draw 2 points along their spine - 10cm above and 5cm below the L5 vertebrae. Ask the pt the bend as far forward as they can. If the distance between the two marks is less than 20, this indicates reduced spine mobility and supports a diagnosis of ankylosis spondylitis

43
Q

Osteomyelitis: most common causative organisms in normal pts

A

Staphylococcus aureus

44
Q

Osteomyelitis: most common causative organism in sickle cell pts

A

Salmonella

45
Q

Describe the XR finding is Ewings Sarcoma

A

Lytic bone lesions, onion skin appearance in periosteum

46
Q

Describe the osteosarcoma XR findings

A

‘Sun ray spiculation’
Codman’s Triangle

47
Q

Describe the chondrosarcoma XR findings

A

Popcorn calcifications, endosteal scalloping, Lytic lesion

48
Q

What is the most common sarcoma in children?

A

Rhabdomyosarcoma

49
Q

Describe the difference in inflammatory markers in active lupus and an acute infection in lupus

A

Active lupus: raised ESR, normal CRP

Acute infection: raised ESR, raised CRP

50
Q

What are the risk factors for osteoporosis?

A

SHATTERED

Steroid use
Hyperthyroidism / hyperparathyroidism
Alcohol and smoking
Thin (low BMI)
Testosterone decrease
Early menopause
Renal or liver failure
Erosive / inflammatory bone disease
Dietary calcium decrease / T2DM

51
Q

Give 3 RFs for Paget’s disease

A
  • older age
  • male
  • northern latitude
  • family history
52
Q

What bones are often affected by Pagets ?

A
  • skull
  • spine
  • pelvis
  • femur
  • tibia
53
Q

What disease is associated with cANCA ?

A

Wegeners Granulomatosis (Granulomatosis with polyangiitis)

54
Q

What diseases are associated with pANCA ?

A
  • Microscopic polyangiitis
  • Eosinophilic granulomatosis with polangitis
55
Q

What are the 4 features of anti phospholipid syndrome?

A

CLOT

Coagulopathy
Livedo reticularis
Obstetric emergencies e.g. recurrent miscarriage
Thrombocytopenia

56
Q

What is the treatment for primary anti phospholipid syndrome?

A

Low dose aspirin

57
Q

What is the treatment for secondary anti phospholipid syndrome?

A

Lifelong warfarin

58
Q

What is the 1st line treatment of neuropathic pain?

A

Serotonin 5-HT3 receptor antagonist e.g. Amitryptyline

59
Q

What genes are associated with SLE?

A

HLA B8
HLA DR2
HLA DR3

60
Q

Name 4 features of SLE that are required to make a clinical diagnoses

A

‘A RASH POINTS AN MD’
Arthritis
Renal disorder
ANA+
Serositis
Haematological disorder
Photosensitivity
Oral ulcers
Immunological disorder
Neurological disorder
Malar rash
Discoid rash

61
Q

What are two lifestyle changes that can be made to reduce SLE symptoms?

A
  • decrease sunlight exposure
  • wear high factor suncream
  • decrease cardiovascular risk factor e.g. obesity, smoking, exercise, cholesterol
62
Q

What medications should be given for an acute attack of SLE and what route should they be given

A

IV cyclophosphamide and Prednisolone

63
Q

What causes the articular cartilage damage in OA?

A

Apoptosis of Chondrichthyes
Loss of cartilage

64
Q

What causes joint ‘locking’

A

Loose body/bone/cartilage fragment in the joint

65
Q

T2DM patient on methotrexate. Presents with septic arthritis.
What change should be made to her meds regimen and why?

A

STOP METHOTREXATE

It is immunosuppressive

66
Q

What is now a rare cause of joint infection due to the standard immunisation schedule in the UK?

A

Haemophilus influenzae

67
Q

What is the most specific blood test result for RA?

A

Positive anti-cyclic citrullinted peptide antibody

68
Q

During active SLE, what will the CRP and complement 3 and 4 be?

A

Low serum complement 3 and 4
High CRP

69
Q

Px: Dry eyes, dry skin, vaginal dryness.
Bloods: ANA positive, anti-Ro positive, anti-La positive, anti-dsDNA negative

Most likely diagnosis and which cancer is it associated with?

A

Sjogrens

Lymphoma

70
Q

What kind of cancer is osteosarcoma

A

Malignant tumour of the bone

71
Q

What is Felty’s syndrome and what is the first line investigation?

A

Complication of RA, including splenomegaly and low white cell count

Abdominal US

72
Q

What is the first sign of ankylosing spondylitis on XR?

A

Sacroiliitis (inflammation of sacroiliac joint)

73
Q

ANkylosing spondylitis gene association?

A

HLA B27

74
Q

Reactive arthritis 1st line Tx?

A

NSAIDs

75
Q

What needs to be monitored post fall and long lie?

A

Potassium, creatinine kinase, myoglobin

Rhabdomyolysis increases risk of AKI and cardiac complications

76
Q

What diagnosis would a T score of -2.3 give?

A

Osteopenia

77
Q

What does DEXA stand for?

A

Dual energy X-ray absorptiometry

78
Q

Explain how menopause can cause osteoporosis

A
  • post menopause means lower oestrogen levels
  • increased number of osteoclasts / premature arrest of osteoblastic synthetic activity
  • high bone turnover
79
Q

What test could differentiate osteoporosis from osteomalacia? What result would be each?

A

Blood test-
Ca2+/phosphate/alkaline phosphatase is normal in osteoporosis.
Low Ca/low phosphate/high alkaline phosphatase in osteomalacia

80
Q

Gout preceipitating factors

A
  • trauma
  • surgery
  • starvation
  • infection
  • diuretics
81
Q

Gout prophylaxis medication? What enzyme does it inhibit?

A

Allopurinol

Xanthine oxidase inhibition

82
Q

What is the crystal that causes pseudogout? What is the most common joint involved

A

Calcium pyrophosphate
Knee

83
Q

Chronic gout pathognomic sign?

A

Tophi

84
Q

What muscles are innervated by the musculocutaneous nerve?

BBC: - biceps brachii
- brachialis
- coracobrachialis

A
85
Q

With loss of sensation over the right lateral upper arm, and weakening of flexion, extension, abduction, external rotation, which nerve is damaged and therefore which muscles are weakened?

A

Axillary nerve - there’s minor and deltoid muscle

Sensory loss over the ‘regimental badge’

86
Q

What is the main source of IL-1?

A

Macrophages

Phase 2a mocks (11 decks)

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