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Phase 3b/finals > MSK/Rheum/Ortho > Flashcards

MSK/Rheum/Ortho Flashcards

1
Q

Which joints in the hand are most likely to be affected in osteoarthritis?

A

Proximal and Distal interphalangeals

DIPs and PIPs

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2
Q

Which joints in the hand are most likely to be affected in rheumatoid arthritis?

A

Metocarpal phalangeal joints and Proximal interphalangeals

MCPs and PIPs and wrist

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3
Q

Where are heberden and bouchard’s nodes

A 
Heberden = PIP
Bouchard = DIP
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4
Q

Describe the daily pattern of stiffness/pain in osteoarthritis?

A

less than an hour of pain in the morning, made worse on exercise
Asymmetrical

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5
Q

What are the radiological/X ray features in osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral Cysts

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6
Q

Pattern of stiffness/pain in rheumatoid arthritis?

A

> 1 hour early morning stiffness, relieved on movement, symmetrical

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7
Q

Name the 3 deformities seen in rheumatoid arthritis?

A

Z-thumb/boutonniere deformity
Ulnar deviation
Swan neck deformity

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8
Q

Which antibody is most specific to rheumatoid arthritis?

A

Anti CCP

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9
Q

How is disease monitored in rheumatoid arthritis?

A

CRP and DAS28 score

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10
Q

What monitoring is required with methotrexate?

A

FBC & LFTs Risk of myelosuppression and liver cirrhosis

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11
Q

1st line prevention of osteoporotic fractures in post menopausal women?

A

Alendronate (bisphosphonates)

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12
Q

Blood results in osteoporosis?

A

All normal

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13
Q

Blood results in primary hyperparathyroidism?

A

Increased calcium, ALP and PTH

Decreased phosphate

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14
Q

Blood results in CKD?

A

Low calcium

High phosphate, ALP and PTH

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15
Q

What crystals are responsible for pseudogout?

A

Calcium pyrophosphate

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16
Q

Antibodies present in SLE?

A

Anti phospholipid
Anti nuclear antibodies
Anti double stranded DNA

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17
Q

Inflammatory marker findings in SLE?

A

Raised ESR, normal CRP

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18
Q

How to prevent SLE flares?

A

Avoid sunlight

Hydroxychloroquine

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19
Q

How to test for Sjrogen’s?

A

Schrimer’s test (tear production <5mm)

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20
Q

What is CREST syndrome?

A

Complete manifestation of systemic sclerosis

Calcinosis
Raynaud's
Esophageal dysfunction
Sclerodactyly
Telangiectasia
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21
Q

Diagnostic antibodies in Systemic sclerosis?

A

Anti topoisomerase antibodies (ATA)

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22
Q

WHat is polymyositis?

A

Inflammation of skeletal muscle

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23
Q

What muscles are affected in polymyositis?

A

Shoulder and neck

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24
Q

Diagnosis of polymyositis?

A

CPK - Creatinine phosphokinase positive

RF and ANA NEGATIVE

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25
Q

What diseases are associated with HLA B27

A

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis

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26
Q

Clinical features of ankylosing spondylitis? (SPINE ACHE)

A 
Saussage digit
Psoriasis
Inflammatory back pain
NSAID response
Enthesitis (heel)
Arthritis
Crohns/Colitis association/raised CRP
HLA B27
Eye (uveitis)
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27
Q

What are the first joints affected in ankylosing spondylitis?

A

Sacroiliac joints

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28
Q

What is the triad of reactive arthritis?

A

Arthritis + conjunctivitis + urethritis

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29
Q

Most common causes of reactive arthritis?

A

Salmonella, shigella and chlamydia

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30
Q

What would you see on X ray of the finger in psoriatic arthritis?

A

Pencil in cup deformity

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31
Q

How do bisphosphonates work?

A

Inhibit osteoclasts

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32
Q

Side effects of bisphosphonates

A

Oesophagitis
Osteonecrosis of the jaw
atypical stress fractures

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33
Q

What do pseudogout crystals look like?

A

weakly positive birefringent rhomboid shaped

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34
Q

Blood results in osteomalacia?

A

low calcium, low phosphate

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35
Q

Name 2 drugs contraindicated in prescribing methotrexate?

A

Trimethoprim
Co trimoxazole
High dose aspirin

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36
Q

Describe gout crystals?

A

Negative birefringence, needle shaped

37
Q

Which antibody is present in nearly 100% of those with Sjrogen’s?

A

Rhematoid factor

38
Q

Paget’s disease treatment?

A

Bisphosphonate

39
Q

What may predispose pseudogout?

A

hyperparathyroidism

40
Q

First line treatment of raynaud’s?

A

CCB e.g. nifedipine

41
Q

What virus is associated with polyarteritis nodosa?

A

Hepatitis B

42
Q

Causes of drug induced lupus?

A

Isoniazid, procainamide, hydralazine

43
Q

What drug interacts with azathioprine?

A

Allopurinol

44
Q

What drug is used as gout prophylaxis?

A

Allopurinol

45
Q

Acute gout treatment?

A

Colchicine

46
Q

How does colchicine work?

A

Inhibits mitosis, limits neutrophil mobility

47
Q

Guve examples of type 1 hypersensitivity

A

Atopy and anaphylaxis

48
Q

give an example of type 2 hypersensitivity?

A

Goodpasture’s syndrome

49
Q

Give an example of type 3 hypersensitivity

A

SLE

50
Q

Type 4 hypersensitivity example

A

TUBERCULOSIS

51
Q

Triad of symptoms in Bechet’s syndrome?

A

oral ulcers, genital ulcers and anterior uveitis

52
Q

What infection is associated with polyarteritis nodose?

A

Hepatitis B

53
Q

What antibody is associated with Wegener’s granulomatosis?

A

cANCA

54
Q

What antibody is associated with Churg-Strauss syndrome

A

pANCA

55
Q

Where is the pain felt in polymyalgia rheumatica?

A

Neck, shoulders and hips i.e. [roximal muslces

56
Q

What activities would a patient with polymyalgia rheumatica struggle with?

A

Combing hair, climbing stairs, getting out of chairs

57
Q

What medication is associated with an increased risk of gout?

A

Thiazides and chemotherapy

58
Q

What are gout crystals composed of?

A

Monosodium urate

59
Q

What are pseudogout crystals made of?

A

Calcium pyrophosphate

60
Q

treatment of psuedogout?

A

Intraarticular corticosteroids

61
Q

Blood results in paget’s disease of bone?

A

Isolated raised alkaline phosphatase (ALP) reflecting osteoblast activity

62
Q

Treatment of paget’s disease?

A

Bisphosphonates

63
Q

X ray features of osteomyelitis

A

Mixed lucency
New bone formation
Cortical erosion

64
Q

Most common causative organism of septic arthritis in native joints?

A

S.aureus

65
Q

Proximal muscle weakness + skin lesions =?

A

Dermatomyositis

66
Q

Blood test results seen in antiphospholipid syndrome?

A

raised APTT and thrombocytopenia

67
Q

Side effect of colchicine

A

diarrhoea

68
Q

Antibodies positive in SLE?

A

anti DNA RF and ANA

69
Q

First line treatment of ankylosing spondylitis?

A

NSAIDs and exercise

70
Q

Anti JO1 antibodies are more specific to…

A

polymyositis

71
Q

Anti Ro/Anti La are specific to…

A

Sjrogens

72
Q

How to distinguish gout and psuedogout on x ray?

A

Chondrocalcinosis is present in pseudogout (calcium deposits in the joint space)

73
Q

What score confirms a diagnosis of osteoporosis?

A

t-score -2.5

74
Q

1st line bisphosphonate drug used in osteoporosis?

A

alendronate

75
Q

1st line treatment of acute reactive arthritis?

A

Ibuprofen/NSAIDs

76
Q

Treatment of Raynaud’s?

A

CCB - Nifedipine

77
Q

Where does the sclerosis stop in limited cutaneous systemic sclerosis?

A

at the elbows.

Sclerosis affects face and distal limbs

78
Q

What antibody is present in drug induced lupus?

A

Anti histone

79
Q

Name a drug that interacts with azathioprine?

A

allopurinol

80
Q

What should be tested before azathioprine is commenced?

A

TPMT - thiopurine methyltransferase

81
Q

What score is used to assess hypermobility?

A

Beighton score

82
Q

Antibody in antiphospholipid syndrome?

A

Anti-Cardiolipin antibody

83
Q

low calcium, low phosphate, raised ALP?

A

Osteomalacia

84
Q

What underlying thing would you be worried about in a patient with dermatomyositis?

A

malignancy!

85
Q

Which muscle is responsible for the first 20 degrees of shoulder abduction?

A

Supraspinatus

86
Q

4 features of antiphospholipid syndrome?

A 
CLOT:
Coagulation defect (raised APTT)
Livido reticularis
Obstetric complications
Thrombocytopenia
87
Q

Which antibody is associated with diffuse systemic sclerosis?

A

Anti-Scl70

88
Q

Cardiac complication of EDS?

A

Aortic regurgitation

89
Q

What would cause pain in lateral epicondylitis?

A

extending wrist against resistance with the elbow extended

Phase 3b/finals (19 decks)

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