MSK/ rheumatoid/ immunology

Question 1

Systemic manifestations of RA?
What can you see on bloods?

Answer 1

Eyes- sojrens, scleritis
sKin - nails, felty’s (leg ulcers)
Nodules - vocal chords, eyes,
Neuro - mononeuritis multiplex, polyneuropathy
Resp - PF, obliterative bronchiolitis
CVD - vascultiis, myocardial fibrosis,
kidneys - amyliodosis
Liver - ALT/AST raised, ALP raised
OP, depression, thryoid, splenomegaly
Bloods - RF, raised ferritin, leukopenia, reactive thrombocytopenia, anaemia

Question 2

Felty’s syndrome (SANTA mnuemonic?) complication of RA

Answer 2

Splenomegaly, anaemia, neutropenia, thrombocytopenia, arthritis (rheumatoid)

Question 3

Numbness on left side of chin? nerve affected? (punched side of chin)

Answer 3

Mental nerve (chin and lip)
comes down level of mandibular 2nd premolars

Question 4

<17YO morbilliform rash, fever, leukocytosis, anaemia, hepatosplenomegaly. followed by arthirits?

Answer 4

Still’s disease

Question 5

Ank spond disease profile? (modified NY criteria?)
extra articular manifestations
score to determine effectiveness of drug therapy and functionality?

Answer 5

<15 - 25 YO back pain 3m+, limited ROM lumbar spine, limited chest expansion for sex and age. sacroilitis.
EA SX: OP, renal amyloid, acute anterior uvitis, restrictive lung disease, cauda equina, aortic lung insufficiency

scores: BASDAI (disease activity index) and BASFI (functionality index)

Question 6

Synovial fluid - needle shaped, negatively bifringent

Answer 6

Gout

Question 7

Pseudogout synovial fluid?

Answer 7

positive bifringeent, rhomboid shaped. calcium pyrophosphate

Question 8

Indications for DEXA scan?

what predisposes to 2ndary OP?

Answer 8

<75YO hx of low trauma fracture , BMI<19, long term CS, post menopausal women with FH of hip fracture, XR with osteopenia/ vertebral collapse, oestrogen deficiency (premature ovarian failure)

2ndary OP: malabsopriton, antiepileptics, RA, PTH hig, TFTs, CKD, cushings, immobile

Question 9

Central chord syndrome?

Answer 9

upper extremities - motor impairment more than lower
bladder dysfunction/ urine retention.
most common type of incomplete spinal syndrome, cervical spondylisis/ OA of neck/ hyperextension injury

Question 10

Anterior chord syndrome

Answer 10

hyperflexion injury of spine/ anterior spinal A ischaemia
B/L loss of pain, temp/ motor below injury. intact proprioception and vibration

Question 11

Sciatica causes?

Answer 11

slipped disc (most common), spondylolisthesis, spinal stenosis, infection, cancer. pain better leaning forward

Question 12

Limited cutaneous systemic sclerosis / CREST syndrome?

Answer 12

ANTI Scl70, anti-centromere, ANA, barium swallow - dysphagia, calcified nodules, raynauds, esophageal dysmotility, sclerodactyl, telangactasia

Question 13

Otawa knee rules?

Answer 13

55+, unable to flex 90 degrees, unable to weight bear, tender at patella and head of fibula

Question 14

Adults: CT head rules? within 1 hr?
within 8 hrs?

Answer 14

GCS<13 at r/v / <12 2 hrs after accident.open/ depressed skull fracture, basal skull fracture signs, siezure, 1x vomit, neurolgoy,
within 8 hrs if: on warfarin/ 65+/ beleding/ clotting disorders/ 30min+ retrograde amnesia/ dangerous mechanism

Question 15

Child CT rules within 1 hr?

Answer 15

<1YO with bruise/ swelling 5cm+ on head. skull fracture/ depressed. GCS<15 immediastely or 2 hrs after injury.

head injury+ LOC 5min/ vomit x3, amnesia 5min+, dangerous mechanism. if onyl 1 RF, then observe for 4 hrs, cT if further drowsiness/ vomitting/ GCS drop

Question 16

When to avoid colchicine?

Answer 16

Blood disorders, EFGR <10, renal impariment, pregnant/ breastfeeding, hepatic impairment, with clarithromycin/ erythromycin/ verapamil, ketokonazole,

Question 17

Colles fracture?

Answer 17

dorsally displaced distal radius fracture, dinnerfork deformity

Question 18

20YO black woman, oral ulcer, facial rash, painful joints.Posiitve ANA?

Answer 18

Anti ds-dna/ anti sm/ anti phospholipid antibodies.
SLE. mild normochromic normocytic anaemia. reduced C3 and C4
Risk of premature atheroscrelorsis

Question 19

high heels wearing, pain electric current between 2nd and 3rd toes?

Answer 19

Morton;s neuroma (irritation of interdigital nerve due to metatarsal head compression). can elicit a click on metatarsal head squeeze

Question 20

30YO japanese man, iritis, oral and genital ulcers, pain in knee joints, erythema nodosum on both shins

Answer 20

behcet’s disease. multisystem vasculitis. also: neuro SX, need cS. behavioural changes in 50%pethargy reaction (rash worse after needle)

Question 21

14YO girl chronic pain and stiff in left foot following injury

Answer 21

Freiberg’s disease - osteochondrosis articular surfaces of 2nd or 3rd toes.

Question 22

Barton’s fracture

Answer 22

intra-articular fracture of distal radius

Question 23

Bennets and rolando fracture?

Answer 23

intra-articular fracture of base of 1st metacarpal.
2 parts - bennets. needs thumb spica cast
3 parts - fist fight/ forced thumb abduction. needs ORIF

Question 24

Mallet finger

Answer 24

sudden flextion of DIP of finger. cant extend finger at DIP due to damage to extensor mechanism. tX - keep splint in slight extension for 6 weeks. heals

Question 25

Sulfasalazine SE?

Answer 25

pneumonitis/ oligospermia/ rashes/ heinz body anaemia,

Question 26

As of ank spond?

Answer 26

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)

Question 27

Drug that causes Exacerbation of myasthenia gravis

Answer 27

Penicillamine

Question 28

SLE features

Answer 28

discoid rash, malar rash, oral ulcers nose ulcers, arthritis, renal/ proteinuria/haemolytic anaemia, anti ds dna, c3/c4 decreased
Risks: premature asthersclerosis