MSK/Rheumatology

Question 1

give 4 causes of Raynaud’s phenomenon

Answer 1

SLE, systemic sclerosis, RA, polycythaemia rubra vera, hypothyroidism, Buerger’s disease.

primary = Raynaud’s disease

Question 2

explain the pathophysiology of Raynaud’s

Answer 2

peripheral digital ischaemia due to vasospasm precipitated by cold and relieved by heat

Question 3

what are the clinical features of Raynaud’s?

Answer 3

skin pallor, then cyanosis, then hot and red.

numbness then burning sensation and severe pain due to hyperaemia.

Question 4

how would you manage a patient with Raynaud’s?

Answer 4

keep hands and feet warm - gloves, heating pads.
smoking cessation.
nifedipine - CCB, vasodilates.

Question 5

what class of drugs should be stopped in patients with Raynaud’s?

Answer 5

beta blockers

Question 6

how would you differentiate polymyalgia rheumatica from a myositis/myopathy?

Answer 6

creatinine kinase levels are NORMAL in PMR - would be raised in myositis/myopathy.

Question 7

name 2 bisphosphonates. what are they used to treat?

Answer 7

alenronate, zoledronate, disodium pamidronate.
used for osteoporosis, severe hypercalcaemia of malignancy, myeloma and breast cancer bone metastases to reduce pathological fractures.

Question 8

how do bisphosphonates work?

Answer 8

reduce bone turnover by inhibiting osteoclasts and promoting apoptosis.
reduce bone loss and improve bone mass.

Question 9

what is strontium ranelate used to treat?

Answer 9

severe osteoporosis