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Elderly, Neuro & MSK > MSK & Rheumatology > Flashcards

MSK & Rheumatology Flashcards

1
Q

Osteoporosis vs osteopenia

A
  • Osteoporosis: significant reduction in bone density.
  • Osteopenia: less severe decrease in bone density.
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2
Q

Why is oestrogen protective against osteoporosis?

A

Reduces bone resorption by inhibiting osteoclast activity.

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3
Q

How does tamoxifen prevent osteoporosis?

A

It’s a selective oestrogen receptor modulator (SERM) that blocks oestrogen receptors in breast tissue, but stimulates oestrogen receptors in the uterus and bones.

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4
Q

Name 2 investigations for osteoporosis

A
  • DEXA scan of hip and spine.
  • Lateral lumbar and thoracic vertebral radiographs.
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5
Q

Name the sero-negative inflammatory arthritises

A
  • Psoriatic arthritis
  • Ankylosing spondylitis
  • Reactive arthritis

Related to HLA B27

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6
Q

Describe the NSAIDs response to inflammatory arthritis compared to OA

A

Inflammatory arthritis has a better response to NSAIDs compared to OA.

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7
Q

Which joints are commonly affected in RA?

A

Wrist, MCP, PIP, MTP

Symmetrical, polyarthritis.

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8
Q

Which joints are commonly affected in OA?

A

Weight bearing joints (hips, knees, cervical & lumbar spine), 1st MCP (thumb), 1st MTP (big toe).

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9
Q

Describe the link between arthritis and eye disease

A
  • Scleritis - RA
  • Uveitis - sero-negative arthropathies
  • Conjunctivitis - reactive arthritis
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10
Q

Hand changes in RA?

A
  • Ulnar deviation
  • Rheumatoid nodules
  • Swan neck deformity
  • Boutonniere deformity
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11
Q

Management for RA

A
  • NSAIDs
  • Steroids
  • DMARDs (methotrexate, sulfasalazine, hydroxychloroquine)
  • Biologic therapies (anti-TNF, rituximab, anti IL-6)
  • Physio/OT
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12
Q

Palpable purpura

A

Vasculitic rash.

If non-palpable - thrombocytopenia.

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13
Q

Name 2 types of ANCA positive vasculitis

A
  • Granulomatosis with polyangiitis (GPA, Wegener’s) - also PR3.
  • Microscopic polyangiitis (MPA) - also MPO.
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14
Q

Where does GPA most commonly affect?

A
  • Head and shoulders
  • Also commonly affects kidneys
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15
Q

Palpable purpuric a rash and abdominal pain

A

Polyarteritis nodosa (PAN)

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16
Q

Asthma and vasculitis symptoms

A

Eosinophilic granulomatosis with polyangiitis (EGPA)

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17
Q

Describe the rash in SLE

A

Facial ‘butterfly’ rash across the cheeks, that spares the nasolabial folds.

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18
Q

Which cancers metastasise to bone?

A

Breast, thyroid, prostate, lung

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19
Q

Where does the sciatic nerve originate?

A

L5-S1

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20
Q

Causes of back pain

A
  • Sciatica
  • Ankylosing spondylitis
  • Mechanical
  • Cauda equina
  • Tumours
  • Infection e.g. discitis, osteomyelitis
  • Disc herniation
  • Degenerative e.g. OA
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21
Q

Gout synovial fluid?

A

Negatively birefringent crystals

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22
Q

Name one important risk factor for osteoporosis

A

Previous fragility fracture

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23
Q

What is the staining like in SLE?

A

Speckled

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24
Q

What is the staining like in scleroderma?

A

Nucleolar (diffuse) or centromere (limited)

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25
Q

Scl 70

A

Scleroderma

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26
Q

RNP

A

Mixed connective tissue disease (MCTD) or overlapping RA/SLE (RUPUS)

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27
Q

Ro

A

Rash - SLE/Sjogren’s

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28
Q

La

A

Sjogrens

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29
Q

Sm

A

SLE

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30
Q

Jo 1

A

Polymyositis

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31
Q

dsDNA

A

SLE

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32
Q

Outline CREST syndrome

A
  • Calcinosis
  • Raynauds
  • Oesophageal dysmotility
  • Sclerodactyly
  • Telangiectasia
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33
Q

What is the most common cause of heel pain in adults?

A

Plantar fasciitis

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34
Q

Which meniscus tear can cause a locked knee?

A

Bucket handle tear

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35
Q

XR findings for OA?

A
  • Osteophytes
  • Loss of joint space
  • Sclerosis
  • Cysts
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36
Q

What factors may predict worse disease in RA?

A

Disease activity, +ve Abs and erosions on XR.

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37
Q

What is the most common cause of death in RA?

A

Accelerated atherosclerosis and associated IHD.

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38
Q

What test should be performed prior to starting biologics in RA?

A

CXR - due to risk of TB reactivation.

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39
Q

What is the most widely used DMARD?

A

Methotrexate

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40
Q

What monitoring is required with methotrexate?

A
  • FBC - myelosuppression.
  • LFTs - liver cirrhosis.
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41
Q

Haemochromatosis is a risk factor for what?

A

Pseudogout

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42
Q

‘Can’t see, pee or climb a tree’ are features of what condition?

A

Reactive arthritis

43
Q

Name 2 skin conditions associated with reactive arthritis

A
  • Circinate balanitis (painless vesicles on the coronal margin of the prepuce).
  • Keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles).
44
Q

Anti-centromere antibodies

A

Limited (central) systemic sclerosis

45
Q

What is the initial management for RA?

A

Conventional DMARD monotherapy (usually methotrexate), often with short-term bridging corticosteroid.

46
Q

Old man, bone pain, raised ALP

A

Paget’s disease

47
Q

What is a useful rule out test for SLE?

48
Q

Which test is useful to rule in SLE?

A

Anti-dsDNA

49
Q

A raised CRP in a patient with SLE may indicate what?

A

An underlying infection (as during active disease CRP may be normal).

50
Q

Which tool screens for psoriatic arthritis in patients with psoriasis?

A

Psoriasis Epidemiological Screening Tool (PEST)

51
Q

Name the seronegative spondyloarthropathies

A
  • Ankylosing spondylitis.
  • Psoriatic arthritis.
  • Reactive arthritis.
  • IBD-associated spondyloarthropathy.

‘Seronegative’ refers to both the lack of rheumatoid factor positivity and the absence of specific antibodies for each disease. They’re associated with the HLA-B27 gene.

52
Q

Abs for Antiphospholipid syndrome

A
  • Anticardiolipin antibodies
  • Anti-beta2 glycoprotein I antibodies
  • Lupus anticoagulant
53
Q

Diagnosis of ankylosing spondylitis can be best supported by what?

A

Sacro-ilitis on a pelvic X-ray

54
Q

Describe the adverse effects of methotrexate

A

Mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, liver fibrosis.

55
Q

Which drugs are used in for the management of pathological fractures?

A

Bisphosphonates and denosumab

56
Q

Patients receiving IV bisphosphonates in the treatment of cancer have a greater risk of which side effect?

A

Osteonecrosis of jaw

57
Q

List the poor prognostic features for RA

A
  • Rheumatoid factor positive
  • Anti-CCP antibodies
  • Poor functional status at presentation
  • X-ray: early erosions (e.g. after < 2 years)
  • Extra articular features e.g. nodules
  • HLA DR4
  • Insidious onset
58
Q

Low serum calcium, low serum phosphate, raised ALP and raised PTH

A

Osteomalacia

59
Q

When is the pain worst for lateral epicondylitis?

A

On resisted wrist extension/supination whilst elbow extended.

60
Q

Malignancy + raised CK

A

Polymyositis

61
Q

Management of psoriatic arthropathy

A
  • Mild - NSAIDs
  • Moderate/severe - methotrexate
62
Q

What blood test should be checked before starting Azathioprine?

A

Thiopurine methyltransferase deficiency (TPMT)

63
Q

Azathioprine may interact with which drug causing bone marrow suppression?

A

Allopurinol

64
Q

Blood test values in osteoporosis?

A

Normal blood test values (e.g. normal ALP, normal calcium, normal phosphate, normal PTH).

65
Q

What is the differential diagnosis for gout?

A

Septic arthritis

66
Q

What is the gold standard investigation for gout?

A

Joint aspiration - needle-shaped monosodium urate crystals that are negatively birefringent under plane-polarised light.

67
Q

Management of patients >= 75 years following a fragility fracture?

A

Start alendronate without waiting for a DEXA scan.

68
Q

Management of patients < 75 following a fragility fracture?

69
Q

What Schober’s test value is indicative of ankylosing spondylitis?

70
Q

Normal calcium, normal phosphate, raised ALP and normal PTH

A

Paget’s disease

71
Q

What should be used whilst starting allopurinol?

A

NSAID or colchicine cover

72
Q

Marfan’s syndrome is caused by a mutation in which protein?

73
Q

Outline the features of Marfan’s syndrome

A
  • Tall stature
  • High-arched palate
  • Arachnodactyly
  • Pectus excavatum
  • Pes planus
  • Aortic sinus dilation - aortic aneurysm, aortic dissection, aortic regurgitation
  • Mitral valve prolapse
  • Pneumothorax
  • Upwards lens dislocation
  • Dural ectasia
74
Q

Raised serum calcium, low serum phosphate, raised ALP and raised PTH

A

Primary hyperparathyroidism (e.g. parathyroid adenoma - most common)

75
Q

When is the pain worse for medial epicondylitis?

A

Wrist flexion and pronation

76
Q

Name the risk factors for pseudogout

A
  • Haemochromatosis
  • Hyperparathyroidism
  • Low magnesium, low phosphate
  • Acromegaly, Wilson’s disease
77
Q

Describe the T and Z scores for osteoporosis

A
  • T-score is a comparison of a person’s bone density with that of a healthy 30-year-old of the same sex.
  • Z-score is a comparison of a person’s bone density with that of an average person of the same age, sex, and race.
78
Q

Management of Raynaud’s phenomenon

A

Nifedipine

79
Q

Name the adverse effects of Azathioprine

A
  • Bone marrow suppression
  • N+V
  • Pancreatitis
  • Increased risk of non-melanoma skin cancer
80
Q

What are the triad of features in Still’s disease

A

Fever, polyarthralgia and salmon-pink rash.

Also elevated serum ferritin.

81
Q

Bone pain, tenderness and proximal myopathy (→ waddling gait)

A

Osteomalacia

82
Q

Management of antiphospholipid syndrome

A
  • Primary thromboprophylaxis: low-dose aspirin.
  • Secondary thromboprophylaxis: lifelong warfarin.
83
Q

What is the most common cause of lateral knee pain in athletes?

A

Iliotibial band syndrome

84
Q

Osteosarcoma vs Ewing’s sarcoma

A
  • Osteosarcoma: most common primary malignant bone tumour, metaphyseal region of long bones, Colman triangle and sunburst pattern on XR.
  • Ewing’s sarcoma: diaphysis of pelvis and long bones, onion skin appearance on XR.
85
Q

If a patient is allergic to sulfasalazine, which other drug will they be allergic to?

86
Q

Which drugs can cause drug-induced lupus?

A
  • Procainamide
  • Hydralazine
  • Isoniazid
  • Minocycline
  • Phenytoin
87
Q

Describe the features of Osteogenesis imperfecta

A

Presents in childhood with features such as bone fractures and deformities, blue sclera and hearing/visual problems.

88
Q

Outline the management of patients at risk of corticosteroid-induced osteoporosis

A
  1. Patients > 65 years or those who’ve previously had a fragility fracture should be offered bone protection.
  2. Patients under < 65 years should be offered a bone density scan (DEXA).
89
Q

What is the treatment choice for SLE?

A
  • Hydroxychloroquine.
  • If internal organ involvement e.g. renal, neuro, eye, then consider prednisolone, cyclophosphamide.
90
Q

Risk factors for Dupuytren’s contracture

A
  • Manual labour
  • Phenytoin treatment
  • Alcoholic liver disease
  • Diabetes mellitus
  • Trauma to the hand
91
Q

List the red flags for back pain

A
  • Age < 20 years or > 50 years
  • History of previous malignancy
  • Night pain
  • History of trauma
  • Systemically unwell e.g. weight loss, fever
  • Thoracic pain
  • Non-mechanical pain
  • Pain worse when supine
  • Presence of neurological signs
  • Past medical history of HIV
  • Immunosuppression or steroid use
  • IV drug use
  • Structural deformity
92
Q

Causes for avascular necrosis

A
  • Long-term steroid use
  • Chemotherapy
  • Alcohol excess
  • Trauma
93
Q

What findings are most consistent with frozen shoulder (adhesive capsulitis)?

A

Active and passive movement limited & external rotation most affected.

94
Q

Treatment of Paget’s disease

A

Bisphosphonates

95
Q

Name one adverse effect of Hydroxychloroquine

A

Retinopathy

96
Q

In osteoporosis, when should the 10 year fracture risk be reassessed for patients taking alendronate?

A

After 5 years

97
Q

Name the most common ocular complication from temporal arteritis

A

Anterior ischaemic optic neuropathy - fundoscopy shows a swollen pale disc and blurred margins.

98
Q

Treatment for temporal arteritis

A
  • No visual loss : high-dose prednisolone.
  • Visual loss: IV methylprednisolone, urgent ophthalmology review.
99
Q

Knee pain after exercise, locking and ‘clunking’

A

Osteochondritis dissecans

100
Q

How can nerve root pain be distinguished from other pain in the leg?

A

By the dermatomal distribution and associated neurological deficit

101
Q

CK level in PMR

102
Q

What drug should be avoided when taking methotrexate?

A

Trimethoprim - may cause bone marrow suppression and severe or fatal pancytopaenia.

103
Q

First line management for back pain

104
Q

RA, splenomegaly and low white cell count

A

Felty’s syndrome

Elderly, Neuro & MSK (5 decks)

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