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GRACE Phase 2a Medicine > MSK/Rheumatology > Flashcards

MSK/Rheumatology Flashcards

1
Q

blood test for rheumatoid arthritis?

A

Anti CCP (most sensitive), rheumatoid factor, raised ESR/CRP

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2
Q

Management of RA

A

Ibuprofen/NSAIDs
Steroids
Methotrexate (DMARDs)
Rituximab (biologics)

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3
Q

Gout

A

intra-articular build up of monosodium urate crystals, associated with hyperuricaemia

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4
Q

Gout presentation

A

1st metatarsal and distal interphalangeal joints often inflamed, formation of tophi (lumps of urate salt)

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5
Q

Management of gout

A

Lifestyle changes (e.g. eat less red meat), NSAIDs (colchicine), allopurinol (xanthine oxidase inhibitor)

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6
Q

Investigations for gout

A

Joint aspiration and polarised light microscopy (needle live negatively birefringent crystals), increased uric acid levels on blood test

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7
Q

Pseudogout

A

Calcium pyrophosphate crystals inducing damage to joints

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8
Q

Risk factors for pseudogout

A

older females, hyperthyroidism, hyperparathyroidsism

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9
Q

presentation of pseudogout

A

hot, swollen, tender joint, often knees

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10
Q

Ix for pseudogout?

A

joint aspiration and polarised light microscopy (rhomboid positive birefringent crystals)

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11
Q

Mx of pseudogout

A

NSAIDs (colchicine)

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12
Q

SLE

A

aNA and aDsDNA antibodies attack soft tissue causing widespread inflammation and damage

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13
Q

SLE risk factors

A

young, black, women

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14
Q

Presentation of SLE?

A

butterfly rash, weight loss, fever, fatigue, joint pain, mouth ulcers, correctable ulnar deviation

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15
Q

Ix for SLE?

A

Bloods - raised ESR, normal CRP, ANA and aDsDNA antibodies present

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16
Q

Management of SLE?

A

Ibuprofen, cyclophosphamide, hydroxychloroquine, prednisolone, methotrexate

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17
Q

Complications of SLE?

A

cardiac, lung and kidney involvement, widespread inflammation causing damage

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18
Q

Inflammation of the kidneys due to SLE?

A

lupus nephritis

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19
Q

What is fibromyalgia

A

unknown aetiology, hyperaesthesia (exaggerated perception of pain), allodynia (pain in response to non-painful stimuli)

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20
Q

Ix of fibromyalgia

A

11/18 tender points for > 6 months, other investigations to exclude other diseases

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21
Q

Mx for fibromyalgia

A

Education of patient and family, TCA (amitriptyline), analgesia, exercise, CBT

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22
Q

Symptoms of fibromyalgia

A

Widespread chronic pain, chronic fatigue, memory problems, non-restorative sleep, morning stiffness

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23
Q

Risk factors for gout

A

FHx, high alcohol intake, purine rich food, excess fructose intake, drugs (e.g. low dose aspirin)

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24
Q

Food group that can help to reduce gout?

A

Dairy

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25
Q

Sjogren’s syndrome

A

autoimmune syndrome that affects exocrine glands (e.g. salivary, lacrimal)

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26
Q

Presentation of Sjogren’s syndrome

A

Dry mucous membranes i.e. dry mouth, dry eyes, dry vagina

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27
Q

Ix for Sjogren’s syndrome

A

Presence of anti-Ro and anti-La antibodies, Schirmer test (tears travelling <10mm)

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28
Q

Risk factors for Sjogren’s syndrome

A

Fx, female, >40

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29
Q

Managment of Sjogren’s syndrome?

A

Artificial tears and saliva, vaginal lubricants, hydroxychloroquine to halt progression

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30
Q

Giant cell arteritis (GCA) pathophysiology

A

affects aorta and/or its major branches (carotid/vertebral arteries), temporal artery often involved (hence aka temporal arteritis)

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31
Q

Risk factors for giant cell arteritis (GCA)

A

> 50, female, Hx of polymyalgia rheumatica

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32
Q

Presentation of giant cell arteritis (GCA)

A

New onset of headache, scalp tenderness (hurts brushing hair), jaw claudication, visual disturbances

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33
Q

Ix for giant cell arteritis (GCA)

A

Raised ESR and/or CRP, temporal artery biopsy (gold standard for diagnosis) shows giant cells and granulomatous inflammation

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34
Q

Mx for giant cell arteritis (GCA)

A

High dose glucocorticoids ASAP (e.g. prednisolone)

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35
Q

Presentation of Takayasu’s arteritis

A

‘pulseless disease’, arm claudication, syncope

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36
Q

Mx for Takayasu’s arteritis

A

steroids

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37
Q

Treatment for Takayasu’s arteritis

A

Angiography = gold standard, elevated ESR and CRP, granulomatous inflammation on histology

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38
Q

Polyarteritis nodosa is associated with…

A

Hepatitis B

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39
Q

Polyarteritis nodosa is associated with which infection?

A

Hepatitis B

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40
Q

Presentation of polyarteritis nodosa

A

peripheral neuropathy, HTN, livedo reticularis, unilateral orchitis, generalised abdominal pain

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41
Q

Ix for polyarteritis nodosa

A

Raised ESR/CRP, HBsAg, biopsy

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42
Q

Mx for polyarteritis nodosa

A

If hep B +’ve - antiviral agent, plasma exchange and corticosteroids
If hep B -‘ve - corticosteroids

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43
Q

Kawasaki disease risk factors

A

children, males, Japanese

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44
Q

Presentation of Kawasaki disease (CREM)

A 
C - conjunctivitis
R - rash
E - erythema of hands and feet
M - mucous membrane changes (strawberry tongue) 
\+ fever
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45
Q

Kawasaki disease

A

arteritis associated with mucocutaneous lymph nodes

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46
Q

EGPA

A

eosinophilic granulomatosis with polyangiitis - small and medium vasculitis, most associated with lung and skin problems

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47
Q

Henoch-Schonlein purpura

A

IgA vasculitis, due to IgA deposits in the blood vessels of affected organs such as skin, kidneys, GI tract

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48
Q

Presentation of Henoch-Schonlein purpura

A

Symmetrical purpuric rash affecting lower limbs or buttocks in children, joint pain, abdominal pain, renal involvement

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49
Q

Granulomatosis with polyangiitis

A

Small vessel vasculitis, affects respiratory tracts and kidney

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50
Q

Granulomatosis with polyangiitis presentation

A

SADDLE-SHAPED NOSE, epistaxis, crusty nasal/ear secretions, sinusitis, cough, wheeze, haemoptysis

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51
Q

Ix for granulomatosis with polyangiitis

A

High eosinophils on FBC, presence of c-ANCA

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52
Q

Marfan syndrome

A

Autosomal dominant condition, affects gene involved in creating fibrillin

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53
Q

Presentation of Marfan syndrome

A

Tall, long limbs and fingers, hypermobility, high arch palate

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54
Q

Mx of Marfan syndrome

A

Lifestyle changes - avoid intense exercise and caffeine, beta blockers and ARBs, annual echocardiogram

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55
Q

Complications of Marfan syndrome

A

Mitral/aortic valve prolapse, aortic aneurysms, lens dislocation, pneumothorax

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56
Q

Risk factors for Marfan syndrome?

A

FHx

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57
Q

Ehlers-Danlos syndrome

A

Rare disease, group of inherited connective tissue disorders, caused by faulty collagen

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58
Q

Presenation of Ehlers-Danlos syndrome

A

(varies but typically) joint hypermobility, easily stretched skin, easy bruising, chronic joint pain, re-occurring dislocation

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59
Q

Mx for Ehlers-Danlos syndrome

A

Physiotherapy, psychological support

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60
Q

Complications of Ehlers-Danlos syndrome

A

Prone to hernias, prolapse, aortic root dilation, joint pain, abnormal wound healing

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61
Q

Antiphospholipid syndrome

A

associated with antiphospholipid antibodies where blood becomes prone to clotting (hypercoagulable state), occurs on its own or secondary to an autoimmune disorder (especially SLE)

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62
Q

presentation for antiphospholipid syndrome

A

thrombosis, recurrent miscarriages, livedo reticularis, thrombocytopenia

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63
Q

Mx for antiphospholipid syndrome

A

long-term warfarin, pregnant women (LMWH and aspirin)

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64
Q

Presentation of SLE?

A

malar rash, fatigue, fever, weight loss, oral ulcers, myalgia, Raynaud’s, lymphadenopathy

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65
Q

Investigations for SLE?

A

ANA, anti-dsDNA, FBC (anaemia, raised CRP/ESR)

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66
Q

Treatment for SLE?

A

Hydroxychloroquine, NSAIDs, steroids (prednisolone), lifestyle (sun protection, exercise)

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67
Q

Antiphospholipid syndrome

A

Autoimmune disease, body produces antiphospholipid antibodies (aPL) to phospholipid-binding plasma proteins –> hypercoagulable state –> venous and arterial thromboses

Leads to recurrent thrombosis (DVT, PE, stoke, MI), frequency miscarriages, arthralgia

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68
Q

Mx for APL syndrome?

A

warfarin (LMWH and aspirin in pregnancy)

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69
Q

Pathophysiology of Sjogren’s syndrome

A

lymphocytic infiltration into lacrimal and salivary glands (–> dry eyes and mouth)

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70
Q

Secondary Sjogren’s?

A

secondary to SLE, systemic sclerosis, RA

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71
Q

Ix for Sjogren’s?

A

Schirmer’s test - see how far tears travel

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72
Q

Polymyositis/dermatomyositis

A

Chronic inflammation of muscles and skin (autoimmune)

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73
Q

Pathophysiology of polymyositis/dermatomyositis

A

Endothelium of endomysial capillaries targeted by antigens –> perifascicular atrophy, capillary loss, B cell infiltration, destruction of muscle fibres

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74
Q

Presentation of polymyositis/dermatomyositis

A

Slow onset proximal muscle weakness, fatigue, weight loss

Dermatomyotisis only - Gottron’s papules, photosensitive erythematous rash

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75
Q

Ix for polymyositis/dermatomyositis

A

Increase serum creatinine kinase (enzyme found in muscle cells), muscle biopsy

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76
Q

Tx for polymyositis/dermatomyositis

A

Steroids (prednisolone), sun protection, IV immunoglobulins (severe disease)

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77
Q

Systemic sclerosis (scleroderma)

A

Multisystem autoimmune disease characterised by vascular damage and fibrosis

78
Q

Pathophysiology of scleroderma

A

Increased fibroblast activity, abnormal growth of connective tissue, excessive collagen production and deposition

79
Q

Presentation of scleroderma?

A

Skin thickening, sclerodactyly, Raynaud’s, GORD, pulmonary HTN

80
Q

Pathophysiology - Marfan’s syndrome

A

Mutations in fibrillin-1 gene –> production of abnormal fibrillin protein –> connective tissue abnormalities

81
Q

Presentation of Marfan’s (MARFANS)

A

Mitral valve prolapse, aortic dissection, retinal detachment, fibrillin-1 mutation, arachnodactyly, near-sightedness, scoliosis

82
Q

Treatment for Marfan’s

A

Beta-blockers, surgical interventions

83
Q

Enhlers-Danlos syndromes

A

Group of connective tissue disorders - due to a genetic mutation, production of faulty connective tissue proteins (e.g. collagen)

84
Q

Presentation of EDS?

A

skin elasticity/fragility, hypermobility, fatigue, easy bruising, striae

85
Q

Which type of joints does osteoarthritis always affect?

A

synovial, weight-bearing joints are most commonly involved (hips, knee, cervical, lumbar spine)

86
Q

How is the joint affected in osteoarthritis?

A

‘Wear and tear’, cartilage worn down, subchondral bone and ligaments also

87
Q

Pathophysiology of OA - 2 part process

A
  1. hyaline cartilage degradation

2. abnormal chondrocyte homeostasis

88
Q

OA pathophysiology

A
  1. Chondrocytes lose ability to generate and repair cartilage
  2. Chondrocytes overexpress proteases and cytokines, cytokines induce inflammation and cartilage breakdown
  3. Exposure of underlying subchondral bone results in sclerosis –> reduced joint space
89
Q

OA risk factors

A

Obesity, genetic predisposition, female, occupation, trauma

90
Q

OA presentation

A

Joint pain (movement of bone on bone), deep dull ache that is relieved with rest and worsened on activity, morning stiffness lasting <30 minutes, limited mobility, no systemic symptoms, weight bearing joints affected (hips, knees, spine, hands

91
Q

How are the hands commonly affected in OA? (think HOB)

A

Herberden’s nodes, Bouchard’s nodes

92
Q

Ix for OA?

A

X-ray, normal bloods

93
Q

Mx for OA?

A

Weight loss, avoid physical activity, paracetamol (1st line), intra-articular corticosteroid injections, surgical joint replacement

94
Q

Risk factors for RA?

A

Genetic predisposition (HLA-DR4), female, smoking, FHx

95
Q

Pathophysiology of RA

A

Complex autoimmune attack against synovium of joint (synovitis), this synovium thickens and grows out of the surface of the cartilage (forming a Pannus). Pannus destroys the articular cartilage and subchondral bone (bone erosion). Antibodies incite this inflammation

96
Q

RA presentation

A

SYMMETRICAL joint pain and swelling (also at rest), morning stiffness >30 mins that improves upon activity, joint deformities (Swan neck, Boutonniere, ulnar deviation)

97
Q

Which joints does RA commonly affect?

A

MCP joints (toes), PIP joints, wrist, knee

98
Q

Joint deformities often seen in RA?

A

Swan neck, Boutonniere, ulnar deviation

99
Q

SPINEACHE - presentation of spondylarthropathies

A

sausage digit, psoriasis, inflammatory back pain, NSAID good response), enthesitis, arthritis, Crohn’s/colitis, HLA-B27, eyes (uveitis)

100
Q

Diagnosis of RA

A

FBC - ESR, CRP raised
Serum antibodies - RF, anti-citrullinated peptide antibodies (most sensitive)
X-rays - show soft tissue swelling and joint narrowings
Sterile synovial fluid with high neutrophil count

101
Q

DMARDs used in RA

A

sulfasalanzine - 1st line for most

methotrexate - in more advanced disease (CI in pregnancy)

102
Q

Presentation of septic arthritis

A

Medical emergency, acute onset, most commonly in knee, hot, red, swollen, painful joint, fever

103
Q

Diagnosis of septic arthritis

A

Joint aspiration - purulent synovial fluid, very high WCC

Elevated ESR/CRP

104
Q

Septic arthritis - treatment

A

antibiotics (flucloxacillin, fusidic acid)

105
Q

Crystals in gout?

A

monosodium urate crystals, needle shaped negatively birefringent

106
Q

Pseudogout crystals?

A

calcium pyrophosphate crystals, rhomboid shaped positively birefringent

107
Q

pathophysiology of gout?

A

purines metabolised into hypoxanthine –> xanthine –> uric acid by xanthine oxidase enzymes. Build up of uric acid –> monosodium urate crystals

Intra-articular deposition of crystals, neutrophils detect as abnormal –> inflammatory response

108
Q

Gout presentation

A

Sudden onset pain, swelling and redness of 1st MTP (big toe)

Pain, erythema, swelling, tenderness, warmth

109
Q

Dx gout

A

joint aspiration and synovial fluid analysis - needle shaped negatively birefringent crystals, raised serum uric acid

110
Q

Tx for gout

A

Lifestyle - reduce alcohol, red meat
NSAIDs
If NSAIDs CI –> Colchicine
Long-term management - allopurinol to reduce uric acid levels

111
Q

Pseudogout risk factors

A

Age, DM, OA, joint trauma

112
Q

Pseudogout presentation

A

Often incidental finding, commonly affects knees and wrists, painful attacks that last longer than gout

113
Q

Diagnosis of pseudogout

A

Joint aspiration - positively birefringent rhomboid shaped crystals

114
Q

Tx for pseudogout

A

NSAIDs, colchicine

115
Q

Osteoporosis - SHATTERED

A 
Steroid use
Hyperpara/thyroidism
Alcohol/smoking
Thin
Testosterone reduced
Early menopause
Renal/liver failure
Erosive bone disease
Dietary calcium low
116
Q

Clinical presentation of osteoporosis

A

FRACTURES, typically occur at thoracic and lumbar vertebrae, proximal femur

117
Q

Diagnosis of osteoporosis

A

DEXA scan

118
Q

1st line medication for osteoporosis

A

Bisphosphonates - inhibit osteoclasts and increased bone mass at hip and spine sites

119
Q

Pathophysiology of osteoporosis

A

increased bone breakdown by osteoclasts and decreased bone formation by osteoblasts

120
Q

Spondyloarthropathies

A

Group of chronic inflammatory arthritic conditions that affect the vertebral column

121
Q

Common spondyloarthropathies

A

Ankylosing spondylitis, psoriatic arthritis, reactive arthritis

122
Q

Common features of spondyloarthropathies

A

Slow arthritis, sacroiliac joints affected, morning stiffness and pain - improves upon movement, enthesitis

123
Q

Ankylosing spondylitis

A

Chronic inflammatory disease of the axial skeleton that leads to partial/complete fusion and rigidity of the spine

124
Q

Gene association with spondyloarthropathies

A

HLA-B27

125
Q

Presentation of ankylosing spondylitis

A

episodic inflammation of sacroiliac joints, pain in 1 or 2 buttocks, limited lumbar spine mobility, enthesitis, uveitis, progressive loss of spinal movement

126
Q

ankylosing spondylitis diagnosis

A

imaging of lumbar spine and pelvis (joint fusion, etc.), elevated ESR due to inflammation, NO AUTOANTIBODIES

127
Q

Tx for ankylosing spondylitis

A

exercises, NSAIDs at night, TNF-alpha blocking drugs

128
Q

Reactive arthritis

A

asymmetric inflammatory oligoarthritis of lower extremities following infection

129
Q

Causes of reactive arthritis

A

GI infections - salmonella, shigella

STIs - urethritis

130
Q

Presentation of reactive arthritis

A

Acute, asymmetrical, LOWER LIMB arthritis (days–>weeks after GI or GU infection), fatigue, malaise, weight loss, sacroilitis, conjunctivitis

131
Q

Dx of reactive arthritis

A

Synovial fluid analysis (sterile - to rule out infection/crystals), raised ESR

132
Q

Tx for reactive arthritis

A

NSAIDs and local corticosteroid injections

133
Q

Psoriatic arthritis

A

inflammation of joints (mostly hands, feet spine) that may occur with psoriasis

134
Q

Clinical presentation of psoriatic arthritis

A

oligoarthritis (asymmetric involvement of both distal and proximal IP joints), spinal involvement, psoriasis, sausage digit, nail pitting

135
Q

Tx for psoriatic arthritis

A

Analgesia and NSAIDs

136
Q

Methotrexate is CI in ?

A

pregnancy

137
Q

Methotrexate can cause a drop in ?

A

WCC/ platelet count

138
Q

Action of methotrexate

A

Inhibits the enzyme dihydrofolate reductase, essential for the synthesis of purines and pyrimidines

139
Q

Which antibody is most specific to the suspected diagnosis of SLE?

A

Anti- ds DNA antibody

140
Q

Mechanism of bisphosphonates?

A

Reduce bone turnover by inhibiting osteoclasts and promoting their apoptosis. Net effect is reduction in bone loss and improvements in bone mass

141
Q

First line bisphosphonate for patients at risk of osteoporosis

A

Alendronate

142
Q

Indications for bisphosphonates? (MOPS)

A

Myeloma (reduce pathological fractures
Osteoporosis
Paget’s disease of bone to reduce bone turnover
Severe hypercalcaemia

143
Q

Indications for calcium/vitamin D medication

A

Osteoporosis
CKD - prevent secondary hyperparathyroidism
Calcium to prevent severe hyperkalaemia (arrhythmias)
Osteomalacia

144
Q

Example of xanthine oxidase inhibitor?

A

Allopurinol

145
Q

Indications for xanthine oxidase inhibitors?

A

gout

146
Q

Example of an anti-gout agent?

A

colchicine

147
Q

What is osteoporosis?

A

systemic skeletal disease define as bone mineral density > 2.5 standard deviations below the young adult mean

148
Q

Risk factors of osteoporosis? (SHATTERED)

A 
Steroid use
Hyperparathyroidism/thyroidism
Alcohol/smoking
Thin
Testosterone reduced
Early menopause
Renal/liver failure
Erosive bone disease
Dietary Ca2+ low
149
Q

Clinical presentation of osteoporosis

A

FRACTURES

150
Q

Gold standard diagnosis for Osteoporosis

A

DEXA scan

151
Q

First line Tx for osteoporosis

A

Bisphosphonates

152
Q

Main pathological features of OA?

A

loss of cartilage, disordered bone repair (osteophytes)

153
Q

Clinical presentation of OA?

A

affects many joints, mechanical pain, loss of movement, morning stiffness <30 mins, commonly affects 1st MTP, DIP joints, Herbeden’s nodes and Bouchard’s nodes

154
Q

What to look for on XRs for OA?- LOSS

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

155
Q

Treatment for OA

A

Lifestyle changes
Physical aids
Analgesia - paracetamol, NSAIDs

156
Q

Extra-articular manifestations of RA?

A 
Systemic - fever, weight loss
Eyes - dry eyes, scleritis
Neurological - carpal tunnel, cord compression
Skin - subcutaneous nodules
Pulmonary - pleural effusion
157
Q

Most sensitive test for RA?

A

Anti-CCP antibody

158
Q

3 key clinical features of spondylarthropathies

A
  1. axial inflammation
  2. asymmetrical peripheral arthritis
  3. strong association with HLA-B27
159
Q

bacteria risk factor for ankylosing spondylitis

A

salmonella, shigella

160
Q

Clinical presentation of reactive arthritis - can’t see, can’t wee, can’t climb a tree

A

acute anterior uveitis
circinate balanitis (painless ulceration of the penis)
enthesitis

161
Q

Most common cause of septic arthritis?

A

Staphylococcus aureus

162
Q

Osteomyelitis

A

Bone marrow inflammation –> localised bone infection

163
Q

Presentation of osteomyelitis?

A

Onset over several days, dull pain at site of infection, aggravated by movement, fever, rigors, malaise

164
Q

5 B’s - cancers that commonly metastasise to bone

A

Breast, brostate, bronchi, bhyroid, bidneys

165
Q

Red flags for bone cancer

A

rest pain, night pain, lump, loss of function, weight loss

166
Q

Test for APL syndrome?

A

Anticardiolipin test

167
Q

Osteomalacia

A

Inadequate bone mineralisation (after the fusion of the epiphyeses

168
Q

Causes of osteomalacia

A

Hyperparathyroidism, vitamin D deficiency, renal disease (inadequate conversion of active vit D), drug induced, liver disease

169
Q

Presentation of osteomalacia

A

Muscle weakness - characteristic waddling gait, difficulty climbing stairs
Widespread bone pain
Fractures

170
Q

Paget’s disease of bone

A

focal disorder of bone remodelling, increased bone resorption, abnormal osteoclast activity, followed by increased rapid bone formation, forming more disorganised, weaker bone

171
Q

What part of the skeleton is affected by Pagets disease of bone in particular?

A

Axial skeleton

172
Q

Px of Paget’s disease of bone

A

pain in bone/nearby joint, can be asymptomatic, deformities (skull enlargement, bowing of tibia)

173
Q

osteomyelitis

A

inflammatory condition of bone caused by infecting organism, most commonly staph aureus

174
Q

Presentation of osteomyelitis

A

limp/reluctance to weight-bear, pain at site of infection, fever, malaise, fatigue

175
Q

Ix for osteomyelitis

A

FBC - raised WCC
Raised ESR and CRP
X-ray
Blood culture

176
Q

Mx for osteomyelitis

A

Antibiotics, supportive care, surgery, debridement

177
Q

Px of primary bone tumours

A

Bone pain worse at night, constant/intermittent, resistant to analgesia, bony/soft tissue swellings, pathological fractures

178
Q

Ix for primary bone tumours

A

1st line - X-ray
Gold standard - biopsy
Bloods - FBC, ESR, ALP

179
Q

Multiple myeloma

A

Neoplastic proliferation of bone marrow plasma cells, produce excess IgG and IgA

180
Q

Px of multiple myeloma (OLD CRAB)

A

OLD age
Calcium elevated (think stones, bones, groans and moans)
Renal impairment
Anaemia
Bone lytic lesions (high suspicion if bone or back pain)

181
Q

Diagnostic criteria for multiple myeloma

A
  1. Monoclonal protein band in serum/urine
  2. Raised plasma cells on BM biopsy
  3. End organ damage (hypercalcaemia, renal failure)
  4. Bone lesions on skeletal survey
182
Q

Tx for multiple myeloma

A 
Analgesia - bone pain
Bisphosphonates - reduce fractures
Local radiotherapy
Transfusion to correct anaemia
Fluids/dialysis - renal failure
183
Q

Osteomalacia

A

Poor mineralisation lead ing to soft bones due to lack of Ca2+

184
Q

Px of osteomalacia

A

Bone pain and tenderness, dull ache that is worse on weight-bearing, muscle weakness, fractures

185
Q

Dx of osteomalacia

A

X-ray - loss of cortical bone
Bloods - low Ca2+ and PO43-
Bone biopsies - incomplete mineralisation

186
Q

Mx for osteomalacia

A

Vitamin D supplements

187
Q

Paget’s disease of bone

A

Excessive bone turnover (formation and resorption) due to increased osteoclastic and blastic activity. Newly formed bone is weaker

188
Q

Px of Paget’s disease

A

bone pain, bone deformity, fractures

189
Q

Mx for Paget’s disease

A

Bisphosphonates, NSAIDs for pain, calcium and vit D supplements

190
Q

Ix for Paget’s disease

A

X-ray - bone enlargement and deformity, V-shaped defected in long bones
Bloods - raised ALP, normal calcium and phosphate

GRACE Phase 2a Medicine (20 decks)

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