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Internal Med > Muscular/FM > Flashcards

Muscular/FM Flashcards

1
Q

4 stages of gout?

A

Stage 1 = Asymptomatic hyperuricemia
Active stage = acute gouty arthritis
Acquired stage = inter-critical gout
Stage 4 = Tophaceous gout

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2
Q

Target serum urate concentration for gout?

A

360 umol/L = target conc for stage 1-3 gout
300umol/L = target conc for stage 4 gout

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3
Q

Common sites of gouty tophi?

A

Olecranon bursa
Extensor surfaces of fingers and hands
Ears
1st MTPJ

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4
Q

Why do gout flares come more at night?

A

Urate crystals precipitate better at lower temp

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5
Q

Diagnostics for gout?

A

Joint aspiration with polarized light microscopy to find needle-shaped crystals that are negatively birefringent.
Serum uric acid level raised
Renal panel for kidney function

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6
Q

XR findings in gout?

A

Punched-out lesions with overhanging lesions. Mouse-bitten appearance.
OA changes not seen on gout. Joint space preserved until very late stage.

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7
Q

Compare joint aspiration of Gout vs Pseudogout?

A

Gout = needle-shaped crystals, negatively birefringent.
Pseudogout = rhomboid-shaped crystals, positively birefringent

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8
Q

Indications for Urate Lowering therapy?

One of these, immediately start ULT

A
  1. At least 2 or more gout flares in last year
  2. Radiographic evidence of erosive gouty arthropathy
  3. visible tophi
  4. Urate stones
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9
Q

Mx of acute gout flare?

A

Non-pharm = rest, ice
Steroids
NSAIDs
Colchicine

Avoid aspirin in acute gout
Avoid NSAIDs in ESRD, PUD
Check renal impairment before Colchicine

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10
Q

How to interpret DEXA BMD scan?

A

normal patient = Above -1
Osteopenic = -1 to -2.5
Osteoporosis = -2.5 or below
Look at T-score of 3 parts of pt’s skeleton = spine, hip, NOF. any of them below -2.5 = enough to diagnose osteoporosis

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11
Q

OSTA score for risk of osteoporosis?

A

Below 0 = low risk. Dont need BMD test
0-20 = minimal risk. Do BMD if pt has other RFs
Above 20 = high risk. Continue with BMD

Calculate with “Age in years - Weight/kg”

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12
Q

FRAX score for osteoporosis??

A

10 year risk of having osteoporotic fracture. Aids decision on starting treatment.
Start treatment if one of following is met:
- 20% or more
- if risk of hip frac 3% or higher

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13
Q

Start treatment for osteoporosis if 1 or 3 following criteria met?

A
  1. fragility frac
  2. BMD T score below -2.5
  3. If pt is osteopenic by BMD DEXA, but pt has high FRAX score
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14
Q

3 things to be careful for bisphosphonate?

It slows bone loss by increasing osteoclast cell death

A

Take at least 30 mins before any food, drink or meds
Must sit up for 30 mins after taking med
Cannot have Cr clearance below 30

and ofc, watch out for ostenecrosis of jaw

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15
Q

MOA of bisphosphonates?

e.g. alendronate

A

Slows bone loss by increasing osteoclast cell death.
Osteoclasts degrade bone to initiate normal bone remodeling and mediate bone loss in pathologic conditions by increasing resorptive activity.

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16
Q

Swollen eyelid. What can u think of?

A

Pre-septal cellulitis = infection of ant eyelid
Orbital cellulitis = progress from pre-septal.

orbital cellulitis is medical emergency

17
Q

3 features of vasculitis urticaria?

A

Over 48 hrs = normal urticaria gone within 48hrs
Painful
Resolves with hyperpigmented scarring

18
Q

Presentation of Henoch-Schonlein purpura?

A

Purpuric rash with abdo pain in kids.
Triad of palpable purpura, abdo pain, arthritis

19
Q

Involvement of Lymph nodes in GAS pharyngitis
vs
In EBV?

A

Only Ant cervical LN affected in GAS pharyngitis.
Both ant and post cervical LN chains involved.

20
Q

How to differentiate between infectious mononucleosis vs GAS pharyngitis?

A

IM will have hepatosplenomegaly.
GAS pharyngitis wont.

21
Q

What is centor score?

A

To decide whether to give abx in strep pharyngitis.
2-3 points = consider
4-5 points = give abx.

Give penicillin or amoxicillin for 10 days.

22
Q

Clinical Fragility score?

A

3 = managing well.
4 = mild frailty, got comorbids and meds and stuff, but can walk
7 = completely dependent for personal care
9 = bedbound

23
Q

What can help to raise HDL?

A

Aerobic exercise

24
Q

My healthy plate campaign?

A

Fill half plate with vegetables and a bit of fruits
Fill quarter with protein.
Fill quarter with whole grains carbs

25
Q

Goals for weight loss?

A

Smart goal for weight loss is 5-10% of body weight in 6 months
150 mins of moderate exercise weekly for maintenance
300 mins of moderate exercise weekly for weight loss

26
Q

Prophylaxis for migraine?

A

Propranolol commonest.
TCAs also can be used.

27
Q

When is migraine prophylaxis indicated?

A

Debilitating,
OR
>2 attacks monthly
OR
Comes with neurological deficits or visual auras

28
Q

MMSE vs AMT in dementia?

A

MMSE more widely used and has higher sensitivity (87%) and specificity (82%)

29
Q
A

Internal Med (18 decks)

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