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Year 3 > Musculoskeletal & Dermatology > Flashcards

Musculoskeletal & Dermatology Flashcards

1
Q

A women who has had a hip replacement due to OA is now feeling pain in the hip radiating down to the knee? What is the most common reason this is happening and so needs a replacement revision?

A

Aseptic loosening of hip replacement

less likely would be prosthetic joint infection

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2
Q

When a patient is first diagnosed with RA, a DMARD is recommended to slow disease progression. Alongside this what is co-prescribed?

A

Short course of prednisolone with the Methotrexate

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3
Q

What scoring system can be used to measure disease activity in RA which considers ‘tender joint count, swollen joint count + ESR, CRP, global patient score’ ?

A

DAS28 (28 for the 28 joints assessed)

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4
Q

Methotrexate and pregnancy?

A

Because this DMARD for RA affects DNA synthesis due to its effects on folate it shouldn’t be given. Needs to be stopped 6 months for BOTH the husband or wife who will conceive the baby. Change to sulfasalazine / hydroxychloroquine

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5
Q

Most common agent of osteomyelitis is?

Most common agent of osteomyelitis in sickle cell patients is?

A

Staph aureus

Salmonella

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6
Q

which nerve is most commonly injured dutring knee arthroplasty and can cause difficulty dorsiflexing the foot?

A

Common peroneal nerve

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7
Q

when should allopurinal be given?

A

it is for recurrent gout prophylaxis

now you give it as soon as someone has one episode of gout

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8
Q

colchicine (option other than NSAID to treat acute gout) side effect?

A

diarrhoea

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9
Q

When prescribing allopurinol what needs to be given alongside?

A

a ‘cover’ of colchine or nsaid as a co-prescription

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10
Q

reactive arthritis key quote

A

cant see, pee or climb a tree

  • conjunctivitis
  • Balanitis
  • arthritis
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11
Q

genetic predisposition SLE

A

HLA DR2 + HLA DR3

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12
Q

score system to assess risk of pressure sores?

A

Waterlow score , screening test

takes into account
- BMI
- nutritional status
- skin type
- mobility
- continence

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13
Q

Rheumatoid factor pathophysio?

A

it itself if an IgM antibody

this antibody targets the bodies IgG antibodies, this caues systemic inflammation

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14
Q

feltys syndrome?

A

Rhuematoid arthritis
splenomegaly
low white cell count

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15
Q

DIPS vs PIPS

A

Distal = osteoarthritis (distal = older)

proximal = RA, occurs a bit younger

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16
Q

if DMARD (methotrexate, hydroxychloroquine, sulfasalazine) not working for RA?

A

TNF inhibitors = etanerceptm, infliximab

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17
Q

osteoarthritis bony deformities?

A

Heberden nodes (DIPS)
Bouchard nodes (PIPs)
squaring at thumb base

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18
Q

complication of steroid use for polymyalgia rheumatica?

A

avascular necrosis of femoral head

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19
Q

corticosteroid induced osteoporosis prophylaxis?

A

e.g. for polymyalgia

alendronate (bisphosphonate)

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20
Q

temporal arteritis summary?

A

headache, jaw claudication, scalp tenderness, visual changes e.g.
tender palpable temporal artery

MX : give prednisolone before biopsy done
- 1st IX = esr, then biopsy
- same day urgent opthalmology review

if no visual loss = high dose oral prednisolone

if vision loss = IV methylprednisolone

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21
Q

hyperuricaemia causes gout, what causes increased uric acid?

A

Chronic kidney disease
thiazide diuretics
tumor lysis syndrome
idiopathic

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22
Q

tophi + podagra?

A

Gout

  • tophi on extensor surface joints
  • podagra is painful MTP of big toe
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23
Q

Gout arthrocentesis with synovial fluid analysis?

A

needle shaped crystals, negative birefringence

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24
Q

PsesudoGout arthrocentesis with synovial fluid analysis?

A

rhomboid shaped crystals, positive birefringence

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25
Q

x-ray gout?

A

Rat bite erosion

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26
Q

why do gram staining and culture for gout?

A

Exclude septic arthritis

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27
Q

septic arthritis synovial fluid analysis?

A

Yellow/green and turbid

90%+ neutrophils

gram stain
S aureus = gram + cocci, coagulase positive

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28
Q

Abx for staph A septic arthritis

A

IV abx = flucloxacillin

clindamycin if penicillin allergy

4-6 weeks

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29
Q

reactive arthritis synovial fluid analysis?

A

yellow and turbid

negative culture

normal WBC maybe a bit increased

no crystals

30
Q

signs in hx hinting to reactive arthritis?

A

Hx of UTI/Gastro/STI (chlamdiya) infection

patients who have HLA-B27 gene

cant see = eye symptoms (conjunctivitis/uveitis)

cant pee (uthretitis/balanitis)

+ enthesitis
+ keratoderma

31
Q

gene linked with rheumatoid arthritis?

A

HLA DR4

32
Q

risk factors for pseudogout

A

risk factors for pseudogout

haematochromatosis
hyperparathyroidism
hypomagnesaemia

33
Q

corticosteroid side effects?

A

Glaucoma
Cataracts

weight gain
insomnia
hypertension
hyperglycaemia
Cushings

34
Q

SLE - type of hypersensitivity?

A

Type 3

35
Q

gene linked to SLE?

A

HLA-DR2 and HLA-DR3

36
Q

SLE is associated with anti-phospholipid syndrome , what are you looking out for ‘CLOT”?

A

Clots
Liverdo reticularis
Obstetric complications
Thrombocytopenia

37
Q

photosensitive rash seen in?

A

SLE

38
Q

specific vs sensitive SLE ix?

A

Specific = anti-dsDNA

Sensitive = ANA (rule out test)

39
Q

when is CRP high in a SLE px?

A

When they have infection

ESR elevates according to disease activity

40
Q

most common form psoriasis? + summary

A

Plaque psoriasis

silver-white scaly eruptions, worsened by beta blockers, ACE, NSAIDs, lithium

better by sun exposure!

41
Q

flexural psoriasis summary

A

smooth skin in creases e.g. groin / armpit

42
Q

guttate psoriasis summary?

A

fine erythemarous scaly papules - water drop appearance on trunk arms legs

after URTI e.g streptococcal

Treat with phototherapy

43
Q

Psoriatic arthritis? Summary

A

HLA B27 linked

asymmetrical polyarthritis (DIPs) , dactylitis, pencil in cup of DIP on Xray
Nail signs - oncholysis, nail pitting

NSAIDs+ DMARDS

AVOID ORAL steroids = worsen skin lesion flare ups

44
Q

Auspitz sign?

A

pinpoint bleeding when scales from psoriasis scraped off

45
Q

topical hydrocortisone first line for psoriasis, but what to be cautious of?

A

8 weeks+ = skin atrophy, rebound symptoms, striae

46
Q

Atopic dermatitis and eczema summary?

A

what - dry, pruritic skin, children, genetic predisposition to increased IgE formation

infants = cheeks, forehead scalp, extensors
children = flexures, antecubital and popliteal fossa

Lichenification and hyperpigmentation (chronic)

Mx = emollient, topical hydrocortisone, severe = oral ciclosporin

47
Q

contact dermatitis?

A

type of eczema occuring following exposure to a causative agent (hx may say patient has new occupation).

48
Q

stage 1 - 4 of pressure ulcers?

A

1 = nonblanchable erythema skin intact

2 = loss of dermis, a superficial ulcer

3 = loss of all skin types

4 = further damage to structures

49
Q

drugs causing urticaria? ‘NOPA’

A

N = NSAIDs
O = opiates
P = penicillin
A = Aspirin

give px antihistamine = loratadine

50
Q

urticaria blanchable?

A

Yes, blanch on palpation. (Hives)

51
Q

Most common cellulitis organisms?

A

Catalase + = Staphy A
Catalase - = streptococcus pyogenes

52
Q

What is erysipelas?

A

A limited version type of cellulitis

in comparison to cellulitis it causes a well defined lesion that is more superficial

caused by strep pyogenes

53
Q

when is cellulitis managed in hospital?

A

significant systemic upset or have a co-morbidity

54
Q

ERON classification for cellulitis?

A

Helps guide management

Class I - no systemic or co -morbid

Class II - either unwell or px has co-morbid

Class III = systemic upset, sepsis,

nec fasc (class IV)

Class I = primary care oral abx
Class II = short term hospital
Class III = urgent hosp admisison

55
Q

Cellulitis 1st line mx for mild/moderate

mx for severe systemic sx?

A

Flucloxacillin

IV-coamoxiclav + cefuroxime + clindamycin/ceftriaxone

if penicillin allergy –> clarithryomycin or doxycycline
If allergic + pregnant –> erythromycin

56
Q

psoriasis adults

A

eczema - children

57
Q

patch test vs skin prick test?

A

For contact dermatitis = skin patch test as its looking for type 4 hypersensitivity (delayed reaction)

skin prick = type 1 e.g. IgE allergen mediates

58
Q

SLE renal biopsy?

A

‘Full house’ type - deposts that stain for IgA, IgG, IgM, C3, C1q-5 = all positive

59
Q

SLE and resp?

SLE and cardio?

A

Pleurisy, pleural effusion, pneumonitis

raynauds phenomenon, myocarditis

60
Q

specific vs sensitive test for RA?

A

sensitive + 1st line = R factor

specific = anti CCP

61
Q

osteomyelitis mx? (after investigating with MRI imaging)

A

flucloxacillin
clindamycin

62
Q

crystals in gout?

when do gout attacks happen?

A

monosodium urate crystals

after purine rich food e.g. red meat, seafood

63
Q

when investigating uric levels for gout when shoudl you measure it?

A

2 weeks after acute attack

64
Q

crystals in pseudogout?

x ray findings?

management?

A

calcium pyrophosphate crystals

chondrocalcinosis

monoarticular disease = intrarticular dexamethasone, NSAIDs, colchine

65
Q

what is allopurinol?

A

xanthine oxidase inhibitor

66
Q

reactive arthritis vs septic arthritis?

A

reactive : NO ABX given
normal range of motion in the joint, can occur after STI e.g. chlamidya
- mx = NSAIDs, steroids, dmard

septic:
adults + children = staph A
sexually active young adult = N gonorrhoea
- fever, joint pain, limited range of motion,
mx - aspiration + culture, antibiotics

67
Q

osteoarthritis mx?

A

paracetamol + topical NSAIDs

try oral if this doesnt work

68
Q

ankylosing spondylitis 5As?

A

anteriore uveitis
apical lung fibrosis
amyloidosis
achiles tendos
aortic regurg

69
Q

ankylosing spondylitis xray?

how to mx?

A

syndesmophytes - bamboo spine + squaring of L vertebrae

NSAIDs+ physio, if severe can give an antiTNF

70
Q

What is the schobers test?

A

Tests spine flexion, decreased in Ankylosing spondy

71
Q

drug induced lupus causes?

A

procainamide , hydralazine

anti-histone antibodies - seen in SLE also seen in drug indueced

72
Q

SLE mx?

A

hydroxychloroquine - need to do visual acquity testing

Year 3 (14 decks)

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