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Year 4 TCDs > Musculoskeletal Health Block > Flashcards

Musculoskeletal Health Block Flashcards

1
Q

What 7 things must be addressed when describing a fracture?

A
  1. Qualities of the xray
  2. Site of the fracture
  3. Type of fracture (transverse, oblique, spiral)
  4. Simple or comminuted
  5. Displaced or not
  6. Angulated or not
  7. Is the bone of normal consistency or not
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2
Q

Name the 3 categories of rheumatological conditions and 3 examples that fall under each category.

A
  1. Joints
    - Rheumatoid arthritis
    - Osteoarthritis
    - Gout and pseudogout
  2. Vessels
    - Granulomatosis with polyangitis (GPA; small vessel disease)
    - Polyarthritis nodosum (PAN; medium vessel disease)
    - Giant cell arteritis (GCA; large vessel disease)
  3. Connective Tissue Disease
    - SLE (and anti-phospholipid syndrome)
    - Scleroderma
    - Sjogren’s syndrome
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3
Q

What joint is typically affected in gout?

A

1st metatarsophalangeal (MTP) joint

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4
Q

What is the cause of gout? (1)

A

Build up of uric acid

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5
Q

What are the 4 main symptoms of lupus?

A
  1. Facial butterfly rash
  2. Abnormal sensitivity to sunlight
  3. Cold, numb fingers
  4. Joint pains
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6
Q

What are 5 deformities of the hands characteristic of rheumatoid arthritis?

A
  1. Z-thumb
  2. Ulnar deviations
  3. Boutonnaire finger deformity (flexion of the PIPJ and hyperextension of the DIPJ)
  4. Swan neck finger deformity (hyperextension of the PIPJ and flexion of the DIPJ)
  5. Guttering (muscle wasting seen on dorsum of the hand)
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7
Q

What are 3 management options for gout?

A
  1. Anti-inflammatories
  2. Colchicine
  3. Steroids
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8
Q

What cells drive inflammation? (2)

A
  1. T cells (cell-mediated response)

2. B cells (humoral response)

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9
Q

What are the 2 types of bone and their respective function?

A
  1. Compact bone = hard/dense + serves mechanical function

2. Trabecular bone = porous + contains bone marrow

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10
Q

What 7 areas are important to address in an MSK history?

A
  1. Age
  2. Sex
  3. Occupation
  4. Hand dominance (for upper limb injuries)
  5. PMH/anaesthetics history (especially previous joint surgeries)
  6. Relevant family history
  7. Current meds/allergies
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11
Q

What are 5 likely signs of an inflammatory disease?

A
  1. Pain worse at rest/in morning
  2. Morning stiffness for > 30min
  3. Night pain troublesome
  4. Systemic symptoms present (fatigue, aches, weight loss)
  5. Acute/subacute presentation
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12
Q

What test is used to diagnose carpal tunnel syndrome?

A

Phalen’s test

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13
Q

What 8 things are you looking for when inspecting a patient’s knee?

A
  1. Scars
  2. Swelling
  3. Skin changes
  4. Posture
  5. Varus (bow leg) or valgus (knock knee) deformity
  6. Muscle wasting
  7. Asymmetry
  8. Cysts
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14
Q

What is the clinical presentation of a neck of femur fracture? (2)

A
  1. Shortened limb

2. Externally rotated

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15
Q

What are 3 bone fixation methods for fractures?

A
  1. Open Reduction Internal Fixation (ORIF) -> plate/screws
  2. Closed Reduction Internal Fixation (CRIF) -> k-wires percutaneously; less common
  3. Intermedullary Fixation of Long Bones -> wires/nails
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16
Q

What is the benefit of compression on a fracture? (1)

A

Allows primary bone healing without callus formation

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17
Q

What is the most important factor when deciding how to treat a hip fracture?

A

Determining whether the fracture is intra-capsular or extra-capsular
- Blood supply to head of femur is damaged in intra-capsular fractures

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18
Q

How do yo decide whether to use a screw or replace a hip?

A

Using the Garden fracture classification (1-4)

“1,2 give it a screw, 3,4 Austin-Moore” (Austin-Moore is n old type of hip replacement)

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19
Q

What are the 4 x-ray features of osteoarthritis?

A

“LOSS”

L-loss of joint space
O- osteophytes
S- subchondral cysts
S- subchondral sclerosis

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20
Q

What is the acute management of an infected joint? (4)

A
  1. Joint aspiration
  2. Send for gram stain (often staph. or strep.)
  3. Microscopy + culture
  4. IV empirical antibiotics (flucloxacillin 4-6wks; vancomycin if MRSA; clindamycin if penicillin allergy)
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21
Q

What is a complication of an infected joint?

A

Septic arthritis -> septic shock

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22
Q

What 3 medications can be used in septic arthritis?

A
  1. Flucloxacillin IV (4-6wks)
  2. Vancomycin (if pt has MRSA)
  3. Clindamycin (if pt allergic to penicillin)
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23
Q

What is the gold standard imaging for osteomyelitis?

A

MRI

- Added contrast will show the periosteal reaction nicely

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24
Q

What are 3 possible causes of osteomyelitis?

A
  1. Local infection
  2. Diabetic foot ulcer
  3. Embolic phenomenon (i.e. infective endocarditis + new back pain)
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25
Q

What are the 2 main causative organisms for osteomyelitis?

A
  1. Staph

2. Salmonella osteomyelitis (in sickle cell patients)

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26
Q

What medication is used for osteomyelitis?

A
  1. Flucloxacillin IV ± rifampicin for first 2wks (duration for 6wks)
  2. Clindamycin IV ± rifampicin for first 2wks (if penicillin allergy)
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27
Q

What is the difference in crystal shape in gout vs pseudo gout? (2)

A

Gout = needle-shaped, bifringent crystals

Pseudo-gout = rhomboid, most are not bifringent

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28
Q

What are 3 causes of a joint effusion?

A
  1. Crystal arthropathy
  2. Inflammatory arthritis
  3. Infection
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29
Q

What are 2 autoantibodies that are positive in RA?

A
  1. Anti-CCP (high specificity/sensitivity)

2. Rheumatoid Factor

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30
Q

What 2 autoantibodies are positive in SLE?

A
  1. Anti-dsDNA (high specificity/sensitivity; monitor disease flare)
  2. ANA (present in 5% of normal population)
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31
Q

What autoantibody is used to diagnose small-vessel vasculitis?

A

ANCA

  1. c-ANCA = granulomatosis with polyangiitis (GPA)
  2. p-ANCA = eosinophilic GPA
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32
Q

How is inflammation treated? (3)

A
  1. Analgesia (paracetamol)
  2. Anti-inflammatories (NSAIDs)
  3. Immunosuppression - DMARDs (steroids; steroid-sparing agents; biologic agents)
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33
Q

What are 5 examples of steroid-sparing agents?

A
  1. Methotrexate
  2. Azathioprine
  3. Sulfasalazine
  4. Hydroxychloroquine
  5. Leflunomide
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34
Q

What are 9 side effects of long-term steroid treatment?

A
  1. Eyes - cataracts, glaucoma
  2. Heart - cardiovascular disease
  3. Skin - hirtuism, skin thinning
  4. Stomach - gastric ulcers
  5. Metabolism - diabetes, weight gain, Cushings
  6. Brain - psychiatric symptoms
  7. Bone - osteonecrosis, osteoporosis
  8. Muscle - Myopathy
  9. Infections
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35
Q

What protective treatments are often given alongside long-term steroid treatment?

A
  1. Vitamin D
  2. Calcium
  3. Bisphosphonates
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36
Q

Give 2 examples of biologic therapies

A
  1. Infliximab

2. Rituximab

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37
Q

What is 1 adverse effect of biologic therapies?

A

Reactivation of latent TB (thus essential to screen for TB before commencing therapy)

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38
Q

What adverse effect links all the steroid-sparing DMARDs? (i.e. methotrexate)

A

Bone marrow suppression

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39
Q

What is a common target for monoclonal antibody/biologic therapy? (1)

A

TNF (tumour necrosis factor)

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40
Q

What is at the centre of the osteon of bone? (1)

A

Haversian canal, which contains blood vessels and nerves

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41
Q

What are 3 adverse effects of bisphosphonates?

A
  1. Esophagitis (most common!)
    - Take 30min before breakfast
    - Drink lots of water
    - Sit upright
  2. Atypical femur fracture
  3. Osteonecrosis
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42
Q

Name 5 investigations that should be performed for blunt trauma patients

A
  1. ABCDE assessment
  2. Secondary survey
  3. Chest x-ray
  4. Pelvic x-ray
  5. FAST (focused assessment with signography in trauma)
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43
Q

What is the trauma triad of death?

A
  1. Coagulopathy
  2. Acidosis
  3. Hypothermia
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44
Q

When does the trauma triad of death occur?

A

If blood loss > fluid resuscitation

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45
Q

What are the 6 components when assessing patient airway (ABCDE assessment)?

A
  1. C-spine immobilisation
    - manual, collar, bags, tape
  2. Airway clear
    - opening, foreign material
  3. Oxygen
    - High flow oxygen via non-rebreathe mask
  4. Adjuncts
    - oro/nasopharyngeal tube; bag + mask
  5. Definitive
    - Endo-tracheal tube; surgical airway
  6. Help
    - anaesthetists
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46
Q

What are the 6 components when assessing patient breathing (ABCDE assessment)?

A
  1. Pulse oximetry
  2. Trachea
  3. Palpation of chest
  4. Chest expansion
  5. Chest percussion
  6. Chest auscultation
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47
Q

Where would you perform an emergency thoracocentesis?

A

Second intercostal space, mid-clavicular line

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48
Q

What are the 4 components when assessing patient circulation (ABCDE assessment)?

A
  1. BP (-> fluids)
  2. Pulse
  3. ECG
  4. Auscultate the heart
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49
Q

What are the 3 components when assessing patient disability (ABCDE assessment)?

A
  1. Blood glucose
  2. Glasgow coma scale
  3. Pupils
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50
Q

What are the 4 components when assessing patient exposure (ABCDE assessment)?

A
  1. Temperature
  2. Remove all clothing
  3. Maintain 37C
  4. Help if needed (ITU?)
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51
Q

How would you manage an open fracture in A&E and why? (6)

A
  1. Examine neurovasculature of the limb
  2. Have gross contamination removed + photograph taken (to avoid repeatedly taking on/off dressing)
  3. Cover wound in saline soaked gauze
  4. Backslab splint
  5. IV antibiotics (every 8h until wound debridement)
  6. Theatre wound washout + debridement + stabilization of fracture within 24h
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52
Q

What are the 3 principles of treating fractures?

A
  1. Reduce
  2. Stabilise and preserve blood supply
  3. Rehabilitate
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53
Q

What are the methods used to stabilize the fracture? (6)

A
  1. Casts/splints
  2. Intramedullary devices
  3. Plates + screws
  4. Tension band wires
  5. K-wires
  6. External fixators
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54
Q

What is a pathological fracture?

A

A fracture through abnormal bone

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55
Q

Name 7 causes of pathological fractures

A
  1. Osteoporosis
  2. Osteomalacia
  3. Osteopenia
  4. Tumour
  5. Infection
  6. Metabolic bone disease
  7. Medications
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56
Q

What are the steps of the WHO analgesic ladder? (3)

A
  1. Mild pain = Non-opioid ± adjuvant analgesia
  2. Mild-moderate pain = Opioid + non-opioid ± adjuvant analgesia
  3. Mod-severe pain = Opioid + non-opioid ± adjuvant analgesia
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57
Q

What are 4 dose-related side effects of opioids?

A
  1. Nausea
  2. Vomiting
  3. Sedation
  4. Respiratory depression
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58
Q

Name 3 opioid agents commonly used for PCA (patient controlled analgesia)?

A
  1. Morphine
  2. Fentanyl (good in patients with renal failure)
  3. Pethidine
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59
Q

What condition should you think of in pain that is not responding to analgesia?

A

Compartment syndrome

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60
Q

What is compartment syndrome?

A

When the pressure within a fascial compartment exceeds the perfusion pressure within the compartment, causing ischemia of the tissues in the compartment

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61
Q

What are 7 signs of compartment syndrome?

A

5Ps (of ischemia)

  1. Pain
  2. Pallor
  3. Paresthesia
  4. Pulselessness
  5. Paralysis
  6. Swollen
  7. Stiff
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62
Q

How is compartment syndrome treated?

A

Emergency fasciotomy

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63
Q

What is delayed union of bone healing?

A

Failure to reach bony union at 6mo post injury

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64
Q

Name 4 local factors that can lead to delayed/non-union of bone

A
  1. Location (scaphoid, distal tibia, base of 5th metatarsal are at risk b/c of blood supply)
  2. Stability
  3. Infection
  4. Pattern (segmental fractures are at higher risk)
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65
Q

Name 5 systemic factors that can lead to delayed/non-union of bone

A
  1. Diabetes
  2. Diet
  3. Smoking
  4. HIV
  5. Medications (NSAIDs, corticosteroids)
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66
Q

In a midshaft humerus fracture, what is the associated nerve injury?

A

Radial nerve

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67
Q

In a fibula neck fracture, what is the associated nerve injury?

A

Common peroneal nerve

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68
Q

In a supracondylar fracture, what is the associated nerve injury?

A

Median nerve

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69
Q

In a shoulder dislocation, what is the associated nerve injury?

A

Axillary nerve

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70
Q

In a hip dislocation, what is the associated nerve injury?

A

Sciatic nerve

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71
Q

What are the 3 classifications of nerve injuries?

A
  1. Neuropraxia (reversible conduction block due to injury to the axon sheath)
  2. Axonotmesis (disruption of the myelin sheath and the axon)
  3. Neurotmesis (complete nerve division + disruption of the endoneurium)
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72
Q

What 2 nerves does the common peroneal nerve split into?

A
  1. Superficial peroneal nerve (sensory)

2. Deep peroneal nerve (supplies the anterior compartment muscles)

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73
Q

What is the WHO definition of osteoporosis?

A

Bone mineral density 2.5 standard deviations below that of a young subject from the same race and sex

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74
Q

What is the most accurate clinical sign to diagnose compartment syndrome?

A

Pain exacerbated by passive stretching

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75
Q

What compartment is most commonly affected by compartment syndrome?

A

Anterior compartment

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76
Q

What 4 muscles and 2 vessels are located in the anterior compartment of the lower leg?

A

Muscles:

  1. Tibialis anterior
  2. Extensor hallicus longus
  3. Extensor digitorum longus
  4. Peroneus tertius muscles

Nerve + artery:

  1. Deep peritoneal nerve
  2. Anterior tibial artery
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77
Q

What are 3 signs of osteogenesis imperfecta?

A
  1. Deafness
  2. Blue sclera
  3. History of fractures
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78
Q

What examination is important to perform in the context of a fractured limb? (1)

A

Neurovascular exam checking for neurovascular injury

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79
Q

A white hand with no pulse in the context of an arm fracture indicates which structures may have been damaged?

A
  1. Brachial artery (trapped, kinked, torn, or intimal tear)

2. Median nerve (ulnar/radial nerves less common)

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80
Q

What is the commonest form of paediatric elbow fracture?

A

Supracondylar fracture

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81
Q

What are 2 steps to determine if there is a supracondylar fracture on x-ray?

A
  1. Use anterior humeral line

2. Anterior humeral line should intersect the middle 1/3 of the capitellum

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82
Q

How long are children’s fractures immobilized?

A

4 weeks = upper limb fracture

6-8 weeks = lower limb fractures

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83
Q

How would a supracondylar fracture be reduced? (2)

A
  1. K-wires

2. Plaster cast

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84
Q

What is the growth plate?

A

An area of cartilage which proliferates and the leading edge calcifies

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85
Q

What is the significance of a growth plate injury? (2)

A
  1. Growth may seize, the limb is shortened

2. Deformity + angulation may occur

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86
Q

Name 4 common fracture locations in children

A
  1. Supracondylar fractures
  2. Buckle wrist fracture
  3. Clavicle
  4. Distal humerus
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87
Q

What is a Greenstick fracture?

A

A fracture of the bone, occurring typically in children, where one side of the bone is broken and the other is only bent.

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88
Q

Why do Greenstick fractures occur? (1)

A
  1. Children’s bones are more flexible and softer than adults

- so instead of breaking completely they often crack when bent.

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89
Q

What are the 2 main differences between child and adult fractures?

A
  1. Child fractures may remodel with growth, thus minor deformity can be accepted
  2. Child fractures heal faster
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90
Q

How can median nerve damage be assessed?

A

Get the patient to make an O with their thumb + index finger

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91
Q

What are 2 typical osteoporotic fracture sites?

A
  1. Neck of femur

2. Colles wrist fracture (fall on outstretched hand)

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92
Q

List 4 methods to control displaced unstable fractures

A
  1. Elastic nails
  2. Moulded plasters
  3. Plates
  4. Wires
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93
Q

What are 2 features of connective tissue diseases?

A
  1. Systemic features (weight loss, lethargy, fever, sweats)

2. Multisystem involvement

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94
Q

What does it mean to be seronegative in the context of inflammatory arthritis? (2)

A
  1. Negative for rheumatoid factor (RF)

2. Negative for cyclic citrullinated factor (CCP)

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95
Q

Name 3 possible signs in seronegative arthritis conditions?

A
  1. Skin psoriasis
  2. Changes in bowel habits
  3. Red/painful eyes
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96
Q

What are the 4 sub-categories of inflammatory arthritis?

A
  1. Connective tissue disease
  2. Vasculitis
  3. Seropositive
  4. Seronegative
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97
Q

What are 4 examples of seronegative arthritis?

A
  1. Ankylosing spondylitis
  2. Psoriatic arthritis
  3. Reactive arthritis
  4. Inflammatory bowel disease arthritis
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98
Q

What is 1 example of seropositive arthritis?

A

Rheumatoid arthritis

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99
Q

What syndrome is associated with Rheumatoid arthritis?

A

Sjogrens syndrome (dry eyes + dry mouth)

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100
Q

What swelling is indicative of inflammatory arthritis?

A

“Boggy” swelling indicating synovitis

Bony swelling is seen in osteoarthritis

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101
Q

What joints does rheumatoid arthritis typically affect? (2)

A
  1. Metacarpophalangeal (MCP) joints

2. Proximal interphalangeal joints

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102
Q

What joints are commonly affected in osteoarthritis + psoriatic arthritis? (1)

A
  1. Distal interphalangeal joints
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103
Q

If suspecting a patient to have RA, what are your immediate next steps? (2)

A
  1. Prescribe analgesia for symptomatic relief

2. Refer urgently to rheumatology

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104
Q

What pain relief would you initially prescribe for a patient with RA?

A

Naproxen 500mg tablets twice daily

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105
Q

What investigations would you request to confirm an RA diagnosis? (5)

A
  1. Baseline bloods (FBC, LFTS, U+Es)
  2. Inflammatory markers (CRP, ESR)
  3. Thyroid function (TFTs)
  4. Immunology (RF, CCP, ANA)
  5. Plain x-ray of hands, feet
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106
Q

What are 5 possible explanations for anemia in RA?

A
  1. Anemia of chronic disease
  2. Iron deficiency anemia secondary to use of NSAIDs or another cause
  3. Felty’s syndrome (anemia, leucopenia, splenomegaly)
  4. Pernicious anemia (autoimmune disease)
  5. Autoimmune hemolytic anemia
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107
Q

What blood test is raised in hemolytic anemia?

A

LFTs - bilirubin is high

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108
Q

What 5 abnormalities might be seen on x-ray of RA in later disease?

A
  1. Periarticular (juxta-articular ) osteopenia
  2. Erosions
  3. Joint space narrowing (uniform)
  4. Deformity
  5. Soft tissue swelling
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109
Q

What are 3 conditions of the lungs that are associated with rheumatoid arthritis?

A
  1. Pulmonary fibrosis
  2. Lung nodules
  3. Pleural effusions
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110
Q

What criteria is used to diagnose rheumatoid arthritis? (4)

A

The 2010 ACR RA classification criteria:

  1. Joint involvement (i.e. > 10 joints + at least 1 small joint)
  2. Serology (i.e. RF, CCF)
  3. Acute-phase reactants (i.e. ESR, CRP)
  4. Duration of symptoms (i.e. ≥6 weeks)
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111
Q

What are 3 broad risk factors for developing RA?

A
  1. Genes
  2. Environment (i.e. infection)
  3. Smoking (i.e. development of anti-CCP antibodies)
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112
Q

What imaging is used to assess the presence of synovitis?

A

Ultrasound

113
Q

Once a patient sees a rheumatologist, what medications will be prescribed for their RA? (3)

A
  1. DMARD (i.e. methotrexate - takes 6-8wks for effect)
  2. Steroid (i.e. depromadone -for short term relief of symptoms)
  3. Biologic DMARD therapy (i.e. rituximab - if not responding to DMARD alone)
114
Q

What are 14 extra-articular features of RA?

A
  1. Carpal tunnel syndrome
  2. Palmar erythema
  3. Pleural effusions
  4. Pericardial effusion
  5. Interstitial lung disease + fibrosis
  6. Vasculitis
  7. Lymphadenopathy
  8. Splenomegaly
  9. Felty’s syndrome
  10. Episcleritis
  11. Keratoconjunctivitis sicca (dry eyes/mouth)
  12. Normochromic normocytic anemia
  13. Amyloidosis
  14. Fatigue, low-grade fever, weight loss
115
Q

What are the 3 pathophysiological features of RA?

A
  1. Synovitis (infiltrate of inflammatory cells)
  2. Cartilage degradation (by matrix-degrading enzymes)
  3. Bone erosion (by matrix-degrading enzymes)
116
Q

What blood test is most likely to be affected if RA treatment with DMARD is affecting a patient’s liver?

A

ALT (more sensitive than ALP)

117
Q

A 72 year old lady with longstanding rheumatoid arthritis has a DAS 28 score of 6.01, she is afebrile and haemodynamically stable but is noted to have a purpuric rash on her legs.

What would you do next?

A

Urine dipstick

  • sounds like small vessel vasculitis
  • look for blood + protein
118
Q

What are the 6 common sites for osteoarthritis?

A
  1. Cervical spine
  2. Lumbar spine
  3. Hips
  4. Knees
  5. Feet
  6. Hands (DIPJ, PIPJ, CMCJ of thumb)
119
Q

What are 2 differentiating features of osteoarthritis from rheumatoid arthritis?

A
  1. Insidious onset (4-5y)

2. Worsening of stiffness/pain throughout the day

120
Q

What differentials would you consider with swollen knees and pain? (5)

A
  1. Crystal - pseudo gout/gout
  2. Septic arthritis
  3. Mechanical disruption (meniscal, ligaments, bursa)
  4. Rapidly progressive OA
  5. Osteonecrosis
121
Q

What group of drugs increase the risk of gout? (1)

A

Diuretics

122
Q

What examination findings would be consistent with osteoarthritis of the knee? (8)

A
  1. Small cool effusion
  2. Painful flexion of knee to 90º
  3. Crepitus
  4. Antalgic gait + instability
  5. Weakness ± muscle wasting
  6. Joint line tenderness
  7. Deformity
  8. Bony swelling
123
Q

What is the term for finger joint swellings associated with OA?

A

Nodal osteoarthritis

124
Q

What are the terms for DIPJ swelling and PIPJ swelling associated with OA? (2)

A

DIPJ swelling = Heberdens nodes

PIPJ swelling = Bouchards nodes

125
Q

What investigations, following examination, would you consider to confirm a diagnosis of OA? (2)

A
  1. Bloods (FBC, U+E, CRP, ESR, RF, CCP)
    - Renal function given diclofenac use for arthritis tx
    - Rule out inflammatory condition + RA
  2. X-ray knees + hands
126
Q

What are the management options for osteoarthritis? (3)

A
  1. Conservative (education, weight loss, exercise/physio)
  2. Pharmacological
    - Analgesia (topical anti-inflammatory/capsaicin cream, WHO ladder)
    - Intra-articular steroid injection for moderate to severe pain
  3. Surgery
    - Symptoms that are refractory to non-surgical tx + affecting quality of life
127
Q

When can osteoarthritis be diagnosed without investigations? (3)

A

All 3 criteria must be met:

  1. Patient > 45y
  2. Activity-related joint pain
  3. No morning stiffness, or stiffness lasting < 30min
128
Q

What are the risk factors for osteoarthritis? (11)

A
  1. Age
  2. Female
  3. BMI
  4. Previous joint injury
  5. Intense sport activities
  6. Occupation (hand, hip)
  7. Quadriceps strength (knee)
  8. Alignment (knee)
  9. Pistol grip deformity (hip)
  10. Genetic
  11. Secondary osteoarthritis
129
Q

What is the main modifiable risk factor for osteoarthritis?

A

BMI

130
Q

What are 5 categories of secondary causes of osteoarthritis?

A
  1. Metabolic (i.e. gout, acromegaly, hemochromatosis, wilsons disease)
  2. Traumatic (i.e. joint injury, surgery, fracture)
  3. Anatomical/congenital (i.e. slipped femoral epiphysis, Perthe’s disease, unequal leg lengths)
  4. Neuropathic (i.e. diabetes, syphilis)
  5. Inflammatory (i.e. septic arthritis, any inflammatory arthropathy)
131
Q

What 3 x-ray findings are typical of RA?

A
  1. Periarticular erosions
  2. Osteopenia
  3. Joint ankylosis/fusion (in advanced stages of RA)
132
Q

What spinal x-ray finding is typical of ankylosing spondylitis? (1)

A

Sydesmophytes

133
Q

What are 6 possible differentials for a hot, swollen joint?

A
  1. Septic arthritis
  2. Gout
  3. Pseudogout
  4. Hemarthrosis
  5. Psoriatic arthritis
  6. Reactive arthritis
134
Q

What are 6 risk factors for gout?

A
  1. Male
  2. Alcohol
  3. High purine intake: steak, oily fish, marmite
  4. Diuretics
  5. Obesity
  6. Metabolic syndromes (diabetes, hypertension)
135
Q

What is the gold standard investigation for gout/pseudogout?

A

Joint aspiration + synovial fluid analysis with microscopy

- polarising microscopy can identify monosodium urate crystals

136
Q

What is the most appropriate medication for acute gout? (2)

A
  1. NSAID + PPI

2. Colchicine 500ug BD/TDS

137
Q

When should prophylactic therapy be introduced with urate-lowering drugs in gout? (4)

A

There is an established diagnosis of gout AND:

  1. 2+ attacks of gout/year
  2. Tophi by clinical/imaging study
  3. CKD stage 2 or worse
  4. Urolithiasis (kidney stones)
138
Q

What is the aim of urate-lowering drug (ULD) therapy?

A

To maintain a lower serum uric acid ≤ 300 micromoles/L

  • “treat to target”
  • lower the sUA, the greater the chances of trophi dissolution
139
Q

How soon after an acute gout attack would a urate-lowering drug be introduced?

A

2-4 weeks after an acute attack has subsided

140
Q

What is the first-line urate-lowering drug used in gout?

A

Allopurinol (xanthine oxidase inhibitor)

  • start at 100mg/day (50mg/day with CKD stage 4+)
  • titrate every 2-5 weeks
  • can precipitate acute gout attacks for first 6mo of tx
  • continued for life!!

Should be prescribed alongside NSAID + colchicine for 6mo to protect against acute attacks

141
Q

What is a rare side effect of allopurinol?

A

Allopurinol Hypersensitivity Syndrome

  • mortality 20-25%
  • seen in first few months of tx
  • more common in asian demographic
142
Q

What is an alternative urate-lowering drug if allopurinol is not tolerated?

A

Febuxostat

143
Q

What is the pathophysiology of gout (2)

A
  1. Excess production of uric acid

2. Impaired excretion of uric acid from the kidney

144
Q

What are 3 differentials for hyper mobility in children?

A
  1. Marfans
  2. Ehlers Danlos
  3. Osteogenesis imperfecta
145
Q

What are the red flag features of 4 differentials of an acute childhood limp?

A
  1. Nocturnal pain, night sweats, weight loss = acute lymphoblastic leukemia
  2. High fever holding leg abducted (no internal rotation due to pain) = septic arthritis
  3. High fever, non weight bearing = osteomyelitis of femur pelvis
  4. Changeable history/unusual history regarding mechanism of history = non-accidental injury
146
Q

After examining the hip, which other areas would you examine (referred pain)? (3)

A
  1. Abdomen (hepatosplenomegaly, mass)
  2. Groin (hernias + external genitalia)
  3. Knee
147
Q

What are 5 features of transient synovitis of the hip?

A
  1. More common in boys (age 4-8y)
  2. Acute onset limp (with or without pain)
  3. Reduced hip movements
  4. Self-limiting (should resolve in a few days - urgent assessment needed if not resolved)
  5. Often preceded by a viral illness (URTI, gastroenteritis)
148
Q

What are 2 risk factors for slipped upper femoral epiphysis?

A
  1. Overweight

2. Hypothyroidism

149
Q

What are the 2 signs of Perthes’ disease?

A
  1. Gradual onset limp

2. Painless

150
Q

What is the cause of Perthes’ disease?

A

Avascular necrosis due to the interruption of blood supply to the femoral epiphysis

151
Q

What is the cause of a slipped upper femoral epiphysis?

A

Proximal femoral growth plate becoming unstable and the epiphysis + diaphysis can slip

152
Q

What are 4 signs of developmental dysplasia of the hip?

A
  1. Asymmetrical skin folds
  2. Leg length discrepancies
  3. Buttock flattening
  4. Walking with the affected leg in external rotation
153
Q

What is the red flag symptom of bone tumour?

A
  1. Nocturnal bone pain which responds to NSAIDs
154
Q

What is the red flag symptom of haematological malignancy in children?

A

Splenomegaly with abdominal mass

155
Q

What are the 7 types of juvenile idiopathic arthritis?

A
  1. Systemic JIA - whole body affected
  2. Oligoarthritis - ≤ 4 joints affected
  3. Polyarticular arthritis, RF negative - 5+ joints affected
  4. Polyarticular arthritis, RF positive - or CCF positive, highest risk for joint damage with erosions compared to other JIA
  5. Psoriatic arthritis - psoriatic rash, fingernails + toes may also be affected
  6. Enthesitis-related arthritis - affects only legs + spine, associated with juvenile ankylosing spondylitis + IBD arthritis
  7. Undifferentiated arthritis - doesn’t fit into the above categories
156
Q

What treatments are given for transient synovitis of the hip (‘irritable hip’)? (2)

A
  1. Ibuprofen

2. Paracetamol

157
Q

What signs are always red flags in a child with joint pain and need urgent assessment by paediatrics + orthapedics? (2)

A
  1. Fever with a limp (or non-weightbearing limp)
158
Q

What are the 4 regions of a bone?

A
  1. Epiphysis
  2. Epiphyseal plate
  3. Metaphysis
  4. Diaphysis
159
Q

How do long bones increase in length?

A

New cartilage is deposited at the epiphyseal plate

160
Q

A 7 year old boy presents with unilateral hip pain of gradual onset. There is no diurnal variation.

What is the most likely diagnosis?

A

Perthes’ disease

161
Q

A child presents with a warm swollen knee. The problem has lasted over 8 weeks with pain worse on waking up in morning and no fever or systemic symptoms. Fixed flexion deformity of knee on examination which is warm with pain on end range hyperextension.

What is the most likely diagnosis?

A

Juvenile idiopathic arthritis

162
Q

What is the most likely cause of hip pain which has developed gradually over weeks in a 13 year old boy?

A

Slipped upper femoral epiphysis

163
Q

An 11 year old girl who is a keen dancer presents with knee and ankle pain after activity.

What is the most likely diagnosis?

A

Joint hypermobility

164
Q

What are 2 suggestive features of cauda equina syndrome?

A
  1. Bilateral leg weakness/’saddle anaesthesia’

2. Bladder or bowel symptoms

165
Q

Name 3 conditions where there is referred pain to the back

A
  1. Peptic ulcer disease
  2. Leaking aortic aneurysm
  3. Pyelonephritis
166
Q

What are the 11 red flags in the evaluation of spinal pain?

A
  1. Age < 20 or > 50
  2. Fever
  3. Pain at night, progressive/constant pain, pain lying flat
  4. Alcohol/drug use
  5. Trauma
  6. Weight loss
  7. Reduced appetite
  8. Neurology - weakness, numbness
  9. Bladder or bowel symptoms
  10. History of cancer
  11. Significant trauma (or acute back pain in elderly? osteoporotic wedge fracture)
167
Q

What is the Schober’s test, and which condition is it seen in?

A

Schober’s test looks for reduced lumbar spine flexion (<5cm)

Seen in Ankylosing spondylitis

168
Q

What are 3 typical managements for mechanical low back pain?

A
  1. NSAIDs ± low dose opioid
  2. Physiotherapy exercise program
  3. CBT
169
Q

What is the natural history of recovery for patients with low back pain?

A

Most patients recover fully within 6-12 weeks

Patients who fail to recover by 4 months are more likely to progress to longterm chronic back pain

170
Q

Name 1 clinical sign that supports the diagnosis of sciatica pain?

A

Positive straight leg raise test

171
Q

What is the commonest cause of sciatica in patients under 50y? Over 60y? (2)

A

< 50 = disc herniations

> 60 = spinal stenosis

172
Q

What imaging is recommended for sciatica back pain? (1)

A

MRI

173
Q

Name 3 medications for chronic back pain

A
  1. Neuropathic pain killer (gabapentin, amitryptiline)
  2. Topical analgesics (capsaicin, lidocaine)
  3. Facet joint injections of corticosteroids
174
Q

TENS is often used by pain clinics in the treatment of resistant lower back pain. What is TENS?

A

Transcutaneous Electrical Nerve Stimulation

  • based on Gate Theory of Pain (stimulation of large unmyelinated fibres at the level of the spinal cord block transmission of pain by small unmyelinated fibres)
175
Q

What does a well circumscribed lesion situated directly behind a vertebral body likely suggest?

A

A neoplasm, possibly a neurofibroma

176
Q

What gene test is used in the diagnosis of ankylosing spondylitis?

A

HLA-B27

177
Q

What are the 4 special tests that can be performed in a shoulder examination, and what pathology do they test for?

A
  1. Empty can test (supraspinatus injury)
  2. Lift off test (subscapularis injury)
  3. Scarf test (acromio-clavicle joint pathology)
  4. Hawkins-Kennedy Test (supraspinatus tendon damage)
178
Q

What is the movement and nerve supply of supraspinatus?

A

Abduction

Suprascapular nerve

179
Q

What is the movement and nerve supply of ifraspinatus?

A

External rotation

Suprascapular nerve

180
Q

What is the movement and nerve supply of teres minor?

A

External rotation

Axillary nerve

181
Q

What is the movement and nerve supply of subscapularis?

A

Internal rotation

Upper + lower subscapular nerves

182
Q

What initial investigation would you request for a patient with shoulder pain?

A

2 view plain x-ray

- will see typical changes of osteoarthritis and not in frozen shoulder

183
Q

What is tendon cuff arthropathy?

A

Rotator cuff tear + arthritis

184
Q

What are the 3 treatment options for tendon cuff arthropathy?

A
  1. Conservative (NSAIDs + physio)
  2. Injection (into steroid + local anaesthetic into subacromial space)
  3. Surgical intervention (arthroplasty)
185
Q

Before joint injections what 3 factors need to be taken into account?

A
  1. Anticoagulation
  2. Diabetes (injection could increase BM, risk of infection)
  3. Systemically well (no antibiotics, allergies)
186
Q

What are 7 risks of joint injection?

A
  1. Failure to work
  2. Infection (1 in 10 000)
  3. Pain
  4. Worsening of symptoms temporarily
  5. Bruising
  6. Bleeding
  7. Skin dimpling
187
Q

Does having a joint injection put any restrictions on future management?

A

Patient cannot have surgical management for at least 3mo after joint injection due to high risk of infection

188
Q

In which areas are tendon ruptures most commonly seen? (2)

A
  1. Type III collagen areas
  2. Hypovascular areas

i.e. Achilles Tendon

189
Q

What ligament injuries commonly occur in adults? In children? (2)

A

Adults = mid-substance tears

Kids = avulsion injury

190
Q

What are the 3 phases of tendon healing?

A
  1. Inflammation
  2. Proliferation (type III collagen)
  3. Remodelling (type I collagen)
191
Q

Name the 3 ligaments of the gleno-humeral joint

A
  1. Superior
  2. Middle
  3. Inferior ligaments
192
Q

What ligament plays a role in the restrictive element of frozen shoulder? (1)

A

Middle gleno-humeral joint ligament

193
Q

What are the 4 rotator cuff muscles?

A
  1. Supraspinatus
  2. Infraspinatus
  3. Subscapularis
  4. Teres minor
194
Q

What are the 2 categories of rotator cuff tears?

A
  1. Traumatic

2. Degenerative

195
Q

What tendon is most commonly affected in rotator cuff tears?

A

Supra ± infraspinatus tendon

196
Q

What movement is restricted in both osteoarthritis + frozen shoulder?

A

External rotation

197
Q

A past medical history of Diabetes or Thyroid disease predisposes to which pathology of the shoulder?

A

Frozen shoulder/adhesive capsulitis

198
Q

What is the most commonly injured nerve in shoulder dislocation?

A

Axillary nerve

199
Q

How is axillary nerve damage tested? (2)

A
  1. Sensation in the regimental badge area

2. Through deltoid contraction

200
Q

Is anterior or posterior dislocation of the shoulder more common?

A

Anterior dislocation

201
Q

Name 2 situations where posterior dislocation of the shoulder can occur?

A
  1. Electrocution

2. Seizure

202
Q

Widespread fatigue + pain + unrefreshed sleep could indicate what? (1)

A

Fibromyalgia

203
Q

What is the cardinal feature of fibromyalgia?

A

Chronic widespread pain

  • > 3mo duration
  • on both sides of the body
  • above + below the waist + along the axial spine
204
Q

What are 3 signs of fibromyalgia?

A
  1. Chronic widespread pain
  2. Difficulty sleeping
  3. Difficulty concentrating/memory
205
Q

What examination must be performed to diagnose fibromyalgia?

A

18 well recognized “tender points” must be palpated
- pressure applied with pulp of thumb until nail blanches

Patients reporting pain in 11+ sites = fibromyalgia

206
Q

What are the 3 diagnostic criteria for fibromyalgia?

A
  1. Fibromyalgia pain (widespread pain index score of 7 and symptom severity scale score of 5; or WPI 3-6 + SS of 9)
  2. Symptoms present at a similar level of intensity for at least 3mo
  3. No other disorder that would explain the pain
207
Q

What investigations would you undertake to rule out any other differential diagnoses when considering fibromyalgia? (7)

A
  1. TFT (exclude hypothyroidism)
  2. 25-hydroxy vitamin D (low levels = muscle pain)
  3. Vitamin B12 (very low levels = pain + fatigue)
  4. Iron studies (fatigue + poor sleep + depressive symptoms)
  5. Magnesium (low levels = muscle spasms)
  6. ESR/CRP (normal in fibromyalgia, raised in inflammatory arthritis)
  7. Antibody screen (ANA, RF, anti-CCP antibodies if considering inflammatory arthritis/connective tissue disease)
208
Q

How is fibromyalgia managed? (3)

A
  1. Exercise
  2. Psychological therapy (CBT)
  3. Pharmacological (duloxetine, pregabalin, tramadol for severe pain; low dose amitriptyline, cyclobenzaprine, or pregabalin for sleep problems)
209
Q

What are 6 risk factors for fibromyalgia?

A
  1. Female sex
  2. Low household income
  3. Lack of further education
  4. Family history of fibromyalgia
  5. Having been through a traumatic event (ie. car crash)
  6. Certain medical conditions (ie. RA)
210
Q

What are the 2 pathophysiological theories of fibromyalgia?

A
  1. Central sensitization (pain hypersensitivity, dynamic tactile allodynia)
  2. Parallel processing
211
Q

Which medication should be avoided in the treatment of fibromyalgia?

A

NSAIDs

212
Q

What is the most likely explanation for peripheral oedema + heavy proteinuria in urine?

A

Nephrotic syndrome

  • systemic disease affecting kidneys (amyloidosis, SLE, diabetes)
  • primary kidney disorders (membranous nephropathy, focal segmental glomerulosclerosis)
213
Q

What is nephrotic syndrome? (3)

A
  1. Heavy proteinuria (>3-5g/24h)
  2. Hypoalbuminemia
  3. Oedema
214
Q

What are the defining characteristics of nephritic syndrome? (6)

A
  1. Hematuria (microscopic or macroscopic)
  2. Proteinuria (<2g/24h)
  3. Hypertension (caused by salt + water retention)
  4. Oedema (periorbital, peripheral or sacral)
  5. Oliguria
  6. Uremia
215
Q

What 2 antibody tests are used in SLE that determine if the disease is active?

A
  1. dsDNA (high if active)

2. compliment levels (low if active)

216
Q

What happens to ESR/CRP in SLE?

A 
ESR = raised
CRP = normal (if raised check for infection)
217
Q

What anti-nuclear antibodies are associated with SLE? (3)

A
  1. dsDNA
  2. Smith
  3. nRNP
218
Q

What anti-nuclear antibodies are associated with Sjorgen’s syndrome? (2)

A
  1. Ro(SSA)

2. La(SSB)

219
Q

What anti-nuclear antibody is associated with dermatomyositis? (1)

A

Jo-1

220
Q

What anti-nuclear antibody is associated with SCLE? (2)

A
  1. Ro(SSA)

2. La(SSB)

221
Q

What anti-nuclear antibody is associated with PSS? (1)

A

Sci-70

222
Q

What anti-nuclear antibody is associated with CREST? 91)

A

Centromere

223
Q

What anti-nuclear antibody is associated with MCTD? (1)

A

nRNP

224
Q

What is the relevance of Ro(SSA) and La(SSB) positivity in pregnancy?

A

Can cross the placenta and result in neonatal lupus

225
Q

What are signs of neonatal lupus? (3)

A
  1. Lupus rash
  2. Complete heart block
  3. Blood abnormalities (ie. cytopenias)
226
Q

What is anti phospholipid syndrome characterized by? (2)

A
  1. Elevated anti phospholipid antibodies

2. Acquired thrombophilia or clotting tendency

227
Q

How is antiphospholipid syndrome diagnosed? (2)

A
  1. Positive anti phospholipid antibodies present (lupus anticoagulant, anticardiolopin antibody, anti-b2 glycoprotein) on 2+ occasions at least 12weeks apart
  2. Vascular thrombosis or pregnancy morbidity
228
Q

What immune responses occur in SLE? (2)

A
  1. Type II hypersensitivity reaction

2. Type III hypersensitivity reaction

229
Q

What are the 4 common features of SLE?

A
  1. Fever
  2. Rash
  3. Joint pain
  4. Woman of child bearing age
230
Q

How is SLE diagnosed? (11)

A

Patient must have 4+ of the following:

  1. Malar rash
  2. Discoid rash
  3. Photosensitivity
  4. Oral ulcers
  5. Nonerosive arthritis
  6. Pleuritis/pericarditis
  7. Renal disorder (persistant proteinuria/red cell casts)
  8. Neurological disorder (seizure/psychosis)
  9. Hematological disorder (hemolytic anemia/leukopenia/lymphopenia/thrombocytopenia)
  10. Immunological disorder (anti-DNA, anti-Sm, antiphospholipid antibodies)
  11. Positive ANA
231
Q

How is lupus nephritis classified by WHO? (6)

A

Class I = mesangial immune deposits without mesangial hypercellularity

Class II = mesangial immune deposits with mesangial hypercellularity

Class III = focal glomerulonephritis (<50% of glomeruli affected)

Class IV = diffuse glomerulonephritis (>50% of glomeruli affected)

Class V = membranous lupus nephritis

Class VI = advanced sclerotic lesions

232
Q

What is the typical treatment for lupus? (3)

A
  1. Hydroxychloroquine
  2. NSAIDs
  3. Steroids (prednisolone)
233
Q

What are risk factors for SLE? (7)

A
  1. Sunlight exposure
  2. Infection
  3. Medications (i.e. isoniazid)
  4. Smoking
  5. Female sex
  6. Age 15-45
  7. Race (african-american, asian, hispanic)
234
Q

What is Samter’s triad?

A
  1. Nasal polyps
  2. Asthma
  3. Aspirin sensitivity
235
Q

What is the triad of symptoms for reactive arthritis?

A
  1. Arthritis
  2. Urethritis
  3. Conjuctivitis/uveitis
236
Q

When sending fluid off from joint aspiration, which tests should you ask to be performed? (2)

A
  1. Microscopy

2. Cytology

237
Q

What is a good blood test to perform assessing if an inflammatory process is occurring? (1)

A

Plasma viscosity

- thicker the blood = more inflammation occurring

238
Q

What is a common cause of eosinophilia? (2)

A
  1. Drug related

2. Allergen related

239
Q

How can the origin of renal disease be determined using the urea:creatinine ratio? (3)

A

Ur:Cr ratio <40 = post renal disease

Ur:Cr ratio 40-100 = renal disease/mixed pathology

Ur:Cr ratio >100 = pre-renal disease

240
Q

Which systems are typically involved in vasculitis? (5)

A
  1. Joints
  2. Skin
  3. Nerves
  4. Lungs
  5. Kidneys
241
Q

What are examples of large vessel vasculitis? (2)

A
  1. Giant cell arteritis

2. Takayasu’s arteritis

242
Q

What are examples of medium vessel vasculitis? (2)

A
  1. Kawasaki’s disease

2. Polyarteritis nodosum

243
Q

What are examples of small vessel vasculitis? (3)

A
  1. Microscopic polyangiitis
  2. Granulomatosis with polyangiitis (Wegener’s granulomatosis)
  3. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss Disease)
244
Q

What is positive ANCA indicative of? (1)

A

Small vessel vasculitis

245
Q

Where is c-ANCA’s target commonly found? (1)

A

In the cytoplasm (hence the “c”)

246
Q

What condition is positive c-ANCA indicative of? (1)

A

Granulomatosis with polyangiitis (Wegener’s)

247
Q

What are the characteristic features of granulomatosis with polyangiitis (Wegener’s granulomatosis)? (3)

A
  1. Nasal crusting
  2. Cavitating lesions in the lung
  3. Saddle-nose deformity
248
Q

Where is p-ANCA’s target commonly found? (1)

A

Peri-nuclear region (hence the “p”)

249
Q

What conditions have positive p-ANCA? (2)

A
  1. Microscopic polyangiitis (found at diagnosis)

2. Eosinophilic granulomatosis with polyangiitis (less commonly found at diagnosis)

250
Q

What is the triad of criteria (Lanham diagnostic criteria) for diagnosing eosinophilic granulomatosis with polyangiitis/Churg-Strauss disease? (3)

A
  1. Asthma
  2. Eosinophilia ( > 1500/mm3)
  3. Multi-organ involvement
251
Q

What drug can cause neutrophilia?

A

Steroids

252
Q

What are the best investigations for a person following diagnosis with Eosinophilic granulomatosis with polyangiitis? (2)

A
  1. Chest x-ray (cavitating lesions)

2. Urine dip (glomerulonephritis)

253
Q

What heart condition can be associated with vasculitis? (1)

A

Pericarditis

- see saddle-shaped global ST elevation + PR depression on ECG

254
Q

What glomerulonephritis diseases are associated with vasculitis? (2)

A
  1. Diffuse proliferative glomerulonephritis (most common type of lupus nephritis associated with complement)
  2. Crescentric glomerulonephritis (serious complication of ANCA-associated vasculitis; crescent formation in glomerulus)
255
Q

What diseases are associated with membranous glomerulonephritis? (4)

A
  1. Malignancies
  2. Drugs (gold, penicillamine, captopril)
  3. Autoimmune diseases (SLE, RA, thyroid)
  4. Infections (Hep B, Syphilis)
256
Q

What causes membroproliferative glomerulonephritis? (2)

A
  1. Hepatitis C

2. Renal transplant causes relapse

257
Q

How is crescentic glomerulonephritis treated? (1)

A

High-dose steroids (immunosuppression)

258
Q

What conditions are associated with IgA nephropathy? (3)

A
  1. Celiac disease
  2. Henoch-Scholein purpura
  3. Dermatitis herpetiformis
259
Q

What is the treatment for small vessel vasculitis? (3)

A
  1. Steroids (prednisolone or methylprednisolone)
  2. Second immunosuppression (cyclophosphamide or rituximab)
  3. Steroid-sparing agent once in remission (methotrexate, azathioprine, mycophenolate mofetil)
260
Q

What factors do you need to consider before starting a patient on high-dose steroids? (4)

A
  1. Gastro-protection
  2. Bone protection
  3. Screen for diabetes
  4. Monitor BP/weight
261
Q

EGPA is a multi-systemic disease with a wide range of presentations. What are the common manifestations and complications that can occur? (8)

A
  1. Lower respiratory tract (asthma, hemoptysis, pneumonitis)
  2. Upper respiratory tract (allergic rhinitis, paranasal sinusitis, nasal polyps)
  3. Heart (pericardial effusion, MI, myocarditis)
  4. Skin (purpura skin nodules, livedo reticularis)
  5. Renal (crescentic glomerulonephritis, HTN, renal failure)
  6. Nervous system (mononeuritis monoplex, stroke)
  7. Ophthalmology (anterior uveitis)
  8. Gastroenterology (mesenteric infarction, bowel perforation)
262
Q

Which drug classically causes an exacerbation of asthma symptoms in someone with EGPA? (1)

A

Montelukast

- leukotriene receptor antagonists

263
Q

What genes are associated with EGPA? (2)

A
  1. HLA-DRB1

2. HLA-DRB4

264
Q

What are acquired risk factors for EGPA? (5)

A
  1. Allergens
  2. Infections
  3. Vaccinations
  4. Drugs
  5. Silica exposure
265
Q

What is brittle asthma?

A

Rare form of severe asthma characterized by a wide variation of Peak Expiratory Flow, in spite of heavy doses of steroids.

266
Q

How is remission from EGPA assessed? (2)

A

Defined using the Birmingham Vasculitis Activity Score (BVAS) of 0 and OGC dose < 4mg/day

267
Q

Why does proper management of giant cell arteritis require a chest x-ray? (1)

A

Because it can also affect the aorta

268
Q

What are the signs of Kawasaki disease? (5)

A
  1. Persistent fever (>5 days)
  2. Lymphadenopathy
  3. Strawberry tongue
  4. Bilateral non-infective conjunctivitis
  5. Desquamating rash
269
Q

What is a complication of Kawasaki disease? (1)

A

Coronary artery aneurysm (hence coronary angiogram + ECHO very important)

270
Q

How is Kawasaki disease treated medically? (2)

A
  1. Aspirin (one of few indications in children)

2. IV immunoglobulin

271
Q

What is Reyes’ syndrome?

A

Rare disorder that causes brain + liver damage as a result of aspirin administration in children

272
Q

What infection is polyarteritis nodosa associated with? (1)

A

Hepatitis B

273
Q

What are signs of Takayasu’s disease? (2)

A
  1. Absent pulses in upper limbs (‘pulseless disease’)

2. Kidney damage

274
Q

What are the components of a comprehensive vasculitis screen? (10)

A
  1. FBC
  2. U+E
  3. LFT
  4. TFT
  5. PV (plasma volume)
  6. CRP
  7. ANA
  8. ANCA
  9. Chest x-ray
  10. Urine dip
275
Q

Peri-nuclear distribution of ANCA reflects the presence of which target? (1)

A

Myeloperoxidase (MPO)

276
Q

What is the key target in c-ANCA positive vasculitis? (1)

A

Proteinase-3 (PR-3)

277
Q

What are the 6 ACR (American college of Rheumatology) criteria for diagnosing EGPA?

A

4+ must be met:

  1. Asthma
  2. Eosinophilia
  3. Neuropathy
  4. Pulmonary infiltrates non-fixed
  5. Paranasal sinus abnormalities
  6. Extravascular eosinophils
278
Q

What is the main complication associated with cyclophosphamide (used in initial tx of EGPA)?

A

Hemorrhagic cystitis due to toxic accumulation of drug in bladder

279
Q

What is the antidote for cyclophosphamide? (1)

A

Mesna

Year 4 TCDs (16 decks)

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