Neurology/ Musculoskeletal Flashcards
What is Gout?
A type of arthritis caused be hyperuricaemia
Which joints are typically affected in Gout?
1st MTPJ (Toe) Usually monoarticular (1 joint)
Which foods are high in purines?
Sardines and bacon
What does RICE stand for?
Rest, ice, compression elevation
What is Naproxen?
NSAID
What is the go to medication for Gout?
Allopurinol
What is the target for Gout medication?
Urate lowering therapy
How is pseudogout different to gout?
Pseudogout = Calcium pyrophosphate crystal deposition
What is the difference in crystals in Gout Vs. Pseudogout?
Negative birefringent crystals Vs positive in pseudogout.
When is pain worse in OA Vs RA?
RA = morning stiffness OA = evening stiffness
Which joints are typically affected in Osteoarthritis?
1st CMCJ (Base of thumb)
Why would you use steroids in osteoarthritis despite condition not being inflammatory?
Local inflammation in joint within OA.
What is Felty’s syndrome?
RA + Splenomegaly + low WBC
Which are the two tests to consider in diagnosing RA?
Rheumatoid factor
Anti-CCP
Which is the most common DMARD?
Methotrexate
Which is the condition which overlaps with Polymyalgia Rheumatica?
Temporal arteritis (GCA)
What are signs specific to GCA? Is the headache bilateral or unilateral?
Unilateral
Scalp tenderness
Jaw claudication (sore, painful)
Visual disturbances
Give three red flags of a headache
- Sudden onset, ‘thunderclap’
- New onset >50 years
- Significant change in characteristics (sudden change from their usual headaches)
- Fever, photophobia, neck stiffness
- Visual disturbances
- Vomiting
Heberden’s and bouchard’s nodes are found in which condition?
Osteoarthritis.
Give x3 features of osteoarthritis.
Asymmetrical
Distal joints
How does osteoarthritis differ from rheumatoid arthritis?
Osteoarthritis = distal joints, asymmetrical
Rheumatoid arthritis = symmetrical, proximal joints. MCP, PIPs, worse in the morning.
What is Gout?
Disorder of purine metabolism.
Uric crystals.
Treat with Allopurinol.
What is Pseudogout?
Calcium pyrophosphate crystals, not uric crystals.
Haemochromatosis = see calcium pyrophosphate.
Name 3 main rheumatological signs
Stiffness, pain, swelling.
Name two monoarthropathies. Why is RA not a monoarthropathy?
Sepsis and Gout.
RA is a polyarthropathy.
What is Sjogren’s syndrome?
Exocrine glands involved.
Dry eyes, dry mouth, dry vagina.
Anti-Ro.
Which tests do we request in RA?
Rheumatoid factor and anti-CCP.
BUT RA has low specificity.
What is Gout?
A disorder of purine metabolism.
Alcoholic, hot joints, 1st MTP affected. Thinking what?
Gout.
What is the difference between the Boutonniere deformity and Swan-neck deformity?
Boutonniere = Proximal interphalangeal joint (PIP) Swan-neck = Distal interphalangeal joint (DIP).
Name three differentials of arthritis.
Osteoarthritis
Rheumatoid arthritis
Crystal arthritis
What are the differentials for a hot swollen joint?
Septic arthritis Crystal arthritis Reactive arthritis (infection giving a reaction). Trauma RA
What is pseudogout?
The calcium pyrophosphate deposits - often in the knee.
What is Felty’s syndrome?
A disorder characterised by:
Rheumatoid Arthritis
Splenomegaly
Neutropenia
Spondyloarthritis
HLA B27+
Sacroiliitis
Arthritis
Name the differentials of an acutely inflamed swollen joint
Infection
Crystal induced
Reactive arthritis
Trauma
Pain/wasting in the base of the thumb is indicative of which condition?
Osteoarthritis
Name the four radiographic features of osteoarthritis.
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
Which is the inflammatory mediator and which is the protective between Cox-1 and Cox-2?
Cox-1 = cytoprotective Cox-2 = inflammatory
Which medication is used in osteoarthritis?
Paracetamol/ NSAIDs.
High MCV can indicate what?
Folate/B12 deficiency
Does a negative test for rheumatoid factor mean an absence of rheumatoid arthritis?
No.
Inflammatory back pain with HLA-B27 positive. What is the diagnosis?
Axial spondyloarthropathy.
Which test would we request specifically in suspected malignancy?
PTH. Parathyroid hormone to assess hypercalcaemia. Calcium is often raised in malignancy.
How do we manage myeloma?
Bisphosphanates, analgesia, IV fluid resuscitation.
What is the triad of Reiter’s syndrome?
Urethritis
Conjunctivitis
Seronegative arthritis
Which medication do we often use in rheumatoid arthritis?
Ciclosporin. BUT common side effect = hypertension.
What is the first line treatment in Osteoporosis?
Alendronate, calcium and vitamin D
Alendronate contraindicated in peptic ulcers
Q. When do we give alendronate?
Q. When may we want an alternative to alendronate?
Q. What would we use as an alternate?
A. Osteoporosis
A. Peptic ulcers
A. Denosumab
Give two signs of rheumatoid arthritis
Boutonniere deformity (flexion at PIP) and (extension at DIP)
Swan neck deformity
Ulnar deviation at the MCP.
What is the triad of reactive arthritis?
Arthritis, urethritis, uveitis.
Which headache is excruciating?
Cluster headache
Double vision and neurological disturbances in a history should make you think of what in a neurology history?
Multiple Sclerosis.
Which cranial nerve exits the brainstem posteriorly?
Trochlear nerve
What is HRCT?
High resolution CT scan.
Red, hot tender joints with no crystals is suggestive of which arthritis?
Septic arthritis.
Name four signs of multiple myeloma
CRAB Calcium renal failure anaemia bone pain/fracture
Cortisol and which hormone trends go together?
Sodium
Name one musculoskeletal cause of chest pain.
Costochondritis.
Which joints are affected in rheumatoid arthritis?
Metacarpophalangeal joints, boutonniere deformity, swan-neck deformity, radial deviation of wrist. (PIP) and metacarpophalangeal.
NOT DIP!
Which drug do we use to treat opiate overdose?
Naloxone.
How do we treat polymyalgia rheumatica?
Prednisolone.
What is the triad for wernicke’s encephalopathy?
Confusion
Ataxia
Opthalmoplegia
What are the signs of tumour lysis syndrome?
Podagra
^K+
Low calcium
