passmed Flashcards
allopurinol and azathiaprine drug interaction causes what
BM supression –> pancytopaenia and agranulocytosis
why do allopurinol and azathiaprine hv a drug interaction
The reason for the pancytopenia is the drug interaction between azathioprine and allopurinol which can cause bone marrow suppression.
-The allopurinol is a xanthine oxidase inhibitor which metabolises 6-mercaptopurine, hence reducing the amount of inactivated 6-mercaptopurine (active form of azathioprine). Thus more active 6-mercaptopurine is incorporated in the DNA in the bone marrow precursors, reducing the platelet cell lines and red and white blood cell line production.
limited systemic sclerosis AB vs diffuse
Limited (central) systemic sclerosis = anti-centromere antibodies
diffuse = anti-scl70 ABs
Greater trochanteric pain syndrome = TROCHANTERIC BURSITIS
- Due to REPEAT MVMNT of the fibroelastic ILIOTIBILAL BAND
- Insiduos onset
- Pain over the LATERAL side of HIP/THIGH (not extending down entire leg) (worsens with ext rotation of hip)
- Tenderness on palpation of the GREATER TROCHANTER
- Most comm in W aged 50-70Y
Meralgia paraesthetica
Caused by compression of lateral cutaneous nerve of thigh
Typically burning sensation over antero-lateral aspect of thigh
Transient idiopathic osteoporosis
An uncommon condition sometimes seen in the third trimester of pregnancy
Groin pain associated with a limited range of movement in the hip
Patients may be unable to weight bear
ESR may be elevated
primary care rheumatoid arthritis first step of Ix after ABs confirmed
NICE advice x-ray of hands and feet for all patients with suspected rheumatoid arthritis. This patient should be referred urgently (within 3 days of presentation), to rheumatology because the small joints of her hands are affected.
other conditions with positive Rheumatoid Fcator
Other conditions associated with a positive RF include: Felty's syndrome (around 100%) Sjogren's syndrome (around 50%) infective endocarditis (around 50%) SLE (= 20-30%) systemic sclerosis (= 30%) general population (= 5%) rarely: TB, HBV, EBV, leprosy
de quiervans tenosynovitis and finkelsteins test
sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed
- females aged 30 - 50 years old
- Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes PAIN over the RADIAL STYLOID process and along the length of extensor pollisis brevis and abductor pollicis longus
mx of de q tenosynovitis
Management analgesia steroid injection immobilisation with a thumb splint (spica) may be effective surgical treatment is sometimes required
Which of the following tests is essential to be performed prior to starting biologics for Rheumatoid arthritis or UC?
It is important to perform a chest X-ray to look for TB prior to starting biologics for rheumatoid arthritis as they can cause reactivation
-pts should be evaluated for both active and TB infection, which usually involves a CXR as well as a tuberculin skin test or interferon-gamma release assay.
which 2 fractures do we most commonly see compartment syndrome with
SUPRACONDYLAR fractures and TIBIAL SHAFT injuries/#
-NB. numbness and paralysis are late signs
types of shoulder dislocation x3
1.Glenohumeral dislocation (COMMONEST): ANTERIOR shoulder dislocation MOST COMMON 95%
mx - lots of diff techniques for reducing shoulders, limited evidence that one is better than another. If dislocation is recent then reduction w/o any analgesia/sedation. However, other patients may req analgesia +/- sedation to ensure the rotator cuff muscles are relaxed.
- Acromioclavicular dislocation (12%): clavicle loses all attachment with the scapula
- Sternoclavicular dislocation (uncommon)
types of glenohumeral dislocation x4
- ANTERIOR shoulder dislocation - ext rot + abd
- 25-40% recurrent (commonest disorder)
- assoc with greater tuberostiy #, Bankart lesion, Hill-Sachs defect - Inferior shoulder dislocation
- Posterior shoulder dislocation - proportion misdx, rim’s sign, light bulb sign, assoc with trough sign
- superior shoulder dislocation - rare + usus after major trauma
renal compl of systemic sclerosis mx
ACEi
what to do with pt presenting with new synovitis
urgent referral to rheumatology
-likely inflammatory joint dis + req blood test for auto-immune ABs incl ANA + RhF
iliopsoas abscess define and 2x types
= collection of pus in iliopsoas compartment (iliopsoas + iliacus)
primary - haematogenous spread of bacteria - S.Aureus most common
secondary (higher mortality rate) - chrons, diverticultis, colorectal c, UTI, GU cancers, vertebral OM, femoral catheter, lithotripsy, endocarditis, IVDU
iliopsoas abscess clin features
fever
back/flank pain
limp
weight loss
iliopsoas abscess: O/E
Patient in the supine position with the knee flexed and the hip mildly externally rotated
Specific tests to diagnose iliopsoas inflammation:
Place hand proximal to the patient’s ipsilateral knee and ask patient to lift thigh against your hand. This will cause pain due to contraction of the psoas muscle.
Lie the patient on the normal side and hyperextend the affected hip. This should elicit pain as the psoas muscle is stretched.
iliopsoas abscess: Ix
CT abdo
iliopsoas abscess: Mx
Antibiotics
Percutaneous drainage is the initial approach and successful in around 90% of cases
Surgery is indicated if:
1. Failure of percutaneous drainage
2. Presence of an another intra-abdominal
psoriatic arthropathy without psoriatic skin lesions dx?
still psoriasis
-Psoriatic arthropathy can present before psoriatic skin lesions - a positive family history of psoriasis may point towards this diagnosis
RhA X-rAY findings
3 early & 2 late
Early x-ray findings:
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
Late x-ray findings:
periarticular erosions
subluxation
which classification systems for which fractures: Gartland/ Salter-Harris/ Ottawa rules / Weber/ Garden
Gartland - supracondylar # in children
Salter-Harris - classify # about growth plate in children
Ottawa rules - detect ankle fractures in pts
Weber - classify ankle fractures about the syndesmosis
Garden - #NOF
