Passmed Flashcards
When should urate lowering therapy (allopurinol) be offered in an individual suffering from gout attacks?
Immediately after a gout attack has subsided
What diseases are most likely to cause a reactive arthritis?
Stis and gastroenteritis
What is the most likely side effect of a patient being treated with interferon alpha?
Flu like symptoms as they are cytokines so cause theae side effects
What are the stages of management of ankylosing spondylitis?
First line is exercise and NSAIDS with physio
Next is anti-tnf therapy
What is the typical age and sex for ankylosing spondylitis?
20-30 year old males
What investigations are useful for ankylosing spondylitis?
Esr and crp are typically raised
Xray of sacroiliac joints show fusing
What lung pattern is shown on spirometry of ankylosing spondylitis and why?
Restrictive due to pulmonary fibrosis, kyphosis and ankylosing of costovertebral joints
What should be done for patients starting long term steroids?
They should start oral alendronate (bisphosphonate)
Should make sure they have sufficient vitamin D and calcium
What is pagets disease and how do you treat it?
This is a disease of the bone associated with increased numbers of osteoclasts and osteoblasts causing bone remodelling and weakness.
It causes a boring bone pain and is treated with bisphosphonates such as alendronic acid and analgesia.
What is the criteria for diagnosing RA called and what are the elements?
It is the ACR criteria (american college rheumatologists)
Joint involvement - more joints higher score
Serology - looks at RF and Anti-CCP
Acute phase reactants - looks at ESR and CRP
Duration of symptoms - more or less than 6 weeks
What are the x ray features of osteoarthritis?
L-loss of joint space
O-Osteophytes
S-Subchondral sclerosis
S-Subchondral cysts
What is dermatomyocytis and if seen then what does this possibly indicate?
It is a proximal weakness myositis combinded with a macular rash.
This can be a paraneoplastic phenomena so need to consider malignacy
What is a common side effect of bisphosphonates?
Heartburn due to oesophageal problems
What antibiotics should be avoided in patients taking methotrexate due to risk of bone marrow supression?
Trimethoprim
What diesase does multiple fractures in a child and a blue sclera indicate?
Osteogenesis imperfecta - this is a collagen disorder
A patient complains of complains of tight, stiff fingers that turn white in the cold. What is the most likely diagnosis?
Limited cutaneous systemic sclerosis
Which is the most appropriate test for suspected scleroderma?
Anti-centromere antibody
Which protein is affected in Marfans?
Fibrillin
What testing should be done as an investigation in temporal arteritis?
Vision testing as temporal arteritis can result in occlusion of the opthalmic artery
What is the likely diagnosis with skull vault expansion and sensorineural hearing loss?
Pagets disease of bone
A 29-year-old man presents to the GP surgery with recent onset of low back pain. The pain is worse at night and often radiates to the hips. It improves with exercise. He is also suffering from sensitivity to light in both eyes and reduced vision in his right eye. What is the diagnosis?
Ankylosing spondylitis
A patient with ankylosing spondylitis is taking NSAIDs that are not helping, what is the next stage of treatment?
TNF alpha blockers such as etanercept because DMARDs have not proven to work in AS
What should not be prescribed alongside methorexate?
Trimethoprim as it increases the risk of haemotological toxicity
How should bisphosphonates be taken and why?
At least 30 mins before breakfast and sit up for 30mins following, this because they cause oesophageal problems
If a patient is on alendronic acid and suffers upper GI side effects what should it be changed to?
Should be changed to risedronate
Which antibody is associated with drug induced lupus?
Antihistone antibody
What is the triad of reactive arthritis?
Conjunctivitis, urethritis and arthritis
What are the two types of ANCA and what are they assocaited with?
cANCA - granulomatosis with polyangiitis (Wegener’s granulomatosis)
pANCA - Churg-Strauss syndrome + others (see below)
What antibody is assocaited with dermatomyositis?
Anti-Jo 1 antibody
What is second line therapy in ankylosing spondylitis after NSAIDs?
Biologicals because there is no role for DMARDs in AS
E.g. etanercept
