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Medicine and Surgery Mushkies > Passmed Rheumatology Mushkies > Flashcards

Passmed Rheumatology Mushkies Flashcards

1
Q

What shoulder never be prescribed with methotrexate?

A

Co-trimoxazole/trimethoprim

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2
Q

What is the MOA of methotrexate?

A

Antimetabolite that inhibits DHFR, which is essential for the synthesis of purines and pyrimidines

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3
Q

What are 3 indications of methotrexate?

A
  1. RhA
  2. Psoriasis
  3. Chemo for e.g. ALL
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4
Q

What are 5 adverse effects of methotrexate?

A
  1. Mucositis
  2. Myelosuppression
  3. Pneumonitis
  4. Pulmonary fibrosis
  5. Liver fibrosis
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5
Q

What are some guidelines regarding methotrexate and pregnancy?

A
  1. Women should avoid pregnancy for at least 6m after treatment has stopped
  2. Men using methotrexate need to use effective contraception for at least 6m after treatment
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6
Q

How often is methotrexate given?

A

Weekly

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7
Q

How is methotrexate monitored?

A

FBC, U&E and LFTs before treatment, weekly until therapy stabilised, then every 2-3m

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8
Q

What should be co-prescribed with methotrexate?

A

Folic acid 5mg once weekly, taken >24hrs after methorexate dose

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9
Q

What is the starting dose of methotrexate?

A

7.5mg weekly

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10
Q

What is the usual dose of one tablet of methotrexate?

A

2.5mg

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11
Q

What is the treatment of choice for methotrexate toxicity?

A

Folinic acid

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12
Q

What drug increases the risk of methotrexate toxicity secondary to redeced excretion?

A

High dose aspirin

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13
Q

When does the risk of osteoporosis increase significantly for pts on steroids?

A

Equivalent of 7.5mg prednisolone per day for 3 or more months

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14
Q

If pt is at risk of corticosteroid induced osteoporosis, what should they be prescribed?

A
  1. Calcium
  2. Vitamin D
  3. Bisphosphonate
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15
Q

What drugs are associated with an increased risk of atypical stress fractures?

A

Bisphosphonates

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16
Q

What is the MOA of bisphosphonates?

A

Inhibit osteoclasts by reducing recruitment and promoting apoptosis

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17
Q

What are 4 uses for bisphosphonates?

A
  1. Prevention and Tx of osteoporosis
  2. Hypercalcaemia
  3. Paget’s
  4. Pain from bone metastases
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18
Q

What are 5 complications of bisphosphonates?

A
  1. Oeseophageal reactions (oesophagitis, oesophageal ulcers)
  2. Osteonecrosis of the jaw
  3. Atypical stress fractures
  4. Acute phase response (fever, myalgia and arthralgia may occur following administration)
  5. Hypocalcaemia
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19
Q

How does the BNF suggest pts should take bisphosphonates?

A

Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet

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20
Q

When should bisphosphonates be stopped after 5 years of treatment?

A
  1. Pt <75 y/o
  2. Femoral neck T score >-2.5
  3. Low risk according to FRAX/NOGG
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21
Q

What kind of receptors do IFNa/b bind to?

A

Type I receptors

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22
Q

What kind of receptors do IFNy receptors bind to?

A

Type II receptors

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23
Q

What are 2 side effects of IFNa?

A

Flu-like symptoms and depression

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24
Q

What are 4 uses of IFNa?

A
  1. Hep B&C
  2. Kaposi’s sarcoma
  3. Metastatic RCC
  4. Hairy cell leukaemia
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25
Q

What is a use for IFNb?

A

Reduces the frequency of exacerbations in pts with relapsing-remitting MS

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26
Q

What are 2 uses for IFNy?

A

CGD and osteopetrosis

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27
Q

What is the treatment for Paget’s disease of the bone?

A

Oral risedronate or IV zoledronate

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28
Q

What are risk factors for Paget’s disease?

A
  1. Age
  2. Male
  3. Northern latitude
  4. FHx
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29
Q

What are classical, untreated features of Paget’s disease?

A

Bowing of tibia and bossing of skull

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30
Q

What are 5 complications of Paget’s disease?

A
  1. Deafness (CN entrapment)
  2. Bone sarcoma
  3. Fractures
  4. Skull thickening
  5. High output CF
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31
Q

Which bones does Paget’s disease typically effect?

A
  1. Skull
  2. Spine/pelvis
  3. Long bones of lower extremities
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32
Q

What is a complication of using TNFa inhibitors?

A

Reactivation of TB

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33
Q

What is the first line management for RhA?

A

DMARD monotherapy +/- a short course of bridging prednisolone

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34
Q

How can you monitor RhA response to tx?

A

CRP and DAS28

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35
Q

What is the most common DMARD used for tx of RhA?

A

Methotrexate?

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36
Q

What are 4 DMARDs?

A

Methotrexate, Sulfasalazine, leflunomide, hydroxychloroquine

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37
Q

What is the current indication for a TNF inhbitor for tx of RhA?

A

Inadequate response to at least 2 DMARDs including methotrexate

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38
Q

How is rituximab given?

A

2 x 1g infusions are given 2 weeks apart

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39
Q

What is the first line analgesic management of OA?

A

Paracetamol + topical NSAIDs

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40
Q

What is the first line conservative management of OA?

A

Weight loss, local muscle strengthening exercises and general aerobic fitness

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41
Q

What are the second line analgesic treatments for OA?

A
  1. NSAIDs/COX2i
  2. Opioids
  3. Capsaicin cream
  4. Intra-articular corticosteroids
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42
Q

What is a non-pharmacological management for OA?

A
  1. Supports and braces
  2. TENS
  3. Shock-absorbing insoles or shoes
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43
Q

How can you classify the X-ray findings of RhA?

A

Early and late X ray findings

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44
Q

What are the early X ray findings of RhA?

A
  1. Loss of joint space
  2. Juxta-articular osteoporosis
  3. Soft tissue swelling
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45
Q

What are the late X ray findings of RhA/

A
  1. Peri-articular erosions

2. Subluxation

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46
Q

Which inflammatory marker is usually normal in SLE?

A

CRP

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47
Q

What is the most common cause of death with diffuse cutaneous systemic sclerosis?

A

Respiratory involvement –> ILD/Pulmonary arterial HTN

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48
Q

What is scleroderma?

A

Tightening of skin without internal organ involvement

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49
Q

What antibodies are associated with drug-induced lupus?

A

Anti-histone

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50
Q

What are some characteristic features of drug-induced lupus?

A

Usually resolves on drug stopping, dsDNA negative

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51
Q

What is a drug that can cause drug-induced lupus?

A

Isoniazid

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52
Q

What is the treatment of choice for acute reactive arthritis?

A

NSAIDs, as long as there are no contraindications

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53
Q

What are treatments for persistent reactive arthritis?

A
  1. Intra-articular steroids
  2. Sulfasalazine
  3. Methotrexate
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54
Q

What is keratoderma blenorrhagicum?

A

Waxy yellow/brown papules on palms and soles due to reactive arthritis

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55
Q

What is circinate balanitis?

A

Painless vesicles on the coronal margin of the prepuce

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56
Q

What is the typical pattern seen in reactive arthritis?

A

Asymmetrical oligoarthritis of the lower limbs

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57
Q

What may/should the ESR be in PMR?

A

> 40mm/hr

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58
Q

What is the management for PMR?

A

Prednisolone e.g. 15mg OD should lead to a dramatic response

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59
Q

What is Felty’s syndrome?

A

Triad of Reactive arthritis, splenomegaly and neutropenia

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60
Q

How can you classify the extra-articular features of RhA?

A
  1. Ocular
  2. Respiratory
  3. IHD
  4. Infections
  5. Depression
    6 Osteoporosis
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61
Q

What are some resp complications of RhA?

A
  1. Pulmonary fibrosis
  2. Pleural efflusion
  3. Pleurisy
  4. Pulmonary nodules
  5. Bronchiolitis obliterans
  6. Methotrexate pneumonitis
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62
Q

What are some ocular complications of RhA?

A
  1. Keratoconjunctivitis sicca (most common)
  2. Episcleritis
  3. Scleritis
  4. Corneal ulceration
  5. Keratitis
  6. Steroid-induced cataracts
  7. HCQ retinopathy
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63
Q

What additional skin change is Behcets syndrome associated with?

A

Erythema nodosum

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64
Q

What is asteatotic eczema also known as?

A

Crazy paving eczema

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65
Q

What is asteatotic eczema associated with?

A

Hypothyroidism and lymphoma

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66
Q

What does guttate psoriasis look like?

A

Teardrops

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67
Q

When is guttate psoriasis typically seen?

A

After streptococcal throat infections

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68
Q

What is the triad of Behcets syndrome?

A

Oral ulcers, genital ulcers, anterior uveitis (it is a clinical diagnosis, there is no definitive test)

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69
Q

What test is suggestive of Behcets?

A

Positive pathergy test (puncture site following needle prick becomes inflamed with small pustule forming)

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70
Q

What is the treatment of choice for osteomalacia?

A

Vitamin D3 supplementation

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71
Q

What are some causes of osteomalacia?

A
  1. Vit D deficiency = malabsorptive, lack of sunlight, diet
  2. Renal failure
  3. Liver disease e.g. cirrhosis
  4. Drugs induced e.g. anticonvulsants
  5. Genetic
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72
Q

What are 5 side effects of sulfasalazine?

A
  1. Oligospermia
  2. Stevens Johnson Syndrome
  3. Lung fibrosis
  4. Myelosuppression
  5. May colour tears –> stained contact lenses
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73
Q

What are 4 poor prognostic features for RhA?

A
  1. RhF positive
  2. HLA DR4
  3. Insidious onset
  4. Anti-CCP Abs
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74
Q

How do you define dermatomyositis?

A

Inflammatory disorder causing symmetrical proximal muscle weakness and characteristic skin lesions

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75
Q

What is dermatomyositis often associated with?

A

Cancer (esp. ovarian, breast, lung) - with dermatomyositis being a paraneoplastic complications of the malignancy

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76
Q

What are 5 skin signs of dermatomyositis?

A
  1. Gottron’s papules
  2. Heliotrope rash (periorbital)
  3. Macular rash over back and shoulder
  4. Nail fold capillary dilatation
  5. Photosensitive
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77
Q

What are gottron’s papules?

A

Roughened red papules over extensor surfaces of fingers

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78
Q

What is pencil cup deformity of the DIPs associated with?

A

Psoriatic arthritis

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79
Q

What are the types of psoriatic arthropathy?

A
  1. Symmetrical polyarthritis (similar to RhA) (30-40%)
  2. Asymmetrical oligoarthritis (20-30%)
  3. DIP joint disease (10%)
  4. Spondyloarthritis
  5. Arthritis mutilans
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80
Q

What is the buzzword for arthritis mutilans?

A

Telescoping fingers

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81
Q

What is needed for definitive diagnosis of ankylosing spondylitis?

A

A radiological feature and clinical feature

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82
Q

What percentage of the general population is HLA B27 positive?

A

12%

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83
Q

What percentage of pts with ankylosing spondylitis are HLA B27 positive?

A

90%

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84
Q

What might you see on X ray of ankylosing spondylitis?

A
  1. Sacroiliitis (subchondral erosions, sclerosis)
  2. Squaring of lumbar vertebra
  3. Bamboo spine
  4. Syndesmophytes
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85
Q

What may you see on CXR of ankylosing spondylitis?

A

Apical fibrosis

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86
Q

What is a syndesmophyte?

A

A bony outgrowth originating inside a ligament

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87
Q

What may you see on spirometry of ankylosing spondylitis?

A

A restrictive defect due to a combination of:

  1. Pulmonary fibrosis
  2. Kyphosis
  3. Ankylosis
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88
Q

How can you distinguish pseudogout from gout on plain radiograph?

A

Chondrocalcinosis

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89
Q

What is chondrocalcinosis?

A

Visible calcification of cartilage

90
Q

What are some risk factors for pseudogout?

A
  1. Haemochromatosis
  2. HPT
  3. Acromegaly
  4. Wilson’s disease
  5. Low Mg/P
91
Q

What is the management of pseudogout?

A
  1. NSAIDS
  2. Inra-articular/muscular steroids
  3. Oral steroids
92
Q

What joints does pseudogout most commonly affect?

A

Knee, wrist and shoulders

93
Q

What are two forms of serositis you can see in SLE?

A

Pleuritis and pericarditis

94
Q

How is denosumab given?

A

SC injection every 6m

95
Q

When do you offer urate lowering therapy to pts with gout?

A

To all pts after their first attack of gout (allopurinol 1st line)

96
Q

What is a good antihypertensive to give to pts with gout and why?

A

Losartan as it has a specific uricosuric action

97
Q

What subtype of dermatomyositis is characterised by a combination of myositis and interstitial lung disease?

A

Anti-synthetase syndrome (anti-Jo1, anti-tRNA synthetase)

98
Q

What are some common and less common drugs that cause drug-induced lupus?

A
  1. Common = procainamide, hydralazine

2. Less common = isoniazid, minocycline, phenytoin

99
Q

What is the mechanism by which Marfan’s causes aortic dissection?

A

Dilatation of the aortic sinuses

100
Q

What gene mutation causes Marfan’s?

A

Fibrillin-1 on Chr 15

101
Q

What are 3 eye signs of Marfans?

A
  1. Upward lens dislocation
  2. Blue sclerae
  3. Myopia
102
Q

What is the leading cause of death in Marfans?

A

Aortic dissection and other CVS problems

103
Q

If a pt is suffering from significant upper Gi s/e from alendronate, what can you change their treatment to?

A

Risedronate or etidronate

104
Q

Can ankylosing spondylitis present with night pain?

A

Ye boi

105
Q

What is the dagger sign and what is it a sign of?

A
  1. A single radiodense line related to ossification of supraspinous and interspinous ligaments
  2. Ankylosing spondylitis
106
Q

What are 4 causes of a raised pANCA?

A
  1. MPA
  2. eGPA
  3. GPA (in 25%, fun fun fun)
  4. Immune crescenteric glomerulonephritis
  5. PSC
107
Q

What are 3 systemic causes of a raised ANCA?

A
  1. IBD (UC > CD)
  2. CTD (RA, SLE, Sjogrens)
  3. Autoimmune hepatitis
108
Q

What are periarticular erosions typically seen in?

A

Rheumatoid arthritis

109
Q

What is a ‘plantar spur’ on X-ray associated with?

A

Psoriatic arthritis

110
Q

What does chondrocalcinosis on X ray suggest?

A

Pseudogout

111
Q

What criteria is used to assess the probability of septic arthritis in children?

A

Kocher’s criteria

112
Q

What are the parameters in Kocher’s criteria?

A
  1. Non-weight bearing
  2. Fever > 38.5
  3. Raised WCC
  4. ESR > 40
113
Q

What are some conditions associated with a positive RhF?

A
  1. RhA, SLE, Sjogrens, Felty’s
  2. Infective endocarditis
  3. SLE
  4. Systemic sclerosis
  5. Infections = TB, HBV. EBV< leprosy
114
Q

In what percentage of the population do you find a positive RhF?

A

5%

115
Q

What test is highly specific for RhA?

A

Anti-CCP (may be detectable up to 10 years before the development of RhA)

116
Q

What is a classic side effect of colchicine?

A

Diarrhoea

117
Q

What is the most specific test for SLE?

A

Anti-smith Abs

118
Q

What markers can be used for disease monitoring of SLE?

A

ESR, C3, C4, anti-dsDNA titres

119
Q

What mushkie is not associated with developing osteoporosis?

A

Obesity (in fact, low body mass is associated with it)

120
Q

What score can be used to help assess hypermobility?

A

Beighton score (positive if >5/9 in adults, >6/9 in children)

121
Q

What is the most common cause of septic arthritis?

A

S. aureus

122
Q

What is the most common cause of septic arthritis in young sexually active people?

A

N. gonorrhoeae

123
Q

How long is abx treatment for septic arthritis?

A

6-12 weeks (BNF)

124
Q

What kind of crystals are found in pseudogout?

A

Weakly positively birefringent rhomboid-shaped crystals

125
Q

What imaging must be done on pts with RhA before having surgery and why?

A
  1. AP and lateral C-spine radiographs
  2. To look for atlanto-axial subluxation, as it can lead to cord compression –> ensure pts neck is not hyperextended on intubation
126
Q

What antibiotics should not be given to pts on sulfasalazine?

A

Sulphonamides, due to cross-sensitivity leading to an allergic reaction

127
Q

What is sulfasalazine?

A

A pro-drug for 5-ASA

128
Q

What medication can be safely used during pregnancy in RhA?

A

HCQ - does cross the placenta, but does not appear to have fetal toxicity with the doses used for Tx of RhA

129
Q

What is the main adverse effect of HCQ?

A

Bull’s eye retinopathy = may result in severe and permanent visual loss

130
Q

How does one monitor the main s’e of HCQ?

A

Monitor visual acuity annually with a fundus photograph,, OCT scan (optical coherence tomography) and FAF imaging (fundus autofluorescence)

131
Q

What is the rate of occurence of bull’s eye retinopathy in pts on HCQ?

A
  1. > 5yrs –> 7%

2. >20yrs –> 20-50%

132
Q

Allergy to new watch - what is the offending precipitant and what is the G&C classification?

A
  1. Nickel

2. IV

133
Q

What is the classical demographic affected by Ankylosing spondylitis?

A
  1. Males (3M:1F) aged 20-30 y/o
134
Q

What is Schober’s test for?

A

Reduced forward flexion in Ankylosing spondylitis

135
Q

How does one perform Schober’s test?

A

A line is drawn 10cm above and 5cm below the dimpes of Venus, the two lines should increase by >5cm when the pt bends as far as possible

136
Q

What are the 8 A’s of ankylosing spondylitis?

A
  1. Anterior uveitis
  2. Apical fibrosis
  3. Aortic regurgitation
  4. AV node block
  5. Achilles tendonitis
  6. Amyloidosis
  7. Arthritis (peripheral)
  8. And cauda equina syndrome
137
Q

When should methotrexate be stopped before trying to conceive?

A

6 months before trying to conceive (in both men and women)

138
Q

Low calcium and phosphate with raised ALP?

A

Osteomalacia

139
Q

What is the Z score in DEXA scans adjusted for?

A

Age, gender and ethnic factors

140
Q

What is the initial management of pts with RhA?

A

DMARD monotherapy (methotrextate) +/- a short course of bridging prednisolone

141
Q

How do you monitor response to RhA treatment?

A

CRP and DAS28

142
Q

What condition does anti-phospholipid syndrome most commonly occur secondary to?

A

SLE

143
Q

How does antiphospholipid syndrome affect?

A

Causes a paradoxical rise in APTT, due to an ex-vivo reaction of the lupus anticoagulant Abs with phospholipids involved in the cascase

144
Q

What treatment should pts with antiphospholipid syndrome be on?

A

Warfarin

145
Q

What is the triad of presentation of anti-phospholipid syndrome?

A
  1. Recurrent venous and arterial thromboses
  2. Recurrent miscarriage
  3. Thrombocytopenia
146
Q

What are the anti-phospholipid antibodies?

A
  1. Anti-cardiolipin antibodies

2. Lupus anticoagulant

147
Q

What are 5 non-skin features of dermatomyositis?

A
  1. Proximal muscle weakness
  2. Raynauds
  3. Respiratory muscle weakness
  4. Interstitial lung disease
  5. Dysphagia, odynophagia
148
Q

How can you classify Sjogrens syndrome?

A
  1. Primary (PSS)

2. Secondary to RhA or other connective tissue disorders

149
Q

When does secondary sjogrens syndrome (SSS) start to appear?

A

10 years after initial onset of disease

150
Q

What malignancy are you at increased risk of with Sjogrens syndrome?

A

Lymphoid malignancy (40-60 fold)

151
Q

What is the M:F ratio of Sjogrens?

A

1M:9F

152
Q

What are the notable Abs positive in Sjogrens syndrome?

A
  1. RhF = almost 100%
  2. Anti-Ro (SSA) = 70%
  3. Anti-La (SSB) = 30%
153
Q

What is the management of sjogrens syndrome?

A
  1. Artificial saliva and tears

2. Pilocarpine may stimulate saliva production

154
Q

What are cautions to consider before a pt is started on sulfasalazine?

A
  1. G6PD deficiency

2. Allergy to aspirin/sulphonamides

155
Q

What causes Lesch-Nyhan syndrome?

A

An X-linked deficiency in HGPRT

156
Q

What are features of Lesch-Nyhan syndrome?

A
  1. Learning disability
  2. Self mutilating behaviour
  3. Hyperuricaemia (and gout)
  4. Renal failure
157
Q

How can you classify the causes of gout?

A
  1. Decreased excretion of uric acid
  2. Increased production of uric acid
  3. Congenital = Lesch-Nyhan syndrome
158
Q

What are 3 causes of decreased excretion of uric acid?

A
  1. Drugs e.g. diuretics
  2. CLD
  3. Lead toxicity
159
Q

What are 3 causes of increased production of uric acid?

A
  1. Myeloproliferative/myeloproliferative disorder
  2. Cytotoxic drugs
  3. Severe psoriasis
160
Q

What are some foods rich in purine?

A

Liver, kidneys, seafood, oily fish and yeast products

161
Q

What are 4 causes of dactylitis?

A
  1. Spondyloarthritis e.g. psoriatic and reactive arthritis
  2. Sickle cell disease
  3. Infection = TB, syphilis
  4. Sarcoidosis
162
Q

What causes trochanteric bursitis and how does it present?

A

Repeated movements of the fibroelastic band and pain and tenderness over the lateral side of the thigh

163
Q

What is meralgia paraesthetica and how does it present?

A
  1. Compression of lateral cutaneous nerve of the thigh

2. Burning sensation over ALT

164
Q

What is transient idiopathic osteoporosis?

A

Uncommon condition sometimes seen in the third trimester of pregnancy, with groin pain associated with a limited range of movement in the hip and inability to weight bear. ESR may be elevated.

165
Q

What is the first line management for ankylosing spondylitis?

A
  1. Regular exercise e.g. swimming and physiotherapy
  2. NSAIDs (1st line treatment)
  3. Anti-TNF should be given to pts with persistently high disease activity despite conventional Tx e.g. sulfasalazine
166
Q

What is the now preferred term for trochanteric bursitis?

A

Greater trochanteric pain syndrome

167
Q

In what pt group is trochanteric bursitis most common?

A

Women aged 50-yo years old

168
Q

How do you differentiate between inflammatory arthritis and osteoarthritis?

A

Inflammatory arthritis has pain that is worse in the mornings, whilst osteoarthritis has pain that is worse on exercise

169
Q

What is the usual time frame for onset of PMR?

A

Usually rapid onset (<1m)

170
Q

What is a solid mnemonic for the causes of gout?

A 
DART
Diuretics
Alcohol
Renal disease
Trauma
171
Q

What joint is most commonly affected by an acute attack of gout?

A

1st MTP joint

172
Q

What other drug can be given to a pt with gout if allopurinol is not tolerated or is c/i?

A

Febuxostat (a XO inhibitor)

173
Q

What is the characteristic pattern of pyrexia in Still’s disease?

A

Rises in the late afternoon/early evening in a daily pattern, and accompanies a worsening of joint symptoms and rash

174
Q

What is the criteria used for the diagnosis of Still’s disease?

A

Yamaguchi criteria

175
Q

What is the management of Still’s disease?

A
  1. NSAIDs
  2. Steroids if not controlled after 1 wk on steroids
  3. Methotrexate, anti-TNF, IL1
176
Q

What are 2 rheum condition are associated with livedo reticularis?

A
  1. Antiphospholipid syndrome

2. Polyarteritis Nodosa

177
Q

What are 2 causes of a saddle shaped nose?

A
  1. GPA

2. Relapsing polychondritis

178
Q

Oligoarthritis with ulcerative colitis, what test and why?

A
  1. HLA B27

2. Enteropathic arthritis is a seronegative spondyloarthropathy

179
Q

What is the prevalence of TPMT deficiency?

A

1/200

180
Q

What levels must be checked before starting a patient on azathioprine?

A

TPMT levels

181
Q

What are 4 features of osteogenesis imperfecta?

A
  1. Multiple fractures
  2. Blue sclerae
  3. Dental caries
  4. Deafness (due to otosclerosis)
182
Q

What may indicate referred lumbar spine pain as a cause of hip pain?

A

A positive femoral nerve stretch test

183
Q

Do you get thrombocytopenia or thrombocytosis in antiphospholipid syndrome?

A

Thrombocytopenia

184
Q

What is the APTT like in antiphospholipid syndrome?

A

Prolonged (a pradoxical rise)

185
Q

What are the rotator cuff muscles?

A 
SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
186
Q

What is the function of supraspinatus?

A

Abducts arm before deltoid (first 20 degrees)

187
Q

What is the function of infraspinatus?

A

External rotation of shoulder

188
Q

What is the function of teres minor?

A

External rotation of shoulder

189
Q

What is the function of subscapularis?

A

Adducts and rotates arm medially

190
Q

Which rotator cuff muscle is most commonly injured?

A

Supraspinatus

191
Q

Which 2 rotator cuff muscles essentially do the same thing?

A

Infraspinatus and teres minor

192
Q

Why should NSAIDs be avoided in elderly pts taking warfarin?

A

Due to the risk of life-threatening GI haemorrhage

193
Q

What is the epidemiology of fibromyalgia?

A
  1. 1M:5F

2. 30-50 y/o

194
Q

What are the features of fibromyalgia?

A
  1. Chronic multi-site pain
  2. Lethargy
  3. Cognitive impairment ‘fibro-fog’
  4. Sleep disturbance, headaches, dizziness
195
Q

What is the management for fibromyalgia?

A
  1. Aerobic exercise (strongest evidence base)
  2. CBT
  3. Amitryptiline/pregabalin/duloxetine
196
Q

What is a fun fact about proximal myopathy in polymyalgia rheumatica?

A

There is no true weakness of limb girdles in PMR on examination, any weakness of muscles is due to myalgia (pain inhibition)

197
Q

What is Buerger’s disease?

A

Segmental thrombotic occlusions of the small and medium sized lower limb vessels, commonest in young male smokers

198
Q

What might you see on angio in Buergers disease?

A

Tortuous corkscrew shaped collateral vessels

199
Q

What can help in the management of Buerger’s disease?

A

Smoking cessation

200
Q

What is a quirk of allopurinol when using it to manage gout?

A

Should not be started until an acute attack has settled, although if they are already prescribed it they should continue to take it

201
Q

What is a cardiac complication of RhA?

A

IHD

202
Q

What is the current guideline regarding bisphosphonate holidays?

A
  1. After a five year period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.
  2. This guidance separates patients into high and low risk groups (high = e.g. age > 75, steroids, T
203
Q

What antibodies must be negative to diagnose adult-onset Still’s disease?

A

RhF and ANA as Still’s is a Diagnosis of exclusion

204
Q

What clinical test is suggestive of ankylosing spondylitis?

A
  1. Schober’s test <5cm
  2. Reduced lateral flexion of the lumbar spine
  3. Loss of lumbar lordosis and accentuated thoracic kyphosis
205
Q

What is the formal name for tennis elbow?

A

Lateral epicondylitis

206
Q

What is a clinical sign of lateral epicondylitis?

A

Pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended

207
Q

What are the 4 management strategies for lateral epicondylitis?

A
  1. Avoiding muscle overload
  2. Simple analgesia
  3. Steroid injection
  4. Physiotherapy
208
Q

When should anti-TNFa be used in pts with axial ankylosing spondylitis?

A

Has failed on 2 different NSAIDS and meets criteria for active disease on 2 occasions 12 weeks apart

209
Q

Have DMARDs been shown to be beneficial for ankylosing spondylitis?

A

NO

210
Q

How can you classify the causes of Raynaud’s?

A
  1. Primary = Raynaud’s disease

2. Secondary = Raynaud’s phenomenon

211
Q

What are some secondary causes of Raynaud’s phenomenon?

A
  1. Connective tissue disorders = scleroderma, RhA, SLE
  2. Leukaemia
  3. Use of vibrating tools
  4. Drugs = OCP
  5. Cervical rib
212
Q

What is the connective tissue disorder most commonly associated with Raynaud’s?

A

Scleroderma

213
Q

What is the management for Raynaud’s disease?

A
  1. CCBs e.g. nifedipine

2. IV prostacyclin infusions (effects may last several weeks/months)

214
Q

What is PAN?

A

A medium-vessel vasculitis with necrotising inflammation leading to aneurysm formation

215
Q

What infection is associated with PAN?

A

Hep B

216
Q

What causes visual loss in GCA?

A

Anterior ischaemic optic neuropathy

217
Q

What is the HLA association for Behcet’s?

A

HLA B51

218
Q

How can you classify the causes of reactive arthritis?

A
  1. Post-STI

2. Post-dysenteric

219
Q

What is the main post-STI organism responsible for reactive arthritis?

A

C. trachomatis

220
Q

What are the post-dysenteric organisms responsible for reactive arthritis?

A
  1. Salmonella
  2. Shigella
  3. Yersinia
  4. Campylobacter

Medicine and Surgery Mushkies (52 decks)

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