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Phase 3A (HV) > Phase 2 Revision/ GP topics > Flashcards

Phase 2 Revision/ GP topics Flashcards

1
Q

When should an urgent referral to endoscopy be made?

A
  • Age 55 or older with
  • weight loss and
  • upper abdominal pain, reflux or dyspepsia
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2
Q

What is the 1st line tx for cellulitis

A

Flucloxacillin

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3
Q

What is the primary cause of primary Hyperparathyroidism

A

Solitary adenoma (80%)

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4
Q

What is the Sx and signs of low calcium?

A

CATS go NUMB (convulsions, arrhythmias, tetany, spasms, numbness)
Chvostek and troseaus sign
ECG- long QT intervals

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5
Q

What medication is recommended by NICE to be given for prophylaxis of SBP?

A

Oral ciprofloxacin

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6
Q

What is the pharmacological treatment for ascites in liver cirrhosis?

A

Spironolactone

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7
Q

What is the classical triad associated with ascending cholangitis?

A

Fever
Jaundice
RUQ abdominal pain

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8
Q

What tx can be given to prevent hepatic encephalopathy?

A

Lactulose (gets rid of ammonia)

Rifaximin- recommended by NICE as option to reduce the recurrence of overt HE

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9
Q

What tx is the first line therapy to maintain remission in chrons disease?

A

Azathioprine

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10
Q

What antibody is prominent in Hashimotos?

A

Anti TPO

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11
Q

What is the genetic mutation responsible for Wilson’s disease?

A

ATP7B

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12
Q

What is a se of levothyroxine?

A

Osteoporosis

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13
Q

What histological findings are associated with coeliac disease?

A

Crypt hyperplasia
Villous atrophy

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14
Q

What rash is coincides with coeliac disease?

A

Dermatitis herpetiformis

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15
Q

What is pellagra?

A

Vitamin b3 (niacin) deficiency

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16
Q

What are the 3 clinical features of pellagra?

A

Dermatitis
Diarrhoea
Dementia

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17
Q

What is triple therapy?

A

Amoxicillin
Clarithromycin
Omeprazole

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18
Q

What endoscopic findings are found in UC?

A

Erythemous mucosa
Loss of hasutral markings
Pseudopolyps

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19
Q

What are the biopsy findings in UC?

A

Loss of goblet cells
Crypt abscess
Lymphocytes

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20
Q

What are the causes of microcytic anaemia

A

Thalassemia
Anaemia of chronic disease
IDA
Lead poisoning
Sideroblastic anaemia

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21
Q

What murmur is associated with aortic stenosis?

A

Ejection systolic murmur

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22
Q

What ,murmur is associated with mitral regurgitation?

A

Pansystolic murmur

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23
Q

When should infective endocarditis be suspected in a patient?

A

Fever + new murmur (no hx of valvular pathology)

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24
Q

List 4 symptoms and signs of infective endocarditis?

A

Sx- fever, new murmur, SOB, malaise, weight loss, night sweats, fatigue

Signs- Janeway lesions, Osler nodes, Roth spots and splinter haemorrhages

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25
Q

What criteria is used to diagnose IE?

A

Dukes

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26
Q

What is stable angina and list 3 sx?

A

Stable angina is reversibel myocardial ischaemia on exertion and relieved by rest or GTN

Chest pain on exertion
Dyspnoea
Diaphoresis
Fatigue
Nausea

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27
Q

What is the 1st line and GS ix of stable angina?

A

1st line- ECG
GS- CT coronary angiogrpahy

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28
Q

WHta is the medical management and secondary prevention for stable angina?

A

Medical mx:
- Immediate relief- GTN spray
-Long term sx rleief- BB/CCB daily

secondary prevention:
-Aspirin 75mg
-ACEI
-Statin
-BB (already on one for long term relief)

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29
Q

What is unstable angina

A

reversible myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis

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30
Q

What ix are indicated in unstable angina and list their results?

A

ECG- ST depression, Transiet ST elevations, T wave changes

Troponin- Normal

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31
Q

List 3 Non-modifiable and 5 modifiable RF for ACS

A

Diabetes
HTN
Smoking
Obesity
Hyperlipidaemia
Physical inactivity

Age, Male, FHx, Ethnicity

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32
Q

What is the mx of prinzmetal’s angina?

A

CCB- verapamil

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33
Q

What is a STEMI?

A

Myocardial infarction caused by a complete occlusion of a coronary artery

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34
Q

What ix would be done in a STEMI?

A

1st line- ECG (ST elevations)
also
Troponin levels- Raised
Coronary angiography

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35
Q

acute Mx of STEMI

A

MONA
Sx- PCI if within 2 hours of medical contact and within 12 hours of sx onset if not Thrombolysis

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36
Q

What investigation results would represent NSTEMI?

A

ECG- (ST depression, Transient ST elevations, T wave changes, pathological Q waves)

Troponin levels- Raised

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37
Q

What is the GRACE score and what is it used for?

A

This scoring system gives 6 month risk of death or repeat MI after having NSTEM

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38
Q

Mx of unsatble angina and NSTEMI

A

Oxygen
Aspirin 300mg and Fondaparinux
GTN
Morphine
Antithrombin therapy if immediate andiogram

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39
Q

What is the post MI mx

A

Apsirin 75mg
Antiplatelet therapy
ACEI
BB
Statin

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40
Q

What is the definition of HF?

A

defined as the failure of the heart to generate sufficient cardiac output to meet the metabolic demands of the body.

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41
Q

List 5 sx/signs of LHF

A

SOBOE
PND
Orthopnea
Pulmonary oedema
Nocturnal cough +/- pink frothy sputum
Fatigue
Cold peripheries

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42
Q

List 5 sx/signs of RHF

A

Hepatomegaly
Ankle oedema
Raised JVP
Ascites
Epistaxis
WG

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43
Q

What classification in used in HF and list the criteria

A

NYHA
Class I - no limitation in physical activity, and activity does not cause undue fatigue, palpitation or dyspnoea.

Class II - slight limitation of physical activity, and comfort at rest. Ordinary physical activity causes fatigue, palpitation and/or dyspnoea.

Class III - marked limitation in physical activity, but comfort at rest. Minimal physical activity causes fatigue (less than ordinary).

Class IV - inability to carry on any physical activity without discomfort, with symptoms occurring at rest. If any activity takes place, discomfort increases.

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44
Q

What is HFrEF and HFpEF?

A

HFrEF- ejection fraction <40%
HFpEF- ejection fraction >40%

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45
Q

What is the 1st line ix for HF?

A

BNP

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46
Q

List the conservative tx for HF

A

Weight loss if BMI >30.

Smoking cessation

Salt and fluid restriction - improves mortality

Supervised exercise-based group rehabilitation

Offer annual influenza and one-off pneumococcal vaccinations for patients diagnosed with heart failure.

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47
Q

What rx is used for symptomatic mx and mortality mx HF?

A

symtpmatic- Furosemide

Mortality-
1st line- ACEI + BB
If sx get worse add
hydralazine, ivarbradine, spiranolactone, digoxin

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48
Q

Signs of hypokalaemia on ECG

A

Prominent U waves
Small/Absent T waves
Prolonged PR interval
ST depression
Long QT interval

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49
Q

Signs of hyperkaleamia on ECG

A

tall-tented T waves,
small P waves,
widened QRS

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50
Q

List the ECG changes seen in A-fib

A

Absent P waves
Narrow QRS complex
Irregularly Iregular Rhythm

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51
Q

List the causes of A-fib?

A

Mrs SMITH
Sepsis
Mitral valve pathology
IHD
Thyrotoxicosis
HTN

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52
Q

What is A-fib?

A

A supraventricular tachyarrythmia characterised by irregular, uncordianted atrial contractions at the rate of 300-600bpm

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53
Q

What is the mx of A-Fib
a) Rate control (when)
b) Rhythm control (when)

A

Rate control- reversible cause, onset >48 hours
- Beta Blockers (Bisoprolol)
- CCB (dialtezam)
- Digoxin

Rhythm control- new onset AF
2 methods
1) electrical cardioversion
2) Pharmacalogical cardioverison e.g. amiodarone, Flecanide (pill in pocket) or Sotalol

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54
Q

What tool is used in AF to mitigate stroke risk?

A

CHADS2VASc Score
C: 1 point for congestive cardiac failure.
H: 1 point for hypertension.
A2: 2 points if the patient is aged 75 or over.
D: 1 point if the patient has diabetes mellitus.
S2: 2 points if the patient has previously had a stroke or transient ischaemic attack (TIA).
V: 1 point if the patient has known vascular disease.
A: 1 point if the patient is aged 65-74.
Sc: 1 point if the patient is female.

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55
Q

What ECG fetures are seen in Atrial flutter

A

Regular rhythm
Saw tooth pattern
Narrow QRS complex

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56
Q

What is V-Tac and what is its mx (pulseless and pulse)?

A

A regular broad complex tachycardia. It can occur with a pulse or it may be pulseless.

no pulse- Shock (x3) + IV adrenaline + IV amiodarone
-adrenaline every 3-5 minuets after

if pulse- IV amiadorone 300mg if not enough shock (X3)

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57
Q

What is V-Fib and list its management?

A

An irregular broad complex tachycardia. This is always a pulseless rhythm.

Shock(x3) + IV adrenaline + IV amiodarone

  • adrenaline every 3-5 minuets after
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58
Q

List the causative agents in infective endocarditis for the folowing?
a) IVDU
b) Poor dental hygeine
c) Prosthetic valve
d) Colorectal cancer

A

a) staph aureus
b) strep viridans
c) Staph epidermidis
d) Strep bovis

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59
Q

List 3 signs of infective endocarditis

A

Splinter haemorrhages

Osler’s nodes: painful pulp infarcts on end of fingers.

Roth spots: boat-shaped retinal haemorrhages with pale centres seen on fundoscopy.

Janeway leisons- painless haemorrhagic cutaneous lesions in the palms and soles

Septic emboli

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60
Q

Which lung cancer most common in non-smokers

A

Adenocarcinoma

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61
Q

Gs investigation for bronchiectasis

A

HRCT- high resolution CT

Thickened dilated airways w or w/o fluid levels

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62
Q

A stony dull percussion indicates what

A

Pleural effusion

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63
Q

What lung cancer is strongly associated with smoking

A

Squamous cell carcinoma

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64
Q

Cancer can spread to the lungs from what areas

A 
Kidney 
Prostate 
Breast 
Bowel 
Bladder
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65
Q

Lung cancer can metastasise to which sites

A

Brain
Adrenals
Bone
Liver

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66
Q

What ECG Changes may you see in COPD

A

Prominent P wave in inferior leads (II,III, aVF)
Right axis deviation
Low voltage QRS
RBBB

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67
Q

What paraneoplastic syndromes are associated with small cell lung cancers

A

ACTH- Cushings
SIADH
Lambert Eaton myasthenia syndrome

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68
Q

What paraneoplastic syndromes is associated with non small cell lung cancer

A

Hyperparthyroidism

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69
Q

What would be seen on histology of an asthmatic

A

Charcot Leyden crystals and crushmann spirals

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70
Q

What drug should be given for prophylaxis against the se of isoniazid

A

Pyridoxine hydrochloride

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71
Q

What are the signs of TB on CXR

A 
Ghon focus
Dense homogenous opacity 
Hilar lymphadenopathy
Pleural effusions 
Tree in a bud sign- nodules w/ poorly defined margins
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72
Q

Differentials for bi-hilar lymphadenopathy

A 
Sarcoidosis 
Silicosis 
Hodgkin lymphoma 
Mycoplasma 
TB
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73
Q

Signs and sx of bronchiectasis

A

Clubbing
Coarse inspiratory crepitations
Cough w/ sputum production
Intermittent haemoptysis
SOB
Wheeze

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74
Q

Complications of COPD

A

Respiratory infections
Lung cancer
Pneumothorax
ARDS

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75
Q

Differentials of COPD

A

Asthma
Bronchiectasis
TB
Congestive HF

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75
Q

COPD encompasses 2 types of chronic lung diseases, what are they?

A

1) Emphysema- enlargement of air spaces and destruction of alveolar walls
2) Chronic Bronchitis-hypertrophy and hyperplasia of mucus glands

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76
Q

Signs of pneumoniae

A

Dull percussion
Increased vocal resonance/ tactile fremitus
Pleural rub
Bronchial breathing

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76
Q

What is the mx of COPD?

A
  1. SABA or SAMA
  2. if no astmathic- +LABA +LAMA
    if astmathic- +LABA +ICS
  3. +LABA +LAMA +ICS
77
Q

Signs of COPD

A

Hyperinflation
Hyper-resonance on percussion
Reduced chest expansion
Decreased/quiet breath sounds

77
Q

List 3 RF for COPD?

A

Smoking
Alpha 1 antitrypsion deficiency
Occupation- coal/cotton/grains

78
Q

Abx to five according to CURB-65

A

0-1= amoxicillin po
2- amoxicillin and clarithromycin/doxycycline
3-5= iv co-amoxiclav and clarithromycin

78
Q
A
79
Q

What drugs can cause pulmonary fibrosis

A

Nitrofurnatoin
Amiadorone
Methotrexate
Bleomycin

80
Q

If PE score is less than 4 what is next line management

A

D dimer

81
Q

If PE score is more than or equal to 4 what’s the next step

A

CTPA and start on DOAC

82
Q

List 5 causes of finger clubbing

A 
Bronchiectasis 
Cystic fibrosis 
VSD 
IPF
Lung cancer
83
Q

List 5 differentials for dry cough

A 
Asthma 
Gord
Pulmonary fibrosis 
Ramipril induced
Sleep apnoea
84
Q

List t differentials for sputum/wet cough

A 
COPD
Bronchiectasis 
Acute bronchitis 
HF
Cystic fibrosis
85
Q

What prophylaxis abx is given in COPD

A

Azithromycin

86
Q

What is the mx of chronic asthma?

A
  1. SABA
  2. SABA + ICS
  3. SABA +ICS + LTRA
  4. SABA +ICS + LABA +/- LTRA
  5. MART(inc ICS) + LABA +/-LTRA
87
Q

What is the acute mx of asthma attack?

A

ABCDE approach
ensure o2 sats 94%-98%
Nebulisers (Salbutamol/Ipratropium)
Steroids (PO Pred/IV Hydro)
IV MgSO4
IV aminophylline

88
Q

What is the causative organism of TB?

A

Mycobacterium tuberculosis (acid fast bacilli)

89
Q

What stain is required to diagnose TB, list the finding?

A

Ziehl neelsen stain
bacteria turns red against blue background

90
Q

What drugs are indicated for TB. List their respective SE?

A

Rifampicin- SE- Red/orange wee
Isoniazid- SE- Peripheral neuropathy
Pyrazinamide- SE- Gout/Hepatitis
Ethambutol- SE- Optic neuritis/colour desaturation

91
Q

What is the CF and its mode of inheritance?

A

CF is a genetic disease caused by mutations in the cystic fibrosis transmembrane
conductance regulator (CFTR) gene

Autosomal Recessive

92
Q

GS Ix for CF?

A

Sweat test (cl- conc >60mmol/L)

93
Q

What is the most common causative organism of CAP?

A

Strep Pneumoniae

94
Q

What risk score is used CAP to assess disease severity?

A

CURB-65
Confusion- 1 point
Urea >7mmol- 1 point
RR >30- 1 point
BP (<90 systolic or <60 diastolic)- 1 Point
Age >65 years- 1 point

95
Q

What is the following CURB scores indicative of in terms of treatment?

A

0/1: home-based care, give oral amoxicillin for 5 days

2: hospital-based care, 7-10 day course of dual antibiotic therapy with amoxicillin (IV or oral) and a macrolide

3: Hospital/ITU-based care, 7-10 day course of dual antibiotic therapy with IV co-amoxiclav/ceftriaxone/tazocin and a macrolide.

96
Q

List 5 sx of Pulmonary fibrosis?

A

Cough
SOB
End expiratory basialr crackles
Clubbing
WL
Fatigue

97
Q

What is sarcoidosis and list 5 sx?

A

multisystem chronic granulomatous disorder of unknown cause commonly
affecting the lungs, skin and eyes.

Bilaterla hilar lymphadenopathy
Erythema nodosum (on shins)
Lupus pernio
Facial palsy
Non-productive cough
Hypercalcaemia
SOB
WL/Polyarthralgia

98
Q

List the spirometry results for onstructive lung disease?

A

TLC + RV- Increased
FEV1- Decreased
FEV1/FVC- Decreased (<0.7)

99
Q

List the spirometry results for restrictive lung disease?

A

TLC + RV- Decreased
FVC- Decreased
FEV1/FVC- increased (>0.7) or normal

100
Q

List the features of crohns disease

A

Diarrhoea- usaully non bloody
Weight loss
Upper GI symptoms, moth ulcers, perianal diseases
Abdomianl mass palpalble in right illiac fossa

101
Q

List the features of UC?

A

Bloody diarrhoea
Abdo pain in the LIF
Tenesmus

102
Q

List the histology for both UC and Crohns?

A

UC- decreased goblet cells, granulomas. Increased lymphocytes. Just submucosal inflammation

Crohns- Increased goblet cells, granulomas. Inflammation in all layers

103
Q

List the endoscopy findings for Crohns and UC?

A

UC- Loss of haustral markings, continous inflammation, Pseudopolyps

Crohns- Ulcers, Skip leisons, cobble stone appaerance

104
Q

List the acute and remission tx for both UC and Crohns

A

Crohns-
acute- Glucocorticoids (PO/IV)
Remission- 1st- azathioprine or mercaptopurine
2nd methotrexate

UC
acute- topical/oral 5ASA +/- corticosteroids
Remission- moderate- oral aminosalicylate
severe- oral azathioprine or oral mercaptopurine

105
Q

definition for the following?

a) Diverticular disease
b) diverticulosis
c)diverticulitis

A

a) presence of diverticula, which are small, bulging pouches most commonly in the sigmoid colon. sx constipation, LLQ pain, Posiible rectal bleeding

b) refers to the simple presence of diverticula. In many cases, diverticulosis is asymptomatic, and individuals may not even be aware that they have these diverticula as they are typically discovered incidentally during tests for other conditions.

c) subset of diverticular disease, occurs when these diverticula become inflamed or infected. This condition is typically characterized by severe abdominal pain, fever, and nausea.

106
Q

list 2 complications of diverticualr disease?

A

Abscess formation
perforation
fistula frmation
fibrosis

107
Q

What is acute cholecystitis and list 5 sx?

A

sudden onset of inflammation in the gallbladder. It is often associated with the presence of gallstones, particularly when one of these stones obstructs the cystic duct

sx- Fever, RUQ pain/epigatsric pain that can radiate to shoulder tip, N+V, RUQ tenderness, Murphy’s sign

108
Q

WHat is the 1st line ix of acute cholecystitis and subsequent mx?

A

1st line- USS

mx- intravenous antibiotics +
cholecystectomy

109
Q

WHat is Murphy’s sign?

A

on examination: inspiratory arrest upon palpation of the right upper quadrant

110
Q

What is charcots triad for ascending cholangitis?

A

Fever
RUQ pain
Jaundice

111
Q

What are the NICE refferal guidelines for colorectal cancer

A

> =40- unexplained WL and abdo pain
=50- unexplained wl
=60- with IDA or change in bowel habit
FIT test shows blood in faeces

112
Q

What is the screening programme for bowel cancer and who is elligible?

A

FIT (Faecal immunochemical test)
The NHS has a national screening programme offering screening every 2 years to all men and women aged 60 to 74 years in England
- test sent through the post
- abnormal results are offered colonoscopy

113
Q

WHta is pyelonephritis and list its features?

A

Pyelonephritis is a urinary tract infection affecting the kidneys/renal pelvis.

Fever/rigors
Malaise
Loin/flank pain
Vomiting
dysuria/uyinary frequency

114
Q

what is the ixs and mx for pyelonehritis?

A

Ix- Urine dipstick, Urine MSU for microscopy, culture and sensitivities, FBC + U&Es

mx- For patients with signs of acute pyelonephritis, hospital admission should be considered
local antibiotic guidelines should be followed if available

115
Q

How is the diagnosis of diabetes made?

A

Fasting glucose- >7.0mmol/l
Random Blood Glucose- >11.1mmol/l
HbA1c >48mmol/l

116
Q

what is DKA and list its Causes?

A

Diabetic ketoacidosis (DKA) is a medical emergency that is characterised by hyperglycaemia, acidosis and ketonaemia.

causes- infection, dehydration, fasting, or the first presentation of Type 1 diabetes

117
Q

What 3 features are required to make a diagnosis of DKA?

A

Hyperglycaemia, presence of blood or urine ketones, metabolic acidosis.

118
Q

What is the mx of DKA?

A

1) IV fluids- 0.9% NaCl
2) Replacemnt of potassium/elctrolytes
3) Insulin infuison
4) Long acting insulin should be continues, short acting insulin should be stopped

Monitor for signs of cerebral oedema- very common in 18-25yrs so give slower infusion to
reduce risk

119
Q

WHat are the blood gas results in DKA?

A

Glucose >11mmol/l
pH <7.3
blood ketones >3mmol/l
bicarbonate <15mmol/l

120
Q

List 3 complications of hyperthroidism ?

A

Thyroid storm
A fib
Osteopenia/osteoporosis
Corneal ulcers/visual loss in Graves’ eye disease

121
Q

What pattern of thyroid function tests would you expect with Grave’s disease?

A

Elevated T3 and T4,
low or suppressed TSH.

122
Q

WHta is the medical mx of hyperthyroidism?

A

Either ‘titration-block’ or ‘block and replace’ regimens

Carbimazole
Propylthiouracil

123
Q

List 2 primary and 2 secondary causes of hyperthyroidism?

A

Primary- Graves disease, Toxid adenoma, medications (amiadorone), Radiation exposure

Secondary Amiodorone, Lithium, pituitary addenoma, Gestational

124
Q

List 5 features of hypethyroidism

A

Heat intolerance
Tachycardia and arrhythmias
Weight loss
Diarrhoea
Sweaty skin
Insomnia and sleep disturbances
Restlessness and tremors

125
Q

List the fetures of graves disese

A

Exophthalmos/proptosis
Lid lag
Thyroid acropachy: Soft tissue swelling in extremities, nail clubbing, and periosteal new bone growth.
Pretibial myxoedema

126
Q

WHat antoboides are indicative of Graves disease?

A

Anti TSH

127
Q

WHat antoboides are indicative of Hashimotos disease?

A

Anti TPO

128
Q

What is the treatment for primary hypothyroidism?

A

Thyroid homrone replacement with levothyroxine.

129
Q

What pattern of thyroid function tests would you expect with hypothyroidism?

A

low T3/4 and raised TSH.

130
Q

List 5 features of hypothyroidism?

A

Cold intolerance
Weight gain
Dry skin
brittle hair
loss of oute 1/3 eyebrows
carpal tunnel syndorme
peripherla neuropathy
constipation
Macroglossia
puffy face

131
Q

What is the first line test for Acromegaly?

A

IGF-1

132
Q

What are the clincial features of acromegaly?

A

Large hands and feet
Outward growth of the jaw and head with increased inter dental spacing and macroglossia
Headaches
Erectile dysfunction
Voice change
Increased sweating
Mood disturbances
Fatigue.

133
Q

What is the best test to confirm the diagnosis of Acromegaly?

A

Oral glucose tolerance test

134
Q

What are the complications of Acromegaly?

A

Visual fields defect
Hypopituitarism
Obstructive sleep apnoea
Type two diabetes mellitus
Arthritis
Carpal tunnel syndrome
IHD/CVS/HTN

135
Q

What is the first line treatment for Acromegaly?

A

Transsphenoidal surgery.

136
Q

What are the other mx options other than sx for acromegaly?

A

Somatostatin receptor ligands- Octreotide
Pegvisomant (GH analogue)
Cabergoline (Dopamine agonist)
Radiotherapy

137
Q

What is acromegly

A

Acromegaly is a condition resulting from excessive growth hormone secretion, usually due to a secreting pituitary adenoma.

138
Q

WHta re the clinical features of cushings syndrome?

A

Striae
Obesity
Hypokalaemia
Moon face
Acne and hirsutism
Interscapular and supraclavicular fat pads
Centripetal obesity
Thin skin
Osteopenia or osteoporosis

139
Q

What are the causes of cushings?

A

ACTH Dependent- pituitary tumour, ectopic ACTH producing tumours

ACTH independent- adrenal adenomas, adrenal carcinomas

140
Q

what is cushings syndrome and cushings disease?

A

Cushing syndrome is a chronic excessive and inappropriate
elevated levels of circulating cortisol whatever the cause.

Cushing’s disease- Specifically refers to excess glucocorticoids resulting from inappropriate
ACTH secretion from pituitary due to tumour

141
Q

what is the 1st line ix for cushings?

A

Dexamethasone suppression test

142
Q

What are the features of osteoarthritis on a XRAY?

A

remembered with the mnemonic LOSS:

Loss of joint space.
Osteophytes.
Subchondral cysts.
Subarticular sclerosis.

143
Q

How can osteoarthristis be distinguished form inflammtaory diseases?

A

Pain in OA is worse with movement and towards the end of the day, and morning stiffness is not prolonged (usually <20 minutes).

In contrast, pain in inflammatory arthritis tends to improve with movement, and morning stiffness is prolonged (>30 minutes).

144
Q

What are the differentials to consider in a presentation of an acute monoarthritis?

A

GHOST
Gout/Pseudogout
Haemarthrosis
OA
Septic arthritis

145
Q

What are the radiological signs of rheumatoid arthritis on an xray?

A

LOSE
loss of joint space,
osteopenia (peri-articular),
soft tissue swelling and subluxation,
erosions and deformities.

146
Q

What is the prophylactic management for gout?

A

allopurinol.

147
Q

What is the first line treatment for osteoarthritis

A

paracetamol and topical NSAIDs are first line

148
Q

What is a potential local complication of intra-articular corticosteroid injection?

A

Septic arthritis due to local immunosuppression

149
Q

What are the three main aspects of osteoarthritis management?

A

1) Conservative (Weight loss, aerobic exercise, and PT / OT input)
2) Pharmacological (Step up the WHO pain ladder, and steroid injections)
3) Surgery (joint arthroplasty)

150
Q

What are the key risk factors for osteoarthritis?

A

Age
Obesity
Previous trauma
Systemic disease including diabetes and other rare arthropathy

151
Q

Which signs in the hands are suggestive of osteoarthritis?

A

Heberden’s and Bouchard’s nodes on the distal and proximal interphalngeal joints respectively.

152
Q

WHta is the gold standard ix for gout and its respective results

A

Arthrocentesis with synovial fluid analysis showing
* Needle shaped urate crystals
* Negatively birefringent of polarised light

153
Q

What is the acute management of gout?

A

First line - NSAIDs.
Second line - colchicine.
Third line - steroids (systemic or intra-articular).

154
Q

What does polarised light microscopy of synovial fluid reveal in pseudogout?

A

Positively birefringent, rhomboid shaped crystals.

155
Q

list the differentials of monoarthropathy

A

The most important differentials of a monoarthropathy are:

1) Septic arthritis
2) Crystal arthropathy - gout/ psuedogout
3) Inflammatory arthritis - rheumatoid arthritis and seronegative arthritis

156
Q

The joint most commonly involved in acute gout is?

A

The first metatarsophalangeal joint

157
Q

What needs to be started alongside allpurinol in gout?

A

Allopurinol transiently raises urate levels and NSAID or colchicine cover has to be introduced for 3 months.

158
Q

symptoms of gout

A

Excruciating sudden burning pain in affected joint
Swelling, redness, warmth and stiffness in affected joint
Assymetric joint distribution
Mild fever

159
Q

Lifestyle changes for the prevention of gout

A

Reduction of alcohol consumption
Reduction of purine-based foods- meat and seafood

160
Q

what medictaions can casue hyperuricaemia and should thus be reviewed

A

Thiazides and loop diuretics
Low dose salicylates
Chemotherapy

161
Q

What monitoring do patients with methotrexate need?

A

Full blood count,
liver function tests and creatinine. These patients also need a chest x ray before starting methotrexate.

162
Q

WHta is RA?

A

Rheumatoid arthritis is a commonon chronic inflammatory autoimmune disease.

163
Q

How is disease activity in rheumatoid arthritis monitored?

A

DAS28 scoring system, consisting of:

CRP or ESR
Number of swollen or tender joints
Patient questionnaire.

164
Q

Which classical deformities of the hands occur in rheumatoid arthritis?

A

Swan-neck finger deformity (MCP flexion, PIP hyperextension, DIP hyperflexion).

Boutonniere finger deformity (PIP flexion, DIP hyperextension).

Ulnar deviation of proximal phalanges.

Z-shaped thumb.

165
Q

What is the triad of Felty’s Syndrome?

A

Rheumatoid Arthritis, splenomegaly and neutropenia

166
Q

What joints affected in RA

A

MTP
MCP
PIP

167
Q

What scoring system is used to assess for the severity of RA

A

DAS28

168
Q

What are the signs/Sx of RA

A 
Early morning stiffness 
Pain eases with use 
Fatigue 
Extra-articular involvement- nodules, pleural effusions, episcleritis, amyloidosis, carpal tunnel 
Symmetrical, deforming polyartropathy
Joint swelling
169
Q

What is the tx for RA

A 
Regular NSAIDs
During flares- corticosteroids 
Remission- 1st line- DMARD monotherapy
			   2nd line- dual DMARD
				3rd line- methotrexate + TNF inhibitor 
4th- methotrexate and rituximab
170
Q

Se of methotrexate

A

Pulmonary fibrosis

Teratogenic

171
Q

5 sx of a ankylosing spondylitis

A 
Back pain 
Buttock pain 
Uveitis
Enthesis 
Weight loss
Fatigue 
Lower back stiffness
Sleep disturbances
172
Q

1st line Ix in ank spon

A

Pelvic/back X-ray

Other- Inflamma markers/Hal b27/ mri

173
Q

What X-ray changes can be seen in ank spon

A

Syndesmophytes (bamboo spine)

Sacroilitis

174
Q

Tx for ank spon

A

Encourage exercise
1st line- NSAIDs
Intra-articulate corticosteroid injection
DMARDs

175
Q

Sx and signs of psoriatic arthritis

A

Symmetrical
Dactylitis
History of Psoriasis- pink scaly patches
Onycholisis/ nail pitting
Pain swelling and stiffness of affected joints

176
Q

What joint is mostly affected in psoriatic arthritis

A

Dip

177
Q

What X-ray sing is seen in psoriatic arthritis

A

Pencil in cup

178
Q

Tx for psoriatic arthritis

A

Mild- NSAIDs
Severe cases- DMARDS
anti TNF
Ustekinumab and seckinimab

179
Q

What is reactive arthritis

A

An inflammatory seronegative spondylarthropathy that occurs after exposure to GI or GU infections

180
Q

What triad of Sx is seen in reactive arthritis

A

Conjunctivitis
Urethritis
Arthritis

181
Q

What rash is commonly associated with reactive arthritis

A

Keratoderma blennorhagia- waxy Paiutes on palms and soles

182
Q

Sx for sjorgens

A 
Dry eyes
Dry mouth
Vaginal dryness
Burning mouth
Arthralgia 
Raynauds
183
Q

What antibodies associated with sjorgen

A

Anti ro and anti la

184
Q

what are the first line ix for RA?

A

Rheumatoid factor
Anti CCP antiboides (MORE SPECIFIC)
inflammatory markers- CRP/ESR (raised- can be used to monitor deisease severity)

185
Q

Which treatments for rheumatoid arthritis slow down progression of the disease?

A

DMARDs eg. Methotrexate, Sulfasalazine, Hydroxychloroquine, Leflunomide

Biologics eg. Anti-TNF’s such as infliximab

186
Q

what joints are typicalaly spared in RA?

A

DIP JOINTS

187
Q

SX of polymyalgia rheumatica?

A

Shoulder/hip girdle stiffness (usually in the mornings) for >1 hour

Low-grade fever
Reduced appetite
Weight loss
Malaise

188
Q

tx for polymyagial rheumatica?

A

Low-dose corticosteroids

189
Q

List 3 red flags for back pain?

A

New onset when aged ≤20 or ≥55 years

Pain is progressive or not relieved by rest – suggests infection or cancer

Spinal (rather than paraspinal) tenderness

Fevers, chills and weight loss – suggest infection or cancer

Early morning stiffness for >30 minutes – suggests inflammatory spondyloarthropathy

Abnormal lower limb neurology or bladder/bowel symptoms – suggests nerve root compression, spinal cord compression or cauda equina syndrome

Phase 3A (HV) (10 decks)

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