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
2
Q
What is the 1st line tx for cellulitis
A
Flucloxacillin
3
Q
What is the primary cause of primary Hyperparathyroidism
A
Solitary adenoma (80%)
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
5
Q
What medication is recommended by NICE to be given for prophylaxis of SBP?
A
Oral ciprofloxacin
6
Q
What is the pharmacological treatment for ascites in liver cirrhosis?
A
Spironolactone
7
Q
What is the classical triad associated with ascending cholangitis?
A
Fever
Jaundice
RUQ abdominal pain
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
9
Q
What tx is the first line therapy to maintain remission in chrons disease?
A
Azathioprine
10
Q
What antibody is prominent in Hashimotos?
A
Anti TPO
11
Q
What is the genetic mutation responsible for Wilson’s disease?
A
ATP7B
12
Q
What is a se of levothyroxine?
A
Osteoporosis
13
Q
What histological findings are associated with coeliac disease?
A
Crypt hyperplasia
Villous atrophy
14
Q
What rash is coincides with coeliac disease?
A
Dermatitis herpetiformis
15
Q
What is pellagra?
A
Vitamin b3 (niacin) deficiency
16
Q
What are the 3 clinical features of pellagra?
A
Dermatitis
Diarrhoea
Dementia
17
Q
What is triple therapy?
A
Amoxicillin
Clarithromycin
Omeprazole
18
Q
What endoscopic findings are found in UC?
A
Erythemous mucosa
Loss of hasutral markings
Pseudopolyps
19
Q
What are the biopsy findings in UC?
A
Loss of goblet cells
Crypt abscess
Lymphocytes
20
Q
What are the causes of microcytic anaemia
A
Thalassemia
Anaemia of chronic disease
IDA
Lead poisoning
Sideroblastic anaemia
21
Q
What murmur is associated with aortic stenosis?
A
Ejection systolic murmur
22
Q
What ,murmur is associated with mitral regurgitation?
A
Pansystolic murmur
23
Q
When should infective endocarditis be suspected in a patient?
A
Fever + new murmur (no hx of valvular pathology)
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
25
What criteria is used to diagnose IE?
Dukes
26
What is stable angina and list 3 sx?
Stable angina is reversibel myocardial ischaemia on exertion and relieved by rest or GTN
Chest pain on exertion
Dyspnoea
Diaphoresis
Fatigue
Nausea
27
What is the 1st line and GS ix of stable angina?
1st line- ECG
GS- CT coronary angiogrpahy
28
WHta is the medical management and secondary prevention for stable angina?
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)
29
What is unstable angina
reversible myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis
30
What ix are indicated in unstable angina and list their results?
ECG- ST depression, Transiet ST elevations, T wave changes
Troponin- Normal
31
List 3 Non-modifiable and 5 modifiable RF for ACS
Diabetes
HTN
Smoking
Obesity
Hyperlipidaemia
Physical inactivity
Age, Male, FHx, Ethnicity
32
What is the mx of prinzmetal's angina?
CCB- verapamil
33
What is a STEMI?
Myocardial infarction caused by a complete occlusion of a coronary artery
34
What ix would be done in a STEMI?
1st line- ECG (ST elevations)
also
Troponin levels- Raised
Coronary angiography
35
acute Mx of STEMI
MONA
Sx- PCI if within 2 hours of medical contact and within 12 hours of sx onset if not Thrombolysis
36
What investigation results would represent NSTEMI?
ECG- (ST depression, Transient ST elevations, T wave changes, pathological Q waves)
Troponin levels- Raised
37
What is the GRACE score and what is it used for?
This scoring system gives 6 month risk of death or repeat MI after having NSTEM
38
Mx of unsatble angina and NSTEMI
Oxygen
Aspirin 300mg and Fondaparinux
GTN
Morphine
Antithrombin therapy if immediate andiogram
39
What is the post MI mx
Apsirin 75mg
Antiplatelet therapy
ACEI
BB
Statin
40
What is the definition of HF?
defined as the failure of the heart to generate sufficient cardiac output to meet the metabolic demands of the body.
41
List 5 sx/signs of LHF
SOBOE
PND
Orthopnea
Pulmonary oedema
Nocturnal cough +/- pink frothy sputum
Fatigue
Cold peripheries
42
List 5 sx/signs of RHF
Hepatomegaly
Ankle oedema
Raised JVP
Ascites
Epistaxis
WG
43
What classification in used in HF and list the criteria
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.
44
What is HFrEF and HFpEF?
HFrEF- ejection fraction <40%
HFpEF- ejection fraction >40%
45
What is the 1st line ix for HF?
BNP
46
List the conservative tx for HF
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.
47
What rx is used for symptomatic mx and mortality mx HF?
symtpmatic- Furosemide
Mortality-
1st line- ACEI + BB
If sx get worse add
hydralazine, ivarbradine, spiranolactone, digoxin
48
Signs of hypokalaemia on ECG
Prominent U waves
Small/Absent T waves
Prolonged PR interval
ST depression
Long QT interval
49
Signs of hyperkaleamia on ECG
tall-tented T waves,
small P waves,
widened QRS
50
List the ECG changes seen in A-fib
Absent P waves
Narrow QRS complex
Irregularly Iregular Rhythm
51
List the causes of A-fib?
Mrs SMITH
Sepsis
Mitral valve pathology
IHD
Thyrotoxicosis
HTN
52
What is A-fib?
A supraventricular tachyarrythmia characterised by irregular, uncordianted atrial contractions at the rate of 300-600bpm
53
What is the mx of A-Fib
a) Rate control (when)
b) Rhythm control (when)
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
54
What tool is used in AF to mitigate stroke risk?
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.
55
What ECG fetures are seen in Atrial flutter
Regular rhythm
Saw tooth pattern
Narrow QRS complex
56
What is V-Tac and what is its mx (pulseless and pulse)?
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)
57
What is V-Fib and list its management?
An irregular broad complex tachycardia. This is always a pulseless rhythm.
Shock(x3) + IV adrenaline + IV amiodarone
- adrenaline every 3-5 minuets after
58
List the causative agents in infective endocarditis for the folowing?
a) IVDU
b) Poor dental hygeine
c) Prosthetic valve
d) Colorectal cancer
a) staph aureus
b) strep viridans
c) Staph epidermidis
d) Strep bovis
59
List 3 signs of infective endocarditis
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
60
Which lung cancer most common in non-smokers
Adenocarcinoma
61
Gs investigation for bronchiectasis
HRCT- high resolution CT
| Thickened dilated airways w or w/o fluid levels
62
A stony dull percussion indicates what
Pleural effusion
63
What lung cancer is strongly associated with smoking
Squamous cell carcinoma
64
Cancer can spread to the lungs from what areas
```
Kidney
Prostate
Breast
Bowel
Bladder
```
65
Lung cancer can metastasise to which sites
Brain
Adrenals
Bone
Liver
66
What ECG Changes may you see in COPD
Prominent P wave in inferior leads (II,III, aVF)
Right axis deviation
Low voltage QRS
RBBB
67
What paraneoplastic syndromes are associated with small cell lung cancers
ACTH- Cushings
SIADH
Lambert Eaton myasthenia syndrome
68
What paraneoplastic syndromes is associated with non small cell lung cancer
Hyperparthyroidism
69
What would be seen on histology of an asthmatic
Charcot Leyden crystals and crushmann spirals
70
What drug should be given for prophylaxis against the se of isoniazid
Pyridoxine hydrochloride
71
What are the signs of TB on CXR
```
Ghon focus
Dense homogenous opacity
Hilar lymphadenopathy
Pleural effusions
Tree in a bud sign- nodules w/ poorly defined margins
```
72
Differentials for bi-hilar lymphadenopathy
```
Sarcoidosis
Silicosis
Hodgkin lymphoma
Mycoplasma
TB
```
73
Signs and sx of bronchiectasis
Clubbing
Coarse inspiratory crepitations
Cough w/ sputum production
Intermittent haemoptysis
SOB
Wheeze
74
Complications of COPD
Respiratory infections
Lung cancer
Pneumothorax
ARDS
75
COPD encompasses 2 types of chronic lung diseases, what are they?
1) Emphysema- enlargement of air spaces and destruction of alveolar walls
2) Chronic Bronchitis-hypertrophy and hyperplasia of mucus glands
76
What is the mx of COPD?
1. SABA or SAMA
2. if no astmathic- +LABA +LAMA
if astmathic- +LABA +ICS
3. +LABA +LAMA +ICS
77
List 3 RF for COPD?
Smoking
Alpha 1 antitrypsion deficiency
Occupation- coal/cotton/grains
78
79
What drugs can cause pulmonary fibrosis
Nitrofurnatoin
Amiadorone
Methotrexate
Bleomycin
80
If PE score is less than 4 what is next line management
D dimer
81
If PE score is more than or equal to 4 what’s the next step
CTPA and start on DOAC
82
List 5 causes of finger clubbing
```
Bronchiectasis
Cystic fibrosis
VSD
IPF
Lung cancer
```
83
List 5 differentials for dry cough
```
Asthma
Gord
Pulmonary fibrosis
Ramipril induced
Sleep apnoea
```
84
List t differentials for sputum/wet cough
```
COPD
Bronchiectasis
Acute bronchitis
HF
Cystic fibrosis
```
85
What prophylaxis abx is given in COPD
Azithromycin
86
What is the mx of chronic asthma?
1. SABA
2. SABA + ICS
3. SABA +ICS + LTRA
4. SABA +ICS + LABA +/- LTRA
5. MART(inc ICS) + LABA +/-LTRA
87
What is the acute mx of asthma attack?
ABCDE approach
ensure o2 sats 94%-98%
Nebulisers (Salbutamol/Ipratropium)
Steroids (PO Pred/IV Hydro)
IV MgSO4
IV aminophylline
88
What is the causative organism of TB?
Mycobacterium tuberculosis (acid fast bacilli)
89
What stain is required to diagnose TB, list the finding?
Ziehl neelsen stain
bacteria turns red against blue background
90
What drugs are indicated for TB. List their respective SE?
Rifampicin- SE- Red/orange wee
Isoniazid- SE- Peripheral neuropathy
Pyrazinamide- SE- Gout/Hepatitis
Ethambutol- SE- Optic neuritis/colour desaturation
91
What is the CF and its mode of inheritance?
CF is a genetic disease caused by mutations in the cystic fibrosis transmembrane
conductance regulator (CFTR) gene
Autosomal Recessive
92
GS Ix for CF?
Sweat test (cl- conc >60mmol/L)
93
What is the most common causative organism of CAP?
Strep Pneumoniae
94
What risk score is used CAP to assess disease severity?
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
What is the following CURB scores indicative of in terms of treatment?
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
List 5 sx of Pulmonary fibrosis?
Cough
SOB
End expiratory basialr crackles
Clubbing
WL
Fatigue
97
What is sarcoidosis and list 5 sx?
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
List the spirometry results for onstructive lung disease?
TLC + RV- Increased
FEV1- Decreased
FEV1/FVC- Decreased (<0.7)
99
List the spirometry results for restrictive lung disease?
TLC + RV- Decreased
FVC- Decreased
FEV1/FVC- increased (>0.7) or normal
100
List the features of crohns disease
Diarrhoea- usaully non bloody
Weight loss
Upper GI symptoms, moth ulcers, perianal diseases
Abdomianl mass palpalble in right illiac fossa
101
List the features of UC?
Bloody diarrhoea
Abdo pain in the LIF
Tenesmus
102
List the histology for both UC and Crohns?
UC- decreased goblet cells, granulomas. Increased lymphocytes. Just submucosal inflammation
Crohns- Increased goblet cells, granulomas. Inflammation in all layers
103
List the endoscopy findings for Crohns and UC?
UC- Loss of haustral markings, continous inflammation, Pseudopolyps
Crohns- Ulcers, Skip leisons, cobble stone appaerance
104
List the acute and remission tx for both UC and Crohns
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
definition for the following?
a) Diverticular disease
b) diverticulosis
c)diverticulitis
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
list 2 complications of diverticualr disease?
Abscess formation
perforation
fistula frmation
fibrosis
107
What is acute cholecystitis and list 5 sx?
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
WHat is the 1st line ix of acute cholecystitis and subsequent mx?
1st line- USS
mx- intravenous antibiotics +
cholecystectomy
109
WHat is Murphy's sign?
on examination: inspiratory arrest upon palpation of the right upper quadrant
110
What is charcots triad for ascending cholangitis?
Fever
RUQ pain
Jaundice
111
What are the NICE refferal guidelines for colorectal cancer
>=40- unexplained WL and abdo pain
>=50- unexplained wl
>=60- with IDA or change in bowel habit
FIT test shows blood in faeces
112
What is the screening programme for bowel cancer and who is elligible?
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
WHta is pyelonephritis and list its features?
Pyelonephritis is a urinary tract infection affecting the kidneys/renal pelvis.
Fever/rigors
Malaise
Loin/flank pain
Vomiting
dysuria/uyinary frequency
114
what is the ixs and mx for pyelonehritis?
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
How is the diagnosis of diabetes made?
Fasting glucose- >7.0mmol/l
Random Blood Glucose- >11.1mmol/l
HbA1c >48mmol/l
116
what is DKA and list its Causes?
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
What 3 features are required to make a diagnosis of DKA?
Hyperglycaemia, presence of blood or urine ketones, metabolic acidosis.
118
What is the mx of DKA?
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
WHat are the blood gas results in DKA?
Glucose >11mmol/l
pH <7.3
blood ketones >3mmol/l
bicarbonate <15mmol/l
120
List 3 complications of hyperthroidism ?
Thyroid storm
A fib
Osteopenia/osteoporosis
Corneal ulcers/visual loss in Graves' eye disease
121
What pattern of thyroid function tests would you expect with Grave's disease?
Elevated T3 and T4,
low or suppressed TSH.
122
WHta is the medical mx of hyperthyroidism?
Either 'titration-block' or 'block and replace' regimens
Carbimazole
Propylthiouracil
123
List 2 primary and 2 secondary causes of hyperthyroidism?
Primary- Graves disease, Toxid adenoma, medications (amiadorone), Radiation exposure
Secondary Amiodorone, Lithium, pituitary addenoma, Gestational
124
List 5 features of hypethyroidism
Heat intolerance
Tachycardia and arrhythmias
Weight loss
Diarrhoea
Sweaty skin
Insomnia and sleep disturbances
Restlessness and tremors
125
List the fetures of graves disese
Exophthalmos/proptosis
Lid lag
Thyroid acropachy: Soft tissue swelling in extremities, nail clubbing, and periosteal new bone growth.
Pretibial myxoedema
126
WHat antoboides are indicative of Graves disease?
Anti TSH
127
WHat antoboides are indicative of Hashimotos disease?
Anti TPO
128
What is the treatment for primary hypothyroidism?
Thyroid homrone replacement with levothyroxine.
129
What pattern of thyroid function tests would you expect with hypothyroidism?
low T3/4 and raised TSH.
130
List 5 features of hypothyroidism?
Cold intolerance
Weight gain
Dry skin
brittle hair
loss of oute 1/3 eyebrows
carpal tunnel syndorme
peripherla neuropathy
constipation
Macroglossia
puffy face
131
What is the first line test for Acromegaly?
IGF-1
132
What are the clincial features of acromegaly?
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
What is the best test to confirm the diagnosis of Acromegaly?
Oral glucose tolerance test
134
What are the complications of Acromegaly?
Visual fields defect
Hypopituitarism
Obstructive sleep apnoea
Type two diabetes mellitus
Arthritis
Carpal tunnel syndrome
IHD/CVS/HTN
135
What is the first line treatment for Acromegaly?
Transsphenoidal surgery.
136
What are the other mx options other than sx for acromegaly?
Somatostatin receptor ligands- Octreotide
Pegvisomant (GH analogue)
Cabergoline (Dopamine agonist)
Radiotherapy
137
What is acromegly
Acromegaly is a condition resulting from excessive growth hormone secretion, usually due to a secreting pituitary adenoma.
138
WHta re the clinical features of cushings syndrome?
Striae
Obesity
Hypokalaemia
Moon face
Acne and hirsutism
Interscapular and supraclavicular fat pads
Centripetal obesity
Thin skin
Osteopenia or osteoporosis
139
What are the causes of cushings?
ACTH Dependent- pituitary tumour, ectopic ACTH producing tumours
ACTH independent- adrenal adenomas, adrenal carcinomas
140
what is cushings syndrome and cushings disease?
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
what is the 1st line ix for cushings?
Dexamethasone suppression test
142
What are the features of osteoarthritis on a XRAY?
remembered with the mnemonic LOSS:
Loss of joint space.
Osteophytes.
Subchondral cysts.
Subarticular sclerosis.
143
How can osteoarthristis be distinguished form inflammtaory diseases?
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
What are the differentials to consider in a presentation of an acute monoarthritis?
GHOST
Gout/Pseudogout
Haemarthrosis
OA
Septic arthritis
145
What are the radiological signs of rheumatoid arthritis on an xray?
LOSE
loss of joint space,
osteopenia (peri-articular),
soft tissue swelling and subluxation,
erosions and deformities.
146
What is the prophylactic management for gout?
allopurinol.
147
What is the first line treatment for osteoarthritis
paracetamol and topical NSAIDs are first line
148
What is a potential local complication of intra-articular corticosteroid injection?
Septic arthritis due to local immunosuppression
149
What are the three main aspects of osteoarthritis management?
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
What are the key risk factors for osteoarthritis?
Age
Obesity
Previous trauma
Systemic disease including diabetes and other rare arthropathy
151
Which signs in the hands are suggestive of osteoarthritis?
Heberden's and Bouchard's nodes on the distal and proximal interphalngeal joints respectively.
152
WHta is the gold standard ix for gout and its respective results
Arthrocentesis with synovial fluid analysis showing
* Needle shaped urate crystals
* Negatively birefringent of polarised light
153
What is the acute management of gout?
First line - NSAIDs.
Second line - colchicine.
Third line - steroids (systemic or intra-articular).
154
What does polarised light microscopy of synovial fluid reveal in pseudogout?
Positively birefringent, rhomboid shaped crystals.
155
list the differentials of monoarthropathy
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
The joint most commonly involved in acute gout is?
The first metatarsophalangeal joint
157
What needs to be started alongside allpurinol in gout?
Allopurinol transiently raises urate levels and NSAID or colchicine cover has to be introduced for 3 months.
158
symptoms of gout
Excruciating sudden burning pain in affected joint
Swelling, redness, warmth and stiffness in affected joint
Assymetric joint distribution
Mild fever
159
Lifestyle changes for the prevention of gout
Reduction of alcohol consumption
Reduction of purine-based foods- meat and seafood
160
what medictaions can casue hyperuricaemia and should thus be reviewed
**Thiazides and loop diuretics**
Low dose salicylates
Chemotherapy
161
What monitoring do patients with methotrexate need?
Full blood count,
liver function tests and creatinine. These patients also need a chest x ray before starting methotrexate.
162
WHta is RA?
Rheumatoid arthritis is a commonon chronic inflammatory autoimmune disease.
163
How is disease activity in rheumatoid arthritis monitored?
DAS28 scoring system, consisting of:
CRP or ESR
Number of swollen or tender joints
Patient questionnaire.
164
Which classical deformities of the hands occur in rheumatoid arthritis?
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
What is the triad of Felty's Syndrome?
Rheumatoid Arthritis, splenomegaly and neutropenia
166
What joints affected in RA
MTP
MCP
PIP
167
What scoring system is used to assess for the severity of RA
DAS28
168
What are the signs/Sx of RA
```
Early morning stiffness
Pain eases with use
Fatigue
Extra-articular involvement- nodules, pleural effusions, episcleritis, amyloidosis, carpal tunnel
Symmetrical, deforming polyartropathy
Joint swelling
```
169
What is the tx for RA
```
Regular NSAIDs
During flares- corticosteroids
Remission- 1st line- DMARD monotherapy
2nd line- dual DMARD
3rd line- methotrexate + TNF inhibitor
4th- methotrexate and rituximab
```
170
Se of methotrexate
Pulmonary fibrosis
| Teratogenic
171
5 sx of a ankylosing spondylitis
```
Back pain
Buttock pain
Uveitis
Enthesis
Weight loss
Fatigue
Lower back stiffness
Sleep disturbances
```
172
1st line Ix in ank spon
Pelvic/back X-ray
Other- Inflamma markers/Hal b27/ mri
173
What X-ray changes can be seen in ank spon
Syndesmophytes (bamboo spine)
| Sacroilitis
174
Tx for ank spon
Encourage exercise
1st line- NSAIDs
Intra-articulate corticosteroid injection
DMARDs
175
Sx and signs of psoriatic arthritis
Symmetrical
Dactylitis
History of Psoriasis- pink scaly patches
Onycholisis/ nail pitting
Pain swelling and stiffness of affected joints
176
What joint is mostly affected in psoriatic arthritis
Dip
177
What X-ray sing is seen in psoriatic arthritis
Pencil in cup
178
Tx for psoriatic arthritis
Mild- NSAIDs
Severe cases- DMARDS
anti TNF
Ustekinumab and seckinimab
179
What is reactive arthritis
An inflammatory seronegative spondylarthropathy that occurs after exposure to GI or GU infections
180
What triad of Sx is seen in reactive arthritis
Conjunctivitis
Urethritis
Arthritis
181
What rash is commonly associated with reactive arthritis
Keratoderma blennorhagia- waxy Paiutes on palms and soles
182
Sx for sjorgens
```
Dry eyes
Dry mouth
Vaginal dryness
Burning mouth
Arthralgia
Raynauds
```
183
What antibodies associated with sjorgen
Anti ro and anti la
184
what are the first line ix for RA?
**Rheumatoid factor
Anti CCP antiboides (MORE SPECIFIC)**
inflammatory markers- CRP/ESR (raised- can be used to monitor deisease severity)
185
Which treatments for rheumatoid arthritis slow down progression of the disease?
DMARDs eg. Methotrexate, Sulfasalazine, Hydroxychloroquine, Leflunomide
Biologics eg. Anti-TNF's such as infliximab
186
what joints are typicalaly spared in RA?
DIP JOINTS
187
SX of polymyalgia rheumatica?
**Shoulder/hip girdle stiffness (usually in the mornings) for >1 hour**
Low-grade fever
Reduced appetite
Weight loss
Malaise
188
tx for polymyagial rheumatica?
Low-dose corticosteroids
189
List 3 red flags for back pain?
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
190
Abx to five according to CURB-65
0-1= amoxicillin po
2- amoxicillin and clarithromycin/doxycycline
3-5= iv co-amoxiclav and clarithromycin
191
Signs of COPD
Hyperinflation
Hyper-resonance on percussion
Reduced chest expansion
Decreased/quiet breath sounds
192
Signs of pneumoniae
Dull percussion
Increased vocal resonance/ tactile fremitus
Pleural rub
Bronchial breathing
193
Differentials of COPD
Asthma
Bronchiectasis
TB
Congestive HF
