random ;p Flashcards
nail changes, rash and dactilytis
psoriatic arthritis
prolonged early morning stiffness better with movement
ankylosing spondylitis
painful red eye, with reduced acuity and a constricted pupil
acute anterior uveitis
negatively birefrigent needle shaped crystals
gout
positively birefirgent rhomboid shaped crystals
pseudogout
neutrophil level in septic arthritis
> 90
which condition is assoc with syndesmophytes
ankylosing spondylitis
gold standard for GCA
temporal artery bioppsy
dermatological sign assoc with antiphospholipid syndrome
livedo reticularis
young female with new-onset headaches, visual changes, arm claudication, and weak or absent pulses in the upper extremities with a blood pressure difference between arms
takaysus arteritis
what is found in 95% patient with RA
anti cyclic citrullinated peptide autoantibody
linear calcification of the articular cartilage
pseudogout
which drugs can cause osteomalacia
anti epileptic drugs
bone pain, myalgia and weakness
osteomalacia
feltys syndrome
splenomegaly neutropenia and RA
what condition is associated with polymyalgia rheumatica
Giant cell arteritis
role of tendons
connect muscle to bone
role of ligamenta
often connect two bones otgetehr
stabilise the joint/ hold the two bones together
antibody assoc with chrug strauss
p-anca
Antibody assoc with granulomatosis with polyangitis
c-anca
which vasculitis is assoc with hep b
polyarteritis nodosa
drugs for ankylosing spondylitis with spinal inflammation
anti-tnf such as adalimumab
drugs for ankylosing spondylitis with peripheral joint disease
dmards such as methotrexate and sulfasalazine
rash over cheeks in combo with systemic illness and mild arthritis
SLE, anti ds-dna
diagnosis for takysus
CT aortogram or magentic resonance aortogram
tender scalp, headache and vsiual loss diagnosis and treatement
GCA, treat with prednisolone
first line investigation for patients with GCA
ESR but if have signs of temporal arteritis then treat without waiting results
diagnostic criteria and specific antibody for APLS
Anti beta 2 glycoprotein 1 antibodies
what is given as a follow up drug post GCA temporal arteritis
biphosphonate to prevent glucocrticoid associated bone loss
what mediciation may be considered in GCA with vascular ischameic complications
aspirin 75mg daily
non traumatic cause of avascular necrosis
steroid use
which drug can increase risk of tendinopathies
ciprofloxacin
best imaging for meniscal tears
MRI as can visualise the soft tissue
locking and swelling knee injury
meniscal tear
hyperintense line in the medial mensicus
medial meniscus injury
test for meniscus injury
mcmurrays
positive anterior drawer test
ACL injury
only arthritis to be assoc with skin and nail changes
psoriatic arthritis
which joints does rheumatoid usually affect
metacarpophalangeal joints
which joints does psoritatic arthritis usually affect
distal interphalangeal joints
definitive diagnosis for osteomyelitis
bone biopsy
gold standard for osteomyeltitis
MRI
role of osteoclast
responsible for bone resorption
MOA of osteoporosis medication
to inhibit osteoclats as they absorb bone
what is lymphopenia often associated with
SLE
poor prognosis of rheumatoid arthritis
rhuematoid nodules, positive rheumatoid factor and anti-CCP antibodies, insidious disease onset, smoking history, HLA-DR4 and poor functional status at presentation.
extra articular features common with ankylosing spondylitis
anterior uveuits
aortic insufficiencies
apical pulmonary fibrosis
meniscal calcification suggestive
pseudogout
what can chronic inflammation of MCP joints result in
ulnar deviation of the digits in rheumatoid arhtitis
risk factors for gout
diuretics and salicytes - aspiirn
help confirm sjrogens
schirmers test
antigen that supports ankylosing spondy
human leukocyte antigen b27
what is impaired renal function a risk factor for
GOUT due to impaired function of urate excretion
first line treatment for polymyalgia rheumatica
oral prednisolone
first line treatment for SLE
hydroxychloroquine
first line gout treatment
nsaids
sign on doppler of temporal arteries in GCA
halo sign showing
xray changes seen in rheumatoid
Periarticular osteopenia- this is often an early sign
Joint erosions
Periarticular soft tissue swelling
Joint space narrowing
risks specific to pseudogout
hyperparathyroidism and haemochromatosis
complication of sjrogens
MALT lymphoma
is GORD suggestive of limited or diffuse sclerosis
limited
what is it important to screen for in SLE
renal involvement via urinakysis
commonest causative organism of septic arthritis in early infections of prosthetic joints
staph aur
which antibodies in sjorgens
anti ro and anti la
what are syndesmophytes
bony outgrowth originating inside a ligament
what disease are syndesmophytes often seen in
ankylosing spondylitis
urgen referral to rheumatology criterai
Small joints of the hands or feet are affected.
More than one joint is affected.
There has been a delay of 3 months or longer between the onset of symptoms and the person seeking medical advice
what should patients get put on to reduce the risk of side effects from steroids
bisphosphonate and PPI
what type of drug is allendronic acid
bisphosphonate
antibody seen in systemic sclerosis
anti scl 70
extra articular manifestations of ankylosing spondylitis
aortitis
anterior uveitis
iga nephrophathy
upper lobe pulmonaryfibroiss
is gout positive or negative birefirngence
negative
what is commonly requested in RA patient pre operation
c spine x rayw
what part of the spine does RA usually spare
lumbar and thoracic spine
what is hypromellose
eye drops for sjorgens to soothe them
what is intermittent parotid gland swelling assoc with
sjrogens
what is necessary for pseudogout confirmation
needle aspiration
when does myositis ossificans usually occur
AFTER TRAUMA USUALLY SPORTING INCIDENTS
Xray finding in ewings sarcoma
onion skin periosteal reaction
what age is ewings more seen in
paediatrics
what does amitryptilline help with
nerve pain so is useful in sciatica
role of bsiphosphonates
slows bone loss
first line treatment for knee osteoarthritis
topical NSAIDS
First medication to strat with RA
methotrexate and steroids
which arthropathy is hypothyroidism assoc with
pseudogout
which nerve root lesion is affected ankle jerk is affected and have weak foot eversion
S1
Treatment for psoriatic arthritis
DMARD - methotrexate
signs of osteomyelitis on xray
focal cortical loss
periosteal reaction ; formation of new bon ein response to injury
regional osteopenia; decrease in bone mineral density
what might septic arthriits lead to
osteomyelitis by spreading to adjacent joints
what test needs to be done as part of baseline for hydroxychloroquine
Baseline ophthalmology assessment including visual acuity incase of hydroxy induced retinopathy
what might granulomatosis with polyangitis cause
myocarditis
classic findings on fundus of Anterior ischemic optic neuropathy
swollen, chalky white, optic disc
antibody assoc with limited systemic sclerosis
anti centromere
antibody assoc with diffuse scleoris
anti- scl 70
what predisposes to tendon ruptures
RA, steroid use and diabetes
what is allopurinol used with to reduce risk of recurring gout
NSAIDS for 3 months as allopurinol may worsen flare at start as can acutely raise levels of urate
treatment for if arthritis gotten so bad even with conservative management
joint arthroplasty
how long are steroids gradually tapered post GCA
daily for 4 weeks then gradually tapered 6 months- year
what is a frequent feature of systemic sclerosis
oesophageal dysmotility
negative gram stain, dysuria
chlamydia
what will nesseria show up as on gram stain
Gram negative intracellular diplococci
why are no organisms seen on gram stain for chlamydia
poorly staining cell wall
investigation for suspected septic arthritis
joint aspiration in thteatre
what might give the clue of septic arrhtir s
previous surgery
caplans syndrome overview
In individuals with rheumatoid arthritis, exposure to dust particles such as coal, asbestos, or silica can result in Caplan’s syndrome, characterized by intrapulmonary nodules leading to shortness of breath.
what should be requeste din all patients presenting with inflammatory back pain
pelvic xray
what antibodies are assoc with psoriatic arthirtis
none
what are anca assoc with
vasculidities
what is warfarin contraindicated in
pregnancy
if have visual compromise in GCA what is given
METHYLPREDNISOLONE
Scleroderma crisis management
ace inhib
most common side effects of colchicine
diarrhoea
signs of fracture
crepitus
swelling
deformity
bony tenderness
what antibiotics are used in an open fracture
within 1 hour
co amoxiclav
co trimazole and metronidazole if allergic
what nerve is the deltoid muscle supplieby
axillary
“locking and twisting” meniscal or ACL?
meniscal
shouolder pain, at night , pain on active and passive movement
frozen shoulder
frozen shoulder treatment
NSAIDS, physio then steroids if not working
common risk factor for frozen shoulder
typw 2 diabetes
what must radius and ulna fractures be treated with
open reduction and internal fixation
stable intertrochanteric fracture treatmetn
dynamic hip screw
when does mensical injury present
12-24 hours after
whne does ACL injury presetn
often right away
classification for ankle fractures
weber
fall onto outstreched hand fracture type
colles fracture
test for cauda equina syndrome
MRI
gold standard for RAA
MRI
DAS-28 components
tender joint count
swollen joint count
esr
global health scan
motor supply to SCM
accessory nerve
MOA of methotrexate
Inhibits dihydrofolate reductase which is crucial for the synthesis of DNA and RNA
what must be prescirbed along with methotrexate
folic acid on a different day to be taken
flu like symptoms in fibromylagia or chornic fatigue syndrome
chronic fatigue syndrome
side effecct of bisphosphonates
oesophagitis, ulcers, erosions and strictures which can present as odynophagia, dysphagia, or new/worsening dyspepsia
feature seen on xray in OA
squarin gof the thumbs
side effect of hydroxychloroquine
retinal toxicity
most sensitive investigation for ankylosng
MRI scan of sacroiliac joints
what is required for straight leg raise
quadriceps tendon
what is enteropathic arthritis a complication of
IBD
common side effect of methotrexate
oral ulcers due to folate disturbance
treatment of reactive arthriits
NSAIDS
side effects of nsaids
nephrotoxicity so shouldnt be used in. acute kidney injury
common presenting pattern of psoriatic arthritis
assymetrical oligoarthritis
antibdoy in diffuse sclerosis
anti-scl
antibody in limited sclerosis
anti centromere
which sclerosis is assoc with scleroderma
diffuse
what is crest syndrome also known as
limited cutaneous systemic sclerosis
what might OA present with
gait
joint crepitus
limiation of movement
is joint swelling seen in oa of the hip
not really as deep as the hip would you see swelling
radiological features of OA
cyst formation and osteophytes
loss of joint space
what investigation is useful in confirming diagnosis of osteoporosis
dexa scan- measures bone mineral density
treatment of osteporosis
bisphosphonates
what is key to maintaining bone density in women
oestrogen
what is offered to women with osteporosis
HRT
what is the menopause a risk factor for
osteoporosis due to less oestrogen
is osteoarthirtis a risk factor for osteoporosis
no
are vitamin d levels low or high in osteomalacia
low
butterfly rash across face
SLE
what type of view is a joint effusion seen better on
lateral view
antibodies in sle
anti nuclear
dsdna
consideration of management in SLE
immunosuppression- azathioprine
steroids
are complement levels low in sle
yes
which complement levels are low in sle
c3,c4
immediate investigations for acute monoarthritis
FBC
Urinalysis
crp
knee radiograph
acute monoarthritis
acute arthritis which occurs in a aingle joint for less than 2 - 4 weeks
what conditions can cause septic arthritis
osteomyelitis
penetrating trauma
staph aur
why is septic arthritis an emergency
the joint can be rapdily destroyed by iinfection
acute gout, previous duodenal ulcer, treatment ?
colchicine due to nsaid contraindication
what lab test may be abnormal and lead to diagnosis of PMR
ESR >40
complications of steroids
cataract
avascular necrosis
osteoporosis
diabetes
what is helpful in AS for those who have peripheral joint problems
methotrexate
daignosis for AS
HLA-B27 , xray of sacroiliac joints
associations with AS
IBD, anterior uveitis, aortic regurg, skin psoriasis, cauda equina syndrome
tests to asses AS
schobers, wall to tragus distance , chest expansion
triad for reactive arthritis
urethirtis, conjunctivitits, sero negative arthritis
is periosteal reaction common in RA
no
what is periosteal reaction
new bone formation
ciclosporin side effects
hypertension, tremulousness- shaking/quivering , and gingival hypertrophy.
is periarticular erosions seen in OA
no its more in RA
what might elevated ALP be a sign of in th epresence of previous breast cancer, lytic lesions
metastatic bone disease
most commonly damaged nerve in shoulder injuries
axillary
what needs to be done to diagnose cauda equina syndrome
whole spine. MRI
what can scapular winging be caused yb
damage to seratus anterior/ long thoracic nerve which innervates it
what is the supraspinatous innervated by
suprascapular nerve
first line for carpal tunnel in pregnancy
wrist splint
positive phalen test
numbness and tingling on passive wrist flexion
early changes in RA
periarticular osteoporosis; localised bone loss occuring around a joint
loss of joint space
soft tissue swelling
later changes in RA
juxta articular erosions , subluxation
what is lipohaemarthrosis
fat and fluid in joint capsule
fall onto flexed knee
what does dequervains tenosivitirs invlve
extensur pollicis brevis and abductor pollicis longues
what imaging modality can show undisplaced fractures
MRI
are there systemic manifestations in osteoarthritis
no
what is the straight let test used for
herniated discs
cannot initiate straight leg raise
quadriceps tendon issue
which drug will achieve best penetration into bone
flucox
is acromegaly assoc with gout or pseudogout
pseudogout
what to monitor as disease progression in RA
CRP
