rheum

Question 1

septic arthritis tx

Answer 1

Iv fluclox

Question 2

does ank spond improve with exercise

Answer 2

yes

Question 3

se methotrexate

Answer 3

mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis

Question 4

pagets affects what areas of the body

Answer 4

The skull, spine/pelvis, and long bones of the lower extremities are most commonly affected.

Question 5

A 78-year-old man presents to the GP with a severe headache and jaw pain for the past two weeks. He describes the headache as constant and throbbing, primarily affecting his right temple and is worse on chewing, talking and when he climbs the stairs. Additionally, he reports fatigue, a low-grade fever and generalised muscle stiffness in his upper and lower limbs which is worse at night. He denies morning stiffness, visual changes or tinnitus. There is no history of any trauma.

Answer 5

temproal arteriitsi

Temporal arteritis is correct. This patient has presented with symptoms of temporal arteritis (or giant cell arteritis) due to the combination of severe headache localised to the right temple, pain worse on chewing/talking, fatigue, low-grade fever and generalised muscle stiffness. Temporal arteritis is more common in older individuals and is very rarely seen in patients under 60 years old.
Polymyalgia rheumatica (PMR) is incorrect. PMR can co-exist with temporal arteritis but they have some distinct clinical features. PMR primarily affects the shoulder, hip girdles, neck and torso muscles and joints causing a more specific pattern of muscle stiffness. Patients often experience morning stiffness specifically (rather than the generalised stiffness this patient experiences which is worse at the end of the day, rather than at the start of the day).

Question 6

how often is methptraxate taken

Answer 6

weekly

Question 7

septic arhtryiss you need to analyse the

Answer 7

synovial fluid

Question 8

clinical findings in ank spond

Answer 8

Clinical findings in anylosing spondylitis include reduced chest expansion, reduced lateral flexion and reduced forward flexion (Schober’s test)

Question 9

PMR associated with what sx

Answer 9

ssociated with symptoms such as low-grade fever, anorexia, malaise and weight loss

Question 10

discoid lupus- hair alopecia

Answer 10

Discoid lupus erythematosus is a benign disorder generally seen in younger females. It very rarely progresses to systemic lupus erythematosus (in less than 5% of cases). Discoid lupus erythematosus is characterised by follicular keratin plugs and is thought to be autoimmune in aetiology

Question 11

sx and mx of discoid lupus

Answer 11

Features
erythematous, raised rash, sometimes scaly
may be photosensitive
more common on face, neck, ears and scalp
lesions heal with atrophy, scarring (may cause scarring alopecia), and pigmentation

Management
topical steroid cream
oral antimalarials may be used second-line e.g. hydroxychloroquine
avoid sun exposure

Question 12

redcued lumbar flexion on schober test under what numerical

Answer 12

Schober’s test <5cm is suggestive of ankylosing spondylitis. This is an indication of reduced lumbar flexion.
reduced forward flexion - Schober’s test - a line is drawn 10 cm above and 5 cm below the back dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible

Question 13

flares of RA managed how

Answer 13

with IM or PO corticosteriods

Question 14

temporal arteritis on fundoscopy

Answer 14

Fundoscopy typically shows a swollen pale disc and blurred margins