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3B GH > Rheum > Flashcards

Rheum Flashcards

1
Q

burning and pins and needles in the hand, wakes at night. Diagnosis?

A

carpal tunnel

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2
Q

OA management

A
  1. exercise to build muscle strength
  2. weight loss
  3. analgesia [PO+topical]
  4. intra-articular steroid injections
  5. PT/OT, heat/cold packs, walking aids
  6. surgery
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3
Q

which is more specific for rheumatoid arthritis, anti CCP or rheumatoid factor?

A

anti CCP

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4
Q

monitoring for DMARDs

A

3 monthly FBC & LFT

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5
Q

methotrexate for ank spond?

A

doesn’t work on spine so only for other affected joints

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6
Q

what is crest syndrome?

A

type of scleroderma - calcinosis, raynauds, oesophageal, sclerodactyly, telangectasia

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7
Q

osteoporosis Mx

A

bloods to rule out [vit D, Ca, TFT]
alendronic acid > risedronate > zolendronate
Adcal

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8
Q

how long would you continue a patient on a bisphos for osteoporosis?

A

5 yrs then break

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9
Q

what chest xray changes might you see in chronic sarcoidosis?

A

hilar lymph node enlargement

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10
Q

sarcoid Mx

A

steroids

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11
Q

does it matter is RA patient is rheumatoid factor +ve or -ve when considering a biologic?

A

yes - unlikely to start in a -ve patient as they dont respond well

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12
Q

what can you do if methotrex Pt having nausea

A

split dose [twice a week instead of once] and ^folic acid from weekly to daily (except on methotrex day)

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13
Q

why do methotrex patients take folic acid?

A

reduces SEs

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14
Q

DMARD side effects

A

nausea, reduced appetite, sore mouth, diarrhoea

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15
Q

ank spond patients suffer with what bowel prob?

A

crohns

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16
Q

why might you switch pt from methotrex PO to SC?

A

100% of injection absorbed

GI SEs

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17
Q

Risk factors for RA

A

Female
Smoking
Genetic

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18
Q

Management of hyper mob/ Ehler Danlos type 3

A

Pain relief

Physio

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19
Q

Complications/ serious manifestations of ehler danlos/ hypermob

A

Dislocated eye lenses

Cardiac - aneurysm, valvular

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20
Q

If patient presents with RA picture + also has psoriasis, how do you diagnose?

A

Rh +ve = RA

Rh -ve = psoriatic

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21
Q

calcium deposits in joint causing inflamm. Dx?

A

pseudogout

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22
Q

what type of drug is hydroxychloroquine?

A

DMARD

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23
Q

what is Takayasu’s arteritis and Tx?

A

large vessel vasculitis. steroids,methotrex

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24
Q

what hip problem is an associated complication of steroid use? and Ix

A

avascular necrosis

MRI (xray wont necessarily show)

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25
Q

what is the clinical triad of wegener’s granulomatosis? (3 areas affected)

A

upper resp tract
lower resp tract
kidneys

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26
Q

describe some Sx of wegeners gran

A 
oral ulcers
bloody nasal discharge
nasal bridge collapse (saddle)
sinusitis
haematuria
dyspnoea
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27
Q

Mx of fibromyalgia

A

meds - pain relief + anti dep
pain clinic
exercise
CBT/ councelling

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28
Q

what effect does fluoxetine have on sleep

A

^ wakefulness

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29
Q

what WBC change might steroids induce on FBC

A

^neutrophils

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30
Q

what is the name of the deformity seen in RA patients where there is flexed PIP and extended DIP?

A

boutonniere

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31
Q

what is the name of the deformity seen in RA patients where there is flexed DIP and extended PIP?

A

swan neck

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32
Q

what blood results might indicate active RA/ inflamm?

A

anaemia
^platelets
^ESR/CRP

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33
Q

72 yr old
3 day Hx pain/swelling of 1 knee
O/E apyrexial, knee warm/swollen w/ effusion
Mx?

A

could be trauma/ RA/ OA, but aspirate and culture synovial fluid to rule out septic arthritis

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34
Q

46 yr old male, DM/ HTN/ hyperlipidaemia
2 day Hx cute onset pain/ swelling of 1 ankle, cant weightbear.
Differetial diagnoses?

A

gout

septic arth

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35
Q

risk factors for septic arth

A 
elderly
malignancy
imm supp
prosthesis
injection
trauma
chronic arthr
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36
Q

most common organism for septic arth

A

staph aureus

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37
Q

if septic arth suspected should you start Abx immediately or wait til after aspirate

A

wait - Abx could skew culture result / false neg

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38
Q

Ix for septic arth

A

blood culture
inflamm markers
joint aspirate + culture

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39
Q

usual Abx for septic arth

+other mx

A

fluclox

surgical washout

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40
Q

multiple hot swollen joints, spreading to other joints, moving. + skin lesions. Diagnosis?

A

gonoccocal arth

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41
Q

extraarticular features of RA

A

lung nodules
scleritis/episcleritis
vasculitis
^risk of IHD

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42
Q

Differential for temporal arteritis in scalp tenderness

A

Migraine

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43
Q

ESR and age criteria for temp arteritis diagnosis

A

Both >50

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44
Q

how does gout present

A

1 JOINT
acute
inflamed
big toe metatarsophalangeal in >50%

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45
Q

common joints for gout other than big toe metatarsophalangeal (in >50%)

A 
ankle
foot
small joints of hand
wrist
elbow
knee
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46
Q

gout is caused by deposition of what

A

monosodium urate crystals

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47
Q

what factors could precipitate gout

A 
trauma
surgery
starvation
infection
diuretics
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48
Q

other than gout, what may occur due to long term raised plasma urate?

A

tophi [deposits] in pinna, tendons, joints

renal disease [stones, interstitial nephritis]

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49
Q

differentials for gout

A 
septic arth
reactive arth
haemarthrosis
CPPD (pseudogout)
palindromic RA
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50
Q

give 5 risk factors for gout

A 
male
age
post-menopause women
impaired renal Fn
HTN
metabolic syndrome
diuretics, antihypertensives, aspirin, warfarin, 
diet [alcohol, red meat etc]
genetic
myelo/lymphoproliferative disorders
psoriasis
tumour-lysis syndrome
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51
Q

what will light microscopy of synovial fluid show in gout

A

-vely birefringent urate crystals [needle-shaped]

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52
Q

Ix in gout

A

joint aspirate and light microscopy of synovial fluid
serum urate levels
XR

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53
Q

what might XR of gout show

A

soft tissue swelling only in early stages

punched out erosions in juxta-articular bone

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54
Q

Mx of acute gout

A 
high dose NSAID
colchisine if NSAID contra-I
beware renal impairment for both!
steroid [PO/IA/IM]
rest + elevate, bed cage, ice pack
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55
Q

gout prevention

A 
weight loss
avoid fasting
avoid alcohol/meat excess
avoid aspirin
prophylaxis: allopurinol
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56
Q

when would you start someone on gout prophylaxis

A

> 1 attack/yr
tophi
renal stones

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57
Q

precautions when starting allopurinol

A

it may trigger an attack, so wait 3 weeks after an episode, and cover with regular NSAID/colchicine for 6 weeks/6 months respectively

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58
Q

how does acute calcium pyrophosphate deposition present

A

large joint
monoarthropathy
acute
in the elderly

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59
Q

how does chronic calcium pyrophosphate deposition present

A

inflammatory RA-like symmetrical polyarthritis + synovitis

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60
Q

what will light microscopy of synovial fluid show in calcium pyrophosphate deposition ?

and on XR?

A

weakly positively birefringent crystals [rhomboid shaped]

soft-tissue calcium deposition

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61
Q

Mx of calcium pyrophosphate deposition

A 
cool packs, rest
aspiration
intra-articular steroids
NSAIDs +/- colchisine
chronic: methotrex, hydroxychloroquine
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62
Q

Sx of OA

A 
pain
crepitus ['crunching/creaking']
background ache at rest
worse with prolonged activity
brief stiffness after rest [10-15 mins]
instability ['gives way']
reduced ROM
(mild inflamm)
boney swelling [heberbens dip/bouchards pip]
KNEE, HIP, DIP/PIP/CMC
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63
Q

xr features OA

A 
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
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64
Q

risk factors for septic arthritis

A 
pre-existing joint disease [RA]
DM
imm.supp.
chronic renal failure
recent joint surg
prosthetic joint
IV drug abuse
age >80
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65
Q

Ix in septic arth

A

urgent joint aspiration M+C
blood cultures
XR may be normal
CRP may be normal

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66
Q

main differential for septic arth

A

crystal arthropathies

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67
Q

common organisms for septic arthritis

A

staph aureus
strep
neisseria gonococcus
gram -ve bacilli

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68
Q

Mx of sertic arthritis

A

Abx

arthrocentesis/surgical washout/debridement

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69
Q

risks of NSAIDs

A

GI bleed
^stroke/MI risk
renal injury

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70
Q

the spondyloarthropathies are a group of related chronic inflamm conditions. They include:

A

ank spond
enteric arthropathy
psoriatic arth
reactive arth

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71
Q

what are the shared clinical features of the spondyloarthropathies [these include Ix findings]

A
  1. seronegative [RF-ve]
  2. HLA B27
  3. axial arthritis [spine+sacroiliac]
  4. asymmetrical large joint oligo/mono
  5. enthesitis [plantar fasc/Achilles tendonitis/costochon]
  6. dactylitis
  7. extra-articular [eyes/rash/oral ulcers/valve/IBD]
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72
Q

main joints effected in ank spond

A

spine

sacroiliac joints

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73
Q

typical presentation of ank spond.

+ other complications/ mainfestations

A 
young man
gradual onset low back pain
worse at night
morning stiffness
sacroiliac joint pain > buttocks/hips
reduced spinal movement in all directions
enthesitis

acute iritis
osteoporosis
aortic valve incompetence
pulm apical fibrosis

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74
Q

XR/ MRI findings in ank spond

A

SI joint space narrowing/widening
ankylosis/fusion
sclerosis
erosions

MRI: as above + active inflamm [bone marrow oedema]

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75
Q

what are syndesmophytes? they are pathognomic for what disease?

A

bony proliferations due to enthesitis between ligaments and vertebrae.

ank spond

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76
Q

Mx of ank spond

A 
exercise/ PT
NSAIDs
TNFa blockers [adalimumab/ etanercept]
local steroid inj
bisphos [osteoP risk]

hip replacement / (spinal osteotomy)

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77
Q

associations of enteric arthropathy

A

IBD
GI bypass
coeliac

78
Q

Mx of psoriatic arthritis

A

IA steroid [in monoarthritis]

methotrex/leflunomide/sulfasalazine [in poly/oligo/ persistent monoarthritis]

NSAIDs

apremilast

etanercept/adalimumab/infliximab

ustekinumab

79
Q

clinical features of reactive arthritis

A

arthritis
Sx of STI
iritis
keratoderma blenorrhagica [brown papules on soles and palms]
circinate balanitis [Chlam penile ulceration]
mouth ulcers
enthesitis

80
Q

what is the triad of reiter syndrome

A

urethritis
arthritis
conjunctivitis

81
Q

what are the features of systemic sclerosis

A

scleroderma (skin fibrosis)
internal organ fibrosis
microvascular abnormalities

82
Q

what antibody is present in 90% of systemic sclerosis patients?

A

ANA

83
Q

in systemic sclerosis, skin disease is limited or diffuse. Which areas are affected in limited?

A

face, hands, feet

[NB. both limited and diffuse can have organ fibrosis but it happens later in limited]

84
Q

what condition of the lungs, that can be life threatening, is ass. w/ limited systemic sclerosis?

How is it treated?

A

pulm HTN

sildenafil

85
Q

sjogrens syndrome can be primary or secondary to what?

A

SLE
RA
systemic sclerosis

86
Q

give 4 features of sjogrens

A

reduced tears [dry eyes, keratoconjunctivitis sicca]
reduced salivation [Xerostomia, caries]
parotid swelling
vaginal dryness, dyspareunia
dry cough
dysphagia
polyarthritis, arthralgia, raynauds, lymphadenopathy, vasculitis, lung, liver, kidney, peripheral neuropathy, myositis, fatigue

87
Q

what CA are sjogrens patients at ^ risk of

A

non-hodgkins lymphoma

88
Q

Mx of sjogrens

A 
artificial tears
frequent drinks
gum/pastilles
NSAIDs, hydroxychloroquine for arthralgia
severe: imm supp
89
Q

give 5 conditions in which raynauds is seen

A 
SLE 
systemic sclerosis
RA
dermato/polymyositis
atheroma
polycythaemia rubra vera
hypothyroid
90
Q

what causes raynauds

A

paroxysmal vasospasm

91
Q

Mx of raynauds [drug + advice]

A

rule out an underlying disease
keep warm
smoking cessation
nifedipine

92
Q

features of polymyositis

A 
progressive
symmetrical
proximal muscle
weakness
\+ muscle inflamm
myalgia
arthralgia
dysphagia
dysphonia
resp weakness

fever, arthralgia, raynauds, initerstitial lung fibrosis, myocarditis, arrhythmia

93
Q

dermatomyositis features

A

those of myositis [muscle inflamm + weakness]
plus skin signs:
macular rash (shawl),
lilac purple rash with oedema on eyelids,
nail fold erythema,
gottrans papules (red over knuckles, elbows, knees)

fever, arthralgia, raynauds, initerstitial lung fibrosis, myocarditis, arrhythmia

94
Q

what enzymes might you see increased in the plasma in myositis [muscle inflamm/ breakdown]

A

CK
LDH
ALT/AST

95
Q

50 yr old female presents with gradually worsening thigh weakness, difficult to stand from sitting without using arms. Her muscles and joints ache, she also has a red rash over her chest, upper back and shoulders. On examination you notice some red papules over her knuckles and elbows. Bloods show ^CK. EMG shows fibrillation potentials.
Diagnosis? And how would you confirm the diagnosis?

A

dermatomyositis

muscle biopsy

96
Q

Mx of myositis

A

pred
imm supp.
cytotoxics
hydroxycloroquine/topical tacrolismus for skin disease

97
Q

diseases associated with rheumatoid factor

A 
sjogrens
RA
felty's syndrome
SLE
systemic sclerosis
98
Q

diseases associated with ANA

A

SLE
systemic scleroiss
autoimmune hepatitis
sjogrens

99
Q

anti ds DNA = what disesase

A

SLE

100
Q

gastric parietal cell / intrinsic factor antibodies =

A

pernicious anaemia

101
Q

alpha gliadin antibody, antitissue transglutaminase Ab …. what disease?

A

coeliac

102
Q

thyroid peroxidase antibodies seen in what diseases?

A

hashimoto’s thyroiditis

grave’s

103
Q

islet cell antibodies, glutamic acid decarboxylase ab see in….

A

DM type 1

104
Q

glomerular basement membrane antibody = what disease

A

goodpastures

105
Q

cANCA seen in what diseases

A

granulomatosis with polyangiitis [wegeners]
microscopic polyangiitis
polyarteritis nodosa

106
Q

pANCA seen in…

A

microscopic polyangitis
churg-strauss
goodpastures

107
Q

acetylcholine receptor antibody seen in ….

A

myasthenia gravis

108
Q

pathology of SLE

A

multisystem autoimmune

autoantibodies > immune complexes > imflammation + damage

109
Q

give 8 features of lupus [can be Sx, manifestations, Investigation findings]

A 
malar/butterfly rash
discoid rash
alopecia
oral/nasal ulcers
synovitis
serositis [pleurisy, pleural effusion, pleural rub/ pericardial pain, pericardial effusion, pericardial rub, pericarditis on ECG]
lupus nephritis [proteinuria, RC casts]
seizure, psychosis, mononeuritis multiplex, myelitis, neuropathy
haemolytic anaemia
leucopenia
thrombocytopenia
\+ve ANA/ anti-dsDNA/low complement/^ESR
110
Q

mX of SLE

A 
hydroxychloroquine
topical steroids for skin flares
NSAIDs
azathiop, methotrex, mycophenalate
belimumab
renal: control BP, ACEi/ARB, RRT, transplant

suncream

111
Q

features of anti-phospholipid syndrome

+ Mx

A 
antibodies cause CLOT:
Coag defects [clots: arterial/venous, cerebral, renal]
Livedo reticularis
Obs [miscarriages]
Thrombocytopenia

Mx = anticoagulants

112
Q

give the types of large vessel and medium vessels vasculitides

A

large: GCA, takayasu
med: polyarteritis nodosa, kawasaki

113
Q

what is the pathology in takayasu’s?
What Sx does this produce?
who does it affect?

A

vasculitis of aorta and its major branches
granulomatous
stenosis, thrombosis, aneurysms

aortic arch: dizzy, weak arm pulses, visual change
systemic: fever, weight loss, malaise
renal artery stenosis: high BP

women age 20-40, in japan

114
Q

complications of takayasu’s arteritis

A 
renal artery stenosis
aortic valve regurg
aortic aneurysm, dissection
ischaemic stroke
IHD
115
Q

Mx of takayasu’s

A

pred
(methotrex, cyclophos)
BP Control
angioplasty/stenting/bypass in stenosis

116
Q

list the small vessel vasculitides

A

ANCA-ass:
microscopic polyangiits
granulomatosis with polyangiits [Weg]
churg-strauss [eosinophilic GWP]

immune complex:
goodpastures
cryoglobulinaemic vasculitis
IgA vasculitis[HSP]

117
Q

Mx of large/medium/small vessel vasculitis

A

large: steroids (+steroid sparing later)

med/small: steroid + e.g. cyclophos/methotrex/azathiop

118
Q

Hx sounds like temporal arteritis but patient is under 55, what other vasculaitis would, you consdier?

A

takayasu’s

119
Q

histroy sounds like temporal arteritis but biopsy is normal. what’s going on?

A

skip lesions, dont be put off by -ve biopsy

120
Q

what would you give a patient with temporal arteritis on long term steroids to avoid risks of steroid treatment?

A

bisphos
calcium with colecalciferol
PPI

121
Q

what does polyarteritis nodosa do

A

necrotizing vasculitis
aneurysms and thrombosis
> infarct
medium vessels

122
Q

features of microscopic polyangiitis

A

glom. neph.

pulm haemorrhage

123
Q

systemic features of vasculitis

A 
fever
malaise
weight loss
arthralgia
myalgia
124
Q

GI features of vasculitis

A

pain
infarct
perf
malabsorption

125
Q

renal features of vasculitis

A 
hypertension
haematuria
proteinura
casts
renal failure
glom.neph
infarcts
126
Q

neuro + psych features of vasculitis

A 
stroke
fits
chorea
psychosis
confusion
impaired cognition
altered mood
mononeuritis multiplex, polyneuropathy
127
Q

what condition does polymyalgia rheumatica often occur alongside?

A

GCA

128
Q

features of polymyalgia rheumatica

A

<2 weeks onset
aching, tender, morning stiffness
in shoulders, hips, proximal muscles
NOT WEAKNESS
fatigue, fever, weight loss, anorexia, depression
age>50
[carpal tunnel, tenosynovitis, polyarthritis]

129
Q

what investigation could help you distinguish polymyalgia rheumatica from myositis/myopathy?

A

CK
raised in myositis/myopathy
not in PMR

130
Q

polymyalgia rheumatica Mx

A

pred
(+ bisphos)
+/-methotrex

131
Q

fibromyalgia Mx

A

GET
CBT
amitriptilline/ pregab
duloxetine if alongside depression/anx

132
Q

what causes sudden blindness in GCA

A

optic nerve ischaemia

133
Q

features of hypertensive retinopathy on fundoscopy

A

“silver wiring” - shiny hardened arteries
“AV nipping”
cotton wool spots [retinal infarcts where narrowed arterioles have become blocked]
hard exudates
macular oedema
papilloedema
flame haemorrhages

^BP damages retinal vessels

134
Q

“roth spots” (small retinal infarcts) occur in what condition?

A

infective endocarditis

135
Q

difference in fundoscopy with central vein occlusion ad branch vein occlusion

A 
central = stormy sunset
branch = confined to wedge of retina
136
Q

what eye changes might be seen in leukaemia

A

retinal haemorrhages

137
Q

differentials of red eye: acute glauc, ant uveitis, conjunc, subconjunc.haem.
What does the pupil look like in each

A

acute glauc - fixed dilated (oval)

ant. uveitis - small, stuck to lens

conjunct/subconjunc haem = normal

138
Q

differentials of red eye: acute glauc, ant uveitis, conjunc, subconjunc.haem.
which has a steamy/ hazy cornea?

A

acute glauc

139
Q

differentials of red eye: acute glauc, ant uveitis, conjunc, subconjunc.haem.
Tx for each

A

acute glauc: IV acetazolamide + pilocarpine

ant uveitis: pred drops + cyclopentolate

conjunc: nothing or chloramphenicol
subconjunc. haem. : resolves spont

140
Q

causes of erythema nodosum

A

sarcoidosis
drugs [sulfasalazine for UC, COCP]
strep infection

less common:
IBD, TB, viruses/fungi

141
Q

describe what erythema multiforme looks like + location

A

‘target lesions’
symmetrical +/- central blister
on palms/soles, limbs

142
Q

erythema migrans [papule developing into a spreading large erythematous ring with central fading] is pathognomic of what disease?

A

lyme disease

143
Q

pyoderma gangrenosum associations
[10cm purulent necrotic ulcers on legs/abdo/face]

sex predominance?

Tx?

A 
IBD
autoimmune hepatitis
granulomatosis with polyangiitis [Weg]
myeloma
neoplasia

female predominance

PO steroids +/-ciclosporin

144
Q

skin manifestations of crohns

A

perianal/vulval/oral ulcers
erythema nodosum
pyoderma gangrenosum

145
Q

skin manifestations of dermatomyositis

A

gottron’s papules
shawls sign
heliotrope rash on eyelids

146
Q

skin manifestations of DM

A

ulcers
necrobiosis lipoidica
granuloma annulare
acanthosis nigricans

147
Q

skin manifestations of coeliac

A

dermatitis herpetiformis

148
Q

skin manifestations of hyperthyroid

A

pretibial myxoedema

thyroid acropachy

149
Q

skin manifestations of liver disease

A 
palmar erythema
spider naevi
gynaecomastia
decreased pubic hair
jaundice
bruising
scratch marks
150
Q

Tx for itch of dermatitis herpetiformis

A

dapsone

151
Q

which rheumatological diseases include raynauds

A

systemic sclerosis
SLE
polymyositis
dermatomyositis

152
Q

differentials for monoarthritis

A

SA
OA
crystal [gout, CPPD]
trauma [haemoarthrosis]

153
Q

differentials for oligoarthritis [<5]

A 
crystal
psoriatic
reactive
ank spond
OA
154
Q

differentials for symmetrical polyarthritis[ >5]

A

RA
OA
viruses [hepABC, mumps]
systemic conditions [SLE, malig, haemochrom etc]

155
Q

differentials for asymmetrical polyarthritis [>5]

A

reactive
psoriatic
systemic [SLE, malig, haemochrom etc]

156
Q

what do you send synovial fluid for following joint aspiration [ie what are you investigating for

A

WCC
gram stain
polarised light microscopy [crystals]
culture

157
Q

red flags for sinister causes of back pain [malig/infection/inflamm]

A 
<20 or >55
acute in elderly
thoracic
morning stiffness
constant/worsening
bilat/alternating leg pain
neuro disturbace incl sciatica
nocturnal pain
sphincter distrbance
worse supine
fever, night sweats, weight loss
recent or current infection
malignancy Hx
imm supp [steroids/HIV]
abdo mass
leg claudication or exercise related leg weakness/numbness [spinal stenosis]
158
Q

a) which nerve roots is straight leg raise?
b) what = a positive test?
c) pathology usually suggested

A

a) L4, L5, S1
b) raise straight leg = pain below knee, worse on dorsiflex
c) irritation to sciatic nerve, most common is lumbar disc prolapse

159
Q

sciatic nerve is formed from which spinal roots?

A

L4-S3

160
Q

a) which nerve are you assessing in femoral stretch test?

b) what = +ve test

A

a) L2-L4

b) patient prone, knee flexed. hip ext > pain in front of thigh on

161
Q

list 4 most likely causes of back pain in 15-30 yr olds

A 
prolapsed disc
trauma
fracture
ank-spond
spondylolisthesis
pregnancy
162
Q

give 3 most likely causes of back pain in 30-50 yr olds

A

prolapsed disc
malig
degenerative

163
Q

give 4 most likely causes of back pain in >50s

A 
osteoporosis wedge fracture
malig
degen
pagets
myeloma
spinal stenosis
164
Q

Ix in red flag back pain

A 
MRI, XR
FBC
urine/serum electrophoresis
ESR/CRP
PSA
U+E
LFT [alp]
165
Q

Mx of back pain

A

neuro deficit- urgent neurosurg r/v

non-spec - advise exercise, analgesia, physio, acupuncture

[surg]

166
Q

features of cauda equine compression

A

alternating / bilat root pain in legs
saddle parastheisa
los o anal tone
bladder/bowel incont

167
Q

features of acute cord compression

A

bilateral pain
LMN signs @ level of compression
UMN + sensory loss below
sphincter disturbance

168
Q

causes of acute cord compression + cauda equina

A 
bony mets
large disc protrusion
myeloma
cord/paraspinal tumour
TB
abscess
169
Q

where is the pain felt + which movements would demonstrate weakness in L2 nerve root lesion

A

pain across upper thigh

hip flexion and adduction

170
Q

L3 nerve root lesion

a) where’s the pain? [dermatome]
b) weakness in what movements?
c) reflex affected?

A

a) across lower thigh
b) hip adduction, knee ext
c) knee jerk

171
Q

L4 nerve root lesion

a) where’s the pain? [dermatome]
b) weakness in what movements?
c) reflex affected?

A

a) across knee to medial malleolus
b) knee ext, foot inversion, dorsiflex
c) knee jerk

172
Q

L5 nerve root lesion

a) where’s the pain? [dermatome]
b) weakness in what movements?
c) reflex affected?

A

a) lateral shin to dorsum of foot and big toe
b) hip ext + abduction, knee flex, foot + big toes dorsiflex
c) big toe jerk

173
Q

S1 nerve root lesion

a) where’s the pain? [dermatome]
b) weakness in what movements?
c) reflex affected?

A

a) post calf to lateral foot + little toe
b) knee flexion, foot and toe plantar flex, foot eversion
c) ankle jerk

174
Q

factors that ^risk or worsen RA

A

female
smoking
50-60s
HLA DR4/1

175
Q

features of RA

A

symm swollen painful stiff small joints of the hands and feet
worse in morn
larger joints can be involved/ fluctuating/various presentations

176
Q

extraart and systemic Sx in RA

A 
fatigue
fever
weight loss
pericarditis
pleurisy
177
Q

early exam signs in RA

A 
inflamm
swollen MCP, PIP, MTP
symm
tenosynovitis [inflamed tendon]
bursitis
178
Q

late exam signs in RA

A

ulnar deviation - wrists and fingers

boutonieres, swan neck, Z thumb

179
Q

what rare complication of RA can threaten the cervical spinal cord

A

atlanto-axial joint subluxation

180
Q

lung extra art manifestations of RA

A

nodules
pleural
interstitial fibroiss
bornchiolitis obliterans

181
Q

extra art manifestations of RA - cardiac

A

cardiac nodules
IHD
pericardiits
percardial effusion

182
Q

Ix findings in RA

A

RF +ve
antiCCP
FBC anaemia of chronic disease, ^platelets
^ESR/CRP
XR - soft tissue swelling, osteopenia, red. joint space, erosions, sublux, carpal destruciton

US/MRI - synovitis, erosions

183
Q

RA Mx

A 
DMARDs [metho, sulfa, hydrox]
biologics [inflix/ritux]
steroids [IM/IA/PO]
nsaids
PT/OT
surg
CV risks
stop smoking
184
Q

SEs of methotrex/ risks

A 
infections
pneumonitis
oral ulcers
nausea + V
hepatotox
teratogenic
185
Q

what diseases should pt be screened for befroe starting dmards

A

TB
hepB/C
HIV

186
Q

SEs of biologics

A

infection
reactivation of TB
worsening HF
blood disorders

187
Q

pathophysiology behind pagets disease of bone + resulting problems

A

^bone turnover [^osteoblasts + osteoclasts]

remodelling, bone enlargement, deformity, weakness

188
Q

clinical features of pagets disease of bone

A

deep boring pain
bony deformmity + enlargement
pelvis, lumbar spine, skull, femur, tibia[sabre]

189
Q

cpmplicaptions of pagets disease of bone

A 
pathological fracures
OA
ca2+^
nerve compression from bone overgrowth: deafness, root
CCF
osetosarcoma
190
Q

XR findings in pagets disease of bone

A

bone enlargement
patchy cortical thickening with sclerosis, osteolysis, deformity
axial/long bone/skull

191
Q

bloods in pagets disease of bone

A

^Ca2+
normal PO43-
^^^alp

192
Q

mx of pagets disease of bone

A

analgesia

bisphos

3B GH (16 decks)

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