Rheum Gap Flashcards
ANA is associated with
diffuse cutaneous systemic sclerosis
Sjogren’s syndrome
limited cutaneous systemic sclerosis
SLE
Anti Jo Antibody is associated with
(Hint: Joey – Polygamy)
polymyositis
Behcets is a triad of
Oral Ulcer
Genital Ulcer
Anterior Uveitis
Behcet’s is associated with which HLA
B51
Which test is suggestive of Behcet’s
Pathergy Test
Investigations of Sjogrens Syndrome
(antibodies)
Rheumatoid factor (RF) positive in nearly 50% of patients
ANA positive in 70%
anti-Ro (SSA) antibodies in 70% of patients with PSS
anti-La (SSB) antibodies in 30% of patients with PSS
Rx of Osteoporosis
- Bisphosphonates are the first-line drug treatment for patients at risk of fragility fractures
- oral ie alendronate and risedronate are typically first-line. These are often taken weekly
- however, the NOGG recommend IV zoledronate as the first-line treatment following a hip fracture This is given yearly - Denosumab is generally used as a second-line treatment: Single cubcut injection every 6 months-
- other possible treatment options include:
strontium ranelate
raloxifene
teriparatide
romosozumab
Plan to prescribe oral bisphosphonates for at least 5 years, or intravenous bisphosphonates for at least 3 years and then re-assess fracture risk.
Paget’s Disease Presentation
- an older male with bone pain and an isolated raised ALP
- bone pain (e.g. pelvis, lumbar spine, femur)
- classical, untreated features: bowing of tibia, bossing of skull
Paget’s disease pathophysiology
excessive osteoclastic resorption followed by increased osteoblastic activity.
Organism of Osteomyelitis in Sickle Cell Disease
Salmonella
Usually- Staph Auerus
Osteopetrosis pathophysiology
Defective osteoclast function resulting in failure of normal bone resorption
Ehler-Danlos syndrome pathophysiology
Abnormality in type III and V collagen
Lesch-Nyhan syndrome is associated with
Enzyme: HGPT
Features: GRNLS
‘Nyhan’- Boys Name
Lesch-Nyhan syndrome
hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency
x-linked recessive therefore only seen in boys
features: gout, renal failure, neurological deficits, learning difficulties, self-mutilation
gout, renal failure, neurological deficits, learning difficulties, self-mutilation indicates
Lesch-Nyhan syndrome
hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency
Adverse effects of Azathioprine
- bone marrow depression- consider a full blood count if infection/bleeding occurs
- nausea/vomiting
- pancreatitis
- increased risk of non-melanoma skin cancer
Diffuse cutaneous systemic sclerosis
associated with —– antibodies
associated with anti scl-70 antibodies
limited cutaneous systemic sclerosis associated with —- antibodies
anti-centromere antibodies associated with limited cutaneous systemic sclerosis
Methotrexate M/A
Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, an enzyme essential for the synthesis of purines and pyrimidines.
Methotrexate Adverse Effects
- mucositis
- myelosuppression
-** pneumonitis- the most common pulmonary manifestation-** similar disease pattern to hypersensitivity pneumonitis secondary to inhaled organic antigens. typically develops within a year of starting treatment, either acutely or subacutely. presents with non-productive cough, dyspnoea, malaise, fever - pulmonary fibrosis
- liver fibrosis
Chondromalacia patellae
- Softening of the cartilage of the patella
- Common in teenage girls
- anterior knee pain on walking up and down stairs and rising from prolonged sitting
- Usually responds to physiotherapy
Osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking
Marfans Genetics
Marfan’s syndrome is an autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1. It affects around 1 in 3,000 people.
When did I see the marfans patient? on my ‘15th’ Night Shift.
She was very Active and Dominant- could do everything. - Autosomal Dominant
Drug Induced Lupus
Most common causes
- procainamide
- hydralazine
Less common causes
- isoniazid
- minocycline
- phenytoin
Rituximab
causes —– cell depletion?
what type of drug? —- antibody
works against which CD? —-?
anti-CD20 monoclonal antibody, results in B-cell depletion
M/A of Bisphophonates
Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.
Food that can precipitate Gout Attacks
Foods to avoid include those high in purines e.g.
- Liver
- Kidneys
- Seafood
- Oily fish (mackerel, sardines)
- Yeast products
Xray signs of Calcification (cartilage) in the joint - —-?
Xray with Widening in the joint (Kids) - —– ?
Xray signs of Calcification (cartilage) in the joint - Pseudogout
Xray with Widening in the joint (Kids) - Rickets
Which movement is affected most in adhesive capsulitis
Features typically develop over days
external rotation is affected more than internal rotation or abduction
pANCA is associated with
PCM
pANCA
Churg Srauss- eosinophilic granulomatosis with polyangiitis
MPO Positive
Inv for antiphospholipid syndrome
antibodies:
- anticardiolipin antibodies
- anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
- lupus anticoagulant
thrombocytopenia
prolonged APTT
In of choice for avascular necrosis
MRI is the investigation of choice
causes of avascular necrosis
long-term steroid use
chemotherapy
alcohol excess
trauma
Vit D supplementation is indicated for
A - Age > 65
B - Breast feeding + pregnancy
C - Children 6 months to 3 years old
D - Dark skinned individuals
E - Exposure to sunlight poor
Most common Visual complication of GCA
anterior ischemic optic neuropathy accounts for the majority of ocular complications. It results from occlusion of the posterior ciliary artery (a branch of the ophthalmic artery) → ischaemia of the optic nerve head. Fundoscopy typically shows a swollen pale disc and blurred margins
Lab Values of Bone Disorders
check from Passmed
Rx of Raynauds
- first-line: calcium channel blockers e.g. nifedipine
- IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months
Cubital Tunnel Syndrome
Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.
cUbital = Ulnar nerve
Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.
Cubital Tunnel Syndrome
occurs due to compression of the ulnar nerve as it passes through the cubital tunnel.
OsteoPetrosis info:
aka-
pathophysiology-
Biochemistry-
Rx-
**aka marble bone disease
rare disorder of defective osteoclast **function resulting in failure of normal bone resorption
results in dense, thick bones that are prone to fracture
bone pains and neuropathies are common.
calcium, phosphate and ALP are normal
stem cell transplant and interferon-gamma have been used for treatment
Presentation of Carpal Tunnel Syndrome
Carpal tunnel syndrome is caused by compression of median nerve in the carpal tunnel.
History
pain/pins and needles in thumb, index, middle finger
Examination findings of Carpal Tunnel Syndrome
Examination
weakness of thumb abduction (abductor pollicis brevis)
wasting of thenar eminence (NOT hypothenar)
Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms
What is Tinels sign
tapping causes paraesthesia
What is Phalens Sign
flexion of wrist causes symptoms
Carpal tunnel = —- nerve compressiob
Cubital Tunnel = —- Nerve
Carpal = Median
cUbital = Ulnar nerve
M/A Bisphosphonates
inhibit osteoclasts by reducing recruitment and promoting apoptosis.
M/A of:
Bisphosphonates: ——
Raloxifene: ——–
Strontium Ranelate: —–
Denosumab: ——-
Bisphosphonates: Inhibit osteoclast ( By inhibiting the recruitment and promoting apoptosis)
Raloxifene: Selective estrogen receptor modulator
Strontium Ranelate: (DUAL ACTION BONE AGENT)
Inhibiting osteoclast
Promoting differentiation of pre-osteoblast to osteoblast
Denosumab: Monoclonal antibody that inhibits RANK ligand and thereby preventing maturation of osteoclast.
Inv of choice for Ank Spondilitis
Pelvic Xray
( sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus
chest x-ray: apical fibrosis )
Poor prognostic features of RA
Poor prognostic features
rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset
Drug Causes of Gout
SPyCy ACiD
S- Salisilic acid - Asprin
Py- Pyrazinamide
Cy- Cytotoxic Agents
A- Alcohol
Ci- Ciclosporin
D - Diuretic - thiazide , frusamide
pain and tenderness localised to the lateral epicondyle
pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
Lateral epicondylitis/tennis elbow
Lateral epicondylitis presents as
pain and tenderness localised to the lateral epicondyle
pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
Red flags of LBP
- age < 20 years or > 50 years
- history of previous malignancy
- night pain
- history of trauma
- systemically unwell e.g. weight loss, fever
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
Which nerve root compression
S1
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
Which nerve root compression
L5
Rx of Spinal Stenosis
Laminectomy
CVS findings of Marfans
Dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation
mitral valve prolapse (75%),
McArdle’s disaease:
Genetics : ——-
Type —— glycogen storage disease
caused by —- deficiency
causes reduced ——
autosomal recessive type V glycogen storage disease
caused by myophosphorylase deficiency
this causes decreased muscle glycogenolysis
Second wind phenomenon seen in
McArdle’s disease
a syndrome of paraesthesia or anaesthesia in the distribution of the lateral femoral cutaneous nerve (LFCN). It is an entrapment mononeuropathy of the LFCN- known as
Meralgia Paresthetica
LFCN originates from L2/3
Methotrexate toxicity
the treatment of choice for Methotrexate Toxicity
Folinic Acid
Methotrexate shouldn’t be co-prescribed with
Trimethoprim or co-trimoxazole - increases risk of marrow aplasia
Which medication increases the risk of Methotrexate toxicity
High dose aspirin
repeated episodes of inflammation and deterioration of cartilage.
Relapsing Polychondritis
- This most commonly affects the ear
Features:
Ears: auricular chondritis, hearing loss, vertigo
Nasal: nasal chondritis → saddle-nose deformity
Respiratory tract: e.g. hoarseness, aphonia, wheezing, inspiratory stridor
Ocular: episcleritis, scleritis, iritis, and keratoconjunctivitis sicca
Joints: arthralgia
Less commonly: cardiac valcular regurgitation, cranial nerve palsies, peripheral neuropathies, renal dysfunction
Psudogout is associated with
haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease
Psudogout xray
x-ray: chondrocalcinosis
in the knee this can be seen as linear calcifications of the meniscus and articular cartilage
Discoid Lupus Rx
Topical steroid cream
oral antimalarials may be used second-line e.g. hydroxychloroquine
avoid sun exposure
Discoid Lupus is characterized by
Follicular Keratin Plugs
SLE is —- type hypersensitivity reaction
associated with HLA —— ?
Type 3
(3 letters in SLE)
associated with 3 HLA:
associated with HLA B8, DR2, DR3
Most common cardiac manifestation of Lupus
Pericarditis
Antibodies associoated with Lupus
- 99% are ANA positive: this high sensitivity makes it a useful rule out test, but it has low specificity
- 20% are rheumatoid factor positive
**- anti-dsDNA: highly specific (> 99%), but less sensitive (70%) - anti-Smith: highly specific (> 99%), sensitivity (30%)**
also: anti-U1 RNP, SS-A (anti-Ro) and SS-B (anti-La)
Rx of Choice for Lupus
Hydroxychloroquine
Neonatal complications of Lupus are associated with —- antibodies
strongly associated withanti-Ro (SSA) antibodies
common neonatal complication of Lupus
congenital heart block
Patterns of systemic sclerosis
- Diffuse cutaneous systemic sclerosis (associated with Anti-scl70)
- Limited Cutaneous (associated with anti-centromere)
- Scleroderma
common cause of death in systemic sclerosis
the most common cause of death is now respiratory involvement, which is seen in around 80%: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)
which pattern of Systemic sclerosis has poor prognosis
Diffuse cutaneous
Fundoscopy finding of anteriod ischemic optin neuropathy
Fundoscopy typically shows a swollen pale disc and blurred margins
Which DMRD is safe for pregnancy and breastfeeding
Sulfasalazine
Adverse effects of Sulfasalazine
oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses
Cautious administration of sulfasalazine is required for
- G6PD deficiency
- allergy to aspirin or sulphonamides (cross-sensitivity)
Xray finding of osteomalacioa
Looser’s zones- also known as pseudofractures or Milkman’s fractures, are characteristic radiographic features seen in Osteomalacia. These are areas of incomplete fracture that appear as lucent bands perpendicular to the surface of the bone, usually bilateral and symmetric
X-Ray of Pagets
characteristic x-ray findings include a mixed pattern of sclerotic and lytic lesions, thickened trabeculae forming a ‘cotton-wool’ appearance, and cortical thickening leading to enlargement of bones affected.
first line for ankylosing spondiytis
pcm vs nsaids?
nsaids
McARDles disease genetics
AR
Type 5 glycogen storage disease
X-Ray findings of OA and RA
OA:
L – loss of joint space
O – osteophytes
S – subchondral sclerosis
S – subchondral cysts
RA
L – loss of joint space
o- juxta-articular osteoporosis/osteopenia
S- soft tissue swelling
Er – Periarticular erosions
S- Subluxation
Ehlers Danlos Syndrome —- type collaegn disorder
Ehlers Danlos Syndrome- 3 word- collagen 3 disorder
Name the type of collagen disorders for each:
osteogenesis imperfecta
Goodpasture’s syndrome
Ehlers Danlos
Collagen type I is defective in osteogenesis Imperfecta. Collagen IV is defective in Goodpasture’s syndrome.
‘Good’- 4 lettes
3 in Ehlers- E has three stripes
—– is most common form of haematogenous osteomyelitis in adults
vertebral osteomyelitis is the most common form of haematogenous osteomyelitis in adults
Sjogrens syndrome has an increased risk of
Lymphoid malignancy
Early feature of RA
juxta-articular osteoporosis/osteopenia
RA vs Psoriatic Arthritis
RA involves PIP and MCP
Psoriatic Arthritis involves DIP
Xray of Psoriatic Arthritis
often have the unusual combination of coexistence of erosive changes and new bone formation
periostitis
Pencil-in-cup’ appearance
Associated features of Ankylosing spondiliutis
Other features - the ‘A’s
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)
Cannot see, cannot pee, cannot climb a tree- —- arthritis?
Reactive arthritis
- Joint- arthritis is typically an asymmetrical oligoarthritis of lower limbs, dactylitis
2.Eye- Conjunctivitis, Anterior uveitis - Skin- circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles) - Kidney- Urethritis
Reactive arthritis is a tetrad of —–
Reactive arthritis
- Joint- arthritis is typically an asymmetrical oligoarthritis of lower limbs, dactylitis
- Eye- Conjunctivitis, Anterior uveitis
- Skin- circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles) - Kidney- Urethritis
+
presents within 4 weeks, not acutely
Gonococcal vs reactive arthritis
- causes septic arthritis, not reactive. there will be joint irritation, therefore not full range of movement. Also, in septic arthritis, the patient will be unwell.
- Gonorrhoea in the history will likely have a mention of urethral discharge, as it is less commonly asymptomatic vs chlymidia.
- presents during acute infection (rather than weeks later in reactive)
Sjogrens association
Eyes- dry eyes: keratoconjunctivitis sicca
Mouth- dry mouth
Genitalia- vaginal dryness
Joints- arthralgia, Raynaud’s, myalgia
Nervous system- sensory polyneuropathy
recurrent episodes of parotitis
Kidney- renal tubular acidosis (usually subclinical)
NO CVS involvement
First line test for suspected RA
RF
RF reacts to—
Rheumatoid factor (RF) is a circulating antibody (usually IgM) that reacts with the Fc portion of the patients own IgG.. It is recommended as the first-line antibody test for patients with suspected rheumatoid arthritis.
Anti ccp associated with
RA
not SLE for god’s sake
most common organism for iliopsoasa abscess
staph aureus
inv of choice for iliopsoasa abscess
CT
Commonest secondary cause of Iliopsias abscess
Chron’s
Mixed Connective Tissue Disease is associated with
It is associated with anti-U1 ribonucleoprotein (RNP) antibodies
Which autoimmune conditons are common in Male?
Speaking rheumatologically, autoimmune conditions commonly target females, except
BAP
Behcets
AS
Pagets
Which autoimmunes conditions are equally prevalent in males and females
Conditions that prevail equally in both genders are;
psoriatic arthropathy and drug-induced SLE.
De Quervans Tenosynovitis is inflammation of
sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.
De Quervans tenosynovitis is ch by
- pain on the radial side of the wrist
- tenderness over the radial styloid process
- abduction of the thumb against resistance is painful
- Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
What is Finkelstein’s test
- Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
Finkelstein’s test positive in
De Quervans
- pain on the radial side of the wrist
- tenderness over the radial styloid process
- abduction of the thumb against resistance is painful
De Quervans
Still’s disease management
- NSAIDs: should be used first-line to manage fever, joint pain and serositis. they should be trialled for at least a week before steroids are added.
- steroids; may control symptoms but won’t improve prognosis
3. if symptoms persist, the use of methotrexate, IL-1 (eg: Anakinra) or anti-TNF therapy can be considered
Diagnostic criteria of Stills disease:
RF +ve/-ve
ANA +ve/-ve
—- criteria
rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative
The diagnosis of Still’s disease in adults can be challenging. The Yamaguchi criteria is the most widely used criteria and has a sensitivity of 93.5%.
Which is more specific in SLE?
ANA
RF
anti-dsDNA
anti-Smith
anti-U1 RNP, SS-A (anti-Ro) and SS-B (anti-La)
99% are ANA positive- this high sensitivity makes it a useful rule out test, but it has low specificity
anti-dsDNA: highly specific (> 99%), but less sensitive (70%)
anti-Smith: highly specific (> 99%), sensitivity (30%)
Name the ENAs and their associations:
Examples
anti-Ro: —–
anti-La: —–
anti-Jo 1: —-
anti-scl-70: ——–
anti-centromere: —–
Examples
anti-Ro: Sjogren’s syndrome, SLE, congenital heart block
anti-La: Sjogren’s syndrome
anti-Jo 1: polymyositis
anti-scl-70: diffuse cutaneous systemic sclerosis
anti-centromere: limited cutaneous systemic sclerosis
Name the ENAs associated with these:
Sjogren’s syndrome, SLE, congenital heart block
Polymyositis
Dffuse cutaneous systemic sclerosis
Limited cutaneous systemic sclerosis
Examples
anti-Ro: Sjogren’s syndrome, SLE, congenital heart block
anti-La: Sjogren’s syndrome
anti-Jo 1: polymyositis
anti-scl-70: diffuse cutaneous systemic sclerosis
anti-centromere: limited cutaneous systemic sclerosis
Polyarteritis nodosa is associated with which infection
Hep B
Choice of Steroid for GCA
if there is no visual loss then high-dose prednisolone is used
if there is evolving visual loss IV methylprednisolone is usually given prior to starting high-dose prednisolone
Marfans Genetics
autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1. Fibrillin. normally envelopes elastin
Bone in Bone appearance in Xray
Osteopetrosis
Name the defects of collagens ;
type 1
type 2
type 3
type 4
type 5
Type I: BONE - Osteogenesis Imperfecta
Type II: carTWOlage - Chondrodysplasia
Type III: ArTHREE (Artery) - Vascular type EDS
Type IV (Four): Under the Floor (basement membrane) - Thinning and splitting of GBS causing Alport Syndrome
Type 5 - Classic Ehlers Danlos Syndome
Osteogenesis Imperfecta
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common
deafness secondary to otosclerosis
fractures following minor trauma
blue sclera
dental imperfections are common
Osteogenesis Imperfecta
Which one is. ot a risk factor of osetoporosis Smoking
Obesity/ Sedentary lifestyle/ Premature menopause/Female sex
Obesity
What needs to be monitored for patient oon Leflunamide?
FBC/LFT and blood pressure
DMARD with a very high wash out period
leflunomide has a very long wash-out period of up to a year which requires co-administration of cholestyramine
what should you screen for following a diagnosis of Dermatomyositis
Malignancy.
may be idiopathic or associated with connective tissue disorders or underlying malignancy (typically ovarian, breast and lung cancer, found in 20-25% - more if patient older). Screening for an underlying malignancy is usually performed following a diagnosis of dermatomyositis
Safe DMRDs in pregnancy
sulfasalazine and hydroxychloroquine
Pagets disease RX
Bisphosphonates
Lateral Epicondylitis
Mnemonic - LETS
Lateral epicondylitis, Extension Pain, Tennis Elbow, Supination Pain
Rx of Familial Mediterranean Fever
Colchicine
Dermatomyositis associated with
Anti Jo 1 antibody
Risk factors of psueogout
ve some underlying risk factor, such as:
haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease
pain over the lateral side of hip/thigh
tenderness on palpation of the greater trochanter
indicates
Greater trochanteric pain syndrome or trochanteric bursitis.
Greater trochanteric pain syndrome is also referred to as trochanteric bursitis.
pain over the lateral side of hip/thigh
tenderness on palpation of the greater trochanter
What needs to be monitored for a patient on hydroxychroloquine
- visual symptoms and monitor visual acuity annually using the standard reading chart
fear of bull’s eye retinopathy
pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
Radial tunnel syndrome
Antiphospholipid Syndrome Biochemistry
Low Platelet
Prolonged APTT
Swelling over the posterior aspect of the elbow- with associated pain, warmth and erythema
Olecranon Bursitis
Pain and tenderness localised to the medial epicondyle
pain is aggravated by wrist flexion and pronation
symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement
Medial epicondylitis (golfer’s elbow)
Name the Rotator Cuff Muscles
SItS - small t for teres minor
Supraspinatus
Infraspinatus
teres minor
Subscapularis
Pain with
- Internal Rotation of Hip joint indicates— ?
- External Rotation of shoulder joint— ?
- aBDUction of shoulder joint (arc)— ?
- Extension of wrist or supination of forearm causing elbow pain—?
- Flexion of wrist or pronating forearm causing elbow pain—?
- Pain increased on pronating forearm ( no references of wrist movements and tenderness distal to elbow joint) —?
- Pain at wrist (base of thumb) while moving towards ulnar side—?
- lateral hip TENDERNESS and pain, pain on internal and external rotation—?
- pain on hip extension—?
- Internal Rotation of Hip joint implies - Avascular Necrosis of Femoral bone
- External Rotation of shoulder joint - Frozen shoulder
- BDUction of shoulder joint (arc) - Supraspinatus tendonitis (Rotator cuff)
- Extension of wrist or supination of forearm causing elbow pain - Tennis elbow (Lateral epicondylitis)
- Flexion of wrist or pronating forearm causing elbow pain - Golf elbow (Medial epicondylitis)
- Pain increased on pronating forearm ( no references of wrist movements and tenderness distal to elbow joint) - Radial tunnel syndrome
- Pain at wrist (base of thumb) while moving towards ulnar side - De Quervain tenosynovitis
- Lateral hip TENDERNESS and pain, pain on internal and external rotation- Trochanteric bursitis: l
- pain on hip extension- iliopsoas abscess
Proximal muscle weakness seen in
Osteomalacia
Polymyositis
Dermatomyosistis
For Dermatomyositis:
Most common antibody
Most specific antibody
ANA most common, anti-Mi-2 most specific
Interpretation of DEXA Scan
> -1 : normal
Between -2.5 & -1: Osteopenic
< -2.5: Osteoprosis
Benign overgrowth of bone is knows as
Osteoma
most common benign bone tumour
Osteochondroma
Mention location of the following bone tumours:
Giant Cell Tumour
Osteosarcoma
Ewing Sarcoma
GEOMED
Giant= Epiphysis
Osteosarcoma = Metaphysis
Ewing = Diaphysis
Onion skin appearance in xray
Ewing Sarcoma
Denosumab M/A
It is a human monoclonal antibody that prevents the development of osteoclasts by inhibiting RANKL.
Which Rx has the strongest evidence base for Fibromyalgia
aerobic exercise: has the strongest evidence base
Mycofenolate M/A
Mycophenolate mofetil is an immunosuppressant commonly used to prevent rejection of organ transplants.
inhibits inosine monophosphate dehydrogenase, which is needed for purine synthesis
as T and B cells are particularly dependent on this pathway it can reduce the proliferation of immune cells
Which cytokine is most important in the pathophysiology of RA
TNF
How to confirm the dx of Antiphospholipid syndrome
In order to make a diagnosis of antiphospholipid syndrome, patients must fulfil one of the following clinical criteria + one of the following laboratory criteria:
Clinical criteria
1. Vascular thrombosis: ≥1 clinical episode of arterial, venous, or small-vessel thrombosis in any tissue or organ, validated by imaging studies or histopathology
2. Pregnancy morbidity: e.g. unexplained, consecutive, and spontaneous abortions
Laboratory criteria
1. Positive for LA on ≥2 occasions at least 12 weeks apart
2. Positive aCL on ≥2 occasions at least 12 weeks apart
3. Positive anti-β2GP1 antibodies on ≥2 occasions at least 12 weeks apart
