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Rheumatology/MSK > Rheum Mix > Flashcards

Rheum Mix Flashcards

1
Q

Methotextrate side effects and toxicity treatment

A

-Mucositis
-myelosupression
-pneumonitis (non-productive cough, dysponea, malaise and fever)
-pulmonary fibrosis
-liver fibrosis

-folinic acid for toxicity

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2
Q

Osteoarthritis x-ray findings

A

-loss of joint space
-osteophytes
-subchondral cysts
-subchondral sclerosis

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2
Q

Reactive arthritis triad

A

Urethritis + arthritis +/- conjunctivitis = reactive arthritis
Chlamydia trachomatis is the most common cause of reactive a.

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3
Q

Hydroxychloroquine side effects

A

-Bull’s eye retinopathy (may result in severe and permanent visual loss) for which baseline ophthalmological examination and annual screening is generally recommended
-safe in pregnancy though

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4
Q

Ankylosing spondylitis x-ray findings

A

-sacro-ilitis on pelvic x-ray (subchondral erosions, sclerosis)
-squaring of lumbar vertebrae
-syndesmophytes
-aytpical fibrosis on cxr
-bamboo spine

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5
Q

Discoid lupus eruthematosus sx + tx

A

erythematous, raised rash, sometimes scaly, may be photosensitive
more common on face, neck, ears and scalp
Tx: topical steroid, 2nd line oral hydroxychloroquine

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6
Q

Cubital Tunnel syndrome vs carpal tunnel syndrome

A

Carpal: pain/pins and needles in thumb, index, middle finger

Cubital: Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.

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7
Q

Investigations + findings for ankylosing spondylitis

A

Pelvic X-ray
-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

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8
Q

What structure is divided in carpal tunnel surgery

A

flexor retinaculum- decompress median nerve

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9
Q

Carpal Tunnel tests

A

-Tinel’s sign: tapping causes paraesthesia
-Phalen’s sign: flexion of wrist causes symptoms
-weakness of thumb abduction (abductor pollicis brevis)
-wasting of thenar eminence (NOT hypothenar)

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10
Q

test for achillies tendon rupture

A

positive Thompson’s test is pathognomonic for Achilles tendon rupture; the patient lies prone and the calf muscle belly is squeezed. The test is positive if the squeezing of the calf does not cause plantarflexion of the calf.

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11
Q

Knee arthroplasty nerve damage

A

common peroneal nerve

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12
Q

ANCA associated vasculitis (Wegener’s granulomatosis) or (Churg-Strauss) Sx

A

-renal impairment
-resp problems (cavitating nodules on CXR)
-joint pain
-sinusitis and epistaxis
Ix: cANCA: wegners
pANCA: churg

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13
Q

Temporal arteritis RF

A

Polymyalgia rheumtica

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14
Q

Temporal arteritis fundoscopy

A

Anterior ischemic optic neuropathy: swollen pale disc and blurred margins

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15
Q

Bone disorder lab values

A
  1. Osteoporosis: all normal
  2. Osteomalacia: decreased Ca and Ph, increased ALP + PTH
  3. Primary hyperparathyroidism: Ca, ALP, PTH increased, Ph decreased
  4. Secondary hyperparathyroidism: Reduced Ca and Ph, elevated PTH and ALP
  5. Paget’s: isolated increase in ALP
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16
Q

Retinal vein occlusion fundoscopy

A

flame haemorrhages, cotton wool spots, optic disc swelling and macular oedema

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17
Q

Reactive arthritis triad

A

Conjunctivitis, urethritis and arthritis
Tx: NSAID

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18
Q

Gout Mx

A

Allopurinol (urate lowering) and then colchicine for acute flares (co-prescribe)
SE: diarrhoea

19
Q

SLE Ix

A
  1. ANA postive (+/-anti dsDNA)

Monitoring: Raised CRP may indicate infection, complement levels C3, C4 are low during active disease

20
Q

RA Mx

A

DMARD i.e. methotextrate + short course of bridging prednisolone
Flares: IM corticosteroids
Monitor using CRP

21
Q

Septic arthritis Mx

A

Fluxloxacillin (clindamycin if allergic) 4-6 weeks

22
Q

Pseudogout RFs and features

A

-haemochromatosis
-hyperparathyroidism
-acromegaly

Features: joint aspiration: shows weakly positive birefringent rhomboid shaped crystals
x-ray: chondrocalcinosis

23
Q

Hip Fracture Mx

A

Undisplaced: intertrochanteric hip screw
Displaced: hemi or total arthroplasty

24
Q

Polymyalgia Rheumatica Sx

A

> 60
Rapid onset
Aching, morning stiffness (NOT weakness)
mya how low mood, night sweats etc.
IX: raised ESR, NORMAL CK and EMG
Tx: prednisolone

25
Q

Gout Sx

A

-pain
-swelling
-erythema
70% 1st presentations uasually affect 1st metatarsopharyngeal joints

26
Q

Gout Ix

A

-measuring uric acid levels (>360 +ve)
-synovial fluid: needle shaped negatively birefringent monosodium urate crystals under polarised light

27
Q

Hypocalcaemia Sx

A

CAT numb
C- convulsions
A- arrhythmias (QT prolongation)
T- tetany
N- numbness in hands, feet, peri-orally

28
Q

Osteoarthritis Mx

A

1st line: topical NSAID
2nd line: oral NSAID + PPI

29
Q

Antiphospholipid Sx, Ix, Mx

A

CLOT
C: clots
L: livedo reticularis (mottling)
O: obstetric complication (recurrent miscarriages)
T: thrombocytopenia

Ix: antibodies: anticardiolipin, lupus anticoag
-thrombocytopenia
-prolonged APTT

Mx: low-dose aspirin, if VTE, should be given lifelong warfarin (INR 2-3)

29
Q

Most common site of metatarsal stress fractures?

A

2nd metatarsal

30
Q

Immunoglobulin secreted in breast milk

A

IgA

31
Q

Rheumatoid Arthritis Ix

A

-Rheumatoid factor
-Anti-CCP antibodies
-Yellow, turbid aspirate findings

32
Q

Lumbar spinal stenosis

A

-Sx mimicking claudication
-Sitting is better than standing

Ix: MRI

33
Q

Osteochondritis dissecans Sx and vs Osgood Schlatter

A

Knee pain, swelling, painful ‘clunk’

Osgood Schlatter: localised over tibial tuberosity, non-clunking

34
Q

Drug induced lupus antibodies

A

Anti-histone antibodies

35
Q

Septic arthritis causative agents by demographic

A

In general: S. Aureus
Young children: S. Pyogenes
Patients has a Prosthetic joint: S. Epidermidis
Sexually-active young adults: N. Gonrrhoeae

36
Q

optic neuritis sx ix mx

A

-unilateral decrease in vision
-poor discrimination of colours (red desaturation)
-relative afferent pupillary defect
-central scotoma
Ix: MRI brain and orbits with gadolinium contrast
Mx: high dose steroids

37
Q

Differentials for vasculitis

A

Usually infective- more acute representation than vasculitis
-HEP B C
-Infective endocarditis
-Cocaine use (granulomatous changes)

38
Q

ANCA pathology

A

Antibodies against neutrophil granule components
cANCA (cytoplasmic)
pANCA (perinuclear)

39
Q

Vasculitis DDs

A
  1. Systemic: infection i.e. endocraditis, neisseria meningitides, hep b & c
  2. malignancy: metastatic carcinoma, paraneoplastic
  3. vessel occulsion: embolitic and thrombolitic
  4. drugs i.e. cocaine can mimic GPA/wegner’s
40
Q

Temporal arteritis is associated with which PMH

A

Polymyalgia Rheumitica

41
Q

Avascular necrosis of femoral head RF and Imaging

A

RF: long term steroid use, chemotherapy
Imaging: X-ray may be normal, MRI is gold standard

42
Q

Colchicine/Allopurinol gout guidelines

A

Lifestyle mods: reduce alcohol, lose weight

1.Colchicine first line (SE diarrhoea)
If on allopurinol continue in acute

  1. Allopurinol offered for urate-lowering therapy after first attack of gout or +4 attacks + colchicine cover for 6 months
43
Q

PMR investigations

A

Raised inflammatory markers e.g. elevated ESR
Normal EMG and creatinine kinase

44
Q
A
45
Q
A

Rheumatology/MSK (2 decks)

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