Rheum/ Ortho

Question 1

What needs to be checked prior to starting a patient on azathioprine?

Answer 1

Thiopurine methyltransferase (TPMT)

• Enzyme required to metabolise azathioprine

azaTHIO ***

Question 2

Who can have a bisphosphonate holiday?

Answer 2

After a five year period for oral bisphosphonates (three years for IV zoledronate) can REASSESS - update DEXA and FRAX scan

High risk patients should stay on bisphosphonates long term:
Age >75
Glucocorticoid therapy
Previous hip/vertebral fractures
Further fractures on treatment
High risk on FRAX scoring
T score <-2.5 after treatment

Question 3

How does paget’s present and how is it treated?

Answer 3

Older male with bone pain and raised ALP

Tx - bisphosphonates

Question 4

Side effects of sulfasalazine

Answer 4

Oligospermia
ILD

Question 5

Hydroxychloroquine side effects

Answer 5

Retinopathy and corneal deposits

Question 6

Biochemimcal results in primary versus secondary hyperparathyroidism

Answer 6

Primary - Low phosphate
High calcium, ALP and PTH

Secondary - Low calcium,
High phosphate, ALP and PTH

Question 7

What are the three types of systemic sclerosis?

Answer 7

Limited cutaneous
- CREST
Diffuse cutaneous
- May involve ILD and renal impairment
Scleroderma
- Skin changes only

Question 8

What is CREST syndrome?

Answer 8

Type of limited cutaneous sysetmic sclerosis

C - calcinosis
R - raynauds
E - oesophageal dysmotility
S - sclerodactyly
T - telangiectasia

Question 9

How are different types of scaphoid fracture managed?

Answer 9

Proximal pole fracture> Surgical fixation is necessary

Occult/ distal pole fractures>wrist splint

Question 10

How does de quervain’s tenosynovitis present?

Question 11

What electrolyte abnormality can bisphosphonates cause?

Answer 11

Hypocalcaemia

Bisphosphonates shove all the calcium into bones so reduces serum levels.
This is why you replace calcium/ vit D before giving bisphosphonates.

Question 12

How does radial tunnel syndrome present?

Answer 12

Similar to lateral epicondylitis but tenderness is distal to the common extensor origin

Nost common in gymnasts, racquet players and golfers who frequently hyperextend at the wrist or carry out frequent supination/pronation. Patients can also complain of hand paraesthesia or aching at the wrist.

Question 13

How do the different types of hip dislocation present?

Answer 13

Posterior dislocation: Accounts for 90% of hip dislocations. The affected leg is shortened, adducted, and internally rotated.

Anterior dislocation: The affected leg is usually abducted and externally rotated. No leg shortening.

Question 14

Which rheumatology drug is associated with the potential side effect of demyelination?

Answer 14

Etanercept