rheum passmed year 5 Flashcards
when is denosumab used in OP tx
after bsiphospphonate tried - two different types
or if renal function is under 30
methotrexate toxicity tx
Folinic acid
antidote to folic acid antagonists (ie, methotrexate and pyrimethamine)
livedo reticularis caused by what thrombotic disease
anitphospholipid syndrome
primary thromboprophylaxis
in antiphsipholipid syndrome
low dose aspirin
Psoriatic arthropathy is an inflammatory arthritis associated with psoriasis and is classed as one of the seronegative spondyloarthropathies. It correlates poorly with cutaneous psoriasis and often precedes the development of skin lesions
what is MX
methotrexate
where do ewing sarcomas arise
Ewing sarcoma typically occurs in the diaphysis or metaphyseal–diaphyseal portion of long bones
what is the periosteum
The periosteum is the medical definition for the membrane of blood vessels and nerves that wraps around most of your bo
what is a periosteal reaction
eriosteal reaction results when cortical bone reacts to one of many possible insults. Tumor, infection, trauma, certain drugs, and some arthritic conditions can elevate the periosteum from the cortex and form various patterns of periosteal reaction
seen in ewing
Chondrosarcoma - cartilage - normally affects where
axial skeleton - skull, v body, rib cage pelvis
osteosarcoma occurs where and pre what
occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure.
causes of drug induced lupus
Most common causes
procainamide
hydralazine
Less common causes
isoniazid
minocycline
phenytoin
when do you lower your dose of aziothiopurine
A significant interaction may occur with allopurinol and hence lower doses of azathioprine should be used.
preg keep same as safe
how does haemachromatosis lead to psedogout
Hemochromatosis (HH) is a condition that can cause calcium pyrophosphate (CPP) crystal deposition in the joints, which is also known as pseudogout. The exact mechanism that causes CPP crystal formation in HH patients is not fully understood, but some studies suggest that iron may play a role:
Iron damage: Excess iron can damage bone cells and chondrocytes.
Osteoclastogenesis: Iron may stimulate osteoclastogenesis, which is associated with premature and severe CPPD
A postmenopausal woman who’s had an osteoporotic vertebral fracture should be started on a bisphosphonate straight away
true
GCA suspected given high dose oral pred - temp biopsy done but comes back normal what to do next and why
Continue high-dose prednisolone and repeat biopsy as Skip lesions occur in giant cell arteritis and may show a normal biopsy
two movement associated with lateral epicondylitis
worse on resisted wrist extension/suppination whilst elbow extended
pagets( increased uncontrolled bone turnover) tx
bisphosphonate (either oral risedronate or IV zoledronate)
pANCA may be positive in which crohns or UC
pANCA may be positive in UC, but will likely be negative in Crohn’s
in septic arthritis what IX is important to do before giving abx
synovial fluid sampling is obligatory
this should be done prior to the administration of antibiotics if necessary
peptic ulcers contradict what drug
NSAID
steriod
polymorphonuclear neutrophil predominance
RA
reactive a. - synovial fluid appears how
Sterile synovial fluid with a high white blood cell count
household bound pt what should they have
vitamin d
what are we worried about in people with marfans which is why we do echocardiography
dilation of the aortic sinuses which may predispose to aortic dissection
Before giving a bisphos what do you need to make sure is checked and corrected if low
calclium
and then give bsipho and vit d and maybe Ca (dietary)
if pt with polymyaglia rheymatica do not repsond to steriods what do you do
cosnider other dx
finger swelling - dactylitis feature of what arthritis
psoriasitic
in gout under what level of uric acid should you measure again 2 weeks later after flare has settled
360
in women when should they be started on bisphos straight away
osteoporotic vertebral fracture in postmenopausal women - dont wait fro dexa
or if over 50 and post on PO steriods
acute gout tx for future recurrence
allopurinol
colchine for flare
Proximal muscle weakness + raised CK + no rash
polymyositis
rheumatica raised ESR
XR findings in ank spond
x-ray findings: subchondral erosions, sclerosis
and squaring of lumbar vertebrae
Bone pain, tenderness and proximal myopathy (→ waddling gait)
osteomalacia
rickets kids
acute flares of RA managed how
flares of RA are often managed with corticosteroids - oral or intramuscular
what needs to be checked with methotrexate
FBC & LFTs i
reflex tachycardia is caused by what drug and what is the mech
nifidipine
Nifedipine causes peripheral vasodilation which leads to the heart compensating for the drop in blood pressure by beating faster.
dermatomyositis what rash is seen over the knuckles
Gottron’s papules, roughened red papules over the knuckles mainly
A 37-year-old man sees his GP complaining of ‘a flu that won’t go away’. On further questioning he has had a 2-week history of fever, nausea and vomiting, myalgia and weakness, and a sensation of itchiness. He also describes a few episodes of red urine. He denies any cough, haemoptysis or any other respiratory symptoms. On examination you notice he has some slight scleral icterus, alongside small palpable purpura on his lower legs and arms.
Given these features, which of the following would be the most likely diagnosis?
The stem may seem overwhelming at first but breaking it down will help reveal clues to the question. His symptoms/signs appear to be rather viral, with the exception of the itchiness, scleral jaundice, haematuria, and purpura. With the systemic symptoms alongside the haematuria and purpura the first thought should be vasculitis, thus eliminating polymyalgia rheumatica.
The scleral jaundice and itchiness suggest a obstructive hepatic impairment. Alongside this, we are also told that the patient has not had any respiratory symptoms. Combining these would help exclude a further three answers and lead to the correct answer of polyarteritis nodosa, which is strongly associated with hepatitis B infection and does not tend to have respiratory features unlike the other 3 vasculitides.
hep b associated with what condition
polyarteritis nodosa
what is PTH raised in osteomalacia and rickets
Raised ALP and PTH and decreased calcium and phosphate are incorrect as this is caused by osteomalacia/rickets. This is a condition characterised by impaired mineralization of bone and has several causes such as vitamin D deficiency, liver disease. PTH is raised in an attempt to increase calcium stores for bone mineralisation, leading to increased PTH and ALP.
difference between methotrexate and felty syndrome with blood results and splenomegaly or not
Felty’s syndrome is a condition characterized by splenomegaly and neutropenia in a patient with rheumatoid arthritis. Hypersplenism results in destruction of blood cells which classically results in neutropenia but can also cause pancytopenia.
methotrexate would not cause splenomegaly
long term steriod use what do you need to also be taking immediately
bisphosphonates
Start oral alendronate + ensure calcium and vitamin D replete
In newly-diagnosed active rheumatoid arthritis what should you tx with
with methotrexate (or sulfasalazine or leflunomide) and oral steroids.
Steroids (oral or intra-articular) can be used to alleviate flares, and patients are often also prescribed paracetamol for pain relief.
is obesity a risk factor for OP
no
malignant tumour that occurs most frequently in the diaphysis of the pelvis and long bones
ewings tumour - onion skin
chrondrosarcoma commonly affects where
axial skeleton - and in middle age people
osteoma are benign and commonly occur where
what condition are they associated with
skull
This condition is also classically associated with Gardner’s syndrome (a variant of familial adenomatous polyposis, FAP).
most common benign bone tumour.
cartilaged capped projection
Osteochondroma
osteosaroma associated with what gene
retinoblastoma gene (and hence retinoblastoma tumours).
why do you get a raised CK in polymyositiis and not polymyalgia rheumatica?
Further, as PMR does not cause muscle breakdown, it would not explain this patient’s raised creatine kinase.
how are chemo pts at increased risk of gout
Chemotherapy patients are at increased risk of gout from increased urate production
how do you manage acute flares of RA
Intramuscular steroids such as methylprednisolone are used to manage the acute flares of rheumatoid arthritis
Reactive arthritis: develops after an infection
where the organism cannot be recovered from the joint
bony outgrowths that occur in the distal interphalangeal joint in association with osteoarthritis
Heberden’s nodes
most commonly sprained ligament in inversion injuries of the ankle
anterior talofibular ligament
Paget’s disease of the bone is treated
bisphosphonates
isolated rise in ALP
You request an x-ray which shows a fracture of the distal radius with posterior displacement. The tip of the ulnar is also fractured.
colles
fever, polyarthralgia and rash
arthralgia
elevated serum ferritin
what could this be
Still’s disease, also known as adult-onset Still’s disease (AOSD), is a rare inflammatory disorder that causes fevers, joint pain, and a rash. It’s a more severe form of juvenile idiopathic arthritis (JIA), which affects children.
Fever/back pain with pain on extension of the hip
iliopsoas abscess
Chronic fatigue syndrome: the symptoms should be present for
3 months before dx then referral onto specialist chronic fatgiue syndrome service
