rheumatology 1 Flashcards
malignant tumour that occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure
Radiographs classically show Codman triangle (a triangular area of new subperiosteal bone) with an associated sunburst appearance.
associated with retinoblastoma gene.
indicative of:
osteosarcoma
- malignant
malignant tumour of cartilage, which most commonly affects the axial skeleton and not the diaphysis of long bones. This type of tumour is also more common in middle-age.
chondrosarcoma
small round blue cell tumour.
seen mainly in children and adolescents.
occurs most frequently in pelvis and long bones. tends to cause severe pain.
x-ray shows ‘onion skin’ appearance
Ewing’s sarcoma
first line drug treatment for raynauds
nifedipine
- calcium channel blocker
NICE guidelines for management of osteoarthritis
paracetamol and topical NSAIDs are first line analgesics
second line: oral NSAIDs
first line investigation for rheumatoid arthritis?
rheumatoid factor antibody
if test negative then test for anti-CCP antibodies
what are syndesmophytes?
- calcifications inside a spinal ligament or of the annulus fibrosis
- seen in ankylosing spondylitis
68 y/o male
pc: painful swollen knee for weeks, no history of trauma
OE: moderately sized effusion
plain radiograph:
- some loss of joint space
- liner calcification of articular cartilage
indicative of:
psuedogout
- form of microcrystalline synovitis
- caused by deposition of calcium pyrophosphate dehydrate crystals in synovium
typically a young man who presents with lower back pain and stiffness of insidious onset
stiffness is usually worse in the morning and improves with exercise
the patient may
experience pain at night which improves on getting up
indicative of:
Ankylosing spondylitis
what does the T score in a DEXA scan show:
compares bone mass to young reference population
T score < -2.5 indicates treatment is advised to reduce risk of future fracture
- alendronate (oral bisphosphonate)
> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis
what does the Z score in a DEXA scan show:
compares bone mass to pee group i.e. same age, sex, ethnic group
typical picture of
- low serum calcium
- low serum phosphate
- raised ALP
- raised PTH
indicative of:
osteomalacia
- softening of bones due to severe vitamin D deficiency
Psuedogout notes
CPPD crystals (calcium pyrophosphate)
Chondrocalcinosis on Xray
Most common in larger joints
Positive birefringent, rhomboid shaped
Gout notes
Uric acid crystals
Most common in 1st MTP joint (podagra)
Negative birefringent, needle-shaped
which antibody has the highest sensitivity for detection of SLE?
99% of SLE patients are ANA positive
what is the treatment of choice for polymyalgia rheumatica?
prednisolone
notes:
typical presentation: morning stiffness in proximal limb muscles but in absence of weakness. Bloods may show increased ESR.
The following symptoms is indicative of what condition?
- proximal muscle weakness
- macular rash over back/shoulders
- violet periorbital rash
- red papules over extensor surfaces
Dermatomyositis. associated with ANA.
Which antibodies are associated with SLE?
Anti-dsDNA
SLE: non specific symptoms –> fatigue, fever, oral ulcers, joint pain and rash
What antibodies are associated with diffuse systemic sclerosis?
anti-scl-70
may present with proximal limb or trunk scleroderma
What is a pharmacological option for Raynaud’s phenomenom?
Calcium channel blocker e.g. nifedipine
works by causing vasodilation.
Raynauds is a vasoconstrictive response of the digital arteries and cutaneous arteriole to cold or emotional stress.
When should bisphosphonates be taken?
30 minutes before a meal
- to ensure adequate absorption
has the potential to cause oesophageal irritation. to reduce the risk of this patients should remain upright for 30 mins post administration
