Rheumatology

Question 1

Gout and its Risk factors

Answer 1

Crystal arthropathy characterised by high levels of Uric acid in the blood. Urate crystals deposit in the joints

Risk Factors:
Male 
Obese 
High meat diet 
Alcohol 
Diuretics 
CV or Kidney disease 
Family history

Question 2

Gout presentation

Answer 2

Single joint 
Acute 
Hot 
Swollen 
Painful 

Most typical joints affected are the base of the big toe, wrist and base of the thumb

Question 3

Gout diagnosis

Answer 3

Usually clinical or on aspiration. If gout aspiration will show needle shaped crystals.

X-ray
Joint space maintained
Lytic lesions
Punched out erosions

Question 4

Gout treatment

Answer 4

Acute treatment:
1st line - NSAIDs (Naproxen or Ibuprofen)
2nd line - Colchicine, used for people with renal impairment or heart disease.
3rd line - Steroids

Question 5

Swelling of the patella of often called housemaids knee or carpet layers knee

Answer 5

Pre-patellar bursitis

Question 6

Calcium and phosphate are normal in what disease?

Answer 6

Paget’s disease

Question 7

Osteoarthritis pathophysiology and RF’s

Answer 7

Combination of genetic factors and over use injury to the joint mainly in synovial joints.

RF
Obesity 
>age 
Occupation 
Trauma 
Female 
Family history

Question 8

Osteoarthritis presentation

Answer 8

Joint pain and stiffness which is worse with activity
Deformity - Herberdens nodes DIP and Bouchards nodes PIP
Instability
Reduced function

Question 9

Osteoarthritis LOSS

Answer 9

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchrondral cysts

Question 10

Osteoarthritis diagnosis and management

Answer 10

Diagnosis can be made if
> over 45
> Typical activity related pain
> No morning stiffness or lasting less than 30 minutes

Treatment
>Lifestyle 
>physio
>OT 
>Analgesia 
- Topical NSAID + Paracetamol 
- Oral NSAID + PPI if regular 
- Opiates used cautiously 
- Steroid injection 
- Joint replacement

Question 11

Crohn’s disease pathophysiology and RF’s

Answer 11

Crohn’s disease is an inflammatory bowel disease that causes damage and inflammation anywhere on the GI tract. It is a large and uncontrolled reaction to an infection. Crohn’s disease extended to the entire depth of the intestinal wall.

RF’s
Family history
Age - adolescent and between 20 - 30

Question 12

Crohn’s disease presentation

Answer 12

Abdo pain, mainly RLQ associated with ileum
Diarrhoea
Blood in stool
Malabsorption

The colon develops a cobblestone appearance

Question 13

Crohn’s disease

Answer 13

Anti inflammatories

Antibiotics

Question 14

Toxic mega colon

Answer 14

Occurs when swelling and inflammation spread to the deeper layers of your colon.

Presentation 
>sepsis 
>abdo swelling 
> fever 
>Tachycardia