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MSK + Rheumatology > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the name given to inflammation of an entire digit?

A

Dactylitis.

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2
Q

What is the approach used for managing trauma patients?

A

ATLS - treat the greatest threat to life first (ABCDE).

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3
Q

What is the physis?

A

The physis is the growth plate in paediatric bone.

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4
Q

What feature of paediatric bone means it can heal rapidly?

A

The thick periosteum.

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5
Q

Describe the 3 initial steps in the management of fractures.

A
  1. Reduce the fracture e.g. restore the length, alignment, rotation.
  2. Immobilise.
  3. Rehabilitate.
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6
Q

What is often the first line management option for paediatric fractures?

A

Non-operative management e.g. traction, casts, splints. This is because paediatric bone heals quickly due to the thick periosteum.

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7
Q

What can happen if the physis is damaged?

A

Physis damage -> growth arrest -> deformity.

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8
Q

What is the name of the classification used for fractures involving the physis?

A

Salter-Harris Fracture classification.

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9
Q

Salter-Harris Fracture classification: describe a type 1 fracture.

A

Transverse fracture through the growth plate.

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10
Q

Salter-Harris Fracture classification: describe a type 2 fracture.

A

A fracture through the growth plate and metaphysis.

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11
Q

Salter-Harris Fracture classification: describe a type 3 fracture.

A

A fracture through the growth plate and epiphysis.

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12
Q

Salter-Harris Fracture classification: describe a type 4 fracture.

A

A fracture through the metaphysis, physis and epiphysis. These fractures often need fixation.

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13
Q

Salter-Harris Fracture classification: describe a type 5 fracture.

A

Crush injury of growth plate! These fractures have a very poor prognosis and growth arrest is likely.

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14
Q

Give 2 ‘red flag’ signs of non-accidental injury in children.

A
  1. Long bone fracture in a child unable to walk.

2. Multiple bruises and fractures.

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15
Q

Describe the management for non-accidental injury in children.

A
  1. Admit the child!
  2. Skeletal survey.
  3. Referral to paediatric medics and safeguarding services.
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16
Q

What can cause a supracondylar fracture in children?

A

Falling on an outstretched hand.

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17
Q

What nerve might be affected in a supracondylar fracture?

A

The median nerve.

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18
Q

What is the treatment for a supracondylar fracture?

A

K-wires.

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19
Q

Give 5 potential complications of fractures.

A
  1. Open fractures.
  2. Neurovascular compromise.
  3. Mal union - bone heals with deformity.
  4. Non union - bone fails to heal.
  5. Compartment syndrome.
  6. Cast problems e.g. tightness, compartment syndrome, plaster burns/blisters.
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20
Q

What is the most serious complication of arthroplasty surgery?

A

Prosthetic joint infection.

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21
Q

Give 2 ways in which prosthetic joint infections can be prevented.

A
  1. Aseptic environment and laminar air flow.

2. Systemic prophylactic antibiotics.

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22
Q

What investigations might you do on someone who you suspect might have a prosthetic joint infection.

A
  1. Aspirate -> microbiology.
  2. Bloods for inflammatory markers and FBC.
  3. X-rays.
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23
Q

What are the three aims of treatment for prosthetic joint infections?

A
  1. Eradicate sepsis.
  2. Relieve pain.
  3. Restore function.
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24
Q

Prosthetic joint infections: what treatment might you choose for a patient that is unfit for surgery?

A

Antibiotic suppression.

25
Q

What is the gold standard treatment for prosthetic joint infections?

A

Exchange arthroplasty.

  • Radical debridement of all infected and dead tissue.
  • Systemic and local antibiotic cover.
  • Sufficient joint and soft tissue reconstruction.
26
Q

Name 2 NSAIDs.

A
  1. Ibuprofen.

2. Naproxen.

27
Q

Give 3 side effects of NSAIDs.

A
  1. Peptic ulcer disease.
  2. Renal failure.
  3. Increased risk of MI and CV disease.
28
Q

What can you do to reduce the risk of gastric ulcers and bleeding in someone taking NSAIDs?

A
  1. Co-prescribe PPI.

2. Prescribe low doses and short courses.

29
Q

Give 5 potential side effects of steroids.

A
  1. Diabetes.
  2. Muscle wasting.
  3. Osteoporosis.
  4. Fat redistribution.
  5. Skin atrophy.
  6. Hypertension.
  7. Acne.
  8. Infection risk.
30
Q

How do DMARDs work?

A

Non-specific inhibition of inflammatory cytokine cascade = reduced joint pain, stiffness and swelling.

31
Q

Give an example of a DMARD.

A

Methotrexate = gold standard.
Hydroxychloroquine.
Sulfasalazine.

32
Q

How often should methotrexate be taken?

A

Once weekly.

33
Q

Give 3 potential side effects of methotrexate.

A
  1. Bone marrow suppression.
  2. Abnormal liver enzymes.
  3. Nausea.
  4. Diarrhoea.
  5. Teratogenic.
34
Q

What can be co-prescribed with methotrexate to reduce the risk of side effects?

A

Folic acid.

35
Q

What are cytokines?

A

Short acting hormones.

36
Q

Name a TNF blocker.

A

Adalimumab.

37
Q

Name a monoclonal antibody that binds to CD20 on B cells.

A

Rituximab: binds to CD20 -> B cell depletion.

38
Q

Describe the mechanism of action of abatacept?

A

Inhibits T cell activation.

39
Q

With what disease would you associate the ‘pencil-in-cup erosion’ seen on a plain XR with?

A

Psoriatic arthritis.

40
Q

With what disease would you associate the Schirmer’s test?

A

Sjögren’s syndrome.

41
Q

You do some investigations on a 30 y/o woman who has presented with painful, red and swollen MCP and PIP joints. The XR shows swelling of soft tissues, deformity and loss of joint space. What auto-antibodies would you expect to see in the serum?

A

Anti-CCP and RF positive.

This patient has rheumatoid arthritis.

42
Q

How does alendronate work?

A

Alendronate reduces bone turnover by inhibiting osteoclast mediated bone resorption.

43
Q

What class of drug is alendronate?

A

Bisphosphonate.

44
Q

Name 2 drugs that act on the HMGCoA pathway.

A
  1. Bisphosphonates e.g. alendronate.

2. Statins e.g. simvastatin.

45
Q

What auto-antibodies are often present in people with RA?

A

RF and anti-CCP.

46
Q

A patient presents with an acute mono-arthropathy of their big toe. What investigations might you do?

A

Joint aspirate.

If septic arthritis - high WCC and neutrophilia and bacteria on gram stain.

If gout - urate crystals.

47
Q

What is polymyalgia rheumatica (PMR)?

A

A condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips

48
Q

What disease is giant cell arteritis associated with?

A

Polymyalgia rheumatica.

49
Q

What class of drugs can cause Raynaud’s?

A

Beta blockers.

50
Q

What class of drugs does Nifedipine fall into and why can it be used to treat Raynaud’s?

A

Nifedipine - CCB.

It relaxes blood vessels and stops vasospasm.

51
Q

What condition must be always ruled out in a acutely inflamed joint?

A

Septic arthritis.

Aspirate the joint!

52
Q

An elderly man presents with worsening bone pain and is found to have an enlarged and bowed tibia. What is the most likely diagnosis?

A

Paget’s disease of bone.

53
Q

What cells secrete RANK ligand?

A

Osteoblasts.

54
Q

What is the function of RANK ligand?

A

It binds to osteoclasts and is essential for their formation, function and survival.

55
Q

What protein inhibits RANK ligand?

A

OPG.

56
Q

What is the function of OPG?

A

OPG inhibits osteoclast formation, function and survival by binding RANK ligand; it prevents RANK ligand from binding to osteoclasts.

57
Q

What is the affect of unopposed RANK ligand?

A

Unopposed RANK ligand leads to increased bone loss. More osteoclasts are stimulated due to a lack of OPG.

58
Q

What enzyme, expressed by osteoclasts, is responsible for bone resorption?

A

Cathepsin K.

MSK + Rheumatology (22 decks)

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