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Finals > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What need to take alongside methotrexate

A

Folic acid- taken weekly at least 24 hours after methotrexate dose

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2
Q

What drugs avoid if on methotrexate

A

Trimethoprin and co-trimoxazole as increases risk of BM aplasia
Aspirin as increases risk of toxicity

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3
Q

Treatment of methotrxate toxicity

A

Folinic acid

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4
Q

Side effects of methotrexate

A

Myelosuppression
Liver fibrosis
Pulmonary fibrosis
Pneumonitis
Mucositis

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5
Q

Antibody for limited cutaneous systemic sclerosis

A

Anti-centromere

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6
Q

Antibody for diffuse cutaneous systemic sclerosis

A

Anti-scl-70

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7
Q

Rfx for pseudogout

A

Haemochromatosis
Hyperparathyroidism
Acromegaly
Wilsons

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8
Q

What are pseudogout crystals made of

A

Calcium pyrophosphate

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9
Q

Management of pseudogout

A

Do aspiration of fluid to exclude septic arthritis
NSAIDS
If severe can do intra-articular or oral steroids

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10
Q

Joint aspiration of pseudogout

A

Positive birefringence rhomboid shaped crystals

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11
Q

Reactive arthritis presentation

A

4 weeks post STI
Asymmetrical oligoarthritis of lower limbs
Urethritis
Conjunctivitis or anterior uveitis
Skin changes- circinate balanitis, keratoderma blenorrhagica

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12
Q

Skin changes in reactive arthritis

A

circinate balanitis
keratoderma blenorrhagica

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13
Q

Lateral epicondylitis presentation

A

Pain and tenderness over lateral epicondyle
Pain worse on extension of wrist against resistance with elbow extended or supination or wrist

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14
Q

When may not need a DEXA scan to diagnose osteoporosis

A

Someone aged over 75 with a fragility fracture

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15
Q

First line for osteoporosis

A

Alendronate and calcium/vitamin D supplements if intake not satisfactory

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16
Q

Management options for osteoporosis

A

All patients will receive a bisphosphonate and calcium/vitaminD replacement if intake not satisfactory. Women can start HRT if want
Second line options include other bisphosphonates- risedronate or etidronate
Third line options- strontium or raloxifene
4th line denosumab

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17
Q

If do not tolerate alendronate then what are second line bisphonates available

A

risedronate or etidronate
Have to have a lower T score to warrant (much stricter)

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18
Q

Third line options for osteoporosis

A

Raloxifene
Strontium ranelate

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19
Q

MOA of raloxifene

A

Selective oestrogen receptor modulator

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20
Q

Risks of raloxifene

A

Increased VTE risk

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21
Q

How is denosumab given

A

Subcut injection every 6 months

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22
Q

Which bones does pagets affect

A

Skull
Spine
Pelvis
Long bones

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23
Q

What causes a V shaped osteolytic lesion

A

Pagets

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24
Q

Typical presentation of pagets

A

Bone pain
Pathological fracture
Bossing of skull
Deafness

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25
Q

Complications of pagets

A

Deafness
Sarcoma
Fractures
High output heart failure

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26
Q

Management of pagets

A

Bisphosphonate

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27
Q

MOA of bisphosphonates

A

Inhibit osteoclasts

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28
Q

Side effects of bisphosphonates

A

Osteonecrosis of jaw
Oesophagitis if do not drink enough water
Acute phase reaction

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29
Q

What must do before giving bisphosphonate

A

Correct vitamin D or calcium deficiency

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30
Q

When is only time give calcium in osteoporosis

A

If not enough dietary intake

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31
Q

What should all patients with osteoarthritis do

A

Local muscle strengthening and weight loss

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32
Q

2nd line for osteoarthritis

A

Oral NSAID and PPI

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33
Q

What can be used if analgesia unsuccessful for OA

A

Intrarticular steroids injections

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34
Q

What is it after starting bisphosphonate develop fever, myalgia and N&V

A

Acute phase reaction- normal

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35
Q

What is main precipitating factor for polyarteritis nodosa

A

Hep B

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36
Q

PAN presentation

A

Fever
Weight loss
Renal failure signs
Livedo reticularis

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37
Q

Rfx for osteoporosis

A

CKD
Endocrine disorders- most
Cancer
Malabsorption

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38
Q

Non antibody blood findings of SLE

A

ESR up
CRP can be normal
Low complement levels in active disease

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39
Q

What gel and coombs is contact dermatitis

A

IV

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40
Q

Management of PMR

A

Prednisolone

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41
Q

What is response of PMR to prednisolone

A

Very good- if no response then consider other diagnoses

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42
Q

Presentation of PMR

A

Older demographic
Rapid onset within 1 month
Aching and morning stiffness in proximal limb muscles
(weakness not a sx)
Can also get depression, fatigue, low grae fever

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43
Q

Investigation results for PMR

A

ESR and inflam markers up
CK normal
EMG normal

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44
Q

What needs to be monitored when on hydroxychloroquine

A

Visual acuity as it causes retinopathy (bulls eye)

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45
Q

RA X ray findings

A

Periarticular erosions
Lossof joint space
Subluxation
Juxta articular osteoporosis

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46
Q

What must do if likely to take steroid over 3 months

A

Take a bisphsophonate

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47
Q

Main side effect of colchicine

A

Diarrhoea

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48
Q

Stills disease presentation

A

Cyclical fever worse in evening
Salmon pink rash
Lymphadenopathy

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49
Q

What is classical blood finding in stills disease

A

Raised ferritin

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50
Q

Which DMARDS can take in pregnancy

A

Hydroxychloroquine
Azathioprine
Sulfasalazine

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51
Q

What is bamboo sign seen in

A

Ank spond

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52
Q

Best rule out test for SLE

A

ANA

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53
Q

Management of discoid SLE

A

Topical steroid cream
2nd line- hydroxychloroquine

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54
Q

Management of reactive arthritis

A

Start NSAID and rheum referral

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55
Q

What must do in all cases of dermatomyositis or polymyositis

A

Do a malignancy screen

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56
Q

What is rash that spares nasolabial folds

A

Malar rash

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57
Q

What is seen on early x ray of ank spond

A

Evidence of sacroiliitis- subchondral erosions and sclerosis
Squaring of vertebrae

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58
Q

First line for ank spond

A

NSAID and regular- exercise like swimming
Physio also recommended

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59
Q

Presentation of psoriatic arthritis

A

Most common- symmetric polyarthritis similar to RA
Asymmetrical oligoarthritis affecting hands and feet
Sacroiliitis
DIP joint disease
Arthritis mutilans

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60
Q

What should be given to patients with persistent very severe ank spond

A

Anti-TNF such as adalimumab and etanercept

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61
Q

What is pencil and cup deformity seen on x ray in

A

Psoriatic arthritis- describes periarticular erosions

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62
Q

How do schobers test

A

Identify L5
Mark 10 cm above and below this point
Ask to bend forward and touch toes with straight knees
Remeasure distance between points and if doesnt increase by 5 then indicative of reduced lumbar flexion

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63
Q

What demotes a positive schobers

A

Less than 5cm

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64
Q

Extra articular features of psoriatic arthritis

A

Skin lesions
Enthesitis
Dactylitis
Nail changes

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65
Q

What is management of psoriatic arthritis

A

Managed by rheumatologist
If mild -NSAID
More moderate/severe then methotrexate
Can consider ustekinumab (IL-12 and IL-23) or secukinumab (IL-17)

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66
Q

What is the underlying pathophysiology in GCA retinopathy

A

Anterior ischaemic optic neuropathy

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67
Q

How does aspirate appear in RA

A

Yellow and cloudy

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68
Q

What is main Ig in breast milk

A

IgA

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69
Q

Most common causes of drug induced lupus

A

Procainamide
Hydralazine
Isoniazid
Phenytoin

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70
Q

How manage drug induced lupus

A

Stopping the drug normally eradicates sx

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71
Q

What is cause if develop tingling, muscle aches and N&V after starting a bisphosphonate

A

Underling vitamin D or calcium defic which has been exacerbated by taking bisphosphonate

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72
Q

What is the Z score from DEXA scan adjusted for

A

Age
Gender
Ethnicity

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73
Q

How differentiate pseudogout from gout on X ray

A

Chondrocalcinosis in pseudo
Also can see same changes as in OA

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74
Q

Most common site of septic arthritis in adults

A

Knee

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75
Q

How monitor RA treatment

A

CRP
Disease activity score- DAS28

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76
Q

What is first line for RA

A

DMARD and short course of bridging prednisolone due to DMARD taking time to taking effect

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77
Q

First line DMARD options for RA

A

Methotrexate
Sulfasazine
Leflunonamide

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78
Q

How manage a RA flare

A

IM methylprednisolone
OR
Oral corticosteroids

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79
Q

When can start biologics in RA

A

Failed response to 2 DMARDS

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80
Q

What biologics recommended currently for RA

A

TNF inhibitors
- etanercept
- infliximab
- adalimumab

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81
Q

How does methotrexate pneumonitis present

A

Fever
SOB
Cough

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82
Q

What HS type is SLE

A

III

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83
Q

Most common SE of bisphosphonates

A

Dyspepsia from oesophageal ulcers and oesophagitis

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84
Q

Skin features of dermatomyositis

A

Photosensitive rash
Heliotrope rash in periorbital area
Gottrons papules on extensor surface of hands

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85
Q

MOA of sulfasalazine

A

5-ASA

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86
Q

Side effects of sulfasalazine

A

Oligospermia
SJS
Pneumonitis

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87
Q

Management of raynauds

A

Refer to rheumatology
First line: CCB nifedipine

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88
Q

What can do if no response to nifedipine in raynauds

A

IV prostacyclin which can last weeks/months

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89
Q

What does T score of -2.5 mean

A

Bone density of 2.5 standard deviations below that of average healthy young adult

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90
Q

Management principles of SLE

A

NSAIDs
Sunblock

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91
Q

Management of SLE if internal organ involvement

A

Prednisolone
Cyclophosphamide

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92
Q

Gout X ray findings

A

Tophi
Joint effusion
Punched out erosions

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93
Q

X ray skull features in pagets

A

Thickening
Early on get lytic lesions these then develop into mixed lytic and sclerotic lesions

94
Q

What is the mutation in in marfans

A

Fibrillin

95
Q

Which wrist movements exacerbate lateral epicondylitis

A

Supination of wrist
Extension of wrist

96
Q

What do if biopsy for GCA negative

A

Continue steroids regardless

97
Q

How manage GCA

A

If eye involvement give IV methylprednisolone and then start high dose prednisolone
Oral prednisolone if no eye involvement
Do BEFORE biposy
Opthalmology review

98
Q

Counselling for taking of bisphosphonate

A

Swallow with lots of water
Take 30 mins before breakfast
Sit upright for 30 mins after taking
To avoid oesophageal reactions

99
Q

Complications of diffuse systemic sclerosis

A

Pulmonary fibrosis
Renal disease- severe glomerulonephritis with crises
Hypertension

100
Q

How manage renal disease in diffuse systemic sclerosis

A

ACEi

101
Q

How does osteomalacia present

A

Bone pain
Muscle tenderness
Proximal myopathy leading to waddling gait
Easy fractures

102
Q

Which muscles are involved in abduction of arm

A

First 20 degrees= supraspinatus
Next part= deltoid

103
Q

What is thromboprophylaxis used in anti-phospholipid syndrome

A

Primary prevention= low dose aspirin
Secondary prevention= lifelong warfarin

104
Q

What is affected in ehlers danlos syndrome

A

Type III collagen

105
Q

Features of ehlers danlos

A

Elastic, fragile skin
Joint hypermobility
Easy brusing
Aortic regurg, mitral valve prolapse
Sub arachnoid

106
Q

What is celecoxib

A

NSAID

107
Q

What type of WCC is seen in RA aspirate

A

Neutrophils

108
Q

Side effects of azathioprine

A

Bone marrow depression
Pancreatitis

109
Q

Features of SLE

A

General features
- fatigue
- fever
- mouth ulcers
- lymphadenopathy
MSK
- arthritis
Cardiovascular
- pericarditis
- myocarditis
Resp
- pleurisy
- fibrosis
Renal
- glomerulonephritis
- proteinuria
Neuropsych
- anxiety and depression
- psychosis

110
Q

Management of fibromyalgia

A

CBT
Aerobic exercise
Medications- amitriptylline, pregabalin, duloxetine

111
Q

Presentation of fibromyalgia

A

Chronic pain at multiple sites
Fatigue
Brain fog

112
Q

How diagnose fibromyalgia

A

Clinical diagnosis using america college of rheum criteria

113
Q

Eye complicatinos of RA

A

Keratoconjunctivitis sicca most common
Episcleritis and scleritis

114
Q

Cardiac risk of RA

A

Increased risk of IHD- similar to that of DM

115
Q

Start new drug and develop oral ulcers

A

Methotrexate due to mucositis

116
Q

How to tell if hip pain is referred from the lumbar spine

A

Positive femoral nerve stretch

117
Q

Most early x ray finding in RA

A

Juxta articular osteopenia/porosis

118
Q

What are syndesmophytes seen in

A

Ank spond

119
Q

If a young male presents with osteoporosis what is important to check

A

Testosterone

120
Q

What are the 2 types of raynauds

A

Raynauds disease (primary)
Raynauds phenomena (secondary)

121
Q

Typical presentation of primary raynauds disease

A

Women under 30
Bilateral disease

122
Q

Causes of secondary raynauds

A

Connective tissue diseases
Leukaemia

123
Q

What suggests secondary raynauds

A

Auto-antibodies
Rash
Unilateral
Ulcers
Arthritis

124
Q

Management of sjogrens

A

Symptomatically
- Artifical tears
- Can use pilocarpine to stimulate saliva production
Hydroxychloroquine if arthritis

125
Q

What connectie tissue diseases are associated with raynauds

A

Systemic sclerosis
RA
SLE
Sjogrens

126
Q

What is risk of sjogrens

A

Lymphoma

127
Q

Person on chemo develops acutely painful joint, most likely cause

A

Gout as chemo increases urate production

128
Q

What medication consider for housebound patients

A

Vitamin D

129
Q

X ray findings of osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral erosions

130
Q

Skin finding of behcets

A

Erythema nodosum

131
Q

Other than shoulders, where else does PMR affect

A

Hip girdle muscles

132
Q

Presentation of meralgia parasthetica

A

Burning sensation over antero-lateral aspect of thigh caused by compression of the lateral cutaneous nerve

133
Q

What nerve is affected in meralgia parasthetica

A

Lateral cutaneous nerve of thigh, comes straight off spinal chord

134
Q

How many different NSAIDs have to be on before trying a TNF alpha inhibitor for ank pond

A

2 12 weeks apart

135
Q

Arthritis with one very swollen finger

A

Psoriatic arthritis due to dactylitis

136
Q

When measure urate in a gout attack

A

2 weeks after inflammation settles as urate levels can be low, normal and high during an attack

137
Q

Poor prognostic factors in RA

A

Anti- CCP antibodies
Early erosions on X ray
RF positive
HLA DR4
Insidious onset
Extra articulate features like rheum nodules
Poor baseline at presentation

138
Q

What is most important investigation to monitor marfans

A

Echocardiogram to look for aortic root dilation as predisposes to aortic dissection

139
Q

Features of osteogenesis imperfecta

A

Pathological fractures
Blue sclera
Hearing loss from otosclerosis
Dental problems

140
Q

How can a RA flare present

A

Acute worsening of stiffness and pain
Fever
Malaise

141
Q

What does raised CRP in SLE suggest

A

Underlying infection

142
Q

Which DMARD causes a low sperm count

A

Sulfasalazine

143
Q

What is chronic fatigue syndrome

A

Where have excessive tiredness for over 3 months which is debilitating physically and mentally with no obvious cause

144
Q

Features of chronic fatigue syndrome

A

sleep problems, such as insomnia, hypersomnia, unrefreshing sleep
muscle and/or joint pains
headaches
painful lymph nodes without enlargement
sore throat
cognitive dysfunction- brain fog
physical or mental exertion makes symptoms worse
general malaise
dizziness
nausea
palpitations

145
Q

Management of chronic fatigue syndrome

A

Refer to CFS specialist for
- CBT
- exercise with expert
- energy management

146
Q

TB drug causing drug induced lupus

A

Isoniazid

147
Q

What investigation need to do prior to doing surgery on a RA patient

A

Cervical X rays to rule out atlanto-axial instability
If this was present could lead to cervical compression during ventilation

148
Q

Uses of denusomab

A

Osteoporosis
Prevention of fractures in bone mets

149
Q

Contraindications for bisphosphonates

A

Reflux
eGFR<30

150
Q

What can be used to prevent pathological fractures in bony mets

A

Bisphosphonates
Denusomab

151
Q

What is presentation of trochanteric bursitis

A

Pain and tenderness over lateral hip/upper thigh
Pain on resisted movement
Can’t lie on it while sleep
In people who overuse legs- runners
Also main demographic is 50-70 year old women

152
Q

X ray finding in psoriatic arthritis

A

Pencil in cup appearance
Periarticular erosions

153
Q

What is antisynthetase syndrome

A

Advanced myositis where get fibrosis of the lungs
Additionally can get scleroderma and raynauds

154
Q

Polyarthritis causes

A

SLE
RA
Seronegative spondyloarthropathies
Sarcoid
TB
HSP
Pseudogout

155
Q

Patient from subcontinent has 3 month history of fever, weight loss and polyarthritis

A

TB

156
Q

What are codmans triangle and sunburst appearance seen in

A

Osteosarcoma

157
Q

What is onion skin appearance on x ray

A

Ewings sarcoma

158
Q

Inheritance of marfans

A

AD

159
Q

Causes of dactylitis

A

SCD
Seronegative spondyloarthropathies
- reactive arthritis
- psoriatic arthritis

160
Q

Antibodies seen in myositis’

A

Anti-jo
ANA

161
Q

What is anti-scl 70 same as

A

Anti topoisomerase

162
Q

What is the management of reactive arthritis

A

Analgesia
If refractory use steroids
If persistent can use methotrexate and sulfasalazine

163
Q

What use for NSAID refractory reactive arthritis

A

Oral pred

164
Q

Which joints most commonly affected in OA of hands

A

Carpometacarpal
DIP

165
Q

Painful purple lesion on finger of someone with SLE

A

Oslers nodes

166
Q

Causes of osler nodes

A

SLE
Endocarditis
Gonorrhoea
Typhoid
Haemolytic anaemia

167
Q

Presentation of osler nodes

A

Painful purple nodes on fingers

168
Q

First line for RA

A

Methotrexate with bridging prednisolone

169
Q

Where do majority of shoulders dislocate

A

Anteriorly

170
Q

Management of shoulder dislocation

A

Reduction in all cases
If recent then can do without sedation/analgesia
If longer duration then may require analgesia/sedation

171
Q

Presentation of medial epicondylitis

A

Pain and tenderness in medial epicondyle
Symptoms worsened by wrist pronation and flexion
Numbness and tingling in 4th and 5th fingers as ulnar nerve compression

172
Q

Medial vs lateral epicondylitis

A

Medial- golfers elbow
Lateral- tennis elbow

173
Q

What is cubital tunnel syndrome

A

Compression of the ulnar nerve

174
Q

Presentation of cubital tunnel syndrome

A

Tingling in the 4th and 5th fingers
Worse when resting elbow on a surface

175
Q

What causes tingling/numbness in 4th and 5th fingers after resting elbow on a flat surface

A

Cubital tunnel syndrome

176
Q

Which movements exacerbate golfers elbow

A

Wrist flexion and pronation

177
Q

Differential for PMR where have shoulder pain and restricted movement

A

Supraspinatus tear

178
Q

Characteristics of spondyloarthropathies

A

Sacroiliitis
Large joint arthritis
Enthesisi
Iritis
Dactylitis

179
Q

Which organisms are associated with reactive arthritis

A

Shigella
Neisseria
Yersinia
Campylobacter
Chlamydia

180
Q

Which T-score reading is used for FRAX tool

A

Neck of femur reading

181
Q

Most specific antibody for SLE

A

Anti-dsDNA

182
Q

What use for osteoporosis if very low eGFR

A

Denosumab

183
Q

When can consider biologic for RA

A

Trialled at least 2 DMARDs and still have moderate disease activity

184
Q

Monitoring for methotrexate

A

FBC, U&Es and LFT every 3 months

185
Q

If no response to NSAIDs for ank spond what use

A

Adalimumab or secukinumab

186
Q

Dose of pred for PMR

A

15mg

187
Q

What imaging most indicated to confirm ank spond

A

MRI whole spine

188
Q

What needs to be given alongside allopurinol when start giving for gout prophylaxis

A

Low dose allopurinol alongside colchicine to prevent acute flares as allopurinol can precipitate attacks

189
Q

What measure when give allopurinol for gout prophylaxis

A

Urate levels

190
Q

Most important side effect to warn people about when starting allopurinol

A

Rash as very common cause of SJS

191
Q

What is alternative to allopurinol in prophylaxis

A

Febuxostat- also a xanthine oxidase inhibitor

192
Q

What medications may be used for fibromyalgia

A

Antidepressants
- fluoxetine
- amitryptylline
- duloxetine

193
Q

What biologics use for RA, alternatives to anti-TNF alpha

A

Anti-IL6
Jak inhibitor
Anti-CD20 (rituximab)

194
Q

What test for pre TNF a inhibitors

A

HIV
Hep B,C
TB

195
Q

If have anorexia, what is most likely to improve bone density

A

Putting on weight
Periods returning

196
Q

What happens when stop denosumab

A

Rebound increase in bone turnover

197
Q

What need to do for patients stopping denosumab

A

Give bisphosphonates as stopping associated with rebound increased bone turnover

198
Q

Markers of SLE disease activity

A

Dropping C3 and C4
Raising ESR
Raising dsDNA titre

199
Q

What is p-ANCA actually

A

Anti myeloperoxidase

200
Q

What is c-ANCA actually

A

Anti proteinase 3

201
Q

Significance of CRP in SLE vs RA

A

SLE- not indicator of disease activity, if raised likely to be infectious cause
RA- indicator of disease activity

202
Q

Stepped approach for OA

A

Topical NSAID
Oral NSAID with PPI
Avoid strong opiates but can use co-codamol if exacerbation
Intrarticular steroids
Joint replacement

203
Q

Ank spond associations

A

5 A’s
AV block
Apical fibrosis
Anterior uveitis
Aortic regurg
Anaemia of chronic disease

204
Q

Spirometry findings of ank spond

A

Restrictive- most typically due to kyphosis and not fibrosis as a late complication

205
Q

Extra presentations of ank spond

A

Plantar fasciitis
Vertebral fractures
Chest pain from inflammation from inflammed sternocostal joints
Dactylitis

206
Q

What is discoid lupus erythematosus

A

Chronic autoimmune skin condition which presents with inflammed, dry and scaly patches plus are highly photosensitive on the face and scalp

207
Q

Chronic effects of discoid lupus erythematosus

A

Scarring
Hyperpigmentation and hypopigmentation

208
Q

Complications of lupus

A

Infection risk
CVD risk
Anaemia- from haemolytic anaemia, ACD, kidney disease
Lupus nephritis
Pleuritis and pericarditis
Interstitial lung disease
Neuropsychiatric complications
VTE from recurrent miscarriage

209
Q

What is main course of SLE

A

Relapsing remitting

210
Q

Most common cause of death in SLE

A

CVD

211
Q

Management principles of SLE at all times

A

Hydroxychloroquine
Good sun protection

212
Q

Management of SLE relapses

A

Steroids
If more severe then DMARDS- methotrexate, mycophenolate motefil, cyclophosphamide
Biologics- rituximab, belimumab

213
Q

Sclerodactyly meaning

A

Skin tightening around hands which reduces movement and function

214
Q

How does calcinosis appear

A

White deposits under skin

215
Q

Consequence of oesophageal dysmobility in systemic sclerosis

A

Dysphagia
Acid reflux

216
Q

How manage GI problems in systemic sclerosis

A

PPIs for GORD
Metoclopramide helpful for dysphagia

217
Q

Management of systemic sclerosis

A

Principles around symptom control like CCB for raynauds, metoclopramide for dysmobility
If diffuse disease then consider DMARDs like methotrexate

218
Q

Principle drug management of pulmonary HTN

A

Bosentan- endothelin receptor antagonists

219
Q

Diagnosing GCA

A

ESR up
USS will show halo sign where occluded temporal artery
Biopsy diagnostic performed by vascular surgeons

220
Q

Management of myositis

A

Refer to rheumatology
- do malignancy screen in new cases
- corticosteroids first line

221
Q

Antibodies in APL

A

Lupus anticoagulant
Anti beta 2 glycoprotein I
Anti cardiolipin

222
Q

Investigations for sjogrens

A

Schirmers- hold paper under eyelid and assess moisture travel
Antibodies- anti Ro and La
Salivary gland biopsy may be used to confirm diagnosis but not necessary

223
Q

First, 2nd and third line for gout

A

1st Naproxen
2nd Colchicine
3rd Prednisolone

224
Q

When start allopurinol for gout prophylaxis

A

Do after even 1 attack
Start a few weeks after attack

225
Q

When taking a bisphosphonate when reassess need

A

3-5 years

226
Q

When encourage HRT for osteoporosis

A

If early menopause

227
Q

What are looser zones seen on x ray in

A

Osteomalacia

228
Q

Osteomalacia management

A

Just vit D- cholecalciferol

229
Q

First line imaging for ank spond

A

MRI whole spine

230
Q

What imaging use for RA

A

USS and MRI will demonstrate inflammation
X rays will show bony changes

Finals (29 decks)

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