Rheumatology

Question 1

Risk factors for septic arthritis

Answer 1

Joint prosthesis
Elderly >80yo
IVDU
Immunosuppression
Overlying skin infection
Pre-existing joint damage
Recent surgery/injection to joint
RA
DM

Question 2

Bacteria in septic arthritis

Answer 2

Staph aureus
Strep
Gonorrhoea
Pseudomonas
E coli

Question 3

Osteoarthritis symptoms

Answer 3

Stiffness in morning or after inactivity
Pain worsens with activity
Usually symmetrical joint involvement
Buckling of joints

Question 4

OA signs

Answer 4

DIPJ changes
-Heberden’s nodes
Bouchard’s nodes at PIPJ
Joint enlargement
Crepitus
Reduced ROM
Mild inflammation
Instability
Malalignment

Question 5

DMARD examples in order of use

Answer 5

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Ciclosporin
Azathioprine
Adalimumab
Infliximab

Question 6

Methotrexate SE and interactions

Answer 6

Nephrotoxic.
Mouth ulcers, nausea, hair loss, cytopenia, elevated LFTs, pneumonitis. TMP and cotrimox cause increase marrow aplasia. Avoid using together. Reduce alcohol. Teratogenic

Question 7

Sulfasalazine SE and interactions

Answer 7

Nausea, abdominal pain, skin rash, hair loss, cytopenia, elevated LFTs, agranulocytosis. Safe in pregnancy. Avoid with digoxin. Causes yellow discolouration of urine and tears

Question 8

Hydroxycloroquine SE and interactions

Answer 8

Photophobia and photosensitivity, blurred vision, rash

Question 9

Leflunomide SE

Answer 9

Weight loss
Rash/itch
Mouth ulcers
Cytpoenias
Elevated LFTs
GI disturbance
HA
HTN
Peripheral neuropathy
Pneumonitis
Interacts with other DMARDs eg methotrexate

Question 10

Scoring system for increased risk of gout

Answer 10

Male
Hx of similar
1st MTPJ
Maori or PI
Joint redness
HTN/cardiovascular disease
Onset <1 day
Elevated serum uric acid