Rheumatology Flashcards
Paget’s disease of bone is treated by
bisphosphonate
Paget’s disease symptoms
the constellation of bony pain, unilateral hearing loss, and an isolated raised ALP should point you in the direction of Paget’s disease of the bone.
Investigations for paget’s
1-bloods
raised alkaline phosphatase (ALP)
calcium and phosphate are typically normal. Hypercalcaemia may occasionally occur with prolonged immobilisation
2-other markers of bone turnover include
procollagen type I N-terminal propeptide (PINP)
serum C-telopeptide (CTx)
urinary N-telopeptide (NTx)
urinary hydroxyproline
3-x-rays
plain radiographs are the first-line investigation and are usually diagnostic
osteolysis in early disease → mixed lytic/sclerotic lesions later
skull x-ray: thickened vault, osteoporosis circumscripta
4-bone scintigraphy
increased uptake is seen focally at the sites of active bone lesions
What condition is suggested by a swollen pale disc and blurred margins on fundoscopy?
Anterior ischemic optic neuropathy (AION)
AION is a sight-threatening condition that requires immediate treatment.
What association with a new headache is suspicious in AION?
Arteritic AION - giant cell arteritis (GCA)
GCA can lead to AION and is clinically significant.
What is the typical fundoscopy finding in AION?
Swollen, pale optic disc with blurred margins
These findings indicate the presence of AION.
What immediate treatment is required for AION?
High-dose corticosteroids
Corticosteroids help manage the inflammation in GCA-related AION.
What is the typical presentation of retinal artery occlusion?
Sudden painless loss of vision with retinal pallor and a ‘cherry-red spot’
Retinal artery occlusion is associated with cardiovascular risk factors.
What would fundoscopy show in retinal artery occlusion?
Retinal pallor, narrowing of the retinal arteries, and a ‘cherry-red spot’
These findings differentiate it from AION.
What are common symptoms preceding retinal detachment?
New floaters and flashing lights in peripheral vision
These symptoms often alert to the possibility of retinal detachment.
How does retinal detachment appear on fundoscopy?
Detachment is clearly visible
This distinguishes it from AION, which shows disc changes.
What findings on fundoscopy are associated with retinal vein occlusion?
Dilated, tortuous veins, ‘cotton wool spots’, and ‘flame haemorrhages’
These features are key indicators of retinal vein occlusion.
What is the typical presentation of vitreous hemorrhage on fundoscopy?
Presence of hemorrhage
The absence of hemorrhage in the case of AION helps differentiate the two conditions.
True or False: Retinal vein occlusion also presents with sudden painless loss of vision.
True
This symptom is common among various ocular conditions.
