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Med Student Finals > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Rheumatoid Arthritis

Functions of Synovium (4)

A

Maintenance of intact tissue surface
Lubrication of cartilage
Control of synovial fluid volume and composition (neutrophils in acute flares)
Nutrition of chondrocytes within joints

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2
Q

Rheumatoid Arthritis

Effect on joint (4)

A

Erosion into corner of bone
Thinning of cartilage
Inflamed tendon sheath
Inflamed synovium spreading across joint surface

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3
Q

Rheumatoid Arthritis

Definition (2)

A

A chronic symmetric polyarticular inflammatory joint disease
The rheumatoid synovial fluid contains neutrophils in acute flares and can cause bone and cartilage destruction

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4
Q

Rheumatoid Arthritis

Autoimmunity (4)

A

Evidence of autoimmunity can be present many years before onset of clinical arthritis
Autoantibodies such as RFs and anti-citrullinated protein antibodies are associated with RA
The autoantibodies recognise either joint antigens or systemic antigens
Autoantibodies activate a complement

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5
Q

Rheumatoid Arthritis

Cells involved in disease perpetuation (4)

A

Cytokine networks involving TNF-am IL-6 and B-cells participate in disease perpetuation
Osteoclasts and fibroblast-like synoviocytes mediate bone and cartilage destruction
Inflammatory cytokines promote angiogenesis and autoantibody production and activate leukocytes
IL-6 mediates systemic effects

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6
Q

Rheumatoid Arthritis

Signs + symptoms

A 
Typical presentation: symmetrical swollen, painful and stiff small joints, worse in morning and can fluctuate and effect larger joints 
Tenosynovitis/bursitis 
Later there is joint damage and deformity: ulnar deviation of fingers and dorsal wrist subluxation, Boutonniere and swan neck finger deformity or Z-deformity of thumbs 
Pain 
Immobility 
Stiffness 
Systemic symptoms 
Swelling 
Tenderness 
Redness 
Heat 
Limitation of movement
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7
Q 
Rheumatoid Arthritis
Systemic consequences (9)
A 
Vasculitis 
Nodules (elbows + lungs) 
Scleritis 
Raynaud's 
Carpal tunnel syndrome
Osteoporosis 
Amyloidosis 
Anaemia of chronic disease 
Increased risk of cardiovascular disease as atherosclerosis is accelerated
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8
Q

Rheumatoid Arthritis

Investigations (7)

A

Rheumatoid factor (+ve 70%)
Anticyclic citrullinated peptide (anti-CCP) highly specific (98%)
High platelets
High ESR
High CRP
X-ray (LESS)
Ultrasound and mRI better at identifying synovitis

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9
Q

Rheumatoid Arthritis

X-ray findings (4)

A

Loss of joint space
Erosions
Soft tissue swelling
Soft bones (osteopenia)

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10
Q

Rheumatoid Arthritis

Disease activity score (3)

A

DAS28 used to measure activity
Assesses tenderness and swelling at 28 joints, ESR and patient’s self-reported symptom severity
Aim to reduce score to <3

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11
Q

Rheumatoid Arthritis

Treatment (4)

A

Early use of DMARDs and biologics improves long-term outcomes
Steroids: rapidly reduce symptoms and inflammation
NSAIDs: good for symptom relief
Physio and OT

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12
Q

Rheumatoid Arthritis

DMARDs (4)

A

1st line
Take 6-12 weeks for symptomatic benefit
Eg. methotrexate, sulfasalazine, ,hydroxychloroquine
Causes: immunosuppression (can result in pancytopenia, increased susceptibility to infection and neutropenic sepsis so regular FBC monitoring required)

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13
Q

Rheumatoid Arthritis

Biologics (6)

A

1st anti-TNF adalimumab
Start biologics after failure, intolerance to at least 2 DMARDs
2nd ani-TNF infliximab, etanercept
3rd B cell depletion rituximab
4h anti IL-1 or IL-6 eg. tocilizumab (anti IL-6) or anakinra (anti IL-1)
5th T cell co-stimulator inhibitor eg. abatacept

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14
Q

Septic Arthritis

Routes of infection (3)

A

Haematogenous
Eruption of bone abscess
Direct invasion- penetrating wound, athroscopy, indwelling IV

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15
Q

Septic Arthritis

Organisms (4)

A

Staph aureus
Streptococci
Neisseria gonococcus
Gram -ve bacilli

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16
Q

Septic Arthritis

Pathology (3)

A

Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzymes
Complete destruction of articular cartilage

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17
Q 
Septic Arthritis 
Risk factors (8)
A 
Pre-existing joint disease (especially RA) 
Diabetes 
Immunocompromised 
Chronic renal failure 
Recent joint surgery 
Prosthetic joints 
IVDU 
Age >80
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18
Q

Septic Arthritis

Signs + symptoms (2)

A

Knee affected in >50% of cases

Acutely inflamed joint

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19
Q 
Septic Arthritis 
Differential diagnoses (4)
A

Acute osteomyelitis
Trauma
Rheumatic fever
Gout

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20
Q

Septic Arthritis

Investigations (4)

A

Urgent joint aspiration for synovial fluid microscopy and culture
X-ray (but may be normal)
CRP (but may be normal)
Blood cultures (guidance for antibiotics)

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21
Q

Septic Arthritis

Treatment (3)

A

Antibiotics: flucloxacillin/clindamycin , vancomycin if MRSA, cefotaxime if gonococcal or gram -ve
Antibiotics for 2 weeks IV, 2-4 weeks orally
Orthopaedics: arthocentesis, lavage and debridement

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22
Q

Ankylosing Spondylitis

Definition (3)

A

Seronegative arthritis
Chronic inflammatory disease of the spine and sacroiliac joints
Typical patient is a man <30

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23
Q

Ankylosing Spondylitis

Signs + symptoms (6)

A

Gradual onset of low back pain, worse at night, with spinal morning stiffness relieved by exercise
Pain radiates from sacroiliac joints to hips/buttocks and usually improves towards the end of the day
Associated with osteoporosis
Progressive loss of spinal movement, hence reduced thoracic expansion
Acute iritis in 1/3 and may lead to blindness
Enthesitis (inflammation of site of tendon/ligament insertion into bone): achilles tendonitis, plantar fasciitis

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24
Q

Ankylosing Spondylitis

Examination (3)

A

Schober’s test
Lateral neck flexion
Kyphosis

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25
Q

Ankylosing Spondylitis

Investigations (7)

A

MRI
X-ray: sacroiliitis earliest feature, erosions, sclerosis
Vertebral syndesmophytes (often T11-L1 initially): bony proliferations due to enthesitis between ligaments and vertebrae
FBC (normocytic anaemia)
High ESR
High CRP
HLA B27 +ve

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26
Q

Ankylosing Spondylitis

Treatment (6)

A

Physiotherapy to maintain posture and mobility
NSAIDs (ibuprofen/naproxen) to relieve symptoms
TNF-a blockers: adalimumab, etanercept ,infliximab
Local steroid injections for temporary relief
Surgery eg. hip replacement/spinal osteotomy
Consider bisphosphonates for increased risk of spinal fractures

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27
Q

Gout

Signs + symptoms (3)

A

Typically acute monoarthropathy with severe joint inflammation
>50% occur at MTP of big toe
Other common joints: ankle, foot, small joints of hand, wrist, elbow or knee

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28
Q

Gout

Pathology (4)

A

Caused by deposition of monosodium urate crystals in and near joints
Often precipitated by trauma, surgery, starvation, infection or diuretics
High plasma urate
In the long term, urate deposits (tophi eg. in pinna, tendons, joints) and renal disease (stones, interstitial nephritis) may occur

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29
Q 
Gout 
Differential diagnoses (4)
A

Septic arthritis
Haemarthrosis
Pseudogout
Palindromic RA

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30
Q

Gout

Aetiology (6)

A 
Hereditary 
High dietary purines 
Alcohol excess 
Diuretics 
Leukaemia 
Also associated with cardiovascular disease, hypertension,diabetes and chronic renal failure
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31
Q

Gout

Investigations (3)

A

Polarised light microscopy of synovial fluid: negatively bifringent urate crystals (needle-shaped)
Increased serum urate
Radiographs only show soft-tissue swelling in the early stages, later ‘punched out’ erosions in juxta-articular bone

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32
Q

Gout

Treatment of acute attack (3)

A

High-dose NSAIDs (symptoms should subside in 3-5 days)
Steroids may be used
Rest, ice and elevation

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33
Q

Gout

Treatment as prophylaxis (4)

A

Start if >1 attack in 12 months, tophi or renal stones
Aim is to reduce attacks and prevent damage caused by crystal deposition
Allopurinol (titrate up until plasma urate <0.3mmol/l)
Use of allopurinol may trigger an attack so wait until 3 weeks after an acute episode

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34
Q

Pseudogout

Signs + symptoms (2)

A

Acute monoarthropathy typically of larger joints in elderly patients
Usually spontaneous and self-limiting but can be provoked by illness, surgery or trauma

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35
Q 
Pseudogout 
Risk factors (3)
A

Old age
Hyperparathyroidism
Haemochromatosis

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36
Q 
Pseudogout 
Investigations (2)
A

Polarised light microscopy of synovial fluid shows weakly positive bifringent crystals (rhomboid shaped calcium pyrophosphate dihydrate crystals)
X-ray (soft tissue calcium deposits)

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37
Q 
Pseudogout 
Treatment (2)
A

Treatment of acute attack: cool packs, rest, aspiration and intra-articular steroids
Treatment as prophylaxis: NSAIDs may prevent acute attacks

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38
Q

Enteric Arthropathy

Associations (3)

A

Inflammatory bowel disease
GI bypass
Coeliac and Whipples disease

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39
Q

Enteric Arthropathy

Treatment (2)

A

Arthropathy often improves with the treatment of bowel symptoms
DMARDs for resistant cases

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40
Q

Psoriatic Arthritis

Epidemiology (1)

A

Occurs in 10-40% with psoriasis and can present before skin changes

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41
Q

Psoriatic Arthritis

Signs + symptoms (5)

A 
Symmetrical polyarthritis 
DIP joints 
Asymmetrical oligoarthritis 
Spinal (similar to ank spond) 
Thickened nails with pits/ridges
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42
Q

Psoriatic Arthritis

Investigations (1)

A

X-ray: erosive changes with deformity

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43
Q

Psoriatic Arthritis

Treatment (5)

A 
NSAIDs
DMARDs: methotrexate, sulfasalazine 
Biologics if failure or intolerance of at least 2 DMARDs 
Adalimumab 1st 
Then 2nd anti-TNF etnarcept/infliximab
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44
Q

Reactive Arthritis

Pathology (4)

A

Sterile arthritis
Typically affects lower limb
1-4 weeks after urethritis (chlamydia) or dysentery (campylobacter, salmonella)
May be chronic or relapsing

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45
Q

Reactive Arthritis

Extra-articular symptoms (3)

A

Iritis
Keratoderma blenorrhagia (brown plaques on soles and palms)
Mouth ulcers

46
Q

Reactive Arthritis

Investigations (4)

A

High ESR and CRP
Culture stool if diarrhoea
Infectious serology
Sexual health review

47
Q

Reactive Arthritis

Treatment (4)

A

NSAIDs
Local steroid injections
Consider sulfasalazine/methotrexate if symptoms >6 months
Treating the original infection may make little difference to arthritis

48
Q

Systemic Sclerosis

Definition (1)

A

Multisystem autoimmune condition, also known as scleroderma

49
Q

Systemic Sclerosis

Pathology (2)

A

Vascular features: widespread vascular damage involving small arteries, arterioles and capillaries, initial endothelial damage with release of cytokines causing vasoconstriction, the damage also produces widespread obliterative arterial lesions and subsequent chronic ischaemia
Fibrotic features: fibroblasts synthesis collagen, causing fibrosis in the lower dermis of the skin as well as the internal organs

50
Q

Systemic Sclerosis

Signs + symptoms (7)

A

Raynaud’s
Tight skin over face, small mouth and beaky nose
Telangiectasia
Oesophageal dysmotility/stricture
Intestinal malabsorption, hypomotility
Thickened skin
Lung disease (pulmonary hypertension in limited and pulmonary fibrosis in diffuse)

51
Q

Systemic Sclerosis

Limited cutaneous systemic sclerosis (4)

A

70% of cases
CREST: Calcinosis (subcutaneous tissues)< Raynaud’s, Esophageal dysmotility, Sclerodactyly (swollen tight digits)< Telangiectasia
Skin involvement is limited to the face, hands and feet
Pulmonary hypertension

52
Q

Systemic Sclerosis

Diffuse cutaneous systemic sclerosis (5)

A

30% of cases
Diffuse skin involvement
Raynaud’s
Early organ fibrosis (lung, cardiac, GI and renal) occurs with general symptoms of lethargy, anorexia and weight loss
Renal involvement can cause an acute hypertensive renal crisis

53
Q

Systemic Sclerosis

Investigations (9)

A

FBC: normocytic anaemia
U&E + creatinine: raised in AKI
Anticentromere antibodies (ACAs) associated with limited systemic sclerosis
Anti-Scl70 associated with diffuse systemic sclerosis
RhF +ve in 30%
ANA +ve in 95%
CXR + HRCT to investigate lung involvement
Barium swallow to investigate oesophageal dysmotility
Anti-Ro antibodies

54
Q

Systemic Sclerosis

Treatment (4)

A

Monitor BP and renal function (regular ACE-i reduces risk of renal crisis)
Raynaud’s: hand warmers, nifedipine or other oral vasodilators
Immunosuppression eg. cyclophosphamide
Moisturise affected skin

55
Q

Polymyositis

Definition (2)

A

Rare disorder of unknown cause

Inflammation of striated muscle, causing proximal muscle weakness

56
Q

Polymyositis

Signs + symptoms (7)

A 
Proximal muscle weakness 
Myalgia +/- arthralgia 
Dysphagia 
Dysphonia 
Respiratory weakness 
Fever
Malaise
57
Q

Polymyositis

Investigations (6)

A

Serum creatinine kinase elevated
Elevated ESR + CRP
Electromyography (EMG) shows fibrillation potentials
Muscle biopsy confirms diagnosis
MRI: muscle oedema and inflammation
Screen for malignancy (CX, mammography, pelvic/abdo US) as may be paraneoplastic phenomenon

58
Q

Polymyositis

Treatment (2)

A

Prednisolone

If resistant: azathioprine, methotrexate

59
Q

Dermatomyositis

Definition (1)

A

Polymyositis with skin involvement

60
Q

Dermatomyositis

Signs + symptoms (4)

A

Features of polymyositis
Macular rash
Lilac-purple (heliotrope) rash on eyelids often with oedema
Roughened red papules over knuckles

61
Q

Dermatomyositis

Investigations (5)

A 
High CK 
High ESR + CRP 
EMG shows fibrillation potentials 
Muscle biopsy 
Screen for malignancy
62
Q

Dermatomyositis

Treatment (3)

A

Prednisolone
If resistant: azathioprine, methotrexate
For skin: hydroxychloroquine or topical tacrolimus

63
Q

Systemic Lupus Erythematosus

Definition (2)

A

Multisystemic autoimmune disease in which autoantibodies are made against autoantigens eg. ANA
Much more common in women (particularly of child-bearing age)

64
Q

Systemic Lupus Erythematosus

Signs + symptoms (9)

A

Malar rash (butterfly)
Discoid rash (erythematous raised patches)
Photosensitivity
Oral ulcers
Non-erosive arthritis (>2 peripheral joints, similar to RA)
Serositis: pleuritis, pericarditis
Renal disorder: proteinuria, cellular casts
CNS disorder: seizures or psychosis
Haematological disorder: haemolytic anaemia or leukopenia or thrombocytopenia

65
Q

Systemic Lupus Erythematosus

Investigations (6)

A 
95% are ANA +ve
Anti-dsDNA (highly specific) 
40% are RF +ve 
Anti-Sm antibody 
Bloods: FBC, U&amp;E, LFT, CRP + urinalysis 
High ESR
66
Q

Systemic Lupus Erythematosus

Treatment (5)

A

Topical steroids for rashes
High factor sunblock creams
NSAIDs and hydroxychloroquine as maintenance for joint and skin symptoms
Azathioprine/methotrexate or low dose steroids
Severe: rituximab

67
Q

Vasculitis

Definition (2)

A

Inflammatory disorder of blood vessel walls, causing destruction (aneurysm/rupture) or stenosis
Can affect the vessels of any organ, presentation depends on which

68
Q

Vasculitis

Categories (5)

A

Large: giant cell arteritis , Takayasu’s arteritis
Medium: polyarteritis nodosa, Kawasaki disease
Small ANCA +ve: glomerulonephritis, Wegener’s granulomatosis
Small ANCA -ve: Henoch-Schonlein purpura, Goodpasture’s syndrome
Malignancy associated

69
Q

Vasculitis

Signs + symptoms (7)

A

Systemic: fever, malaise, weight loss, arthralgia
Skin: purpura, ulcers
Eyes: episcleritis, scleritis, visual loss
Pulmonary: haemoptysis, dyspnoea
Cardiac: angina/MI (coronary arteritis)
GI: pain/perforation
Renal: hypertension, haematuria, proteinuria, casts, renal failure

70
Q

Vasculitis

Investigations (6)

A 
High ESR 
High CRP 
ANCA (often +ve) 
High creatinine if renal failure 
Urinalysis: protein + haematuria 
Angiography +/- biopsy: diagnostic
71
Q

Vasculitis

Treatment (2)

A

Steroids

Azathioprine may be useful as steroid sparing

72
Q 
Fibromyalgia
Risk factors (5)
A 
Female (10:1 F:M) 
Middle aged 
Low household income 
Divorced 
Low educational status
73
Q

Fibromyalgia

Associations (4)

A

Chronic fatigue syndrome
IBS
Chronic headache syndromes
Found in 25% with RA, SLE, AS

74
Q

Fibromyalgia

Signs + symptoms (10)

A

Pain that is chronic (>3 months)
Pain that is widespread in the absence of inflammation
Pain on palpation of min. II/18 tender points, eg. suboccipital muscle insertions, post. greater trochanter
Morning stiffness
Fatigue
Poor concentration
Low mood
Sleep disturbance
Allodynia (pain in response to non-painful stimulus)
Hyperaesthesia (exaggerated perception of pain in response to a mildly painful stimulus)

75
Q

Fibromyalgia

Investigations (2)

A

All normal

Just exclude other causes of pain/fatigue eg. RA, vasculitis, hypothyroidism, myeloma

76
Q

Fibromyalgia

Treatment (5)

A

Education on coping strategies and inform about relapsing and remitting course
CBT
Long-term graded exercise programmes
No response to NSAIDs or steroids as no inflammation
Low dose TCAs (eg. amitriptyline/pregabilin) + tramadol

77
Q

Raynaud’s Syndrome

Definition (1)

A

Peripheral digit ischaemia due to paroxysmal vasospasm, precipitated by cold/emotion

78
Q

Raynaud’s Syndrome

Aetiology (8)

A 
Idiopathic- Raynaud's disease
Underlying cause- Raynaud's phenomenon 
Connective tissue disease- SLE, RA, systemic sclerosis, dermato/polymyositis
Occupational- vibrating tools 
Obstructive- obstruction, atheroma 
Blood- thrombocytosis, polycythaemia rubra vera 
Drugs- B blockers 
Hypothyroidism
79
Q

Raynaud’s Syndrome

Signs + symptoms (2)

A

Fingers/toes ache and change colour

Pale (ischaemia) –> blue (deoxygenation) –> red (reactive hyperaemia)

80
Q

Raynaud’s Syndrome

Investigations (1)

A

Rule out causes

81
Q

Raynaud’s Syndrome

Treatment (3)

A

Keep warm
Stop smoking
Nifedipine

82
Q

Sjogren’s Syndrome

Definition (3)

A

Chronic inflammatory autoimmune disorder
Primary: mostly females in 4th-5th decade
Secondary: associated with connective tissue disease such as RA, SLE, systemic sclerosis

83
Q

Sjogren’s Syndrome

Pathology (1)

A

Lymphocytic infiltration and fibrosis of exocrine glands, especially lacrimal and salivary glands

84
Q

Sjogren’s Syndrome

Signs + symptoms (10)

A 
Reduced tear production (dry eyes, keratoconjunctivitis sicca) 
Reduced salivation 
Parotid swelling 
Other glands affected causing vaginal dryness, dry cough, dysphagia 
Raynaud's 
Lymphadenopathy 
Vasculitis 
Peripheral neuropathy 
Fatigue
85
Q

Sjogren’s Syndrome

Investigations (5)

A 
Anti-Ro 
Anti-La 
ANA usually +ve 
RhF may be +ve 
Biopsy shows focal lymphocytic aggregation
86
Q

Sjogren’s Syndrome

Treatment (3)

A

Treat sicca symptoms eg. hypromellose (artificial tears), frequent drinks
NSAIDs + hydroxychloroquine for arthralgia
Immunosuppressants in severe systemic disease

87
Q

Juvenile Idiopathic Arthritis

Criteria for diagnosis (3)

A

Age of onset <16
Duration of disease >6 weeks
Presence of joint swelling or 2 of the following: painful/limited joint movement, tenderness, warmth

88
Q 
Juvenile Idiopathic Arthritis 
Clinical subtypes (3)
A 
Pauciaticular/oligoarticular (55%)- 4 or less joints 
Polyarticular (25%)- 5 or more joints 
Systemic onset (20%
89
Q

Juvenile Idiopathic Arthritis

Pauciarticular Type 1 (7)

A 
Always before age 5, peak 1-3
Girls:Boys 8:1
Presentation: limp rather than pain 
Mainly LL joints 
Knee > ankle > hand/elbow 
\+ve ANA in 40-75% 
Chronic uveitis in 20% of cases (95% if female <2 years), asymptomatic in 50%
90
Q

Juvenile Idiopathic Arthritis

Pauciarticular Type 2 (5)

A 
Age: after 8-9 
Girls:Boys 1:7 
Presentation: limp 
Mainly LL joints: knee, ankle, hip can be affected early 
Acute iridocyclitis in 10-20%
91
Q

Juvenile Idiopathic Arthritis

Pauciarticular Type 3 (6)

A 
Any age during childhood 
Girls:Boys 4:1 
Presentation: asymmetric UL + LL arthritis, dactylitis 
Chronic iridocyclitis in 10-20% 
Can be very destructive arthritis
Family history of psoriasis in 40%
92
Q

Juvenile Idiopathic Arthritis

Pauciarticular Extended Arthritis (1)

A

30% of those presenting with pauciarticular JIA can go on to develop more severe polyarticular course

93
Q

Juvenile Idiopathic Arthritis

Polyarticular Rheumatoid Factor -ve (4)

A

Any age, often early
Girls:Boys 9:1
Presentation: constitutional (fever, malaise), hepatosplenomegaly, anaemia, growth abnormalities
Symmetric large and small joints (knees, wrists, ankles, MCPs, PIPs, neck)

94
Q

Juvenile Idiopathic Arthritis

Polyarticular Rheumatoid Factor +ve (5)

A 
Late childhood 12-16 years 
Girls:Boys 7:1
Presentation: constitutional (fever, malaise, weight loss), anaemia, nodules 
Similar to adult RA 
Erosions on X-ray
95
Q 
Juvenile Idiopathic Arthritis 
Systemic Onset (6)
A

Most serious short and long term morbidity and mortality
Extra-articular features (fever in evenings but normal in morning, rash on trunk/thighs, lymph nodes, hepatosplenomegaly, abdo pain, pericarditis)
Arthritis only in 75% wtihin 3-12 months of onset of fever, effects wrists, knees, ankles, cervical spine, hips and TMJ
20% of JIA
Age: 4-6
AKA Still’s Disease

96
Q

Juvenile Idiopathic Arthritis

1st line therapy (2)

A

NSAIDs

Joint steroid injections

97
Q

Juvenile Idiopathic Arthritis

2nd line therapy (1)

A

Methotrexate

98
Q

Juvenile Idiopathic Arthritis

3rd line therapy (3)

A

Anti-TNFa (eg. adalimumab, infliximab)
Anti-IL-6 for systemic arthritis (eg. tocilizumab)
Anti IL-1 receptor for systemic (eg. anakinra)

99
Q 
Osteoporosis
Bone metabolism (7)
A

Continuous turnover of bone
Osteoblasts: bone building
Osteocytes: regulate osteoblasts + osteoclasts
Osteoclasts: bone resorption
Low extracellular Ca stimulates parathyroid hormone which promotes resorption
Vit D converted to calcitriol in response to elevated PTH
Calcitriol increases calcium absorption in the gut and kidneys, stimulates osteoclasts

100
Q

Osteoporosis

Epidemiology (1)

A

1/3F and 1/5M have an osteoporotic fracture at some point

101
Q

Osteoporosis

Aetiology (8)

A 
Age 
Hypothyroidism 
Hypo/hyperparathyroidism 
Cushings 
Malabsorption 
Myeloma 
Rheumatic diseases
Drugs (steroids, warfarin, PPIs)
102
Q 
Osteoporosis
Risk factors (6)
A 
Steroids 
RA 
Alcohol excess
Low BMI 
Smoking 
Premature menopause + early menarche
103
Q

Osteoporosis

Signs + symptoms (3)

A

Asymptomatic until fracture occurs
Fracture on low impact/minor trauma
Commonly fracture neck of femur if older or Colles fracture if younger/fitter

104
Q 
Osteoporosis
Differential diagnoses (2)
A

Osteomalacia

Myeloma

105
Q

Osteoporosis

Investigations (2)

A

DEXA scan hip and spine: T score based on bone mass, normal >-1, osteopenia -1 to -2.5, osteoporosis

106
Q

Osteoporosis

Treatment (7)

A

Fracture prevention if T score

107
Q

Polymyalgia Rheumatica

Epidemiology (2)

A

> 50 0

F:M 2:1

108
Q

Polymyalgia Rheumatica

Signs + Symptoms (6)

A 
Subacute (<2 weeks) onset 
Shoulder +/- pelvic girdle stiffness but no weakness
Anaemia 
Weight loss 
Fever 
Depression
109
Q

Polymyalgia Rheumatica

Investigations (2)

A

FBC: normochromic, normocytic anaemia
ESR: >50

110
Q 
Polymyalgia Rheumatica 
Differential diagnoses (3)
A

Recent onset RA
Hypothyroidism
Osteoarthritis

111
Q

Polymyalgia Rheumatica

Treatment (1)

A

Oral prednisolone with PPI and bisphosphonate as treatment is prolonged

Med Student Finals (23 decks)

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