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Priority 1 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Investigations for Paget’s disease

A 
Raised ALP
Negative NM bone scan
Normal/high Ca
Normal phosphate
High urinary excretion of hydroxyproline
Urinalysis
XR
Bone isotopic scans
Bone biopsy
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2
Q

Management of maintenance in bone remodelling disease

A

Pain management
Physiotherapy
Ca and vitamin D supplements

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3
Q

Define remodelling disease

A

Excessive breakdown and formation of bone

Disorganised remodelling of bone

Unknown aetiology

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4
Q

Joints commonly affected in osteoarthritis

A 
DIPs - Heberden's nodes
1st CMC (base of thumb)
Hips
Knees
L/C spine
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5
Q

Signs and symptoms of osteoarthritis

A

Signs:
Swelling/deformity
Pain on palpation
Limited ROM in active motion
Pain limits passive movement (flexion and internal rotation)
Resisted movement fine but can be weakness if not used
Mild synovitis

Symptoms:
Pain
Crepitus
Gelling of joints
Stiffness
Bony tenderness
Mild swelling
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6
Q

Commonly affected sites in Paget’s disease

A

Spine, skull, pelvis, femur, tibia

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7
Q

Presentation of remodelling disease

A 
Mostly asymptomatic
Bone pain at rest (unusual)
Deformity
OA
Pathological fracture
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8
Q

Define osteomalacia

A

Loss of bone mineralisation

Quality of bone

Related to vitamin D deficiency

Bone softens due to inadequate deposits of calcium and phosphorus in bone matrix (mineralisation defect)

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9
Q

Define osteopetrosis

A

Hardening of bones
Increased sclerosis and obliteration of medullary canal
Decreased OC function
Failure of bone resorption

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10
Q

Risk factors for osteoporosis

A 
Family history
RA
Thyroid/liver disease
Spinal cord injury
Poor lifestyle/physical activity
Thyroid replacement
Corticosteroid use
Antacids
LT anticonvulsant use
Smoking and alcohol
Menopause
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11
Q

Primary aetiology of osteoarthritis

A 
Idiopathic
Wear and tear/trauma/high impact sports
Obesity
Occupation
Poor nutrition
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12
Q

Management of active bone remodelling disease

A

Short course of bisphosphonates
8wks of high dose risedronate, IV zoledronarte
Often induces sustained remission
Surgical management of fractures

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13
Q

Secondary aetiology of osteoarthritis

A

Pre-existing joint damage (gout)
Metabolic disease (haemochromatosis)
Systemic (haemophilia)
Genetics

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14
Q

Investigations for osteomalacia

A 
Low Ca
Low phosphate
Low vitamin D
Raised pH
X-ray/bone scans
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15
Q

Management of osteoporosis

A

Conservative:
Lifestyle, weight-bearing exercise, avoid smoking and alcohol

Medical:
Oestrogen replacement, Ca and Vitamin D replacement

Anti-resorptive:
Bisphosphonates, RANKL inhibitors, SERM (selective osterogen reuptake modulators
Anabolic synthetic PTH

Surgical:
Vertebroplasty, kyphoplasty

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16
Q

Pathophysiology of Paget’s disease

A

Bone is softer but thickened and liable to pathological fractures

17
Q

Osteomalacia vs Rickets

A

Similarities:
Skeletal pain, bony tenderness, fractures

Differences
Osteomalacia:
Waddling gait, hypotonia

Rickets:
Poor growth, ricketic rosary, Harrison’s groove

18
Q

Management of osteomalacia

A

Treat cause e.g. coeliac, hypo-phosphataemia and vit D supplements

19
Q

Causes of osteomalacia

A

Vitamin D deficiency (reduced intake and absorption, excess loss, metabolism defect - hereditary rickets, CKD, Fanconi)

Calcium deficiency

Phosphate deficiency

20
Q

Phases of remodelling disease

A

Lytic (OC resorption)

Mixed (resorption and formation)

Sclerotic (OB formation)

21
Q

Define osteoarthritis

A 
Progressive
Degenerative joint disease
Age related degeneration of articular cartilage 
Most common joint condition
3x more common in men
Typically >50s
22
Q

Define osteoporosis

A

Loss of bone density

Micro-architectural deterioration of bone tissue

Consequent increase in bone fragility and susceptibility to fracture

23
Q

Presentation of osteoporosis

A 
Silent disease
Kyphosis
Pathological fractures
Any low trauma fracture age >50 consider osteoporosis or bony mets
NOF fracture
Colles fracture
Vertebral collapse/compression fractures
24
Q

Causes of osteoporosis

A

Idiopathic:
Oestrogen decline, ageing, etc

Secondary:
Malabsorption disorders
Medications (steroids, phenytoin, heparin, aromatase inhibitors, androgen deprivation)
Rheumatology (RA, SLE, ankylosing spondylitis)
Organs (renal / liver disease)
Endocrinology (hyperparathyroidism, hyperthyroidism, premature menopause, DM, Cushing’s syndrome)
Malignancy (myeloma, lymphoma, leukaemia)

25
Q

4 signs on imaging in OA - LOSS

A

Loss of joint space
Osteophytes
Subchondral cyst (within bone)
Subchondral thickening/sclerosis (white line)

26
Q

FRAX tool score in osteoporosis

A

Low FRAX score:
Lifestyle changes + supplements and follow up in 5 years

Medium FRAX score :
DEXA scan

High FRAX/T score:
<2.5/fragility fracture
Pharmacological management

27
Q

Classification of osteoporosis

type 1 and type 2

A

Type 1:
Post menopausal - low oestrogen, loss of trabecular bone, accelerated bone loss

Type 2:
Senile, >70yrs, nutritional and decreased physical activity, loss of cortical and trabecular bone, non-accelerated bone loss

28
Q

DEXA scan in osteoporosis

A

T score:
SD the bone density is above or below the young normal mean bone mineral density from population of 20-30 years old Caucasian women (race and sex)

Z score:
SD the measurement is above or below the age, gender & ethnicity matched mineral bone density

29
Q

Management of osteopetrosis

A

Bone marrow transplantation

Calcitriol

30
Q

Presentation of osteomalacia

A 
Bone pain
Proximal
Weakness
Malaise
Deranged calcium
Deformity
Fracture
31
Q

Investigations for osteoporosis

A

Bloods (FBC, TFT, U&Es, vitamin D, bone profile, Ca)

Exclude multiple myeloma with blood and urine electrophoresis

32
Q

Management of osteoarthritis

A

Conservative:
RICE, lifestyle change, physio, quit smoking, weight loss, walking aids, hot water bottle

Medical:
Paracetamol +/- anti-inflammatory, topical capsaicin may help, steroid and LA injections, hyaluronic acid injections, beware GI bleeding and worsening asthma with NSAIDs

Surgical:
Replace joint
Other options:
osteotomy: realignment of joint by excision and fusion to stop pain

Excision:
Removal of joint without fusion

Arthroplasty:
Replacement of all or part of joint surface by an artificial material

33
Q

Investigations for osteoarthritis

A 
History 
Exam
Bloods (raised CRP)
X-ray (AP, lateral)
Arthoscopy

Priority 1 (17 decks)

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