Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

phase 2a > Rheumatology & MSK > Flashcards

Rheumatology & MSK Flashcards

1
Q

what is the most common arthritis?

A

osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

who gets osteoarthritis?

A 
older
females
overweight 
excessive joint use 
trauma/malalignment etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how do you end up with bony changes in osteoarthritis?

A

mechanical forces –> cartilege lost
cartilege loss = cytokines - TNFa, IL-1, NO
cytokines = cartilege cannot repair properly
loss of cartilege = bone rubbing on bone
reactive changes in bone, it is not designed to rub on bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

reactive changes you see in the bone in osteoarthritis?

A 
loss of joint space 
osteophytes 
sclerosis
subchondral cysts  
synovial hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is sclerosis in relation to arthritis?

A

thickening and widening of the bone at the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is an osteophyte?

A

an area of bone which has been reactively laid down in the wrong place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what joints might be affected in osteoarthritis? (give 5)

A 
those that are used a lot! 
knees
hips
sacro ileac
cervical spine 
wrist
carpmetacarpal - base of thumb 
DIP
PIP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how is the pain different in osteooarthritis vs inflammatory arthritis?

A

osteo - morning stiffness only lasting up to 15 mins, generally worsens throughout day
RA - - stiff for 30+ mins, better with use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

apart from pain, give 3 other clinical presentations of osteoarthritis?

A 
effusion 
crepitus 
pt reports the joint 'gives way'
tender to palpation 
deformity 
herbedens/bouchards nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are herbedens and bouchards nodes?

A 
soft tissue swellings on the fingers 
seen in the early stages of osteoarthritis
herbedens = DIP 
bouchards = PIP 
(HD AND BP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when would arthroscopy be indicated?

A

knee ‘locking’ indicates a loose body which can be removed (arthroscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

4 x ray changes typical of osteoarthritis?

A 
LOSS 
L - loss of joint space 
O - osteophytes 
S - subchondral sclerosis 
S - subchondral cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

some management options of osteoarthritis?

A 
physio
weight loss 
occupational therapy eg footwear, walking aid 
nsaid
opioid 
amytriptiline 
topical capsaicin 
steroid injection
hydroxychloroquine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what produces synovial fluid?

A

the synovial membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

typical patient with RA?

A

post menpausal woman
smoker
past infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the pathophysiology of RA?

A

a reaction to self antigens eg type II collagen, vimentin
= inflammation at the synovial membrane
= damage to soft tissue and cartilege
= damage to bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what joints are affected in RA?

A

small joints
symmetrical
hands, wrists & feet
not DIP or spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

if you were examining the hands of someone with RA give 5 things you might expect to see?

A 
DIP not affected 
hurts to squeeze the joints
joints are warm 
ulnar deviation 
cannot make a fist 
z thumb
swan neck deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

are there any systemic features of RA?

A 
myalgia, malaise and low grade fever, if the cytokines go around the body
Rheumatoid nodules - skin 
eye inflammation eg scleritis 
ihd/pericarditis 
lung inflam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

3 blood tests you could do if you suspect RA?

A

ESR/CRP
rheumatoid factor - low sensitivity and specificity
anti-CCP (anti- cyclic citrillunated peptide) - good specificity, sensitive enough to highlight the most severe disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

some bony changes you might see on x ray in RA?

A

you dont see bony changes on x ray immediately!
soft tissue swelling
periarticular ostoepenia (low bone density)
loss of joint space
subluxation
erosion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

3 drugs you could give in RA?

A 
Methotrexate 
sulphasalazine 
hydroxychloroquine 
infliximab 
short term NSAID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

who gets gout?

A 
men over 40 - esp diabetes, overweight, hypertension 
purine rich diet 
renal impairment 
IHD
diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what enzyme converts hypoxanthine to xanthine and xanthine to uric acid?

A

xanthine oxidase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what happens when urate crystals are deposited in the joint?
they activate phagocytes --> inflammation --> joint pain (gout)
26
give 2 causes of too much uric acid production, other than diet?
increased cell turnover, as in: - myeloproliferative disorders - psoriasis - tumour lysis syndrome
27
what drugs can impair uric acid excretion?
tacrolimus aspirin thiazides
28
which joint is most commonly affected in gout?
1st MTPJ (metatarsalphalyngeal joint) - big toe
29
how does gout present?
``` usually monoarticular - big toe/foot/ankle/knee sudden onset 1-3 weeks intense pain esp at night heat, swelling, redness stiffness ```
30
what do you see in the joint aspirate in gout?
needle shaped crystals | negatively birefringent
31
what do you see on an x ray in gout, how can you differentiate it from other arthritis?
joint effusion punched out lesions no loss of joint space no periarticular osteopenia
32
how do you manage acute gout?
nsaids, colchicine intrarticular steroid inj rest and elevate dont start allopurinol until the acute stage has finished
33
what drug is first line for maintaining remission of gout? what is the mechanism of action? 2 side effects?
allopurinol xanthine oxidase inhibitor, stops the conversion of purines to uric acid rash, headache, hypersensitivity
34
what is the second line treatment for gout, when should it not be used?
febuxostat | not for renal or hepatic impairment
35
what foods have high purines?
``` meat seafood alcohol beans/lentils mushrooms carbonated drinks / fructose ```
36
3 risk factors for pseudogout?
``` osteoarthritis age haemachromotosis high PTH low phosphate low magnesium hypothyroidism acromegaly illness surgery trauma ```
37
pseudogout is caused by crystals of ?
calcium pyrophosphate
38
what joints does pseudogout affect?
larger - knee/wrist/elbow/shoulder | symmetrical, if chronic
39
what kind of crystals do you see in the joint aspirate in pseudogout?
rhomboid shaped | positively birefringent
40
what might you see on the x ray of pseudogout?
chondrocalcinosis calcification of cartilege (neither is specific)
41
what is the management for pseudogout?
aspiration to relieve pain NSAID/colchicine/prednisolone to relieve pain hydroxychloroquine/methotrexate may help
42
some infections that commonly trigger reactive arthritis?
``` salmonella shigella yersinia enterocolitica chlamydia n. gonorrhoea (but more commonly causes gonococcal arthritis which is different) (STI or GI) e. coli (GI symptoms) EBV - rarely ```
43
what is the presentation of reactive arthritis?
'can't see, pee or climb a tree' conjunctivitis sterile urethritis arthritis
44
what is the arthritis like in reactive arthritis?
acute asymmetrical lower leg
45
some other things (apart from conjunctivitis, urethritis and arthritis) associated with reactive arthritis?
``` iritis keratoderma blenorrhagica - red pustules and brown scaly feet circinate balanitis enthesitis mouth ulcers ```
46
4 investigations you would do for ?reactive arthritis?
joint aspiration - to exclude septic arthritis and gout serology/stool culture/STI swab - to find infectious cause X ray - enthesitis, periosteal reaction CRP
47
Typical exam presentation for ankylosing spondylitis?
young male
48
what HLA is ankylosing spondylitis associated with?
hla b 27
49
explain the pathophysiology of ankylosing spondylitis?
inflammation in the anterior corners of the spine fat is laid down fat is replaced with bone (syndesmophites) joint fusion =stiffness
50
what joints does ankylosing spondylitis affect?
spine sacroiliac 1-3 joints asymetrical
51
what is the time course of ankylosing spondylitis?
at least 3 months | with flares/remitting
52
is there morning stiffness in ankylosing spondylitis?
yes
53
some presentations of ankylosing spondylitis? (4)
``` lower back or buttock pain vertebral fractures enthesitis dactylitis chest pain - costovertebral/costosternal joints eye inflammation kyphotic posture ```
54
what changes would you see on x ray in ankylosing spondylitis? (5)
``` bamboo spine fusion of facet joints squaring of vertebral bodies ossification syndesmophites subchondral sclerosis erosion ```
55
3 extra articular features of ankylosing spondylitis?
``` anterior uveitis weight loss fatigue anaemia pulmonary fibrosis aortitis ```
56
treatment for ankylosing spondylitis?
infliximab Nsaids steroids
57
osteomyelitis is?
infection of the bone
58
3 risk factors for osteomyelitis?
``` inflammatory arthritis sickle cell IVDU immunocomp diabetes prosthesis trauma ```
59
4 bacteria that commonly cause osteomyelitis?
staph aureus pseudomonas aeruginosa salmonella TB
60
what bacteria is particularly associated with osteomyelitis in sickle cell?
salmonella
61
how might contigious spread come about?
from infectious soft tissue, eg an ulcer
62
what are some features of chronic osteomyelitis, why do they happen?
sequestrum involcrums because there is necrosis and the osteoblasts try to remodel
63
what types of bones are normally affected by haematogenous osteomyelitis?
long bones in children | vertebrae in adults
64
what is the clinical presentation of osteomyelitis?
rigor, sweats, malaise and fever vertebral fractures lesions/fractures take ages to heal joint exudate - when infection has broken through the cortex
65
what is the gold standard investigation for osteomyelitis?
open bone biopsy - for culture and histology
66
what x ray changes would you see in osteomyelitis?
``` cortical erosion periosteal reaction lucency sclerosis sequestrae, involcrums ```
67
what can you see on mri and ct? - relating to rheumatology?
bone marrow inflammation
68
management for osteomyelitis? (3)
debridement abx analgaesia
69
2 differential diagnoses for osteomyelitis?
``` cellulitis charcot avascular necrosis gout fracture malignancy ```
70
what is septic arthritis?
infection of the joint
71
what bacteria commonly cause septic arthritis? (give 4)
``` staph aureus staph epidermis strep A/B/pneumoniae n. gonoorhoea pseudomonas e coli TB ```
72
what is the most common bacteria in septic arthritis?
staph aureus
73
what bacteria is often associated with prosthetics in septic arthritis?
staph epidermis
74
pseudomonas septic arthritis is usually seen in who?
elderly immunocomp IVDU
75
what joints are most commonly affected by septic arthritis?
knee hip shoulder
76
presentation of septic arthritis?
hot, tender, red, swollen very painful limited range of movement fever
77
3 investigations for septic arthritis?
arthrocentesis (joint aspiration) --> mc&s blood culture plain x ray
78
what investigation d you do if you suspect TB septic arthritis?
synovial biopsy
79
3 typical antibiotics for septic arthritis?
flucloxacillin clindamycin ciprofloxacin vancomycin
80
how does gonococcal arthritis present?
fever, arthritis, tendonitis multiple joints maculopapular pustular rash on palms + soles
81
how would an infected prosthetic joint present?
``` chronic low grade pain ever since it was done staph aureus/enterococci low esr, crp, normal wcc diagnosis - joint aspirate arthropathy (remove and replace) ```
82
the epidemiology of psoriatic arthritis?
10% pts with psoriasis within 10yrs of getting psoriasis typically middle aged
83
3 main patterns of psoriatic arthritis?
symmetrical polyarthritis - hands, wrists, ankles, DIP - women asymmetrical oligoarthritis - hands + feet spondyloarthritis - spine - men
84
is there morning stiffness in psoriatic arthritis?
yes
85
extra articular features of psoriatic arthritis?
``` psoriatic skin plaques pitting / onikolysis enthysitis conjuntivitis/uveitis aortitis ```
86
3 x ray features of psoriatic arthritis?
pencil in cup - due to central erosion of bone osteolysis fusion soft tissue swelling periostitis
87
what is ustekumab?
il-12, il-23 inhibitor biologic - used for inflam arthritis
88
what is the epidemiology of lupus?
women 15-30 african-carribean or asian
89
what genetic associations is there in lupus?
HLA DR2 HLA DR 3 complement C4 allele
90
what are the antibodies against in lupus?
ANA - anti nuclear antibody anti ds-DNA also sometimes phospholipids etc
91
what kind of hypersensitivity reaction is lupus? how is it mediated?
type 3 hypersensitivity | T, B, cells, ytokines and complement
92
some clinical presentations (5) of lupus?
malar erythromatous rash - 'butterfly' muscle & joint pain - arthritis is symmetrical and affects the tendons and ligaments more than the bone fatigue fever discoid/photosensitivity rash/lupus profundus alopecia raynauds nephritis pericarditis headache -- seizure -- mononeuropathy -- psychosis autoimmune haemolytic anaemia
93
what tests would you do for lupus?
ANA - non specific but negatively predictive anti DS DNA - more specific urinalysis for asymptomatic proteinuria complement (low) ESR high, CRP normal - in managed lupus. In a flare, CRP is also high
94
treatment of lupus? (5)
``` hydroxychloroquine methotrexate rituximab NSAIDs/steroids for short term warfarin - because antiphospholipid syndrome = greater risk of clotting manage triggers eg sunlight ```
95
what is osteoporosis?
low bone density | + architectural deficits in bone
96
5 risk factors for osteoporosis?
``` inflam arthritis / connective tissue dis IBD high PTH cushings low oestrogen/testosterone (low bodyweight/athlete/post menopausal) reduced skeletal loading fractures family history smoking/alcohol renal/liver failure ```
97
what is bone strength determined by?
bone mineral density (at its peak and the rate of loss) size quality - architecture/turnover/mineralisation
98
how does menopause affect osteoporosis?
oestrogen is supposed to restrict bone turnover with oestrogen gone there is more bone turnover cancellous bone is particularly affected
99
why do bones weaken with age? (what part of the bone is affected?)
there is a reduction in trabecular thickness and the number of trabeculae decrease
100
what system is used to predict the risk off osteoporotic fracture? what things does it consider?
FRAX | bmi, age, smoking, drugs, medical history
101
what is a DEXA scan?
dual energy x ray absorptiometry measures bone mineral density at most common fracture sites - hip, lumbar spine, distal radius t score - how different to a young healthy adult it is
102
what is osteopenia?
weakening of the bone, but not as much as osteoporosis
103
how does alendronate work?
-onate = bisphosphonate inhibit farnesyl phosphatase -- > osteoclast apoptosis
104
some treatments for osteoporosis? (4)
bisphosphonate eg alendronate HRT denosumab - RANK-L antibody - prevents osteoclast activation teriparatide - PTH analogue, decreases bone resorption raloxifene - stimulates oestrogen receptors on bone
105
primary bone tumours originate from the _____ tissue
mesenchymal
106
what is osteochondroma? 3 things to say
forms cartilege benign long bones of men under 25
107
what is osteosarcoma? 4
bone forming (produce osteoid) malignant in the young ALP will be raised, as osteoblast hyperactivity
108
what is a giant cell bone tumour?
malignant or benign osteoclasts after trauma
109
what is an osteoid osteoma?
``` benign bone forming osteoblasts disorganised blood vessels and trabeculae pain worse at night ```
110
what is a ewing sarcoma?
``` malignant bone marrow mesenchymal stem cells/neuroectodermal cells very young lamellated bone can compress nerves lytic bone lesions, onion skinning ```
111
chondrosarcoma?
forms cartilege old people chondrocytes
112
osteoblastoma?
benign bone forming axial skeleton can compress nerves
113
what kind of anaemia in myeloma?
microcytic
114
some presentations of a bone tumour? - 5
constant, non mechanical bone pain swelling fracture b symptoms - fever, night sweats, malaise avascular necrosis symptoms of nerve compression - numbness/weakness
115
serum ____ is high in secondary bone tumours
calcium
116
____ level is a marker of osteoBLAST activity?
ALP
117
do sclerotic or lytic lesions mean benign/malignant?
``` sclerotic = healed or benign lytic = malignant ```
118
what does the zone of transition tell you?
wide zone of transition - means there is poor definition of healthy | not healthy - so more likely to be malignant narrow zone of transmission does not always mean benign, beware of myeloma esp in old people
119
stages of the periosteal reaction and what they tell you about the tumour?
1. callus - slow growing 2. lamellated / onion skinning - slow growing but deffo a tumour - ewings 3. sunburst spicules, codmans triangle -- an aggressive tumour eg osteosarcoma
120
how to tell on an x ray if something if a tumour of bone or cartilege?
cartilege: popcorn stippling / rings and arcs eg chondrosarcoma bone: fluffy/trabecular
121
what other conditions is fibromyalgia associated with?
functional eg IBS, chronic fatigue | inflammatory eg RA, SLE
122
why may the pain signals be amplified in fibromyalgia?
high substance p | low 5ht
123
allodynia is ___
pain in response to a non painful stimulus
124
what is the pain like in fibromyalgia, what pattern of joints are affected?
widespread symmetrical above and below the waist morning stiffness
125
what do you need to remember to exclude in fibromyalgia?
osteoarthritis - probably not the same presentation hypothyroidism anything inflam - esr/crp lupus hypercalcaemia - would cause the same parasthesia
126
management of fibromyalgia?
amitriptyline duloxetine lifestyle
127
what is sjogrens syndrome?
secondary to RA anti-Ro and anti-La antibodies (anti-La is more specific) dry mucus membranes - eyes/mouth/vagina
128
what is osteomalacia?
'soft bone' due to defective mineralisation - eg low calcium
129
why is osteomalacia less common in the UK than it once was
used to be common because we have little sunlight in the UK | no foods are fortified with vit D
130
3 risk factors for osteomalacia?
``` lack of exposure to sunlight eg indoors, lots of clothing dark skin malabsorption eg IBD low dietary vit D, eg vegan kidney disease (they activate vit D) ```
131
in the skin, ________ (made from ________) is metabolised to vit D3, in the presence of _______
previt D3 cholesterol UVB
132
vit D is important for bones because ________
it is needed for the absorption of calcium and phosphate from the GI tract
133
in the ________, vit D3 is metabolised to _________
liver | calcidiol/25-hydroxyvitamin D
134
in the _______, _________ is metabolised to __________ (calcitriol)
kidney 25 hydroxyvitamin D 1,25-dihydroxyvitamin D
135
how does the body respond to low vit D?
there will be low calcium and phosphate (because vit D is needed to absorb them) so PTH is released PTH mobilises calcium from bones = bone weakness --> osteomalacia
136
what is ricketts?
osteomalacia in children, before the growth plates have fused
137
4 presentations of osteomalacia?
``` bone pain - esp hip/rib/pelvis/thigh/foot fractures muscle weakness/pain muscle spasm due to hypocalcaemia fatigue waddling gait - late sign ```
138
first line investigation for osteomalacia?
serum 25-hydroxyvit D
139
gold standard test for osteomalacia?
iliac bone biopsy with double tetracycline labelling
140
in osteomalacia ALP will be ..
high
141
what is the supplementary vitamin D (that you would give for osteomalacia) called?
cholecalciferol
142
what is spondylolithesis & lumbar spondylosis?
spondylolithesis = vertebrae slips out of place | lumbar spondylosis = damage to the intervertebral disk
143
what is facet joint syndrome? how does it develop? what position relieves it?
secondary to lumbar spondylosis joints become misaligned -- secondary osteoarthritis worse when bending backwards
144
what is fibrositic nodulosis?
tender nodules in the buttock
145
when does the pain happen if it is caused by mechanical lower back pain?
sudden onset worse in evening or on exercise no morning stiffness
146
when there is a visible muscle spasm in the lower back, the pain is generally better when..
sitting or lying
147
when would you do a spinal x ray in lower back pain?
``` when there is red flags eg nocturnal pain leg pain sphincter disturbance violent trauma ```
148
a differential for lower back pain with no obvious cause or red flags?
polymyalgia rheumatica -- muscle ache affecting the shoulders, arms, hips, neck will have a raised ESR
149
epidemiology of vasculitis?
50 + associated with polymyalgia & RA in general rare, GCA is the most common type
150
aetiology of vasculitis? 3
``` idiopathic autoimmune secondary to infection secondary to RA drugs ```
151
in GCA which layers of the artery are affected? what is the net effect of this?
tunica media + interna | inflammation = narrowing of lumen
152
what arteries are commonly affected in GCA?
common temporal (splits into frontal + temporal) linguinal / facial cilliary (to retina)
153
4 presentations of cranial GCA?
abrupt temporal unilateral headache changes to vision - amaurosis faux/diplopia/flashing lights scalp tenderness jaw claudication visible dilation of temporal artery on side of face
154
presentation of non temporal GCA? 3
polymyalgia chronic low grade fever/malaise limb claudication
155
what is the gold standard investigation for cranial GCA? | what other imaging could you use?
temporal artery biopsy (you see giant multinucleated cells) duplex temporal artery ultrasound - halo sign + inflammation
156
how could you image for systemic / non cranial vasculitis?
PET-CT using a glucose tracer
157
what blood tests results would you see in vasculitis?
raised ESR normocytic anaemia thrombocytosis raised ALP
158
treatment for GCA
initially - iv prednisolone wean off steroids after 1-2 yrs methotrexate or tocilizumab if steroids not tolerated
159
what size vessels does ANCA vasculitis affect?
small
160
what are the two ANCA associated vasculitides?
p-ANCA: microscopic polyangiitis, eosinophillic, UC, primary schlerosing cholangitis c-ANCA: granulomatosis with polyangiitis (aka wegeners)
161
some general features of all vasculitis? 4
``` pain purpura HTN neuropathy fever weight loss ```
162
what is an intervertebral disk made up of?
outer fibrous : annulus fibrosis | inner gel like : nucleus propulsus. becomes dehydrated over time
163
what part of the spine is usually affected by vertebral disk degeneration?
lumbar
164
how does vertebral disk degeneration present?
``` shooting pain sudden onset radiates to arms/legs muscle spasm tingling / parasthesia / numbnesss ```
165
two types of surgery for prolapsed vertebral disks?
corpectomy | discectomy
166
what is pagets disease of the bone?
excessive activity of osteoblasts and osteoclasts
167
what is the epidemiology of pagets?
over 40 triggered by infection genetic link
168
3 phases of pagets disease?
1. lytic: osteoclasts -- low density bone 2. lytic + blastic -- patchy lysis and sclerosis 3. blastic (latent) - osteoblasts lay down weak new bone
169
clinical presentation of pagets?
generalised bone pain fracture deformity hearing loss
170
what do you see on x ray in pagets? 3
cotton wool skull lysis (osteolysis circumscripta) + sclerosis big bones v shaped defects in long bones
171
treatment for pagets?
bisphosphonate eg allendronate
172
what do you need to give alongside bisphosphonates? how do they need to be taken?
calcium/vit D supplement once a week sitting upright empty stomach
173
3 drugs that can cause drug induced lupus?
isoniazid procainamide hydralazine
174
what antibiotics interact with methotrexate to cause pancytopenia?
trimethoprim because they are both anti folate drugs (they both have meth in) they also compete for renal excretion
175
some presentations of granulomatosis with polyangiitis?
``` upper and lower resp tract - granulomas in lungs - haemoptysis - saddle nose glomerulonephritis weight loss/night sweats coagulopathy PE mitral stenosis pulm hypertension conjunctivitis ```
176
what colour are the fingers in raynauds?
white -- blue -- red
177
what are some causes of secondary raynauds? | what features distinguish secondary raynauds from primary?
lupus, drugs, trauma | red marks on the nail bed, asymmetrical - suggestive of secondary
178
what fbc results would you expect in lupus?
low WCC low platelet (antiphospholipid syndrome = increased clotting but not because of platelets)
179
what blood test results would you see in pagets?
raised ALP | normal calcium, phosphate, PTH, etc
179
what blood test results would you see in pagets?
raised ALP | normal calcium, phosphate, PTH, etc
180
symptoms of L4 (L3-L4) lesion?
thigh to calf pain | loss of knee jerk
181
symptoms of L5 (L4-L5) lesion?
weak dorsiflexion | buttock to foot pain
182
symptoms of L1 lesion?
sciatic pain buttock to ankle pain loss of ankle jerk
183
what is a normal/osteopenic/osteoporotic T score?
``` osteosclerosis = 2.5 or more normal = 1 - -1 osteopenia = -1 or less osteoporosis = -2.5 severe osteoporosis = -2.5 or less + silly fracture ```
184
what does schoberg's test measure, what diagnosis is a positive result associated with?
spine mobility | ankylosing spondylitis
185
presentation of antiphospholipid syndrome?
``` CLOT C - coagulopathy - raised APTT normal PT L - livedo reticularis - red/blue skin O - obstretic problems eg miscarriage T - thrombocytopenia can be primary, or secondar, eg to lupus (also non infective endocarditis) ```
186
risk factors for osteoporosis?
``` S - steroid H - hyperthyroid, hyperparathyroid A - alcohol, smoking T - thin T - testosterone decrease E - early menopause R - renal/liver failure (less vit D activation) E - erosive bone dis D - diet/diabetes ```
187
'hidden' places where you may find psoriasis?
scalp behind ears genitals
188
which primary cancers are most likely to metastasise to bone?
breast/prostate lung kidney (renal cell carcinoma) thyroid
189
what blood test is used to monitor lupus?
ESR
190
what antibodies are there in anti phospholipid syndrome?
anti cardiolipin - also in syphilis lupus anticoagulant anti beta 2 Glyco Protein 1 = hypercoagulable state
191
microscopic polyangiitis affects only the
kidney and lung
192
eosinophilic granulomatosis presents similarly to
allergy | asthma
193
Henoch-Schoenlein purpura
rash abdo pain glomerulonephritis arthritis/arthralgia
194
what is a swan neck deformity?
hyperextension of PIP | hyperflexion of DIP
195
what is burronaires deformity?
feature of RA hyperflexion of PIP hyperextension of DIP
196
explain how to do Schober's test?
``` have the patient stand locate L5 vertebrae mark a point 10cm above and 5cm below as pt to bend over as far s they can measure the new distance less than 20cm is positive for AS ```
197
how are asthma attacks categorised according to severity? (for people aged 12+)
moderate = peak flow below 75% acute severe = peak flow below 50%, resp 25+, pulse 110, accessory muscle use, or unable to complete sentence life threatening: peak flow below 33%, sats less than 92%, confused, or silent chest
198
what is acute severe asthma in a child 5-12?
resp rate 30 | pulse 125
199
what is acute severe asthma in child 2-5 yrs?
resp rate 40 | pulse 140

phase 2a (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions