roma Flashcards

Question

Frozen shoulder presentation

Answer 1

Unilateral pain and stiffness First pain followed by stiffness

Answer 2

positively birefringent rhomboid shaped crystals. Pseudogout, also known as calcium pyrophosphate deposition (CPPD) disease, is characterized by the presence of positively birefringent rhomboid shaped crystals in the joint fluid. These crystals are composed of calcium pyrophosphate dihydrate (CPPD) and can cause acute inflammation and pain in affected joint

Answer 3

Classic triad: fever/joint pain/restricted ROM Monoarticular usually Gonococcal arthritis is a variant Absence of fever not rule out SA Wbc count increased in synovial fluid analysis Arthrocentesis with synovial fluid analysis Xray of affected joint-might be normal

Answer 4

Postinfectious with chlamydia, ureaplasma, shigella, salmonella, campylobacter, yersinia 1-4 wks latency Oligoarthritis, asimetrik, acute onset Sacroilitis, enthesitis, dactylitis Conjunctivitis, urethritis, oral ulcers, aortic regurg, av block, pericarditis, diarrhea Dx: clinical diagnosis—stool culture, urethral swab, labs-cbc: wbc and platelets high, esr and crp high, gram stain and cultures might be negative but PCR would show for chylamydia and gonorrhea Tx: treat infection,nsaids first line-start high titrate down, steroids if nsaids contraindc, dmard if more than 6 months of ongoing symptoms-sulfasalazine/methotrexate

Answer 5

Juxtaarticular osteoporosis/osteopenia Swelling in small joints of hands

Answer 6

Early x-ray findings loss of joint space juxta-articular osteoporosis soft-tissue swelling periarticular erosions subluxation

Answer 7

T-score of -1.0 to -2.5 indicates osteopenia, and a T-score of -2.5 or lower indicates osteoporosis

Answer 8

Schober's test <5cm is suggestive of ankylosing spondylitis. This is an indication of reduced lumbar flexion.

Answer 9

Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis and cauda equina syndrome peripheral arthritis (25%, more common if female)

Answer 10

Testosterone Hypogonadism is a common cause of osteoporosis in men. It is classified either as hypergonadotropic (primary gonadal failure) or hypogonadotropic (secondary to a defect in the hypothalamic-pituitary axis) hypogonadism. The role of androgens on male bone metabolism is twofold. First, androgens stimulate bone formation during puberty. Second, androgens prevent bone resorption during and after puberty.

Answer 11

Acute management NSAIDs or colchicine are first-line the maximum dose of NSAID should be prescribed until 1-2 days after the symptoms have settled gastroprotection (e.g. a proton pump inhibitor) may also be indicated colchicine inhibits microtubule polymerization by binding to tubulin, interfering with mitosis. Also inhibits neutrophil motility and activity has a slower onset of action may be used with caution in renal impairment: the BNF advises to reduce the dose if eGFR is 10-50 ml/min and to avoid if eGFR < 10 ml/min BNF the main side-effect is diarrhoea oral steroids may be considered if NSAIDs and colchicine are contraindicated. a dose of prednisolone 15mg/day is usually used another option is intra-articular steroid injection if the patient is already taking allopurinol it should be continued Indications for urate-lowering therapy (ULT) the British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy to all patients after their first attack of gout ULT is particularly recommended if: >= 2 attacks in 12 months tophi renal disease uric acid renal stones prophylaxis if on cytotoxics or diuretics ULT- allopurinol is first-line initial dose of 100 mg od, with the dose titrated every few weeks to aim for a serum uric acid of < 360 µmol/l CKS a lower target uric acid level below 300 µmol/L may be considered for patients who have tophi, chronic gouty arthritis or continue to have ongoing frequent flares despite having a uric acid below 360 µmol/L a lower initial dose of allopurinol should be given if the patient has a reduced eGFR colchicine cover should be considered when starting allopurinol. NSAIDs can be used if colchicine cannot be tolerated. The BSR guidelines suggest this may need to be continued for 6 months the second-line agent when allopurinol is not tolerated or ineffective is febuxostat (also a xanthine oxidase inhibitor) in refractory cases other agents may be tried: uricase (urate oxidase) is an enzyme that catalyzes the conversion of urate to the degradation product allantoin. It is present in certain mammals but not humans in patients who have persistent symptomatic and severe gout despite the adequate use of urate-lowering therapy, pegloticase (polyethylene glycol modified mammalian uricase) can achieve rapid control of hyperuricemia. It is given as an infusion once every two weeks

Answer 12

Nifedipine

Answer 13

Ewing's sarcoma - malignant tumour that occurs most frequently in the diaphysis of the pelvis and long bones Onion skin appearance on xray Ews fli1 protein

Answer 14

most common benign bone tumour more in males, usually diagnosed in patients aged < 20 years cartilage-capped bony projection on the external surface of a bone

Answer 15

most common primary malignant bone tumour seen mainly in children and adolescents occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure, with 40% occuring in the femur, 20% in the tibia, and 10% in the humerus x-ray shows Codman triangle (from periosteal elevation) and 'sunburst' pattern mutation of the Rb gene significantly increases risk of osteosarcoma (hence association with retinoblastoma) other predisposing factors include Paget's disease of the bone and radiotherapy

Answer 16

malignant tumour of cartilage most commonly affects the axial skeleton more common in middle-age

Answer 17

benign 'overgrowth' of bone, most typically occuring on the skull associated with Gardner's syndrome (a variant of familial adenomatous polyposis, FAP)

Answer 18

tumour of multinucleated giant cells within a fibrous stroma peak incidence: 20-40 years occurs most frequently in the epiphyses of long bones X-ray shows a 'double bubble' or 'soap bubble' appearance

Answer 19

pyrazinamide and ethambutol can increase uric acid levels.

Answer 20

Anterior ischemic optic neuropathy accounts for the majority of ocular complications in temporal arteritis

Answer 21

Haemochromatosis is a risk factor for pseudogout Risk factors include haemochromatosis, hyperparathyroidism, hypophosphataemia, hypothyroidism and hypomagnesemia. Also old age is a big risk factor.

Answer 22

patients with Sjogren's syndrome have an increased risk of lymphoid malignancies.

Answer 23

Psoriatic arthritis due to periarticular erosions and bone resorption

Answer 24

Trimethoprim and co-trimoxazole, anti-folate antibiotics, should be avoided concurrently with methotrexate due to the risk of bone marrow aplasia

Answer 25

General features fatigue fever mouth ulcers lymphadenopathy Skin malar (butterfly) rash: spares nasolabial folds discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas. Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic photosensitivity Raynaud's phenomenon livedo reticularis non-scarring alopecia Musculoskeletal arthralgia non-erosive arthritis Cardiovascular pericarditis: the most common cardiac manifestation myocarditis Respiratory pleurisy fibrosing alveolitis Renal proteinuria glomerulonephritis (diffuse proliferative glomerulonephritis is the most common type) Neuropsychiatric anxiety and depression psychosis seizures

Answer 26

Ankylosing spondylitis