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acute joint pain and swelling
.
115
Medical
Undergraduate 4
05/23/2017

Additional Medical Flashcards

 


 

Cards

Term
< 5 joint involvement is known as?
Definition
oligoarthritis

>5 joint is polyarthritis
Term
examples of monoarthritis?
Definition
septic
crystal
OA
trauma e.g haemarthroses
Term
examples of polyarthritis?
Definition
RA
OA
viral e.g hep A/B/C and mumps

reactive and psoriatic arthritis
Term
examples of oligoarthritis?
Definition
ank spond
reactive
psoriatic
crystal
OA
Term
if you were aspirating a joint what would you ix for?

could you aspirate through a psoriatic plaque?
Definition
WCC
culture
gram stain
polarised light


no you should aspirate through inflamed skin such as a psoriatic plaque
Term
features of OA on xray

LOSS

subarticular sclerosis) hard one to remember
Definition
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis
Term
features of RA on xray

remember: Just JLS
Definition
Juxta articular osteopenia
Loss of joint space
Soft tissue swelling
Joint deformity
Term
features of gout on XRAY?

PNS
Definition
periarticular erosions
normal joint space
soft tissue swelling
Term
which one out of the following 3 has normal joint space on xray?

OA
RA
gout?
Definition
gout

features are:-

periarticular erosions
normal joint space
soft tissue swelling
Term
what features on xray would you see in psuedogout?
Definition
chondrocalcinosis.
Term
mx of OA
Definition
exercise to improve muscle strength
weight loss if obese
paracetamol and topical NSAIDs: if ineffective use codeine short term or PO NSAID + PPI
topical capsaisin
severe: intra articular steroid

non pharmacological: physio, heat/cold packs, walking aids, stretching, manipulation, TENS
Term
definitive way to manage OA?
Definition
surgery and joint replacement
Term
if pt takes aspirin and has OA which drugs should be avoided?
Definition
PO NSAIDs and COX 2 inhibitors
Term
which is the most common surgical procedure for OA of hip?
Definition
cemented hip replacement
Term
post advice for pts undergoing hip surgery for OA
Definition
sleep on back for 1st 6 weeks
do not cross legs
avoid low chairs
avoid felxing hip > 90 degrees
Term
how long should you take LMWH after a hip op?
Definition
4 weeks
Term
what happens to pain stiffness with use of muscles in OA and RA?
Definition
in OA rest improves pain
in RA stiffness improves on movement.
Term
which joint is affected in more than 50% cases of septic arthritis?
Definition
the knee.
Term
risk factors for septic arthritis
Definition
immunocompromised
DM
age > 80
prosthetic joints
pre existing joint disease
recent joint surgery
IVDU
Term
treat for septic arthritis caused by staph aureus?
Definition
Flucoxicillin 1g/6hours IV
if allergic to penicillin then give

Clindamycin
Term
pt has septic arthritis and hx of MRSA. Which ABx would you give?
Definition
Vancomycin 1g/12hour IV
Term
which antibx in gonoccocal or gram neg septic arthritis?
Definition
Cefotaxime 1g/8hours IV
Term
which HLAs are involved in RA?
Definition
HLA DR4 and HLA DR1

whats the 41?
Term
frozen shoulder, carpal tunnel and de quervains tenosynotvitis are soft tissue problems associated with which disease? OA or RA?
Definition
RA
Term
ulnar deviation of fingers is a late sing in which condition?
Definition
RA
Term
where are Heberdons nodes found?
Definition
on DIP

bouchards on PIP
Term
seen in RA, this syndrome is characterised by

splenomegaly
neutropenia and
RA

what is it?
Definition
felty's syndrome
Term
which scans are better at detecting synovitis, effusions than conventional exrays?
Definition
USS
MRI
Term
how is disease activity measured in RA?
Definition
DAS28 score.

the aim is to keep the score < 3
Term
what is accelerated in RA that results in increased risk of CVS and CVA?
Definition
atherosclerosis

also smoking increases symptoms of RA
Term
what name is given when gout affects big toe?
Definition
Podagra - lol
Term
you see needle shaped negative bifringent urate crystals under polarised light. what are you thinking?
Definition
gout
Term
mx of gout
Definition
high dose NSAIDS or COXIBS should subside symptoms in 3-5 days

if these are CI e.g HF, peptic ulcer, anticoagulation use colchicine
Term
in acute mx of gout why might NSAIDS or COXIBS be CI?

what should be used instead?
Definition
CI in HF, peptic ulcer or anticoagulation

use colchicine instead
Term
what is problematic in renal failure and gout?
Definition
use of NSAIDS and colchicine. in this case steroids may be used.

rest and elevation also advised +/- ice packs
Term
when would you start prophylaxis rx with allopurinol?
Definition
if the pt has had >1 attack of gout in 12 months

do not use in acute attacks but 3 weeks after you may start
Term
when might Febuxostat be used?
Definition
prophylaxis of Gout when allopurinol is CI or not tolerated

SE: increased LFTs
Term
features and mx of psuedogout
Definition
risk factors: old age, hyperparathyroid, hypophosphatemia, haemochormotosis

mx: ice pack, rest, intra articular steroids, cochicine nsaids in acute

chornic mx: MTX and hydroxychloroquine have a role

XRAY: soft tissue calcium deposition

tests: positively bifringement rhomboid shaped
Term
features of spondyloarthropathies
Definition
seronegative
rf negative
HLA B27
axial arthritis
extra articular manifestations
Term
earliest xray feature of ank spond?
Definition
sacroilliitis

bamboo spine is a late sign
Term
mx of Ank spond
Definition
vigourous exercise, not rest. plus physio for posture
NSAIDs if not CI

severe activie disease: TNF alpha blockers
local steroid injections
surgery e.g. hip replacement

consider bisphosphonates due to risk of osteoporotic spinal fractures.
Term
signs of worse prognosis in ankylosing spondylitis?
Definition
ESR > 30
onset < 16 years
early hip involvement
poor response to NSAIDs
Term
in which type of arthritis may you see pencil in cup deformity?
Definition
psoriatic
Term
mx of psoriatic arthritis?
Definition
NSAIDS
sulfasalazine
MTX
ciclosporin
anti TNF agents
Term
associated features of reactive arthritis?
Definition
iritis
keratoderma blenorrhagica
circinate balanitis
mouth ulcers
enthesitis
Term
mx of reactive arthritis?
Definition
no cure
splint affected joints
rx NSAIDs or local steroid injections
if symptoms >6 months consider sulfasalazine or MTX
Term
anticentromere Antibodies found in diffuse cutaneous disease?
Definition
FALSE!!

found in limited cutaneous disease

in diffuse cutaneous disease it is SCL-70 antibodies
Term
in CREST syndrome where may HTN present sub clinically?
Definition
pulmonary HTN
Term
shawl sign is a rash ove rthe back and should found in which condition?
Definition
dermatomyositis

also Gottrons papules, these are roughened papules over the knuckles
Term
pathognomonic signs of dermatomyositis?
Definition
shawl sign positive
Gottrons papules along with raised CK
Term
which Antibodies seen in SLE?
Definition
anti nuclear antibodies
anti dsDNA antibodies highly specific and indicate disease severity
Term
Libman Sacks syndrome is a non infective endocarditis associated with which AI condition?
Definition
SLE
Term
anti-Jo antibodies associated with?
Definition
dermatomyositis
Term
how to diagnose SLE?
Definition
if 4 out of 11 are present
malar rash
discoid rash
photosensitivity
oral ulcers
non erosive arthritis
serositis
renal disorder
CNS disorder
haematological disorder
immunological disorder
Term
3 things to monitor in SLE?
Definition
Anti dsDNA antibodies
complement levels of C3/4
ESR
Term
which antibodies are found in ~100% of drug induced lupus?
Definition
antihistone antibodies.
Term
what antibodies sene in antiphospholipid syndrome?
what is management?
what are features?
Definition
antibodies seen: antiphospholipid, anticardiolipi, lupus anticoagulant

mx: low dose aspirin or warfarin

features: CLOT
Coagulation defect
Livedo reticularis
Obstretric problems
Thrombocytopenia
Term
ANCA positives tend to affect which part of the body?
Definition
respiratory tract and kidneys
Term
henoch schonlein purpura
Goodpastures
Cryoglobulineamia are all what?
Definition
ANCA -ve vasculitis
Term
mx of large vessel vasculitis?
Definition
steroids
Term
mx of medium/small vessel vasculitis?
Definition
steroids and IV cyclophosphamide 15mg/kg
Term
mx for suspectd GCA?
Definition
60mg prednisolong daily PO

usually on steroids for 2 years
give PPI and bisphosphonates.
Term
which medium vessel vasculitis is associated with Hep B?
Definition
Polyarteritis Nodosa (PAN)
Term
mx for PMR
Definition
15mg pred PO daily.
there shold be a dramatic response in 1 week. if not then reconsider diagnoses
decrease dose 1mg per month
usually on steroids for 2 years
Term
which rash is seen in rheumatic fever?
Definition
erythema marginatum
Term
rash of lyme disease?
Definition
erythema migrans
Term
sarcoidosis may present with nodules on shin these AKA?
Definition
erythema nodosum
Term
what can you treat the itchy rash of dermatitis herpetiformis?
Definition
dapsone.
Term
anti Jo-1 anti Mi-2 seen in?
Definition
dermatolyositis
Term
which colour does sulfasalazine turn your urine?
Definition
orange

it can also affect blood count and reduce sperm count
Term
features of MTX dosing
Definition
tablets come in 2.5mg and 10mg but for safety and to avoid confusion only 2.5mg is used.

starting dose 7.5 -15mg. max dose 25mg
take folic acid 5mg on a day that MTX isn't taken.
MTX taken once a week

meds to avoid whilst on MTX: trimethoprim and septrin

also avoid live vaccines
Term
how long should you used contraception for after stopping MTX?
Definition
at least 3 months
Term
women on leflunamide who want a baby are asked to stop the drug and get a wash out treatment. if they do not want a wash out rx how long should they avoid not getting pregnant for?
Definition
2 years.
Term
how is washout of leflunomide done?
Definition
taking cholestyrammine for 11 days
Term
what are differences in onset of action between DMARDs and biologics?
Definition
DMARDS take a lot longer to show an effect compared to biologics that exert their effect within days to weeks.
Term
with TNA alpha inhibitors there is an increased risk for reactivation of which disease?
Definition
TB
Term
my MOA is by interacting with p55 and p75 cell surface TNF receptors. People who use me shold carry a special alert card. which drug am I?
Definition
Adalimumab
Term
aged 30-99 year olds can used which score to asses 10 year risk of fracture?
Definition
qfracture

FRAX is for 40-90 year olds
Term
what term is used when there is normal bony tissue but decreased mineral content in adults?
Definition
osteomalacia

rickets in children

the difference is fusion of the epiphysis.
Term
imaging modality of choice for osteomyelitis?
Definition
MRI

mx: fluclox for 6 weeks or clindamycin if penicillin allergy
Term
Rf is usually an IgM antibody. which 2 test can be used to detect it?
Definition
Rose-Waller test: sheep red cell
Latex agglutinin test: less specific
Term
antibodies in Srogens?
Definition
Anti-Ro
Anti-La

histology shows local lymphocytic infiltration
Term
how would you define kyphosis?
Definition
a curvature in xs of 45 degrees

it is usually associated in adults with osteoporosis
Term
name of disease that is the commonest cause of kyphosis in adolescents?
Definition
Scheurmanns disease. osteochondrosis of the thoracic vertebral bodies.
Term
common causes of genu valgum (valgus knees)
Definition
RA/OA
arthritis of knee
trauma
RA usually presents with valgus knees
OA can also present with this but varus knees is common.
Term
mx for Dupuytrens contracture
Definition
injectable collagenase
radiotherapy
surgical: fasciectomy, fisciotomy

splinting and steroid injections are NOT recommended.
Term
which nerve provides secretomotor fibres to parotids?
Definition
glossopharyngeal
Term
which CN innervates cricothyroid muscle?
Definition
vagus
Term
difference between myasthenia gravis and lambert eaton
Definition
MG: antibodies to acetyl choline receptor, fatiguabily after repetition of activity, reflexes normal, normal conduction velocity of peripheral nerves

lamber eaton: paraneoplastic syndrome, antibodies to voltage gated calcium channels, gets more stronger with repetitive activity, reflexes absent
Term
what is the 1st way to manage hyponatremia?
fluid restriction or fluid administration?
Definition
fluid restriction. this is to exclude dilutional hyponatremia
Term
signs of frontal lobe lesion?
Definition
primitive reflexes
emotional lability
intellectual impairment
personality change
urinary incontinence
mono/hemi paresis
Term
management of trigger finger
this commonly affects little, ring finger or thumb
more common in the right hand
Definition
conservative: not treating is an option as 1 in 5 get better spontaneously with rest and analgesia
splinting may help some people
medical:steroid injections
surgical: trigger finger release
Term
causes of trigger finger
Definition
idiopathic
occupational: jobs using a lot of screw drivers or pressure on palms
disease: RA, diabetes, amyloidosis, carpal tunnel, people on dialysis
Term
which imaging modality gives the most information about the extent of a tendon rupture?
Definition
MRI
Term
which people are at increased risk of tendon rupture?
Definition
people over 60
but young people may get these from sporting injuries
Term
which Abx has been reported to cause tendon rupture?
Definition
Quinolones
Term
proximal biceps tendon rupture management
Definition
conservative: most become asymptomatic within 4-6 weeks, can use NSAIDs and physio
surgical: distal reattachment is an option.
Term
biceps tendon rupture can be proximal or distal. proximal is more common.

what age group does distal tendon bicep rupture occur?
Definition
middle aged active males
usually due to a single traumatic event caused by flexion against resistance.
Term
distal bicep tendon rupture management
Definition
conservative: can result in persistant elbow weakness
surgical: surgery needs to be performed early to prevent scarring of biceps. with delayed rx biceps may be attached to brachioradialis
Term
presentation of distal bicep tendon rupture
Definition
sharp tearing sensation
painful swollen elbow
weakness of flexion and supination
Term
in delayed surgical rx of biceps tendon rupture which muscle can it be attached to?
Definition
brachioradialis
Term
complications of biceps tendon rupture?
Definition
bicep tendonitis
median nerve compression
Term
which tendon maintains the arch of the foot and damage to it is a cause of acquired flat foot?
Definition
the posterior tibial tendon
Term
what causes mallet finger?
Definition
damage to extensor tendons
leads to permanent flexion of the DIP
mx: splint worn day and night for 6-8 weeks cures the problem in most cases.

if the above fails then surgery is needed
Term
mx for ulnar nerve palsy
Definition
conservative: improve work and lifestyle ergonomics, NSAIDs may help, splinting

when to consider surgery? no improvement, progressive palsy and evidence of muscle wasting and clawing

surgery options: decompression surgery, transposition of the nerve, medial epicondylectomy
Term
mx for carpal tunnel
Definition
conservative: try not to over use your wrist, if you are overweight weight loss can help, NSAIDs, not treating is also an option, wrist splint for a few weeks.

medical: steroid injection
surgical: cut flexor retinaculum.
Term
polydactyly is most common on which side of the hand?
Definition
Ulnar side. AKA postaxial polydactyly

there are two types type A and type B
type A = can be functional
type B = varies from a nubbin to non functional finger

mx: don't cause an issue but surgically removed for cosmetic reasons
Term
define syndactyly
Definition
where two or digits are fused together

mx: surgery with skin graft
Term
features of mortons neuroma
Definition
benign
affects intermetatarsal plantar nerve
more common In women
presents with pain in 3rd intermatatarsophalangeal space, more worse when walking
pts may feel they have a pebble in their shoe
mulders click: hold neuron between thumb and finger and using other hand squeeze metatarsals, you will hear a click due to the neuroma moving between metatarsal heads

mx: avoid heels, metatarsal pads, corticosteroid injection, surgical removal of neuroma and neurectomy of the interdigital nerve.
Term
define hallux valgus
Definition
when proximal part of big toe points laterally and the tip of big toe bends medially aka bunion toe
Term
define hallux rigidus?
Definition
stiff big toe
degenerative condition due to bone spurs affecting MTP at base of hallux

mx: rest, NSAIDs, corticosteroids, surgery
Term
features and definition of hammer toe
Definition
deformity of proximal interphalangeal joint leading to permanent bentness


mallet toe is deformity of the distal joint
causes: high heels, ill fitting shoes,

mx: conservative with physical therapy and brace and toe exercises
surgical in serious cases to correct deformity
Term
define claw toe
Definition
this may occur in any tow except the big toe

toes contracted at the PIP and DIP joints
Term
which toe deformity often occurs with bunions?
Definition
hammer toe. this usually affects the second toe
Term
fancy word for flat foot?
Definition
pes planus

pes cavus = high arched foot
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