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on 18-Jun-2015 (Thu)

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Flashcard 150896345

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#medicine #rheumatology
Question
What are the Red flags for sinister causes of back pain ?
Answer
  • Aged < 20 yrs or > 55 yrs old
  • Acute onset in elderly people
  • Constant or progressive pain
  • Nocturnal pain
  • Worse pain on being supine
  • Fever, night sweats, weight loss
  • History of malignancy
  • Abdominal mass
  • Thoracic back pain
  • Morning stiff ness
  • Bilate al or alternating leg pain
  • Neurological disturbance (incl sciatica)
  • Sphincter disturbance
  • Current or recent infection
  • Immunosuppression, eg steroids/ HIV
  • Leg claudication or exercise-related leg weakness/ numbness (spinal stenosis)

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Flashcard 150896352

Tags
#medicine #rheumatology
Question
What nerve roots does the Straight leg test ?
Answer
L4 , L5 , S1

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Flashcard 150896359

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Question
What are the likely causes of back pain in adults > 50 yrs
Answer
  • Degenerative,
  • osteoporotic vertebral collapse,
  • Paget’s Disease
  • malignancy
  • Multiple Myeloma
  • spinal stenosis

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Flashcard 150896366

Tags
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Question
What are the most likely causes of back pain in adults 15 – 30 yrs?
Answer
  • Prolapsed disc
  • trauma
  • fractures
  • ankylosing spondylitis ( AS ; p 552 )
  • spondylolisthesis (a forward shift of one vertebra over another, which is congenital or due to trauma)
  • pregnancy

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Flashcard 150896373

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#medicine #rheumatology
Question
What are the most likely causes of back pain in adults 30 – 50 yrs ?
Answer
  • Degenerative spinal disease
  • prolapsed disc
  • ​malignancy

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Flashcard 150896380

Tags
#medicine #rheumatology
Question
What are the important blood test to perform in Back Pain ?
Answer
FBC , ESR and CRP (myeloma, infection, tumour), U&E , ALP (Paget’s ), serum/urine electrophoresis (myeloma), PSA .

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Flashcard 150896387

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#medicine #rheumatology
Question
What are the features of Acute cauda equina compression?
Answer
  • Alternating or bilateral root pain in legs
  • Saddle anaesthesia (perianal)
  • Loss of anal tone on PR
  • Bladder ± bowel incontinence

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Flashcard 150896394

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#medicine #rheumatology
Question
What are the features of Acute cord compression?
Answer
  • Bilateral pain
  • LMN signs (p 451 ) at level of compression
  • UMN and sensory loss below
  • Sphincter disturbance

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Flashcard 150896401

Tags
#medicine #rheumatology
Question
What is the most common joint condition ?
Answer
Osteoarthritis (OA)

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Flashcard 150896408

Tags
#medicine #rheumatology
Question
What is the typical age of onset for Osteoarthritis ??
Answer
onset typically >50 yrs

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Flashcard 150896415

Tags
#medicine #rheumatology
Question
What are the commonly affected joints in Osteoarthritis?
Answer
  • DIP joints
  • Thumb carpometacarpal joints
  • Knees

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Flashcard 150896425

Tags
#medicine #rheumatology
Question
What are the symptoms of Localized osteoarthritis ?
Answer
  • Pain on movement and crepitus
  • Worse at end of day
  • Background pain at rest
  • Joint gelling — stiffness after rest up to ~ 30 min
  • Joint instability

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Flashcard 150896432

Tags
#medicine #rheumatology
Question
What are the clinical signs associated with Osteoarthritis ?
Answer
  • Joint tenderness
  • Derangement and bony swelling (Heberden’s nodes at DIP, Bouchard’s nodes at PIP )
  • Decreased Range of movement
  • Mild synovitis

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Flashcard 150896439

Tags
#medicine #rheumatology
Question
What are the aspects of Management in Osteoarthritis?
Answer
  • Multidisciplinary approach
  • Exercise
  • Weight lost
  • Regular paracetamol ± topical NSAID
  • Joint replacement - Last Resort

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Flashcard 150896446

Tags
#medicine #rheumatology
Question
What is the most commonly affected Joint in Septic Arthritis ?
Answer
The knee is affected in >50 % cases

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Flashcard 150896453

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#medicine #rheumatology
Question
What are the risk factors for Septic Arthritis?
Answer
  • Pre-existing joint disease (especially rheumatoid arthritis)
  • Diabetes mellitus
  • Immunosuppression
  • Chronic renal failure
  • Recent joint surgery
  • Prosthetic joints (where infection is particularly difficult to treat)
  • IV drug abuse
  • Age >80 yrs

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Flashcard 150896460

Tags
#medicine #rheumatology
Question
What is the key investigation in Septic Arthritis ?
Answer
Urgent joint aspiration for synovial fluid microscopy and culture

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Flashcard 150896467

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#medicine #rheumatology
Question
What are the common causative organisms of Septic Arthritis ?
Answer
  • Staph. aureus
  • Streptococci
  • Neisseria gonococcus
  • Gram – ve bacilli

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Flashcard 150896474

Tags
#medicine #rheumatology
Question
What is the management for Septic Arthritis?
Answer
  • Flucloxacillin
  • Splint for ≤ 48 h
  • Adequate analgesia
  • Physiotherapy.

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Flashcard 150896481

Tags
#medicine #rheumatology
Question
What are the two main side effects with NSAIDs ?
Answer
Gastrointestinal bleeding and Renal impairment

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Flashcard 150896488

Tags
#medicine #rheumatology
Question
What information should be provided to Patients when receiving NSAID medication ?
Answer
  • Drugs are to relieve symptoms: on good days, don’t take any. In rheumatoid arthritis, cod liver oil (eg 10 g/d) reduces reliance on NSAID S by 30 %.
  • Abdominal pain may be a sign of impending GI problems: stop the tablets, and come back for more advice if symptoms continue.
  • Report black stools ± faints at once.
  • Don’t supplement prescribed NSAID with ones bought over the counter (eg ibuprofen): mixing NSAID can increase risks 20 -fold.
  • Smoking and alcohol increase NSAID risk

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Flashcard 150896495

Tags
#medicine #rheumatology
Question
What is the cardiovascular risk associated with NSAIDs ?
Answer
small increased risk of MI and stroke

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Article 150896510



http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-67202007000100010



Flashcard 150896515

Tags
#medicine #rheumatology
Question
What is Rheumatoid Arthritis?
Answer
A chronic systemic inflammatory disease, characterized by a symmetrical, deforming, peripheral polyarthritis.

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Flashcard 150896522

Tags
#medicine #rheumatology
Question
What is the Genetic Links in Rheumatoid Arthritis ?
Answer
HLA DR4 / DR1 linked

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Flashcard 150896529

Tags
#medicine #rheumatology
Question
What is the typical presentation of Rheumatoid Arthritis ?
Answer
Symmetrical swollen, painful, and stiff small joints of hands and feet, worse in the morning. This can fluctuate and larger joints may become involved.

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Flashcard 150896536

Tags
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Question
What are the features of Felty's Syndrome ?
Answer
Felty’s syndrome: Rheumatoid Arthritis + splenomegaly + neutropenia

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Flashcard 150896543

Tags
#medicine #rheumatology
Question
What are the features of Early Rheumatoid Arthritis ?
Answer
Early (inflammation, no joint damage): swollen MCP, PIP, wrist, or MTP joints (often symmetrical). Look for tenosynovitis or bursitis

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Flashcard 150896550

Tags
#medicine #rheumatology
Question
What are the features of Late Rheumatoid Arthritis ?
Answer
Later (joint damage, deformity): ulnar deviation of the fingers and dorsal wrist subluxation. Boutonnière and swan-neck deformities of fingers or Z -deformity of thumbs occur.

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Flashcard 150896557

Tags
#medicine #rheumatology
Question
What are the Extra Articular Features of Rheumatoid Arthritis ?
Answer
  • Nodules — elbows & lungs
  • lymphadenopathy
  • vasculitis
  • Fibrosing alveolitis
  • Obliterative bronchiolitis
  • Pleural & pericardial effusion
  • splenomegaly
  • episcleritis
  • scleritis
  • scleromalacia
  • keratoconjunctivitis sicca
  • osteoporosis
  • amyloidosis

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Flashcard 150896564

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Question
What is the relationship between Rheumatoid Factor and Disease Severity ?
Answer
A high titre is associated with severe disease, erosions and extra-articular disease.

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Flashcard 150896571

Tags
#medicine #rheumatology
Question
What antibody is highly specific for Rheumatoid Arthritis ?
Answer
Anticyclic citrullinated peptide antibodies ( ACPA /anti- CCP ) are highly specific (~ 98 %) for RA

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Flashcard 150896578

Tags
#medicine #rheumatology
Question
What are the side effects of Methotrexate ?
Answer
  • pneumonitis (get urgent respiratory help),
  • oral ulcers,
  • hepatotoxicity
  • Immunosuppression

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Flashcard 150896585

Tags
#medicine #rheumatology
Question
What is used to assess the disease activity of Rheumatoid Arthritis ?
Answer
28 joint Disease Activity Score

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Flashcard 150896592

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#medicine #rheumatology
Question
What joint is most commonly affected by Gout ?
Answer
>50 % occur at the metatarsophalangeal joint of the big toe

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Flashcard 150896599

Tags
#medicine #rheumatology
Question
How does Gout typically present ?
Answer
An acute monoarthropathy with severe joint inflammation

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Flashcard 150896606

Tags
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Question
What biochemical increase is Gout associated with ?
Answer
It is associated with raised plasma urate.

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Flashcard 150896613

Tags
#medicine #rheumatology
Question
What are the possible aetiologies of Gout ?
Answer
  • Hereditary
  • Dietary purines
  • Alcohol excess
  • Diuretics
  • Leukaemia
  • Cytotoxics (tumour lysis)

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Flashcard 150896620

Tags
#medicine #rheumatology
Question
What does Polarized light microscopy of synovial fluid in suspected Gout show ?
Answer
Negatively birefringent urate crystals

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Flashcard 150896627

Tags
#medicine #rheumatology
Question
How should Acute Gout be treated ?
Answer
  • High-dose NSAID or coxib
  • Rest and Elevation of Joint
  • Ice Packs

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Flashcard 150896634

Tags
#medicine #rheumatology
Question
When should Gout Prophylaxis be started ?
Answer
Start if >1 attack in 12 months, tophi or renal stones.

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Flashcard 150896641

Tags
#medicine #rheumatology
Question
What medication is used in Gout Prophylaxis ?
Answer
Allopurinol

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Flashcard 150896648

Tags
#medicine #rheumatology
Question
What lifestyle changes can help prevent Gout ?
Answer
  • Lose weight.
  • Avoid prolonged fasts, alcohol excess, purine-rich meats and low-dose aspirin

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Flashcard 150896655

Tags
#medicine #rheumatology
Question
How does Pseudogout (acute CPP Crystal Arthritis) typically present ?
Answer
an acute monoarthropathy typically of larger joints in elderly patients.

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Flashcard 150896662

Tags
#medicine #rheumatology
Question
What does the polarized light microscopy of synovial fluid show in Calcium Pyrophosphate Deposition ?
Answer
Weakly positively birefringent crystals

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Flashcard 150896669

Tags
#medicine #rheumatology
Question
How should CPPD acute attacks be managed ?
Answer
  • cool packs
  • rest
  • aspiration
  • intra-articular steroids

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Seks bez zobowiązań - czy każdy facet to lubi? - Sympatia.pl
Stock Spotkania bez zobowiązań to podob<span>no idealne rozwiązanie dla większości mężczyzn. Utarło się, że prawie każdy facet zalogowany na portalach randkowych marzy tylko o tym, by wybrać się na randkę bez zobowiązań, ze śniadaniem... Czy tak jest faktycznie? &#1




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