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what are charcot's joints?
severely deformed joints due to neuropathic injury
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what are the causes of charcot's joints?
- syringomyelia
- tabes dorsalis (neurosyphilis)
- DM neuropathy
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what are the x-ray characteristics of pagets disease of the bone?
sclerotic and lytic lesions (bone formation and breakdown)
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what are the blood test findings of pagets disease of the bone?
raised Alk phase
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what are the cardiac features of pagets disease?
high output heart failure
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what is the treatment of pagets disease?
bisphosphonates (pamidronate)
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in which disease do both ESR and CRP rise during active disease?
RA
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what are the differences in the biochemical markers between osteomalacia and osteoporosis?
- osteomalacia: low serum calcium, low phosphate, raised ALP, raised PTH
- osteoporosis: serum calcium, phosphate and al phase are normal
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what are the xray changes in osteomalacia?
- looser's zones: incomplete stress fractures eg in pubic rami, femoral neck and humeral neck, scapulae
- pseudofractures
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what is osteoporosis?
- reduced bone density
- see on DEXA scan
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in OP, what detects where the fractures happen?
- if trabecular bone is mostly affected: vertebral crush fractures (dowagers hump)
- if cortical bone: long bone fracture e.g. femoral neck
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what is the treatment of osteoporosis?
- calcium rich diet
- bisphosphonates
- calcium and vit D supplements
- Raloxifene (SERM) may also reduce breast ca risk
- calcitonin: reduces pain post vertebral fracure
- recombinant PTH: teriparatide. stimulates new bone formation and prevents fractures (use if intol to bisphos)
- strontium ranelate: increase bone formation, reduce resorption, reduce fracture rate
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what is osteomalacia?
- normal amount of bone
- but reduced mineral content (excess uncalcified osteoid and cartilage)
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what are the causes of osteomalacia? (4 categories)
- vitamin D deficiency: malab, poor diet, no sun
- renal: no 1alpha hydrox
- vitamin D resistance
- liver disease: less 25 hydroxyls and cirrhosis causes malab of vitamin D
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what are the symptoms of osteomalacia?
- bone pain
- fracures
- proximal myopathy and waddling gait as low phosphate and vitamin D deficiency
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what is the treatment of osteomalacia?
- if due to malab: give calciferol (active vitaminD3) tablets
- if vitamin D resistanct give calciferol
- if renal disease: alphacalcidiol (1alpha hydroxy vitamin D) n.b. check calcium rise!
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what are the SE of gold as a DMARD?
- BM suppression
- anaemia
- agranulocytosis and infection
- purpuric rash
- (give weekly injection)
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what are the SE of penicillamine?
- lupus like syndrome
- high ANA too!
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what are the SE of hydroxychloroquine? what type of drug is it?
- anti malarial
- retinopathy
- BM suppression
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what is behcets disease associated with, which HLA?
B51
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what are the symptoms/complicaitons of pagets?
- asymptomatic
- bone pain
- enlarged skull, femur, clavicle
- pathological fractures
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what are the complications of pagets?
- nerve deafness (bone growth)
- high output CCF
- bone sarcoma
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what is the treatment of pagets?
- analgesia
- bisphosphonates
- Calcitonin if bis don't work
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which autoAb are associated with sjogrens?
anti-Ro
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how would you differentiate PMR from DM or PM on blood tests?
in PMR the CK would be normal as it is not a myositis
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