Rheumatology and bone disease

Published on 05/05/2015 by admin

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Last modified 05/05/2015

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10 Rheumatology and bone disease

Questions

Question 1

How can gabapentin and carbamazepine act with a cervical disc prolapse?

Question 2

Do patients with cervical spondylosis, experiencing neck pain and stiffness, benefit from putting on a neck collar? If so, for how long should the collar be worn?

Question 3

What is indicated by a straightening of the lumbar spine with a loss of normal lordosis, and is there any relation to ankylosing spondylitis?

Question 4

Can cervical spondylosis cause hypertonia in one upper limb?

Question 5

Should a female patient, with mild congestive cardiac failure, microalbuminuria and cervical spondylosis receive IV vitamin D/ analogues? Would this not increase the risk of calcium stones owing to the mild renal impairment? Would oral vitamin D be preferable?

Question 6

What is the recommended treatment for spinal canal stenosis? Do carbamazepine or vasodilators have a role to play in its treatment?

Question 7

What technique is used for injecting steroids locally in the case of carpal tunnel syndrome?

Question 8

In a patient who has sustained an anterior cruciate ligament (ACL) knee injury and whose pain and swelling have subsided on conservative treatment, what are the chances of complications (e.g. osteoarthritis, fibrosis) from the torn ligament. Will the patient be able to lead a normal life?

Question 9

Is either gapapentin or carbamazepine effective in the treatment of meralgia paraesthetica?

Question 10

What is the clinical differentiation between Dupuytren’s contracture and ulnar nerve palsy? Is it the absence of sensory deficit in the former? Are there any other differentiating factors?

Question 11

1. Is a local corticosteroid injection in the palm effective in the case of Dupuytren’s contracture?
2. Can Dupuytren’s contracture occur in early or well-controlled diabetes, or is it more likely to occur in uncontrolled diabetes?

Question 12

Besides cirrhosis of the liver and diabetes mellitus (DM), what other causes of Dupuytren’s contracture are there? What is the pathophysiology behind it?

Question 13

According to one of my lecturers, who is a very well-qualified doctor and orthopaedic specialist, there is an indirect connection between osteoarthritis and subclinical local infections (such as periodontal abscesses), changing the pH of bodily fluids. Can you explain this mechanism?

Question 14

What do you mean by saying that in nodal osteoarthritis each joint is affected one at a time? Is it that each proximal interphalangeal (PIP) or distal interphalangeal (DIP) joint is affected alone, or that at any one time PIP or DIP joints are affected together in one or both hands?

Question 15

What are the criteria for diagnosing osteoarthritis (OA) of the knee joint radiologically? Are changes to be expected with advancing age? To what extent would I consider it significant in those below 50 years of age? Would you give me some X-ray examples if possible?

Question 16

1. In a young patient with osteoarthritis, does long-term treatment with paracetamol (acetaminophen) 500mg/day, rather than ibuprofen 600mg/day, lower the incidence of renal toxicity?
2. How great is the risk of renal toxicity with both these treatments?

Question 17

In India, total knee replacements are being recommended for every case of severe osteoarthritis, without considering factors such as age, weight or medical condition. What are the correct indications for surgery?

Question 18

Methotrexate therapy is usually begun in rheumatoid arthritis that doesn’t respond to NSAIDs plus 40–120mg methylprednisolone depot. If a remission is then induced, how long should methotrexate therapy be continued? Will the patient (now in remission) be given maintenance therapy?

Question 19

What is the dose and regimen for folinic acid rescue after methotrexate in rheumatoid arthritis?

Question 20

1. What are the indicators of remission in rheumatoid arthritis? Is it normalization of erythrocyte sedimentation rate (ESR) or clinical improvement?
2. Does the rheumatoid factor disappear during a remission of rheumatoid arthritis?

Question 21

What is the relationship between rheumatoid arthritis and weight loss? Can treatment aid the weight loss at the same time as controlling the disease?

Question 22

Can oral folic acid (1mg/day) be used for high-dose methotrexate therapy with subsequent leucovorin rescue in the treatment of rheumatoid arthritis?

Question 23

How often should a patient, on 8 mg/day methylprednisolone for the treatment of rheumatoid arthritis and on osteoporosis prophylaxis in the form of 1000mg calcium and 400 IU vitamin D daily, have a dual energy X-ray absorptiometry (DXA) scan to detect the development of osteoporosis?

Question 24

In what percentage of patients with psoriatic arthritis does the arthritis precede the onset of skin or scalp lesions?

Question 25

1. Is reactive arthritis a synonym for Reiter’s syndrome?
2. It is said that Reiter’s disease has been related to Chlamydia trachomatis infection. Is this correct?

Question 26

1. Is the response of an acutely inflamed joint to colchicine pathognomonic of gouty arthritis?
2. We are told that, other than clinical tests, joint fluid microscopy is the specific diagnostic test for gout. What does joint fluid microscopy reveal? Is it the same as a polarized light study revealing needle-shaped urate deposits?

Question 27

In the prevention of gout, should allopurinol be used for life in a patient who is hypertensive, alcoholic and overweight?

Question 28

Does a serum uric acid level of 5.7mmol/L need treatment? Can it be significant with cholesterol levels of 213mg/dL (5.5mmol/L)? What is the treatment?

Question 29

In the diet of patients suffering from gout, should tea, coffee or other compounds containing methylxanthine products be restricted?

Question 30

1. When do joints that appear slightly swollen, but not warm, need to be tapped?
2. In what circumstances might an immunologically suppressed patient not mount a fever or not have heat around a septic joint?

Question 31

What is the cause of Pott’s disease?

Question 32

One thing that often baffles me is that patients with systemic lupus erythematosus often suffer recurrent thrombosis due to lupus anticoagulants (antiphospholipid syndrome). How can an anticoagulant cause thrombosis?

Question 33

Are elevated homocysteine levels an independent risk factor for progression of systemic lupus erythematosus (SLE)/scleroderma? Kindly suggest some references if possible.

Question 34

1. What are the indicators of remission in systemic lupus erythematosus (SLE)? Is it the normalization of erythrocyte sedimentation rate (ESR) and the disappearance of antinuclear antibodies (ANA) and other antibodies, or is it clinical improvement?
2. During remission of SLE, do ANA and other antibodies disappear?

Question 35

When should the use of cyclophosphamide in systemic lupus erythematosus (SLE) be commenced? What is the correct and safe dosage of cyclophosphamide?

Question 36

1. Given the benefits of dexamethasone, which lacks any mineralocorticoid activity, why is this not prescribed in your book for diseases that require long-term steroid therapy, such as systemic lupus erythematosus or giant cell arteritis?
2. Does dexamethasone have more serious adverse effects than prednisolone? Why is it not generally preferred?

Question 37

Would an elevated C-reactive protein (CRP) level, in association with a high erythrocyte sedimentation rate (ESR) and in the absence of infection and serositis, exclude the diagnosis of systemic lupus erythematosus?

Question 38

How do steroids precipitate a crisis in patients with systemic sclerosis?

Question 39

Are neck and face muscles commonly affected in poly- and dermatomyositis? Does this differ from the muscles that are affected with myasthenia gravis?

Question 40

1. In dermatomyositis, what is the shawl sign?
2. How frequently is dermatomyositis associated with Gottron’s papules?

Question 41

How can cranial arteritis be diagnosed in the absence of any physical symptom or feature of the disease other than headache?

Question 42

Do pulmonary manifestations in Behçet’s syndrome present with pulmonary infiltrates in the upper zone of the lung?

Question 43

1. Is Behçet’s disease accompanied by an elevated erythrocyte sedimentation rate (ESR)? If so, how often?
2. Can Behçet’s disease be diagnosed in a young adult with an ischaemic stroke and a history of almost weekly mouth ulcers that heal quickly, but with no other symptoms of Behçet’s disease?

Question 44

Mouth ulcers are too common to be a cardinal feature in the diagnosis of Behçet’s disease. Are there any distinguishing features other than mouth ulcers that would confirm diagnosis?

Question 45

Please explain how to diagnose familial Mediterranean fever. Is a diagnosis of exclusion still used or are there now more up-to-date tools for the diagnosis?

Question 46

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