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MSK > ask disease profiles pt 2 > Flashcards

ask disease profiles pt 2 Flashcards

1
Q

what are inflammatory myopathies characterised by

A

weakness

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2
Q

what is polymayalgia rheumatica characterised by

A

pain and stiffness

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3
Q

what is fibromyalgia characterised by

A

pain and fatigue

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4
Q

presentation of muscle diseases

A

muscle pain, weakness, tiredness, stiffness, abnormal blood test, other organ features

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5
Q

what is a myopathy

A

a disease of the muscle where the fibres do not function properly

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6
Q

what does a myopathy result in

A

muscle weakness

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7
Q

acquired inflammatory myopathies

A

polymyositis, dematositis and immune mediated necrotising myopathy

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8
Q

prevalence of polymyositis and dermatomyositis

A

1/100,000

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9
Q

peak incidence of polymyositis and dermatomyositis

A

40-50 years

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10
Q

female to ale ratio of polymyositis and dermatomyositis

A

40-50

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11
Q

what does polymyositis and dermatomyositis put people at risk of

A

malignancy

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12
Q

clinical features of polymyositis and dermatomyositis

A

insidious onset, worsening over months, usually symmetrical, proximal muscles, often specific problems like brushing hair and climbing stairs and mild myalgia in 25-50%

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13
Q

what is seen in dermatomyositis

A

gottrons sign, heliotrope rash and shawl sign

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14
Q

what is gottrons sign

A

red rash over the back of fingers

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15
Q

what is helioscope rash

A

rash round the eyes

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16
Q

greatest risk of malignancy in people with dermatomyositis and polymyositis

A

men over 45

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17
Q

investigations of polymyopathy and dermatomyopathy

A

muscle enzymes (CK), inflammatory markers, electrolytes, calcium, PTH, TSH, ANA, anti-Jo-1, myositis, specific antibodies, EMG

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18
Q

EMG findings in myopathies

A

increased fibrillations, abnormal motor potentials, complex repetitive discharges

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19
Q

diagnosis of muscle myopathies

A

muscle biopsy, MRI

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20
Q

muscle biopsy findings in muscle myopathies

A

perivascular inflammation and muscle necrosis

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21
Q

MRI findings of muscle myopathies

A

muscle inflammation, oedema, fibrosis and calcification

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22
Q

treatment of muscle myopathies

A

cotricosteroids and immunosuppression

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23
Q

who gets polymyalgia rheumatica

A

over 50s

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24
Q

what is the prevelance of polymyalgia rheumatica

A

1%

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25
Q

what is polymyalgia rheumatica associated with

A

temporal arteritis and giant cell arteritis

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26
Q

clinical presentation of polymyalgia rheumatica

A

ache in shoulder and hip girdle, morning stiffness, usually symmetrical fatigue, anorexia, weight loss and fever, reduced movement of shoulders, neck and hips muscle strength is normal

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27
Q

what is temporal arteritis/giant cell arteritis

A

granulomatous arteritis of large vessels

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28
Q

features of granulatous arteritis

A

headache, scalp tenderness, jaw claudication, visual loss, tender enlarged non pulsatile temporal arteries

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29
Q

diagnosis of granulatous arteritis

A

raised ESR,plasma viscosity, CRP, temporal artery biopsy, temporal artery USS

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30
Q

treatment of granulates arteritis

A

low dose steroids gradual reduction of steroids over 18 months to 2 years

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31
Q

what does of prednisolone for PMR

A

15mg

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32
Q

what does of prednisolone for GCA

A

40-60 mg

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33
Q

what is a common cause of chronic musculoskeletal pain

A

fibromyalgia

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34
Q

is fibromyalgia associated with inflammation

A

no

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35
Q

female to male ratio of fibromyalgia

A

6:1

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36
Q

what might trigger fibromyalgia

A

emotional or physical trauma

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37
Q

what is the diagnostic criteria for fibromyalgia

A

ACR

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38
Q

treatment of fibromyalgia

A

patient education, multidisciplinary response, graded exercise programme, CBT, acupuncture, anti depressants, analgesia, gabapentin and pregabalin

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39
Q

what is vasculitis

A

inflammation of blood vessels

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40
Q

what does primary vasculitis occur from

A

inflammatory response that targets the vessel walls and has no known cause

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41
Q

what does secondary vasculitis occur from

A

triggered by infection a drug, or a toxin or another type of inflammatory disorder or cancer

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42
Q

clinical features of vasculitis

A

depends on which vessel it affects, systemic symptoms - fever, malaise, weightless and fatigue

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43
Q

classifications of vasculitis

A

immune complex mediated vasculitis, medium vessel vasculitis, large vessel vasculitis, anti GBM disease and ANCA associated small cell vasculitis

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44
Q

what examples of immune complex mediated vasculitis

A

cryoglobulinemic vasculitis, IgA vasculitis, hyppelmentamic urticarial Vasculitis

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45
Q

large vessel vasculitis

A

takayaski arteritis and giant cell arteritis

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46
Q

who does takayaski arteritis affect

A

females under 40

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47
Q

signs of takayaski arteritis

A

bruit in carotid artery and blood pressure differences

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48
Q

who gets giant cell arteritis

A

GCA over 50 years

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49
Q

symptoms of giant cell arteritis

A

temporal headache, temporary visual disturbances, blindness and/or jaw claudication

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50
Q

what is giant cell arteritis associated with

A

polymyalgia rheumatica

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51
Q

investigations of large vessel vasculitis

A

ESR,plasma viscosity and CRP is raised US and CT

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52
Q

management of large vessel vasculitis

A

40-60 mg prednisolone, steroid sparing agents (leflunamide, methotrexate, toclizumab

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53
Q

anca + small vessel vasculitis

A

churg strauss, wegeners, microscopic polyangitis

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54
Q

anca- small vessel vasculitis

A

cryoglobulnemia

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55
Q

what is wegeners also known as

A

granulonatosis with polangitis

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56
Q

what is churg strauss also known as

A

eosinophilic granulommatosis with polyangitis

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57
Q

GPA male to female ratio

A

1.5:1

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58
Q

age of onset of GPA

A

35-55 years

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59
Q

what is common in GPA

A

constitutional symptoms and arthralgia

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60
Q

ENT features of GPA

A

sinusitis, nasal crustin, epistaxis, mouth ulcers, sensorineural deafness, otitis media and deafness, saddle nose, sub glottic inflammation

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61
Q

ocular features of GPA

A

conjunctivitis, episcleritis, uveitis, optic nerve vasculitis, retinal artery occlusion, proptosis

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62
Q

resp symptoms of GPA

A

cough, heamoptysis , pulmonary infiltrates, diffuse alveolar haemorrhage, caveatting nodules on CXR

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63
Q

cutaneous features of GPA

A

palpale purpura, cutaneous ulcers

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64
Q

renal features of GPA

A

necrotising glomerulonephritis

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65
Q

nervous system manifestations of GPA

A

mononeuritis multiplex, sensorimotor polyneuropathy, cranial nerve palsies

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66
Q

difference between EGPA and GPA

A

late onset of asthma, high eosinophil count and ANCA specificity

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67
Q

what does microscopic polyangitis cause

A

renal impairment

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68
Q

what is Henoch - schonein purport

A

an acute immunoglobulin IgA mediated disorder

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69
Q

what does HSP involve

A

generalised vasculitis of small vessels of skin, gI tract, kidneys, joints and rarely lungs and CNS

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70
Q

what is the common infection leading to HSP

A

group A strep

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71
Q

preceding illness predates when in HSP

A

1-3 week s

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72
Q

what is the presentation of HSP

A

purpuric rash typically over buttocks and lower limbs, colicky abdominal pain, bloody diarrhoea joint pain, renal involvement

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73
Q

investigations of vasculitis

A

urine dipstick, FBc, liver and renal profile, inflammatory markers, ANCA and specific antibodies, connective tissue disease screen, compliment levels, Cxr, CT, nerve conduction tests, tissue biopsy

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74
Q

what is ANCA

A

auto antibodies against antigens in the cytoplasm if neutrophil granulocytes

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75
Q

what is used to detect ANCA

A

immuno fluorescenze

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76
Q

cANCA appearance

A

more round

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77
Q

pANCA appearance

A

more globular

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78
Q

varum

A

ditsal towards

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79
Q

valgum

A

distal part away

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80
Q

complications of knee replacememnt

A

deep infection, pain, stiffness, early failure/ loosening and medical complications and blood clots

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81
Q

what stress does MCL resist

A

valgus

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82
Q

what tsress does LCL resist

A

LCL

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83
Q

what stress does ACL RESIST

A

internal rotatio of the tibia

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84
Q

grade 1 ligament injury

A

sprain

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85
Q

grade 2 ligament injdury

A

partial tear

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86
Q

grade 3 ligamnet injury

A

complete tear

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87
Q

PCL injury leads to

A

recureent hyperextension

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88
Q

acute locked knee inidctaotes

A

displaced bucket handle meniscal tear

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89
Q

what isFAI

A

altered morphology of femoral neck or acetabular

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90
Q

PIncer typle iningement

A

acetabular

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91
Q

where is hip arthritis felt

A

in the groin

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92
Q

presentation of FAI

A

activity related pain in groin, difficulty sittig, C sign positive

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93
Q

management of FAI

A

observation in asymtomatic - symptomatic surgery

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94
Q

avascular necorosis

A

usually idiopathic faure of perfusion to the femoral head

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95
Q

risk factors of avascukar necrosis

A

STEROID AND TRAUMA

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96
Q

presentation of avascular necrosis

A

insiduois onset of groin pain, exacerbated by stairs or impact, examination normla

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97
Q

staging system for avascular necorsis

A

STeinberg

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98
Q

management of avascular necrosis

A

drilling,,

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99
Q

what stage does avascular necrosis become irreversible

A

stage 3

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100
Q

iTOH is

A

local hyperaremia and impaired venous return wuth marrow oedema and increased intramedullary pressure

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101
Q

diagnosis of ITOH

A

elevation ESR, radiographs, MRI and bone scan

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102
Q

management of OTOH

A

self limiting - 9-10months, analgesua, crutches

103
Q

what is trochanteric bursitis caused by

A

repetitive trauma caused by the iliotibial band

104
Q

presentation of trochanteric bursitis

A

pain on the lateraspect of the hip - pain palpation of the greater trochanter

105
Q

management of trochanteric bursitis

A

analgesa, NSAIDs, physiotherapy,m steorid injection

106
Q

lipomas usually occur

A

in the neck

107
Q

what mist lipomas be

A

superficial

108
Q

chronic back pain defined at

A

3 months

109
Q

subacute back pain

A

6 weeks

110
Q

back pain in the tailbone known as

A

coccydynia

111
Q

back pain intrinsic to the spin causes

A

spinal MSK system, neurological, haemopoeitic system

112
Q

back pain extrinsic to the spine causes

A

extrinsic MSK system, neighbouring viscera, neurological system

113
Q

what could be causing back pain

A

degenerative, vascular, neoplasm, infection, inflammatory, trauma, metabolic dosorder, neighbouring viscera

114
Q

red flags for back pain

A

neurological deficit, history of cancer, systemic features, IV drug use, immunosuppression, trauma, osteoporosis, thoracic back pain, pain at rest and at night, >50 <16

115
Q

when to suspect non traumatic fractures

A

in patients with osteoporosis, elderly patients and patients on long term steroids

116
Q

what to do in a suspected back fracture

A

immobilise, assess UL and LL neurology, perineal sensation assess further UMN signs

117
Q

investigations of back fracture

A

XR, CT, urgent MRI if neurological deficit

118
Q

what is caudal equine syndrome

A

dysfunction of multiple lumbar and sacral nerve roots

119
Q

what to assess in suspected caudal equina syndrome

A

assess LL neurology, perineal sensation, anal tone and squeeze, bladder scan assess further if UMN signs detecte d

120
Q

investigations of caudal equine syndrome

A

urgent MR of lumbar spine, rest of spine if negative

121
Q

what is acute foot drop

A

weakness of ankle dorsiflexion

122
Q

what is acute foot drop caused by

A

L4 or l5 weakness of perineal nerve pathology

123
Q

presentation of acute cord compression

A

rapid onset spinal pain, severe weakness / numbness of extremities +/- sphincter disturbance

124
Q

what is spinal osteomyelitis +/- epidural abscess

A

infection of the spine

125
Q

what is the presentation of spinal osteomyelitis +/- epidural assess

A

focal back pain and low grade fevers

126
Q

coronal deformity

A

seen when you look at the patient from the back

127
Q

saggital deformi

A

seen when you look at the patient from the side

128
Q

saggital deformi

A

seen when you look at the patient from the side

129
Q

what happens to the spinal processes in scoliosis as the spine curves

A

they also rotate

130
Q

specific test for scoliosis

A

Adams tes

131
Q

what is kyphosis

A

accessive convex curvature of the spine commonly involving the thoracic plane

132
Q

causes of kyphosis

A

scheuermanns disease, osteposrsis with wedge fractures

133
Q

what is spondyosthesis

A

subluxation of one vertebra on another

134
Q

commonest level of Spondylolisthesis

A

L5S1

135
Q

what is cervical radicolpathy

A

a problem that results when a nerve in the neck is irritated as it leaves the spinal canal.

136
Q

what is cervical radicolopathy caused by

A

nerve root is being pinched by a herniated disc or a bone spur.

137
Q

wha is the most mobile joint in the body

A

shoulder girdle

138
Q

rotator cuff muscles

A

Supraspinatus, infraspinatusm teres minor, supscapularis

139
Q

who gets rotator cuff tears

A

over 40s

140
Q

what to under 40 s get in the shoulder

A

labral tear

141
Q

median nerve neuropathy

A

carpal tunnel

142
Q

ulnar nerve neuropathy

A

cubital tinnel

143
Q

what is a mucous cyst

A

outpouching of synvoial fluid from DIPJOA

144
Q

management of mucous cyst

A

left or excised

145
Q

what are ganglions

A

outpouchings of synovial cavity

146
Q

managements of ganglions

A

usually resolve over time, wack, aspirate or excise

147
Q

what is trigger finger

A

a condition that effects one or most of the hands tendons making it difficult to bend the effected finger or thumb

148
Q

cause of trigger finger

A

swelling leads to irritation and more swelling and the tendom gets caight on AI pulley

149
Q

presentation of trigger fonger

A

pain over AI pulley may need another hand to extend and may not be able to extend at all

150
Q

management of trigger finger

A

conservative - usually resolves spontaneously, splint to prevent flexion, tendon sheath injction - steroid + LA, or surgery under GA or LA and divide AI pulley

151
Q

presentation of carpal tunnel

A

buring, tingling or itching numbness in your palm and thumb or your index and middle fingers, weakness and trouble holding things, shock like feelings that move into fingers, tingling taht moves up into your arm

152
Q

what nerve is impacted in carpal tunnel

A

median

153
Q

median nerve supplies (motor)

A

lateral two lumbricals, opponens pollicis, abductor pollicis brevis and flexor pollicis brevis

154
Q

sensory supply of the median nerve

A

palmar aspect of the hand, thumb, index, middle and radial hald of ring finger

155
Q

sensory involvemnet of radial 3 and a half fingers, relieved by shaking hand, worse at night,

A

carpal tunnel

156
Q

sensory involvemnet of radial 3 and a half fingers, relieved by shaking hand, worse at night,

A

carpal tunnel

157
Q

femal to male ratio of carpal tunnel

A

5-8: 1

158
Q

identifiable causes of carpal tunnel

A

DM, pregnancy, hypoT4, fluid overload, acromegaly, Rh arthritis

159
Q

examinations of carpal tunnel

A

examination of lOAF muscles, pahelns test and tinels test

160
Q

results of compressive neuropathy in carpal tunnel

A

increased latency and decrased amplitude

161
Q

carpal tunnel questionnaire

A

kamath and starthard

162
Q

management of carpal tunnel

A

splintage, diagnostic steroid injection or surgery

163
Q

management of carpal tunnel

A

splintage, diagnostic steroid injection or surgery

164
Q

what is de quervain tenosynovitis

A

a painful condition affecting the tendons on the thumb side of the wrist

165
Q

presentation of de quervaisn

A

spontaneous, painful, swollen and red, finklesteins test,

166
Q

management of dequervains

A

NSAIDs, splint, rest, steroid injection, decompression surgery

167
Q

what is dupuytrens contracture

A

one or more fingers bend towards the palm

168
Q

patholgy of dupuytrens contracture

A

thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers

169
Q

presentation of dupuytrens contracture

A

painless gradual progression, usually starting as palmer pit/nodule

170
Q

cause of dupuytrens contracture

A

genetics, DM, alcohol, smoking, epilepsy, trauma and dupyterns diathesis

171
Q

examination of dupuytrens contracture

A

feel cords, MCP/PIP involvement - measure angles, table top test

172
Q

treatemnt of dupuytrens contracture

A

surgery or steroid sht if painful

173
Q

what is paronychia

A

infection within a nail fold

174
Q

who usually gets paronychia

A

children

175
Q

risks or paronychia

A

nail biting

176
Q

managemnet of paronychia

A

elevate, antibiotics, incise and drain

177
Q

what is flexor tendon sheath infection

A

a infection within sheath tracking up palm and arm

178
Q

presentation of flexor tendon sheath

A

extermely painful limited extension, affected finger held in fixed flexion, fusiform swelling over finger, painful to perciss over the sheath, painful on passive extension

179
Q

management of flexor tendon sheath infection

A

EMERGENCY wash out tendon sheath - A1 and A5 pulleys

180
Q

where is A1 pulley

A

metacarpal head

181
Q

where is A2 pulley

A

start of proximal phalnyx

182
Q

A3 pulley

A

PIP joint

183
Q

A4 joint

A

middle of middle phalynx

184
Q

A5 pulley

A

start of distal phalynx

185
Q

tedinopathy

A

painful tendon

186
Q

tendinosis

A

degneration of tendon

187
Q

tenosynovitis

A

inflammation in tendon sheath

188
Q

enthesopathy

A

tendon inserts into bone

189
Q

tendonitis

A

inflammation on tendon

190
Q

tendonosis pathology

A

degeneration of collagen and extracellualr matrix

191
Q

what is tendonosis likely caused by

A

MMPs

192
Q

where does tendonosis uusuallly occur

A

in areas of poor blood supply

193
Q

management of tendonosis

A

rest, physio, analgesics, injections - rotator cuff and tennis elbow, splinting

194
Q

when not to use steroid injections in tendonosis

A

achille tendon or extensor mechanism

195
Q

when to use splinting in tendonosis

A

achilles tendon

196
Q

debridement

A

removal of diseased tissue

197
Q

decompression can be used in

A

supraspinatous tendonitis and sub acromial decompression

198
Q

what does synovectomy do

A

prevent rupture

199
Q

when are synovectomies useful

A

tenosynovitis of the ectensor tendons of the writs in RA

200
Q

clinical findings of rotator cuff pathology

A

achy pain down arm, difficulty sleeping on affeced side, reaching overhead and on lifting, painful arc and positive impingment tests

201
Q

management of rotator cuff pathology

A

physia, ject and surgical subacromial decompression

202
Q

presentation of biceps tendinopathy

A

pain anterior shoulder radiating to embow, aggregated by shoulder flexion and snapping with shoulder movements if subluxation

203
Q

diagnosis of biceps tendinopathy

A

clinical exam and USS

204
Q

what is tennis elbow kown as

A

lateral epicondylitis

205
Q

tennis elbow presentation pain

A

pain and tenderness over the lateral epicondyle the origin oextensors

206
Q

medial epicondylitis known as

A

golfers elbow

207
Q

pain over styloid process

A

de quervains tenosynovitis

208
Q

managemnet of de quervains tenosynovitis

A

splint, rest, physio, analgesics, inject surgical decompression

209
Q

RA and weakness in wrist extension or dropped finger

A

extensor tendon rupture

210
Q

what is trigger finger

A

a tenosynovitis

211
Q

level of MRI used for tendons

A

T2

212
Q

insertion of patellar tendon into tibial tuberosity

A

osgood schlatters disease

213
Q

progressive elongation. then rupture

A

tenosynovitis

214
Q

what does tenosynovitis of the tibilalis posterior lead to

A

progressive flat foot and valgus hind foot

215
Q

what is a subungal haematoma

A

a heamatoma underneath the nail plate

216
Q

type 1 ans 2 nail injury

A

soft tissue only

217
Q

type 3 nail injury

A

soft, tissue nail and bone

218
Q

type 4 nail injury

A

proximal 1/3 of the phalanx

219
Q

type 5 nail injury

A

proximal to the DIP joint

220
Q

level 1 and 2 nail injury management

A

dressing

221
Q

level 3 nail injury management

A

repair nail bed and stabilise bone

222
Q

level 4 nail injury management

A

repair and stabilise bone unless less that 5 mm of nail bed then ablate

223
Q

typical age pf supra spinets tendonitis

A

35- 65

224
Q

what rotator cuff muscle tends to cause the most trouble

A

Supraspinatus

225
Q

who is frozen shoulder more common with

A

diabetics

226
Q

what is bursitis

A

inflammation of the synovial lined sacs that protect the bony prominaces and jounts

227
Q

management of bursitis

A

NSAIDs, antibiotics

228
Q

what should you never aspire

A

GANGLIONS

229
Q

management of gout

A

NSAIDs, steroids, alluopurinol

230
Q

what are bouchards nodes and heberdens nodes

A

bony swellings of the interphalangeal joints in hands

231
Q

where are bouchards nodes

A

proximal interphalangeal nodes

232
Q

what are heberdens nodes

A

distal interphalangeal nodes

233
Q

what is dupuytrens

A

progressive disease resulting in digital flexion contractors

234
Q

pathophysiology of dupuytrens

A

nvolves a fibroplastic hyperplasia and altered collagen matrix of the palmar fascia

235
Q

predisposing factors to dupuytrens

A

genetic, environmental, local and global protein expression

236
Q

management of dupuytrens

A

needle fascitomy, limited fasciotomy, dermofasciectomy and graft

237
Q

what is giant cell tumour of tendon sheath

A

regenerative hyperplasia

238
Q

managemnet of giant cell tumour of tendon

A

NOTHING

239
Q

management of lipoma

A

excise if problematic - S shaped incised

240
Q

what is a osteochondroma

A

benign lesion derived from aberrant cartilage from pericondral ring

241
Q

where and when do osteochondromas occur

A

in the knee in adolescnec

242
Q

presentation of osteochindroma

A

painless hard lump, symptoms with activity,

243
Q

pain in osteochondroma

A

from tendons

244
Q

management of osteochndroma

A

watch or surgery

245
Q

where do sabeceous cysts occur

A

around hair follicles

246
Q

what are sebaceous cyst filled with

A

keratin (caseous aterial)

247
Q

presentation of sebaceous cyst

A

slow growing, painless, mobile discreet swellings can become infected

248
Q

what is myositis ossificans

A

abnormal calcification of a muscle haematoma

249
Q

management of myositis ossifcans

A

observe, intervene if symptoms demand - wait until maturity

250
Q

what is neurapraxia

A

hen the nerve has a temporary conduction defect from compression or stretch and resolve over time with full recovery (can take up to 28 days).

251
Q

what is neurotmesis

A

is a complete transection of a nerve and is rare in closed injuries but can occur in penetrating injuries. No recovery will occur unless the affected nerve is surgically repaired. Again recovery is variable.

252
Q

axonomesis

A

either a sustained compression or stretch or from a higher degree of force. Although the nerve remains in continuity and the internal structure (endoneurial tubes) remain intact, the long nerve cell axons distal to the point of injury die in a process known as Wallerian degeneration. The axons then regenerate along the endoneurial tubes at a rate of 1mm per day. Longer peripheral nerves therefore take longer to recover. Recovery is variable and full power or sensation may not be achieved. Recovery can be predicted by nerve conduction studies from around a month from the time of injury.

253
Q

What type of collagen is produced in Dupuytren’s contracture?

A

type 3

MSK (19 decks)

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