Conditions summary Flashcards
morning stiffness joint pain and swelling (DIP sparing) nodules RF positive anti-CCP positive joint erosions on xray
rheumatoid arthritis
rheumatoid arthritis treatment
symptomatic aspirin paracetamol NSAIDs (eg ibuprofen) steroid (eg prednisolone) opioids (eg codeine, morphine)
DMARD1
DMARD1 + DMARD2
DMARD1 + DMARD2 + DMARD3
biologics
DMARDs - methotrexate, sulfasalazine, hydroxychloroquine
biologics - anti-TNF
rheumatoid arthritis flare up treatment
steroids
heberdens nodes (DIP)
bouchards nodes (PI)
squaring of thumb base
bakers cyst at knee
worse at end of day
elderly
osteoarthritis
xray of osteoarthritis
LOSS - loss of joint space, osteophytes, sclerosis, subchondral/subarticular cysts
osteoarthritis treatment
weight loss
paracetamol
surgery - joint replacement
osteoarthritis flare up treatment
steroids
teenager lower back/buttock pain pain relieved by exercise limited lumbar movement question mark spine
ankylosing spondylitis
ankylosing spondylitis treatment
symptomatic - physio, pain relied, DMARDs
scaly plaques on extensor surfaces onycholysis (lifting of nail from nail bed) joint pain dactylitis (sausage fingers) 'pencil in cup' on xray
psoriatic arthritis
psoriatic arthritis treatment
DMARDs (methotrexate, sulfasalazine, hydroxychloroquine)
anti TNF
steroids for flare ups
GI infection 3 weeks ago
can see
painful urination
joint pain
reactive arthritis
reactive arthritis treatment
steroids
antibiotics for infection
DMARDs if >3 months
abdo pain
joint pain/stiffness
weight loss
change in bowels
enteropathic arthritis
enteropathic arthritis treatment
sort IBD
paracetamol
DMARDs
NOT NSAIDs - make IBD worse
surgery 2 weeks ago OR prosthetic joint OR PWID
bone pain
fever
hot, red swollen site of wound
acute osteomyelitis
acute osteomyelitis treatment
antibiotics
debridement
chronic osteomyelitis treatment
complex surgery for debridement
antibiotics
monoarthritic pain hot, red, swollen, v painful joint fever tachycardia increased WCC
septic arthritis
septic arthritis treatment
antibiotics - flucloxacillin
surgery = debridement and joint replacement
short stature blue sclera
fractures bones easily
brittle bone disease (osteogenesis imperfecta)
brittle bone disease (osteogenesis imperfecta) treatment
bisphosphonates
prominent forehead short limbs long back short stature learning difficulties
achondroplasia (type of skeletal dysplasia/short stature)
skeletal dysplasia/short stature treatment
nothing
tall long limbs high arched palate retinal detachment arachnodactyly (long fingers)
marfans syndrome
joint dislocations/hypermobility
easy bruising
tissue elasticity
Ehlers danlos syndrome
trisomy 21
short stature
joint laxity
downs syndrome
boy age 5 gowers manoeuvre swollen 'woody' calves muscle wasting
duchenne muscular dystrophy
muscle wasting
‘hatchet’ like face
myotonia (difficulty relaxing muscles after contraction)
myotonic dystrophy
muscular dystrophy treatment
nothing
duchenne muscular dystrophy but with better prognosis
no gowers sign
swollen ‘woody’ calves
beckers muscular dystrophy
‘waiters tip’ posture from no muscle movement in upper arm
newborn baby
erbs palsy
erbs palsy treatment
physio
paralysis of hand/wrist/fingers
newborn
klumpkes palsy
floppy arms abnormal gait learning difficulties 'fencing reflex' epilepsy visual impairment missed developmental milestones speech difficulties
cerebral palsy (lots of types)
cerebral palsy treatment
physio
symptomatic
hair patch on lower back
high arched foot
bladder/bowel problems
mild spina bifida (spina bifida occulta)
flu like illness (infection!)
growth defects
muscle weakness
polio
woman fever malaise weight loss lymphadenopathy butterfly malar rash painless nasal/mouth ulcers reynaulds inflammatory arthritis seizures ANA, anti-dsDNA, anti-Sm positive Complement 4 (C4) present
lupus (SLE)
lupus (SLE) treatment
steroids - prednislone
immunosuppressants - methotrexate, hydroxychloroquine, azathioprine, cyclophosphamide
dry eyes
dry mouth
rheumatoid arthritis
ANA, anti-Ro, anti-La positive
sjogrens syndrome
sjogrens syndrome treatment
methotrexate
symptomatic
thickening of skin proximal to forearms, and torso
breathing difficulty
anti-scl70 positive
ANA positive
diffuse cutaneous systemic sclerosis
thickening of skin distal to forearms, and face (not torso)
anti-centromere positive
ANA positive
reynaulds!
limited systemic sclerosis
systemic sclerosis treatment
symptomatic; vasodilators - for reynaulds ACE inhibitors - for renal involvement PPI - for GI involvement immunosuppression - for lung involvement
anti RNP positive pulmonary hypertension reynaulds scleroderma sclerodactyly lots of random things
mixed connective tissue disease
levido-reticularis - lace like purple pattern on skin recurrent arterial/venous thrombosis lupus miscarriages anticardiolipin positive anti phospholipid antibodies positive
anti-phospholipid syndrome (APS)
anti-phospholipid syndrome (APS) treatment
warfarin
LMW heparin if pregnant
red, hot, v painful joint monoarthritic pain - 1st MTP joint overnight/rapid onset needle shape negative birefringent crystals on aspiration urate crystal deposition
gout
gout treatment
expose, cool, elevate joint
NSAIDs/colcochine
allopurinol prophylaxis
calcium pyrophosphate crystal deposition
elderly
red, hot, v painful joint
monoarthritic pain - knees, wrist, ankles
rectangular, rhomboid, envelope shaped crystals with positive birefringence on aspiration
pseudogout
pseudogout treatment
NSAIDs
steroids
no prophylaxis :(
hydroxyapatite crystal deposition (see on xray)
shoulder joint pain
reduced movement
50 y/o female
Milwaukee shoulder
idiopathic inflammatory myopathy
polymyositis or polymyalgia rheumatica
polymyositis + skin involvement
dermatomyositis
like polymyositis but distal limbs
inclusion body myositis
idiopathic non inflammatory myopathy
fibromyalgia
40 y/o female muscle weakness - proximal limbs weight loss fever difficulty brushing hair, climbing stairs etc ANA, anti-jo positive CK raised inflammatory markers raised
polymyositis
40 y/o female muscle weakness - proximal limbs weight loss fever gottrons papules heliotrope rash shawl sign/rash difficulty brushing hair, climbing stairs etc ANA, anti-jo positive CK raised inflammatory markers raised
dermatomyositis
dermatomyositis and polymyositis treatment
steroid - prednisolone 40mg
immunosuppressant - methotrexate
distal muscle weakness
fever
weight loss
50 y/o male
inclusion body myositis
no muscle weakness
muscle pain - shoulder and hip
morning stiffness >1 hour
raised inflammatory markers
polymyalgia rheumatica
polymyalgia rheumatica treatment
prednisolone 15mg
abdo pain depression fatigue pain - neck, shoulders, lower back etc general aches and pain inflammatory markers normal antibodies negative muscle biopsy negative
fibromyalgia
fibromyalgia treatment
patient education
gabapentin - pain relief
treat IBS
anti depressants
elderly female early menopause low impact fractures steroids coeliac disease
osteoporosis
osteoporosis treatment
calcium and vit D supplementation
bisphosphonates
denosumab (renal failure)
> 50 y/o
unilateral temporal headache
tender, enlarged, non pulsatile arteries
fever
jaw claudication (osteoarthritis in TMJ)
unilateral hypertension
polymyalgia rheumatica (morning stiffness in shoulders and hips)
giant cell arteritis (GCA)
patient >50 y/o with sudden onset headache
giant cell arteritis (GCA)
giant cell arteritis treatment
steroids, reduce over 2 years;
prednisolone 40mg if no visual symptoms
prednisolone 60-80mg if visual symptoms
aspirin long term
PPI long term
important investigation in giant cell arteritis (GCA)
fundoscopy
treatment of all small vessel vasculitis (GPA, EGPA, MPA, HSP)
IV steroids
IV cyclophosphamide
long term immunosuppression - methotrexate
ENT symptoms - nosebleeds, oral ulcers, cough, nasal cartilage collapse purpura haemoptysis late onset asthma/rhinitis pANCA positive anti-MPO positive
eosinophilic granulomatosis with polyarteritis (EGPA) aka churg strauss
ENT symptoms - nosebleeds, oral ulcers, nasal cartilage collapse, cough haemoptysis purpura cANCA positive anti-PR3 positive
granulomatosis with polyarteritis (GPA) aka wegners
pANCA positive
anti-MPO positive
microscopic polyarteritis (MPA)
IgA mediated children 2-11 y/o URTI 3 weeks ago purpuric rash over buttocks and lower limbs abdo pain bloody diarrhoea
henoch schnlein purpura (HSP)
genetic condition easy bruising multiple scars bone fractures joint deformity premature death likely
congenital insensitivity to pain (CIP)
lateral curvature of the spine (posture to the L or R)
resp distress
scoliosis
scoliosis, kyphosis and spondylolisthesis treatment
physio
brace/cast/wheelchair
surgery - if deteriorating
chance fracture
worsening posture ('slouching')kyphosis
recurrent back pain with no neuro symptoms
poor posture
obese
pain worse on exercise, relieve by rest
mechanical back pain
mechanical back pain treatment (4)
generally nothing
pain relief
increase exercise (NOT bedrest)
physio, acupuncture
pain in lower back then in legs pain worse walking up hill
retired construction worker
slipped disc
slipped disc treatment (3)
generally nothing, 70% self limiting in 3 months
pain relief
increase exercise (NOT bedrest)
physio
forward slippage of one vertebrae onto another
lower back pain
young and sporty
spondylolisthesis
reduced leg power
unilateral leg pain in dermatomal pattern
sciatica
sciatica treatment
symptomatic and curative
self limiting
surgery (v v v v rare)
55 year old male retired manual worker obese painful back and legs when walking downhill enjoys cycling
spinal stenosis
spinal stenosis treatment (3 - think of risk factor)
physio
decrease weight
surgery - spinal decompression
severe sudden exacerbations of pain
worse as day goes on, worse with activity
deep seated central back pain
discogenic back pain
discogenic back pain treatment (2)
physio
pain relief
morning stiffness
back pain worse after prolonged rest
pain relieved by exercise
facet arthropathy
treatment for facet arthropathy (3)
exercise
pain relief
injections
lower back pain
loss of bladder/bowel control
saddle anaesthesia - bilateral loss of sensation to buttocks/perineum/inner thigh
loss of anal tone on PR exam
cauda equina syndrome
cauda equina syndrome treatment
complications
emergency surgery within 24 hours
paralysis if no treatment
painful lateral epicondyle
resisted middle finger and wrist extension
pain worse when opening jar
tennis elbow (lateral epicondylitis)
tennis elbow (lateral epicondylitis) treatment (5)
rest physio pain relief steroid injections surgery last resort
painful medial epicondyle
wrist flexion painful pain worse on opening jar
golfers elbow (medial epicondylitis)
golfers elbow (lateral epicondylitis) treatment (4+1 not)
rest
physio
pain relief
surgery last resort
NOT steroid injections (may damage ulnar nerve!)
paraesthesia (pins and needles) of medial 1.5 fingers
weakness of thumb
ulnar nerve compression
cubital tunnel syndrome
cubital tunnel syndrome treatment
surgery - nerve decompression/release of tight structures
swelling at olecranon process
olecranon bursitis
lump on medial aspect of 1st MTP
pain in little toes
hallux valgus (bunion)
lump above 1st MTP (on dorsal surface)
pain on walking
hallux rigidus
treatment of hallux rigidus or hallux valgus
pain relief
better footwear
surgery - last line
60 year old male diabetes alcoholic cirrhosis ring (or little) finger gets 'stuck' on flexion cant be extended actively
dupuytrens contracture
palmar thickening with myoofibroblasts and type 3 collagen production
dupuytrens contracture
treatment of dupuytrens contracture (2)
stretches
surgery if impaired function
‘clicking’ of middle (or ring) finger on flexion
can extend finger actively
trigger finger
inflammation of flexor digit tendon = nodule formation = catches on A1 pulley
trigger finger
trigger finger treatment (2)
steroid injection (up to 3 times as necessary) surgery if steroid injection not effective
recently given birth to baby
house wife
pain on radial styloid process
positive finklesteins test
dequervains tenosynovitis
dequervains tenosynovitis treatment (4)
splint, rest, NSAIDs
physio
steroid injection
surgery - for decompression
cant fully extend finger after an injury at netball
mallet (staved) finger
mallet finger (staved finger) treatment
splint for 4 weeks
any carpal dislocation treatment
complication of no treatment
emergency surgery
osteoarthritis
treatment of finger dislocation (2)
local anaesthetic and reduce dislocation
then splint to neighbouring finger asap
arthritis type involving MCP and carpals
rheumatoid arthritis
arthritis type involving PIP, DIP, base of thumb
osteoarthritis
fluid filled cyst at DIP joint
transiluminate
well defined
firm
ganglion cyst
30 year old female
pregnant
numbness in digits 1-3 and lateral half of digit 4
reduced thumb function
carpal tunnel syndrome
carpal tunnel syndrome treatment (2)
steroid injection
surgical decompression
cubital tunnel syndrome
surgical decompression
65 year old male
paraesthesia of ulnar 1.5 fingers
weakness of 1st dorsal interosseous and adductor pollicis muscles
injury to elbow
cubital tunnel syndrome
where is AVN most common
hip
severe groin pain
AVN
severe trochanter pain
trochanteric bursitis
hip AVN treatment (2)
surgery for decompression of pressure
joint replacement
trochanteric bursitis treatment (4 + 1 not)
self limiting
NSAIDs
injections
physio
NOT surgery
wrist/ankle AVN treatment (2)
surgery for decompression
joint fusion
painful
shortened leg
externally rotated
hip fracture
painful
shortened leg
internally rotated
hip dislocation
hip dislocation treatment
emergency reduction
knee osteoarthritis first line treatment (3)
weight loss
increase activity
mobility aids
knee osteoarthritis second line treatment (if end stage and elderly)
surgery - total knee replacement
knee osteoarthritis second line treatment (if young)
partial knee replacement
valgus instability (knock kneed)
pain for months
ACL damage
knee ligament rupture
MCL rupture
football tackle hyperextension of knee varum stance PCL damage knee ligament rupture
LCL rupture
treatment of MCL and LCL
nothing
sports injury to knee haemarthrosis pain for a few days twisting/popping sensation positive anterior drawer test positive lachman test
ACL rupture
ACL rupture treatment
physio
surgery - ligament graft
anterior tibial injury hyperextension instability going downstairs 'sagging tibia' positive posterior drawer test knee pain
PCL rupture
general treatment of knee ligament ruptures
nothing unless several ligaments and v bad stability
twisting sporting injury to knee sharp sudden pain effusion next day catching and locking positive steinmans test
meniscal tear (probs medial meniscus)
imaging used for knee ligament problems
MRI
xray - to rule out fracture
rupture of one of; quads, quads tendon, patella, patellar retinaculum, patellar ligament
in a body builder with chronic steroid use
extensor mechanism rupture
inflammation of insertion of patellar tendon at tibial tubercle
Osgood schlatters disease
bony lump at tibial tubercle
adolescent boy
pain worse after exercise
positive straight leg raise
Osgood schlatters disease
swelling in popliteal fossa
bakers cyst
30-40 year old
painful arc 60-120 shoulder abduction
positive Hawkins kennedy test
impingement syndrome
impingement syndrome treatment (3)
NSAIDs/analgesia
physio 3 months
3 steroid injections
> 40 year old
jerk of arm with sudden shoulder pain and muscle weakness
rotator cuff tear
rotator cuff tear treatment (3)
NSAIDs
physio
steroid injections
40-60 year old female
shoulder pain for 6 months then stiffness (pain goes away)
frozen shoulder
frozen shoulder treatment (3)
physio!
NSAIDs
steroid injections
self limiting <2 years
acute severe shoulder pain
calcification above shoulder on xray
acute calcific tendonitis
acute calcific tendonitis treatment (2)
self limiting
steroids/analgesia for pain
sports injury to shoulder badge patch dullness
positive findings on xray
anterior shoulder dislocation
anterior shoulder dislocation treatment (4 - need them all)
calm patient - analgesia, sedation, O2
closed reduction/manipulation of joint
sling 2-4 weeks
physio
asymmetric shoulders
lightbulb sign on xray
no pain
posterior shoulder dislocation from ligamentous laxity condition (eg ehlers danlos, marfans)
> 60 year old
gradual onset shoulder pain, reduced movement
LOSS on xray
glenohumeral osteoarthritis
glenohumeral osteoarthritis treatment (4)
analgesia
physio
steroid injections
surgery
swimmer
popeye sign
pain in shoulder, worse on elbow/shoulder flexion
bruising
biceps tendonitis
biceps tendonitis treatment
rest and physio
surgery if severe
biceps tendonitis complications
tendon rupture
aetiology of intoeing in kids (3)
femoral neck anteversion
internal tibial torsion
metatarsal adductus
new born
breech in womb
inverted, plantarflexed, supinated feet
clubfoot (talipes equinovarus)
clubfoot (talipes equinovarus) treatment (2)
splints from birth - age 4
surgery
fixed flat feet in kid
tarsal coalition
tarsal coalition treatment
splint
surgery
new born girl breech birth asymmetrical extra skin fold in thigh asymmetrical shortened limb positive barlow test
developmental dysplasia of the hip (DDH)
treatment of developmental dysplasia of the hip (DDH)
relocate hip and splint (pavlik harness) to stabilise
3 year old breech birth asymmetrical short leg Trendelenburg gait painless limp
developmental dysplasia of the hip (DDH) late diagnosis (usually diagnosed at birth)
age 2-10 boy upper RTI - fever sudden onset pain non weight bearing limp high inflammatory markers (other investigations normal)
transient synovitis of the hip (irritable hip)
treatment of transient synovitis of the hip (irritable hip)
nothing - bed rest, NSAIDs
if persistent after 2 weeks = look for a different cause
aged 4-8 boy hyperactive short stature Trendelenburg gait, limp hip pain
perthes (idiopathic AVN of hip)
treatment of perthes (2)
nothing - NSAIDs, avoid physical activity
surgery if severe
age 10-16 overweight boy pain - knee and/or hip probs weight bearing limp
SUFE (slipped upper femoral epiphysis
SUFE (slipped upper femoral epiphysis) treatment
urgent surgery - pin to stabilise femoral head (maybe in both legs to prevent the other hip from slipping too)
adolescent female
pain in knee from muscle imbalance
predisposed to osteoarthritis later in life
anterior knee pain, nothing you can do
‘catching and locking’ of knee
teenager
lump at medial femoral epicondyle
ostechondirits dissecans (OCD) of the knee
bone pain back pain weakness fatigue weight loss renal failure anaemia recurrent infections proteinuria
multiple myeloma
bone pain, 'shin splints' enlarged bones (eg bigger head) increased metabolism fractures increased alk phos (ALP) normal Ca
pagets disease of bone
pagets disease of bone treatment
bisphosphonates - inhibits osteoclasts = prevents disease progression
treatment of benign bon tumours
curettage to remove it
treatment of malignant bone tumours
excision with a 3-4cm circumference
when is spinal stenosis pain relived (which activity)
cycling (bc spinal flexion)
