Corrections 2 Flashcards
In what 2 scenarios should you avoid giving sulfalazine?
1) G6PD deficiency
2) Allergy to aspirin or sulphonamides (cross-sensitivity)
Which DMARD can cause oligospermia?
Sulfalazine
When should bisphosphonate treatment be re-assessed?
After 5 years
Repeat FRAX score and DEXA scan to assess need for ongoing treatmnet
Where is the most common site of metatarsal stress fractures?
2nd metatarsal shaft
Typical mechanism of injury in meniscal tears?
Twisting injuries
Features of meniscar tears?
- pain worse on straightening the knee
- knee may ‘give way’
- displaced meniscal tears may cause knee locking
- tenderness along the joint line
What is Raynaud’s?
An exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress.
It may be primary (Raynaud’s disease) or secondary (Raynaud’s phenomenon).
Who does Raynaud’s typically present in?
Young women e.g. 30 y/o with bilateral symptoms
Does Raynaud’s typically present with unilateral or bilateral symptoms?
Bilateral
What is the most common 2ary cause of Raynaud’s?
Scleroderma
Typical age of onset in 1ary vs 2ary Raynaud’s?
1ary - onset <40 y/o
2ary - onset >40 y/o
Marfan’s syndrome is caused by a mutation in which protein?
Fibrillin
What would you expect to see on an XR in a Colle’s fracture?
Dorsally displaced distal radius fracture
1st line mx of carpal tunnel syndrome?
1st –> conservative: wrist splint +/- steroid injection
Trial for 6 weeks
2nd line –> surgical decompression: flexor retinaculum division
What accounts for the majority of ocular complications in temporal arteritis?Anterior ischemic optic neuropathy
Anterior ischemic optic neuropathy
What condition is a common cause of BILATERAL carpal tunnel syndrome?
RA
In ulcers with associated cellulitis, what does the initial improvement of cellulitis with antibiotics but persistent discharge and localised tenderness/swelling indicate?
Abscess formation –> requires surgical drainage
What is Simmond’s triad?
1) palpation of tendon
2) calf squeeze test
3) examination of angle of decline at rest
This is used for examining an Achilles’ tendon rupture
What score is a useful tool to assess hypermobility?
Beighton score
What is involved in a Salter-Harris IV fracture?
Fracture involves the physis, metaphysis and epiphysis
What rash may be present in APS?
Livedo reticularis (lace or net-like appearance, which can be blue or purple)
What does a positive straight leg test indicate?
Sciatic nerve pain
Mx of lower back pain caused by prolapsed disc (i.e. sciatica)?
1st line –> analgesia, physiotherapy, exercises
Trial for 4-6 weeks
2nd line –> consider referral for MRI
What may patients who are allergic to aspirin also react to?
Sulfalazine
What are the commonent carpal fractures?
Scaphoid fractures
Typical mechanism of injury in a scaphoid fracture?
FOOSH
What are the main physical signs in a scaphoid fracture?
1) swelling and tenderness in anatomical snuffbox
2) pain on wrist movements
3) pain on longitudinal compression of thumb
What is a Galeazzi fracture?
Radial shaft fracture with associated dislocation of the distal radioulnar joint
What is a Smith’s fracture?
Reverse Colles’ fracture:
- Volar angulation of distal radius fragment (Garden spade deformity)
- Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
Typical mechanism of injury in an ACL rupture?
High twisting force applied to a bent knee
Typical presentation of an ACL rupture?
- loud crack
- pain
- RAPID joint swelling (haemoarthrosis)
often have poor healing
Typical mechanism of injury in a PCL rupture?
hyperextension injuries
How are ligmanentous injuries of the knee (e.g. ACL rupture) best confirmed?
MRI
what type of knee injury is Murray’s test used to test for?
Meniscal tear
What 2 tests can be used clinically to investigate ACL rupture?
1) Anterior drawer test
2) Lachman’s test
Describe the anterior drawer test
1) the patient lies supine with the knee at 90 degrees
2) the examiner should place one hand behind the tibia and the other grasping the patient’s thigh. It is important that the examiner’s thumb be on the tibial tuberosity
3) the tibia is pulled forward to assess the amount of anterior motion of the tibia in comparison to the femur
4) an intact ACL should prevent forward translational movement
Atlantoaxial subluxation is a rare complication of rheumatoid arthritis.
What investigations are required pre-operatively to screen for this complication?
Anteroposterior and lateral cervical spine radiographs
