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Yr 5 - MSK > Corrections 3 > Flashcards

Corrections 3 Flashcards

1
Q

What is the key investigation in suspected septic arthritis?

A

Synovial fluid sampling

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2
Q

What is the most common organism implicated in a psoas abscess?

A

Staph. aureus

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3
Q

Features of a psoas abscess?

A

1) Lumbar tenderness (point of insertion of the psoas muscle is T12-L5)

2) Patient will prefer to lie with their knees slightly flexed

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4
Q

XR changes in osteoarthritis?

A

L - Loss of joint space

O - Osteophytes at joint margins

S - Subchondral cysts

S - Subchondral sclerosis

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5
Q

Cause of de Quervain’s tenosynovitis?

A

Inflammation of the tendons on the lateral aspect of the wrist and thumb.

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6
Q

What test is used to diagnose de Quervain’s tenosynovitis?

A

Finkelstein’s test

The hand should be deviated medially rapidly and sharp pain occurs along the distal radius.

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7
Q

What are 2 medications that commonly cause drug-induced lupus?

A

1) procainamide
2) hydralazine

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8
Q

What are 3 medications that less commonly cause drug-induced lupus?

A

1) isoniazid
2) minocycline
3) phenytoin

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9
Q

Cause of a shortened, internally rotated leg?

A

Hip dislocation (most likely posterior displacement of the femoral head).

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10
Q

Cause of a shortened, externally rotated leg?

A

NOF fractures

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11
Q

What abs are seen in limited systemic sclerosis?

A

Anti-centromere antibodies

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12
Q

What 2 fractures is compartment syndrome msot commonly associated with?

A

1) supracondylar fractures (arm)

2) tibial shaft fractures (leg)

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13
Q

Mx of plantar fasciitis?

A

1) weight loss
2) simple stretching
3) rest

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14
Q

What nerve injury is a common complication of a posterior hip dislocation?

A

Sciatic nerve injury

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15
Q

Are most hip dislocations anterior or posterior?

A

Posterior (90%)

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16
Q

How can sciatic nerve injury result in foot drop?

A

As the sciatic nerve supplies the common peroneal nerve.

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17
Q

What investigation is it important to do before starting biologics?

A

CXR - look for TB (can cause reactivation)

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18
Q

Mx of Paget’s disease of the bone?

A

Bisphosphonates

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19
Q

What type of reaction is allergic contact dermatitis? e.g. nickel

A

Type IV hypersensitivity (delayed)

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20
Q

Referral time for suspected cancer in children vs adults?

A

Children - 48h
Adults - 2w

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21
Q

What is a pharmacological option for Raynaud’s?

A

Nifedipine

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22
Q

1st line mx for pseudogout?

A

NSAIDs and colchicine (note - allopurinol is ineffective in pseudogout as uric acid is not implicated).

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23
Q

Risk factors for pseudogout?

A

1) age

2) haemochromatosis

3) hyperparathyroidisim

4) hypophosphataemia

5) hypothyroidism

6) hypomagnesaemia

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24
Q

What nerve is implicated in carpal tunnel syndrome?

A

Median nerve compression

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25
Q

Features of carpal tunnel syndrome?

A

1) pain/pins and needles in thumb, index, middle finger

2) symptoms may ‘ascend’ proximally

3) patient shakes hand to obtain relief, classically at night

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26
Q

What movement is weakened in carpal tunnel syndrome?

A

Thumb abduction (abductor pollicis brevis)

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27
Q

What is there wasting of in carpal tunnel syndrome?

A

Wasting of the thenar eminence (NOT the hypothenar)

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28
Q

What is Tinel’s sign?

A

Tapping of the median nerve causes paraesthesia

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29
Q

What is Phalen’s sign?

A

Flexion of the wrist causes symptoms

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30
Q

What 2 signs are seen in carpal tunnel?

A

1) tinel’s

2) phalen’s

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31
Q

What investigation is ankylosing spondylitis most supported by?

A

Sarco-ilitis on a pelvic XR

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32
Q

What is an important differential for tibial stress syndrome?

A

Stress fracture of the tibia –> get an XR!

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33
Q

What monitoring is required in methotrexate?

A

FBC, U&Es and LFTs every 3 months

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34
Q

What is the imaging modality of choice for suspected Achilles tendon rupture?

A

US

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35
Q

What is ‘Simmond’s test positive’?

A

Absence of plantar flexion on squeezing the calf on the affected leg –> this sign is pathognomonic of an Achilles tendon rupture.

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36
Q

What is cubital tunnel syndrome?

A

Compression of the ulnar nerve –> tingling/numbness of the 4th and 5th finger.

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37
Q

What is the purpose of Tinel’s test?

A

Used to diagnose nerve compression or damage.

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38
Q

What is the most common reason that a total hip replacement needs to be revised?

A

Aspectic loosening (hip or groin pain radiating down to the knee).

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39
Q

What radiculopathy causes weakness of hip abduction & foot drop?

A

L5 radiculopathy

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40
Q

Most common cause of an L5 radiculopathy?

A

Slipped disc compressing the nerve root.

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41
Q

What radiculopathy causes a reduced knee jerk?

A

L4

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42
Q

What radiculopathy causes a reduced ankle jerk?

A

S1

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43
Q

Are reflexes affected in L5 radiculopathy?

A

No

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44
Q

What is a Ewing’s scarcoma?

A

A malignant tumour that occurs most frequently in the diaphysis of the pelvis and long bones.

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45
Q

XR feature of a Ewing’s scarcoma?

A

‘Onion skin’ appearance on XR

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46
Q

What is Schober’s test used to investigate?

A

Reduced forward flexion in AS

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47
Q

What is Schober’s test?

A

Line is drawn 10cm above and 5cm below the back dimples.

The distance between the 2 lines should increase by >5cm when the patient bends forward.

48
Q

What are some additional features that may be seen in AS? (the A’s)

A
  • anterior uveitis
  • apical lung fibrosis
  • AV node block
  • aortic regurgitation
  • achilles tendonitis
49
Q

What is the most useful investigation in establishing a diagnosis of AS?

A

Plain XR of sacroiliac joints –> sarco-ilitis

50
Q

XR features in AS?

A

1) Sacroilitis: subchondral erosions, sclerosis

2) Squaring of lumbar vertebrae

3) ‘Bamboo spine’: late & uncommon

4) Syndesmophytes: due to ossification of outer fibers of annulus fibrosus

51
Q

If the x-ray is negative for sacroiliac joint involvement in ankylosing spondylitis but suspicion for AS remains high, what is the next step?

A

MRI

52
Q

Cause of a restrictive picture on spirometry in AS?

A

Combination of pulmonary fibrosis, kyphosis and ankylosis of the costovertebral joints.

53
Q

1st & 2nd line mx of AS?

A

1st –> NSAIDs, physio & regular exercise

2nd line –> DMARDs e.g. sulphalazine

54
Q

What is a key risk factor for infective olecranon bursitis?

A

Immunosuppressed

55
Q

What organism is most commonly responsible for infective olecranon bursitis?

A

Staph. aureus

56
Q

What are 2 systemic conditions that can lead to olecranon bursitis?

A

1) RA
2) Gout

57
Q

What may be present if olecranon bursitis is associated with gout?

A

Tophi

58
Q

What movement causes pain in olecranon bursitis?

A

When elbow is in full flexion (swollen bursa is compressed)

59
Q

Does straw-coloured fluid from a joint indicate an infection?

A

No

Normal synovial fluid is usually straw-colored, clear, and slightly sticky or stringy.

60
Q

Local corticosteroid injections may be considered in cases of persistent, non-septic olecranon bursitis that do not respond to conservative measures.

However, what does this increase the risk of?

A

Infection & tendon rupture

61
Q

What are the 2 fractures carrying the highest risk for compartment syndrome?

A

1) Tibial shaft

2) Supracondylar

62
Q

Give 2 causes of compartment syndrome

A

1) Fractures

2) Ischaemia reperfusion injury in vascular patients

63
Q

What intracompartmental pressure measurement is diagnostic of compartment syndrome?

A

≥40mmHg

64
Q

Why may aggressive IV fluids be needed after a fasciotomy in compartment syndrome?

A

Due to potential myoglobinuria

65
Q

What accumulates in joints in gout?

A

Monosodium urate (MSU) crystals

66
Q

How can CKD cause gout?

A

Reduced renal excretion of urice acid

67
Q

Are investigations always required in the fx of gout?

A

No - investigations not needed if features suggestive of gout and no suspicions of other conditions (e.g. septic arthritis)

68
Q

Synovial fluid analysis in gout?

A

1) MSU crystals

2) Needle shaped

3) Negatively birefringent

69
Q

When should serum uric acid levels be measured after an acute attack of gout?

A

4-6 weeks after

70
Q

What may be seen on an XR in chronic gout?

A

Punched out, lytic lesions

71
Q

What is the 2nd line agent for uric acid lowering in gout(when allopurinol is not tolerated or ineffective)?

A

Febuxostat: also a xanthine oxidase inhibitor

72
Q

Give some risk factors for pseudogout

A
  • increasing age
  • haemochromatosis
  • hyperparathyroidism
  • low mg, low phosphate
  • acromegaly
  • Wilson’s
73
Q

Key XR finding in pseudogout?

A

Chondrocalcinosis

74
Q

What medications may be indicated in the mx of fibromyalgia?

A

1) duloxetine
2) pregabalin
3) amitriptyline

75
Q

What has the strongest evidence base for mx of fibromyalgia?

A

Aerobic exercise

76
Q

Results of osteomalacia blood tests?

A
  • low calcium
  • low phosphate
  • high ALP
77
Q

Mx of osteomalacia?

A

Vitamin D supplements

78
Q

1st line mx of HTN in systemic sclerosis?

A

ACEi

79
Q

Initial mx of suspected or confirmed scaphoid fracture?

A

1) immobilisation with a Futuro splint or standard below-elbow backslab

2) Referral to orthopaedics

80
Q

Mx of suspected scaphoid fracture when initial imaging is inconclusive?

A

Clinical review with further imaging should be arranged for 7-10 days later

81
Q

Orthopaedic mx of scaphoid fractures:

a) undisplaced

b) displaced

c) proximal scaphoid pole fractures

A

a) cast for 6-8 weeks

b) requires surgical fixation

c) require surgical fixation

82
Q

What is Pott’s fracture?

A

Bimalleolar ankle fracture due to forced foot eversion

83
Q

What is the main neurovascular structure that is compromised in a scaphoid fracture?

A

Dorsal carpal arch of the radial artery –> risk of avascular necrosis

84
Q

Does a negative gram stain rule out septic arthritis?

A

No - Gram staining is negative in around 30-50% of cases of septic arthritis

85
Q

What is a buckle fracture?

A

incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex.

86
Q

What is found on the joint aspirate in reactive arthritis?

A

No organism growth on gram stain

87
Q

1st line medical mx of Raynaud’s?

A

CCBs e.g. nifedipine

88
Q

Describe phalen’s test

A

The patient’s wrist is held in maximum flexion (reverse prayer sign) for 30-60 second.

The test is positive if there is numbness in the median nerve distribution

89
Q

What is the most common cardiac manifestation of SLE?

A

Pericarditis

90
Q

What are 3 cardiac features that may be late signs of Lyme disease?

A

1) Heart block
2) Pericarditis
3) Myocarditis

91
Q

What is an alternative to doxycycline in the mx of Lyme disease (e.g. in pregnancy)?

A

Amoxicillin

92
Q

Mx of disseminated lyme disease?

A

Ceftriaxone

93
Q

What may occur after initiating therapy in Lyme disease?

A

Jarisch-Herxheimer reaction

94
Q

When can OA be diagnosed clinically without further investigations? (3)

A

1) age >45 y/o
2) exercise related pain
3) no morning stiffness or morning stiffness lasting > 30 minutes

95
Q

What gait may be seen in osteomalacia?

A

Waddling gait due to proximal myopathy

96
Q

Give some causes of 2ary osteoporisis

A

1) hyperparathyroidism
2) hyperthyroidism
3) alcohol
4) immobilisation

97
Q

What are the 3 most common fractures occuring in osteoporosis?

A

1) NOF
2) Colles
3) Vertebral compression wedge fracture

98
Q

What % of vertebral compression fractures are symptomatic?

A

Only 2/3

99
Q

DEXA scan T score results:

a) normal
b) osteopenia
c) osteoporosis

A

a) > -1.0

b) -1.0 to -2.5

c) ≤ -2.5

100
Q

Define severe osteoporosis

A

T score ≤ -2.5 AND a fragility fracture

101
Q

What is a monoclonal antibody that can be used in the mx of severe osteoporosis?

A

Denosumab

102
Q

Give some situations where oral bisphosphonates would be offered straight away in the mx of osteoporosis?

A

1) DEXA scan: T score ≤ -2.5

2) ≥75 y/o with a fragility fracture

3) Post-menopausal woman or man ≥50 y/o with a symptomatic osteoporotic vertebral fracture

4) Post-menopausal woman or man ≥50 y/o treated with steroids

103
Q

What dose of steroids indicate the need for bisphosphonates?

A

if starting ≥7.5 mg/day prednisolone or equivalent for the next 3 months

104
Q

Which SERM may be used in osteoporosis?

A

Raloxifene

105
Q

NICE guidelines recommend referring people to a rheumatologist who present with atypical features of PMR.

What are some atypical features?

A

1) <60 y/o
2) red flags e.g. weight loss, night pain or neurological features

3) do not have the core symptoms of PMR

4) have unusual features of PMR e.g. limited response to steroids

106
Q

What is the most common type of intracapsular fracture in the proximal femur?

A

Subcapital fracture (a break in the neck of the femur that occurs at the junction of the head and neck).

107
Q

What medication is indicated in housebound patients?

A

Vitamin D

108
Q

Next step in mx of AS if oral NSAIDs haven’t helped?

A

TNF-alpha blockers such as infliximab and etanercept.

109
Q

What should be corrected before giving bisphosphonates?

A

Hypocalcaemia/vitamin D deficiency

110
Q

How long should symptoms be present for before a diagnosis of chronic fatigue syndrome?

A

3 months

111
Q

Which TB drug canc cause drug-induced lupus?

A

Isoniazid

112
Q

Does an asymmetrical presentation suggests psoriatic arthritis or rheumatoid?

A

Psoriatic arthritis

113
Q

When is a total hip replacement favoured to hemiarthroplasty?

A

If patients:

a) were able to walk independently out of doors with no more than the use of a stick and

b) are not cognitively impaired and

c) are medically fit for anaesthesia and the procedure.

114
Q

Blood test results in APS? (2)

A

1) prolonged APTT (paraxodically)

2) low platelets

115
Q

Is azathioprine safe to use in pregnancy?

A

Yes

116
Q

Type A vs B v C ankle fractures (Weber classification)?

A

Type A: below the syndesmosis

Type B: fractures start at the level of the syndesmosis

Type C: above the syndesmosis

117
Q
A

Yr 5 - MSK (22 decks)

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