Formative Assessments Flashcards
Name 3 blood tests to Dx osteomyelitis
FBC + diff WCC ESR CRP Blood cultures x3 U&E's
Name 3 types of imaging which can be used to Dx osteomyelitis
X-ray USS Labelled white cell scan Aspiration MRI
Name 3 DDx of acute osteomyelitis
Acute septic arthritis
Trauma (fracture, dislocation)
Transient synovitis
Acute inflammatory arthritis
Soft tissue infection:
Cellulitis
Erysipelas
Necrotising Fasciits
Name 2 likeliest organisms responsible for acute osteomyelitis
Staph. aureus
Strep. Pyogenes
Haemophilus influenzar
Which organism would be suspected to cause acute osteomyelitis in sickle cell disease
Salmonella
Name 2 Rx for acute osteomyelitis
Analgesia Rehydration Rest Spintage IV abx
Name 3 potential complications of acute osteomyelitis
Pathological fracture Chronic osteomyelitis Septicaemia Death Metastatic infection Septic artritis Altered bone growth (esp since young)
True or false:
Congenital clubfoot is a rare birth defect
False
It is a common one
True or false:
Congenital clubfoot is caused by a single gene defect
Fale
True of false:
Congenital clubfoot the sole of the foot turns laterally and the foot is everted
False
Turned medially and is inverted
Name 3 different types of synovial joints and where they are found
Plane (wrist) Hinge (elbow, knee) Condyloid/Ellipsoid Picot (atlas and axis) Saddle (thumb) Ball and socket (hip and shoulder)
Name 3 components of synovial fluid
Lubricin
Hyaluronic acid
Fluid component
Name 1 function of synovial fluid
Lubrication
Nutrition of cartilage
Removal of waste products
Name 2 anatomical features that aid in the stability of a joint
Ligaments
Muscles
Shape of articulating surface
Capsule
Name 3 groups of individual involved in the management of OA
GP Consultant Patient Physio OT
Name 2 non-pharmacological Rx for patients with OA
Thermotherapy
Electrotherapy
Manual therapy
Aids and devices
What non-pharmacological Rx do NICE NOT recommend for OA
Acupuncture
Nutraceuticals
Name 2 pharmacological Rx for OA
Analgesia Paracetamol NSAIDS Topical NSAIDS (Capsaicin) Steroid injections
Name 4 potential causes of a fracture slow healing
Infection Age Steroid use Metabolic disorder Smoking Malnutrition Radiotherapy Warfarin Immune suppressants
Describe strength in UMN lesions
Decreased
Describe strength in LMN lesions
Decreased
Describe tone in UMN lesions
Increased/hypertonia
Describe tone in LMN Lesions
Decreased/hypotonia
Describe reflexes in UMN lesions
Increased/hyperreflexia
Describe reflexes in LMN lesins
Decreased/hyporeflexia
Describe clonus in UMN lesions
Present
Describe clonus in LMN lesons
Absent
Describe babinskis in UMN lesions
Present
Describe Babinskis in LMN lesons
Absent
Is atrophy present in UMN lesions
No
Is atrophy present in LMN lesions
Yes
50yr F presents with sensation of painful clicking in volar aspect of her ring finger when bending it. Most likely diagnosis?
a. OA of MCJ
b. Duputryens disease
c. Flexor ganglion
d. Trigger finger
e. Ruptures flexor tenson
d. Trigger Finger
Name 4 muscles of the thenar eminence of the hand
Abductor pollicis brevis
Flexor pollivis brevis
Opponent pollicis
Adductor pollicis
60yr F attends surgery complaining of pain at base of thumb when putting on clothes and using it. Suspect OA of thumb. Name 2 operative and non-operative management of this lady
Non-operative: Analgesia (NSAIDs) Splinting Steroid injection Lifestyle modifications
Operative:
Fusion
Trapezioectomy
Replacement
Name 3 non-operative managements for painful foot conditions
Orthotics Weight loss Activity modification Footwear assessment/modification Physio
40yr old woman complains of shooting pains in 3rd web space of her foot made worse by wearing high heels. You suspect Mortons Neuroma. Name 2 clinical signs you might elicit. Name 2 Rx for this condition?
Signs:
Mulder click
Altered sensation in 3rd webspace
Palpable swelling of the nerve
Rx:
Excision
Steroid injection
50yr old DM attends clinical complaining of heel pain first thing in morning and on walking. You suspect plantar fasciitis. Give one differential diagnosis.
OA
Nerve entrapment syndrome
Calcaneal pathology
Name 4 traditional treatments used to treat plantar fasciitis
Weight loss Activity limitation Rest Steroid injections Stretching ICE NSAIDs
Name2 newer/third line rx for plantar fasciitis
Extracorpeal Shock Wave Therapy Nitric Oxide Platelet rich plasma Topaz Plasma Coblation Endoscopic/Open surgery
Name 3 muscles that attach to the clavicle
Trapezius Sternocleidomastoid Omohyoid Deltoid Stenohyoid Subclavius Pectoralis major
Name 3 directions in which the shoulder can dislocated
Anterior
Inferior
Posterior
What is the most common direction of shoulder dislocation
Anterior
Name 2 treatments for shoulder dislocation
Analgesia
Manipulation
Immobilisation
Physio.
Name 2 injuries where the axillary nerve is at risk
Shoulder dislocation
Fracture of surgical neck of humerus
What is the motor deficit of axillary nerve palsy
Loss of deltoid and trees minor
Cannot bend arm at elbow
Sensory deficit of axillary nerve palsy
Lateral arm sensation loss
Regimental badge area
Name 2 injuries where the radial nerve is at risk
Entrapment
Compression
Trauma
What is the motor deficit of radial nerve palsy
Wrist drop
Name 2 static constraints of the knee
Collateral ligaments (medial and lateral) Anterior cruciate ligament Posterior cruciate ligament Capsule ITB Meniscii
Name 2 dynamic constraints of the knee
Quadriceps
Hamsrings
Medial and lateral gastric.
Popliteus
Name 2 flexors of the knee
Biceps femoris
Semimembranosus
Semitendinosis
Gastrocnemius
Name 2 extensors of the knee
Rectus femoris
Vastus medialis
Vastus lateralis
Vastus intermedialis
Name 3 causes of caudal equine syndrome
Tumours Central lunar disc prolapse Trauma Infection Iatrogenic (spinal surgery or manipulation)
Name 2 clinical features of caudal equine
Bilateral sciatica Saddle anaesthesia Bladder incontinence Bowel incontinence Urinary retention
What is the Rx for caudal equine
Urgent surgical decompression
Name 3 types of blunt force injury
Contusions/Bruising
Abrasions
Lacerations
Names 2 types of sharp force injury
Incision
Stab wounds
What is the clinical term used for diffuse brain injury
Diffus axonal injury
What is the pathological term used for diffuse brain injury
Traumatic Axonal Injury
60yr M falls whilst working in his garden fracturing his left hip once he has recovered from the fracture which of the following would be the next step in his management?
a. Reassure him that it was simply bad luck as men of his age not at risk of osteoporosis
b. Commence him on bisphosphonate therapy
c. Refer for a bone density scan
d. Advise him to avoid working in the garden
e. Commence calcium and Vitamin D tablets
C. refer for a bone density scan
75yr M presents acute onset unilateral headaches, scalp tenderness and pain in his jaw on eating on a background of 2 month history of pain and stiffness of the shoulder what is the next best investigation?
a. ESR
b. RF
c. CT head
d. Temporal artery biopsy
e. ANA
d. temporal artery biopsy
Suspected GCA
50rs M attends GP complaining of swelling of his toes. He has just returned from a holiday. He has hypertension and his BMI is 32
What test wold be the most helpful to establish a Dx
Aspirate joint
22yr F presents 3mnth history of stiffness of hand joints and new onset right sides sharp chest pain on inspiration. Urinanalysis shows microscopic haematuria and proteinuria
What is the suspected Dx?
Which antibody should be tested
Lupus
Anti double stranded DNA Ab (dsANA)
Which cells are directly responsible for loss of articular cartilage
a. Macrophages
b. Synovial fibroblasts
c. T cells
d. B cells
e. Osteoclasts
Osteoclasts
78yr healthy woman on no medications presents acutely with a hot swollen left knee. She was previously well with only mild knee pain on coming down the stairs no other joint involvement. She is struggling to weight bear on the knee. What is the most likely Dx?
a. RA
b. Psoriatic arthritis
c. Pseudogout
d. Trauma
e. OA
Pseudogout (knee is what gout is to the big toe)
50yr lady attends GP concerned about osteoporosis as her mother had it. How should GP proceed
a. Perform a fracture risk assessment
b. Refer bone density scan
c. Explain she is too young and return in 5yrs time
d. Comment therapy HRT
e. Commence calcium and Vit D supplements
A. Perform a fracture risk assessment
23yr student sees his GP with a several year history back pain and stiffness. Pain is worse at night, first thing in morning and if he has been sitting for long periods of time. Otherwise well apart from previous episode of red painful eye which he received steroid eye drops for. O/E reduced Schobers test and is tender over his right sacroiliac joint. Which Ix would be most helpful in reaching a Dx
CRP HLA-B27 MRI whole spine Anti-CC antibody Trial of NSAIDs
c. MRI whole spine
Likely Dx = ankylosing spondylitis
HLA-B27 will be useful but not give whole Dx
67yr F presents with 3mnth history of proximal weakness of the upper and lower limbs. She struggles to lift her arms above the shoulder level and to stand from sitting unaided. Her blood tests show ESR at 80 and creatinine kinase at 5x the upper limit of normal range. What is the most likely Dx?
Polymyositis
- 30yr F newly diagnose with RA. 2yr old daughter currently trying for another baby. She has synovitis across the MCPs in both hands and has evidence of erosions and joint damage on x-ray
Which Rx should she receive?
a. NSAIDs
b. Methotrexate
C. Sulfasalazine
d. Leflunomide
e. Paracetemol
Sulfasalazine
a. NSAIDS (not strong enough)
b. Methotrexate - Not safe for pregnancy
c. Sulfasalazine - Safe for pregnancy
d. Leflunomide- Not safe for pregnancy
e. Paracetemol - Does not treat the disease
