Misc 2 Flashcards
What complications are associated with Takayasu’s arteritis?
Renal artery stenosis
What is phlegmasia cerulean dolens?
Rare complication of DVT
Presents suddenly with complete venous occlusion
Triad of lower extremity oedema, cyanosis + severe pain after 24hrs of blanching + edema
Management of phlegmasia cerulean dolens
Catheter directed thrombolysis
2nd line = thrombectomy
What is an ape hand deformity?
Occurs in median nerve damage
Inability to abduct + oppose thumb due to paralysis of thenar muscle
Describe the presentation of GPA
URT: epistaxis, sinusitis, nasal crusting
LRT: SOB, haemoptysis
Glomerulonephritis
Saddle shaped nose
Describe the 2 types of scleroderma
Limited = skin involvement limited to face + hands/ elbows only. CREST symptoms Diffuse = limited + full body skin involvement + renal damage + pulmonary fibrosis
What antibody is linked to diffuse + limited scleroderma?
Limited = anti-centromere Diffuse = Scl70
How do you manage scleroderma?
DMARDS, cyclophosphamide, biologics
What diseases are associated with ANCA?
Vasculitis
What disease is associated with anti-Ro?
Sjogrens syndrome
Describe rheumatic fever
Caused by strep pyogenes (sore throat) Erythema marginatum Sydenham’s chorea Polyarthritis Carditis Subcutaneous nodules
How do you treat myositis?
Steroids, DMARDS, biologics, IVIG
What other conditions is PMR related to?
GCA + temporal arteritis
Where does PMR usually affect?
Shoulders + thighs
What is pseudogout?
Acute CPP crystal arthritis (CPP = calcium pyrophosphate)
Presentation of acute CPP crystal arthritis
Sudden pain + stiffness (commonly knee)
Swelling, red, inflamed skin over joint
Fever
Presentation of acute calcific tendonitis
Painful swelling around joint, usually shoulder
Redness + tenderness
Settles in 2-4 weeks
Systemic sclerosis presentation
Stiffening, hardening or tightening of skin
Dysphagia + heartburn
Raynauds
Joint/ muscle pain/ stiffness
Investigation results for osteomalacia
Low Vit D, rasied ALP, low calcium, low phosphate
Blood results for osteoporosis
Normal bloods
Investigation results + presentation for Paget’s disease
Rise in ALP
Characteristic x ray changes; thickened skull vault, bowing of tibia + bossing of skull
Bone pain
Management of Pagets
Bisphosphonate
What do you need to check before starting azathioprine?
Check thiopurine methyltransferase deficiency (TPMT) before treatment
What score is used to measure RA impact?
DAS28
What are the associated features of ankylosing spondylitis?
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis
What is the most specific test for systemic sclerosis?
Anti-centromere antibodies
What antibodies are associated with RA?
Anti-CCP
What is a serious complication of dermatomyositis?
Ovarian, breast and lung tumours
What is Felty’s syndrome?
Splenomegaly
Neutropenia
Occurs in a pt with RA
What disease are cANCA + pANCA associated with?
cANCA = granulomatosis with polyangiitis pANCA = EGPA + others
What disease is associated with anti-Scl-70 ab?
Diffuse scleroderma (systemic sclerosis)
What disease is associated with anti-dsDNA ab?
SLE
What disease is associated with anti-CCP ab?
RA
What disease is associated with AMA?
Primary biliary sclerosis
Causes of drug induced SLE
Procainamide Hydralazine Isoniazid Minocycline Phenytoin
What ab are positive in SLE?
99% are ANA positive
20% are rheumatoid factor positive
anti-dsDNA: highly specific (> 99%), but less sensitive (70%)
anti-Smith: most specific (> 99%), sensitivity (30%)
also: anti-U1 RNP, SS-A (anti-Ro) and SS-B (anti-La)
Management of AS
NSAIDs then TNF inhibitors
Presentation of Sjogrens syndrome
dry eyes: keratoconjunctivitis sicca dry mouth vaginal dryness arthralgia Raynaud's, myalgia sensory polyneuropathy recurrent episodes of parotitis renal tubular acidosis (usually subclinical)
What is blue sclera associated with?
Osteogenesis imperfecta
What is the presentation of antiphospholipid syndrome?
Arterial/ venous thrombosis
Miscarriage
Livedo reticularis
What is Takayasu’s arteritis + what is the presentation?
Inflammatory arteritis of aorta
Upper limb claudication
Absent pulses
What is polyarteritis nodosu + what is the presentation?
Systemic necrotizing vasculitis of small + medium vessels
Common with hep B
What is wegeners granulomatosis + what is the presentation?
Small + medium sized necrotizing vasculitis
Cutaneous vascular lesions seen
What is a posterior femoral nerve stretch indicative of?
Referred lumbar spine pain as a cause of hip pain
What is Marfans caused by?
Autosomal dominant connective tissue disorder
Defect in FBN1 gene on chromosome 15
Defect in fibrillin
What are plantar spur and pencil + cup deformities typical of?
X ray features of psoriatic arthritis
What DMARD is safe in pregnancy?
Hydroxychloroquine
What does joint aspiration show in gout?
Needle shaped negatively birefringent crystals
What is a Z score on a DEXA scan adjusted for?
Age, gender + ethnicity
What antibody is positive in myositis?
Anti-Jo1
If someone is positive for Anti-Jo1 ab predispose you to?
Lung fibrosis (antisynthetase syndrome)
Describe the presentation of adult onset Stills
Joint pain, spiking fevers and pink bumpy rash
High serum ferritin and leukocytosis
RF for osteoporosis
Steroid use RA Alcohol excess Hx of parental hip fracture Low bmi Current smoking
What structure is divided in surgical management of carpal tunnel?
Flexor retinaculum
Burning thigh pain is indicative of what?
Meralgia paraesthetica – lateral cutaneous nerve compression
What is the most common cause of compartment syndrome?
Tibial fracture + supracondylar fracture
What are the complications of compartment syndrome in the kidneys?
Rhabdomyolysis caused myoglobin release in the blod
Deposits in renal tubules causing AKI
Results in dark brown urine, + for blood
Treatment of intracapsular fractures, based on mobility + displacement
Undisplaced = internal fixation Undisplaced + significant comorbidities = hemiarthroplasty Displaced <70 = internal fixation Displaced >70 = total hip replacement Displaced + immobile = hemiarthroplasty
Treatment of reverse oblique, transverse or subtrochanteric fracture
Intramedullary nail
Treatment of intertrochanteric fracture
Dynamic hip screw
What imaging is best for ?Achilles tendon rupture?
US
What is cubital tunnel syndrome?
Compression of ulnar nerve
Causes pins + needles in 4th + 5th finger
How does subacromial impingement present?
Painful arc of abduction (worse between 90 + 120 degrees)
What is adhesive capsulitis?
Frozen shoulder
Common in middle aged females, associated with DM
Describe the features of L3 nerve root compression
Sensory loss over anterior thigh
Weak quads
Reduced knee reflex
Positive femoral stretch test
Describe the features of L4 nerve root compression
Sensory loss over anterior aspect of knee
Weak quads
Reduced knee reflex
Positive femoral stretch test
Describe the features of L5 nerve root compression
Sensory loss over dorsum of foot
Weak in foot + big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
Describe the features of S1 nerve root compression
Sensory loss over posterolateral aspect of leg + lateral aspect of foot
Weak in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
Describe plantar fasciitis
Most common cause of heel pain
Pain in medial calcaneal tuberosity
Worse when walking on toes
When should a DEXA scan be done?
FRAX score >10%
What is Morton’s neuroma?
Benign neuroma affecting intermetatarsal plantar nerve, commonly 3rd MTP space
Causes forefoot pain, worse on walking
Mulder’s click if pressed
What is the motor, sensory nerve + typical injury that occurs to C5-C7?
Musculocutaneous nerve
Motor = elbow flexion + supination
Sensory = lateral part of forearm
Injured in brachial plexus injury
What is the motor, sensory nerve + typical injury that occurs to C5, C6?
Axillary nerve
Motor = shoulder abduction (deltoid)
Sensory = inferior region of deltoid
Injured in humeral neck fracture, results in flattened deltoid
What is the motor, sensory nerve + typical injury that occurs to C5-C8?
Radial nerve
Motor = Extension of forearm, wrist, fingers, thumb
Sensory = small area between dorsal aspect of 1st + 2nd metacarpals
Injured in humeral midshaft fracture, palsy results in wrist drop
What is the motor, sensory nerve + typical injury that occurs to C6, C8, T1?
Median nerve
Motor = LOAF muscles
Sensory = palmar aspect of lateral 3.5 figners
Causes carpal tunnel syndrome when compressed at wrist
Loss of pronation + weak wrist flexion when damaged