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MSK Flashcards

1
Q

What is Paget’s disease of the bone

A

Osteitis deformans

  • increased bone turnover
  • disorganise remodelling, deformity, weakness
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2
Q

cause of Pagets disease of the bone

A
  • genes- SQSTM1, RANK

- viral- RSV,

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3
Q

sx of pagets disease of the bone

A
  • asx in most
  • deep, boring pain
  • deformity- pelvis, L spine, femur, tibia, frontal bossing of the skill
  • headaches
  • pathological #
  • OA
  • nerve compression
  • malignancy, HF, kidney stones
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4
Q

ix ?paget’s

A
  • skeletal XR survery
  • bloods - ALP raised, Ca PO4 normal
  • **- boneturnover markers in urine
  • **- bone scans
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5
Q

tx paget’s

A
  • analgesia
  • bisphos- alendronic acid
  • calcitonin 3m
  • surgery- osteotomy, arthroplasty, # alignment
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6
Q

What is osteomalacia

A

normal amount of bone, low minerl acontent

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7
Q

causes of otseomalacia

A
  • Vit D deficiency
  • CKD- 1,25,dihroxy cholecalciferol deficiency
  • liver disease- reduced hydroxylation of Vit D and malabs
  • tumour induced- hyperphosphaturia
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8
Q

describe the way in which UV, vitamin D is processed in the body and used

A
  • UV on skin causes 7-dehydrocholesterol to be converted to pre- vit D3
  • pre- vit D3 is converted into cholecaliferol (vit D3)
  • vit D3 and D2 are eaten via supplements, fish and meat
  • Vit D3 is converted in 25-hydoxyvitD3 in LIVER
  • KIDNEYS release 1alpha hydroxylase, whihc converts hydroxy vit D3 into 1,25-dihydroxyvitmain D ie calcitriol
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9
Q

what does calcitriol do

A

ie 1,25-dihydroxycholecalciferol

INCREASES SERUM CA

  • increases Ca absorption in gut
  • increases reabs of Ca in kidneys
  • increases bone breakdown (osteoclasts)
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10
Q

presentaiton of osteomalacia

A
  • rickets
  • hypocalcaemia- confusion, numbness, spasms, seizure, MI
  • bone pain
  • pathological #
  • proximal myopathy- waddling
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11
Q

ix osteomalacia

A

bloods- hypoCa, hypophosphataemia, increased ALP and PTH, decreased vit D

XR- loss of cortical bone, #

bone biopsy- poor mineralisation

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12
Q

management of osetomalacia

A
  • vit D
  • Ca
  • calcitriol
  • phsophate
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13
Q

What is oeseoporosis

A
  • low bone mass and microarchitectural deterioration-

- thinned, disconnected trabeculae

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14
Q

causes of OP

A
  • inflammation- cytokines increase bone resorp
  • endocrine- hyperthyroid, Cushing’s, steroids,
  • oestrogen/testosterone
  • poor skeletal loading (immobility, low body wt)
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15
Q

ix OP

A
  • FRAX score- 10 yr prob of hip/bone #

- dual energy XR- t-score

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16
Q

what are the cut offs and definitions of a T-score

A

> -1 = normal
-1 to -2.5= Osteopenia
< -2.5 = OP
< -2.5 + # = severe OP

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17
Q

Management of OP

A

Cause

  • HRT in early menopause/hysterectomy
  • control thyroid
  • control inflammatory conditions

Bisphosphonates
- alendronate PO, Zoledronate IV

  • Denosumab- monoclonal antibody to RANKL- blocks bone resorption
  • Teriparatide-
  • synthetic PTH analogue, daily injection
  • increases osteoblast activity and bone formation (dont think too hard about it)
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18
Q

what instructions do you give some taking oral alendronic acid

A
  • dont lie down for 30min after
  • have with water
  • get dental appt before taking- linked with osteonecrosis of the jaw
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19
Q

what is osteogenesis imperfecta

A
  • disorder of type 1 collagen
  • brittle , fragile bones
  • bone heals with deformity
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20
Q

types of osteogenesis imperfecta

A

Type 1- least severe

Type 3- severe, pogressively deforming

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21
Q

presentation of oesteogenesis imperfecta

A
  • #
  • bowing of long bones
  • blue sclera
  • hearing loss
  • short stature, scoliosis
  • ***- ligamentous laxity– hyperextensible joints
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22
Q

ix ?osteogenesis imperfecta

A
  • foetal USS_ only picks up severe, type 3
  • bloods- ALP raised
  • genetic testing
  • skin biopsy- assess collagen
  • bone biopsy
  • XR
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23
Q

Management of osteogenesis imperfecta

A
  • Ca
  • bisphosphonates
  • synthetic calcitonin (opposes PTH, usually produced by thyroid)
  • intramedullary rods to prevent bowing
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24
Q

What is Scheuermann’s disease

A
  • slow growth of anterior spine

- leads to kyphosis, deformity

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25
Q

management of scheuermann’s

A
  • lifestyle- physio, back braces

- surgery to manage pain

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26
Q

what is osteopetrosis

A
  • inherited

- increased bone density and abnormal growth

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27
Q

sx osteopetrosis

A
  • neonatal bone marrow failure , pancytopenia
  • incidental findings on XR
  • #
    • short stature
    • nerve compression
    • hypocalcameia- confusion, seizures, spasms
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28
Q

management of osteopetrosis

A
  • vit D
  • EPO/bone marrow transplant
  • surgery
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29
Q

what is achondroplasia

A
  • autosomal dominant
  • overproduction and deposition of collagen
  • cartilage does not harden to bone on grwth plate
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30
Q

sx achondroplasia

A

Deformity

  • dwarfism- short, enlarged head, frontal bossing
  • kyphosis, lordosis
  • leg bowing
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31
Q

management of achondroplasia

A
  • GH therapy

- limb lengthening surgery- controversial

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32
Q

OA sx

A
  • painful joints- stiffness
  • worse with activity
  • srepitus
  • herberdens and bouchards nodes
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33
Q

ix oA

A 
XR
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
  • bloods- bone profile (Ca, D, PO4, ALP- normal
  • diagnostic injeciton
  • arthroscopy
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34
Q

tx OA

A
  • lifestyle- physio, wt loss, footwear
  • ibuprofen gel
  • analgeisia
  • steroid intra-art injections
  • DMARDS- if inflam element
  • surgery- arthroplasty, fusion
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35
Q

RA sx

A
  • symmterical, deforming, polyarthropathy
  • swan neck (hyperextension PIP, flexion DIP)
  • Boutonniere- flexion PIP, hyperextension DIP)
  • ulnar deviation
  • joint pain and stiffness worse in morning/inactivity , >30min
  • swollen, red hot joint in flare
  • fatigue, malaise, wt loss

Extra artiuclar

  • Lungs- nodules, fibrosis= caplans syndrome
  • skin- nodules, rashes, vasculitis
  • **- eyes- sjogrens, scleritis/episcleritis
  • **- neuro- peripehral neuro
  • CVS- CVA, endocarditis/pericarditis/ CVD
  • OP (cytokines increase bone turnover)
  • *- glomerulonephritis
  • *- hepatitis
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36
Q

ix ?RA

A
  • CRP/ESR
  • Anti-nuclear antibodies, RF, Anti-cyclic citrullinated peptide
XR
Loss of joint space
*Erosion of joint
Subchondral sclerosis
*Soft tissue swelling
  • CXR if ?lung involvement
  • MSU if ?renal involvement, echo
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37
Q

when to urgently refere RA

A
  • small joints in hands/feet
  • > 1 joitn affecte
  • delay in >3m between onset of sx and seeking medical advice
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38
Q

management RA

A
  • smoking cessation
  • walking aids, splints, physio, OT
  • bridge DMARD with steroid
    1. DMARD- methotrexate or sulfasalazine, or hydroxychloroquine
    2. combination DMARDs
    3. biological DMARDS +methotrexate - infliximab, rituximab, abatacept, tocilizumab
  • surgery to improve function and prevent deformtiy
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39
Q

what monitoring is there of RA

A
  • CRP until remission/low-activity disease
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40
Q

what crystals are involved in gout

A
  • urate- purine breakdown pyproduct
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41
Q

causes of gout

A

Hyperuricaemia

  • high purine diet
  • drugs
  • renal failure
  • genes
Underexcretion of urate
- alcohol
- Renal impairement
genes
- ****diuretics, aspirin, anti-TB, lead

Overproduction of urate

  • myeloproliferative
  • ***CT
  • **psoriasis
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42
Q

sx gout

A
  • acute (overnight)- severe joint pain
  • hallux MTP most commonly
  • red, swollen joint
  • reduced ROM
  • tophi- aggregates, go in 2 years
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43
Q

ix ?gout

A

hx- meds, wt, HTN, alcohol

  • bloods- UE, urate (NOT diagnostic)
  • XR- effusion, punched out lesions (rat bites)
  • synovial fluid aspiration polarised light micro
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44
Q

what do crystals look like in gout on synovial fluid aspiration, polarised light micro

A
  • negatively birefringent needles
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45
Q

tx acute gout

A

Acute

  • NSAID, PPI
  • Colchicine
  • *- aspiration
  • *- IA steroid injection
  • *- PO steroids
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46
Q

tx gout LT

A

Chronic

  • Allopurinol/febuxosat (xanthine oxidase inhibitors)– give >2w post latest attack, monitor UEs
  • co-prescribe colchicine at 1st as can cause flare in uric acid in 1st w
  • never give with azathioprine- can cause reaction
  • diet– reduce beer, purine high foods (fish, meats)
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47
Q

what crystals cause pseudogout

A

Ca pyrophosphate

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48
Q

sx pseudogout

A
  • monoarthritis
  • severe pain
  • stiffness, swelling
  • +-fever
    trigger
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49
Q

trigger of gout/pseudogout

A
  • trauma to joint
  • dehydration
  • illness
  • post surgery
  • endocrine/metabolic disorder
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50
Q

ix ?pseudogout

A
  • XR_ chondrocalcinosis
  • synovial aspiration- polarised light micro
  • iron studies, bone profile, Mg
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51
Q

what ye see on polarised light microscopy for pseudo gout

A

positively birefringent rhomboids

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52
Q

management of pseudogout

A
  • NSAIDs, PPI
  • Colchicine
  • arthrocentesis
  • ***- IA steroid
  • **- trial anti-rheumatic drug- hydrocychloroquine, methotrexate
  • **- synovectomy, surgery
  • physio
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53
Q

what causes juvenile gout

A

Lesch-Nyhan Syndrome

  • genetic X linked
  • enzyme deficiency
  • build up of uric acid
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54
Q

What are seronegative spondyloarthropathies

A
  • a group of conditions
  • associated with HLAB27- human leukocyte antigen
  • will NOT test positive for RF (seronegative)
  • unknown disease mechanism
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55
Q

What are the seronegative spondyloarthropathic conditions?

A
  • Ankylosing spondylitis
  • Psoriatic Arthritis
  • Enteropathic arthritis
  • Reactive arthritis (Reiter’s)
  • ## Junvenile idiopathic arthritis
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56
Q

sx of ank spond

A
  • stiffening and fusion of the spine (reduced neck movements, twisting, chronic flexion)
  • pain in ilio-scaral joint
  • alternating buttock pain
  • *- stiffness- worse in morning
  • insidious onset
  • *- dactylitis
  • *- enthesitis- achilles, elbow, knee, costochondritis
  • *- spinal # predisposition
  • *- iritis/anterio uveitis
  • lung fibrosis (apical)
  • aortic regurg, AV node block
  • *- amyloidosis
  • other AI cnoditions
  • fatigue wt loss
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57
Q

ix for ?ankylosing spondylitis

A
  • o/e- tenderness over spine/iliosacral joints, reduced lateral flexion, schober’s positive (foward flexion), reduced chest expansion
  • FBC- normocytic anaemia of chronic disease
  • CRP/ESR
  • RF negatvie
  • XR spine- bamboo
  • MRI- oedema
  • *- DEXA- OP
  • *- genetics- HLAB27
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58
Q

Management of ank spond

A
  • smoking cessation
  • physio, hydrotherapy, exercise
  • NSAIDs, paracetemol, codeine
  • anti-TNF biologics- etanercept, adalimumab
  • steroid injections- ST relief of flares
  • surgery- vertebral osteotomy to correct deformity
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59
Q

what proportion of psoriatic patients are affected by psoriatic arthritis

A

15%

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60
Q

sx of psoriatic arthritis

A
  • large joint oligoarthritis
  • DIP arthritis
  • pain
  • arthritis mutilans- floppy fingers poiting in wrong directions, osteolysis, telescoping, no pain anymore
  • *- dactylltis- v. painful
  • psoriasis- extensor surfaces
  • genital , scalp and belly button psoriasis

NAILS - in 80%

  • moth eaten looking
  • onycholysis- lifting off, thickened, creamy
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61
Q

ix for ?psoriasis

A
  • psoriasis epidemiological screening tool
  • bloods- anaemia of chronic disease, CRP/ESR, RF -ve
  • XR- DIP erosion (pencil in cup), periostitis, ankylosis, osteolysis
  • MRI- dtects early changes
  • HLA27
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62
Q

tx ank spond

A
  • NSAID
  • steroid injections

Immunosups (same as RA
1. DMARD- metho, ciclosporin, sulfalazine
2. 2x DMARD
3. Metho + anti-TNF (etanercept, infliximab, adalimumab
-

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63
Q

What is enteropathic arthritis

A
  • arthritis associated with IBD
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64
Q

sx enteropathic arthritis

A
  • sacroilitis
  • peripheral arthritis- commonly symmetrical
  • enthesitis (tendon/ligament insertion pain)
  • GI sx
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65
Q

management of enteropathic arthritis

A
  • treat IBD (pred/hydrocortisone (IBD), aminosalicylate (UC) methotrexate, azathioprine)
  • DMARDs- methotrexate, azathioprine
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66
Q

What is reactive arthritis

A
  • GI (salmonella, shigella) or STIs (chlamydia) trigger sterile inflammation of synovial membrane/fascia/tendons
  • higher incidence in those with psoriasis
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67
Q

sx of reactive arthritis

A
  • GI sx
  • STI sx
Cant see, wee, climb a tree
Arthritis:
- sacroilitis, spondylitis
- datylitis
- enthesitis

Eye

  • conjunctivitis
  • iritis
  • urethritis
  • balanitis

skin- brownish scaling on palms/soles (keratoderma blennorrhagica)

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68
Q

ix ? reactive arthritis

A
  • ESR/CRP,
  • *- RF negative
  • aspirate joint to exclude crystals, septic
  • stool culture, urethral/vagina swab
  • *+- XR/**MRI
  • *- HLA b27
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69
Q

tx reactive arthritis

A

NSAIDs

  • IA steroid injection
  • recurrent cases- DMARD (sulfalazine, anti-TNF)
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70
Q

presentation of juvenile idiopathic arthritis

A
  • Gradual Onset
  • stiffness, pain after rest
  • limp
  • ant. uveitis (may be presenting sx)- photophobia, redness, tearing, blurring, floaters
  • malaise, irritability, rash, fever, wt loss
  • may have hx of sore throat, URTI, prev. infection
  • fam hx of HLAB27 sx (iritis, arthritis, psoriasis)
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71
Q

diagnosis of junveline idiopathic arthritis

A

Of exclusion- rule out:

  • septic arthritis (joint aspiration)
  • reactive arthritis (swab/urine, stool)
  • *- trauma (XR)
  • *- malignancies (leukaemia, bone) (XR, FBC)
  • ‘Juvenile’ <16yo
  • idiopathic- no cause found
  • arthritis- join swelling/painful restriction >56w

ix

  • bloods- anaemia, ESR/CRP,
  • antibodies (RG, ANA, anti-ccp)- negative
  • infection screen, joint aspirate
  • STI swabs, Stool culture
  • XR, MRI
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72
Q

management of juvenile idiopathic arthritis

A
  • NSAIDs, analgesia
  • methotrexate
  • corticosteroids (avoid if poss- growth, OP)
  • biologics- TNFa, IL-6 blocker (tocilizumab)
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73
Q

complications of junvenile idiopathic arthritis

A
  • increased BF due to inflammation–> bone overgrowth–> limp/deformity
  • joint destruction needing replacement early
  • *- severe visual impairment from uveitis
  • *- anaemia of chronic disease
  • *- OP
  • growth failure
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74
Q

What is the pathophysiology of systemic lupus erythematosus

A
  • multisystem autoimmune condition
  • type 3 hypersensitivity
  • immune complex formation
  • these deposit in organs
  • immune complex mediated inflammation–> tissue damage
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75
Q

key sx in presentation of SLE to look out for

A
  • malar/butterfly rash (in 1/3)- across nose, cheeks, defined boarders
  • discoid rash- scarring
  • levedo reticularis- mottled skin
  • photosensitivity- disease made worse by UV
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76
Q

other sx of SLE (not key)

A
  • sicca- dry eyes/mouth
  • *- oral ulcers
  • alopecia
  • resp- SOB, chest pain (pleuritis, pulm HTN, fibrosis)
  • CV- HTN, CVA, raynauds, IHD
  • GI- D+V, pain (peritonitis, pancreatitis)
  • renal- HTN, renal failure
  • *- MSK- arthritis, **tendon rupture
  • *- Neuro- meningitis, MG, seizures
  • psych issues
  • anaemia, thrombocytopenia (bleeding), thrombosis
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77
Q

diagnosis of SLE

A
  • no diagnostic test
  • FBC- pancytopenia
  • *- coomb’s- haemolytic anaemia
  • ESR
  • UE- dysfunction, urinalysis
  • *- coag
  • anti-dsDNA antibody (specific), ANA, RF, **cardiolipin
  • CXR, echo, MRI head
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78
Q

management of SLE

A
  • statins, antiHTN, antiplatelets
  • skin- sunscreen, topical steroids
  • joints- NSAID, IA steroids

MILD- hydroxychloroqiune + NSAID

MODERATE- corticosteroids+ methotrexate/azathioprine, mycophenolate mofetil

SEVERE- corticosteroid +cyclophosphamide, biologics

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79
Q

What is antiphospholipid syndrome

A
  • autoimmune attack on fat molecules

- increase clot risk

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80
Q

sx antiphospholipid syndrome

A
  • thrombosis- DVT, stroke, TIA, MI, PE
  • HTN
  • **- balance and mobility issues
  • ** - vision/speech/memory issues
  • parasethesia, migraines
  • fatigue
  • unexlpained miscarriage, PROM, severe pre-eclampsia
  • livedo reticularis- mottled skin
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81
Q

antibodies may be present in antiphosphalipid syndrome

A
  • lupus anticoagulant
  • anti-apoliproprotein
  • anti-cardiolipin
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82
Q

tx antiphospholipid syndrome

A
  • anticoag/antiplatelets lifelong

- acute - SC heparin

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83
Q

what is systemic sclerosis (scleroderma)

A
  • autoimmune

- microvasc damage

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84
Q

sx systemic sclerosis/scerloderma

A

CREST
Calcinosis (under skin, esp in fingers- infections, bumpy)
Raynaud’s
oEsophageal dysmotility
Strictures/sclerodactylyl (white fingers)
Telangiectasia

  • sx in the systems
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85
Q

ix scleroderma

A
  • ANA
  • anaemia of chronic disease (normo)
  • ESR
  • ix for systems if sx (ECG, echo, CXR, CT, XR)
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86
Q

tx scleroderma/systemic sclerosis

A
  • smoking cessation
  • stretch skin to keep ROM, emollient
  • raynauds- vasodilators— iloprost, sildenafil, nifedipine
  • GORD- omeprazole
  • renals- ACEI
  • antihistamines for itch
  • cyclophosphamide
  • methotrexate
  • organ transplant
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87
Q

what is sjorgrens

A
  • lymphocytic infiltration of tear and salivary glands

- can coincide with other autoimmune conditions

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88
Q

sx sjogrens

A
  • sicca- dry mucous membranes
  • enlarged salivary glands, stones
  • cough, dyspareunia, oesophagitis
  • systemic features (arthralgia, neuropathies, thyroid etc.)
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89
Q

ix ?sjogrens

A
  • bloods- anaemia, ESR, **raised igG
  • **- RF (100%)!!!!!!!!!
  • **- anti-ro, anti-la (70%)
  • ANA
  • **- schirmer’s test- filter paper 5 min on eye– <10mm travel
  • salivary gland biopsy- lymphocytes
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90
Q

tx sjogrens

A
  • oral hygeine
  • artificial tears, saliva, lube
  • muscarinic agonist (pilocarpine)- increase saliva prod via parasymp stim.
  • steroids, DMARDS
  • hydroxychloroquine
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91
Q

what is polymyositis/dermatomyositis

A
  • symmetrical inflammation of skin and striated muscle

- can present as a paraneoplastic syndrome as underlying cancers in breast, lung, ovarian, gastric

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92
Q

sx polymyositis/dermatomyositis

A

dermato: - rash, Gottrons papules- red papules over knuckles
- muscle pain- proximal, symmetrical, shoulder, pelvis– onset over weeks
- muscle weakness
- fever, arthralgia
* *- raynauds
* *- fibrosis, arrhythmias
* *- other AI conditions

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93
Q

ix polymyositis/dermatomyositis

A
  • CK >1000
  • ANA, Anti-SRP
  • *- EMG - abnormal muscle activity
  • raised WBC, ESR
  • definitive – skin/muscle biopsy

**- screen for malignancy- CXR, TFTs, CT

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94
Q

management of polymyositis/dermatomyositis

A
  • PT/OT
  • high dose steroids, OD/top
  • methotrexate
  • azathioprine
  • IV ig
  • infliximab, etanercept (biologics)
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95
Q

Name large vessel vasulitises

A
  • Takyasu

- Giant cell/temporal

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96
Q

Name small vessel vasulitises

A
  • microscopic polyangitis
  • granulomatosis with polyangitis (wegner’s)
  • eosinophilic granulomatosis with polyangitis (churg-strauss)
  • buerger’s/thomboangiitis obliterans
  • polyarteritis nodosa
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97
Q

general presentation of vasculitis

A
  • systemically unwell, fever
  • *- arthralgia/arthritis
  • wt loss, anorexia
  • infarction (stroke, bowel, peripheral vasc, ulcers, gangrene)
  • HTN, renal failure via glomerluonephritis
  • *- scleritis, sight loss
  • *- psychosis, chorea, seizures, impaired cognition
  • angina
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98
Q

ix for ?vasculitis

A
  • ANCA- small/medium
  • cANCA
  • pANCA
  • vessel biopsy
  • dopplers
  • CT/MRI for larger vessels
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99
Q

tx for vasculitis (generally)

A
  • smoking cessation
  • steroids (cortico- pred)
  • methotrexate
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100
Q

sx giant cel arteritis

A
  • headache, scalp tenderness
  • impalpable temporal arteries– distended with reduced pulsation
  • jaw/tongue cramp
  • ischaemic optic neuro- sudden painless monocular and severe visual loss- irreversible- amaurosis fugax
  • may be preceded by transient loss- emergency, reversible
  • malaise, fatigue, wt loss
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101
Q

what conditions is giant cell arteritis assoc with?

A
  • polymyalgia rheumatica (pain, stiffness in shoulder /neck/hip girdle muscles over days)
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102
Q

ix of ?giant cell arteritis

A
  • bloods- ESR/CRP, FBC, UE
  • temporal artery USS (thickening)
  • temporal artery biopsy- skip lesions, mulitnucleated cells
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103
Q

diagnostic criteria fro giant cell arteritis

A

3 or more of

  • > 50yo
  • new headache
  • tmeporal artery tenderness/decreased pulsation
  • ESR >50
  • abnormal temptoral artery biopsy
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104
Q

tx giant cell

A
  • pred 80mg PO OD
  • azathioprine, metho, biologics
  • Ca/vit D/bisphos/DEXA
  • use falling ESR as guidance
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105
Q

sx of behcet’s disease

A
  • oral ulcer
  • genital ulcer
  • *- ant. uveitis
  • *- arthritis
  • systems sx- GI, cardiac, resp, neuro
  • systemic sx
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106
Q

ix for ?behcet’s

A
  • Pathergy- skinprick– swollen >5mm in 48hours
  • XR, FBC, UE, ESR
  • HLA B51
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107
Q

tx behcet’s

A
  • betamethasone oral
  • lidocaine genital
  • colchicine and steroids PO
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108
Q

what is polymyalgia rhuematica

A
  • inflam of shoulder, neck and pelvic girdle
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109
Q

sx of polymyalgia rhuematica

A
  • stiffness, worse at rest
  • shoulder, neck, pelvic, arm (BL) pain
  • fever, fatigue, anorexia, wt loss
  • carpal tunnel, arthritis, oedema
  • +- GCA sx
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110
Q

ix for ?polymyalgia rheumatica

A
  • ESR/CRP raised
  • CK (rhabdo/polymyositis), ALP, EMG, TFT, MSU (bence jones), ANA/anti-ccp, – all normal
  • response to steroids is often used to diagnose
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111
Q

tx polymyalgia rheumatica

A
  • 15mg pred PO OD
  • monitor ESR/CRP
  • screen for giant cell arteritis
112
Q

tx fibromyalgia

A
  • exercise
  • relxation/meitation
  • CBT
  • amitriptyline/pregablin
  • duloxetine, SSRI
113
Q

what is rheumatic fever

A
  • inflam of skin, heart, eyes and joint
  • 2-4w post strep infection of the throat (pyogens)

-

114
Q

sx rheumatic fever

A
  • fever, malaise, myalgia, fatigue
    jOINTS- oligoarthritis, arthralgia
    SKIN- non-itchy erythema marginatum- pink ring-like, torso and spread to limb, well defined
    HEART- cnog HF sx- chest pain, SOB, tachy
  • chorea
115
Q

ix ?rhuematic fever

A
  • throat cultures- Group A beta-haemolytic strep (pyogens)
  • anti-streptolysin O tire- rasie (blood)
  • echo (valve, large heart)
  • ECG- arrhythmia
  • CRP
116
Q

tx rheumatic fever

A
  • FeverPain score
  • phenoxymethylpenicillin
  • valve replacement/repair
117
Q

tx of Raynaud’s

A
  • med review for causes (beta blockers, lidocaine, adrenaline, amphetamine, cocaine, cytotoxics, interferons)
  • nifedipine- vasodilation (can cause severe hypotension
  • admit urgently if ischaemia
118
Q

signs on XR of primary bone cancer

A
  • lytic/sclerotic lesions
  • codman’s triangle- peristeum lifted off with new bone formation underneath)
  • sunburst- calcification of tumour BS
  • onion-skin appearance- periosteum repeatedly liufted
  • bone destruction
119
Q

management of bone cancer

A
  • CT/RT
  • prophylactic plating
  • removal - surgical, ablation
  • bisphosphonates
120
Q

what are the benign bone cancers, who do they occur in

A
  • osteoid osteoma (child,teens)
  • osteochondroma (child,teens)
  • chondroma (adults)
  • osteoclastomas/giant cell tumour (adults)
121
Q

malignant bone cancers- name them, who do they occur in

A
  • osteosarcoma (tween or older adult)
  • ## chondrosarcoma (adults)
122
Q

common sites of primary sites for bone mets

A
  • renal
  • thyroid
  • lung
  • prostate
  • breast (most common)
123
Q

presentation of primary or secondary bone malignancy

A
  • bone pain- constant, progressive, mobility reduced
  • #
  • compression sx (spinal)
  • hypercalcaemia sx- abdo pain, bone pain, stones, psych, constipation, polyuria
124
Q

what nerve does carpal tunnel effect

A

median

125
Q

what is physiological carpal tunnel

A

during pregnancy

126
Q

sx carpal tunnel

A

PALMAR- THUMB, fore finger, index finer and 1/2 of ring finger:

  • nocturnal dysaesthesia
  • relieved by hand shaking (initially)
  • weakness, clumsiness
127
Q

signs of carpal tunnel

A
  • wasting of thenar eminence
  • weakness of thumb- opposition, abduction, flexion
  • Tinel’s- tapping exacerbatings
  • Phalen’s- reverse prayer
128
Q

management of carpal tunnel

A
  • rest, NSAIDs
  • nigth splinting
  • physio
  • steroid injection
  • decompression
129
Q

what is trigger finger

A
  • stenosing flexor tenosynovitis

- assoc with AI conditions, and hx of use of hand

130
Q

sx trigger finger

A
  • clicking/locking when in flexion trying to extend
  • cannot actively extend finger
  • finger can be extended passively (unlike dupuytren’s)
  • +- pain
131
Q

tx trigger finger

A
  • small splint holding in extension
  • analgesia
  • steroid injection
  • finger release, via needle, or surgical decomp if severe
  • may recur
132
Q

what is dupuytren’s

A
  • thickening/fibrosis of palmar fascia/ligaments
  • causes nodules and digital contractures
  • assoc w alcoholism, liver disease, fam hx, smoking, DM , peyronie’s
133
Q

sx dupuytren’s

A
  • FIXED flexion, cannot passively extend finger
  • may be as subtle in ealry stages- finger can entend fully but there is a blanching/tight ligament on palmar aspect of hand– FEEL palm
134
Q

tx dupuytrens

A
  • surgery with Z fasciotomy
135
Q

sx dupuytrens of the foot

A
  • plantar fibroma in arch
136
Q

tx dupuytrens of the foot

A
  • steroids
  • orthotics
  • surgery
137
Q

what is de queviain’s tenosynovitis

A
  • extensor pollicis brevis and abductor pollicis longus-inflammation of tendons (radial aspect of hand, insert on thumb)
138
Q

sx de quevains tenosynovitis

A
  • pain over radial styloids

- full ROM

139
Q

ix and tx for de quevains

A
  • finkeisteins test- pt hols thumb in fist and gently bands wrist ulnarly — +=pain

tx

  • rest, splint
  • physio
  • steroid injection
  • surgical release
140
Q

What is tennis elbow

A
  • soft tissue tendinopathy - LATERAL epicondylitis

- of ligaments of forearm extensors - insert onto lateral epicondyle of the humerus

141
Q

what is golfer elbow

A
  • soft tissue tendinopathy - MEDIAL epicondylitis

- of ligaments of forearm extensors - insert onto medial epicondyle of the humerus

142
Q

sx and hx of elbow epicondylitis, signs o/e

A
  • hx of overuse of the forearm
  • elbow pain

o/e

  • epicondyle tenderness
  • v.sensitive
  • painful movements, but ROM fine if pushes
143
Q

special test for elbow epicondylitis

A

Active wrist Flexion against resistant

  • with elbow flexed 90 degrees
  • palpate medial
  • medial epicondyle (golFers)

Active exTension against resistant

  • palpate laTeral
  • laTeral epicondyle (Tennis)
144
Q

Describe the brachial plexus

A
  • C5-T1 roots
  • combine into sup, middle, inf trunks
  • continue behind subclavian artery, over lung apices and 1st rib
  • behind the clavicle, each trunk splits into ant and post divisions*
  • enter axilla
  • these divisions (6) each split into ant, medial and post cords*
  • these divide and combine to form;
  • Musculocutaneous
  • Axillary
  • Radial
  • Median
  • Ulnar
145
Q

What does the axillary nerve to

A
  • deltoid - shoulder abduction
  • teres minor- humeral external rotation
  • sensation over deltoid
146
Q

what does the radial nerve do

A
  • sensation on dorsum of hand (thumb, fore finger, middle finger, 1/2 ring)
  • forearm and wrist extension
147
Q

what does the median nerve do

A
  • sensation to palmar aspect of thumb, fore,index, middle fingers and 1/2 of ring finger
  • flexion of digits at MCP, thumb movements and forearm /wrist flexion

(test- break ok sign)

148
Q

what does ulnar nerve do

A
  • sensation of dorsal aspect of hand
  • grip strength- finger flexion, extension, abduction, thumb adduction

(test grip and finger abduction)

149
Q

describe where the nerve roots supply sensation to the skin of the upper limb

A
  • C4- shoulder
  • C5 lateral upper arm
  • C6 lateral forearm and thumb
  • C7- middle finger
  • C8- little finger
  • T1 inside of upper arm
  • T2- axxila
150
Q

common mechanism of radial, ulnar, axillary mononeuropathies

A
  • inflammation
  • trauma

ulnar- medial epicnodyle trauma

radial- saturday night (arm over back of chair), humeral shaft #

axillary- anterior dislocation of shuolder

151
Q

sx of common upper limb mononeuropathies

A

Radial

  • wrist drop
  • decreased sensation/paraesthesia anatomical snuff box

Ulnar

  • claw hand- cannot extend 4th and 5th digit- weak resisted finger abduction
  • sensation over palmar aspect of hand
  • the more proximal the injury, the less the deficit

Axillary

  • cannt abduct arm
  • regimental badge numbeness (over delt)
152
Q

tx mononeurpathies upper limb

A
  • splitnging
  • physio
  • decompression (not for axillary)
153
Q

What bones are involved in the shoulder joint

A 
Humerus
Scapular
- glenoid process
- acromion
Clavicle
154
Q

what is frozen shoulder, sx

A
  • inflam
  • leads to fibrous tissue and sticky avascular capsule whihc sticks to humeral head
  • very stiff shoulder
  • aching pain worse at night
  • external rotation is 1st movement to go
155
Q

ix and tx frozen shoulder

A
  • XR to exclude OA
  • NSAIDs, physio
  • IA injections
  • anaesthetic manipulation
  • arthroscopic electrodiathermy
156
Q

what is impingement syndroem

A
  • supraspinatus is caught and compressed between acromion and humeral
  • particularly when arm is raised over head
157
Q

sx impingement syndrome

A
  • hx of repetitive overhead activity

- pain on overhead movement

158
Q

o/e signs of impingement syndrome

A

– painful arc 45-160 degrees

Hawkin- kennedy

  • pt shoulder and elbow at 90 degrees
  • quickly move pt arm into internal rotation
  • pain localised to subacromial space = +ve
159
Q

ix and tx impingement

A
  • XR exclude OA
    MRI- rotator cuff
  • NSAID
  • physio
  • steroid injection
  • subacromial decompression.- basically shaving off the lower edge of the acromion
160
Q

what is calfici tendonitis, sx , tx

A

Ca deposits in shoulder inflam RC

  • pain, stiffness, catching
  • gradual onset
  • decompression
161
Q

what are the rotator cuff muscles in the order they insert into humeral head , function

A

SITS
- supraspinatus- abd and int rot
- infraspinatus- ext rot
- teres minor- ext rotation,
- subscap (attaches posteriorly)- int rotation, abduction
TESTS:
you hail a taxi (horner blowers, teres minor)
you go for a drive (ext rot, teres minor/infraspinatus)
you have a drink (empty can, supraspinatus)
You get arrested (gerbers lift off, subscap)

162
Q

how do you test supraspinatus

A
  • empty can/jobe
163
Q

how do you test infraspinatus

A
  • resisted ext rotation
164
Q

how do you test teres minor

A
  • external rotation against resistance

- horn blower- push arm down, pt weak

165
Q

how do you test subscap

A

lift off

166
Q

immediate management of open#

A
  • CABCDE
  • stop haemorrhage
  • NV examination
  • rmeove gross debris
  • straightne and align
  • repeat NV
  • photograph wound
  • cover wound with sterile, moist (slaine) dressing
  • split
  • repeat NV exmination
  • IV coamox/clinda
  • tetanus prophylaxis
167
Q

what is not recommended in immeidat emanagement of open #

A
  • mini debridement
  • washing
  • digital exploration of wound
168
Q

sx scaphoid #

A
  • snuff box tenderness
  • pain on axial loading of thumb
  • pain on scaphoid tubercle (prox. part of palm at base of thumb)
  • pain on prayer/reverse prayer
169
Q

tx of scpahoid #

A
  • NSAIDs, elevation
  • when confirmed #- scaphoid cast (below elbow backslab with thumb immobilised
  • refer to # clinic for repeat XR in 2w as risk of necrosis
  • surgicla fixation if necrosis or displaced
170
Q

what is boxer’s #

A

transverse # of 5th metacarpal neck

171
Q

name the carpal bones of the hand

A

Some, Lover, Try , Positions , That , They , Can’t , Handle

Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapizoid
Capitate
Hamate
172
Q

What is a colle’s #

A

dorsal displacement of radial head # compared to radial shaft

fall onto extended wrist

173
Q

what is smith’s #

A

volar displacement of radial head compared to radial shaft

fall onto flexed wrist

174
Q

what is a chauffer;s / hutchinson/backfire#

A
  • radial styloid #

- falling onto outstretched hand, compresison of scaphoid onto styloid

175
Q

whats the terirble triad of theelbow

A
  • humeral dislocation from humeroulnar joint
  • coronoid # (ulnar bony buttress that, with the olecranon, acts as cup around humeral head)
  • radial head/neck #
176
Q

what is a complication of elbow #/dislocation

A

Anterior interosseous nerve injury

  • branch of median nerve
  • when asked to make ok sign, cannot round their thumb and forefinger
  • need to go to theatre
177
Q

what nerve is in danger of damage in humeral shaft #

A

radial

178
Q

what shoulder dislocation is most common

A

anterior

179
Q

complciation of anterior hsoulder dislocation

A
  • axillary nerve injury
  • brachial plexus injury
  • longstanding instability
180
Q

What is a Hill-sachs lesion

A

anterior shoulder dislocation

- as humeral head has collided with anterior part of glenoid, bone is damaged and notched

181
Q

what is a bankart lesion

A

anterior dislocation

- anterior part of glenoid labrum is damaged, bony part of glenoid has broken off with the labral tear

182
Q

tx of shoulder dislocation

A
  • closed reduction
  • ice then heat
  • splint/sling 3w
  • pendulum exercises
  • collar and cuff in not stable
183
Q

what sling do you use for humeral #

A

collar and cuff, so gravity and realign the broken bone

184
Q

red flags for posterior shoulder dislocation

A
  • post seizure
  • unable to actively or passively externally rotate arm
  • light bulb sign on XR
185
Q

Special tests for shoulder instability

A
  • apprehension test- abduct arm and put them into ext/ rot
  • put your thumb on back of humeral head
  • put anterior force
  • pt will be umcomfortable
  • pec will contract

Beighton scoring /9

186
Q

what si the beighton scoring

A

hypermobility

  • Major 4/9
  • minor 1-3/9
  • little fingers dorsiflexion >90 degrees (1,1)
  • thumbs to arm (1,1)
  • elbows- hyperentension (1,1)
  • knees- hyperextension (1,1)
  • touch floor with palms no knee bending (1)
187
Q

what is a bakers cyst, ddx

A
  • popliteal cyst

ddx
- popliteal aneurysm (pulsatile)

188
Q

ACL tear sx

A
  • popping heard r felt
  • very painful
  • immediate effusion, swelling
  • giving way of joint
  • painful to wt bear, reduced ROM
189
Q

special tests for ACL, ix

A

Lachman
- pull tibia forward

Anterior draw

MRI

190
Q

tx ACL

A
  • non op- if young, not hgihly active, no subluxation

- reconstruction

191
Q

mechanism of ACL injury

A
  • sudden deceleration , turning with foot planted
192
Q

mechanism of meniscal tear

A
  • forceful twist/rotation whilst fully weight bearing
193
Q

sx of meniscal tear

A
  • pain, swelling, stiffness
  • mechanical ex- locking/cllinking
  • trouble with knee extension
194
Q

special test for meniscal tear

A

McMurrays

  • Maximally flex hip and knee
  • put valgus force on knee and turn toes out/ext rot- out into extension
  • pain/locking/clicking= medial

varus force and internal rotation for lateral

195
Q

ix for ?meniscal tear

A

MRI

- absent bow tie sign

196
Q

what are the bones of the ankle

A

tibia, fibula

  • calcaneus (heel bone)
  • *- talus
  • navicular
  • cuneiforms
  • cuboid
  • metatarsals
  • phalanes
197
Q

what are the sx of plantar fssciitis

A
  • sharp heel pain
  • insidious
  • may prefer to walk on toes
  • worse after standing
198
Q

tx of plantar fasciitis

A
  • analgesia, splinting, stretching
  • shockwave
  • gastrocneumius resection
  • surgical plantar fasciotomy
199
Q

what is mortons neuroma

A
  • neuroma causing compression of interdigital nerve on plantar foot
200
Q

sx and signs of mortons neuroma

A
  • neuroma
  • pain on weight bearing or narrow shoes
  • sx relief on massaging, removal of shoes
  • paraesthesia on plantar aspect of webspace
  • positive webspace compression test- squeeze dorsally and ventrally - nerve pain
  • MTPJ squeeze– bursal click
201
Q

tx mortons nueroma

A
  • wide shoes with firm sole
  • corticosteroid injection
  • neurectomy
202
Q

what is a bunion

A

hallux valgus

203
Q

tx bunion

A
  • shoe modification

- osteotomy

204
Q

management of achilles tendinopthay

A
  • exclude rupture (thompsons)
  • RICE
  • NSAIDs
  • gentle strecthing of front and back of lower leg
  • physio
  • eccentric heel drop
  • avoid/stop quinolones eg cipro
205
Q

achilles tendon rupture- sx

A
  • going for a sprint
  • sharp pain in back of leg
  • may hear snap or pop
  • thinks someone has kicked them in the leg
  • inability to plantar flex foot (push off), or stand on toes
206
Q

ahcilles rupture special test

A

thompsons test

207
Q

tx ahcilles ruputre

A

if <1cm gap, non athlete, early presentation

  • equinas boot
  • increasing amounts of plantar flexion (wedges)

if >1cm gap, athlete, late presentation
- repair

208
Q

what classificaiton is use for fibular #

A

weber

A- under syndesmosis
B- at syndesmosis
C- above syndesmosis (unstable)

209
Q

what sign on XR suggests ligamentous injury and instability after an ankle #

A

talar shift (widening of tibiofibular joint space)

210
Q

What is a Lisfranc injury

A
  • torn lisfranc ligament
  • between 2nd metatarsal and most medial cuneiform
  • this ligament connect forefoot and hindfoot
  • injured due to dislocation of the foot, due to dislocation of 2nd metatarsal
  • on XR it’ll look like the 1st metatarsal bone is very far away from the 2nd metatarsal bone, or all the metatarsals will look shifted laterally compared to cuneiform (homolateral)
211
Q

mechanism of lisfranc injury

A
  • axial loading through foot whilst on tip toes :)

- twisting on a plantar flexed foot

212
Q

hallmark sign of lisfranc injury

A
  • plantar ecchymosis
213
Q

XR sign of lisfranc injury

A
  • widening of space between 1st and 2nd metatarsal

or if homolateral all metatarsals shifted laterally

214
Q

red flags CES

A
  • lower back pain
  • UL/BL lower limb sensory/motor abnomrality
  • *- loss of reflexes legs
  • bowel, bladder dysfunction- retention, incontinence
  • saddle paraesthesia/perineal area
  • sexual dysfunction
215
Q

what are the sensory dermatomes of the lower leg and buttocks?

A

ANTERIOR

  • L2- IFs
  • L3 - hip, top of leg, medial thigh
  • L4 - lateral upper thigh, knee, medial lower leg, ankle and foot
  • L5- top of buttock, posterior hip, lateral edge of leg, anterior shin and top of foot, achilles
POSTERIOR
- S1- back of leg lateral 1/2
S2- back of leg medial 1/2
S3-S5- perineal area
S5- anus

S2/3- genitalia

216
Q

ix ?CES, and tx

A
  • urgent MRI
  • immobilise if due to trauma

tx

  • urgent spinal decompression
  • abx if infection
  • steroid- inflammation
  • CT/RT- neoplasms
217
Q

sx and signs septic arthitis

A
  • severe pain
  • red, hot, swollen joint
  • cannot wt bear or move

Hip
- FABER position- flexed, abducted, ext. rot.

218
Q

common causes of septic arthirits

A

S.aureus

  • MRSA
  • Staph epidermis
  • N.gonorrhoea
  • gram -ve bacilli-e.col, proteus, klebsiella
  • strep
219
Q

ix for septic arthritis

A
  • Aspiration- WBC >50,000, stain, culture, polarised light microscopy– crystal analysis, glucose level ***<60% of serum
  • blood culture
  • XR
  • *- USS
  • *- MRI if ?osteomyelitis
220
Q

tx septic arthritis

A

fluclox IV 4-6w
or clinda
MRSA- vanc or teicoplanin

gonorrhoea/gram -ve– cefotaxime

surgery- irrigation, drainage, culture, debridement

221
Q

most common micro org to cause osteomyelitis?

A

Staph aureus

222
Q

sx osteomyelitis

A
  • fever, fatigue, nausea
  • painful, red hot swelling
  • decreased ROM

vertebral- severe back pain (esp at night)

223
Q

ix ?osteomyelitis

A
  • XR
  • CT- ID necrotic bone
  • MRI- best for early diagnosis and surgical planning

*****bone biopsy and culture– gold standard

224
Q

tx of osteomyelitis

A

Empirical- fluclox 6w, clinda if allergic

MRSA- vanc or teicoplanin

consider adding fusidic acid or rifampicin to all of the above for 1st 2 weeks

surgery- debridement/amputation/irrigation

225
Q

sx and signs of hip OA

A 
groin, lateral hip, deep buttck pain
- aggravated by movement
- stiffness
- grinding/crunching
Severe:
- reduced ROM
- fixed flexion deformity-- Thomas test (w max flexion of other hip the pathological leg flexes, woth 
 hand placed under lumbar spine)
- trendelenburg gait- weakness in hip abductors, dropping pelvis on other side when wt bearing
- trendelenburg sign
226
Q

causes of osteonecorsis/AVN of the hip

A
  • intra capsular #
  • sickle cell
  • steroids (LT use)
  • alcoholism
  • autoimmune
  • chemotherapy
  • hypercoag
  • avscular nec of the hip in adolescents
227
Q

sx osteonecrosis of the hip

A
  • insidious pain
  • stairs, incline, impact pain
  • anterior hip pain
228
Q

ix ?osteonecrosis of the hip

A
  • XR- osteopenia, micro#s
  • MRI
    (- isotope Bone scan- not as sensitive as MRI)
229
Q

tx osteonecrosis of the hip

A
  • bisphos
  • core decompression +- bone grafting– core taken out of femoral head and tibial bone is inserted into the core .. :O
  • osteotomy
  • THR
  • hip arthrodesis
230
Q

sx hip labral tear

A

when happens:- sharp catching pain

  • then dull pain, lateral hip (C sign)
  • refrre pain- buttock, leg, lower back
  • giving way of hip
  • locking
  • grinding, popping when ext. rotation
  • ROM preserved
231
Q

ix labral tear

A
  • XR

- MRI arthrogram with dye

232
Q

management of labral tear

A
  • physio
  • analgesia
  • surgery- repair, reconstruction, debridement
233
Q

pelvic ring #- sx

A
  • deformity of pelvic
  • sig pain
  • swelling
  • hypovolaemic shock
  • inability to weight bear

**- bruising- perineal, scrotal, labial

234
Q

ix of pelvic ring #

A
  • CABCDE
  • full NV assessment of lower limbs incl anal tone, perirectal sensation
  • abdo examination
  • urethral injuries– UO
  • internal open- rectum, vagina– DRE and PV exams

CT

235
Q

classification of pelvic ring#

A

***- young and burdess

antero posterior compression (pubis symphis separated)

**lateral compression (pubic tubercle/ilium wings #)

vertical shear (pubic tubercle and sacroiliac joint)

236
Q

when type of hip # threatens blood supply to the head of femur

A

intracapsular (which includes subcaptial and transcervical NOF #)

237
Q

interpretation of XR ?hip #

A
  • shentons line
  • levels of lesser trochs
  • symmetry of fem head and neck laterally
238
Q

blood supply to fem head

A
  • profunda/deep branch of common femoral
  • profunda splits into medial and laterlal circumflex
  • form retinacular vessels- supply the head
  • foveolar artery is in teres ligament (connects head to acetabulum)
  • in adults , they rely on BS from one of the branches more, so at higher risk of necrosis
  • younger people have more collateral flow, so the femoral head can be saved if quick
239
Q

management of extracapsular (intertrochanteric, and subtrochanteric) hip #s

A
  • dynamic hip screws-

- can do intramed screw if further down humeral shaft

240
Q

Management of intracapsular hip # (subcapital, trancervcal)

A
  • old- hemiarthroplasty
  • young- cannulated hip screws emergency to save femoral head

within 36 hours

241
Q

what nerves cause foot drop

A

L5 (L4, S1 sometimes)

peroneal nerve

242
Q

causes of foot drop

A

compressiom:

  • sciatica
  • CES

Peripheral:

  • peroneal nerve injury (sciatic branch)– prox fibula #, knee dislocation, knee/hip replacement
  • diabetes wth peripheral neuropathy

Central:

  • stroke
  • MS
  • cerebral palsy
  • brain malignancy
243
Q

sx sciatica

A
  • shooting pain
  • lower back– back of leg, outside/front of leg
    • sudden onset
    • usually after activity- heavy lifting
    • UL sx
  • weakness/numbness in leg and foots
244
Q

what nerve roots form the sciatic nerve

A
  • L4,5,S1,2,3
245
Q

causes of sciatica

A
  • disc herniation
  • spndololisthesis
  • spinal stenosis
  • pelvic tumour
  • pregnancy
246
Q

signs of sciatica

A
  • straight leg raise- shotting pain is aggravated
247
Q

management of sciatica

A
  • exercises
  • CBT
  • NSAIDs
  • amitryptyline
  • radiofrquency denervation
  • epidurals od local anaesthetic and stenois if acute and severe
  • spinal decompression
248
Q

signs of disc herniation

A
  • Low back pain
  • CES
  • hip adduction and knee ext wekness (L3)
  • ankle dorsiflesion and reduced patella reflex- L4
    • tradelenburg gait- hip abductors, anke dorsiflexion, extnsion of hallux (L5)
  • plantar flexion of ankle, achilles relfex (S1)
  • straight leg raise, aggravated by dorsiflexion
249
Q

tx disc herniation

A
  • NSAIDs
  • physio
  • nerve root corticosteroid injection
  • laminitomy
  • discectomy
250
Q

sx discitis

A
  • severe back pain (worse at night)
  • children- refusal to walk, back arching
  • no radiation
  • fevers rigors
251
Q

causes of discitis

A
  • S aureus, TB, aseptic
252
Q

ix ?discitis

A
  • bloods- WCC, culture, CRP, ESR

- MRI

253
Q

tx discitis

A
  • IV or oral cipro, vanc

- little and often movement

254
Q

most common site of compartment syndrome

A

lower limb

255
Q

number of compartments in lower limb

A 
lower leg- 4---
ant
lateral
superior post
deep post.

Thigh- 3
ant, medial, post

256
Q

how to differentiate between different arteritises

A

Takayasu’s

  • large vessels
  • intermittent limb claudication
  • weak femorals
  • young women, 20-40s (maybe asian)
  • Aortic involvement- different BPs in each arm

GCA- yk

Goodpastures

  • small vessles in lungs and kindeys
  • haemoptysis
  • glomerulonephritis- haematuria etc

Granulomatosis with polyangitis (wegner’s)

  • BVs in nose/sinus/throat, lungs, kidneys
  • blocked/runny nose, nosebleeds, nostril crusting
  • sinusitis
  • earache, hearing loss
  • cough, SOB, wheeze, chest pain
  • nephropathy- haematuria, HTN
  • skin rashes

Polyarteritis nodosa

  • medium
  • spares aorta
  • kidney, heart, CNS, skin, GI
  • rash, ulcers
  • perpiheral neuropathy
  • abdo pain, bleeding
  • MI, CHF
257
Q

what criteria is used to calculate likelihood of septic arthritis

A 
The Kocher criteria 
each is 1 point:
- Non weight-bearing. 
- Temp > 38.5°C / 101.3°F
- ESR > 40mm/hr. 
- WBC > 12,000 cells/mm3.

1-2- radiological and ortho input for ?aspiration
3-4- aspiraiton in the operating room

258
Q

what classification system is used for NOF #

A 
Garden
1- incomplete stable
2- compleye but non displaced
3- complete partial displacement
4- complete and completely displaced
259
Q

what is the gartland classification used for

A

supracondylar (distal humerlal #) in children

260
Q

what classification system is used to classify # of or around the growth plate in children

A 
salter harris- SALTER
S- straight across, just above GP
A- Above (into bone above GP)
L- Lower (into the GP)
T- Two or through (from bone above GP into GP)
ER- cRush- GP compressed against bone
261
Q

what rules are used to determine need for XR in ankle #

A

ottowa

262
Q

what classification system is used for ankle/fibula # location

A

weber

263
Q

what nerve wouldve been damaged in a patient with weak knee extension, hip flexion, loss of knee jerk and thigh numbness

A

femoral

264
Q

what nerve is damaged in weak knee flexion and foot movements, pain and numbness from gluteal region to ankle

A

sciatic

265
Q

what nerve would’ve been damaged in patient with weak hip adduction, numbness over medial thigh

A

obturator

forceps delivery
anterior hip dislocation

266
Q

what nerve is damaged in patient with weak ankle dorsiflexion, numbness in calf and foot

A

lumbosacral trunk

267
Q

sx of common peroneal nerve injury

A
  • foot drop (loss of dorsiflexion)- also occurs with L5
  • loss of foot eversion

sensation on dorsum of foot and lower lateral leg affected

fibula neck # or tightly applied lower limb plaster

268
Q

what nerve injury causes positive trendelenburg test

A

superior gluteal nerve (controls hip abduction)

269
Q

what nerve root and nerve root controls achilles tendon reflex

A

S1, tibial/sciatic

270
Q

what nerve and nerve root controls patella reflex

A

L4, femoral

271
Q

what nerve controls biceps reflex

A

C5

272
Q

what nerve controls triceps reflex

A

C7-8

273
Q

what nerve controls pronator reflex

A

C6-7

274
Q

what is a Monteggia fracture

A
  • dislocation of the proximal radial head/radioulnar joint from humerus with a PROXIMAL ULNAR fracture
  • seen in children fallen on outstretched hand (4-10yrs old)
  • Manchester (Monteggia) United (ulnar)
275
Q

what is a Galeazzi #

A
  • fracture of the DISTAL RADIUS with an associated dislocation of the distal radioulnar joint/radial head
  • Galaxy Rangers

Finals (15 decks)

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