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MSk Flashcards

1
Q

Describe Barlow’s test

A

Adduct hips and push posteriorly to see if femoral heads are dislocatable (Barlow = break)

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2
Q

Describe Ortolani’s test

A

Abduct hip and push femurs towards yourself to try and reduce a dislocated hip

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3
Q

What imaging is required for all babies in breech position regarding DDH?

A

US hip at 6 weeks

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4
Q

What is the main goal of management of Perthes?

A

Keep femoral head in the acetabulum by casting/bracing

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5
Q

Main treatment of Perthes?

A

Observation and symptom relief

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6
Q

Which system is used to classify fractures that involve growth plates?

A

Salter-Harris

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7
Q

Describe each stage of the Salter Harris classification

A
  1. # involving only physis
  2. # involving physis and metaphysis
  3. # involving physis and epiphysis (inc joint)
  4. # involving, physis, metaphysis, epiphysis
  5. crush injury involving physis
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8
Q

Which organism causes osteomyelitis? Which organism is more common in sickle cell patients?

A

Staphylococcus aureus most common

Salmonella in sickle cell patients

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9
Q

What is the preferred imaging for osteomyelitis?

A

MRI highly sensitive in early disease.

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10
Q

What is the hallmark of giant cell arteritis?

A

ESR and CRP raised

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11
Q

Treatment of giant cell arteritis?

A

Corticosteroid treatment is imperative to reduce risk of vision loss

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12
Q

What features are shared between Wegener’s and Churg Strauss?

A

Sinusitis
Dyspnoea
Vasculitis (weight loss, fever, night sweats)

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13
Q

What features differentiate between Wegener’s and Churg Strauss?

A

Wegeners: renal failure, epistaxis, cANCA

Churg-Strauss: asthma, eosinophilia, pANCA

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14
Q

Features of Behçet’s?

A

Genital ulcers
Oral ulcers
Anterior/posterior uveitis
Skin lesions

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15
Q

Association/additional features of AS?

A 
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis 
AVN block
Amyloidosis
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16
Q

1st line treatment for AS?

A

NSAIDs

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17
Q

Which organism most commonly causes post-STI reactive arthritis?

A

Chlamydia trachomatis

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18
Q

Which organism most commonly causes post-dysteric reactive arthritis?

A

Shigella/Salmonella

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19
Q

Which eye manifestation is seen in AS?

A

Anterior uveitis (aka iritis)

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20
Q

Which blood tests would you order to investigate osteoporosis?

A
  • FBC, U&E, CRP
  • TFT
  • Vitamin D
  • Bone profile: calcium, phosphate, ALP, albumin
  • Testosterone
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21
Q

1st line treatment for osteoporosis?

A

oral bisphosphonates (alendronate)

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22
Q

Mechanism of action of bisphosphonates?

A

Inhibits osteoclasts

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23
Q

What can be given to post-menopausal women to reduce risk of osteoporosis?

A

oral SERM (raloxifene)

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24
Q

Side effect of bisphononates?

A
  • Oesophagitis - take sitting up and drink plenty of water

- Osteonecrosis of jaw

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25
Q

What is given if bisphosphonates are not tolerated?

A

Strontium ranelate

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26
Q

Treatment of osteomalacia?

A

Vitamin D

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27
Q

Which bones are affected in Paget’s?

A

Spine, pelvis, skull, femur, tibia

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28
Q

Hallmark of Paget disease?

A

Increased ALP with normal calcium, phosphate, PTH

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29
Q

How is calcium, phosphate, ALP and PTH affected in osteomalacia?

A
  • Decreased
  • Decreased
  • Increased
  • Increased
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30
Q

Which drugs can induce SLE?

A

Hydralazine, isoniazid, procainamide, penicillamine

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31
Q

How do complement levels change during active SLE flares?

A

C3 and C4 levels decreased

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32
Q

Treatment for SLE?

A

NSAIDs for arthritis
Steroids
Hydroxychloroquine 1st line

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33
Q

What is given to treat severe SLE?

A

methotrexate, Rituximab

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34
Q

What malignancy are those with Sjogren’s at risk of?

A

Lymphoma

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35
Q

Features of Sjogrens?

A
  • Dryness of eyes and mouth (some may have vaginal dryness)
  • Painful joints and muscles
  • Fatigue
  • Raynauds
  • Dysphagia and oesophageal dysmotility
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36
Q

Which 2 tests must be done in order to truly diagnose Sjogrens?

A
  • Positive anti-Ro/anti-La Abs

- Parotid/Labial gland biopsy

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37
Q

Treatment for Sjogrens?

A
  • Hydroxychloroquine for arthalgia and fatigue

- Artificial tears and saliva

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38
Q

Which antibodies are seen in antiphospholipid syndrome?

A
  • Anticardiolipin
  • b2 glycoprotein
  • Lupus anticoagulant
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39
Q

What is the normal treatment for those with APS?

A

low dose aspirin

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40
Q

What treatment options are there for APS in pregnant women?

A
  • Aspirin if patient has only had obstetric manifestations and no thrombosis
  • LMWH instead of warfarin
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41
Q

What is the treatment for those with APS who have had VTE event?

A

lifelong warfarin

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42
Q

What additional features as seen in diffuse systemic sclerosis vs limited systemic sclerosis?

A
  • Skin sclerosis is diffuse
  • Myocardial fibrosis
  • Scleroderma renal crisis
  • Pulmonary fibrosis
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43
Q

What blood test results indicate myositis?

A
  • raised CK

- raised ESR and CRP

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44
Q

Treatment of myositis?

A

-high dose glucocorticoids

IV Ig rescue

45
Q

Which cancers are associated with development of dermatomyositis?

A 
(LOOBC)
Lung
Ovary
Oesophageal
Breast
Colon
46
Q

Hallmark diagnostic feature of PMR?

A

Raised ESR and CRP

47
Q

Treatment for PMR?

A

Prednisolone 15-20mg

Referral to ophthalmology

48
Q

Symptoms of temporal arteritis?

A
  • Headache with scalp tenderness
  • Jaw claudication
  • Vision loss
  • Fatigue and pain in proximal muscles
  • PMR
  • Temporal artery tenderness
49
Q

Investigations for temporal arteritis?

A

-Blood test shows raised ESR and CRP

50
Q

Management for temporal arteritis?

A
  • High dose 60mg prednisolone

- Referral to ophthalmology if vision is affected

51
Q

Red flags for back pain?

A
  • Onset before 20 or after 50
  • Lasts >6 weeks
  • Associated with systemic illness such as fever and weight loss
  • Cauda equina symptoms
52
Q

Which gene loci is associated with RA?

A

HLA-DR4, HLA-DR1

53
Q

Which eye manifestations are seen in RA?

A

Scleritis and episcleritis, scleromalacia perforans

54
Q

What cardiac manifestations are seen in RA?

A
  • Ischaemic heart disease
  • Pericarditis
  • Endocarditis, myocardial disease
55
Q

What is Felty’s syndrome?

A

Splenomegaly and neutropaenia

56
Q

Which gene is associated with Felty syndrome?

A

HLA-DR4

57
Q

X-ray findings in RA?

A

Early disease: juxta-articular osteopenia and decreased joint space

Late disease: bony erosions, subluxation, carpal destruction

58
Q

What scoring system is used to assess RA severity?

A

DAS28

59
Q

Which antibodies can be found in RA?

A

RF, anti-cyclic citrullinated protein antibody (anti-CCP)

60
Q

What role do steroids have in the management of RA?

A

Slows down disease progression and treats acute exacerbations of joint inflammation

61
Q

Main treatment regime for RA?

A
  • NSAIDs, analgesics and steroids for joint pain
  • Methotrexate
  • Biologics if 2 DMARDs have failued
62
Q

Side effects of methotrexate

A
  • Teratogenic
  • Liver fibrosis
  • Myelosuppression
  • Pulmonary fibrosis
63
Q

What monitoring tests are needed during methotrexate use?

A
  • CXR
  • FBC for myelosuppression
  • LFTs for liver fibrosis
64
Q

Concurrent use of what drugs with methotrexate can cause bone marrow suppression and severe pancytopaenia?

A

Trimethoprim-containing antibiotics

65
Q

Side effects of sulfasalazine?

A
  • Hepatitis
  • Reduced sperm count
  • Myelosuppression
  • Neutropaenia
66
Q

Side effects of hydroxychloroquine?

A
  • Irreversible retinopathy

- Nightmares

67
Q

Side effects of leflunomide?

A
  • Liver fibrosis
  • Peripheral neuropathy
  • Hypertension
  • Myelosuppression
  • Teratogenicity
68
Q

When should biologics be considered for RA treatment

A

Failure to respond to 2 DMAIDs including methotrexate

69
Q

Give examples of TNFalpha blockers

A
  • Infliximab
  • Adalimumab
  • Etanercept
70
Q

Side effects of TNFalpha blockers?

A
  • Reactivation of TB

- Reactivation of hepatitis

71
Q

How does rituximab work?

A

Monoclonal antibody against CD20 receptor of B cells

72
Q

Side effects of rituximab?

A
  • Nightmares

- Thrombocytopaenia

73
Q

What indicates poor prognosis of RA?

A
  • High titres of anti-CCP and RF

- X-ray shows early erosive damage

74
Q

Which joint does gout most commonly occur in? What is this called?

A

1st MTP joint

Called podagra

75
Q

What dietary foods increase the risk of gout?

A

Red meat, alcohol, seafood, sweeteners

76
Q

What kind of drugs increase the risk of gout?

A

Thiazide diuretics

77
Q

Joint fluid microscopy findings in gout?

A

Needle shaped, negatively birefringent crystals under polarised light

78
Q

X-ray findings in gout?

A
  • Soft tissue swelling

- Punched out appearance in juxta-articular bone in the long term

79
Q

What is the treatment for acute gout?

A
  • DO NOT START ALLOPURINOL
  • High dose NSAIDs (colchicine is NSAIDs are contraindicated)
  • Steroids if NSAIDs and colchicine are contraindicated
  • RICE
80
Q

What is the general management of gout?

A

-Allopurinol with NSAID/colchicine

81
Q

What uric acid level is the target for gout patients?

A

Below 360micromol/L

82
Q

Mode of action of allopurinol?

A

Xanthine oxidase inhibitor

83
Q

Side effects of allopurinol?

A

Skin rash

GI intolerance

84
Q

What are the crystals seen in pseudogout made of?

A

Calcium pyrophosphate dihydrate (CPPD)

85
Q

What are the risk factors for pseudogout?

A

Age
Hyperparathyroidism
Haemochromatosis
Hypophosphataemia

86
Q

Management of pseudogout?

A

NSAIDs/colchicine

Intra-articular steroids for acute attacks

87
Q

Most common causative organism in septic arthritis?

A

Staph. aureus

88
Q

Which joints are commonly affected in pseudogout?

A

Knee, wrist, shoulders

89
Q

X-ray features of pseudogout?

A

Chondrocalcinosis

90
Q

Which gene loci is associated with reactive arthritis?

A

HLA-B27

91
Q

Which sexually transmitted organism is responsible for reactive arthritis in young adults?

A

Chlamydia trachomatis

92
Q

What organism is responsible for septic arthritis in young, sexual active adults?

A

Neisseria gonorrhoeae

93
Q

Which eye manifestation is seen in reactive arthritis?

A

Conjunctivitis

Anterior uveitis

94
Q

What triad of symptoms is seen in reactive arthritis?

A

Reiter’s triad:

Urethritis/balanitis, conjunctivitis/anterior uveitis, arthritis

95
Q

Which 2 types of infection are most common in reactive arthritis?

A
  • Gastroenteritis

- STI

96
Q

How to manage a suspected septic arthritis?

A
  • Antibiotics

- Joint aspiration for gram staining, culture&sensitivity, crystal analysis

97
Q

How can septic arthritis occur?

A
  • Haematogenous spread of bacteria from other site of infection
  • Pre-existing bone infection
  • Penetrative injury and introduction of bacteria from environment
98
Q

X-ray findings in psoriatic arthritis?

A

Pencil in cup appearance

99
Q

Side effects of etanercept?

A

Encephalitis

100
Q

Side effects of colchicine?

A

Diarrhoea, nausea, vomiting

101
Q

Difference in presentation between PMR and polymyositis?

A

PMR has muscle tenderness/stiffness but no true weakness

Polymyositis has no muscle tenderness but reduced power

102
Q

What is the management for undisplaced intracapsular hip fractures?

A
  • Internal fixation if fit and well

- Hemiarthroplasty if unfit

103
Q

What is the management for displaced intracapsular hip fractures?

A
  • Hemiarthroplasty if unfit

- Total hip replacement if fit

104
Q

What is the management for extracapsular hip fractures?

A
  • Stable intertrochanteric fracture = DHS

- Reverse oblique, transverse, subtrochanteric = intramedullary nail

105
Q

Which muscles carry how shoulder abduction and by how much?

A
  • Supraspinatus 0-15deg
  • Deltoid 15-90 deg
  • Trapezius and serratus anterior past 90 (rotates scapula)
106
Q

How to manage the renal complications of limited cutaneous systemic sclerosis? (hypertension & AKI)

A

ACE-i

107
Q

Side effects of ciprofloxacin?

A

Tendonitis and tendon rupture

108
Q

What are the myotome movements? (C5 to S2)

A 
C5: shoulder abduction
C5-6: pick up sticks
C7-8: close the gate & wrist extension
C8-T1: finger abduction/adduction
L2-3: lift the knee
L3-4: kick the door
L4-5: toes point to the sky
L5-S1: kick my bum
S1-2: stand on my shoe

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