MSK Flashcards
What is Perthe’s disease?
Idiopathic avascular necrosis of the femoral head, most commonly seen in 4-8 year olds
Describe the Ottowa knee rules
Age of 55 or over
Isolated tenderness of the patella
Isolated tenderness of the fibular head
Inability to flex knee beyond 90 degrees
Inability to bear weight both immediately and in the ED
What is the Mondor sign?
Bruising that tracks to the sole of the foot, seen in calcaneal fractures
Name some indications for a DEXA scan
Patient <75 with a history of a low trauma fracture
BMI <19
Long term steroid use
Incidental finding of vertebral collapse or osteopaenia
Oestrogen deficiency
What does synovial fluid analysis in gout show?
Needle shaped, negatively birefringent crystals
What does synovial fluid analysis in pseudogout show?
Weakly positively birefringent, rhomboid or rod shaped
Name some ocular features of RA
Scleritis, episcleritis and sicca symptoms
What is Freiburg’s disease?
Osteochondrosis affecting the toes - articular surfaces of the second or third metatarsal heads collapse
Name the patterns of malunion
Malrotation
Volar angulation
Lateral angulation
Shortening
Name a second line preventative drug for gout
Febuxostat
Which antibodies are associated with CREST?
Anti-centromere antibodies
Which antibodies are associated with systemic slceroderma?
Anti-scl70
Which antibodies are associated with SLE?
Anti ds, antinuclear, anti Sm, anti phospholipid
Name some extra articular manifestations of ank spond
Anterior uveitis
Aortic valve insufficiency
Restrictive lung disease
Renal amyloid
Cauda equina syndrome
Osteoporosis
Where does the mental nerve come off?
Inferior alveolar nerve
What is a Maisonneuve fracture?
A spiral fracture of the upper third of the fibula associated with a tear of the distal tibiofibular syndesmosis
What is spondylolisthesis?
The proximal vertebra moving forward relative to a distal vertebra
In which condition is anti Jo-1 elevated?
Dermatomyositis
What is a Bennett’s fracture?
Two part intraartiuclar fracture of the base of the first metacarpal
Name some adverse effects of bisphosphonates
Oesophageal reactions: oesophagitis, Oesophageal ulcers (especially alendronate)
Osteonecrosis of the jaw
Increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
Acute phase response: fever, myalgia and Arthralgia may occur following administration
Hypocalcaemia: due to reduced calcium efflux from bone. Usually clinically unimportant
Name an important adverse effect of hydroxychloroquine
Bull’s eye retinopathy - may result in severe and permanent visual loss
Name the ‘As’ of Ank Spond
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
Name the skin manifestations of dermatomyositis
photosensitive
macular rash over back and shoulder
heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers
‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
nail fold capillary dilatation
Name some features of osteosarcoma
most common primary malignant bone tumour
seen mainly in children and adolescents
occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure, with 40% occuring in the femur, 20% in the tibia, and 10% in the humerus
x-ray shows Codman triangle (from periosteal elevation) and ‘sunburst’ pattern
mutation of the Rb gene significantly increases risk of osteosarcoma (hence association with retinoblastoma)
other predisposing factors include Paget’s disease of the bone and radiotherapy
Name some features of Ewing’s sarcoma
small round blue cell tumour
seen mainly in children and adolescents
occurs most frequently in the pelvis and long bones. Tends to cause severe pain
associated with t(11;22) translocation which results in an EWS-FLI1 gene product
x-ray shows ‘onion skin’ appearance
Name some SEs of etanercept
Demyelination
Reactivation of tuberculosis
Name some SEs of sulphasalazine
Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease
Name some SEs of leflunomide
Liver impairment
Interstitial lung disease
Hypertension
Name some SEs of rituximab
Infusion reactions are common
Name some features of drug induced lupus
arthralgia
myalgia
skin (e.g. malar rash) and pulmonary involvement (e.g. pleurisy) are common
ANA positive in 100%, dsDNA negative
anti-histone antibodies are found in 80-90%
anti-Ro, anti-Smith positive in around 5%
Name some causes of drug induced lupus
Most common causes
procainamide
hydralazine
Less common causes
isoniazid
minocycline
phenytoin
Describe the management of Paget’s disease
indications for treatment include
bone pain
skull or long bone deformity
fracture
periarticular Paget’s
bisphosphonate (either oral risedronate or IV zoledronate)
calcitonin is less commonly used now
Name some complications of Paget’s disease
deafness (cranial nerve entrapment)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure
Name the biochemical features of secondary hyperparathyroidism
Low Ca
High PO4
High PTH
High ALP
At what T score should patients be offered bone protection?
Less than 1.5
What are the indications for urate lowering therapy?
Indications for urate-lowering therapy (ULT)
the British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy to all patients after their first attack of gout
ULT is particularly recommended if:
>= 2 attacks in 12 months
tophi
renal disease
uric acid renal stones
prophylaxis if on cytotoxics or diuretics
Name some red flags for lower back pain
age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever
Name some associations of club foot
spina bifida
cerebral palsy
Edward’s syndrome (trisomy 18)
oligohydramnios
arthrogryposis
Name some adverse effects of sulphasalazine
oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses
What is the MOA of 5-ASA?
works through decreasing neutrophil chemotaxis alongside suppressing proliferation of lymphocytes and pro-inflammatory cytokines.
Which antibodies are associated with limited cutaneous systemic sclerosis?
Anti-centromere
Which antibodies are associated with diffuse cutaneous systemic sclerosis?
Anti scl-70
