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NEED TO KNOW Before Exams!!! > MSK > Flashcards

MSK Flashcards

1
Q

What blood marker is absent in someone with a seronegative spondyloarthropathy?

A

Rh factor

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2
Q

How is progression of RA monitored

A

ESR/CRP

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3
Q

1 life-threatening complication of RA

A

Felty syndrome

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4
Q

Side effects of bisphosphonates?

A

Oesophagitis, Osteonecrosis of jaw, Oesophageal ulcers, GI distress,
hypocalcaemia, renal toxicity

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5
Q

Name some risk factors for osteoporosis?

A

Steroid (prednisolone use) – others; heparin, PPIs, SSRIs, GnRH analogues
(goserelin)
Hyperthyroidism, hypercalciuria and hyperparathyroidism + Cushing’s
Alcohol and tobacco
Thin – BMI < 18.5, T1DM
Testosterone ↓ - ↑ bone turnover, hypogonadism turner’s/Klinefelter
Early menopause – ↑ bone turnover, premature ovarian failure
Renal or liver failure
Erosive/inflammatory bone disease – RA/myeloma
Dietary calcium ↓ or malabsorption, T1DM

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6
Q

Extra-articular features of RA

A

Skin: Nodules, vasculitis (ulcers, splinter haemorrhages)
Ocular, Oral: Sjogren’s
Pulmonary: Pleuritis, effusions
Renal: Glomerulonephritis
Neuro: peripheral neuropathy (rare)
Haematology: deranged bloods
Cardiac: atherosclerosis, pericarditis, MI

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7
Q

2 signs/symptoms of osteomalacia

A

Bone pain and tenderness
Fractures (esp. femoral neck)
Waddling gait (proximal myopathy)

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8
Q

First Line options for rheumatoid arthritis

A

Methotrexate
Leflunomide
Sulfasalazine

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9
Q

Name of skin lesions in Dermatomyositis

A

Gottron lesions

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10
Q

Give two potential extra-articular manifestations of ankylosing spondylitis.

A

5 A’s: anterior uveitis (2), autoimmune bowel disease (2), apical lung fibrosis (2),
aortic regurgitation (2), amyloidosis (2)

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11
Q

How to carry out Shober’s test

A

Have the patient stand (1), locate L5 vertebrae (1), mark a point 10cm above
(1) and 5cm below (1) this point. Ask the patient to bend over forwards as far
as they can (1), and measure the distance between the two points (1). A
distance of less than 20cm (1) indicates reduced lumbar movement and will
help support a diagnosis of Ank. Spon. (1)

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12
Q

Signs seen on spondylosing ankylosis

A

Bamboo spine or calcification of all the ligaments of the spine (1),
squaring of the vertebral bodies (1), subchondral sclerosis (1), syndesmophytes
(1), ossification (1), fusion of joints (facet / sacroiliac / costovertebral)

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13
Q

Treatment for spondylosing ankylosis

A

NSAIDS (1), Steroids during flares (1), Anti-TNF i.e., etanercept,
infliximab, adalimumab (2)

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14
Q

Indicators of good asthma control may be:

A

● No night-time symptoms
● Inhaler used no more than three times per week
● No breathing difficulties, cough or wheeze on most days
● Able to exercise without symptoms
● Normal lung function test

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15
Q

What is Felty syndrome

A

-Rheumatoid arthritis
- Splenomegaly
- Neutropenia (decreased WCC → repeated infections)

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16
Q
  1. Jemma is a 27-year-old lady who recently suffered from assault, with a stab injury
    to her lower back. She has a hemisection of the spinal cord resulting in differing
    symptoms on either side of her body, below the level of the stab wound.
    a. What is the name of this condition? (2 marks)
    b. Jemma has loss of pain and temperature sensation in her left lower body,
    starting around 2 inches below the wound.
    i. Which spinal tract(s) are responsible for these modalities? (2 marks)
    ii. Which side of her spinal cord is transected? (1 mark)
    c. Jemma also has a loss of motor function, vibration, deep touch and
    proprioception on one side of her body.
    iii. Which side of her body would this be, given the side of her spinal cord
    that was transected? (1 mark)
    iv. Which spinal tract(s) are responsible for this? (2 marks)
    v. Where in the CNS does this tract decussate? (2 marks)
A

a. Brown-Sequard Syndrome (2)
b. Jemma has loss of pain and temperature sensation in her left lower
body, starting around 2 inches below the wound.
i. Spinothalamic tract (2) (Accept: Anterolateral tract)
ii. Right side - spinothalamic tract results in contralateral loss of
pain and temperature sensation from 1-2 levels below the
lesion. (1)

c. Jemma also has a loss of motor function, vibration, fine touch and
proprioception on one side of her body.
i. Right side (ipsilateral) (1)
ii. Dorsal Column Medial Lemniscus pathway (2 marks)
iii. Medulla oblongata (2 marks). 1 mark for just ‘brain stem’.

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17
Q

Infective endocardtiis: You need to take blood cultures from Michael. What is the protocol for taking
blood cultures for a patient with this suspected diagnosis (assume that he is
not acutely septic)?

A

3 cultures (1) from 3 different sites (1), taken at different times* (1).

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18
Q

What is the first-line management of an upper GI bleed caused by an
oesophageal tear, if the bleeding is persistent?

A

Surgical: Upper GI endoscopy and clipping +/- adrenaline OR thermal
coagulation (2)
High-dose proton pump inhibitor post-surgery (1).
Manage contributing factors.

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19
Q

Glasgow Blatford Score

A
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20
Q

G.S for Upper GI bleed

A
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21
Q

What radiological intervention can be used to treat renal tract stones?

A

ultrasound shock wave lithotripsy (3)

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22
Q

Meningitides organisms

A

Neisseria Meningitidis (2) Gram negative (1), diplococci (1)
OR
Streptococcus pneumoniae (2) Gram positive (1) cocci (1)

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23
Q

Antibiotic for meniningits

A

Cefotaxime (2) or ceftriaxone (2), 3rd generation Cephalosporin

24
Q

Chest X ray signs for aortic stenosis

A

Cardiomegaly (1), dilated ascending aorta (1),
pulmonary oedema (1) calcification of aortic valve (1)

25
Signs of sepsis
Fevers (1), rigors (1), night sweats (1), weight loss (1), anaemia (1), splenomegaly (1), clubbing (1)
26
Liver enymes for diagnosis.
Gamma-GT indicates damage to the liver and bile ducts. All LFTs will likely be raised, though GGT is mainly associated with alcohol use. Alanine transaminase (ALT) is an enzyme that helps convert proteins into energy - this rises with liver damage. Aspartate transaminase (AST) is an enzyme that helps metabolise amino acids - high AST indicates liver damage or muscle damage. Alkaline phosphatase (ALP) is found in the liver and bone and is involved in protein catabolism - high ALP may indicate liver diseases such as a blocked bile duct or certain bone diseases.
27
signs of delirium tremens
Acute confusion (1), severe agitation (1), delusions and hallucinations (1), tremor (1), tachycardia (1), hypertension (1), hyperthermia (1), ataxia (1), arrhythmias (1).
28
Travel - suspected pneumonia
Leigonella pneumophilia
29
Bones typically affected in Pagets disease
Skull vertebrae pelvis femur
30
Investigations for Paget's disease
Elevated alkaline phosphatase (2), calcium and phosphate normal (2), XR – lytic lesions, bone biopsy (to exclude malignancy)
31
Treatment for Paget's disease
Bisphosphonates (antiresorptive medications) (2) or calcitonin (2)
32
antiphospholipid antibodies
Lupus anticoagulant Anticardiolipin antibodies Anti-beta-2 glycoprotein I antibodies
33
temporal artery biopsy
Multinucleated giant cells are found on the temporal artery biopsy. This is what gives rise to the giant cell arteritis name. This is worth remembering for your exams as it is a popular question. Duplex ultrasound of the temporal artery shows the hypoechoic halo sign
34
Polyarteritis Nodosa rash
livedo reticularis.
35
Giant cell arteritis is commonly associated with
polymylagia rheumatica
36
Dermatomyositis Skin Features
Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees Photosensitive erythematous rash on the back, shoulders and neck
37
Disc compression
38
Scale used for Ehler-Danlos syndrome
The Beighton score is used to assess the extent of hypermobility
39
Signs to look out for in emphysema
Hoover Campbell Dahl
40
Cystic fibrosis menminc
Cystic Fibrosis A-Autosomal recessive, Alkalosis and hypotonic dehydration, Absense /congenital atresia of vas deferens B-Bronchiectasis C-Chloride channel block/ciliary dysfunction, chronic cough/wheezing, clubbing D- Diabetes mellitus E- Exocrine pancreatic failure, electrolyte elevation in skin (salty sweat) F-Fat malabsorption, G-Gall stone/gene mutation on chromosome 7 H-Hepatic cirrhosis/Haemoptysis I-Intestinal obstruction/infertility
41
Bronchiectasis mnemonic
Airway Lesion, chronic obstruction Sequestration Infection, inflammation Cystic fibrosis Kartagners syndrome Allergic bronchopulmonary aspergilliosis Immunodeficiencies (myeloma, lymphoma, hypogammaglobinaemia) Reflux, inhalation injury Willam Campbell syndrome Aspiration Yellow nail syndrome/Young syndrome
42
Clinical findings for sarcoidosis
Clinical findings: Skin findings (erythema nodosum, plaques, lupus pernio) Arryhtmias, ACE increase Renal Stone Cranial Nerve Palsies, cardiomyopathy, Ca2+ elevation Osteoporosis Interstital lung disease Diabetes insipudus Ocular Findings (uveitis, photophobia) Splenomegaly, Schaumann calcification Inguinal lymph node enlargement Stridor
43
Chest X ray pleural effucion
44
Pathphysiogy of tension pneumothorax
Look out for swinging and bubbling
45
Remember two key examination findings that would automatically indicate an urgent chest x-ray:
finger clubbing and supraclavicular lymphadenopathy
46
Epiglottitis x ray sign
thumbprint sign
47
should be ruled out in all patients with new-onset neurological disturbances,
Hypoglycaemia should be ruled out in all patients with new-onset neurological disturbances, so the serum glucose should be checked
48
Head Injury Table
49
MS diagnostic criteria
McDonald diagnostic criteria
50
GBS pathophysiology
cross-reaction of antibodies with gangliosides in the peripheral nervous system correlation between anti-ganglioside antibody (e.g. anti-GM1) and clinical features has been demonstrated anti-GM1 antibodies in 25% of patients Brighton criteria used
51
Signs of GBS
52
Motor Neurone disease what is it
Amyotrophic lateral sclerosis (ALS) is the most common and well-known specific motor neurone disease. Stephen Hawking had amyotrophic lateral sclerosis. Progressive bulbar palsy is the second most common form of motor neurone disease. It affects primarily the muscles of talking and swallowing. Other types of motor neurone disease to be aware of are progressive muscular atrophy and primary lateral sclerosis.
53
Medication for epilepsy
Management of tonic-clonic seizures is with: First line: sodium valproate Second line: lamotrigine or carbamazepine Focal First line: carbamazepine or lamotrigine Second line: sodium valproate or levetiracetam Absence: First line: sodium valproate or ethosuximide Atonic: First line: sodium valproate Second line: lamotrigine Myoclonic: First line: sodium valproate Other options: lamotrigine, levetiracetam or topiramate
54
Carpal tunnel syndrome link
the link between bilateral carpal tunnel syndrome and acromegaly came up several times.
55
Thenar muscles
Abductor pollicis brevis (thumb abduction) Opponens pollicis (thumb opposition – reaching across the palm to touch the tips of the fingers) Flexor pollicis brevis (thumb flexion)
56
Duchenne Muscular Dystrophy

NEED TO KNOW Before Exams!!! (13 decks)

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