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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
Q

Signs of sepsis

A

Fevers (1), rigors (1), night sweats (1), weight loss (1), anaemia
(1), splenomegaly (1), clubbing (1)

26
Q

Liver enymes for diagnosis.

A

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
Q

signs of delirium tremens

A

Acute confusion (1), severe agitation (1), delusions and hallucinations (1),
tremor (1), tachycardia (1), hypertension (1), hyperthermia (1), ataxia (1),
arrhythmias (1).

28
Q

Travel - suspected pneumonia

A

Leigonella pneumophilia

29
Q

Bones typically affected in Pagets disease

A

Skull
vertebrae
pelvis
femur

30
Q

Investigations for Paget’s disease

A

Elevated alkaline phosphatase (2), calcium and phosphate normal (2),

XR – lytic lesions, bone biopsy (to exclude malignancy)

31
Q

Treatment for Paget’s disease

A

Bisphosphonates (antiresorptive medications) (2) or calcitonin (2)

32
Q

antiphospholipid antibodies

A

Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein I antibodies

33
Q

temporal artery biopsy

A

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
Q

Polyarteritis Nodosa rash

A

livedo reticularis.

35
Q

Giant cell arteritis is commonly associated with

A

polymylagia rheumatica

36
Q

Dermatomyositis Skin Features

A

Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees
Photosensitive erythematous rash on the back, shoulders and neck

37
Q

Disc compression

A
38
Q

Scale used for Ehler-Danlos syndrome

A

The Beighton score is used to assess the extent of hypermobility

39
Q

Signs to look out for in emphysema

A

Hoover
Campbell
Dahl

40
Q

Cystic fibrosis menminc

A

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
Q

Bronchiectasis mnemonic

A

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
Q

Clinical findings for sarcoidosis

A

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
Q

Chest X ray pleural effucion

A
44
Q

Pathphysiogy of tension pneumothorax

A

Look out for swinging and bubbling

45
Q

Remember two key examination findings that would automatically indicate an urgent chest x-ray:

A

finger clubbing and supraclavicular lymphadenopathy

46
Q

Epiglottitis x ray sign

A

thumbprint sign

47
Q

should be ruled out in all patients with new-onset neurological disturbances,

A

Hypoglycaemia should be ruled out in all patients with new-onset neurological disturbances, so the serum glucose should be checked

48
Q

Head Injury Table

A
49
Q

MS diagnostic criteria

A

McDonald diagnostic criteria

50
Q

GBS pathophysiology

A

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
Q

Signs of GBS

A
52
Q

Motor Neurone disease what is it

A

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
Q

Medication for epilepsy

A

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
Q

Carpal tunnel syndrome link

A

the link between bilateral carpal tunnel syndrome and acromegaly came up several times.

55
Q

Thenar muscles

A

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
Q

Duchenne Muscular Dystrophy

A

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

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