MSK Flashcards by Elle Dodds

Which nerve is affected in carpal tunnel?

Which fingers do you get symptoms

Median

Thumb, index and middle

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Polymyalgia rheumatic key features

Key Ix

Management?

Usually pts > 60
Usually rapid onset (e.g. < 1 month)
aching, morning stiffness in proximal limb muscles

also mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats

ESR (inflam markers will be up)

Steroids

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How to manage Carpal tunnel

Mild-moderate:
6 week trial of conservative treatments e.g.
corticosteroid injection, wrist splints at night.

If severe/conservative measures don’t help:
surgical decompression (flexor retinaculum division)

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FRAX used risk factors for osteoporosis

Bones SPARC

BMI (low)
Smoking
Parental hip fracture
Alcohol XS
Rheumatoid arthritis
Corticosteroid use (more than 3 months at a dose of prednisolone 10mg daily)

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What do DXA results mean?

> -1 = normal
-1-> -2.5 osteopoenia
< - 2.5 osteoporosis.

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Osteoporosis management - lifestyle

Falls risk assessment, weight bearing and muscle strengthening exercises, adcal, calculate FRAX

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When would you use bisphosphonates in osteoporosis

if 10y risk of fracture >1%
OR
hip or vertebral fracture
OR
T score <-2.5 or less at femoral neck
OR
T-score between -1 and -2.5 (osteopoenic) AND 10y probability of a hip fracture >3%

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What can be used for osteoporosis above bisphosphonates if indicated

Denosumab

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What is Tennis elbow?
How do you test for it?

lateral epicondylitis

Get pt to hold arm at 90 degrees whilst supinated then push wrist down into your hand (extend wrist) - will reproduce pain.

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What is golfers elbow?
How do you test for this?

medial epicondylitis

Get pt to hold arm at 90 degrees whilst supinated then flex wrist (I’m pointing to ME)

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What condition is anti phospholipid syndrome most commonly associated with

lupus

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What happens to coag in anti phospholipid syndrome

Prolonged APTT

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Features of anti-phospholipid syndrome?

Clots, recurrent miscarriages, low platelets

livedo reticularis

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How to investigate anti phospholipid syndrome

Antibodies:
- Anticardiolipin antibodies
- Anti-beta2 glycoprotein I (anti-beta2GPI)

Lupus anticoagulant
FBC (thrombocytopenia)
Coag (prolonged APTT_

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Anti phospholipid syndrome management

Aspirin

If pt develops a clot then warfarin

If they get another clot whilst on this increase target INR to 3-4 and consider adding aspirin

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Other ank spond Features

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

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What is cubital tunnel

When can symptoms be worse?

Little and ring finger affected
Ulnar nerve

Can be worse when leaning on the affected elbow. Often assoc w. trauma/ OA to the area

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First line bisphosphonate for osteoporosis

Aledronate

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When are bisphosphonates C/I?

eGFR less than 35

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X ray changes in OA?

LOSS

Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts

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Which autoantibody has the highest specificity for RA?

Anti CCP

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In what other conditions might RF be positive

Felty’s syndrome (around 100%)

Sjogren’s syndrome (around 50%)

Infective endocarditis (around 50%)

SLE (= 20-30%)

systemic sclerosis (= 30%)

general population (= 5%)
rarely: TB, HBV, EBV, leprosy

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Classic radiograph features of osteosarcoma

Radiographs classically show Codman triangle (a triangular area of new subperiosteal bone) with an associated sunburst appearance.

Classic radiograph features of Ewing’s sarcoma

Onion skin

What condition is osteosarcoma associated with

Retinoblastoma

What is a fragility fracture

Fall from standing height or less

If pt over 75 falls and get a fragility fracture what do you do

Start bisphosphonates

When would you start bisphoshonates in women without screening

If over 50 and had a fragility fracture

meralgia paraesthetica - which nerve is affected?

Lateral cutaneous nerve of the thigh

Pseudogout microscopy

Positively bifringent crystals.

Gout timeline

Reaches maximum intensity within 24 hours, and resolves within 5-15 days.

What do gout crystals look like? What do pseudo gout crystals look like? What are the made of?

Gout: Negatively bifringent Needle shaped Monosodium urate Pseudogout: Positively bifringent Rhomboidal Calcium pyrophosphate

Chronic Gout x ray appearances

Joint effusion is usually the earliest sign. Later, x-rays show punched out lytic lesions, sclerotic margins and outlines of tophi. Top are caused by MSU Crystal deposition

What is pseudo gout also called?

Calcium Pyrophosphate Deposition Disease

Main differences in management gout/pseudogout

Pseudogout - rate lowering therapies won't work

Osteomalacia sx

-Bone pain -Bone/muscle tenderness -Fractures: especially femoral neck -Proximal myopathy: may lead to a waddling gait

What blood results would you expect in osteomalacia? What would XR look like?

Bloods: - low vitamin D - low calcium, phosphate (in around 30%) - Raised alkaline phosphatase (in 95-100% of patients) x-ray translucent bands (Looser's zones or pseudofractures)

How to treat osteomalacia?

Vit D supplement

What is Finkelstein's test and what does it indicate?

Pulls the thumb of the patient in ulnar deviation and longitudinal traction. Indicates De Quervain's tenosynovitis. This is where the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.

How to start allopurinol for gout?

Initial dose of 100 mg od. Titrate every few weeks to aim for a serum uric acid of < 360 µmol/ Colchicine cover (NSAIDS if can't tolerate)

When should bisphosphonates be taken?

At least 30 mins before breakfast with lots of water, sit upright for 30 mins after

Knee pain and a history of lots of kneeling?

Infrapatellar bursitis

when would you start bisphosphonates without investigating?

If over 75 and sustained a fragility fracture

Reactive arthritis classic features and other name

Reiters syndrome. Joint pain, conjunctivitis, urethritis can't see, pee or climb a tree

Which antibodies most common in Sjogrens

Anti-Ro rheumatoid factor (RF) positive in nearly 50% of patients ANA positive in 70% anti-Ro (SSA) antibodies in 70% of patients with PSS anti-La (SSB) antibodies in 30% of patients with PSS

Common cause of lateral knee pain in runners?

Iliotibial band syndrome

Subacromial impingement examination signs

painful arc of abduction. With subacromial impingement, this is typically between 60 and 120 degrees.

What does CREST syndrome indicate and what does it stand for

Limited systemic sclerosis Calcinosis Raynaud's phenomenon oEsophageal dysmotility Sclerodactyly Telangiectasia

3 subtypes of systemic sclerosis

Limited systemic sclerosis (CREST) Diffuse cutaneous systemic sclerosis Scleroderma

Which antibodies are associated with systemic sclerosis and which subtypes

Antibodies ANA positive in 90% RF positive in 30% anti-scl-70 antibodies associated with diffuse cutaneous systemic sclerosis associated with a higher risk of severe interstitial lung disease anti-centromere antibodies associated with limited cutaneous systemic sclerosis

Diffuse cutaneous systemic sclerosis features

- Trunk and proximal limbs mainly affected - anti scl-70 antibodies the most common cause of death is now respiratory involvement, which is seen in around 80%: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) other complications include renal disease and hypertension poor prognosis

Which DMARD can cause oligospermia

Sulfasalzine Also ILD and Heinz body anaemia

How to manage acute flare of RA

IM Methylpred

When would you give a TNF inhibitor in RA

If inadequate response to 2 DMARDs