Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 4 > MSK > Flashcards

MSK Flashcards

1
Q

What is ankylosing spondylitis?

A

a chronic progressive inflammatory arthropathy associated with HLA-B27 gene which ultimately may lead to radiographical changes in the spine and sacroiliac joints.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what percentage of patents with ankylosing spondylitis have HLA-B27 gene? what chromosome is it found on?

A

90%
autosomal dominant on chromosome 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are 3 risk factors for ankylosing spondylitis?

A

HLA-B27
FHx
male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are 5 presentations of ankylosing spondylitis?

A

Severe inflammatory (improved by NSAIDs) back/ butt pain and stiffness
worse in morning (>30 mins) improves with activity
Systemic symptoms
Ethesitis - inflammation of where tendons or ligaments insert into bone
Dactylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are 5 associated conditions with ankylosing spondylitis?

A

5As

Anterior uveitis
Aortic regurgitation
AV block
Apical lung fibrosis
Anaemia of chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what age group most commonly presents with ankylosing spondylitis?

A

late teens to 20s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what test can be done o/e for ankylosing spondylitis?

A

Schober’s test - assesses spinal mobility

may also have reduced lateral flexion and chest expansion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are 4 investigations for ankylosing spondylitis?

A

spine and sacral Xray
HLA-B27 gene testing
Inflammatory markers
MRI spine - bone marrow oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are 7 radiological signs of ankylosing spondylitis?

A

bamboo spine
squaring of vertebral bodies
subchondral sclerosis
subchondral erosions
Syndesmophtes - areas of bone growth where ligaments insert into bone
Ossifications
Fusions - facet, sacroiliac and costovertebral joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the treatment for ankylosing spondylitis?

A

1 - NSAIDs

2- anti-TNF - infliximab, etancercept, adalimumab

3 - IL-17 MAB - secukinumab, ixekizumab
OR
JAK inhibitor - Upadacitinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are 5 complications of ankylosing spondylitis?

A

osteoporosis
vertebral fractures
anaemia
cauda equina
apical fibrosis and pulmonary involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the 5 seronegative spondyloarthropathies?

A

Psoriatic arthritis
ankylosing spondylitis
reactive arthitis
IBD associated arthritis
juvenile idiopathic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the 8 common symptoms of the seronegative spodyloarthropathies?

A

SPINE ACHE

sausage digits - dactylitis
Psoriasis
inflammatory back pain
NSAID responsive
Enthesitis - inflammation at point tendon attaches to bone
Arthritis
Crohn’s/Colitis/CRP elevated
HLA-B27
eyes - uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is fibromyalgia?

A

a chronic pain syndrome diagnosed by the presence of widespread body pain and tender points at specific anatomical locations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

does fibromyalgia affect more men or women?

A

women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the overlapping pain conditions with fibromyalgia?

A

IBS
TMJD
interstitial cystitis
vulvodynia
tension headaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are 3 risk factors for fibromyalgia?

A

FHx
rheumatic conditions
age 30-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are 5 clinical manifestations of fibromyalgia?

A

chronic pain
diffuse tenderness on examination
fatigue unrelieved by rest/sleep disturbance
morning stiffness
headaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are 3 differentials for fibromyalgia?

A

rheumatoid arthritis
vitamin D deficiency
chronic fatigue syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the treatment for fibromyalgia?

A

Education
exercise
CBT
Pregabalin
Duloxetine
Amitriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the criteria for a fibromyalgia diagnosis?

A

American college of rheumatology 31 point questionnaire including widespread pain score and symptom severity score

Widespread pain index >7 and symptom severity scale score >5
OR
WPI 3-6 and SS scale score >9

Symptoms present for at least 3 months
No other explanation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

where are the 9 tender sites in fibromyalgia?

A

Occiput
Lower cervical region
Trapezius
Supraspinatus
Second rib
Lateral epicondyle
Gluteal region
Greater trochanter
Knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is giant cell arteritis?

A

a granulomatous vasculitis of large and medium-sized arteries. It primarily affects branches of the external carotid artery, and it is the most common form of systemic vasculitis in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is gout?

A

an inflammatory arthritis caused by deposition of monosodium urate crystals within joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are grout crystals like?

A

monosodium urate - negatively bifringent

needle shaped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what joints is most commonly associated with gout?

A

big toe - MTP (metatarsophalangeal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is gout most commonly caused by?

A

renal under excretion of urate - 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are 3 risk factors for gout?

A

Diet of red meat, seafood and alcohol
Diuretics + low dose aspirin
Metabolic syndrome
impaired renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the pathophysiology of gout?

A

High urate levels result in super saturation and crystal formation => monosodium urate crystals in joint interact with undifferentiated phagocytes and trigger acute inflammation by inducing TNF-alpha and activating signalling pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are 4 clinical manifestations of gout?

A

rapid onset of severe joint pain in few joints
joint stiff, red, hot
tophi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what renal disease can gout lead to?

A

Interstitial nephritis and eventually CKD due to urate crystal deposit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are 3 investigations for gout?

A

joint aspiration - gold

serum uric acid levels - 4-6 weeks after attack

joint X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what may be seen on x-ray in gout?

A

Usually normal

chronic -
Joint effusion but space maintained
Punched out erosions
Lytic lesions
Sclerotic margins
Outlines of tophi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what are 3 bloods needed in a gout work up?

A

U+E - assess renal function for appropriate dose orf allopurinol
FBC - WCC may be raised Fasting glucose and lipid profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are 3 differentials for gout?

A

pseudo gout
septic arthritis
rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the management of an acute gout attack?

A

1 - NSAID - Naproxen 750mg one off then 250mg every 8 hours
OR
1 - Colchicine - 500 micrograms 2-4x a day - 3-6 days

2 - corticosteroids - 15mg Pred OD PO

continue allopurinol if already on it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is an adverse effect of colchicine?

A

diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

who should colchicine be used with caution in?

A

renal impairment
dose reduction if eGFR 10-50
Avoid if eGFR <10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is the management of gout chronically?

A

lifestyle advise

Uric acid lowering therapy - 1 - allopurinol - 100mg OD PO
2 - Febuxostat

Uricosuric agent - sulfinpyrazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the serum urate target in gout?

A

<360 micromol/L

<300 micromol/L with tophi, arthritis or ongoing flares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what class of medication is allopurinol?

A

xanthine oxidase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How long should you wait to start urate lowering therapy after an acute attack?

A

2 weeks - not lots of evidence but may precipitate further attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is the criteria for starting urate lowering therapy?

A

Can start after 1st attack

Definitely if:
2+ attacks
Tophi
Renal disease
uric acid renal stones
prophylaxis if on cytotoxics or diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what are 3 complications of gout?

A

joint destruction + tophi
kidney disease - acute uric acid nephropathy
urate nephrolithiasis + CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what is osteoarthritis?

A

a non-inflammatory degenerative arthritis characterised by progressive synovial joint damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what are 7 risk factors for osteoarthritis?

A

Older age - 50+
Obesity
Occupation
Physically demanding job/sport
Trauma
Family history
Female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what are the 5 X-ray manifestations of osteoarthritis?

A

JOSSA
joint space narrowing
osteophyte formation
subchondral sclerosis
subchondral cysts
abnormalities of bone contour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what is the pathophysiology of osteoarthritis?

A

there is a failure in maintaining the homeostatic balance of the cartilage matrix synthesis and degradation, resulting from reduced formation or increased catabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what are 5 presentations of osteoarthritis?

A

Pain
Functional difficulty and reduced ROM
Crepitus
Bony deformaities and joint enlargement
Effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what joints does osteoarthritis usually affect?

A

weight bearing joints asymmetrically

Hips, knees, DIPJ, CMC joint at base of thumb, Lumbar spine, cervical spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are 5 hand signs of OA?

A

Heberdens nodes - DIP joints
Bouchards nodes - PIP joints
Squaring of base of thumb - CMC joint
Weak grip
Reduced ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the criteria for OA diagnosis?

A

> 45 years old, typical pain, no /<30 mins of morning stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what is the management for osteoarthritis?

A

Non pharma - therapeutic exercise, weight loss, occupational therapy

Pharma -
1 - Topical NSAIDs

2 - oral NSAIDs + PPI

3 - intra-articular steroid injections - 2-10 weeks relief

Surgical
- joint replacement

Weak opiates and paracetamol for short infrequent use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are 5 side effects of NSAIDs?

A

Gastritis and peptic ulcers - GI bleeds
Renal - AKI (acute tubular necrosis), CKD
Cardio - HTN, heart failure, MI, stroke
Exacerbating asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are heberden’s node?

A

osteoarthritic nodes of the DIP joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what are Bouchard’s nodes?

A

osteoarthritic nodes of the PIP joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what kind of appearance does erosive OA have on Xray?

A

gulls wing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is osteomyelitis?

A

an inflammatory condition of bone caused by an infecting organism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what is the most common cause of osteomyelitis?

A

S. Aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what is the most common bacterial cause of Osteomyelitis in sickle cell?

A

Salmonella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what are the 3 paths of infection in osteomyelitis?

A

Direct inoculation

Contiguous spread from adjacent tissues

Haematogenous spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what are 7 risk factors for Osteomyelitis?

A

Open fracture
orthopaedic operations - esp prosthetics
diabetes - esp with ulcers
peripheral arterial disease
IVDU
Immunosuppression
Sickle cell disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what organisms mainly cause osteomyelitis in infants?

A

S. Aureus
group B strep
aerobic gram -ve bacili
candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what organisms mainly causes osteomyelitis in children?

A

1 - S. Aureus

2 - Strep pneumoniae

Haemophilus influenzae in unvaccinated children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what organisms mainly cause osteomyelitis in adults?

A

1 - S. Aureus

coagulase negative staph
aerobic gram negatives
anaerobic gram +ve peptostreptococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what organisms mainly cause osteomyelitis in the elderly?

A

gram negative bacili

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what organisms usually cause osteomyelitis in IVDU?

A

S. Aureus

Can also get pseudomonas in pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what are 3 risk factors for osteomyelitis?

A

pHx of osteomyelitis
penetrating injury
IVDU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what is the presentation of acute osteomyelitis?

A

Symptoms over a few days

Pain, erythema, swelling, warmth
Fever
malaise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what are 3 cpresentations of chronic osteomyelitis?

A

Local symptoms - swelling, erythema, pain - no systemic symptoms

Draining sinus tract
Non-healing fractures
Diabetes ulcers >2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what are 3 investigations for osteomyelitis?

A

Bloods - FBC, CRP, Cultures
X-ray - may be negative for first 2 weeks
MRI/CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what are 3 signs of osteomyelitis on x-ray?

A

periosteal reaction - change in surface of bone
Localised osteopenia
Destruction of areas of bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what is the gold standard for osteomyelitis?

A

bone biopsy, cultures and histopathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what is the treatment of osteomyelitis?

A

6 weeks IV Abx
- IV Flucloxacillin 8g /day
- Pen allergy - Clarithromycin

Debridement - surgery to remove necrotic bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what is required for management of osteomyelitis with prosthetic joint involvement?

A

may require complete revision surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what are 3 complications of osteomyelitis?

A

drug reactions
amputation
recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

what is osteoporosis?

A

Systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue with consequent increase in bone fracture and fragility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

how do bisphosphonates work?

A

slow down osteoclast activity => reduce bone breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

how does Denosumab work?

A

anti-resorbative - inhibits osteoclast activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

how does teriparatide work?

A

anabolic - synthetic parathyroid hormone, increases osteoblastic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what are the T score ranges?

A

> -1 = normal
-1 - -2.5 = osteopenia
< -2.5 = osteoporosis
< -2.5 + a fracture = severe osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is pseudogout?

A

an acute inflammatory arthritis of one or more joints due to calcium pyrophosphate deposition on joint surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what are 7 risk factors for pseudogout?

A

advanced age >65
injury/trauma
hyperparathyroidism
haemochromatosis
wilsons disese
acromegaly
low magnesium and phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what kind of crystals are deposited in psudogout?

A

calcium pyrophosphate crystals

positively bifringent rhomboid shaped crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what are 3 manifestations of pseudogout?

A

Most commonly knee, wrist and shoulders

red painful and tender joints
sudden worsening of osteoarthritis
joint effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what can be see on xray in pseudogout?

A

chondrocalcinosis - calcification in the hyaline and/or fibrocartilage - white line in joint space

can also have oesteoarthritis type changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what are 3 investigations for pseudogout?

A

synovial fluid aspirate analysis - gold

joint X ray - chondrocalcinosis

serum calcium + PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what are 3 differentials for pseudogout?

A

gout
septic arthritis
osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

what is the management for pseudogout?

A

1 - NSAIDs or Colchicine
corticosteroid intra-articular

Intra-articular steroids
Oral steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what is the general order of affected joints in pseudogout?

A

Knee > wrist > shoulders > ankles >elbows

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is psoriatic arthritis?

A

a seronegative chronic inflammatory joint disease associated with psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what are 5 different types of psoriatic arthritis?

A

Asymmetrical oligoarthritis - affecting 1-4 joints at a time
Symmetrical polyarthritis >4 joints
Distal interphalangeal predominant pattern
Spondylitis
Arthritis mutilans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what is arthritis mutilans?

A

most severe form form of psoriatic arthritis - causes osteolysis of bones around joints leading to progressive shortening of digits - telescoping digits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what are 3 risk factors for psoriatic arthritis?

A

psoriasis
FHx
Hx of joint/tendon trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

what is one features of psoriatic arthritis that distinguishes it from RhA?

A

DIP joint involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

what are 5 hand signs of psoriatic arthritis?

A

Psoriasis plaques
Nail pitting
onycholysis
Dactylitis
Enthesitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

what are 5 manifestations of psoriatic arthritis?

A

Painful stiff joints - DIP involvement
Symmetrical or asymmetrical
psoriatic skin lesions - though often precedes plaques
Nail changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

what screening tool can be used for psoriatic arthritis?

A

psoriasis epidemiological screening tool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What are 4 X-ray features of psoriatic arthritis?

A

Pencil in cup deformity
periostitis - inflammation of periosteum
ankylosis
osteolysis
dactylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what is the mangement for psoriatic arthritis?

A

NSAIDs - mild

DMARDs - methotrexate, sulfasalazine
anti0TNF-alpha inhibitors - infliximab
MAB - Ustekinumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

what are 3 complications of psoriatic arthritis?

A

Joint deformity
cardiovascular risks
malignancy- skin cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is reactive arthritis?

A

A sterile inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

what is the classic triad of reactive arthritis? what is the way to remember it?

A

Arthritis
Urethritis + balantitis
Conjunctivitis/anterior uveitis

Can’t see, can’t wee, can’t climb a tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

is reactive arthritis usually asymmetrical?

A

YES - also usually only affects one joint - mono arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

who is reactive arthritis most common in?

A

Men with HLA-B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what is one condition that is often associated with reactive arthritis?

A

HIV - should exclude in presenting patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

what are 5 causative organisms for reactive arthritis?

A

GU - chlamydia trachomatis, gonorrhoea

GI - salmonella, shingella, campylobacter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what are 4 risk factors for reactive arthritis?

A

HLA-B27
male
chlamydial/GI infection
HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what are 3 investigations for reactive arthritis?

A

ESR/CRP - elevated
joint aspiration
infectious serology/urine/stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what are 3 differentials for reactive arthritis?

A

gout
pseudogout
septic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

what is the management of reactive arthritis?

A

PRESUME SEPTIC UNTIL PROVEN OTHERWISE

NSAIDs - naproxen/ibruprofen
corticosteroids injections
Tx triggering infection

usually gone in 6 months

DMARDs - in recurrent cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

what are 3 complications of reactive arthritis?

A

circinate balanitis
uveitis
keratoderma blennorhagicum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is rheumatoid arthritis?

A

An autoimmune chronic inflammatory condition of the synovial lining of joints, tendon sheaths and bursa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

what are 4 risk factors for Rheumatoid arthritis ?

A

Female
Smoking
Obesity
Fhx - HLA DR4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what are 6 manifestations of RhA?

A

Symmetrical polyarthritis > 6 weeks
Morning stiffness lasting >30 mins
Joint deformities
Rheumatoid nodules

Systemic symptoms - fatigue, wt loss, flu like illness, muscle aches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what joints are usually spared in rheumatoid arthritis?

A

DIP

Lumbar spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what is felt on palpating rheumatoid arthritis joint?

A

feel boggy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what are the 4 deformities associated with Rheumatoid arthritis?

A

Swan’s neck
Boutonniere - pip always bent
Ulnar deviation
Z-thumb deformity - hyperextension of thumb IPJ and flexed MCP joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

what are 12 extra-articular manifestations of rheumatoid arthritis?

A

Pulmonary fibrosis
Felty’s syndrome
Sjogrens syndrome
Anaemia of chronci disease
CVD
eye manifestations
rheumatoid nodules
Lymphadenopathy
Carpel tunnel
Amyloidosis
Bronchiolitis obliterans
Caplan syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

what are 6 ocular manifestations of rheumatoid arthritis?

A

Dry eye syndrome - keratoconjunctivitis sicca - most common
episcleritis
scleritis
keratitis
cataracts - secondary to steroids
retinopathy - secondary to hydroxychloroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

what is Felty’s syndrome?

A

Triad

rheumatoid arthritis
Neutropenia
Splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what is bronchiolitis obliterans?

A

small airway destruction and airflow obstruction in lungs

associated with rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what is caplan syndrome?

A

pulmonary nodules in rheumatoid arthritis patient exposed to coal, silica, asbestos or dust

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

what are 2 autoantibodies present in Rheumatoid arthritis?

A

Rheumatoid factor
anti-CCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

what are 6 conditions associated with positive rheumatoid factor?

A

Felty’s syndrome
Sjorgren’s syndrome
infective endocarditis
SLE
Systemic sclerosis
General population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what is the most sensitive and specific autoantibody in Rheumatoid arthritis?

A

Anti-CCP (cyclic citrullinated peptide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what is one serious cervical spine complication in rheumatoid arthritis?

A

Atlantoaxial subluxation - damage to ligaments around odontoid peg of axis allows for it to shift within atlas which can lead to subluxation and spinal cord compression

Need to be considered in general anaesthetic - visualise with MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

what are 5 x-ray findings in rheumatoid arthritis?

A

Soft tissue swelling
periarticular osteopenia/porosis
joint space narrowing
Periarticular erosions
subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

what questionnaire can be used to assess functional ability and response to treatment in rheumatoid arthritis?

A

Health assessment questionnaire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What questionnaire can be used to monitor disease activity in rheumatoid arthritis?

A

Disease activity score 28 joints - DAS28

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What is the management of 1st presentation of rheumatoid arthritis in GP?

A

NSAID cover
Urgent referral to Rheumatology
Physio and OT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

what is the initial specialist therapy for rheumatoid arthritis?

A

DMARD monotherapy - methotrexate, sulfasalazine, leflunomide, hydroxychloroquine

+/- Prednisolone bridging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

when are patients with rheumatoid arthritis trialled on a TNF-inhibitor?

A

Inadequate response to 2 DMARDs

Etanercept
Infliximab
Adalimumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

what are 2 rheumatoid arthritis medications that are safe in pregnancy?

A

Sulfasalazine
Hydroxychloroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

after what gestation should NSAIDs not be used?

A

32 weeks - risks early closure of ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

what is the MOA of methotrexate?

A

inhibits dihydrofolate reductase - enzyme for synthesis of purines and pyrimidines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

what are 5 adverse effects of methotrexate?

A

Mucositis
Myelosuppression
Pneumonitis
Pulmonary fibrosis
Liver fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

How long before conception does methotrexate need to be stopped in both men and women?

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

How often is methotrexate taken?

A

ONCE A WEEK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

how often should people on methotrexate be monitored?

A

FBC, U+E, LFT every 2-3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

what should be prescribed with methotrexate?

A

5mg folic acid once a week

take >24h after methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

what are 3 medications that CANNOT be prescribed with methotrexate?

A

Trimethoprim
Co-trimoxazole
High dose aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

what is the treatment of methotrexate toxicity?

A

Folinic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

What is septic arthritis?

A

the acute infection of 1 or more joints caused by pathogenic inoculation of microbes. It occurs either by direct inoculation or via haematogenous spread and can destroy a joint in under 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

what is the most common joint to be infected with septic arthritis?

A

knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

what is the most common causative organism for septic arthritis?

A

S. Aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

who 2 gram negative bacteria cause septic arthritis? what patients in?

A

E. COLI and PSEUDOMONAS AERUGINOSA

IVDU
immunosuppressed
neonates
elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

what are 2 gram positive causative bacteria of septic arthritis? what patients affected?

A

Strep group A (pyogenes) - <5yrs

Staph epidermis - prosthetic joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

who gets neisseria gonorrhoea septic arthritis?

A

sexually active people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

what are 6 risk factors for septic arthritis?

A

underlying joint disease/prosthetic joint
IVDU, indwelling catheters
immunosuppression
Skin infections
Extremes of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

what are 5 manifestations of septic arthritis?

A

hot, swollen, painful, red
restricted ROM
fever
affecting single joint (90%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

what are 3 investigations for septic arthritis?

A

joint aspiration - gold

FBC - leukocytosis
CRP and ESR - high
blood cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

what are 3 differentials for septic arthritis?

A

osteoarthritis
pseudogout
Gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

what is the management of septic arthritis?

A

IV antibiotics - 4-6 weeks
- Fluclox, Clindamycin, Vancomycin

Surgical drainage either needle aspiration or arthroscopy

STOP methotrexate and anti-TNF alpha
double steroids (if on)
rest and splint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

what is the aspirate WCC in septic arthritis usually?

A

> 50 000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

what are 3 complications of septic arthritis?

A

sepsis
osteomyelitis
joint destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

What is systemic lupus erythramatosus?

A

a chronic systemic autoimmune condition caused by a type 3 hypersensitivity reaction leading to immune complex deposition in many organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

what is the typical demographic for SLE

A

Female
Afro-Caribbean
20-40 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

what are 10 manifestations of SLE?

A

Malar (butterfly)/ photosensitive /discoid rash

Non-specific - fatigue, wt loss, arthralgia, myalgia, fever

lupus nephritis - oedema
Arthritis
Raynaud’s phenomenon

SOB, pleuritic chest pain
Splenomegaly
mouth ulcers
hair loss
lymohadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

what are 3 antibody tests for SLE?

A

ANA (anti-nuclear antibodies) - most sensitive

Anti-dsDNA - most specific

Anti-smith antibodies - very specific, not sensitive

Anti-Ro, Anti-La
Anti-Scle-70
Anti-Jo-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

are complement levels high or low in SLE?

A

low in active disease as formation of immune complexes leads to consumption of complement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

what blood clotting disorder can occur secondary to SLE?

A

Antiphospholipid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

what are 3 differentials for SLE?

A

Rheumatoid Arthritis- SLE less symmetrical
antiphospholipid syndrome
mixed connective tissue disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

what is the management of SLE?

A

1 - hydroxychloroquine

NSAIDs
corticosteroids - prednisolone

2 - DMARDs - methotrexate, biologics - rituximab, belumumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

what are 9 complications of SLE?

A

Cardiovascular disease - due to chronic inflammation
Anaemia
Pericarditis
Pleuritis
interstitial lung disease
Lupus nephritis
Neuropsychiatric SLE
Recurrent miscarriage, IUGR, Pre-eclampsia, pre-term labour
VTE - anti-phospholipid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

what antibodies are found in drug induced lupus?

A

anti-histone antibodies

ANA usually positive
dsDNA usually negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

what are 5 medications that can cause drug induced lupus?

A

Procainamide
hydralazine
isoniazid
minocycline
phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

what is the most common form of lupus nephritis?

A

Diffuse proliferative glomerulonephritis

presents with haematuria, proteinuria, hypertension, oedema

most severe!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

what can be seen on renal biopsy in SLE sclerosing glomreulonephritis?

A

Hypercellular glomerulus
Thickened basement membrane
Wire-loop appearance of endothelial and mesangial proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

what is the management of lupus nephritis?

A

lifestyle - stop smoking, exercise, diet
Corticosteroids
immunosuppression
Hydroxychloroquine

Dialysis
ACEi for renoprotection and HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

how long does morning stiffness in OA last?

A

<30 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

what is FRAX?

A

predicts risk of fragility fracture over the next 10 years

age, BMI, smoking, alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

what group of people does N. Gonorrhoea cause septic arthritis in?

A

sexually active young adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

what antibiotics are used in septic arthritis?

A

IV flucoxacillin - gram pos
(clindamycin in allergy)
IV cefotaxime - gram neg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

what are 4 risk factors for SLE?

A

female
FHx
middle aged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

what is the gold standard investigation of osteomalacia?

A

iliac bone biopsy with double tetracycline labelling

rare as invasive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

what is osteomalacia?

A

a metabolic bone disease characterised by incomplete mineralisation of the underlying mature organic bone matrix (osteoid) following growth plate closure in adults

caused by vitamin D deficiency

rickets in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

what causes osteomalacia?

A

vitamin D deficiency

calcium or phosphate deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

what is the presentation for osteomalacia and vitamin D deficiency?

A

Fatigue
Bone pain
Muscle weakness
muscle aches
pathological or abnormal fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

what are 3 skeletal changes that can be seen in osteomalacia?

A

Pseudofractures - Looser’s zones - radiolucent bands traversing part way though bones due to demineralisation

Bowing deformities

Vertebral fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

what are 4 risk factors for osteomalacia?

A

risks for low vitamin D

Darker skin
low sunlight exposure
living in cold climates
spending most of time indoors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

what is normal serum vitamin D?

A

50-75 nmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

what are 5 investigations for osteomalacia?

A

serum calcium and phosphate
serum 25-hydroxyvitamin D
PTH level - may be high
Alk phos - might be high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

what is the treatment of osteomalacia?

A

Colecalciferol - 50 000 IU weekly for 6 weeks or 4000IU OD for 10 weeks

IM calcitrol - if suspected absorption issue

should check calcium in first month as low vitamin d may mask hypercalcaemia in primary hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

How much vitamin d should everyone be taking?

A

400IU (10 micrograms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

which discs are most commonly affected in vertebral disc degeneration?

A

lower lumbar spine - L5/S1 then L4/L5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

what are 5 risk factors for disc prolapse?

A

Increasing age
Smoking
genetics
High BMI
Occupation - heavy lifting, bending, operating machinery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

what is the pathophysiology of disc prolapse?

A

Over time nucleus pulposus loses mechanical ability to withstand pressure
There is also weakening of posterior longitudinal ligament

prolapsed disc causes compression of nearby nerve roots and/or cauda equina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

what are 5 manifestations of vertebral disc prolapse?

A

Lower back pain
Radiculopathy
Neurological weakness
Paraesthesia
Cauda equina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

what is the presentation of a L3 nerve root compression?

A

Sensory - loss over anterior thigh

Motor - weak hip flexion, knee extension and hip adduction

Reflex - Knee reduced

Positive femoral stretch test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

what is the presentation of L4 nerve root compression?

A

Sensory - loss of anterior aspect of knee and medial malleolus

Motor - weak knee extension and hip adduction

Reflex - reduced knee

Positive femoral stretch test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

what is the presentation of L5 nerve root compression?

A

Sensory - loss to dorsum of foot

Motor - weakness in dorsiflexion

Reflexes - intact

Positive sciatic nerve stretch test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

what is the presentation of S1 nerve root compression?

A

Sensory - loss of posterolateral leg and lateral foot

Motor - weak plantarflexion

Reflex - reduced ankle reflex

Positive sciatic nerve stretch test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

what imaging is done for disc prolapse?

A

MRI spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

what is the conservative management of disc prolapse?

A

Continue with life but restrict painful activity
Physio
Analgesia - 1 - NSAIDs
1 - amitriptyline for radiculopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

what are 3 indications for surgery in disc prolapse?

A

Cauda equina syndrome
Progressive neurological weakness
Pain >6 weeks not responding to conservative tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

what surgery can be done for disc prolapse?

A

Laminectomy and microdiscectomy

Spinal fusion if unstable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

what are 5 complications of spinal surgery for disc prolapse?

A

Re-herniation
Infection - discitis, meningitis, abscess
Injury to adjacent structures
haematoma and spinal compression
Spondylolisthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

what is Paget’s disease of the bone?

A

A disease of increased uncontrolled bone turnover thought to be due to excessive osteoclastic resorption followed by increased osteoblastic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

what are 3 risk factors for Paget’s disease?

A

FHx
50+
infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

what are the 3 stages of Paget’s disease?

A

lytic phase - excessive osteoclast activity

mixed osteoclastic and osteoblastic phase - excessive resorption and disorganised bone formation

Sclerotic phase – osteoblast lay down excessive disorganised bone with osteoclasts being less active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

what are 5 manifestations of Paget’s disease?

A

bone pain
growth of bones in face - leontiasis, hearing loss, vision loss
kyphosis
pathological fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

what disease can cause cotton wool appearance of skull on x-ray?

A

Paget’s disease - due to osteoclastic activity and sclerotic lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

what are 3 investigations for Paget’s disease of the bone?

A

X-ray - osteolytic lesions, fractures, slerotic changes, bone enlargement and deformity

Radionucleotide bone scan

LFTs - raised alk phos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

what is the management of Paget’s disease of the bone?

A

1 - Bisphosphonates - alendronic or zolendronic acid

calcitonin
analgesia
calcium + vitamin D
surgery for severe deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

what are 4 complications of Paget’s disease of the bone?

A

Hearing loss - if affecting ossicles/vestibulocochlear nerve
Heart failure - high output due to vascular new bone
osteosarcoma
spinal stenosis and cord compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

what chromosome is the mutation that causes Marfan’s on?

A

chromosome 15

Affects gene responsible for creating fibrillin - protein fibrillin-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

what is the inheritance pattern of marfans?

A

autosomal dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

what are 10 symptoms of Marfan’s?

A

Tall, long arms, long legs, long nek
long fingers and toes
Pectus carinatum or excavatum
Hypermobility
downward slanting palpebral fissures
crowded teeth
stretch marks
High arched palate
Flat feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

what are 2 ways to test for arachnodactyly?

A

long fingers

Cross thumb cross palm - thumb crosses opposite edge

Wrap hand around wrist - fingers and thumb overlap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

what are 3 cardiac conditions associated with Marfans?

A

Mitral valve prolapse and regurgitation
Aortic valve prolapse and regurgitations
Aortic aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

what are 5 non-cardiac conditions associated with marfans?

A

Lens dislocation in eye
joint dislocation
scoliosis
Pneumothorax
GORD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

How are people with marfans monitored?

A

Yearly echo
yearly ophthalmology review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

where is type 1 collagen found?

A

skin, tendons, organs, bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

where is type 2 collagen found?

A

cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

where is type 3 collagen found?

A

supporting mesh of soft organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

where is type 4 collagen found?

A

basal lamina (basement membranes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

where is type 5 collagen found?

A

cells surfaces, hair, placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

what are the 4 different types of Elhers-Danlos syndrome?

A

Hypermobile EDS
Classical EDS
Vascular EDS
Kyphoscoliotic EDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

what type of collagen is most affected in EDS?

A

type III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

what is the inheritance pattern for all bar kyphoscoliotc EDS?

A

Autosomal dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

what is the inheritance pattern for kyphosoliotic EDS?

A

autosomal recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

what is the presentation of hypermobile EDS?

A

joint pain and hypermobility
Joint dislocation
soft and stretchy skin with stretch marks and easy bruising
Poor wound healing and bleeding
Chronic pain and fatigue
Autonomic dysfunction - POTS
GORD, abdo pain and IBS
Menorrhagia, dysmenorrhoea, PROM, pelvic organ prolapse
TMJ dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

what scoring system is used to assess hypermobility in EDS?

A

Beighton score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

what can be seen in classical EDS?

A

Stretchy, smooth, velvety skin
Joint hypermobility
joint pain
abnormal wound healing
Prone to hernia, prolapses, mitral regurg, aortic root dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

what can be seen in kyphoscoliotic EDS?

A

hypotonia as a neonate
kyphoscoliosis as they grow
Joint hypermobility
joint dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

what is antiphospholipid syndrome?

A

antiphospholipid antibodies which cause clinical features characterised by thromboses and pregnancy related morbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

what other condition is antiphospholipid syndome associated with?

A

SLE in 20-30% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

what sex is antiphospholipid syndrome more common in?

A

females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

what are 4 signs of antiphospholipid syndrome?

A

CLOTs

Coagulation defects
Livedo reticularis - lace lie purple discolouration of skin
Obstetric issues - miscarriage
Thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

what are 3 investigations of antiphospholipid syndrome?

A

anticardiolipin test - IgG or IgM antibodies
lupus anticoagulant test
Anti-B2-glycoprotein test

232
Q

what is the management of antiphospholipid syndrome?

A

warfarin

pregnancy - aspirin and SC heparin

233
Q

what is the Z score?

A

bone density compared to average for their age and gender

234
Q

what drug class is allopurinol and what is its MOA?

A

Xanthine oxidase inhibitor

Xanthine oxidase metabolises xanthine into uric acid => inhibits metabolism so therefore lowers plasma uric acid

235
Q

where is hidden psoriasis found?

A

genitals
soles
scalp
ears

236
Q

what is the name of 1 bisphosphonate?

A

Alendronate

237
Q

how do you take bisphosphonates?

A

take on empty stomach once a week and remain upright for at least half an hour afterwards

238
Q

What are the bloods like in Paget’s disease?

A

ALP - high
Calcium - normal
Phosphate - normal

239
Q

what is the 1st line treatment of Paget’s disease?

A

bisphosphonates - alendronate

240
Q

what are 3 complications of Paget’s disease?

A

osteosarcoma
leontiasis
fractures

241
Q

what are 5 of the diagnostic criteria for giant cell arteritis?

A

50+
temporal artery abnormality
abnormal temoral artery biopsy
elevated ESR

242
Q

what is the name of the blotchy skin pattern in antiphospholipid syndrome?

A

Livedo reticularis

243
Q

what disease can antiphospholipid syndrome be mistaken for due to positive antibody test?

A

Syphilis

244
Q

what reflex comes from S1?

A

Ankle jerk

245
Q

what is Sjogren’s syndrome?

A

autoimmune disorder of diminished lacrimal and slivery gland secretions

presents with fatigue, dry eyes, dry mouth, dry vagina

246
Q

what antibodies are in sjogren’s syndrome?

A

anti-Ro (SS-A) - more specific
anti-La (SS-B) - more specific

rheumatoid factor
ANA

247
Q

what are conditions associated with secondary Sjögren’s syndrome?

A

rheumatoid arthritis
SLE

248
Q

what is a key eponymous test for sjorgren’s syndrome and what is it?

A

Schirmer’s test

filter paper placed in corner of eye to measure secretions <10mm is significant

249
Q

what is the treatment for Sjögren’s syndrome?

A

1 - artificial tears (polyvinyl alcohol and carbomer), salivary substitutes, vaginal lubricant

Pilocarpine - stimulates tear and saliva production

Hydroxychloroquine is associated joint pain

250
Q

what are 3 complications of Sjögren’s syndrome?

A

Eye - keratoconjuctivitis sicca and corneal ulcers

oral- dental cavities, candida

vagina - candida, sexual dysfunction

251
Q

what cancer does Sjögren’s syndrome increase risk of?

A

non-Hodgkin’s lymphoma 5x normal population

252
Q

what are the 5 extra-articular manifestations of AS?

A

5 As

Anterior uveitis
Autoimmune bowel disease
Apical lung fibrosis
Aortic regurgitation
Amyloidosis

253
Q

what test is used to determine spinal motility?

A

Schober’s test

find L5 and make mark 10cm above, ask patient to bend over as far as possible and mark 5cm below L5 => if distance between 2 marks <20cm =. reduced lumbar movement

254
Q

what is a compound fracture?

A

open fracture where skin is broken and bone exposed to air

255
Q

what is a stable fracture?

A

when section of bone remains in alignment at the fracture

256
Q

what is a salter-harris fracture?

A

a fracture occurring in children which affects the growth plate. Classified from 1-5

257
Q

what is a transverse fracture?

A

break in bone perpendicular to long axis (across bone)

258
Q

what is an oblique fracture?

A

a break diagonally across the width of the bone along the longitudinal axis

259
Q

what usually causes a spiral fracture?

A

twisting motion

260
Q

what is a spiral fracture?

A

fracture that wraps around bone

261
Q

what is a comminuted fracture?

A

breaking into multiple fragments

262
Q

what is a segmental fracture?

A

when a bone breaks in at least 2 places separating a segment of bone

263
Q

what is a greenstick fracture?

A

where a fracture occurs only on one side of the bone an does not go all the way through - happens in children <10 usually

264
Q

what is a buckle fracture?

A

force on one end of the bone makes the side of the bone bulge out sideways without breaking the bone all the way through - usually in children <10 years

265
Q

what is cole’s fracture?

A

transverse fracture of distal radius near wrist causing distal portion to displace posteriorly

Usually caused by a fall on to out stretched hands

causes dinner fork deformity - swan neck bendy wrist

266
Q

what is a smith’s fracture?

A

volar angulation of distal radius fragment - garden spade deformity

caused by falling backwards onto palm of outstretched hand or falling with wrists flexed

267
Q

what is a bennett’s fracture?

A

Intra-articular fracture at base of thumb metacarpal

impact on flexed metacarpal - fist fight

X-ray - triangular fragment at base of metacarpal

268
Q

what is a monteggia’s fracture?

A

dislocation of proximal radioulnar joint in association with ulnar fracture

fall on outstretched hand with forced pronation

269
Q

what is a galeazzi fracture?

A

radial shaft fraction with associated dislocation of distal radioulnar joint

fall onto hand with rotation force

X-ray - displaced fracture of radium and prominent ulnar head due to dislocation

270
Q

what is a barton’s fracture?

A

distal radius fracture (coles/smiths) with associated radiocarpal dislocation

fall onto extended pronated wrist

271
Q

what is a key sign of scaphoid fracture?

A

tenderness in the anatomical snuff box

272
Q

what is a key complication of a scaphoid fracture?

A

avascular necrosis and non-union of the scaphoid as there is retrograde blood supply to the scaphoid

273
Q

what system can be used to classify lateral melleolus (distal fibula) ankle fractures?

A

Weber classification

274
Q

what is Weber type a fracture?

A

fracture below level of ankle joint - syndesmosis intact

275
Q

what is Weber type B fracture?

A

fracture at level of ankle joint - syndesmosis intact or partially torn

276
Q

what is Weber type c fracture?

A

above ankle joint - syndemosis will be disrupted

277
Q

what are 5 common cancers that metastasise to bone?

A

PoRTaBLe

Prostate
Renal
Thyroid
Breast
Lung

278
Q

what are 4 adverse effects of bisphosphonates?

A

Acid reflux and oesophageal erosions
Atypical Fractures
Osteonecrosis of the jaw
Osteonecrosis of external auditory canal

279
Q

what is 1st principle of fracture management?

A

mechanical alignment - either closed reduction via manipulation of the limb or open reduction with surgery

280
Q

what is the 2nd principle of fracture management?

A

provide relative stability to allow healing to occur via fixation

281
Q

what are 6 different types of fracture fixation devices?

A

external casts
K wires
Intramedullary wires
intramedullary nails
screws
plate and screws

282
Q

what is the ottawa ankle rules?

A

assessment of whether an ankle Xray is indicated in ankle injury

283
Q

what are the 4 tenderness points in the ottawa ankle rules?

A

Posterior edge/tip of lateral malleolus (6cm above malleolus) tender
Posterior edge or tip of medial malleolus (and 6cm above) tender
Tenderness at base of 5th metatarsal
Navicular tenderness

284
Q

what is the component of the ottawa ankle rules about weight bearing?

A

inability to bear weight both immediately after injury and in ED - able to take <4 steps => X ray indicated

285
Q

what are 11 long term complications of fractures?

A

delayed union
malunion
non-union
avascular necrosis
infection
joint instability
joint stiffness
contractures
arthritis
chronic pain
complex regional pain syndrome

286
Q

what is a fat embolism and when do they occur?

A

occur following fracture of long bone - fat globules released into circulation from fracture leading to reduction in circulation to tissues

mortality 10% - supportive management

287
Q

what is Gurd’s criteria and what is it for?

A

Diagnosis of fat embolism
3 Major criteria
- Resp distress
- Petichial rash
- Cerebral involvement
Some minor
- jaundice
- thrombocytopenia
- fever
- tachy

288
Q

what arteries supply the head of the femur?

A

medial and lateral circumflex femoral arteries

branches off deep femoral artery

supplies retrograde blood supply to femoral head

289
Q

what is an intra-capsular hip fracture?

A

fracture of femoral neck within capsule of hip joint, proximal to intertrochanteric line

290
Q

what is the classfication system of intra-capsular NOF fractures?

A

Garden classification

291
Q

what is the garden classification from grade I-IV?

A

I - incomplete fracture and non-displaced
II - complete fracture and non-displaced
III - partial displacement
IV - full displacement

292
Q

what is the possible management of a garden grade I or II NOF fractures?

A

internal fixation to hold femoral head if blood supply intact

293
Q

what is the management of garden grade III or IV NOF fractures?

A

Hemiarthroplasty or total hip replacement (for more fit patients)

294
Q

what is the management of intertrochanteric fractures?

A

dynamic hip screw (sliding hip screw

295
Q

what is the management of subtrochanteric fractures?

A

Intramedullar nail - metal pole inserted through greater trochanter into the central cavity of the shaft of the femur

296
Q

what is the typical presentation of hip fracture? 3

A

pain in groin or hip which may radiate to knee
unable to weight bear
shorted abducted externally rotated leg

297
Q

what is shenton’s line?

A

continuous curving line on x-ray of inferior border of superior pubic ramus and medial border of femoral neck

disruption of shenton’s line is key sign in NOF fracture

298
Q

How quickly should hip fracture surgery be carried out?

A

within 48 hours

299
Q

How quickly should open fractures be debrided and washed out?

A

within 6 hours

300
Q

what are 5 presentations of rib fracture?

A

Severe, sharp chest wall pain worse on deep inspiration or coughing
chest wall tenderness and bruising
auscultation - crackles, reduced breath sounds
reduced O2 sats due to lung injury
pneumothorax

301
Q

what causes flail chest?

A

two or more rib fractures along 3+ consecutive ribs usually anteriorly

302
Q

what is a sign of flail chest?

A

paradoxical breathing

303
Q

what is the gold standard investigation of rib fracture?

A

CT chest

304
Q

what is the management of rib fractures?

A

1 - conservative with good analgesia so breathing is not affected by pain

2 - if after 12 weeks of conservative management has failed surgical fixation can be considered to manage pain

305
Q

what grading system can be used to grade open fractures?

A

Gustilo and anderson system

306
Q

what is the management of buckle fractures?

A

typically self limiting so do not require surgery and can sometimes be managed with splining and immobilisation

307
Q

what is the management of patella fracture?

A

non-operative management usually with a hinged knee brace for 6 weeks and full weight bearing

308
Q

what are early complication of colles fracture?

A

median nerve injury - carpal tunnel - weakness or loss of thumb or index finger flexion

309
Q

what is the blood supply to the scaphoid?

A

dorsal carpa branch of radial artery - retrograde supply

310
Q

what is the typical presentation of scaphoid fracture?

A

pain along radial aspect of wrist at the base of thumb
loss of grip/pinch strength

311
Q

what are 5 signs of scaphoid fracture?

A

Maximal tenderness in anatomical snuffbox

Wrist joint effusion

Pain on thumb telescoping (longitudinal compression)

Tenderness of scaphoid tubercle

Pain on ulnar deviation of wrist

312
Q

what is the initial management of scaphoid fracture?

A

Futuro splint or standard below elbow backslab immobilisation

Reereal to ortho - review 7-10 days later if Xray inconclusive

313
Q

what is the ortho management of scaphoid fracture?

A

undisplaced - cast for 6-8 weeks

displaced - surgical fixation

proximal scaphoid pole fractures - surgical fixation

314
Q

what is bennett’s fracture?

A

boxers fracture
intraarticular fracture of 1st carpometacarpal joint

xray - triangular fragment at ulnar base of metacarpal

315
Q

what is monteggia’s fracture?

A

dislocation of proximal radioulnar joint + ulnar fracture

fall on out stretched hand with forced pronation

316
Q

what usually causes 5th metatarsal fractures?

A

following inversion injuries of ankle - proximal avulsion fractures - most common

Jones fractures - ransverse fracture at metaphyseal diaphyseal junction

317
Q

what is a toddlers fracture?

A

oblique tibial fracture in infants

318
Q

Why do NSAIDs cause HTN?

A

inhibit prostaglandins which cause vasodilation leading to vasoconstriction

Use with caution in Hx of HTN

319
Q

How are he hand joints usually affected in OA?

A

usually CMC and DIP joints more affected than PIP joints, usually affects one joint at a time bilaterally over time

320
Q

what are 2 risk factors for developing polymyalgia rheumatica?

A

50+ years - peak 70-80
Female

321
Q

what other condition is polymyalgia rheumatica associated with?

A

Giant cell arteritis

322
Q

what is the clinical presentation of polymyalgia rheumatica ?

A

2-6 week Hx of

Shoulder / Pelvic girdle / Neck pain and stiffness >45 mins, worse in morning
Systemic symptoms - low grade fever, fatigue, anorexia, wt loss, depression

323
Q

when should patients with polymyalgia rheumatica be referred?

A

<60 years
Red flads - Wt loss, night pain, neuro features
Unusual features of PMR

324
Q

what investigations should be done for polymyalgia rheumatica ?

A

Clinical diagnosis but…

Bloods
- FBC
- U+E
- LFTs
- Calcium
- Serum protein electophoresis
- TSH
- CK
- Rheumatoid factor
- Urine dip

325
Q

what is the managemet of polymyalgia rheumatica ?

A

15mg Prednisone PO OD

Reducing regime
- Until symptoms fully controlled
taper 12.5mg for 3 weeks, 10mg 4-6 weeks, reducing 1mg every 4-8 weeks

Usually on prednisolone for 1-2 years

326
Q

what is the management of patients on long term steroids?

A

Don’t STOP

Don’t - don’t stop if >3 weeks steroid treatment, may precipitate adrenal crisis

Sick day rules - usually double dose

Treatment card - patient should carry

Osteoporosis prevention - bisphosphonates, calcium vitamin D

Protom pump inhibitors - gastroprotection

327
Q

what might be used 2nd line in secondary care for polymyalgia rheumatica?

A

DMARD treatment - methotrexate

3 - Tocilizumab

328
Q

what are 3 complications of polymyalgia rheumatica ?

A

Relapse
Corticosteroid risks - osteoporosis, infection, T2DM, HTN etc
GCA

329
Q

what are 7 risks of long term corticosteroids?

A

Osteoporosis
increased risk of infection
T2DM
Hypertension
Cataracts
Glaucoma
Skin changes - thinning, bruising

330
Q

what are 5 differentials for polymyalgia rheumatica?

A

Degenerative disorders and osteoarthritis
Thyroid/parathyroid disorders
Inflammatory disorders
Cancer - multiple myeloma, leukaemia, lymphoma, lung cancer
Drug related - myositis or myalgiaa due to statins

331
Q

what are Bursae?

A

Sacs created by synovial membrane filled with small amounts of synovial fluid

Found at bony prominences to reduce friction between bones and soft tissue during movement

332
Q

what are 6 risk factors for trochanteric bursitis?

A

Female
Trauma
Overuse/posture
Co-morbidities - lower back pain, prev surgery, osteoarthritis
Lifestyle - inactivity, obesity

333
Q

what is the other name for trochanteric bursitis?

A

greater trochanter pain syndrome

334
Q

what are 5 presentations of trochanteric bursitis?

A

Chronic, intermittent lateral hip/thigh/buttock pain
Exacerbated by weight bearing and lying on affected side
Pain on palpation
Trendelenburg test postive

335
Q

what 2 investigations can be used in trochanteric bursitis?

A

US hip
MRI Hip

336
Q

what is the trendelenburg test?

A

Pain on resisted abduction of high, resisted internal and external rotation of hip

Patient stands on affected leg and other side of pelvis drops due to weakness in hips

337
Q

what is the management of trochanteric bursitis?

A

Lifestyle - wt loss, avoidance of excessive hip adduction
Physio for gluteal muscle strengthening
Rest
Analgesia - paracetamol or NSAIDs

Peri-trochanteric corticosteroid injections

can take 6-9 months to recover

338
Q

what are 7 common locations for bursitis?

A

prepatellar
infrapatella
anserine
plecranon
trochanteric
subacromial
retrocalcaneal

339
Q

what are 3 clinical features of olecranon bursitis?

A

Swelling over olecranon process - posterior aspect of elbow
tenderness in full flexion
erythema

340
Q

why is tenderness at the base of the 5th metatarsal significant in ankle sprain?

A

Could indicate a jones fracture - transverse fracture at base of 5th metatarsal

341
Q

what is the management of ankle sprains?

A

RICE
rest, ice, compress, elevate

Orthosis, cast or crutches may be necessary for short term relief

342
Q

what does the Achilles tendon connect?

A

connects gastrocnemius to soleus

343
Q

what are the 2 different type of Achilles tendinopathy?

A

insertion tendinopathy
mid-portion tendinopathy

344
Q

what are 5 risk factors for Achilles tendinopathy?

A

Sports - basketball, tennis, athletics
Inflammatory conditions
Diabetes
Raised cholesterol
Fluoroquinolone antibiotics - ciprofloxacin, levofloxacin

345
Q

what are 5 presentations of Achilles tendinopathy?

A

Pain or aching in Achilles
stiffness
tenderness
swelling
nodularity on palpation of tendon

346
Q

what is the presentation of Achilles tendon rupture?

A

large pain in achilles, calf or ankle following an audible pop in ankle
Inability to walk or continue sport
Wwelling in calf
Weakness on plantarflexion
Unable to stand on tiptoes

347
Q

what is simmonds triad?

A

for Achilles rupture

Abnormal angle of declination - greater dorsiflexion of injured ankle and food
Palpation - Feel for gap in tendon
Calf squeeze test

348
Q

what is the Simmons calf squeeze test?

A

patient prone or kneeling with feet hanging freely off bench/couch
Squeezing calf muscle does not cause plantar flexion as it should

349
Q

what investigation is used for Achilles tendon rupture?

A

Ultrasound

350
Q

what is the surgical management of Achilles rupture?

A

surgical reattachment of Achilles followed by non-surgical management

351
Q

what is the non-surgical management of Achilles rupture?

A

boot immobilisation graduating from full plantar flexion poot to neutral position over 6-12 weeks

352
Q

what are 3 intrinsic risk factors for ACL injury?

A

Female - due to anatomical, hormonal and neuromuscular differences - wider intercondylar notch

Younger

Genetics

Biomechanical markers

353
Q

what are 3 extrinsic risk factors for ACL injury?

A

Sporting activity
Environmental conditions
Ergonomics

354
Q

where doe s the ACL attach?

A

At the anterior intercondylar area on tibia

355
Q

where does the PCL attach?

A

posterior intercondylar area on tibia

356
Q

what kind of injury usually causes a ACL injury?

A

twisting injury

357
Q

what 2 tests can be done for ACL injury?

A

Anterior draw test

Lachman test

358
Q

what is the anterior draw test?

A

for ACL injury

Patient supine with hips flexed 45 degrees, knees flexed 90 degrees and feet flat on couch

Examiner attempts to pull proximal tibia anteriorly - normally there is slight movement but in ACL injury there will be excessive movement due to instability of ligament

359
Q

what is the gold standard investigation for dx of cruciate ligament tear?

A

Arthroscopy

360
Q

what is the usual 1st line instigation for cruciate ligament injury?

A

MRI knee

361
Q

What is the conservative management of cruciate ligament injury?

A

RICE - rest, ice, compress, elevate
NSAIDs
Crutches and knee brace
physio

362
Q

what is the surgical management of cruciate ligament injury?

A

arthroscopic surgery
New ligament is formed from graft using hamstring, quadriceps or bone patellar tendon

363
Q

what are 5 features of meniscal tear?

A

pain worse on straightening knee
knee may give way
displaced meniscal tear may cause locking
tenderness along joint line
Thessaly’s test

364
Q

what is Thessaly’s test?

A

for meniscal tear

weight bearing at 20 degrees of knee flexion supported by doctor
positive if pain on twisting knee

365
Q

what is plantar fasciitis?

A

gradual onset of pain on plantar aspect of heel worse with pressure when standing or walking for prolonged periods

Manged with rest, ice, analgesia, physio

366
Q

How can ligamentous injury be categorised?

A

Grade I - mild - minimal fibre damage, no loss of function

Grade II - Moderate - partial tear, some loss of function

Grade III - Severe - complete tear, significant loss of function

367
Q

what is osgood-schlatter disease?

A

inflammation of the tibial tuberosity where patella ligament inserts causing anterior knee pain in adolescents - usually unilateral but can be bilateral. causes hard lump at front of knee

Common in 10-15 year olds

368
Q

what are 3 presentations of osgood-schlatter?

A

visible or palpable hard tender lump at tibial tuberosity
pain in anterior knee
pain exacerbated by activity, kneeling or extension of knee

369
Q

what is a complication of osgood-schlatters?

A

avulsion fracture - tibial tuberosity separated from tibia

370
Q

what is the management of osgood-schlaters?

A

reduction in physical activity
ice
NSAIDs

371
Q

what bacterium causes Lyme disease?

A

Borrelia burgdoferi

372
Q

what kind of ticks transmit Lyme disease?

A

Ixodes

373
Q

what kind of bacteria is borrelia burgdoferi?

A

spirochete

374
Q

what are the early (<30 days) features of Lyme disease? 5

A

Erythema migrans - bulls-eye rash 1-4 weeks after bite, painless and >5cm usually

Headache
lethargy
fever
arthralgia

375
Q

what are 5 late (>30 days) features of Lyme disease?

A

Cardiovascular
- heart block
- Peri/myocarditis

Neuro
- facial nerve palsy
- radicular pain
- meningitis

376
Q

how is Lyme disease diagnosed?

A

clinically with erythema migrans

Enzyme linked immunosorbent assay antibodies to borrelia burgdorferi

immunoblot test

377
Q

what is the management of Lyme disease?

A

1 - Doxycycline - 200mg OD 21 days - 400mg if neurology

Pregnancy - Amoxicillin - 1g TDS 21 days

Dissenimated disease - Ceftriaxone

378
Q

what is a complication of treatment of Lyme disease?

A

Jarisch-herxheimer reaction - fever, rash, tachycardia after 1st dose

more common in syphilis

379
Q

what are 5 complications of Lyme disease?

A

neuro - meningitis, encephalomyelitis, encephalopathy
heart block
Oligoarticular arthritis/errosive arthritis
keratitis

380
Q

what criteria can be used for diagnosis of septic arthritis in children?

A

Kocher criteria

381
Q

what is the kocher criteria?

A

for septic arthritis in children

score for:
non weight bearing
temp >38.5
ESR >40mm/hr
WCC >12

> 2 = 40% septic arthritis
3 = 90% septic arthritis

382
Q

what are the ottawa knee rules?

A

for imaging in knee trauma

> 55 years
patella tenderness without other tenderness
fibular head tenderness
cannot flex knee 90 degrees
cannot weight bear - 4 steps

383
Q

what is the first line investigation for meniscal tear?

A

MRI knee

384
Q

what is a baker’s cyst?

A

fluid filled sack in popliteal fossa due to leak out of knee joint

385
Q

what are 4 conditions that can be associated with baker’s cyts?

A

meniscal tears
osteoarthritis
knee injury
inflammatory arthritis

386
Q

what is the management of symptomatic bakers cysts?

A

modified activity
analgesia
physio
US aspiration
steroid injection
Surgery

387
Q

what is an acetabular labral tear?

A

a tear of the cartilaginous ring surrounding acetabulum usually due to trauma or chronic wear

388
Q

what are 3 features of acetabular labral tear tear?

A

Pain - in hip/groin usually worsening
Clicking, locking, giving way of hip
May also cause reduced range of movement

389
Q

what is the management of acetabular labral tear?

A

limited efficacy of conservative management

Surgery after 4 weeks - hip arthroscopy with either debridement or repair

390
Q

what is frozen shoulder?

A

adhesive capsulitis

Pain and stiffness in shoulder (glenohumeral) joint due to inflammation and fibrosis of joint capsule

391
Q

what is the typical course of frozen shoulder?

A

Painful phase - shoulder pain often 1st symptom, may be worse at night

Stiff frozen phase - stiffness in both active and passive movement

Thawing phase - gradual improvement

can take 1-3 years to resolve

392
Q

what movement is most affected by froze shoulder?

A

external rotation

393
Q

what test can be used to assess for supraspinatus tendinopathy?

A

empty can test - positive if arm gives way on resistance

394
Q

what test can be used to assess acromioclavicular joint arthritis?

A

scarf test - pain caused by wrapping arm around chest and opposite shoulder

395
Q

what is the management of frozen shoulder?

A

Continued use of arm
Analgesia - NSAIDs
Physio
Intra-articular corticosteroids
Hydrodilation

Surgery if resistant/severe
- manipulation under anaesthesia
- arthroscopy

396
Q

what are 3 risk factors for frozen shoulder?

A

diabetes
thyroid dysfunction
hyperlipidaemia

397
Q

what are the muscles of the rotator cuff?

A

SItS

Supraspinatus
Infraspinatus
Teres Minor
SUbscapularis

398
Q

what is the function of the supraspinatus?

A

Abducts arm before deltoid

Rotator cuff - most commonly injured

399
Q

what is the function of the infraspinatus?

A

Externally rotates arm

400
Q

what is the function of teres minor?

A

externally rotates arm

401
Q

what is the function of subscapularis?

A

internally rotates arm

402
Q

what is the presentation of a rotator cuff tear?

A

Either acute onset after injury or gradual onset

Shoulder pain
weakness and pain with specific movements relating to location of tear

Supraspinatus and infraspinatus atrophy in massive tears

403
Q

what is Gerber’s lift off test?

A

evaluates subscapularis - internal rotation

Patient attempts to lift hand from small of back against resistance

404
Q

what test will elicit pain/weakness in the infraspinatus or teres minor tear?

A

Resisted external rotation

405
Q

what is the painful arc test used to diagnose?

A

Subacromial impingement

406
Q

what are 2 examinations that can be done to test for subacromial impingement?

A

Neer’s impingement test - anterolateral shoulder pain during forward flexion with arm internally rotated

Hawkin’s test - forced internal rotation of arm held at shoulder height and elbow bent at 90 causes anterolateral shoulder pain

407
Q

when should patients with shoulder pain be imaged in GP?

A

Acute trauma presentation
symptoms > 4 weeks
Restriction of movement
severe pain

408
Q

what imaging can be done of a shoulder in primary care?

A

Plain film X-ray - True AP and lateral or scapular Y views

409
Q

When can patients with shoulder pain be referred to secondary care?

A

Pain >6 weeks of conservative management

Sudden inability to abduct arm - 2ww - suggestive of acute cuff tear

410
Q

what is the imaging modality for shoulders in secondary care?

A

MRI

Can also do US

411
Q

What are 3 possible findings on MRI in shoulder injury?

A

Hyperintense signal on T2 imaging extending to articular or bursal surfaces
Discontinuity within tendons
Evidence of inflammation - increased fluid in subacromial space and subdeltoid busa, thickening and increased signal of tendons

412
Q

what is the management of rotator cuff tear?

A

Mainly conservative in elderly/degenerative tears
- Rest, analgesia, physio

Surgery - arthroscopic rotator cuff repair

413
Q

what is sublaxation?

A

partial dislocation

414
Q

do shoulders more commonly dislocate anterior or posterior?

A

anterior

415
Q

what are 3 risk factors for posterior dislocation of the shoulder?

A

3 Es

electric shock
epilepsy
Ethanol - typically after a fall

416
Q

what are 5 structures that can be damaged in shoulder dislocation?

A

Glenoid labrum - rim of cartilage around glenoid cavity that can tear

Hill-sachs lesions - compression fractures of the posterolateral part of humeral head due to impact with the anterior rim of glenoid cavity

Axillary nerve damage

Fractures - humeral head, greater tuberosity of humerus, acromion, clavicle

Rotator cuff

417
Q

what are bankart lesions?

A

tear to anterior portion of labrum in shoulder dislocation - occur with recurrent subluxation or dislocation

418
Q

what does anterior arm dislocation present like?

A

Arm slightly abducted and externally rotated

Loss of normal rounded appearance to shoulder
may be possible to palpate humeral head below position of coracoid process

419
Q

what does posterior dislocation present like?

A

Arm adducted and internally rotated

Posterior shoulder more prominent and anterior shoulder flattened

Inability to externally rotate

420
Q

what is the 1st line investigation for shoulder dislocation

A

X-ray:
AP
Lateral/scapular Y view
Axillary view

MRI used to assed other damage

421
Q

what is the management of shoulder dislocation?

A

Analgesia and sedation - gas and air may be used
Closed reduction after fractures are excluded
Post reduction x-ray
immobilisation period

surgery for open reduction if closed reduction fails

422
Q

what are 3 complications of shoulder dislocation?

A

Shoulder instability
Axillary nerve damage
bankart/hills-sachs lesions

423
Q

what are 2 clinical features of axillary nerve damage?

A

Loss of sensation of lateral shoulder - regimental badge area
Weakness of deltoid - weak arm abduction

424
Q

what nerve roots form the axillary nerve?

A

C5/6

425
Q

what is epicondylitis?

A

inflammation at the point where the tendons of the forearm inset into the epicondyles at the elbow due to repetitive strain - AKA tennis/golfers elbow

426
Q

what 5 muscles insert onto medial epicondyle and what do they do?

A

Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor digitorum superficialis
Flexor carpi ulnaris

Flex the wrist

427
Q

what do the muscles that inset onto the lateral epicondyle do?

A

extend wrist

428
Q

what is the other name for lateral epidondylitis?

A

tennis elbow

429
Q

what is the presentation of tennis elbow?

A

Pain over lateral epicondyle, radiating down forearm

can lead to weakness of grip strength

430
Q

what are 2 tests for tennis elbow?

A

Mills test - extend and pronate forearm and flex wrist with pressure on lateral epicondyle - pain = +ve

Cozen’s test - extended, pronated forearm with wrist deviated radially - hold elbow and put pressure on lateral epicondyle. Apply resistance to back of hand - pain = +ve

431
Q

what is the other name for medial epicondylitis?

A

golfers elbow

432
Q

what is the management of epicondylitis?

A

Rest and lifestyle adaption
Analgesia - NSAIDS
physio
orthotics
steroid injection

rarely surgery

433
Q

what is a t-score for osteoporosis?

A

<-2.5

434
Q

what is the t-score for osteopenia?

A

-1 to -2.5

435
Q

what is the z-score?

A

the number of standard deviations the patient is away from the average for their age, sex and ethnicity

436
Q

what are 5 medications that increase risk osteoporosis?

A

Corticosteroids (long term 7.5mg+ for 3 months+)
SSRIs
PPIs
antiepileptics
anti-oestrogens

437
Q

what are 3 chronic diseases that increase risk of osteoporosis?

A

ckd
hyperthyroidism
rheumatoid arthritis

438
Q

what are 7 risk factors for osteoporosis?

A

older age
post menopausal
reduced mobility and activity
lower bmi <19
low calcium or vitamin d
alcohol and smoking
FHx or personal history

439
Q

what are 5 groups who should be assessed for osteoporosis?

A

Long term corticosteroids
Prev fragility fractures
>50 with risk factors
Women >65
Men >75

440
Q

what are 7 lifestyle changes that can help in the management of osteoporosis?

A

increased exercise
maintain healthy weight
good ca intake
good Vit D intake
avoiding falls
stopping smoking

441
Q

what is the management of osteoporosis?

A

Address reversible risk factors

Add calcium (1000mg) and
vitamin D (400-800IU)

1 - Bisphosphonates (alendronate, risendronate, zoledronic acid)

442
Q

what are 4 side effeccts of bisphosphonates?

A

reflux and oesophageal erosions
atypical fractures
osteonecrosis of the jaw
osteonecrosis of external auditory canal

443
Q

how should bisphosphonates be taken?

A

on an empty stomach
with full glass of water
sit upright for 30 mins
30 mins before moving or eating

444
Q

what are 4 medications for osteoporosis started by a specialist?

A

denosumab - MAB targeting osteoclasts
Romosuzumab
Teriparatide - acts as parathyroid hormone
HRT
Raloxifene - selective oestrogen receptor modulator
strontium ranelate

445
Q

what are 2 side effects of strontium ranelate?

A

increased VTE risk
increased MI risk

446
Q

what 2 scores can be used to identify 10 year risk of osteoporotic fracture?

A

FRAX score

QFracture tool

447
Q

How do bisphosphonates work?

A

reduce osteoclastic activity

448
Q

what are 3 examples of bisphosphonates?

A

Alendronate (70mg once week)
risedronate (35mg once a week)
Zoledronic acid (5mg once yearly IV)

449
Q

what are 4 side effects of bisphosphonates?

A

reflux and oesophageal erosions
atypical fractures
osteonecrosis of the jaw
osteonecrosis of external auditory canal

450
Q

what follow up is necessary in osteoporosis?

A

follow up DEXA in 3-5 years

451
Q

what is T score?

A

the number of standard deviations the patient is away from an average healthy young adult

452
Q

what are 9 risk factors for secondary osteoporosis?

A

Hyperthyroidism
hyperparathyroidism
Hyperandrogenism in males
CKD
Immobility
Vitamin d deficiency
malabsorption
cushings
chronic liver failure

453
Q

what does DEXA stand for?

A

Dual-energy X-ray absorptiometry

454
Q

what are 4 causes of avascular necrosis of the hip?

A

long term steroid use
chemotherapy
alcohol excess
trauma

455
Q

what is the imaging modality of choice for avascular necrosis of the hip?

A

MRI

456
Q

what system is used to classify spinal fractures?

A

AO-Magerl system

A - compression
B - Distraction
C - Rotation

457
Q

what are 5 risk factors for spinal fractures?

A

osteoporosis
increased Age
Female - post-menopausal
Trauma
Cancer

458
Q

when is MRI indicated in spinal fractures?

A

with neurological symptoms

459
Q

what are 5 complications of spinal fractures?

A

Neurological deficits
Pulmonary complications - due to reduced mobility
Chronic pain
Kyphosis
VTE

460
Q

what are ganglion cysts?

A

sac of synovial fluid originating from tendon sheaths or joints

common on dorsal wrists and fingers but can form anywhere

461
Q

what is the presentation of ganglion cysts?

A

visible and palpable non-painful lump

Usually 0.5-5 cm
firm
well circumscribed
transilluminates

462
Q

what is the management of ganglion cysts?

A

usually conservative

Needle aspiration surgical excision

have high recurrence rate with aspiration

463
Q

what nerve is compressed in carpal tunnel syndrome?

A

median nerve

464
Q

what sensation is the branch of the median nerve which passes through the carpal tunnel responsible for?

A

sensory innervation of palmar aspect of thumb, index and middle fingers and lateral half of ring finger

465
Q

what motor function in the hand is the median nerve responsible for?

A

Abductor pollicis brevis - thumb abduction
Opponens pollicis - thumb opposition
Flexor pollicis brevis - thumb flexion

Thumb abduction, opposition and flexion

466
Q

what are 7 risk factors for carpal tunnel syndrome?

A

repetitive strain
obesity
perimenopause
rheumatoid arthritis
diabetes
acromegaly (bilateral)
hypothyroidism

467
Q

what is the presentation of carpal tunnel syndrome?

A

numbness
paraesthesia
burning sensation
pain

shaking hand to relive symptoms

Weakness of thumb movements
weakness of grip
difficulty with fine movements involving the thumb
wasting of thenar muscles

468
Q

what are 2 tests o/e for carpal tunnel syndrome?

A

Tinel’s test
Phalen’s test

469
Q

what questionnaire can be used to diagnose carpal tunnel syndrome?

A

Kamath and Stothard carpal tunnel questionnaire

470
Q

what is the 1st line investigation for carpal tunnel syndrome?

A

nerve conduction studies

471
Q

what is the management of carpal tunnel syndrome?

A

1 - 6 weeks conservative management

rest and altered activities
Wrist splints
Steroid injections

surgery - flexor retinaculum division

472
Q

what is systemic sclerosis?

A

autoimmune connective tissue disease due to inflammation and fibrosis of connective tissures, skin and internal organs

473
Q

what are the 2 main patterns of disease in systemic sclerosis?

A

limited systemic sclerosis
diffuse cutaneous systemic sclerosis

474
Q

what are 5 features of cutaneous systemic sclerosis?

A

CREST (used to be called crest syndrome)

Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia

475
Q

how are internal organs affected in diffuse systemic sclerosis?

A

cardiovascular problems - HTN, coronary artery disease
Lungs - Pulmonary HTN, fibrosis
Renal - scleroderma renal crisis

476
Q

what is scleroderma?

A

hardening of skin giving appearance of shiny tight skin without normal skin folds

477
Q

what is sclerodactyly?

A

skin tightening around joints restricting ROM, fat pads on fingers are lost and skin can break and ulcerate

478
Q

what are telangiectasia?

A

dilated blood vessels in skin >1mm

479
Q

what is calcinosis?

A

calcium deposits under skin - most common in fingertips

480
Q

what is oesophageal dysmotility?

A

atrophy and dysfunction of smooth muscle and fibrosis of oesophagus - causing swallowing difficulties, chest pain, acid reflux and oesophagitis

481
Q

what is the most common secondary cause of raynaud’s phenomenon?

A

systemic sclerosis

can also be seen in SLE

482
Q

what can be used to differentiate between raynaud’s disease and raynauds phenomenon caused by systemic sclerosis?

A

Nailfold capillaroscopy - magnify and examine peripheral capillaries at based of fingernail - abnormal capillaries suggest systemic sclerosis

483
Q

what is the management of raynaud’s disease?

A

Keep hands warm

Calcium channel blockers - nifedipine

other specialist drugs - losartan, ACEi, Sildenafil, fluoxetine

484
Q

what are 3 autoantibodies associated with systemic sclerosis?

A

Antinuclear antibodies (ANA) - non-specific but often +ve

Anti-centromere antibodies - associated with limited cutaneous systemic sclerosis

Anti-scl-70 antibodies - diffuse cutaneous systemic sclerosis

485
Q

what is the management of systemic sclerosis?

A

DMARDs - methotrexate
Biologics - rituximab

Avoid smoking
gentle skin stretching for ROM
regular emollients
Avoid cold triggers
Physio
OT

486
Q

What is takayasu’s arteritis?

A

Large vessel vasculitis characterised by granulomatous inflammation of aorta and it’s branches

487
Q

who is takayasu’s arteritis common in?

A

young females and Asian people

488
Q

what are 6 presentations of takayasu’s arteritis?

A

Systemic features - malaise, headache
Unequal BP in upper limbs
Carotid bruit and tenderness
Absent/weak peripheral pulses
Upper and lower limb claudication
Aortic regurgitation

489
Q

what investigations are used in takayasu’s arteritis?

A

BP upper and lower limbs

Vascular imaging of arterial tree - CTA or MRA

490
Q

what is the management of takayasu’s arteritis?

A

1 - Steroids
Low dose aspirin

2 - immunosuppressives

491
Q

what is Polyarteritis nodosa?

A

Vasculitis of medium sized vessels causing necrotising inflammation leading to thrombosis, aneurysm formation and organ ischaemia most commonly renal

492
Q

who is Polyarteritis nodosa common in?

A

Middle aged men

Can be idiopathic of often associated with Hep B infection

493
Q

what are 5 risk factors for Polyarteritis nodosa?

A

Middle age
Male
Hep B or C
Immunosuppression
Genetic predisposition - associated with familial Mediterranean fever

494
Q

what is the presentation of Polyarteritis nodosa?

A

Systemic symptoms - wt loss, fatigue, myalgia, fever

Numbness and paraesthesia, peripheral neuropathy
Renal failure
Vasculitic purpuric rash - livedo reticularis
Digital infarcts
HTN

495
Q

what is the gold standard investigation for Polyarteritis nodosa?

A

Biopsy - transmural inflammation with fibrinoid necrosis

496
Q

what is the management of Polyarteritis nodosa?

A

1 - High dose prednisolone

Antiviral therapy
ACEi

2 - Cyclophosphamide immunosuppression

For maintenance - azithioprine or methotrexate, corticosteroids

497
Q

what are 5 complications of Polyarteritis nodosa?

A

organ damage
haemorrhage
Infections
chronic pain
hypertension

498
Q

what are 3 ANCA associated vasculitises?

A

Granulomatosis with polyangiitis (wergner’s granulomatosis)
Eosinophilic granulomatosis with polyangiitis (churg-straus syndrome)
Microscopic polyangiitis

499
Q

what is Granulomatosis with polyangiitis?

A

Prev - Wegener’s granulomatosis

Small vessel necrotising vasculitis affecting respiratory tract and kidneys

500
Q

what is the presentation of Granulomatosis with polyangiitis?

A

URT - epistaxis, sinusitis, nasal crusting
LRT - SOB, Haemoptysis

Rapidly progressing glomerulonephritis

Saddle shaped nose deformity - ;ate sign due to chronic inflammation and erosion of upper airway

Vasculitis rash, proptosis, cranial nerve lesion

501
Q

what autoantibody is present in Granulomatosis with polyangiitis?

A

cANCA

502
Q

what is the management of Granulomatosis with polyangiitis?

A

1 - high dose prednisolone
OR
Cyclophosphamide

Maintenance - Azathioprine, methotrexate

503
Q

what criteria can be used for diagnosis of Granulomatosis with polyangiitis?

A

ELK (ENT, Lung and kidney presentations)
AND
positive cANCA

504
Q

what are 6 complications of Granulomatosis with polyangiitis?

A

AKI
CKD
Lung damage
Scleritis
Mononeuritis multiplex
side effects of long term steroids

505
Q

what is eosinophilic granulomatosis with polyangiitis?

A

Prev. Churg-Strauss syndrome

Small-medium vessel vasculitis

506
Q

what is the presentation of eosinophilic granulomatosis with polyangiitis?

A

Worsening asthma
Sinusitis pain
Parasthesia or numbness, signs of peripheral neuropathy
Weight loss
vasculitis rash

507
Q

what are 4 investigations for eosinophilic granulomatosis with polyangiitis?

A

FBC - for eosinophilia
CXR
Autoantibodies
Biopsy

508
Q

what autoantibodies are present in eosinophilic granulomatosis with polyangiitis?

A

pANCA

509
Q

what is the American college of rheumatology criteria for eosinophilic granulomatosis with polyangiitis?

A

at least 4/6 of

Asthma
eosinophilia >10%
Mononeuropathy or polyneuropathy
Non-fixed pulmonary infiltrates
paranasal sinus abnormalities
positive biopsy

510
Q

what is the management of eosinophilic granulomatosis with polyangiitis?

A

1 - corticosteroids

2 - immunosuppression

511
Q

what are 4 complications of eosinophilic granulomatosis with polyangiitis?

A

Long lasting peripheral neuropathy
Severe asthma
heart disease
side effects of long term steroids

512
Q

what is one medication that can precipitate eosinophilic granulomatosis with polyangiitis?

A

leukotriene receptor antagonists - montelukast

513
Q

what is Microscopic polyangiitis?

A

small vessel necrotising vasculitis typically affecting lungs and kidneys

NON-granulomatous

514
Q

what autoantibody is in Microscopic polyangiitis?

A

pANCA - 50-75%

cANCA - 40%

515
Q

what is seen on renal biopsy in Microscopic polyangiitis?

A

crescentic glomerulonephritis and small vessel vasculitis

516
Q

what is the presentation of Microscopic polyangiitis?

A

renal impairment - raised creatinine, haematuria, proteinuria
fever, lethargy, malaise, wt loss
Rash
Cough, SOB, haemoptysis

517
Q

what are 4 non-vasculitis conditions that are associated with positive pANCA?

A

UC
Primary sclerosing cholangitis
anti-GBM disease
Crohn’s

518
Q

what are myositoses?

A

autoimmune disorders causing muscle inflammation - polymyositis or dermatomyositis

Can be due to underlying cancers - paraneoplastic

519
Q

what is the presentation of Polymyositis ?

A

gradual onset symmetrical proximal muscle weakness

Difficulty standing from chair, climbing stairs, lifting overhead

Muscle pain

NO SKIN FEATURES

Can be raynauds and lung involvement

520
Q

what autoantibody is associated with Polymyositis ?

A

Anti-Jo-1 antibodies

AKA - histidine-tRNA ligase

521
Q

what muscle enzyme is significantly raised in Polymyositis and dermatomyositis?

A

Creatinine Kinase

522
Q

what is the management of polymyositis?

A

1 - High dose prednisolone

2 - immunosuppression - azathioprine, methotrexate

523
Q

what are 4 skin presentations of Dermatomyositis?

A

Gottron lesions - scaly erythematous patches on knuckles, elbows, knees

Helitrope rash - purple rash on face and eyelids

Periorbital oedema

Photosensitive erythematous rash on back, shoulders and neck - shawl sign

524
Q

what are 4 risk factors for Dermatomyositis?

A

female
40-50 years
Afro-Caribbean
Childhood

525
Q

what are 2 autoantibodies loosely related to Dermatomyositis?

A

Anti-Jo - 30%
Anti-M2

526
Q

what are 5 cancers related to myositis?

A

Ovarian
Lung
pancreas
stomach
Colon

527
Q

what is the management of Dermatomyositis?

A

1 - Prednisolone
exercise and physio
Sun protection

2 - immunosuppression, IVIG, biologics

528
Q

what is discitis?

A

inflammation in intervertebral disc space - can lead to sepsis or epidural abscess

529
Q

what are 3 features of discitis?

A

back pain
general - pyrexia, rigors, sepsis
Neuro features dependant on level

530
Q

what is the most common cause of discitis?

A

S. aureus

531
Q

what are 2 investigations for discitis?

A

MRI

CT guided biopsy for sensitivities

532
Q

what is the management of discitis?

A

6-8 weeks IV Abx - flucloxacillin, vancomycin
Assess for endocarditis - Transthoracic echo

533
Q

what are 5 risk factors for discitis?

A

Age - children more common due to better blood supply
Male
Recent invasive spinal procedure
Immunosuppression
Diabetes
IVDU

534
Q

what are 7 causes of pathological fracture?

A

Osteoporosis
CKS-metabolic bone disease
Hyperparathyroidism
Metastatic cancer
Infection
Primary bone tumours
bone biopsies

535
Q

what system can be used to assess risk of pathological fracture?

A

Mirels’ scoring system

score >9 = may need prophylactic fixation

536
Q

how long can it take for DMARDs to work?

A

2-3 months

537
Q

what are 5 notable side effect of leflunomide?

A

raised BP
rashes
peripheral neuropathy
teratogenic
bone marrow suppresion

538
Q

how does leflunomide work?

A

interferes production of pyrimidine used to make RNA and DNA

539
Q

how does hydroxychloroquine work as an immunosuppressant?

A

interferes with toll-like receptors disrupting antigen presentation

540
Q

what are 4 notable side effects of hydroxychloroquine?

A

nightmares
macular toxicity
liver toxicity
skin pigmentation

541
Q

what is a notable side effect of sulfasalazine?

A

male infertility - reduction in sperm count

542
Q

what is a notable side effect of anti-TNF?

A

reactivation of TB and hepatitis B

543
Q

what are 2 notable side effects of rituximab?

A

night sweats
thrombocytopenia

544
Q

what is Behcet’s syndrome?

A

Complex multisystem autoimmune inflammatory disorder of recurrent oral ulcer, genital ulcers and anterior uveitis

545
Q

what gene is there a link with in behcet’s disease?

A

HLA-B51

more common in eastern mediterranean people

546
Q

what are 8 features of behcet’s disease?

A

Oral ulcers - painful, well circumscribed erosions with red halo - at least 3 episodes in last year

genital ulcers
anterior uveitis

Erythema nososum
Arthritis
thrombophlebitis and DVT
Neuro involvement - aseptic meningitis
GI - Abdo pain, diarrhoea, colitis

547
Q

what test can be used to assess for Behcet’s disease?

A

pathergy test

sterile needle makes pin pricks on forearm - r/v in 24-48 hours for erythema, induration (thickening) and non-specific skin hypersensitivity

+ve in Behcet’s disease, sweet’s syndrome or pyoderma gangrenosum

548
Q

what is the management of Behcet’s disease?

A

Colchicine - for acute inflammation

Topical/systemic steroids - for acute outbreaks

Immunosuppression - azithioprine, methotrexate, cyclosporine

biologics - infliximab, adalimumab - in refractory cases

549
Q

what are 5 complications of Behcet’s disease?

A

Occular - uveitus, retinal vasculitises
Vascular - VTE, vasculitis
Neuro - aseptic meningitis
GI ulcers, perforation
Relapse - relapsing remitting course

550
Q

what are 7 causes of mechanical back pain?

A

muscle or ligament sprain
facet joint dysfunction
sacroiliac joint dusfunction
herniated disc
spondylolisthesis - anterior displacement of vertebra
scoliosis
degenerative changes

551
Q

what are 4 causes of neck pain?

A

muscle or ligamant strain
torticollis - muscle spasms causing stiff and painful neck
whiplash
cervical spondylosis

552
Q

what are 5 red flag causes of back pain?

A

spinal fracture
cauda equina
spinal stenosis
ankylosing spondylitis
spinal infection

553
Q

what nerves form the sciatic nerve?

A

L4-S3

554
Q

how many of each vertebrae are there?

A

7 cervical
12 thoracic
5 Lumbar
5 sacral (fused)
4 coccyx (fused)

555
Q

what is the pathway of the sciatic nerve?

A

exits pelvis through greater sciatic foramen
travels down back of leg to knee
divides into tibial nerve and common peroneal nerve

supplies sensation to lateral lower leg and foot and motor to posterior thigh, lower leg and foot

556
Q

what are 3 causes of sciatica?

A

herniated disc
spondylolisthesis
spinal stenosis

557
Q

what test can be used to assess sciatica?

A

Sciatic stretch test

patient lies on back with legs straight

examiner lifts leg from ankle with knee extended till maximum hip flexion then dorsiflexes ankle

reproduces sciatica pain indicating nerve root irritation

558
Q

what tool can be used to assess risk of chronic back pain from an acute presentation?

A

STarT back screening tool

559
Q

what is low, medium and high risk in the STarT back screening tool?

A

Low - total score <3, subscore <3

Medium - total score >3, subscore <3

high - total score >3, subscore >3

560
Q

what is the management of patients at low risk of chronic back pain presenting with pain?

A

self management
education
reassurance
analgesia
staying active and mobilising as tolerated

561
Q

what is the management for patients at medium to high risk of developing chronic back pain presenting with pain?

A

As with low risk PLUS

physiotherapy
group exercise
CBT

562
Q

what are 3 options for analgesia in back pain?

A

1 - NSAIDs - Naproxan, ibuprofen

codeine

benzodiazepine - for muscle spasms - up to 5 days

563
Q

what anaesthetic technique can be used for lower back pain due to facet joint dysfunction?

A

radiofrequency denervation

564
Q

what is the management of sciatica?

A

Amitriptyline
Duloxitine

565
Q

what are 4 specialist options for chronic sciatica?

A

epidural corticosteroid injections
local anaesthetic injections
radiofrequency denervation
spinal decompression

566
Q

what are 5 red flags for lower back pain?

A

age <20 or >50
Hx of malignancy
night pain
Hx of trauma
Systemically unwell

cauda equina symptoms

567
Q

what are the features of L3 nerve root compression?

A

sensory loss over anteior thigh
weak hip flexion, knee extension, hip adduction

reduced knee reflex
positive femoral stretch test

568
Q

what are the features of L4 nerve root compression?

A

sensory loss to anterior aspect on knee and medial malleolus

weak knee extension and hip adduction

reduced knee reflex
positive femoral stretch test

569
Q

what is the presentation of L5 nerve root compression?

A

sensory loss over dorsum of foot
weakness in foot and big toes dorsiflexion

reflexes intact
positive sciatic nerve stretch test

570
Q

what is the presentation of S1 nerve root compression?

A

sensory loss posteriolateral aspect of leg and lateral aspect of foot

weakness in plantar flexion of foot
reduced ankle reflex
positive sciatic nerve stretch test

571
Q

what is the femoral stretch test?

A

patient lies prone

maximal flexion of knee to end range
if no symptoms hip is extended with knee flexed

if pain is felt in posterior thigh, buttocks or lumbar region - +ve

572
Q

what is classed as acute backpain?

A

<6 weeks

573
Q

what is classed as chronic back pain?

A

> 12 weeks

574
Q

what are 8 risk factors for back pain?

A

prev episode
obesity
physically demanding occupation
physical inactivity
psychological distress
other chronic health conditions
lower socio-economic status
smoking

575
Q

what is the most common level for a prolapsed disc?

A

L5/S1

Phase 4 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions