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AKT Prep > MSK > Flashcards

MSK Flashcards

1
Q

What are the 4 key features of deep gluteal syndrome?

A

Buttock pain;
Aggravation of pain on prolonged sitting;
Tenderness on deep palpation of the buttock; and,
Passive stretching or resisted contraction tests cause pain.

(Previously called piriformis syndrome)

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2
Q

What are the DMARDS of choice in RA? (2)

A

Methotrexate and sulfasalazine are the DMARDs of choice due to their more favourable efficacy and toxicity profiles.

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3
Q

Spondyloarthritis are most commonly associated with what other MSK presentation?

A

Enthesitis (inflammation of tendonous or ligamentous insertions onto bone)

Achillies, plantar and patellar most common

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4
Q

SUFE - What age, gender and other patient features are most common?

A

SUFE
> 10 yrs
More common in boys

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5
Q

SUFE:
1) Investigation
2) Mangement

A

1) AP and frog lateral radiographs showing medial displacement of the femoral epiphysis

2) Same day surgical referral

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6
Q

How do you distinguish between Perthe’s and SUFE based on patient age?

A

Perthes’ - 4-10yrs
SUFE: > 10yrs

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7
Q

A patient is taking alendronic acid for osteoporosis following several fractures. They are experiencing GI side effects. What’s the next option?

A

Swap alendronic acid to risedronate

GI symptoms are common adverse effect of bisphosphonates, this is due to a local irritant and erosive effect and not an acid effect.
- Therefore PPI and/or ranitidine would make no difference

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8
Q

What are the 5 Ottwa criteria for knee x-ray?

A
  • Age 55 years or older
  • Isolated tenderness of the patella (no bone tenderness of the knee other than the patella)
  • Tenderness of the head of the fibula
  • Inability to flex the knee to 90°
  • Inability to weight bear both immediately and during the consultation for four steps (inability to transfer weight twice onto each lower limb regardless of limping)
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9
Q

Name 3 conditions more common in patients with rheumatoid arthritis?

A

Hypertension
Ischaemic heart disease
Osteoporosis
Depression

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10
Q

What is sudek’s atrophy?

A

Alternative name for complex regional pain syndrome

Presents with any of oedema, changes in skin blood flow, abnormal motor activity, allodynia, hyperalgesia or hyperaesthesia - usually lasting 6 months or more, generally changes distal to injury

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11
Q

What features characterise an ACL injury? (3)

A

Non-contact, twisting injuries characterised by an audible pop or crack and a large immediate swelling

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12
Q

What is the most common mechanism of PCL injuries?

A

Posterior cruciate ligament injuries are less common and rarely occur in isolation, they usually occur from direct impact to the flexed knee

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13
Q

What nerve is affected in Saturday night palsy - what symptoms may it present with?

A

Radial nerve

Sensory - Snuffbox, dorsum of proximal thumb, index and middle finger
Motor- finger and wrist drop

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14
Q

Lateral epicondylitis - name 3 presenting features other than lateral epicondyl tenderness?
- What is the name of the two tests which can be done for lateral epicondylitis?

A

1) Weak hand grip
2) Pain on resisted middle finger extension (Maudsley’s test)
3) Pain on lateral side of the elbow produced by flexing and pronating the wrist with the elbow extended and stabilized (Mill’s test)

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15
Q

A patients with PAD should be taking what medication?

A

Clopidogrel + statin

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16
Q

FRAX score can be used between which ages?

A

FRAX may be used for patients aged 40-90 years

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17
Q

You suspect a patient may have rheumatoid arthritis - how urgently do you refer to rheum?

A

Refer urgently if small joint involvement, persistent symptoms for 3 months before medical opinion sought, or more than 1 joint affected.

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18
Q

A 12yr old patient presents with persistent L knee pain, you are querying osteosarcoma in your head. What’s the next step?

A

Consider a very urgent direct access X ray (within 48 hours) to assess for bone sarcoma in children and young people with unexplained bone swelling or pain.

Consider a very urgent referral (within 48 hours) for specialist assessment for children and young people if an X ray suggests the possibility of bone sarcoma.

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19
Q

A ‘painful arc’ between 60 and 120 degrees is a sign of what?

A

Shoulder impingement
(Most commonly due to supraspinatus tendinitis)

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20
Q

What is the management of achillies tendonitis?
- At what point do you refer for physio?

A

Rest, NSAIDS

Referral to physio only if going on past 7 days

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20
Q

How do you distinguish between gastric and duodenal ulcers in the history?

A

Gastric - worse by eating
Duodenal - relieved by eating

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21
Q

1st and 2nd line medications for low back pain, no red flags?

A

1) NSAIDS
2) Codeine +/- paracetamol

NO role for paracetamol alone

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22
Q

What are the three diagnostic criteria for fibromyalgia?

A

Widespread pain index (WPI) ≥ 7 and symptom severity (SS) scale score ≥ 5, or WPI 3–6 and SS scale score ≥ 9

Symptoms have been present at a similar level for at least three months

The patient does not have a disorder that would otherwise explain the pain

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23
Q

According to the WHO which t-score is diagnostic of osteoporosis?

A

-2.5 or less

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24
Q

When should patients with OA be referred for surgery?

A

Joint symptoms (pain, stiffness and reduced function) that have a substantial impact on their quality of life and are refractory to non-surgical treatment.

Refer before there is prolonged and established functional limitation and severe pain.

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25
Q

What vaccination should be offered prior to starting DMARD therapy?

A

Pneumococcal

(Should also then also have annual flu’s)

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26
Q

When do NICE recommended DEXA scans if underweight?

A

After 1 year of being underweight if child or 2 years of being underweight if adult

Sooner if bone pain or recurrent fractures

27
Q

What is the normal range for BMI?

A

18.5-24.9

28
Q

What is Sever’s disease?

A

Calcaneal apophysitis at the point of insertion of the achilles tendon

Presents as heal pain in young/ adolescent atheletes, normal examination other than tenderness to palpation of heel

29
Q

What criteria should be met to be able to make a clinical diagnosis of OA?

A

Age 45 or over
Activity related joint pain
Morning stiffness lasting less than 30 mins (or no stiffness)

30
Q

What are the three criteria of the ottowa ankle rules?

A

Point tenderness at posterior edge (of distal 6 cm) or tip lateral malleolus

Point tenderness at posterior edge (of distal 6 cm) or tip medial malleolus

Inability to weight bear (four steps) immediately after the injury and in emergency department

31
Q

What are the characteristics of a testicular hydrocele?

A

Not seperate from testicle
Soft mass
Transilluminates

32
Q

Dermatomyositis is most common in what age group, what is it commonly associated with?

A

50-70’s

Associated with internal malignancy

33
Q

PMR is commonly associated with an ESR result over…?

A

Over 40
(Although can be much higher)

CK usually normal

34
Q

What is QFRacture, how does it differ to FRAX?

A

Alternative to FRAX

  • Includes ethnicitiy (recommended by SIGN in preference to FRAX)
35
Q

What is the recommended daily calcium intake?

A

700–1200 mg daily

If at osteopenia/ porosis risk then needs vitamin D also (400-800IU)

36
Q

What is the recommended daily vitamin D supplimentation for most people?

A

400-800IU

37
Q

What is a DAS28 used for and what does it consist of?

A

Assessing severity in RA

Assessment of 28 joints, swelling and pain
CRP and ESR
Patients global assessment of their health

38
Q

What is used for diagnosis of osteoporosis, t or z score?

A

T score < -2.5

Z score matches to age and is not used in osteoporosis diagnosis

39
Q

A patient with osteoporosis is intolerant of alendronate and risindronate. How should you manage?

A

Refer to secondary care

They may use:
zoledronic acid, raloxifene, denosumab and teriparatide

40
Q

Reactive arthritis:
1) Two types
2) Associated with what blood marker?

A

1) Sexual or enteric (GI) most common triggers

2) 60–90% of the genital and enteric forms of the disease are associated with HLA B27.

41
Q

A 14-year-old patient consults with a rapidly growing 10 cm soft tissue swelling on the right upper arm. On examination, the swelling is tender, fixed and feels deep to the fascia.

What is the SINGLE MOST appropriate management option?

A

Refer for urgent USS within 2 days

Adults with suspected sarcoma should have urgent USS within 2 weeks

Children with suspected sarcoma should have urgent USS within 2 days

42
Q

A 58-year-old woman with mild sero-negative arthritis has been taking naproxen for three months, which controls her symptoms. She develops urticaria which resolves when she stops the naproxen. However, her pain is no longer controlled and paracetamol is ineffective.

Which is the most appropriate alternative medication to prescribe?

A

Codeine

If intollerant to one NSAID, likely will be to all. Step up the pain ladder to weak opioids

43
Q

What test is used to diagnose De Quevain’s tenosynovitis?

A

Finkelstein’s test

44
Q

Finkelstein’s test is performed how?

A

Positive if pain on moving a patient’s wrist in an ulnar direction with fingers flexed over their thumb

45
Q

SIGN guidance suggests DEXA should be performed at what FRAX risk cut off?

A

Over 10%

46
Q

How does trigger finger usually present?

A

Patients with trigger finger initially report an atraumatic catching and locking of the affected digit on flexion and painless snapping. This can progress with inability to actively extend the affected digit

47
Q

How does morton’s neuroma typically present?

A

Pain in the third inter-metatarsophalangeal space

Sharp pain while walking, and patients may describe the sensation of having a pebble under the toe
- Loss sensation under the toe is strong indicator

Classically women in 40’s, high heeled shoes

48
Q

How does Chondromalacia patellae typically present?

A

Chondromalacia patellae is softening of the articular cartilage of the patella. It is a significant cause of anterior knee pain in teenage girls.

49
Q

How does Osgood–Schlatter syndrome present?

A

Osgood–Schlatter syndrome is an example of an overuse syndrome associated with physical exertion before skeletal maturity. Patients, usually boys, complain of pain, tenderness and a lump over the tibial tubercle. Pain follows activity and may be bilateral.

50
Q

Which NSAIDS have the most favourable thrombotic profiles?

A

Ibuprofen + naproxen lowest risk

51
Q

Which is the SINGLE MOST appropriate ESTIMATE of the percentage of patients with knee pain that can accurately localise the site of their pain?

A

70%

52
Q

How is risk of osteoporotic fracture assessed in patients with major risk factors under the age of 40?

A

DEXA

(FRAX only for 40 or above)

53
Q

What is the difference between t and z scores?
- Which is used to diagnose osteoporosis?

A

T- SD’s from young adult mean
Z- SD’s from age matches controls

T only for osteoporosis

54
Q

Exercise is advised for chronic pain. Name 4 strategies that can improve adherance:

A
  • Supervised exercise sessions
  • Individualised exercises in group settings
  • Additional supplementary material
  • Combined group and home exercise programme
55
Q

What scale is used to diagnose joint hypermobility?

A

Nine-point Beighton scale

(i.e. Placing hands flat on the floor without bending the knees)

56
Q

Your patient on methotrexate for RA has a flare. They have a history of gastric ulcer. What management options do you have?

A

Likely avoid NSAID

1) Intraarticular steroid (if localised)
2) Intramuscular steroid (if generalised)

  • Oral steroid if (2) is not practical (Course reducing over 2-4 weeks until see’s specialist)
57
Q

How do you manage RA flares in GP?

A

NSAID, lowest effective dose for shortest possible time

Refer urgently to rheum:
Intra-articular/ intramuscular steroids. oral steroids

58
Q

Tenderness over the calcaneal tubercle and pain is reproduced on dorsiflexion of the toes would suggest what diagnosis?

A

Plantar fascitis

59
Q

Plantar fascitis is associated with what other conditions?

Name two other risk factors?

A

Plantar fasciitis is typically associated with the HLA B27 spondyloarthropathies which includes ankylosing spondylitis, psoriatic arthritis, reactive arthritis and Reiter’s syndrome

Also overweight/ highly active

60
Q

How does erythema nodosum usually present?

A

Typically, erythematous, warm nodules and plaques 1–5 cm in diameter develop over the lower legs.

Painful, develops over weeks then fades
May often follow strep infection

(Self limiting over weeks to months)

61
Q

What is the minimum amount of time you should wait to check urate levels following a gout attack?

A

2-4 weeks

62
Q

What are the bnf’s renal recommendations for allopurinol?

A

Max dose in renal impairement 100mg

If severe renal impairement reduce below 100mg

63
Q

What is Polyarteritis nodosa?
How may it present?

A

Polyarteritis nodosa is a vasculitis of medium sized arteries.

Polyarthralgia is present in 60% of cases and myalgia in 30–80%.
- May have weight loss, fever, hypertension and other vague vasculitis signs

64
Q

Which are the SINGLE MOST appropriate threshold ages at which to consider assessment of fragility fracture risk in patients with no specific risk factors? (M+F)?

A

Fracture risk assessment should be targeted. In patients with no other risk factors, fracture risk assessment should be considered from age 65 years in women and age 75 years in men.

65
Q

When are MRI’s indicated in knee pain?

A

MRI scans are advised in patients aged younger than 60 years with:
- Suspected meniscal tear, ligament injury, suspicious lump or recurrent anterior knee pain.

AKT Prep (22 decks)

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