MSK Flashcards
What haem condition can predispose to pseudogout
hemochromatosis
allopurinol MOA
xanthine oxidase inhibitor
Main SE of colchicine
diarrhoea
treatment of septic arthritis
flucloxacillin/clindamycin for staph aureus 4-6 weeks
Cipro if gonorrhoea
Rheumatoid arthritis monitoring
DAS28 + CRP
most common extra-articular manifestation of RA
keratoconjunctivitis sicca
how to differentiate reactive and septic
in reactive, organism cannot be recovered from joint
specific eye conditions associated with reactive arthritis
conjunctivitis and anterior uveitis
psoriasis management
First line
1. potent corticosteroid + vitamin d analogue
Second line
1. Phototherapy (can cause SCC)
2. Oral methotrexate
Long term management of antiphospholipid syndrome
low dose aspirin (warfarin lifelong if had thrombotic event)
What can cause polymyositis and dermatomyositis
paraneoplastic syndrome
viral infection e.g. cosackie virus/HIV
Critical test for myositis
CK
What tests are done for ACL
Anterior drawer tests (ACl moves)
Lachmans (ACL moves)
Bakers cyst important differential
DVT
serious complication of baker cyst
compartment syndrome
Why do you not use steroid injections in foot
rupture of plantar fascia or fat pad atrophy
What is bechets disease
oral ulcers
genital ulcers
anterior uveitis
Why do you get AKI with compartment syndrome
accumulation fo myoglobin in kidneys
Which clinical sign points towards compartment syndrome
pain on passive stretch
How does ostechondritis dissicens present
pain after exercise
intermittent locking and swelling of joint
most common cause of death is systemic sclerosis
respiratory involvement: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)
Antibodies associated with systemic sclerosis
CREST: anti-centromere
Diffuse: Anti-SCL70
CREST syndrome
Calcinosis
Raynauds
oesophageal motility
sclerodactyly
telangtascia
What antibiotic should you not co-prescribe with methotrexate
trimethoprim
severe bone marrow suppression and pancocytopenia
What medication can cause drug induced lupus
isonazid
diagnostic investigation for osteomyelitis
MRI
RA x-ray findings
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation
ottawa ankle rules
Inability to walk four steps
Bony tenderness at the medial malleolar zone (tip of medial malleolus to lower 6cm of posterior border of tibia)
Bony tenderness at the lateral malleolar zone (tip of lateral malleolus to lower 6cm of posterior border of fibula).
Pain on the radial side of the wrist/tenderness over the radial styloid process ?
De Quervain’s tenosynovitis
bisphosphonate alternative?
denosumab if egfr <30
pre-op imaging in someone with RA
Anteroposterior and lateral cervical spine radiographs
- Atlantoaxial subluxation can lead to cervical cord compression.
L3 nerve root
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L4 nerve root
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L5 nerve root
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
S1 nerve root
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
who is more likely to get osteonecrosis of the jaw with bisphosphonates
cancer patients
extra articular signs of psoriatic arthritis
tenosynovitis and soft tissue inflammation resulting in:
- enthesitis: inflammation at the site of tendon and ligament insertion e.g. Achilles tendonitis, plantar fascitis
- tenosynovitis: typically of the flexor tendons of the hands
- dactylitis: diffuse swelling of a finger or toe
- nail changes
pitting
onycholysis
x-ray findings with psoriatic arthritis
‘Plantar spur’ and ‘pencil and cup’
how to differentiate psoas abscess and osteomyelitis
psoas has pain on hip extension
most common cause of psoas abscess
Staphylococcus aureus: most common
crohns
what should be checked before starting azathioprine/mercaptopurine
thiopurine methyltransferase deficiency (TPMT)
colles fracture complications
- median nerve injury
- compartment syndrome
- vascular compromise
- osteoarthritis
- complex regional pain syndrome
colles fracture
dorsally displaced distal radius -> dinner fork deformity
4 features of scaphoid fracture
- pain on longitudinal compression of thumb
- tenderness in anatomical snuffbox
- pain along the radial aspect of the wrist, at the base of the thumb
- loss of pincer grip strength
ulnar paradox
proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions
ulnar nerve damage features
- weak finger abduction and adduction with reduced sensation over the ulnar border of his hand
- clawing of 4th and 5th digits
CK in PMR
normal but raised ESR
osteomyelitis cause
Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate
what drug reduces risk of renal crisis in systemic sclerosis
ace-inhibitors
AS x ray
subchondral erosions, sclerosis
and squaring of lumbar vertebrae
routine monitoring with methotrexate
LFTs
methotrexate toxicity treatment
Folinic acid
complications of pagets
deafness (cranial nerve entrapment)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure
adverse effects of methotrexate
mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
most common type of intracapsular hip fracture
subcapital fracture
what nerve meralgia paresthetica
lateral cutaneous nerve of thigh compression
psoas abscess investigation
CT abdomen
features of de quervain’s tenosynovitis
- pain on the radial side of the wrist
- tenderness over the radial styloid process
- abduction of the thumb against resistance is painful
- Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
most common cause of discitis
staph aureus
How to differentiate bullous pemphigoid and pemphigoid vulgaris
no mucosal involvement (in exams at least*): bullous pemphigoid
mucosal involvement: pemphigus vulgaris
what is mcmurrys test for
meniscal tears
ACL: drawer test
posterior hip dislocation nerve
sciatic (leads to foot drop as common peroneal is a branch)
nerve conduction in carpal tunnel
Action potential prolongation in both sensory and motor axons
myeloma biochemical features
high calcium, normal/high phosphate and normal alkaline phosphate
what should never be prescribed with allopurinol
azathioprine -> bone marrow suppression
psoriatic arthritis complications
CVD
charcot joint
diabetes and described as gammy
what antibiotic increases risk of achilles tendon rupture
cipro
