MSK Flashcards
What are the clinical findings of ankylosing spondylitis?
reduced chest expansion, reduced lateral flexion and reduced forward flexion (Schober’s test)
Sulfasalazine can cause what?
Reduced sperm count -> usually returns to normal upon stopping the medication
What would joint aspiration of rheumatoid arthritis show?
- High WBC
- Polymorph neutrophils
- Cloudy/Yellow appearance
What is previous chemo a big risk factor for?
Avascular necrosis
Methotrexate plus trimethoprim can cause what?
Bone marrow suppression and panycytopenia
DIP swelling and dactylitis with arthritis suggests what?
Psoriatic arthritis
Which antibody is specific for anti-phospholipid syndrome?
Anticardiolipin antibody
What are the smoking cessation drugs?
- Nicotine replacement (causes N+V, headaches, flu symptoms)
- Varenicline (causes nausea and C/I in pregnancy/BF)
- Bupropion (reduces seizure threshold)
What type of shock does tension pneumothorax cause?
Obstructive
Which lung cancer is gynaecomastia associated with?
Adenocarcinoma of the lung
What does an isolated rise in ALP suggest?
Pagets disease of the bones
What is Paget’s disease of the bone?
Increased but uncontrolled bone turnover- XS osteoclast resorption and increased osteoblastic activity
What is most commonly affected in Paget’s
Skull, spine/pelvis, long bones of lower extremities
Paget’s predisposing factors?
Age, male, northern latitude, FHx
Paget’s CP
- 5% symptomatic
- older male with bone pain and raised ALP
- bone pain: pelvis, lumbar, femur
- bowing of tibia, bossing of skull
Paget’s Ix
- bloods
- other markers of bone turnover
- x-ray= osteolysis in early disease; mixed lytic/sclerotic lesions later. Skull= thickened vault, osteoporosis circumscripta
- Bone scintigraphy (increased uptake at sites of active bone lesions)
Bloods in Paget’s?
- Raised ALP
- Ca and phosphate normal (sometimes hypercalcaemia with prolonged immobilisation)
Other markers of bone turnover in Paget’s?
- procollagen type I N-terminal propeptide (PINP)
- serum C-telopeptide (CTx)
- urinary N-telopeptide (NTx)
- urinary hydroxyproline
Paget’s Mx?
- Bisphosphonate (oral risedronate or IV zoledronate)
- calcitonin less common
Paget’s indications for Mx
Bone pain, skull or long bone deformity, fracture, periarticular Paget’s
Paget’s Cx
Deafness, bone sarcoma, fractures, skull thickening, high-output cardiac failure
subchondral erosions, sclerosis
and squaring of lumbar vertebrae
Anklyosing spondylitis
What is the most common site of metatarsal stress fractures?
2nd metatarsal
hyperpigmentation of the palmar creases indicates what?
Addisons