msk Flashcards
features of L3 nerve root compression
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
features of L4 nerve root compression
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
features of L5 nerve root compression
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
features of S1 nerve root compression
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
drug induced lupus:
1. most common causes (2)
2. less common causes (3)
- procainamide (used to treat SVT)
hydralazine
2.isoniazid
minocycline (a tetreacycline)
phenytoin
clinical features of drug induced lupus (4)
arthralgia
myalgia
skin (malar rash)
pulmonary involvement (e.g. pleurisy)
drug induced lupus antibodies:
ANA +ve in 100% (dsDNA -ve)
anti-histone antibodies are found in 80-90%
anti-Ro, anti-Smith positive in around 5%
RA poor prognostic features (7)
rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset
azathioprine
- test prior to starting
- adverse effects (4)
- drug interaction (1)
- is it pregnancy safe?
- TPMT (thiopurine methyltransferase)
- bone marrow supression (do FBC if pt develops infection/ bleeding)
nausa & vomiting
pancreatitits
non-melanoma skin cancer - allopurinol (use lower dose)
- yes
hip #mgt - intracapsular
i. undisplaced
ii. displaced
i. internal fixation or hemiarthoplasty if fit
ii. THR
hip #mgt - extracapsular
DHS (if stable intra-trochaneteric #)
im nail if oblique/ transverse/ subtrochanteric
nerve affected by meralgia paraesthetica
lateral cutaneous n. of thigh
osteomalacia bloods findings
i. calcium
ii. phosphate
iii. ALP
iv. PTH
i. calcium - low
ii. phosphate - low
iii. ALP - high
iv. PTH - high
primary hyperparathyroidism blood results:
i. calcium
ii. phosphate
iii. ALP
iv. PTH
i. calcium - high
ii. phosphate - low
iii. ALP - high
iv. PTH - high
CKD (secondary hyperparathyroidism) blood results:
i. calcium
ii. phosphate
iii. ALP
iv. PTH
i. calcium - low
ii. phosphate - high
iii. ALP - high
iv. PTH - high
antiphospholipid syndrome features: (3)
- venous/arterial thrombosis
- recurrent miscarriages
- livedo reticularis
other features: pre-eclampsia, pulmonary hypertension
antiphospholipid syndrome
i. antibodies (3)
ii. blood tests
i. anticardiolipin antibodies
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
lupus anticoagulant
ii. FBC - thrombocytopenia
clotting - prolonged APTT
hydroxychloroquine
i. key adverse effect
ii. is it pregnancy safe?
i. bull’s eye retinopathy (can also get corneal deposits)
ii. yes
reactive arthritis skin features (2) :
circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
osteomyelitis:
- most common causative organism
- most common causative organism in sickle cell
- s. aureus
- non-typhi salmonella
methotrexate SE (3)
Myelosuppression
Liver cirrhosis
Pneumonitis
sulfasalazine SE (4)
Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease
sulfasalazine cautions: (2)
pregnancy safe?
G6PD deficiency
aspirin/ sulphonamide allergy (cross sensitivity)
is pregnancy safe
Leflunomide SE (3)
Liver impairment
Interstitial lung disease
Hypertension
gold SE (1)
proteinuria
penicillamine SE (2)
proteinuria
exacerbation of myaesthenia gravis
entanercept SE (2)
demyelination
reactivation of TB
infliximab and adalimumab SE
reactivation of TB
drug causes of gout (5)
diuretics –> thiazides & furosemide
ciclosporin
alcohol
cytotoxic agents
pyrazinamide
aspirin
ankylosing spondylitis examination features:
reduced:
- lateral flexion
- forwards flexion (Schober’s test)
- chest expansion
ankylosing spondylitis other features “A” (8)
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
cAuda equina syndrome
peripheral Arthritis (25%, more common if female)
RA x-ray features: (5)
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation
