MSK Flashcards
In reactive arthritis, what would be seen in a joint aspiration of the knee?
Sterile synovial fluid with a high white blood cell count
Reactive arthritis: develops after an infection where the organism cannot be recovered from the joint
What joints are more involved in osteoarthritis?
Carpometacarpal and distal interphalangeal joint
What is the most specific antibody for rheumatoid arthritis?
Anti-cyclic citrullinated peptide (anti-CCP)
What is given for cute flares of rheumatoid arthritis?
Intramuscular steroids such as methylprednisolone
When would a 10-year fracture risk be reassessed?
After 5 years of treatment with alendronate
What condition causes Gottorn’s papules (roughened red papules over extensor surfaces of fingers)
Dermatomyositis
What is a side effect of methotraxate?
Iatrogenic pulmonary fibrosis
What is the BNF advice regarding methotrexate and pregnancy?
She should wait at least 6 months after stopping methotrexate before trying to conceive
What is first line treatment of Knee osteoarthritis?
topical NSAIDs
What would you see in an X-ray of Ankylosing spondylitis?
x-ray findings: subchondral erosions, sclerosis
and squaring of lumbar vertebrae
What is a side effect of Hydroxychloroquine?
severe and permanent retinopathy
What is treatment of mild-moderate symptoms of carpal tunel syndrome?
Wrist splinting
When starting allopurinol, what should be added?
Add colchicine cover for the first 6 months
when starting allopurinol, colchicine or NSAID cover is recommended to reduce the risk of precipitating another acute gout attack. Colchicine interferes with the inflammatory process by inhibiting neutrophil motility and activity, thereby preventing flare-ups during the initiation of urate-lowering therapy.
What is osteogenesis imperfecta?
- brittle bone disease
- group of disorders of collagen metabolism, resulting in bone frailty and fractures
What are the blood results for osteogenesis imperfecta?
Normal adjusted calcium, normal PTH, normal ALP and normal PO4
What is a CT chest/abdomen/pelvis are done after a diagnosis of Dermatomyositis?
paraneoplastic phenomenon
What is Dermatomyositis?
An inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions
Usually idiopathic with connective tissue disorders or underlying malignancy
What is Systemic sclerosis and the 3 types?
- unknown aetiology characterised by hardened, sclerotic skin and other connective tissues. More common in females.
Types:
- Limited cutaneous systemic sclerosis
- Diffuse cutaneous systemic sclerosis
- Scleroderma (without internal organ involvement)
What is Limited cutaneous systemic sclerosis?
- Raynaud’s may be the first sign
- scleroderma affects face and distal limbs predominately
- associated with anti-centromere antibodies
- a subtype of limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
What is Diffuse cutaneous systemic sclerosis?
- scleroderma affects trunk and proximal limbs predominately
- associated with anti scl-70 antibodies
- Causes interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)
- other complications include renal disease and hypertension
patients with renal disease should be started on an ACE inhibitor - poor prognosis
What is scleroderma?
- tightening and fibrosis of skin
- may be manifest as plaques (morphoea) or linear
What are signs of Anterior ischemic optic neuropathy?
fundoscopy typically shows a swollen pale disc and blurred margins
What are signs of De Quervain’s tenosynovitis?
Pain on the radial side of the wrist/tenderness over the radial styloid process
What are signs of Lateral epicondylitis?
worse on resisted wrist extension/suppination whilst elbow extended
What are signs of Medial epicondylitis?
Pain is worse on flexion and pronation of the wrist.
What are signs of Anterior interosseous syndrome?
- damage to the anterior interosseous nerve
- pain in the forearm and weakness of flexion of the index finger and the distal phalanx of the thumb.
What medications can increase risk of atypical stress fractures?
Bisphosphonates e.g. Alendronic acid
What never is compressed in cubital tunnel syndrome?
ulnar nerve and can present with tingling/numbness of the 4th and 5th finger
What are signs of L2 nerve root compression?
- back, groin, and anterior thigh pain.
- There may be weakness of hip flexion
- lower limb reflexes tend to be normal.
What are signs of L3 nerve root compression?
- sensory loss over the anterior thigh, weakened quadriceps, and a reduced knee reflex.
What are signs of L4 nerve root compression?
- sensory loss over the anterior aspect of the knee, weakened quadriceps, and a reduced knee reflex.
What are signs of L5 nerve root compression?
- weakness of hip abduction and foot drop
- sensory loss over the dorsum of the foot
- Lower limb reflexes remain intact
What are signs of S1 nerve root compression?
- sensory loss of the posterolateral aspect of the leg and lateral aspect of the foot
- weakness of foot plantar flexion and a reduced ankle reflex
What are early signs of rheumatoid arthritis on an X-ray?
Juxta-articular osteoporosis/osteopenia
What is Osteochondritis dissecans?
- knee pain after exercise, locking and ‘clunking’
- in children
What is a common cause of neutropenia?
Staphylococcus epidermidis
What is koilonychia?
Spoon shaped nails
What electrolyte abnormality is caused by transfusion of RBCs?
Hyperkalaemia
What does a raised CRP in SLE patients indicate?
Infection
Pain on longitudinal compression of the thumb indicates what?
Scaphoid fracture
When is osteoarthritis worst?
Pain on exercise
When is rheumatoid arthritis worst?
In the mornings
Azathioprine and allopurinol interaction cause what?
Bone marrow suppression
How to treat methotrexate toxicity?
Folinic acid
What is Felty’s syndrome?
Rheumatoid arthritis + splenomegaly + low with blood cell count
What is the most common bacterial cause of discitis?
Staphylococcus aureus
What is Bennett’s fracture?
- Intra-articular fracture of the first carpometacarpal joint
- Impact on flexed metacarpal, caused by fist fights
- X-ray: triangular fragment at ulnar base of metacarpal
- ” He hurts his thumb when he punches his opponent.”
What is a T-score?
It is a measure of the bone mineral density compared to a healthy young adult
How to diagnose osteoporosis/ osteopenia from T score?
- less than -2.5 = osteoporosis
- between -1 and -2.5 = osteopenia
What is a Z-score?
It is a measure of bone mineral density compared to the average of those of the same age, ethnicity, and gender.
How to diagnose osteoporosis with a Z-score?
The Z-score is not used to diagnose osteoporosis, but is still useful in males under the age of 50 or premenopausal women, as a score of less than -2 suggests bone mineral density below the expected range.
What are signs of scaphoid fracture?
- tenderness in the anatomic snuffbox dorsally
- The superficial depression of skin that emerges when the thumb is held in abduction
- The wrist is in ulnar deviation is the anatomical snuffbox
What causes a colles’ fracture?
Fall onto extended outstretched hand
What are features of a colles’ fracture?
- Transverse fracture of the radius
- 1 inch proximal to the radio-carpal joint
- Dorsal displacement and angulation
transverse fracture of the distal radius that occurs due to axial loading and wrist hyperextension. Dorsal displacement of the radius
What is a smith’s fracture?
Distal radius fracture that occurs when the wrist is flexed. Anterior displacement of the radius
What is given for bone protection for long term steroids?
Start oral alendornate ad ensure calcium and vitamin D
What is Gottron’s papules a sign of?
dermatomyositis
What is the most common mechanism of ankle sprain?
inversion of the foot
What are the blood results of polymyalgia rhematica?
isolated raise in esr
