MSK Flashcards by Henry Marshall

Which % FRAX score indicates DEXA scan

10%

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XR findings for ankylosing spondylitis

Subchondral erosions (loss of joint space also seen in eg OA

Sclerosis (higher density)

Squaring of lumbar vertebrae

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1st line Mx for ankylosing spondylitis

Exercise e.g. swimming

NSAIDs

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Which nerve innervates foot dorsiflexion and sensation of dorsum

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Which nerves control the leg reflexes

Knee jerk = L3 and L4
‘Three four kick the door’

Ankle jerk = S1 and S2
‘One two buckle my shoe’

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Which Abx not to take with methotrexate

TriMETHoprim

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Which t2dm medication increases fracture risk

Glitazones e.g. pioglitazone.

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Most common cardiac manifestation of SLE

Pericarditis

Also presents with fatigue , fever, mouth ulcers, lymphadenopathy, skin rashes, photosensitivity, arthralgia, pleurisy its crazy

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4 key XR changes in osteo

LOSS

Loss of joint space
Osteophytes (bone spurs)
Subarticular sclerosis (increased density along the joint line)
Subchondral cysts (fluid filled holes in the bones)

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Boutonniere’s vsswan neck deformity

Boutonnières is flexed PIP and hyperextended DIP

Swan neck is hyperextended PIP and flexed DIP

Both in RA

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2 common SE of sulfasalazine

Orange urine

Male infertility (reduces sperm count)

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3 common SE of hydroxychloroquine

Retinal toxicity (e.g. uveitis)

Blue-grey skin pigmentation

Hair bleaching

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Skin presentation of SLE

Malar rash worsened by sunlight

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Which antibody is most specific to SLE

Anti-dsDNA (double stranded)

Antiphospholipid syndrome can then occur in people with SLE causing increased risk of VTE

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5 complications of SLE

Recurrent miscarriages
Pericarditis
CVD and hypertension due to chronic inflam in BVs
Pleuritis/ ILD
Anaemia
Nephritis
VTE
Neuropsychiatric (optic neuritis/ psychosis)

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How does limited cutaneous systemic sclerosis present

CREST
Calcinosis- calcium deposits on e.g. fingertips
Raynaud’s
Esophageal dysmotility- swallowing, reflux, pain
Sclerodactyly- skin tightening of hands
Telangiectasia- dilated bv in skin

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How does diffuse cutaneous systemic sclerosis differ from limited

CREST Sx in limited

Plus:
- CV problems e.g. hypertension and CAD
- lung problems e.g. pulmonary fibrosis
- kidney problems e.g. scleroderma renal crisis

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Which management for diffuse cutaneous systemic sclerosis do you need to be careful doing

Steroids can cause scleroderma renal crisis which is a complication of DCSS

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Which blood test for myositis

CK really high

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What do you give in antiphospholipid syndrome to prevent complications

Long term warfarin - target 2-3

Give LMWH and aspirin in pregnancy

Prevents DVTS and miscarriages etc

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Which test to diagnose Sjögrens

Schirmer test

Filter paper under lower eyelid- moisture should travel 15mm, less than 10 is significant

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How to remember the arm reflex myotomes

C5+C6 I grab some sticks (biceps reflex),

C7+C8 I lay them straight (triceps reflex).

3 RF for pseudogout

Hyperparathyroidism

haemochromatosis

Low Mg, low phosphate

Acromegaly, Wilson’s disease

5 bones which are most likely to have avascular necrosis

NOF
Scaphoid
Talus
Humeral head
Knee

Which Abx can cause Achilles tendonitis

Ciprofloxacin (/any quinolones e.g. any floxacin)

Which hand movements test which nerve

Finger extension vs resistance for radial nerve Finger abduction vs resistance for ulnar nerve Thumb abduction vs resistance for median nerve (palm and thumb to ceiling)

How to manage people after their first VTE with antiphospholpid syndrome

Lifelong warfarin

What is the ulnar paradox

More proximal nerve injury creates a LESS pronounced deformity So ulnar injury at the elbow creates a less pronounced deformity than at the wrist

Pigmented palmar creases which endocrine disorder

Addisons disease Diagnose with ACTH stimulation test

Finding on respiratory exam with AS

Reduced chest expansion If there is rib involvement can have breathing discomfort and then take shallower breaths leading to scarring and reduced ability for the chest to expand

Which antibody is raised in IBD

PANCA may be positive in UC but likely negative in crohns

Which two rheum drugs can cause bone marrow suppression when used together

Azathioprine and allopurinol when put together have aSEVERE interaction Azathioprine for UC and allopurinol for gout

RA with low white cells,neutropenia and splenomegaly

Felty’s syndrome NOT methotrexate SE as this wouldn’t cause splenomegaly

Which nerve is most likely to be injured during knee arthroplasty and effect

Common perineal nerve Can cause foot drop

Anti-Ro which autoimmune disorder

Primary Sjogren’s Syndrome Aka SS-a antibodies Found in 60-70 % of patients with PSS Presents with dry mouth, dry eyes, arthralgia

Anti Jo1 which autoimmune disease

Dermatomyositis Presents with macular rash on back and shoulder Heliotrope rash in periorbital region Gottron’s papules- rough red papules on extensor surfaces Dry and scaly hands Proximal weakness Raynauds

How does hip dislocation and NOFF differ in presentation

ANTERIOR hip dislocation is abducted and externally rotated POSTERIOR Hip dislocation is shortened and INTERNALLY rotated NOFF is shortened and EXTERNALLY rotated

What do you see on blood test results in osteomalacia

= low vit D levels Low calcium, low phosphate High ALP and high PTH

What do diabetics need before surgery

Must put them on variable rate (sliding scale) insulin if they are insulin dependant

L5 nerve root compression what symptoms

Sensory loss of dorsum of foot Weakness in foot and big toe dorsiflexion Reflexes intact Positive sciatic nerve stretch test (SLR)

Obturator nerve injury presentation

Weakness in hip abduction Numbness over medial thigh Most common during instrumental delivery ? (L2-L4 roots)

Right-sided Abdo pain relieved by hip flexion, pain on extension and internal rotation WHICH INV TO CONFIRM

Psoas abscess CT abdomen to confirm Mx with Abx and percutaneous drainage, surgery if doesn’t work

Mx of scaphoid fracture

Undisplaced= cast for 6-8 weeks Displaced= surgical fixation Proximal scaphoid pole fractures also require surgical fixation

Subtrocahnteric fracture of NOF Mx

Intramedullary device All extratrochanteric fractures are Mx with either IMD or dynamic hip screw DHS used in intertrochanteric #

If a shoulder is externally rotated and abducted then what is the problem

Anterior dislocation Think throwing position 95 % of shoulder dislocations

Dupuytren’s contracture causes

Manual labour Phenytoin Alcoholic liver disease DIABETES Trauma

What is the surgery done in carpal tunnel

Flexor retinaculum division Forms the roof of the carpal tunnel Dividing this decompresses the median nerve

How does the presentation of polymalgia rheumatica differ to polymyositis

PR presents with aching of proximal muscles, but they are not weak Polymyositis presents with muscle weakness +/- aching

How do you manage people with antiphosphopipid syndrome

If they haven’t had a thrombotic event then give low-dose aspirin If they have had an event then they are given lifelong warfarin

Which nerve is most at risk from a humeral shaft fracture vs supracondylar fracture vs proximal fracture

Shaft= radial nerve- presents with wrist drop Supracondylar = ulnar Proximal= axillart

Sjögren’s syndrome Mx

Artificial tears Pilocarpine may help to stimulate saliva production Doesn’t seem to be any actual treatment

Most common mechanism of ankle sprain

Inversion of the foot

What antibiotics can you not take with aspirin

Erythromycin and clarythromcyin