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5th Year!! > MSK > Flashcards

MSK Flashcards

1
Q

Which % FRAX score indicates DEXA scan

A

10%

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2
Q

XR findings for ankylosing spondylitis

A

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

Sclerosis (higher density)

Squaring of lumbar vertebrae

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3
Q

1st line Mx for ankylosing spondylitis

A

Exercise e.g. swimming

NSAIDs

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4
Q

Which nerve innervates foot dorsiflexion and sensation of dorsum

A

L5

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5
Q

Which nerves control the leg reflexes

A

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

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

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6
Q

Which Abx not to take with methotrexate

A

TriMETHoprim

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7
Q

Which t2dm medication increases fracture risk

A

Glitazones e.g. pioglitazone.

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8
Q

Most common cardiac manifestation of SLE

A

Pericarditis

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

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9
Q

4 key XR changes in osteo

A

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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10
Q

Boutonniere’s vsswan neck deformity

A

Boutonnières is flexed PIP and hyperextended DIP

Swan neck is hyperextended PIP and flexed DIP

Both in RA

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11
Q

2 common SE of sulfasalazine

A

Orange urine

Male infertility (reduces sperm count)

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12
Q

3 common SE of hydroxychloroquine

A

Retinal toxicity (e.g. uveitis)

Blue-grey skin pigmentation

Hair bleaching

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13
Q

Skin presentation of SLE

A

Malar rash worsened by sunlight

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14
Q

Which antibody is most specific to SLE

A

Anti-dsDNA (double stranded)

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

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15
Q

5 complications of SLE

A

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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16
Q

How does limited cutaneous systemic sclerosis present

A

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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17
Q

How does diffuse cutaneous systemic sclerosis differ from limited

A

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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18
Q

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

A

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

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19
Q

Which blood test for myositis

A

CK really high

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20
Q

What do you give in antiphospholipid syndrome to prevent complications

A

Long term warfarin - target 2-3

Give LMWH and aspirin in pregnancy

Prevents DVTS and miscarriages etc

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21
Q

Which test to diagnose Sjögrens

A

Schirmer test

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

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22
Q

How to remember the arm reflex myotomes

A

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

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

23
Q

3 RF for pseudogout

A

Hyperparathyroidism

haemochromatosis

Low Mg, low phosphate

Acromegaly, Wilson’s disease

24
Q

5 bones which are most likely to have avascular necrosis

A

NOF
Scaphoid
Talus
Humeral head
Knee

25
Q

Which Abx can cause Achilles tendonitis

A

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

26
Q

Which hand movements test which nerve

A

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)

27
Q

How to manage people after their first VTE with antiphospholpid syndrome

A

Lifelong warfarin

28
Q

What is the ulnar paradox

A

More proximal nerve injury creates a LESS pronounced deformity

So ulnar injury at the elbow creates a less pronounced deformity than at the wrist

29
Q

Pigmented palmar creases which endocrine disorder

A

Addisons disease
Diagnose with ACTH stimulation test

30
Q

Finding on respiratory exam with AS

A

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

31
Q

Which antibody is raised in IBD

A

PANCA may be positive in UC but likely negative in crohns

32
Q

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

A

Azathioprine and allopurinol when put together have aSEVERE interaction

Azathioprine for UC and allopurinol for gout

33
Q

RA with low white cells,neutropenia and splenomegaly

A

Felty’s syndrome

NOT methotrexate SE as this wouldn’t cause splenomegaly

34
Q

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

A

Common perineal nerve

Can cause foot drop

35
Q

Anti-Ro which autoimmune disorder

A

Primary Sjogren’s Syndrome

Aka SS-a antibodies

Found in 60-70 % of patients with PSS

Presents with dry mouth, dry eyes, arthralgia

36
Q

Anti Jo1 which autoimmune disease

A

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

37
Q

How does hip dislocation and NOFF differ in presentation

A

ANTERIOR hip dislocation is abducted and externally rotated

POSTERIOR Hip dislocation is shortened and INTERNALLY rotated

NOFF is shortened and EXTERNALLY rotated

38
Q

What do you see on blood test results in osteomalacia

A

= low vit D levels

Low calcium, low phosphate

High ALP and high PTH

39
Q

What do diabetics need before surgery

A

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

40
Q

L5 nerve root compression what symptoms

A

Sensory loss of dorsum of foot

Weakness in foot and big toe dorsiflexion

Reflexes intact

Positive sciatic nerve stretch test (SLR)

41
Q

Obturator nerve injury presentation

A

Weakness in hip abduction

Numbness over medial thigh

Most common during instrumental delivery ?

(L2-L4 roots)

42
Q

Right-sided Abdo pain relieved by hip flexion, pain on extension and internal rotation

A

Psoas abscess

CT abdomen to confirm

Mx with Abx and percutaneous drainage, surgery if doesn’t work

43
Q

Mx of scaphoid fracture

A

Undisplaced= cast for 6-8 weeks

Displaced= surgical fixation

Proximal scaphoid pole fractures also require surgical fixation

44
Q

Subtrocahnteric fracture of NOF Mx

A

Intramedullary device

All extratrochanteric fractures are Mx with either IMD or dynamic hip screw

DHS used in intertrochanteric #

45
Q

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

A

Anterior dislocation

Think throwing position

95 % of shoulder dislocations

46
Q

Dupuytren’s contracture causes

A

Manual labour

Phenytoin

Alcoholic liver disease

DIABETES

Trauma

47
Q

What is the surgery done in carpal tunnel

A

Flexor retinaculum division

Forms the roof of the carpal tunnel

Dividing this decompresses the median nerve

48
Q

How does the presentation of polymalgia rheumatica differ to polymyositis

A

PR presents with aching of proximal muscles, but they are not weak

Polymyositis presents with muscle weakness +/- aching

49
Q

How do you manage people with antiphosphopipid syndrome

A

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

50
Q

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

A

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

51
Q

Sjögren’s syndrome Mx

A

Artificial tears

Pilocarpine may help to stimulate saliva production

Doesn’t seem to be any actual treatment

52
Q

Most common mechanism of ankle sprain

A

Inversion of the foot

53
Q

What antibiotics can you not take with aspirin

A

Erythromycin and clarythromcyin

5th Year!! (10 decks)

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