MSK Flashcards
How does temporal arteritis present?
Temporal arteritis: usually rapid onset unilateral headache with jaw claudication and raised ESR
What is ankylosing spondylitis?
a HLA-B27-associated spondyloarthropathy typically presenting in men aged 20-30
How do we manage ankylosing spondylitis?
First-line management involves the use of an NSAID, such as ibuprofen, along with extensive physiotherapy.
How does ankylosing spondylitis present on XR?
X-ray of the pelvis is particularly useful as the sacroiliac joints are commonly affected, demonstrating subchondral erosions and sclerosis.
Where do you see a positive Simmon’s sign?
Achilles tendon rupture
How does De Quervain’s tenosynovitis present?
De Quervain’s tenosynovitis is an idiopathic pain syndrome involving the tendons of extensor pollicis brevis and abductor pollicis longus at the radial wrist.
What is Finkelstein’s test?
Finkelstein’s test, which is performed by pulling the patient’s thumb with ulnar deviation and longitudinal traction, can aid the diagnosis of De Quervain’s tenosynovitis. Finkelstein’s test is positive if the manoeuvre reproduces pain.
What is CREST syndrome?
This patient has Sclerodactyly and Raynaud’s phenomenon. Telangiectasia can also be seen on the hands. She therefore has the RST of CREST syndrome, or more accurately limited cutaneous systemic sclerosis.
What is bamboo spine?
bamboo spine with a single central radiodense line related to ossification of supraspinous and interspinous ligaments which is called dagger sign. Ankylosing is detectable in both sacroiliac joints.
What is the other name for tennis elbow?
lateral epicondylitis, also known as tennis elbow. This condition is characterized by pain and tenderness over the lateral epicondyle of the humerus, which is aggravated by wrist extension against resistance with the elbow extended.
What is trochanteric bursitis?
Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years
What are Gottron’s papules?
Gottron’s papules are roughened red papules over the extensor surfaces and are seen in dermatomyositis
How can we treat Raynaud’s phenomenon pharmacologically?
Oral nifedipine
Which movement temporarily causes the pain in lateral epicondylitis?
Lateral epicondylitis: worse on resisted wrist extension/suppination whilst elbow extended
Which antibiotic is associated with achilles tendon rupture?
Cipro causes achilles tendon rupture
Cipro stops you from going pro
How does reactive arthritis present?
Urethritis + arthritis +/- conjunctivitis = reactive arthritis
What is the McMurray’s test?
A meniscal tear is usually caused by twisting of the knee and on examination, McMurrays test will be positive. To perform McMurrays test, the knee is held in one hand, which is placed along the joint line, and flexed while the sole of the foot is held with the other hand. One hand is placed on the medial side of the knee to pull the knee towards a varus position. The other hand is used to rotate the leg internally whilst extending the knee. If pain or a ‘click’ is felt, this constitutes a ‘positive McMurray test’.
What is the most common reason THRs need revising?
Aseptic loosening is the most common reason for total hip replacement revision. This often presents with pain in the hip or groin region radiating down to the knee.
How does PMR present?
Features
typically patient > 60 years old
The core symptoms are pain and stiffness of the:
Shoulders, potentially radiating to the upper arm and elbow
Pelvic girdle (around the hips), potentially radiating to the thighs
Neck
The characteristic features of the pain and stiffness are:
Worse in the morning
Worse after rest or inactivity
Interfere with sleep
Take at least 45 minutes to ease in the morning
Somewhat improve with activity
What is olecranon bursitis?
Olecranon bursitis (‘student’s elbow’) is a common cause for elbow swelling and may be caused by prolonged pressure, trauma or rheumatoid arthritis
Where would you see anti-Ro antigen?
Primary Sjogren’s syndrome is an autoimmune disorder characterised by lymphocytic infiltration of the exocrine glands, particularly the salivary and lacrimal glands, leading to symptoms such as dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca). Anti-Ro (also known as SS-A) autoantibodies are found in approximately 60-70% of patients with primary Sjogren’s syndrome, making it the most associated autoantibody for this condition.
How does lateral epicondylitis present?
Sometimes referred to as ‘tennis’ elbow, but remember other activities can also trigger it.
Worse on resisted wrist extension/suppination whilst elbow extended
How does medial epicondylitis present?
This condition is commonly referred to as ‘golfer’s’ elbow. The pain is aggravated by wrist flexion and pronation. Sometimes it is associated with ulnar nerve compression. The symptoms in the question do not suggest medial epicondylitis as the pain is worsened on resisted extension and there are no other associated features.
Who must we refer to when starting hydroxychloroquine?
H-eye-droxychloroquine
Recent data suggest that retinopathy caused by hydroxychloroquine is more common than previously thought and the most recent RCOphth guidelines (March 2018) suggest colour retinal photography and spectral domain optical coherence tomography scanning of the macula for patients likely to be taking the drug for more than 5 years.
Which nerve is most likely to be damaged in knee arthroplasty?
Common peroneal nerve
How does SLE present?
The malar rash, arthralgia, lethargy and history of mental health points towards a diagnosis of SLE. Remember that the CRP (in contrast to the ESR) is typically normal in SLE.
Name an important SE of alendronate
Bisphosphonates can cause a variety of oesophageal problems
How should oral bisphosphonates be taken?
Oral bisphosphonates should be swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking
Give a common SE of methotrexate
Methotrexate may cause pneumonitis - typically presents with cough, dyspnoea and fever
How do we manage >75 years following a fragility fracture
Alendronate and then DEXA scan
How do we treat acute reactive arthritis?
NSAIDs
How do we interpret FRAX score?
FRAX
a colour ‘risk’ is given by the calculator - green, orange or red
patients in the orange zone should have a DEXA scan if not already done to further refine their 10-year risk
patients in the red zone should also have a DEXA scan if not already done to act as a baseline and guide drug treatment
A 59-year-old man with a history of gout presents with a swollen and painful first metatarsophalangeal joint. He currently takes allopurinol 400mg od as gout prophylaxis. What should happen to his allopurinol therapy?
Allopurinol is a xanthine oxidase inhibitor that reduces the production of uric acid, and it is used as a long-term management strategy for gout. According to the UK guidelines, during an acute attack of gout, existing urate-lowering therapy (like allopurinol) should not be discontinued or altered in dosage. This is because changes in serum urate levels can precipitate acute attacks. Therefore, continuing allopurinol at its current dose would be the most appropriate course of action.
How does aspirin react with sulfsalazine?
Patients who are allergic to aspirin may also react to sulfasalazine`
How does lumbar spinal stenosis present?
Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication. One of the main features that may help to differentiate it from true claudication in the history is the positional element to the pain. Sitting is better than standing and patients may find it easier to walk uphill rather than downhill.
How does meniscal tear present?
Meniscal tears result in a variety of symptoms including pain (which is often intermittent), locking, catching, and the knee giving way. Swelling usually occurs but develops several hours after the injury. On examination, there is well-localised pain over the joint line (anteromedial or anterolateral), along with varying levels of swelling and reduced mobility.
How do we diagnose meniscal tears?
MRI
How do we manage intertrochanteric (extracapsular) proximal femoral fracture?
Dynamic hip screw
What must we check before starting azathioprine?
Thiopurine methyltransferase is the enzyme required to metabolism azathioprine, a small proportion of the population had reduced activity or deficiency of this enzyme putting them at risk of azathioprine toxicity. Accordingly. levels should be tested prior to commencing the drug with cautious dosing or an alternate therapy used if TPMT is found.
azaTHIOprine - THIOpurine easy to memorise
How does L5 lesion present?
L5 lesion features = loss of foot dorsiflexion + sensory loss dorsum of the foot
Give the red flags in back pain
Trauma/tenderness
Unexplained weight loss
Neurological findings
Age > 50 years old or <20
Fever
IVDU
Steroids use
History of cancer
What is cubital tunnel syndrome?
Cubital tunnel syndrome is caused by compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger. Usually conservative management.
What is a type 1 hypersensitivity reaction?
Anaphylaxis
What is etanercept, and what is a risk factor of its use?
TNF-α inhibitors may reactivate TB
Used in RA
Hydroxychloroquine is used in the management of rheumatoid arthritis and systemic/discoid lupus erythematosus. What is the main SE to be aware of?
Importantly, there is a risk of retinopathy and so patients on hydroxychloroquine should be advised to look out for visual symptoms and should have their visual acuity assessed annually.
How does psoriatic arthritis differ from RA?
An asymmetrical presentation suggests psoriatic arthritis rather than rheumatoid
How does subacromial impingement present?
Subacromial impingement often presents with a painful arc of abduction
How does a supraspinatus tear present?
A supraspinatus tear is the closest differential from these options for the cause of this man’s presentation. Shoulder pain and acromial tenderness would both be expected but the pain would be limited to the initial 60 degrees of abduction rather than the midpoint indicating impingement as the more likely cause. Depending on the extent of the tear, abduction can also be limited due to difficulty initiating the movement.
How does frozen shoulder present?
Active and passive movement limited + external rotation most affected. Frozen shoulder, also known as adhesive capsulitis, is characterised by pain and stiffness in the shoulder joint. It typically presents with both active and passive movement limitation due to fibrosis and inflammation of the joint capsule. External rotation is usually the most affected movement in frozen shoulder, followed by abduction and then internal rotation.
How does dermatomyositis present?
Derma-to-myositis
Derma-: Skin Symptoms first Gottron’s papules, heliotrope and macular rash)
to- : Followed by muscle symptoms
myositis-: muscle weakness due to inflammation
How does facet joint present?
May be acute or chronic
Pain worse in the morning and on standing
On examination there may be pain over the facets. The pain is typically worse on extension of the back
How do we manage temporal arteritis?
Glucocorticoids (e.g. pred) should be given once a diagnosis of temporal arteritis is suspected - don’t wait for the temporal artery biopsy etc
What is Paget’s disease?
Paget’s disease is a disease of increased but uncontrolled bone turnover. It is thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by increased osteoblastic activity.
