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MSK Flashcards

1
Q

IT band sx and mx

A

tenderness 2-3cm above the lateral joint line
Common in runners

Management
activity modification and iliotibial band stretches
if not improving then physiotherapy referral

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2
Q

Red flags back pain

A

age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever
Thoracic back pain

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3
Q

Hip disclocation sx

A

shortened and internally rotated leg

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4
Q

Mx and complications of hip dislocation

A

A reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis.

Sciatic or femoral nerve injury
Avascular necrosis
Osteoarthritis: more common in older patients.
Recurrent dislocation: due to damage of supporting ligaments

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5
Q

calcification of the articular cartilage dx

A

Pseudogout

Chondrocalcinosis

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6
Q

Spinal stenosis

A

Usually gradual onset
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down

Clinical examination is often normal

Requires MRI to confirm diagnosis

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7
Q

Signs of scaphoid fracture

A

Point of maximal tenderness over the anatomical snuffbox
This is a highly sensitive (around 90-95%), but poorly specific test (<40%) in isolation
2. Wrist joint effusion
Hyperacute injuries (<4hrs old), and delayed presentations (>4days old) may not present with joint effusions.
3. Pain elicited by telescoping of the thumb (pain on longitudinal compression)

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8
Q

Infrapatella bursitis

A

associated with kneeling as seen in clergymen
Swelling and tenderness

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9
Q

Psoriatic arthritis sx

A

symmetric polyarthritis
very similar to rheumatoid arthritis
30-40% of cases, most common type
asymmetrical oligoarthritis: typically affects hands and feet (20-30%)

Dactylitis, sometimes described as ‘sausage fingers’

periarticular disease - tenosynovitis and soft tissue inflammation resulting in:
enthesitis: inflammation at the site of tendon and ligament insertion e.g. Achilles tendonitis, plantar fascitis
tenosynovitis: typically of the flexor tendons of the hands
dactylitis: diffuse swelling of a finger or toe
nail changes
pitting
onycholysis

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10
Q

X ray psoriatic arthritis

A

‘pencil-in-cup’ appearance

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11
Q

Dermatomyositis sx

A

Skin features
photosensitive
macular rash over back and shoulder
heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers

proximal muscle weakness +/- tenderness

ANA+
Anti Jo

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12
Q

Right-sided hip pain radiating to knee and joint instability, post THR

A

Aseptic loosening

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13
Q

If UGI SE from alendronate

A

Change to risedronate

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14
Q

Acute mx of gout

A

NSAID
Colchicine - avoid if GFR <10
Oral steroids if others CI

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15
Q

SE of entanjrcept

A

Reactivation of TB

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16
Q

AS mx

A

Ibuprofen

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17
Q

AS XR

A

sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus

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18
Q

Clubfoot findings

A

Inverted + plantar flexed foot which is not passively correctable.

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19
Q

PMR sx and mx

A

typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
aching, morning stiffness in proximal limb muscles
ESR>40

Pred 15mg- 1 week then reassess

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20
Q

Sjogren AB

A

Positive anti-Ro and anti-La antibodies

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21
Q

Sjogren’s syndrome sx

A

dry eyes: keratoconjunctivitis sicca
dry mouth
vaginal dryness
arthralgia
Raynaud’s, myalgia
sensory polyneuropathy
recurrent episodes of parotitis

positive Schirmer’s test

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22
Q

Mx of hip fracture

A

Undisplaced Fracture:
internal fixation, or hemiarthroplasty if unfit.

Displaced Fracture:
arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture
total hip replacement is favoured to hemiarthroplasty if patients:
were able to walk independently out of doors with no more than the use of a stick and
are not cognitively impaired and
are medically fit for anaesthesia and the procedure.

stable intertrochanteric fractures: dynamic hip screw

if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

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23
Q

AS features

A

reduced lateral flexion
reduced forward flexion - Schober’s test
Pain at night
Reduced chest expansion

Anterior uveitis
Aortic regurgitation
Achilles tendonitis

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24
Q

Prepatellar bursitis

A

Associated with more upright kneeling

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25
Bone protection if started on long term steroids
Immediate bisphosphonate prescription
26
Phalen sign
Flexion of wrist produces carpal tunnel signs
27
Sickle cell osteomyelitis organism
Salmonella- noon typhi
28
When is colchicine CI
he BNF advises to reduce the dose by up to 50% if creatinine clearance is less than 50 ml/min and to avoid if creatinine clearance is less than 10 ml/min.
29
Mx of prolapsed disc
irst-line is NSAIDs +/- proton pump inhibitors rather than using neuropathic analgesia (e.g. duloxetine) if symptoms persist e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate
30
High risk group of fragility fractures
Age >75 Glucocorticoid therapy (People who are taking high doses of oral corticosteroids (more than or equivalent to prednisolone 7.5 mg daily for 3 months or longer) Previous hip/vertebral fractures Further fractures on treatment High risk on FRAX scoring T score <-2.5 after treatment
31
When should you continue/stop bisphosphonates
Any high risk- continue indefinitely Low risk- repeat DEXA, 2 year break if >-2.5
32
Taking bisphosphonates
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
33
Limited scleroderma sx
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
34
Diffuse cutaneous systemic sclerosis
scleroderma affects trunk and proximal limbs predominately associated with anti scl-70 antibodies the most common cause of death is now respiratory involvement, which is seen in around 80%: 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
35
Hydroxycholorqiune SE
bull's eye retinopathy - may result in severe and permanent visual loss Corneal opacities
36
Mx of GCA with temporal arteritis
Oral pred IV if visual loss
37
Allopurinol during gout attacks
If already on it- continue Just do not start on it on first attack
38
X ray sign of rheumatoid
loss of joint space juxta-articular osteoporosis soft-tissue swelling periarticular erosions subluxation
39
Tx of osteoporosis in stage 4 CKD
Denosumab BP CI
40
Movement making lateral/medial epicondylitis worse
Lateral epicondylitis: worse on resisted wrist extension/suppination whilst elbow extended Medial -wrist flexion and pronation
41
Medications causing gout
diuretics: thiazides, furosemide ciclosporin alcohol cytotoxic agents pyrazinamide
42
Nerve root of triceps
Main C7
43
Osteosarcoma features
x-ray shows Codman triangle (from periosteal elevation) and 'sunburst' pattern metaphyseal region of long bones prior to epiphyseal closure
44
Ewing sarcoma
x-ray shows 'onion skin' appearance
45
Baker Cyst
Foucher's sign describes the increase in tension of the Baker's cyst on extension of the knee. More likely to develop in patients with arthritis or gout and following a minor trauma to the knee
46
Dermatomyositis features
Skin features photosensitive macular rash over back and shoulder heliotrope rash in the periorbital region Gottron's papules - roughened red papules over extensor surfaces of fingers Other features proximal muscle weakness +/- tenderness Raynaud's
47
Radial tunnel syndrome
tenderness distal to the common extensor origin in comparison to lateral epicondylitis where there is pain over the common extensor origin. It is most common in gymnasts, racquet players and golfers who frequently hyperextend at the wrist or carry out frequent supination/pronation. Patients can also complain of hand paraesthesia or aching at the wris
48
Sulfasalazine SE
Oliospermia Rashes
49
Gold SE
Proteinuria
50
Antiphospholipid sx bloods
Antiphospholipid syndrome leads to a raised APTT and normal PT and can result in thrombocytopenia.
51
Nerve likely to be injured ion TKR
Common Peroneal nerve
52
Etanercept SE
Demyelination Reactivation of TB
53
Methotrexate SE
Myelosuppression Liver cirrhosis Pneumonitis
54
Mx of Raynaud's
Oral nifedipine
55
What do you have to do before giving bisphosphonates
Hypocalcemia/vitamin D deficiency should be corrected before giving bisphosphonates
56
Drug induced lupus causes
Proncainamide Hydralazine
57
Plantar fascitis sx
The pain is usually worse around the medial calcaneal tuberosity. Pain is worse when you ask them to walk on their toes.
58
L3 vs L4 compression
L3 nerve root compression Sensory loss over anterior thigh Weak hip flexion, knee extension and hip adduction Reduced knee reflex Positive femoral stretch test 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
59
Pencillamine SE
Proteinuria Exacerbation of MG
60
Femeroacetabular impingement
presents with hip/groin pain worse on prolonged sitting and associated with snapping, clicking or locking of the hip. There is an association between FAI and prior hip pathology eg Perthes in childhood.
61
Adhesive capsulitis sx
External rotation (on both active and passive movement) is classically impaired
62
Mx of RA false
IM or oral pred
63
Drug induced lupus AB
Antihistone
64
Cough, dyspnoea and fever on methotrexate
Drug induced pneumonitis
65
Greater trochanteric pain syndrome
Pain and tenderness over the lateral side of thigh Most common in women aged 50-70 years (trochanteric bursitis)
66
Sjogrens AB
Anti Ro
67
Dermatomyositis AB
Anti Jo
68
Myxoid cyst
digital mucous cysts, are benign lesions that typically occur on the fingers or toes, particularly around the nail bed. Associated With OA
69
Risk of stress factures
Inadequate calories Menstrual irregularities Increased/new intensity sports
70
Dupuytrens contracture causes
manual labour phenytoin treatment alcoholic liver disease diabetes mellitus trauma to the hand
71
Tx of reactive arthritis
NSAIDs
72
Test before adalimumab
CXR
73
Pancytopaenia with methotrexate cause
Taking with trimethoprim
74
CKD biochem on Ca, P , ALP
High P, high ALP, high PTH
75
Chronic fatigue diagnosis
Diagnosed after at least 3 months of disabling fatigue affecting mental and physical function more than 50% of the time in the absence of other disease which may explain symptoms
76
Adivse post hip replacement
avoiding flexing the hip > 90 degrees avoid low chairs do not cross your legs sleep on your back for the first 6 weeks
77
Mx of achilles tendonitis
Achilles tendonitis management: rest, NSAIDs, and physio if symptoms persist beyond 7 days
78
Poor prognostic features of RA
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
79
Reactive arthritis sx
Arthritis Eye pain Dactylitis Dysuria
80
Skin disorder with antiphospholipid syndrome
Lived reticularis
81
Osteomalacia sx
Low Ca, P, raised ALP Proximal myopathy
82
If allergic to aspirin which RA drug are you likely allergic to
Sulfalazine
83
Inversion ligament damage
anterior talofibular ligament is the most commonly sprained
84
Antibodies associated with each condition
A: Anti-centromere antibodies Limited cutaneous systemic sclerosis (CREST Syndrome) B: Anti-Scl70 antibody Diffuse systemic sclerosis (Scleroderma) C: Anti-Jo antibodies -myositis e.g. Polymyositis, dermatomyositis D: Anti-mitochondrial antibodies Primary biliary cholangitis (PBC) E: Anti-neutrophil cytoplasmic antibodies (ANCA) Small vessel vasculitis F: Anti-nuclear antibodies (ANA) Autoimmune conditions e.g. SLE, RA, Sjogrens G: Anti-phospholipid antibodies Blood clots & Miscarriages H: Anti-Ro antibodies SLE or Sjogrens I: Parietal cell antibodies Pernicious anaemia J: Anti-gliadin antibodies Coeliac disease K: Anti-histone antibodies Drug-induced lupus
85
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MSRA (11 decks)

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