MSK Flashcards
How does methotrexate work?
inhibits dihydrofolate reductase which is responsible for converting dihydrofolate to tetrahydrofolate
What can happen to blood test results when taking methotrexate?
Pancytopenia
deficiency in tetrahydrofolate –> used in DNA and RBS synthesis
How should methotrexate be taken and monitored?
taken weekly
monitored with FBC, LFTS, U&Es every 2-3 months
What should be prescribed with methotrexate?
folic acid 5mg
taken 24 hours + after dose
What two fractures are most at risk of compartment syndrome?
- supracondylar fracture
- tibial shaft injuries
What are the signs of compartment syndrome?
- pallor
- pain, even on passive movement
- paresthesia
-lack of pulses
What are the features of antiphospholipid syndrome?
- venous and arterial thrombus
- recurrent miscarriage
- livedo reticularis
What are the investigations and results for antiphospholipid syndrome?
Antibodies: anti-cardiolipin
thrombocytopenia
prolonged APTT
Management of antiphospholipid syndrome
- low dose aspirin
if they have a venous event:
- lifelong warfarin ( target INR 2-3)
How does achilles tendinitis present?
pain in posterior heel that gets worse with exercise
can cause morning stiffness and pain
How does an achilles rupture present?
- hear a ‘pop’
- sudden onset pain
- unable to continue activity
What test is performed for achilles rupture?
Simmonds
What is the first line investigation for achilles rupture?
US
What should be given to patients immediately if GCA is suspected?
high dose steroids
What does positive Fouchers sign mean?
Increase tension of bakers cyst on extension of knee
What are red flags for back pain?
- <20 years old and >50 years old
- history of malignancies
- trauma
- night pain
What does T-score on DEXA scan measure?
bone density compared to healthy population
What does z-score on DEXA scan measure?
bone density compared to same gender, age and ethnicity
What is the most common organism for septic arthritis?
Staph. aureus
What is the most common organism for septic arthritis in young people, who are sexually active?
Neisseria gonorrhoeae
Investigations for Septic arthritis
- needle join aspiration
- blood cultures
- imagine of joint
Management of septic arthritis
- IV flucloxacillin ( clinda if allergic) –> lasts 4-6 weeks and can switch to oral after 2
- wash out
What are the x-ray findings in AS?
- subchondral erosions, sclerosis (sacroiliitis)
- squaring of lumbar vertebrae
- bamboo spine ( uncommon and at later stages)
Management of AS
1) Exercises and NSAIDS
2) anti-TNF (etanercept and adalimumab)
How does spinal stenosis present?
- gradual onset
- unilateral / bilateral pain
- ## pain better when sitting and leaning forward
What is management of raynaud’s?
1) nifedipine
What does positive birefringence show?
pseudogout
What liver condition is associated with psuedogout?
haemochromatosis
Management of pseudogout
NSAIDs
What is TInels sign in carpal tunnel syndrome?
tapping causes paresthesia
What is Phalen’s sign in carpal tunnel?
flexion of wrist causes symptoms
What is a severe side effect of hydroxychloroquine?
Bulls eye retinopathy
depigmentation of a macula surrounded by thin speckled rings of hyper-pigmentation
What is dermatomyositis?
inflammatory condition with symmetrical, proximal muscle weakness and characteristic skin lesions
What are features of dermatomyositis?
Skin : heliotrope rash, photosensitive, macular rash on back and shoulders, gottron’s papules, mechanics hands
Muscle: proximal weakness, raynauds
What are the features of a iliopsoas abscess?
fever
back pain
pain on extension
What are painless nodes associated with osteoarthritis?
Heberden’s nodes- DIP joints
Bouchards nodes- PIP joints
What are the signs of osteoarthritis on an xray?
widening of joint spaces
osteophytes
subchondral sclerosis
erosion of joint
What is seen on xray of ewing’s sarcoma?
onion skin like appearance
What are features of reactive arthritis?
- proceeding an infection (usually within 4 weeks)
- asymmetrical arthritis usually in lower limb
- anterior uveitis
- urethritis
- keratoderma blennorrhagica
‘can’t see, can’t pee or can’t climb a tree’
What injury would give a positive lachman’s test?
ACL rupture
What are the Xray findings for RA?
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation
Signs of hip fracture
pain
shortened and externally rotated leg
What are the two different types of hip fractures?
Intracapsular: from the edge of the femoral head to the insertion of the capsule of the hip joint
Extracapsular: hese can either be trochanteric or subtrochanteric
What system is used for grading hip fractures?
Garden system
What level of garden system is high risk of blood disruption?
III and IV
How to manage extracapsular hip fracture?
dynamic hip screw
How to manage intracapsular hip fracture?
arthroplasty ( hemi or total)
What are Xray finding of psoriatic arthritis?
pencil in a cup
What is used to assess risk of fracture?
FRAX score
What movement is most affected in adhesive capsulitis?
external rotation of the shoulder
What investigation is important to perform before starting anti-TNF therapy?
Chest XRAY to check for TB
Management for polymyalgia rheumatica
prednisolone
What is dactylitis suggestive of?
Psoriatic arthritis
AS
What should you do if patient does not respond to steroids and they have polymyalgia rheumatica?
reconsider diagnosis as the should respond drastically
What complement levels are used to measure active disease in SLE?
C3 and C4
If a patient is allergic to sulfa containing medications (e.g co-triomoxazole) what should they not be prescribed?
sulfasalazine
What is a useful rule out test for SLE?
ANA
What test is used to asses meniscal tear?
McMurrays
What should you image and with what modality with suspected RA?
XRAY of hands and feet
What are the symptoms of osteomalacia?
bone pain
proximal myopathy
What is seen on XRAY of osteomalacia?
looser zones
pseudofractures
What antibodies is limited scleroderma associated with?
Anti- centromere
What antibodies are diffuse scleroderma associated with?
anti- scl70
What is cubital tunnel syndrome caused by?
ulnar nerve compression
What should you not give to patients when they are on methotrexate?
co-trimoxazole
trimethoprim
an cause marrow aplasia
How do you treat methotrexate toxicity?
folinic acid
What should you do when starting some on Allupurinol?
add colchicine or NSAID cover for 6 months
What nerve is affected in shoulder dislocation?
Axillary nerve
What to give in GCA and vision is worsening?
IV methylprednisolone
What is the treatment for an acute flare of SLE?
Pred + IV cyclophosphamide
What is injured in a boxers fracture?
5th Metacarpal
