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Year 6 > MSK > Flashcards

MSK Flashcards

1
Q

How does methotrexate work?

A

inhibits dihydrofolate reductase which is responsible for converting dihydrofolate to tetrahydrofolate

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2
Q

What can happen to blood test results when taking methotrexate?

A

Pancytopenia

deficiency in tetrahydrofolate –> used in DNA and RBS synthesis

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3
Q

How should methotrexate be taken and monitored?

A

taken weekly
monitored with FBC, LFTS, U&Es every 2-3 months

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4
Q

What should be prescribed with methotrexate?

A

folic acid 5mg
taken 24 hours + after dose

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5
Q

What two fractures are most at risk of compartment syndrome?

A
  • supracondylar fracture
  • tibial shaft injuries
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6
Q

What are the signs of compartment syndrome?

A
  • pallor
  • pain, even on passive movement
  • paresthesia
    -lack of pulses
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7
Q

What are the features of antiphospholipid syndrome?

A
  • venous and arterial thrombus
  • recurrent miscarriage
  • livedo reticularis
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8
Q

What are the investigations and results for antiphospholipid syndrome?

A

Antibodies: anti-cardiolipin
thrombocytopenia
prolonged APTT

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9
Q

Management of antiphospholipid syndrome

A
  • low dose aspirin

if they have a venous event:
- lifelong warfarin ( target INR 2-3)

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10
Q

How does achilles tendinitis present?

A

pain in posterior heel that gets worse with exercise
can cause morning stiffness and pain

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11
Q

How does an achilles rupture present?

A
  • hear a ‘pop’
  • sudden onset pain
  • unable to continue activity
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12
Q

What test is performed for achilles rupture?

A

Simmonds

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13
Q

What is the first line investigation for achilles rupture?

A

US

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14
Q

What should be given to patients immediately if GCA is suspected?

A

high dose steroids

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15
Q

What does positive Fouchers sign mean?

A

Increase tension of bakers cyst on extension of knee

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16
Q

What are red flags for back pain?

A
  • <20 years old and >50 years old
  • history of malignancies
  • trauma
  • night pain
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17
Q

What does T-score on DEXA scan measure?

A

bone density compared to healthy population

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18
Q

What does z-score on DEXA scan measure?

A

bone density compared to same gender, age and ethnicity

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19
Q

What is the most common organism for septic arthritis?

A

Staph. aureus

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20
Q

What is the most common organism for septic arthritis in young people, who are sexually active?

A

Neisseria gonorrhoeae

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21
Q

Investigations for Septic arthritis

A
  • needle join aspiration
  • blood cultures
  • imagine of joint
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22
Q

Management of septic arthritis

A
  • IV flucloxacillin ( clinda if allergic) –> lasts 4-6 weeks and can switch to oral after 2
  • wash out
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23
Q

What are the x-ray findings in AS?

A
  • subchondral erosions, sclerosis (sacroiliitis)
  • squaring of lumbar vertebrae
  • bamboo spine ( uncommon and at later stages)
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24
Q

Management of AS

A

1) Exercises and NSAIDS
2) anti-TNF (etanercept and adalimumab)

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25
Q

How does spinal stenosis present?

A
  • gradual onset
  • unilateral / bilateral pain
  • ## pain better when sitting and leaning forward
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26
Q

What is management of raynaud’s?

A

1) nifedipine

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27
Q

What does positive birefringence show?

A

pseudogout

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28
Q

What liver condition is associated with psuedogout?

A

haemochromatosis

29
Q

Management of pseudogout

A

NSAIDs

30
Q

What is TInels sign in carpal tunnel syndrome?

A

tapping causes paresthesia

31
Q

What is Phalen’s sign in carpal tunnel?

A

flexion of wrist causes symptoms

32
Q

What is a severe side effect of hydroxychloroquine?

A

Bulls eye retinopathy
depigmentation of a macula surrounded by thin speckled rings of hyper-pigmentation

33
Q

What is dermatomyositis?

A

inflammatory condition with symmetrical, proximal muscle weakness and characteristic skin lesions

34
Q

What are features of dermatomyositis?

A

Skin : heliotrope rash, photosensitive, macular rash on back and shoulders, gottron’s papules, mechanics hands

Muscle: proximal weakness, raynauds

35
Q

What are the features of a iliopsoas abscess?

A

fever
back pain
pain on extension

36
Q

What are painless nodes associated with osteoarthritis?

A

Heberden’s nodes- DIP joints
Bouchards nodes- PIP joints

37
Q

What are the signs of osteoarthritis on an xray?

A

widening of joint spaces
osteophytes
subchondral sclerosis
erosion of joint

38
Q

What is seen on xray of ewing’s sarcoma?

A

onion skin like appearance

39
Q

What are features of reactive arthritis?

A
  • 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’

40
Q

What injury would give a positive lachman’s test?

A

ACL rupture

41
Q

What are the Xray findings for RA?

A

loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation

42
Q

Signs of hip fracture

A

pain
shortened and externally rotated leg

43
Q

What are the two different types of hip fractures?

A

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

44
Q

What system is used for grading hip fractures?

A

Garden system

45
Q

What level of garden system is high risk of blood disruption?

A

III and IV

46
Q

How to manage extracapsular hip fracture?

A

dynamic hip screw

47
Q

How to manage intracapsular hip fracture?

A

arthroplasty ( hemi or total)

48
Q

What are Xray finding of psoriatic arthritis?

A

pencil in a cup

49
Q

What is used to assess risk of fracture?

A

FRAX score

50
Q

What movement is most affected in adhesive capsulitis?

A

external rotation of the shoulder

51
Q

What investigation is important to perform before starting anti-TNF therapy?

A

Chest XRAY to check for TB

52
Q

Management for polymyalgia rheumatica

A

prednisolone

53
Q

What is dactylitis suggestive of?

A

Psoriatic arthritis
AS

54
Q

What should you do if patient does not respond to steroids and they have polymyalgia rheumatica?

A

reconsider diagnosis as the should respond drastically

55
Q

What complement levels are used to measure active disease in SLE?

A

C3 and C4

56
Q

If a patient is allergic to sulfa containing medications (e.g co-triomoxazole) what should they not be prescribed?

A

sulfasalazine

57
Q

What is a useful rule out test for SLE?

A

ANA

58
Q

What test is used to asses meniscal tear?

A

McMurrays

59
Q

What should you image and with what modality with suspected RA?

A

XRAY of hands and feet

60
Q

What are the symptoms of osteomalacia?

A

bone pain
proximal myopathy

61
Q

What is seen on XRAY of osteomalacia?

A

looser zones
pseudofractures

62
Q

What antibodies is limited scleroderma associated with?

A

Anti- centromere

63
Q

What antibodies are diffuse scleroderma associated with?

A

anti- scl70

64
Q

What is cubital tunnel syndrome caused by?

A

ulnar nerve compression

65
Q

What should you not give to patients when they are on methotrexate?

A

co-trimoxazole
trimethoprim

an cause marrow aplasia

66
Q

How do you treat methotrexate toxicity?

A

folinic acid

67
Q

What should you do when starting some on Allupurinol?

A

add colchicine or NSAID cover for 6 months

68
Q

What nerve is affected in shoulder dislocation?

A

Axillary nerve

Year 6 (19 decks)

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