MSK Flashcards
Investigations for suspected Rheumatoid?
Rheumatoid factor, ESR, FBC, ANA
Treatment for Rheumatoid
start with NSAIDS (if not contraindicated) then if persists try DMARDs either methotrexate/sulfasalazine. Steroids can by used for acute relief but not long term
Joint distribution for rheumatoid
polyarthritis that usually spares DIPs
if wrist arthritis what might you be worried about from swelling and how to test?
Carpel tunnel, tinels test
Symmetrical arthrites
OA, RA, Viruses
Assymetrical Arthrites
Psoriatic, reactive
Monoarthritis
OA, Crystal, septic
Oligoarthritis
Crystal, psoriatic, reactive, OA, Ankylosing spondylitis
Polyarthritis
OA, RA, virus, reactive, psoriatic
Shenton mennard line is…
smooth line on XR of ischium of pelvis. if any disruption= subluxation/fracture
Fracture Mx
Correct shock, fluid balance relieve pain Sterile cover, prevent infection Anti-tetanus Immobilize, reduce injury to other parts of body?
When to use external fixation…
Burns, loss of skin or an open fracture
Complications of surgery to repair fractures
bleeding, organ injury, nerve and vessel injury
compartment syndrome
pressure sores, infection, mal union
DVT, embolism, pneumonia, crush syndrome
Fracture hip complication
avascular necrosis
Tibia fracture complication
peroneal nerve damage–>foot drop
Nerve damage in shoulder dislocation?
axillary nerve
Nerve/blood vessel damaged in humerus fracture?
Radial nerve, brachial artery
Radial nerve injury causes…
wrist drop
Damage to axillary nerve causes what signs…
deltoid wasting, weakened abduction
Carpal tunnel causes…
wasting of thenar eminence, loss of sensation/parasthesia to lateral 3.5 on palmar aspect and fingers of lateral 3.5 on dorsum
Where do rotator cuff muscles attach
greater tuberosity
Carpal tunnel causes…
idiopathic, RA, DM, Hypothyroid, pregnancy
Rx Carpal tunnel
corticosteroid injection, surgery
Contents of carpal tunnel
4 FDP, 4 FDS, FPL, median nerve
What is multiple myeloma?
Malignant clonal proliferation of plasma cells
Blood results in myeloma
anaemia, neutropenia, thrombocytopenia–>symptoms of these (tired, infection, bleeding)
Renal complication of myeloma
light chain deposits inhibit function
Electrolyte key in myeloma?
Calcium retained in kidney + osteoclasts
Rx Multiple myeloma
Analgesia, bisphosphonate, EPO, dialysis, Abx
Regular IV IgG may be needed or chemo
Screening for multiple myeloma
beta-2-microglobulin in urine
What kills people in myeloma?
Infection, kidney fail
Morning stiffness >30 minutes… OA or RA
RA
OA X-ray features
loss of joint space, subchondral cysts, sclerosis, osteophyte formation
What is swan neck deformity?
Extension at PIP, flexion DIP
What is boutonierres deformity?
Flexion at PIP, extension at DIP
Bouchards nodes in? Herbedens in?
RA
OA
Signs and Sx OA
Localized joint pain, worse after use, crepitus
Signs and Sx RA
Morning stiffness, inflammation, systemic tiredness
Tests for RA
ESR, CRP, RF, Anti-CCP
Rheumatoid factor is positive in… % of RA
70%
X-ray sign RA
Soft tissue swelling, decreased joint space, erosion, juxta-articular osteopenia
Mx RA
Physio, exercise
NSAIDS, analgesia
Methotrexate, Sulfasalazine, Steroid, TNF inhibitors
Mx OA
Exercise, glucosamine and chondroitin, analgesia (SE of NSAIDS= GI, renal)
Joint replacement if necessary
RFs for gout
diuretics, infections, surgery, trauma, high protein diet
DDx gout
Septic arthritis, pseudogout, trauma, OA
What is pseudo gout?
calcium phosphate deposit as opposed to urate. self limiting
DDx for back pain
Muscular, OA, prolapsed disc (sciatica), RA, vertebral crush fracture, spinal stenosis, malignancy, referred abdo pain
Hypercalcaemia symptoms
Renal stones, painful bones, abdo groans, psychic moans
Causes of hypercalcaemia
Most commonly malignancy, hyperparathyroidism
hyperthyroidism
Ix hypercalcaemia
TFT, TBC, protein electrophoresis, bone scan, 24 hour urinary Ca2+, PTH
What is osteoporosis vs osteopenia
Osteoporosis is bone density score <-.25, osteopenia is loss of bone density but not to that extent
Causes of osteoporosis
Age related, secondary to coeliac disease, vit D deficiency, cirrhosis, malignancy, hyperparathyroidism, medications
Clinical features of osteoporosis
usually asymptomatic until fracture, maybe loss of height
Mx Osteoporosis
Increase Vit D and Ca2+ intake, check eye sight, regular exercise, stop smoking, hip protectors, home modifications, bisphosphonates
What is CREST?
Calcinosis, Raynauds, Oesophageal dysmotility, sclerodactyl, telangiectasia
Describe fracture
Simple or comminuted, Open or closed
Transverse, spiral etc
Bone name
Describe proximal and distal in relation (shortening, rotation, lateral/medial displacement)
