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4th year OSCE > MSK > Flashcards

MSK Flashcards

1
Q

Investigations for suspected Rheumatoid?

A

Rheumatoid factor, ESR, FBC, ANA

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2
Q

Treatment for Rheumatoid

A

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

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3
Q

Joint distribution for rheumatoid

A

polyarthritis that usually spares DIPs

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4
Q

if wrist arthritis what might you be worried about from swelling and how to test?

A

Carpel tunnel, tinels test

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5
Q

Symmetrical arthrites

A

OA, RA, Viruses

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6
Q

Assymetrical Arthrites

A

Psoriatic, reactive

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7
Q

Monoarthritis

A

OA, Crystal, septic

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8
Q

Oligoarthritis

A

Crystal, psoriatic, reactive, OA, Ankylosing spondylitis

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9
Q

Polyarthritis

A

OA, RA, virus, reactive, psoriatic

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10
Q

Shenton mennard line is…

A

smooth line on XR of ischium of pelvis. if any disruption= subluxation/fracture

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11
Q

Fracture Mx

A 
Correct shock, fluid balance
relieve pain
Sterile cover, prevent infection
Anti-tetanus
Immobilize, reduce
injury to other parts of body?
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12
Q

When to use external fixation…

A

Burns, loss of skin or an open fracture

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13
Q

Complications of surgery to repair fractures

A

bleeding, organ injury, nerve and vessel injury
compartment syndrome
pressure sores, infection, mal union
DVT, embolism, pneumonia, crush syndrome

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14
Q

Fracture hip complication

A

avascular necrosis

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15
Q

Tibia fracture complication

A

peroneal nerve damage–>foot drop

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16
Q

Nerve damage in shoulder dislocation?

A

axillary nerve

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17
Q

Nerve/blood vessel damaged in humerus fracture?

A

Radial nerve, brachial artery

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18
Q

Radial nerve injury causes…

A

wrist drop

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19
Q

Damage to axillary nerve causes what signs…

A

deltoid wasting, weakened abduction

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20
Q

Carpal tunnel causes…

A

wasting of thenar eminence, loss of sensation/parasthesia to lateral 3.5 on palmar aspect and fingers of lateral 3.5 on dorsum

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21
Q

Where do rotator cuff muscles attach

A

greater tuberosity

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22
Q

Carpal tunnel causes…

A

idiopathic, RA, DM, Hypothyroid, pregnancy

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23
Q

Rx Carpal tunnel

A

corticosteroid injection, surgery

24
Q

Contents of carpal tunnel

A

4 FDP, 4 FDS, FPL, median nerve

25
Q

What is multiple myeloma?

A

Malignant clonal proliferation of plasma cells

26
Q

Blood results in myeloma

A

anaemia, neutropenia, thrombocytopenia–>symptoms of these (tired, infection, bleeding)

27
Q

Renal complication of myeloma

A

light chain deposits inhibit function

28
Q

Electrolyte key in myeloma?

A

Calcium retained in kidney + osteoclasts

29
Q

Rx Multiple myeloma

A

Analgesia, bisphosphonate, EPO, dialysis, Abx

Regular IV IgG may be needed or chemo

30
Q

Screening for multiple myeloma

A

beta-2-microglobulin in urine

31
Q

What kills people in myeloma?

A

Infection, kidney fail

32
Q

Morning stiffness >30 minutes… OA or RA

A

RA

33
Q

OA X-ray features

A

loss of joint space, subchondral cysts, sclerosis, osteophyte formation

34
Q

What is swan neck deformity?

A

Extension at PIP, flexion DIP

35
Q

What is boutonierres deformity?

A

Flexion at PIP, extension at DIP

36
Q

Bouchards nodes in? Herbedens in?

A

RA

OA

37
Q

Signs and Sx OA

A

Localized joint pain, worse after use, crepitus

38
Q

Signs and Sx RA

A

Morning stiffness, inflammation, systemic tiredness

39
Q

Tests for RA

A

ESR, CRP, RF, Anti-CCP

40
Q

Rheumatoid factor is positive in… % of RA

A

70%

41
Q

X-ray sign RA

A

Soft tissue swelling, decreased joint space, erosion, juxta-articular osteopenia

42
Q

Mx RA

A

Physio, exercise
NSAIDS, analgesia
Methotrexate, Sulfasalazine, Steroid, TNF inhibitors

43
Q

Mx OA

A

Exercise, glucosamine and chondroitin, analgesia (SE of NSAIDS= GI, renal)
Joint replacement if necessary

44
Q

RFs for gout

A

diuretics, infections, surgery, trauma, high protein diet

45
Q

DDx gout

A

Septic arthritis, pseudogout, trauma, OA

46
Q

What is pseudo gout?

A

calcium phosphate deposit as opposed to urate. self limiting

47
Q

DDx for back pain

A

Muscular, OA, prolapsed disc (sciatica), RA, vertebral crush fracture, spinal stenosis, malignancy, referred abdo pain

48
Q

Hypercalcaemia symptoms

A

Renal stones, painful bones, abdo groans, psychic moans

49
Q

Causes of hypercalcaemia

A

Most commonly malignancy, hyperparathyroidism

hyperthyroidism

50
Q

Ix hypercalcaemia

A

TFT, TBC, protein electrophoresis, bone scan, 24 hour urinary Ca2+, PTH

51
Q

What is osteoporosis vs osteopenia

A

Osteoporosis is bone density score <-.25, osteopenia is loss of bone density but not to that extent

52
Q

Causes of osteoporosis

A

Age related, secondary to coeliac disease, vit D deficiency, cirrhosis, malignancy, hyperparathyroidism, medications

53
Q

Clinical features of osteoporosis

A

usually asymptomatic until fracture, maybe loss of height

54
Q

Mx Osteoporosis

A

Increase Vit D and Ca2+ intake, check eye sight, regular exercise, stop smoking, hip protectors, home modifications, bisphosphonates

55
Q

What is CREST?

A

Calcinosis, Raynauds, Oesophageal dysmotility, sclerodactyl, telangiectasia

56
Q

Describe fracture

A

Simple or comminuted, Open or closed
Transverse, spiral etc
Bone name
Describe proximal and distal in relation (shortening, rotation, lateral/medial displacement)

4th year OSCE (7 decks)

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