MSK Flashcards by rob Duguid

Investigations for suspected Rheumatoid?

Rheumatoid factor, ESR, FBC, ANA

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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

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Joint distribution for rheumatoid

polyarthritis that usually spares DIPs

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

Carpel tunnel, tinels test

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Symmetrical arthrites

OA, RA, Viruses

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Assymetrical Arthrites

Psoriatic, reactive

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Monoarthritis

OA, Crystal, septic

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Oligoarthritis

Crystal, psoriatic, reactive, OA, Ankylosing spondylitis

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Polyarthritis

OA, RA, virus, reactive, psoriatic

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Shenton mennard line is…

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

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Fracture Mx

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

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When to use external fixation…

Burns, loss of skin or an open fracture

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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

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Fracture hip complication

avascular necrosis

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Tibia fracture complication

peroneal nerve damage–>foot drop

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Nerve damage in shoulder dislocation?

axillary nerve

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Nerve/blood vessel damaged in humerus fracture?

Radial nerve, brachial artery

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Radial nerve injury causes…

wrist drop

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Damage to axillary nerve causes what signs…

deltoid wasting, weakened abduction

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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

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Where do rotator cuff muscles attach

greater tuberosity

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Carpal tunnel causes…

idiopathic, RA, DM, Hypothyroid, pregnancy

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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

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)