MSK Flashcards
1
Q
Where is pain from the acromioclavicular joint felt?
A
In the joint itself
2
Q
Where is pain from the rotator cuff or glenohumeral joint felt?
A
Upper arm
3
Q
Where is pain from tennis elbow felt?
A
Outside elbow joint
4
Q
Where can pain from a trapped nerve be felt?
A
Around it’s distribution,
Eg sciatica
5
Q
Where can pain from the knee be felt?
A
Knee, hip or ankle
6
Q
What does pain due to nerve causes usually present with?
A
Paraesthesia.
Numbness
7
Q
How does non inflammatory pain very with exercise?
A
Gets worse
8
Q
How does inflammatory pain vary
A
Randomly
9
Q
Early morning stiffness lasting more than 2 hours is associated with?
A
Rheumatoid arthritis
10
Q
What is the Thomas test, what is a positive sign and what does it assess?
A
When lumbar lordosis is removed and hip is fully flexed, other leg lifts off the couch
Fixed flexion deformity
11
Q
What is a Trendelenberg’s test, what’s an abnormal sign, and what does it test for?
A
Patient stands on one leg alternatively
Hip dips to contralateral side - abductors of hip aren’t working
Assess hip and gluteal muscle strength
12
Q
What is an antalgic gait and what does it look like?
A
A painful gait
Limping
13
Q
What is a Trendelenberg’s gait and what does it look like?
A
Proximal muscle weakness leading to change in gait
Waddling gait
14
Q
What is bow-leggedness?
A
Varus deformity
15
Q
What is knock-knees called?
A
Valgus deformity
16
Q
What is the best way to assess valgus and varus deformity?
A
When the patient is standing up and weight bearing
17
Q
What are the ways to test for effusion in the knee?
A
Patella tap and cross fluctuation
18
Q
What does a posterior sag or step back of tibia suggest?
A
Posterior cruciate ligament damage
19
Q
What is a positive anterior drawer test and what does it suggest?
A
Tibia shows a noticeable range of movement went pulled gently towards examiner when knee is flexed and hamstrings are relaxed
Suggests anterior cruciate ligament damage
20
Q
What muscles are involved in hip flexion?
A
Sartorius
Iliopsoas
Rectus femoris
21
Q
What are the muscles of hip extension?
A
Gluteus Maximus
hamstrings
22
Q
What are the muscles of hip abduction?
A
Gluteus Medius and Minimus
23
Q
What are the signs of osteoarthritis in an x ray?
A
Osteophytes
Cysts
Subchondral sclerosis
Narrow joint space
24
Q
Name three types of monoarthritis/oligoarthritis
A
Septic arthritis
Gout
Reactive arthritis
25
Name three inflammatory polyarthritis
Rheumatoid
Psoriatic
Chronic tophaceous gout
26
What are the presenting symptoms for rheumatology?
```
Joint stiffness
Symmetry
Location
Joint pain
Morning stiffness
Swelling
Warmth
```
27
What are differentials for back pain in 15 to 30 year olds?
```
Prolapsed disc,
spondylothesis,
pregnancy,
trauma, fractures,
ankylosing spondylitis
```
28
What are differentials for back pain in 30 to 50 year olds?
Degenerative spinal disease, prolapsed disk, malignancy
29
What are differentials for back pain in 50 to 70 year olds?
Degenerative, osteoporotic vertebral collapse, malignancy, melanoma, spiral stenosis, Paget's
30
Name two neurosurgical emergencies that present with back pain
Acute cauda equina
| Acute cord compression
31
Why does cord compression and cauda equina need immediate surgical attention?
Prevents irreversible loss
32
What is the classic presentation of osteoarthritis?
Stiffness lasting for more 30 min, pain worse in the evening, reduced range of movement, bony swelling, background pain, pain and crepitus on movement, joint tenderness
33
What are the risk factors for septic arthritis?
Pre-existing arthritis, artificial joints, immunosuppression, DM, chronic renal failure, recent joint surgery
34
What's the typical presentation of rheumatic arthritis?
Symmetrical swollen proximal joints, with stiffness, pain worst at morning,
35
Name five less common presentations of rheumatoid arthritis
Widespread systemic arthritis,
Persistent monoarthritis of a single joint
Systemic illness with extra auricular symptoms
Recurrent soft tissue problems (eg carpal tunnel, frozen shoulder)
Recurrent mono/poly arthritis
36
What are the early signs of rheumatoid arthritis?
Swollen and tender mcp, pip, wrist and mtp joints. Check for synovitis and tendinitis
37
What are the late signs of rheumatoid arthritis?
Swan neck deformity, ulnar deviation, z thumb, dorsal wrist subluxation, with similar foot changes
38
What are the extra articulate signs of rheumatoid arthritis?
Nodules, lymphadenopathy, vasculitis, scleritis, episcleritis, fibrosing alveolitis, obliterating bronchitis, carpal tunnel, splenomegaly, raynaud's, peripheral neuropathy, amyloidosis, osteoporosis
39
What investigations can be done for suspicion of rheumatoid arthritis?
Rheumatoid factor,
X-rays for soft tissue swelling, loss of joint space and juxta articular osteopenia
MRI, ct, to look for synovitis and tendinitis,
40
What causes gouty arthritis?
Deposition of mono sodium urate crystals in and near joints.
Associated with high serum urate
Causes long term arthritis and renal failure
41
What are the causes of gouty arthritis?
| Name 5
Hereditary, excess dietary purines, alcohol, leukaemia, cytotoxicosis
42
What conditions are associated with gouty arthritis?
CVD, hypertension, DM, chronic renal failure
43
What is the classic presentation for gouty arthritis?
Acute monoarthropathy of a single joint with severe joint inflammation.
More than 50% on mtp joint of big toe
44
What is the principal investigation for gouty arthritis?
Polarized photography of synovial fluid shows negatively birefringement of urate crystals
45
What is ankylosing spondylitis?
Chronic inflammatory disease of spine and sacroiliac joints of unknown aetiology
46
What is the classic presentation of ankylosing spondylitis?
30 year old male complaining of morning spine stiffness and lower back pain that relieves with exercise. Usually better by the end of the day.
Pain radiates from sacroiliac joints to hips and buttocks.
Progressive stiffening of spine and thorax in all directions, hence reduced thoracic expansion and question mark posture.
Achilles tendinitis, palmar fasciitis, acute iritis, enthesitis
47
What can be seen in an X-ray of ankylosing spondylitis?
Sacroilitis
| Bamboo spine
48
What is systemic lupus erythromatous?
A multi-system autoimmune condition resulting from B cells making antibodies to self antigens causing tissue damage through a variety of autoimmune mechanisms
49
What is the classic presentation of SLE?
Fever, myalgia, fatigue,
Also: lymphadenopathy, weight loss, non infective endocarditis, alopecia, nail fold infarcts, migraine, stroke and Renal exudates
50
What is the diagnostic criteria for SLE?
3 of the following
Malar rash, Discoid rash, photosensitive skin
CNS disorder, haematological disorder, immunological disorder, renal disorder
Non erosive arthritis, serositis, oral ulcers
Antibodies
51
What are the causes of generalised arthralgia?
| Name ten for full marks
Infective- Viral (rubella, mumps, hep B), bacterial (staph, TB, Borrelia), fungal
Post infective- rheumatoid fever, reactive arthritis
Inflammatory- RA, SLE, ank. Spond., systemic sclerosis
Degenerative- Osteoarthritis
Tumour- primary(osteo&chondrosarcoma), metastatic, and effect of tumour
Gout, pseudo gout, trauma
Fibromyalgia, sjorgen's, hypermobility
52
What are the causes of localized arthralgia?
Trauma, tendinitis, enthesopathies, bursitis, nerve entrapment
53
Name six presentations of monoarthritis and give examples where necessary
Infective traumatic arthritis (staph A, staph epidermidis, salmonella, TB, E. coli, H influenzae, gonorrhoea)
Bleeding diathesis, post traumatic (causing haemarthrosis)
Degenerative (acute exacerbation, eg Charcot)
Metabolic (gout, pseudogout)
Poly arthritis presenting as monoarthritis (RA)
54
Name four presentations of oligoarthritis and give examples where necessary
Degenerative (osteoarthritis)
Infective (TB, sarcoidosis, gonorrhoea, bacterial endocarditis)
Inflammatory poly arthritis presenting as oligo (reactive arthritis, psoriatic, ank. Spond.)
55
What defines oligoarthritis?
Involvement of 2-4 joints
56
What defines poly arthritis?
Involvement of more than 4 joints
57
What are the inflammatory causes of poly arthritis?
SLE, RA
58
What are the non-inflammatory causes of poly arthritis?
Infective- bacterial (lymes, subacute endocarditis), viral (mumps, hep b, c, HIV, glandular fever, chickenpox, rubella)
Post infective- rheumatoid fever
Osteoarthritis- with heberden's Or Bouchard's nodes
Haemochromatosis
Hypertrophic pulmonary osteoathropathy
59
Pain from traumatic injury is...
Usually immediate but also aggregated by later movement,
| And can be increased by bleeding into the joint
60
What can cause acute, severe pain that develops quickly and erythema (redness) over the joint?
Crystal arthritis
| Gout and pseudo gout
61
What can cause paint that develops within a day or two?
Septic arthritis
62
What can cause joint pain which starts in one joint and moves to affect others over a period of days?
Gonococcal arthritis and rheumatic fever
63
What is bone pain usually described as?
Deep, boring pain, words eat night
64
What can cause localised bone pain?
Tumour, infection (osteomyelitis,a vascular necrosis or osteoid osteoma
65
What can cause diffuse pain?
Generalized bone conditions like osteomalacia
66
What is muscle pain usually described as?
Stiffness and is poorly localised, deep, and aggravated by use of the muscle.
67
What is the difference between polymyositis and polymyalgia rheumatica?
Muscle weakness in polymyositis
68
What's the difference between partial and full muscle tears?
Partial muscle tears are painful
| Full muscle tears are relatively painfree
69
What is fracture pain described as?
Sharp and stabbing, aggravated by movement and attempted movement, relieved by splinting and rest
70
What can cause shooting pain?
Mechanical trapping of nerve
71
What can cause buttock pain that shoots down the back of the leg?
Lumbar inverted disc protrusion
72
What pain is a feature of chronic pain syndrome?
Pain all over, unrelenting, little diurnal variation, dulled by analgesics or anti-inflammatory drugs
73
Chronic joint pain in people over 40 is usually caused by?
Osteoarthritis
74
What can neurological involvement cause to joint pain?
Loss of joint pain or disproportionate joint pain to deformity
75
What can cause neurological involvement in joints?
Syringomyelitis, leprosy, DM and syphilis
76
Name the three common presentations of the chronic pain syndrome
Widespread arthralgia, muscle pain and tenderness
77
What is the definition of chronic pain?
Pain present for more than 3 months.
78
What is chronic pain associated with?
Sleep disorders, psychological stress and depression
79
What should treatment for chronic pain focus on?
Coping mechanisms for pain, physio, treatment for sleep problems
80
What can cause pain disproportionately greater than expected?
Compartment syndrome
81
Where is C1/C2 pain felt at?
Occiput
82
Where is C3 C4 pain felt at?
Inter scapular region
83
Where is C5 pain felt at?
Tip of shoulder
| Outer aspect of arm
84
Where is C6 C7 pain felt at?
Inter scapular region or radial fingers and thumb
85
Where is C8 pain felt at?
Ulnar side of forearm, ring and little fingers
86
Where is thoracic spine pain felt at?
Chest
87
Where is Lumbar spine pain felt at?
Buttocks, knees, legs
88
Where is shoulder pain felt at?
Lateral aspect of upper arm
89
Where is elbow pain felt at?
Forearm
90
Where is Hip pain felt at?
Anterior thigh, knee
91
Where is knee pain felt at?
Thigh, hip
92
What are the causes of myalgia?
Infective: bacterial (Strep pneumonia, mycoplasma), viral (coxsackie, CMV, echovirus), parasitic (toxoplasmosis, schistosomiasis), inflammatory (dermatomyositis, myosotis, polymyalgia rheumatica)
Trauma: tears, haematoma, rhabdomyosis
Drugs: alcohol, statins, zidovudine
Neuropathic
93
What should you suspect if stiffness predominates over pain?
Spasticity or tetany
94
What is the definition of spasticity?
Increasing muscle contraction in response to stretch
95
Define tetany
Involuntary sustained contraction
96
What's the pattern of stiffness seen in polymyalgia rheumatica?
Shoulder and pelvic areas
97
What is an entheosopathy? Give some examples
Inflammation at tendon insertion sites
| Medial and lateral epicondyles (golfer's and tennis elbows respectively)
98
What are the differences between the presentations of inflammatory and non inflammatory joint pain?
Inflammatory arthritis presents with morning stiffness, relieved by an hour of exercise
Non inflammatory pain occurs after resting, for a few minutes on movement. There may be pain on movement, eases with rest, may return later in the day
99
In what kinds of arthritis is erythema and warmth common in?
Acute inflammatory arthritis, infective, traumatic and crystal induced joint conditions
It is unusual in RA and SLE. If it exists it suggests coexisting inflammation
100
Why does the injury of vascular structure cause rapid swelling? What makes this process faster?
Bleeding into the joints
| Anticoagulants and bleeding disorders
101
Why do avascular structure injuries cause slow growing swelling?
It is caused by a reactive effusion which takes longer to develop
102
What are the causes of muscle weakness?
Peripheral nerve lesion (eg. median nerve in carpal tunnel)
Muscle disease
Can be secondary to pain, or focal, or generalized
103
What can cause proximal muscle weakness?
Primary muscle disease:
Immune mediated inflammatory disease (dermatomyositis, polymyositis)
Non inflammatory myopathy (secondary to chronic alcohol use, thyrotoxicosis, steroid therapy)
104
What can cause distal muscle weakness?
Neurological:
| B12 or thiamine deficiency, connective tissue disorders, hereditary sensory motor neuropathy (Charcot-Marie-Tooth)
105
Which muscular dystrophies are x linked and what is their gene product?
Duchenne and Becker
| Dystrophin
106
What is the gene product of dystrophia myotonica?
Myotonin
107
Which muscular dystrophies are autosomal dominant?
Dystrophia myotonica and fascioscapulohumeral
108
What is the pattern if inheritance of limb girdle?
Autosomal recessive
109
What is Gower's sign and what is it seen in?
Difficulty in getting up from a prone position: after rolling over, patient walks the hands and feet towards each other, then unsee hands to climb legs, and reaches an upright position by swinging arms and trunk sideways and upwards
Seen in duchenne's muscular dystrophy
110
What does intermittent weakness that worsens with exercise suggest?
Myasthenia gravis
111
What does slowly progressive generalised weakness suggest?
Motor neurone disease
112
What does a sudden onset of weakness (like foot or wrist drop) suggest?
Mononeuritis multiplex
| Associated with RA, vasculitis, connective tissue disease, DM or HIV
113
What is locking defined as?
Incomplete range if movement at a joint because of an anatomical block
114
What causes true locking?
Mechanical obstruction causing a block to usual range of movement. Eg, loose body or torn meniscus preventing the joint from reaching extremes of the normal range of movement.
Patients usually can unlock the joint using trick manoeuvres
115
What is pseudo-locking?
Loss of range of movement due to pain
| Eg, patients with patellofemoral pain hold knee in full extension and won't flex it
116
What is triggering?
When finger in extended from flexed position, there is a knock to extension that gives suddenly
117
What causes finger triggering?
Nodular thickening or a fibrous thickening of flexor sheath
118
Which fingers are usually affected by triggering?
In adults- ring or middle fingers
| Congenital- thumb
119
Define subluxation
Partial malapposition of joint surfaces
120
Define dislocation
Complete malapposition of joint surfaces
121
What can cause acute deformity?
Fracture, dislocation or swelling (haemarthrosis or intramuscular haematoma
122
Weight loss, low grade fever and malaise are extra articular symptoms of what diseases?
RA and SLE
123
High spiking fever in the evening with a rash are symptoms of which disease?
Still's
124
What does Headache, jaw pain in chewing and scalp tenderness suggest?
Temporal arthritis
125
What does predominant involvement if the small joint of hands feet or wrist suggest?
Inflammatory arthritis
126
What does medium or large joint swelling suggest?
Degenerative or zero negative arthritis
| Eg, psoriatic or Ank. spond.
127
What does involvement of distal interphalangeal joints and carpometacarpal joint of thumb suggest?
Nodal osteoarthritis
128
How does Felty's syndrome manifest outside the musculoskeletal system?
RA with splenomegaly, lymphadenopathy and neutropenia
129
How does Sjögren's syndrome manifest outside the musculoskeletal system?
Arthritis with dry eyes (keratoconjunctivitis sicca), xerostomia, salivary gland enlargement and Raynaud's phenomenon
130
What is xerostomia and what is it associated with?
reduced or absent saliva production
| Sjörgen's
131
How does enteropathic arthritis manifest outside the musculoskeletal system?
Associated with IBD (UC and Crohn's)
132
How does psoriatic arthritis manifest outside the musculoskeletal system?
Skin and nail features of psoriasis
133
How does haemophilia manifest in the musculoskeletal system?
Knee arthropathy due to haemarthrosis
134
How does sickle cell disease manifest in the musculoskeletal system?
Osteonecrosis of hip
135
Why does sickle celled disease causes Osteonecrosis of the hip?
Bone infarction
136
How does still's manifest in the musculoskeletal system?
Juvenile idiopathic arthritis
137
How does reactive arthritis manifest?
Urethritis, conjunctivitis,
inflammatory oligoarthropathy 1-3 weeks after sexually transmitted chlamydia infection or infective gastroenteritis
Mouth or genital ulcers,
enthesopathy (Achilles tendinopathy, plantar fasciitis),
rash (keratoderma blennorrhagica
138
How does septic arthritis manifest outside the musculoskeletal system?
Fever, malaise, source of sepsis (e.g. Throat, skin, gut
139
How does gouty arthritis manifest outside the musculoskeletal system?
Signs of renal failure, tophi
140
How does ankylosing spondylitis manifest outside the musculoskeletal system?
Enthesopathy, iritis
141
How does RA manifest outside the musculoskeletal system?
Raynaud's, rheumatoid nodules, dry eyes, pleurisy, episcleritis
142
How does SLE manifest outside the musculoskeletal system?
Fever, episcleritis, alopecia, Raynaud's, photosensitive rash, especially on face
143
What does seropositive mean in terms of inflammatory arthritis?
Indicates presence significant amounts of IgM rheumatoid factors in serum of patients with poly arthritis
144
What does seronegative mean in terms of inflammatory arthritis?
Indicates absence significant amounts of IgM rheumatoid factors in serum of patients with poly arthritis
145
What kinds of arthritis are seronegative?
RA, ank. Spond, reactive arthritis, psoriatic arthritis
146
What are seronegative arthritis associated with?
HLA b27
Same extra articular features,
Have asymmetrical joint involvement
147
Which musculoskeletal conditions have a monogenic pattern of inheritance (ie are single gene defect diseases)?
Osteogenesis imperfecta, Charcot-Marie-Tooth, Marfans, muscular dystrophies, Ehlers-Danlos syndrome
148
Which musculoskeletal conditions have a polygenic pattern of inheritance?
Osteoarthritis, osteoporosis, gout, RA, seronegative sponykoarthritis
149
What is the pattern of joint involvement of RA?
Symmetrical
Small and large joints
Upper and lower limbs
150
What is the pattern of joint involvement of seronegative psoriatic arthritis?
Asymmetrical
large joints > small joints
Associated peri articular inflammation, giving dactylitis
151
What is the pattern of joint involvement of seronegative inflammatory arthritis?
Asymmetric
Large joints > small joints
Axial involvement
152
What is the pattern of joint involvement of Osteoarthritis?
Symmetrical
| Small and large joints
153
How do steroids effect the musculoskeletal system adversely?
Avascular necrosis, osteoporosis, myopathy, infections
154
How do statins effect the musculoskeletal system adversely?
Myalgia, myopathy, myositis
155
How do ACE inhibitors effect the musculoskeletal system adversely?
Myalgia, arthralgia, positive antinuclear antibodies
156
How do antiepileptics effect the musculoskeletal system adversely?
Arthralgia, osteomalacia
157
How do immunosuppressants effect the musculoskeletal system adversely?
Infections
158
How do quinolones effect the musculoskeletal system adversely?
Tendonopathy, tendon rupture
159
Which conditions are linked to HLA b27?
Ankylosing spondylitis
Enteropathic arthritis (UC and Crohn's)
Reactive arthritis
Psoriatic arthritis
160
What can alcohol do to the musculoskeletal system?
Trauma, myopathy, rhabdomyolysis, nerve palsies
161
What can smoking do to the musculoskeletal system?
Bony metastasis, hypertrophic pulmonary osteoarthropathy
162
What can diet do to the musculoskeletal system?
Vitamin deficiencies - osteomalacia, scurvy
| Anorexia (osteoporosis)
163
What is thickened, tight skin characteristic of?
Systemic sclerosis
164
What are the skin, nail and sof fissure changes seen in systemic sclerosis?
Telangiectasia, thickened tight skin, calcium deposits in finger pulp, flexion contracture, tissue ischaemia that leads to ulceration
165
Describe rheumatoid nodules
Firm and non tender
Felt at pressure or friction sites (like sacrum)
Associated with positive rheumatoid factor
Can occur in lungs
166
What can be seen in a rheumatoid hand?
Ulnar deviation, z thumb, swan neck, small muscle wasting, synovial swelling at carpal, metacarpophalangeal and proximal interphalangeal joints
167
What is the difference between bony nodules and rheumatoid nodules?
Bony nodules: caused by osteoarthritis, smaller and harder than rheumatoid nodules
Rheumatoid nodules: caused by RA
168
What are heberden's nodes?
Bony nodules at distal interphalangeal joints
169
What are Bouchard's nodes?
Bony nodules at proximal interphalangeal joints
170
Describe gouty tophi
Firm, white, irregular subcutaneous crystal collections
171
What are the common sites for gouty tophi?
Extensor aspects of hands, toes and fingers
| Helix of ear
172
What can happen to the overlying skin in gouty tophi?
Overlying skin may ulcer we, discharging tissue
| Can be secondarily infected
173
What can cause small, red vasculitis spots?
Small skin infarcts
Seen in inflammatory diseases: RA, SLE, polyarteritis no dosa
Indicate active disease
174
What are the common sites for these red vasculitic spots?
Nail folds, finger and toe tips, pressure areas
175
What MSK conditions is conjunctivitis a feature of?
SLE, RA, sjorgen's via keratoconjunctivitis
| Reactive arthritis, ank spond.
176
What is keratoconjunctivitis sicca?
Reduced tear production with dry eyes
177
What does keratoconjunctivitis sicca cause?
Conjunctivitis and inflammation of the eyelid
178
What condition can cause the sclera to go blue?
Osteogenesis imperfecta
179
What test is used to diagnose keratoconjunctivitis sicca and describe the test?
Schemer tear test:place notched blotting paper on lower eyelid and ask patient to look up mad close eye. After five minutes, measure how far the tear has moved
180
Which genetic diseases can cause hyper mobility?
Marphans and Ehlers Danlos syndrome
181
What can cause tender thickening in the wrist?
Hypertrophic pulmonary osteoarthritis
182
How do patients with limb length discrepancies walk?
Tiptoe on the shorter side
183
What is a Trendelenberg's gait?
Contralateral hemi pelvis falls
184
What can cause a Trendelenberg gait?
Weakness of hip abductors(in polio or paralysis of sup. gluteal nerve)
Painful hip joint (congenital hip dislocation)
Structural joint problems (osteoarthritis)
185
Why is the gait high stepping in a common peroneal nerve palsy?
Foot drop
| High stepping gait compensates to allow the clearance of the weak foot
186
What is the change in gait in cerebral palsy?
Energy inefficient crouch gait
Weak Solaris and gastrocnemius
Hips and knees are always flexed
187
Define scoliosis
Lateral inflection of spine
188
Define kyphosis
Curvature of spine in sagittal plane, with apex posterior
189
Define lordosis
Curvature of spine in sagittal plane, with apex anterior
190
Define gibbus
Spinal deformity caused by an anterior wedge deformity localized to a single vertebrae, causing an increase in forward flexion
191
Define spondylosis
Degenerative change in spine
192
Define spondylolisthesis
One vertebrae slipping anteriorly over another vertebrae
193
Define spondylolysis
Defect in pars inter articulates of a vertebral arch
194
Define retrolisthesis
One vertebrae slipping posteriorly over another vertebrae
195
Name 10 common spinal problems
Spinal stenosis, ank. Spond. Mechanical back pain, scoliosis, prolapsed intervertebral disk, compensatory scoliosis from leg length discrepancy, cervical rib, spinal instability, cervical myelopathy, osteoporotic fracture, pathological pain (osteomyelitis, tumour, myeloma)
196
What can cause loss of lordosis or a flexion deformity?
Acute lesions, RA, trauma
197
What can cause increased lordosis?
Ank. Spond.
198
What can cause torticollis?
| Wry neck
Sternocleidomastoid contracture, trauma
199
What can cause lateral flexion of the neck?
Erosion of lateral mass of atlas due to RA
200
What are the presenting symptoms of the thoracic spine?
Localized spinal pain, pain radiating to chest wall, symptoms of paresis, sensory loss, leg weakness and incontinence
201
What are the causes of thoracic pain in adolescents and young adults?
Ank. Spond, schuermann's, disc protrusion
202
What are the causes of thoracic pain in the middle aged and elderly?
Degenerative change
| Osteoporotic fracture
203
What are the causes of thoracic pain in all ages?
Tumour, infection
204
Describe sciatica pain
Radicular back pain that radiates to the posterior of the leg
205
Describe pain due to inflammation of sacroiliac joints
At buttocks
| Can be referred down to both legs
206
What does lower back pain usually indicate?
Age related, Degenerative, spondylosis
207
What does lower back pain in a young person suggest?
Inflammation of sacroiliac joints and lumbar spine
208
Name 10 red flags for acute lower bag pain
Age <20 or >55, Waking up from the pain, Steroid use, Weightloss, Incontinence, Difficulty in micturition, Saddle anaesthesia, Sexual dysfunction, Recent trauma, Motor weakness, Bilateral sciatica, Fever, Toracic pain (dissecting aortic aneurysm)
209
Acute onset of low back pain in a young adult, associated with bending and lifting suggests what?
Slipped disc
210
What does an acute onset of severe progressive back pain, associated with night sweats, weight loss and malaise suggest?
Hint: history of immunosuppression
Pyogenic or tuberculous infection of sacroiliac joint
211
What is the presenting symptom of lumbrosacrsl spinal stenosis?
Diffuse pain on thigh and buttocks from standing too long or walking
212
Name an important differential for lumbrosacral spinal stenosis?
Claudication
213
What can problems with the femoral nerve cause?
Weak knee jerk, quadriceps weakness
214
What muscles do the median nerve supply?
Opens and abductor, most of the wrist and finger flexors
215
What does the ulnar nerve supply?
Adductor of thumb, most lumbericals and interossei
216
What does the radial nerve supply?
Extensors of wrist and hand
217
What are the symptoms of carpal tunnel?
Pain, tingling and numbness in the thumb and fingers
Pain can extend proximally up the arm
Patient may wake up from the pain
Pain is relieved by shaking the hand
Weakness might lead to poor grip- wasting of then an eminence
218
What test is used for carpal tunnel?
Phalan's test
219
What condition can cause long fingers?
Marfans
220
What can cause rotational deformities of the finger?
Phalange fracture
221
What do gout tophi typically look like and wherein their typical site?
White, subcutaneous
| Juxta-articular
222
What do calcification deposits look like and where is their typical site?
White, subcutaneous, on the fleshy pulp of fingers
223
What disorders can cause calcium deposits?
SLE, dermatomyositis
224
What can cause dilated capillaries in the nail fold?
Systemic sclerosis, dermatomyositis, SLE
225
Name two common causes of pain at the elbow
Epiconcondylitis and RA
226
What is tennis elbow?
Lateral epicondylitis
227
What is golfer's elbow?
Medial epicondylitis
228
What problems with the rotator cuff can cause shoulder pain?
Rotator cuff degeneration,
Calcification tendinitis
Tendon rupture
229
What problems with the subacromial bursa can cause shoulder pain?
Calcific bursitis
| Poly arthritis
230
What problems with the capsule can cause pain in the shoulder?
Adhesive capsulitis
231
How can the head of the femur cause shoulder pain?
Osteonecrosis
Fractures
Dislocation
Tumour
232
How can problems with the joints cause shoulder pain?
Glenohumeral, stereo clavicularjoints- synovitis, osteoarthritis, dislocation
Acromioclavicular joint- osteoarthritis
233
Name six common non trauma related conditions that can affect the shoulder
RA, impingement syndrome of the rotator cuff, calcific tendonitis, adhesive capsulitis, bicipital tendonitis, rotator cuff syndromes (eg supraspinatus, infraspinatus tendonitis)
234
Name fice common trauma related conditions affecting the shoulder
```
Rotator cuff tear
Fracture of head or neck of humerus
Fracture of clavicle
Dislocation of glenohumeral joint
Dislocation of acromioclavicular joint
```
235
Adhesive tendonitis is also called:
Frozen shoulder
236
What can cause winging of the scapula?
Paralysis of nerve to serratus ant.
237
What causes of hip pain are painful at rest and night?
Avascular necrosis and tumours
238
What does lateral hip or thigh pain, aggravated by lying on ones side at night, suggest?
Trochanteric bursitis
239
What does tenderness at the greater trochanter on palpating suggest?
Trochanteric bursitis
240
What problems with the hip can cause leg shortening?
| Name 6
Juvenile osteochondritis, un reduced hip dislocation, femoral fracture, after hip athroplasty, missed congenital dislocation of hip, congenital coxa Vera, septic arthritis, loss of articular cartilage, slipped upper femoral epiphysis
241
What problems with the growth of femur and tibia can lead to leg shortening?
Congenital, poliomyelitis, osteomyelitis, septic arthritis, cerebral palsy, fracture, epiphyseal injury
242
Name 3 bursae that lie anterior to the knee
Suprapatellar
Prepatellar (between patella and skin)
Infrapatellar (between skin and tibial tuberosity/patellar ligament)
243
What suggests a knee haemarthrosis?
Rapid swelling
244
How long does the joint need tos well in septic arthritis?
Few hours with pain
245
What causes predisposition to haemarthrosis?
Coagulation disorders or anti coagulation therapy
246
What can cause knee locking?
Meniscal tears and loose bodies
247
What can cause loose bodies in the knee?
osteoarthritis, osteochondritis dissecans, synovial chondromatosis
248
What causes a sprain?
Some fibres are torn but ligament remains intact
249
What does plantar surface Heel pain that is worse on the foot strike phase of walking suggest?
Plantar fasciitis
250
What can cause post. Heel pain?
Achilles tendonitis
251
What can cause spontaneous lancinate pain in the forefoot radiating to contiguous sides of adjacent toes?
Morton's neuroma
252
What is splay foot?
Widening at level of metatarsal head
253
What is splay foot associated with?
Mtp joint synovitis
254
What is fibromyalgia?
Long term condition causing widespread pain and tenderness
255
What are the symptoms of fibromyalgia?
Widespread pain, extreme fatigue, sleep disturbance, poor circulation (causing tingling and numbness in the extremitis, headaches), feeling irritable, micturition, IBS
256
What is Sjogren's syndrome?
Autoimmune disorder that affects the mucus producing cells
257
What are the symptoms of Sjogren's?
Dry eyes, mouth, dry throat, dry everything, joint inflamation, fatigue
258
What tests are used to diagnose Sjogren's? Name 5
Eye exam, Schimer (tear test), ultrasound, saliva production, blood tests (raised ESR)
259
what is polymyositis?
Inflammation of the mucles
260
what is dermatomyositis?
Inflammation of muscles with a rash
261
What are the symptoms of polymyositis?
Fatigue, muscle weakness, tiring, weight loss, night sweats, malaise
262
What are the symptoms of dermatomyositis?
Fatigue, muscle weakness, tiring, weight loss, night sweats, malaise
AND
Red/pink rash on upper eyelids, face, neck, backs of hands, fingers
swelling of affected skin
263
What are the differentials for polymyositis?
side-effects of some medications (for example, steroids or statins)
toxic effects of long-term alcohol excess
hormonal conditions such as under- or over-active thyroid
low vitamin D levels or abnormal calcium or magnesium levels
infections
rarer nerve–muscle diseases such as muscular dystrophies.
264
What is polymyalgia rheumatica?
An inflammatory disease that causes painful muscles
265
Who is typically affected by polymyalgia rheumatica?
>50, typically>60,
| women more than men
266
What are the symptoms of polymyalgia rheumatica?
Severe, symmetrical, widespread pain and stiffness, on thighs and shoulder, worse in the morning and with rest, better with exercise
Also: night pain, weightloss, low mood, fever, fatigue
267
What important condition is linked to polymyalgia rheumatica?
Giant cell arteritis
268
What is myotonic dystrophy?
A genetic condition leading to muscle weakness and atrophy as well as prolonged muscle contraction
269
What are the symptoms of myotonic dystrophy?
Muscle weakness, myotonia, cataracts, cardiac conduction problems, infertitlity
270
What is Raynaud's phenomenon?
Disorder caused by lack of blood flow to the fingers (and toes)causing fingers to change colour from white to blue then red. May also be seen in the nose. Pain, tingling and numbness is usually felt.
271
What are the complications of Raynaud's?
open sores, and gangrene
272
What causes the colour change in Raynaud's?
White-reduced blood supply
Blue-cyanosis
red-blood comes rushing back
273
what tests can be used to investigate Raynaud's?
Cervical rib pressing on brachial artery, Full blood count, nailfold microscopy, cold stress test
274
Define enthesopathy
Disorder involving the attachment of tendon or ligament to a bone
275
Name ten enthesopathies
```
Achilles spondylitis
Ank. Spond
Plantar fasciitis
Adhesive capsulitis of shoulder
Rotator cuff syndrome of shoulder and allied disorders
Periarthritis of shoulder
Scapulohumeral fibrositis
Synovitis of hand or wrist
Periarthritis of wrist
Gluteal tendinitis
Iliac crest spur
Psoas tendinitis
Trochanteric tendinitis
```
276
What is limb girdle dystrophy?
group of disorders with muscle wasting and weakness around shoulders and hips
277
What are the signs and symptoms of limb girdle dystrophy?
```
Cardiac myopathy, arrhythmia
Resp depression,
assymetric distal wasting,
Calf hypertrophy
scapular winging
Contractures/rigid spine
```
278
what is used to diagnose limb girdle dystrophy?
High creatine kinase
279
What is fascioscapulohumeral dystrophy?
An autosomal dominant muscular dustrophy with presenting symptoms of facial, shoulder or arm weakness and wasting followed by weakness of foot dorsiflexion and foot drop
280
What are the bone conditions associated with a pathological fracture?
Name 7
Osteoporosis, osteomalacia, osteogenesis imperfecta, Paget's, renal osteodystrophy, primary or secondary tumour, parathyroid bone disease
281
Define osteoporosis
Systemic loss of bone mineral density that causes microarchitectural changes
282
What are the risk factors for osteoarthritis?
| Name 10
Age, sex, post menopause, late menarche, amenorrhea, immobility, alcohol, lack of vitamin D, smoking, family history, steroid therapy, early menopause, hypogonadism(due to anorexia nervosa, over excerci sing, hyperprolactinaemia)
283
What are the early systemic effects of a fracture?
Hypovolemia, shock, ARDS, fat embolism
284
What are the late systemic effects of a fracture?
Chest infection
| UTI
285
What are the early effects of a fracture on the bone?
Osteomyelitis
286
What are the late effects of a fracture on the bone?
Malunion, delayed or non union
Osteomyelitis
Necrosis
287
What are the late effects of a fracture on the joint?
Osteoarthritis, stiffness, instability
288
What are the early effects of a fracture on the soft tissue?
```
Compartment syndrome
Nerve injury
Vascular injury
Muscle/tendon Injury
Adjacent structure damage
```
289
What are the late effects of a fracture on soft tissue?
Pneumothorax
Reflex sympathetic dystrophy
Peripheral nerve and cord injury
Ischaemic contracture
290
What are the types of fractures?
Spiral, horizontal, oblique, overlapping, spiral, transverse, rotational, communicated, angulated, compacted
291
What is the IgM rheumatoid Factor?
A factor found In raised concentrations in 60-70% of RA patients
292
Is the IgM Rheumatoid factor conclusive for RA?
No, because it it raised in 15% of the normal population
293
What test in specific for RA?
Anti-Cyclic citrullinated peptides
294
What factors are found in SLE
Antinuclear factors, anti-dsDNA, Anti-Sm
295
What factors are present (in blood) in Sjögren's syndrome?
Anti-Ro and anti-La
296
What can show increased uptake in an isotope bone scan?
Paget's and tumours
297
What is the gold standard test for osteoporosis?
Dual-energy X-ray absorbtiometry
298
What do positively birefringent rhomboidal crystals in a joint aspiration indicate?
Calcium phosphate in joint
| Pseudogout
299
What do negatively birefringent needle shaped crystals in the joint fluid indicate?
Mono sodium urate crystals in the joint
| Gout
300
Is raised urea conclusive for gout?
NO
301
What is still's disease?
Severe version of juvenile idiopathic artheritis, seen in adult's instead?
302
What are the risk factors and causes for Still's?
Nobody knows
303
What are the symptoms of Still's disease?
Joint pain and stiffness, worse at morning. multiple joints affected
Fever that occurs in the afternoon or evening
Salmon pink rash that occurs with fever
Splenomegaly, hepatomegaly, lymphadenopathy, pericarditis, myocarditis, pleural effusion
304
What are the complications of still's disease?
Macrophage activation syndrome, thrombotic, thrombocytopenic purpura, diffuse alveolar haemorrhage, disseminated coagulopathy, pulmonary arterial hypertension
305
What are tophi?
Uric acid deposits under the skin seen in gout
306
what does Raynaud's phenomenon suggest?
presence of an auntoimmune condition, like scleroderma, lupus, RA, sjogren's
Cancer, (lymphoma, multiple myeloma, and acute lymphoblastic leukaemia)
Viral infections (blood borne, like hep B and C)
Iatrogenic (antimigraine, betablockers, chemo drugs, contraceptives, HRT, ACEi, decongestants)
307
what is osteogensis imperfecta?
An autosomal dominant connective tissue disorder that causes bone fragility
308
What features can be seen in patients with osteogenesis imperfecta? Name 10
Blue sclera, fractures, scoliosis, triangular facies, barrel chest, macrocephaly, hearing loss, growth retardation, joint laxity, defective dentation, limb deformitis
constipation and sweating
309
What causes osteogenesis imperfecta?
A defect in the genes encoding type1 collagen causing a reducction in the quantity or quality of type 1 collagen,
This affects tissues where type 1 collagen is an important constituent, such as sclera, bone, ligament, dentin
310
How do patients with osteogenesis imperfecta typically present?
Fractures from minor trauma, easy bruising.
| Prenatal screening may reveal fractures, long bones, limb shortening and decreased skull echogenicity
311
what is the mildest type of osteogenesis imperfecta?
Type 1
312
What happens to patients with type 1 osteogenesis imperfecta?
Premature deafness, blue sclera, increased bone fractures, bone fragility and normal height. exercise tolerance and muscle strength is reduced
313
What is the most common type of osteogenesis imperfecta?
Type 1
314
What type of osteogenesis imperfecta usually causes still birth or death soon after?
type 2
315
In what type of osteogenesis imperfecta does the blueness of the sclera fade>
Type 3
316
How many types of osteogenesis imperfecta are there?
8
317
What are the complications of osteogenesis imperfecta?
Post partum haemorrhage, basilar impression (due to large head), repeated resp infections, high metabolism so hypothermia during anaesthesis
318
Name 5 possible differentials for osteogenesis imperfecta
Osteoporosis, Osteopetrosis, Wilson's disease, Rickets, Scurvy, Achondroplasia, cushing's
319
What tests are done for osteogenesis imperfecta?
Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), cyande bromide mapping, thermal stability studies
320
What radiological features are typically seen in osteogenesis imperfecta?
Fractures, beaded ribs, pectus carintum, wormian bones, excessive callus formation and popcorn bones, narrow pelvis, compression fractures, protrusio acetabuli, shepherd's crook deformity of the femur
321
What is Ehlers-Danlos syndrome?
Group of genetic connective tissue disorders due to a defect in collagen and connective tissue synthesis and structure
322
Which type of Ehlers-danlos syndrome is most severe?
Type IV, because patients have an increased risk of large artery rupture and internal organ perforation
323
What is the clinical presentation of Ehlers-Danlos?
Hypermobility, muscle weakness, easily bruising skin, difficulty walking, soft, hyperextensible skin, molluscoid pseudotumours, cigarette paper scars
324
What are the complications of ehlers danlos syndrome?
Aneurysms, frequent dislocation, scarring, organ rupture (uterus or intestines)
325
Name the seronegative arthropathies?
Juvenile idiopathic arthritis, Behchet's disease, enteropathic arthritis, psoriatic arthritis, Ank. Spond, reactive arthritis
326
What does seronegative refer to?
Absence of IgM RF or anti-CCP in blood
327
FUN FACT
Reactive arthritis is no longer called Reiter's phenomenon because he was an evil Nazi doctor
328
What is reactive arthritis?
Autoimmune asymmetric oligoarthritis effecting weight bearing joints that develops in response to an infection
329
What organisms are associated with reactive arthritis?
Camplylobacter, shigella, salmonella, chlamydia trachomatis
330
What is the triad of reactive arthritis?
Arthritis, non infectious urethritis, conjunctivitis
331
How does reactive arthritis present?
with acute onset, often with fever, myalgi, fatigue and malaise
332
What can occur in the MSK system due to reactive arthritis?
Aymmetric Oligoarthritis, enthesopathy, sacroilitis
333
What can occur in the skin due to reactive arthritis?
Keratoderma blennorrhagicum; erythema nodosum (uncommon); onychodystrophy
334
What can occur in the eye due to reactive arthritis?
Conjunctivitis; anterior uveitis; keratitis; scleritis; episcleritis; cataracts; hypotony; glaucoma; corneal ulceration; disc or retinal edema; retinal vasculitis; optic neuritis; dacryoadenitis
335
What can occur in the GU tract due to reactive arthritis?
Meatal oedema and erythema. Clear mucoid discharche, prostatis, vaginitis, cervicitis, cystitis, salpingo-oophoritis, pyelonephritis, bartholinits
336
What can occur in GI tract due to reactive arthritis?
Diarrhoea, abdopain, lesions like IBD
337
What are the seronegative arthropathies associated with?`
HLA B27
338
What is the typical reactive arthritis patient?
Young and male
339
What is Psoriatic arthriris?
A seronegative arthritis commonly seen in patients with psoriasis, with a defining pattern of distal joint involvement and arthritis mutilans
340
What is the onset of psoriasis and arthritis in psoriatic arthritis?
Psoriasis preceds arthritis by average 10 years in 70% of patients
341
What are the findings seen in psoriatic arthritis?
Enthesopathies, dactylitis, arthritis mutilans, psoriasis, psoriatic nail changes, achilles tendonitis and plantar fasciitis
342
What are the five patterns of psoriatic arthritis joint involvement?
```
Asymmetrical oligoarticular arthritis
Symmetrical polyarthritis
Distal Interphalangeal arthropathy
Arthritis mutilans
Spondylitis with or without sacroiliitis
```
343
What're the radiological features seen in psoriatic arthritis?
Arthritis mutilans, joint space narrowing (or widening) in the hand, fluffly periostitis, sacroilitis, bilateral, asymmetric fusiform soft-tissue swelling
344
What is compartment syndrome?
Tissue pressure in a closed muscle compartment exceeds perfusion pressure causing muscle and nerve ischaemia. Occurs after a traumatic event (most likely a fracture)
345
What causes compartment syndrome?
Increased tissue pressure and lack of clearence of waste products
346
What is the presentation of compartment syndrome?
Pain severity oyt of proportion with injury, evidence of trauma. Tense feeling, burning pain.
347
What can manifest in compartment syndrome?
Limb ischaemia
348
What are the signs of limb ischaemia?
Pallor, poikilothermia, pain, pulselessness, paraesthesia
349
How are intracapsular neck of femur fractures treated?
Hemiarthroplasty or totalarthroplasty if the patient is below 75
Hip screw if the patient is young
350
How are extracapsular neck of femur fractures treated?
Hip screw (because head of femure is unlikely to have undergone osteonecrosis
351
What is finkelstein's test?
1) you bend your thumb across the palm of your hand 2)bend your fingers down over your thumb.
3) Then you bend your wrist toward your little finger.
4) If this causes pain on the thumb side of your wrist, test is positive
352
What does finkelstein's test assess?
De Quervain's tensosynovitis
353
What is DeQuervain's tensosynovitis?
An entrampment tendinitis of the tendons in the dorsal compartment of the wrist, causing pain on thumb movement
354
What is the presentation of DeQuervain's tensosynovitis?
Pain on moving thumb, thickend and hardend radial styloid
355
What is osteochondritis dissecans?
A fragment of cartilage or subchondral bone separates from it's articular surface
356
What is the cause of Osteochondritis dissecans?
Trauma and ischaemia
357
What are the four stages of osteochondritis dissecans
1) small are of compression of subchondral bone
2) partially detached subchondral bone
3) completely detached subchondral bone
4) Loose body
358
What are the symptoms of osteochondritis dissecans?
Vary with stages. Stage one is swelling and pain. stage 3 and 4 manifest as locking and giving away
359
What is synovial chondromatsis?
A rare pisease where the foci of cartiledge develop in the synovial membranes of joints, tendons or bursae due to the metaplasia of subsynovial joint tissue. This causes painful effucions and the generation of synovial loose bodies
360
What is the typical presentation of synovial chondromatosis?
Largely monoarticular, affecting large joints (esp. knees)
361
What is an enteropathic arthritis?
Rheumatological conditions associated with GI infection. Typically reactive arthritis with IBD
362
What is HLA B27?
One of the antigen presenting molecules present ofn MHc type 1 molecules on CD8 or supressor T Cells. This complex is related to many immune mediated conditions, most predominantly with Ank. Spond.
363
Name 5 HLAB27 syndromes
| Hint: A PAIR
Acute ant. uveitis, ank. spond. reactive arthritis, psoriatic arthritis, IBD
364
What is behcet's disease?
A rare disease categorized by oral aphthous ulcers, genital ulcers, uveitis and inflammatory arthritis thought to have an auntoimmune (infection triggered) cause
365
What is the classic presentation of Behcet's
Uveitis, opthalmic lesions, genital and oral ulcers memory damage in late stage of the disease, inflammatory arthritis,
366
What are the ivestigations for Behcet's?
Imaging studies and synovial joint aspiration
367
What is achondroplasia?
A skeletal dysplasia causing dwarfism
368
What morbidities are associated with achondroplasia?
Hydrocephalis, spinal deformities (kyphosis, lordosis, scoliosis), obesity, otitis media, cervicomedullary compressions (causing resp depression and feeding problems), obstructive and respiratory complications, spinal canal stenosis
369
What is the treatment of polymyalgia rheumatica?
Steroids
370
What is seen in blood tests for polymyalgia rheumatica?
Raised ESR
