Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 M&M OSCE > MSK > Flashcards

MSK Flashcards

1
Q

management of OA

A
  1. topical analgesia + lifestyle factors
  2. Paracetamol
  3. NSAID plus PPI (eg Naproxen 250-500mg BD)
  4. Corticosteroid intraarticular injection
  5. Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

management of RA

A
  1. DMARD (Methotrexate)
    - Adjunct corticosteroid (Prednisolone) or NSAID (eg Naproxen)
    If giving steroid long term, supplement with Vitamin D and calcium)
  2. DMARD Combination therapy e.g. Hydroxychloroquine or Sulfalazine
  3. Biologic Agent (e.g. TNF alpha inhibitors, etanercept, infliximab, adalimumbab)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

management of Ank Spond

A
  1. NSAID plus physiotherapy and stretching and exercise advice
    eg Naproxen 500mg BD
  2. TNF alpha inhibitor eg alalimumbab , etanercept
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Fibromyalgia Management

A
  1. Lifestyle and relaxation techniques

TCAs eg Amitriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the features of fibromyaligia?

A
  • chronic pain
  • diffuse tenderness on examination ( need >11/18 tender points)
  • fatigue unrelieved by rest
  • sleep and mood disturbance
  • abnormal sensations
  • sensitivity to bright colours , loud noises and strong odours
  • headaches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the most accurate movement for measuring hip function and hip pain?

A

internal rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are red flags in the history of hip pain in a child?

A
  1. night pain, night sweats, weight loss = Acute lymphoblastic leukaemia
  2. fever, holding leg ABDUCTED = septic arthritis
  3. Fever, NON WEIGHT BEARING= osteomyelitis of femur pelvis
  4. changeable , unclear or unusual history= NON ACCIDENTAL INJURY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are some causes of hip pain in a child?

A
  1. fracture
  2. developmental dysplasia of the hip (aka congenital dislocation)
    - Girls>Boys, Congenital, skin folds and buttock flattening, Born with it.
  3. Transient synovitis (follows urti)
  4. juvenile idiopathic arthritis
  5. Perthes disease (Boys 4-8 yrs) AVN and remodelling of femoral epiphyses
  6. Slipped upper femoral epiphyseal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the signs of cauda equina?

A
  1. bladder/bowel dysfunction
  2. bilateral sciatica
  3. saddle anaesthesia

MRI scan these patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

back pain red flags

A
  1. weight loss, fever, systemic illness
  2. cauda equina symptoms
  3. severe tearing pain : AAA?also exclude other abdo causes
  4. immunosuppressed, IVDU , corticosteroid patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is a pathological fracture? and what are some causes

A

a fracture through abnormal bone

e.g. osteoporosis, osteomalacia, osteopenia, bony mets, infections, bony metabolic diseases, secondary to medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how would you manage an open fracture?

A
  1. Primary survey (ABCDE)
  2. Secondary survey (look for further injuries)
  3. Remove gross contamination
  4. Photograph the wound
  5. Place a saline soaked gauze over the wound and put limb in a splint
  6. give iv prophylactic antibiotics
  7. list for theatre within 24 hours for debridement and washout and stabilization

Imaging also chest abdo pelvis x ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

signs of compartment syndrome

A

Pain, especially on movement (even passive)
Parasthesiae
Pallor may be present
Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise
Paralysis of the muscle group may occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is compartment syndrome

A

Compartment Syndrome is when the pressure within a fascial compartment exceeds the perfusion pressure within the compartment, causing ischaemia of the tissues within the compartment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what would you do if you suspected compartment syndrome

A
  1. Review neurovascular status of limb
  2. review analgesia and release any dressings or casts which might be increasig the pressure
  3. position limb at level with the heart
  4. contact senior, as they may need emergency fasciotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are some factors which may cause mal union or non union

A

local factors: blood supply, infection, stability, pattern

systemic factors: smoking, diabetes, corticosteroids, HIV, diet, NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the most senstitive clinical sign for diagnosing compartment syndrome

A

pain on passive stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

x ray features of gout

A
  • gouty tophi
  • punched out lesions
  • soft tissue swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

treatment of gout

A

acute: NSAIDs and Colchicine

long term: Allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

which compartment of the leg is most commonly affected by compartment syndrome?

A

anterior compartment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is pagets disease of the bone?

A

occurs in people >55 years
focal bone resorption followed by excessive and chaotic bone deposition
affects in order spine, skull, pelvis, femur
ALP raised
abnormal thickened sclerotic bone on x ray
treat with Bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Raynauds disease

  • who gets it
  • what is it
  • how to treat it
A

typically presents in females under the age of 30
symmetrical attacks
spasms of arterioles can lead to diminshed blood supply to the affected area causing them to turn white or even blue
typically affects the hands and feet
treated with calcium channel blocker (Nifedipine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Raynauds Phenomenon
secondary to CTD
what features suggest this?

A 
typically occuring secondary to CTDs
features which indicate raynauds from CTD:
-presenting >40 yrs
-systemic features
-asymmetry
-rashes
-auto antibodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the small vessel vasculitides

A

Granulomatosis Polyangiitias
Eosinophillic Granulomatosis Polyangiitis
Microscopic polyangiitis
Henoch Schonlein purpura (IgA mediated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

medium vessel vasculitides

A 
Kawasaki disease (paediatrics, strawberry tongue, treat with aspirin)
Polyarteritis nodosa (necrotising inflammation, associated with hep b and livedo reticularis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

large vessel vasculitides

A

Takayasu

Giant Cell Arteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

microscopic polyangiitis

A

Microscopic polyangiitis is a small-vessel ANCA vasculitis

Features
renal impairment: raised creatinine, haematuria, proteinuria
fever
other systemic symptoms: lethargy, myalgia, weight loss
rash: palpable purpura
cough, dyspnoea, haemoptysis
mononeuritis multiplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is nephrotic syndrome

A 
hypoalbuminaemia,
oedema, 
heavy proteinuria (>3-5g/24hrs),
hyperlipidaemia, 
lipiduria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is nephritic syndrome?

A 
haematuria,
 oliguria, 
hypertension, 
proteinuria (>2g/24hrs), 
oedema
 ureamia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

symptoms of SLE

A
  • raynauds
  • mouth ulcers
  • rash on cheeks
  • weight loss
  • low grade fever
  • fatigue
  • joint pain and swlling
  • oedema
  • pleural effusion
  • pericarditis/pericadial effusion
  • loss of appetite
  • photosensitivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the antibody for SLE

A

Anti-ds DNA , Smith , nRNP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is the antibody for Sjorgens syndrome?

A

Ro(SSA) La (SSB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the antibody for subacute cutaneous lupus erythematosus (SCLE)

A

Ro (SSA) La(SSB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the antibody associated with dermatomyositis

A

Anti Jo

35
Q

what is the antibody associated with progressive systemic sclerosis? (diffuse systemic sclerosis)

A

Anti Sci 70

36
Q

what is the antibody associated with CREST syndrome? (limited systemic sclerosis)

A

anti-centromere antibody

37
Q

3 patterns of sclerosis

A
  • diffuse systemic sclerosis
  • limited systemic sclerosis (CREST)
  • scleroderma
38
Q

what are the symptoms of CREST syndrome

A 
C-calcinosis
R-raynauds
E-eosophageal strictures
S-sclerodactylitiy (thickening of skin)
T-telagniectasia
39
Q

what are the features of De Quevrains tenosynovitis

A 
-commonest in females 30-50
pain at the radial side of the wrist
-tenderness at radial styloid process
-abduction of the thumb against resistance is painful
-Finkelsteins test produces pain
40
Q

what is plantar fasciitis

A

most common cause of heel pain in adults

worse over medial calcaneal tuberosity

41
Q

which blood tests would you order in someone with suspected SLE?

A
  • FBC,WCC, U&Es, LFTs(albumin), ANAs (anti nuclear antigens), ENAs (extractable nuclear antigens- will only be present if ANA is positive!)
  • Urine dip- look for proteinuria /haematuria
  • CRP and ESR
  • compliment levels (activity marker in SLE, low=active)
  • MSU look for casts
  • protein:creatine ratio of urine
42
Q

what would CRP and ESR show in SLE?

A

CRP is usually normal or near normal
ESR is raised in active disease
(if CRP is high you need to exclude infection)

43
Q

what is ANA and what does it mean

A

ANA means anti nuclear antibody
if negative it means that a CTD or SLE is very unlikely
ANA positve suggests a rheumatological or CTD disease (but 5% of the healthy population has ANA )

44
Q

what are the considerations of pregnancy and SLE

A
  • pregnancy should be planned to ensure stability of the disease (no flare ups)
  • ensure immunosuppressants being used are safe for the baby
  • check Anti RO and anti La antibodies (these can cross the placenta and cause neonatal lupus)
  • check for anti-phospholipid syndrome (increased risk of miscarriage)
45
Q

what are the features of neonatal lupus?

A
  • Lupus rash
  • complete heart block
  • blood abnormalities (including cytopenias)
46
Q

treatment of lupus

A

Induction of remission: Corticosteroids
or
cyclophosphamide/mycopentolate if Lupus nephritis

maintaining remission: NSAIDs may be sufficient if no
then lowest dose corticosteroid/immunosuppressive therapy (hydroxychloroquine,methotrexate)

47
Q

treatment of raynauds?

A

-nifedipine (calcium channel blocker)

48
Q

which drug should you ask specifically about if you suspect gout?

A

thiazide diuretics

49
Q

what type of hypersensitivity reaction takes place in lupus nephritis?

A

Type 3

50
Q

how can you diagnose Lupus nephritis?

A

with a biopsy
urine sample and serology may help
(haematuria, proteinuria)

51
Q

what would a biopsy of a kindey with lupus nephritis show?

A
  • wire loop lesions
  • crescent shaped swelling
  • thickening of capillary loops
52
Q

diagnostic criteria for SLE

A

Any >4 of the following

  1. malar rash
  2. discoid rash
  3. oral ulcers
  4. photosensitivity
  5. arthitis
  6. serositis (pericarditis, pleuritis)
  7. renal disorder
  8. neurological disorder (seizures/psychosis
  9. haematological disorder (haemolytic anaemia, thrombocytopenia, lymphopenia, leukopenia
  10. immunological disorder (Anti Ds Dna, anti smith)
  11. antinuclear antibody
53
Q

what is onycholysis?and when may it be seen?

A

lifting of nail bed

seen in psoriasis

54
Q

nailfold infarcts are a sign of…

A

SLE

Vasculitis

55
Q

what is feltys syndrome?

A

splenomegaly
neutropenia
RA

56
Q

what is Bechets disease? (features)

A

RARE disease characterised by blood vessel formation throughout body

  • mouth ulcers
  • uveitis
  • IBD
  • genital sores
  • arthritis
57
Q

what is osteogenesis imperfecta?

A 
autosomal dominant collagen disease
results in brittle bones which are prone to fractures
-ask blue sclera
-deafness (otosclerosis)
-Family hx
58
Q

what may help identify Non accidental injury in achild

A
  • unclear hx /changeable hx
  • known to social services
  • poor parent-child relationship
  • injuries inkeeping with developmental age
59
Q

what is important to check with any fracture?

A

-neurovascular integrity

60
Q

management of a supracondylar fracture (in kids)

A
  • analgesia
  • list for theatre
  • reduction
  • fixation with K wires
  • plaster cast

K wires and cast removed at clinic in 4 weeks

61
Q

which structures may be damaged in a supracondylar fracture?

A
  • brachial artery
  • ulnar nerve
  • median nerve
62
Q

how long do childhood fractures take to heal?

A

-4-6 weeks upper limb
-6-8 weeks lower limb
generally quicker than adults

63
Q

what are some common childhood fractures

A
  • supracondylar
  • clavicle
  • wrist
  • buckle (bone buckles in on itself as opposed to breaking)
64
Q

what is a greenstick fracture and why does it occur?

A

it is a fracture commonly seen in children where it is a crack and not a complete fracture
happens because childhood bone is softer than adult bone

65
Q

main differences between childhood fractures and adult fractures

A
  • childhood fractures heal faster

- childhood fractures remodel with growth hence minor deformity is more accepted

66
Q

how can you check the median nerve function?

A

get the patient to make an O shape with their thumb and index finger

67
Q

fractures associated with osteoporosis

A
  • Colles fracture (FOOSH)
  • wedge fracture of vertebra
  • NOF fracture
68
Q

name some tools/stuff which can be used to secure a fracture

A
  • wires
  • plates
  • moulded plaster
  • elastic nails
69
Q

hip pain may be referred from?

A
  • spine
  • knee
  • abdomen (including hernial orifices)
  • testicles
70
Q

most likely cause of hip pain in a child?

A

transient synovitis of hip

71
Q

transient synovitis of hip featues

A

boys>girls
4-8yrs
acute onset limp
preceeded by URTI or other viral illness eg gastroenteritis

72
Q

what is perthes disease?

A

degenerative condition affecting the hip joints in children. AVN femoral head
most respond to conservative management (bracing of femoral head in acetabulum)

73
Q

blood supply to femoral head?

A

most comes from the retinacular arteries originating from the
LATERAL CIRCUMFLEX FEMORAL ARTERY

74
Q

red flags for hip pain in a child

A

-night pain
-weight loss
-weight loss, night pain, night sweats = Acute lymphoblastic leukaemia
-fever
-

75
Q

what is slipped upper femoral epiphysis and what are risk factors

A
  • displacement of the femoral epiphyseal head postero inferiorly
  • risk factors: male , overweight, hypothyroidism, >10 yrs
76
Q

DDH signs/features

A

more common in girls
picked up in newborns
leg length discrepencies / unequal skin folds

77
Q

juvenile idiopathic arthritis features

A
  • most are pauciarticular (less than 4 joints)
  • medium sized joints (knee, ankle, elbows
  • associated with anterior uveitis
  • ANA may be positive
  • limp
78
Q

Langhams triad of EGPA

A
  • asthma
  • eosinophilia
  • multi organ involvement
79
Q

what should you do if you find blood in the urine on au urine dip?

A

send off for red cell casts - this may be a nephritis

80
Q

cresenteric glomerulonephritis is a serious complication of…

A

ANCA associated vasculitides

treat with high dose immunosuppression (steroids)

81
Q

treatment of a small vessel vasculitis

A

induction: steroid and either rituximab or cyclophosphamide
maintenance: taper steroid and continue either azathiorpine, rituximab, methotrexate,

82
Q

when starting patients on high dose steroids what do you need to consider?

A
  • gastro protection
  • bone protection
  • screen for diabetes
  • check weight and blood pressure
83
Q

what drug is associated with worsening asthma symptoms in EGPA?

A

Montelukast

84
Q

differentials of fibromyalgia

A 
rheumatoid
-SLE
-polymyalgia rheumatica
endocrine
-addisons
-hyperparathyroid
-hypothyroid
-vit D deficiency
infection
malignancy

Year 4 M&M OSCE (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions