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MSK Flashcards

1
Q

what test can help diagnose antiphospholipid syndrome?

A

anti-cardiolipin

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2
Q

what paradoxical test result is seen in antiphospholipid syndrome?

A

prolonged APTT

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3
Q

what else is reduced in antiphospholipid syndrome?

A

platelets - thrombocytopaenia

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4
Q

name 3 features of antiphospholipid syndrome (other than the clots)

A

livedo reticularis (mottled + red)
preeclampsia
pulmonary HTN

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5
Q

management of initial VTE in antiphospholipid syndrome

A

warfarin - target INR of 2-3 for 6mo

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6
Q

management of recurrent VTEs in antiphospholipid

A

lifelong warfarin

if already taking warfarin - increase target INR to 3-4

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7
Q

what treatment worsens compartment syndrome?

A

anticoagulation

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8
Q

what complication can occur after ischaemia reperfusion injury in vascular patients?

A

compartment syndrome - can occur after VTE

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9
Q

which 2 main fractures carry the risk of compartment syndrome?

A

supracondylar fractures and tibial shaft injuries

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10
Q

list 4 possible symptoms of compartment syndrome

A

pain (active + passive)
paraesthesia
pallor
paralysis of muscle group

4 Ps

arterial pulsation may still be felt as necrosis is due to microvascular compromise

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11
Q

how to diagnose compartment syndrome?

A

measure pressure inside compartment

> 20 - abnormal
40 - diagnostic

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12
Q

treatment of compartment syndrome

A

prompt + extensive fasciotomy

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13
Q

what complication can result from fasciotomy? how to manage?

A

myoglobinuria - can cause renal failure

give aggressive IV fluids (before or after found??)

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14
Q

how quickly can muscle groups die in compartment syndrome?

A

4-6h

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15
Q

pain on wrist EXTENSION against resistance (arm straight)

A

laTeral epicondylitis - Tennis elbow - pain on exTension

laTeral Tennis exTension

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16
Q

natural history of lateral epicondylitis (ie timing)

A

acute pain for 6-12 weeks

episodes last 6mo-2 years

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17
Q

management of lateral epicondylitis

A

physio
simple analgesia
avoid muscle overload
steroid injection

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18
Q

how would osteomalacia affect calcium, phosphate, vitamin D, ALP + PTH?

A

low calcium, phosphate, vitamin D

high ALP + PTH

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19
Q

what is the common type of osteomalacia?

3 causes

A

vitamin D deficiency - malabsorption, lack of sun, diet

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20
Q

how do you manage osteomalacia?

A

calcium with vitamin D tablets

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21
Q

how does osteoporosis affect bloods?

A

bloods are normal

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22
Q

what effect does myeloma have on calcaemia?

A

hypercalcaemia

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23
Q

what effect does primary hyperparathyroidism have on calcaemia?

A

hypercalcaemia

24
Q

investigations for myeloma?

A

serum electrophoresis

skeletal survey

25
Q

other than vitamin D deficiency, what can cause osteomalacia?

A

renal or liver disease

drug induced eg anticonvulsants

26
Q

features of osteomalacia

A

bone - pain + fractures

muscles - tenderness + proximal myopathy

27
Q

features of compartment syndrome

A

pain, esp on active/passive movement
paraesthesiae
pallor
local paralysis

28
Q

what intracompartmental pressures indicate compartment syndrome?

A

> 40 - diagnostic

>20 - abnormal

29
Q

CREST syndrome - what is it + what are the features?

A

limited cutaneous form of SSc

calcinosis - skin deposits
raynaud's - dysphagia
esophageal dysmotility
sclerodactyly
telangiectasia
30
Q

Elderly woman. 2wk hip + shoulder pain + early morning stiffness. Difficulty raising arms. Power normal. ESR raised, CK normal. Diagnosis?

A

Polymyalgia rheumatica

31
Q

What is the key blood result in polymyositis?

A

Raised CK

32
Q

What joints does OA tend to present in?

A

Weight bearing eg hips + knees

33
Q

What crystal is involved in pseudogout?

A

Calcium pyrophosphate

34
Q

Where does pseudogout most commonly affect?

A

Mono-articular; knees then hips

35
Q

what does chondrocalcinosis indicate?

A

pseudogout

36
Q

what is pseudogout like on aspiration?

A

weakly positively birefringent rhomboid shaped crystals

37
Q

pseudogout - management

A

aspirate to exclude septic arthritis

NSAIDs or IA/IM/PO steroids

38
Q

plantar fasciitis - presentation

A

heel pain worsened by tip toes, usually worse medially

39
Q

plantar fasciitis - management

A

rest feet + stretches
regular paracetamol + NSAIDs if painful
arched + cushioned heels, insoles

40
Q

what would you find on examination of temporal arteritis?

A

pulseless temporal artery

tenderness on palpation

41
Q

systemic sclerosis - antibodies

A

anti-centromere or anti-scl (depends on type)

90% - ANA

42
Q

3 things that can cause carpal tunnel

A

rheum disorders
pregnancy
oedema eg HF

43
Q

carpal tunnel - 2 symptoms + 2 signs

A

pain/paraesthesia in thumb, 1st + 2nd finger
shaking hand (oft at night) relieves
weak thumb abduction
wasting thenar eminence

44
Q

carpal tunnel - management

A

corticosteroid injection
wrist splints at night
surgery

45
Q

what is a complication of scaphoid fracture? what is the problem with scaphoid fractures?

A

avascular necrosis

often not seen on xray

46
Q

what is osteomalacia? what causes it?

A

softened bones due to inadequate phosphate, calcium + vitamin D

47
Q

what is CK like in PMR?

A

normal

48
Q

CREST syndrome - which antibody?

A

anti-centromere

49
Q

what is the difference between limited cutaneous SSc and diffuse cutaneous SSc?

A

limited - “CREST syndrome” - anti-centromere, systemic involvement limited
diffuse - “progressive/malignant scleroderma” - anti-scl, greatest chance of lung, gut, heart, renal involvement

50
Q

how does diffuse cutaneous scleroderma present?

A

more extensive + internal organ involvement
mask-like face, wrinkled skin around a small mouth
tethering of skin over nose - beaking
interstitial pulmonary fibrosis
renal dysfunction + THN
atonic oesophagus - reflux + aspiration

51
Q

seronegative arthritis - types?

A

psoriatic, reactive, ank spond, enteropathic

52
Q

seronegative arthritis - presentation?

A 
asymmetrical oligoarthritis + sacroiliitis
anterior uveitis (acute ivitis)
53
Q

dupuytren’s - what is it?

A

thickening of palmar aponeurosis, preventing flexor tendons working properly
little + ring fingers most commonly affected

54
Q

dupuytren’s - presentation

A

oft - painless deformity in middle aged men
starts as firm painless nodule ± palmar skin pitting
± knuckle pad thickening
cord formation
leads to FF contracture of MCPs ± PIPs

55
Q

dupuytren’s - RFs

A

?microtrauma
FH
alcohol, smoking, diabetes
phenytoin

56
Q

dupuytren’s - treatment

A

no treatment if managing with ADLs
segmental fasciectomy - so sig recurrence rate
post op splinting + physio

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