MSK Flashcards
what test can help diagnose antiphospholipid syndrome?
anti-cardiolipin
what paradoxical test result is seen in antiphospholipid syndrome?
prolonged APTT
what else is reduced in antiphospholipid syndrome?
platelets - thrombocytopaenia
name 3 features of antiphospholipid syndrome (other than the clots)
livedo reticularis (mottled + red)
preeclampsia
pulmonary HTN
management of initial VTE in antiphospholipid syndrome
warfarin - target INR of 2-3 for 6mo
management of recurrent VTEs in antiphospholipid
lifelong warfarin
if already taking warfarin - increase target INR to 3-4
what treatment worsens compartment syndrome?
anticoagulation
what complication can occur after ischaemia reperfusion injury in vascular patients?
compartment syndrome - can occur after VTE
which 2 main fractures carry the risk of compartment syndrome?
supracondylar fractures and tibial shaft injuries
list 4 possible symptoms of compartment syndrome
pain (active + passive)
paraesthesia
pallor
paralysis of muscle group
4 Ps
arterial pulsation may still be felt as necrosis is due to microvascular compromise
how to diagnose compartment syndrome?
measure pressure inside compartment
> 20 - abnormal
40 - diagnostic
treatment of compartment syndrome
prompt + extensive fasciotomy
what complication can result from fasciotomy? how to manage?
myoglobinuria - can cause renal failure
give aggressive IV fluids (before or after found??)
how quickly can muscle groups die in compartment syndrome?
4-6h
pain on wrist EXTENSION against resistance (arm straight)
laTeral epicondylitis - Tennis elbow - pain on exTension
laTeral Tennis exTension
natural history of lateral epicondylitis (ie timing)
acute pain for 6-12 weeks
episodes last 6mo-2 years
management of lateral epicondylitis
physio
simple analgesia
avoid muscle overload
steroid injection
how would osteomalacia affect calcium, phosphate, vitamin D, ALP + PTH?
low calcium, phosphate, vitamin D
high ALP + PTH
what is the common type of osteomalacia?
3 causes
vitamin D deficiency - malabsorption, lack of sun, diet
how do you manage osteomalacia?
calcium with vitamin D tablets
how does osteoporosis affect bloods?
bloods are normal
what effect does myeloma have on calcaemia?
hypercalcaemia
what effect does primary hyperparathyroidism have on calcaemia?
hypercalcaemia
investigations for myeloma?
serum electrophoresis
skeletal survey
other than vitamin D deficiency, what can cause osteomalacia?
renal or liver disease
drug induced eg anticonvulsants
features of osteomalacia
bone - pain + fractures
muscles - tenderness + proximal myopathy
features of compartment syndrome
pain, esp on active/passive movement
paraesthesiae
pallor
local paralysis
what intracompartmental pressures indicate compartment syndrome?
> 40 - diagnostic
>20 - abnormal
CREST syndrome - what is it + what are the features?
limited cutaneous form of SSc
calcinosis - skin deposits raynaud's - dysphagia esophageal dysmotility sclerodactyly telangiectasia
Elderly woman. 2wk hip + shoulder pain + early morning stiffness. Difficulty raising arms. Power normal. ESR raised, CK normal. Diagnosis?
Polymyalgia rheumatica
What is the key blood result in polymyositis?
Raised CK
What joints does OA tend to present in?
Weight bearing eg hips + knees
What crystal is involved in pseudogout?
Calcium pyrophosphate
Where does pseudogout most commonly affect?
Mono-articular; knees then hips
what does chondrocalcinosis indicate?
pseudogout
what is pseudogout like on aspiration?
weakly positively birefringent rhomboid shaped crystals
pseudogout - management
aspirate to exclude septic arthritis
NSAIDs or IA/IM/PO steroids
plantar fasciitis - presentation
heel pain worsened by tip toes, usually worse medially
plantar fasciitis - management
rest feet + stretches
regular paracetamol + NSAIDs if painful
arched + cushioned heels, insoles
what would you find on examination of temporal arteritis?
pulseless temporal artery
tenderness on palpation
systemic sclerosis - antibodies
anti-centromere or anti-scl (depends on type)
90% - ANA
3 things that can cause carpal tunnel
rheum disorders
pregnancy
oedema eg HF
carpal tunnel - 2 symptoms + 2 signs
pain/paraesthesia in thumb, 1st + 2nd finger
shaking hand (oft at night) relieves
weak thumb abduction
wasting thenar eminence
carpal tunnel - management
corticosteroid injection
wrist splints at night
surgery
what is a complication of scaphoid fracture? what is the problem with scaphoid fractures?
avascular necrosis
often not seen on xray
what is osteomalacia? what causes it?
softened bones due to inadequate phosphate, calcium + vitamin D
what is CK like in PMR?
normal
CREST syndrome - which antibody?
anti-centromere
what is the difference between limited cutaneous SSc and diffuse cutaneous SSc?
limited - “CREST syndrome” - anti-centromere, systemic involvement limited
diffuse - “progressive/malignant scleroderma” - anti-scl, greatest chance of lung, gut, heart, renal involvement
how does diffuse cutaneous scleroderma present?
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
seronegative arthritis - types?
psoriatic, reactive, ank spond, enteropathic
seronegative arthritis - presentation?
asymmetrical oligoarthritis + sacroiliitis anterior uveitis (acute ivitis)
dupuytren’s - what is it?
thickening of palmar aponeurosis, preventing flexor tendons working properly
little + ring fingers most commonly affected
dupuytren’s - presentation
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
dupuytren’s - RFs
?microtrauma
FH
alcohol, smoking, diabetes
phenytoin
dupuytren’s - treatment
no treatment if managing with ADLs
segmental fasciectomy - so sig recurrence rate
post op splinting + physio
