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1
Q

Which 2 main fractures carry a high risk of complication with compartment syndrome?

A

Humeral supracondylar fracture and tibial shaft fractures.

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2
Q

Which intracompartmental pressure is diagnostic of compartment syndrome?

A

Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic.

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3
Q

What is a complication which can be prevented following fasciotomy?

A

Myoglobinuria may occur resulting in renal failure and for this reason, patients undergoing this procedure require aggressive IV fluids.

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4
Q

Which nerve is compressed in carpal tunnel syndrome?

A

Median nerve

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5
Q

Which condition should be a differential considered when you suspect carpal tunnel syndrome?

A

Degenerative cervical myelopathy (43% of patients who underwent surgery for degenerative cervical myelopathy, had been initially diagnosed with carpal tunnel syndrome).

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6
Q

What is Hoffmans sign?

A

It is a sign of upper motor neuron dysfunction. To elicit0 flick patients middle finger distal phalanx to cause momentary flexion- a positive test is exaggerated flexion of the thumb.

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7
Q

What does a positive lachmans test indicate?

A

ACL tear (patient leg is at 30 degrees). (Anterior draw test the knee is at 90 degrees).

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8
Q

What is the other name for Churg-Straus syndrome?

A

Eoisinophillic granulomatosis with polyangitis.

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9
Q

What is Churg-Strauss syndrome?

A

It is an ANCA associated small medium cell vasculitis.

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10
Q

What are the features of Churg-Strauss syndrome?

A

Asthma, pANCA and eoisinophilia

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11
Q

Clinical features of Churg-Strauss

A

A 56-year-old female presents with a new onset cough and wheeze. She also reports having a runny and blocked nose. On examination there is widespread bilateral expiratory wheeze on chest examination. Nasal polyps are also evident.

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12
Q

How do you test for infraspinatous tear/inflamm?

A

Get the patient to externally rotate the shoulder against resistance- this will cause pain.

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13
Q

How do you test for supraspinatous tear/inflamm?

A

Painful arc and jobes test (you ask them to hold out there arm and put thumbs down, against resistance this will cause pain.

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14
Q

How do you test for subscapularis tendonitis?

A

Dorsum of hand on back then against resistance.

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15
Q

How do you test for terres minor tendinitis?

A

abduct arm to 90 degrees and bend elbow to 90 degrees then passively externally rotate and this will cause pain.

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16
Q

Most common cause of heel pain in adults?

A

Plantar fasciitis

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17
Q

Where is the pain usually worse in plantar fasciitis?

A

Around the medial calcaneal tuberosity

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18
Q

What is a key risk factor for developing avascular necrosis of the femoral head?

A

Long term steroid use

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19
Q

Other RFs for AVN?

A

Alcohol use, trauma (NOF fracture), chemo

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20
Q

Treatment of dupreytrons?

A

Fasciectomy

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21
Q

Tx of spinal canal stenosis?

A

Laminectomy.

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22
Q

Anti-ro antibodies are raised in which conditions?

A

Lupus & sjogens

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23
Q

What could a raised CK indicate? (amongst other things)

A

Hyperthyroidism- patient is constantly moving.

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24
Q

Which cancers are connective tissue diseases linked with?

A

Solid tumours- GI, breat, lung & some blood cancers

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25
What percentage of patients with SLE also have anti-phospholipid syndrome?
20-30%
26
In which conditions may you see livedo reticularis?
Anti-phospholipid syndrome and SLE, The blood clots in the small blood vessels can be a secondary effect of a condition that increases a person's risk of forming blood clots, including a wide array of pathological and nonpathological conditions . Examples include hyperlipidemia, microvascular hematological or anemia states, nutritional deficiencies, hyper- and autoimmune diseases, and drugs/toxins.
27
Reactive arthritis associated skin changes?
Can't see, can't pee, can't climb a tree- circinate balanitis (painless vesicles on the coronal margin of the prepuce), keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
28
What type of heart murmer is associated with ankylosing spondylitis?
Aortic Regurg
29
Which antibody test is an important diagnostic test for RA?
Anti-CCP antibody
30
Which antibody is found in scleroderma?
Anti-centromere antibody (associated with limited | CENTRAL systemic sclerosis). Also anti-scl antibodies in diffuse systemic sclerosis
31
When do you prescribe allopurinol for gout prevention?
If you have more than 2 attacks in 1 year
32
Which cancer is 20x more likely to occur in sjogens?
Lymphoma
33
What is the criteria used for diagnosing sjogens?
Copenhagen criteria and American-European consensus criteria. Diagnosis is based on clinical features- dry eyes, dry mouth, RO & LA antibody positivity
34
Which meniscus is more prone to injury?
Medial
35
If a patient twists the knee and blood is in the joint, which injury most likely caused this?
ACL tear (check for common perineal damage- get the patient to dorsiflex the foot)
36
Which score is used to measure disease activity in rheumatoid arthritis?
DAS28 score- tender/swollen/ESR & VAS patient score.
37
Which muscle flexes at the hip?
Ilio-psoas
38
Which muscle extends the hip?
Gluteus maximus
39
Which muscle abducts the hip?
Gluteus minimus and medius
40
Which muscles adduct the hip?
Adductor longus, magnus and brevis
41
What does lipo-heamoarthrosis in a joint confirm?
There has been a fracture. Escape of fat and blood from the bone marrow into the joint
42
What is thomas' test?
Inability to fully extend the hip when the other leg is flexed at the knee
43
How do meniscal tears present in a knee exam?
The patient is unable to fully extend the knee.
44
How do bisphosphonates work?
They inhibit osteoclast bone resorption and so reduce break down of bone.
45
How might a triple A appear on an abdominal X-ray?
You may loose the outline of psoas as this is retro-peritoneal
46
In a septic joint- what do you request from the lab regarding the synovial fluid?
Culture, leukocyte count, gram staining, polarising microscopy (to exclude crystal arthropathys).
47
Predictive features of GCA?
Temporal headache. Scalp tenderness. ESR significantly elevated. Anaemia.
48
Differentials for GCA?
Migraine, tension type headache, Polyarteritis nodosa
49
How do you manage GCA?
``` Pred 40mg ( if jaw claud give 60). Once symptoms resolve you can reduce the dose gradually over a period of time. Also start patients on 75mg of aspirin + PPI ```
50
What is dequervains synovitis?
De Quervain's tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. This causes pain on the radial aspect affecting the thumb
51
What is found on aspiration of a joint with gout?
Needle shaped negatively birefringent crystals under polarised light
52
Cause of gout?
Hyperuricaemia- ususally due to impaired renal excretion of urate, some people are under-excreters and over-producers of urate. Metabolic disorder of purine metabolism.
53
Gradual swelling of a knee joint v sudden
Sudden- usually ACL tear | Gradual- meniscal tear
54
Bakers cysts
Foucher's sign describes the increase in tension of the Baker's cyst on extension of the knee. Can be non-tender lumps.
55
Which movement is most affected in frozen shoulder?
External rotation
56
RF for frozen shoulder?
Diabetics (occur in 20%) Elderly After a long hospital stay
57
What is mc murrays test used to detect?
Meniscal tear
58
pANCA | cANCA associations
``` p= churg straus c= granulomatosis with polyangiitis ```
59
Leriche snydrome
Claudication of the buttocks and thighs 2. Atrophy of the musculature of the legs 3. Impotence (due to paralysis of the L1 nerve)
60
Good prognostic factor in RA?
RF negative
61
Management of RA?
DMARD (methotrex) and at least one other DMARD plus short-term glucocorticoids. Women who want to have babies should wait at least 3 months after stopping methotrexate.
62
Monitoring of methotrexate
Monitoring of FBC & LFTs is essential due to the risk of myelosuppression and liver cirrhosis.
63
Occular complication of GCA?
Ischaemic optic neuropathy
64
What is the most common reason that a total hip replacement needs revised?
Aseptic loosening of the implant
65
What is a charcot joint?
A Charcot joint is also commonly referred to as a neuropathic joint. It describes a joint which has become badly disrupted and damaged secondary to a loss of sensation. (can get charcot shoulder as well).
66
Which condition is ANA antibodies associated with?
Dermatomyositis (MASSIVE CRP)
67
What can cause a loss of sensation over the deltoid?
Anterior shoulder dislocation, involving the axilly nerve
68
What diagnosis might carpel tunnel syndrome indicate?
Look for hallmarkers of RA
69
What is pseudogout?
calcium pyrophosphate dihydrate deposits
70
Too that NICE use to assess is someone is at risk of a fracture?
FRAX tool- estimates the 10-year risk of a fragility fracture. Focuses on things like steroid use, prev fall, low bmi
71
Imagining of choice in osteomyelitis?
MRI
72
First line drug in patients with Raynauds?
Nifedipine
73
First line tx in osteroarthritis?
Oral paracetamol + topical NSAIDs (if knee/hand)
74
If a patient wants to stop taking their bisphosphonate, what should you do?
FRAX score and a dex-scan and assess risk from this. Also if the patient is >75- risk of fragility fractures increases.
75
What are RA patients at an increased risk of?
IHD
76
First line in ank spond?
NSAIDs
77
Which antibody is present in 90% of patients with drug-induced lupus?
Anti-histone antibodies
78
T score for DEX scan
T score > -1.0 = normal -1.0 to -2.5 = osteopaenia > -2.5 = osteoporosis
79
What is cubital tunnel syndrome?
Compression of the ulnar nerve
80
Which muscle is responsible for the first 20 degrees of abduction?
Supraspinatous
81
Which antibodies are present in dermatomyositis?
Anti-Jo1
82
Complications of gout?
Hyperuricaemia Renal failure Tophaceous arthritis
83
Treatment of gout?
NSAID high dose, continue until 2 days after attack. | Discuss lifestyle factors, alcohol, exercise, fluid intake, weight loss
84
Complications of scleroderma?
Renal artery stenosis, pulmonary fibrosis
85
Which condition is associated with watermelon stomach?
Scleroderma (bleeding of the lining of the stomach).
86
Associations with ankylosing spondylitis?
``` Anterior uveitis IgA nephropathy Amyloidosis Achillies tendinitis Aortitis Apical lung fibrosis ```
87
Skin associations with dermatomyositis?
Heliotrope rash | Gottrons papules
88
If you suspect dermatomyositis, what tests should you order?
Electromyography (EMG) CK Spirometry
89
If you suspect lupus, what should you do?
Do an FBC to look for pancytopenia, anti-dsdna antibosy, ANA antibodies, urine dip (look for casts & protein)
90
What are the 3's in RA?
Presents in 3rd decade, HLA DR3, 3x more common in women.
91
Complications of pagets?
Deafness, blindness, osteosarcoma
92
What is goodpastures?
Antibodies (anti-GBM) attack basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure. (collagen 4). Treatment is plasmophoresis.
93
What is wegeners?
Vasculitis affecting small and medium sized blood vessels. commonly affects the upper resp tract and the kidneys and the symptoms involve nose bleeds, inflammation of the uveal layer of the eye, arthritis, sensory neuropathy.

Final year (16 decks)

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