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MSK Flashcards

1
Q

Best imaging for osteomyelitis?

A

MRI

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2
Q

Risks for septic arthritis?

A

IVDU

DIabetes

Rheumatoid or osteo

Prostheses

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3
Q

Septic arthritis symptoms?

A

Short history of symptoms

Fever

Hot swollen tender joint with restriction

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4
Q

First line investigations to diagnose septic arthritis?

A

Aspiration of synovial fluid for gram stain and culture also look for crystals

Blood cultures also- Preferably before ABX

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5
Q

Causative organisms in septic arthritis?

A

Overall Staph Aureus is the most common but

Young sexually active - ~75%Gonococcal

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6
Q

Septic arthritis treatment?

A

Washout ABX and aspirate to dryness as often as possible/needed

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7
Q

Symptoms of GCA?

A

>50 and female usually

Headache, PMR symptoms, claudication cranial vessel tenderness

Low grade fever and fatigue systemically unwell

PainLESS loss of vision

pain on chewing

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8
Q

Investigations initially in to GCA?

A

ESR, CRP, FBC,LFTS

Artery biopsy

ESR raised often >50mm

CRP↑

Anaemic (normocytic)

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9
Q

Treatment of GCA doses etc referall?

A

visual symptoms — 60 mg as a one-off dose (they should be seen by an ophthalmologist the same day).

without visual symptoms — 40 to 60 mg daily (minimum 0.75 mg/kg)

If not contraindicated- Aspirin 75mg

Don’t forget the PPI

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10
Q

Additional preventative medications when using steroids?

A

PPI and bone protection

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11
Q

Pain in which part of the spine is a red flag?

A

Thoracic

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12
Q

Cauda equina red flags and questions?

A

Severe low back pain, Sciatic, saddle anaesthesia

Bladder problems -incontinence or retention (when did you last urinate/open bowels?)

Bowel sphincter weakness can you tense

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13
Q

Shortened and externally rotated leg, diagnosis? Other symptoms?

A

Likely #NOF

Pain, cannot weight bear pain with hip movement

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14
Q

Risks for hip fracture?

A

Female sex, osteoporosis, falls, low BMI

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15
Q

Imaging of chocie in hip fracture?

A

Plain X-ray

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16
Q

Undisplaced hip fracture treatment?

A

Internal fixation or hemisrthroplasty if unfit

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17
Q

Displaced hip fracture treatment?

A

young and fit i.e. <70 years- Reduction and internal fixation (if possible).

older and reduced mobility- Hemiarthroplasty or total hip replacement.

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18
Q

Extracapsular hip fracture treatment?

A

dynamic hip screw

if reverse oblique, transverse or subtrochanteric: intramedullary device

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19
Q

What type of fracture if this?

Treated?

A

Intertrochanteric

Likely dynamic hip screw as extracapsular

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20
Q

Strongly suspect hip fracture but X-ray normal next investigation?

A

MRI

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21
Q

When to consider internal fixation of hip fractures?

A

Displaced (if possible) or Undisplaced, intracapsular and young <70

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22
Q

What is this fracture?

Treatment?

A

Intracapsular fracture of left hip

Hemiarthroplasty if elderly and immobile Total replacement if able and well

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23
Q

Offer THR rather than hemi to patient with undisplaced intracapsular and…

A

were able to walk independently out of doors with no more than the use of a stick and

are not cognitively impaired and

are medically fit

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24
Q

VTE prophlaxis in hip fractures?

A

1 month of LMWH starting 6-12hrs after surgery

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25
Q

Common symptoms of compartment syndrome?

A

Pain- Severe and disproportianate to the injury and on passive stretching

history of surgery or sports playing/trauma

Tightness

Paraesthesia

Pulselessness pallor and paralysis are late and uncommon

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26
Q

Loss of cartilage, sclerosis and eburnation of the subchondral bone, osteophytes, and subchondral cysts Characteristic of?

A

Osteoarthritis

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27
Q

What features are seen on this xray?

A

Osteophytes Distally (heberdens)

Base of thumb also,

asymmetrical joint space narrowing

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28
Q

Xray features in Rhematoid arthritis?

A

joint space narrowing: symmetrical or concentric

fusiform and periarticular; it represents a combination of joint effusion, oedema and tenosynovitis 5

PIP and MCP joints (especially 2nd and 3rd MCP)

ulnar styloid

triquetrum

As a rule the DIP are spared

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29
Q

What is seen and diagnosis?

A

Rheumatoid arthritis

  • Sparing of DIPs

Joint space symetrically loss in MCP joints wrist changes

Subchondral cysts Ulnar styloid involvement

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30
Q

L4 nerve root?

A

Foot inversion and dorsiflexion

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31
Q

Foot eversion and toe plantarflexion nerve root?

A

S1

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32
Q

Great toe dorsiflexion nerve root?

A

L5

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33
Q

Management of lower back pain with no red flags?

A

Analgesia: paracetamol ± NSAIDs ± codeine  Muscle relaxant: low-dose diazepam (short-term)  Facet joint injections

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34
Q

Symptoms of Osteoarthritis?

A

Pain: worse with movement, background rest/night pain, worse @ end of day.  Stiffness: especially after rest, lasts ~30min (e.g. AM)  Deformity

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35
Q

Conservative management of OA?

A

↓ wt. Alter activities: ↑ rest, ↓ sport Physio: muscle strengthening  Walking aids, supportive footwear, home mods

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36
Q

Medical management of OA?

A

NSAID/topical, Paracetamol, topical capcaisin (hand or knee)

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37
Q

Surgical management of OA

A

Arthroscopic washout: esp. knee.  Trim cartilage, remove foreign bodies.  Arthroplasty: replacement (or excision)

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38
Q

Monitor disease activity in RA?

A

DAS28

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39
Q

Bloods in RA?

A

RF +ve in 70%

Anti-CCP: 98% specific (Ag derived from collagen) ANA: +ve in 30%

FBC anaemia, ↓PMN, ↑plat, ↑ESR, ↑CRP

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40
Q

Extra articular manifestations of RA?

Carpal Tunnel Syndrome Pulmonary

Fibrosing alveolitis (lower zones)

Pleural effusions (exudates) Ophthalmic

Epi-/scleritis

Sjogren’s Syndrome

Raynaud’s

A
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41
Q

Diagnosis of RA?

A
  1. Morning stiffness >1h (lasting >6wks)
  2. Arthritis ≥3 joints
  3. Arthritis of hand joints
  4. Symmetrical
  5. Rheumatoid nodules
  6. +ve RF
  7. Radiographic changes

Need 4/7

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42
Q

Mainstay agents in RA?

A

DMARDS

Methorexate: hepatotoxic, pulmonary fibrosis

Sulfasalazine: hepatotoxic, SJS, ↓ sperm count

Hydroxychloroquine: retinopathy, seizures

Leflunomide

Then Biological (Anti TNF)

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43
Q

Gout Pathophysiology?

A

Deposition of monosodium urate crystals in and around joints → erosive arthritis

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44
Q

Urate deposits in pinna and tendons called?

A

Tophi

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45
Q

Gout differentials

A

 Septic arthritis  Pseudogout  Haemarthrosis

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46
Q

Microscopy of gout aspirate?

A

Polarised light microscopy  Negatively birefringent needle-shaped crystals

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47
Q

Acute gout treatment? Pharmacological and conservative

A

NSAIDS- First Line Naproxen

Elevate limb, cold compress, avoid trauma

Second line Colchicine is on warfarin or heart failure or gastric issues or renal

Very severe renal issue use steroids

48
Q

How to introduce allopurinol?

A

Allopurinol  Use if recurrent attacks, tophi or renal stones  Introduce with NSAID or colchicine cover for 3/12

at least 2 weeks after acute attack

49
Q

Polarized light microscopy shows Positively birefringent rhomboid-shaped crystals?

A

Pseudo gout

50
Q

Xray pseudogout may show?

A

Chondrocalcinosis

51
Q

Ankylosing spondylitis in who and when?

A

Males ore common 6 fold, late teens to early 20s 95% HLA B27 +ve

52
Q

Features of Ankylosing spondylitis?

A

Radiates from SI joints to hips and buttocks

Worse @ night morning stiffness

Relieved by exercise.

Progressive loss of all spinal movements

Schober’s test <5cm

Some develop thoracic kyphosis and neck hyperextension = question mark posture

Enthesitis: Achilles tendonitis, plantar fasciitis  Costochondritis

53
Q

Extra-articular manifestations of ankylosing spondylitis?

A

Osteoporosis

Iritis/Uveitis

Fibrosis

54
Q

Xrays of Ank Spon?

A

Sacroliliitis: irregularities, sclerosis, erosions

Vertebra: corner erosions, squaring syndesmophytes (bony proliferations)

Bamboo spine: calcification of ligaments, periosteal bone formation

55
Q

What is shown?

A

Bamboo spine

56
Q

What is shown?

A

Ank spon- squaring of vertebrae and loss of cancavity

57
Q

Bloods in ank spon?

A

FBC (anaemia), ↑ESR, ↑CRP, HLA-B27

58
Q

Ankylosing spondylitis initial treatment?

A

NSAIDS with PPI

Coxibs have been used but questions rasied RE cardiac

59
Q

Ankylosing spondylitis refractory to NSAIDs?

A

TNF alpha and continued NSAIDs

60
Q

Features of psoriatic arthritis?

A

Psoriatic plaques  Nail changes  Pitting  Subungual hyperkeratosis  Onchyolysis  Enthesitis: Achilles tendonitis, plantar fasciitis  Dactylitis

61
Q

Joint involvement psoriatic arthritis?

A

Asymmetrical oligoarthritis: 60% (commonest)

Distal arthritis of the DIP joints: 15% (classical)

62
Q

Pencil in cup sign?

A

Psoriatic arthritis due to erosion

63
Q

Psoriatic arthritis treatment?

A

Similar to RA

64
Q

Reactive arthritis symptoms and presentation?

A

Asymmetrical lower limb oligoarthritis: esp. knee

Iritis, conjunctivitis

Keratoderma blenorrhagica: plaques on soles/palms

Circinate balanitis: painless serpiginous penile ulceration

↑ESR, ↑CRP

Cant see cant pee cant climb a tree

65
Q

Reactive arthritis reaction to what?

A

Urethritis (chlamydia) or dysentry

66
Q

Treatment of Reactive arthritis?

A

NSAIDs steroids, may need dmards if relapse

67
Q

What is enteropathic arthritis?

A

Assoc with IBD

68
Q

Joint affected in enteropathic arthritis?

A

Asymmetrical large joints affecting lower limbs

69
Q

What is shirmers test what is it used for?

A

Quantitatively measures tears. A filter paper is placed in the lower conjunctival sac. The test is positive if less than 5 mm of paper is wetted after 5 minutes.

70
Q

Antibodies in sjogrens?

A

Anti ro and anti la

71
Q

What is CREST syndrome?

A

Calcinosis

Raynaud’s

Esophageal and gut dysmotility → GOR

Sclerodactyly

Telangiectasia

72
Q

Best diagnostic antibody SLE?

Most Specific antibody for SLE?

A

ANA ~ 100% positive

dsDNA

73
Q

Antibodies in drug induced lupus? Which drugs?

A

Anti histone

Phenytoin, Isoniazid, hydralazine

74
Q

Treatment for many aspects of SLE?

A

Hydroxychloroquine

Sun screen

ACEi for nephro involvement

High dose pred

75
Q

Weak abduction of arm what nerve?

A

Axillary

76
Q

Fracture of humerus what nerve and palsiy?

A

Radial wrist drop/waiters tip

77
Q

Elbow dislocation nerve and sign?

A

Ulnar claw hand

78
Q

Hip dislocation and fracture of fibular causes what palsy?

A

Foot drop

79
Q

Monteggia fracture?

A

of proximal 3rd of ulna shaft § Anterior dislocation of radial head at capitellum §

May → palsy of deep branch of radial nerve → weak finger extension but no sensory loss

80
Q

Galleazzi fracture?

A

of radial shaft between mid and distal 3rds § Dislocation of distal radio-ulna joint

81
Q

Colles fracture? Usual mechanism?

A

FOOSH

Extra-articular # of dist. radius (w/i 1.5” of joint)

Dorsal displacement of distal fragment

Dinner fork deformity

82
Q

Frozen Shoulder: Adhesive Capsulitis presentation?

A

Progressive ↓ active and passive ROM ↓ ext. rotation <30degrees

↓ abduction <90degree

• Shoulder pain, esp. @ night (can’t lie on affected side)

83
Q

Treatment of frozen shoulder?

A

Usually NSAIDS and physio

?steroid injection if bad

84
Q

Impingement Syndrome / Painful Arc presentation? What is affected?

A

Entrapment of supraspinatus tendon and subacromial bursa between acromion and grater tuberosity of humerus.

→ subacromial bursitis and/or supraspinatous tendonitis

Painful arc: 60-120º

Weakness and ↓ ROM

+ve Hawkin’s test

85
Q

Where does a shoulder dislocate usually?

A

Anteriorly in 95%

86
Q

Ottawa ankle rules?

A

Tenderness along distal 6cm of posterior tib / fib including posterior tip of the malleoli.

Inability to bear weight both immediately and in ED

Needs Xray if either

87
Q

Most common cause of haemarthosis in trauma?

A

ACL injury

88
Q

Lateral blow to the knee can give what?

A

Unhappy Triad

Damage to:

ACL

MCL

Medial Meniscus

89
Q

Z score for osteoporosis?

A
90
Q

Z score of -1 to -2.5 is what?

A

Ostepoaenia

91
Q

Most important risk factor for the dveelopment of osteoporosis?

A

Steroids

92
Q

Treatment of osteoporosis without assessment in who?

A

Women previous fragility fracture, and people over 70 taking steroids, but NICE reccomends assessment of people with risks for fragility

93
Q

Offer a dual-energy X-ray absorptiometry (DXA) scan in?

A

Over 50 years of age with a history of fragility fracture.

Younger than 40 years of age who have a major risk factor for fragility fracture

94
Q

What to consider prescribing for >50 taking high dose steroids >7.5mg pred for 3 months

A

Bisphos- Alendronate or risendronate

95
Q

Core symptoms of PMR?

A

Bilateral shoulder and/or pelvic girdle pain. Initially this may be unilateral but quickly becomes bilateral, is worse with movement, and interferes with sleep.

Stiffness lasting for at least 45 minutes after waking or periods of rest that may cause the person to have difficulty turning over in bed

SYSTEMIC- Low-grade fever, fatigue, anorexia, weight loss, and depression

96
Q

Prednisilone dose for PMR ?

A

15mg for a week and assess response then continue until resolution then reduce

97
Q
A
98
Q

PMR age and duration?

A

>50 at least 2 weeks of symptoms

99
Q

Disorganised mosaic pattern of lamellar bone?

A

Pagets

100
Q

Where is affected msot in pagets?

A

Most to least - spine, skull, pelvis and femur

101
Q

Pagets blood tests?

A

Everything normal except ALP

102
Q

Symptoms of pagets?

A

Typical asymptomatic or pain localised to bone with lesions, or fracture and or joint problem from bne remodelling

103
Q

Xray change in pagets?

A

Sclerotic and lytic bone lesions

104
Q

What is shown what blood test may be high?

A

Left pelvic pagets disease likely ↑raised ALP

105
Q

Pagets treatment?

A

Bisphosphonates

106
Q

Proximal muscle weakness and bone pain?

A

Osteomalacia

107
Q

Diagnostic bloods for osteomalacia?

A

Low Vit D, Low or normal calcium, and elevated PTH

ALP ↑

108
Q

Drugs that cna cause osteamalacia?

A

Anticonvulsants

109
Q

Antibody sensitive for SLE and antibody specific?

A

ANA sensitive, DsDNA specific and also anti smith

110
Q

Most common joints affected for osteoarthritis?

A

Hips, knees and small bones of hand (thumb)

111
Q

Limited cutaneous sclerosis features?

A

Calcinosis

Raynauds

Eosopahgeal dysmotility

Sclerodactyly

Telangectasia

112
Q

What is this what syndrome associated?

A

Sclerodactyly- CREST

limited cutaneous sclerosis

113
Q

Which antibodies for CREST?

A

Anti centromere

114
Q

What is subchonral sclerosis?

A

Thickening of bone (looks more white)

115
Q

What are osteophytes?

A

Bone spurs coming off the bones

Finals (16 decks)

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