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MSK Flashcards

1
Q

What indicators are there of an inflammatory condition?

A
  • Morning stiffnes > 30 mins - Pain after rest - Systemic symptoms - Night time pain - Acute/ subacute presentation
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2
Q

What indicators are there of a non-inflammatory condition?

A
  • Pain towards end of day - Pain better at night - Long standing/ chronic nature
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3
Q

What steps are there in interpretation of a joint X-ray?

A

Details Site Type of fracture - transverse, oblique, spiral Simple of Comminute Displaced Angulated Consistency of bone

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4
Q

What indicators are there of Oesteoathritis on joint X-rays?

A

LOSS Loss of joint space Osteophytes Subchondral cysts Subchondral sclerosis

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5
Q

What would a joint aspiration show if a patient had gout?

A
  • needle like, negatively bifringent in polar light crystals of monosodium urate
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6
Q

What would a joint aspiration show if a patient had pseudogout?

A

Rhomboid and parallelogram shaped crystals which are positvely bifringent to polarised light and made of calcium pyrophosphate crystals

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7
Q

Apart from Pseudo/Gout, what else can a joint aspiration be used for?

A

Gram stain and culture for septic arthritis

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8
Q

What antibodies are used for rheumatoid arthritis?

A

Rheumatoid factor Anti-CCP (more sensitive)

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9
Q

What might Anti-ds DNA suggest?

A

SLE

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10
Q

What anti-bodies indicate sjogrens disease?

A

Anti- LA Anti- Ro Also present in SLE

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11
Q

What auto-antibodies work in polymyositis dermatomyostitis?

A

Anti-Jo1 Anti-Mi2

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12
Q

What does anti Scl-70 indicate?

A

Systemic sclerosis

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13
Q

What ANCA is present in Granulomatosis and polyangitis?

A

c-ANCA

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14
Q

What ANCA is present in Churg-Strause?

A

This is Eosinophilic granulomatosis and polyangitis. p-ANCA is present

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15
Q

What is the True positive rate (Sensitivity)?

A

TP/(TP+FN) - ability of a test to rule in or detect the disease

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16
Q

What is the True negative rate (specificity)?

A

TN/(TN+FP) - ability of a test to rule out or exclude the disease

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17
Q

What should be considered when giving steroids?

A

PPI Vit D Biphosphonates

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18
Q

What side effects are there to steroids?

A

• Myopathy – muscle wasting • Osteonecrosis • HPA axis dysunction • DM, fluid retention, lipogenesis • Gastric ulcer • Hirtuism • Skin thinning • Catarcts • Increased cardiovascular risk

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19
Q

What DMARDs are there?

A

Aziothioprine Methotrexate Sulfalazine Hydrochloroquine Leflonomide

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20
Q

What is the definition of a pathological fracture?

A

A fracture in abnormal bone (metabolic, metastatic, infected, osteopenic or osteomalacia)

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21
Q

What principles are there for management of a fracture?

A

Reduce - approximate anatomically the broken tissues Immobilise - Casts, surgical stabilisation Rehabilitate - physio

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22
Q

What systemic factors can cause a delay in bone union?

A

poor blood supply like that of scaphoid, distal tibia, stability and infection

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23
Q

What local factors can cause a delay in bone union?

A

diet, DM, smoking (big time), HIV and medication (corticosteroids and NSAIDS)

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24
Q

What nerve palsy is associated with a Midshaft of the humerus fracture?

A

Radial nerve

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25
Q

What nerve palsy is associated with a Fibular neck fracture?

A

Common peroneal fracture

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26
Q

What nerve palsy is associated with a Supracondylar humeral fracture?

A

Median nerve

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27
Q

What nerve palsy is associated with a shoulder dislocation?

A

Axillary nerve - deltoid, teres minor and some of the triceps

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28
Q

What nerve palsy is associated with a Hip disclocation?

A

Sciatic nerve

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29
Q

What is the definition of osteoporosis?

A

Bone mineral density that lies 2.5 SD away from average for a normal person when accounting for age, race and sex

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30
Q

What investigation might be considered for rheumatoid arthritis?

A
  • Base line bloods – FBC, LFT, U&E - Inflammatory markers - TFTs - Immunology -RF, anti-CCP, ANCA - X-ray hands and feet
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31
Q

What is the NICE criterial for referral for rheumatoid arthritis?

A
  • Persistant synovitis - Urgent o Small joints of hand and feet are effected o More than one joint is effected o Delay of >3m between onset of symptoms and seeking medical advice
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32
Q

What conservative treatment is there for osteoarthritis?

A

o Patient education o Weight loss o Exercise and physiotherapy

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33
Q

What medical treatment is there fore oesteoathritis?

A

Analgesia - according to WHO Inter-articular steroid injections

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34
Q

What DD are there for a swollen joint?

A
  • Septic arthritis - Gout - Pseudogout - Haemarthrosis - Psoriatic arthritis - Reactive arthritis
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35
Q

What RF are there for gout?

A
  • Male - Alcohol intake - High purine intake – steak, oily fish and marmite - Diuretics - Overweight - Metabolic syndrome – DM, HTN ‘
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36
Q

What condition should be excluded before a diagnosis of gout can be made?

A

Septic arthritis

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37
Q

What is the management of acute gout?

A
  1. Analgesia - NSAIDS 2. Cholchicine - within 12 hours 3. Steroids
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38
Q

When should allopurinol be started?

A

o >2 attacks o Trophi identified (urate deposites) o CKD stage II o Urolithiasis

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39
Q

What is are the common side effects to allopurinol?

A

 Hypersensitivity  Rash  Increased risk of acute gout attack in first 6m of treatment

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40
Q

What is an alternative to allupurinol?

A

Febuxostat

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41
Q

Long term management of patient who has suffered from attacks of gout?

A

Lifestyle - decrease alcohol, decrease diet of fish oil, marmite. Medical - start urate lowering drug like allupurinol

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42
Q

When should a urate lowering therapy like allopurinol be started after an attack of gout?

A

Start 2-4 weeks post acute attack

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43
Q

What steps are needed to interpretate a joint XRAY?

A
  • Details - Site - Type of fracture - Simple or communicated - Displaced - Angulated - Bone consistency
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44
Q

What is communicated fracture?

A

break or splinter into more than two fragments

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45
Q

In a patient controlled analgesia what is lockout time?

A

That after patient give themselves more analgesia another dose will not be given for a give amount of time.

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46
Q

Patient has pain in calf after surgery which is resistant to analgesia. MLD?

A

Compartment syndrome

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47
Q

How is compartment syndrome managed?

A
  • position limb below level of the heart. - Release dressing - Emergency fasciotomy
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48
Q

What factors might slow a fracture from healing

A

smoking arterial supply - 5metacarpal, scaphoid DM Meds -steroids, NSAIDS diet smoking

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49
Q

What is nerve is at risk with a hip dislocation?

A

sciatic

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50
Q

What is nerve is at risk with a shoulder dislocation?

A

axillary

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51
Q

What is nerve is at risk with a supracondylar fracture of the humerus?

A

Median nerve

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52
Q

What is nerve is at risk with a fibular fracture?

A

Common perineal nerve

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53
Q

What is nerve is at risk with a mid shaft fracture of the humerus?

A

radial nerve

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54
Q

What is the definition of the osteoporosis?

A

BMD of 2.5 sd below the normal for a young person of a comparable rase and sex

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55
Q

What is a highly sensitive clinical test to diagnose compartment syndrome?

A

Pain on passive stretch

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56
Q

What management of servers open lower limb fractures?

A
  • IV abs stat - Restore vascular compromise within 6 hours - wound irrigation and decried meant IN THEARTRE
57
Q

What questions would help rule in or out osteogenesis imperfects from a family history?

A

FH of: - fractures - blue sclera - deafness

58
Q

Child falls with arms out stretched and a fracture occurs. What is the most likely fracture?

A

Supracondylar fracture elbow fracture

59
Q

What does an anterior fat pad on elbow X-ray suggest?

A

Elbow effusion, look for fracture.

60
Q

What is the anterior humeral line in the context of a elbow fracture?

A

the anterior cortex of the humeral bone should intersect the middle 1/3 of the capitellum head of the humerus. If not look for fracture. If posterior displaced consider supracondylar fracture.

61
Q

What is a common wrist fracture for osteoprortic adults?

A

Colles wrist fracture. distal radius is bent backwards

62
Q

Who commonly get buckle fractures?

A

Children - quick recovery in splint of around 3-4 weeks

63
Q

What to include in a ROS for rheumatology?

A

Start from head to toe Skin - Rashes, raynauds Hair loss Dry eyes or mouth SoB Bowel and urinary Discharge

64
Q

What is felty’s syndrome?

A

Anaemia

Lecaepenia

Enlarged spleen

65
Q

What criteria is used to diagnose RA?

A

2010 ACR/EULAR RA classification criteria

66
Q

How is RA activity monitored?

A

DAS 28 Acute phase protein - CPR or ESR

67
Q

What articular features are there of RA

A

Carpal tunnel syndrome Peulmomary effusion Episcleritis Felty’s anaemia Osteoporosis Sicca syndrome

68
Q

What joint are typically associated with RA> OA?

A

RA affects MCP and PIP OA affects DIP

69
Q

A patient has is diagnosed with high activity of RA. What is the recommended treatment?

A

combination DMARD methotrexate and HCI

70
Q

What Red conditions should be ruled out with a limping child?

A

Acute lymphoblastic leukaemia Septic arthritis Osteomyelitis of femur plevis NAI

71
Q

What symptoms indicate ALL?

A

Nocturnal pain

Night sweats

Weight loss

72
Q

What movement would a patient with septic arthritis have pain most in?

A

There would be pain on internal rotation. The patient/ child would be abducted

73
Q

What should also be examined in addition to a hip joint examination when there is hip pain?

A

Abdomen Hernia orifices Testicles Knee

74
Q

7 yo male with acute onset limp +/- pain and ROM. Patient is well. MLD?

A

Transient synovitis - ACUTE onset. Though admittedly did admit cold 2w ago. common in <10

75
Q

7 yo male with a gradual onset limp +/- pain. Patient is well. MDL?

A

Perthes disease - GRADUAL onset. common in < 10. Common in males

76
Q

Male 10-15 yo with cute hip pain. MLD?

A

Slipped epiphyseal femoral epiphyses. Pain can refer to knee.

77
Q

RF for SUFE?

A

Hypothyroidism Overweight

78
Q

What screening is there fore DDH?

A

Look for symmetry- leg length, skin folds Otolani test Barlow test

79
Q

What investigations are done for DDH?

A

USS or iff to old hip radiograph

80
Q

What is Otlani test?

A

Abdunction leading to Anterior dislocation Think Otlani = Out

81
Q

What is Barlows test?

A

Adduction leading to posterior dislocation

82
Q

When should juvenile idiopathic arthritis be suspected?

A

Arthritis in <16 yo who has 4 or more joints affected for > 3m

83
Q

What is diagnosis from the XRAY?

A

Bilateral - Perthes disease

84
Q

What is diagnosis from the XRAY?

85
Q

What woudl be done for a febrile child with limp who is non-weightbearing im GP land?

A

Urgent refferal to peadiatric or orthopeadics

86
Q

What is the history of a patient with Osgoods Schlatters disease?

A

Patient 10-15 which is more common in males. Pain worse on exerecise leads to inflammation of epiphiseal plate on patella tendon insertion on to tibial plate.

o/e Exagerated tibial tuberasity which in tender. Pian worse on hip flexion.

87
Q

Differentials of hip pain in a child

A

Septic ArthritisPerches diseaseTransient synovitisSlipped upper femoral epiphysisDevelopmental dysplasia of the hip JIACancerFracture Referred pain from knee, back, testes

88
Q

Transient synovitis

A

Boys aged 4-8Limp with or without pain Self limitingOccurs after URTItreat with ibuprofenResolves after few daysSepsis safeguard!

89
Q

Slipped upper femoral epiphysis

A

Boys over age of 10Usually obese or hypothyroidSudden onset painNon weight bearing Limp

90
Q

Developmental dysplasia of the hip

A

Girls, usually discovered at birth Change in leg length

91
Q

Perthes disease

A

Boys aged 4-8 Avascular necrosis of head of femur Can be bilateral

92
Q

Hip pain in child- Nocturnal pain, night sweats, weight loss

A

Think ALL!

93
Q

Treatment of osteoarthritis

A

Patient educationWeight lossExercisePhysioAnalgesia- WHO ladderCan escalate to steroid joint injectionsJoint replacement

94
Q

X-ray changes in osteoarthritis

A

Loss of joint spaceOsteophytesSubchondral cystsSubchondral sclerosis

95
Q

Osteoarthritis examination findings

A

Heberdens nodes on DIPBouchards nodes on PIPBoxing of hand

96
Q

Rheumatoid Arthritis X-ray findings

A

LESSloss of joint spaceErosionsSoft tissue swelling Soft bones (osteopenia)

97
Q

Rheumatoid arthritis clinical examination findings

A

Ulnar deviation of fingersSubluxation of jointsZ thumbBoggy joint swellingsSwan neck deformitiesBoutinierres deformity Can have nail changes

98
Q

Negatively birefringent needles under polarised light

A

Gout - urate crystals

99
Q

Treatment of gout

A

Ibuprofen or colchicine if ibuprofen contraindicatedFebuxostat also used Allopurinol if repeated attacks (be aware of increase in episodes in first 6 months)

100
Q

Risk factors for gout

A

High urate intake- red meats, marmite, alcohol Diuretic use especially thiazides Metabolic disorders (genetics)Dehydration

101
Q

Pseudogout

A

Calcium pyrophosphate crystalsWeakly positive rhomboid shaped crystals Treatment- ibuprofen, steroid injections, stay hydrated

102
Q

Describe a fracture

A

Simple vs comminuted Transverse, oblique, spiralSiteDisplaced or notAngulated or notIs the bone normal?Ask for lateral view

103
Q

Treatment of intra capsular neck of femur fracture

A

Hemiarthroplasty if not very active and co morbiditiesFull hip replacement if active and healthy or pre existing joint disease

104
Q

Presentation of hip fracture

A

Pain especially on greater trochanter and on rotation Usually after fallLeg externally rotated Shortened leg Non weight bearing Could be referred to knee

105
Q

Treatment of extra capsular NOF fracture

A

Dynamic hip screw or intramedullary fixation Think about bone protection, analgesia, IV access

106
Q

Secondary causes of OA in young people

A

Crystal deposition, acromegaly, haemochromatosis, Wilson’s disease, joint injury, surgery, SUFE, diabetes, syphillis, inflammatory arthritis

107
Q

Hot swollen painful joint

A

Septic arthritis until proven otherwise!GoutRheumatoid arthritis PseudogoutPsoriatic arthritisHaemoarhrosisReactive arthritis

108
Q

Symptoms of septic arthritis

A

Hot painful swollen jointSystemically unwellFeversAcute onset

109
Q

Diagnosis of septic arthritis

A

Joint aspirate and culture!!

110
Q

Treatment of septic arthritis

A

AnalgesiaBroad spec antibiotics eg ceftriaxoneUsually a stall aureus infection Look for underlying risks such as immunosuppression

111
Q

Back pain In 15-30 YOA

A

Prolapsed discTraumaFracturesAnkylosing spondylitis

112
Q

Back pain in 30-50 YOA

A

Degenerative spinal disease, prolapsed disc, malignancy

113
Q

Back pain in over 50s

A

Degenerative, osteoporotic vertebral collapse, pagets, malignancy, myeloma, spinal stenosis

114
Q

Positive straight leg raise

A

SciaticaUnder 50s due to prolapsed discOver 50 due to spinal stenosis

115
Q

Symptoms of lupus

A

Malar rashDiscoid rashPhotosensitivity Oral ulcersArthritisPleuritisRenal involvementHaematological involvementImmune involvementPositive ANA

116
Q

SLE antibodies

A

ANA >95% Anti dsDNA- over 60%

117
Q

Treatment for SLE

A

Anti inflammatories eg ibuprofenCorticosteroids during flare upImmunosuppressionSymptom control- suncream, kidney treatment if necessary

118
Q

Positive c-ANCA

A

Small vessel vasculitisMicroscopic polyangitisGPA

119
Q

GPA- granulomatosis polyangitis

A

Positive c ANCANasal crusting, lung lesions, saddle nose deformities

120
Q

P ANCA

A

Church StraussEosinophilia granulomatosis polyangitis EGPALinked with asthma

121
Q

Medium vessel vasculitis

A

Kawasaki- symptoms in children, fever, strawberry tongue, rash

122
Q

Giant cell arteritis

A

Temporal arteritisGive prednisone ASAP Need biopsy within seven days of starting pred to get positive biopsy.Increase ESR!!Jaw claudicationTemporal tendernessHeadache around eye

123
Q

Takayasu’s arteritis

A

Absent pulsesHappens in younger PeoplePET scan shows activityPred and strong DMARDS eg cyclophosphamide

124
Q

Polyarteritis nodosa

A

Associated with hep BGet aneurysms Control BP as affects kidneys

125
Q

Symptoms of fibromyalgia

A

Pain in at least 11 of the 18 pain points- above and below waist, either side of axis and on spineDifficulty sleepingChronic widespread pain lasting over three months

126
Q

Risk factors of fibromyalgia

A

Low education, low income, female, FH, traumatic event

127
Q

Treatment for fibromyalgia

A

Exercise!Screen for depression and anxiety Sleep hygiene

128
Q

Reactive arthritis

A

After GU or GI infectionReiter’s anterior uveitis, arthritis, urethritis

129
Q

Ankylosing spondylitis

A

Back pain In young malesHLAB27 positive in 90%Pain in sacroiliac joints

130
Q

Associations with ankylosing spondylitis

A

Aortic regurgitation Apical fibrosisigA nephropathyAnterior uveitisAchilles tendinitisAmyloidosis

131
Q

Treatment of ankylosing spondylitis

A
  1. Exercise2. Ibuprofen3. If necessary anti TNF-a or local steroid injections
132
Q

Symptoms of rheumatoid arthritis

A

Boggy swelling in handsStiffness and pain worse in morningSymmetrical usually in wrists, MCP, PIPPositive for RF and anti CCP

133
Q

Monitor rheumatoid arthritis

A

DAS28 helps to monitor disease activity

134
Q

side effects of methotrexate

A

Mucositis, penumonitis, oral ulcers, hepatotoxicity

135
Q

TNF alpha blocker side effects

A

Serious infection risk including reactivation of TB, hep BWorsens heart failureHypersensitivityInjection site reaction

136
Q

Anti Ro and Anti La

137
Q

CREST

A

Anti centromere antibodies

138
Q

Anti SCL 70

A

Scleroderma

139
Q

Anti ds DNA and ANA

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