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Year 5 > MSK > Flashcards

MSK Flashcards

1
Q

commonest cause of SA

A

staph aureus

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2
Q

staph aureus morphology

A

gram +ve cocci

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3
Q

treatment for SA

A

IV benzylpenecillin and flucloxacillin

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4
Q

what are contraindications to joint aspiration?

A

overlying infection or psoriatic plaques

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5
Q

what should joint aspiration be sent for

A

MS+C
gram stain
leukocyte count

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6
Q

what other condition is polymyalgia rheumatica commonly associated with

A

GCA

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7
Q

scalp tenderness, jaw claudication, painless visual loss

A

GCA

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8
Q

bloods in GCA

A

ESR raised
normocytic normochromic anaemia
LFT- low albumin, high ALP, high GGT

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9
Q

Definitive diagnostic test for GCA

A

temporal artery biopsy

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10
Q

treatment for GCA

A

60-100mg prednisolone OD/ in divided doses reduce once symptoms resolve. may need long term low dose to prevent recurrence

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11
Q

features of spinal cord compression

A

Spastic paraparesis / tetraparesis
Radicular pain at the level of the compression
Sensory loss below the level of the compression

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12
Q

cause of spinal cord compression

A

degenerative disc lesions- herniated disc
degerative vertebral lesions- OP
TB
epidural abscess
malignancy- mets (prostatae, thyroid) myeloma, menningioma, neurofibroma
epidural haemorrhage
Paget’s

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13
Q

nodes on distal interphalangeal joints

A

Heberdens

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14
Q

nodes on proximal interphalangeal joints

A

Bouchards

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15
Q

RFs for osteoarthritis

A 
genes
previous trauma
obesity
occupation
(note osteoporosis reduces risk)
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16
Q

Xray changes OA

A
  1. joint space narrowing
  2. osteophyte formation
  3. Subchondral cysts
  4. subarticular sclerosis
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17
Q

OA more in DIP/ PIP

A

PIP

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18
Q

common osteoporosis fractures

A

vertebral crush
femoral neck
colles

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19
Q

secondary causes of osteoporosis (ie not due to increased osteoclast activity)

A

endocrine
malabsorption
malignancy

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20
Q

3 RFs for osteoporosis

A

post menopause
glucocorticoid use
CKD/ CLD
low BMI

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21
Q

What is a T score

A

bone density score
>1 normal
-1 to -2.5 osteopenia
-2.5 osteoporosis

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22
Q

How often should DEXA be done if diagnosis of osteoporosis?

A

2 yearly (yearly if on steroids)

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23
Q

SEs of bisphosphonates

A

ostenecrosis of jaw

oesophagitis

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24
Q

advice for taking bisphosphonates

A

To be taken first thing in the morning, on an empty stomach
Not to eat for 30 minutes afterwards
To remain sitting upright or standing for 2 hours after taking

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25
Q

pink/red nodules on elbow that have a rubbery texture

A

rheumatoid nodules

26
Q

fingers become hyperextended at the PIP, and flexed at the DIP

A

swan neck deformity

27
Q

hand signs seen in RA

A 
Swan neck
subluxation of MCP
Z thumb
guttering
carpal tunnel
ulnar deviation
fixed flexion deformity
28
Q

dry eyes and dry mouth in RA

A

sjrogens

29
Q

pulmonary fibrosis in RA upper or lower?

A

All connective tissue diseases cause lower lobe fibrosis – except AS, which causes upper lobe fibrosis
All occupational diseases cause upper lobe fibrosis, except asbestosis, which causes lower lobe fibrosis

30
Q

systemic signs of RA

A

CVS- anaemia, vasulitis/ raynauds, pericarditis, CVD
resp- diffuse pulm fibrosis, lung nodules
GI
nervous- episcleritis/ scleritis/ uveitis, peripheral neuropathy
other- depression, lymphadenopathy

31
Q

how many joints involved for diagnosis of RA

A

> 3

32
Q

how long symptoms for diagnosis of RA

A

> 6 weeks

33
Q

serology in RA

A

RF, anti-CCP

may be ANA +ve

34
Q

Xray changes in RA

A

bony erosions, osteopenia

35
Q

methotexate is in which class of drugs?

A

DMARD- anti-folate drug

36
Q

SEs of methotrexate

A

GI upset, liver problems, teratogenic, myelosuppression, rash
dont take with alcohol

37
Q

pain and morning stiffness in shoulders/ pelvic girdle

A

polymyalgia rheumatica

38
Q

which drugs should be avoided in PMR

A

NSAIDs

39
Q

calcium pyrophosphate rhomboid crystals

A

pseudogout

40
Q

negatively birefringent needle shaped crystals

A

gout

41
Q

which drugs increase risk of gout

A

thiazides

42
Q

what skin changes are seen in chronic poorly controlled gout

A

tophi

43
Q

how does allopurinol work

A

xanthene oxidase inhibitor

44
Q

respiratory tract infection-> palpable purpura on buttocks, GI tenderness, athritis and glomerulonephritis-> haematuria

A

HSP

45
Q

small vessel vasculitis

A

HSP
churg strauss
Wegener’s granulomatosis

46
Q

Medium vessel vasculitis

A

polyarteritis nodosa

Kawasaki

47
Q

large vessel vasculitis

A

GCA

48
Q

symptoms of small vasculitis

A

purpura
urticaria
glomerulonephritis
splinter haemorrhage

49
Q

symptoms of medium vasculitis

A

ulcers
cutaneous nodules
digital gangrene
microaneurysms

50
Q

symptoms of large vasculitis

A 
limb claudication
assymetric BP
absence of pulses
bruit
aortic dilatation
51
Q

vasculitis
asthma
pANCA

A

Churg-Strauss

52
Q

vasculitis

renal failure/ glomerulonephritis cANCA

A

Wegener’s granulomatosis

53
Q

mechanical back pain

A

worse on movement, relieved by rest, systemically well. history of heavy lifting

54
Q

acute vs chronic mechanical back pain

A

acute <4 weeks

chronic >12 weeks

55
Q

nerve roots contributing to sciatic nerve

A

L4-S3

56
Q

Most commonly affected disc in sciatica

A

L5/S1 compressing S1 nerve root

57
Q

how might sciatica present

A

S1 nerve root – will cause symptoms from the buttocks to the foot, and particularly on the lateral side of the foot. There will be calf weakness, and altered ankle reflexes.

58
Q

patient supine, feels pain when leg at 30-70 degrees

A

sciatic stretch test

59
Q

how many prolapsed discs self resolve

A

90% if lasting >12 weeks need MRI

60
Q

What surgical procedure can be used for chronic prolapsed discs

A

microdiscectomy

61
Q

what is the most common cause of cauda equina

A

massive disc herniation needs MRI and surgical decompression.

62
Q

less common causes of nerve root compression (other than disc herniation)

A 
Neoplasm
Skeletal disorders – e.g. spondylosis, RA, Paget’s Disease
Infection – e.g. TB or abscess
Trauma
Vascular disease – e.g. haemorrhage

Year 5 (12 decks)

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