MSK Flashcards
Ottawa ankle rules:
o Point tenderness posterior to lat/med malleolus
o Inability to weight bear at least 4 steps at time of injury and at time of consultation
SEs of leflunomide
HTN
Hepatitis
GI disturbance
Hypospermia SE of which drug?
Sulfasalazine
also ILD
Felty’s Syndrome features + Rx
Triad: Splenomegaly + RA + NPenia
Other features:
LNopathy
skin ulcers
Rx:
Control RA
Consider splenectomy for neutropenia
Ddx for DIPJ involvement
OA
Psoriatic arthritis
Patterns of psoriatic arthritis
Symmetrical polyarthritis
Asymmetrical oligoarthritis
Spondylitis +/- sacro-ilitis
Arthritis mutilans: rare, involves significant deformation of fingers and toes
Blue sclera
Short and tall height
- associated with which vasculitis?
Ehler’s danlos
Almost essential criteria for Any Spond
Radiological evidence of sacro-iliitis
Minocycline SE
drug-induced lupus
ie. no longer used in acne Rx
Morning stiffness a feature of RA or OA
RA
Mild SLE uncontrolled by NSAIDs, ?Rx
Hydroxychloroquine
Monitoring for hydroxychloroquine
Annual eye assessment as can cause irreversible retinopathy
Most useful initial Ix if suspecting And Spond
Plain film XR
Score assessing joint flexibility
Beighton score, out of 9
Higher=more flexible
Caplan’s syndrome
Pulmonary fibrosis usually in coal miners/exposure to asbestos/silica, who have RA
AB associated with microscopic polyangiitis
P-Anca
Hot swollen wrist
Xray shows chondrocalcinosis
Pseudogout
Galeazzi sign
Assessing for DDH
Discrepancy in knee length when flex hip and knee to 90deg
Useful test after newborn period ie. >3mo
Common sites for osteosarcoma
Metaphyses of long bones
eg. around knee or proximal femur
Bone XR:
Osteolysis
Periosteal relaying
“onion skinning appearance”
Ewings sarcoma
Xray features of RA
LESS Loss of joint space Erosions (marginal) Soft tissue swelling Soft bones (osteopenia/porosis)
Mcmurrays test tests for?
MENISCAL tear
Initial treatment of compartment syndrome
Remove cast
Smith’s fracture
Fall onto BACK of hand
ie. distal radial fragment tilted ANTERIORLY
Scheurmanns disease Px
Most common cause of kyphosis in adolescents
13-16yo with poor posture and back pain
48 hour post pelvic fracture -> tachypnea++, petechial rash -> respiratory failure
What is this complication?
How do you reduce risk of it?
Fat embolism syndrome
~occludes blood vessels
Risk reduced if fracture immobilised early
Post fracture: Pink, sweaty, stiff and tender hand. Intact pulses
Dx and Rx?
Reflex sympathetic dystrophy
Rx: NSAIDs + physic
Carpal tunnel S initial Rx
Physio
Post-THR advice
o Avoid >90deg flexion
o Avoid low chair
o Don’t sit cross-legged
o Sleep on your back for 6/52
Positive femoral nerve stretch test ?cause
Referred lumbar spine pain ~femoral nerve compression
Osteoporisis therapy
o 1st: alendronate (other: risedronate, etidronate)
o 2nd: strontium ranelate or raloxifene
o 3rd: denosumab 6 monthly injections
Boxer’s # definition + Rx
= # of 5th MC
Rx:
Place in volar splint
Discuss with hand/plastic surgery as may need surgical fixation
Trochanteric bursitis ftrs
o Isolated lateral hip pain (can radiate) + GT tenderness
o Eg. not able to lie on side
o Commonly seen after increase in activity
o ~50-70yo women
Radiographic finding of chondrocalcinosis ?cause
A feature of pseudogout that can differentiate it from gout
Osteonecrosis of femoral head presentation and RFs
GRADUAL ONSET
RFs: Long term steroid use Hypercoagulable state AI Alcohol
Ank spond Rx:
o NSAIDs + regular exercise + PT
o DMARDs for RA reserved if there is peripheral J involvement
o Ongoing research re: timing of introduction of anti-TNF
Knee locking + giving way + Thessaly’s test + worse on straightening
~meniscal tear
Knee jerk reflex
~L3-4
Ankle reflex
S1-2
L5 lesion + reflexes?
intact
Relationship between BMI and osteoporosis
Low BMI a RF - not obesity
Features of facet joint pain
tender facets
worse on extension of back
worse in morning
worse on standing
Triceps reflex
C6-7 predominantly C7
Allopurinol prescribing for gout
After 1st attack, when settled
• initially 100mg with NSAID/Colch cover
+ve sciatic nerve stretch test
~L5-S1 compression
o L5: weak dorsiflexion and dorsal sensation
o S1: weak plantar flexion and posterolateral sensation + reduced ankle reflex
Recurrent gout + PUD ?Dx
~features of polycythaemia
Trigger finger features, RFs, Rx
~pain on flexion + gets stuck + nodule at base of finger
RFs: DM, RA, women
Rx: steroid injection +/. Finger splint +/- ?surgery if non responder
Chondromalacia patellae/Patellofemoral painsyndrome
Definition
Risk group
Px
Rx
~softening of cartilage due to use
o ~teenage girls
o Px: pain without effusion, whenclimbing stairs or rising from sitting
o Rx: physio
• De Quervians tenosynovitis
Definition
Features
Rx
= Inflamed tendon sheath of APL + EPB
o Pain on radial side of wrist
o Tender radial styloid
o Abduction of thumb against resistance = pain
Rx: analgesia, steroid, splint, ?surgery
NB. Finkelsteins test: flex thumb, put wrist in flexion and ulnar deviation = pain
First line treatment of Paget’s
alendronate
