MSK Flashcards

Question

name the types of biologic drugs

Answer 1

``` TNF alpha blockers - infliximab etanercept adalimumab certolizumab golimumab ``` rituximab (anti-CD20) abatacept (blocks T cell-APC interaction) tocilizumab (blocks IL-6) baricitinib, tofacitinib, upadacitinib (JAK inhibitors)

Answer 2

``` infective risk atypical infections (paronychia, oral candidiasis, pneumonia) hold if active infection reactivation of TB pneumonitis increased cancer risk (lymphoma, skin cancer) anaphylaxis MS-like illness HF ```

Answer 3

weekly folic acid, blood monitoring

Answer 4

no regular blood monitoring | before starting - CXR, hep B, C, HIV, varicella immunity ANA, IGRA (latent TB), immunoglobulins (rituximab only)

Answer 5

``` shuffling gait - Parkinsonism ataxic gait - cerebellar disease high stepping gait - syphilis intoning gait - foot progression angle Charlie Chaplin gait ```

Answer 6

weak gluteal muscles unilateral - dipping bilateral - waddling gait, John Wayne walk

Answer 7

short tibia | short femur

Answer 8

positive - the affected thigh raises off the bed indicating a loss of hip extension = a fixed flexion deformity of the hip

Answer 9

``` self-limiting disease seasonal 5-7 days URTI limitation of movement normal inflammatory markers diagnosis of exclusion - rule out septic arthritis of the hip ```

Answer 10

avascular necrosis dislocation (in sickle cell disease) osteomyelitis of femoral neck

Answer 11

think hip AP + frog lateral of both hips knee x-ray

Answer 12

bone infection that can interfere with growth and destroy bone

Answer 13

``` acute injury overuse - repetitive running, jumping sedentary infection tumour scoliosis kyphosis (Schuermann's) spondylosis spondylolisthesis ```

Answer 14

``` fever weight loss night pain pain at rest trouble walking weakness numbness in legs and feet pain that goes down one/both legs bowel/bladder problems ```

Answer 15

type of arthritis defined by wear and tear to the spine | scotty dog of LaChapelle

Answer 16

slipped vertebrae | acute fracture of pars

Answer 17

sciatic scoliosis (due to muscle spasm) listhetic torsional scoliosis both resolve after treatment of spondylolithesis occasional typical idiopathic curve above a spondylolithesis resolves separately

Answer 18

postural - excessive curve of the back rounds when bending | Scheuermann's - no smoothing of the back occurs due to structural changes in the spine

Answer 19

wedging of 3 adjacent vertebrae by at least 5 degrees or more thoracic kyphosis of >40 degrees thoracolumbar kyphosis >30 degrees

Answer 20

``` failure to walk (paraplegia) abdominal pain back pain tight hamstrings loss of spinal rhythm inflammatory markers ```

Answer 21

sacro-iliitis (body piercings) discitis (abdominal pain) spinal tuberculosis tumour

Answer 22

``` eosinophilic granuloma osteoid osteoma osteoblastoma aneurysmal bone cyst metastatic neuroblastoma spinal cord tumours spinal cord developmental lesions (diastematomyelia) cord tethering ```

Answer 23

osteoid osteoma

Answer 24

DIP flexion | callus/corn forms when the toe rubs the shoe

Answer 25

PIP flexion | callus/corn forms when the toe rubs the shoe

Answer 26

PIP flexion MTP extension push-up test

Answer 27

the ball of the foot becomes painful and inflamed

Answer 28

``` hold heel neutral in palm observe relationship of 1st MT head overactive peroneus longus shoes with drop-in toe box lateral forefoot wedge ```

Answer 29

sepsis crystals blood ``` false/first presentation of inflammatory arthritis reactive arthritis pigmented villonodular synovitis chondrosarcoma osteoid osteoma metastatic disease mensical tear osteonecrosis fracture ```

Answer 30

``` immunocompromised IV drug abuse diabetes recent bacteraemia (chest, urine, throat, skin breaks) at risk/recent STI direct penetrating wound local skin infection ```

Answer 31

``` previous episodes previous podagra excess alcohol diuretics renal impairment ```

Answer 32

bleeding disorder anticoagulants trauma

Answer 33

``` gram stain WCC crystals joint XR CXR urinalysis urine/swab (gonorrhoea, chlamydia) ``` always aspirate always take blood cultures

Answer 34

haematogenous spread from other infection (UTI, LRTI) local spread, local tissue infection, penetrating trauma can cause rapid joint destruction

Answer 35

``` staph aureus (commonest) staph epidermis neisseria gonorrhoea viruses fungi ```

Answer 36

``` IV flucloxacillin and benzylpenicillin/po fusidic acid IV clindamycin if penicillin allergic x 6 weeks regular joint aspiration/lavage fluid balance analgesia rest ice packs thromboprophylaxis failure to improve - artificial joint, surgical washout ```

Answer 37

precipitation of monosodium urate crystals in tissue, most often causing recurrent acute or chronic arthritis

Answer 38

asymptomatic hyperuricaemia acute gout intercriticial gout (between attacks) chronic tophaceous gout

Answer 39

``` decreased excretion (hereditary, alcohol, diuretics, renal impairment) increased production (blood cancers, cancer treatment, psoriasis, obesity, HGPRT deficiency) increased purine intake/dietary (liver, kidney, herring, mussles, sweetbreads) ```

Answer 40

very severe pain may settle spontaneously usually 1st MTP mono arthritis (podagra) in early attacks but ankle, knee wrist and elbow also seen later attacks - spread to other joints/soft tissue triggers - trauma, surgery, drugs, stress

Answer 41

``` routine bloods serum urate (query usefulness in acute attack) aspirate joint fluid x-ray bedside US ```

Answer 42

``` gouty changes on US gouty erosions (x-ray) negatively birefringent needle shaped crystals on polarised light microscopy ```

Answer 43

``` ease pain and inflammation NSAIDs colchicine steroids (oral, IM, intra-articular) ice packs rest recurrent/tophi/x-ray changes/urate nephropathy - prevention strategy ```

Answer 44

tissue deposition of uric acid toothpaste-like material inflammation and tissue damage chronic tophaceous gout - chronic symmetric deforming arthritis

Answer 45

lower urate <0.30mmol/L xanthine oxidase inhibitors - allopurinol, febuxostat (safer in renal impairment) NSAID or colchicine cover required warn patient regarding risk of flare

Answer 46

minimal clinical manifestations intermittent attacks of acute arthritis (pseudo gout) knees most commonly then wrists degenerative arthropathy, often severe (chronic pyrophosphate arthritis)

Answer 47

unknown cause | associated with haemochromatosis, hyperparathyroidism

Answer 48

gout is caused by uric acid crystals | pseudo gout is caused by CPPD crystals

Answer 49

aspirate joint fluid for crystals and culture CPPD crystals in synovial fluid chondrocalcinosis on x-ray

Answer 50

NSAIDs and/or corticosteroid joint injections - shorten pain duration and dysfunction of acute attacks colchicine - prevent attacks control inflammation - halt progress of joint degeneration

Answer 51

``` trauma anticoagulation clotting disorders fracture pigmented villonodular synovitis (rare) ```

Answer 52

joint aspiration | management - rest, analgesia, ice, correct underlying coagulopathy

Answer 53

inflammation of the sacroiliac joint

Answer 54

umbrella term for inflammatory diseases that affect the back, pelvis, neck, some other joints, intestines, eyes most common of which is ankylosing spondylitis

Answer 55

axial - axial spondylitis, non-radiological axial spondyloarthropathy peripheral - psoriatic arthritis, enteropathic arthritis, reactive arthritis, undifferentiated anterior uveitis, inflammatory back pain, enthesitis, erythema nodosum, asymmetric peripheral arthritis

Answer 56

``` back pain <45yrs that persists >3months worse in the morning and during the night improves with exercise and NSAIDs alternating buttock pain may affect upper back/ribs tendinitis, fasciitis, dactylitis fatigue fever recurrent unilateral uveitis HLA B27 + (>90% positive, but being positive is not a diagnosis of AS) elevated acute phase reactants ```

Answer 57

``` schober displacement >5cm faber's test to stress SI joints acute uveitis aortic incompetence apical lung fibrosis scalp and nail examination (psoriasis, reactive arthritis, IBD) ```

Answer 58

``` ESR and CRP not always elevated seronegative (anti-CCP, RF) faecal calprotectin (IBD) joint fluid aspiration (usually non-specific) US x-ray MRI ```

Answer 59

nail pitting, leukonychia, crumbling, subungal keratosis, onycholysis, splinter haemorrhages ethesitis dactylitis more likely to be asymmetrical

Answer 60

NSAIDs regular exercise/stretches biologics peripheral manifestations (arthritis, enthesitis, dactylitis) - local steroids, DMARDs (methotrexate, sulfasalazine)

Answer 61

``` NSAIDs exercise antibiotics (doxycycline for chlamydia) methotrexate - psoriasis and IBD sulfasalazine - settle UC leflunomide anti-TNF, anti-IL17, JAK inhibitors ```

Answer 62

robust activation of PG E2 and the IL-23-IL-17 axis, leading to the influx of innate immune cells mesenchymal tissue responses and new bone formation

Answer 63

IL-17, IL-23 and TNF inhibition NSAIDs can help DMARDs largely ineffective

Answer 64

calcification - DEXA architecture - biopsy rate of gain/loss - bone enzymes

Answer 65

average bone density of a 25yo

Answer 66

low bone mass and microarchitectual deterioration of bone tissue leading to enhanced bone fragility and increase in fracture risk

Answer 67

a broken bone after falling from standing or sitting or with a degree of force not normally associated with breaking a bone typically hip, vertebra, wrist, ankle, shoulders, upper arm

Answer 68

``` post-menopausal steroid use FHx poor diet - Ca, protein, vitamin D alcohol (men) smoking lack of weight bearing exercise breast and prostate cancer treatments epilepsy drugs ```

Answer 69

``` 1000-1200mg Ca 50-60g protein >50mmol/L vitamin D (absorbs and prevents Ca loss) bisphosphonates denosumab teriparatide HRT therapy ```

Answer 70

renal failure - not converted to its active form hyperparathyroidism - vitamin D causes Ca levels to rise obesity - stored in fat tissue and require high doses

Answer 71

act on osteoblasts taken on an empty stomach and cannot lie down afterwards >10 years, no evidence that they continue to increase BMD or reduce fractures increased risk of rare adverse events (AFF, ONJ) reduce osteoclast healing of micro-cracks in bone and sockets in jaw drug holiday reduces AFF and ONJ risk but continue Ca and vitamin D

Answer 72

sc injection every 6 months biological drug (antibody) bind RANKL stop communication between cells and switch off osteoclasts does not build up in bones rapid loss of BMD and increase fracture risk above previous for a short period if stopped

Answer 73

daily hormone injection (PTH) | most severe cases (T score

Answer 74

increased risk of breast cancer especially with O&P HRT large decline in fracture risk

Answer 75

``` dsDNA - SLE scl-70 - diffuse systemic sclerosis centromere - limited systemic sclerosis Ro/La - sjogrens jo-1 - polymyositis lupus anticoagulant - antiphospholipid syndrome ```

Answer 76

UV exposure genetic female sex hormones chlorpromazine

Answer 77

``` skin (photosensitive, malaria and discoid rash) alopecia arthralgia/arthritis raynaud's oral ulceration pleuritis, pericarditis, peritonitis nephritis/nephrotic syndrome seizures, psychosis, cognitive dysfunction, stroke, headaches anaemia leucopenia thrombocytopenia fever, fatigue, weight loss phlebitis arterial/venous thromboembolic phenomenon recurrent miscarriage liver reticularis ```

Answer 78

``` ANA ESR dsDNA complement FBC - lymphopenia U&E, LFTs urinalysis ACR antiphospholipid Ab lupus anticoagulant CK anti-CCP RF skin and renal biopsies ```

Answer 79

hydroxychloroquine - withdrawal associated with disease flare, continue in pregnancy, ocular screening sunscreen consider vitamin D more severe - prednisolone, methotrexate, azathioprine, mycophenolate more resistant - cyclophosphamide, belimumab

Answer 80

gottrons papules photo distributed rash heliotrope rash mechanics hands

Answer 81

``` proximal muscle weakness weakness of neck flexors respiratory muscle (dyspnoea) cardiac muscle oesophageal muscle (dysphagia) interstitial pneumonitis raynauds ```

Answer 82

``` autoantibody screen CK EMG MRI muscle biopsy CXR PFTs CT paraneoplastic screen ```

Answer 83

steroids steroid sparing agent (methotrexate/azathioprine) hydroxychloroquine for skin

Answer 84

multi systemic disorder characterised by skin tightening (excess collagen) vascular ischaemia other autoimmune features defined as limited or diffuse

Answer 85

limited initial skin involvement distal to elbows, feet, face anticentromere antibody

Answer 86

widespread initial skin involvement | SCL-70 antibody

Answer 87

``` calcinosis cutis raynauds oesophageal involvement sclerodactyly telangiactasia ```

Answer 88

``` pulmonary artery hypertension interstitial lung disease cardiac involvement (fibrosis, cardiomyopathy) GI involvement with malabsorption acute renal crisis ```

Answer 89

white - ischaemic blue - deoxygenated red - reperfusion

Answer 90

primary (if no other associated rheumatic disease) or secondary management - good hand care, avoid triggers, double gloves/socks, smoking cessation, Ca antagonists further management - fluoxetine, IV prostanoids, phosphodiesterase 5 inhibitors

Answer 91

fibrosis of exocrine glands associated with anti-Ro and anti-La antibodies primary or secondary

Answer 92

``` dry eyes dry mouth vaginal dryness parotid swelling Raynaud's arthralgia/arthritis ``` risk of lymphoma high ESR and IgG level

Answer 93

``` recurrent oral and genital ulceration acneiform lesions pustules nodules erythema nodosum uveitis neurological disease vascular disease arthritis no specific antibody test pathergy test ```

Answer 94

1 or 2x daily fever rash - salmon pink maculopapular arthritis high ESR, ferritin, WCC

Answer 95

inflammation of blood vessel wall narrowing and occlusion tissue or organ damage focal aneurysm formation

Answer 96

``` relatively rare giant cell arteritis ANCA associated treated with immunosuppressive therapy long-term morbidity - disease flare, low-grade grumbling disease, damage from previous disease activity, damage from drug therapy ```

Answer 97

``` ethnicity genes (HLA) gender UV light viral (hep b, c, HIV, parvovirus, CMV, varicella zoster) toxins drugs allergy smoking ```

Answer 98

``` purpura ulcers sinusitis bloody nasal discharge/crusting deafness hoarseness scleritis uveitis orbital mass glomerulonephritis confusion seizures peripheral neuropathy mononeuritis multiplex fever weight loss malaise arthralgia ```

Answer 99

vasculitis of large and medium arteries | particularly cranial arteries

Answer 100

``` headache scalp tenderness visual disturbances jaw/tongue claudication polymyalgia weight loss fever tender thickened temporal artery with reduced/absent pulse tender scalp retinal change (ischaemic optic neuropathy) granulomatous inflammation on temporal artery biopsy US halo sign PET-CT ```

Answer 101

prednisolone oral 40-60mg daily visual involvement - IV methylprednisolone at least 1yr tocilizumab (anti IL-6)

Answer 102

``` easy bruising osteoporosis steroid induced diabetes increased risk of infection GI toxicity proximal myopathy mood changes cataracts increased cardiovascular risk HTN ```

Answer 103

``` <20yrs palpable purpura/purpuric rash abdominal pain blood diarrhoea (bowel angina and ischaemia) self-limiting ```

Answer 104

anti-neutrophil cytoplasms antibody a subgroup of small vessel vasculitis with specific features granulomatous polyangitis GPA eosionophilic granulomatous polyangitis EGPA microscopic polyangitis MPA

Answer 105

``` nasal/oral inflammation (oral ulcers, purulent or blood nasal discharge, nasal deformity) saddle-nose deformity necrotic and purpuric skin lesions lung nodules haemorrhage glomerulonephritis granulomatous inflammation on biopsy c-ANCA ```

Answer 106

glomerulonephritis pulmonary haemorrhage no granulomatous inflammation p-ANCA

Answer 107

prodrome (lasts for years) - asthma, allergic rhinitis, nasal polyposis second phase - peripheral blood and tissue eosinophilia, chronic eosinophilic pneumonia/gastroenteritis third phase - systemic vasculitis, neuropathy

Answer 108

``` steroid and immunosuppressant combination prednisolone 1mg/kg/day (max 60) cyclophosphamide (associated with female infertility and bladder cancer) rituximab plasma exchange pneumocystis prophylaxis TB screening aggressive management of CV risk factors ``` once in remission - switch to azathioprine or methotrexate for maintenance

Answer 109

``` pain and stiffness of shoulder and pelvic girdle early morning stiffness fever fatigue anorexia weight loss overlap with temporal arteritis subacromial/subdeltoid bursitis and trochanteric bursitis on US ```

Answer 110

poor defined syndrome of widespread aches and pains associated with fatigue, poor sleep pattern and functional symptoms poor circulation - tingling, numbness, swelling in hands and feet irritability/feeling miserable urgency (especially at night) irritable/uncomfortable bowels (diarrhoea, constipation, abdominal pain)

Answer 111

resassurance self-management graded aerobic exercise amitriptyline

Answer 112

``` degen disc disease herniated disc spinal stenosis tumour infection cauda equina ```

Answer 113

``` non-mechanical pain onset <20 or >55yrs thoracic pain systemic symptoms widespread neurological symptoms bilateral symptoms ```

Answer 114

early - bilateral leg symptoms, urinary symptoms (hesitancy, change in sensation), sexual dysfunction late - saddle anaesthesia, retention with overflow urinary incontinence, foot weakness

Answer 115

``` backpain radicular pain sensory loss lower limb weakness loss of sphincter control ```

Answer 116

anterior - iliofemoral and pubofemoral ligaments | posterior - ischiofemoral ligament

Answer 117

``` analgesia functional ability stiffness/deformity clicking/snapping referred childhood hip problems ```

Answer 118

neurological examination of joint above and below

Answer 119

joint aspiration CT MRI (avascular necrosis) MR arthrogram

Answer 120

an irreversible degenerative disorder that results from the biochemical breakdown of articular (hyaline) cartilage in synovial joints predominately involves weight-bearing joints

Answer 121

``` idiopathic (primary) trauma infection AVN childhood hip disorder crystal deposition previous RA skeletal dysplasia metabolic (haemarthrosis, hyperparathyroidism) neuropathic (Charcot's arthropathy) ```

Answer 122

``` pain on weight bearing pain at night cyclical referred pain painful, restricted ROM stiffness deformity, crepitus (knee) x-ray - loss of joint space, osteophytes, subchondral cysts, sclerosis ```

Answer 123

surgical - total (hip/knee) replacement, osteotomy, arthrodesis, girdlestone excision arthroplasty, uni-compartmental knee replacement (medial, lateral, patellar femoral)

Answer 124

``` dislocation infection neuromuscular injury limb length inequality DVT/PE fracture bleeding/transfusion persistant pain life/revision anaesthetic risk ```

Answer 125

``` femoral neck fracture posterior hip dislocation steroids alcohol coagulopathy sufe perthes' ```

Answer 126

swelling (effusion, haemarthrosis, baker's cyst) deformity (genu algum/varum, patella position) muscle bulk (quads wasting) gait (antalgic)

Answer 127

PFJ crepitus extensor lag spingy block (bucket handle meniscal tear) rigid block (fixed flexion deformity)

Answer 128

MCL - valgus stress test LCL - varus stress test ACL - anterior drawer test, Lachmann's test, pivot shift test PCL instability - posterior sag, posterior drawer test meniscal tests

Answer 129

``` routine bloods x-ray CT MRI joint aspiration ```

Answer 130

``` osteoarthritis OA RA gout pseudogout chondromalacia patella bursitis baker's cyst patella tendonitis osteochondritis dessicans (OCD) ```

Answer 131

``` osteoarthritis pain stiffness reduced function substantial impact on QOL ```

Answer 132

``` infection DVT/PE neurovascular injury fracture bleeding/transfusion persistant pain lifetime/revision anaesthetic risk ```

Answer 133

``` genetics obesity age diet (alcohol, fructose-based drinks, seafood) kidney disease metabolism issues diuretics trauma ```

Answer 134

uric acid crystals in knee aspirate NSAIDs - can work really well if taken as soon as symptoms appear rest - elevate the joint to reduced swelling and avoid strenuous activity steroids - orally or IM can reduce inflammation

Answer 135

``` age post trauma genetic mineral imbalances underactive thyroid ```

Answer 136

pain at the front of the knee especially on going downstairs after sitting for long periods many noises when moves damage to the cartilage at the back of the knee cap usually due to a combination of muscle imbalance, altered biomechanics and overuse exercises, knee straps, medications, shoe insoles, activity modifications

Answer 137

general pain and swelling around the knee excessive friction due to running, jumping or muscle tightness can lead to bursa swelling rest from aggravating activities and strengthening and stretching exercises

Answer 138

pain and swelling around the knee fluid associated with arthritis or a cartilage tear leaking into the bursa and causing it to swell after any knee damage ice, medication, injections to reduced pain and swelling, exercise surgery in severe cases

Answer 139

pain just below the kneecap, especially after prolonged rest/exercise knee stiffness early morning repetitive jumping and kicking leads to small tears and weakness in the tendon rest from any activities that cause pain, exercise, surgery, knee straps

Answer 140

pain, locking and clunking sensations, limited movement and swelling genetic, minor repetitive joint damage from movements such as jumping and kicking rest, physical therapy, knee braces surgery if necessary

Answer 141

``` alignment valgus/varus hindfoot mid foot deformity single and double heel raise joint stability ```

Answer 142

``` AP and lateral weight bearing x-rays US MRI CT isotope bone scan ```

Answer 143

``` pain swelling stiffness deformity associated with osteoarthritis, RA, post-traumatic arthritis ``` analgesia ankle support/bracing injection surgery - arthrodesis of affected joints

Answer 144

medial ankle pain becomes lateral ankle pain as deformity progresses difficulty performing single heel raise too many toes sign x-ray, US, MRI conservative initially surgery - repair or reconstruct the tendon and correct the deformity or fuse the hindfoot if arthritis present

Answer 145

``` achilles tendinopathy plantar fasciitis (fasciopathy) ``` physiotherapy do not inject into achilles tendon due to rupture risk injection of plantar fascia helps but also risks rupture shockwave therapy

Answer 146

bunion; painful bony bump on the medial foot painful when wearing tight footwear hereditary x-ray; confirms the degree of deformity and assesses the joints orthotics footwear modification physiotherapy surgical correction; depends on severity, 1st MTP condition and patient

Answer 147

``` arthritis of the 1st MTP pain stiffness swelling dorsal bunion ``` ``` footwear modification orthotics analgesia surgery; depends on degree of arthritis, level of activity cheilectomy for early arthritis arthrodesis of advanced arthritis ```

Answer 148

freibergs disease, stress fracture, inter metatarsal bursitis metatarsalgia thickening and irritation of interdigital nerves 3rd web space, sometimes 2nd shoe modification orthotics physiotherapy can be excised if still painful

Answer 149

chronic instability; injury to ATFL +/- CFL stability relies on proprioception, neuromuscular control, integrity of ligaments and tendons medial deltoid injury (less common) physiotherapy orthotic management bracing surgery; failed conservative treatment, lateral or medial ligament reconstruction

Answer 150

plain x-ray US CT MRI/athropathy

Answer 151

usually young people involved in sport commonly anterior posterior dislocation associated with seizures and electrocution multidirectional associated with joint laxity

Answer 152

depends on age, recurrence, direction, joint laxity, physiotherapy engagement management options determined by imaging findings (MR arthrogram goes standard) surgery - arthroscopic/open shoulder stabilisation procedures

Answer 153

may be history of trauma gradually increasing severity of pain with reducing ROM as pain settles, range of movement becomes the problem ``` analgesia glenohumeral steroid injection physiotherapy hydrodilatation manipulation under anaesthetic arthroscopic arthrolysis ```

Answer 154

subchondral sclerosis joint space narrowing osteophytes subchondral cysts

Answer 155

analgesia local anaesthetic and steroid injections lifestyle modifications physiotherapy surgery - depends on how badly QOL is affected hemi-shoulder replacement total shoulder replacement reverse geometry total shoulder replacement

Answer 156

flexor tendons; 2 to each finger, FPL flexor sheaths/pulleys dorsal extensor compartments

Answer 157

median; LOAF, sensation to thumb, index, middle and radial 1/2 ring finger ulnar; all other intrinsics, ulnar 1/2 ring and little finger (dorsal sensory branch) radial; sensation to dorsum 1st web space

Answer 158

``` muscle wasting flexors or extensors pain on resisted movement median and ulnar; sensory and motor radial; sensory only collateral ligaments; UCL thumb, MCP/PIP joints volar plate ```

Answer 159

middle-aged females armpit diabetes; CTS vs peripheral neuropathy steroid injection surgical release

Answer 160

painful popping or catching finger jamming in flexion reduced flexion steroid injection surgical release

Answer 161

m>f ulnar side fixed flexion deformity and cord increased risk with DM, alcohol, anti-epileptics, FH surgical excision collagenase injections

Answer 162

outer annulus - concentric rings, type 1 collagen | inner nucleus - water, proteoglycans, type 2 collagen, cells

Answer 163

``` water loss disaggregation of proteoglycans collagen changes cell death loss of height ```

Answer 164

degenerative disc disease

Answer 165

herniated disc | spinal stenosis

Answer 166

neoplasia infection inflammatory

Answer 167

GI disease renal abdominal aortic aneurysm

Answer 168

``` non-mechanical (inflammatory) pain onset <20 or >55yrs thoracic pain PMHx carcinoma, steroids, HIV systemic symptoms - malaise, weight loss, fever widespread neurological symptoms ```

Answer 169

decreased sensation on dorsum of foot | decreased power EHL

Answer 170

depressed ankle jerk creased sensation on sole of foot creased power plantar flexion of foot

Answer 171

x-ray | MRI - can confirm clinical suspicion of herniated discs

Answer 172

most commonly at L4/5 and L5/S1 30-50yrs root pain nerve root irritation nerve root compression positive scan

Answer 173

non-surgical treatment for at least 1 month; narcotics (pain control), epidural corticosteroid injections exceptions; cauda equina syndrome, progressive foot drop severe pain and neurological deficits; MRI and consider surgery

Answer 174

middle ages f>m nerve root pain neurogenic claudication

Answer 175

acquired/developmental narrowing of the spinal canal >55yrs root pain neurogenic claudication + scan exclude all other causes of loss mobility

Answer 176

``` variable claudication distance delayed relief after walking pain eases on sitting or flexing sharp/numb pain moves proximal to distal back pain common ``` nerve root-like pain or paraesthesia in the legs follows a progressive course if it becomes socially disabling will require surgery

Answer 177

``` fixed claudication distance immediate relief after walking pain eases on standing pain when walking up hill/cycling crampy pain moves distal to proximal back pain uncommon ```

Answer 178

``` physiotherapy (reduce risk of falls) analgesics NSAIDs epidural corticosteroids surgical decompression spinal fusion + decompression if addition spondylolisthesis ```

Answer 179

85% due to secondary deposits metastatic; lung, breast, prostate, renal, GI, unknown haemopoeitic malignancies; myeloma, lymphoma

Answer 180

low back pain of at least 3 months duration improved by exercise and not relieved by rest limitation of lumbar spinal motion in sagittal (sideways) and frontal (forwards and backwards) planes chest expansion decreased relative to normal values bilateral sacroiliitis grade 2-4 or unilateral sacroiliitis grade 3 or 4

Answer 181

increasing unilateral or bilateral root pain | difficulty with urinary voiding

Answer 182

loss of perineal sensation urinary incontinence or retention foot weakness

Answer 183

``` back pain radicular pain sensory loss lower limb weakness loss of sphincter control ```

Answer 184

oral corticosteroids dexamethasone 8mg PO BD tapering regimen post-operatively

Answer 185

spectrum shallow acetabulum to dislocation FHx breech female first born

Answer 186

abnormal skin creases leg length discrepancy limitation of abduction Barlow's and ortolani's (hip out) tests x-ray US

Answer 187

pavlik harness; <6 months, in hips that can be reduced monitored clinically and by US risk of AVN

Answer 188

predominately boys pain, limp, restricted ROM, epiphyseal dysplasia may be bilateral but never symmetrical

Answer 189

no treatment shown to effect long term outcome symptomatic relief; analgesia, rest, traction ROM maintenance containment of femoral head younger do well and older do worse

Answer 190

peak age 11.5 girls and 12.5 boys 50% not obese 50% thigh pain, 25% knee and thigh pain, 25% knee pain

Answer 191

``` trauma irritable hip septic arthritis perthes SUFE arthritis ```

Answer 192

abductor weakness; lever arm, muscle weakness hip dysplasia cerebral palsy

Answer 193

cerebral palsy congenital clubfoot neurological/muscular disorders

Answer 194

internal femoral torsion internal tibial torsion metatarsus adductus adducted great toe

Answer 195

external femoral torsion | external tibial torsion

Answer 196

intramalleolar separation >8cm

Answer 197

intracondylar separation >8cm

Answer 198

``` exclude neurology cerebral palyst friederich's ataxia CMT polio ```

Answer 199

should walk by 18 months ``` asymmetrical progressive painful loss of motion fixed ```

Answer 200

traumatic bone or joint injury focal bone lesions established arthritis

Answer 201

widely available relatively low radiation dose excellent spatial resolution poor soft tissue detail arthritis; poor sensitivity for erosions of synovitis 2D image

Answer 202

no radiation dose god soft tissue resolution for superficial structures allow dynamic assessment facilitates image guided interventions poor assessment of bone structures patient dependent; difficult if high BMI user dependent

Answer 203

excellent spatial resolution excellent bone detail multiplanar facilitates image guided injections, interventions and biopsy high radiation dosage poor soft tissue resolution vs MRI

Answer 204

no radiation dose excellent soft tissue resolution/contrast vs CT multiplanar time consuming prone to artefacts poor bone details vs CT contraindications; claustrophobia, pacemaker, cochlear implants, previous metallic injury (bomb blast)

Answer 205

injection of contrast into joint prior to MR imaging assesses labral (fibrocartilage) or chondral (cartilage) tears especially hip and shoulder posterior dislocations previous surgery

Answer 206

the presence of bone tumours or bony metastasis painful prosthetic joints the presence of infection, fractures or arthritis

Answer 207

highly sensitive to changes in bony metabolism; early detection of many pathological condition can be superimposed with CT or MRI to produce fusion images; correlation of findings between 2 different modalities (CT/PET, PET/MRI) low specificity often require further imaging high radiation dose

Answer 208

a velocity-dependent increase in muscle tone due to a disruption within the CNS insufficient descending inhibition

Answer 209

level T6 or above sympathetic hyperactivity secondary to noxious stimulus hypertension bradycardia sweating headache remove problem (bladder distension, sore, rectal distension) GTN spray clonidine

Answer 210

``` simple, quick end bearing rotational stability self suspension lower trim lines excellent sitting balance longer level arm ``` synovial leak flap necrosis low knee centre cosmetically poorer

Answer 211

``` early morning and evening stiffness generalised stiffness lasts >30 mins worse on rest eases with exercise, NSAIDs, steroids soft tissue swelling ```

Answer 212

``` stiffness as day progresses stiffness may be more localised lasts <30 mins night pain eases with rest worse with exercise crepitus and bony swelling ```

Answer 213

``` neck, back or buttock pain additional axial disease diarrhoea (IBD) psoriasis penile or vaginal discharge, dysuria (urethritis) painful red eyes (iritis) fever fatigue weight loss preceding illness ```

Answer 214

skin thinning and bruising, rashes - long-term steroid use nail pitting, onycholysis - nail fold vasculitis thenar eminence muscle wasting - carpal tunnel syndrome warm, swollen, tender joints - active synovitis

Answer 215

heberden's node | Bouchard's node

Answer 216

``` swan neck deformity boutonniere deformity rheumatoid nodules MCP subluxation ulnar deviation ```

Answer 217

DM IHD cerebrovascular disease COPD