Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Practice > MSK > Flashcards

MSK Flashcards

1
Q

what are the signs and symptoms of osteoarthritis?

A

1st CMC
hip/knee
nodal OA; PIP and DIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

name the seronegative spondyloarthropathies

A 
RF negative
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis (associated with IBD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe ankylosing spondylitis

A

progressive inflammatory back pain from early 20s
buttock pain
peripheral joint involvement (large joints, hips, shoulders)
enthesitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe the presentation of psoriatic arthritis

A

can present as a small joint polyarthropathy
affects DIPs
oligoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the signs and symptoms of reactive arthritis?

A 
acute oligoarthritis
inflammatory back pain/sacroiliitis
enthesitis
fever
malaise
keratoderma blennorrhagica
circinate balanitis
mouth ulcers
conjunctivitis
uveitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are examples of radiating pain?

A

sciatica

referred pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are some of the conditions associated with arthritis?

A 
psoriasis
bowel problems
red/painful eyes, vision problems
gastroenteritis
STIs
SLE
fibromyalgia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe the general management plan for MSK disorders

A

pain management advice (topical, simple analgesia, NSAIDs)
joint/soft tissue injection
inflammatory disease control (NSAIDs, steroids orally/IM, intra-articular steroids, DMARDs, biologic drugs)
surgical intervention
physio/OT/podiatry, orthopaedics/social work referral
cardiovascular risk assessment
osteoporosis risk assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe rheumatoid arthritis

A

chronic systemic inflammatory symmetrical small joint polyarthritis
multi-system disease
MCPs, PIPs
DIPs spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the aetiology and pathogenesis of rheumatoid arthritis?

A

breakdown of immune tolerance and synovial inflammation
pannus erodes through cartilage and into bone
= bony destructions and erosions
complex interaction between genes and environment
smoking increased risk x 20-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the signs and symptoms of rheumatoid arthritis?

A 
early morning stiffness
immobility stiffness
eases with exercise and NSAIDs
soft tissue swelling
swelling of PIP and MCP joints
subluxation at MCPs
ulnar deviation at MCPs
Z shaped thumb
small muscle wasting of hand
swan neck and Boutonniere deformity
rheumatoid nodules (firm, non-tender and moveable, can be painful or asymptomatic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the investigations for rheumatoid arthritis?

A

anti-CCP; specific
RF; not specific, can be positive in other autoimmune rheumatic disorders or any chronic immune stimulation (bronchiectasis)
seropositive; increased severity, nodules, systemic disease and more erosive disease
inflammatory markers

x ray; juxta-articular, loss of joint space, bone erosions
US; joint effusion with synovial proliferation, more sensitive for detecting early change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the risk factors for systemic, extra-articular disease?

A 
age
RF
anti-CCP
early disability
smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

describe rheumatoid vasculitis

A

occurs with longstanding, joint-destructive RA
when the erosive process that led to joint destruction has become less active
affects skin, digits, peripheral nerves, eyes and heart

cutaneous foot/leg ulcers; necrotising vasculitis of medium-sized arteries
can lead to digital ischaemia, necrosis and gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

describe vasculitic neuropathy

A

both mono neuritis multiplex and a distal symmetric sensory or sensorimotor neuropathy can occur
similar to diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

name some of the systemic manifestations of rheumatoid arthritis

A 
rheumatoid vasculitis
vasculitic neuropathy
scleritis
scleromalacia perforans
lung nodules
interstitial lung disease
pleural disease
anaemia
felty's syndrome (neutropenia, splenomegaly)
secondary sjogren's syndrome (dry eyes and mouth)
secondary raynaud's phenomenon
rheumatoid neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

define felty’s syndrome

A

a rare, potentially fatal disorder characterised by rheumatoid arthritis, splenomegaly and neutropenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

describe rheumatoid neck

A

the atlantoaxial joint is prone to subluxation in multiple directions
leading to cervical myelopathy
laxity of the transverse ligament induced by proliferative C1 to C2 synovial tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the signs, symptoms and treatment of rheumatoid neck?

A

pain radiating superiorly to back of head
slowly progressive spastic quadriparesis
painless sensory loss in hands or feet
radiograph shows >3mm separation between dens and C1 arch of atlas
treatment - conservative/surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the long-term risks of rheumatoid arthritis?

A

cardiovascular disease
lymphoproliferative disease
osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the assessments of disease activity?

A

28 tender joint count
28 swollen joint count
VAS
ESR/CRP

doesn’t include feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the treatment for rheumatoid arthritis?

A 
TICORA
steroids (usually IM)
aggressive escalation of DMARDs
biologics
simple analgesia
NSAIDs
joint injection
education
MDT referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the side effects associated with methotrexate?

A 
infection
lung irritation
blood abnormalities
liver abnormalities
nausea
teratogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the drugs used in rheumatoid arthritis?

A

DMARDs (methotrexate, hydroxychloroquine, leflunomide, sulfasalazine)
failed 2 DMARDs, one of which must be methotrexate
biologics (work better with DMARDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

name the types of biologic drugs

A 
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the side effects of biologic drugs?

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what monitoring is required for methotrexate?

A

weekly folic acid, blood monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what monitoring is required for biologic drugs?

A

no regular blood monitoring

before starting - CXR, hep B, C, HIV, varicella immunity ANA, IGRA (latent TB), immunoglobulins (rituximab only)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what types of gait are seen on examination?

A 
shuffling gait - Parkinsonism
ataxic gait - cerebellar disease
high stepping gait - syphilis
intoning gait - foot progression angle
Charlie Chaplin gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what does a positive trendelenburg sign show?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what does the Galeazzi test show?

A

short tibia

short femur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what does the Thomas test show?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

describe transient synovitis

A 
self-limiting disease
seasonal
5-7 days
URTI
limitation of movement
normal inflammatory markers
diagnosis of exclusion - rule out septic arthritis of the hip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what are the complications of septic arthritis of the hip?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what investigations should be performed with knee pain in children/adults?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

describe osteomyelitis

A

bone infection that can interfere with growth and destroy bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the causes of back pain in children?

A 
acute injury
overuse - repetitive running, jumping
sedentary
infection
tumour
scoliosis
kyphosis (Schuermann's)
spondylosis
spondylolisthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are the concerning associated symptoms of back pain in children?

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

describe spondylosis

A

type of arthritis defined by wear and tear to the spine

scotty dog of LaChapelle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

describe spondylolithesis

A

slipped vertebrae

acute fracture of pars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what are the complications of spondylolithesis?

A

sciatic scoliosis (due to muscle spasm)
listhetic torsional scoliosis
both resolve after treatment of spondylolithesis

occasional typical idiopathic curve above a spondylolithesis
resolves separately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is the different between postural and Scheuermann’s kyphosis?

A

postural - excessive curve of the back rounds when bending

Scheuermann’s - no smoothing of the back occurs due to structural changes in the spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

define Scheuermann’s roundback

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the presentation of childhood vertebral infection?

A 
failure to walk (paraplegia)
abdominal pain
back pain
tight hamstrings
loss of spinal rhythm
inflammatory markers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what are the causes of vertebral infection?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what are the causes of a vertebra plana?

A 
eosinophilic granuloma
osteoid osteoma
osteoblastoma
aneurysmal bone cyst
metastatic
neuroblastoma
spinal cord tumours
spinal cord developmental lesions (diastematomyelia)
cord tethering
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is the cause of painful scoliosis?

A

osteoid osteoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

describe a mallet toe

A

DIP flexion

callus/corn forms when the toe rubs the shoe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

describe a hammer toe

A

PIP flexion

callus/corn forms when the toe rubs the shoe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

describe a claw toe

A

PIP flexion
MTP extension
push-up test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

describe metatarsalgia

A

the ball of the foot becomes painful and inflamed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

how do you examine for a plantar flexed 1st metatarsal?

A 
hold heel neutral in palm
observe relationship of 1st MT head
overactive peroneus longus
shoes with drop-in toe box
lateral forefoot wedge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what are the causes of acute mono arthritis?

A

sepsis
crystals
blood

false/first presentation of inflammatory arthritis
reactive arthritis
pigmented villonodular synovitis
chondrosarcoma
osteoid osteoma
metastatic disease
mensical tear
osteonecrosis
fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are the risk factors for infection?

A 
immunocompromised
IV drug abuse
diabetes
recent bacteraemia (chest, urine, throat, skin breaks)
at risk/recent STI
direct penetrating wound
local skin infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are the features suspicious of crystals?

A 
previous episodes
previous podagra
excess alcohol
diuretics
renal impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what are the features suspicious of haemarthrosis?

A

bleeding disorder
anticoagulants
trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what investigations should be performed in acute mono arthritis?

A 
gram stain
WCC
crystals
joint XR
CXR
urinalysis
urine/swab (gonorrhoea, chlamydia)

always aspirate
always take blood cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

describe septic arthritis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what pathogens cause septic arthritis?

A 
staph aureus (commonest)
staph epidermis
neisseria gonorrhoea
viruses
fungi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what is the management of septic arthritis?

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

define gout

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what are the phases of gout?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what are the causes of hyperuricaemia?

A 
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

describe acute gout

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what investigations are performed in suspected gout?

A 
routine bloods
serum urate (query usefulness in acute attack)
aspirate joint fluid
x-ray
bedside US
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

how is gout diagnosed?

A 
gouty changes on US
gouty erosions (x-ray)
negatively birefringent needle shaped crystals on polarised light microscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what is the management of an acute attack of gout?

A 
ease pain and inflammation
NSAIDs
colchicine
steroids (oral, IM, intra-articular)
ice packs
rest
recurrent/tophi/x-ray changes/urate nephropathy - prevention strategy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

define tophus

A

tissue deposition of uric acid
toothpaste-like material
inflammation and tissue damage

chronic tophaceous gout - chronic symmetric deforming arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

describe the preventative management of gout

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what are the features of CPPD (Ca pyrophosphate dihydrate) crystal deposition disease/chondrocalcinosis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what is the cause/associations with CPPD?

A

unknown cause

associated with haemochromatosis, hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what is the difference between gout and pseudo gout?

A

gout is caused by uric acid crystals

pseudo gout is caused by CPPD crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

how is acute pseudogout diagnosed?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what is the treatment of CPPD arthritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what are the causes of haemarthrosis?

A 
trauma
anticoagulation
clotting disorders
fracture
pigmented villonodular synovitis (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what is the diagnosis and management of haemarthrosis?

A

joint aspiration

management - rest, analgesia, ice, correct underlying coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

define sacroiliitis

A

inflammation of the sacroiliac joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what is spondyloarthritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

what diseases are described by spondyloarthritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what are the symptoms and signs of AXSPA?

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what are the findings of an examination of AXSPA?

A 
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what investigations are performed in SPA?

A 
ESR and CRP not always elevated
seronegative (anti-CCP, RF)
faecal calprotectin (IBD)
joint fluid aspiration (usually non-specific)
US
x-ray
MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what features are present in SPA?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what is the treatment of AXSPA?

A

NSAIDs
regular exercise/stretches
biologics

peripheral manifestations (arthritis, enthesitis, dactylitis) - local steroids, DMARDs (methotrexate, sulfasalazine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what is the treatment of SPA?

A 
NSAIDs
exercise
antibiotics (doxycycline for chlamydia)
methotrexate - psoriasis and IBD
sulfasalazine - settle UC
leflunomide
anti-TNF, anti-IL17, JAK inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what is the pathology of enthesitis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what is the treatment of enthesitis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

how is bone strength measured?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

what is a T score?

A

average bone density of a 25yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

define osteoporosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

define osteoporotic fractures

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what are the causes of osteoporosis?

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what is the management of osteoporosis?

A 
1000-1200mg Ca
50-60g protein
>50mmol/L vitamin D (absorbs and prevents Ca loss)
bisphosphonates
denosumab
teriparatide
HRT therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what conditions affect vitamin D metabolism?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

describe bisphosphonates

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

describe denosumab

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

describe teriparatide

A

daily hormone injection (PTH)

most severe cases (T score

98
Q

what are the side effects of HRT?

A

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

99
Q

what antibodies are associated with connective tissue disease?

A 
dsDNA - SLE
scl-70 - diffuse systemic sclerosis
centromere - limited systemic sclerosis
Ro/La - sjogrens
jo-1 - polymyositis
lupus anticoagulant - antiphospholipid syndrome
100
Q

what are the causes of lupus?

A

UV exposure
genetic
female sex hormones
chlorpromazine

101
Q

what are the signs and symptoms of lupus?

A 
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
102
Q

what investigations are required for the diagnosis of lupus?

A 
ANA
ESR
dsDNA
complement
FBC - lymphopenia
U&E, LFTs
urinalysis
ACR
antiphospholipid Ab
lupus anticoagulant
CK
anti-CCP
RF
skin and renal biopsies
103
Q

what is the treatment of lupus?

A

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

104
Q

what are the skin features of dermatomyositis?

A

gottrons papules
photo distributed rash
heliotrope rash
mechanics hands

105
Q

describe the features of myositis

A 
proximal muscle weakness
weakness of neck flexors
respiratory muscle (dyspnoea)
cardiac muscle
oesophageal muscle (dysphagia)
interstitial pneumonitis
raynauds
106
Q

what investigations are required to diagnose myositis?

A 
autoantibody screen
CK
EMG
MRI
muscle biopsy
CXR
PFTs
CT
paraneoplastic screen
107
Q

what is the treatment of myositis?

A

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

108
Q

define systemic sclerosis

A

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

109
Q

describe limited systemic sclerosis

A

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

110
Q

describe diffuse systemic sclerosis

A

widespread initial skin involvement

SCL-70 antibody

111
Q

what are the symptoms of systemic sclerosis?

A 
calcinosis cutis
raynauds
oesophageal involvement
sclerodactyly
telangiactasia
112
Q

what are the complications of systemic sclerosis?

A 
pulmonary artery hypertension
interstitial lung disease
cardiac involvement (fibrosis, cardiomyopathy)
GI involvement with malabsorption
acute renal crisis
113
Q

describe the triphasic change of raynaud’s

A

white - ischaemic
blue - deoxygenated
red - reperfusion

114
Q

describe raynaud’s and its treatment

A

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

115
Q

describe sjogren’s

A

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

116
Q

what are the features of sjogren’s?

A 
dry eyes
dry mouth
vaginal dryness
parotid swelling
Raynaud's
arthralgia/arthritis

risk of lymphoma
high ESR and IgG level

117
Q

what are the features of behcet’s?

A 
recurrent oral and genital ulceration
acneiform lesions
pustules
nodules
erythema nodosum
uveitis
neurological disease
vascular disease
arthritis
no specific antibody test
pathergy test
118
Q

what are the features of adult-onset still’s disease?

A

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

119
Q

define vasculitis

A

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

120
Q

describe systemic vasculitis

A 
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
121
Q

what are the causes of systemic sclerosis?

A 
ethnicity
genes (HLA)
gender
UV light
viral (hep b, c, HIV, parvovirus, CMV, varicella zoster)
toxins
drugs
allergy
smoking
122
Q

what are the signs and symptoms of systemic sclerosis?

A 
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
123
Q

define giant cell/temporal arteritis

A

vasculitis of large and medium arteries

particularly cranial arteries

124
Q

what are the symptoms and signs of giant cell arteritis?

A 
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
125
Q

what is the treatment of giant cell arteritis?

A

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

126
Q

what are the side effects of high-dose steroids?

A 
easy bruising
osteoporosis
steroid induced diabetes
increased risk of infection
GI toxicity
proximal myopathy
mood changes
cataracts
increased cardiovascular risk
HTN
127
Q

describe henoch-schonlein purpura

A 
<20yrs
palpable purpura/purpuric rash
abdominal pain
blood diarrhoea (bowel angina and ischaemia)
self-limiting
128
Q

describe ANCA-associated vasculitis

A

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

129
Q

what are the features of granulomatous polyangitis GPA?

A 
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
130
Q

what are the features of microscopic polyangitis (MPA)?

A

glomerulonephritis
pulmonary haemorrhage
no granulomatous inflammation
p-ANCA

131
Q

describe eosinophilic granulomatous polyangitis (EGPA)?

A

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

132
Q

what is the treatment of systemic vasculitis?

A 
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

133
Q

describe polymyalgia rheumatica

A 
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
134
Q

describe fibromyalgia

A

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)

135
Q

what is the treatment of fibromyalgia?

A

resassurance
self-management
graded aerobic exercise
amitriptyline

136
Q

what are the causes of back pain?

A 
degen disc disease
herniated disc
spinal stenosis
tumour
infection
cauda equina
137
Q

what are the red flag features associated with back pain?

A 
non-mechanical pain
onset <20 or >55yrs
thoracic pain
systemic symptoms
widespread neurological symptoms
bilateral symptoms
138
Q

what are the symptoms of caudal equina?

A

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

139
Q

what are the symptoms of metastatic spinal cord compression?

A 
backpain
radicular pain
sensory loss
lower limb weakness
loss of sphincter control
140
Q

name the ligaments that surround the hip joint

A

anterior - iliofemoral and pubofemoral ligaments

posterior - ischiofemoral ligament

141
Q

what topics should be covered in a hip pain history?

A 
analgesia
functional ability
stiffness/deformity
clicking/snapping
referred
childhood hip problems
142
Q

what is essential in any joint examination?

A

neurological examination of joint above and below

143
Q

what investigations should be performed in a hip examination?

A

joint aspiration
CT
MRI (avascular necrosis)
MR arthrogram

144
Q

define osteoarthritis

A

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

145
Q

what are the causes of osteoarthritis?

A 
idiopathic (primary)
trauma
infection
AVN
childhood hip disorder
crystal deposition
previous RA
skeletal dysplasia
metabolic (haemarthrosis, hyperparathyroidism)
neuropathic (Charcot's arthropathy)
146
Q

what are the features of osteoarthritis?

A 
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
147
Q

what is the treatment of osteoarthritis?

A

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

148
Q

what are the risks associated with total hip replacement?

A 
dislocation
infection
neuromuscular injury
limb length inequality
DVT/PE
fracture
bleeding/transfusion
persistant pain
life/revision
anaesthetic risk
149
Q

what are the risk factors for avascular necrosis?

A 
femoral neck fracture
posterior hip dislocation
steroids
alcohol
coagulopathy
sufe
perthes'
150
Q

what are the causes of knee deformities?

A

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

151
Q

what is looked for in the move section of a knee exam?

A

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

152
Q

what is looked for in the special tests section of a knee exam?

A

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

153
Q

what investigations are required to diagnose a knee problem?

A 
routine bloods
x-ray
CT
MRI
joint aspiration
154
Q

name some common knee condition?

A 
osteoarthritis OA
RA
gout
pseudogout
chondromalacia patella
bursitis
baker's cyst
patella tendonitis
osteochondritis dessicans (OCD)
155
Q

what are the indications for total knee replacement?

A 
osteoarthritis
pain
stiffness
reduced function
substantial impact on QOL
156
Q

what are the risks of a total knee replacement?

A 
infection
DVT/PE
neurovascular injury
fracture
bleeding/transfusion
persistant pain
lifetime/revision
anaesthetic risk
157
Q

what are the risk factors for gout?

A 
genetics
obesity
age
diet (alcohol, fructose-based drinks, seafood)
kidney disease
metabolism issues
diuretics
trauma
158
Q

how is gout diagnosed and treated?

A

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

159
Q

what are the risk factors for developing pseudo gout/CPPD?

A 
age
post trauma
genetic
mineral imbalances
underactive thyroid
160
Q

what are the symptoms, causes and treatment of chondromalacia?

A

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

161
Q

what are the symptoms, causes and treatment of bursitis?

A

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

162
Q

what are the symptoms, causes and treatment of baker’s cyst?

A

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

163
Q

what are the symptoms, causes and treatment of patellar tendonitis/tendonosis?

A

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

164
Q

what are the symptoms, causes and treatment of osteochondritis dessicans (OCD)?

A

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

165
Q

what are you looking for in a foot examination?

A 
alignment
valgus/varus hindfoot
mid foot deformity
single and double heel raise
joint stability
166
Q

what investigations are carried out in foot disease?

A 
AP and lateral weight bearing x-rays
US
MRI
CT
isotope bone scan
167
Q

what are the symptoms, signs and treatment of ankle arthritis?

A 
pain
swelling
stiffness
deformity
associated with osteoarthritis, RA, post-traumatic arthritis

analgesia
ankle support/bracing
injection
surgery - arthrodesis of affected joints

168
Q

what are the symptoms, signs and treatment of ankle arthritis?

A

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

169
Q

what are the causes and treatment of heel pain?

A 
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

170
Q

describe the pathology and treatment of hallux vagus

A

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

171
Q

describe the pathology and treatment of hallux rigidus

A 
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
172
Q

describe the causes, symptoms and treatment of Mortons neuroma

A

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

173
Q

describe the causes and treatment of ankle instability/sprains

A

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

174
Q

what investigations are used to diagnose shoulder disease?

A

plain x-ray
US
CT
MRI/athropathy

175
Q

describe shoulder instability

A

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

176
Q

what is the treatment of shoulder instability?

A

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

177
Q

describe the symptoms, signs and treatment of a frozen shoulder?

A

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
178
Q

describe the radiological features of shoulder arthritis

A

subchondral sclerosis
joint space narrowing
osteophytes
subchondral cysts

179
Q

what is the management of shoulder arthritis?

A

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

180
Q

name the tendons of the hand

A

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

181
Q

describe the nerve supply of the hands

A

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

182
Q

describe the examination of the hand

A 
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
183
Q

describe the pathology and treatment of carpal tunnel syndrome

A

middle-aged females
armpit
diabetes; CTS vs peripheral neuropathy

steroid injection
surgical release

184
Q

describe the pathology and treatment of carpal tunnel syndrome

A

painful popping or catching
finger jamming in flexion
reduced flexion

steroid injection
surgical release

185
Q

describe the pathology and treatment of dupuytren’s disease?

A

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

surgical excision
collagenase injections

186
Q

what are the constituents of the intervertebral discs?

A

outer annulus - concentric rings, type 1 collagen

inner nucleus - water, proteoglycans, type 2 collagen, cells

187
Q

what occurs when the intervertebral discs age?

A 
water loss
disaggregation of proteoglycans
collagen changes
cell death
loss of height
188
Q

what is the cause of non-specific back pain?

A

degenerative disc disease

189
Q

what are the causes of root pain/neurogenic claudication?

A

herniated disc

spinal stenosis

190
Q

what are the causes of serious spine pathology?

A

neoplasia
infection
inflammatory

191
Q

what are the causes of referred visceral back pain?

A

GI disease
renal
abdominal aortic aneurysm

192
Q

what are the red flags for back back pain?

A 
non-mechanical (inflammatory) pain
onset <20 or >55yrs
thoracic pain
PMHx carcinoma, steroids, HIV
systemic symptoms - malaise, weight loss, fever
widespread neurological symptoms
193
Q

what signs are present in a neurological deficit of L5?

A

decreased sensation on dorsum of foot

decreased power EHL

194
Q

what signs are present in a neurology deficit of S1?

A

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

195
Q

what investigations should be performed to confirm spinal disease?

A

x-ray

MRI - can confirm clinical suspicion of herniated discs

196
Q

what is the pathophysiology and investigations required for diagnosis of spinal disc prolapse?

A

most commonly at L4/5 and L5/S1
30-50yrs

root pain
nerve root irritation
nerve root compression
positive scan

197
Q

what is the treatment of spinal disc prolapse?

A

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

198
Q

describe degenerative spondylolisthesis

A

middle ages
f>m
nerve root pain
neurogenic claudication

199
Q

describe the symptoms and diagnosis requirements for spinal stenosis

A

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

200
Q

describe neurogenic claudication

A 
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

201
Q

describe vascular claudication

A 
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
202
Q

what is the treatment of spinal stenosis

A 
physiotherapy (reduce risk of falls)
analgesics
NSAIDs
epidural corticosteroids
surgical decompression
spinal fusion + decompression if addition spondylolisthesis
203
Q

describe spinal tumours

A

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

204
Q

what are the symptoms and signs of ankylosing spondylitis of the spine?

A

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

205
Q

describe early (incomplete) cauda equina syndrome

A

increasing unilateral or bilateral root pain

difficulty with urinary voiding

206
Q

describe late (complete) cauda equina syndrome

A

loss of perineal sensation
urinary incontinence or retention
foot weakness

207
Q

what are the symptoms and signs of metastatic spinal cord compression?

A 
back pain
radicular pain
sensory loss
lower limb weakness
loss of sphincter control
208
Q

what’s the management of metastatic spinal cord compression?

A

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

209
Q

what is the pathophysiology and risk factors of DDH (developmental dysplasia of the hip)?

A

spectrum shallow acetabulum to dislocation

FHx
breech
female
first born

210
Q

what are the symptoms, signs and investigations that are required to diagnose DDH?

A

abnormal skin creases
leg length discrepancy
limitation of abduction
Barlow’s and ortolani’s (hip out) tests

x-ray
US

211
Q

what is the treatment of DDH?

A

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

212
Q

describe the pathophysiology, signs and symptoms of perthes disease

A

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

213
Q

what is the treatment of perthes disease?

A

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

214
Q

describe SUFE (slipped upper femoral epiphysis)

A

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

215
Q

what are the causes of an antalgic gait?

A 
trauma
irritable hip
septic arthritis
perthes
SUFE
arthritis
216
Q

what are the signs and causes of a trendelenburg gait?

A

abductor weakness; lever arm, muscle weakness

hip dysplasia
cerebral palsy

217
Q

what are the causes of an equinus gait?

A

cerebral palsy
congenital
clubfoot
neurological/muscular disorders

218
Q

what are the causes of in toeing?

A

internal femoral torsion
internal tibial torsion
metatarsus adductus
adducted great toe

219
Q

what are the causes of out toeing?

A

external femoral torsion

external tibial torsion

220
Q

define genu valgum

A

intramalleolar separation >8cm

221
Q

define genu varum

A

intracondylar separation >8cm

222
Q

what are the causes of pes cavus?

A 
exclude neurology
cerebral palyst
friederich's ataxia
CMT
polio
223
Q

what are signs of concern in walking?

A

should walk by 18 months

asymmetrical
progressive
painful
loss of motion
fixed
224
Q

what are x-rays used to assess in MSK?

A

traumatic bone or joint injury
focal bone lesions
established arthritis

225
Q

what are the pros and cons of using plain radiograph x-rays in MSK?

A

widely available
relatively low radiation dose
excellent spatial resolution

poor soft tissue detail
arthritis; poor sensitivity for erosions of synovitis
2D image

226
Q

what are the pros and cons of using US in MSK?

A

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

227
Q

what are the pros and cons of using CT in MSK?

A

excellent spatial resolution
excellent bone detail
multiplanar
facilitates image guided injections, interventions and biopsy

high radiation dosage
poor soft tissue resolution vs MRI

228
Q

what are the pros and cons of using MRI in MSK?

A

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)

229
Q

describe MR arthropathy

A

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

230
Q

what is nuclear medicine used for in MSK?

A

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

231
Q

what are the pros and cons of nuclear medicine?

A

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

232
Q

define spasticity

A

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

233
Q

what are the causes, symptoms and treatment of autonomic dysreflexia?

A

level T6 or above
sympathetic hyperactivity secondary to noxious stimulus

hypertension
bradycardia
sweating
headache

remove problem (bladder distension, sore, rectal distension)
GTN spray
clonidine

234
Q

what are the pros and cons of through knee amputation?

A 
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

235
Q

what are the symptoms and signs of inflammatory joint disease?

A 
early morning and evening stiffness
generalised stiffness
lasts >30 mins
worse on rest
eases with exercise, NSAIDs, steroids
soft tissue swelling
236
Q

what are the symptoms and signs of degenerative joint disease?

A 
stiffness as day progresses
stiffness may be more localised
lasts <30 mins
night pain
eases with rest
worse with exercise
crepitus and bony swelling
237
Q

what other symptoms may be present in a patient with hand rheumatic disease?

A 
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
238
Q

what are the causes of certain signs and symptoms on the hands?

A

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

239
Q

what are the hand features of osteoarthritis (nodal OA)?

A

heberden’s node

Bouchard’s node

240
Q

what are the hand features of RA?

A 
swan neck deformity
boutonniere deformity
rheumatoid nodules
MCP subluxation
ulnar deviation
241
Q

what co-morbidities are associated with requiring amputation?

A

DM
IHD
cerebrovascular disease
COPD

Clinical Practice (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions