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2A - Stuff i just cannot remember > MSK > Flashcards

MSK Flashcards

1
Q

Rheumatoid Arthritis deformities

A

Boutonniere
Ulnar deviation
Swan-neck
Z thumb

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2
Q

Osteoarthritis deformities

A

Bouchard - (PIP)

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3
Q

Osteoporosis mx:

1L, 2L

A

1L: Alendronic acid (bisphosphonate) + AdCal (vitD + Ca)

2: DMARD - Denosumab (monoclonal Ab to RANK > inhibit osteoclasts)

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4
Q

Gout Mx

+ brief pharmacology

A

Flare-up: COLCHICINE

Prophylaxis: Allopurinol + Febuxostat

Allopurinol = xanthine-oxidase inhibitor)

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5
Q

Osteoarthritis X-ray px

A

LOSS

Loss joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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6
Q

Rheumatoid arthritis X-ray

A 
Bony erosions
Joint subluxation 
Reduced joint space 
Osteopenia 
Soft tissue swelling
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7
Q

Bisphosphonate Pharmacology

A

Inhibit Farnesyl Pyrophosphate Synthase > inhibit osteoclasts

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8
Q

Denosumab Pharmacology

A

Monoclonal Ab to RANK Ligand > inhibit osteoclasts

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9
Q

Osteoporosis Mx + pharmacology

Include tx option for someone post-menopausal or on a glucocorticoid

A

1L] Bisphosphonate - Alendronate; inhibit cholesterol synthesis > slows osteoclasts

2L] Denosumab; RANK Ligand Ab > matures osteoclasts
(Deno DINO BONES + -mAB = Ab)

Raloxifene; (post-menopause/ on glucocorticoid) - binds estrogen receptor, inhibits osteoclasts

Teriparatide; PTH analogue

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10
Q

Side effects of Bisphosphonates

A

Oesopagheal ulcers

Take with big glass of water, once weekly. Sit upright for 30 minutes after.

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11
Q

What is a DEXA scan?

A

DEXA Scan - T-score; compares bone density to younger pt of same sex

Used to diagnose osteoporosis

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12
Q

Osteoarthritis joints affected + X-ray findings

A

Wt-bearing, DIP, PIP

Weight-bearing joints = knee, hip, lumbar spine.

DIP - Heberden’s
PIP - Bouchard’s

X-RAY: 
Lost joint space
Osteophytes 
Subchondral sclerosis
Subchondral cysts
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13
Q

Rheumatoid Arthritis joints affected + deformities + other presentations

A

Symmetrical. MCP, PIP

Swan-neck
Boutonniere
Ulnar deviation
Rheumatoid nodules + factor

Dry cough (pleural effusion/ fibrosis). 
Neck pain. Splenomegaly.
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14
Q

Rheumatoid arthritis GOLD investigation

A

Anti-cyclic citrullinated peptide Ab (Anti-CCP/ ANCPA)

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15
Q

Rheumatoid arthritis management

A

DAS28 score.

NSAIDs, paracetamol

DMARDs - Methotrexate (Sulfasalazine/ hydroxychloroquine). Prednisolone.

TNF-a inhibitors - Infliximab

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16
Q

RA risk factors

A

F, HLA-DR4, 40-60, Rheumatoid Factor, smoking

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17
Q

Osteoarthritis management

A

Physio, wt loss, aerobics.

Paracetamol, NSAIDs.

Short-term intra-articular steroids.

Curative = joint replacement

18
Q

Most common overall cause of osteomyelitis and septic arthritis

A

Staphylococcus aureus

19
Q

Moat common cause of osteomyelitis in IVD users

A

Pseudomonas

E coli

20
Q

Most common cause of osteomyelitis in Sickle Cell patients

A

Salmonella

21
Q

Most common cause of osteomyelitis/ septic arthritis following a joint-replacement

A

Staphylococcus epidermis

22
Q

Treatment of osteomyelitis

A

Flucloxacillin + Fusidic Acid

or

Vancomycin + Cefotaxime

23
Q

Most common cause of septic arthritis in young sexually-active adults

A

Neisseria gonorrhoea

24
Q

Most common cause of septic arthritis in IVD users

A

Pseudomonas aeruginosa

25
Q

Treatment of septic arthritis

A
  1. Drainage of joint
  2. Remove prosthetic
  3. EMPIRICAL - Flucloxacillin + Vancomycin
  4. S. aureus - vancomycin
    N. gonorrhoea - Ceftriaxone
26
Q

Most common bacterial STI?

Second most common bacterial STI?

Investigations?

A

Most common: Chlamydia Trachomatis

Second most common:
Neisseria gonorrhoea

1L: NAAT

Gold: Microscopy:

N. gonorrhoea: Gram-negative diplococci with polymorphs

27
Q

Management of Chlamydia Trachomatis

A

Avoid sex until course finished

Doxycycline/ azithromycin

Contact trace

28
Q

Management of Neisseria gonorrhoea

A

Ceftriaxone + Azithromycin

29
Q

Sjorgren syndrome investigations

A

Salivary Gland Biopsy -
ANA, Anti-Ro, Anti-La

Schirmer’s Test, Rose Bengal Stain

30
Q

Sjorgren syndrome shows a ____ __ _________ of minor glands

A

Type 4 Hypersensitivity

31
Q

Significantly raised ALP indicates…

A

Paget’s Disease of Bone

32
Q

Methotrexate uses

A

= anti-metabolite + immunosuppressant

  • breast, skin, head, neck cancers

Autoimmune disorders:

  • Inflammatory arthritis
  • Psoriasis
  • Crohn’s
33
Q

DEXA T-scores

A

Normal: T >-1

Osteopenia: -1> T >-2.5

Osteoporosis: T < -2.5

34
Q

Classical symptoms of Reactive Arthritis

A

Classic triad:

  1. Conjunctivitis
  2. Urethritis
  3. Arthritis

CAN’T SEE
CAN’T PEE
CAN’T CLIMB A TREE

35
Q

Pt cannot flex ring finger. He has a Hx of alcohol abuse.

Likely diagnosis?

A

Dupuytren contracture

  • affected palma fascia of 4th and 5th fingers
  • RF: alcohol, liver disease
36
Q

30yr old pt presents with joint pain. He describes <30 minutes of morning stiffness.

Likely diagnosis? Initial management?

A

Osteoarthritis

Arthroscopy because he is UNDER 45 so may be more sinister

37
Q

Young Pt uses his arms to move forward in a seated position. Name of sign? Indicates?

A

Gower’s sign

Suggests Duchenne Muscular Dystrophy

38
Q

Gorlin sign. Suggests?

A

Ability to touch tip of nose with tongue

Ehlers Danlos Syndrome

39
Q

Lasegue Sign. Suggests?

A

Pain when lying flat on back, with leg raised vertically, and ipsilateral knee is straight.

Herniated disk.

40
Q

Tinnel’s sign. Suggests

A

Pins and needles in area innervated by nerve, when nerve is tapped.

Carpal tunnel - median nerve

41
Q

ADPKD presentations, investigations, management

A

Px: 30-40yrs

  • renal dysfunction
  • side/back pain
  • renal enlargement
  • Bulging abdomen + GI symptoms
  • Uremic encephalopathy (confusion, unstable)

Screen for:

  • liver cysts
  • heart valve prolapse
  • brain aneurysmys

2A - Stuff i just cannot remember (19 decks)

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