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MSK and rheumatology Flashcards

1
Q

what is a common laboratory finding in Paget’s disease of the bone

A

Raised ALP

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2
Q

give 4 features of ankylosing spondylitis on radiograph

A

Sacroilitis : subchondral erosions , sclerosis
squaring of lumbar vertebrae
bamboo spine
syndesmophytes : ossification of outer fibers of annulus fibrosus

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3
Q

sign of Ankylosing spondylitis on chest xray

A

Apical fibrosis

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4
Q

what’s the imaging of choice in Osteomyelitis ?

A

MRI of affected leg and hip

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5
Q

most common cause of septic arthritis in sexually active adults

A

Neisseria Gonorrhoea

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6
Q

first line investigation for suspected septic arthritis

A

Synovial fluid sampling

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7
Q

what is an adverse effect of hydrochloroquine

A

Bulls eye retinopathy - leading to severe and permanent visual loss

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8
Q

most common cause of discitis

A

Staph. Aureus

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9
Q

how do Gottron’s papules present ? what condition is it present in ?

A

Roughened red papules over extensor surfaces of fingers. Dermatomyositis

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10
Q

what is the key investigation in patients with suspected septic arthritis

A

Synovial fluid sampling

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11
Q

what haematological findings are seen in APL

A

thrombocytopenia
prolonged APTT

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12
Q

which antibody is +ve in APL

A

Anti cardiolipin antibody

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13
Q

APL syndrome presents with which dermatological finding

A

Livedo Reticularis

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14
Q

what type of reaction is anaphylaxis

A

Type 1

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15
Q

how is Reactive arthritis managed ( 1st line and 2nd line)

A

Analgesia, NSAID’s , intra articular steroids

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16
Q

which inflammatory marker is raised in Polymyalgia rheumatica

A

ESR

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17
Q

what is the management of Polymyalgia Rheumatica

A

Prednisolone 15 mg / od

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18
Q

what is the gold standard treatment of SLE

A

Hydroxychloroquine

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19
Q

which condition is polymyalgia rheumatica associated with ?

A

Temporal arteritis

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20
Q

what xray feature best supports the diagnosis of polymyalgia rheumatica

A

Sacro-ilitis on Pelvic xray

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21
Q

what is the first line management of ankylosing spondylitis

A

exercise regimes and NSAID’s

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22
Q

which antibody is specific and sensitive for Rheumatoid arthritis

A

Anti cyclic citrullinated peptide

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23
Q

what is the first line management of Raynaud’s

A

Nifedipine

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24
Q

give 5 early xray findings of RA

A

Loss of joint space
Juxta-articular osteoporosis
Soft tissue swelling
periarticular erosion
Subluxation

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25
Q

Achilles tendonitis can present with which condition

A

Ankylosing spondilytis

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26
Q

give 3 xray findings seen in ankylosing spondylitis

A

Subchondral erosions
sclerosis
squaring of vertebrae

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27
Q

which is the test for SLE with the highest sensitivity

A

ANA

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28
Q

which are tests for SLE that are highly specific

A

anti-dsDNA
Anti-smith

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29
Q

why is the use of methotrexate and trimethoprim together contraindicated

A

it can lead to bone marrow suppression and severe or fatal Ppancytopaenia

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30
Q

what is the management of methotrexate toxicity

A

folinic acid

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31
Q

what are the instructions for a patient on consuming bisphosphonates

A

swallow tablets with water while sitting / standing on empty stomach 30 mins before breakfast and stay upright for 30 mins

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32
Q

patients with Sjogren’s syndrome have an increased risk of which malignancy

A

Lymphoid malignancy

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33
Q

what is the initial management regime for RA

A

DMARD monotherapy + short course of bridging prednisolone

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34
Q

how do you manage flares of RA

A

Corticosteroids ( oral /IM)

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35
Q

most common causes of drug induced SLE

A

procainamide
hydralazine

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36
Q

give 3 less common causes of drug induced SLE

A

Isoniazid
Minocycline
Phenytoin

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37
Q

which antibodies are positive in APL syndrome

A

anti-cardiolipin antibodies

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38
Q

T score, what is normal, osteopenia, osteoporosis

A

> -1 = normal
-1 to -2.5 = Osteopaenia
< - 2.5 = osteoporosis

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39
Q

what is the management when a diagnosis of temporal arteritis is suspected ?

A

urgent high dose glucocorticoids

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40
Q

what is the most common ocular complication of temporal arteritis

A

anterior ischaemic optic neuropathy

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41
Q

which tumour presents on radiograph with ‘‘onion skin’’ appearance ?

A

Ewing’s sarcoma

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42
Q

which is the most common primary malignant bone tumour

A

Osteosarcoma

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43
Q

ewing’s sarcoma most commonly affects which bones

A

pelvis + long bones

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44
Q

give 2 features seen on xray in Osteosarcoma

A

Codman triangle
sunburst pattern

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45
Q

how does giant cell tumour present on xray

A

double bubble / soap bubble

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46
Q

what is the most common benign bone tumour

A

Osteochondroma

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47
Q

which scoring system is used as a disease measure of RA

A

DAS28

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48
Q

'’plantar spur’’ and ‘‘pencil in cup’’ deformity are typical xray features seen in __________.

A

Psoriatic arthritis

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49
Q

is psoriatic arthritis symmetrical or asymmetrical ?

A

Asymmetrical

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50
Q

give 3 expected findings on examination of chest and spine in ankylosing spondylitis

A

reduced chest expansion
reduced lateral flexion
reduced forward flexion

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51
Q

is azathioprine safe to use in pregnancy

A

yes

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52
Q

which xray finding can be used to distinguish gout from pseudogout ?

A

pseudogout : chondrocalcinosis
gout : no chondrocalcinosis

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53
Q

how long do symptoms need to be present for a diagnosis of chronic fatigue syndrome to be made ?

A

3 months

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54
Q

give 3 features of inflammatory arthritis

A

pain in the morning
systemic features
raised inflammatory markers

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55
Q

_______ presents with pain and tenderness over the lateral side of the thigh

A

trochanteric bursitis

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56
Q

how does meralgia paraesthetica present

A

compression of lateral cutaneous nerve of thigh with a burning sensation of antero-lateral aspect of thigh

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57
Q

give 5 side effects of methotrexate

A

mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis

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58
Q

what is the drug given to manage methotrexate toxicity

A

Folinic acid

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59
Q

blue sclera is associated with _______

A

osteogenesis imperfecta

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60
Q

how does pseudogout present under the microscope ?

A

weakly +ve bi-fringent rhomboid shaped crystals

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61
Q

what is the imaging of choice for achilles tendon rupture

A

ultrasound

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62
Q

what are the red flag features of suggesting an alternative diagnosis to osteoarthritis

A

rest pain
night pain
morning stiffness >2 hours

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63
Q

which finger joints are more commonly affected in osteoarthritis

A

PIP
DIPJ

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64
Q

patients with ________ often get relief from shaking their hands

A

Carpal tunnel syndrome

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65
Q

what are the red flags for lower back pain

A

age < 20, >50
history of previous malignancy
night pain
history of trauma
systemically unwell ( weight loss and fever)

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66
Q

what is the most appropriate investigation to confirm the diagnosis of ACL injury

A

MRI

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67
Q

what is the most common PCL injury

A

Dashboard injury , occurs when knee is flexed

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68
Q

ACL injury caused by hyperextension / flexion ?

A

Hyperextension

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69
Q

what test can be performed to test for PCL damage

A

Posterior draw test

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70
Q

which structure is divided in surgical management of carpal tunnel syndrome

A

flexor retinaculum

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71
Q

prescribing folate with methotrexate reduces the risk of _________

A

Myelosuppression

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72
Q

what is the most common form of hip dislocation

A

Posterior dislocation

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73
Q

how does posterior dislocation of the hip present

A

affected leg is shortened, adducted and internally rotated

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74
Q

how does anterior dislocation of the hip present

A

affected leg is abducted and externally rotated ; no leg shortening

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75
Q

which type of back pain is a red flag symptom

A

thoracic back pain

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76
Q

what is the investigation of choice for Cauda Equina syndrome ?

A

MRI Spine

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77
Q

what is a late sign of cauda equina syndrome

A

Urinary incontinence

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78
Q

in how many hours should a patient with suspected cauda equina receive an MRI

A

6 hours

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79
Q

What type of injuries lead to meniscal tears?

A

Twisting injuries

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80
Q

what test can be used to check for a meniscal tear

A

Thessaly’s test

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81
Q

which 2 arteries mainly supply the hip joint ?

A

medial and lateral circumflex femoral arteries

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82
Q

damage to the medial circumflex femoral artery can lead to __________

A

Avascular necrosis of the femoral head

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83
Q

which 3 nerves supply the hip joint

A

sciatic femoral and obturator nerves

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84
Q

what is the classical sign of a hip fracture

A

shortened and externally rotated leg

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85
Q

what is a key sign on x-ray of NOF Fracture

A

Shenton’s line

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86
Q

Biceps rupture may lead to a ———– deformity in the middle of the upper arm

A

Popeye

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87
Q

how are simple rib fractures managed ?

A

Conservative management with analgesia

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88
Q

what is a serious complication of rib fracture

A

Pneumothorax

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89
Q

what is the management of lumbar canal stenosis ?

A

Laminectomy

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90
Q

what is the management of a displaced intracapsular fracture ?

A

Hemiarthroplasty

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91
Q

cubital tunnel syndrome occurs due to the compression of which nerve ?

A

ulnar nerve

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92
Q

what is the key feature of cubital tunnel syndrome?

A

Tingling and numbness of 4th and 5th finger, starting off as intermittent and then becoming constant.

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93
Q

how does L5 disc prolapse present

A

loss of foot dorsiflexion and sensory loss on the dorsum of the foot

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94
Q

how does S1 nerve root compression present ?

A

sensory loss posterolateral aspect of leg and lateral aspect of foot
weakness in plantar flexion
reduced ankle reflex

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95
Q

What is the most common location for Ganglion ?
how does it present ?

A

Dorsal aspect of the wrist. Presents as a firm and well circumbscribed mass that trans-illuminates

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96
Q

how does a ganglion present

A

firm and well circumscribed mass that trans-illuminates

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97
Q

In a child with an asymptomatic, fluctuant swelling behind the knee the most likely diagnosis

A

Baker’s cyst

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98
Q

which nerve is most likely to be injured during knee arthroplasty

A

common peroneal nerve

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99
Q

what is raloxifene used for ? what is its mechanism ?

A

selective oestrogen receptor modulator and mimics the effect of oestrogen on bone - used for management of post menopausal osteoporosis

inhibition of osteoclast activity

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100
Q

what are the symptoms seen in in Behcet’s syndrome?

A

oral ulcers
genital ulcers
anterior uveitis

thrombophlebitis and DVT
erythema nodosum

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101
Q

what is Behcet’s syndrome

A

It is a complex multisystem disorder associated with auto-immune mediated inflammation of arteries and veins

102
Q

How does Olecranon bursitis present?

A

Swelling of the posterior aspect of the elbow with associated pain warmth and erythema.
Generally seen in middle aged male patients.

103
Q

how does lateral epicondylitis present ? What is it commonly known as?

A

pain and tenderness on the lateral epicondyle worse on resisted wrist extension with elbow extended or supination of forearm with elbow extended.

tennis elbow

104
Q

How does Medial epicondylitis present ? What is it commonly known as?

A

Pain and tenderness localised to the medial epicondyle.
aggravated by wrist flexion and pronation.
numbness and tingling in the 4th and 5th finger due to ulnar involvement

golfers elbow

105
Q

what is radial tunnel syndrome caused by and what are its features?

A

Compression of the posterior interosseous branch of radial nerve.

Features include :

features of lateral epicondylitis
4-5 cm distal to lateral epicondyle

106
Q

what is adhesive capsulitis commonly known as ? What condition is associated with? What are its features?

A

Frozen shoulder.
Associated with diabetes mellitus.

external rotation and active and passive movement affected.

107
Q

what motion is a meniscal tear caused by? What test is used in its diagnosis?

A

Caused by twisting of the knee.
McMurray test positive

108
Q

what motion is ACL tear caused by? what test confirms it ?

A

Twisting of the knee. Amplified with positive draw test.

109
Q

what features of a humerus fracture would indicate an urgent need for surgery?

A

distal neurovascular deficit

110
Q

what can the co-prescription of azathioprine and allopurinol cause?

A

Bone marrow suppression

111
Q

what are the key features of polymyalgia rheumatica?

A

patients > 60
rapid onset
aching morning stiffness in proximal limb muscles - no weakness

112
Q

what is the most common type of shoulder dislocation? What nerve is commonly injured?

A

Anterior shoulder dislocation
Axillary nerve affected

113
Q

what antibodies are positive in Sjogren’s syndrome?

A

RF
ANA
Anti Ro, Anti La

114
Q

what are the key features of spinal stenosis ? How is the diagnosis confirmed?

A

gradual onset of unilateral or bilateral leg pain, numbness and weakness which is worse on walking and resolves on sitting.
Pain is also relieved by sitting down, leaning forwards and crouching down.
MRI is needed to confirm diagnosis.

115
Q

what malignancies can dermatomyositis be associated with?

A

ovarian
breast
lung

116
Q

what are the skin features of dermatomyositis?

A

Photosensitivity
Macular rash over the back and shoulder
Heliotrope rash in periorbital region
Gottron’s papules : consisting of roughened red papules over the extensor surfaces of the fingers.

117
Q

what antibodies are positive in dermatomyositis

A

ANA
Jo-1 - most specific

118
Q

what are the Ottawa ankle rules?

A

ankle x-ray needed if :
Pain in malleolar zone and -

  1. Inability to weight bear for 4 steps
  2. Tenderness on distal tibia
  3. Bone tenderness on distal fibula
119
Q

what is the management of ankle fractures :

A

Prompt reduction of fracture to remove pressure on overlying skin and subsequent necrosis.
young patients usually require surgical repair with a compression plate
elderly patients generally require conservative management

120
Q

how can you distinguish psoriatic arthritis from rheumatoid arthritis ?

A

Psoriatic arthritis presents with nail changes such as pitting and onycholysis

121
Q

what is the first line management of lower back pain - mechanical?

A

NSAID’s ( paracetamol monotherapy ineffective)

122
Q

what is the most common mechanism of an ankle sprain?

A

Ankle inversion

123
Q

What do the T-score and Z-score in a DEXA scan represent?

A

T-Score : based on bone mass of young reference population
Z-score : adjusted for age, gender and ethnic factors

124
Q

how does paget’s disease of the bone present on xray?

A

mixed lytic and sclerotic lesions

125
Q

what are the features of Felty’s syndrome?

A

splenomegaly
neutropenia
rheumatoid arthritis

126
Q

where does osteosarcoma most commonly present?

A

Metaphyseal region of long bones prior to epiphyseal closure.

127
Q

where does giant cell tumour most commonly occur?

A

Epiphyseas of long bones

128
Q

which antibodies are diffuse cutaneous systemic sclerosis associated with?

A

anti scl-70 antibodies

129
Q

what is a rheumatological drug that is safe to use in pregnancy?

A

Hydroxychloroquine

130
Q

what are the causes of avascular necrosis of the hip?

A

Long term steroid use
chemotherapy
alcohol
trauma

131
Q

what are the cautions for sulfasalazine use?

A

G6PD deficiency
allergy to aspirin / sulphonamides

132
Q

what are the adverse effects related to sulfasalazine

A

oligospermia
Stevens Johnson syndrome
pneumonitis/ fibrosis
myelosuppression

133
Q

What are the features of Still’s disease?

A

arthralgia
elevate ferritin
salmon pink maculopapular rash
pyrexia
lymphadenopathy

134
Q

What antibodies are present in Stills disease

A

RF, ANA

135
Q

How is Still’s disease managed?

A

NSAID’s
steroids

136
Q

what are the most common site for stress fractures? where do they most commonly occur?

A

Metatarsals
most commonly occur at the 2nd metatarsal shaft

137
Q

what are the risk factors for pseudogout?

A

Hemochromatosis
Hyperparathyroidism
acromegaly, Wilson’s disease
low magnesium, phosphate

138
Q

what is Ehler-Danlos syndrome? What are it’s features and complications?

A

autosomal dominant connective tissue disorder mainly affecting type III collagen.
Features include:
elastic, fragile skin
joint hypermobility and recurrent joint dislocation
easy bruising

complications include :
Aortic regurgitation
mitral valve prolapse
aortic regurgitation
SAH

139
Q

how are flares of RA managed?

A

Corticosteroids - oral /IM

140
Q

Children and young people with unexplained bone swelling or pain- ?

A

Very urgent direct access X-ray to assess for bone sarcoma

141
Q

what features are seen with ankylosing spondylitis

A

A’s

apical fibrosis
anterior fibrosis
aortic regurgitation
achilles tendonitis
AV node block
amyloidosis

142
Q

what is the action of a statin ?

A

inhibition of HMG-CoA - rate limiting enzyme in hepatic chlolesterol control

143
Q

what is the most common cause of heel pain seen in adults ? Where is the pain worse? How is it manahed

A

plantar fasciitis - around medial calcaneal tuberosity
management -
rest feet where possible
wear shoes with good support
insoles and heel pads

144
Q

what is the first line medication for the management of Raynaud’s

A

nifedipine

145
Q

what test is used in the diagnosis of sjogren’s syndrome

A

Schirmers

146
Q

what type of medication is allopurinol

A

xanthine oxidase inhibitor

147
Q

what is the most severe and dangerous form of Ehler’s Danlos syndrome?

A

Vascular Ehlers Danlos syndrome

148
Q

What syndrome, associated with Ehlers-Danlos syndrome, occurs as a result of autonomic dysfunction and causes significant tachycardia on sitting or standing along with presyncope or syncope

A

postural orthostatic tachycardia syndrome

149
Q

describe swan neck and boutonniere’s

A

swan neck - hyperextended PIP and flexed DIP
Boutonniere- hyperextended DIP and flexed PIP

150
Q

What medical emergency causing severe hypertension and renal failure can be caused by diffuse cutaneous systemic sclerosis?

A

Scleroderma renal crisis

151
Q

What condition typically causes self-limiting episodes of inflammatory arthritis, similar to rheumatoid arthritis, that last several days before completely resolving?

A

Palindromic rheumatism

152
Q

What is the major complication of giant cell arteritis?

A

permanent vision loss

153
Q

What test used in diagnosing Behçet’s disease involves using a sterile needle to make multiple pricks on the forearm, then reviewed 24-48 hours later to look for erythema and induration?

A

pathergy test

154
Q

What is the most common and least severe type of Ehlers-Danlos syndrome?

A

hypermobile ehlers danlos syndrome

155
Q

What is the main presenting symptom of myositis?

A

gradual onset , symmetrical , proximal muscle weakness

156
Q

give 2 dermatological side effects of hydroxychloroquine

A

blue grey skin
hair bleaching

157
Q

What scoring system can be used to assess for hypermobility and support a diagnosis of hypermobile Ehlers-Danlos syndrome?

A

Beighton score

158
Q

What skin changes are most associated with Kawasaki disease?

A

widespread erythematous maculopapular rash
desquamation ( skin peeling) of palms and soles

159
Q

What term refers to inflammation of the points of insertion of tendons into bone, often seen in psoriatic arthritis?

A

enthesitis

160
Q

What scoring system for calculating the risk of a major osteoporotic fracture or hip fracture is preferred in the NICE guidelines? (1)

What time frame does this score apply to? (1)

A

QFracture
10 years

161
Q

Which DMARD notably causes peripheral neuropathy

A

leflunomide

162
Q

What investigation is used to confirm a diagnosis of discoid lupus erythematosus? (1)

A

skin biopsy

163
Q

What nail signs may be seen in psoriatic arthritis?

A

nail pitting
onycholysis - seperation of the nail from the nail bed

164
Q

What tool is used to screen for psoriatic arthritis in patients with psoriasis?

A

psoriasis epidemiological screening tool

165
Q

What rare bone-related side effects can occur with the use of bisphosphonates? (3)

A

atypical fractures- femoral
osteonecrosis of the jaw
osteonecrosis of the external auditory canal

166
Q

What simple blood test is used in the diagnosis of myositis?

A

CK

167
Q

What joint in the thumb is most often affected by osteoarthritis?

A

Carpometacarpal joint

168
Q

what is the definition of accelerated progression of kidney disease

A

Sustained decline in the eGFR within 1 year of either 25% or 15 ml/ min / 1.73 m2

169
Q

What oral medication may be used to stimulate tear and saliva production in patients with Sjögren’s syndrome?

A

pilocarpine

170
Q

What pattern of skin colour changes is characteristically seen in patients with Raynaud’s phenomenon when exposed to a cold trigger, and why do these changes occur?

A

white - due to vasoconstriction
then blue - cyanosis
red - reperfusion and hyperaemia

171
Q

What are the characteristic presenting features of Behçet’s disease?

A

recurrent oral ulcers
genital ulcers

172
Q

What is the mechanism of action of adalimumab, infliximab and etanercept?

A

tumour necrosis factor inhibitors

173
Q

What special technique can help distinguish between idiopathic Raynaud’s and Raynaud’s secondary to systemic sclerosis?

A

nailfold capillaroscopy

174
Q

What class of medication often worsens the symptoms of Raynaud’s phenomenon?

A

beta blockers

175
Q

What is the usual medical treatment for Kawasaki disease?

A

aspirin and IV immunoglobulins

176
Q

explain t score

A

at the femoral neck
the number of standard deviations that the patients bone mineral density is from an average health adult

177
Q

Which DMARD notably causes orange urine and a reduced sperm count?

A

sulfasalazine

178
Q

Which DMARDs are most harmful in pregnancy?

A

methotrexate
leflunomide

179
Q

What test assesses spinal mobility, particularly where ankylosing spondylitis is suspected? (1)

What reference points are marked in this test? (1)

What cutoff when bending forwards suggests restriction in lumbar movement? (1)

A

Schober’s test
10 cm above and 5 m below the L5 vertebrae
less than 20 cm length between the reference marks suggests restriction

180
Q

What unusual pathogens may cause infection in a transplant patient taking immunosuppressants?

A

PCP
CMV
TB

181
Q

What gene is linked with Behçet’s disease?

A

HLA B51

182
Q

Which DMARD notably causes retinal toxicity?

A

Hydroxychloroquine

183
Q

What are the key conditions associated with ankylosing spondylitis (5 As mnemonic)?

A

anterior uveitis
aortic regurgitation
av block
apical lung fibrosis
aocd

184
Q

What is the medical term for a bunion?

A

hallux valgus

185
Q

What term is used to describe the misaligned healing of a fracture?

A

malunion

186
Q

What resisted movements can be used to establish a diagnosis of trochanteric bursitis?

A

external rotation
internal rotation
abduction

187
Q

What are the three phases of frozen shoulder? (3)

How long does each phase last on average? (1)

A

painful, stiff, thawing

6 month each

188
Q

Why would a bladder scan be indicated in a patient with back pain?

A

suspected cauda equina

189
Q

what test assesses duputrens contracture

A

table top

190
Q

What classification system can be used to describe fractures of the lateral malleolus of the ankle? (1)

What bone is affected? (1)

In relation to what important structure is the fracture described? (1)

What is the significance of this structure in relation to the fracture? (1)

A

weber
fibula
distal syndesmosis between tibia and fibula
fracture disprupts syndesmosis = surgery more liekly

191
Q

What investigation can be used to measure the pressure in a compartment?

A

needle manometry

192
Q

most common reason for total hip replacement revision.

A

Aseptic loosening - presenting with hip or groin region pain radiating down to the knee

193
Q

how does posterior dislocation of the hip present ?

A

typically presents acutely with a ‘clunk’, pain and inability to weight bear
on examination there is internal rotation and shortening of the affected leg

194
Q

what is a sign of scaphoid fracture

A

pain on longitudinal compression of thumb

195
Q

where does the scaphoid get its blood supply from and what does interruption of this blood flow risk

A

dorsal carpal branch of the radial artery with disruption causing avascular necrosis of the scaphoid

196
Q

what are the signs of a scaphoid fracture

A

point of maximal tenderness over anatomical snuffbox

pain elicited on longitudinal compression of the thumb

tenderness of scaphoid tubercle

pain on ulnar deviation of wrist

197
Q

Ivx done for scaphoid injury

A

plain film radiographs in AP and lateral views
MRI definitive

198
Q

how is a scaphoid fracture managed

A

immobilisation with a futuro splint or standard below backslab

199
Q

how are undisplaced fractures of the scaphoid managed

A

cast for 6-8 weeks

200
Q

how are displaced scaphoid fractures managed

A

surgical fixation

201
Q

meniscal tear test

A

Thessaly’s test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee

202
Q

what investigation is essential prior to commencing biologics

A

chest xray

203
Q

mx of scaphoid pole fractures

A

surgical fixation

204
Q

how does compartment syndrome present renally

A

raised myoglobin

205
Q

differentiate between direct and indirect injury of the patella

A

direct generally involves a blow or trauma to the front of the knee, generally an undisplaced crack

indirect injury is generally is when the quadriceps forcefully contracts against a block to knee extension ( like when catching foot against solid object)

206
Q

investigations for patellar fracture

A

plain film radiograph generally AP anf lateral

207
Q

management of patellar fracture

A

undisplaced - if they have intact extensor mechanism then hinged knee brace for 6 weeks

displaced - operative management with tension band wire, inter fragmentary screws etc

208
Q

distinguish between galeazzi and monteggia fracture

A

monteggia - ulnar fracture, foosh
galaezzi - radial shaft fracture , reverse foosh

209
Q

management of temporal arteritis

A

no visual loss - high dose pred
visual loss - IV methylpred
continue even if normal biopsy due to skip lesions

210
Q

Osteochondritis dissecans

A

typically presents with knee pain after exercise, locking and ‘clunking’

211
Q

spinal stenosis diagnosis

A

MRI

212
Q

feature suggesting primary raynaud’s

A

young women

213
Q

key features of APL

A

anticardiolipin
thrombocytopenia
prolonged APTT

214
Q

causes of dupuytren’s contracture

A

manual labour
phenytoin treatment
alcoholic liver disease
diabetes DM

215
Q

tool used to assess hypermobility

A

Beighton score

216
Q

what is visual loss in temporal arteritis caused by

A

anterior ischaemic optic neuropathy

217
Q

how would you describe a club foot

A

inverted and plantar flexed foot which is not passively correctable

218
Q

what are the features of fat embolism

A

respiratory distress, altered mental status, and a rash.

219
Q

mx of fat embolism

A

fixation of long bone fractures

220
Q

anterior vs posterior dislocation

A

posterior : leg is shortened, adducted and internally rotated
anterior : abducted and externally rotated with no leg shortening

221
Q

which lung condition are persons with marfans most likely to develop

A

pneumothorax

222
Q

which skin feature is behcets syndrome associated with

A

erythema nodosum

223
Q

management of rib fractures

A

conservative management with analgesia
nerve block
surgical fixation if fracture has failed to heal following 12 weeks of conservative mx

224
Q

how to distinguish between anterior cruciate ligament tear and medial meniscus tear

A

ACL = rapid joint swelling due to bleeding
meniscal tear= gradual swelling

225
Q

Baker’s cyst

A

develop in patients with arthritis or gout following minor trauma to the knee

226
Q

which meds should be considered in all housebound patients

A

vitamin D

227
Q

squaring of the thumb suggests ?

A

osteoarthritis

228
Q

marfans is characterised by a deficiency of

A

fibrillin

229
Q

how is APL managed

A

primary - low dose aspirin
secondary - lifelong warfarin

230
Q

anterior and posterior shoulder dislocation

A

anterior - FOOSH
posterior - seizures and electrical shock

231
Q

which is the main immunoglobulin found in breast milk

A

IgA

232
Q

what is the management of subluxation of the radial head

A

analgesia
passive supination of the elbow joint while elbow is flexed up to 90 degrees

233
Q

summary of osteogenesis imperfects

A

brittle bone disease
autosomal dominant
childhood- fractures following minor trauma, blue sclera, deafness and dental problems

calcium, phosphate , pth and alp generally normal

234
Q

features of osteosarcoma

A

Codman’s triangle
most common
sunburst pattern

235
Q

management of shoulder dislocation

A

recent dislocation = attempt reduction without analgesia or sedation

236
Q

Ant synthetase syndrome

A

Anti Jo1
myositis
ILD
thickened and cracked skin
Raynaud’s

237
Q

most common causes of drug induced SLE

A

procainamide
hydralazine
isoniazid
minocycline
phenytoin

238
Q

C8 radiculopathy

A

weak flexion of all digits including the thumb

239
Q

features of cauda equina

A

lower back pain
bilateral sciatica
decreased anal tone

240
Q

Anterior ischemic optic neuropathy

A

swollen pale disc and blurred margins

241
Q

virchows triad

A

stasis
hypercoagulability
endothelial damage

242
Q

signs of central disc prolapse

A

weakness
urinary retention
incontinence
peri-anal sensory loss
reduced anal tone

243
Q

HLA type associated with RA

A

HLA DR4/DR1

244
Q

surgical management of carpal tunnel syndrome

A

decompression studies : division of the flexor retinaculum

245
Q

ulnar nerve entrapment

A

Numbness and paraesthesia of the ulnar half of the ring finger and the little finger

246
Q

survival rate of osteosarcoma

A

55% 5 year survival

247
Q

froment’s sign

A

Froment’s sign - present in carpal tunnel syndrome : flexion of PIP while grasping a piece of paper between thumb and index

248
Q

radiological signs of avascular necrosis of the femoral head

A

none initially
sclerosis and otolysis
fractures, flattening of femoral head
joint space narrowing

249
Q

mx of hip dislocation

A

Reduction under general anaesthesia within 4 hours = reduces risk of avascular necrosis

250
Q

ottawa knee rules

A

Age 55 / more
Patellar head tenderness
Fibular head tenderness
Can’t flex knee
Can’t weight bear

251
Q
A

SBA passmed Flashcards (30 decks)

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