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Year 6 > MSK & Ortho > Flashcards

MSK & Ortho Flashcards

1
Q

L3 nerve root compression

A

Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

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2
Q

L4 nerve root compression

A

Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

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3
Q

symptoms of L5 nerve root compression

A

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

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4
Q

symptoms of S1 nerve root compression

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

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5
Q

loss of foot dorsiflexion and dorsal foot sensory loss?

A

L5 nerve root compression

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6
Q

nerve roots of sciatic nerve

A

L4 to S3

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7
Q

most common part of the bone affected in osteomyelitis in children

A

metaphysis

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8
Q

most common part of the bone affected in osteomyelitis in adults

A

epiphysis

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9
Q

when is a cast used?

A

to maintain the reduction of a displaced fracture

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10
Q

how long are stable fractures managed with a CAM boot?

A

6 weeks

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11
Q

Bennett’s fracture

A

intra-articular fracture at the base of the thumb metacarpal which commonly results from forced abduction of the first metacarpal.

Mr Bennett Thumb in the Butt

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12
Q

Galeazzi fracture

A

a radial shaft fracture associated with dislocation of the distal radioulnar joint.

On x-ray, we would expect to see a displaced fracture of the radius and a prominent ulnar head due to dislocation of the inferior radio-ulnar joint.

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13
Q

Pott’s fracture

A

a bimalleolar ankle fracture that occurs when there is forced foot eversion

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14
Q

what is a late sign of caudal equina syndrome indicating irreversible damage?

A

urinary incontinence

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15
Q

most common nerve injury with posterior hip dislocation

A

sciatic nerve

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16
Q

mechanisms of ACL injury

A
  • lateral blow to knee
  • sudden twisting
  • awkward landing
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17
Q

which test for ACL injury is superior

A

Lachman&raquo_space; Anterior Drawer (sensitivity)

difference is the knee is kept at 20-30 at the test, rather than 90 degrees in supine

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18
Q

Test used to identify meniscal tear

A

McMurray’s test

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19
Q

Test used to assess integrity of supraspinatus muscle

A

Empty can test

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20
Q

causes of Dupuytrens contracture [5]

A

manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand

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21
Q

how is a undisplaced scaphoid fracture treated?

A

cast for 6-8 weeks

union is achieved in > 95%
certain groups e.g. professional sports people may benefit from early surgical intervention

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22
Q

how is a displaced scaphoid waist fracture treated?

A

surgical fixation

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23
Q

two complications of scaphoid fracture

A

non union

avascular necrosis

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24
Q

how is a proximal scaphoid pole fracture treated?

A

surgical fixation

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25
Q

first line treatments for ankylosing spondylitis

A

NSAIDs and regular exercise like swimming

also physiotherapy

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26
Q

when should DMARDs be used in ankylosing spondylitis

A

if there is peripheral joint involvement

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27
Q

which radiological sign is indicative of bamboo spine

A

dagger sign

ossification of the supraspinous and interspinous ligaments

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28
Q

when should anti TNF alphas be started in someone with axial ankylosing spondylitis

A

when 2 different NSAIDs have failed

and meets criteria for active disease on 2 occasions 12 weeks apart.

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29
Q

5 Ankylosing spondylitis X-ray findings

A

sacroiliitis: subchondral erosions, sclerosis

squaring of lumbar vertebrae

‘bamboo spine’ (late & uncommon)

syndesmophytes: due to ossification of outer fibers of annulus fibrosus

chest x-ray: apical fibrosis

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30
Q

difference between rheumatoid arthritis and psoriatic arthritis

A

PsA can be asymmetrical and can affect the DIP

RA spares the DIP and it most symmetrical

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31
Q

what needs to be monitored regularly in the bloods of someone taking methotrexate?

A

FBC
U&Es
LFTs

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32
Q

how often is methotrexate taken?

A

once weekly

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33
Q

what should be co-prescribed with methotrexate?

A

folic acid 5mg once weekly

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34
Q

which medications should be not be prescribed alongside methotrexate? [3]

A

trimethoprim
co-trimoxazole
high dose aspirin

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35
Q

LESS signs of Rheumatoid Arthritis

A

Loss of joint space
Erosions (periarticular)
Soft bones
Soft tissue swellings

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36
Q

first line treatment for OA

A

topical diclofenac

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37
Q

second line treatment for OA

A

oral NSAID with PPI

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38
Q

what infection is associated with Polyarteritis nodosa

A

Hep B

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39
Q

what does polyarteritis nodosa lead to the formation of

A

aneurysm

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40
Q

polyarteritis nodosa presenting features

A

fever, malaise, arthralgia
weight loss
hypertension
mononeuritis multiplex, sensorimotor polyneuropathy
testicular pain
livedo reticularis
haematuria, renal failure

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41
Q

What scoring system would be most helpful to determine if a patient has a secondary cause of osteoporosis

A

Z-score

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42
Q

describe the optic disc in anterior ischaemic optic neuropathy

A

swollen pale disc and blurred margins

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43
Q

which artery is affected in anterior ischaemic optic neuropathy

A

inflammation in the posterior ciliary artery (a branch of the ophthalmic artery) causing ischaemic to the anterior optic nerve

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44
Q

Indications for an ankle x ray

A

Inability to walk four steps immediately after the injury or in the emergency department

Bony tenderness at the medial malleolar zone (tip of medial malleolus to lower 6cm of posterior border of tibia)

Bony tenderness at the lateral malleolar zone (tip of lateral malleolus to lower 6cm of posterior border of fibula).

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45
Q

which AB is sensitive for SLE

A

ANA

poorly specific though

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46
Q

which AB is specific for SLE

A

anti-dsDNA

associated with poor prognosis

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47
Q

How should patients on long term corticosteroids under 65 be monitored for their DEXA

A

T score dependent:

Greater than 0–>Reassure

Between 0 and -1.5–>Repeat bone density scan in 1-3 years

Less than -1.5 –> offer bone protection

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48
Q

which malignancy are Sjogrens patients at more risk of

A

lymphoma

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49
Q

treatment of Sjogren’s

A

artificial saliva and tears
pilocarpine may stimulate saliva production

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50
Q

endocrine causes of osteoporosis [5]

A

hyperthyroidism
hypogonadism (e.g. Turner’s, testosterone deficiency)
growth hormone deficiency, hyperparathyroidism
diabetes mellitus

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51
Q

common cause of lateral knee pain in keen runners.

A

Iliotibial band syndrome

tenderness 2-3cm above the lateral joint line

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52
Q

treatment of lumbar spinal stenosis

A

laminectomy

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53
Q

What relieves pain in spinal stenosis

A

sitting down or leaning forward

also find it easier to walk uphill

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54
Q

How is compartment syndrome diagnosed

A

made by measurement of intracompartmental pressure measurements.

Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic

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55
Q

Initial management of compartment syndrome [3]

A

Keep limb level to the body
aggressive IV fluids
pain control

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56
Q

Investigations for Sjogrens:
bloods and extra

A

rheumatoid factor (RF)
ANA
anti-Ro (SSA)
anti-La (SSB)

Schirmer’s test: filter paper near conjunctival sac to measure tear formation

histology: focal lymphocytic infiltration

also: hypergammaglobulinaemia, low C4

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57
Q

which tools are used in assessing the risk of fragility fractures

A

FRAX and QFRACTURE

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58
Q

how does back pain progress during the day in ankylosing spondylitis

A

Stiffness is usually worse in morning and improves with activity

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59
Q

most common causative agent of disci tis

A

Staph aureus

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60
Q

2 complications of discitis

A

sepsis
epidural abscess

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61
Q

how is discitis diagnosed

A

MRI and CT guided biopsy

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62
Q

what other investigation must be done for those with discitis

A

screening for endocarditis therefore an echo

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63
Q

How is mild SLE treated

A

NSAIDS and hydroxychloroquine

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64
Q

How is SLE with organ involvement treated

A

long term corticosteroids with DMARDs

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65
Q

How is severe SLE with renal, neuro and haem effects treated?

A

high dose corticosteroids and immunosuppression e.g. cyclophosphamide

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66
Q

hand joints involved in RA

A

MCP
PIPS
MTP

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67
Q

hand joints involved in OA

A

MCP
DIPS
CMC

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68
Q

which examination sign is highly sensitive for scaphoid fracture

A

anatomical snuffbox tenderness

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69
Q

what is the ulnar paradox

A

proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions

explanation: When the ulnar nerve is damaged at the wrist, the medial two lumbrical muscles are affected (the lateral two being supplied by the median nerve). Denervation of the lumbricals, which flex the metacarpal phalangeal joints (MCPJ) and extend the interphalangeal joints (IPJ), causes unopposed extension of the MCPJ by extensor digitorum longus and flexion of the IPJ by flexor digitorum profundus and superficialis. This gives the hand a claw like appearance.

When the ulnar nerve is damaged at the elbow, the ulnar half of flexor digitorum profundus is also affected resulting in a less marked clawing due to reduced unopposed flexion at the IPJ.

As the patient recovers, the deformity will get worse, as flexor digitorum is reinnervated, before getting better.

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70
Q

The most common classification system for open fractures

A

Gustilo and Anderson classification system

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71
Q

When should open fracture be repaired when there is soft tissue injury

A

once the soft tissue has recovered an ORIF can be done. in the interim, an external fixation device is used

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72
Q

What is a late sign of caudal equine syndrome that indicates an irreversible state

A

urinary incontinence

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73
Q

Red flags for back pain according to The UK Royal College of Emergency Medicine (RCEM) [7]

A
  • non-mechanical back pain
  • past history of cancer/HIV
  • generally unwell
  • unexplained weight loss
  • widespread neurological symptoms
  • structural deformity
  • thoracic back pain
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74
Q

why is thoracic spine pain serious? what are the possible differentials?

A

spinal cord compression, spinal osteomyelitis, or epidural abscess

The thoracic spine is less prone to mechanical stress compared to the cervical and lumbar region therefore is more likely to have some underlying pathology

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75
Q

features of compartment syndrome [4]

A
  • Pain, especially on movement (even passive)
  • excessive use of breakthrough analgesia
  • Parasthesiae
  • Pallor
  • Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise
    -Paralysis of the muscle group
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76
Q

If scaphoid fracture is suspected, but imaging is inconclusive, what should be done

A

referral to ortho and follow up imaging in 7-10 days

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77
Q

what is trigger finger?

A

also known as stenosing tenosynovitis, occurs when inflammation or nodules develop in the flexor tendon sheath of a finger, causing pain and difficulty in movement.

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78
Q

treatment of trigger finger

A

steroid injection is successful in the majority of patients. A finger splint may be applied afterwards

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79
Q

treatment of Talipes equinovarus

A

Ponsenti method

manipulation and progressive casting which starts soon after birth. The deformity is usually corrected after 6-10 weeks

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80
Q

what is talipes equinovarus

A

club foot, describes an inverted (inward turning) and plantar flexed foot. It is usually diagnosed on the newborn exam.

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81
Q

which age groups should be assessed for osteoporosis [3]

A

all women aged >= 65 years and all men aged >= 75 years

Younger patients should be assessed in the presence of risk factors

82
Q

Risk factors in young patients that warrant assessment for osteoporosis

A

previous fragility fracture
current use or frequent recent use of oral or systemic glucocorticoid
history of falls
family history of hip fracture
other causes of secondary osteoporosis
low body mass index (BMI) (less than 18.5 kg/m²)
smoking
alcohol intake of more than 14 units per week for women and more than 14 units per week for men.

83
Q

If the FRAX assessment was done without a bone mineral density (BMD): how would a low risk patient be treated

A

reassure and give lifestyle advice

84
Q

If the FRAX assessment was done without a bone mineral density (BMD): how would a intermediate risk patient be treated

A

offer Bone Mineral Density test

85
Q

If the FRAX assessment was done without a bone mineral density (BMD): how would a high risk patient be treated

A

offer treatment

86
Q

Golfer’s elbow

A

medial epicondylitis

87
Q

Tennis elbow

A

lateral epicondylitis

88
Q

what aggravates Golfer’s elbow

A

wrist flexion and forearm pronation

89
Q

what aggravates Tennis elbow

A

wrist extension with elbow extended and forearm supination with elbow extended

90
Q

most common cause of heel pain in adults

A

plantar fasciitis

exacerbated when walking on tip toes

91
Q

where on the foot is the pain worse in plantar fasciitis?

A

medial calcaneal tuberosity

92
Q

management of plantar fasciitis

A

rest the feet where possible
wear shoes with good arch support and cushioned heels
insoles and heel pads may be helpful

93
Q

definition treatment of hip OA

A

total hip replacement

94
Q

how does meralgia parasthetica present

what nerve is compressed that causes this

what worsens the symptoms

A

burning and tingling sensation over the upper lateral area of the thigh, which is supplied by the lateral femoral cutaneous nerve. Most commonly originates from the L2/3 segments.

Symptoms are usually aggravated by standing, and relieved by sitting

95
Q

risk factors of meralgia parasthetica [5]

A

obesity and sudden weight gain
pregnancy
tense ascites
trauma

96
Q

antidote fro methotrexate toxicity

A

IV folinic acid (Leucovorin)

97
Q

when should external fixation be used

A

when there is extensive soft tissue damage

98
Q

poor prognostic indicator of rheumatoid arthritis [3]

A

positive RhF
early erosions
HLA DR4

99
Q

when is stiffness worse in RA

A

in the morning, for hour +
better with exercise

100
Q

features of RA in the hands [5]

A

ulnar deviation of MCPs
radial deviation at wrsit
swan neck
boutonieniere
Z thumb

101
Q

investigation of RA [4]

A

DAS28
squeeze test
serology for AB: RhF, anti CCP, ANA
imaging: XR

102
Q

what is Felty Syndrome

A

a triad of rheumatoid arthritis, neutropenia and splenomegaly

103
Q

how is synovitis detected in RA

A

USS or MRI

104
Q

treatment of acute RA flare

A

steroids

105
Q

long term treatment of RA [3]

A

Monotherapy with methotrexate, leflunomide or sulfasalazine

Combination treatment with multiple cDMARDs

Biologic therapies (usually alongside methotrexate)

106
Q

DMARDs safe in pregnancy [2]

A

Hydroxychloroquine and sulfasalazine (with folic acid)

107
Q

Biologics used in RA [4]

A

adalimumab, infliximab and etanercept (TNF inhibitors)
rituximab (a monoclonal antibody that targets the CD20 proteins on the surface of B cells)

They cause immunosuppression, increasing the risk of infection, certain cancers (e.g., skin) and reactivation of latent TB.

108
Q

acute management of gout

A

NSAID, colchicine

109
Q

chronic management of gout

A

1st line: allopurinol
2nd: febuxostat

probenecid, lorsartan, rasburicase

110
Q

drugs that can cause gout [4]

A

loop and thiazide diuretics
aspirin
cytotoxics
pyrazinamide

111
Q

signs and symptoms of Behcets [4]

treatment

A

recurrent oral and/or genital ulceration
uveitis
erythema nodosum
VTE

treatment: immunosuppression

112
Q

adverse effects of methotrexate [5]

A

mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis

113
Q

CK levels and EMG in temporal arteritis

A

normal

114
Q

heart issues in those with Marfans [2]

A

dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation

mitral valve prolapse (75%),

115
Q

What should you do with allopurinol during an acute attack

A

continue taking it

116
Q

when should gout prophylaxis be started

A

a couple weeks after the acute attack to prevent another attack

117
Q

features of PMR
- age
- onset
- symptoms

A

typically patient > 60 years old

usually rapid onset (e.g. < 1 month)

aching, morning stiffness in proximal limb muscles; also mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats

118
Q

treatment of pagets disease

A

bisphosphonates

oral risedronate or IV zoledronate

119
Q

complications of pagets [5]

A

deafness (cranial nerve entrapment, both Sens and cond)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure

120
Q

investigation of stress fracture

A

x-ray look for callus

121
Q

how do bones in Paget’s appear on X-ray

A

thickened and sclerotic

122
Q

most common reason for hip replacement revision

A

aseptic loosening

123
Q

features of ACL rupture [3]

A

sudden ‘popping’ sound
knee swelling
instability, feeling that knee will give way

124
Q

name a risk factor for adhesive capsulitis

A

diabetes

125
Q

how does a patient present with an iliopsoas abscess

how do you investigate

A

laying supine with their knees flexed and hips mildly externally rotated

investigate with CT abdo

126
Q

how does caudal equina syndrome present [5]

A

possible symptoms:
low back pain
bilateral sciatica (around 50% of cases)
reduced sensation/pins-and-needles in the perianal area
decreased anal tone (poor sensitivity and specificity for CES)
urinary dysfunction

127
Q

the most common upper limb injury in children under the age of 6

management?

A

subluxation of the radial head (pulled elbow)
Signs include elbow pain and limited supination and extension of the elbow. The child usually refuses examination on the affected elbow due to the pain.

analgesia and passively supination of the elbow joint whilst the elbow is flexed to 90 degrees

128
Q

what is a ganglion

A

Swelling in association with a tendon sheath commonly near a joint

129
Q

what parts does limited cutaneous systemic sclerosis affect

A

face and distal limbs predominately

130
Q

what parts does diffuse cutaneous systemic sclerosis affect

A

affects trunk and proximal limbs predominately

131
Q

which antibodies are present in diffuse cutaneous systemic sclerosis

A

anti-scl-70 antibodies

132
Q

which antibodies are present in limited cutaneous systemic sclerosis

A

anti-centromere antibodies

133
Q

what should patients with diffuse cutaneous systemic sclerosis be started on if they have renal disease

A

ACEi

134
Q

most common cause of death in diffuse cutaneous systemic sclerosis

A

pulmonary: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)

135
Q

features and complications of Ehlers Danlos syndrome

A

elastic, fragile skin
joint hypermobility: recurrent joint dislocation
easy bruising
aortic regurgitation, mitral valve prolapse and aortic dissection
subarachnoid haemorrhage
angioid retinal streaks

136
Q

how is hypermbility tested

A

Beighton score

Beighton score is positive if at least 5/9 in adults, or at least 6/9 in children.

137
Q

which bones are most commonly affected in Pagets

A

skull
spine/pelvis
long bones lower limbs

138
Q

adverse effect of hydroxychloroquine

A

bull’s eye retinopathy - may result in severe and permanent visual loss

therefore baseline examination needed by opthalmologist

139
Q

first line treatment for reactive arthritis

A

NSAIDs

140
Q

features of polymyositis

A

proximal muscle weakness +/- tenderness
Raynaud’s
respiratory muscle weakness
interstitial lung disease
e.g. fibrosing alveolitis or organising pneumonia
seen in around 20% of patients and indicates a poor prognosis
dysphagia, dysphonia

141
Q

key investigations in polymyositis

A

elevated creatine kinase
other muscle enzymes (lactate dehydrogenase (LDH), aldolase, AST and ALT) are also elevated in 85-95% of patients
EMG
muscle biopsy
anti-synthetase antibodies
anti-Jo-1 antibodies are seen in pattern of disease associated with lung involvement, Raynaud’s and fever

142
Q

management of polymyositis

A

high-dose corticosteroids tapered as symptoms improve
azathioprine may be used as a steroid-sparing agent

143
Q

investigation of gout in the acute setting

A

uric acid

≥ 360 umol/L is seen as supporting a diagnosis
< 360 umol/L during a flare and gout is strongly suspected, repeat the uric acid level measurement at least 2 weeks after the flare has settled

144
Q

what would Synovial fluid analysis show in gout

A

needle shaped negatively birefringent monosodium urate crystals under polarised light

145
Q

features of CREST syndrome

A

Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

146
Q

hand deformities seen in OA o

A

Painless nodes (bony swellings)
Heberden’s nodes at the DIP joints
Bouchard’s Nodes at the PIP joints
these nodes are the result of osteophyte formation.

Squaring of the thumbs

147
Q

morning stiffness comparison between OA and RA

A

OA lasts a few minutes
RA lasts for a while (1 hr+)

148
Q

Skin features of SLE

A

malar (butterfly) rash: spares nasolabial folds
discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas. Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic
photosensitivity
Raynaud’s phenomenon
livedo reticularis
non-scarring alopecia

149
Q

General features of SLE

A

fatigue
fever
mouth ulcers
lymphadenopathy

150
Q

Musculoskeletal features of SLE

A

arthralgia
non-erosive arthritis

151
Q

Cardiovascular features of SLE

A

pericarditis: the most common cardiac manifestation
myocarditis

152
Q

Respiratory features of SLE

A

pleurisy
fibrosing alveolitis

153
Q

Renal features of SLE

A

proteinuria
glomerulonephritis (diffuse proliferative glomerulonephritis is the most common type)

154
Q

Neuropsychiatric features of SLE

A

anxiety and depression
psychosis
seizures

155
Q

definition of open fracture

A

refers to a disruption of the bony cortex associated with a breach in the overlying skin

156
Q

what score helps predict the need of primary amputation in Type IIIc injuries

A

Mangled Extremity Scoring System (MESS)

157
Q

overall management of open fracture

A
  • immobilise including the proximal and distal joints
  • check for associated injuries
  • control of haemorrhage
  • imaging
  • neurovascular status check following reduction and immobilisation
  • dressing and Abx IV broad spec
  • ?tetanus
  • early debridement and lavage within 6 hours of injury (removal of foreign material)
  • wound irrigation with 6L saline
  • fracture stabilised and external fixator used
158
Q

oblique fracture

A

Fracture lies obliquely to long axis of bone

159
Q

comminuted fracture

A

> 2 fragments

160
Q

segmented fracture

A

more than one fracture along a bone

161
Q

transverse fracture

A

perpendicular to long axis of bone

162
Q

spiral fracture

A

Severe oblique fracture with rotation along long axis of bone

163
Q

causes of drug induced lupus

A

Hydralazine, Procainamide

Isoniazid,Minocycline,Phenytoin

investigation: anti histone ABs

164
Q

how is disease activity monitored in SLE

A

anti-dsDNA titres
complement levels
ESR levels

165
Q

ESR and CRP levels in SLE

A

ESR will be elevated
in active disease CRP will be normal usually unless there is an underlying infection

166
Q

which complement are investigated in SLE and what do they mean

A

low C4 in moderately active SLE
low C3 in very active SLE

167
Q

treatment of severe SLE flares

A

prednisolone and IV cyclophosphamide

Proteinuria → ACEi
Aggressive GN (lupus nephritis) → immunosuppression

168
Q

what are the manifestations of severe SLE flare

A

AIHA
nephritis
CNS disease
pericarditis

169
Q

maintenance treatment of SLE

A

hydroxychloroquine is mainstay

can include DMARDs and low dose steroids

170
Q

treatment of Raynaud’s

A

gloves/avoid cold
CCBs (nifedipine)
PDE V inhibitors (sildenafil)
IV prostacyclin (iloprost)

171
Q

features of dermatomyositis

A

photosensitive
macular rash over back and shoulder
heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers
‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
nail fold capillary dilatation
proximal muscle weakness +/- tenderness
Raynaud’s
respiratory muscle weakness
interstitial lung disease: e.g. Fibrosing alveolitis or organising pneumonia
dysphagia, dysphonia

172
Q

investigations for dermatomyositis

A

CK raised
EMG
biosy
malignancy screen
myositis panel:
80% ANA positive
30% aminoacyl-tRNA synthetases (anti-synthetase antibodies), including:
antibodies against histidine-tRNA ligase (also called Jo-1)
antibodies to signal recognition particle (SRP)
anti-Mi-2 antibodie

173
Q

which are the large vessel vasculitides

A

GCA
Takayasu arteritis

174
Q

which are the medium vessel vasculitides

A

Polyarteritis nodosa
Kawasaki disease

175
Q

which are the small vessel vasculitides
- c-ANCA
- p-ANCA [2]
- ANCA -ve [3]

A

c-ANCA +ve:
Granulomatosis with polyangitis (Wegener)

p-ANCA +ve:
Eosinophilic granulomatosis with polyangitis (Churg Strauss)
Microscopic polyangitis

ANCA -ve:
HSP
Goodpasture’s
cryoglobulinaemia

176
Q

investigation of GCA

A

temporal artery USS–> halo sign

if negative –> biopsy, will see skip lesions

177
Q

features of GCA

A

scalp tenderness
jaw claudication
headaches
amaurosis fugal

178
Q

key features of Takayasu arteritis

A
  • Asian
    systemic features of a vasculitis e.g. malaise, headache
    unequal blood pressure in the upper limbs
    carotid bruit and tenderness
    absent or weak peripheral pulses
    upper and lower limb claudication on exertion
    aortic regurgitation (around 20%)
179
Q

what needs to be followed up in HUS

A

BP and urine dipstick

180
Q

features of fibromyalgia

A

chronic pain: at multiple site, sometimes ‘pain all over’
lethargy
cognitive impairment: ‘fibro fog’
sleep disturbance, headaches, dizziness are common

181
Q

treatment of fibromyalgia

A

explanation
aerobic exercise: has the strongest evidence base
cognitive behavioural therapy
medication: pregabalin, duloxetine, amitriptyline

182
Q

treatment of diabetic neuropathy

A

duloxetine

183
Q

key rash in Still’s disease

what are some other features

A

salmon pink rash

elevated serum ferritin
RF -ve
pyrexia and lymphadenopathy

184
Q

management of Still’s disease

A

NSAIDs
should be used first-line to manage fever, joint pain and serositis
they should be trialled for at least a week before steroids are added.

steroids
may control symptoms but won’t improve prognosis

if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered

185
Q

investigations in septic arthritis

A

synovial fluid sampling
blood cultures
joint imaging

186
Q

triad in Still’s disease

A

joint pain, spiking fevers, and a pink bumpy rash

other:
high serum ferritin and leucocytosis

187
Q

3 features of Colle’s fracture

A
  1. Transverse fracture of the radius
  2. 1 inch proximal to the radio-carpal joint
  3. Dorsal displacement and angulation
188
Q

what dislocation is associated with a Hill Sachs lesion

A

glenohumeral dislocation

189
Q

which rotator cuff muscle is torn most often

A

supraspinatus

190
Q

Menisceal tear

A

Rotational sporting injuries
Delayed knee swelling
Joint locking (Patient may develop skills to ‘unlock’ the knee
Recurrent episodes of pain and effusions are common, often following minor trauma

Arthroscopic menisectomy is the usual treatment.

191
Q

De Quervain’s tenosynovitis

A

pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful

192
Q

adverse effects of azathioprine

A

bone marrow depression
consider a full blood count if infection/bleeding occurs
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer

193
Q

is azathioprine safe in pregnancy

A

yes

194
Q

how does a meniscal tear present

A

pain worse on straightening the knee
knee may ‘give way’
displaced meniscal tears may cause knee locking
tenderness along the joint line
delayed knee swelling
Thessaly’s test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee

195
Q

how is the tibia positioned to the femur in a PCL injury

A

tibia lies back on the femur and can be drawn forward during a paradoxical draw test.

196
Q

treatment of undisplaced intracapulsar hip fracture

A

internal fixation, or hemiarthroplasty if unfit.

197
Q

treatment of displaced intracapsular hip fracture

A

arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture

total hip replacement is favoured to hemiarthroplasty if patients:
were able to walk independently out of doors with no more than the use of a stick and
are not cognitively impaired and
are medically fit for anaesthesia and the procedure.

198
Q

treatment of extracapsular hip fracture

A

stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

199
Q

Occupational exposure to industrial dyes and rubber chemicals may increase risk of which renal cancer

A

Transitional cell carcinoma

200
Q

what parts of the bone does a Salter Harris 4 fracture involve

A

Fracture involving the physis, metaphysis and epiphysis.

201
Q

features of Leriche syndrome

A
  1. Claudication of the buttocks and thighs
  2. Atrophy of the musculature of the legs
  3. Impotence (due to paralysis of the L1 nerve)

Leriche syndrome, is atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries. Management involves correcting underlying risk factors such as hypercholesterolaemia and stopping smoking. Investigation is usually with angiography.

202
Q
A

Year 6 (19 decks)

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