MSK - ortho Flashcards
Systemic manifestations of RA?
What can you see on bloods?
Eyes- sojrens, scleritis
sKin - nails, felty’s (leg ulcers)
Nodules - vocal chords, eyes,
Neuro - mononeuritis multiplex, polyneuropathy
Resp - PF, obliterative bronchiolitis
CVD - vascultiis, myocardial fibrosis,
kidneys - amyliodosis
Liver - ALT/AST raised, ALP raised
OP, depression, thryoid, splenomegaly
Bloods - RF, raised ferritin, leukopenia, reactive thrombocytopenia, anaemia
Felty’s syndrome (SANTA mnuemonic?) complication of RA
Splenomegaly, anaemia, neutropenia, thrombocytopenia, arthritis (rheumatoid)
Numbness on left side of chin? nerve affected? (punched side of chin)
Mental nerve (chin and lip)
comes down level of mandibular 2nd premolars
<17YO morbilliform rash salmon pink, swinging fever, leukocytosis, anaemia, hepatosplenomegaly. followed by arthirits?
risk of this ?
Still’s disease - systemic JIA
Macrophage activation syndrome (DIC, anaemia, LOW ESR)
Ank spond disease profile? (modified NY criteria?)
extra articular manifestations?
score to determine effectiveness of drug therapy and functionality?
<15 - 25 YO back pain 3m+, limited ROM lumbar spine, limited chest expansion for sex and age. sacroilitis.
EA SX: OP, renal amyloid, acute anterior uvitis, restrictive lung disease, cauda equina, aortic lung insufficiency
scores: BASDAI (disease activity index) and BASFI (functionality index)
Synovial fluid - needle shaped, negatively bifringent
Gout
Pseudogout synovial fluid?
positive bifringeent, rhomboid shaped. calcium pyrophosphate
osteoporosis assessment?
Indications for DEXA scan? scores mean?
what predisposes to 2ndary OP?
FRAX if Rf present/ 50YO+- if 10%+, do DEXA
DO DEXA without FRAX if <40 and has 1 major RF/ 50+ and known #
RF: previous #, CS 7.5mg OD 3 months, falls, BMI<18, FH hip #, alcohol 14 units+, post menopausal women with FH of hip fracture, XR with osteopenia/ vertebral collapse, oestrogen deficiency (premature ovarian failure)
T score -1–2.5 osteopenia, <-2.5 OP, # severe OP
2ndary OP: malabsorption, antiepileptics, RA, PTH hig, TFTs, CKD, cushing’s, immobile
TX: ca 1g/day, vit D 400-800
Central chord syndrome?
upper extremities - motor impairment more than lower
bladder dysfunction/ urine retention.
most common type of incomplete spinal syndrome, cervical spondylisis/ OA of neck/ hyperextension injury
Anterior chord syndrome
hyperflexion injury of spine/ anterior spinal A ischaemia
B/L loss of pain, temp/ motor below injury. intact proprioception and vibration
Sciatica causes?
slipped disc (most common), spondylolisthesis, spinal stenosis, infection, cancer. pain better leaning forward
Limited cutaneous systemic sclerosis / CREST syndrome?
ANTI Scl70 (diffuse), anti-centromere (limited), ANA, barium swallow - dysphagia, calcified nodules, raynauds, esophageal dysmotility, sclerodactyl, telangactasia
Otawa knee rules?
for XR: medial malleolus/ lateal pain on palpation and 6 cm below, cant W/B, 55+, unable to flex 90 degrees,
Adults: CT head rules? within 1 hr?
within 8 hrs?
GCS<13 at r/v / <12 2 hrs after accident.open/ depressed skull fracture, basal skull fracture signs, siezure, 1x vomit, neurolgoy,
within 8 hrs if: on warfarin/ 65+/ beleding/ clotting disorders/ 30min+ retrograde amnesia/ dangerous mechanism
Child CT rules within 1 hr?
<1YO with bruise/ swelling 5cm+ on head. skull fracture/ depressed. GCS<15 immediastely or 2 hrs after injury.
head injury+ LOC 5min/ vomit x3, amnesia 5min+, dangerous mechanism. if onyl 1 RF, then observe for 4 hrs, cT if further drowsiness/ vomitting/ GCS drop
When to avoid colchicine?
Blood disorders, EFGR <10, renal impariment, pregnant/ breastfeeding, hepatic impairment, with clarithromycin/ erythromycin/ verapamil, ketokonazole,
Colles fracture?
dorsally displaced distal radius fracture, dinnerfork deformity
20YO black woman, oral ulcer, facial rash, painful joints.Posiitve ANA?
Anti ds-dna/ anti sm/ anti phospholipid antibodies.
SLE. mild normochromic normocytic anaemia. reduced C3 and C4
Risk of premature atheroscrelorsis
high heels wearing, pain electric current between 2nd and 3rd toes?
Morton’s neuroma (irritation of interdigital nerve due to metatarsal head compression). can elicit a click on metatarsal head squeeze
30YO japanese man, iritis, oral and genital ulcers, pain in knee joints, erythema nodosum on both shins
behcet’s disease. multisystem vasculitis. also: neuro SX, need cS. behavioural changes in 50%pethargy reaction (rash worse after needle)
14YO girl chronic pain and stiff in left foot following injury
Freiberg’s disease - osteochondrosis articular surfaces of 2nd or 3rd toes.
Barton’s fracture
intra-articular fracture of distal radius
Bennets and rolando fracture?
intra-articular fracture of base of 1st metacarpal.
2 parts - bennets. needs thumb spica cast
3 parts - fist fight/ forced thumb abduction. needs ORIF
Mallet finger
sudden flextion of DIP of finger. cant extend finger at DIP due to damage to extensor mechanism. tX - keep splint in slight extension for 6 weeks. heals
Sulfasalazine SE?
pneumonitis/ oligospermia/ rashes/ heinz body anaemia,
As of ank spond?
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)
Drug that causes Exacerbation of myasthenia gravis
Penicillamine
SLE features
discoid rash, malar rash, oral ulcers nose ulcers, arthritis, renal/ proteinuria/haemolytic anaemia, anti ds dna, c3/c4 decreased
Risks: premature asthersclerosis
pain in heel, worse on tip toes
plantar fasciitis
pain using shoulder in overhead activities, positiv epainful arc at 90 to 120, grinding, popping, snapping
painful arc positive in first 60 degrees?
subacromial impingement
first 60 degrees movement- supraspinatus tear
pain, numbness in little and ring ginger, worse leaning on elbow?
cubital tunnel syndrome (ulnar nerve compression
dorsum foot sens loss, weak big toe dorsiflextion and foot, reflexes normal, positive sciatic stretch
L5 nerve root compression
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L4 nerve root compression
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L3 nerve root compression
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
S1 nerve root compression
Hip shorted IR, adducted?
posterior hip dislocation
Hip ER, not shorted, abducted?
anterior hip dislocation
back pain worse in the morning and on standing. pain is worse on extension of the back
facetjoint
Unilateral or bilateral leg pain/ backpain, numbness, and weakness which is worse on walking. ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
spinal stenosis
myxoid cyst?
benign ganglion cyst distal dorsal finger with OA, middle aged women
erb’s
c5, c6, waiter’s tip upper part of brachial plexus. arm is IR and elbow extended. shoulder dystocia
Klumpbke’s palsy?
lower brachial plexus, C8, t1. AF horner’s syndrome. CX: birth/ sudden upward jerking of hand
triceps reflex
radial nerve, (c7)
ulna # with proximal radio-ulnar dislocation?
monteggia. FOOSH forced pronation
radial shaft # with dislocation of distal radioulnar joint, prominent ulna head
galeazzi. fOOSH with rotational injury
weight bearing at 20 degrees of knee flexion, positive if pain on twisting knee
thassaly’s test for meniscal tear
pain over radial styloid on forced abduction/ flextion of thumb?
recently had a child?
finkelstein positive test for De quervain;s tenosynovitis
cx of dupytren’s?
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
ulnar-sided hand pain and swelling following a punch injury. XR shows?
5th metacarpal minimally displaced # (boxer)
Burning thigh pain, man, worse standing, better sitting. recreate sx by deep palpating below ASIS. normal sensation, no weakness?
meralgia parasthetica - laterl femoral cutaneous nerve.
positive pelvic compression test. do USS guided LA injection
ankle sprain caused by excessive inversion injuy?
aterior talofibular ligament (always tear first, most common)
Peripheral vasc disease vs spinal canal stenosis?
PVD - quicker recovery, skin changes, vasc rf
canal stenosis - lower to reciver, may need to sit, worse going down hill and better leaning forwards. wmay have neurp sx/ back pain
child hip pain with flattening of femoral head, reduced joint spac. pain over few weeks
4-8 YO AVN of hip. perthe’s disease
15 YO child with knee/ distal thigh pain and loss of internal rotation of leg in flextion
slipped upper femoral epiphysis
