MSK / Orthopaedics Flashcards
What is the most sensitive sign for patient with comparment syndrome?
Pain on passive stretching
Commonest site for compartment syndrome
leg
What is a key symptom of compartment syndrome?
Pain out of proportion (i.e not controlled by morphine)
Patient has MSK pain which is out of proportion with injury and not controlled by strong painkillers including morphine, which diagnosis should you suspect?
Compartment syndrome
Compartment syndrome 5 signs (5Ps)?
Pain Parasthesia Pulslessness Paralysis Painful swelling
You suspect that a patient may have comparmtnet syndrome, you order a measurement of the compartment pressure. What pressure reading would indicate compartment syndrome diagnosis?
> /= 40 mmHg
What is the operative management of compartment syndrome?
Fasciotomy
Give the patient demographics typical of polymyalgia rheumatica?
Caucasian Woman >50
Is polymyalgia an inflammatory or non-inflammatory MSK condition?
Inflammatory
Patient presents with pain across their shoulders and pelvis, it gets worse with movement and is disturbing their sleep. They are stiff for an hour on a morning, feel fatigued and have a low mood.
Likely diagnosis?
Differentials?
Polymyalgia Rheumatica
OA, RA, myositis,
Fibromyalgia, SLE, osteomalacia
What is the management of polymyalgia rheumatica?
15mg prednisolone/day
70% improvement in 3-4wks
What other inflammatory condition is polymyalgia rheumatica associated with?
GCA
Polymyalgia rheumatica patients take long term corticosteroid treatments. Considering this, what additional management measures should be put in place?
Dont STOP
Dont= don’t stop abruptly, risk of adrenal crisis
S= sick day rules
T= treatment card- steroid tx card to alert others
O= OP prophylaxis e.g bisphosphonates, calcium, vit D
P= PPI (corticosteroids increase acid production)
In investigation a potential diagnosis of polymyalgia rheumatica the investigations below are carried out. Which differential are they exploring the possiblilty of... Calcium (high)= RF= Calcium (low)= ANA= CK= Urine bence jones proteins= Anti-CCP= Serum plasma electrophoresis= TSH=
Calcium high= cancer / hyperparathyroid RF= RA Calcium low= osteomalacia ANA= SLE CK= myositis Urine bence jones protein= myeloma Anti-CCP= RA Serum plasma electrophoresis= myeloma TSH= hyper / hypothyroidism
What does Anti-CCP stand for? It is found in most patients with what condition?
Anti-cyclic citrillunated peptide
Antibody positive in most patients with RA
CPK (creatinine phosphokinaze enzyme) is used as a marker of what?
Muscle tissue damage/inflammation to heart / brain
What is an EMG
Electromyograph
Measures muscle response / electrical activity in response to nerve stimulation
Does hyper or hypokalaemia cause muscle weakness?
Hypokalaemia may present with muscle weakness
A dinner fork deformity is a sign of what kind of fracture
Colle’s fracture (fracture of radius from upward displacement of forearm)
A complete fracture of the radius resulting from upwards displacement of forearm describes what kind of fracture?
Colle’s fracture
Give a primary cause of large, medium, med/small and small vasculitis?
Large= GCA Medium= Kawasaki Med/Sml= wegner's granulomatosis Small= heoch-shonlein purpura
Methotrexate can cause bone marrow suppression, as a result what should we monitor?
Bloods and LFTs
Anti-TNF medications are associated with reactivation of which infectious disease? As a result what should you do?
Reactivation of latent TB
Screen for TB with mantoux / CXR / quantiferon
If (+), tx TB 3mo before anti-TNF
Describe the pathophysiology of sjogren’s syndrome?
AI condition effecting exocrine glands leading to dry mucous membranes
A patient presents complaining of dry eyes, mouth, +/- vagina, what is the suspected diagnosis and what investigations might you carry out?
Sjogren’s syndrome (dry eyes, mouth, vagina)
Ix= schirmers test (filter paper under eye lid <10mm significant). anti-ro, anti-la antibodies.
What is the management of sjogren’s syndrome?
artificial tears, artificial saliva, PV lubricants
Hydroxychloroquine to halt progression
Sjogren’s syndrome causing dry mucous membranes at the eyes, mouth and vagina. Give 2 potential complications at each site that may occur?
Eyes= conjunctivitis / corneal ulcer Mouth= candida / cavities PV= candidiasis / sexual dysfunction
Both RF and Anti-CCP are associated with RA, which one is more specific for RA and hence a better investigation to confirm diagnosis of RA?
Anti-CCP
10% pop= RF positive
(1% pop= Anti-CCP)
RA Mx
DMARD e.g Methotrexate / sulfasalazine
Then add hydroxychloroquine
If not working move to biologic e.g adalimumab
Azothiprine- indication?
SLE
Ptx started on methotrexate 6 weeks ago, presents with dry cough, low grade fever, SOB. What resp complication most likely?
Pneumonitis- acute reaction to methotrexate in lungs, most common in first 6 weeks of treatment
What is the management of a patient with suspected GCA?
Prednisolone 60mg daily until reviewed by opthalmology/rheumatology
What is the management of polymalgia?
Prednisolone 15mg daily
Red flags for back pain?
Age <16 or >50 NEW pain Hx CA Wt loss Fever Bladder/bowel sx Neuro sx
Describe a Galeazzi fracture?
Fracture of distal third of radius and dislocation at distal radioulnar joint
Describe a monteggia fracture?
Fracture of ulna
Dislocation at proximal radial
Most important sign of compartment syndrome?
pain on passive stretch
How many and what are the names of the compartments are there in the leg?
4 Anterior Lateral Superficial posterior Deep posterior
Splinting a fracture helps in what way?
Pain relief (fragments no longer movement) Reduces muscle spasms
Which fracture within elderly population must be fixed within 36hrs?
Hip
