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Maud- Phase 3b > MSK / Orthopaedics > Flashcards

MSK / Orthopaedics Flashcards

1
Q

What is the most sensitive sign for patient with comparment syndrome?

A

Pain on passive stretching

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2
Q

Commonest site for compartment syndrome

A

leg

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3
Q

What is a key symptom of compartment syndrome?

A

Pain out of proportion (i.e not controlled by morphine)

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4
Q

Patient has MSK pain which is out of proportion with injury and not controlled by strong painkillers including morphine, which diagnosis should you suspect?

A

Compartment syndrome

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5
Q

Compartment syndrome 5 signs (5Ps)?

A 
Pain 
Parasthesia
Pulslessness 
Paralysis 
Painful swelling
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6
Q

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?

A

> /= 40 mmHg

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7
Q

What is the operative management of compartment syndrome?

A

Fasciotomy

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8
Q

Give the patient demographics typical of polymyalgia rheumatica?

A

Caucasian Woman >50

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9
Q

Is polymyalgia an inflammatory or non-inflammatory MSK condition?

A

Inflammatory

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10
Q

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?

A

Polymyalgia Rheumatica

OA, RA, myositis,
Fibromyalgia, SLE, osteomalacia

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11
Q

What is the management of polymyalgia rheumatica?

A

15mg prednisolone/day

70% improvement in 3-4wks

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12
Q

What other inflammatory condition is polymyalgia rheumatica associated with?

A

GCA

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13
Q

Polymyalgia rheumatica patients take long term corticosteroid treatments. Considering this, what additional management measures should be put in place?

A

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)

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14
Q 
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=
A 
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
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15
Q

What does Anti-CCP stand for? It is found in most patients with what condition?

A

Anti-cyclic citrillunated peptide

Antibody positive in most patients with RA

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16
Q

CPK (creatinine phosphokinaze enzyme) is used as a marker of what?

A

Muscle tissue damage/inflammation to heart / brain

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17
Q

What is an EMG

A

Electromyograph

Measures muscle response / electrical activity in response to nerve stimulation

18
Q

Does hyper or hypokalaemia cause muscle weakness?

A

Hypokalaemia may present with muscle weakness

19
Q

A dinner fork deformity is a sign of what kind of fracture

A

Colle’s fracture (fracture of radius from upward displacement of forearm)

20
Q

A complete fracture of the radius resulting from upwards displacement of forearm describes what kind of fracture?

A

Colle’s fracture

21
Q

Give a primary cause of large, medium, med/small and small vasculitis?

A 
Large= GCA
Medium= Kawasaki
Med/Sml= wegner's granulomatosis 
Small= heoch-shonlein purpura
22
Q

Methotrexate can cause bone marrow suppression, as a result what should we monitor?

A

Bloods and LFTs

23
Q

Anti-TNF medications are associated with reactivation of which infectious disease? As a result what should you do?

A

Reactivation of latent TB
Screen for TB with mantoux / CXR / quantiferon

If (+), tx TB 3mo before anti-TNF

24
Q

Describe the pathophysiology of sjogren’s syndrome?

A

AI condition effecting exocrine glands leading to dry mucous membranes

25
Q

A patient presents complaining of dry eyes, mouth, +/- vagina, what is the suspected diagnosis and what investigations might you carry out?

A

Sjogren’s syndrome (dry eyes, mouth, vagina)

Ix= schirmers test (filter paper under eye lid <10mm significant). anti-ro, anti-la antibodies.

26
Q

What is the management of sjogren’s syndrome?

A

artificial tears, artificial saliva, PV lubricants

Hydroxychloroquine to halt progression

27
Q

Sjogren’s syndrome causing dry mucous membranes at the eyes, mouth and vagina. Give 2 potential complications at each site that may occur?

A 
Eyes= conjunctivitis / corneal ulcer 
Mouth= candida / cavities 
PV= candidiasis / sexual dysfunction
28
Q

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?

A

Anti-CCP

10% pop= RF positive
(1% pop= Anti-CCP)

29
Q

RA Mx

A

DMARD e.g Methotrexate / sulfasalazine
Then add hydroxychloroquine

If not working move to biologic e.g adalimumab

30
Q

Azothiprine- indication?

A

SLE

31
Q

Ptx started on methotrexate 6 weeks ago, presents with dry cough, low grade fever, SOB. What resp complication most likely?

A

Pneumonitis- acute reaction to methotrexate in lungs, most common in first 6 weeks of treatment

32
Q

What is the management of a patient with suspected GCA?

A

Prednisolone 60mg daily until reviewed by opthalmology/rheumatology

33
Q

What is the management of polymalgia?

A

Prednisolone 15mg daily

34
Q

Red flags for back pain?

A 
Age <16 or >50 NEW pain 
Hx CA
Wt loss
Fever
Bladder/bowel sx 
Neuro sx
35
Q

Describe a Galeazzi fracture?

A

Fracture of distal third of radius and dislocation at distal radioulnar joint

36
Q

Describe a monteggia fracture?

A

Fracture of ulna

Dislocation at proximal radial

37
Q

Most important sign of compartment syndrome?

A

pain on passive stretch

38
Q

How many and what are the names of the compartments are there in the leg?

A 
4
Anterior
Lateral 
Superficial posterior 
Deep posterior
39
Q

Splinting a fracture helps in what way?

A 
Pain relief (fragments no longer movement)
Reduces muscle spasms
40
Q

Which fracture within elderly population must be fixed within 36hrs?

A

Hip

Maud- Phase 3b (14 decks)

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