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PT prep > MSK- orthopaedics and rheumatology > Flashcards

MSK- orthopaedics and rheumatology Flashcards

1
Q

What are the seronegative spondyloarthropathies

A

Ankylosing spondylitis
Psoriatic arthritis
IBD related arthritis
Reactive arthritis

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2
Q

Most common primary malignant bone tumour

A

Osteosarcoma
Seen mostly in children and adolescents
Sunburst pattern on xray

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3
Q

Ewing’s sarcoma sign on xray

A

Onion skin appearance

Severe long bone pain

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4
Q

Differentials for polyarteritis

A 
Rheumatoid arthritis 
SLE
Seronegative spondyloarthropathies 
Henoch-Schonlein purpura
Sarcoidosis
Tuberculosis
Pseudogout
Viral infection: EBV, HIV, hepatitis, mumps, rubella
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5
Q

Classical Colle’s fracture

A

Fall onto an extended outstretched hand
Transverse fracture of the radius
1 inch proximal to the radio-carpal joint
Dorsal displacement and angulation

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6
Q

Bennett’s fracture

A

Intra-articular fracture of the first carpometocarpal joint

Caused by fist fights

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7
Q

Pott’s fracture

A

Bimalleolar ankle fracture

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8
Q

Blood results in PMR

A

Raised ESR and CRP

Normal CK and anti-CCP

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9
Q

Typical features of PMR

A 
Usually patient >60
Association with GCA
Usually rapid onset
Aching, morning stiffness in proximal limb muscles (which may present as weakness but is not true weakness)
Mild polyarthralgia
Lethargy and depression
Low grade fever
Anorexia 
Night sweats
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10
Q

Schober’s test

A

A line is drawn at the level of the ASIS
10cm above and 5cm below
Gap should increase on lumbar flexion by more than 5cm

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11
Q

Management of De Quervain’s tenosynovitis

A

Analgesia
Steroid injection
Immobilisation with a thumb splint
Surgical treatment may be required

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12
Q

Signs of ank spon on Xray

A

Sacroilitis- subchondral erosions and sclerosis (most useful in establishing diagnosis)
Squaring of lumbar vertebrae
Syndesmophytes due to ossification of the annulus fibrosus
Bamboo spine (late stages)
‘Shiny corners’ on MRI

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13
Q

Felty’s syndrome

A

RA
Splenomegaly
Low WCC

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14
Q

Sulfasalazine

A

5-ASA- decreases neutrophil chemotaxis and suppresses lymphocytic prophylaxis

Allergy to sulphonamides

S/E: oligospermia, Stevens-Johnson, pneumonitis/ fibrosis, myelosuppression, anaemia

Considered safe in pregnancy and breast-feeding

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15
Q

Anterior compartment of the lower leg

Innervated by

A

Tibialis anterior
Extensor digitorum longus
Peroneus tertius
Extensor hallucis longus

Deep peroneal nerve

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16
Q

Superficial posterior compartment of the lower leg

Innervated by

A

Gastrocnemius
Soleus

Tibial nerve

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17
Q

Deep posterior compartment of the lower leg

Innervated by

A

Flexor digitorum longus
Flexor hallucis longus

Tibialis posterior

18
Q

Still’s disease in adults

A 
Arthralgia 
Elevated serum ferritin
Salmon-pink, maculopapular rash
Pyrexia in a daily pattern- rises in the late afternoon 
Lymphadenopathy 
RF and ANA negative
19
Q

Most common cause of mitral stenosis

A

Rheumatic fever

20
Q

Erythema marginatum

A

Pathognomonic for rheumatic fever
Annular erythematous rash that commonly affects the trunk and inner surfaces of arms and legs and can persist for several months
Non-pruritic rings that are barely raised
Generally spares the face

21
Q

Clinical features of ankylosing spondylitis

A

Young caucasian man in teens or 20s
Sacroiliitis- MRI can show early oedema
Back pain in the night or early morning, especially on inactivity
Unilateral buttock pain that radiates to the groin

22
Q

Complications of ankylosing spon

A

Enphysitis- inflammation between tendon and bone
Costochondritis
Rarely jaw pain
Apical interstitial fibrosis
Fusing of syndesmophytes late stage causes bamboo spine

23
Q

Treatment of ankylosing spondiliitis

A

NSAIDs- ibuprofen and/or naproxen
Exercise
Physiotherapy
If this isn’t successful then biologics can be used- infliximab

24
Q

Management of OA

A

Exercise to improve muscle strength and general aerobic fitness
MDT approach, PT and OT
Heat or cold packs, walking aids and TENS

Analgesia- regular paracetamol and topical NSAIDs, can use codeine or oral NSAIDs if ineffective
Intra-articular steroid injections temporarily relieve pain in severe cases

Surgical- Joint replacement

25
Q

Management of septic arthritis

A

Which organisms and how did they get there? immunosuppression, CKD, recent surgery, STI, IV drug abuse

2 weeks broad spectrum antibiotics IV until sensitivities are known and then more specific by local guidelines
4 weeks oral

Orthopaedic review for athrocentesis, washout and debridement

26
Q

Extra-articular manifestations of rheumatoid arthritis

A

Nodules- elbow, lungs, cardiac, CNS, lymphadenopathy, vasculitis
Lungs- pleural disease, interstitial fibrosis, bronchiolitis obliterans
Cardiac- IHD, pericarditis, pericardial effusion
Carpal tunnel syndrome
Peripheral neuropathy
Felty’s syndrome
Eye- episcleritis, scleritis, scleromalacia, keratoconjunctivitis sicca
Osteoporosis
Amyloidosis

27
Q

Investigating ?RA

A

Anti-rheumatoid factor- positive in 70%
Anti- citric citrullinated peptide- highly specific (90-95%)
FBC- anaemia of chronic disease, raised platelets
ESR raised
Raised CRP
Xrays- loss of joint space, erosions, soft tissue swelling, juxta-articular osteoporosis

28
Q

Management of RA

A

Disease activity monitoring via DAS28
DMARDs and biological agents (after trialling at least 2 DMARDs)
Steroids to bridge, reducing symptoms and inflammation
NSAIDs
PT and OT

29
Q

Crystals in gout

A

Monosodium urate

30
Q

Limited systemic sclerosis

A

Anti-centromere antibodies

Involves the hands, face and feet, pulmonary hypertension is often subclinical

31
Q

What should be screened for in any myositis?

A

Malignancy- lung, pancreatic, ovarian or bowel

Can often present as a paraneoplastic phenomenon, even before the disease takes hold

32
Q

Clinical features of dermatomyositis

A

Myositis- symmetrical, proximal muscle weakness
Macular rash- heliotrope rash on eyelids often with oedema
Nailfold erythema
Gottron’s papules- pathognomic if raised CK and weakness

33
Q

Differentials for myositis

A 
Dermatomyositis
Polymyositis
Inclusion body myositis 
Carcinomatous myopathy 
Muscular dystrophy (Becker's if older)
PMR
Endocrine/metabolic myopathy
Rhabdomyolysis 
Infection
Drugs- penicillamine, colchicine, statins, chloroquine
34
Q

Tests for myositis

A

CK and other muscle enzymes- ALT, AST, LDH, aldolase
EMG
Muscle biopsy
Anti-Mi2 or anti-Jo1

35
Q

Clinical features of systemic lupus erythematosus

A

Malaise, fatigue, myalgia, fever
Lymphadenopathy, weight loss, alopeecia, nail-fold infarcts, Raynaud’s
Malar rash- flat or raised, sparing of the nasolabial folds, can be photosensitive
Oral nasal uclers
Synovitis
Serositis- pleura or pericardium
Haemolytic anaemia- positive direct Coombs test

36
Q

Antibodies in drug induced lupus

A

Anti-histone

37
Q

Laboratory features of SLE

A 
\+ANA
Anti-dsDNA
Anti-smith
Low complement C3 and C4
\+direct Coombs test 
Antiphospholipid antibodies in 20-30%
38
Q

Management of SLE

A

MDT, specialist team/ nephritis clinic

General measures- high factor sunblock, hydroxychloroquine, screen for co-morbidities and medication toxicity

Maintenance- NSAIDs and hydroxychloroquine
Also can use methotrexate, azathioprine, mycophenolate or biologics

Mild flares- hydroxychloroquine or low dose steroids
Moderate may require DMARDs

Severe flares- urgent high dose steroids, mycophenolate, rituximab, cyclophosphamide
MDT for neuropsychiatric SLE

39
Q

Antiphospholipid syndrome manifestations

HINT: CLOT

A

Coagulation defect with paradoxical raised APTT
Livedo reticularis
Obstetric complications- recurrent miscarriage
Thrombocytopenia

40
Q

Antiphospholipid antibodies

A

Anti-cardiolipin
Anti glycoprotein
Lupus anticoagulant

PT prep (9 decks)

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