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Difficult Passmed- MLA > MSK + Rheum > Flashcards

MSK + Rheum Flashcards

1
Q

Knee extension, thigh flexion
Ant + medial aspect of thigh + lower leg sensory.
Usually affected in hip + pelvic fractures and stab/gunshot wounds.

which nerve

A

femoral nerve

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1
Q

Knee extension, thigh flexion
Ant + medial aspect of thigh + lower leg sensory.
Usually affected in hip + pelvic fractures and stab/gunshot wounds.

which nerve

A

femoral nerve

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2
Q

Thigh adduction, medial thigh sensation. Damaged in anterior hip dislocation

which nerve

A

Obturator nerve

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3
Q

Compression of nerve near ASIS usually - meralgia paraesthetica

which nerve

A

lateral cutaneous nerve of thigh

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4
Q

Foot plantarflexion + inversion
Sole of foot sensory
Not commonly injured

which nerve

A

tibial nerve

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5
Q

Foot dorsiflexion + eversion + EHL motor, dorsum foot and lower lat part sensory
Injury often at neck fibular
Tightly applied lower limb plaster cast etc and injury cause foot drop

which nerve

A

common peroneal nerve

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6
Q

Hip adduction
Dmaaged by misplaced iM injection, hip surgery, pelvic fracture, post hip dislocation.
Positive trendelenburg sign

which nerve

A

superior gluteal nerve

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7
Q

Hip extension + lateral rotation
Generally injured in ass with sciatic nerve - difficulty rising from seated (cant jump, cant climbs tairs)

which nerve

A

inferior gluteal nerve

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8
Q

Worse on resisted wrist extension
Typically acute pain 6-12 weeks

What’s this called

A

Lateral epicondylitis
Tennis elbow

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9
Q

Pain aggravated by wrist flexion + pronation
Can have tingling 4/5th finger (ulnar nerve entrapment)

What is this called

A

Golfers
medial epicondylitis

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10
Q

Pins and needles, shakes hand at night.

What condition and mx

A

Carpal tunnel
Median nerve
6 week trial splint/CS injection and if severe surgery

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11
Q

Compression ulnar nerve symptoms

A

Compression of ulnar nerve
Tingling/numbness 4/5th finger, muscle wasting etc
If ulnar nerve palsy do sign (pull piece paper between thumb and index)

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12
Q

which nerve:

Damaged by humeral neck fracture/dislocation
Flattened deltoid

A

axillary nerve

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13
Q

which nerve:

Dagae usually by humeral midshaft fracture - wrist drop

A

radial nerve

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14
Q

which nerve

Usually damaged by medial epicondyle fracture - claw hand
Hypothenar wasting
Cant abduct thumb

A

ulnar nerve

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15
Q

hand benediction
Wasting of thenar muscles

which nerve

A

median

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16
Q

Often in sports, damaged
Winged scapula

which nerve

A

long thoracic nerve C5-7

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17
Q

Mx Talipes equinovarus (club foot)

A

Ponseti method 6-10 weeks.
Night time braces until child 4

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18
Q

Post vs anterior hip dislocation + mx

A

Posterior (affected leg shortened, adducted, internally rotated), anterior (abducted, Ext rotated, no leg shortening) or central. Reduction under GA within 4hrs due to avascular necrosis risk.

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19
Q

Barlows/Ortolani positive, unequal skin folds/leg length, often picked up newborn exam.

A

DDH
Pavlik harness

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20
Q

4-8 (7) males, hip pain progressive with limp, stiffness, ROM,

DX, XR CHANGES

A

Perthes
XR (widened joint space -> decreased fem head/flattening)

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21
Q

10-15 (12), more in obese children/boys. Loss of internal rotation of leg in flexion

A

SUFE

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22
Q

knee injury

Twisting.
Anterior drawer test + Lachman positive.
Poor healing

A

ACL

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23
Q

Knee injury

Dashboard injuries hyperextension injuries

A

PCL

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24
Q

knee injury

From skiing/valgus stress
Abnormal passive abduction of knee

A

MCL

25
Q

Knee injury….

From twisting. Locking + giving way common
Thessalys test

A

menisci

26
Q

Teen girls after injury to knee. Pain on going downstairs or at rest. Tenderness, quadriceps watsing

A
26
Q

Teen girls after injury to knee. Pain on going downstairs or at rest. Tenderness, quadriceps watsing

A

Chrondromalacia patellae

27
Q

Pathological process affecting subchondral bone with secondary effects on joint cartilage etc. Children/young adults and can become degenerative. Knee pain + swelling typically after exercising, locking, clunking. XR might show subchondral crescent sign or loose bodies, MRI can evaluate cartilage.

A

Osteochondritis dissecans

28
Q

Most common organism disci tis

A

staph aureus

29
Q

Ix and Abx of choice for osteomyelitis

A

MRI Best
Flucloxicillin 6 weeks

30
Q

young man, stiffness worse in morning + improves with activity

dx and mx

A

ankylosing spondylitis
NSAIDs (+ pPI)

31
Q

Hemisection spinal cord, ipsiateral paralysis, ipsilateral loss proprioception and fine discrimination, contralateral loss pain and temp

A

brown squared syndrome

32
Q

Bloods tests - ca/po4/alp/pth for Osteoporosis and tx

A

N Ca, N PO4, N ALP, N PTH
Fragility fractures = need DEXA and FRAX if <75, if >75 start Mx without Ix
Vit d + calcium supplementation before bisphosphonates- Alendronate 1st line

33
Q

Bloods tests - ca/po4/alp/pth for osteomalacia

A

↓Ca/PO4, ↑ALP/PTH

34
Q

Bloods tests - ca/po4/alp/pth for primary hyperparathyroidism

A

↑Ca/ALP/PTH, ↓Po4

35
Q

Bloods tests - ca/po4/alp/pth - for CKD (2 hyperparathyroidism

A

↓Ca, ↑PO4/ALP/PTH

36
Q

Bloods tests - ca/po4/alp/pth - pages disease

A

N Ca/PO4/PTH, ↑ALP

37
Q

Disorder collagen metabolism. Autosomal dominant. Presents childhood with fractures after minor trauma, blue scleria, deafness, dental imperfections

A

osteogenesis imperfecta

38
Q

Ab ass with

Proximal muscle weakness and ksin lesions
Can be ass with malignancy
Photosensitive macular rash, Gottron’s papules (extensory surfaces fingers), mechanics hand, nail fold capillary dilation

A

Dermatomyositis
Anti-Jo-1 Ab
Most ANA positive and might have anti-synthetase Abs

39
Q

Polymyositis

A

Ass with malignancy. Symmetrical, proximal muscle weakness. Anti-synthetase Abs - anti-Jo-1
High dose corticosteroids

39
Q

Polymyositis

A

Ass with malignancy. Symmetrical, proximal muscle weakness. Anti-synthetase Abs - anti-Jo-1
High dose corticosteroids

40
Q

Polymyositis

A

Ass with malignancy. Symmetrical, proximal muscle weakness. Anti-synthetase Abs - anti-Jo-1
High dose corticosteroids

41
Q

XR changes OA

A

Loss Joint space, Osteophytes at joint margins, subchondral sclerosis, subchondral cysts

42
Q

1st line analgesia in OA

A

1st line Mx is paracetamol + topical NSAIDs (if knee/hand(

43
Q

RA XR changes

A

loss joint space, juxta-articular osteoporosis, periarticular erosions, subluxation.

44
Q

Mx RA

A

DMARD monotherapy +/- short course prednisolone for flares. If inadequate response to at least 2 DMARDs (inc M) then TNF-inhibitor (etanercept, infliximab- reactive TB, adalimumab)

45
Q

Psoriatic arthropathy symptoms

A

Nail changes, arthritis mutilans (telescoping fingers- pencil in cup on XR). DIP jint disease in some, sacroiliitis, hands and feet

46
Q

Urethritis, conjunctivitis, arthritis after dysenteric illness typ <4wks (STI).

diagnosis and mx

A

Reactive arthritis
NSAIDs, steroids, analgesia etc. Sulfasalazine/methotrexate for persistent disease and symp rarely >12m

47
Q

Gout, ix, tx

A

Mostly 1st MTP- neg befringement, uric acid usually high.
Acute (NSAIDs/colchicine), Urate lowering therapy (allopurinol or febuxostat 2nd line). In acute, if already taking allopurinol continue

48
Q

Pseudogout - ix

A

Deposition ca pyrophosphate dihydrate crystals in syonovium. Positive befringement rhomboid shaped crystals. CHondrocalcinosis

49
Q

Male 20-30, stiffness worse morning and improves with exercise. Reduced Shobers. Other systemic features eg, amyloidosis, anterior uveitis, aortic regurg

dx, xray, mx

A

Ankylosing spondylitis

HLA-27.
Dx = Best supported by sacro-ilitis on pelvic XR
Subchondral erosions, sclerosis and Squaring lumbar vertebrae, sarcoilitis, bamboo spine, syndesmophytes. Apical fibrosis on CXR. NSAIDs first line

50
Q

Muscle stiffness + raised inflammation markers
Abrupt onset bilateral early morning stiffness in over 60s
>60, rapid onset, aching et

diagnosis, mx

A

polymyalgia rheumatica

Need prednisolone (if unresponsive re think diagnosis)

51
Q

Chronic fatigue time frame for diagnosis

A

> 3m

52
Q

Mx raynauds

A

CCBs (nifedipine)

53
Q

Tall stature, high arched palate, pectus excavatum, mitral prolapse, dilation aortic sinuses, dural ectasia…

A

marfans

54
Q

pain/stiffness/myoglobinuria, low lactate levels in exercise

diagnosis

A

McArdlle’s disease
Autosomal recessive T5 glycogen storage disease -> muscle glycogenolysis – pain/stiffness/myoglobinuria, low lactate levels in exercise

55
Q

Mx temporal arteritis

A

high dose glucocorticosteroids immediately and if visual loss IV methylprednisolone.

56
Q

Raynauds may be 1st sign, scleroderma, ass with anti-centromere Abs. Subtype is CREST (calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia)

diagnosis

A

Limited systemic sclerosis (ANA)

57
Q

Anti scl-70 Abs, most common cause of death resp involvement, cx is renal disease.
Scleroderma – tightening of fibrosis of skin.

dx

A

Diffuse systemic sclerosis

58
Q

Ab in systemic sclerosis

A

ANA

59
Q

Key S/E hydroxychloroquine

A

S/E bulls eye retinopathy (visual loss).

Difficult Passmed- MLA (26 decks)

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