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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
knee injury From skiing/valgus stress Abnormal passive abduction of knee
MCL
25
Knee injury.... From twisting. Locking + giving way common Thessalys test
menisci
26
Teen girls after injury to knee. Pain on going downstairs or at rest. Tenderness, quadriceps watsing
26
Teen girls after injury to knee. Pain on going downstairs or at rest. Tenderness, quadriceps watsing
Chrondromalacia patellae
27
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.
Osteochondritis dissecans
28
Most common organism disci tis
staph aureus
29
Ix and Abx of choice for osteomyelitis
MRI Best Flucloxicillin 6 weeks
30
young man, stiffness worse in morning + improves with activity dx and mx
ankylosing spondylitis NSAIDs (+ pPI)
31
Hemisection spinal cord, ipsiateral paralysis, ipsilateral loss proprioception and fine discrimination, contralateral loss pain and temp
brown squared syndrome
32
Bloods tests - ca/po4/alp/pth for Osteoporosis and tx
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
Bloods tests - ca/po4/alp/pth for osteomalacia
↓Ca/PO4, ↑ALP/PTH
34
Bloods tests - ca/po4/alp/pth for primary hyperparathyroidism
↑Ca/ALP/PTH, ↓Po4
35
Bloods tests - ca/po4/alp/pth - for CKD (2 hyperparathyroidism
↓Ca, ↑PO4/ALP/PTH
36
Bloods tests - ca/po4/alp/pth - pages disease
N Ca/PO4/PTH, ↑ALP
37
Disorder collagen metabolism. Autosomal dominant. Presents childhood with fractures after minor trauma, blue scleria, deafness, dental imperfections
osteogenesis imperfecta
38
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
Dermatomyositis Anti-Jo-1 Ab Most ANA positive and might have anti-synthetase Abs
39
Polymyositis
Ass with malignancy. Symmetrical, proximal muscle weakness. Anti-synthetase Abs - anti-Jo-1 High dose corticosteroids
39
Polymyositis
Ass with malignancy. Symmetrical, proximal muscle weakness. Anti-synthetase Abs - anti-Jo-1 High dose corticosteroids
40
Polymyositis
Ass with malignancy. Symmetrical, proximal muscle weakness. Anti-synthetase Abs - anti-Jo-1 High dose corticosteroids
41
XR changes OA
Loss Joint space, Osteophytes at joint margins, subchondral sclerosis, subchondral cysts
42
1st line analgesia in OA
1st line Mx is paracetamol + topical NSAIDs (if knee/hand(
43
RA XR changes
loss joint space, juxta-articular osteoporosis, periarticular erosions, subluxation.
44
Mx RA
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
Psoriatic arthropathy symptoms
Nail changes, arthritis mutilans (telescoping fingers- pencil in cup on XR). DIP jint disease in some, sacroiliitis, hands and feet
46
Urethritis, conjunctivitis, arthritis after dysenteric illness typ <4wks (STI). diagnosis and mx
Reactive arthritis NSAIDs, steroids, analgesia etc. Sulfasalazine/methotrexate for persistent disease and symp rarely >12m
47
Gout, ix, tx
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
Pseudogout - ix
Deposition ca pyrophosphate dihydrate crystals in syonovium. Positive befringement rhomboid shaped crystals. CHondrocalcinosis
49
Male 20-30, stiffness worse morning and improves with exercise. Reduced Shobers. Other systemic features eg, amyloidosis, anterior uveitis, aortic regurg dx, xray, mx
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
Muscle stiffness + raised inflammation markers Abrupt onset bilateral early morning stiffness in over 60s >60, rapid onset, aching et diagnosis, mx
polymyalgia rheumatica Need prednisolone (if unresponsive re think diagnosis)
51
Chronic fatigue time frame for diagnosis
>3m
52
Mx raynauds
CCBs (nifedipine)
53
Tall stature, high arched palate, pectus excavatum, mitral prolapse, dilation aortic sinuses, dural ectasia…
marfans
54
pain/stiffness/myoglobinuria, low lactate levels in exercise diagnosis
McArdlle’s disease Autosomal recessive T5 glycogen storage disease -> muscle glycogenolysis – pain/stiffness/myoglobinuria, low lactate levels in exercise
55
Mx temporal arteritis
high dose glucocorticosteroids immediately and if visual loss IV methylprednisolone.
56
Raynauds may be 1st sign, scleroderma, ass with anti-centromere Abs. Subtype is CREST (calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia) diagnosis
Limited systemic sclerosis (ANA)
57
Anti scl-70 Abs, most common cause of death resp involvement, cx is renal disease. Scleroderma – tightening of fibrosis of skin. dx
Diffuse systemic sclerosis
58
Ab in systemic sclerosis
ANA
59
Key S/E hydroxychloroquine
S/E bulls eye retinopathy (visual loss).

Difficult Passmed- MLA (26 decks)

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