MSK (T&O and rheumatology) Flashcards
1
Q
Achilles tendinitis/tendinopathy investigation
A
USS - thickened and blurred degenerative tendon
2
Q
Achilles tendinitis management
A
Reduce activity
Calf muscle exercise
Analgesia
3
Q
Simmond’s triad for achilles rupture
A
Lie on front with feed over edge
- greater dorsiflexion
- palpable gap
- no plantarflexion on calf squeeze
4
Q
Achilles rupture management
A
Conservative if partial
Surgical if total
5
Q
Bunion management
A
Orthotics
Comfortable shoe and size
Surgery
6
Q
Ankle fracture management
A
Open: emergency surgery with irrigation and debridement
Closed: reduction and splint
7
Q
Most common metatarsal fracture
A
5th - proximal avulsion / pseudo-Jones following ankle inversion
8
Q
Most common stress metatarsal fracture
A
2nd - in runners
9
Q
Thickening of fibrous tissue around nerve - feeling of lump under foot and shooting pain - cause and management?
A
Morton’s neuroma
Conservative (raise, ice pack etc.)
Radiofrequency ablation
Steroid injections
10
Q
Plantar fasciitis management
A
Conservative
11
Q
Bursitis management + if septic
A
Conservative
Steroids
Surgical removal
PO abx and aspiration if septic bursitis
12
Q
Investigations for gout
A
Synovial fluid analysis
Uric acid after acute episode
USS/X-ray - erosions
13
Q
Acute management of gout
A
NSAIDs after symptoms settle or colchicine
14
Q
Long-term management of gout
A
Conservative: lose weight, less alcohol, no purine food e.g. seafood
1) Allopurinol - urate-lowering, start 2 weeks after first attack
2) Febuxostat - xanthine oxidase
15
Q
Ankylosing spondylitis imaging findings
A
Sacroiliac joint x-ray (most important) lumbar vertebrae squaring, syndesmophytes, CXR (apical fibrosis)
16
Q
Ankylosing spondylitis management
A
Conservative (exercise, physiotherapy)
1) NSAIDs
2) Steroid injection
3) DMARDs
17
Q
Pseudogout presentation
A
Painful knee, wrist, and shoulders
18
Q
What is seen on x ray in pseudogout?
A
Chondrocalcinosis
19
Q
Pseudogout management
A
NSAIDs or steroids
20
Q
Difference between Tennis elbow and Golfer’s elbow
A
Tennis elbow: lateral epincondylitis, worse on wrist extension and supination
Golfer’s elbow: medial epicondylitis, worse on wrist flexion and pronation
21
Q
What is fibro fog?
A
Cognitive impairment in fibromyalgia
22
Q
Diagnosis of fibromyalgia
A
Tenderness in 11/18 tender points
23
Q
Fibromyalgia management
A
Aerobic exercise
CBT
Meds: pregabalin, duloxetine, amitriptyline
24
Q
Transient synovitis management
A
Analgesia and rest
25
Polymyositis investigations
Tumour markers
High CK
Anti-synthetase antibodies e.g. anti-Jo-1
Electromyograph abnormalities
Muscle biopsy: inflammatory infiltrates, necrosis
26
Polymyositis management
1) High-dose corticosteroids
2) Methotrexate or azathioprine
27
Antibodies in dermatomyositis
ANA (80%)
Anti-synthetase antibodies (30%)
28
Face rash in dermatomyositis
Heliotrope rash in perioribital region
29
Cerebral complication of Ehlers-Danlos
Subarachnoid haemorrhage
30
Pathophysiology of Ehlers-Danlos
Autosomal dominant disorder affecting type III collagen
31
Pathophysiology of Marfan syndrome
Autosomal dominant disorder affecting fibrillin-1
32
Leading cause of death in Marfan
Aortic dissection
33
Marfan investigations and management
Echo
Genetic
Beta blockers
Heart surgery
34
Joint dislocation management
Reduction and immobilisation
+/- analgesia
35
ACL tear imaging
X-ray - usually negative but may have lateral capsular sign or capsular avulsion
36
ACL tear management
Conservative: rest, elevation, ice, physio, bracing
NSAIDs
Surgical reconstruction - patellar tendon autograft or hamstring tendon graft
37
Meniscal tear presentation, investigation, and a definitive management
Locking and giving way
MRI
Arthroscopic repair
38
Where is tenderness felt in iliotibial band syndrome?
2-3cm above lateral joint line
39
Where is ache felt in patellofemoral syndrome?
Behind patella
40
Osteoarthritis hand joints affected
Carpometacarpal joints
Distal interphalangeal joints
41
Morning stiffness of osteoarthritis compared to RA
Shorter time
42
Where are Heberden's and Bouchard's nodes in osteoarthritis?
Heberden's - DIP
Bouchard's - PIP
43
What is the CMC deformity causing fixed adduction of the thumbs in osteoarthritis called?
Squaring of thumbs
44
Osteoarthritis investigations
Clinical
X-ray (Loss of joint space, osteophytes at joint margins, subchondral cysts, subchondral sclerosis)
45
Osteoarthritis management
Conservative: weight loss, exercise, braces
1) Topical NSAIDs (hand and knee) + paracetamol
2) Oral NSAIDs, opiods, capsaicin cream, IA corticosteroids
3) Joint replacement
46
Which dislocation is a complication of total hip replacement and how does it present?
Posterior
Internal rotation and shortening
47
2 types of osteomyelitis and which is more common in adults?
Haematogenous
Non-haematogenous (more in adults)
48
2 causes of osteomyelitis
Staph. aureus
Salmonella spp. in sickle-cell
49
Osteomyelitis imaging
MRI
50
Osteomyelitis management
Flucloxacillin or clindamycin
51
Abdo, neuro, and psych symptoms
Urine red on standing
Condition and investigation?
Acute intermittent porphyria
Raised urinary porphobilinogen
52
Acute intermittent porphyria management
Avoid triggers
IV haematin or IV glucose
53
Psoriatic arthitis investigations
X-ray: erosive changes, new bone, pencil-in-cup
54
Psoriatic arthitis management
NSAIDs
Biological e.g. ustekinumab
55
Rheumatoid arthitis joints mostly affected and other characteristic deformities
MCP and PIP
Swan neck and boutonnier deformity
56
Eye problem in rheumatoid arthitis
Keratoconjunctivitis sicca
57
Rheumatoid arthritis investigations
Anti-cyclic citrullinated peptide
XR - loss of joint space, juxta-articular osteoporosis, soft-tissue swelling
USS - synovitis
58
Rheumatoid arthritis long-term management
Short-course briding prednisolone + DMARD e.g. methotrexate
TNF-inhibitors if no response to 2 DMARds including methotrexate
59
Rheumatoid arthritis flare management
Corticosteroids
60
Rheumatoid arthritis treatment monitoring
CRP and disease activity (DAS28 score)
FBC and LFTs for methotrexate
61
What does methotrexate inhibit?
Dihydrofolate reductase (for synthesis of purines and pyrimidines)
62
How is folic acid prescribed with methotrexate?
5mg OW
63
Methotrexate side effects
Myelosuppression
Pneumonitis
Pulmonary fibrosis
Liver fibrosis
64
Contraception advice for methtrexate
Use for 6 months after stopping
65
Which drug does methotrexate interact with risking marrow aplasia?
Trimethoprim (and therefore co-trimoxazole)
66
Conjunctivitis, urethritis, arthitis, skin lesions - condition and what would trigger this (2 types)
Reactive arthritis
Post-STI: chlamydia
Post-dysenteric: shigella, salmonella
67
X-ray finding for reactive arthritis
Sacroilitis and enthesopathy
68
Reactive arthritis management
Symptomatic e.g. NSAIDs, steroid injection
Methotrexate if persistent
69
Which drug combination can cause rhabdomyolosis?
Statins + clarithromycin (but also statins alone)
70
Rhabdomyolosis management
1) IV saline
2) Correct electrolyes
71
Septic arthritis cause (general and young sexually active adults)
S. aureus
Gonorrhoea
72
Would you do imaging for septic arthritis
XR not for diagnosis but baseline for joint and may have degenerative changes
73
Septic arthritis management
IV flucloxacillin or clindamycin for 2 weeks then oral for another 2-4 weeks
74
Pain and limited shoulder movement for 18 months, worse at night - condition?
Adhesive capsulitis (frozen shoulder)
75
Rotator cuff tear vs subacromial impingement
Pain on abduction
Tear: first 60 degrees
Subacromial impingeent: 60-120 degrees
76
Management of rotator cuff in young vs old patient
Young - surgery
Old - physio, conservative
77
Sjogrens investigations
ANA
Anti-Ro
Anti-La
Schirmer's test
Salivary gland biopsy - lymphocytic infiltration
78
Sjogrens management
Artificial tears
Cholingergics (dry mouth)
Paracetamol, NSAIDs
Corticosteroids (Vasculitis)
IVIG (neuropathy)
79
Most common cause of discitis
Staph. aureus
80
Discitis management
IV abx 6-8 weeks
81
SLE skin signs
Malar rash sparing nasolabial folds
Discoid rash in sun-exposed areas
Livedo reticularis
82
SLE antibodies and C3, C4 levels
ANA
Anti-dsDNA
Low C3, C4
83
SLE management
Conservative: sun protection, psych, stop smoking
Hydroxychloroquine
NSAIDs
84
What does CREST syndrome involve, what is the condition and which antibodies are involved?
Limited cutaneous systemic sclerosis (face and distal limbs)
Calcinosis
Reynaud's
Oeseophageal dysmotility
Sclerodactyly
Telangiectasia
Anti-centromere antibodies
84
Which part of the body does diffuse cutaneous systemic sclerosis affect?
Trunk and proximal limbs
Resp involvement
85
Diffuse cutaneous SS antibodies
Anti-scl-70
86
Systemic sclerosis management
Emollient
Topical corticosteroids
ACE inhibitors if renal disease
87
Excessive use of breakthrough analgesia following a supracondyla fracture or tibial shaft injury, paraesthesia, and arterial pulsation. What is the cause?
Compartment syndrome
88
Diagnosis and management of comparment syndrome
Intercompartmental pressure >40mmHg
Fasciotomy or debridement
IV fluids due to myglobinuria
89
Examples of large vasculitis
Takayasu's arteritis
Temporal arteritis
90
Examples of medium vasculitis
Polyarteritis nodosa
Kawasaki disease
91
Vasculitis with microaneurysms and livedo reticularis
Polyarteritis nodosa
92
Antibodies in GPA and eGPA
GPA- cANCA
eGPA - pANCA
93
How does microscopic polyangiitis present differently to eGPA and GPA?
Skin manifestations
94
Carpal tunnel management
Wrist splint
Steroid injection
95
Which conditions are polyarteritis nodosa associated with?
Hep B and C
96
Condition with thumb and radial wrist pain and the test used to show?
De Quervain's tenosynovitis
FInkelstein's test
97
Garden system for hip fracture
Type I: Stable
Type II: Complete
Type III: Displaced + boney contact
Type IV: No contact, complete disruption
98
Management for undisplaced intracapsular hip fracture
Internal fixation (cannulated screws)
99
Management for displaced intracapsular hip fracture
Total hip replacement (healthy) or hemiathroplasty (not fit)
100
Management for stable intertrochanteric hip fracture (extracapsular)
Dynamic hip screw
101
Management for reverse oblique, transverse, or subtrochanteric hip fracture (extracapsular)
Intramedullary device
102
Transverse fracture of radius close to radio-carpal joint
Colles' - falling flat on hand, dorsal displacement
Smith's - falling on flexed hand, volar displacement
103
Nerve damaged from Colles' fracture
Median nerve
104
What movement does median nerve control?
Thumb and index finger flexion
105
Colles' fracture management
Mild: closed reduction
Severe: fixation
106
Management for displaced hand tendon?
K wire
107
Management for Bennet's fracture (non-displaced)
Spica thumb cast
108
Management for displaced Bennett's fracture
Open reduction and internal fixation with a screw (or K-wire)
109
What is a fracture of the proximal 1/3 of the ulnar shaft accompanied by the dislocation of the radial head called?
Monteggia's fracture
110
What is a radial shaft fracture with associated dislocation of the distal radioulnar joint called?
Galeazzi fracture
111
What is a distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation called?
Barton's fracture
