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Year 6 > MSK (T&O and rheumatology) > Flashcards

MSK (T&O and rheumatology) Flashcards

1
Q

Achilles tendinitis/tendinopathy investigation

A

USS - thickened and blurred degenerative tendon

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2
Q

Achilles tendinitis management

A

Reduce activity
Calf muscle exercise
Analgesia

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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

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4
Q

Achilles rupture management

A

Conservative if partial
Surgical if total

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5
Q

Bunion management

A

Orthotics
Comfortable shoe and size
Surgery

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6
Q

Ankle fracture management

A

Open: emergency surgery with irrigation and debridement
Closed: reduction and splint

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7
Q

Most common metatarsal fracture

A

5th - proximal avulsion / pseudo-Jones following ankle inversion

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8
Q

Most common stress metatarsal fracture

A

2nd - in runners

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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

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10
Q

Plantar fasciitis management

A

Conservative

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11
Q

Bursitis management + if septic

A

Conservative
Steroids
Surgical removal

PO abx and aspiration if septic bursitis

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12
Q

Investigations for gout

A

Synovial fluid analysis
Uric acid after acute episode
USS/X-ray - erosions

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13
Q

Acute management of gout

A

NSAIDs after symptoms settle or colchicine

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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

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15
Q

Ankylosing spondylitis imaging findings

A

Sacroiliac joint x-ray (most important) lumbar vertebrae squaring, syndesmophytes, CXR (apical fibrosis)

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16
Q

Ankylosing spondylitis management

A

Conservative (exercise, physiotherapy)
1) NSAIDs
2) Steroid injection
3) DMARDs

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17
Q

Pseudogout presentation

A

Painful knee, wrist, and shoulders

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18
Q

What is seen on x ray in pseudogout?

A

Chondrocalcinosis

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19
Q

Pseudogout management

A

NSAIDs or steroids

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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

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21
Q

What is fibro fog?

A

Cognitive impairment in fibromyalgia

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22
Q

Diagnosis of fibromyalgia

A

Tenderness in 11/18 tender points

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23
Q

Fibromyalgia management

A

Aerobic exercise
CBT
Meds: pregabalin, duloxetine, amitriptyline

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24
Q

Transient synovitis management

A

Analgesia and rest

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25
Q

Polymyositis investigations

A

Tumour markers
High CK
Anti-synthetase antibodies e.g. anti-Jo-1

Electromyograph abnormalities
Muscle biopsy: inflammatory infiltrates, necrosis

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26
Q

Polymyositis management

A

1) High-dose corticosteroids
2) Methotrexate or azathioprine

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27
Q

Antibodies in dermatomyositis

A

ANA (80%)
Anti-synthetase antibodies (30%)

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28
Q

Face rash in dermatomyositis

A

Heliotrope rash in perioribital region

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29
Q

Cerebral complication of Ehlers-Danlos

A

Subarachnoid haemorrhage

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30
Q

Pathophysiology of Ehlers-Danlos

A

Autosomal dominant disorder affecting type III collagen

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31
Q

Pathophysiology of Marfan syndrome

A

Autosomal dominant disorder affecting fibrillin-1

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32
Q

Leading cause of death in Marfan

A

Aortic dissection

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33
Q

Marfan investigations and management

A

Echo
Genetic

Beta blockers
Heart surgery

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34
Q

Joint dislocation management

A

Reduction and immobilisation
+/- analgesia

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35
Q

ACL tear imaging

A

X-ray - usually negative but may have lateral capsular sign or capsular avulsion

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36
Q

ACL tear management

A

Conservative: rest, elevation, ice, physio, bracing
NSAIDs
Surgical reconstruction - patellar tendon autograft or hamstring tendon graft

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37
Q

Meniscal tear presentation, investigation, and a definitive management

A

Locking and giving way
MRI
Arthroscopic repair

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38
Q

Where is tenderness felt in iliotibial band syndrome?

A

2-3cm above lateral joint line

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39
Q

Where is ache felt in patellofemoral syndrome?

A

Behind patella

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40
Q

Osteoarthritis hand joints affected

A

Carpometacarpal joints
Distal interphalangeal joints

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41
Q

Morning stiffness of osteoarthritis compared to RA

A

Shorter time

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42
Q

Where are Heberden’s and Bouchard’s nodes in osteoarthritis?

A

Heberden’s - DIP
Bouchard’s - PIP

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43
Q

What is the CMC deformity causing fixed adduction of the thumbs in osteoarthritis called?

A

Squaring of thumbs

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44
Q

Osteoarthritis investigations

A

Clinical
X-ray (Loss of joint space, osteophytes at joint margins, subchondral cysts, subchondral sclerosis)

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45
Q

Osteoarthritis management

A

Conservative: weight loss, exercise, braces
1) Topical NSAIDs (hand and knee) + paracetamol
2) Oral NSAIDs, opiods, capsaicin cream, IA corticosteroids
3) Joint replacement

46
Q

Which dislocation is a complication of total hip replacement and how does it present?

A

Posterior
Internal rotation and shortening

47
Q

2 types of osteomyelitis and which is more common in adults?

A

Haematogenous
Non-haematogenous (more in adults)

48
Q

2 causes of osteomyelitis

A

Staph. aureus
Salmonella spp. in sickle-cell

49
Q

Osteomyelitis imaging

A

MRI

50
Q

Osteomyelitis management

A

Flucloxacillin or clindamycin

51
Q

Abdo, neuro, and psych symptoms
Urine red on standing
Condition and investigation?

A

Acute intermittent porphyria

Raised urinary porphobilinogen

52
Q

Acute intermittent porphyria management

A

Avoid triggers
IV haematin or IV glucose

53
Q

Psoriatic arthitis investigations

A

X-ray: erosive changes, new bone, pencil-in-cup

54
Q

Psoriatic arthitis management

A

NSAIDs
Biological e.g. ustekinumab

55
Q

Rheumatoid arthitis joints mostly affected and other characteristic deformities

A

MCP and PIP
Swan neck and boutonnier deformity

56
Q

Eye problem in rheumatoid arthitis

A

Keratoconjunctivitis sicca

57
Q

Rheumatoid arthritis investigations

A

Anti-cyclic citrullinated peptide
XR - loss of joint space, juxta-articular osteoporosis, soft-tissue swelling
USS - synovitis

58
Q

Rheumatoid arthritis long-term management

A

Short-course briding prednisolone + DMARD e.g. methotrexate
TNF-inhibitors if no response to 2 DMARds including methotrexate

59
Q

Rheumatoid arthritis flare management

A

Corticosteroids

60
Q

Rheumatoid arthritis treatment monitoring

A

CRP and disease activity (DAS28 score)
FBC and LFTs for methotrexate

61
Q

What does methotrexate inhibit?

A

Dihydrofolate reductase (for synthesis of purines and pyrimidines)

62
Q

How is folic acid prescribed with methotrexate?

A

5mg OW

63
Q

Methotrexate side effects

A

Myelosuppression
Pneumonitis
Pulmonary fibrosis
Liver fibrosis

64
Q

Contraception advice for methtrexate

A

Use for 6 months after stopping

65
Q

Which drug does methotrexate interact with risking marrow aplasia?

A

Trimethoprim (and therefore co-trimoxazole)

66
Q

Conjunctivitis, urethritis, arthitis, skin lesions - condition and what would trigger this (2 types)

A

Reactive arthritis

Post-STI: chlamydia
Post-dysenteric: shigella, salmonella

67
Q

X-ray finding for reactive arthritis

A

Sacroilitis and enthesopathy

68
Q

Reactive arthritis management

A

Symptomatic e.g. NSAIDs, steroid injection
Methotrexate if persistent

69
Q

Which drug combination can cause rhabdomyolosis?

A

Statins + clarithromycin (but also statins alone)

70
Q

Rhabdomyolosis management

A

1) IV saline
2) Correct electrolyes

71
Q

Septic arthritis cause (general and young sexually active adults)

A

S. aureus
Gonorrhoea

72
Q

Would you do imaging for septic arthritis

A

XR not for diagnosis but baseline for joint and may have degenerative changes

73
Q

Septic arthritis management

A

IV flucloxacillin or clindamycin for 2 weeks then oral for another 2-4 weeks

74
Q

Pain and limited shoulder movement for 18 months, worse at night - condition?

A

Adhesive capsulitis (frozen shoulder)

75
Q

Rotator cuff tear vs subacromial impingement

A

Pain on abduction
Tear: first 60 degrees
Subacromial impingeent: 60-120 degrees

76
Q

Management of rotator cuff in young vs old patient

A

Young - surgery
Old - physio, conservative

77
Q

Sjogrens investigations

A

ANA
Anti-Ro
Anti-La
Schirmer’s test
Salivary gland biopsy - lymphocytic infiltration

78
Q

Sjogrens management

A

Artificial tears
Cholingergics (dry mouth)
Paracetamol, NSAIDs
Corticosteroids (Vasculitis)
IVIG (neuropathy)

79
Q

Most common cause of discitis

A

Staph. aureus

80
Q

Discitis management

A

IV abx 6-8 weeks

81
Q

SLE skin signs

A

Malar rash sparing nasolabial folds
Discoid rash in sun-exposed areas
Livedo reticularis

82
Q

SLE antibodies and C3, C4 levels

A

ANA
Anti-dsDNA
Low C3, C4

83
Q

SLE management

A

Conservative: sun protection, psych, stop smoking
Hydroxychloroquine
NSAIDs

84
Q

What does CREST syndrome involve, what is the condition and which antibodies are involved?

A

Limited cutaneous systemic sclerosis (face and distal limbs)

Calcinosis
Reynaud’s
Oeseophageal dysmotility
Sclerodactyly
Telangiectasia

Anti-centromere antibodies

84
Q

Which part of the body does diffuse cutaneous systemic sclerosis affect?

A

Trunk and proximal limbs
Resp involvement

85
Q

Diffuse cutaneous SS antibodies

A

Anti-scl-70

86
Q

Systemic sclerosis management

A

Emollient
Topical corticosteroids
ACE inhibitors if renal disease

87
Q

Excessive use of breakthrough analgesia following a supracondyla fracture or tibial shaft injury, paraesthesia, and arterial pulsation. What is the cause?

A

Compartment syndrome

88
Q

Diagnosis and management of comparment syndrome

A

Intercompartmental pressure >40mmHg

Fasciotomy or debridement
IV fluids due to myglobinuria

89
Q

Examples of large vasculitis

A

Takayasu’s arteritis
Temporal arteritis

90
Q

Examples of medium vasculitis

A

Polyarteritis nodosa
Kawasaki disease

91
Q

Vasculitis with microaneurysms and livedo reticularis

A

Polyarteritis nodosa

92
Q

Antibodies in GPA and eGPA

A

GPA- cANCA
eGPA - pANCA

93
Q

How does microscopic polyangiitis present differently to eGPA and GPA?

A

Skin manifestations

94
Q

Carpal tunnel management

A

Wrist splint
Steroid injection

95
Q

Which conditions are polyarteritis nodosa associated with?

A

Hep B and C

96
Q

Condition with thumb and radial wrist pain and the test used to show?

A

De Quervain’s tenosynovitis

FInkelstein’s test

97
Q

Garden system for hip fracture

A

Type I: Stable
Type II: Complete
Type III: Displaced + boney contact
Type IV: No contact, complete disruption

98
Q

Management for undisplaced intracapsular hip fracture

A

Internal fixation (cannulated screws)

99
Q

Management for displaced intracapsular hip fracture

A

Total hip replacement (healthy) or hemiathroplasty (not fit)

100
Q

Management for stable intertrochanteric hip fracture (extracapsular)

A

Dynamic hip screw

101
Q

Management for reverse oblique, transverse, or subtrochanteric hip fracture (extracapsular)

A

Intramedullary device

102
Q

Transverse fracture of radius close to radio-carpal joint

A

Colles’ - falling flat on hand, dorsal displacement
Smith’s - falling on flexed hand, volar displacement

103
Q

Nerve damaged from Colles’ fracture

A

Median nerve

104
Q

What movement does median nerve control?

A

Thumb and index finger flexion

105
Q

Colles’ fracture management

A

Mild: closed reduction
Severe: fixation

106
Q

Management for displaced hand tendon?

A

K wire

107
Q

Management for Bennet’s fracture (non-displaced)

A

Spica thumb cast

108
Q

Management for displaced Bennett’s fracture

A

Open reduction and internal fixation with a screw (or K-wire)

109
Q

What is a fracture of the proximal 1/3 of the ulnar shaft accompanied by the dislocation of the radial head called?

A

Monteggia’s fracture

110
Q

What is a radial shaft fracture with associated dislocation of the distal radioulnar joint called?

A

Galeazzi fracture

111
Q

What is a distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation called?

A

Barton’s fracture

Year 6 (19 decks)

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