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Year 2 > Msk Treatments > Flashcards

Msk Treatments Flashcards

1
Q

Pagets disease

A

1st: analgesia
2nd: bisphosphonates

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2
Q

non pharmacological management of OA (when to use)

A

non pharmacological 1st line: physio, weight loss, activity modification-

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3
Q

pharmacological management of OA (when to use)

A

1st line: paracetomol + topical NSAId (if knee/ hand)
2nd: oral nsaid + ppi

intra-articular steroid injections (up to 3 per year)- if other management is unsuitable

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4
Q

surgical management of OA (whent to use)

A

joint replacement- if other methods not working/greatly impacting life,
arthroscopic surgery to remove loose bodies

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5
Q

septic arthritis
Tx for >5 yrs old

A

1) flucoxacillin IV
clindamycin if penicillin allergic

2) after blood results- IV antibiotic specific for culture for 1-2 weeks- gd response then give PO antibiotics for 6 weeks

possible wash out of joint

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6
Q

acute gout management (not including prophylaxis)
when is management stopped

(3 diff lines of management)

A

NSAIDs- prescribe til 1-2 days after attack:
1)naproxen (do not give nsaid to ckd patient)

2) (po) colchicine is alternative (for ppl w/ HF, CKD-except for ESRD, gastric ulcers)

3) steroids (oral/injection)- use if on dialysis/ have End Stage Renal Disease (ESRD)

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7
Q

acute gout prophylaxis management and who gets it?
management: 1st line and 2ns line

when is prophylaxis started?

A

Every1 after 1st attack

management:
2 weeks after acute attack start Urate Lowering Drugs (ULD)
-xanthine oxidase inhibitors: 1st- allopurinol, 2nd-febuxostat

have to prescribe colchicine/NSAID w/ allopurinol for first 6 months

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8
Q

intra-capsular fracture low functionn management

A

hemi arthroplasty

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9
Q

intra-capsular fracture management for high functioning patient

A

Displaced fracture:
Total hip replacement

undisplaced:
dynamic hip screw/internal fixation

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10
Q

extra-capsular fracture: intertrochanteric

A

Dynamic hip screw

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11
Q

extracapsular fracture- subtrochanteric

A

Inter Medullary Nail

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12
Q

Rhuematoid arthritis management]
give exact das threshold
and what do you prescribe … with

A

within 3 months of onset
1st) DMARDs (methotrexate 1st) - prescribe with folate (to reduce bone marrow supression)
2nd) add another DMARD
3rd) despite 2 DMARDs if Das28 is >3.2 then biologic is added (anti-tnf etc)

steroids, analgesiacs etc used for symptomatic relief

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13
Q

ankylosing spondylitis management

A

1st line NSAIDs (have to try 2 b4 going onto anti-tnf + physio
DMARDs only if there is peripheral joint involvement
3) anti-tnf: for highly persistent disease, if all else fails

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14
Q

polymyalgia rheumatica management

A

prednisolone eg. 15mg

(patients typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis)

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15
Q

Giant cell arteritis management

include if there is vision loss

and any other necessary actions

A

-urgent high dose glucocorticoids- b4 temporal artery biopsy
-if there is is vision loss then IV methylprednisolone
there should be a dramatic response, if not another diagnosis should be considered
-urgent opthatmology review

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16
Q

Acute flare of rheumatoid arthritis treatment

A

IM or PO methylprednisolone

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17
Q

Plantar fasciitis treatment
(4 points)

A

Rest, achilles and plantar fascia stretching excersises and a gel filled heel pad may help.
Corticosteroid injections may alleviate symptoms.

(Surgical release of PF is not beneficial)

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18
Q

Management if quadricep tendon rupture

A

Almost always surgically managed
(as quadricep tendon is vital for leg extension therefore ambulation/knee function)

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19
Q

What tendons tears absolutely require surgical management

A

Quadricep tendon and patellar tendon

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20
Q

When is arthodesis used

A

End stage ankle arthritis
Wrist arthritis
First MTP joint of foot (hallux rigidus)

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21
Q

Myositis ossificans Tx

include prophylactic treatment

A

Once settled, abnormal bone is excised.

High strength NSAIDs (indomethacin)
Or
Radiotherapy used as prophylaxis

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22
Q

CRPS (chronic regional pain syndrome) management

A

reuires urgent referral to a specialist (to improve prognosis).

tx: analgesiacs, anticonvulsabts, steroids, TENs machines, physio, lidocaine patches & sympathetic nerve blocking injections may help.

tricky to manage

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23
Q

1st line carpal tunnel syndrome treatment

A

wrist splints +/- steroid injections

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24
Q

achillies tendonitis management

A

rest, NSAIDs,
if symptoms persist beyond 7 days then physio too

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25
Q

treatment of an ankle fracture which has disrupted the tibio fibular syndemosis (widening of ankle mortise) (weber c classification)

A

requires ORIF- open reduction internal fixation

(although if elderly then avoid surgery- usually)

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26
Q

treatment for Weber B fracture
what does this fracture describe

(4)

A

fibular fracture at the level of syndemosis ankle

operate depending on instability of fracture and age.

if old then dont operate, instead:

application of below the knee plaster cast to include midfoot.
(boot goes om after cast)

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27
Q

treatment weber type A fracture
and also decribe what this type of fracture is

A

(conservative management)

below the knee cast 6 weeks

fibular fracture distal to syndemosis (tibiofibular)

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28
Q

initial management of open fracture

What should be avoided?

A

IV antibiotics, photography and application of saline soaked gauze w impermeable dressing

THEN

wound debridement and external fixation

ORIF should be avoided

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29
Q

most appropriate initial management for a suspected scaphoid fracture

A

Futuro splint or standard below-elbow backslab before specialist review

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30
Q

definitive treatment for non displaced scaphoid fracture

(distal vs proximal)

A

cast for 6 weeks if distal, if proximal then surgery

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31
Q

osteoporosis treatment
(3 points)

A

vit D and Ca++ (unless they defo have enough already)
bisphosphonates: 1st line: alendronate, 2nd: ritedonate

32
Q

APP syndrome management

A

primary thrombprophylaxis:
low dose aspirin

secondary thromboprophylaxis (so after venous thromboembolic events): lifelong warfarin w/ target INR of 2-3

33
Q

SLE treatment of choice
(2 lines)

A

hydroxychloroquine

prednisolone/biologics indicated in sever disease

34
Q

sciatica treatment
(1st and 2nd line)

A

1st: analgesia and physio

2nd: refer to neurosurgery if symptoms havent improved after 4-6 weeks of analgesia/physio

35
Q

acute gout management for someone with heart failure

A

colchicine
( the alternative to naproxen)

36
Q

acute gout management for someone with chronic kidney disease

A

colchicine
( the alternative to naproxen)

37
Q

displaced scaphoid fracture treatment

A

usually surgical fixation

38
Q

rib fracture treatment

A

conservative

if morphine/analgesia is not managing pain then give a nerve blocker

when to consider surgival fixation:
if symptoms have not been controlled after 12 weeks

39
Q

management for dermosytosis/polymyositosis
(4 points)

A

1st line: high dose corticosteroids, reduce over time to eventually stop

if not responsive:
2nd- immunosupression eg aza
(other biologucs etc can be used in severe cases)

40
Q

treatment for kawasaki disease

A

High dose aspirin
IV immunoglobulin

41
Q

SUFE management

A

internal fixation
(typically with a single cannulated screw)

42
Q

stage … CKD and someone with an eGFR of …. or less requires what alternative to bisphosphonates?

A

IV , 35mL/minute/1.73m2
denosumab (human monocolonal antibody): given as a subcutaneous injection every 6 months

(denosumab is 2nd line to alendronic acid for those who cannot tolerate it )

43
Q

septic arthritis tx for <5 yrs

A

flucoxacillin IV and ceftriioxine IV (Ceft. covers h.influ)
give clindamycin instead of flucox if allergic

2) after blood results- IV antibiotic specific for culture for 1-2 weeks-

gd response then give PO antibiotics for 6 weeks

44
Q

scleroderma renal crisis treatment

A

1st line: ace inhibitor ie. ramipril

45
Q

trigger finger management

A

1st: steroid injection, finger splint

2nd line: surgery

46
Q

psoriatic arthritis tx

A

mild peripheral: NSAID

more severe: DMARD
3rd: 2 DMARDS

47
Q

reactive arthritis treatment

A

symptomatic: NSAIDS, intra-articular steroids

persistent disease: sulfasalzine/methotrexat

48
Q

osteoporotic crush fracture treatment

A

Conservative or balloon vertebroplasty

49
Q

if allergic to co-trimaxazole what anti rheumitic drug should you not take

A

sulfasalazine (as co trimaoxazole is a sufa drug)

50
Q

when should steroids be co-prescribed with bisphosphonates

A

if someone will be taking steroids for 3 months or more then bisphosphonates should be prescribed immedietley to reduced the risk of osteoporosis

51
Q

treatment for prolapsed disc

A

nsaids +/- ppi

if it perists for 4-6 weeks then referral for consideration of MRI is appropriate

52
Q

high velocity radial shaft fracture tx in a young healthy patient

A

surgical fixation

53
Q

mechanical back pain tx

A

NSAIDS and KEEp MOVING

54
Q

acute disc tear tx

A

analgesia and physio

55
Q

cauda equina tx

A

surgery

(cauda equina - urinary incontenence, poo yourself, cant feel legs etc)

56
Q

duputryens contracture management

A

1st: reassure, self limiting

2nd: (if not flattening)then refer to specialist for surgical intervention/ inject enzyme therapy

57
Q

potts disease tx

A

anitbiotics, rifampicin, isonazid & spinal mobilisiation!

58
Q

necrotising fasciitis tx

A

urgent surgical debridement and Abx IV to culture

59
Q

bunion tx

A

conservativ: wider/deeper shoes

2nd: surgical: osteotomies

60
Q

Mortons nueroma tx

A

1st line: conservative- pad/insole. steroids/LA injections

61
Q

talipes equinovarus (club foot) tx

A

1st: manipulation + progressive casting soon after birth
takes 6-10 wks to correct

85% then require achilles tetonotomy

62
Q

achilles tendon rupture tx

A

medical: series of casts with foot plantarflexed

surgical: tendon repair

63
Q

ACL tear mx

(3)

A

(1) ask patient to return in 6-7 days to re-examine

(1) NSAIDS + RICE
rest
Ice
Compression
Elevation

(1) many will require arthroscopic surgery for tendon graft surgery

64
Q

patella fracture mx

A

strengthen quadriceps

65
Q

avascular necrosis tx

A

drill holes into affected head

if evidence of bone collapse then total hip replacement

66
Q

trochanteric bursitis tx

A

analgesia + NSAIDs
steroid injetions

67
Q

femoral shaft fracture inital and definitive

A

inital: femoral nerve block and thomas splint

definitive: intermedullary nail

68
Q

acetabulum fracture management

A

undisplaced: conservative

displaced: young- reduction + fixation
old- Total hip replacement

69
Q

boxers fracture tx

A

strap to neighboring finger (occurs on 5th metacarpal)

wash fight bite out in theatre

70
Q

lateral epidondyitis tx vs medial epidoncylitis tx

A

lat: rest + NSAIDs + steroid injections
medial: the same but no steroid injections

71
Q

olecranon fracture tx

A

ORIF

If avulsion= tension band wiring

72
Q

mx for acromioclavicular joint injury

A

grade I/II= sling

grade IV-VI = surgery

73
Q

shoulder dislocation management

A

closed reduction under sedation/ anaethetic

sling

74
Q

spinal stenosis management

A

laminectomy

75
Q

frozen shoulder tx

A

1st line: avoid activities tht exacerbate condtion, NSAIDs then physio

2nd: corticosteroid injections

Year 2 (50 decks)

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