MSK- wrong answers Flashcards
first line management for carpal tunnel syndrome
conservative-
wrist splint
corticosteroid injections
clinical signs on examination for ankylosing spondylitis
reduced lateral flexion of lumbar spine
reduced forward flexion- schobers test
reduced chest expansion
what is the initial investigation for achilles tendonitis
ankle USS
what can be used to manage acute flares of rheumatoid arthritis
oral or intramuscular steroids such as methylprednisolone
medical management of osteoarthritis
1st line- topical NSAID
2nd line- oral NSAIDA with PPI
management of achilles tendonitis
rest, NSAIDs, analgesia
when are patients with achilles tendonitis given physiotherapy
if symptoms persist longer than 7 days
first line management of ankylosing spondylitis
NSAID with PPI
first line management of obvious ankle injuries if neurovascular compromise is present
immediate reduction / stabilisation instead of XRAY
Pain on the radial side of the wrist/tenderness over the radial styloid process ?
de quervains tenosynovitis
which clinical test is used to diagnose de quervains tenosynovitis
finkelsteins test
which type of back pain is a red flag
thoracic back pain
what is the most appropriate investigation for ankylosing spondylitis
pelvic XRAY- to identify sacro-iliitis
what bone protection should be provided for long term steroid use
alendronic acid
calcium/vitamin D
medical management of psoriatic arthritis
- NSAIDs
- csDMARDs
- anti-TNF
what is the most common mechanism of an ankle sprain
inversion of the foot
what is the most common mechanism of a 5th metatarsal fracture
inversion of foot and ankle
medical management of gout
- NSAIDs
- colchicine
- steroids
Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?
osteomalacia
bone profile blood test results in osteomalacia
high ALP
low calcium
low phosphate
which antibiotics should not be taken with methotrexate due to risk of severe bone marrow depression
trimethoprim
co-trimoxazole
which nerve root compression would cause sensory loss over anterior thigh
L3
which nerve root compression would cause sensory loss over anterior aspect on knee
L4
which nerve root compression would cause sensory loss over dorsum of foot
L5
which nerve root compression would cause sensory loss over the posterolateral aspect of leg and lateral aspect of foot
S1
typical features of prolapsed disc
leg pain worse than back
pain often worse when sitting
methotrexate can cause what lung disease
pulmonary fibrosis
pneumonitis
medical management of osteomalacia
vitamin d therapy
calcium and phosphate supplementation
Excessive use of breakthrough analgesia should raise suspicion for what?
compartment syndrome
ankylosing spondylitis XRAY findings
subchondral erosions
sclerosis and squaring of lumbar vertebrae
lateral epicondylitis (tennis elbow) is worse on wrist extension/flexion
extension
what organism is neisseria gonnorhea
gram negative diplococci
which pathology does a positive straight leg raise suggest
sciatic nerve pain
As a guide, a QFracture score ≥ ? means a DEXA scan should be arranged
> /=10%
blood test results for osteoporosis
normal ALP
normal calcium
normal phosphate
normal PTH
NORMAL
polymyositis causes muscle weakness/muscle aches?
muscle weakness
polymalgia rheumatica causes muscle weakness/muscle aches?
muscle aches- strength normal
dinner fork deformity associated with what fracture
colles fracture
what long-term medication should be offered to patients with their first attack of gout
allopurinol
which drug has been associated with an increased risk of atypical stress fractures of the proximal femoral shaft?
bisphosphonates
How long should the symptoms be present for before a diagnosis of chronic fatigue can be made?
3 months at least
lateral epicondylitis causes pain worse on supination/pronation?
supination
when is spinal stenosis often relieved
by sitting down or leaning forward
How many different NSAID drugs must a patient with ankylosing spondylitis must have failed to respond to before he can be started on anti-TNF alpha inhibitors, in someone with predominantly axial disease?
2
What investigation is required prior to starting this biologic- anti-TNF
chest XRAY- tb
De Quervain’s tenosynovitis: inflammation of the sheath containing which muscles of the hand
abductor policuss longus
extensor policus brevis tendons
management of ankle fractures webers A class
remain weight bearing as tolerated in a CAM boot for 6 weeks
management of ankle fractures webers C class
open reduction and internal fixation
what might you see in chest x-ray in later ankylosing spondylitis
apical fibrosis
a Z score below what is abnormal
</=-2
risk factors for osteoporosis
post-menopause
low BMI
chronic kidney disease
lifestyle- smoking, alcohol, lack of exercise, poor diet
reduced sunlight exposure (vitamin d)
drugs- breast cancer, corticosteroids
what may be used to monitor flares of SLE
complement levels- often low during active disease (C3 and C4)
In children, where is the most common site where osteomyelitis occurs in a long bone
metaphysis
what is a normal T score
> /=-1
what is the most common site for metatarsal stress fractures
2nd metatarsal shaft
