MSRA Clinical 2 Flashcards
L3 nerve root compression
- Sensory loss over anterior thigh
- Weak quadriceps
- Reduced knee reflex
- Positive femoral stretch test
L4 nerve root compression
- Sensory loss anterior knee
- Weak quadriceps
- Reduced knee reflex
- Positive femoral stretch test
L5 nerve root compression
- Sensory loss dorsum of foot
- Weakness in foot and big toe dorsiflexion
- Reflexes intact
- Positive sciatic nerve stretch test
S1 nerve root compression
- Sensory loss posterolateral leg and lateral foot
- Weakness in plantar flexion
- Reduced ankle reflex
- Positive sciatic nerve stretch test
Ottawa rules
Ankle x-ray if there is pain in malleolar zone and one of:
- Bony tenderness at lateral malleolar zone (including distal 6cm fibular)
- Bony tenderness at medial malleolar zone (including distal 6cm tibia)
- Inability to weight bear 4 steps immediately and in ED
Golfer’s elbow
Medial epiondylitis
- Tender medial epicondyle
- Medial wrist pain on resisted wrist pronation
Tennis elbow
Lateral epicondylitis
- Tender lateral epicondyle
- Lateral elbow pain on resisted wrist extension
Causative organism bone infections in SCA/malaria
Non-typhi salmonella
Patellofemoral pain syndrome AKA
chondromalacia patellae
Patellofemoral pain syndrome features
Softening of cartilage of patella
Teenage girls
Anterior knee pain on alking up/down stairs and rising from prolonged sitting
Responds to physio
Infraptellar bursitis
=clergyman’s knee
Associated with kneeling
Prepatellar bursitis
=Housemaid’s knee
Associated with upright kneeling
ACL injury
Caused by twisting of knee + popping noise
Rapid knee effusion
Positive draw test
PCL injury
Anterior force applied to proximal tibia (eg knee hitting dashboard)
Collateral ligament injury
Tenderness over affected ligament
Knee effusion
Mensical lesion
Caused by twisting of the knee
Locking and giving way are common features
Tender joint line
OA of knee
Intermittent swelling, crepitus, limitation of movement
Methotrexate side effects
Myelosuppression
Liver cirrhosis
Pneumonitis
Sulfasalazine side effects
Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease
Leflunomide side effects
Liver impairment
Interstitial lung disease
Hypertension
Hydroxychloroquine side effects
Retinopathy
Corneal deposits
Prednisolone side effects
Cushingoid Osteoporosis Impaired glucose tolerance Hypertension Cataracts
Gold side effects
Proteinuria
Penicillamine side effects
Proteinuria
Exacerbation of myasthenia gravis
Etanercept side effects
Demyelination
Reactivation of Tb
Infliximab side effects
Reactivation of Tb
Adalimumab side effects
Reactivation of Tb
Rituximab side effects
Infusion reaction
Hip OA findings
Reduction in internal rotation
Referred lumbar spine pain
Femoral nerve stretch positive
Ankylosing spondylitis A features
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis
Antiphospholipid syndrome clotting screen
Paradoxically prolonged APTT
Low platelets
Drugs which cause drug-induced lupus
- procainamide
- hydralazine
less common causes:
- isoniazid
- minocycline
- phenytoin
Indication for secondary prevention of osteoporotic fracture
After osteoporotic fracture in post-menopausal woman with confirmed osteoporosis (T-score of -2.5 SD or below)
Antibodies associated with diffuse cutaneous systemic sclerosis
anti-scl-70
+ ANA + RF
Antibodies associated with limited cutaneous systemic sclerosis
anti-centromere
+ ANA + RF
Lesch-Nyhan syndrome
Inherited enzyme deficiency.
“juvenile gout”,
self-mutilation behaviour
Pseudogout findings
- calcium pyrophosphate dihydrate crystals
- x-ray: chondrocalcinosis
- aspiration: weakly-positively birefringent rhomboid crystals
Pseudogout risk factors
- haemochromatosis
- hyperparathyroidism
- acromegaly
- low magnesium, low phosphate
- Wilson’s disease