Musc/Rheum Flashcards

1
Q

Common extraarticular manifestations of ankylosing spondylitis

A

Anterior uvietis
Apical fibrosis
Aortic regurg
AVN block
Amyloidosis
Atlantoxial dislocation

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2
Q

Mx of ankylosing spondylitis

A

Physiotherapy
NSAIDs
Smoking cessation

Intraarticular/intralesional/im steroid for enthesitis/arthritis
Methotrexate for peripheral but not axial disease
Anti-TNF agents for axial disease once failed 2 NSAIDs at max dose for 4 weeks

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3
Q

Mx of ankylosing spondylitis

A

Physiotherapy
NSAIDs
Smoking cessation

Intraarticular/intralesional/im steroid for enthesitis/arthritis
Methotrexate for peripheral but not axial disease
Anti-TNF agents for axial disease once failed 2 NSAIDs at max dose for 4 weeks

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4
Q

Mx of rheumatoid arthritis?

A

Methotrexate + short term prednisolone
Measure disease activity DAS-28 score

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5
Q

What joint affected increases suspicion of psoriatic arthritis over rheumatoid arthritis

A

DIPJ

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6
Q

Mx of psoriatic arthropathy?

A

NSAIDs

Steroid injections

DMARDs if NSAIDs fail
Anit-TNF afents
Ustekinumab

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7
Q

GCA Mx

A

EMERGENCY
40mg Prednisolone
IV methylprednisolone 500mg if visual loss

Request temporal artery biopsy

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7
Q

What is Ehlers-Danlos Syndrome

A

Skin hyperextensibility
Joint hypermobility
Easy bruising, muscle aches, weakness

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8
Q

Causes of erythema nodosum

A

Sarcoidosis
Inflammatory Bowel Disease (crohns more often than ulcerative colitis)
Behcet’s disease
Hodgkins lymphoma, leukaemia
Pregnancy

Infection: TB, leprosy, Hep B

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9
Q

Causes of bihilar lymphadenopathy

A

Sarcoidosis
Infection: TB, HIV
Malignancy
Silicosis

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10
Q

Describe the anatomy of the carpal tunnel

A

Formed by flexor retinaculum and carpal bones
contains median nerve

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11
Q

What is the typical patterns of sensory loss seen in carpal tunnel syndrome?

A

median nerve supplies thenar eminence and lateral 3.5 fingers

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12
Q

Main cause of carpal tunnel syndrome

A

Idiopathic
Radial fracture
Inflammation - RA, gout
Soft tissue swelling; lipomas, ganglia, acromegaly, amyloidosis

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13
Q

Surgical Tx of carpal tunnel

A

Carpal tunnel decompression by division of flexor retinaculum

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14
Q

What are the 4 classic features of RA on X-ray

A

Loss of joint space

Periarticular Erosions

Soft tissue Swellings

Soft bones i.e. periarticular osteopenia

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15
Q

Causes of positive tredelenberg test

A

Osteoarthritis
Abductor wasting
Sup. gluteal N. injury: surgery
Structural: DDH

16
Q

Causes of hip shortening

A

NOF
Dislocation
Osteomyelitis
Surgery
SUFE, Perthe’s
Scoliosis

17
Q

Caused of fixed flexion deformity in the hip

A

Osteoarthritis (most likely)

NOF
Muscle contracture

18
Q

Features of OA of hip

x5

A

± Trendelenberg gait or +ve Test
Pain
Stiffness
↓ ROM: esp. internal rotation
Fixed flexion deformity

19
Q

Osteoarthritis Ix

A

Exclude Rheumatological Disease
FBC
ESR
RF, ANA

Check Renal Function: U+E
(important before prescribing NSAIDs)

X-ray Changes

20
Q

X-ray changes in osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

21
Q

Osteoarthritis Mx

A

MDT
Lifestyle: ↓ wt., ↑ exercise
Physio: muscle strengthening, walking aids

Analgesia
Joint injection: local anaesthetic and steroids

Sx: arthroplasty, realignment

22
Q

What causes longer early morning stiffness, OA or RA.
Which joints are affected in the hands for OA and RA

A

RA long early morning stiffness

RA: PIPJs and MCPJs
OA: PIPJs and DIPJs

23
Q

Commonest complication of total hip replacement

24
Mx of intracapsular hip fracture
Undisplaced Fracture: internal fixation, or hemiarthroplasty if unfit. Displaced: Total hip replacement, or hemiarthroplasty if unfit.
25
Mx of extracapsular hip fracture
stable intertrochanteric fractures: dynamic hip screw if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
26
Mx of ACL
Rest and phyio to strengthen quads and hamstrings Gold-standard is autograft repair surgery
27
What is Hallux
Stiff big toe (varus or valgus)
28
Causes of charcot joints
DM Leprosy Syringomelia Peripheral nerve injury
29
Describe antalgic gait? Cause?
Decreased stance Increased swing (classic limp) Pain
30
Cause of high stepping gait
Raises one leg like a weirdo Common peroneal nerve injury L5 disc
31
Causes of winged scapular
Seratus Anterior Weakness Long-thoracic nerve damage: e.g. axillary surgery Upper brachial plexus injury
32
Mx of carpal tunnel
Wrist splint Carpal tunnel decompression by division of the flexor retinaculum