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Finals (HV) > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What blood test must be carried out before starting azathioprine?

A

check thiopurine methyltransferase deficiency (TPMT)

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2
Q

What is ankylosing spondylitis and list sx?

A

a HLAB27 associated spondylarthropathy

sx- Morning pain and stiffness of back and hip that improves with activity

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3
Q

List 3 examination fidings of ank spon?

A

Reduced chest expansion
Reduced forward flexion
Reduced lateral flexion

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4
Q

What are sx and mx of achilles tendonitis?

A

sx- Gradual onset of posterior heel pain (worse after activity), morning pain and stiffness is common

mx- simple analgisia, physio

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5
Q

What is the ix of choice in achilles tendon rupture?

A

USS

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6
Q

List 3 indications for methotrexate?

A

Inflammatory Arthritis
Psoriasis
Chemo–>ALL

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7
Q

List the cautions of methotrexate use in preganancy?

A

Women should stop 6 months prior to pregnancy

Men should use effective contraception for 6 months after tx

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8
Q

What other medication must be co-prescribed with methotrexate?

A

Folic acid (should be taken 24 hours apart)- reduces the risk of myelosuppression

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9
Q

What abx should be avoided when using methotrexate and why?

A

Trimethoprim, and co-trimoxazole- increases risk of marrow aplasia

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10
Q

What is the tx for methotrexate toxicity?

A

Folinic Acid

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11
Q

What is osteomalacia?

A

Softeneing of bones secondary to vit D deficiency.

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12
Q

List sx of OM?

A

Bone pain
Bone/muscle tenderness
Fracture (*NOF)
Proximal myopathy- ‘waddling gait’

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13
Q

List the bone profile in a patient with OM?

A

Low Vit D, Calcium, Phosphate
High ALP
High PTH

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14
Q

What is systemic sclerosis?

A

Condition of unknown aetiology characterised by hardened sclerotic skin and CT

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15
Q

What is limited cutatenous systemic sclerosis and list its features?

A

a subtype of systemic sclerosis which predominantly affects face and distal limbs.

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16
Q

What is often the first sign of limited cutaneous systemic sclerosis?

A

Raynauds Phenomenon

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17
Q

What is the antibody associated with Limited cutaneous systemic sclerosis?

A

Anti centromere antibodies

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17
Q

What antibody is associated with diffuse cutaneous sclerosis?

A

anti SCL-70

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18
Q

What is diffuse cutaneous sclerosis and list its features?

A

A subtype of systemic sclerosis which predominantly affects the trunk and proximal limbs. Carries a worse prognosis

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19
Q

What is CREST syndrome?

A

a subtype of limited cutaneous sclerosis.
Calcinosis
Raynauds
oEsophageal dysmotility
Sclerodactyly
Telangiecstasia

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20
Q

What is dermatomyositis?

A

an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions

*polymyositis is a variant of the disease where skin manifestations are not prominent

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21
Q

List the features of dermatomyosistis?

A

Skin manifestations
Photosensitive malar rash
macular rash over back and shoulders
Heliotrope rash in periorbital region
Grottons papules- roughened red papules over extensor surfaces of fingers

other features:
Proxiaml muscle weakness
Raynauds
Resp muscle weakness
ILD
Dysphagia

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22
Q

What antibodies are present in dermatomyositis?

A

anti-Mi-2 antibodies
anti jo-1 antibodies
antibodies to signal recognition particle (SRP)

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23
Q

What are the features of antiphospholipid syndrome?

A

Venous/arterial thrombosis
Recurrent miscarriages
Livedo reticularis
Pre-eclamsia, Pulmonary HTN

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24
Q

What is the results of a joint aspiration in pseudogout?

A

Positively birefringent rhomboid-shaped crystals

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25
Q

What antibodies are highly specific for SLE?

A

anti-dsDNA
anti smith

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26
Q

how can pseudogout and gout be distinguished on x-ray?

A

chondrocalcinosis, the finding of calcification of the articular cartilage. Although not specific, this is suggestive of pseudogout.

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27
Q

What is Marfan’s syndrome?

A

an autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1.

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28
Q

State 5 features of Marfan’s?

A

Pectus excavatum
Tall stature
High arched palate
Pes planus
Scoliosis
heart (aortic regurg, aortic dissection, dialtion of aortic sinuses, mitral valve prolapse)
repeated pneumothoraces
eyes (blue sclera, upwards lens dislocation, myopia)

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29
Q

Where is the most common site where osteomyelitis occurs in children?

A

long bone is the metaphysis

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30
Q

what is the investigation of choice in osteomyelitis?

A

MRI

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31
Q

What is the most common reason for a THR revsion?

A

Aseptic loosening

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32
Q

What antibodies are present in anti-phospholipid syndrome?

A

anticardiolipin antibodies
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
lupus anticoagulant

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33
Q

What is de-quervin’s tenosynovitis?

A

A common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.

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34
Q

List the 4 common features/sx of de-quervain’s tenosynovitis?

A

pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
pain over radial styloid process when thumb in ulnar deviation

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35
Q

What is the mx of de-quervain’s tenosynovitis?

A

analgesia
steroid injection
immobilisation with a thumb splint (spica) may be effective
surgical treatment is sometimes required

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36
Q

What are the x-ray findings of ank-spon?

A

Subchondral erosions
Subchondral sclerosis
Squaring of lumbar vertebrae (bamboo spine)

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37
Q

What are the x-ray findings of OA?

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

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38
Q

What are the x-ray findings of RA?

A

Loss of joint space
Periarticular erosisons
Soft tissue swelling
Subluxation

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39
Q

What are the x-ray findings of gout?

A

Soft tissue swelling
Punched out bone lesions
Overhanging scelrotic margins

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40
Q

What are the common joints in the hands are affecetd by OA?

A

Carpometacarpal Joints
DIPJ>PIPJ
Squaring of thumb

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41
Q

In cauda equina what late sign would indicate irreversible damage?

A

Urinary incontinence

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42
Q

What T score indictaes osteoporosis?

A

T-score of < -2.5 confirms a diagnosis of osteoporosis.

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43
Q

What is the most common cause of discitis?

A

Staph aureus

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44
Q

What is discitis?

A

an infection in the intervertebral disc space.

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45
Q

List the priamary cause and 3 secondary causes of iliopsoas abscesses?

A

1- Staph aureus- hetrogenous spread

2- crohns, IVDU, Diverticulitis, endocarditis, Vertebral osteomyelitis

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46
Q

what are the sx of an iliopsoas abscess?

A

Fever
Back/flank pain
Limp
WL

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47
Q

What is the ix of choice and subsequent mx of a ilopsoas abscess?

A

CT Abdomen

Abx
Percutaneous drainage
Sx- if PD fails or other intra-abdominal pathology shown

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48
Q

What 2 muscles comprise the iliopsosa compartment?

A

Illiacus
Iliopsoas

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49
Q

What medication is indicated in patients with renal complications with a background of systemic sclerosis?

A

ACEI

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50
Q

What clinical features are present if the femoral nerve is damaged?

A

Weakness in knee extension,
loss of the patella reflex,
numbness of the thigh

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51
Q

What clinical features are present if the obturator nerve is damaged?

A

Weakness in hip adduction,
numbness over the medial thigh

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52
Q

What clinical features are present if the Sciatic nerve is damaged?

A

Weakness in knee flexion and foot movements,
pain and numbness from gluteal region to ankle

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53
Q

What nerve is most at risk and thus a complication of posterior hip dislocation?

A

Sciatic nerve

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54
Q

What is the management of plantar fascitis?

A

Initially with rest, stretching and weight loss if overweight

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55
Q

What are the causes of compartment syndrome?

A

Following fractures
Ischaemia repurfusion injury

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56
Q

What are the common types of fractures that result in compartment syndrome?

A

Supracondylar fractures
Tibial shaft fractures

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57
Q

List the sx of compartment syndrome?

A

Pain (esp on movement, not controllled by analgesia/opiates)
Parasthesia
Pulseless/pulse
paralysis of muscle group
pallor

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58
Q

How is compartment syndrome diagnosed

A

Needle manometry- measure intracompartmental pressure
>20mmHg- Abnormal
>40mmHg- Diagnostic

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59
Q

What is the mx of compartment syndrome?

A

Escalating to the orthopaedic registrar or consultant
Removing any external dressings or bandages
Elevating the leg to heart level
Emergency Fasciotomy +/- derbridement

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60
Q

what sx are present in an L3 nerve root compression?

A

sensory loss over anterior thigh
weak hip flexion, knee extension and hip adduction
reduced knee reflex
+ve femoral stretch test

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61
Q

what sx are present in an L4 nerve root compression?

A

Sensory loss over anterior aspect of knee and medial malleolus
weak knee and hip extension
reduced knee reflex

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62
Q

what sx are present in an L5 nerve root compression?

A

Sensory loss dorsum of foot
weakness in foot and big toe dorsiflexion
Knee reflex intact

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63
Q

what sx are present in an S1 nerve root compression?

A

Sensory loss over posterolateral aspect of leg
weakness of plantar flexion

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64
Q

What are the Ottawa Ankle rules that minimise the use of xrays in ankle injuries?

A

If pain in malleolar zone AND
1. Inability to weight bear for 4 steps
2. Tenderness over distal tibia
3. Bone tenderness over distal fibula

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65
Q

What is a toddler’s fracture?

A

Oblique tibial fracture

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66
Q

What is a greenstick injury?

A

unilaterla cortical breach in bone

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67
Q

What other conditions are linked with pseudogout?

A

Haemochromotosis
Hyperparathyroidism
Low magnesium and phosphate
Acromegaly
Wilson’s disease

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68
Q

What are the features of Behcet’s diseases?

A

Oral ulcers
Genital ulcers
Anterior uveitis

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69
Q

What are the expected bone chemistry results (PTH, Ca, PO4, and ALP) in osteogenesis imperfecta?

A

All values are normal

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70
Q

What is osteogenesis imperfecta?

A

An autosomal dominant group of conditions that affect collagen metabolism thus leading to bone fragility thus more to prone to fractures

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70
Q

List 4 features of Osteogenesis Imperfecta?

A

Present in childhoos
Blue sclera
Fractures following minor trauma
deafness 2ndry to osteosclerosis
Dental imperfections

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71
Q

List the triad of sx in reactive arthritis?

A
  1. Urethritis
  2. Conjuntivitis
  3. Arthritis
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72
Q

What investigation is key to perform in SLE?

A

ANA antibody screen- good to rule out

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73
Q

What investigations are done to diagnose SLE?

A

ANA antibody= +ve
ESR= Increased
Low complement levels (suggest active disease)
anti dsDNA
anti Smith

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74
Q

How would a posterior hip dislocation present as?

A

affected leg:
- shortened
- Internally rotated
- Adducted

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75
Q

How would a anterior hip dislocation present as?

A

Externally rotated + Abducted

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76
Q

List 3 complications of hip disclocations?

A

Sciatic or femoral nerve injury
Osteoarthritis
Recuurennt hip dislocations
Avascular necrosis

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77
Q

Which bones are affected in osteosarcoma?

A

Metaphysis region of long bones (femur, tibia, humerus)

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78
Q

What Xray changes are seen in osteosarcomas?

A
  • Codmans triangle- periosteal elevation
  • Sunburst appearance
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79
Q

What genetic associations are there with osteosarcomas?

A

Retinoblastoma

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80
Q

What is the most common malignant bone tumour?

A

Osteosarcoma

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81
Q

Which bones are affected in Ewings sarcoma?

A

Pelvis and Long bones

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82
Q

List 3 benign bone tumours?

A
  1. Osteoma- linked with gardeners syndrome
  2. Osteochonroma- most common BBT
  3. Giant cell tumour- xray- double bubble, soap sign
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83
Q

What are the features of osteochondritis dissecans?

A
  • Knee pain and swelling
  • Knee catching and locking
  • Painful clunk when extending and flexing knee
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84
Q

What xray changes would be present in osteochondritis dissecans?

A

Sunchondral crescent sign
Loose bodies

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85
Q

What would a RA joint aspirate show in synovial fluid analysis?

A

Yellow , cloudy fluid
Increased WBC count- predominantly polymorphular neutrophils
Absence of crystals

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86
Q

What are the triad of symptoms in Felty’s syndrome?

A

RA
Splenomegaly
Low WCC

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87
Q

What is the highest risk complication in individuals with marfan’s syndrome?

A

Repeated pneumothoraces

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88
Q

What are the following test results in polymyalgia rheumatic (ESR, CRP, CK, EMG) ?

A

ESR, CRP- Elevated
Normal EMG and CK

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89
Q

What is the mx of RA flares?

A

Oral or IM corticosteroids

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90
Q

List 4 causes for AVN of the hip?

A

Long term stroid usage
Alcohol excess
Chemotherapy
Trauma

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91
Q

What is the Ix of choice for AVN of hip?

A

MRI

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92
Q

What are the sx of tennis elbow?

A

Pain and tenderness at elbow joint
Pain worse on wrist extension against resistance w/ elbo extended
Painful supination of elbow

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93
Q

What is Ehlers danlos syndrome?

A

Autosomal dominant connective tissue disorder, most likely affecting type 3 collagen

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94
Q

What type of collagen is affected in ehlers danlos?

A

Type 3

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95
Q

What score is used to assess hypermobility?

A

Beighton score
>5/9 in adults and >6/9 in children

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96
Q

What is Sjogren syndrome?

A

Autoimmune disorder affecting the exocrine glands, thus resulting in dry mucosal surfaces

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97
Q

List 5 sx of Sjogren’s syndrome?

A

Dry eyes- Keratoconjunctivitis Sicca
Dry mouth
Vaginal dryness
Arthralgia
Raynauds

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98
Q

List the antibodies specific to Sjogren?

A

Anti RO and Anti La

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99
Q

What abx should never be co-prescribed with methotrexate?

A

Trimethoprim or Co-trimoxazole

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100
Q

What monitoring is required with methotrexate use?

A

FBC, U&Es, and LFTs every 3 months

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101
Q

What is the mx of sjogren’s?

A

Artificial tears and saliva

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102
Q

What antibody/ies are present in dermatomyositis?

A

Anti Jo-1
Anti Mi-2 (more specific)

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103
Q

What antibody/ies are present in polymyositis?

A

Anti Jo-1

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104
Q

What antibody/ies are present in drug-induced lupus?

A

Anti-histone

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105
Q

What is the mx of anti-phospholipid syndrome?

A

Long term coagulation with Warfarin (target INR 2.0-3.0)

Low dose aspirin should be considered

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106
Q

How does the mx of anti-phospholipid syndrome differ in pregnancy?

A

During pregnancy, women with APS are typically managed with low molecular weight heparin (LMWH) and low-dose aspirin to reduce the risk of miscarriage and other complications such as pre-eclampsia.

Warfarin must be avoided due to teratogenicity.

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107
Q

What nerve roots form the sciatic nerve?

A

L4-S1

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108
Q

List the clinical features of sciatica?

A

Lower back pain
Unilateral leg pain
Paraesthesia
Weakness
Diminished reflexes

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109
Q

What IX can be performed in clinic to diagnose sciatica?

A

Straight leg raise (SLR) - radiating pain is felt when the hip is flexed to between 30 and 60 degrees.

110
Q

What is the mx of sciatica?

A

1st line- NSAIDs
alt if NSAIDs contrindicated- Codeine +/- Paracetamol

111
Q

What are the deficits in a C6 nerve root compression? (Motor, refelx, sensory)

A

Motor- Weakness in elbow flexion and wrist extension

Reflexes- Biceps ans supinator affected

Sensory- Along lateral forearm, thumb and first finger

112
Q

What are the deficits in a C7 nerve root compression? (Motor, refelx, sensory)

A

Motor- Weakness in elbow extension and wrist flexion and finger extension

Reflexes- Triceps reflex

Sensory- Middle finger

113
Q

List the clinical features of spinal stenosis?

A

Bilateral back, buttock/thigh/leg pain, with associated numbness, tingling, weakness

Symptoms are exacerbated when walking/ exertion, or prolonged standing - claudication.

Symptoms are exacerbated by back extension, and relieved by flexion which increases the canal space - trolley cart sign.

Symptoms are relieved by rest, or sitting down/leaning forwards

114
Q

What is the 1st line Ix in suspected spinal stenosis

A

MRI Spine

115
Q

What is the cauda equina?

A

The collection of peripheral nerves (L1-S5) in the lumbar canal

116
Q

List the clinical features of cauda equina syndrome?

A

Back pain
Scaitica (UL/BL)
Lower limb weakenss
Bladder dysfunction
Saddle anaesthesia
Bowel dysfunction
ED

117
Q

List 3 red flags back pain?

A

Age > 50 years
Gradual, insidious onset of symptoms which have not improved with 4-6 weeks
Severe back pain, often worse at night disrupting sleep
Back pain exacerbated by increased by valsalva (e.g. sneezing, defaecation)
Localised pain on palpation
Systemic features - weight loss
History of malignancy

118
Q

What is the mx of olecranon bursitis?

A

Non-infective - RICE, analgesia, consider symptomatic aspiration or steroid injection

Infective
-Aspirate bursal fluid and send for MCS
-Antibiotics (flucloxacillin 1st line) whilst a/w MCS

119
Q

What is the mx of suspected cauda equina syndrome?

A

1st line: MRI - ideally obtained within 1-2 hours of presentation

emergency surgical decompression within 24-48 hours

120
Q

List 3 causes of compartment syndrome?

A

Commonly due to trauma, including fractures, crush injuries, or muscle overuse.
Ischaemia-reperfusion injury
Burns
Vascular injuries
Bleeding disorders
Prolonged limb compression
Tight bandages

121
Q

What are the clinical features of compartment syndrome?

A

Commonly in lower limb
Classically severe pain disproportionate to injury
Tightness
Paraesthesia

122
Q

What examination findings may be present in compartment sysndorme?

A

Decreased sensation- particularly first web space of foot
Diminished pulses, and pallor or cyanosis.
Pain with passive stretch of affected muscles

Severe cases:
Paralysis
Absent pulses.

123
Q

What Ix may aid diagnosis of compartment syndrome?

A

Compartment pressure measurement with manometry can aid diagnosis (>40mmHg diagnostic)

124
Q

What is the definitive mx of compartment syndrome?

A

Immediate decompression via open fasciotomy

125
Q

List 2 complications of compartment syndrome?

A

Myoglobinuria
Nerve damage
Renal damage
Limb loss

126
Q

What is the pathophysiology behind compartment syndrome?

A

Increased pressure within a muscle compartment leads to compromised tissue perfusion and nerve function

127
Q

What is dermatomyositis?

A

an inflammatory condition resulting in symmetrical proximal muscle weakness and skin lesions.L

128
Q

List the clinical features of dermatomyositis?

A

Heliotrope periorbital rash
Red macular rash affecting back and shoulders
Gottron’s red papules on extensor surfaces
Symmetrical, proximal weakness +/- tenderness
Fatigue
Weight loss
Night sweats

129
Q

List the causes of dermatomyositis?

A

most cases- idiopathic
may indicate an underlying malignancy in as many as 25% of patients - ovarian, breast, lung

130
Q

What is the mx of dermatomyositis?

A

Steroids - Prednisolone
Patients should be screened for malignancy

131
Q

What is the most common causative organism in discitis?

A

Staphylococcus aureus

132
Q

What is the GS ix for discitis?

A

MRI - the most sensitive and specific diagnostic test

133
Q

What is the 1st line mx for discitis?

A

IV ABx - with cover for staph aureus - flucloxacillin, clindamycin
Surgical debridement may be required

134
Q

What is the 1st lien mx for tennis elbow?

A

Analgesia - 1st line: paracetamol or topical NSAID.

2nd line: PO NSAID

135
Q

What are the clinical features of carpal tunnel syndrome?

A

Intermittent paraesthesia, sensory changes, or neuropathic pain in the distribution of the median nerve
Reduced grip strength or loss of dexterity
Symptoms are often worse during the night, often disturbing sleep
Patients may shake their hands to relieve the pain

136
Q

What Ix is conducted in carpal tunnel syndrome?

A

CTS is a clinical diagnosis, but nerve conduction studies can be performed for confirmation.

137
Q

What is the mx of CTS?

A

Mild-moderate symptoms - try the following:
Wrist splint
Corticosteroid injection into the carpal tunnel

if sx persistent- Carpal tunnel decompression surgery

138
Q

List the RF for fibromyalgia?

A

Depression/anxiety
Dissatisfaction with family/work
Associated with chronic fatigue syndrome, IBD, chronic headache syndromes

139
Q

What clinical features will be present in fibromyalgia?

A

Chronic widespread pain (Affects both sides of body + above and below waist + persists >3months)
Associated fatigue
Joints feel swollen
Low mood
Symptoms may worsen with physical or emotional stress

140
Q

What is required to make a diagnosis of fibromyalgia?

A

Based on clinical assessment
Presence of at least 11/18 tender points on palpation

141
Q

What is the mx of fibromyalgia?

A

Aim to improve symptoms and quality of life

Patient education
Graded exercise
Refer for cognitive-behavioural therapy (CBT)
Pharmacotherapy for symptom management (e.g., analgesics, antidepressants)
Neuropathic medications can help pain and sleep (amitriptyline/pregabalin/gabapentin/duloxetine)

142
Q

What is the plantar fascia?

A

a fibrous band of connective tissue, extending from the calcaneus bone to the tendons of the forefoot and proximal phalanges, which supports the arch of the foot

143
Q

List RF of plantar fasciitis?

A

Age 40-60, obesity, high arched feet, flat feet, excess use (walking, standing, running)

144
Q

What examination may be done to diagnose plantar fasciitis?

A

Pain on palpation of the heel
Positive Windlass test - extension of the 1st MTP reproduces the pain

145
Q

What is morton’s neuroma?

A

A benign, thickening of the common digital plantar nerve due to persistent irritation from compression (usually within the third intermetatarsal space).

146
Q

Where do ganglion cysts arise from?

A

originate from the synovial lining of joints and tendons.

147
Q

How can a ganglion be differentiated from other types of lumps?

A

They transilluminate, reflecting their fluid contents, which helps differentiate them from other types of lump.

148
Q

What is the mx of ganglion cysts?

A

They often resolve without intervention.

Treatment is generally only recommended by if the cyst is causing significant pain or affecting the range of movement of a joint.
- Aspiration-high recurrence rates
- Surgery

149
Q

What causes gout?

A

Deposition of monosodium urate monohydrate within the synovium (as a result of hyperuricaemia)

150
Q

What are the RF of Gout?

A

Factors which increase urate synthesis ( high cell turnover), or impair urate excretion.

Drugs: Aspirin, thiazides, furosemide, cytotoxics, ciclosporin

Comorbidities: CKD, psoriasis

151
Q

What sit he 1st lien Ix of Gout?

A

Measure the serum urate level - if 360 or more, this confirms the diagnosis

152
Q

What Ix is indicated if the 1st line ix for gout remains uncertain?

A

Joint aspiartion

153
Q

What are the results of joint aspiration show in gout?

A

polarised light microscopy - Needle shaped, negatively birefringent crystals

154
Q

What is the 1st line mx for the acute mx of gout?

A

NSAID (naproxen) OR colchicine OR Short course of oral prednisolone ( this is off label)

155
Q

What is the main SE of colchicine?

A

Diarrhoea

156
Q

What is the 1st line chronic mx of gout?

A

Allopurinol OR Febuxostat
+ Colchine

157
Q

Whe should urate lowering theraphy be initiated?

A

Urate lowering therapy (ULT) should be considered after the first attack of (2-4 weeks after acute attack).

158
Q

What is the MOA of Allopurinol?

A

xanthine oxidase inhibitor

159
Q

What is the MOA of Febuxostat?

A

xanthine oxidase inhibitor

160
Q

What should be done prior to starting Fexubostat?

A

Ensure LFTs are checked before commencing treatment

161
Q

What is the mx of pseudogout?

A

Manage with NSAIDs or steroids (PO/IA/IM)

162
Q

What is pseudogout?

A

microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate crystals

163
Q

List the clinical features of Greater trochanteric pain syndrome?

A

Chronic pain felt in around the greater trochanter and around the buttock, thigh or lateral hip.
Pain may come and go or be persistent and is exacerbated by activity or external pressure - e.g. exercise, or lying in bed on the affected side
Symptoms are usually of gradual onset and progressive
On examination - tenderness on palpation of the GT, antalgic gait, trendelenburg may be positive

164
Q

List the differential of hip pain i children?

A

DDH
SUFE
Transient synovitis
Perthes
Septic arthritis

165
Q

What are the examination findings in DDH?

A

Leg length discrepancy
Reduced hip abduction due to hip contractures
Barlow’s sign positive (Adduction- subluxation/dislocation)
Ortolani’s sign positive- (clunk when femoral head relocated into acetabulum?

166
Q

What is the Ix of choice to diagnose DDH?

A

Ultrasound if age < 6 months
AP pelvic XR if > 6 months

167
Q

What is the mx of DDH?

A

Age < 6 months - Pavlik harness
Age 6-18 months - closed reduction with spica casting
Age > 18 months or failed treatment - open reduction and hip reconstrucion

168
Q

What are the clincial features of perthes?

A

Several weeks of limping
Hip pain (but may be painless)
Progressive hip stiffness
O/E: Antalgic gait, restricted ROM esp. abduction and internal rotation

169
Q

What are the clinical features of SUFE?

A

Pain in the hip or knee
Restricted ROM
Loss of Internal rotation and flexion

170
Q

What is JIA?

A

Joint swelling for more than 6 weeks in <16 years old with no defined cause

171
Q

What re the different types of JIA?

A

Periarticular (<4 joints affected)
RhF negative
RhF positive
Stills Disease (Systematic sx and ANA +ve)
Psoriatic
Enthetitis related
Undifferentiated

172
Q

What is the 1st line mx for peri articular JIA?

A

NSAIDs

173
Q

What is the 1st line mx for polyarthritis?

A

DMARDs (Methotrexate)

174
Q

List 2 complications of JIA?

A

Uveitis (ANA positive patients)
Joint contracture
Growth disturbances
Osteoporosis
Amyloidosis
Anaemia
Psychosocial impact

175
Q

What is the role of ACL?

A

Responsible for restraint vs anterior/forward movement of the tibia

176
Q

What is the mechanism of injury for an ACL injury?

A

A sudden deceleration or change in direction on a fixed foot - for example, netball

177
Q

What are the clinical features for an ACL injury?

A

Sudden painful Pop
Rapid swelling
Positive Lachman test
Anterior draw may be positive
Lateral knee tenderness

178
Q

What is the Ix of choice for an ACL injury?

A

MRI

179
Q

What is the role of the PCL?

A

Responsible for restraint vs backwards/posterior movement of the tibia

180
Q

What is the mechanism of injury of a ruptured PCL?

A

A high energy, direct blow to the proximal tibia, whilst the knee is inflexion (e.g. RTC or contact sport injury)

181
Q

What are the clinical features of a PCL injury?

A

Pain in the back of the knee
Positive posterior draw test
Posterior sag test may be positive
Mild knee effusion/swelling can be present

182
Q

What are the clinical features of a meniscal injury?

A

Knee pain - localised over the anteromedial or anterolateral joint line
Locking or clicking
Effusion, tenderness as above
McMurray test may be positive

183
Q

What is the Mechanism of injury of a MCL injury?

A

A direct blow to the LATERAL aspect of the knee - for example during contact sport

184
Q

What is the Mechanism of injury of a LCL injury?

A

A direct blow to the MEDIAL aspect of the knee - for example during contact sport

185
Q

What are the clinical features of a Quadriceps tendon rupture / Patellar tendon rupture?

A

Unable to perform straight leg raise
Unable to extend knee
Patella migration - away from the rupture

186
Q

What is OA?

A

Degeneration of the articular cartilage, and remodelling of bone

187
Q

Which joints in the hands are most affected by OA?

A

The Carpometacarpal Joints and DIPJs>PIPJs

188
Q

List the clinical features of OA?

A

Pain worse at the end of the day
Bony deformities (Hebden, Bouchard)
Sqauring of CMC
Wasting of thenar eminence
Joint tenderness and swelling
crepitus

189
Q

What are the xray findings in OA?

A

LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

190
Q

What is the 1st line of mx in OA?

A

Paracetamol + Topical NSAIDs

191
Q

What is Osteomalacia?

A

‘Softening’ of bones due to inadequate mineralisation
(Rickets in children)

192
Q

What is the most common cause of osteomalacia?

A

Vitamin D deficiency

193
Q

List the clinical features of osteomalacia?

A

Bone pain (esp, back, legs, pelvis)
Weakness
Fragility fractures

194
Q

What sx may be seen in Rickets?

A

Bone pain
Skeletal deformities in Rickets - knock knee, bow legs, scoliosis, thickening of ankles/wrists
Short height
Waddling gait

195
Q

What would be the results of a bone profile in osteomalacia?

A

LOW: calcium, phosphate
HIGH: PTH (compensatory), ALP
Low Vitamin D/ chronic kidney disease

196
Q

What is the mx of osteomalacia?

A

Treat underlying cause - most commonly replacement of vitamin d

197
Q

What is the mode of infection and spread in acute osteomyelitis in adults?

A

Usually contiguous spread

198
Q

What is the mode of infection and spread in acute osteomyelitis in children?

A

Typically haematogenous spread

199
Q

What the most common causative organism in acute osteomyelitis?

A

Staphylococcus aureus

200
Q

What the most common causative organism of acute osteomyelitis in sickle cell patients?

A

salmonella

201
Q

What is the 1st line ix for osteomyelitis?

A

Typically, X-ray- soft tissue swelling, periosteal reaction and cortical destruction

202
Q

What is the GS Ix for osteomyelitis?

A

MRI

203
Q

What is the mx of osteomyelitis?

A

Abx- Flucloxacillin, usually for a minimum of 6 weeks

204
Q

What is OA?

A

Complex skeletal disease characterised by low bone density and micro-architectural defects in bone tissue, resulting in increased bone fragility and susceptibility to fracture

205
Q

What bones do fragility fractures most affect?

A

Wrist
Spine
Hip

206
Q

What is a fragility fracture?

A

fractures occurring spontaneously (vertebral), following a fall from standing height or less or during a routine activity.

207
Q

List 5 RF for osteoporosisi?

A

hx fragility fracture,
falls,
hypogonadism,
premature menopause,
endocrine disorders,
malabsorptive disorders,
rheumatoid, myeloma, COPD/CLD/CKD.
Smoker,
alcohol > 14 units/wk,
low BMI

208
Q

Which hormones/electrolytes manage bone remodelling?

A

PTH, Calcitonin, vitamin D

209
Q

Where is calcitonin produced?

A

C cells of thyroid gland

210
Q

What score is indicative of osteopenia?

A

T Score - 1.0 - -2.5 = osteopenia

211
Q

What score is indicative of osteoporosis?

A

T score < -2.5 = osteoporosis

212
Q

What is the 1st line mx of osteoporosis?

A

oral bisphosphonates e.g. alendronate or risedronate

213
Q

List alternative tx of osteoporosis if 1st lien mx is not tolerated?

A

zoledronic acid, strontium ranelate, raloxifene,
denosumab, and teriparatide.

214
Q

What is the MOA of bisphosphonates?

A

Pyrophosphate analogues - inhibit osteoclastic bone resorption

215
Q

List the adverse effects of bisphosphonates?

A

gastritis/oesophagitis,
osteonecrosis of jaw,
atypical fractures

216
Q

What is the MOA of Desonumab?

A

monoclonal antibody which inhibits RANK-ligand - inhibits osteoclast development

217
Q

List the SE for desonumab?

A

Dyspnoea, Diarrhoea

218
Q

What is ontogenesis imperfecta?

A

An autosomal dominant disease characterised by low levels of type 1 collagen - ‘brittle bone disease’

219
Q

What are the nerve roots for the Musculocutaneous nerve and its sensation?

A

C5-C7
Lateral forearm

220
Q

What is the motor innervation of the Musculocutaneous nerve?

A

Biceps and brachialis- flexion and supination of elbow

221
Q

What would the clinical features be if there was a Musculocutaneous nerve radiculopathy?

A

Loss of elbow flexion, loss of biceps reflex

222
Q

What are the nerve roots for the axillary nerve and its sensation?

A

Nerve roots - C5/C6
Sensation - Regimental badge - lower deltoid

223
Q

What is the motor innervation of the axillary nerve?

A

Deltoid and teres minor - abduction, flexion and ER of the shoulder

224
Q

What can cause an axillary nerve palsy?

A

Anterior shoulder dislocation
Fracture of the neck of the humerus

225
Q

What are the features of an axillary nerve palsy?

A

Loss of shoulder abduction, regimental badge numbness
Radial nerve

226
Q

What are the nerve roots for the radial nerve and its sensation?

A

Nerve roots - C5-T1
Sensation - Posterior arm and forearm, lateral 2/3rd of dorsal hand and fingers

227
Q

What is the motor innervation of the radial nerve?

A

Triceps - elbow extension

228
Q

What can cause a radial nerve palsy?

A

Fracture of proximal humerus
Fracture of radius
Saturday night palsy - falling asleep with arm over back of chair

229
Q

What are the clinical features of a radial nerve palsy?

A

Loss of elbow extension, wrist extension, absent triceps reflex, loss of sensation over posterior forearm/arm

Wrist drop - cannot extend wrist/fingers → unopposed flexion

230
Q

What are the nerve roots for the median nerve and its sensation?

A

Nerve roots - C5-T1
Sensation - Hand - thenar eminence, lateral 2/3 palm and lateral 3.5 fingers

231
Q

What is the motor innervation of the median nerve?

A

anterior compartment of forearm - wrist flexion and abduction, pronation of forearm,

LLOAF muscles of hand

232
Q

What can cause a median nerve palsy?

A

Carpal tunnel syndrome
Supracondylar humeral fractures

233
Q

What are the clinical features of a median nerve palsy?

A

Hand of benediction, loss of sensation/motor as above

234
Q

What are the clinical features of an ulnar nerve palsy?

A

Numbness over the medial 1/3rd hand, fingers and hypothenar eminence.
Weakness in flexion and aDduction of wrist
Claw hand.

235
Q

What are the causes of ulnar nerve palsy?

A

Fractures of the medial epicondyle
Supracondylar humeral fractures
Cubital tunnel syndrome

236
Q

What is the motor function of the femoral nerve?

A

Muscles in the anterior thigh - knee extension and thigh flexion

237
Q

What is the sensory function of femoral nerve?

A

Anterior + medial thigh, medial leg and foot

238
Q

What is the motor function of obturator nerve?

A

Thigh aDduction

239
Q

What is the sensory function of the obturator nerve?

A

Medial thigh

240
Q

What is the most likely nerve to be affected in a hip fracture?

A

Femoral nerve

241
Q

What is the most likely nerve to be affected in an anterior hip dislocation?

A

Obturator nerve

242
Q

what is the motor function of the sciatic nerve?

A

Posterior compartment of thigh - knee flexion + all muscles of leg and foot

243
Q

what is the sensory function of the sciatic nerve?

A

Posterior thigh, lateral side of leg and sole and dorsum of foot

244
Q

What is the motor function of the superior gluteal nerve?

A

Gluteus medius and minimus - hip aBduction

245
Q

What is the sign present in a superior nerve palsy?

A

Positive trendelenburg sign - when standing on the affected leg/during walking the pelvis drops on the contralateral/swing side

246
Q

What nerve innervates the gluteus maximus?

A

Inferior gluteal nerve

247
Q

What is the motor function of the gluteus maximus?

A

hip extension/lateral rotation

248
Q

What is the 1st line mx of Raynauds?

A

calcium channel blockers (nifedipine)

249
Q

What is the 2nd line mx of raynauds?

A

IV Prostacyclin (epoprostenol infusions)

250
Q

What genetic allele is most associated with RA?

A

Associated with HLA-DR4

251
Q

Which joints are spared in RA?

A

Spares the DIP joints

252
Q

What is the mx of RA flares?

A

Short-term treatment with steroids

253
Q

What is the 1st lien mx of RA?

A

Commence DMARD monotherapy

254
Q

What are the adverse effects for methotrexate?

A

Myelosuppression - monitor FBC
Liver cirrhosis - monitor LFTs
Methotrexate pneumonitis, pulmonary fibrosis

255
Q

What are the adverse associated with sulfasalazine?

A

Oligospermia, interstitial lung disease, heinz body anaemia

256
Q

What are the adverse associated with Leflunomide?

A

Hypertension, liver impairment, interstitial lung disease

257
Q

What are the adverse associated with Hydroxychloroquine?

A

Ophthalmic disease- retinopathy, corneal deposits

258
Q

What is the mx of RA in pregnancy?

A

Safe DMARDs during pregnancy: Sulfasalazine, Hydroxychloroquine (SHafe in pregnancy)

AVOID Methotrexate & leflunomide

259
Q

What is palindromic rheumatism?

A

Relapsing/remitting monoarthritis of large joint

260
Q

What is the mx of palindromic rheumatism?

A

Management: DMARDs as above - hydroxychloroquine

261
Q

What markers may be raised in bloodworks of a patient with sarcoidosis?

A

Hypercalcaemia (overproduction of 1,25-(OH)2D3 by macrophages)
Raised ACE
Raised ESR

262
Q

What spirometry pattern is consistent with sarcoidosis?

A

Restrictive pattern - low FVC, high Fev1%

263
Q

List the muscles and their respective function of the rotator cuff?

A

Supraspinatus - 1st 15 degrees of shoulder ABduction

Infraspinatus - lateral rotation

Teres minor - ADduction and lateral rotation

Subscapularis - ADduction and medial rotation

264
Q

What is the mx of spinal mets?

A

Analgesia as per WHO 3-step ladder
Bisphosphonates
—For all patients with vertebral involvement from myeloma or breast cancer
—Consider in prostate cancer if other analgesia fails
Radiotherapy or surgery

265
Q

What are the clinical features and mechanism of injuryW of a mallet finger?

A

Extensor tendon avulsed from distal phalanx
Mechanism: ball striking tip of finger causing hyperextension

266
Q

What is the Ix and Mx of a mallet finger?

A

Investigation
XR to ensure no avulsion fracture

Management
Splint for 6 weeks

267
Q

What are the clinical features of flexor tenosynovitis?

A

Kanavel signs:
Uniform swelling
Pain palpation tendon
Pain passive flexion
Finger held in flexion

268
Q

What is the mx of flexor tenosynovitis?

A

If any Kanavel signs ——- > Urgent surgery to release pus
Antibiotics

269
Q

what is the mx of paronychia?

A

Warm compress
Topical (fusidic) systemic (flucloxacillin) antibiotics
If severe i.e. fluctuant pus or abscess- incision and drainage

270
Q

What are the complications associated with a scaphoid fracture?

A

Higher risk in proximal or displaced fractures
Non-union
Avascular necrosis
–Impairment of vascular supply to involved bone fragment
–Stiff and painful wrist
–Later on: loss of strength, reduced ROM wrist and osteoarthritis

271
Q

What is a colles fracture?

A

Distal radial fracture

Results in dorsal displacement of distal fragment
‘Dinner-fork’ deformity

272
Q

What is the mx of a colles fracture?

A

Immobilise in dorsal backslab cast and elevate with sling
Manipulation under anaesthetic (MUA) if above does not results in satisfactory position
If complex (comminuted, intra-articular, re-displaced) or above fails- surgical fixation

273
Q
A

Finals (HV) (15 decks)

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