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PACES final > Musculoskeletal station > Flashcards

Musculoskeletal station Flashcards

1
Q

back pain red flags

A

Age < 20, Age >55, Sphincter disturbance, Infection, Malignancy, Stiffness morning, Neurological disturbance, FLAWS

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2
Q

rheumatoid arthritis signs

A

MCP swelling, swan neck deformity = flexed DIP, boutonniere = extended DIP, Z-thumb deformity, ulnar deviation, MCP subluxation, nodules on elbows, reduced function

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3
Q

rheumatoid additional signs

A

No nail changes. If nail changes = psoriatic
Scar = carpel tunnel syndrome
Cushingoid appearance = steroids

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4
Q

Features of RA

A

Improves with use
Bilateral
Systemic symptoms XRAY - LESS

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5
Q

rheumatoid extra–articular manifestations

A

Pulmonary = effusions, fibrosis, bronchiectasis
Eyes = sjogren’s, scleritis
Haem = anaemia, felty’s syndrome
Neurological = carpal tunnel, atlanto-axial subluxation
Other = amyloidosis, nephrotic syndrome, pericarditis

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6
Q

rheumatoid arthritis investigations

A

RF = 80% sensitive
Anti-CCP

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7
Q

management of rheumatoid arthritis

A

NSAIDs for symptoms
Steroids for flare ups
DMARDS = methotrexate, Sulfasalazine, hydroxychloroquine
Biologicals - Anti-TNFs = interferon gamma test + CXR first

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8
Q

rheumatoid arthritis xray changes

A

Loss of joint space Erosions periarticular Soft tissue swelling Subluxation + deformity

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9
Q

OA signs

A

Bony swelling, heberdon’s nodes, bouchard’s nodes (before = proximal), fixed flexion deformity in the knee following knee replacement, midline knee scar, unable to fully extend, weight bearing joints more likely affected

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10
Q

Features of OA

A

Pain following use
Improves with rest
Unilateral

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11
Q

OA management

A

Conservative = Weight loss and exercise
Medical = Analgesia = NSAID’s + PPI, Intra-articular steroids
Surgical = Total joint replacement

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12
Q

xray changes in OA

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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13
Q

Psoriatic arthritis signs

A

Rash, arthritis, nail pitting, extensor plaques with scales, nail onycholysis, hyperkeratosis, psoriatic arthritis mutilans

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14
Q

Psoriatic arthritis diagnostic criteria

A

CASPAR criteria
= skin psoriasis, nail changes, dactylitis, negative rheumatoid factor, new bone formation on xray

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15
Q

Psoriatic arthritis nail signs

A

Pitting
Onycholysis
Subungual hyperkeratosis
Ridging

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16
Q

Psoriatic arthritis management

A

Conservative = stop precipitants e.g. smoking, beta blockers, stress, alcohol
Medical = calcipotriol + steroids + tar
Surgical = UV light

17
Q

Gout investigations

A

Polarised light microscopy = negatively birefringent needle shaped crystals
Serum urate = can be normal
Monosodium urate crystals

18
Q

Gout treatment

A

1st = Colchicine, NSAIDs
PO steroids if renal impairment
Chronic prevent = WL, EToh, allopurinol

19
Q

pseudogout investifations

A

Polarised light microscopy = positive birefringent rhomboid shaped crystals

20
Q

pseudogout treatment

A

Analgesia
NSAIDS

Steroids

21
Q

Ankylosing spondylitis features

A

Back pain
Relieved by exercise
Costochondritis
SOB

22
Q

Ankylosing spondylitis investigations

A

Schober’s test
<5cm increase = positive
Xray spine

23
Q

Ankylosing spondylitis treatment

A

Conservative = Exercise/ physio
Medical = NSAID
Surgical = hip replacement

24
Q

Reactive arthritis

A

Sterile arthritis after 1-4 weeks after urethritis or dysentery (Chlamydia
Campylobacter)

NSAID’s
PO steroids
Sulfasalazine

25
Q

PMR signs and treatment

A

Pain/stiff
Shoulder neck and hips Raised ESR, CRP, ALP
15mg PO prednisolone

26
Q

CXR presentation

A

This film is a PA/AP chest x-ray of X, born on the Y. This was taken on the Z date for W reason at S hospital.
The film is not rotated and there is adequate inspiration. There is also adequate penetration and exposure of the film.
The main abnormality in the film is…
The trachea is central and non-deviated.
Both lung fields are clear in all zones, there are no obvious well-defined lesions or areas of patchy/nodular consolidation. Lung markings are visible throughout the lung field.
The heart is normal size/cannot comment on it. There is no mediastinal enlargement or syins of lymphadenopathy.
The diaphragm is normal/flattened/raised. The costrodiaphagmantic and cardiodiaphragmatic angles are visible/blunted.
There are not obvious soft tissue abnormalities. The gastric bubble is present.
There are no obvious fractures, and there are midline sternotomy pins visible which may indicate a cardiac surgery.
There is a NG tube/ECG leads/monitoring attached to the patient.
In conclusion this was abnormal chest x-ray with main findings…
My top differential is…

27
Q

shoulder movements

A

Ad/bduction: 180 degrees
Flexion: 180
Extension: 60
External rotation: 90
Internal rotation: 90
Painful arc
 60-120 degrees = impingment or rotator
cuff tendonitis
 140-180 = ACJ OA
Movements in Abduction
 0-30: supraspinatus only
 30-90: deltoid
 90-180: scapulothoracic movement

28
Q

knee movements

A

Flexion: up to 140
Extension: at 0 degrees, shouldn’t go more than -5
degrees

29
Q

Fixed flexion deformity causes

A

OA and NOF fracture

30
Q

Hip movements

A

Flexion: 120
Extension: 20
Abduction: 45
Adduction: 30
Internal rotation: 30
External rotation: 45

31
Q

what is Schober’s test

A

a line is drawn 10 cm above and 5 cm below the back
dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm
when the patient bends as far forward as possible

32
Q

4 major stabilising ligaments of the knee?

A

ACL, PCL, MCL & LCL

33
Q

What intra-articular structure is commonly damaged
with an ACL tear?

A

The lateral meniscus

34
Q

Are ACL injuries more common in men or women?

A

Women

35
Q

2 grafts commonly used in ACL reconstruction

A

Quadriceps tendon, Hamstring tendons

36
Q

give some complications of ACL reconstruction?

A

Graft failure, Septic arthritis, Fibrosis of the joint,
Saphenous nerve irritation, Complex Regional Pain
Syndrome

PACES final (12 decks)

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