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AMC Key > Ortho & Rheumatology > Flashcards

Ortho & Rheumatology Flashcards

1
Q

Fibromyalgia

A

4 body parts( 4 quadrants)
3 month’s SX with 11/18 tender points
Female4:1 onset : 29-37 ∆: 44-53yrs
A/W sleep, fatigue, cognitive
+/- depression
Rx: CBT
amitriptyline
Duloxetine

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2
Q

Red flags (not fibromyalgia)

A

Fever,night sweats
Wt loss
Older age onset
Neurological involved
Hx of malignancy

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3
Q

Trigger for fibromyalgia

A

Stress

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4
Q

Buerger Disease (TAO)

A

Non atherosclerotic,segmental occlusion of medium&small sized arteries
Male,smoker
Ischemia and gangrene due to thrombo occlusion of vessels of extremities
Amputation: prevent 2°infection and pain

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5
Q

Raynaud phenomenon

A

Episodic arteriolar vasospasm of the fingers and toes
Blue >red>pale colour changes
Trigger: cold,stress, anxiety
No amputation

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6
Q

One sided clavicular #

A

X-ray AP view of the side(R/L)
CT : if tracheal or thoracic involved
Or lat 3rd displaced with coracoclavicular ligament injury

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7
Q

Polymyalgia rheumatica

A

Symmetrical involvement of hip/shoulder girdle
Tenderness
Raised ESR, CRP, Normochromic anemia
CK : Normal
Rx : steroid !!!

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8
Q

Flexor tenosynovitis

A

Kanavel signs: 90%sensitive
By order
1. Pain on passive extension
2. Tender flexor tendon sheath
3. Fusiform swelling
4. Fixed flexion at resting position
Fever suggests systemic involved

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9
Q

Rheumatoid arthritis of large joint

A

Hx of morning stiffness
Tender, swelling noted
X-ray:
Joint space narrowing
Periarticular osteopenia
Soft tissue swelling
Joint margin erosion

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10
Q

X-ray changes in OA

A

Joint space narrowing
Subchondral sclerosis
Osteophytes

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11
Q

OA Vs RA

A

OA: aggravated by activity relieved by rest

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12
Q

Acute Back pain in a history of cancer

A

Red flag sign of metastatic bone involvement usually a pathological #

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13
Q

Other signs of metastatic bone

A

•H/o cancer
•Wt loss
•Acute back pain
•Nocturnal pain
•Age>50 or <20
•Pain not alleviated in 1mth

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14
Q

Q58 Ortho table

A

All the conditions with specific sx

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15
Q

Gouty arthritis

A

NSAID ( Naproxen & Indomethacin)
Colchicine 2nd line

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16
Q

Steroid use in gout

A

Oral or injection(preferred if only one joint involved) usually when 1st line contraindicated eg PUD/CKD; given for 10 days in tapering dose

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17
Q

Acute gout

A

1st line: NSAID if Contraindicated
Then colchicine if Contraindicated then steroid
Colchicine (gfr<30 : avoid , renal impaired: reduced dose)

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18
Q

Neonatal lupus erythematosus

A

Transplacental maternal autoantibodies
Causing cardiac,hepatic and skin problem
Cardiac : rhythm disorder eg block
Ix: Anti RO

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19
Q

SLE

A

4/11: SOAP BRAIN MD
1 clinical 1 lab 1 immunology
2or > joints involved
Hydoxychloroquine main long term
Cyclophosphamide for severe cases
Steroids for acute exacerbations

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20
Q

Low back pain (lumbar strain)
Rx option

A

Reassurance
Continue activity
Analgesia
R/v 4-6weeks time
W/out red 🛑flag signs

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21
Q

Cauda equina syndrome
Signs

A

Fecal incontinence
Urine retention
Saddle anaesthesia
LL weakness and paraesthesia

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22
Q

Low back pain with SLRT + but NO red flag sign 🛑

A

Conservative mngt
NSAID
Resume activity
Physiotherapy if severe and debilitating
R/v 4-6 weeks
No need imaging !!!

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23
Q

RA features q 47

A

Cardiac
Renal
Skin
Neuro
Lung
Hematology
Oral
GIT
*No hepatomegaly

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24
Q

Lateral epicondylitis

A

Caused by ECRB muscle
Brace, counterforce bracing treatment of choice

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25
Q

Olecranon bursitis

A

Swelling at posterior elbow
Idiopathic, painless ( aseptic)
Pain due to pressure applied/ need TRO septic bursitis (rare)

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26
Q

Red flag conditions for low back pain

A

Metastatic bone
Infection
Cauda equina syndrome
Vertebral #
Ankylosing spondylitis

27
Q

Ankylosing spondylitis low back features

A

Morning stiffness
Alternating buttocks pain
Younger age
Wakes up 2nd half of night pain
Pain improves with exercise

28
Q

Colles # most common complication

29
Q

Colles #
Earliest complication

A

Volkmann ischaemic contracture
=Due to compartmental syndrome
• permanent shortened muscles of forearm
•claw like deformity fingers,wrist, hand

30
Q

Colles #. RX

A

Reduction,casting from below wrist and forearm (thumb not covered)
Severe displacement=above elbow
Cast : 10°wrist flexed &10°ulnar deviation

31
Q

Scaphoid #
Initial mngt if x-ray normal

A

Thumb spica
Immobilisation 7-10 days( upto 14 days)
Repeat x-ray, still normal but symptoms+, MRI

32
Q

Anterior dislocation shoulder
CMR using meds

A

IV Midazolam
&
Intranasal fentanyl

33
Q

Common risk of nerve injury and muscle in anterior dislocation of shoulder

A

Axillary nerve: patch of hyposthesia
Deltoid: unable to abduct above head

34
Q

Most accurate test for GCA/polymyalgia rheumatica

A

Temporal artery biopsy
ESR: initial test, and as measuring index to start steroids

35
Q

Polymyalgia rheumatica sx& Rx

A

Symmetrical involvement joints
Stiffness
Systemic : fever/Wt loss/fatigue
Sensation of muscle weakness
Synovitis
+/- GCA, elderly women
ESR> 40mm !!!
Prednisolone: 10-20mg , >1 yr (upto 2-3yrs) ,higher dose if GCA

36
Q

Steroids Rx in PMR. Advise

A

Weight bearing exercises
Calcium
Vitamin D ( if needed)
Bisphosphonate
Periodically dexa scan

37
Q

Open #
Steps

A
  1. Clean the wound, photo and cover with sterile patch
  2. analgesic. for pain & reduction
  3. Reduce# by traction
  4. Antibiotics prophylaxis
  5. Tetanus prophylaxis
  6. x-ray
  7. Ot arrangements for surgical debridement
38
Q

Synovial fluid analysis
General

A

WCC=
Normal: <200
Inflammatory: 2000-50,000
Septic:> 50,000 ( but need workup above 5000)
Degenerative (OA): 200-2000

39
Q

Synovial detailed analysis
Q23 table

40
Q

Hip #

41
Q

Intracapsular # of femoral neck
(Garden classification)

A

Garden 1-2: Closed reduction,IF
Garden 3-4: hip arthroplasty (elderly), IF in younger age

42
Q

Ankylosing spondylitis Rx

A
  1. NSAID ( 2nsaid combo if needed)
  2. Add on simple analgesia/opioid
    3.if NSAID contraindicated , start with analgesia and
    4.infliximab, TNF for pain despite on maximum NSAID
43
Q

Axial Ankylosing spondylitis

A

Radiological findings i.e fuse of the vertebrae leads to stiffness of the spine.
TNF inhibitors best modalities.

44
Q

Severe Ankylosing spondylitis

A

NSAID maximum dosage, if doesn’t work change to other NSAID
Or
TNF inhibitors
Options of answers

45
Q

Dupuytren’s contracture

A

Painless, usually bilateral
Affect 4th and 5th digit
Palmar sheath thickening with nodule
USG : thickened palmar fascia and nodule
Intralesional steroid
AW DM: check GM

46
Q

Surgery for Dupuytren’s contracture

A

If flexion deformity >30° mcpj and pip >15°

47
Q

HLA-B27 Spondyloarthropathies

A
  1. Ankylosing spondylitis
  2. Reactive arthritis
  3. Psoriatic arthritis
  4. IBD
  5. Undifferentiated SPA
48
Q

Axial SPA
Vs peripheral SPA
RX

A

Common: NSAID maximum
Axial: next TNF inhibitors
Peripheral: methotrexate/sulfasalazine

49
Q

GCA with polymyalgia rheumatica

A

Elderly, new onset Headache + joint pain and stiffness+ fever combo patients
O/e : symmetrical joint tender, unilateral temporal scalp tenderness

50
Q

OA Rx

A
  1. Mild to Mod: regular PCM advised 4gm/day > prn basis
  2. Mod: not improving, inflammatory signs, NSAID
    NSAID : ✖️ PUD, ✖️ IHD
  3. Mod to severe: PCM + opiate ( codeine> tramadol)
51
Q

Dislocated joint with neurovascular compromise
Eg ankle dislocated, dpa not palpable

A

Reduction 1st with analgesia in ED
(morphine IV)

52
Q

Man with contracted finger
Alcoholic

A

Dupuytren’s contracture

53
Q

Important step to prevent infection & complications of open #/wound

A

Debridement

54
Q

Displaced/dislocated joint

A

First is to reduce irrespective of the vascular status, then wound care,abx,Tetanus,traction,call oT for WD ( in order)

55
Q

Stick aid for OA

A

Stick on good leg,1st step on bad leg

56
Q

Sjogren
Syndrome

A

•Lymphocytic infiltration if exocrine glands mainly salivary and lacrimal glands
•coexist with RA,SLE
•Female, 4-5th decade
CVS/RS/Git/Renal/Skin/CNS sx

57
Q

Lab Ix Sjogren

A

ESR CRP ANA RF : can be +

58
Q

Best ix Sjogren

A

Salivary gland biopsy

59
Q

1° vs 2° OA

A

1° : symmetrical, base of thumb,1st MTPJ, DIPJ fingers MC
2°: unilateral, mainly large joint i.e knee joint
•Worsened with activity, relieved by rest
•rx: PCM
NSAID only if inflammatory signs eg. Pain at rest, stiffness, nocturnal pain
*** immobilisation is never an option for Rx in OA !!!

60
Q

Atraumatic AVN of femoral neck

A

Elderly with sudden onset joint pain
Risk FX :1.Hx of long term steroid use
2.ch alcohol abuse
3.sickle cell disease
4.past hip #
Best initial: x-ray : uneven femoral head
Most accurate:MRI ( Geographic Subchondral bone)
USG: done TRO joint effusion seen in RA flare ups/septic arthritis

61
Q

Post op most important options

A

Analgesics
To prevent
1. Pressure sores
2. VTE
3. Pneumonia

62
Q

SPA

A

Enthesitis, or inflammation of the sites where the tendons or ligaments insert into the bone, is a key pathological finding in SpA

63
Q

Seronegative spondyloarthropathies

A

•As name implies results of iserology markers are NORMAL
•Inflammatory response ESR CRP may be elevated or normal

AMC Key (11 decks)

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