Orthopaedics and Rheumatology Flashcards
Urethritis, conjunctivitis, arthritis
Associated lesions include circinate balanitis
Keratoderma blenorrhagica
Mouth ulcers
Previous STI or gastroenteritis
Reiter’s syndrome
Young male, buttock/sacroiliac pain worse in morning, relieved by exercise Syndesmophytes, ‘bamboo spine’ on X-ray
Associations include 4 As: arthritis, anterior uveitis, apical lung fibrosis, aortic regurgitation
Ankylosing spondylitis
Nail dystrophy, ‘pitting’
Joints show central erosion on X-ray
Can be highly deforming (arthritis mutilans)
Psoriatic arthritis
Arthritis in UC/Crohn’s patient
Asymmetrical, mainly affects lower limbs
Enteropathic arthropathy
Dry eyes, dry mouth
Positive Schirmer’s test
Sjögren’s syndrome
Proximal muscle weakness, pain and tenderness
Increased serum CK
Polymyositis
Proximal muscle weakness, pain and tenderness
Increased serum CK
Heliotrope (purple) rash
Dermatomyositis
More common in Turkish, Iranian patients
Orogenital ulceration, uveitis, arthritis
Pathergy reaction is pathognomonic
Behçet’s disease
Usually woman
Persistently cold, cyanosed fingers
Raynaud’s phenomenon
Calcinosis (nodules)
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
CREST
Systemic sclerosis
Usually elderly patient with headache
Scalp tenderness
Jaw claudication
Sudden unilateral blindness can occur
Associated with polymyalgia rheumatica
Temporal/giant cell arteritis
Granulomas in respiratory tract
Generalised vasculitis
cANCA, anti-PR3 positive
Wegener’s granulomatosis
Usually child (particularly under age 5)
Purpuric rash over buttocks, extensor surfaces
Associated with arthritis, abdominal pain and nephritis
Henoch-Schönlein purpura
Usually middle-aged male
Asthma, rhinitis and systemic vasculitis
+++ eosinophilia
Churg-Strauss syndrome
Usually under 5 years
Main features are:
- protracted fever
- acute cervical lymphadenopathy
- bilateral non-purulent conjunctivitis
- dry, cracked, fissured lips
- redness, oedema of palms and soles
Platelets and CRP usually elevated
Kawasaki’s disease
Anti double-stranded DNA
SLE
Anti-Jo-1 antibodies
Polymyositis
Anti-centromere
Limited systemic sclerosis
Anti-topoisomerase
Diffuse systemic slcerosis
cANCA, anti-PR3
Wegener’s granulomatosis
α-endomysial antibody
Coeliac disease
Anti-cyclic citrullinated peptide antibody
Rheumatoid arthritis
Radiological findings
- Loss of joint space
- Subchondral sclerosis
- Subchondral cysts
- Osteophytes
Osteoarthritis
Radiological findings
- Loss of joint space
- Juxta-articular osteoporosis
- Erosions
- Subluxation joints
Rheumatoid arthritis
Radiological findings
- Localised enlargement of bone with deformity (e.g. enlarged skull, bowed tibia)
Paget’s disease
Radiological findings
- Syndesmophytes
- ‘Bamboo-spine’ appearance
Ankylosing spondylitis
‘Sunray’ spiculation
Osteosarcoma
‘Onion-peel sign’
Ewing’s sarcoma
Thickening, fibrosis palmar fascia
Dupuytren’s contracture
Forced adduction and flexion thumb elicits pain on radial side wrist
De Quervain’s syndrome
Failure to abduct shoulder after dislocation
Axillary nerve injury
Painful shoulder following seizure
Posterior dislocation shoulder
‘Dinner fork’ deformity
Colles’ fracture
Flexed, adducted and externally rotated leg
Femoral shaft fracture
Locked knee, positive McMurray’s test
Meniscal tear
Drop foot after hip replacement
Sciatic nerve injury
Drop foot after knee injury
Common peroneal nerve injury
Excessive anterior glide tibia on femur
Anterior cruciate ligament injury
Excessive posterior glide tibia on femur
Posterior cruciate ligament injury
Prominent tender tibial tubercle
Osgood-Schlatter disease
Monosodium urate crystals with strong negative birefringence
Gout
Calcium pyrophosphate dehydrate crystals with weakly positive birefringence
Pseudogout
30-year-old woman complains of joint pain in her hands and feet. Her chest x-ray shows reduced lung volumes.
SLE
12-year-old boy presents with pain in his right hip. On examination, the hip is flexed, abducted and externally rotated.
Slipped femoral epiphysis
6-year-old boy presents with pain in the hip and a limp. All movements at the hip are limited. His x-ray shows decrease in size of the nuclear femoral head with patchy density.
Perthes’ disease
Hip is adducted, externally rotated and shortened
Fractured neck of femur
Constant backache
ESR and serum calcium are markedly elevated
Myeloma
Females during puberty
Wedge-shaped vertebral bodies
Kyphosis
Abnormal ossification of ring epiphyses of thoracic vertebrae
Scheuermann’s disease
Recurrent attacks of pain and swelling in the nose and external ear
Features can include vasculitis and seronegative arthritis
Polychondritis
Pain, swelling, oedema, change in skin temperature, altered sweating
Complex regional pain syndrome / Sudeck’s atrophy
Pleuritic chest pain after orthopaedic/pelvic surgery
Pulmonary embolus
Absence of callus at the fracture site
Delayed union
Weakness of wrist extensors
Radial nerve injury
Used in infants for femoral fractures
Gallows traction
Pain and swelling at the anatomical snuffbox after injury to the arm/hand suggests fracture of the…
scaphoid
68-year-old woman presents with:
Fracture at the distal radial head with dorsal displacement of distal fragment after a fall
Colles’ fracture
More common in children after a fall on the outstretched hand
May present with swollen painful elbow
Supracondylar fracture
Loss of shoulder contour
Absent sensation on a patch below the shoulder, due to axillary nerve damage
Anterior dislocation shoulder
Wrist drop (radial nerve injury) due to fracture of the…
humeral shaft
Shoulder pain aggravated in abduction of the arm between 60 and 120o
Impingement syndrome
Aching shoulder; flexing the elbow reveals a prominent lump in the upper arm
This injury occurs after lifting/pulling activity
Ruptured long head of biceps
9-month history of stiffness in shoulder
Shoulder was originally extremely painful but now only the stiffness remains
Adhesive capsulitis
(‘frozen shoulder’)
14-year-old girl successful treated for rickets shows bow-legged deformity
Genu varum
Condition in which the knees angle in and touch one another when the legs are straightened
Genu valgum
50-year-old carpet layer presents with a swelling directly over the patella
Joint is normal
Pre-patellar bursitis
Benign swelling of the semimembranosus or more rarely some other synovial bursa found behind the knee joint
Baker’s cyst
Presents with lower back pain and stiffness that was worse in the morning
Question-mark posture
Ankylosing spondylitis
Used for prophylaxis of gout
Allopurinol
(xanthine oxidase inhibitor)
Gross irreversible retinopathy due to what drug?
Hydroxychloroquine
Oligospermia in a patient on DMARD treatment - what is the drug?
Sulfasalazine
Patient on long-term DMARD treatment shows pulmonary and hepatic fibrosis - what is the drug?
Methotrexate
Afro-Carribean woman
Progessive SoB and fever
Hands have been painful and stiff
Mouth ulcers
Bilateral pleural effusions
Raised ESR, normal CRP
SLE
An elderly patient with bone pain has the following blood result:
- Normal serum calcium
- Normal serum phosphate
- Raised serum alkaline phosphatase
Paget’s disease
What drug can be used in Raynaud’s syndrome?
Nifedipine
(calcium channel blocker)
Splenomegaly and neutropenia in a patient with rheumatoid arthritis
Felty’s syndrome
Most appropriate treatment for acute episodes of gout is…
NSAIDs
