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Module 3 > Orthopaedics and Rheumatology > Flashcards

Orthopaedics and Rheumatology Flashcards

1
Q

What type of crystals accumulate in gout?

A

Uric acid crystals

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2
Q

What are the risk factors for gout?

A

High meat/seafood/alcohol intake, male, older-age, thiazide/loop diuretics, aspirin, G6PD deficiency

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3
Q

What is the management of recurrent gout?

A

Allopurinol - A xanthine oxidase inhibitor that reduces uric acid levels

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4
Q

What is the management of acute gout?

A

NSAIDs, COXi (if increased risk of GI bleeds), colchicine or corticosteroids.

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5
Q

What type of crystals accumulate in pseudo gout?

A

Calcium pyrophosphate

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6
Q

What antibodies are seen in rheumatoid arthritis?

A

Anti-cyclic citrullinated antibodies and rheumatoid factor

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7
Q

What is the management of rheumatoid arthritis?

A

DMARD (methotrexate), corticosteroid (prednisolone) and NSAID.

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8
Q

What common skin complaint is reported in juvenile RA?

A

Salmon coloured rash on trunk/proximal extremities

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9
Q

What are the 3 regions of the body affected in polymyalgia rheumatica?

A

Neck, shoulder and pelvis

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10
Q

What condition is often seen alongside polymyalgia rheumatica?

A

Giant cell arteritis

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11
Q

What is Sjogren’s Syndrome characterised by?

A

Xerostomia (reduced salivary gland secretions) and keratoconjunctivitis sicca (reduced lacrimal gland secretions)

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12
Q

What antibodies are seen in SLE?

A

Antinuclear antibodies (ANA) and antiphospholipid antibodies (increase risk of venous/arterial thrombosis)

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13
Q

What are the 3 skin complaints first seen in SLE?

A

Malar butterfly rash, photosensitive rash and discoid rash

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14
Q

What type of tissue does scleroderma affect?

A

Connective tissue - causes hardening/thickening of skin, internal organs and blood vessels

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15
Q

What size muscular artery does polyarteritis nodosa affect?

A

Medium-sized (kidneys, brain, heart)

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16
Q

What autoimmune disorder causes raised red plaques on knuckles as well as muscle aches?

A

Polyarteritis myositis

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17
Q

What are the two most common causative agent of cellulitis?

A

Streptococcous pyogenes and Staphylococcus aureus.

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18
Q

What are the main symptoms of septic arthritis?

A

Acute joint pain, fever, erythema/warmth/swelling

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19
Q

What bones does osteomyelitis tend to affect?

A

Long bones i.e. in the leg

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20
Q

What causes bone erosion in osteomyelitis?

A

The leukocytes secrete enzymes to destroy the pathogen, but in fact erode the bone

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21
Q

What is a risk factor for osteomyelitis in a diabetic person?

A

A diabetic ulcer

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22
Q

What infections does reactive arthritis succeed?

A

GI/GU infections

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23
Q

What is the most common cause of reactive arthritis?

A

Chlamydia

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24
Q

What are the triad symptoms of reactive arthritis?

A

Arthritis of large joints, conjunctivitis/uveitis, GU inflammatory conditions - balantitis, urethritis

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25
Q

What type of drug is given to a CKD patient suffering from gout?

A

Corticosteroid

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26
Q

What drug is given to patients with gout who are at a high risk of peptic ulcers/GI bleeding?

A

Colchicine

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27
Q

What causes compartment syndrome?

A

Increased interstitial pressure in a closed compartment - damages microvasculature and muscles.

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28
Q

What is the surgical management of compartment syndrome?

A

Fasciotomy

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29
Q

What condition is caused by compression of the nerve root bundle in the lumbar region of the spinal cord?

A

Cauda Equina Syndrome

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30
Q

What medical emergency causes bowel and urinary dysfunction alongside severe back pain?

A

Cauda Equina Syndrome

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31
Q

Who tends to be most at risk of adhesive capsulitis?

A

Females, aged 40-70 years

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32
Q

What is the rotator cuff?

A

Group of muscles and tendons responsible for shoulder stabilisation. Rotator cuff disorders cause tears in the muscles/tendons of the rotator cuff.

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33
Q

What condition can cause deltoid pain, which tends to radiate down into the forearm and worsens at night?

A

Rotator cuff disorders

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34
Q

What body part is affected in De Quervain’s tenosynovitis?

A

The thumb and its surrounding tendon sheath

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35
Q

What condition causes locking of the finger and a tender nodule formation at the metacarpal head?

A

Trigger finger

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36
Q

What are the risk factors for Dupuytren’s Contracture?

A

Male, European, middle-aged, alcohol, smoking, T2DM, family history

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37
Q

What are the risk factors for Carpal Tunnel Syndrome?

A

Female, 40-60 years, high BMI, previous wrist damage, diabetes, RA, pregnancy

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38
Q

What tendon is affected in lateral epicondylitis/tennis elbow?

A

Common extensor tendon

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39
Q

What condition can cause buttock pain and may show sacroiliitis on a pelvic x-ray?

A

Ankylosing Spondylitis

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40
Q

What conditions are associated with ankylosing spondylitis?

A

Iritis, uveitis, sacroiliitis

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41
Q

Back pain that worsens at night is a sign of what?

A

Compression fractures due to osteoporosis

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42
Q

Kyphosis presents with what type of deformity?

A

Hunchback

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43
Q

What common condition affecting the elderly causes kyphosis?

A

Osteoporosis - causes compression fractures resulting in a hunchback appearance.

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44
Q

What is the most common cause of spinal stenosis?

A

Older age - ligaments thicken, bone spurs bulge, degenerative disc disease.

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45
Q

Which knee injury presents with pain on going downhill?

A

Posterior cruciate ligament injury

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46
Q

What body part refers pain to the knee?

A

The hip

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47
Q

What investigation confirms muscle/tendon tears?

A

MRI

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48
Q

What type of cruciate ligament injury causes pain on flexion?

A

Anterior cruciate ligament

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49
Q

What knee injury presents with pain behind the patella that worsens on inclines/declines?

A

Patellofemoral pain syndrome

50
Q

What are the 5 Ottawa Ankle Rules?

A
  1. Pain in malleolar zone
  2. Pain in posterior edge/lateral malleolus (distal 6cm)
  3. Pain at base of fifth metatarsal
  4. Navicular pain
  5. Inability to bear weight
51
Q

A Hallux Valgus is a…

A

Bunion

52
Q

What are the risk factors for the development of Hallux Valgus?

A

Osteoarthritis, older age, family history, females

53
Q

Where are the interdigital nerve branches that are affected in Morton’s Neuroma?

A

Third inter metatarsal space

54
Q

What are the risk factors for Morton’s Neuroma?

A

Female, middle-aged, high heels, high-impact sport

55
Q

The sensation of a small stone underfoot is a sign of what condition?

A

Morton’s Neuroma

56
Q

What adulthood condition can cause flat feet?

A

Osteoarthritis

57
Q

A child with knock knees will present with

A

Knees and ankles not being able to touch

58
Q

A child with bow legs will present with

A

Knees being unable to touch (ankles able)

59
Q

Knock knees is associated with what vitamin/mineral deficiency?

A

Vitamin C/D and calcium deficiency

60
Q

What conditions can cause Bow Legs?

A

Blount’s disease, Rickets, dwarfism

61
Q

What causative agent commonly causes septic hip?

A

Staph aureus

62
Q

What haematological disorder increases the risk of septic hip?

A

SCD

63
Q

What is a lifestyle-related risk factor for slipped upper femoral epiphysis?

A

Obesity

64
Q

What is a common complication of a bone cyst?

A

Fracture

65
Q

What are the signs/symptoms of osteosarcoma?

A

Worsening pain, worse at night, pain just below the knee, mass/swelling, limp

66
Q

What is the term given to a fracture at the 5th metacarpal base?

A

Boxer’s Fracture

67
Q

What fracture occurs after falling onto an outstretched hand?

A

Colle’s fracture

68
Q

What fracture occurs after falling onto a flexed hand?

A

Smith’s fracture

69
Q

Who commonly experiences Greenstick fractures?

A

Children

70
Q

What is the most common pelvic fracture in elderly people?

A

Inferior and superior pubic rami fracture

71
Q

What nodes are seen on the middle fingers in OA?

A

Bouchard’s nodes

72
Q

What nodes are seen on the distal fingers in OA?

A

Heberden’s nodes

73
Q

What are the adverse effects of NSAIDs?

A

Increased MI/stroke risk, GI toxicity (ulcers, bleeding) and renal toxicity

74
Q

Who should avoid NSAIDs?

A

Those with severe renal impairment, heart failure, liver failure. Low doses for people with peptic ulcers, GI bleeding, CVD/renal impairment.

75
Q

NSAIDs reduce the effectiveness of what type of drugs?

A

Anti-hypertensives

76
Q

What are the common dermatological side effects of steroids?

A

Striae, skin thinning, acne

77
Q

What is the risk of suddenly stopping steroid treatment?

A

Adrenal crisis

78
Q

What supplement must be taken alongside (on a different day) to methotrexate?

A

Folic acid

79
Q

What is the function of bisphosphonates?

A

Prevent/slow loss of bone mass in osteoporosis.

80
Q

What type of drug is alendronic acid?

A

Bisphosphonate

81
Q

Bisphosphonates should be avoided in people with..

A

Upper GI disease/bleeding/oesophageal disorders

82
Q

What are risk factors for avascular necrosis?

A

High cholesterol, alcohol, smoking, steroid treatment (prednisolone), chemotherapy.

83
Q

What are the risk factors for osteoporosis?

A

Female, low BMI, older age, steroid therapy (prednisolone), smoking.

84
Q

Osteomalacia causes

A

Softening of bones

85
Q

Paget’s Disease is caused by

A

Increased bone remodelling/growth. This increases the risk of bony deformities, fractures, bone/back pain.

86
Q

Renal osteodystrophy is secondary to

A

CKD

87
Q

Septic arthritis is most commonly caused by 3 bacteria?

A
  1. Staph aureus
  2. Strep
  3. Disseminated gonococcal infection
88
Q

5 RF for septic arthritis

A
  1. Age
  2. PMH of arthritis (OA/RA)
  3. Recent joint surgery
  4. Immunocompromised
  5. IV drug user
89
Q

What differentiates cellulitis from septic arthritis?

A

In septic arthritis, the pain/swelling/erythema/warmth is localised to the joint

90
Q

Most common cause of osteomyelitis

A

Staph aureus

91
Q

5 RF for osteomyelitis

A
  1. Open fracture
  2. Recent orthopaedic surgery
  3. Immunocompromised
  4. IV drug use
  5. Artificial joints/screws
92
Q

Investigations for Reiter’s/Reactive arthritis

A

Bloods: Raised ESR and CRP
STI screening (GU)
Stool cultures (GI)
Antibody testing for RA

93
Q

3 non-surgical causes of compartment syndrome

A
  1. Burns
  2. Crush injuries (i.e. in a car crash)
  3. Infection
94
Q

What renal complication arises following compartment syndrome?

A

AKI - requiring dialysis

95
Q

An absent Achilles tendon reflex with sciatica back pain could be a sign of

A

Cauda Equina Syndrome

96
Q

Adhesive capsulitis is commonly known as

A

Frozen shoulder

97
Q

Pain in the wrist when writing/moving could be a sign of

A

De Quervain’s tenosynovitis

98
Q

Locking of the fingers and a painful popping could be a sign of

A

Trigger finger

99
Q

Tennis elbow is also known as

A

Lateral epicondylitis

100
Q

Tennis elbow affects which tendon?

A

Common extensor tendon

101
Q

Golfer’s elbow is also known as

A

Medial epicondylitis

102
Q

Back pain that worsens at rest is a sign of

A

AS, osteomyelitis

103
Q

Back pain that worsens after exercise is a sign of

A

Spinal stenosis

104
Q

Back pain after straining is a sign of

A

Degenerative disc disease

105
Q

5 red flags of back pain

A
  1. < 20 y/o or > 55 y/o
  2. Acute onset in elderly
  3. Constant/progressive pain
  4. Nocturnal pain
  5. Fever/night sweats/weight loss/neurological dysfunction
106
Q

Common genotype seen in AS?

A

HLA-B27 +

107
Q

5 Ottawa knee rules

A
  1. > 55 y/o
  2. Fibula head tenderness
  3. Isolated patella tenderness
  4. Inability to flex knee > 90 degrees
  5. Inability to bear weight
108
Q

Where does Morton’s neuroma commonly affect?

A

Third intermetatarsal space

109
Q

Management for a clavicle fracture not affecting the medial third

A

Broad arm sling

110
Q

Management for a clavicle fracture affecting the medial third

A

Surgery

111
Q

High risk complication of scaphoid fracture

A

Avascular necrosis

112
Q

Boxer’s fracture affects the

A

5th metacarpal base

113
Q

Management for Boxer’s fracture

A

Immobilisation and internal fixation with K wires

114
Q

Colle’s fracture is caused by a fall on a what hand?

A

Outstretched

115
Q

Colle’s fracture affects the

A

Radius

116
Q

Management for a Colle’s fracture

A

Closed reduction and immobilisation

117
Q

A Smith’s fracture is caused by a fall on what hand?

A

Flexed

118
Q

A Smith’s fracture affects

A

Distal radius

119
Q

Management for a Smith’s fracture

A

Casting and/or surgery

120
Q

A Greenstick fracture typically affects the what bones in what age group?

A

Long bones, children

121
Q

Supracondylar fracture can damage what 2 nerves

A

Medial and ulna nerves

Module 3 (6 decks)

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