Orthopaedics and Rheumatology Flashcards
What type of crystals accumulate in gout?
Uric acid crystals
What are the risk factors for gout?
High meat/seafood/alcohol intake, male, older-age, thiazide/loop diuretics, aspirin, G6PD deficiency
What is the management of recurrent gout?
Allopurinol - A xanthine oxidase inhibitor that reduces uric acid levels
What is the management of acute gout?
NSAIDs, COXi (if increased risk of GI bleeds), colchicine or corticosteroids.
What type of crystals accumulate in pseudo gout?
Calcium pyrophosphate
What antibodies are seen in rheumatoid arthritis?
Anti-cyclic citrullinated antibodies and rheumatoid factor
What is the management of rheumatoid arthritis?
DMARD (methotrexate), corticosteroid (prednisolone) and NSAID.
What common skin complaint is reported in juvenile RA?
Salmon coloured rash on trunk/proximal extremities
What are the 3 regions of the body affected in polymyalgia rheumatica?
Neck, shoulder and pelvis
What condition is often seen alongside polymyalgia rheumatica?
Giant cell arteritis
What is Sjogren’s Syndrome characterised by?
Xerostomia (reduced salivary gland secretions) and keratoconjunctivitis sicca (reduced lacrimal gland secretions)
What antibodies are seen in SLE?
Antinuclear antibodies (ANA) and antiphospholipid antibodies (increase risk of venous/arterial thrombosis)
What are the 3 skin complaints first seen in SLE?
Malar butterfly rash, photosensitive rash and discoid rash
What type of tissue does scleroderma affect?
Connective tissue - causes hardening/thickening of skin, internal organs and blood vessels
What size muscular artery does polyarteritis nodosa affect?
Medium-sized (kidneys, brain, heart)
What autoimmune disorder causes raised red plaques on knuckles as well as muscle aches?
Polyarteritis myositis
What are the two most common causative agent of cellulitis?
Streptococcous pyogenes and Staphylococcus aureus.
What are the main symptoms of septic arthritis?
Acute joint pain, fever, erythema/warmth/swelling
What bones does osteomyelitis tend to affect?
Long bones i.e. in the leg
What causes bone erosion in osteomyelitis?
The leukocytes secrete enzymes to destroy the pathogen, but in fact erode the bone
What is a risk factor for osteomyelitis in a diabetic person?
A diabetic ulcer
What infections does reactive arthritis succeed?
GI/GU infections
What is the most common cause of reactive arthritis?
Chlamydia
What are the triad symptoms of reactive arthritis?
Arthritis of large joints, conjunctivitis/uveitis, GU inflammatory conditions - balantitis, urethritis
What type of drug is given to a CKD patient suffering from gout?
Corticosteroid
What drug is given to patients with gout who are at a high risk of peptic ulcers/GI bleeding?
Colchicine
What causes compartment syndrome?
Increased interstitial pressure in a closed compartment - damages microvasculature and muscles.
What is the surgical management of compartment syndrome?
Fasciotomy
What condition is caused by compression of the nerve root bundle in the lumbar region of the spinal cord?
Cauda Equina Syndrome
What medical emergency causes bowel and urinary dysfunction alongside severe back pain?
Cauda Equina Syndrome
Who tends to be most at risk of adhesive capsulitis?
Females, aged 40-70 years
What is the rotator cuff?
Group of muscles and tendons responsible for shoulder stabilisation. Rotator cuff disorders cause tears in the muscles/tendons of the rotator cuff.
What condition can cause deltoid pain, which tends to radiate down into the forearm and worsens at night?
Rotator cuff disorders
What body part is affected in De Quervain’s tenosynovitis?
The thumb and its surrounding tendon sheath
What condition causes locking of the finger and a tender nodule formation at the metacarpal head?
Trigger finger
What are the risk factors for Dupuytren’s Contracture?
Male, European, middle-aged, alcohol, smoking, T2DM, family history
What are the risk factors for Carpal Tunnel Syndrome?
Female, 40-60 years, high BMI, previous wrist damage, diabetes, RA, pregnancy
What tendon is affected in lateral epicondylitis/tennis elbow?
Common extensor tendon
What condition can cause buttock pain and may show sacroiliitis on a pelvic x-ray?
Ankylosing Spondylitis
What conditions are associated with ankylosing spondylitis?
Iritis, uveitis, sacroiliitis
Back pain that worsens at night is a sign of what?
Compression fractures due to osteoporosis
Kyphosis presents with what type of deformity?
Hunchback
What common condition affecting the elderly causes kyphosis?
Osteoporosis - causes compression fractures resulting in a hunchback appearance.
What is the most common cause of spinal stenosis?
Older age - ligaments thicken, bone spurs bulge, degenerative disc disease.
Which knee injury presents with pain on going downhill?
Posterior cruciate ligament injury
What body part refers pain to the knee?
The hip
What investigation confirms muscle/tendon tears?
MRI
What type of cruciate ligament injury causes pain on flexion?
Anterior cruciate ligament
What knee injury presents with pain behind the patella that worsens on inclines/declines?
Patellofemoral pain syndrome
What are the 5 Ottawa Ankle Rules?
- Pain in malleolar zone
- Pain in posterior edge/lateral malleolus (distal 6cm)
- Pain at base of fifth metatarsal
- Navicular pain
- Inability to bear weight
A Hallux Valgus is a…
Bunion
What are the risk factors for the development of Hallux Valgus?
Osteoarthritis, older age, family history, females
Where are the interdigital nerve branches that are affected in Morton’s Neuroma?
Third inter metatarsal space
What are the risk factors for Morton’s Neuroma?
Female, middle-aged, high heels, high-impact sport
The sensation of a small stone underfoot is a sign of what condition?
Morton’s Neuroma
What adulthood condition can cause flat feet?
Osteoarthritis
A child with knock knees will present with
Knees and ankles not being able to touch
A child with bow legs will present with
Knees being unable to touch (ankles able)
Knock knees is associated with what vitamin/mineral deficiency?
Vitamin C/D and calcium deficiency
What conditions can cause Bow Legs?
Blount’s disease, Rickets, dwarfism
What causative agent commonly causes septic hip?
Staph aureus
What haematological disorder increases the risk of septic hip?
SCD
What is a lifestyle-related risk factor for slipped upper femoral epiphysis?
Obesity
What is a common complication of a bone cyst?
Fracture
What are the signs/symptoms of osteosarcoma?
Worsening pain, worse at night, pain just below the knee, mass/swelling, limp
What is the term given to a fracture at the 5th metacarpal base?
Boxer’s Fracture
What fracture occurs after falling onto an outstretched hand?
Colle’s fracture
What fracture occurs after falling onto a flexed hand?
Smith’s fracture
Who commonly experiences Greenstick fractures?
Children
What is the most common pelvic fracture in elderly people?
Inferior and superior pubic rami fracture
What nodes are seen on the middle fingers in OA?
Bouchard’s nodes
What nodes are seen on the distal fingers in OA?
Heberden’s nodes
What are the adverse effects of NSAIDs?
Increased MI/stroke risk, GI toxicity (ulcers, bleeding) and renal toxicity
Who should avoid NSAIDs?
Those with severe renal impairment, heart failure, liver failure. Low doses for people with peptic ulcers, GI bleeding, CVD/renal impairment.
NSAIDs reduce the effectiveness of what type of drugs?
Anti-hypertensives
What are the common dermatological side effects of steroids?
Striae, skin thinning, acne
What is the risk of suddenly stopping steroid treatment?
Adrenal crisis
What supplement must be taken alongside (on a different day) to methotrexate?
Folic acid
What is the function of bisphosphonates?
Prevent/slow loss of bone mass in osteoporosis.
What type of drug is alendronic acid?
Bisphosphonate
Bisphosphonates should be avoided in people with..
Upper GI disease/bleeding/oesophageal disorders
What are risk factors for avascular necrosis?
High cholesterol, alcohol, smoking, steroid treatment (prednisolone), chemotherapy.
What are the risk factors for osteoporosis?
Female, low BMI, older age, steroid therapy (prednisolone), smoking.
Osteomalacia causes
Softening of bones
Paget’s Disease is caused by
Increased bone remodelling/growth. This increases the risk of bony deformities, fractures, bone/back pain.
Renal osteodystrophy is secondary to
CKD
Septic arthritis is most commonly caused by 3 bacteria?
- Staph aureus
- Strep
- Disseminated gonococcal infection
5 RF for septic arthritis
- Age
- PMH of arthritis (OA/RA)
- Recent joint surgery
- Immunocompromised
- IV drug user
What differentiates cellulitis from septic arthritis?
In septic arthritis, the pain/swelling/erythema/warmth is localised to the joint
Most common cause of osteomyelitis
Staph aureus
5 RF for osteomyelitis
- Open fracture
- Recent orthopaedic surgery
- Immunocompromised
- IV drug use
- Artificial joints/screws
Investigations for Reiter’s/Reactive arthritis
Bloods: Raised ESR and CRP
STI screening (GU)
Stool cultures (GI)
Antibody testing for RA
3 non-surgical causes of compartment syndrome
- Burns
- Crush injuries (i.e. in a car crash)
- Infection
What renal complication arises following compartment syndrome?
AKI - requiring dialysis
An absent Achilles tendon reflex with sciatica back pain could be a sign of
Cauda Equina Syndrome
Adhesive capsulitis is commonly known as
Frozen shoulder
Pain in the wrist when writing/moving could be a sign of
De Quervain’s tenosynovitis
Locking of the fingers and a painful popping could be a sign of
Trigger finger
Tennis elbow is also known as
Lateral epicondylitis
Tennis elbow affects which tendon?
Common extensor tendon
Golfer’s elbow is also known as
Medial epicondylitis
Back pain that worsens at rest is a sign of
AS, osteomyelitis
Back pain that worsens after exercise is a sign of
Spinal stenosis
Back pain after straining is a sign of
Degenerative disc disease
5 red flags of back pain
- < 20 y/o or > 55 y/o
- Acute onset in elderly
- Constant/progressive pain
- Nocturnal pain
- Fever/night sweats/weight loss/neurological dysfunction
Common genotype seen in AS?
HLA-B27 +
5 Ottawa knee rules
- > 55 y/o
- Fibula head tenderness
- Isolated patella tenderness
- Inability to flex knee > 90 degrees
- Inability to bear weight
Where does Morton’s neuroma commonly affect?
Third intermetatarsal space
Management for a clavicle fracture not affecting the medial third
Broad arm sling
Management for a clavicle fracture affecting the medial third
Surgery
High risk complication of scaphoid fracture
Avascular necrosis
Boxer’s fracture affects the
5th metacarpal base
Management for Boxer’s fracture
Immobilisation and internal fixation with K wires
Colle’s fracture is caused by a fall on a what hand?
Outstretched
Colle’s fracture affects the
Radius
Management for a Colle’s fracture
Closed reduction and immobilisation
A Smith’s fracture is caused by a fall on what hand?
Flexed
A Smith’s fracture affects
Distal radius
Management for a Smith’s fracture
Casting and/or surgery
A Greenstick fracture typically affects the what bones in what age group?
Long bones, children
Supracondylar fracture can damage what 2 nerves
Medial and ulna nerves
