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Overview Flashcards

1
Q

How do you treat temporal arteritis?

A

High dose prednisolone

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2
Q

Who gets takayasu arteritis?

A

Asian, female with pulseless arch syndrome

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3
Q

Name the two large vessel vasculitis

A

Takayasu

Giant cell

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4
Q

Name the three ANCA small vessel vasculitis

A

Microscopic polyangiitis
GPA
Eosinophilic granulomatosis with polyangiitis

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5
Q

Describe GPA

A

c-ANCA
anti-PR3
ENT - saddle nose, sinusitis
LRT, uveitis, GN

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6
Q

Describe EGPA

A

pANCA
anti-MPO
Late onset asthma, eosinophilia, sinusitis, neuropathy

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7
Q

Describe MPA

A

Commonly causes GN

pANCA

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8
Q

How is small vessel vasculitis treated?

A

Cyclophosphamide + Steroids

Plasma exchange

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9
Q

How does Kawasaki disease present?

A

High grade fever in kids, strawberry tongue, red hands/feet, conjunctivitis, lymphadenopathy

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10
Q

What is the treatment for kawasaki?

A

High dose aspirin
IV immunoglobulins
Echo

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11
Q

What is the RA antibody?

A

Anti-CCP

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12
Q

What deformities can occur in RA?

A

Jaccoud’s
Swan neck
Boutonniere

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13
Q

How is RA treated?

A

DMARD
Prednisolone cover
Biologics

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14
Q

Name two DMARDs used in RA

A

Methotrexate

Sulfasalazine - red pee

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15
Q

When are biologics used in RA?

A

No response to 2 DMARDs

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16
Q

What is the buzzword for ank spond xray?

A

Bamboo spine

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17
Q

How is Ankylosing Spondylitis treated?

A

NSAIDs

Physio

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18
Q

Name three seronegative arthropathies

A

Psoriatic - pencil in cup
Enteropathic - IBD
Reactive - GI/GU

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19
Q

How is gout treated?

A

Acute - NSAID, colchicine

Chronic - allopurinol, febuzostat

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20
Q

What are the side effects of chronic gout treatments?

A

Bone marrow suppression

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21
Q

What is seen on polarised microscopy in gout?

A

Needle shaped crystals and negative birefringence

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22
Q

What is seen on polarised microscopy in pseudo gout?

A

Rhomboid shaped crystals and positive birefringence

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23
Q

Describe the CPPD distinguishing feature

A

Chondrocalcinosis on x-ray

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24
Q

Summerise polymyalgia rheumatica

A 
>60 year female 
GCA 
Morning stiffness, proximal myalgia 
Raised inflammatory 
Treat with prednisolone
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25
Q

Summerise dermatomyositis

A 
Inflammatory 
Symmetrical weakness and tenderness 
Cutaneous - heliotrope rash, shawl and grotons
Lung disease and dysphagia 
ANA 
Anti-jo 
Prednisolone, methotrexate
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26
Q

What is affected in sjogrens?

A

Exocrine glands

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27
Q

Name the antibodies in sjogrens

A

Anti-RO

Anti- La

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28
Q

What is the most common antibody in SLE?

A

Anti-dsDNA

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29
Q

How is SLE treated?

A

HCQ
Azathioprine
Immunoglobulins/rituximab

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30
Q

Describe limited systemic sclerosis

A 
Calcinosis 
Raynauds
Eosophagus 
Sclerodactyl 
Telangiectasia
Anti-centromere
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31
Q

Describe diffuse systemic sclerosis

A

Scleroderma of trunk and proximal limbs

Anti-Scl70

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32
Q

How do you treat systemic sclerosis?

A

Raynauds - CCB
Renal - ACEi
Lung - cyclophosphamide
GI - PPI

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33
Q

What antibodies are in APLS?

A

Anti-lupus anticoagulant

Anti-cardiolipin

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34
Q

How is APLS treated?

A

Warfarin

Aspirin/heparin

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35
Q

What is the most common bone tumour?

A

Osteochondroma

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36
Q

What is an osteochondroma?

A

Bony out growth with cartilaginous cap

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37
Q

Describe enchondroma

A

Intramedullary usually metaphysical cartilage tumour - failure of normal ossification
Patchy sclerosis

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38
Q

What does a osteoid osteoma look like?

A

Small nidus of immature bone surrounded by intense sclerotic halo

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39
Q

What helps the pain of osteoid osteoma?

A

NSAIDs

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40
Q

How are bone cysts treated?

A

Curettage

Bone graft

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41
Q

What are the reg flags for bone tumours?

A

Skeletal pain
Worse at night
Ill defined bony swelling
Systemic symptoms

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42
Q

Name the most common malignant tumour

A

Osteosarcoma - usually at knees

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43
Q

How do you treat osteosarcoma?

A

Adjuvant chemo

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44
Q

What bone tumour has the worst prognosis?

A

Ewings Sarcoma

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45
Q

How does Ewings sarcoma present?

A

Fever

Raised inflammatory markers

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46
Q

Summarise paget’s disease

A

Bone turnover increased
Bone pain + raised ALP
Treat - bisphosphonates
Affects the long bones

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47
Q

What is the most common organism in osteomyelitis?

A

Staph Aureus

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48
Q

What cell predominates in osteomyelitis in sickle cell patients?

A

Salmonella

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49
Q

What is the name for infected bone walled off in thin sclerotic bone?

A

Brodie’s Abscess

50
Q

Describe septic arthritis

A

Staph or strep
Acute hot, red, inflamed, painful - no weight bearing
Aspirate
Antibiotics - lavage

51
Q

State the back pain red flags

A

Young
New onset >60
Constant/severe/worse at night
Systemic upset

52
Q

Describe the classic presentation of acute disc tear

A

Heavy lifting
Sever pain worse on coughing
MRI if suspected herniation
Resolves in 2-3 months with analgesia/physio

53
Q

How does cauda equina present and what is the management?

A

Lower back pain, bilateral sciatica, saddle anaesthesia, bowel/bladder/sexual dysfunction
DRE
Urgent MRI

54
Q

Describe spinal stenosis

A

Claudication
Degenerative changes compress lumbar spinal canal space
extension

55
Q

Name the function of the rotator cuff muscles

A

Supraspinatus - abduction
Infraspinatus - external rotation
Teres minor - external rotation
Subscapularis - internal rotation

56
Q

How does a rotator cuff tear present?

A

Minimal trauma
Sudden jerk
Supraspinatus most common - weakness and wasting

57
Q

What causes impingement syndrome?

A

Tendonitis, bursitis, osteophyte, rotator cuff tear

58
Q

How can impingement be treated?

A

Conservative
Steroids
Surgery

59
Q

Describe frozen shoulder

A

Pain - stiffness - recovery
Loss of external rotation
Conservative treatment, injections, surgical release if not tolerated

60
Q

How is acute calcific tendonitis treated?

A

Steroid

Anaesthetic

61
Q

What are tennis and golfers elbow?

A

Tennis - lateral (extensor micro tears)

Golfer - medial (flexor mircotears)

62
Q

Describe trigger finger

A

Flexor tendon tendonitis
- nodular enlargement and catch under A1 pulley
Treat with steroid or surgery

63
Q

What is duputren’s associated with?

A

Peyronie’s - penis

Ledderhose - feet

64
Q

How does de quervains present?

A

Pain on radial side of wrist, tenderness of radial styloid process, abduction of thumb against resistance is painful

65
Q

What test is used to diagnose de quervains?

A

Finkelsteins

66
Q

Where is true hip pain felt?

67
Q

Why does hip pain present with a sore knee?

A

Obturator nerve

68
Q

Why is the hip susceptible to AVN?

A

Retrograde blood supply

69
Q

What test identifies a meniscal tear?

A

Steinmann’s

70
Q

How are soft tissue knee injuries investigated?

71
Q

Describe ACL rupture

A

High impact rotation force
Pop felt - haemarthrosis and chronic instability
Physio
ACL reconstruction

72
Q

What causes PCL injury?

A

Usually high energy accidents

73
Q

How are MCL tears treated?

A

Valgus stress - Hinged knee brace

74
Q

What often occurs with LCL injury?

A

Common perineal nerve injury

75
Q

What happens in a complete knee dislocation?

A

Rupture of all 4 ligaments

Popliteal artery injury

76
Q

Name the extensor mechanisms

A 
Tibial tuberosity 
Patellar tendon 
Patella 
Quadriceps tendon 
Quadriceps muscle
77
Q

What predisposes to extensor mechanism rupture?

A 
Tendonitis 
Steroids 
Diabetes
RA
CKD 
Quinolone 
Ciprofloxacin
78
Q

What must not be used in extensor mechanism rupture?

A

Steroid injections

79
Q

What clinical test is used for extensor mechanism rupture?

A

Straight leg raise

80
Q

Describe hallux valgus and how it is treated

A

Medial deviation of the 1st metatarsal and lateral deviation of the toe
Results in an inflamed bursa - bunion
Conservative then surgery

81
Q

What is osteotomy?

A

Surgical realignment of a bone

82
Q

Describe hallux rigidus

A

OA of 1st MTP

Gold standard is surgery - arthrodesis

83
Q

What is Morton’s neuroma?

A

Repeated trauma leads to inflammation and swelling of the plantar interdigital nerve fibres
Burning and tingling radiating to toes loss of sensation

84
Q

What is the characteristic sign of morton’s neuroma and how is it treated?

A

Mulders click
Conservative - pad or steroids
Surgical excision

85
Q

What can cause achilles tendonitis?

A 
Repetitive strain 
Degenerative 
Quinolone 
Inflammatory arthritis 
Treatment is conservative do not use steroids
86
Q

Describe achilles rupture

A

Middle age to older patients - sudden deceleration with resisted calf muscle contraction leads to sudden onset sharp pain and weak plantar flexion

87
Q

What is the clinical test for achilles rupture?

A

Simmonds - no plantar flexion on when squeeze calf

88
Q

What is pes planus?

89
Q

What is the name for a high arched foot?

90
Q

Name four toe deformities

A

Claw toe
Mallet toe
Hammer toe
Curley toe

91
Q

Describe charcot joint

A

Diabetics

Damage due to loss of sensation, extensive remodelling and fragmentation

92
Q

At what level is a cervical spine injury most concerning?

A

C3 - C3,4,5 - phrenic nerve

93
Q

What causes a thoracolumbar spinal injury?

A

High energy fall from height

OA wedge - elderly

94
Q

What is spinal shock?

A

Physiological response to trauma, loss of sensory and motor function below the level of injury
Bulbocavernosus reflex is absent until resolution

95
Q

Describe neurogenic shock

A

Temporary shutdown of sympathetic outflow
Vasodilation and bradycardia
High level injuries resolve in 24-48 hours
Priapism

96
Q

What imaging is used to assess lumbar spine?

97
Q

Name five types of fracture

A 
Segmental 
Comminuted 
Oblique 
Spiral 
Transverse
98
Q

What is the difference between primary and secondary bone healing?

A

Primary - bridges the gap with new osteoblasts

Secondary - inflammatory response and recruitment of pluripotent stem cells

99
Q

Describe chronic regional pain syndrome

A

Constant burning, throbbing allodynia, swelling and stiffness
Requires specialist pain management

100
Q

Who gets a humeral neck fracture?

A

Usually at surgical neck in elderly patients with osteoporosis FOOSH

101
Q

What is at risk in a humeral shaft fracture?

A

Radial nerve - wrist drop and loss of sensation

102
Q

What is bilateral shoulder dislocation associated with?

103
Q

What can be injured in shoulder dislocation?

A

Axillary artery/nerve - regimental patch

104
Q

Name two lesions associated with shoulder dislocation

A

Bankart - detachment of labrum and capsule

Hill-Sachs - posterior head fracture

105
Q

What X-ray sign is seen in posterior shoulder dislocation?

A

Light bulb sign

106
Q

What is monteggia fracture?

A

Ulnar fracture with dislocation of radial head

107
Q

What is galeazzi fracture?

A

Radial fracture with ulnar dislocation

108
Q

Describe a colles fracture

A

Extra-articular with dorsal displacement of distal radius
FOOSH onto extended wrist
Risk of median nerve compression

109
Q

Describe a smith’s fracture

A

Extra-articular with volar displacement of distal radium
FOOSH onto flexed wrist
ORIF

110
Q

What is a Barton’s fracture?

A

Intra-articular with dorsal or volar displacement of rim - intra-articular distal radius requires ORIF

111
Q

What is the risk of a scaphoid fracture?

A

FOOSH
Anatomical snuff box
Risk of non-union - AP lateral and oblique x-ray

112
Q

Why is the scaphoid susceptible to non-union?

A

Retrograde blood supply

113
Q

What is mallet finger and what is the treatment?

A

Avulsion of extensor tendon in terminal phalanx
Forced flexion of extended DIJP
Splint 4 weeks

114
Q

Name the three broad types of pelvic fracture

A

Lateral
Anteroposterior
Vertical

115
Q

What must be done in pelvic trauma?

A

PR exam to assess sacral nerve root function and look for blood

116
Q

Name the three types of hip fracture

A

Intracapsular
Extracapuslar
- subtrochanteric
- intertrochanteric

117
Q

What is the risk of an intracapuslar hip fracture?

A

AVN and non-union

118
Q

What line is interrupted in an intracapuslar fracture?

A

Shenton’s

119
Q

What is the treatment for an intracapsular hip fracture?

A

Replacement

120
Q

How are extra capsular hip fractures managed?

A

Internal fixation with dynamic hip screw

121
Q

What is the difference between anterior and posterior dislocation?

A

Posterior - short adducted internally rotated leg

Anterior - abducted and externally rotated but not short

MSK (22 decks)

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