Passmed/Pastest/Capsule Flashcards
what are features of Still’s Disease
arthralgia
elevated serum ferritin
rash: salmon-pink, maculopapular
pyrexia
typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
lymphadenopathy
rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative
how do you manage Still’s Disease
NSAIDs - should be used first-line to manage fever, joint pain and serositis, they should be trialed for at least a week before steroids are added.
steroids may control symptoms but won’t improve prognosis
if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered
what is Simmonds test
patient lies facing down with leg below knee hanging off the end of the bed with foot in dorsiflexion, calf is squeezed and if there is no plantarflexion movement of the foot then the achilles tendon is damaged - +ve = damage
what test should you do in a patient presenting with discitis
echocardiography - may have IE
what should you suspect in a patient with signs of sepsis and developing lower limb neuropathy, particularly if there is no pain
lumbar epidural abscess
whats leriche syndrome
Type of Peripheral Arterial Disease
Classically, it is described in male patients as a triad of symptoms:
- Claudication of the buttocks and thighs
- Atrophy of the musculature of the legs
- Impotence (due to paralysis of the L1 nerve)
what antibiotic is not recommended for prescription in patients taking methotrexate + why
trimethoprim due to it causing myelosuppression and fatal pancytopenia
what antibiotic is most associated with achilles tendon disorders
ciprofloxacin
what should be done before commencing someone on hydroxychloroquinine
opthalmology review due to retinopathy risk
what is Sheurmans disease
self-limiting skeletal disorder of childhood, where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior.
what is brown-sequard syndrome
rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.
what is mallet thumb
injury to the end of a finger that forces it to flex inwards
what test is used to diagnose menisceal tears + what is it
Thessaly’s test . The patient is supported by doctor and is asked to stand on the affected leg, flexed to 20 degree. The test is positive if there is pain on twisting knee
what FRAX score warrants a DEXA scan
10% or higher
what results are consistent with osteomalacia
low calcium, low phosphate, high ALP
what is lesch-Nyhan syndrome
inherited enzyme deficiency also known as ‘juvenile gout’. It is also linked with self injuring behaviour, cognitive impairment and nervous system impairment.
what is lesch-nyhan syndrome linked with
gout
In Gout, what are drug contraindiations for a Gout prescription
azathioprine, as this causes myelosuppression
in a scaphoid fracture what is the neurovascular structure that is most at risk
Dorsal carpal branch of the radial artery
what should be checked before starting azathioprine
thiopurine methyltransferase deficiency - causes myelosuppression
what is the imaging modality of choice when viewing the achilles tendon
ultrasound
what is a Hill-Sach lesion
a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.
what does marfans cause a deficiency in
fibrillin-1
what drug is associated with an increased risk of atypical stress fractures
bisphosphonates
what is the most common reason for surgical re-intervention of a total hip replacement
aseptic loosening of the implant
when prescribing DMARDS for rheumatoid arthritis, what would a patient with an allergy to a sulfa drug (e.g. co-trimaxazole) also not be able to take
sulfasalazine
what is Pott’s fracture
bimalleolar ankle fracture
what is Bennet’s fracture
Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal
What is Barton’s fracture
Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
Fall onto extended and pronated wrist
What is Smith’s fracture
reverse colles fracture
Volar angulation of distal radius fragment (Garden spade deformity)
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
what is schobers test and what is considered a significant result
test to measure spine flexion - mainly used in ankylosing spondylitis
<5cm is suggestive of ankylosing spondylitis
what nerve root is the tricep reflex testing
median nerve - C7
what is the classification system for open fractures
Gustilo-Anderson
What classification requires knowledge of syndesmosis anatomy
Weber
What is the first parameter to change in hypovolaemic shock
Respiratory rate
where do you find woven bone
calluses and in new undeveloped bone
what are the red flags for back pain
TUNA FISH
T - trauma
U - unexplained weight loss
N - Neurological Symptoms
A - age (<20, >55)
F - Fever
I - IVDU
S - Steroid use
H - Hx of Cancer
what is a yellow flag
psychosocial patient factors that although not associated with serious organic pathology nonetheless indicate an increased likelihood of chronic back pain and resultant long term disability and potential loss of work
what arethe yellow flags for back pain
A belief that pain and activity is harmful or severely disabling Fear-avoidance behaviour Sickness behaviours Low mood Social withdrawal An expectation that passive treatment rather than active participation will help Issues with compensation system Poor job satisfaction Difficulty at work Overprotective family Lack of social support Financial problems
what condition is associated with ‘cotton wool calcification’ on an Xray
chondrosarcoma
which rib forms the costal margin on the mid axillary line
10th Rib
What is described as a ‘skiiers thumb’ injury
Ulnar collateral ligament of the thumb injury
what causes osteopenia with a normal bone matrix to bone mineral ratio
osteoporosis
what nerves are most commonly affected by supracondylar humeral fractures and what are the effects of this
median and anterior interrosseus nerve - weakness to ipsilateral index finger and weakened wrist flexion
what is characteristic of a scaphoid fracture
distortion of the anatomical snuffbox anatomy
which nerve is susceptible to compression in injury to the lateral head/neck of the tibia
common peroneal nerve
what nerve controls foot dorsiflexion
common peroneal nerve
fracture of the femoral head causing avascular necrosis occurs due to interruption of which artery
median circumflex artery
what tendon would a fracture and inferior displacement of the sustentaculum tali affect
flexor hallucis longus
how is slipped upper femoral capital epiphysis treated
in situ screw fixation
what nerve is most at risk in a mid-shaft humeral fracture and how would its injury manifest
radial nerve, loss of sensation in dorsum of hand
what is a late sign of compartment syndrome that indicates a poor prognosis
complete anaethesia of the affected portion
what antiepileptic is associated with chronic acidosis and what implications does this have for bone health
topiramate, causes an osteomalacia-type state due to defective bone mineralisation
what artery is most at risk in a supracondylar fracture of the humerus
brachial artery
damage to what muscle causes winging of the scapula
serratus anterior
whats the treatment of choice for a subtrochanteric hip fracture
intermedullary nail
what is the treatment of choice for a suspected hip fracture in a RTA
Thomas splint - allows immobilisation of the injury for further assessment
