passmed questions Flashcards
what is the best investigation for a suspected meniscal tear
MRI
-ultrasound not so great as difficult tell if there is a tear when there is a high degree of swelling
features of a meniscal tear in knee
typically result from a twisting injury
pain worse on straightening the knee
knee can give way
knee locking = displaced meniscal tears
tenderness along the joint
Thessaly’s test - weight bearing at 20 degrees of knee flexion - positive if pain on twisting knee
investigation for suspected osteomyelitis
MRI
what is osteomyelitis
infection of the bone
what is haematogenous osteomyelitis
results from bacteraemia
usually mono microbial
most common in children
vertebral haematogenous osteomyelitis is most common in adults
risk factors:
sickle cell anaemia
IVdu
immunosuppression
infective endocarditis
what is non-haematogenous osteomyelitis
results from the contiguous spread of infection from adjacent soft tissues to the bone or from direct injury/trauma to bone
often polymicrobial
most common form in adults
risk factors:
diabetic foot ulcers/pressure sores, DM, peripheral arterial disease
what is the most common organism found to cause osteomyelitis
staph aureus
what is the most common organism found to cause osteomyelitis in patients with sickle cell anaemia
salmonella species
management of osteomyelitis
flucloxacillin for 6 weeks
>clindamycin if penicillin allergic
what is FRAX
acronym for Fracture Risk Assessment tool
> fracture risk in patients can be used in people between 40years and 90 with or without bone mineral density value
estimates the 10 year risk of fragility fracture
what is DEXA
Dual energy x-ray absorpimetry
> used to measure bone mineral density
when should you be worries about osteoporosis in younger patients
previous fragility fracture
current use of frequent recent use of oral or systemic glucocorticoid
history of falls
family history of hip fracture
low BMI > 18.5kg/m2
smoking
alcohol intake of more than 14 units per week
squaring of the thumbs, chronic pain and worsening stiffness, morning stiffness in a 75 yr old woman
what is going on here?
OA
-squaring of the thumbs is a characteristic feature of hand OA
what is Reiter’s syndrome
aka reactive arthritis
presents with the classic triad of conjunctivitis, urethritis and oligoarthritis
>can’t see can’t pee can’t bend the knee
what are some characteristic features of rheumatoid arthritis
swan - neck deformity
Boutonierres
ulnar deviation
subluxation of the carpal bones
how does OA present
typically presents with worsening stiffness following long periods of inactivity (sleep)
stiffness tends to last a few minutes (in RhA stiffness lasts about an hour)
pain tends to be worse with activity and is relieved by rest
what is OA
results from the loss of cartilage at synovial joints ‘wear and tear’ and is often accompanied by the degeneration of underlying bone
who gets OA
women
positive family history
the presence of hand OA increases the risk of future hip and knee OA
risk factors for OA
previous trauma of joint > increases chance for that joint
obesity
hypermobility of a joint
occupation eg farmers/pianists
osteoporosis reduces the risk of OA
what are some features of OA
it is usually bilateral
episodic joint pain - an intermittent ache , provoked by movement and relieved by resting the joint
stiffness - worse after long periods of inactivity and only lasts a few minutes
painless nodes - Heberden nodes (DIP joints) Bouchards nodes (PIP joints)
investigations for OA
x-ray
radiologically there are osteophytes and joint space narrowing
You are a doctor working in the emergency department. A 41-year-old man attends complaining of new left leg tingling and weakness. Three days ago he reports he was independent and walking normally. He has a past medical history of type 2 diabetes mellitus for which he takes insulin.
On examination he has a heart rate of 121 beats per minute, a blood pressure of 101/72 mmHg and a temperature of 38.3ºC. He has 4/5 power throughout the right leg. Sensation is altered over the right anterior thigh and knee. The left leg has 4/5 power in hip flexion and extension, 3/5 power in knee flexion, knee extension and ankle dorsiflexion and there is 0/5 power in great toe extension and plantarflexion. Sensation is altered on the left over the thigh and knee but absent to both light touch and pin prick in the left foot.
What is the most likely diagnosis?
lumbar epidural abscess
signs of systemic sepsis with changing lower limb neurology = possible epidural abscess
the epidural abscess causing compression of the cauda equina
diabetes mellitus is a risk factor for developing an epidural abscess
what is discitis
an infection in the intervertebral disc space
can lead to serious complications such as sepsis or an epidural abscess
features of discitis
back pain
general = pyrexia, rigors, sepsis
neurological features
causes of discitis
bacterial = staphylococcus aureus
viral
TB
aseptic
investigation for discitis
MRI
treatment for discitis
6-8 weeks of antibiotic therapy
>depends on culture
A 35-year-old runner presents with heel pain. On examination, there is diffuse tenderness which is worse on the medial aspect of the heel bed. Although the patient has stopped running for the past week, the pain is aggravated by being on their feet at work all day. Pain is worse when you ask them to walk on their toes.
What is the most likely diagnosis?
plantar fasciitis
exacerbated by walking on tip toes is the take away message
