pastest Flashcards
patient presents after a car accident with nasal bleeding with a clear fluid, orbital haematoma, glasgow coma scale 3/15
which type of fracture do they most likely have?
anterior fossa skull fracture
-clear fluid is CSF which is only possible with an anterior skull fracture
a patient has hyperextended PIP joints and flexed DIP joints, subcutaneous nodules near her elbows, joint stiffness lasting more than an hour in the morning
what is the diagnosis
rheumatoid arthritis
what is the histological composition of subcutaneous nodules in rheumatoid arthritis
areas of fibrinoid necrosis surrounded by palisading epithelioid cells
specific test for rheumatoid arthritis
anti-CCP
is glucosamine recommended by NICE for treatment for osteoarthritis
no
which test do you do for SLE
anti-double stranded DNA
a patient has pain and swelling of the knees, ankles, elbows and metacarpophalangeal joints. She is sensitive to sunlight and she has a butterfly-shaped erythematous rash on her face
most likely diagnosis?
SLE
how would you treat a 78 year old woman, fall and sustained a right-sided intertrochanteric neck of femur fracture
dynamic hip screw
how would you treat a 84 year old man with left inferior and superior pubic rami fracture
no femoral neck fracture
PMH hypertension
analgesia and physio
how would you treat a woman with right ankle injury, x-ray shows bimalleolar fracture
open reduction and internal fixation
how would you treat a 64 year old woman with a history of osteoporosis with a displaced sub-capital fracture of the right femoral neck
total hip replacement
what is an effective method of analgesia for patients with a neck of femur fracture
iliofascial nerve block
which drug has an interaction with azathioprine that causes bone marrow suppression
allopurinol
patient has unilateral leg pain, progressing over the last 6 months, associated with mild weakness of the left leg on any activity. Pain radiates posteriorly down patients left leg and is worse on walking
back and neuro exam are normal
no smoking of cardiovascular disease history
what is the diagnosis
lumbar canal spinal stenosis
if a patient suffers upper GI side effects from alendronate (for osteoporosis) what should it be changed to
risedronate or etidronate
pharmacological treatment for osteoarthritis
first line - oral paracetamol
second line - oral paracetamol + topical NSAIDS
third line - addition of opioid analgesics
a 63 year old lady undergoes an axillary clearance for breast cancer.
8 weeks post op she suffers severe shoulder pain, on examination she had reduced active movements in all planes and loss of passive external rotation
what is the diagnosis
adhesive capsulitis (frozen shoulder)
28 year old man has pain and weakness in his shoulder. Recently been unwell with glandular fever but has fully recovered. On examination there is muscle wasting and a degree of winging of the scapula. Power during active movements is impaired
what is the diagnosis
Parsonage - turner’s syndrome
a 32 year old rugby player presents to emergency department with a painful knee, she describes feeling a popping sensation in her right knee during the match, knee is swollen and the patient is unable to fully extend her knee
diagnosis?
meniscal tear
what is the most appropriate form of investigation for a meniscal tear
MRI
if a patient has sensory loss of posterolateral aspect of the leg, and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex and a positive sciatic nerve stretch, what root compression has this patient experienced
S1
if a patient has discomfort over the groin and upper thigh region with associated weakness of the pelvic and psoas muscles, difficulty lifting the affected leg and walking upstairs, what nerve root compression is this?
L1-2
if a patient has sensory loss of the anterior aspect of the thigh, weakness of the quadriceps with a reduction of knee flexion on the affected side and pain in the anterior thigh when performing femoral stretch test, what nerve root compression is this?
L3
if a patient presents with similar symptoms as a L3 nerve root compression but instead of sensory loss of anterior aspect of thigh, there is sensory loss over anterior aspect of the knee, what nerve root compression is this?
L4
if a patient has evidence of sensory loss on the dorsum aspect of the foot with weakness of the foot and big toe dorsiflexion, positive sciatic nerve stretch, which nerve root compression is this?
L5
a woman has SLE, no joint pain, malar rash, she’s anaemic and her dsDNA antibody titres were markedly raised, what bedside test needs to be done for her in clinic?
urine dipstick test
-look for proteinuria which is evidence of lupus glomerulonephritis
if a patient presents with swollen red tender knee and the joint fluid aspiration reveals positively befringent, rhomboid shaped crystals and gram stain is negative, what is the diagnosis?
pseudogout
which antibodies are associated with systemic sclerosis
Scl-70, anticentromere and anti-RNA polymerase III
if a 22 year old patient has swollen, red, tender knee but also has tender pustular lesions on the dorsum of his left hand, what bacteria most likely caused this?
neisseria gonorrhoea
how often should methotrexate always be given
once weekly
a 58 year old female with longstanding diffuse cutaneous systemic sclerosis presents to A&E with severe headache, on examination her observations are:
T 37.6, BP 200/120, HR 89, SaO2 98% on air.
U&Es show urea 9.1, creatine 201
what is the diagnosis
scleroderma renal crisis
what is first line treatment for a scleroderma renal crisis
captopril (ACEi)
what antibodies are associated with psoriatic arthritis
none
-its seronegative
which drug makes raynaud’s phenomenon worse?
propanolol
a patient has pain in his right knee and he has recently had a total knee replacement
there are no systemic symptoms and his observations are stable, there is swelling and erythema over the joint
what is next best investigation?
joint arthrocentesis in theatre
-rule out septic arthritis
what is the result of joint aspiration in gout
negatively birefringent needle-shaped crystals
a 60 year old man has excruciating pain in his left toe, passive movement hurts his toe and even putting a blanket on it hurts. No trauma. Recently diagnosed with diffuse large B cell lymphoma and was started on chemo. His bloods show hyperkalaemia and he is being managed on the acute kidney injury protocol
most likely diagnosis?
gout
which drug is eosinophilic granulomatosis with polyangiitis stongly associated with
leukotriene receptor antagonists (montelukast)
clinical diagnosis of osteoporosis
- patient is aged over 45 years AND
- patient has activity-related joint pain AND
- patient has no morning stiffness or morning stiffness lasts less than 30 mins
which virus is associated with polyarteritis nodosa
hep B
75 year old woman presents to A&E with pain in her wrist over past two weeks, she has a history of haemochromatosis, her wrist is swollen warm and tender
what is the diagnosis?
pseudogout
should joint aspiration be attempted before starting antibiotics in a potential septic arthritis or should IV antibiotics be started straight away?
joint aspiration first
