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Progress test packs > R&O > Flashcards

R&O Flashcards

0
Q

smith fracture

A

fall on palmar flexed hand

anterior displacement of radius

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1
Q

colles frac

A

fall on outstretched hand

posterior displacement of radius

dinner fork deformity

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2
Q

forearm: Galeazzi vs Monteggia

A
  • Gal
    Radial frac
    Ulnar dislocate at Wrist

-Mont
Ulnar frac
Radial head disloc at Elbow

GRUW MURE

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3
Q

scaphoid frac

A

fall on outstretched hand

look for if no obvious frac at wrist but still painful
- especially tender in anat snuff box

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4
Q

epiphyseal fracture in kids

A

salter harris classification

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5
Q

fracture neck of femur

A

v common frac of old age
- esp in females
mortality: 1/3 in 1y; 1/3 into care
risk - oteoporo, cog impair, dm, alcoholism

leg shortened, external rot
xray - loss of shenton’s line, interruption in trabelcular lines

Intracapsular

  • compromise vessels, poor healing
  • GARDEN classification
    • 1 partial, 2 full, 4 full disp
  • t: arthroplasty (full or hemi)

Extracapsular

  • trochanteric or subtronchanteric
  • dynamic hip screw or intramedullary nail
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6
Q

Comps of NOF frac

A

AVN

  • residual pain
  • xray showed increased density

Non union

Osteorathritis

  • all avoided by total hip replacement
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7
Q

fracture complications

A

dvt & pe
- stockings, heparin may be indicated

compartment syndrome

traction neuropraxia

later:
mal/non union
avascular necrosis
algodystrophy
- aka complex regional pain, reflex symp dystrophy
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8
Q

compartment syndrome

A

pain out of proportion
pain on passive movement

later: pallor, paraes, pulse, paralysis

do fasciotomy

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9
Q

complex regional pain

algodyst, refelx sym dyst

A

burning pain, sweating, swelling, stiffness, skin changes

often in hand or foot

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10
Q

neurovascular injuries to look for with fracture

nerve injury = traction neuropraxia

A

humeral shaft: radial nerve: wrist drop

knee: common peroneal: foot drop
supracondylar: brachial artery and r,m,u nerves

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11
Q

fracture healing

A

haematoma
inflam and cell prolif

DAYS
callus formation (chondroblasts and osteoblasts)
- soft then hard
- leaves woven bone

WEEKS
consolidation + mineralization
- leaves trabecular bone (aka lamellar)

YEARS
remodelling - blasts and clasts
- leaves compact bone

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12
Q

fracture healing times

A

kids 3-4 weeks

adult, excluding complication
upper limb 6-8 weeks
lower limb 12 weeks

for each complication (compound, infection) add 6 weeks

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13
Q

fracture management rules

A

upper limb conservative management
unless displaced: fix with plate and screws

lower limb surgery always required
- intramedullary pin
for hip
DHS if extracapsular of intracapsular, non displaced and < 60
intracapsular displaced or > 60: hemiarthroplasty

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14
Q

open (compound) fracture

A

break in skin communicating with frac
usually high energy
risk infection

require surgical washout
may require external fixation

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15
Q

OSCE: describing fracture on xray

A

plain film radiograph
taken on…
of patient…

shows left/right forearm/shoulder/hand etc
in AP/lateral view

adequate exposure/penetration
- show joint above and below

is it a child - epiphyseal plates

fracture
- where on shaft - prox/mid/distal
- displaced or undisplaced
translational, angulation, rotation, shortening
- comminuted or simple transverse/oblique/spiral

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16
Q

Vertebral fractures in osteoporo

A

sudden severe pain - radiate around front (ribs abdo)

v tender alog central spinal processes

but 2 in 3 are asympotmatic

get pain from subsequent accumulated mechanical derangement
- increased kyphosis

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17
Q

osteoporosis

A

loss of normal bone mass/density/architecture
- increase fragility - inc fracture risk

DEXA bone density scan
(dual energy xray absorptiometry)
- give T score - how many SD’s from young healthy adult mean
- give Z score - how many SD’s from age matched normal

Risk factors

  • age, female, low bmi, fh
  • smoking, steroid, alcohol
  • RA, liver, renal, copd
  • oestrogen deficiency
  • vit D deficiency, hyperparathyroid
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18
Q

osteoporosis causes

A 
early menopause
cushings (high steroid)
DM
chronic renal fail
RA
coeliac, IBD
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19
Q

treatment and prevent osteoporo

A
    • bisposphonates (inhib osteoclasts)
  • w water,uproght, no food for 30 mins

calcium
vit D

smoking cessation
reduce falls

for spinal fractures - bed rest and analgesia

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20
Q

pagets

osteitis deformans

A

disorder of bone remodelling
excessive resorp then increased formation - structurally abnormal

often asympto (incidental xray finding)later get pain, deform, nerve palsy

commonly pelvis, lumbar spine, femur

not below 40, inc dramatically with age

raised ALP

t: bisphosphonate

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21
Q

skull x ray

A

think pagets
- inc bone turnover affecting skull and long bones

bisphosphonates

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22
Q

HISTORY: back pain

A

HPC

  • pain tender stiff
  • pattern (AS worse in morn, good with exercise)
  • location
  • wake at night (AS)
  • injury or mechanism worse on extension
  • radiate to buttock

system: fatigue, fever, wl

assoc w inflammatory disease: 
peripheral joints (mainly knee hip), rib pain, eyes (AS)

neuro: tingling, shooting pain, saddle anaesth, urinary incont

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23
Q

back pain history

A

HPC

  • pain tender stiff
  • pattern (AS worse in morn, good with exercise)
  • location
  • wake at night (AS)
  • injury or mechanism worse on extension
  • radiate to buttock

system: fatigue, fever, wl

assoc:
rib pain, eyes (AS)

neuro: tingling, shooting pain, saddle anaesth, urinary incont

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24
Q

back pain red flags

A

<20 or >50
persistent

worse at night or early morn (AS)

systemic: fever, wl, fatigue
neurology: pain, ting, urinary, saddle

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25
Q

ankylosing spondylitis

A 
young adults (slight male predom)
>90% HLA B27

seronegative but

  • esr, crp raised
  • wcc may be raised

episodic inflam in spine

  • lower back pain, tender, stiff
  • also in buttocks (alternating)

fatigue
stiffness worse in morning, improve w exercise
waking at night (second half)

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26
Q

AS management

A

physio: daily, morning exercises
- can prevent accumulative disability
- spinal mobility, chest expan, posture

active inlfamm: NSAIDs

persistent inflam: consider antiTNF
(methotrexate reserved for peripheral arthritis)

consider genetics:
if hla +, 50% chance of passing on, 30% chance of devel

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27
Q

later effects of AS

A

gradually limit spinal flexion

  • reliably measure w Schoeber’s
  • fusion - bamboo spine

costochondritis
- may limit chest expansion

uveitis / red eye

not well prevented (w exercises)
- dorsal kyphosis (question mark post), affect gait, chest expan, paraspinal muscle wasting

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28
Q

ank spond xray changes

A

sacroilitis
squaring of vert
syndesmophytes (calcific of anulus fibrosis)
bamboo fusion

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29
Q

spondylosis

A

degenerative changes in fibrous intervertebral joints

  • dehydration of gel in disc - fissures in outer zone
    • prone to prolapse
  • sclerosis and spurs at vertebrae
  • OA at facet joints

may see

  • episodic pain
  • stiffening
  • disc prolapse: nerve irritation
  • stenosis
  • spodylolisthesis
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30
Q

disc prolapse

A

protrusion of nucleus pulposus through fissure in annulus fibrosis
often underlying spondylosis - but also often in young fit adults

can affect cervical, thoracic, lumbar spine

onset w local strain or injury
- ie lifting, stooping for lumbar
- often less prominent for cervical
see local pain, may be worse w coughing/straining
may get local muscle spasm, tenderness

then get onset of nerve pain and neuro symptoms (weakness, sensory)

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31
Q

Disc prolapse

A

Lateral - nerve root compression (also c by root canal stenosis)
Central (less common) - cauda equina (f/u incont, numb weak)

Root compression

  • sciatic pain
  • paraesthesia
  • fem (l2-4) stretch or straight leg raise (l4-s3)

Xrays not helpful
MRI if suspicious

Rest, analgesia. Surgery if severe/persist/neurol

Exclude tumour, inflam (AS)
Muscular - physio

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32
Q

disc prolapse

A

see leg pain (worse when sitting)
straight leg raise positive

t: analgesia and physio
if no improve consider MRI

L3 - thigh; L4 - knee

  • weak quads
  • red knee reflex
  • femoral stretch positive

L5 - dorsum: S1 - postero-lat
- sciatic stretch positive

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33
Q

acute lumbar disc prolapse

A

commonly set off by lifting twisting bending

on its own: diffuse pain (often unilat, to buttock) and muscle spasm
nerve irritation: tingling, pain, weakness

  • *ask about saddel anaesth, incont
  • cauda equina lesion

straight leg raise - sciatic - L4-S3
femoral nerve stretch - L2-L4

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34
Q

treatment disc prolapse

A

2-3 days bed rest

  • flat if lower lumb
  • semi-rec if upper lumbar

analgesia and muscle relaxants

once tolerable - mobilise, physio

? may need xray guided nerve root injection
? may require surgery - microdiscectomy

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35
Q

Back pain differential: myeloma

A

Malignancy of plasma cells
Seen in elderly

In most, will have both..
Blood: monoclonal paraprotein
Urine: bence jones

For diagnosis need one of these plus

  • radiolog evidence of lytic bone lesions,
  • high plasma cells on bm aspirate

Also raised ESR, and crp
Blood film: rouleux

Features:

  • bone destruction: hypercalc and fractures
  • marrow infiltration - anaemia and infections
  • fatigue, wl, fever
  • renal impariment
**Steroids and Chemotherapy**
Radiotherapy for local painful lesions
Bisphosphonates useful
Plasmaphoresis vs viscosity
Tranfusion vs anaemia, Abx vs infec
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36
Q

malignant bone pain

A

nsaids good

then think bisphosphonates and radiotherapy

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37
Q

mechanical lower back pain

A

on exam - stiffness? spasm? scoliosis?

analgesia, physio, gentle exercise

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38
Q

facet joint syndrome

A

pain worse on extension (or straightening form flexed)
radiate to buttocks

major relief when anaeastheitc injected under xray
=diagnositc

treat: steroid injec, physio, weightloss

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39
Q

fibrositic nodulosis

A

low back pain rad to buttock thigh

can pinpoint v tender nodules on buttock and iliac crest

benefit from steroid injection into nodules

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40
Q

spondylolisthesis

  • vertebrae slipping out of alignment
A

can cause cauda equina syndrome

in young adult
- due to congenital bilat pars interarticularis defects

in older
- due to degenerative changes (lumbar spondylosis, facet joint OA)

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41
Q

stenosis: spinal & root canal

A

caused by:

  • loss of disk height
  • facet joint OA
  • bony spurs
  • buckling of ligamentum flavum

present with nerve root pain and spinal claudication

spinal claudication:
- pain and paraesth is brought on by walking - gradually disappears on rest
(unlike vascular claud - immed relief, absent pulses)
- may occur in arms if lesion is cervical

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42
Q

DISH

diffuse idiopathic skeletal hyperstosis

A

ossification of ligaments and muscle insertions
bony overgrowths
stiffness

occurs in lumbar spine but also pelvis, patella, feet

t: analgesia, nsaids, exercise

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43
Q

dermamyositis and polymyositis

A

inflammation of striated muscle - proximal muscle weakness
eventually may affect respiratory muscles, swallowing
May see interstitial lung disease

derma- when skin also involved

  • heliotrope (purple around eye)
  • papules on palms soles

High risk malignancy

Anti-Jo antibody (specific), raised CK

Steroid, immunosup

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44
Q

Calcific tendinosis and bursitis

A

Often seen at shoulder

Deposition of calcium crystals on tendon visible on xray

Pain (acute or chronic) and restricted range of movement

Steroid injection may help

May resolve, persist or become complicated by crystals shedding into subacromial bursae causing bursitis

Bursitis will be hot red v painful - ie differential of gout, pseudogout and septic arthritis

45
Q

Dupuytrens

A

Idiopathic or familial
- onset w age, worse in men
also alcoholic liver disease and DM
also trauma, manual labour

Fibrosis of palmar aponeurosis - thickened palmar fascia

  • w flexion of fingers
  • skin changes (nodules, pitting)

Can be bilateral
Can affect soles of feet

‘Ectopic manifestations’
- fibrosis also seen at knuckles, feet, penis

‘Dupuytrens diathesis’
- early, severe, bilat, w ectopic manifests

Tx: steroid inject, surgical release

46
Q

Tenosynovitis

A

Finger flexors
- may cause trigger finger

De quervains - thumb flexor

T: rest splint nsaids
steroid injection
?therapeutic ultrasound

47
Q

Golfers elbow

A

Epicondylitis

Flexors insertion into medial epicondyle

48
Q

Tennis elbow

A

Extensors insertion into lateral epicondyle

Epicondylitis

49
Q

Carpal tunnel

A

Median nerve
Wake at night with tingling numbness pain
- relieved by shaking

Thenar wasting (abd policis brevis)

Tinnels, Phalens

T: 
night splint 
- relief: diagnostic; may see full recovery
Steroid inj into tunnel (not nerve!)
Decompression
50
Q

Sjogrens

A

sicca (dry eyes dry mouth)
- schirmer test

raynauds
vasculitis
parotid or lymph gland swelling (risk lymphoma)

anti La and anti Ro

51
Q

antiphospholipid syndrome APS

A

thrombosis
recurrent miscarriage
persistently +ve blood test for antiphospholidi antibodies - mainly anti-cardiolipin (ie on 2 occasions, 6wks apart)

can occur alone or with another ARD (autoimmune rheumatic disease) eg SLE (in 20-30%)

can get cerebral and cardiac probs

52
Q

clinical features APS

A

thrombosis
- stroke in 20%, DVT in 40%

of ladies who have 2 spont miscarriages, 27% have APS

other assoc features:

  • thrombocytop
  • chorea, migraine, epilepsy
  • valve disease, livedo reticularis, renal involve (thromboses)

test: antiphospholipid antibodies
1) anti-cardiolipin
2) lupus anticoagulant

53
Q

treat APS

A

long term warfarin if had thrombosis

during pregnancy - aspirin, subcut heparin

54
Q

gout

A

middle aged man
painful red swollen

commonly DIP’s
also often 1st MTP (big toe)

age, obesity, alcohol, protein
metabolic syndrome (dm, ihd, chol, htn)
family history

overprod: alcohol
impaired excretion: renal, htn, drug (diuretic)

negatively birofringent crystals

55
Q

gout mgmt

A

flare up respond well to nsaid (diclofenac, naproxen)
- also colchicine

lifestyle - weight, exercise, smoking, diet

  • limit beer and spirits (wine ok)
  • fizzy drinks
  • offer leaflet on foods

allopurinol

  • not within month of attack
  • can precip, so cover with nsaids
56
Q

management septic arthritis

A

aspirate

  • gram stain instantly
  • but also culture

blood for culture, wcc, esr/crp

start treatment Abx

  • iv 2 weeks, oral 6 weeks
  • eg fluclox for staph aureus
57
Q

pseudogout

A

calcium pyrophosphate crystals
- positively birofringent

elderly women
knee wrist
heamochromatosis/wilsons (in young)

t: nsaids, colchicine

58
Q

raynauds

A

primary

or secondary to SSc, SLE, RA

T: CCB

59
Q

systemic sclerosis SSc

  • epid
  • aet
  • patho
A

3:1 f:m
30’s 40’s

environmental factors - silica dust, chloride, rapeseed oil, drugs: bleomycin
? genetic factors

patho:

  • inc fibroblast act
  • vascular damage, excess collagen + fibrosis in tissues partic skin skin
60
Q

SSc features

limited cutaneous (ana, anti-centromere)

A

raynauds

70% have limited cutaneous scleroderma

  • 15yrs after raynauds get tightening, thickening of skin in hands face feet forearms
  • flexion deform in fingers
  • beak nose and small mouth
  • painful ulcers on fingers
  • telangectasia

CREST
- calcinosis, raynauds, eosophageal, sclerodactyl, telangectasia

also see GI involve, pulmonary hypertension

61
Q

SSc features

diffuse cutaneous (ana, anti-topoisomerase, anti-scl70)

A

raynauds is quickly followed or concurrent w oedema and stiffness which turns to sclerosis/skin thickening

may have lethargy, weight loss

oesophaegeal: heartburn, reflux, dysphagia
anal incontinence
poor function of bowel - malabsorption

renal involve - chronic or acute eg acute hypertensive renal crisis (often cause of death)
- may see raised bp as first sign

lung - fibrosis, pulm htn
heart - myocardial fibrosis - arrhyth

62
Q

SSc investigations

A

CXR to get baseline of heart and lungs in case involved
?Barium swallow
xray hands - calcium deposits

Echo might show pulm htn

63
Q

SSc blood

A

aneamia - normochro, normocyt - or haemolytic

urea and elec rise with renal involve

antibodies: ANA in 90% RhF in 30%
limited: anti centromere ACA 70%
diffuse: anti-topoisomerase (aka anti-SCL-70) 30%

64
Q

SSc management

A

organ specific
no cure
corticosteroids and immunosuppressants rarely used (except if have pulm fibrosis)

nifedipine for raynauds 
exercise skin lubricants
ppi for oesophageal sx
nutritional suppl for malab
abx for bacterial overgrowth
ace for kidneys
65
Q

SSc prognosis

A

in limited form 70% ten year survival
worse survial in diffuse form

death from pulmonary involvement 50% also renal cardiac

66
Q

large vessel vasculitides

A

giant cell arteritis

polymyalgia rheumatica

67
Q

polymyalgia rheumatica

A

sudden onset severe pain and stiffness of shoulders, neck, hip, lumbar spine
worst in morning
pt >50yrs

tiredness, fever, weightloss, depression, night sweats

15% have GCA

raised ESR and/or CRP =halllmark
raised ALP, GGT
anaemia
assoc w temporal arteritis

68
Q

PMR and GCA treat

A

prednisolone for 18m to 2y

  • 10-15mg fro PMR
  • 40-60mg for GCA (grad reduced)

Aspirin
- red risk of thromboembolic - ie in opthalmic: visual loss

alongside prednis
vit-D, Ca, do DEXA scan
ppi

69
Q

giant cell arteritis

A

inflammatory granulomatous arteritis
often in assoc w polymyalgia rheumatica
often temporal

v tender, headache (stabbing), erythema, jaw claudication
**may get sudden painless loss of vision in one eye (involve opthalmic artery)

systemically tiredness malaise fever

anaemia
raised esr and very high CRP
diagnosis: biopsy

70
Q

medium vessel vasculitis

A

polyarteritis nodosa

kawasakis

71
Q

small vessel vasculitis

A

ANCA assoc:
microscopic poyangitis
wegeners (granulomatous polyangitis)
churg-straus

other:
henoch-schonlein purp

72
Q

polyarteritis nodosa

A

initially fever malaise wl myalgia

then acute features due to organ infarction:
neuro (mononeuritis multiplex), abdo, renal, cardiac, skin, lung

T: prednis and immunosuppress

73
Q

wegeners primarily affects..

A

lungs and kidneys

perhaps also skin and nerves

74
Q

kawasaki

A

mainly affects children under 5

fever lasting more than 5 days
bilat conjunctival congestion
dry, red lips/mouth
redness, oedema on palms, soles

75
Q

sle presentation

A

9:1 f:m
in 20’s 30’s
higher in afro-caribbean
ANA positive

fatigue/malaise, arthralgia, skin probs
fever in exacerbations
also: kidney, lungs, cv, nervous, eyes, GI

76
Q

sle aetiology

ANA positive

A

family history relevant
some identified genetic links
premenopausal women (also hormone therapy inc flare risk)
UV light: flare up

drug induced sle (mild)
- isoniazid, hydralazine

77
Q

management of sle

A

NSAIDs good for arthralgia, fever, pleuritis, pericarditis
- or consider corticosteroids

Can measure anti-dsDNA as marker of activity
Also urine dipstick to monitor kidneys easily

topical steroids for skin

high dose steroids and immunosupression for renal, cerebral

steroids for haemolytic anaemia, thrombocytopenia

immunosuppression: cyclophosphamide, mycofenolate mofetil, azathioprine, rituximab

w/ steroids - bisphopsh, vitd, calcium, ppi

78
Q

course/prog of sle

A

episodic
remission may last for long time
but can also be chronic progressive

early death due to severe renal, cerebral, infective comp. then stroke, ihd

79
Q

joint muscle skin features in sle

A

joints >90%
- symmetrical small joint pain, some swelling, deformity rare
(nb jaccoud arthropathy - rare type of major joint deformity)

muscle: myalgia in 50%

skin 85%

  • butterfly rash
  • fingertip/nail fold vasculitic lesions
  • photosensitivity
  • other: purpura, urticaria, livedo reticularis, palm/plantar rashes, pigmentation, alopecia

raynauds common

(nb discoid lupus - benign variant - only skin)

80
Q

kidney lungs and CV in sle

A

kidneys 30%

  • glomerulonephritis
  • may present with nephritic or nephrotic syndrome

lungs in 50% - pleurisy, effusions, restrictive changes

heart 25%

  • pericarditis (as in RA)
  • mild myocarditis – arryth
  • rarer: valve

cv
raynauds, vasculitis, thrombosis
- higher risk stroke/ihd (due to systemic inflam, vasculitic involve, steroids=atherogenic)

81
Q

nervous, GI and eyes in sle

A

nervous involve 60%

  • depression, sometime more severe psychiatry
  • epliepsy, migraines, cerebellar ataxia, cranial nerve lesions, stroke, polyneuropathy

eyes

  • sjogrens
  • episcleritis, conjunctivitis, optic neuritis

GI

  • mouth ulcers
  • vasculitis can affect bowel (inflam, infarct, perforate)
82
Q

bloods in sle

A

low wcc, low platelet (due to autoimmune)

anaemia (normochro, normocyt - or autoimmune haemolytic)

esr raised but crp normal (unless partic cause)

urea and creat rise when renal impair

autoantibodies: ANA, anti-dsDNA (more specific less sensitive), anti-Ro, anti-La (also autoimmune hepatitis), anti-Sm (very specific but only 20%)

low C3 and C4

83
Q

Sle lymph nodes

A

Axillary and cervical

Risk glandular fever and lumphoma

84
Q

pregnancy in sle

A

fertility normal unless in severe disease
but recurrent miscarriage common (esp w antiphospholipid antibodies)

often see exacerbations post paartum (as with RA)
continue usual treatment in preg

anti-Ro anti-La – 2% risk of neonatal lupus (rash hepatitis heart block)

85
Q

histology in sle

A

immune depositions seen in biopsies of skin and kidneys

86
Q

rheumatoid arthritis

A

70% seropositive (RF)
anti-CCP more specific

commonly female 30’s 40’s
symmet pain swelling stiffness
small joints of hands/feet (especially MCP)
worse in morning

develop wasting, deformity

typically slowly progressive, relapsing remitting
but may be rapidly progressive, or transient remitting

87
Q

RA investigations

A

rasied esr, crp

anaemia (normocyt, normochro)

anti-CCP +/- RF

xray: erosion and periartic osteopenia (in advanced disease)

88
Q

DAS 28

A

disease activity score

  • considers 28 joints - how many tender, how many swollen
  • consider esr and crp
  • considr subjective ‘global score’ of health
89
Q

Xray changes in RA

A 
loss of joint space
periarticular osteopenia
juxtaarticular erosions
subluxation and deformity
periarticular soft tissue swelling

may see cysts

90
Q

management RA

A

NSAIDs and analgesia
-ppi cover over 65

prednisolone to induce remission

DMARDs: methotrex/sulfasalazine

  • then combine
  • then consider biolog (antiTNF)
91
Q

non-articular RA manifestations

A

anaemia

soft tissue
- nodules, bursitis, tenosynovitis

lung fibrosis
pericarditis
cvd risk

eyes

  • dry eyes and mouth (sjogrens)
  • scleritis

kidneys

92
Q

methotrexate counselling

A

pill taken weekly
long term for disease control
take folic acid also (three days later)

gen se:

  • mouth ulcers
  • GI upset
more signif:
pulmonary
liver
bone marrow (infection, bruise)
renal

> > do bloods and ray before
monitor bloods every month (more initially)

limit alcohol
contraception: avoid pregancy
avoid trimethoprim and septrin (talk to doc)
avoid live vaccines (talk to doc)

93
Q

sulfasalazine counselling

A

long term for disease control

gradually increase dose
(od for 1 week, bd fro a week…up to qds)

take daily after food
enteric coated

gen se: mouth ulcer, GI, rash
also: stain urine and contacts

signif:
- thrombocyto (infection, bruising)
- liver

baseline bloods then 4 monthly once stable

94
Q

osteoarthritis

A

DIP’s affected most
- heberden’s (may also see bouchard’s)

worse with activity, late in day

big joints also effected
- weight bearing

xray: loss of space, osteophytes, sclerosis

95
Q

OA on exam

A 
heberden & bouchard
no major deformity
crepitus
tender
limited movement
?may see effusion, wasting
96
Q

Yellow flags - poor psychological prognosis

A

Think rest good, exercise bad for back

96
Q

OA xray changes

A

narrowing of joint space
osteophytes (spurs) - quite specific
sclerosis - quite specific
cysts

?can see erosions in postmenopausal women

97
Q

management OA

A

weight loss
exercise
hydrotherapy/massage

paracetamol
NSAIDs - local gel (eltenac)
opioid analgesia

(oral nsaids and aspirin not routinely used)

joint injection +/- aspiration

replacement

98
Q

osteo vs rheumatoid arthritis

A

rheum

  • systemic sx
  • worse in am
  • effusions
  • nodes on extensors (not heb/bouch)
  • symmetrical

osteo

  • big joints
  • more painful throughout day
  • heberden and bouchard nodes on fingers
  • asymmet
  • less swelling
99
Q

joint pain history

A

cardinal Sx: swelling, pain, tender, stiff

  • which joints
  • when worst (early, late)
other Sx:
skin (psoriasis)
nails
eyes
lower back pain (p.a)

family history
pmh
diet (especially alcohol for gout)

100
Q

Psoriatic arthropathy

A 
arthritis in people w psoriasis (10%)
- often just DIP's symmetrically but may be poly
- nail changes prominent
- also enthesitis and tenosynovitis
	- sausage fingers/toes (dactylitis)
		(also in reactive)

5% have arthritis mutilans - telescoping
15% have lower back pain (spondylosis, sacoiliitis)

seronegative (no markers)
but 50% hla-b27

xray: pencil in cup
tx: nsaid, analg, steroid injection, methotrex/sulfa

101
Q

Nail changes

A

Psoriatic HOP

  • hyperkaratosis
  • onycholisis
  • pitting

RA
- linear ridging +

102
Q

behcets disease

A

polyarthritis
recurrent oral ulceration
ant uveitis
neurological probs - like dementia, ms, parkinsons

steroid, immunosupress

103
Q

reactive arthritis

A

sterile synovitis following infection (by days or weeks)
- dysentry, uti, std

higher risk if hla b27
more in men

acute, asymmetrical, lower limb

  • knee
  • mtp
  • dactylitis (sausage toes)

also
- enthesitis (plantar, achilles)

if severe:

  • urethritis
  • lower back pain (SIJ, spondy)
  • foot rash (keratoderma blennorhagica)
  • ulcers on glans penis

treat infection if still present
NSAID, joint injec
if relapsing: methotrexate

104
Q

nsaids

A

renal impair
gastric irritation
asthma

105
Q

allopurinol se

A

skin rash
GI upset

rarely: hypersensitive

106
Q

steroid side effects

A

bones (vit-D, Ca, DEXA)
gastric (PPI)

weight gain, sleep disturb, infection

less freq: diabetes, cushings

107
Q

fibromyalgia

A

history of widespread pain
multiple widespread points of tenderness

?exercise beneficial
?low dose amitriptyline

108
Q

knee complaints in kids

A

chondromalacia patellae

  • teen girls
  • ant knee pain up and down stairs/ standing up
  • > physio

O-S

  • sporty teen
  • tib tubercle pain tender swell

patellar tendonitis

  • sporty boys
  • worse w activity
  • tender below patellar

osteo chondritis disecans

  • pain post exercise
  • intermittent welling and LOCKING

patellar subluxation
- med knee giving way

109
Q

tallipes equinevarus - club foot

A

inverted plantar flex deform at birth

grad non surgical correction

110
Q

autoantibodies summary

A 
AMA - prim bil cirr
SMA, ANA - auto hep
ANA, anti-dsDNA, anti-Smith - SLE
RhF, anti CCB - RA
ANA, anti centromere - cutaneous SSc
ANA, anti topoisomerase - diffuse SSc

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