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MIND AND MOVEMENT > Rheumatology and Ortho > Flashcards

Rheumatology and Ortho Flashcards

1
Q

Differentials of hip pain in a child

A 
Septic Arthritis
Perches disease
Transient synovitis
Slipped upper femoral epiphysis
Developmental dysplasia of the hip 
JIA
Cancer
Fracture 
Referred pain from knee, back, testes
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2
Q

Transient synovitis

A 
Boys aged 4-8
Limp with or without pain 
Self limiting
Occurs after URTI
treat with ibuprofen
Resolves after few days
Sepsis safeguard!
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3
Q

Slipped upper femoral epiphysis

A 
Boys over age of 10
Usually obese or hypothyroid
Sudden onset pain
Non weight bearing 
Limp
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4
Q

Developmental dysplasia of the hip

A

Girls, usually discovered at birth

Change in leg length

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5
Q

Perthes disease

A

Boys aged 4-8
Avascular necrosis of head of femur
Can be bilateral

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6
Q

Hip pain in child- Nocturnal pain, night sweats, weight loss

A

Think ALL!

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7
Q

Treatment of osteoarthritis

A 
Patient education
Weight loss
Exercise
Physio
Analgesia- WHO ladder
Can escalate to steroid joint injections
Joint replacement
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8
Q

X-ray changes in osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

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9
Q

Osteoarthritis examination findings

A

Heberdens nodes on DIP
Bouchards nodes on PIP
Boxing of hand

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10
Q

Rheumatoid Arthritis X-ray findings

A 
LESS
loss of joint space
Erosions
Soft tissue swelling 
Soft bones (osteopenia)
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11
Q

Rheumatoid arthritis clinical examination findings

A 
Ulnar deviation of fingers
Subluxation of joints
Z thumb
Boggy joint swellings
Swan neck deformities
Boutinierres deformity

Can have nail changes

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12
Q

Negatively birefringent needles under polarised light

A

Gout - urate crystals

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13
Q

Treatment of gout

A

Ibuprofen or colchicine if ibuprofen contraindicated
Febuxostat also used
Allopurinol if repeated attacks (be aware of increase in episodes in first 6 months)

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14
Q

Risk factors for gout

A

High urate intake- red meats, marmite, alcohol
Diuretic use especially thiazides
Metabolic disorders (genetics)
Dehydration

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15
Q

Pseudogout

A

Calcium pyrophosphate crystals
Weakly positive rhomboid shaped crystals
Treatment- ibuprofen, steroid injections, stay hydrated

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16
Q

Describe a fracture

A 
Simple vs comminuted 
Transverse, oblique, spiral
Site
Displaced or not
Angulated or not
Is the bone normal?

Ask for lateral view

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17
Q

Treatment of intra capsular neck of femur fracture

A

Hemiarthroplasty if not very active and co morbidities

Full hip replacement if active and healthy or pre existing joint disease

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18
Q

Presentation of hip fracture

A 
Pain especially on greater trochanter and on rotation 
Usually after fall
Leg externally rotated 
Shortened leg 
Non weight bearing

Could be referred to knee

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19
Q

Treatment of extra capsular NOF fracture

A

Dynamic hip screw or intramedullary fixation

Think about bone protection, analgesia, IV access

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20
Q

Secondary causes of OA in young people

A

Crystal deposition, acromegaly, haemochromatosis, Wilson’s disease, joint injury, surgery, SUFE, diabetes, syphillis, inflammatory arthritis

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21
Q

Hot swollen painful joint

A

Septic arthritis until proven otherwise!

Gout
Rheumatoid arthritis 
Pseudogout
Psoriatic arthritis
Haemoarhrosis
Reactive arthritis
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22
Q

Symptoms of septic arthritis

A

Hot painful swollen joint
Systemically unwell
Fevers
Acute onset

23
Q

Diagnosis of septic arthritis

A

Joint aspirate and culture!!

24
Q

Treatment of septic arthritis

A

Analgesia
Broad spec antibiotics eg ceftriaxone
Usually a stall aureus infection
Look for underlying risks such as immunosuppression

25
Q

Back pain In 15-30 YOA

A

Prolapsed disc
Trauma
Fractures
Ankylosing spondylitis

26
Q

Back pain in 30-50 YOA

A

Degenerative spinal disease, prolapsed disc, malignancy

27
Q

Back pain in over 50s

A

Degenerative, osteoporotic vertebral collapse, pagets, malignancy, myeloma, spinal stenosis

28
Q

Positive straight leg raise

A

Sciatica
Under 50s due to prolapsed disc
Over 50 due to spinal stenosis

29
Q

Symptoms of lupus

A 
Malar rash
Discoid rash
Photosensitivity 
Oral ulcers
Arthritis
Pleuritis
Renal involvement
Haematological involvement
Immune involvement
Positive ANA
30
Q

SLE antibodies

A

ANA >95%

Anti dsDNA- over 60%

31
Q

Treatment for SLE

A

Anti inflammatories eg ibuprofen
Corticosteroids during flare up
Immunosuppression

Symptom control- suncream, kidney treatment if necessary

32
Q

Positive c-ANCA

A

Small vessel vasculitis
Microscopic polyangitis
GPA

33
Q

GPA- granulomatosis polyangitis

A

Positive c ANCA

Nasal crusting, lung lesions, saddle nose deformities

34
Q

P ANCA

A

Church Strauss
Eosinophilia granulomatosis polyangitis EGPA
Linked with asthma

35
Q

Medium vessel vasculitis

A

Kawasaki- symptoms in children, fever, strawberry tongue, rash

36
Q

Giant cell arteritis

A 
Temporal arteritis
Give prednisone ASAP 
Need biopsy within seven days of starting pred to get positive biopsy.
Increase ESR!!
Jaw claudication
Temporal tenderness
Headache around eye
37
Q

Takayasu’s arteritis

A

Absent pulses
Happens in younger People
PET scan shows activity
Pred and strong DMARDS eg cyclophosphamide

38
Q

Polyarteritis nodosa

A

Associated with hep B
Get aneurysms
Control BP as affects kidneys

39
Q

Symptoms of fibromyalgia

A

Pain in at least 11 of the 18 pain points- above and below waist, either side of axis and on spine
Difficulty sleeping
Chronic widespread pain lasting over three months

40
Q

Risk factors of fibromyalgia

A

Low education, low income, female, FH, traumatic event

41
Q

Treatment for fibromyalgia

A

Exercise!
Screen for depression and anxiety
Sleep hygiene

42
Q

Reactive arthritis

A

After GU or GI infection

Reiter’s anterior uveitis, arthritis, urethritis

43
Q

Ankylosing spondylitis

A

Back pain In young males
HLAB27 positive in 90%
Pain in sacroiliac joints

44
Q

Associations with ankylosing spondylitis

A 
Aortic regurgitation 
Apical fibrosis
igA nephropathy
Anterior uveitis
Achilles tendinitis
Amyloidosis
45
Q

Treatment of ankylosing spondylitis

A
  1. Exercise
  2. Ibuprofen
  3. If necessary anti TNF-a or local steroid injections
46
Q

Symptoms of rheumatoid arthritis

A

Boggy swelling in hands
Stiffness and pain worse in morning
Symmetrical usually in wrists, MCP, PIP
Positive for RF and anti CCP

47
Q

Monitor rheumatoid arthritis

A

DAS28 helps to monitor disease activity

48
Q

side effects of methotrexate

A

Mucositis, penumonitis, oral ulcers, hepatotoxicity

49
Q

TNF alpha blocker side effects

A

Serious infection risk including reactivation of TB, hep B
Worsens heart failure
Hypersensitivity
Injection site reaction

50
Q

Anti Ro and Anti La

A

Sjogrens

51
Q

CREST

A

Anti centromere antibodies

52
Q

Anti SCL 70

A

Scleroderma

53
Q

Anti ds DNA and ANA

A

SLE

MIND AND MOVEMENT (6 decks)

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