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3b general care > Rheumatology and Orthopaedics > Flashcards

Rheumatology and Orthopaedics Flashcards

1
Q

What are the red flags for back pain?

A 
Age <20 or >50
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever

others- thoracic pain, immunosuppression, structural deformity, neuro signs

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2
Q

What are back pain emergencies?

A

infection, malignancy, nerve compromise and fracture

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3
Q

What features of back pain point towards a prolapsed disc?

A

leg pain usually worse than back

pain often worse when sitting

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4
Q

What features are of a L3 nerve compression?

A

sensory loss over anterior thigh
weak quads
reduced knee reflex
+ve femoral stretch test

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5
Q

What features are of a L4 nerve compression?

A

sensory loss over anterior knee
weak quads
reduced knee reflex
+ve femoral stretch test

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6
Q

What features are of a L5 nerve compression?

A

sensory loss over dorsum of foot
weakness in foot and big toe dorsiflexion
reflexes intact
+ve sciatic nerve stretch test

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7
Q

What features are of a S1 nerve compression?

A

sensory loss posterolateral leg and foot
weakness in plantar flexion
reduced ankle reflex
+ve sciatic nerve stretch test

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8
Q

What features of back pain point towards peripheral arterial disease?

A

pain on walking, relieved by rest
absent or weak foot pulses
smoking history or other vascular disease

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9
Q

What syndromes are associated with HLA-B27?

A

ankylosing spondylitis
reiter’s syndrome
acute anterior uveitis

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10
Q

What is ankylosing spondylitis?

A 
ankylosing= stiffness in a joint
spondylitis= inflammation of the spine
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11
Q

What are associations of ankylosing spondylitis?

A

IBD
Chlamydial urethritis
psoriasis

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12
Q

features of ankylosing spondylitis?

A

lower back pain and stiffness
worse in morning and improves with exercise
reduced lateral and forward flexion
reduced chest expansion

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13
Q

‘A’ features of ank spond?

A 
Apical fibrosis
Anterior uveitis
Aortic regurg
Achilles tendonitis
AV node block
Amyloidosis 
Peripheral arthritis
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14
Q

Ix of ank spond?

A

ESR/CRP
HLA-B27
Xray of sacroiliac joints- later findings are bamboo spine, subchondrial erosions, sclerosis, squaring of the lumbar vertebrae, syndesmophytes

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15
Q

Tx of ank spond?

A

encourage regular exercise
NSAIDs
DMARDs
Anti-TNF if persistently high disease activity (must have failed 2 NSAIDs first)

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16
Q

What are features of spinal cord compression?

A

back pain- may be worse on lying down and coughing
lower limb weakness
sensory loss and numbness
nocturnal
lesions above L1-> UMN signs in legs and a sensory level
lesions below L1->LMN signs in the legs and perianal numbness

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17
Q

Mx if you suspect spinal cord compression?

A

Whole spine MRI
high dose dexamethasone
urgent oncological assessment for consideration of radiotherapy or surgery

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18
Q

What is cauda equina syndrome?

A

Damage to the cauda equina- peripheral nerves protruding from the bottom of the spinal cord

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19
Q

What is the structure of the spinal cord?

A 
31 spinal nerves
C8
T12
L5
S5
1 coccygeal 
L5 onwards travel together to form the cauda equina
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20
Q

What are causes of cauda equina syndrome?

A 
lumbar disc herniation
spinal stenosis
AS
spondylolisthesis- vertebra displaced by trauma, surgery or degeneration e.g. anterolisthesis
Trauma to spine
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21
Q

features of cauda equina syndrome?

A 
incontinence due to decreased tone of anal sphincter and muscles of bladder wall
decreased sexual function
saddle anaesthesia
leg weakness
sciatic pain
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22
Q

Diagnosis of cauda equina syndrome?

A

MRI/CT

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23
Q

Tx of cauda equina syndrome?

A

surgical decompression within 48 hours of sudden onset (tumour,trauma)
corticosteroids and Abx of gradual onset (degeneration)

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24
Q

What are general features of rheumatoid arthritis?

A 
swollen,painful joints in hands and feet
stiffness worse in mornings and hot weather
gradual larger joint involvement
positive squeeze test- metacarpals
rheumatoid nodules
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25
Q

What are hand signs of rheumatoid arthritis?

A 
swan necking
Z-thumb
subluxtion of the MCP
muscle wasting
ulnar deviation
fixed flexion deformity- Boutonniere deformity
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26
Q

Name some eye signs of rheumatoid arthritis?

A

keratoconjunctivitis sicca
episcleritis/scleritis
corneal ulceration

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27
Q

Name some pulmonary signs of rheumatoid arthritis?

A

pulmonary fibrosis, pleural effusion, pulmonary modules, pleurisy, caplan’s syndrome, infection secondary to immunosuppression

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28
Q

Name some systemic signs of rheumatoid arthritis?

A 
swollen bursea
anaemia
vasculitis
lymphadenopathy
splenomegaly
Raynaud's Sjogren's syndrome
septic arthritis 
amyloidosis
pericarditis
depression
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29
Q

Ix of rheumatoid arthritis?

A 
RF circulating antibody
anti-CCP antibody
ESR/CRP
Joint aspiration
MRI
XR
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30
Q

XR findings of rheumatoid arthritis?

A

Loss of joint space
Erosions (periarticular)
Soft tissue swelling
Soft bones (osteopenia)

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31
Q

Tx of rheumatoid arthritis?

A

1st line= DMARD monotherapy +/- a short course of bridging prednisolone
DMARDS- methotrexate, sulfasalazine, leflunomide, hydroxychloroquine

Can add TNF-inhibitors after 2 failed DMARDS e.g. etanercept, infliximab

Rituximab
anti-CD20 monoclonal antibody, results in B-cell depletion
two 1g intravenous infusions are given two weeks apart
infusion reactions are common

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32
Q

monitoring and SEs of methotrexate?

A

Monitor FBC and LFT due to risk of liver cirrhosis and myelosuppression
SE- pneumonitis, liver toxicity, bone marrow suppression, GI toxicity e.g. stomatitis

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33
Q

SEs of sulfasalazine?

A

Increased risk of allergy if also allergic to aspirin

SE- rashes, oligospermia, interstitial lung disease, staining of contact lenses, steven-johnson syndrome

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34
Q

SEs of leflunomide?

A

Liver impairment, hypertension, interstitial lung disease

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35
Q

SEs of hydroxychloroquine?

A

retinopathy, corneal deposits

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36
Q

SEs of TNF inhibitors?

A

reactivation of TB

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37
Q

What is felty’s syndrome?

A

RA + splenomegaly + low WCC

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38
Q

what causes gout?

A

deposition of uric acid in the synovium

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39
Q

causes of gout?

A

decreased excretion of uric acid- diuretics, aspirin, CKD, lead toxicity
increased production of uric acid- myeloproliferative disorder, cytotoxic drugs, severe psoriasis
Diet- red meat, alcohol, high sat fats

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40
Q

What is primary gout?

A

may result from an inherited gene#excess de novo purine

synthesis or reduced renal excretion of uric acid

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41
Q

What is secondary gout?

A

increased lysis of cells e.g. chemo

diuretics or chronic renal disease

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42
Q

features of acute gout?

A

70% 1st MTP- pain,swelling, erythema

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43
Q

features of chronic (tophaceous) gout?

A 
occurs after many attacks
asymmetrical polyarthritis
cartilage and bone 'punched out' lesions
deposition of urate crystals- resulting in tophi 
restriction of joint movements
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44
Q

Ix of gout?

A

serum urate
WCC
ESR
synovial fluid aspiration- negatively birefringent under polarised light (needle shaped)

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45
Q

Tx of gout?

A

1st line: NSAIDs and colchicine (PPI needed)
prednisolone 15mg/day in contraindicated
intra-articular steroid injection

Urate lowering therapy- allopurinol (xanthene oxidase inhibitor)
- delayed starting
-100mg OD then titrated every few weeks until serum uric acid <300umol/L
-lower initial dose if reduced eGFR
can use febuxostat instead of allopurinol

lifestyle advice- diet and alcohol

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46
Q

What is pseudogout?

A

caused by deposition of calcium pyrophosphate in the synovium
It usually presents as a monoarthritis in the elderly
knee, wrist and shoulder most commonly affected

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47
Q

RFs for pseudogout?

A 
hyperparathyroidism
hypothyroidism
haemochromatosis
acromegaly
low Mg, low phosphate
Wilson's disease
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48
Q

Ix of pseudogout?

A

joint aspiration- weakly positive birefringent rhomboid shaped crystals
X-ray- chondrocalcinosis

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49
Q

Tx of pseudogout?

A

aspiration of joint fluid to exclude septic arthritis

NSAIDs or intra-articular, IM or oral steroids as per gout

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50
Q

What is enteropathic arthropathy?

A

associated with IBD and coeliac disease
HLA-B27 associated
seronegative therefore ANA and ANCA negative

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51
Q

types of psoriatic arthritis?

A 
Rheumatoid-like polyarthritis
Asymmetrical oligoarthritis: hands and feet typically
Sacroilitis
DIP joint disease
Arthritis mutilans
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52
Q

Nail changes in psoriatic arthritis?

A 
psoriatic nail dystrophy
discolouration of nails
oncholysis
pitting nails 
subungal hyerkeratosis
ridging
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53
Q

Ix of psoriatic arthritis?

A

synovial biopsy- not routinely performed

XR-pencil-in-cup deformity

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54
Q

Tx of psoriatic arthritis?

A

treat as RA
DMARDS- methotrexate and leflunomide
hydroxychloroquine is avoided as it exacerbates skin disease

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55
Q

Causes of reactive arthritis?

A

follow an infection (usually an STI) where the organism can’t be recovered from a joint
STIs- chlamydia (more common in men)
Dysentry- shigella, salmonella, E.coli, campylobacter

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56
Q

features of reactive arthritis?

A

typically develops 4 weeks after infection
asymmetrical oligoarthritis, dactylitis, urethritis, eyes: conjunctivitis, anterior uveitis
skin: blennorrhagia (waxy yellow/brown apules on palms and soles), circunate balanitis (painless vesicles on prepuce), keratoderma

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57
Q

Ix for reactive arthritis?

A

bloods- ESR/CRP
stool sample
test for STIs

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58
Q

Tx for reactive arthritis?

A

symptomatic- analgesia, NSAIDs, intra-articular steroids
sulfasalazine and methotrexate are sometimes used for persistent disease
symptoms may last for up to 12 months

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59
Q

causes of septic arthritis?

A

most common organism overall is Staphylococcus aureus
in young adults who are sexually active Neisseria gonorrhoeae should also be considered
in adults, the most common location is the knee

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60
Q

RFs for septic arthritis?

A 
immunocompromised
DM
prosthetic joint
RA/OA
steroids
IVDU
unprotected sex
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61
Q

features of septic arthritis?

A

acute onset, singular joint
gets progressively worse
concurrent infection e.g. UTI
constitutional symptoms (febrile, hypotensive, tachycardic)

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62
Q

Kocher criteria for the diagnosis of septic arthritis?

A

fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC

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63
Q

Mx of septic arthritis?

A

synovial fluid should be obtained before starting treatment
intravenous antibiotics which cover Gram-positive cocci are indicated. The BNF currently recommends flucloxacillin or clindamycin if penicillin allergic
antibiotic treatment is normally be given for several weeks (BNF states 6-12 weeks)
needle aspiration should be used to decompress the joint
arthroscopic lavage may be required

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64
Q

epidemiology of SLE?

A 
black africans and indian Asians
peak incidence is 25-35 years
female
genetic predisposition
UV light exposure
can be caused by chlorpromazine, hydralazine, isoniazid, procainamide
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65
Q

diagnostic criteria of SLE

A

4/11 needed for diagnosis from American College of Rheumatology-
1- Malar rash
2- Oral ulceration
3- Discoid rash (oval or round) seen in areas exposed to sunlight
4- Arthritis
5- Photosensitivity
6-Serositis
7- Neuro disorders- seizures, psychosis
8- Renal disease- proteinuria, red cell casts in urine
9- Haematological disorder- leucopenia, lymphopenia, haemolytic anaemia, thrombocytopenia
10- immunological disorder- antibodies to DsDNA, Anti-SM
11- ANA positive

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66
Q

Ix of SLE?

A

Urine dipstick- proteinuria, red cell casts
ESR is often raised but CRP is normal
ANA positive in >95%
dsDNA +ve in 65%-highly specific for SLE- used for disease monitoring

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67
Q

tx of acute flare ups of SLE?

A

IV cyclophosphamide and high-dose prednisolone

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68
Q

maintenance tx of SLE?

A

NSAIDs
Hydroxychloroquine- Useful for skin lesions, arthralgia, myalgia and malaise
Cyclophosphamide is reserved for treatment of life-threatening disease
DMARDS as steroid sparing agents

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69
Q

What is antiphospholipid syndrome associated with?

A

SLE

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70
Q

Features of antiphospholipid syndrome?

A 
CLOTS
Coagulation defect (thrombosis)
Livedo reticularis
Obstetric (recurrent miscarriage)
Thrombocytopenia
SLE
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71
Q

antibody for antiphospholipid syndrome?

A

anti-cardolipin

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72
Q

Tx for antiphospholipid syndrome?

A

warfarin for VTE risk

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73
Q

what is systemic sclerosis? (scleroderma)

A

vascular damage within skin and organs leads to fibrosis

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74
Q

what are the different types of scleroderma?

A
  1. Limited cutaneous scleroderma

2. Diffuse cutaneous scleroderma

75
Q

What is Limited cutaneous scleroderma?

A 
CREST
Calcinosis
Raynaud's
oesophageal dysmotility
Sclerodactyly- thickening of the skin
Telangiectasia
76
Q

what is diffuse cutaneous scleroderma?

A

affects trunk and proximal limbs predominantly and there is multi-system involvement
Can be life-threatening

77
Q

What antibodies are associated with which type of scleroderma?

A

scl-70 antibodies associated with limited cutaneous Anti-centromere associated with diffuse cutaneous

78
Q

mx of scleroderma?

A

no cure
IV cyclophosphamide for organ involvement and progressive skin disease
Monitor BP and renal function

79
Q

what is Sjogren’s syndrome?

A

autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces

80
Q

causes of Sjogren’s syndrome?

A

primary or
secondary to RA and other CNDs
females

81
Q

features of Sjogren’s syndrome?

A 
dry mouth 
dry eyes(keratoconjunctivitis sicca)
vaginal dryness
arthralgia
Raynaud's, myalgia
sensory polyneuropathy
recurrent episodes of parotitis
renal tubular acidosis
82
Q

antibodies associated with Sjogren’s syndrome?

A

RF +ve
ANA +ve in 70%
anti-Ro
Anti-la

83
Q

what is Schirmer’s test?

A

measures tear infiltration

84
Q

tx of Sjogren’s syndrome?

A

artificial saliva and tears

pilocarpine may stimulate saliva production

85
Q

what does polymyalgia rheumatica overlap with?

A

temporal arteritis/GCA

86
Q

what is polymyalgia rheumatica?

A

vasculitis with giant cells

87
Q

features of polymyalgia rheumatica

A 
aching, morning stiffness in proximal limbs
NO WEAKNESS
mild polyarthralgia
lethargy
depression
low-grade fever
anorexia
night sweats
88
Q

core criteria for diagnosis of polymyalgia rheumatica

A 
bilateral shoulder or pelvic girdle pain
morning stiffness >45 mins
age >50 years
duration of symptoms >2 weeks
raised ESR or CRP
89
Q

tx of polymyalgia rheumatica?

A

prednisolone- should have dramatic response

oral alendronate and calcium and Vit D replacement

90
Q

what is an important SE of prednisolone?

A

avascular necrosis

91
Q

what is dermatomyositis?

A

an inflammatory disorder caused symmetrical, proximal muscle weakness and characteristic skin lesions

(connective tissue disorder)

92
Q

features of dermatomyositis?

A 
photosensitive
macular rash over back and shoulders
helitrope rash in the periorbital region
Gottron's papules- roughened red papules over extensor surfaces of fingers
nail fold capillary dilatation
resp muscle weakness
interstitial lung disease
dysphaghia, dysphonia
93
Q

Ix for dermatomyositis?

A 
ANA positive
Anti-Mi-2 positive in 25%
bloods- CK, AST, LDH
skin biopsy
muscle biopsy
EMG testing 
MRI
94
Q

tx of dermatomyositis?

A

oral prednisolone
hydroxychloroquine may reduce the photosensitive rash
immunosuppressive drugs- methotrexate, mycophenolate, azathioprine, cyclophosphamide
Diltiazem may reduce calcinosis
avoid sun exposure

95
Q

what is polymyositis?

A

a variant of the disease where skin manifestations are not prominent

96
Q

features of polymyositis?

A

diffuse weakness in proximal muscles
(distal muscles spared)
pharyngheal weakness can cause dysphagia

97
Q

Ix of polymyositis?

A

CK >50 times normal
20% have anti-Jo-1 antibodies
muscle biopsy and EMG are diagnostic

98
Q

tx of polymyositis

A

same as dermatomyositis

99
Q

what are causes of primary vs secondary raynauds?

A 
primary- Raynaud's disease
secondary:
- CTD- scleroderma, SLE, RA
- leukaemia
- type 1 cryoglobulinaemia, cold agglutinins
- use of vibrating tools
- drugs- OCP, ergot
- cervical rib
100
Q

mx of raynauds

A 
1st line- CCBs e.g. nifedipine
IV prostacyclin (epoprostenol) infusions: effects may last severeal weeks/months
101
Q

what is vasculitis?

A

inflammation of the blood vessel walls

102
Q

what is Takayasu’s arteritis?

A

vasculitis causing occlusion of the aorta

103
Q

RFs for Takayasu’s arteritis?

A

female and asian

104
Q

features of Takayasu’s arteritis?

A

systemic features- malaise, headache
unequal blood pressure in the upper limbs
carotid bruit
intermittent claudication
aortic regurgitation
ESR often affected during the acute phase

105
Q

association with Takayasu’s arteritis?

A

renal artery stenosis

106
Q

tx of Takayasu’s arteritis?

A

steroids

107
Q

what is buerger’s disease?

A

large artery vasculitis associated with smoking

108
Q

features of buerger’s disease?

A

extremely ischaemic, superficial thrombophlebitis
Raynaud’s phenomenon
tortuous corkscrew vessels seen on angiography

109
Q

what is polyarteritis nodosa?

A

systemic necrotising granulomatous vasculitis

RFs- middle aged men, hep B infection

110
Q

What is Granulomatosis with polyangiitis?

medium sized arteries

A

prev known as Wegener’s granulomatosis
autoimmune condition associated with a necrotising graumlomatous vasculitis affecting both the upper and lower resp tract as well as the kidneys

111
Q

features of Granulomatosis with polyangiitis

A

upper resp tract- epistaxis, sinusitis, nasal crusting
lower resp tract- dyspnoea, haemoptysis
rapidly progressing glomerulonephritis
saddle-shaped nose deformity
vasculitic rash
eye involvement e.g. proptosis, cranial nerve lesions

112
Q

Ix of Granulomatosis with polyangiitis?

A

cANCA +ve in >90%
pANCA +ve in 25%
CXR- cavitating lesions
renal biopsy- epithelial crescents in Bowman’s capsule

113
Q

tx of Granulomatosis with polyangiitis?

A

median survival 8-9 years
steroids
cyclophosphamide
plasma exchange

114
Q

what is ANCA-associated small vessel vasculitis?

A 
prev Churg-Strauss syndrome
asthma
blood eosinophilia
paranasal sinusitis
mononeuritis multiplex
115
Q

what is Henoch- schonlein purpura?

A

IgA-mediated small vessel vasculitis

overlaps with berger’s disease

116
Q

when is HSP commonly seen?

A

in children following an infection

117
Q

features of HSP?

A

Palpable purpuric rash (with localised oedema) over buttocks and extensor surefaces of arms and legs
abdo pain
polyarteritis
IgA nephropathy- haematuria, renal failure

118
Q

tx for HSP?

A

analgesia for arthralgia
self-limiting in children, esp without renal involvement
around 1/3 of patients have a relapse

119
Q

what makes up cartilage?

A 
75% water
collagen (type II)
chondrocytes
fibroblasts
proteoglycans
120
Q

what is osteoarthritis?

A

loss of cartilage at synovial joints

121
Q

RFs for OA?

A 
genetics 
prev trauma
obesity
hypermobile joints
manual labourers
female ,increasing age
DDH
122
Q

features of OA?

A 
Joint pain and stiffness- pain provoked by movement, stiffness after inactivity
joint instability
muscle wasting
audible joint crepitus
squaring of the hand
123
Q

what are heberden’s and bouchard’s nodes in OA

A

heberden’s nodes (DIP)

bouchard’s nodes (PIP)

124
Q

most common joints for OA?

A

Knee

hip

125
Q

XR feature of OA?

A

Loss of joint space
Osteophyte formation
Subchondral cysts
Subchondral sclerosis

126
Q

other investigations for OA?

A

bloods
MRI
arthroscopy

127
Q

mx for OA?

A

Weight loss, exercise, supports and braces
paracetamol and topical NSAIDs first line
intra-articular cortocisteroids
PT
joint replacement

128
Q

What is a type 1 hypersensitivity reactions?

A

IgE bound to mast cells

anaphylactic, atopy

129
Q

What is a type 2 hypersensitivity reactions?

A

IgG or IgM cell bound

autoimmune haemolytic anemia, ITP, goodpasture’s etc

130
Q

What is a type 3 hypersensitivity reactions?

A

free antigen complex immune bound

SLE, post-strep GN, extrinsic allegic alveolitis

131
Q

What is a type 4 hypersensitivity reactions?

A

delayed hypersensitivity, T-cell mediated

TB, allergic contact dermatitis, MS, GBS

132
Q

What is a type 5 hypersensitivity reactions?

A

antibodies that bind to cell surface receptors

grave’s disease, myasthenia gravis

133
Q

what is ehler-danlos syndrome?

A

AD connective tissue disease affecting type III collagen results in tissue becoming more elastic

134
Q

features of ehler-danlos syndrome?

A

elastic,fragile skin
joint hyperbility- recurrent joint dislocation
east bruising
aortic regurg, mitral valve prolapse, aortic dissection
SAH

135
Q

What muscles are involved in the rotator cuff?

A

supraspinatus- abduction
infraspinatus-rotates arm laterally
teres minor- adducts and lateral rotation
subscapularis- adducts and rotates arm medially

136
Q

what length of rotator cuff tear needs surgical repairal?

A

> 2cm

With rotator cuff tears the pain may be in the first 60 degrees.

137
Q

what are signs of impingement syndrome?

A

painful arc of abduction. With subacromial impingement, this is typically between 60 and 120 degrees.
tenderness over anterior acromion

138
Q

what is a colles’ fracture?

A

FOOSH
distal radial fracture with dorsal displacement of fragments
dinner fork type deformity

139
Q

what is a smith’s fracture?

A

falling backwards onto palm
volar angulation of distal radium fragment
garden spade deformity

140
Q

what are features of a hip fracture?

A

pain, shortened and externally rotated leg

141
Q

what is the classification of hip fractures?

A

gardner’s classification
intracapsular- can be displaced or undisplaced
extracapsular- subtrochanteric or intertrochanteric

142
Q

what is management of a intracapsular fracture?

A

undisplaced-
young and fit- internal fixation
old- hemiarthroplasty

displaced-
young and fit- reduced and internal fixation
old but good mobility- total hip replacement
old with bad mobility- hemiarthroplasty

143
Q

mx of extracapsular hip fracture?

A

intertrochanteric- dynamic hip screw

extratrochanteric- intramedullary nail

144
Q

mx of fall patient

A 
A-E assessment
rule out head injury
cardiac symptoms- pain, SOB, palpitations- ECG
stroke 
infection- urine dip
lying and standing BP (sigf if SBP drops by 20 or DBP drops by 10)
BM
c-SPINE
145
Q

Criteria for immediate head CT?

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture.
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting
more than 30 minutes’ retrograde amnesia of events immediately before the head injury

146
Q

what happens if patient on warfarin with head injury but no other symptoms?

A

CT head within 8 hours

147
Q

mx of an open fracture?

A 
broad spec abx e.g. coamoxiclav
tetanus booster
analgesia
IVI/ transfusion
imaging- XR
bloods- pre-op bloods: FBC, U&amp;E, group and save, renal function, clotting
ECG
Cannula
specialist- reduce and splint, surgical debridement, then fixation later
148
Q

what is adhesive capsulitis

A

frozen shoulder

149
Q

RFs for adhesive capsulitis?

A

female, DM

150
Q

features of adhesive capsulitis?

A

external rotation affected most
both active and passive movement affected
painful freezing stage -> adhesive stage -> recovery stage
lasts 6 months- 2 years

151
Q

mx of frozen capsulitis

A

`NSAIDs
PT
oral corticosteroids
intra-articular corticosteroids

152
Q

what is Bechet’s syndrome?

A

oral ulcers, genital warts and anterior uveitis

153
Q

what is compartment syndrome?

A

can occur following fractures

raised pressure within a closed anatomical space -> compromised tissue perfusion -> necrosis

154
Q

causes of compartment syndrome?

A

supracondylar fractures

tibial shaft injuries

155
Q

features of compartment syndrome?

A

pain, paraesthesia, pallor, paralysis

arterial pulsation may still be felt

156
Q

diagnosis of compartment syndrome?

A

measurement of intracompartmental pressure
>40mmHg is diagnostic
no pathology seen on XR

157
Q

tx of compartment syndrome?

A

fasciotomy

aggressive IV fluids due to myoglobinuria risk

158
Q

what is Ottawa ankle rules?

A

An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:

bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)

bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)

inability to walk four weight bearing steps immediately after the injury and in the emergency department

159
Q

what is weber classification for an ankle fracture

A

Type A is below the syndesmosis
Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis
Type C is above the syndesmosis which may itself be damaged

160
Q

mx of an ankle fracture

A

unstable (proximal)- surgical repair

stable- cast

161
Q

what is carpal tunnel syndrome?

A

compression of median nerve in the carpal tunnel

162
Q

causes of carpal tunnel syndrome?

A 
idiopathic
pregnancy
oedema e.g. heart failure
lunate fracture
rheumatoid arthritis
163
Q

features of carpal tunnel syndrome?

A

pains/ pins and needles in the thumb, index and middle finger
shakes hand to obtain relief
weakness of thumb abduction
tinels and Phalen’s sign

164
Q

mx of carpal tunnel syndrome?

A

corticosteroid injection
wrist splints at night
surgical decompression

165
Q

what is involved in a myeloma screen?

A 
FBC with film
U+Es including calcium
Urinary bence-jones proteins
serum electrophoresis
XR of painful bones
166
Q

what are common organisms for osteomyelitis?

A

staph aureus

salmonella if sickle-cell anaemia

167
Q

predisposing conditions for osteomyelitis?

A 
diabetes mellitus
sickle cell anaemia
intravenous drug user
immunosuppression due to either medication or HIV
alcohol excess
168
Q

mx of osteomyelitis?

A

MRI
flucloxacillin for 6 weeks
clindamycin if allergic

169
Q

how does power change in UMN lesions in upper and lower limbs?

A

UMN lesions- flexors>extensors in upper limbs, extensors >flexors in lower limbs

170
Q

what signs do lesions above and below L1 present with?

A

above- UMN signs in legs and a sensory level

below- LMN signs and perianal numbness

171
Q

how doe a NOF appear on clinical examination?

A

leg shortened and externally rotated

172
Q

how does an anterior and posterior dislocation present on clinical examination?

A

anterior- abducted and externally rotated. No leg shortening

posterior- leg is shortened, adducted, and internally rotated

173
Q

complications of hip dislocation?

A

Sciatic or femoral nerve injury
Avascular necrosis
Osteoarthritis: more common in older patients.
Recurrent dislocation: due to damage of supporting ligaments

174
Q

what is a fat embolism?

A

hypoxic, neurological (confused), petechial rash, pyrexic

175
Q

what is FRAX?

A

10 year risk of fragility score

176
Q

what is marfan’s syndrome?

A

mutation in protein fibrollin-1

tall, high-arched palate, pectus excavatum, heart problems, pes planus

177
Q

mx of a subtrochanteric femoral fracture?

A

intramedullary nail

weight bear immediately after operation

178
Q

what is a monteggia fracture?

A

fracture of proximal ulna and dislocation of proximal head of radius
commonly seen in children

179
Q

SE of steroids?

A 
impaired glucose tolerance
OP
avascular necrosis
cushing's syndrome
hypertension
dyspepsia
cataracts
increased risk of infections
180
Q

Ottawa rules for ankle fracture?

A

ankle/foot XR only required if there is tenderness in:
-lateral malleolus
-medial malleolus
- base of 5th metatarsal head
- navicular bone (medial)
OR inability to walk more than 4 steps in ED

181
Q

how to describe fractures?

A 
AABCS
Adequacy
Alignment
Bones
Cartilage
Soft tissue

OLD ACID
Open/closed
Location- proximal/mid/distal
Degree- complete/incomplete

Articular involvement (joint)/ angulation
Communication and pattern
Intrinsic bone quality
Displacement/rotation

182
Q

what to send joint aspiration for in septic arthritis?

A

glucose
gram stain
MC&S

183
Q

atraumatic causes of avascular necrosis?

A 
lupus
steroids
diabetes
pregnancy-related
perthes
184
Q

sign of anterior shoulder dislocation on XR?

A

light bulb sign

more medial

3b general care (3 decks)

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