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MSRA 2023 > Rheumatology + MSK > Flashcards

Rheumatology + MSK Flashcards

1
Q

Ix Rheumatoid arthritis

A

Rheumatoid facture-> 1st LINE
- does not indicate disease activity

anti-CCP (cyclic citrullinated peptide)
- (+) 10yrs before development RA

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2
Q

Mx Rheumatoid arthritis flare

A

po/im steroid

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3
Q

DMARD medications

A

MTX, salfasalazine, leflunomide, hydroxychloroquine

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4
Q

IC NOF mx

A

undisplaced: internal fixation/ hemi if unfit
displaced: THR/ hemi to ALL pt

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5
Q

when to consider THR

A

THY: independent (max use of stick)
no cognitive impairment
MFFD for anaesthetics

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6
Q

EC NOF mx

A

stable INTERTROCHANTERIC: DHS

reverse oblique, transverse, subtrochanteric #: IM

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7
Q

stable intertrochanteric # mx

A

DHS

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8
Q

reverse oblique, transver, subtrochanteric EC NOF

A

IM nail

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9
Q

Ankylosing spondylitis typical presentation + during which time of day worst

A

back pain + stiffness
stiffness worse in morning + improves with exercise
reduced lateral flexion

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10
Q

Schrober’s test

A

Ankylosing spondylitis: line drawn 10cm above + 5cm below back imple
If distance btw 2 line does NOT increase by >5cm when pt bends

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11
Q

which other disease associated with ankylosing spondylitis
(name eye condition)

A

anterior uveitis

(A’s: ant uveitis, apical fibrosis, aortic regurg, achilles tendonitis, AV node block, amyloidosis, CES, periph arthritis

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12
Q

Mx Ankylosing spondylitis

A

regular exercise
NSAIDS- 1st line
Phyio
DMARD- sulphsalazine only useful if periph joints involved
anti-TNF if persistently high disease activity

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13
Q

what is the % for HLA (+) in ankylosing spondylitis

A

90% (+) HLA-B27

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14
Q

Spinal epidural abscess (Ix + Mx + most common pathogen)

A

Staph Aureus
Ix: MRI whole spine, sepsis workup , may need echo or dental XR

Mx: long term broad spectrum abx-> until culture results
large/compressive abscess with progressive neuro deficit-> SURGERY

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15
Q

Rheumatoid arthritis Mx

A

RA:

1) initial Tx: DMARD monotx +/- short course of bridging prednisolone

MTX: monitoring FBC/ LFT risk of myelosuppresion + liver cirrhosis
other: sulfasalazine, lefluomide, hydroxychloroquine

2) TNF inhibitor: if inadequate response to least 2 DMARD incl MTX
- etanercept, infliximab, adalimumab MAKE SURE CXR + Tuberculin test. May cause reactivation of TB

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16
Q

chondromalacia patella

A

aka Runner’s knee knee problem in children

softening of cartilage of patella, common anterior knee pain. Cartilage on underside of patella kneecap becomes siftened + irritated due to overuse/ poor alignment

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17
Q

Osgood-Schlatter disease

A

tibial apophysitis
knee problem in children, sporty teens. Bony prominence just below kneecap over tibial tubercle

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18
Q

Osteochondritis dissecans

A

small fragment of bone + cartilage become detachedfrom surrounding tissue due to inadequate blood supply, intermittent swelling + locking

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19
Q

Thessaly’s test

A

To check meniscal tear

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20
Q

Perthes disease

A

Degeneration of hip joints affecting ages 4-8 years due to a vascular necrosis of femoral head.

Pain progressively over weeks, limp
XR widening of joint spaces, decreased or flattening of femoral head

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21
Q

Red flag sx of back pain

A

Age <20 or >50
Prev malignancy
Night pain
Hx trauma
Unwell
Thoracic back pain
Focal neurology: urinary or fecal incontinence or urinary retention, Lowe ling weakness, decreased sphincter tone

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22
Q

Web Duchenne Palsy

A

Damage to upper brachial plexus c5&6
Arm along side , internal rotation, elbow extended

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23
Q

Klumpke injury

A

Damage to lower part of brachial plexus c8, t1

MCP Joint extended
IP joints flexed

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24
Q

Colles fracture

A

Dorsal displacement
Fracture of radius

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25
Q

Smiths fracture

A

Reverse colles fracture
Volar angulation of distal radius fragment

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26
Q

Bennett’s fracture

A

Intra articulated fracture at base of thumb metacarpal

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27
Q

Monteggias fracture

A

Dislocation prox radioulnar joint ass with ulnar fracture

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28
Q

Galeazzi fracture

A

Radial shaft fracture with dislocation of distal radioulnar joint

29
Q

Which crystal in pseudogout

A

Calcium pyrophosphate crystal deposition
Weakly + birefringent rhomboid shaped crystals

30
Q

Ix and mx of pseudogout

A

Joint aspiration: weakly positive bigringent rhomboid shaped crystal, calcium pyrophosphate dehydrate crystal

Mx: nsaids, intra articular or muscular steroid

31
Q

Uric acid level in gout and which crystal

A

Uric acid >450umol/l

Monosodium urate crystal

32
Q

Osteoarthritis mx and radio findings

A

Loss of joint space
Osteophytes
Sunbxhondral sclerosis
Subchondral cyst

Mx: 1st line, topical analgesics
2nd line: po nsaids with ppi

33
Q

Most common reason for revision in ThR

A

Aseptic loosening

34
Q

FRAX Score

A

10 year risk of fragility fracture
Valid 40-90 years

Assess: age, sex, weight, height, prev fracture, parenteral fracture, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol intake

35
Q

Dx of Achilles rupture

A

Simmonds/thompson: lie prone with feet over edge. Pressing calf does not elicit plantar flexion

Initially dx: us of heel

36
Q

Adhesive capsulitis risk factor and which movement affected. Phases

A

Frozen shoulder
Risk factor: DM !!!!

Phases: painful, adhesive phase and recovery phase. Affects external rotation> internal rotation

37
Q

Most common pathogen in osteomyelitis especially in sickle cell

A

Staph aureus
Sickle cell: salmonella

38
Q

Most common pathogen discitis

A

Staph aureus

39
Q

Causes of talipes equinovarus.
Also foot position

A

Inverted and plantar flexion

Most common: idiopathic

Others: spina bifida, cerebral palsy, Edward’s syndrome, oligohydramnios

40
Q

Compartment syndrome dx

A

Intracompartment pressure >40mmHg diagnostic
If >20mmHg abnormal

41
Q

Signs seen in carpal tunnel syndromes

A

Trapping of median nerve

Tinel sign: tapping of the palmar surface of wrist elicits sx
Phalens sign: flexion of wrists elicit sx

42
Q

Dermatomyositis what is it and what do you need to look for, Dx, signs

A

Inflammatory disorder of skin and muscle.

Ass with underlying connective/ maliganancy therefore NB to Ix further.

Affects skin: heliotrope rash/ gottrons papule

Muscle: prox muscle weakness, interstitial lung disease

Ab: 80% +ANA,
30% aminoacyl tRNA synthntase. Jo-1 histidine tRNA ligament Ab, Ab signal recognition particle, anti-Mi-2 Ab which is seen in acute phase ass with better prognosis

43
Q

What is seronegative arthropod-atheist and diseases included in this group

A

Inflammatory rheumatic disease involving axial, peripheral and enthesitis. + for HLA B27 but negative for rheumatoid factor.

Group: ankylosis spondylitis, reactive arthritis, psoriatic arthritis, Behçet, juvenile idiopathic arthritis, behests, enteropathic arthritis.

Share anterior uveitis, IBD

44
Q

Common sx for Ankylosing spondylitis, which test and dx

A

Young male back pain and stiffness.
Reduced lateral flexion. Schrobers test- dimple <5cm on when bending forward

Apical fibrosis, anterior uveitis, Achilles tendinitis, AV node block, anhydrosis,.

XR bamboo spine

45
Q

Mx of ankylosing spondylitis

A

NSAIDS
DMARD; sulphasalazine
Anti TNF: given when persistently high disease activity

46
Q

Pulmonary function in ankylosing spondylitis

A

Restrictive picture due to fibrosis
CXR: apical fibrosis

47
Q

What does high rhetoric factor mean in rheumatoid arthritis

A

Disease severity

48
Q

When to add TNF-alpha inhibitor in RA

A

When 2 DMARdS fails including methotrexate

49
Q

What do need to check before starting TNF-alpha inhibitors

A

Tuberculin test and CxR

50
Q

MTX Side effect

A

Pneumonia is
Liver cirrhosis, myelosuppr4ssion

51
Q

Sulfasalazine SE

A

Oligospermia, interstitial lung disease, Heinz body anaemia, rashes

52
Q

Leflunomide side effect

A

Interstitial lung disease
Liver impairment
HTN

53
Q

Hydroxychloroquine SE

A

Retinopathy, corneal deposit

54
Q

Gold SE

A

Proteinuria

55
Q

Penicillamine

A

Proteinuria
Myasthenia gravis

56
Q

SE of etanercept,infliximab, adalimumab, rituximab

A

Etanercept: demyelination react TB

Inflixi : +Tb

Adali: +tb

Rituximab: infusion reaction

57
Q

Sjogrens syndrome dx, mx

A

Affects exocrine glands.

Ab: RF+, ANA+, Anti Ro 9ssA) Ab 70%, anti-La SSB Ab

Schirmers test

Pilocarpine + salivation

58
Q

Systemic sclerosis classification and antibodies

A

Limited cutaneous SS: anti centromere
Diffuse SS: anti alc-70 Ab <anti-DNA></anti-DNA>

OtherANA, RF

59
Q

Polymyalgia Rheumatica sx, mx, lab findings

A

PMR - affects shoulder and hip joint, rheumatic disease affecting joint but not muscle

Associated temporal arthritis

Morning stiffness

Lab: >ESR .40mm/hr
CK and EMG normal

Mx:prednisolone 15mg OD responds well

60
Q

Mx raynauds

A

1st line calcium channel blocker

If prostacyclin infusion

Avoid beta-blocker

61
Q

SLE dx and antibodies

A

SOAP BRAIN MD

Serositis
Oral or nasal ulcer
Arthritis >2 joints
Photosensitivity

Blood disorder: anaemia, thrombocytopenia
Renal: Proteinuria
ANA +
Immunological: Anti Smith, Anti-dsDNA, Anti-phospholipid- false + in syphilis, Kuous Ab, Anti beta 2 GP I
Neuro: seizure, psychosis, anxiety

Malar rash
Discoud rash

62
Q

Mx giant cell arteritis, dx

A

Dx: high EsR >50, CRp may be elevated

Biopsy: temporal artery biopsy shows skip lesions

Mx: high dose steroid

63
Q

Anti phospholipid syndrome lab findings include Ab and fbc and coat profile

A

Anti cardiolipin Ab
Anti beta glycoprotein I Ab
Thrombocytopenia
Prolonged aptt

64
Q

Meralgia paraesthetica

A

Anaesthesia in distribution of lateral femoral cutaneous nerve
Burning tingling coldness shooting pain and numbness in upper lateral thigh

65
Q

Type 1 hypersensitivity mechanism

A

IgE bound to mast anaphylaxis, asthma, eczema, hayfever

66
Q

Type II mech

A

IgG or IgM

Autoimmune haemolytic anaemia, ItP, goodpastures syndrome
Pernicious anaemia
Acute haemolytic transfusion
Rheumatoid fever
Pemphigus vulgaris/ bulbous emphigoid

67
Q

Type III hypersensitivity mechanism

A

Free antigen and Ab igG and IgA combine

Serum sickness, SLe, post streptococcal glomerulonephritis, extrinsic allergic alveolitis

68
Q

Type IV delayed hypersensitivity mechanism of action

A

T cell mediated
TB
Graft vs host disease
Scabies
Extrinsic allergic alveolitis
Multiple sclerosis
gbS

69
Q

Rotator cuff tear vs subacromial impingement

A

Subacromial impingement 60-120 degree
Rotator cuff tear 1-60 degrees and tenderness over anterior acromion

MSRA 2023 (22 decks)

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