Rheumatology + MSK Flashcards
Ix Rheumatoid arthritis
Rheumatoid facture-> 1st LINE
- does not indicate disease activity
anti-CCP (cyclic citrullinated peptide)
- (+) 10yrs before development RA
Mx Rheumatoid arthritis flare
po/im steroid
DMARD medications
MTX, salfasalazine, leflunomide, hydroxychloroquine
IC NOF mx
undisplaced: internal fixation/ hemi if unfit
displaced: THR/ hemi to ALL pt
when to consider THR
THY: independent (max use of stick)
no cognitive impairment
MFFD for anaesthetics
EC NOF mx
stable INTERTROCHANTERIC: DHS
reverse oblique, transverse, subtrochanteric #: IM
stable intertrochanteric # mx
DHS
reverse oblique, transver, subtrochanteric EC NOF
IM nail
Ankylosing spondylitis typical presentation + during which time of day worst
back pain + stiffness
stiffness worse in morning + improves with exercise
reduced lateral flexion
Schrober’s test
Ankylosing spondylitis: line drawn 10cm above + 5cm below back imple
If distance btw 2 line does NOT increase by >5cm when pt bends
which other disease associated with ankylosing spondylitis
(name eye condition)
anterior uveitis
(A’s: ant uveitis, apical fibrosis, aortic regurg, achilles tendonitis, AV node block, amyloidosis, CES, periph arthritis
Mx Ankylosing spondylitis
regular exercise
NSAIDS- 1st line
Phyio
DMARD- sulphsalazine only useful if periph joints involved
anti-TNF if persistently high disease activity
what is the % for HLA (+) in ankylosing spondylitis
90% (+) HLA-B27
Spinal epidural abscess (Ix + Mx + most common pathogen)
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
Rheumatoid arthritis Mx
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
chondromalacia patella
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
Osgood-Schlatter disease
tibial apophysitis
knee problem in children, sporty teens. Bony prominence just below kneecap over tibial tubercle
Osteochondritis dissecans
small fragment of bone + cartilage become detachedfrom surrounding tissue due to inadequate blood supply, intermittent swelling + locking
Thessaly’s test
To check meniscal tear
Perthes disease
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
Red flag sx of back pain
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
Web Duchenne Palsy
Damage to upper brachial plexus c5&6
Arm along side , internal rotation, elbow extended
Klumpke injury
Damage to lower part of brachial plexus c8, t1
MCP Joint extended
IP joints flexed
Colles fracture
Dorsal displacement
Fracture of radius
Smiths fracture
Reverse colles fracture
Volar angulation of distal radius fragment
Bennett’s fracture
Intra articulated fracture at base of thumb metacarpal
Monteggias fracture
Dislocation prox radioulnar joint ass with ulnar fracture
Galeazzi fracture
Radial shaft fracture with dislocation of distal radioulnar joint
Which crystal in pseudogout
Calcium pyrophosphate crystal deposition
Weakly + birefringent rhomboid shaped crystals
Ix and mx of pseudogout
Joint aspiration: weakly positive bigringent rhomboid shaped crystal, calcium pyrophosphate dehydrate crystal
Mx: nsaids, intra articular or muscular steroid
Uric acid level in gout and which crystal
Uric acid >450umol/l
Monosodium urate crystal
Osteoarthritis mx and radio findings
Loss of joint space
Osteophytes
Sunbxhondral sclerosis
Subchondral cyst
Mx: 1st line, topical analgesics
2nd line: po nsaids with ppi
Most common reason for revision in ThR
Aseptic loosening
FRAX Score
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
Dx of Achilles rupture
Simmonds/thompson: lie prone with feet over edge. Pressing calf does not elicit plantar flexion
Initially dx: us of heel
Adhesive capsulitis risk factor and which movement affected. Phases
Frozen shoulder
Risk factor: DM !!!!
Phases: painful, adhesive phase and recovery phase. Affects external rotation> internal rotation
Most common pathogen in osteomyelitis especially in sickle cell
Staph aureus
Sickle cell: salmonella
Most common pathogen discitis
Staph aureus
Causes of talipes equinovarus.
Also foot position
Inverted and plantar flexion
Most common: idiopathic
Others: spina bifida, cerebral palsy, Edward’s syndrome, oligohydramnios
Compartment syndrome dx
Intracompartment pressure >40mmHg diagnostic
If >20mmHg abnormal
Signs seen in carpal tunnel syndromes
Trapping of median nerve
Tinel sign: tapping of the palmar surface of wrist elicits sx
Phalens sign: flexion of wrists elicit sx
Dermatomyositis what is it and what do you need to look for, Dx, signs
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
What is seronegative arthropod-atheist and diseases included in this group
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
Common sx for Ankylosing spondylitis, which test and dx
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
Mx of ankylosing spondylitis
NSAIDS
DMARD; sulphasalazine
Anti TNF: given when persistently high disease activity
Pulmonary function in ankylosing spondylitis
Restrictive picture due to fibrosis
CXR: apical fibrosis
What does high rhetoric factor mean in rheumatoid arthritis
Disease severity
When to add TNF-alpha inhibitor in RA
When 2 DMARdS fails including methotrexate
What do need to check before starting TNF-alpha inhibitors
Tuberculin test and CxR
MTX Side effect
Pneumonia is
Liver cirrhosis, myelosuppr4ssion
Sulfasalazine SE
Oligospermia, interstitial lung disease, Heinz body anaemia, rashes
Leflunomide side effect
Interstitial lung disease
Liver impairment
HTN
Hydroxychloroquine SE
Retinopathy, corneal deposit
Gold SE
Proteinuria
Penicillamine
Proteinuria
Myasthenia gravis
SE of etanercept,infliximab, adalimumab, rituximab
Etanercept: demyelination react TB
Inflixi : +Tb
Adali: +tb
Rituximab: infusion reaction
Sjogrens syndrome dx, mx
Affects exocrine glands.
Ab: RF+, ANA+, Anti Ro 9ssA) Ab 70%, anti-La SSB Ab
Schirmers test
Pilocarpine + salivation
Systemic sclerosis classification and antibodies
Limited cutaneous SS: anti centromere
Diffuse SS: anti alc-70 Ab <anti-DNA></anti-DNA>
OtherANA, RF
Polymyalgia Rheumatica sx, mx, lab findings
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
Mx raynauds
1st line calcium channel blocker
If prostacyclin infusion
Avoid beta-blocker
SLE dx and antibodies
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
Mx giant cell arteritis, dx
Dx: high EsR >50, CRp may be elevated
Biopsy: temporal artery biopsy shows skip lesions
Mx: high dose steroid
Anti phospholipid syndrome lab findings include Ab and fbc and coat profile
Anti cardiolipin Ab
Anti beta glycoprotein I Ab
Thrombocytopenia
Prolonged aptt
Meralgia paraesthetica
Anaesthesia in distribution of lateral femoral cutaneous nerve
Burning tingling coldness shooting pain and numbness in upper lateral thigh
Type 1 hypersensitivity mechanism
IgE bound to mast anaphylaxis, asthma, eczema, hayfever
Type II mech
IgG or IgM
Autoimmune haemolytic anaemia, ItP, goodpastures syndrome
Pernicious anaemia
Acute haemolytic transfusion
Rheumatoid fever
Pemphigus vulgaris/ bulbous emphigoid
Type III hypersensitivity mechanism
Free antigen and Ab igG and IgA combine
Serum sickness, SLe, post streptococcal glomerulonephritis, extrinsic allergic alveolitis
Type IV delayed hypersensitivity mechanism of action
T cell mediated
TB
Graft vs host disease
Scabies
Extrinsic allergic alveolitis
Multiple sclerosis
gbS
Rotator cuff tear vs subacromial impingement
Subacromial impingement 60-120 degree
Rotator cuff tear 1-60 degrees and tenderness over anterior acromion
