selftest part 2 Flashcards
What is a common symptom of an Achilles tendon rupture?
Painful pop at the back of the heel and inability to plantar flex.
Forced plantar flexion against a dorsiflexed foot.
What is the management for an Achilles tendon rupture?
Same day urgent referral to orthopedics.
What are the symptoms of a patellar tendon rupture?
Acute pain and possibly hearing a ‘pop’.
Pain at the bottom of the left knee.
What characterizes anterior cruciate ligament injuries?
Often non-contact, twisting injuries with an audible pop or crack and large immediate swelling.
What can chronic compartment syndrome mimic?
Peripheral artery disease (PAD).
What is a normal Ankle-Brachial Pressure Index (ABPI)?
ABPI of 1.0-1.4 is normal.
What does an ABPI greater than 1.4 indicate?
Calcification.
What symptoms may indicate the presence of PAD?
ABPI of 0.91-0.99 may indicate PAD.
Symptoms include aching, squeezing, cramping, tightness, or pressure.
What is the typical presentation of ankle injuries?
77% are lateral ligament strains, primarily to the anterior talofibular ligament.
When are NSAIDs contraindicated?
In patients with a history of hypersensitivity to aspirin or any other NSAID.
What are cancer red flag symptoms?
Over 50 years of age, gradual onset of symptoms, severe unremitting pain, localized spinal tenderness, no improvement after four to six weeks, unexplained weight loss, and past history of cancer.
What types of cancer are most likely to metastasize to bone?
Breast, lung, gastrointestinal, prostate, renal, and thyroid cancers.
What is the first-line treatment for low back pain?
NSAIDs should always be given first.
What should be used as a second-line treatment for low back pain?
Codeine with or without paracetamol.
What is the initial treatment for neuropathic pain?
Amitriptyline, duloxetine, gabapentin, or pregabalin.
What may be considered for chronic primary pain (CPP)?
Antidepressants such as citalopram.
What non-pharmacological management techniques are used for persistent non-specific low back pain?
Manual therapy techniques such as spinal manipulation, mobilization, or massage.
What is chronic regional pain syndrome (CRPS)?
Pain after a fracture that has healed, usually occurring four to six weeks after a minor limb injury or surgery.
What are the Budapest diagnostic criteria used for?
To clinically diagnose chronic regional pain syndrome (CRPS).
What are the initial symptoms of CRPS?
Pain, erythema, and swelling of the affected limb.
What qualifies for ankle radiographs?
Pain in the malleolar zone and bone tenderness along specific areas or inability to bear weight.
What indicates a need for a foot radiograph?
Pain in the midfoot zone and specific bone tenderness or inability to bear weight.
What criteria indicate a knee x-ray is needed?
Age 55 or older, isolated tenderness of the patella, tenderness of the head of the fibula, inability to flex the knee to 90°, or inability to weight bear.
What are the symptoms of rotator cuff tears?
Pain and weakness of the lateral deltoid, exacerbated by overhead movement.
What examination techniques are effective for rotator cuff tears?
Active painful arc test, drop arm test, and weakness on external rotation.
What is acute calcific tendonitis?
A condition affecting women aged 20-40, where calcium crystals deposit near the supraspinatus tendon.
What can a Pancoast tumor cause?
Referred shoulder pain and muscle wasting in the forearm and hand, along with Horner’s syndrome.
What is a common cause of anterior dislocation of the shoulder?
A fall onto the hand.
What is ‘Saturday night palsy’?
Loss of sensation over the anatomical snuff box due to radial nerve damage.
What are the symptoms of chronic fatigue syndrome (CFS)?
Recurrent fatigue, sleep disturbance, post-exertional malaise, muscle or joint pain, and cognitive dysfunction.
What is the acceptable range of movement after a total knee replacement?
From full extension to 90 degrees of flexion.
What characterizes lateral epicondylitis (tennis elbow)?
Overuse of extensor tendons with preserved range of motion and pain localized to the lateral epicondyle.
What is dermatomyositis?
A condition with proximal symmetrical muscle weakness, muscle biopsy evidence of myositis, and characteristic skin involvement.
What is the recommended amount of exercise per week?
150 mins of exercise or 75 mins of vigorous exercise
Regular exercise is important for overall health and can aid in weight management.
What defines diabetic remission?
HbA1c less than 48 and repeated after 3 months
Annual diabetic review is still required.
When should Orlistat be discontinued?
If no more than 5% body loss in the first 3 months
Orlistat is a weight loss medication.
What are the criteria for CKD specialist assessment?
Any of the following:
* 5-year risk of renal replacement therapy > 5%
* ACR of 70 mg/mmol or more
* ACR > 30 mg/mmol with haematuria
* Sustained decrease in eGFR of 25% or more
* Sustained decrease in eGFR of 15 ml/min/1.73 m2 or more per year
* Poorly controlled hypertension despite 4 antihypertensive medicines
* Known or suspected rare or genetic causes of CKD
* Suspected renal artery stenosis
What is severe prolonged vitamin D deficiency associated with?
Osteomalacia
Vitamin D is essential for bone health.
Which SSRI is associated with hyponatremia?
Fluoxetine
Hyponatremia is a condition characterized by low sodium levels in the blood.
What medication is effective for painful diabetic neuropathy?
Duloxetine
Alternatives include amitriptyline, gabapentin, or pregabalin.
How often should patients with diabetes have their blood pressure monitored?
At least annually if they do not have hypertension or renal disease
What is the target serum urate level for allopurinol?
Below 360 micromole/litre (0.36 mmol/l or 6 mg/dl)
What is the classification of CKD Stage 1?
eGFR of 60–89 ml/min/1.73 m2 with evidence of kidney damage
What should be offered to women with a previous baby weighing 4.5 kg or more?
Gestational diabetes screening
What is the optimal HbA1c level prior to surgery?
Less than 69 mmol/L
What condition does selenium improve in mild thyroid eye disease?
Slows disease progression and improves quality of life
What is hypervolaemic hyponatraemia caused by?
Conditions such as heart failure, profound hypothyroidism, liver and kidney failure
What should be measured to investigate hirsutism?
Early-morning total and free levels of testosterone
What side effect is associated with Mirtazapine?
Weight gain
What are the characteristics of thyroid stimulating hormone receptor antibodies (TRAbs)?
98% sensitive and 99% specific for Graves’ disease
When is surgery considered for obesity?
For BMI >35 kg/m² with comorbidities or >40 kg/m² without comorbidities
What is the reference range for TSH?
0.4–4 mU/l
What is the peak season for new cases of type 1 diabetes?
Winter months
What is the urgent action for patients with severe hypercalcaemia?
Refer urgently for assessment and treatment
What is the most specific way of diagnosing acute gout?
Fluid aspiration for crystals
What is the definition of subclinical hypothyroidism?
TSH >10 above normal range but T4 within normal range
What is the cause of 75% of kidney stones?
Calcium oxalate
What is the diagnosis process for hypogonadism?
Initial serum testosterone is low, then repeat fasting sample after four weeks
What are the classic symptoms of Addison’s disease?
Hyponatremia and hyperkalemia
What should be done during an adrenal crisis?
Double the normal dose of hydrocortisone for fever or infection
What does an AST:ALT ratio above 1 indicate?
Fibrosis needs to be ruled out
What initial treatment is recommended for CKD with ACR >30 mg/mmol?
Angiotensin-converting enzyme inhibitor such as ramipril
What is the most common cause of primary adrenal insufficiency?
Autoimmune adrenalitis
What is the diagnostic criteria for gestational diabetes?
Fasting plasma glucose ≥ 5.6 mmol/l or two-hour plasma glucose ≥ 7.8 mmol/l
What tests are used to diagnose Cushing’s syndrome?
24h urinary free cortisol, late night salivary cortisol, dexamethasone suppression test
What causes hyponatremia?
Diuretics, SSRIs, antipsychotics
What is pre-tibial myxoedema associated with?
Graves’ disease
What is the side effect of Exenatide?
Pancreatitis
What condition is associated with Gliclazide?
Renal cysts
When is C-peptide recommended in type 1 diabetes diagnosis?
When features suggest a monogenic form of diabetes
What is hyperprolactinaemia a feature of?
Normal pregnancy
How often should thyroid function tests be done for patients on antithyroid drugs?
Every 3 months
What defines microalbuminuria?
ACR of more than 3 mg/mmol
Who should have annual screening for diabetic retinopathy?
All people aged 12 years and over with diabetes
What is the aim for glycaemic control in surgery?
Less than 69 mmol/mol within 3 months of referral
What is the benefit of BP control in T2DM?
Preventing diabetic retinopathy for up to five years
What should be checked if autoimmune thyroid disease is suspected?
Anti-thyroid peroxidase antibodies
What are the stages of CKD based on eGFR?
Stage 1 (G1): eGFR > 90 ml/min
Stage 2 (G2): eGFR 60-89 ml/min
Stage 3a (G3a): eGFR 45-59 ml/min
Stage 3b (G3b): eGFR 30-44 ml/min
Stage 4 (G4): eGFR 15-29 ml/min
Stage 5 (G5): eGFR < 15 ml/min
What is the goal for HbA1c in type 2 diabetes treatment?
Aim for an HbA1c level of 48 mmol/mol with lifestyle and metformin
How should patients with rising HbA1c levels be managed?
Reinforce diet and lifestyle advice, support to aim for HbA1c of 53 mmol/mol, intensify drug treatment
What defines obesity hypoventilation syndrome?
Obesity (BMI ≥ 30 kg/m2), raised CO2 levels, breathing abnormalities during sleep
What should be done after starting vitamin D supplementation?
Check serum calcium one month later
How often should testosterone and haematocrit levels be tested in patients on testosterone?
Annually, with three-monthly checks in the first year
What are tophi in gout?
Deposits of urate crystals, can cause ulceration and movement restriction
What is transient synovitis?
Self-limiting inflammation of the hip synovium, lasting 3-10 days
What condition causes inflammation of the patellar tendon at the tibial tuberosity?
Osgood-Schlatter disease
What is chondromalacia patellae?
Softening of the articular cartilage of the patella
What is the recommendation for DXA scans in osteoporosis?
Offer DXA without calculating fragility score if over 50 with a fracture
What is the normal bone density T score?
T score > -1
What is osteoporosis defined as?
T score < -2.5
What should be the first-line treatment for osteoporosis?
Alendronic acid
What are the second-line treatments for osteoporosis?
Risedronate and etidronate
What is the treatment for hip fracture with osteopenia?
Zoledronic acid infusion every 18 months for 6 years
This treatment is indicated if oral bisphosphonates are not tolerated or contraindicated.
What T score indicates osteoporosis?
T score < -2.5
What are the first-line treatment options for osteoporosis?
Alendronic acid
Alendronic acid is the first-line treatment, followed by risedronate and etidronate as second-line options.
What are the side effects of bisphosphonate treatment?
GI reflux, acid issues, osteonecrosis of the jaw
What should be done for patients on oral corticosteroids regarding osteoporosis treatment?
Continue bisphosphonates and/or calcium and vitamin D until corticosteroid treatment has stopped, then reassess fracture risk
What is the first-line treatment for ankylosing spondylitis?
NSAIDs
What are some extra-articular manifestations of ankylosing spondylitis?
- Anterior uveitis
- Apical lung fibrosis
- Atrioventricular block
- Aortic regurgitation
- Aortitis
- Amyloidosis
- Achilles tendonitis
- Plantar fasciitis
How is osteoarthritis diagnosed in patients over 45 years of age?
Clinically, with activity-related joint pain and morning stiffness lasting no longer than 30 minutes
What are the characteristic findings in osteoarthritis?
- Joint space narrowing
- Subchondral sclerosis
- Osteophyte formation
What is the treatment for localized flare of rheumatoid arthritis?
Intra-articular glucocorticoid injection
What are the comorbid conditions associated with rheumatoid arthritis?
- Hypertension
- Ischaemic heart disease
- Osteoporosis
- Depression
What antibodies are associated with rheumatoid arthritis?
Antibodies to citrullinated proteins (anti-CCP)
What is the significance of a DAS28 score greater than 5.1?
Indicates active disease
What is polyarteritis nodosa?
Vasculitis of medium-sized arteries
What is the definitive diagnosis for polyarteritis nodosa?
Histological or angiographic demonstration of microaneurysms
What are the two subtypes of reactive arthritis?
- Genital form related to sexual activity
- Enteric form related to gastrointestinal infection
What are the common causative organisms for enteric reactive arthritis?
- Salmonella
- Yersinia
- Shigella
- Campylobacter
What is the first-line treatment for carpal tunnel syndrome?
Splinting
What condition is characterized by heel pain due to inflammation of the plantar fascia?
Plantar fasciitis
What is Sever’s disease?
Calcaneal apophysitis at the point of insertion of the Achilles tendon
What is the recommended action for suspected soft tissue sarcomas in adults?
Refer for an urgent ultrasound scan within two weeks
What is Sudeck’s atrophy?
A form of complex regional pain syndrome with changes in skin color
What lab findings are associated with Paget’s disease?
Elevated alkaline phosphatase with a normal serum calcium
What characterizes osteomalacia?
Proximal muscle weakness, low serum calcium, elevated alkaline phosphatase
What is fibromyalgia characterized by?
Chronic widespread pain
What is patellofemoral pain syndrome (PFPS)?
Diffuse knee pain exacerbated by incline running, stairs, and squatting
What is the treatment recommendation for a meniscal tear?
6 weeks of no conservative treatment
