Year pre-exam questions Flashcards
Hypothenar atrophy is associated with what nerve pathology?
Ulnar
Perthes - Primary school kids (4-8 years old) Remember P = P
Slipped upper femoral epiphysis - Secondary school kids (11-15) Remember S = S
Perthes - Primary school kids (4-8 years old) Remember P = P
Slipped upper femoral epiphysis - Secondary school kids (11-15) Remember S = S
A heliotrope rash is present in what condition?
Heliotrope rash is caused by dermatomyositis (DM), a rare connective tissue disease. People with this disease have a violet or bluish-purple rash that develops on areas of the skin. They can also experience muscle weakness, fever, and joint aches. The rash may be itchy or cause a burning sensation.
Hyperextension knee injury most commonly results in what injury?
ACL tear
Repeated jumping and landing on hard surfaces causes what injury?
Repeated jumping and landing on hard surfaces causes patella tendinopathy or ‘jumper’s knee’. It results in anterior knee pain over 2-4 weeks which comes on with exercise and worsens with jumping.
What is the mechanism for a meniscal tear injury?
Twisting knee injury can result in a meniscal tear (with potential medial collateral ligament sprain).
How would a meniscal tear present and what test would be positive?
The knee would be swollen and painful to palpate. McMurray’s test would also be positive (painful click).
Ankylosing spondylitis - x-ray findings:
Ankylosing spondylitis - x-ray findings: subchondral erosions, sclerosis and squaring of lumbar vertebrae
Which joints are specifically affected in psoriatic arthritits?
Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of psoriatic arthritis.
Polymyalgia rheumatica presentation:
Polymyalgia rheumatica (PMR) is characterized by symmetrical aching and stiffness of the shoulders, hip girdle, neck, and torso. Symptoms are worst on waking. It typically occurs in patients over the age of 50 and is the most likely diagnosis for this patient.
Treatment for polymyalgia rheumatica:
Oral prednisolone is the treatment of choice for polymyalgia rheumatica.
Chondrocalcinosis is a feature of what condition?
Chondrocalcinosis is a feature of pseudogout.
What pituitary condition increase risk of pesudogout?
Acromegaly patients can develop pseudogout.
Lung (haemoptysis) and kidney (haematuria) involvement leads you to what two key differentials?
Goodpastures syndrome and ANCA associated vasculitis.
How is ankylosing spondylitis diagnosed?
Diagnosis of ankylosing spondylitis can be best supported by sacro-ilitis on a pelvic X-ray.
Behcet’s syndrome is associated with what derm condition?
Behcet’s syndrome is associated with erythema nodosum.
Long term steroids requires what other medication|?
Bone protection for patients who are going to take long-term steroids should start immediately wth bisphosphonates and vitD and calcium supps.
After the first VTE, patients with antiphospholipid syndrome should be on what prophylaxis and for how long?
Lifelong warfarin.
What is a salter harris fracture?
A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone, specifically the zone of provisional calcification. It is thus a form of child bone fracture. It is a common injury found in children, occurring in 15% of childhood long bone fractures.
How to remember the classification of Salter harris fractures:
SALTR
What is the most common type of salter harris fracture?
Type 2
Fracture passes across most of the growth plate and up through the metaphysis
SALTR
- Slipped - fracture plane passes all the way through the growth plate, not involving bone.
- Above - fracture passes across most of the growth plate and up through the metaphysis.
- Lower - fracture plane passes some distance along with the growth plate and down through the ephphysis.
- Transverse - fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis.
- Ruined -
crushing type injury does not displace the growth plate but damages it by direct compression.
Green strick fracture
A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces. The fracture looks similar to what happens when you try to break a small, “green” branch on a tree. Most greenstick fractures occur in children younger than 10 years of age.
Buckle fracture
A buckle fracture, also called a torus fracture, is an extremely common injury seen in children. Because children have softer, more flexible bones, one side of the bone may buckle upon itself without disrupting the other side of the bone—also known as an incomplete fracture—and cause symptoms.
Paget’s disease usually affects which bones?
Skull, spine, pelvis, and long bones of the lower extremities
How to remember which bones are affected in Paget’s?
It is easy to remember which bones are most commonly affected by Paget’s disease by drawing an imaginary line down the centre of a patient. The bones covered are the skull, vertebral bones and pelvis. Along with the femur and tibia, these are the most commonly affected bones by Paget’s disease.
What anti-bodies are positive in drug induced lupus?
Anti-histone antibodies positive
What drugs cause drug induced lupus?
SHIPP for drug induced lupus guys:
S: Sulfonamide - ABx
H: Hydralizine - heart failure
I: Isoniazid - TB
P: Phenytoin - seizures
P: Procainamide - arrhythmia
What causes dermatomyositis?
Dermatomyositis is usually an autoimmune condition, being most common in women aged 50-70. However, it can also be a paraneoplastic disease, with ovarian, breast and lung tumours being the most common underlying cancers. The possibility of underlying malignancy should be considered, especially in older patients.
How does dermatomyositis present?
An inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions.
What are the skin features of dermatomyositis?
- photosensitive
- macular rash over back and shoulder
- heliotrope rash in the periorbital region
- Gottron’s papules - roughened red papules over extensor surfaces of fingers
- ‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
- nail fold capillary dilatation
Carpal tunner is associated with wasting of what muscle?
Carpal tunnel is associated with wasting of the thenar eminence.
Hypothenar atrophy is associated with ulnar nerve pathology.
Biggest risk factor for SUFE?
The x-ray shows a left-sided slipped upper femoral epiphysis (SUFE). A large amount of adipose tissue can also be seen. Obesity is a known risk factor for SUFE.
Name the type of fracture:
These describe a common fracture in children in which a distal radius fracture is accompanied by dislocation of the radioulnar joint.
Galeazzi fracture
Name the fracture:
A break of the thumb base due to forced abduction of the first metacarpal.
A Bennett fracture describes a break of the thumb base due to forced abduction of the first metacarpal.
Sometimes thought as ‘reverse-colle’s fractures’, these breaks in the in the distal radius associated with anterior angulation/displacement and are commonly caused by falling onto the posterior aspect of the hand.
Smith’s fracture
Gout treatment:
Colchicine should be used to treat acute gout if NSAIDs are contraindicated for example a peptic ulcer.
Allupurinol for prophylaxis.
Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?osteomalacia
Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?osteomalacia
Twisting knee injury - possible meniscal tear
Twisting knee injury - possible meniscal tear
AS xray findings (spine)
Ankylosing spondylitis - x-ray findings: subchondral erosions, sclerosis and squaring of lumbar vertebrae.
What scoring system is used for rheumatoid?
DAS28 is a measure of disease activity in rheumatoid arthritis
prolonged APTT + low platelets in someone with a DVT =
APS
Biggest risk factor of adhesive capsulitis and aka…
Frozen shoulder - big risk factor is diabetes mellitus.
Oral ulcers + genital ulcers + anterior uveitis =
Oral ulcers + genital ulcers + anterior uveitis = Behcet’s
What is the most likely location of a stress fracture in the foot?
The most common site of metatarsal stress fractures is the 2nd metatarsal shaft.
What antibiotic is given for septic arthritis?
Septic arthritis: IV flucloxacillin
An intravenous drug user with an acute, hot and swollen knee is most likely to have what?
Septic arthritis
What is the first line management of ankylosing spondylitis?
Exercise regimes and NSAIDs are the 1st line management for ankylosing spondylitis.
Diagnosis of Ankylosing spondylitis:
Plain radiograph of the pelvis: show’s sacroilitis on x-ray.
What are the features of ankylosing spondylitis: the 6 A’s
Ankylosing spondylitis features - the ‘A’s
- Apical fibrosis
- Anterior uveitis
- Aortic regurgitation
- Achilles tendonitis
- AV node block
- Amyloidosis
Treatment of Paget’s
Paget’s disease of the bone is treated with bisphosphonates.
A 27-year-old woman is referred to orthopaedics. Three years ago she had chemotherapy for non-Hodgkin’s lymphoma. Follow up scans to date have shown no evidence of any disease recurrence. For the past two months, she has been experiencing gradually increasing pain in her right hip which is worse on exercising. On examination, passive movement of the hip is painful in all directions, especially internal rotation. An x-ray ordered by her GP has been reported as normal.
What is the most likely diagnosis?
Avascular necrosis
Previous chemotherapy is a significant risk factor for avascular necrosis
Painful stiff hands: see photo
What’s the diagnosis?
The image clearly shows nail changes which suggests a diagnosis of psoriatic arthritis.
A condition of unknown aetiology characterised by hardened, sclerotic skin and other connective tissues. It is four times more common in females.
Systemic sclerosis
Limited cutaneous systemic sclerosis
- Raynaud’s may be first sign.
- Scleroderma affects face and distal limbs predominately.
- Associated with anti-centromere antibodies.
- A subtype of limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia.
Diffuse cutaneous systemic sclerosis
- scleroderma affects trunk and proximal limbs predominately
- associated with scl-70 antibodies
- the most common cause of death is now respiratory involvement, which is seen in around 80%: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)
- other complications include renal disease and hypertension
- poor prognosis
What antibodies are present in patients with systemic sclerosis?
- ANA positive in 90%
- RF positive in 30%
- Anti-scl-70 antibodies associated with diffuse cutaneous systemic sclerosis
- Anti-centromere antibodies associated with limited cutaneous systemic sclerosis
Read this summary on lumbar spinal stenosis:
Lumbar spinal stenosis is a condition in which the central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.
Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication. One of the main features that may help to differentiate it from true claudication in the history is the positional element to the pain. Sitting is better than standing and patients may find it easier to walk uphill rather than downhill. The neurogenic claudication type history makes lumbar spinal stenosis a likely underlying diagnosis, the absence of such symptoms makes it far less likely.
Polymyalgia rheumatica (PMR) is a relatively common condition seen in older people characterised by muscle stiffness and raised inflammatory markers.
Which distinct marker is not raised?
Creatinine kinase
Note: Elevated CK would indicate a polymyositis picture
A 73-year-old man presents with pain in the right leg. It is most uncomfortable on walking. On examination he has a deformity of his right femur, which on x-ray is thickened and sclerotic. His serum alkaline phosphatase is elevated, but calcium is within normal limits.
Diagnosis?
Paget’s - classic x-ray findings
What does joint aspiration show in rheumatoid arthritis?
Joint aspirate in rheumatoid arthritis shows a high WBC count, predominantly PMNs. Appearance is typically yellow and cloudy with absence of crystals.
Features of heart failure on chest x-ray:
Alveolar oedema (bat’s wings), Kerley B lines (interstitial oedema), Cardiomegaly, Dilated prominent upper lobe vessels, Effusion (pleural) are features of heart failure on a chest x-ray.
Stereotypical presentation of what condition is an older male with bone pain and an isolated raised ALP:
Paget’s
What classification system is used to classify NOF’s?
The Garden system
Clinical examination of ankle fractures is guided by what?
Clinical examination is facilitated by the Ottawa ankle rules to try and minimise the unnecessary use of x-rays.
These state that x-rays are only necessary if there is pain in the malleolar zone and:
- Inability to weight bear for 4 steps
- Tenderness over the distal tibia
- Bone tenderness over the distal fibula
L? radiculopathy: Weakness of hip abduction and foot drop, no specific reflex lost
L5 radiculopathy: Weakness of hip abduction and foot drop, no specific reflex lost
L5
How is spinal stenosis diagnosed?
An MRI is needed to confirm the diagnosis of spinal stenosis and exclude other causes such as metastatic disease.
Imaging used to diagnose achille’s tendon rupture?
Ultrasound
Presentation of a psoas abacess:
Presents with right-sided abdominal pain which is relieved by hip flexion. He has a low-grade temperature and has a positive psoas sign. These signs and symptoms, together with his history of immunosuppression, is suggestive of psoas abscess.
Investigation for psoas abscess:
CT abdomen is the investigation of choice for suspected psoas abscess. MRI has a similar sensitivity to contrast CT but is less accessible.
De Quervain’s tenosynovitis is caused by inflammation of the extensor pollicis brevis and abductor pollicis longus tendon sheath causing radial styloid process pain and painful abduction of the thumb against resistance.
De Quervain’s tenosynovitis is caused by inflammation of the extensor pollicis brevis and abductor pollicis longus tendon sheath causing radial styloid process pain and painful abduction of the thumb against resistance.
Tibialis nerve functions
Anterior = Dorsiflexion & Inversion Posterior = Plantarflexion & Eversion
Function of the common peroneal nerve:
droPED = Peroneal **Everts and Dorsiflexes**, causing footdrop if injured. TIPtoe = Tibial, Inverts and Plantarflexes, causing inability to tiptoe.
A subcapital fracture is the commonest type of intracapsular fracture of the proximal femur.
What is the treatment for this?
Hemiarthroplasty or total hip replacement is the treatment of choice for all patients with a displaced hip fracture
Treatment of an extracapsular NOF?
Extracapsular femoral fracture - dynamic hip screw
Squaring of the thumbs is a characteristic feature of what arthritic condition?
Squaring of the thumbs is a characteristic feature of hand osteoarthritis.
1, 2 - Buckle my shoe (ankle reflex)
3, 4 - kick down the door (knee jerk reflex)
5, 6 - pick up sticks (biceps reflex)
7, 8 - close the gate (triceps reflex)
1, 2 - Buckle my shoe (ankle reflex)
3, 4 - kick down the door (knee jerk reflex)
5, 6 - pick up sticks (biceps reflex)
7, 8 - close the gate (triceps reflex)
Pain on the radial side of the wrist/tenderness over the radial styloid process ?
De Quervain’s tenosynovitis
Compartment syndrome will typically not show any pathology on an x-ray, and it’s diagnosis is made mostly on clinical suspicion.
Compartment syndrome will typically not show any pathology on an x-ray, and it’s diagnosis is made mostly on clinical suspicion.
