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FINALS > MSK/rheum > Flashcards

MSK/rheum Flashcards

1
Q

What is gout

A
  • Crystal arthropathy
  • Chronically high blood uric levels
  • Gouty tophi= subcutaneous deposits of uric acid
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2
Q

Gout S+S

A
  • Severe pain
  • Heat
  • Swelling
  • Redness
  • Rapid onset
    -Tophi
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3
Q

Gout RF

A
  • Male
  • Obesity
  • High purines = meat, seafood
  • Alcohol
  • Diuretics
  • Cardio or kidney disease
  • FHx
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4
Q

Joints affected in gout

A
  • Base of big toe = metatarso-phalangeal joint
  • Wrists
  • Base of thumb = carpometacarpal
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5
Q

Gout Ix

A
  • serum urate = >360 micromol
  • Aspiration = needle shaped crystals, negatively bifringent, monosodium urate crystals
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6
Q

Gout Mx

A

Acute flare
- NSAIDs 1st line
- Colchicine 2nd line

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7
Q

Gout prophylaxis

A
  • Allopurinol
  • Lifestyle changes
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8
Q

Psudogout S+S

A
  • Older adult
  • Hot
  • Swollen
  • Stiff joint = knee, shoulders, wrists, hips
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9
Q

Pseudogout aspiration

A
  • Calcium pyrophosphate crystals
  • Rhomboid shaped
  • Positively bifringent
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10
Q

Mx pseudogout

A
  • NSAIDs
  • Colchicine
  • Aspiration
  • Steroid injections
  • Oral steroids
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11
Q

why is osteoarthritis thought to occur

A

imbalance between cartilage damage and chondrocyte response

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12
Q

XR changes OA

A

LOSS
- Loss joint space
- Osteophytes
- Subarticular sclerosis
- Subchondral cysts

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13
Q

S+S OA

A
  • joint pain and stiffness
  • Worse with activity and end of day
  • bulky enlargement
  • Resitrcted ROM
  • Crepitus and effusions
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14
Q

Hand signs OA

A
  • Heberdens = DIP
  • Bouchards = PIP
  • squaring base of thumb
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15
Q

Dx OA

A
  • > 45, typical pain and no morning stiffness = OA
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16
Q

Mx OA

A
  • Self care
  • Topical and oral NSAIDs
  • Weak opiates for short term
  • Injections
  • replacement
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17
Q

pattern of RA

A

symmetrical polyarthritis

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18
Q

gene assocaited with RA

A

HLA DR4

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19
Q

how many RA pateitns in RF seen in

A

70%

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20
Q

antibodies that are more specific than RF

A
  • Anti CCP antibodies = 80% of patients
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21
Q

S+S RA

A
  • pain, stiffness and swelling
  • tender and synovial thickening
  • systemic symptoms
  • worse in morning, better on activity
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22
Q

when to refer for RA

A
  • Small joints of hands or feet
  • More than 1 joint affected
  • Delay of 3 months or longer between onset and advice seek
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23
Q

Hand signs in RA

A
  • Z shaped thumb
  • Swan neck
  • Boutonniere
  • Ulnar deviation
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24
Q

eye manifestations related to RA

A
  • dry eye syndrome
  • episcleritis
  • scleritis
  • keratitis
  • cataracts
  • retinopathy
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25
Q

Dx RA

A
  • RF
  • Anti CCP
  • Inflam markers
  • X rays
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26
Q

XR changes RA

A
  • Periarticular osteopenia
  • Bony erosions
  • Soft tissue swelling
  • Joint destruction and deformity
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27
Q

Mx RA

A
  1. monotherapy with methotrexate, leflunomide, sulfasalazine and short course pred
    - Combo with multiple cDMARDs
    - Biologics = methotrexate
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28
Q

RA tx in pregnancy

A
  • hydroxycholorquine and sulfasalazine safest
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29
Q

SE methotrexate

A
  • bone marrow suppression, teratogenic, leukopenia
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30
Q

SE leflunomide

A
  • HTN and peripheral neuropathy
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31
Q

SE sulfasalazine

A
  • orange urine and male infertitlity
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32
Q

SE hydroxychloroquine

A
  • retinal toxicity, blue grey skin pigmentation, hair bleaching
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33
Q

what are the seronegative spoldyloarthopathies

A
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Reactive arthritis
    HLA B27
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34
Q

Signs of psoriatic arthrtis

A
  • symmetrical polyarthritis
  • Psoriatic plaques
  • Nail pitting
  • Oncholysis
  • Dactylitis
  • Enthesitis
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35
Q

XR psoriatic

A
  • Erosive changes = pencil in cup
  • periostitis
  • ankylosis
  • osteolysis
  • dactylitis
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36
Q

Mx psoriatic arthritis

A
  • NSAIDs
  • Steroids
  • DMARDs = methotrexate
  • Anti TNF
  • monoclonal abs = ustekinumab
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37
Q

RF for reactive arthritis

A
  • preceeding chlamydia or GI infection
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38
Q

S+S Reactive

A
  • acute synovitis in 1 or more joints
  • typically knee
  • conjunctivitis
  • urethritis
  • circinate balanitis
  • cant see cant pee cant climb a tree
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39
Q

Ix and Mx reactive

A
  • Rule out septic = joint aspiration
  • Treat infection
  • NSAIDs
  • Steroids
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40
Q

Main joints affected in AS

A
  • Sacroiliac joints
  • Vertebral column joints
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41
Q

S+S AS

A
  • Young men in 20s
  • Pain and stiffness in lower back
  • Sacroiliac pain
  • Improves with movement
  • worse at night
  • > 30 mins to improve in morning
  • enthesitis, dactylitis, SOB
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42
Q

AS associations

A
  • Anterior uveitis
  • Aortic regurgitation
  • AV block
  • Apical lung fibrosis
  • Anaemia chronic disease
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43
Q

Schobers test

A
  • 10cm above L5 and 5 cm below this
  • Length <20cm when touching toes = AS
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44
Q

Ix AS

A
  • Inflammatory markers
  • HLA B27
  • X ray
  • MRI
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45
Q

AS XR changes

A
  • Bamboo spine
  • Squaring vertebral bodies
  • Subchondral sclerosis
  • Syndesmophytes
  • Ossification
  • Fusion
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46
Q

AS Mx

A
  • NSAIDs 1st line
  • Anti TNF 2nd line
  • 3rd line = IL17 monoclonal abs or JAK inhibs
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47
Q

Patho of SLE

A
  • ANA generate a chronic inflammatory response
  • ANA = autoantibodies against proteins within the nucleus
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48
Q

S+S SLE

A
  • fatigue
  • weight loss
  • arthralgia and myalgia
  • non-erosive arthritis
  • photosensitive malar rash
  • LN
  • hair loss
  • Raynauds
  • SOB
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49
Q

Ix SLE

A
  • Autoantibodies = ANA and Anti dsDNA
  • FBC
  • CRP and ESR
  • Urinalysis
  • Renal biopsy
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50
Q

Complications SLE

A
  • Cardiovascular disease
  • Infection
  • Anaemia
  • Pericarditis
  • Pleuritis
  • ILD
  • Lupus nephritis
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51
Q

Mx SLE

A
  • Hydroxychloroquine
  • NSAIDs
  • Steroids
  • Severe = DMARDs and biologics
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52
Q

presentation PMR

A
  • rapid onset
  • 2 weeks before diagnosis consideres
  • pain and stiffness in shoulders, pelvic girdle, neck
  • worse in morning and rest
  • > 45 mins to ease
  • some imprvement on activity
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53
Q

associated features PMR

A
  • systemic
  • muscle tenderness
  • carpal tunnel
  • peripheral oedema
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54
Q

IX for PMR before steroids

A
  • FBC
  • U+E
  • LFT
  • Calcium
  • Serum protein electrophoresis
  • TSH
  • CK
  • RF
  • urine
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55
Q

Mx PMR

A
  • 15mg prednisolone daily
  • follow up after 1 week
  • 15 mg until fully controlled
  • 12.5mg for 3 w then
  • 10mg for 4-6w then
  • reduce by 1mg every 4-8 w
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56
Q

Dont STOP for steroids

A
  • Dont = dont stop immediate = adrenal crisis
  • Sick day rules = increase
  • Treatment card
  • Osteoporosis prevention
  • PPI
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57
Q

presentation GCA

A
  • unilateral headache
  • Scalp tenderness
  • jaw claudication
  • blurred or double vision
  • Loss of vision
58
Q

Dx GCA

A
  • Clinical presentation
  • Raised inflammatory markers
  • TA biopsy
  • duplex USS
59
Q

Mx GCA

A
  • 40-60mg prednisolone if no vision or jaw, 500-1000mg if visual or jaw
  • aspirin
  • PPI
  • bone protection
60
Q

T scores for OP

A

Normal = > -1
Openia = -1 to -2.5
Oporosis = <-2.5
Severe = -2.5 + fracture

61
Q

Mx OP

A
  • Reversible RF
  • Calcium 1000mg and Vit D 400-800
  • ## Bisphosphonates = alendronate, zole
62
Q

SE Bisphosphonates

A
  • reflux and oesophageal erosions
  • atypical fractures
  • osteonecrosis jaw or auditory canal
63
Q

S+S osteomalacia

A
  • fatigue
  • bone pain
  • musle weakness and aches
  • pathological fractures
64
Q

Ix osteomalacia

A
  • Serum 25-hydroxyvitamin D = <25 def
  • Low Ca and P, high ALP and PTH
  • XR = osteopenia
  • DEXA
65
Q

Tx omalacia

A
  • colecalciferl
  • 50,000IU once weekly for 6 w or 4000 IU daily for 10
66
Q

Pagets patho

A
  • Excessive bone turnover
  • increased osteoclast and blast activity
  • patchy areas of sclerosis and lysis
67
Q

S+S pagets

A
  • bone pain
  • deformity
  • fractures
  • hearing loss
  • raised ALP
68
Q

XR pagets

A
  • bone enlargement
  • OP curcumscripta
  • cotton wool skull
  • V shaped osteolytic defects in long bones
69
Q

Mx pagets

A
  • Bisphosphonates
  • NSAIDs
70
Q

complications pagets

A
  • hearing loss
  • HF
  • osteosarcoma
  • spinal stenosis
71
Q

Polymyositis

A
  • no skin features
  • proximal weakness, symmetrical
  • dermatomyositis
  • CK raised
  • steroids
72
Q

Dermatomyositis

A
  • same as pol but skin
  • Gottron papules
  • helitrope rash
  • periorbital eodema
  • photosensitive rash on back
73
Q

Antiphospholipid syndrome

A
  • increase risk of thrombosis
  • pregnancy complications
  • mx = APL antibodies
  • long term warfarin
  • pregnancy = LMWH and aspirin
74
Q

Sjogrens

A
  • dry eyes, dry mouth, dry vagina
  • joint pain and stiffness
  • Anti Ro and anti La
  • artificial tears etc
75
Q

main feature bechets

A
  • recurrent oral and genital ulcers
  • HLA B51
  • pathergy test
  • steroids
76
Q

ehlers danlos

A
  • joint pain and hypermobility
  • beighton score
77
Q

what is a colles fracture

A
  • transverse fracture of distal radius
78
Q

what is compartment syndrome

A
  • pressure within fascial compartment is abnormally elevated = cut off blood flow
79
Q

5 Ps of acute compartment syndrome

A
  • Pain
  • Paraesthesia
  • Pale
  • Pressure high
  • Paralysis
80
Q

Mx compartment syndrome

A

needle naometry
-remove dressings, elevate lef, maintain BP
- fasciotomy

81
Q

most common bug in osteomyelitis

A
  • staphylococcus aureus
82
Q

S+S omyelitis

A
  • fever
  • pain
  • red
  • swelling
83
Q

Ix and mx omyelitis

A
  • XR = periosteal reaction, osteopenia, destruction
  • MRI
  • cultures
    Mx
  • debridement
  • 6w flucloxacillin
84
Q

trochnteric bursitis

A
  • inflammation of bursa over trochanter on outer hip
  • gradual onset outer hip pain, aching or burning, worse activity, hard to lie
85
Q

special tests fot troncharic bursitis

A
  • trendelenburg
  • resisted abduction
  • resisted internal rotation
  • resisted external rotation
86
Q

mx trochanteric bursitis

A
  • rest
  • ice
  • anaglesia
  • physio
  • steroid injections
87
Q

olecranon bursitis

A
  • bony lump at elbow
  • repetitive movements
  • swollen, warm, tender, fluid filled
  • aspirate if think infection
  • rest, ice, compression, analgesia
88
Q

what is a compound fracture

A

skin is broken and bone exposed to the air

89
Q

what is a stable fracture

A

sections of bone remain in alignment at the fracture

90
Q

pathological fracture

A

bone breaks due to an abnormality within the bone

91
Q

what is a colles fracture

A

transverse fracture of the distal radius near the wrist
- distal portion displaces upwards

92
Q

which bones have vulnerable blood supplies (risk avascular necrosis)

A
  • Scaphoid bone
  • Femoral head
  • Humeral head
  • Talus
  • Navicular
  • 5th metatarsal foot
93
Q

weber classification of fractures to lateral malleolus

A
  • A = below ankle joint
  • B = at level of ankle joint
  • C = above the ankle joint = syndesmosis disrupted
94
Q

gurds major criteria for fat embolism

A
  • resp distress
  • petechial rash
  • cerebral involvement
95
Q

Intracapsular hip fracture

A
  • Break in femoral neck within capsule of hip joint
  • 1 = incomplete and non-displaced
  • 2 = complete fracture and non-displaced
  • 3 = partial displacement
  • 4 = full displacement
96
Q

extracapsular

A
  • leave head of femur intact
97
Q

surgery for intertrochanteric fractures

A
  • dynamic hip screw
98
Q

subtrochanteric fractures surgery

A
  • intramedullary nail
99
Q

presentation hip fracture

A
  • pain in groin or hip
  • not able to weight bear
  • shortened, abducted and externally rotated leg
100
Q

F1 mx hip fracture

A
  • analgesia
  • X rays
  • VTE proph
  • pre-op assessment
  • orthogeris
101
Q

septic arthritis common bacteria

A
  • staph aureus most
  • n gonorrhoea
102
Q

Mx septic arthritis

A
  • joint aspiration
  • empirical antibiotics IV
  • 4-6w abx
  • fluclox 1st line, clindamycin in pen allergy
103
Q

GCA presentation

A
  • unilateral headache
  • scalp tenderness
  • jaw claudication
  • blurred/loss vision
104
Q

dx GCA

A
  • presenttion
  • raised inflam markers
  • temporal artery biopsy
  • duplex USS = halo sign
105
Q

GCA biopsy finds

A

multinucleated giant cells

106
Q

Mx GCA

A
  • 40-60mg pred if no vision or jaw claud
  • 500-1000mg pred if visual or jaw
  • aspirin
  • PPI
  • bisphosphonates
107
Q

skin changes in dermatomyositis

A
  • gottron papules
  • heliotrope rash
108
Q

presentation myositis

A
  • muscle weakness, gradual onset and symmetrical
  • pain
109
Q

test in myositis

A

creatinine kinase = high due to inflammation = in thousands

110
Q

polymyositosis antibody

A

anti-jo 1

111
Q

antiphospholipid syndrome

A
  • antip antibodies = cause inflammation and increase thrombosis
  • VTE and pregnancy complications
112
Q

specific signs antiphospholipid

A
  • livedo reticularis = lace rash
  • libmann sacks endocarditis
  • thrombocytopenia
113
Q

Mx antip

A
  • warfarin long term
  • LMWH and aspirin pregnancy
114
Q

antip antibodies

A
  • lupus anticoagulant
  • anticardiolipin
  • anti b2 glycoprotein
115
Q

sjogrens

A
  • dry eyes, mouth and vagina
  • joint pain
  • dry skin
    anti ro and anti la
116
Q

presentation polymyalgia rheumatica

A
  • shoulder pain and stiffness
  • pelvic girdle pain and stiffness
  • neck pain and stiffness
  • worse in morning and after rest, interferes sleep
117
Q

tx PMR

A
  • 15mg prednisolone daily
  • follow up 1 week
118
Q

limited cutaneous systemic sclerosis

A
  • Calcinosis
  • Raynauds
  • Esophageal dysmotility
  • Sclerodactyly
  • Telangiectasia
119
Q

diffuse cutaneous systemic sclerosis

A
  • cardio problems = systemic and pul htn
  • lung problems = fibrosis
  • kidney problems
120
Q

anti centromere bodies in

A

limited cutaneous ss

121
Q

anti scl 70 antibodies in

A

diffuse cutaneous ss

122
Q

ottawa rules ankle fracture

A

Ankle XR only needed if pain in malleolar zone and 1 of
- Bony tenderness at lateral malleolar zone
- Bony tenderness at medial malleolar zone
- inability to walk 4 weight bearing steps immediately after injury and in ED

123
Q

Colles fracture

A
  • transverse fracture of radius
  • 1 inch proximal to radio-carpal joint
  • dorsal displacement and angulation
  • Complications = median nerve injury, compartment syndrome
124
Q

anterior cruciate ligament

A
  • lateral blow to the knee
  • pop
  • swollen
  • instability
  • anterior draw
  • lachmans
125
Q

medial epicondylitis

A
  • pain worse with wrist flexion and pronation
  • pain and tenderness localised to medial epicondyle
126
Q

Garden classification hip fractures

A

1 = incomplete and non displaced
2 = complete and non-displaced
3 = partial displacement (angle)
4 = full displacement (parallel)

127
Q

SE displaced intracapsular fractures

A
  • disrupt blood supply = avascular necrosis
  • no disruption in extra = heal well
128
Q

how does a displaced hip fracture look

A
  • short leg
  • externally rotated
129
Q

posterior dislocated femur with no fracture looks

A

short leg
internal rotation

130
Q

Mx undisplaced IC fracture

A
  • early mobilisation
  • internal fixation
  • cannulated screw
131
Q

Mx displaced IC frcture

A
  • hemiarthroplasty or tota hip replacement
132
Q

Mx intertrochanteric extracapsular

A
  • sliding or dynamic screw
133
Q

mx subtrochanteric EC fracture

A

Intramedullary nail

134
Q

all ankle fractures should be…

A

promptly reduced to remove pressure and necrosis

135
Q

marfans genetics

A

autosomal dominant = affects gene responsible for creating fibrillin

136
Q

features marfans

A
  • tall
  • long neck
  • arachnodactyly
  • high arch palate
  • hypermobile
  • pectus carinatum or exavatum
137
Q

associated conditions marfans

A
  • pneumothorax
  • GORD
  • mitral valve prolapse with regurgitation
  • aortic valve prolapse with regurgitation
  • aortic aneurysms
  • scoliosis
138
Q

marfans preventative meds

A
  • bb
  • angiotensin 2 receptor antagonists
139
Q

most common type ehlers danlos

A
  • hypermobile ED = joint hypermobility and stretchy soft skin
  • AD
140
Q

presentation ed

A
  • joint pain
  • hypermobile
  • dislocations
  • soft stretchy skin
  • poor wound healing
141
Q

score for hypermobility

A

beighton

142
Q
A

FINALS (31 decks)

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