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1
Q

infant symptoms in osteomyelitis

A

failure thrive, drowsy, irritable, tender swelling, decreased ROM, position change, knee.

2
Q

child symptoms in osteomyelitis

A

severe pain, reluctance to move, tender fever, malaise

3
Q

adult signs in osteomyelitis

A

backache, immunocompromised

4
Q

investigations for osteomyelitis

A
FBC + diff WBC
ESR
CRP
blood cultures 3*
U+E’s 

X-Ray, US, isotope bone scan, labelled white cell scan, MRI, aspiration

5
Q

treatment for osteomyelitis

A

Supportive
rest + splintage
4-6 weeks empirical initially antibiotics

surgery for aspiration, drainage, debridement, replacing joint replacements

if chronic eradicate surgically, consider amputate

6
Q

differential diagnosis for osteomyelitis

A

Consider synovitis or septic arthritis, or soft tissue infection

7
Q

acute septic arthritis neonate symptoms and signs

A

irritable, resistant to movement, ill

8
Q

child acute septic arthritis symptoms and signs

A

acute pain in single joint, reluctant to move, fever, pulse, tender

9
Q

child acute septic arthritis investigations

A

FBC, WBC, ESR, CRP, blood cultures, US, aspirate

10
Q

treatment for child acute septic arthritis

A

Supportive

antibiotics 3-4 weeks, surgical drainage and lavage

11
Q

failure thrive, drowsy, irritable, tender swelling, decreased ROM, position change, knee. symptoms of

A

osteomyelitis in child

12
Q

TB joint manifestation symptoms

A

Insidious onset
TB contact
night pain, Weight loss, swelling, pyrexia, decreased ROM, ankylosis, deformity

13
Q

investigations for TB joint manifestation

A

FBC, ESR, Mantoux, sputum, urine culture, X-ray, joint aspiration and biopsy

14
Q

treatment for TB joint manifestation

A

8 weeks
rifampicin
isoniazid
ethambutol

6-12months
rifampicin
isoniazid

15
Q

rheumatoid arthritis symptoms

A

Morning stiffness, 3 or more joints, symmetric, nodules. Pain, immobility, poor function, systemic. Swelling, tenderness, redness and heat. Fatigue, weight loss, anaemia

16
Q

RA investigations

A

RF
anti CCP
X-Ray
US doppler

17
Q

gout treatment flare

A

NSAIDS, colchicine, steroids

18
Q

gout repeated attacks

A

symptomatic

xanthine oxidase inhibitor, febuxostat, uricosuric agents, canakinumab, lifestyle

19
Q

pseudogout symptoms

A

Elderly female, knee, erratic flares, triggers

20
Q

pseudogout treatment

A

NSAIDS, steroids

21
Q

polymyalgia rheumatica symptoms

A

Correlates with GCA. Sudden onset of shoulder and pelvic girdle stiffness, malaise, weight loss, fever, depression, arthralgia occasional synovitis
> age of 50

22
Q

Paget’s disease symptoms and signs

A
Deformity and fracture
>40yrs with bone pain
excess heat
neurological comp. deafness 
osteosarcoma
23
Q

biochemical signs of Pagets

A

raised ALK P

24
Q

treatment of Paget’s disease

A

Treat symptomatic with IV bisphosphonate therapy 1 off IV zoledronic acid

25
Q

acute pain in single joint, reluctant to move, fever, pulse, tender symptoms of

A

acute septic arthritis in a child

26
Q

Morning stiffness, 3 or more joints, symmetric, nodules. Pain, immobility, poor function, systemic. Swelling, tenderness, redness and heat. Fatigue, weight loss, anaemia symptoms of

A

Rheumatoid arthritis

27
Q

Insidious onset

night pain, Weight loss, swelling, pyrexia, decreased ROM, ankylosis, deformity symptoms of

A

TB joint manifestation

28
Q

Correlates with GCA. Sudden onset of shoulder and pelvic girdle stiffness, malaise, weight loss, fever, depression, arthralgia occasional synovitis
> age of 50 - symptoms of

A

polymyalgia rheumatica

29
Q

Elderly female, knee, erratic flares, triggers - symptoms of

A

pseudogout

30
Q
Deformity and fracture
>40yrs with bone pain
excess heat
neurological comp. deafness 
osteosarcoma - symptoms of
A

Paget’s disease

31
Q
Progressive deforming bone 
defective tooth formation
hearing loss
blue sclera
scoliosis
barrel chest
ligamentous laxity
easy bruising  symptoms of
A

Osteogenesis imperfecta

32
Q

treatment for osteogenesis imperfecta

A

Treat fractures
IV bisphosphonates to prevent
education
genetic counselling

33
Q

investigation of osteoporosis

A

DXA bone scan

34
Q

osteogenesis imperfecta symptoms

A
Progressive deforming bone 
defective tooth formation
hearing loss
blue sclera
scoliosis
barrel chest
ligamentous laxity
easy bruising
35
Q

osteoporosis treatment

A
Fall prevention stragety
ensure good calcium and Vit D, HRT, SERM 
main Bisphosphonates
biologic Denosumab  
teriparatide
36
Q

SLE symptoms

A
Butterfly rash, fever
depression
vasculitis, purpura
urticaria, pleurisy
pleural effusion
fibrosis
Raynaund’s
aseptic necrosis of hip, arthritis, alopecia, fits
ataxia, hemiplegia
P. neuropathy 
CN lesions
pericarditis
endocarditis
aortic valve lesions
myopathy, anaemia
leukopenia 
thrombocytopenia
37
Q

investigations for SLE

A
Anti-ds DNA, SM, cardiolupin, lupus anticoagulant, low complement 
low WCC
U+E’s
dipstix 
biopsy kidney if haematuria  
ANA
38
Q

mild SLE treatment

A

hydroxychloroquine

39
Q

moderate SLE treatment

A

azathioprine, methotrexate, mycophenolate

40
Q

severe SLE treatment

A

cyclophosphamide, rituximab

41
Q

scleroderma symptoms

A
Morphea local
systemic limited
oesophageal disability
Sclerodactyly
telangiectasia 
Calcinosis
Raynauds 
distal to the elbows and knees 
systemic  diffuse 
fixed flexion deformities of fingers, feel encased
42
Q

scleroderma investigation

A

Regular monitoring of RH function and lung function

ANA

43
Q

scleroderma mild treatment

A

mild – hydroxychloroquine

44
Q

moderate scleroderma treatment

A

azathioprine, methotrexate, mycophenolate

45
Q

severe scleroderma tx

A

cyclophosphamide, rituximab

46
Q

Sjorgren’s syndrome symptoms

A

GS dysphagia, altered motility, interstitial lung disease, fits, hemiplegia, ataxia, CN lesions, renal tubular acidosis, palpable purpura, Raynaud’s syndrome, arthralgia, dryness, fatigue, myalgia, fever

47
Q

investigations for Sjogren’s syndrome

A

Schirmer’s test

Biopsy of minor saliva gland below lip

48
Q

mild Sjogren’s syndrome tx

A

hydroxychloroquine

49
Q

moderate Sjogren’s syndrome Tx

A

azathioprine, methotrexate, mycophenolate

50
Q

severe Sjogren’s syndrome Tx

A

cyclophosphamide, rituximab

51
Q

auto-immune myositis symptoms

A

Muscle weakness
symmetrical diffuse, proximal, polymyositis, dermatomyositis Gottron’s papules, heliotrope rash.
no pain
Shawl’s sign

52
Q

auto-immune myositis mild Tx

A

hydroxychloroquine

53
Q

auto-immune myositis moderate Tx

A

azathioprine, methotrexate, mycophenolate

54
Q

auto-immune myositis severe Tx

A

cyclophosphamide, rituximab

55
Q

GCA symptoms

A

> 50
new headache
Temporal tenderness

56
Q
Butterfly rash, fever
depression
vasculitis, purpura
urticaria, pleurisy
pleural effusion
fibrosis
Raynaund’s
aseptic necrosis of hip, arthritis, alopecia, fits
ataxia, hemiplegia
P. neuropathy 
CN lesions
pericarditis
endocarditis
aortic valve lesions
myopathy, anaemia
leukopenia 
thrombocytopenia  - symptoms of
A

SLE

57
Q
Morphea local
systemic limited
oesophageal disability
Sclerodactyly
telangiectasia 
Calcinosis
Raynauds 
distal to the elbows and knees 
systemic  diffuse 
fixed flexion deformities of fingers, feel encased  - symptoms of
A

scleroderma

58
Q

GS dysphagia, altered motility, interstitial lung disease, fits, hemiplegia, ataxia, CN lesions, renal tubular acidosis, palpable purpura, Raynaud’s syndrome, arthralgia, dryness, fatigue, myalgia, fever - symptoms of

A

Sjogren’s syndrome

59
Q

Muscle weakness
symmetrical diffuse, proximal, polymyositis, dermatomyositis Gottron’s papules, heliotrope rash.
no pain
Shawl’s sign - symptoms of

A

auto-immune myositis

60
Q

> 50
new headache
Temporal tenderness - symptoms of

A

GCA

61
Q

GCA mild treatment

A

hydroxychloroquine

62
Q

GCA investigation

A

ESR > 50

Biopsy of temporal artery

63
Q

GCA moderate treatment

A

azathioprine, methotrexate, mycophenolate

64
Q

GCA severe treatment

A

cyclophosphamide, rituximab

65
Q

Ankylosing Spondylitis symptoms

A

Axial, back pain, limited movements anteriorly, posteriorly and laterally, limited chest expansion, bilateral sacroiliitis, erosions or sclerosis

peripheral joints, uveitis, tendonitis, cardiac, pulmonary, GI, osteoporosis, cauda equina, renal amyloidosis

66
Q

ankylosing spondylitis investigation

A

HLA B27 positive
modified Schober for spinal mobility
X-ray

67
Q

ankylosing spondylitis Tx

A

Physiotherapy, NSAIDs, sulfasalazine, anti TNF, anti IL-17

treat osteoporosis, surgery rarely

68
Q

psoriatic arthritis symptoms

A

Distal inter pharyngeal changes with nail changes and psoriasis affecting knees, toes, ankle, base of spine, elbow, wrist, hand, neck and shoulder

69
Q

Tx psoriatic arthritis treatment

A
Sulfasalazine
methotrexate
leflunomide
cyclosporine
anti TNF 
Anti IL 17 +23 
physio + OT
70
Q

reactive arthritis symptoms

A

Mono or oligoarthritic, may be systemic, dactylitis and enthesis be also be seen
skin and mucous involvement keratoderma blennorrhagia, iritis, urethritis, Reighte’r syndrome

71
Q

reactive arthritis treatment

A

NSAID, sulfasalazine, methotrexate

72
Q

reactive arthritis acute treatment

A

Acute NSAID, joint injections, treat underlying infection

73
Q

enteropathy arthritis Tx

A

Sulfasalazine, steroids, methotrexate, anti TNF, bowel resection

74
Q

meniscal tear symptoms

A
Pain
clicking
locking 
intermittent swelling
effusion, tender, mechanical block, fail deep squat, McMurray’s positive, Thassaly’s positive
75
Q

meniscal tear investigations

A

X-Ray

MRI

76
Q

meniscal tear treatment

A

Rest
NSAIDS
physiotherapy

Arthroscopy for repair or resection

77
Q

Axial, back pain, limited movmeents anteriorly, posteriorly and laterally, limited chest expansion, bilateral sacroiliitis, erosions or sclerosis

peripheral joints, uveitis, tendonitis, cardiac, pulmonary, GI, osteoporosis, cauda equina, renal amyloidosis - symptoms of

A

ankylosing spondylitis

78
Q

Distal inter pharyngeal changes with nail changes and psoriasis affecting knees, toes, ankle, base of spine, elbow, wrist, hand, neck and shoulder - symptoms of

A

psoriatic arthritis

79
Q

Mono or oligoarthritic, may be systemic, dactylitis and enthesis be also be seen
skin and mucous involvement keratoderma blennorrhagia, iritis, urethritis, Reighte’r syndrome - symptoms of

A

reactive arthritis

80
Q
Pain
clicking
locking 
intermittent swelling
effusion, tender, mechanical block, fail deep squat, McMurray’s positive, Thassaly’s positive  - symptoms of
A

meniscal tear

81
Q

osteoarthritis symptoms

A

pain and stiffness

82
Q

anterior cruciate ligament tear symptoms

A
Pop/crack
immediate swelling
deep pain 
anterior draw
pivot shift
Lachmanns test
83
Q

ACL investigations

A

X-ray

MRI

84
Q

ACL Tx

A

Focused Quadricep programme

ACL reconstruction, partial menisectomy, hamstring graft, ligament repair or augmentation

85
Q

MCL symptoms

A

Pop/crack
painful
unable to continue playing
localised swelling, bruising medial knee
lock, tender medially and at femoral insertion, painful full extension, opening on valgus stress

86
Q

MCL investigations

A

X-Ray

MRI – modality of choice

87
Q

MCL treatment

A

Rest, NSAIDS, brace for comfort, physiotherapy

operative only for failed non operative, or severe with repair or reconstruction

88
Q

osteochondritis dissecans symptoms

A
Activity related pain
recurrent effusion
locking
block to full movement 
tender
stiffness
Wilson’s test
89
Q

osteochondritis dissecans investigations

A

X-ray

MRI

90
Q

osteochondritis dissecans Tx

A

Restricted weight bearing, ROM brace

operative Arthroscopy or open fixation

91
Q

Hallux Valgus symptoms

A

Pressure from shore wear
pain from crossing over of toes
metatarsalgia

92
Q

Hallux Valgus investigation

A

X-ray

clinical

93
Q

Hallux Valgus non-operative treatment

A

shoe wear modification
orthotics
analgesia
activity modification

94
Q

Hallux Valgus operative TX

A

release lateral soft tissues, osteotomy of 1st metatarsal

95
Q

Hallux Rigidus symptoms

A

Asymptomatic
pain at extreme of dorsiflexion
limited ROM

96
Q

Hallux Rigidus Tx

A
Activity modification
rigid sole
analgesia
Cheilectomy
arthrodesis
arthroplasty 
gold standard is a 1st MTPJ fusion
97
Q

Pain and stiffness of joint - symptoms of

A

OA

98
Q
Pop/crack
immediate swelling
deep pain 
anterior draw
pivot shift
Lachmanns test - symptoms
A

ACL tear

99
Q

Pop/crack
painful
unable to continue playing
localised swelling, bruising medial knee
lock, tender medially and at femoral insertion, painful full extension, opening on valgus stress - symptoms

A

MCL

100
Q
Activity related pain
recurrent effusion
locking
block to full movement 
tender
stiffness
Wilson’s test - symptoms of
A

Osteochondritis dissecans

101
Q

Pressure from shore wear
pain from crossing over of toes
metatarsalgia - symptoms of

A

Hallux Valgus

102
Q

Asymptomatic
pain at extreme of dorsiflexion
limited ROM - symptoms of

A

Hallux Rigidus

103
Q

Lesser Toe deformity symptoms

A

Deformity
pain from dorsum
metatarsalgia

104
Q

treatment for Lesser Toe deformity

A
Activity modification
flat shoes with high toes box 
orthotic insoles
operative 
flexor to extensor transfer
fusion of interphalangeal joint
release of metatarsophalangeal joint
shortening osteotomy of metatarsal
105
Q

Morton’s Neuroma symptoms

A

Affects 3rd followed by 2nd webspace toes
neuralgic burning pain
intermittent
altered sensation

106
Q

Morton’s Neuroma investigation

A

Mulder’s click
US best
clinical
MRI

107
Q

Morton’s Neuroma treatment

A

injection and excision

108
Q

Dorsal foot ganglia symptoms

A

Pain from pressure from shoe wear

pain from underlying problem

109
Q

dorsal foot ganglia treatment

A

Aspiration and excision

110
Q

plantar fibromatosis treatment

A

Avoid pressure/ orthotics
excisions
RT+/- surgery

111
Q

achilles tendinopathy symptoms

A

Pain during excersise, following exercise, recurrent, difficult fitting shoes

112
Q

achilles tendinopathy investigations

A

Tenderness
check for rupture simmond’s test
US
MRI

113
Q

achilles tendinopathy treatment

A
Weight loss
activity modification 
shoe wear modification
physiotherapy
extra corporeal shockwave treatment 
immobilise
operative
debridement and release
Gastrocnemius resection
114
Q

plantar fasciosis symptoms

A

Pain first thing in morning, pain on weight bearing following rest, pain located at origin of plantar fascia, long lasting

115
Q

Plantar fasciosis investigations

A

Clinical
x-Ray
US
MRI

116
Q

Plantar fasciosis Tx

A
Rest
stretching
Ice
NSAIDS
orthoses heel pads
physio
weight loss
injections of corticosteroids 
night splinting
117
Q

diabetic foot ulcer Tx

A

Prevention
modify the main detriments; smoking, diabetic, vascular, external and internal pressure, infection, nutrition

surgical debride, correct deformity, amputation

118
Q

Charcot neuroarthropathy symptoms

A

Acute swollen erythematous foot with neuropathy
greater than 3-degree difference between limbs
not painful

119
Q

Affects 3rd followed by 2nd webspace toes
neuralgic burning pain
intermittent
altered sensation - symptoms

A

Morton’s Neuroma

120
Q

Pain from pressure from shoe wear

pain from underlying problem - symptoms

A

Dorsal foot ganglia

121
Q

Pain during exercise, following exercise, recurrent, difficult fitting shoes - symptoms

A

achilles tendinopathy

122
Q

Pain first thing in morning, pain on weight bearing following rest, pain located at origin of plantar fascia, long lasting - symptoms

A

plantar fasciosis

123
Q

plantar fasciosis differentials

A

Nerve entrapment syndrome
arthritis
calcaneal pathology

124
Q

Acute swollen erythematous foot with neuropathy
greater than 3-degree difference between limbs
not painful - symptoms

A

charcot neuroarthropathy

125
Q

Sarcoma symptoms

A

Deep
>5cm
rapid hard craggy, non-tender growth
ma be painless

126
Q

sarcoma investigations

A

MRI

127
Q

Bone tumour symptoms

A

Pain – progressive, rest, night, activity
mass

malignant may be deep seated and boring pain, difficulty weight bearing and deep swelling

128
Q

bone tumour investigations

A
X-ray
CT
isotope bone scan 
MRI scan of choice 
PET for response to chemo
Biopsy after other investigations
129
Q

osteosarcoma symptoms

A

Pain, loss of function, warm swelling, pathological fractures, effusion, deformity, neurovascular effects, systemic effects. Analgesia not effective, not related to exercise, worse at night

130
Q

osteosarcoma investigation

A

MRI

131
Q

pathological fractures from bone tumours treatment

A
Early chemo 
DXT
prophylactic internal 
fixation
bone cement 
aim for early painless weight bearing + mobilisation
132
Q

spinal central cord

hyperextension injury

A

weakness of arms > legs

perianal sensation and lower extremity power preserved

133
Q

spinal anterior cord hyperflexion,

A

fine touch and proprioception preserved but profound weakness

134
Q

Brown Sequard

paralysis of affected side ,

A

Brown Sequard
paralysis of affected side , loss of proprioception and fine discrimination, pain and temperature loss of opposite side below lesion

135
Q

treatment of spinal cord injury

A
Prevent secondary insult 
in-field stabilization
ATLS resus
pharmacologic agents 
prompt medical care  

posteriorly pedicle screws

long term

physio
OT
psychological support
urological

136
Q

investigation for spinal cord injury

A

ASIA classification

X-rays
CT
MRI

137
Q

Tibialis posterior tendon dysfunction investigation

A

Clinical diagnosis double and single heel raise

MRI

138
Q

treatment for Tibialis posterior tendon dysfunction

A

Orthoses or surgery

tendon reconstruction
triple fusion

139
Q

IV disk prolapse symptoms

A

Nerve root pain – limb pain worse than back, nerve distribution

140
Q

cauda equina symptoms

A

Bladder and anal sphincter dysfunction and incontinence

bilateral buttock and leg pain, and dysesthesia, weakness

141
Q

treatment for cervical and lumbar spondylosis

A

Lateral recess stenosis
nerve root injection, epidural injection
surgery

central stenosis
epidural steroid
surgery

foraminal stenosis
non-operative
epidural injection
surgery

142
Q

spinal claudication symptoms

A
Bilateral
Sensory dysesthesia
poss weakness
takes several minutes to ease after stopping walking
worse walking down hills
143
Q

Deep
>5cm
rapid hard craggy, non-tender growth
ma be painless - symptoms

A

sarcoma

144
Q

Pain – progressive, rest, night, activity
mass

malignant may be deep seated and boring pain, difficulty weight bearing and deep swelling - symptoms

A

bone tumours

145
Q

Pain, loss of function, warm swelling, pathological fractures, effusion, deformity, neurovascular effects, systemic effects. Analgesia not effective, not related to exercise, worse at night - symptoms

A

osteosarcoma

146
Q

weakness of arms > legs

perianal sensation and lower extremity power preserved - symptoms

A

central cord

hyperextension injury

147
Q

loss of proprioception and fine discrimination, pain and temperature loss of opposite side below lesion

A

Brown Sequard

paralysis of affected side

148
Q

, fine touch and proprioception preserved but profound weakness

A

anterior cord hyperflexion

149
Q

Bladder and anal sphincter dysfunction and incontinence

bilateral buttock and leg pain, and dysesthesia, weakness

A

cauda equina

150
Q
Bilateral
Sensory dysesthesia
poss weakness
takes several minutes to ease after stopping walking
worse walking down hills
A

spinal claudication

151
Q

Dupuytren’s disease symptoms

A

Not painful
loss of finger extension
difficulty with hand in pocket, gripping things, washing face

152
Q

Dupuytren’s treatment

A
Operative
partial fasciectomy
dermo-fasciectomy
arthrodesis
amputation
collagenase
percutaneous needle fasciotomy
153
Q

Trigger finger symptoms

A

Clicking
lump in hand under pulley
may unlock

154
Q

trigger finger treatment

A

Splintage, steroid, percutaneous release, open surgery

155
Q

De Quervain’s syndrome symptoms

A

Localised swelling
pain localised to radial side of wrist
aggravated by movement of the thumbs , localised tenderness over tunnel

156
Q

de Quervain’s investigation

A

Finklestein’s test

resisted thumb extension

157
Q

De Quervain’s treatment

A

Splint
steroids
decompression

158
Q

ganglia symptoms

A

Lump, firm, non -tender, change in size, smooth, lobulated, not fixed

159
Q

OA treatment

A

Manage social, occupation, mood, sleep, support network, comorbidity, pain, exercise
thermotherapy,
electrotherapy, aids and devices, manual therapy

analgesia, NSAIDS, capsaicin, steroids

160
Q

Erb-Duchenne sign

A

Arm-Porter’s tip

161
Q

ulnar nerve symptoms and signs

A

Claw hand, hypothenar wasting, 1st dorsal interosseous wasting, sensory deficit little finger

162
Q

median nerve signs and symptoms

A

Thenar wasting, pointing finger, volar aspect thumb sensory loss

163
Q

radial nerve signs and symptoms

A

Wrist drop, sensory deficit 1st web space dorsally

164
Q

Not painful
loss of finger extension
difficulty with hand in pocket, gripping things, washing face - symptoms

A

dupuytren’s disease

165
Q

Clicking
lump in hand under pulley
may unlock - symptoms

A

trigger finger

166
Q

Lump, firm, non -tender, change in size, smooth, lobulated, not fixed - symptoms

A

ganglia

167
Q

45+ years, activity related joint pain plus no morning related stiffness or morning stiffness that lasts no longer than 30 minutes - symptoms

A

OA

168
Q

Wrist drop, sensory deficit 1st web space dorsally

A

radial nerve injury

169
Q

Thenar wasting, pointing finger, volar aspect thumb sensory loss

A

median nerve

170
Q

Claw hand, hypothenar wasting, 1st dorsal interosseous wasting, sensory deficit little finger

A

ulnar nerve