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CLINICAL Flashcards

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1
Q

osteoarthritis?

A

protective cartilage wears down
wear and tear disease
damaged joint
form of arthritis

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2
Q

what occurs in osteoarthritis ?

A

breakdown of cartilage
changes in bone
connective tissue deteriorates
inflammation

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3
Q

osteomyelitis is? due to?(causes in infants and kids)

A

infection in bone due to

infants - staph aureus
kids - staph aureus/strep pyogenes/haemophilus influenza

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4
Q

pathology of osteomyelitis?

A 
trauma etc 
vascular stenosis 
acute inflam 
pus increases 
necrosis of bone 
new bone form 
re solves it self or not
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5
Q

dermatome?

A

area of skin supplied by single spinal nerve

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6
Q

septic arthritis ?

pattern of pathology

A

painful joint infection

infection 
inflammation 
increase in pressure 
lead to less blood flow 
more damage
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7
Q

drugs for tb? 4

A

isoniazid
rifampin
ethambutol
pyrazinamide

combo taken over few months

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8
Q

2 types of tb?

A

latent - inactive tb - no symptoms - can form active

active -

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9
Q

brachial plexus is?

A

c5-t1

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10
Q

erbs palsy?

A

c5/6 damage in brachial plexus

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11
Q

klumphes palsy?

A

lower roots of brachial plexus are damaged

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12
Q

carpal tunnel?

A

narrow passageway surrounded by bone and ligaments on palm side of hand

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13
Q

radial nerve palsy lead to?

A

numbness towards FINGERS AND TRICEP
pinching and grasping problems
wrist drop
weakness

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14
Q

carpal tunnel syndrome?

A

compression of median nerve

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15
Q

two types of tests carried out for carpal tunnel syndrome?

A

tinels - tap nerve

phalens - flex hands and wrists

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16
Q

ulnar nerve palsy test?

A

froments test - see ability to punch and grasp

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17
Q

where is lumbar plexus in relation to muscles?

A

on surface of quadrates lomborum

within body of poses muscle

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18
Q

femoral nerve roots?

A

L2-4

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19
Q

ROUTE of femoral nerve?

A

pass thru psoas muscle
exit under inguinal ligament
lateral to femoral artery/vein/lymph in femoral triangle

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20
Q

lateral cutaneous femoral nerve roots?

A

l2,3

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21
Q

roots of ulnar nerve?

A

c7,c8,t1

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22
Q

median nerve runs how? and roots?

A

closely related to brachial artery - c7,8,t1

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23
Q

lateral cutaneous femoral nerve how it runs?

how does it get compressed

A

lies on surface of iliac muscle - exits pelvis under lateral end of inguinal ligament - can be compressed by it!

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24
Q

sciatic nerve? roots?
runs how?
gives rise to what branches? 2

A

l4-s3 from sacral plexus
runs from buttocks and back of thigh to heel of foot and sole

gives rise to tibial and common fibular nerve

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25
compression of common fibular nerve leads to what?
foot drop and slapping gait
26
sarcoma?
malignant tumour arising from connective tissue
27
bone tumours usually what?
usually secondary - common
28
bon forming tumours called?
Osteo-
29
tumour like lesion in bone example?
bone cyst - hole in bone
30
commonest primary malignant bone tumour in young and old?
young - osteosarcoma | old - myeloma
31
main clinical feature of bone tumours ?
PAIN - activity related or progressive at rest and night
32
osteoid osteoma?
tiny benign bone tumour that develops in long bones of body - such as femur/ tibia
33
3 most common bone cancers and explain briefly each?
osteosarcoma - most common - bone producing cells- younger chondrosarcoma - cartilage producing cells - older Ewing sarcoma - pelvis/legs - younger
34
why is biopsy taking need to be performed well?
can do it in wrong place and can spread biopsy in biopsy line!
35
what cancers commonly spread to bone? 6
``` breast cancer melanoma lung liver / kidney prostate ```
36
common places for bone mets in order?
``` vertebrae femur pelvis ribs/sternum skull ```
37
prophylactic fixation ?
placing metal into bone to stabilise it and strengthen it to prevent breaking - prevent fracture
38
what is used to measure fracture risk in bone cancer patients?
mirel's scoring system
39
commonest soft tissue tumour?
lipoma
40
splint?
device to maintain the position of a displaced moveable part - like a cast
41
sequestrum meaning and occurs when?
dead bone tissue - necrosis - in chronic osteomyelitis
42
involucrum meaning and occurs where/when?
new bone forming around sequestrum - in chronic osteomyelitis
43
most common spread of osteomyelitis cause?
haemolytic spread - blood
44
conservative treatment of osteomyelitis?
nutrition pain meds rest support
45
acute osteomyelitis defined as what?
less than 3 weeks
46
pain of tumours/infection is?
increasing - progressive pain at rest worst disturbs sleep
47
dorsum and volar of hand means?
dorsum - back of hand volar- palm of hand
48
list characteristics for a fracture to occur in bone? 4
large size lytic - holes painful weight bearing bone
49
sclerotic/blastic meaning?
new bone being produced
50
motor unit? efferent/afferent? located where?
efferent anterior horn cell located in gray matter of spinal cord muscle fibres
51
sensory unit? | where?
cell bodies in posterior root ganglia - lie outside spinal cord
52
what combines to form spinal nerve?
anterior and posterior root combined
53
structure of a nerve - layers and covers? axons fascicles nerve nerve surrounded by?
axons - long processes of neurons - coated in endoneurium fascicles - grouped axons - covered with perineurium fascicles group together - to form nerve covered with epineurium neurone surrounded by Schwann cells
54
types of injury of nerve?
compression trauma - direct - blow and laceration indirect - traction
55
neurapraxia?
mildest form of injury - loss of conduction without changes in axonal structure - nerve still in continuity axon intact
56
axonotmesis?
injury to nerve - axons and myelin sheath damaged but endoneurium/perineurium/epineurium intact - undergoes wallerian degeneration
57
neurotmesis?
complete nerve division - most serious damage - often by laceration
58
closed nerve damage meaning? recovery?
whole peripheral nerve intact but with either neuropraxis/axonotmesis recovery possible
59
open nerve damage meaning?
related to nerve division - laceration
60
wallerian degeneration?
degeneration process of axon occurs when nerve fibre is cut or crushed - part of axon distal to injury degenerates - part of healing process
61
nerve injuries to sensory and motor leads to?
sensory - numbness - disordered sensation - pins/needles motor - weakness - paralysis - muscle wasting - dry skin
62
prognosis of healing depending on whether lesion is proximal or distal ?
proximal lesion - is worse
63
tinels sign?
detects irritated nerves - tap nerve - to get sensation feeling
64
injury of nerve assessed and monitored by ?
electrophysiological nerve conduction studies - fire electrical impulses up nerve and test nerve recovery
65
neuroma?
nerve tumour - benign growth - pinched nerve - painful condition
66
fasciotomy?
surgery where fascia is cut to relieve tension/pressure -
67
partial and dermo fasciectomy?
open up - excise thicker bands - fix position of hands and fingers
68
dupuytrens disease?
hand deformity - fixed bent flexed position - thickened layer of tissue under skin of palm - thick cord that is a pulley - pulls on fingers
69
enzyme injections in dupuytrens disease?
collagenase -
70
trigger finger? explain pathology of it
finger stuck in bent position - locked in this position - where tendon sheath becomes irritated and inflamed - disrupts motion of tendon through sheath - most likely A1 pulley swells
71
de quervains syndrome?
affect tendons of wrist - due to 2 tendons at base of thumb swollen and irritated - leading to pain
72
ganglion cyst?
non cancerous lump along tendon/joint of wrist and hand - filled with fluid painless
73
trapeziectomy?
surgery where one of bones of the thumb joint is removed
74
what ligaments are?
dense bands of collagenous tissue - multiple ones at one joint - anchored to the bone at either end
75
difference between ligaments and tendons?
ligaments have less collagen - less organised fibres
76
what ligaments contain?
collagen fibers and fibroblasts
77
when would you do conservative treatment? 3
partial injuries no instability poor candidate for surgery
78
when would you do surgery treatment? 3
instability present expectation - patient plays sport compulsory - multiple injuries/issues
79
healing process explain of ligament rupture?
haemorrhage - blood clot proliferative response - scar tissue remodelling - regain function
80
tendons? | contains?
muscle to bone connection | longitudinal arrangement of tenocytes cells and collagen fibers
81
3 layers and covers in a tendon explain?
collagen bundles covered by endotenon fascicles covered by paratenon tendon covered by epitenon
82
vinculum?
connective tissue that connects tendon to bone carries blood to tendons too
83
enthesioathy?
inflammation at insertion of tendon into bone -
84
avulsion of tendons meaning?
can be +/- bone fragments - pulling off tendons from bone - failure to insert and carry out motion
85
mallet finger?
when tendon at end of finger is damaged - leads to flexion forced on finger
86
cancellous bone? | where?
spongy bone found in vertebrae centre and the ends of long bones - in inner layer -
87
cortical bone?
forms external layer of bones - in limbs - circumferentially layed down
88
4 stages of fracture?
inflammation soft callus hard callus bone remodelling
89
plasma platelet conc fluid used for?
used to help healing of fractures -
90
osteoinductive and osteoconductive?
qualities of a bone graft cells osteoconductive - ability for cells to form bone in graft area - osteoinduction - ability of cell to differentiate into osteoblast - DONT WANT THIS IN BONE GRAFT
91
DELAYED AND NO UNION fractures meaning?
delayed - healing of fracture not in expected time | no union - no healing of fracture
92
myotomes of upper limb? brachial plexus
``` c5 - shoulder abduction - deltoid c6 - elbow flexion/wrist extensors - biceps c7 - elbow extension - triceps c8 - thumb extension - fds.fdp t1 - finger adduction - interossei ```
93
impingement meaning?
rubbing of surfaces at joint - as space narrows
94
most common direction for shoulder dislocation?
anterior
95
osteophytes?
bony lumps around joint where OA present - where there is local inflammation or injury
96
frozen shoulder meaning?
stiff shoulder - restricted movement in all directions
97
arthroscopy?
tiny arthroscope - restore function of joint - restore function of joint - repair tendons
98
complex reconstruction done how?
3d reconstructions done to make specific implants for patient
99
froments sign??
ulnar nerve damage sign
100
tennis elbow and golfers elbow?
tennis elbow - lateral epicondylitis - pain on outside of elbow golfers elbow - medial epicondylitis - pain on inside of elbow
101
how many vertebrae in cervical thoracic lumbar sacrum?
c - 7 t - 12 l - 5 s - 5
102
curvature in each part of spine?
cervical - lordosis thoracic - kyphosis lumbar - lordosis sacral - kphyosis
103
costo vertebral and costo tranverse joints?
cv joints - bodies of vertebrae - ct joints - rib and transverse process
104
myotome?
group of muscles that a single spinal nerve innervates
105
myotomes of lower limbs? explain what boundaries
L2 - S1 ``` l2 - hip flexion - illiopsoas l3,4 - knee extension - quads l4 - ankle dorsiflexion - tip ant l5 - big toe extension - EHL S1 - ankle plantar flexion - gastroc ```
106
clavicle fracture most likely where?
middle 1/3
107
test where for axillary nerve?
regimental badge
108
recurrence of shoulder dislocation why?
younger male involved in contact sports
109
colles fracture?
distal forearm fracture with broken end of radius
110
most common fracture in hand carpus?
scaphoid fractures
111
scaphoid fracture? what blood supply exists here
fracture at wrist carpal bones - anatomical snuff box - retrograde blood supply
112
Bennetts fracture ?
base of thumb fracture - 1st metacarpal
113
invertebrate disc blood supply?
avascular
114
structure of invertebrate disc?
annulus fibrosis - outer layer - fibers run obliquely nucleus pulposus - gelatinous core - water,collegan, proteoglycans
115
disc prolapses usually where?
postero-lateral
116
disc problems? 4 types
bulge - common - protrusion - annulus weakened but intact extrusion -annulus disrupted sequestration - material leaked and free in canal
117
cervical disc prolapse?
c5/6
118
disc prolapse common where?
lumbar - l4/5 cervical - c5/6 thoracic - t11/12
119
l5/s1 disc prolapse causes?
l5/s1 disc prolapse - sensory loss in little toe and sole of foot motor weakness plantar flexion
120
l4/5 disc prolapse causes?
sensory loss in great toe and 1st dorsal web space motor weakness in EHL tendon
121
l3/4 disc prolapse causes?
sensory loss in medial aspect of lower leg motor weakness in quads
122
main symptoms of caudate enquina?
sever lower back pain saddle anaesthesia bladder dysfunction
123
commonest cause of CES?
lumbar disc prolapse
124
is the invertebrate disc a joint?
it is a secondary cartilaginous joint - to allow movement between vertebrae
125
cervical spondylosis?
wear and tear of spinal discs in neck - OA and degenerative changes here at joints
126
ligament flavum?
between laminae of vertebrae
127
pars interarticularis?
part of vertebrae located between inferior and superior articular processes of facet joint - and in another plane lies between laminae and pedicle
128
spondylosis and spondylitis difference?
spondylosis - degenerative | spondylitis - inflammation of vertebrae
129
spondylosis in lumbar spine?
pars fracture - degenerative changes seen too
130
vascular claudication vs spinal claudication?
``` spinal - bilateral numbness takes time to ease after stopped walking worse on walking down hill - better on walking up hill/cycling ```
131
stenotic canal meaning?
narrowing of spinal canal -
132
spondylolisthesis?
outcome of spondolyosis - where one vertebrae translates forward and backward over the other
133
two type of spinal stenosis ?
lateral - compression and inflammation of spinal nerve as it emerges from sc central - compression and inflam of spinal cord - deformity and congenital issue here
134
2 types of infant MSK issues?
manufacturing defects - in growth of limbs in womb packaging defects - limbs normal but forces in womb and childbirth cause issues
135
msk issues that cause concern in kids? 5
``` in toed gait bow legs flat feet curly toes late walkers ```
136
femoral ante version lead to?
twisting of thigh bone - causes knees and feet to turn inward - in toeing
137
internal tibial torsion?
increased inward twisting of shin bones - feet turn inward
138
what should be considered when looking at lower limb angular deformity? 2
symmetry = none is bad | age - older or younger = older is bad
139
5 S's to refer someone to paeds orthopaedics?
``` symptoms - pain symmetry - asymmetry is bad stiffness syndromes systemic illness - pyrexia/sleep disturb ```
140
commonest cause of limp?
toxic/transient synovitis - commonest septic arthritis trauma /injury Osteomyelitis
141
commonest site of origin of limp in kids?
hip
142
gowers manoeuvre?
used to check kid for muscle dystrophy - ask up and down - see if they use hands on leg to stand
143
most common place for septic arthritis ?
knee and hip
144
arththrotomy?
creating of an opening in a joint - that can be used in drainage
145
reduced weight bearing meaning?
decreased amount of weight a person can put through on an injured limb
146
transient synovitis? common in who
inflam in hip joint - mostly in kids 2-8 yrs
147
ESR level?
indicate inflammation - speed at which red blood cells settle
148
crp level ?
measure level of inflammation
149
physeal fractures? types? classification - most common one
growth plate fracture - in the physis of long bones type 1 to 5 - Slater-harris classification type 2 most common
150
fixation of fracture means?
stabilises misaligned bones - pins/frame and nail
151
avulsion fracture?
when small part of bone attached to tendon or ligament is pulled away from bone
152
ways cerebral palsy can be classified? 2 ways - each describe
``` physiologic - location of abnormality spastic athetoid ataxia mixed ``` ``` anatomical - what is affected monoplegia - one limb involved hemiplegia - one side of body affected diplegia - lower limbs quadriplegia - all 4 limbs ```
153
main complication of cerebral palsy?
contracture - muscle shortening
154
cerebral palsy?
group of motor disorders - pre-birth - that affect muscle tone, posture, movement abnormalities in development of brain
155
GMFCS classification describe? tells us what
motor function - classification tells us risk of hip dislocation level I - walks without limitations normal level II - walks with limits level III - walks with hand held device level iv - SELF MOBILITY with limitations - powered mobility level V - transported in manual wheelchair
156
osteotomy?
cuts and reshapes bone
157
scoliosis when is it of clinical significance?
when over 10 degrees deviation
158
2 types of scoliosis
structural - structure of vertebrae disrupted - abnormal rotation - spinal issue non-structural - due to extrinsic cause - e.g. - hip problem - leg issue etc
159
club feet?
common birth defect - when foot twisted out of shape and position
160
Cobb angle in scoliosis?
curve magnitude - tells us the severity
161
braces in scoliosis explain?
braces worn 24/7 delays progression of curve custom made
162
DDH ?
in children - hip joint not developed correctly
163
signs of DDH?
ORTolani sign Barlow sign piston motion sign hamstring sign
164
screening for DDH?
CLINICAL EXAM or US is selective
165
Perthes disease?
in kids! when blood supply to ball part of hip joint is interrupted and bone starts to die and weaken
166
4 stages of Perthes disease on film?
waldenstorm initial stage - bone death fragmentation stage - reossification stage - new bone forms healed stage
167
SUFE?
IN CHILDREN WHERE IN GROWTH plate of thigh bone suffers fracture and head of femur slips out
168
classification of SUFE? 3
acute v chronic magnitude of slip angle stable v unstable
169
chronic SUFE?
MORE THAN 3 weeks
170
magnitude of slip in SUFE ? explain
angle or proportion
171
stable v unstable?
unstable - unable to weight bear | stable - able to weight bear
172
what is the risk of unstable slip in SUFE?
AVN
173
erbs palsy leads to ? WHAT IS AFFECTED LEADS TO
injury to upper trunk - leads to waiters tip | C5-6
174
klumpkes palsy is? affects? leads to?
injury to lower trunk affects intrinsic muscles pf hand claw hand
175
how to test for FDP?
isolate DIPJ ask to flex end of finger
176
how to test for FDS?
take out FDP hold down other fingers out straight and flex one finger
177
2 arches in palm explain origins?
superficial palmar arch - from ulnar artery deep palmar arch - from radial artery
178
Allens test?
test for ulnar and radial artery - | where you occlude both arteries at wrist and then release to see repurfusion
179
where to test for axillary nerve damage? 2
badge area for numbness/sensory loss weakness of deltoid
180
2 ways axillary nerve can be damaged?
shoulder dislocation | fracture surgical neck of humerus
181
colles fracture? where and caused by what?
fracture of distal radius - falling on extended wrist
182
smiths fracture? where and caused by what?
fracture of distal radius - falling on flexed wrist
183
what happen to extensor digitorum tendons ?
flatten to for extensor expansions on dorsal surface of digits 2-5
184
what does the extensor expansion do?
a tendinous aponeurosis that wraps around the dorsum and sides of metacarpal and base of proximal phalanx 1 central part - base of mid phalanx 2 lateral parts - merge to form conjoint tendon - base of distal phalanx
185
what muscles stabilise the extensor expansion? 2
lumbricals and interossei muscles
186
supervised neglect meaning?
when a doctor routinely examines a patient who exhibits symptoms of a disease or problem and the patient is not aware of the situation and its progress
187
osteotomy for what ages?
above 7yrs
188
causes of DDH? 4
FAM history breech delivery oligohydraminos other lower limb deformities
189
greenstick fracture?
occur in babies - soft bone - in which bone bends and breaks - unstable need surgery
190
buckle fracture?
compression fractures - when one side of bone buckles or bends - but doesn't break all way through -so parts still together - stable - can do surgery to repair basically just bump on bone -sprain can't see any deformity
191
previous chest infection can lead to what in hip bone??
transient synovitis
192
diagnosis of DDH due to mostly?
lower limb discrepancy when child correctly positioned
193
bilateral genu varus vs valgus ?
varus - in bowing of legs - lower leg is angled medially valgus - knock knees -
194
physiological causes more likely at what age?
in younger - when systems have malfunctioned
195
young or old should get surgery?
young - better outcome
196
how does transient synovitis appear on X-ray?
no changes - its just inflammation
197
when does transient synovitis occur?
after viral infection
198
how does SUFE occur in X-ray?
line through growth plate lead to head of femur - can tell if slipped
199
Perthes disease - gender ratio?
more likely in male than female
200
Perthes disease - presents how?
presents with thigh and knee pain on exercise
201
what causes DDH? list them
anything that decreases space for baby in womb - oligohydraminos - breech - fam history - increased weight
202
closed fracture?
no contamination from outside environment - infection
203
comminuted fracture?
bone in more than 2 pieces
204
simple fracture?
bone in 2 pieces
205
fracture on growth plate - does what?
increases blood supply increase overgrowth can occur OR growth arrest
206
ORTLANI test?
positive result in DDH | abduct the hip
207
deep groin creases seen where?
seen in affected lower limb with lower limb discrepancy in DDH
208
congenital issue is manufacturing or packaging?
manufacturing
209
varus and valgus genu in life?
``` 1-2 = varus 2-13 = Valgus ```
210
exact definition of cerebral palsy?
permanent and non-progressive motor disorder due to brain damage before birth or during the first 2 yrs of life
211
TEV - foot deformities associated with it?
``` CAVE caves of mid foot adductus of mid foot varus of hind foot/ankle equinus of ankle ```
212
herbs palsy affects what muscles? palsy of C5/6
deltoid, biceps, brachialis, infraspinatus, supraspinatus, and serratus anterior muscles
213
where does pect major attach to intertubrcular sulcus?
lateral
214
what nerve is damaged in winging scapula?
long thoracic nerve - controls serrates anterior
215
synovial provides blood supply?
no
216
Describe RA?
symmetric polyarticular inflam joint disease
217
classic deformity with RA in mcp joints?
ulnar deviation of mcp joints
218
classic symptoms of arthritis?
pain stiffness swelling
219
what is RA? - characteristics
``` chronic autoimmune systemic symmetrical peripheral arthritis poly joints ```
220
disease activity score - where and explain numbers?
DAS - measure severity of disease - in RA DAS less than 2.4 - clinical remission DAS more than 5.1 - biologic therapy eligible
221
immunology in RA? 3
RF anti-CCP ACPA
222
explain stages of RA?
early - smaller joints - hand/feet | later - spreads - ankle, shoulder, elbow etc
223
functions of synovium? 4
maintain intact tissue surface lubricate cartilage control synovial fluid vol nutrition to chondrocytes
224
what is happening at joint in RA? 4
pannus - synovitis inflam infiltration - T cells B cells synoviocyte proliferation neoangiogenesis - new bv form
225
what does the synovial pannus cause? | mediated by what?
bone and cartilage destruction mediated by osteoclasts - bone destroying mediated by proteases - cartilage destroying
226
two types of RA? explain both
sero positive - all autoantibodies detectable | sero negative - none detectable
227
genetic association with RA?
HLA-DRB1 locus
228
systemic consequences of RA?
``` scleritis vasculitis CVD ANAEMIA fatigue and reduced cognitive function interstitial lung disease ```
229
key cytokines in RA? 2 they do what?
TNF-ALPHA IL-6 bring about systemic consquences
230
4 drugs used in RA?
DMARD NSAIDS steroids biologics
231
DMARD? | and eg
group of med that slow onset of RA BUT HAS slow effect METHOTREXATE/SULFAZALAZINE
232
seronegative RA is what? associated with genetically? pattern?
associated with negative RF associated with HLA-B27 ASYMMETRIC on larger joints
233
different examples of seronegative RA? 5
``` ankylosing spondylitis psoriatic arthritis bowel related arthiritis reactive arthritis juvenile AS ```
234
what present in all/most spondyloarthropathies? and what are they all?
sacroilitis - inflam of end of spine into pelvis | all seronegative
235
ankylosing spondylitis? onset? gender?
inflam rheumatic disorder in axial skeleton male over female onset in second to third decade of life
236
schober test?
measure how stiff spine is - | bend over and measure difference of two fingers over lower back of spine
237
what radiographic changes seen on X-ray in AS?
BILATERAL SACROILITIS
238
AS - FEATURES?
BACK PAIN limit movements xray changes
239
reactive arthritis is when?
sterile synovitis after distant infection
240
oligoarthirtis means?
less than 5 joints
241
triad of reactive arthritis?
arthritis urethritis conjunctivitis
242
is HLA B27 diagnostic of AS/SPa?
NO
243
morning stiffness tells us what?
tells us inflam or mechanical back pain | worse if its inflam
244
pauciarticular? classification where
less then 4 joints - classification of JIA
245
explain pauciarticular JIA? | types - each explain - gender/limb?
pauciarticular - most common - less than or 4 joints type 1 - most, girls, lower limb type 2 - boys, LL, type 3 - girls, ul&ll,
246
polyarticular JIA? | types - each explain - gender, presentation
equal or more than 5 joints 2nd most common JIA types 1 - RF NEGATIVE = girls, symmetric, 2 - RF POSITIVE = girls, systemic manifestations,
247
systemic JIA? gender, common? explain features
LEAST COMMON girls fever rash hepatomegaly polyarthiritis
248
osteoporosis drugs are?
biphosphonate drugs iv or oral
249
characteristic feature of pagets disease?
elevation of serum alkaline phosphatase
250
what is pagets disease?
disease of bone interferes with body's normal recycling process - lead to fragile and misshapen bone
251
osteomalacia and rickets?
severe vitamin D deficiency - soft bones rickets - child osteomalacia - adult
252
osteogenesis imperfecta is what?
genetic disorders of connective tissue - collagen type 1 characterised by fragile bones - fracture easily imperfect bone formation various types
253
other features of OI?
``` growth deficiency hearing loss blue sclera scoliosis defective tooth formation ```
254
main aim of OI Management?
prevent and treat fractures
255
osteoporosis is what? characteristics
metabolic bone disease | characterised by low bone mass, deterioration of bone tissue, increase fragility of bone
256
risk of fracture related to? measured by what?
age BMD falls bone turnover Q fracture used in UK
257
what assessment tells you if osteoporosis risk or not?
fracture risk assessment tool
258
when is risk significant for osteoporosis?
when over 10% risk then referred to DXA scan
259
risk factors for osteoporosis?
``` age race family history steroids hormonal - thyroid up, cushings, decrease in androgens already suffered low trauma fracture ```
260
prevent fracture by doing what?
calcium vit D falls prevention strategies
261
what are crystal deposition diseases? common examples?2
deposition of mineralised material within joints and peri-articular tissue gout pseudo gout
262
tophus?
massive accumulations of uric acid in joints
263
gout explain what is it?
inflammatory crystal arthropathy caused by deposition of uric acid due to hyperuricaemia
264
medications for gout? 2 | and their aim?
NSAIDs and steroids then try to lower uric acid and increase secretion febuxostat allopurinol
265
crystals in pseudogout?
calcium pyrophosphate dehydrate crystals
266
pseudo gout where and seen commonly in who?
in knee and in elderly women
267
different things leading hyperuricaemia?
overproduction = malignancy, drugs ``` under excretion = renal impairment hypertension hypothyroidism exercise ```
268
polymyalgia rheumatica? | and diagnosis?
muscle pain and stiffness - shoulders and pelvic girdle older, ESR increased, female
269
polymyalgia associated with what?
giant cell arteritis
270
what is lupus?
autoimmune disease that is systemic inflammation affecting nay body system
271
autoantibodies for SLE?
ANA anti-ds DNA LOTS OF OTHERS
272
characteristics seen in SLE?
butterfly rash, fever, weight loss, fatigue | systemic issues - nephritis, chest pain or arthritis
273
SLE mostly seen in who?
women of child bearing age
274
systemic sclerosis is?
autoimmune fibrosis of skin an internal organs when overproduction of collegan
275
systemic sclerosis seen in who?
women | 30-50 yrs
276
2 types of systemic sclerosis?
limited - cutaneous - skin | diffuse - faster progression
277
Sjogren syndrome?
dry eyes and dry mouth | autoimmune disorder
278
Sjogren syndrome in who?
women any age
279
myositis is ? | type of disease?
inflam in muscles - weakness, swelling, pain autoimmune disease systemic - affects different organs
280
what is giant cell arteritis? | explain the features of GCS?
inflam in lining of arteries - mostly in temples ``` more than 50 yrs headache tenderness in temples ESR up abnormal temporal biopsy ```
281
explain what you see in temporal artery biopsy in GCS?
INFLAM infiltrate in artery wall and intimal hyperplasia and luminal occlusion
282
complications of GCS?
visual loss aortic aneurysms stroke
283
treatment for GCS?
prednisone high dose corticosteroid | and gradually reduce
284
Metacarpophalangeal joints are affected in psoriatic arthritis?
NO
285
ACPA as a diagnosis of RA?
not present in all RA just tells severity and progression
286
smoking is related with what bone disease?
RA
287
Psoriatic arthritis affects what joints mainly ?
DIJ/PIJ joints more
288
psoriatic arthritis is what?
psoriatic plaques on ski and joint pain
289
JIA is in which gender more common? | systemic consequences? 3
more in girls than boys kids high temp rash pericarditis
290
AS seen in which gender ?
males
291
AS progression seen how?
posture is bent and spine bent
292
steroids do what to bone?
increase chances of osteoporosis
293
bone protection is done how?
prophylaxis | biphosphonates
294
moving the joint in septic arthritis means?
installs pain when moving the joints
295
commonest MSK tumour in kids?
osteosarcoma
296
trigger finger associated with what?
diabetes mellitus
297
what meniscal tear is more common?
medial meniscal tear
298
mcmurrays test for?
positive test for meniscal tears
299
thassalys test for?
test for meniscal tears - positive result
300
main cause of ACL tear in knee?
non-contact pivot injury
301
most common ligament injury of knee?
MCL tear
302
osteochondritis dissecans?
where bone underlying cartilage of joint dies - due to lack of blood flow - leads to bone detaching
303
osteochondritis dissecans occurs mostly where?
mostly knee
304
tronchanteric bursitis occurs where?
In hip - bursa inflames
305
Femoroacetabular impingement lead to?
where extra bone grows along on elf hip bones and form hip joint and give hip irregular shape - so don't fit correctly and so bones rub against each other
306
FADIR test FOR?
positive result fro impingement - positive in FAI
307
FABER test for?
positive result is labral tear
308
forefoot, mid foot, hind foot means?
forefoot - metatarsals, toes mid foot - tarsals hindfoot = heel,calcaneus,talus
309
hallux valgus is what?
bunions
310
hallux valgus pathogenesis? explain what occurs
lateral angulation of great toe
311
hallux rigidus is what?
stiff big toe - OA of 1st MTP joint
312
cheilectomy is?
surgical removal of bone spurs from around the big toe joint. This procedure is done to reduce pain that results from hallux rigidus
313
Mortons neuroma? what where pathology explain
inflammation severe pain and numbness on sole of foot between 3rd and followed by 2nd webspace/toes thickening of the tissue around one of the nerves leading to your toes.
314
diagnostic sign for Mortons neuroma?
mulders click
315
metatarsalgia?
any pain coming from forefoot - can have lots of causes
316
dorsal foot ganglia?
is a cluster of neurons (a ganglion) in a dorsal root of a spinal nerve
317
what is the equivalent of dupuytrens of foot?
plantar fibromatosis
318
achilles rupture tests? 2
Simmonds calf squeeze test | angle of the dangle/matles
319
Charcot arthropathy is?
syndrome in patients where loss of sensation in foot and ankle resulting in gradual progression of destruction of bone and soft tissue
320
incised wounds vs stab wounds?
incised - superficial - slashes - longer than deeper stab wounds - deeper than width -
321
subluxation is?
partial dislocation - not fully out of joint
322
gustilo classification for what?
for open fractures type 1 type 2 type 3
323
medial ligament tears of knee are associated with what?
with anterior cruciate tears
324
lesser toe deformities?
hammer toe claw toe mallet toe
325
subarachnoid deformity leads to?
loss of consciousness and cardiac arrest
326
fibromyalgia is? associated with? in who?
widespread pain around body - with tenderness - inflammatory disorder in older people assocaited with GCA
327
``` dislocation direction more common how in shoulder elbow hip ankle ```
shoulder - anterior elbow-posterior hip-posterior ankle - lateral
328
explain gustilo grading?
type 1 - low energy wound less than 1cm type 2 - moderate soft tissue damage, 1-10cm type 3 - high energy, wound more than 10cm,
329
traction is what? | what type of reduction is it?
force - pulling to restore alignment | indirect, closed reduction
330
stability of fractures to shortening oblique spiral transverse comminuted
oblique - on occasion is stable spiral - unstable transverse - stable commented - unstable
331
transverse fracture due to? oblique fracture due to? spiral fracture due to?
transverse - direct blow oblique - bending moment of force spiral - rotational force
332
rotational malignant of fracture described as?
internal/external | can be examined through clinical examination
333
4 ways to describe deformity in fracture?
displacement - diameter of bone angulation - degrees rotational axial deformity - cm - impaction/distraction
334
what areas of body bruise more easily?
buttocks, abdomen bruise less easily as no underlying bone
335
L5 nerve root compression lead to?
foot drop | no big toe dorsiflexion
336
S1 nerve root compression lead to?
weakness in plantar flexion of foot | sensory loss in lateral aspect of foot
337
L4 nerve root compression lead to?
reduced patellar reflex and knee extension weakness
338
explain eras palsy position?
medially rotated arm with an extended and pronated forearm with a flexion of the wrist WAITERS TIP
339
why thiazides should be stopped?
lead to gout
340
raynauds pehnomenon? common in who? treatment?
when vasospasm of small arteries that decrease blood flow to skin - causes colour change common in females CCB used to treat -
341
carpal tunnel syndrome lead to what clinical feature?
loss of grip strength
342
best 1st line management for plantar fasciitis? | AND WHY?
analgesia rest weight loss supportive footwear AS IT RESOLVES ITSELF WITH TIME
343
risks for AVN? 3
ALCOHOL trauma steroid use
344
red eye and back pain/stiffness is?
ankylosing spondylitis
345
trigger finger when?
PAIN/STIFFNESS AT BASE of finger/thumb | pain/clicking when you move it - particularly in the morning
346
normal range of bmi?
18-23
347
osteosarcoma caused by injury? and commonly where?
isn't caused by injury COMMON IN KNEE
348
AXILLARY NERVE WHERE?
between heads of triceps
349
knee reflex in what dermatome?
L4
350
INCREASE IN creatinine kinase means what?
bone damage
351
differences between polymyositis and polymyalgia rheumatic?
polymyositis - muscle WEAKNESS elevated muscle enzymes polymyalgia reumatica - stiffness, muscle PAIN in shoulder associated with GCA ELEAVTED esr,crp
352
ruptured flexor tendon means what?
cause decrease in flexion of fingers unlike trigger finger
353
serum urate levels in gout?
normal - mostly or high
354
what nerve enters both greater and lesser sciatic foramen?
pudendal nerve
355
what does the saphenous nerve innervate?
the medial aspect of lower leg and foot
356
SLE immunology? 3
ANA positive anti-dsDNA RF
357
BOXER fracture affects what ?
5th metacarpal affected
358
bony mets from where to bone? 4
thyroid breast lungs kidney
359
morning stiffness seen in which disease and not in which?
seen in RA | not in OA
360
side effect of biphosphonates?
oesophageal reactions
361
disc invertebrate prolapse means what to structure of the disc?
herniation of nucleus pulposes
362
most common cause of heel pain in adults?
plantar fascitis
363
explain what fibromyalgia presents as?
pain all over body with tender points
364
explain presentation of PR?
increase CPR, ESR AND is associated with giant cells arteritis
365
positive phalens and tingles test in hand means what?
carpal tunnel syndrome
366
carpal tunnel syndrome presents as how?
tingling and pain in hand - helps by shaking hand to relieve it
367
Dupuytren's contracture explain presentations? 2 and what is associated with?
progressive, fibrotic thickening of the palmar fascia. fixed flexion deformity of the 4th and 5th digit alcohol
368
first sign of OA in hip?
reduced internal rotation
369
adverse effects of methotrexate? 2
myelosuprression | liver fibrosis
370
tibial shaft fracture causes what?
sural nerve damage
371
Trochanteric bursitis presents how?
lateral hip pain swelling positive Trendelenberg test
372
presentation of AS? 5
``` back pain early morning stiffness uveitis in eye tenderness over sacroiliac joints better with movement ```
373
features of OI? 4
blue sclera fractures easily deafness dental imperfections
374
fibromyalgia presentation?
``` pain widespread tender points fatigue mood changes sleep changes ```
375
if flexion impaired but supination is intact - what is affected?
short head of biceps brachii
376
intracapsular vs extra capsular fractures explain?
intracpasular - includes femoral head and neck extra capsular - includes intertrochanteric, trochanteric, and subtrochanteric fractures
377
methotrexate is what type of drug?
immune suppression drug
378
how beta blockers affect renin-angiotensinogen system?
decreases renin | to decrease blood pressure
379
where do RA affect in hands?
PIP and MCP
380
SIDE effects of NSAIDS ?
SAK stomach - gi ulcers, dyspepsia asthma - deterioates kidneys - nephrotoxic
381
side effects of biphosphonates?
oesophageal reactions | osteonecrosis of jaw
382
sjogrens syndrome antibodies?
anti RO | anti La
383
associated stuff with AS? 4
IBD uveitis - eye redness osteoporosis buttocks pain
384
normal or increased anion gap caused by?
increased - more acid normal - loss of bicarbonate
385
nephritic and nephrotic which is proliferative and not?
nephrotic - non-p - scarring | nephritic - p = excessive inflam cells
386
ankle/knee reflex loss due to what disc prolapse?
ankle - s1 | knee - l4
387
DDH/PERTHES/SUFE - how to differentiate?
DDH - babies PERTHES - 4-10yrs SUFE - teens
388
how perthes presents?
limited internal rotation and abduction
389
how SUFE presents?
limited external rotation
390
bloods in refeeding syndrome? 3
hypo K hypo phosphate hypo Mg
391
ADH - induce aquaporins where?
in distal tubule and collecting duct
392
NSAIDS lead to increase or decrease in grr?
decrease
393
explain pageTS?
disorder of osteoclasts - too much reabsorption old man raised ALP bone pain
394
L3 radiculopathy lead to?
hip adduction weakness
395
L4 radiculopathy affects what and where?
femoral nerve and knee extension
396
nursemaids elbow means?
radial head subluxation out of annular ligament
397
intracapsular fracture lead to?
lead to AVN of femoral head
398
OA with movement ? in contrast with AS?
OA is worse on movement - gets better with rest AS is better with movement
399
4 features of OA joint?
loss of space osteophytes subchondral cysts subarticular sclerosis
400
osteoporosis features main?
female | age - older
401
treatment for RA? explain what used
NSAIDS /oral steroids DMARDS biologics
402
side effects of methotrexate
hepatotoxicity renal impairment pulmonary fibrosis
403
IN AS what investigation to do ?
pelvic x ray - not HLAB27 as its not diagnostic of AS
404
BEST investigation for PR?
ESR level
405
straight leg raise sign for ?
test for herniated disc - positive if pain is installed
406
first line treatment for acromegaly?
surgery | then somatostatin analogues etc
407
methotrexate used in?
RA
408
ankle reflex is what dermatome?
S1

MSK (4 decks)

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