Conditions summary Flashcards by Jay Slater

morning stiffness 
joint pain and swelling (DIP sparing)
nodules 
RF positive 
anti-CCP positive 
joint erosions on xray

rheumatoid arthritis

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rheumatoid arthritis treatment

symptomatic 
aspirin 
paracetamol 
NSAIDs (eg ibuprofen) 
steroid (eg prednisolone) 
opioids (eg codeine, morphine)

DMARD1
DMARD1 + DMARD2
DMARD1 + DMARD2 + DMARD3
biologics

DMARDs - methotrexate, sulfasalazine, hydroxychloroquine
biologics - anti-TNF

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rheumatoid arthritis flare up treatment

steroids

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heberdens nodes (DIP)
bouchards nodes (PI)
squaring of thumb base
bakers cyst at knee

worse at end of day
elderly

osteoarthritis

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xray of osteoarthritis

LOSS - loss of joint space, osteophytes, sclerosis, subchondral/subarticular cysts

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osteoarthritis treatment

weight loss
paracetamol
surgery - joint replacement

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osteoarthritis flare up treatment

steroids

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teenager
lower back/buttock pain 
pain relieved by exercise 
limited lumbar movement
question mark spine

ankylosing spondylitis

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ankylosing spondylitis treatment

symptomatic - physio, pain relied, DMARDs

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scaly plaques on extensor surfaces
onycholysis (lifting of nail from nail bed) 
joint pain 
dactylitis (sausage fingers) 
'pencil in cup' on xray

psoriatic arthritis

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psoriatic arthritis treatment

DMARDs (methotrexate, sulfasalazine, hydroxychloroquine)
anti TNF

steroids for flare ups

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GI infection 3 weeks ago
can see
painful urination
joint pain

reactive arthritis

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reactive arthritis treatment

steroids
antibiotics for infection

DMARDs if >3 months

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abdo pain
joint pain/stiffness
weight loss
change in bowels

enteropathic arthritis

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enteropathic arthritis treatment

sort IBD
paracetamol
DMARDs

NOT NSAIDs - make IBD worse

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surgery 2 weeks ago OR prosthetic joint OR PWID
bone pain
fever
hot, red swollen site of wound

acute osteomyelitis

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acute osteomyelitis treatment

antibiotics

debridement

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chronic osteomyelitis treatment

complex surgery for debridement

antibiotics

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monoarthritic pain 
hot, red, swollen, v painful joint 
fever
tachycardia 
increased WCC

septic arthritis

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septic arthritis treatment

antibiotics - flucloxacillin

surgery = debridement and joint replacement

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short stature blue sclera

fractures bones easily

brittle bone disease (osteogenesis imperfecta)

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brittle bone disease (osteogenesis imperfecta) treatment

bisphosphonates

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prominent forehead 
short limbs 
long back 
short stature 
learning difficulties

achondroplasia (type of skeletal dysplasia/short stature)

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skeletal dysplasia/short stature treatment

nothing

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``` tall long limbs high arched palate retinal detachment arachnodactyly (long fingers) ```

marfans syndrome

joint dislocations/hypermobility easy bruising tissue elasticity

Ehlers danlos syndrome

trisomy 21 short stature joint laxity

downs syndrome

``` boy age 5 gowers manoeuvre swollen 'woody' calves muscle wasting ```

duchenne muscular dystrophy

muscle wasting 'hatchet' like face myotonia (difficulty relaxing muscles after contraction)

myotonic dystrophy

muscular dystrophy treatment

nothing

duchenne muscular dystrophy but with better prognosis no gowers sign swollen 'woody' calves

beckers muscular dystrophy

'waiters tip' posture from no muscle movement in upper arm | newborn baby

erbs palsy

erbs palsy treatment

physio

paralysis of hand/wrist/fingers | newborn

klumpkes palsy

``` floppy arms abnormal gait learning difficulties 'fencing reflex' epilepsy visual impairment missed developmental milestones speech difficulties ```

cerebral palsy (lots of types)

cerebral palsy treatment

physio | symptomatic

hair patch on lower back high arched foot bladder/bowel problems

mild spina bifida (spina bifida occulta)

flu like illness (infection!) growth defects muscle weakness

polio

``` woman fever malaise weight loss lymphadenopathy butterfly malar rash painless nasal/mouth ulcers reynaulds inflammatory arthritis seizures ANA, anti-dsDNA, anti-Sm positive Complement 4 (C4) present ```

lupus (SLE)

lupus (SLE) treatment

steroids - prednislone | immunosuppressants - methotrexate, hydroxychloroquine, azathioprine, cyclophosphamide

dry eyes dry mouth rheumatoid arthritis ANA, anti-Ro, anti-La positive

sjogrens syndrome

sjogrens syndrome treatment

methotrexate | symptomatic

thickening of skin proximal to forearms, and torso breathing difficulty anti-scl70 positive ANA positive

diffuse cutaneous systemic sclerosis

thickening of skin distal to forearms, and face (not torso) anti-centromere positive ANA positive reynaulds!

limited systemic sclerosis

systemic sclerosis treatment

``` symptomatic; vasodilators - for reynaulds ACE inhibitors - for renal involvement PPI - for GI involvement immunosuppression - for lung involvement ```

``` anti RNP positive pulmonary hypertension reynaulds scleroderma sclerodactyly lots of random things ```

mixed connective tissue disease

``` levido-reticularis - lace like purple pattern on skin recurrent arterial/venous thrombosis lupus miscarriages anticardiolipin positive anti phospholipid antibodies positive ```

anti-phospholipid syndrome (APS)

anti-phospholipid syndrome (APS) treatment

warfarin | LMW heparin if pregnant

``` red, hot, v painful joint monoarthritic pain - 1st MTP joint overnight/rapid onset needle shape negative birefringent crystals on aspiration urate crystal deposition ```

gout

gout treatment

expose, cool, elevate joint NSAIDs/colcochine allopurinol prophylaxis

calcium pyrophosphate crystal deposition elderly red, hot, v painful joint monoarthritic pain - knees, wrist, ankles rectangular, rhomboid, envelope shaped crystals with positive birefringence on aspiration

pseudogout

pseudogout treatment

NSAIDs steroids no prophylaxis :(

hydroxyapatite crystal deposition (see on xray) shoulder joint pain reduced movement 50 y/o female

Milwaukee shoulder

idiopathic inflammatory myopathy

polymyositis or polymyalgia rheumatica

polymyositis + skin involvement

dermatomyositis

like polymyositis but distal limbs

inclusion body myositis

idiopathic non inflammatory myopathy

fibromyalgia

``` 40 y/o female muscle weakness - proximal limbs weight loss fever difficulty brushing hair, climbing stairs etc ANA, anti-jo positive CK raised inflammatory markers raised ```

polymyositis

``` 40 y/o female muscle weakness - proximal limbs weight loss fever gottrons papules heliotrope rash shawl sign/rash difficulty brushing hair, climbing stairs etc ANA, anti-jo positive CK raised inflammatory markers raised ```

dermatomyositis

dermatomyositis and polymyositis treatment

steroid - prednisolone 40mg | immunosuppressant - methotrexate

distal muscle weakness fever weight loss 50 y/o male

inclusion body myositis

no muscle weakness muscle pain - shoulder and hip morning stiffness >1 hour raised inflammatory markers

polymyalgia rheumatica

polymyalgia rheumatica treatment

prednisolone 15mg

``` abdo pain depression fatigue pain - neck, shoulders, lower back etc general aches and pain inflammatory markers normal antibodies negative muscle biopsy negative ```

fibromyalgia

fibromyalgia treatment

patient education gabapentin - pain relief treat IBS anti depressants

``` elderly female early menopause low impact fractures steroids coeliac disease ```

osteoporosis

osteoporosis treatment

calcium and vit D supplementation bisphosphonates denosumab (renal failure)

>50 y/o unilateral temporal headache tender, enlarged, non pulsatile arteries fever jaw claudication (osteoarthritis in TMJ) unilateral hypertension polymyalgia rheumatica (morning stiffness in shoulders and hips)

giant cell arteritis (GCA)

patient >50 y/o with sudden onset headache

giant cell arteritis (GCA)

giant cell arteritis treatment

steroids, reduce over 2 years; prednisolone 40mg if no visual symptoms prednisolone 60-80mg if visual symptoms aspirin long term PPI long term

important investigation in giant cell arteritis (GCA)

fundoscopy

treatment of all small vessel vasculitis (GPA, EGPA, MPA, HSP)

IV steroids IV cyclophosphamide long term immunosuppression - methotrexate

``` ENT symptoms - nosebleeds, oral ulcers, cough, nasal cartilage collapse purpura haemoptysis late onset asthma/rhinitis pANCA positive anti-MPO positive ```

eosinophilic granulomatosis with polyarteritis (EGPA) aka churg strauss

``` ENT symptoms - nosebleeds, oral ulcers, nasal cartilage collapse, cough haemoptysis purpura cANCA positive anti-PR3 positive ```

granulomatosis with polyarteritis (GPA) aka wegners

pANCA positive | anti-MPO positive

microscopic polyarteritis (MPA)

``` IgA mediated children 2-11 y/o URTI 3 weeks ago purpuric rash over buttocks and lower limbs abdo pain bloody diarrhoea ```

henoch schnlein purpura (HSP)

``` genetic condition easy bruising multiple scars bone fractures joint deformity premature death likely ```

congenital insensitivity to pain (CIP)

lateral curvature of the spine (posture to the L or R) | resp distress

scoliosis

scoliosis, kyphosis and spondylolisthesis treatment

physio brace/cast/wheelchair surgery - if deteriorating

``` chance fracture worsening posture ('slouching') ```

kyphosis

recurrent back pain with no neuro symptoms poor posture obese pain worse on exercise, relieve by rest

mechanical back pain

mechanical back pain treatment (4)

generally nothing pain relief increase exercise (NOT bedrest) physio, acupuncture

pain in lower back then in legs pain worse walking up hill | retired construction worker

slipped disc

slipped disc treatment (3)

generally nothing, 70% self limiting in 3 months pain relief increase exercise (NOT bedrest) physio

forward slippage of one vertebrae onto another lower back pain young and sporty

spondylolisthesis

reduced leg power | unilateral leg pain in dermatomal pattern

sciatica

sciatica treatment symptomatic and curative

self limiting surgery (v v v v rare)

``` 55 year old male retired manual worker obese painful back and legs when walking downhill enjoys cycling ```

spinal stenosis

spinal stenosis treatment (3 - think of risk factor)

physio decrease weight surgery - spinal decompression

severe sudden exacerbations of pain worse as day goes on, worse with activity deep seated central back pain

discogenic back pain

discogenic back pain treatment (2)

physio | pain relief

morning stiffness back pain worse after prolonged rest pain relieved by exercise

facet arthropathy

treatment for facet arthropathy (3)

exercise pain relief injections

lower back pain loss of bladder/bowel control saddle anaesthesia - bilateral loss of sensation to buttocks/perineum/inner thigh loss of anal tone on PR exam

cauda equina syndrome

cauda equina syndrome treatment complications

emergency surgery within 24 hours paralysis if no treatment

painful lateral epicondyle resisted middle finger and wrist extension pain worse when opening jar

tennis elbow (lateral epicondylitis)

tennis elbow (lateral epicondylitis) treatment (5)

``` rest physio pain relief steroid injections surgery last resort ```

painful medial epicondyle | wrist flexion painful pain worse on opening jar

golfers elbow (medial epicondylitis)

golfers elbow (lateral epicondylitis) treatment (4+1 not)

rest physio pain relief surgery last resort NOT steroid injections (may damage ulnar nerve!)

paraesthesia (pins and needles) of medial 1.5 fingers | weakness of thumb

ulnar nerve compression | cubital tunnel syndrome

cubital tunnel syndrome treatment

surgery - nerve decompression/release of tight structures

swelling at olecranon process

olecranon bursitis

lump on medial aspect of 1st MTP | pain in little toes

hallux valgus (bunion)

lump above 1st MTP (on dorsal surface) | pain on walking

hallux rigidus

treatment of hallux rigidus or hallux valgus

pain relief better footwear surgery - last line

``` 60 year old male diabetes alcoholic cirrhosis ring (or little) finger gets 'stuck' on flexion cant be extended actively ```

dupuytrens contracture

palmar thickening with myoofibroblasts and type 3 collagen production

dupuytrens contracture

treatment of dupuytrens contracture (2)

stretches | surgery if impaired function

'clicking' of middle (or ring) finger on flexion | can extend finger actively

trigger finger

inflammation of flexor digit tendon = nodule formation = catches on A1 pulley

trigger finger

trigger finger treatment (2)

``` steroid injection (up to 3 times as necessary) surgery if steroid injection not effective ```

recently given birth to baby house wife pain on radial styloid process positive finklesteins test

dequervains tenosynovitis

dequervains tenosynovitis treatment (4)

splint, rest, NSAIDs physio steroid injection surgery - for decompression

cant fully extend finger after an injury at netball

mallet (staved) finger

mallet finger (staved finger) treatment

splint for 4 weeks

any carpal dislocation treatment complication of no treatment

emergency surgery osteoarthritis

treatment of finger dislocation (2)

local anaesthetic and reduce dislocation | then splint to neighbouring finger asap

arthritis type involving MCP and carpals

rheumatoid arthritis

arthritis type involving PIP, DIP, base of thumb

osteoarthritis

fluid filled cyst at DIP joint transiluminate well defined firm

ganglion cyst

30 year old female pregnant numbness in digits 1-3 and lateral half of digit 4 reduced thumb function

carpal tunnel syndrome

carpal tunnel syndrome treatment (2)

steroid injection | surgical decompression

cubital tunnel syndrome

surgical decompression

65 year old male paraesthesia of ulnar 1.5 fingers weakness of 1st dorsal interosseous and adductor pollicis muscles injury to elbow

cubital tunnel syndrome

where is AVN most common

hip

severe groin pain

AVN

severe trochanter pain

trochanteric bursitis

hip AVN treatment (2)

surgery for decompression of pressure | joint replacement

trochanteric bursitis treatment (4 + 1 not)

self limiting NSAIDs injections physio NOT surgery

wrist/ankle AVN treatment (2)

surgery for decompression | joint fusion

painful shortened leg externally rotated

hip fracture

painful shortened leg internally rotated

hip dislocation

hip dislocation treatment

emergency reduction

knee osteoarthritis first line treatment (3)

weight loss increase activity mobility aids

knee osteoarthritis second line treatment (if end stage and elderly)

surgery - total knee replacement

knee osteoarthritis second line treatment (if young)

partial knee replacement

valgus instability (knock kneed) pain for months ACL damage knee ligament rupture

MCL rupture

``` football tackle hyperextension of knee varum stance PCL damage knee ligament rupture ```

LCL rupture

treatment of MCL and LCL

nothing

``` sports injury to knee haemarthrosis pain for a few days twisting/popping sensation positive anterior drawer test positive lachman test ```

ACL rupture

ACL rupture treatment

physio | surgery - ligament graft

``` anterior tibial injury hyperextension instability going downstairs 'sagging tibia' positive posterior drawer test knee pain ```

PCL rupture

general treatment of knee ligament ruptures

nothing unless several ligaments and v bad stability

``` twisting sporting injury to knee sharp sudden pain effusion next day catching and locking positive steinmans test ```

meniscal tear (probs medial meniscus)

imaging used for knee ligament problems

MRI | xray - to rule out fracture

rupture of one of; quads, quads tendon, patella, patellar retinaculum, patellar ligament in a body builder with chronic steroid use

extensor mechanism rupture

inflammation of insertion of patellar tendon at tibial tubercle

Osgood schlatters disease

bony lump at tibial tubercle adolescent boy pain worse after exercise positive straight leg raise

Osgood schlatters disease

swelling in popliteal fossa

bakers cyst

30-40 year old painful arc 60-120 shoulder abduction positive Hawkins kennedy test

impingement syndrome

impingement syndrome treatment (3)

NSAIDs/analgesia physio 3 months 3 steroid injections

>40 year old | jerk of arm with sudden shoulder pain and muscle weakness

rotator cuff tear

rotator cuff tear treatment (3)

NSAIDs physio steroid injections

40-60 year old female | shoulder pain for 6 months then stiffness (pain goes away)

frozen shoulder

frozen shoulder treatment (3)

physio! NSAIDs steroid injections self limiting <2 years

acute severe shoulder pain | calcification above shoulder on xray

acute calcific tendonitis

acute calcific tendonitis treatment (2)

self limiting | steroids/analgesia for pain

sports injury to shoulder badge patch dullness | positive findings on xray

anterior shoulder dislocation

anterior shoulder dislocation treatment (4 - need them all)

calm patient - analgesia, sedation, O2 closed reduction/manipulation of joint sling 2-4 weeks physio

asymmetric shoulders lightbulb sign on xray no pain

posterior shoulder dislocation from ligamentous laxity condition (eg ehlers danlos, marfans)

>60 year old gradual onset shoulder pain, reduced movement LOSS on xray

glenohumeral osteoarthritis

glenohumeral osteoarthritis treatment (4)

analgesia physio steroid injections surgery

swimmer popeye sign pain in shoulder, worse on elbow/shoulder flexion bruising

biceps tendonitis

biceps tendonitis treatment

rest and physio | surgery if severe

biceps tendonitis complications

tendon rupture

aetiology of intoeing in kids (3)

femoral neck anteversion internal tibial torsion metatarsal adductus

new born breech in womb inverted, plantarflexed, supinated feet

clubfoot (talipes equinovarus)

clubfoot (talipes equinovarus) treatment (2)

splints from birth - age 4 | surgery

fixed flat feet in kid

tarsal coalition

tarsal coalition treatment

splint | surgery

``` new born girl breech birth asymmetrical extra skin fold in thigh asymmetrical shortened limb positive barlow test ```

developmental dysplasia of the hip (DDH)

treatment of developmental dysplasia of the hip (DDH)

relocate hip and splint (pavlik harness) to stabilise

``` 3 year old breech birth asymmetrical short leg Trendelenburg gait painless limp ```

developmental dysplasia of the hip (DDH) late diagnosis (usually diagnosed at birth)

``` age 2-10 boy upper RTI - fever sudden onset pain non weight bearing limp high inflammatory markers (other investigations normal) ```

transient synovitis of the hip (irritable hip)

treatment of transient synovitis of the hip (irritable hip)

nothing - bed rest, NSAIDs if persistent after 2 weeks = look for a different cause

``` aged 4-8 boy hyperactive short stature Trendelenburg gait, limp hip pain ```

perthes (idiopathic AVN of hip)

treatment of perthes (2)

nothing - NSAIDs, avoid physical activity | surgery if severe

``` age 10-16 overweight boy pain - knee and/or hip probs weight bearing limp ```

SUFE (slipped upper femoral epiphysis

SUFE (slipped upper femoral epiphysis) treatment

urgent surgery - pin to stabilise femoral head (maybe in both legs to prevent the other hip from slipping too)

adolescent female pain in knee from muscle imbalance predisposed to osteoarthritis later in life

anterior knee pain, nothing you can do

'catching and locking' of knee teenager lump at medial femoral epicondyle

ostechondirits dissecans (OCD) of the knee

``` bone pain back pain weakness fatigue weight loss renal failure anaemia recurrent infections proteinuria ```

multiple myeloma

``` bone pain, 'shin splints' enlarged bones (eg bigger head) increased metabolism fractures increased alk phos (ALP) normal Ca ```

pagets disease of bone

pagets disease of bone treatment

bisphosphonates - inhibits osteoclasts = prevents disease progression

treatment of benign bon tumours

curettage to remove it

treatment of malignant bone tumours

excision with a 3-4cm circumference

when is spinal stenosis pain relived (which activity)

cycling (bc spinal flexion)