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MBBS Orthopedics > Misc > Flashcards

Misc Flashcards

1
Q

6 causes of bone deformity

A 
o Congenital
o Rickets/ osteomalacia 
o Bone dysplasia
o Physeal injury
o Fracture malunion
o Paget’s dx
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2
Q

6 causes of joint deformity

A 
o Skin contracture- burn
o Fascial contracture- Dupuytren's
o Muscle contracture – Volkmann's 
o Muscle imbalance
o Joint instability
o Joint destruction
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3
Q

Hx for knee

A

any

  • locking
  • giving way
  • pain (one point or whole joint line)
  • pain when climbing stairs or standing
  • stiffness: morning or constant
  • swollen
  • noise along joint
  • functional: can walk? climb stairs? squat down?
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4
Q

What muscle weakness you expect in sciatic nerve injury?

A

Difficulty

  • ankle flexion/ extension/ inversion/ eversion
  • great toe extension
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5
Q

What are the side effects of H&L

A

with repeated injections

  • lowered efficacy
  • risk of tendon rupture
  • infection
  • hypo pigmentation over site of injection
  • steroid flare
  • fat necrosis
  • periarticular osteoporosis
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6
Q

The 3 stages of RA

A

1: synovitis
2: destructive
3: deformity

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7
Q

X ray features of RA

A

1: ST swelling and osteoporosis around joints
2: narrowing of joint spaces, small periarticular erosions
3. marked articular destruction, joint deformity and dislocation

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8
Q

NF1

  • inheritance
  • skeletal abnormalities
A

AD
bony dysplasia of sphenoid
long bone abnormalities like pseudoarthrosis of tibia

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9
Q

Mgx of gout

A

non pharm: weight loss, avoid high purine food (red meat, beans)

Pharm:

  • xanthine oxidase inhibitor (allopurinol)
  • uricosuric agent (probenecid)

acute flare: NSAID, colchicine

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10
Q

Mgx of ganglion

A 
Conservative:
- follow up in 1 year
- cyst aspiration
SX:
- excision with partial synovectomy
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11
Q

bankart vs hillsach lesions

A

both from anterior dislocations of the shoulder

bankart: anteroinferior lesion on gelooid labrum
hillsach: posterolateral lesion of humeral head

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12
Q

Criteria for Ankylosing Spondylitis

A

Rome criteria
NY critieria
- B/l Sacroilitis >grade1 or unilateral sacroilitis >grade 2 AND any of the following
> LBP inflammatory
> dec lumbar spine movement in sagittal and frontal planes
> dec chest expansion

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13
Q

Grading of ankylosing spondylitis radiologically

A

1: widening of joint
2: joint erosion
3: sclerosis on both sides
4: ankylosis

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14
Q

Types of seronegative spondyloarthritis

A

PAIRS - psoriatic arthritis, ankylosing arthritis, IBD, Reiter, Still’s disease

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15
Q

Causes of sacroilitis

A

PUB CAR

Psoriatic, UC, behcet, crohns, ankylosing spondylitis, Reiter

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16
Q

Symptoms of ankylosing spondylitis

and extraskeletal manifestations

A

11 As of Anks Spons

  1. Appearance: question mark posture
  2. Army boys
  3. Arthritis: axial - cervical, lumber, SIJ TMJ, costovertebral joints (if peripheral jts,LL>UL)
    - Ankylosis severity: posture, occiput wall distance, thoracolumbar ROM, schober test, chest expansion
    cx: radiculopathy, spinal stenosis, myelopathy
  4. Atlanto-axial instability
  5. Achilles tendinitis and other forms of enthesitis (plantar, prebatellar, costochondritis)
  6. Anterior uveitis
  7. Aortitis, AR
  8. AV nodal block, Arrhythmias
  9. Apical interstitial lung disease
  10. AA Amyloidosis (abdomen)
  11. IgA nephropathy
  12. Anemia
17
Q

x ray findings of ankylosing spondylitis

A 
SIJ: erosion and fuzziness
Vertebrae:
- squaring
- erosion at vertebrae corners and sclerosis (Romanus lesion)
- syndesmophytes
- face joint effusion, vertebral fusion
- bamboo spine
- costovertebral joint involvement
- atlantoaxial dislocation
- osteoporosis, hyperkyphosis of thoracic spine
18
Q

Mgx of ankylosing spondylitis

A

Conservative:

  • genetic counselling (AD), fall prevention, lifestyle modification - physiological, exercise, avoid rest
  • meds: NSAIDs, sulphasalazine
  • RT
  • anti TNFalpha (infliximab)
  • steroid injections

sx:

  • arthroplasty of joints
  • spine osteotomy (rare)
19
Q

Features of psoriatic arthritis

A
  • asymmetrical polyarthritis
  • IPJ of fingers and toes > arthritis mutilans
  • sacroilitis and spondylitis in 1/4 of patients
  • no rheumatoid nodules
  • psoriasis of skin and nails (skin folds)
20
Q

Reiter triad

A

polyarthritis
conjunctivitis
non specific urethritis (or colitis)

21
Q

What is still’s disease and its types

A

Juvenile chronic arthritis - non infective inflammatory joint dz in children <16yo

Types:

  • pauciarticular JCA (commonest): medium size joints
  • polyarticular seropositive JCA: juvenile RA
  • seronegative spondarthritis: juvenile AS
  • systemic JCA (classic still): fever, rash, malaise, LN, hepatosplenomeg, joint swelling
22
Q

Differentials for monoarthritis

A

GHOST: gout, haemarthrosis, osteoarthritis, septic, trauma

23
Q

Gouty involvement

A

MTPJ of big toes (podagra), ankle, finger joints, tendoachilles, olecranon bursae, pinnae of ears, lesser toes

24
Q

gout x ray features

A

punched out lesions in para-articular bone ends with overhanging edges

erosion with joint space preservation

may have secondary OA

25
Q

Mgx of gout

A 
Acute: rest, NSAID, colchicine
Chronic: 
- weight loss, stop alcohol, diuretics
- xanthine oxidase inhibitor: allopurinol
- uricosuric drug: probenecid
26
Q

components of calcium pyrophosphate dihydrate deposition

synovial fluid findings

A
  • chondrocalcinosis: calcific material in articular cartilage and menisci
  • pseudo gout: crystal induced acute synovitis
  • chronic pyrophosphate arthropathy: degenerative joint disease in non weight bearing joints
  • affects larger joints

weakly positively birefringent rhomboid shaped crystals in synovial fluid

27
Q

Causes of secondary osteoporosis

A

congenital

  • osteogenesis imperfecta
  • trisomy 18
  • ehler danlos syndrome
  • inborn errors of metabolism
  • neuromuscular diseases and dystrophies
  • gonadal dysgenesis

acquired

  • endocrine: hypogonad, adrenal cortical (Addison, cortical hyperplasia), pituitary (cushing, acromegaly), hyperthyroidism, hyperPTH
  • DM
  • Disuse atrophy
  • Nutrition deficiency (vit C, protein, calcium, malnutrition)
  • Liver dz
  • Iatrogenic (steroid, heparin)
28
Q

What is Paget disease (osteitis deformans)

A

increased osteoblastic and osteoclastic activity resulting in enlargement and thickening of bone but abnormal and brittle internal architecture
- in pelvis and tibia commonest

29
Q

s/s of Paget disease

A 
dull pain
bone
- tibia and femoral bowing
- enlarged and flattened skull
- kyphosis
- otosclerosis (deafness)
Neuro:
- CN compression
- spinal cord/ nerve root compression
Steal syndrome:
- cerebral impairment, spinal ischemia, high output cardiac failure
30
Q

what is maffucci syndrome

A

multiple enchondromas + haemangiomas of skin and viscera

31
Q

what is osteogenesis imperfecta

A

heritable CT disorder: abnormal synthesis and structural defects of T1 collagen

bone fragility, osteopenia, recurrent #
ligament laxity
crumbling teeth

x ray:
generalised osteopenia
# in various stages of healing
vertebral compression
spinal deformity

MBBS Orthopedics (13 decks)

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