Misc

Question 1

6 causes of bone deformity

Answer 1

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

Question 2

6 causes of joint deformity

Answer 2

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

Question 3

Hx for knee

Answer 3

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?

Question 4

What muscle weakness you expect in sciatic nerve injury?

Answer 4

Difficulty

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

Question 5

What are the side effects of H&L

Answer 5

with repeated injections

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

Question 6

The 3 stages of RA

Answer 6

1: synovitis
2: destructive
3: deformity

Question 7

X ray features of RA

Answer 7

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

Question 8

NF1

• inheritance
• skeletal abnormalities

Answer 8

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

Question 9

Mgx of gout

Answer 9

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

Pharm:

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

acute flare: NSAID, colchicine

Question 10

Mgx of ganglion

Answer 10

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

Question 11

bankart vs hillsach lesions

Answer 11

both from anterior dislocations of the shoulder

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

Question 12

Criteria for Ankylosing Spondylitis

Answer 12

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

Question 13

Grading of ankylosing spondylitis radiologically

Answer 13

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

Question 14

Types of seronegative spondyloarthritis

Answer 14

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

Question 15

Causes of sacroilitis

Answer 15

PUB CAR

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

Question 16

Symptoms of ankylosing spondylitis

and extraskeletal manifestations

Answer 16

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

Question 17

x ray findings of ankylosing spondylitis

Answer 17

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

Question 18

Mgx of ankylosing spondylitis

Answer 18

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)

Question 19

Features of psoriatic arthritis

Answer 19

• 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)

Question 20

Reiter triad

Answer 20

polyarthritis
conjunctivitis
non specific urethritis (or colitis)

Question 21

What is still’s disease and its types

Answer 21

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

Question 22

Differentials for monoarthritis

Answer 22

GHOST: gout, haemarthrosis, osteoarthritis, septic, trauma

Question 23

Gouty involvement

Answer 23

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

Question 24

gout x ray features

Answer 24

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

erosion with joint space preservation

may have secondary OA

Question 25

Mgx of gout

Answer 25

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

Question 26

components of calcium pyrophosphate dihydrate deposition synovial fluid findings

Answer 26

- 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

Question 27

Causes of secondary osteoporosis

Answer 27

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)

Question 28

What is Paget disease (osteitis deformans)

Answer 28

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

Question 29

s/s of Paget disease

Answer 29

``` 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 ```

Question 30

what is maffucci syndrome

Answer 30

multiple enchondromas + haemangiomas of skin and viscera

Question 31

what is osteogenesis imperfecta

Answer 31

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 ```