MSk Flashcards
(108 cards)
1
Q
Describe Barlow’s test
A
Adduct hips and push posteriorly to see if femoral heads are dislocatable (Barlow = break)
2
Q
Describe Ortolani’s test
A
Abduct hip and push femurs towards yourself to try and reduce a dislocated hip
3
Q
What imaging is required for all babies in breech position regarding DDH?
A
US hip at 6 weeks
4
Q
What is the main goal of management of Perthes?
A
Keep femoral head in the acetabulum by casting/bracing
5
Q
Main treatment of Perthes?
A
Observation and symptom relief
6
Q
Which system is used to classify fractures that involve growth plates?
A
Salter-Harris
7
Q
Describe each stage of the Salter Harris classification
A
- # involving only physis
- # involving physis and metaphysis
- # involving physis and epiphysis (inc joint)
- # involving, physis, metaphysis, epiphysis
- crush injury involving physis
8
Q
Which organism causes osteomyelitis? Which organism is more common in sickle cell patients?
A
Staphylococcus aureus most common
Salmonella in sickle cell patients
9
Q
What is the preferred imaging for osteomyelitis?
A
MRI highly sensitive in early disease.
10
Q
What is the hallmark of giant cell arteritis?
A
ESR and CRP raised
11
Q
Treatment of giant cell arteritis?
A
Corticosteroid treatment is imperative to reduce risk of vision loss
12
Q
What features are shared between Wegener’s and Churg Strauss?
A
Sinusitis
Dyspnoea
Vasculitis (weight loss, fever, night sweats)
13
Q
What features differentiate between Wegener’s and Churg Strauss?
A
Wegeners: renal failure, epistaxis, cANCA
Churg-Strauss: asthma, eosinophilia, pANCA
14
Q
Features of Behçet’s?
A
Genital ulcers
Oral ulcers
Anterior/posterior uveitis
Skin lesions
15
Q
Association/additional features of AS?
A
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AVN block Amyloidosis
16
Q
1st line treatment for AS?
A
NSAIDs
17
Q
Which organism most commonly causes post-STI reactive arthritis?
A
Chlamydia trachomatis
18
Q
Which organism most commonly causes post-dysteric reactive arthritis?
A
Shigella/Salmonella
19
Q
Which eye manifestation is seen in AS?
A
Anterior uveitis (aka iritis)
20
Q
Which blood tests would you order to investigate osteoporosis?
A
- FBC, U&E, CRP
- TFT
- Vitamin D
- Bone profile: calcium, phosphate, ALP, albumin
- Testosterone
21
Q
1st line treatment for osteoporosis?
A
oral bisphosphonates (alendronate)
22
Q
Mechanism of action of bisphosphonates?
A
Inhibits osteoclasts
23
Q
What can be given to post-menopausal women to reduce risk of osteoporosis?
A
oral SERM (raloxifene)
24
Q
Side effect of bisphononates?
A
- Oesophagitis - take sitting up and drink plenty of water
- Osteonecrosis of jaw
25
What is given if bisphosphonates are not tolerated?
Strontium ranelate
26
Treatment of osteomalacia?
Vitamin D
27
Which bones are affected in Paget's?
Spine, pelvis, skull, femur, tibia
28
Hallmark of Paget disease?
Increased ALP with normal calcium, phosphate, PTH
29
How is calcium, phosphate, ALP and PTH affected in osteomalacia?
- Decreased
- Decreased
- Increased
- Increased
30
Which drugs can induce SLE?
Hydralazine, isoniazid, procainamide, penicillamine
31
How do complement levels change during active SLE flares?
C3 and C4 levels decreased
32
Treatment for SLE?
NSAIDs for arthritis
Steroids
Hydroxychloroquine 1st line
33
What is given to treat severe SLE?
methotrexate, Rituximab
34
What malignancy are those with Sjogren's at risk of?
Lymphoma
35
Features of Sjogrens?
- Dryness of eyes and mouth (some may have vaginal dryness)
- Painful joints and muscles
- Fatigue
- Raynauds
- Dysphagia and oesophageal dysmotility
36
Which 2 tests must be done in order to truly diagnose Sjogrens?
- Positive anti-Ro/anti-La Abs
| - Parotid/Labial gland biopsy
37
Treatment for Sjogrens?
- Hydroxychloroquine for arthalgia and fatigue
| - Artificial tears and saliva
38
Which antibodies are seen in antiphospholipid syndrome?
- Anticardiolipin
- b2 glycoprotein
- Lupus anticoagulant
39
What is the normal treatment for those with APS?
low dose aspirin
40
What treatment options are there for APS in pregnant women?
- Aspirin if patient has only had obstetric manifestations and no thrombosis
- LMWH instead of warfarin
41
What is the treatment for those with APS who have had VTE event?
lifelong warfarin
42
What additional features as seen in diffuse systemic sclerosis vs limited systemic sclerosis?
- Skin sclerosis is diffuse
- Myocardial fibrosis
- Scleroderma renal crisis
- Pulmonary fibrosis
43
What blood test results indicate myositis?
- raised CK
| - raised ESR and CRP
44
Treatment of myositis?
-high dose glucocorticoids
| IV Ig rescue
45
Which cancers are associated with development of dermatomyositis?
```
(LOOBC)
Lung
Ovary
Oesophageal
Breast
Colon
```
46
Hallmark diagnostic feature of PMR?
Raised ESR and CRP
47
Treatment for PMR?
Prednisolone 15-20mg
| Referral to ophthalmology
48
Symptoms of temporal arteritis?
- Headache with scalp tenderness
- Jaw claudication
- Vision loss
- Fatigue and pain in proximal muscles
- PMR
- Temporal artery tenderness
49
Investigations for temporal arteritis?
-Blood test shows raised ESR and CRP
50
Management for temporal arteritis?
- High dose 60mg prednisolone
| - Referral to ophthalmology if vision is affected
51
Red flags for back pain?
- Onset before 20 or after 50
- Lasts >6 weeks
- Associated with systemic illness such as fever and weight loss
- Cauda equina symptoms
52
Which gene loci is associated with RA?
HLA-DR4, HLA-DR1
53
Which eye manifestations are seen in RA?
Scleritis and episcleritis, scleromalacia perforans
54
What cardiac manifestations are seen in RA?
- Ischaemic heart disease
- Pericarditis
- Endocarditis, myocardial disease
55
What is Felty's syndrome?
Splenomegaly and neutropaenia
56
Which gene is associated with Felty syndrome?
HLA-DR4
57
X-ray findings in RA?
Early disease: juxta-articular osteopenia and decreased joint space
Late disease: bony erosions, subluxation, carpal destruction
58
What scoring system is used to assess RA severity?
DAS28
59
Which antibodies can be found in RA?
RF, anti-cyclic citrullinated protein antibody (anti-CCP)
60
What role do steroids have in the management of RA?
Slows down disease progression and treats acute exacerbations of joint inflammation
61
Main treatment regime for RA?
- NSAIDs, analgesics and steroids for joint pain
- Methotrexate
- Biologics if 2 DMARDs have failued
62
Side effects of methotrexate
- Teratogenic
- Liver fibrosis
- Myelosuppression
- Pulmonary fibrosis
63
What monitoring tests are needed during methotrexate use?
- CXR
- FBC for myelosuppression
- LFTs for liver fibrosis
64
Concurrent use of what drugs with methotrexate can cause bone marrow suppression and severe pancytopaenia?
Trimethoprim-containing antibiotics
65
Side effects of sulfasalazine?
- Hepatitis
- Reduced sperm count
- Myelosuppression
- Neutropaenia
66
Side effects of hydroxychloroquine?
- Irreversible retinopathy
| - Nightmares
67
Side effects of leflunomide?
- Liver fibrosis
- Peripheral neuropathy
- Hypertension
- Myelosuppression
- Teratogenicity
68
When should biologics be considered for RA treatment
Failure to respond to 2 DMAIDs including methotrexate
69
Give examples of TNFalpha blockers
- Infliximab
- Adalimumab
- Etanercept
70
Side effects of TNFalpha blockers?
- Reactivation of TB
| - Reactivation of hepatitis
71
How does rituximab work?
Monoclonal antibody against CD20 receptor of B cells
72
Side effects of rituximab?
- Nightmares
| - Thrombocytopaenia
73
What indicates poor prognosis of RA?
- High titres of anti-CCP and RF
| - X-ray shows early erosive damage
74
Which joint does gout most commonly occur in? What is this called?
1st MTP joint
| Called podagra
75
What dietary foods increase the risk of gout?
Red meat, alcohol, seafood, sweeteners
76
What kind of drugs increase the risk of gout?
Thiazide diuretics
77
Joint fluid microscopy findings in gout?
Needle shaped, negatively birefringent crystals under polarised light
78
X-ray findings in gout?
- Soft tissue swelling
| - Punched out appearance in juxta-articular bone in the long term
79
What is the treatment for acute gout?
- DO NOT START ALLOPURINOL
- High dose NSAIDs (colchicine is NSAIDs are contraindicated)
- Steroids if NSAIDs and colchicine are contraindicated
- RICE
80
What is the general management of gout?
-Allopurinol with NSAID/colchicine
81
What uric acid level is the target for gout patients?
Below 360micromol/L
82
Mode of action of allopurinol?
Xanthine oxidase inhibitor
83
Side effects of allopurinol?
Skin rash
| GI intolerance
84
What are the crystals seen in pseudogout made of?
Calcium pyrophosphate dihydrate (CPPD)
85
What are the risk factors for pseudogout?
Age
Hyperparathyroidism
Haemochromatosis
Hypophosphataemia
86
Management of pseudogout?
NSAIDs/colchicine
| Intra-articular steroids for acute attacks
87
Most common causative organism in septic arthritis?
Staph. aureus
88
Which joints are commonly affected in pseudogout?
Knee, wrist, shoulders
89
X-ray features of pseudogout?
Chondrocalcinosis
90
Which gene loci is associated with reactive arthritis?
HLA-B27
91
Which sexually transmitted organism is responsible for reactive arthritis in young adults?
Chlamydia trachomatis
92
What organism is responsible for septic arthritis in young, sexual active adults?
Neisseria gonorrhoeae
93
Which eye manifestation is seen in reactive arthritis?
Conjunctivitis
| Anterior uveitis
94
What triad of symptoms is seen in reactive arthritis?
Reiter's triad:
| Urethritis/balanitis, conjunctivitis/anterior uveitis, arthritis
95
Which 2 types of infection are most common in reactive arthritis?
- Gastroenteritis
| - STI
96
How to manage a suspected septic arthritis?
- Antibiotics
| - Joint aspiration for gram staining, culture&sensitivity, crystal analysis
97
How can septic arthritis occur?
- Haematogenous spread of bacteria from other site of infection
- Pre-existing bone infection
- Penetrative injury and introduction of bacteria from environment
98
X-ray findings in psoriatic arthritis?
Pencil in cup appearance
99
Side effects of etanercept?
Encephalitis
100
Side effects of colchicine?
Diarrhoea, nausea, vomiting
101
Difference in presentation between PMR and polymyositis?
PMR has muscle tenderness/stiffness but no true weakness
Polymyositis has no muscle tenderness but reduced power
102
What is the management for undisplaced intracapsular hip fractures?
- Internal fixation if fit and well
| - Hemiarthroplasty if unfit
103
What is the management for displaced intracapsular hip fractures?
- Hemiarthroplasty if unfit
| - Total hip replacement if fit
104
What is the management for extracapsular hip fractures?
- Stable intertrochanteric fracture = DHS
| - Reverse oblique, transverse, subtrochanteric = intramedullary nail
105
Which muscles carry how shoulder abduction and by how much?
- Supraspinatus 0-15deg
- Deltoid 15-90 deg
- Trapezius and serratus anterior past 90 (rotates scapula)
106
How to manage the renal complications of limited cutaneous systemic sclerosis? (hypertension & AKI)
ACE-i
107
Side effects of ciprofloxacin?
Tendonitis and tendon rupture
108
What are the myotome movements? (C5 to S2)
```
C5: shoulder abduction
C5-6: pick up sticks
C7-8: close the gate & wrist extension
C8-T1: finger abduction/adduction
L2-3: lift the knee
L3-4: kick the door
L4-5: toes point to the sky
L5-S1: kick my bum
S1-2: stand on my shoe
```
