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MSK Flashcards

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1
Q

How does methotrexate work?

A

inhibits dihydrofolate reductase which is responsible for converting dihydrofolate to tetrahydrofolate

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2
Q

What can happen to blood test results when taking methotrexate?

A

Pancytopenia

deficiency in tetrahydrofolate –> used in DNA and RBS synthesis

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3
Q

How should methotrexate be taken and monitored?

A

taken weekly
monitored with FBC, LFTS, U&Es every 2-3 months

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4
Q

What should be prescribed with methotrexate?

A

folic acid 5mg
taken 24 hours + after dose

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5
Q

What two fractures are most at risk of compartment syndrome?

A
  • supracondylar fracture
  • tibial shaft injuries
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6
Q

What are the signs of compartment syndrome?

A
  • pallor
  • pain, even on passive movement
  • paresthesia
    -lack of pulses
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7
Q

What are the features of antiphospholipid syndrome?

A
  • venous and arterial thrombus
  • recurrent miscarriage
  • livedo reticularis
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8
Q

What are the investigations and results for antiphospholipid syndrome?

A

Antibodies: anti-cardiolipin
thrombocytopenia
prolonged APTT

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9
Q

Management of antiphospholipid syndrome

A
  • low dose aspirin

if they have a venous event:
- lifelong warfarin ( target INR 2-3)

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10
Q

How does achilles tendinitis present?

A

pain in posterior heel that gets worse with exercise
can cause morning stiffness and pain

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11
Q

How does an achilles rupture present?

A
  • hear a ‘pop’
  • sudden onset pain
  • unable to continue activity
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12
Q

What test is performed for achilles rupture?

A

Simmonds

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13
Q

What is the first line investigation for achilles rupture?

A

US

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14
Q

What should be given to patients immediately if GCA is suspected?

A

high dose steroids

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15
Q

What does positive Fouchers sign mean?

A

Increase tension of bakers cyst on extension of knee

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16
Q

What are red flags for back pain?

A
  • <20 years old and >50 years old
  • history of malignancies
  • trauma
  • night pain
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17
Q

What does T-score on DEXA scan measure?

A

bone density compared to healthy population

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18
Q

What does z-score on DEXA scan measure?

A

bone density compared to same gender, age and ethnicity

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19
Q

What is the most common organism for septic arthritis?

A

Staph. aureus

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20
Q

What is the most common organism for septic arthritis in young people, who are sexually active?

A

Neisseria gonorrhoeae

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21
Q

Investigations for Septic arthritis

A
  • needle join aspiration
  • blood cultures
  • imagine of joint
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22
Q

Management of septic arthritis

A
  • IV flucloxacillin ( clinda if allergic) –> lasts 4-6 weeks and can switch to oral after 2
  • wash out
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23
Q

What are the x-ray findings in AS?

A
  • subchondral erosions, sclerosis (sacroiliitis)
  • squaring of lumbar vertebrae
  • bamboo spine ( uncommon and at later stages)
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24
Q

Management of AS

A

1) Exercises and NSAIDS
2) anti-TNF (etanercept and adalimumab)

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25
How does spinal stenosis present?
- gradual onset - unilateral / bilateral pain - pain better when sitting and leaning forward -
26
What is management of raynaud's?
1) nifedipine
27
What does positive birefringence show?
pseudogout
28
What liver condition is associated with psuedogout?
haemochromatosis
29
Management of pseudogout
NSAIDs
30
What is TInels sign in carpal tunnel syndrome?
tapping causes paresthesia
31
What is Phalen's sign in carpal tunnel?
flexion of wrist causes symptoms
32
What is a severe side effect of hydroxychloroquine?
Bulls eye retinopathy depigmentation of a macula surrounded by thin speckled rings of hyper-pigmentation
33
What is dermatomyositis?
inflammatory condition with symmetrical, proximal muscle weakness and characteristic skin lesions
34
What are features of dermatomyositis?
Skin : heliotrope rash, photosensitive, macular rash on back and shoulders, gottron's papules, mechanics hands Muscle: proximal weakness, raynauds
35
What are the features of a iliopsoas abscess?
fever back pain pain on extension
36
What are painless nodes associated with osteoarthritis?
Heberden's nodes- DIP joints Bouchards nodes- PIP joints
37
What are the signs of osteoarthritis on an xray?
widening of joint spaces osteophytes subchondral sclerosis erosion of joint
38
What is seen on xray of ewing's sarcoma?
onion skin like appearance
39
What are features of reactive arthritis?
- proceeding an infection (usually within 4 weeks) - asymmetrical arthritis usually in lower limb - anterior uveitis - urethritis - keratoderma blennorrhagica 'can't see, can't pee or can't climb a tree'
40
What injury would give a positive lachman's test?
ACL rupture
41
What are the Xray findings for RA?
loss of joint space juxta-articular osteoporosis soft-tissue swelling periarticular erosions subluxation
42
Signs of hip fracture
pain shortened and externally rotated leg
43
What are the two different types of hip fractures?
Intracapsular: from the edge of the femoral head to the insertion of the capsule of the hip joint Extracapsular: hese can either be trochanteric or subtrochanteric
44
What system is used for grading hip fractures?
Garden system
45
What level of garden system is high risk of blood disruption?
III and IV
46
How to manage extracapsular hip fracture?
dynamic hip screw
47
How to manage intracapsular hip fracture?
arthroplasty ( hemi or total)
48
What are Xray finding of psoriatic arthritis?
pencil in a cup
49
What is used to assess risk of fracture?
FRAX score
50
What movement is most affected in adhesive capsulitis?
external rotation of the shoulder
51
What investigation is important to perform before starting anti-TNF therapy?
Chest XRAY to check for TB
52
Management for polymyalgia rheumatica
prednisolone
53
What is dactylitis suggestive of?
Psoriatic arthritis AS
54
What should you do if patient does not respond to steroids and they have polymyalgia rheumatica?
reconsider diagnosis as the should respond drastically
55
What complement levels are used to measure active disease in SLE?
C3 and C4
56
If a patient is allergic to sulfa containing medications (e.g co-triomoxazole) what should they not be prescribed?
sulfasalazine
57
What is a useful rule out test for SLE?
ANA
58
What test is used to asses meniscal tear?
McMurrays
59
What should you image and with what modality with suspected RA?
XRAY of hands and feet
60
What are the symptoms of osteomalacia?
bone pain proximal myopathy
61
What is seen on XRAY of osteomalacia?
looser zones pseudofractures
62
What antibodies is limited scleroderma associated with?
Anti- centromere
63
What antibodies are diffuse scleroderma associated with?
anti- scl70
64
What is cubital tunnel syndrome caused by?
ulnar nerve compression
65
What should you not give to patients when they are on methotrexate?
co-trimoxazole trimethoprim an cause marrow aplasia
66
How do you treat methotrexate toxicity?
folinic acid
67
What should you do when starting some on Allupurinol?
add colchicine or NSAID cover for 6 months
68
What nerve is affected in shoulder dislocation?
Axillary nerve
69
What to give in GCA and vision is worsening?
IV methylprednisolone
70
What is the treatment for an acute flare of SLE?
Pred + IV cyclophosphamide
71
What is injured in a boxers fracture?
5th Metacarpal
72

Year 6 (19 decks)

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