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MSK Flashcards

1
Q

Where is pain from the acromioclavicular joint felt?

A

In the joint itself

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2
Q

Where is pain from the rotator cuff or glenohumeral joint felt?

A

Upper arm

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3
Q

Where is pain from tennis elbow felt?

A

Outside elbow joint

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4
Q

Where can pain from a trapped nerve be felt?

A

Around it’s distribution,

Eg sciatica

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5
Q

Where can pain from the knee be felt?

A

Knee, hip or ankle

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6
Q

What does pain due to nerve causes usually present with?

A

Paraesthesia.

Numbness

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7
Q

How does non inflammatory pain very with exercise?

A

Gets worse

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8
Q

How does inflammatory pain vary

A

Randomly

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9
Q

Early morning stiffness lasting more than 2 hours is associated with?

A

Rheumatoid arthritis

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10
Q

What is the Thomas test, what is a positive sign and what does it assess?

A

When lumbar lordosis is removed and hip is fully flexed, other leg lifts off the couch
Fixed flexion deformity

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11
Q

What is a Trendelenberg’s test, what’s an abnormal sign, and what does it test for?

A

Patient stands on one leg alternatively
Hip dips to contralateral side - abductors of hip aren’t working
Assess hip and gluteal muscle strength

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12
Q

What is an antalgic gait and what does it look like?

A

A painful gait

Limping

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13
Q

What is a Trendelenberg’s gait and what does it look like?

A

Proximal muscle weakness leading to change in gait

Waddling gait

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14
Q

What is bow-leggedness?

A

Varus deformity

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15
Q

What is knock-knees called?

A

Valgus deformity

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16
Q

What is the best way to assess valgus and varus deformity?

A

When the patient is standing up and weight bearing

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17
Q

What are the ways to test for effusion in the knee?

A

Patella tap and cross fluctuation

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18
Q

What does a posterior sag or step back of tibia suggest?

A

Posterior cruciate ligament damage

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19
Q

What is a positive anterior drawer test and what does it suggest?

A

Tibia shows a noticeable range of movement went pulled gently towards examiner when knee is flexed and hamstrings are relaxed
Suggests anterior cruciate ligament damage

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20
Q

What muscles are involved in hip flexion?

A

Sartorius
Iliopsoas
Rectus femoris

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21
Q

What are the muscles of hip extension?

A

Gluteus Maximus

hamstrings

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22
Q

What are the muscles of hip abduction?

A

Gluteus Medius and Minimus

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23
Q

What are the signs of osteoarthritis in an x ray?

A

Osteophytes
Cysts
Subchondral sclerosis
Narrow joint space

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24
Q

Name three types of monoarthritis/oligoarthritis

A

Septic arthritis
Gout
Reactive arthritis

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25
Q

Name three inflammatory polyarthritis

A

Rheumatoid
Psoriatic
Chronic tophaceous gout

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26
Q

What are the presenting symptoms for rheumatology?

A 
Joint stiffness
Symmetry
Location
Joint pain
Morning stiffness
Swelling
Warmth
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27
Q

What are differentials for back pain in 15 to 30 year olds?

A 
Prolapsed disc, 
spondylothesis, 
pregnancy, 
trauma, fractures, 
ankylosing spondylitis
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28
Q

What are differentials for back pain in 30 to 50 year olds?

A

Degenerative spinal disease, prolapsed disk, malignancy

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29
Q

What are differentials for back pain in 50 to 70 year olds?

A

Degenerative, osteoporotic vertebral collapse, malignancy, melanoma, spiral stenosis, Paget’s

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30
Q

Name two neurosurgical emergencies that present with back pain

A

Acute cauda equina

Acute cord compression

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31
Q

Why does cord compression and cauda equina need immediate surgical attention?

A

Prevents irreversible loss

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32
Q

What is the classic presentation of osteoarthritis?

A

Stiffness lasting for more 30 min, pain worse in the evening, reduced range of movement, bony swelling, background pain, pain and crepitus on movement, joint tenderness

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33
Q

What are the risk factors for septic arthritis?

A

Pre-existing arthritis, artificial joints, immunosuppression, DM, chronic renal failure, recent joint surgery

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34
Q

What’s the typical presentation of rheumatic arthritis?

A

Symmetrical swollen proximal joints, with stiffness, pain worst at morning,

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35
Q

Name five less common presentations of rheumatoid arthritis

A

Widespread systemic arthritis,
Persistent monoarthritis of a single joint
Systemic illness with extra auricular symptoms
Recurrent soft tissue problems (eg carpal tunnel, frozen shoulder)
Recurrent mono/poly arthritis

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36
Q

What are the early signs of rheumatoid arthritis?

A

Swollen and tender mcp, pip, wrist and mtp joints. Check for synovitis and tendinitis

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37
Q

What are the late signs of rheumatoid arthritis?

A

Swan neck deformity, ulnar deviation, z thumb, dorsal wrist subluxation, with similar foot changes

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38
Q

What are the extra articulate signs of rheumatoid arthritis?

A

Nodules, lymphadenopathy, vasculitis, scleritis, episcleritis, fibrosing alveolitis, obliterating bronchitis, carpal tunnel, splenomegaly, raynaud’s, peripheral neuropathy, amyloidosis, osteoporosis

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39
Q

What investigations can be done for suspicion of rheumatoid arthritis?

A

Rheumatoid factor,
X-rays for soft tissue swelling, loss of joint space and juxta articular osteopenia
MRI, ct, to look for synovitis and tendinitis,

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40
Q

What causes gouty arthritis?

A

Deposition of mono sodium urate crystals in and near joints.
Associated with high serum urate
Causes long term arthritis and renal failure

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41
Q

What are the causes of gouty arthritis?

Name 5

A

Hereditary, excess dietary purines, alcohol, leukaemia, cytotoxicosis

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42
Q

What conditions are associated with gouty arthritis?

A

CVD, hypertension, DM, chronic renal failure

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43
Q

What is the classic presentation for gouty arthritis?

A

Acute monoarthropathy of a single joint with severe joint inflammation.
More than 50% on mtp joint of big toe

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44
Q

What is the principal investigation for gouty arthritis?

A

Polarized photography of synovial fluid shows negatively birefringement of urate crystals

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45
Q

What is ankylosing spondylitis?

A

Chronic inflammatory disease of spine and sacroiliac joints of unknown aetiology

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46
Q

What is the classic presentation of ankylosing spondylitis?

A

30 year old male complaining of morning spine stiffness and lower back pain that relieves with exercise. Usually better by the end of the day.
Pain radiates from sacroiliac joints to hips and buttocks.
Progressive stiffening of spine and thorax in all directions, hence reduced thoracic expansion and question mark posture.
Achilles tendinitis, palmar fasciitis, acute iritis, enthesitis

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47
Q

What can be seen in an X-ray of ankylosing spondylitis?

A

Sacroilitis

Bamboo spine

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48
Q

What is systemic lupus erythromatous?

A

A multi-system autoimmune condition resulting from B cells making antibodies to self antigens causing tissue damage through a variety of autoimmune mechanisms

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49
Q

What is the classic presentation of SLE?

A

Fever, myalgia, fatigue,
Also: lymphadenopathy, weight loss, non infective endocarditis, alopecia, nail fold infarcts, migraine, stroke and Renal exudates

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50
Q

What is the diagnostic criteria for SLE?

A

3 of the following
Malar rash, Discoid rash, photosensitive skin
CNS disorder, haematological disorder, immunological disorder, renal disorder
Non erosive arthritis, serositis, oral ulcers
Antibodies

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51
Q

What are the causes of generalised arthralgia?

Name ten for full marks

A

Infective- Viral (rubella, mumps, hep B), bacterial (staph, TB, Borrelia), fungal
Post infective- rheumatoid fever, reactive arthritis
Inflammatory- RA, SLE, ank. Spond., systemic sclerosis
Degenerative- Osteoarthritis
Tumour- primary(osteo&chondrosarcoma), metastatic, and effect of tumour
Gout, pseudo gout, trauma
Fibromyalgia, sjorgen’s, hypermobility

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52
Q

What are the causes of localized arthralgia?

A

Trauma, tendinitis, enthesopathies, bursitis, nerve entrapment

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53
Q

Name six presentations of monoarthritis and give examples where necessary

A

Infective traumatic arthritis (staph A, staph epidermidis, salmonella, TB, E. coli, H influenzae, gonorrhoea)
Bleeding diathesis, post traumatic (causing haemarthrosis)
Degenerative (acute exacerbation, eg Charcot)
Metabolic (gout, pseudogout)
Poly arthritis presenting as monoarthritis (RA)

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54
Q

Name four presentations of oligoarthritis and give examples where necessary

A

Degenerative (osteoarthritis)
Infective (TB, sarcoidosis, gonorrhoea, bacterial endocarditis)
Inflammatory poly arthritis presenting as oligo (reactive arthritis, psoriatic, ank. Spond.)

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55
Q

What defines oligoarthritis?

A

Involvement of 2-4 joints

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56
Q

What defines poly arthritis?

A

Involvement of more than 4 joints

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57
Q

What are the inflammatory causes of poly arthritis?

A

SLE, RA

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58
Q

What are the non-inflammatory causes of poly arthritis?

A

Infective- bacterial (lymes, subacute endocarditis), viral (mumps, hep b, c, HIV, glandular fever, chickenpox, rubella)
Post infective- rheumatoid fever
Osteoarthritis- with heberden’s Or Bouchard’s nodes
Haemochromatosis
Hypertrophic pulmonary osteoathropathy

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59
Q

Pain from traumatic injury is…

A

Usually immediate but also aggregated by later movement,

And can be increased by bleeding into the joint

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60
Q

What can cause acute, severe pain that develops quickly and erythema (redness) over the joint?

A

Crystal arthritis

Gout and pseudo gout

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61
Q

What can cause paint that develops within a day or two?

A

Septic arthritis

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62
Q

What can cause joint pain which starts in one joint and moves to affect others over a period of days?

A

Gonococcal arthritis and rheumatic fever

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63
Q

What is bone pain usually described as?

A

Deep, boring pain, words eat night

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64
Q

What can cause localised bone pain?

A

Tumour, infection (osteomyelitis,a vascular necrosis or osteoid osteoma

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65
Q

What can cause diffuse pain?

A

Generalized bone conditions like osteomalacia

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66
Q

What is muscle pain usually described as?

A

Stiffness and is poorly localised, deep, and aggravated by use of the muscle.

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67
Q

What is the difference between polymyositis and polymyalgia rheumatica?

A

Muscle weakness in polymyositis

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68
Q

What’s the difference between partial and full muscle tears?

A

Partial muscle tears are painful

Full muscle tears are relatively painfree

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69
Q

What is fracture pain described as?

A

Sharp and stabbing, aggravated by movement and attempted movement, relieved by splinting and rest

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70
Q

What can cause shooting pain?

A

Mechanical trapping of nerve

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71
Q

What can cause buttock pain that shoots down the back of the leg?

A

Lumbar inverted disc protrusion

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72
Q

What pain is a feature of chronic pain syndrome?

A

Pain all over, unrelenting, little diurnal variation, dulled by analgesics or anti-inflammatory drugs

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73
Q

Chronic joint pain in people over 40 is usually caused by?

A

Osteoarthritis

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74
Q

What can neurological involvement cause to joint pain?

A

Loss of joint pain or disproportionate joint pain to deformity

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75
Q

What can cause neurological involvement in joints?

A

Syringomyelitis, leprosy, DM and syphilis

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76
Q

Name the three common presentations of the chronic pain syndrome

A

Widespread arthralgia, muscle pain and tenderness

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77
Q

What is the definition of chronic pain?

A

Pain present for more than 3 months.

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78
Q

What is chronic pain associated with?

A

Sleep disorders, psychological stress and depression

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79
Q

What should treatment for chronic pain focus on?

A

Coping mechanisms for pain, physio, treatment for sleep problems

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80
Q

What can cause pain disproportionately greater than expected?

A

Compartment syndrome

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81
Q

Where is C1/C2 pain felt at?

A

Occiput

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82
Q

Where is C3 C4 pain felt at?

A

Inter scapular region

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83
Q

Where is C5 pain felt at?

A

Tip of shoulder

Outer aspect of arm

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84
Q

Where is C6 C7 pain felt at?

A

Inter scapular region or radial fingers and thumb

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85
Q

Where is C8 pain felt at?

A

Ulnar side of forearm, ring and little fingers

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86
Q

Where is thoracic spine pain felt at?

A

Chest

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87
Q

Where is Lumbar spine pain felt at?

A

Buttocks, knees, legs

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88
Q

Where is shoulder pain felt at?

A

Lateral aspect of upper arm

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89
Q

Where is elbow pain felt at?

A

Forearm

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90
Q

Where is Hip pain felt at?

A

Anterior thigh, knee

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91
Q

Where is knee pain felt at?

A

Thigh, hip

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92
Q

What are the causes of myalgia?

A

Infective: bacterial (Strep pneumonia, mycoplasma), viral (coxsackie, CMV, echovirus), parasitic (toxoplasmosis, schistosomiasis), inflammatory (dermatomyositis, myosotis, polymyalgia rheumatica)
Trauma: tears, haematoma, rhabdomyosis
Drugs: alcohol, statins, zidovudine
Neuropathic

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93
Q

What should you suspect if stiffness predominates over pain?

A

Spasticity or tetany

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94
Q

What is the definition of spasticity?

A

Increasing muscle contraction in response to stretch

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95
Q

Define tetany

A

Involuntary sustained contraction

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96
Q

What’s the pattern of stiffness seen in polymyalgia rheumatica?

A

Shoulder and pelvic areas

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97
Q

What is an entheosopathy? Give some examples

A

Inflammation at tendon insertion sites

Medial and lateral epicondyles (golfer’s and tennis elbows respectively)

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98
Q

What are the differences between the presentations of inflammatory and non inflammatory joint pain?

A

Inflammatory arthritis presents with morning stiffness, relieved by an hour of exercise
Non inflammatory pain occurs after resting, for a few minutes on movement. There may be pain on movement, eases with rest, may return later in the day

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99
Q

In what kinds of arthritis is erythema and warmth common in?

A

Acute inflammatory arthritis, infective, traumatic and crystal induced joint conditions

It is unusual in RA and SLE. If it exists it suggests coexisting inflammation

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100
Q

Why does the injury of vascular structure cause rapid swelling? What makes this process faster?

A

Bleeding into the joints

Anticoagulants and bleeding disorders

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101
Q

Why do avascular structure injuries cause slow growing swelling?

A

It is caused by a reactive effusion which takes longer to develop

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102
Q

What are the causes of muscle weakness?

A

Peripheral nerve lesion (eg. median nerve in carpal tunnel)
Muscle disease
Can be secondary to pain, or focal, or generalized

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103
Q

What can cause proximal muscle weakness?

A

Primary muscle disease:
Immune mediated inflammatory disease (dermatomyositis, polymyositis)
Non inflammatory myopathy (secondary to chronic alcohol use, thyrotoxicosis, steroid therapy)

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104
Q

What can cause distal muscle weakness?

A

Neurological:

B12 or thiamine deficiency, connective tissue disorders, hereditary sensory motor neuropathy (Charcot-Marie-Tooth)

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105
Q

Which muscular dystrophies are x linked and what is their gene product?

A

Duchenne and Becker

Dystrophin

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106
Q

What is the gene product of dystrophia myotonica?

A

Myotonin

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107
Q

Which muscular dystrophies are autosomal dominant?

A

Dystrophia myotonica and fascioscapulohumeral

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108
Q

What is the pattern if inheritance of limb girdle?

A

Autosomal recessive

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109
Q

What is Gower’s sign and what is it seen in?

A

Difficulty in getting up from a prone position: after rolling over, patient walks the hands and feet towards each other, then unsee hands to climb legs, and reaches an upright position by swinging arms and trunk sideways and upwards
Seen in duchenne’s muscular dystrophy

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110
Q

What does intermittent weakness that worsens with exercise suggest?

A

Myasthenia gravis

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111
Q

What does slowly progressive generalised weakness suggest?

A

Motor neurone disease

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112
Q

What does a sudden onset of weakness (like foot or wrist drop) suggest?

A

Mononeuritis multiplex

Associated with RA, vasculitis, connective tissue disease, DM or HIV

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113
Q

What is locking defined as?

A

Incomplete range if movement at a joint because of an anatomical block

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114
Q

What causes true locking?

A

Mechanical obstruction causing a block to usual range of movement. Eg, loose body or torn meniscus preventing the joint from reaching extremes of the normal range of movement.
Patients usually can unlock the joint using trick manoeuvres

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115
Q

What is pseudo-locking?

A

Loss of range of movement due to pain

Eg, patients with patellofemoral pain hold knee in full extension and won’t flex it

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116
Q

What is triggering?

A

When finger in extended from flexed position, there is a knock to extension that gives suddenly

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117
Q

What causes finger triggering?

A

Nodular thickening or a fibrous thickening of flexor sheath

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118
Q

Which fingers are usually affected by triggering?

A

In adults- ring or middle fingers

Congenital- thumb

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119
Q

Define subluxation

A

Partial malapposition of joint surfaces

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120
Q

Define dislocation

A

Complete malapposition of joint surfaces

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121
Q

What can cause acute deformity?

A

Fracture, dislocation or swelling (haemarthrosis or intramuscular haematoma

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122
Q

Weight loss, low grade fever and malaise are extra articular symptoms of what diseases?

A

RA and SLE

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123
Q

High spiking fever in the evening with a rash are symptoms of which disease?

A

Still’s

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124
Q

What does Headache, jaw pain in chewing and scalp tenderness suggest?

A

Temporal arthritis

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125
Q

What does predominant involvement if the small joint of hands feet or wrist suggest?

A

Inflammatory arthritis

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126
Q

What does medium or large joint swelling suggest?

A

Degenerative or zero negative arthritis

Eg, psoriatic or Ank. spond.

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127
Q

What does involvement of distal interphalangeal joints and carpometacarpal joint of thumb suggest?

A

Nodal osteoarthritis

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128
Q

How does Felty’s syndrome manifest outside the musculoskeletal system?

A

RA with splenomegaly, lymphadenopathy and neutropenia

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129
Q

How does Sjögren’s syndrome manifest outside the musculoskeletal system?

A

Arthritis with dry eyes (keratoconjunctivitis sicca), xerostomia, salivary gland enlargement and Raynaud’s phenomenon

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130
Q

What is xerostomia and what is it associated with?

A

reduced or absent saliva production

Sjörgen’s

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131
Q

How does enteropathic arthritis manifest outside the musculoskeletal system?

A

Associated with IBD (UC and Crohn’s)

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132
Q

How does psoriatic arthritis manifest outside the musculoskeletal system?

A

Skin and nail features of psoriasis

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133
Q

How does haemophilia manifest in the musculoskeletal system?

A

Knee arthropathy due to haemarthrosis

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134
Q

How does sickle cell disease manifest in the musculoskeletal system?

A

Osteonecrosis of hip

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135
Q

Why does sickle celled disease causes Osteonecrosis of the hip?

A

Bone infarction

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136
Q

How does still’s manifest in the musculoskeletal system?

A

Juvenile idiopathic arthritis

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137
Q

How does reactive arthritis manifest?

A

Urethritis, conjunctivitis,
inflammatory oligoarthropathy 1-3 weeks after sexually transmitted chlamydia infection or infective gastroenteritis
Mouth or genital ulcers,
enthesopathy (Achilles tendinopathy, plantar fasciitis),
rash (keratoderma blennorrhagica

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138
Q

How does septic arthritis manifest outside the musculoskeletal system?

A

Fever, malaise, source of sepsis (e.g. Throat, skin, gut

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139
Q

How does gouty arthritis manifest outside the musculoskeletal system?

A

Signs of renal failure, tophi

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140
Q

How does ankylosing spondylitis manifest outside the musculoskeletal system?

A

Enthesopathy, iritis

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141
Q

How does RA manifest outside the musculoskeletal system?

A

Raynaud’s, rheumatoid nodules, dry eyes, pleurisy, episcleritis

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142
Q

How does SLE manifest outside the musculoskeletal system?

A

Fever, episcleritis, alopecia, Raynaud’s, photosensitive rash, especially on face

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143
Q

What does seropositive mean in terms of inflammatory arthritis?

A

Indicates presence significant amounts of IgM rheumatoid factors in serum of patients with poly arthritis

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144
Q

What does seronegative mean in terms of inflammatory arthritis?

A

Indicates absence significant amounts of IgM rheumatoid factors in serum of patients with poly arthritis

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145
Q

What kinds of arthritis are seronegative?

A

RA, ank. Spond, reactive arthritis, psoriatic arthritis

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146
Q

What are seronegative arthritis associated with?

A

HLA b27
Same extra articular features,
Have asymmetrical joint involvement

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147
Q

Which musculoskeletal conditions have a monogenic pattern of inheritance (ie are single gene defect diseases)?

A

Osteogenesis imperfecta, Charcot-Marie-Tooth, Marfans, muscular dystrophies, Ehlers-Danlos syndrome

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148
Q

Which musculoskeletal conditions have a polygenic pattern of inheritance?

A

Osteoarthritis, osteoporosis, gout, RA, seronegative sponykoarthritis

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149
Q

What is the pattern of joint involvement of RA?

A

Symmetrical
Small and large joints
Upper and lower limbs

150
Q

What is the pattern of joint involvement of seronegative psoriatic arthritis?

A

Asymmetrical
large joints > small joints
Associated peri articular inflammation, giving dactylitis

151
Q

What is the pattern of joint involvement of seronegative inflammatory arthritis?

A

Asymmetric
Large joints > small joints
Axial involvement

152
Q

What is the pattern of joint involvement of Osteoarthritis?

A

Symmetrical

Small and large joints

153
Q

How do steroids effect the musculoskeletal system adversely?

A

Avascular necrosis, osteoporosis, myopathy, infections

154
Q

How do statins effect the musculoskeletal system adversely?

A

Myalgia, myopathy, myositis

155
Q

How do ACE inhibitors effect the musculoskeletal system adversely?

A

Myalgia, arthralgia, positive antinuclear antibodies

156
Q

How do antiepileptics effect the musculoskeletal system adversely?

A

Arthralgia, osteomalacia

157
Q

How do immunosuppressants effect the musculoskeletal system adversely?

A

Infections

158
Q

How do quinolones effect the musculoskeletal system adversely?

A

Tendonopathy, tendon rupture

159
Q

Which conditions are linked to HLA b27?

A

Ankylosing spondylitis
Enteropathic arthritis (UC and Crohn’s)
Reactive arthritis
Psoriatic arthritis

160
Q

What can alcohol do to the musculoskeletal system?

A

Trauma, myopathy, rhabdomyolysis, nerve palsies

161
Q

What can smoking do to the musculoskeletal system?

A

Bony metastasis, hypertrophic pulmonary osteoarthropathy

162
Q

What can diet do to the musculoskeletal system?

A

Vitamin deficiencies - osteomalacia, scurvy

Anorexia (osteoporosis)

163
Q

What is thickened, tight skin characteristic of?

A

Systemic sclerosis

164
Q

What are the skin, nail and sof fissure changes seen in systemic sclerosis?

A

Telangiectasia, thickened tight skin, calcium deposits in finger pulp, flexion contracture, tissue ischaemia that leads to ulceration

165
Q

Describe rheumatoid nodules

A

Firm and non tender
Felt at pressure or friction sites (like sacrum)
Associated with positive rheumatoid factor
Can occur in lungs

166
Q

What can be seen in a rheumatoid hand?

A

Ulnar deviation, z thumb, swan neck, small muscle wasting, synovial swelling at carpal, metacarpophalangeal and proximal interphalangeal joints

167
Q

What is the difference between bony nodules and rheumatoid nodules?

A

Bony nodules: caused by osteoarthritis, smaller and harder than rheumatoid nodules

Rheumatoid nodules: caused by RA

168
Q

What are heberden’s nodes?

A

Bony nodules at distal interphalangeal joints

169
Q

What are Bouchard’s nodes?

A

Bony nodules at proximal interphalangeal joints

170
Q

Describe gouty tophi

A

Firm, white, irregular subcutaneous crystal collections

171
Q

What are the common sites for gouty tophi?

A

Extensor aspects of hands, toes and fingers

Helix of ear

172
Q

What can happen to the overlying skin in gouty tophi?

A

Overlying skin may ulcer we, discharging tissue

Can be secondarily infected

173
Q

What can cause small, red vasculitis spots?

A

Small skin infarcts
Seen in inflammatory diseases: RA, SLE, polyarteritis no dosa
Indicate active disease

174
Q

What are the common sites for these red vasculitic spots?

A

Nail folds, finger and toe tips, pressure areas

175
Q

What MSK conditions is conjunctivitis a feature of?

A

SLE, RA, sjorgen’s via keratoconjunctivitis

Reactive arthritis, ank spond.

176
Q

What is keratoconjunctivitis sicca?

A

Reduced tear production with dry eyes

177
Q

What does keratoconjunctivitis sicca cause?

A

Conjunctivitis and inflammation of the eyelid

178
Q

What condition can cause the sclera to go blue?

A

Osteogenesis imperfecta

179
Q

What test is used to diagnose keratoconjunctivitis sicca and describe the test?

A

Schemer tear test:place notched blotting paper on lower eyelid and ask patient to look up mad close eye. After five minutes, measure how far the tear has moved

180
Q

Which genetic diseases can cause hyper mobility?

A

Marphans and Ehlers Danlos syndrome

181
Q

What can cause tender thickening in the wrist?

A

Hypertrophic pulmonary osteoarthritis

182
Q

How do patients with limb length discrepancies walk?

A

Tiptoe on the shorter side

183
Q

What is a Trendelenberg’s gait?

A

Contralateral hemi pelvis falls

184
Q

What can cause a Trendelenberg gait?

A

Weakness of hip abductors(in polio or paralysis of sup. gluteal nerve)
Painful hip joint (congenital hip dislocation)
Structural joint problems (osteoarthritis)

185
Q

Why is the gait high stepping in a common peroneal nerve palsy?

A

Foot drop

High stepping gait compensates to allow the clearance of the weak foot

186
Q

What is the change in gait in cerebral palsy?

A

Energy inefficient crouch gait
Weak Solaris and gastrocnemius
Hips and knees are always flexed

187
Q

Define scoliosis

A

Lateral inflection of spine

188
Q

Define kyphosis

A

Curvature of spine in sagittal plane, with apex posterior

189
Q

Define lordosis

A

Curvature of spine in sagittal plane, with apex anterior

190
Q

Define gibbus

A

Spinal deformity caused by an anterior wedge deformity localized to a single vertebrae, causing an increase in forward flexion

191
Q

Define spondylosis

A

Degenerative change in spine

192
Q

Define spondylolisthesis

A

One vertebrae slipping anteriorly over another vertebrae

193
Q

Define spondylolysis

A

Defect in pars inter articulates of a vertebral arch

194
Q

Define retrolisthesis

A

One vertebrae slipping posteriorly over another vertebrae

195
Q

Name 10 common spinal problems

A

Spinal stenosis, ank. Spond. Mechanical back pain, scoliosis, prolapsed intervertebral disk, compensatory scoliosis from leg length discrepancy, cervical rib, spinal instability, cervical myelopathy, osteoporotic fracture, pathological pain (osteomyelitis, tumour, myeloma)

196
Q

What can cause loss of lordosis or a flexion deformity?

A

Acute lesions, RA, trauma

197
Q

What can cause increased lordosis?

A

Ank. Spond.

198
Q

What can cause torticollis?

Wry neck

A

Sternocleidomastoid contracture, trauma

199
Q

What can cause lateral flexion of the neck?

A

Erosion of lateral mass of atlas due to RA

200
Q

What are the presenting symptoms of the thoracic spine?

A

Localized spinal pain, pain radiating to chest wall, symptoms of paresis, sensory loss, leg weakness and incontinence

201
Q

What are the causes of thoracic pain in adolescents and young adults?

A

Ank. Spond, schuermann’s, disc protrusion

202
Q

What are the causes of thoracic pain in the middle aged and elderly?

A

Degenerative change

Osteoporotic fracture

203
Q

What are the causes of thoracic pain in all ages?

A

Tumour, infection

204
Q

Describe sciatica pain

A

Radicular back pain that radiates to the posterior of the leg

205
Q

Describe pain due to inflammation of sacroiliac joints

A

At buttocks

Can be referred down to both legs

206
Q

What does lower back pain usually indicate?

A

Age related, Degenerative, spondylosis

207
Q

What does lower back pain in a young person suggest?

A

Inflammation of sacroiliac joints and lumbar spine

208
Q

Name 10 red flags for acute lower bag pain

A

Age <20 or >55, Waking up from the pain, Steroid use, Weightloss, Incontinence, Difficulty in micturition, Saddle anaesthesia, Sexual dysfunction, Recent trauma, Motor weakness, Bilateral sciatica, Fever, Toracic pain (dissecting aortic aneurysm)

209
Q

Acute onset of low back pain in a young adult, associated with bending and lifting suggests what?

A

Slipped disc

210
Q

What does an acute onset of severe progressive back pain, associated with night sweats, weight loss and malaise suggest?
Hint: history of immunosuppression

A

Pyogenic or tuberculous infection of sacroiliac joint

211
Q

What is the presenting symptom of lumbrosacrsl spinal stenosis?

A

Diffuse pain on thigh and buttocks from standing too long or walking

212
Q

Name an important differential for lumbrosacral spinal stenosis?

A

Claudication

213
Q

What can problems with the femoral nerve cause?

A

Weak knee jerk, quadriceps weakness

214
Q

What muscles do the median nerve supply?

A

Opens and abductor, most of the wrist and finger flexors

215
Q

What does the ulnar nerve supply?

A

Adductor of thumb, most lumbericals and interossei

216
Q

What does the radial nerve supply?

A

Extensors of wrist and hand

217
Q

What are the symptoms of carpal tunnel?

A

Pain, tingling and numbness in the thumb and fingers
Pain can extend proximally up the arm
Patient may wake up from the pain
Pain is relieved by shaking the hand
Weakness might lead to poor grip- wasting of then an eminence

218
Q

What test is used for carpal tunnel?

A

Phalan’s test

219
Q

What condition can cause long fingers?

A

Marfans

220
Q

What can cause rotational deformities of the finger?

A

Phalange fracture

221
Q

What do gout tophi typically look like and wherein their typical site?

A

White, subcutaneous

Juxta-articular

222
Q

What do calcification deposits look like and where is their typical site?

A

White, subcutaneous, on the fleshy pulp of fingers

223
Q

What disorders can cause calcium deposits?

A

SLE, dermatomyositis

224
Q

What can cause dilated capillaries in the nail fold?

A

Systemic sclerosis, dermatomyositis, SLE

225
Q

Name two common causes of pain at the elbow

A

Epiconcondylitis and RA

226
Q

What is tennis elbow?

A

Lateral epicondylitis

227
Q

What is golfer’s elbow?

A

Medial epicondylitis

228
Q

What problems with the rotator cuff can cause shoulder pain?

A

Rotator cuff degeneration,
Calcification tendinitis
Tendon rupture

229
Q

What problems with the subacromial bursa can cause shoulder pain?

A

Calcific bursitis

Poly arthritis

230
Q

What problems with the capsule can cause pain in the shoulder?

A

Adhesive capsulitis

231
Q

How can the head of the femur cause shoulder pain?

A

Osteonecrosis
Fractures
Dislocation
Tumour

232
Q

How can problems with the joints cause shoulder pain?

A

Glenohumeral, stereo clavicularjoints- synovitis, osteoarthritis, dislocation
Acromioclavicular joint- osteoarthritis

233
Q

Name six common non trauma related conditions that can affect the shoulder

A

RA, impingement syndrome of the rotator cuff, calcific tendonitis, adhesive capsulitis, bicipital tendonitis, rotator cuff syndromes (eg supraspinatus, infraspinatus tendonitis)

234
Q

Name fice common trauma related conditions affecting the shoulder

A 
Rotator cuff tear
Fracture of head or neck of humerus
Fracture of clavicle
Dislocation of glenohumeral joint
Dislocation of acromioclavicular joint
235
Q

Adhesive tendonitis is also called:

A

Frozen shoulder

236
Q

What can cause winging of the scapula?

A

Paralysis of nerve to serratus ant.

237
Q

What causes of hip pain are painful at rest and night?

A

Avascular necrosis and tumours

238
Q

What does lateral hip or thigh pain, aggravated by lying on ones side at night, suggest?

A

Trochanteric bursitis

239
Q

What does tenderness at the greater trochanter on palpating suggest?

A

Trochanteric bursitis

240
Q

What problems with the hip can cause leg shortening?

Name 6

A

Juvenile osteochondritis, un reduced hip dislocation, femoral fracture, after hip athroplasty, missed congenital dislocation of hip, congenital coxa Vera, septic arthritis, loss of articular cartilage, slipped upper femoral epiphysis

241
Q

What problems with the growth of femur and tibia can lead to leg shortening?

A

Congenital, poliomyelitis, osteomyelitis, septic arthritis, cerebral palsy, fracture, epiphyseal injury

242
Q

Name 3 bursae that lie anterior to the knee

A

Suprapatellar
Prepatellar (between patella and skin)
Infrapatellar (between skin and tibial tuberosity/patellar ligament)

243
Q

What suggests a knee haemarthrosis?

A

Rapid swelling

244
Q

How long does the joint need tos well in septic arthritis?

A

Few hours with pain

245
Q

What causes predisposition to haemarthrosis?

A

Coagulation disorders or anti coagulation therapy

246
Q

What can cause knee locking?

A

Meniscal tears and loose bodies

247
Q

What can cause loose bodies in the knee?

A

osteoarthritis, osteochondritis dissecans, synovial chondromatosis

248
Q

What causes a sprain?

A

Some fibres are torn but ligament remains intact

249
Q

What does plantar surface Heel pain that is worse on the foot strike phase of walking suggest?

A

Plantar fasciitis

250
Q

What can cause post. Heel pain?

A

Achilles tendonitis

251
Q

What can cause spontaneous lancinate pain in the forefoot radiating to contiguous sides of adjacent toes?

A

Morton’s neuroma

252
Q

What is splay foot?

A

Widening at level of metatarsal head

253
Q

What is splay foot associated with?

A

Mtp joint synovitis

254
Q

What is fibromyalgia?

A

Long term condition causing widespread pain and tenderness

255
Q

What are the symptoms of fibromyalgia?

A

Widespread pain, extreme fatigue, sleep disturbance, poor circulation (causing tingling and numbness in the extremitis, headaches), feeling irritable, micturition, IBS

256
Q

What is Sjogren’s syndrome?

A

Autoimmune disorder that affects the mucus producing cells

257
Q

What are the symptoms of Sjogren’s?

A

Dry eyes, mouth, dry throat, dry everything, joint inflamation, fatigue

258
Q

What tests are used to diagnose Sjogren’s? Name 5

A

Eye exam, Schimer (tear test), ultrasound, saliva production, blood tests (raised ESR)

259
Q

what is polymyositis?

A

Inflammation of the mucles

260
Q

what is dermatomyositis?

A

Inflammation of muscles with a rash

261
Q

What are the symptoms of polymyositis?

A

Fatigue, muscle weakness, tiring, weight loss, night sweats, malaise

262
Q

What are the symptoms of dermatomyositis?

A

Fatigue, muscle weakness, tiring, weight loss, night sweats, malaise
AND
Red/pink rash on upper eyelids, face, neck, backs of hands, fingers
swelling of affected skin

263
Q

What are the differentials for polymyositis?

A

side-effects of some medications (for example, steroids or statins)
toxic effects of long-term alcohol excess
hormonal conditions such as under- or over-active thyroid
low vitamin D levels or abnormal calcium or magnesium levels
infections
rarer nerve–muscle diseases such as muscular dystrophies.

264
Q

What is polymyalgia rheumatica?

A

An inflammatory disease that causes painful muscles

265
Q

Who is typically affected by polymyalgia rheumatica?

A

> 50, typically>60,

women more than men

266
Q

What are the symptoms of polymyalgia rheumatica?

A

Severe, symmetrical, widespread pain and stiffness, on thighs and shoulder, worse in the morning and with rest, better with exercise
Also: night pain, weightloss, low mood, fever, fatigue

267
Q

What important condition is linked to polymyalgia rheumatica?

A

Giant cell arteritis

268
Q

What is myotonic dystrophy?

A

A genetic condition leading to muscle weakness and atrophy as well as prolonged muscle contraction

269
Q

What are the symptoms of myotonic dystrophy?

A

Muscle weakness, myotonia, cataracts, cardiac conduction problems, infertitlity

270
Q

What is Raynaud’s phenomenon?

A

Disorder caused by lack of blood flow to the fingers (and toes)causing fingers to change colour from white to blue then red. May also be seen in the nose. Pain, tingling and numbness is usually felt.

271
Q

What are the complications of Raynaud’s?

A

open sores, and gangrene

272
Q

What causes the colour change in Raynaud’s?

A

White-reduced blood supply
Blue-cyanosis
red-blood comes rushing back

273
Q

what tests can be used to investigate Raynaud’s?

A

Cervical rib pressing on brachial artery, Full blood count, nailfold microscopy, cold stress test

274
Q

Define enthesopathy

A

Disorder involving the attachment of tendon or ligament to a bone

275
Q

Name ten enthesopathies

A 
Achilles spondylitis
Ank. Spond
Plantar fasciitis
Adhesive capsulitis of shoulder
Rotator cuff syndrome of shoulder and allied disorders
Periarthritis of shoulder
Scapulohumeral fibrositis
Synovitis of hand or wrist
Periarthritis of wrist
Gluteal tendinitis
Iliac crest spur
Psoas tendinitis
Trochanteric tendinitis
276
Q

What is limb girdle dystrophy?

A

group of disorders with muscle wasting and weakness around shoulders and hips

277
Q

What are the signs and symptoms of limb girdle dystrophy?

A 
Cardiac myopathy, arrhythmia
Resp depression, 
assymetric distal wasting,
Calf hypertrophy
scapular winging
Contractures/rigid spine
278
Q

what is used to diagnose limb girdle dystrophy?

A

High creatine kinase

279
Q

What is fascioscapulohumeral dystrophy?

A

An autosomal dominant muscular dustrophy with presenting symptoms of facial, shoulder or arm weakness and wasting followed by weakness of foot dorsiflexion and foot drop

280
Q

What are the bone conditions associated with a pathological fracture?
Name 7

A

Osteoporosis, osteomalacia, osteogenesis imperfecta, Paget’s, renal osteodystrophy, primary or secondary tumour, parathyroid bone disease

281
Q

Define osteoporosis

A

Systemic loss of bone mineral density that causes microarchitectural changes

282
Q

What are the risk factors for osteoarthritis?

Name 10

A

Age, sex, post menopause, late menarche, amenorrhea, immobility, alcohol, lack of vitamin D, smoking, family history, steroid therapy, early menopause, hypogonadism(due to anorexia nervosa, over excerci sing, hyperprolactinaemia)

283
Q

What are the early systemic effects of a fracture?

A

Hypovolemia, shock, ARDS, fat embolism

284
Q

What are the late systemic effects of a fracture?

A

Chest infection

UTI

285
Q

What are the early effects of a fracture on the bone?

A

Osteomyelitis

286
Q

What are the late effects of a fracture on the bone?

A

Malunion, delayed or non union
Osteomyelitis
Necrosis

287
Q

What are the late effects of a fracture on the joint?

A

Osteoarthritis, stiffness, instability

288
Q

What are the early effects of a fracture on the soft tissue?

A 
Compartment syndrome
Nerve injury
Vascular injury
Muscle/tendon Injury
Adjacent structure damage
289
Q

What are the late effects of a fracture on soft tissue?

A

Pneumothorax
Reflex sympathetic dystrophy
Peripheral nerve and cord injury
Ischaemic contracture

290
Q

What are the types of fractures?

A

Spiral, horizontal, oblique, overlapping, spiral, transverse, rotational, communicated, angulated, compacted

291
Q

What is the IgM rheumatoid Factor?

A

A factor found In raised concentrations in 60-70% of RA patients

292
Q

Is the IgM Rheumatoid factor conclusive for RA?

A

No, because it it raised in 15% of the normal population

293
Q

What test in specific for RA?

A

Anti-Cyclic citrullinated peptides

294
Q

What factors are found in SLE

A

Antinuclear factors, anti-dsDNA, Anti-Sm

295
Q

What factors are present (in blood) in Sjögren’s syndrome?

A

Anti-Ro and anti-La

296
Q

What can show increased uptake in an isotope bone scan?

A

Paget’s and tumours

297
Q

What is the gold standard test for osteoporosis?

A

Dual-energy X-ray absorbtiometry

298
Q

What do positively birefringent rhomboidal crystals in a joint aspiration indicate?

A

Calcium phosphate in joint

Pseudogout

299
Q

What do negatively birefringent needle shaped crystals in the joint fluid indicate?

A

Mono sodium urate crystals in the joint

Gout

300
Q

Is raised urea conclusive for gout?

A

NO

301
Q

What is still’s disease?

A

Severe version of juvenile idiopathic artheritis, seen in adult’s instead?

302
Q

What are the risk factors and causes for Still’s?

A

Nobody knows

303
Q

What are the symptoms of Still’s disease?

A

Joint pain and stiffness, worse at morning. multiple joints affected
Fever that occurs in the afternoon or evening
Salmon pink rash that occurs with fever
Splenomegaly, hepatomegaly, lymphadenopathy, pericarditis, myocarditis, pleural effusion

304
Q

What are the complications of still’s disease?

A

Macrophage activation syndrome, thrombotic, thrombocytopenic purpura, diffuse alveolar haemorrhage, disseminated coagulopathy, pulmonary arterial hypertension

305
Q

What are tophi?

A

Uric acid deposits under the skin seen in gout

306
Q

what does Raynaud’s phenomenon suggest?

A

presence of an auntoimmune condition, like scleroderma, lupus, RA, sjogren’s
Cancer, (lymphoma, multiple myeloma, and acute lymphoblastic leukaemia)
Viral infections (blood borne, like hep B and C)
Iatrogenic (antimigraine, betablockers, chemo drugs, contraceptives, HRT, ACEi, decongestants)

307
Q

what is osteogensis imperfecta?

A

An autosomal dominant connective tissue disorder that causes bone fragility

308
Q

What features can be seen in patients with osteogenesis imperfecta? Name 10

A

Blue sclera, fractures, scoliosis, triangular facies, barrel chest, macrocephaly, hearing loss, growth retardation, joint laxity, defective dentation, limb deformitis
constipation and sweating

309
Q

What causes osteogenesis imperfecta?

A

A defect in the genes encoding type1 collagen causing a reducction in the quantity or quality of type 1 collagen,
This affects tissues where type 1 collagen is an important constituent, such as sclera, bone, ligament, dentin

310
Q

How do patients with osteogenesis imperfecta typically present?

A

Fractures from minor trauma, easy bruising.

Prenatal screening may reveal fractures, long bones, limb shortening and decreased skull echogenicity

311
Q

what is the mildest type of osteogenesis imperfecta?

A

Type 1

312
Q

What happens to patients with type 1 osteogenesis imperfecta?

A

Premature deafness, blue sclera, increased bone fractures, bone fragility and normal height. exercise tolerance and muscle strength is reduced

313
Q

What is the most common type of osteogenesis imperfecta?

A

Type 1

314
Q

What type of osteogenesis imperfecta usually causes still birth or death soon after?

A

type 2

315
Q

In what type of osteogenesis imperfecta does the blueness of the sclera fade>

A

Type 3

316
Q

How many types of osteogenesis imperfecta are there?

A

8

317
Q

What are the complications of osteogenesis imperfecta?

A

Post partum haemorrhage, basilar impression (due to large head), repeated resp infections, high metabolism so hypothermia during anaesthesis

318
Q

Name 5 possible differentials for osteogenesis imperfecta

A

Osteoporosis, Osteopetrosis, Wilson’s disease, Rickets, Scurvy, Achondroplasia, cushing’s

319
Q

What tests are done for osteogenesis imperfecta?

A

Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), cyande bromide mapping, thermal stability studies

320
Q

What radiological features are typically seen in osteogenesis imperfecta?

A

Fractures, beaded ribs, pectus carintum, wormian bones, excessive callus formation and popcorn bones, narrow pelvis, compression fractures, protrusio acetabuli, shepherd’s crook deformity of the femur

321
Q

What is Ehlers-Danlos syndrome?

A

Group of genetic connective tissue disorders due to a defect in collagen and connective tissue synthesis and structure

322
Q

Which type of Ehlers-danlos syndrome is most severe?

A

Type IV, because patients have an increased risk of large artery rupture and internal organ perforation

323
Q

What is the clinical presentation of Ehlers-Danlos?

A

Hypermobility, muscle weakness, easily bruising skin, difficulty walking, soft, hyperextensible skin, molluscoid pseudotumours, cigarette paper scars

324
Q

What are the complications of ehlers danlos syndrome?

A

Aneurysms, frequent dislocation, scarring, organ rupture (uterus or intestines)

325
Q

Name the seronegative arthropathies?

A

Juvenile idiopathic arthritis, Behchet’s disease, enteropathic arthritis, psoriatic arthritis, Ank. Spond, reactive arthritis

326
Q

What does seronegative refer to?

A

Absence of IgM RF or anti-CCP in blood

327
Q

FUN FACT

A

Reactive arthritis is no longer called Reiter’s phenomenon because he was an evil Nazi doctor

328
Q

What is reactive arthritis?

A

Autoimmune asymmetric oligoarthritis effecting weight bearing joints that develops in response to an infection

329
Q

What organisms are associated with reactive arthritis?

A

Camplylobacter, shigella, salmonella, chlamydia trachomatis

330
Q

What is the triad of reactive arthritis?

A

Arthritis, non infectious urethritis, conjunctivitis

331
Q

How does reactive arthritis present?

A

with acute onset, often with fever, myalgi, fatigue and malaise

332
Q

What can occur in the MSK system due to reactive arthritis?

A

Aymmetric Oligoarthritis, enthesopathy, sacroilitis

333
Q

What can occur in the skin due to reactive arthritis?

A

Keratoderma blennorrhagicum; erythema nodosum (uncommon); onychodystrophy

334
Q

What can occur in the eye due to reactive arthritis?

A

Conjunctivitis; anterior uveitis; keratitis; scleritis; episcleritis; cataracts; hypotony; glaucoma; corneal ulceration; disc or retinal edema; retinal vasculitis; optic neuritis; dacryoadenitis

335
Q

What can occur in the GU tract due to reactive arthritis?

A

Meatal oedema and erythema. Clear mucoid discharche, prostatis, vaginitis, cervicitis, cystitis, salpingo-oophoritis, pyelonephritis, bartholinits

336
Q

What can occur in GI tract due to reactive arthritis?

A

Diarrhoea, abdopain, lesions like IBD

337
Q

What are the seronegative arthropathies associated with?`

A

HLA B27

338
Q

What is the typical reactive arthritis patient?

A

Young and male

339
Q

What is Psoriatic arthriris?

A

A seronegative arthritis commonly seen in patients with psoriasis, with a defining pattern of distal joint involvement and arthritis mutilans

340
Q

What is the onset of psoriasis and arthritis in psoriatic arthritis?

A

Psoriasis preceds arthritis by average 10 years in 70% of patients

341
Q

What are the findings seen in psoriatic arthritis?

A

Enthesopathies, dactylitis, arthritis mutilans, psoriasis, psoriatic nail changes, achilles tendonitis and plantar fasciitis

342
Q

What are the five patterns of psoriatic arthritis joint involvement?

A 
Asymmetrical oligoarticular arthritis
Symmetrical polyarthritis
Distal Interphalangeal arthropathy
Arthritis mutilans
Spondylitis with or without sacroiliitis
343
Q

What’re the radiological features seen in psoriatic arthritis?

A

Arthritis mutilans, joint space narrowing (or widening) in the hand, fluffly periostitis, sacroilitis, bilateral, asymmetric fusiform soft-tissue swelling

344
Q

What is compartment syndrome?

A

Tissue pressure in a closed muscle compartment exceeds perfusion pressure causing muscle and nerve ischaemia. Occurs after a traumatic event (most likely a fracture)

345
Q

What causes compartment syndrome?

A

Increased tissue pressure and lack of clearence of waste products

346
Q

What is the presentation of compartment syndrome?

A

Pain severity oyt of proportion with injury, evidence of trauma. Tense feeling, burning pain.

347
Q

What can manifest in compartment syndrome?

A

Limb ischaemia

348
Q

What are the signs of limb ischaemia?

A

Pallor, poikilothermia, pain, pulselessness, paraesthesia

349
Q

How are intracapsular neck of femur fractures treated?

A

Hemiarthroplasty or totalarthroplasty if the patient is below 75
Hip screw if the patient is young

350
Q

How are extracapsular neck of femur fractures treated?

A

Hip screw (because head of femure is unlikely to have undergone osteonecrosis

351
Q

What is finkelstein’s test?

A

1) you bend your thumb across the palm of your hand 2)bend your fingers down over your thumb.
3) Then you bend your wrist toward your little finger.
4) If this causes pain on the thumb side of your wrist, test is positive

352
Q

What does finkelstein’s test assess?

A

De Quervain’s tensosynovitis

353
Q

What is DeQuervain’s tensosynovitis?

A

An entrampment tendinitis of the tendons in the dorsal compartment of the wrist, causing pain on thumb movement

354
Q

What is the presentation of DeQuervain’s tensosynovitis?

A

Pain on moving thumb, thickend and hardend radial styloid

355
Q

What is osteochondritis dissecans?

A

A fragment of cartilage or subchondral bone separates from it’s articular surface

356
Q

What is the cause of Osteochondritis dissecans?

A

Trauma and ischaemia

357
Q

What are the four stages of osteochondritis dissecans

A

1) small are of compression of subchondral bone
2) partially detached subchondral bone
3) completely detached subchondral bone
4) Loose body

358
Q

What are the symptoms of osteochondritis dissecans?

A

Vary with stages. Stage one is swelling and pain. stage 3 and 4 manifest as locking and giving away

359
Q

What is synovial chondromatsis?

A

A rare pisease where the foci of cartiledge develop in the synovial membranes of joints, tendons or bursae due to the metaplasia of subsynovial joint tissue. This causes painful effucions and the generation of synovial loose bodies

360
Q

What is the typical presentation of synovial chondromatosis?

A

Largely monoarticular, affecting large joints (esp. knees)

361
Q

What is an enteropathic arthritis?

A

Rheumatological conditions associated with GI infection. Typically reactive arthritis with IBD

362
Q

What is HLA B27?

A

One of the antigen presenting molecules present ofn MHc type 1 molecules on CD8 or supressor T Cells. This complex is related to many immune mediated conditions, most predominantly with Ank. Spond.

363
Q

Name 5 HLAB27 syndromes

Hint: A PAIR

A

Acute ant. uveitis, ank. spond. reactive arthritis, psoriatic arthritis, IBD

364
Q

What is behcet’s disease?

A

A rare disease categorized by oral aphthous ulcers, genital ulcers, uveitis and inflammatory arthritis thought to have an auntoimmune (infection triggered) cause

365
Q

What is the classic presentation of Behcet’s

A

Uveitis, opthalmic lesions, genital and oral ulcers memory damage in late stage of the disease, inflammatory arthritis,

366
Q

What are the ivestigations for Behcet’s?

A

Imaging studies and synovial joint aspiration

367
Q

What is achondroplasia?

A

A skeletal dysplasia causing dwarfism

368
Q

What morbidities are associated with achondroplasia?

A

Hydrocephalis, spinal deformities (kyphosis, lordosis, scoliosis), obesity, otitis media, cervicomedullary compressions (causing resp depression and feeding problems), obstructive and respiratory complications, spinal canal stenosis

369
Q

What is the treatment of polymyalgia rheumatica?

A

Steroids

370
Q

What is seen in blood tests for polymyalgia rheumatica?

A

Raised ESR

FOCP (12 decks)

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