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MSK Flashcards

1
Q

Secondary bone tumours

A

Breast, prostate, lung, thyroid, kidney, testes

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2
Q

effects of myeloma

A

marrow infiltration
hypercalcaemia
osteolytic bone lesions
immunoglobulin excess

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3
Q

padgets disease and features

A

chronic bone disease characterised by focal areas of increased bone remodelling - overgrowth of poorly organised, weak bone

bone pain, deformity
osteoarthritis
spinal cord compression
pathological fractures

paget’s sarcoma - elder,y early metastases

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4
Q

genetic defect in ewing’s sarcoma

A

translocation between 11 and 22

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5
Q

Tendinopathy

A

chronic tendon injury of overuse (repetitive loading), causing degeneration, disorganisation of collagen fibres, increased cellularity

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6
Q

RF for tendon damage

A 
old
chronic disease
diabetes/RA
adverse biomechanics 
repetitive exercise
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7
Q

Treatment of tendinopathy

A

NSAIDs
rest
physio
`GTN patches to increase perfusion

operative: debridement and excision of diseased tissue

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8
Q

Compartment syndrome

A

elevated interstitial pressure within a closed fascial compartment, resulting in microvascular compromise

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9
Q

causes of compartment syndrome

A

trauma: fractures, entrapment, bleeding
muscle oedema
re-perfusion
venous obstruction eg. DVT

external
casts and bandages
positioning in theatre
full thickness burns

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10
Q

mechanism of compartment syndrome

A

pressure exceeds pressure in capillaries
muscle becomes ischaemic and develops oedema
fluid leaks into interstitial space, further increasing pressure
necrosis begins, myoglobin released
neuropraxic
compromise of arterial supply

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11
Q

presentation of compartment syndrome

A 
6 p's
pain out of proportion
pale
pulseless
perishingly cold
parasthesia 
pallor 
paralysis
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12
Q

management of compartment syndrome

A

fasciotomy - full length surgical decompression of compartment and excision of necrotic muscle

wound is left open and later closed with a skin graft

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13
Q

features of temporal arteritis

A

fatigue, headaches, jaw claudication
fever, weight loss, myalgia, morning joint stiffness

v high ESR and CRP

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14
Q

Features of HSP deposit IgA

A

purpuric rash
abdominal pain
polyarthritis

nephritic glomerulonephritis

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15
Q

polymyalgia rheumatica

A

pain in shoulder girdle and pelvic girdle
elderly and women
large vessel

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16
Q

Polyarteritis nodosa

A

medium vessel
necrotitising vasculitis which causes aeurysms and thrombosis
renal artery stenosis and aneurysms
MI and stroke

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17
Q

wtf is sjogren’s syndrome

A

a systemic auto-immune disorder characterised by the presence of dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) as a consequence of lymphocytic infiltration into the lacrimal and salivary glands

predisposes to lymphoma

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18
Q

characteristics of dermatomyositis

A

heliotrope rash
macular rash
gotton’s papules
prominent nail fold capillaries

-> inflammation of perimysium

asoc with malignancy (lung, pancreatic, bowel) in elderly

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19
Q

characteristics of polymositis

A

-> inflammation of endomysium

progressive, symmetrical proximal muscle weakness
myalgia 
dysphagia
pelvic and shoulder girdle
fever, malaise and weight loss
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20
Q

features of SLE and diagnosis

A 
malar rash
arthritis
fatigue, weight loss, fever, malaise 
generalised erythematous rash 
oral ulceration
pericarditis 
membranous glomerulonephritis (nephrotic)

dsDNA ab and ANA

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21
Q

Scleroderma / systemic sclerosis

A

scleroderma (morphea or linear), internal organ fibrosis and microvascular abnormalities

swelling hands and feet
raynauds
ischaemic ulceration distil digits 
GI: heartburn, reflux, dysphagia
interstitial lung disease

causes: autoimmune so ANA positive

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22
Q

causes of AVN

A

mechanical blockage by rigid RBCs in sickle cell anaemia
vascular supply disruption due to trauma
mechanical stress
CORTICOSTEROIDS

23
Q

sign of AVN on Xray

A

crescent sign - due to subchondral radiolucency

24
Q

Kenbock’s disease

A

AN, fragmentation and collapse of lunate bone in wrist

25
Q

Fracture healing

A

inflammation, repair, remodelling

Haematoma and inflammation: clot, swelling and inflammation

Soft callus:
Formation of granulation tissue - procallus
Fibroblasts start to secrete collagen fibres
Chondrocytes begin to produce fibrocartilage (T2)

Hard callus:
Osteoblasts produce woven bone

Remodelling:
Osteoclasts remodel into compact and trabecular bone

26
Q

Risk factors for osteoporosis

A 
SHATTERED
steroids
hyperthyroidism/hyper parathyroidism
Alcohol 
Thin 
Testosterone low 
Early menopause
Renal failure 
Erosive/inflam bone disease eg. RA
Dietary calcium/malabsorption synd
27
Q

Reasons to do DEXA

A

Low trauma fracture
In women over 65 with one or more RF for OP
Prior to LT steroid therapy

28
Q

Bisphosphonates

A

eg. alendrotnic acid

bind to hydroxyapatite binding site which inhibits the ability of the osteoclast to bind

29
Q

Raloxifene

A

oestrogen receptor modulator

enhances inhibitory effects of oestrogen on rank L less OC activated

30
Q

Strontium ranelate

A

increase OC decrease OB

31
Q

Denosumab

A

MAB to rank L

prevent rank L binding to rank

32
Q

Features of OA

A

pain and creps on movement, background ache at rest
decreased range of movement
morning stiffness
asymmetrical, large joints

hands: DIP and PIP joints (distal)
LOSS xray

33
Q

causes septic arthritis and ABX, investigation

A

staph aureus
neisseria gonorrhoea
haemophilus influenzae

joint aspiration for culture
flucloxacillin and gentamicin

34
Q

causes reactive arthritis and triad

A

chlamydia, salmonella, shigella

post food posioning 1-4 week

TRIAD: arthritis, uveitis, urerithritis

ethensitis

affects sacroiliac joint

acute asymmetrical, joint red, stiff swollen and painful

35
Q

features of RA

A

symmetrical, deforming peripheral polyarthritis

HLA DR4

36
Q

Endocrine asoc of pseudo gout

A

hyperparathyroidism and haemochromatosis

37
Q

Features of cauda equina syndrom

A 
bilateral sciatica 
reduced anal tone 
focal neurological deficit 
bladder and bowel dysfunction 
saddle anasthesia
38
Q

Posriatic arthritis

A

asoc with onycholysis
erosion of DIP joints, pencil in cup
dactylitis and sacroilitis

39
Q

Ankylosing spondylitis

A

LBP that improves with exercise and not relieved at rest
HLAB27
sacroiliac joint

40
Q

3x DMARDs in RA

A

methotrexate (oral ulcers, GI upset)
sulfasalazine (decreased sperm count)
hydroxychloroquine

41
Q

Genetic predisposition to RA

A

HLA DR4

42
Q

SLE Autoantibodies

A

ANA and dsDNA

43
Q

Systemic sclerosis

A

ANA

44
Q

Autoantibody in RA

A

RF and anti CCP

45
Q

Autoantibodies in Sjogrens syndrome

A

anti 60kd Ro and La

46
Q

Methotrexate mechanism and SE

A

Dihydrofolate reductase inhibitor

SE: pulmonary fibrosis, cirrhosis, pancytopenia

47
Q

RA XRay

A

Loss of joint space
Periarticular erosion
Juxta articular osteoporosis
Subluxation

48
Q

Rituximab mechanism

A

Targets CD20 on B cells

49
Q

4 psoriasis nail changes

A

pitting, yellowing, onycholysis and hyperkeratosis

50
Q

Xray features pseudogout

A

chrondrocalcinosis

51
Q

Pseudogout RF

A

Haemochromatosis, hyperparathyroid, acromegaly

Weekly positive rhomboid shaped crystals

52
Q

XRay features of ankylosing spondylitis

A

SYndesmophytes (ossification of outer fibres of annulus fibrosis)

Sacroilitis
Squaring of vertebrae
Bamboo spine

Apical fibrosis on CXR

53
Q

Tendons in DeQuervain’s

A

EPB and APL

extensor pollicus brevis

abductor pollicus longus

MSK (1 decks)

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