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Year 4 Medicine Manchester > MSK > Flashcards

MSK Flashcards

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1
Q

What indicators are there of an inflammatory condition?

A
  • Morning stiffnes > 30 mins - Pain after rest - Systemic symptoms - Night time pain - Acute/ subacute presentation
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2
Q

What indicators are there of a non-inflammatory condition?

A
  • Pain towards end of day - Pain better at night - Long standing/ chronic nature
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3
Q

What steps are there in interpretation of a joint X-ray?

A

Details Site Type of fracture - transverse, oblique, spiral Simple of Comminute Displaced Angulated Consistency of bone

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4
Q

What indicators are there of Oesteoathritis on joint X-rays?

A

LOSS Loss of joint space Osteophytes Subchondral cysts Subchondral sclerosis

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5
Q

What would a joint aspiration show if a patient had gout?

A
  • needle like, negatively bifringent in polar light crystals of monosodium urate
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6
Q

What would a joint aspiration show if a patient had pseudogout?

A

Rhomboid and parallelogram shaped crystals which are positvely bifringent to polarised light and made of calcium pyrophosphate crystals

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7
Q

Apart from Pseudo/Gout, what else can a joint aspiration be used for?

A

Gram stain and culture for septic arthritis

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8
Q

What antibodies are used for rheumatoid arthritis?

A

Rheumatoid factor Anti-CCP (more sensitive)

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9
Q

What might Anti-ds DNA suggest?

A

SLE

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10
Q

What anti-bodies indicate sjogrens disease?

A

Anti- LA Anti- Ro Also present in SLE

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11
Q

What auto-antibodies work in polymyositis dermatomyostitis?

A

Anti-Jo1 Anti-Mi2

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12
Q

What does anti Scl-70 indicate?

A

Systemic sclerosis

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13
Q

What ANCA is present in Granulomatosis and polyangitis?

A

c-ANCA

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14
Q

What ANCA is present in Churg-Strause?

A

This is Eosinophilic granulomatosis and polyangitis. p-ANCA is present

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15
Q

What is the True positive rate (Sensitivity)?

A

TP/(TP+FN) - ability of a test to rule in or detect the disease

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16
Q

What is the True negative rate (specificity)?

A

TN/(TN+FP) - ability of a test to rule out or exclude the disease

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17
Q

What should be considered when giving steroids?

A

PPI Vit D Biphosphonates

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18
Q

What side effects are there to steroids?

A

• Myopathy – muscle wasting • Osteonecrosis • HPA axis dysunction • DM, fluid retention, lipogenesis • Gastric ulcer • Hirtuism • Skin thinning • Catarcts • Increased cardiovascular risk

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19
Q

What DMARDs are there?

A

Aziothioprine Methotrexate Sulfalazine Hydrochloroquine Leflonomide

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20
Q

What is the definition of a pathological fracture?

A

A fracture in abnormal bone (metabolic, metastatic, infected, osteopenic or osteomalacia)

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21
Q

What principles are there for management of a fracture?

A

Reduce - approximate anatomically the broken tissues Immobilise - Casts, surgical stabilisation Rehabilitate - physio

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22
Q

What systemic factors can cause a delay in bone union?

A

poor blood supply like that of scaphoid, distal tibia, stability and infection

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23
Q

What local factors can cause a delay in bone union?

A

diet, DM, smoking (big time), HIV and medication (corticosteroids and NSAIDS)

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24
Q

What nerve palsy is associated with a Midshaft of the humerus fracture?

A

Radial nerve

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25
What nerve palsy is associated with a Fibular neck fracture?
Common peroneal fracture
26
What nerve palsy is associated with a Supracondylar humeral fracture?
Median nerve
27
What nerve palsy is associated with a shoulder dislocation?
Axillary nerve - deltoid, teres minor and some of the triceps
28
What nerve palsy is associated with a Hip disclocation?
Sciatic nerve
29
What is the definition of osteoporosis?
Bone mineral density that lies 2.5 SD away from average for a normal person when accounting for age, race and sex
30
What investigation might be considered for rheumatoid arthritis?
- Base line bloods – FBC, LFT, U&E - Inflammatory markers - TFTs - Immunology -RF, anti-CCP, ANCA - X-ray hands and feet
31
What is the NICE criterial for referral for rheumatoid arthritis?
- Persistant synovitis - Urgent o Small joints of hand and feet are effected o More than one joint is effected o Delay of \>3m between onset of symptoms and seeking medical advice
32
What conservative treatment is there for osteoarthritis?
o Patient education o Weight loss o Exercise and physiotherapy
33
What medical treatment is there fore oesteoathritis?
Analgesia - according to WHO Inter-articular steroid injections
34
What DD are there for a swollen joint?
- Septic arthritis - Gout - Pseudogout - Haemarthrosis - Psoriatic arthritis - Reactive arthritis
35
What RF are there for gout?
- Male - Alcohol intake - High purine intake – steak, oily fish and marmite - Diuretics - Overweight - Metabolic syndrome – DM, HTN ‘
36
What condition should be excluded before a diagnosis of gout can be made?
Septic arthritis
37
What is the management of acute gout?
1. Analgesia - NSAIDS 2. Cholchicine - within 12 hours 3. Steroids
38
When should allopurinol be started?
o \>2 attacks o Trophi identified (urate deposites) o CKD stage II o Urolithiasis
39
What is are the common side effects to allopurinol?
 Hypersensitivity  Rash  Increased risk of acute gout attack in first 6m of treatment
40
What is an alternative to allupurinol?
Febuxostat
41
Long term management of patient who has suffered from attacks of gout?
Lifestyle - decrease alcohol, decrease diet of fish oil, marmite. Medical - start urate lowering drug like allupurinol
42
When should a urate lowering therapy like allopurinol be started after an attack of gout?
Start 2-4 weeks post acute attack
43
What steps are needed to interpretate a joint XRAY?
- Details - Site - Type of fracture - Simple or communicated - Displaced - Angulated - Bone consistency
44
What is communicated fracture?
break or splinter into more than two fragments
45
In a patient controlled analgesia what is lockout time?
That after patient give themselves more analgesia another dose will not be given for a give amount of time.
46
Patient has pain in calf after surgery which is resistant to analgesia. MLD?
Compartment syndrome
47
How is compartment syndrome managed?
- position limb below level of the heart. - Release dressing - Emergency fasciotomy
48
What factors might slow a fracture from healing
smoking arterial supply - 5metacarpal, scaphoid DM Meds -steroids, NSAIDS diet smoking
49
What is nerve is at risk with a hip dislocation?
sciatic
50
What is nerve is at risk with a shoulder dislocation?
axillary
51
What is nerve is at risk with a supracondylar fracture of the humerus?
Median nerve
52
What is nerve is at risk with a fibular fracture?
Common perineal nerve
53
What is nerve is at risk with a mid shaft fracture of the humerus?
radial nerve
54
What is the definition of the osteoporosis?
BMD of 2.5 sd below the normal for a young person of a comparable rase and sex
55
What is a highly sensitive clinical test to diagnose compartment syndrome?
Pain on passive stretch
56
What management of servers open lower limb fractures?
- IV abs stat - Restore vascular compromise within 6 hours - wound irrigation and decried meant IN THEARTRE
57
What questions would help rule in or out osteogenesis imperfects from a family history?
FH of: - fractures - blue sclera - deafness
58
Child falls with arms out stretched and a fracture occurs. What is the most likely fracture?
Supracondylar fracture elbow fracture
59
What does an anterior fat pad on elbow X-ray suggest?
Elbow effusion, look for fracture.
60
What is the anterior humeral line in the context of a elbow fracture?
the anterior cortex of the humeral bone should intersect the middle 1/3 of the capitellum head of the humerus. If not look for fracture. If posterior displaced consider supracondylar fracture.
61
What is a common wrist fracture for osteoprortic adults?
Colles wrist fracture. distal radius is bent backwards
62
Who commonly get buckle fractures?
Children - quick recovery in splint of around 3-4 weeks
63
What to include in a ROS for rheumatology?
Start from head to toe Skin - Rashes, raynauds Hair loss Dry eyes or mouth SoB Bowel and urinary Discharge
64
What is felty's syndrome?
Anaemia Lecaepenia Enlarged spleen
65
What criteria is used to diagnose RA?
2010 ACR/EULAR RA classification criteria
66
How is RA activity monitored?
DAS 28 Acute phase protein - CPR or ESR
67
What articular features are there of RA
Carpal tunnel syndrome Peulmomary effusion Episcleritis Felty's anaemia Osteoporosis Sicca syndrome
68
What joint are typically associated with RA\> OA?
RA affects MCP and PIP OA affects DIP
69
A patient has is diagnosed with high activity of RA. What is the recommended treatment?
combination DMARD methotrexate and HCI
70
What Red conditions should be ruled out with a limping child?
Acute lymphoblastic leukaemia Septic arthritis Osteomyelitis of femur plevis NAI
71
What symptoms indicate ALL?
Nocturnal pain Night sweats Weight loss
72
What movement would a patient with septic arthritis have pain most in?
There would be pain on internal rotation. The patient/ child would be abducted
73
What should also be examined in addition to a hip joint examination when there is hip pain?
Abdomen Hernia orifices Testicles Knee
74
7 yo male with acute onset limp +/- pain and ROM. Patient is well. MLD?
Transient synovitis - ACUTE onset. Though admittedly did admit cold 2w ago. common in \<10
75
7 yo male with a gradual onset limp +/- pain. Patient is well. MDL?
Perthes disease - GRADUAL onset. common in \< 10. Common in males
76
Male 10-15 yo with cute hip pain. MLD?
Slipped epiphyseal femoral epiphyses. Pain can refer to knee.
77
RF for SUFE?
Hypothyroidism Overweight
78
What screening is there fore DDH?
Look for symmetry- leg length, skin folds Otolani test Barlow test
79
What investigations are done for DDH?
USS or iff to old hip radiograph
80
What is Otlani test?
Abdunction leading to Anterior dislocation Think Otlani = Out
81
What is Barlows test?
Adduction leading to posterior dislocation
82
When should juvenile idiopathic arthritis be suspected?
Arthritis in \<16 yo who has 4 or more joints affected for \> 3m
83
What is diagnosis from the XRAY?
Bilateral - Perthes disease
84
What is diagnosis from the XRAY?
Left SUFE
85
What woudl be done for a febrile child with limp who is non-weightbearing im GP land?
Urgent refferal to peadiatric or orthopeadics
86
What is the history of a patient with Osgoods Schlatters disease?
Patient 10-15 which is more common in males. Pain worse on exerecise leads to inflammation of epiphiseal plate on patella tendon insertion on to tibial plate. o/e Exagerated tibial tuberasity which in tender. Pian worse on hip flexion.
87
Eosinophilic GPA is related to which renal condition?
Crescenting glomerulonepthritis - this can either be nophrotic or nephritic
88
What anti-asthma drug exacerbates eGPA?
Montelukast
89
What is induction therapy for eGPA?
Steroids and cylcophosphemide
90
Any Rheum thing what is the diagnostic criteria...
as oer ACR - american college of rhuematology
91
What radiographic sign is shown and what is its significant
Broken Shentons line on left hip This indicates a DDH or a NOF#
92

Year 4 Medicine Manchester (20 decks)

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