MSK Flashcards
(139 cards)
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
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
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
4
Q
What indicators are there of Oesteoathritis on joint X-rays?
A
LOSS Loss of joint space Osteophytes Subchondral cysts Subchondral sclerosis
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
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
7
Q
Apart from Pseudo/Gout, what else can a joint aspiration be used for?
A
Gram stain and culture for septic arthritis
8
Q
What antibodies are used for rheumatoid arthritis?
A
Rheumatoid factor Anti-CCP (more sensitive)
9
Q
What might Anti-ds DNA suggest?
A
SLE
10
Q
What anti-bodies indicate sjogrens disease?
A
Anti- LA Anti- Ro Also present in SLE
11
Q
What auto-antibodies work in polymyositis dermatomyostitis?
A
Anti-Jo1 Anti-Mi2
12
Q
What does anti Scl-70 indicate?
A
Systemic sclerosis
13
Q
What ANCA is present in Granulomatosis and polyangitis?
A
c-ANCA
14
Q
What ANCA is present in Churg-Strause?
A
This is Eosinophilic granulomatosis and polyangitis. p-ANCA is present
15
Q
What is the True positive rate (Sensitivity)?
A
TP/(TP+FN) - ability of a test to rule in or detect the disease
16
Q
What is the True negative rate (specificity)?
A
TN/(TN+FP) - ability of a test to rule out or exclude the disease
17
Q
What should be considered when giving steroids?
A
PPI Vit D Biphosphonates
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
19
Q
What DMARDs are there?
A
Aziothioprine Methotrexate Sulfalazine Hydrochloroquine Leflonomide
20
Q
What is the definition of a pathological fracture?
A
A fracture in abnormal bone (metabolic, metastatic, infected, osteopenic or osteomalacia)
21
Q
What principles are there for management of a fracture?
A
Reduce - approximate anatomically the broken tissues Immobilise - Casts, surgical stabilisation Rehabilitate - physio
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
23
Q
What local factors can cause a delay in bone union?
A
diet, DM, smoking (big time), HIV and medication (corticosteroids and NSAIDS)
24
Q
What nerve palsy is associated with a Midshaft of the humerus fracture?
A
Radial nerve
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
Differentials of hip pain in a child
Septic ArthritisPerches diseaseTransient synovitisSlipped upper femoral epiphysisDevelopmental dysplasia of the hip JIACancerFracture Referred pain from knee, back, testes
88
Transient synovitis
Boys aged 4-8Limp with or without pain Self limitingOccurs after URTItreat with ibuprofenResolves after few daysSepsis safeguard!
89
Slipped upper femoral epiphysis
Boys over age of 10Usually obese or hypothyroidSudden onset painNon weight bearing Limp
90
Developmental dysplasia of the hip
Girls, usually discovered at birth Change in leg length
91
Perthes disease
Boys aged 4-8 Avascular necrosis of head of femur Can be bilateral
92
Hip pain in child- Nocturnal pain, night sweats, weight loss
Think ALL!
93
Treatment of osteoarthritis
Patient educationWeight lossExercisePhysioAnalgesia- WHO ladderCan escalate to steroid joint injectionsJoint replacement
94
X-ray changes in osteoarthritis
Loss of joint spaceOsteophytesSubchondral cystsSubchondral sclerosis
95
Osteoarthritis examination findings
Heberdens nodes on DIPBouchards nodes on PIPBoxing of hand
96
Rheumatoid Arthritis X-ray findings
LESSloss of joint spaceErosionsSoft tissue swelling Soft bones (osteopenia)
97
Rheumatoid arthritis clinical examination findings
Ulnar deviation of fingersSubluxation of jointsZ thumbBoggy joint swellingsSwan neck deformitiesBoutinierres deformity Can have nail changes
98
Negatively birefringent needles under polarised light
Gout - urate crystals
99
Treatment of gout
Ibuprofen or colchicine if ibuprofen contraindicatedFebuxostat also used Allopurinol if repeated attacks (be aware of increase in episodes in first 6 months)
100
Risk factors for gout
High urate intake- red meats, marmite, alcohol Diuretic use especially thiazides Metabolic disorders (genetics)Dehydration
101
Pseudogout
Calcium pyrophosphate crystalsWeakly positive rhomboid shaped crystals Treatment- ibuprofen, steroid injections, stay hydrated
102
Describe a fracture
Simple vs comminuted Transverse, oblique, spiralSiteDisplaced or notAngulated or notIs the bone normal?Ask for lateral view
103
Treatment of intra capsular neck of femur fracture
Hemiarthroplasty if not very active and co morbiditiesFull hip replacement if active and healthy or pre existing joint disease
104
Presentation of hip fracture
Pain especially on greater trochanter and on rotation Usually after fallLeg externally rotated Shortened leg Non weight bearing Could be referred to knee
105
Treatment of extra capsular NOF fracture
Dynamic hip screw or intramedullary fixation Think about bone protection, analgesia, IV access
106
Secondary causes of OA in young people
Crystal deposition, acromegaly, haemochromatosis, Wilson’s disease, joint injury, surgery, SUFE, diabetes, syphillis, inflammatory arthritis
107
Hot swollen painful joint
Septic arthritis until proven otherwise!GoutRheumatoid arthritis PseudogoutPsoriatic arthritisHaemoarhrosisReactive arthritis
108
Symptoms of septic arthritis
Hot painful swollen jointSystemically unwellFeversAcute onset
109
Diagnosis of septic arthritis
Joint aspirate and culture!!
110
Treatment of septic arthritis
AnalgesiaBroad spec antibiotics eg ceftriaxoneUsually a stall aureus infection Look for underlying risks such as immunosuppression
111
Back pain In 15-30 YOA
Prolapsed discTraumaFracturesAnkylosing spondylitis
112
Back pain in 30-50 YOA
Degenerative spinal disease, prolapsed disc, malignancy
113
Back pain in over 50s
Degenerative, osteoporotic vertebral collapse, pagets, malignancy, myeloma, spinal stenosis
114
Positive straight leg raise
SciaticaUnder 50s due to prolapsed discOver 50 due to spinal stenosis
115
Symptoms of lupus
Malar rashDiscoid rashPhotosensitivity Oral ulcersArthritisPleuritisRenal involvementHaematological involvementImmune involvementPositive ANA
116
SLE antibodies
ANA \>95% Anti dsDNA- over 60%
117
Treatment for SLE
Anti inflammatories eg ibuprofenCorticosteroids during flare upImmunosuppressionSymptom control- suncream, kidney treatment if necessary
118
Positive c-ANCA
Small vessel vasculitisMicroscopic polyangitisGPA
119
GPA- granulomatosis polyangitis
Positive c ANCANasal crusting, lung lesions, saddle nose deformities
120
P ANCA
Church StraussEosinophilia granulomatosis polyangitis EGPALinked with asthma
121
Medium vessel vasculitis
Kawasaki- symptoms in children, fever, strawberry tongue, rash
122
Giant cell arteritis
Temporal arteritisGive prednisone ASAP Need biopsy within seven days of starting pred to get positive biopsy.Increase ESR!!Jaw claudicationTemporal tendernessHeadache around eye
123
Takayasu’s arteritis
Absent pulsesHappens in younger PeoplePET scan shows activityPred and strong DMARDS eg cyclophosphamide
124
Polyarteritis nodosa
Associated with hep BGet aneurysms Control BP as affects kidneys
125
Symptoms of fibromyalgia
Pain in at least 11 of the 18 pain points- above and below waist, either side of axis and on spineDifficulty sleepingChronic widespread pain lasting over three months
126
Risk factors of fibromyalgia
Low education, low income, female, FH, traumatic event
127
Treatment for fibromyalgia
Exercise!Screen for depression and anxiety Sleep hygiene
128
Reactive arthritis
After GU or GI infectionReiter’s anterior uveitis, arthritis, urethritis
129
Ankylosing spondylitis
Back pain In young malesHLAB27 positive in 90%Pain in sacroiliac joints
130
Associations with ankylosing spondylitis
Aortic regurgitation Apical fibrosisigA nephropathyAnterior uveitisAchilles tendinitisAmyloidosis
131
Treatment of ankylosing spondylitis
1. Exercise2. Ibuprofen3. If necessary anti TNF-a or local steroid injections
132
Symptoms of rheumatoid arthritis
Boggy swelling in handsStiffness and pain worse in morningSymmetrical usually in wrists, MCP, PIPPositive for RF and anti CCP
133
Monitor rheumatoid arthritis
DAS28 helps to monitor disease activity
134
side effects of methotrexate
Mucositis, penumonitis, oral ulcers, hepatotoxicity
135
TNF alpha blocker side effects
Serious infection risk including reactivation of TB, hep BWorsens heart failureHypersensitivityInjection site reaction
136
Anti Ro and Anti La
Sjogrens
137
CREST
Anti centromere antibodies
138
Anti SCL 70
Scleroderma
139
Anti ds DNA and ANA
SLE
