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MSK Flashcards

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1
Q

commonest cause of SA

A

staph aureus

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2
Q

staph aureus morphology

A

gram +ve cocci

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3
Q

treatment for SA

A

IV benzylpenecillin and flucloxacillin

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4
Q

what are contraindications to joint aspiration?

A

overlying infection or psoriatic plaques

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5
Q

what should joint aspiration be sent for

A

MS+C
gram stain
leukocyte count

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6
Q

what other condition is polymyalgia rheumatica commonly associated with

A

GCA

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7
Q

scalp tenderness, jaw claudication, painless visual loss

A

GCA

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8
Q

bloods in GCA

A

ESR raised
normocytic normochromic anaemia
LFT- low albumin, high ALP, high GGT

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9
Q

Definitive diagnostic test for GCA

A

temporal artery biopsy

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10
Q

treatment for GCA

A

60-100mg prednisolone OD/ in divided doses reduce once symptoms resolve. may need long term low dose to prevent recurrence

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11
Q

features of spinal cord compression

A

Spastic paraparesis / tetraparesis
Radicular pain at the level of the compression
Sensory loss below the level of the compression

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12
Q

cause of spinal cord compression

A

degenerative disc lesions- herniated disc
degerative vertebral lesions- OP
TB
epidural abscess
malignancy- mets (prostatae, thyroid) myeloma, menningioma, neurofibroma
epidural haemorrhage
Paget’s

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13
Q

nodes on distal interphalangeal joints

A

Heberdens

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14
Q

nodes on proximal interphalangeal joints

A

Bouchards

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15
Q

RFs for osteoarthritis

A 
genes
previous trauma
obesity
occupation
(note osteoporosis reduces risk)
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16
Q

Xray changes OA

A
  1. joint space narrowing
  2. osteophyte formation
  3. Subchondral cysts
  4. subarticular sclerosis
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17
Q

OA more in DIP/ PIP

A

PIP

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18
Q

common osteoporosis fractures

A

vertebral crush
femoral neck
colles

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19
Q

secondary causes of osteoporosis (ie not due to increased osteoclast activity)

A

endocrine
malabsorption
malignancy

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20
Q

3 RFs for osteoporosis

A

post menopause
glucocorticoid use
CKD/ CLD
low BMI

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21
Q

What is a T score

A

bone density score
>1 normal
-1 to -2.5 osteopenia
-2.5 osteoporosis

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22
Q

How often should DEXA be done if diagnosis of osteoporosis?

A

2 yearly (yearly if on steroids)

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23
Q

SEs of bisphosphonates

A

ostenecrosis of jaw

oesophagitis

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24
Q

advice for taking bisphosphonates

A

To be taken first thing in the morning, on an empty stomach
Not to eat for 30 minutes afterwards
To remain sitting upright or standing for 2 hours after taking

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25
pink/red nodules on elbow that have a rubbery texture
rheumatoid nodules
26
fingers become hyperextended at the PIP, and flexed at the DIP
swan neck deformity
27
hand signs seen in RA
``` Swan neck subluxation of MCP Z thumb guttering carpal tunnel ulnar deviation fixed flexion deformity ```
28
dry eyes and dry mouth in RA
sjrogens
29
pulmonary fibrosis in RA upper or lower?
All connective tissue diseases cause lower lobe fibrosis – except AS, which causes upper lobe fibrosis All occupational diseases cause upper lobe fibrosis, except asbestosis, which causes lower lobe fibrosis
30
systemic signs of RA
CVS- anaemia, vasulitis/ raynauds, pericarditis, CVD resp- diffuse pulm fibrosis, lung nodules GI nervous- episcleritis/ scleritis/ uveitis, peripheral neuropathy other- depression, lymphadenopathy
31
how many joints involved for diagnosis of RA
>3
32
how long symptoms for diagnosis of RA
>6 weeks
33
serology in RA
RF, anti-CCP | may be ANA +ve
34
Xray changes in RA
bony erosions, osteopenia
35
methotexate is in which class of drugs?
DMARD- anti-folate drug
36
SEs of methotrexate
GI upset, liver problems, teratogenic, myelosuppression, rash dont take with alcohol
37
pain and morning stiffness in shoulders/ pelvic girdle
polymyalgia rheumatica
38
which drugs should be avoided in PMR
NSAIDs
39
calcium pyrophosphate rhomboid crystals
pseudogout
40
negatively birefringent needle shaped crystals
gout
41
which drugs increase risk of gout
thiazides
42
what skin changes are seen in chronic poorly controlled gout
tophi
43
how does allopurinol work
xanthene oxidase inhibitor
44
respiratory tract infection-> palpable purpura on buttocks, GI tenderness, athritis and glomerulonephritis-> haematuria
HSP
45
small vessel vasculitis
HSP churg strauss Wegener's granulomatosis
46
Medium vessel vasculitis
polyarteritis nodosa | Kawasaki
47
large vessel vasculitis
GCA
48
symptoms of small vasculitis
purpura urticaria glomerulonephritis splinter haemorrhage
49
symptoms of medium vasculitis
ulcers cutaneous nodules digital gangrene microaneurysms
50
symptoms of large vasculitis
``` limb claudication assymetric BP absence of pulses bruit aortic dilatation ```
51
vasculitis asthma pANCA
Churg-Strauss
52
vasculitis | renal failure/ glomerulonephritis cANCA
Wegener's granulomatosis
53
mechanical back pain
worse on movement, relieved by rest, systemically well. history of heavy lifting
54
acute vs chronic mechanical back pain
acute <4 weeks | chronic >12 weeks
55
nerve roots contributing to sciatic nerve
L4-S3
56
Most commonly affected disc in sciatica
L5/S1 compressing S1 nerve root
57
how might sciatica present
S1 nerve root – will cause symptoms from the buttocks to the foot, and particularly on the lateral side of the foot. There will be calf weakness, and altered ankle reflexes.
58
patient supine, feels pain when leg at 30-70 degrees
sciatic stretch test
59
how many prolapsed discs self resolve
90% if lasting >12 weeks need MRI
60
What surgical procedure can be used for chronic prolapsed discs
microdiscectomy
61
what is the most common cause of cauda equina
massive disc herniation needs MRI and surgical decompression.
62
less common causes of nerve root compression (other than disc herniation)
``` Neoplasm Skeletal disorders – e.g. spondylosis, RA, Paget’s Disease Infection – e.g. TB or abscess Trauma Vascular disease – e.g. haemorrhage ```

Year 5 (12 decks)

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