MSK and Rheumatology Flashcards
(243 cards)
1
Q
Define hemiarthroplasty
A
replacing half of the joint (e.g., the head of the femur in the hip joint)
2
Q
What is the role of the C5 myotome?
A
Shoulder abduction
3
Q
What is the role of the C6 myotome?
A
Elbow flexion
Wrist extension
4
Q
What is the role of the C7 myotome?
A
Elbow extension
5
Q
What is the role of the C8 myotome?
A
Flexion of fingers
6
Q
What is the role of the T1 myotome?
A
Finger abduction
7
Q
What is the role of the L2 myotome?
A
Hip flexion
8
Q
What is the role of the L3/4 myotomes?
A
Knee extension
9
Q
What is the role of the L4 myotome?
A
Ankle dorsiflexion
10
Q
What is the role of the L5 myotome?
A
Big toe extension
11
Q
What is the role of the S1 myotome?
A
Ankle plantar flexion
12
Q
Where is the most common site for cervical disc prolapse?
A
C5/6
13
Q
at which level is the phrenic nerve and what is the consequence of damage to this nerve?
A
C3-5
Damage = loss of respiratory function
14
Q
What is caudal equina?
A
Compression of sacral nerve roots
15
Q
What can cause caudal equina?
A
disc prolapse, tumours, trauma, spinal stenosis, infection
16
Q
How is cauda equina managed?
A
MRI and surgery within 48 hours
17
Q
How does spinal claudication present?
A
Bilateral sensory dysesthesia +/- weakness
18
Q
What makes spinal claudication worse?
A
Walking down hills
19
Q
What causes brown-sequard syndrome?
A
Heme-section of the spinal cord
20
Q
How does brown-sequard syndrome present?
A
paralysis on the affected side (corticospinal)
loss of proprioception and fine discrimination (dorsal columns) on the affected side
loss of pain and temperature on the opposite side below the lesion (spinothalamic)
21
Q
How does central cord syndrome present?
A
disproportionate impairment of the upper limb motor function compared to the lower limbs
22
Q
What causes central cord syndrome?
A
arthritic changes in the neck compressing the cord
23
Q
What causes anterior cord syndrome?
A
ischaemia to the anterior spinal artery
24
Q
How does anterior cord syndrome present?
A
like brown squard except Fine touch and proprioception are preserved
25
What is spinal stenosis?
Narrowing of the spinal cord causing compression of spinal cord or nerve roots
26
How does spinal stenosis present?
Claudication-like feeling in buttock and leg
Bending forward improves symptoms
27
What is the pathophysiology behind dupuytren's contracture?
palmar aponeurosis becomes thickened and contracted, pulling the fingers into a flexed state
28
What conditions is Dupuytren’s Disease associated with?
* Diabetes
* Alcohol
* Tobacco
* HIV
* Epilepsy
29
What factors are associated with worse outcomes in those with Dupuytren’s Disease?
Family hx
Early or bilateral disease
30
How is Dupuytren’s Disease managed?
Surgically- cut the aponeurosis
31
What causes trigger finger?
Swelling on tendon catches on pulley
32
What tendons are involved in De Quervain’s Syndrome?
- Abductor pollicis longus (APL) tendon
- Extensor pollicis brevis (EPB) tendon
33
What causes De Quervain’s Syndrome?
Overuse causes the extensor reticulatum to swells causing pain in the tendon running up the thumb
34
What clinical sign is indicative of De Quervain’s Syndrome?
Extension of thumb against resistance will cause pain
35
How is De Quervain’s Syndrome managed?
Splints, steroid injections and surgical decompression of reticulatum
36
Name 3 of the clinical findings you may see when examining the hands of a patient with osteoarthritis
- Heberden’s nodes
- Bouchard’s nodes
- Squaring at base of thumb
37
In osteoarthritis, how is squaring of the base of the thumb managed?
Trapeziectomy
38
What are the x-ray features associated with osteoarthritis?
L-loss of joint space
O-osteophytes
S-Subchondral sclerosis (increased density of bone along the joint line)
S- Subchondral cysts (fluid filled cavities in the bone)
39
When would osteoarthritis be a clinical diagnosis?
>45 years old
typical arthritic pain
and
no morning stiffness lasting >30 minutes
40
Which nerve roots cause erb's palsy?
C5, 6
41
What causes erb's palsy?
Downward traction (e.g. forceps)
42
What is erb's palsy otherwise known as due to the way it presents?
Waiter's tip
43
What nerve root is damaged in Klumpke's palsy?
T1
44
What causes Klumpke's palsy?
Upward traction (e.g. swinging from a tree)
45
Which nerve is damaged when there is parasthesia of the regimental badge area?
Axillary nerve
46
What is the most common cause of axillary nerve injury?
damage to the surgical neck of humerus
47
Which nerve is damaged in 'Saturday night palsy'?
Radial nerve
48
How does Saturday night palsy present?
Loss of sensation and wrist extension
49
Which nerve is compressed in carpal tunnel syndrome (give the nerve root for extra points!)
Median nerve
C5-T1
50
What is cubital tunnel?
Compression of the ulnar nerve at the cubital tunnel (the space between the medial epicondyle and the olecranon)
51
What does cubital tunnel syndrome cause?
Numbness on the ulnar aspect of hand and arm
52
Which nerve (+ the roots!) is damaged in patients with pain/burning/tingling on the anteriolateral aspect of thigh
Anterior cutaneous nerve of the thigh (L2/3)
53
What are the nerve roots for the sciatic nerve?
L3-4
54
What is bilateral sciatica a red flag for?
Caudal equina
55
How is sciatica managed
Amitriptyline or duloxetine
56
What nerve (+roots!) causes foot drop
Common peroneal nerve L4-S2
57
What type of injury causes damage to the meniscus of the knee?
Twisting
58
What characteristic 'symptoms' indicate a meniscal injury
Knee locking or giving way
59
What is the best imaging modality to visualise the meniscus of the knee?
MRI
60
How is a meniscal injury of the knee managed?
RICE, NSAIDs, physio, surgical options if exhausted everything else
61
What is the function of the anterior cruciate ligament?
stops the tibia from sliding forward in relation to the femur.
62
What is the function of the posterior cruciate ligament?
Stops the tibia sliding backwards in relation to the femur.
63
How can cruciate injuries be differentiated from meniscal injuries on knee examination?
Cruciate injury causes knee instability
64
What is osgood-schlatter disease?
Inflammation and avulsion fractures of tibial tuberosity where patellar tendon insert
65
How is osgood-schlatter disease managed?
Supportive management
66
Prescription of which antibiotic is associates with achilles tendon rupture
fluoroquinolone antibiotics (-floxacin)
67
What is the inheritance pattern os Ehler's Danlos?
Autosomal dominant
68
What is the most common form of ehler's danlos syndrome?
Hypermobile
69
Other than hypermobile, what other types of ehler's danlos are there?
vascular (fragile blood vessels prone to rupture)
kyphoscoliotic (poor muscle tone)
70
Which scoring system is used to assess Ehler's Danlos?
Beighton score
71
What are gout crystals made from and how do they look under microscopy?
Monosodium urate (from purine breakdown)
Needle shaped, negatively bifringent (negative needles)
72
What are pseudogout crystals made from and how do they look under microscopy?
Calcium pyrophosphate dihydrate
Rhomboid shaped, positively bifringent (pseudo positive)
73
How is gout managed 1st line?
NSAIDS
74
What medication should be used to treat an acute attack of gout if NSAIDs are not tolerated?
Colcechine
75
What medication is given to prevent gout?
Allopurinol
76
When should allopurinol be started for a patient with gout?
after 1st attack has settled
77
What should be prescribed alongside allopurinol when it is given for the first time?
colcechine for the first 6 months of allopurinol treatment as ‘cover’
78
What lifestyle modifications can help prevent gout?
Avoid alcohol, dehydration, red meat and being fat
79
What is the common x-ray finding in patients with pseudo gout?
chondrocalcinosis
80
How is pseudo gout managed?
NSAIDs, colcechine and steroids
81
What is the most common cause of osteomyelitis?
Staph aureus
82
How long should antibiotic therapy be taken for in patients with acute osteomyelitis?
4-6 weeks
83
What is the antibiotic of choice for a patient with an s. aureus osteomyelitis?
Flucloxacillin
84
Which antibiotic is used to treat chronic osteomyelitis?
Gent
85
What is the most common bacterial cause of septic arthritis in a patient with
A) Their own joint
B) An artificial joint
A) Own joint = S. Aureus
B) Artificial joint = S. Epidermis
86
How is septic arthritis managed?
Surgical drainage & lavage + 3-4 weeks of antibiotics.
87
How can osteoarthritis be managed?
- Paracetamol and NSAIDs
- Intra-articular joint injections
- Joint replacement
88
What is osteosarcoma?
Bone cancer
89
What is chondrosarcoma?
Cancer of the cartilage
90
Which demographic is most commonly affected by Ewing's sarcoma?
Children and young adults
91
How does Ewing's sarcoma look on x-ray?
Onion skin appearance
92
Name the tool used to assess a patient's risk of fragility fracture in the next 10 years
FRAX tool
93
What is a 'complete' fracture
Bone is completely severed
94
What is a 'greenstick' fracture?
Snapped but not completely disconnected
95
What is a 'buckle' fracture?
Longitudinal compression
96
What is a 'plastic' bone deformity?
Bone is bent not broken
97
What is a physeal fracture?
A fracture involving the growth plate
98
How are physeal fractures graded?
Salter-Harris
99
What is the most common part of the clavicle to fracture?
Middle 1/3rd
100
What does a Colle's fracture look like?
Dinner fork deformity
101
Which nerve is commonly injured in patients with a colle's fracture?
Median
102
What mechanism of injury most commonly causes a colle's fracture?
FOOSH
103
What is the biggest risk for a patient with a scaphoid fracture
Avascular necrosis
104
Discuss the imaging requirements in scaphoid fractures
Re-xray 2 weeks after injury if initial x-ray normal
105
What is the common mechanism of action resulting in a scaphoid fracture?
FOOSH
106
What is a Bennet's fracture?
Intra-articular fracture at the base of the first metacarpal
107
What is the common mechanism of injury causing a Bennet's fracture?
Boxing or FOOSH
108
How is a Bennet's fracture managed?
Unstable fracture- will require reduction +/- wires / screw fixation and a cast
109
What is Gamekeeper's thumb?
rupture of ulnar collateral ligament of the thumb
110
How does gamekeeper's thumb present?
pain on the radial border of the thumb with a weak pinch grip and a history of injury
111
How is gamekeeper's thumb managed?
cast +/- surgical repair
112
How are intra-capsular hip fractures classified?
Garden Criteria
113
How would you fix:
A) Non-displaced intra-capsular hip fracture
B) Displaced intra-capsular hip fracture
A) Internal fixation
B) Hemiarthroplasty if previously poor mobility, total hip replacement if mobile
114
How would you fix:
A) intertrochanteric extra-capsular hip fracture
B) sub-trochanteric extra-capsular hip fracture
A) Dynamic hip screw
B) Intramedullary nail
115
How are fractures of the lateral malleolus classified?
Weber's classification
Type A- below the ankle joint
Type B- At the level of the ankle joint
Type C- Above the ankle joint
116
What is the most common direction for a shoulder to dislocate?
Anterior
117
What is a posterior shoulder dislocation associated with?
electric shocks and siezures.
118
Name the two different types of reduction which can be used for an anterior shoulder dislocation
Hippocratic and Kocher reduction
119
What is the significant clinical sign associated with subacromial impingement?
painful arc when raising arm (joint injection, physio and decompressive surgery)
120
What are the three stages in the disease progression of frozen shoulder?
Freezing, frozen and thawing (1 year total time)
121
How is frozen shoulder managed?
Self limiting
Physio
Hydrodilation can be tried
122
Is golfers elbow medial or lateral?
Medial
123
Is tennis elbow medial or lateral?
Lateral
124
What causes tennis/golfers elbow?
Inflammation where tendons insert into epicondyles of elbow.
125
What is Paget's disease?
Increased bone reabsorption followed by increased bone formation
126
How does Paget's disease present?
Old man, Hearing loss (unilateral deafness!!), bone pain and bowing of long bones
127
What would you see on blood tests that indicates Paget's disease?
Isolated rise in ALP
128
How is symptomatic Paget's / Paget's with skull involvement managed?
IV bisphosphonates
129
What is Ricketts?
Vitamin D deficiency in a child
130
What is osteomalacia?
Vitamin D deficiency in an adult
131
What lab test can be used to identify vitamin D deficiency?
serum 25-hydroxyvitamin D (<25 nmol/l = deficiency)
132
How does ricketts present?
stunted growth and abnormal bone shape
133
How does osteomalacia present?
bone pain, increased fracture risk and muscle weakness
134
What is given to treat rickett's/osteomalacia?
calcium and colecalciferol (vitamin D)
135
What is osteogenesis imperfecta?
Genetic disorder of collagen
136
How does osteogenesis imperfecta present?
Blue sclera & hearing loss along with fractures
137
What medication is given to prevent fractures in patients with osteogenesis imperfecta?
IV Bisphosphonates
138
What is osteopetrosis?
Defective osteoclasts- bones grow abnormally and become too dense. They then are brittle and fracture easily
139
What is osteoporosis?
Low bone mass and deterioration of structural bone tissues
140
Which patient's should get a DEXA scan?
FRAX score >10%
Low impact mechanism of injury
Young person with unexpected fractures
141
What is a t score in a DEXA?
T score = bone mass compared to a healthy young adult (T for Teenager). Measured at femoral neck.
142
What is a Z score in a DEXA?
compared to an adult of the patient’s age, sex and ethnicity
143
What DExA score is
A) Normal
B) Osteopenic
C) Osteoporotic
A) >1
B) 1 to -2.5
C) <-2.5
144
What is developmental dysplasia of the hip?
Ball and socket" joint of the hip does not properly form in babies and young children
145
What are the risk factors for developmental dysplasia of the hip?
* First born
* Breech
* Female
* Oligohydramnios
* High birth weight
146
How is developmental dysplasia of the hip clinically assessed?
Barlow’s and ortalanis
147
What is the gold standard test for diagnosing developmental dysplasia of the hip?
Ultrasound
148
How is developmental dysplasia of the hip managed?
Pavlik Harness
149
What is Perthe's disease?
Avascular necrosis of femoral head
150
What are the risk factors associated with Perthe's disease?
Male of primary school age
Coagulation issues
repetitive minor trauma
familial history
151
How does Perthe's disease present?
Short stature and a limp
152
How is Perthe's disease staged?
Waldestrom staging
1. Sclerosis and increased joint space
2. Fragmentation of the epiphysis
3. Reossification (new bone begins to appear around the fragments
4. Reformation of the humeral head
153
How is Perthe's disease managed?
Splints & physio
Osteotomy may be useful in some children >7 years old
154
What is Slipped Upper Femoral Epiphysis?
Femoral head slips off the neck of the bone at the epiphysis (growth plate) in a backward direction.
155
What is the classic demographic of a patient with Slipped Upper Femoral Epiphysis?
Overweight boy around 13
156
How does Slipped Upper Femoral Epiphysis present?
Groin pain persisting for >3 months
Shortened and internally rotated leg
157
How is Slipped Upper Femoral Epiphysis managed?
Hips will need to be pinned to prevent slippage after reduction
158
How does transient synovitis present?
- Limping child mainly well
- Hx of viral infection
- Apyrexic, low CRP and WCC
159
What is the triad of clinical findings in non-accidental injury?
retinal haemorrhage
subdural haemorrhage
encephalopathy
160
What are the requirements for juvenile idiopathic arthritis to be diagnosed?
Patient must be <16 and have suffered symptoms for >6 weeks
161
How is idiopathic juvenile arthritis managed?
NSAIDs and biologics (methotrexate, anti-TNF)
162
How does juvenile idiopathic arthritis present?
Localised growth failures may occur causing things like leg length discrepancies, shortening of the fingers, hands, forearms toes and feet and issues with jaw growth (micrognathia)
Can cause blindness so eye screen is essential
163
What is STILLs disease?
Body wide inflammation
164
How does STILLs disease present?
salmon-red eruption rash on trunk and thighs
Abdominal pain, splenomegaly, hepatitis, serotitis and pericarditis
165
What is Pauciarticular (oligioarticular) arthritis?
- <4 joints involved
- Most common
166
What condition is Pauciarticular (oligioarticular) arthritis associated with?
Anterior uveitis
167
what is Polyarticular arthritis?
Can be Rheumatoid factor negative or positive
Affects >5 joints
Affects large and small joints in a symmetrical fashion
168
What is Polymyalgia Rheumatica?
inflammatory condition of the elderly which causes muscle pain and stiffness in the neck, shoulders and pelvic girdle.
169
What condition is Polymyalgia Rheumatica strongly associated with?
Temporal arteritis
170
What lab test is helpful when diagnosing polymyaglia rheumatica?
ESR (>45)
171
How is polymyalgia rheumatica managed?
steroids (pred)- there will be a dramatic response
172
What is the gene associated with rheumatoid arthritis?
HLA-DR4
173
What is the pathophysiology behind rheumatoid arthritis?
Autoimmune inflammation of the synovial membrane causes thickening and the production of RANKL factor which activates osteoclasts
174
What physical findings might you see in the hands of a patient with rheumatoid arthritis
Z-shaped thumb deformity
swan neck deformity
Boutonniere deformity
ulnar deviation of fingers at MCP
175
Which joints are most commonly affected in rheumatoid arthritis?
MCP and PIP joints
176
List the x-ray findings you might see in a patient with rheumatoid arthritis
* Peri-articular osteopenia
* Boney erosions
* Soft tissue swelling
* Joint destruction and deformity
177
Which rheumatoid arthritis patients are eligible for biological therapy?
Disease activity score (DAS28) > 4.5 = eligible for biologic therapy
178
Which drug is most commonly used in rheumatoid arthritis?
Methotrexate
179
What is SLE?
Autoimmune attack of cells
180
What is the most common complication of SLE?
Cardiovascular disease
181
What are the most common autoantibodies associated with SLE?
ANA
Anti-ds DNA
182
What is given to patients with anti-phospholipid syndrome? (not pregnant and pregnant)
Not pregnant = Warfarin (INR target 2-3)
Pregnant = LMWH and aspirin
183
What skin rash is antiphospholipid syndrome associated with?
Livedo Reticularis (purple lace like rash)
184
What skin rash is SLE associated with?
Malar rash
185
how is SLE managed?
NSAIDs & hydroxychloroquine first line
DMARDs and biologics for severe disease
186
How does discoid lupus erythematous present?
Circular, round, flaky lesions on face, neck and ears
Scarring alopecia and hyper or hypo pigmentation
187
What is localised scleroderma?
fibrosis of the skin and subcutaneous fat
188
What autoantibody is associated with localised scleroderma?
ANA
189
How does limited cutaneous systemic sclerosis present?
CREST
calcinosis, Raynaud’s, oesophageal dysmotility, sclerodactyly, TelangiectasiaH
190
What test can be used to differentiate sclerotic and idiopathic Raynaud’s?
Nailfold capilloscopy
191
What is raynauds treated with?
Nifedipine
192
Which autoantibodies is CREST syndrome associated with?
ANA and Anti-centromere
193
Is CREST syndrome fast or slow progressing?
Slow
194
How is CREST syndrome managed?
DMARDs and Steroids
195
Which autoantibodies are associated with Diffuse cutaneous systemic sclerosis?
ANA
Anti-Scl70
196
How does Diffuse cutaneous systemic sclerosis present?
CREST + Internal organ fibrosis
197
How is Diffuse cutaneous systemic sclerosis managed?
DMARDs and Steroids
198
What is Sjogrens syndrome and how does it present?
Autoimmune destruction of exocrine salivary and tear ducts causing oral, ocular and vaginal dryness.
199
What autoantibodies are associated with Sjogren's?
Anti-Ro or Anti-La
200
How can you test for Sjorgren's?
Schirmer’s test - <10mm of moisture diffusion = significant
201
How is Sjrogren's managed?
artificial lubricants and saliva.
Pilocarpine stimulates tears and saliva.
202
What is the difference between polymyositis and dermatomyositis
Both associated with muscle weakness, dermatomyositis also has a skin rash (Gottron's papule and Heliotrope rash)
203
What antibody is associated with polymyositis?
Anti-jo
204
What autoantibody is associated with dermatomyositis?
Anti-jo & Anti-Mi-2
205
What blood result will be significantly elevated in autoimmune myositis (polymyositis and dermatomyositis)?
CK
206
What is the gold standard for diagnosing Autoimmune myositis?
Muscle biopsy
207
How is autoimmune myositis managed?
Steroids
208
name the small vessel vasculitisis
Henloch-Schönlein Purpura
Microscopic Polyangiitis
Granulomatosis with Polyangiitis (Wegner’s)
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)
209
What are the key features of Henloch-Schönlein Purpura?
Affects children
IgA deposits in blood vessels cause rash and nephritis
210
What are the key features of microscopic polyangitis?
p-ANCA
Glomerulonephritis causes renal failure
Diffuse alveolar haemorrhage
211
What are the key features of Granulomatosis with Polyangiitis (Wegner’s)
c-ANCA
Nasal and respiratory symptoms
Saddle shaped nose due to bridge collapse
Glomerulonephritis
212
What are the key features of Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)?
p-ANCA
Eosinophils
Affects lungs and skin
Late onset asthma
Sinusitis and rhinitis
213
Name the vasculitis-is affecting medium sized vessels
Polyarteritis Nodosum
Kawasaki disease
214
What are the key features of Polyarteritis Nodosum?
Often occurs secondary to Hep B
Renal impairment
Hypertension
Cardiovascular events
Tender skin nodules
215
What are the key features of Kawasaki disease?
High fever
Widespread rash
Bilateral conjunctivitis
Strawberry tongue
Coronary artery aneurisms
216
What is the most important complication of Kawasaki disease?
Coronary artery aneurisms
217
Name the two large vessel vasculitis-is
Giant cell arteritis
Takayasu’s arteritis
218
What are the key features of giant cell arteritis?
Raised ESR
Unilateral headache
Scalp tenderness
Vision loss
219
What is the gold standard diagnostic modality for giant cell arteritis?
Temporal artery biopsy is gold standard – remember lesions can skip so a normal biopsy is not definitive
220
What sign might you see on ultrasound in a patient with giant cell arteritis?
Halo sign
221
How is giant cell arteritis managed?
Aspirin and IV immunoglobulins
222
What are the key features of Takayasu’s arteritis?
Aortic arch affected
Pulseless disease
223
What is Behçet’s Disease?
Recurrent oral and genital ulcers caused by inflammation of blood vessels and tissues
224
What gene is associated with Behçet’s Disease?
HLA-B51
225
What test is used to diagnose Behçet’s Disease/
Pathery test
226
how is Behçet’s Disease managed?
Steroids and colchicine
227
Name the 3 seronegative arthropathies and the gene they are all associated with
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
HLA-B27
228
What does "seronegative" mean?
negative rheumatoid factor
229
What is ankylosing spondylitis?
Inflammation of axial skeleton
230
How does ankylosing spondylitis present?
Morning pain & stiffness improving with exercise
231
ankylosing spondylitis can cause fibrosis in other body systems. What are the 5 A's associated with ankylosing spondylitis?
* A- Anterior uveitis
* A- Aortic regurgitation
* A- Atrioventricular block
* A- Apical lung fibrosis
* A- Anaemia of chronic disease
232
What might you see on the X-ray of a patient with Ankylosing spondylitis?
Syndesmophites, bamboo spine, subchondral erosions and sclerosis
233
How is Ankylosing spondylitis managed?
NSAIDs and Anti-TNF
234
What joints are affected in psoriatic arthritis?
DIP joints and axial skeleton
235
What other associated symptoms might you see in a patient with psoriatic arthritis?
Nail changes
uveitis and IBD
236
What is the classic X-ray finding in psoriatic arthritis?
Pencil in cup deformity
237
How is psoriatic arthritis managed?
NSAIDs, Steroids & DMARDs
238
Name the causes of reactive arthritis
Chlamydia
dysentery caused by salmonella, shigella or campylobacter
239
How does reactive arthritis present?
Can’t see, pee or climb a tree (anterior uveitis/conjunctivitis, urethritis and arthritis)
240
What condition must you test for in a patient with reactive arthritis?
HIV
241
How is reactive arthritis managed?
Joint aspiration, treat underlying cause, steroids
242
How is Kawasaki disease treated?
High dose aspirin
243
