MSK and trauma Flashcards
(89 cards)
1
Q
XR features in septic arthritis
A
- may be normal initially or show only soft tissue swelling
- later features - bone destruction, subluxation, narrowing of spaces, erosive changes
- wide spaces suggests effusion
2
Q
Kocher criteria for septic arthritis
A
- temp >38.5
- increased ERSR
- increased WCC
- non-weight bearing
3
Q
antibiotic usually given in septic arthritis
A
flucloxacillin, clindamycin if allergic
given 6-12 weeks
4
Q
which arteries are inflamed in GCA
A
posterior ciliary arteries
5
Q
why can GCA cause visual disturbances
A
secondary to anterior ischaemic optic neuropathy
6
Q
when to consider Takayusu’s in GCA
A
if <55
7
Q
investigations for GCA
A
- ESR >50
- temporal artery biopsy (skip lesions?)
8
Q
retinal appearance in GCA
A
- pale papilloedema
- ischaemic disc is pale, waxy, elevated
- splinter haemorrhages
9
Q
at which level is a prolapsed disc most common
A
L4-5 or L5-S1
10
Q
what to consider as a differential for spinal cord compression
A
if on steroids - may have caused some proximal myopathy
will have a normal neurological exam other than some wasting/maybe reduced hip flexion which is symmetrical
11
Q
neurological signs of spinal cord compression depending on level of lesion
A
- lesions above L1 = UMN signs in legs
- lesions below L1 = LMN signs in legs and perianal numbness
12
Q
analgesia to use in osteoarthritis
A
- topical NSAIDs + paracetamol
- if ineffective - oral NSAIDs + PPI
13
Q
most common sites of fragility fractures
A
- vertebrae
- hip (proximal femur)
- wrist (distal radius)
14
Q
risk assessment to do in those on oral steroids over 3 months
A
FRAX tool for osteoporosis
15
Q
first line bisphosphonate to use in osteoporosis
A
alendronate
review after 5 years (3 years for zolendronic acid)
16
Q
drug to use for osteoporosis in severe osteoporosis in postmenopausal women and men at high risk of fracture
A
strontium ranelate - increases MI risk
17
Q
what is palindromic RA
A
relapsing/remitting mono arthritis of different large joints
18
Q
what is a poor prognostic factor in RA
A
positive rheumatoid factor (positive in 70% but can also be raised in Sjogren’s Felty’s SLE etc)
19
Q
more specific antibody in RA
A
anti-CCP antibodies
20
Q
FBC findings in RA
A
normocytic, normochromic anaemia and reactive thrombocytosis
ESR and CRP may be increased
21
Q
DMARDs to use in RA
A
- monotherapy +/- short course prednisolone
- give methotrexate, or sulfasalazine, hydroxychloroquine, leflunomide
22
Q
when to give TNF inhibitors in RA
A
if inadequate response to at least 2 DMARDs including methotrexate
E.g:
- etanercept
- adalimumab
- infliximab
23
Q
condition associated with GCA
A
polymyalgia rheumatica
24
Q
bloods results in PMR
A
- ESR >40
- raised CRP
- ALP raised in 30%
- CK and EMG NORMAL
25
histology in PMR
- vasculitis with giant cells
- skip lesions
- muscle bed arteries most affected
26
dose of prednisolone to give in PMR
15mg/d PO
reduce dose slowly
most need for >2 years (remember GI and bone protection)
27
2nd line drugs for PMR after prednisolone
- methotrexate
| - tocilizumab
28
drugs which can precipitate gout
diuretics
| cytotoxic
29
what is Lesch Nyhan syndrome
X-linked recessive disorder causing gout, renal failure, neurological deficits
30
joint aspirate in gout
negatively birefringent crystals
31
drugs to give in acute gout attack
NSAIDs + colchicine
if contraindicated - prednisolone 15mg/day
32
what to give for gout remission if allopurinol contraindicated
febuxostat
aim for serum uric acid <300
33
risk factors for pseudogout
- hyperparathyroidism
- hypothyroidism
- haemochromatosis
- acromegaly
- low magnesium, low phosphate
- Wilson's disease
34
joint aspirate in pseudogout
positively birefringent rhomboid shaped crystals
35
XR finding in pseudogout
chonedrocalcinosis
36
investigation to diagnose spinal stenosis
MRI
37
what does a straight leg raise test for
lumbar root irritation
38
genes associated with ankylosing spondylitis and reactive arthritis
HLA-B27 (only positive in 10%)
seronegative
39
XR changes in ankylosing spondylitis
- normal in early disease
- sacroiliitis: subchondral erosions, sclerosis
- squaring of lumbar vertebrae
- bamboo spine (late)
- syndesmophytes - due to ossification of outer fibres of annulus fibrosis
40
what might spirometry show in ankylosing spondylitis
restrictive defect due to:
- pulmonary fibrosis
- kyphosis
- ankylosis of costovertebral joints
41
6 As of ankylosing spondylitis
- apical fibrosis (CXR)
- anterior uveitis
- aortic regurgitation
- achilles tendonitis
- AV node block
- amyloidosis
42
first line drugs for ankylosing spondylitis
NSAIDs
43
when to use DMARDs in ankylosing spondylitis
only if peripheral joint involvement
44
can't see, pee or climb a tree
reactive arthritis - urethritis, conjunctivitis, arthritis
asymmetrical oligoarthritis of lower limbs
45
usual organism causing reactive arthritis
chlamydia (do PCR) - develops within 4 weeks of initial infection
46
2 fractures commonly causing compartment syndrome
- supracondylar
| - tibial shaft fractures
47
why may arterial pulsation still be felt in compartment syndrome
necrosis occurs due to microvascular compromise
48
investigations for compartment syndrome
measurement of intra-compartmental pressure:
- >20mmHg abnormal
- >40mmHg diagnostic
49
why can renal failure occur after fasciotomy
myoglobinuria - need aggressive IV fluids
50
what can cause chronic compartment syndrome
young athletes - excessive training
51
ligaments involved in high ankle sprain
tibia and fibula syndesmosis (what binds them together)
52
ligaments involved in low ankle sprain
lateral collateral ligaments
53
most common ligament affected in low ankle sprain
inversion injury causing tear of ATFL
54
what is Hopkin's squeeze test
pain when tibia and fibula squeezed together at mid-calf
shows a high ankle sprain
55
management of low ankle sprain
RICE
| crutches etc.
56
management of high ankle sprain
non-weight bearing orthosis
if widening of tibiofibular joint (diastasis) then operative fixation needed
57
how does Colles' fracture occur
FOOSH - dinner fork deformity
distal radius fracture with dorsal displacement of fragments
58
nerve which can be damaged in Colles' fracture
median or ulnar nerve
may experience acute carpal tunnel syndrome
59
what is a Smith's fracture
reverse Colles' - anterior displacement of distal fragments - garden spade deformity
60
type of hip fracture at risk of avascular necrosis
intracapsular
61
what is broken in hip fractures
Shenton's line
62
classification of hip fractures I-IV
I = stable fracture with impaction in valgus, inferior cortex intact
II = complete fracture but undisplaced
II = displaced
IV = complete bony disruption
63
management of intracapsular hip fractures
surgery within 24 hours
- undisplayed = internal fixation with screws, hemiarthroplasty if unfit
- displaced = young and fit then reduction and internal fixation, if older and reduced mobility then hemiarthroplasty/total hip replacement
64
management of extra capsular hip fractures
- dynamic hip screw
| - if reverse oblique, transverse or subtrochanteric: intramedullary device
65
cerebral perfusion pressure equation
CPP = MAP - ICP
66
why can increased ICP result in ipsilateral pupillary dilatation
increased ICP = herniation of temporal lobe through tentorial hiatus = compresses oculomotor nerve
67
what is Battle's sign
bruising over mastoid process - sign of basal skull fracture but takes several days to appear
68
what NOT to use in a basal skull fracture
nasopharyngeal airway
69
when to do an immediate CT scan after head injury
```
o GCS <13 initial assessment
o GCS <15 2 hours post injury
o Suspected open/depressed skull fracture o Any sign basal skull fracture
o Post traumatic seizure
o Focal neurological deficit
o >1 episode vomiting
```
70
when to do a CT scan within 8 hours after head injury
if some LOC/amnesia and ANY of:
- 65+
- history bleeding/clotting problems
- dangerous mechanism of injury - fall >1m, pedestrian struck by car etc.
- >30 min retrograde amnesia of events immediately before injury
if on warfarin
71
score 1-4 in Eye on GCS
Eye opening:
- spontaneous = 4
- to speech = 3
- to pain = 2
- none = 1
72
score 1-5 in verbal on GCS
Verbal response:
- orientated = 5
- confused = 4
- inappropriate words = 3
- sounds = 2
- none = 1
73
score 1-6 in motor on GCS
Best motor response:
- obeys commands = 6
- localises to pain = 5
- normal flexion = 4
- abnormal flexion = 3
- extension = 2
- none = 1
74
what is the trauma triad of death
hypothermia
coagulopathy
acidosis
75
ATOM FC for major thoracic injury
Airway obstruction
Tension pneumothorax
Open chest wound
Massive haemothorax
```
Flail chest (2+ ribs broken in 2+ places)
Cardiac tamponade
```
76
type of shoulder dislocation associated with seizures
posterior dislocation (limited external rotation)
but rare type of dislocation
77
triad of symptoms in reactive arthritis
urethritis
conjunctivitis
arthritis
78
investigation results in reactive arthritis
- ESR and CRP raised
| - HLA-B27 positive in majority of those affected
79
why do PCR in reactive arthritis
to test for chlamydia (because reactive arthritis is usually caused by chlamydia)
80
management of reactive arthritis
- analgesia, NSAIDs, intra-articular steroids if unresponsive to NSAIDs
- antibiotics to treat causative organism
- sulfasalazine and methotrexate if persistent disease
81
extra-articular manifestations of seronegative arthritis
- uveitis
- pulmonary fibrosis (upper zone)
- amyloidosis
- aortic regurgitation
82
examples of seronegative arthritis
- ankylosing spondylitis
- psoriatic arthritis
- Reiter's syndrome (reactive arthritis)
- enteropathic arthritis (associated with IBD)
- JIA (rare)
83
causes of osteomalacia
- vitamin D deficiency
- renal failure
- drugs
- liver disease
84
what does XR show in osteomalacia
translucent bands
85
sclerotic bone tumour - likely primary?
prostate
86
lytic bone tumour - likely primary?
breast, myeloma
87
treatment of lupus nephritis, vasculitis and cerebral lupus
cyclophosphamide
88
lung problems associated with scleroderma
ILD
| pulmonary artery HTN
89
CK levels in myositis
>1000
