MSK - ortho Flashcards
Systemic manifestations of RA?
What can you see on bloods?
Eyes- sojrens, scleritis
sKin - nails, felty’s (leg ulcers)
Nodules - vocal chords, eyes,
Neuro - mononeuritis multiplex, polyneuropathy
Resp - PF, obliterative bronchiolitis
CVD - vascultiis, myocardial fibrosis,
kidneys - amyliodosis
Liver - ALT/AST raised, ALP raised
OP, depression, thryoid, splenomegaly
Bloods - RF, raised ferritin, leukopenia, reactive thrombocytopenia, anaemia
Felty’s syndrome (SANTA mnuemonic?) complication of RA
Splenomegaly, anaemia, neutropenia, thrombocytopenia, arthritis (rheumatoid)
Numbness on left side of chin? nerve affected? (punched side of chin)
Mental nerve (chin and lip)
comes down level of mandibular 2nd premolars
<17YO morbilliform rash salmon pink, swinging fever, leukocytosis, anaemia, hepatosplenomegaly. followed by arthirits?
risk of this ?
Still’s disease - systemic JIA
Macrophage activation syndrome (DIC, anaemia, LOW ESR)
Ank spond disease profile? (modified NY criteria?)
extra articular manifestations?
score to determine effectiveness of drug therapy and functionality?
<15 - 25 YO back pain 3m+, limited ROM lumbar spine, limited chest expansion for sex and age. sacroilitis.
EA SX: OP, renal amyloid, acute anterior uvitis, restrictive lung disease, cauda equina, aortic lung insufficiency
scores: BASDAI (disease activity index) and BASFI (functionality index)
Synovial fluid - needle shaped, negatively bifringent
Gout
Pseudogout synovial fluid?
positive bifringeent, rhomboid shaped. calcium pyrophosphate
osteoporosis assessment?
Indications for DEXA scan? scores mean?
what predisposes to 2ndary OP?
FRAX if Rf present/ 50YO+- if 10%+, do DEXA
DO DEXA without FRAX if <40 and has 1 major RF/ 50+ and known #
RF: previous #, CS 7.5mg OD 3 months, falls, BMI<18, FH hip #, alcohol 14 units+, post menopausal women with FH of hip fracture, XR with osteopenia/ vertebral collapse, oestrogen deficiency (premature ovarian failure)
T score -1–2.5 osteopenia, <-2.5 OP, # severe OP
2ndary OP: malabsorption, antiepileptics, RA, PTH hig, TFTs, CKD, cushing’s, immobile
TX: ca 1g/day, vit D 400-800
Central chord syndrome?
upper extremities - motor impairment more than lower
bladder dysfunction/ urine retention.
most common type of incomplete spinal syndrome, cervical spondylisis/ OA of neck/ hyperextension injury
Anterior chord syndrome
hyperflexion injury of spine/ anterior spinal A ischaemia
B/L loss of pain, temp/ motor below injury. intact proprioception and vibration
Sciatica causes?
slipped disc (most common), spondylolisthesis, spinal stenosis, infection, cancer. pain better leaning forward
Limited cutaneous systemic sclerosis / CREST syndrome?
ANTI Scl70 (diffuse), anti-centromere (limited), ANA, barium swallow - dysphagia, calcified nodules, raynauds, esophageal dysmotility, sclerodactyl, telangactasia
Otawa knee rules?
for XR: medial malleolus/ lateal pain on palpation and 6 cm below, cant W/B, 55+, unable to flex 90 degrees,
Adults: CT head rules? within 1 hr?
within 8 hrs?
GCS<13 at r/v / <12 2 hrs after accident.open/ depressed skull fracture, basal skull fracture signs, siezure, 1x vomit, neurolgoy,
within 8 hrs if: on warfarin/ 65+/ beleding/ clotting disorders/ 30min+ retrograde amnesia/ dangerous mechanism
Child CT rules within 1 hr?
<1YO with bruise/ swelling 5cm+ on head. skull fracture/ depressed. GCS<15 immediastely or 2 hrs after injury.
head injury+ LOC 5min/ vomit x3, amnesia 5min+, dangerous mechanism. if onyl 1 RF, then observe for 4 hrs, cT if further drowsiness/ vomitting/ GCS drop
When to avoid colchicine?
Blood disorders, EFGR <10, renal impariment, pregnant/ breastfeeding, hepatic impairment, with clarithromycin/ erythromycin/ verapamil, ketokonazole,
Colles fracture?
dorsally displaced distal radius fracture, dinnerfork deformity
20YO black woman, oral ulcer, facial rash, painful joints.Posiitve ANA?
Anti ds-dna/ anti sm/ anti phospholipid antibodies.
SLE. mild normochromic normocytic anaemia. reduced C3 and C4
Risk of premature atheroscrelorsis
high heels wearing, pain electric current between 2nd and 3rd toes?
Morton’s neuroma (irritation of interdigital nerve due to metatarsal head compression). can elicit a click on metatarsal head squeeze
30YO japanese man, iritis, oral and genital ulcers, pain in knee joints, erythema nodosum on both shins
behcet’s disease. multisystem vasculitis. also: neuro SX, need cS. behavioural changes in 50%pethargy reaction (rash worse after needle)
14YO girl chronic pain and stiff in left foot following injury
Freiberg’s disease - osteochondrosis articular surfaces of 2nd or 3rd toes.