MSK - ortho Flashcards

1
Q

Systemic manifestations of RA?
What can you see on bloods?

A

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

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2
Q

Felty’s syndrome (SANTA mnuemonic?) complication of RA

A

Splenomegaly, anaemia, neutropenia, thrombocytopenia, arthritis (rheumatoid)

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3
Q

Numbness on left side of chin? nerve affected? (punched side of chin)

A

Mental nerve (chin and lip)
comes down level of mandibular 2nd premolars

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4
Q

<17YO morbilliform rash salmon pink, swinging fever, leukocytosis, anaemia, hepatosplenomegaly. followed by arthirits?
risk of this ?

A

Still’s disease - systemic JIA
Macrophage activation syndrome (DIC, anaemia, LOW ESR)

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5
Q

Ank spond disease profile? (modified NY criteria?)
extra articular manifestations?
score to determine effectiveness of drug therapy and functionality?

A

<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)

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6
Q

Synovial fluid - needle shaped, negatively bifringent

A

Gout

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7
Q

Pseudogout synovial fluid?

A

positive bifringeent, rhomboid shaped. calcium pyrophosphate

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8
Q

osteoporosis assessment?

Indications for DEXA scan? scores mean?

what predisposes to 2ndary OP?

A

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

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9
Q

Central chord syndrome?

A

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

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10
Q

Anterior chord syndrome

A

hyperflexion injury of spine/ anterior spinal A ischaemia
B/L loss of pain, temp/ motor below injury. intact proprioception and vibration

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11
Q

Sciatica causes?

A

slipped disc (most common), spondylolisthesis, spinal stenosis, infection, cancer. pain better leaning forward

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12
Q

Limited cutaneous systemic sclerosis / CREST syndrome?

A

ANTI Scl70 (diffuse), anti-centromere (limited), ANA, barium swallow - dysphagia, calcified nodules, raynauds, esophageal dysmotility, sclerodactyl, telangactasia

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13
Q

Otawa knee rules?

A

for XR: medial malleolus/ lateal pain on palpation and 6 cm below, cant W/B, 55+, unable to flex 90 degrees,

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14
Q

Adults: CT head rules? within 1 hr?
within 8 hrs?

A

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

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15
Q

Child CT rules within 1 hr?

A

<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

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16
Q

When to avoid colchicine?

A

Blood disorders, EFGR <10, renal impariment, pregnant/ breastfeeding, hepatic impairment, with clarithromycin/ erythromycin/ verapamil, ketokonazole,

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17
Q

Colles fracture?

A

dorsally displaced distal radius fracture, dinnerfork deformity

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18
Q

20YO black woman, oral ulcer, facial rash, painful joints.Posiitve ANA?

A

Anti ds-dna/ anti sm/ anti phospholipid antibodies.
SLE. mild normochromic normocytic anaemia. reduced C3 and C4
Risk of premature atheroscrelorsis

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19
Q

high heels wearing, pain electric current between 2nd and 3rd toes?

A

Morton’s neuroma (irritation of interdigital nerve due to metatarsal head compression). can elicit a click on metatarsal head squeeze

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20
Q

30YO japanese man, iritis, oral and genital ulcers, pain in knee joints, erythema nodosum on both shins

A

behcet’s disease. multisystem vasculitis. also: neuro SX, need cS. behavioural changes in 50%pethargy reaction (rash worse after needle)

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21
Q

14YO girl chronic pain and stiff in left foot following injury

A

Freiberg’s disease - osteochondrosis articular surfaces of 2nd or 3rd toes.

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22
Q

Barton’s fracture

A

intra-articular fracture of distal radius

23
Q

Bennets and rolando fracture?

A

intra-articular fracture of base of 1st metacarpal.
2 parts - bennets. needs thumb spica cast
3 parts - fist fight/ forced thumb abduction. needs ORIF

24
Q

Mallet finger

A

sudden flextion of DIP of finger. cant extend finger at DIP due to damage to extensor mechanism. tX - keep splint in slight extension for 6 weeks. heals

25
Q

Sulfasalazine SE?

A

pneumonitis/ oligospermia/ rashes/ heinz body anaemia,

26
Q

As of ank spond?

A

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)

27
Q

Drug that causes Exacerbation of myasthenia gravis

A

Penicillamine

28
Q

SLE features

A

discoid rash, malar rash, oral ulcers nose ulcers, arthritis, renal/ proteinuria/haemolytic anaemia, anti ds dna, c3/c4 decreased
Risks: premature asthersclerosis

29
Q

pain in heel, worse on tip toes

A

plantar fasciitis

30
Q

pain using shoulder in overhead activities, positiv epainful arc at 90 to 120, grinding, popping, snapping
painful arc positive in first 60 degrees?

A

subacromial impingement

first 60 degrees movement- supraspinatus tear

31
Q

pain, numbness in little and ring ginger, worse leaning on elbow?

A

cubital tunnel syndrome (ulnar nerve compression

32
Q

dorsum foot sens loss, weak big toe dorsiflextion and foot, reflexes normal, positive sciatic stretch

A

L5 nerve root compression

33
Q

Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

A

L4 nerve root compression

34
Q

Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

A

L3 nerve root compression

35
Q

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

A

S1 nerve root compression

36
Q

Hip shorted IR, adducted?

A

posterior hip dislocation

37
Q

Hip ER, not shorted, abducted?

A

anterior hip dislocation

38
Q

back pain worse in the morning and on standing. pain is worse on extension of the back

A

facetjoint

39
Q

Unilateral or bilateral leg pain/ backpain, numbness, and weakness which is worse on walking. ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down

A

spinal stenosis

40
Q

myxoid cyst?

A

benign ganglion cyst distal dorsal finger with OA, middle aged women

41
Q

erb’s

A

c5, c6, waiter’s tip upper part of brachial plexus. arm is IR and elbow extended. shoulder dystocia

42
Q

Klumpbke’s palsy?

A

lower brachial plexus, C8, t1. AF horner’s syndrome. CX: birth/ sudden upward jerking of hand

43
Q

triceps reflex

A

radial nerve, (c7)

44
Q

ulna # with proximal radio-ulnar dislocation?

A

monteggia. FOOSH forced pronation

45
Q

radial shaft # with dislocation of distal radioulnar joint, prominent ulna head

A

galeazzi. fOOSH with rotational injury

46
Q

weight bearing at 20 degrees of knee flexion, positive if pain on twisting knee

A

thassaly’s test for meniscal tear

47
Q

pain over radial styloid on forced abduction/ flextion of thumb?

A

finkelstein positive test for De quervain;s tenosynovitis

48
Q

cx of dupytren’s?

A

manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand

49
Q

ulnar-sided hand pain and swelling following a punch injury. XR shows?

A

5th metacarpal minimally displaced # (boxer)

50
Q

Burning thigh pain, man, worse standing, better sitting. recreate sx by deep palpating below ASIS. normal sensation, no weakness?

A

meralgia parasthetica - laterl femoral cutaneous nerve.
positive pelvic compression test. do USS guided LA injection

51
Q

ankle sprain caused by excessive inversion injuy?

A

aterior talofibular ligament (always tear first)

52
Q

Peripheral vasc disease vs spinal canal stenosis?

A

PVD - quicker recovery, skin changes, vasc rf
canal stenosis - lower to reciver, may need to sit, worse going down hill and better leaning forwards. wmay have neurp sx/ back pain

53
Q

child hip pain with flattening of femoral head, reduced joint spac. pain over few weeks

A

4-8 YO AVN of hip. perthe’s disease

54
Q

15 YO child with knee/ distal thigh pain and loss of internal rotation of leg in flextion

A

slipped upper femoral epiphysis