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MSK & RHEUM Flashcards

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1
Q

ANKYLOSING SPONDYLITIS
What is the treatment for ankylosing spondylitis?

A

1st line
- regular exercise regimes
- NSAIDs
- corticosteroid injections
- DMARD (if NSAIDs not tolerated/ineffective) = ADALINUMAB, ETANERCEPT or INFLIXIMAB

2nd line
- surgery

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2
Q

PSORIATIC ARTHRITIS
What investigations might you do in someone you suspect to have psoriatic arthritis?

A

X-ray

- Erosion in DIPJ + periarticular new-bone formation  - Osteolysis  - Pencil-in-cup deformity

Bloods

  • ESR + CRP - normal or raised
  • Rheumatoid factor -ve
  • anti-CCP - negative

Joint aspiration - no bacteria or crystals

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3
Q

PSORIATIC ARTHRITIS
How do you treat psoriatic arthritis?

A

MILD DISEASE
- NSAIDS + physiotherapy
- intra-articular steroids

PROGRESSIVE DISEASE
- DMARDs (1st line = methotrexate, sulfasalazine is alternative)
- biologic agents (etanercept or infliximab)

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4
Q

REACTIVE ARTHRITIS
How is reactive arthritis treated?

A

1st line
- NSAIDs
- intra-articular corticosteroids
- antibiotics if active STI

2nd line
- oral corticosteroids
- DMARD (methotrexate or sulfalazine)
- infliximab

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5
Q

OESTEOPOROSIS
Give 4 properties of bone that contribute to bone strength

A
  1. Bone mineral density
  2. Bone size
  3. Bone turnover
  4. Bone micro-architecture
  5. Mineralisation
  6. Geometry
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6
Q

OESTEOPOROSIS
Give 5 risk factors for osteoporosis

A
  • old age, women, FHx, previous fracture, smoking, alcohol, Asian/Caucasian

‘SHATTERED’

  • Steroid use
  • Hyperthyroidism, hyperparathyroidism, hypercalciuria
  • Alcohol + tobacco use
  • Thin (BMI < 18.5)
  • Testosterone (low)
  • Early menopause
  • Renal or liver failure
  • Erosive/inflammatory bone disease (e.g. myeloma or RA)
  • Dietary low calcium /malabsorption or Diabetes type 1
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7
Q

OESTEOPOROSIS
which endocrine diseases can be responsible for causing osteoporosis?

A
  1. Hyperthyroidism and primary hyperparathyroidism - TH and PTH increase bone turnover
  2. Cushing’s syndrome - cortisol leads to increase bone resorption and osteoblast apoptosis
  3. Early menopause, male hypogonadism - less oestrogen/testosterone to control bone turnover
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8
Q

OESTEOPOROSIS
which medications can cause osteoporosis?

A
  • glucocorticoids (steroids
  • phenytoin
  • heparin
  • ciclosporin
  • PPIs
  • pioglitazone
  • SSRIs
  • Aromatase inhibitors
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9
Q

OESTEOPOROSIS
What is a T score?

A

Is a standard deviation that is compared to a gender-matched young adult mean

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10
Q

OESTEOPOROSIS
How do bisphosphonates work?

A

Inhibit cholesterol formation –> osteoclast apoptosis

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11
Q

GIANT CELL ARTERITIS
What is the diagnostic criteria for giant cell arteritis?

A
  1. Age >50
  2. New headache
  3. Temporal artery tenderness
  4. Abnormal artery biopsies
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12
Q

GIANT CELL ARTERITIS
Describe the treatment for giant cell arteritis

A
  1. High dose corticosteroids - prednisolone ASAP
  2. DMARDs - methotrexate (sometimes)
  3. Osteoporosis prophylaxis is important - lansoprazole, alendronate, Ca2+, vit D
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13
Q

GRANULOMATOSIS WITH POLYANGIITIS
What is the pathophysiology of granulomatosis with polyangiitis?

A

Necrotising granulomatous vasculitis affecting arterioles and venules
ANCAs can activate primed circulating neutrophils which leads to fibrin deposition in vessel walls and deposition of destructive inflammatory mediators

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14
Q

GRANULOMATOSIS WITH POLYANGIITIS
What are the clinical features?

A

SYMPTOMS
- epistaxis
- sinus congestion
- cough +/- haemoptysis
- haematuria
- joint pain
- paraesthesia and numbness

SIGNS
- nasal crusting or bleeding
- nasal or oral inflammation
- saddle nose deformity
- crackles or wheeze
- tender, swollen joints
- signs of peripheral neuropathy
- vasculitic rash (purpura)

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15
Q

GRANULOMATOSIS WITH POLYANGIITIS
What investigations might you do in someone you suspect to have granulomatosis with polyangiitis?

A

ANCA testing - c-ANCA
CRP/ESR = raised
renal function tests
urine dipstick + microscopy
CXR/CT chest
renal biopsy (gold standard) = necrotising glomerulonephritis
FBC - high eosinophils

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16
Q

GRANULOMATOSIS WITH POLYANGIITIS
What is the treatment for granulomatosis with polyangiitis?

A

1st line
- corticosteroids (prednisolone)
- cyclophosphamide
- maintenance therapy (azathioprine or methotrexate)

2nd line
- rituximab (may be used instead of cyclophosphamide)
- plasma exchange

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17
Q

OSTEOARTHRITIS
Describe the pathophysiology of osteoarthritis

A

Mechanical stress –> progressive destruction and loss of articular cartilage
exposed subchondral bone becomes sclerotic
cytokine mediated TNF/IL/NO involved
deficiency in growth factors

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18
Q

OSTEOARTHRITIS
Give 5 radiological features associated with OA

A

LOSS

  1. Loss of joint space - articular cartilage destruction
  2. Osteophyte formation - calcified cartilaginous destruction
  3. Subchondral sclerosis - exposed
  4. Subchondral cysts
  5. Abnormalities of bone contour
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19
Q

OSTEOARTHRITIS
Describe the pharmacological management of OA

A

1st line
- simple analgesia (paracetamol)
- topical NSAIDs

2nd line
- oral NSAIDs with PPI
- weak opioids (codeine)
- topical capsaicin
- intra-articular corticosteroid injection

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20
Q

OSTEOARTHRITIS
Nodal osteoarthritis can affect the DIP and PIP joints. What are the 2 terms sued for nodes on these joints?

A
  1. PIP = Bouchard’s nodes

2. DIP = Heberden’s nodes

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21
Q

Give an example of an autoimmune connective tissue disease

A
  1. SLE
  2. Systemic sclerosis (scleroderma)
  3. Sjogren’s syndrome
  4. Dermatomyositis/Polymyositis
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22
Q

SLE
Describe the pathogenesis of SLE

A

Type 3 hypersensitivity reaction = immune complex mediated

Autoantibodies to a variety of auto antigens result in formation and deposition of immune complexes

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23
Q

SLE
what are the clinical features of SLE?

A

GENERAL
- fatigue
- fever
- lymphadenopathy

DERMATOLOGICAL
- malar ‘butterfly’ rash
- photosensitivity
- discoid rash
- livedo reticularis
- non-scarring alopecia
- raynauds phenomenon

MSK
- arthralgia
- non-erosive arthritis

PULMONARY
- pleurisy
- interstitial lung disease
- PE

CARDIOVASCULAR
- pericarditis/myocarditis

GI
- lupus peritonitis
- mesenteric artery occlusion

RENAL
- lupus nephritis (diffuse proliferative glomerulonephritis)

OPHTHAMOLOGICAL
- keratoconjunctivitis
- sjogrens syndrome

HAEMATOLOGICAL
- warm autoimmune haemolytic anaemia
- thrombocytopaenia
- antiphospholipid syndrome

OTHER
- mouth + nose ulcers

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24
Q

SLE
Describe the pharmacological treatment for SLE

A

ACUTE FLARE
- mild = prednisolone + hydroxychloroquine + NSAIDs
- moderate/severe = prednisolone + hydroxychloroquine + immunosuppressant (azathioprine or ciclosporin)
- refractory cases = biologics (rituximab)

MAINTENANCE
- hydroxychloroquine

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25
SYSTEMIC SCLEROSIS Describe the pathophysiology of scleroderma
Various factors cause endothelial lesion and vasculopathy Excessive collagen deposition --> inflammation and auto-antibody production
26
SYSTEMIC SCLEROSIS what are the features of limited scleroderma?
CREST 1. Calcinosis - skin calcium deposits 2. Raynauds 3. Esophageal reflux/stricture 4. Sclerodactyly - thick tight skin on fingers/toes 5. Telangiectasia - dilated facial spider veins Pulmonary arterial hypertension - skin thickening distal to elbows + knees - raynauds phenomenon often precedes skin changes -
27
SYSTEMIC SCLEROSIS what are the features of diffuse scleroderma?
Skin changes develop more rapidly and are more widespread than inlimited cutaneous scleroderma/CREST 1. Proximal scleroderma 2. interstitial lung disease 3. Bowel involvement 4. hypertension 5. Renal crisis - skin thickening extends proximally, affecting trunk + proximal limbs predominantly - raymauds phenomenon occurs before or after skin changes - early visceral involvement
28
SYSTEMIC SCLEROSIS what are the investigations?
BLOODS - FBC = anaemia (microcytic) - U&Es = may demonstrate renal failure - CRP + ESR = elevated ANTIBODIES - ANA = positive - anti-centromere = limited systemic sclerosis - anti-Scl 70 = diffuse systemic sclerosis to consider - ECG + echo - CXR - pulmonary function tests - -barium swallow
29
SYSTEMIC SCLEROSIS Describe the management of scleroderma
SKIN - emollient - methotrexate (for skin thickening) - prednisolone (for pruritus) RAYNAUDS - avoid cold + wear gloves - nifedipine - topical nitrate (if poor response) - sildenafil (if ulcers present) PULMONARY ARTERY HTN - bosentan INTERSTITIAL LUNG DISEASE - cyclophosphamide RENAL CRISIS - ACE inhibitor - dialysis (if required) GI - PPI
30
SJOGRENS What is the pathophysiology of sjögren's syndrome?
T-lymphocyte mediated type 4 hypersensitivity reaction
31
SJOGRENS What investigations might you do in someone who you suspect to have sjögren's syndrome?
- lip biopsy - schirmers test (measure tears produced) - antibodies = anti-Ro and anti-La - ESR/CRP = elevated to consider - occular surface staining - unstimulated salivary flow rate - total protein - MRI - joint x-ray
32
SJOGRENS What is the treatment for sjögren's syndrome?
- Artificial tears, artificial saliva, vaginal lubricants - Hydroxychloroquine - NSAID - M3 agonist - pilocarpine
33
DERMATOMYOSITIS what are the clinical features of dermatomyositis?
SYMPTOMS - symmetrical muscle weakness - difficulty walking, lifting arms + standing up - myalgia - joint pains - dysphagia - feeling depressed SIGNS - muscle tenderness (around pelvic + pectoral girdle) - shawl sign (red rash over shoulders, arms + upper back in v-shape) - heliotrope rash (dusky red rash on hands or face) - Gottrons papules (red/purple hardened or eroding areas of skin on upper surface of finger joints/knees and elbows) - periungual telangiectasia (dilated capillaries at skin folds around nail bed - photosensitivity
34
DERMATOMYOSITIS What investigations might you do in someone who you suspect has dermatomyositis?
- CRP/ESR = raised - LFTs = ALT/AST raise - TFTs - CK, LDH + ANA = raised - myositis-specific auto-antibodies = anti-jo 1 and anti-Mi 2 - electromyogram to consider - muscle biopsy - skin biopsy
35
DERMATOMYOSITIS What is the treatment for dermatomyositis?
1st line - exercise + physio - sun protective measures 2nd line - immunosuppressants (methotrexate, azathioprine or cyclophosphamide) - immunoglobulin therapy - biologic (rituximab)
36
SEPTIC ARTHRITIS what are the causes of septic arthritis?
- staph.aureus = most common in all age groups - staph.epidermidis = prosthetic joints - strep.pyogenes = children <5yrs - n.gonorrhoea = young sexually active - pseudomonas aeruginosa = immunosuppressed, elderly + IVDU
37
SEPTIC ARTHRITIS Describe the treatment for septic arthritis
ANTIBIOTICS - IV for 2 weeks followed by oral for 4 weeks - empirical = flucloxacillin (clindamycin in penicillin allergy) - suspected MRSA = vancomycin - gonococcal = cefotaxime or ceftriaxone SURGERY - arhtroscopic washout - srugical debridement
38
OSTEOMYELITIS What organisms can cause osteomyelitis?
1. Staph. aureus = most common 2. Coagulase negative staph (s. epidermidis) 3. Aerobic gram negate bacilli (salmonella) 4. haemophilus influenza 5. Mycobacterium TB
39
OSTEOMYELITIS what changes to bone might you see histologically in acute osteomyelitis?
1. Inflammatory cells 2. Oedema 3. Vascular congestion 4. Small vessel thrombosis
40
OSTEOMYELITIS what changes to bone might you see histologically in chronic osteomyelitis?
1. Necrotic bone - 'squestra' 2. New bone formation 'involucrum' 3. Neutrophil exudates 4. Lymphocytes and histiocytes
41
OSTEOMYELITIS Describe the usual treatment for osteomyelitis
ACUTE PERIPHERAL OM/ACUTE OM IN PATIENT WITH DIABETIC FOOT - 1st line = IV flucloxacillin - if MRSA suspected = vancomycin - if pseudomonas = piperacillin/tazobactam - supportive = analgesia, hydration - 2nd line = surgical debridement VERTEBRAL OM - referral to infectious diseases - if neuro involvement = surgery - no neuro involvement = vancomycin + ceftriaxone - supportive = analgesia + hydration CHRONIC OM - MDT referral - consideration for surgery - optimise contributing co-morbidities - treat acute flares with IV antibiotics
42
RHEUMATOID ARTHRITIS Describe the pathophysiology of RA
1. Chronic inflammation - B/T cells and neutrophils infiltrate 2. Proliferation --> pannus formation (synovium grows out and over cartilage) 3. Pro-inflammatory cytokines --> proteinases --> cartilage destruction
43
RHEUMATOID ARTHRITIS What is seen on an X-ray of someone with RA?
LESS: - Loss of joint space (due to cartilage loss) - Erosion - Soft tissue swelling - Soft bones = osteopenia - subluxation - periarticular osteoporosis
44
RHEUMATOID ARTHRITIS Describe the treatment for rheumatoid arthritis
PRIMARY CARE - NSAIDs - refer to specialist - physiotherapy + occupational therapy SECONDARY CARE - DMARD (methotrexate, sulfasalazine or hydroxychloroquine) - steroids can be given whilst DMARDs take effect - biologics (abatacept, rituximab) MANAGING FLARES - NSAIDs - intra-articular steroid injection
45
GOUT Name 3 common precipitants of a gout attack
1. Aggressive introduction of hypouricaemic therapy 2. Alcohol or shellfish binges 3. Sepsis, MI, acute severe illness 4. Trauma
46
GOUT How would you treat acute gout?
ACUTE FLARE - 1st line = NSAIDs or colchicine with PPI - 2nd line = intra-articular steroids PREVENTION - 1st line = allopurinol - 2nd line = febuxostat - may require colchicine to help cover first couple of weeks as allopurinol + febuxostat can cause gout
47
PSEUDOGOUT What can cause pseudogout?
1. Hypo/hyperthyroidism 2. Haemochromatosis 3. Diabetes 4. Magnesium levels
48
PSEUDOGOUT Describe the treatment for pseudogout
- anti-inflammatory = NSAIDs or colchicine - corticosteroid = intra-articular steroids
49
SARCOMA Name 3 soft tissue sarcomas
1. Liposarcoma = malignant neoplasm of adipose tissue 2. Leiomyosarcoma = malignant neoplasm of smooth muscle 3. Rhabdomyosarcoma = malignant neoplasm of skeletal muscle
50
PHARMACOLOGY Give 5 potential side effects of steroids
1. Diabetes 2. Muscle wasting 3. Osteoporosis 4. Fat redistribution 5. Skin atrophy 6. Hypertension 7. Acne 8. Infection risk
51
PHARMACOLOGY Name a TNF blocker
InfliximabAdalimumab
52
PHARMACOLOGY Name a monoclonal antibody that binds to CD20 on B cells
Rituximab - binds to CD 20 --> B cell depletion
53
PHARMACOLOGY Name 2 drugs that act on the HMGcoA pathway
1. Bisphosphonates - alendronate | 2. Statins - simvistatin
54
REACTIVE ARTHRITIS what treatment should be used if reactive arthritis relapses?
methotrexate or sulfasalazine
55
ANTIPHOSPHOLIPID SYNDROME what are the risk factors for antiphospholipid syndrome?
- diabetes - hypertension - obesity - female - underlying autoimmune condition - smoking - oestrogen therapy
56
ANTIPHOSPHOLIPID SYNDROME what is the clinical presentation of antiphospholipid syndrome?
- thrombosis - miscarriage - livedo reticularis - purple lace rash - ischaemic stroke, TIA, MI - DVT, budd-chiari syndrome - thrombocytopenia - valvular heart disease, migraines, epilepsy
57
ANTIPHOSPHOLIPID SYNDROME what is the pathophysiology of antiphospholipid syndrome?
- Antiphospholipid antibodies (aPL) play a role in thrombosis by binding tophospholipid on the surface of cells such as endothelial cells, platelets andmonocytes - Once bound, this change alters the functioning of those cells leading tothrombosis and/or miscarriage - Antiphospholipid antibodies (aPL) cause CLOTs: * Coagulation defect * Livedo reticularis - lace-like purplish discolouration of skin * Obstetric issues i.e. miscarriage * Thrombocytopenia (low platelets)
58
ANTIPHOSPHOLIPID SYNDROME what is the treatment for antiphospholipid syndrome?
PRIMARY PROPHYLAXIS - low dose aspirin AFTER VTE EPISODE - lifelong warfarin - 1st episode INR = 2-3 - if experience further VTE whilst on warfarin, INR = 3-4
59
SARCOMA which is the most common sarcoma in adults?
chondrosarcoma
60
SYSTEMIC SCLEROSIS what are the risk factors for scleroderma?
- exposure to vinyl chloride, silica dust, rapeseed oil, trichloroethylene - bleomycin - genetic
61
what is the clinical presentation of polymyositis?
- symmetrical progressive muscle weakness and wasting - affects proximal muscles of shoulder and pelvic girdle - difficulty squatting, going upstairs, rising from chair and raising hands above head - involvement of pharyngeal, laryngeal and respiratory muscles = dysphagia, dysphonia and respiratory failure - pain and tenderness = uncommon
62
what is the treatment for polymyositis/dermatomyositis?
- bed rest + exercise plan - oral prednisolone - steroid sparing immunosuppressive - azathioprine, methotrexate, ciclosporin - hydroxychloroquine for skin disease
63
OSTEOPOROSIS what factors are used in the FRAX score calculation?
- age - sex - height and weight - previous fractures - smoking - parent fractured hip (FHx) - steroid (glucocorticoid use) - RA - secondary osteoporosis - alcohol consumption (>3 units) - femoral neck bone mineral density
64
RHEUMATOID ARTHRITIS what is the diagnostic criteria for RA?
RF RISES - >6 weeks and >4 of following: - RF positive - Finger/hand/wrist involvement - Rheumatoid nodules present - Involvement of >3 joints - Stiffness in morning >1 hr - Erosions on x-ray - Symmetrical involvement
65
SYSTEMIC SCLEROSIS what is limited scleroderma?
- skin involvement limited to hands, face, feet and forearms - characteristic ‘beak’-like nose and small mouth - Microstomia - small mouth
66
SYSTEMIC SCLEROSIS what is diffuse scleroderma?
skin changes develop more rapidly and are more widespread Raynaud’s phenomenon coincident with skin involvement GI, Renal, Lung involvement
67
PAGETS DISEASE what are the investigations for paget's disease?
plain film x-ray radionucleotide bone scan LFTs = raised ALP bone profile = calcium normal vitamin D level = normal to consider - urinalysis - bone biopsy
68
PAGETS DISEASE what is the management for paget's disease?
ASYMPTOMATIC - observation SYMPTOMATIC/HIGH RISK - 1st line = bisphosphonates (alendronic acid or zolendronic acid) - 2nd line = calcitonin - supportive measures = education, analgesia, orthoses, walking aids SEVERE DISEASE - surgery
69
OSTEOMALACIA what are the causes of osteomalacia?
malnutrition (most common) vitamin D deficiency drug induced defective 1-alpha hydroxylation Liver disease
70
OSTEOMALACIA what is the clincial presentation of osteomalacia?
SYMPTOMS - generalised bone pain (rib, hip, pelvis, thigh and foot pain) - proximal muscle weakness - difficulty walking upstairs - fracture (secondary to mild trauma) SIGNS - waddling gait - signs of hypocalcaemia e.g. Chvostek sign - skeletal deformities
71
OSTEOMALACIA what are the investigations for Osteomalacia / rickets?
- low calcium - low phosphate - low vitamin D - raised ALP X-RAY - translucent bands (Looser's zones, pseudofractures)
72
OSTEOMALACIA what is the management for osteomalacia/rickets?
depends on vitamin D levels VITAMIN D DEFICIENCY - loading regimen followed by maintenance dose of vitamin D - increased oral calcium intake VITAMIN D INSUFFICIENCY - only treat if pt has concomitant risk factors - same as above ADEQUATE VITAMIN D - vitamin D supplementation
73
PSOROIATIC ARTHRITIS what is the diagnostic criteria?
CASPAR criteria - history of psoriasis (+2) - psoriatic nail changes (+1) - RF negative (+1) - history of dactylitis (+1) - radiological evidence = juxta-articular peristitis (+1) score >2 = positive diagnosis
74
BURSITIS what is the management?
1st line - conservative = rest, ice, compression - analgesia = paracetamol, ibuprofen 2nd line - corticosteroid injection 3rd line - bursectomy
75
COMPARTMENT SYNDROME what is the management of chronic compartment syndrome?
- massage + stretching - physio - orthotics - anti-inflammatories (NSAIDS) - surgical fasciotomy
76
PATHOLOGICAL FRACTURE what scoring system can be used?
Mirels scoring system - used to guide the need for prophylactic fixation
77
LOWER LIMB FRACTURES what are the different types of foot fractures?
- jones fracture - lisfranc injury - calcaneal fracture - talar neck fracture
78
LOWER LIMB FRACTURES what are the clinical features of a hip fracture?
- inability to weight bear - shortened + externally rotated leg
79
LOWER LIMB SOFT TISSUE INJURIES what is the clinical presentation of greater trochanteric pain syndrome?
- gradual onset - lateral hip + buttock pain - worse with activity, prolonged standing or sitting - tenderness over greater trochanter - trendelenberg gait
80
UPPER LIMB SOFT TISSUE INJURIES what are the clinical features of frozen shoulder?
- painful phase followed by stiffness - stiffness on active + passive movement, particularly external rotation - subsequent thawing to resolution - total duration is 1-3 years
81
UPPER LIMB SOFT TISSUE INJURIES what are the clinical features of supraspinatus tendinopathy?
- positive empty can test - painful arc on shoulder abduction between 60-120 degrees
82
UPPER LIMB SOFT TISSUE INJURIES what muscles make up the rotator cuff?
- supraspinatus - infraspinatus - teres minor - subscapularis
83
UPPER LIMB SOFT TISSUE INJURIES what are the clinical features of rotator cuff tear?
- shoulder pain + weakness - special tests = gerbers lift off, neers and hawkins
84
UPPER LIMB SOFT TISSUE INJURIES what are the clinical features of medial epicondylitis?
- pain at medial epicondyle - radiates down forearm - pain on wrist flexion + pronation - paraesthesia in ulnar nerve distribution
85
UPPER LIMB SOFT TISSUE INJURIES what is the clinical presentation of lateral epicondylitis?
pain on resisted wrist extension
86
UPPER LIMB SOFT TISSUE INJURIES what is the mechanism of injury for frozen shoulder?
- primary - secondary to trauma, surgery or reduced mobilisation
87
UPPER LIMB SOFT TISSUE INJURIES what is the mechanism of injury for supraspinatus tendinopathy?
- overhead activities compounded by narrowing joint space
88
UPPER LIMB SOFT TISSUE INJURIES what is the mechanism of injury for rotator cuff tears?
- trauma - repetitive strain - associated with overhead activities - chronic degeneration
89
UPPER LIMB SOFT TISSUE INJURIES what is the mechanism of injury for medial epicondylitis?
repetitive use - golfers elbow
90
UPPER LIMB SOFT TISSUE INJURIES what is the mechanism of injury for lateral epicondylitis?
repetitive use - tennis elbow
91
UPPER LIMB SOFT TISSUE INJURIES what is the clinical presentation of de quervains tenosynovitis?
- radial wrist pain over radial styoid process - pain on resisted thumb abduction - finkelsteins test positive
92
LYME DISEASE what is it caused by?
infection by borrelia burgdorferi from tick bites
93
LYME DISEASE what are the clinical features of early disseminated disease?
- multiple bulls eye rashes - weakness of facial muscles (CN VII palsy)
94
LYME DISEASE what are the clinical features of late disease?
- arthritis (oligoarthritis with synovitis) - unilateral discolouration of extensor surfaces (acrodermatitis chronica atrophicans)
95
LYME DISEASE what is the management?
1st line - doxycycline BD for 21 days - if unsuitable, use amoxicillin instead 2nd line - if not managed by 1st antibiotics a second course of antibiotics is considered
96
SEPTIC ARTHRITIS what is the diagnostic criteria?
Kocher criteria - non-weight bearing = 1 - temp >38.5 = 1 - ESR > 40mm/hr = 1 - WCC >12x10 9/L = 1 score of 2 = 40% probability score of 3 = 93% probability
97
OSTEOMALACIA what are the risk factors?
- limited exposure to sunlight - dark skin - dietary vitamin D deficiency (fish, cheese, eggs) - CKD - liver dysfunction - malabsorption (IBD) - anticonvulsant use (phenytoin, carbamazepine + phenobarbital use)
98
BACK PAIN what is the management of mechanical back pain?
CONSERVATIVE - reassurance + patient education - regular exercise +/- physio MEDICAL - 1st line = NSAIDs (IBUPROFEN) +/- PPI - 2nd line = codeine +/- paracetamol - 3rd line = benzodiazepines (DIAZEPAM) if maximum 5 days for muscle spasm) do not use opioids or antidepressants for low back pain
99
UPPER LIMB FRACTURES what is the mechanism of injury for a Monteggia's fracture?
fall onto outstretched hand with forced pronation
100
UPPER LIMB FRACTURES what are the features of a Monteggia's fracture?
- dislocation of proximal radioulnar joint in association with ulnar fracture
101
UPPER LIMB FRACTURES what is the mechanism of injury for Galeazzi fractures?
fall onto the hand with rotational force superimposed
102
UPPER LIMB FRACTURES what are the features of a Galeazzi fracture?
- radial shaft fracture with dislocation of distal radioulnar joint - bruising over lower forearm
103
UPPER LIMB FRACTURES what are the clinical features of a radial head fracture?
- tenderness at head of radius - impaired movement at elbow - sharp pain at lateral side of elbow at extremes of rotation (supination + pronation)
104
LOWER LIMB FRACTURE what is the classification system for lateral malleolar fractures?
Weber classification type A = # distal to syndesmosis type B = # at level of syndesmosis type C = # proximal to syndesmosis
105
ANKYLOSING SPONDYLITIS what are the signs on x-ray?
- Bamboo spine - Squaring of vertebral bodies - dagger sign - Subchondral sclerosis + erosions - Syndesmophytes - Ossification of ligaments, discs + joints - Fusion of facet, SI + costovertebral joint
106
HIP FRACTURES what classification system is used for intra-articular hip fractures?
garden
107
HIP FRACTURES what is the management of intracapsular hip fractures?
- undisplaced = internal fixation - displaced = total hip replacement (hemiarthroplasty if unfit)
108
HIP FRACTURES what is the management for extracapsular hip fractures?
- stable = dynamic hip screw - reverse oblique, transverse or subtrochanteric = intramedullary device
109
DRUG INDUCED LUPUS what are the investigations?
- ANA positive - anti-dsDNA negative - anti-histone positive

MY REVISION - ALL TO DO 2 (24 decks)

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