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Year 2 > Msk Treatments > Flashcards

Msk Treatments Flashcards

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1
Q

Pagets disease

A

1st: analgesia
2nd: bisphosphonates

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2
Q

non pharmacological management of OA (when to use)

A

non pharmacological 1st line: physio, weight loss, activity modification-

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3
Q

pharmacological management of OA (when to use)

A

1st line: paracetomol + topical NSAId (if knee/ hand)
2nd: oral nsaid + ppi

intra-articular steroid injections (up to 3 per year)- if other management is unsuitable

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4
Q

surgical management of OA (whent to use)

A

joint replacement- if other methods not working/greatly impacting life,
arthroscopic surgery to remove loose bodies

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5
Q

septic arthritis
Tx for >5 yrs old

A

1) flucoxacillin IV
clindamycin if penicillin allergic

2) after blood results- IV antibiotic specific for culture for 1-2 weeks- gd response then give PO antibiotics for 6 weeks

possible wash out of joint

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6
Q

acute gout management (not including prophylaxis)
when is management stopped

(3 diff lines of management)

A

NSAIDs- prescribe til 1-2 days after attack:
1)naproxen (do not give nsaid to ckd patient)

2) (po) colchicine is alternative (for ppl w/ HF, CKD-except for ESRD, gastric ulcers)

3) steroids (oral/injection)- use if on dialysis/ have End Stage Renal Disease (ESRD)

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7
Q

acute gout prophylaxis management and who gets it?
management: 1st line and 2ns line

when is prophylaxis started?

A

Every1 after 1st attack

management:
2 weeks after acute attack start Urate Lowering Drugs (ULD)
-xanthine oxidase inhibitors: 1st- allopurinol, 2nd-febuxostat

have to prescribe colchicine/NSAID w/ allopurinol for first 6 months

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8
Q

intra-capsular fracture low functionn management

A

hemi arthroplasty

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9
Q

intra-capsular fracture management for high functioning patient

A

Displaced fracture:
Total hip replacement

undisplaced:
dynamic hip screw/internal fixation

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10
Q

extra-capsular fracture: intertrochanteric

A

Dynamic hip screw

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11
Q

extracapsular fracture- subtrochanteric

A

Inter Medullary Nail

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12
Q

Rhuematoid arthritis management]
give exact das threshold
and what do you prescribe … with

A

within 3 months of onset
1st) DMARDs (methotrexate 1st) - prescribe with folate (to reduce bone marrow supression)
2nd) add another DMARD
3rd) despite 2 DMARDs if Das28 is >3.2 then biologic is added (anti-tnf etc)

steroids, analgesiacs etc used for symptomatic relief

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13
Q

ankylosing spondylitis management

A

1st line NSAIDs (have to try 2 b4 going onto anti-tnf + physio
DMARDs only if there is peripheral joint involvement
3) anti-tnf: for highly persistent disease, if all else fails

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14
Q

polymyalgia rheumatica management

A

prednisolone eg. 15mg

(patients typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis)

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15
Q

Giant cell arteritis management

include if there is vision loss

and any other necessary actions

A

-urgent high dose glucocorticoids- b4 temporal artery biopsy
-if there is is vision loss then IV methylprednisolone
there should be a dramatic response, if not another diagnosis should be considered
-urgent opthatmology review

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16
Q

Acute flare of rheumatoid arthritis treatment

A

IM or PO methylprednisolone

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17
Q

Plantar fasciitis treatment
(4 points)

A

Rest, achilles and plantar fascia stretching excersises and a gel filled heel pad may help.
Corticosteroid injections may alleviate symptoms.

(Surgical release of PF is not beneficial)

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18
Q

Management if quadricep tendon rupture

A

Almost always surgically managed
(as quadricep tendon is vital for leg extension therefore ambulation/knee function)

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19
Q

What tendons tears absolutely require surgical management

A

Quadricep tendon and patellar tendon

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20
Q

When is arthodesis used

A

End stage ankle arthritis
Wrist arthritis
First MTP joint of foot (hallux rigidus)

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21
Q

Myositis ossificans Tx

include prophylactic treatment

A

Once settled, abnormal bone is excised.

High strength NSAIDs (indomethacin)
Or
Radiotherapy used as prophylaxis

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22
Q

CRPS (chronic regional pain syndrome) management

A

reuires urgent referral to a specialist (to improve prognosis).

tx: analgesiacs, anticonvulsabts, steroids, TENs machines, physio, lidocaine patches & sympathetic nerve blocking injections may help.

tricky to manage

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23
Q

1st line carpal tunnel syndrome treatment

A

wrist splints +/- steroid injections

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24
Q

achillies tendonitis management

A

rest, NSAIDs,
if symptoms persist beyond 7 days then physio too

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25
treatment of an ankle fracture which has disrupted the tibio fibular syndemosis (widening of ankle mortise) (weber c classification)
requires ORIF- open reduction internal fixation (although if elderly then avoid surgery- usually)
26
treatment for Weber B fracture what does this fracture describe (4)
fibular fracture at the level of syndemosis ankle operate depending on instability of fracture and age. if old then dont operate, instead: application of below the knee plaster cast to include midfoot. (boot goes om after cast)
27
treatment weber type A fracture and also decribe what this type of fracture is
(conservative management) below the knee cast 6 weeks fibular fracture distal to syndemosis (tibiofibular)
28
initial management of open fracture What should be avoided?
IV antibiotics, photography and application of saline soaked gauze w impermeable dressing THEN wound debridement and external fixation ORIF should be avoided
29
most appropriate initial management for a suspected scaphoid fracture
Futuro splint or standard below-elbow backslab before specialist review
30
definitive treatment for non displaced scaphoid fracture (distal vs proximal)
cast for 6 weeks if distal, if proximal then surgery
31
osteoporosis treatment (3 points)
vit D and Ca++ (unless they defo have enough already) bisphosphonates: 1st line: alendronate, 2nd: ritedonate
32
APP syndrome management
primary thrombprophylaxis: low dose aspirin secondary thromboprophylaxis (so after venous thromboembolic events): lifelong warfarin w/ target INR of 2-3
33
SLE treatment of choice (2 lines)
hydroxychloroquine prednisolone/biologics indicated in sever disease
34
sciatica treatment (1st and 2nd line)
1st: analgesia and physio 2nd: refer to neurosurgery if symptoms havent improved after 4-6 weeks of analgesia/physio
35
acute gout management for someone with heart failure
colchicine ( the alternative to naproxen)
36
acute gout management for someone with chronic kidney disease
colchicine ( the alternative to naproxen)
37
displaced scaphoid fracture treatment
usually surgical fixation
38
rib fracture treatment
conservative if morphine/analgesia is not managing pain then give a nerve blocker when to consider surgival fixation: if symptoms have not been controlled after 12 weeks
39
management for dermosytosis/polymyositosis (4 points)
1st line: high dose corticosteroids, reduce over time to eventually stop if not responsive: 2nd- immunosupression eg aza (other biologucs etc can be used in severe cases)
40
treatment for kawasaki disease
High dose aspirin IV immunoglobulin
41
SUFE management
internal fixation (typically with a single cannulated screw)
42
stage ... CKD and someone with an eGFR of .... or less requires what alternative to bisphosphonates?
IV , 35mL/minute/1.73m2 denosumab (human monocolonal antibody): given as a subcutaneous injection every 6 months (denosumab is 2nd line to alendronic acid for those who cannot tolerate it )
43
septic arthritis tx for <5 yrs
flucoxacillin IV and ceftriioxine IV (Ceft. covers h.influ) give clindamycin instead of flucox if allergic 2) after blood results- IV antibiotic specific for culture for 1-2 weeks- gd response then give PO antibiotics for 6 weeks
44
scleroderma renal crisis treatment
1st line: ace inhibitor ie. ramipril
45
trigger finger management
1st: steroid injection, finger splint 2nd line: surgery
46
psoriatic arthritis tx
mild peripheral: NSAID more severe: DMARD 3rd: 2 DMARDS
47
reactive arthritis treatment
symptomatic: NSAIDS, intra-articular steroids persistent disease: sulfasalzine/methotrexat
48
osteoporotic crush fracture treatment
Conservative or balloon vertebroplasty
49
if allergic to co-trimaxazole what anti rheumitic drug should you not take
sulfasalazine (as co trimaoxazole is a sufa drug)
50
when should steroids be co-prescribed with bisphosphonates
if someone will be taking steroids for 3 months or more then bisphosphonates should be prescribed immedietley to reduced the risk of osteoporosis
51
treatment for prolapsed disc
nsaids +/- ppi if it perists for 4-6 weeks then referral for consideration of MRI is appropriate
52
high velocity radial shaft fracture tx in a young healthy patient
surgical fixation
53
mechanical back pain tx
NSAIDS and KEEp MOVING
54
acute disc tear tx
analgesia and physio
55
cauda equina tx
surgery (cauda equina - urinary incontenence, poo yourself, cant feel legs etc)
56
duputryens contracture management
1st: reassure, self limiting 2nd: (if not flattening)then refer to specialist for surgical intervention/ inject enzyme therapy
57
potts disease tx
anitbiotics, rifampicin, isonazid & spinal mobilisiation!
58
necrotising fasciitis tx
urgent surgical debridement and Abx IV to culture
59
bunion tx
conservativ: wider/deeper shoes 2nd: surgical: osteotomies
60
Mortons nueroma tx
1st line: conservative- pad/insole. steroids/LA injections
61
talipes equinovarus (club foot) tx
1st: manipulation + progressive casting soon after birth takes 6-10 wks to correct 85% then require achilles tetonotomy
62
achilles tendon rupture tx
medical: series of casts with foot plantarflexed surgical: tendon repair
63
ACL tear mx (3)
(1) ask patient to return in 6-7 days to re-examine (1) NSAIDS + RICE rest Ice Compression Elevation (1) many will require arthroscopic surgery for tendon graft surgery
64
patella fracture mx
strengthen quadriceps
65
avascular necrosis tx
drill holes into affected head if evidence of bone collapse then total hip replacement
66
trochanteric bursitis tx
analgesia + NSAIDs steroid injetions
67
femoral shaft fracture inital and definitive
inital: femoral nerve block and thomas splint definitive: intermedullary nail
68
acetabulum fracture management
undisplaced: conservative displaced: young- reduction + fixation old- Total hip replacement
69
boxers fracture tx
strap to neighboring finger (occurs on 5th metacarpal) wash fight bite out in theatre
70
lateral epidondyitis tx vs medial epidoncylitis tx
lat: rest + NSAIDs + steroid injections medial: the same but no steroid injections
71
olecranon fracture tx
ORIF If avulsion= tension band wiring
72
mx for acromioclavicular joint injury
grade I/II= sling grade IV-VI = surgery
73
shoulder dislocation management
closed reduction under sedation/ anaethetic sling
74
spinal stenosis management
laminectomy
75
frozen shoulder tx
1st line: avoid activities tht exacerbate condtion, NSAIDs then physio 2nd: corticosteroid injections

Year 2 (50 decks)

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