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PACES week > Musc/Rheum > Flashcards

Musc/Rheum Flashcards

1
Q

Common extraarticular manifestations of ankylosing spondylitis

A

Anterior uvietis
Apical fibrosis
Aortic regurg
AVN block
Amyloidosis
Atlantoxial dislocation

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2
Q

Mx of ankylosing spondylitis

A

Physiotherapy
NSAIDs
Smoking cessation

Intraarticular/intralesional/im steroid for enthesitis/arthritis
Methotrexate for peripheral but not axial disease
Anti-TNF agents for axial disease once failed 2 NSAIDs at max dose for 4 weeks

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3
Q

Mx of ankylosing spondylitis

A

Physiotherapy
NSAIDs
Smoking cessation

Intraarticular/intralesional/im steroid for enthesitis/arthritis
Methotrexate for peripheral but not axial disease
Anti-TNF agents for axial disease once failed 2 NSAIDs at max dose for 4 weeks

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4
Q

Mx of rheumatoid arthritis?

A

Methotrexate + short term prednisolone
Measure disease activity DAS-28 score

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5
Q

What joint affected increases suspicion of psoriatic arthritis over rheumatoid arthritis

A

DIPJ

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6
Q

Mx of psoriatic arthropathy?

A

NSAIDs

Steroid injections

DMARDs if NSAIDs fail
Anit-TNF afents
Ustekinumab

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7
Q

GCA Mx

A

EMERGENCY
40mg Prednisolone
IV methylprednisolone 500mg if visual loss

Request temporal artery biopsy

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7
Q

What is Ehlers-Danlos Syndrome

A

Skin hyperextensibility
Joint hypermobility
Easy bruising, muscle aches, weakness

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8
Q

Causes of erythema nodosum

A

Sarcoidosis
Inflammatory Bowel Disease (crohns more often than ulcerative colitis)
Behcet’s disease
Hodgkins lymphoma, leukaemia
Pregnancy

Infection: TB, leprosy, Hep B

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9
Q

Causes of bihilar lymphadenopathy

A

Sarcoidosis
Infection: TB, HIV
Malignancy
Silicosis

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10
Q

Describe the anatomy of the carpal tunnel

A

Formed by flexor retinaculum and carpal bones
contains median nerve

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11
Q

What is the typical patterns of sensory loss seen in carpal tunnel syndrome?

A

median nerve supplies thenar eminence and lateral 3.5 fingers

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12
Q

Main cause of carpal tunnel syndrome

A

Idiopathic
Radial fracture
Inflammation - RA, gout
Soft tissue swelling; lipomas, ganglia, acromegaly, amyloidosis

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13
Q

Surgical Tx of carpal tunnel

A

Carpal tunnel decompression by division of flexor retinaculum

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14
Q

What are the 4 classic features of RA on X-ray

A

Loss of joint space

Periarticular Erosions

Soft tissue Swellings

Soft bones i.e. periarticular osteopenia

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15
Q

Causes of positive tredelenberg test

A

Osteoarthritis
Abductor wasting
Sup. gluteal N. injury: surgery
Structural: DDH

16
Q

Causes of hip shortening

A

NOF
Dislocation
Osteomyelitis
Surgery
SUFE, Perthe’s
Scoliosis

17
Q

Caused of fixed flexion deformity in the hip

A

Osteoarthritis (most likely)

NOF
Muscle contracture

18
Q

Features of OA of hip

x5

A

± Trendelenberg gait or +ve Test
Pain
Stiffness
↓ ROM: esp. internal rotation
Fixed flexion deformity

19
Q

Osteoarthritis Ix

A

Exclude Rheumatological Disease
FBC
ESR
RF, ANA

Check Renal Function: U+E
(important before prescribing NSAIDs)

X-ray Changes

20
Q

X-ray changes in osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

21
Q

Osteoarthritis Mx

A

MDT
Lifestyle: ↓ wt., ↑ exercise
Physio: muscle strengthening, walking aids

Analgesia
Joint injection: local anaesthetic and steroids

Sx: arthroplasty, realignment

22
Q

What causes longer early morning stiffness, OA or RA.
Which joints are affected in the hands for OA and RA

A

RA long early morning stiffness

RA: PIPJs and MCPJs
OA: PIPJs and DIPJs

23
Q

Commonest complication of total hip replacement

A

DVT

24
Q

Mx of intracapsular hip fracture

A

Undisplaced Fracture:
internal fixation, or hemiarthroplasty if unfit.

Displaced:
Total hip replacement, or hemiarthroplasty if unfit.

25
Q

Mx of extracapsular hip fracture

A

stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

26
Q

Mx of ACL

A

Rest and phyio to strengthen quads and hamstrings

Gold-standard is autograft repair surgery

27
Q

What is Hallux

A

Stiff big toe (varus or valgus)

28
Q

Causes of charcot joints

A

DM
Leprosy
Syringomelia
Peripheral nerve injury

29
Q

Describe antalgic gait?
Cause?

A

Decreased stance
Increased swing (classic limp)

Pain

30
Q

Cause of high stepping gait

A

Raises one leg like a weirdo

Common peroneal nerve injury
L5 disc

31
Q

Causes of winged scapular

A

Seratus Anterior Weakness

Long-thoracic nerve damage: e.g. axillary surgery
Upper brachial plexus injury

32
Q

Mx of carpal tunnel

A

Wrist splint

Carpal tunnel decompression by division of the flexor retinaculum

PACES week (8 decks)

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