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AMC Key > Ortho & Rheumatology > Flashcards

Ortho & Rheumatology Flashcards

(63 cards)

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1
Q

Fibromyalgia

A

4 body parts( 4 quadrants)
3 month’s SX with 11/18 tender points
Female4:1 onset : 29-37 ∆: 44-53yrs
A/W sleep, fatigue, cognitive
+/- depression
Rx: CBT
amitriptyline
Duloxetine

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2
Q

Red flags (not fibromyalgia)

A

Fever,night sweats
Wt loss
Older age onset
Neurological involved
Hx of malignancy

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3
Q

Trigger for fibromyalgia

A

Stress

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4
Q

Buerger Disease (TAO)

A

Non atherosclerotic,segmental occlusion of medium&small sized arteries
Male,smoker
Ischemia and gangrene due to thrombo occlusion of vessels of extremities
Amputation: prevent 2°infection and pain

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5
Q

Raynaud phenomenon

A

Episodic arteriolar vasospasm of the fingers and toes
Blue >red>pale colour changes
Trigger: cold,stress, anxiety
No amputation

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6
Q

One sided clavicular #

A

X-ray AP view of the side(R/L)
CT : if tracheal or thoracic involved
Or lat 3rd displaced with coracoclavicular ligament injury

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7
Q

Polymyalgia rheumatica

A

Symmetrical involvement of hip/shoulder girdle
Tenderness
Raised ESR, CRP, Normochromic anemia
CK : Normal
Rx : steroid !!!

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8
Q

Flexor tenosynovitis

A

Kanavel signs: 90%sensitive
By order
1. Pain on passive extension
2. Tender flexor tendon sheath
3. Fusiform swelling
4. Fixed flexion at resting position
Fever suggests systemic involved

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9
Q

Rheumatoid arthritis of large joint

A

Hx of morning stiffness
Tender, swelling noted
X-ray:
Joint space narrowing
Periarticular osteopenia
Soft tissue swelling
Joint margin erosion

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10
Q

X-ray changes in OA

A

Joint space narrowing
Subchondral sclerosis
Osteophytes

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11
Q

OA Vs RA

A

OA: aggravated by activity relieved by rest

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12
Q

Acute Back pain in a history of cancer

A

Red flag sign of metastatic bone involvement usually a pathological #

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13
Q

Other signs of metastatic bone

A

•H/o cancer
•Wt loss
•Acute back pain
•Nocturnal pain
•Age>50 or <20
•Pain not alleviated in 1mth

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14
Q

Q58 Ortho table

A

All the conditions with specific sx

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15
Q

Gouty arthritis

A

NSAID ( Naproxen & Indomethacin)
Colchicine 2nd line

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16
Q

Steroid use in gout

A

Oral or injection(preferred if only one joint involved) usually when 1st line contraindicated eg PUD/CKD; given for 10 days in tapering dose

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17
Q

Acute gout

A

1st line: NSAID if Contraindicated
Then colchicine if Contraindicated then steroid
Colchicine (gfr<30 : avoid , renal impaired: reduced dose)

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18
Q

Neonatal lupus erythematosus

A

Transplacental maternal autoantibodies
Causing cardiac,hepatic and skin problem
Cardiac : rhythm disorder eg block
Ix: Anti RO

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19
Q

SLE

A

4/11: SOAP BRAIN MD
1 clinical 1 lab 1 immunology
2or > joints involved
Hydoxychloroquine main long term
Cyclophosphamide for severe cases
Steroids for acute exacerbations

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20
Q

Low back pain (lumbar strain)
Rx option

A

Reassurance
Continue activity
Analgesia
R/v 4-6weeks time
W/out red 🛑flag signs

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21
Q

Cauda equina syndrome
Signs

A

Fecal incontinence
Urine retention
Saddle anaesthesia
LL weakness and paraesthesia

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22
Q

Low back pain with SLRT + but NO red flag sign 🛑

A

Conservative mngt
NSAID
Resume activity
Physiotherapy if severe and debilitating
R/v 4-6 weeks
No need imaging !!!

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23
Q

RA features q 47

A

Cardiac
Renal
Skin
Neuro
Lung
Hematology
Oral
GIT
*No hepatomegaly

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24
Q

Lateral epicondylitis

A

Caused by ECRB muscle
Brace, counterforce bracing treatment of choice

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25
Olecranon bursitis
Swelling at posterior elbow Idiopathic, painless ( aseptic) Pain due to pressure applied/ need TRO septic bursitis (rare)
26
Red flag conditions for low back pain
Metastatic bone Infection Cauda equina syndrome Vertebral # Ankylosing spondylitis
27
Ankylosing spondylitis low back features
Morning stiffness Alternating buttocks pain Younger age Wakes up 2nd half of night pain Pain improves with exercise
28
Colles # most common complication
Malunion
29
Colles # Earliest complication
Volkmann ischaemic contracture =Due to compartmental syndrome • permanent shortened muscles of forearm •claw like deformity fingers,wrist, hand
30
Colles #. RX
Reduction,casting from below wrist and forearm (thumb not covered) Severe displacement=above elbow Cast : 10°wrist flexed &10°ulnar deviation
31
Scaphoid # Initial mngt if x-ray normal
Thumb spica Immobilisation 7-10 days( upto 14 days) Repeat x-ray, still normal but symptoms+, MRI
32
Anterior dislocation shoulder CMR using meds
IV Midazolam & Intranasal fentanyl
33
Common risk of nerve injury and muscle in anterior dislocation of shoulder
Axillary nerve: patch of hyposthesia Deltoid: unable to abduct above head
34
Most accurate test for GCA/polymyalgia rheumatica
Temporal artery biopsy ESR: initial test, and as measuring index to start steroids
35
Polymyalgia rheumatica sx& Rx
Symmetrical involvement joints Stiffness Systemic : fever/Wt loss/fatigue Sensation of muscle weakness Synovitis +/- GCA, elderly women ESR> 40mm !!! Prednisolone: 10-20mg , >1 yr (upto 2-3yrs) ,higher dose if GCA
36
Steroids Rx in PMR. Advise
Weight bearing exercises Calcium Vitamin D ( if needed) Bisphosphonate Periodically dexa scan
37
Open # Steps
1. Clean the wound, photo and cover with sterile patch 2. analgesic. for pain & reduction 3. Reduce# by traction 4. Antibiotics prophylaxis 5. Tetanus prophylaxis 6. x-ray 7. Ot arrangements for surgical debridement
38
Synovial fluid analysis General
WCC= Normal: <200 Inflammatory: 2000-50,000 Septic:> 50,000 ( but need workup above 5000) Degenerative (OA): 200-2000
39
Synovial detailed analysis Q23 table
Q23 table
40
Hip #
41
Intracapsular # of femoral neck (Garden classification)
Garden 1-2: Closed reduction,IF Garden 3-4: hip arthroplasty (elderly), IF in younger age
42
Ankylosing spondylitis Rx
1. NSAID ( 2nsaid combo if needed) 2. Add on simple analgesia/opioid 3.if NSAID contraindicated , start with analgesia and 4.infliximab, TNF for pain despite on maximum NSAID
43
Axial Ankylosing spondylitis
Radiological findings i.e fuse of the vertebrae leads to stiffness of the spine. TNF inhibitors best modalities.
44
Severe Ankylosing spondylitis
NSAID maximum dosage, if doesn't work change to other NSAID Or TNF inhibitors Options of answers
45
Dupuytren's contracture
Painless, usually bilateral Affect 4th and 5th digit Palmar sheath thickening with nodule USG : thickened palmar fascia and nodule Intralesional steroid AW DM: check GM
46
Surgery for Dupuytren's contracture
If flexion deformity >30° mcpj and pip >15°
47
HLA-B27 Spondyloarthropathies
1. Ankylosing spondylitis 2. Reactive arthritis 3. Psoriatic arthritis 4. IBD 5. Undifferentiated SPA
48
Axial SPA Vs peripheral SPA RX
Common: NSAID maximum Axial: next TNF inhibitors Peripheral: methotrexate/sulfasalazine
49
GCA with polymyalgia rheumatica
Elderly, new onset Headache + joint pain and stiffness+ fever combo patients O/e : symmetrical joint tender, unilateral temporal scalp tenderness
50
OA Rx
1. Mild to Mod: regular PCM advised 4gm/day > prn basis 2. Mod: not improving, inflammatory signs, NSAID NSAID : ✖️ PUD, ✖️ IHD 3. Mod to severe: PCM + opiate ( codeine> tramadol)
51
Dislocated joint with neurovascular compromise Eg ankle dislocated, dpa not palpable
Reduction 1st with analgesia in ED (morphine IV)
52
Man with contracted finger Alcoholic
Dupuytren's contracture
53
Important step to prevent infection & complications of open #/wound
Debridement
54
Displaced/dislocated joint
First is to reduce irrespective of the vascular status, then wound care,abx,Tetanus,traction,call oT for WD ( in order)
55
Stick aid for OA
Stick on good leg,1st step on bad leg
56
Sjogren Syndrome
•Lymphocytic infiltration if exocrine glands mainly salivary and lacrimal glands •coexist with RA,SLE •Female, 4-5th decade CVS/RS/Git/Renal/Skin/CNS sx
57
Lab Ix Sjogren
ESR CRP ANA RF : can be +
58
Best ix Sjogren
Salivary gland biopsy
59
1° vs 2° OA
1° : symmetrical, base of thumb,1st MTPJ, DIPJ fingers MC 2°: unilateral, mainly large joint i.e knee joint •Worsened with activity, relieved by rest •rx: PCM NSAID only if inflammatory signs eg. Pain at rest, stiffness, nocturnal pain *** immobilisation is never an option for Rx in OA !!!
60
Atraumatic AVN of femoral neck
Elderly with sudden onset joint pain Risk FX :1.Hx of long term steroid use 2.ch alcohol abuse 3.sickle cell disease 4.past hip # Best initial: x-ray : uneven femoral head Most accurate:MRI ( Geographic Subchondral bone) USG: done TRO joint effusion seen in RA flare ups/septic arthritis
61
Post op most important options
Analgesics To prevent 1. Pressure sores 2. VTE 3. Pneumonia
62
SPA
Enthesitis, or inflammation of the sites where the tendons or ligaments insert into the bone, is a key pathological finding in SpA
63
Seronegative spondyloarthropathies
•As name implies results of iserology markers are NORMAL •Inflammatory response ESR CRP may be elevated or normal

AMC Key (11 decks)

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