Orthopaedics and Rheumatology Flashcards by Carlos Noble Jesus

Urethritis, conjunctivitis, arthritis

Associated lesions include circinate balanitis

Keratoderma blenorrhagica

Mouth ulcers

Previous STI or gastroenteritis

Reiter’s syndrome

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Young male, buttock/sacroiliac pain worse in morning, relieved by exercise Syndesmophytes, ‘bamboo spine’ on X-ray

Associations include 4 As: arthritis, anterior uveitis, apical lung fibrosis, aortic regurgitation

Ankylosing spondylitis

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Nail dystrophy, ‘pitting’

Joints show central erosion on X-ray

Can be highly deforming (arthritis mutilans)

Psoriatic arthritis

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Arthritis in UC/Crohn’s patient

Asymmetrical, mainly affects lower limbs

Enteropathic arthropathy

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Dry eyes, dry mouth

Positive Schirmer’s test

Sjögren’s syndrome

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Proximal muscle weakness, pain and tenderness

Increased serum CK

Polymyositis

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Proximal muscle weakness, pain and tenderness

Increased serum CK

Heliotrope (purple) rash

Dermatomyositis

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More common in Turkish, Iranian patients

Orogenital ulceration, uveitis, arthritis

Pathergy reaction is pathognomonic

Behçet’s disease

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Usually woman

Persistently cold, cyanosed fingers

Raynaud’s phenomenon

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Calcinosis (nodules)

Raynaud’s phenomenon

Esophageal dysmotility

Sclerodactyly

Telangiectasia

CREST

Systemic sclerosis

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Usually elderly patient with headache

Scalp tenderness

Jaw claudication

Sudden unilateral blindness can occur

Associated with polymyalgia rheumatica

Temporal/giant cell arteritis

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Granulomas in respiratory tract

Generalised vasculitis

cANCA, anti-PR3 positive

Wegener’s granulomatosis

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Usually child (particularly under age 5)

Purpuric rash over buttocks, extensor surfaces

Associated with arthritis, abdominal pain and nephritis

Henoch-Schönlein purpura

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Usually middle-aged male

Asthma, rhinitis and systemic vasculitis

+++ eosinophilia

Churg-Strauss syndrome

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Usually under 5 years

Main features are:

protracted fever
acute cervical lymphadenopathy
bilateral non-purulent conjunctivitis
dry, cracked, fissured lips
redness, oedema of palms and soles

Platelets and CRP usually elevated

Kawasaki’s disease

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Anti double-stranded DNA

SLE

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Anti-Jo-1 antibodies

Polymyositis

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Anti-centromere

Limited systemic sclerosis

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Anti-topoisomerase

Diffuse systemic slcerosis

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cANCA, anti-PR3

Wegener’s granulomatosis

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α-endomysial antibody

Coeliac disease

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Anti-cyclic citrullinated peptide antibody

Rheumatoid arthritis

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Radiological findings

Loss of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes

Osteoarthritis

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Radiological findings

Loss of joint space
Juxta-articular osteoporosis
Erosions
Subluxation joints

Rheumatoid arthritis

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Radiological findings * Localised enlargement of bone with deformity (e.g. enlarged skull, bowed tibia)

Paget's disease

Radiological findings * Syndesmophytes * 'Bamboo-spine' appearance

Ankylosing spondylitis

'Sunray' spiculation

Osteosarcoma

'Onion-peel sign'

Ewing's sarcoma

Thickening, fibrosis palmar fascia

Dupuytren's contracture

Forced adduction and flexion thumb elicits pain on radial side wrist

De Quervain's syndrome

Failure to abduct shoulder after dislocation

Axillary nerve injury

Painful shoulder following seizure

Posterior dislocation shoulder

'Dinner fork' deformity

Colles' fracture

Flexed, adducted and externally rotated leg

Femoral shaft fracture

Locked knee, positive McMurray's test

Meniscal tear

Drop foot after hip replacement

Sciatic nerve injury

Drop foot after knee injury

Common peroneal nerve injury

Excessive anterior glide tibia on femur

Anterior cruciate ligament injury

Excessive posterior glide tibia on femur

Posterior cruciate ligament injury

Prominent tender tibial tubercle

Osgood-Schlatter disease

Monosodium urate crystals with strong negative birefringence

Gout

Calcium pyrophosphate dehydrate crystals with weakly positive birefringence

Pseudogout

30-year-old woman complains of joint pain in her hands and feet. Her chest x-ray shows reduced lung volumes.

SLE

12-year-old boy presents with pain in his right hip. On examination, the hip is flexed, abducted and externally rotated.

Slipped femoral epiphysis

6-year-old boy presents with pain in the hip and a limp. All movements at the hip are limited. His x-ray shows decrease in size of the nuclear femoral head with patchy density.

Perthes' disease

Hip is adducted, externally rotated and shortened

Fractured neck of femur

Constant backache ESR and serum calcium are markedly elevated

Myeloma

Females during puberty Wedge-shaped vertebral bodies Kyphosis Abnormal ossification of ring epiphyses of thoracic vertebrae

Scheuermann's disease

Recurrent attacks of pain and swelling in the nose and external ear Features can include vasculitis and seronegative arthritis

Polychondritis

Pain, swelling, oedema, change in skin temperature, altered sweating

Complex regional pain syndrome / Sudeck's atrophy

Pleuritic chest pain after orthopaedic/pelvic surgery

Pulmonary embolus

Absence of callus at the fracture site

Delayed union

Weakness of wrist extensors

Radial nerve injury

Used in infants for femoral fractures

Gallows traction

Pain and swelling at the anatomical snuffbox after injury to the arm/hand suggests fracture of the...

scaphoid

68-year-old woman presents with: Fracture at the distal radial head with dorsal displacement of distal fragment after a fall

Colles' fracture

More common in children after a fall on the outstretched hand May present with swollen painful elbow

Supracondylar fracture

Loss of shoulder contour Absent sensation on a patch below the shoulder, due to axillary nerve damage

Anterior dislocation shoulder

Wrist drop (radial nerve injury) due to fracture of the...

humeral shaft

Shoulder pain aggravated in abduction of the arm between 60 and 120^o

Impingement syndrome

Aching shoulder; flexing the elbow reveals a prominent lump in the upper arm This injury occurs after lifting/pulling activity

Ruptured long head of biceps

9-month history of stiffness in shoulder Shoulder was originally extremely painful but now only the stiffness remains

Adhesive capsulitis | ('frozen shoulder')

14-year-old girl successful treated for rickets shows bow-legged deformity

Genu varum

Condition in which the knees angle in and touch one another when the legs are straightened

Genu valgum

50-year-old carpet layer presents with a swelling directly over the patella Joint is normal

Pre-patellar bursitis

Benign swelling of the semimembranosus or more rarely some other synovial bursa found behind the knee joint

Baker's cyst

Presents with lower back pain and stiffness that was worse in the morning Question-mark posture

Ankylosing spondylitis

Used for prophylaxis of gout

Allopurinol | (xanthine oxidase inhibitor)

Gross irreversible retinopathy due to what drug?

Hydroxychloroquine

Oligospermia in a patient on DMARD treatment - what is the drug?

Sulfasalazine

Patient on long-term DMARD treatment shows pulmonary and hepatic fibrosis - what is the drug?

Methotrexate

Afro-Carribean woman Progessive SoB and fever Hands have been painful and stiff Mouth ulcers Bilateral pleural effusions Raised ESR, *normal* CRP

SLE

An elderly patient with bone pain has the following blood result: * Normal serum calcium * Normal serum phosphate * Raised serum alkaline phosphatase

Paget's disease

What drug can be used in Raynaud's syndrome?

Nifedipine | (calcium channel blocker)

Splenomegaly and neutropenia in a patient with rheumatoid arthritis

Felty's syndrome

Most appropriate treatment for acute episodes of gout is...

NSAIDs

Orthopaedics and Rheumatology Flashcards

(76 cards)