Overview Flashcards
1
Q
How do you treat temporal arteritis?
A
High dose prednisolone
2
Q
Who gets takayasu arteritis?
A
Asian, female with pulseless arch syndrome
3
Q
Name the two large vessel vasculitis
A
Takayasu
Giant cell
4
Q
Name the three ANCA small vessel vasculitis
A
Microscopic polyangiitis
GPA
Eosinophilic granulomatosis with polyangiitis
5
Q
Describe GPA
A
c-ANCA
anti-PR3
ENT - saddle nose, sinusitis
LRT, uveitis, GN
6
Q
Describe EGPA
A
pANCA
anti-MPO
Late onset asthma, eosinophilia, sinusitis, neuropathy
7
Q
Describe MPA
A
Commonly causes GN
pANCA
8
Q
How is small vessel vasculitis treated?
A
Cyclophosphamide + Steroids
Plasma exchange
9
Q
How does Kawasaki disease present?
A
High grade fever in kids, strawberry tongue, red hands/feet, conjunctivitis, lymphadenopathy
10
Q
What is the treatment for kawasaki?
A
High dose aspirin
IV immunoglobulins
Echo
11
Q
What is the RA antibody?
A
Anti-CCP
12
Q
What deformities can occur in RA?
A
Jaccoud’s
Swan neck
Boutonniere
13
Q
How is RA treated?
A
DMARD
Prednisolone cover
Biologics
14
Q
Name two DMARDs used in RA
A
Methotrexate
Sulfasalazine - red pee
15
Q
When are biologics used in RA?
A
No response to 2 DMARDs
16
Q
What is the buzzword for ank spond xray?
A
Bamboo spine
17
Q
How is Ankylosing Spondylitis treated?
A
NSAIDs
Physio
18
Q
Name three seronegative arthropathies
A
Psoriatic - pencil in cup
Enteropathic - IBD
Reactive - GI/GU
19
Q
How is gout treated?
A
Acute - NSAID, colchicine
Chronic - allopurinol, febuzostat
20
Q
What are the side effects of chronic gout treatments?
A
Bone marrow suppression
21
Q
What is seen on polarised microscopy in gout?
A
Needle shaped crystals and negative birefringence
22
Q
What is seen on polarised microscopy in pseudo gout?
A
Rhomboid shaped crystals and positive birefringence
23
Q
Describe the CPPD distinguishing feature
A
Chondrocalcinosis on x-ray
24
Q
Summerise polymyalgia rheumatica
A
>60 year female GCA Morning stiffness, proximal myalgia Raised inflammatory Treat with prednisolone
25
Summerise dermatomyositis
```
Inflammatory
Symmetrical weakness and tenderness
Cutaneous - heliotrope rash, shawl and grotons
Lung disease and dysphagia
ANA
Anti-jo
Prednisolone, methotrexate
```
26
What is affected in sjogrens?
Exocrine glands
27
Name the antibodies in sjogrens
Anti-RO
| Anti- La
28
What is the most common antibody in SLE?
Anti-dsDNA
29
How is SLE treated?
HCQ
Azathioprine
Immunoglobulins/rituximab
30
Describe limited systemic sclerosis
```
Calcinosis
Raynauds
Eosophagus
Sclerodactyl
Telangiectasia
Anti-centromere
```
31
Describe diffuse systemic sclerosis
Scleroderma of trunk and proximal limbs
| Anti-Scl70
32
How do you treat systemic sclerosis?
Raynauds - CCB
Renal - ACEi
Lung - cyclophosphamide
GI - PPI
33
What antibodies are in APLS?
Anti-lupus anticoagulant
| Anti-cardiolipin
34
How is APLS treated?
Warfarin
| Aspirin/heparin
35
What is the most common bone tumour?
Osteochondroma
36
What is an osteochondroma?
Bony out growth with cartilaginous cap
37
Describe enchondroma
Intramedullary usually metaphysical cartilage tumour - failure of normal ossification
Patchy sclerosis
38
What does a osteoid osteoma look like?
Small nidus of immature bone surrounded by intense sclerotic halo
39
What helps the pain of osteoid osteoma?
NSAIDs
40
How are bone cysts treated?
Curettage
| Bone graft
41
What are the reg flags for bone tumours?
Skeletal pain
Worse at night
Ill defined bony swelling
Systemic symptoms
42
Name the most common malignant tumour
Osteosarcoma - usually at knees
43
How do you treat osteosarcoma?
Adjuvant chemo
44
What bone tumour has the worst prognosis?
Ewings Sarcoma
45
How does Ewings sarcoma present?
Fever
| Raised inflammatory markers
46
Summarise paget's disease
Bone turnover increased
Bone pain + raised ALP
Treat - bisphosphonates
Affects the long bones
47
What is the most common organism in osteomyelitis?
Staph Aureus
48
What cell predominates in osteomyelitis in sickle cell patients?
Salmonella
49
What is the name for infected bone walled off in thin sclerotic bone?
Brodie's Abscess
50
Describe septic arthritis
Staph or strep
Acute hot, red, inflamed, painful - no weight bearing
Aspirate
Antibiotics - lavage
51
State the back pain red flags
Young
New onset >60
Constant/severe/worse at night
Systemic upset
52
Describe the classic presentation of acute disc tear
Heavy lifting
Sever pain worse on coughing
MRI if suspected herniation
Resolves in 2-3 months with analgesia/physio
53
How does cauda equina present and what is the management?
Lower back pain, bilateral sciatica, saddle anaesthesia, bowel/bladder/sexual dysfunction
DRE
Urgent MRI
54
Describe spinal stenosis
Claudication
Degenerative changes compress lumbar spinal canal space
extension
55
Name the function of the rotator cuff muscles
Supraspinatus - abduction
Infraspinatus - external rotation
Teres minor - external rotation
Subscapularis - internal rotation
56
How does a rotator cuff tear present?
Minimal trauma
Sudden jerk
Supraspinatus most common - weakness and wasting
57
What causes impingement syndrome?
Tendonitis, bursitis, osteophyte, rotator cuff tear
58
How can impingement be treated?
Conservative
Steroids
Surgery
59
Describe frozen shoulder
Pain - stiffness - recovery
Loss of external rotation
Conservative treatment, injections, surgical release if not tolerated
60
How is acute calcific tendonitis treated?
Steroid
| Anaesthetic
61
What are tennis and golfers elbow?
Tennis - lateral (extensor micro tears)
| Golfer - medial (flexor mircotears)
62
Describe trigger finger
Flexor tendon tendonitis
- nodular enlargement and catch under A1 pulley
Treat with steroid or surgery
63
What is duputren's associated with?
Peyronie's - penis
| Ledderhose - feet
64
How does de quervains present?
Pain on radial side of wrist, tenderness of radial styloid process, abduction of thumb against resistance is painful
65
What test is used to diagnose de quervains?
Finkelsteins
66
Where is true hip pain felt?
Groin
67
Why does hip pain present with a sore knee?
Obturator nerve
68
Why is the hip susceptible to AVN?
Retrograde blood supply
69
What test identifies a meniscal tear?
Steinmann's
70
How are soft tissue knee injuries investigated?
MRI
71
Describe ACL rupture
High impact rotation force
Pop felt - haemarthrosis and chronic instability
Physio
ACL reconstruction
72
What causes PCL injury?
Usually high energy accidents
73
How are MCL tears treated?
Valgus stress - Hinged knee brace
74
What often occurs with LCL injury?
Common perineal nerve injury
75
What happens in a complete knee dislocation?
Rupture of all 4 ligaments
| Popliteal artery injury
76
Name the extensor mechanisms
```
Tibial tuberosity
Patellar tendon
Patella
Quadriceps tendon
Quadriceps muscle
```
77
What predisposes to extensor mechanism rupture?
```
Tendonitis
Steroids
Diabetes
RA
CKD
Quinolone
Ciprofloxacin
```
78
What must not be used in extensor mechanism rupture?
Steroid injections
79
What clinical test is used for extensor mechanism rupture?
Straight leg raise
80
Describe hallux valgus and how it is treated
Medial deviation of the 1st metatarsal and lateral deviation of the toe
Results in an inflamed bursa - bunion
Conservative then surgery
81
What is osteotomy?
Surgical realignment of a bone
82
Describe hallux rigidus
OA of 1st MTP
| Gold standard is surgery - arthrodesis
83
What is Morton's neuroma?
Repeated trauma leads to inflammation and swelling of the plantar interdigital nerve fibres
Burning and tingling radiating to toes loss of sensation
84
What is the characteristic sign of morton's neuroma and how is it treated?
Mulders click
Conservative - pad or steroids
Surgical excision
85
What can cause achilles tendonitis?
```
Repetitive strain
Degenerative
Quinolone
Inflammatory arthritis
Treatment is conservative do not use steroids
```
86
Describe achilles rupture
Middle age to older patients - sudden deceleration with resisted calf muscle contraction leads to sudden onset sharp pain and weak plantar flexion
87
What is the clinical test for achilles rupture?
Simmonds - no plantar flexion on when squeeze calf
88
What is pes planus?
Flat foot
89
What is the name for a high arched foot?
Pes cavus
90
Name four toe deformities
Claw toe
Mallet toe
Hammer toe
Curley toe
91
Describe charcot joint
Diabetics
| Damage due to loss of sensation, extensive remodelling and fragmentation
92
At what level is a cervical spine injury most concerning?
C3 - C3,4,5 - phrenic nerve
93
What causes a thoracolumbar spinal injury?
High energy fall from height
| OA wedge - elderly
94
What is spinal shock?
Physiological response to trauma, loss of sensory and motor function below the level of injury
Bulbocavernosus reflex is absent until resolution
95
Describe neurogenic shock
Temporary shutdown of sympathetic outflow
Vasodilation and bradycardia
High level injuries resolve in 24-48 hours
Priapism
96
What imaging is used to assess lumbar spine?
MRI
97
Name five types of fracture
```
Segmental
Comminuted
Oblique
Spiral
Transverse
```
98
What is the difference between primary and secondary bone healing?
Primary - bridges the gap with new osteoblasts
| Secondary - inflammatory response and recruitment of pluripotent stem cells
99
Describe chronic regional pain syndrome
Constant burning, throbbing allodynia, swelling and stiffness
Requires specialist pain management
100
Who gets a humeral neck fracture?
Usually at surgical neck in elderly patients with osteoporosis FOOSH
101
What is at risk in a humeral shaft fracture?
Radial nerve - wrist drop and loss of sensation
102
What is bilateral shoulder dislocation associated with?
Seizures
103
What can be injured in shoulder dislocation?
Axillary artery/nerve - regimental patch
104
Name two lesions associated with shoulder dislocation
Bankart - detachment of labrum and capsule
| Hill-Sachs - posterior head fracture
105
What X-ray sign is seen in posterior shoulder dislocation?
Light bulb sign
106
What is monteggia fracture?
Ulnar fracture with dislocation of radial head
107
What is galeazzi fracture?
Radial fracture with ulnar dislocation
108
Describe a colles fracture
Extra-articular with dorsal displacement of distal radius
FOOSH onto extended wrist
Risk of median nerve compression
109
Describe a smith's fracture
Extra-articular with volar displacement of distal radium
FOOSH onto flexed wrist
ORIF
110
What is a Barton's fracture?
Intra-articular with dorsal or volar displacement of rim - intra-articular distal radius requires ORIF
111
What is the risk of a scaphoid fracture?
FOOSH
Anatomical snuff box
Risk of non-union - AP lateral and oblique x-ray
112
Why is the scaphoid susceptible to non-union?
Retrograde blood supply
113
What is mallet finger and what is the treatment?
Avulsion of extensor tendon in terminal phalanx
Forced flexion of extended DIJP
Splint 4 weeks
114
Name the three broad types of pelvic fracture
Lateral
Anteroposterior
Vertical
115
What must be done in pelvic trauma?
PR exam to assess sacral nerve root function and look for blood
116
Name the three types of hip fracture
Intracapsular
Extracapuslar
- subtrochanteric
- intertrochanteric
117
What is the risk of an intracapuslar hip fracture?
AVN and non-union
118
What line is interrupted in an intracapuslar fracture?
Shenton's
119
What is the treatment for an intracapsular hip fracture?
Replacement
120
How are extra capsular hip fractures managed?
Internal fixation with dynamic hip screw
121
What is the difference between anterior and posterior dislocation?
Posterior - short adducted internally rotated leg
| Anterior - abducted and externally rotated but not short
