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Flashcards in Rheumatology Deck (89)
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1

Name some recognised systemic manifestations of SLE

Alopecia
Vasculitis
Epilepsy
Polyneuritis
Stroke
Chorea
Pleurisy
Atelectasis
Pulmonary fibrosis

2

In a patient presenting with low back pain, what are 3 important factors to ask about in the history?

Neurological symptoms in legs: weakness, numbness, paraesthesia
Urinary/bowel symptoms: incontinence
FH of ankylosing spondylitis

3

What are the Calin criteria for inflammatory back pain?

Age of patient at onset: under 40 (1)
Insidious onset (1)
Morning stiffness (1)
Persistence for months: over 3 (1)
Response to exercise: improves (1)

4

HLA B27 test has 90% sensitivity and 90% specificity in a population with chronic back pain for ank spond. In that population 5% will have ank spond. What are the chances of a patient with chronic back pain and a positive HLAB27 having ank spond?

about 30%
200 people with chronic back pain, 10 will have ank spond
Of those 10, 9 will test positive for HLAB27 (sensitivity)
Of the 190 that don't have it, 10% false positive rate so 19. Out of 200 tests: 9 positives from people with AS, 19 positives from people without AS. So 9/28 chance = around 30%

5

What blood results would make you suspect that a patient has Paget's disease of the bone?

Raised alkaline phosphatase
Plasma calcium, phosphate and aminotransferase all normal

6

What is osgood schlatter disease?

Tension at patella tendon leading to avulsion fracture
Symptoms of pain and swelling over tibial tubercle

7

What is osgood schlatter disease?

Tension at patella tendon leading to avulsion fracture
Symptoms of pain and swelling over tibial tubercle

8

What is an enthesis?

Where tendon inserts into bone, where the collagen fibres are mineralised and integrated into bone tissue

9

What is a bursa?

Fluid filled sac located between a bone and tendon which normally serves to reduce friction between two moving surfaces

10

How can you differentiate between articular and periarticular problems?

Articular: pain all planes, active = passive, capsular swelling/effusion, joint line tenderness, diffuse erythema/heat
Periarticular: pain in plane of tendon, active > passive, linear swelling, localised tenderness, localised erythema/heat

11

What is flexor tenosynovitis?

Inflammation of flexor tendon sheaths
Pain and stiffness in flexor finger/thumb, may extend to wrist
Reduced active flexion, crepitus, thickened tender tendon sheaths
May be associated with nodule – trigger finger
Can be associated with RA, Diabetes

12

What is treatment for flexor tenosynovitis?

Injection hydrocortisone
Surgery

13

What is de Quervains tenosynovitis? How can you test for it?

Inflammation of tendon sheath containing extensor pollicis brevis and abductor pollicis longus tendons
Pain, swelling radial wrist
Localised tenderness, crepitus, pain worse over radial styloid
Positive Finkelstein’s test

14

What is Finklesteins test?

With thumb flexed across the palm of the hand, ask patient to move the wrist into flexion and ulnar deviation
Positive if reproduces pain

15

What is the management for de Quervains tenosynovitis?

Rest from precipitating activity
Splintage
Steroid injection
Surgery

16

What conditions can precipitate carpal tunnel syndrome?

Diabetes
Hypothyroidism
RA
Pregnancy
Acromegaly
Vasculitis
Trauma
Amyloid
Sarcoid

17

What does the median nerve supply in the hand?

Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Sensory: Palmar surface thumb, lateral 2 1/2 digits

18

What are clinical features of carpal tunnel syndrome?

Numbness/parasthesia in median nerve distribution
Pain, can radiate up arm
Worse at night
Hang hand over end of bed
Weakness of thumb (abduction)
Thenar wasting
Positive Tinel’s/Phalen’s

19

What investigation can be done for carpal tunnel syndrome?

Nerve conduction studies show reduced nerve conduction velocities across wrist

20

What is the management for carpal tunnel syndrome?

Avoidance of precipitating activity
Night time splints
Local steroid injection
Surgery – division of flexor retinaculum and decompression of carpal tunnel (80% success)

21

What are tennis and golfers elbows?

Tennis elbow: lateral epicondylitis, inflammation common extensor origin
Golfer’s elbow: medial epicondylitis, inflammation common flexor origin
Pain localised to specific area
Elbow flexion/extension does not cause pain
Pain upon: resisted wrist extension (Tennis)
resisted wrist flexion (Golfer’s)

22

What is management for tennis and golfers elbows?

Rest from precipitating activity
Elbow clasps
Local corticosteroid injection
Physiotherapy – ultrasound and acupuncture
Surgery (often ineffective)

23

What problems can occur with the rotator cuff?

Supraspinatous tendinitis/rupture
Rotator cuff tear
Adhesive capsultitis (frozen shoulder)
Acute calcific supraspinatous tendonitis
Subacromial bursitis
Acromioclavicular joint OA

24

What are the muscles of the rotator cuff and what are their functions?

Supraspinatous - abduction
Infraspinatous – external rotation
Teres minor – external rotation
Subscapularis – internal rotation

25

What is rotator cuff syndrome? And what test can be done for it?

Spectrum from mild supraspinatus tendinitis to complete tendon rupture
Chronic impingement of cuff under acromial arch
Pain often over acromial area extending into deltoid
Painful mid arc
Impingement test – abducted, flexed and internally rotated
Supraspinatus stress

26

How can a rotator cuff problem be investigated?

USS

27

What is the management for rotator cuff syndrome?

Rest, NSAIDs
Local steroid injection around tendon – subacromial space and PT
If chronic/rupture refer to Orthopaedics for surgical opinion

28

What is acute calcific supraspinatus tendonitis?

Calcium hydroxyapatite deposition near supraspinatus enthesis
Young adults, F>M, acute pain over several hours
Normally resolves over few days

29

What is the management for acute calcific supraspinatus tendonitis?

Minor – NSAID
Moderate – consider steroid injection
Severe – consider aspirating calcified material

30

What is adhesive capsulitis (frozen shoulder)?

Progressive pain and stiffness
Global reduction in movement, but particularly external rotation
Three phases: Pain (3-5 months), Adhesive phase (4-12 months), Recovery phase (12-42 months)
Associated with diabetes
Most patients recover by 30 months, but still have reduced movements