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MIND AND MOVEMENT > Rheumatology and Ortho > Flashcards

Rheumatology and Ortho Flashcards

(53 cards)

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1
Q

Differentials of hip pain in a child

A 
Septic Arthritis
Perches disease
Transient synovitis
Slipped upper femoral epiphysis
Developmental dysplasia of the hip 
JIA
Cancer
Fracture 
Referred pain from knee, back, testes
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2
Q

Transient synovitis

A 
Boys aged 4-8
Limp with or without pain 
Self limiting
Occurs after URTI
treat with ibuprofen
Resolves after few days
Sepsis safeguard!
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3
Q

Slipped upper femoral epiphysis

A 
Boys over age of 10
Usually obese or hypothyroid
Sudden onset pain
Non weight bearing 
Limp
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4
Q

Developmental dysplasia of the hip

A

Girls, usually discovered at birth

Change in leg length

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5
Q

Perthes disease

A

Boys aged 4-8
Avascular necrosis of head of femur
Can be bilateral

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6
Q

Hip pain in child- Nocturnal pain, night sweats, weight loss

A

Think ALL!

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7
Q

Treatment of osteoarthritis

A 
Patient education
Weight loss
Exercise
Physio
Analgesia- WHO ladder
Can escalate to steroid joint injections
Joint replacement
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8
Q

X-ray changes in osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

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9
Q

Osteoarthritis examination findings

A

Heberdens nodes on DIP
Bouchards nodes on PIP
Boxing of hand

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10
Q

Rheumatoid Arthritis X-ray findings

A 
LESS
loss of joint space
Erosions
Soft tissue swelling 
Soft bones (osteopenia)
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11
Q

Rheumatoid arthritis clinical examination findings

A 
Ulnar deviation of fingers
Subluxation of joints
Z thumb
Boggy joint swellings
Swan neck deformities
Boutinierres deformity

Can have nail changes

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12
Q

Negatively birefringent needles under polarised light

A

Gout - urate crystals

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13
Q

Treatment of gout

A

Ibuprofen or colchicine if ibuprofen contraindicated
Febuxostat also used
Allopurinol if repeated attacks (be aware of increase in episodes in first 6 months)

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14
Q

Risk factors for gout

A

High urate intake- red meats, marmite, alcohol
Diuretic use especially thiazides
Metabolic disorders (genetics)
Dehydration

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15
Q

Pseudogout

A

Calcium pyrophosphate crystals
Weakly positive rhomboid shaped crystals
Treatment- ibuprofen, steroid injections, stay hydrated

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16
Q

Describe a fracture

A 
Simple vs comminuted 
Transverse, oblique, spiral
Site
Displaced or not
Angulated or not
Is the bone normal?

Ask for lateral view

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17
Q

Treatment of intra capsular neck of femur fracture

A

Hemiarthroplasty if not very active and co morbidities

Full hip replacement if active and healthy or pre existing joint disease

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18
Q

Presentation of hip fracture

A 
Pain especially on greater trochanter and on rotation 
Usually after fall
Leg externally rotated 
Shortened leg 
Non weight bearing

Could be referred to knee

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19
Q

Treatment of extra capsular NOF fracture

A

Dynamic hip screw or intramedullary fixation

Think about bone protection, analgesia, IV access

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20
Q

Secondary causes of OA in young people

A

Crystal deposition, acromegaly, haemochromatosis, Wilson’s disease, joint injury, surgery, SUFE, diabetes, syphillis, inflammatory arthritis

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21
Q

Hot swollen painful joint

A

Septic arthritis until proven otherwise!

Gout
Rheumatoid arthritis 
Pseudogout
Psoriatic arthritis
Haemoarhrosis
Reactive arthritis
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22
Q

Symptoms of septic arthritis

Study These Flashcards
A

Hot painful swollen joint
Systemically unwell
Fevers
Acute onset

23
Q

Diagnosis of septic arthritis

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A

Joint aspirate and culture!!

24
Q

Treatment of septic arthritis

Study These Flashcards
A

Analgesia
Broad spec antibiotics eg ceftriaxone
Usually a stall aureus infection
Look for underlying risks such as immunosuppression

25
Back pain In 15-30 YOA
Prolapsed disc Trauma Fractures Ankylosing spondylitis
26
Back pain in 30-50 YOA
Degenerative spinal disease, prolapsed disc, malignancy
27
Back pain in over 50s
Degenerative, osteoporotic vertebral collapse, pagets, malignancy, myeloma, spinal stenosis
28
Positive straight leg raise
Sciatica Under 50s due to prolapsed disc Over 50 due to spinal stenosis
29
Symptoms of lupus
``` Malar rash Discoid rash Photosensitivity Oral ulcers Arthritis Pleuritis Renal involvement Haematological involvement Immune involvement Positive ANA ```
30
SLE antibodies
ANA >95% | Anti dsDNA- over 60%
31
Treatment for SLE
Anti inflammatories eg ibuprofen Corticosteroids during flare up Immunosuppression Symptom control- suncream, kidney treatment if necessary
32
Positive c-ANCA
Small vessel vasculitis Microscopic polyangitis GPA
33
GPA- granulomatosis polyangitis
Positive c ANCA | Nasal crusting, lung lesions, saddle nose deformities
34
P ANCA
Church Strauss Eosinophilia granulomatosis polyangitis EGPA Linked with asthma
35
Medium vessel vasculitis
Kawasaki- symptoms in children, fever, strawberry tongue, rash
36
Giant cell arteritis
``` Temporal arteritis Give prednisone ASAP Need biopsy within seven days of starting pred to get positive biopsy. Increase ESR!! Jaw claudication Temporal tenderness Headache around eye ```
37
Takayasu’s arteritis
Absent pulses Happens in younger People PET scan shows activity Pred and strong DMARDS eg cyclophosphamide
38
Polyarteritis nodosa
Associated with hep B Get aneurysms Control BP as affects kidneys
39
Symptoms of fibromyalgia
Pain in at least 11 of the 18 pain points- above and below waist, either side of axis and on spine Difficulty sleeping Chronic widespread pain lasting over three months
40
Risk factors of fibromyalgia
Low education, low income, female, FH, traumatic event
41
Treatment for fibromyalgia
Exercise! Screen for depression and anxiety Sleep hygiene
42
Reactive arthritis
After GU or GI infection | Reiter’s anterior uveitis, arthritis, urethritis
43
Ankylosing spondylitis
Back pain In young males HLAB27 positive in 90% Pain in sacroiliac joints
44
Associations with ankylosing spondylitis
``` Aortic regurgitation Apical fibrosis igA nephropathy Anterior uveitis Achilles tendinitis Amyloidosis ```
45
Treatment of ankylosing spondylitis
1. Exercise 2. Ibuprofen 3. If necessary anti TNF-a or local steroid injections
46
Symptoms of rheumatoid arthritis
Boggy swelling in hands Stiffness and pain worse in morning Symmetrical usually in wrists, MCP, PIP Positive for RF and anti CCP
47
Monitor rheumatoid arthritis
DAS28 helps to monitor disease activity
48
side effects of methotrexate
Mucositis, penumonitis, oral ulcers, hepatotoxicity
49
TNF alpha blocker side effects
Serious infection risk including reactivation of TB, hep B Worsens heart failure Hypersensitivity Injection site reaction
50
Anti Ro and Anti La
Sjogrens
51
CREST
Anti centromere antibodies
52
Anti SCL 70
Scleroderma
53
Anti ds DNA and ANA
SLE

MIND AND MOVEMENT (6 decks)

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