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MSRA 2023 > Rheumatology + MSK > Flashcards

Rheumatology + MSK Flashcards

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1
Q

Ix Rheumatoid arthritis

A

Rheumatoid facture-> 1st LINE
- does not indicate disease activity

anti-CCP (cyclic citrullinated peptide)
- (+) 10yrs before development RA

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2
Q

Mx Rheumatoid arthritis flare

A

po/im steroid

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3
Q

DMARD medications

A

MTX, salfasalazine, leflunomide, hydroxychloroquine

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4
Q

IC NOF mx

A

undisplaced: internal fixation/ hemi if unfit
displaced: THR/ hemi to ALL pt

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5
Q

when to consider THR

A

THY: independent (max use of stick)
no cognitive impairment
MFFD for anaesthetics

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6
Q

EC NOF mx

A

stable INTERTROCHANTERIC: DHS

reverse oblique, transverse, subtrochanteric #: IM

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7
Q

stable intertrochanteric # mx

A

DHS

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8
Q

reverse oblique, transver, subtrochanteric EC NOF

A

IM nail

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9
Q

Ankylosing spondylitis typical presentation + during which time of day worst

A

back pain + stiffness
stiffness worse in morning + improves with exercise
reduced lateral flexion

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10
Q

Schrober’s test

A

Ankylosing spondylitis: line drawn 10cm above + 5cm below back imple
If distance btw 2 line does NOT increase by >5cm when pt bends

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11
Q

which other disease associated with ankylosing spondylitis
(name eye condition)

A

anterior uveitis

(A’s: ant uveitis, apical fibrosis, aortic regurg, achilles tendonitis, AV node block, amyloidosis, CES, periph arthritis

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12
Q

Mx Ankylosing spondylitis

A

regular exercise
NSAIDS- 1st line
Phyio
DMARD- sulphsalazine only useful if periph joints involved
anti-TNF if persistently high disease activity

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13
Q

what is the % for HLA (+) in ankylosing spondylitis

A

90% (+) HLA-B27

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14
Q

Spinal epidural abscess (Ix + Mx + most common pathogen)

A

Staph Aureus
Ix: MRI whole spine, sepsis workup , may need echo or dental XR

Mx: long term broad spectrum abx-> until culture results
large/compressive abscess with progressive neuro deficit-> SURGERY

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15
Q

Rheumatoid arthritis Mx

A

RA:

1) initial Tx: DMARD monotx +/- short course of bridging prednisolone

MTX: monitoring FBC/ LFT risk of myelosuppresion + liver cirrhosis
other: sulfasalazine, lefluomide, hydroxychloroquine

2) TNF inhibitor: if inadequate response to least 2 DMARD incl MTX
- etanercept, infliximab, adalimumab MAKE SURE CXR + Tuberculin test. May cause reactivation of TB

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16
Q

chondromalacia patella

A

aka Runner’s knee knee problem in children

softening of cartilage of patella, common anterior knee pain. Cartilage on underside of patella kneecap becomes siftened + irritated due to overuse/ poor alignment

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17
Q

Osgood-Schlatter disease

A

tibial apophysitis
knee problem in children, sporty teens. Bony prominence just below kneecap over tibial tubercle

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18
Q

Osteochondritis dissecans

A

small fragment of bone + cartilage become detachedfrom surrounding tissue due to inadequate blood supply, intermittent swelling + locking

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19
Q

Thessaly’s test

A

To check meniscal tear

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20
Q

Perthes disease

A

Degeneration of hip joints affecting ages 4-8 years due to a vascular necrosis of femoral head.

Pain progressively over weeks, limp
XR widening of joint spaces, decreased or flattening of femoral head

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21
Q

Red flag sx of back pain

A

Age <20 or >50
Prev malignancy
Night pain
Hx trauma
Unwell
Thoracic back pain
Focal neurology: urinary or fecal incontinence or urinary retention, Lowe ling weakness, decreased sphincter tone

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22
Q

Web Duchenne Palsy

A

Damage to upper brachial plexus c5&6
Arm along side , internal rotation, elbow extended

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23
Q

Klumpke injury

A

Damage to lower part of brachial plexus c8, t1

MCP Joint extended
IP joints flexed

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24
Q

Colles fracture

A

Dorsal displacement
Fracture of radius

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25
Smiths fracture
Reverse colles fracture Volar angulation of distal radius fragment
26
Bennett’s fracture
Intra articulated fracture at base of thumb metacarpal
27
Monteggias fracture
Dislocation prox radioulnar joint ass with ulnar fracture
28
Galeazzi fracture
Radial shaft fracture with dislocation of distal radioulnar joint
29
Which crystal in pseudogout
Calcium pyrophosphate crystal deposition Weakly + birefringent rhomboid shaped crystals
30
Ix and mx of pseudogout
Joint aspiration: weakly positive bigringent rhomboid shaped crystal, calcium pyrophosphate dehydrate crystal Mx: nsaids, intra articular or muscular steroid
31
Uric acid level in gout and which crystal
Uric acid >450umol/l Monosodium urate crystal
32
Osteoarthritis mx and radio findings
Loss of joint space Osteophytes Sunbxhondral sclerosis Subchondral cyst Mx: 1st line, topical analgesics 2nd line: po nsaids with ppi
33
Most common reason for revision in ThR
Aseptic loosening
34
FRAX Score
10 year risk of fragility fracture Valid 40-90 years Assess: age, sex, weight, height, prev fracture, parenteral fracture, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol intake
35
Dx of Achilles rupture
Simmonds/thompson: lie prone with feet over edge. Pressing calf does not elicit plantar flexion Initially dx: us of heel
36
Adhesive capsulitis risk factor and which movement affected. Phases
Frozen shoulder Risk factor: DM !!!! Phases: painful, adhesive phase and recovery phase. Affects external rotation> internal rotation
37
Most common pathogen in osteomyelitis especially in sickle cell
Staph aureus Sickle cell: salmonella
38
Most common pathogen discitis
Staph aureus
39
Causes of talipes equinovarus. Also foot position
Inverted and plantar flexion Most common: idiopathic Others: spina bifida, cerebral palsy, Edward’s syndrome, oligohydramnios
40
Compartment syndrome dx
Intracompartment pressure >40mmHg diagnostic If >20mmHg abnormal
41
Signs seen in carpal tunnel syndromes
Trapping of median nerve Tinel sign: tapping of the palmar surface of wrist elicits sx Phalens sign: flexion of wrists elicit sx
42
Dermatomyositis what is it and what do you need to look for, Dx, signs
Inflammatory disorder of skin and muscle. Ass with underlying connective/ maliganancy therefore NB to Ix further. Affects skin: heliotrope rash/ gottrons papule Muscle: prox muscle weakness, interstitial lung disease Ab: 80% +ANA, 30% aminoacyl tRNA synthntase. Jo-1 histidine tRNA ligament Ab, Ab signal recognition particle, anti-Mi-2 Ab which is seen in acute phase ass with better prognosis
43
What is seronegative arthropod-atheist and diseases included in this group
Inflammatory rheumatic disease involving axial, peripheral and enthesitis. + for HLA B27 but negative for rheumatoid factor. Group: ankylosis spondylitis, reactive arthritis, psoriatic arthritis, Behçet, juvenile idiopathic arthritis, behests, enteropathic arthritis. Share anterior uveitis, IBD
44
Common sx for Ankylosing spondylitis, which test and dx
Young male back pain and stiffness. Reduced lateral flexion. Schrobers test- dimple <5cm on when bending forward Apical fibrosis, anterior uveitis, Achilles tendinitis, AV node block, anhydrosis,. XR bamboo spine
45
Mx of ankylosing spondylitis
NSAIDS DMARD; sulphasalazine Anti TNF: given when persistently high disease activity
46
Pulmonary function in ankylosing spondylitis
Restrictive picture due to fibrosis CXR: apical fibrosis
47
What does high rhetoric factor mean in rheumatoid arthritis
Disease severity
48
When to add TNF-alpha inhibitor in RA
When 2 DMARdS fails including methotrexate
49
What do need to check before starting TNF-alpha inhibitors
Tuberculin test and CxR
50
MTX Side effect
Pneumonia is Liver cirrhosis, myelosuppr4ssion
51
Sulfasalazine SE
Oligospermia, interstitial lung disease, Heinz body anaemia, rashes
52
Leflunomide side effect
Interstitial lung disease Liver impairment HTN
53
Hydroxychloroquine SE
Retinopathy, corneal deposit
54
Gold SE
Proteinuria
55
Penicillamine
Proteinuria Myasthenia gravis
56
SE of etanercept,infliximab, adalimumab, rituximab
Etanercept: demyelination react TB Inflixi : +Tb Adali: +tb Rituximab: infusion reaction
57
Sjogrens syndrome dx, mx
Affects exocrine glands. Ab: RF+, ANA+, Anti Ro 9ssA) Ab 70%, anti-La SSB Ab Schirmers test Pilocarpine + salivation
58
Systemic sclerosis classification and antibodies
Limited cutaneous SS: anti centromere Diffuse SS: anti alc-70 Ab OtherANA, RF
59
Polymyalgia Rheumatica sx, mx, lab findings
PMR - affects shoulder and hip joint, rheumatic disease affecting joint but not muscle Associated temporal arthritis Morning stiffness Lab: >ESR .40mm/hr CK and EMG normal Mx:prednisolone 15mg OD responds well
60
Mx raynauds
1st line calcium channel blocker If prostacyclin infusion Avoid beta-blocker
61
SLE dx and antibodies
SOAP BRAIN MD Serositis Oral or nasal ulcer Arthritis >2 joints Photosensitivity Blood disorder: anaemia, thrombocytopenia Renal: Proteinuria ANA + Immunological: Anti Smith, Anti-dsDNA, Anti-phospholipid- false + in syphilis, Kuous Ab, Anti beta 2 GP I Neuro: seizure, psychosis, anxiety Malar rash Discoud rash
62
Mx giant cell arteritis, dx
Dx: high EsR >50, CRp may be elevated Biopsy: temporal artery biopsy shows skip lesions Mx: high dose steroid
63
Anti phospholipid syndrome lab findings include Ab and fbc and coat profile
Anti cardiolipin Ab Anti beta glycoprotein I Ab Thrombocytopenia Prolonged aptt
64
Meralgia paraesthetica
Anaesthesia in distribution of lateral femoral cutaneous nerve Burning tingling coldness shooting pain and numbness in upper lateral thigh
65
Type 1 hypersensitivity mechanism
IgE bound to mast anaphylaxis, asthma, eczema, hayfever
66
Type II mech
IgG or IgM Autoimmune haemolytic anaemia, ItP, goodpastures syndrome Pernicious anaemia Acute haemolytic transfusion Rheumatoid fever Pemphigus vulgaris/ bulbous emphigoid
67
Type III hypersensitivity mechanism
Free antigen and Ab igG and IgA combine Serum sickness, SLe, post streptococcal glomerulonephritis, extrinsic allergic alveolitis
68
Type IV delayed hypersensitivity mechanism of action
T cell mediated TB Graft vs host disease Scabies Extrinsic allergic alveolitis Multiple sclerosis gbS
69
Rotator cuff tear vs subacromial impingement
Subacromial impingement 60-120 degree Rotator cuff tear 1-60 degrees and tenderness over anterior acromion

MSRA 2023 (22 decks)

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