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Step 2 Flashcards

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1
Q

anterior vs posterior hip dislocation clinical sign

A

anterior - leg lengthened and externally rotated

posterior - leg shortened and internally rotated

hip fracture - leg shortened and externally rotated

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2
Q

anterior vs posterior shoulder dislocation clinical sign

A

anterior (most common) - arm in abduction and externally rotated

posterior (seizures, electrocution) - arm adducted and internally rotated

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3
Q

acute onset of anterior shoulder pain with weakness on abduction and external rotation of the shoulder ?diagnosis ?management

A

acute rotator cuff tear
minor - conservative
surgery if lack of active movement with preserved passive movement

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4
Q

diaphyseal fracture of proximal ulna with radial head subluxation

A

Monetggia fracture
- ORIF + closed reduction of radial head

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5
Q

diaphyseal fracture of radial shaft and dislocation of distal radioulnar joint

A

Galazzeazi fracture
- ORIF of fracture + casting in supination to reduce dislocation

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6
Q

scaphoid fracture management

A

thumb spica cast
serial x-rays
if non-union or displacement >1mm then surgical fixation

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7
Q

boxer’s fracture management

A

5th metacarpal fracture
closed reduction + splint
surgery if >1 metacarpal fracture

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8
Q

Baker’s cyst may develop in a patient with what underlying condition

A

osteoarthritis

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9
Q

patient presents with bruising over the medial malleolus, calf pain and weak dorsiflexion of the foot. ?diagnosis ?management

A

Baker’s cyst
- presents with knee pain, painless buldge at the back of the knee, tibial nerve injury, calf pain + ‘crescent sign’ (eccymosis over medial malleolus)

management:
- doppler to rule out DVT
- supportive with NSAIDS etc
- surgery if remains symptomatic

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10
Q

Ottawa rules for ankle X-ray

A

cannot walk 4 steps

or

either;
- pain over malleolar zone + medial or lateral malleolus
- pain over mid foot and navicular or proximal metatarsals

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11
Q

inpatient who had a chest tube inserted for pneumonia 3 days ago is not able to abduct his arm past 90 degrees ?diagnosis

A

long thoracic nerve injury

other causes include;
- axillary node disseaction
- stab wound to axilla

associated with winged scapula on examination

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12
Q

what is Benedict sign

A

when asked to make a fist, there is failed flexion (causing extension) of the 2nd and 3rd fingers with abduction of the thumb

caused by proximal median neve injury

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13
Q

absent biceps reflex ?nerve injured

A

musculocutaneous

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14
Q

patient with shoulder dislocation is unable to flex his elbow ?cause

A

musculocutaneous nerve injury

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15
Q

foot drop ?nerve injured

A

common peroneal

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16
Q

nerve injured that causes trendelenburg gait and what side is affected

A

superior gluteal nerve (supplied gluteus medius and minimus)

contralateral side to nerve injury drops because the nerve cannot supply the muscles required for abduction

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17
Q

impaired knee jerk/reflex ?nerve injured

A

femoral

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18
Q

weak hip flexion and knee extension ?nerve injured

A

femoral

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19
Q

patient with history of previous road traffic accident, presents with ongoing pain in right leg . on examination there is loss of leg hair, hypersensitive to touch and pain is located in a non-anatomical distrubution ?diagnosis ?initial tretament

A

complex regional pain syndrome

  • NSAIS + physical/occupational therapies

other:
- steroids, TCA’s, gabapentin, pregabalin
- chemical sympathetic blockade
- refer to chronic pain specialist

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20
Q

most common metastatic location of osteosarcoma

A

lung

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21
Q

soap bubble on Xr

A

giant cell tumour
- benign

associated with Paget’s disease

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22
Q

treatment for giant cell tumours

A

Denosumab

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23
Q

osteochondroma, osteoblastoma and osteoid osteoma treatment

A

osteochondroma - serial XR
osteoblastoma - resection +/- chemo
osteoid osteoma - conservative, surgery if refractory

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24
Q

bone tumour that projects out of the growth plate

A

osteochondroma

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25
benign bone tumour commonly found in the spine
osteoblastoma (blasts the back) usually > 2cm
26
what benign bone tumour can have malignant transformation into chondrosarcoma
endochondroma - inital classic finding of endochondroma is lytic lesion in hand/foot associated with FHx of Ollier disease or Maffucci syndrome
27
most common benign bone tumour
osteochondroma - projects out of the growth plate - often young males - painless bony mass - manage with serial X-rays
28
empirical abx for septic joint
ceftriaxone + vancomycin
29
young male presents with thigh pain. XR shows small lucid nidus. ?diagnosis ?treatment
osteoid osteoma treat with NSAIDS
30
causative organism of osteomyelitis if foot puncture wound
pseudomonas
31
causative organism of osteomyelitis if recent hip surgery
staph epidermidis (coagulase negative staph)
32
causative organism of osteomyelitis if diabetic
polymicrobial, staph aureus, pseudomonas, streptococci, anaerobes
33
test of choice and most accurate test for suspected osteomyelitis
test of choice: MRI most accurate: bone aspiration with gram stain and culture
34
whats the correlation with penicillin and cephalosporin allergy
they have some cross-reactivity if someone has allergic rash to penicillin then can have cephalosporin but if its an anaphylactic reaction then avoid cephalosporin and use non-beta lactam antibiotic
35
explain how osteomyelitis can cause cancer
a possible complication of osteomyelitis is chronic osteomyelitis with a long standing draining sinus which can develop into squamous cell carcinoma (Majorlins ulcer) marjolins ulcer is the development of cutaneous SCC at the site of injury/trauma/burn
36
what underlying condition can increase risk of development of gram negative rod osteomyelitis
gram negative rod-shaped bacillus = salmonella - sickle cell disease - treat with ceftriaxone or ciprofloxacin
37
HLA associated with rheumatoid arthritis
HLA-DR4
38
Caplan syndrome
one of the RA- associated syndromes - rhuematoid arthritis - pneumoconiosis - lung nodules
39
Felty's syndrome
one of the RA-associated syndromes - rheumatoid arthritis - splenomegaly - neutropenia
40
RA vs psoriatic arthritis joint location
DIP is spared in RA but can be involved in psoriatic arthritis
41
IgM bodies against the Fc region of IgG
rheumatoid arthritis
42
diagnostic criteria for rheumatoid arthritis
6 or more of the following; - RF or anti-CCP positive - elevated ESR or CRP - inflammatory arthritis of 3 or more joints (up to 5 points) - symptoms present > 6 weeks - not explained by other similar conditions i.e. SLE, psoriatic arthritis
43
1st line for rheumatoid arthritis
methotrexate NSAIDS or steroids can be used while bridging DMARD therapy
44
extra-articular manifestations associated with rheumatoid arthritis
carpal tunnel syndrome sjogrens syndrome vasculitis lung fibrosis anaemia of chronic disease cardiovascular disease amyloidosis caplan syndrome felty syndrome scleritis
45
cutaneous features found in reactive arthritis
painless ulcerative lesions on glands penis (circinate balanitis) lesions on palms and soles (keratoderma blanorrhagica)
46
patient presents with weakness of the shoulders and a rash that involves the upper shoulders, upper chest and back ?diagnosis
dermatomyositis
47
what are gottrons papules
papular rash with scales overlying bony prominences of dorsum of the hands found in dermatomyositis
48
biopsy finding polymyositis vs dermatomyositis
dermatomyositis = perifasicular inflammatory infiltrates polymyositis = endomysial inflammatory infiltrate around muscle fibres
49
malignancies associated with dermatomyositis
lung, breast, ovarian
50
complications associated with polymyositis and dermatomyositis
malignancy (D>Polymyositis) interstitial lung disease (10%) cardiac: myocarditis + conduction defects oesophageal = dysphagia
51
best initial treatment for dermatomyositis/polymyositis
steroids - methotrexate or azathioprine for refractory disease
52
elevated AST and ALT (AST>ALT) but no sign of alcohol or fatty liver disease. what blood test should you check?
CK for myopathy - AST and ALT are muscle enzymes, as well as LDH and aldolase
53
what antibody is a risk factor for renal crisis in a patient with scleroderma
anti-RNA polymerase III antibody
54
1st line tretament for scleroderma renal crisis
ACE inhibitors
55
medication for limited scleroderma
methotrexate
56
medication for acute flares of systemic sclerosis
steroids (but beware as can increase risk of renal crisis)
57
antiboydy associated with neonatal lupus and what does this increase the risk of
Anti-Ro risk of heart block
58
medication used for severe lupus nephritis
cyclophosphamide or mycophenalate must obtain renal biopsy prior to starting treatment
59
medication used for SLE with strictly joint and skin involvement
hydroxychloroquine
60
patients with SLE can have what false negative test
venereal disease research laboratory (VDRL) and rapid plasma reagin test (RPR)
61
treatment for giant cell arteritis if vision loss
if vision loss then give pulse-dose steroids
62
artery involved in temporal arteritis
anterior ischaemic optic neuropathy due to ischaemia of posterior ciliary artery (branch of ophthalmic artery)
63
asian female is evaluated and found to have different BP on each arm and absent peripheral pulses. ESR and CRP are elevated ?diagnosis ?treatment
takayasu arteritis CT or MR angio of aorta will show narrowing treat with high dose steroids
64
behcets disease and common cause of mortality
recurrent painful oral and genital ulcers + uveitis topical steroids for ulcers ophthlamic steroids for uveitis prevention with colchicine thrombosis major cause of morbidity
65
tretament for polymyalgia rheuamtica
low dose steroids 10-20mg/day
66
delta pressure for compartment syndrome
diastolic pressure - compartment pressure positive if < 30
67
why is sensory dysfunction spared over the thenar eminence in late carpal tunnel syndrome
thenar motor innervation is median nerve but sensory innervation is from palmar sensory cutaneous nerve
68
negatively birefringent crystals vs positively birefringent crystals on microscopy
positively birefringent rhomboid shaped crystals = pseudogout negatively birefringent ceedle shaped crystals = gout
69
conditions associated with pseudogout
haemochromatosis hyperparathyroidism (hypercalcaemia) hypothyroidism
70
what pre-existing medications are a contraindication to the use of allopurinol or febuxostat for gout prophylaxis
azathioprine or 6 mercaptopurine xanthine oxidase inhibitors inhibit the metabolism of these drugs
71
alternative to xanthine oxidase inhibitors for people who are already on azathioprine or 6 mercaptopurine
uricosuric agents i.e. probenacid contraindicated in people with tophi, nephrolithiasis or CKD
72
adverse effect of xanthine oxidase inhibitors i.e. allopurinol
can increase urate nephropathy
73
side effects of colchicine
inhibits neutrophil chemotaxis bone marrow suppression (neutropenia) diarrhoea neuromyopathy
74
indications for gout prophylaxis and prophylactic options
2 or more flares, tophi or structural joint damage xanthine oxidase inhibitors i.e. allopurinol, febuxostat uricouric agents i.e. probenacid
75
diagnostic clinical test for herniated disc
passive straight leg raise eliciting pain
76
treatment for refractory spinal stenosis
surgical laminectomy mild: NSAIDS severe: epidural steroid injections refractory: surgical laminectomy
77
13 year old gymnast complains of lower back pain that is worse when doing gymnastics and relieved with rest. there is a papable bony region lateral to the lumbosacral vertebra. ?diagnosis
spongylolisthesis or spondylosis common in pre-adolescents with repetitive back extension and rotation i.e. divers/gymnasts spondylolithsthesis = anterior displacement of lumbar vertebra sponylosis = bilateral fracture of posterior arch of the vertebra manage with rest, symptom controL (stretching) and close follow up. watch for any red flag signs which may warrant imaging.
78
nerve roots affected with disc herniation if associated urinary incontinence and sexual dysfunction and what cutaneous sensation does this provide
S2-S4 sensation to posterior and medial thigh + perianal area anocutaneous reflex
79
nerve root affected with disc herniation if loss of patella reflex ? what movements is this nerve root responsible for? sensation distrubution?
L2-L4 hip flexion, knee extension and foot dorsiflexion (tibialis anterior) sensation over anterior thigh and medial lower leg
80
nerve root affected with disc herniation if loss of achillies reflex ? what movements is this nerve root responsible for? sensation distrubution?
S2 hip extension and plantar flexion sensation over lateral aspect of lower leg and little toe
81
nerve root affected with disc herniation if unable to dorsiflex big toe? what movements is this nerve root responsible for? sensation distrubution?
L5 big toe dorsiflexion and eversion (peroneal nerves) sensation over lateral aspect of foot and big toe
82
intrinsic and extrinsic risk factors for club feet (congenital talipes equinovarus)
intrinsic; - spina bifida (most common) - trisomies - myotonic dystrophy - spinal muscular dystrophy extrinsic; - diabetic mother - oligohydramnios - breech presentation - multiple gestations - uterine abnormalities
83
abx of choice for catch scratch disease (B henselae)
macrolide i.e. azithromycin
84
polymyositis vs polymyalgia rheumatica presentation
polymyositis - proximal muscle weakness, elevated CRP/CK/ESR/AST/ALT/LADH polymyalgia rheumatica - proximal and girdle muscle stiffness, elevated ESR
85
2nd line option for RA if methotrexate not tolerated
etanercept
86
etanercept side effects
reactivation of TB and hep B
87
history of HIV presents with bakc pain. XR shows lytic lesion with surrounding abscess. Bone biopsy shows necrotic tissue and inflammatory infiltrates with multi-nucleated giant cells ?diagnosis
Pott's disease - spinal TB
88
DMARDS safe during pregnancy
hydroxychloroquine certolizumab pegol

MSK (4 decks)

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