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Ortho and Rheum 2

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bethdrysdale's version from 2017-11-13 15:13

Section 1

Question Answer
what is trigger finger? associated with abnormal flexion, disparity between the size of the tendon and pulleys through which they pass. In simple terms the tendon becomes 'stuck' and cannot pass smoothly through the pulley. Women, RA and diabetes. steroid injections
DMARDs - Sulfasalazineinflammatory arthritis. allergy to aspirin contraindicates use.
Bone protection for long term steroidsoral alendronate + ensure calcium and vitamin D replete
Herbedens nodesosteoarthritis
Greater trochanteric pain syndrome (Trochanteric bursitis)Due to repeated movement of the fibroelastic iliotibial band Pain and tenderness over the lateral side of thigh Most common in women aged 50-70 years
"pencil-in-cup" changes on xraypsoriaritic arthropathy.Around 10-20% percent of patients with skin lesions develop an arthropathy. rheumatoid-like polyarthritis: (30-40%, most common type)
DMARDs - Leflunomideteratogenic! monitor FBC/LFTs and BP. adverse effects: hypertension, GI effects, weight loss, myelosuppression, peripheral neuropathy
Golfers vs Tennis elbowgolfers = medial epicondylitis. tennis = lateral epicondylitis. overuse injuries. Lateral epicondylitis: worse on resisted wrist extension/supination whilst elbow extended
Gout treatmentstart allopurinol if 2 or more attacks in 12 months. Aspirin at doses lower than 150mg does not have effect on uric levels.
Patella Dislocationcommon cause of haemarthrosis, many spontaneously reduce when leg is straightened. Chronic = physio to strengthen quadriceps
DMARDs - Infliximab and Adalimumabreactivation of tuberculosis!!!!
Fat embolism symptomsrepiratory = tachycardia, tachypnoea, pyrexia. Derm = red/brown impalpable petechial rash. CNS = confusion, agitation.
back pain with no red flags - managementoral non-steroidal anti-inflammatory drugs (NSAIDs) for managing low back pain, taking into account potential differences in gastrointestinal, liver and cardio-renal toxicity, and the person's risk factors, including age. NSAIDs can worsen kidney disease.
Marfans syndromeautosomal dominant connective tissue disorder. It is caused by a defect in the fibrillin-1 gene on chromosome 15
Ankylosing spondylitischronic inflammatory rheumatic disease which results in lower back pain that is worse in the mornings and typically improved by exercise. The condition usually begins in early adulthood and is associated with human leukocyte antigen B27 (HLA-B27). Other features - the 'A's Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis and cauda equina syndrome peripheral arthritis (25%, more common if female)
Polymyalgia RheumaticaTo differentiate between polymyalgia rheumatica and statin-induced myopathy, ESR is usually measured. Patients with polymyalgia rheumatica will have a significantly elevated ESR. Pathophysiology overlaps with temporal arteritis. Treatment prednisolone e.g. 15mg/od. morning stiffness in proximal limb muscles (not weakness)
Felty's syndromeFelty's syndrome is a condition characterized by splenomegaly and neutropenia in a patient with rheumatoid arthritis. Hypersplenism results in destruction of blood cells which classically results in neutropenia but can also cause pancytopenia.
Compartment syndromeSymptoms and signs Pain, especially on movement (even passive) Parasthesiae Pallor may be present Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise Paralysis of the muscle group may occur
Systemic sclerosisLimited cutaneous systemic sclerosis Raynaud's may be first sign scleroderma affects face and distal limbs predominately associated with anti-centromere antibodies a subtype of limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia.
Scleroderma Scleroderma (without internal organ involvement) tightening and fibrosis of skin may be manifest as plaques (morphoea) or linear
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Section 2

Question Answer
Takayasu's arteritisaorta and major branches, women of child bearing age. divided into acute systemic phases and the chronic pulseless phase. In the latter part of the disease process the patient may complain of symptoms such as upper limb claudication. In the later stages of the condition the vessels will typically show changes of intimal proliferation, together with band fibrosis of the intima and media.
Buergers Diseasemost common in young male smokers. In the acute lesion the internal elastic lamina of the vessels is usually intact. As the disease progresses the changes progress to hypercellular occlusive thrombus. Tortuous corkscrew collaterals may reconstitute patent segments of the distal tibial or pedal vessels. Large abd medium arteries.
Giant Cell arteritistemporal common. symptoms of headache and visual loss, or with a less acute clinical picture. Sight may be threatened and treatment with immunosupressants should be started promptly.
Polyarteritis nodosa and Wegeners granulomatosissmall and medium arteries
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Section 3

Question Answer
Salter-Harris Ifracture through physis only (normal xray)
Salter-Harris IIfracture through physis and metaphysis
Salter-Harris IIIfracture through physis and epiphysis to include joint
Salter-Harris IVfracture involving physis, meta and epiphysis
Salter-Harris Vcrush injury involving physis (xray may be normal)
Club foot - newbornTalipes equinovarus, or club foot, describes an inverted (inward turning) and plantar flexed foot.
Slipped upper femoral epiphysistypically an overweight adolescent boy with knee / hip problems
Perthe's diseasex-ray shows widening of the right hip joint space with flattening of the femoral head
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Section 4

Question Answer
Methotrexate and anti-folate antibioticsTrimethoprim and co-trimoxazole, anti-folate antibiotics, should be avoided concurrently with methotrexate due to the risk of bone marrow aplasia. This reaction is due to the additive folate depletion when the medications are combined. Fatal pancytopenia and megaloblastic anaemia have occurred. Penicillins may reduce the excretion of methotrexate, and there are no interactions reported in the BNF with nitrofurantoin or cefalexin.
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