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60 Cards in this Set
- Front
- Back
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A 54-year-old woman presents to her GP with swollen painful handsand feet, which are stiffer in the mornings. On examination there aresigns of ulnar deviation and subluxation at the MCP joints. |
C. Rheumatoid Arthrits HINT: Morning Stiffness, Advanced disease : Ulnar deviation, Subluxation at the MCP joints. |
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A 65-year-old woman complains of pain in her fingers on movement,which is worst at the end of the day. OE : there is jointtenderness and bony lumps at the DIP joints. A radiograph shows lossof joint space. |
N. Osteoarthrits HINT: DIP bony lumps, Worse at end of day, loss of joint space. |
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A 30-year-old woman complains of joint pain in her hands and feet. CXR shows reduced lung volumes. |
E. Systemic Lupus Erythmatosus HINT: Lung mainifstation |
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A 22-year-old man presents with an acute arthritis of the left knee,dysuria and bilateral conjunctivitis. He has recently suffered from gastroenteritis. |
H. Reiter's Syndrome ( a.k.a Reactive Arthritis ) Triad: Urethritis + Conjunctivitis + Seronegative arthritis. it is reacting to a previous infection. ( e.g. gastroenteritis ) |
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A 45-year-old woman presents with bilateral painful deformed DIPjoints. OE: reveals discoloration and onycholysis of the nails. |
A. Psoriatic arthritis one of seronegative spondyloarthritides. HINT: DIP joint deformation |
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A 64-year-old patient who has recently been started on medicationfor hypertension presents with a very painful, hot, swollen metatarsophalangeal joint. |
L. Gout assx wth hyperuricaemia, thus may be precipitated by increased production /execretion of uric acid. ( such as the thiazide diuretics in HtN drugs) |
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A 12-year-old haemophiliac presents to A&E with severe pain afterfalling over and banging his right knee. |
F. Haemarthrosis bleeding into the joint happens in all ppl, but more in pt with coagulation disorders |
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A 55-year-old man presents to A&E with fever and an exquisitelypainful right knee. On examination his right knee is red, hot andswollen. Purulent fluid is aspirated from the joint. |
K. Septic Arthritis a Medical emergency, joint space should be aspirated and fluid sent for urgent gram staining and culture asap |
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A 60-year-old woman presents with a painful swollen knee. Her radio-graph shows chondrocalcinosis and joint aspiration reveals presenceof weakly positive birefringent crystals. |
J. Pseudogout refers to the acute synovitis caused by deposition of calcium pyrophosphate crystals into a joint |
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A 65-year-old woman presents with a 1-month history of pain andstiffness in her shoulders, worse in the mornings. She says that shewas treated in hospital last year for headache and jaw pain. |
D. Polymyalgia is assx with giant cell arteritis and is very rare before the age 50. Pt also complains of depression and fatigue. High ESR MX: Oral prednisone |
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An obese 12-year-old boy presents with pain in his right hip. OE the hip is flexed, abducted and externally rotated. Hismother has suffered from TB in the past. |
A. Sliped Femoral Epiphysis the tb hx of mother is NOT significant HINT: Obese. ; limping , pain in groin /thigh /knee common 10-16 years old |
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A 6-year-old boy presents with a pain in the hip and a limp. Allmovements at the hip are limited. His radiograph shows decrease insize of the nuclear femoral head with patchy density. |
M. Perthes' Disease is Osteochondritis of the femoral head and classically affects 3-11 y old. Mx: REST, sever : Surgery |
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A 3-year-old girl presents to the orthopaedic clinic with a waddlinggait. Her mother says that there has been a delay in walking. OE there is an extra crease on the left thigh. |
C. Congenital dislocation of hip usually common after breech delivery. Ortolani's test + Barlow manovre are performed to identify them at birth |
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An 80-year-old woman presents to A&E after a fall. On examinationthe left hip is adducted, externally rotated and excruciatingly painful. |
J. Fractured Sacroiliac joint PS: the hip is adducted externally rotated and shortened after a fractured neck of femur |
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An 8-year-old boy presents to A&E with marked limping and pain inthe right hip, which resolves within 48 h. His radiographs show noabnormality at the hip or other joint involvement. Bone scan 2 weekslater is also normal. The patient’s mother suffers from osteoarthritis. |
E. Transient synovitis HINT: Normal Xray ( a.k.a. Irritable hip) |
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22-year-old man complains of stiffness in the lower back and buttock pain that is relieved by exercise. He also suffers from bouts ofpainful red eye. ESR is raised. Radiograph shows blurring ofthe upper vertebral rims of the lumbar spine. |
K. ankylosing spondylitis Buttock pain : caused by Sarcoiliitis Blurring Verteberal Rims : from enthesitis at the insertion of intervertebral ligaments. Then Bony Spurs ( syndesmophytes : due persistent enthesitis |
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A 60-year-old woman presents with constant backache. Her ESR andserum calcium are markedly elevated. |
G. Myeloma. ( malignant tumor of Bone marrow ) Common in older people and cause usually benign ( usually ) , ( however ) Constants symptoms. + Raised ESR + Raised Ca = Suspicious Myeloma |
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A 65-year-old man with osteoarthritis complains of back pain worse onwalking along, with aching and heaviness in both legs that force him tostop walking. Pain is relieved slowly after rest or leaning forward. |
J. Spinal Stenosis Classical Spinal Claudication ( Leaning forward opens the spinal canal and relieves pain ) PS : in Vascular claudication : pain relieved quickly unlike spinal. Mx: Operative decompression |
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A 13-year-old girl complains of backache and fatigue. She is worriedthat she is becoming increasingly round-shouldered. On examination,she has a smooth thoracic kyphosis. Her radiograph shows wedge-shaped vertebral bodies in the thoracic spine. |
C. Scheuermann's Disease abnormal ossification of ring epiphyses o thoracic vertbrae => giving raise to wedge shaped vertebral bodies. MX: spends on degree of kyphosis and range: Back strengthening excersices and postural training in those mild, to operative correction and fusion in severe. |
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A 35-year-old tourist complains of severe back pain with inability tostraighten up after lifting a suitcase yesterday. He now presents withweakness of his big toe extension and loss of sensation on the outerside of the calf. |
D. Verterbral Disc Prolapse Sx of compression of L5 level |
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A 45-year-old woman complains of cold numb fingers and difficultyin swallowing. On examination she has tight skin, thickening of thefingers and telangiectasia |
H. Systemic Sclerosis a multi system connective tissue disease that is classified as either limited or diffuse cutaneous scleroderma. Characterist : beak nose, tight skin , small mouth Raynaud's phenomenon , esophageal dysmotility , sclerodactly , telangectasia Ing: anti-topoismerase, and anti RNA Antibodies |
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A 51-year-old woman complains of weakness in her shoulders andthighs. She has a significantly raised CK level. |
A. Polymyositis an autoimmune condition characterized by non suppurative inflammation of striated muscle the give rise to a symmetrical proximal myopathy. CK elevated EMG: Fibrillation potential |
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A 25-year-old man has been referred to rheumatology clinic withmultiple painful stiff joints and uveitis. He also complains of ulcers onhis penis and mouth. |
B. Behcet's Disease inflammatorydierder of unknown aetiology characterized by signs of urogenital ulceration and eye lesions. Erythema nodosum |
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A 45-year-old woman presents with dryness in the eyes and mouth.Her Schirmer’s test is positive. |
K. Sjogren's Syndrome HINT: Dry eyes (Xerophthalmia ) ,dry mouth ( xerostomia) ING: ( 75% ) anti-Ro antibodies in primary SS . ( 10-15% in Secondary SS) Schrimer's test ( tear test ) to identify production of tears MX: manage sx with artificial tears and saliva |
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A patient presents to rheumatology clinic with recurrent attacks ofpain and swelling in the nose and external ear. |
D. Relapsing Polychondritis Inflammatory disease affecting cartilage ( mainly nose and ear ) Other feature include vasculitis and seronegative Arthritis |
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A 25-year-old man presents with a blue right arm with absent radialpulse and painful passive finger extension after a supracondylar fractureof humerus. |
A. Compartment Syndrome Fracture => direct injury to vessel / Edema => increased pressure => profound ischemia => necrosis of muscle and nerve SURGICAL EMERGENCY ( Decompression ) |
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40-year-old woman presents 5 weeks after a radial fracture with apainful swollen hand. The hand is cold and cyanosed with heightenedtemperature sensitivity |
H. Sudeck's Atrophy ( a.k.a : Complex regional pain syndrome type 1 ) pain and swelling are close to , ( but not exactly at ) the area of injury Skin may be oedematous , may be altered sweat production Aetiolgoy = Unknown |
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A 70-year-old woman complains of right-sided pleuritic chest pain 10days after a fractured neck of femur. |
E. Pulmonary Embolus |
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A 60-year-old woman complains of pain, swelling and reduced mobility 4 months after suffering a fractured neck of femur. Her radiographshows absence of callus at fracture site. |
G. Delayed union HINT: absence of callus at fracture site ( Delayed ) Malunion : only if Xray show medullary cavity has been closed off |
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A 65-year-old woman who falls on an outstretched arm shows weakness of wrist extensors. |
L. Radial Nerve Injury supplies motor innervention of extensors of wrist |
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A 24-year-old man presents with a swollen painful hand after a fallingover playing squash. His radiograph reveals a scaphoid fracture. Mx? |
J. Plaster from below elbow to above knuckle The wrist is held in dorsiflexion. A plaster cast from the wrist to abovethe knuckle provides insufficient support. |
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A 1-year-old baby requires traction after fracture of the right femur. Mx? |
E. Gallow's Traction ( image of casted legs hanging on an overhead beam ) done to up 2 y. ( 18 kg ) |
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A 65-year-old woman requires treatment for displaced fractured neckof femur. Mx |
F. Internal fixation |
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E A 35-year-old woman presents after a fall on an outstretched arm.Her radiograph shows an undisplaced transverse fracture of the righthumerus. Mx |
B. Collar and cuff sling provides sufficient support for this fracture.A broad sling is used to stabilize a fractured clavicle |
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75-year-old woman suffers a displaced Colles’ fracture. |
H. manipulation under local anesthesia and cast cast applied from just below elbow to palm of hand with wrist in neutral position / slightly flexed |
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A 24-year-old woman presents with pain on wrist movements after afall on to her hand. On examination there is tenderness and swellingin the anatomical snuffbox. |
F. Scaphoid Fracture HINT: Anatomy of Snuffbox Mx; plaster cast may be applied and X-ray repeated in 2 weeks |
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A 68-year-old woman presents with fracture at distal radial headwith dorsal displacement of distal fragment after a fall. |
A. Colles' fracture is sometimes described as exhibiting a‘dinner-fork’ deformity. more common in older womenw/ osteoporosis PS: A Smith’sfracture is a form of ‘reverse’ Colles’ fracture where the radial fragment isangled forwards. These fractures are rare and often unstable, requiringinternal fixation. |
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A 7-year-old boy presents with a swollen painful elbow after a fall.He is unable to move the arm because of the pain. |
J. Supracondylar Fracture More common in childer look for brachial artery injury Mx: elbow kept extended ( avoid artery damage) Surgical emergencies ( if displaced fracture ) mx: reduction under general surgery |
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A 19-year-old rugby player falls on a backward stretched hand andpresents with loss of shoulder contour and absent sensation on apatch below the shoulder. |
E. Anterior dislocation shoulder Axillary nerve damage causes loss of sensation Mx: reduced with Kocher's manoevre : Elbow flexed 90 degree traction applied arm slowly externally rotated to about 90 degree brought across the chest internally rotated |
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A 40-year-old woman presents after a fall on an outstretched handwith wrist drop. |
K. fractured humeral shaft Radial nerve injury ( due to it winding around the uterus in the spiral groove ) |
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A 21-year-old woman presents with a very painful shoulder locked inmedial rotation after an epileptic fit. |
G. Posteriour dislocation shoulder coracoid process may be prominent and the humeral head felt posteriorly Epileptic fit common cause of it |
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55-year-old man complains of shoulder pain aggravated in abductionof arm between 60° and 120°. |
E. impingement syndrome ( a.k.a Swimmer's shoulder ) Rotator cuff inflammation ex: internally restate arm => supraspinatous tendon to be impinged against the anterior inferior acromion Mx: Physiotherapy, corticosteroid, local anethetic injeciton |
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A 30-year-old bodybuilder presents with an aching shoulder. Flexingelbow reveals a prominent lump in the upper arm. |
A. ruptured long head of biceps good function usually returns and surgery rarely indicated |
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A 50-year-old man complains of a 9-month history of stiffness in theshoulder. The shoulder was originally extremely painful but now onlythe stiffness remains. |
K. adhesive capsulitis (a.k.a Frozen Shoulder ) Ex: marked reduction in passive and active movement hx of previous injury reported ( or not reported) No definitive mx: symptomatic NSAIDs, intra-articular steroids, physiotherapy |
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A 65-year-old woman presents with shoulder pain and restrictedmovement in all directions. Her radiograph shows reduced joint spaceand subchondral sclerosis. |
D. Osteoarthrites HINT: Xray reduced joint space, subcentral sclerosis |
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A 22-year-old figure-skater presents with a painful locked knee withlimited extension after a twisting injury. |
F. Meniscal Tear it is a 'TWISTING' injury the displaced torn portion can become jammed b/n the femur and tibia => locking |
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A 24-year-old footballer presents with a painful knee after a tacklefrom behind. With the quadriceps relaxed, the anterior glide of thetibia on the femur is 1.0 cm. |
J. Anterior Cruciate ligament tear th norm ant glide of tibia on femur ( on a 90 degree flexed knee ) = ),5 cm Excessive glide anteriorly => Anterior Cruciate ligament tear Excessive Posteriorly=> posterior cruciate tear. |
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A 14-year-old girl successfully treated for rickets 3 years ago showsbow-legged deformity. |
A. Genu varum |
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A 16-year-old boy complains of a painful knee after exercise and atender lump over the tibial tuberosity. |
L. Osgood - Schlatter disease ( inflammation of the patellar ligament at the tibial tuberosity ) more common in older children Pain on straight leg raise against resistance -DX : Lump over the tibial tuberosity Mx: spontaneous recovery , advice avoid sport until then |
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A 50-year-old carpet layer presents with a swelling directly over thepatella. The joint is normal. |
E. Pre- Patellar Bursitis (a.k.a Housemaid's Knee) mx: firm bandaging and abstaining from kneeling position |
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A 24-year-old man presented with lower back pain and stiffness thatwas worse in the morning. He has a question-mark posture. Mx? |
A. Exercise & Physiotherapy Dx: Ankylosing Spondylitis Exercise instead of rest ( esp Hydrotherapy ) |
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An 80-year-old man with a 30-year history of rheumatoid arthritispresents to A&E with fever and pain in the right knee. On examinationhis right knee is red, hot and swollen. Aspirated synovial fluid is franklypurulent. Mx |
H. IV Flucloxacillin, Oral Fusidic acid ( ab of penicillin ) , ( used for skin infection) inv: aspiration of joint and culture to check for inflammation, infection , Crystal arthropathy |
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A 65-year-old woman recently diagnosed with osteoarthritis requiresmedication for joint pain. Mx |
B. Paracetamol should be prescribed before NSAIDs for Ostoarthritis pain. due to risk of NSAIDS S/E ( GI Bleeding ) in an chronic disease |
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A 64-year-old woman who has been successfully treated for acutegout requires prophylactic medication. Mx? |
C. Allopurinol ( decrease level of uric acid) Only used for prophylaxis NOT treatment In an acute gout : use : Clochicine (alternative to NSAIDS for those with allergy or heart failure ) decreases swelling and build of uric acid crystals reduces gout pain |
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A 65-year-old woman with polymyalgia rheumatica. mx? |
G. Oral Prednisolone ( Anti-inflammatory , steroid ) the treatment of choice |
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CT of patient on long-term DMARD treatment shows pulmonary andhepatic fibrosis. Responsible drug? DMARDs =. Disease modifying anti-rheumatic drug |
H. Methotrexate Mech of Action : Antiproliferative, immunoserprassive Used for: Malignancies , severe psoriasis Toxicity : pulmonary and hepatic fibrosis |
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Fertility testing reveals oligospermia in a 48-year-old man on DMARDtreatment. Responsible drug? |
B. Sulfasalazine causes reversible oligospermia |
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patient complains of grossly swollen gums. Responsible drug? |
C. Ciclosporin monitor kidney function Nephrotoxicity m hyperkalamia ( gum hypertrophy also seen in phenytoin and CCB) |
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A patient taking an intramuscular DMARD presents with an itchy ery-thematous rash covering the whole body. Responsible drug? |
K. Gold MEDICAL EMERGINCY can cause hypothermia , fluid los, hypoalmubminaemia , capillary leak syndrome ( also Sulphonamides can give such sx) |
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A 65-year-old woman patient presents with gross irreversibleretinopathy. Responsible drug? |
E. Hydroxychloroquine Retinopathy is Irreversible. Regular ophthalmological monitoring is required |
