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MSK > Clinical > Flashcards

Clinical Flashcards

1
Q

What 3 things must you look for always on elbows?

A
  • Gouty tophi
  • Psoriatic plaques
  • Rheumatoid nodules
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2
Q

How does carpal tunnel syndrome present?

A

Paresthesia in thumb and distal 2 1/2 fingers

Loss of sensation - worse at night (improved by hanging hand out of bed)

Weakness in thumb/clumsiness when using hand

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3
Q

Define parasthesia

A

Abnormal sensation in skin with no apparent physical cause

Pins n needles
Stinging
Burning
Numbness

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4
Q

In what condition may you find wasting of thenar eminence?

A

Severe carpal tunnel syndrome - due to median nerve compression

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5
Q

What test can be done specifically for carpal tunnel syndrome alongside testing for sensation in affected fingers and Tinel’s test (percussing over median nerve)?

A

Phalen’s test

Hands in reverse prayer position - if +ve will cause parasthesia

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6
Q

What can confirm carpal tunnel syndrome diagnosis?

A

Nerve conduction studies

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7
Q

What advice must be given to patients on long dose steroids?

A

Don’t STOP
Don’t - do not stop steroids as body is now dependant
S - sick day rules - increase meds if feeling unwell
T - treatment card - carry on at all times
O - osteoporosis prophylaxis - bisphosphates + Ca2+ and vit D supplements
P - PPIs

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8
Q

What fingers are felt to test for function of:
median nerve
radial nerve
ulnar nerve

A

Median nerve

  • palmar thumb and radial 2 1/2 fingers
  • dorsal 2 1/2 radial fingertips

Radial - back of thenar area and thumb

Ulnar - both palmar and dorsal remaining fingers not affected by median nerve and hypothenar

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9
Q

What tests can be done to test for carpal tunnel syndrome?

A

Phalen’s test - hands hanging freely for 30s-1min

Tinel’s test - tapping over carpal tunnel causes electric shock sensation

Phalens = falcon = falling = flopped hands
Tinels = Tapping
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10
Q

What does Froment’s test test the intergrity of?

How is it conducted?

A

Paper between thumb and forefinger - thumb flat

Try pull paper away

Tests intergrity of ulnar nerve - tests ADDuctor pollicis

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11
Q

Define valgus

Define varus

A

Valgus - distal part of limb more lateral from midline

Varus - distal part of limb more medial to midline

L in vaLgus = l in Lateral

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12
Q

How to tell between growing pains and something more suspicious?

A

Growing pains DO NOT CAUSE LIMP

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13
Q

If a child presents with knee pain what must be done?

A

Hip examination - can be referred pain

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14
Q

Define sublaxation?

A

Partial dislocation

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15
Q

In what circumstances would you use a GALS examination?

A

Rheumatology when trying to establish what more detailed examination to do

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16
Q

What 3 questions must be asked in GALS examination?

A
  1. Do you have any pain in joints, muscles or spine?
  2. Do you have any difficulty dressing yourself?
  3. Do you have any difficulty getting up and down stairs?
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17
Q

What are the movements used to assess the hand in the GALS examination?

A

Make a fist

Thumb to each finger

Grip examiner’s hands

Grip across MCP joints

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18
Q

What must be remembered to be looked for in Gait section of GALS?

This may not be visible when lying up

A

Feet - check for arches

19
Q

What are the 3 common gaits?

A
  • Trendelenburg
  • Antalgic - gait changed to reduce pain
  • Stiff
20
Q

How can you tell the difference between antalgic and stiff gait?

A

Stiff gait will be slow with little pain

Antalgic gait is painful with minimal time spent on affected side

21
Q

If when moving shoulder actively patient has pain, you should try to passively assist the movement.

For the following responses what would the underlying pathology be:

  • Able to fully complete movement with assistance
  • Unable to fully complete movement even with assistance
A

Fully complete - weakness

Unable to complete - pain and stiffness

22
Q

What is a painful arc on shoulder examination indicative of?

A

Rotator cuff problems

23
Q

With orthopaedic issues is it generally better to keep active and mobile or rest?

A

Keep active and mobile

24
Q

What questions should be asked to establish a patient’s pain level?

A
  • Analgesic use?
  • Rest pain?
  • Sleep disturbance?
25
Q

After how many weeks does a rheumatological condition go from acute to chronic?

A

6 weeks

26
Q

How is carpal tunnel syndrome managed?

A
  • Splintage
  • Steroid injection
  • Surgery
27
Q

For the following ligament gradings: what does each mean?

Grade I
Grade II
Grade III

A

Grade I - sprain
Grade II - partial tear
Grade III - complete tear

28
Q

What must be investigated at every dislocation?

A

Neurovascular sufficiency to the distal limb before AND after reduction

29
Q

How do you correctly test neurovascular status?

A

Neuro - test sites that are supplied by peripheral nerves

Vascular - pulse, cap refill, temperature

30
Q

When assessing functional status when taking a history of an injured limb, what information must be attained?

A
  • Dominant hand?
  • Previous function of limb?
  • Employment (could have a massive impact on career)
31
Q

When a patient comes in with trauma what is the anagram for the quick history that is vital to be collected?
Explain it

A

AMPLE

Allergies
Medications
PMH
Last ate 
Events leading up to presentation
32
Q

What does “collateral history” mean?

A

History from those other than patient

33
Q

How do you assess neurological status of lower limb?

  • Deep peroneal/fibular nerve
  • Superficial peroneal/fibular nerve
  • Tibial nerve
A

Deep peroneal/fibular nerve - 1st dorsal web space
Superficial peroneal/fibular nerve - dorsum of foot
Tibial nerve - sole of foot

34
Q

When in resus all patients should be put on high flow oxygen. 15l through non-breather mask. True or false?

A

True

35
Q

What is the only liquid that should be used as a fluid for resus?
If needing IV access, where is the cannula fitted and what type is fitted?

A

Blood (O- if unsure of patients blood type)

Cubital fossa

36
Q

How high must your systolic pressure be to have a radial pulse?

A

80 mmHg

37
Q

Describe the term “permissive hypotension”

A

This is the understanding that the first clot is the best clot.
Do not want to greatly increase BP as to damage clot formed by body.

Keep BP at around 80mmHg systolic to prevent damaging clot formed but keep perfusion to the brain

38
Q

Why would tranexamic acid 1g IV be used?

A

To promote clotting

39
Q

With intense bruising and trauma to the abdomen what should be suspected?
How is this investigated?

A

Internal bleed

CT

40
Q

Why is the patients head rested at 30 degrees if C-spine cleared?

A

Reduces cranial pressure

41
Q

What are the 5 factors required to clear a C-spine injury?

Is it better to have a poorly fitted neck brace or no brace at all?

A
  • No post midline cervical tenderness
  • No evidence of intoxication
  • No distracting injuries
  • Alert to situation
  • No focal neurological defect

Can be v difficult in major trauma without CT

No brace at all

42
Q

Damage to what muscle causes a winged scapula?

A

Serratus anterior

43
Q

What does a raised ALP mean?

A

Increased osteoblastic activity

MSK (41 decks)

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