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3 - Musculoskeletal > Clinical MSK > Flashcards

Clinical MSK Flashcards

1
Q

GALS screening questions for musculoskeletal history

A

Do you have any pain or stiffness in your muscles, joints or back?
Can you dress yourself completely without any difficulty?
Can you walk up and down stairs without any difficulty?

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2
Q

A sensory nerve supplying a JOINT also supplies the MUSCLES

moving the joint and the SKIN overlying the insertions of these muscles

A

Hilton’s Law

e.g. musculocutaneous nerve gives sensory supply to anterior capsule of elbow

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3
Q

The “rule of 3” in surgery for traumatic peripheral nerve injury

A

Clean + sharp injuries: immediate surgery within 3 days

Blunt/ contusion injuries: early surgery within 3 weeks

Closed injuries: delayed surgery within 3 months

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4
Q

4 signs of osteoarthritis shown on X-ray

A
  1. Reduced joint space
  2. Subchondral sclerosis (whitening of bone)
  3. Development of osteophytes
  4. Subchondral cyst formation
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5
Q

Definition of an injury

A

Damage to any part of the body due to the application of mechanical force

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6
Q

Calculating the kinetic energy of a weapon causing an injury

A

Kinetic energy = 1/2mass x velocity

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7
Q

3 types of blunt force injuries

A

Contusions (bruises) = burst blood vessels in intact skin

Abrasions (graze, scratch) = epidermis scraped off

Lacerations (cut/tear) = tear/split of skin due to crushing

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8
Q

Factors affecting the prominence of a contusion (bruise)

A 
Skin pigmentation
Depth and location
Amount of s/c fat
Age
Coagulative disorders
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9
Q

Identifying a laceration (as not an incised wound)

A

Lacerations…

  • are usually over bony prominences
  • have tissue bridges btw the sides of the wound when pulled apart
  • have rough edges
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10
Q

Types of sharp force injuries (and the difference btw them)

A

Incised wound

  • superficial
  • caused by slashing motion
  • longer than it is deep

Stab wounds

  • penetrating
  • caused by thrusting motion
  • deeper than it is long
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11
Q

Identifying defensive type injuries

A

Passive (victim raises arms for protection)
- incised wounds over backs of hands and forearms

Active (victim tries to grab weapon)
- incised wounds on palms and web spaces btw fingers

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12
Q

Commonest cause of extradural haemorrhage

A

Skull fracture damaging arteries

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13
Q

Commonest cause of subdural haemorrhage

A

acceleration-deceleration injury causing veins to tear

often a lucid interval as blood accumulates slowly

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14
Q

Most common cause of subarachnoid haemorrhage

A

Berry aneurysm

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15
Q

Cause of traumatic subarachnoid haemorrhage

+ cause of death

A

Rapid rotational movement of the head, usually due to a blow to the jaw
Causes rupture of vertebral arteries at base of skull causing haemorrhage around the brainstem.

Patient often dies IMMEDIATELY - so cause of death is likely from rotational tearing of axons in brainstem at the same time.

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16
Q

Common leg development

A

Bow legs common <2 years
Knock-knees common from 2-7 years
Most legs are straight by the teens

17
Q

Number of steps per minute =

A

cadence

normal = 100-115 steps/min

18
Q

Average comfortable walking speed (CWS) =

A

80m/min (5km/h, 3mph)

19
Q

Gait pattern in which the stance phase on the affected side is shortened

A

Antalgic gait

common causes: splinter in foot!, OA, tendinitis

20
Q

Causes of an increased walking base (normal = 5-10cm)

A

Deformities (abducted hip, valgus knee)

Instability

21
Q

Indications for treatment of paediatric orthopaedic conditions

A 
Symptoms - night pain/NWB pain
Symmetry - lack of it
Stiffness/ paralysis
Syndromes - associated features
Systemic illness - e.g. pyrexia
22
Q

Knee pain may be a sign of…

A

HIP PATHOLOGY!

23
Q

Members of the trauma team

A

Emergency department (ED) doctor
Anaesthetics
Radiology
Surgical

24
Q

Important information in paramedic handover to trauma team

A 
Time of injury
Mechanism of injury (photos)
Suspected serious injuries
Vital signs
interventions carried out
25
Q

Parts of a trauma assessment

A

Primary survey:

  • ABCs
  • detects AND TREATS immediate threats to life

Secondary survey:
- identification of ALL injuries + more detailed history

26
Q

Clinical features of nerve injury

A

Dysaethesiae (disordered sensation)

  • anaesthesia
  • hypo/hyperaesthesia (heightened/reduced)
  • paraesthesia (pins+needles)
Paresis (weakness)
Paralysis
Wasting
Dry skin (motor nerve fibres --> sweat glands)
Altered reflexes
27
Q

Pain related to a hip pathology is worse…

A

The weight bearing
((but always present as hip is always weight bearing))

also - difficulty reaching feet (tying shoelaces etc.)

28
Q

Stages of bone regeneration

A

Stage 1: inflammation
- haemorrhage into fracture –> haematoma
- angiogenesis
Stage 2: soft callus
- bony fragments united by cartilage/fibrous tissue
Stage 3: hard callus
- conversion of cartilage to woven bone
Stage 4: bone remodelling
- conversion of woven bone to medullary bone

29
Q

Types of bone graft

Replace missing bone to repair complex fractures

A

Autogenous cancellous bone graft (uses patients own bone from elsewhere)

  • gold standard
  • osteoconductive (bone regrows through it) + osteoinductive (stimulates bone growth)
Allograft bone (from tissue bank/cadaver)
 - only osteoconductive
30
Q

Battlefield Advanced Trauma Life Support (BATLS)

A

ABCDEG

C-atastrophic haemorrhage control (CAT)
A-irway with c-spine control
B-reathing and O2
C-irculation + haemorrhage control
D-isability (neuro)
E-xposure + environment (keep warm)
G-lucose
31
Q

The “lethal triad” in haemorrhage control and how to manage it

A

Bleeding –> acidosis + hypothermia –> coagulopathy –> ↑bleeding

management: give platelets and fresh frozen plasma (FFP) to increase clotting

32
Q

Investigations for the multiply injured trauma patient

not bedside tests

A

FAST (Focussed Assessment with Sonography for Trauma) scan

CT (Trauma mattress is CT compatible so no log roll needed)

33
Q

Tests for assessment of spinal mobility

used for assessing AS

A
  • Modified Schober’s test
  • Lateral spinal flexion
  • Occiput to wall + tragus to wall
  • Cervical rotation
34
Q

Bony secondary tumours are common from primaries in…

A

Lung
Breast
Prostate
Kidney

If a patient over 50 presents with a bone tumour, it is likely metastatic

35
Q

An anterior labral tear (of the hip) presents with pain on…

A

Flexion
ABduction
External Rotation

= +ve FABER

3 - Musculoskeletal (7 decks)

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