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J MSK > Conditions summary > Flashcards

Conditions summary Flashcards

1
Q 
morning stiffness 
joint pain and swelling (DIP sparing)
nodules 
RF positive 
anti-CCP positive 
joint erosions on xray
A

rheumatoid arthritis

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2
Q

rheumatoid arthritis treatment

A 
symptomatic 
aspirin 
paracetamol 
NSAIDs (eg ibuprofen) 
steroid (eg prednisolone) 
opioids (eg codeine, morphine)

DMARD1
DMARD1 + DMARD2
DMARD1 + DMARD2 + DMARD3
biologics

DMARDs - methotrexate, sulfasalazine, hydroxychloroquine
biologics - anti-TNF

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3
Q

rheumatoid arthritis flare up treatment

A

steroids

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4
Q

heberdens nodes (DIP)
bouchards nodes (PI)
squaring of thumb base
bakers cyst at knee

worse at end of day
elderly

A

osteoarthritis

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5
Q

xray of osteoarthritis

A

LOSS - loss of joint space, osteophytes, sclerosis, subchondral/subarticular cysts

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6
Q

osteoarthritis treatment

A

weight loss
paracetamol
surgery - joint replacement

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7
Q

osteoarthritis flare up treatment

A

steroids

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8
Q 
teenager
lower back/buttock pain 
pain relieved by exercise 
limited lumbar movement
question mark spine
A

ankylosing spondylitis

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9
Q

ankylosing spondylitis treatment

A

symptomatic - physio, pain relied, DMARDs

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10
Q 
scaly plaques on extensor surfaces
onycholysis (lifting of nail from nail bed) 
joint pain 
dactylitis (sausage fingers) 
'pencil in cup' on xray
A

psoriatic arthritis

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11
Q

psoriatic arthritis treatment

A

DMARDs (methotrexate, sulfasalazine, hydroxychloroquine)
anti TNF

steroids for flare ups

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12
Q

GI infection 3 weeks ago
can see
painful urination
joint pain

A

reactive arthritis

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13
Q

reactive arthritis treatment

A

steroids
antibiotics for infection

DMARDs if >3 months

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14
Q

abdo pain
joint pain/stiffness
weight loss
change in bowels

A

enteropathic arthritis

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15
Q

enteropathic arthritis treatment

A

sort IBD
paracetamol
DMARDs

NOT NSAIDs - make IBD worse

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16
Q

surgery 2 weeks ago OR prosthetic joint OR PWID
bone pain
fever
hot, red swollen site of wound

A

acute osteomyelitis

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17
Q

acute osteomyelitis treatment

A

antibiotics

debridement

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18
Q

chronic osteomyelitis treatment

A

complex surgery for debridement

antibiotics

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19
Q 
monoarthritic pain 
hot, red, swollen, v painful joint 
fever
tachycardia 
increased WCC
A

septic arthritis

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20
Q

septic arthritis treatment

A

antibiotics - flucloxacillin

surgery = debridement and joint replacement

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21
Q

short stature blue sclera

fractures bones easily

A

brittle bone disease (osteogenesis imperfecta)

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22
Q

brittle bone disease (osteogenesis imperfecta) treatment

A

bisphosphonates

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23
Q 
prominent forehead 
short limbs 
long back 
short stature 
learning difficulties
A

achondroplasia (type of skeletal dysplasia/short stature)

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24
Q

skeletal dysplasia/short stature treatment

A

nothing

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25
Q 
tall 
long limbs 
high arched palate 
retinal detachment 
arachnodactyly (long fingers)
A

marfans syndrome

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26
Q

joint dislocations/hypermobility
easy bruising
tissue elasticity

A

Ehlers danlos syndrome

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27
Q

trisomy 21
short stature
joint laxity

A

downs syndrome

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28
Q 
boy 
age 5 
gowers manoeuvre 
swollen 'woody' calves
muscle wasting
A

duchenne muscular dystrophy

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29
Q

muscle wasting
‘hatchet’ like face
myotonia (difficulty relaxing muscles after contraction)

A

myotonic dystrophy

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30
Q

muscular dystrophy treatment

A

nothing

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31
Q

duchenne muscular dystrophy but with better prognosis
no gowers sign
swollen ‘woody’ calves

A

beckers muscular dystrophy

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32
Q

‘waiters tip’ posture from no muscle movement in upper arm

newborn baby

A

erbs palsy

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33
Q

erbs palsy treatment

A

physio

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34
Q

paralysis of hand/wrist/fingers

newborn

A

klumpkes palsy

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35
Q 
floppy arms 
abnormal gait 
learning difficulties 
'fencing reflex' 
epilepsy 
visual impairment 
missed developmental milestones 
speech difficulties
A

cerebral palsy (lots of types)

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36
Q

cerebral palsy treatment

A

physio

symptomatic

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37
Q

hair patch on lower back
high arched foot
bladder/bowel problems

A

mild spina bifida (spina bifida occulta)

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38
Q

flu like illness (infection!)
growth defects
muscle weakness

A

polio

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39
Q 
woman
fever 
malaise 
weight loss 
lymphadenopathy 
butterfly malar rash 
 painless nasal/mouth ulcers 
reynaulds 
inflammatory arthritis seizures 
ANA, anti-dsDNA, anti-Sm positive 
Complement 4 (C4) present
A

lupus (SLE)

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40
Q

lupus (SLE) treatment

A

steroids - prednislone

immunosuppressants - methotrexate, hydroxychloroquine, azathioprine, cyclophosphamide

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41
Q

dry eyes
dry mouth
rheumatoid arthritis
ANA, anti-Ro, anti-La positive

A

sjogrens syndrome

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42
Q

sjogrens syndrome treatment

A

methotrexate

symptomatic

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43
Q

thickening of skin proximal to forearms, and torso
breathing difficulty
anti-scl70 positive
ANA positive

A

diffuse cutaneous systemic sclerosis

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44
Q

thickening of skin distal to forearms, and face (not torso)
anti-centromere positive
ANA positive
reynaulds!

A

limited systemic sclerosis

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45
Q

systemic sclerosis treatment

A 
symptomatic; 
vasodilators - for reynaulds 
ACE inhibitors - for renal involvement 
PPI - for GI involvement 
immunosuppression - for lung involvement
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46
Q 
anti RNP positive
pulmonary hypertension
reynaulds 
scleroderma 
sclerodactyly 
lots of random things
A

mixed connective tissue disease

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47
Q 
levido-reticularis - lace like purple pattern on skin recurrent arterial/venous thrombosis 
lupus
miscarriages  
anticardiolipin positive 
anti phospholipid antibodies positive
A

anti-phospholipid syndrome (APS)

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48
Q

anti-phospholipid syndrome (APS) treatment

A

warfarin

LMW heparin if pregnant

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49
Q 
red, hot, v painful joint 
monoarthritic pain - 1st MTP joint 
overnight/rapid onset
needle shape negative birefringent crystals on aspiration
urate crystal deposition
A

gout

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50
Q

gout treatment

A

expose, cool, elevate joint
NSAIDs/colcochine

allopurinol prophylaxis

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51
Q

calcium pyrophosphate crystal deposition
elderly
red, hot, v painful joint
monoarthritic pain - knees, wrist, ankles
rectangular, rhomboid, envelope shaped crystals with positive birefringence on aspiration

A

pseudogout

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52
Q

pseudogout treatment

A

NSAIDs
steroids

no prophylaxis :(

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53
Q

hydroxyapatite crystal deposition (see on xray)
shoulder joint pain
reduced movement
50 y/o female

A

Milwaukee shoulder

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54
Q

idiopathic inflammatory myopathy

A

polymyositis or polymyalgia rheumatica

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55
Q

polymyositis + skin involvement

A

dermatomyositis

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56
Q

like polymyositis but distal limbs

A

inclusion body myositis

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57
Q

idiopathic non inflammatory myopathy

A

fibromyalgia

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58
Q 
40 y/o female 
muscle weakness - proximal limbs 
weight loss 
fever 
difficulty brushing hair, climbing stairs etc 
ANA, anti-jo positive 
CK raised 
inflammatory markers raised
A

polymyositis

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59
Q 
40 y/o female 
muscle weakness - proximal limbs 
weight loss 
fever 
gottrons papules 
heliotrope rash 
shawl sign/rash 
difficulty brushing hair, climbing stairs etc 
ANA, anti-jo positive 
CK raised 
inflammatory markers raised
A

dermatomyositis

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60
Q

dermatomyositis and polymyositis treatment

A

steroid - prednisolone 40mg

immunosuppressant - methotrexate

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61
Q

distal muscle weakness
fever
weight loss
50 y/o male

A

inclusion body myositis

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62
Q

no muscle weakness
muscle pain - shoulder and hip
morning stiffness >1 hour
raised inflammatory markers

A

polymyalgia rheumatica

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63
Q

polymyalgia rheumatica treatment

A

prednisolone 15mg

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64
Q 
abdo pain 
depression 
fatigue 
pain - neck, shoulders, lower back etc 
general aches and pain 
inflammatory markers normal 
antibodies negative 
muscle biopsy negative
A

fibromyalgia

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65
Q

fibromyalgia treatment

A

patient education
gabapentin - pain relief
treat IBS
anti depressants

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66
Q 
elderly female
early menopause 
low impact fractures 
steroids
coeliac disease
A

osteoporosis

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67
Q

osteoporosis treatment

A

calcium and vit D supplementation
bisphosphonates
denosumab (renal failure)

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68
Q

> 50 y/o
unilateral temporal headache
tender, enlarged, non pulsatile arteries
fever
jaw claudication (osteoarthritis in TMJ)
unilateral hypertension
polymyalgia rheumatica (morning stiffness in shoulders and hips)

A

giant cell arteritis (GCA)

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69
Q

patient >50 y/o with sudden onset headache

A

giant cell arteritis (GCA)

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70
Q

giant cell arteritis treatment

A

steroids, reduce over 2 years;
prednisolone 40mg if no visual symptoms
prednisolone 60-80mg if visual symptoms

aspirin long term
PPI long term

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71
Q

important investigation in giant cell arteritis (GCA)

A

fundoscopy

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72
Q

treatment of all small vessel vasculitis (GPA, EGPA, MPA, HSP)

A

IV steroids
IV cyclophosphamide
long term immunosuppression - methotrexate

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73
Q 
ENT symptoms - nosebleeds, oral ulcers, cough, nasal cartilage collapse  
purpura 
haemoptysis 
late onset asthma/rhinitis 
pANCA positive 
anti-MPO positive
A

eosinophilic granulomatosis with polyarteritis (EGPA) aka churg strauss

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74
Q 
ENT symptoms - nosebleeds, oral ulcers, nasal cartilage collapse, cough 
haemoptysis 
purpura 
cANCA positive 
anti-PR3 positive
A

granulomatosis with polyarteritis (GPA) aka wegners

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75
Q

pANCA positive

anti-MPO positive

A

microscopic polyarteritis (MPA)

76
Q 
IgA mediated 
children 2-11 y/o
URTI 3 weeks ago 
purpuric rash over buttocks and lower limbs 
abdo pain 
bloody diarrhoea
A

henoch schnlein purpura (HSP)

77
Q 
genetic condition 
easy bruising 
multiple scars 
bone fractures 
joint deformity 
premature death likely
A

congenital insensitivity to pain (CIP)

78
Q

lateral curvature of the spine (posture to the L or R)

resp distress

A

scoliosis

79
Q

scoliosis, kyphosis and spondylolisthesis treatment

A

physio
brace/cast/wheelchair
surgery - if deteriorating

80
Q 
chance fracture 
worsening posture ('slouching')
A

kyphosis

81
Q

recurrent back pain with no neuro symptoms
poor posture
obese
pain worse on exercise, relieve by rest

A

mechanical back pain

82
Q

mechanical back pain treatment (4)

A

generally nothing
pain relief
increase exercise (NOT bedrest)
physio, acupuncture

83
Q

pain in lower back then in legs pain worse walking up hill

retired construction worker

A

slipped disc

84
Q

slipped disc treatment (3)

A

generally nothing, 70% self limiting in 3 months

pain relief
increase exercise (NOT bedrest)
physio

85
Q

forward slippage of one vertebrae onto another
lower back pain
young and sporty

A

spondylolisthesis

86
Q

reduced leg power

unilateral leg pain in dermatomal pattern

A

sciatica

87
Q

sciatica treatment

symptomatic and curative

A

self limiting

surgery (v v v v rare)

88
Q 
55 year old male 
retired manual worker 
obese 
painful back and legs when walking downhill 
enjoys cycling
A

spinal stenosis

89
Q

spinal stenosis treatment (3 - think of risk factor)

A

physio
decrease weight
surgery - spinal decompression

90
Q

severe sudden exacerbations of pain
worse as day goes on, worse with activity
deep seated central back pain

A

discogenic back pain

91
Q

discogenic back pain treatment (2)

A

physio

pain relief

92
Q

morning stiffness
back pain worse after prolonged rest
pain relieved by exercise

A

facet arthropathy

93
Q

treatment for facet arthropathy (3)

A

exercise
pain relief
injections

94
Q

lower back pain
loss of bladder/bowel control
saddle anaesthesia - bilateral loss of sensation to buttocks/perineum/inner thigh
loss of anal tone on PR exam

A

cauda equina syndrome

95
Q

cauda equina syndrome treatment

complications

A

emergency surgery within 24 hours

paralysis if no treatment

96
Q

painful lateral epicondyle
resisted middle finger and wrist extension
pain worse when opening jar

A

tennis elbow (lateral epicondylitis)

97
Q

tennis elbow (lateral epicondylitis) treatment (5)

A 
rest 
physio 
pain relief 
steroid injections 
surgery last resort
98
Q

painful medial epicondyle

wrist flexion painful pain worse on opening jar

A

golfers elbow (medial epicondylitis)

99
Q

golfers elbow (lateral epicondylitis) treatment (4+1 not)

A

rest
physio
pain relief
surgery last resort

NOT steroid injections (may damage ulnar nerve!)

100
Q

paraesthesia (pins and needles) of medial 1.5 fingers

weakness of thumb

A

ulnar nerve compression

cubital tunnel syndrome

101
Q

cubital tunnel syndrome treatment

A

surgery - nerve decompression/release of tight structures

102
Q

swelling at olecranon process

A

olecranon bursitis

103
Q

lump on medial aspect of 1st MTP

pain in little toes

A

hallux valgus (bunion)

104
Q

lump above 1st MTP (on dorsal surface)

pain on walking

A

hallux rigidus

105
Q

treatment of hallux rigidus or hallux valgus

A

pain relief
better footwear

surgery - last line

106
Q 
60 year old male
diabetes 
alcoholic cirrhosis 
ring (or little) finger gets 'stuck' on flexion 
cant be extended actively
A

dupuytrens contracture

107
Q

palmar thickening with myoofibroblasts and type 3 collagen production

A

dupuytrens contracture

108
Q

treatment of dupuytrens contracture (2)

A

stretches

surgery if impaired function

109
Q

‘clicking’ of middle (or ring) finger on flexion

can extend finger actively

A

trigger finger

110
Q

inflammation of flexor digit tendon = nodule formation = catches on A1 pulley

A

trigger finger

111
Q

trigger finger treatment (2)

A 
steroid injection (up to 3 times as necessary) 
surgery if steroid injection not effective
112
Q

recently given birth to baby
house wife
pain on radial styloid process
positive finklesteins test

A

dequervains tenosynovitis

113
Q

dequervains tenosynovitis treatment (4)

A

splint, rest, NSAIDs
physio
steroid injection
surgery - for decompression

114
Q

cant fully extend finger after an injury at netball

A

mallet (staved) finger

115
Q

mallet finger (staved finger) treatment

A

splint for 4 weeks

116
Q

any carpal dislocation treatment

complication of no treatment

A

emergency surgery

osteoarthritis

117
Q

treatment of finger dislocation (2)

A

local anaesthetic and reduce dislocation

then splint to neighbouring finger asap

118
Q

arthritis type involving MCP and carpals

A

rheumatoid arthritis

119
Q

arthritis type involving PIP, DIP, base of thumb

A

osteoarthritis

120
Q

fluid filled cyst at DIP joint
transiluminate
well defined
firm

A

ganglion cyst

121
Q

30 year old female
pregnant
numbness in digits 1-3 and lateral half of digit 4
reduced thumb function

A

carpal tunnel syndrome

122
Q

carpal tunnel syndrome treatment (2)

A

steroid injection

surgical decompression

123
Q

cubital tunnel syndrome

A

surgical decompression

124
Q

65 year old male
paraesthesia of ulnar 1.5 fingers
weakness of 1st dorsal interosseous and adductor pollicis muscles
injury to elbow

A

cubital tunnel syndrome

125
Q

where is AVN most common

A

hip

126
Q

severe groin pain

A

AVN

127
Q

severe trochanter pain

A

trochanteric bursitis

128
Q

hip AVN treatment (2)

A

surgery for decompression of pressure

joint replacement

129
Q

trochanteric bursitis treatment (4 + 1 not)

A

self limiting
NSAIDs
injections
physio

NOT surgery

130
Q

wrist/ankle AVN treatment (2)

A

surgery for decompression

joint fusion

131
Q

painful
shortened leg
externally rotated

A

hip fracture

132
Q

painful
shortened leg
internally rotated

A

hip dislocation

133
Q

hip dislocation treatment

A

emergency reduction

134
Q

knee osteoarthritis first line treatment (3)

A

weight loss
increase activity
mobility aids

135
Q

knee osteoarthritis second line treatment (if end stage and elderly)

A

surgery - total knee replacement

136
Q

knee osteoarthritis second line treatment (if young)

A

partial knee replacement

137
Q

valgus instability (knock kneed)
pain for months
ACL damage
knee ligament rupture

A

MCL rupture

138
Q 
football tackle 
hyperextension of knee 
varum stance 
PCL damage 
knee ligament rupture
A

LCL rupture

139
Q

treatment of MCL and LCL

A

nothing

140
Q 
sports injury to knee 
haemarthrosis 
pain for a few days 
twisting/popping sensation 
positive anterior drawer test 
positive lachman test
A

ACL rupture

141
Q

ACL rupture treatment

A

physio

surgery - ligament graft

142
Q 
anterior tibial injury 
hyperextension 
instability going downstairs 
'sagging tibia' 
positive posterior drawer test 
knee pain
A

PCL rupture

143
Q

general treatment of knee ligament ruptures

A

nothing unless several ligaments and v bad stability

144
Q 
twisting sporting injury to knee
sharp sudden pain 
effusion next day 
catching and locking 
positive steinmans test
A

meniscal tear (probs medial meniscus)

145
Q

imaging used for knee ligament problems

A

MRI

xray - to rule out fracture

146
Q

rupture of one of; quads, quads tendon, patella, patellar retinaculum, patellar ligament

in a body builder with chronic steroid use

A

extensor mechanism rupture

147
Q

inflammation of insertion of patellar tendon at tibial tubercle

A

Osgood schlatters disease

148
Q

bony lump at tibial tubercle
adolescent boy
pain worse after exercise
positive straight leg raise

A

Osgood schlatters disease

149
Q

swelling in popliteal fossa

A

bakers cyst

150
Q

30-40 year old
painful arc 60-120 shoulder abduction
positive Hawkins kennedy test

A

impingement syndrome

151
Q

impingement syndrome treatment (3)

A

NSAIDs/analgesia
physio 3 months
3 steroid injections

152
Q

> 40 year old

jerk of arm with sudden shoulder pain and muscle weakness

A

rotator cuff tear

153
Q

rotator cuff tear treatment (3)

A

NSAIDs
physio
steroid injections

154
Q

40-60 year old female

shoulder pain for 6 months then stiffness (pain goes away)

A

frozen shoulder

155
Q

frozen shoulder treatment (3)

A

physio!
NSAIDs
steroid injections

self limiting <2 years

156
Q

acute severe shoulder pain

calcification above shoulder on xray

A

acute calcific tendonitis

157
Q

acute calcific tendonitis treatment (2)

A

self limiting

steroids/analgesia for pain

158
Q

sports injury to shoulder badge patch dullness

positive findings on xray

A

anterior shoulder dislocation

159
Q

anterior shoulder dislocation treatment (4 - need them all)

A

calm patient - analgesia, sedation, O2
closed reduction/manipulation of joint
sling 2-4 weeks
physio

160
Q

asymmetric shoulders
lightbulb sign on xray
no pain

A

posterior shoulder dislocation from ligamentous laxity condition (eg ehlers danlos, marfans)

161
Q

> 60 year old
gradual onset shoulder pain, reduced movement
LOSS on xray

A

glenohumeral osteoarthritis

162
Q

glenohumeral osteoarthritis treatment (4)

A

analgesia
physio
steroid injections
surgery

163
Q

swimmer
popeye sign
pain in shoulder, worse on elbow/shoulder flexion
bruising

A

biceps tendonitis

164
Q

biceps tendonitis treatment

A

rest and physio

surgery if severe

165
Q

biceps tendonitis complications

A

tendon rupture

166
Q

aetiology of intoeing in kids (3)

A

femoral neck anteversion
internal tibial torsion
metatarsal adductus

167
Q

new born
breech in womb
inverted, plantarflexed, supinated feet

A

clubfoot (talipes equinovarus)

168
Q

clubfoot (talipes equinovarus) treatment (2)

A

splints from birth - age 4

surgery

169
Q

fixed flat feet in kid

A

tarsal coalition

170
Q

tarsal coalition treatment

A

splint

surgery

171
Q 
new born girl 
breech birth 
asymmetrical extra skin fold in thigh 
asymmetrical shortened limb 
positive barlow test
A

developmental dysplasia of the hip (DDH)

172
Q

treatment of developmental dysplasia of the hip (DDH)

A

relocate hip and splint (pavlik harness) to stabilise

173
Q 
3 year old
breech birth 
asymmetrical short leg
Trendelenburg gait
painless limp
A

developmental dysplasia of the hip (DDH) late diagnosis (usually diagnosed at birth)

174
Q 
age 2-10 
boy 
upper RTI - fever
sudden onset pain 
non weight bearing 
limp
high inflammatory markers (other investigations normal)
A

transient synovitis of the hip (irritable hip)

175
Q

treatment of transient synovitis of the hip (irritable hip)

A

nothing - bed rest, NSAIDs

if persistent after 2 weeks = look for a different cause

176
Q 
aged 4-8
boy 
hyperactive 
short stature
Trendelenburg gait, limp 
hip pain
A

perthes (idiopathic AVN of hip)

177
Q

treatment of perthes (2)

A

nothing - NSAIDs, avoid physical activity

surgery if severe

178
Q 
age 10-16
overweight boy 
pain - knee and/or hip
probs weight bearing  
limp
A

SUFE (slipped upper femoral epiphysis

179
Q

SUFE (slipped upper femoral epiphysis) treatment

A

urgent surgery - pin to stabilise femoral head (maybe in both legs to prevent the other hip from slipping too)

180
Q

adolescent female
pain in knee from muscle imbalance
predisposed to osteoarthritis later in life

A

anterior knee pain, nothing you can do

181
Q

‘catching and locking’ of knee
teenager
lump at medial femoral epicondyle

A

ostechondirits dissecans (OCD) of the knee

182
Q 
bone pain 
back pain 
weakness
fatigue
weight loss
renal failure
anaemia 
recurrent infections 
proteinuria
A

multiple myeloma

183
Q 
bone pain, 'shin splints' 
enlarged bones (eg bigger head) 
increased metabolism 
fractures 
increased alk phos (ALP) 
normal Ca
A

pagets disease of bone

184
Q

pagets disease of bone treatment

A

bisphosphonates - inhibits osteoclasts = prevents disease progression

185
Q

treatment of benign bon tumours

A

curettage to remove it

186
Q

treatment of malignant bone tumours

A

excision with a 3-4cm circumference

187
Q

when is spinal stenosis pain relived (which activity)

A

cycling (bc spinal flexion)

J MSK (30 decks)

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