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MSKJaz > Cortex > Flashcards

Cortex Flashcards

1
Q

risk factors for type 1/post menopausal osteoporosis

A 
early menopause
white caucasians
smoking
alcohol
low exercise
poor diet
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2
Q

risk factors for type 2/ old age osteoporosis

A

vit D / sunshine

inactivity

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3
Q

emergency Rx of very high serum Ca2+

A

IV fluids
biphosphonates
calcitonin

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4
Q

PTH increases bone ___ and renal ___ of Ca2+

A

resorption

reabsorption

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5
Q

CKD => decreased ___ excretion and inactive activation of ___ => _____ => __+__+__

A 
phosphate
vitamin D
2ndry hyperparathyroidism
sclerosis of bone
osteomalacia
calcification of soft tissues
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6
Q

seronegative arthitises

A

ank spond
psoriatic
reactive
enteropathic

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7
Q

seropositive arthritises

A 
RA
lupus
scleroderma
vasculitis
Sjogrens
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8
Q

limited type systemic sclerosis is ass with which auto Ig

A

anti centromere

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9
Q

diffuse type systemic sclerosis is ass with which auto Ig

A

anti-Scl-70

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10
Q

myositis is ass with which auto Ig

A

anti Jo 1

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11
Q

typical xray of OA (LOSS)

A

loss of joint space
osteophytes
sclerosis
subchondral cysts

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12
Q

sacroiliitis, uveitis, dactylitis and enthesopathies are common features of ___

A

seronegative arthritis

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13
Q

v aggressive and destructive form of psoriatic arthritis

A

arthritis mutilans

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14
Q

enteropathic arthritis tends to be a __ joint _____ ___arthiritis

A

large
asymmetrical
oligo

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15
Q

Reiter’s syndrome =

A

urethritis
uveitis/conjunctivitis
reactive arthritis

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16
Q

___ is low in active SLE and especially in ___

A

C3/4

renal disease

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17
Q

used to monitor the activity level of SLE

A

C3/4

anti dsDNA Ig

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18
Q

auto Igs in Sjogrens

A

anti Ro + La

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19
Q

For Sjogrens: ___ can stimulate saliva production but may cause facial flushing

A

pilocarpine

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20
Q

3 stages in cutaneous systemic sclerosis

A

oedematous -> indurative > atrophic

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21
Q

beaking of the nose skin is a sign of

A

systemic sclerosis

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22
Q

MCTD is ass with which auto Ig

A

anti-RNP Ig

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23
Q

usual sites of pseudogout

A

knee
wrist
ankle

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24
Q

chondrocalcinosis =

A

calcium pyrophashate deposition in cartilage/other soft tissues without acute inflammation

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25
Q

antigens specific to myositis

A

anti-Jo-1

anti SRP

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26
Q

Rx for dermato+polymyositis

A

prednisolone (initially 40mg)

IS eg. methotrexate

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27
Q

early features of Takayasu arteritis

A 
low grade fever
night sweats
wt loss
arthralgia
fatigue
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28
Q

Takayasu arteritis population?

A

East Asian 100x the risk

young F 10-30yo

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29
Q

later signs of Takayasu arteritis

A

claudication in upper and lower limbs

if untreated = vascular stenosis and aneurysms

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30
Q

ass with cANCA and PR3

A

GPA

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31
Q

brittle bone disease =

defect of __+__

A

osteogenesis imperfecta

maturation and organisation of Type 1 collagen

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32
Q

commonest skeletal dysplasia

A

Achondroplasia

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33
Q

IQ in achondroplasia is ___

A

normal

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34
Q

double jointed - ness inheritance pattern =

A

dominant inheritance

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35
Q

Ehlers Danlos - abnormal __+__ formation

inheritance =

A

elastin and collagen

autosomal dominant

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36
Q

DMD = ___ gene defect involved in __ transport

A

dystrophin

Ca2+

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37
Q

Diagnosis of DMD is by __+__

A

increased serum creatinine phosphokinase

muscle biopsy

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38
Q

similar to DMD but able to walk in teens and live til 30-40yo

A

Beckers muscular dystrophy

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39
Q

upper motor system = __+__

A

brain and spinal cord

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40
Q

lower motor system = ++_

A

anterior horn cells
nerve roots
peripheral nerves

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41
Q

spastic CP is caused by injury to __/__/___

A

motor cortex
upper motor neurons
corticospinal tract

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42
Q

ataxic CP is caused by injury to __

A

cerebellum

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43
Q

athetoid CP is caused by injury to __+__+__

A

extrapyramidal motor system, pyramidal tract and basal ganglia

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44
Q

spina bifida is caused by __ not fusing

A

two halves of posterior vertebral arch

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45
Q

polio is an infection of the ____ cells in ____ = L/UMN deficit

A

motor anterior horn cells
spinal cord/brainstem
LMN

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46
Q

2 digits fused together congenitally =

A

syndactyly

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47
Q

fibular hemimelia =

features =

A

partial/complete abscence of fibula often with abscence of lateral foot rays
shortened limb, tibia bowing + ankle deformity

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48
Q

Erb’s palsy is caused by __+__ damage
loss of motor innervation to __+__+__+__+__
classic sign =

A

C5 +6
deltoid, supraspinatus, infraspinatus, biceps and brachialis
Waiters tip posture

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49
Q

watiers tip sign of __

A

Erbs palsy

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50
Q

Klumpkes palsy = __+__ injury due to forceful ___ => paralysis of ___ +/- finger and wrist ___
possible ___ syndrome
fingers are in ___ position

A 
C8 T1
adduction
intrinsic hand muscles
flexors
Horners
flexed
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51
Q

Blount’s disease =

A

growth disorder of medial proximal tibial physis => genu varum - also called tibia vara

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52
Q

DDH: __/___ of femoral head in perinatal that affects development of the hip

A

subluxation/dislocation

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53
Q

Pavlik harness for ___ keeps in __+__

A

DDH (dislocated/unstable) - keeps in flexion and abduction

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54
Q

most common cause of hip pain in childhood
usually preceded by ___
age:
M:F

A

Transient synovitis of the hip
URTI (viral)
2-10yo
M>F

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55
Q

presentation of transient synovitis of the hip

A

limp/no wt bearing
motion restriction
low grade fever

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56
Q

Ix for transient synovitis of the hip

A

radiographs (exclude Perthes)
normal CRP (exclude septic arth)
MRI (exclude osteomyelitis)

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57
Q

Rx for transient synovitis of the hip

A

NSAIDs and rest - resolves in a few weeks

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58
Q

idiopathic osteochondritis of the femoral head =

A

Perthes

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59
Q

presentation of Perthes

A

pain and limp
loss of internal rotation
+ve trendelenburg test (loss of abduction + gluteal weakness)

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60
Q

Rx for Perthes

A

regular xray + decrease physical activity

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61
Q

mainly affects overweight prepubertal boys

hypothyroid and renal might predispose

A

SUFE

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62
Q

in SUFE get loss of ___ (movement)

A

internal rotation

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63
Q

Rx for SUFE =

A

urgent Sx pinning
replacement
osteotomyif chronic

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64
Q

jumpers knee =

Rx:

A

patellar tendonitis

rest +/- physio

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65
Q

Sinding-Larsen-Johansen =

A

inferior pole of patella apophysitis of patellar tendon

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66
Q

patellofemoral dysfunction =

A

anterior knee pain in adolescents

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67
Q

adolescent with poorly localised knee pain, effusion and locking =

A

Osteochondritis Dissecans

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68
Q

___ technique for splinting talipes equinovarus =

A

Ponseti

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69
Q

tarsal coalition is between ___ or ___

A

calcaneus-navicular

talus-calcaneus

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70
Q

management of cauda equina syndrome =

A

urgent PR -> MRI > discectomy

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71
Q

cervical disc prolapse is usually __/___ nerve roots that are affected

A

C7/8

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72
Q

Downs and Rheum arth are at risk of _/__ spine subluxation

A

C1/2

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73
Q

rotator cuff muscle that initiates abduction

attaches to ___

A

supraspinatus

greater tuberosity

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74
Q

rotator cuff muscle that is external rotator

attaches to ___

A

infraspinatus and

greater tuberosity

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75
Q

rotator cuff muscle that is internal rotator

attaches to ___

A

subscapularis

lesser tuberosity

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76
Q

in frozen shoulder: initial ___ (subsides in ___ months) as ___ increases (for __ months)

A

pain
2-9months
stiffness
4-12 months

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77
Q

Ca2+ deposition in supraspinatus tendon seen on xray just proximal to greater tuberosity
=> ___

A

Acute calcific tendonitis

acute severe shoulder pain

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78
Q

Rx of acute calcific tendonitis =

A

self limiting as Ca2+ resorbs

injection of subacromial steroid and local anaesthetic

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79
Q

carpal tunnel contains -

A

median nerve

9 flexor tendons ( 4x FDS + FDP and 1 FPL) with synovial covering

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80
Q

carpal tunnel syndrome => paraesthesia of ____
worse at ___
loss of ___ and ___ of thumb or __ of hand

A

thumb and radial 2 1/2 fingers
night
sensation and weakness
clumsiness

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81
Q

Osborne’s fascia

A

tight band over cubital tunnel roof

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82
Q

cubital tunnel syndrome => paraesthesia in ___

A

ulnar 1 1/2 fingers

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83
Q

__+__ supinate forearm

A

biceps and supinators

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84
Q

__+__ pronate forearm

A

pronator teres and pronator quadratus

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85
Q

hyperplasia of myofibroblast cells and production of type 3 not 1 collagen in palmar fascia =

A

Dupuytrens contracture

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86
Q

__+__ contractures occur in Dupuytrens

A

MCP and PIP

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87
Q

deformities of hand and wrist in RA

A 
volar MCPJ subluxation
ulnar deviation
swan neck 
boutonniere
z-shaped thumb
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88
Q

hanging rope sign =

A

AVN of femoral head

89
Q

pain and tender at greater trochanter and pain on ____

A

troachanteric bursitis

resisted abduction

90
Q

menisci are made from ___

A

fibrocartilagenous

91
Q

degenerative meniscal tears are Steinmann’s ___

A

-ve

92
Q

usually extensor mech part that ruptures in < and > 40yos

A 
<40yo = patellar
> = quadriceps
93
Q

avoid ___ in tendonitis in extensor mechanism as increases rupture risk

A

steroid injection

94
Q

___ (Abx) that can cause tendonitis

A

quinolones

95
Q

patellofemoral dysfunction encompasses (3)

A

chondromalacia patellae
adolescent ant knee pain
lateral patellar compression syndrome

96
Q

quad muscle tends to pull patella medially/laterally

this is greater in F/M due to ___

A

laterally

F - wider hips

97
Q

patella almost always dislocates ___

and is reduced when __

A

laterally

leg is straightened

98
Q

OA of foot and ankle common in __ due to repeated dorsiflexion => osteophytes and impingement
___ Rx is more reliable and has fewer re-op rates
___Rx has a better functional outcome, usually only in elderly

A

footballers
Arthrodesis
replacements

99
Q

hallux valgus is due to ___ of 1st MT and ___ of toe

A

medial deviation

lateral deviation

100
Q

gold standard for hallux rigidis (1st MTPJ OA)

means F can no longer___

A

arthrodesis

wear heels

101
Q

plantar interdigital nerves (from medial and lateral plantar nerves) overlying intermetatarsal ligaments can be subjected to repeated trauma. Become swollen and inflamed =

A

Morton’s neuroma

102
Q

Morton neuroma => ___ pain and ___ into toes

A

burning

tingling

103
Q

most common site of Morton’s neuroma

A

3rd interspace nerve > 2nd

104
Q

Med-laterally compressing MT heads reproduces burning pain and toe tingling and produces a click =
test for

A

Mulder’s click test

Mortons neuroma

105
Q

Rx of Mortons neuroma

A

US
may => MT pad/offloading insole
Steroid and LA injections
can be excised

106
Q

MT stress # is usually in ___ then ___ next most common

Rx =

A

2nd > 3rd
xray might not show til 3rd wk and bone scan may be useful
6-12wk in rigid soled boot

107
Q 
tibialis posterior distal insertion is predominantly \_\_\_ 
function =
A

medial navicular

support medial arch (+ plantarflexion + invertor of foot)

108
Q

hyperextension at MTPJ and hyperflex at PIP+DIPJ =

A

claw toe

109
Q

hyperextension at MTPJ + DIPJ and hyperflex at PIPJ =

A

hammer toe

110
Q

metal particles in arthroplasty can => ___ => ___

A 
inflammatory granuloma (pseudotumour)
bone and muscle necrosis
111
Q

polyethylene particles in arthroplasty can => ___ => __+__

A

inflammation in bone

osteolysis and loosens joint replacement

112
Q

___ used in arthroplasty can shatter due to being brittle

A

ceramics

113
Q

arthrodesis = remove __+___ and stabilise bone with __

A

hyaline cartilage and subchondral bone

fusion

114
Q

arthrodesis is an option for __++

A

ankle arthritis
wrist arthritis
hallux rigidis

115
Q

osteotomy =

A

remove a wedge of bone to redistribute weight, realign and correct deformity

116
Q

osteotomy can be used for __+__

A

early hip and knee arthritis

117
Q

___ may infect osteocytes intracellularly

A

S. aureus

118
Q

in neonates some metaphyses are ___ and so osteomyelitis can cause

A

intra articular

septic arthritis

119
Q

Brodies abscess =

A

children’s subacute osteomyelitis where abscess is walled by thin sclerotic bone

120
Q

most common site in spine for osteomyelitis

A

lumbar

121
Q

neonatal organisms of osteomyelitis

A

S aureus
enterobacter spp
Strep A + B

122
Q

4m -4yo organisms of osteomyelitis

A

S. aureus
Strep A
H. infu
enterobacter spp

123
Q

4yo - adult orgs of osteomyelitis

A

S aureus 80%
Strep A
H influ
enterobacter spp

124
Q

adult orgs of osteomyelitis

A

S aureus

occasionally Strep/enterobacter spp

125
Q

sickle cell anaemic org.s of osteomyelitis

A

S. aureus

salmonella - unique to this group

126
Q

salmonella osteomyelitis is unique to which pop group

A

Sickle cell anaemics

127
Q

late onset haemotologically spread causative org.s of infection post ortho Sx =

A

S. aureus
beta strep
enterobacter

128
Q

in primary healing gap fills with

A

new bone from osteoblasts

129
Q

hypertrophic non-union occurs if ____ => abundant ___ but no bridging

A

excessive movement

hard callus

130
Q

cause of transverse # = __ force

A

bending

131
Q

oblique fractures are caused by a ___ force

A

shearing (fall/deceleration)

132
Q

transverse #s may ___ and don’t ___ unless completely displaced

A

angulate

shorten

133
Q

oblique fractures tend to ___ and may ___

fix with ____

A

shorten
angulate
interfragmentary screws

134
Q

spiral #s are due to ___ forces

A

torsional

135
Q

most spiral fractures are unstable to ___ and can ___. Fix with ___

A

rotation
angulate
interfragmentary screws

136
Q

bone fracture with >=3 parts =

usually high E / poor bone quality

A

comminuted

137
Q

2 separate fractures =

need ___ Rx

A

segmental

need stabilisation with rod / plates

138
Q

direct translation of distal fragment =

A

displacement

139
Q

direction the distal fragment to the degree of deformity

A

angulation

140
Q

Ix for #s =

A 
1st line = AP and lateral xray
perhaps later: tomography (mandibular)
CT complex/Sx plan)
MRI (occult #)
technetium bone scan (stress #)
141
Q

compartment syndrome:

__+__ increase pressure in fascial compartment => compress ___ => ____ as ___ cant supply

A 
blood
inflammation
veins
secondary ischaemia
arteries
142
Q

if untreated compartment can => necrosis => ____

A

Volkmann’s ischaemic contracture

143
Q

increased pain on passive stretching and more severe pain than expected

A

compartment syndrome

144
Q

contusion =

A

bruising

145
Q

blisters are caused by:

A

inflammatory exudates lift epidermis

146
Q

of tibia take ___ to unite

A

16wk-1yrs

147
Q

of the femoral shaft take ___ to unite

A

3-4 months

148
Q

___ heal faster that cortical #

A

metaphyseal

149
Q

fracture disease symptoms = __+__ usually Rx =

A

stiffness
weakness
resolve with time

150
Q

sites prone to non-union =

A

scaphoid waist
distal clavicle
subtrochanteric femoral
Jones # of 5th MT

151
Q

heightened chronic pain response after injury =

A

CRPS - chronic regional pain syndrome

152
Q

type 1+2 CRPS =

A

1 - due to peripheral nerve injury

2 - no cause

153
Q

Rx for CRPS

A 
analgesia
amitriptylline
gabapentin + steroids
TENS
lidocaine patches
symp nerve block injections
154
Q

Gustilo classifaction describes the degree of __+__+__ in assessing ____

A

contamination, wound size, if can be closed, if vascular injury
open #s

155
Q

Rx of open #s =

A

IV broad spectrum Abx (fluclox, gent + metro if soil contaminants) + sterile dressing =>
debride + int/ext fixation => close wound

156
Q

skin grafts don’t take to +++

A

bare tendon, bone, metal or fat

157
Q

most disclocations Rx =

A

closed manipulation and anaesthesia

158
Q

__+__ tendon tears need repair to restore function

A

quad and patellar

159
Q

+++ tendon tears can be treated conservatively unless reduced function

A

achilles
rotator cuff
long head of biceps brachii
distal biceps

160
Q

suspect ___ if septic arthritis in multiple joints

A

endocarditis

161
Q

Organisms of Septic arthritis

A 
S aureus (most common)
strep
H influ (kids)
Neisseria gonorrhoea
E coli (IS, elderly, IVDUs)
162
Q

Rx in septic arthritis

A

aspirate
Abx ( after confirmed diagnosis and organism)
Sx washout

163
Q

criteria for a clinically clear (collar can be removed) C spine =

A 
no Hx of loss of consciousness
GCS 15 without intoxication
no other sig distracting injuries
no neuro
no midline tenderness
no pain on neck movement
164
Q

if C spine not clinically cleared must ___ clear

A

radiologically

CT/xray

165
Q

Rx for C spine #

A

immobilise in halo vest or stabilise

166
Q

flexion distraction # with failure of posterior ligaments of thoracolumbar spine

A

Chance #

167
Q

spinal shock = physiological response to ___ with complete loss of ++_
resolves in __
____ return signals its end

A

injury
sensory, motor and reflexes
24hrs
Bulbocavernous reflex

168
Q

Bulbocavernous reflex =

signals end of ___

A

anal sphincter contracts with squeeze of glans penis/ tap mons pubis / pull urethral catheter

169
Q

neurogenic shock is 2ndry to ____ of ___

A

temporary shutdown of sympathetic outflow from T1-L2

170
Q

in men neurogenic shock may => ___ due to unopposed

A

priapism

parasympathetics

171
Q

neurogenic shock => __+__ resolves in ___

A

hypotension
bradycardia
24-48hrs

172
Q

corticospinal tract is responsible for __

A

motor

173
Q

spinothalmic tract is responsible for __+__+_

A

coarse touch

pain and temp

174
Q

central cord syndrome more commonly affects __ >___ as corticospinal tracts lie more ___ than __ ones

A

arms > legs
central
leg

175
Q

anterior cord syndrome = loss of __+__ with __+__+__ preserved

A 
corticospinal tract (motor) + lateral spinothalmic tract (coarse touch, pain temp)
proprioception, vibration sense and light touch (dorsal collumns)
176
Q

Brown Sequard syndrome:
due to ___ of cord => loss of ___ sensation (proprioception, vibration sense and light touch) and ___ ipsilaterally
an contralateral loss of ++_ sensation as ___ nerves cross 1/2 levels above entry into cord + others cross in ___

A 
hemisection
dorsal
paralysis
pain, temp and coarse touch
medulla
177
Q

lateral compression # of pelvis:
__ impact
1 hemipelvis is displaced ___
#s through __/___ + ___ #/____ disruption

A

side
medially
pubic rami/ischium
sacral compression #/ SIJ disruption

178
Q

Vertical shear # of the pelvis:
__ force on one hemipelvis where its displaced ___
may cause __+___ injury and major haemorrhage
leg on affected side will look ___

A

axial
superiorly
sacral nerve root + lumbosacral plexus
shorter

179
Q

anteroposterior compression injury to pelvis => ___ of ___ (“____” #) = substantial bleeding

A

wide disruption
pubic symphysis
open book #

180
Q

low E pelvic #s in elderly:

usually __ displaced __ compression injuries with __/___ posteriorly

A

minimally
lateral
sacral#/ SIJ disruption

181
Q

___ needed for Sx planning of acetabulum #s

A

CT

182
Q

most common humeral neck # =

A

surgical neck with medial displacement of humeral shaft due to pull of pectoralis major muscle

183
Q

Rx of humeral neck Rx =

A

sling

if repeatedly displaced # = internal fixation

184
Q

Bankart lesion =

A

anterior glenoid labrum and capsule detach

185
Q

post humeral head impact on ant glenoid causing an impaction # of posterior head =

A

Hill-Sachs lesion

186
Q

light bulb sign is seen in __ xrays = sign of

A

AP

posterior GHJ dislocation

187
Q

__ union rate ; ___ angulation is acceptable in humeral shaft #s as __+__ are mobile

A

90%
<=30 degrees
elbow and shoulder

188
Q

radial nerve injury => ___ + ___ sensation loss

A

wrist drop

first dorsal web space sensation loss

189
Q

humeral shaft # Rx =

A

functional humeral brace

internal fixation may => quicker recovery

190
Q

olecranon # is caused by fall onto __ with ___ contraction

Rx =

A

elbow point
triceps
ORIF

191
Q

radial head + neck # Rx =

A

sling and physio

may need ORIF

192
Q

Rx of Galeazzi and Montegggia # dislocations

A

ORIF

193
Q

volarly displaced/angulated extra-art # of distal radius usually due to fall on back of flexed wrist =

A

Smith’s #

194
Q

intra art # of distal radius involving dorsal/volar rim and carpal bones sublux with displaced rim # fragment

A

Barton’s #

195
Q

intra-art Smith’s # =

A

volar Barton’s #

196
Q

intra-art Colles # =

A

dorsal Barton’s #

197
Q

anatomical snuff box is between __/__ + __ tendons

A

APB/EPB

EPL

198
Q

spilt cup sign on xray =

A

lunate dislocation

199
Q

lateral ankle ligs affected in a sprain=

A

ant and posterior talofibular and calcaneofibular

200
Q

stable ankle # = ___ without __/___

A

isolated distal fibular #

medial#/ deltoid lig rupture

201
Q

suspect deltoid lig rupture if ___

A

medial tenderness

202
Q

if talar shift then ___ msut be ruptured

A

deltoid lig

203
Q

Rx of talar # =

A

reduce and screw fixation

204
Q

prox diaphyseal # of 5th MT

A

Jones #

205
Q

in paeds ___ angulation is corrected with every year of growth remaining

A

10 degrees

206
Q

treat #s in kids that are ___ as adults as remodelling potential is less

A

12-14yo

207
Q

Salter harris I classification of physeal #s

A

purely physeal separation

least likely to result in growth arrest

208
Q

Salter harris II classification of physeal #s

A

most common

physeal separation + small metaphyseal fragment attached to physis and epiphysis

209
Q

Salter harris III + IV classification of physeal #s

A

intraarticular + # splits physis

must reduce and stabilise

210
Q

Salter harris V classification of physeal #s

A

compression injury to physis => growth arrest

only detected when angular deformity shows

211
Q

if displaced forearm # in paeds Rx=

A

flexible IM nail

212
Q

__ are more common than ___ as causes for supracondylar # of elbow in paeds

A

FOOSH

flexion #

213
Q

median nerve branch predominantly damaged in supracondylar #s?
=> no __ sign as lose __+__ to index

A

anterior interosseous
OK
FPL + FDP

214
Q

Rx of femoral shaft # in <2yo

A

Gallows traction and early hip spica cast

215
Q

Rx of femoral shaft # in 2-6yo

A

Thomas splint/ hip spica cast

216
Q

Rx of femoral shaft # in 6-12yo

A

flexible IM nail

217
Q

Rx of femoral shaft# in >12yo

A

adult IM nail

218
Q

undisplaced spiral tibial shaft # is common in (age groups)

Rx =

A

toddlers

cast

MSKJaz (28 decks)

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