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Musculoskeletal System > Disease Profiles 6 > Flashcards

Disease Profiles 6 Flashcards

1
Q

Simple Bone Cyst

A

Single cavity benign fluid filled cyst in a bone

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2
Q

Simple Bone Cyst: Aetiology

A

Growth defect in the bone physis

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3
Q

Simple Bone Cyst: Normal locations

A

Metaphysis of long bones - proximal humerus and femur
Talus
Calcaneus

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4
Q

Simple Bone Cyst: Clinical Presentation

A

Weakened bone can lead to pathological fracture

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5
Q

Simple Bone Cyst: Investigations (2)

A

X-ray
MRI scan

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6
Q

Simple Bone Cyst: Management

A

Curettage and bone grafting +/- stabilisation

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7
Q

Aneurysmal Bone Cyst

A

Chambers in the bones filled with blood or serum

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8
Q

Aneurysmal Bone Cyst: Aetiology

A

Small arteriovenous malformation

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9
Q

Aneurysmal Bone Cyst: Location

A

Metaphyses of long bones, flat bones and vertebral bodies

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10
Q

Aneurysmal Bone Cyst: Pathophysiology

A

Locally aggressive lesion causes cortical expansion and destruction

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11
Q

Aneurysmal Bone Cyst: Clinical presentation

A

Painful mass or swelling that may cause a pathological fracture

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12
Q

Aneurysmal Bone Cyst: Investigation

A

X-ray

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13
Q

Aneurysmal Bone Cyst: Management

A

Curettage and grafting
Use of bone cement

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14
Q

Fibrous Dysplasia

A

Benign developmental disorder of bone that causes normal skeletal tissue to be replaced by fibrous tissue

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15
Q

Fibrous Dysplasia: Aetiology

A

Genetic mutation

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16
Q

Fibrous Dysplasia: Presents in what age?

A

Adolescents

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17
Q

Fibrous Dysplasia: Pathophysiology

A

Genetic mutation results in lesions of fibrous tissue and immature bone

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18
Q

Fibrous Dysplasia: Defective mineralisation may result in what?

A

Angular deformities causing wider bone with thinned cortices

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19
Q

Fibrous Dysplasia: Clinical Presentation (3)

A

Bone pain
Deformity
Pathological fractures

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20
Q

Fibrous Dysplasia: Investigation

A

Bone scan

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21
Q

Fibrous Dysplasia: What does the bone scan show?

A

Intense increase in uptake during development but the lesion become inactive

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22
Q

Fibrous Dysplasia: Presentation of Femur on bone scan

A

Shepherd’s crook deformity on X-ray

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23
Q

Fibrous Dysplasia: Management Options (3)

A

Bisphosphonates
Stabilise pathological fractures with internal fixation and cortical bone graft
Simple intralesional excision

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24
Q

Henoch-Schlonlein Purpura

A

IgA-mediated generalised vasculitis involving small vessels of the skin, GI tract, kidneys, joints, the lungs and CNS

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25
Q

Henoch-Schlonlein Purpura: Most common age range

A

2-11 years old

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26
Q

Henoch-Schlonlein Purpura: This is preceded by what in 75% of cases?

A

Infection - mainly Group A Streptococcus 1-3 weeks before

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27
Q

Henoch-Schlonlein Purpura: Clinical presentation (5)

A

Purpuric rash over the buttocks and lower limbs
Colicky abdominal pain
Bloody diarrhoea
Joint pain
Renal involvement

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28
Q

Henoch-Schlonlein Purpura: Test for definitive diagnosis

A

Tissue biopsy

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29
Q

Henoch-Schlonlein Purpura: Management

A

Usually self-limiting - 8 weeks
Urinalysis and BP should be monitored due to risk of renal failure

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30
Q

Scaphoid Fractures: What is the most common fracture?

A

Of the carpal bone

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31
Q

Scaphoid Fractures: Mechanism of injury

A

Fall on an outstretched hand

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32
Q

Scaphoid Fractures: Clinical presentation

A

Pain and tenderness in the anatomical snuffbox

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33
Q

Scaphoid Fractures: Investigations

A

X-ray - AP, Lateral and Two obliques (should be repeated after 10 days)
MRI

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34
Q

Scaphoid Fractures: Conservative management

A

Cast

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35
Q

Scaphoid Fractures: Operative management options (2)

A

Percutaneous screw fixation
Open reduction with internal fixation

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36
Q

Scaphoid Fractures: Complications - What blood supply is at risk?

A

Dorsal branch of the radial artery in the distal pole of the scaphoid

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37
Q

Scaphoid Fractures: Complications (4)

A

Damage to the dorsal branch of the radial artery
Non-union
AVN
Early wrist Osteoarthritis

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38
Q

Pelvic Soft Tissue Injury: Acute causes due to what?

A

Muscle tear or tendon avulsion

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39
Q

Pelvic Soft Tissue Injury: Can occur secondary to what?

A

Pelvic fracture

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40
Q

Pelvic Soft Tissue Injury: Investigations (2)

A

US
MRI

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41
Q

Pelvic Soft Tissue Injury: Management

A

RICE

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42
Q

Bone Marrow Oedema: Pathophysiology

A

Impaction to the articular surface leads to microscopic fracture of the trabecular bone with bleeding and impaction

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43
Q

Bone Marrow Oedema: Clinical presentation - Major source of pain

A

Meniscal or Ligament injuries

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44
Q

Bone Marrow Oedema: Investigation

A

MRI

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45
Q

Bone Marrow Oedema: Management - Self resolves within what time line?

A

3 months to one year

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46
Q

Bone Marrow Oedema: Complication

A

Hyaline cartilage may deteriorate to leave a full thickness chondral defect

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47
Q

Claw and Hammer Toes

A

Conditions that deform the shape of the four smaller toes leaving them in a curved position

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48
Q

Claw and Hammer Toes: Aetioogy

A

Acquired imbalance between the flexor and extensor tendons

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49
Q

Claw and Hammer Toes: Claw toes have what pathophysiology?

A

Hyperextension at the MTP joint with flexion in the PIP and DIP joints

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50
Q

Claw and Hammer Toes: Hammer toes have what pathophysiology?

A

Flexion of the PIP joint, Extension of the DIP joint and neutral MTP joint

51
Q

Claw and Hammer Toes: Management - for skin problems

A

Toe sleeves or corn plasters

52
Q

Claw and Hammer Toes: Surgical management options (4)

A

Tenotomy - division of an overactive tendon
Tendon transfer
Arthrodesis of the PIP joint
Toe amputation

53
Q

Cerebral Palsy

A

A persisting qualitative motor disorder appearing before the age of three years due to non-progressive damage to the brain before the growth of the CNS is complete

54
Q

Cerebral Palsy: Aetiology (6)

A

Insult to the brain before, during or after birth
Genetics
Hypoxia
Prematurity
Brain malformation
Meningitis or intrauterine infection

55
Q

Obstetric Brachial Plexus Palsy: Incidence

A

2 in 1000 vaginal deliveries

56
Q

Obstetric Brachial Plexus Palsy: Most commonly arises in what cases? (3)

A

Large babies - macrosomia in diabetes
Twin deliveries
Shoulder dystocia

57
Q

Obstetric Brachial Plexus Palsy: Most common type

A

Erb’s Palsy

58
Q

Obstetric Brachial Plexus Palsy: Erb’s Palsy - Aetiology

A

Injury to C5 and C6 nerve roots

59
Q

Obstetric Brachial Plexus Palsy: Erb’s Palsy - Pathophysiology

A

Causes loss of motor innervation to the deltoid, supraspinatus, infraspinatus, biceps and brachialis muscles

60
Q

Obstetric Brachial Plexus Palsy: Erb’s Palsy - Clinical presentation

A

Injury leads to internal rotation of the humerus - due to unopposed subscapularis

61
Q

Obstetric Brachial Plexus Palsy: Erb’s Palsy - Management first and second line

A

Physiotherapy - prevents contractures early on
Surgical release of contractures and tendon transfers

62
Q

Obstetric Brachial Plexus Palsy: Klumple’s Palsy - Aetiology

A

Injury to the lower brachial plexus - C8 + T11 roots due to forceful adduction

63
Q

Obstetric Brachial Plexus Palsy: Klumple’s Palsy - Clinical presentation (2)

A

Paralysis of the intrinsic hand muscles +/- finger and wrist flexors
Fingers typically flexed

64
Q

Obstetric Brachial Plexus Palsy: Klumple’s Palsy - Why are fingers typically flexed?

A

Paralysis of the interossei and lumbricals which assist extension at the PIP joints

65
Q

Obstetric Brachial Plexus Palsy: Klumple’s Palsy - What syndrome may occur and why?

A

Horner’s Syndrome - due to disruption of the first sympathetic ganglion from T1

66
Q

Obstetric Brachial Plexus Palsy: Klumple’s Palsy - Management

A

None

67
Q

Mechanical Back Pain

A

Recurrent relapsing and remitting back pain with no neurological symptoms

68
Q

Mechanical Back Pain: Mean age

A

20-55 years old

69
Q

Mechanical Back Pain: Risk Factors - Modifiable (5)

A

Obesity
Poor posture
Poor lifting technique
Lack of physical activity
Depression

70
Q

Mechanical Back Pain: Non-modifiable risk factors (3)

A

Facet joint osteoarthritis
Degenerative disc prolapse
Spondylosis

71
Q

Spondylosis

A

Intervertebral disc lose water content with age resulting in less cushioning and increased pressure on the face joint

72
Q

Mechanical Back Pain: Clinical Presentation (2)

A

Pain in the lumbosacral region, buttocks and thighs - dull pain above the knee
Mechanical pain - varies with activity

73
Q

Discogenic Back Pain

A

An acute tear of the outer fibrosis of an intervertebral disc

74
Q

Discogenic Back Pain: Clinical presentation

A

Pain is worse on coughing - as increases disc pressure

75
Q

Discogenic Back Pain: Investigation

A

MRI

76
Q

Discogenic Back Pain: Management

A

Analgesia
Physiotherapy
Symptoms take 2-3 months to settle

77
Q

Sciatica

A

Characteristic pain felt in the lower back, buttocks and the posterior of the lower leg

78
Q

Sciatica: Aetiology

A

Compression of a nerve root of the Sciatic nerve - most commonly L5/S1

79
Q

Intervertebral Disc Prolapse: Intervertebral discs consist of what

A

Concentric collagenous fibres surrounding a central nucleus of degenerated collagen

80
Q

Intervertebral Disc Prolapse: Healthy discs contain what?

A

Water

81
Q

Intervertebral Disc Prolapse: Ageing causes what to happen to the discs?

A

Dehydrated
Weakening of the disc

82
Q

Intervertebral Disc Prolapse: When does prolapse occur?

A

When there is a defect in the annulus fibrosus that allows the nucleus to herniate

83
Q

Intervertebral Disc Prolapse: Herniation of the nucleus occurs due to what?

A

Strenuous physical activity involving the lumbar spine

84
Q

Intervertebral Disc Prolapse: Prolapsed disc material can impinge on nerve roots causing what?

A

Pain and altered sensation in a dermatomal distribution as well as reduced power in a myotomal distribution

85
Q

Intervertebral Disc Prolapse: Most common site

A

Lower lumbar spine in L4, L5 and S1 nerve roots

86
Q

Sciatica: Aetiology - Examples of root compressions by degenerative disease (4)

A

Bone spurs
Canal stenosis
Spondylolisthesis
Facet arthropathy

87
Q

Sciatica: Aetiology - Examples of sinister causes (3)

A

Tumour
Fractures
Tuberculosis

88
Q

Sciatica: Aetiology - Examples of root compression from outside of the spine (4)

A

Piriformis syndrome
Endometriosis
Pelvic disease
Peroneal compression

89
Q

Sciatica: Aetiology - Causes without root compression (2)

A

Arachnioditis
Peripheral neuropathy

90
Q

Sciatica: Classic description

A

Sharp, shooting electric unilateral leg pain that radiates to the foot

91
Q

Sciatica: Management - Management

A

NSAIDs and Analgesia

92
Q

Bony Nerve Root Entrapment

A

Osteoarthritis of the facet joints

93
Q

Bony Nerve Root Entrapment: Complications

A

Osteophytes impinge on exit nerve roots

94
Q

Bony Nerve Root Entrapment: Management

A

Surgical decompression with trimming of impinging osteophytes

95
Q

Spinal Stenosis and Claudication

A

Narrowing of the central spinal canal, intervertebral foramen and lateral recess causing progressive nerve root compression

96
Q

Spinal Stenosis and Claudication: Aetiology - Main cause

A

Degenerative joint disease

97
Q

Spinal Stenosis and Claudication: Aetiology - Common age

A

Middle aged to elderly

98
Q

Spinal Stenosis and Claudication: Pathophysiology - What may cause the lumbar spine to have less space?

A

Sponylosis
Bulging discs
Bulging ligamentum flavum
Osteophytosis

99
Q

Spinal Stenosis and Claudication: Clinical Presentation - Main symptom

A

Claudication - pain in legs on walking

100
Q

Spinal Stenosis and Claudication: Clinical Presentation - Differential diagnosis from vascular claudication

A

Claudication distance is inconsistent
Burning pain - instead of cramping
Spinal extension (standing or walking downhill) exacerbates symptoms whilst flexion improves symptoms
Pedal pulses are preserved

101
Q

Spinal Stenosis and Claudication: Management - Conservative

A

Analgesia
Physiotherapy
Weight loss

102
Q

Spinal Stenosis and Claudication: Management - MRI evidence of stenosis

A

Surgical decompression of the spin to increase space for the cauda equina

103
Q

Cauda Equina Syndrome

A

Compression of the nerve roots caudal to the level of spinal cord termination

104
Q

Cauda Equina Syndrome: Most common aetiology

A

Compression arising from large lumbar disc herniation at the L4/5 and L5/S1 level

105
Q

Cauda Equina Syndrome: Clinical Presentation (4)

A

Bilateral leg pain
Loss of motor or sensory function of the bowel and bladder
Perineal anaestheiae
Progressive motor weakness in the legs or gait

106
Q

Cauda Equina Syndrome: Signs

A

PR exam shows loss of anal sphincter tone

107
Q

Cauda Equina Syndrome: Investigation

A

Urgent MRI to determine level of prolapse

108
Q

Cauda Equina Syndrome: Management

A

Urgent disectomy

109
Q

Cauda Equina Syndrome: Complications - prolonged compression can cause what? This requires what management?

A

Permanent nerve damage - colostomy and urinary diversion

110
Q

Cervical Spondylosis: Clinical presentation

A

Slow onset stiffness and pain in the neck that radiates to the shoulders and occiput

111
Q

Cervical Spondylosis: Management

A

Physiotherapy and analgesics

112
Q

Cervical Disc Prolapse

A

Acute and degenerative disc prolapse in the cervical spine to cause neck pain and nerve root compression

113
Q

Cervical Disc Prolapse: Nerve root compression clinical presentation

A

Shooting neuralgic pain down a dermatomal distribution with weakness and loss of reflexes

114
Q

Cervical Disc Prolapse: Most common affected nerve

A

Lower nerve root - C7 root for C6/7 disc or C8 root for C7/T1 disc

115
Q

Cervical Disc Prolapse: Large central prolapse can have what impact?

A

Compress the cord leading to myelopathy with upper motor neurone symptoms

116
Q

Cervical Disc Prolapse: Investigation

A

MRI

117
Q

Cervical Disc Prolapse: Management (3)

A

Analgesia
Physiotherapy
Surgery

118
Q

Atlanto-Axial Subluxation: Aetiology

A

In RA destruction of the synovial joint between the atlas and dens and rupture of the transverse ligament

119
Q

Atlanto-Axial Subluxation: Management

A

Collar to prevent flexion
If more severe requires surgical fusion

120
Q

Lower Cervical Subluxation: Aetiology

A

Destruction of the synovial facet joints and uncovertebral joints due to RA

121
Q

Lower Cervical Subluxation: Measurements are taken from what?

A

Flexion-Extension X-rays

122
Q

Lower Cervical Subluxation: Management - When is conservative management (analgesia and physiotherapy) used?

A

If instability does not involve or threaten neurological structures

123
Q

Lower Cervical Subluxation: Management - Severe casses

A

Stabilisation and fusion

Musculoskeletal System (9 decks)

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