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MSKsara > Misc > Flashcards

Misc Flashcards

1
Q

What is charcots joints?

A

A.k.a. Neuropathic arthropathy
Occurs in patients with sensory denervation so they will put massive loads through affected joints without causing pain. This leads to structural damage

gross deformity, swelling and instability.

patient should be educated and joint protected.

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2
Q

What types of disease’s cause Charcot joints?

A 
Diabetes
Charcot Marie tooth disease 
Syringomyelia - cyst within spinal cord 
Tabes dorsalis - degeration of neural tracts 
Traumatised nerves 
leprosy
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3
Q

What is chronic regional pain syndrome ?

A

Condition associated with long term pain without an obvious cause (often stimulated by trauma but then persists for no reason)
Impulse from periphery to CNS and back via SNS to create burning, allodynia, hyperalgesia, skin temp and colour changes, oedema and reduced ROM.

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4
Q

What are the causes of hypermobility ?

A 
Marfans
Ehlers danlos 
Osteogenesis imperfecta
Bone shape 
Hypotonia 
Absent/ reduced proprioception
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5
Q

what organisms causing osteomyelitis is linked to sickle cell disease?

A

blood and bone infections caused by non-typhi salmonella are commonly associated with malaria and sickle cell disease

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6
Q

what is the most common organism responsible for osteomyelitis?

A

S.aureus

expect for those with sickle cell where salmonella species dominate

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7
Q

what are the predisposing factors to osteomyelitis?

A 
diabetes
IV drug use
immunosuppression
alcohol
sickle cell
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8
Q

how would you manage osteomyelitis?

A

MRI is the best imaging modality
flucoxacillin for 6 weeks
clindamycin if pen allergy

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9
Q

what are oslers nodes and what are they commonly associated with?

A 
endocarditis
SLE
gonorrhoea
typhoid 
haemolytic anaemia.
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10
Q

What is leriches syndrome?

A

An atherosclerotic disease affecting the abdominal aorta and iliac arteries. This leads to triad of symptoms:

  • buttock claudication
  • impotence
  • atrophy of muscle in legs
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11
Q

how is leriches syndrome treated?

A

modify risk factors: hypercholesterolemia and smoking
can also use endovascular angioplasty and stent insertion
view/diagnose via angiography.

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12
Q

describe the features of L3 nerve root compression?

A

sensory loss over anterior thigh.
weak quads
reduced knee reflex
positive femoral stretch test

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13
Q

describe the features of L4 nerve root compression?

A

sensory loss anterior aspect of knee
reduced knee reflex
positive femoral stretch test

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14
Q

describe features of L5 nerve root compression

A

sensory loss dorsum of foot
weakness in foot and big toe dorsiflexion
reflexes intact
positive sciatic nerve test

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15
Q

describe features of S1 nerve root compression?

A

sensory loss on posteriolateral aspect of leg and lateral aspect of foot.
weak plantar flexion and reduced ankle reflex.
positive sciatic stretch test

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16
Q

what is the femoral nerve stretch test?

A

patient prone with pillow under abdomen. Extend hip and keep knee flexed at 90 degrees. Pain in anterior and lateral thigh
indicates irritation of femoral nerve or L2,3,4

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17
Q

what is the beighton score?

A

scoring system for hypermobility - out of 9 points
2 points for hyperextended knees (one on each side)
2 points for hyperextended elbows (one on each side)
2 points hyperextension of little finger to >90 degrees
2 points for flexion of thumb to forearm.
1 point for touching hands on floor from standing

score of 4 or more indicates hypermobility

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18
Q

what are the complications of hypermobility?

A

joint pain
prone to dislocation
back pain

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19
Q

what is multiple exostoses?

A

inherited autosomal dominant condition where there is abnormal bone remodelling and formation of benign bone tumour esp. in distal femur and proximal tibia.
treated with surgical excision, physio and pain management

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20
Q

what is SONK?

A

spontaneous osteonecrosis of the knee

pain over medial femoral condyle - sudden onset and bone oedema.

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21
Q

what is surgical emphysema?

A

air becomes trapped in subcutaneous tissue, most commonly in the chest, neck or face.
patients complain of localised pain. in neck there maybe dysphagia or dyspnoea
on examination the skin feels bubbly and may make a crackling sound.

caused by pneumothorax, fistula, ruptured oesophagus/trachea, CPAP, chest drain insertion, gas gangrene

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22
Q

who does hallux valgs mainly affect?

A

older women

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23
Q

name 4 vascular causes of joint pain.

A

wegeners
churg strauss
Bechet
Takayasu

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24
Q

what is churg strauss?

A

eosinophilic granulomatosis with polyangiitis
eosinophils will be raised
in atopic individuals i.e. also symptoms of asthma
arthritis

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25
Q

what does Bechet syndrome cause?

A 
optic neuropathy 
ulceration
thrombosis
arthritis 
vasculitis
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26
Q

what causes bursitis?

A

over use - increased friction
autoimmune - RA, SLE, scleroderma
infection
iatrogenic

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27
Q

what is the most common site of bursitis?

A

subacromial bursitis

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28
Q

why might a patient being treated for compartment syndrome require aggressive IV fluid treatment?

A

Fasciectomy may lead to myoglobinuria which can result in kidney injury so to avoid this give fluids.

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29
Q

what should be done if muscles are necrotic by the time of fasciectomy after compartment syndrome?

A

remove necrotic tissue

consider if amputation is needed

30
Q

which part of the proximal humerus is most likely to be fractured?

A

surgical neck

rare to have fractures of anatomical neck.

31
Q

what is the risk of anatomical neck fractures of humerus?

A

if displaced by >1cm they carry a risk of AVN of humeral head.

32
Q

which type of shoulder injury is often misdiagnosed?

A

posterior shoulder dislocation

33
Q

what are the main functions of each rotator cuff muscle?

A

supraspinatus - first 0-15 degrres abduction
subscapular - internal reduction
infraspinatus and teres minor - external rotation

34
Q

what is meralgia paraesthetica?

A

compression of the lateral cutaneous nerve of the thigh. leads to burning sensation over the anterolateral thigh

35
Q

how do fat emboli present?

A

tahcypnoea, tachycardia, pyrexia, hypoxia, petechial rash, confusion, retinal haemorrhage

36
Q

what is metabolic bone disease?

A

bone disease i.e. abnormal growth affected by metabolic factors e.g. GH, androgens, T3/4, PTH, vitamin C, D and calcitonin.
these include osteoporosis, osteomalacia/rickets, hyperparathyroidism, hypoparathyroidism, hyperthyroid, renal osteodystrophy and pagets.
also osteogenesis imperfect and anchondroplasia

37
Q

what metabolic bone disease is caused by abnormalities in collagen?

A

osteogenesis imperfect

- collagen type 1 disease (abnormal synthesis by osteoblasts) - autosomal dominant

38
Q

what are the clinical features of osteogenesis imperfect?

A

leads to severe weakness in bones - recurrent fractures in childhood (need to rule out non accidental injuries)
blue sclera
hearing loss
short stature.

39
Q

what is achondroplasia?

A

autosomal dominant condition with mutation in FGFR-3. This effects ENDOCHONDRAL ossification. therefore normal head and spine but shortened limbs - type of dwarfism.

40
Q

what is pagets disease?

A

bone looses normal architecture and develops and increased blood supply. there is a focal increase in bone remodelling (i.e. excess breakdown and remodelling) which results in abnormal weak bone

41
Q

what bones are mainly affected by pagets disease?

A

pelvis, spine, skull, femur and tibia

42
Q

what causes pagets disease?

A

paramyxovirus of osteoclasts

generic and dietary factors all interplay

43
Q

how does pagets disease present?

A 
painful bones and warm to touch due to increased blood supply
bone expansion and deformity 
arthritis in joints nearby 
pathological fractures
hearing loss
44
Q

what are the phases of pagets disease?

A

osteoclastic
mixed osteoclastic-osteoblastic
osteoblastic

45
Q

what investigations findings are positive for pagets disease ?

A

raised ALP
hot on bone isotope scan
Xray shows areas of bone expansion/ deformity and osteosclerotic areas and osteolytic areas.

46
Q

what are the complications of pagets disease?

A

can lead to osteosarcoma

high output cardiac failure if AV shunts are formed within bone

47
Q

how do we treat pagets disease?

A

anti-resporptive drugs to reduce bone turnover
analgesia
surgery to fix fractures/deformity

48
Q

what is osteopetrosis?

A

also known as marble bone disease - bone becomes abnormally solid so much so that it is brittle.
autosomal dominant caused by carbonic anhydrase mutation (this enzyme normally produces an acidic environment for calcium resorption)
results in poor osteoclast function
patients also suffer from renal tubular acidosis and hydrocephalus.

49
Q

how do you differentiate vascular and neurological claudication?

A

vascular: distal to proximal pain and goes within seconds of rest
neurological: proximal to distal and lasts for minutes. improves with leaning forward for spinal stenosis e.g. uphill walking

50
Q

outline general conservative management for MSK problems

A

weight loss
physio/exercise - often and little.
occupational therapy to make adjustments to house
orthoses - splints/boots e.g. for foot drop
hydrotherapies
pain clinic to improve psychological factors

51
Q

what medications specifically help nerve pain?

A

gabapentin and amitriptyline

52
Q

what are the surgical options for OA?

A

osteotomy - remove bony parts that are causing friction
arthroplasty - repair/ replace joint
arthrodesis - fuse joint

53
Q

What advice would you generally give to patients with back pain?

A

It is common and most often not serious
Most likely to only last few weeks - months
Best dealt with by staying active and good posture
- walking , swimming, maintain lumbar lordosis ( e.g. Use a cushion)

Persist with exercises by physio - stretching and strengthening

54
Q

How long does radiculopathy pain last ?

A

Atleast a few months

55
Q

What does it mean by radicular pain centralising ?

A

Pain going out from limbs and towards back

A good sign

56
Q

At what degree leg raise is sciatic pain usually felt ?

A

30’degrees

57
Q

For back pain how long is bed rest beneficial ?

A

Not beneficial for >2 days

58
Q

what are the nerve roots of the brachial plexus?

A

C5, C6, C7, C8, T1

59
Q

what nerve roots make up the long thoracic nerve?

A

C5,6,7

60
Q

what are the trunks of the brachial plexus and what makes these up?

A

superior trunk - C5, C6
middle trunk - C7
inferior trunk - C8, T1

61
Q

describe the different parts of the brachial plexus

A

roots, trunks, divisions, cords, branches

62
Q

what are the divisions of the brachial plexus and what are they formed from?

A

the superior and middle and inferior trunk each give off an anterior and posterior division. these go on to form cords.

63
Q

what are the cords of the brachial plexus and what are they formed from?

A

lateral cord - from anterior divisions of the superior and middle trunk

posterior cord - from posterior divisions of the superior, middle and inferior trunks

medial cord - anterior division of the inferior trunk

64
Q

what are the branches of the brachial plexus and how are they formed?

A

musculocutaneous - from the lateral cord (C5-C7)

axillary - from posterior cord (C5, C6)

radial - from posterior cord ( C5-T1)

median - from lateral and medial cord (C5-T1)

ulnar - from medial cord (C8, T1)

65
Q

state the key locations for testing sensation of the upper limb:

A 
C5 - just above lateral elbow
C6 - thumb
C7 - middle finger
C8 - little finger
T1 - medial elbow
66
Q

state the key locations for testing sensation of the lower limb:

A 
L1 - groin
L2 medial upper thigh
L3 - medial anterior knee
L4  - medial malleolus
L5 - dorsum of foot (medial side more)
S1 - achillis/ heal 
S2 - back of knees
67
Q

how can the branches of brachial plexus sensation be tested?

A 
axillary nerve - regimental badge
musculocutaneous - lateral forearm
median - thenar eminence
radial - dorsum of hand
ulnar - little finger
68
Q

how can we test the upper limb myotomes

A 
C5 - elbow flexion
C6 - wrist extension 
C7 - elbow extension 
C8 - finger flexion 
T1 - finger abduction.
69
Q

how can we test lower limb myotomes?

A 
L2 - hip flexion
L3 - knee extension
L4 - ankle dorsiflexion 
L5 - big toe extension 
S1 - ankle plantar flexion
70
Q

what nerve roots make up

a) ankle reflex
b) knee jerk
c) biceps
d) triceps reflex

A

a) S1, S2
b) L3, L4
c) C5,C6
d) C7, C8

71
Q

what parts of the spinal nerve roots form the brachial plexus?

A

anterior rami of C5-T1

72
Q

the cords of the brachial plexus are named relative to which artery ?

A

axillary

MSKsara (9 decks)

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