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MSK Year 2 > More disorders > Flashcards

More disorders Flashcards

1
Q

Compartment syndrome

A

When the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves. It usually occurs in the legs, feet, arms or hands, but can occur wherever there’s an enclosed compartment inside the body.

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2
Q

What areas does compartment syndrome usually affect?

A

Calf and forearm

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3
Q

Causes of Compartment syndrome

A

Trauma (complication of fracture)

Continued pressure on a limb (eg. Lying for hours in the same position on the same limb. Often seen in drug and alcohol abuse)

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4
Q

Clinical features of Compartment syndrome

A

Often co-exists with fractures

Suspicious if Pain out of proportion, Pain increases over time (despite analgesia)

Often increased pain on passive flexion and extension of the fingers and toes of the affected limb

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5
Q

Compartment syndrome investigations

A

Measure compartment pressure
> <30mmHg is normal
> >40mmHg is high

Compare diastolic arterial and compartmental pressures – the difference needs to be >30mmHg for adequate perfusion

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6
Q

Compartment syndrome Management

A

Fasciotomy - Needs to be done as soon as possible to minimise risk of irreversible ischaemia

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7
Q

Osteomyelitis

A

Infection of the bone and/or bone marrow - can affect all ages

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8
Q

Common organisms involved in osteomyelitis

A

o Staph aureus
o Pseudomonas
o E. coli
o Strep

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9
Q

Features of osteomyelitis

A 
o	Acute illness with extreme pain over the affected bone 
o	Symptoms may vary
o	Fever
o	Erythema and swelling
o	Unwillingness to move limb
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10
Q

What groups of patients are most likely to get osteomyelitis?

A

> 

Neonates
Drug users
HIV
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11
Q

What part of bones are usually affected in osteomyelitis?

A
  • Long bones usually

* Most commonly in the metaphysis

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12
Q

Investigations in osteomyelitis

A

Positive blood cultures

Increased WBC, ESR

Xrays - Will be normal early on, After 2 weeks will show loss of density and new bone outlining the raised periosteum

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13
Q

Treatment for osteomyelitis

A

o Rest
o IV antibiotics (flucloxacillin and gentamicin)
o Drainage of any abscesses and removal of sequestra (pieces of dead bone)

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14
Q

What IV antibiotics are used in osteomyelitis?

A

IV flucloxacillin and gentamicin

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15
Q

Complications of osteomyelitis

A
  1. Septicaemia
  2. Acute pyogenic arthritis
  3. Growth retardation
  4. Chronic osteomyelitis
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16
Q

What are the complications of fractures?

A
  • Avascular necrosis
  • Mal-union
  • Non-union
  • Delayed union
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17
Q

Avascular necrosis

A

A disease that results from the temporary or permanent loss of blood supply to the bone. When blood supply is cut off, the bone tissue dies and the bone collapses. Early complication (within 48 hours of surgery)

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18
Q

What bone is usually affected by Avascular necrosis?

A

Usually hip (treated with total hip replacement) - Can occur at the end of any long bone

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19
Q

How quickly does avascular necrosis (a complication of fractures) occur

A

Early complication (within 48 hours of surgery)

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20
Q

Clinical features of avascular necrosis

A
  1. Cold
  2. Pulseless
  3. Ischaemia
  4. Paralysis
  5. Paraesthesia of the limb
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21
Q

Investigations in avascular necrosis

A
  1. Xray – normal in the early stages

2. Angiography – confirms diagnosis

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22
Q

Management in avascular necrosis

A

Surgery to revascularise the limb

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23
Q

What is mal-union?

A

Complication of fractures - the separate areas of bone heal, but with incorrect alignment

Proper placement and reduction of the fracture at the time of injury can prevent it - Significant mal-union can be corrected by osteotomy

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24
Q

What is Non-union?

A

Complication of fractures - Non-union (the separated areas of bone do not fuse) - If union has not occurred by 6 months, then it is unlikely to do so without intervention

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25
Q

Investigations for non-union

A
  1. Ongoing pain
  2. Ongoing oedema
  3. Movement at the fracture site
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26
Q

Delayed union of bones

A

Difficult to distinguish between delayed and non-union

X-ray at 6 months is definitive

In both instances the join is likely to be painful throughout

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27
Q

How to tell difference between non-union and delayed union

A

X-ray at 6 months - if still no union over 6 months, it is unlikely to ever unite therefore its a non-union

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28
Q

Tenosynovitis

A

The inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. Tenosynovitis can be either infectious or noninfectious.

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29
Q

Causes of Tenosynovitis

A

De quervain’s tenosynovitis

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30
Q

De Quervain’s tenosynovitis

A

A painful condition affecting the tendons on the thumb side of your wrist. If you have this, it will probably hurt when you turn your wrist, grasp anything or make a fist.

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31
Q

Clinical features of Tenosynovitis

A
  • Pain on the radial side of the wrist - tenderness is most acute over the tip of the radial styloid
  • Abduction of the thumb against resistance is painful
  • Tendon sheath may be thickened
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32
Q

What muscles (within the tendon sheath) are affected in Tenosynovitis?

A
  1. Extensor pollicis brevis

2. Abductor pollicis longus

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33
Q

What are the predisposing factors for Tenosynovitis?

A

> 

Diabetes
IV drug abuse
Immunocompromised
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34
Q

Tennis elbow a.k.a lateral epicondylitis

A

Is an overuse injury - Exacerbated by forced palmar flexion of the wrist

Painful & tender lateral epicondyle and pain on resisted middle finger and wrist extension

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35
Q

Golfer’s elbow (medial epicondylitis)

A

Is an overuse injury - Exacerbated by forced dorsiflexion of the wrist

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36
Q

Treatment for overuse injuries (medial and lateral epicondylitis)

A 
o	Avoid cause
o	Painkillers
o	NSAIDs
o	Steroid
o	physio
o	Use of brace
o	They are self-limiting
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37
Q

Developmental dysplasia of the hip (DDH)

A

Dislocation or subluxation of femoral head during the perinatal period which affects subsequent development of the hip joint - If left untreated, acetabulum is very shallow. In severe cases, a false acetabulum occurs proximal to original with shorter limp.

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38
Q

Risk factors for Developmental dysplasia of the hip (DDH)

A

> 

Breech position in the 2nd/3rd trimester
Family history
Other MSK abnormalities
Girl
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39
Q

Clinical features of Developmental dysplasia of the hip (DDH)

A
  1. Presents in babies
  2. Older child - lump ever since they started walking
  3. Limb shortening, asymmetrical groin/thigh skin
  4. Clicky hip
  5. Ortolani manoeuvre and the barlow manoeuvre – dislocatable hip
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40
Q

Diagnosis of Developmental dysplasia of the hip (DDH)

A
  1. USS as femoral head not ossified yet

2. X-ray after 4-6 months

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41
Q

Treatment for Developmental dysplasia of the hip (DDH)

A
  1. Palvik harness – up to age 4-6 months
  2. Over 18 months – open reduction
  3. Splint
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42
Q

Transient synovitis

A

Commonly called irritable hip, is the most common cause of limping in children. It is due to inflammation (swelling) of the lining of the hip joint. In most cases of irritable hip, your child will have recently recovered from a viral infection.
o 2-10 years
o More common in boys
o Insidious onset

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43
Q

Most common cause of hip pain in childhood

A

Transient synovitis

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44
Q

Clinical features of Transient synovitis

A
  1. Low grade pyrexia
  2. Generally well
  3. Limp - Resistance to internal rotation
  4. Pain on thigh/groin, knee
  5. Restricted range of motion
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45
Q

Investigation for Transient synovitis

A

> 

Throat swab (to check for recent infection)
Osteomyelitis possible diagnosis – MRI to exclude
Aspiration of him or open surgical drainage to limit cartilage damage
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46
Q

Treatment for Transient synovitis

A

NSAID + rest. Pain resolves in weeks

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47
Q

Perthes AKA Legg-Calve-Perthes disease

A

Idiopathic osteochondritis of the femoral head - Afects 4 – 9 years, usually boys - Transient

A rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of the femur is temporarily disrupted. Without an adequate blood supply can lead to avascular necrosis.

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48
Q

Clinical features of Perthes disease

A

> 

Reduced range of movement
Pain at the groin, knee, thigh, buttocks
Limp
Unilateral
Loss of internal rotation
Loss of abduction – positive Trendelenburg test
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49
Q

Investigations for Perthes disease

A
  1. Bloods

2. Xray (can show femoral head collapse)

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50
Q

Treatment for Perthes disease

A

> 

Bed rest
Recurrent attacks increase the risk of necrosis
Avoidance of physical activity
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51
Q

Trendelenburg test

A

A useful procedure for detecting hip-joint dysfunction.

A positive Trendelenburg sign is identified when the patient is unable to maintain the pelvis horizontal to the floor while standing first on one foot and then on the other foot

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52
Q

Slipped Upper Femoral Epiphysis (SUFE)

A

Fat teenage boys - Femoral head slips inferiorly in relation to the femoral neck - 10-16 years

Higher incidence in black people

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53
Q

Causes of Slipped Upper Femoral Epiphysis (SUFE)

A
  1. Local trauma
  2. Mechanical factors
  3. Genetics
  4. Hypothroidism or renal disease may predispose to SUFE

NOT actaully known what causes SUFE could be weight and horomes

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54
Q

Why is there knee pain in Slipped Upper Femoral Epiphysis (SUFE)

A

Might present with knee pain due to obturator nerve supplying both hip and knee joint

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55
Q

Examination findings in Slipped Upper Femoral Epiphysis (SUFE)

A

> 

Pain on hip
Loss of internal rotation***
Trethowans’ sign
X-ray shows subtle changes. Lateral view must be taken
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56
Q

Treatment for Slipped Upper Femoral Epiphysis (SUFE)

A
  1. Pin the femoral head to prevent further slippage

2. Risk of avascular necrosis

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57
Q

What conditions are associated with Carpal tunnel syndrome?

A

Hypothyroidism and acromegaly; RA; conditions with increased fluid retention; fracture (colles)

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58
Q

What nerve is affected in Carpal tunnel syndrome?

A

Median nerve

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59
Q

Carpal tunnel syndrome

A

Is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling and weakness in the hand and arm.

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60
Q

Clinical features of Carpal tunnel syndrome

A

> Numbness
Tingling, Pain
Pins and needles
Affects thumb, index, middle and half of ring finger
Wasting of the thenar eminence (late sign)

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61
Q

Investigations for Carpal tunnel syndrome

A
  1. Phalen’s test (upside-down prayer sign to elicit symptoms)
  2. Tinel’s test (tapping over the medial aspect of the wrist to elicit symptoms)
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62
Q

Diagnosis of Carpal tunnel syndrome

A

> 

Often made clinically

> If in doubt – nerve conduction studies

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63
Q

Phalen’s test

A

Upside-down prayer sign to elicit symptoms

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64
Q

Tinel’s test

A

Tapping over the medial aspect of the wrist to elicit symptoms

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65
Q

Treatment for Carpal tunnel syndrome

A
  1. Splint
  2. Steroid injections
  3. Surgical decompression
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66
Q

Cubital tunnel syndrome

A

Involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand.

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67
Q

Causes of Cubital tunnel syndrome

A

 Compression and stretching
 Acute/delayed trauma
 OA
 RA

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68
Q

Clinical features of Cubital tunnel syndrome

A
  1. Pain
  2. Paraesthesia
  3. Numbness (over ring and little finger)
  4. Weak pinch
  5. Claw hand deformity
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69
Q

Claw hand

A

Clawing of the 4th and little finger - in cubital tunnel syndrome

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70
Q

Investigations for Cubital tunnel syndrome

A

Froment’s sign (patient holds paper with fingers and needs to exert considerably more force than expected to hold it)

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71
Q

Froment’s sign

A

Patient holds paper with fingers and needs to exert considerably more force than expected to hold it

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72
Q

Treatment for Cubital tunnel syndrome

A

> 

Split

> Anterior transposition

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73
Q

Radial nerve palsy

A

o Axillary compression

o Trauma at the neck of the humerus

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74
Q

Radial nerve palsy clinical features

A
  1. Pain
  2. Paraesthesia
  3. Numbness
  4. Wrist drop/finger drop
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75
Q

Treatment for Radial nerve palsy

A

> 

Supportive
Steroid injection 
Splint
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76
Q

Trigger finger

A

Permanently flexed finger due to tendonitis of a flexor tendon to a digit resulting in a nodular enlargement of the affected tendon.

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77
Q

Trigger finger epidemiology

A
  • Males
  • Caucasian
  • Late adulthood
  • Associated with diabetes and alcohol
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78
Q

Clinical features for Trigger finger

A 
o	Catching
o	Snapping
o	Locking
o	Dysfunction
o	Pain
79
Q

Causes for Trigger finger

A
  1. Idiopathic
  2. Inflammation (tenosynovitis)
  3. Autosomal dominant inheritance
80
Q

What conditions are associated with trigger finger?

A

Associated with diabetes and alcohol

81
Q

Treatment for trigger finger

A

Steroid injection

Surgery

82
Q

Dupuytren’s contracture

A

An abnormal thickening of the skin in the palm of your hand at the base of your fingers. This thickened area may develop into a hard lump or thick band. Over time, it can cause one or more fingers to curl (contract), or pull sideways or in toward your palm.

83
Q

What fingers are usually affected in Dupuytren’s contracture

A

Ring or little finger

84
Q

Pathophysiology of Dupuytren’s contracture

A

Palmar fascia undergoes hyperplasia. Result of contracture and fibrosis of the palmar aponeurosis. Production of abnormal collagen (type 3 instead of type 1)

85
Q

Epidemiology of Dupuytren’s contracture

A
  • Tends to be men
  • Scandanavian/northern European people
  • Associated with diabetes, liver disease, epilepsy
  • Associated with a history of alcohol excess
  • Other fibromatoses like peyronie and ledderhose disease
86
Q

What conditions are associated with Dupuytren’s contracture?

A

Associated with diabetes, liver disease, epilepsy
Associated with a history of alcohol excess
Other fibromatoses like peyronie and ledderhose disease

87
Q

Clinical features of Dupuytren’s contracture

A

o Tender palpable nodule on palm
o Progressive deformity
o Pain subsides as it progresses
o Contracture of the MCP and PIP joints

88
Q

Management of Dupuytren’s contracture

A
  1. Steroid injections

2. Surgery (Removal of diseased tissue – faciectomy or division of cord – fascioctomy)

89
Q

Posterior hip dislocation

A
  1. Shortening and internal rotation

2. Happens in RTA (where knees hit the dashboard)

90
Q

Anterior hip dislocation

A

Less common

  1. Causes pain in the hip and inability to walk or adduct the leg
  2. Externally rotated – abducted and extended at the hip
91
Q

Shoulder impingement

A

Shoulder impingement is when a tendon in your shoulder rubs or catches on a nearby bone - is a syndrome not a diagnosis

Chronic thickening of the rotator cuff from repeated wear and tear

92
Q

Another name for Shoulder impingement

A

Supraspinatus tendonitis

93
Q

Clinical features of shoulder impingement

A
  • Reaching upwards with the arm exacerbates the pain
  • Painful arc between 50 and 120 degrees - On either side of the arc, it is painless
  • Still full range of movement unlike frozen shoulder
94
Q

Treatment for shoulder impingement

A
  1. NSAIDs
  2. Analgesics
  3. Steroid injections
  4. Physiotherapy
  5. Surgery can be used to make more space
95
Q

Frozen shoulder

A

Shoulder is painful and stiff

96
Q

Frozen shoulder clinical features

A

o Unilateral shoulder pain
o Restriction of movement
o Tenderness of examination
o Over several months, the pain subsides but movement becomes restricted

97
Q

Frozen shoulder management

A
  1. Analgesics

2. Mobilising exercises

98
Q

Difference in shoulder impingement and frozen shoulder

A

Difference in range of movement; in frozen shoulder range of movement is restricted at 50-120 degrees, shoulder impingement has no restirction

99
Q

Rotator cuff tear features

A

o Night pain
o Muscle wasting
o Classically a sudden jerk with subsequent pain and weakness
o Usually involve supraspinatus

100
Q

What 4 muscles make up the rotator cuff?

A
  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
  4. Subscapularis
101
Q

Difference between full thickness and partial thickness rotator cuff tear

A

Full thickness (active shoulder movement is impossible) or partial thickness (movement is possible but there is pain)

102
Q

Acute calcific tendonitis

A

o Acute onset of severe shoulder pain
o Calcium deposition in supraspinatus
o Self-limiting
o Pain can be eased by needling the lesion

103
Q

Plantar fasciitis

A

Pain at the attachment of the plantar fascia to the medial tubercle of the calcaneus - type of enthesitis/enthesopathy

104
Q

Plantar fasciitis clinical features

A

o Worse in the morning
o Aggravated by standing
o Worse after activity
o Occurs in runners

105
Q

Treatment of Plantar fasciitis

A
  1. Rest
  2. Modified footwear
  3. Pain relief
106
Q

Oblique fractures

A

Oblique = compression
> Diagonal
> Follows impact

107
Q

Transverse fractures

A

Transverse = bending tension on one side, compression on the other side
> Right angle to bone
> Follows impact

108
Q

Spiral fractures

A

Spiral = twisting

109
Q

Commuted fractures

A

Rubbish bone quality, low energy fracture

110
Q

Segmental fractures

A

Same bone broken twice
> Very unstable
> Needs surgery

111
Q

Crush fractures

A

In the middle, you’ll get a white bit of bone

This is because the bones are overlying each other

112
Q

Varus fracture

A

Bends medial - inwards angulation

113
Q

Valgus fracture

A

Bends laterally

114
Q

Management of open fractures

A
  1. Cover wound with dressing
  2. Broad spectrum antibiotics (IV)
  3. Ensure tetanus immunisation
  4. Early debridement in theatre
115
Q

Mechanical back pain

A

Recurrent back pain with no neurological symptoms
• Worse with movement relieve by rest.
• No red flag symptoms

116
Q

Causes of mechanical back pain

A

Obesity; posture; poor lifting technique; lack of physical activity; depression; degenerative disc prolapse; facet joint OA; spondylosis.

117
Q

Management of mechanical back pain

A
  • Analgesia & physiotherapy.

* Maintain normal function as much as possible

118
Q

Acute disc tear

A

Acute tear of outer annulus fibrosus after lifting a heavy object
Pain worse on coughing. Symptoms resolve in months
Treatment – analegesia & physiotherapy

(nucleus pulposis is inner portion if disc)

119
Q

Lumbar Radiculopathy

A

Often secondary to compression and inflammation of a spinal nerve - if it travels down the back of the legs to the calf - its called scaitica

120
Q

Sciatica

A

Describes nerve pain in the leg that is caused by irritation and/or compression of the sciatic nerve. Sciatica originates in the lower back, radiates deep into the buttock, and travels down the posterior leg.

121
Q

Features of Lumbar Radiculopathy

A

Pain & altered sensation in a dermatomal distribution

Reduced power in a myotomal distribution

122
Q

L4 root entrapment

A

(L3/4 prolapse). Loss of quad power, reduced knee jerk

123
Q

L5 root entrapment

A

(L4/5 prolapse). Pain to dorsum of foot. Reduced extensor hallucis longus & tibialis anterior

124
Q

S1 root entrapment

A

(L5/S1 prolapse). Pain to sole of foot. Reduced plantar flexion, reduced ankle jerk

125
Q

Spinal stenosis & claudication

A

Narrowing of spinal canal - Reduced space for the cauda equina as a result of spondylosis or bulging disc, bulging ligamentum flavum & osteophytes.

Multiple nerve roots compressed & irritated

126
Q

Spinal stenosis clinical features

A

Over 60s, pain in legs on walking (claudication)

Symptoms similar to vascular claudication.

pain less on walking up hill (spin flexion creates more space for cauda equina)

pedal pulses preserved

127
Q

Treatment of Spinal stenosis & claudication

A
  • Conservative – physio + weight loss

* MRI evidence of stenosis then decompression

128
Q

Difference in peripheral vascular disease and spinal stenosis

A

Differences include: inconsistent claudication distance; burning rather than cramping pain; pain less on walking up hill (spin flexion creates more space for cauda equina); pedal pulses preserved

129
Q

Cauda Equina syndrome

A

Large central disc prolapse compressing all nerve roots of cauda equina. Surgical emergency as prolongment can cause permanent nerve damage

130
Q

Cauda Equina syndrome features

A

Bilateral leg pain, paraesthesiae or numbness and saddle anaesthesia

Altered urinary & bowel function.

131
Q

Investigations and management of Cauda Equina syndrome

A
  • PR exam is mandatory
  • Urgent MRI & discectomy

Patients have residual nerve injury with permanent bladder & bowel dysfunction

132
Q

Back pain causes in young patient (<20)

A

Osteomyelitis, discitis, spondylolisthese, osteoid osteoma, osteosarcoma

133
Q

New back pain in older patient (>60)

A

Arthritic change, crush fracture; higher risk or neoplasia (metastatic disease & multiple myeloma)

134
Q

Constant, severe pain worse at night

A

Pain from tumour or infection tends to be constant & unremitting

135
Q

Cervical spondylosis

A

Commonly called arthritis of the neck, is the age-related, wear-and-tear changes that occur over time. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones osteophytes.

Osteophytes can also impinge on exiting nerve roots resulting in radiculopathy involving upper limb.

136
Q

Features of Cervical spondylosis

A

Slow onset stiffness & pain in neck radiating to shoulders and occiput - commonly called arthritis of the neck, is the medical term for the wear-and-tear changes that occur in the cervical spine

137
Q

Sacroilitis

A

Sacroiliitis is an inflammation of one or both of your sacroiliac joints

138
Q

Saddle anesthesia

A

Refers to reduced sensation in the area that would be in contact with a saddle if sitting on one. This includes the perineum, buttocks, anus, groin and upper thighs.

Saddle anaesthesia will make these areas feel numb and abnormal

139
Q

Atlantoaxial instability

A

Characterised by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bony or ligamentous abnormality.

Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved.

140
Q

Xerotrachea

A

Dryness of the tracheobronchial mucosa which can manifest as a dry cough.

141
Q

Xerostomia

A

Dry mouth

142
Q

keratoconjunctivitis sicca

A

Dry eyes

143
Q

Wilson’s disease

A

A rare inherited disorder that causes copper to accumulate in your liver, brain and other vital organs

144
Q

Renal Osteodystrophy

A

A form of metabolic bone disease seen in patients with chronic renal insufficiency characterized by bone mineralization deficiency due to electrolyte and endocrine abnormalities.

Patients present with osteomalacia, osteonecrosis and pathologic fractures

145
Q

Haemochromatosis

A

An inherited condition where iron levels in the body slowly build up over many years

146
Q

Spondylolisthesis

A

Where one of the bones in your spine, known as a vertebra, slips out of position. It’s most common in the lower back, but it can also happen in the mid to upper back

147
Q

Spondylolisthesis verus slipped disc

A

Spondylolisthesis - slipped vertebrae

Slipped disc - slipped intravertebral dosc BETWEEN vertebrae

148
Q

Trendelenburg gait

A

An abnormal gait resulting from a defective hip abductor mechanism. The muscles involved are the gluteus medius and gluteus minimus. The weakness of these muscles causes drooping of the pelvis to the contralateral side while walking.

149
Q

How to take Biphosphonates

A

Take at least 30 mins before breakfast with water and sit uprightfor 30 mins following.

150
Q

Oftawa ankle rules

A

States Xrays are only necessary for suspected ankle fracture if

1) inability to weight bear for 4 steps
2) Tenderness over distal tibia
3) Tenderness over distal fibula

151
Q

Maisonneuve fracture

A

A spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.

152
Q

Most common causive organism for Psoas abscess

A

Staph aureus

153
Q

iliopsoas abscess

A

An iliopsoas abscess describes a collection of pus in iliopsoas compartment (iliopsoas and iliacus).

154
Q

Causes of primary illiopsoas abscess

A

Haematogenous spread of bacteria

Staphylococcus aureus: most common

155
Q

Causes of secondary illiopsoas abscess

A 
Crohn's (commonest cause in this category)
Diverticulitis, colorectal cancer
UTI, GU cancers
Vertebral osteomyelitis
Femoral catheter, lithotripsy
Endocarditis
intravenous drug use
156
Q

Clinical features of Psoas abscess

A 
Patient in the supine position with the knee flexed and the hip mildly externally rotated
Fever 
Back pain
Limp
Weight loss
157
Q

Iliopsoas abscess investigation

A

CT abdomen

158
Q

Management of iliopsoas abscess

A 
Antibiotics
Percutaneous drainage
Surgery is indicated if:
1. Failure of percutaneous drainage
2. Presence of an another intra-abdominal pathology which requires surgery
159
Q

Medications that worsen osteoporosis

A 
SSRIs
antiepileptics
proton pump inhibitors
glitazones
long term heparin therapy
aromatase inhibitors e.g. anastrozole
160
Q

Iliotibial band syndrome

A

Iliotibial band syndrome is a common cause of lateral knee pain in runners. Athletes commonly present with a sharp or burning pain around the lateral knee joint line.

161
Q

Characteristic feature of hand osteoarthritis

A

Squaring of the thumb

162
Q

Avascular necrosis causes

A

long-term steroid use
chemotherapy
alcohol excess
trauma

163
Q

Management for renal complications of systemic sclerosis

A

ACE inhibitors - e.g. rampiril

164
Q

Behcet’s syndrome.

A

A complex multisystem disorder associated with presumed autoimmune-mediated inflammation of the arteries and veins.

165
Q

Behcet’s syndrome Features

A

1) oral ulcers 2) genital ulcers 3) anterior uveitis
thrombophlebitis and deep vein thrombosis
arthritis
neurological involvement (e.g. aseptic meningitis)
GI: abdo pain, diarrhoea, colitis
erythema nodosum

166
Q

The new preferred name for trochantric bursitis

A

Greater trochantric pain syndrome

167
Q

First line treatment for Raynaud’s

A

first-line: calcium channel blockers e.g. nifedipine

168
Q

Anti-histone antibodies

A

Drug induced Lupus

169
Q

Drug induced Lupus causes

A 
procainamide
hydralazine
isoniazid
minocycline
phenytoin
170
Q

Associations of Frozen shoulder

A

Diabetes

171
Q

Specific feature of frozen shoulder

A

external rotation is affected more than internal rotation or abduction

172
Q

Hand/knee osteoarthritis management

A

Paracetmol + Topical NSAIDs are indicated only for OA of the knee or hand

173
Q

Investigations of anklyosing spondylitis

A

Diagnosis of ankylosing spondylitis can be best supported by sacro-ilitis on a pelvic X-ray

174
Q

Facet joint pain

A

May be acute or chronic

Pain worse in the morning and when standing - may have pain over the facets

Pain is typically worse on extension of the back

175
Q

Supraspinatus

A

Abducts arm before Deltoid - most commonly injured

176
Q

Infraspinatus

A

Rotates arm laterally

177
Q

Teres minor

A

Rotates and adducts arm laterally

178
Q

Subscapularis

A

Adducts and rotates arm medially

179
Q

Cuada equana syndrome management

A

Urgent surgical decompression

180
Q

L3 nerve root compression

A

Sensory loss over anterior thigh
weak quadriceps
reduced knee jerk reflex
positive femoral stretch test

181
Q

L4 nerve root compression

A

Sensory loss over anterior aspect of knee
weak quadriceps
reduced knee jerk reflex
positive femoral stretch test

182
Q

L5 nerve root compression

A

Sensory loss over dorusm of foot
Weakness in big toe and foot dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

183
Q

S1 nerve root compression

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

184
Q

Femoral nerve lesions

A

Weakness in knee extension,
Loss of patella reflex
Numbness of thigh

185
Q

Lumbosacral trunk lesions

A

Weakness in ankle dorsiflexion

Numbness of calf and foot

186
Q

Sciatic nerve lesions

A

Weakness in knee flexion and foot movements

Pain and numbness from gluteal region to ankle

187
Q

Obturator nerve

A

Weakness in hip adduction

Numbness over medial thigh

188
Q

Long thoracic nerve (C5-C7)

A

Supplies MOTOR supply to serratus anterior

189
Q

Musculocutaneous nerve (C5-C7)

A

MOTOR: Elbow extension & supination (biceps brachii)
SENSORY: Lateral part of forearm

190
Q

Axillary nerve (C5-C6)

A

MOTOR: Shoulder abduction (deltoid)
SENSORY: Inferior region of deltoid also known as the regimental badge area

191
Q

Radial nerve (C5-C8)

A

MOTOR: Extension of forearm, wrist, fingers & thumb
SENSORY: Small area between the dorsal aspect of the 1st and 2nd metacarpals

192
Q

Median nerve (C6, C8, T1)

A

MOTOR: LOAF muscles
Features depend on sight of lesion
1) Wrist - Paralysis of thenar
2) Elbow - Loss of pronation of forearm and wrist flexion

193
Q

Ulnar nerve (C8, T1)

A

MOTOR: Intrinsic hand muscles except LOAF - wrist flexion

MSK Year 2 (3 decks)

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