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MSK Flashcards

1
Q

Which artery is at risk with a femoral neck fracture?

A

Medial circumflex femoral artery

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2
Q

Which nerve is at risk with humeral shaft fracture?

A

Radial nerve

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3
Q

Which nerve and artery is at risk with a humeral neck fracture?

A

Axillary nerve

Posterior humeral circumflex artery

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4
Q

What fracture is suggestive of cancer rather than osteoporosis?

A

Vertebral above T4

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5
Q

What does the cystic artery branch from?

A

Right hepatic artery

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6
Q

What is Behcet’s disease?

A

Complex inflammatory condition characteristically presents with recurrent oral and genital ulcers.

Link with HLA B51 gene

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7
Q

What are the features of Behcet’s disease?

A

Mouth ulcers (red halo) at least 3/year

Genital ulcers

Skin: erythema nodosum, papules and pustules and vasculitic type rash

Eyes: anterior or posterior uvetitis, retinal vasculitis and retinal haemorrhages

MSK: morning stiffness, arthralgia

GI

CNS: memory impairment, headaches, aseptic meningitis

Veins: Budd-chiari syndrome, DVT

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8
Q

What are the investigations of Behcet’s disease?

A

Clinical diagnosis based on features

Pathergy test

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9
Q

What is the management of Behcet’s disease?

A

Topical steroids to mouth ulcers (soluble betamethasone)

Prednisolone

Colchicine

Topical anesthetics e.g. lidocaine

Immunosuppressants

Infliximab

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10
Q

What are the four key changes on xray in osteoarthritis?

A

LOSS

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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11
Q

What is the management of osteoarthritis?

A
  1. Paracetamol and topical NSAIDs
  2. Oral NSAIDs and PPI
  3. Opiates
  4. Intra-articular steroid injections
  5. Joint replacement
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12
Q

What are the genetic associations of rheumatoid arthritis?

A

HLA DR4

HLA DR1

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13
Q

Which antibodies are linked to rheumatoid arthritis?

A

Rheumatoid factor

Cyclic citrullinated peptide antibotides (anti-CCP)

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14
Q

What are the xray changes in rheumatoid arthritis?

A

Joint destruction and deformity
Soft tissue swelling
Periarticular osteopenia
Boney erosions

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15
Q

What is the management of rheumatoid arthritis?

A
  1. NSAIDs and PPI
  2. one off: methotrexate, lefllunomide or sulfasalazine.
  3. Combination of these two
  4. Methotrexate + biological therapy
  5. Methotrexate + rituximab

Hydroxychloroquinine is the midlest anti-rheumatic drug

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16
Q

What are the signs of psoriatic arthritis?

A

Plaques of psoriasis on the skin
Pitting of nails
Onycholysis
Enthesitis

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17
Q

What are the xray changes seen in psoriatic arthritis?

A 
Periostitis
Ankylosis
Osteolysis
Dactylitis
Pencil-in-cup appearance
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18
Q

What is the management of psoriatic arthritis?

A

NSAIDs
DMARDs
Anti-TNF meds
Ustekinumab

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19
Q

What is reactive arthritis?

A

Where synovitis occurs as a reaction to recent infection.

Known as Reiter Syndrome.

Acute monoarthritis, affecting a single joint.

No infection present

Most common triggers are gastroenteritis and chlamydia

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20
Q

What are the features of reactive arthritis?

A

Bilateral conjunctivitis
Anterior uveitis
Circinate balanitis

Can’t see, pee or climb a tree.

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21
Q

What is the management of reactive arthritis?

A

Aspirate and send for gram staining, C+S

NSAIDs
Steroid injections
Systemic steroids

Most resolve within 6 months

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22
Q

What is ankylosing spondylitis?

A

Inflammatory condition affecting spine that causes progressive stiffness and pain

Linked to HLA-B27

Bamboo spine on xray

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23
Q

What is the presentation of ankylosing spondylitis?

A

Young adult malle in late teens or 20s

Slow onset >3months
Lower back pain and stiffness
Sacroiliac pain
Worse with rest and improves with movement
Pain worse at night and in the morning 
Takes 30mins for stiffness to improve

Vertebral fractures

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24
Q

What are the investigations in ankylosing spondylitis?

A

Inflammatory markers (CRP, ESR)
HLA B27 genetic test
Xray of spine and sacrum
MRI of spine shows bone marrow oedema

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25
Q

What are the Xray changes seen in akylosing spondylitis?

A

Bamboo spine

Squaring
Subchondral sclerosis
Syndesmophytes
Ossification
Fusion of the facet, sacroiliac and costovertebral joints
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26
Q

What is the management of ankylosing spondylitis?

A

NSAIDs
Steroids
Anti-TNF
Secukinumab

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27
Q

Where does the trachea bifurcate? (carina)

A

T4-T5, at the angle of louis

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28
Q

What is the action of the parotid gland?

A

Secretomotor action via glossopharygeal and auricotemporal nerves

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29
Q

Which fracture gives dinner form deformity?

A

Colle’s fracture

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30
Q

What is osteomalacia?

A

Condition where there is defective bone mineralisation causing “soft” bones.

This is due to a lack of vitamin D

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31
Q

What is the presentation of osteomalacia?

A 
Fatigue
Bone pain
Muscle weakness
Muscle aches
Pathological or abnormal fracture
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32
Q

What are looser zones in relation to osteomalacia?

A

Fragility fractures that go partially through the bone

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33
Q

What are the investigations in osteomalacia?

A

Serum 25-hydroxyvitamin D

<25 - Vit D deficiency
25-50 - Vit D insufficiency
>75 - Optimal

Low calcium
Low phosphate
High PTH
Osteopenia on xray

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34
Q

What is the treatment for osteomalacia>

A

Supplementary vit D (calciferol)

Maintenance dose should be continued lifelong after treatment

If insufficient vit D, can be started on maintenance without treatment

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35
Q

What is osteoporosis?

A

Condition where there is reduction in the density of the bones

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36
Q

What are the risk factors for osteoporosis?

A 
Older age
Female
Reduced mobility and activity
Low BMI
Rheumatoid arthritis
Alcohol and smoking
Long term corticosteroids
Post menopausal women
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37
Q

What is a FRAX tool?

A

Prediction of the risk of a fragility fracture over the next 10 years

A score of 10% or more warrants a DEXA scan

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38
Q

What is the management of osteoporosis?

A

Lifestyle changes
Vitamin D and calcium (calciferol)
Bisphosphonates - 1st line

39
Q

What is polymyalgia rheumatica?

A

Inflammatory condition that causes pain and stiffness in the shoulder, pelvic girdle and neck.

Strong association to giant cell arteritis

40
Q

What are the core features of polymyalgia rheumatica?

A

Following present for at least 2 weeks:

Bilateral shoulder pain that may radiate to the elbow

Bilateral pelvic girdle pain

Worse with movement

Interferes with sleep

Stiffness for at least 45 minutes in the morning

41
Q

What is the diagnosis of polymyalgia rheumatica?

A

Diagnosis based on clinical presentation and response to steroids.

Inflammatory markers raised

Bloods and tests to rule out other conditions

42
Q

What is the treatment of polymyalgia rheumatica?

A

Steroids

  1. Prednisolone 15mg/day

After 1 week, if poor response consider alterantive diagnosis

After 3-4 weeks would expect 70% improvement. If so, reduce regime to get patient off steroids

43
Q

What is sjogren’s syndrome and give the different types

A

Autoimmune condition that affects the exocrine glands.

Leads to dry mucous membranes: dry eyes, mouth and vagina

Primary sjogren’s: where the condition is in isolation

Secondary sjogren’s where it occurs related to SLE or rheumatoid arthritis

44
Q

What are the antibodies associated with sjogren’s?

A

anti-Ro and anti-La

45
Q

What is the schrimer test?

A

Diagnostic test for sjogrens

If tears travel <10mm is significant (15mm is normal)

46
Q

What is the management of sjogren’s?

A

Artificial tears
Artificial saliva
Vaginal lubricants
Hydroxychloroquine is to used to halt the progression of the disease

47
Q

What is carpal tunnel syndrome?

A

Caused by compression of the median nerve in the carpal tunnel

48
Q

What is the presentation of carpal tunnel syndrome?

A

Pain/Pins/needles in thumb, index and middle finger

Shakes hand for relief at night

49
Q

What is the examination in carpal tunnel syndrome?

A

Weakness of thumb abduction
Wasting of thenar eminence
Tinel’s sign (tapping causes paraesthesia)
Phalen’s sign (flexion of wrist causes symptoms)

50
Q

What is the management of carpal tunnel syndrome?

A

Corticosteroid injection
Wrist splints at night
Surgical decompression

51
Q

What is chronic fatigue syndrome?

A

Diagnosed after at least 4 months of disabling fatigue affecting mental and physical function more than 50% of the time.

52
Q

What is gout?

A

A type of crystal arthropathy associated with high uric acid levels

53
Q

Which are the typical joints affected in gout?

A

Base of big toe
Wrists
Base of thumb

54
Q

What is the diagnosis of gout?

A

Clinically or by aspiration of fluid from joint

Aspirated fluid will show:
No bacterial growth
Needle shaped crystals
Negatively birefringent of polarised light
Monosodium urate crystals
55
Q

What is seen on joint x-ray in gout?

A

Space between joint maintained
Lytic lesions in bone
Punched out erosions
Erosions can have sclerotic borders with overhanging edges

56
Q

What is the management of gout?

A

Acute:

  1. NSAIDs
  2. Colchicine
  3. Steroids

Prophylaxis:
Allopurinol (can be continued during attack)
Lifestyle changes

57
Q

What are the features of fibromyalgia?

A

Chronic pain
Lethargy
Cognitive impairment
Sleep disturbance, headache, dizziness are common

58
Q

What is the diagnosis and management of fibromyalgia?

A

Clinical

CBT
Pregabalin, duloxetine, amitriptyline

59
Q

What is osteomyelitis?

A

Infection in the bone and bone marrow

Staph aureus

60
Q

What is the presentation of osteomyelitis

A

More common in boys <10yr

Refusing to weight bear
Pain
Swelling
Tenderness

61
Q

What are the investigations in osteomyelitis?

A 
Xrays = initial investigation
MRI = best imaging

Blood tests: high CRP and ESR

Blood culture

62
Q

What is the management of osteomyelitis?

A

Extensive and prolonged antibiotic therapy.

Maybe drainage and debridement of infected bone

63
Q

What is osteogenesis imperfecta?

A

Genetic condition that results in brittle bones that are prone to fractures.

Affects the formation of collagen.

64
Q

What is the presentation of osteogenesis imperfecta?

A

Recurrent and inappropriate fractures

Hypermobility
Blue/grey sclera

Triangular face
Short stature
Deafness
Dental problems
Bone deformities
Joint and bone pain
65
Q

What is the diagnosis and management of osteogenesis imperfecta?

A

Clinical diagnosis

Bisphosphonates
Vitamin D supplementation

No cure

66
Q

What is the management of septic arthritis?

A

Empirical IV antibiotics until sensitivities are known

3-6weeks in total

Depending on local guidelines but e.g.

  1. Flucloxacillin + rifampicin
    2 Vancomycin + rifampicin
67
Q

What is SLE?

A

Inflammatory autoimmune connective tissue disease

Often relapsing-remitting

68
Q

What is the presentation of SLE?

A

Photosensitive malar rash (butterfly shaped) - worse with sunlight

Fatigue
Weight loss
Myalgia
Lymphadenopathy + splenomegaly
SOB
Mouth ulcers
Hair loss
69
Q

What are the antibodies associated with SLE?

A

anti-nuclear antibodies = DIAGNOSTIC

anti-double stranded DNA

70
Q

What is the treatment of SLE?

A 
First line:
NSAIDs
Steroids (prednisolone)
Hydroxychloroquine
Suncream and sun avoidance

More Immunosuppressants in more severe lupus

Biological therapies

71
Q

What is slipped upper femoral epiphysis (SUFE)?

A

Where the head of the femur is displaced along the growth plate

Common in boys 8-15yrs

72
Q

What is the presentation of SUFE?

A

Hip, groin, thigh or knee pain
Restricted range of hip movement
Painful limp
Restricted movement in the hip

73
Q

What is the diagnosis of SUFE?

A

Initial = Xray

Blood tests
Technetium bone scan
CT scan
MRI scan

74
Q

What is the management of SUFE?

A

In situ screw fixation

75
Q

Which nerve is at risk in sacrospinous fixation of vault prolapse?

A

Sciatic

76
Q

What are the functions of the facial nerve?

A

Carries secretomotor fibres to lacrimal gland through greater petrosal nerves

Associated developmentally with 2nd brachial arch

Supplies muscles of facial expression

Anterior 2/3 taste via chorda tympani

Secretomotor to submandibular and sublinguial glands

77
Q

Which nerve and muscle causes winging of the scapula?

A

Long thoracic nerve

Serratus anterior

78
Q

Name of amputation at ankle joint?

A

Syme’s amputation

79
Q

Which artery supplies the lesser curvature of the stomach?

A

Left gastric artery

80
Q

Most common cause of varicose veins?

A

Long saphenous vein

81
Q

What is meralgia parasthetica?

A

Entrapment of the lateral cutaneous nerve of thigh (L2, L3)

82
Q

What is the nerve supply for the medial and anterior aspects of the thigh?

A

Medial: Obturator nerve
Anterior: Femoral nerve

83
Q

Which nerve is damaged in a supracondylar fracture and how does it present?

A

Anterior interosseous nerve

Presents with weakness to the R index finger

84
Q

What is Bennett’s fracture caused by>

A

Boxer’s injury

85
Q

What is the preferred management of an intertrochanteric (extracapsular) proximal femoral fracture?

A

Dynamic hip screws

86
Q

What is the preferred management of an intracapsular femoral fracture?

A

hemiarthroplasty or total hip replacement

Hemi preferred if frail or if no history of osteoarthritis

87
Q

What is given for rheumatoid flares?

A

IM methylprednisolone

88
Q

What is used to monitor SLE flares?

A

Complement levels, levels are usually low during active disease

89
Q

Which score is used to test for hypermobility?

A

Beighton score

90
Q

Patients with temporal arteritis would most likely have a history of which other condition?

A

Polymyalgia rheumatica

91
Q

Describe the location of an indirect hernia?

A

Traverses the inguinal canal through both the superficial and deep rings

92
Q

What is the characteristic feature of hand osteoarthritis?

A

Squaring

93
Q

Which dermatological condition is associated with rhuematoid arthritis?

A

Pyoderma gangrenosum

Finals (20 decks)

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