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MSK Flashcards

1
Q 
chronic pain at multiple sites - 'pain all over'
lethargy 
cognitive impairment 
sleep disturbance 
dizziness 
headache
A

fibromyalgia

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2
Q

diagnosis of fibromyalgia

A

11/18 tender points

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3
Q

management of fibromyalgia

A

Gabapentin and amitriptyline

CBT and aerobic exercise can also be useful

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4
Q

severe pain
erythema
swelling
usually the 1st MTP joint affected

hx of high purine diet, thiazide use and excessive alcohol/dehydration

A

gout

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5
Q

investigation for gout

A

joint aspiration and crystal analysis

negatively birefringent crystals

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6
Q

management for gout

A

acute = NSAIDs (& appropriate gastroprotection)
colchicine can be given but slower to act

chronic = allopurinol, might start with colchicine
second line = febuxostat

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7
Q 
pain mainly in the hip and shoulder 
pain/aching in the morning 
stiffness in the proximal limbs 
polyarthralgia 
lethargy 
depression 
low grade fever
A

polymyalgia rheumatica

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8
Q

Ix for PMR

A

ESR/CRP

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9
Q

management of PMR

A

prednisolone

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10
Q

episodic attacks of hot, swollen joints. Typically knee is affected

A

pseudogout

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11
Q

investigation of pseudogout

A

aspiration = positively birefringent crystals - rhomboid
(exclude septic arthritis)
calcium pyrophosphate

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12
Q

management of pseudogout

A

IA steroid injection

NSAIDs

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13
Q 
arthritis 
uveitis 
urethritis 
fever 
dactylitis

hx of GI/GU infection 1-4 weeks prior
usually male and HLA-B27

A

reactive arthritis/reiter’s syndrome

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14
Q

management of reactive arthritis/reiter’s syndrome

A

NSAIDs first line
steroid second line

persistent disease = sulfasalazine and methotrexate

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15
Q

usually in 20-30s , more common in females
multiple, peripheral joins - MCPs and PIPs
symmterical, joint pain and stiffness
stiffness worse in the morning - improves with as the day goes on
positive squeeze test

A

rheumatoid arthritis

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16
Q

Diagnosis of rheumatoid arthritis

A

anti-CCP

X - rays = erosions

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17
Q

management of rheumatoid arthritis

A

DMARDs - methotrexate/sulfasalazine
- usually taken with folic acid

start with bridging steroids
give steroids IM/PO in acute flares
TNF-a/biologics in inadequate responses

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18
Q 
Fever, malaise and arthralgia 
HTN 
peripheral motor neuropathy 
livedo reticularis 
weight loss

commonly with 40-60yrs old and Hep B infections

A

polyarteritis nodosa

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19
Q

Ix for polyarteritis nodosa

A

biopsy = full thickness necrotizing inflammation

raised ESR/CRP
normocytic, normochromic anaemia

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20
Q

management of polyarteritis nodosa

A

steroids

+/- DMARDs

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21
Q

common in knee and DIPs
usually mono/oligoarthritis - asymmetrical
dactylitis
pitting nails
swelling of associated tendons - enthesis

dry erythematous skin

A

psoriatic arthritis

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22
Q

Ix of psoriatic arthritis

A

X-ray hands and feet = pencil in cup deformity

ESR/CRP raised

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23
Q

management for psoriatic arthritis

A

mild cases = NSAIDs

DMARDs and immunosuppressants - TNFa inhibitors

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24
Q 
severe dry eyes and dry mouth 
fatigue 
arthralgia 
Raynauds phenomenon 
vaginal dryness 
recurrent parotitis 
positive schimer's test
A

Sjogren’s syndrome

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25
Q

Ix for sjogren’s

A

diagnostic = parotid gland biopsy

+SSRA/Ro, +SSA/La antibodies

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26
Q

treatment for sjogren’s

A

symptomatic relief from eye drops
sialogogues
punctal plugs

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27
Q 
C= calcinosis 
R = raynauds
E = esophageal dysmotility 
S = sclerodactyly 
T = telangiectasia
A

scleroderma (fibrosis of skin)

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28
Q

Ix for scleroderma

A

Scl-70, anti-topoisomerase I

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29
Q

management of scleroderma

A

relieve symptoms

steroids, immunosuppressants

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30
Q 
fatigue, fever and mouth ulcers 
lympahdenopathy 
malar/butterfly discoid rash - spares nose 
raynaud's phenomenon 
livedo reticularis 
arthralgia 
pericarditis 
glomerulonephritis
A

systemic lupus erythematous

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31
Q

Ix for SLE

A

anti-dsDNA, anti-smith

complement C3/4

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32
Q

management of SLE

A

hydroxychloroquine (anti-malarial) - retinal toxicity

NSAIDs and steroids

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33
Q

weakness in the proximal muscles
weakness>pain

complains of trouble getting out of chair, trouble brushing hair
usually age >40

A

polymyositis

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34
Q

Ix for polymyositis

A

CK massively elevated
EMG

definitive dx = muscle biopsy

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35
Q

management of polymyositis

A

steroids

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36
Q

aged under 16 with arthritis for over 6 weeks
more common in women
joint pain and swelling, commonly in the knee
intermittebn spiking fevers (1-2 a day)
extra articular - uveitis

A

juvenile rheumatoid arthritis

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37
Q

Ix for JRA

A

elevated CRP/ESR

possibly positive for RF/ANA

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38
Q

management of JRA

A

NSAIDs first line

DMARDs second line

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39
Q

joint pain following use, improves with rest
DIPs and PIPs joints - herberden and bouchard nodes
joint crepitus
affects mainly the weight bearing joints

older age

A

Osteoarthritis

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40
Q

Ix for OA

A

X-ray = loss of joint space, subchondral sclerosis and osteophyte formation

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41
Q

Management of OA

A

pt ed, weight loss, exercise
pain control - analgesia, joint aspirations/steroid injection
replace joint as last resort

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42
Q

Osteoporosis risk factors

A 
menopausal women 
increased age 
smoking 
steroid use (long term)
low BMI
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43
Q

Diagnosis for osteoporosis

A

T-score on DEXA scan = - 2.5 SD or below

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44
Q

presentation of osteoporosis

A

usually asymptomatic until a fracture appears

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45
Q

management of osteoporosis

A

bisphosphonates - osteonecrosis of the jaw/atypical femoral fractures
give a ‘drug holiday’ = come off medication every 3-5yrs

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46
Q

older male with bone pain
isolated ALP elevation
bowing of tibia, bossing of skull

A

Paget’s disease

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47
Q

skull x-ray: thickened vault, osteoporosis circumscripta

A

paget’s disease

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48
Q

management for paget’s disease

A

bisphosphonate (either oral risedronate or IV zoledronate)

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49
Q 
usually a single area 
non-specific pain 
fever 
malaise/fatigue 
inflammation 
swelling

hx of IC drug use, HIV and penetrating injuries

A

acute osteomyelitis

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50
Q

management of osteomyelitis

A

high dose antibiotics - flucloxacillin

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51
Q

screening of choice for osteomyelitis

A

MRI

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52
Q

acute hot swollen and erythematous swelling of joint
tender
restricted ROM
systemically unwell with a fever

A

septic arthritis

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53
Q

diagnosis of septic arthritis

A

Aspirate - culture and gram stain

if prosthetic joint - refer to ortho specialist

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54
Q

management of septic arthritis

A

IV vancomycin

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55
Q 
typically elderly
frail
hx of osteoporosis 
pain in groin 
shortened and externally rotated leg 
unable to bear weight
A

femoral neck fracture

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56
Q

Ix for femoral neck fracture

A

X-ray
MRI
disruption to shenton’s line

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57
Q

management of femoral neck fracture

A

intramedullary screws/dynamic hip screws

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58
Q 
major trauma 
hip pain 
inability to bear weight 
obvious deformity 
leg shorter 
internal rotation
A

hip dislocation

59
Q

Diagnosis of hip dislocation

A

X-Ray

60
Q

management of hip dislocation

A

ABCDE approach + analgesia
reduce within 4hrs under GA

long term mx may involve physiotherapy

61
Q

thick cord-like strand forming in the palm of hand
closer to the ring finger
finger ‘gets caught on things’
no pain typically

commonly in men, 40-60s
diabetics and smokers often affected
positive tabletop test

A

dupuytren’s contracture

62
Q

management for dupuytren’s contracture

A

monitor in early cases
corticosteroid injection for certain cases
surgery in later stages

63
Q

fracture in the 5th metatarsal joint after punching someone or something

A

boxer’s fracture

64
Q

unable to straighten finger - can lead to avulsion fracture

often referred to as basketball fracture

A

mallet finger

65
Q

management of mallet finger

A

splint & surgery

66
Q

more common in the thumb, middle, or ring finger
initially stiffness and snapping when extending
nodule may be felt at the base of the affected finger

A

trigger finger

67
Q

management of trigger finger

A 
<3months = steroid injection and hand therapy 2-4 weeks 
>3months = inject and consider surgical referral
68
Q

pain in anatomical snuffbox

hx of FOOSH

A

scaphoid fracture

69
Q

Scaphoid fracture diagnosis

A

normal X-ray

MRI better

70
Q

Management of scaphoid fracture

A

immobilise/splint ASAP to avoid risk of AVN

71
Q

dinner fork deformity
dorsal displacement of distal radius
hx of FOOSH

A

colles fracture

72
Q

management of colles fracture

A

straighten deformity & immobilise in 6 weeks

73
Q

pain/pins and needles in thumb, index, middle finger
unusually the symptoms may ‘ascend’ proximally
patient shakes his hand to obtain relief, classically at night

A

carpal tunnel

74
Q

tests for carpal tunnel

A

phalen’s and tinel’s test

diagnostic = nerve conduction studies

75
Q

management of carpal tunnel

A

NSAIDs, splints and steroid injections

surgical decompression

76
Q

discomfort and pain everytime the patient turns wrist, grasps anything or makes fist
Finkelsteins test positive

A

de Quervain’s tenosynovitis

77
Q

management of de Quervain’s tenosynovitis

A

analgesia, splint, steroid injection and surgery

78
Q

opposite to colles fracture but less common
distal radius displaced vetrally
caused by falling on flexed wrists

A

smiths fracture

79
Q

common in 5yrs and most often from swinging by the arm

usually child will not use the affected arm
distressed only on elbow movement
marked resistance and pain with supination of the forearm

A

pulled/nursemaid’s elbow

80
Q

Ix of pulled/nursemaid’s elbow

A

X-ray

81
Q

management of nursemaid’s/pulled

A

reduction and mobilisation

82
Q

point tenderness on the lateral aspect of the elbow

A

lateral epicondylitis

83
Q

point tenderness on the medial aspect of the elbow

A

medial epicondylitis

84
Q

epicondylitis management

A

Rest, physio and NSAIDs

85
Q

shoulder pain
painful arc abduction from 60-120°
tenderness over anterior acromion

A

sub-acromial impingement

86
Q

other rotator cuff injuries

A

calcific tendonitis
rotator cuff tears
rotator cuff arthropathy

87
Q

most commonly after FOOSH
affected arm externally rotated and close to body
loss of round and greater fullness

A

anterior dislocation of shoulder

88
Q

which nerve should be checked in anterior dislocation

A

axillary nerve - sensation of deltoid checked

89
Q

usually due to seizures of electrocution
affected arm medially rotated and locked
shoulder looks flat
swollen
prominent coracoid process

A

Posterior dislocation of shoulder

90
Q

management of shoulder dislocations

A

check neurovascular status before and after and do a closed reduction.

91
Q

slow progressive passive loss of ROM of shoulder joint
affects adls
severe stiffness in shoulder
+ve coracoid pain test

can be a complication of shoulder injury/surgery
more common in women compared to men, typically in 40-70yr olds
RFs = DM, thyroid disease

A

adhesive capsulitis (aka frozen capsulitis)

92
Q

management of adhesive capsulitis

A

first line = NSAIDS and physio

second line = IA steroid injection

93
Q

back pain red flags

A 
significant injury/trauma 
bowel or bladder incontinence 
history of metastatic cancer 
major neuro deficit 
saddle anaesthesia 
suspected spinal infection
94
Q

management of back pain

A

patient ed, NSAIDs, paracetamol, muscle relaxants

avoid bed rest, most cases resolve

95
Q

insidious morning stiffness
relieved by exercise
positive schober’s test - <5cm increase

typically in young (~25), caucasian male, HLA-B27

A

ankylosing spondylitis

96
Q

Ix for ankylosing spondylitis

A

sacroiliitis, squaring of lumbar vertebrae, ‘bamboo spine’
syndesmophytes
CXR = apical fibrosis

97
Q

saddle anaesthesia/paresthesia
recent onset of bladder or faecal incontinence
progressive/severe neurodeficit in the lower limbs

A

cauda equina

98
Q

Ix for cauda equina

A

immediate MRI

99
Q

management for cauda equine

A

Urgent surgical decompression

100
Q

what is compressed in cauda equina

A

nerves L1-S5

101
Q

management for ankylosing spondylitis

A

NSAIDs and regular exercise & physio

DMARDs - peripheral joint involvement

102
Q

groin pain radiating to the leg
pain despite analgesia

RFs = alcoholism, steroid/chemo and sickle cell anaemia

A

avascular necrosis in the hip

103
Q

AVN in hip Ix

A

MRI and orthopaedic referral for 6 weeks of pain with normal X-rays

104
Q

management of AVN in hip

A

hip replacement

105
Q

limp, externally rotated leg
knee pain
groin pain
restricted ROM

typically boys aged 10-17, obese and hypogonadism

A

Slipped Capped femoral epiphysis (SCFE)

106
Q

Ix for SCFE

A

X-ray

107
Q

management for SCFE

A

surgical fixation with screws

done on both side prophylactically

108
Q 
painless limp 
complains of hip and knee pain 
sometimes painful after activity but relieved by rest 
reduced ROM
typically presents unilaterally
A

legg calve perthes

109
Q

legg calves perthes Ix

A

X-rays - AP and frog leg views

110
Q

management of legg calves perthes

A

cast/braces
<6yrs - observe
>6yrs - surgically manage

111
Q

localised pinpoint tenderness on the outside of the hip (laterally)
pain on movement
moves down the thigh
pain on palpating the greater trochanter

typically on women aged 50-70yrs

A

trochanteric bursitis

112
Q

management of trochanteric bursitis

A

exercises

steroid injection into the affected site/bursa

113
Q 
insidious back pain 
bilateral leg pain 
better when leaning forward 
relieved lying supine 
paresthesia on ambulation - worse standing /walking
A

spinal stenosis

114
Q

Ix for spinal stenosis

A

MRI scanning

115
Q

management of spinal stenosis

A

laminectomy (surgery in which a surgeon removes part or all of the vertebral bone (lamina)).

116
Q

kyphosis

A

hunchback - usually seen in osteoporotic/elderly

117
Q

scoliosis

A

the spine twists and curves to the side

118
Q

lordosis

A

usually seen in pregnancy - spine protrudes forwards

119
Q

management of spinal deformities

A

dependent on the degree of curvature - <20° = exercise and monitoring
21-45° = exercise and monitoring
>45 = surgery

120
Q

hypermobile patella with significant crepitus
pain aggravated by deep bending

typically >50 years and overweight

A

chondromalacia patella

loss of cartilage under the patella

121
Q

Ix for chondromalacia patella

A

bone on bone patella and femur

122
Q 
twisting injuries 
transient locking of knee
severe knee pain 
knee effusion/swelling 
knee giving way
A

meniscal injuries

123
Q

special tests for meniscal injury

A

McMurray and Apley

MRI definitive

124
Q

management of meniscal injury

A

conservative management = ICE, analgesia, physio and rest

If torn = open or arthroscopic surgery

125
Q

loss of anterior or posterior stability
swollen and painful knee
audible ‘pop’ at the time of injury
instability on ambulation

anterior is usually more common
positive draw tests

A

cruciate injury

126
Q

ortolani test = characteristic clunk that is felt as the femoral head slides over the posterior rim of the acetabulum and is reduced.

barlow test = mild adduction and applying a slight forward pressure with the thumb. If the hip is unstable, the femoral head will slip over the posterior rim of the acetabulum, again producing a palpable sensation of subluxation or dislocation.

RF = fist born girls, breech baby, oligohydromnios, L>R hip and a family history

A

developmental hip dysplasia

127
Q

diagnosis of developmental hip dysplasia

A 
<6months = ultrasound 
>6months = X-ray
128
Q

management of developmental hip dysplasia

A

observe and consider splinting

if hip dislocated = reduce and then splint

129
Q

pain and swelling over the tibial tuberosity
point tenderness
pain usually aggravated by loaded knee extension

typically in growing teenagers aged 10-14years
usually active/play football

A

osgood sclater

tibial tuberosity opophysitis

130
Q

management of osgood sclater

A

modification of exercises, physio and NSAIDs

131
Q

recent trauma + ankle pain and swelling
inability to bear weight
swollen malleolus
tender on palpation

A

ankle fractures

132
Q

what rules are used to decide is X-ray is indicated in ankle injuries

A

bony tenderness on either to medial or lateral malleolus

unable to bear weight for 4 steps

133
Q

management for ankle fractures

A

open fracture = surgical fixation

closed fracture = reduce and splint

134
Q

swelling, bruising and pain after injury around an ankle

ottawa rules don’t apply

A

ankle sprain/strain

135
Q

Investigation for ankle sprain/strain

A

no fracture seen on X-ray

MRI/US = better for soft tissue

136
Q

heel pain with a gradual onset - worse following activity
morning pain and stiffness common

RFs = quinolone use & hypercholesterolemia

A

Aschilles tendinitis

137
Q

management of achilles tendinitis

A

simple analgesia, calf, muscle eccentric exercises

138
Q

audible pop in the ankle with sudden onset of significant pain
uanble to tiptoe

positive simmons test/thompson’s test
absence plantar reflec on calf squeeze

A

achilles tendon rupture

139
Q

stabbing heel pain and on pressure point under foot
most painful in the first few steps in the mornign

typically in runners and also in obese, aged 40-60yrs

A

plantar fascitis

140
Q

plantar fascitis management

A

heel padding, insoles, exercises
physiotherapy
NSAIDs

141
Q

pain between the 3rd and 4th toes
described to be like walking on a marble
elicit pain by squeezing toes from the side
palpate web space

more common in women more than men

A

mortons neuroma

142
Q 
rocker foot deformity 
swelling 
pain 
redness 
altered shape in the foot

hx of severe peripheral neuropathy = diabetes, peripheral

A

charcot’s joint

143
Q 
unilateral leg pain 
back pain 
leg pain > back pain 
usually radiates to foot/toes 
worse on sitting down 
numbness and paresthesia
A

herniated nucleus pulposus

144
Q

Ix for herniated nucleus pulposus

A

MRI

FCM (16 decks)

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