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ICM Revision > MSK > Flashcards

MSK Flashcards

1
Q

What does investigations of osteoporosis involve?

A

assess/estimate risk of fragility fractures

DEXA scans

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2
Q

When would you assess risk of fragility #?

A

women >65yr, males >75yrs
OR
women <65yrs, males <75yrs with the presence RFs - previous

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3
Q

What two ways are there to assess risk of Fragility #

A

FRAX score - 10yr risk assessment, in 40-90yrs, assess risk factors, can account BMD (better estimate if included)

Qfracture - 10yr risk assessment, in 30-99yrs, assess a larger group of RFs

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4
Q

FRAX score interpretation (w/o BMD) & relevant mx?

A

low risk = reassure, lifestyle advice, reassess in ~5yrs depending on context

intermediate risk = measure BMD and recalculate risk - check to see above/below intervention threshold

high risk = consider tx without BMD measurement. sometimes BMD appropriate such as in younger postmenopausal women

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5
Q

Indications for a DEXA scan?

A
  1. high fragility fracture risk (FRAX score or QFracture)
  2. 50yrs+ with hx of fragility fracture
  3. <40yrs + major risk of fragility fracture
    (may need fracture liaison service referral)
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6
Q

interpret DEXA scan results

A

0 = normal bone density
0+ = good bone density
-2.5 - 0 = osteopenia (mild weakening)
< -2.5 = osteoporosis

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7
Q

VItamin D levels request indications?

A

osteomalacia (or rickets)

fragility fractures

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8
Q

Interpret vitD levels in fragility fractures context?

A

<30 = deficieint - high dose repalcement

30-50 = insufficient = medium/maintenance dose

> 50 = sufficient = no tx indication at this point

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9
Q

What is arthroscopy?

Indications?

A

surgical procedure - often as keyhole surgery
= thin telescope with light source allowing inside of the joint to be visualised

indications = diagnostic and surgical/therapeutic procedures
- mainly used in the investiagtion/treatment of knee problem - Meniscal/Cruciate injuries

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10
Q

Complications with arthroscopy?

A

accidental damage to joint and surrounding structures

excessive bleeding into joint

infection

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11
Q

Indications of joint aspiration?

What is analysed in aspirate for each indication

A
  1. septic joint
    - cloudy/purulent appearance
    - gram stain
    - WCC
    - culture
    - crystal analysis
  2. Gout
    - crystal analysis
    (- culture to r/o septic joint)
    - neg birefringent crystals
  3. Pseudogout
    - crystal analysis
    (- culture to r/o septic joint)
    - positive birefringent crystals
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12
Q

What other Ix are done in septic joint/gout presentations?

A

Imaging/XR knee

  • septic joint = effusions
  • gout = eccentric erosions, punched out lesions, soft tissue trophi
  • pseudogout = chondrocalcinosis = linear calcifications
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13
Q

What are the Investigations done in acute compartment syndrome?

A

intracompartmental pressure measurements

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14
Q

What assessment criteria is used in Cauda Equina?

A

ASIA

american spinal injury assessment

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15
Q

What is the main Ix of choice in suspected Cauda Equina

A

Urgent MRI

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16
Q

What scoring system is used in cervical spine fractures?

what does it account?

A

Canadian C-spine rule

age >65, extremity parasthesia or dangerous mechanism of injury
low risk factors
able to rotate neck 45° left and right

low risk = r/o fracture w/o imaging
high risk = XR spine

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17
Q

Indication for imaging in C-spine fractures?

A

intoxicated at time of injury/presentation
altered GCS
neck pain/tenderness
distracting injury present

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18
Q

What other Ix can be done in C-spine fractures?

A

XR, CT and MRI

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19
Q

what investigations are done in joint dislocation?

A

XR (not ankle)
CT (+/- angio - if associated vascular injury)
MRI - evaluate soft tissue injury

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20
Q

open fracture assessment tools include?

A

Gustilo anderson classification - size of wound/soft tissue injury

BOAST 4 guidelines

  • initial assessment and management
  • fracture in long bone, hind foot or midfoot
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21
Q

Investigations for open fractures?

A

Bloods
XR

CT (with/out angio depends on any associated vascular damage)

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22
Q

Investigations for a NOF?

A

Bloods - FBC, U&E, LFTs, TFTs, VitD, Folate/B12, clotting

XR = Shenton line disruption
- if normal consider MRI

MRI not available within 24hrs= do CT

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23
Q

What investigation is done in distal radius fractures?

A

XR - AP and lateral

24
Q

What XR should be done on scaphoid fracture?

what if XR is normal?

A

AP, lateral and scaphoid views (Ulnar deviation + 45° pronation)

if XR NAD = repeat in 10-14days (immbolise wrist)

CT/MRI can be done for occult fractures

25
Q

Investigations of forearm fractures?

A

Full length XR - AP and lateral

elbow and wrist joint imaged too

26
Q

What is used to determine XR in ankle?

A

Ottowa ankle rules

  • bony tenderness in lateral malleolus
  • bony tenderness in medial malleolua
  • point tenderness on base of 5th Metarsal
  • point tenderness on navicular bone
  • inability to weight bear (<4steps)
27
Q

What forms of imaging are done in Ankle fractures?

A

XR - AP, Mortise & lateral views
(mortise = 15-20° internal rotation)

CT scan - complex fractures

MRI - occult # or ligamentous injury suspected

28
Q

Ix in Quadriceps tendon rupture

A

often times a clinical diagnosis
XR = r/o other causes

USS = confirmation of diagnosis

MRI = nature and extent of rupture

29
Q

Investigations in achilles tendon rupture?

A

usually a clinical diagnosis
XR - rule out other causes

USS = confirm diagnosis

MRI - nature and extent of rupture

30
Q

What investigations are done in suspected Ankylosing Spondylitis?

A

ESR/CRP - usually raised

XR

  • sacroillitis = sclerosis & subchondral erosions
  • syndesmophytes
  • ossification of ligaments, discs, joints
  • fusion of facet, sacroiliac and costovertebral
  • ‘bamboo spine’ - sqauring of lumbar vertebrae

IF XR NAD but suspicion remains high - MRI may reveal early inflammation involving sacroilliac joints

Genetic testing for HLA-B27

CXR - apical fibrosis

Spirometry - may revela a restrictive picture

31
Q

What investigations are done in suspected Herniated Nucleus Pulposus/herniated disc?

A

MRI is usually diagnostic

32
Q

What investigations are done in suspected spinal stenosis?

A

MRI

Exclusion of PAD
- ABPI and CT angio - r/o intermittent claudication

33
Q

What investigations are done in suspected Chrondomalacia patella/patellofemoral pain syndrome?

A

XR knee = skyline view

- bone on bone patella and femur

34
Q

What investigations are done in suspected Meniscial Injury?

A

XR - if ottowa rules warrant
MRI scan - first line imaging to establish diagnosis
Arthroscopy - gold standard for meniscial tear

35
Q

What investigations are done in suspected cruiciate injury?

A

MRI scan first line imaging

arthroscopy - gold standard for diagnosing a cruciate ligament tear

36
Q

What investigations are done in suspected osgood-schlatter disease?

A

usually a clinical diagnosis

37
Q

What investigations are done in suspected patella bursitis?

A

bursal aspirate - to rule out septic/crystal-induced bursitis

XR - in suspected bony pathology

Blood tests = CRP/ESR, ECC, uric acid, glucose, ANA Ab and RF

38
Q

What investigations are done in suspected SCFE?

A

XR

  • AP
  • bilateral hip and frog leg lateral views
39
Q

What investigations are done in suspected Legg perthes disease?

A

AP hip XR and frog leg lateral views
- widening of joint space
decreased femoral head size/flattening

40
Q

What investigations are done in suspected developmental hip dysplasia?

A

USS - used to confirm a diagnosis if clincally suspected

> 4.5months - XR

41
Q

What investigations are done in suspected trochanteric bursitis?

A

usually a clinical diagnsis

42
Q

What investigations are done in suspected Dislocated hip?

A

XR

43
Q

What investigations are done in suspected AVN of Hip?

A

XR

  • initally normal
  • osteopenia and presence of microfractures
  • crescent sign

MRI scans
- >6wks of symptoms with normal XRs

44
Q

What investigations are done in suspected NOF?

A

XR

  • AP and lateral
  • shentons line disrupted

MRI/CT is XR normal but clinical suspicion

45
Q

What investigations are done in suspected septic arthritis?

A

Joint aspirate - gram stain and culture

46
Q

What investigations are done in suspected acute osteomyelitis

A

Bloods - raised WCC, CRP/ESR

XR = osteopenia & bone destruction

MRI - >sensitivity

Blood cultures - +ve causative organisms
Bone cultures - establish organism and Abx sensitivity

47
Q

What investigations are done in suspected Osteoarthritis?

A

XR changes

  • loss of joint space
  • osteophytes
  • subchondral sclerosis
48
Q

What investigations are done in suspected Osteomalacia?

A

bloods - vit D, calcium, phosphate (usually all low), raised ALP

XR - translucent bands

49
Q

What investigations are done in suspected Paget’s bone disease?

A

blood - raised ALP, normal Ca2+/PO4-
Other markers - PINP, CTx, NTx, urinary hydroxyproline

XR - osteolysis in early disease
- later disease = mixed lytic/sclerotic lesions

skull XR - thickened vault and osteoporosis

Bone scintigraphy - increased uptake - focally active lesions

50
Q

What investigations are done in suspected renal bone disease?

A

XR

  • spinal XR shows sclerosis at both ends of vertebrae
  • osteomalacia in centre of vertebra
51
Q

What investigations are done in suspected osteosarcoma?

A

XR

Codman triangle and ‘sunburst pattern’

52
Q

What investigations are done in suspected carpal tunnel syndrome?

A

nerve conduction studies

electrophysiological studies

53
Q

What investigations are done in suspected ruptured achilles tendon?

A

mostly a clinical diagnosis

USS is usually used to confirm rupture

XR can be done r/o fractures and MRI to asses the nature/extent of rupture

54
Q

What investigations are done in suspected bunion/Hallux Valgus & Hammer toes?

A

XR

- weight bearing

55
Q

What investigations are done in suspected plantar fasciitis

A

usually a clinical diagnosis

56
Q

What investigations are done in suspected morton’s neruoma?

A

US or MRI to confirm diagnosis

ICM Revision (19 decks)

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