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ICM - OBS > MSK > Flashcards

MSK Flashcards

1
Q

Vitamin D values

A

< 30 = Deficient – high dose replacement
30 – 50 = Insufficient – medium dose
> 50 = Sufficient - none

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2
Q

What does vitamin d do?

A
  • Helps regulate amount of calcium and phosphate in the body.
  • These in turn required to keep bones, teeth and muscles healthy.
  • Check levels in suspected fragility fractures
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3
Q

Indications for DEXA scan

A
  1. High fragility fracture risk score (Frax or Qfracture)
  2. Over 50 yrs with history of fragility fractures
  3. Under 40 with major risk factor for fragility fracture + refer to FLS
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4
Q

Diagnosis of osteoporosis using DEXA scan- value

A

T score of -2.5 or below is a diagnosis of osteoporosis

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5
Q

Indications for Vitamin D levels

A

osteomalacia (or rickets)

fargility fractures

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6
Q

Can you differentiate between osteomalacia and osteoporosis using DEXA

A

No

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7
Q

What is osteomalacia?

A

metabolic bone disease characterised by incomplete mineralisation of the underlying mature organic bone matrix

inadequate levels of calcium, phosphate or vitamin D,

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8
Q

What is arthroscopy?

A

Surgical procedure where thin telescope with light source (arthroscope) to look inside joints.

Diagnostic or Arthroscopic surgery.

Mainly used to investigate or treat knee problems.
Can be used in other joints too.

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9
Q

Indications for joint aspiration

A

any patients with inflamed joints with no established diagnosis.

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10
Q

Joint aspiration of gout vs septic arthritis:

A

Gout: needle shaped negatively-birefringent uric acid crystals

Septic arthritis:
1. joint fluid aspiration appears cloudy or purulent

  1. cell count with WBC > 50,000 is considered diagnostic for septic arthritis
  2. gram stains only identifies infective organism 1/3 of time
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11
Q

Rheumatoid + osteoarthritis inflammatory differences

A

High ESR + CRP = RA

Normal ESR + CRP = Osteroarthritis

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12
Q

When to refer urgently for rheumatoid arthritis?

A
  • Small joints of the hands or feet are affected
  • More than one joint is affected
  • There has been a delay of 3 months or longer between the onset of
    symptoms and the person seeking medical advice
  • Do not delay referral if blood tests are normal or results have not returned from the laboratory.
  • Early intervention may help prevent irreversible joint damage
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13
Q

Ix for SLE

A
  1. Anti-dsDNA
  2. Anti-smith
    antibodies
  3. ANA +

–> confirmatory of SLE with symptoms

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14
Q

Anti-CCP specific to…

A

Rheumatoid arthritis

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15
Q

Rheumatoid factor

A

Non- specific marker

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16
Q

Rheumatoid arthritis markers

A

Anti-CCP

RF

17
Q

What is ANA?

A

Non specific marker for autoimmune disease.

Nearly all patient have +’ve ANA and this is positive in many cases.

18
Q

Acute compartment syndrome symptoms

A

Mainly PAIN

Late signs (Ischemic Limb):
Pallor
Paraesthesia
Perishingly cold
Pulselessness
Paralysis
19
Q

Ix for Acute compartment syndrome

A 
Clinical diagnosis (early signs/patient at risk)
Compartment pressure monitoring.
20
Q

Symptoms of cauda equina

A

Back pain
Uni/bilateral leg pain
Bowel and bladder dysfunction
Reduced power lower limb

21
Q

Signs of cauda equina

A
  • Bilateral sciatica
  • Urinary retention (50-70%)
  • Faecal incontinence
  • Saddle anaesthesia
  • Loss of anal tone
22
Q

Ix for CES

A

Urgent MRI

23
Q

Sx for Cervical spine fracture

A

Neck pain/tenderness
Neck spasm
Reduced range of movement
Occipital headache

24
Q

Indication for imaging for symptoms of cervical spine fracture

A

Intoxication OR
Altered GCS OR
Neck pain or tenderness OR
Distracting Injury

25
Q

Ix for cervical spin fracture

A

X-rays (AP, Lateral, Peg view)
CT scan
Flexion and extension
MRI (ligament and disc injuries

26
Q

Symptoms of joint dislocation

A 
History of trauma
Intense pain
Deformity of joint area
Swelling
Inability to weightbear
27
Q

Imaging for join dislocation

A

X-ray (not ankle)
CT +/- angio
(if vascular injury suspected)
MRI to evaluate soft tissue injury

28
Q

Imaging for suspected fracture

A

X-ray

29
Q

Presentation of NOF fracture

A

Hip/groin pain
Inability to weight bear
May be shortened and externally rotated limb

30
Q

Ix for NOF fracture

A

Bloods
- FBC, U+E, LFTs, TFTs, Vit D, Folate, Vit B12, Clotting

X-ray
X-ray normal but high suspicion – MRI

If MRI not available 24 hrs or contraindicated - CT

31
Q

Examples of distal radius fracture

A

Colles’

smiths

32
Q

Presentation of distal radius fracture

A

History of FOOSH
Pain + swelling
Visible deformity of displaced

33
Q

Ix for distal radius fracture

A

X-rays AP + Lateral

34
Q

Presentation of scaphoid fracture

A

Localised pain in the wrist
Classical sign – snuffbox tenderness (non specific)
Longitudinal thumb compression

35
Q

Imaging for scaphoid fracture

A

Xrays – AP + Lateral, Scaphoid views (AP with ulnar deviation + 45deg pronation)

If negative but high clinical suspicion – repeat in 10 -14 days
CT/MRI – most sensitive for diagnosis of occult fracture

ICM - OBS (18 decks)

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