MSK Flashcards
What would the clinical picture be of someone with compression of L3 nerve root? (4)
- sensory loss of anterior thigh
- weak quads (knee extension)
- reduced knee reflex
- positive femoral stretch test
What would the clinical picture be of someone with compression of L4 nerve root? (4)
- sensory loss anterior aspect of knee
- weak quads (knee extension)
- reduced knee reflex
- positive femoral stretch test
What would the clinical picture be of someone with compression of L5 nerve root? (3)
- sensory loss dorsum of foot
- weakness in foot and big toe dorsiflexion
- reflexes intact
- positive sciatic nerve stretch test
What would the clinical picture be of someone with compression of S1 nerve root? (4)
- weak foot plantarflexion and eversion
- loss of ankle jerk
- calf pain
- decreased sensation sole of foot/back of calf
- positive sciatic nerve stretch test
What is tennis elbow and how do you test for it?
Lateral epicondylitis
Pain worse on:
- wrist extension with elbow extended (shoo pigeons)
- supination of forearm with elbow extended
What is golfer’s elbow and how do you test for it?
Medial epicondylitis
Pain worse on:
- wrist flexion
- pronation
(elbow extended)
What is cubital tunnel syndrome?
Compression of ulnar nerve
What is olecranon bursitis?
swelling over posterior aspect of elbow
- hot, red, painful
What is radial tunnel syndrome?
Compression of radial nerve
- pain is 4-5cm distal to lateral epicondyle
What are the different patterns of systemic sclerosis?
- limited cutaneous systemic sclerosis
- diffuse cutaneous systemic sclerosis
What are features of limited cutaneous systemic sclerosis?
CREST syndrome
C – Calcinosis
R – Raynaud’s phenomenon
E – oEsophageal dysmotility
S – Sclerodactyly
T – Telangiectasia
What are features of diffuse cutaneous systemic sclerosis?
CREST + CVS/lung/kidney problems
Which antibodies would be present in diffuse/limited systemic sclerosis?
diffuse = anti-Scl 70
limited = anti centromere
What is pseudogout?
Microcrystal synovitis caused by deposition of calcium pyrophosphate dihydrate crystals in the synovium.
Which joints are most commonly affected in pseudogout?
knee, wrist, shoulders
What would you find on joint aspiration of someone with pseudogout?
weakly-positive birefringent rhomboid-shaped crystals
What would you see on X-ray of someone with pseudogout?
chondrocalcinosis
How would you manage someone with pseudogout?
- aspiration of joint fluid (rule out septic arthritis)
- NSAIDs or intraarticular steroids
What is the most common cause of septic arthritis overall/in young people?
overall = staph aureus
young peeps = neisseria gonorrhoeae
How could test whether hip pain is actually just referred lumbar spine pain?
femoral nerve stretch test would be positive (due to femoral nerve compression)
Pain over lateral side of thigh in women aged 50-70 might point to which diagnosis?
trochanteric bursitis
Burning sensation of antero-lateral aspect of thigh would point to which diagnosis?
meralgia paraesthetica
Which antibodies would you find in someone with SLE?
99% are ANA positive
anti-dsDNA more specific
What X ray findings would you see in someone with Ankylosing Spondylitis?
- Sacroilitis
- Subchondral erosions
- Sclerosis
- Squaring of lumbar vertebrae
What is the management for someone with ankylosing spondylitis?
- NSAIDs
- physio
- DMARD (if peripheral joint involvement)
Which organism is most often responsible for osteomyelitis?
Staph aureus
What investigation would you carry out on someone with suspected osteomyelitis?
MRI
Who should be assessed for osteoporosis?
women over 65
men over 75
younger people with
- prev fragility fracture
- low BMI
- high alcohol intake/smoking
- FH of hip fracture
- prolonged steroid use
What is FRAX?
A scoring system used to estimate probability of fragility fracture in next 10 years
What would you do if FRAX score was low/intermediate/high?
low - reassure and lifestyle
medium - Order DEXA scan
high - bone protection treatment
When would you perform a DEXA scan?
- before starting treatment that may have a rapid adverse effect on BMD
- people <40 with major risk factor
What is osteoporosis?
Condition where bone gradually decreases in bone mineral density, increasing likelihood of fragility fractures.
Where is the most common site of fragility fracture?
Spine
What is discitis and what is the most common causative organism ?
Infection in the intervertebral disc space
- staph aureus
What scoring system is used to assess if an ankle injury needs an X-ray?
Ottawa ankle rules
When should you order an X-ray for an ankle injury?
Pain in malleolar zone
AND
1. inability to weight bear for 4 steps
2. tenderness over distal tibia
3. bone tenderness over distal fibula
What blood results would you expect to see in osteoporosis?
- Alk Phos normal
- calcium normal
What blood results would you expect to see in someone with a secondary bone tumour?
- raised serum calcium
- raised Alk Phos
