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msk Flashcards

1
Q

What other antibody can be seen if RF is negative (in rheumatoid arthritis)

A

Anti-CCP (cyclic citrullinated peptide) antibody

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2
Q

What is the diagnostic criteria for RA

A

DAS 28

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3
Q

Define shoulder dislocation

A

When the humeral head dislodges from the Glenoid cavity of the scapula

These dislocations are almost always anterior

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4
Q

A 24-year-old man presents to the emergency department after a fall whilst cycling a couple of hours ago. He is grasping his right shoulder and is in obvious pain. The patient does not report any fever or other systemic symptoms and there is no red skin around the joint. An anteroposterior x-ray is ordered which shows that the humeral head is dislodged from the glenoid cavity of the scapula anteriorly.

Given the likely diagnosis, what is the most appropriate initial management?

A

Kosher technique reduction

The affected arm is bent at the elbow, pressed against the body and rotated outwards until resistance is felt
Then lift the affected arm that is externally rotated in the Sagittal plane as far as possible forwards and finally turn inwards slowly

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5
Q

What is an early radiological finding in RA

A

Juxta-articular osteoporosis
Soft tissue swelling

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6
Q

What are late radiological findings of RA

A

Periarticular erosions
Subluxation

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7
Q

Features of psoriatic arthritis

A

Dactylitis - “sausage fingers”
Asymmetrical poly arthritis
Afebrile
HLA B27

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8
Q

What antibody is anti-phospholipid syndrome

A

Anti-cardiolipin

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9
Q

Features of anti-phospholipid syndrome

A

Predisposition to both venous and arterial thromboses
Recurrent foetal loss
Thrombocytopenia
Livedo reticularis

May occur as primary
May be secondary to SLE

Causes a paradoxical rise in APTT

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10
Q

Investigation for anti-phospholipid syndrome

A

Antibodies - cardiolipin
Thrombocytopenia
Prolonged APTT

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11
Q

Management for anti-phospholipid syndrome

A

Low dose aspirin

2nd =
Lifelong warfarin with a target INR of 2-3

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12
Q

A patient with sjogrens is more at risk to which type of malignancy

A

Lymphoma / lymphoid malignancies

Ie weight loss, night sweats, painless swelling

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13
Q

What is sjogrens

A

An autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces

More common in women

Features:
Dry eyes
Dry mouth
Vaginal dryness
Arthralgia
Raynauds
Sensory polyneuropathy
Parotitis
Renal tubular acidosis

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14
Q

Investigation for sjogrens

A

RF - positive in most patients
ANA - positive
Anti-Ro /La - positive
Schirmers test - tear formation
Histology - focal lymphocytic infiltration

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15
Q

Management of sjogrens

A

Artificial tears and saliva
Pilocarpine

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16
Q

What is this ?

Swelling over the posterior aspect of the elbow
May be associated pain, warmth and erythema
Typically affecting middle aged male patients

A

Olecranon bursitis

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17
Q

Patient experience intermittent tingling in the 4th and 5th finger
May be worse when the elbow is resting on firm surfaces or flexed for extended periods
Later numbness in 4th and 5th finger with associated weakness

A

Cubital tunnel syndrome

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18
Q

Compression of the posterior interosseus branch of the radial nerve
Thought to be a result of overuse

Symptoms similar to lateral epicondylitis
Can be made worse when elbow is extended and pronating forearm
Pain also tends to be distal to the lateral epicondyl

What disease matches this profile ?

A

Radial tunnel syndrome

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19
Q

What are features of lateral epicondylitis (tennis elbow)

A

Pain and tenderness localised to the lateral epicondyl
Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with elbow extended
Episodes last typically between 6 months and 2 years and patients tend to have acute pain for 6-12 weeks

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20
Q

Features of golf elbow (medial epicondylitis)

A

Pain and tenderness @ medial epicondyl
Pain is aggravated by wrist flexion and pronation
Symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement

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21
Q

Antibody for SLE

A

Anti-dsDNA (specific)

Sensitive - ANA

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22
Q

What is the most common causative organism for discitis

A

Staph aureus

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23
Q

What is discitis

A

An infection in the intervertebral disc space > can lead to serious complications such as sepsis or an epidural abscess

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24
Q

Features of discitis

A

Back pain
Pyrexia
Rigors
Sepsis

Neurological features = lower limb , epidural abscess formation

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25
Q

What are causes of discitis

A

Bacterial = STAPH AUREUS
Viral
TB
Aseptic

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26
Q

Investigation for discitis

A

MRI - disc space narrowing will be seen

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27
Q

Treatment for discitis

A

Standard therapy = 6-8 weeks of IV antibiotic therapy

Patients should be assessed for infective endocarditis via trans thoracic echo (discitis is usually due to haematogenous seeding of the vertebrae implying that the patient has had a bacteria emit adn seeding could have occurred elsewhere

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28
Q

Complications of discitis

A

Sepsis
Epidural abscess

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29
Q

What is Polymyalgia rheumatica

A

An inflammatory conditions which result in pain and stiffness and myalgia particularly around the shoulder and pelvic girdle

There is no weakness of the muscles themselves however pain can make movement difficult

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30
Q

Symptoms of Polymyalgia rheumatica

A

Rapid onset
Aching, morning stiffness in proximal limb muscles

Mild = lethargy, depression, low-grade fever, anorexia and night sweats

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31
Q

What are the tendons involved in De Quervain’s

A

Extensor pollicis brevis and abductor pollicis longus

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32
Q

What is the test used to confirm De Quervains

A

Finkelsteins test

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33
Q

How often is methotrexate taken

A

Weekly

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34
Q

MoA methotrexate

A

Antimetabolite that inhibits dihydrofolate reductase - an enzyme essenrtal for the synthesis of purines and pyrimidines

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35
Q

Adverse effects of methotrexate

A

Mucositis
Myelosuppression
Pneumonitis
Pulmonary fibrosis
Liver fibrosis

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36
Q

What else should be given when prescribe methotrexate

A

Folic acid 5mg

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37
Q

What should not be taken if you are on methotrexate

A

High dose aspirin
Trimethoprim or co-trimoxazole

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38
Q

Pencil in cup appearance on distal interphalangeal joints

A

Psoriatic arthropathy

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39
Q

Which is better for a diagnosis of RA : anti - CCP or RF

A

Anti - CCP it has a higher specificity

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40
Q

Which nerve is commonly injured in a shoulder dislocation - sensation tested in the ‘regimental badge area’

A

Axillary nerve

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41
Q

Anterior dislocation of shoulder features

A

Common
Axillary nerve damage
May follow a fall on the arm of shoulder
Always do a radiograph
Tx. = reduction, analgesia, sling

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42
Q

Posterior dislocation of the shoulder

A

Rare (cause by seizure or electrocution)
‘Lightbulb sign’ on x-ray
Refer to the orthopaedic surgeons

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43
Q

*lightbulb sign on x-ray ?

  • = buzzword
A

Posterior shoulder dislocation

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44
Q

Clinical features of SLE

A

Rash on cheeks (butterfly rash)
Tired all the time
Tenderness on MCPs and MTPs on hands and feet
Oral ulcers

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45
Q

Drug to help Raynauds

A

Nifedipine

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46
Q

Positive Anti-Ro / La antibodies show ? *

A

Sjogrens

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47
Q

A 21-year-old female football player comes to the walk in clinic with severe left knee pain. She states that she has landed awkwardly on her knee during a football game. She heard a ‘snapping sound’ when she injured her knee which was followed by significant swelling around the left knee joint. Physical examination reveals increased laxity on anterior drawer of the left tibia relative to the femur. Which of the following tests would be most appropriate in confirming the diagnosis?

A

Left knee magnetic resonance imaging (MRI)

Ligamentous injuries of the knee joint are best confirmed though MRI

The footballer is likely to have torn their ACL > patients will complain of a popping sensation followed by a rapid onset of haemarthrosis

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48
Q

*Sudden ‘popping’ sound after suddenly twisting or awkward landing

A

ACL torn - knee ligament

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49
Q

What are the 2 tests to diagnose ACL tear

A

Anterior drawer
Lachman’s

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50
Q

A 24-year-old man is brought to the emergency department have suffered a crush injury to his forearm. Assessment demonstrates that the arm is tender, red and swollen. He is experiencing significant pain in the forearm. There is clinical evidence of an ulnar fracture and the patient cannot move their fingers and complains they are numb. Which is the most appropriate course of action?

A

Fasciotomy

Suspect compartment syndrome for crush injury, limb swelling, inability to move digits

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51
Q

Symptoms of compartment syndrome

A

Pain - on movement / passive
Excessive use of breakthrough analgesia
Parasthesiae
Arterial pulsation may still be felt
Paralysis of a muscle group

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52
Q

What is the diagnostic measure for compartment syndrome

A

> 40mmHg = diagnostic

> 20mmHg is abnormal

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53
Q

What drug that manages RA and SLE can cause bull’s eye retinopathy

A

Hydroxychloroquine

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54
Q

*Bull’s eye retinopathy

A

Caused by hydroxychloroquine

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55
Q

What does this DEXA scan show ?

A

Osteopaenia in vertebrae , osteoporosis in femoral neck

(Below 2.5 = osteoporosis, from -1 to -2.5 = osteopaenia, and 0 - -1 = normal)

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56
Q

CREST syndrome / limited cutaneous systemic sclerosis - what is it

A

Sclerodactyly , Raynauds, Telangiectasis , scleroderma , oesophageal dysmotility , calcinosis , interstitial lung disease

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57
Q

What antibodies are associated with CREST / systemic sclerosis

A

ANA +
RF +
Anti-scl-70 (diffuse)
Anti-centromere (limited)

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58
Q

What is hemiparesis

A

Weakness or inability to move one side of the body

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59
Q

What is paraesthesia

A

Burning or prickling sensation felt in hands/arms/legs/feet

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60
Q

What is aphasia

A

Difficulty with language or speech

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61
Q

A 32-year-old female intravenous drug user (IVDU) presents to the emergency department demanding analgesia for her back pain. You recognise her as a frequent attender, most recently being treated for a groin abscess.

On examination her heart rate is 124/min, temperature 38.1ºC, respiratory rate is 22/min and she is alert. The patient is lying on her right hand side with her knees slightly flexed and you find tenderness over L3-L4.

What is the likely diagnosis ?

A

Psoas abscess - characterised by lumbar tenderness (T12 - L5) and her preferring to lie with her knees slightly flexed, IVDU

Common causative organisms = staph and strept.

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62
Q

What is an iliopsoas abscess

A

Describes a collection of pus in iliopsoas compartment (iliopsoas + iliacus)

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63
Q

Clinical features of psoas abscess

A

Fever
Back/flank pain
Limp
Wt. loss

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64
Q

Specific test for psoas abscess + investigation

A

Hyperextension of the affected hip

CT abdo

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65
Q

Management of psoas abscess

A

Antibiotics
Percutaneous drainage
Surgery only if: 1. Failure of percutaneous drainage 2. Presence of another intra-abdominal pathology

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66
Q
  • rising pyrexia in the late afternoon/ evening which is gone by morning , accompanied by worsening joint symptoms and rash
A

Still’s disease

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67
Q

A 28-year-old man presents to his GP complaining of fever and joint pains that have worsened over the last 3 weeks. The fever occurs each evening and can be as high as 39.5ºC but drops to normal by the morning. He reports pain and swelling in the shoulders, wrists and metacarpophalangeal joints that worsens with the fever. He also says that his girlfriend has noticed a salmon-pink rash on his back however no rash is present on examination. He also complains of a persistent sore throat. He hasn’t noticed any weight loss or night sweats. His past medical history is unremarkable.

What is the most likely explanation for this patient’s symptoms?

A

Still’s

Mxm = NSAIDs , steroids , biologics or methotrexate

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68
Q

What is important to consider following a FOOSH

A

Scaphoid fracture do not show up on X-ray

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69
Q

*clicking feeling on internal rotation of knee

A

= positive Murray’s test

> = meniscal tear

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70
Q

A 17-year-old boy presents to his GP with a 3 month history of lower back pain which is worse in the mornings. A lumbar spine x-ray demonstrates sacroiliitis. No other joints are affected.

What is the most appropriate initial management whilst awaiting a rheumatology referral?

A

Physiotherapy and NSAIDs

(Exercise regimes and NSAIDs are 1st line for management for ankylosing spondylitis)

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71
Q

What are the early x-ray findings of ankylosing spondylitis

A

Subchondral erosions
Sclerosis
Squaring of lumbar vertebrae

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72
Q

*burning thigh pain

A

= meralgia pareaesthetica

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73
Q

*meralgia paraesthetica

A

= lateral cutaneous nerve of thigh compression

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74
Q

What test is used to diagnose meralgia paraesthetica ?

A

Pelvic compression test

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75
Q

*shortened leg and externally rotated

A

Hip fracture

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76
Q

T/F rheumatoid arthritis spares the distal interphalanges

A

T

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77
Q

The arrows indicate chondrocytes - what is the name given to the space that each of these cells occupies ?

A

Lacuna - a space within the extracellular matrix

Chondrocytes are ACTIVE cells - they secrete and also maintain the ecm around them

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78
Q

Bone enlargement, thickened cortices, thickened trabecular with mixed areas of lysis and sclerosis are all radiographing findings of what disease

A

Paget’s disease

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79
Q

What bones does paget’s commonly affect ?

A

Pelvis
Femur
Skull
Tibia and ear ossicles

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80
Q

What could: serum alkaline phosphatase +++ Ca (normal) Phosphorous (Normal) indicate ?

A

Paget’s

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81
Q

Treatment of Paget’s

A

Biphosphonates
Calcitonin

——

Joint replacement may be necessary + pathological fracture need stabilised

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82
Q
A

Margins of osteons = cement lines

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83
Q

What is A

A

Haversion Canal

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84
Q

What is osteomalacia

A

A qualitative defect of bone with abnormal softening of the bone due to deficient mineralisation of osteoid secondary to inadequate amounts of calcium and phosphorus

Rickets is the paediatric version

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85
Q

What bone cell is responsible for ‘drilling’ into the bone to form a new tunnel and are responsible for bone resorption ?

A

Osteoclasts

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86
Q

What is the function of osteoprogenitor cells ?

A

They serve as a pool of reserve osteoblasts

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87
Q

What are osteoblasts ?

A

Bone forming cells found on the surface of developing bone - they have plentiful RER and prominent mitochondria

Osteoblasts line the tunnel and begin laying down new lamellar bone

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88
Q

Where can an osteocyte be found ?

A

trapped within the bone matrix

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89
Q

What is the basic multicellular unit ?

A

The collection of osteoclasts and osteoblasts that participate in the process of bone remodelling

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90
Q

What is a ganglion

A

A cystic swelling which occurs around a synovial joint or tendon sheath - as a result of out-pouching of a weak joint portion of joint capsule or tendon sheath

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91
Q

What is the basic multicellular unit ?

A

The collection of osteoclasts and osteoblasts that participate in the process of bone remodelling

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92
Q

What anatomical sites are affected by osteochondritis dissecans

A

This is fragmentation with separation of bone and cartilage within a joint - so only intra-articulatar sites are affected

Ie Talar dome , lateral part of medial femoral condyle in the knee, femoral head, humeral capitellum

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93
Q

what is a giant cell tumour

A

Often occurring in the knee and distal radius with a ‘soap bubble’ appearance

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94
Q

*soap bubble appearance

A

Giant cell tumour

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95
Q

*shepherd’s crook deformity

A

Fiberous displasia

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96
Q

What is a simple bone cyst and why are they clinically relevant

A

It is a single cavity of benign fluid filled cyst in a bone - most likely from a bone defect from the physis and are therefore metaphysical in long bones

May be asymptomatic - incidental finding on x-ray (usually a child or young adult) however they can cause weakness leading to pathological fracture

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97
Q

What is this : A lucent, multi-loculated cyst found within the medulla of many different bones, often with associated cortical expansion

A

Aneurysmal bone cyst

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98
Q

What is this : a mostly lucent lesion with a patchy sclerosis found within the metaphysical region of long bones

A

Echondroma

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99
Q

What is this : a bony spur originating in the metaphysical region of long bones growing away from the epiphysis

A

Osteochondroma

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100
Q

What is A

A

Perimysium

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101
Q

What is B

A

Endomysium

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102
Q

what is Ewing’s sarcoma ?

A

A malignant tumour of endothelial cells in the marrow - most cases occur between ages 10 and 20

*onion skinning

May be associated with fever, raised inflammatory markers and a warm swelling and may be misdiagnosed as osteomyelitis

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103
Q

T/F do the striations present in skeletal muscles result from the orientation of the myofibrils - which run across the fibre ?

A

F - they are oriented longitudinally

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104
Q

what is the second most abundant components of cartilage ecm - after water ?

A

(25%) Organic material - 60% type II collagen and 40% proteoglycan aggregates

Water = 75%

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105
Q

what is the difference between type I collagen and type II collagen

A

Type II = finer 15-45nm and forms a 3 dimensional meshwork

Type I = 75 nm and form linear bundles

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106
Q

Which primary malignant tumour commonly metastasises to bone

A
  1. Breast (most common!)
  2. Prostrate
  3. Lung
  4. Renal
  5. Thyroid adenocarcinoma
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107
Q

What type of tissue is this

A

skeletal muscle

108
Q

What is the most common benign bone tumour

A

Osteochondroma - however 1% risk of malignant transformation

109
Q

Pulmonary embolism, pleurisy, MI and pericarditis are complication of what autoimmune disease

A

SLE

110
Q

pneumothorax is associated with what autoimmune disease ?

A

Anti-phospholipid syndrome

111
Q

What are these features associated with: recurrent pregnancy loss, livedo reticularis, venous thrombosis, and migraine

A

Anti-phospholipid syndrome

112
Q

T/F there is an increased incidence of lymphoma in patients with primary Sjogren’s

A

T

113
Q

what are all the antibodies that can occur in Sjogrens

A

Anti-ro
Anti-la
ANA
RF

114
Q

What is the antibody associated with SLE

A

Anti-DNA binding molecule

115
Q

What is the best therapeutic approach to connective tissue diseases ?

A

Treat symptomatically and monitor closely for major complications

116
Q

A person with anti-phospholipid syndrome has a PE with no other clinical risk factors - what medication should they be started on

A

Life long warfarin

117
Q

Is pulmonary fibrosis seen more in diffuse systemic sclerosis or limited systemic sclerosis

A

Diffuse = raynauds, dry eyes, facial telangiectasia and puffy hands + pul. Fibrosis

118
Q

What do low levels of complement proteins mean (in regard to SLE)

A

That is is active - complement proteins are consumed in response to the formation of immune antigen/antibody complexes

119
Q

what are the extra-article manifestations common in the spondyloarthritides

A

Achilles tendinitis
Aortic valve incompetence
Uveitis
Dactylitis

120
Q

A woman with triple therapy to manage her RA still is struggling with her RA - what management next ?

A

Anti - TNF therapy

Triple therapy = methotrexate, sulphasalazine, hydroxychloroquine

121
Q

Allopurinol, feuxostat and colchicine are treatments for what condition ?

A

Gout

122
Q

what x-ray finding is indicative for pseudo gout ?

A

Chondrocalcinosis

123
Q

*chondrocalcinosis on x-ray ?

A

Pseudogout

124
Q

Peri-articular osteopenia and erosion are x-ray findings associated with what disease ?

A

RA

125
Q

Which RA treatment is safe to have in pregnancy

A

Sulphasalazine

126
Q

What percentage of reactive arthritis cases resolve spontaneously

A

90%

127
Q

what are the treatments for reactive arthritis

A

Intra-articular or orla steroids

DMARDs

128
Q

What forms Reiter’s disease

A

Uveitis
Arthritis
Urethritis

129
Q

MRI early findings for ankylosing spondylitis

A

Bone marrow oedema
Romanus lesions
Enthesitis

130
Q

Is crystal arthropathy associated with erosive or hypertrophic joint changes ?

A

Erosive

131
Q

Is treatment for Polymyalgia rheumatica likely to continue lifelong ?

A

No

PMA and GCA persist for around 18 months - 2 years then resolve

132
Q

What is the immunological test would you require in suspicion of small vessel vasculitis

A

ANCA

133
Q

What is the Beighton classification of joint hypermobility

A

It is a scoring system of 9 point made up of the ability to passively touch the forearm with the thumb with the wrist in flexed position

Passive hyper extension of the fingers or little finger beyond 90 degrees

Hyperextension of the elbows of knees beyond 10 degrees

Ability to touch the floor with both palms with legs straight

> 4 = hypermobility

134
Q

How does allopurinol reduced urate in gout

A

Inhibiting xanthine oxidase

135
Q

Treatment for fibromyalgia

A

Amitriptyline, gabapentin (analgesics)
Graded exercise and pyschological approaches ie cognitive behavioural therapy

136
Q

How do you reduce the side effects of steroids

A

Osteoporosis prophylaxis
Use lowest possible dose for as short a time as possible
Consider steroid sparing agents
Monitor cv risk

137
Q

*Older man with bone pain and an isolated raised ALP ?

A

Paget’s

Management is with biphosphonate

138
Q

what is pagets ?

A

A disease of increased but uncontrolled bone turnover

Thought to be primarily a disorder of osteoclasts with osteoclastic re-absorption followed by increased osteoblastic activity

The skull, spine and long bones of lower extremities are most commonly affected

139
Q

Clinical features of Pagets

A

Older male with bone pain
Isolated raised ALP
Bowing of tibia, bossing of skull

140
Q

X-ray of pagets - what could be seen ?

A

Osetolysis in early disease ——> which would become mixed lytic/sclerotic lesions later

Skull x-ray = thickened vault, osteoporosis circumscripta

141
Q

A 56-year-old woman presents to her GP with three weeks of worsening shortness of breath, fever and dry cough. Four weeks ago she was started on a new medication for an inflammatory arthritis. Auscultation of her chest reveals bibasal fine crackles.

What medication is most likely to have caused this presentation?

A

Methotrexate = adverse effect is pneumonitis

142
Q

How long can a woman suffer from chronic fatigue syndrome before a diagnosis can be made

A

Symptoms have to persist for 3 months to be diagnosed

143
Q

What classification system is used to classify neck of femur fractures

A

Garden

144
Q

When are the Ottawa rules used

A

To detect possible ankle fracture

145
Q

What are the garland and salter-Harris classification systems used for ?

A

Children

Gartland = supracondylar
SalterHarris = growth plate

146
Q

*dinner fork type deformity

A

Colles fracture / FOOSH

= distal radius fracture with dorsal displacement of fragments

147
Q

Early complication of Colles

A

Median nerve injury

148
Q

What is lumbar spinal stenosis

A

A condition in which the central canal is narrowed by tumour or something else

Patients present with a combination of back pain, neuropathic pain and symptoms mimicking claudication

149
Q

75 year old women presents with horrible pain in her back and legs which has recently got so bad it impairs her walking tolerance : she finds bending over helps, walking up a hill is better than walking down one, and sitting is better than standing.

What is goin awn ….

A

Lumbar spinal stenosis

150
Q

Lumbar disc prolapse site - S1

A

Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex , positive sciatic nerve stretch test

151
Q

Lumbar disc prolapse S2 - tests

A

Can cause weak ankle reflex
Is not positive for sciatic nerve stretch test
Sensory loss on the medial side of the inferior aspect of foot and posterior middle segment

152
Q

Where are the sciatic nerve roots

A

L4 L5 S1

153
Q

Nerve roots and reflexes mnemonic

A

S1 + S2 i tie my shoe (ankle reflex)
L3 + L4 i kick the door (knee jerk reflex)
C5 + C6 i grab some sticks (biceps reflex)
C7 + C8 i lay them straight (triceps reflex)

154
Q

What is used to manage an acute flare up of RA

A

Methylprednisolone IM (intramuscular steroids)

155
Q

Pain on longitudinal compression of the thumb is a sign for what fracture ?

A

Scaphoid fracture

156
Q

What is better for a diagnosis of SLE ? ANA or Anti-dsDNA

A

ANA is 99% specific
Anti-dsDNA is 60%

157
Q

What is finkelsteins test

A

Pain over radial styloid on forced abduction/flexion of the thumb

Used to diagnose De Quervains

158
Q

What is the definitive management of primary hyperparathyroidism ?

A

Parathyroidectomy

159
Q

Sensory loss over dorsum of the foot

A

L5 nerve root compression

160
Q

What relieves spinal stenosis

A

Sitting down
Leaning forward
Walking up a hill&raquo_space; walking down a hill

161
Q

What are the nerve roots injured in Erb’s palsy

A

C5 and C6

162
Q

What is Erb’s palsy

A

Loss of motor function to deltoid, supraspinatus, infraspinatus, biceps and brachialis

Results in ‘waiter’s tip’ posture

163
Q

Risk factors for DDH

A

Family history of DDH
Breech presentation
First born
Down syndrome
Girl

164
Q

When should babies be speaking a few words

A

9-12 months

165
Q

When should a baby have loss of primitive reflexes

A

1-6 months

166
Q

When should a baby have head control

A

2 months

167
Q

When should a baby be eating with fingers + use a spoon

A

14 months

168
Q

When should a baby be able to stack 4 blocks

A

18 months

169
Q

When should a baby be able to understand about 200 words, and learns 10 words/day

A

18 months

170
Q

When should a baby be potty trained

A

2-3 years

171
Q

When should a baby be able to sit alone, and crawl

A

6-9 months (motor)

172
Q

When should a baby be able to stand

A

8-12months (motor)

173
Q

When should a baby be able to walk ?

A

14-17 months (motor)

174
Q

When should a baby be able to jump

A

24 months

175
Q

When should a baby be able to manage stairs independently

A

3 years

176
Q

Mobile / flexible flat - footedness causes

A

Ligamentous laxity
Can be familial

This is where the flattened medial arch forms with Dorsiflexion of the great toe

177
Q

What is the test for flexible/mobile flat footedness

A

Jack test

178
Q

Cause of rigid type flat foot

A

Tarsal coalition

179
Q

What is Ehlers Danlos

A

A heterogenous condition featuring abnormal elastin and collagen formation , clinical features include profound joint hypermobility, vascular fragility with ease of bruising joint instability and scoliosis

180
Q

What is club foot

A

A congenital deformity affecting boys x2 more than girls
Due to in utero abnormal alignment of joints between the talus, calcaneus and navicular

181
Q

What is contained in a myelomeningocle

A

Cerebrospinal fluid, meninges and spinal cord/cauda equine

182
Q

Pathophysiology of Duchennes

A

A defect in the dystrophin gene involved in calcium transport results in muscle weakness > progressively gets worse > boys can’t walk by the age of 20 > progressive cardiac and respiratory failure develop

183
Q

What conditions can atraumatic cervical spine instability occur

A

Down syndrome
Rheumatoid arthritis

184
Q

What is the term for acute angular deformity in the spine in Sagittal plane

A

Gibbus - in an older patient = not a concern
In a young patient = concern

185
Q

*back pain worse on coughing

A

Acute disc tear

186
Q

Management of mechanical back pain

A

Physiotherapy

187
Q

Management of chronic osteomyelitis

A

Antibiotics
Surgery > to gain deep bone tissue cultures + remove sequestrum
Debridement
Bone must also be stabilised (if not already)

188
Q

Which bone of the Lower limbs takes the longest to heal

A

Tibia

189
Q

T/F lower limb fractures heal faster than upper limb fractures

A

F - upper limb fractures heal faster due to better blood supply

190
Q

T/F metaphyseal fractures heal faster than cortical fractures

A

T

191
Q

What tendon tears require surgery ?

A

Quadriceps , patelllar (sometimes Achilles)

Otherwise splintage will do

192
Q

What is a pseudo tumour

A

An inflammatory granuloma produced in response to metal wear particles in the context of a joint replacement - may be locally invasive but cannot metastasise

193
Q

Which types of salter-Harris fractures are intra- articular

A

III and IV

194
Q

What is an osteotomy

A

Surgical realignment of a bone which can be used for deformity correction or to redistribute load across an arthritic joint

195
Q

What Glasgow coma score implies loss of airway control

A

8

196
Q

Impaired grip strength may arise if there is malunion of distal radius fracture - is this associated loss extension or flexion ?

A

Extension

197
Q

When is surgery indicated in hallux Valgus

A

Small, non-painful lesion, patient can’t wear shoes anymore = cosmetic surgery is a good reason

Pain and restriction of function = surgery

Not being able to wear high heels = NO

Prophylactic surgery - NO

198
Q

Management of Achilles tendon it is

A

Rest
Physiotherapist
Use of heel raise
Splint or boot

NOT A STEROID INJECTION

199
Q

Test to see if there has been auxiliary nerve damage in an anterior shoulder dislocation

A

Test for sensation over the lower half of the right deltoid (regimental badge area)

C5-6

200
Q

How does osteogenesis imperfecta present ?

A

Blue sclera
Learning difficulties
Hearing loss
Short stature
Childhood fractures

201
Q

What type of fracture is commonly FOOSH

A

Scaphoid

202
Q

What to do if scaphoid fracture is suspected but on x-ray there is no visible fracture ?

What os the next best step in the management ?

A

Immobilisation of the wrist in a thumb spica cast and arrange a repeat x-ray in 10-14 days

As scaphoid fractures are not always detected by the initial radiographs - especially if I displaced

203
Q

What is a green stick fracture ?

A

Occurs in paediatric patients when force is applied to a bone - it bends in such a way that the structural integrity of the cortex surface is overcome

The bending force applied does not break the bone completely

(Kids bones are bendy)

204
Q

*lower limb weakness, constipation, urinary retention, reduces anal tone and perianal sensation

A

Cauda equina syndrome

205
Q

*progressive deformity in 4th and 5th digits of hands, cannot be passively corrected with skin puckering and tethering

Also patient has history of alcohol misuse

A

Dupuytrens

206
Q

Nerve damaged in ‘foot drop’

A

Common peroneal nerve

Muscle affected is tibialis anterior

207
Q

Investigations to see if antibiotics are working properly

A

ESR
CRP

208
Q

Treatment of osteoporosis

A

Biphosphonates ie alendronate

209
Q

MoA Biphosphonates

A

Inhibition of osteoclasts

(Osteoclasts are responsible for Bone resorption which is why they are not useful in osteoporotic patients who already have reduced bone density)

210
Q

Management of tendinopathies

A

Conservative - with rest and analgesia (NSAIDs)

211
Q

What is Baker’s cyst

A

Extension of the knee synovium that develops between the medial head of gastrocnemius and the semi-membranous muscle

212
Q

causes of Baker’s cyst

A

Can be caused by trauma or occur in knees affected by conditions such as rheumatoid , gout, osteoarthritis

213
Q

1st line for frozen shoulder

A

Analgesia (NSAIDs) + physiotherapy

214
Q

2nd line for frozen shoulder

A

Local intra-articulate steroid injection

215
Q

Nerve roots of ulnar nerve

A

C8-T1

Motor = innervates intrinsic muscles of the hand , innervates flexor capris ulnaris adn the medial half of flexor digitorum

Sensory = 4th adn 5th digits adn associated palm area

216
Q

All the muscles in the hand are innervated by the X nerve apart from the LOAF muscles which are innervated by Y

A

X = ulnar

Y = median nerve

LOAF = lateral two lumbricals, opponens policis, abductor pollicis brevis , flexor pollicis brevis

217
Q

Management of cauda equina syndrome

A

Urgent surgical decompression within 48 hours

This is a medical emergency

218
Q

Management of osteomyelitis

A

Empirical antibiotics ie flucloxacillin + fusidic acid

Stop IV and switch to oral abx when the patient is table / 2 weeks post surgery

(Antibiotics for a minimum of 4-6 weeks)

Then surgical debridement = mainstay of treatment for chronic osteomyelitis

Acute infection can be treated with extensive surgical cleaning early on with antibiotics

219
Q

What type of prothesis is this ?

A

Dynamic hip screw

220
Q

What is a common radiogrpahic change seen in osteoarthritis

A

Loss of joint space / narrowed joint space

Due to loss of articular cartilage

Also : osteophyte formation, subchondral sclerosis, subchondral cysts

221
Q

Pharmacological management of osteoarthritis

A

Analgesia - paracetamol, NSAIDs
1st = topical NSAIDs

More severe = intra-articular steroids injections

222
Q

Surgical management of osteoarthritis

A

Joint replacement (arthroplasty) in severe cases = good pain reliever but will not improve function

223
Q

+ Cozens test ?

A

Lateral epicondylitis aka tennis elbow

The test involves asking the patient to flex their elbow to 90 degrees making a fist and deviating their wrist radially - resistance in this extension positions elicits pain over the lateral epicondyle

224
Q

Which cancer commonly metastasis to bones and causes sclerotic lesions ?

A

Prostate cancer

225
Q

Management of SUFE

A

Surgery via fixation with a screw

Needs to be promptly - SUFE risk of Avascular necrosis of the femoral head

226
Q

How is SUFE diagnosed

A

X-ray = frogs legs

Short displaced epiphysis and widened growth plate

227
Q

Investigation for cauda equina syndrome

A

Urgent WHOLE spine MRI Q

Management = aim to decompress within 48 hours

228
Q

Management of cauda equina syndrome where there is clinical suspicion of malignancy ?

A

Administration of dexamethasone 16 mg daily in divided doses

229
Q

Features of a meniscal tear

A

Does not produce a positive drawer test - unless in combination with ACL tear

Swelling occurs 12-24 hours after injury

230
Q

*cannot straight leg raise

A

Quadriceps tendon rupture

231
Q

+ lachman’s

A

ACL rupture

232
Q

What is an osteochondroma

A

Commonest form of benign bone tumour = which results in bony outgrowth on the external surface with cartilaginous cap

Small chance (1%) that it can become malignant

Can be an autosomal dominant hereditary disorder

233
Q

FOOSH causes what kinds of fractures

A

Colles
Smiths

234
Q

Management of Colles and smiths

A
  1. Manipulation under anaesthetic
    Then ORIF
235
Q

Features of Galeazzi fracture

A

Distal radius fracture 1/3

Distal ulnar joint dislocation

236
Q

Monteggia fracture features

A

Proximal ulnar fracture

Proximal radial joint dislocation

237
Q

Commonest cause of humeral surgical neck fracture

A

Osteoporosis

238
Q

Management of humeral surgical neck fracture

A

Sling

239
Q

Nerve affected in humeral surgical neck fracture

A

Axillaru

240
Q

Commonest cause of humeral mid shaft fracture

A

Direct trauma

241
Q

Nerve affected in humeral mid shaft fracture

A

Radial —> wrist drop

242
Q

Management of humeral mid shaft fracture

A

Functional humeral brace

… if there is non-union —> plating and bone graft

243
Q

Muscles for hip extensions

A

Gluteus max

244
Q

Which hand muscles are innervated by median nerve

A

LOAF

Lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

245
Q

What are the two muscles involved in De Quervain

A

Extensor pollicis brevis
Abductor pollicus longus

246
Q

Structures found in the carpal tunnel

A

Flexor digitorum profundity
Flexor digitorum superficialis
Flexor pollicis longus
Median nerve

247
Q

*fractured neck of fibula

A

Common peroneal nerve damage

248
Q

*anterior thigh + reduced knee reflex

A

L3

249
Q

Bone at base of thumb

A

Trapezium

250
Q

Where is the radial artery found

A

Anatomical snuffbox

251
Q

*medial aspect heel pain - made worse when walking on toes

A

Plant fasciitis

252
Q

How is acute reactive arthritis managed

A

NSAIDs

253
Q

Initial imaging modality of choice for Achilles tendon rupture

A

US

254
Q

What is the imaging modality of choice for osteomyelitis

A

MRI

255
Q

Cardiac complication of Ehlers-Danlos

A

Aortic regurgitation

256
Q

SE of bisphosphonates

A

A wide variety of oesophageal problems

Ie patient must take these at least 30 minutes before breakfast with plenty of water + sit upright for 30 minutes

257
Q

*McMurray’s - painful click

A

Meniscal tear

258
Q

What movement makes lateral epicondylitis worse

A

Resisted writs extension with the elbow extended

259
Q

Most common causative organism of osteomyelitis

A

Staph aureus

260
Q

Why is Folate co-prescribed with methotrexate

A

Reduces the risk of myelosuppression

261
Q

Management of subtrochanteric/extracapsular fracture of femur

A

IM device

262
Q

Important side effect of biphosphonate

A

Heartburn (oesophageal problems)

263
Q

Useful test to diagnose drug induced lupus

A

Anti-histone antibodies

264
Q

Which drugs can cause drug - induced lupus

A

Isoniazid
Penicillamine
Procainamide
Phenytoin

265
Q

How can an undisplaced patella fracture with an intact extensor mechanism be managed ?

A

Conservatively with knee immobilisation

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