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PACES Y6 > MSK > Flashcards

MSK Flashcards

1
Q

XR findings of osteoarthritis

A

Loss of joint space
Osteophytes
Subcondral sclerosis
Subcondral cysts

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2
Q

XR findings of rheumatoid arthritis

A

Loss of joint space
Juxta-articular osteoporosis
Soft-tissue swelling

Peri-articular erosions
Subluxation

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3
Q

Compartments of the knee

A

Medial
Lateral
Patellofemoral

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4
Q

Investigations of osteoarthritis

A

Clinical

Bedside: obs (systemically well)
Bloods: infection, inflammation, bone profile
Imaging: x-ray

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5
Q

Management of osteoarthritis of hip or knee

A

MDT approach

Conservative: risk factor modification such as weight loss and exercise, physio to strengthen muscles and modifications of ADLS under supervision of OT

Medical includes analgesia according to Who pain ladder and sometimes IA steroids but this only short term relief

Ultimately surgery may be required, decision made by orthopod after weighing up pros and cons

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6
Q

Why would a patient have arthroscopy?

A

Anterior cruciate ligament tear
Meniscus tear (trim or repair torn meniscus)
Synovitis (remove inflamed tissue)
Osteoarthritis sometimes to clean debris

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7
Q

What is a patellofemoral joint replacement and when would it be done?

A

Partial knee replacement (unicompartmental)

Replacing the back of the patella and front of the femur, replacement sits between

Due to isolated patellofemoral arthritis, preserves more natural anatomy in knee for younger, active patients

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8
Q

Complications of knee replacement

A

Infection
Pain
Bleeding
Stiffness

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9
Q

Ankylosing spondylitis presentation

A

Reduced lateral flexion
Reduced forward flexion
Reduced chest expansion

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10
Q

Investigations and management for ankylosing spondylitis

A

Bedside: spirometry (restrictive)
Bloods: ESR, CRP
Imaging: XR of sacroiliac joints (sacroiliitis: subcondral erosions, sclerosis), CXR, if negative do MRI

Conservative: exercise, physio
Medical: NSAIDs, consider DMARDs, consider anti-TNF

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11
Q

Acute back pain in a&e management

A

Neuro exam (including DRE for sensation and tone)
Urgent MRI
Surgical decompression

(may also see bilateral sciatica and urinary dysfunction in cauda equina)

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12
Q

Presenting difference between spinal stenosis and prolapsed disc

A

Spinal stenosis
- better when sitting
- better when leaning forward
- back pain and claudication pain
(laminectomy)

Prolapsed disc
- worse when sitting
- leg pain worse than back
- LMN and sensory signs
(conservative management for 4 weeks, then MRI)

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13
Q

Differentials for leg length discrepancy

A

Developmental dysplasia
Fractured femur
Hip osteoarthritis
Pelvic tilt (true leg length the same)

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14
Q

What is Shenton’s line and why is it significant?

A

Curved line along inferior border of superior pubic ramus and inferiomedial border of neck of femur

Suspect hip fracture or dislocation if line disrupted

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15
Q

What are the types of gait?

A

Antalgic - stance phase reduced on affected leg
Hemiplegic - circumduct leg due to weakness and spasticity
Diplegic - bilateral hemiplegic
Parkinsonian
Ataxic (like drunk)
Neuropathic - foot drop, dragging toes, high stepping
Myopathic - weakness of hip abductors, waddling

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16
Q

Indications for differnet types of hip replacement

A

Intracapsular, undisplaced - internal fixation (cannulated screws)
Intracapsular, displaced - THR or hip hemiarthroplasy
Extracapsular (intertrochanteric), undisplaced - dynamic hip screw
Extracapsular, displaced - intramedullary device

17
Q

Angles of ROM in a hip exam

A

Flexion - 120
Extension 180
Internal rotation - 40
External rotation - 45
Abduction - 45
Adduction - 40

18
Q

What does Trendelenberg’s test check?

A

Identify weakness of hip abductors

Stand on one foot, drop to opposite side of weak hip

19
Q

Septic arthritis cause

A

Staphylococcus aureus

Neisseria gonorrhoeae in sexually active young adults

20
Q

Which tests would you omit in a knee exam if you saw a replacement scar?

A

Patellar effusion
Ligament/menisci tests

21
Q

Rheumatoid arthritis investigations and management

A

Bedside: obs
Bloods: infection, inflammation, rheumatoid factor, anti-cyclic citrullinated peptide antibody
Imaging: x-ray of hands and feet

Short-course briding prednisolone + DMARD e.g. methotrexate
TNF-inhibitors if no response to 2 DMARds including methotrexate

22
Q

Epicondylitis investigations and management

A

Consider x-ray or USS

Physio
Analgesia
Steroid injection

Episodes 6 months - 2 years (acute pain usually a couple of months)

23
Q

Gout investigations and management

A

Bedside: obs
Bloods: urate after acute attack
Imaging: synovial fluid analysis, erosions on radiograph (chondrocalcinosis in pseudogout)

Acute: NSAIDs, steroids, colchicine
Long-term: allopurinol, febuxostat

24
Q

Osteoarthritis hand features

A

Bouchard’s nodes (PIP)
Heberden’s nodes (DIP)
Squaring of thumbs

25
Q

Rheumatoid arthritis hand features

A

Swan neck deformity (late)
Boutonniere deformity (late)
Ulnar deviation

26
Q

Carpel tunnel investigations and management

A

Clinical
Nerve conduction studies
Electromyography
USS

Wrist splint
Steroid injection
Surgery to relieve pressure

27
Q

Osteoarthritis of hand management

A

Conservative
1. Paracetamol and topical NSAIDs
2. Oral NSAIDs

28
Q

Rotator cuff muscles

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

29
Q

Painful arc affected muscles

A

First 60 degrees: rotator cuff tear
60-120 degrees: supraspinatus impingement

30
Q

Shoulder movements and relevant muscles

A

Empty can test - supraspinatus
Painful arc - rotator cuff and supraspinatus
External rotation against resistance - infraspinatus and teres minor
Internal rotation against resistance - subscapularis
Scarf test - acromioclavicular joint pathology

31
Q

Erb’s vs Klumpke’s

A

Erb - C5, C6 - waiter’s tip
Klumpke - T1 - claw hand

32
Q

ACL tear management

A

Conservative: rest, elevation, ice, physio, bracing
NSAIDs
Surgical reconstruction - patellar tendon autograft or hamstring tendon graft (back of knee)

33
Q

Which knee replacement is preferred in older patients?

A

Total knee replacement - usually more severe knee damage, and also provides better pain relief and improved function (despite more risk of complications and longer hospital stays)

34
Q

Is hemiarthroplasty or total hip replacement preferred in older patients?

A

Hemiarthroplasty

35
Q

Investigations and management for mechanical back pain

A

MRI only if malignancy, fracture, cauda equina suspected

Stay active
NSAIDs (+ PPI >45yrs)

PACES Y6 (6 decks)

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