MSK Flashcards
How is a diagnosis of medial meniscus confirmed
Hyperintense medial meniscus seen on MRI
A positive McMurray test suggests what kind of MSK injury
Meniscus injury
McMurray tests - manoeuvre of passive external rotation of the patient’s tibia with valgus stress (for medial meniscus) or passive internal rotation of the patient’s tibia with varus stress (for lateral meniscus) while extending the knee. Positive if pain or audible pop/click sound is elicited on performing the manoeuvre.
How does meniscal tears present typically
Pain and swelling of the knee, and patients may complain of ‘locking’ or ‘buckling’ of the knee.
Most likely Dx
“dashboard” injury after RTA
Leg internally rotated, slightly flexed and adducted and the patient is not be able to bear weight due to severe pain.
Posterior hip dislocation
Most likely Dx
Leg is externally rotated leg, slightly flexed and abducted
Anterior hip dislocation
A positive Lachman test is suggestive of which MSK injury
Anterior cruciate ligament (ACL) injury
Lachman test is the passive forward jerking of the proximal lower leg while the knee is flexed around 45 degrees
A positive anterior drawer test indicates the presence of which kind of injury?
Anterior cruciate ligament (ACL) injury
Which two examination tests can be performed to test for the presence of an anterior cruciate ligament (ACL) injury?
- Lachman test
- Anterior drawer test
A positive posterior drawer test indicates the presence of which kind of injury?
Posterior cruciate ligament (PCL) injury
Pseudogout typically affects which joints?
Larger joints such as the knee joint
Risk factors for Pseudogout
Increasing age
Haemochromatosis
Wilson’s disease
Chondrocalcinosis is an XR feature of which MSK condition
Psuedogout
Chondrocalcinosis refers to calcification of the cartilage of the affected joint
Lightbulb sign on XR of the shoulder is pathognomonic of which kind of injury?
Posterior shoulder dislocation
The lightbulb sign occurs when the head of the humerus is in the same axis as a shaft, producing a shape of a lightbulb on x-ray
In posterior shoulder dislocation, typically the arm is held in which kind of position?
Internal rotation and adduction position
What is the typical presentation of a patient with rotator cuff tear
Shoulder pain
Functional weakness
Night pain
Pain is aggravated by overhead activities
What is the definitive management a Bimalleolar fracture
Open reduction and internal fixation (ORIF)
Because it is an unstable fracture that requires strong fixation
What is a Bimalleolar fracture
Fracture of the lateral and medial malleoli
What are the 4 characteristic features of osteoarthritis on an XR
Mnemonic LOSS:
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis
What is the first-line analgesic therapy for knee osteoarthritis
Topical NSAID treatment.
Paracetamol is not routinely offered unlike in other osteoarthritis in which it is first line
What is the first line pharmacological treatment of Raynaud’s phenomenon
Calcium channel blockers usually Nifedipine
They act as vasodilators, improving blood flow to the digits
Can reduce both frequency and severity of attacks
Which blood test is positive in around 90% of ankylosing spondylitis cases
Human Leukocyte Antigen B27 (HLA-B27)
Likely Dx
Inflammatory nature of the back pain (worse in the morning, better with exercise, prolonged morning stiffness) in a young male
Ankylosing spondylitis
What are the 5 key diseases in the group of spondyloarthropathies
1) Ankylosing spondylitis
2) Reactive arthritis
3) Enteropathic arthritis
4) Psoriatic arthritis
5) Behcet’s disease
Likely Dx:
Back pain with associated leg or buttock pain, often relieved with flexion e.g. leaning forward to sit, and worsened with extension e.g. climbing stairs
Spinal stenosis
CREST (Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility,
Sclerodactyly, Telangiectasia).
Are features of which rheumatoid condition?
Systemic sclerosis
Which antibody is specific for limited cutaneous systemic sclerosis
Anti-centromere antibodies
Which antibody is specific for diffuse systemic sclerosis
Anti-Scl-70 antibodies
What are the three extra-articular features associated with ankylosing spondylitis
Anterior uveitis (most common)
Aortitis (which can lead to aortic regurgitation)
Apical pulmonary fibrosis
X-Ray features of ankylosing spondylitis
Squaring of vertebral bodies
Syndesmophytes (bony bridges between adjacent vertebrae)
Sacroiliitis
Bamboo spine (late stage- complete fusion of the vertebral column)
What is the most sensitive investigation for sacroiliitis
MRI
What is the first line medication to manage ankylosing spondylitis
NSAIDs + PPI (proton pump inhibitor)
What is the investigation of choice to assess the size and location of the uterine fibroids
Trans-vaginal ultrasound
What are the 5 Ps for the classic signs of compartment syndrome
Pain
Pallor
Paresthesia
Paralysis
Pulseness
Headache and unilateral visual loss in those over 55 years old is what condition until proven otherwise
Giant cell arteritis
Falls onto his outstretched hand with pain in the anatomical snuffbox is pathognomonic of what condition
Scaphoid fracture
What antibodies are associated with anti-phospholipid syndrome
Anti-cardiolipin
Anti-beta2-GPI antibodies
Lupus anticoagulant assay
Damage to what nerve causes a foot drop
Common peroneal nerve
Name the classification system used to grade intra-capsular fractures of the femoral neck
Garden classification - rated based on if complete or uncomplete fracture and how displaced it is
Grade 1 (best) -> 4 (worst)
Grade 1 and 2 fractures are often treated using a dynamic hip screw
Grade 3 and 4 fractures are treated using open reduction and internal fixation or a hip arthroplasty
Distal radial fracture with volar displacement of the distal bones is pathognomonic of what type of fracture
Smith fracture
Distal radial fracture with dorsal displacement of the distal bones is pathognomonic of what type of fracture
Colles fracture
Likely Dx:
Pain bilateral hips
No Hx of falls or trauma
Chronic steroid use
Tenderness and stiffness of the hips
Avascular necrosis of the femoral heads
Strongly associated with chronic steroid use
What are the 3 characteristic features of Felty’s syndrome
Rheumatoid arthritis
Splenomegaly
Neutropenia
What is the gold standard investigation to confirm giant cell arteritis
Temporal artery biopsy
A negative temporal artery biopsy does not exclude GCA due to the presence of skip lesions
cANCA is an antibody specific to what condition
Granulomatosis with polyangiitis (formerly known as Wegner’s granulomatosis)
Type of small vessel vasculitis
What drug should be co-prescribed with methotrexate
Folic acid
pANCA is an antibody specific to what condition
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
What are the two rheumatological conditions that are ANCA positive
Granulomatosis with polyangiitis (formerly known as Wegner’s granulomatosis)
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
Achilles tendonitis is strongly associated with which rheumatoid condition
Ankylosing spondylitis
Likely Dx:
Malar rash
Photosensitivity
Mucosal ulcers
Alopecia
SLE
Before starting biologics, what condition do patients have to be screened for
Mycobacterium tuberculosis
Pain during resisted flexion of the wrist and digits is characteristic of which type of epicondylitis
Medial epicondylitis
Pain during resisted extension of the wrist and digits is characteristic of which type of epicondylitis
Lateral epicondylitis
What serum enzymes are raised in polymyositis and dermatomyositis
DM and PM turn your muscles into CLAAA (clay)
Creatine kinase
Lactate
Aldolase
ALT
AST
What is the classical triad of Sjogren syndrome
Dry mucosa (especially eye and mouth)
Fatigue
Joint pain
Schirmer’s test confirms the extent of the patient’s dry eyes
What XR finding is characteristic of psoriatic arthropathy
Pencil in cup deformity
What is the classical triad of Behcet’s disease
Recurrent ulcerations (oral and genital)
Uveitis
Erythema nodosum
De Quervain’s tenosynovitis refers to inflammation of which two tendons?
Abductor pollcis longus tendon
Extensor pollcis brevis tendon
Inflammation at their distal insertion points at the wrist.
Patients experience pain at the base of the thumb which is exacerbated on abduction
Pain at night and on both active and passive movement of the shoulder are highly suggestive of what condition?
Frozen shoulder
What two antibodies are raised in Rheumatoid arthritis
Rheumatoid factor
Anti-CCP
What does Schirmer’s test test for?
Used to test tear production
Useful to determine dry eyes, particularly in Sjogren syndrome
Rheumatoid arthritis spares which joints in the fingers?
Distal interphalangeal joints (DIP)
RADS - RA DIP sparing
What tunnel syndrome is caused by compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger
Cubital tunnel syndrome
What is most common organism for Septic arthritis
Staphylococcus aureus
Septic Arthritis (SA) = Staph Aureus (SA)
What is the most common reason total hip replacements need to be revised
Aseptic loosening
What is the first line pharmacological agent for polymyalgia rheumatica
Oral prednisolone
Anti-Jo-1 antibody is raised in what condition
Polymyositis
jO1 = pOIymyositis
Proximal muscle weakness + raised CK + no rash is pathognomonic of what condition
Polymyositis
What is the inheritance pattern for Marfan’s syndrome
Autosomal Dominant
Caused by mutation of Fibrillin-1 mutation on chromosome 15q21
Characterised by loss of elastic tissue, affecting the musculoskeletal, cardiovascular, neurological, respiratory systems, and the skin and eyes.
Aspiration results of septic arthritis
Yellow in appearance
Raised white cell count ( >10,000/mm3)
High neutrophil count (> 90%)
Management of supracondylar fracture of the humerus
Admit for neurovascular observation and closed reduction
The neurovascular integrity (particularly the ulner nerve and brachial artery) are at risk so needs to be carefully monitored.
Cast fixation is an option in partially displaced fracture, closed reduction reduces the risk of complications such as ischaemic contracture and malunion. Open reduction with internal fixation is used if the fracture is fully displaced
What medication should be given in addition to high dose steroids in giant cell arteritis
Bisphosphonate
Usually, bone protection with Calcium, Vitamin D and bisphosphonate are required to prevent glucocorticoid associated bone loss
What is the microscopic features of Staph aureus
Gram positive cocci in grape-like clusters
What lung disorder is very common in
Pulmonary fibrosis
Occur in up to 80% of cases
Anti-centromere antibodies are associated with what condition?
Systemic sclerosis (scleroderma)
Anti Mi-2 antibodies are associated with what condition?
Dermatomyositis
X-ray findings of the hip x-ray:
Inferior and medial translation of the left femoral epiphysis and Klein lines that do not intersect the epiphysis
This describes which condition?
Slipped upper femoral epiphysis (SUFE).
Seen commonly in obese adolescent boys
Due to weakening and widening of the physis due to factors like obesity and puberty
X-ray findings of the hip x-ray:
Femoral head collapse and fragmentation suggestive of osteonecrosis
This describes which condition?
Perthes’ disease
Self-limiting disease of the femoral head comprising of necrosis, collapse, repair and re-modelling
HLA-DR4 is strongly associated with which rheumatoid condition?
Felty syndrome (variety of RA)
Colles fracture of the wrist is described as a fracture of the distal radius with what kind of angulation of the distal fracture fragments?
Dorsal
dinner fork deformity is a pathognomonic XR feature of what kind of fracture
Colles Fracture
Smiths fracture of the wrist is described as a fracture of the distal radius with what kind of angulation of the distal fracture fragments?
Volar angulation
Fall onto a outstretch hand is a common mechanism for which of these fractures:
A) Colles
B) Smiths
A) Colles
Fall onto a flexed wrist is a common mechanism for which of these fractures:
A) Colles
B) Smiths
B) Smiths
What is the scoring classification tool used to classify lateral malleolar fractures related to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis
Weber
A->C
Weber A: fracture is below the level of the joint
Weber B: fracture is going through the joint level
Weber C: fracture is above i.e. proximal, to the joint
What is the first choice of treatment for eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
High dose corticosteroids
See vasculitis choose steroids
What is the gold standard investigation for the definitive diagnosis of Osteomyelitis
Bone biopsy for pathology and culture
Osteomyelitis refers to infection of the bone (acute or chronic)
What is the mainstay of treatment for chronic osteomyelitis
Surgical debridement
What is the mainstay of treatment for acute osteomyelitis
Antibiotics + Surgical debridement
Most commonly IV flucloxacillin (as Staph aureus is most common causative agent)
What type of embolism can develop after trauma presenting as shortness of breath, neurological symptoms (e.g. confusion, fatigue) and petechial rash
Fat embolism
How is fat embolism (a complication of trauma surgery) managed
Conservatively with supportive measures
The Ottawa ankle rules are a decision aid for use in the assessment of acute ankle injuries and the need for radiological imaging.
What are the 3 requirements for x-ray if there is malleolar pain
Ankle x-ray is required if any of the following are present:
- Bone tenderness at the posterior edge or tip of the lateral malleolus
- Bone tenderness at the posterior edge or tip of the medial malleolus
- Inability to bear weight both immediately and in emergency department for four steps.
The Ottawa ankle rules are a decision aid for use in the assessment of acute ankle injuries and the need for radiological imaging.
What are the 3 requirements for x-ray if there is midfoot pain
Foot x-ray is required if any of the following are present:
- Bone tenderness at base of the fifth metatarsal
- Bone tenderness at navicular bone.
- Inability to bear weight both immediately and in emergency department for four steps.
What are the XR features of gout
Normal joint space
Soft tissue swelling
Periarticular erosions
First-line treatment for mild to moderate osteoarthritis
Paracetamol +/- topical NSAIDS (not oral, which is second line)
What is the gold standard investigation for diagnosing calcaneal fractures
CT
Likely Dx:
Hx of childhood fractures
Blue sclera
Dental abnormalities
Hearing defects
Osteogenesis imperfecta
Defect of type 1 collagen synthesis (Type I collagen is for bONE)
What is a clay-shoveller fracture
Fracture of the spinous process and not the vertebral body
XR Feature:
An oblique lucency through the level of the spinous process seen on the lateral view
Associated with trauma such as injury from a road-traffic accident or a direct blow to the spine
CREST syndrome is for what type of cutaneous systemic sclerosis:
A) Limited
B) Diffuse
A) Limited cutaneous systemic sclerosis
Anti-double stranded DNA (dsDNA) autoantibodies are associated with what condition
SLE
dsDNA are a subgroup of anti-nuclear antibody (ANA)
What joint is most likely the joint first affected by gout
Great toe metatarsalphalangeal joint
