MSK Flashcards
What are the Ottawa rules?
Bony tenderness at the posterior tip of the mallelous
Unable to weight bear at time of injury AND when seen
What is osteomalacia?
Chronic low vit D in adults. Causes bony pain/ tenderness/ muscle weakness.
First line treatment of acute gout?
NSAIDS (or Colchicine)
What is the inheritance of Elhers Danos syndrome and what are the features?
Autosomal dominant
Hyperelastic skin and atrophic scars
Anti centromere is a/w?
Sclerosis
Drug induced lupus is caused by which drugs?
Chlorpromazine, Minocycline, Methyldopa, Hydralazine, Isoniazid, D-penicillamine.
What are some complications of Paget’s?
High output cardiac failure, deafness, bone sarcoma, skull thickening.
Calcium/ ALP/ Phosphate. What happens in Pagets/ Oestemalacia/ Osteoporosis?
Osteoporosis- normal bloods
Pagets- Raised ALP - (isolated)
Osteomalacia- Raised ALP. Low calcium/ low phosphate
What drug is used after initial therapy for Lupus?
Hydroxychloroquinine
What monitoring is required for hydroxychloroqunine?
Yearly eye check
What is the normal range for calcium (corrected)
2.2-2.7
What are the blood results for Osteomalacia and how does it present?
Treatment
Raised ALP
LOW calcium
Presents with bony pain/ potential for fractures (femoral)
Tx: high dose vitamin D
Median nerve supplies?
Thumb and first 2 fingers
Simmonds test - tests for?
Achilles tendon rupture.
What is Feltys syndrome?
RA/ Neutropenia/ Splenomegaly
What is Caplands syndrome?
RA and pulmonary fibrosis in coal miners
P-ANCA is positive in x2
Both small vessel vasculitis
1. Churg Strauss (EGPA)
2. Microscopic Polyangitis (MPA)
C- ANCA is positive in?
Wegners
Granulomatosis with polyangitis
How does eosinophilic granulomatosis with polyangiitis present? Classic triad
‘Churg Strauss’
Asthma
Vasculitis
Eosinophilia
What are the features of Polyarteritis Nodosa?
Aneurysm formation
Associated with Hep B
Constitutional symptoms/ Rash/ Renal failure
What is Galeazzis Test
Used to test for DDH when >3-4 months old.
Knees are a different height.
What is the most common bone tumour?
Osteosarcoma
How does Ewings Sarcoma present and what are the Xray findings?
Lots of pain
Long bones and pelvis
Children and adolescents
Xray- onion skin appearance.
(Small round blue tumour)
Wrist drop = palsy of which nerve?
Radial nerve palsy.
Associated with sensory loss over back of hand
High stepping gait indicates?
Foot drop
Foot drop= common peroneal nerve injury
What does McMurrays test for?
Test for meniscal tears/ injuries
Classical Perthes presentation?
PAIN
Boys aged 4-8
Progressivley painful limp over a couple of weeks
What are the examination findings in SUFE?
Loss of internal rotation
Colles vs Smiths fracture?
Colles= classic= FOOSH. Distal radius displaced dorsally
Smiths= falling on back of hand. Distal radius goes anterior.
What is Potts disease?
TB of the spine and causes angular kyphosis. Treatment with TB medications.
What is the presentation with a rotator cuff injury? AKA SUPRASPINATUS TENDONITIS
Painful arc of abduction.
What is the examination findings for adhesive capsulitis?
Loss of external rotation.
How to grade muscle power MRC rating 0-5
5= Normal power
4= Resistance
3= Gravity
2= Some active movement
1= Flicker of contraction
0= Nothing
Shoulder dislocation
- What type is the most common and what is the presentation?
- Complications?
Anterior shoulder dislocation is the most common
Presents with the arm externally rotated
Complications include damage to axillary nerve. Regimental patch- sensory loss. AND weakness of deltoid muscle.
What is the T value to diagnose osteoporosis?
Less than -2.5
What do these antibodies indicate?
AMA
ANA
Anticentromere
Anti Ro, Anti LA
AMA = PBC
ANA= SLE
Anticentromere= CREST
Anti Ro/ Anti La= Sjogrens
Boxers fracture is the most common type of fracture of which bone?
Most common metacarpal fracture
Bartons fracture is a fracture where?
Distal radius but intra-articular (as opposed to Smiths or Colles)
What investigations form part of the secondary survey in Trauma ?
CXR
Pelvic XR
Lateral Spine
What are the associations with adhesive capsulitis? what people at risk?
Middle age females
Diabetics!!
Passive and active range of movement
How does a Gastronemius muscle tear present?
Pop after sudden push off
How may a patellar fracture present?
Compressive blow
In displaced transverse fractures= inability to straight leg raise.
Swelling
Tibial plateau fracture presents how?
Bumper fracture
Car into lateral side of knee
Swollen and deformed
CREST syndrome is a/w which condition and which antibody?
Limited cutaneous systemic sclerosis
ANTI-CENTROMERE!
How do stress fractures present?
Repetitive injury
How would a supracondylar fracture present?
FOSH in children
Check for neurovascualar compromise!
What are the Ottawa KNEE rules ?
Age > 55, Tenderness over patella, Tenderness at head of fibula, Inability to flex to 90 degrees
What is the acute management of Gout?
NSAIDS! Naproxen!
Colchicine (main side effect is diarrhoea)
Anticentromere antibody is a/w which disease?
Limited cutaneous systemic sclerosis
What blood test is the most SPECIFIC to RA?
Anti CCP
Regimental patch is supplied by which nerve and how could it be damaged?
Axillary nerve- damaged by dislocation of shoulder OR humeral fracture.
Shoulder dislocation- what are some facts?
Fall on outstretched hand
Most common is ANTERIOR
Assess for axillary nerve damage- regimental patch
Presentation- elbow is flexed, arm in abduction
Traumatic rotator cuff tear- presentation and management?
Trauma- eg traction injury/ shoulder is forcibly stretched
DROP ARM TEST! Pt cannot hold their arm up.
Management- needs referral to ortho.
Patella dislocation- presents how?
Dislocation laterally
Twisting injury
Patella is displaced laterally
Knee is held in flexion
McMurreys Test is used for?
To test for mensical TEARS
What are the 2 risk scores for osteporosis fracture risk and when can they be used?
QFracture aged 30-84
FRAX - aged 40-90
Drug induced lupus- what are the 2 common drugs?
procainamide
hydralazine
What sign is pathognomonic of sarcoidosis?
lupus pernio- blue rash on tip of nose is characteristic of sarcoidosis
