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MSK Flashcards

1
Q

what are the key x-ray changes seen in osteoarthritis ?

A

LOSS
Loss of Joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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2
Q

what is the presentation of osteoarthritis ?

A

joint pain and stiffness that worsens with activity
worsens at the end of the day
morning stiffness lasting < 30 minutes

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3
Q

what are the signs of osteoarthritis ?

A

Heberden’s nodes : DIP
Bouchard’s nodes : PIP

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4
Q

what is the criteria for diagnosis for Osteoarthritis

A

> 45
typical pain
no morning stiffness

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5
Q

what is the management of osteoarthritis

A

lifestyle changes
topical NSAID’s Followed by oral NSAID’s
weak opiates and paracetamol
infrequently
intra-articular steroid injections

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6
Q

what are the 2 major risk factors for hip fractures

A

age
osteoporosis

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7
Q

what is the difference between intra-capsular and extra-capsular fractures of the hip?
what system is used to classify hip fractures?

A

Intra-capsular fractures : they are from the edge of the femoral head to the insertion of the capsule.
Non displaced : Have an intact blood supply
Displaced : disrupt blood supply

Extra-capsular : can be trochanteric or subtrochanteric

Garden system used in the classification of hip fractures.

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8
Q

how does a hip fracture present?

A

hip/ groin pain
unable to weight bear
short, abducted and externally rotated leg

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9
Q

what is the investigation used in the diagnosis of hip fracture?
how is it managed ?

A

X-ray : AP view and lateral view

Intra-capsular fractures :

Non displaced : internal fixation ( as blood supply may be intact)

Displaced: total hip replacement or hemiarthroplasty

Extra-capsular fractures :
Stable intertrochanteric fracture : dynamic hip screw
Reverse oblique, transverse or sub trochanteric : Inter-medullary device

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10
Q

what is compartment syndrome ? how does it present ?
which fractures carry this complication?
how is it diagnosed and managed ?

A

A complication of fractures characterised by raised pressure within a closed anatomical space eventually compromising tissue perfusion causing necrosis.

features include :
Pain on movement with excessive use of breakthrough analgesia
paraesthesia
pallor
arterial pulsation
paralysis

Supracondylar and tibial shaft fractures carry the highest risk

diagnosis :
made by measurement of intra-compartmental pressure ( > 20 mm is abnormal and > 40 mm Hg is diagnostic)

management involves fasciotomies

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11
Q

what is the cause of greater trochanteric pain syndrome?

A

repeated movement of fibro-elastic iliotibial band.
features include :
pain on lateral side of hip/ thigh
tenderness on palpation of the greater trochanter

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12
Q

what are the risk factors for tendon disorders?
What are the most common tendon disorders?

A

quinolone use ( Ciprofloxacin)
Hypercholesterolaemia

Achilles tendinopathy ( tendinitis)
Achilles tendon rupture

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13
Q

what are the features and management of Achilles tendinopathy

A

gradual onset of posterior heel pain worse following activity
morning stiffness and pain

managed with simple analgesia and rest

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14
Q

how does Achilles tendon rupture present? How is it managed?

A

Should be suspected if person described a sudden ‘‘pop’’ while playing a sport and sudden onset significant pain.

Simmonds triad can be used to examine and ultrasound is used for imaging.

referral to orthopaedic specialist should be managed.

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15
Q

which is the most commonly injured knee ligament

A

Anterior cruciate ligament

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16
Q

what are the features of ACL injury?

A

Sudden ‘‘popping’’ sound
knee swelling
instability

typically occurs from twisting injuries

anterior draw test and Lachman’s test

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17
Q

most common cause of heel pain in adults ?

A

Plantar fasciitis

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18
Q

describe osteomalacia. What is it known as in children’s?

A

softening of the bones secondary to low vitamin D levels. Known as rickets if it occurs in growing children.

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19
Q

what are the causes of osteomalacia ?

A

Vitamin D deficiency
(malabsorption, lack of sunlight and diet )
CKD

20
Q

what are the features of osteomalacia ?

A

Bone pain
bone / muscle tenderness
fractures ( femoral neck)
proximal myopathy leading to a waddling gait

21
Q

How is osteomalacia investigated and managed?

A

Bloods ( low vitamin D, low calcium ,phosphate, raised ALP)

x-ray shows translucent bands

management :
vitamin D supplementation

22
Q

what is the difference between haematogenous and non haematogenous osteomyelitis ?

A

haematogenous : pathogen is carried through the blood and seeded in bone ( most common)

Non-haematogenous : direct contamination ( fracture site, operation)

23
Q

what is the most common cause of osteomyelitis ?

A

Staph. Aureus
salmonella - most common in sickle cell disease

24
Q

how is osteomyelitis investigated and managed

A

MRI
blood tests, bone cultures and blood cultures.
surgical debridement

flucloxacillin for 6 weeks with rifampicin or fusidic acid added for the 1st 2 weeks ( clindamycin if penicillin allergic)

25
Q

what is the Boxer fracture?

A

minimally displaced fracture of the 5th metacarpal that generally occurs after a patient punching a hard surface

26
Q

what is Colle’s fracture? How does it present ? what are its complications?

A

follows Fall onto an outstretched hand
Dorsally Displaced Distal radius leading to Dinner fork Deformity.

complications :

median nerve injury ( acute carpal tunnel injury)

27
Q

what is smith’s fracture and how does it present?

A

Reverse Colle’s fracture
Caused by falling backwards onto the palm of an outstretched hand / falling with wrists flexed

28
Q

How does carpal tunnel syndrome present ?

A

pain + pins and needles in the thumb, index finger and middle finger

29
Q

what does examination show in carpal tunnel syndrome

A

weakness of thumb abduction
wasting of thenar eminence
Tinel’s and Phalen’s sign

30
Q

How is carpal tunnel syndromemanaged?

A

6 week trial of conservative measures
mild-moderate :
corticosteroids
wrist splints at night ( esp. if pregnant / transient factors)
surgical decompression of flexor retinaculum division

31
Q

what are the causes of carpal tunnel syndrome

A

idiopathic
pregnancy
oedema e.g. heart failure
lunate fracture
rheumatoid arthritis

32
Q

what is discitis ?
what are its complications?

A

It is an infection in the intervertebral disc space that can lead to serious complications such as sepsis / epidural abscess.

33
Q

what are the causes of discitis ?

A

Bacterial : Staph. Aureus
viral
TB
Aseptic

34
Q

What are the features of discitis ?

A

Back pain
general features : pyrexia, rigors, sepsis
neurological features : changing lower limb neurology

35
Q

what is the investigation and management of discitis?

A

MRI : highest sensitivity
treatment : 6-8 weeks of IV Abx therapy
assess for endocarditis

36
Q

what is De quervain’s tenosynovitis ?
What are its features and management ?

A

Condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendon is inflamed.

features include :

pain on radial side of the wrist
tenderness over the radial styloid process
abduction of thumb against resistance is painful

management : analgesia
steroid injection
immobilisation
surgical treatment

37
Q

what test can aid the diagnosis of De Quervain’s tenosynovitis ?

A

Finkelstein’s test

38
Q

what is a scaphoid fracture a complication of ?

A

FOOSH - fall on outstretched hand
Contact sports

39
Q

what is a complication of scaphoid fractures?

A

avascular necrosis of the scaphoid

40
Q

what are the signs and symptoms of scaphoid fractures

A

Pain along the radial aspect of the wrist - at the base of the thumb
loss of grip / pinch strength

signs include :

Point of maximal tenderness is over the anatomical snuffbox
wrist joint effusion
pain elicited by telescoping of the thumb

40
Q

how are scaphoid fractures investigated and managed?

A

Plain film radiographs
MRI- definitive

Management

Immobilisation with Futuro Splint
referral to orthopaedics

40
Q

what are the patterns of disease in systemic sclerosis ?

A

Limited cutaneous systemic sclerosis
Diffuse cutaneous systemic sclerosis
Scleroderma

41
Q

what are the features of limited cutaneous systemic sclerosis

A

CREST syndrome

Calcinosis
Raynaud’s
oesophageal dysmotility
Sclerodactyly
Telangiectasia

Associated with anti-centromeric antibodies
Scleroderma affects face and distal limbs predominantly

42
Q

what are the features of diffuse cutaneous systemic sclerosis ?

A

affects trunk and proximal limbs
respiratory involvement : ILD, PAH
can cause renal disease and HTN

Anti scl-70 antibodies

43
Q

what is the nature of inheritance of Marfan’s syndrome?
What are its features ?

A

Autosomal dominant connective tissue disorder.
Features include :
tall stature
high arch plate
pectus excavatum
pes planus
scoliosis
mitral valve prolapse and dilation of the aortic sinuses
repeat pneumothoraces
lens dislocation
dural ectasia

44
Q

what is an iliopsoas abscess? what is it caused ( primary and secondary)?
What are its clinical features? How is it investigated and managed?

A

Collection of pus in the iliopsoas compartment.
Caused by :
Haematogenous spread
Staph aureus

Secondary causes include:
Crohn’s
diverticulitis, colorectal cancer
UTI’s, GU cancer
vertebral osteomyelitis
endocarditis
IVDU

features include :
fever, back/flank pain, limp and weight loss
hyperextension of the effected hip will cause pain.

Investigation :
CT abdomen

Management :
ABx
Percutaneous drainage

45
Q
A

SAQ style flashcards (4 decks)

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