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Finals passmed > MSK > Flashcards

MSK Flashcards

1
Q

What are the features of adhesive capsulitis?

A

symptoms develop over a few days. frozen shoulder. external rotation worse, both active and passive movement, painful phase, freezing phase, recovery phase, usually lasts between 6 months and 2 years

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2
Q

What are the features of trochanteric bursitis?

A

Pain over the lateral side of the hip
Tenderness on palpation on the greater trochanter

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3
Q

When should you reassess fracture risk in patients on alendronate?

A

After 5 years of treatment

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4
Q

If someone has a high FRAX score, what is the next step?

A

DEXA scan

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5
Q

What is the definition of reactive arthritis?

A

Arthritis that develops following an infection where no organism can be recovered from the joint

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6
Q

What is the management of reactive athritis?

A

symptomatic: NSAIDS, intra-articular steroids
sulfasalazine and methotrexate if persistant
usually lasts less than 12 months

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7
Q

What is the classical triad of reactive athritis?

A

Cant see, cant pee, cant climb a tree

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8
Q

What is found in the synovial fluid of someone with reactive athritis?

A

sterile synovial fluid with a high white cell count

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9
Q

Which type of arthritis has bouchards and heberdens nodes?

A

Osteoarthritis

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10
Q

Are bouchards and heberdens nodes painful?

A

No

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11
Q

What are the features of spinal stenosis?

A

gradual onset, unilateral/bilateral leg and back pain, numbness and weakness, worse on walking, resolves on sitting/crouching

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12
Q

What are the features of ankylosing spondylitis?

A

lower back pain and stiffness, worse in the morning and improved by exercise, peripheral arthritis

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13
Q

What are the features of facet joint pain?

A

pain worse in the morning and on standing, pain over facets. usually worse on extension of the back.

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14
Q

What is a positive straight leg raise?

A

Pain on raising leg from lying - sciatic nerve pain

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15
Q

What are the features of venous ulcers?

A

brown pigmentation, lipodermatosclerosis (champagne bottle legs), eczema, painless, usually above the ankle

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16
Q

What are the features of arterial ulcers?

A

occur on toes and heel, deep, punched-out appearance, painful, cold, low pulses

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17
Q

What are the features of neuropathic ulcers?

A

over plantar surface of metatarsal head and plantar surface of hallux, due to pressure, usually in diabetics

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18
Q

What is the management of an extracapsular hip fracture?

A

Intertrochanteric - dynamic hip screw
other extracapsular - intramedullary device

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19
Q

What is the management of an undisplaced intracapsular hip fracture?

A

internal fixation or hemiarthroplasty if unfit

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20
Q

What is the management of a displaced intracapsular hip fracture?

A

arthroplasty (hemiarthroplasty if unfit)

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21
Q

After how many years of bisphosphonates should you re-assess FRAX and DEXA?

A

Five years for oral bisphosphonates
three years for IV

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22
Q

What can cause avascular necrosis of the hip?

A

long-term steroids, chemo, alcohol, trauma

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23
Q

What are the features of trochanteric bursitis?

A

Lateral hip/thigh pain over greater trochanter, usually worse when lying on side, older women

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24
Q

What are the features of compartment syndrome?

A

Pain on movement even passive, parasthesia, pallor, arterial pulsation
commonly supracondylar and tibial shaft fractures

25
Q

What is the most commonly affected joint in septic arthritis?

A

knee

26
Q

What organism most commonly causes septic arthritis?

A

staphylococcus aureus (or gonorrhoeae in young adults)

27
Q

What is the management of septic arthritis?

A

flucloxacillin or clindamycin if pen allergic (IV 2 weeks then oral 2 weeks)
needle aspiration to decompress joint

28
Q

What is chondrocalcinosis and when is this seen?

A

linear calcifications of the meniscus and articular cartilage - seen in pseudogout

29
Q

What are the features of De Quervain’s tenosynovitis?

A

inflammation of sheath of extensor pollicis brevis and abductor pollicis longus tendon
- causes radial wrist pain, usually middle-aged women
Finkelstein’s test (adduct and flex thumb, radial wrist hurts)

30
Q

How do you manage an open fracture?

A
  • debridement
  • external fixation after soft tissue healing
  • IV broad spectrum Abx
31
Q

What are the features of osteomalacia?

A

bone pain, tenderness and proximal myopathy (waddling gait)
low Calcium, low phosphate, raised ALP, raised PTH

32
Q

Which muscles do which parts of arm abduction?

A

Supraspinatus (0-15)
Deltoid (15-90)
Trapezius (the rest)

33
Q

What is the painful arc?

A

60-120 degrees - due to supraspinatus impingement

34
Q

What must you do when starting allopurinol?

A

Give colchicine cover for up to 6 months

35
Q

What is the difference in presentation between an anterior and posterior dislocation?

A

posterior - leg shortened, adducted, and internally rotated
anterior - abducted and externally rotated

36
Q

How do you diagnose a DVT?

A
  • Wells score <= 1 - D dimer, if +ve then doppler US
  • Wells score >2 Doppler US
37
Q

What condition causes an isolated raise in ALP?

A

Paget’s disease

38
Q

What is paget’s disease and it’s management?

A

Increased but uncontrolled bone turnover
Mx: bisphosphonates

39
Q

What are the features of iliotibial band syndrome?

A

Tenderness on the lateral knee, usually in runners

40
Q

What is the management of a proximal scaphoid fracture?

A

surgical fixation

41
Q

What are the features of subclavian steal syndrome?

A

Dizziness and vertigo during exertion of arm - due to stenosis of subclavian artery, causing flow reversal from vertebral artery

42
Q

What are the ottowa rules for doing an ankle X-Ray?

A
  • inability to walk 4 steps
  • bony tenderness around either of the malleoli
43
Q

Which compartments of the leg are innervated by which nerves?

A

Anterior: deep peroneal nerve
Lateral: superficial peroneal nerve
posterior: tibial nerve

44
Q

What diagnosis causes a positive Simmond’s sign?

A

Achilles tendon rupture

45
Q

What are the features of Paget’s disease of the bone?

A

A disease of increased but uncontrolled bone turnover. Effects long bones and axial bones. Isolated raised ALP. Treat with bisphosphonates if symptomatic

46
Q

What is the first line management of ankylosing spondylitis?

A

Physiotherapy and NSAIDs

47
Q

Which foot bone is the most common site of stress fractures?

A

The second metatarsal

48
Q

What is the management of osteomyelitis?

A

Flucloxacillin for 6 weeks

49
Q

What are the clinical features of a fat embolism?

A

Recent injury
Resp: early tachycardia, pyrexia, hypoxia
derm: petechial rash
CNS: confusion and agitation

50
Q

What is the first line investigation for suspected osteomyelitis?

A

MRI

51
Q

What is meralgia parasthetica?

A

Thigh pain - paraesthesia or anaesthesia in distribution of the lateral femoral cutaneous nerve due to entrapment. pain on palpation
RF: obesity, pregnancy, trauma, sports

52
Q

What are the features of osteochondritis dissecans?

A

Usually in young adults, knee pain and swelling after exercise, knee locking or giving way, pain on femoral condyles, joint effusion

53
Q

How do you diagnose osteochondritis dissecans?

A

X-Ray subchondral crescent sign or loose bodies
MRI

54
Q

How do you differentiate a neck of femur fracture from a hip dislocation?

A

NOF - shortened and externally rotated
Posterior dislocation - shortened and internally rotated
Anterior dislocation - abducted and externally rotated

55
Q

What investigation can you use to diagnose ankylosing spondylitis?

A

Pelvic X-Ray to identify sacro-iliitis

56
Q

What is angulation in a fracture?

A

the amount of deviation from the normal angle of the distal and proximal fragments

57
Q

What is displacement in a fracture?

A

misalignment of the fragments, represents the distance the distal fracture fragment is from the proximal fragment

58
Q

Why does a hip fracture cause an external rotation and shortening?

A

Psoas muscle attaches to the lesser trochanter, and pulls it in and externally rotates.

59
Q

What is worse an intra or extracapsular fracture?

A

intra - due to the blood supply - more likely to get avascular necrosis

Finals passmed (23 decks)

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