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MSK 2 Flashcards

1
Q

AVN is what
commonest place
XR

A

ischemic necrosis of bone predom in adults

hip joint commonest place . groin pain

hanging rope on XR

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2
Q

extensor mechanism rupture how
RF
what should be avoided that can lead to this
ix

A

fall onto flexed knee with quads contracted

prev tendonitis, steroids, CRF, cipro, RA

steroid injection on prev tendonitis

unable to straight leg raise. palpable gap in some

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3
Q

MCI symp

rx

A

laxity on valgus stress and pain
tenderness over origin or insertion of MCL

heals well

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4
Q

LCL symp
cx
rx

A

marked instability on rotation movement
perineal nerve injury
complete rupture - urgent repair if early
late - reconstruction with hamstring or other tendon

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5
Q

ACL symp
ix
rx

A

pop heard or felt. haemarthrosis within 1 hour. pain in knee. knee gives way when turning on planted foot . knee swelling
ant translation
ACL reconstruction with allograft, autograft or synthetic graft

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6
Q

PCL symp

rx

A

popliteal knee pain and swelling
instability - recurrent hyperextension or feeling unstable going down stairs

isolated - doesn’t need reconstruction

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7
Q

bone joint infection organisms

A

SA, strep group A, coliforms, pseudomonas aergnosa

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8
Q

PJI prophylaxis

A

first dose within 60 mins of start of surgery
should not continue 24 hours after surgery
screen for MRSA pre op
co amox 1.2g peri op and 2 doses post op
PA co tramoxazole

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9
Q

osteomyelitis treatment

what is it

A

infection of bone and medullary cavity

high dose flucoxicillin 4-8 weeks

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10
Q

septic arthritis is what

rx

A

infection of joint space
SA - high dose fluc IV
<5 add ceftrixone for king ella and HI cover
2-4 weeks of AB

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11
Q

cellulitis organisms

treatment

A

beta haemolytic strep. SA

rest, analgesia, splint

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12
Q

abscess when

rx

A

history or trauma

surgical incision and drain

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13
Q

gas gangrene spores
organism
treatment

A

clostridium perfringes - gram neg strictly anaerobic rods
spores germinate - gas bubbles crepitus

urgent debirdement
penicillin +/- metho

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14
Q

tetanus organism

what causes the paralysis

A

clostridium tetani
gram neg strictly anaerobic rods
neurotoxin causes spastic paralysis - lock jaw

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15
Q

cervical spondolysis
what is it
symp

A

disc degeneration

slow onset stiffness and pain in the neck - can radiate to neck and occiput

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16
Q

cervical disc prolapse symp

treatment

A

neck pain and potential nerve compression

conservative treatment or discectomy

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17
Q

cervical instability

A

downs

RA - atlanto axial subluxation

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18
Q

mechanical back pain

A

worse with activity relieved by rest

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19
Q

acute disc tear what is it
symp
treatment

A 
acute disc tear in annulus fibrous of disc 
lifting a heavy object 
worse on coughing 
analgesia and physio
can take 2-3 months to resolve
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20
Q

sciatica is what

symp

A

if disc tears gelatinous nucleus pulporis can herniate or prolapse throughout the tear - press on exiting on nerve root - impinge

paina nd altered sensation, decreased power, decreased reflexes

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21
Q

bony nerve entrapment how
symp
treatment

A

OA of facet joints - osteophytes impinge on nerve root

nerve root pain and radiation

surgical decompression with trimming of osteophytes

22
Q

osteoporotic crush fracture

A

severe osteoarthritis leads to spontaneous crush fracture

acute pain and kyphosis
conservative treatment

23
Q

cauda equina symp
ix
rx

A

bilateral leg pain. paraesthesia. numbness. saddle anaesthesia. urinary retention, incontinecne. fiscal retention incontincance

PR exam. urgent MRI

surgery

24
Q 
spinal stenosis and claudication
what is it 
age 
symptoms 
treatment
A

spine has less pace due to spondolysis and bulging discs -> spinal stenosis. multiple nerve roots can be compressed/irritated

> 60s

distance inconsistent
pain burning (not cramping)
pain less walking uphill
peripheral pulses present

conservative. decompression surgery

25
Q

GCT of tendon sheath is what

A

firm discrete swelling on volar aspects of digits

may be tender

26
Q

ganglion cyst is what

treatment

A

mucous cyst adjacent to a tendon on a synovial joint

surgical excision if localised discomfort

27
Q

OA of hands and wrists

A

DIP OA common in menopause women
bouchards DIP and herbends PIP
squaring of thumb

28
Q

RA hands

A 
volar MCP joint subluxation 
ulnar deviation 
swab neck E, F
boutonné deformity F, E
bouchards 
Z shaped thumb
29
Q

trigger finger
what is it
where is it commonest
treatment

A

tendonitis of flexor tendon leading to nodular enlargement of tendon
A1 commonest
steroid injections around tendon in sheath

30
Q

dupytrens contracture is what

A

collagen change form 1 to 3

31
Q

carpal tunnel syndrome is what
investigations
treatment

A

median nerve compression
tinnels test, phalans test
steroid injection, splint

32
Q

cubital tunnel syndrome is what
tests
treatment

A

ulnar nerve compression
tinnels. froments - weak grip - adductor pollicis
surgical release of any tight structures

33
Q

polymyositis cells

Dermato cells

A

muscle inflammation of CD8 and CD4 T cells

B and T cells

34
Q

DMD genetics

what is it

A

X linked recessive

progressive proximal muscle weakness

35
Q

BMD

A

later onset

slower progression

36
Q

myotonic dystrophy

A

muscle weakness
cataracts
frontal balding
low intelligence

37
Q

myasthenia gravis

A

AI disease affecting NM transmission. females. 20-40s
25% have thyoma others have thyme hyperplasia
weakness more at end of the day
proptosis. fatigue. dysphagia

38
Q

flat foot commonest cause in elderly women

A

tibialis posterior tendon dysfunction

no steroid injection!

39
Q

tendoachilles tendonitis causes
symptoms
treatment

A

over training. cipro. RA. gout. CTD

pain in main bit of tension or at insertion into calcaneus
morning stiffness. eases with heat/walking

self limiting

40
Q

tendoachilles rupture

A

tendonitis predisposes to rupture
sudden pain and difficulty weight bearing
weakness of plantar flexion and palpable gap in tendon
simmonds test - calf squeeze

41
Q

plantar fasciitis

A

pain with walking felt on instep or foot with localised tenderness on palpation
worse after exercising
tinnels test for baxter nerve positive
self limiting 18-24 months

42
Q

mortons neuroma
what is it
symptoms
treatment

A

degenerative fibrosis of the digital nerve near its bifurcation
burning pain and tingling radiating into affected toes
murders click test
excise or insoles

43
Q

impingement syndrome what is it
signs
investigations
treatment

A

tendons of rotator cuff are contraindicated in the tight acromial space - pain
painful arc 60-120, pain radiates -> deltoid and upper arm and tender below lateral edge of acromium

hawkins positive

conservative. subacromial steroid injection

44
Q

acute calcific tendonitis

A

acute onset of severe shoulder pain
calcium depositis in supra tendon
subacromial steroid injection and local anaesthetic injection

45
Q

rotator cuff tear how

A

sudden jerk in >40s with pain and tenderness
20% of >60s - asymp cuff tears due to degeneration
weakness of initiation of abduction, internal rotation and external rotation
MRI

46
Q 
adhesive capusilitis (frozen shoulder)
risk factors 
symptoms
loss of what 
treatment
A

DM. high cholesterol. dyptrens
progressive pain and stiffness. 40-60s. resolves after 10-24months
pain subsides over 2-9 months. stiffness increases for 4-12 months then that resolves
loss of external rotation
physio. analgesia. intra articular glenohumeral injections

47
Q

lateral epicondylitis/ tennis elbow

A

micro tears in extensor origin
self limiting
rest, NSAIDs, physio, steroid injection, brace

48
Q

medial epicondylitis/ golfers elbow

A

less common

steroid injections carries risk of injury to ulnar nerve

49
Q

volkmans contracture is what

causes

A

claw like - permanent flexion

result of un diagnosed compartment syndrome

50
Q

complex regional syndrome

A

exaggerated pain after injury

burning neuralgic pain, swelling , skin changes

2 (25 decks)

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