MSK 2 Flashcards
- in duchenne’s MD what is the vital protein missing?
- describe the inheritance of Duchenne’s MD
- What age groups does Becker’s and Duchenne’s MD typically affect?
- Gowers manouvre is pathognomonic in Duchenne’s MD - T/F?
- scoliosis is not a common feature of duchenne’s MD. T/F
- dystrophin
- X-linked recessive
- Becker’s tends to affect adolescents but Duchenne’s will affect early childhood (4-5)
- true
- false. scoliosis is a significant issue in DMD
23 year old student goes to see his GP with a year history of back pain and stiffness. the pain is worse at night and first thing in the morning and if he has been sitting for long periods of studying. he is otherwise well apart from a previous episode of a red, painful eye for which he has received some steroid eye drops. on examination he has a reduced schober’s test and is tender over his right sacroiliac joint. what is the most appropriate treatment for this man?
NSAIDs and spinal exercise
other treatment involves
steroids, DMARDS (sulfasalazine), biologics (anti-IL-17 and infliximab), exercise and PT/OT or surgery (joint replacements and spinal surgery)
the most likely cause of the eye pain is anterior uveitis.
investigations for spondyloarthritis are:
FBC
spinal mobility assessment - schobers, lateral spinal flexion, occiput and tragus to wall
cervical rotation
XR - bamboo spine, bilateral sacroiliitis, juxta-articular sclerosis, syndesmophyte formation and marginal erosions with disc calcifications with pseudoarthritis
MRI - assess the whole spine
name 3 potential causes of cauda equina syndrome
- central lumbar disc prolapse - commonest
- tumours
- trauma - burst or chance fracture of disc or spinal stenosis
- infection - epidural abscess
- iatrogenic - spinal surgery or manipulation, spinal epidural injection
a 32 year old man presents to the minor injuries walk in clinic and is complaining of back pain. this had started suddenly that morning after he had lifted a heavy box at home. he mentions that the pain has been shooting down his left leg and he cannot walk without the support of his friend. he has not passed urine the onset of pain. on neurological examination of the lower limbs, tone and power cannot be assessed due to pain but there are decreased ankle reflexes and a sacral anaesthesia. what is the most appropriate next step?
arrange an urgent MRI of the mans spine
what is charcot’s foot?
progressive degeneration of a WB joint, marked by bony destruction, resorption and eventual deformity. the onset is usually insidious.
AKA - neuropathic osteoarthropathy
Investigate with an XR
Complications - joint deformity, ulceration, superinfection, loss of function, amputation and death
what are some complications of charcot’s foot?
investigate with an XR
- joint deformity
- ulceration
- superinfection
- loss of function
- amputation
- death
what is congenital vertical talus?
a rare condition in which there is rigid irreducible deformity of the foot. it is also known as rocker bottom foot.
management is a reverse ponseti serial casting
what is dejerine-Klumpke palsy?
a variety of partial palsies of the lower roots of the brachial plexus (C8-T1). it is very rare and only occurs in 0.6% of brachial plexus injuries.
what is the presentation of Dejerine-Klumpke’s palsy?
- clawed hand pose
- paralysis of the intrinsic muscles of the hand
- C8/T1 dermatome distribution numbness
what is the main cause for Klumpke’s palsy?
Breech delivery
with regard to cerebral palsy diplegia involves 2 limbs - an arm and a leg - true or false?
false - ot involves both legs
cognitive problems occur in half cases of cerebral palsy - TF?
True
hip displacement is inversely proportional to the GMFCS - true or false?
false - it is proportional
a GMFCS V patient can walk normally except for using a bannister on stairs - TF?
False - they are wheelchair bound
botulinum toxin is used as a permanent neuromuscular blocking agent - TF?
true - its effects will wear off after -12 weeks due to arborisation
what is meralgia paraesthetica?
a condition in which there is numbness or pain in the outer, lateral, thigh not caused by injury to the thigh but instead to the lateral femoral cutaneous nerve of the thigh. this is also known as skinny pant syndrome
it will present as numbness of the thigh and pain in the thigh
how does meralgia paraesthetica present?
numbness of the thigh and pain in the thigh
a 75 year old man presents with acute sudden onset unilateral headache, on a background of 2 month history of pain and stiffness of the shoulder girdle. suggest an appropriate investigation to help the diagnosis
temporal artery biopsy
a 70 year old woman presents to her GP complaining of severe unilateral headache over the left side of her head. on further questioning, she mentions that she has been having bilateral shoulder and neck pains over the past few weeks. she has also been feeling lethargic. what is the most likely diagnosis?
giant cell arteritis
name 4 treatments which can be used for hallux valgus
- shoe wear modification
- orthotics to offload pressure
- activity modification
- analgesia
- elease of lateral soft tissues (operative)
- osteotomy 1st metatarsal and proximal phalanx (operative)
in an ulnar nerve palsy due to compression at the elbow, what is the area of skin in the hand where sensation is altered?
- little finger volar and dorsal
- ring finger ulnar half volar and dorsal
- hypothenar eminence
- dorsal skin over the 5th metacarpal
how would you manage qa 50 year old male with gout?
- acute relief:
a. NSAIDs high dose (but beware if renal failure)
b. steroids
c. colchicine
d. rest and elevation with ice
treat his hyperuricaemia if
a. 2nd attack within 1 year
b. urate calculi
c. single attack of polyarticular gout
d. renal insufficiency
e. tophaceous gout
prophylactic medication
- xanthine oxidase inhibitors
a. allopurinol and febuxostat - uricosuric agents
a. these will increase urate excretion and is rarely used in patient who under excrete uric acid. sulfinpyrazone - lifestyle management
- low fat dairy products, lose weight, avoid long fasts and alcohol XS and purine rich meats and avoid low dose aspirin
4.. increase vitamin C
allopurinol may cause fever rash and decreased WCC and may also trigger an attack of gout
what lifestyle modifications can you change to help treat someone with gout?
- low fat dairy products
- lose weight
- avoid long fasts
- alcohol XS
- purine rich meats and
- avoid low dose aspirin
- increase vitamin C
what are the side effects of allopurinol and to what family of medications does it belong to?
xanthine oxidase inhibitor
it can cause rash, fever low WCC and may trigger an attack of gout
xanthine oxidase inhibitors and uricosuric agents are used to treat gout. name 1 drug form each family
xanthine oxidase inhibitors
- allopurinol
uricosuric agent
- sulfinpyrazone
a 53 year old man who works as a chef presents to the ED with sudden onset severe pain and tenderness and swelling of the 1st metatarsal joint. he is known to suffer from acute gout and has had several previous similar episodes. what is the most appropriate treatment?
NSAIDs
in reference to MSK, what are ganglion?
synovial filled lump attached to a synovial cavity (associated with a joint or tendon sheath), with slow onset (over months). most occur on the dorsum of the wrist and can present as multiple
they present with pain and paraesthesia but are otherwise asymptomatic
they may cause carpal tunnel syndrome
treatment includes aspiration, excision or reassure and observe
a young netball player lands awkwardly after receiving the ball. a sharp pain and a pop is felt in the knee. the joint is seen to swell rapidly over the next 30 minutes. the cause of the swelling is most likely to be due to?
haemarthroses
name 4 standard/basic treatments for plantar fasciitis
- rest and change training
- stretching (achilles and direct stretching)
- ice
- NSAIDs
- orhoses (heel pads)
- weight loss
- injections - corticosteroid which are good in short term but may make condition worse in long term
- night splinting
name 2 new or third line treatments for plantar fasciitis
- extracorporeal shockwave therapy
- topaz plasma coblation
- nitric oxide
- platelet rich plasma
- endoscopic/open surgery
you see a patient with a cavus deformity. name 3 questions or tests that will hep in the diagnosis of the cause
- is it progressive?
- is there a family history?
- is there muscle pain or weakness?
- is there an elevated creatinine kinase?
- is there altered sensation?
what is Erb’s Duchenne palsy?
paralysis of the arm caused by injury to the upper group of the arm’s main nerves (C5-6). they make up 65% of the brachial plexus injuries.
presentation - waiter’s tip pose with the shoulder adducted, internally rotated and elbow fully extended and pronated and wrist flexed
mostly caused by shoulder dystocia during birth
managed with physio. most cases will recover spontaneously. biceps function is a good predictor of the recovery
name 2 non-pharmacological methods of treating osteoarthritis
- exercise and weight loss
- thermotherapy
- electrotherapy
- aids and devices
- manual therapy (stretching and manipulation but not recommended by NICe guidelines)
in a patient with pagets disease, what are the most likely blood tests results?
normal serum calcium and serum phosphate but elevated alkaline phosphatase
XR will show an expansion and deformity of long bones. there will be mixed osteolytic and sclerotic areas.
presentation:
- bone pain - pelvis lumbar sine and femur
- bone deformity - sabre tibia, increased head size and frontal bossin
- basilar invagination
- hearing loss
- fractures
what is the most common causative agent of osteomyelitis?
staph aureus
what are the characteristics of a LMN lesion?
- decreased strength
- decreased tone
- decreased tendon reflexes
- absent clonus
- absent babinski
- atrophy present
what are the clinical characteristics of an UMN lesion
- decreased strength
- increased tone
- increased deep tendon reflexes
- clonus is present
- babinski is present
- absent atorphy
name 6 clinical features of a peripheral nerve injury
- sensory
- dysaethesia
- anaesthesia
- hypoesthetic
- paraesthesia - motor
- paresis (weakness)
- paralysis (and wasting)
- dry skin - reflexes
- diminished
- absent
what types of peripheral nerve injuries are caused by trauma
- neuropraxia
- axonotmesis
- neurotmesis
name 2 ways of monitoring the healing of the nerve
- tinels sign
2. electrophysiological nerve conduction studies.
a 75 year old man presents with an aucte sudden onset unilateral headache, on a background of 2 month history of pain and stiffness of the shoulder girdle. what is an appropriate next test?
temporal artery biopsy
70 year old woman presents to her GP complaining of severe unilateral headache over the left side of her head. on further questioning, she mentions that she has been having bilateral shoulder and neck pains over the past few weeks. she has also been feeling lethargic. on examination, the left side of her scalp is painful to touch. what is the most likely diagnosis?
giant cell arteritis
what antibody is specific for rheumatoid arthritis?
anti CCP
a 32 year old man presents to a and e with a 1 day history of pain in his right knee and he also mentions that he has had a fever and is feeling generally unwell. on examination the right knee is swollen, warm and extremely painful to move. what is the most appropriate next step?
- aspiration of the joint and blood cultures.
what are the 3 symptoms and signs or tests used in the diagnosis of SUFE?
- painful hip or knee
- externally rotated posture or gait
- reduced internal rotation or hip especially flexion
- plain XR showing SUFE
treatment is with surgical fixation and reduction
what si the clinical presentation of subacromial impingement?
painful arc
name 2 treatments for subacromial impingements
- subacromial steorid injection
- physiotherapy
- arthroscopic subacromial decompression
how would you treat giant cell arteritis?
glucocorticoids highdose without waiting for biopsy results
