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MSK Flashcards

1
Q

what is potts disease

A

TB of intervertebral discs

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2
Q

what is a Jefferson fracture

A

fracture of anterior and posterior arches of C1

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3
Q

the olecranon process is a feature of what bone

A

ulna

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4
Q

how does a anterior dislocation of the shoulder occur

A

ABduction, arm is externally rotated/hyperextended or blow to the posterior shoulder

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5
Q

how does an anterior shoulder dislocation clinically present

A

loss of symmetry with loss of roundness of the shoulder and arm held in an ADDucted position supported by the patients other arm

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6
Q

what do teres minor and infraspinatus do

A

external rotation

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7
Q

the common extensor mechanism arises from where

A

the lateral epicondyle

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8
Q

what is a swan neck deformity

A

hyperextension at the PIP and flexion at the DIP

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9
Q

boutenniere deformity

A

hyperflexion at the pip and extension at the DIP

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10
Q

what is ulnar drift

A

fingers all move towards the pinky

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11
Q

z shape deformity

A

hyperextension of the interphalangeal joints and fixed flexion and subluxation of the metacarpal phalangeal joint

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12
Q

what does ustekinumab do

A

inhibits IL12 and IL23

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13
Q

what is usekinumab good for

A

psoriatic arthritis

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14
Q

what is secukinimab used for

A

psoriatic arthritis and ankylosing spondylitis

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15
Q

what does secukinimab do

A

inhibits IL17

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16
Q

what is celecoxib

A

a COX 2 inhibitor NSAID

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17
Q

when would you not use celecoxib

A

not used in people with increased risk of cardiovascular events

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18
Q

side effects of leflunomide

A

similar efficacy to methotrexate, similar side effects to methotrexate, thrombocytopaenia, leucopaenia hepatitis, cirrhosis, pneumonitis, nausea/diarrhoea
also tetarogenic needs to stop 2 years before conception

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19
Q

side effects of sulfasalazine

A

NEUTROPAENIA, reversible oligozoospermia

nausea, rash, mouth ulcers, can also rarely cuase a paraticularly nasty rash which stops when dtop taking drug

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20
Q

side effects of hydroxychoroquine

A

no effect on joint damage
used in connective tissue damage eg in SLE helps skin joints, and general malaise, sjogrens and RA
can rarely cause IRREVERSIBLE RETINOPATHY

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21
Q

side effects of TNFa

A

risk of infection-TB
potentially increased risk of cancer specially skin cancer
contraindicated in pulmonary fibrosis and heart failure

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22
Q

what side effect can allopurinol cause

A

can precipitate an acute attack of gout
can cause a rash-vasculitis in the elderly, more common in elderly and in renal impairment-so use lower doses in these patients

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23
Q

what would you no co presecrible with azithoprine

A

allopurinol

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24
Q

why is allopurinol and azathioprine contraindicated

A

as you can cause marrow aplasia

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25
Q

HLA in RA

A

HLA DR4

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26
Q

what is good for looking at joints in early RA

A

ultrasound

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27
Q

what level on DAS28 indicates active disease

A

greater than 5.1

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28
Q

what does an increase PV mean

A

inflammation or tissue damage

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29
Q

what are the MRI findings of early Ankylosing spondylitis

A

bone barrow oedema, Romanus lesions and enthesittis

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30
Q

can you take live vaccines while you are on DMARDS

A

no

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31
Q

how does Febuxostat work

A

it is a XO inhibitor

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32
Q

how do uricosuric agents work

A

they don’t affect production of uric acid but they increase the clearance of uric acid

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33
Q

when are uricosuric agents contraindicated

A

in renal impairment

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34
Q

what is the capitellum a bony feature of

A

the humerus

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35
Q

what is the elbow joint formed of

A

the radio-capitellar joint and the humero-ulnar joint

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36
Q

what does the radio-capitellar joint do

A

supination and pronation

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37
Q

what does the humero-ulnar joint do

A

flexion and extension

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38
Q

what muscles do pronation

A

pronator teres proximally and pronator quadratus distally

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39
Q

what is supination performed by

A

the biceps and supinator muscles

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40
Q

what is chronic regional pain syndrome

A

characteristics are variable but include constant burning or throbbing sensation, sensitivity to stimuli not normally painful cold, light touch, chronic swelling, paniful movement and skin changes
more common in patients with chronic pain issues
need specialist pain services
pharmacological agents include analgesics, antidepressants, anticonvulsants and steroids

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41
Q

which muscle tears can be treated conservatively

A

Achilles tendon, rotator cuff, longhead biceps brachii, distal biceps

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42
Q

what part fo the vertebral body is involved in a wedge fracture

A

the anterior part

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43
Q

does a wedge fracture require surgical intervention

A

no

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44
Q

where are the flexors located

A

on the volar aspect of the forearm

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45
Q

what mechanism helps prevent against muscle fatigue

A

asynchronous motor units, recruitmenet during submaximal contractions

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46
Q

how is summation of twitches possible

A

the duration of action potential is much shorter than the duration of resulting twitch
it is therefore possible to summate twitches to bring about a stronger contraction through repetitive fast stimulation of skeletal muscle

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47
Q

if a muscle fibre is stimulated so rapidly that it doesn’t have an opportunity to relax at all between stimuli this is called

A

tetanus

48
Q

can cardiac muscle be tetansied

A

no because the long refractory period prevents against generation of tetanic contraction

49
Q

if the skeletal muscle is stimulated once a what is produced

A

a twitch

50
Q

what does a twitch produce

A

produces little tension, and it is not useful in bringing about meaningful skeletal muscle activity

51
Q

what happens if skeletal muscel receives a second stimulation before it had time to completely relax

A

the second response add to the first and a greater muscle tension is developed

52
Q

how does the tension of a skeletal muscle increase

A

it increases with increasing frequency of stimulation

53
Q

when can maximal tetanic contraction be achieved

A

when the muscle is at its optimum length

54
Q

when is optimum length achieved

A

when the point of optimal overlap lf thick and thin filament cross bridges
at this point maximal tetanic tension can be achieved

55
Q

when is the optimal length achieved in the body

A

the resting length of a skeletal muscle is approximately its optimal length

56
Q

what is isotonic contraction used for

A

body movements and for moving objects

57
Q

what does changing muscle length do to tension in isotonic contraction

A

muscle tension remains constant as the muscle length changes

58
Q

what is isometric contraction used for

A

supporting objects in fixed positions and for maintain body posture

59
Q

how does muscle tension develop in isometric contraction

A

muscle tension develops at constant muscle length

60
Q

how is muscle tension transmitted to bone

A

via the elastic components of the muscle

61
Q

how does the velocity of muscle shortening change

A

velocity of muscle shortening decreases as the load increases

62
Q

when maximum load is carried

A

zero velocity of shortening ie isometric contraction

63
Q

are skeletal muscle fibres all the same

A

no

64
Q

spinal segment and peripheral nerve in knee jerk

A

L3, L4

femoral nerve

65
Q

spinal segment and peripheral nerve in ankle jerk

A

S1,S2 tibial nerve

66
Q

biceps jerk

A

C5-C6 musculocutaneous nerve

67
Q

brachioradioradialis

A

C5-C6 Radial nerve

68
Q

triceps jerk

A

C6-C7 Radial nerve

69
Q

what are the sensory receptors for the stretch reflex

A

muscle spindles are the sensory receptors for the stretch reflex

70
Q

what are muscle spindles known as

A

intrafusal fibres

71
Q

what are ordinary muscle fibres referred to

A

extrafusal fibres

72
Q

where are muscel spindles found

A

within the belly of muscles

73
Q

where do muscle spindle run in relation to ordinary muscle fibres

A

muscle spindles are found within the belly of muscles and run parallel to ordinary muscle fibres

74
Q

what are the sensory nerve endings known as

A

annulospiral fibres

75
Q

what happens as the muscle spindles are stretched

A

the discharge from the muscle spindle sensory endings increases as the muscle and hence the spindles are stretched

76
Q

what is the nerve supply to the muscle spindles

A

muscle spindles have their own efferent (motor) nerve supply

77
Q

what are the efferent neurons that supply the muscle spindles

A

gamma y motor neurons

78
Q

how do the y motor neurons work

A

they adjust the level of tension in the muscle spindles to maintain their sensitivity when the muscle shorten during muscle contraction

79
Q

delayed relaxation after voluntary contraction

A

myotonia

80
Q

what does EMG do

A

electrodes detect the presence of muscular activity
records frequency and amplitude of muscle fibres action potentials
helps differentiate primary muscle disease from muscle weakness caused by neurological disease

81
Q

what is a stretch reflex

A

serves as a negative feedback that resists passive change in muscle length to maintain optimal resting length of muscle

82
Q

where is an enchondroma most commoly found

A

in the digits

83
Q

what are multiple enchondromas associated with

A

a non inheritable condition Olliers syndrome

84
Q

what are multiple enchondromas and haemangiomas associated with

A

Maffuccis syndrome

85
Q

where do osteomas tend to be found

A

in the cranial bones

86
Q

what are some of the features of an osteoid osteoma

A

tend to be sore at night

pain resolved by NSAIDS as tumour releases prostaglandins

87
Q

features of osteosarcoma

A

tend to be in kinds
tend to be long bones
x ray shows codmans triangle
any malignant tumour that produces osteoid is osteosarcoma until proven otherwise

88
Q

features of Ewings sarcoma

A

malignant tumour of unknown cell origin
small round blue cell tumours
specific genetic abnormlaity

89
Q

what type of collagen is found in cartilage

A

type II

90
Q

how does type II cartilage differ from type I cartilage

A

type II is finer and forms a 3D meshwork but type I is thicker and aggregates into linear bundles

91
Q

what is the most common type of cartilage

A

hyaline cartilage

92
Q

what are the three forms of cartilage

A

hyaline, elastic, fibrocartilage

93
Q

what is fibrocartilage

A

a hybrid between tendon and hyaline cartilage, it has bands of densely packed type I collagen interleaved with rows of chondrocytes surrounded by small amounts of cartilaginous ECM

94
Q

what is bone made up of

A

mineral-calcium hydroxapatit crystals, water, collagen and non collagen protiens

95
Q

where is cancellous bone found

A

cancellous or trabecular bone is found at the ends of the bone the epiphyses

96
Q

what type of bone is lamellar

A

both cortical and cancellous are lamellar

97
Q

what are the living cells in bone

A

osteocytes

98
Q

what are the lines surrounding the osteon called

A

cement lines

99
Q

where and what are volkmanns canals

A

they are inside osteons, they transmit blood vessels from the periosteum into the bone and lie perpendicular to and communicate with the haversian canals

100
Q

what does trabecular bone lack

A

it lacks haversian canals but because the struts are thin, the osteocytes can survive from contact with the marrow spaces

101
Q

what is osteoid

A

collagen, glycosaminoglycans, proteoglycans and other organic components of the matrix which becomes mineralised over time in the extracellular space

102
Q

where are osteoclasts derived from

A

macrophages, several of these will fuse to form a single giant cell

103
Q

how is bone laid down after it is broken

A

the collagen fibres are laid down in a random fashion=woven bone
this is not as strong as lamellar bone and is subsequently remodelled into lamellar bone by being broken down by osteoclasts and reformed by new osteoblasts

104
Q

what is the short head of biceps supplied by

A

common peroneal nerve

105
Q

what is adductor magnus supplied by

A

tibial nerve

106
Q

what is the nerve supply to the posterior thigh

A

tibial L5-S1

107
Q

what are the nerve roots of the femoral nerve and obturator nerve

A

L2-L4

108
Q

what is froments test for

A

palsy of the ulnar nerve associated with cubital tunnel syndrome
it specifically tests for the adductor pollicis

109
Q

common extensor origin

A

lateral epicondyle

110
Q

common flexor origin

A

medial epicondyle

111
Q

what is a swan neck due to

A

volar plate rupture

112
Q

what is a boutenniere deformity due to

A

torn central slip extensor

113
Q

dislocation at lunate can cause what type of nerve injury

A

median-ie carpal tunnel syndrome

114
Q

what tests can be used for carpal tunnel

A

Phalens test and Tinels test

115
Q

what tests can be used for cubital tunnel and describe how they work

A

hold piece of paper, test the adductor pollis muscle usually thumb will be straight but with positive forments the thumb isn’t straight
can also get hyperextension of the thumb on the ok sign

116
Q

what is finkelsteins test

A

grab the thumb and ulnar and deviate the hand sharply

check for tenosynovitis in the ABductor pollicis longus and the extensor pollicis brevis

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