MSK Flashcards
1
Q
What is prognosis of LCL tear?
A
Doesn’t tend to heal and can cause varus or rotatory instability
2
Q
What is a complication of LCL injury?
A
Stretching of common peroneal nerve - foot drop
3
Q
Treatment of complete LCL tear?
A
Urgent repair - if you get in early enough you can repair it
4
Q
Popliteal knee pain and bruising?
A
PCL rupture
5
Q
Complication of patellar dislocation?
A
Medial patellofemoral ligament may tear and osteochondral # may occur - look out for small opacification on x-ray
6
Q
Knee pivots through flexion/extension onto which compartment?
A
Medial compartment - medial meniscus
7
Q
Which two movements does the ACL resist?
A
- Anterior subluxation of the tibia
2. Internal rotation of the tibia in extension
8
Q
Which two movements does the PCL resist?
A
- Posterior subluxation of the tibia
2. Hyperextension of the knee
9
Q
What is the posterolateral corner of the knee and what is it’s function?
A
PCL and LCL with popliteus and other small ligaments
Resists external rotaton of the tibia in flexion
10
Q
Varus + rotatory instability = ?
A
Posterolateral corner rupture
11
Q
Treatment of MCL tear?
A
Hinged knee brace
12
Q
Treatment of chronic MCL instability?
A
MCL tightening or reconstruction with tendon graft
13
Q
What tends to be the first sign of hip pathology?
A
Loss of internal rotation
14
Q
Which two muscles are associated with abductor weakness?
Which test can you do to assess this?
A
Gluteus medius + minimus
Trendellenburg sign
15
Q
Hanging rope sign = ?
A
AVN
16
Q
Risk factors for AVN?
A
Alcohol abuse
Steroids
Hyperlipidaemia
Thrombophilia
17
Q
Pain on resisted abduction of the hip = ?
A
Trochanteric bursitis
18
Q
What do you need to rule out in suspected impingement syndrome?
A
Cervical radiculopathy
Ask about head position, numbness, tingling
19
Q
Which two conditions can cause acute shoulder pain with redness?
A
Septic arthritis
Calcific tendonitis
20
Q
What is a Hill-Sach lesion?
What causes it?
A
Big notch out of the back of the head of the humerus
Muscles go into spasm and the humerus is pulled up onto the sharp upper edge of the glenoid causing part of it to break off
21
Q
Which operation is done for recurrent shoulder dislocation?
A
Bankart repair
22
Q
Which structures pass through the carpal tunnel?
A
Median nerve
FDS and FDP to four digits
FPL
23
Q
What is Tinels test?
A
Reproduce symptoms of carpal tunnel by percussing over median nerve
24
Q
What is Phalen’s test?
A
Hold the wrist hyperflexed to decrease space in the carpal tunnel
25
Name and describe two possible causes of cubital tunnel syndrome
1. Osborne's fascia - tight band of fascia forming over the roof of the tunnel
2. Tightness at the intermuscular septum where the nerve passes through/between two head of origin of flexor carpi ulnaris
26
What is Keller's procedure?
Excision arthroplasty of 1st MTP
27
Why is osteomyelitis difficult to treat?
Enzymes from leukocytes cause local osteolysis and pus formation, impairing local blood flow and making infection very difficult to eradicate
28
What is a sequestrum?
Dead fragment of bone
| Once present, antibiotics alone won't treat the infection
29
What is an involucrum?
New bone forming around an area of necrosis
30
Acute osteomyelitis in the absence of recent injury occurs in who?
Children + immunosuppressed
31
What is a Brodie's abscess?
Subacute osteomyelitis in children where the bone reacts by walling off the abscess with a thin rim of sclerotic bone
32
Which organism causes osteomyelitis in sickle cell anaemia patients?
Salmonella
33
Which patients are at risk of osteomyelitis in the spine?
Diabetics
PWID
Immunocompromised
34
What are flat footed people at high risk of?
Posterior tibialis tendonitis
35
Treatment of tibialis posterior tendon dysfunction?
Physiotherapy is the main treatment, insole to support LA, NSAIDs
If fails to settle, surgical decompression and tenosynovectomy may prevent rupture
36
What causes a swan neck deformity?
Volar plate rupture
37
What causes Boutonniere deformity?
Torn central slip extensor
38
Name four injuries that can damage the median nerve
Supracondylar # of the humerus
Colles #
Stab wound
Dislocation of lunate
39
Patient in a below knee cast - which nerve injury?
Common peroneal nerve
40
What is Tinel's test positive for in plantar fasciitis?
Baxter's nerve
41
Which procedure is most commonly done for hallux valgus?
Distal osteotomy
42
Natural history of hallux rigidus?
Pain usually stops around to years
43
What is Mulder's click test?
Medio-lateral compression of the metatarsal heads may reproduce symptoms or produce a characteristic "click" in Morton's neuroma
44
What is Simmond's test?
No plantar flexion of the foot when the calf is squeezed
45
What does Xray of metatarsal stress # show?
X ray may not show # until around 3 weeks until resorption at the # ends occurs or callus begins to appear
46
What is the most commonly sprained ankle ligament?
Anterior talofibular ligament (ATFL)
| Inversion or twisting on a planted foot
47
What is the 2nd most commonly sprained ankle ligament?
Medial deltoid ligament
| Eversion sprain
48
What is the most commonly performed operation for ankle sprain?
Brostom Gould
49
How are ankle fractures graded?
Weber's classification
- A: distal fibular #
- B: # goes through and around the ankle joint and syndesmoses
- C: occurs above syndesmoses, usually stable
50
What do stable ankle fractures usually involve?
One side of the ankle
| Tend to be distal fibular # with no medial malleolus # or no ligament rupture
51
What do unstable ankle fractures tend to involve?
Distal fibular # with medial malleolus # or deltoid ligament rupture
52
What are the three most common 5th metatarsal injuries occurring from proximal to distal?
1. Avulsion by peroneus brevis tendon – associated with sudden inversion e.g. stepping off curb
2. Jones fracture – poor blood supply, 25% risk non-union – this is intra-articular
3. Proximal shaft – common site for stress fracture
53
Fall from height onto heel = ?
Calcaneal #
54
How does the heel tend to move in calcaneus #?
Heel tends to drift into valgus with a widened heel causing impingement of lateral ankle tendons
55
Treatment of chronic pain from calcaneal #?
Subtalar arthrodesis
56
Forced dorsiflexion from rapid deceleration = ?
Talar neck #
57
What is a Lisfranc #?
Fracture of base of 2nd metatarsal associated with dislocation of the base of 2nd metatarsal with or without dislocation of the other metatarsals at the tarso-metatarsal joints
58
Treatment of multiple displaced metatarsal #?
Stabilize with K wires
59
What type of hypersensitivity disease are lupus and RA?
SLE - type III
| RA - type IV
60
What is the significance of ANA in SLE?
Autoantibodies are against nuclear antigens - means that some sort of defective apoptosis drives SLE
61
Child with severe infections + intractable diarrhoea + eczema + very early onset T1DM = ?
IPEX syndrome
62
What type of inheritance does IPEX syndrome show?
X linked - more commonly affects boys
63
Short and long term treatment of IPEX?
Cure: hematopoietic stem cell transplantation (HSCT)
| Supportive care: immunosuppressive drug + total parental nutrition
64
Where is the mutation in IPEX syndrome?
FOXP3 gene - essential for development of regulatory T cells
| Causes a failure of peripheral tolerance due to defective regulatory T cells (Tregs)
65
What is the associated HLA allelle with each of the following:
- Ankylosing spondylitis
- RA
- SLE?
AS: B27
RA: DR4
SLE: DR3
66
Which cells of the body express which HLA/MHC genes?
All nucleated cells express Class I (HLA-A, HLA-B, HLA-C) on the cell surface
Specialised antigen-presenting cells also express Class II (HLA-DR, HLA-DQ, HLA-DP)
Each individual possesses 2 variants of each HLA molecule
Overall each person has 16 alleles
67
What is the basic pathophysiology of type III hypersensitivity reactions?
Large complexes can be cleared by macrophages but macrophages have difficulty in the disposal of small immune complexes; small immune complexes insert themselves into small blood vessels, joints, and glomeruli, causing symptoms
68
Which three types of analgesic can you use together for pain?
Cocodamol
NSAID
Adjuvant e.g. amitryptilline, gabapentin
69
Give three examples of NSAIDs
Ibuprofen
Naproxen
Diclofenac
70
Give one advantage and one disadvantage of COX2 inhibitors
Reduces risk of peptic ulceration
| Increases risk of CVS disease
71
What must you give with Methotrexate?
Folic acid supplement because it is a folate antagonist
72
Give five side effects of methotrexate
1. Leucopaenia/thrombocytopaenia
2. Hepatitis/cirrhosis
3. Pneumonitis
4. Rash, mouth ulcers
5. Nausea, diarrhoea
73
What should you advise re contraception in methotrexate?
Stop in males + females at least 3 months before conception
74
Which drug works similarly and has similar side effects to MTX?
What is important about withdrawing this medication?
Leflunomide
Very long half life, so requires washout
If you just stop it you must advise the patient to not get pregnant for at least 2 years
75
Give two serious side effects of Sulphasalazine
Neutropenia - if you stop it, this will recover
| Oligozoospermia - temporary male infertility
76
What is an important side effect of hydroxychloroquine?
Retinopathy - rare but irreversible
77
What infection should you be worried about when using anti-TNF therapy?
TB
78
When is anti-TNF therapy contraindicated?
Pulmonary fibrosis
| Heart failure
79
Common side effect of Colchicine?
Diarrhoea
80
Which drug should you not use with allopurinol?
Azathioprine - irreversible bone marrow loss
81
When should you not use Febuxostat?
Renal impairment
| Ischaemic heart disease
82
Why is surgery for mechanical back pain not good?
Same outcome as conservative management after 5 years
83
What are the indications for surgery for mechanical back pain?
Single level involvement
| Instability
84
What causes sciatica?
Nucleus pulposis herniates through a disc tear and presses on the exiting nerve root causing pain and altered sensation in a dermatomal distribution and muscle weakness in a myotomal distribution
Can also be caused by OA of the facet joint
85
Which nerve roots are affected with each vertebra?
In lumbar spine - usually lower of the two e.g. L3/4 prolapse = L4 root entrapment
Very lateral disc prolapse - impingement of the nerve root corresponding to the one above e.g. L4/5 impingement = L4 nerve radiculopathy
86
Slow onset stiffness and pain in the neck which can radiate locally to shoulders + occiput = ?
Treatment?
```
Cervical spondylosis (causing accelerated OA in facet joints)
Physio + analgesia
```
87
What are the six clinical criteria required to clear the cervical spine?
1. No history of loss of consciousness
2. GCS 15 with no alcohol intoxication
3. No significant distracting injury
4. No neurological symptoms in upper of lower limbs
5. No midline tenderness on palpation of the c-spine
6. No pain on gentle active neck movement
88
Elderly + osteoporosis = what type of spinal #?
Wedge insufficiency #
89
Axial loading causing compression = what type of spinal #?
Burst #
90
What is a chance #?
Flexion-distraction type # with failure of posterior ligaments
Caused by lap seatbelts
Most commonly occurs in upper lumbar spine
Associated with abdominal injuries
91
What is neurogenic spinal shock?
Occurs secondary to temporary shut down of sympathetic outflow from the cord, leading to bradycardia and hypotension
Usually resolves in 24-48h
92
Do reflexes return in complete spinal cord injury?
Yes
93
Hyperextension injury to cervical spine with OA = which spinal syndrome?
Central cord syndrome
Paralysis of arms more than legs
Fibres for arms run more central in SC than those for legs
94
Loss of motor function, coarse touch, pain and temperature sensation
Proprioception, vibration and light touch preserved
Which SC syndrome?
Anterior cord syndrome
95
Loss of proprioception + vibration + light sense touch = which SC syndrome?
Posterior cord syndrome
96
What is Brown-Sequard syndrome?
Hemisection of the cord usually from penetrating injury
Ipsilateral loss of motor function, vibration, proprioception and coarse touch sensation
Contralateral loss of pain, temperature and coarse touch sensation
97
Multiple fragility fractures + blue sclera + loss of hearing = ?
Where is the defect?
Osteogenesis imperfecta
| Type 1 collagen
98
What is the most common type of cerebral palsy?
Spastic
99
What does ataxic cerebral palsy cause?
Affects cerebellum - reduces co-ordination and balance
100
What does athetoid cerebral palsy cause?
Affects extrapyramidal motor system
| Uncontrolled writhing motion, sudden changes in tone, difficulties controlling speech
101
What can spinda bifida cystica be associated with?
Hydrocephalus
102
What is fibular hemimelia?
Partial or complete absence of fibula
103
What is considered abnormal knee alignment?
Plus/minus 6 degrees from mean value for age
104
Marked + persisting varus deformity = ?
| What causes it?
Blount's disease
| Growth disorder of medial proximal tibial physis
105
What is Osgood-Schlatter's disease?
Inflammation of the tibial tubercle apophysis
106
Fragment of hyaline cartilage and bone breaks off = ?
Osteochondritis dissecans
107
Popping sensation in a child's knee = ?
Abnormally shaped discoid meniscus
108
Waddling gait = ?
Spondylolisthesis
