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The Holy Grail (Treatments) > MSK > Flashcards

MSK Flashcards

1
Q

Osteochrondroma

  • Benign
  • bony outgrowth with cartilagenous cap
  • local pain
A

Surgical removal

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2
Q

Endochondroma

  • Benign
  • intramedullary and metaphyseal cartilaginous tumour caused by failure of normal enchondral ossification
A

Curettage + bone graft

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3
Q

Simple Bone cyst

  • benign
  • asymptomatic, found on proximal humerus and femur.
A

Curettage + bone graft

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4
Q

Osteoid Osteoma

  • benign
  • small collection of immature bone surrounded by an intense sclerotic halo
  • constant pain, worse at night
A

Self-resolving
NSAIDS
CT guided radiofrequency ablation

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5
Q

Brodie’s Abscess

  • benign
  • subacute osteomyelitis
A

Currettage

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6
Q

Osteosarcoma

  • most common malignant bone tumour
  • produces bone
  • in knees of young patients
A

Chemotherapy

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7
Q

Ewings Sarcoma

  • malignant tumour of primitive cells in the marrow
  • “onion skin” appearance on XR
  • fever, warm swelling, raised inflammatory markers
  • common in teens
  • chromosome 22, EWS gene
A

Radiotherapy
Chemotherapy
Surgery

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8
Q

Osteogenesis Imperfecta

  • brittle bone disease
  • blue sclera
  • multiple fractures
  • defect of type 1 collagen
  • loss of hearing
A

Splintage
Traction
Stabilisation (Sofield procedure)

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9
Q

Achondroplasia

  • short stature
  • prominent forehead
  • widened nose
  • lax joints
  • normal mental IQ
A

Deformity correction
Limb lengthening
Growth hormone therapy

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10
Q

Ehler-Danlos Syndrome

  • abnormal elastic and collagen formation
  • hypermobility
  • vascular fragility (easily bruised)
A

Surgery (for dislocating joints)

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11
Q

Duchenne Muscular Dystrophy

  • progressive muscle weakness in boys
  • trendelenburg positive + Gowers sign positive
  • resp and cardio failure related death in 20s
  • raised CK
  • X linked, dystrophin gene- calcium linked
A

Physiotherapy
Splintage and deformity correction
Surgery (for scoliosis)

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12
Q

Beckers Muscular Dystrophy

- similar to DMD but live into their 40s

A

Physiotherapy
Splintage and deformity correction
Surgery (for scoliosis)

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13
Q

Erb’s Palsy

  • obstetric injury
  • waiters tip posture
  • C5-6 nerves
  • associated with scoliosis, ptosis and horners syndrome
A

Physiotherapy
Nerve transfer
Subscapularis releases
Latissimus Dorsi Tendon Transfers

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14
Q

Klumpke’s Paralysis

  • C8-T1 nerves
  • paralysis of forearm and hand muscles
A

Physiotherapy

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15
Q

Developmental Dysplasia of the Hip (DDH)

  • perinatal dislocation of the hip
  • shortened limb
A

Pavlik Harness

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16
Q

Transient Synovitis

- inflammation of the synovium of a joint following a viral infection

A

Self-limiting

Rest + NSAIDS

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17
Q

Perthes Disease (Legg-Calvé-Perthes)

  • idiopathic osteochondritis of the femoral head
  • age 4-9, commonly boys
  • pain, limb, Trendelenburg positive
  • AVN of femoral head
A

Self-healing (18+ months)
NSAIDS
Physiotherapy (Swimming etc)

If non-healing: Osteotomy

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18
Q

Sipped Upper Femoral Epiphysis (SUFE)

  • inferiorly slipped neck of femur due to growth plate not being able to cope with weight
  • pain in knee, groin
  • loss of internal rotation
A

Immediate internal fixation in-situ using screws to prevent slippage

Chronic slipping: Osteotomy

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19
Q

Talipes Equinovarus (Club Foot)

  • feet are rotated medially and inferiorly
  • congenital deformity
A

Ponseti technique splintage (4-6 week blocks)

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20
Q

Shoulder Impingement Syndrome

  • tendons of the rotator cuff are compressed in the tight subacromial space during movement
  • pain between 60-120 degrees on extension
A

NSAIDS, Analgesia, Physiotherapy
Subacromial steroid injection
Subacromial decompression

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21
Q

Tarsal Coalition

- abnormal bridge between calcaneus, navicular and talus

A

Splintage

Resistant: Surgery to remove connection

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22
Q

Rotator Cuff Tear

- pain and weakness in shoulder muscles

A

Surgery

Physiotherapy

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23
Q

Adhesive Capsulitis (Frozen Shoulder)

  • pain and stiffness of shoulder between 40-60 degrees on abduction
  • loss of external rotation
A

Self-limiting (18-24months)
Physiotherapy + NSAIDS
Steroid injections
MUA (Manipulation under anaesthetic)

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24
Q 
Medial Epicondylitis (Golfer's Elbow)
- painful and tender on flexion
A

Rest + NSAIDs
Steroid injection
Brace

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25
Q 
Lateral Epicondylitis (Tennis Elbow)
- painful and tender on extension
A

Rest + NSAIDs
Steroid injection
Brace

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26
Q

Tendonitis

- inflammation of a tendon

A

Self-limiting

Steroid/ anaesthetic injection

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27
Q

Torn tendon of biceps (Popeye’s deformity)

A

Self-healing
Rest
Sometimes: surgical repair

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28
Q

Dupuytren’s Contracture

  • proliferation of type 3 collagen fibres
  • begins in palm, works outwards
  • thickens tendons in palm
  • ring finger is most common
  • common in alcoholics, Peyronie’s disease and diabetics
A

Fasciectomy
Fasciotomy
Needle aponeurotomy
Amputation of finger(s)

30 degrees is tolerated
Table top test= positive= treatment

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29
Q

Trigger Finger

  • tendonitis of flexor tendon with nodular enlargement
  • gets caught on A1 pulley
  • clicking sensation on straightening finger
  • 3rd/4th digit
A

Steroid injection

Surgery

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30
Q

Ganglion Cyst

  • cyst at synovial joint
  • transilluminates
A

Recurrent: Aspiration/ excision

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31
Q

Trochanteric Bursitis

  • inflammation of a bursae at a joint
  • caused by over activity
A

Rest, analgesia, NSAIDS, Physiotherapy

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32
Q

Anterior Cruciate Ligament Rupture

  • painful sports injury
  • twisting movement on planted feet with “pop”
  • instant haemarthrosis and swelling
  • positive Lachman’s test and anterior drawer test
A

ACL reconstruction/ tendon graft (using patellar tendon)
Rehab
1 year out of sport

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33
Q

Posterior Cruciate Ligament Rupture

  • head on blow to the shin
  • instability on going down stairs
  • doesn’t swell as much as ACL
  • posterior sublaxation of the tibia, positive posterior drawer test
A

Reconstruction

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34
Q

De Quervain’s Tenosynovitis

  • spontaneous swelling and pain in the thumb
  • common in middle-aged women, RA and pregnancy
A

NSAIDS
Splint/ rest
Steroid injection
Decompression surgery

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35
Q

Medial Collateral Ligament Rupture

- pain on medial stress

A

Knee brace

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36
Q

Lateral Collateral Ligament Rupture

  • pain on lateral stress
  • more unstable than MCL
A

Reconstruction

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37
Q

Patellar Instability

  • due to direct blow/ twist
  • usually dislocated laterally
  • spontaneous reduction
A

Physiotherapy to strengthen quadriceps

Recurrent: Surgery and reconstructed medial palatofemoral ligament

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38
Q

Compartment Syndrome

  • internal bleeding and exudate from fracture and injury
  • rise in internal pressure
  • compression of the venous system, causing congestion within muscle
  • secondary ischaemia as arterial blood cannot supply the congested muscle
  • severe pain
  • nerves are compressed resulting in parasthesia and sensory loss
A

Emergency fasciotomy

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39
Q

Giant Cell Tumour

  • benign
  • locally destructive
  • around knee and distal radius
  • multinucleated giant cells
  • “soap bubble” appearance on XR
A

Excision

Phenol/ bone cement/ liquid nitrogen

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40
Q

Fibrous Dysplasia

  • common in adolescents, head and neck
  • defective mineralisation
  • affected bone is wider with thin cortices, can stress fracture
  • shepherd’s crook deformity in the proximal femur
A

Biphosphonates- reduce pain
ORIF + cortical graft
High recurrence: Excision

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41
Q

Chondrosarcoma

  • malignant
  • cartilage producing bone tumour
  • in their 40s, pelvis and femur
A

Surgery

Doesn’t respond to chemo/radio therapy

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42
Q

Myeloma

  • a type of cancer that develops from cells in the bone marrow called plasma cells
  • age 45-65
  • recurrent infection
  • deposition of AL amyloid
  • weakness, back pain, bone pain,
A

Solitary plasmacytoma: radiotherapy

Multiple myeloma: chemotherapy

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43
Q

Lipoma

- a benign neoplastic proliferation of fat

A

Excision

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44
Q

Baker’s Cyst

- swelling of synovial fluid in the popliteal

A

Leave alone

Recurrence: Excision

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45
Q

Abscess

- cellulitis in wound / blocked sweat gland / cyst

A

Self-limiting

Incision + drainage

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46
Q

Implantation Dermoid

  • Epithelial Cells in subcutaneous tissue
  • Cyst with pseudocapsule and grey fluid
A

Excision

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47
Q

Angiosarcoma

- Malignant tumour of the blood vessels

A

Chemotherapy: Doxorubicin

Surgery

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48
Q

Osteochondritis

- An area of bone that has lost blood supply leading to cartilage chipping off

A

Detaching cartilage: Pin back in place
Detached: Fix or remove
Sometimes spontaneously self-heals

49
Q

Avascular Necrosis

A

Drilling into the bone to decompress it

50
Q

Osteoporosis

A
  • Vitamin D, Calcium, weight bearing exercises, balanced diet, sun exposure
  • Biphosphonates (alendronate, risedronate, etidronate)
  • Desuromab
  • Strontium

Post-menopause: Raloxifene

Annual Zoledronic injection (biphosphate)

51
Q

Osteomalacia

A
  • Vitamin D, Calcium, weight bearing exercises, balanced diet, sun exposure
  • Biphosphonates (alendronate, risedronate, etidronate)
52
Q

Paget’s Disease

A
  • Biphosphonates (alendronate, risedronate, etidronate)

- Calcitonin

53
Q

IPEX Syndrome

Extremely prone to infections

A

Supportive
Immunosuppressants
Total parental nutrition

54
Q

Osteoarthritis

  • Loss of joint space
  • Osteophytes
  • Sclerosis (hardening of bone)
  • Subchondral cysts
A

Analgesia + NSAIDS
Opiates + intraarticular steroids (short term)
Physiotherapy + occupational therapy + weight loss
Glucosamine phosphate supplement
Joint replacement

55
Q

Osteoarthritis of hands/fingers

  • PIP and DIP joints
  • Base of thumb
  • Heberden’s nodes
  • Bouchard’s nodes
A

Analgesia + NSAIDS
Opiates + intraarticular steroids (short term)
Physiotherapy + occupational therapy + weight loss
Glucosamine phosphate supplement
Fusion of joints

56
Q

Rheumatoid Arthritis

  • MCP + PIP joints
  • Swan neck deformity
  • Boutonniere’s deformity
DAS28 Score:
<2.6: remission
2.7-3.2: Low disease activity 
3.3-5.1: Moderate
>5.1: High
A

Patients with newly diagnosed active RA start a combination of DMARDs (including methotrexate and at least one other DMARD, plus short-term glucocorticoids.

Short term: Analgesia, NSAIDS, Steroids (injection/oral)
Long term:
- DMARDS (methotrexate, sulphasalazine, hydroxychloroquine, leflunomide)

If >5.1 DAS28 Score

  • Anti-TNFs (etanercept, infliximab, adalimumab)
  • Biologics (rituximab, abatacept)
57
Q

Ankylosing Spondylitis

- chronic inflammation of the spine and sacroiliac joints

A

Physiotherapy + exercise
NSAIDS
Anti-TNF

58
Q

Psoriatic Arthritis

A

Methotrexate
Doesn’t respond: Anti-TNF
Still severe: Joint replacement/ fusion

59
Q

Enteropathic Arthritis (IBD Arthritis)

A

Analgesia
Steroids
DMARDS
Anti-TNF (Infliximab, adalimumab)

60
Q

Reactive Arthritis

  • In response to infection (usually genitourinary)
  • Associates with Reiter’s syndrome
A

Self-limiting
Treat underlying disease
Steroids (injection)
Chronic: DMARDS

61
Q

Systemic lupus erythematosus (SLE)

  • Systemic autoimmune disease
  • Type III hypersensitivity
A

Skin and arthralgia: hydroxychloroquine, topical steroids + NSAIDS
Inflammatory arthritis/ organ involvement: Azathioprine, mycophenolate, corticosteroids
Severe organ disease: IV Steroids/ cyclophosphamide
Unresponsive cases: IV Ig, rituximab

62
Q

Sjogren’s Syndrome

A 
Lubricating eye drops
Dental care
Pilocarpine
Hydroxychloroquine
DMARDS
63
Q

Systemic Sclerosis

A

Raynauds: CCBS, iloprost, bosentan
Renal: ACE inhibitors
GI: PPIs
ILD: DMARDS + cyclophosphamide

64
Q

Anti-phospholipid Syndrome

A

Warfarin

LMWH

65
Q

Gout

A

Acute:

  • NSAIDS (indomethacin)
  • corticosteroids, opiate analgesia
  • Colchicine

Recurrent/ presence of gout tophi: Alluprinol

66
Q

Pseudogout

Calcium pyrophosphate dihydrate (CPPD)

A

Acute: NSAIDS, Colchicine
Recurring: Hydroxychloroquine, methotrexate

67
Q

Polymyalgia Rheumatics

- myalgia of hip and shoulder of elderly

A

Prednisolone

Screen for GCA

68
Q

Giant Cell Arteritis

  • Large Cell Vasculitis
  • Transmural inflammation of arteries
  • > 50 year olds
  • Multinucleated giant cells
  • Visual problems, headaches, jaw claudication, scalp tenderness
A

Prednisolone

Methotrexate/ azathioprine

69
Q

Dermatomyositis

  • V-shaped rash over chest
  • Heliotrope rash
  • Gottron’s papules
A

Prednisolone

Methotrexate/ azathioprine

70
Q

Polymyositis

- symmetrical proximal muscle weakness “trouble climbing stairs”

A

Prednisolone (slow response)

Methotrexate/ azathioprine

71
Q

Fibromyalgia

  • widespread muscle pain + fatigue
  • Associated with RA (25% have FM) and SLE (50% have FM)
A

Self-management therapy
Amitriptyline
Gabapentin
Pregabalin

72
Q

Takayasu Arteritis

- Large cell arteritis

A

Prednisolone

Methotrexate/ azathioprine

73
Q

Granulomatosis with polyangitis
(Wegner’s)
- ANCA Associated Small Vessel Vasculitis
- ENT symptoms (epitaxis, deafness, sinusitis, nose collapse)
- Resp symptoms (haemoptysis, cavitating lesions)

A

IV steroids + cylophosmamide

74
Q

Eosinophilic granulomatosis with polyangitis
(Churgg-Strauss Syndrome)
- ANCA Associated Small Vessel Vasculitis
- late onset asthma
- increased eosinophils in blood
- mononeuritis multiplex

A

IV steroids + cylophosmamide

75
Q

Microscopic Polyangitis

  • ANCA Associated Small Vessel Vasculitis
  • causes glomerulonephritis
A

IV steroids + cylophosmamide

76
Q

Henoch-Schonlein purpura

  • Non-ANCA Associated Small Vessel Vasculitis
  • a disease of the skin, mucous membranes, and sometimes other organs that most commonly affects children
  • the disease causes palpable purpura (small, raised areas of bleeding underneath the skin), often with joint pain and abdominal pain
  • kidney involvement
  • following an infection
A

Self-limiting

77
Q

Cerebral Palsy

Spastic: Damage to motor cortex, upper motorneurons or corticospinal tract. Causing: weakness and spasticity.
Ataxis: Damage to the cerebellum. Reduces co-ordinatino and balance.
Athetoid: Damage to pyramidal motor system, pyramidial tract, and basal ganglion. Causes writhing and speech difficulty.

A 
Physiotherapy + splintage
Baclofen injection into subacromial space
Botox injection to spastic muscles 
Rhizotomy
Surgical release and fusion of joints
78
Q

Spina Bifida
- 2 halves of the posterior vertebral arch fail to fuse

  • Spina bifida occulta: Mild- high arched foot/toe claws/ back dimple with tuft of hair
  • Spina bifida cystica: Severe- herniation of meninges. If myelomeningocele, there may be a neurological deficit. Below region will not function properly.
A

Cannot cure nerve damage
Closed within 48 hours- surgery
Shunt to reduce hydrocephalus
Systemic evaluation

79
Q

Polio

  • Viral infection that affects the anterior motor horn cells in spinal cord
  • Enters via GI tract
  • Muscle paralysis in limbs within 2-3 days (sensation is preserved)
A

Residual paralysis: Splintage
Shortened limb: Shoe raise
Paralysis: Tendon transfers/ fusion

80
Q

Internal Tibial Torsion

A

Self resolves by age 6

81
Q

Metatarsus Adductus

- front half of the foot turns inwards

A

Self resolves

Casting may help

82
Q

Femoral Neck Anteversion

A

Of no consequence- leave be

83
Q

Genu Varum

A

Leave be

Osteotomy

84
Q

Genu Valgus

A

Leave be

If young and severe: growth plate manipulation surgery

85
Q

In-toeing
Due to:
- femoral neck anteversion
- internal tibial torsion

A

Self-resolving

86
Q

Pes Planus (Flat feet)

Flexible: tibialis posterior tendon dysfunction, normal in kids
Rigid: tarsal coalition

A

No treatment needed

87
Q

Patellar tendonitis

A

Self-limiting

88
Q

Apophysitis
- inflammation of tubercle where tendon attaches

Osgood-Schlatter’s disease: tibial tuberosity
Sindig-Larsen-Johansson syndrom: inferior pole of the patella

A

Self-limiting

Rest and physiotherapy

89
Q

Adolescent knee paint

A

Self-limiting

Physiotherapy

90
Q

Osteochondritis dissectans

- Hyaline cartilage broken off at a joint

A

Leave or remove fragments

91
Q

Scoliosis

- lateral curvature of the spine

A

Mild: leave
Severe: Surgery

92
Q

Spondylolisthesis

  • slippage of vertebrae over one another
  • L4/5/S1
  • overweight adolescents
  • lower back pain
A

Minor degree of slippage: rest + physiotherapy

Severe: stabilization + reduction

93
Q

Mechanical back pain

A

Analgesia + physiotherapy
Return to work (no bed rest)
Self resolving

94
Q

Sciatica

  • disc tear
  • impingement of nerve roots
  • L4/5/S1
A

Gabapentin
Maintaining mobility
Physiotherapy
Discectomy

95
Q

Spinal stenosis

  • multiple nerve entrapment
  • burning pain in legs on walking
A

Physiotherapy and weight loss

Surgery- decompress + increase space

96
Q

Cauda Equina Syndrome

A

Emergency surgical decompression

97
Q

Carpal Tunnel Syndrome

  • median nerve
  • paraesthesia in thumb and radial 2.5 fingers
A

Splints to reduce flexion
Corticosteroid
Surgical decompression- disection of transverce carpal ligament

98
Q

Cubital Tunnel Syndrome

  • ulnar nerve
  • paraesthesia in little finger and 1/2 ring finger
A

Surgical release

99
Q

Knee arthritis

A

Isolated OA: unicompartmental knee replacement

Severe: TKR

100
Q

Meniscal tears

A

Steroid injection

Self-resolving

101
Q

Ankle Arthritis

A

Cheilectomy (removal of osteophytes causing impingement)

Elderly: Ankle prosthesis

102
Q

Hallux Valgus

- lateral deviation of big toe

A

Cheilectomy

Arthrodesis

103
Q

Mortons neuroma

A

Insoles
Steroid/ anaesthetic injection
Excision if continued pain

104
Q

Achilles Tendonitis

A

Rest, physiotherapy
Self-limiting

DO NOT USE STEROIDS- Causes rupture

105
Q

Achilles Tendon Rupture

A

Surgical repair and 8 weeks in cast

106
Q

Plantar Fascitis

  • pain on walking
  • due to stress on aponeurosis
A 
Rest
Stretching exercises
Corticosteroid injection
Surgical release of plantar fascia 
Self-limiting
107
Q

Tibialis posterior tendon dysfunction

A

Medial arch support

Tendonectomy

108
Q

Pes Cavus (High arch foot)

A

Soft tissue release
Tendon transfer
Calcaneal osteotomy
Arthrodesis

109
Q

Claw Toes

- hyperextension of MTP and hyperfelxion of PIP and DIP

A

Tenotomy
Tendon transfer
Arthrodesis of PIP
Amputation

110
Q

Hammer Toes

- hyperextension at MTP, hyperflexion at PIP, hyperextension at DIP

A

Tenotomy
Tendon transfer
Arthrodesis of PIP
Amputation

111
Q

Tetanus

- spastic paralysis due to neurotoxin

A

Surgical debridement
Antitoxin
Supportive measures

112
Q

Neuropraxia

- nerve conduction block/ demyelination due to compression or stretch

A

Self healing (28 days)

113
Q

Axonotmesis

- Death of axons distal to injury (Wallerian degeneration)

A

Self-healing (1 month)

1mm per day

114
Q

Neurotmesis

- transection of nerve

A

No recovery unless surgical repair

115
Q

Complex Regional Pain Syndrome (CRPS)

- heightened chronic pain syndrome after injury

A 
Analgesia 
Amitriptyline 
Gabapentin 
Steroids 
Physiotherapy
Lidocaine
116
Q

Soft tissue injury

A

RICE

Rest
Ice
Compression
Elevation

117
Q

Aneurysmal bone cyst

  • benign
  • painful, filled with blood, multiple bones, local destruction and cortical expansion
A

Curettage + bone graft

118
Q

Paget’s

  • hearing loss
  • skull
  • back pain
A

Biphosphonates:

  • tiludronate
  • aldronate

The Holy Grail (Treatments) (13 decks)

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