MSK Flashcards by John Smith

A weakness in which muscle results in a winged scapula?

What are some causes of weakness to this muscle?

Serratus Anterior

Long thoracic nerve damage
Brachial Plexus injury
C5-7 nerve root injury / infection
Muscular Dystrophy

How well did you know this?

Not at all

Perfectly

How would you manage a patient with possible UNSTABLE SPINAL #?

Initial triple immobilisation
Analgesia
AP and Lateral XR of C-Spine C1-T1 &amp; a peg view
Discuss with neurosurgeon/orthopaedics
Further imaging CT or MRI

How well did you know this?

Not at all

Perfectly

What is the surgical management for EXTRA CAPSULAR NOF#?

Dynamic Hip Screw

How well did you know this?

Not at all

Perfectly

What is the surgical management for INTRA CAPSULAR NOF# that is UNDISPLACED in a YOUNG patient?

Cannulated screws

How well did you know this?

Not at all

Perfectly

What is the surgical management for SUBTROCHANTERIC NOF#?

Intermedullary nails

How well did you know this?

Not at all

Perfectly

What paediatric condition describes hip fracture particularly common to adolescent obese males?

Slipped upper femoral epiphysis (SUFE)

How well did you know this?

Not at all

Perfectly

How does OA of the hip present?

Progressive pain and loss of function in hip
Groin pain
Pain on movement / on standing from sitting
Pain at night
Hx of OA in other joints or FHx of OA
Previous trauma?

How well did you know this?

Not at all

Perfectly

What are some lifestyle changes and therapies that may help with osteoarthritis of the knee?

Weight loss
Stop smoking
Physiotherapy

How well did you know this?

Not at all

Perfectly

What is the dose of methotrexate?

2.5 mg tablets / injections

How well did you know this?

Not at all

Perfectly

What are some possible side effects of methotrexate?

Sickness, Diarrhoea, Skin Rash, Mouth Ulcers, Hair Loss

How well did you know this?

Not at all

Perfectly

Am I allowed to drink alcohol whilst on methotrexate?

No, increased damage to liver with methotrexate

How well did you know this?

Not at all

Perfectly

What regular blood tests are required on methotrexate?

FBC (Including WCC and Platelets), LFT, Renal

NB:

Bone marrow suppression can occur abruptly when on methotrexate, especially if on another anti-folate drug (e.g. trimethoprim). Clinically significant drop in FBC or WCC calls for immediate withdrawal.
Liver toxicity, Tx shouldn’t be started if symptoms of hepatotoxicity or deranged LFTs
Pulmonary toxicity is a special problem in RA, discontinue if pneumonitis is suspected
Avoid self-medicating with aspirin or ibuprofen OTC whilst on methotrexate

How well did you know this?

Not at all

Perfectly

What are the rules on pregnancy and breast feeding with methotrexate?

Methotrexate can harm the baby, therefore should not become pregnant or father a baby for at least 3 months after stopping.

Must use effective contraception during use.

Must not breast feed.

How well did you know this?

Not at all

Perfectly

I heard methotrexate can make me infertile

This can happen, however it is thought to go back to normal after treatment is stopped.

Speak to your doctor if you have any concerns.

How well did you know this?

Not at all

Perfectly

What symptoms should you make a patient about to start methotrexate aware of to notify the doctor about? What pathology do the symptoms indicate?

Sore throat, unusual bruising, mouth ulcers (Bone Marrow Toxicity)

Sickness, abdo pain, dark urine (Hepatotoxicity)

SOB, Cough (Pneumonitis)

How well did you know this?

Not at all

Perfectly

Can you give me anything to reduce the likelihood of experiencing side effects of methotrexate?

Folic Acid 5mg on a different day to methotrexate can help with GI and mucosal side effects

How well did you know this?

Not at all

Perfectly

What are the 5 RED FLAGS of BACK PAIN?

Progressively worsening, not relieved by rest

<20 or >50 years old

Urinary / Faecal incontinence, Leg weakness, Saddle anaesthesia

Severe trauma or minor trauma with known osteoporosis

History of cancer; weight loss; fever

How well did you know this?

Not at all

Perfectly

Tx for cord compression?

DEXAMETHASONE

Urgent surgery

Which rheumatological condition is associated with painful or red eyes?

HLA-B27 associated conditions

Psoriatic
Ankolysing
Enteropathic
Reactive

with UVEITIS (red itchy eyes)

What pattern of joint involvement is found in SLE?

Symmetrical small-joint polyarthritis

and/or

Arthralgia

Who does SLE typically affect? Around what stage of life does it onset?

Non-Caucasian Females

Age of onset around early adulthood

What are some common features of SLE?

ORAL ULCERS
RAYNAUD'S PHENOMENON
dry eyes +/- mouth
photosensitivity
MALAR RASH
Discoid rash
fever &amp; general malaise

What is a typical presentation of fibromyalgia?

Pain produced over specific trigger points WITHOUT joint involvement.

Complaints of swelling (despite lack thereof)

Associated with DEPRESSIOON & IBS

What drugs may be used for mild symptoms of lupus?

Hydroxychloroquinine (antimalarial)

NB: risk of ocular toxicity, therefore requires regular check ups with opthalmologist

What is the first line medication for fibromyalgia?

Amitriptyline

How would you test for tear of the rotator cuff muscles? Supraspinatus (anterosuperior cuff) Subscapularis (anteroinferior cuff) Teres minor & Infraspinatus (posterior cuff)

Supraspinatus - Jobes test (thumbs up thumbs down) Subscapularis - Gerbert's liftoff / Belly press (performed below the scapula) Teres minor / Infraspinatus - Resisted external shoulder rotation

What are some complications of anterior dislocation of the shoulder (95% are anterior)?

Auxillary nerve damage Brachial plexus nerve damage Auxillary artery damage Recurrent shoulder dislocation Rotator cuff injury

What are some causes of adhesive capsulitis (frozen shoulder)?

Unknown aetiology Can occur - Spontaneously - After a rotator cuff injury - After immobility (stroke) Most commonly affects 40-65 year old Involves adhesive capsulitis of the GH joint

What special tests can you perform for shoulder impingement syndrome?

Hawkin's test / Cross arm test - Flex shoulder and arm to 90 - Force further internal rotation - Pain = positive test Jobe's test: painful arc indicates supraspinatus tendonitis due to impingement of underside of acromion on the inflamed tendon.

Causes of apparent leg length shortening?

Fixed flexion deformity of hip | Fixed ADduction deformity of hip (in OA)

Causes of true leg length shortening? Name pathologies distal and proximal to the trochanters.

Distal to trochanter - Femur # - Tibial # - Growth disturbance (polio, epiphyseal trauma) Proximal to trochanter - NOF# - OA - Hip dislocation

Which type of NOF# has a high risk of AVN of femoral head?

Displaced INTRACAPSULAR Disruption of intramedullary vessels and cervical arteries

What is the blood supply to the femoral head?

- Cervical arteries running in joint capsule retinaculum (main supply) - Intramedullary vessels in femoral neck - Vessels of ligamentum teres (negligible contribution)

What muscles make up the knee flexors?

Hamstring muscles - Semitendinosis - Semimembranosis - Biceps femoris

What muscles make up the knee extensors?

Quadriceps muscles - Rectus femoris - Vastus lateralis - Vastus medialis - Vastus intermedius

Describe the anatomy of the common peroneal nerve in terms of its trajectory and the muscles innervated by the superficial and deep branches, and finally the sensory innervation.

Descends OBLIQUELY along LATERAL side of POPLITEAL FOSSA Winds around the fibular NECK Superficial branch supplies LATERAL leg compartment (foot eversion) Deep branch supplies ANTERIOR leg compartment (dorsiflexion) SENSORY innervation to LATERAL LEG and DORSAL FOOT

What nerve root compression elicits pain during the straight leg raise test?

L5-S1 sciatic nerve

What nerve root compression elicits pain during the femoral stretch test?

L4 nerve root compression Pain will radiate down anterior leg

What XRAY findings are present in ankylosing spondylitis?

Sacroiliitis Bamboo spine - Squaring vertebra - Disc ossification - Spinal fusion (syndesmophytes)

What are some associated features of ankylosing spondylitis?

Uveitis Peripheral enthesitis* in 33% (especially Achilles tendonitis) *Enthesitis is inflammation of the entheses, sites where tendons or ligaments insert onto the bone

What is the cause of neurogenic claudications present in a spine exam?

Spinal stenosis

What is spinal stenosis?

Lumbrosacral Osteoarthritis with narrowing of the foramina and therefore nerve root impingement This is progressive, developing with age

What are the classic exacerbating alleviating factors of neurogenic claudication / spinal stenosis?

Calf / buttock / thigh discomfort when walking Classically relieved by bending forwards at waist (spinal flexion opens up bony foramina)

Causes of back pain? (mechanical, inflammatory, serious pathology)

Can be divided into mechanical, inflammatory and other serious pathology. Mechanical can be - Muscular injury - Disc prolapse - OA - # - Spondylolisthesis (vertebral slipping) - Spinal stenosis Inflammatory can be - Ankylosing Spondylitis Other serious pathology can be - Bony mets - TB - Myeloma - Osteomyelitis