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1
Q

A weakness in which muscle results in a winged scapula?

What are some causes of weakness to this muscle?

A

Serratus Anterior

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

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2
Q

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

A 
Initial triple immobilisation
Analgesia
AP and Lateral XR of C-Spine C1-T1 & a peg view
Discuss with neurosurgeon/orthopaedics
Further imaging CT or MRI
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3
Q

What is the surgical management for EXTRA CAPSULAR NOF#?

A

Dynamic Hip Screw

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4
Q

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

A

Cannulated screws

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5
Q

What is the surgical management for SUBTROCHANTERIC NOF#?

A

Intermedullary nails

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6
Q

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

A

Slipped upper femoral epiphysis (SUFE)

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7
Q

How does OA of the hip present?

A

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?

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8
Q

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

A

Weight loss
Stop smoking
Physiotherapy

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9
Q

What is the dose of methotrexate?

A

2.5 mg tablets / injections

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10
Q

What are some possible side effects of methotrexate?

A

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

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11
Q

Am I allowed to drink alcohol whilst on methotrexate?

A

No, increased damage to liver with methotrexate

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12
Q

What regular blood tests are required on methotrexate?

A

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
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13
Q

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

A

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.

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14
Q

I heard methotrexate can make me infertile

A

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.

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15
Q

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

A

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

Sickness, abdo pain, dark urine (Hepatotoxicity)

SOB, Cough (Pneumonitis)

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16
Q

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

A

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

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17
Q

What are the 5 RED FLAGS of BACK PAIN?

A

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

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18
Q

Tx for cord compression?

A

DEXAMETHASONE

Urgent surgery

19
Q

Which rheumatological condition is associated with painful or red eyes?

A

HLA-B27 associated conditions

  • Psoriatic
  • Ankolysing
  • Enteropathic
  • Reactive

with UVEITIS (red itchy eyes)

20
Q

What pattern of joint involvement is found in SLE?

A

Symmetrical small-joint polyarthritis

and/or

Arthralgia

21
Q

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

A

Non-Caucasian Females

Age of onset around early adulthood

22
Q

What are some common features of SLE?

A 
ORAL ULCERS
RAYNAUD'S PHENOMENON
dry eyes +/- mouth
photosensitivity
MALAR RASH
Discoid rash
fever &amp; general malaise
23
Q

What is a typical presentation of fibromyalgia?

A

Pain produced over specific trigger points WITHOUT joint involvement.

Complaints of swelling (despite lack thereof)

Associated with DEPRESSIOON & IBS

24
Q

What drugs may be used for mild symptoms of lupus?

A

Hydroxychloroquinine (antimalarial)

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

25
Q

What is the first line medication for fibromyalgia?

A

Amitriptyline

26
Q

How would you test for tear of the rotator cuff muscles?

Supraspinatus (anterosuperior cuff)
Subscapularis (anteroinferior cuff)
Teres minor & Infraspinatus (posterior cuff)

A

Supraspinatus - Jobes test (thumbs up thumbs down)

Subscapularis - Gerbert’s liftoff / Belly press (performed below the scapula)

Teres minor / Infraspinatus - Resisted external shoulder rotation

27
Q

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

A

Auxillary nerve damage
Brachial plexus nerve damage
Auxillary artery damage

Recurrent shoulder dislocation

Rotator cuff injury

28
Q

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

A

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

29
Q

What special tests can you perform for shoulder impingement syndrome?

A

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.

30
Q

Causes of apparent leg length shortening?

A

Fixed flexion deformity of hip

Fixed ADduction deformity of hip (in OA)

31
Q

Causes of true leg length shortening?

Name pathologies distal and proximal to the trochanters.

A

Distal to trochanter

  • Femur #
  • Tibial #
  • Growth disturbance (polio, epiphyseal trauma)

Proximal to trochanter

  • NOF#
  • OA
  • Hip dislocation
32
Q

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

A

Displaced INTRACAPSULAR

Disruption of intramedullary vessels and cervical arteries

33
Q

What is the blood supply to the femoral head?

A
  • Cervical arteries running in joint capsule retinaculum (main supply)
  • Intramedullary vessels in femoral neck
  • Vessels of ligamentum teres (negligible contribution)
34
Q

What muscles make up the knee flexors?

A

Hamstring muscles

  • Semitendinosis
  • Semimembranosis
  • Biceps femoris
35
Q

What muscles make up the knee extensors?

A

Quadriceps muscles

  • Rectus femoris
  • Vastus lateralis
  • Vastus medialis
  • Vastus intermedius
36
Q

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.

A

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

37
Q

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

A

L5-S1 sciatic nerve

38
Q

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

A

L4 nerve root compression

Pain will radiate down anterior leg

39
Q

What XRAY findings are present in ankylosing spondylitis?

A

Sacroiliitis

Bamboo spine

  • Squaring vertebra
  • Disc ossification
  • Spinal fusion (syndesmophytes)
40
Q

What are some associated features of ankylosing spondylitis?

A

Uveitis

Peripheral enthesitis* in 33% (especially Achilles tendonitis)

*Enthesitis is inflammation of the entheses, sites where tendons or ligaments insert onto the bone

41
Q

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

A

Spinal stenosis

42
Q

What is spinal stenosis?

A

Lumbrosacral Osteoarthritis with narrowing of the foramina and therefore nerve root impingement

This is progressive, developing with age

43
Q

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

A

Calf / buttock / thigh discomfort when walking

Classically relieved by bending forwards at waist (spinal flexion opens up bony foramina)

44
Q

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

A

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

Revision (21 decks)

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