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Phase 2a > MSK > Flashcards

MSK Flashcards

1
Q

what are the differentials of osteomyelitis

A 
soft tissue infection/cellulitis
charcot joint
avascular necrosis
gout
fracture
bursitis
malignancy
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2
Q

define acute osteomyelitis

A

associated with inflammatory bone changes caused by pathogenic bacteria
present within 2 weeks

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3
Q

define chronic osteomyelitis

A

involves BONE NECROSIS

symptoms not until 6 weeks after onset infection

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4
Q

describe haemotagenous OM in the long bone

A

metaphysis = common site of infection
blood vessels penetrate midshaft then go to either end = metaphysis
at metaphysis blood flow is slower and no BM present and no phagocytes lining the capillaries so bacteria moves easily from blood to bone

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5
Q

why does OM occur in long bones of children

A

metaphysis very metabolically active due to growth

= large flow of blood to this area = higher chance of infection

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6
Q

why does OM occur in vertabrae of elderly

A

with age vertebrae = more vascular = more blood flow and higher chance of infection

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7
Q

what microbial factors help cause OM

A

different bacteria have different virulence factors

some bacteria e.g. S.aureus bind more easily to fibronectin, fibrinogen and collagen = easier cause OM

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8
Q

describe the hostological changes in acute OM

A
  1. bacteria reach bone and proliferate
  2. dendritic cell/macrophage activation
  3. immune system breaks down and destroys bacteria
  4. osteoblast/clast repair damaged bone
  5. resolution
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9
Q

describe the histological changes in chronic OM

A
  1. necrotic bone
  2. formation of sequestrum
  3. osteoblast form new bone around sequestrum = involucrum
  4. periosteum loosely attached to compact bone
  5. abscess formation
  6. tracking to nearby joints/muscles/skin/blood vessels
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10
Q

describe mycobacterium osteomyelitis

A

= extrapulmonary TB
slower onset and symptoms
biopsy essential for diagnosis
longer treatment = 12 months

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11
Q

what is gonococcal arthritis

A

joint infection caused by neisseria gonorrhoea
affects multiple joints
causes fever, arthritis, tenosynovitis and maculopapular pustular rash

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12
Q

what primary tumours are most likely to metastasis to bone

A 
kidney = lytic
prostate = sclerotic
thyroid = lytic
breast = lytic
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13
Q

what does lytic mean

A

bone destructive

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14
Q

what does sclerotic mean

A

bone forming

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15
Q

name the 5 most common primary bone tumours

A
  1. multiple myeloma = lytic
  2. hodgkin lymphoma = sclerotic
  3. ewing’s sarcoma = lytic
  4. osteosarcoma = lytic
  5. chondrosarcoma = lytic, sclerotic at higher grades
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16
Q

what are the red flags for bone malignancy

A 
night pain
weight loss
rapid deterioration
gross loss of movement
infection
non-mechanical
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17
Q

how does Paget’s present on XR

A

moth eaten bones

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18
Q

median nerve examination of hand

A

ask patient to make OK sign
check sensation of radial 3 digits on palm
median nerve palsies = loss of flexion in the two index fingers

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19
Q

radial nerve examination of hand

A

check patient can point with index finger
check sensation on back of hand of radial 3 and half digits
radial nerve palsies typically present with wrist drop

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20
Q

ulnar nerve examination of hand

A

ask patients to cross fingers
check sensation on ulnar side of hand
ulnar nerve palsies = claw hand as individuals unable to extend fingers

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21
Q

name 3 types of hip fracture

A
  1. sub-trochanteric
  2. intertrochanteric = always fixable
  3. intracapsular = likely chance of avascular necrosis if femur head displaced
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22
Q

what are the key principles of fracture management

A

reduction
stabilisation
rehabilitation

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23
Q

what is the number 1 cause of death for ages 1-46

A

trauma

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24
Q

define a fracture

A

soft tissue injury with loss of continuity of bone

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25
Q

what are the 5 Ps of compartment syndrome

A 
pain
pallor
pulselessness
paralysis
perishingly cold
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26
Q

what shoulder dislocation is more common

A

anterior dislocation

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27
Q

name 6 metabolic diseases associated with pseudogout

A 
haemochromatosis
hyperparathyroidism
hypophosphatasia
hypomagnesaemia
hypothyroidism 
acromegaly
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28
Q

what joints does RA commonly affect

A 
hands = MCP and wrist
neck and shoulder
elbow
knee
ankle
foot = MTP
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29
Q

how does RA present on XR

A

Loss of joint space
Erosions
Soft tissue swelling
Soft bones = osteopenia

+ juxta-articular bony lesions

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30
Q

what is fibromyalgia

A

chronic condition that causes muscular and musculoskeletal pain and stiffness
no known cause but believed to have genetic link
can be triggered by physical or emotional event

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31
Q

what is vertebral disk degeneration

A

anatomical changes and LOF of one or more intervertebral disk of the spine which causes symptoms

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32
Q

how does vertebral disk degeneration present

A

lower pack or upper neck pain = does not collate with level of deterioration
pain radiating to hips, buttocks, thigh or legs
pain worse on bending, lifting or twisting
arthritis, scoliosis, hypokyphosis or hyperlordosis may occur

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33
Q

how is vertebral disk degeneration diagnosed

A

radiography shows degenerative changes

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34
Q

how is vertebral disk degeneration treated

A

physical therapy
NSAIDs
epidural steroid injections
surgery

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35
Q

describe the Enneking system of grading malignant tumours

A 
G1 = histologically benign, low mitotic count
G2 = low grade malignant, few mitoses, low risk of mets
G3 = high grade malignant, frequent mitoses, high risk of mets
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36
Q

describe the Enneking classification of benign tumours

A

grade 1 = latent, well defined and may heal spontaneously
grade 2 = active, progressive growth, may expand, negligible recurrence after resection
grade 3 = aggressive, mets present in 5%, high recurrence after resection

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37
Q

what does the prefix osteo mean

A

originates from bone

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38
Q

what does the prefix chondro mean

A

originates from cartilage

39
Q

what does the prefix rhabdomyo mean

A

originates from skeletal muscle

40
Q

what does the suffix -oma mean

A

benign tumour

41
Q

what does sarcoma mean

A

malignant connective tissue tumour

42
Q

what does carcinoma mean

A

malignant epithelial/endothelial tumour

43
Q

what does blastoma mean

A

malignant tumour of embryonic cells

44
Q

what is Paget’s disease

A

condition that causes dysregulated cellular remodelling of bone which results in structural changes and deformity

45
Q

where does Pagets most commonly affect

A

femur
pelvis
lumbar vertbra
skull

46
Q

how does Pagets disease present

A 
deformity first noticed in the skull
headaches
hearing loss
bone pain
bone weakness (pathological fracture)
pain
arthritis 
vision loss (rare)
47
Q

name 6 disease that can be caused by Pagets disease

A 
osteoarthritis
heart failure
kidney stones
nervous system issues
chronic dental issues/jaw infection 
ulceration of female reproductive organs
48
Q

how is paget’s disease diagnosed

A

elevated alkaline phosphatase
normal Ca, Phosphate, aminotransferase
characteristic XR = moth eaten

49
Q

how do you treat Paget’s disease

A

Bisphosphonates = alendronic acid
calcitonin
surgery = fix fractures/ degenerative arthritis/bone deformity fixation

50
Q

what is Feltys syndrome

A

neutropenia
splenomegaly
RA

51
Q

what is caplans syndrome

A

combination of RA and pneumoconiosis that manifests as intrapulmonary nodules
appear homogenous and well defined on XR

52
Q

what is pneumoconiosis

A

disease of lungs due to inhalation of dust

inflammation, coughing, fibrosis

53
Q

what activities increase the risk of MSK issues

A 
heavy manual handling = over 2kg
lifting above shoulders
repetitive tasks
lifting from below knee height
incorrect manual handling/poor posture or grip
fast repetitive work
54
Q

what is epicondylitis

A

inflammation of epicondyles can be medial or lateral
associated with forceful pronation/supination = lateral
medial = forceful flexion/extension

55
Q

how is epicondylitis treated

A

NSAIDS
rest
surgery

56
Q

what is tenosynovitis

A

inflammation of a tendon/tendon sheath (sometimes)

associated with repetitive forceful work and hyperextension

57
Q

how is de quervains tenosynovitis diagnosed

A

finklestein’s test = ask patient put thumb on the inside of hand and then ulnar deviate = pain is positive diagnosis

58
Q

how is tenosynovitis treated

A

NSAIDs
rest
steroid injections
surgery

59
Q

what is repetitive strain disorder

A

repetitive use of hand muscles causing cramp and fatigue
causes non-specific hand pain
associated with computer usage
treated with ergonomic working areas/reduced work load

60
Q

what is hand arm vibration syndrome

A

due to excessive vibration of the hands
can cause secondary Raynauds
causes numbness/tingling/loss of dexterity

61
Q

what is carpal tunnel

A

compression of median nerve due to swelling of carpal tunnel

can cause numbness, thenar wasting and tingling

62
Q

what is carpal tunnel syndrome associated with

A 
repeated flexion/extension of wrist
hand transmitted vibrations
obesity
pregnancy
RA
hypothyroidism 
acromegaly
63
Q

how is Carpal Tunnel syndrome diagnosed

A

positive Tinel’s test = tap on wrist with tendon hammer = pain
positive Phalen’s test = hold wrist flexed for few minutes = pain = indicate carpal tunnel

64
Q

describe rotator cuff issues

A

usually affects supraspinitus = tears/damage
associated with shoulder impingement, OA, heavy manual handling, lifting above shoulder, throwing
painful arc between 70-120 degrees of lifting

65
Q

what is thoracic outlet syndrome

A

compression of trunks of brachial plexus or subclavian artery
associated with poor posture and shoulder loading
causes pain or tingling down arm/blanching of fingers

66
Q

describe mechanical back pain

A

pain associated with abnormal stress or strain on vertebral column
associated with heavy manual lifting, stooping, twisting while lifting, whole body vibration

67
Q

what are common causes of mechanical back pain

A

sprain/strain
disk herniation
vertebral column fracture

lumbar spinal stenosis
spondylolisthesis

68
Q

how is mechanical back pain treated

A

NSAIDs/other analgesics
spinal exercises
encouragement of normal activity

69
Q

what is dupytren’s contracture

A

thickening of palmar tendons

associated with vibrating tool use

70
Q

what is game keepers thumb

A

dislocation of thumb

associated with hyperextension

71
Q

what is writers cramps

A

focal dystonia where hand is stuck in pen holding way

72
Q

what are the most common causes of septic arthritis and osteomyelitis

A

OM = s. aureus

Septic arthritis = s.aureus EXCEPT in sexually active young people = N. gonorrhoea

73
Q

most common cause of reactive arthritis

A

chlamydia

74
Q

what is antiphospholipid syndrome

A

acquired disorder
1. predisposition to venous/arterial clots
2. recurrent fetal loss
3. thrombocytopenia

30% have +ve antiphospholipid antibody

75
Q

what condition can antiphospholipid syndrome occur secondary to

A

SLE

76
Q

what are the features of antiphospholipid syndrome

A

venous/arterial thrombosis
recurrent miscarriages
pre-eclampsia
pulmonary HTN

77
Q

what investigation findings in antiphospholipid syndrome

A

+ve antibodies
anticardiolipin antibodies
thrombocytopenia
prolonged APTT

78
Q

how is antiphospholipid syndrome managed

A

primary:
low dose aspirin
secondary:
initial event = lifelong warfarin 2-3
second event = add aspirin + target 3-4

79
Q

what is olecranon bursitis, how do you diagnose it, what is first line tx and what is an important ddx

A

inflamm + swelling over bursa of elbow
caused by leaning/infection/inflamm
diagnose with aspiration of synovial fluid + gram stain
treat with flucloxacillin (clarithromycin in pen allergic)
key ddx is gout/pseudogout

80
Q

hiker/runner with gradual onset heel pain
what is it? how do you treat? what are the complications of treatment?

A

plantar fasciitis
give steroid injections
can cause rupture of plantar fascia
can cause fat pad atrophy

81
Q

what is the landmark of a fractured NOF on XR

A

disruption of shentons line

82
Q

how to manage an intracapsular NOF?
how to manage an intratrochanteric NOF?
how to manage a subtrochanteric NOF?

A

intrascapular = hemiarthroplasty / total hip replacement
intratrochanteric = dynamic hip screw
subtrochanteric = intramedullary nail

83
Q

what can cause achilles tendon rupture and what movement is weak?
what is the clinical test?

A

clindamycin
ankle plantarflexion
simmonds calf squeeze

84
Q

knee joint that goes pop after twisting, swelling, pain, restricted RoM + locks and gives way?
what special tests?
what test is gold standard?

A

meniscal tear
mcmurrays
apley grind test
MRI
arthroscopy = gold

85
Q

what is first line carpal tunnel management

A

wrist splints at night

86
Q

what condition is trigger finger associated with

A

diabetes

87
Q

what is mortons neuroma?
what special test?
what special sign?
how to treat?

A

dysfunction of nerve in intermetatarsal space
= lump on foot, painful
Metatarsal squeeze test
mulders sign = painful click when manipulating metatarsal head
tx with steroid injections

88
Q

what chemical is raised in gout

A

uric acid

89
Q

crystals in gout vs pseudo gout

A

gout = negatively befringement needle monosodium urate crystals
pseudogout = positively befringement rhomboid calcium phosphate crystals

90
Q

what is the medical term for bunion

A

hallux valgus

91
Q

what are some causes of bakers cysts and what is the clinical sign

A

osteoarthritis
meniscal tear
RA
fouchers sign = soft swelling when knee flexed

92
Q

guidelines for deciding whether to treat osteoporosis

A

NOGG

93
Q

what would you see on XR and blood tests for osteomalacia

A

XR = looser zones
raised ALP
raised PTH
low Ca
low Phosphate

94
Q
A

Phase 2a (15 decks)

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