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3rd year medicine > msk > Flashcards

msk Flashcards

1
Q

twisting knee injury knee swollen and painful to palpate - worse on straightening knee McMurray’s test positive (painful click) diagnosis

A

possible meniscal tear

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2
Q

falling hard onto bent knee positive posterior drawer test diagnosis?

A

injury to posterior cruciate ligament

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3
Q

direct trauma to knee positive patellar apprehension test diagnosis?

A

patella dislocation

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4
Q

hyperextension of knee positive anterior drawer test diagnosis

A

anterior cruciate ligament rupture

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5
Q

repeated jumping and landing on hard surfaces anterior knee pain over 2-4wks which comes on with exercise and worsens with jumping diagnosis

A

patella tendinopathy (or ‘jumpers knee)

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6
Q

causes of carpal tunnel syndrome

A

idiopathic pregnancy oedema (heart failure) lunate fracture rheumatoid arthritis

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7
Q

isolated lateral hip/thigh pain with tenderness over greater trochanter able to weight bear no trauma hx systemically well discomfort worse at night when lying on that side diagnosis

A

greater trochanteric pain syndrome (trochanteric. bursitis) due to repeated movement of fibroelastic iliotibial band - most common in women 50-70

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8
Q

rugby player painful knee popping sensation in right knee during match swollen unable to fully extend knee most appropriate imaging?

A

meniscal tear: MRI

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9
Q

36yr 6wk hx painful wrist pain over radial aspect of wrist elicited by forced adduction and flexion of thumb test name? most likely diagnosis?

A

Finkelstein’s test De Quervain’s tenosynovitis

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10
Q

diagnosis?

A

collar on scotty dog appearance = Spondylolysis

Spondylolysis = fracture of pars interarticularis (sticking out bit of vertebra)

Spondylolisthesis: fracture + slipping of one vertebral body on another

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11
Q

diagnosis

sporting injury - forced abduction and external rotation

loss of deltoid mass

A

anterior dislocation of humeral head

  • humerus inconguinent with glenoid (inferior to glenoid and overlaps)
  • most common type of shoulder dislocation
  • forced abduction and external rotation
  • loss of deltoid mass

posterior dislocation: is usually in line so harder to spot on AP

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12
Q

fall on outstretched hand

diagnosis?

A

posterior humeral dislocation

light bulb sign - fixed in internal rotation so humeral head looks more round (like light bulb)

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13
Q

reducing mechanisms for anterior humeral dislocation

A
  • hanging arm (stimson maneuvre) - hanging arm with weight
  • Kocher: traction with external rotation, adduction, then internal rotation
  • Hippocrates: foot in armput and pull on arm
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14
Q

neers classification

A

for humerus head fracture

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15
Q

what movement do you lose first in frozen shoulder

A

lose external rotation first

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16
Q

management for frozen shoulder

A

also called adhesive capsulitis - inflammation of capsule

Mx:

  • first line conservative
  • if not better after 3 months:
  • manipulation under anaesthesia
  • arthroscopy/ open capsular release
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17
Q

features of supracondylar fracture of distal humerus

A

usually child falling on outstretched hand

reduction in extension

stiffness in elbow joint

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18
Q

Volkmann’s ischaemic contracture

A

permanent flexion contracture of forearm following a period of ischaemia that can follow a supracondylar fracture

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19
Q

Mx for supracondylar fracture of distal humerus

A

surgical - bicortical wire fixation

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20
Q

intra-articular fractures Mx

A

intra-articular: within the joint

open reduction, internal rigid fixation

  • to promote primary bone healing
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21
Q

olecranon fracture Mx

A

undisplaced: immobilization and cast
displaced: surgery - tension band wiring or plate

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22
Q

fall on outstretched hand

diagnosis?

management?

A

posterior dislocation of ulner

Mx:

uncomplicated: reduce with traction

collar and cuff flexed at 90 degrees

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23
Q

what is tennis elbow

Mx

A

lateral epicondylosis (in extensor tendons)

Mx:

  • XR
  • anti-inflammatory
  • corticosteroid + LA injection
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24
Q

what is golfer’s elbow

A

pain over medial epicondyle

flexor tendons

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25
Q

colles vs smith fracture

Mx

A

colles:

  • fall on outstretched hand
  • dorsal (upward) displacement

smiths:

  • fall on back of hand
  • palmar displacement

Mx: closed reduction, back slab and repeat XR

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26
Q

scaphoid palpable in anatomical snuffbox when thumb hyperextended

diagnosis?

Mx:

A

scaphoid palpable: scaphoid fracture

Mx: POP cast

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27
Q

saturday night palsy

Mx

A

radial nerve palsy

fall asleep drunk on chair with arm over back of chair –> compression of radial nerve in axilla

wrist drop + sensory loss

Mx: wrist splints

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28
Q

nerve compression

Ix

Mx

A

Ix: nerve conduction studies

Mx: splint

if needed surgical decompression

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29
Q

what test is used to determine the arterial blood supply of the hand

A

allens test

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30
Q

diagnosis?

A

ganglion cyst

fixed to deep tissue but not to overlying skin

transilluminates

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31
Q

test for de quervains tenosynovitis

A

Finkelsteins

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32
Q

causes of carpal tunnel syndrome

A

ICRAMPS

Idiopathic

Colles, Cushings

Rheumatoid

Acromegaly/Amyloid

Myxoedema, mass, (diabetes) Mellitus

Pregnancy

Sarcoid, SLE

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33
Q

shortened and externally rotated leg

A

neck of femur fracture

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34
Q

what to worry about with intracapsular fracture of femur

A

avascular necrosis

due to disruption of lateral femoral circumflex artery

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35
Q

garden classification

A

for neck of femur fractures

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36
Q

diagnosis

A

posterior hip dislocation

flexxed, internally rotated and adducted

usually due to fall from height

Mx: relocation in A&E or in theatre under GA

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37
Q

band of pain going down lower back

A

sacroiliac joint disfunction

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38
Q

recent URTI

mild fever

acute groin/thigh pain

in children

refuse to weight bare

in flexion abduction and external rotation

diagnosis?

Mx

A

Transient Synovitis of the Hip (paeds)

  • must rule out septic arthritis
  • XR normal
  • do USS if suspicious of septic arthritis

Mx: treat conservatively (NSAIDs)

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39
Q

hot painful swollen joint

fever

systemically unwell

knee most commonly

A

septic arthritis

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40
Q

most common bacteria causing septic arthritis

A

staph.aureus

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41
Q

risk factors for septic arthritis

A
  • Common in patients >80yo with history of:
  • crystal arthropathy,
  • IVDU,
  • endocarditis
  • recent bacteraemia
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42
Q

Mx of septic arthritis

A

A-E

bloods: WCC and CRP

aspiration and sent for C&S

  • IV abx STAT and joint wash out in theatre
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43
Q

swollen painful knee with varus or valgus deformity

diagnosis

Ix

Mx

A

tibial plateau fracture

Ix: CT

Mx:

  • undisplaced: hinge brace
  • displaced: ORIF
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44
Q

ACL and PCL role

A

ACL: prevents anterior movement of tibia

connects from back of femur to front of tibia

PCL: restricts posterior movement of tibia

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45
Q

ACL/ PCL classical presentation

Mx

A

on side stepping sports

snap/ pop sound

immediate swelling of knee

feeling of instability with knee

Mx:

  • conservatively with drainage of haemarthrosis with PT
  • PCLs recover well under conservative
  • surgical reconstruction: tendon transfer from hamstring or patella
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46
Q

medial/ collateral ligament injury

valgus or varus of each?

A

Valgus (MCL injury)

Varus (LCL injury)

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47
Q

does meniscal injury in the knee cause slow or quick swelling

A

slow swelling

48
Q

anterior vx posterior knee dislocation

Mx

A

anterior: tibia forward, femur back
posterior: tibia back, femur forward

Mx: urgent reduction under anaesthesia

49
Q

signs of osteoarthritis on XR

A

LOSS

L: loss of joint space

O: osteophytes

S: subchondral sclerosis

S: subchondral cyst

50
Q

management of knee osteoarthritis

A

usually conserative

as it progresses surgery:

knee arthroplasty

total knee replacement

51
Q

diagnosis

A

dislocation of patella

52
Q

presentation of Osgood Schlatter’s disease

A

inflammation where tendon from kneecap (patella tendon) attaches to tibia

pain and lump after exercise over tibial tuberosity

pain worse when going up stairs

Mx: rest and restriction of activity

53
Q

what type of bursitis is housemaids knee

A

prepatella bursitis

  • lying over the patella
  • working on knees frequently
54
Q

what type of bursitis is clergymans knee

A

infrapatella bursitis

  • below patella over patella tendon
  • also occurs in people who work on knees
55
Q

managment of prepatella and infrapatella busitis

A

firm bandaging

avoiding kneeling without protective padding

bursa may require aspiration

56
Q

what classification is used for ankle fractures

A

Webers classification: a,b,c

57
Q

mangement of ankle fractures according to weber classification

A

A & B: cast/boot and weight bear as tolerated

C (unstable - above level of syndesmosis): ORIF

58
Q

unilateral foot in dorsiflexed position

been running up hill

simmonds test positive

diagnosis

A

achilles tendon rupture

  • simmonds test: squeezing calf produces no plantar flexion in affected foot
59
Q

slow onset over time

diagnosis?

Mx

A

bunion (hallux valgus)

metatarsopharyngeal joint

Mx:

wear wider shoes

surgery

60
Q

management of plantar fasciitis

A

common cause of heel pain

conservative

surgery after 9months if conservative not helping –> plantar fasciotomy

61
Q

the 5P’s of compartment syndrome

A

Pain (with passive stretch)

Paraesthesia

Perishingly cold, Pallor

Paralysis

Pulselessness

severe pain disproportionate to injury

presents within hrs

pain may be absent with nerve damage

62
Q

diagnosis of compartment syndrome

A

mostly clinical

if uncertain: intra-compartmental pressure monitor >30

creatinine kinase may be elevated

63
Q

management of compartment syndrome

A

early recognition

immediate surgical treatment: urgent fasciotomies

skin incisions are left open and a re-look is planned for 24-48hrs (for debridement of dead tissue)

monitor renal function

also:

  • keep leg in neutral position (not elevated or lowered)
  • high flow O2
  • help BP with bolus of IV crystalloid fluids
  • Remove all dressings / splints / casts
64
Q

developmental dysplasia of hip Ix and Mx

A

all infants screened after birth

<4months: USS

4-6months after ossification begins : XR

<6months: Pavlick harness (abduction bracing)

6-18 months: closed reduction and spica casting

>18months: open reduction with spica casting

>2yrs: osteotomy

65
Q

screening tests for developmental dysplasia of hip

A

Barlow test: (Barlow bad)

  • push down with legs together
  • hip started reduced - test will dislocate hip

Ortolani test:

  • push leg apart and round
  • hip started dislocated - test will reduce hip
66
Q

cancers that commonly spread to bone

A

breast

bronchus

thyroid

renal

prostate

67
Q

most common primary bone cancer

A

multiple myeloma (bone marrow)

lytic lesions

68
Q

most likely type of cancer

A

osteosarcoma

  • presents most commonly in knee, femor or tibia
69
Q

bone cancer most likely to affect children

A

Ewing’s sarcoma

-presents children 5-30

in upper and lower leg, pelvis, upper arm and ribs

70
Q

chondrosarcoma

A

cancer of cartilage

71
Q

differentials for hip pain in children

A
72
Q

normal serum calcium

normal serum phosphate

normal ALP

normal PTH

diagnosis?

A

osteoporosis

in elderly and more common in women

73
Q

decreased calcium

decreased phosphate

increased ALP

increased PTH

diagnosis

A

osteomalacia

(rickets in children)

have low vit D

Mx: calcium + vit D

74
Q

normal calcium

normal phosphate

increased ALP

normal PTH

A

Pagets disease

75
Q

claw hand following medial epicondyle fracture

A

ulner nerve damage

76
Q

rheumatoid arthritis features

A

autoimmune

more common in females

adults of all ages

MCP (2nd and 3rd) and PIP joints

morning stiffness - improves with use

bilateral symptoms

systemic upset

77
Q

rheumatoid arthritis X-ray findings

A

loss of joint space

juxta-articular osteoporosis

periarticular erosions

subluxation

78
Q

features of osteoarthritis

A
79
Q

bone pain

deaf

isolated raised ALP

A

pagets disease of bone

80
Q

middle aged woman

raynauds phenomenon

dysphagia

multiple telangiectasia

A

systemic sclerosis

part of CREST symptoms: limited systemic sclerosis

81
Q

polyarteritis nodosa

A

more common in middle aged men

associated with hep B infection

features:

  • fever
  • malaise
  • arthralgia (joint stiffness)
  • livedo reticularis
  • neuropathy
82
Q

FRAX for osteoporosis:

A

FRAX:

history of glucocorticoid use

rheumatoid arthritis

alcohol excess

history of parental hip fracture

low body mass index

current smoking

83
Q

foot drop following a fibular neck fracture

which nerve

A

common peroneal nerve

84
Q

what condition do you get this in

A

chondrocalcinosis (calcium deposits in articular cartilage)

gout

pseudogout

high calcium

high PTH

85
Q

common symptoms of meniscal injury

A

locking and giving way

86
Q

unhappy triad following a lateral blow to knee

damage to what?

A

medial collateral ligament

anterior cruciate ligament

meniscus

87
Q

which nerve damage results in winged scapula

A

long thoracic nerve

often injured during sport

complication of mastectomy (breast removal)

88
Q

wrist drop

which nerve and where most likely injured

A

radial nerve

due to humeral midshaft fracture

89
Q

flattened deltoid muscle

which nerve and where injured

A

axillary nerve

injured at humeral neck fracture/ dislocation

90
Q

Erb-Duchenne palsy (waiter’s tip) vs Klumpke injury

A

Erb-Duchenne palsy (waiter’s tip):

  • damage to upper trunk of brachial plexus (C5,C6)
  • can be 2ndry to shoulder dystocia

Klumpke injury:

  • damage of lower trunk of brachial plexus
  • due to sudden upward jerk of hand
  • may be 2ndry to shoulder dystocia
91
Q

which nerve supplies pincer grip

A

median nerve

92
Q

calcium

phosphate

ALP

PTH

levels in MSK conditions

A
93
Q

adhesive capsulitis of shoulder

features

A

external rotation impaired

painful stiff shoulder

94
Q

most common bacteria for osteomyelitis

A

staph. aureus

95
Q

marfans syndrome

deficiency of what

A

deficiency of fibrillin –> disorder of connective tissue

mutation on chromosome 15

96
Q

contraindication for bisphosphonates

A

if eGFR <35

can give strontium ranelate or raloxifene (if T-score <-3.5)

strictest criteria for denosumab

97
Q

type of fracture

A

buckle fracture

bulging of the cortex

typically 5-10yrs

usually self limiting or splinting and immobilisation

98
Q

what type of fractures are at increased risk on bisphosphonates

A

atypical stress fractures at increased risk on bisphosphonates

99
Q

imaging for osteomyelitis

A

MRI (looking for bone marrow oedema)

100
Q

most common site of metatarsal stress fractures

A

2nd metatarsal shaft

need MRI to visualise fracture

101
Q

Behcets syndrome

A

autoimmune inflammation of arteries and veins

triad:

  • oral ulcers
  • genital ulcers
  • anterior uveitis
102
Q

fat embolism presentation

A

after recent injury

early persistent tachycardia

tachypnoea, dyspnoea, hypoxia usually 72hrs following injury

pyrexia

red/brown impalpable petechial rash

confusion and agitation

103
Q

man suspected of giant cell arteritis (temporal arteritis)

given prednisolone

biopsy normal

what next

A

can have skip lesions in giant cell arteritis

may therefore show normal biopsy

continue prednisolone regardless of biopsy result

104
Q

nerves in legs and injury sites

A
105
Q

which nerve at risk during total hip replacement

A

sciatic nerve

106
Q

common peroneal nerve

A

causes dorsiflexion of foot

injury results in foot drop

nerve runs around neck of fibula

107
Q

what should patients be given when taking long-term steroids

A

bone protection started immediately = alendronate + calcium and vit D replete

108
Q

knee pain after exercise

locking and ‘clunking’

A

osteochondritis dissecans

overuse of joints due to sporting activity - big risk factor

most commonly btwn 12-19yrs

109
Q

SUFE ix and mx

A

teenage obese

loss of internal rotation of leg in flexion

emergency due to risk of avascular necrosis

Ix: AP and lateral (frog leg) Xray

Mx: internal fixation across growth plate

110
Q

fever

back/flank pain

pain on extension of hip

A

iliopsoas abscess

most common cause: staph aureus

most common secondary cause: chrons

raise thigh against hand will elicit pain (contraction of psoas muscle)

lie patient on normal side and hyperextend affected hip - pain as psoas stretched

CT is investigation of choice

Mx: abx + percutaneous drainage

111
Q

most likely neurovascular structure compromised in scaphoid fracture

A

dorsal carpal arch of the radial artery

leading to avascular necrosis

112
Q

long term steroid use

progressive pain in right hip joint

painful in all directions

no shortening or external rotation

xray: osteopenia and microfractures

A

avascular necrosis of the femoral head

risk factors:

  • long term steroid use
  • chemo
  • alcohol excess
  • trauma

pain in affected joint

Xray: early on shows osteopenia and microfractures

collapse of articular surface may show crescent sign

MRI is ix of choice

joint replacment may be needed

113
Q

test to show median nerve injury

A

make a 6 with thumb and forefinger

114
Q

examining for ulner nerve injury

A

spread fingers apart

115
Q

repeating units of muscle

A

sarcomere

repeating units of actin and myosis

3rd year medicine (31 decks)

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