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Finals > MSK > Flashcards

MSK Flashcards

1
Q

Amyloidosis - Management

A

FL: bortozemib, lenalinomide, dexamethasone (protease inhib, IMD, steroid)
HDM-ASCT is preffered in younger, more fit patients with less severe Dx

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2
Q

Amyloidosis disease monitoring

A

Free light chain

or M-protein

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3
Q

Amyloidosis Complications and Management

A

Nephrotic syndrome: loop diuretic, salt restriction ?human albumin
CKD: monitor function, dialysis if nec. Transplant only if low extra-renal amyloid or clonal remission
Hypertension: ACEi, ARB
CHF: loop diuretic

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4
Q

Prognosis of amyloidosis

A

Untreated is progressive and fatal
Cardiac involvement bad sign
Avg. survival is now years but depends on organs affected

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5
Q

Achilles tendinosis Define

A

Tendon degeneration (not inflammatory state) causing disruption of collagen fibres.

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6
Q

Achilles tendinosis epi

A

200:100,000 annual incidence

Common amongst active people - most commonly middle aged and middle/long distance runners

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7
Q

Aetiology/Risk factors for achilles tendinosis

A

Fluoroquinonlones
DM
Hyperlipidaemia

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8
Q

Achilles tendinosis history

A

Aching (sometimes sharp) in heel made worse on activity
Stiffness in tendon
Mid point: pain 2-6cm proximal to insertion that limits activity
Insertional: pain and swelling at insertion on posterior calcaneus
- Can have both
Risk factors: DM, dyslipidaemia, fluoroquinolone use

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9
Q

Achilles tendinosis examination

A

Examine both legs look for: redness, swelling, asymmetry
Palpate tendon assessing: tenderness, heat, crepitus, thickening, nodularity (is it distal or mid point)
Pain worsens with passive dorsiflexion

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10
Q

achilles tendinonsis investigations

A

VISA-A questionnaire indicates severity
Clincal Dx so imaging not usually indicated
Arrange Ix for lipids/HbA1c if riak factors likely

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11
Q

Achilles tendinosis management - primary care

A

Primary care:
Manage underlying cause (fluoroquinolones, DM, hypercholesterolaemia)
Self care (ice packs, paracetamol, rest, weight bear as tolerated)
Refer to physio if not improved after 7-10 days
NOT CORTICOSTEROIDS
If chronic or fails to respond arrange sports physician/ortho referral

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12
Q

Achilles tendinosis management - secondary care

A

Secondary care:
Exercise programme (eccentric contraction based)
Extracorporeal shock wave therapy - acoustic waves may help diseased tissue - uncertain efficacy
Surgery: if chronic and unresponding, debridement and removal of diseased tendon

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13
Q

Achilles tendinosis complications

A

rupture

irreversible degeneration

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14
Q

Achilles tendinosis prognosis

A

Pain can take weeks-months to resolve

If adequate management not undertaken can go into degenerative tendinopathy which may be irreversible

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15
Q

Achilles rupture epi

A

18:100,000 annual incidence

Mean age 37-44

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16
Q

Achilles rupture aetilogy/RF

A 
Activity! - weekend warriors
Age 30-50
Inflexible gastrocsoleus
Cavus foot
Chronic renal failure
DM
17
Q

Achilles rupture diagnosis

A

Sudden pain in back of leg +/- audible snap
Ache in calf, swelling, bruising, weakness
Difficulty weight bearing

18
Q

Achilles rupture examination

A

Simonds triad (examined prone with feet dangling off end of bed) - angle of declination (greater dorsiflexion in injured foot), palpation for break in tendon, calf squeeze test (injured will remain in neutral position)

19
Q

Achilles rupture investigations

A

In trauma: x-ray to exclude fracture

Can confirm Dx w/USS/MRI

20
Q

Achilles tendon rupture management

A

Arrange same day referral to orthopaedics
Initially: RICE
Can be operative or non-op
Non op: Generally comorbid/sedentary lifestyle. Possible increased risk of re-rupture. Lower complication rate
Op: quicker return to work

Non-op techniques involve serial casting/functional bracing
All operative approaches involve reapproximating torn ends

Rehab is key - strength and ROM

21
Q

achilles tendon rupture complications

A

Rerupture (v rare if surgically managed)
Wound healing Cx 5-10%
Sural nerve injury

22
Q

Prognosis achilles rupture

A

Usually full recovery - in some non athletes there is a risk of reduced ROM
Non operative re-rupture rate is up to 40% compared to 0.5% surgically

23
Q

Bunions definition

A

deformity which occurs when the great toe moves towards the second toe (and may sometimes overlie it). This causes a prominent first metatarsal head, sometimes associated with bursitis

24
Q

Bunions epidemiology

A

Exact prevalence unknown but is common in elderly

25
Q

Aetiology of bunions

A

exact cause unknown
A/w narrow tight footwear
Gout/RA
Connective tissue Dx

26
Q

Symptoms of bunions

A

Pain
Deformity (great toe towards second toe leaving prominent metatarsal head)
?bursitis

27
Q

Bunion Ix

A

clinical diagnosis

28
Q

Bunion management

A

C: low heeled, wide shoes, soft sole. If DM refer to foot protection
M: simple analgesia (para/NSAID). Bunion pad/icepack ?podiatry referral for footwear advice/night splints/orthosis
S: only indicated for pain. Refer if deformity worsening/painful or second toe involvement or difficulty finding shoes

29
Q

Complications of bunions

A 
Pain, difficulty finding footwear
OA of 1st MTP
Deformity/dislocation of second toe
Increased risk of fall in elderly
Surgery: infection, stiffness, pain/tender ball of foot, recurrence, nerve damage
30
Q

Bunion prognosis

A

Only surgical Mx will prevent progression

Improves pain and alignment in 90%

31
Q

Ankle types

A

ankle: #tibia, fibula, talus
Metatarsal stress: repeated injury to MT bones
Lisfranc: tarsometatarsal fracture dislocation. Traumatic (medial cuneiform and base of 2nd MT)

32
Q

ankle epidemiology

A

A: most common # in 15-60
MTS: common in athletes
Lisfranc: uncommon, M:F 4:1. RTA

33
Q

Aetiology/RF for #ankle

A

A: usually twisting mechanism
MTS: overuse
L: RTA

34
Q

Symptoms of #ankle

A

A: pain, deformity, swelling. ?inability to weight bear. Sudden occurence
MTS: swelling/warmth, pain. Progressively worse w/activity Tender top of foot/lateral ankle and #site
L: severe midfoot pain, inability to bear weight

35
Q

Examination of #ankle

A

A: swelling, deformity, ?inability to weight bear
MTS: swelling, pain. Palpate for max tenderness (is it bony)
L: medial plantar ecchymosis, midfoot swelling. Tender TMT. ?Dorsal subluxation of 2nd metatarsal on applying dorsal force

36
Q

Investigations #ankle

A

x-ray. AP, Lateral, oblique views of ankle/foot

37
Q

Management #ankle

A

A: reduce ASAP. Stable = boot w/unrestricted WB. Unstable: ORIF (6wk cast if unfit). think VTE proph for all #
MTS: Shaft: supportive shoe and progressive WB. Prox segment: splint and non WB case r/v 7days and if normal x-ray allow WB
L: non-op: 8 wk cast (only non-displaced OR unfit for surgery) Op: temp. pinning w/delayed ORIF (skip delay if >2mm instability)

38
Q

Complications #ankle

A

A: compartment syndrome (fasciotomy), dislocation (surgery) limited ROM (physio). Operative risks
MTS: rare. can progress w/o Mx. Deformity, malunion
L: Plantovalgus deformity if non-op or non-anatomic ORIF post-traumtic arthritis (if non-anatomically ORIF Mx by arthrodesis) Deep infection (debridemen)

39
Q

Prognosis #ankle

A

A: non-op: excellent (back to exercise 6-8wks) ORIF: WB 12w but can be 2y return to baseline. Poor prognosis in elderly (12% mortality at 65)
MTS: excellent. WB within days/weeks full recovery expected
L: variable ~70% full return to exercise. Risk of planovalgus deformity and chronic pain

Finals (10 decks)

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