MSK Flashcards
Which of the following is of greatest concern following a posterior hip dislocation?
sciatic nerve injury -> foot drop
common feature of clinical injury indicating avascular necrosis?
acetabular #
The affected leg is shortened, adducted, and internally rotated. what type of hip injury is described?
posterior dislocation
The affected leg is usually abducted and externally rotated. No leg shortening. type of hip injury described?
anterior dislocation
27-year-old woman presents with painful genital ulceration. She has had recurrent attacks for the past four years. Oral aciclovir has had little effect on the duration of her symptoms. She has also noticed for the past year almost weekly attacks of mouth ulcers which again are slow to heal. Her only past medical history of note is being treated for thrombophlebitis two years ago. What is the most likely diagnosis?
behcets syndrome
oral ulcers, genital ulcers and anterior uveitis triad points to?
behcets syndrome
also thrombophlebitis and DVT, erythema nodosum
man presents to the emergency department 30 minutes after falling onto his left hand during a social basketball game. He complains of swelling and significant pain on the radial side of his left wrist. On examination, the man describes the pain as unbearable when asked to squeeze the examiner’s finger with his left hand no x-ray changes. dx?
scaphoid # after FOOSH
In the emergency department, suspected scaphoid fractures should be managed..???
immobilisation using a Futuro splint or standard below-elbow backslab before specialist review
refer to ortho for 7-10/7 rv. also XR
history and examination together, previous trauma to a limb, with paraesthesia (an early sign), disproportionate pain on assessment of tone (passive rather than active movements) and normal x-ray findings should raise suspicion of??????
compartment syndrome -> refer to orthopaedic surgeons
subcapital fracture of the femur with partial displacement. What is the most likely surgical treatment option for this type of fracture? in patient with cognitive impairment ->
hemiarthroplasty
Intracapsular femoral fracture -
hemiarthroplasty
intracapsular = subcapital
extracapsular femoral # ->
dynamic hip screw
34-year-old man visits his GP due to worsening weakness and pain in his arms and hands, and increasing fatigue, especially on exertion. On examination there are faint fine crackles audible in the lower-mid zones. The GP also notices thickened and cracked skin on the patient’s hands, as well as difficulty when the patient moves up from the chair onto the examination couch. dx?
antisynthetase syndrome
myositis
which Ab ix for antisynthetase syndrome?
anti-jo1 Abs
first line pharma mx for Raynaud’s syndrome:
nifedipine (CCB)
rugby -> shoulder injury - commonly?
AC jt injury
ankle XR: A minimally displaced, transverse fracture is seen distally through the lateral malleolus, below the level of the talar dome. No talar shift is seen. The medial malleolus is not involved. classification and mx?
weber A - stable
discharge from ED with walking boot and analgesia for f/u r/v to check healing
what is the most common cardiac manifestation of SLE and is included in many classification criteria including those outlined by the British Society for Rheumatology in their 2018 guidelines for SLE?
pericarditis
25-year-old man with a history of Crohn’s disease presents asking for advice. He currently takes methotrexate and asks if it is alright for him and his partner to try for a baby.
What is the most appropriate advice?
wait 6 months from finishing tx with MTX before trying
extremely painful joint at the base of his thumb which came on suddenly overnight. The 1st metacarpal-phalangeal (MCP) joint is swollen and erythematous. dx?
gout
bone pain for the past few weeks. He has also had a reduction in his hearing recently. His blood results show an isolated rise in alkaline phosphate.
Given the likely diagnosis, which bone is most likely to be in pain?
pelvis - pagets disease of bone
granulomatosis with polyangiitis: which antibodies?
wegener’s
cANCA
eosinophilic granulomatosis with polyangiitis (aka churg-strauss) + others - which antibodies to ix?
pANCA
78-year-old man is investigated for headaches. A routine blood screen is normal other than an elevated ALP. A skull x-ray is ordered: likely dx even without seeing XR:
Pagets disease of bone
septic arthritis: which abx?
IV flucloxacillin
what is first line tx in ankylosing spondylitis?
physio + NSAIDS
what should be used to manage the acute flares of rheumatoid arthritis in patients on chronic treatment?
IM Methylprednisolone
what bloods are normally seen in Osteogenesis imperfecta ?
normal adjusted Ca, PTH, ALP, P04
32-year-old woman presents with recurrent deep vein thromboses and pulmonary embolisms. She has a past medical history of recurrent miscarriages. Blood results reveal low platelets and a prolonged APTT. dx?
antiphospholipid syndrome
antiphospholipid syndrome: which antibody is investigated?
anti-Cardiolipin Ab
upwards lens dislocation, tall stature, high arch palate, pectus excavatum are all signs of ?
marfans syndrome
basketballers. mutation in fibrillin-1 protein (AD)
78-year-old man presents with symptoms of headaches and deteriorating vision. He notices that there is marked pain on the right hand side of his face when he combs his hair. dx?
GCA
needs pred and vision test
diagnostic angiogram is performed which shows an abrupt cut off at the level of the anterior tibial artery, together with the formation of corkscrew shaped collateral vessels distally.
Buergers disease
common in young male smokers
lady is referred to the vascular clinic. She has been feeling generally unwell for the past six weeks. She works as a typist and has noticed increasing pain in her forearms whilst working. On examination she has absent upper limb pulses. Her ESR is measured and mildly elevated. dx?
takayasu’s arteritis
what is an effective and commonly used method of analgesia for patients with a neck of femur fracture?
iliofascial nerve block
the classic signs are a shortened and externally rotated leg???
hip #. nof
undisplaced nof # mx?
internal fixation, or hemiarthroplasty if unfit.
displaced nof # in fit <70yo mx?
Reduction and internal fixation (if possible)
displaced nof # in older unfit pt mx?
hemiarthroplasty or total hip replacement
extracapsular hip # mx?
dynamic hip screw
if reverse oblique, transverse, subtrochanteric - intramedullary device
classification system for hip #?
garden system
what is Foucher’s sign?
increase in tension of the Baker’s cyst on extension of the knee
history of diabetes, osteoarthritis and hypertension. She twisted her leg whilst getting out of a car and developed increasing pain weight bearing which has eased with simple analgesia. She also tells you she has a lump under her knee. On examination, she has a 4cm non-tender lump just below the popliteal fossa which becomes tense on extending the leg. dx?
bakers cyst
40-year-old woman presents with new onset dull lower back pain since moving home. She is normally fit and well. She has a normal examination with no neurology or concerning features. What would be the first-line treatment for her pain?
naproxen
nsaids first line for lower back pain
+PPI
lower back pain analgesia if cannot tolerate NSAIDS?
co-codamol / codeine
lower back pain analgesia if spasm is a feature?
short course benzos
if have to ix lower back pain, which ix should ya use?
MRI
A patient with a subtrochanteric femoral fracture fixed with intramedullary nail should be given what advice re weight bearing after post-op?
weight bear immediately post op
Carpometacarpal and distal interphalangeal joint involvement is characteristic of??
hand OA
PIP involvement and joint effusions are typical of?
RA
Pencil in cup appearance is pathognomonic of
psoriatic arthritis
also plantar spurring
thumb squaring in which arthritis typically?
OA
how is avascular necrosis ix in scaphoid injury?
mri
blood supply to scaphoid???
80% dorsal carpal branch of the radial artery
public health terms for anatomical snuff box tenderness in ?scaphoid #?
highly sensitive >90%
poorly specific <40%
scaphoid # - how long cast on?
6-8/52 (only this if confirmed undisplaced - no f/u)
proximal scaphoid pole fractures
mx?
surgical fixation
Which one of the following pathologies does a positive straight leg raise suggest?
sciatic nerve pain
also need loss of ankle jerk and plantar response for this
IVDU R flank pain -> lower back pain
in pain. tender over l1,2
cannot weight bear
X-R no abnormalities. likely dx?
psoas abscess
likely organisms for psoas abscess?
saureus
ix psoas abscess?
CT abdo
mx psoas abscess?
abx
drainage percutaneous
surgery
weber A # mx?
weight bear as tolerable in a CAM boot for 6 weeks
regimental badge area nerve?
axillary
commonly injured in shoulder dislocations
(anterior - >95%)
Twisting knee injury - dx?
?meniscus tear - MRI
direct blow to knee ->?
patella dislocation
Falling hard onto a bent knee can injure the?
PCL
positive posterior drawer test =
PCL injury
Hyperextension knee injury most commonly results in ?
ACL rupture
positive anterior drawer test =
ACL injury
Repeated jumping and landing on hard surfaces causes?
patella tendinopathy or jumpers knee
McMurray’s test would also be positive (painful click).
meniscal tear
plus/minus MCL injury
knee pain worse on crouching ->
meniscal tear
Thessaly’s test 20degree flexion
cauda equina ix?
MRI urgent
what is a common cause of knee pain, particularly in runners
ITBS
in discitis caused by stapholococcus, what do you need to rule out and how?
ECHO endocarditis
All proximal scaphoid pole fractures require ?
surgical fixation
what predisposes to the development of a Charcot joint?
alcoholic neuropathy
non-tender, swollen, erythematous and hot foot are pathognomonic?
acute charcot joint
XR - extensive bone remodelling in midfoot
what are cx of discitis?
epidural abscess
changing lower limb neurology
sepsis
27-year-old man was admitted to hospital 6 hours previously following a fractured right tibia while playing a football match. His pain has been well controlled until 30 minutes ago, but he is now complaining of intense pain in his right lower leg. On examination he is in severe pain, worsened by passive movement of the foot. You are able to palpate the dorsalis pedis and posterior tibial pulse on the right foot. His heart rate and respiratory rate are both raised + sweating - dx?
compartment syndrome
DO NOT GIVE ANTICOAGULANTS - WORSENS
differentiate between vertebral OM and psoas abscess?
position ext rotation and lack of hip extension will help psoas abscess as it does not stretch the muscle
in OM these will make 0 difference
Fracture involving the physis, metaphysis and epiphysis. grade?
salter-harris 4
Finkelstein test positive?
pain over her radial styloid on forced abduction/flexion of the thumb
finkelstein test + indicates?
de quervain’s tenosynovitis
4-year-old girl with a three month history of a limp. Her parents report that she has ‘not been right’ for a few weeks now. She typically complains of pain in her left hip and right knee in the morning which gets better during the day.
dx?
JIA
7-year-old boy is brought in by his mother. For the past day he has felt generally unwell with a headache and nausea. This morning he complained of pain in his right hip and now just able to walk with a limp. On examination flexion, extension and rotation of the hip is painful and limited. Examination of the ears, throat and chest is normal. His temperature is 38.2ºC dx?
septic arthritis
6-year-old boy with a limp. His parents report that this has been getting steadily worse over the past few weeks. He complains of pain in the right groin/hip region. An x-ray shows widening of the right hip joint space with flattening of the femoral head.dx?
perthes disease
tenderness over the medial epicondyle and medial wrist pain on resisted wrist pronation.?
golfers elbow
tenderness over the lateral epicondyle and lateral elbow pain on resisted wrist extension.
tennis elbow
Management of a grade 1-2 AC joint injury:
conservative with resting and a sling
The Stimson Maneuver is used for?
reduction of disloacted shoulders
A 63-year-old lady undergoes an axillary clearance for breast cancer. She makes steady progress. However, 8 weeks post operatively she still suffers from severe shoulder pain. On examination she has reduced active movements in all planes and loss of passive external rotation.
dx?
adhesive capsulitis
DM is a RF
A 78-year-old man complains of a long history of shoulder pain and more recently weakness. On examination active attempts at abduction are impaired. Passive movements are normal.
dx?
rotator cuff tear
A 28-year-old man complains of pain and weakness in the shoulder. He has recently been unwell with glandular fever from which he is fully recovered. On examination there is some evidence of muscle wasting and a degree of winging of the scapula. Power during active movements is impaired.
dx?
parsonage-turner syndrome
what is parsonage-turner syndrome?
post-viral peripheral neuropathy
spontaneously resolves
which organism are sickle cell patients prone to getting which gives them OM?
salmonella
OM ix?
MRI
71F diagnosed with polymyalgia rheumatica. On prednisolone 15mg od. What is the most appropriate approach to bone protection?
start alendronate + ca + vitD replacement
over 65 or previous fragility # start asap
when would you not start someone on bone protection if they have been started on pred for rheum condition?
if under 65 - offer a bone density scan first and that dictates further mx
if going to be on long term - start immediately
T score interpretation:
> 0 fine
0 - -1.5: rescan 1-3 yrs
lower than -1.5 - offer bone protection without rescan
63F urticaria and difficulty breathing after a recent medication change. PMH osteoporosis, hypertension, refractory rheumatoid arthritis and GORD. Allergic to pollen, aspirin. what drug caused this reax?
sulfasalazine can cause reaction in those allergic to aspirin
Azathioprine is another DMARD that can be used in the management of refractory rheumatoid arthritis. Its use is contraindicated in patients with hypersensitivity to which drug?
metaclopramide
sulfasalazine adverse effects and caution:
caution G6PD deficiency, aspirin and sulfonamides
adverse effects: oligospermia
if adverse reax to co-trimoxazole - CI
which RA DMARD safe to use in pregnancy?
sulfasalazine
hydroxychloroquine safe too
etanercept for flare during preg
Patients with anti-phospholipid syndrome who haven’t had a thrombosis previously are generally given what for prophylaxis?
low dose aspirin
if previous clot LMWH
warfarin INR target for antiphospholipid syndrome?
2-3
pagets disease of bone tx:
IV Bisphosphonates
Radiolucency of subarticular region suggestive of osteolysis. Some areas of patchy sclerosis
on X-ray of right femur, with normal bloods except a raised ALP:
pagets disease of bone
low calcium and phosphate combined with the raised alkaline phosphatase point towards?
osteomalacia
what is osteomalacia called if growing still?
Rickets
tx osteomalacia?
ca+vitD
Hand XR: (mainly metacarpophalangeal and proximal interphalangeal joints) and changes seen (erosions, subluxation and loss of joint space) points to a diagnosis of ?
RA
which syndrome is a condition characterized by splenomegaly and neutropenia in a patient with rheumatoid arthritis?
Felty’s syndrome
63-year-old male presents to emergency department with acute monoarthritis waking him from sleep. He reports he has never experienced this in the past. Joint aspiration reveals negatively birefringent urate crystals under polarised light. dx?
GOUT
13M 3-month history of a growing lump on the posterior aspect of his right arm, extremely painful over the last two weeks. A shoulder XR: lytic lesion in the diaphysis of the right humerus with an ‘onion skin’ appearance. Fine-needle aspiration of the lesion is subsequently undertaken, analysis of which identifies the presence of EWS-FLI1 protein. dx?
ewing’s sarcoma
where does Ewing’s sarcoma commonly present?
diaphysis of pelvis or long bones
where does chondrosarcoma present and which demographic?
axial skeleton or diaphysis of long bones
middle age
commonest benign bone tumour?
osteochondroma - 20yo males
what is the most common primary malignant bone tumour?
osteosarcoma
which tumour typically metaphyseal region of long bones prior to epiphyseal closure. It also shows a ‘sunburst’ pattern on x-ray and is most commonly associated with mutations in the retinoblastoma gene (and hence retinoblastoma tumours).???
osteosarcoma
affects young people
bone mets in woman with CKD 4. which tx for bone protection from pathological #?
denosumab
as egfr<30
gout prevention but patient on azathioprine - which prophylactic agent?
febuxostat
azathioprine: sfx, preg?
pancreatitis, bone marrow suppression when given with allopurinol
safe in preg
56F referred to rheumatology clinic due to severe Raynaud’s phenomenon associated with arthralgia of the fingers. On examination you note shiny and tight skin of the fingers with a number of telangiectasia on the upper torso and face. She is also currently awaiting a gastroscopy to investigate heartburn. Which one of the following antibodies is most specific for the underlying condition? dx?
limited (central, cutaneous) systemic sclerosis
features of CREST
anti-centromere abs
which abs associated with diffuse cutaneous systemic sclerosis?
anti-scl-70
35F multiple spontaneous miscarriages, recurrent DVT / PEs review appointment. Purpuric rashes, splinter haemorrhages and livedo reticularis. Given the likely diagnosis, which of the following would be the most appropriate auto-immune antibody test to perform?
Anti-phospholipid syndrome
ANti-cardiolipin Abs
Lupus Anticoagulant Abs too
antibodies in SLE?
anti-double stranded DNA Abs (spec)
anti-ANA*** (sens)
Anti-CCP (cyclic citrullinated peptide) Abs for?
RA
anti-Jo-1 and anti-Mi-2 Abs for?
polymyositis
Anti-Ro and Anti-La abs for?
Sjogren’s syndrome
Urethritis + arthritis + conjunctivitis =
reactive arthritis
which organism likely caused reactive arthritis in young male?
chlamydia trachomatis
reactive arthritis mx?
symptomatic: analgesia, NSAIDS, intra-articular steroids
The x-ray demonstrates juxta-articular erosive changes around the 1st MTP joint with overhanging edges and associated with a moderate soft tissue swelling. The joint space is maintained. These findings are consistent with:
gout
signs of asymmetrical inflammation of peripheral joints, with a background of inflammatory bowel disease. This points towards a diagnosis of?
enteropathic arthritis
HLA-B27
HLA-B51 is associated with ?
behcet’s disease
reactive arthritis: synovial fluid aspiration interpretation:
develops after an infection where the organism cannot be recovered from the joint
would be yellow colour, culture negative, crystal negative, WCC 20,000ish
29M -> GP recent onset of low back pain. Worse at night and often radiates to the hips. It improves with exercise. He is also suffering from sensitivity to light in both eyes and reduced vision in his right eye. Oral NSAIDs have failed to improve his symptoms. Which of the following drugs would be most appropriate in the next step of management?
Ank spond
Etanercept (TNF-a blocker, others: Infliximab)
use these when 2 drugs have failed
31F 4 week history of joint pain, a pink, bumpy rash on arms, legs, and trunk, and fevers that spike in the evenings. On examination, there is bilateral cervical lymphadenopathy and the spleen is palpable. Blood tests are ordered, which show a marked leucocytosis (≥ 10,000/µL) and high serum ferritin (350ng/mL) levels but negative tests for antinuclear antibody and rheumatoid factor. dx?
adult onset of Still’s disease
salmon rash
joint pain, spiking fevers, and a pink bumpy rash is very characteristic of
(also high ferritin, leucocytosis)
adult onset of Still’s disease
Renal impairment, respiratory symptoms, joint pain, systemic features → consider ?
ANCA - associated vasculitis
62-F -> GP with severe tiredness and muscle pain around her shoulder and hips. 3/52. worsening. She was still able to walk up and down the stairs although this might be painful. She also complained of some stiffness, especially in the morning. The stiffness got better throughout the day. She denied any swelling in her joints or rash. On examination, there was no evidence of muscle wasting. what suggests could be polymyalgia rheumatica?
if normal power on resisted movements of hip and shoulder
- no true weakness limb girdles in polymyalgia rheumatica on examination. Any weakness of muscles is due to myalgia (pain inhibition)
Bloods in PMR:
ESR>40
CK normal EMG normal
Mx PMR:
15mg Pred OD - should be dramatic response to steroids, if not consider other dx
osteoporosis RFs:
smoking, sedentary, Low BMI, female, FHx premature menopause
Pectus excavatum and pes planus are features of?
marfans
12-year-old girl presents to a paediatric clinic after being referred by her GP. On examination, her height is in the 90th centile for her age. Her fingers seem long and ‘spidery’ and she is able to the wrap her thumb and little finger around her wrist easily. Her father died of an aortic dissection at the age of 40. dx?
marfans
positive schobers test:
ank spond
positive if <5cm
23-year-old man is referred to the medical team after being treated for acute liver failure in the emergency department. Investigations confirm a diagnosis of Wilson’s disease and he is subsequently managed with first-line chelating treatment. Three days later the man presents to the emergency department again with prominent bilateral leg swelling and periorbital oedema. what has caused this?
Penicillamine can cause membranous glomerulonephropathy in patients with Wilson’s disease
bone healing stages:
haematoma formation
soft callous formation
hard callous formation
bone remodelling
how to reduce a # in ED:
analgesia
exagerrate injury
pull back into place
purpose of analgesia in # reduction:
what is used?
pt comfort and also muscle relaxation
oromorph and nerve block. Penthrox. conscious sedations (anaesthetics)
how is reduction maintained in displaced #?
-backslabs in acute setting as swelling expected
x-ray after backslab
-cast
-neighbouring strapping
shoulder pain: active and passive movements limited and external rotation most affected?
adhesive capsulitis - frozen shoulder
Classically, it is described in male patients as a triad of symptoms:
- Claudication of the buttocks and thighs
- Atrophy of the musculature of the legs
- Impotence (due to paralysis of the L1 nerve) dx?
leirche syndrome
patient exhibits the classical ‘painful arc’ associated with this condition. ??
supraspinatus tendonitis
isolated lateral hip/thigh pain with tenderness over the greater trochanter - dx?
trochanteric bursitis
what can cause rhabdomyolisys after a tibial #
compartment syndrome
history of lower back pain which is worse on walking is very characteristic of ?
spinal stenosis
spinal stenosis: dx?
MRI spine bro
27-M - ED frontal crash with his motorbike. He is awake and alert but he complains of excruciating pain in his left leg. On examination, there is an open fracture of the left tibia with extensive soft tissue damage and contamination. Intravenous antibiotics have been prescribed. 1st line mx?
urgent IV abx and debridement in theatre
??? compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger
cubital tunnel syndrome
Respiratory sx
Neurological sx
Petechial rash (tends to occur after the first 2 symptoms)?
fat embolus
A patient presents with numbness and tingling along the ulnar border of his wrist and forearm. On examination you also note weak flexion of all the digits including the thumb. dx?
c8 radiculopathy
A 23-year-old female presents with a painless swelling on the back of her wrist: what is it?
ganglion presents as a ‘cyst’ arising from a joint or tendon sheath. They are most commonly seen around the back of the wrist and are 3 times more common in women. spontaneously resolve over months
weber classification ankle # a-c:
Type A is below the syndesmosis
Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis
Type C is above the syndesmosis which may itself be damaged
A 24-year-old man falls sustaining an inversion injury to his ankle. On examination he is tender over the lateral malleolus only. On x-ray there is a fibular fracture that is distal to the syndesmosis. mx?
below knee plaster cast to include the midfoot
25-M suffers an injury whilst playing rugby involving a violent twist to his left lower leg. On examination both malleoli are tender and the ankle joint is very swollen. On x-ray there is a spiral fracture of the fibula and widening of the ankle mortise. mx?
surgical fixation
weber C
ottowa rules ankle injury?
x-ray only if pain in the malleolar zone and any one of:
- bony tenderness at the lateral malleolar zone
- bony tenderness at the medial malleolar zone
- inability to walk four weight bearing steps immediately after the injury and in ED
A 45-year-old man presents with a painful swelling on the posterior aspect of his elbow. There is no history of trauma. On examination an erythematous tender swelling is noted. What is the most likely diagnosis?
olecrannon bursitis
Signs of systemic sepsis with changing lower limb neurology =
possible epidural abscess
38-F emergency department due to pain in her shin that has been present now for 2/12. Pain over the tibia. Relieved by rest, it is concerning her as she has an upcoming three-day hike with the army. Diffuse tenderness over the tibia. ix?
x-ray legs
stress #
A FRAX score of 10% or greater warrants ?
dexa scan
weakness of thumb abduction (abductor pollicis brevis)
wasting of thenar eminence (NOT hypothenar)
Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms
carpal tunnel syndrome
electrophysiology findings carpal tunnel?
motor and sensory prolongation of AP
A 64-F who is known to have RA pain right ring finger when she flexes it. On one occasion she reports it became ‘stuck’. Palpable nodule at the base of the finger. What is the most likely diagnosis?
trigger finger
Any patient presenting with symptoms of intermittent claudication not worsened by increasing exertion - think?
neurogenic not ischemic
65-F->GP 6/12 back and leg pain while walking and has noticed a reduced walking distance over the past 2 months due to an increase in the severity of pain. She finds that bending over relieves her pain. She struggles to walk downhill after managing to walk uphill with no symptoms. PMH T2DM. Foot pulses are present, there is no weakness or atrophy of the leg muscles. dx?
spinal stenosis
XRay: fracture of the distal radius with posterior displacement. The tip of the ulnar is also fractured. The fracture is across the metaphysis of the radius and there is no involvement of the articular cartilage.
What is the name of this kind of fracture?
colle’s
what ix is first line in occult hip fractures?
mri
A 22-year-old drunk man is involved in a fight. He hurts his thumb when he punches his opponent.
name of #?
bennets
A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.
name of #?
potts
A 19-M prolonged marching exercise and presents with a sudden onset, severe pain, in the forefoot. Tenderness along the second metatarsal. Plain x-rays are taken of the area, these demonstrate callus surrounding the shaft of the second metatarsal. dx?
stress #
2nd metatarsal commonest site
idiopathic pregnancy oedema e.g. heart failure lunate fracture rheumatoid arthritis all causes of????
carpal tunnel syndrome
RA->bilat
dislocation of the distal radioulnar joint with an associated fracture of the radius - which #?
galeazzi
14M->GP by mother. Pain in his right leg which feels like it is coming from his bone just below his knee. Several weeks and is constant and dull, often worsening at nighttime. Bony swelling on his tibia, just below his knee joint. Which ix should this child be referred to have within 48 hours?
x-ray right leg
bone sarcoma
30-F->ED 5/7 hx right side thumb and wrist pain. Pain down the dorsal aspect of her thumb towards the radial aspect of her wrist which occurs when she is at work and using her computer mouse for extended periods of time. Not present at rest. Pain when she abducts her thumb against resistance. Pain when you palpate over her radial styloid process. No other sensory or motor deficits. No erythema or swelling - dx?
de quervains tenosinovitis
Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of?
psoriatic arthritis
Malignancy + raised CK → ?
polymyositis
4M -> ED. ?# femur. He has had several visits over the past few months. Teeth appear abnormal and he is very skinny. His father is also concerned about the boys hearing. Diagnosis?
osteogenesis imperfecta
(AD)
also blue sclera
A raised CRP in a patient with known SLE may indicate?
underlying infection
however, CRP often normal in SLE, ESR is raised
which ix will indicate active disease in SLE?
complement 3, 4 low in active disease process
Syndesmophytes (ossification of outer fibres of annulus fibrosus) are a feature of?
ank spond on XR
also reactive arthritis, psoriatic arthritis
sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus
on XR =?
ank spond
62M->ED sudden onset headache and pain in his jaw whilst he was chewing breakfast in the morning. High dose prednisolone is commenced and an appropriate biopsy is performed which later comes back to be normal. What is the most appropriate next step in the patient’s management? why?
keep on pred regardless of biopsy result
skip lesions can occur in GCA
75M weakness of the legs. Skin changes present, with purple plaques on the dorsum of the hands. You suspect a diagnosis of dermatomyositis. Which underlying condition is associated with dermatomyositis and should be considered?
internal malignancy
paraneoplastic of ovarian, breast and lung
ana sens, mi-2 specific
Ankylosing spondylitis features - the ‘A’s (6)
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis
40M Hx ETOH, long-term prednisolone use for brittle asthma, 2/12 hx left hip pain. Limited movement of the hip in all directions. XR: subchondral fracture, segmental flattening of the femoral head and osteopaenia. dx?
avascular necrosis
52M complains of numbness and pain over the lateral skin of the left thigh. dx?
meralgia paraesthetica
43F right hip pain. Patient lies on her left side and the right hip is extended with a straight leg. Flexing the knee then recreates the pain. dx?
referred lumbar spine pain
positive femoral nerve stretch test
Antihistone antibodies are associated with???
drug-induced lupus
(eg hx of jt pain on TB meds which stopped when they stopped taking isoniazid)
other drugs hydralazine, procainamide
Limited cutaneous systemic sclerosis - where is the boundary of the hardened skin?
below elbows
also on face
25M painful, swollen left knee. 4/52 babck from Spain. No hx trauma and no knee problems previously. Swollen, warm left knee with a full range of movement. His ankle joints are also painful to move but there is no swelling. On the soles of both feet you notice a waxy yellow rash. dx?
reactive arthritis
rash on the soles is keratoderma blenorrhagica.
GI infection or chlamydia
as systemic - tx = po pred
Chondrocalcinosis:
seen in pseudogout (PTH is RF)
distinguishes from gout
which drug should not be co-prescribed with MTX?
trimethorpim -> bone marrow suppression and pancytopenia
Septic arthritis - most common organism:
staph aureus in most ages
neisseria gonorrhoea in young males
Renal impairment, respiratory symptoms, joint pain, systemic features →
cANCA - granulomatosis with polyangiitis (Wegener’s)
dx of ank spond - how?
pelvic XR - sacro-ilitis
gout hx but the pt on warfarin - acute flare. what tx?
colchicine as nsaid + warfarin -> GI haemorrhage
SLE is which type of hypersensitivity reaction?
type 3
35F->GP complaining of persistent oral ulcers that have been present for 1 month. She also comments that over the past 2 weeks she has noticed her hands have become quite swollen and painful. On examination the GP notices the presence of a rash on the patient’s face that crosses the nasal bridge but spares the nasolabial folds. What antibody test is most specific for the underlying condition?
anti-dsdna
sle
offered as first line pain relief for rheumatoid arthritis??
paracetamol regularly
to reduce need for nsaids and cox-2is
disease severity monitoring RA?
DAS 28
RA mx: initial?
patients with evidence of jt inflammation - DMARD ASAP
analgesia, physio, sx
In initial mx - DMARD +/- bridging Pred (short course)
MTX sfx?
myelosuppression and liver cirrhosis. Other important side-effects include pneumonitis
After the first VTE, patients with antiphospholipid syndrome should be on?
lifelong warfarin
acute gout flare up in chronic gout pt - allopurinol mx?
continue on current dose
when starting allopurinol - nsaid cover
41F lethargy and pain all over her body. 6/12. worse when she is stressed or cold. Exam unremarkable other than a large number of tender points throughout her body. A series of blood tests including an autoimmune screen, inflammatory markers and thyroid function are normal. Given the likely diagnosis, tx beneficial?
cbt
A 54-year-old male with a past medical history of hypertension, obesity, gout and hypercholesterolemia has a sudden onset of diarrhoea.
which med?
colchicine
A 60-year-old man presents with weakness and a skin rash on his upper eyelids. He also complains of a cough which has been present for 3 months. He has a 60 pack-year smoking history. On examination he is noted to have symmetrical proximal muscle weakness.
dx, abs?
dematomyositis
Anti-jo1
70F loss of vision in her left eye. 2/52 painful frontal headaches and has been feeling generally lethargic. Visual acuity is 6/9 in the right eye but on the left side only hand movements can be made seen. Fundoscopy of the left side reveals a pale and oedematous optic disc. dx?
temporal arteritis
lead to ischemic disc left eye
Dupuytren’s contracture causes:
manual labour phenytoin treatment alcoholic liver disease diabetes mellitus trauma to the hand
nerve dorsifelxion of foot?
common peroneal nerve
60M A&E with a fall. He lives with his wife and still works as a restaurant manager. PMH BPH- taking tamsulosin. Right hip tenderness on movement in all directions. A hip x-ray confirms an intertrochanteric fracture. mx?
dynamic hip screw
86F- A&E following a fall. Right hip pain. Hypertension - bendrofluazide. She lives alone and mobilises with a Zimmer frame. Her right leg is shortened and externally rotated. A hip x-ray confirms a displaced intracapsular fracture. mx?
hemiarthroplasty
older, less mobile individuals
74M A&E with a fall. PMH RA- methotrexate and paracetamol. He lives alone in a bungalow and enjoys playing golf. He is independent with his ADLs. He complains of left groin pain, therefore has a hip x-ray which confirms a displaced intracapsular fracture. mx?
total hip replacement
pre-existing joint disease, good level of activity and a relatively high life expectancy, therefore THR is preferable to hemiarthroplasty.
54-F -GP painful right hip last 10 months. Codeine and paracetamol four times a day. There is no history of trauma or injury to her hip. PMH mild asthma, and she is in remission from breast cancer that was treated with a bilateral mastectomy and chemotherapy 3 years ago. She drinks 2 glasses of wine over the weekend and does not smoke. No visible deformity of her right hip, but it is tender on palpation. She walks with a visible limp and appears to be in discomfort.
Pelvis X-ray: crescent sign. ???
Which of the following is the strongest risk factor for this patient’s presentation?
avascular necrosis
chemotherapy
oral steroids use, etoh, trauma
?jt replace
knee pain after exercise, locking and ‘clunking’???
osteochondritis dissecans
Weakness of hip abduction and foot drop, no specific reflex lost?? also positive straight leg raise and loss of sensory dorsum foot
L5 radiculoapthy
which shoulder pathology often presents with a painful arc of abduction?
subacromial impingement
red flag in patients presenting with back pain?
thoracic pain An age of <20 or >50 The presence of trauma in hx worst at night prev malignancy systemically unwell
radiograph shows a fracture involving the palmar surface of the distal radius, with minimal dorsal angulation and no disruption of the dorsal cortex. The growth plate appears normal. 10 yo F
greenstick #
what endocrine condition associated with carpal tunnel in o50s?
acromegaly
X-rays of the patient’s left elbow and forearm are carried out which show a proximal fracture of the ulna in association with a dislocation of the proximal radial head. #?
monteggia
incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They typically occur in children aged 5-10 years. #?
buckle
5th metatarsal fractures often follow??
forced inversion of foot and ankle
Undisplaced patella fractures with an intact extensor mechanism can be managed?
conservatively - non-op
morning stiffness >2h indicates?
inflammatory arthritis
carpal tunnel: Which of the following structures is divided during the surgery to treat this condition and decompress the median nerve?
flexor retinaculum
osteolytic region suggestive of osteomyelitis - what part of the bone is most commonly affected in children?
metaphysis
Failed conservative management of plantar fasciitis:
refer to physio and orthopaedics
conservative mx = wt loss, stretches, rest
most common reason total hip replacements need to be revised?
aseptic loosening (1) then pain, dislocation
simple rib fractures are managed?
conservatively with good analgesia
what causes mixed glomerulonephritis, also linked to arthritis, and antiphospholipid syndrome (Miscarriage and PE) ?
SLE
A 66-year-old lady presents with pain in her right hip. It has been increasing over the previous three weeks and waking her from sleep. On examination she is tender on internal rotation. Blood tests reveal a mildly elevated serum calcium and alkaline phosphatase levels. dx?
metastatic tumour to bone eg breast
raised ca, alp
triceps tendon with a tendon hammer. Which nerve (and its nerve root) are you testing?
radial c7
produces pain on passive stretch - eg passive dorsiflexion?
compartment syndrome
ix - compartment pressure
club foot exam findings?
inverted +plantar flexed foot which is not passively correctable
Burning thigh pain - ? meralgia paraesthetica -
lateral cutaneous nerve of thigh compression
child with an asymptomatic, fluctuant swelling behind the knee the most likely diagnosis is ?
baker’s cyst
Retinal haemorrhages and intra-arterial fat globules on fundoscopy can be assoicated with ?
fat embolism
Pain on the radial side of the wrist/tenderness over the radial styloid process ? also pain recreatable with ulnar deviation?
de quervain’s tenosynovitis
A 22-year-old rugby player falls onto an outstretched hand and sustains a fracture of the distal radius. The x-ray shows a dorsally angulated comminuted fracture. tx?
admit for open reduction and fixation
A 10-year-old boy undergoes a delayed open reduction and fixation of a significantly displaced supracondylar fracture. On the ward he complains of significant forearm pain and paraesthesia of the hand. Radial pulse is normal. mx?
fasciotomy
due to delay
A 23-year-old rugby player falls directly onto his shoulder. There is pain and swelling of the shoulder joint. The clavicle is prominent and there appears to be a step deformity. dx?
acromio-clavicular jt dislocation
A 22-year-old man falls over and presents to casualty. A shoulder x-ray is performed, the radiologist comments that a Hill-Sachs lesion is present. dx?
glenohumeral dislocation
An 82-year-old female presents to A&E after tripping on a step. She complains of shoulder pain. On examination there is pain to 90o on abduction. dx?
supraspinatous tear
Ryan, a 17-year-old boy, presents to the emergency department following a seizure. On examination, he has a unilateral shoulder deformity and his shoulder is locked in an internally rotated position. A shoulder x-ray has just been ordered. dx?
posterior dislocation
shoulder dislocation is associated with FOOSH??
anterior
shoulder dislocation associated with epilepsy seizures, electric shocks?
posterior
28M ED severe pain in the right knee following an injury during a football match. He states that he was tackled from behind, and then felt a ‘pop’ and severe pain which was followed by rapid swelling of the joint. On examination there is a right sided knee effusion and a positive Lachman test. dx?
ACL rupture
A newborn baby is noted to have bilateral clubfoot. What is the treatment of choice?
manipulation and progressive casting starting soon after birth
A 50-year-old man is admitted after falling from scaffolding. He has an open fracture of his tibia with a 15 cm wound. He is neurovascularly intact. What is the best initial course of action?
IV Abx, photography and application of saline soaked gauze with impermeable dressing
32M ED RTA. He mentions severe pain in his right ankle and is unable to bear weight. Tenderness over the distal tibia. Dorsalis pedis pulse (right) absent. No neurological signs are present. XR confirmed displaced ankle fracture. first thing to do?
reduce the # to prevent damage to skin
sciatica hx/
MRI Lumbar and Sacral Spine:
Normal alignment and segmentation.
Small left para-central L4/5 disc prolapse causing compression of the transiting L5 nerve root. No compression of the cauda equina with CSF visible around all nerve roots. All other discs are normal and there are no bony abnormalities visible. mx?
physio referral with gabapentin for pain
dermatomal distribution and an associated neurological deficit =>
nerve root pain
A 68-year-old man presents to the plastics team with severe burns to his hands. He is not distressed by the burns. He has bilateral charcot joints. On examination; there is loss of pain and temperature sensation of the upper limbs. dx??
syringomyelia
A 24-year-old man presents with localised spinal pain over 2 months which is worsened on movement. He is known to be an IVDU. He has no history suggestive of tuberculosis. The pain is now excruciating at rest and not improving with analgesia. He has a temperature of 39 oC. dx?
osteomyelitis
A 22 year man is shot in the back, in the lumbar region. He has increased tone and hyper-reflexia of his right leg. He cannot feel his left leg. dx?
brown-sequard syndrome
imaging modality of choice for suspected Achilles tendon rupture??
USS
What is the Z score adjusted for?
age, gender, ethnic factors
Osteoporosis is commonly associated with which blood values?
normal everything
70F feeling generally run-down and has muscle aches. The back, arm and thigh muscles ache and are stiff, particularly in the morning. These symptoms have been present for the past two weeks. Prior to this she was generally fit and well. Tenderness over her deltoid and thigh muscles. Muscle strength is normal. dx??
PMR
renal complications of systemic sclerosis - tx?
ACE-Is
Which one of the following drugs has been associated with an increased risk of atypical stress fractures of the proximal femoral shaft?
alendronate
use other bisphosphonates (also do this if GI sfx)
good prog indicator in RA?
rheumatoid factor -ve
ITP - type X hypersensitivity reaction?
2
Azathioprine - check before starting?
TPMT levels
1st line tx pseudogout?
NSAIDs and colchicine
OA first line?
paracetamol and topical nsaid (if hand/knee)
exercises first line
interferon alpha (for hep C) - sfx?
flu- like sx
painful aphthous-like ulcers for the past 3 weeks since starting a new medication.<???
mtx
A 78-year-old woman is discharged following a fractured neck of femur. On review she is making good progress but consideration is given to secondary prevention of further fractures. mx?
oral bisphosphonate - high risk as previous # so don’t do dexa…
It is important to do what prior to starting biologics for rheumatoid arthritis ? (etanercept, tnf-a-i)
CXR to look for TB as they can cause reactivation
This 60-year-old woman who is being treated for heartburn comes for review. She has developed some spots on her lips: dx?
telangiectasia - crest
Hydroxychloroquine - sfx?
severe and permanent retinopathy
73yo on alendronate 6yrs having had a distal radial fracture at this time. There have been no further fractures, nor any preceding this injury. Six years ago, her DEXA scan showed a T-score of -2.4. PMH unremarkable and she has no recent history of falls. She has never smoked. bisphosphonate holiday?
repeat dexa now and frax score and stop for 2 years if low risk (T score now >-2.5) and review in 2yrs
(some recommend checking this after 5yrs)
One of the cardiac complications of Ehler-Danlos is???
aortic regurg (faint diastolic murmur)
weakly positively birefringent rhomboid-shaped crystals?
pseudogout
A 58-year-old female presents with a 3 month history of dry eyes, dry mouth, arthralgia and fatigue. On examination there is evidence of conjunctival injection, decreased salivary pool, dry mucous membranes and oral ulceration. She has a positive Schirmer’s test.
dx, ix?
sjogren’s syndroe
Anti-ro, la
Bisphosphonates can cause ?sfx?
heartburn - oesophageal sx ON jaw atypical stress # acute phase reax hypocalcaemia
A 54-year-old woman who has had two Colle's fractures in the past three years has a DEXA scan: T-score L2-4 -1.4 Femoral neck -2.7 interp?
Osteoporosis femoral neck
osteopenia vertebrae
may be positive in UC, but will likely be negative in Crohn’s???
pANCA
lung condition in someone from bangladesh causes polyarthritis?
TB
decrease of joint space
subchondral sclerosis
subchondral cysts
osteophytes forming at joint margins?
OA XR
65M- GP with painless swelling of lymph nodes in his left armpit. Feeling hot at night and says he has lost some weight. PMH Sjogrens syndrome and is on hydroxychloroquine. 3cm rubbery lump in his left axilla. There are no other palpable lumps anywhere else. His observations are normal. dx?
lymphoma
sjogrens
Gottron’s papules, roughened red papules over the knuckles mainly, are seen in?
dermatomyositis
Which immunoglobulin will this patient be providing to her infant? breastmilk
IgA
hypersensitivity reaction - allergic contact dermatitis?????
Type 4 - delayed sensitivity
which patients are at increased risk of gout from increased urate production?
chemotherapy
RA Cx?
pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, methotrexate pneumonitis, pleurisy
keratoconjunctivitis sicca (most common), episcleritis, scleritis, corneal ulceration, keratitis, steroid-induced cataracts, chloroquine retinopathy
osteoporosis
IHD
infections
depression
amyloidosis
causes of dactylitis?
spondyloarthritis: e.g. Psoriatic and reactive arthritis
sickle-cell disease
other rare causes include tuberculosis, sarcoidosis and syphilis
anaphylaxis is type X hypersensitivity reaction?
1
A 45-year-old lady, with a past medical history of rheumatoid arthritis, is scheduled to have a laparoscopic cholecystectomy. What imaging should be performed pre-operatively?
AP and lateral C-spine X-ray
atlanto-axial subluxation rare cx of RA
long standing COPD - new presentation sudden onset back pain - what happened and what is mechanism?
vertebral # - osteoporosis due to long term steroid use for COPD
joint aspirate in RA:
high WBC count, predominantly PMNs. Appearance is typically yellow and cloudy with absence of crystals
X useful tool to assess hypermobility. ?
beighton score - positive if at least 5/9 in adults, or at least 6/9 in children
EDS
A 37-year-old man sees his GP complaining of ‘a flu that won’t go away’. On further questioning he has had a 2-week history of fever, nausea and vomiting, myalgia and weakness, and a sensation of itchiness. He also describes a few episodes of red urine. He denies any cough, haemoptysis or any other respiratory symptoms. On examination you notice he has some slight scleral icterus, alongside small palpable purpura on his lower legs and arms - dx?
polyarteritis nodosa
Systemic vasculitic symptoms in the presence of hepatitis B signs and in the absence of pulmonary symptoms/signs suggests
Juxta-articular osteoporosis/osteopenia is an early x-ray feature of?
ra
also see periarticular erosions
Patients with anti-phospholipid syndrome who haven’t had a thrombosis previously are generally on?
low dose aspirin
fixed flexion, fusiform swelling, tenderness and pain on passive extension of finger??
Kanavel’s signs of flexor tendon sheath infection
‘infective flexor tenosynovitis’
70F-> GP surgery having fallen in her kitchen last week. ->ED found to have some bruising, but no fractures. She is worried that she might fall again, and is worried about a fracture occurring in the future. You suggest an assessment of the patient’s fracture risk. Which most appropriate in assessing the patient’s fracture risk?
FRAX tool
ulnar paradox:
proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions
A patient sustains an injury to one of the nerves of his upper limb. He complains of weak finger abduction and adduction with reduced sensation over the ulnar border of his hand. On examination you note clawing of the 4th and 5th digits. During recovery, the patient notices worsening of this deformity before eventually resolving. dx?
damage to ulnar nerve at elbow
A 35-year-old runner presents with heel pain. On examination, there is diffuse tenderness which is worse on the medial aspect of the heel bed. Although the patient has stopped running for the past week, the pain is aggravated by being on their feet at work all day. Pain is worse when you ask them to walk on their toes. dx?
plantar fasciitis
typically an overweight adolescent boy with knee / hip problems. lost internal rotation of hip???
slipped upper femoral epiphysis
Typical age group = 2-10 years
Acute hip pain associated with viral infection
Commonest cause of hip pain in children
transient synovitis
osteomyelitis commonest organism causing?
saureus
Weakness in knee extension, loss of the patella reflex, numbness of the thigh dx?
femoral nerve damage
Weakness in hip adduction, numbness over the medial thigh dx?
obturator nerve damage
A 42-year-old lady who has systemic lupus erythematosus presents to the clinic with a 5 day history of a painful purple lesion on her index finger. On examination she has a tender red lesion on the index finger. dx?
oslers nodes
endocarditis. However, other causes include SLE, gonorrhoea, typhoid and haemolytic anaemia.
A 62-year-old lady presents with an non tender lump overlying the distal interphalangeal joint of the index finger. On examination she has a hard, non tender lump overlying the joint and deviation of the tip of the finger. dx?
heberden’s nodes
swelling of the distal interphalangeal joint with deviation of the finger tip.
A 17-year-old male is brought to the clinic by his mother who is concerned about a lesion that has developed on the dorsal surface of his left hand. On examination he has a soft fluctuant swelling on the dorsal aspect of the hand, it is most obvious on making a fist. dx?
ganglion
what is vital in rib fractures mx?
pain mx and chest physio - breathing is not affected by pain; inadequate ventilation may predispose to chest infections
A 19-year-old sportswoman presents with knee pain which is worse on walking down the stairs and when sitting still. On examination there is wasting of the quadriceps and pseudolocking of the knee. dx?
chondromalacia patellae (anterior knee pain) mx - physio
A tall 18-year-old male athlete is admitted to the emergency room after being hit in the knee by a hockey stick. On examination his knee is tense and swollen. X-ray shows no fractures. dx?
patellar dislocation
An athletic 15-year-old boy presents with knee pain of 3 weeks duration. It is worst during activity and settles with rest. On examination there is tenderness overlying the tibial tuberosity and an associated swelling at this site. dx?
osgood-schlatter’s disease
‘Popeye’ deformity in the middle of the upper arm, problems with supination?
biceps tendon rupture
A 75-year old male presents to the emergency room after being involved in a head-on car crash. He complains of severe pain in his left knee. On examination of the lower limbs, you note that the tibia displaces posteriorly on application of a force. dx?
PCL rupture
posterior drawer test
Cauda equina syndrome classically presents with lower back pain, sciatica, reduced perianal sensation. Late signs include??
urinary incontinence
racture through the physis only (x-ray often normal). in child - classification?
salter-harris 1
exam of choice for ?ruptured achilles?
Simmonds triad (palpation, examining the angle of declination at rest and the calf squeeze test
what is the management for subluxation of the radial head?
passive supination of the elbow joint while flexed to 90 degrees
A 32-year-old man presents with a painful swelling over the volar aspect of his hand after receiving a hard blow to his palm. On examination, he experiences pain on moving the wrist and on longitudinal compression of the thumb. dx?
scaphoid #
A 26-year-old man presents to the emergency department with a swelling over his left elbow after a fall on an outstretched hand. On examination, he has tenderness over the proximal part of his forearm, and has severely restricted supination and pronation movements. dx?
radial head #
what is used to confirm a Morton’s neuroma??
USS
forefoot pain, most commonly in the third inter-metatarsophalangeal space
worse on walking. May be described as a shooting or burning pain. Patients may feel they have a pebble in their shoe
Mulder’s click: one hand tries to hold the neuroma between the finger and thumb. The other hand squeezes the metatarsals together. A click may be heard as the neuroma moves between the metatarsal heads
there may be loss of sensation distally in the toes
morton’s neuroma
benign. females.
Ligamentous injuries of the knee joint are best confirmed through??
MRI
The risk factors for congenital hip dislocation include:
female, breech, fhx, first-born, oligohydramnios
first-line mx for osteoporotic vertebral ##?
spinal XR
Hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes.) dx?
bouchard’s nodes
They are a sign of osteoarthritis, and are caused by formation of calcific spurs of the articular cartilage.
A 36-year-old woman presents with a 6 week history of a painful wrist. On examination pain over the radial aspect of the wrist is is elicited by forced adduction and flexion of the thumb. dx?
de quervain’s tenosynovitis
Consider surgical treatment of Dupuytren’s contracture when ??
metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table
A 34-year-old man reports the sudden onset of back pain after bending over to tie his shoe laces. There is tenderness over the lumbar spine on examination and leaning back worsens the pain. Neurological examination and straight leg raising is normal dx?
facet jt pain
A 76-year-old man reports pain is his buttocks when he walks the dog. The pain comes on after around 500 yards and resolves when he stops. He has a past history of chronic obstructive pulmonary disease and ischaemic heart disease. Neurological examination is normal and the foot pulses are difficult to feel in both feet dx?
peripheral artery disease
A 68-year-old obese man presents with a one-day history of progressively more severe lower back pain. There was no obvious trigger. Abdominal examination is unremarkable. Blood pressure is 90/60 mmHg and his pulse is 120 bpm dx?
leaking AAA
38F lower back pain radiating down her right leg whilst performing DIY. Severe, sharp, stabbing pain which is worse on movement. Positive straight leg raise test on the right side but otherwise the examination is unremarkable. Appropriate analgesia is prescribed. mx?
prolapsed disc -> physiotherapy
conservative mx
A 52-year-old woman develops pain shooting down the posterior aspect of the left leg. On examination she has reduced sensation on the lateral aspect of the left foot and weakness of left foot plantar flexion. nerve root?
S1
A 31-year-old man with sudden onset back pain radiating to the anterior aspect of his right knee. Examination reveals an absent knee jerk with reduced sensation over the patella and the medial aspect of his calf. The quadriceps are also noted to be weak on the affected side. nerve root?
L4
A 44-year-old man complains of pain radiating from his left hip to foot for the past week. On examination all reflexes are intact and the only positive finding is weak dorsiflexion of the left big toe nerve root?
L5
- normal reflexes!!
ankle sprain caused by ?mechanism?
inversion of foot (lat malleolar)
A 72-year-old man develops a foot drop after a revision total hip replacement. - nerve?
sciatic injured
A 56-year-old man undergoes a low anterior resection with legs in the Lloyd-Davies position. Post operatively he complains of foot drop. - nerve?
peroneal
A 23-year-old man complains of severe groin pain several weeks after a difficult inguinal hernia repair. nerve??
ilioinguinal nerve injury
what is most commonly associated with supracondylar and tibial #s?
compartment syndrome
??? causative medication with new onset achilles tendon disorders; tendinitis and tendon rupture is a key side effect of which to be aware
ciprofloxacin
