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Year 4 > MSK > Flashcards

MSK Flashcards

1
Q

hip fracture location

A
  • intracapsular: sub capital, transcervical, basicervical
  • intertrochanteric
  • subtrochanteric
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2
Q

hip intracapsular fracture classification

A

Garden

  • stage 1: incomplete fracture line or impacted fracture
  • stage 2: complete fracture line, non displaced
  • stage 3: complete fracture line, partially displaced
  • stage 4: complete fracture line, completely displaced
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3
Q

intracapsular wrist fractures

A 
barton (distal radius, dorsal displacement)
volar plate (palmar displacement)
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4
Q

extra capsular wrist fracture

A
  • colles (dorsal displacement): dinner fork appearance

- smiths (palmar displacement)

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5
Q

ankle fracture classification

A

Webber

  • type A: below syndesmosis, no talor drift
  • type B: distal extent of syndesmosis
  • type C: above level of syndesmosis, talor drift
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6
Q

management of ankle fracture

A
  • weber A: can walk straight away/cast
  • weber B: see if theres a tailor drift on standing (XRAY), if not the fracture is stable: cast
  • weber C: surgery
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7
Q

hip intracapsular fracture management

A

garden: 1;, 2 give it a screw, 3, 4 arthroplasty

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8
Q

hip extra capsular fracture management

A
  • DHS or IM nails
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9
Q

def pathological fracture and causes

A

fracture through abnormal bone

causes: osteoporosis, osteomalacia, osteopenia, tumours, infection, metabolic bone disease, medications

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10
Q

hip surgery complications

A
  • infections (chest, UTI, surgical site)
  • DVT/PE
  • delirium
  • pressure sores
  • death
  • dislocate
  • leg length discrepancy
  • non union
  • avascular necrosis
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11
Q

fracture management:

A
  • resuscitation (ABCDE and infection management)
  • reduce (immobilisation)
  • restriction (stabilisation and neurovascular supply preservation: joint above and below immobilised)
  • rehabilitate

open fracture: debrideded and lavaged within 6h

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12
Q

growth plate fractures classification

A

Salter Harris system:
type 1: fracture goes through physics
type 2: fracture through physis and metaphysics
type 3: fracture through physis and epiphysis to include the joint
type 4: fracture through physis, metaphysics and epiphysis
type 5: crush injury involving the physis

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13
Q

common humerus fracture

A

supracondylar fracture of humerus

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14
Q

common types of childhood fractures

A
  • complete
  • toddlers fracture (oblique tibial fracture in infants)
  • plastic deformity (stress on bone resulting in deformity without cortical disruption)
  • greenstick fracture (unilateral cortical breach )
  • buckle fracture (incomplete cortical disruption resulting in periosteal haematoma only)
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15
Q

mechanical back pain causes

A 
spondylosis 
disc herniation 
spondylolisthesis
spinal stenosis 
fractures 
idiopathic
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16
Q

inflammatory cause of back pain

A

spondyloarthopathies

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17
Q

infectious cause of back pain

A

vertebral osteomyelitis
epidural abscess
septic discitis

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18
Q

metabolic cause of back pain

A

osteoporotic compress fracture

page’s disease

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19
Q

referred pain to spine

A
  • major viscera
  • retroperitoneal structures
  • urogenital
  • aorta
  • hip
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20
Q

difference between spondylosis and spondylitis

A
  • spondylitis is inflammatory

- spondylosis is degenerative

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21
Q

spinal stenosis presentation

A
  • gradual onset
  • pain
  • legs: bilateral or unilateral pain, weakness, parasthesia (also in buttocks)
  • unsteadiness of gait
  • induced by standing or walking
  • reduced by sitting or flexing forward
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22
Q

what is spondylolisthesis

A

anterior displacement or vertebra on bone beneath it (secondary to degenerative changes in disc and facet joint)

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23
Q

ankylosis spondylisis presentation

A
  • young man
  • lower back pain/sacroiliac joint pain (+ pain at night that gets better on getting up)
  • stiffness (worse in the morning, gets better with exercise)
  • peripheral arthritis
  • linked with spondyloarthropathies (FH)

+ the As:
- apical fibrosis, anterior uveitis, aortic regurg, achilles tendonitis, AV node block, amyloidosis, card equine syndrome

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24
Q

causes of structural neck pain

A
  • mechanics/non specific
  • prolapsed intervertebral disc
  • cervical myelopathy
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25
Q

causes of inflammatory neck pain

A
  • RA
  • polymyalgia rheumatica and GCA
  • spondyloarthropathies
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26
Q

causes of infectious neck pain

A
  • discitis
  • osteomyelitis
  • paraspinal abscess
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27
Q

causes of metabolic neck pain

A

Paget’s disease

28
Q

degenerative causes of shoulder pain

A
  • capsulitis
  • biceps rupture
  • adhesive capsulitis
29
Q

inflammatory causes of shoulder pain

A
  • RA
  • bursitis
  • tendinitis
30
Q

traumatic causes of shoulder pain

A
  • fractures
  • subluxation/dislocation
  • rotator cuff tear
31
Q

rotator cuff injury presentation

A
  • shoulder pain worse on abduction
  • painful arc of abduction (subacromial impingement between 60-120° or pain in first 60° for tears)
  • tenderness over anterior acromian
  • muscle weakness indicates tear
32
Q

adhesive capsulitis presentation

A
  • middle aged women
  • external rotation most affected
  • three phases: painful freezing phase, adhesive phase, recovery phase
  • can be bilateral
  • episodes lasts 6-12 months
33
Q

fibromyalgia presentation

A
  • widespread musculoskeletal pain
  • hyperalgstic spotes
  • stiffness
  • sleep disturbances
  • associations: IBS, depression, fatigue on waking
34
Q

pathogenesis of rheumatoid arthritis

A

autoimmune synovitis and synovial hypertrophy

35
Q

antibodies in RA

A

RF

anti-CCP

36
Q

risk factors for RA

A
  • genetics
  • age
  • diet
  • smoking
  • infectious agents
37
Q

presentation of RA

A
  • athralgia (symmetrical, small joints of hands and feet)
  • stiffness worse in the morning
  • boggy swelling
  • insidious presentation
  • extraarticular: anaemia, scleritis, interstitial lung disease etc)
38
Q

RA investigations

A
  • blood tests (infection + antibodies)

- XRAY joint

39
Q

RA management

A
  • physio/excercise
  • NSAIDS
  • DMARDs (conventional or biological)
  • glucocorticoids as short term for flare ups
40
Q

pathogenesis of gout

A

deposition of rate crystals in the joint (inflammatory)

  • increase uric acid production
  • decrease uric acid output
41
Q

risk factors for gout

A
  • male
  • alcohol intake
  • purine intake
  • diuretics
  • metabolic syndrome
  • CKD
  • leukaemia
42
Q

presentation of gout

A
  • acute onset
  • monoarthitis
  • pain, swelling, erythema
  • joint affected: 1st MTP, ankle, wrist, knee
  • tophi
43
Q

investigations for gout

A
  • serum urate
  • bloods: FBC, CRP, ESR (check for septic arthritis), LFTs, U&Es
  • joint aspiration (strongly negative befringence needle shaped)
  • XRAY
44
Q

management of gout

A
  • conservative: education, lifestyle
  • acute: NSAIDs, colchicine, steroids (from first to last, dependent on contraindications): continue for 6 months if prescribing allopurinol
  • prophylaxis: allopurinol
45
Q

differentials for one hot swollen joint

A
  • septic arthritis
  • gout
  • pseudo gout
  • haemarthrosis
  • psoriatic arthritis
  • reactive arthritis
46
Q

septic arthritis presentation

A
  • knee
  • acute red swollen joint
  • warm to touch
  • restriction of movement
  • fever
  • history of trauma, infection
47
Q

risk factors for pseudo gout

A

5hs

  • haematomochrosis
  • hyperparathyroidism
  • hypothyroidism
  • hypomagnesium
  • hypo phosphate
  • acromegaly + Wilson’s disease
48
Q

presentation of pseudo gout

A
  • mono arthritis
  • knee, wrist, shoulder
  • red, painful and hot
  • low grade fever
  • large tense joint effusion
49
Q

investigations for pseudo gout

A
  • bloods: raised WCC, ESR, CRP
  • joint aspiration: weekly positive befringement rhomboid shaped crystals + rule out septic arthritis
  • X ray: chondrocalcinosis
50
Q

management pseudo gout

A

NSAIDS

intra articular, intramuscular or oral steroids

51
Q

psoriatic arthopathy presentation

A
  • joint: symmetrical polyarthiris (similar to RA)
  • nail changes
  • dactylitis
  • rashes on extensor surfaces
52
Q

management of psoriatic arthritis

A

NSAIDS

DMARDS

53
Q

reactive arthritis presentation

A

classic triad

  • arthritis
  • urethritis
  • conjunctivitis
  • associated with GI and GU infections
54
Q

management of reactive arthritis

A
  • NSAIDS, intra articular steroids

- sulfasalazine and methotrexate (if persistent)

55
Q

risk factors for osteoarthritis

A
  • age
  • obesity
  • previous injury
  • intense sport activity
  • leg deformity
  • genetics
56
Q

clinical presentation of osteoarthritis

A
  • asymmetrical painful joints (weight bearing and hands)
  • relieved by rest, exacerbated by exercise
  • weather affects it
  • stiffness (reduced joint movement)
  • tenderness on palpation
  • joint effusion on acute exacerbations
  • crepitations
57
Q

investigations for osteoarthritis

A

Xray

58
Q

management of osteoarthritis

A
  • conservative: education, weight loss, xcercise/physio, heat/cold therapy
  • pharmacological: analgesia + intra articular steroids
  • surgical: replacement
59
Q

risk factors for SLE

A
  • genetics (asian and african)
  • UV radiation
  • smoking
  • virus/bacteria
  • oestrogen
60
Q

presentation of SLE

A

classical:

  • women of childbearing age
  • fever
  • joint pain
  • rash

+ malar rash, photosensitive rash, hair loss, mouth ulcers, renal involvement, seizures, psychosis, anaemia, Raynaullds, thrombocytopenia, fatigue, pleuritis, pericarditis

61
Q

investigations for SLE

A
  • bedside: BP, urine dip (red cell casts, proteinuria)
  • bloods: FBC, WBC, CRP, ESR, platelets, U&Es, LFTs
  • inflam: ANA, ENAs,(Ro/La/RNP/Sm), dsDNA, C3/C4
  • 24h urinary protein/ protein:creatinine ratio
62
Q

management of SLE

A
  • monitoring (regular urinalysis, BP, renal, lipid and glucose profile)
  • inflammation (hydroxychloriqune, steroids, methotrexate)
  • treat symptoms
63
Q

complications of SLE

A
  • cardiovascular risk (disease +glucocorticoids)
  • pregnancy (morbidity, meds are toxic)
  • renal
  • joint deformity
64
Q

different types of large vessel vasculitis

A
  • giant cell arthritis

- Tokaysu’s arthritis

65
Q

different types of medium vessel arthritis

A
  • polyarthritis nodosa

- Kawasaki disease

66
Q

different types of small vessel disease

A
  • microscopic polyangitis
  • granulomatosis with polyangitis
  • eosinophilic granulomatous with polyangitis (Churg Strauss syndrome)
67
Q

eosinophilic granuomatus with polyangitis presentation

A
  • resp: asthma, haemoptysis, pneumonitis, nasal polyps, paranasal sinusitis
  • heart: pericardial effusion, MI, myocarditis
  • skin: purpura reticularis
  • renal: glomerulonephritis, renal failure, hypertension
  • NS: mononeuritis monosimplex, strokes
  • ophthalmology: anterior uveitis
  • gastro: mesenteric infarction, bowel perforation

Year 4 (13 decks)

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