MSK Flashcards
What would symmetrical small joint swelling suggest?
Rheumatoid arthritis
Name the categories of inflammatory arthritis?
Seropositive
Seronegative
Infectious
Crystal induced
Name the seropositive arthritis?
RA Lupus Sclerodema Vasculitis Sjorgens
Name the seronegative arthritis?
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Inflammatory bowel disease arthritis
What is the ‘S factor’?
Stiffness
Swelling
Squeezing is painful = an inflammatory arthritis
How do we diagnose RA?
History and clinical exam
Inflammatory markers (CRP,plasma viscosity)
Autoantibodies
Imaging
Which auto-antibody is most specific for RA?
Anti-CCP antibody
Treatment for RA?
Early recognition and diagnosis
Early treatment with DMARDS
Tight control with target of remission Patient education
What is the description of uric acid crystals as seen under polarised light microscopy?
Negatively birefringent, needle shaped crystals
2 main crystal arthropathies?
Gout Pseudogout (Calcium pyrophosphate deposition disease)
How does gout present?
Intense pain, redness and swelling
How do CPPD uric acid crystals appear?
Rhomboid shaped and weakly positive birefringent
Name key features of OA on X-ray?
Loss of joint space Osteophyte formation Subchondral sclerosis Subchondral cysts - remember LOSS
Which type of arthritis has periarticular erosions?
RA
In a patient with fibromyalgia, what blood abnormalities would you expect to see?
No abnormality
Would morphine sulfate be a suitable treatment for fibromyalgia?
NO
Treatment for fibromyalgia?
Use atypical analgesics (amitriptyline, gabapentin) Graded exercise programmes CBT Paracetamol NOT STEROIDS
What can precipitate fibromyalgia?
Emotional or physical trauma
Best investigation when you suspect septic arthritis?
Synovial fluid analysis and culture
Symptoms of septic arthritis?
Often a normal joint with previous trauma.
Fever, erythema, warm affected joint. Decreased range fo motion, severe pain when bearing weight
What is carpal tunnel syndrome caused by?
Compression of the median nerve as it travels under the flexor retinaculum
Why does pregnancy predispose to Carpal Tunnel Syndrome?
Increased oedema causes a narrowing of the carpal tunnel, predisposing entrapment of the median nevrve
Symptoms of carpal tunnel syndrome?
Numbness, paresthesia in median nerve distribution (thumb, index, middle and radial half of ring finger)
Treatment of CTS?
Splint the wrist or local corticosteroids
What are the common sites of compartment syndrome?
Calf
Forearm/hand
Foot
Thigh/buttock
Signs of compartment syndrome?
Disproportionate pain Pain on passive stretch of compartment. Parasethesia Pallor Pulselessness (late sign)
Treatment for compartment syndrome?
Fasciotomy
Which nerve is most likely to be displaced secondary to a Colle’s fracture?
Median
What is the most suitable treatment for a displaced distal fibular fracture with talar shift?
Open reduction, internal fixation (ORIF)
When would external fixation be used?
Temporary fixation of open injuries or severe soft tissue/bone loss
What are the goals of fracture management?
Restore joint surfaces
Restore alignment, length and rotation
If the bone is displaced ….
Reduce it (open or closed) and stabilise
If the bone isn’t displaced and is stable…
Use a splint/cast
If the bone isn’t displaced but also isn’t stable…
Stabilise it with wires
How does fat embolism syndrome present>
Hypoxia
CNS depression
Pulmonary oedema
Petechial rash
What is fat embolism syndrome?
Caused by inflammatory response to embolised fat globules. Fat and marrow are embolised in the blood stream during acute long bone fracture or intramedullary instrumentation
What tests are used to test for ACL injury?
Lachman
ACL draw test
What tests are used to test for PCL injury?
Posterior draw test
When is dynamic hip screw used?
Extra-capsular fractures
What do intra-capsular fractures carry a high risk of?
AVN
especially if displaced so are often replaced
