MSK and rheumatology Flashcards
what is a common laboratory finding in Paget’s disease of the bone
Raised ALP
give 4 features of ankylosing spondylitis on radiograph
Sacroilitis : subchondral erosions , sclerosis
squaring of lumbar vertebrae
bamboo spine
syndesmophytes : ossification of outer fibers of annulus fibrosus
sign of Ankylosing spondylitis on chest xray
Apical fibrosis
what’s the imaging of choice in Osteomyelitis ?
MRI of affected leg and hip
most common cause of septic arthritis in sexually active adults
Neisseria Gonorrhoea
first line investigation for suspected septic arthritis
Synovial fluid sampling
what is an adverse effect of hydrochloroquine
Bulls eye retinopathy - leading to severe and permanent visual loss
most common cause of discitis
Staph. Aureus
how do Gottron’s papules present ? what condition is it present in ?
Roughened red papules over extensor surfaces of fingers. Dermatomyositis
what is the key investigation in patients with suspected septic arthritis
Synovial fluid sampling
what haematological findings are seen in APL
thrombocytopenia
prolonged APTT
which antibody is +ve in APL
Anti cardiolipin antibody
APL syndrome presents with which dermatological finding
Livedo Reticularis
what type of reaction is anaphylaxis
Type 1
how is Reactive arthritis managed ( 1st line and 2nd line)
Analgesia, NSAID’s , intra articular steroids
which inflammatory marker is raised in Polymyalgia rheumatica
ESR
what is the management of Polymyalgia Rheumatica
Prednisolone 15 mg / od
what is the gold standard treatment of SLE
Hydroxychloroquine
which condition is polymyalgia rheumatica associated with ?
Temporal arteritis
what xray feature best supports the diagnosis of polymyalgia rheumatica
Sacro-ilitis on Pelvic xray
what is the first line management of ankylosing spondylitis
exercise regimes and NSAID’s
which antibody is specific and sensitive for Rheumatoid arthritis
Anti cyclic citrullinated peptide
what is the first line management of Raynaud’s
Nifedipine
give 5 early xray findings of RA
Loss of joint space
Juxta-articular osteoporosis
Soft tissue swelling
periarticular erosion
Subluxation
Achilles tendonitis can present with which condition
Ankylosing spondilytis
give 3 xray findings seen in ankylosing spondylitis
Subchondral erosions
sclerosis
squaring of vertebrae
which is the test for SLE with the highest sensitivity
ANA
which are tests for SLE that are highly specific
anti-dsDNA
Anti-smith
why is the use of methotrexate and trimethoprim together contraindicated
it can lead to bone marrow suppression and severe or fatal Ppancytopaenia
what is the management of methotrexate toxicity
folinic acid
what are the instructions for a patient on consuming bisphosphonates
swallow tablets with water while sitting / standing on empty stomach 30 mins before breakfast and stay upright for 30 mins
patients with Sjogren’s syndrome have an increased risk of which malignancy
Lymphoid malignancy
what is the initial management regime for RA
DMARD monotherapy + short course of bridging prednisolone
how do you manage flares of RA
Corticosteroids ( oral /IM)
most common causes of drug induced SLE
procainamide
hydralazine
give 3 less common causes of drug induced SLE
Isoniazid
Minocycline
Phenytoin
which antibodies are positive in APL syndrome
anti-cardiolipin antibodies
T score, what is normal, osteopenia, osteoporosis
> -1 = normal
-1 to -2.5 = Osteopaenia
< - 2.5 = osteoporosis
what is the management when a diagnosis of temporal arteritis is suspected ?
urgent high dose glucocorticoids
what is the most common ocular complication of temporal arteritis
anterior ischaemic optic neuropathy
which tumour presents on radiograph with ‘‘onion skin’’ appearance ?
Ewing’s sarcoma
which is the most common primary malignant bone tumour
Osteosarcoma
ewing’s sarcoma most commonly affects which bones
pelvis + long bones
give 2 features seen on xray in Osteosarcoma
Codman triangle
sunburst pattern
how does giant cell tumour present on xray
double bubble / soap bubble
what is the most common benign bone tumour
Osteochondroma
which scoring system is used as a disease measure of RA
DAS28
'’plantar spur’’ and ‘‘pencil in cup’’ deformity are typical xray features seen in __________.
Psoriatic arthritis
is psoriatic arthritis symmetrical or asymmetrical ?
Asymmetrical
give 3 expected findings on examination of chest and spine in ankylosing spondylitis
reduced chest expansion
reduced lateral flexion
reduced forward flexion
is azathioprine safe to use in pregnancy
yes
which xray finding can be used to distinguish gout from pseudogout ?
pseudogout : chondrocalcinosis
gout : no chondrocalcinosis
how long do symptoms need to be present for a diagnosis of chronic fatigue syndrome to be made ?
3 months
give 3 features of inflammatory arthritis
pain in the morning
systemic features
raised inflammatory markers
_______ presents with pain and tenderness over the lateral side of the thigh
trochanteric bursitis
how does meralgia paraesthetica present
compression of lateral cutaneous nerve of thigh with a burning sensation of antero-lateral aspect of thigh
give 5 side effects of methotrexate
mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
what is the drug given to manage methotrexate toxicity
Folinic acid
blue sclera is associated with _______
osteogenesis imperfecta
how does pseudogout present under the microscope ?
weakly +ve bi-fringent rhomboid shaped crystals
what is the imaging of choice for achilles tendon rupture
ultrasound
what are the red flag features of suggesting an alternative diagnosis to osteoarthritis
rest pain
night pain
morning stiffness >2 hours
which finger joints are more commonly affected in osteoarthritis
PIP
DIPJ
patients with ________ often get relief from shaking their hands
Carpal tunnel syndrome
what are the red flags for lower back pain
age < 20, >50
history of previous malignancy
night pain
history of trauma
systemically unwell ( weight loss and fever)
what is the most appropriate investigation to confirm the diagnosis of ACL injury
MRI
what is the most common PCL injury
Dashboard injury , occurs when knee is flexed
ACL injury caused by hyperextension / flexion ?
Hyperextension
what test can be performed to test for PCL damage
Posterior draw test
which structure is divided in surgical management of carpal tunnel syndrome
flexor retinaculum
prescribing folate with methotrexate reduces the risk of _________
Myelosuppression
what is the most common form of hip dislocation
Posterior dislocation
how does posterior dislocation of the hip present
affected leg is shortened, adducted and internally rotated
how does anterior dislocation of the hip present
affected leg is abducted and externally rotated ; no leg shortening
which type of back pain is a red flag symptom
thoracic back pain
what is the investigation of choice for Cauda Equina syndrome ?
MRI Spine
what is a late sign of cauda equina syndrome
Urinary incontinence
in how many hours should a patient with suspected cauda equina receive an MRI
6 hours
What type of injuries lead to meniscal tears?
Twisting injuries
what test can be used to check for a meniscal tear
Thessaly’s test
which 2 arteries mainly supply the hip joint ?
medial and lateral circumflex femoral arteries
damage to the medial circumflex femoral artery can lead to __________
Avascular necrosis of the femoral head
which 3 nerves supply the hip joint
sciatic femoral and obturator nerves
what is the classical sign of a hip fracture
shortened and externally rotated leg
what is a key sign on x-ray of NOF Fracture
Shenton’s line
Biceps rupture may lead to a ———– deformity in the middle of the upper arm
Popeye
how are simple rib fractures managed ?
Conservative management with analgesia
what is a serious complication of rib fracture
Pneumothorax
what is the management of lumbar canal stenosis ?
Laminectomy
what is the management of a displaced intracapsular fracture ?
Hemiarthroplasty
cubital tunnel syndrome occurs due to the compression of which nerve ?
ulnar nerve
what is the key feature of cubital tunnel syndrome?
Tingling and numbness of 4th and 5th finger, starting off as intermittent and then becoming constant.
how does L5 disc prolapse present
loss of foot dorsiflexion and sensory loss on the dorsum of the foot
how does S1 nerve root compression present ?
sensory loss posterolateral aspect of leg and lateral aspect of foot
weakness in plantar flexion
reduced ankle reflex
What is the most common location for Ganglion ?
how does it present ?
Dorsal aspect of the wrist. Presents as a firm and well circumbscribed mass that trans-illuminates
how does a ganglion present
firm and well circumscribed mass that trans-illuminates
In a child with an asymptomatic, fluctuant swelling behind the knee the most likely diagnosis
Baker’s cyst
which nerve is most likely to be injured during knee arthroplasty
common peroneal nerve
what is raloxifene used for ? what is its mechanism ?
selective oestrogen receptor modulator and mimics the effect of oestrogen on bone - used for management of post menopausal osteoporosis
inhibition of osteoclast activity
what are the symptoms seen in in Behcet’s syndrome?
oral ulcers
genital ulcers
anterior uveitis
thrombophlebitis and DVT
erythema nodosum
what is Behcet’s syndrome
It is a complex multisystem disorder associated with auto-immune mediated inflammation of arteries and veins
How does Olecranon bursitis present?
Swelling of the posterior aspect of the elbow with associated pain warmth and erythema.
Generally seen in middle aged male patients.
how does lateral epicondylitis present ? What is it commonly known as?
pain and tenderness on the lateral epicondyle worse on resisted wrist extension with elbow extended or supination of forearm with elbow extended.
tennis elbow
How does Medial epicondylitis present ? What is it commonly known as?
Pain and tenderness localised to the medial epicondyle.
aggravated by wrist flexion and pronation.
numbness and tingling in the 4th and 5th finger due to ulnar involvement
golfers elbow
what is radial tunnel syndrome caused by and what are its features?
Compression of the posterior interosseous branch of radial nerve.
Features include :
features of lateral epicondylitis
4-5 cm distal to lateral epicondyle
what is adhesive capsulitis commonly known as ? What condition is associated with? What are its features?
Frozen shoulder.
Associated with diabetes mellitus.
external rotation and active and passive movement affected.
what motion is a meniscal tear caused by? What test is used in its diagnosis?
Caused by twisting of the knee.
McMurray test positive
what motion is ACL tear caused by? what test confirms it ?
Twisting of the knee. Amplified with positive draw test.
what features of a humerus fracture would indicate an urgent need for surgery?
distal neurovascular deficit
what can the co-prescription of azathioprine and allopurinol cause?
Bone marrow suppression
what are the key features of polymyalgia rheumatica?
patients > 60
rapid onset
aching morning stiffness in proximal limb muscles - no weakness
what is the most common type of shoulder dislocation? What nerve is commonly injured?
Anterior shoulder dislocation
Axillary nerve affected
what antibodies are positive in Sjogren’s syndrome?
RF
ANA
Anti Ro, Anti La
what are the key features of spinal stenosis ? How is the diagnosis confirmed?
gradual onset of unilateral or bilateral leg pain, numbness and weakness which is worse on walking and resolves on sitting.
Pain is also relieved by sitting down, leaning forwards and crouching down.
MRI is needed to confirm diagnosis.
what malignancies can dermatomyositis be associated with?
ovarian
breast
lung
what are the skin features of dermatomyositis?
Photosensitivity
Macular rash over the back and shoulder
Heliotrope rash in periorbital region
Gottron’s papules : consisting of roughened red papules over the extensor surfaces of the fingers.
what antibodies are positive in dermatomyositis
ANA
Jo-1 - most specific
what are the Ottawa ankle rules?
ankle x-ray needed if :
Pain in malleolar zone and -
- Inability to weight bear for 4 steps
- Tenderness on distal tibia
- Bone tenderness on distal fibula
what is the management of ankle fractures :
Prompt reduction of fracture to remove pressure on overlying skin and subsequent necrosis.
young patients usually require surgical repair with a compression plate
elderly patients generally require conservative management
how can you distinguish psoriatic arthritis from rheumatoid arthritis ?
Psoriatic arthritis presents with nail changes such as pitting and onycholysis
what is the first line management of lower back pain - mechanical?
NSAID’s ( paracetamol monotherapy ineffective)
what is the most common mechanism of an ankle sprain?
Ankle inversion
What do the T-score and Z-score in a DEXA scan represent?
T-Score : based on bone mass of young reference population
Z-score : adjusted for age, gender and ethnic factors
how does paget’s disease of the bone present on xray?
mixed lytic and sclerotic lesions
what are the features of Felty’s syndrome?
splenomegaly
neutropenia
rheumatoid arthritis
where does osteosarcoma most commonly present?
Metaphyseal region of long bones prior to epiphyseal closure.
where does giant cell tumour most commonly occur?
Epiphyseas of long bones
which antibodies are diffuse cutaneous systemic sclerosis associated with?
anti scl-70 antibodies
what is a rheumatological drug that is safe to use in pregnancy?
Hydroxychloroquine
what are the causes of avascular necrosis of the hip?
Long term steroid use
chemotherapy
alcohol
trauma
what are the cautions for sulfasalazine use?
G6PD deficiency
allergy to aspirin / sulphonamides
what are the adverse effects related to sulfasalazine
oligospermia
Stevens Johnson syndrome
pneumonitis/ fibrosis
myelosuppression
What are the features of Still’s disease?
arthralgia
elevate ferritin
salmon pink maculopapular rash
pyrexia
lymphadenopathy
What antibodies are present in Stills disease
RF, ANA
How is Still’s disease managed?
NSAID’s
steroids
what are the most common site for stress fractures? where do they most commonly occur?
Metatarsals
most commonly occur at the 2nd metatarsal shaft
what are the risk factors for pseudogout?
Hemochromatosis
Hyperparathyroidism
acromegaly, Wilson’s disease
low magnesium, phosphate
what is Ehler-Danlos syndrome? What are it’s features and complications?
autosomal dominant connective tissue disorder mainly affecting type III collagen.
Features include:
elastic, fragile skin
joint hypermobility and recurrent joint dislocation
easy bruising
complications include :
Aortic regurgitation
mitral valve prolapse
aortic regurgitation
SAH
how are flares of RA managed?
Corticosteroids - oral /IM
Children and young people with unexplained bone swelling or pain- ?
Very urgent direct access X-ray to assess for bone sarcoma
what features are seen with ankylosing spondylitis
A’s
apical fibrosis
anterior fibrosis
aortic regurgitation
achilles tendonitis
AV node block
amyloidosis
what is the action of a statin ?
inhibition of HMG-CoA - rate limiting enzyme in hepatic chlolesterol control
what is the most common cause of heel pain seen in adults ? Where is the pain worse? How is it manahed
plantar fasciitis - around medial calcaneal tuberosity
management -
rest feet where possible
wear shoes with good support
insoles and heel pads
what is the first line medication for the management of Raynaud’s
nifedipine
what test is used in the diagnosis of sjogren’s syndrome
Schirmers
what type of medication is allopurinol
xanthine oxidase inhibitor
what is the most severe and dangerous form of Ehler’s Danlos syndrome?
Vascular Ehlers Danlos syndrome
What syndrome, associated with Ehlers-Danlos syndrome, occurs as a result of autonomic dysfunction and causes significant tachycardia on sitting or standing along with presyncope or syncope
postural orthostatic tachycardia syndrome
describe swan neck and boutonniere’s
swan neck - hyperextended PIP and flexed DIP
Boutonniere- hyperextended DIP and flexed PIP
What medical emergency causing severe hypertension and renal failure can be caused by diffuse cutaneous systemic sclerosis?
Scleroderma renal crisis
What condition typically causes self-limiting episodes of inflammatory arthritis, similar to rheumatoid arthritis, that last several days before completely resolving?
Palindromic rheumatism
What is the major complication of giant cell arteritis?
permanent vision loss
What test used in diagnosing Behçet’s disease involves using a sterile needle to make multiple pricks on the forearm, then reviewed 24-48 hours later to look for erythema and induration?
pathergy test
What is the most common and least severe type of Ehlers-Danlos syndrome?
hypermobile ehlers danlos syndrome
What is the main presenting symptom of myositis?
gradual onset , symmetrical , proximal muscle weakness
give 2 dermatological side effects of hydroxychloroquine
blue grey skin
hair bleaching
What scoring system can be used to assess for hypermobility and support a diagnosis of hypermobile Ehlers-Danlos syndrome?
Beighton score
What skin changes are most associated with Kawasaki disease?
widespread erythematous maculopapular rash
desquamation ( skin peeling) of palms and soles
What term refers to inflammation of the points of insertion of tendons into bone, often seen in psoriatic arthritis?
enthesitis
What scoring system for calculating the risk of a major osteoporotic fracture or hip fracture is preferred in the NICE guidelines? (1)
What time frame does this score apply to? (1)
QFracture
10 years
Which DMARD notably causes peripheral neuropathy
leflunomide
What investigation is used to confirm a diagnosis of discoid lupus erythematosus? (1)
skin biopsy
What nail signs may be seen in psoriatic arthritis?
nail pitting
onycholysis - seperation of the nail from the nail bed
What tool is used to screen for psoriatic arthritis in patients with psoriasis?
psoriasis epidemiological screening tool
What rare bone-related side effects can occur with the use of bisphosphonates? (3)
atypical fractures- femoral
osteonecrosis of the jaw
osteonecrosis of the external auditory canal
What simple blood test is used in the diagnosis of myositis?
CK
What joint in the thumb is most often affected by osteoarthritis?
Carpometacarpal joint
what is the definition of accelerated progression of kidney disease
Sustained decline in the eGFR within 1 year of either 25% or 15 ml/ min / 1.73 m2
What oral medication may be used to stimulate tear and saliva production in patients with Sjögren’s syndrome?
pilocarpine
What pattern of skin colour changes is characteristically seen in patients with Raynaud’s phenomenon when exposed to a cold trigger, and why do these changes occur?
white - due to vasoconstriction
then blue - cyanosis
red - reperfusion and hyperaemia
What are the characteristic presenting features of Behçet’s disease?
recurrent oral ulcers
genital ulcers
What is the mechanism of action of adalimumab, infliximab and etanercept?
tumour necrosis factor inhibitors
What special technique can help distinguish between idiopathic Raynaud’s and Raynaud’s secondary to systemic sclerosis?
nailfold capillaroscopy
What class of medication often worsens the symptoms of Raynaud’s phenomenon?
beta blockers
What is the usual medical treatment for Kawasaki disease?
aspirin and IV immunoglobulins
explain t score
at the femoral neck
the number of standard deviations that the patients bone mineral density is from an average health adult
Which DMARD notably causes orange urine and a reduced sperm count?
sulfasalazine
Which DMARDs are most harmful in pregnancy?
methotrexate
leflunomide
What test assesses spinal mobility, particularly where ankylosing spondylitis is suspected? (1)
What reference points are marked in this test? (1)
What cutoff when bending forwards suggests restriction in lumbar movement? (1)
Schober’s test
10 cm above and 5 m below the L5 vertebrae
less than 20 cm length between the reference marks suggests restriction
What unusual pathogens may cause infection in a transplant patient taking immunosuppressants?
PCP
CMV
TB
What gene is linked with Behçet’s disease?
HLA B51
Which DMARD notably causes retinal toxicity?
Hydroxychloroquine
What are the key conditions associated with ankylosing spondylitis (5 As mnemonic)?
anterior uveitis
aortic regurgitation
av block
apical lung fibrosis
aocd
What is the medical term for a bunion?
hallux valgus
What term is used to describe the misaligned healing of a fracture?
malunion
What resisted movements can be used to establish a diagnosis of trochanteric bursitis?
external rotation
internal rotation
abduction
What are the three phases of frozen shoulder? (3)
How long does each phase last on average? (1)
painful, stiff, thawing
6 month each
Why would a bladder scan be indicated in a patient with back pain?
suspected cauda equina
what test assesses duputrens contracture
table top
What classification system can be used to describe fractures of the lateral malleolus of the ankle? (1)
What bone is affected? (1)
In relation to what important structure is the fracture described? (1)
What is the significance of this structure in relation to the fracture? (1)
weber
fibula
distal syndesmosis between tibia and fibula
fracture disprupts syndesmosis = surgery more liekly
What investigation can be used to measure the pressure in a compartment?
needle manometry
most common reason for total hip replacement revision.
Aseptic loosening - presenting with hip or groin region pain radiating down to the knee
how does posterior dislocation of the hip present ?
typically presents acutely with a ‘clunk’, pain and inability to weight bear
on examination there is internal rotation and shortening of the affected leg
what is a sign of scaphoid fracture
pain on longitudinal compression of thumb
where does the scaphoid get its blood supply from and what does interruption of this blood flow risk
dorsal carpal branch of the radial artery with disruption causing avascular necrosis of the scaphoid
what are the signs of a scaphoid fracture
point of maximal tenderness over anatomical snuffbox
pain elicited on longitudinal compression of the thumb
tenderness of scaphoid tubercle
pain on ulnar deviation of wrist
Ivx done for scaphoid injury
plain film radiographs in AP and lateral views
MRI definitive
how is a scaphoid fracture managed
immobilisation with a futuro splint or standard below backslab
how are undisplaced fractures of the scaphoid managed
cast for 6-8 weeks
how are displaced scaphoid fractures managed
surgical fixation
meniscal tear test
Thessaly’s test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee
what investigation is essential prior to commencing biologics
chest xray
mx of scaphoid pole fractures
surgical fixation
how does compartment syndrome present renally
raised myoglobin
differentiate between direct and indirect injury of the patella
direct generally involves a blow or trauma to the front of the knee, generally an undisplaced crack
indirect injury is generally is when the quadriceps forcefully contracts against a block to knee extension ( like when catching foot against solid object)
investigations for patellar fracture
plain film radiograph generally AP anf lateral
management of patellar fracture
undisplaced - if they have intact extensor mechanism then hinged knee brace for 6 weeks
displaced - operative management with tension band wire, inter fragmentary screws etc
distinguish between galeazzi and monteggia fracture
monteggia - ulnar fracture, foosh
galaezzi - radial shaft fracture , reverse foosh
management of temporal arteritis
no visual loss - high dose pred
visual loss - IV methylpred
continue even if normal biopsy due to skip lesions
Osteochondritis dissecans
typically presents with knee pain after exercise, locking and ‘clunking’
spinal stenosis diagnosis
MRI
feature suggesting primary raynaud’s
young women
key features of APL
anticardiolipin
thrombocytopenia
prolonged APTT
causes of dupuytren’s contracture
manual labour
phenytoin treatment
alcoholic liver disease
diabetes DM
tool used to assess hypermobility
Beighton score
what is visual loss in temporal arteritis caused by
anterior ischaemic optic neuropathy
how would you describe a club foot
inverted and plantar flexed foot which is not passively correctable
what are the features of fat embolism
respiratory distress, altered mental status, and a rash.
mx of fat embolism
fixation of long bone fractures
anterior vs posterior dislocation
posterior : leg is shortened, adducted and internally rotated
anterior : abducted and externally rotated with no leg shortening
which lung condition are persons with marfans most likely to develop
pneumothorax
which skin feature is behcets syndrome associated with
erythema nodosum
management of rib fractures
conservative management with analgesia
nerve block
surgical fixation if fracture has failed to heal following 12 weeks of conservative mx
how to distinguish between anterior cruciate ligament tear and medial meniscus tear
ACL = rapid joint swelling due to bleeding
meniscal tear= gradual swelling
Baker’s cyst
develop in patients with arthritis or gout following minor trauma to the knee
which meds should be considered in all housebound patients
vitamin D
squaring of the thumb suggests ?
osteoarthritis
marfans is characterised by a deficiency of
fibrillin
how is APL managed
primary - low dose aspirin
secondary - lifelong warfarin
anterior and posterior shoulder dislocation
anterior - FOOSH
posterior - seizures and electrical shock
which is the main immunoglobulin found in breast milk
IgA
what is the management of subluxation of the radial head
analgesia
passive supination of the elbow joint while elbow is flexed up to 90 degrees
summary of osteogenesis imperfects
brittle bone disease
autosomal dominant
childhood- fractures following minor trauma, blue sclera, deafness and dental problems
calcium, phosphate , pth and alp generally normal
features of osteosarcoma
Codman’s triangle
most common
sunburst pattern
management of shoulder dislocation
recent dislocation = attempt reduction without analgesia or sedation
Ant synthetase syndrome
Anti Jo1
myositis
ILD
thickened and cracked skin
Raynaud’s
most common causes of drug induced SLE
procainamide
hydralazine
isoniazid
minocycline
phenytoin
C8 radiculopathy
weak flexion of all digits including the thumb
features of cauda equina
lower back pain
bilateral sciatica
decreased anal tone
Anterior ischemic optic neuropathy
swollen pale disc and blurred margins
virchows triad
stasis
hypercoagulability
endothelial damage
signs of central disc prolapse
weakness
urinary retention
incontinence
peri-anal sensory loss
reduced anal tone
HLA type associated with RA
HLA DR4/DR1
surgical management of carpal tunnel syndrome
decompression studies : division of the flexor retinaculum
ulnar nerve entrapment
Numbness and paraesthesia of the ulnar half of the ring finger and the little finger
survival rate of osteosarcoma
55% 5 year survival
froment’s sign
Froment’s sign - present in carpal tunnel syndrome : flexion of PIP while grasping a piece of paper between thumb and index
radiological signs of avascular necrosis of the femoral head
none initially
sclerosis and otolysis
fractures, flattening of femoral head
joint space narrowing
mx of hip dislocation
Reduction under general anaesthesia within 4 hours = reduces risk of avascular necrosis
ottawa knee rules
Age 55 / more
Patellar head tenderness
Fibular head tenderness
Can’t flex knee
Can’t weight bear
