MSK Core Conditions Flashcards
What are the causes of cellulitis?
Beta haemolytic Strep
Staph Aureus
ImmunoC: Pseudomonas, Cryptococcus, Pasteurella
What is the pathophysiology of cellulitis?
Micro-organisms gain entry to dermal & subcutaneous tissue via disrupted cutaneous barrier
What are the signs & symptoms of cellulitis?
Macular erythema with indistinct borders
Raised erythema w/clearly demarcated margins- ERYSIPELAS
How is cellulitis investigated?
Bloods: FBC, WCC
Blood culture: Growth of typical pathogen
Purulent focus culture
What is the management of cellulitis?
Severe: Admit, IV Vancomycin Upper/lower limb: Flucloxacillin Orbital: Vancomycin & Ceftriaxone Diabetic foot: Amoxicillin & Doxycycline Animal Bite: Amoxicillin/ Trimethoprim Frequent relapse: Phenoxymethylpenicillin MRSA cause: Vancomycin Pseudomonas cause: Ceftazidime
What are the causes of septic arthritis?
Staph Aureus Prosthetic joint infection TB & Anaerobic organisms N. Gonorrhoeae H. Influenzae- kids
What are the RFs for septic arthritis?
Age DM Prior joint damage Hip/knee prosthesis Immunodeficiency Prev joint surgery IVDU Alcoholism
What are the signs & symptoms of septic arthritis?
Unilateral single swollen red warm tender joint Pain on passive & active movement Held immobile by muscle spasm Fever & rigors Bacteraemia Neutrophil leukocytosis
Which joint is the most commonly affected in septic arthritis?
Knee
How is septic arthritis investigated?
Aspirate joint: Gram staining & culture
Blood Cultures: AT LEAST 2Anti-Streptolysin O titre: Group A strep infection
Leucocytosis
Bloods: CRP, Synovial WCC, Lactate
CT & MRI
Radionuclide scans
How is septic arthritis managed?
Joint immobilisation Abx: Flucloxacillin 4-6weeks MRSA suspected: Vancomycin Gonococcal suspected: Cefotaxime Aspirate Prosthesis: Remove & fill joint space with Abx (Teicoplanin) for 3-6weeks
Why is it important to treat septic arthritis as soon as possible?
Joint destruction can occur in 24hours
What are the risk factors for a fractured NOF
Age
Bone disorder: Osteoporosis
Trauma
Bone metastases
What are the different types of hip fractures?
Intracapsular: Subcapital, transcervical
Extracapsular: Trochanteric, subtrochanteric, transtrochanteric
What are the signs & symptoms of a femoral fracture?
Shortened
Externally rotated
15% no deformity
What are the complications of femoral fractures?
Avascular necrosis
Non-union in intracapsular fractures
How are femoral fractures investigated?
X-ray: AP & Lateral Pelvis
ECG
Bloods: FBC, U&E, G&S
What are the radiological signs of a hip fracture?
Shentons Line: Line from inf neck of femur to inf superior pubic ramus
What is the management of a hip fracture?
IV opiate/ local nerve block
Avoid NSAIDs
Thromboprophylaxis: LWMH (Stop 12hours before surgery)
Conservative
Surgery: Internal fixation, arthroplasty, hip screws within ?24-48hours
What are the types of shoulder dislocations? How do they occur?
90% ANTERIOR
Anterior/inferior: Forced external rotation of upper limb
Posterior: Forced internal rotation & adduction
What is the management of a shoulder dislocation?
Entonox
Reduction
Immobilise for 3weeks
Surgery: Arthroplasty
What are the signs & symptoms of a shoulder dislocation?
A: Externally rotated, abduction
P: Internally rotated, adduction, cannot be externally rotated
I: Fully abducted, elbow flexed/behind head
Swelling
Pain & tenderness
What are the red flag symptoms of back pain?
Non-mechanical pain (unrelated to time/activity) esp if constant & worsening at night
Thoracic pain
Prev carcinoma, steroids, HIV
Fever, night sweats, weight loss
Structural spinal deformity
Widespread neuro signs (sphincter disturbance)
What are signs of spinal cord involvement and not just nerve root problems in back pain?
Unilateral muscle weakness
Contralateral sensory changes
What are the different causes of back pain?
Structural: Prolapse, spinal stenosis, mechanical, spondylosis
Ca: Multiple myeloma, mets
Referred
Infection: Osteomyelitis, paraspinal abscess
Inflammation
Metabolic: Pagets, hyperPT, osteomalacia
What are the signs & symptoms of cauda equina?
Acute lower back pain Radiation to legs Lower lib weakness Altered sacral & perineal sensation Altered bowels/bladder
What are the investigations for cauda equina?
MRI
How is cauda equina treated?
Surgery within 24hours of bladder symptoms
What signs & symptoms are suggestive of malignant back pain?
Pain in thoracic/cervical spine Progressive lumbar pain Severe unremitting pain Localised tenderness Pain worse on straining (cough, sneeze, stools) Nocturnal pain
How is back pain investigated?
Majority no investigations
Red flags/?CE: Urgent MRI
How is back pain managed?
Analgesia: NSAIDs
Muscle relaxants
Stay active (Physio)
Sciatica: Epidural injection
What are the Ottawa rules for an ankle injury?
Pain in the malleolar zone and:
Tenderness at the post edge/tip of the lateral malleolus (A)
OR
Tenderness at the post edge/tip of the medial malleolus (B)
OR
Inability to bear weight both immediately & ED for 4 steps
What is the most common type of distal radial fracture?
Colles
What are the main causes of a radial fracture?
FOOSH/FOpronated wrist
Direct blow
Stress fractures: Primarily in athletes putting repetitive load on bones with high forces
What are the cancer related red flags for back pain?
Hx of cancer Unexplained weight loss >10kg in 6months >50yo, <18yo Failure to improve w/therapy Pain persists for >4-6weeks Night or rest pain
What are the Ottawa rules for an foot injury?
X-Ray series required if there is any pain the midfoot zone and:
Tenderness at the base of the 5th metatarsal (C)
OR
Bone tenderness at the navicular (D)
AND
Inability to bear weight both immediately & ED for 4 steps
