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ACC > MSK Core Conditions > Flashcards

MSK Core Conditions Flashcards

1
Q

What are the causes of cellulitis?

A

Beta haemolytic Strep
Staph Aureus
ImmunoC: Pseudomonas, Cryptococcus, Pasteurella

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2
Q

What is the pathophysiology of cellulitis?

A

Micro-organisms gain entry to dermal & subcutaneous tissue via disrupted cutaneous barrier

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3
Q

What are the signs & symptoms of cellulitis?

A

Macular erythema with indistinct borders

Raised erythema w/clearly demarcated margins- ERYSIPELAS

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4
Q

How is cellulitis investigated?

A

Bloods: FBC, WCC
Blood culture: Growth of typical pathogen
Purulent focus culture

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5
Q

What is the management of cellulitis?

A 
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
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6
Q

What are the causes of septic arthritis?

A 
Staph Aureus
Prosthetic joint infection 
TB & Anaerobic organisms
N. Gonorrhoeae
H. Influenzae- kids
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7
Q

What are the RFs for septic arthritis?

A 
Age
DM
Prior joint damage
Hip/knee prosthesis
Immunodeficiency
Prev joint surgery 
IVDU
Alcoholism
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8
Q

What are the signs & symptoms of septic arthritis?

A 
Unilateral single swollen red warm tender joint 
Pain on passive & active movement
Held immobile by muscle spasm
Fever & rigors
Bacteraemia
Neutrophil leukocytosis
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9
Q

Which joint is the most commonly affected in septic arthritis?

A

Knee

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10
Q

How is septic arthritis investigated?

A

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

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11
Q

How is septic arthritis managed?

A 
Joint immobilisation
Abx: Flucloxacillin 4-6weeks
MRSA suspected: Vancomycin
Gonococcal suspected: Cefotaxime
Aspirate
Prosthesis: Remove & fill joint space with Abx (Teicoplanin) for 3-6weeks
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12
Q

Why is it important to treat septic arthritis as soon as possible?

A

Joint destruction can occur in 24hours

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13
Q

What are the risk factors for a fractured NOF

A

Age
Bone disorder: Osteoporosis
Trauma
Bone metastases

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14
Q

What are the different types of hip fractures?

A

Intracapsular: Subcapital, transcervical
Extracapsular: Trochanteric, subtrochanteric, transtrochanteric

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15
Q

What are the signs & symptoms of a femoral fracture?

A

Shortened
Externally rotated
15% no deformity

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16
Q

What are the complications of femoral fractures?

A

Avascular necrosis

Non-union in intracapsular fractures

17
Q

How are femoral fractures investigated?

A

X-ray: AP & Lateral Pelvis
ECG
Bloods: FBC, U&E, G&S

18
Q

What are the radiological signs of a hip fracture?

A

Shentons Line: Line from inf neck of femur to inf superior pubic ramus

19
Q

What is the management of a hip fracture?

A

IV opiate/ local nerve block
Avoid NSAIDs
Thromboprophylaxis: LWMH (Stop 12hours before surgery)
Conservative
Surgery: Internal fixation, arthroplasty, hip screws within ?24-48hours

20
Q

What are the types of shoulder dislocations? How do they occur?

A

90% ANTERIOR
Anterior/inferior: Forced external rotation of upper limb
Posterior: Forced internal rotation & adduction

21
Q

What is the management of a shoulder dislocation?

A

Entonox
Reduction
Immobilise for 3weeks
Surgery: Arthroplasty

22
Q

What are the signs & symptoms of a shoulder dislocation?

A

A: Externally rotated, abduction
P: Internally rotated, adduction, cannot be externally rotated
I: Fully abducted, elbow flexed/behind head
Swelling
Pain & tenderness

23
Q

What are the red flag symptoms of back pain?

A

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)

24
Q

What are signs of spinal cord involvement and not just nerve root problems in back pain?

A

Unilateral muscle weakness

Contralateral sensory changes

25
Q

What are the different causes of back pain?

A

Structural: Prolapse, spinal stenosis, mechanical, spondylosis
Ca: Multiple myeloma, mets
Referred
Infection: Osteomyelitis, paraspinal abscess
Inflammation
Metabolic: Pagets, hyperPT, osteomalacia

26
Q

What are the signs & symptoms of cauda equina?

A 
Acute lower back pain
Radiation to legs
Lower lib weakness
Altered sacral & perineal sensation
Altered bowels/bladder
27
Q

What are the investigations for cauda equina?

A

MRI

28
Q

How is cauda equina treated?

A

Surgery within 24hours of bladder symptoms

29
Q

What signs & symptoms are suggestive of malignant back pain?

A 
Pain in thoracic/cervical spine
Progressive lumbar pain
Severe unremitting pain
Localised tenderness
Pain worse on straining (cough, sneeze, stools)
Nocturnal pain
30
Q

How is back pain investigated?

A

Majority no investigations

Red flags/?CE: Urgent MRI

31
Q

How is back pain managed?

A

Analgesia: NSAIDs
Muscle relaxants
Stay active (Physio)
Sciatica: Epidural injection

32
Q

What are the Ottawa rules for an ankle injury?

A

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

33
Q

What is the most common type of distal radial fracture?

A

Colles

34
Q

What are the main causes of a radial fracture?

A

FOOSH/FOpronated wrist
Direct blow
Stress fractures: Primarily in athletes putting repetitive load on bones with high forces

35
Q

What are the cancer related red flags for back pain?

A 
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
36
Q

What are the Ottawa rules for an foot injury?

A

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

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