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MSK cortext Flashcards

1
Q

what is a lipoma

A

neoplastic proliferation of fast which usually occurs in subcutaneous tissue but can grow in fat

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2
Q

GCT of tendon sheet what do they look like histologically and microscopically?
what are they called when in a joint

A

pigmented and contain multinucleate giant cells and haemosiderin
pigmented villonodular synovitis (PVN)

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3
Q

what are some rare causes of AVN

A

sea diving

decompression sickness

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4
Q

what are the two types of osteoporosis

A

type 1 - post menopausal increase in osteoclastic bone resorption with loss of protective effects of oestrogen
type 2 - osteoporosis of old age

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5
Q

what do bisphosphonates do and give some examples

A

reduce osteoclast production

alendronate, risedronate, etidronates

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6
Q

what type of drug is zoledronic and how often is it given

A

IV bisphosphonate

once yearly

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7
Q

what kind of drug is desunomab and what does it do

A

monoclonal AB

decreases osteoclast activity

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8
Q

what does strontium do

A

increases osteoblast production and decreases absorption

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9
Q

what is osteomalacia

A

abnormal softening of the bone due to deficient mineralisation of osteoid secondary to inadequate amounts of calcium and phosphate

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10
Q

what is the presentation of osteomalacia

A

bone pain, deformity, pathological fracture, symptoms of hypocalcaemia, pseudo fractures (loosers zones)

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11
Q

what is brittle bone disease and what causes it

A

osteogenesis imperfecta

defect in type 1 collagen

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12
Q

is osteogensis imperfect autosomal dom or recessive
what are the symptoms/signs
what do the bones look like

A

dominant
fragility fractures, blue sclera, loss of hearing
thin (gracile) with thin cortices and osteopenic

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13
Q

why does skeletal dysplasia occur

A

genetic error - abnormal development of bone and connective tissue

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14
Q

what type of skeletal dysplasia is the commonest - give the occurrence/cause, what does it present like, what are the joints like and does it have an effect on mental development

A

achondroplasia
autosomal dom but 80% are sporadic
disproportionally short limbs with prominent forehead and widened nose
joints are lax and mental development is normal

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15
Q

how does marfans syndrome occur
what does it look like
other signs

A

autosomal dominant or sporadic mutation of fibrillin gene
tall stature with disproportionally long limbs and ligamentous laxity
high arched palate, scoliosis, flattening of chest, eye problems, aortic aneurysm, cardiac valve incompetence

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16
Q

what is ehlers-danlos syndrome
how does it occur
wha are the signs

A

abnormal collagen and elastin formation
autosomal dom
joint hyper mobility, joint instability, scoliosis

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17
Q

commonest type of CP

A

spastic 80% - injury to motor cortex

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18
Q

Ataxic CP what does it affect and what are the signs

A

cerebellum

decreased co ordination and balance

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19
Q

what does athetoid CP affect and what are the signs

A

extra pyramidal motor system, pyramidal triangle, basal ganglia
uncontrolled writhing motion, sudden changes in tone and difficulty controlling speech

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20
Q

monoplegic
hemiplegic
diplegia
total body involvement

A

one limb
one ipsilateral upper and lower limb
both legs
all 4 limbs

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21
Q

treatment of CP

A

physio
orthotics
baclofen - injection intrathecally in the subarachnoid space to reduce spasticity

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22
Q

what is spina bifida

A

congenital disorder where the two halves of the posterior vertebral arch fail to fuse

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23
Q

spina bifida occult is what kind of form
what can some patients develop
when do neurological symptoms occur
what are some characteristics of this condition

A

mildest form
tethering of spinal cord and roots which leads to claw toes and pes cavus
neurological symptoms can occur at any age
tell tale sign of tuft of hair in skin overlying defect

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24
Q

spina bifida cystica is what form

what happens

A

severe form
contents of vertebral canal herniate through defect with either herniation of meninges alone (meningocele) or with the spinal cord or caudal equina

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25
Q

is meningocele associated with neurological effects

but

A

no

but myelomeningocele has neurological defects below lesion

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26
Q

what is spina bifida cystia associated with

A

hydrocephalus (excess CSF around increase intracranial pressure)

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27
Q

how is spina bifida cystia treated

A

defect usually closed within 48 hours of birth

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28
Q

what is polio and what does it affect

A

viral infection

affects motor anterior horn cells in the spinal cord or brain stem resulting in lower motor neurone deficit

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29
Q

how does the virus in polio enter and what does it lead to

A

vie GIT with a flu like illness leading to a variable degree of paralysis usually affecting a group of muscles within 2-3 days

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30
Q

what is the treatment of residual paralysis of polio

A

splint age

shortening of leg can be treated with a shoe raise

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31
Q

what is syndactyly

A

2 digits fused together due to failure of separation of skin/soft tissues or pahalnges of adjacent digits

32
Q

what is polydactyl

A

extra digit formed

33
Q

what is fibular hemimelia

A

partial or complete loss of fibula leading to a shortened limb

34
Q

what does an absence or hypoplasia of radium lead to

A

absence of thumb

radial clubhand

35
Q

how does tarsal coalition occur and what is it

A

congenital fusion

painful flat feet in later childhood

36
Q

what is Erbs palsy and what does it lead to
what are the signs
treatment

A

inquiry to C6 and C7 motor neurones
loss of motor innervation to deltoid, supra, infra, biceps, brachialis
internal rotation of humerus, classic waters tip posture
physio

37
Q

what is klumpke’s palsy
cause
leads to what
sign

A

c8 and T1 roots damage
forceful adduction
paralysis of intrinsic hand muscles and finger and wrist flexors
fingers are flexed

38
Q

when do bow legs (virus knees) become normal aligned and what does this then progress to

A 
14 months
knock knees (valgus)
39
Q

what are valgus knees

A

knock knees 10-15 degrees at the age of 3 and progresses to 6 degrees by 6-9

40
Q

test for mobile flat feet

A

jacks test - medial arch is formed with dorsiflexion of great toe

41
Q

what happens when jacks test for flat feel is negative

and what are the causes of this

A

rigid flat feet

underlying bone abnormality (tarsal coalition), underlying inflam disorder or neurological disorder

42
Q

what is developmental dysplasia of the hip (DDH)

A

dislocation or subluxation of the femoral head in the perinatal period which affects development of the hip joint

43
Q

who does DDH occur
where
and both sides or just one?

A

females more than men
left hip commoner
only 20% bilateral

44
Q

what are the risk factors for DDH?

A

FH
first born
Downs
other congenital disorders

45
Q

what are the signs of DDH

A

limb shortening, assym groin/thick skin creases

click/clunk on ortolani or barlow manoeuvre

46
Q

describe ortolani and barlow manœuvres

A

O - reducing dislocated hip with abduction and anterior displacement
B - dislocatable hip with flexion and posterior displacement

47
Q

what are the investigations for DDH and the limitation

A

XR but can’t be used until after 6 months as femoral head hasn’t ossified

48
Q

what is the treatment for DDH depending on the stages
mild
dislocated or persistently unstable
over 18 months

A

closely observed US done
reduced and help with parlik harness (used full time for 6 weeks then part time for 6 weeks - used in ages 4-6 months)
over 18 months - open reduction

49
Q

when does transient synovitis occur
who does it occur in
what is the treatment

A

after a URTI
2-10 year old. boys
short course of steroids and rest

50
Q

what is the commonest cause of hip pain in childhood

A

transient synovitis

51
Q

what is perthes disease

A

idiopathic osteochonditis of the femoral head

femoral head loses blood supply becomes necrotic and leads to abnormal growth

52
Q

who does perthes disease occur in and how do they present

what are the signs

A

4-9 yr olds
active boys with short stature
pain and limp
loss of internal rotation followed by loss of abduction and tredenlburgs sign is positive

53
Q

what might bilateral perthes disease mean

A

underlying skeletal dysplasia or thrombophilia

54
Q

what is the treatment of perthes disease

A

XR observation and avoid physical activity

55
Q

who does a SUFE occur

A

obese pre pubertal boys

56
Q

what is a SUFE

A

femoral head slips inferiorly in relation to femoral neck

57
Q

when does a SUFE occur in girls

A

hypothyroidism or renal disease predisposes them to a SUFE

58
Q

presentation of a SUFE

A

limp
pain - may only be pain in knee
loss of internal rotation

59
Q

investigation and treatment of SUFE

A

lateral view XR
pin femoral head
if chronic then osteotomy

60
Q

what is apophysitis and where can it occur

A

inflammation of growing tubercle where tendon attaches

either side of the patella tendon

61
Q

what is Osgood shatters

A

inflammation of tibial tubercle apophysitis

62
Q

what can osteochondiritis discens result in which predisposes to OA

A

loose bodies - pot holes on surface

63
Q

meniscal problems in children are caused why

treatment

A

some children have abnormally shaped discoid meniscus which is circular and can cause pain and popping
arthroscopic partial meniscectomy

64
Q

what is clubfoot and what is the treatment

A 
ankle equinus (plantar flexion) supination of forefoot and various alignment of foot
donsets technique
65
Q

what is tarsal coalition

A

abnormal bridge between calcaneus and navicular or between talus and calcaneus

66
Q 
what is spondolythesis 
where does it usually occur
who does it usually occur in 
symptoms/signs 
treatment
A

slippage of one vertebrae over the other
L4/L5 or L5/S1
adolescents
low back pain, flat back, waddling gait
physio. if severe stabilisation and reduction

67
Q

what can metal particles in joint replacement lead to

what can polyethylene particles in joint replacement lead to

A 
inflam granuloma (pseudotumour)
osteolysis
68
Q

in osteomyelitis if there is dead bone what can happen

A

might break off (sequestrum)

and new bone (involucrum) will form around the area of necrosis

69
Q

what is a brodies abscess

A

in osteomyelitis in children the area is just cut off - abscess formed with thin rim of sclerotic bone

70
Q

how can chronic OM present

what can cause it

A

can lie dormant for years
localised pain, inflammation
systemic upset
TB esp spinal OM

71
Q

how does spinal OM present

A

insidious back pain which is constant and unremitting
paraspinal muscle spasm
tenderness in spine
fever

72
Q 
list the nerves that can be damaged in the following fractures/dislocations:
colles fracture 
anterior shoulder dislocation 
humeral shaft fracture 
supracondylar fracture 
posterior dislocation of the hip
bumper injury to lateral knee
A 
median nerve 
axillary nerve 
radial nerve 
intertossous branch of median nerve 
sciatic nerve 
common perineal nerve
73
Q

what does degloving mean and what are the symptoms

A

avulsion of skin from underlying blood vessels

skin will not bleach on pressure and loss of sensation

74
Q

treatment of soft tissue injuries

A 
RICE
rest
ice
compression
elevation
75
Q

commonest cause of septic arthritis in adults, second most commonest cause
commonest cause in children
young adults
E Coli occurs in who

A

SA, streptococci
H influence - not since vaccination
Neisseria gonorrhoea (rare)
elderly, IVDU, very ill

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