MSK Cortext Documents Flashcards
Which pathology is also known as brittle bone disease
Osteogenesis Imperfecta
Which pathology causes gracile bones
Osteogenesis Imperfecta
What effect can Osteogenesis Imperfecta have on the eyes and ears
Blue Sclera
Hearing loss
What is the pathology in osteogeneis imperfecta
Defect in type 1 collagen
Where can aneurysms occur in someone with Marfan’s
Aorta
Which connective tissue disorder can cause scoliosis
Ehlers-Danlos
What is Babinski’s sign
extensor plantar response
What causes cerebral palsy
Insult to immature brain before, during or after birth
What are the 4 classifications of cerebral palsy to do with which limbs are involved
1 limb (monoplegic)
Ipsilateral limbs (hemiplegic)
Both legs only (diplegic)
Total body involvement
Which two foot pathologies can be a part of the presentation of spina bifida
High arched foot (pes cavus) Clawing of toes
What actually causes spina bifida
Two halves of posterior vertebral arch fail to fuse in first 6 weeks of gestation
What is Fibular hemimelia
Partial or complete absence of fibula often with absence of lateral foot rays
Are children born with straight legs
No, born with genu varus
Name some risk factors for DDH
Family history
Breech birth
First born
What special harness can be used in children with DDH
Pavlik harness
Who does transient synovitis most commonly affect
Commonly occurs after an URT infection typically in 2-10 year old boys
What is Perthe’s disease
An idiopathic osteochondritis of femoral head
Who does Perthe’s commonly affect
Short stature boys aged 4-9
What is the first clinical sign of Perthes
Loss of internal rotation
Loss of abduction
Positive Trendelenburg test
Who does Slipped Upper Femoral Epiphysis affect
Mainly affects overweight pre-pubescent boys where femoral head slips inferiorly in relation to femoral neck
What is chondromalacia patellae
Softening of hyaline cartilage in patella
Causing anterior knee pain
Which 3 deformities make up Talipes Equinovarus (clubfoot)
Ankle Equinus (plantarflexion)
Supination of Forefoot
Varus alignment of forefoot
What splintage technique is used to treat Clubfoot
Ponseti technique
Which part of the intervertebral disc is richly innervated
Periphery
Where is the most common site for disc material to impinge on a nerve root
L4/5
What is the insertion of the rotator cuff muscles
Supraspinatus, Teres minor, Infraspinatus all insert at greater tuberosity of humerus
Subscapularis inserts at lesser tuberosity of humerus
What is the popeye deformity seen in
Biceps tendon rupture
What is divided in carpal tunnel decompression surgery
The transverse carpal ligament
What is the name of the fascia which forms the roof of the cubital tunnel
Osborne’s fascia
What is the test done for cubital tunnel syndrome and what muscle does it use
Tinel’s test
Froment’s test (adductor pollicus)
Why can steroid injections not be given in golfer’s elbow
Risk of injury to ulnar nerve
How many degrees of flexion can be tolerated in Dupuytren’s before surgery is indicated
30 degrees
What hand pathology is characterised by multinucleate giant cells and haemosiderin staining
Giant cell tumours of tendon sheath
What are some early complications of a joint replacement
Infection, dislocation, nerve injury
What are some early systemic complications of a joint replacement
MI, Chest infection, UTI, P.E
What does the hanging rope sign suggest
Avascular necrosis
What are the treatment options for avascular necrosis of the hip and what do they depend on
Pre-collapse - decompression
Post- collapse - THR
What movement does the ACL resist
Abnormal internal rotation
What movement does the PCL resist
Hyperextension of knee
Anterior movement of femur
How do meniscal injuries often occur
Twisting force on a loaded knee
What kind of effusion is usually present with an ACL tear
Haemarthrosis
What is the principal complaint of ACL rupture
Rotatory instability
Name the extensor mechanism from superior to inferior
Quadriceps muscles Quadriceps tendon Patella Patellar tendon Tibial tuberosity
Which class of antibiotics can cause tendon rupture
Quinolones
ciprofloxacin
What is the gold standard treatment for hallux rigidus
Arthrodesis
Which toe pathology often accompanies pes cavus
Claw toes
What is a pseudotumour in terms of joint replacements
Metal particles cause an inflammatory granuloma
What can polyethylene particles cause in bones
Bone resorption (osteolysis)
Which technique uses a special external fixator to to lengthen short limbs
Lizarov technique
What respiratory problem can scoliosis cause
Restrictive lung disease
What is an involucrum
New bone will form around the area of necrosis in osteomyelitis
What is a Brodie’s Abscess
When bone reacts by walling off the abscess with a thin rim of sclerotic bone - seen in osteomyelitis
What does displacement mean when describing a fracture
The direct translation of the distal fragment
What does angulation mean when describing a fracture
The direction in which the distal fragment points towards and the degree of this deformity
What is a de-gloving injury
A shearing force on the skin which results in avulsion of the skin from its underlying blood vessels
What are the two types of non-union
Hypertrophic
Atrophic
What does hypertrophic non-union occur due to
Instability and excessive motion at the fracture site
What does atrophic non-union occur due to
Rigid fixation with a fracture gap (lack of blood supply)
What antibiotics are typically given to manage an open fracture and what cover do they provide
Flucloxacillin- gram positive Gentamicin- gram negatives Metronidazole- anaerobes
What is the bulbocavernous reflex
Reflex contraction of the anal sphincter with either a squeeze of the glans penis, tapping the mons pubis or pulling on a urethral catheter
what does absence of the bulbocavernous reflex indicate
Spinal shock
What is spinal shock
Physiological response to injury with complete loss of sensation and motor function and loss of reflexes below the level of the injury
What does sacral sparing indicate in terms of incomplete spinal injury
A better prognosis
What is central cord syndrome
Paralysis of the arms more than the legs occurs due to corticospinal (motor) tracts of the upper limbs being more central than those of the lower limbs
What is the difference between anterior cord syndrome and posterior cord syndrome
Proprioception, vibration and light touch senses are preserved in anterior cord syndrome but motor function is lost
What is Brown-Sequard syndrome
Ipsilateral paralysis and loss of dorsal column sensation occurs with contralateral loss of pain, temperature and coarse touch
What are the three types of pelvis fracture
Lateral compression
Vertical shear
Anteroposterior compression
What is a Bankart lesion
Detachment of the anterior glenoid labrum and capsule
What is a Hill‐Sachs lesion
Impaction fracture of posterior humeral head after impacting on anterior glenoid
Where in the humeral shaft does the radial nerve sit
Spiral groove
What is a Barton’s fracture
Intra‐articular fractures of the distal radius involving the dorsal or volar rim
What is a volar Barton’s fracture also known as
An intra-articular Smith’s fracture
What is a dorsal Barton’s fracture also known as
An intra-articular Colles’ fracture
What is a Lisfranc fracture
Fracture of the base of the 1st/ 2nd metatarsal associated with dislocation of the other metatarsals
What are calcium, phosphate, ALP & PTH levels like in osteoporosis
All normal
What is osteomalacia
Softening of the bones, typically through a deficiency of vitamin D or calcium
What are the levels of Ca, Phosphate, ALP & PTH like in osteomalacia
Decreased Calcium & phosphate
Increased ALP & PTH
What are the levels of Ca, Phosphate, ALP & PTH like in primary hyperparathyroidism
Increased Ca & PTH
Increased ALP
Decreased Phosphate
What are the levels of Ca, Phosphate, ALP & PTH like in chronic kidney disease
Decreased calcium
Increased Phosphate
Increased ALP & PTH
What are the levels of Ca, Phosphate, ALP & PTH like in Paget’s disease
Increased ALP
Normal everything else
What are the levels of Ca, Phosphate, ALP & PTH like in bone malignancy
High calcium
Very High ALP
PTH normal
What is a Brown tumour
A bone lesion which arises in the setting of excess osteoclast activity e.g hyperparathyroidism
What is osteochondritis dissecans (OCD)
an osteochondritis where a fragment of hyaline cartilage with a variable amount of bone fragments and breaks off the surface of the joint
What test is used to differentiate between mobile and fixed flat foot
Jack’s test
What is Jack’s test and what is it used for
A flattened medial arch forms with dorsiflexion of the great toe (Jack test) -> Mobile flat foot
Used to differentiate between mobile and fixed flat feet
What are three possible causes of flexible flat feet
Ligamentous laxity
Familial
Idiopathic
What does dynamic flat footedness mean
It is present on weight bearing only
What is the most common cause of mobile/flexible flat feet in adults
Tibialis posterior dysfunction
What is the most common cause of rigid flat feet
Tarsal coalition
Asides from tarsal coalition, what else can cause rigid flat feet
Underlying inflammatory disorder
Neurological disorder
What the three commonest primary tumours which metastasise to bone
Breast, Prostate, Lung
What is Caisson’s disease
Decompression sickness
Which joint pathology can Caisson’s disease lead to
Avascular necrosis
What organism seen in the joint aspirate in reactive arthritis
No organism, usually sterile
Which type of arthritis is associated with Z-shaped thumb
Rheumatoid Arthritis
Which type of arthritis is associated with squaring of the base of the thumb
Osteoarthritis
When is lifelong warfarin indicated in a patient with Anti-Phospholipid syndrome
After a thrombotic event
Which joint pathology will cause thrombocytosis
Rheumatoid Arthritis
What ANCA result do most large vessel vasculitis have
Usually ANCA negative
Which classification is used for sorting vasculitis
Chapel-Hill classification
Which antibody is associated with GPA (Wegener’s)
Anti-PR3
Which antibody is associated with eGPA (Churg-Strauss) )
Anti-MPO ANCA
What proportion of SUFE cases are bilateral
1/3rds
Which congenital MSK condition is a hip pathology but can present with knee pain
SUFE
Which movement is lost in SUFE
Internal rotation
What actually is DDH
Dislocation/ Subluxation of the femoral head in the neonatal period
Name 4 risk factors for DDH
Female sex
Breech birth
Down syndrome
A family history of DDH
Which way does the patella usually dislocate
Laterally
Which structure is torn when the patella laterally dislocates
Medial patellofemoral ligament
Which knee examination test will be positive when examining a suspected patellar dislocation
Positive apprehension test
Which investigation is done to diagnose DDH
Ultrasound
What is the method of transmission of osteogenesis imperfect
Autosomal dominant & autosomal recessive
What is Myositis Ossificans
heterotopic ossification (bone forming outside the skeleton) occurs in muscles usually after an injury
Where can the ulnar nerve become trapped asides from within the cubital tunnel
Guyon’s canal
ulnar tunnel
What is the minimum score someone can get on the Glasgow Coma Scale
3
If Froment’s test is positive, which muscle supplied by which nerve will be weak and which muscle, supplied by which nerve, will be used to compensate
If Froment’s test positive
Adductor Pollicus is weak -> Ulnar nerve
Flexor Pollicus Longus compensates -> Median nerve
What should you suspect if someone comes in with severe joint pain and systemic upset
Septic arthritis
If there are clinical signs of a scaphoid fracture but it is not visible on X-Ray, what should you do
Review in 2 weeks
Which part of the scaphoid is susceptible to Avascular Necrosis and why
Proximal end
because the blood supply is derived from the distal end via a branch of the radial artery
What splint is used to temporarily immobilise a suspected scaphoid fracture
Discharge home with futura splint and fracture clinic appointment
