MSK (MCQBank) Flashcards
Ottawa’s knee rules
Knee X-ray is needed if there are any of the following:
- >=55y/o
- isolated tenderness of patella
- tenderness of head of fibula
- inability to flex to 90 degrees
- inability to weight bear both immediately and in ED (not more than 4 steps)
Treatments NOT advocated by NICE osteoarthritis guidance
Electro-acupuncture
Glucosamine or chondoitin
Rubefacients (substance that causes vasodilation/increase blood circulation)
Intra-articular hyaluronan injections
Tennis elbow VS Golfer’s elbow
Lateral epicondylitis - tennis
Medial epicondylitis - golfer
Simmonds calf squeeze test is positive - what does this mean?
When squeezed calf, there is NO plantarflexion of foot. Indicating rupture of Achilles tendon.
Arm VS Forearm
Upper part of the upper limb - ARM
Lower part of the upper limb - FOREARM
Organism causing reactive arthritis
Chlamydia trachomatis
Neisseria gonorrhoea
Ureaplasma urealyticum
Salmonella
Shigella
Yersinia
Campylobacter
Treatment of piriformis syndrome
Avoid the movement that causes irritation to the sciatic nerve (it runs through the greater sciatic foramen below the piriformis muscle)
Corticosteroid injection near the site where the piriformis muscle crosses the sciatic nerve
What test to check function of anterior cruciate ligament?
Lachman test (anterior drawers test)
Pain on shoulder abduction
- WITH pain on passive external rotation
- WITHOUT pain on passive external rotation
List of diagnosis?
WITH pain - adhesive capsulitis (ie frozen shoulder)
WITHOUT pain - shoulder impingement syndrome, subacromial bursitis, rotator cuff tear
Most common bacteria causing septic arthritis
Staph aureus
What position of the joint might you see for someone with septic arthritis? (think of baby with hip septic arthritis)
position that increases its intracapsular volume
- abducted
- flexed
- externally rotated
what is Morton’s neuroma?
irritation of interdigital digit by compression between metatarsal heads often in tight fitting footwear
occassionally accompanied by inflammed bursa of the same site
commonest site - 3rd & 4th metatarsal heads
squeezing the metatarsal head may elicit a painful click - mulder’s click
Gout VS Pseudogout
Gout : negatively birefringent crystals, needle shaped, monosodium urate crystals, appear YELLOW when aligned parallel to slow axis of compensator and BLUE when perpendicular
Pseudogout: positively birefringent crystals, rhomboid shaped, calcium pyrophosphate crystals, appear BLUE when aligned parallel to slow axis of compensator and YELLOW when perpendcular.
Dorsal VS Ventral
Ventral - anterior
Dorsal - posterior
Common cancer to metastasise to bone (in order to frequency)
Breast
Prostate
Lung
Colon
Stomach
Bladder
Uterus
Rectum
Thyroid
Kidney
Common site of metastasis: SPINE
What is Still’s disease?
Rare systemic form of arthritis before onset of 7y/o.
PC: spiking fever, systemic symptoms BEFORE arthritis. Associated with morbiliform rash, hepatosplenomegaly, serositis, anaemia, leococytosis.
X-ray findings of RA
early: soft tissue swelling, juxta-articular demineralisation/osteopororis/osteopenia
late: joint space narrowing, periarticular erosions, joint deformation, subluxations
what is the Mondor sign?
bruise found in the sole of the foot - a sign of calcaneal fracture
Spondylosis VS spondylolithesis
Spondylosis - degenerative changes of vertebrae and disk
Spondylolithesis - slippage of the vertebrae body (ie displacement). Causes: congenital anomalies of vertebrae, damage of ligaments or joints secondary to degeneration, inflammation or trauma
Examination findings of scaphoid fracture
Tenderness of palmar and dorsal aspect of the scaphoid - anatomical snuff box.
wrist joint effusion.
Pain on compressing the thumb longitudinally.
Pain on general flexion and ulnar deviation of wrist.
What rheumatological condition is strongly associated with GCA?
Polymyalgia rheumatica
which antibody is highly SPECIFIC for rheumatoid arthritis
Anti-CCP
what are the systemic features of rheumatoid arthritis?
Eyes - Sjogren’s, scleritis, episcleritis
Skin - leg ulcers, rash, nail fold infarcts
Rheumatoid nodules
Polyneuropathy, mononeuritis multiplex
Respiratory: pulmonary fibrosis, obliterative bronchiolitis, Caplan’s syndrome
Pericardial involvement, valvulitis, myocardial fibrosis, immune complex vasculitis
Kidney: analgesic nephropathy, amyloidosis
Liver: mild hepatomegaly
Thyroid disorders, osteoporosis, depression, splenomegaly
Colchicine should be avoided if patients have..?
Blood disorders
eGFR<10 (colchicine is excreted via kidneys)
Renal impairment
Severe hepatic impairment
Pregnancy/breastfeeding
Taking p-glycoprotein inhibitors (increase colchicine levels) eg clarithromycin, erythromycin, ritonavir, verapamil or strong CYP3A4 inhibitors
Indication for DEXA bone scan
<75y/o of low trauma fracture
x-ray finding of incidental or vertebrae collapse
postmenopausal women with history of hip fracture
low BMI <19
Long term steroid tx
Oestrogen deficiency
Conditions that predispose to osteoporosis:
- malabsortion
- dermatomyositis
- RA
- anorexia
- CKD
- HYperthyroidism
Cushing;s
treatment of polymyalgia rheumatica
steroids
Bennet VS gamekeeper’s thumb
Bennet -carpo-metacarpal area fracture & dislocation of 1st thumb. Swelling, bruising and cannot move thumb. Can damage flexor pollicis longus.
Gamekeeper (aka skier’s thumb or UCL tear)- at the level of metacarpo-phalangeal level. small avulsion fracture of ulnar corner at base of proximal 1st phalanx. Chronic ulnar collateral ligament rupture.
Osgood schlatter
Pain in the upper part of tibia - due to overuse in sports.
Age: 10-13males8-12female
7yo from Ghana with pain of left knee worse on movement. Pyrexial, with warm upper shin and small knee effusion ? Diagnosis
Osteomyelitis
8 yo with painful right hip and limp. X-ray showed sclerotic hip. ?diagnosis
Avascular necrosis (sure to the sclerotic femur)
15yo girl, anterior knee pain worse on going downstairs, valgus knee deformity, shrug test positive
Chondromalacia patella/ runner’s knee/ patellofemoral pain syndrome (softening of cartilage around patella)
which hepatitis is linked with polyarteritis nodosa?
hep B
PAN is a necrotising vasculitis.
x-ray findings of osteoarthritis VS rheumatoid arthritis
OA: joint space narrowing, osteophytes, subchondral cysts, subchondral sclerosis
RA: soft tissue swelling, juxta-articular demineralisation, joint space narrowing, erosions, joint deformation
difference between osteoporosis, osteomalacia, rickets, Paget’s disease in terms of Ca, PO, Alkphos
Ca - PO - ALP
osteoporosis: N, N, N
osteomalacia: Low/n, N/low, Raised
Rickets: ?, Low, Raised
paget’s disease: N/raised, N, Raised
x-ray findings of osteomalacia
linear areas of low density
mechanism of injury for acromioclavicular dislocation
fall onto shoulder tip
fall on outstretched arm - ? causes what type of injury
young child: posterior displacement of distal radial epiphysis, greenstick fracture of forearm bone, supracondylar fracture of humerus
teenager: fracture of clavicle
young adult: fracture of scaphoid
elderly: colles’ fracture
what test to do for Behcet’s disease?
Pathergy test
- inserting a small needle under the skin and evaluating the site 24-48hrs later
- if there is a papule at the site of puncture - this means it is positive
what is auspitz sign?
bleeding when the scales are taken off - seen in psoriasis
osteochondritis dissecans -?PC
separation of subchondral bone articular cartilage from joint surface
vague and achy joint pain worse by activity and accompanied by swelling.
locking, catching, giving way are common features - due to intra-=articular loose bodies
knee pain worse in sports
flexion of hips cause external rotation
SUFE
x-ray finding for vit D deficiency
Looser’s zones (translucent bands)
elderly patient with muscle weakness and tenderness ?diagnosis
generalised muscle stiffness, weight loss, bilateral tenderness/pain of upper arms ?diagnosis
proximal muscle weakness more in the lower limb & linked with malignancy ?diagnosis
widespread pain for 3 months and multiple localised tenderness ?diagnosis
bilateral shoulder pain and tenderness of acute or subacute onset with bilateral upper arm tenderness. can also involve pelvic girdle and neck.
polymyositis
polymyalgia rheumatics (if 3 or more of criteria met: bilateral shoulder/neck stiffness, onset of illness<2weeks, ESR>40, morning stiffness >1hr, age >65, depression or weight loss, bilateral tenderness of upper arms)
polymyositis
fibromyalgia
polymyalgia rheumatica
Monteggia VS Galeazzi fracture
MugGeR
Monteggia Ulnar Fracture (Radial Head dislocation) - proximal (monteggiA - A is at the start)
Galeazzi Radial Fracture (Ulnar dislocation) - distal (galeazZi - Z is at the end/distal)
chronic pain and tingling of buttocks & worse when sitting in toilet seat or chair for too long. no lumbar pain. can elicit pain by internally rotating hip.
?diagnosis
piriformis syndrome
3yo hip pain and limp. recent URTI.
?diagnosis
transient synovitis of hip
what can be found to diagnose felty syndrome?
RA
splenomegaly
neutropenia
But - can also remember by: SANTA
splenomegaly
anaemia
neutropenia
thrombocytopenia
arthritis
what is Freiberg’s disease?
osteochondrosis/avascular necrosis of toes- articular surfaces of second or third metatarsal head collapse
- common in girls 12-15yo
- pain on weight bearing and restricts physical activity
- Tx: rest and use a metatarsal head-> surgery to remove the fragments of articular cartilage and resectioning the dorsal aspect of metatarsal head to allow the joint to move freely and painlessly.
Ottawa’s ankle rules VS Ottawa’s foot rules
ANkle x-rays required only if there is bony pain in the malleolar zone AND any 1 of the following:
- tenderness along distal 6cm of the posterior edge of the tibia or tip of medial malleolus
- tenderness along distal 6cm of posterior edge of fibula or tip of lateral malleolus
- inability to weight bear both immediately and in ED for 4 steps.
Foot x-rays required if there is bony pain in the midfoot zone and any 1 of the following:
- tenderness of base of 5th metatarsal
- tenderness of navicular bone
- inability to weight bear both immediately and in ED for 4 steps
Maisonneuve fracture - what is it?
spiral fracture of the upper third of fibula and tear of distal tibiofibular syndesmosis and the interosseous membrane.
- usually involving pronation-external rotation force.
- associated fracture of medial malleolus or rupture of deep deltoid ligament
March fracture - what is it?
stress fracture of metatarsals
- for repetitive walking or running - ie in the army/runners etc
- commonest site is 2nd metatarsal shaft (or 3rd or rarely navicular)
- tender lump on dorsum of foot that is palpable from distal to mid-shaft of foot
- tx: analgesia, elevation, rest and modified daily activity.
treatment of rheumatoid arthritis
DMARDS
- methotrexate and sulfasalazine - efficacy
- can also use axathioprine, cyclophosphamide, ciclosporin
Can also consider glucocorticoid steroids or monoclonal antibodies that block TNF-alpha (infliximab or etanercept).
risk factors for chronic back pain
smoking
psychological morbidity - anxiety/depression
low income / social class
co-existing CVS disease
poor work conditions
large numbers of children
what injury occurs in a bumper fracture or fall from height?
tibial plateau fracture - fracture of the tibial condyles
- occur in 50-60yo
- badly swokken and deformed knee but cannot find an acual positive examination due to pain and haemarthrosis
