MSK notes Flashcards
What are the 4 main seronegative arthritides
Ankylosing Spondylitis
Reactive Arthritis
Psoriatic Arthritis
Enteropathic Arthritis
What is the innervation of the Gluteus maximus
Inferior Gluteal Nerve
Which muscle is continuous with the iliotibial tract
Tensor Fascia Lata
The greater and lesser sciatic foramen are passageways into which structures
Greater - Pelvis
Lesser - Perineum
Which spinal cord segments make up the sciatic nerve
L4-S3
Which spinal cord segments make up the pudendal nerve
S2-4
Which three ligaments are part of the hip joint
Iliofemoral
Pubofemoral
Ischiofemoral
Name the articulations of the knee joint
2x Femorotibial
1x Femoropatellar
Which spinal cord segments are involved in the ankle jerk reflex
S1, S2
The tendons of which two muscles make up the calcaneal/Achilles tendon
Gastrocnemius & Soleus
Name the differences between skeletal and cardiac muscle in terms of :
Neuromuscular Junctions
Gap junctions
Striations
Skeletal and cardiac muscle is striated
Skeletal muscle has Neuromuscular Junctions
Cardiac muscle has Gap junctions
Define a motor unit of skeletal muscle
A single alpha motor neuron and all the muscle fibres it supplies
What is A-band
Thick filaments along with thin filaments that overlap in both ends of thick filaments
What is I-Band
Remaining portion of thin filaments which don’t project into A-band
What is H-zone
Lighter area in middle of A-band where thin filaments don’t reach
What is M line
A line down the middle of H-zone
How is Ca2+ released in muscle cells
When the surface action potential spreads down the transverse T-tubules, Ca2+ is released from the lateral sacs of the Sarcoplasmic Reticulum
What 2 things does gradation of muscle tension depend on
Number of muscle fibres
Tension developed by each fibre
What is the optimal length of skeletal muscle
The resting length
What are the two contraction types and when are they useful
Isotonic - muscle length changes
Isometric - muscle length stays constant
What are the three metabolic pathways to supply ATP in skeletal muscle
Creatinine Phosphate - via ADP - immediate
Oxidative Phosphorylation - When O2 is present
Glycolysis - When O2 is absent
What are the three muscle fibre types and when are they used
Type 1 -Slow oxidative (slow twitch) - Prolonged low work
Type 2a - Fast oxidative (intermediate) - Prolonged moderate work
Type 2x - Fast Glycolytic (fast twitch) - Short term high intensity
Are muscle spindle fibres intrafusal or extrafusal
Intrafusal
Normal muscle fibres are extrafusal
What are the muscle spindle sensory nerve endings called
Annulospiral fibres
What is the name of the muscle spindle’s efferent nerve supply
gamma motor neurons
What is the most common causative organism in osteomyelitis in a patient with sickle cell disease
Salmonella
What is a common causative organism in osteomyelitis if a prosthetic joint and what is the treatment
Staph Epidermidis
Vancomycin
What is the incubation period of Clostridium tetani
4 days - several weeks
What colour are each of the muscle fibre types on a succinate dehydrogenase stain
Type 1 - Dark purple
Type 2a - Light purple
Type 2x - Almost white
How much of hyaline cartilage is water and what is the other component
75% water
25% organic material
What is the organic material of hyaline cartilage made up of
60% type 2 collagen
40% proteoglycan aggregates
What is the terminal division of a motor neurone called
Terminal bouton
What surrounds a terminal bouton
Schwann cell
How is choline transferred into the terminal
via Na+ symport through the choline transporter
Which enzyme combines choline with ____ to form Ach
Choline Acetyltransferase (CAT) Combines choline and acetyl-CoA
What 2 things do the arrival of the action potential at the terminal cause
Depolarisation of voltage-activated Ca2+ channels
Allows Ca2+ entry into the terminal
What does e.p.p stand for, in terms of the neuromuscular junction
End Plate Potential
What is the end plate potential caused by
ACh activates nicotinic ACh receptors located in the muscle end-plate
This opens a gate causing influx of Na+ which is greater than efflux of K+: a depolarization known as the end plate potential (e.p.p.) is generated
What is a synarthrosis
A fibrous joint
What is an amphiarthrosis
A cartilaginous joint
What is a diarthrosis
A synovial joint
What does rapid movement do to the elasticity and viscosity of synovial fluid
Increases elasticity
Decreases viscosity
What 2 things break down chondrocytes
Metalloproteinase
Proteolytic enzyme
What are the three types of pain
Nociceptive
Inflammatory
Pathological
What are the two types of pain fibres and what is the difference between them
A-fibres - thinly myelinated - sense fast pain
C- fibres - unmyelinated - sense prolonged pain
Which gene is associated with RA
HLA-DR4
What is a pannus
The inflamed synovium
How is early RA defined
<2 years since the onset of symptoms
What is seen in synovial fluid which is a marker for cartilage degradation
Type 2 collagen
How is hyperuricaemia defined
Serum uric acid > 7
What is the gold standard investigation for crystal arthropathy
Joint Aspirate
What crystal builds up in Milwaukee shoulder
Hydroxyapatite
What stain is a buzzword for Milwaukee shoulder
Alizarin red stain
What is the single gene defect that results in IPEX syndrome
FOXP3
Does inclusion body myositis affect distal or proximal muscles
Causes distal muscle weakness
Is muscle strength affected by Polymyalgia Rheumatica
No, it is normal
In Vasculitis, which layer of the blood vessel are dendritic cells activated in
Tunica Adventitia
What are the two main large cell vasculitis
Takayasu & Giant Cell Arteritis
What are the two main medium vessel vasculitis
Kawasaki disease
Polyarteritis Nodosa
Who does Kawasaki disease predominantly affect
Children under 5
What is the first line treatment for ANCA-associated vasculitis at a systemic level
Cyclophosphamide + steroids
What is Henoch-Schonlein Purpura
IgA mediated vasculitis which affects the GI tract, skin and kidneys
Where do motor and sensory neurons originate from
Motor - Anterior grey horn
Sensory - Dorsal root ganglion
Where does the spinal cord end
L1
Which three muscles make up the erector spinae
Iliocostalis
Longissimus thoracis
Spinalis thoracis
What is a chance fracture
Common in car crashes
Fractured bone in front of spine
Torn ligaments at the back
When should Genu Valgus be referred
If intermalleolar distance is more than 8cm at 11 years old
What are the three possible causes of in-toeing
Internal tibial torsion
Metatarsus Adductus
Femoral neck anteversion
Which score is used to classify joint laxity
Beighton score (9 point system)
Nerve root for ankle dorsiflexion
L5
What is the bowstring test used for
Checking for sciatic nerve irritation
What is the other test that can be used to check for sciatic nerve irritation, apart from bowstring test
Sciatic stretch test
What is Heuter-Volkmann’s law
Compression forces across an epiphyseal plate inhibit growth and tensile forces stimulate growth
What is Volkmann’s ischaemic contracture a complication of
Compartment syndrome
What is a sequestrum
A dead fragment of bone seen in chronic osteomyelitis
What is O’Donoghue’s triad (unhappy knee triad)
Injury to the anterior cruciate ligament, medial collateral ligament, and medial meniscus
What are the 4 meniscal tear patterns
Longitudinal
Radial
Bucket handle
Parrot Beak
How many grades are there for a knee ligament injury
3 grades
How does an extensor mechanism rupture occur
Fall onto knee with quads contraction
What is the most common cause of acquired flat foot
Tibialis posterior dysfunction
Does tibialis posterior pass posterior to the medial or lateral malleolus
Medial
When is Tinel’s test positive for Baxter’s nerve
Plantar Fasciitis
Which test is positive for Achilles tendon rupture
Simmond’s test
When is Mulder’s click test positive and why
Morton’s neuroma
Fibrosis of digital nerve
All muscles in anterior compartment of forearm are supplied by median nerve with the exception of which two muscles
Flexor carpi ulnaris
Medial part of Flexor Digitorum Profundus (supplying ring and little finger)
All upper limb extensors are supplied by which nerve
Radial
Which type of arthritis is a “pencil-in-cup appearance”
Psoriatic Arthritis
Views taken for a suspected cervical spine fracture
AP, Lateral & odontoid peg
Views taken for a suspected scaphoid fracture
AP, Lateral & 2 obliques
How can you differentiate between an avulsion fracture and an avulsion fracture mimic
Avulsion fracture mimics have completely corticated borders
What is the weakest part of children’s bones
Growth plate
What are outpouching of synovial fluid or synovial cavity called
Synovial fluid - Mucous cyst
Synovial cavity - Ganglion cyst
What is the test for De Quiverain’s tenosynovitis
Finklestein’s test
What are tendon’s mainly made of
Type 1 collagen
What is Mill’s test done for
Lateral Epicondylitis (tennis elbow)
What is myositis ossificans
Intramuscular Haematoma which calcifies
What is a Pilon fracture and what is a common cause
Fracture of the distal part of the tibia, involving its articular surface at the ankle joint
Fall from height
Which connective tissue disease is the Anti-Smith antibody highly specific for
SLE
Which type of fracture is described as an incomplete fracture of the shaft of a long bone with bulging of the cortex and who does this tend to affect
Buckle fracture
Kids 5-10
Ankylosing spondylitis can cause pain at night true or false
True
Can temporal arteritis present with a low-grade fever and vastly elevated CK
A low-grade fever may be present but CK and EMG tend to be normal
What is Foucher’s sign
Increase in tension of a Baker’s cyst seen on knee extension
What pathology is indicated by a step deformity after a history of a fall onto the shoulder
Acromioclavicular dislocation
What is a McMurray test
Same as Steinmann’s test but listening out for a click to indicate a meniscal tear
Which ANCA is associated with GPA and eGPA respectively
cANCA –> GPA
pANCA –> eGPA
Which antibodies could be associated with GPA and eGPA respectively
GPA –> Anti-PR3
eGPA –> Anti-MPO
Which triad would suggest Behcet’s disease
Oral ulcers
Genital ulcers
Anterior uveitis
Carpal tunnel syndrome will show wasting of which eminence
Thenar eminence
Osteoporosis is associated with low/high body mass
Low body mass
Which triad is associated with fat embolism
Resp. symptoms
Neuro symptoms
Petechial rash
What are CRP levels like in SLE
Typically normal
A positive straight leg raise test is seen with what kind of pain
Sciatic nerve pain
What is the imaging modality for choice for osteomyelitis
MRI
Which drug can be given for Raynaud’s
Nifedipine
A teenage girl presents with knee pain walking downstairs
Chondromalacia patellae
What drug treatment should you give for osteoarthritis of the knee/hand
Paracetamol + topical NSAID
Which antibody will be positive for drug-induced lupus
Anti-histone antibody
Where does the triceps muscle insert
olecranon process of ulna
Clubfoot is associated with which 2 serious paediatric conditions
Spina Bifida
Cerebral palsy
