MSK - PASSMED Flashcards
1
Q
Which bones are typically affected in Paget’s disease:
A
Skull, Spine/Pelvis and long bones of the lower limb
2
Q
Morning stiffness > 2 hours indicates
A
Likely inflammatory arthritis
3
Q
Most common joint for septic arthritis in adults:
A
Knee
4
Q
Dermatomyositis px.
A
Photosensitive
Macular rash over back and shoulder (SHAWL)
Heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers
5
Q
Dermatomyositis should prompt investigations for which other condition:
A
Cancer
6
Q
Non cutaneous symptoms of dermatomyositis:
A
Proximal muscle weakness
Raynaud’s
Respiratory muscle weakness
7
Q
Osteoporosis in a male -> what should be checked
A
Testosterone
8
Q
Which drug should not be prescribed with methotrexate due to folate antagomism:
A
Trimpethoprim
9
Q
Z-score osteoporosis: adjusted for ->
A
AGE
Age, gender, ethnicity
Think CAGE (eGFR) minus creatinine (C)
10
Q
Which TB drug may cause drug-induced lupus
A
ISONIAZID
11
Q
Reactive arthritis tx. -
A
NSAIDs
12
Q
Ix. of choice in psoas abscess
A
CT abdomen
13
Q
Tx. Anti-phospholipid syndrome:
Primary prophylaxis
Secondary prophylaxis
A
Primary = aspirin Secondary = Warfarin
14
Q
Earliest sign of ankylosing spondylitis
A
Reduction in lateral flexion
15
Q
If a patient is to take steroids for longer than 3 months: what should be initiated immediately:
A
Bone protection
16
Q
What is first-line bone protection:
A
Alendronate
17
Q
AC joint injury grading:
A
I-VI
18
Q
Which AC joint injury grades may be managed conservatively:
A
I & II -> maybe III (debated)
19
Q
Adhesive capsulitis management options:
A
NSAIDs
Physiotherapy
Oral corticosteroids
Intra-articular steroids
20
Q
Ankle injuries: Weber classification:
A
Type A = Below syndesmosis
Type B = Start at level of tibial plafond and may involve syndesmosis
Type C = above syndesmosis which may be damaged
21
Q
Maisonneuve fracture:
A
Ankle injury: spiral fibular fracture leads to disruption of syndesmosis and widening of the ankle joint.
Surgery is required
22
Q
All ankle fractures should be:
A
Promptly reduced to remove pressure on the overlying skin and prevent necrosis
23
Q
Most common low ankle sprain:
A
ATFL
Inversion injury
24
Q
Avascular necrosis of the hip investigation:
A
MRI is investigation of choice
Plain x-ray may be normal -> osteopenia and microfractures may be seen early on. - crescent sign
25
Rupture of a baker's cyst may cause symptoms similar to:
Deep vein thrombosis - pain, redness and swelling in the calf.
Majority of ruptures are asymptomatic
26
2 risk factors for biceps rupture:
Corticosteroids
| Smoking
27
Biceps rupture investigation:
US
| If suspected distal tendon rupture: urgent MRI
28
Scoring system used to assess fracture risk in bone metastasis
Mirel scoring system
29
Buckle fracture characteristic x-ray finding:
Bulging of the cortex
30
Carpal tunnel EMG finding:
Motor and sensory: prolongation of the action potential
31
Carpal tunnel management:
6-week trial of conservative:
wrist splints at night
corticosteroid injection
If severe symptoms: surgical decompression
32
Most common disc prolapse in cauda equina syndrome
L4/L5
| L5-S1
33
Cauda equina signs:
Bilateral sciatica
Reduced sensation/pins & needles in the perianal area
Decreased anal tone
Urinary dysfunction
34
Cervical spondylosis: may px. w/
Neck pain - referred pain may mimic headaches
35
Which two fractures are most commonly complicated by compartment syndrome
Supracondylar fractures
| Tibial shaft fractures
36
Diagnostic intra-compartmental pressure in compartment syndrome
> 40 mmHg is diagnostic
37
Renal complication following fasciotomy
Myoglobinuria -> renal failure
| pts. require AGRESSIVE fluid resuscitation
38
Most common organism in discitis:
Staphylococcus aureus
39
Discitis features:
Changing lower limb neurology - if abscess develops
Back pain
Pyrexia, rigors, sepsis
40
Discitis investigations:
| Further investigation
MRI
CT guided biopsy may be required to guide antimicrobial therapy
Assess patient for endocarditis w/ TRANSTHORACIC or TRANSOESOPHAGEAL ECHO
41
Discitis tx.
6-8 weeks of IV anti-biotics
42
Specific causes of Dupuytren's
```
Manual labour
Phenytoin
alcoholic liver disease
Diabetes
Trauma
```
43
Bennet's fracture:
Intra-articular fracture of first MCP joint (base of thumb)
causes by FIST fights
44
Barton's fracture:
Distal radial fracture (colle's/smith's) w/ associated radio-carpal dislocation.
Fall onto extended and pronated wrist
45
Fat embolism: dermatological fx.
Red/brown impalpable petechial rash
| Sub-conjunctival and oral haemorrhage/petichiae
46
Fat embolism: CNS findings ->
Confusion and agitation
| Retinal haemorrhages and intra-arterial fat globules on fundoscopy
47
What is greater trochanteric pain syndrome also called:
Trochanteric bursitis
48
Most common hip dislocation:
POSTERIOR dislocation
49
Complications of hip dislocation:
```
Posterior = sciatic and femoral nerve injury
Anterior = obturator nerve
```
50
Garden system:
Whats it for?
Grading?
```
Hip fractures
Type I: Stable
Type II: Complete fracture, undisplaced
Type III: Displaced fracture
Type IV: Complete boney disruption
```
51
Intra-capsular hip fracture management:
Undisplaced:
Displaced:
Internal fixation or hemi if unfit
Arthroplasty (THR if pt. young, fit and healthy, hemi-arthroplasty if not)
52
Extracapsular hip fracture management:
Stable intertrochanteric: dynamic hip screw
Sub-trochanteric: Intra-medullary device
53
Iliopsoas abscess most common organism:
Staphylococcus aureus
54
Iliopsoas abscess Ix. of choice:
CT abdomen
55
Iliopsoas abscess - management:
Antibiotics
Percutaneous drainage
surgery if these fail
56
Iliotibial band syndrome:
| causes pain where for who?
Lateral knee pain in runners
57
Chondromalacia patellae:
Who gets:
Presents as:
Teenage girls following knee injury
Pain on going down stairs or at rest
Tenderness, quadriceps wasting
58
Thessaly's test:
| What does it indicate:
Weight bearing at 20 degrees of knee flexion - pt. supported by doctor.
Meniscal tear
59
What is Leriche syndrome?
| How does it present:
Atheromatous disease involving the iliac vessels
| Buttock claudication and impotence
60
Red flags for back pain (5)
```
Age <20 yrs or >50 yrs
Night pain
History of previous malignancy
History of previous trauma
Systemically unwell
```
61
First-line mx for lower back pain:
NSAIDs
| w/ PPI cover for patients > 45 yrs.
62
Lower back pain investigations:
Lumbar spine X-ray should NOT be offered
| MRI should only be offered to pts. w/ non-specific back pain if likely to influence management
63
L3 nerve root compression:
Sensory loss:
Motor loss:
Femoral stretch test:
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
64
L4 nerve root compression:
Sensory loss:
Motor loss:
Femoral stretch test:
Loss over anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
65
L5 nerve root compression:
Sensory loss:
Motor loss:
Sciatic stretch test:
Sensory loss over DORSUM of FOOT
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
66
S1 nerve root compression:
Sensory loss:
Motor loss:
Sciatic stretch test:
Sensory loss over postero-lateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
67
When is MRI indicated in prolapsed disc:
If prolapsed disc symptoms persist for >4-6 weeks
68
Superior gluteal nerve injury:
Sensory loss:
Motor loss:
Injured in:
None
Hip abduction
Posterior hip dislocation
Pelvic fracture
Hip surgery
69
Lumbar spinal stenosis investigation and tx.
MRI
| Laminectomy
70
Meralgia paraesthetica nerve implicated:
Lateral femoral cutaneous nerve (L2/L3)
71
Meralgia paraesthetica test:
Pelvic compression test (deep palpation just under ASIS): highly sensitive
72
Most common metatarsal fracture:
5th metatarsal
| 2nd metatarsal is most common in STRESS fracture
73
Most common metatarsal in Morton's neuroma:
3rd
74
Morton's neuroma: when to refer?
If not relief in symptoms after 3 months despite footwear modifications
75
Most common OA location
| second?
Knee is most common
| Hip is second
76
Management of OA of hip?
Oral analgesia
Intra-articular injections
Total hip replacement = definitive treatment
77
Most common reason for revision of hip replacement:
Aseptic loosening
78
Osteochondritis dissecans presents as:
Knee pain and swelling, typically after exercise
Knee catching, locking or giving way
Feeling a clunk when flexing or extending the knee
79
Osteochondritis dissecans Ix:
X-ray (anteroposterior, lateral and tunnel views) - may show subchondral crescent sign or loose bodies)
MRI used to evaluate cartilage
80
Osteomyelitis most common organism:
| Except in:
Staphylococcus aureus
Except in sickle-cell anaemia - where salmonella species predominate.
81
Imaging of choice in osteomyelitis
MRI
82
Osteomyelitis tx. of choice:
Flucloxacillin for 6 weeks
| Clindamycin if allergic
83
Most common location/form of haematogenous osteomyelitis in adults:
Vertebral osteomyelitis
84
At what ages should men/women by assessed for fragility fractures:
Men - 75 yrs
| Women - 65 yrs
85
Method of risk assessment: osteoporosis
FRAX and Qfracture
86
What is a Toddler's fracture:
Oblique TIBIAL fracture in infants
87
What is a Greenstick fracture:
Unilateral cortical breach only
88
Osteopetrosis inheritance
Autosomal RECESSIVE
89
Patellar fracture: Investigation
Plain x-ray - minimum of TWO views required
90
Undisplaced patellar fracture management:
Displaced patellar fracture management:
w/ intact extensor mechanism managed conservatively w/ hinged brace for 6 weeks - FULLY weight bear
Surgery then 4-6 weeks hinged knee brace
91
Where is plantar fasciitis worst:
Medial calcaneal tuberosity
92
Rib fractures investigations:
CT scan of the chest - will show fractures in 3D as well as assoc. soft tissue injuries
93
Rib fractures after no improvement from conservative management for ___ weeks:
12 weeks -> Surgical fixation considered
94
Most common sarcoma in adults:
Malignant fibrous histiocytoma
95
What is a malignant fibrous histiocytoma:
Sarcoma which may arise in soft tissue and bone
96
Blood supply to scaphoid
Dorsal carpal branch of RADIAL artery
97
Scaphoid fracture imaging:
X-ray
CT
MRI
X-ray requested w/ scaphoid views (PA, lateral, oblique)
CT requested if on-going clinical suspicion or planning operative tx.
MRI considered definitive diagnosis to confirm
98
Initial management of scaphoid fracture:
Immobilisation w/ futuro splint or standard below elbow backslab
Referral to orthopaedics
99
When should further imaging of scaphoid fractures be done:
Should be arranged for 7 to 10 days after initial if inconclusive imaging
100
Management of scaphoid fracture - orthopaedics
If displaced scaphoid waist or scaphoid pole fractures: Surgical fixation
If undisplaced: cast for 6 weeks
101
Shoulder dislocation w/ light bulb and Rim's sign:
Posterior shoulder dislocation
102
What is the pattern of neurological signs in infarction of the spinal cord
Dorsal column signs: Loss of proprioception and fine discrimination
103
Myotomes: long finger flexors:
C8
104
Myotomes: small finger abductors:
T1
105
What results from a 'pulled elbow'
Subluxation of the radial head
106
Signs of subluxation of the radial head:
Limited supination and extension of the elbow
107
Management of pulled elbow (subluxation of the radial head)
Analgesia passive supination of elbow joint while it is flexed to 90 degrees
108
Trigger finger mx.
Steroid injection successful in majority of pts.
| Surgery reserved for those who do not response to steroid injection
109
Sensory innervation to the small area between the dorsal aspect of the 1st and 2nd metacarpals:
Radial nerve
110
Nerve injury in medial epicondyle fracture:
Ulnar nerve
111
Most common Organism in septic arthritis: young people
Neisseria Gonorrhoea
112
dislocation seen in seizures and electric shock
Posterior shoulder dislocation
