MSK - PASSMED Flashcards
Which bones are typically affected in Paget’s disease:
Skull, Spine/Pelvis and long bones of the lower limb
Morning stiffness > 2 hours indicates
Likely inflammatory arthritis
Most common joint for septic arthritis in adults:
Knee
Dermatomyositis px.
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
Dermatomyositis should prompt investigations for which other condition:
Cancer
Non cutaneous symptoms of dermatomyositis:
Proximal muscle weakness
Raynaud’s
Respiratory muscle weakness
Osteoporosis in a male -> what should be checked
Testosterone
Which drug should not be prescribed with methotrexate due to folate antagomism:
Trimpethoprim
Z-score osteoporosis: adjusted for ->
AGE
Age, gender, ethnicity
Think CAGE (eGFR) minus creatinine (C)
Which TB drug may cause drug-induced lupus
ISONIAZID
Reactive arthritis tx. -
NSAIDs
Ix. of choice in psoas abscess
CT abdomen
Tx. Anti-phospholipid syndrome:
Primary prophylaxis
Secondary prophylaxis
Primary = aspirin Secondary = Warfarin
Earliest sign of ankylosing spondylitis
Reduction in lateral flexion
If a patient is to take steroids for longer than 3 months: what should be initiated immediately:
Bone protection
What is first-line bone protection:
Alendronate
AC joint injury grading:
I-VI
Which AC joint injury grades may be managed conservatively:
I & II -> maybe III (debated)
Adhesive capsulitis management options:
NSAIDs
Physiotherapy
Oral corticosteroids
Intra-articular steroids
Ankle injuries: Weber classification:
Type A = Below syndesmosis
Type B = Start at level of tibial plafond and may involve syndesmosis
Type C = above syndesmosis which may be damaged
Maisonneuve fracture:
Ankle injury: spiral fibular fracture leads to disruption of syndesmosis and widening of the ankle joint.
Surgery is required
All ankle fractures should be:
Promptly reduced to remove pressure on the overlying skin and prevent necrosis
Most common low ankle sprain:
ATFL
Inversion injury
Avascular necrosis of the hip investigation:
MRI is investigation of choice
Plain x-ray may be normal -> osteopenia and microfractures may be seen early on. - crescent sign
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
2 risk factors for biceps rupture:
Corticosteroids
Smoking
Biceps rupture investigation:
US
If suspected distal tendon rupture: urgent MRI
Scoring system used to assess fracture risk in bone metastasis
Mirel scoring system
Buckle fracture characteristic x-ray finding:
Bulging of the cortex
Carpal tunnel EMG finding:
Motor and sensory: prolongation of the action potential
Carpal tunnel management:
6-week trial of conservative:
wrist splints at night
corticosteroid injection
If severe symptoms: surgical decompression
Most common disc prolapse in cauda equina syndrome
L4/L5
L5-S1
Cauda equina signs:
Bilateral sciatica
Reduced sensation/pins & needles in the perianal area
Decreased anal tone
Urinary dysfunction
Cervical spondylosis: may px. w/
Neck pain - referred pain may mimic headaches
Which two fractures are most commonly complicated by compartment syndrome
Supracondylar fractures
Tibial shaft fractures
Diagnostic intra-compartmental pressure in compartment syndrome
> 40 mmHg is diagnostic
Renal complication following fasciotomy
Myoglobinuria -> renal failure
pts. require AGRESSIVE fluid resuscitation
Most common organism in discitis:
Staphylococcus aureus
Discitis features:
Changing lower limb neurology - if abscess develops
Back pain
Pyrexia, rigors, sepsis
Discitis investigations:
Further investigation
MRI
CT guided biopsy may be required to guide antimicrobial therapy
Assess patient for endocarditis w/ TRANSTHORACIC or TRANSOESOPHAGEAL ECHO
Discitis tx.
6-8 weeks of IV anti-biotics
Specific causes of Dupuytren’s
Manual labour Phenytoin alcoholic liver disease Diabetes Trauma
Bennet’s fracture:
Intra-articular fracture of first MCP joint (base of thumb)
causes by FIST fights
Barton’s fracture:
Distal radial fracture (colle’s/smith’s) w/ associated radio-carpal dislocation.
Fall onto extended and pronated wrist
Fat embolism: dermatological fx.
Red/brown impalpable petechial rash
Sub-conjunctival and oral haemorrhage/petichiae
Fat embolism: CNS findings ->
Confusion and agitation
Retinal haemorrhages and intra-arterial fat globules on fundoscopy
What is greater trochanteric pain syndrome also called:
Trochanteric bursitis
Most common hip dislocation:
POSTERIOR dislocation
Complications of hip dislocation:
Posterior = sciatic and femoral nerve injury Anterior = obturator nerve
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
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)
Extracapsular hip fracture management:
Stable intertrochanteric: dynamic hip screw
Sub-trochanteric: Intra-medullary device
Iliopsoas abscess most common organism:
Staphylococcus aureus
Iliopsoas abscess Ix. of choice:
CT abdomen
Iliopsoas abscess - management:
Antibiotics
Percutaneous drainage
surgery if these fail
Iliotibial band syndrome:
causes pain where for who?
Lateral knee pain in runners
Chondromalacia patellae:
Who gets:
Presents as:
Teenage girls following knee injury
Pain on going down stairs or at rest
Tenderness, quadriceps wasting
Thessaly’s test:
What does it indicate:
Weight bearing at 20 degrees of knee flexion - pt. supported by doctor.
Meniscal tear
What is Leriche syndrome?
How does it present:
Atheromatous disease involving the iliac vessels
Buttock claudication and impotence
Red flags for back pain (5)
Age <20 yrs or >50 yrs Night pain History of previous malignancy History of previous trauma Systemically unwell
First-line mx for lower back pain:
NSAIDs
w/ PPI cover for patients > 45 yrs.
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
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
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
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
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
When is MRI indicated in prolapsed disc:
If prolapsed disc symptoms persist for >4-6 weeks
Superior gluteal nerve injury:
Sensory loss:
Motor loss:
Injured in:
None
Hip abduction
Posterior hip dislocation
Pelvic fracture
Hip surgery
Lumbar spinal stenosis investigation and tx.
MRI
Laminectomy
Meralgia paraesthetica nerve implicated:
Lateral femoral cutaneous nerve (L2/L3)
Meralgia paraesthetica test:
Pelvic compression test (deep palpation just under ASIS): highly sensitive
Most common metatarsal fracture:
5th metatarsal
2nd metatarsal is most common in STRESS fracture
Most common metatarsal in Morton’s neuroma:
3rd
Morton’s neuroma: when to refer?
If not relief in symptoms after 3 months despite footwear modifications
Most common OA location
second?
Knee is most common
Hip is second
Management of OA of hip?
Oral analgesia
Intra-articular injections
Total hip replacement = definitive treatment
Most common reason for revision of hip replacement:
Aseptic loosening
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
Osteochondritis dissecans Ix:
X-ray (anteroposterior, lateral and tunnel views) - may show subchondral crescent sign or loose bodies)
MRI used to evaluate cartilage
Osteomyelitis most common organism:
Except in:
Staphylococcus aureus
Except in sickle-cell anaemia - where salmonella species predominate.
Imaging of choice in osteomyelitis
MRI
Osteomyelitis tx. of choice:
Flucloxacillin for 6 weeks
Clindamycin if allergic
Most common location/form of haematogenous osteomyelitis in adults:
Vertebral osteomyelitis
At what ages should men/women by assessed for fragility fractures:
Men - 75 yrs
Women - 65 yrs
Method of risk assessment: osteoporosis
FRAX and Qfracture
What is a Toddler’s fracture:
Oblique TIBIAL fracture in infants
What is a Greenstick fracture:
Unilateral cortical breach only
Osteopetrosis inheritance
Autosomal RECESSIVE
Patellar fracture: Investigation
Plain x-ray - minimum of TWO views required
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
Where is plantar fasciitis worst:
Medial calcaneal tuberosity
Rib fractures investigations:
CT scan of the chest - will show fractures in 3D as well as assoc. soft tissue injuries
Rib fractures after no improvement from conservative management for ___ weeks:
12 weeks -> Surgical fixation considered
Most common sarcoma in adults:
Malignant fibrous histiocytoma
What is a malignant fibrous histiocytoma:
Sarcoma which may arise in soft tissue and bone
Blood supply to scaphoid
Dorsal carpal branch of RADIAL artery
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
Initial management of scaphoid fracture:
Immobilisation w/ futuro splint or standard below elbow backslab
Referral to orthopaedics
When should further imaging of scaphoid fractures be done:
Should be arranged for 7 to 10 days after initial if inconclusive imaging
Management of scaphoid fracture - orthopaedics
If displaced scaphoid waist or scaphoid pole fractures: Surgical fixation
If undisplaced: cast for 6 weeks
Shoulder dislocation w/ light bulb and Rim’s sign:
Posterior shoulder dislocation
What is the pattern of neurological signs in infarction of the spinal cord
Dorsal column signs: Loss of proprioception and fine discrimination
Myotomes: long finger flexors:
C8
Myotomes: small finger abductors:
T1
What results from a ‘pulled elbow’
Subluxation of the radial head
Signs of subluxation of the radial head:
Limited supination and extension of the elbow
Management of pulled elbow (subluxation of the radial head)
Analgesia passive supination of elbow joint while it is flexed to 90 degrees
Trigger finger mx.
Steroid injection successful in majority of pts.
Surgery reserved for those who do not response to steroid injection
Sensory innervation to the small area between the dorsal aspect of the 1st and 2nd metacarpals:
Radial nerve
Nerve injury in medial epicondyle fracture:
Ulnar nerve
Most common Organism in septic arthritis: young people
Neisseria Gonorrhoea
dislocation seen in seizures and electric shock
Posterior shoulder dislocation
