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Musculoskeletal > MSK Swellings > Flashcards

MSK Swellings Flashcards

1
Q

What features of an MSK history would make you think of an infection?

A

Systemic upset
Pyrexia
Trauma (break in skin)
Association with medical co-morbities

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2
Q

What are the common examination findings when there is infection present

A

Calor
Dolor
Rubor
Tumor

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3
Q

What is cellulitis and how does it normally appear?

A

Inflammation and infection of the soft tissues

A generalised swelling rather than a discreet lump

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4
Q

What organisms usually cause a cellulitis?

A

β-haemolytic streps, staphylococci

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5
Q

How is cellulitis managed?

A 
Rest
elevation
analgesia
splint					
Antibiotics - penicillin

NOT SURGERY

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6
Q

What is an abscess and how does it clinically present?

A

Discreet collection of pus

Presentation: Defined and fluctuant swelling
Erythema, pain

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7
Q

How is an abscess treated?

A

SURGICAL INCISION and DRAINAGE
“If there’s pus, let it out”
+ Rest, elevation, analgesia, splint, Antibiotics

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8
Q

How does a joint become bacterially infected?

A

Traumatic (joint penetration)

Haematoginous spread

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9
Q

Why is septic arthritis an orthopaedic emergency?

A

Pus causes irreversible damage to hyaline articular cartilage

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10
Q

What organisms are most likely to cause a septic arthritis?

A

Staph. Aureus / Strep. / E.Coli

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11
Q

How do ganglia usually appear?

A

Discreet, round swellings
Non-tender
<10mm – several cms
Skin mobile, fixed to underlying structures

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12
Q

What joints are more prone to ganglia?

A

Wrists
feet
knees

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13
Q

Why should ganglia not be aspirated?

A

They will just refill with synovial fluid

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14
Q

What name is given to a ganglion of the popliteal fossa?

A

Baker’s Cyst

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15
Q

How does a Bakers cyst usually present?

A

Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture

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16
Q

What can happen if a Bakers Cyst ruptures?

A

Fluid can travel down calf and produce pain there

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17
Q

What condition is characterised by Inflammation of the synovium lined sacs that protect bony prominences and joints?

A

Bursitis

18
Q

What can form if a bursitis becomes secondarily infected?

A

abscess

19
Q

How is a bursitis treated?

A

NSAIDs / Analgesia

If infected:
Antibiotics
Incision and drainage

Very rarely excision (chronic cases)

20
Q

What is thought to be the cause of Rheumatoid nodules?

A

Repetitive trauma in RA

21
Q

Rheumatoid nodules respond to DMARDS. TRUE/FALSE?

A

FALSE

22
Q

What is the difference between Bouchard’s and Heberden’s Nodes?

A

Bouchard’s nodes:

  • PIP joints
  • OA or RA

Heberden’s nodes:

  • DIP
  • OA
23
Q

What are the two types of Giant Cell Tumours that occur in the tendon sheath

A

Localised (common)

Diffuse (uncommon)

24
Q

How do Giant cell Tumours of the tendon sheath usually present?

A

Slowly enlarging
Firm, discreet swelling, usually on volar aspect of digits
Can occur in toes
May or may not be tender

25
Q

How are giant cell tumours of the tendon sheath usually treated?

A

No tx if not affecting Pt

Surgery:
marginal excision, ie. not complete
BUT Incidence of recurrence

26
Q

Where does an osteochondroma usually present?

A

Distal femur / proximal tibia metaphyseal regions

27
Q

Who usually gets an osteochondroma?

A

adolescents, outgrowth of physis

28
Q

Why do osteochondromas feel hard when palpated

A

Cartilage capped ossified pedicle

29
Q

How would a patient with an osteochondroma present?

A

Painless, hard lump
Symptoms with activity
(pain from tendons; numbness from nerve compression)

30
Q

How is an osteochondroma treated?

A

Close observation

Possible surgical excision

31
Q

What condition is described as a malignant primary bone tumour of the endothelial cells in the marrow?

A

Ewings Sarcoma

32
Q

What age are the patients who usually develop a Ewings sarcoma?

A

10-20 years old

33
Q

Where does a Ewings sarcoma usually present?

A

diaphysis/metaphysis of long bones and pelvis

34
Q

How does a Ewings sarcoma present clinically?

A

Hot, swollen, tender joint or limb with raised inflammatory markers
=> Can mimic infection

=> ask about night pain etc

35
Q

What is a Lipoma?

A

Benign neoplastic proliferation of fat

36
Q

How does a lipoma usually present?

A
  • discreet or less well defined
  • Slow growing
  • painless/non-tender
  • large (several cms)
  • soft, movable masses
  • No overlying skin changes
37
Q

What must the patient consider about surgery for a lipoma?

A

The scar they are left with may be larger or more painful than the original lipoma

38
Q

Where are sebaceous cysts more commonly found?

A

Head
Neck
Trunk

39
Q

What condition is described as abnormal calcification of a muscle?

A

Myositis ossificans

40
Q

Why must you wait until a muscle ossification has matured before surgically intervening?

A

If ossification is not mature, there is a risk of recurrence (6-12 months)

Musculoskeletal (27 decks)

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