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YR6 Images + Instruments > MSK Vivas > Flashcards

MSK Vivas Flashcards

1
Q

What is seen here?

A

THR scar

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2
Q

What is seen here?

A

Total knee replacement

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3
Q

What is seen here?

A

Carpal tunnel decompression release

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4
Q

What is seen here? What condition is this seen in?

A

Heberdans nodes
OA

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5
Q

What is seen here? What condition is this seen in?

A

Bouchards nodes
OA

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6
Q

What is seen here? What condition is this seen in?

A

1st CMC squaring
OA

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7
Q

What is seen here? What condition is this seen in?

A

Boutonniere deformity
RhA

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8
Q

What is seen here? What condition is this seen in?

A

Swan neck deformity
RhA

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9
Q

What is seen here? What condition is this seen in?

A

Ulnar deviation
RhA

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10
Q

X-ray features of RhA

A

Loss of joint space
Juxta-articular osteoporosis
Soft-tissue swelling
Periarticular erosions
Subluxation

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11
Q

X-ray features of OA

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

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12
Q

Unilateral swollen joint differential diagnosis

A

Septic arthritis
Haemarthrosis
Crystal arthropathy: gout or pseudogout
Bursitis
Reactive arthritis

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13
Q

Diagnosis of OA

A

Clinical dx if:
>,45
+
have activity-related joint pain
+
have either no morning joint-related stiffness or morning stiffness that lasts < 30 mins.

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14
Q

Conservative management of OA

A

Therapeutic exercise
Weight loss
Walking aids/ grip aids

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15
Q

Medical management of OA

A

Topical NSAID for knee OA

NSAID PO if ineffective/ unsuitable + PPI

Consider IA CS injection when other Tx ineffective- only short term relief 2-10w

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16
Q

Imaging for OA

A

Do NOT routinely use imaging for f/u or to guide non-surgical Mx

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17
Q

When should a patient be referred for joint replacement in OA?

A

Joint Sx are substantially impacting QoL
AND
Non-surgical Mx is ineffective/ unsuitable

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18
Q

Rheumatoid typical presentation

A

Symmetrical synovitis of small joints of hands + feet, although any synovial joint may be affected
Pain: worse at rest
Swelling: AROUND joint ‘boggy’
Early morning stiffness >1h

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19
Q

What may distinguish RhA from other conditions?

A

Inability to make a fist or flex fingers

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20
Q

List 3 features additional to synovitis in RhA

A

Rheumatoid nodules: hard, firm swellings over extensors
Extra-articular: vasculitis, eye, lungs, heart
Systemic: fever, sweats, WL

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21
Q

Describe assessment of potential RhA

A

Refer those with persistent synovitis with unknown cause to rheumatologist
within 3w
Offer NSAIDs whilst awaiting +PPI

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22
Q

Ix for RhA

A

Clinical dx
Rheumatoid factor
Anti-CCP
Hand + feet XR

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23
Q

Mx for RhA

A

DMARD: Methotrexate
Bridging therapy/ flares: PO/ IM/ IA CS

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24
Q

When should patients with RhA be referred for surgical opinion?

A

If any of the following dont respond to non-surgical Mx:
Persistent pain due to joint damage
Worsening joint function
Progressive deformity
Persistent localised synovitis

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25
Q

Achilles tendinopathy S/S

A

Gradual onset posterior heel pain, worse following activity
Morning pain + stiffness

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26
Q

RFs for achilles tendinopathy

A

Quinolone use e.g. Ciprofloxacin
Hypercholesterolaemia (predisposes to tendon xanthomata)

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27
Q

Achilles tendinopathy Mx

A

Analgesia
Reduce precipitating activities
Calf muscle eccentric exercises

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28
Q

In which patients is adhesive capsulitis seen? What are the S/S?

A

Middle age, diabetics
Painful, stiff movement
Limited movement in all directions
Loss of external rotation + abduction

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29
Q

What is supraspinatus tendonitis?

A

Rotator cuff injury: subacromial impingement
Painful arc of abduction 60-120 degrees
Tender over anterior acromion

30
Q

What is shoulder dislocation?

A

Humeral head dislodges from glenoid cavity of scapula
Anterior accounts for >95%

31
Q

Septic arthritis S/S

A

Acute swollen joint
Warm, fluctuant joint
Fever

32
Q

Septic arthritis most common cause

A

S aureus
(In young, sexually active: N gonorrhoea)

33
Q

Septic arthritis Ix

A

Synovial fluid sampling prior to abx
Blood cultures
Joint imaging

34
Q

Septic arthritis Mx

A

IV Abx: Flucloxacillin
Needle aspiration to decompress
+/- Arthroscopic lavage

35
Q

Psoriatic arthritis nail changes

A

Pitting
Onycholysis
Subungual hyperkeratosis
Loss of nail

36
Q

Psoriatic arthritis patterns

A

Symmetric poly arthritis (most common)
Asymmetrical oligoarthritis (hands + feet)
Sacroiliitis
DIP joint disease
Arthritis mutilans

37
Q

What is seen here? What condition is this seen in?

A

Arthritis mutilans
Psoriatic arthropathy

38
Q

What is seen here? What conditions is this seen in?

A

Dactylitis
Psoriatic arthritis
Reactive arthritis
Sickle cell

39
Q

Describe the periarticular disease manifestations in psoriatic arthritis

A

Enthesitis: achilles tendonitis, plantar fasciitis
Tenosynovitis: flexor tendons of hands
Dactylitis

40
Q

What is seen here? In what condition is this seen?

A

Pencil-in-cup appearance
Psoriatic arthritis

41
Q

Psoriatic arthritis Ix

A

XR:
erosive changes
new bone formation
periostitis
pencil-in-cup appearance

42
Q

Psoriatic arthritis Mx

A

Managed by rheumatologist
Mild: NSAID
Mod/ severe: Methotrexate
Biologics e.g. Ustekinumab

43
Q

What is the most common cause of heel pain in adults?

A

Plantar fasciitis
Worse around medial calcanea tuberosity

44
Q

Mx of plantar fasciitis

A

Rest feet where possible
Wear shoes with good arch support + cushioned heels
Insoles + heel pads

45
Q

Scaphoid fracture S/S

A

FOOSH/ contact sports
Pain along radial aspect of wrist, at base of thumb
Loss of pinch/ grip strength
Max. tenderness over anatomical snuffbox
Wrist joint effusion

46
Q

What is seen here?

A

Scaphoid fracture

47
Q

Scaphoid fracture management

A

Immobilisation: futuro splint/ below-elbow backslab
Refer to orthodox: further imaging within 7-10 days
Undisplaced: cast 6-8w
Displaced/ proximal scaphoid pole: surgical fixation

48
Q

Complications of scaphoid fracture

A

Non-union: pain + early OA
Avascular necrosis

49
Q

Innervation of thenar muscles

A

Median nerve

50
Q

Innervation of hypothenar muscles

A

Ulnar nerve

51
Q

Tests for carpal tunnel syndrome

A

Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes Sx

52
Q

Carpal tunnel syndrome S/S

A

Pain/ pins + needles in thumb, index + middle finger
Patients shake hand to obtain relief
Weakness of thumb abduction
Wasting of thenar eminence

53
Q

Carpal tunnel syndrome Mx

A

6w conservative: wrist splints at night + CS injection
If severe/ persistent: surgical decompression

54
Q

What is surgical decompression for CTS?

A

Flexor retinaculum division

55
Q

What is seen here?

A

Unicompartmental knee replacement

56
Q

What is seen here?

A

Total knee replacement

57
Q

Indication for unicompartmental knee replacement. Positives and negatives

A

OA limited to a single compartment
+ves: less invasive, quicker rehab
-ves: highly specialised, likely going to need to replace other compartment

58
Q

Indication for total knee replacement. Positives and negatives

A

OA affecting all knee compartments
+ves: well established, no progression of OA, less specialised
-ves: more invasive, slower rehab

59
Q

What are the clinical signs of a fracture?

A

Pain
Swelling
Crepitus
Deformity
Adjacent structural injury: nerves, vessels, ligaments, tendons

60
Q

Describe management of a closed fracture

A

Reduction: manipulation/ traction
Hold: plaster/ traction
Rehabilitate

61
Q

Describe management of an open fracture

A

Reduce: mini-incision/ full exposure
Hold: fixation (internal or external)
Rehabilitate

62
Q

What does rehabilitation of a fracture involve?

A

Use: pain relief
Move
Strengthen
Weight bear

63
Q

4 general complications of a fracture

A

Fat embolus
DVT
Infection
Prolonged immobility: UTI, chest infections, bed sores

64
Q

5 specific complications of a fracture

A

Neuromuscular injury
Muscle/ tendon injury
Non union/ malunion
Local infection
Degenerative change (intra-articular)

65
Q

3 causes of NOF fracture

A

Osteoporosis (older)
Trauma (younger)
Combination

66
Q

5 Clinical findings of NOF fracture

A

Leg shortened, externally rotated + abducted
Palpation of hip painful
Unable to perform straight leg raise
Pain on gentle internal + external rotation of leg (log roll test)
Soft tissue Sx: bruising + swelling in + around the hip area

67
Q

Imaging for NOF fracture

A

XR: AP + Lateral hip first line
MRI: gold standard to exclude hip fracture

68
Q

Management of extra capsular hip fractures

A

Fix with plate + screws (dynamic hip screw)
Minimal risk to blood supply + AVN

69
Q

Management of undisplayed intracapsular hip fractures

A

Fix with screws
Less risk to blood supply

70
Q

Management of displaced intracapsular hip fractures

A

> 65 + fit: THR
65 + less fit: hemiarthroplasty
<55: reduce + fixation with screws

71
Q

Initial management of NOF fracture

A

Analgesia: paracetamol, opioids + iliofascial/ femoral nerve blocks. NOT NSAIDs.

IV access: for fluid resus, blood transfusion + administration of medications.

Assess + manage complications to prevent delays in surgical Mx (e.g. correct anaemia, anticoagulation, volume depletion + infection).

72
Q

What are the principles of surgical management o NOF fractures?

A

Urgent reduction + internal fixation (<36h)
Early mobilisation

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