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3 FoCP > MSK Week 6 > Flashcards

MSK Week 6 Flashcards

1
Q

cardinal symptoms in MSK hx

A 
injury
pain
stiffness
swelling
deformity
instability
weakness
altered
sensation
loss of fx
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2
Q

what types of pain are common in MSK conditions

A

throbbing and aching -> arthritis

burning & stabbing -> nerve

night pain -> red flag (cancer)

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3
Q

3 commonest patterns of inflammatory arthritis? examples of each?

A

acute - septic arthritis, gout/pseudogout/reactive arthritis

chronic - inflammatory arthritis (RA, PA), chronic tophaceous gout

spinal - ankylosing spondylitis

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4
Q

what should be done when suspecting septic arthritis?

A

aspirate joint

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5
Q

features of septic arthritis

A

fever, raised inflammatory markers, joint tenderness/restriction

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6
Q

cause of gout?

A

urate crystals in joints

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7
Q

what is tophaceous gout?

A

whitish appearance on swollen joints due to hard deposits of uric acid

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8
Q

what causes pseudogout?

A

calcium pyrophosphate crystals

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9
Q

features of rheumatoid arthritis

A

spontaneous sudden joint pain commonly in hands and feet

joint swelling and warmth

eye dryness

stiffness

ulnar deviation of fingers

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10
Q

how does psoriatic arthritis present?

A

psorisasis on extensor surfaces (knee, elbow)
toe swelling
can affect nails

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11
Q

signs of ankylosing spondylitis

A

sacroilitis
stiffness in back
question mark posture

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12
Q

xray features of osteoarthritis joint

A

joint space loss
osteophytes
subchondral sclerosis
subchondral cysts

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13
Q

how to perform GALS?

A

ask 3 screening questions - clothes, stairs, pain

stand up patient, inspect spine, inspect illiosacral joint, inspect limbs, inspect spine lordosis/kyphosis

ear to shoulder, jaw side to side

arm movements, hand inspection, grip strength and pinching.

limb inspection, patella tap, feet inspection, movements hip flexion, knee flexion, hip internal/external rotation

stand up patient and look at gait

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14
Q

what is developmental dysplasia of the hip?

A

asymmetrical femur length

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15
Q

what is perthes disorder

A

necrosis of femoral epiphysis due to avascularisation.

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16
Q

what is slipped upper femoral epiphysis?

A

femoral head cartilage has slipped off the bone head

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17
Q

4 features on xray of osteoarthritis

A

joint space loss
subchondral sclerosis
subchondral cysts
osteophytes

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18
Q

difference between intracapsular and extracapsular fracture of femur?

A

blood supply to head of femur is disrupted in intracapsular fracture - hemiarthroplasty

extracapsular BS preserved - screws/osteotomy

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19
Q

how to perform hip examination?

A

look
feel - pain, muscle bulge/wasting

move - flexion/internal/external rotation

tomas test
trendelenburgs test
measurement of leg length

gait

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20
Q

joint history questions

A 
pain
swelling
redness
stiffness
early morning stiffness?
episodic or constant?
weakness
instability
locking
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21
Q

common age for medial/lateral collateral ligament injury

A

active age teens - mid age

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22
Q

how to perform knee exam

A

look
feel - joint line, patella tap
move - extension/flexion, temperature

hyperextension

ACL/PCL/MCL/LCL

gait

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23
Q

what eye condition can RA patients also get

A

sjogrens disease

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24
Q

what lung condition can some RA patients get

A

pleural effusion

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25
Q

what posture does someone with ankylosing spondylitis have?

A

question mark posture - ?

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26
Q

25M presented with painful hip, red and swollen o/e, pyrexic, known drug user.

what is the first ddx?

A

septic arthritis

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27
Q

risk factor of gout

A 
thiazide diuretics
recent heavy alcohol intake
high purine diet
renal failure
dehydration
psoriasis
chemotherapy
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28
Q

what is the strongest risk factor of psoriatic arthritis?

A

genes

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29
Q

presentation of gout

A

acute inflammatory arthritis, most common in MTP joint of big toe, coming on at night over 2-4 hours.

might also present with fatigue and high fever

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30
Q

most common age and gender for acute gout?

A

middle aged male

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31
Q

differentials for someone presenting with acute inflammatory arthritis?

A

acute gout
septic arthritis
osteomyelitis
cellulitis

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32
Q

who are more commonly affected with pseudogout

A

elderly women

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33
Q

what is osteomyelitis?

A

haematogenous spread of bacteria to the joints causing infection, inflammation

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34
Q

most common causative organism of septic arthritis

A

staph aureus

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35
Q

RF of septic arthritis

A

prosthetic joints
pre-existing joint disease
DM
recent intra-articular steroid injection

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36
Q

risk factors for rheumatoid arthritis

A 
female
30-50 YO
family history
smoking
obesity
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37
Q

which hand joints are more commonly affected in RA

A

MCP and PIP joints

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38
Q

which joints are not involved in rheumatoid arthritis?

A

thoracic and lumbar spine

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39
Q

where are rheumatoid nodules usually found?

A 
elbow
finger joints
wrist
hip 
lower back
Achilles tendon
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40
Q

signs and symptoms of psoriatic arthritis

A 
RA symptoms
nail pitting
finger swelling
scaly skin lesions
fatigue
lower back pain
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41
Q

what is the question mark posture?

A

loss of lumbar lordosis and hyper-kyphosis of thorax

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42
Q

most common type of patients to get osteoarthritis

A

elderly patients over 60

more common in females

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43
Q

risk factors of OA

A 
obesity
occupation
female
injuries
genetic
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44
Q

pathogenesis of osteoarthritis

A

breakdown of articular cartilage, causing subchondral bone sclerosis and osteophyte formation

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45
Q

clinical features of osteoarthritis

A 
joint pain increasing during the day
bony enlargement of joint
stiffness
muscle wasting
crepitus
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46
Q

characteristic of joint pains in osteoarthritis

A

worst on movement, relieved by rest, worse throughout the day

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47
Q

what are Heberden’s and bouchards nodes

A

bony swelling in osteoarthritis: of PIP = bouchards, DIP = heberden’s

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48
Q

common joints affected in osteoarthritis

A

vetebrae, hips, knees.

DIPs

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49
Q

difference between OA and RA

A

pattern of joint involvement
RA has early morning stiffness
OA has no systemic features

50
Q

what causes of back pain are more common in age 15-30?

A

mechanical
prolapse intervertebral disc
ank spon
spondylolisthesis

51
Q

what is spondylolithesis?

A

slipping of one vertebral disc on top of another

52
Q

what is cauda equina syndrome

A

compression of cauda equina (below L1)

bowel and bladder dysfunction
bilateral leg pain 
saddle anaesthesia
absent achilles reflex
gait disturbance
weakness of lower limb muscles
53
Q

what can cause cauda equina syndrome?

A 
trauma
tumor
spinal stenosis
epidural abscess/haematoma
disc herniation
54
Q

risk factors of osteoporosis

A 
female
early menopause
alcohol
smoking
low BMI
vitamin D deficiency
55
Q

where do osteoporotic fractures characteristically occur?

A

thoracic and lumbar vertebrae

proximal femur

distal radius (colles fracture)

56
Q

how to investigate osteoporosis>

A

DEXA scan

serum biochemistry

57
Q

where does prostate cancer often metastasise to?

A

bone

58
Q

what can a pathological fracture indicate?

A

bone metastasis

59
Q

what other symptoms of bone mets are there

A 
severe pain
spinal cord compression
pathological fracture
hypercalcaemia
anaemia
spinal instablity
60
Q

what is polymyalgia rheumatica

A

systemic inflammatory disease causing pain and other symptoms

61
Q

symptoms of polymyalgia rheumatica

A 
morning pain and stiffness in joints
fatigue
anorexia
anaemia
malaise
low-grade pyrexia
62
Q

how to perform thomas’ test?

A

lie patient flat, one hand under back to feel for flattening.

ask patient to bend one knee and bring as close to chest as possible, look at contralateral knee to check for flexion -> indicative of fixed flexion of the hips

63
Q

how to perform trendelenburg’s test?

A

stand on my foot and look at other hip to check for dipping.

if dipping positive that means foot that patient is standing on has hip abduction dysfunction

64
Q

which side will a patient with a trendelenburg gait lean to?

A

towards injured side

65
Q

what are 3 common causes of haemiarthrosis in the knee

A

ACL rupture
peripheral meniscal tear
osteochondral fracture

66
Q

causes of knee locking

A 
meniscal tear
acl rupture
loose body
arthritis
pain inhibition (pseudolocking)
67
Q

which collateral ligament is more likely to be injured?

A

medial

68
Q

symptoms of collateral ligament injury

A

pain on injured side and effusion

instability

69
Q

how to perform knee exam?

A

look

feel - patella tap, joint lines, bony landmarks, temperature

move - active and passive(hyperextension)

special tests - ACL/PCL/MCL/LCL tests.

70
Q

what is trigger finger?

A

Stenosing tenosynovitis

swelling of tendon to form a nodule, obstructing extension of tendon due to tendon sheath.

71
Q

risk factors of trigger finger

A

female>men
middle age
diabetes
gout/RA

72
Q

functions in the hand of the median nerve

A

sensory to radial 3 fingers on palmar side

motor to thenar, lumbricals, flexion of index, middle and wrist.

73
Q

symptoms of carpal tunnel syndrome

A

numbless, tingling and pain in radial 3 fingers.

74
Q

which nerve is usually spared in carpal tunnel syndrome?

A

palmar cutaneous brunch

75
Q

how to investigate suspected carpal tunnel syndrome?

A

Tinel’s sign

phalens test

76
Q

how to do phalen’s test?

A

hold wrist flexion for 60s and ask about numbness/tingling

77
Q

what is dupuytren’s disease

A

benign proliferative disease of palmar fascia causing permanent flexion of fingers.

78
Q

symptoms of dupuytren’s disease

A

starts with slight flexion with one finger getting progressively worse to become curled and permanent.

thickening of palmar fascia

cords

79
Q

why does basal thumb arthritis happen?

A

cos force at base of thumb is a lot higher than anywhere else when pinching

80
Q

what is cubital tunnel syndrome?

A

ulnar nerve compression at elbow causing sensory and motor deficits of ulnar nerve function

81
Q

sensory supply of ulnar nerve

A

ulnar side 2 fingers

82
Q

motor function of ulnar nerve

A

flexion of fingers, hypothenar and intrinsic hand muscles

83
Q

symptoms of cubital tunnel syndrome

A

numbness and tingling on little and ring finger. hand weakness. worse on flexion of elbow

84
Q

how to conduct hand examination?

A

hand on pillow

Look

Feel - joints, muscle, temperature, sensation, squeeze mcp, elbow

Move - wrist flexion/extension active and passive, finger extension, thumb adduction, finger abduction, make fist and squeeze.

function - pincer pinch test

phalens test

85
Q

4 rotator cuff muscles

A

supraspinatous
infraspinatous
subscapularis
teres minor

86
Q

presentation of shoulder arthritis

A

pain, restricted movements

87
Q

what conditions can cause painful arc syndrome

A

subacromial impingement

88
Q

how to elicit rotator cuff tear injury

A

test power of shoulder flexion and abduction

89
Q

what is frozen shoulder?

A

inflammation and thickening of shoulder joint capsule causing restricted movement and pain, often triggered by injury

90
Q

which direction of shoulder dislocation is most common?

A

anterior

91
Q

what nerve is commonly injured in an anterior shoulder dislocation?

A

axillary

92
Q

what else should u consider in someone with acute lower back pain

A

AAA

93
Q

red flags of back pain

A 
extremes of ages
thoracic pain
night pain
fever, sweats, weight loss
hx of Ca
immunosuppresion
neurological deficit
94
Q

yellow flags of back pain

A

emotional problems

work related/compensation issues

95
Q

what is radical back pain

A

when pain follows nerve root distribution down the legs

96
Q

what scan is best for back

A

MRI

97
Q

what is the imaging mark of disc degeneration

A

narrowed disc space leads to lucency in between vertebrae due to air

98
Q

what does a T2 MRI show?

A

water

99
Q

how to conduct spin exam

A

Look - muscle, asymm, scoliosis, spinal curvature

feel - vertebrae and muscle for pain

move - lumbar flx/ext, thoracic rotation, cervical flx/ext/lateral flex/rotation

on bed - leg raise + foot dorsiflex to elicit pain, reflex test, dorsiflexion big toe (L5), peripheral pulses, neuro exam if need

100
Q

what does dorsiflexion of the big toe in a spinal exam test?

A

L5

101
Q

how to conduct shoulder exam?

A

Look

Feel - start at clavicle, any pain, muscle wasting

Move - active & passive, hand behind head, hand behind back. abd/flx/ext, internal/ext rotation

special tests - painful arc, impingement

102
Q

what is reactive arthritis?

A

acute polyarticular autoimmune inflammatory arthritis

associated with STI or GI infection

103
Q

classical triad of reactive arthritis

A

can’t pee - urethritis
can’t see - conjunctivities
can’t bend the knee - acute arthritis

104
Q

which joints typically affected in reactive arthritis?

A

knee and ankle

105
Q

how to investigate suspected reactive arthritis (e.g high risk of STI)

A 
joint aspirate -> aseptic
raised ESR and CRP
STI testing
stool culture (GI infection)
106
Q

common features of reactive arthritis

A 
urethritis
conjunctivitis
diarrhea
acute assymetrical polyarthritis
brown plaques on sole
107
Q

what is found in a gout joint aspirate

A

negatively birefringent needle crystals
polymorphonuclear cells

no bacteria culture

108
Q

which genetic HLA types are associated with severe RA?

A

HLA DR4 and DR1

109
Q

systemic features of rheumatoid arthritis?

A 
fatigue
feeling unwell (flu-like sx)
fever
sweats
weight loss
110
Q

describe swan neck and boutonniere deformity

A

swan neck involves hyperextension of the PIP and fixed flexion of the DIP

boutonniere involves fixed flexion of the PIP and hyperextension of the DIP

111
Q

what is palindromic rheumatoid arthritis?

A

acute onset monoarticular joint pain and systemic illness

112
Q

who is more susceptible to palindromic RA?

A

men

113
Q

eye complications of RA?

A

sjogren’s, scleritis, episcleritis

114
Q

where can you find rheumatoid nodules?

A

elbow, wrists, eyes, lung, heart

115
Q

pulmonary complications of rheumatoid arthritis?

A

pulmonary fibrosis, obliterative bronchiolitis, caplan’s syndrome

116
Q

what is caplan’s syndrome

A

rheumatoid arthritis associated with pneumoconiosis. patients present with cough, shortness of breath, crackles on asucultation and pulmonary nodules on CXR

117
Q

what are common liver complication of RA?

A

mild hepatomegaly

abnormal transaminase

118
Q

diagnostic test for RA?

A

anti-CCP

119
Q

first line investigation for someone suspected of having RA? with clinical signs of synovitis

A

rheumatoid factor

120
Q

what is the monitoring score method for someone with RA?

A

DAS28

121
Q

what do DAS28 scores mean?

A

≥ 5.1 implies active disease,
<3.2 well-controlled disease,
< 2.6 remission

122
Q

carpal tunnel syndrome is a complication of RA - T or F

A

T

3 FoCP (11 decks)

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