MSK Week 6 Flashcards
1
Q
cardinal symptoms in MSK hx
A
injury pain stiffness swelling deformity instability weakness altered sensation loss of fx
2
Q
what types of pain are common in MSK conditions
A
throbbing and aching -> arthritis
burning & stabbing -> nerve
night pain -> red flag (cancer)
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
4
Q
what should be done when suspecting septic arthritis?
A
aspirate joint
5
Q
features of septic arthritis
A
fever, raised inflammatory markers, joint tenderness/restriction
6
Q
cause of gout?
A
urate crystals in joints
7
Q
what is tophaceous gout?
A
whitish appearance on swollen joints due to hard deposits of uric acid
8
Q
what causes pseudogout?
A
calcium pyrophosphate crystals
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
10
Q
how does psoriatic arthritis present?
A
psorisasis on extensor surfaces (knee, elbow)
toe swelling
can affect nails
11
Q
signs of ankylosing spondylitis
A
sacroilitis
stiffness in back
question mark posture
12
Q
xray features of osteoarthritis joint
A
joint space loss
osteophytes
subchondral sclerosis
subchondral cysts
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
14
Q
what is developmental dysplasia of the hip?
A
asymmetrical femur length
15
Q
what is perthes disorder
A
necrosis of femoral epiphysis due to avascularisation.
16
Q
what is slipped upper femoral epiphysis?
A
femoral head cartilage has slipped off the bone head
17
Q
4 features on xray of osteoarthritis
A
joint space loss
subchondral sclerosis
subchondral cysts
osteophytes
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
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
20
Q
joint history questions
A
pain swelling redness stiffness early morning stiffness? episodic or constant? weakness instability locking
21
Q
common age for medial/lateral collateral ligament injury
A
active age teens - mid age
22
Q
how to perform knee exam
A
look
feel - joint line, patella tap
move - extension/flexion, temperature
hyperextension
ACL/PCL/MCL/LCL
gait
23
Q
what eye condition can RA patients also get
A
sjogrens disease
24
Q
what lung condition can some RA patients get
A
pleural effusion
25
what posture does someone with ankylosing spondylitis have?
question mark posture - ?
26
25M presented with painful hip, red and swollen o/e, pyrexic, known drug user.
what is the first ddx?
septic arthritis
27
risk factor of gout
```
thiazide diuretics
recent heavy alcohol intake
high purine diet
renal failure
dehydration
psoriasis
chemotherapy
```
28
what is the strongest risk factor of psoriatic arthritis?
genes
29
presentation of gout
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
30
most common age and gender for acute gout?
middle aged male
31
differentials for someone presenting with acute inflammatory arthritis?
acute gout
septic arthritis
osteomyelitis
cellulitis
32
who are more commonly affected with pseudogout
elderly women
33
what is osteomyelitis?
haematogenous spread of bacteria to the joints causing infection, inflammation
34
most common causative organism of septic arthritis
staph aureus
35
RF of septic arthritis
prosthetic joints
pre-existing joint disease
DM
recent intra-articular steroid injection
36
risk factors for rheumatoid arthritis
```
female
30-50 YO
family history
smoking
obesity
```
37
which hand joints are more commonly affected in RA
MCP and PIP joints
38
which joints are not involved in rheumatoid arthritis?
thoracic and lumbar spine
39
where are rheumatoid nodules usually found?
```
elbow
finger joints
wrist
hip
lower back
Achilles tendon
```
40
signs and symptoms of psoriatic arthritis
```
RA symptoms
nail pitting
finger swelling
scaly skin lesions
fatigue
lower back pain
```
41
what is the question mark posture?
loss of lumbar lordosis and hyper-kyphosis of thorax
42
most common type of patients to get osteoarthritis
elderly patients over 60
| more common in females
43
risk factors of OA
```
obesity
occupation
female
injuries
genetic
```
44
pathogenesis of osteoarthritis
breakdown of articular cartilage, causing subchondral bone sclerosis and osteophyte formation
45
clinical features of osteoarthritis
```
joint pain increasing during the day
bony enlargement of joint
stiffness
muscle wasting
crepitus
```
46
characteristic of joint pains in osteoarthritis
worst on movement, relieved by rest, worse throughout the day
47
what are Heberden's and bouchards nodes
bony swelling in osteoarthritis: of PIP = bouchards, DIP = heberden's
48
common joints affected in osteoarthritis
vetebrae, hips, knees.
| DIPs
49
difference between OA and RA
pattern of joint involvement
RA has early morning stiffness
OA has no systemic features
50
what causes of back pain are more common in age 15-30?
mechanical
prolapse intervertebral disc
ank spon
spondylolisthesis
51
what is spondylolithesis?
slipping of one vertebral disc on top of another
52
what is cauda equina syndrome
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
what can cause cauda equina syndrome?
```
trauma
tumor
spinal stenosis
epidural abscess/haematoma
disc herniation
```
54
risk factors of osteoporosis
```
female
early menopause
alcohol
smoking
low BMI
vitamin D deficiency
```
55
where do osteoporotic fractures characteristically occur?
thoracic and lumbar vertebrae
proximal femur
distal radius (colles fracture)
56
how to investigate osteoporosis>
DEXA scan
| serum biochemistry
57
where does prostate cancer often metastasise to?
bone
58
what can a pathological fracture indicate?
bone metastasis
59
what other symptoms of bone mets are there
```
severe pain
spinal cord compression
pathological fracture
hypercalcaemia
anaemia
spinal instablity
```
60
what is polymyalgia rheumatica
systemic inflammatory disease causing pain and other symptoms
61
symptoms of polymyalgia rheumatica
```
morning pain and stiffness in joints
fatigue
anorexia
anaemia
malaise
low-grade pyrexia
```
62
how to perform thomas' test?
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
how to perform trendelenburg's test?
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
which side will a patient with a trendelenburg gait lean to?
towards injured side
65
what are 3 common causes of haemiarthrosis in the knee
ACL rupture
peripheral meniscal tear
osteochondral fracture
66
causes of knee locking
```
meniscal tear
acl rupture
loose body
arthritis
pain inhibition (pseudolocking)
```
67
which collateral ligament is more likely to be injured?
medial
68
symptoms of collateral ligament injury
pain on injured side and effusion
instability
69
how to perform knee exam?
look
feel - patella tap, joint lines, bony landmarks, temperature
move - active and passive(hyperextension)
special tests - ACL/PCL/MCL/LCL tests.
70
what is trigger finger?
Stenosing tenosynovitis
swelling of tendon to form a nodule, obstructing extension of tendon due to tendon sheath.
71
risk factors of trigger finger
female>men
middle age
diabetes
gout/RA
72
functions in the hand of the median nerve
sensory to radial 3 fingers on palmar side
motor to thenar, lumbricals, flexion of index, middle and wrist.
73
symptoms of carpal tunnel syndrome
numbless, tingling and pain in radial 3 fingers.
74
which nerve is usually spared in carpal tunnel syndrome?
palmar cutaneous brunch
75
how to investigate suspected carpal tunnel syndrome?
Tinel's sign
| phalens test
76
how to do phalen's test?
hold wrist flexion for 60s and ask about numbness/tingling
77
what is dupuytren's disease
benign proliferative disease of palmar fascia causing permanent flexion of fingers.
78
symptoms of dupuytren's disease
starts with slight flexion with one finger getting progressively worse to become curled and permanent.
thickening of palmar fascia
cords
79
why does basal thumb arthritis happen?
cos force at base of thumb is a lot higher than anywhere else when pinching
80
what is cubital tunnel syndrome?
ulnar nerve compression at elbow causing sensory and motor deficits of ulnar nerve function
81
sensory supply of ulnar nerve
ulnar side 2 fingers
82
motor function of ulnar nerve
flexion of fingers, hypothenar and intrinsic hand muscles
83
symptoms of cubital tunnel syndrome
numbness and tingling on little and ring finger. hand weakness. worse on flexion of elbow
84
how to conduct hand examination?
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
4 rotator cuff muscles
supraspinatous
infraspinatous
subscapularis
teres minor
86
presentation of shoulder arthritis
pain, restricted movements
87
what conditions can cause painful arc syndrome
subacromial impingement
88
how to elicit rotator cuff tear injury
test power of shoulder flexion and abduction
89
what is frozen shoulder?
inflammation and thickening of shoulder joint capsule causing restricted movement and pain, often triggered by injury
90
which direction of shoulder dislocation is most common?
anterior
91
what nerve is commonly injured in an anterior shoulder dislocation?
axillary
92
what else should u consider in someone with acute lower back pain
AAA
93
red flags of back pain
```
extremes of ages
thoracic pain
night pain
fever, sweats, weight loss
hx of Ca
immunosuppresion
neurological deficit
```
94
yellow flags of back pain
emotional problems
| work related/compensation issues
95
what is radical back pain
when pain follows nerve root distribution down the legs
96
what scan is best for back
MRI
97
what is the imaging mark of disc degeneration
narrowed disc space leads to lucency in between vertebrae due to air
98
what does a T2 MRI show?
water
99
how to conduct spin exam
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
what does dorsiflexion of the big toe in a spinal exam test?
L5
101
how to conduct shoulder exam?
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
what is reactive arthritis?
acute polyarticular autoimmune inflammatory arthritis
associated with STI or GI infection
103
classical triad of reactive arthritis
can't pee - urethritis
can't see - conjunctivities
can't bend the knee - acute arthritis
104
which joints typically affected in reactive arthritis?
knee and ankle
105
how to investigate suspected reactive arthritis (e.g high risk of STI)
```
joint aspirate -> aseptic
raised ESR and CRP
STI testing
stool culture (GI infection)
```
106
common features of reactive arthritis
```
urethritis
conjunctivitis
diarrhea
acute assymetrical polyarthritis
brown plaques on sole
```
107
what is found in a gout joint aspirate
negatively birefringent needle crystals
polymorphonuclear cells
no bacteria culture
108
which genetic HLA types are associated with severe RA?
HLA DR4 and DR1
109
systemic features of rheumatoid arthritis?
```
fatigue
feeling unwell (flu-like sx)
fever
sweats
weight loss
```
110
describe swan neck and boutonniere deformity
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
what is palindromic rheumatoid arthritis?
acute onset monoarticular joint pain and systemic illness
112
who is more susceptible to palindromic RA?
men
113
eye complications of RA?
sjogren's, scleritis, episcleritis
114
where can you find rheumatoid nodules?
elbow, wrists, eyes, lung, heart
115
pulmonary complications of rheumatoid arthritis?
pulmonary fibrosis, obliterative bronchiolitis, caplan's syndrome
116
what is caplan's syndrome
rheumatoid arthritis associated with pneumoconiosis. patients present with cough, shortness of breath, crackles on asucultation and pulmonary nodules on CXR
117
what are common liver complication of RA?
mild hepatomegaly
| abnormal transaminase
118
diagnostic test for RA?
anti-CCP
119
first line investigation for someone suspected of having RA? with clinical signs of synovitis
rheumatoid factor
120
what is the monitoring score method for someone with RA?
DAS28
121
what do DAS28 scores mean?
≥ 5.1 implies active disease,
<3.2 well-controlled disease,
< 2.6 remission
122
carpal tunnel syndrome is a complication of RA - T or F
T
