Musculoskeletal Flashcards
On what movement does subacromial impingement cause pain?
Shoulder abduction, between 60 and 120 degrees
What feature of ank spond might distinguish it from other pathology?
Pain at night that improves on getting up
What is an intracapsular fracture?
From the edge of the femoral head to the insertion of the capsule of the hip joint
What is an extracapsular fracture?
Either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)
What is a Garden system type I fracture?
Stable fracture with impaction in valgus
What is a Garden system type II fracture?
Complete fracture but undisplaced
What is a Garden system type III fracture?
Displaced fracture, usually rotated and angulated, but still has boney contact
What is a Garden system type IV fracture?
Complete boney disruption
What is a heliotrope rash?
A purplish rash to the eye lids seen in dermatomyositis
What are Gottron’s papules?
Roughened red papules over the extensor surfaces of the fingers seen in dermatomyositis
What are the Ottawa Rules for ankle x-rays?
Pain in the malleolar zone plus any one of the following:
Bony tenderness at the lateral malleolar zone
Bony tenderness at the medial malleolar zone
Inability to walk four weight bearing steps immediately after the injury and in the ED
What skin change is most associated with antiphospholipid syndrome?
Livedo reticularis
Which organism is most commonly indicated in discitis?
S aureus
For how many months must symptoms persist to be termed chronic fatigue?
4 months
How should polymyalgia rheumatica (PMR) be treated?
Steroids - should be a rapid improvement in symptoms (within a week) - failure to respond rapidly should result i in considerations of alternative diagnoses
How raised is ESR in PMR?
> 40
When in pain elicited most in lateral epicondylitis?
Resisted wrist extension/supination whilst elbow extended
What is lateral epicondylitis also known as?
Tennis elbow
When in pain elicited most in medial epicondylitis?
Pain is elicited during wrist flexion and pronation
What is medial epicondylitis also known as?
Golfer’s elbow
What are the conditions where doctors should offer immediate bone protection on commencement of long-term steroids?
Pt >65, or those that have previously suffered fractures - offer alendronate and ensure calcium and vitamin D replete
Pt’s <65 should be offered a bone density scan instead
How should you manage a pt according to their T-score in bone density scanning?
> 0 = reassure
0 - -1.5 = repeat scan in 1-3 years
< -1.5 = offer bone protection
What proportion of talipes is bilateral?
50%
Using the Ponseti method, after how long is talipes usually corrected after birth?
6-10 weeks
For how long should night-time braces be worn by children with talipes?
Up to the age of 4
What is the most common cause of talipes?
Idiopathic
What is the main S/E of colchicine?
Diarrhoea
What is the pathopneumonic feature of pseduogout?
Chrondrocalcinosis on XR - presents as ‘linear calcifications of the articular cartilage’
What are the RFs for the development of pseudogout at <50 y/o?
Haemochromatosis Hyperparathyroidism Low magnesium, low phosphate Acromegaly Wilson's disease
What type of crystals are deposited in the synovium in pseudogout?
Calcium pyrophosphate crystals
What are type I hypersensitivity reactions?
Anaphylaxis - antigen reacts with IgE bound to mast cells
What are type II hypersensitivity reactions?
Cell bound - IgG or OgM binds to antigen on cell surface
What are type III hypersensitivity reactions?
Immune complex - free antigen and antibody combine
What are type IV hypersensitivity reactions?
Delayed hypersensitivity - T-cell mediated
Graves disease and MG are examples of which type of hypersensitivity reaction?
Type V
What are the 4 features of osteoarthritis on XR?
Decrease of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes forming at joint margins
What is meralgia parasthetica caused by?
Lateral cutaneous nerve of thigh compression
What are myxoid cysts?
Also known as mucous cysts, they are benign ganglion cysts usually found on the distal, dorsal aspect of the finger. There is usually osteoarthritis in the surrounding joint
What anti-rheumatic drug should be avoided in pt’s with aspirin allergy?
Sulphasalazine
What is the risk associated with a scaphoid fracture?
Risk of avascular necrosis due to the blood supply to the scaphoid bone
What are the poor prognostic features of RA?
Rheumatoid factor positive Anti-CCP antibodies Poor functional status at presentation X-ray: early erosions (e.g. after < 2 years) Extra articular features e.g. nodules HLA DR4 iInsidious onset
What is tested for McMurray’s Test?
Meniscal tears
What can alendronate be switched for when significant upper GI side effects are experienced?
Risedronate or etidronate
Which test may be positive in referred lumbar spine pain?
Femoral nerve stretch test may be positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped
What are the red flags for back pain?
Age < 20 years or > 50 years History of previous malignancy Night pain History of trauma Systemically unwell e.g. weight loss, fever
How is the femoral head epiphysis displaced in SUFE?
Postero-inferiorly
What is the most common cause of posterior heel pain?
Achilles tendon disorders
What are the features of ank spond?
The A’s =
- Apical fibrosis
- Anterior uveitis
- Aortic regurgitation
- Achilles tendonitis
- AV node block
- Amyloidosis
What are common features of meniscal tears?
Knee locking and feeling of ‘giving way’
What are the classical features of untreated Paget’s disease of the bone?
Bowing of tibia
Bossing of skull
What is meant by ‘Finkelstein test positive’?
Pain over her radial styloid on forced abduction/flexion of the thumb
In what condition is Finkelstein test positive?
De Quervain’s tenosynovitis
When does chondromalacia patellae (patellofemoral pain syndrome) classically cause pain?
Anterior knee pain on walking up and down stairs and rising from prolonged sitting.
Is azathioprine safe in pregnancy?
Yes
What is the classical description of pain in iliotibial band syndrome?
Tenderness 2-3cm above the lateral joint line
What are the most common causes of drug-induced lupus?
Procainamide
Hydralazine
How is Paget’s disease of the bone treated?
Bisphosphonates - e.g. alendronate
What should be done with regard to allopurinol prophylaxis in acute gout flares?
Allopurinol should be continued at normal dose during a gout flare
Within what age range is the FRAX tool valid?
Age 40-90 years old
What are the conditions for which NICE recommends a DEXA scan rather than clinical risk score?
- Before starting treatments that may have a rapid adverse effect on bone density
- In people <40 y/o who have a major risk factor, such as history of multiple fragility fracture, major osteoporotic fracture, or current or recent use of high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer)
Which nerve root compressions will result in a positive femoral stretch test?
L3 or L4
Which nerve root compression will result in a positive sciatic nerve stretch test?
L5 or S1
What is a flattened deltoid as a result of?
Axillary nerve damage - C5-C6 - may occur as a result of a humeral neck fracture or dislocation
What does radial nerve palsy result in?
Wrist drop (radial nerve = C5-C8) - may occur as a result of a humeral mid-shaft fracture
Damage to what may result in carpel tunnel syndrome?
Median nerve - C6, C8, T1
What is ‘claw hand’ as a result of?
Damage to the ulnar nerve - C8, T1 - may occur as a result of medial epicondyle fracture
What is ‘winged scapula’ as a result of?
Long thoracic nerve - C5-C7 - may occur during sport (e.g. following a blow to the ribs), or as a complication of mastectomy
What is ‘waiter’s tip’ as a result of?
Erb-Duchenne palsy - damage to C5-C6 of the brachial plexus, may be secondary to shoulder dystocia during birth
What is Klumpke injury as a result of?
Due to damage of the lower trunk of the brachial plexus - C8, T1 - may be secondary to shoulder dystocia or a sudden upward movement of the hand. It is associated with Horner’s syndrome
What are the XR changes seen in rheumatoid arthritis?
Early findings:
- Loss of joint space
- Juxta-articular osteoporosis
- Soft-tissue swelling
Late findings:
- Periarticular erosions
- Subluxation
Which drugs can precipitate gout?
Thiazides Furosemide Ciclosporin Alcohol Cytotoxic agents Pyrazinamide Aspirin
What should be tested for before prescribing azathioprine?
Thiopurine methyltransferase (TPMT) - deficiency in this can lead to myelosuppression, and thus predict pt’s whom are at increased risk of azathioprine toxicity
What is the most common responsible organism for osteomyelitis in most patients?
S. aureus
What is the most common responsible organism for osteomyelitis in sickle cell patients?
Salmonella
What is the most common reason total hip replacements need revision?
Aseptic loosening
What scale is used to measure disease activity in rheumatoid arthritis?
DAS28
How can you differentiate between acute compartment syndrome and a DVT?
Acute compartment syndrome = pain rapidly increases - ‘out-of-proportion’ - and pain on passive extension. Pain on passive dorsiflexion is Homan’s sign and more indicative of DVT
Where in the world is Bechet’s disease more common?
Turkey, Iran and Japan
What is mononeuritis multiplex?
A neuropathy of two or more non-anatomically related peripheral nerves - diabetes and RA are a common cause - most cases result in full spontaneous recovery in 3-6 months
When should prophylactic treatment be started in relation to an acute attack of gout?
1-2 weeks or it can exacerbate the acute episode
Which test will be positive in De Quervain’s tenosynovitis?
Finkelstein’s test (resisted abduction to the thumb is painful in a +ve test)
Which nerve is at risk in an anterior shoulder dislocation?
Axillary nerve - damage results in decreased sensation over the deltoid muscle and weakness
How may cluster headaches be treated acutely?
Intranasal sumitriptan
Home oxygen - not suitable for smokers
What type of fracture occurs in children as a result of FOOSH?
Supracondylar fracture of humerus
Which autoantibodies are associated with SLE?
ANA Anti-dsDNA Anti-Ro Anti-Sm Anti-La
Which autoantibodies are associated with systemic sclerosis?
ACA Anti-ScL-70 Anti-RNA polymerase ANA - 95% RhF - 30%
How do you manage an undisplaced intracapsular fracture?
Cannulated screw or replacement (preferred)
How do you manage a displaced intracapsular fracture?
Hemiarthropathy or THR
How do you manage an extracapsular fracture?
Cannulated screw
How do you manage an extracapsular fracture that is either peritrochanteric or intertrochanteric?
Dynamic Hip Screw
What is the name of a long-standing ulcer in which an SCC is found?
Marjolin’s ulcer
Does a negative temporal artery biopsy exclude GCA? And why?
No, because skip lesions are common
How do patient’s present with patella dislocation?
Knee held in flexion, patella laterally dislocated, usually teenage girls
What are gout deposits made up of?
Monosodium urate
How do gout crystals appear?
Needle-shaped negatively birefringent crystals
Which autoantibody has 95% sensitivity for SLE?
ANA
When would Simmonds test (for Achilles tendon rupture) be considered positive?
Absence of normal plantar flexion on squeezing the calf muscle indicates a complete tendon rupture
How would you investigate an Achilles Tendon Rupture?
USS (MRI if the diagnosis were unclear, e.g. Simmonds test wasn’t positive)
What type of fracture causes a dinner-fork deformity?
Colles’ fracture (of the wrist)
What is Gamekeepers Thumb also known as?
Skiers Thumb
What types of fracture might result from a FOOSH (wrist in flexion)?
Falling on the hand outward = Colles’ (of the wrist)
Falling on the hand inward = Smith’s fracture (of the wrist)
What is the most prevalent finger tendon injury in sport?
Mallet finger
What is the most common type of metacarpal fracture?
Boxer’s fracture
Should glucosamine and/or chondroitin supplements be used in OA?
No
What is the most common type of shoulder dislocation?
Anterior - 95% of the time
How does an anterior shoulder dislocation appear on XR?
AP XR - humeral head lies under the coracoid process
What is spondylolisthesis?
Slippage of a vertebrae, usually forward, relative to the vertebrae below?
What injury tends to occur in children when they FOOSH?
Supracondylar fracture (BE AWARE OF NEUROVASCULAR STATUS)
What posture may people with ank spond presnt with?
Question-mark posture
What is Mondor sign? And what is it pathognomonic for?
= bruising that tracts distally to the sole of the foot. Sign of calcaneal fracture
What is CREST syndrome also called?
Limited cutaneous systemic sclerosis
Which autoantibodies are are associated with CREST syndrome?
Anti-nuclear and anti-centromere antibodies
Which auto-antibody is most specific for RA?
Anti-CPP
What is Lachman’s test testing for?
Anterior cruciate ligament (ACL) injury of the knee
What is a bumper fracture also known as?
Tibial plateau fracture
What is a common complication of a scaphoid fracture?
Avascular necrosis