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Phase 2 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What are the risk factors for a NOF fracture?

A
  1. Osteoporosis/osteopenia
  2. older age → > 65
  3. female sex
  4. height >5’8
  5. high energy trauma in young patients
  6. Estrogen deficiency
  7. Low body weight
  8. Poor nutrition → vitamin D or calcium deficiency
  9. anything that increases falls risk
    1. muscle weakness
    2. difficulty walking and impaired coordination
    3. vision loss
  10. smoking and alcohol use
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2
Q

what comorbidities might contribute to a #NOF?

A
  1. anaemia
  2. diabetes → diabetic neuropathy
  3. arrhythmia → syncopal episodes
  4. dementia → confusion
  5. infections → delirium
  6. medications
  7. functional status → Previous CVA → vision, gait disturbance etc
  8. environment → loose carpets, stairs etc`
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3
Q

What Investigations should be ordered for #NOF and why?

A

Bloods

  1. Group and hold → need surgery and also can bleed massively from broken bone
  2. Coags → surgery
  3. FBC → anaemia check, platelet level check, WBCs for infection check

Biochemistry

  1. CMP → calcium and phosphate to look at levels if contributed to osteoporosis
  2. UECs → hyponatreamia, hypokalaemia can contribute to falls risk
  3. iron studies
  4. LFTs
  5. PTH
  6. TFTs
  7. Vitamin B12 and folate
  8. Vitamin D level

Bedside

  1. UA → infection
  2. ECG → arrhythmia cause
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4
Q

What are the 4 features seen on Xray for a NOF?

A
  1. Interruption of Shenton’s line
    → inferomedial femoral neck to superior pubic ramus
  2. increased density of bone due to impaction at the fracture site
  3. any breach of the bone cortex either medially or laterally
  4. on lateral view → anterior displacement of femoral shaft or neck relative to the head
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5
Q

What are the main principles of management for a NOF?

A
  1. ABCDE assessment
  2. Consult orthopaedics urgently
  3. Analgesia
    • paracetamol, opioids, femoral nerve block (especially in elderly to reduce delirium)/Fascia Iliaca Block
      • With ropivacaine
  4. Management of fluid status and insertion of IDC
  5. Surgical interventions
  6. early PT and OT
  7. mobilising D1PO
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6
Q

How do you treat hyperkalaemia?

A

salbutamol
resonium
Normal saline fluids

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7
Q

What are the high risk medications for causing falls?

A
  • Antihypertensives
  • anticholinergics
  • benzodiazepines
  • neuroleptics
  • antidepressants
  • anticonvulsants
  • antiarhythmics
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8
Q

What medications increase risk of osteoporosis?

A
  • glucocorticoids

- anticonsulsants

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9
Q

What are some secondary causes of osteoporosis?

A
  1. hyperthyroidism, hyperPTH, chronic inflammatory conditions
  2. liver failure, renal failure
  3. Malabsorption, multiple myeloma
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10
Q

what are DDx for monoarthritis that is hot, red and swollen?

A
  1. septic arthritis
  2. traumatic
  3. Gout or pseudogout
  4. Haemarthrosis
  5. seronegative spondylarthropathies
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11
Q

What are causes of carpal tunnel syndrome?

A
  1. occupation related
  2. RA
  3. Hypothyroidism
  4. acromegaly
  5. pregnancy
  6. Gout
  7. Obesity
  8. Amyloidosis
  9. DM
  10. Idiopathic
  11. Carpal bone osteomyelitis
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12
Q

What are the antibodies to order for RA investigation?

A
  • Rheumatoid factor and anti-ccp, ANA
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13
Q

What are the early and late signs of RA on xray?

A

Early signs

  1. soft tissue swelling
  2. juxta-articular osteopenia

Late signs

  1. joint space narrowing
  2. marginal bone/cartilage erosions
  3. generalised osteopenia
  4. subchondral cysts
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14
Q

What are examples of conventional DMARDs used in RA treatment?

A
  • methotrexate
  • hydroxychloroquine
  • sulfasalazine
  • leflunomide
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15
Q

Biologic DMARDs examples

A
  • TNF-a inhibitors → mabs
  • B-cell inhibitors
  • T cell inhibitors
  • IL-1 or 6 inhibitors
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16
Q

What comorbidities increase the risk of carpal tunnel?

A
  • RA, OA, hypothryoidism, diabetes, acromegaly
17
Q

What are signs and symptoms of carpal tunnel?

A
  1. burning, tingling pain and loss of sensation in the distribution of the median nerve
  2. gradual onset with symptoms worsening at night and relieved by shaking or flicking the wrist
  3. positive phalens and tinels signs
  4. thenar atrophy
  5. weakened pinch grip → patient may report dropping objects
18
Q

DDx for carpal tunnel?

A
  1. radiculopathy → C6 and C7
  2. ulnar neuropathy
  3. stroke
  4. osteoarthritis
  5. multiple sclerosis
  6. De Quervains Tenosynovitis
19
Q

What is the number 1 investigation for carpal tunnel?

A
  1. electomyography or nerve conduction studies
    • localises nerve damage to median nerve in carpal tunnel
    • categorises severity of damage to guide management
20
Q

what are 5 strategies/ options for management of carpal tunnel → increasingly more invasive?

A
  1. Splinting and hand braces → worn at night
  2. Physiotherapy/OT options for increased protective movements for hands
  3. NSAIDs for pain relief
  4. corticosteroid injections for up to 1 month relief
  5. surgical intervention to release flexor retinaculum in refractory patients.
21
Q

What are the two defining features of the seronegative spondylarthropathies?

A
  • mainly affect the vertebral column
  • associated with HLA-B27
  • Absence of rheumatoid factor
22
Q

what are common pathogens of the urinary and git systems that cause reactive arthritis?

A
  1. Urinary
    • chlamydia
  2. Gastrointestinal
    • shigella
    • yersinia
    • salmonella
    • campylobacter
23
Q

what is the classic triad of reactive arthritis?

A
  1. uveitis
  2. urethritis
  3. arthritis
    - symptoms preceding infection → diarrhoea, dysuria, urethritis
24
Q

what are some diagnositic tests available for reactive arthritis?

A
  1. raised inflammatory markers
  2. genetic testing for HLA-B27
  3. arthrocentesis
    • leukocytosis → mainly PMNs
    • culutres and gram stains should be negative
25
Q

what are 3 main methods for symptom control and treatment of Reactive arthritis?

A

typically resolves spontaneously within a year, but high reoccurance rate

  1. NSAIDS and physiotherapy
  2. glucocorticoids
  3. DMARDs in chronic cases
26
Q

what are non-pharmacological strategies for Ankylosing spondylitis management?

A
  1. physiotherapy
  2. smoking cessation
  3. screening and treating for osteoporosis
27
Q

What are pharmacological/surgical management options for ankylosing spondylitis?

A
  1. NSAIDs
  2. TNF-a inhibitors → adalimumab
  3. DMARDs or intra-articular glucocorticoids in refractory or severe symptoms
  4. surgical hip arthroplasty, spinal osteotomy to improve QOL in patient with severe disease
28
Q

What are the 5 classes of drugs for osteoporosis and examples?

A
  1. Bisphosphonates -> inhibit osteoclasts -> alendronate, risedronate
  2. Denosumab -> monoclonal Ab that inhibits RANK-L
  3. Teriparatide -> Synthetic PTH
  4. HRT
  5. Raloxifene -> Selective oestrogen receptor modulator

Phase 2 (10 decks)

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