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GP FELLOWSHIP RNZGP > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Mortons neuroma clinical sign

A

Mulder’s sign

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2
Q

Pagets investigations

A

ALP
P1NP (bone specific ALP)
Xray

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3
Q

Treatment of Paget’s

A

Bisphosphonates:
Zoledronic acid the best

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4
Q

Clinical features of Paget’s

A

Skull enlargement: Headache, hat size increase, facial appearance change

Fractures

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5
Q

Risk factors for osteoporosis (in >60 men or >50 for women)

A
  • Smoking
  • etOH >4std /day
  • family hx fracture
  • Vit D deficiency
  • BMI <20
  • recurrent falls
  • immobility
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6
Q

Causes of secondary osteoporosis

A
  • Corticosteroid use (7.5mg for 3 months)
  • Endocrine conditions: hypogonadism, cushings, hyperparathyroidism, hyperthyroidism)
  • premature menopause
  • AN with amenorrhoea >12 months
  • RA
  • CKD, CLD
  • Coeliac
  • DM (1 or 2)
  • MM or MGUS
  • HIV
  • Medications: anti-epileptics, anti-rejection therapy, aromatase inhibitors, anti-androgens, excessive thyroxine
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7
Q

Saturday night palsy approach

A
  • Nerve conduction studies
  • Physiotherapy

Mean recover 3-4 months

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8
Q

Radial nerve clinical exam

A

Wrist and finger extension
THUMBS UP

Sensation:
Webspace - 1st dorsal

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9
Q

Median nerve clinical exam

A

Pincer function
“A OK sign “

Senation: index finger volar tip

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10
Q

Ulnar nerve clinical exam

A

Finger adduction and abduction

Sensation: Little finger volar tip

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11
Q

Restless leg syndrome history questions

A

Restless legs character ‘URGE’
- Urge to move
- Rest induces symptoms
- Gets better with activity
- Evening worse

Rule out other causes
- Cramps
- Restlessness during the day (akathisia)
- Pain on exertion (PVD)
- Numbness

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12
Q

Medications that worsen restless legs

A
  • Sedating antihistamines
  • Metaclopramide (dopamine agonist)
  • Mirtazepine
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13
Q

Tests for restless legs

A

EUC
B12 - peripheral neuropathy
Iron - associated with RLS
Hba1c
FBC - anaemia may contribute

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14
Q

Treatment for restless leg syndrome (non pharmacological)

A

Distracting activities (crosswords)
Regular exercise (30mins/day)
Stretching
Keep legs cooler than rest of body
No caffeine
No etOH

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15
Q

Rest less legs treatment (pharmacological)

A

MILD
Levodopa & Benserzide (100mg /25mg) nocte

SEVERE
Pregabalin 75mg nocte
or
Gabapentin 100mg
or
Pramipexole 0.125mg (not in risk of gambling, addicts)

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16
Q

Special tests for ankle injury

A

Positive anterior drawer test: ruptured ATFL

Lateral talar tilt test: ruptured ATFL and CFL

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17
Q

Name these fractures (hint: first one fine)

A
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18
Q

Jone’s fracture: where and management

A
  • 5th metatarsal (proximal diaphyseal region)
  • Surgical due to risk of malunion
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19
Q

Plantar fasciitis management

A
  • Rest
  • Simple analgesia
  • Ice after activity
  • Stretches: soleus, gastroc & achilles
  • Podiatry referral
    –> then cortisone injection
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20
Q

Differentials for plantar fasciitis/heel pain

A
  • Calcaneal (specify which side) stress fracture
  • Calcaneal fat pad syndrome/atrophy
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21
Q

Posterior heel pain differentials

A
  • Achilles tendinitis
  • Retrocalcaneal bursitis
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22
Q

Age for perthes

A

3-12 yrs old

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23
Q

Type of imaging for suspected spinal epidural abscess

A

MRI with gadolinium contrast

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24
Q

Paediatric proximal humeral fracture indications for ORIF

A

<12 yrs old:
60 deg angulation
50% displacement

> 12
30 deg angulation
30 % displacement

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25
Q

Wrist extension and finger: which nerve

A

Radial

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26
Q

Risk factors for SUFE

A
  • Afrocarribean
  • Obestity
  • Radiation or chemo
  • Hypothryoidism
  • Hypoputitarism
  • Hyperparathryoidism
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27
Q

Sign on xray for SUFE

A

Trethowan sign

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28
Q

SALTER HARRIS types of fractures

A
29
Q

Red flag fractures for NAI

A

Metaphyseal fractures
Rib (esp posterior)
Scapular
Sternal

30
Q

Lisfranc injury definition

A

Injury to tarsometatarsal joint complex

Tarsometatarsal fracture dislocation - disruption between articulation of medial cuneiform & base of the 2nd MT

31
Q

Fibromyalgia pharmacotherapy

A

First line TCA:
Amitryptiliine 10-25mg nocte

If concurrent depression or if wanting SNRI
Then Duloxetine 30mg

If not tolerating TCA
Then gabapentin 100-300mg or pregabalin 25-75mg

32
Q

Examination for De Querviain’s

A
  • Finkelstein test positive
33
Q

Medial ankle tendinopathy

A
  • Tibialis posterior tendinopathy
  • Flexor hallicus longus tendinopathy
34
Q

Clinical features of Tibialis posterior tendinopathy

A

-
- Pain on eversion !!!!
- Pain medial ankle
- Weakness in medial ankle and foot
- Standing on toes painful
- Common in dancers and those with flat feet

35
Q

Clinical features of Tibialis posterior tendon rupture:

A
  • Too many toes sign
  • Flat foot (abnormal)
36
Q

Flexor hallicus longus tendinitis clinical features

A

Pain with great toe flexion on exam

37
Q

Tarsal Tunnel syndrome clinical features

A
  • Burning toe and sole of the foot
38
Q

Young people (7-15yrs old) with posteroinferior heel pain most likely ddx

A

Sever’s disease (Calcaneal apophysitis)

39
Q

Young people (7-15yrs old) with posteroinferior heel pain most likely ddx

A

Sever’s disease (Calcaneal apophysitis)

40
Q

Bruise in the arch of the foot- diagnosis

A

Lisfranc injury

41
Q

What am I

A

Osteoid Osteoma

42
Q

What is a monkey muscle tear?

A

Rupture of medial head of Gastrocnemius
(ddx achilles tendon rupture)

43
Q

Jumper’s knee (patella tendinopathy) key features

A

Pain below the knee
Jumping exercises

44
Q

Iliotibial band syndrome key features

A
  • Pain with heel strike
  • Think in runners
  • pain on lateral edge of knee
45
Q

Mechanisms for development of bursitis

A
  • Prolonged pressure (eg elbow on desk)
  • Overuse or strenuous activity
  • Crystal- induced arthropathy
  • Inflammatory arthritis
46
Q

Olecranon bursitis management

A
  • Compression bandage
  • Corticosteroid injection
  • Drainage (if painful) controversial
  • NSAID
47
Q

Causes for Carpal Tunnel Syndrome

A
  • Pregnancy
  • Idiopathic
  • Hypothyroidism
  • Diabetes mellitus
  • Occupational: repetitive work with flexed wrists
  • Tophaceous gout
48
Q

Pain and tenderness of 2nd and 3rd MTPJs diagnosis not to miss

A

Hereditary Haemochromatosis

49
Q

Reynauds pharmacological management

A

Amlodipine 5mg -10mg
or
Nifedipine 30mg-120mg

50
Q

Investigations for pseudogout (CPPD)

A

Weakly positively birefringent crystals

CMP
ALP
PTH
IRON STUDIES

51
Q

DVT dose of anticoagulant (apixaban)

A

10mg BD for 7 days then5mg BD

52
Q

What type of fracture are you thinking of?

A

Orbital blowout fracture
or
Orbito-zygomatic fracture

53
Q

Knocked knees when to refer

A
  • Persistent beyond 8yrs old
  • Intermalleloar space >8cm
  • Asymmetrical
  • Progressive
  • Other issue in addition eg: height <5th centile

** also do xray

54
Q

Osteoporosis non-pharmacological

A
  • Weight bearing impact loading exercise guided by AEP
  • Smoking cessation
  • etOH reduction
  • Dietary calcium 1300mg
  • 5-10mins sun exposure most days for vit D
  • OT assessment for falls risk reduction
55
Q

Empty can test for…

A

Supraspinatus tear

56
Q

Osteopenia/porosis, amenorrhea, disordered eating.

WHAT AM I?

A

Female athlete triad syndrome

Relative energy deficient syndrome

57
Q

C7 Radiculopathy signs

A

SENSATION
Palm, index middle finger (almost median)

POWER
- Elbow & wrist extension
- Forearm pronation
- Wrist Flexion

REFLEX
- Triceps

58
Q

What is this called?
What other imaging would you do?

A

Consider Maisonneuve fracture

Needs proximal fibula to be imaged

59
Q

What is this called?
What other imaging would you do?

A

Consider Maisonneuve fracture

Needs proximal fibula to be imaged

60
Q

Monteggia fracture what is it?

What to do?

A

ULNAR fracture
Radial head dislocation

EMERGENCY urgent intervention

61
Q

Physical exam findings of anterior shoulder dislocation ?

A
  • Arm in slight abduction and external rotation
  • Humeral head palpable anterior to glenohumeral fossa
  • Reduced global ROM
  • Loss of normal deltoid contour
62
Q

Complications/risks of corticosteroid injection ?

A
  • Joint infection
  • Fat pad atrophy
  • Tendon rupture
  • Allergic reaction
  • Vagal response
  • Haemarthroses of specific joint
63
Q

What to do with this fracture? What is it?

A

ED for urgent reduction
Monteggia

64
Q

What type of 5th metatarsal fracture needs referral ?

A
  • JONES (Proximal diaphysis)
  • Angulated midshaft
65
Q

Mallet finger indications for surgical management

A
  • > 30% articular surface
  • volar subluxation
66
Q

L5 dermatome
L5 myotome

A

Dorsum of foot

Dorsiflexion big toe and ankle

67
Q

L3/4 dermatome
L3/4 myotome

A

Anterolateral thigh

Knee extension

68
Q

S1 dermatome
S1 myotome

A

Sole of foot

Ankle plantar flexion

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