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Musculoskeletal 2 Flashcards

1
Q

Bowing of tibia, bossing of skull =

A

Paget’s disease

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2
Q

What foods should you avoid in gout?

A

Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products

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3
Q

How long should the symptoms be present for before a diagnosis of chronic fatigue can be made?

A

4 months

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4
Q

Name two RF for tendinopathies

A
  1. Quinolone use

2. High cholesterol

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5
Q

Name two features for achilles tendonitis

A
  1. Posterior heel pain

2. Morning pain and stiffness

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6
Q 
Achilles tendonitis
Diagnostic Ix (1)
Mx (3)
A

USS

  1. Simple analgesia
  2. Reduction in activities that trigger pain
  3. Calf muscle eccentric exercises
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7
Q

Pop in the ankle, sudden onset severe pain, unable to walk/ continue with activity =

A

achilles tendon rupture

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8
Q

Simmond’s triad checks for (1)

What are the three tests?

A

Achilles tendon rupture

  1. Calf squeeze
  2. Greater dorsiflexion when feet over bed in prone position
  3. Feel for gap in tendon
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9
Q

What is the most commonly sprained ankle ligament?
Invert or evert?
Mx

A

Anterior talofibular ligament
(Lower)
Invert

Mx

  1. RICE
  2. Can use removable orthosis/ splint/ crutches if needed
  3. If pain not resolving consider MRI
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10
Q

What are the grades of a lower ankle sprain

A

I micro tear, mild pain + swelling, nil pain on weight bearing
II partial tear, mod pain + swelling, minimal pain on weight bearing
III complete tear, severe pain + swelling, severe pain on weight bearing

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11
Q

High ankle sprain = injury to?

Low ankle sprain = injury to?

A
  1. Syndesmosis

2. Lateral collateral ligaments

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12
Q

Mechanism of injury to syndesmosis

A

External rotation of the foot

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13
Q

What is the Hopkin’s squeeze test?

What injury do you see it in?

A

Pain on squeezing tibia and fibula together

High ankle sprains

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14
Q

What might you see on high ankle sprains xray?

Mx (2)

A

Diastasis - widening of tibiofibular joint

Mx

  1. If nil diastasis - non-weight-bearing orthosis or cast until pain subsides
  2. If diastasis or failed non operative management then for operative fixation
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15
Q

What is a Boxer’s fracture

A

A minimally displaced fracture of the fifth metacarpal

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16
Q

A minimally displaced fracture of the fifth metacarpal is also known as

A

Boxer’s fracture

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17
Q

What nerve is compressed in cubital tunnel syndrome?

A

Ulnar nerve

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18
Q

Name four features of cubital tunnel syndrome

A
  1. Tingling/ pins and needles in 5th and 4th finger, intermittent then constant
  2. Pain worse on leaning on elbow
  3. Hx of OA or trauma to area
  4. Weakness and muscle wasting
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19
Q

Mx cubital tunnel syndrome (4)

A

Avoid aggravating activity
Physiotherapy
Steroid injections
Surgery in resistant cases

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20
Q

De Quervain’s tenosynovitis
Inflammation of what two muscles?
F/M
Age

A

Extensor pollicis brevis and longus
F>M
30-50yo

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21
Q

Explain Finkelsteins test

What is it used for?

A

Pull thumb towards ulnar with wrist - pain at radial styloid process
De Quervain’s tenosynovitis

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22
Q

Name three features of De Quervain’s tenosynovitis

A
  1. Tenderness at radial styloid process
  2. Pain at radial side of wrist
  3. Abduction of the thumb against resistance is painful
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23
Q

Management of De Quervain’s tenosynovitis (4)

A
  1. Simple analgesia
  2. Steroid injection
  3. Immobilisation with a thumb splint (spica)
  4. Surgical mx
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24
Q

Most common cause of bacterial discitis?

A

Staph Aureus

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25
Q

Name two investigations to diagnose discitis

A
  1. MRI

2. CT guided biopsy to assess which abx is needed

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26
Q

List five causes of Duputren’s contracture
(DAMPt)

Mx

A
  1. DM
  2. Alcoholic liver disease
  3. Manual labour
  4. Phenytoin
  5. Trauma

DAMPT

Mx - if loss of function then for surgery

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27
Q

What is golfer’s elbow?

What movements elicit pain?

A

Medial epicondylitis

Wrist flexion and pronation

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28
Q

What is radial turn syndrome?

Which movements elicit pain?

A

Pain tends to be around 4-5 cm distal to the lateral epicondyle
Extension of elbow and pronation of the forearm

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29
Q

What is greater trochanteric pain syndrome/ trochanteric bursitis caused by?

Features (2)
F/M
Age

A

Repeated movement of the fibroelastic iliotibial band

Features 
1. Greater trochanter tenderness
2. Pain along iliotibial band/ lateral side of hip/ thigh
F>M
50-70yo
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30
Q

What is Barlow’s and Ortalani’s test for?
Name a feature (1)
Age group

A

Development dysplasia of the hip
Skin folds unequal
Newborn

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31
Q

What is transient synovitis?

Common age group

A

Acute hip pain associated with viral infection
Commonest cause of hip pain in children
2-10yo

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32
Q

What is Perthe’s disease?

Common age group?

A

Avascular necrosis of the femoral head

4-8yo

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33
Q

What are the common features in slipped upper femoral epiphysis? (3)
Age group

A
  1. Obesity
  2. Knee or distal thigh pain
  3. Loss of internal rotation in leg flexion
    10-15yo
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34
Q

How many joints are affected in juvenile idiopathic arthritis (JIA)?
Which joints are usually affected?
Age

A
  1. <= 4 joints only
  2. Middle sized joints e.g knee, ankle, elbow
    <16yo
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35
Q

Lateral knee pain in runners =

Mx

A

Iliotibial band pain
Mx
1. Activity modification and stretches
2. Physio

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36
Q

What movement will give you a meniscal tear?

Name four features

A

Twisting injury

  1. Tenderness along joint line
  2. Pain on knee extension
  3. Knee locking
  4. Knee may give way
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37
Q

Weight bearing at 20 degrees of knee flexion, patient supported by doctor, positive if pain on twisting knee is what test?

A

Thelassy’s test

Used to assess for meniscal tears

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38
Q

What is infrapatellar bursitis associated with?

A

Kneeling

Clergyman’s knee

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39
Q

What is clergyman’s knee?

A

Infrapatellar bursitis

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40
Q

What is housemaids knee?

A

Prepatellar bursitis

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41
Q

What is prepatellar bursitis associated with?

A

Upright kneeling

Housemaids knee

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42
Q

ACL tear features (3)

A
  1. Positive anterior draw test
  2. Twisting of knee, may hear pop
  3. Sudden knee effusion
43
Q

PCL tear features (2)

A
  1. Positive posterior draw test

2. Caused by anterior force applied to tibia

44
Q

Collateral ligament

A
  1. Tenderness over the affected ligament

2. Knee effusion may be seen

45
Q
  1. Positive anterior draw test
  2. Twisting of knee, may hear pop
  3. Sudden knee effusion
46
Q
  1. Tenderness over the affected ligament

2. Knee effusion may be seen

A

Collateral ligament tear

47
Q
  1. Positive posterior draw test

2. Caused by anterior force applied to tibia

48
Q

Name five red flags for lower back pain

A
  1. <20yo or >50yo
  2. Hx of malignancy
  3. Pain at night
  4. Hx of trauma
  5. Systemic symptoms
49
Q 
Name four features of spinal stenosis
Hint:
Type of pain
Acute/ gradual onset 
Worse by
Eased by
A
  1. Gradual onset
  2. Bilateral/ unilateral leg pain/ weakness or numbness
  3. Worse when walking
  4. Eased when sitting, leaning forward, crouching
50
Q

How do you diagnose spinal stenosis?

51
Q

1st line management for back pain

52
Q

When should you prescribe a PPI with an NSAID for lower back pain?

53
Q

Clear dermatomal leg pain associated with neurological deficits may indicate which condition?

A

Prolapsed disc

54
Q

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

55
Q

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

56
Q

How may someone with a prolapsed disc present?

A

Clear dermatomal leg pain with neurological deficits

57
Q

S1 nerve root compression

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

58
Q

L3 nerve root compression

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

59
Q

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

A

L5 nerve root compression

60
Q

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

A

S1 nerve root compression

61
Q

Mx prolapsed disc

A
  1. NSAIDs
  2. Physio + exercises
  3. If persistent after 4-6 weeks - MRI
62
Q

Mx spinal stenosis

A
  1. Laminectomy
63
Q

What is a myxoid cyst?
Where is it found?
Gender and age with what condition?

A

Benign ganglion cysts usually found on the distal, dorsal aspect of the finger
Middle aged women with OA

64
Q

Caused of olecranon bursitis

Movement of elbow should be painless/painful?

A
  1. Trauma
  2. Infection
  3. RA
  4. Gout
    Painless
65
Q

Name five signs of olecranon bursitis
If you see effusions in other joints which disease is this associated with?
If there is tophi, what disease is this associated with?

A
  1. Swelling over posterior elbow
  2. Erythema + tenderness
  3. Fluctuant, well circumscribed
  4. Appears over hours to days
  5. Skin abrasion

If RA - will have effusions in other joints
If has tophi - gout

66
Q

Hx of groin ache following exercise and relieved by rest =

67
Q

Red flags for hip pain (3)

A
  1. Pain at rest
  2. Pain at night
  3. Morning stiffness >2 hours
68
Q

Name four reasons for revision of total hip replacement

A
  1. Aseptic loosening
  2. Infection
  3. Dislocation
  4. Pain
69
Q

Name four complications post hip replacement

A
  1. Intra-op fracture
  2. Nerve injury
  3. VTE (4 weeks of LMWH)
  4. Infection
70
Q

Types of total hip replacements (3)

A
  1. Cemented
  2. Uncemented (for younger more active patients)
  3. Hip resurfacing - metal cap over the head, used in younger patients with neck intact
71
Q

Advise regarding movements post THR

A
  1. Do not sit cross legged
  2. Avoid low chairs
  3. Don’t flex hip >90 degrees
  4. Sleep on back for first 6 weeks
72
Q

What does FRAX assessment do?

A

Assesses risk of fracture within 10 years

73
Q

Name eight RF for fragility fracture

A
  1. Low BMI
  2. Prev fracture
  3. FH of fracture
  4. Use of steroids
  5. Smoking
  6. ETOH
  7. Hx of falls
  8. Secondary osteoporosis
74
Q

Results of FRAX

Reassess how often?

A

low risk: reassure and give lifestyle advice
intermediate risk: offer BMD test
high risk: offer bone protection treatment
Every 2 years

75
Q

Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Common in teenage girls

A

Patellafemoral syndrome

76
Q

Patellafemoral syndrome is also known as

A

Chondromalacia patellae

77
Q

Patellafemoral syndrome - what is it?
Who is it common in?
Mx

A

Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Common in teenage girls
Mx physio

78
Q

What is adhesive capsulitis also known as?

A

Frozen shoulder

79
Q

Frozen shoulder/ adhesive capsulitis
Which movements are difficult?
Associated with which condition?

A
  1. Associated with DM

2. External rotation difficulty more than internal rotation or ABduction

80
Q

Frozen shoulder rx (4)

A
  1. NSAIDs
  2. Physio
  3. PO steroids
  4. Intra-articular steroids
81
Q

What is impingement syndrome? (3)

A

Subacromial impingement
Pain from 60-120 degrees, painful arc
Tenderness over anterior acromion

82
Q

Club foot is also known as
What is the positioning of the foot?
F/M

A

Talipes equinovarus
Inverted, plantarflexed
M>F

83
Q

Name five causes of talipes equinovarus

A
  1. Edwards syndrome
  2. Oligohydramnios
  3. Congenital contractures - arthrogryposis
  4. Cerebral palsy
  5. Spina bifida
84
Q

Congenital contractures =

A

Arthrogryposis

85
Q

Mx of talipes equinovarus (3)

A
  1. Manipulation and progressive casting which starts soon after birth - 6-10 weeks total
  2. Achilles tenotomy required (85% of cases)
  3. Night time brace until 4yo
86
Q

Trigger finger is associated with which conditions (2)

What may you find on examination? (1)

A
  1. DM
  2. RA
    Nodule may be felt at the base of the affected finger
87
Q

Mx trigger finger (3)

A
  1. Steroid injection
  2. Splint
  3. Surgery
88
Q

What is Barton’s fracture?

Type of fall

A

Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
Fall onto extended and pronated wrist

89
Q

Anatomical snuffbox pain =

A

Scaphoid fracture

90
Q

Radial head fracture features (1)

Common in which age group

A

Common in young adults

Pain at the lateral side of the elbow at the extremes of rotation (pronation and supination)

91
Q

Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
Fall onto extended and pronated wrist
=

A

Barton’s fracture

92
Q

Scaphoid fracture symptom (1)

A

anatomical snuff box pain

93
Q

Common in young adults

Pain at the lateral side of the elbow at the extremes of rotation (pronation and supination) =

A

radial head fracture

94
Q

Deltoid ligament damage in what injury

95
Q 
Osteoporosis management (3) 
When would HRT be used?
A 
If >= 75yo with fracture, or <75 with DEXA <2.5 with fracture. Vit D and calcium for all women. 
1. Alendronate - can have GI S/E
2nd line
2. Risedronate or etidronate
Third line
3. Strontium ranelate and raloxifene

HRT - if went through menopause <45yo and to take until 50yo

96
Q

Transient idiopathic osteoporosis
Which patient group?
Features (2)

A

Seen in third trimester of pregnancy
Groin pain associated with a limited range of movement in the hip
May be unable to weight bear
ESR elevated

97
Q

Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years

A

Greater trochanteric bursitis

98
Q

Greater trochanteric bursitis
Features (2)
M/F
Age group

A

Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years

99
Q

Femoroacetabular impingement

A

anterior hip pain

100
Q

Triad RF for stress fractures

A
  1. Menstrual irregularities
  2. Low BMI/ reduced caloric intake
  3. Increased exercise intensity
101
Q

What is Foucher’s sign?

A

increase in tension of a Baker’s cyst on extension of the knee

102
Q

What is Felty’s syndrome

Triad

A

Complication of RA

  1. Splenomegaly
  2. RA
  3. Neutropenia
103
Q

What is the Modified New York criteria?

A

Used to diagnose ank spond
x3 clinical criteria + radiological finding
1. Lower back pain >3 months, eased by exercise
2. Reduced lumbar region motion in saggital and frontal planes
3. Limited chest expansion
xray or MRI of sacroilitis
Definite 1 clinical + radiological finding
Probable no clinical criteria with radiological finding or all three criteria with no radiological findings

MSRA (22 decks)

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