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Yr1 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What is carpel tunnel syndrome?

A
  • the medial nerve is compressed at the wrist
  • commonly affects women
  • can be caused by forceful and repetitive work
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2
Q

What tests can you use for diagnosis of carpel tunnel?

A
  • Tinel’s
  • Phalen’s
  • both will give a positive result
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3
Q

What is tenosynovitis?

A
  • Caused by inflammation of APL and EPB tendon-sheath

- Diagnosis via Finkelstein’s test

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4
Q

What is the treatment for tenosynovitis?

A
  • NSAIDS
  • Steroid injection
  • Rest
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5
Q

How do you diagnose an inflamed joint?

A
  • Blood culture
  • then aspirate the joint
  • if infected, it is cloudy and thicker than water
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6
Q

How would you manage an inflamed joint?

A
  • DMARD and anti-TNF injections
  • IV flucloxacillin
  • Prednisolone
  • Analgesia
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7
Q

What is septic arthritis?

A
  • painful infection in the joint

- Common organisms include staph aureus, streptococci, gonorrhoea, gram -ve bacilli

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8
Q

What is gonococcal arthritis?

A
  • Septic joint, in those with gonorrhea

- Disseminated gonococcal infection

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9
Q

What are the symptoms of gonococcal arthritis?

A
  • fever
  • tenosynovitis
  • pustular rash (common in palms and soles). Painful before visible
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10
Q

What are risk factors for a septic joint?

A
  • Any cause for bacteraemia
  • Direct trauma
  • Skin breaks/ulcers
  • Damaged joints
  • RA/ diabetes / elderly / immunosuppressed
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11
Q

What is the clinical presentation of a septic joint?

A
  • Painful, red, swollen, hot
  • fever
  • 90% monoarthritis (asymmetrical)
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12
Q

What is the management for a septic joint?

A
  • Aspiration
  • Antibiotics
  • Joint washout
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13
Q

What are the inflammatory markers used?

A
  • Single CRP (>10) and ESR (>30) = if raised, 50% chance of infection
  • Multiple CRP and ESR = if raised, 80% chance of infection
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14
Q

What is osteomyelitis?

A
  • Bone marrow inflammation, where the infection is localised to the bone
  • Severe, which needs to be recognised as early as possible
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15
Q

What are host factors for risk of osteomyelitis?

A
  • Behavioural e.g. risk of trauma
  • Vascular supply = DM or sickle-cell
  • Pre-existing bone/joint problem
  • Immune deficiency
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16
Q

What bacteria is mainly in osteomyelitis?

A
  • Staph aureus
  • C -ve staph
  • aerobic gram-ve bacilli
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17
Q

What are the signs and symptoms of osteomyelitis?

A
  • onset = several days
  • dull pain at site
  • systemic infection
  • Acute OM = tenderness and swelling
  • Chronic = draining sinus tract and large ulcers failing to heal
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18
Q

What can osteomyelitis of the joint also present as?

A
  • Septic arthritis

- when infection breaks through cortex resulting in discharge of pus into the joint (knee, hip, and shoulder).

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19
Q

What investigations can you do for osteomyelitis?

A
  • Lab tests = high WCC in acute OM. Raised inflammatory markers
  • Imaging - Xray or MRI
20
Q

What is the differential diagnosis of osteomyelitis?

A
  • Soft tissue infection
  • Avascular necrosis
  • Gout
21
Q

What is the treatment for osteomyelitis?

A
  • Surgical (debridement or removal)

- Antimicrobial therapy

22
Q

What are the red flag signs for soft bone tumours?

A
  • Pain at rest and in the night
  • Lump present - tender and deep to fascia
  • Loss of function
  • Unwell / weight loss
23
Q

What are the investigations for bone tumours?

A
  • Blood tests
  • X-ray
  • CT scan = bone quality
  • MRI scan = changes in soft tissue
24
Q

What is osteosarcoma?

A
  • Cell neoplasms that produce osteoid
  • Secondary includes Paget’s
  • Most common type
  • location: knee, proximal humerus or femur
25
Q

What is the management of osteosarcoma?

A
  • If left untreated, will be fatal
  • Chemotherapy pre-op
  • Limb salvage surgery as well as chemotherapy
26
Q

What is intramembranous bone growth?

A
  • Bone develops directly from sheets of mesenchymal connective tissue
27
Q

What is endochondrial bone growth?

A
  • Bone develops by replacing hyaline cartilage
28
Q

What is crystal arthropathy?

A
  • Arthritis caused by crystal deposition in joint lining

- Most common is urate = gout

29
Q

How do crystal arthropathies present?

A
  • Intense pain

- Acute with hot, swollen joints

30
Q

What is gout?

A
  • MSU crystals deposited in joint
  • Can be acute or chronic
  • Common in men 40+
31
Q

Why is purine related to gout?

A
  • Purine is in red meat and additives in fizzy drinks
  • When metabolised, some is excreted into renal or intestine
  • Get hypouricemic
32
Q

What is hyperuricaemia?

A
  • Excessive uric acid in the blood

- Major risk factor for gout

33
Q

What can precipitate an attack of gout?

A
  • Anything that causes sudden alteration in uric acid concentration
  • Alcohol/ shellfish binges
  • Sepsis, MI, acute illness
  • Trauma, surgery
34
Q

What is the treatment for gout?

A
  • anti-inflammatories
  • NSAIDS, colchicine, steroids
  • Xanthine oxidase inhibitors = allopurinol
35
Q

What is pseudogout?

A
  • Deposition of calcium pyrophosphate crystals on joint surface
  • These elicit an acute inflammatory response
  • Generaly MCPs, wrists, knees
36
Q

What are the features of pseudogout?

A
  • Acute synovitis
  • Severe pain, stiffness, swelling
    fever
  • resolved in 1-3 weeks
  • has pattern of involvement
37
Q

What is osteoporosis?

A
  • Skeletal disease with low bone mass and deterioration of bone tissue
  • Susceptible to fractures
38
Q

What is post-menopausal osteoporosis?

A
  • Loss of effects of oestrogen on bone turnover

- Preventable by oestrogen replacement

39
Q

How do you diagnose osteoporosis?

A
  • Bone densitometry
  • X-ray
  • DXA
  • T-score
40
Q

What is osteopenia?

A
  • Bones are weaker than normal, but do not have osteoporosis
41
Q

What can increase your risk of osteoporosis?

A
  • Inflammatory diseases e.g. RA and IBD
  • Endocrine diseases
  • Reduced skeletal loading
  • Medication e.g. glucocorticoids
42
Q

What is a FRAX score?

A
  • determines risk of injury or fracture
43
Q

What is the treatment for osteoporosis?

A
  • Anti-resorptive = biphosphonates (1st) and HRT

- Anabolic = teriparatide

44
Q

What are the pros and cons for hormone replacement therapy for osteoporosis

A
  • Pros = reduces risk of fractures by 50%
  • Stop bone loss
  • prevents hot flushes and menopausal symptoms
  • Risks include breast cancer, stroke, CVD
45
Q

What are examples of biphosphonates?

A
  • Oral = aledronate or risedronate

- IV = ibandronate

46
Q

What is denosumab?

A
  • Rapid acting and potent anti-resorptive
  • Good fracture risk reduction
  • rebound increase of bone turnover when stopped

Yr1 (13 decks)

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