Musculoskeletal Emergency Presentations Flashcards
What could a lump suggest?
see= A hernia
feel= lmyph nodes
What could change in sensation indicate?
nerve impingement
What is the difference between osteoporosis and osteomalacia?
In osteoporosis, bone mass decreases, but the ratio of bone mineral to bone matrix is normal. In osteomalacia, the ratio of bone mineral to bone matrix is low.
What are the risk factors for osteoporosis?
women
age
alcoholism
glucocorticoid excess (e.g., diabetes)
hypogonadism
diet
anorexia
What is a treatment for menopause?
hormone replacement therapy
What could cause limping in a child?
What is the criteria for septic arthritis?
Non-weight bearing
Temperature >38.5
ESR >40mm/hr (inflammatory marker)
WBC high
What would you do if there is septic arthritis in the hip?
Antibiotics wouldn’t reach hip, so you would wash out the puss
What tests would you do if you through there was septic arthritis?
Full blood count
BIopsy
X-ray
Heart rate, blood pressure
ESR
CRP
renal function
Autoantibodies
MRI?
What is transient synovitis?
an acute, non-specific, inflammatory process affecting the joint synovium
child gets a viral infection and they have immature immune system it goes on overload
- so they aren’t sick, gets better quickly
- blood count is normal
What is the difference in treatment for septic arthritis and transient synovitis in children?
What can inflammation in a joint lead to?
Excess fluid, (oedema)
Describe this knee.
This is a left knee which looks swollen, erythematous, warm to tough compared to the other side and painful on palpation. These are cardinal signs of inflammation. Inflammation can be caused by several things.
What tests would you do for this knee?
Bloods: FBS , Esr, CRP, renal function Urate
Glucose
HBA1c
? autoantibodies
Xray knee
Aspirate joint and send fluid for culture
? MRI
How will bacteria change the joint fluid and blood in a swollen knee?
The clear straw-coloured joint lubricating fluid would have changed its colour and consistency. In the presence of infection, it would look turbid or cloudy, perhaps darker, presence of pus, increased viscosity and large volume of effusions from swellings.
How would a change in blood and fluid of a swollen knee be reflected in blood tests and joint fluid examination?
Inflammatory markers within the blood tests include white cell count, ESR and CRP. Joint fluid should be aspirated and sent for MC&S, gram staining and to rule out crystal arthropathy like gout/pseudogout.
What is ESR?
erythrocyte sedimentation rate
inflammation marker
What are the different routes of spread of bacteria?
Inoculation, blood, from bone
What is treatment for a swollen infected knee?
Aspirate
Then antibiotics
If confirmed infection: washout with keyhole arthroscopy Continue antibiotics
What is key in management of any condition?
History and examination
