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Exams :) > Orhtopaedics/MSK Medicine > Flashcards

Orhtopaedics/MSK Medicine Flashcards

1
Q

Osteoarthritis radiological features (4)

A
  1. Joint space narrowing
  2. Subchondral sclerosis
  3. Osteophytes
  4. Subchondral cysts
  5. ?Joint erosions
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2
Q

?Diagnosis

Pain/swelling at posteromedial aspect of ankle
Seen in ballet dancers/jumping sports
pain w/ resistive flexion of great toe

A

Flexor hallicus longus tendinopathy

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3
Q

?Diagnosis

Pain/swelling posterior to medial malleolus
Worse w/ weight bearing, inversion against resistance/plantarflexion against resistance

A

Posterior tibial tendinopathy

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4
Q

?Which conditions (2)

Too many toes sign

A

-Medial ankle tendinopathy (posterior tib, flex. hal. longus)
-Posterior tib tendon rupture

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5
Q

?Diagnosis

Pain worse at night
Relieved by NSAIDs
Small radiolucent nidus (high prostaglandin production)
Prox. Femur most common, also tibia
Boys >girls

A

Osteoid osteoma

benign bone tumour

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5
Q

?Diagnosis

Pain worse at night
Relieved by NSAIDs
Small radiolucent nidus (high prostaglandin production)
Prox. Femur most common, also tibia
Boys >girls

A

Osteoid osteoma

benign bone tumour

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6
Q

Rheumatoid arthritis radiological features (4)

A

Loss of joint space
Erosions of joint margins
Subluxation
Subchondral cysts

Gout = punched out erosions

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7
Q

Ottawa Ankle rules

A

Need inability to weight-bear immediately + in ED
+ bone tenderness at posterior aspect of lat/med. malleolus, navicular/5th metatarsal base

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8
Q

How to differentiate between:

Tibia stress fractures vs. shin splints (medial tibial stress syndrome)

A

Stress # - pinpoint pain
Shin splints - wider area of pain

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9
Q

Muscle strain/tear Rx principles (4)

A

RICE initially + panadol
NO nsaids after 48 hrs (?inhibits muscle repair)
Exercise
Recover 5-8 weeks

Ligament sprain –> NSAIDs okay

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10
Q

Gastroc. tear Rx principles (4)

A

Firm elastic bandage
RICE (48 hrs)
Heel raise
–> passive stretching, strength training

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11
Q

?Diagnosis

-Middle age 40-60 y.o. ?Overload from lifestyle, exercise
-RFs - overweight/obesity, poor biomechanics, barefoot walking, abnormal foot arches
* History
○ Severe heel pain in morning/after rest
○ –> Subsides w/ movement but worsens again after prolonged weight-bearing
* Exam
○ Tenderness over medial calcaneal tubercle
○ Pain w/ dorsiflexion 1st toe

A

Plantar fasciitis

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12
Q

Osteoarthritis Pharm. Mx options (5)

A
  1. Topical NSAID QID
  2. Topical capsaicin 0.025% QID
  3. Panadol/panadol osteo/NSAIDs
  4. Intra-articular steroid injections
  5. Duloxetine 30mg –> 60mg daily

Opioids - limited role

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12
Q

Osteoarthritis examination findings (5)

A

○ Bony enlargement, weakness/wasting of muscles around joint
○ Crepitus
○ No redness/warmth/swelling
○ Joint line/peri-articular tenderness
○ Reduced ROM

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13
Q
  1. Minimal trauma # of hip/vertebra ->?next steps
  2. Minimal trauma # any other site ->?next steps
A
  1. DEXA for baseline bmd BUT straight to Rx (denosumab, bisphos, oestrogen replacement)
  2. DEXA scan -> if T score <-1.5 –> start Rx, if T score >-1.5 - refer for specialist r/v
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14
Q

Osteoporosis non-pharm Rx (5), pharm Rx options (3)

A

Non-pharm
-Falls reduction strategies
-Weight-bearing/strengthening exercise
-Diet (calcium >1g daily)/smoking/eTOH
-Healthy BMI
-Sun exposure

Pharm
-Bisphosphonates (e.g alendronate 70mg weekly)
–A/e myalgias, upper GI side effects, hypocalcaemia
–Rare risk osteonecrosis of jaw, atypical femoral shaft #

-Denosumab
–Compliance essential -↑risk vertebral fractures if suddenly stopped
–Rare risk osteonecrosis of jaw, atypical femoral shaft #

-Teriparitide - specialist, need >2 min trauma #s and T score < -3.0

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15
Q

When to recheck DEXA for osteoporosis (monitoring)

A

-Consider 2 years after starting Rx
-1-2 years after significant change to Rx
-If stable - recheck interval 2-5 years
—If worsening - check adherence, consider switching therapy

Bisphosphonate duration of therapy 5-10 years

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16
Q

?Diagnosis

consistent shoulder pain
Nocturnal pain + weakness
older age >65 y.o

A

Rorator cuff tendinopathy
or gleonhumeral/shoulder osteoarthritis

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17
Q

Rotator cuff tendinopathy Rx aspects (4)

A

-Complete rest contraindicated
-Reduced load - modified work/activity plan
-Physio - strengthening/ROM exercises
-NSAIDs/paracetamol
-short-term steroid injection benefit - ?detrimental med-long term?

?Limited evidence for subacromial decompression surgery

18
Q

Carpal tunnel Rx options (4)

A

-Oral NSAID
-Local steroid injection (preferred for pregnant women)
-Overnight wrist splint
-Elevate hand overnight

19
Q

Lateral epicondylitis clin. features (6)

A

○ Reduced grip strength
○ Pain w/ gripping
○ Pain w/ resisted extension
○ Pain w/ resisted supination
○ Pain w/ passive stretching of common extensor origin
○ Tenderness over distal/anterior lateral epicondyle/lateral supracondylar ridge

20
Q

Lat/medial epicondylitis Rx options

A
  1. NSAIDs (oral OR topical up to QID)
  2. Steroid injections (6-12 week, short term benefit only)
  3. Physio/exercise - progressive loading program
    4.

Imaging not that helpful

21
Q

Lat/medial epicondylitis Rx options (4)

A
  1. NSAIDs (oral OR topical up to QID)
  2. Steroid injections (6-12 week, short term benefit only)
  3. Physio/exercise - progressive loading program
  4. ?brace ?enlarge grip surface of tools/rackets
22
Q

Greater trochanteric pain syndrome - examination features (4)

A

○ Focal tenderness over greater trochanter
○ Passive external rotation w/ hip flexed 90 deg –> pain
○ Resisted de-rotation of externally rotated hip –> pain
○ Resisted hip abduction –> pain

23
Q

De Quervain’s tenosynovitis clin. feautres (4)
Any Ix?

A

○ Pain + swelling over radial styloid, agg. by thumb motion/wrist deviation
○ Difficulties w/ lifting/grasping/twisting
○ Finkelstein’s test
○ Eichoff’s test - similar, but pt holds thumb in flexion using own fingers

	-**USS** may be helpful (per eTG)
24
Q

De Quervain tenosynovitis Rx aspects (3)

A

○ NSAIDs, steroid injections
○ OT/hand therapy for splint
§ 4-6 weeks for splint
○ Activity modification

	○?Soft tissue massage
	○ ?Taping
	○ ?Graded pain-free exercises
25
Q

?Diagnosis

Back pain insidious onset age <45
Worse in AM w/ morning stiffness
HLA-B27 +ve
Sacro-iliac joints + lower spine affected

A

Ankylosing spondylitis

26
Q

Back pain red flags (4 main conditions)

A

Tumour:
-Hx. of cancer
-LOW
-Night pain
-Age >40 or <15 y.o

Fracture:
-History of trauma, or RFs for fragility #

Infection:
-Fever >38
-Night sweats/chills
-Immunosuppression
-IV drug use

Cauda equina:
-Urinary retention
-Saddle anaesthesia
-Progressive neuro - flaccid paralysis

27
Q

Chronic back pain non-pharm Rx options (7)

A

-Education
-Cold/hot packs
-Weight loss (>5% of body weight)
-Early return to activity
-Exercise (low stress/light)
-Physiotherapy - strengthening, posture control, core exercises
-Pyschology - CBT, progressive relaxation

28
Q

Chronic back pain pharm Rx options (5)

A

-Paracetamol
-NSAIDs
-Antidepressants
-?tapentadol
-Intra-articular facet joint injections

29
Q

Acute low back pain DDx (many - think broad categories)

A

-Compression #
-Herniated disc nucleus pulposus (leg pain > back pain, worse w/ sitting)
-Lumbar strain/sprain
-Spondylolysis
-Spondylolisthesis (similar to spinal stenosis)
-Spinal stenosis (leg pain > back pain, worse w/ standing/waling, better w/ spine flexed, uni or bilat)

-Inflammatory spondyloarthropathy
-Malignancy
-Vertebral discitis/OM

-AAA
-GI conditions - pancreatitis, peptic ulcer disease, cholecystitis
-Herpes zoster
-Pelvic conditions - PID, endometriosis, prostatitis
-Retroperitoneal conditions - renal colic, pyelonephritis

30
Q

Ottawa Knee Rules (after acute knee injury) (5)

A

○ Age >55
○ Tenderness over head of fibula
○ Isolated patellar tenderness
○ Inability to flex knee 90 deg
○ Inability to weight-bear

1 age, 2 palpate, 2 ROM

31
Q

Osteoarthritis DDx (7)

A
  • Crystal arthropathy
    • Spondyloarthropathies
    • Inflammatory arthritis
    • Septic arthritis
    • Fibromyalgia
    • Tendinopathy
      Osteonecrosis
32
Q

Osteoporosis risk factors (many)
-Lifestyle
-Diseases
-Medications

A

See pic

33
Q

JIA examination aspects (general) (6)

A

○ Joint exam
○ Lymphadenopathy
○ Hepatosplenomegaly
○ Fever/rash
○ Nail changes
○ Bruising/bleeding

34
Q

JIA Ix (5) - when to order?

A
  • Ix (if symptoms >4 weeks)
    ○ FBE
    -ESR
    -CRP
    ○ Xray
    ○ ?Autoimmune panel (discuss w/ paeds rheum) - do not use to screen as can be +ve in healthy kids
35
Q

JIA Initial Rx (5)

A

○ NSAIDs, paracetamol (no evidence for topical NSAIDS)
○ Exercise
○ Diet - Calcium/Vit D supp
○ Heat/ice packs
○ Splints/foot orthotics

36
Q

JIA DDx (8)

A
  • Septic arthritis - acute painful monoarticular arthritis w/ fever
    • Post-infectious/reactive (Ross River, mumps, Dengue)
    • Rheumatic fever
    • Trauma/NIA
    Less common
    * Inflammatory (IBD/sarcoidosis)
    * Infection - OM/Lyme disease
    * SLE, HSP
    * Acute lymphocytic leukaemia
37
Q

AC subluxation/seperation: return to sport timeframe?

A

2-6 weeks

Rx: RICE, broad arm sling

38
Q

Osgood Schlatter Rx aspects (4)

A

○ Modification of sporting activities (avoid complete rest)
○ Quads strengthening/stretching exercises
○ Cold/ice packs post-activity
○ Knee-brace/strap during activity

39
Q

?Diagnosis

○ Common in adolescents
○ Anterior knee pain - behind kneecap
○ Exac by running/jumping, or prolonged sitting (movie theatre sign)
○ +/- popping/catching sensation
○ Exam: +ve patellar grind test, audible/palpable crepitus

A

Patellofemoral pain syndrome

40
Q

?Diagnosis

○ Irritation/impingement of infrapatellar fat –> burning/aching pain below kneecap

A

Infrapatellar fat pad (Hoffa’s) syndrome

?MRI

41
Q

Achille’s tendinopathy examination aspects (2)

Management (5)

A

○ ?Pain exac by dorsiflexion - Achilles tendon irritation
-Squeeze test - test tendon integrity

	Rx: -		○ Avoid exacerbating activity
	○ NSAID short course
	○ Heel raise/pad in shoe
	○ Physio  - calf strengthening exercises
	○ Topical Rxs - ?NSAID + neuropathic cream medication
42
Q

Acute haemarthrosis DDx (3)

A

Intra-articular fracture
ACL rupture
Patella dislocation

43
Q

Inability to straighten knee DDx (5)

A
  • Injury to quad tendon
    • Injury to patella tendon
    • Patella fracture
    • Loose chondral/osteochondral defect
    • ACL/meniscal tear
44
Q

Areas to optimise pre-operatively for TKR (7)

A

Diabetes
Smoking
Weight - Aim BMI <40
Opioid use
Anaemia
Malnutrition
Vit D deficiency

Exams :) (20 decks)

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