Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine - Year 1 > Soft tissue - Clinical Medicine > Flashcards

Soft tissue - Clinical Medicine Flashcards

1
Q

a) What are the 3 main ligaments in the leg?
b) What are teatment options for ligament pain?

A

a)

  1. Medial collateral ligament
  2. Lateral collateral ligament
  3. Ankle ligaments

b)

  • RICE
  • Analgesia
  • Physiotherpay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What occurs in lateral ankle sprains?

A

The anterior talofibular portion of the lateral ligament is commonly injured in inversion injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name 3 most common disorders with veins that can cause leg pain

A
  1. Varicose veins
  2. Superficial thrombophlebitis (inflamed veins)
  3. Deep vein thrombosis (DVT - occurs when a blood clot form in a deep vein causing pain and swelling)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explain peripehral vascular disease

A
  1. Blockages can occur in more than one muscle
  2. Muscle below blockage begins to die due to less blood flow
  3. This causes pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

a) What is deep vein thrombosis?
b) What are the clinical symptoms
c) What is the main differentiant diagnosis of DVT and how can this be differentiated?

A

a) a medical condition that occurs when a blood clot forms in a deep vein. These clots usually develop in the lower leg, thigh, or pelvis
b) Pain, swelling, red or discoloured skin, warmth
c) Cellulitis - however skin tempearture is cool, skin colour normal and skin surface is smooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk factors to deep vein thrombosis?

A
  • Sticky blood - birth control, smokers
  • Obesity
  • Immobility
  • Pregnancy
  • Orthopaedic patient - pelvic surgeries
  • Varicose veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List ways we can treat/reduce the risk of DVT

A
  1. Heparin (anticoagulant)
  2. Excercise
  3. Keep calf pump mobile
  4. Compressive stockings
  5. Birth control - low in oestrogen
  6. Lose weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List 3 soft tissue disorders that can cause nerve pain in the leg

A
  • Referred nerve pain e.g., sciatica
  • Peripheral neuropathy - ‘glove and stocking’ distribution which can be due to druge, vit D deficicency, diabetes
  • Entrapment e.g., meralgia paraesthetica (latral cutaneous nerve of thigh can be entrapped in people who are overweight/obese causing pain in front of leg)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

a) Lymphoedema can cause pain in the legs. What causes this?
b) What must you exclude in unilateral lymphoedema in leg and what else must you do to exclude this?

A

a) Lymphoedema occurs when the lymphatic system is disrupted
b) You must exclude pathology in the pelvis e.g.,tumour that is disrupting lymphatic system. Must image pelvis for malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What disorders/disease/injuries with the bone/joint can cause leg pain?

A
  • Fractures
  • Paget’s
  • Tumour
  • Infection
  • Osteoarthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a hernia?

A

Weakness of abdominal wall so bowel pushes through

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the differences the clinical features between a muscle, tendon and ligament tear

A
  • Muscle tear - pain and bruising
  • Tendon tear - no function around that tendon and worsened on activty
  • Ligament tear (sprain) - loss of stability around that joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe what a bursitis is

A
  • A bursa is potential space with epithelial lining
  • It produces synovial fluid which reduces friction and trauma
  • Inflammation of a bursa causes bursitis. This can be idiopathic, part of a systemic inflammatory disease or due to injury, infection, or got
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name the type of bursitis you can get, causing leg pain

A
  • Prepatellar bursitis
  • Infrapatellar bursitis
  • Suprapatellar bursitis
  • Pes anserine
  • Retrocalcaneal bursitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

a) What causes an olecranon bursitis?
b) What will you find on examination?
c) How is it treated?

A

a) Percipitated by excessive friction at the elbow
b) Bursa is distended and tender
c) Healed with phsyiotherapy (self-limiting). The bursa fluid should only be aspirated in cases of sepsis (as patient can develop chronic signs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

a) Describe the clinical presentation of a trochanteric bursitis
b) Which type of people does it usually present in?
c) Describe the treatment

A

a) Pain over the affected trochanter, exacerbated by movement
b) Usually presents in women because they have shorter legs, those with a different pelvis and RhA patients

c)

  • Physiotherapy
  • Steroid injections in more severe cases
  • Surgery for persistent and debilitating trochanteric bursitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

a) What is an infrapatellar bursitis known as?
b) Describe the presentation of prepatellar and infrapatellar bursitis
c) What you find on examination
d) Describe the treatment for prepatellar/infrapatellar bursitis
e) Name 2 other type of bursas apart from infrapatellar bursa and prepatellar bursa found in the knee

A

a) Housemaids’s knee
b) Hot, red swelling develops over the front of the patella (prepatellar bursitis) or patellar tendon (infrapatellar bursitis)
c) Active knee extension is usually quite painful

d)

  • Rest
  • Antibiotics for infected bursitis
  • Fromal incision and drainage for infected bursitis that fails to settle with antibiotics

e)

  1. Suprapatellar bursa
  2. Pes anserine bursa -inflammation of the bursa in pes anserine (a region where tendinous structures of the semitendinosus, gracilis, and sartorius muscles join to insert at the medial knee)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why must you not inject a retrocalcaneol bursitis with steroids?

A
  • The retrocalcaneal bursitis sits underneath the achilles tendon which does not have a tendon sheath
  • Therefore it is not injected as there is a risk that it would cause the achilles tendon to rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What problems with the tendon can occur and cause leg pain?

A
  • Inflammatory e.g., tenosynovitis and enthesitis
  • Degenerative/overuse/tear e.g., achilles tendon, patellar tendon, tendinopathies (degenerative), adductor tendinits (overuse)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the mechanisms of soft tissue injuries?

A
  • Direct injury
  • Degenerative/ long-term wear and tear
  • Inflammatory
  • Repetitive injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What investigations can be undertaken for a soft tissue injury?

A
  • Ultrasound scan
  • CT scan (to investigate associated fracture)
  • MRI scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why are you unlikely to use an x-ray to investigate a soft tissue disorder/injury?

A

X-rays do not show soft tissue well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the treatment options for soft tissue injuries?

A
  • Analgesia
  • RICE
  • Immboilise (splint, sling, brace)
  • Physiotherapy
  • Surgical repair
  • Education/information
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Acromioclavicular joint distribution is a mechanism of injury that leads to defomity. How is it treated?

A
  • Physiotherapy
  • Surgery in severe cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

a) Who does distal biceps rupture usually occur in?
b) What are the findings on clinical examination?
c) What investigations need to be ndertaken?
d) How is it treated?

A

a) Usually men in late 40s/50s and bodybuilders as anabolic steroids makes tendons easier to tear
b) Positive hook test and struggle to supinate
c) MRI/ultrasound

d)

  • Sling and physiotherapy
  • Surgery reconstruction - if dominant hand and required for occupation
26
Q

Describe the hook test

A
  • The hook test is used to check for distal biceps tendon rupture/avulsion
  • It is performed by askingthe patient to actively flex the elbow to 90 degrees and fully supinate forearm .The examiner uses index finger to hook the latera edge of the biceps tendon
  • With an intact/partially torn tendon, finger can be inserted 1cm beneath the biceps tendon
  • If the distal biceps tendon is completely ruptured, the examiner won’t feel the cord like structure within the hooks of the finger
27
Q

a) Whhat special etests can you do for a suspected ACL tear?
b) What investigations are undertaken?
c) How is it treated
d) What may occur due to the changed biomechanics in the knee?

A

a)

  • Anterior draw test and Lachman’s test
  • Do other tests for other ligaments and see if they extend their legs (checks if quadriceps are okay)

b) MRI

c)

  • Usually, conservative treatment in a brace and physiotherapy
  • Surgical reconstruction - pt factors e.g., age, activity and job taken into consideration

d) Post-traumatic OA

28
Q

a) What are the findings on clinical examination of an achilles tendon rupture?
b) What investigations can be undertaken?
c) How is it treated?
d) What are the risk factors of achilles tendon rupture?

A

a) Swelling of achilles tendon, positive calf squeeze/thompson test (absence of plantar flexion)
b) Ultrasound/MRI

c)

  • Conservative - walking boot for 3 months (tendons proximate)
  • Surgical repair

d)

  • Age
  • Certain antibiotics
  • Steroids
  • Increased BMI
  • Smoking
  • Peripheral vascular disease
  • Diabetes
29
Q

a) What does compression injury result in?
b) What are the most common compression neuropathies in the upper limb?
c) What is the most common site of compression of the peripheral nerves in the lower limb

A

a) Compression resultsin ischaemia and demyelination of the nerve, affecting its ability to conduct
b) Carpal tunnel syndrome and cubital tunnel syndrome
c) Common peroneal nerve

30
Q

What does carpal tunnel syndrome (CTS) result from?

A

CTS results from compression of the median nerve as it passes through the carpal tunnel at the wrist

31
Q

a) What are is the main cause of carpal tunnel syndrome
b) Who does it present in the most?

A

a) Usually idiopathic
b) Women 35-55 years of ages

32
Q

What are the risk factors for carpal tunnel syndrome?

A
  • Diabetes
  • Trauma (post wrist fracture/lunate dislocation)
  • Pregnancy (common)
  • Hypothyroid (rare)
  • RhA (synovitis)
  • Chronic renal failure
  • Space occupying lesion (ganglion, tumour)
33
Q

What are the typical symptoms and signs of carpal tunnel syndrome?

A
  • Pain, numbness and tingling in the distribution of the median nerve (first 3 lateral digits)
  • Nocturnal dyseshesias (abnormal sensation in night - wake and shake hand)
  • Parathesia on driving, using telephone, reading
  • Reduced dexterity (skills in performing tasks e.g., buttons, coins, sewing)
  • Thenar wasting - late sign, irreversible (reduced grip strength)
  • Positive tinel’s tap
  • Positive phalen’s test
34
Q

Name the muscles the median nerve supplies in the hand and describe how you can test the motor function of these muscles in patients

A

Loaf

  • Lateral (1st and 2nd) lumbricals
  • Opponens pollicis - ask pt to touch the thumb to the little finger and resist attempts to seperate the two
  • Abductor pollicis brevis - with dorsum of hand flat on the tabel desk ask patient to abduct thum and then resist adduction force
  • Flexor pollicis brevis - ask pt to flex thumb at MCP joint and abduct thumb and then resist adduction force
35
Q

Describe the useful role of electrophysiology in carpal tunnel syndrome (nerve conduction studies - NCS)

A
  • Diagnostic uncertainty
  • Quantify degree of severity -to councel patient expectation of carpal tunnel decompression
  • Persistence of symptoms of post carpal tunnel decompression
  • Recurrence of symptoms post carpal tunnel decrompression - to find alternate cause of symptoms
36
Q

When should you not use electrophysiology

A
  • When the diagnosis is clear and the patient is not keen to delay
  • Elderly patients
37
Q

Here are results from an electrophyisiology. What do the following headings mean?

a) SNC
b) MNC
c) Velocity
d) Latency
e) Amplitude

A

a) Sensory nerve conduction
b) Motor nerve conduction
c) Speed of response
d) Time of response
e) Amplitude

38
Q

What are differential diagnosis of carpal tunnel syndrome?

A
  • C6 radiculopathy (get MRI)
  • Proximal site compression (rare) - flexor dystrophy syndrome, pronator syndrome
  • Non-organic/non-anatomical cause
39
Q

What are the treatments for carpal tunnel syndrome?

A
  • Observation (may settle e.g., pregnancy)
  • Splints (for night symptoms)
  • Steroid injections (injected in 30 degree angle, ulnar ide of palmaris longus tendon. Aloth 75% end up having a carpal tunnen decompression eventually)
  • Carpal tunnel decompression
40
Q

Carpal tunnel decompression is performed under local anaesthetics and takes 10 minutes

a) What do you tell patients who have had a carpal tunnel decompression
b) Desribe the prognosis

A

a)

  • Wound takes 2 weeks to heal
  • Return to work between 2-4 weeks (office-manual)

b)

  • Good at relieving pain, however numbness recovery is less consisitent.
  • Expectation of outcome depends on the severity
41
Q

What are the complications of carpal tunnel syndrome?

A
  • Infection (rare)
  • Bleeding and haematoma (rare)
  • Scar pain/tenderness - common/last several weeks
  • Pillar pain (pain over bony borders - may last several weeks)
  • Recurrence (<1%)
  • Chronic regional pain syndrome (rare)
  • Incomplete relief of symptoms
42
Q

Describe the similarities and differences between open vs endoscopic carpal tunnel decompression

A
  • There is no difference in: symptomatic relief, revision rates and grip strength
  • Endoscopic carpal tunnel decompression has quicker return to work and higher rate of neve compared to open carpal tunnel syndrome
43
Q

What is cubital tunnel syndrome?

A

Ulnar nerve compression as it passes behind the medial epicondyle

44
Q

What are differential diagnosis of cubital tunnel syndrome?

A
  • Thoracic outlet syndrome
  • Pan coasts tumour
  • C8/T1 radiculopathy
45
Q

Describe the symptoms and signs of cubital tunnel syndrome

A
  • Postural - leaning on elbow/night symptoms
  • Altered sensation - loss of sensation over the hypothenar eminence and ulnar 1 and 1/2 fingers (unlar side of ring finger and pinky)
  • Wartenberg - little finger in persistent abduction due to weak third palmar interosseous muscle wsting
  • Clawing - loss of extension at PIP and loss of flexion at MTP of little finger and ring finer
  • Froments - keep thumb straight and grip paper. A positive test is if thumb flexes at interphlangeal test, to compensate for a weak adductor pollicis muslce
  • Tinel’s at epicondyle - marked parathesia can be reproduced in the ulnar portion of the hand by tapping on the medial epicondyle of the humerus
46
Q

What investigations are undertake for cubital tunnel syndrome?

A
  • Nerve conduction studies
  • X-ray - look for arthritis elbow
47
Q

Describe the treatment for cubital tunnel syndrome

A
  • Postural advice
  • Nocturnal splints
  • Surgery consideration in any numbness/weakness and positive nerve conduction study - in situ decompress or transportation (moving the nerve)
48
Q

What are surgical indications of cubital tunnel syndrome?

A
  • Failure of non-operative management
  • Motor weakness/loss of sensation
  • (Counsel patient appropriately in late presentation)
49
Q

a) When would you do a in situ compression vs transposition (moving the nerve) for cubital tunnel syndrome sugrery?
b) Describe the recovery process?
c) What must you councel patients on in terms of the surgery?

A

a) In situ decompression if there is no nerve subluxation and transposition if there is a nerve subluxation
b) Recovery is slow and sensation improves at a slow rate 1-2m a day
c) Established wastng and dense numbness may not recover

50
Q

What is neurotmesis?

A

Complete disruption of nerve and sheath. It is chronic

51
Q

What is neuropraxia?

A

Transient nerve dysfunction, no damange to nerve or sheath, will recover fully

52
Q

What is axonotmesis?

A

Disruption of axon but schwann cell myelin sheath intact, recovery could occur if insulting force removed in timely fashion

53
Q

a) What are the signs of a achilles tendon ruputure
b) Describe the treatment

A

a) onset of pain preceded by popping sound, swelling and tenderness of achilles tendon, difficulty walking, increased passive dorsiflexion, positive simmond’s test
b) Conservative - rest and analgesia/walking boot for 3 months

54
Q

What are the risk factors of an achilles tendon rupture

A
  • Age
  • Certain antibiotics (fluroquinolone antibiotics e.g., ciprofloxacin)
  • Steroids
  • Icreased BMI
  • Smoking
  • Peripheral vascular disease
  • Diabetes
55
Q

a) What is greater trochanteric syndrome?
b) What is the clinical presentation?
c) What condition is a risk factor to greater trochanteric syndrome?
d) What is the treatment?

A

a) This is inflmmation of greater trochanter bursa (aka trochanteric bursa)
b) lateral hip pain, swelling, a positive tredelenberg test
c) RhA
d) Conservative, analgesia, physiotherapy, bursecotmy in severe cases

56
Q

a) Describe the clinical features of patellar tenodnitis (Jumper’s knee)
b) Who does it usually affect?
c) Describe the treatment

A

a) Anterior knee pain on the inferior pole of the patella, chronic course, worse on activity and better with rest
b) Ofter occurs in people who are keen runners or perform repativte jumps (hence then name Jumper’s knee)
c) Analgesia, rest and modification of activities

57
Q

a) What is a “frozen shoulder”?
b) Describe the clinical features
c) Describe the management

A

a) Frozen shoulder is a painful, stiff shoulder caused by adhesive capsulitis - thickening and contraction of the glenohumeral joint capsule and formation of adhesions

b)

  • Most common in adults aged 40-60
  • More common in those with diabetes, stroke, cardiovascular disease, cancer and connective tissue disorders
  • Presents with gradual onset pain and stiffness of the shoulder with reduced movement, most notably external rotation
  • Pain worsens initially and persists for weeks-months
  • Stiffness can persist for months-years
  • Unclear pathophysiology, often idiopathic

c)

  • Analgesia (NSAIDs)
  • Physiotherapy and exercise
  • Local intraarticular steroid injection
58
Q

Describe the treatment for carpal tunnel syndrome

A
  • Treatment of secondary cause if there is one
  • Splinting - mild to moderate
  • Local steroid injections - moderate
  • Carpal tunnel decompression (perfromed by dividing the tunnel roof - flexor retinaculum)
59
Q

a) What is achilles tenodnitis?
b) What are the clinical features?
c) What are somes causes/risk factors?
d) Describe the treatment

A

a) Inflammation of the achilles tendon sheath
b) Posterior ankle pain, pain on palpation of the achilles tendon, swelling and thickening of the achilles tendon
c) Sports (particularly running), Ciprofloxacin
c) Conservative - rest and analgesia (NSAIDs most useful)

60
Q

a) List the pre-operative management aims of a fracture
b) List the pre-operative principles of a fracture

A

a)

  • Reduce pain
  • Reduce bleeding
  • Reduce stress on surrounding soft tissues, nerves and blood vessels
  • Reduce the risk of infection

b)

  • Effective analgesia
  • Reduction of deformity
  • Irrigation and debridement of open fractures
  • Administration of antibiotics where indicated
  • Immobilisation of fracture
61
Q

a) What are trigger fingers?
b) What are the risk factors?
c) Describe the clinical presentation
d) Describe the treatment

A

a) Trigger finger occurs as a result of mechanical impingement of the A1 pulley (the most proximal annular ligament of the finger, located at the metacarpal head)
b) Age between 5th and 6th decacde, female, dominant hand involvemement, diabetes
c) Catching and locking of the affacted digit
d) Splinting, rest, corticosteroid injection or surgical release

62
Q

The pattern of a radial nerve injury depends on the location of the lesion. Describe the most likely injury and symptoms for:

a) Very high lesions (compression of radial nerve at axilla)
b) High lesions (compression of radial nerve at humerus)
c) Low lesions (compression of radial nerve at forearm)

A

a) e.g., due to crutches or ‘Saturday night palsy’. Here, there will be wrist drop and triceps weakness
b) E.g., a humeral shaft fracture. This will give wrist drop, reduced sensation in the anatomical snuffbox but no triceps weakness

E.g., fracture in the forearm such as the head of the radius. This leads to finger drop with no sensory loss.

Medicine - Year 1 (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions