Week 1 - Surgical history taking & MSK Flashcards
What are 4 symptoms of inflammation in rheumatic diseases?
Stiffness = the earlier it occurs and the longer it takes to limber up are significant factors of severity of inflammation
Gelling = stiffness after rest it is caused when the fluid leaks from blood vessels surrounding an inactive joint and waterlogs the cartilage in the joint.
What are the 5 cardinal features of inflammation?
List 9 Common Rheumatic Diseases?
& 8 Specific but very common ones?
RA reducing in prevalence whilst gout increasing in prevalence.
Myopathy associated with statins.
What is Fibromylagia?
- Sex?
- Secondary to which diseases?
- Sx?
Fibromyalgia – the ability of the individual to deal with pain = subjective.
Fibromyalgia often seen with depression/anxiety.
List some of the tender points in fibromyalgia?
What are the clinical features of Osteoarthritis - Which joints are involved?
Tends to spare MCP joints
Vs. RA = soft tissue swelling
Not a uniform loss of cartilage = patchy
Osteophytes/bone spurs
What is the most common type of inflammatory arthritis overall? (men vs. women?)
Which newly presenting patients should you consider a diagnosis of Rheumatoid Arthritis in?
4 ways to classify rheumatoid arthritis?
1 extra-articular manifestation of Rheumatoid arthritis and an associated syndrome?
Rheumatoid nodules or ‘grains of rice’
Sjogren’s syndrome can be associated with RA - dry mucous membranes – eyes & mouth & dyspareunia (no vaginal lubrication) & pancreas ensure not on any anticholinergic drugs and no history of head and neck radiation
What is Inclusion body myositis? 6 Clinical features?
An inflammatory myopathy characterized by slowly progressive weakness of both the proximal and distal muscle groups. Typically seen in men over the age of 50. Muscle biopsy shows endomysial inflammation and characteristic intramuscular vacuoles that resemble inclusion bodies of aggregated proteins.
What are the 3 Orthopaedic Soft Tissues?
- Muscle
- Tendon
- Ligaments
What is Skeletal muscle?
5 Skeletal muscle attachments?
5 Skeletal muscle attachments
1. Deep fascia
2. Intermuscular septa
3. Interosseous membranes
4. Ligaments
5. Bones
What does Unipennate mean? Example?
If all the fascicles are on the same side of the tendon, the pennate muscle is called unipennate.
What is a Bipennate muscle? Example?
A type of pennate muscle wherein the muscle fibers or fascicles are in opposite sides of the central tendon. Muscles that have fibers on two sides of a tendon are considered bipennate.
Example of a multipennate muscle?
What is a parallel muscle? Example?
Parallel muscles have fibres that, as the name suggests, run parallel to each other and are sometimes called strap muscles. They are normally long muscles which cause large movements, and are not very strong but have good endurance. Examples include Sartorius and Sternocleidomastoid.
What is a tendon? Blood supply?
Blood supply
- paratendon = good
- tendon = poor
What are ligaments?
Blood supply to ligaments is good
What are the types of muscle injuries? Where do they often occur?
Clinical Features of Compartment Syndrome? 6 Ps?
Compartment Syndrome
- Early Treatment?
Compartment Syndrome
- Early Treatment?
Compartment Syndrome - Late treatment?
Treatment for muscle injuries?
List some common causes of acute abdominal pain?
List some less common causes of acute abdominal pain?
List 7 gynaecological causes of acute abdominal pain?
What are the biochemical changes you would expect in a patient who has been vomiting as a result of malignant pyloric stenosis?
Vomiting produces dehydration, metabolic alkalosis, and hypokalemia. One to two liters of stomach secretions containing up to 150 MEq of hydrogen and sodium ion per liter and an isoelectric quantity of chloride ion are produced each day.
Hypokalaemia, metabolic alkalosis
or uraemia.
What is Hypertrophic pyloric stenosis? Epidemiology?
Epidemiology
* Incidence: 0.5–5:1000 live births (considered to be the most common cause of gastric outlet obstruction in infants)
* Sex: ♂ > ♀ (∼ 5:1)
* More common in firstborn children
* The incidence is higher in white populations.
Hypertrophic pyloric stenosis - Aetiology?
Hypertrophic pyloric stenosis - Clinical features?
Hypertrophic pyloric stenosis - Diagnostics?
Rotator Cuff Tears
- Aetiology? (3)
- 4 Clinical Features?
Aetiology
1. Chronic degenerative tear is seen in individuals aged > 50 years.
2. Acute injury is seen mostly in athletes (e.g., infraspinatus tear in baseball pitchers).
3. Inflammation: a potential complication of rotator cuff tendinitis
Clinical features
1. Most commonly affects the supraspinatus tendon
2. Acute rupture: acute severe pain and loss of strength
3. Degenerative rupture: chronic pain; loss of strength is less pronounced
4. Restricted range of motion (depending on the muscle involved)
Rotator Cuff Tears
- Diagnosis? (3)
- Treatment?
Diagnostics
Clinical diagnosis (see “Diagnostics” above)
X-ray: superior displacement of the humeral head (high-riding humeral head)
Ultrasound and then possibly MRI to determine the location and extent of the rupture
Treatment
Treatment of degenerative tears is often conservative, especially in older and/or sedentary patients (see “Conservative treatment” above).
Surgical repair of the rotator cuff is recommended in patients with traumatic rupture, especially those who are physically active or who do not respond to conservative treatment.
Subacromial impingement syndrome
- Definition?
- 3 Clinical Features?
- 3 Stages?
- 2 Complications?
Definition: a clinical syndrome caused by compression of tissues around the glenohumeral joint (e.g., rotator cuff tendons, subacromial bursa) during shoulder abduction
Clinical features: Symptoms are most commonly due to supraspinatus injury or subacromial bursitis.
1. Pain on movement that is worsened by overhead activities
2. Painful arc and movement restriction depending on the muscle involved
3. Nocturnal exacerbation of pain, especially when lying on the affected shoulder.
Stages
1. Degeneration
2. Fibrosis of the bursa
3. Rupture of the rotator cuff, intermittent bursitis, and pseudoparalysis of the arm
Complications
1. Rotator cuff tendinitis
2. Rotator cuff tear
Frozen shoulder (adhesive capsulitis)
- Definition?
- Epidemiology?
- Aetiology: 5 conditions associated with?
- 4 Clinical Features?
- 3 Stages?
- Prognosis?
- Complications?
Definition: inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint
Epidemiology
- ♀ > ♂
- Onset > 40 years of age (peak incidence 56 years of age)
Etiology: associated with diabetes mellitus, thyroid disorders (esp. hypothyroidism), shoulder injuries (e.g., rotator cuff tear, proximal humerus fracture), and prolonged immobilization
Clinical features
1. Typically affects the nondominant shoulder
2. Dull shoulder pain
3. Stiffness
4. Severe restriction of both active and passive range of motion of the glenohumeral joint in all planes, especially: External rotation & Passive abduction (restricted to < 90°)
Shoulder dislocation
- Epidemiology?
- Aetiology?
- Classification?
Epidemiology
- Most common joint dislocation
- Sex: ♂ > ♀
- Peak incidence: 20–29 years
Classification
1. > 95% anterior (subcoracoid) and/or anterior-inferior (subglenoid)
2. ∼ 4% posterior
3. ∼ 1% inferior
Clinical features of shoulder dislocation?
3 Diagnostics - Shoulder dislocation?
Treatment for Shoulder Dislocation? (3)
The primary aim of treatment is to reposition the humeral head into the glenoid cavity and restore full range of motion. This may be achieved by either closed reduction or surgical repair.
7 Complications of Shoulder joint dislocation?
5 Imaging goals of MRI?
Different sequence types & uses?
- Extent of disease
- Anatomical detail
- Bone marrow assessment (haematological spread)
- Signal abnormalities (cartilage involvement)
- Contrast enhancement (abscess, neoplasm characterisation)
What is this?
= T2 Fat Sat: No fracture but water (oedema) in the bone = loading injury = bone bruising
What is a Lisfranc fracture?
Midfoot fracture (Lisfranc fracture): a tarsometatarsal fracture; may involve damage to the cartilage of the midfoot joints
How do we diagnose fractures?
Information to include in description? (6)
Fractures - Diagnosis
- Clinical
- Initial diagnostic imaging review - xray
- If uncertain but suspicious, follow up in 10-14 days and reimage?
- If concerned or follow up imaging is unequivocal, further imaging with CT, MRI or Bone scan could be considered
Describe this fracture.
= Comminuted, intra-articular fracture of the humeral head that is also dislocated and involves the greater tubercle (management affected as tendon attachment point affected).
Order of imaging investigations for Bone neoplasms?
7 Things to include when describing bone neoplasm on imaging?
- Radiograph
- CT - extent of bony involvement
- MRI - soft tissue involvement
What is Osteopoikilosis?
Osteopoikilosis is a benign, autosomal dominant sclerosing dysplasia of bone characterized by the presence of numerous bone islands in the skeleton.
What is a Barium enema?
3 Appropriate uses?
A diagnostic procedure in which x-rays of the colon and rectum are taken after rectal administration of a contrast agent. Double contrast barium enema (DCBE) technique is a method of imaging the colon with fluoroscopy. “Double contrast” refers to imaging with the positive contrast of barium sulfate contrast medium (rarely water-soluble iodinated contrast) as well as with the negative contrast of gas (CO2 preferable). An exam with only a positive contrast agent is considered a single contrast barium enema.
Barium Enema
- 5 Indications?
- 5 Contraindications?
- Single vs Double contrast technique?
The double contrast technique is preferred over the single contrast technique when one wants a better visualisation of the mucosa. In the past it had been used for colon cancer (e.g. polyp) screening, especially as a follow-up for failed colonoscopies, but CT colonography has effectively replaced it for that role.
Single contrast barium enema is usually sufficient for fistula or postoperative leak evaluation.
What 5 pathologies or abnormalities might a radiologist be looking for when interpreting a barium enema study?
8 Indications/Appropriate uses for Barium Swallow Study?
- high or low dysphagia
- gastro-oesophageal reflux disease (GORD)
- assessment of a hiatus hernia
- generalised epigastric pain
- globus pharyngeus
- persistent vomiting
- assessment of fistula
- inability to pass the endoscope during an upper GI endoscopy
3 Contraindications to Barium Swallow Study?
- Interpretation? (4)
- Suspected esophageal perforation.
- Severe dysphagia (risk of aspiration)
- Pregnancy
What is an Ultrasound?
List 9 Advantages of Ultrasound?
List 5 Disadvantages of Ultrasound?
List 8 Uses of Ultrasound in the Perioperative setting?
