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FLASH FINALS > MSK - PASSMED > Flashcards

MSK - PASSMED Flashcards

1
Q

Which bones are typically affected in Paget’s disease:

A

Skull, Spine/Pelvis and long bones of the lower limb

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2
Q

Morning stiffness > 2 hours indicates

A

Likely inflammatory arthritis

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3
Q

Most common joint for septic arthritis in adults:

A

Knee

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4
Q

Dermatomyositis px.

A

Photosensitive
Macular rash over back and shoulder (SHAWL)
Heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers

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5
Q

Dermatomyositis should prompt investigations for which other condition:

A

Cancer

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6
Q

Non cutaneous symptoms of dermatomyositis:

A

Proximal muscle weakness
Raynaud’s
Respiratory muscle weakness

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7
Q

Osteoporosis in a male -> what should be checked

A

Testosterone

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8
Q

Which drug should not be prescribed with methotrexate due to folate antagomism:

A

Trimpethoprim

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9
Q

Z-score osteoporosis: adjusted for ->

A

AGE

Age, gender, ethnicity

Think CAGE (eGFR) minus creatinine (C)

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10
Q

Which TB drug may cause drug-induced lupus

A

ISONIAZID

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11
Q

Reactive arthritis tx. -

A

NSAIDs

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12
Q

Ix. of choice in psoas abscess

A

CT abdomen

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13
Q

Tx. Anti-phospholipid syndrome:
Primary prophylaxis
Secondary prophylaxis

A 
Primary = aspirin 
Secondary = Warfarin
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14
Q

Earliest sign of ankylosing spondylitis

A

Reduction in lateral flexion

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15
Q

If a patient is to take steroids for longer than 3 months: what should be initiated immediately:

A

Bone protection

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16
Q

What is first-line bone protection:

A

Alendronate

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17
Q

AC joint injury grading:

A

I-VI

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18
Q

Which AC joint injury grades may be managed conservatively:

A

I & II -> maybe III (debated)

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19
Q

Adhesive capsulitis management options:

A

NSAIDs
Physiotherapy
Oral corticosteroids
Intra-articular steroids

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20
Q

Ankle injuries: Weber classification:

A

Type A = Below syndesmosis
Type B = Start at level of tibial plafond and may involve syndesmosis
Type C = above syndesmosis which may be damaged

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21
Q

Maisonneuve fracture:

A

Ankle injury: spiral fibular fracture leads to disruption of syndesmosis and widening of the ankle joint.
Surgery is required

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22
Q

All ankle fractures should be:

A

Promptly reduced to remove pressure on the overlying skin and prevent necrosis

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23
Q

Most common low ankle sprain:

A

ATFL

Inversion injury

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24
Q

Avascular necrosis of the hip investigation:

A

MRI is investigation of choice

Plain x-ray may be normal -> osteopenia and microfractures may be seen early on. - crescent sign

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25
Q

Rupture of a baker’s cyst may cause symptoms similar to:

A

Deep vein thrombosis - pain, redness and swelling in the calf.
Majority of ruptures are asymptomatic

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26
Q

2 risk factors for biceps rupture:

A

Corticosteroids

Smoking

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27
Q

Biceps rupture investigation:

A

US

If suspected distal tendon rupture: urgent MRI

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28
Q

Scoring system used to assess fracture risk in bone metastasis

A

Mirel scoring system

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29
Q

Buckle fracture characteristic x-ray finding:

A

Bulging of the cortex

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30
Q

Carpal tunnel EMG finding:

A

Motor and sensory: prolongation of the action potential

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31
Q

Carpal tunnel management:

A

6-week trial of conservative:
wrist splints at night
corticosteroid injection

If severe symptoms: surgical decompression

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32
Q

Most common disc prolapse in cauda equina syndrome

A

L4/L5

L5-S1

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33
Q

Cauda equina signs:

A

Bilateral sciatica
Reduced sensation/pins & needles in the perianal area
Decreased anal tone
Urinary dysfunction

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34
Q

Cervical spondylosis: may px. w/

A

Neck pain - referred pain may mimic headaches

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35
Q

Which two fractures are most commonly complicated by compartment syndrome

A

Supracondylar fractures

Tibial shaft fractures

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36
Q

Diagnostic intra-compartmental pressure in compartment syndrome

A

> 40 mmHg is diagnostic

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37
Q

Renal complication following fasciotomy

A

Myoglobinuria -> renal failure

pts. require AGRESSIVE fluid resuscitation

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38
Q

Most common organism in discitis:

A

Staphylococcus aureus

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39
Q

Discitis features:

A

Changing lower limb neurology - if abscess develops
Back pain
Pyrexia, rigors, sepsis

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40
Q

Discitis investigations:

Further investigation

A

MRI
CT guided biopsy may be required to guide antimicrobial therapy

Assess patient for endocarditis w/ TRANSTHORACIC or TRANSOESOPHAGEAL ECHO

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41
Q

Discitis tx.

A

6-8 weeks of IV anti-biotics

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42
Q

Specific causes of Dupuytren’s

A 
Manual labour 
Phenytoin 
alcoholic liver disease 
Diabetes 
Trauma
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43
Q

Bennet’s fracture:

A

Intra-articular fracture of first MCP joint (base of thumb)
causes by FIST fights

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44
Q

Barton’s fracture:

A

Distal radial fracture (colle’s/smith’s) w/ associated radio-carpal dislocation.
Fall onto extended and pronated wrist

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45
Q

Fat embolism: dermatological fx.

A

Red/brown impalpable petechial rash

Sub-conjunctival and oral haemorrhage/petichiae

46
Q

Fat embolism: CNS findings ->

A

Confusion and agitation

Retinal haemorrhages and intra-arterial fat globules on fundoscopy

47
Q

What is greater trochanteric pain syndrome also called:

A

Trochanteric bursitis

48
Q

Most common hip dislocation:

A

POSTERIOR dislocation

49
Q

Complications of hip dislocation:

A 
Posterior = sciatic and femoral nerve injury 
Anterior = obturator nerve
50
Q

Garden system:
Whats it for?
Grading?

A 
Hip fractures
Type I: Stable 
Type II: Complete fracture, undisplaced 
Type III: Displaced fracture 
Type IV: Complete boney disruption
51
Q

Intra-capsular hip fracture management:
Undisplaced:
Displaced:

A

Internal fixation or hemi if unfit

Arthroplasty (THR if pt. young, fit and healthy, hemi-arthroplasty if not)

52
Q

Extracapsular hip fracture management:

A

Stable intertrochanteric: dynamic hip screw

Sub-trochanteric: Intra-medullary device

53
Q

Iliopsoas abscess most common organism:

A

Staphylococcus aureus

54
Q

Iliopsoas abscess Ix. of choice:

A

CT abdomen

55
Q

Iliopsoas abscess - management:

A

Antibiotics
Percutaneous drainage
surgery if these fail

56
Q

Iliotibial band syndrome:

causes pain where for who?

A

Lateral knee pain in runners

57
Q

Chondromalacia patellae:
Who gets:
Presents as:

A

Teenage girls following knee injury

Pain on going down stairs or at rest
Tenderness, quadriceps wasting

58
Q

Thessaly’s test:

What does it indicate:

A

Weight bearing at 20 degrees of knee flexion - pt. supported by doctor.

Meniscal tear

59
Q

What is Leriche syndrome?

How does it present:

A

Atheromatous disease involving the iliac vessels

Buttock claudication and impotence

60
Q

Red flags for back pain (5)

A 
Age <20 yrs or >50 yrs 
Night pain 
History of previous malignancy 
History of previous trauma 
Systemically unwell
61
Q

First-line mx for lower back pain:

A

NSAIDs

w/ PPI cover for patients > 45 yrs.

62
Q

Lower back pain investigations:

A

Lumbar spine X-ray should NOT be offered

MRI should only be offered to pts. w/ non-specific back pain if likely to influence management

63
Q

L3 nerve root compression:
Sensory loss:
Motor loss:
Femoral stretch test:

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex

Positive femoral stretch test

64
Q

L4 nerve root compression:
Sensory loss:
Motor loss:
Femoral stretch test:

A

Loss over anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

65
Q

L5 nerve root compression:
Sensory loss:
Motor loss:
Sciatic stretch test:

A

Sensory loss over DORSUM of FOOT
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

66
Q

S1 nerve root compression:
Sensory loss:
Motor loss:
Sciatic stretch test:

A

Sensory loss over postero-lateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

67
Q

When is MRI indicated in prolapsed disc:

A

If prolapsed disc symptoms persist for >4-6 weeks

68
Q

Superior gluteal nerve injury:
Sensory loss:
Motor loss:
Injured in:

A

None
Hip abduction

Posterior hip dislocation
Pelvic fracture
Hip surgery

69
Q

Lumbar spinal stenosis investigation and tx.

A

MRI

Laminectomy

70
Q

Meralgia paraesthetica nerve implicated:

A

Lateral femoral cutaneous nerve (L2/L3)

71
Q

Meralgia paraesthetica test:

A

Pelvic compression test (deep palpation just under ASIS): highly sensitive

72
Q

Most common metatarsal fracture:

A

5th metatarsal

2nd metatarsal is most common in STRESS fracture

73
Q

Most common metatarsal in Morton’s neuroma:

A

3rd

74
Q

Morton’s neuroma: when to refer?

A

If not relief in symptoms after 3 months despite footwear modifications

75
Q

Most common OA location

second?

A

Knee is most common

Hip is second

76
Q

Management of OA of hip?

A

Oral analgesia
Intra-articular injections
Total hip replacement = definitive treatment

77
Q

Most common reason for revision of hip replacement:

A

Aseptic loosening

78
Q

Osteochondritis dissecans presents as:

A

Knee pain and swelling, typically after exercise
Knee catching, locking or giving way
Feeling a clunk when flexing or extending the knee

79
Q

Osteochondritis dissecans Ix:

A

X-ray (anteroposterior, lateral and tunnel views) - may show subchondral crescent sign or loose bodies)
MRI used to evaluate cartilage

80
Q

Osteomyelitis most common organism:

Except in:

A

Staphylococcus aureus

Except in sickle-cell anaemia - where salmonella species predominate.

81
Q

Imaging of choice in osteomyelitis

A

MRI

82
Q

Osteomyelitis tx. of choice:

A

Flucloxacillin for 6 weeks

Clindamycin if allergic

83
Q

Most common location/form of haematogenous osteomyelitis in adults:

A

Vertebral osteomyelitis

84
Q

At what ages should men/women by assessed for fragility fractures:

A

Men - 75 yrs

Women - 65 yrs

85
Q

Method of risk assessment: osteoporosis

A

FRAX and Qfracture

86
Q

What is a Toddler’s fracture:

A

Oblique TIBIAL fracture in infants

87
Q

What is a Greenstick fracture:

A

Unilateral cortical breach only

88
Q

Osteopetrosis inheritance

A

Autosomal RECESSIVE

89
Q

Patellar fracture: Investigation

A

Plain x-ray - minimum of TWO views required

90
Q

Undisplaced patellar fracture management:

Displaced patellar fracture management:

A

w/ intact extensor mechanism managed conservatively w/ hinged brace for 6 weeks - FULLY weight bear

Surgery then 4-6 weeks hinged knee brace

91
Q

Where is plantar fasciitis worst:

A

Medial calcaneal tuberosity

92
Q

Rib fractures investigations:

A

CT scan of the chest - will show fractures in 3D as well as assoc. soft tissue injuries

93
Q

Rib fractures after no improvement from conservative management for ___ weeks:

A

12 weeks -> Surgical fixation considered

94
Q

Most common sarcoma in adults:

A

Malignant fibrous histiocytoma

95
Q

What is a malignant fibrous histiocytoma:

A

Sarcoma which may arise in soft tissue and bone

96
Q

Blood supply to scaphoid

A

Dorsal carpal branch of RADIAL artery

97
Q

Scaphoid fracture imaging:
X-ray
CT
MRI

A

X-ray requested w/ scaphoid views (PA, lateral, oblique)

CT requested if on-going clinical suspicion or planning operative tx.

MRI considered definitive diagnosis to confirm

98
Q

Initial management of scaphoid fracture:

A

Immobilisation w/ futuro splint or standard below elbow backslab
Referral to orthopaedics

99
Q

When should further imaging of scaphoid fractures be done:

A

Should be arranged for 7 to 10 days after initial if inconclusive imaging

100
Q

Management of scaphoid fracture - orthopaedics

A

If displaced scaphoid waist or scaphoid pole fractures: Surgical fixation

If undisplaced: cast for 6 weeks

101
Q

Shoulder dislocation w/ light bulb and Rim’s sign:

A

Posterior shoulder dislocation

102
Q

What is the pattern of neurological signs in infarction of the spinal cord

A

Dorsal column signs: Loss of proprioception and fine discrimination

103
Q

Myotomes: long finger flexors:

A

C8

104
Q

Myotomes: small finger abductors:

A

T1

105
Q

What results from a ‘pulled elbow’

A

Subluxation of the radial head

106
Q

Signs of subluxation of the radial head:

A

Limited supination and extension of the elbow

107
Q

Management of pulled elbow (subluxation of the radial head)

A

Analgesia passive supination of elbow joint while it is flexed to 90 degrees

108
Q

Trigger finger mx.

A

Steroid injection successful in majority of pts.

Surgery reserved for those who do not response to steroid injection

109
Q

Sensory innervation to the small area between the dorsal aspect of the 1st and 2nd metacarpals:

A

Radial nerve

110
Q

Nerve injury in medial epicondyle fracture:

A

Ulnar nerve

111
Q

Most common Organism in septic arthritis: young people

A

Neisseria Gonorrhoea

112
Q

dislocation seen in seizures and electric shock

A

Posterior shoulder dislocation

FLASH FINALS (34 decks)

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