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MSK Flashcards

1
Q

What are the primary and secondary risk factors for osteoporosis?

A

Primary:
-ageing
-gonadal insufficiency

Secondary:
-nutrition- scurvy, malnutrition, malabsorption
-malignancy- leukaemia, myeloma
-endocrine- hyperparathyroid, thyrotoxicosis, cushing’s
-drugs- corticosteroids, alcohol, heaprin
-systemic disease- TB, RA, chronic liver disease (esp PBC)

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2
Q

Most common bacteria that causes osteomyelitis

A

Staph aureus

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3
Q

Most common organism to cause osteomyelitis in:
-sickle cell anaemia patients
-IVDU
-HIV/ AIDS
-immunosuppressed/ long term IV meds/nutrition

A

-Salmonella (also septic arthritis)
-Pseudomonas
-Bartonella
-Fungal osteomyelitis

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4
Q

Commonest site for ostemyelitis?

A

Long bones (upper/ lower limbs)

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5
Q

Commonest site for osteomyelitis in dialysis patients

A

Thoracic spine + ribs

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6
Q

Commonest site for osteomyelitis in IVDU patients

A

Medial/ lateral clavicle

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7
Q

Risk factors for osteomyelitis

A

Recent trauma/ surgery
systemic dieases- DM/ sickle cell
poor vascular supply
peripheral neuropathy
IVDU

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8
Q

What is the reverse popeye sign indicative of?

A

Distal biceps brachii tendon rupture

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9
Q

Risk factors for biceps brachii tendenopathy

A

-steroids
-smoking
-flouroquinolone abx
-CKD

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10
Q

With rupture of the biceps brachii tendon which forearm action would be the weakest

A

Elbow supination

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11
Q

What are the potential spaces between the neck fascia

A

Retropharyngeal space
Visceral space

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12
Q

Describe the potential spaces between the neck fascia

A

Retropharyngeal- between the pretracheal (visceral) and prevertebral fascia
-extends from skull base -> posterior mediastinum

Visceral- space within visceral pre-tracheal fascia
-extends from hyoid –> superior mediastinum

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13
Q

What types of injuries are likely to be missed in a FAST scan

A

Retroperitoneal injuries
(eg: renal laceration)

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14
Q

Commonest organism to cause septic arthritis in young sexually active adults

A

N Gonorrhea

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15
Q

Describe the Trendenlenburgs position and physiological effects

A

Head down-legs up

Improves blood pressure
Increases venous return
reduces intra-cranial pressure

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16
Q

Describe the Reverse- Trendenlenburgs position and physiological effects

A

Head up-legs down

Reduces blood pressure
Reduced venous return
Reduced cerebral perfusion

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17
Q

Fractures of which bones are most likely to indicate high energy trauma and severe hidden soft tissue injuries?

A

Sternum
Scapula
1st rib

[extremely hard to brake- have great vessels and cardiopulmonary apparatus underneath]

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18
Q

Describe the flexor tendon injury zones

A

https://orthofixar.com/wp-content/uploads/flexor-tendon-zones-2.webp

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19
Q

What nerve supplies all muscles in the extensor compartment of the forearm

A

Radial nerve

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20
Q

How many muscles are there in the superficial extensor compartment

A

7:
-Brachioradialis
-Extensor carpi radialis longus
-brevis
-Extensor digitorum
-Extensor digiti minimi
-Extensor carpi ulnaris
-Anconeus

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21
Q

What are the muscles of the deep extensor compartment of the forearm

A

-Supinator
-Abductor pollicis longus
-Extensor pollicis longus
-brevis
-Extensor indicis

(only to thumb + index finger)

22
Q

Patient presents with new confusion, shortness of breath, tachycardia, pyrexia, oliguria and a petechial rash following a RTA with a femoral fracture the day before.

Whats the Dx?

A

Fat embolism syndrome

23
Q

Risk factors for Fat embolism syndrome

A

Long bone fractures
IM nailing

24
Q

What structures are damaged in O’Donoghue’s triad/ unhappy triad

A

-ACL
-MCL
-medial meniscus

25
Q

What was later found to be contradictory to the unhappy triad?

A

LCL tears are more likely to accompany ACL ruptures than MCL tears

26
Q

When are Abx indicated in orthopaedic surgery

A

-All joint replacements
-All prosthetic/FB implantations

27
Q

Clinical characteristics of osteogenesis imperfectica

A

B-blue sclera
D-dentogenesis imperfectica (stained teeth)
S- sensorineural hearing loss
M- multiple fractures

28
Q

What is the difference in having hypertension w/ bradycardia vs hypotension w/ bradycardia?

A

HYPER +brady = raised ICP (cushings triad)
HYPO + brady (in absence of hypovolaemia) = cervical cord injury (loss of sympathetic drive)

29
Q

Clinical findings suggestive of cervical cord injury

A

-pain above but not below clavicle
-flaccid areflexia
-can flex but not extend at elbows
-hypotension + bradycardia
-diaphragmatic breathing
-priapism

30
Q

Why does cervical cord injury lead to diaphramatic breathing

A

No innervation of intercostal muscles when there is a spinal cord injury above T1 hence only the diaphragm is available for breathing

31
Q

Commonest salter harris type fracture?

A

Salter harris type 2

32
Q

Least common SH fracture

A

Salter harris type 5 then type 1

33
Q

Describe a Jefferson fracture

A

Blow out/ burst fracture of the ATLAS (anterior and posterior parts separate)
Best diagnosed on CT (not open mouth xr view)

34
Q

Describe a hangman’s fracture

A

Bilateral fracture of the pars interarticularis of the AXIS

35
Q

MOI of jefferson and hangman’s fractures

A

Jeffersons = axial loading
Hangmans = hyperextension of neck

36
Q

How would you identify a cervical vertebra

A

-large triangular vertebral foramen
-short transverse processes w/ foramina
-short bifid spinous process
-no/ v-small vertebral bodies

37
Q

What pass’s through the transverse foramina of cervical vertebrae

A

Vertebral arteries

38
Q

What section of vertebrae increase in size the further down the spine you go

A

Lumbar

39
Q

Describe thoracic vertebrae

A

-Large vertebral bodies
-long transverse and spinous processes
-circular vertebral foramen
-have costal and 2 demi facets each (articulate with ribs)

40
Q

Where are the lamina and pedicles on the vertebrae

A

Lamina= connects the transverse and spinous processes

Pedicle= just next to the vertebral bodies, connect it to the rest of the vertebral arch

41
Q

Name the spinal ligaments from anterior to posterior

A

-Anterior spinal ligament
-Posterior
-ligamentum flavum
-interspinal ligament
-supraspinal ligament

42
Q

Superiorly in the cervical spine, what does the supraspinous ligament continue as

A

Nuchal ligament

43
Q

Describe the classification of odontoid peg fractures

A

ADERSON & D’ALONZO classification:

Type1 = odontoid tip # (due to disruption of alar ligament)

Type 2= base of odontoid peg # (high non-union rate/ AVN as vascular supply disrupted)

Type 3 = # extends into body of axis (C2)

44
Q

What are the ligaments present between C1 & C2

A

2 alar ligament
1 apical ligament
1 transverse ligament

45
Q

Describe the sequence of changes to bone in osteomyelitis

A

-transient bacteriaemia
-focus of acute inflammation at the metaphysis of long bones
-necrosis of bone and formation of sequestrum
-formation of new subperiosteal bone that forms a shell over the dead bone

-pus may drain into:
nearby joint OR through sinus out onto skin surface

46
Q

T/F: Children are more affected by septic arthritis than adults

A

True

47
Q

Risk factors for septic arthritis

A

-steroid injections
-diabetes
-RA
-immunosuppression

48
Q

Which organisms cause septic arthritis in:
-normal patients
-IVDU
-children
-discitis
-prosthetic joints

A

-staph aureus
-gram -ve organisms
-H. influenzae
-brucella abortus
-staph epidermidis

49
Q

What are the steps in bone healing following a fracture

A

Fracture = damage to bone + periosteal blood vessels

-Haematoma forms
-macrophages, polymorphs and fibroblasts arrive at haematoma
-fibrosis, angiogenesis and formation of an organised clot (end of week 1)
-osteoblasts lay down woven bone to form callus
-woven bone remodelled into lamellar bone (according to stress orientation)

50
Q

Commons sites for AVN

A

-NOF
-anatomical neck of humerus
-scaphoid
-talus

mrcs (21 decks)

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