MSK Quiz Questions Flashcards
Colles’ fracture
Fracture of distal radius with posterior displacement. Colles’ fracture usually occurs as when a patient falls on an outstretched hand. It forms a dinner fork type deformity due to posterior displacement of distal fragment of the radius. There is a risk of median nerve damage.
Colles’ fracture common occurs how?
Fall where she fell on to her outstretched hand. FOSH fracture?
A 24-year-old lady is stabbed in the buttock. Following the injury the wound is sutured in the emergency department. Eight weeks later she attends the clinic, as she walks into the clinic room she has a waddling gait and difficulty with thigh abduction. On examination she has buttock muscle wasting. Which nerve has been injured?
Damage to the superior gluteal nerve will result in a Trendelenburg gait.
During a hip examination, John, a 68-year-old male, is found to have a positive trendelenburg’s sign. When he stands on only his left leg, his right pelvis drops. What muscles are affected in John?
The superior gluteal nerve innervates the gluteus minimus and gluteus medius muscles. The action of these muscles include abduction and medial rotation of the lower limb. Additionally, these muscles prevent pelvic drop of the opposing limb. Therefore, as an example, when standing on only the right leg, the right gluteus minimus and gluteus medius muscles stabilise the pelvis. When the right superior gluteal nerve is damaged, there is lack of innervation to the right gluteus minimus and gluteus medius muscles and when the patient stands on their right leg there is lack of stability and the left pelvis drops.
Gluteus maximus function and innervation:
The inferior gluteal nerve innervate the gluteus maximus muscles, which is the main extensor of the thigh and also does lateral rotation.
Menachem is a 24-year-old male who presents to the emergency department with an anteriorly dislocated shoulder and fracture of the surgical neck of the humerus. Given the likely nerve damage, whichsign will most likely be elicited?
A patient has difficult abducting their arm following a humeral neck fracture - axillary nerve. Loss of sensation over the deltoid muscle and outer upper arm.
Cholesterol deposition in nodules is characteristic of what form of arthritis?
Rheumatoid arthritis Note: Rheumatoid arthritis (RA) typically presents as symmetric arthritis in 3+ joints.
Serological testing shows what in rheumatoid arthritis?
Positive anti-cyclic citrullinated peptide and rheumatoid factor.
What triad characterises reactive arthritis?
Reactive arthritis is characterised by a triad of conjunctivitis, urethritis, and arthritis, with patients often also having diarrhoea. Patients can also develop keratoderma blennorhagicum (hyperkeratotic vesicles on the palms and soles).
Septic arthritis presentation:
Septic arthritis classically presents as a single red, swollen, and painful joint and is an invasion of the synovial membrane which produces a yellow, turbid synovial fluid with high neutrophils. This is most commonly found with infection by Staphylococcus aureus.
What is this classical presentation? Presents with a short duration of morning stiffness with symptoms that worsen with weight-bearing throughout the day. Features on x-ray include loss of joint space, osteophytes, subchondral sclerosis and subchondral cysts.
Osteoarthritis
What is the most common cause of osteolytic bone metastasis in children?
Neuroblastomas are a relatively common childhood tumour and have a strong tendency to developing widespread lytic metastasis.
Where does the anterior cruciate ligament originate and insert?
The anterior cruciate ligament is attached to the anterior intercondylar area of the tibia. Is then passes posterolaterally to insert into the posteromedial aspect of the lateral femoral condyle.
Function of the ACL:
Anterior tibia to lateral intercondylar notch femur: prevents tibia sliding anteriorly.
The long head of the triceps inserts where?
The long head of the triceps muscle inserts onto the infraglenoid tubercle of the scapula.
What are the origins and insertions of the three heads of the tricep?
Long head - originates from infraglenoid tubercle of the scapular
Lateral head - dorsal surface of the humerus
Medial head - posterior surface of the humerus
These fibers converge to form one tendon which inserts onto olecranon process of the ulna.
What are the contents of the cubital fossa?
The contents of the cubital fossa are (from lateral to medial): radial nerve, brachial tendon, brachial artery, median nerve.
Really Need Beer To Be At My Nicest.
Ulnar nerve goes posterior to medial epicondyle to enter the forearm.
Ulnar nerve goes posterior to medial epicondyle to enter the forearm.
A 60-year-old woman presents with a severe, bilateral temporal headache. Further questioning reveals an experience of temporary loss of vision in one eye and jaw pain. What is the most likely diagnosis?
Temporal / Giant cell arteritis
What is this classical presentation?
Associated with headache attacks lasting hours, often preceded by an aura such as scintillating scotoma around 1-2 hours beforehand, and changes to mood, appetite, and sleepiness hours to days beforehand.
Migraine
Temporal arteritis aka Giant cell arteritis
Headache in temporal arteritis relates to the site of the pathology: the inflamed temporal artery. Jaw pain and amaurosis fugax (temporary loss of vision in one eye) are due to restrictions in blood supply to the jaw (causing a buildup of lactic acid due to anaerobic respiration) and eye, respectively.
A 30-year-old weightlifter presents to your general practice with a painful shoulder. For the past 10 days, he has had a dull, intermittent ache affecting the posterior aspect of his shoulder. The pain is brought on by his usual weightlifting exercises. On examination, there is tenderness on the posterior aspect of the shoulder. Abducting the arm against resistance brings on the pain. One of your differentials for this patient is quadrangular space syndrome. There are some questions that you should ask based on the functions of the nerve that passes through the quadrangular space. Which nerve passes through the quadrangular space?
Axillary nerve
The tibial pulse can be found where?
Posterior tibial pulse can be found inferoposteriorly to the medial malleolus.
A 16-year-old boy is on a date at the cinema, throughout the film he has his arm over his girlfriends seat. When the film ends he finds that he cannot move his wrist very well. On examination he cannot extend his wrist and his anatomical snuff box has reduced sensation. Which nerve has he damaged at the cinema?
A radial nerve palsy is commonly refereed to as a wrist drop. This is a mononeuropathy which results in the patient being unable to extend their wrist and instead it hangs flaccidly.
The question here is referring to ‘saturday night syndrome’. This is named after people sleeping with their arm over the back of a chair which will compress the brachial plexus.
Bouchard’s nodes
Bouchard’s nodes are hard knobs at the middle finger joints and those at the farthest away finger joint are known as Heberden’s nodes and both are a common feature of osteoarthritis in the hands. They signify moderate-severe osteoarthritis and are not usually the first sign.
Psoas major attaches onto the lesser trochanter.
