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MSK Flashcards

1
Q

What nerve is most likely to be damaged in a humeral shaft fracture?

A

Radial

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2
Q

An externally rotated hip is most suggestive of what pathology?

A

Fractured neck of femur

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3
Q

If a patient presents with a joint problem, what 4 things should you always ask about?

A

Pain, stiffness, weakness, loss of movement

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4
Q

What muscles are primarily responsible for flexion of the knee? What is the nerve supply?

A

Hamstrings - supplied by the sciatic nerve (L4-S3)

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5
Q

Steinmann’s test assesses for what injury?

A

Acute meniscal tear

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6
Q

Performing internal rotation against resistance assesses which rotator cuff muscle power?

A

Subscapularis

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7
Q

Arterial supply to the hip is largely via which arteries?

A

Medial and lateral circumflex arteries (branches of the profunda femoris artery)

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8
Q

What muscle is the chief flexor of the hip joint? What is its nerve supply?

A

Iliopsoas - anterior rami of L1-L3

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9
Q

Describe Phalen’s test used to assess for carpal tunnel syndrome?

A

Holding wrist in flexion for 30 seconds should recreate the pain

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10
Q

Where should you assess sensation of the median nerve?

A

Lateral aspect of index finger

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11
Q

Loss of which movement is most sensitive for indicating shoulder pathology, especially frozen shoulder?

A

External rotation

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12
Q

If a knee injury is thought to be significant, what is the best investigation to use?

A

MRI

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13
Q

Patients will not be able to straight leg raised if they have damage to which muscles or which nerve?

A

Quadriceps muscles or femoral nerve

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14
Q

During a femoral stretch test, back pain radiating down the anterior leg is suggestive of what pathology?

A

L4 nerve root compression

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15
Q

Pain in the anterior mid-groin is most suggestive of pathology where?

A

The hip joint itself

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16
Q

What spinal movements should be assessed within a GALS exam?

A

Lateral flexion of cervical spine and flexion of lumbar spine

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17
Q

Which movements of the lower limb should be assessed within a GALS exam?

A

Flexion and extension of the knee, internal rotation of the hip

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18
Q

A total hip replacement or posterior hip dislocation are most likely to cause damage to which nerve?

A

Sciatic (L4-S3)

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19
Q

What muscle is responsible for external rotation of the knee joint? What is its nerve supply?

A

Biceps femoris - supplied by the sciatic nerve (L4-S3)

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20
Q

Which nerve is most likely to be damaged in an anterior shoulder dislocation or humeral neck fracture?

A

Axillary

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21
Q

A fixed flexion deformity of the hip is most commonly caused by which pathology?

A

Osteoarthritis

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22
Q

What is the cause of a 1) True and 2) Apparent leg length discrepancy?

A

1) Bony/joint pathology 2) pelvic tilting (e.g. fixed flexion deformity, scoliosis)

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23
Q

Other than the iliopsoas, what other muscles are responsible for flexion at the hip joint? What is their nerve supply?

A

The anterior compartment of the thigh (quadriceps femoris, sartorius, pectineus) - supplied by the femoral nerve (L2-L4)

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24
Q

What muscles are responsible for external rotation of the hip? What is their nerve supply?

A

Lots of muscles, but specifically the external rotator group, innervated by the lumbosacral plexus (L4-S2)

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25
Q

AVN of the femoral head is most likely caused by damage to which artery?

A

Medial circumflex artery

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26
Q

If taking a history of knee pain, what are some useful symptoms to ask about?

A

Giving way, locking, clicking/catching

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27
Q

Where should you assess sensation of the axillary nerve?

A

Regimental badge patch area

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28
Q

A Thomas’ test for a fixed flexion deformity is positive if what happens?

A

The thigh lifts off the couch

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29
Q

If a patient presents with a joint problem that you suspect could be systemic, other than those already discussed in the systemic enquiry, what are some other important systems to ask about?

A

Skin changes and/or eye problems

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30
Q

Which nerve is most likely to be damaged in a posterior elbow dislocation?

A

Ulnar nerve

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31
Q

Hearing a ‘pop’ at the time of a knee injury and developing haemarthrosis within one hour is generally suggestive of what pathology?

A

ACL rupture

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32
Q

An acutely inflamed joint is what until proven otherwise?

A

Septic arthritis

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33
Q

Describe Tinel’s test used to assess for carpal tunnel syndrome?

A

Percussing the median nerve over the ventral aspect of the wrist should recreate the pain

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34
Q

What muscles are responsible for hip adduction? What is their nerve supply?

A

Medial compartment of the thigh (adductor magnus/brevis/longus, gracilis) - supplied by the obturator nerve (L2-L4)

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35
Q

Scapula winging is a sign caused by palsy of which nerve?

A

Long thoracic nerve

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36
Q

Anterior and posterior drawer tests assess the stability of what structure?

A

Anterior and posterior cruciate ligaments

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37
Q

True knee locking is a sign of what injury?

A

Bucket handle meniscal tear

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38
Q

A combination of what three knee injuries makes up the ‘unhappy triad’?

A

MCL rupture, medial meniscus tear, ACL rupture

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39
Q

What are the two main risk factors for AVN of the hip?

A

Steroid use and alcohol abuse

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40
Q

What special tests should you perform in a shoulder exam of an older person who you suspect may have a rotator cuff tear?

A

Perform rotator cuff movements against resistance

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41
Q

What muscles are responsible for extension of the hip? What is their nerve supply?

A

Posterior compartment of the thigh (hamstrings- biceps femoris, semimembranosus, semitendinosus) supplied by the sciatic nerve (L4-S3) and the gluteus maximus supplied by the interior gluteal nerve (L5-S2)

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42
Q

Which nerve is most likely to be damaged in a Colles fracture?

A

Median nerve

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43
Q

What nerve is damaged to cause a claw hand?

A

Ulnar nerve

44
Q

The hip joint is primarily innervated by which nerves?

A

Sciatic, femoral and obturator

45
Q

A hip joint which is shortened and internally rotated is most suggestive of what pathology?

A

Posterior dislocation

46
Q

What movement of the hand assesses the function of the median nerve?

A

Thumb abduction

47
Q

Where should you assess sensation of the ulnar nerve?

A

Medial aspect of the little finger

48
Q

Which muscle is responsible for internal rotation of the shoulder? What is the nerve supply?

A

Subscapularis - supplied by the upper and lower subscapular nerves (C5/6)

49
Q

What muscles are responsible for internal rotation of the hip? What is their nerve supply?

A

Gluteus medius and minimus - supplied by the superior gluteal nerve (L4-S1)

50
Q

What are the steps of management for lower limb arthritis?

A

1) Weight loss (if necessary) 2) Analgesia 3) Physiotherapy 4) Walking aids 5) Surgical intervention

51
Q

What muscle is responsible for flexion and extension of the shoulder?

A

Deltoid

52
Q

During a straight leg raise, back pain radiating down the posterior leg beyond 90 degrees is suggestive of what pathology?

A

L5/S1 nerve root compression

53
Q

What muscle is responsible for abduction beyond 15 degrees?

A

Deltoid

54
Q

What special tests should you perform in a shoulder exam of a young person?

A

Look for sulcus sign and perform shoulder apprehension tests

55
Q

If the medial collateral ligament is damaged, it is highly likely that what other structure in the knee is also damaged?

A

Medial meniscus

56
Q

What muscle is responsible for the first 15 degrees of abduction? What is its nerve supply?

A

Supraspinatus - supplied by the suprascapular nerve (C5/6)

57
Q

What muscles are responsible for hip abduction? What is their nerve supply?

A

Gluteus medius and minimus - supplied by the superior gluteal nerve (L4-S1)

58
Q

What nerve is damaged to cause wrist drop?

A

Radial nerve

59
Q

What is the pathology behind impingement syndrome?

A

Supraspinatus tendonitis

60
Q

What are some particularly important questions to ask when taking a history about back pain?

A

Does it wake you at night? Any lower limb sensory/motor deficits? Any saddle anaesthesia? Any bladder/bowel changes?

61
Q

Trochanteris bursitis typically presents with pain on what movement?

A

Resisted abduction

62
Q

What muscle is responsible for adduction and internal rotation of the shoulder?

A

Teres major

63
Q

What is the nerve supply to the deltoid muscle?

A

Axillary nerve (C5/6)

64
Q

A Schober’s test is within normal range if the gap increases by more than what value on flexion?

A

5cm

65
Q

What neurovascular structures are most likely to be damaged in a supracondylar fracture of the elbow?

A

Median nerve and brachial artery

66
Q

You should only do a heel height test in a knee exam if you are suspecting what injury?

A

Bucket handle meniscal tear

67
Q

How is trochanteric bursitis treated?

A

Self-limiting, provide analgesia (paracetamol, ibuprofen, steroid injections) and physiotherapy

68
Q

A Trendelenberg gait or a positive Trendelenberg test is caused by unilateral weakness of which group of muscles? This can be secondary to damage to which nerve?

A

The hip abductors (gluteus medius/minimus) / Superior gluteal nerve (L4-S1)

69
Q

A femoral shaft fracture is likely to result in damage to which neurovascular structures?

A

Femoral artery and sciatic nerve

70
Q

The scarf test used in the shoulder exam may indicate what problem?

A

AC joint pathology

71
Q

Jobe’s test assesses which rotator cuff muscle power?

A

Supraspinatus

72
Q

What movement of the hand assesses the function of the radial nerve?

A

Wrist and finger extension

73
Q

Which muscle is responsible for external rotation of the shoulder? What is the nerve supply?

A

Infraspinatus (suprascapular nerve) and teres minor (axillary nerve) - both C5/6

74
Q

Performing external rotation against resistance assesses which rotator cuff muscle power?

A

Infraspinatus/teres minor

75
Q

What muscles are primarily responsible for internal rotation of the knee joint? What is its nerve supply?

A

Semimembranosus and semitendinosus - supplied by the tibial nerve (L5-S2)

76
Q

Pain in the medial groin is most suggestive of pathology where?

A

Pubic rami - ? fracture

77
Q

A foot drop is caused by damage to what nerve?

A

Common fibular nerve (L4-S2)

78
Q

Describe Froment’s test used to assess for ulnar nerve damage?

A

Ask patient to pinch paper between a straight thumb and index finger while pulling the paper away- flexion of the thumb at the DIP joint is a positive test

79
Q

What is usually the first movement to be reduced in hip pathology such as OA?

A

Internal rotation

80
Q

Where should you assess sensation of the radial nerve?

A

Dorsal first interosseous space

81
Q

What special tests should you perform in a shoulder exam of a middle-aged person who you suspect may have instability?

A

Painful arc and Hawkins-Kennedy test

82
Q

What movement of the hand assesses the function of the ulnar nerve?

A

Finger abduction

83
Q

What three questions should you ask patients before starting a GALS exam?

A

Do you currently have any pain or stiffness in your joints or muscles? Do you have any difficulty getting dressed? Do you have any difficulty getting up and down stairs?

84
Q

What muscle group is responsible for extension of the knee? What is its nerve supply?

A

Quadriceps femoris - supplied by the femoral nerve (L2-L4)

85
Q

What is seen in this x-ray?

A

Left subcapital (intracapsular) hip fracture

86
Q

What is seen in this x-ray?

A

Left subcapital (intracapsular) hip fracture

87
Q

What is seen in this x-ray?

A

Left intertrochanteric (extracapsular) hip fracture

88
Q

What is seen in this x-ray?

A

Left subtrochanteric (extracapsular) hip fracture

89
Q

What is seen in this x-ray?

A

(Impacted) Left subcapital (intracapsular) hip fracture

90
Q

What is seen in this x-ray?

A

Right subtrochanteric (extracapsular) hip fracture

91
Q

What is seen in this x-ray?

A

Left intertrochanteric (extracapsular) hip fracture

92
Q

How are intracapsular (subcapital) hip fractures treated?

A

Total hip replacement in high functioning patients

Hemiarthroplasty in those with poor mobility and/or cognitive impairment

93
Q

How are intertrochanteric extracapsular hip fractures treated?

A

Dynamic hip screw (DHS)

94
Q

How are subtrochanteric extracapsular hip fractures treated?

A

IM nail

95
Q

What are some specific things to look at in an x-ray where a hip fracture is suspected?

A

Trace Shenton’s line

Look for asymmetry (particularly of the lesser trochanter)

96
Q

What things should you do first when looking at an MSK x-ray?

A

Confirm patient name/DOB and assess the adequacy of the film

97
Q

How do you assess the adequacy of an MSK x-ray?

A

Make sure there are AP and lateral views

Ensure the joint above and below are imaged

Make sure the film isn’t rotated and is adequately penetrated

98
Q

What are the 4 steps to looking at an MSK x-ray?

A

Alignment and joint spaces

Bony texture

Cortices

Soft tissues

99
Q

What should you comment on in the alignment and joint space section of an MSK x-ray?

A

Are the bones displaced or angulated in any way?

Is there any joint space narrowing, new bone formation or subchondral sclerosis?

100
Q

How can you tell that bony texture is normal on an x-ray?

A

Trabeculae (fine white lines) are visible within the internal matrix of the bone, and there is a thick external covering

101
Q

What sort of things are you looking for when assessing the soft tissues on an x-ray?

A

Swelling/effusions, foreign bodies

102
Q

How should you describe a fracture?

A

Location (proximal/middle/distal third of bone x, intra or extracapsular)

Complete/incomplete and type

Open or closed

Any displacement or angulation

103
Q

What are some examples of incomplete fracture types?

A

Buckle, bowing, greenstick

104
Q

What are some examples of complete fracture types?

A

Oblique, transverse, comminuted, segmental, spiral

105
Q

How is displacement of a fracture described?

A

% displacement (in reference to the width of the bone) of the distal fragment anteriorly/posteriorly/medially/laterally

106
Q

How is angulation of a fracture described?

A

Degrees of angulation of the distal fragment anteriorly/posteriorly/medially/laterally

OSCE (14 decks)

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