MSK Flashcards by Charis Gibson

Child with muscle weakness from age of 2, loose shoulder muscles (feels like slips through mothers hands on carrying) and bulky calf muscles. Diagnosis? Method of acquiring?

Duchennes’ muscular dystrophy
X-linked recessive

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6 y/o boy, limp for 24 hours, lethargic/feverish, hip huts. Cold few weeks ago. Temp: 37.9 degrees.
What invgX and DDxs?

Transient synovitis or septic arthritis.

Joint aspirate to differntiate

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Classification for intra-capsular fractures of hip?

Garden

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What supplies sensation over medial aspect of lower leg and foot?

Saphenous

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What can ilicit pain in lateral epicondylitis?

Supinating forearm and extending wrist against resistance

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What is the most likely complication following treatment of long bone fractures?

VTE

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Patient with lower back pain but no red flags, what analgesia you want to give?

NSAIDs (consider GI, Liver, cardio-renal toxicity though)
Consider weak opiods +/- paracteamol

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Common cause of lateral knee pain in runners?

Iliotibial band syndrome

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What is a significant risk factor for AVN if you’ve had cancer before?

Chemo treatment

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Simmond’s sign indicates what?

Achilles tendon rupture

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Treatment of choice for all pateints with displaced hip fracture?

Hemiarthroplasty or total hip replacement

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Shortened, internally rotated leg?

Posterior hip fracture

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What elbow pain cause is worse on resisted wrist extension/supination + elbow extended?

Lateral epicondylitis (tennis)

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What diseases are associated with reactive arthritis?

Chlamydia
Gonorrhoea
Gastroenteritis

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What is a buckle fracture?

Incomplete fracture of the shaft of long bone
Characterized by bulging cortex
Child aged 5-10 probs

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Nerve compressed in cubital tunnel syndrome?

Ulnar
-Presents with tingling/numbness of 4th/5th finger

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Presnetation of radial nerve palsy?

Wrist drop
Loss of sensation from 1st dorsal web-space

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Colles fracture presentation?

FOOSH
-Distal radius fracture with dorsal displacement of most distal fragment

-1 inch proximal to radiocarpal joint
-Dorsal displacement
-Angulation

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What can statins cause, resulting in high CK?

Rhabdomyolysis

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Abrupt onset of bilateral early morning stiffness in over 60’s?

Polymyalgia rheumatica

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Weakness in muscles of proximal arms and legs, which improves on movement?

Lambert-Eaton syndrome

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Lambert Eaton syndrome vs Myaesthenia gravis?

MG: Affects face and arms earlier
LE: Gets slightly better with muscle use whereas MG gets worse

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What are the features of post-thrombotic syndrome?

Painful heavy calves
Pruritus
Swelling
Varicose veins
Venous ulceration

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If shown a skull x-ray in an exam what should you always think?

Paget's disease

L2 nerve compression would cause what?

Pain, weakness, numbness, tingling, burning sensations in anterior aspect of thigh

What fractures are most associated with compartment syndrome?

Supracondylar and tibial shaft fractures

Exacerbated pain on passive stretching indicates what?

Compartment syndrome

Galaezzi fracture is what

Dislocation of distal radioulnar joint with associated fracture of the radius

Monteggia fracture is what?

Fracture of proximal ulna with associated dislocation of proximal radioulnar joint

What is Klumple's paralysis?

C8/T1 nerve root damage "All fingers of affected hand are flexed into claw position. Loss of sensation along ulnar aspect of whole hand and arm"

Typical mechanism of injury for Klumpke's palsy?

Falling from a tree Birth injury

What is Erb's palsy?

C5/6 nerve roots damaged early in the brachial plexus

Presentation of Erb's palsy?

Weakness in deltoids, biceps, hands &wrist movements generally not affected

Saturday night palsy features?

Wrist drop and finger extension weakness -Damage to radial nerve in axilla

What type of injury is associated with seizure/electric shock?

Posterior shoulder dislocation

Shoulder locked in internally rotated position is highly suggestive of what?

Posterior dislocation

What is syringomyelia?

Disorder where cystic cavity forms within spinal cord

Features of syringomyelia?

-Dorsal column and medial leminiscus spared -Spinothalamic tract affected: loss of pain and temperature

Most common variant of syringomyelia?

Arnold-Chiari malformation: cavity connects with congenital malformation affecting cerebellum

IVDU + back pain + pyrexia = susp of what?

Osteomyelitis

Sickle Cell osteomyelitis cause?

Salmonella

What eye symptoms can be associated with fat embolism?

Retinal haemorrhages and intra-arterial fat globules on fundoscopy

Pain on hip extension + lying on back with knee slightly flexed, hip externally rotated. What does this indicate in an IVDU?

Psoas abscess

Schober's test <5cm is indicative of what?

Osteomyelitis

8 months of old child with discrpenacy between skin creases behind right and left hips?

Developmental dysplasia of the hip

Most common site affected by osteomyelitis in children?

Metaphysis

Why do people with coeliac disease receive the pneumococcal vaccine?

Hyposplenism -This makes it important for them to have as it causes mil immunosuppression

SALTER HARRIS Types rememebring technique?

1: Slipped: 2: Above growth plate 3: Lower than growth plate 4: Through (through both above and below growth plate) 5: Rammed (crush)

Management of reverse, oblique, transverse or subtrochanteric fractures?

Intramedullary device

What mechanism of fracture comes often with 5th MT fractures?q

Inversion of foot and ankle

Extracapsular/INTERTROCHANTERIC proximal femor fractures management?

Dynamic hip screw

Displaced hip fracture surgical management?

Hemiarthroplasty

DdX: old man, bone pain, raised ALP?

Paget's

Analgesia for patients with neck of femur fracture?

Iliofascial nerve block

Waddling gait diagnosis?

Osteomalacia

Most common child abuse fractures?

Radial Humeral Femoral

Most common site of stress fractures?

2nd metatarsals

Biochem of osteomalacia?

Low calcium Low phosphate Raised ALP Raised PTH

What is Pott's disease?

Form of TB that occurs outside lungs, common in vertebrae -Back pain and fever, wt loss, limp

What can iliiopsoas abscess be secondary to?

Crohn's Diverticulitis/colorectal cancer UTI/GU Cancers Vertebral osteomyelitis Femoral catheter Endocardits IVDU

InvGx for iliopsoas abscess?

CT Abdo

What should you look for if a patient has staphylococcus and discitis?

Endocarditis

Olecranon bursitis presentation?

Inflammation of bursa located at tip of elbow Painful Erythematous swelling on posterior elbow No preceding trauma

First line method of diagnosing Achilles tendon rupture?

US Scan CT would work but more radiation than necessary MRI also would work but not first line as US is more quick and easy

What is an important next investigation following diagnosis of spinal stenosis?

MRI: Discount Mets and confirm diagnosis

Spot diagnosis: -Burning and tingling sensation over upper lateral area of thigh

Meralgia paraethetica

What supplies upper lateral area of thigh?

Lateral femoral cutaneous nerve

Why can meralgia paraethetica occur?

Compression of lateral femoral cutaneous nerve due to weight gain Also affected by: - Pregnancy - Ascites - Trauma -Iatrogenic

Triad of fat embolism symptoms?

Respiratory distress Neurological distress Petechial rash

Treatment of Weber A fractures?

Weight bear as tolerated in CAM Boot for 6 weeks

Snapping sensation + hip/groin pain?

Acetabular labral tear

Reflex nerve root for achilles?

S1-S2 (Buckle my shoe)

Reflex nerve root for patellar reflex?

L3-L4 (Kick the floor)

Nerve root for biceps reflex?

C5-C6 (Pick up sticks)

Nerve root reflex for tricepts?

C7-8 Lay them straight

Rapid joint swelling of knee is suggetsive of what + what two injuries?

Haemoarthrosis -ACL and PCL injury

Positive lachman's suggest?

ACL injury

Prominent clavicle + loss of shoulder contour makes you think what?

Acromioclavicular dislocation

Hills Sachs lesion is what?

When the cartilage surface of the humerus is in contact with rim of glenoid

What is Hills Sachs lesion associated with?

Glenohumeral dislocation

Old woman, trips on step, complains of shoulder pain, pain to 90 degree abduction? Spot diagnosis

Supraspinatous tear

What is Simmond's triad?

Calf squeeze test Observation of angle of declination Palpation of tendon

Twisting sport injury + delayed onset of knee swelling & locking are strongly suggestive of what?

Meniscal tear

Tibia lying back on femur indicative of what?

PCL rupture

High twisting force to flexed knee + rapid joint swelling?

ACL Rupture

What condition is exacerbated by walking on tip toes?

Plantar fasciitis

Description of club foot?

Inverted Plantar flexed foot Not passively correctable

Features of meniscal tear?

Knee locking Giving away

Management for subluxation of radial head?

Passive supination of elbow joint whilst flexed to 90 degrees

Nerve root with pathology if: - Weakness of plantar flexion -Reduced ankle reflex

Nerve root with pathology if: - Sensory loss over naterior thigh -Weak hip flexion, knee extension and hip adduction -Reduced knee reflex

S ymptoms of L3 nerve root compression?

Sensory loss over anterior thigh Weak hip flexion + adduction Weak knee extension Reduced knee reflex

Positive McMurray's test indicates what?

Meniscal tear (positive = painful click)

Investigation for sus psoas abscess?

CT Abdomen

Bi-malleloar fracture of ankle?

Pott's

Name of fracture for "a hurt thumb when punching opponent"?

Bennett's

Name of fracture for sore wrist, transverse fracture of radius 2cm proximal to radio-carpal joint with dorsal displacement and angulation?

Colles

Squaring of thumbs indicates what disease?

Osteoarthritis

Nerve conduction study findings in carpal tunnel?

AP prolongation in both sensory and motor axons

Advice for management of compartment sydnrome?

Keep limb level with the body IV Fluids Pain control Fasciotomy DON'T GIVE ANTI-COAGS

Management of proximal scaphoid pole fractures?

Surgical fixation

Hand joints involved in osteoarthritis?

DIPs Carpometacarpal

Initial treatment of ankle fracture with assoc dislocation?

Closed reduction under sedation

Most common intervention used in an intertrochanteric fracture?

Dynamic hip screw

Older, less mobile individuals with displaced intracapsular fracture?

Hemiarthroplasty (instead of Fracture reduction and fixation, for more younger patients)

Intertrochanteric fracture device used vs subtrochanteric fracture device used?

Inter: Dynamic hip screw Sub: Intramedullary nail

What antibiotic is associated with new onset Achilles tendon disorders?

Ciprofloxacin

L5 nerve root affected features?

Loss of foot dorsiflexion Sensory loss dorsum of foot

AC joint grading?

Grade I-VI 1-2: Common, conservatively managed with sling 3-5: Surgical intervention

Straight leg raise indicates what?

Sciatic nerve pain

RFs for congenital hip dislocation?

Femal Breech FamHx First born Oligohydramnios

Nerve affected in meralgia paraesthetica with burning thigh pain?

Lateral cutaneous nerve of thigh

What is Leriche syndrome?

- Claudication of buttocks and thighs - Atrophy of musculature of the legs - Impotence (due to paralysis of L1)

Weakness of hip abduction and foot drop, no loss of specific reflexes?

L5 nerve affected

ZSensory loss over anterior thigh, weak hip flexion, knee extension and hip adduction Reduced knee reflex?

L3 nerve root compression

ME is typically aggravated by what two movements?

Wrist flexion and pronation

MSK Flashcards

(118 cards)