MSK Flashcards
(13 cards)
What is the most common type of ankle injury?
Lateral ligament sprain (Accounts for ~ 77% of ankle injuries, mostly involving sprain of the anterior talofibular ligament)
What QFracture score should patients be referred for DEXA scan?
QFracture is the risk of having an osteoporotic fracture in the next 10 years
If it is 10% of higher the patient should be referred for a DEXA scan
What is the typical presentation of chronic compartment syndrome?
Pain in a muscle group that has onset shortly after beginning the exercise (normally in the legs, e.g during running) but wears off after about 10-20 mins of rest or with elevation.
No interval pain or pain during ADLs.
Mx is physio, consideration of orthotics
What are the Ottawa Knee Rules when determining if the patient needs a knee XR?
order an XR if any of the following present:
- Age > 55
- Isolated tenderness of the patella
- Isolated tenderness of the fibula head
- Inability to flex the knee to 90 degrees
- Large effusion that developed < 2 hours of the injury (suspect haemarthrosis)
- Inability to weightbear immediately after the injury and during the consultation unable to WB > 4 steps
What treatment options are available for essential tremor?
Beta blocker
Primidone
In which patients should you carry out a fracture risk assessment?
Every man > 75 and woman > 65
If under these ages but risk factor present:
- Current or frequent steroid use
- Previous fragility fracture or a family history of hip fracture
- History of falls
- Smoker
- Regularly drinks > 14 units per week
- Secondary cause of osteoporosis (hypogonadism, hyperprolactinaemia, hyperthyroidism, hyperparathyroidism, Cushing’s, diabetes, CKD, immobility, coeliac disease, inflammatory bowel disease, chronic liver disease, chronic pancreatitis, cystic fibrosis, COPD, haematological conditions, rheumatological conditions)
Don’t routinely use fracture risk assessment in those < 50 unless MAJOR risk factor
- Current or frequent steroid use
- Untreated early menopause
- Previous fragility fracture
Which fracture risk assessments are recommended by NICE and what risk do they calculate?
QFracture or FRAX
QFracture can be used aged 30-84, includes ethnicity but doesn’t include the option of adding bone mineral density result
FRAX - can be used aged 40 - 90
They both calculate the 10 year absolute fracture risk
What are the target serum urate levels in people with gout on urate-lowering therapy?
General target = < 360 micromol/L
If tophi, severe gouty arthritis or ongoing gout flares then target < 300
Should start low dose ULT and then use monthly urate levels to titrate upwards until in target then can stepdown to annual urate levels once in target
What advice on diet and lifestyle should be given to patients with gout?
EXPLAIN THAT NO EVIDENCE THAT ANY PARTICULAR DIET LOWERS THE RISK OF GOUT FLARES
Should be advised to aim for a normal BMI and to reduce alcohol
Which patients should be started on urate-lowering therapy after the 1st presentation of gout?
Those on diuretics
Those with CKD stage 3 and below
Those with tophi or chronic gouty arthritis
Those with multiple or troublesome flares
What urate lowering therapy should be first line in gout?
Can offer EITHER allopurinol or febuxostat first line for ULT
Allopurinol should be 1st line if major cardiovascular disease ie MI, stroke, unstable angina
Can switch to whichever option wasn’t tried first if not reaching target levels
What are the indications to refer a patient with gout to rheumatoogy?
If diagnostic uncertainty
If CKD stage 3b or below (ie eGFR < 45)
If prev organ transplant
If treatment ineffective
What is the typical presentation of iliotibial band syndrome?
Iliotibial band syndrome presents with LATERAL knee pain, especially when running down hill in runners (and sometimes cyclists)
Multi factorial but closely linked to weakness of hip abductor muscles
