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MSK Flashcards

1
Q

Give the steps of the BAPRAS management of open fractures

A
  • ATLS / C spine
  • remove gross contamination
  • photo
  • dressing
  • analgesia
  • IV abx
  • tetanus
  • splint
  • x Ray
  • refer to ortho, plastics or vascular
  • transfer
  • regular assessment
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2
Q

What are the iv abx you would give to someone with an open fracture, and the doses

A

Coamoxiclav 1.2 g or 1.5g cefuroxime , 8 hourly

Or clindamycin 600mg if pen allergic

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3
Q

When would primary amputation be considered in a patient with open fracture

A 
Uncontrollable haemorrhage
Incomplete traumatic amputation 
4-6 hours ishcaemia
Segmental muscle loss in 2 compartments
Bone loss greater than1/3 tibia
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4
Q

What temporary dressings are put on a patient with open fracture

A
  • negative pressure VAC

- abx beads under semi permeable membrane

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5
Q

When putting a patient into surgery for definitive stabilisation and soft tissue coverage, which antibiotics are given

A

Gentamycin or vancomycin and teicoplanin at induction as one off

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6
Q

What are the pressures in the compartment space and CVP?

A

Compartment space is usually 10 mmHg

CVP is 5 mmHg

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7
Q

What is the pressure within a compartment in acute compartment syndrome

A

50 mmHg

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8
Q

What is usual mean arterial pressure

A

90 mmHg

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9
Q

What is the epidemiology of acute compartment syndrome - who is it most common in

A
  • common in LL
  • m>f
  • Young>old
  • low energy
  • sport
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10
Q

What are the causes of acute compartment syndrome

A 
Fracture (70%) 
Crushing
Bleeding disorder
Anticoagulants
Soft tissue injury without fracture
Reperfusion injury
Infection
Iatrogenic
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11
Q

How would you assess a patient with acute compartment syndrome once you’ve taken their history and performed examination

A

Split circumferential dressings
Analgesia - single dose opiate, not pcas
Reassess regularly
+/- Compartment pressure management

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12
Q

List the complications associated with acute compartment syndrome

A 
Delayed fracture Union
Muscle necrosis leading to deformity e.g. volkmanns ishcaemic contracture, and weakness
Joint stiffness 
Nerve fibrosis (dysthaesia, sensory>motor)
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13
Q

What may be used to assess intracompartmental pressure

A

Slit catheter/manometer

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14
Q

How may you prevent acute compartment syndrome post operatively

A 
Leave wounds open
Loose absorbent dressings
Gentle elevation
Fluid balance and analgesia
Re inspect and debridement 
Delayed closure if required
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15
Q

What are some of the closure options for acute compartment syndrome

A

Delayed primary closure
Subcuticular ladder
Shoelace closure
Vacuum assisted closure

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16
Q

What are the ishcaemic contractures like in the lower limb

A

Plantarflexion/clawing/curly toes

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17
Q

How wild you treat a patient with lower limb ischaemia contractures

A

Muscle and tendon releases
Lengthening tendons
Tendon transfers
Nerve decompression

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18
Q

What do forearm ischaemia contractures look like

A

Flexion/pronation/clawing

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19
Q

How would you treat an ischaemic contracture of the forearm

A

Muscle and tendon release
Transfer of tendons
Excision of tendons
Nerve decompression

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20
Q

How many compartments are there in the leg and what are they?

A 
4
Anterior
Lateral
Deep Posterior 
Superficial Posterior
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21
Q

What are the compartments of the thigh

A

Anterior
Medial
Posterior

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22
Q

How many compartments are there in the leg

A

4

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23
Q

How many compartments are there in the forearm and what are they

A

3
Flexor
Extensor
Radial

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24
Q

What are the compartments of the hand and how many are there

A 
There are 10
4 dorsal
3 palmar
Adductor policis
Thenar
Hypothenar
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25
Q

What may cause you to suspect a pathological fracture in a patient

A

Pain
Abnormal x ray
Minimal trauma
Concomitant disease

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26
Q

What are the investigations for pathological bone scan in terms of bloods etc

A 
CXR
PSA blood test
BJP, immunoelectrophoresis
Isotope bone scan
CT chest
MRI lesion
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27
Q

What is an osteosarcoma

A

A malignant neoplasm of mess chukar origin, prevalent in young adults

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28
Q

Where do osteosarco as tend to occur

A

At sites of bone growth, such as the distal femur/prix tibia

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29
Q

How is osteosarcoma treated

A

Resection

May be given in conjunction with chemo

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30
Q

What is Ewing’s sarcoma

A

A lytic malignant tumour of bone and soft tissue, peak incidence 10-20 years old

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31
Q

What is the treatment of Ewing’s sarcoma

A

Multi drug chemo and surgery +/- radiation

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32
Q

what is chondrosarcoma

A

Malignant tumour of cartilage, that can present at any age

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33
Q

What is a stereognosis test

A

Ask patients to handle objects and recognise them by touch alone

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34
Q

What are the nerve roots of the femoral nerve

A

L2-L4

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35
Q

What are the nerve roots for the sciatic nerve

A

L4-S3

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36
Q

What is the most common organism causing osteomyeltis

A

Staph aureus is most common causative organism

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37
Q

What does the Hawkins test in the shoulder examination test for

A

Impingement of the structures between the greater tubercle and the coracohumeral ligament

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38
Q

What does the empty can test in the shoulder examination test for

A

The supraspinatus

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39
Q

What does the scarf test in the shoulder exam test for

A

ACJ pathology (e,g, OA?)

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40
Q

What does the liftoff test in the shoulder examination test for

A

The subscapsularis

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41
Q

How do you test the function of the infra spinsters when doing a shoulder examination

A

Put arms at sides, flex elbow at 90 degrees and internally rotated at 45 degrees. Ask patient to externally rotate against pressure

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42
Q

Which nerve supplies the supraspinatus

A

Suprascapular n

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43
Q

Which nerve inner tes the infra spinsters

A

Suprascapular n

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44
Q

Which nerve inner aged the teres minor

A

Axillary n

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45
Q

Which nerve innervates the subscapularis

A

Subscapular nerve

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46
Q

List the conditions of the shoulder more commonly found in the elderly

A 
Frozen shoulder
Rotator cuff tears
Calcific tendinitis
Arthritis
Fractures
Dislocation
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47
Q

What is frozen shoulder/adhesive capsulises

A

The connective tissue surrounding the glenohumeral joint becomes inflamed and stiff, greatly restricting motion and causing chronic pain

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48
Q

What is medial epicondylitis also known as

A

Golfers elbow

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49
Q

What is lateral epicondylitis also known as

A

tennis elbow

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50
Q

Which muscle may become wasted in RA of the shoulder

A

Deltoid

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51
Q

What may an Xray of a shoulder affected by RA show

A

Rarefaction of bone, narrowing of cartilage space, eventually erosion of bone at margins

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52
Q

What is the operative approach to RA of the shoulder

A

Replacement with Arthroplasty

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53
Q

What are predisposing factors to OA of the shoulder

A

Previous injury or disease, vascular necrosis of humeral head, age (shoulder often not affected by OA)

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54
Q

What is the surgical management of OA of the shoulder

A

Arthroplasty

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55
Q

What is the underlying pathology of adhesive capsulises / frozen shoulder

A

Unknown cause

There is loss of resilience of joint capsule, adhesion formation and fibrosis

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56
Q

Is adhesive capsulitis reversible

A

Yes, range of movement can be mostly restored unless the movements are not practised regularly

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57
Q

Is there any abnormality of the shoulder on Xray in a patient with adhesive capsulitis/frozen shoulder

A

No

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58
Q

What are the requirements to diagnose a patient with frozen shoulder

A

Uniform limitation of all glenohumeral joint movements without evidence of inflammatory or destructive changes (external rotation first movement to go…)

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59
Q

How is adhesive capsulitis/frozen shoulder managed

A
  • in acute stage, rest arm in sling - remove for short periods to allow arm to move
  • NSAIDs
  • steroid injections in some patients
  • manipulation under anaesthesia to break down residual adhesions
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60
Q

How do incomplete tears of the rotator cuff present

A

May present as painful arc syndrome without complete loss of power

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61
Q

How may complete tears of the rotator cuff present

A

Serious impairment of movements e.g. Abduction, and weakness

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62
Q

What are the cusses of rotator cuff tears

A

Tendon/s giving way under strain, usually caused by fall

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63
Q

What is the main predisposing factor to rotator cuff tears

A

Age related degeneration of tendon/s

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64
Q

Which tendon is most commonly torn in rotator cuff tears

A

Supraspinatus

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65
Q

What age range is most common for rotator cuff tears to occur in

A

Over 60

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66
Q

What are the signs and symptoms of rotator cuff tears

A
  • pain at shoulder tip and down the arm
  • local tenderness
  • no movement on attempt to abduct arm without assistance
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67
Q

How may rotator cuff tears be diagsed

A

USS to pick up tears, MRI for mor detailed view

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68
Q

List the muscles involved in each stage of shoulder a diction

A
  • first 15 deg = supraspinatus
  • 15-90 deg = deltoid
  • above 90 deg = trapezius and serratus anterior
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69
Q

What is painf arc syndrome

A

Characteristic pain in the shoulder and upper arm during shoulder abduction. This is due to nipping of a tender structure e.g. Supraspinatus tendon between the humerus tuberosity, acromion process and coracoacromial arch

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70
Q

Give some possible structures that can be nipped within the should,er joint to produce painful arc syndrome

A
  • minor tear in supraspinatus tendon
  • supraspinatus tendinitis
  • calcified deposits in supraspinatus tendon
  • subacromial bursitis
  • greater tuberosity injury
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71
Q

What are the signs and symptoms of painful arc syndrome

A

Pain during subduction of the arm, beginning at about 60 degrees and peri siting through the arc, up to about 120 degrees. Pain also on descent from elevation

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72
Q

What is the treatment for painful arc syndrome

A

Often unnecessary if mild
Depends on underlying chase - e.g. Calcified deposits in tendon can be treated with hydrocortisone, fractures of tuberosity with exercises, tendinitis/bursitis with physio and mobilisation
Open or arthroscopic procedure if severe enough

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73
Q

What are the signs and symptoms of ACJ OA

A

Pain localised specifically to the ACJ aggravated by strenuous use of the limb, especially overhead work

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74
Q

What may be found on examination of a patient with ACJ OA

A

Irregular bony thickening at joint margin
Osteophytes may be felt
NO increase of local temp
Pain at extremities of movement range

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75
Q

What do radiographs of patients with OA of the ACJ show

A

Narrowing of the cartilage space and marginal osteophytes

MRI can give information on soft tissue

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76
Q

What is the treatment of ACJ OA

A

Modification of everyday activities

Of more severe, then operation which would involve excision of lateral end of clavicle

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77
Q

Why may pancoasts tumour also present with shoulder pain

A

Involvement of lower trunks of brachial plexus

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78
Q

Which conditions, irritating the phrenic nerve, can cause pain in the shoulder

A

Pleurisy, cholecystitis, subphrenic abscess

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79
Q

What is calcification tendinitis

A

Swelling and tension in supraspinatus tendon cussed by hydroxyapatite crystal being deposited. May be associated with impingement

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80
Q

How can calcification tendinitis be treated

A

Operation to remove calcific material, shockwave therapy to disintegrate crystals, corticosteroid injection

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81
Q

Where does the long head of the biceps originate

A

Supraglenoid tubercle

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82
Q

Where does the short head of the biceps originate

A

Coracoid process

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83
Q

How does torn head of biceps present

A

“Popeye’s sign” - active flex ion causes belly of the muscle to contract and appears as prominent bulge

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84
Q

What causes torn head of biceps

A

Often elderly patients feel something snap when lifting heavy objects

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85
Q

What does SLAP lesion stand for

A

(damage to) Superior part of glenoid Labrum Anteriorly and Posteriorly

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86
Q

What causes SLAP lesions

A

FOOSH - fall followed by pain in shoulder.

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87
Q

How may SLAP lesions present

A

Following a fall, the patient experiences a painful “click” on lifting arm above shoulder height, with loss of power

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88
Q

In which direction to dislocations of the shoulder most commonly go

A

Anteriorly - usually occurs when arm is forced into abduction, external rotation and extension

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89
Q

What is a bankart lesion

A

an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation.

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90
Q

What is a Hill-Sachs lesion

A

Cortical depression in the posterolateral head of the humerus resulting from forceful impaction of the humeral head against the anteroinferior glenoid rim during anterior dislocation (opposite side to direction of dislocation)

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91
Q

Which everyday actions are particularly impacted in rheumatoid arthritis of the shoulder

A

Combing hair, washing back

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92
Q

Which joints in the shoulder are most commonly affected by RA

A

ACJ and glenohumeral joint

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93
Q

What are some of the possible complications of rheumatoid arthritis of the shoulder

A

Chronic synovitis, rupture of rotator cuff, joint erosion

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94
Q

What are some of the clinical feature of osteomyeltis

A

Systemic illness - pyrexia, severe local pain and swelling at site of infection
Adjacent joint is commonly swollen from the effusion of fluids

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95
Q

What are the radiogroahical feature of osteomyeltis

A

May be none at first however with progression, there can be rarefaction and new bone formation in an attempt to wall in the infection

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96
Q

What may radiographs show in chronic osteomyelitis

A

Irregular thickening. Patchy areas of sclerosis, cavitation

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97
Q

What is the management for osteomyelitis

A

Rest, antibiotics, analgesia
Abscess drainage
Removal of sequestra (infected necrotic bone)
Stabilisation of skeleton

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98
Q

What is the normal carrying angle of the elbow in males and females

A

Males - 10 deg

Females - 15 deg

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99
Q

What is usually the chase of cubitus valgus

A

Previous injury or disease such as capitulum fracture, interference with epiphyseal growth etc

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100
Q

Exocet for deformity, what are the other secondary effects of cubitus valgus

A

Interference with function of the ulnar nerve - tingling, blunting of sensation, weakness and wasting of ulnar - innervates small hand muscles

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101
Q

How is cubitus values treated

A

If deformity small and uncomplicated, leave alone
Of angular ion is severe, osteotomy at the discos end of the humerus
Ulnar nerve transposition if function impaired

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102
Q

What is cubitus varus

A

Carrying angle of the fully extended elbow is decreased

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103
Q

What are the underlying causes of cubitus varus

A

Previous fractures, interference with growth of epiphyseal plates on medial side etc.

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104
Q

How is cubitus varus treated

A

Minor - left alone

Severe angulation - osteotomy at distal end of humerus

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105
Q

What is tennis elbow/lateral epicondylitis

A

Pain and acute tenderness in the origin of the extensor muscles of the forearm from the lateral epicondylitis.

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106
Q

What is the cause of lateral epicondylitis

A

Strain of extensor muscle due to repetitive activities

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107
Q

What is golfers elbow/medial epicondylitis

A

Pain and acute tenderness in the origin of the flexor muscles of the forearm at the medial epicondylitis, due to repetitive activities

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108
Q

What is the treatment for medial or lateral epicondylitis

A

Rest and NSAIDs
Injection of local anaesthetics and steroids
Operative treatment if severe

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109
Q

Expect for traumatic Olecranon bursitis (students elbow), what other causes are there for olecranon bursitis

A

Septic, gouty

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110
Q

How can Olecranon bursitis be treated if conservative management does not help

A

Aspiration, follow by injection with hydrocortisone

Bursa may be excised if swelling recurs

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111
Q

How is septic bursitis treated

A

Drainage

+ Antibiotic therapy for appropriate underlying organism

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112
Q

Where in its oath on the humerus is the ulnar nerve vulnerable to friction

A

Behind the medial epicondyle

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113
Q

Why may the ulnar nerve function be interfered

A

Constriction or recurrent friction behind the medial epicondyle

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114
Q

How may a constricted or damaged ulnar nerve present

A

Loss of sensation in ulnar border of hand and little finger

Wasting of ulnar-supplied muscles

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115
Q

How do you treat a patient whose ulnar nerve becomes compressed or constricted over the medial epicondyle

A

Decompress nerve by dividing overlying aponeurosis of flexor carpi ulnaris
Nerve transposition in front of medial epicondyle

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116
Q

Where are hand ganglions most commonly seen?

A

The back of the wrist

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117
Q

What is the pathology of a ganglion in the hand?

A

Arises from cystic degeneration in the joint capsule or tendon sheath. Contains fluid.

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118
Q

How do ganglions of the hands usually present?

A

A well defined, painless lump in the back of the wrist, not tender and may occasionally have a slight ache.
May be attached to (and move with) one of the tendons

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119
Q

What would happen if you apply pressure on a ganglion in the hand?

A

It may disperse

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120
Q

How do you manage a ganglion in the hand?

A

May leave alone as it often disappears after some months, but can be aspirated if it is troublesome.

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121
Q

What is the progression of ganglions in the hand?

A

Tend to recur.

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122
Q

What conditions may predispose to carpal tunnel syndrome?

A

Menopause, rheumatoid arthritis, pregnancy and myxoedema

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123
Q

What age group is usually affected by carpal tunnel syndrome?

A

40-50 year olds

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124
Q

What are the signs and symptoms of carpal tunnel syndrome?

A

Pain and paraesthesia occurring in the distribution of the median nerve,
Patient woken at night by pain , tingling and numbness and seeks relief by hanging arm over side or shaking it

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125
Q

In late progressive cases, what are the signs that may be see in carpal tunnel syndrome?

A

Wasting of the thenar muscles , weakness of thumb abduction and sensory dulling of median nerve territory

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126
Q

What special test may be done to look at nerve conduction across the wrist in carpal tunnel syndrome?

A

Electrodiagnostic tests

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127
Q

What differential of carpal tunnel syndrome may also cause similar symptoms?

A

Radicular symptoms of cervical spondylitis

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128
Q

What is the definition of spondylitis?

A

Inflammation of the joints of the backbone

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129
Q

How is tuberculous arthritis of the wrist treated?

A

Anti-tuberculous drugs, wrist splint, abscess drainage

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130
Q

What is treatment for early rheumatoid arthritis?

A

Splintage and local cauticosteroid injection and systemic treatment,
Synovectomy - if persistent synovitis

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131
Q

Which joints in the hand are most commonly affcted by osteoarthritis

A

DIPJs

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132
Q

How is osteoarthritis of the wrist treated?

A

Analgesia, splint, possible excision of styloid process, arthrodesis if extensive

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133
Q

What is tenosynovitis and tenovaginitis?

A

Synovial inflammation causing secondary thickening of tendon sheath and stenosis of the compartment

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134
Q

How is tenosynovitis treated?

A

Rest, anti-inflammatories, injection of corticosteroids

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135
Q

Which compartments of the hand are most commonly affected by tenosynovitis?

A

First dorsal and second dorsal

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136
Q

What does the first dorsal compartment of the hand contain?

A

Tendons of the abductor policis longus and extensor policis brevis

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137
Q

What does the second dorsal compartment of the hand contain?

A

Extensor carpi radialis longus and brevis

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138
Q

How would osteoarthritis of the first carpometacarpal joint (thumb) present?

A

Pain and swelling around the proximal thumb, sharply localised to the joint
Hebredens nodes

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139
Q

What does an x-Ray of an osteoarthritic joint usually show?

A

Joint space narrowing, sclerosis and osteophyte formation

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140
Q

What is the treatment for osteoarthritis of he first carpometacarpal joint?

A

Local injection of corticosteroid, excision of trapezium, joint replacement

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141
Q

What is De Quervain’s disease?

A

Tenovaginitis of the first dorsal compartment

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142
Q

What are the signs and symptoms of De Quervain’s disease?

A

Pain and swelling on radial side of wrist, tendon sheath feels thick and hard, tenderness at tip of radial styloid

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143
Q

What is Finkelstein’s test?

A

Hold patient’s hand firmly, keeping thumb tucked towards the palm, then turn wrist sharply towards ulnar side

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144
Q

What is a positive Finkelstein’s test?

A

Stab of pain over radial styloid

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145
Q

What is the treatment for De Quervain’s disease?

A

Corticosteroid injections if early; if resistant, operation to slit thickened sheath

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146
Q

What are the signs of OA in the hand

A
  • swollen and tender joints - usually one or two
  • hebredens nodes
  • DIPJs usually involved
  • bouchards nodes is PIPJs involved
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147
Q

What causes hebredens and bouchards nodes

A

Underlying osteophyte formation

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148
Q

Which joints and which condition do you find bouchards and hebredens nodes in

A

OA

  • DIPJs - hebredens
  • PIPJs - Bouchards
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149
Q

How do you treat OA of the hands

A

Analgesia
If DIPJs > fusion (arthrodesis)
If PIPJs or MCPJs > Arthroplasty (as these are more proximal)

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150
Q

What is the pathology of Dupuytrens contracture

A

Nodular hypertrophy + contracture of the palmar aponeurosis

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151
Q

What are the risk factors for developing Dupuytrens contractures

A
  • family history
  • heavy alcohol use
  • smoking
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152
Q

What are the signs and appearance of Dupuytrens contractures

A
  • puckered and thickened Palm
  • thickened subcutaneous cords
  • flex ion deformities of the MCP and PIP joint
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153
Q

What other conditions may be associated with Dupuytrens contractures

A

Thickened soles of feet and Peyronie’s disease

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154
Q

What is the treatment for Dupuytrens contractures

A

None is needed usually
If marked contracture > 30 deg flexion, then corrective surgical treatment may be needed.
Thickened part of fascia excised
Collagenase injection to dissolve the cord
Hand splinted

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155
Q

What is ulnar claw hand?

A

Hyperextension at the MCPJs and flexion at the IPJs in the medial fingers due to paralysis of intrinsic muscles supplied by the ulnar nerve

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156
Q

What is a boutonnière deformity?

A

Flexion enormity at the PIPJ and extension of the DIPJs (RA)

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157
Q

What is swan neck deformity?

A

Reverse boutonnière,
PIPJ hyperextended, DIPJS flexed (RA)
Imbalance between extensor and flexor action requiring tendon rebalancing

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158
Q

What is trigger finger?

A

When the hand is clenched and then opened, the finger or thumb gets stuck in flexion, and with a little more effort it snaps into full extension again

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159
Q

What is the pathology of trigger finger

A

Thickening of fibrous tendon sheath causing the flexor tendon to become temporarily trapped at the entrance to its sheath. When forced into extension it passes the constriction with a snap

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160
Q

What is the treatment for trigger finger

A

Often spontaneously resolves, usually cured with corticosteroid injection
Refractory cases may need surgery to incise fibrous sheath

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161
Q

Which compartments are infections of the hand usually limited to?

A 
Under the nail fold (paronychia)
Pulp space
Subcutaneous tissues
Tendon sheath
Deep fascial space
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162
Q

Which organism is usually responsible for infections of the hand?

A

Staphylococcus

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163
Q

What are the clinical signs and symptoms of infections of the hand?

A

Tenderness, systemic infections such as fever, and increase in pressure

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164
Q

How are infections of the hand treated?

A

Antibiotics, rest, elevation, drainage, splintage, physiotherapy as necessary

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165
Q

What is he common organism in dog bites

A

Pasteurella multiocida

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166
Q

What are the early signs of rheumatoid arthritis in the hands

A

Synovitis of proximal joints and tendon sheaths

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167
Q

What are the later signs of rheumatoid arthritis in the hands

A

Joint and tendon erosion, joint instability, tendon rupture, deformity, loss of function

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168
Q

What are the signs on examination of rheumatoid arthritis in the hands

A
  • pain and stiffness in fingers
  • MCPJs and PIPJs swollen
  • symmetrical
  • joint mobility and grip strength decreased
  • deformities
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169
Q

What deformities appear in rheumatoid arthritis of the hands

A
  • ulnar deviation of fingers
  • subluxation of MCPJs
  • swan neck and boutonnière deformity
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170
Q

What do initial x-Rays of RA of the hands show?

A

Soft tissue swelling and osteoporosis around joints

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171
Q

What are the later signs on x-Ray of RA of the hands

A
  • narrowing of joint spaces
  • periarticular erosions
  • articular destruction
  • deformity and dislocation
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172
Q

How do you treat RA of the hands

A

Splinting, local steroid injection for synovitis, synovectomy, physio, systemic treatment

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173
Q

What are less common organisms causing acute oesteomyelitis

A

Strep pyogenes, S. pneumoniae

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174
Q

What are the pathological features of acute osteomyeltis

A
  • pus
  • abscess formation
  • necrosis
  • new bone formation to try and close in the infection
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175
Q

How does acute osteomyelitis present.

A
  • severe pain
  • malaise
  • fever
  • localised tenderness
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176
Q

What are the radiography all changes seen in a patient with osteomyelitis

A
  • no changes initially
  • bone rarefaction with time
  • new periosteal none trying to wall off infection
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177
Q

What may blood tests show in acute osteomyelitis

A
  • increased ESR
  • increased WBC
  • positive blood cultures may be present
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178
Q

What is the antibiotic used to treat acute osteomyelitis

A

Iv flucloxacillin (or fusidic acid)

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179
Q

What is the treatment for acute osteomyelitis

A
  • antibiotics (flucloxacillin)
  • splinting
  • analgesia
  • abscess drainage
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180
Q

What are the possible complications of acute osteomyelitis

A
  • spread
  • pathological fractures
  • growth disturbance
  • chronic osteomyelitis is common
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181
Q

What are sequestra

A

Fragments of infected dead bone

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182
Q

What do X-rays show in chronic osteomyelitis

A
  • patchy bone

- rarefaction surrounded by sclerosis

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183
Q

What does CT/MRI show in chronic osteomyelitis

A

Bone destruction, oedema, sequestra, abscesses

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184
Q

What is the treatment for chronic osteomyelitis

A
  • antibioitcs
  • sequestrectomy
  • abscess drainage
  • surgery - external fixation, bone grafts to fill in missing areas of bone
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185
Q

How does TB reach the skeletal system

A

Through Haematogenous spread

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186
Q

Which part of the MSK system is most commonly affcted by TB

A

Vertebrae

Sometimes synovium in joints

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187
Q

What is the pathology of TB infection in the MSK system

A
  • chronic inflammatory reaction with caseation and granuloma formation
  • may be abscess formation
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188
Q

What are the clinical features of TB of the MSK system

A
  • pain, swelling
  • osteoporosis
  • bone erosion
  • joint narrowing
  • irregularity of joint
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189
Q

What do non-radiological investigations of TB in the MSK system show

A
  • increased ESR
  • Mantoux test positive
  • synovial biopsy and culture positive
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190
Q

What is the treatment for TB of the MSK system

A
  • TB antibiotics
  • rest, traction, splintage
  • occasionally operation
  • joint replacement may be necessary
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191
Q

What is the blood supply to the head of the femur

A
  • blood supply through ligamentum teres (acetabular branch of obturator artery)
  • retinacular arteries from medial and lateral circumflex from profunda femoris
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192
Q

Which artery do the retinacular arteries arise from in the hip

A

Profunda femoris

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193
Q

What is shentons line?

A

An imaginary line drawn along the inferior border of the superior pubic ra is and the inferomedial border of the neck of femur. Should be continuous and smooth - if it isn’t then it’s either due to DDH or fractured NOF etc

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194
Q

What is the main muscle flexing the hip

A

Iliopsoas

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195
Q

What are the. AIN addicted of the hip

A

Adductor Magnus, pectineus, gracilis

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196
Q

What are the main medial rotator of the hip

A

Gluteus medius and minimus

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197
Q

What is the primary extensor as well as lateral rotator of the hip

A

Gluteus maximus

198
Q

What is Garden classification 1-4 of hip fractures

A

1) undisplaced, incomplete fracture
2) undisplaced, complete
3) incompletely displaced, complete fracture
4) completely displaced, complete fracture

199
Q

What is the usual cause for NOF in young patients

A

High energy trauma, such as skiing, race car accidents, head on car collisions etc

200
Q

Which parts of the neck of femur are fractured in intracapsular fractures

A

Subcapital neck, transcervical neck

201
Q

Which parts of the neck of femur are fractured in an extracapsular fracture

A

Intertrochanteric,subtrocahnteric

202
Q

Which artery supplies most of the blood supply to the head of femur

A

Medial circumflex

203
Q

What is the main complication of neck of femur fractures

A

Avascular necrosis or non/malunion

204
Q

How does a Posteriorly dislocated hip appear

A

Foot internally rotated

205
Q

What does anterior dislocation of the hip look like

A

Foot externally rotated

206
Q

How does a dislocated hip look on Xray

A
  • femoral head out of acetabulum and shentons line is disrupted
  • lesser trochanter less prominent
  • ASIS shifted upwards
207
Q

At which age does developmental dysplasia of the hip present

A

Within first 2 years of life

208
Q

What is conventional dysplasia of the hip

A

Spontaneous dislocation of the hip occurring either before or during birth (important. To ask about difficulties during birth)

209
Q

What are the predisposing factors for congenital dysplasia of the hip

A

Genetically determined joint laxity, hormonal joint laxity (females), genetically determined dysplasia of the hip, breech malposition, postnatal positioning

210
Q

What is the pathology of congenital dysplasia of the hip

A

Femoral head is dislocated upwards and laterally in the acetabulum

211
Q

What are the signs that a baby has. Congenital dislocation of the hip

A

Asymmetry, shortening of limb, walking delayed, waddling gait, restricted abduction

212
Q

What are the Xray features of congenital dislocation of the hip

A

Acetabular for has pronounced upward slope, femoral head displaced upwards and laterally from normal position

213
Q

How may congenital dislocation of the hip be imaged in newborn

A

USS

214
Q

How is congenital dislocation do the hip be managed

A

Corrected by putting infant in harness (leg encouraged to stay abducted)
Splintage with plaster of Paris
Reduction if older - open or closed

215
Q

At which age is perhaps disease common

A

5-10

216
Q

What is Perthes disease

A

Childhood conduits, where there is temporary disturbance of blood supply causing avascular necrosis of femoral head. Unknown cause

217
Q

What happens to the shape of the femoral head in Perthes disease

A

Becomes deformed and softened

218
Q

How do patients with Perthes present

A

Pain in groin or thing
Limp
Usually one hip
Limitation in all movements of affected hip

219
Q

What is ESR and blood count like in patients with Perthes

A

Normal

220
Q

What are the changes on Xray of a patient with Perthes disease

A

Occasionally changes very subtle

Later there may be flattening of femoral head

221
Q

Which imaging technique is more sensitive for picking up changes in Perthes disease

A

MRI

222
Q

What are the main complications of Perthes disease in later life

A

Functioning of hip affected, higher risk of OA

223
Q

What is the treatment for Perthes

A

Physio and monitoring
Bed rest recommended
Surgery

224
Q

What does SUFE stand for

A

Slipped Upper Femoral Epiphysis

225
Q

What age is SUFE common in

A

Late childhood

226
Q

What is a SUFE

A

Displacement of upper femoral epiphysis from its normal position

227
Q

What Xray views should you request for a patient presenting with SUFE

A

Ant-post, lateral

228
Q

What is the main predisposing factor for SUFE

A

Being overweight, endocrine abnormalities

Displacement usually occurs following a fall

229
Q

What is the position for the SUFE to move into

A

Postero-inferior

230
Q

What can happen if SUFEs are left untreated

A

Epiphysis can fuse in abnormal position, growth impaired etc

231
Q

How may a patient with SUFE present

A

After fall, usually pain in hip, limp, sometimes pain in knee

232
Q

What are some of the complications of SUFE

A

Avascular necrosis of epiphysis, cartilage necrosis,late OA

233
Q

How is a SUFE treated

A
  • fixation with screws and wires along neck of femur and into epiphysis
  • operative replacement of epiphysis if severe
234
Q

What is transient synovitis

A

Short lived condition of uncertain cause, may be mild inflammation of synovial embrace irritated by minor injury or perhaps viral infection. Children

235
Q

What do radiographs show in patients with transient synovitis

A

Nothing

236
Q

Why must transient synovitis of the hip in children be investigated and not dismissed on presentation

A

May be other cause e.g. Perthes, pyogenic arthritis, tuberculous arthritis,

237
Q

What are the main sources of spread of infection to the hip, causing septic arthritis

A

Osteomyelitis of the upper femur, Haematogenous spread, rarely a penetrating would

238
Q

How may presentation of RA of the hip be different from RA in other joints

A

Unlike other more superficial joints, the temperature of the overlying skin may not be perceptibly increased, and swelling may also not be obvious
Fixed flexion deformity may also occur

239
Q

Why is RA often described as self limiting

A

Disease often becomes inactive after months or years

240
Q

What is the treatment for RA in the Jo

A
  • physiotherapy, exercises
  • intrarticular hydrocortisone injection (not repeated)
  • replacement Arthroplasty if walking limited
241
Q

What previous conditions may predispose someone to getting OA of the hip

A
  • SUFE
  • Perthes
  • fracture, including that of the acetabulum
  • ischaemia of femoral head
242
Q

What are the symptoms of OA of the hip

A

Gradual onset pain, worse on walking
Pain in hip, thigh, sometimes knee
Stiffness, loss of function

243
Q

What are the causes for coax vara

A

Congenital, SUFE, feature,softening of bone, Rickets, Paget’s disease

244
Q

How is OA of the h managed

A
  • mild : best left untreated
  • mod : mild analgesics, NSAIDs, physio, injection into the joint (hydrocortisone +/- local anaesthetic)
  • severe : Arthroplasty, arthrodesis, upper femoral osteotomy
245
Q

How can OA of the knee be treated

A

Physio to strengthen quads, intraarticular hydrocortisone injection, arthroscopic washout, removal of loose bodies, osteotomy, athroplasty

246
Q

What are the changes to the joint that haemarthroses causes

A

Degenerative cartilage changes, thickening of synovial membrane

247
Q

What movement usually causes mensical tears in the knee

A

Twisting force with knee flexed

248
Q

Which meniscus is affcted more by mensical tears of the knee - medial or lateral meniscus

A

Medial

249
Q

How do mensical tears usually present

A

Sporting injuries, usually young males
Patient falls in pain at anteromedial aspect of knee and inability to straighten knee fully
Subsides over time, but knee then suddenly gives way during twisting

250
Q

When does locking of the knee usually occur

A

Torn (medial) meniscus

251
Q

What may be found on ex animation of a a patient with a medial meniscus tear

A

Fluid effusion, wasting of quadriceps, local tenderness antero-medially

252
Q

What is the most reliable imaging technique for picking up mess last tears

A

MRI

253
Q

What is the treatment for mensical tears -

A

Excuse the meniscus, or the displaced fragment, repair by suture

254
Q

What is osteochondritis decissans

A

Local ischaemic necrosis of a segment of articular surface of the bone and often the overlying cartilage. Eventual separation of this segment

255
Q

How does osteochondritis decissans of the knee present

A

Pain and discomfort of exercise, insecurity, intermittent swelling

256
Q

What do X-rays of a knee with osteochondritis decissans show

A

Defect of bone at articular surface, lose body may be seen in joint

257
Q

How is osteochondritis decissans treated

A

Removal of loose body

Fixing loose body with pin

258
Q

What are some of the predisposing conditions to genuine varum and valgum

A

Injury, RA, OA, fracture, rickets/osteomalacia, Paget’s disease, osteomyelitis, uneven grower of epiphyseal plates

259
Q

What are some of the causes of popliteal cysts

A

Bakers cyst

Semimembranosus bursitis

260
Q

What is a bakers cyst

A

Herniation of synovial cavity of the knee. Here is a soft cystic bulge near the midline of the knee

261
Q

What are the underlying causes for bakers cyst

A

Synovial effusion, RA, OA

262
Q

What is congenital talipes

A

Club foot - feet curved downwards and inwards. Skin and soft tissues of medial side of foot are short and under developed

263
Q

What cod irons are associated with congenital talipes

A

CHD, spina bifida

264
Q

What is the treatment for congenital talipes

A

Manipulation, adhesive strapping or application of plaster of Paris casts to maintain the correction.
Foot is splinted until child is 3 years old

265
Q

What is the operative treatment congenital talipes

A

Releasing joint tethers and ligamentous contractures and fibrotic bands - to cause lengthening of the foot to cause normal positioning. Then apply cast. Kwires in foot bones

266
Q

What is pes planus

A

Flat feet - longitudinal arch of the foot is collapsed and medial border is in contact with the ground

267
Q

Does the heel of the foot become valgus or varus with flat feet

A

Valgus

268
Q

How may problematic pes planus be treated

A

Medial arch supports
Heel cups
Surgery lengthen lateral side of foot
Temporary cast or splint

269
Q

What pes cavus

A

Highly arched/clawed foot, which forces the metatarsal heads down into the sole

270
Q

What is the management of pes cavus

A

Foot supports, custom made shoes, tendon balance surgery

271
Q

What is hallux valgus

A

excessive lateral angulation of the hallux, with prominence of the medial side of head of first metatarsal (bunion)

272
Q

What is the normal angle for first toe valgus

A

15 deg

273
Q

What is the treatment for hallux valgus

A
  • wide shoes
  • soft tissue rebalancing op
  • metatarsal osteotomy, realignment
274
Q

What is hallux rigidus

A

Rigidity of first MTPJ due to local trauma, oa, or osteochondritis decissans etc of first metatarsal head. Big toe cannot dorsiflex, push off painful

275
Q

What is the oresentation of hallux rigidus

A

Pain on walking, especially up slopes or on rough ground. Pain on push off at end of stance phase

276
Q

What is the treatment for hallux rigidus

A

Special shoes

Osteotomy

277
Q

What is hammer toe

A

Isolated flexion deformity of proximal IPJ

278
Q

Which toes are most commonly affected by hammer toe

A

2 and 3rd

279
Q

What is the management of hammer toe

A

Operative correction involves straightening the PIPJ by managing muscle imbalance. Fusion of bones

280
Q

What is mallet toe

A

DIPJ is flexed. The tip of the toe presses downwards

281
Q

What is the treatment for mallet toe

A

Chiropody, padding, flexor tenotomy, arthrodesis

282
Q

What is Achilles tendinitis

A

Pain and swelling around the Achilles’ tendon, due to irritation of the tendon sheath

283
Q

How does Achilles’ tendon rupture present

A

Tendon ruptures while pushing off, feels as if they’ve been struck in the heel

284
Q

Which movement is a patient unable to do if they have Achilles’ tendon rupture

A

Standing on tip toes

285
Q

What is Simmonds test

A

Patient is prone and the calf is squeezed. If tendon is intact, the foot plantar flexes involuntarily. If the tendon is ruptured, foot doesnt plantar flex

286
Q

What imaging test may be used to diagnose Achilles’ tendon rupture

A

USS

287
Q

How is Achilles’ tendon rupture treated

A
  • if ends approximate, can place in cast

- operative repair

288
Q

Why may calcaneal bursitis

A

Posterolateral portion of calcaneus is prominent and shoe friction causes bursitis

289
Q

Which specific test is done in the knee examination for knee locking/meniscal tears

A

Mcmurray’s

290
Q

List red flag symptoms of spine history

A
  • non mechanical back pain
  • thoracic pain
  • fevers/rigors
  • difficulty passing urine
  • bilateral sciatica
291
Q

List the red flag signs of a spine history

A
  • saddle anaesthesia
  • reduced anal tone
  • widespread neurology
  • urinary retention
  • progressive neurology
292
Q

Lis the red fag features of a spinal history

A
  • history of malignancy
  • 50 with NEW onset pain
  • unexplained weight loss
  • long standing steroid use
  • recent significant infection
293
Q

List yellow flag symptoms of spinal history

A
  • biopsychosocial model
  • indications for poor outcome
  • attitude/beliefs/emotions
  • compensation
  • diagnosis
  • family
  • work
294
Q

Which direction do prolapsed discs tend to go in

A

Posterior(postero-lateral)

295
Q

In an L3-L4 disc herniation, which nerves are compressed, depending on direction of herniation

A
  • Lateral = L3

- Posterior = L4

296
Q

What are the layers through which a needle passes to enter the epidural space

A

Skin, subcutaneous tissues, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space

297
Q

What is spinal stenosis

A

Abnormal narrowing/compression of the spinal cord, caused by constriction of the spinal cord by various causes. Results in neurological deficit

298
Q

How does spinal stenosis present/what are the features

A

Patient feels pain in limb/s when standing or walking.
Symptoms bilateral
Relief is felt when flexing the spine - sitting or lying with knees drawn up

299
Q

What imaging technique is best used in assessing spinal stenosis

A

MRI

300
Q

List some causes of spinal stenosis

A

Narrowing of the spinal canal caused by variety of things e.g. Osteophytes, tumours, cysts, thickening of ligamentum flavum etc

301
Q

What is a differential diagnosis you should not confuse spinal stenosis with

A

Intermittent claudication - however neurogenic claudication has subtly different presentation than vascular intermittent claudication

302
Q

How is spinal stenosis treated

A
  • lifestyle changes if not severe e..g NSAIDs, exercises, weight loss, physio
  • operation to decompress the spinal cord may be attempted in more severe cases - tackling the underlying cause
303
Q

By what mechanism may spinal stenosis occur

A

Age related changes or precipitated by injury

304
Q

Which part of the intervertebral disc herniated

A

Nucleus pulposus herniates through the annulus fibrosus

305
Q

What is the cauda equina

A

A bundle of spinal nerves and spinal nerve roots, starting at L2, arising from the conus medullaris.

306
Q

What is cauda equina syndrome

A

Damage of the cauda equina causes loss of function of the lumbar plexus, (variety of underlying causes)

307
Q

What are the signs and symptoms of cauda equina syndrome

A
  • severe back pain
  • saddle anaesthesia/paraesthesia
  • bladder and bowel dysfunction
  • sexual dysfunction
  • absent anal reflex
  • decreased anal tone
  • sciatica-type pain
  • weakness of muscles of lower leg, paraplegia
  • Achilles reflex absent on both sides
  • gait disturbance
308
Q

How is cauda equina syndrome diagnosed

A

Neurological deficits detected on history and examination

DRE - anal tone…

309
Q

What is the management of cauda equina syndrome

A

Surgical decompression

Managing underlying cause

310
Q

Why is it important to promptly treat cauda equina syndrome

A

Surgical emergency - prevent nerve getting damaged to an extent where it’s severe enough to be irreversible

311
Q

List possible underlying causes for cauda equina syndrome

A
  • tumours, lesions
  • prolapse (Central disc prolapse)
  • spinal stenosis e.g. Spondelisthesis
  • ank spond
312
Q

What are the clinical features/presentation of tumours of the spine

A
  • insidious onset
  • relentless worsening of symptoms without remission
  • neurological disturbance
313
Q

Which different structures can tumours in the spine arise from/affect

A
  • bony spinal column itself (bone tumours)
  • the meninges
  • spinal cord
  • fibrous component of a peripheral nerve (neurofibroma), which can even grow within the SC
  • adjacent soft tissues
314
Q

What are the local eefcts of spine tumours

A
  • skeletal destruction
  • compression of SC
  • interference with peripheral nerves
315
Q

What imaging can be used to diagnose spinal tumours

A
  • radioisotope scanning (earlier detection)
  • radiography (born erosion)
  • MRI (extent and infiltration)
316
Q

What is spodylolisthesis

A

Vertebral displacement/slippage where a vertebra shifts forward on the vertebra below it

317
Q

What is the normal locking mechanism which usually prevents spondelisthesis occurring in the first place

A

Laminae and facets of the vertebrae lock to prevent vertebrae shifting on each other. If this fails (listhesis - slippage) can occur

318
Q

List some of the underlying reasons for spondylolisthesis occurring

A

Causes are those which compromise the locking mechanism

  • dysplasia of lumbosacral facet joints
  • separation or fracture
  • OA degeneration of facet joints causing them to lose their stability
  • destructive process e.g. TB, tumours
319
Q

What if found on imaging of patients with spondylolisthesis

A
  • forward shifting of upper part of spinal column on the stable vertebrae below
  • defective facets may be seen
320
Q

What is the treatment for spondylolisthesis

A
  • conservative : as per back pain
  • op if dis soling, interfering with activity, severe degree of slippage etc: posterior or anterior fusion; decompression
321
Q

What is a characteristic finding on examination of a patient with spondylolisthesis

A

Palpable “step” felt above the sacral crest usually

322
Q

What is spina bifida

A

failure of the embryonic neural plate to fold and forma a closed neural tube

323
Q

What is scoliosis

A

Lateral curvature of the spine

324
Q

What is the treatment for scoliosis

A
  • exercises to maintain muscle tone
  • bracing (corset, supports)
  • operation e.g. Rod fixation
325
Q

When is an operative approach considered in patients who have scoliosis

A
  • severe angulation
  • if it’ll affect development
  • rapidly-deteriorating deformity
326
Q

What is kyphosis

A

excessive posterior curvature of the spinal column, causing “hump back” appearance

327
Q

What are the causes for kyphosis

A

Underlying conditions such as wedge compression, of vertebral body, ank spond, osteoporosis, destructive tumours

328
Q

How do you treat kyphosis

A

Manage underlying condition

329
Q

What is lordosis

A

excessive anterior curvature of the spine

330
Q

What causes lordosis

A

Lax muscles

Compensation to heavy abdomen etc.

331
Q

Which structure is at the posterior part of the vertebral column, hence disc herniation can be directed towards it

A

Posterior longitudinal ligament

332
Q

What are some of the symptoms of intervertebral disc herniation

A
  • pressure on nerve root cussing paraesthesia and numbness in corresponding dermatome
  • weakness and depressed reflexes
333
Q

How does intervertebral disc herniation first present

A

Usually following lifting or straining, there is sudden back pain. Patient may experience sciatica, paraesthesia, weakness.
Patient may slightly tilt to the side

334
Q

What are sciatica symptoms which may be present with intervertebral disc herniation

A

Strange leg raising painful on affected side

Dorsiflexion of foot aggravates pain

335
Q

At which angles is straight leg raise being painful an indication of sciatica

A

30-70 degrees

336
Q

Wh in imaging technique is the best way to diagnose intervertebral disc herniation

A

CT/MRI, identifying the disc, and localising the lesion

337
Q

How is intervertebral disc herniation managed

A
  • rest and NSAIDs
  • traction
  • operation to remove herniated disc
  • physiotherapy
338
Q

How is septic arthritis of the spine managed

A

Antibioitcs, bed rest, brace for stabilisation and support, drainage of abscess

339
Q

What is syringomyelia

A

Disorder in which a cyst or cavity forms within the spinal cord resulting in pain and paralysis

340
Q

What are the clinical features of syringomyelia

A

Pain, paralysis, weakness
Stiffness of the back
Cape-like distribution of loss of pain and temperature sensation

341
Q

How is syringomyelia treated

A

Surgically

342
Q

What is Brown-Sequard syndrome

A

Damage to one half of the spinal column, resulting in paralysis and loss of proprioception on ipsilateral side; and loss of pain and temperature on contralateral side

343
Q

What is spondylolysis

A

Defect in vertebrae, where there is a loss of continuity between articular process. Can lead to back pain

344
Q

What are pilon fractures

A

Severe axial compression of the ankle joint e.g. Fall from height, which may shatter the tibial plafond

345
Q

How may pilon fractures be treated

A
  • external fixation
  • orif with plates and screws
  • elevation after fixation
346
Q

What is a Mantegna fracture

A

Fractures of the shaft of the ulna, associated with disruption of the radio ulnar joint. Radius displaced anteriorly

347
Q

What is a galeazzi fracture

A

Fracture of distal third of radius, with disruption of radioulnar joint, and the ulna is displaced posteriorly

348
Q

What is rheumatoid arthritis

A

Inflammatory joint disease. Of unknown cause

349
Q

What is thought to be the cause of RA

A

Abnormal immune response/autoimmune

HLA-DR4

350
Q

What are the characteristic features and symptoms of rheumatoid arthritis

A
  • insidious, symmetrical polyarthritis
  • early morning stiffness
  • swelling, warmth over joints, tenderness
  • restricted and painful movements
351
Q

What may happen to tendons surrounding a joint affected by RA as the disease progresses

A

They may rupture

352
Q

What are the Xray features of RA

A
  • soft tissue swelling
  • periarticular osteoporosis
  • bony erosions at joint margins
  • narrowing of articular space later
  • joint deviation
353
Q

What may bloods show in rheumatoid arthritis

A
  • increased ESR and CRP if active

- rheumatoid factor positive in 80% of cases

354
Q

What are the 3 diagnostic criteria for rheumatoid arthritis

A
  • bilateral symmetrical polyarthritis
  • proximal joints of hands and feet
  • present for at least 6 months
355
Q

List some differential diagnoses for arthritis

A
  • psoriatic arthritis
  • ank spond
  • connective tissue diseases
  • poly articular gout
  • poly myalgia rheumatica
  • Reiters diseases
  • OA
356
Q

List some extra-articular features of RA

A
  • rheumatoid nodules
  • vasculitis
  • visceral disease affecting lungs etc
  • low grade fever
  • lymphadenopathy
  • scleritis
  • peripheral neuropathy
357
Q

What is the treatment for rheumatoid arthritis

A
  • DMARDS (once weekly methotrexate)
  • NSAIDs
  • anti TNF therapy
  • intraarticular steroid injection
  • physio
  • surgery
358
Q

What are some of the surgical options for RA

A
  • osteotomy
  • arthrodesis
  • Arthroplasty
359
Q

Is psoriatic arthritis as symmetrical as RA

A

No

360
Q

What are the most common sites for psoriatic arthritis

A

IPJs of fingers and toes

361
Q

How is psoriatic arthritis managed

A
  • controlling skin condition : topical medications
  • NSAIDs
  • immunosuppressive treatments if severe
  • splintage and surgery for unstable joints
362
Q

What is the triad of Reiters disease

A
  • polyarthritis
  • non specific urethritis
  • conjunctivitis
363
Q

What is the cause of Reiters disease

A

Abnormal reaction to an infection (e,g, non specific urogenital or GI) - the joints themselves aren’t infected

364
Q

How is Reiters disease treated

A
  • treat the underlying urogenital/GI infection e.g. Tetracycline for chlamydia
  • NSAIDs
  • steroid injection+/- DMARDS if severe condition
365
Q

What is charcots disease / neuropathic arthritis

A

Repaid degenerative disease of a joint which lacks position sense and protective pain sensation

366
Q

What are the a pathological features of charcots disease of the joints

A

Rapidly progressive form of OA - destroyed cartilage destroyed und,drying bone. New bone formation at the periphery, lax ligaments

367
Q

What are the clinical features of charcots disease

A

Instability, swelling, deformity
Underlying neurological disease
NO tenderness

368
Q

What causes charcots disease

A

Conditions which cause decreased peripheral sensation, proprioception and fine motor control such as DM, alcoholic neuropathy, syphillis etc.

369
Q

How is charcots disease managed

A

Treat the underlying neurological disease.
Apply external splintage, treat symptoms
Surgery NOT advised

370
Q

What is ankylosing spondylitis

A

A form of spinal arthritis that causes abnormal stiffness and immobility of the spine (ankylosis) and sacroiliac joints

371
Q

Which genes are present in ankylosing spondylitis

A

HLA-B27

372
Q

What is the usual presentation for an,helsing spondylitis

A

Young males, with persistent backache and stiffness, worse on morning/with inactivity

373
Q

Which moe,cute is raised in the blood during active phase of ankylosing spondylitis

A

ESR

374
Q

What are the a ontological features of ankylosing spondylitis

A
  • ossification across the periphery of intervertebral discs

- synovitis

375
Q

What are the radiological features of ankylosing spondylitis

A
  • erosion of SIJ’S, later becoming sclerosed

- bamboo spine

376
Q

Why does bamboo spine occur in ankylosing spondylitis

A

Ossification (of fibrous tissue) across intervertebral discs produces bony bridges

377
Q

What is the treatment for ankylosing spondylitis

A
  • posture/physio
  • NSAIDs
  • TNF inhibitors
  • surgery e.g,. Osteotomy, bone erosion.
378
Q

Define gout

A

Disorder of purine metabolism characterised by deposition of urate crystals in joints and periarticular tissues provoke inflammatory reaction, and synovitis

379
Q

What drugs can cause gout

A

Those that impair uric acid excretion e.g. Thiazides diuretics

380
Q

What are the commoner sites of gout

A

Small joints of hands and feet, MTPJs, Achilles’ tendon, Olecranon bursar, ear pinnae

381
Q

What does Xray show for those affcted by gout

A

Soft tissue swelling

If chronic, cysts and joint space narrowing

382
Q

In a n acute attack, how does gout present

A
  • joint pain
  • spontaneous or can be precipitated by trauma
  • extremely hot and tender joint
383
Q

What is seen on microscopy of fluid aspirated from joints in gout

A

Characteristic bifringent crystals

384
Q

What are the characteristics of chord gout

A

Recurrent attacks, tophi may appear, joint erosion, chronic pain, stiffness and deformity

385
Q

List some differential diagnoses of gout

A
  • pseudo gout
  • septic arthritis
  • cellulitis
  • infected bunion
386
Q

What is the treatment of gout

A
  • during acute attack : rest, ice packs, NSAIDs. Colchicine, corticosteroid injection
  • allopurinol to prevent recurrent attacks
387
Q

What lifestyle changes may be made to prevent recurrent attacks of gout

A

Weight loss, alcohol reduction

388
Q

What molecules cause pseudo gout

A

Calcium pyrophospahte crystal deposition

389
Q

How is pseudo gout differentiated form gout

A

Joint fluid aspirate and microscopy

390
Q

What is the treatment for pseudo gout

A

Similar to that of gout - rest, NSAIDs, Joint aspiration, intrarticular injection of corticosteroid

391
Q

Which conditions is haemophilic Arthropathy associated with

A

Bleeding disorders such as haemophilia, Christmas disease, x linked conditions

392
Q

What is haemorphilic Arthropathy

A

Recurrent haemarthroses caused by bleeding into the joint even with trivial injury. Progressive joint destruction

393
Q

What are the clinical features and symptoms of haemophilic Arthropathy

A
  • pain, warmth, boggy swelling
  • tenderness
  • limited movement
394
Q

What is the treatment for haemophilic Arthropathy

A
  • iv purified clotting factors, or if this is not available, cryoprecipitate or FFP
  • splint
  • surgery
395
Q

Define osteoarthritis

A

Chronic disintegration of articular cartilage, accompanied by new bone growth at margins, and capsular fibrosis

396
Q

What are the four typical pathological features of osteoarthritis

A
  • loss of joint space
  • osteophytes
  • Subchondral sclerosis
  • subarticular cysts
397
Q

List some risk factors for OA

A
  • joint dysplasia - e.g. Perthes
  • trauma
  • family history
398
Q

Which has a faster progression rate - OA or RA

A

RA

399
Q

What is the progression of OA through thou the day

A

Aggravated by exertion and relieved by rest, therefore worse in the evening

400
Q

What is the treatment for OA in the early stages

A

Rest, pain relief, NSAIDs, reduce load by use of walking stick, physio

401
Q

What is the treatment for OA in the later stages

A

Surgery needed eventually - joint replacement or more rarely arthrodesis

402
Q

What do calcium and phosphate blood levels give indications for

A

Levels of osteoclast activity breaking down bone

403
Q

What does serum alp conc give and indication of in bone disease

A

Osteoblast activity

404
Q

What are the conditions where osteoblast activity is increased

A
  • osteomalacia
  • Paget’s
  • metastasis
  • hyperparathyroidism
405
Q

What is urinary hydroxyproline in blood a measurement of

A

Bone turnover e.g. Paget’s

406
Q

What is primary bone healing

A

Direct attempt of the cortex to reestablish itself, without formation of callus. Formation of cutting cones

407
Q

When does priamry bone healing occur

A

Only if edges are touching exactly, rigidly apposed, as in unicortical fracture etc.

408
Q

What are the stages of secondary bone helsing

A

Injury causes haemorrhage, primary cartilaginous soft callus is formed, this is mineralised to cause a bony callus. The callus is then remodelled with time.

409
Q

What is osteochondritis

A

Condition where there is compression, fragmentation and separation of a small segment of bone attached to end articular cartilage

410
Q

What are the symptoms of osteocondritis/osteochondrosis

A

Intermittent pain, swelling, small effusion, locking of knee if fragment becomes detached

411
Q

What is seen on radiology of a patient with osteocondritis/osteochondrosis

A

Demarcation of the ischaemic fragment, picked up better with MRI in the early stages

412
Q

What is the treatment for osteochondritis

A

Load reduction, reduce activity, pinning of fragment back in place surgically

413
Q

What is the cause of osteonecrosis

A

Trauma, damage of blood supply

414
Q

List some non traumatic causes of osteonecrosis

A

Infection, septic arthritis, Perthes disease, sickle cell disease, ionising radiation etc

415
Q

What are the most susceptible sites for osteonecrosis

A

NOF, femroal condyles, head of humerus, proximal pole of scaphoid, proximal pole of talus

416
Q

By the time a patient with osteonecrosis presents, it is often well advanced, what are the symptoms

A

Pain, stiffness,s tenderness, swollen nearby joint, restricted movements

417
Q

What are the Xray features of osteonecrosis

A

Increased bone density in subarticular segment due to reactive new bone formation,

418
Q

What is the treatment of osteonecrosis

A
  • weight relief and splintage
  • pain control
  • surgical decompression of bone
  • realignment osteotomy
  • joint replacement
419
Q

What is oosteoporosis

A

Decreased bone density as compared to what is expected of someone that age and sex

420
Q

How is bone mineral density measured

A

DEXA scan spine and hips

421
Q

Which cells act to reduce bone density in osteoporosis

A

Increased osteoclast/reduced osteoblast activity

422
Q

List risk factors of osteoporosis

A
  • menopause
  • Caucasian/Asian
  • family history
  • low bone density
  • slim build, nutritional insufficiency
  • oopherectomy, hysterectomy
  • lack of exercise
  • smoking, alcohol abuse
423
Q

What is the treatment for osteoporosis

A

Bisphosphanates e.g. Alendronic acid

424
Q

How does Alendronic acid work

A

Suppresses osteoclastic bone resorption

425
Q

How often are bisphosphanates administered

A

Once weekly

426
Q

Why is HRT no longer used as a treatment for osteoporosis

A

Associated with increased thrombosis, uterine and breats cancer risk

427
Q

What is Rickets/osteomalacia

A

Inadequate mineralisation of bone due to inadequate vitamin D,

428
Q

Why may one have reduced vitamin D levels

A

Reduced dietary intake, under exposure to sunlight, intestinal malabsorption, liver disease, renal disease (both reduced hydroxyl action), calcium insufficiency

429
Q

What are the pathological features of rickets/osteomalacia

A

Bone is “softened”, thick layers of uncalcified osteoid surrounding thin trabeculae

430
Q

What is the treatment for rickets/osteomalacia

A

Vitamin d, calcium

431
Q

What is Paget’s disease of bone

A

Disease causing bone deformity due to fluctuating periods of high bone resorption and bone formation, enlarged and thickened bone, abnormal architecture

432
Q

Which bones are parktuckarly affcted by Paget’s disease

A

Pelvis and tibia

433
Q

What are the radiological features of Paget’s disease

A

Bone deformed, phases seen on Xray

434
Q

What are the complications of Paget’s disease

A

Fractures, nerve compression, sarcoma, hypercalcaemia, hf

435
Q

What is the treatment for Paget’s disease

A

Bisphosphanates may help reduce bone turnover

Pathological fractures treated surgically

436
Q

What are the symptoms of hyperparathyroidism

A 
anorexia, nausea, abdo pain
Depression
Fatigue
Muscle weakness
Renal calculi
437
Q

What do bloods of patients with hyperparathyroidism show

A
  • serum hypercalcaemia
  • hypophosphataemia
  • raised PTH
438
Q

What is achondroplasia

A

Short stature/dwarfism caused by mutation in fibroblast growth factor 3, which has a regulatory effect on bone growth.

439
Q

What is the inheritance pattern of achondroplasia

A

Autosomal dominant

440
Q

What is osteogenesis imperfecta

A

Brittle bone disease, caused by defective synthesis in type 1 collagen

441
Q

Which tissues except for bones are affected by osteogenesis imperfecta

A

Teeth, ligaments, sclera

442
Q

What Beighton score is require to be defined as being hypermobile/having joint laxity

A

5 or more

443
Q

What is Marfans syndrome

A

Cross linkage defect of collage and elastin leading to tall stature, generalised joint laxity, dislocations etc

444
Q

What is Ehlers Danlos syndrome

A

defect in producing and processing collagen, leading to hypermobiltiy, laxity of joints, blood vessel fragility (AAA)

445
Q

What are the things tested for in the Beighton score

A
  • put hands flat on floor with knees straight
  • bend elbow backwards
  • bend knee backwards
  • bend thumb to front of forearm
  • bend little finger up at 90 degrees to back of hand
446
Q

What is fibroma of the bone

A

Developmental defect where there is a nest of fibrous tissue within the bone

447
Q

What is osteoma

A

Benign tumour op consisting of osteoid

448
Q

What is chondroma

A

Islands of cartilage persisting in bone metaphysis, risk of malignant change

449
Q

What is oestochondroma

A

Cartilage-capped exostasis starting as overgrowth of cartilage at bone end, and develops into bony protuberance by endochondral ossification

450
Q

What is chondroblastoma

A

Rare tumour of immature cartilage, well demarcated

451
Q

What is Chondromyxoid fibroma

A

Solid tumour of mixed cartilage, fibrous and myxomatous tissues

452
Q

Where do simple bone cysts tend to occur

A

At metaphysi of long bone

453
Q

Where are giant cell tumours of bone usually found

A

Epiphysis of long bones. Usually young adult

454
Q

List three main types of malignant bone tumour

A
  • osteosarcoma
  • chondrosarcoma
  • Ewing’s sarcoma
455
Q

What is osteosarcoma

A

Highly malignant bone tumour arising within the bone (mesenchymal origin), which spreads rapidly outwards to the periosteum and surrounding tissues

456
Q

Which age group most commonly experiences osteosarcoma

A

Children and adolescents

457
Q

What are the symptoms of osteosarcoma

A

Constant pain, worse at night, with increasing severity

Lump, swelling, local tenderness

458
Q

Which molecule levels are increased in the blood with osteosarcoma

A

ESR and ALP

459
Q

What does Xray of osteosarcoma show

A

Osteolytic lesion, with poorly defined tumour margins

Cortex often breached

460
Q

How should osteosarocma be diagnosed

A

Biopsy

461
Q

What is the treatment for osteosarcoma

A

Chemo, wide resection, bone graft

462
Q

chondrosarcoma is either a primary tumour or can be secondary to malignant change form a previous benign tumour, what are the previous being tumours it can arise form

A

Chorndroma

Osteochondroma

463
Q

What age group has the highest incidence of osteochondroma

A

40-50

464
Q

What are the symptoms of osteochondroma

A

Slowly enlarging, dull ache, lump

465
Q

What do X-rays of chondrosarcomas how

A

Radiolucent area with flecks of calcification

466
Q

What is the treatment of chondrosarcoma

A

Wide excision, prosthetic replacement
Amputation in some cases
DOESNT respond to radiotherapy or chemo

467
Q

Where is Ewing’s sarcoma thought to arise from

A

Endothelial cells in the bone marrow

468
Q

Which age group is most commonly affcted by Ewing’s sarcoma

A

10-20 year olds

469
Q

Wh in bones are most commonly affcted by Ewing’s sarcoma

A

Tibia, fibula, clavicle

470
Q

What are the symptoms of Ewing’s sarcoma

A

Pain, swelling, bone pain, tenderness, warmth, pyrexia

471
Q

What do X-rays of Ewing’s sarcoma show

A

Bone destruction in mid diaphysis

472
Q

What is the treatment for Ewing’s sarcoma

A

Radio and chemo therapy, surgery

473
Q

What is Paget’s sarcoma

A

Paget’s disease of bone has undergone malignant transformation, highly malignant, often metastasis by presentation

474
Q

What is the treatment for Paget’s sarcoma

A

Radical resection/amputation +/- chemo

Palliation

475
Q

What is multiple myeloma

A

Malignant B cell lymphoproliferative disorder of the bone marrow . Lytic lesion as increased osteoclast activity

476
Q

What age group is most typically affcted by multiple myeloma

A

45-65

477
Q

Which molecules are raised I. Multiple myeloma

A

Increased ESR, Bence Jones protein, hypercalcaemia

478
Q

What are the symptoms of multiple myeloma

A

Weakness, backache, bone pain, pathological fractures, anaemia

479
Q

What is the treatment for multiple myeloma

A

Analgesia, cytotoxic agents, Corticosteroids

480
Q

Which sites of cancer commonly metastasise to bone

A
  • breast
  • prostate
  • kidney
  • lung
  • thyroid
  • git
481
Q

Which bone sites are common for others cancers to metastasise to

A

Vertebrae, pelvis, proximal femur and humerus

482
Q

Which imaging techniques can be sued for bone cancers

A

Xray

Radioscintigraphy

483
Q

What is the treatment for metastatic bone disease

A

Surgery and radiotherapy
Prevent pathological fractures by fixation
Spinal stabilisation
Analgesia

484
Q

What is radiculopathy

A

Involvement of nerve roots, most commonly due to vertebral trauma, intervertebral disc herniation, merve root infections e.g. Herpes zoster

485
Q

What is plexopathy

A

Brachial plexus injury of viral infection

486
Q

What are the different types of distal neuropathy

A
  • nerve injury (single nerve)
  • multiple mononeuropathy e,g, leprosy
  • widespread dysfunction e.g. DM (polyneuropathy)
487
Q

How does hyperparathyroidism affect bones

A

Raised serum calcium, increased absorption of calcium, increased osteoclast activity

488
Q

What are the symptoms of brown sequard syndrome

A
  • contralateral loss of pain and temp

- ipsilateral loss of proprioception and paralysis

489
Q

Which structures are contained in the first dorsal compartment of the hand

A

Extensor policis brevis

Abductor policis longus

490
Q

Which structures make up the borders of the anatomical snuffbox

A

Extensor policis brevis
Abductor policis longus
Extensor policis longus

MSK (2 decks)

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