MSK Flashcards
(100 cards)
Joints most commonly affected in septic arthritis?
Organisms?
Joints = knee and hip
Organisms = Staph, Strep, gram -ve cocci (neisseria gonococcus), gram -ve bacilli
Risk factors for septic arthritis?
- Joint disease (RA)
- Immunosuppression
- Recent joint surgery
- IV drug abuse
- DM
- CKD
- Prosthetic joints
- Age >80 yrs
Investigations in septic arthritis?
- Bloods
- FBC (WCC), CRP, ESR, cultures
- Joint aspiraiton
- Yellow, purulent synovial fluid - MC+S
- Raised WCC, organisms on gram stain, +ve culture
- X-Ray
- As baseline - may show joint destruction later
Management of septic arthritis?
Urgent orthopaedic referral
- Joint aspiration until dry - rest joint
- May need arthrocentesis, lavage and debridement.
- Analgesia – NSAIDs
- High dose IV abx – local guidelines. (~2 weeks then 4 weeks PO) after diagnostic joint aspiration.
- Typical - Flucloxacillin (1g/6h IV) – Clindamycin if pen allergic.
- Gonococcal or Gram –ve - Cefotaxime (1g/8h IV)
What happens in GCA?
Caused by immune response to undefined stimulus causing vasculitis à vascular stenosis and occlusion
Symptoms and signs of GCA?
Symptoms
- >50, headache, jaw claudication, visual problems, aching muscles, weight loss, night sweats, scalp tendernes
- Extracranial symptoms = dyspnoea, morning stiffness, unequal or weak pulses
Signs
- Temporal artery and scalp tenderness, pulseless or nodular temporal artery
.
Complications of GCA?
Blindness (10-50%), TIA/stroke, scalp necrosis, lingual infarction, aortic dissection/aneurysm, complications of high-dose steroids
Investigations in GCA?
Bloods - ↑↑ESR (50mm/h), ↑CRP, ↑plts, ↓Hb all suggestive
Biopsy – within 7 days of starting steroids
Management of GCA?
- Prednisolone 60mg/day PO immediately (+ PPI/bisphosphonate protection)
- Urgent ESR
- IV methylprednisolone if visual involvement (consult ophthalmology)
Two year course of steroids à complete remission.
Causes of spinal cord compression?
Secondary malignancy = commonest cause (PB KTL)
- Infection (epidural abscess)
- Cervical disc prolapse
- Haematoma (warfarin)
- Intrinsic cord tumour
- Atlanto-axial subluxation
- Myeloma
Signs of cord compression?
- Weakness
- Numbness (+/- pain) below lesion
- Incontinence
- Dermatomal distribution; UMN below lesion, LMN at lesion (tone + reflexes can be reduced in acute compression)
- Spastic and hyper-reflexic
Signs in cauda equina?
- Leg weakness and pain (often bilateral)
- Urinary and/or faecal incontinence (retention –> overflow incontinence).
- ↓Perianal sensation
- ↓Anal tone
- ↓Leg power, sensation and reflexes
- Flaccid and areflexic - not spastic and hyper-reflexic
Investigations in cord compression/cauda equina?
- PR examination
- Bloods
- FBC, ESR, B12, syphilis serology, U+E, LFT, PSA, serum electrophoresis/bence jones protein
- URGENT MRI whole spine
- CXR (rule out malignancy)
Differentials for sudden onset leg weakness?
- Transverse myelitis/MS
- Spinal artery thrombosis
- Trauma
- Dissecting aneurysm
- Guillain-Barré
Management of cord compression?
- Lie flat to minimise spine movement
- Urgent MRI spine
- Analgesia
- Dex IV 16mg + PPI cover (if malignancy)
- Refer to neurosurgery/onc for palliative radiotherapy
Symptoms of OA?
Pain on movement and crepitus, worse at end of day; background pain at rest; joint gelling; joint instability
Complications of OA?
Assess effect of symptoms on occupation, family duties, hobbies and lifestyle
Investigations in OA?
X-Ray (LOSS)
- Loss of joint space
- Osteophytes
- Subarticular sclerosis
- Subchondral cysts
Bloods – CRP may be slightly elevated

Management of OA?
Conservative
- Exercise to improve muscle strength and general fitness
- Weight loss if overweight
- MDT approach – physios and OT
- Heat/cold packs at site of pain, walking aids, stretching/manipulation or TENS
Medical
- Regular paracetamol and topical NSAIDs
- Codeine or short-term oral NSAID (+PPI) if ineffective
- Intra-articular steroid injection – temporary relief in severe symptoms
Surgical
- Joint replacement (hips/knees)
Definition of osteoporosis and osteopenia?
- Defined as BMD >2.5 SDs bellow the young adult mean (T-score of -2.5).
- Osteopenia is diagnosed if T-score between -1 and -2.5
Factors contributing to osteoporosis?
Endocrine
Hypogonadism (prem menopause, anorexia, androgen blockade, aromatase inhibitors), hyperthyroidism, hyperparathyroidism, hyperprolactinaemia, Cushing’s disease, T1DM, steroid use
GI
Coeliac disease/other malabsorption, IBD, chronic liver disease, chronic pancreatitis
Rheumatological
RA, other inflammatory arthropathies
Other
Immobility, multiple myeloma, haemoglobinopathy, systemic mastocytosis, CF, COPD, CKD, homocystinuria
What is a fragility fracture?
- Fracture sustained from falling from < standing height
- Common fractures = hip, wrist (Colle’s), osteoporotic vertebral collapse
Investigations in osteoporosis?
Fracture Risk Prediction
- FRAX or QFracture – provide info on 10 year probability of hip or other osteoporotic fracture.
DEXA
- Gold standard for diagnosis – measures bone mineral density (BMD).
Bloods (identify underlying causes and rule out differentials – osteomalacia, myeloma)
- FBC, ESR/CRP
- U+E, LFT, TFT, serum calcium
- Testosterone/gonadotrophins in men
- Serum immunoglobulins and paraproteins, urinary Bence-Jones’ proteins
Management of osteoporosis?
Conservative
- Nutrition (Normal BMI, adequate intake of calcium and vitamin D)
- Regular Exercise
- Stop Smoking
- Reduce Alcohol
Medical
- Alendronate 10mg OD or 70mg once weekly, or risedronate 5mg OD or 35mg once weekly
- Vitamin D/calcium supplements (higher doses for housebound/elderly)
- HRT for women with premature menopause




