MSK Flashcards
(435 cards)
1
Q
Which is more common? Malignant primary bone tumours or metastatic cancer affecting the bone?
A
metastatic cancer affecting bone
2
Q
What is the commonest benign bone tumour and what are its characteristics?
A
Osteochondroma- produces a bony outgrowth on the external surface with a cartilaginous cap
3
Q
True or false: an Osteochondroma is always benign?
A
False- there is a small risk of malignant transformation
4
Q
What causes an Enchondroma?
A
failure of the normal enchondral ossification at the growth plate causing a metaphyseal cartilaginous tumour.
5
Q
Where do enchondromas usually occur?
A
Femur, humerus, tibia and small bones of the hands and feet.
6
Q
What is a simple bone cyst?
A
a single cavity benign fluid filled cyst in a bone.
7
Q
What is the difference between aneurysmal bone cysts and simple bone cysts?
A
Simple bone cysts are just fluid filled sacs on the bone but aneurysmal bone cysts contain chambers that are filled with blood or serum.
8
Q
Where to Giant cell tumours occur?
A
around the knee and in the distal radius but can also occur in the long bones, pelvis and the spine.
9
Q
What is the appearance of giant cell tumours on x-ray?
A
soap bubble appearance
10
Q
If giant cell tumours were to metastasise, where are they most likely to?
A
lung
11
Q
What is the treatment for a giant cell tumour?
A
intralesional excision with use of phenol, bone cement or liquid nitrogen to destroy remaining tumour material.
12
Q
What is fibrous dysplasia?
A
disease of the bone usually occuring in adolescence where a genetic mutation results in lesions of fibrous tissue and immature bone. The affected bone is wider with thinned cortices.
13
Q
When would a shepards crook deformity occur?
A
When there is extensive involvement with the proximal femur in fibrous dysplasia.
14
Q
What is the treatment for fibrous dysplasia?
A
bisphosphonates may reduce pain and pathologic fractures should be stabilised with internal fixation and cortical bone graphs used to improve strength.
15
Q
Are giant cell tumours benign or malignant?
A
benign
16
Q
What is an osteoid osteoma?
A
a small nidus of immature bone surrounded by a sclerotic halo. They are characterised by intense constant pain worse at night due to the inflammatory response.
17
Q
What is the treatment for an osteoid osteoma?
A
NSAIDs help with the inflammatory process. The lesion may resolve spontaneously over time but some cases need CT guided radiofrequency ablation.
18
Q
What are the benign one tumours?
A
Osteochondroma, enchondroma, giant cell tumour, fibrous dysplasia, osteoid osteoma, simple bone cyst & aneurysmal bone cyst.
19
Q
What are the cancers most likely to metastasise to bone?
A
Breast Bronchus (lung) prostate thyroid kidneys
20
Q
What age groups are most commonly affected from metastatic bone tumours?
A
people under 20 and over 60.
21
Q
What might be seen on x-ray in metastatic bone cancer?
A
cortical destruction, a periosteal reaction (raised periosteum producing bone), new bone formation and extension into the surrounding soft tissue envelope.
22
Q
What is the most common form of primary bone tumour?
A
Osteosarcoma
23
Q
Where do osteosarcomas usually present?
A
Around the knee, proximal femur, proximal humerus and pelvis.
24
Q
What is the treatment for osteosarcomas?
A
they are not radiosensitive but adjuvant chemotherapy can prolong survival.
25
What is a chondrosarcoma?
A cartilage producing primary bone tumour and is less common and less aggressive than osteosarcoma.
26
Do chondrosarcomas metastasise?
yes
27
Where are chondrosarcomas usually found?
the pelvis or proximal femur.
28
What is a fibrosarcoma?
fibrous malignant primary bone tumours which tend to occur in abnormal bone e.g. fibrous dysplasia, post irradiation, Pagets disease.
29
What is Ewings Sarcoma?
malignant tumour of primitive cells in the marrow. it is the second most prevalent primary bone tumour.
30
How does Ewings Sarcoma present?
fever, raised inflammatory markers and a warm swelling- it may be misdiagnosed as osteomyelitis.
31
Which malignant bone tumour has the worst prognosis?
Ewings sarcoma
32
What is the treatment of primary bone tumours?
tends to involve surgery to remove the tumour and surrounding tissue to reduce the risk of recurrence. Adjuvant chemotherapy and radiotherapy are used if appropriate.
33
What is a lymphoma?
a cancer of round cells of the lymphocytic system. it can occur as a primary bone tumour (non-Hogekins) from the marrow or lymphoma and can metastasise to bone.
34
What is polymyalgia rheumatica?
inflammatory condition causing myalgia at the hip and shoulder girdles
35
Who does polymyalgia tend to affect?
women over 50
36
What would blood tests show?
Raised CRP/ESR/PV
37
What other condition is polymyalgia rheumatica related to?
Giant cell arteritis
38
What is the treatment for polymyalgia rheumatica?
15mg of prednisolone reduced over 18 months
39
What is the commonest form of systemic vasculitis?
Giant cell arteritis
40
What are the symptoms of GCA?
visual disturbances, headaches, jaw claudication, scalp tenderness, fatigue
41
What is the disease process in GCA?
transmural inflammation of the intima, media and adventitia. patchy infiltration of lymphocytes, macrophages and granulomas with vessel wall thickening leading to ischaemia.
42
What investigations would be done for GCA?
temporal artery biopsy & bloods (raised ESR/CRP/PV)
43
What is the treatment of GCA?
if visual impairment: 60mg of prednisolone, if no visual impairment: 40mg of prednisolone.
44
What is polymyositis?
idiopathic inflammatior myopathy that causes symmetrical proximal muscle weakness
45
What is the difference between polymyalgia rheumatica and polymyositis?
PR- muscle stiffness but no weakness.
| Polymyositis: muscle weakness
46
What is the pathogenesis of polymyositis?
CD8 T cells and macrophages surround healthy tissue and initiate a cytotoxic response
47
What are the symptoms of polymyositis?
symmetrical proximal muscle weakness in the upper and lower limbs, myalgia, insidious onset, dysphagia, fever, weight loss, raynaud's, polyarthritis, SOB, cough
48
What investigations would be done for polymyositis?
inflammatory markers, serum CK (often raised x10), auto-antibodies, muscle biopsy (shoes different stages of inflammation, necrosis and regeneration)
49
What antibodies are seen in polymyositis?
ANA, Anti-Jo-1 and Anti-SRP
50
What is the treatment for polymyositis?
40mg prednisolone or immunosuppressive drugs such as azathioprine or methotrexate
51
What is dermatomyositis?
similar to polymyositis with cutaneous manifestations
52
What are the symptoms of dermatomyositis?
V shaped rash over chest, gottrons papules (purple colouring over the skin over the MCP and PIP joints), heliotrope rash and myalgia/muscle weakness
53
Is there a risk of malignancy in those with dermatomyositis?
```
Yes- found in 25% 5 years after diagnosis. increased risk of:
breast
ovarian
lung
colon
oesophageal
bladder
```
54
What is fibromyalgia?
muscle condition causing widespread muscle pain and fatigue
55
Who commonly suffers from fibromyalgia?
young and middle aged females
56
What are the symptoms of fibromyalgia?
persistent widespread pain >3months on both sides of the body, above and below the waist including the axial skeleton, anxiety, depression, IBS, migraines
57
What is the treatment for fibromyalgia?
education, analgesia
58
What are the symptoms of SLE?
weight loss, fever, fatigue, arthralgia, myalgia, inflammatory arthritis, avascular necrosis, malar rash, photosensitivity, discoid lupus, oral/nasal ulceration, raynauds, alopecia
59
What auto-antibody is most specific to SLE?
Anti-dsDNA
60
What are complement levels like when disease is active in SLE?
Complement levels (C3/C4) are low
61
What investigations can be done to look for organ involvement in SLE?
urinalysis, CT chest, MRI, echo
62
What is the treatment for SLE?
skin disease and arthralgia: Hydroxychloroquine, topical steroids, NSAIDs
inflammatory arthritis: azathioprine, corticosteroids
Severe organ involvement: cyclophosphamide & IV steroids
63
What is Sjogrens?
autoimmune condition characterised by lymphocyte infiltrates in exocrine organs
64
What are the symptoms of Sjogrens?
ocular dryness, mouth dryness, arthralgia, fatigue, vaginal dryness and parotid gland swelling
65
How is Sjogrens Diagnosed?
Ocular dryness via Schirmers test, antibodies.
66
What auto-antibodies are positive for Sjogrens?
Anti-Ro and Anti-La
67
What is the treatment for Sjogrens?
Lubricating eye drops, pilocarpine, hydroxychloroquine and immunosuppression
68
What is Pilocarpine?
it is a medication used to treat increased pressure in the eye and dry mouth.
69
What are the characteristics of systemic sclerosis?
Raynaud's, fibrosis and atrophy of the skin, excessive collage deposition can cause skin and internal organ changes
70
What does limited systemic sclerosis involve?
skin involvement generally limited to face, hands and forearms. Organ involvment occurs later
71
What is the antibody present in limited systemic sclerosis?
anti-centromere antibody
72
What does diffuse systemic sclerosis involve?
skin changes come rapidly and tend to affect more areas including the trunk and arms. Significant early organ involvement.
73
What is the antibody present in diffuse systemic sclerosis?
Anti-Scl-70
74
What is the treatment for Raynauds?
calcium channel blockers, iloprost, bosentan and sildenophil
75
What is the antibody present in Mixed connective tissue disease?
Anti-RNP
76
What are the characteristics of Anti-phospholipid syndrome?
Recurrent venous or arterial thrombosis and fetal loss (after 10 weeks)
77
What are the complications of anti-phospholipid syndrome?
increased frequency of stroke and MI, pulmonary hypertension, organ failure, livedo reticularis
78
Which antibody is present in anti-phospholipid syndrome?
Anti-Cardiolipin
79
What is the treatment for anti-phospholipid syndrome?
Warfarin or LMWH for during pregnancy
80
What are the vessel changes that occur in vasculitis?
vessel wall thickening, vessel stenosis and occlusion of vessels with subsequent infarction
81
What are the 2 types of large vessel vasculitis?
GCA and Takayasu arteritis
82
What are the arteries affected in Takayasu arteritis?
Arteries off the branch of the aorta
83
What is the treatment for large cell arteritis?
40-60mg of prednisolone which is gradually reduced
84
What are the types of medium vessel vasculitis?
Kawasaki disease, polyarteritis nodosa and Buergers disease
85
What are the symptoms of Kawasaki disease?
conjunctivitis, rash over the body, adenopathy, strawberry tongue, hands and feet swelling
86
Which vasculitis can be seen on angiogram as a string of beads?
Polyarteritis nodosa
87
What are the types of small vessel vasculitis?
GPA, EGPA, MPA, HSP
88
What are the antibodies for Granulomatosis with polyangiitis?
cANCA +ve and anti-PR3
89
Where does GPA affect?
nasopharynx, lungs and kidneys causing sinusitis, bloody mucous, saddle nose deformities and difficulty breathing
90
What vasculitis causes saddle nose deformities?
GPA
91
What does microscopic polyangiitis cause?
glomerulonephritis
92
What are the antibodies present in MPA?
pANCA +ve
93
What antibodies are present in EGPA?
Anti-MPO and anti-PR3
94
How does Henloch schonlein purpura present?
with palpable purpura which is like little bruises due to fibrosis occuring in the affected vessel over the buttocks and lower legs. Also presents with abdo pain, vomiting and joint pain
95
Which forms of vasculitis are ANCA positive and how are they treated?
MPA and GPA which can be treated with IV steroids and cyclophosphamide
96
What is the disease mechanism in Henloch Schonlein purpura?
IgA targets endothelial cells via molecular mimicry
97
How does alcohol and steroid use cause avascular necrosis?
they alter fat metabolism causing mobilisation of fat in the circulation, capillary system sruggles to maintain normal flow. this promotes coagulation in prone areas of blood. increased fat content also compresses venous outflow causing stasis and ischaemia
98
Where are common sites for avascular necrosis/
femoral head, scaphoid bone, femoral condyles, head of humerus, capitellum, proximal part of tallus
99
Is there pain associated with AVN?
there is constant pain or when weight bearing
100
How does AVN look on imaging?
large wedge shaped area of discolouration & trabeculae without osteophytes in the lacunae.
101
what is the treatment of AVN?
if the articular surface has not collapsed then drilling under fluoroscopy to decompress the bone. if articular surface has collapsed then joint replacement or fusion is considered in the wrist or ankle bones
102
What is osteochondritis?
inflammation of bone and cartilage
103
Who does osteochondritis usually affect and why?
tends to affect children and young adults due to increased physical activity and increased body weight.
104
What is traction osteochondritis at the tibial tubercle also called?
Osgood Schlatters disease
105
What is osteochondritis dissecans?
Fragmentation with separation of bone and cartilage within a joint.
106
What is the treatment of osteochondritis?
damaged bone is replaced with osteotomy, large or unstable fragments of bone are pinned for repair and small fragments are removed arthroscopically
107
What is a giant cell tumour?
it is a firm small swelling arising from a synovial tendon sheath or joint
108
what do giant cell tumours look like?
pigmented multinucleated giant cells which have haemosiderin giving them a brown appearance
109
What is a pigmented villonodular synovitis?
giant cell tumour of tendon sheath occurring in the knee joint
110
What is a rhabdomyosarcoma?
malignant tumour of skeletal muscle
111
Where does a synovial sarcoma usually manifest?
around the knee
112
What is a ganglion cyst?
herniation of synovial fluid at a weak point in the joint capsule or tendon sheath. it is well defined and trans-illuminates
113
Where is a Bakers cyst found?
popliteal fossa
114
What type of crystals accumulate in gout?
urate crystals
115
What are causes of high uric acid?
increased protein intake, increased cell breakdown, renal underexcretion, diuretics, renal failure, excessive alcohol, diet
116
What is gouty trophi?
painless white accumulations of uric acid which can occur in soft tissues and occasionally erupt through the skin
117
What is needed for the diagnosis of gout?
joint aspiration for serum urate >7mg
118
Where is a common site for gout?
The 1st MTP joint
119
What is the treatment for acute attacks of gout?
NSAIDs (colchicine), coricosteroids, opiods analgesia
120
What is the treatment for chronic gout?
Allopurinol
121
What are the X-ray findings for osteoarthritis?
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
122
Which joints are affected by osteoarthritis?
DIPs, large weight bearing joints, spinal cord
123
What is the treatment for osteoarthritis?
analgesia, NSAIDs, steroids, education, weight loss, physiotherapy
124
Which joints are affected in rheumatoid arthritis?
PIPs, MCPs and is symmetrical
125
What are the hallmarks of RA?
Synovitis, tenosynovitis, pannus formation (inflamed spongy synovium as a result of inflammation and hypertrophy) and bony erosions (increased osteoclast activity)
126
What is the most specific antibody to RA?
Anti-CCP
127
What is the management of rheumatoid arthritis?
methotrexate, sulfasalazine, biologics (if 2 DMARDs are unsuccessful) e.g. infliximab
128
What is the grading score for RA and what are the boundaries?
DAS28
<2.6: remission
>5.1: severe active RA
129
What is Osteoporosis?
increased bone porosity and decreased bone mineral density
130
What is the cause of osteoporosis?
increased osteoclastic response after the menopause or decreased oestrogen
131
What is a Colles fracture?
fracture involving the distal radius where the fractured bone is bent backwards
132
How is osteoporosis diagnosed?
DEXA scan
133
What is the treatment for osteoporosis?
calcium supplements, vitamin D, bisphosphonates
134
What is the mechanism of bisphosphonates?
reduce osteoclast activity. examples include alendronate, riseadronate, etc.
135
What is the mechanism of strontium?
increases osteoblast replication and decreases osteoclastic activity
136
What is osteomalacia?
abnormal softening of the bone due to deficient mineralisation of osteoid with decreased phosphate and calcium
137
What are the causes of osteomalacia?
insufficient calcium, deficiency or resistance to vitamin D, phosphate deficiency, long term anti-convulsant use, chronic kidney disease, inherited disease
138
What are the symptoms of osteomalacia?
bone pain, deformities from soft bones, pathological fractures, hypocalcaemia, pseudofractures
139
What is the biochemistry of osteomalacia?
decreased phosphate & calcium. increased ALP
140
What is the treatment for osteomalacia?
Vitamin D therapy, calcium supplementation and phosphate supplementation
141
What is hyperparathyroidism?
overactivity of parathyroid glands resulting in increased PTH
142
What is the cause of hyperparathyroidism?
benign adenoma, hypocalcaemia, decreased phosphate
143
What is Paget's disease?
chronic disease of bone causing thickened, brittle and misshaped bone
144
What causes pagets disease?
viral infection with paramyxoviruses and genetic defects
145
What is the disease mechanism in Paget's disease?
potentially due to an exaggerated vitamin D response, there is an increased osteoclast activity which causes osteoblasts to become more active. There is new bone formed but it is brittle
146
How does Paget's disease appear on x-ray?
Enlarged bone, thickened cortices, thickened and coarse trabeculae and mixed areas of lysis and sclerosis
147
What is the biochemistry of Pagets disease?
Raised ALP, normal calcium and normal phosphate
148
What is the treatment for Paget's disease?
Bisphosphonates, calcitronin, joint replacement and stabilisation of femoral fractures with long intramedullary nails
149
What is osteogenesis imperfecta?
it is an autosomal dominant condition causing brittle bone disease via a defect in the maturation and organisation of type 1 collagen in bone
150
What is the presentation of osteogenesis imperfecta?
multiple fragility fractures, short stature, multiple deformities, BLUE SCLERAE, loss of hearing
151
What do bones look like in osteogenesis imperfecta?
thin and gracile, thin cortices, osteopenia and fractures heal poorly with poor quality callus
152
What kind of inheritance is Marfans?
autosomal dominant- mutation or defect in fibrillin gene causing tall stature with disproportionately long limbs and ligamentous laxity
153
What are the features of Marfan's?
high arched palate, scoliosis, pectus excavatum, eye problems, aortic aneurysm, cardiac valve incompetence, spontaneous pneumothorax, long limbs
154
What is Skeletal dysplasia?
Dwarfism
155
What is the most common form of skeletal dysplasia?
achondroplasia- it is disproportionate
156
What is the mode of inheritance of achondroplasia?
Autosomal dominant
157
What is the mode of inheritance of duchenne muscular dystrophy?
X-linked recessive
158
What is Gower's sign and what is it associated with?
it is a sign of muscle weakness in young boys with duchenne muscular dystrophy where the patient gets on all 4's and progresses to put hands on knees before standing up
159
How is Duchenne Muscular dystrophy diagnosed?
By a raised serum CK and abnormalities on biopsy
160
What is Beckers muscular dystrophy?
a milder version of duchennes
161
What mode of inheritance is Ehlers-Danlos syndrome?
Autosomal dominant
162
How does Ehlers Danlos syndrome present?
joint hypermobilty, vascular fragility and scoliosis
163
What is cerebral palsy?
neuromuscular disorder caused by an insult to the immature brain before, during or after birth
164
What is the most common form of cerebral palsy?
spastic
165
In Ataxic cerebral palsy, where is the insult in the brain?
The cerebellum
166
What is Spina Bifida?
congenital disorder where 2 halves of the verterbal arch fail to join
167
What is the mildest form of Spina Bifida and how does it present?
Spina bifida occulta. Spinal cord and roots may tether to vertebral defects causing pes cavus and clawing of the toes. hair may be over the defect.
168
What is the severe form of spina bifida?
Spina Bifida cystica- contents of vertebral canal herniate through the defect- can be the meninges alone or the spina cord and cauda equina
169
How is Spina Bifida treated?
defect closed within 48 hours of birth
170
What is Syndactyly?
fusion of 2 digits
171
What is polydactyl?
extra digits
172
What is Fibular Hemimelia?
partial or complete absence of the fibula
173
What are the causes of brachial plexus injury?
large baby, twin delivery, shoulder dystocia
174
What is Erbs Palsy?
Injury to C5 and C6 roots
175
What are the characteristics of Erbs palsy?
Waiters tip posture because there is loss of innervation to all other rotator cuff muscles except subscapularis.
176
What is Talipes equinovarus?
club foot- a congential deformity of the foot due to in utero abnormal aligment of the joints between the talus, calcaneus and navicular.
177
What is the treatment for Talipes Equinovarus?
Ponseti technique: held in plaster cast for 6 weeks and then changed
178
What is Hallux Valgus
Valgus of the 1st MTP with lateral deviation
179
What is Scoliosis?
Lateral curvature of the spine
180
What is spondylolisthesis?
slippage of one vertebrae over another
181
What are the symptoms of spondylolisthesis?
lower back pain, radiculopathy (severe slippage), flat back and waddling.
182
What is radiculopathy?
a pinched nerve
183
Where does osgood schlatters disease occur?
the patellar tendon attaching to the tibial tubercle
184
What are risk factors for patello-femoral dysfunction?
female, muscle imbalance, ligamentous laxity, genu varum, wide hips, femoral neck anteversion
185
What is the most common type of meniscal tear?
bucket handle
186
What is characteristic of meniscal tear
knee locking
187
What gene are spondyloarthropathies usually linked with?
HLA-B27
188
What is enthesis?
inflammation at insertion of tendons onto bones
189
What joints does ankylosing spondylitis usually involve?
sacroiliac involvement
190
What other conditions are associated with ankylosing spondylitis?
All the A's:
| Anterior uveitis, aortic valve, apical pulmonary fibrosis, amyloidosis, achilles tendonitis, atlanto-axial subluxation
191
What tests confirm diagnosis?
Schober's, bamboo spine on x-ray
192
what is the most common fracture in kids?
Bucket fracture
193
What is the mechanism of action of bisphosphonates?
inhibit osteoclasts by reducing recruitment and promoting apoptosis
194
What are the adverse effects of bisphosphonates?
oesophageal reactions, osteonecrosis of the jaw, increased risk of atypical stress factor
195
How should bisphosphonates be taken?
should be swallowed with plenty of water on an empty stomach at least 30 minutes before breakfast with the patient standing or sitting up
196
What nerve can be compressed to cause referred lumbar pain?
Femoral
197
What kind of epicondylitis is Tennis and Golfers elbow?
Lateral- Tennis, Medial- Golf
198
What are the symptoms of lateral epicondylitis?
pain and tenderness on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
199
What is the typical age group affected by ankylosing spondylitis?
20-30
200
What is the commonest cause of hip pain in children?
Transient synovitis- it is an acute hip pain associated with viral infection
201
What tests are positive in developmental displasia of the hip?
Barlows and Ortolanis
202
What are the features of perthes disease?
hip pain that is getting progressively worse over a few weeks, limp, stiffness and reduced range of hip movement.
203
What are the causes of Perthes disease?
Avascular necrosis of the femoral head
204
What x-ray changes would be seen for perthes disease?
Widening of the joint space, decreased femoral head size/flattening
205
Is Perthes disease more common in males or females?
Males- 5x more common
206
What kind of hip pain does obese children usually present with?
Slipper upper femoral epiphysis
207
What are the features of SUFE?
displacement of the femoral head epiphysis postero-inferiorly causing knee or distal thigh pain and loss of internal rotation of the leg in flexion
208
What is Juvenile idiopathic arthritis?
arthritis occuring in someone who is less than 16 years old that lasts for more than 3 months
209
What are the features of juvenile idiopathic arthritis?
joint pain and swelling in the knees, ankles or elbows, limp and ANA may be positive
210
What is the most common organism involved in septic arthritis?
Staphylococcus aureus, in young adults who are sexually active, consider Neisseria gonorrhoea
211
What is the first line investigation that should be done before starting treatment in septic arthritis?
Synovial fluid should be aspirated
212
What is the treatment for septic arthritis?
Flucloxacillin (to cover gram negatives) or clindamycin if penicillin allergic
213
What kind of drug is colchicine
NSAID
214
What are the Ottawa rules for X-raying an ankle?
bony tenderness at the lateral & medial malleolar zone
| unable to weight bear or walk 4 steps
215
What is chondroclacinosis and in what condition is it seen?
linear calcification of the articular cartilage and distinguishes pseudogout from gout
216
What is the most appropriate investigation for suspected achilles tendon rupture?
Ultrasound of the ankle
217
What is a risk factor of quinolones (ciprofloxacin)?
tendon disorders
218
What are the features of achilles tendonitis?
gradual onset of posterior heel pain that is worse following activity, morning pain and stiffness
219
What is the management of achilles tendinopathy?
supportive: analgesia and reduction in activities
220
What are the features of achilles tendon rupture?
an audible pop in the ankle, sudden onset significant pain in the calf or ankle or the inability to walk
221
What is osteomalacia?
Normal bony tissue but decreased mineral content.
222
What is Rickets?
osteomalacia in the young
223
What is the biochemistry of osteomalacia?
Low calcium, low phosphate, low vitamin D3 and raised ALP and PTH
224
What is the treatment of osteomalacia?
Vitamin D replacement
225
what are the features of avascular necrosis?
Symptoms may be gradual or sudden onset and may follow high dose steroid therapy or previous hip fracture
226
What rotations are affected in adhesive capsulitis?
External rotations is more affected than others
227
What are the 2 signs that are positive in carpal tunnel?
Tinel's and phalens
Tinel's: tapping causes paraesthesia
Phalens: flexion of the wrist causes symptoms
228
What is first line treatment for lower back pain?
NSAIDs- naproxen
229
What does a positive simmonds sign mean?
Achilles tendon rupture
230
What antibiotic has to be avoided with use of methotrexate due to the risk of bone marrow suppresion?
Trimethoprim
231
What are the featuers of a Galeazzi fracture?
It is a radial fracture with ulnar displacement
232
A fall on an outstretched hand with pain at the lateral side of the elbow during pronation and suppination is likely to be?
fracture of the radial head
233
When are scaphoid fractures likely to occur
a direct blow to the palm
234
What is a Colles fracture?
fall onto an extended outstretched hand and is described as a dinner fork deformity. Transverse fracture of the radius with dorsal displascement and angulation
235
What is the opposite of a colles fracture?
Smiths fracture- caused by falling backwards
236
What is the most common causative organism in psoas abscess?
Staph aureus
237
What is a psoas abscess?
Causes lumbar pain and all the other systemic signs of infection- patients may favour a particular side to lie on
238
what is a Greenstick fracture?
a fracture of the bone, occurring in children in which one side is broken and the other only bent
239
What is a buckle fracture?
when one part of the bone fractures but the other side is undisrupted. It is an incomplete fracture
240
What are the Salter Harris fractures?
They are fractures of the growth plate.
type I: through the physis
Type II: through physis and metaphysis
Type III: through the physis and epiphysis
Type IV: through the physis, epiphysis and metaphysis
Type V: crush involving the physis
241
What is the most common type of intracapsular hip fracture?
Subcapital fracture
242
What is the treatment for intracapsular hip fractures?
Undisplaced: internal fixation or hemi if unfit
Displaced: reduction and internal fixation if young, Hemi or THR if old
243
What is the treatment for extracapsular hip fracture?
dynamic hip screw or if oblique, transverse or subtrochanteric then intramedullary nail
244
What are the features of SLE?
```
General:
fatigue, fever, mouth ulcers, lymphadenopathy
Skin:
Malar rash, discoid rash, photosensitivity, raynauds, livedo reticularis, alopecia
MSK:
arthralgia, arthritis
CVS:
pericarditis, myocarditis
Respiratory:
pleurisy, fibrosing alveolitis
Renal:
proteinuria, glomerulonephritis
Neuro:
anxiety, depression, psychosis, seizures
```
245
What are the features of anti-phospholipid syndrome?
venous and arterial thromboses, recurrent fetal loss and thrombocytopenia
246
What is the antibody for limited systemic sclerosis?
anti-centromere
247
What is the antibody for diffuse systemic sclerosis?
Anti-Scl-70
248
What are the features of limited cutaneous systemic sclerosis?
Raynauds, scleroderma affecting face and distal limbs, CREST syndrome (calcinosis, raynauds, oesophageal dysmotility, sclerodactyly, telangiectasia)
249
What are the features of diffuse systemic sclerosis?
scleroderma, respiratory involvement, renal disease and hypertension
250
What causes painful arc of abduction?
subacromial impingement
251
What is the key investigation of temporal arteritis?
Vision testing
252
What is the treatment for temporal arteritis?
prednisolone- there will be a dramatic response
253
What are the likely blood test results in osteoporosis?
All normal!
254
What are you likely to see in the blood tests in Paget' disease?
Raised ALP alone
255
What are the risk factors for osteoporosis?
corticosteroids use, smoking, alcohol, low BMI, family history
256
What is first line treatment for osteoporosis?
Alendronate
257
What is Feltys syndrome?
RA, splenomegaly and a low WCC
258
What is McMurrays test used for?
Meniscal tears
259
What usually causes meniscal tears?
Twisting of the knee
260
What causes an ACL tear?
may be caused by twisting of the knee and with a popping noise. Rapid onset of knee effusion
261
What causes a PCL tear?
anterior force applied to the proximal tibia
262
What type of hypersensitivity reaction is involved in SLE?
Type 3
263
What is the most common cardiac complication of Ehler-Danlos syndrome?
Aortic regurgitation
264
What kind of collagen is affected in Ehler-Danlos syndrome?
III
265
What are the features of Ehler-Danlos syndrome?
```
elastic, fragile skin
joint hypermobility
easy bruising
aortic regurgitation
subarachnoid haemorrhage
retinal streaks
```
266
What is the mutation in marfans syndrome?
Fibrillin
267
What is De Quervains tenosynovitis?
It is when the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed
268
What is the most common complication of posterior hip dislocation?
Sciatic nerve injury
269
Which nerve innervates the anterior compartment of the lower leg?
Deep peroneal nerve
270
What nerve innervates the peroneal compartment of the lower limb?
Superficial peroneal nerve
271
Which nerve innervates the superficial posterior compartment of the lower limb?
tibial nerve
272
Which nerve innervates the deep posterior compartment of the lower limb?
Tibial nerve
273
What are the muscles that flex the toes?
Flexor digitorum longus: flexes the lateral four toes
| Flexor hallucis longus: flexes the great toe
274
What would a shortened, internally rotated leg suggest?
Dislocation of the hip
275
What would suggest a shortened externally rotated leg?
Neck of the femur fracture
276
What are the features of a fat embolism?
fever, breathlessness, confusion and retinal haemorrhages which can occur up to 3 days after trauma. a petechial rash on the back may be present
277
What causes rupture to the MCL?
leg forced into valgus via force outside the leg
278
What is the most common causative organism in osteomyelitis?
staph aureus
279
What is the treatment for osteomyelitis?
Flucloxacillin for 6 weeks. if penicillin allergic then clindamycin
280
what is the treatment for Raynauds?
Nifedipine
281
What is a classic side effect of colchicine
Diarrhoea
282
What is the treatment for pseudogout?
NSAIDs and colchicine
283
What is a Bennett's fracture?
intra-articular fracture of the first carpometacarpal joint- caused by fist fights
284
What is a smiths fracture?
Volar angulation of distal radius fragment- caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
285
What is a Monteggia fracture?
dislocation of the proximal radioulnar joint in associated with an ulnar fracture. MURD- ulnar fracture with radial deviation
286
What is a Galeazzi fracture?
radial shaft fracture with associated dislocation of the distal radioulnar joint- GRUD- radial fracture with ulnar deviation
287
What is a Pott's fracture?
bimalleolar ankle fracture.
288
What is a Bartons's fracture?
distal radius fracture (Colles/smiths) with associated radiocarpal dislocation- fall onto extended wrist
289
What is pANCA associated with?
Churg-Strauss- eGPA
290
What is cANCA associated with?
GPA
291
What is Reiters syndrome?
Triad of urethritis, conjunctivitis and arthritis
292
What is a trigger finger?
condition associated with abnormal flexion of the digits. it is thought to be caused by a disparity between the size of the tendon and pulleys through which they pass.
293
When is a trigger finger likely to occur?
More common in women and can happen in RA and DM
294
What is the treatment of osteoarthritis?
paracetamol and topical NSAIDs if knee/hand
295
What group of patients typically get a psoas abscess?
PWID
296
What is the most common rotator cuff tear?
Supraspinatus
297
What is the most appropriate management of diagnosing meniscal tears?
MRI
298
What is divided in surgical management of carpal tunnel syndrome?
Flexor retinaculum
299
What joints are affected by psoriatic arthritis?
DIPs
300
What is seen on x-ray for psoriatic arthritis?
Pencil in cup appearance
301
What are common causative infections for reactive arthritis?
Urogential and enterogenic e.g. chylamydia, salmonella, shigella
302
What is circinate balanitis?
dermatitis of glans penis
303
Is reactive arthritis one of the seronegative arthritis'?
Yes- it has raised HLA-B27
304
What nerve is responisible for foot drop?
Common fibular/peroneal
305
What nerve is responsible for wrist drop?
Radial
306
What type of inflammatory arthritis is associated with IBD?
Enteropathic
307
What dermatomes are responsible for hip flexion?
L1/2
308
What dermatoses are responsible for knee extension?
L3/4
309
What dermatome is responsible for foot dorsiflexion
L5
310
What dermatomes are responsible for ankle plantarflexion?
S1/2
311
What nerve roots are disturbed in sciatica?
L4/5/S1
312
How can osteoarthritis cause sciatica?
Oateophytes can impinge on nerve roots causing sciatica
313
What symptoms accompany L3/L4 prolapse?
pain down medial ankle, loss of quadriceps power, reduction in knee jerk
314
What symptoms accompany a L4/L5 prolapse?
pain down to foot dorsum and loss of power to extensor hallicus longus and tibialis anterior
315
What are the characteristics of a prolapsed disc?
neuralgic burning or severe tingling pain which radiates to the back of the thigh below the knee
316
What is spondylosis?
Intervertebral discs lose water content with age which causes less cushioning and secondary OA due to increased facet joint pressure
317
What is Spinal Stenosis?
Narrowing of the spinal canal due to a bulging ligamentum flavum, osteophytes, bulging disc etc
318
What movement does supraspinatus do?
Initiation of abduction
319
What movement does infraspinatus and Teres minor do?
external rotation
320
What movement does subscapularis do?
Internally rotates the shoulder
321
Where do the rotator cuff muscles insert?
Supra/infra/teres minor- insert into the greater tuberosity of the humerus
Sub- inserts into the lesser tuberosity
322
What causes impingement?
pain due to the tendons of the rotator cuff muscles caused by compression in the subacromial space during movement
323
What is Biceps tendonitis?
anterior shoulder pain on resisted biceps contraction and popeye deformity
324
What nerve is compressed in carpal tunnel syndrome?
Median
325
What fingers go numb in carpal tunnel syndrome?
thumb and radial 2 1/2 fingers
326
What is Tinel's test?
percussion over the median nerve
327
What is Phalen's test?
holding the wrists hyperflexed
328
What is the treatment of carpal tunnel syndrome?
Wrist splints, injection of corticosteroids, carpal tunnel decompression, division of transverse carpal ligament
329
what nerve is compressed in cubital tunnel syndrome?
ulnar nerve
330
What is the humero-ulnar joint responsible for?
flexion/extension
331
What is the radio-capitellar joint responsible for?
supination/pronation
332
What are the muscles of the upper arm and what do they do?
BBC:
Brachialis- powers flexion
Biceps Brachii- powers flexion
Coracobrachialis
333
What joints in the hands are affected in osteoarthritis?
DIP joints and carpo-metacarpal joints
334
How does RA present in the hands?
Synovitis & tenosynovitis
erosions of the joints- inflammatory pannus
joint instability and tendon rupture- subluxations and chronic tenosynovitis may cause extensor tendon ruptures
335
What is a swan neck deformity?
hyperextension at PIPs with flexion at DIPs
336
What are the characteristics of meniscal injuries?
localised pain to the joint line, effusion the following day, catching or locking sensation, feeling of the knee giving way
337
In an ACL, where would you expect the tibia to translate to on drawer test?
anteriorly
338
What test is positive in meniscal tears?
Steinmann's
339
What is patellofemoral dysfunction?
anterior knee pain with grinding or clicking and pseudolocking
340
Where does the patella tend to dislocated to?
Lateral
341
What is developmental dysplasia of the hip?
dislocation or subluxation of the femoral head in the perinatal period which affects joint development
342
What are the signs of developmental dysplasia of the hip?
asymmetry, clicking/clunking when moving affected hip joint on Barlow's/Ortlani's test, decreased leg length
343
What is Ortlani's test?
reducing a dislocated hip with abduction and anterior displacement
344
What is Barlow's test?
Dislocatable hip with flexion/adduction and posterior displacement
345
What is the treatment for Developmental dysplasia of the hip?
Pavlick harness for 6 weeks at a time
346
What is the treatment for late developmental dysplasia of the hip?
combined femoral and acetabular surgery
347
What is the commonest cause of hip pain in children?
transient synovitis
348
What is the treatment of transient synovitis?
rest and NSAIDs
349
What is Perthes?
idiopathic osteochondritis of the femoral head leading to AVN
350
What is the pulley usually involved un trigger finger?
A1
351
What are the patterns of pelvic injury?
lateral- half of pelvis is displaced medially
vertical sheer- causes superior displacement which causes leg on affected side to be shorter
Anteroposterior- open back pelvic fracture
352
How do you treat c-spine fractures?
Stable: firm cervical collar
Unstable: halovest
353
What is the commonest injury pattern in the spine?
central cord syndrome- caused by hyperextension injury in cervical spine
354
How do you treat intra-articular distal humeral fractures?
ORIF
355
What is the treatment of radial head and neck fractures?
Undisplaced: sling & early elbow exercises to minimise stiffness
Displaced: ORIF
356
What is a Bankart lesion?
injury of the anterior glenoid capsule of the shoulder due to anterior shoulder dislocation
357
When would you see a light bulb sign on x-ray?
Shoulder dislocation
358
Which nerve is at risk in a shoulder dislocation?
axillary nerve
359
What is the treatment for intracapsular hip fractures?
Hemi or THR
360
What is the treatment of extracapsular hip fractures?
internal fixation via dynamic hip screw or intramedullary nail
361
How would you treat a subtrochanteric fracture?
intramedullary nail
362
How would you treat a trochanteric fracture?
Dynamic hip screw
363
Where does pain from SUFE present?
knee
364
How does avascular necrosis look on x-ray?
patchy sclerosis of weight bearing area. lytic zone underneath patchy sclerosis which causes classical sagging rope sign
365
What is the treatment of AVN?
pre-collase: drill holes in femoral neck into the diseased region to decompress, promote healing and prevent collapse
Collapsed: THR
366
What is a nightstick fracture?
fracture of the ulnar shaft
367
What is the treatment of both forearm bones?
ORIF with plates and screws
368
What is the treatment for Monteggia and Galeazzi fractures?
ORIF
369
What are the features of a Colles Fracture?
extra-articular fracture of the distal radius within an inch of the articular surface and dorsal displacement. it is associated with median nerve compression and can damage the extensor pollicus longus
370
What is abnormal Genu varum?
>16 degrees from mean, short stature and painful
371
Is flat foot normal?
it is normal in the young and then the medial arch develops as the posterior tibialis strenghtens
372
What is the treatment of Raynauds?
Calcium channel blockers
373
What is the first line treatment of arthritis?
Methotrexate. NSAIDs are given for flares
374
Why are frequent blood tests taken when a patient is taking methotrexate or other DMARDs?
due to the risk of leucopenia, thrombocytopaenia, hepatitis and cirrhosis
375
What are the side effects of DMARDs?
leukopaenia, low sperm count, hepatitis, cirrhosis, nausea, diarrhoea, rash, ulcers, temporary hair loss
376
What is 2nd line treatment for arthritis?
Methotrexate and sulfasalazine
377
What is the treatment of gout?
Colchicine- acute
| Allopurinol- chronic.
378
What is the treatment of stable ankle fractures?
walking cast or splint for 6 weeks
379
What is the treatment for an unstable ankle fracture?
ORIF with plates and screws
380
Where does a stress fracture normally occur?
The 2nd metatarsal- it is not visible on x-ray until healing has begun
381
What are the characteristics of claw toes?
Hyperextension at the MTP joints and hyperflexion at the PIP and DIP joints
382
What are the characteristics of hammer toes?
hyperextension at the MTP joints, hyperflexion at the PIP joints, hyperextension at DIP joints
383
Is age of first dislocation proportional to risk of recurrent shoulder dislocation?
Yes- the younger the first dislocation, the increased chance of recurrence
384
Is the periosteum of children's long bones thicker than adult bones?
Yes
385
What is the treatment of septic arthritis?
urgent orthopaedic review and debridement of the joint
386
Which deformity is not well tolerated in a boxers fracture and requires fixation and manipulation?
Rotational deformity- treatment is by neighbour strapping of the affected digit
387
What bones make up the ankle bone?
Talus, tibia and fibula
388
Do wedge fractures require surgical inervention?
no, they are stable fractures in the anterior column of the spinal vertebrae
389
What nerve is most at risk in a displaced Colles fracture?
Median nerve
390
What is a Colles fracture?
Extra-articular fracture of the distal radius within an inch of the articular surface and with dorsal displacement or angulation.
391
A GCS of what implies loss of airway control?
8
392
What nerve is most at risk from a blow to the lateral aspect of the knee?
Common peroneal nerve
393
What nerve is most as risk due to a posterior dislocation of the hip?
Sciatic nerve
394
What nerve is most at risk due to a supracondylar fracture of the distal humerus
median nerve
395
What are the classificiations of the Salter-Harris fractures?
I: pure physeal separation, best prognosis
II: physeal with a small metaphyseal fragment
III: intra-articular and with the fracture splitting the physis
IV:same as above
V: compression injury to the physis with subsequent growth arrest
SALTER:
I: Straight across
II: Above
III: Lower
IV: Through Everything
V: cRush
396
What is Chronic regional pain syndrome?
heightened chronic pain response following trauma.
397
Which vessel is at risk in a shoulder dislocation?
Axillary artery
398
Which vessel is at risk in a knee dislocation?
Popliteal artery
399
Which vessel is at risk in a paediatric supracondylar fracture/
Brachial artery
400
in spinal stenosis, when is pain worst?
when walking downhill, it is better when sitting forward
401
In peripheral artery disease, when is pain worse on walking?
uphill- the muscles in the legs must work harder, the oxygen and blood supply demand is greater and therefore the claudication is exacerbated quicker
402
in which condition whould you see a shepherds crook deformity?
fibrous dysplasia
403
What would show up on x-ray as a soap bubble?
giant cell tumour
404
What histological features are present in cortical bone?
osteons, volkmann canals and haversian canals
405
What compartment of the knee will be affected by varus malalignment?
median
406
Where is pain localised in plantar fasciitis?
calcaneal tuberosity
407
which principal clinical sign on examination is indicative of adhesive capsulitis?
external rotation
408
Which bone is the slowest healer?
Scaphoid and tibia
409
Which is he most common type of shoulder dislocation?
Anterior
410
What are common side effects of NSAIDs?
renal impairment, dyspepsia, wheeze, increased CVS
411
What type of splint is used for the temporary splintage of femoral shaft fractures?
Thomas splint
412
What is impinged in hip impingement?
acetabular labrum
413
What are the features of an aneurysmal bone cyst?
a lucent multi-lobulated cyst found within the medulla of many different bones often with associated cortical expansion
414
What is osteochondritis?
fragmentation with separation of bone and cartilage within a joint
415
What are the commonly affected sites in osteochondritis?
medial femoral condyle of the knee, femoral head and talar dome
416
Where would you see Bouchard's nodes?
PIP joints- RA
417
Where would you see Heberden's nodes?
DIP joints- OA
418
What type of collagen is produced in Dupuytren's contracture?
Type III
419
What is Klumpke's palsy?
it is a rare lower brachial plexus injury (C8 and T1) where there is paralysis of the intrinsic hand muscles
420
What would an abnormal straight leg raise be indicative of?
prolapsed disc
421
Old man, bone pain, isolated raised ALP
Pagets disease
422
How do posterior hip disloactions present?
shortened and internally rotated leg
423
How would a neck of the femur fracture present?
shortened, externally rotated leg
424
What are the abnormal curvatures of the back in ankylosing spondylitis?
Thoracic Kyphosis
425
What is the Barlow testing?
abducting and applying pressure to try to dislocate the hips
426
What is the Ortlani test?
It adducts and flexes the hips and puts pressure on the greater trochanter to cause posterior dislocation
427
What is the most common cause of hip pain in children?
Transient synovitis
428
What is idiopathic osteochondritis of the femoral head?
Perthes
429
What is Blounts disease?
Pathological cause of genu varum
430
Injury to which nerve might prevent plantarflexion and inversion of the foot?
Tibial nerve
431
Injury to which nerve causes claw hand?
Ulnar nerve
432
Injury to which nerve causes a winged scapula?
Long thoracic nerve
433
Which nerve is usually injured in humerus fractures?
Axillary nerve
434
A positive trendelenburg test is indicative of injury to which nerve?
Superior gluteal nerve
435
Which nerve is most likely to be injured in a THR?
Obturator
