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MSK Flashcards

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1
Q

Best imaging for osteomyelitis?

A

MRI

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2
Q

Risks for septic arthritis?

A

IVDU

DIabetes

Rheumatoid or osteo

Prostheses

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3
Q

Septic arthritis symptoms?

A

Short history of symptoms

Fever

Hot swollen tender joint with restriction

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4
Q

First line investigations to diagnose septic arthritis?

A

Aspiration of synovial fluid for gram stain and culture also look for crystals

Blood cultures also- Preferably before ABX

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5
Q

Causative organisms in septic arthritis?

A

Overall Staph Aureus is the most common but

Young sexually active - ~75%Gonococcal

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6
Q

Septic arthritis treatment?

A

Washout ABX and aspirate to dryness as often as possible/needed

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7
Q

Symptoms of GCA?

A

>50 and female usually

Headache, PMR symptoms, claudication cranial vessel tenderness

Low grade fever and fatigue systemically unwell

PainLESS loss of vision

pain on chewing

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8
Q

Investigations initially in to GCA?

A

ESR, CRP, FBC,LFTS

Artery biopsy

ESR raised often >50mm

CRP↑

Anaemic (normocytic)

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9
Q

Treatment of GCA doses etc referall?

A

visual symptoms — 60 mg as a one-off dose (they should be seen by an ophthalmologist the same day).

without visual symptoms — 40 to 60 mg daily (minimum 0.75 mg/kg)

If not contraindicated- Aspirin 75mg

Don’t forget the PPI

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10
Q

Additional preventative medications when using steroids?

A

PPI and bone protection

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11
Q

Pain in which part of the spine is a red flag?

A

Thoracic

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12
Q

Cauda equina red flags and questions?

A

Severe low back pain, Sciatic, saddle anaesthesia

Bladder problems -incontinence or retention (when did you last urinate/open bowels?)

Bowel sphincter weakness can you tense

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13
Q

Shortened and externally rotated leg, diagnosis? Other symptoms?

A

Likely #NOF

Pain, cannot weight bear pain with hip movement

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14
Q

Risks for hip fracture?

A

Female sex, osteoporosis, falls, low BMI

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15
Q

Imaging of chocie in hip fracture?

A

Plain X-ray

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16
Q

Undisplaced hip fracture treatment?

A

Internal fixation or hemisrthroplasty if unfit

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17
Q

Displaced hip fracture treatment?

A

young and fit i.e. <70 years- Reduction and internal fixation (if possible).

older and reduced mobility- Hemiarthroplasty or total hip replacement.

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18
Q

Extracapsular hip fracture treatment?

A

dynamic hip screw

if reverse oblique, transverse or subtrochanteric: intramedullary device

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19
Q

What type of fracture if this?

Treated?

A

Intertrochanteric

Likely dynamic hip screw as extracapsular

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20
Q

Strongly suspect hip fracture but X-ray normal next investigation?

A

MRI

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21
Q

When to consider internal fixation of hip fractures?

A

Displaced (if possible) or Undisplaced, intracapsular and young <70

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22
Q

What is this fracture?

Treatment?

A

Intracapsular fracture of left hip

Hemiarthroplasty if elderly and immobile Total replacement if able and well

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23
Q

Offer THR rather than hemi to patient with undisplaced intracapsular and…

A

were able to walk independently out of doors with no more than the use of a stick and

are not cognitively impaired and

are medically fit

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24
Q

VTE prophlaxis in hip fractures?

A

1 month of LMWH starting 6-12hrs after surgery

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25
Common symptoms of compartment syndrome?
Pain- Severe and disproportianate to the injury and on passive stretching history of surgery or sports playing/trauma Tightness Paraesthesia Pulselessness pallor and paralysis are late and uncommon
26
Loss of cartilage, sclerosis and eburnation of the subchondral bone, osteophytes, and subchondral cysts Characteristic of?
Osteoarthritis
27
What features are seen on this xray?
Osteophytes Distally (heberdens) Base of thumb also, asymmetrical joint space narrowing
28
Xray features in Rhematoid arthritis?
joint space narrowing: symmetrical or concentric fusiform and periarticular; it represents a combination of joint effusion, oedema and tenosynovitis 5 PIP and MCP joints (especially 2nd and 3rd MCP) ulnar styloid triquetrum As a rule the DIP are spared
29
What is seen and diagnosis?
Rheumatoid arthritis * **Sparing of DIPs** Joint space symetrically loss in MCP joints wrist changes Subchondral cysts Ulnar styloid involvement
30
L4 nerve root?
Foot inversion and dorsiflexion
31
Foot eversion and toe plantarflexion nerve root?
S1
32
Great toe dorsiflexion nerve root?
L5
33
Management of lower back pain with no red flags?
Analgesia: paracetamol ± NSAIDs ± codeine  Muscle relaxant: low-dose diazepam (short-term)  Facet joint injections
34
Symptoms of Osteoarthritis?
Pain: worse with movement, background rest/night pain, worse @ end of day.  Stiffness: especially after rest, lasts ~30min (e.g. AM)  Deformity
35
Conservative management of OA?
↓ wt. Alter activities: ↑ rest, ↓ sport Physio: muscle strengthening  Walking aids, supportive footwear, home mods
36
Medical management of OA?
NSAID/topical, Paracetamol, topical capcaisin (hand or knee)
37
Surgical management of OA
Arthroscopic washout: esp. knee.  Trim cartilage, remove foreign bodies.  Arthroplasty: replacement (or excision)
38
Monitor disease activity in RA?
DAS28
39
Bloods in RA?
RF +ve in 70% Anti-CCP: 98% specific (Ag derived from collagen) ANA: +ve in 30% FBC anaemia, ↓PMN, ↑plat, ↑ESR, ↑CRP
40
Extra articular manifestations of RA? Carpal Tunnel Syndrome Pulmonary Fibrosing alveolitis (lower zones) Pleural effusions (exudates) Ophthalmic Epi-/scleritis Sjogren’s Syndrome Raynaud’s
41
Diagnosis of RA?
1. Morning stiffness \>1h (lasting \>6wks) 2. Arthritis ≥3 joints 3. Arthritis of hand joints 4. Symmetrical 5. Rheumatoid nodules 6. +ve RF 7. Radiographic changes Need 4/7
42
Mainstay agents in RA?
DMARDS Methorexate: hepatotoxic, pulmonary fibrosis Sulfasalazine: hepatotoxic, SJS, ↓ sperm count Hydroxychloroquine: retinopathy, seizures Leflunomide Then Biological (Anti TNF)
43
Gout Pathophysiology?
Deposition of monosodium urate crystals in and around joints → erosive arthritis
44
Urate deposits in pinna and tendons called?
Tophi
45
Gout differentials
 Septic arthritis  Pseudogout  Haemarthrosis
46
Microscopy of gout aspirate?
Polarised light microscopy  Negatively birefringent needle-shaped crystals
47
Acute gout treatment? Pharmacological and conservative
NSAIDS- First Line Naproxen Elevate limb, cold compress, avoid trauma Second line Colchicine is on warfarin or heart failure or gastric issues or renal Very severe renal issue use steroids
48
How to introduce allopurinol?
Allopurinol  Use if recurrent attacks, tophi or renal stones  Introduce with NSAID or colchicine cover for 3/12 at least 2 weeks after acute attack
49
Polarized light microscopy shows Positively birefringent rhomboid-shaped crystals?
Pseudo gout
50
Xray pseudogout may show?
Chondrocalcinosis
51
Ankylosing spondylitis in who and when?
Males ore common 6 fold, late teens to early 20s 95% HLA B27 +ve
52
Features of Ankylosing spondylitis?
Radiates from SI joints to hips and buttocks Worse @ night morning stiffness Relieved by exercise. Progressive loss of all spinal movements Schober’s test \<5cm Some develop thoracic kyphosis and neck hyperextension = question mark posture Enthesitis: Achilles tendonitis, plantar fasciitis  Costochondritis
53
Extra-articular manifestations of ankylosing spondylitis?
Osteoporosis Iritis/Uveitis Fibrosis
54
Xrays of Ank Spon?
Sacroliliitis: irregularities, sclerosis, erosions Vertebra: corner erosions, squaring syndesmophytes (bony proliferations) Bamboo spine: calcification of ligaments, periosteal bone formation
55
What is shown?
Bamboo spine
56
What is shown?
Ank spon- squaring of vertebrae and loss of cancavity
57
Bloods in ank spon?
FBC (anaemia), ↑ESR, ↑CRP, HLA-B27
58
Ankylosing spondylitis initial treatment?
NSAIDS with PPI Coxibs have been used but questions rasied RE cardiac
59
Ankylosing spondylitis refractory to NSAIDs?
TNF alpha and continued NSAIDs
60
Features of psoriatic arthritis?
Psoriatic plaques  Nail changes  Pitting  Subungual hyperkeratosis  Onchyolysis  Enthesitis: Achilles tendonitis, plantar fasciitis  Dactylitis
61
Joint involvement psoriatic arthritis?
Asymmetrical oligoarthritis: 60% (commonest) Distal arthritis of the DIP joints: 15% (classical)
62
Pencil in cup sign?
Psoriatic arthritis due to erosion
63
Psoriatic arthritis treatment?
Similar to RA
64
Reactive arthritis symptoms and presentation?
Asymmetrical lower limb oligoarthritis: esp. knee Iritis, conjunctivitis Keratoderma blenorrhagica: plaques on soles/palms Circinate balanitis: painless serpiginous penile ulceration ↑ESR, ↑CRP Cant see cant pee cant climb a tree
65
Reactive arthritis reaction to what?
Urethritis (chlamydia) or dysentry
66
Treatment of Reactive arthritis?
NSAIDs steroids, may need dmards if relapse
67
What is enteropathic arthritis?
Assoc with IBD
68
Joint affected in enteropathic arthritis?
Asymmetrical large joints affecting lower limbs
69
What is shirmers test what is it used for?
Quantitatively measures tears. A filter paper is placed in the lower conjunctival sac. The test is positive if less than 5 mm of paper is wetted after 5 minutes.
70
Antibodies in sjogrens?
Anti ro and anti la
71
What is CREST syndrome?
Calcinosis Raynaud’s Esophageal and gut dysmotility → GOR Sclerodactyly Telangiectasia
72
Best diagnostic antibody SLE? Most Specific antibody for SLE?
ANA ~ 100% positive dsDNA
73
Antibodies in drug induced lupus? Which drugs?
Anti histone Phenytoin, Isoniazid, hydralazine
74
Treatment for many aspects of SLE?
Hydroxychloroquine Sun screen ACEi for nephro involvement High dose pred
75
Weak abduction of arm what nerve?
Axillary
76
Fracture of humerus what nerve and palsiy?
Radial wrist drop/waiters tip
77
Elbow dislocation nerve and sign?
Ulnar claw hand
78
Hip dislocation and fracture of fibular causes what palsy?
Foot drop
79
Monteggia fracture?
of proximal 3rd of ulna shaft § Anterior dislocation of radial head at capitellum § May → palsy of deep branch of radial nerve → weak finger extension but no sensory loss
80
Galleazzi fracture?
of radial shaft between mid and distal 3rds § Dislocation of distal radio-ulna joint
81
Colles fracture? Usual mechanism?
FOOSH Extra-articular # of dist. radius (w/i 1.5” of joint) Dorsal displacement of distal fragment Dinner fork deformity
82
Frozen Shoulder: Adhesive Capsulitis presentation?
Progressive ↓ active and passive ROM ↓ ext. rotation \<30degrees ↓ abduction \<90degree • Shoulder pain, esp. @ night (can’t lie on affected side)
83
Treatment of frozen shoulder?
Usually NSAIDS and physio ?steroid injection if bad
84
Impingement Syndrome / Painful Arc presentation? What is affected?
Entrapment of supraspinatus tendon and subacromial bursa between acromion and grater tuberosity of humerus. → subacromial bursitis and/or supraspinatous tendonitis Painful arc: 60-120º Weakness and ↓ ROM +ve Hawkin’s test
85
Where does a shoulder dislocate usually?
Anteriorly in 95%
86
Ottawa ankle rules?
Tenderness along distal 6cm of posterior tib / fib including posterior tip of the malleoli. Inability to bear weight both immediately and in ED Needs Xray if either
87
Most common cause of haemarthosis in trauma?
ACL injury
88
Lateral blow to the knee can give what?
Unhappy Triad Damage to: ACL MCL Medial Meniscus
89
Z score for osteoporosis?
90
Z score of -1 to -2.5 is what?
Ostepoaenia
91
Most important risk factor for the dveelopment of osteoporosis?
Steroids
92
Treatment of osteoporosis without assessment in who?
Women previous fragility fracture, and people over 70 taking steroids, but NICE reccomends assessment of people with risks for fragility
93
Offer a dual-energy X-ray absorptiometry (DXA) scan in?
Over 50 years of age with a history of fragility fracture. Younger than 40 years of age who have a major risk factor for fragility fracture
94
What to consider prescribing for \>50 taking high dose steroids \>7.5mg pred for 3 months
Bisphos- Alendronate or risendronate
95
Core symptoms of PMR?
Bilateral shoulder and/or pelvic girdle pain. Initially this may be unilateral but quickly becomes bilateral, is worse with movement, and interferes with sleep. Stiffness lasting for at least 45 minutes after waking or periods of rest that may cause the person to have difficulty turning over in bed SYSTEMIC- Low-grade fever, fatigue, anorexia, weight loss, and depression
96
Prednisilone dose for PMR ?
15mg for a week and assess response then continue until resolution then reduce
97
98
PMR age and duration?
\>50 at least 2 weeks of symptoms
99
Disorganised mosaic pattern of lamellar bone?
Pagets
100
Where is affected msot in pagets?
Most to least - spine, skull, pelvis and femur
101
Pagets blood tests?
Everything normal except ALP
102
Symptoms of pagets?
Typical asymptomatic or pain localised to bone with lesions, or fracture and or joint problem from bne remodelling
103
Xray change in pagets?
Sclerotic and lytic bone lesions
104
What is shown what blood test may be high?
Left pelvic pagets disease likely ↑raised ALP
105
Pagets treatment?
Bisphosphonates
106
Proximal muscle weakness and bone pain?
Osteomalacia
107
Diagnostic bloods for osteomalacia?
Low Vit D, Low or normal calcium, and elevated PTH ALP ↑
108
Drugs that cna cause osteamalacia?
Anticonvulsants
109
Antibody sensitive for SLE and antibody specific?
ANA sensitive, DsDNA specific and also anti smith
110
Most common joints affected for osteoarthritis?
Hips, knees and small bones of hand (thumb)
111
Limited cutaneous sclerosis features?
Calcinosis Raynauds Eosopahgeal dysmotility Sclerodactyly Telangectasia
112
What is this what syndrome associated?
Sclerodactyly- CREST limited cutaneous sclerosis
113
Which antibodies for CREST?
Anti centromere
114
What is subchonral sclerosis?
Thickening of bone (looks more white)
115
What are osteophytes?
Bone spurs coming off the bones

Finals (16 decks)

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