MSK Flashcards
(139 cards)
1
Q
Bony outgrowth with cartilagenous cap
Knee
A
Osteochondroma
Autosomal dominant
Most common
Excise
2
Q
Intramedullary, metaphyseal tumour
Lucent/sclerotic
Long and small tublar bones
A
Enchondroma
failure of ossification at growth plate
Curretage to treat
3
Q
Solitary unicystic growth
long bones
Fractures can occur
A
Curretage and bone graft
Possible stabilisation
4
Q
Lucent
Multiloculated cyst in medulla
Pain and fractures
A
Aneurysmal bone cyst
Curretage and cement
5
Q
Pain and fracture
lung mets
soap bubble appearance
A
Giant cell tumour
Translocation of 1 + 2
Excise and bone cement
Joint replacement
6
Q
Widened bone thin cortices
Stress fractures
‘Shepherds crook deformity’
A
Fibrous dysplasia
Fault in g protein signalling leading to immature bone
treat with bisphosphonates, fixation and remove it
7
Q
Pain worse at night and reieved by NSAIDs
X ray with sclerotic halo
A
Osteoid osteoma
leave alone/ablate/ en bloc excision
8
Q
Lytic lesion
History of subacute osteomyelitis
A
Brodies abscess
9
Q
Lytic lesions
history of hyperparathyroidism
A
Brown tumours
10
Q
Most common primary bone tumour
A
Osteosarcoma
Treat with chemotherapy
11
Q
Herringbone pattern
Abnormal bone pathology
Young
A
Fibrosarcoma
12
Q
Fever raised ESR Swelling Onion skin pattern Small blue round cell tumours
A
Ewings sarcoma
11:22 translocation on Ch22
Give chemo and raddiotherapy
13
Q
what test shows multiple myeloma
A
Bence Jones
Trat with chemo
14
Q
Where do bone mets go?
A
Prostate (blastic) Breast (mixed) Kidney (lytic) Thryoid (lytic) Lungs (lytic)
15
Q
Sagging rope sign
History of clotting
A
AVN
Precollapse: Drill to get blood flowing
Collapse: Replacement
16
Q
Distinguish osteoporosis, osteomalacia and pagets
A
OP: >2.5 decrease in bone density and normal biochemistry
OM: <2.5 decrease, pseudofractures, low Ca2+ and PO
P: Raised ALP, thickened bone cortices
17
Q
overcontracted muscle
Anti K+ antibodies
A
Neuromyotonia
Anticonvulsants
18
Q
Muscle weakness due to Ca2+ antibodies
A
LE myasthenic syndrome
Anticholinesterases and K blockers
19
Q
Progressive eye and muscle weakness
A
Anticholinesterases
Immunosuppressants
20
Q
Joint pain
DIP and PIP
<1hr + worsens activity
LOSS on X ray
A
OA Lifestyle NSAIDS IA steroids Joint replacement
21
Q
Joint pain PIP and MCP C1 C2 involvement stiffness >1hr and eases on activity Anti CCP and RF
A
RA Investigate with MRI 1. MTX + steroid 2. + SFZ/HCQ 3. + TNFi
22
Q
Male
Reduced lordosis and increased kyphosis
Bamboo spine
A
Ank spond
Schober’s +ve
23
Q
Nail changes
Psoriasis
‘pencil in cup’ X ray
A
Psoriatic arthritis
24
Q
Arthritis and IBD features
A
Enteropathic
25
3 weeks after infection
| Clear joint aspirate
Reactive arthritis
26
```
Butterfly rash
Arthritis
Systemic problems
Anti-dsDNA
Anti-sm
C2/4 low
```
SLE
27
Dryness of mucosa
Ant-Ro/La
T cells on biopsy
Sjogrens
| give pilocarpine for dryness
28
CREST syndrome
| can be limited to distal skin or spread to trunk
Systemic sclerosis
Limited: centromere
Diffuse: anti-scl-70
29
Systemic symptoms
| Anti-RNP
MCTD
30
Young stroke
Miscarriages
Prolonged APTT
Anticardiolpin
APLS
| Anticoag
31
Muscle STIFFNESS
Shoulder and girdle
Spreads from one side to the other
Polymylagia rheumatica
Normal CK
Resposnds to low dose steroids
32
Steroids for GCA
40mg if no visual
| 60mg if yes
33
```
Muscle WEAKNESS
10x CK
Anti-Jo SRP
V shaped rash
Gottrons papules
Heliotrope rash
```
Myositis
Treatment:
40mg prednisilone
Immunosuppressants
34
>50
| polymyalgia rheumatica
GCA
35
<50s
| Asian woman
Takayasu
36
'String of beads'
Blood clots
Gi and renal inolvement
Pa
37
Neck stiffness that radiates to shoulders
| Occurs over time
Cervical spondylosis
conservative
Dcompression if upper limb symptoms
38
Shooting dermatomal pain
Poor reflexes
Weakness
Cervical disc prolapse
do MRI
Conservative and surgery
39
Downs/RA patients
Abnormal neck movements
Upper MN signs
```
C spine instablity
Flexion/extension
Treatment:
Collar if moderate
Fusion if severe
```
40
RA, diabetes, CKD, colles fracture
altered sensation in thumb and radial fingers
Muscle wasting at thumb
worse at night
Carpal tunnel syndrome
Wrist splint
Steroids
41
Ulnar 2.5 fingers
Tinels test
Frontmants
Cubital tunnel
| Decompress
42
Intervertebral discs are
2ndary catilagenous
43
Lumbar puncture is at
Post iliac crest L4, PSIS S2
44
Red flags for back pain
<20
>60 new onset
Constant severe pain
Systemic upset
45
Heavy lifting
Severe back pain on coughing
Neuropathic pain/weakness
Acute disc tear
Conservative
Surgery
46
Over 60
Claudicaton thats better on hill walking
Osteophytes on x ray
Spinal stenosis
| Analgesia and physio
47
Back pain that worsens on activity
| No neuro symptoms
Mechanical back pain
analgesia and physio
surgery if instable
48
Bruning pain in thigh and knee
Stretching knee recreates pain
crossover sign positive
Sciatica
Analgesia
Neuropathic meds
Surgery if severe
49
How is a crush fracture treated
Balloon vertebroplasty
50
Numb saddle area
Bilateral leg pain
Incontinence
Cauda equina syndrome
PR
MRI
Discectomy
51
frontal spinal fracture with ripped back
Chance
52
Distal radius fracture with volar displacement
Smiths
53
Bimalleolar fracture
Potts
54
Comprression fracture in osteoporosis
Wedge
55
Extreme trauma causing multiple fractures
Burst
56
Childhood fractures
Blue sclera
Hearing loss
Osteogenesis imperfecta
| Stablise with IM
57
odd limbs
big forehead
bendy joints
Achondroplasia
Surgical correction
GH therapy
58
outline normal lower limb developement
varus at birth
valgus
reduced valgus
59
Internal rotation of humerus
| Waiters tip
```
Erbs palsy (C5,6)
Physio and surgery
```
60
horners syndome
| internally rotated hand
Klumpkes palsy
| c8 t1
61
Flat feet
| Jacks test positive
Pathological flat feet
62
Breech birth, Downs girl
Skin creases
Shortened limb
+ve ortolani and bartlows
DDH
Observe
> 3months: pavlik/ reduce/dye manipulate
63
young boys with URTI
slow onset of hip pain
US shows effusion
TTSH
X ray to exclude perthes
Drain and NSAIDs
64
Pain in knee and groin
loss of interna roatation and abduction
flattened femoral head on x ray
Perthes (AVN of femoral head)
| Osteotomy of acetabulum and femur
65
Young sporty overweight boys
loss of internal rotation and knee pain
inferior slipping of femoral head
SUFE
confirm with lateral X ray
Pin head to stop movement
66
Clubfoot is treated with
Ponsetti method
67
Incomplete fracture following compression
Buckle
| 3-4 weeks splintage
68
Distal radius
Broken on one side
Bent on other
Greenstick
| Manipulate and cast
69
Forearm fracture
ulnar break
Radial dislocation
Montaggia
| Reduce and screw/plate fixate
70
Forearm fracture
Radial break
Ulnar dislocation
Galeazzi
| Reduce and screw/plate fixate
71
supracondylar fracture of elbow
mild: reduce and wire fixate
Severe: Open reduction
MEDIAN NERVE
BRACHIAL ARTERY
72
Fall onto flexed kee
Femoral shaft fracture
How to manage?
<2: gallows and hip spica
2-6: thomas splint + hip spica
6-12: flexible IM
12+: IM
73
Hanging rope sign on X ray
Patchy sclerosis
Groin pain
AVN
drill pre-collapse
THR if collapse
74
Resisted abduction causes pain
Trochanteric bursitis
| Supportive and physio
75
Altered morphology of hip
| grips hip with a C sign
hip impingement
Cam surgery
pincerc: osteotomy
76
Twisting on loaded knee
Effusion and joint line tendernes in knee
+ve steinmans
May lock
Meniscal tear
Suture if young and longituindal outer 3rd
Menisectomy if not
77
Lateral turn on planted foot
Pop and rapid effusion in knee
Instability
+ve anterior drawer test
ACL rupture
| Primary repair or reconstruction
78
Direct blow to front of knee
| Posterior drawer test
PCL rupture
79
varum blow that causes valgus pain when re-created
MCL tear
Hinged knee brace
Tightening/graft construction
80
valgus blow that causes varus pain when recreated
LCL injury
Repair/reconstruct
COMMON FIBULAR NERVE AT RISK
81
Rapid contraction leading to either high or low patella
| Palpable gap in extensor mechanism
Extensor mechanism rupture
PTR: young
QTR: old
Tendon-tendon repair
82
Anterior knee pain
Worse downhill
grinds and clicks
PF disfunction
Physio
Release
83
Pain and effusion in knee follwoing shearing injury
Osteochondral injury
| Fibrocartilage/drilling
84
Blow to knee causing lateral disloaction of patella
| lipohaemarthrosis may be seen
Patellar instability
| Straighten leg and manipulate
85
Solider/athelete experiencing pain in 2/3 metatarsal after training
X ray after 3 weeks shows callus
Stress fracture
| 6-12 weeks rigid soled boot
86
Medial arch loss and valgus heel
Tibialis posterior dysfunction
Splint with medial arch support
Decompression
Arthrodesis if severe
87
Poor alignment of big toe causing ulcers
Hallux valgus
Wide shoes and spacer
Surgery if symptomatic
88
OA of 1 MTP
Hallux rigidus
| Stiff soles/arthrodesis
89
Burning in sole between 2/3 digital nerves
| Clicking on mediolateral compression w US confirms
Morton's neuroma
Conservative
Excise if not
90
Popping at ankle during sport
| +ve simmonds test
Achlles tendon rupture
| Suture/equinous cast
91
Pain on instep when walking
Plantar fasciitis
stretching exercises
Gel heel pad + steroids
PLANTAR NERVE INJURIES
92
```
Diabetic presents with
Swelling
Loss of sensation
Joint deformity
X ray shows fucked swollen foot
```
Charcot's foot
Assess vasculature
infection
Amputate
93
What can be damaged in a pelvic fracture?
Internal iliac and venous plexus
| Lumbosacral pleus nerves
94
Open book fractures are dangerous as?
Increased volume for bleeding
95
RTA with kness hitting dashboard
| Damage to posterior wall o acetabulum
Acetabular fracture
Conservative
Reduce and fixate if young
THR i old
96
Fracture within capsule
Intracapsular
| femoral head replacment/THR
97
Fracture outwidth capsule
Extracapsualr
| internal fixation
98
Fracture below trochater after a fall
Subtrochanteric fracture
| IM nail
99
High energy injury
| Blood loss and fat embolus
```
Femoral shaft frature
Resuscitate
femoral nerve block
Thomas splint
IM nail/plate fixate
```
100
hyperextension/rotation leading to knee instability
Knee dislocation
Reduce revascularise
Fixate reconstruct
101
What nerves are at risk in a proximal tibia fracture
Fibular if valgus
| Peroneal if varus
102
Proximal tibial fracture managemnt
```
reduce surface
rigid fixation (plate and screw)
```
103
Tibial shaft fracutre managemnt
Conservative
Above knee cast
Internal fixation
104
Distal tibial fractures
pilon fracture
External fixation when swollen
Interal fixation if not
105
Ankle injury
ORIF
106
Talar fractures
closed reduction with screw fixation
107
Metatarsal fracture
Stout boot
| K wires
108
Toe fracture
Stout boot
| fixate
109
Shoulder pain that radiates to deltoid and upper arm
| Pain on abduction and internal rotation
Impingement
Supportive
Steroid injection
110
Weak abduction of shoulder
| Rotational movement causes pain
Rotator cuff tear
| Physio, steroids and surgery
111
Pain for 6-9 months in shoulder followed by stiffness
Adhesive caspulitis
| Physio, steroids, surgery
112
Shoulder pain
| X ray shows calcific deposits
Acute calcific tendotinits
| Steroids and anaesthetic
113
Feeling of shoulder going to dislocate
| Sulcus signs
Instability of shoulder
| Traumatic + anterior: Bankart repair
114
Deltoid labrum tears
MRI arthrogram
| biceps tenotomy, resection or repair
115
Painful lateral epicondyle
| Pain on extension of middle finger and wrist
Lateral epicondylitis
| Rest, steroids, brace
116
Painful medial epicondyle
Medial epicondylitis
| Dont inject steroids due to ulnar nerve
117
Ulnar finger tingling
| Tinels and frontmans test +ve
Cubital tunnel syndrome
| Release
118
Tinging in radial fingers
Worse at night
loss of thumb sensation
tinels and phalens test
Carpal tunnel syndrome
Splints + steroids
Decompress flexor retinaculum
119
Trigger finger
A1 pulley division
120
medial displacement of humeral neck due to fracture
sling if minimal
internally fixate if moderate
Replace shoulder if fucked
121
Loss of symmetry and internal rotation i humerus
May see hill sacks lesion
NUMB REG BADGE AREA
humeral fractures
Closed reduction and sling
Bankart repair if recurrent
122
Acromioclavicular injury
Sling and physio
123
Humeral shaft fracture
| RADIAL NERVE INJURY
RADIAL NERVE INJURY MAY OCCUR BTW
| Humeral brace and IM nail
124
Distal humerus fracture/olecranon fossa
Tension band wiring
| ORIF
125
Lateral elbow pain and twisting of forearm
Full extension of arm not possible
Fat pad sign on X ray
Radial head and neck fracture
Sling and physio
ORIF if displaced
126
Posterior damage to elbow after FOOSH
| Probable NV injury
closed reduciton
ORIF if complicated
Replacement if recurrent
127
Ulnar fracture
Nightstick fracture
| Check radial head for monteggia
128
Both forearm fracture
Child: plaster cast
Adult: ORIF
129
Fracture to radial head and dislocation of ulna
Galeazzi
| ORIF
130
Ulnar fracture and radial dislocation
Montaggia
| ORIF
131
Dorsal displacement of radius with MEDIAN NERVE COMPRESSION
Colles
| ORIF
132
Volar displacemetnt of distal radius
Smiths fracture
| ORIF
133
Intrarticular fracture of distal radius
ORIF
| Bartons
134
Tender anatomical snuffbox
| RADIAL ARTERY AND NERVE DAMAGE
Scaphoid
cast if undisplaced
Displaced: Compression screw
135
penetrating hand injuries
Volar: Flexors digital nerve and arteries at risk
Dorsal: extensor
Surgical repair
136
Staving injury leads to DIPJ injury
Mallet flinger
| Mallet splint
137
Flexor tendon injuries
Explore, smooth repair
138
Metacarpal injuries
Usually 5th broken with fight bite
| Infection
139
Phalangeal injuries
Splint and k wiring if displaced
