MSK Core Conditions Flashcards by Amy Spicer

What are the causes of cellulitis?

Beta haemolytic Strep
Staph Aureus
ImmunoC: Pseudomonas, Cryptococcus, Pasteurella

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What is the pathophysiology of cellulitis?

Micro-organisms gain entry to dermal & subcutaneous tissue via disrupted cutaneous barrier

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What are the signs & symptoms of cellulitis?

Macular erythema with indistinct borders

Raised erythema w/clearly demarcated margins- ERYSIPELAS

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How is cellulitis investigated?

Bloods: FBC, WCC
Blood culture: Growth of typical pathogen
Purulent focus culture

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What is the management of cellulitis?

Severe: Admit, IV Vancomycin
Upper/lower limb: Flucloxacillin
Orbital: Vancomycin &amp; Ceftriaxone
Diabetic foot: Amoxicillin &amp; Doxycycline
Animal Bite: Amoxicillin/ Trimethoprim
Frequent relapse: Phenoxymethylpenicillin
MRSA cause: Vancomycin
Pseudomonas cause: Ceftazidime

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What are the causes of septic arthritis?

Staph Aureus
Prosthetic joint infection 
TB &amp; Anaerobic organisms
N. Gonorrhoeae
H. Influenzae- kids

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What are the RFs for septic arthritis?

Age
DM
Prior joint damage
Hip/knee prosthesis
Immunodeficiency
Prev joint surgery 
IVDU
Alcoholism

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What are the signs & symptoms of septic arthritis?

Unilateral single swollen red warm tender joint 
Pain on passive &amp; active movement
Held immobile by muscle spasm
Fever &amp; rigors
Bacteraemia
Neutrophil leukocytosis

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Which joint is the most commonly affected in septic arthritis?

Knee

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How is septic arthritis investigated?

Aspirate joint: Gram staining & culture
Blood Cultures: AT LEAST 2Anti-Streptolysin O titre: Group A strep infection
Leucocytosis
Bloods: CRP, Synovial WCC, Lactate
CT & MRI
Radionuclide scans

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How is septic arthritis managed?

Joint immobilisation
Abx: Flucloxacillin 4-6weeks
MRSA suspected: Vancomycin
Gonococcal suspected: Cefotaxime
Aspirate
Prosthesis: Remove &amp; fill joint space with Abx (Teicoplanin) for 3-6weeks

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Why is it important to treat septic arthritis as soon as possible?

Joint destruction can occur in 24hours

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What are the risk factors for a fractured NOF

Age
Bone disorder: Osteoporosis
Trauma
Bone metastases

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What are the different types of hip fractures?

Intracapsular: Subcapital, transcervical
Extracapsular: Trochanteric, subtrochanteric, transtrochanteric

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What are the signs & symptoms of a femoral fracture?

Shortened
Externally rotated
15% no deformity

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What are the complications of femoral fractures?

Avascular necrosis

Non-union in intracapsular fractures

How are femoral fractures investigated?

X-ray: AP & Lateral Pelvis
ECG
Bloods: FBC, U&E, G&S

What are the radiological signs of a hip fracture?

Shentons Line: Line from inf neck of femur to inf superior pubic ramus

What is the management of a hip fracture?

IV opiate/ local nerve block
Avoid NSAIDs
Thromboprophylaxis: LWMH (Stop 12hours before surgery)
Conservative
Surgery: Internal fixation, arthroplasty, hip screws within ?24-48hours

What are the types of shoulder dislocations? How do they occur?

90% ANTERIOR
Anterior/inferior: Forced external rotation of upper limb
Posterior: Forced internal rotation & adduction

What is the management of a shoulder dislocation?

Entonox
Reduction
Immobilise for 3weeks
Surgery: Arthroplasty

What are the signs & symptoms of a shoulder dislocation?

A: Externally rotated, abduction
P: Internally rotated, adduction, cannot be externally rotated
I: Fully abducted, elbow flexed/behind head
Swelling
Pain & tenderness

What are the red flag symptoms of back pain?

Non-mechanical pain (unrelated to time/activity) esp if constant & worsening at night
Thoracic pain
Prev carcinoma, steroids, HIV
Fever, night sweats, weight loss
Structural spinal deformity
Widespread neuro signs (sphincter disturbance)

What are signs of spinal cord involvement and not just nerve root problems in back pain?

Unilateral muscle weakness

Contralateral sensory changes

What are the different causes of back pain?

Structural: Prolapse, spinal stenosis, mechanical, spondylosis Ca: Multiple myeloma, mets Referred Infection: Osteomyelitis, paraspinal abscess Inflammation Metabolic: Pagets, hyperPT, osteomalacia

What are the signs & symptoms of cauda equina?

``` Acute lower back pain Radiation to legs Lower lib weakness Altered sacral & perineal sensation Altered bowels/bladder ```

What are the investigations for cauda equina?

MRI

How is cauda equina treated?

Surgery within 24hours of bladder symptoms

What signs & symptoms are suggestive of malignant back pain?

``` Pain in thoracic/cervical spine Progressive lumbar pain Severe unremitting pain Localised tenderness Pain worse on straining (cough, sneeze, stools) Nocturnal pain ```

How is back pain investigated?

Majority no investigations | Red flags/?CE: Urgent MRI

How is back pain managed?

Analgesia: NSAIDs Muscle relaxants Stay active (Physio) Sciatica: Epidural injection

What are the Ottawa rules for an ankle injury?

Pain in the malleolar zone and: Tenderness at the post edge/tip of the lateral malleolus (A) OR Tenderness at the post edge/tip of the medial malleolus (B) OR Inability to bear weight both immediately & ED for 4 steps

What is the most common type of distal radial fracture?

Colles

What are the main causes of a radial fracture?

FOOSH/FOpronated wrist Direct blow Stress fractures: Primarily in athletes putting repetitive load on bones with high forces

What are the cancer related red flags for back pain?

``` Hx of cancer Unexplained weight loss >10kg in 6months >50yo, <18yo Failure to improve w/therapy Pain persists for >4-6weeks Night or rest pain ```

What are the Ottawa rules for an foot injury?

X-Ray series required if there is any pain the midfoot zone and: Tenderness at the base of the 5th metatarsal (C) OR Bone tenderness at the navicular (D) AND Inability to bear weight both immediately & ED for 4 steps