Musculoskeletal Flashcards
(116 cards)
1
Q
On what movement does subacromial impingement cause pain?
A
Shoulder abduction, between 60 and 120 degrees
2
Q
What feature of ank spond might distinguish it from other pathology?
A
Pain at night that improves on getting up
3
Q
What is an intracapsular fracture?
A
From the edge of the femoral head to the insertion of the capsule of the hip joint
4
Q
What is an extracapsular fracture?
A
Either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)
5
Q
What is a Garden system type I fracture?
A
Stable fracture with impaction in valgus
6
Q
What is a Garden system type II fracture?
A
Complete fracture but undisplaced
7
Q
What is a Garden system type III fracture?
A
Displaced fracture, usually rotated and angulated, but still has boney contact
8
Q
What is a Garden system type IV fracture?
A
Complete boney disruption
9
Q
What is a heliotrope rash?
A
A purplish rash to the eye lids seen in dermatomyositis
10
Q
What are Gottron’s papules?
A
Roughened red papules over the extensor surfaces of the fingers seen in dermatomyositis
11
Q
What are the Ottawa Rules for ankle x-rays?
A
Pain in the malleolar zone plus any one of the following:
Bony tenderness at the lateral malleolar zone
Bony tenderness at the medial malleolar zone
Inability to walk four weight bearing steps immediately after the injury and in the ED
12
Q
What skin change is most associated with antiphospholipid syndrome?
A
Livedo reticularis
13
Q
Which organism is most commonly indicated in discitis?
A
S aureus
14
Q
For how many months must symptoms persist to be termed chronic fatigue?
A
4 months
15
Q
How should polymyalgia rheumatica (PMR) be treated?
A
Steroids - should be a rapid improvement in symptoms (within a week) - failure to respond rapidly should result i in considerations of alternative diagnoses
16
Q
How raised is ESR in PMR?
A
> 40
17
Q
When in pain elicited most in lateral epicondylitis?
A
Resisted wrist extension/supination whilst elbow extended
18
Q
What is lateral epicondylitis also known as?
A
Tennis elbow
19
Q
When in pain elicited most in medial epicondylitis?
A
Pain is elicited during wrist flexion and pronation
20
Q
What is medial epicondylitis also known as?
A
Golfer’s elbow
21
Q
What are the conditions where doctors should offer immediate bone protection on commencement of long-term steroids?
A
Pt >65, or those that have previously suffered fractures - offer alendronate and ensure calcium and vitamin D replete
Pt’s <65 should be offered a bone density scan instead
22
Q
How should you manage a pt according to their T-score in bone density scanning?
A
> 0 = reassure
0 - -1.5 = repeat scan in 1-3 years
< -1.5 = offer bone protection
23
Q
What proportion of talipes is bilateral?
A
50%
24
Q
Using the Ponseti method, after how long is talipes usually corrected after birth?
A
6-10 weeks
25
For how long should night-time braces be worn by children with talipes?
Up to the age of 4
26
What is the most common cause of talipes?
Idiopathic
27
What is the main S/E of colchicine?
Diarrhoea
28
What is the pathopneumonic feature of pseduogout?
Chrondrocalcinosis on XR - presents as 'linear calcifications of the articular cartilage'
29
What are the RFs for the development of pseudogout at <50 y/o?
```
Haemochromatosis
Hyperparathyroidism
Low magnesium, low phosphate
Acromegaly
Wilson's disease
```
30
What type of crystals are deposited in the synovium in pseudogout?
Calcium pyrophosphate crystals
31
What are type I hypersensitivity reactions?
Anaphylaxis - antigen reacts with IgE bound to mast cells
32
What are type II hypersensitivity reactions?
Cell bound - IgG or OgM binds to antigen on cell surface
33
What are type III hypersensitivity reactions?
Immune complex - free antigen and antibody combine
34
What are type IV hypersensitivity reactions?
Delayed hypersensitivity - T-cell mediated
35
Graves disease and MG are examples of which type of hypersensitivity reaction?
Type V
36
What are the 4 features of osteoarthritis on XR?
Decrease of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes forming at joint margins
37
What is meralgia parasthetica caused by?
Lateral cutaneous nerve of thigh compression
38
What are myxoid cysts?
Also known as mucous cysts, they are benign ganglion cysts usually found on the distal, dorsal aspect of the finger. There is usually osteoarthritis in the surrounding joint
39
What anti-rheumatic drug should be avoided in pt's with aspirin allergy?
Sulphasalazine
40
What is the risk associated with a scaphoid fracture?
Risk of avascular necrosis due to the blood supply to the scaphoid bone
41
What are the poor prognostic features of RA?
```
Rheumatoid factor positive
Anti-CCP antibodies
Poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
Extra articular features e.g. nodules
HLA DR4
iInsidious onset
```
42
What is tested for McMurray's Test?
Meniscal tears
43
What can alendronate be switched for when significant upper GI side effects are experienced?
Risedronate or etidronate
44
Which test may be positive in referred lumbar spine pain?
Femoral nerve stretch test may be positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped
45
What are the red flags for back pain?
```
Age < 20 years or > 50 years
History of previous malignancy
Night pain
History of trauma
Systemically unwell e.g. weight loss, fever
```
46
How is the femoral head epiphysis displaced in SUFE?
Postero-inferiorly
47
What is the most common cause of posterior heel pain?
Achilles tendon disorders
48
What are the features of ank spond?
The A's =
1. Apical fibrosis
2. Anterior uveitis
3. Aortic regurgitation
4. Achilles tendonitis
5. AV node block
6. Amyloidosis
49
What are common features of meniscal tears?
Knee locking and feeling of 'giving way'
50
What are the classical features of untreated Paget's disease of the bone?
Bowing of tibia
| Bossing of skull
51
What is meant by 'Finkelstein test positive'?
Pain over her radial styloid on forced abduction/flexion of the thumb
52
In what condition is Finkelstein test positive?
De Quervain's tenosynovitis
53
When does chondromalacia patellae (patellofemoral pain syndrome) classically cause pain?
Anterior knee pain on walking up and down stairs and rising from prolonged sitting.
54
Is azathioprine safe in pregnancy?
Yes
55
What is the classical description of pain in iliotibial band syndrome?
Tenderness 2-3cm above the lateral joint line
56
What are the most common causes of drug-induced lupus?
Procainamide
| Hydralazine
57
How is Paget's disease of the bone treated?
Bisphosphonates - e.g. alendronate
58
What should be done with regard to allopurinol prophylaxis in acute gout flares?
Allopurinol should be continued at normal dose during a gout flare
59
Within what age range is the FRAX tool valid?
Age 40-90 years old
60
What are the conditions for which NICE recommends a DEXA scan rather than clinical risk score?
1. Before starting treatments that may have a rapid adverse effect on bone density
2. In people <40 y/o who have a major risk factor, such as history of multiple fragility fracture, major osteoporotic fracture, or current or recent use of high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer)
61
Which nerve root compressions will result in a positive femoral stretch test?
L3 or L4
62
Which nerve root compression will result in a positive sciatic nerve stretch test?
L5 or S1
63
What is a flattened deltoid as a result of?
Axillary nerve damage - C5-C6 - may occur as a result of a humeral neck fracture or dislocation
64
What does radial nerve palsy result in?
Wrist drop (radial nerve = C5-C8) - may occur as a result of a humeral mid-shaft fracture
65
Damage to what may result in carpel tunnel syndrome?
Median nerve - C6, C8, T1
66
What is 'claw hand' as a result of?
Damage to the ulnar nerve - C8, T1 - may occur as a result of medial epicondyle fracture
67
What is 'winged scapula' as a result of?
Long thoracic nerve - C5-C7 - may occur during sport (e.g. following a blow to the ribs), or as a complication of mastectomy
68
What is 'waiter's tip' as a result of?
Erb-Duchenne palsy - damage to C5-C6 of the brachial plexus, may be secondary to shoulder dystocia during birth
69
What is Klumpke injury as a result of?
Due to damage of the lower trunk of the brachial plexus - C8, T1 - may be secondary to shoulder dystocia or a sudden upward movement of the hand. It is associated with Horner's syndrome
70
What are the XR changes seen in rheumatoid arthritis?
Early findings:
1. Loss of joint space
2. Juxta-articular osteoporosis
3. Soft-tissue swelling
Late findings:
1. Periarticular erosions
2. Subluxation
71
Which drugs can precipitate gout?
```
Thiazides
Furosemide
Ciclosporin
Alcohol
Cytotoxic agents
Pyrazinamide
Aspirin
```
72
What should be tested for before prescribing azathioprine?
Thiopurine methyltransferase (TPMT) - deficiency in this can lead to myelosuppression, and thus predict pt's whom are at increased risk of azathioprine toxicity
73
What is the most common responsible organism for osteomyelitis in most patients?
S. aureus
74
What is the most common responsible organism for osteomyelitis in sickle cell patients?
Salmonella
75
What is the most common reason total hip replacements need revision?
Aseptic loosening
76
What scale is used to measure disease activity in rheumatoid arthritis?
DAS28
77
How can you differentiate between acute compartment syndrome and a DVT?
Acute compartment syndrome = pain rapidly increases - 'out-of-proportion' - and pain on passive extension. Pain on passive dorsiflexion is Homan's sign and more indicative of DVT
78
Where in the world is Bechet's disease more common?
Turkey, Iran and Japan
79
What is mononeuritis multiplex?
A neuropathy of two or more non-anatomically related peripheral nerves - diabetes and RA are a common cause - most cases result in full spontaneous recovery in 3-6 months
80
When should prophylactic treatment be started in relation to an acute attack of gout?
1-2 weeks or it can exacerbate the acute episode
81
Which test will be positive in De Quervain's tenosynovitis?
Finkelstein's test (resisted abduction to the thumb is painful in a +ve test)
82
Which nerve is at risk in an anterior shoulder dislocation?
Axillary nerve - damage results in decreased sensation over the deltoid muscle and weakness
83
How may cluster headaches be treated acutely?
Intranasal sumitriptan
| Home oxygen - not suitable for smokers
84
What type of fracture occurs in children as a result of FOOSH?
Supracondylar fracture of humerus
85
Which autoantibodies are associated with SLE?
```
ANA
Anti-dsDNA
Anti-Ro
Anti-Sm
Anti-La
```
86
Which autoantibodies are associated with systemic sclerosis?
```
ACA
Anti-ScL-70
Anti-RNA polymerase
ANA - 95%
RhF - 30%
```
87
How do you manage an undisplaced intracapsular fracture?
Cannulated screw or replacement (preferred)
88
How do you manage a displaced intracapsular fracture?
Hemiarthropathy or THR
89
How do you manage an extracapsular fracture?
Cannulated screw
90
How do you manage an extracapsular fracture that is either peritrochanteric or intertrochanteric?
Dynamic Hip Screw
91
What is the name of a long-standing ulcer in which an SCC is found?
Marjolin's ulcer
92
Does a negative temporal artery biopsy exclude GCA? And why?
No, because skip lesions are common
93
How do patient's present with patella dislocation?
Knee held in flexion, patella laterally dislocated, usually teenage girls
94
What are gout deposits made up of?
Monosodium urate
95
How do gout crystals appear?
Needle-shaped negatively birefringent crystals
96
Which autoantibody has 95% sensitivity for SLE?
ANA
97
When would Simmonds test (for Achilles tendon rupture) be considered positive?
Absence of normal plantar flexion on squeezing the calf muscle indicates a complete tendon rupture
98
How would you investigate an Achilles Tendon Rupture?
USS (MRI if the diagnosis were unclear, e.g. Simmonds test wasn't positive)
99
What type of fracture causes a dinner-fork deformity?
Colles' fracture (of the wrist)
100
What is Gamekeepers Thumb also known as?
Skiers Thumb
101
What types of fracture might result from a FOOSH (wrist in flexion)?
Falling on the hand outward = Colles' (of the wrist)
| Falling on the hand inward = Smith's fracture (of the wrist)
102
What is the most prevalent finger tendon injury in sport?
Mallet finger
103
What is the most common type of metacarpal fracture?
Boxer's fracture
104
Should glucosamine and/or chondroitin supplements be used in OA?
No
105
What is the most common type of shoulder dislocation?
Anterior - 95% of the time
106
How does an anterior shoulder dislocation appear on XR?
AP XR - humeral head lies under the coracoid process
107
What is spondylolisthesis?
Slippage of a vertebrae, usually forward, relative to the vertebrae below?
108
What injury tends to occur in children when they FOOSH?
Supracondylar fracture (BE AWARE OF NEUROVASCULAR STATUS)
109
What posture may people with ank spond presnt with?
Question-mark posture
110
What is Mondor sign? And what is it pathognomonic for?
= bruising that tracts distally to the sole of the foot. Sign of calcaneal fracture
111
What is CREST syndrome also called?
Limited cutaneous systemic sclerosis
112
Which autoantibodies are are associated with CREST syndrome?
Anti-nuclear and anti-centromere antibodies
113
Which auto-antibody is most specific for RA?
Anti-CPP
114
What is Lachman's test testing for?
Anterior cruciate ligament (ACL) injury of the knee
115
What is a bumper fracture also known as?
Tibial plateau fracture
116
What is a common complication of a scaphoid fracture?
Avascular necrosis
