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GP FELLOWSHIP RNZGP > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

(68 cards)

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1
Q

Mortons neuroma clinical sign

A

Mulder’s sign

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2
Q

Pagets investigations

A

ALP
P1NP (bone specific ALP)
Xray

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3
Q

Treatment of Paget’s

A

Bisphosphonates:
Zoledronic acid the best

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4
Q

Clinical features of Paget’s

A

Skull enlargement: Headache, hat size increase, facial appearance change

Fractures

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5
Q

Risk factors for osteoporosis (in >60 men or >50 for women)

A
  • Smoking
  • etOH >4std /day
  • family hx fracture
  • Vit D deficiency
  • BMI <20
  • recurrent falls
  • immobility
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6
Q

Causes of secondary osteoporosis

A
  • Corticosteroid use (7.5mg for 3 months)
  • Endocrine conditions: hypogonadism, cushings, hyperparathyroidism, hyperthyroidism)
  • premature menopause
  • AN with amenorrhoea >12 months
  • RA
  • CKD, CLD
  • Coeliac
  • DM (1 or 2)
  • MM or MGUS
  • HIV
  • Medications: anti-epileptics, anti-rejection therapy, aromatase inhibitors, anti-androgens, excessive thyroxine
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7
Q

Saturday night palsy approach

A
  • Nerve conduction studies
  • Physiotherapy

Mean recover 3-4 months

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8
Q

Radial nerve clinical exam

A

Wrist and finger extension
THUMBS UP

Sensation:
Webspace - 1st dorsal

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9
Q

Median nerve clinical exam

A

Pincer function
“A OK sign “

Senation: index finger volar tip

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10
Q

Ulnar nerve clinical exam

A

Finger adduction and abduction

Sensation: Little finger volar tip

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11
Q

Restless leg syndrome history questions

A

Restless legs character ‘URGE’
- Urge to move
- Rest induces symptoms
- Gets better with activity
- Evening worse

Rule out other causes
- Cramps
- Restlessness during the day (akathisia)
- Pain on exertion (PVD)
- Numbness

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12
Q

Medications that worsen restless legs

A
  • Sedating antihistamines
  • Metaclopramide (dopamine agonist)
  • Mirtazepine
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13
Q

Tests for restless legs

A

EUC
B12 - peripheral neuropathy
Iron - associated with RLS
Hba1c
FBC - anaemia may contribute

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14
Q

Treatment for restless leg syndrome (non pharmacological)

A

Distracting activities (crosswords)
Regular exercise (30mins/day)
Stretching
Keep legs cooler than rest of body
No caffeine
No etOH

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15
Q

Rest less legs treatment (pharmacological)

A

MILD
Levodopa & Benserzide (100mg /25mg) nocte

SEVERE
Pregabalin 75mg nocte
or
Gabapentin 100mg
or
Pramipexole 0.125mg (not in risk of gambling, addicts)

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16
Q

Special tests for ankle injury

A

Positive anterior drawer test: ruptured ATFL

Lateral talar tilt test: ruptured ATFL and CFL

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17
Q

Name these fractures (hint: first one fine)

A
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18
Q

Jone’s fracture: where and management

A
  • 5th metatarsal (proximal diaphyseal region)
  • Surgical due to risk of malunion
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19
Q

Plantar fasciitis management

A
  • Rest
  • Simple analgesia
  • Ice after activity
  • Stretches: soleus, gastroc & achilles
  • Podiatry referral
    –> then cortisone injection
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20
Q

Differentials for plantar fasciitis/heel pain

A
  • Calcaneal (specify which side) stress fracture
  • Calcaneal fat pad syndrome/atrophy
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21
Q

Posterior heel pain differentials

A
  • Achilles tendinitis
  • Retrocalcaneal bursitis
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22
Q

Age for perthes

A

3-12 yrs old

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23
Q

Type of imaging for suspected spinal epidural abscess

A

MRI with gadolinium contrast

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24
Q

Paediatric proximal humeral fracture indications for ORIF

A

<12 yrs old:
60 deg angulation
50% displacement

> 12
30 deg angulation
30 % displacement

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25
Wrist extension and finger: which nerve
Radial
26
Risk factors for SUFE
- Afrocarribean - Obestity - Radiation or chemo - Hypothryoidism - Hypoputitarism - Hyperparathryoidism
27
Sign on xray for SUFE
Trethowan sign
28
SALTER HARRIS types of fractures
29
Red flag fractures for NAI
Metaphyseal fractures Rib (esp posterior) Scapular Sternal
30
Lisfranc injury definition
Injury to tarsometatarsal joint complex Tarsometatarsal fracture dislocation - disruption between articulation of medial cuneiform & base of the 2nd MT
31
Fibromyalgia pharmacotherapy
First line TCA: Amitryptiliine 10-25mg nocte If concurrent depression or if wanting SNRI Then Duloxetine 30mg If not tolerating TCA Then gabapentin 100-300mg or pregabalin 25-75mg
32
Examination for De Querviain's
- Finkelstein test positive
33
Medial ankle tendinopathy
- Tibialis posterior tendinopathy - Flexor hallicus longus tendinopathy
34
Clinical features of Tibialis posterior tendinopathy
- - Pain on eversion !!!! - Pain medial ankle - Weakness in medial ankle and foot - Standing on toes painful - Common in dancers and those with flat feet
35
Clinical features of Tibialis posterior tendon rupture:
- Too many toes sign - Flat foot (abnormal)
36
Flexor hallicus longus tendinitis clinical features
Pain with great toe flexion on exam
37
Tarsal Tunnel syndrome clinical features
- Burning toe and sole of the foot
38
Young people (7-15yrs old) with posteroinferior heel pain most likely ddx
Sever's disease (Calcaneal apophysitis)
39
Young people (7-15yrs old) with posteroinferior heel pain most likely ddx
Sever's disease (Calcaneal apophysitis)
40
Bruise in the arch of the foot- diagnosis
Lisfranc injury
41
What am I
Osteoid Osteoma
42
What is a monkey muscle tear?
Rupture of medial head of Gastrocnemius (ddx achilles tendon rupture)
43
Jumper's knee (patella tendinopathy) key features
Pain below the knee Jumping exercises
44
Iliotibial band syndrome key features
- Pain with heel strike - Think in runners - pain on lateral edge of knee
45
Mechanisms for development of bursitis
- Prolonged pressure (eg elbow on desk) - Overuse or strenuous activity - Crystal- induced arthropathy - Inflammatory arthritis
46
Olecranon bursitis management
- Compression bandage - Corticosteroid injection - Drainage (if painful) controversial - NSAID
47
Causes for Carpal Tunnel Syndrome
- Pregnancy - Idiopathic - Hypothyroidism - Diabetes mellitus - Occupational: repetitive work with flexed wrists - Tophaceous gout
48
Pain and tenderness of 2nd and 3rd MTPJs diagnosis not to miss
Hereditary Haemochromatosis
49
Reynauds pharmacological management
Amlodipine 5mg -10mg or Nifedipine 30mg-120mg
50
Investigations for pseudogout (CPPD)
Weakly positively birefringent crystals CMP ALP PTH IRON STUDIES
51
DVT dose of anticoagulant (apixaban)
10mg BD for 7 days then5mg BD
52
What type of fracture are you thinking of?
Orbital blowout fracture or Orbito-zygomatic fracture
53
Knocked knees when to refer
- Persistent beyond 8yrs old - Intermalleloar space >8cm - Asymmetrical - Progressive - Other issue in addition eg: height <5th centile ** also do xray
54
Osteoporosis non-pharmacological
- Weight bearing impact loading exercise guided by AEP - Smoking cessation - etOH reduction - Dietary calcium 1300mg - 5-10mins sun exposure most days for vit D - OT assessment for falls risk reduction
55
Empty can test for...
Supraspinatus tear
56
Osteopenia/porosis, amenorrhea, disordered eating. WHAT AM I?
Female athlete triad syndrome Relative energy deficient syndrome
57
C7 Radiculopathy signs
SENSATION Palm, index middle finger (almost median) POWER - Elbow & wrist extension - Forearm pronation - Wrist Flexion REFLEX - Triceps
58
What is this called? What other imaging would you do?
Consider Maisonneuve fracture Needs proximal fibula to be imaged
59
What is this called? What other imaging would you do?
Consider Maisonneuve fracture Needs proximal fibula to be imaged
60
Monteggia fracture what is it? What to do?
ULNAR fracture Radial head dislocation EMERGENCY urgent intervention
61
Physical exam findings of anterior shoulder dislocation ?
- Arm in slight abduction and external rotation - Humeral head palpable anterior to glenohumeral fossa - Reduced global ROM - Loss of normal deltoid contour
62
Complications/risks of corticosteroid injection ?
- Joint infection - Fat pad atrophy - Tendon rupture - Allergic reaction - Vagal response - Haemarthroses of specific joint
63
What to do with this fracture? What is it?
ED for urgent reduction Monteggia
64
What type of 5th metatarsal fracture needs referral ?
- JONES (Proximal diaphysis) - Angulated midshaft
65
Mallet finger indications for surgical management
- >30% articular surface - volar subluxation
66
L5 dermatome L5 myotome
Dorsum of foot Dorsiflexion big toe and ankle
67
L3/4 dermatome L3/4 myotome
Anterolateral thigh Knee extension
68
S1 dermatome S1 myotome
Sole of foot Ankle plantar flexion

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