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Musculoskeletal Flashcards

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1
Q 
Long thoracic nerve innervates which muscle?
Clinical sign (1)
A

serratus anterior

winging of scapula

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2
Q

Name the fracture:

  1. 1 inch proximal to the radio-carpal joint
  2. Transverse fracture of the radius
  3. Dorsal angulation and impaction
A

Fall onto outstretched hands

Colle’s fracture

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3
Q

Name the fracture:
Dinner fork type deformity, AKA
Garden spade type deformity, AKA

A

Colle’s

Smith’s (reverse Colle’s)

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4
Q

Name the fracture:
Volar angulation of distal radius fragment
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed

A

Smith’s fracture

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5
Q

Bennett’s fracture

Name an xray finding (1)

A

X-ray: triangular fragment at the base of metacarpal

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6
Q

Name the fracture:
Intra-articular fracture at the base of the thumb metacarpal
Common in fist fights

A

Bennet’s fracture

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7
Q
  1. Dislocation of the proximal radioulnar joint (aka radial head) in association with an ulna fracture
  2. Fall on outstretched hand with forced pronation
A

Monteggia’s fracture

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8
Q

Name the fracture:
Radial shaft fracture with associated dislocation of the distal radioulnar joint
Occur after a fall on the hand with a rotational force superimposed on it.

X Rays reveal the displaced fracture of the radius and a prominent ulnar head due to dislocation of the inferior radio-ulnar joint.

A

Galeazzi’s fracture

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9
Q

RA

Name two antibodies associated with RA

A
  1. RhF

2. Anti-CCP (anti-cyclic citrullinated peptide antibody)

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10
Q

Behcet’s syndrome
Triad of symptoms
Genetic predisposition
Ix

A
  1. oral ulcers
  2. genital ulcers
  3. anterior uveitis

Genetics
1. HLA B51

Ix
1. Positive pathergy test - skin prick leads to ulcer/ pustule formation

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11
Q

Sjorgren’s syndrome
What is it?
Name two antibodies
Mx (2)

A

Autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces

  1. RhF
  2. Anti-RoLa

Mx

  1. artificial saliva and tears
  2. pilocarpine may stimulate saliva production
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12
Q 
OA 
Xray findings (4)
A
  1. Loss of joint space
  2. Subchondral cysts
  3. Subchondral sclerosis
  4. Osteophytes
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13
Q 
RA 
Xray findings (4)
A
  1. Loss of joint space
  2. Juxta-articular osteoporosis
  3. Periarticular erosions
  4. Subluxation
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14
Q 
Bloods for bone disorders: Ca, PO4, ALP, PTH 
Osteoporosis 
Osteomalacia 
Primary hyperparathyroidism 
Secondary hyperparathyroidism (CKD) 
Paget's disease 
Osteopetrosis
A 
Normal, normal, normal, normal 
Low, low, high, high 
High, low, high, high 
Low, high, high, high 
Normal, normal, high, normal 
Normal, normal, normal, normal
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15
Q

Ca, PO4, ALP, PTH
High, low, high, high

Options
Osteoporosis 
Osteomalacia 
Primary hyperparathyroidism 
Secondary hyperparathyroidism (CKD) 
Paget's disease 
Osteopetrosis
A

Primary hyperparathyroidism

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16
Q

Ca, PO4, ALP, PTH
Low, high, high, high

Options 
Osteoporosis 
Osteomalacia 
Primary hyperparathyroidism 
Secondary hyperparathyroidism (CKD) 
Paget's disease 
Osteopetrosis
A

Secondary hyperparathyroidism (CKD)

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17
Q

Ca, PO4, ALP, PTH
Normal, normal, normal, normal

Options 
Osteoporosis 
Osteomalacia 
Primary hyperparathyroidism 
Secondary hyperparathyroidism (CKD) 
Paget's disease 
Osteopetrosis
A

Osteoporosis

Osteopetrosis

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18
Q

Ca, PO4, ALP, PTH
Normal, normal, high, normal

Options 
Osteoporosis 
Osteomalacia 
Primary hyperparathyroidism 
Secondary hyperparathyroidism (CKD) 
Paget's disease 
Osteopetrosis
A

Paget’s

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19
Q

Ca, PO4, ALP, PTH
Low, low, high, high

Options 
Osteoporosis 
Osteomalacia 
Primary hyperparathyroidism 
Secondary hyperparathyroidism (CKD) 
Paget's disease 
Osteopetrosis
A

Osteomalacia

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20
Q

SLE
Antibodies (1)
Race
Features: (4)

A
  1. ANA
  2. Afro- Caribbean

Features

  1. Malar rash
  2. Discoid rash - erythematous, well demarcated rash in sun-exposed areas. Can become hyperpigmented and hyperkeratotic
  3. Livedo reticularis
  4. Non scarring alopecia
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21
Q

Reactive arthritis

Features Triad

A

Usually 4 weeks post STI

  1. Urethritis
  2. Uveitis (conjunctivitis or ant uveitis)
  3. Arthritis
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22
Q

What is dactylitis?

A

Swollen fat fingers/ sausage like fingers

Severe inflammation of the finger and toe joints

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23
Q

What is keratoderma blenorrhagica?

A

waxy yellow/brown papules on palms and soles

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24
Q

What is circinate balanitis?

Associated with which condition?

A

Painless vesicles on penis associated with reactive arthritis

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25
What does the femoral nerve innervate? S M Common injury
Sensory Anterior and medial aspect of the thigh and lower leg Motor Knee extension, thigh flexion Hip and pelvic fractures Stab/gunshot wounds
26
What does the obturator nerve innervate? S M Common injury
Sensory Medial thigh Motor Thigh adduction Anterior hip dislocation
27
What does the lateral cutaneous nerve of the thigh innervate? S M Common injury
Sensory Lateral and posterior surfaces of the thigh Motor None Compression of the nerve near the ASIS → meralgia paraesthetica, a condition characterised by pain, tingling and numbness in the distribution of the lateral cutaneous nerve
28
What does the tibial nerve innervate? S M Common injury
Sensory Sole of foot Motor Foot plantarflexion and inversion Not commonly injured Popliteal lacerations, posterior knee dislocation
29
What does the common peroneal nerve innervate? S M Common injury
Sensory Dorsum of the foot and the lower lateral part of the leg Motor Foot dorsiflexion and eversion Extensor hallucis longus Injury causes foot drop
30
What does the superior gluteal nerve innervate? S M Common injury
Sensory None Motor Hip abduction Injury results in a positive Trendelenburg sign
31
What does the inferior gluteal nerve innervate? S M Common injury
Sensory None Motor Hip extension and lateral rotation Injury results in difficulty rising from seated position. Can't jump, can't climb stairs
32
Pseudogout | Name x5 RFs
1. Low phosphate, low magnesium 2. Acromegaly 3. Wilson's disease 4. Haemochromatosis 5. Hyperparathyrodism
33
Pseudogout What do you seen on joint aspiration? What do you see on xray? Which joints are usually affected?
1. Weakly-positively birefringent rhomboid-shaped crystals 2. Chondrocalcinosis 3. Knee, wrist, shoulder
34
Ottowa rules | When to get an xray
Pain in the malleolar zone AND 1. An inability to weight bear immediately AND in the ED for four steps OR 2. Bone tenderness at the posterior edge of lateral OR medial malleolus Pain in the midfoot zone AND 1. An inability to weight bear immediately AND in the ED for four steps OR 2. Bone tenderness at the navicular OR 3. Tenderness at base of the fifth metatarsal
35
Systemic sclerosis types (3)
1. Limited 2. Diffuse 3. Scleroderma
36
``` Systemic sclerosis - Limited Antibodies (2) Associated with which condition? First symptom Where does scleroderma typically affect? ```
``` ANA anti-centromere Associated with CREST syndrome Raynauds first symptom Scleroderma affects face and distal limbs ```
37
``` Systemic sclerosis DiffuSe Antibodies (2) Where does scleroderma typically affect Systemic features (4) ```
ANA anti-scl-70 Scleroderma affects trunk and proximal limbs mainly Other effects: 1. ILD - interstitial lung disease 2. PAH - pulmonary arterial hypertension 3. Renal disease 4. HTN
38
Systemic sclerosis Scleroderma - what is it? Antibodies (1)
ANA | tightening and fibrosis of skin, can manifest as plaques
39
What is CREST syndrome | What disease and subtype is it associated with?
CREST syndrome: Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia Associated with limited systemic sclerosis
40
Hypersensitivities Type I Name two
Anaphylaxis | Atopy
41
Hypersensitivities Type II Name four
Autoimmune haemolytic anaemia ITP Goodpastures Pernicious anaemia (B12)
42
Hypersensitivities Type III Name two
SLE | post Strep GN
43
Hypersensitivities Type IV Name five
``` TB GVHS Allergic contact dermatitis Scabies Guillian Barre ```
44
What is this type of sensitivity? SLE post Strep GN
III | Immune complex
45
``` What is this type of sensitivity? TB GVHS Allergic contact dermatitis Scabies Guillian Barre ```
IV delayed hypersensitivity T cell mediated
46
What is this type of sensitivity? Anaphylaxis Atopy
I Anaphylactic IgE binds with mast cells
47
``` What is this type of sensitivity? Goodpastures Pernicious anaemia (B12) ```
II IgG or IgM binds to antigen on cell surface Cell bound
48
Marfan's syndrome What is it? AD/AR
1. defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1 2. AD
49
Marfan's syndrome | Features (5)
1. Tall 2. Pectus excavatum 3. Aortic (or mitral) valve issues e.g regurg/ prolapse/ dissection 4. Pneumothorax 5. High-arched palate
50
``` Wegener's/ granulomatosis polyangitis Features (5) p/c-ANCA Small/medium/large vessel vasculitis? Rx ```
1. Saddle shape nose 2. Epistaxis 3. Haemoptysis 4. Dyspnoea 5. Chronic sinusitis c-ANCA Small Rx immunosuppressive therapy
51
``` Churg Strauss Features p/c-ANCA Small/medium/large vessel vasculitis? Rx ```
1. Sinusitis 2. Asthma 3. Mononeuritis multiplex 4. Eosinophilia p-ANCA Small Rx immunosuppressive therapy
52
Microscopic polyangiitis Small/medium/large vessel vasculitis? Features (4)
``` Small 1. raised creatinine, haematuria, proteinuria 2. palpable purpura 3. cough, dyspnoea, haemoptysis 4. fever p-ANCA ```
53
Ankylosing spondylitis HLA? What is Schober's test? Examination findings (3)
``` HLA B27 Reduced forward flexion (should be >5cm) 1. Reduced forward flexion 2. Reduced lateral flexion 3. Reduced chest expansion ```
54
``` AV node block Apical fibrosis Aortic regurgitation Anterior uveitis Achilles tendonitis Amyloidosis cAuda equina peripheral Arthritis ``` Associated with which condition?
Ankylosing spondylitis | Features (not the ones you will remember i.e stiff in the morning, better over the day, lower back pain)
55
Ankylosing spondylitis Most useful Ix of choice (1) Findings on Ix (4) What might you find on CXR? 2nd line investigation
``` Xray sacroiliac joints 1. sacroiliitis: subchondral erosions, sclerosis 2. squaring of vertebrae 3. bamboo spine 4. syndesmophytes CXR 1. Apical fibrosis ``` MRI
56
Ankylosing spondylitis | Mx (4)
1. Exercise 2. NSAIDs 3. Physiotherapy 4. anti-TNF (DMARDs)
57
Antiphospholipid syndrome What is it? Features (5)
``` Autoimmune condition which predisposes patients to thrombosis Features 1. Venous/ arterial thrombosis 2. Recurrent miscarriages 3. livedo reticularis 4. thrombocytopenia 5. prolonged APTT ```
58
Antiphospholipid syndrome Mx (2) Associated with which other disease? Antibody
1. Low dose aspirin 2. Lifelong warfarin SLE Anti-cardiolipin
59
Polyarteritis nodosa Small/ medium/ large? What is it? Features (4)
``` Medium vessel vasculitis? Systemic necrotising medium vessel vasculitis 1. Assoc Hep B 2. Mononeuritis multiplex 3. Renal infarcts - HTN 4. Livedo reticularis ``` Fever, myalgia, weight loss, rash
60
Dermatomyositis What is it? What three cancers are associated with it?
an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions 1. Breast 2. Lung 3. Ovarian
61
Dermatomyositis What is it? What three cancers are associated with it?
an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions 1. Breast 2. Lung 3. Ovarian
62
Dermatomyositis Features Antibody
1. Gottron's papules 2. Helitrope rash 3. Weakness of proximal muscles 4. Shawl rash (photosensitivity) ANA
63
Drug induced lupus | Antibodies (2)
ANA and anti-histone
64
Drug induced lupus | Caused commonly by which two drugs
procainamide | hydralazine
65
Gout drugs causes:
1. Diuretics 2. Ciclosporin 3. Alcohol 4. Pyrazinamide 5. Aspirin DCAPA
66
Punched out erosions on xray =
gout
67
Gout Mx Acute Prophylaxis
1. NSAIDs or colchicine If CI or not tolerated 2. Pred 1. Allopurinol 2. Febuxostat Aim uric acid <300
68
Tennis elbow AKA | What is it
lateral epicondylitis pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
69
Myopathies | Features (3)
1. Proximal muscle weakness 2. Bilateral 3. Difficulty in getting up from sitting
70
``` Myopathies Causes Inflammatory (1) Inherited (2) Endo (2) Other (1) ```
Inflammtory Polymyositis Inherited Duchenne muscular dystrophy Becker Endo Cushings Thyrotoxicosis Other ETOH
71
How to diagnose OA (3)
1. >45yo 2. Exercise related pain 3. Nil morning stiffness, or morning stiffness lasts >30mins
72
Osteogenesis imperfecta Abnormality in _______ AD/AR
abnormality in type 1 collagen | AD
73
Which patient's should be started on bisphosphonate without a DEXA
If has had fragility fracture AND aged >=75yo (65yo according to RCP, 75yo according to NICE)
74
What DXA scan score should you get to be started on bisphosphonates?
-2.5
75
List 6 medications that worsen osteoporosis
1. PPIs 2. Steroids 3. SSRIs 4. Antiepileptics 5. Glitazones 6. Heparin 7. Aromatose inhibitors PASHGAS or GASHPAS
76
RF for osetoporosis
1. Low BMI 2. Steroid use 3. RA 4. FH of fracture 5. Smoking 6. ETOH SSRELF
77
Name four groups of people who should take vit D
1. If you are not exposed to the sun very often (e.g house bound) 2. Age 3 months - 5yo (unless formula fed) 3. All pregnant and breastfeeding women 4. >65yo
78
Predisposing RF for Paget's disease (4) Age Gender Geogrpahic
1. increasing age 2. male 3. FH 4. northern latitude
79
Isolated raised ALP =
Pagets
80
Rx for Paget's (1)
Bisphosphonates
81
Paget's complications (5)
1. Deafness (cranial nerve entrapment) 2. Sarcoma bone 3. Fractures 4. Skull thickening 5. High output cardiac failure
82
Arthritis mutilans/ telescoping fingers =
Psoriatic arthropathy
83
Diseases associated with Raynauds (3) | Rx
1. SLE 2. Reactive arthritis 3. Scleroderma (most common) Rx CCB (nifedipine)
84
RA Mx (
1. DMARD monotherapy +/- prednisolone
85
Name three TNF inhibitors
1. Infliximab 2. Etanercept 3. Adalimumab
86
What scoring system can be used to assess management of RA?
DAS28
87
Name 7 factors that if +ve suggest a poor prognosis of RA
1. RhF +ve 2. Anti-CCP +ve 3. X-ray: early erosions within 2 years
88
Name 7 factors that if +ve suggest a poor prognosis of RA
1. RhF +ve 2. Anti-CCP +ve 3. X-ray: early erosions within 2 years 4. Poor functional status at presentation 5. Extra-articular features such as nodules 6. HLA-DR4 7. Insidious onset
89
RA: Name five (three early, two late) findings on xray
Early x-ray findings 1. loss of joint space 2. juxta-articular osteoporosis 3. soft-tissue swelling Late x-ray findings 4. periarticular erosions 5. subluxation
90
Rotator cuff muscles SITS
Supraspinatus Infraspinatus Teres minor Subscapularis
91
Supraspinatus
Abducts arm (with deltoid)
92
Infraspinatus
External rotation
93
Teres minor
Adducts | External rotation
94
Subscapularis
Adducts | Internal rotation
95
Most common bacteria causing septic arthritis
Staph Aureus
96
Most common bacteria in young adults who are sexually active causing septic arthritis
N. gonorrhea
97
Mx septic arthritis
Fluclox or clinda in pen allergic for 6-12 weeks
98
Sjogren's syndrome rx
1. Artificial saliva and tears | 2. Pilocarpine
99
1. keratoderma blenorrhagica 2. circinate balanitis 3. dactylitis Associated with which condition?
Reactive arthritis
100
``` Features 1. Sensory polyneuropathy 2. Raynaud's 3. Parotitis Associated with which condition? ```
Sjogrens
101
1. blue sclera 2. deafness secondary to otosclerosis 3. dental imperfections are common Associated with which condition?
Osteogenesis imperfecta
102
Most common shoulder dislocation? Commonly caused by which direction of force? How does the patient hold their arm?
Anterior Posterior direction Externally rotated, adducted/ side of body
103
Reduced range of movement Weakness/ crepitus and tenderness over cuff insertions and subacromial region = Xray can show?
Rotator cuff injury | Bony avulsion

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