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MSRA > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

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
Q

What does the femoral nerve innervate?
S
M
Common injury

A

Sensory
Anterior and medial aspect of the thigh and lower leg

Motor
Knee extension, thigh flexion

Hip and pelvic fractures
Stab/gunshot wounds

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26
Q

What does the obturator nerve innervate?
S
M
Common injury

A

Sensory
Medial thigh

Motor
Thigh adduction

Anterior hip dislocation

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27
Q

What does the lateral cutaneous nerve of the thigh innervate?
S
M
Common injury

A

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

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28
Q

What does the tibial nerve innervate?
S
M
Common injury

A

Sensory
Sole of foot

Motor
Foot plantarflexion and inversion

Not commonly injured
Popliteal lacerations, posterior knee dislocation

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29
Q

What does the common peroneal nerve innervate?
S
M
Common injury

A

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

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30
Q

What does the superior gluteal nerve innervate?
S
M
Common injury

A

Sensory
None

Motor
Hip abduction

Injury results in a positive Trendelenburg sign

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31
Q

What does the inferior gluteal nerve innervate?
S
M
Common injury

A

Sensory
None

Motor
Hip extension and lateral rotation

Injury results in difficulty rising from seated position. Can’t jump, can’t climb stairs

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32
Q

Pseudogout

Name x5 RFs

A
  1. Low phosphate, low magnesium
  2. Acromegaly
  3. Wilson’s disease
  4. Haemochromatosis
  5. Hyperparathyrodism
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33
Q

Pseudogout
What do you seen on joint aspiration?
What do you see on xray?
Which joints are usually affected?

A
  1. Weakly-positively birefringent rhomboid-shaped crystals
  2. Chondrocalcinosis
  3. Knee, wrist, shoulder
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34
Q

Ottowa rules

When to get an xray

A

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

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35
Q

Systemic sclerosis types (3)

A
  1. Limited
  2. Diffuse
  3. Scleroderma
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36
Q 
Systemic sclerosis - Limited
Antibodies (2)
Associated with which condition? 
First symptom
Where does scleroderma typically affect?
A 
ANA
anti-centromere
Associated with CREST syndrome
Raynauds first symptom 
Scleroderma affects face and distal limbs
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37
Q 
Systemic sclerosis
DiffuSe
Antibodies (2) 
Where does scleroderma typically affect
Systemic features (4)
A

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
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38
Q

Systemic sclerosis
Scleroderma - what is it?
Antibodies (1)

A

ANA

tightening and fibrosis of skin, can manifest as plaques

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39
Q

What is CREST syndrome

What disease and subtype is it associated with?

A

CREST syndrome: Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

Associated with limited systemic sclerosis

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40
Q

Hypersensitivities
Type I
Name two

A

Anaphylaxis

Atopy

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41
Q

Hypersensitivities
Type II
Name four

A

Autoimmune haemolytic anaemia
ITP
Goodpastures
Pernicious anaemia (B12)

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42
Q

Hypersensitivities
Type III
Name two

A

SLE

post Strep GN

43
Q

Hypersensitivities
Type IV
Name five

A 
TB
GVHS
Allergic contact dermatitis
Scabies 
Guillian Barre
44
Q

What is this type of sensitivity?
SLE
post Strep GN

A

III

Immune complex

45
Q 
What is this type of sensitivity?
TB
GVHS
Allergic contact dermatitis 
Scabies 
Guillian Barre
A

IV
delayed hypersensitivity
T cell mediated

46
Q

What is this type of sensitivity?
Anaphylaxis
Atopy

A

I
Anaphylactic
IgE binds with mast cells

47
Q 
What is this type of sensitivity?
Goodpastures 
Pernicious anaemia (B12)
A

II
IgG or IgM binds to antigen on cell surface
Cell bound

48
Q

Marfan’s syndrome
What is it?
AD/AR

A
  1. defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1
  2. AD
49
Q

Marfan’s syndrome

Features (5)

A
  1. Tall
  2. Pectus excavatum
  3. Aortic (or mitral) valve issues e.g regurg/ prolapse/ dissection
  4. Pneumothorax
  5. High-arched palate
50
Q 
Wegener's/ granulomatosis polyangitis 
Features (5)
p/c-ANCA
Small/medium/large vessel vasculitis?
Rx
A
  1. Saddle shape nose
  2. Epistaxis
  3. Haemoptysis
  4. Dyspnoea
  5. Chronic sinusitis
    c-ANCA
    Small
    Rx immunosuppressive therapy
51
Q 
Churg Strauss 
Features 
p/c-ANCA
Small/medium/large vessel vasculitis?
Rx
A
  1. Sinusitis
  2. Asthma
  3. Mononeuritis multiplex
  4. Eosinophilia
    p-ANCA
    Small
    Rx immunosuppressive therapy
52
Q

Microscopic polyangiitis
Small/medium/large vessel vasculitis?
Features (4)

A 
Small 
1. raised creatinine, haematuria, proteinuria
2. palpable purpura
3. cough, dyspnoea, haemoptysis
4. fever 
p-ANCA
53
Q

Ankylosing spondylitis
HLA?
What is Schober’s test?
Examination findings (3)

A 
HLA B27
Reduced forward flexion (should be >5cm)
1. Reduced forward flexion 
2. Reduced lateral flexion 
3. Reduced chest expansion
54
Q 
AV node block
Apical fibrosis 
Aortic regurgitation 
Anterior uveitis
Achilles tendonitis 
Amyloidosis 
cAuda equina 
peripheral Arthritis

Associated with which condition?

A

Ankylosing spondylitis

Features (not the ones you will remember i.e stiff in the morning, better over the day, lower back pain)

55
Q

Ankylosing spondylitis
Most useful Ix of choice (1)
Findings on Ix (4)
What might you find on CXR?

2nd line investigation

A 
Xray sacroiliac joints 
1. sacroiliitis: subchondral erosions, sclerosis
2. squaring of vertebrae 
3. bamboo spine 
4. syndesmophytes
CXR 
1. Apical fibrosis

MRI

56
Q

Ankylosing spondylitis

Mx (4)

A
  1. Exercise
  2. NSAIDs
  3. Physiotherapy
  4. anti-TNF (DMARDs)
57
Q

Antiphospholipid syndrome
What is it?
Features (5)

A 
Autoimmune condition which predisposes patients to thrombosis 
Features 
1. Venous/ arterial thrombosis 
2. Recurrent miscarriages 
3. livedo reticularis
4. thrombocytopenia
5. prolonged APTT
58
Q

Antiphospholipid syndrome
Mx (2)
Associated with which other disease?
Antibody

A
  1. Low dose aspirin
  2. Lifelong warfarin
    SLE
    Anti-cardiolipin
59
Q

Polyarteritis nodosa
Small/ medium/ large?
What is it?
Features (4)

A 
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
Q

Dermatomyositis
What is it?
What three cancers are associated with it?

A

an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions

  1. Breast
  2. Lung
  3. Ovarian
61
Q

Dermatomyositis
What is it?
What three cancers are associated with it?

A

an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions

  1. Breast
  2. Lung
  3. Ovarian
62
Q

Dermatomyositis
Features
Antibody

A
  1. Gottron’s papules
  2. Helitrope rash
  3. Weakness of proximal muscles
  4. Shawl rash (photosensitivity)
    ANA
63
Q

Drug induced lupus

Antibodies (2)

A

ANA and anti-histone

64
Q

Drug induced lupus

Caused commonly by which two drugs

A

procainamide

hydralazine

65
Q

Gout drugs causes:

A
  1. Diuretics
  2. Ciclosporin
  3. Alcohol
  4. Pyrazinamide
  5. Aspirin

DCAPA

66
Q

Punched out erosions on xray =

A

gout

67
Q

Gout Mx
Acute
Prophylaxis

A
  1. NSAIDs or colchicine
    If CI or not tolerated
  2. Pred
  3. Allopurinol
  4. Febuxostat
    Aim uric acid <300
68
Q

Tennis elbow AKA

What is it

A

lateral epicondylitis
pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended

69
Q

Myopathies

Features (3)

A
  1. Proximal muscle weakness
  2. Bilateral
  3. Difficulty in getting up from sitting
70
Q 
Myopathies 
Causes 
Inflammatory (1)
Inherited (2)
Endo (2)
Other (1)
A

Inflammtory
Polymyositis

Inherited
Duchenne muscular dystrophy
Becker

Endo
Cushings
Thyrotoxicosis

Other
ETOH

71
Q

How to diagnose OA (3)

A
  1. > 45yo
  2. Exercise related pain
  3. Nil morning stiffness, or morning stiffness lasts >30mins
72
Q

Osteogenesis imperfecta
Abnormality in _______
AD/AR

A

abnormality in type 1 collagen

AD

73
Q

Which patient’s should be started on bisphosphonate without a DEXA

A

If has had fragility fracture AND aged >=75yo (65yo according to RCP, 75yo according to NICE)

74
Q

What DXA scan score should you get to be started on bisphosphonates?

A

-2.5

75
Q

List 6 medications that worsen osteoporosis

A
  1. PPIs
  2. Steroids
  3. SSRIs
  4. Antiepileptics
  5. Glitazones
  6. Heparin
  7. Aromatose inhibitors

PASHGAS or
GASHPAS

76
Q

RF for osetoporosis

A
  1. Low BMI
  2. Steroid use
  3. RA
  4. FH of fracture
  5. Smoking
  6. ETOH

SSRELF

77
Q

Name four groups of people who should take vit D

A
  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
Q

Predisposing RF for Paget’s disease (4)
Age
Gender
Geogrpahic

A
  1. increasing age
  2. male
  3. FH
  4. northern latitude
79
Q

Isolated raised ALP =

A

Pagets

80
Q

Rx for Paget’s (1)

A

Bisphosphonates

81
Q

Paget’s complications (5)

A
  1. Deafness (cranial nerve entrapment)
  2. Sarcoma bone
  3. Fractures
  4. Skull thickening
  5. High output cardiac failure
82
Q

Arthritis mutilans/ telescoping fingers =

A

Psoriatic arthropathy

83
Q

Diseases associated with Raynauds (3)

Rx

A
  1. SLE
  2. Reactive arthritis
  3. Scleroderma (most common)

Rx CCB (nifedipine)

84
Q

RA Mx (

A
  1. DMARD monotherapy +/- prednisolone
85
Q

Name three TNF inhibitors

A
  1. Infliximab
  2. Etanercept
  3. Adalimumab
86
Q

What scoring system can be used to assess management of RA?

A

DAS28

87
Q

Name 7 factors that if +ve suggest a poor prognosis of RA

A
  1. RhF +ve
  2. Anti-CCP +ve
  3. X-ray: early erosions within 2 years
88
Q

Name 7 factors that if +ve suggest a poor prognosis of RA

A
  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
Q

RA: Name five (three early, two late) findings on xray

A

Early x-ray findings

  1. loss of joint space
  2. juxta-articular osteoporosis
  3. soft-tissue swelling

Late x-ray findings

  1. periarticular erosions
  2. subluxation
90
Q

Rotator cuff muscles SITS

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

91
Q

Supraspinatus

A

Abducts arm (with deltoid)

92
Q

Infraspinatus

A

External rotation

93
Q

Teres minor

A

Adducts

External rotation

94
Q

Subscapularis

A

Adducts

Internal rotation

95
Q

Most common bacteria causing septic arthritis

A

Staph Aureus

96
Q

Most common bacteria in young adults who are sexually active causing septic arthritis

A

N. gonorrhea

97
Q

Mx septic arthritis

A

Fluclox or clinda in pen allergic for 6-12 weeks

98
Q

Sjogren’s syndrome rx

A
  1. Artificial saliva and tears

2. Pilocarpine

99
Q
  1. keratoderma blenorrhagica
  2. circinate balanitis
  3. dactylitis

Associated with which condition?

A

Reactive arthritis

100
Q 
Features 
1. Sensory polyneuropathy
2. Raynaud's 
3. Parotitis
Associated with which condition?
A

Sjogrens

101
Q
  1. blue sclera
  2. deafness secondary to otosclerosis
  3. dental imperfections are common

Associated with which condition?

A

Osteogenesis imperfecta

102
Q

Most common shoulder dislocation?
Commonly caused by which direction of force?
How does the patient hold their arm?

A

Anterior
Posterior direction
Externally rotated, adducted/ side of body

103
Q

Reduced range of movement
Weakness/ crepitus and tenderness over cuff insertions and subacromial region =
Xray can show?

A

Rotator cuff injury

Bony avulsion

MSRA (22 decks)

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