MSK Flashcards by Elise Giblin

Baker cyst is a what? what rheumatological condition is it associated with

swelling behind the knee associated with rheumatoid arthritis

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According to the DAS-28 scoring system, active rheumatoid arthiritis is a score of_ and remission is a score of _

active- more than 5.1
remission- less than 2.6

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Are patients with mild ankylosing spondylitis offered DMARDs?

No - NSAIDs and exercise

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Arthritis mutilans refers to a particularly destructive form of-

psoriatic arthritis

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Back pain that is constant, severe, and worse at night is a red flag, true or false?

True

Mechanical back pain tends to be worse with activity and relieved by rest

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Biological agents are associated with a higher risk of infections than synthetic DMARDs, true or false?

TRUE

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Bone is laid down perpendicular to areas of stress, true or false?

FALSE

It’s laid down along areas of stress

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Boutonniere deformity (thumb), ulnar deviation (MCPs), swan-neck deformity (DIPs), and atlanto-axial subluxation are associated with what condition?

rheumatoid arthritis

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Cartilage is a vascular tissue, true or false?

FALSE

Chondrocytes are supplied by nutritents in the extracellular/synovial fluid

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Chondrocytes live within space in the extracellular matrix termed the-

lacunae

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Chronic back pain in a 65-year-old patient is a red flag, true or false?

False

New back pain in an older patient (>60 years) is a red flag for metastasis. Chronic back pain is probably arthritis.

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Define a motor unit in muscle physiology

a single alpha motor neuron and all the skeletal muscle fibres it innervates

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DMARDs can be used to treat spinal progression in ankylosing spondylitis, true or false?

False - can only help with peripheral symptoms; do not affect spinal progression

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Do steroids have a role in management of osteoarthritis?

Yes - injections in acute flare-ups

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Heberden’s nodes (of the DIPs), Bouchard’s nodes (of the PIPs), and squaring of the thumb are associated with what condition?

osteoarthritis

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How do bisphosphonates work?

attach to bone- get eaten by osteoclasts- trigger apoptosis- less bone resorbed

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How do you take a bisphosphonate tablet?

Take at least 30 minutes before breakfast with plenty of water + sit-upright for 30 minutes following.

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How long of a wash-out period does a patient on methorexate need to wait before trying to get pregnant?

At least 3 months!

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In cartilage physiology, what do high levels of keratin sulphate and type II collagen in synovial fluid suggest?

Cartilage degradation

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In cartilage, TNF-alpha and IL-1 are catabolic/anabolic factors?

catabolic

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In inflammatory arthritis, early morning stiffness lasts longer than how long?

30 mins

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in muscle physiology, during what type of contraction does muscle tension change and muscle length stay the same. this is helpful for what action?

isometric contraction
helpful for posture/bracing

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in muscle physiology, during isometric contraction, muscle tension changes/stays the same? and muscle length changes/stays constant? this is helpful for what?

muscle tension changes
muscle length remains constant
helpful for posture/bracing

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in muscle physiology, what type of contraction does muscle tension remain constant whilst muscle length changes?

isotonic

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In reactive arthritis, joint aspirate is usually positive for microorganisms, true or false?

FALSE The joint aspirate in reactive arthritis is usually sterile - if it was positive for organisms on gram stain or culture then it is a septic arthritis.

In rheumatology, infliximab and etenercept are examples of what drug class?

anti-TNF agents

In rheumatology, name two examples of anti-TNF agents

infliximab etenercept

In rheumatology, rituximab is an example of what drug class?

CD20-positive b cell depletor

In rheumatology, name an example of a CD20-positive b cell depletor

rituximab

In rheumatology, tocilizumab is an example of what drug class?

IL-6 blocker

In rheumatology, name an example of a IL-6 blocker

tocilizumab

In skeletal muscle physiology, the _______ is made up of thick filaments along with portions of thin filaments that overlap in both ends of thick filaments

A band

In skeletal muscle physiology, the ______extends vertically down the middle of the A-band within the centre of the H-zone

M-line

Men do not need to worry about the effect of methotrexate on conception/pregnancy, true or false?

FALSE Men must observe a 3-month washout between finishing methotrexate and attempting pregnancy

NSAIDs are generally safe in pregnancy, true or false?

FALSE NSAIDS are not recommended during pregnancy especially in the 3rd trimester as may inhibit prostaglandin synthesis, leading to cardiac malformations including premature closing of the ductus arteriosus. Although can use for trimesters 1/2 in significant cases (eg, migraine)

Osteoblasts are present where in bone?

on the surface of bone

Periarticular erosions are associated with osteoarthritis, true or false?

FALSE Associated with rheumatoid arthritis

Rheumatoid arthritis affects the spine where?

only at C1/C2

Rheumatoid arthritis is driven by type _ hypersensitivity, also known as ______ hypersensitivity

type IV delayed type

Soft tissue swelling is rare in seronegative arthritis, true or false?

FALSE Common, especially in psoriatic arthritis

Steroids are safe in pregnancy, true or false?

Depends who you ask, but yes they are used in pregnant rheumatoid patients

Sulfasalazine is safe in pregnancy, true or false?

TRUE

The histological hallmark of rheumatoid arthritis is formation of what kind of tissue?

pannus (inflamed granulation tissue)

the histology hallmark of what condition is formation of pannus tissue?

rheumatoid arthritis

The main mineral of bone is-

calcium phosphate (hydroxyapatite)

The specific hallmark of seronegative arthritis is reactive new bone formation, true or false?

TRUE Causes ankylosis (joint fusion)

Type 1 muscle fibres (also known as fast/slow oxidative/glycolytic are used for prolonged, low-work activity, for example walking

slow oxidative

What analgesia should be offered for simple low back pain?

NSAIDs (eg naproxen) - NOT paracetamol alone

What antibodies should be tested for in a patient with suspected rheumatoid arthritis symptoms?

Anti-CCP antibodies

What are the components of the DAS-28 score?

swollen and tender joint count CRP visual analogue scale

What arthritis is associated with a 'pencil-in-cup' deformity?

psoriatic arthritis

nail pitting seen in what type of arthritis?

psoriatic arthritis

What conditions are associated with carpal tunnel syndrome?

- Rheumatoid arthritis (synovitis -> less space) - Conditions resulting in fluid retention (pregnancy, diabetes, chronic renal failure, hypothyroidism -> myxoedema) - Previous wrist fracture (especially a Colles fracture)

What does enthesitis refer to?

Inflammation at insertion of tendons (Achilles tendinitis, plantar fasciitis, etc)

What does the following constellation hint at? Axial arthritis Anterior uveitis Aortic regurgitation Apical fibrosis Amyloidosis IgA nephropathy Achilles tendonitis Plantar fasciitis

ankylosing spondylitis

What imaging investigation is useful in early rheumatoid arthritis?

Joint ultrasound

What is the hallmark clinical sign of ankylosing spondylitis?

Sacroiliitis

What supplement should be given with methotrexate treatment?

Folic acid

What type of arthritis is associated with 'sausage finger' (or 'sausage toe'), as well as DIP and spinal involvement?

Psoriatic arthritis

When should patients with rheumatoid arthritis be given biological agents?

Failure to respond to two DMARDs (including methotrexate) and DAS28 > 5.1 Give MTX with biologic; screen for TB, hepatitis, HIV, and varicella

Which of the following are NOT examples of seropositive inflammatory arthritis? Rheumatoid arthritis IBD arthritis Systemic lupus erythematosus Ankylosing spondylitis Scleroderma Psoriatic arthritis Sjogren's Vasculitis Reactive arthritis

Seronegative inflammatory arthritis (spondyloarthripides): IBD arthritis Ankylosing spondylitis Psoriatic arthritis Reactive arthritis

Which of the following DMARDs in rheumatoid arthritis does not prevent erosions? Methotrexate Sulfasalazine Hydroxychloroquine Leflunomide

Hydroxychloroquine

Which of the following DMARDs in rheumatoid arthritis is safe in pregnancy? Methotrexate Sulfasalazine Hydroxychloroquine Leflunomide

Sulfasalazine (possibly also azathioprine +/- hydroxychloroquine)

Which of the following drugs for rheumatoid arthritis should not be given to patients with Von Gierke's disease (G6PD deficiency) or co-trimoxazole allergy? Steroids Methotrexate Sulfalazine Hydroxychloroquine Leflunomide

Sulfasalzine

Which of the following is not a DMARD in rheumatoid arthritis? Steroids Methotrexate Sulfalazine Hydroxychloroquine Leflunomide

Steroids - reduce inflammation but do not alter disease course

Which of the following is the first-line treatment for rheumatoid arthritis? Steroids Methotrexate Sulfalazine Hydroxychloroquine Leflunomide

Methotrexate (+/- steroids for short-term relief of symptoms) - Needs folic acid supplementation + LFTs - Once-weekly dosing, rapid (ish) onset of action

Which ophthalmological finding is associated with ankylosing spondylitis?

Uveitis

_______ syndrome is a condition characterized by splenomegaly and neutropenia in a patient with rheumatoid arthritis

feltys syndrome

Question mark spine and bamboo spine are associated with what rheumatological condition?

advanced ankylosing spondylitis

______ syndrome refers to a triad of urethritis, uveitis, and arthritis. it is often secondary to GI or chlamydia infection

Reiters

Which immunological tests are helpful in rheumatoid arthritis. which is much more specific?

rheumatoid factor and anti-CCP anti-CCP much more specific

Rheumatoid factor is an Ig_ antibody against the__portion of Ig_

igM against Fc region of igG

A clinical feature of rheumatoid arthritis is positive ________ of MCP/MTP joints

compression test

A photosensitive malar rash sparing the nasolabial folds is a feature of what condition?

SLE

A thrombotic event in a patient with antiphospholipid syndrome is an indication for life-long anti-coagulation, true or false?

TRUE

After physical examination and bloods tests, what three investigations are helpful in myopathy?

EMG, muscle biopsy (definitive), and MRI

An elderly patient with normal Ca2+, normal phosphate, ↑ALP, and normal PTH likely has what condition?

Paget's disease Commonly asymptomatic, discovered with incidental isolated raised ALP or xray abnormality (although can cause bone pain/deformity)

Anti-cardiolipin antibody, lupus anticoagulant, and beta-2 glycoprotein are diagnostic for which condition?

anti-phospholipid syndrome must be positive on two occasions 12 weeks apart

Anti-dsDNA and anti-Sm antibodies are poorly sensitive but very specific in what condition?

SLE anti-dsdna can be used to monitor disease activity

Anti-Ro and anti-La are usually positive in what condition?

sjogrens syndrome

Anti-topoisomerase antibody is more commonly known as anti-

Scl70 diffuse systemic sclerosis

Antibody levels should dictate treatment in connective tissue diseases, true or false?

FALSE Treat symptomatically and monitor closely for major complications; although some antibody levels will vary with effective treatment (eg anti-DNA binding antibodies in SLE), most will not. Antibody levels alone should not dictate therapy.

c-ANCA more specific/sensitive for which type of ANCA associated vasculitis

GPA

p-ANCA can be positive in which type of ANCA associated vasculitis

EPGA and MPA

C3/C4 are low/high in immune complex vasculitis, especially with?

low especially lupus nephritis

Chest pain in SLE can be caused by which manifestations?

pericarditis pleurisy pleural effusion pericardial effusion

Define a functional unit in muscle physiology

The sarcomere (distance between two Z lines) (don't confuse it with motor unit)

Eosinophilia is associated with what vasculitis

EPGA

In bone healing, remodelling occurs straight after soft callus formation, true or false?

FALSE Haematoma -> cartilagenous soft callus -> woven bone hard callous -> remodelling into lamellar bone

In polymyositis, which biochemical marker (not immune test) is elevated?

creatine kinase

In the treatment of gout, which drug inhibits xanthine oxidase

allopurinol

In the treatment of gout, allopurinol inhibits which enzyme

xanthine oxidase

Is arthritis more common at the sternoclavicular or acromioclavicular joints?

Acromioclavicular >>>>>> sternoclavicular

isolated raised serum ALP in an elderly patient with deafness and lion faces is consistent with ________ it is treated with what two drugs?

pagets disease bisphosphonates and calcitonin

Malar rash is associated with which two rheumatological disorders?

SLE and dermatomyositis

Muscle fibres are grouped into structures called

fascicles

Non-scarring alopecia is a symptom of SLE, true or false?

TRUE

Outline the treatment of gout

- NSAIDs/colchicine/steroids (acutely) - Diet/lifestyle modification (alcohol, red meat, fructose drinks) - Allopurinol/febuxostat

Outline the treatment of pseudogout

- NSAIDs/colchicine/steroids - Rehydration

Paget's disease involves the entire skeleton, true or false?

FALSE Localised process involving one or more bones (eg, pelvis, femur, skull)

Painful mouth ulcers are symptoms of SLE, true or false?

FALSE Painless ulcers are a symptom

SLE is driven by type __ hypersensitivity also known as-

type III aka immune-complex mediated

The most common presenting feature of myopathy is

muscle weakness

What antibodies should be tested for in a patient with suspected CREST syndrome and breathing difficulties?

Anti-centromere antibody

What crystal arthropathy presents with rapid joint deterioration, often in the shoulder, with no crystals but red lumps (Alizarin stain) in the synovial fluid?

Hydroxyapatite arthropathy- calcific tendonitis

What are tophi?

Chalky accumulations of uric acid in soft tissues; secondary to gout

What drug class can be used to treat Raynaud's disease?

- Calcium channel blockers - Phosphodiesterase inhibitors (sildafenil)

What does mosaic, puzzle-piece, lamellar bone suggest?

Paget's disease

What is CREST and what is it associated with?

Calcinosis, Raynaud's, (o)esophageal dysmotility, sclerodactyly, and telangiectasia Systemic sclerosis

What is the clinical presentation of fibromyalgia?

Excessive tenderness of soft tissues (11/18 points) without raised inflammatory markers

What is the difference between a simple and compound synovial joint?

Compound = more than one pair of articular surfaces

What is the pathogenesis of systemic sclerosis?

Excessive collagen deposition

What is the difference between temporal/giant cell arteritis and Takayasu arteritis?

Takayasu = under 50 years of age; mainly affects aorta/large vessels; young Asian women Temporal/giant cell = over 50 years of age; mainly affects temporal arteries; old Swedish women

What is the treatment for polymyalgia rheumatica?

Low-dose steroids (15mg prednisolone)

when is Gottron's sign (hands) seen

dermatomyositis

shawl sign (back)-

dermatomyositis

Heliotrope rash -

dermatomyositis

What neurological condition is associated with anti-phospholipid syndrome?

Migraine

What ophthalmological complication can occur in temporal arteritis?

Anterior ischaemic optic neuropathy

What other treatment should be initiated in an elderly patient who is started on steroid therapy?

Bone protection (oral alendronate)

What symptom is almost pathnogonomic of temporal arteritis?

Jaw claudication

When should a patient with their first attack of gout take allopurinol?

If they have more than one attack in a year

Which rheumatological condition presents with skin changes on the arms (above the elbows), interstitial lung disease, and renal crisis?

Diffuse cutaneous systemic sclerosis

Which rheumatological condition presents with skin changes on the arms (below the elbows), pulmonary hypertension, and swallowing problems?

Systemic sclerosis

Which vasculitis commonly presents with ENT symptoms such as nose bleeds, deafness, recurrent sinusitis and nasal crusting?

Wegener's/granulomatosis with polyangiitis

Would you give naproxen to a patient with CKD?

NO! Give codeine instead

________ causes acute onset of severe shoulder pain and is characterized by calcium deposition in the ______ tendon

acute calcific tendonitis supraspinatus

Anti-centromere antibody is associated with limited/diffuse systemic sclerosis?

limited

which antibody is associated with polymyositis?

anti-jo-1

Anti-Jo-1 is associated with which condition?

polymyositis

Which antibody is very sensitive but not specific in SLE

ANA

Which antibody is associated with diffuse systemic sclerosis

Anti-Scl-70

Which crystal arthropathy is associated with monosodium urate

gout

Which crystal arthropathy is associated with needle-shaped, negative birefringence crystals?

gout

Henoch-Schonlein purpura is an acute Ig_ ?-mediated generalised vasculitis, occurring usually in children aged 3-10 years. It can mimic what surgical condition?

igA appendicitis

______ biopsy is indicated in suspected myositis

muscle biopsy

what type of cell are responsible for bone resorption?

osteoclasts

What condition only occurs in patients older than 50 years. It affects the shoulders and hips. The defining clinical symptoms are morning stiffness with normal muscle strength

polymyalgia rheumatica

patients with polymyalgia rheumatica are at increased risk of what condition?

giant cell arteritis

what are the defining clinical symptoms of polymyalgia rheumatica

morning stiffness normal muscle strength

what condition presents with symmetrical painless weakness in proximal muscles and swallowing difficulties

polymyositis

polymyositis is a ____- cell mediated cytotoxic process against ____ antigens ?

CD8+T cell mediated against muscle antigens

Which crystal arthropathy is associated with calcium pyrophosphate

pseudogout

Which crystal arthropathy is associated with rhomboid-shaped, weakly positive birefringence crystals?

pseudogout

What rheumatological condition can be drug-induced (often due to hydralazine, procainamide, or isoniazid) and is characterised by anti-histone antibody. Its resolves with removal of the drug?

SLE

________biopsy is indicated in suspected giant cell arteritis

temporal artery DO NOT WAIT FOR RESULTS BEFORE STARTING STEROIDS!

Anti-phospholipid syndrome is associated with thrombosis in veins or arteries?, what cutaneous manifestation? and what haematological abnormalities?

veins and arteries livido reticularis thrombocytopenia and prolonged APTT

A 'hanging rope sign' on xray is a classic finding in-

Perthe's disease/AVN

A bony spur, originating the in metaphyseal regions of long bones and growing away from the epiphysis, is most likely to be an

osteochondroma

A common complication of anterior shoulder dislocation is injury to the _____ nerve

axillary

A patient develops tingling and numbness on the outer aspect of the thigh due to peripheral nerve compression. Which nerve roots have been affected?

L2,3 (lateral cutaneous nerve of thigh)

A patient presents with a bony lesion near the epiphysis. This is most likely a

osteochondroma

A patient presents with a bony lesion of the femur with pain relieved by NSAIDs. Xray shows a circular lytic lesion with a halo of cortical reaction. This is most likely-

osteoid osteoma

A patient who presents to primary care with shoulder trauma + pain + weakness, or sudden loss of ability to actively raise the arm (with or without trauma), should be referred to physiotherapy, true or false?

FALSE Suspect acute rotator cuff tear -> urgent referral to orthopaedic shoulder clinic (NICE)

what type of tumour has a characteristic “soap bubble” appearance on xray. It is the only bone tumour to arise in the epiphysis, often around the knee in adults. It is relevant pathologically due to locally aggressive destruction and metastatic risk (5%)?

giant cell tumour of bone

giant cell tumour of the tendon sheath is a small firm swelling usually found where- Macroscopically they are pigmented lesions and histologically contain multinucleated giant cells and haemosiderin. When in a joint the lesion is known as-

on the PIP of the index/middle finger PVNS

All children with Perthes' disease need urgent surgery regardless of age, true or false?FALSE

Surgical repair of Perthes' disease is only indicated in children age >6. In those age <6, the prognosis is good with no intervention.

Any back pain in a child or adolescent is a red flag, true or false?

True Differential: - Osteomyelitis, discitis (young children) - Spondylolisthesis (adolescents) - Rare things can be benign (osteoid osteoma) or malignant (osteosarcoma)

At birth, children have varus/valgus knees. By age three the knees become very varus/valgus before regressing to slightly varus/valgus in adulthood.

varus valgus valgus

Chondrosarcoma is less common but more aggressive than osteosarcoma, true or false?

FALSE Osteosarcoma is both more common and more aggressive :-(

Dupuytren's contracture is caused by overproduction of type _ collagen

type III collagen Palmar fascia should normally be type 1

Froment's test assesses for weakness of the _____ nerve

ulnar

How should this patient be managed? They have an extremely painful finger with red streaks up their arm.

Flexor tendon sheath infection - SURGICAL EMERGENCY!

In bone disease, normal calcium, normal serum phosphate, and normal serum alkaline phosphatase is consistent with what condition?

osteoporosis

In bone disease, low calcium, low serum phosphate, and high serum alkaline phosphatase is consistent with what conditions?

osteomalacia and rickets

in what paediatric orthopaedic condition, extensive involvement of the proximal femur can produce a shepherd’s crook deformity

fibrous dysplasia

In fibrous dysplasia, extensive involvement of the proximal femur can produce a _______ deformity

Shepards crook deformity

Injection should be avoided in tennis/golfer's elbow (ulnar nerve damage risk)

golfer's

Liposarcomas arise from superficial or deep fatty tissues?

deep

Most cases of Perthes disease are bilateral, true or false?

FALSE Most cases are unilateral

Name that bacteria causing osteomyelitis A patient who has had a dog or cat bite?

Pasteurella

Name that bacteria causing osteomyelitis A patient with a diabetic foot ulcer, or an IV drug user?

Pseudomonas aeroginosum

Name that bacteria causing osteomyelitis A patient with back pain

TB (Pott's disease)

Name that bacteria causing osteomyelitis A patient with sickle-cell anaemia?

Salmonella or S aureus

Name that bacteria causing osteomyelitis A sexually active young adult?

Neisseria gonorrheae

Name that bacteria causing osteomyelitis The most common common overall cause

Staphyloccocus aureus

Recurrent anterior shoulder dislocation can be treated with a ______ repair

Bankart

Rotator cuff tears typically involve the ______ muscle and occur in what type of patients?

supraspinatus elderly

Steroid injection should be avoided in tendonitis of the patellar/quadriceps tendon, true or false?

TRUE High risk of tendon rupture

SUFE can commonly be bilateral, true or false?

TRUE

SUFE - Usually occurs in which patients? - Presents with what symptoms? - Predominant clinical sign loss of - - Any indication of what symptom? = clinical emergency - Long-term sequelae include what complication?

overweight preteen boys knee pain and limp internal hip rotation inability to weight bear AVN

Talipes equinovarus (clubfoot) is equally common in girls as in boys, true or false?

FALSE More common in boys

The flexor pollicis longus travels in the carpal tunnel, true or false?

TRUE

The most common benign tumour of bone is an-

osteochondroma

The most common malignant tumour of bone is-

osteosarcoma

The palmaris longus travels in the carpal tunnel, true or false?

FALSE

The sciatic nerve supplies the gluteal muscles, true or false?

FALSE Supplies nothing in the gluteal region

The spinal cord ends (and cauda equina begins) at which vertebral level?

The ulnar nerve travels in the carpal tunnel, true or false?

FALSE

The L1/2 myotome is tested with what movement?

hip flexion

The L3/4 myotome is tested with what movement?

knee extension

The L5 myotome is tested with what movement?

foot dorsiflexion

The S1/2 myotome is tested with what movement?

ankle plantarflexion

the __ myotome is tested with ankle plantarflexion

S1/2

the __ myotome is tested with foot dorsiflexion

the __ myotome is tested with knee extension

L3/4

the __ myotome is tested with hip flexion

L1/2

Type 1/2 osteoporosis is known as post-menopausal osteoporosis. Colles fractures and vertebral insufficiency fractures tend to occur in this group

type 1

Type 1/2 osteoporosis is known as osteoporosis of old age. Femoral neck fractures and vertebral fractures predominate in this group

type 2

What are the three biggest risk factors for childhood hip dysplasia?

Breech birth, family history, female sex (but many cases present without risk factors)

What diagnosis would you suspect in a child who is small for their age with failure to thrive, who has chest wall deformity and cupping of the epiphysis of the long bones at the wrist?

Rickets

What does bilateral leg pain, saddle anaesthesia, urinary and faecal retention/incontinence, and loss of rectal tone suggest?

CAUDA EQUINA SYNDROME!!!! Any patient with bilateral leg symptoms/signs with any suggestion of altered bladder or bowel function is a cauda equina syndrome until proven otherwise. Urgent MRI needed.

What factor in a child's birth makes hip dysplasia more likely?

Breech position

What is appropriate management for a patient with shoulder pain, but no red flags? Examples include shoulder OA, frozen shoulder, painful arc (without weakness) in an older person.

- Analgesia (paracetamol, NSAID) - Advise normal activity - Manage expectations; advise that this could take up to 6 months - Physio referral - Review in 2 weeks

What is important to elicit in a history of carpal tunnel syndrome?

Night-time symptoms

What is the difference between osteoblastoma and osteoid osteoma? Which one responds to NSAIDs?

Blastoma = back, bloody awful because NSAIDs don't work Osteoid osteoma = o-o = looooong bones, respond to NSAIDs

What is the treatment for developmental hip dysplasia, when caught early?

Pavlik harness for 3-6 months

What proportion of SUFE cases are bilateral?

1/3

What symptoms distinguish sciatica from back pain?

Both can be associated with buttock/thigh pain but back pain cannot radiate below the knee

What tests are helpful in sciatica?

- Straight leg raise - Sciatic stretch test (extend foot) - Bowstring test (pressure on popliteal fossa)

What tests can be done in newborns for developmental hip dysplasia?

Ortolani test (pull legs Out) and Barlow test (push legs Back)

Women are affected by carpal tunnel syndrome more than men, true or false?

TRUE

Women are more commonly affected by Dupuytren's contracture, true or false?

FALSE Men affected more than women 10:1

Carpal tunnel syndrome affects the _____ nerve and presents with parathesia in which digits?

median nerve thumb and radial 2½ fingers

What bone tumour is a benign tumour of cartilage. It arises in the medulla, and often occurs in small tubular bones of the hands and feet.

chrondroma

What bone tumour is a malignant tumour of cartilage. It arises in the medulla, and often occurs in the pelvis or proximal femur.

chondrosarcoma

_______ cysts can occur anywhere except the palms/soles but are most common in hairless areas and around the genitals.

epidermoid

Which bone tumour arises from neuroectoderm cells and has a 11;22 translocation. The tumour arises on diaphysis of long bones in male children, grows in the medullary cavity, and shows an onion-skin appearance on X-ray

Ewings sarcoma

Ewings sarcoma has an _____ appearance on X-ray

onion-skin

Fibrous dysplasia causes lesions of fibrous tissue and immature bone, most often which bones? It is genetic and occurs in adolescents. It is treated with bisphosphonates, stabilisation of pathologic fractures, and cortical bone grafts.

bones of the head and neck

__________ refers to progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18-24 months. The principal clinical sign is loss of external rotation

frozen shoulder

frozen shoulder refers to progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18-24 months. The principal clinical sign is-

loss of external rotation

____________ results from irritation to the plantar interdigital nerves of the foot, causing a localised swelling with burning pain/tingling radiating into the affected toes. It occurs most commonly between the third and fourth metatarsals

Mortons neuroma

Mortons neuroma results from irritation to the plantar interdigital nerves of the foot, causing a localised swelling with burning pain/tingling radiating into the affected toes. It occurs most commonly between where in the foot?

between third and fourth metatarsals

Mortons neuroma can be tested with what test?

mulders click test (squeeze forefoot)

Simmonds test involves squeezing the calf to elicit plantarflexion of the foot; it can be used to test for-

achilles tendon rupture

________ test involves squeezing the calf to elicit plantarflexion of the foot; it can be used to test for achilles tendon rupture

Simmonds

________ is defined as inflammation of a tendon

tendonitis

________ is defined as disease of a tendon

tendonopathy

________ is defined as inflammation of the tendon sheath

tenosynovitis

_______ is the commonest cause of hip pain in childhood. It often follows viral respiratory tract infection

transient synovitis

Transient synovitis is the commonest cause of hip pain in childhood. It often follows _______ . Crucial differentials are which three conditions?

viral respiratory tract infection septic arthritis Perthes disease juvenile idiopathic arthritis/rheumatoid arthritis

A 19-year-old male is playing football when another player’s boot collides with the lateral aspect of his knee joint. There is pain and about 4 hours later, there is stiffness, bruising and swelling of the joint with pain felt on the medial aspect of the knee. On examination, there is abnormal passive abduction of the knee joint. Which ligament is most likely to have been injured?

Medial collateral ligament

A 22-year-old female returns from a skiing holiday complaining of a ‘floppy’ left foot that ‘slaps’ on the floor during walking. On examination, the doctor also notices that she has a reduced sensation in the 1st web space of her left foot. Injury to which nerve specifically is the most likely reason for this presentation?

Deep fibular nerve

A 24-year-old footballer presents with a painful knee after being tackled from behind. With the quadriceps femoris muscle relaxed, the tibia is able to glide anteriorly on the femur when the knee joint is flexed to 30°. What is the suspected ligament injury in this patient?

Anterior cruciate ligament

A 28-year-old motor mechanic presents to your GP surgery with a swollen knee, which she says has been getting worse for the past few weeks. On examination, you find a ballottable swelling superior to the patella. Which bursa is most likely to be inflamed?

Suprapatellar bursa

A common complication of a “bumper” injury to the lateral knee is _______ nerve palsy

common fibular

A common complication of supracondylar fracture of the elbow is _______ nerve injury

median

A common complication of anterior shoulder dislocation is injury to the _____ nerve

axillary nerve

A common complication of what upper arm injury is injury to the axillary nerve

anterior shoulder dislocation

A common complication of humeral shaft fracture is injury to the ______ nerve

radial nerve

A common complication of what upper arm injury is injury to the radial nerve

humeral shady fracture

A distal fibula fracture with medial malleolus involvement is stable/unstable?

unstable

A less common type of obstetric brachial plexus palsy is ______ palsy. caused by injury to _______ nerve roots. It causes paralysis of intrinsic hand muscles and wrist flexors

Klumple's C8 and T1

A patient arrives at the general practice clinic complaining of a limp. The GP observes his gait and notices that the patient’s left hip drops on lifting his left leg off the ground. Which muscle is likely to be affected?

Gluteus medius

A patient develops loss of knee extension and sensory loss to the anterior and medial aspect of the thigh following a stab injury. Which structure is likely to be damaged?

Femoral nerve

A patient develops tingling and numbness on the outer aspect of the thigh due to peripheral nerve compression. Which nerve roots have been affected?

L2,3 (lateral cutaneous nerve of thigh)

A patient who can no longer abduct his arm following a humeral fracture likely has injury to what nerve?

Axillary nerve

A patient who has foot drop following a fibular fracture likely has injury to what nerve?

Common fibular (peroneal) nerve

A patient with pain down the dorsum of foot, and reduced power of extensor hallucis longus and tibialis anterior likely has radiculopathy due to L_____ prolapse L_ root entrapment

L4/5 prolapse L5 root entrapment

A patient with claw hand after fracture of the medial epicondyle likely has injury to what nerve?

Ulnar nerve

A patient with pain down to the medial ankle, loss of quadriceps power, and reduced knee jerk likely has radiculopathy due to L____ prolapse L_ root entrapment

L3/4 L4

A patient with pain to the sole of foot, reduced power of plantarflexion, and reduced ankle jerk reflex likely has radiculopathy due to L__ prolapse __ root entrapment

L5/S1 prolapse S1 root entrapment

A patient with wrist drop following a humeral fracture likely has injury to what nerve?

Radial nerve

A patient with pins and needles in the thumb and index finger likely has injury to what nerve?

Median nerve

A Smith fracture can be managed conservatively, true or false?

FALSE Very unstable; invariably managed with open reduction and internal fixation

A young boy presents with difficulty walking straight, raised creatinine phosphokinase, and fatty inclusions on muscle biopsy. The diagnosis is-

Duchenne's muscular dystrophy- X-linked defect in the dystrophin gene

a Thomas splint is used in the immediate management of _______ fractures

femoral shaft fractures

a _____ splint is used in the immediate management of humeral shaft fractures

Thomas splint

After suffering from a posterior hip dislocation, a patient has weak flexion of the knee joint and is unable to plantar or dorsiflex her ankle joint. She also has anaesthesia of the skin inferior to the knee joint except for the medial aspect of the leg. Which nerve is likely to have been injured?

Sciatic nerve

Although usually autosomal dominant, some cases of osteogenesis imperfecta can be recessive, true or false?

TRUE Important when thinking about non-accidental injury.

An extra-articular fracture of the distal radius with dorsal displacement is known as a ______ fracture

colles fracture

An extra-articular fracture of the distal radius with dorsal/volar displacement is known as a Colles fracture

dorsal

An extra-articular fracture of which bone? with dorsal/volar displacement is known as a Colles fracture

distal radius

An extra-articular fracture of the distal radius with volar displacement is known as a _______ fracture

smith fracture

An extra-articular fracture of the distal radius with volar displacement is known as a Smith fracture

volar

Ataxic is the most common type of cerebral palsy, true or false?

FALSE Spastic (weakness, spasticity) is the most common type. Ataxic (reduced coordination, balance) and athetoid (extrapyramidal symptoms) are less common.

Atlanto-axial (C1/C2) instability is associated with which two conditions?

- Down's syndrome - Rheumatoid arthritis (if untreated)

Following rupture, ACLs can sometimes be surgically repaired, true or false?

FALSE Repairs never work; ligament needs to be reconstructed

Fracture of the midshaft of the humerus is likely to injure what nerve?

Radial

Galeazzi injury is a fracture of the radius/ulna with dissociation of the radius/ulna head

fracture of distal third radius dislocation of ulnar head

How are extracapsular hip fractures usually treated?

DIH screw or IM nail

How are intracapsular hip fractures usually treated?

total hip replacement, CHS, or hemiathroplasty

How does Salter-Harris type affect fracture management in children?

Type I/II - no epiphyseal involvement, conservative management Type III/IV - consider operative management as physeal plate involved

How good is recovery after ACL injury?

- 1/3 do very well - 1/3 'manage' - 1/3 do poorly and need reconstruction

How would you manage this patient presenting to A&E after a fight? (5th metacarpal fracture)

Boxer's fracture -> buddy taping (if not displaced)

in children, Monteggia and Galeazzi fracture-dislocations can be managed conservatively, true or false?

FALSE Need rigid fixation with plates/screws

In knee injury, what does the unhappy triad refer to?

Injury to medial meniscus, MCL, and ACL

In patellar dislocation, the medial/lateral patello-femoral ligament is most often damaged

medial

In the knee, rotary instability with giving way on turning is strongly suggestive of _____ injury

ACL

In the knee, tenderness on the medial joint line and locking is strongly suggestive of ______ injury

meniscal

Intracapsular hip fractures are more likely to feature interruption of the blood supply to the femoral head, true or false?

TRUE

Medial meniscal tears are more common than lateral tears, true or false?

TRUE

Metatarsal stress fractures most commonly occur in what digits?

2nd metatarsal followed by the 3rd

Monteggia injury is a fracture of the radius/ulna with dislocation of the radius/ulna head?

fracture of ulna dislocation of radius

Name that hip fracture management Displaced intracapsular fracture, significant comorbidities

hemiarthroplasty

Name that hip fracture management Extracapsular fracture (non special type)

Dynamic hip screw

Name that hip fracture management Extracapsular fracture - reverse oblique, transverse, or sub-trochanteric

IM nail

Physiotherapy is helpful in hallux valgus, true or false?

FALSE

This patient is complaining of wrist pain in anatomical snuffbox, what fracture do you suspect?

scaphoid fracture

Tibial and femoral shaft fractures take 4-6 weeks to heal, true or false?

FALSE They take 3-4 months!

Undisplaced scaphoid fractures are usually treated in a cast for 6-12 weeks, true or false?

TRUE

What complication might you suspect in a recovering trauma patient who develops hypoxia, confusion, and a rash?

PE picture + rash -> fat embolism

what does Blue sclera suggest

osteogenesis imperfecta

What is the most common type of Salter-Harris fracture?

Type II

What kind of cartilage is found in epiphyseal growth plates, tracheal rings, costal cartilage, and articular surfaces?

Hyaline cartilage

What might a 'dinner fork' deformity of the wrist suggest?

Colles fracture

What nerve innervates the anterior compartment of the arm?

Musculocutaneous nerve (Biceps, brachialis, coracobrachialis)

What significant complication (a medical emergency) can occur with any tibial fracture?

Compartment syndrome

What substance gives synovial fluid its high viscosity?

Hyaluronic acid

What type of elbow fracture is common in children?

Supracondylar fracture

What type of fixation is appropriate in a patient with an open tibial fracture?

External fixation - you don't want to do internal fixation on a dirty wound

Which distal fibular fractures need ORIF (as opposed to a cast)?

Rupture of the deltoid ligament (medial bruising and tenderness) or any talar shift on xray

Which immunosuppressant is used in severe lupus?

IV cyclophosphamide

WHO defines osteoporosis as bone mineral density greater than _____ SD below the mean peak value of young adults of the same race and sex. Osteopenia is an intermediate stage where bone mineral density is ________ SD below mean peak value.

2.5 1-2.5

You would suspect what type of knee injury in a patient with rotary instability following knee trauma

ACL rupture

You would suspect what type of knee injury in a patient with valgus instability following knee trauma

MCL rupture

You would suspect what type of knee injury in a patient who cannot descend stairs following knee trauma

PCL rupture

You would suspect what type of knee injury in a patient with popliteal pain and bruising following knee trauma

PCL rupture

_______injury typically presents as a sports injury with high twisting force applied to a bent knee, with a loud crack, pain and rapid joint swelling

ACL

Avascular necrosis can occur in structures with retrograde blood supply, for example after fracture of the what wrist bone?

scaphoid

Creeping substitution is a buzzword for what?

AVN

__________ is a specific term used to describe the lack of full extension possible in a displaced bucket handle meniscal tear

knee locking

____ injury typically results from a hyperextension injury to the knee

PCL

MSK Flashcards

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