First Year > MSK Management > Flashcards

MSK Management Flashcards

(50 cards)

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1
Q

Clubfoot

A

Ponsetti technique - splinting and casting
Tenotomy of achilles tendon
Surgery if resistant to splintage
Brace

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2
Q

Tip toe walking

A

PT
Leg braces or splints
surgery to lengthen muscles
serial casting

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3
Q

Cerebral Palsy

A

Hip dislocation- surgery
scoliosis - spinal fusion
manage side effects

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4
Q

Standard burns treatment

A

respiratory
manage infection
rehydrate
pain relief

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5
Q

hand specific burns treatment

A

excised damaged skin
perform split skin grafts
aggressive mobilization to prevent finger stiffness
escharotomy - surgical release of eschar

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6
Q

severe hand mutilation initial

A

Initial
- preserve amputated parts on ice
- clean wound
- establish bone support
- establish vascularity
- repair all tissue
- establish skin cover (grafts etc)
- prevent infection
- aggressive mobilisation

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7
Q

severe hand mutilation further

A

plastic surgery
microsurgery
split skin grafts
flaps to cover exposed bone
amputations if necessary
prosthetics later on

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8
Q

Dupuytrens contracture

A
  1. conservative
    monitor
    stretches
    activity modification
  2. surgery
    segmental fasciectomy
    fasciectomy
    dermofasciectomy
    amputation
  3. Newer treatments
    collagenase injection
    percutaneous need fasciectomy
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9
Q

PIPJ Dislocation

A

joint can be pulled back (reduction)
buddy strapped after reduction
if fractured - needs fixation/stabilised

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10
Q

boxers fracture

A

buddy strap
early mobilisation

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11
Q

Bennetts fracture

A

thumb is surgically reduced onto bony fragment and fixed with K wires

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12
Q

Trigger Finger

A

Conservative
- often reverses itself
- splint to prevent flexion
Tendon Sheath Injection
- steroid and local anesthetic
Surgical release
- division of the a1 pulley under GA/LA

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13
Q

Paronychia

A

elevate
antibiotics
incise
drain puss collection

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14
Q

Nail bed injuries

A

TYPE 1 Soft tissue only - dressing only
TYPE 2 Soft tissue and nail - dressing only
TYPE 3 Soft tissue, nail and bone - repair nail bed + stabilise the bone
TYPE 4 proximal 1/3 of phalanx - repair nail bed + stabilise the bone
TYPE 5 proximal to DIP - if tip not available, terminalise the finger or perform a V-Y flap

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15
Q

subungual haematoma

A

if pressure is causing pain -Trephine (small hole pierced in the nail plate to drain)

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16
Q

Flexor tendon sheath infection

A

elevation and high dose antibiotics
emergency surgery - wash out sheath, open up a1 and a5 pulley

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17
Q

flexor tendon injuries

A

conservative - wound care and early ROM
Surgery - flexor tendon repair/reconstruction/transfer

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18
Q

Mallet finger (extensor tendon injury)

A

mallet splint
reduce joint and fixate with K wires and screw
dermatotenodesis in chronic cases

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19
Q

extensor pollicus longus rupture (extensor tendon injury)

A

synovectomy or tendon transfer

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20
Q

SLE

A

MILD
HCQ (hydrochloroquine) and NSAIDs then GC
MODERATE
HCQ (hydrochloroquine) then GC or Immunosuppressants like Azathioprine / Methotrexate
SEVERE
HCQ (hydrochloroquine) then GC and cyclophosphamide

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21
Q

Sjogren’s syndrome

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A

Hypromellose (tear and saliva replacement)
vaginal lube
good dental care and analgesia

HCQ
immunosuppression for major organ involvement

22
Q

Systemic sclerosis

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A

yearly echo and PFT scans
treat raynauds and ulcers
treat reflux - PPI
skin infections- antibiotics
organ involvement - immunosuppression

23
Q

Raynaud’s

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A

keep warm
vasodilators- CCBs, PDE5 inhibitors
Digital Ulcers - Prostacyclin analogues, botox injections, endothelin receptor antagonists

DO NOT GIVE PROPRANOLOL

24
Q

Anti phospholipid syndrome

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A

current thrombosis
- LMWH and warfarin or 75mg aspirin

+ve antibodies but no previous episodes
- do not need anti coagulant

thrombotic event
- life long anti coagulant

pregnant
- LMWH and 75mg aspirin

25
Rheumatoid Arthritis
sort term relief - NSAIDS, analgesics and steroids First line - DMARDs like oral methotrexate (not in preg) Second line- Biological DMARDs eg Anti TNFagents + T Cell receptor blockers Surgery Make sure vaccines are up to date
26
Gout
NSAIDs Colchicine if NSAID not suitable Steroids - 3rd line must exclude septic arthritis first lifestyle modifications Prophylactic therapy (always give NSAIDs to cover) -Xanthine oxidase inhibs (Allopurinol or febuxostat) -Uricosuric drugs (sulfinpyrazone)
27
Pseudogout
no prophylactive management NSAIDs Colchicine Steroids rehydration
28
Hydroxyapatite deposition disease - milwaukee shoulder
usually self limiting NSAID PT Surgical removal of calcifications LAST LINE - partial or total arthroplasty
29
soft tissue rheumatism
pain control rest and ice comprssion PT steroid injections surgery
30
Hyper Mobility Syndrome
patient education PT analgesia if required surgery NOT recommended
31
Anklylosing Spondylitis
NSAIDs Corticosteroids DMARDs Anti TNF Other biologics (secukinumab (IL17 inhib))
32
Psoriatic arthritis
NSAIDs Corticosteroids DMARDs Anti TNF Other biologics (secukinumab (IL17 inhib))
33
Enteropathic arthritis
usually find meds to manage underlying conditions NSAIDs Corticosteroids DMARDs Anti TNF Other biologics (secukinumab (IL17 inhib))
34
Reactive arthritis
NSAIDs Corticosteroids DMARDs Anti TNF Other biologics (secukinumab (IL17 inhib))
35
Osteoarthritis
activity modification topical NSAIDS Oral analgesia steroid injections- give 3 per year
36
Septic arthitis
surgical washout avoid empirical abx if septic - flucloxacillin (if under 5 - ceftriaxone) once organisms are confirmed give 1-2 weeks of abx
37
Prosthetic Joint Infection
early - DAIR debridement antibiotics 12 wks implant retention chronic - stage 2 exchange remove joint (for 6 wks) 6 wks antibiotics (cement) replace joint frail patients - stage 1 exchange remove prosthetic antibiotics loaded cement spacer 6 wks no planned replacement rifampicin if organism is +ve rifampacin sensitive staphlococci
38
acute osteomyelitis
await microbiological diagnosis unless septic best guess antibiotics IV unless there is an abscess that requires draining
39
chronic osteomyelitis
not abx alone surgery - deep bone cultures, remove sequestrum, debridement then IV abx for several weeks if debridement caused bone instability - fixate bone with internal or external fixtures
40
osteoporosis
1. lifestyle mod - increase vit D and Calcium, weight training, avoid excess alc and smoking. fall prevention 2. oral biphosphates like alendronic acid, risedronate, etidronate do not take with food and must wait min of 2 hrs before taking Ca supplement 3. 2nd line - zoledronic acid or desunomab (RANKL) 4. for post menopause Teriparatide or romosozumab
41
osteomalacia / ricketts
Vit D medications and Calcium and Phosphate supplements D3 tablets Calcitriol Alfacalcidol Adcal D3
42
Pagets disease of bone
bisphosphates
43
dermatomyositis/ polymyositis/anti-synthase syndrome
1. corticosteroids - prednisolone 2. immunosuppressants - methotrexate ect
44
fibromyalgia
patient education cognitive therapy analgesia gabapentin or pregabalin anti depressants - SSRIs tricyclics
45
Giant cell arteritis
prednisolone 40-60mg daily
46
polymyalgia rheumatica
prednisolone 15mg daily
47
myonecrosis - clostridium
immediate surgical debridement and antibiotic therapy
48
pyomyositis
antibiotics and surgery - debridement
49
viral myositis
symptomatic relief - rest, hydration, pain relief
50
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