FSEM MSK Diploma flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Ottawa ankle rules

Ankle radiography is indicated if there is malleolar pain plus bone tenderness at the posterior lateral or medial malleolus, or inability to weight bear four steps.

Lachman test

Knee test performed at about 30° flexion; the anterior cruciate ligament is assessed by anterior tibial translation. It is more sensitive than the anterior drawer test.

Likelihood ratio positive formula

LR+ equals sensitivity divided by (1 minus specificity). Values above 10 substantially increase post-test probability of the target condition.

SnNout rule

A highly sensitive test that is negative helps rule out disease; a highly specific test that is positive helps rule it in (SpPin).

Thompson test

With the patient prone, squeezing the calf should plantarflex the ankle; absence of plantarflexion indicates a complete Achilles tendon rupture.

Septic arthritis aspiration

Joint aspiration before antibiotics is the key investigation; synovial white cell counts above 50,000 per microlitre with neutrophil predominance suggest infection.

Gout crystal identification

Polarised light microscopy of aspirated synovial fluid shows needle-shaped, negatively birefringent monosodium urate crystals, which confirms gout.

Progressive tendon loading

Tendinopathy rehabilitation uses progressive, high-load strength work, such as heavy slow resistance or eccentric exercise, typically for 12 weeks, with load increased as pain allows.

ACL return to sport criteria

Return to running and sport is criteria-based, including quadriceps and hamstring limb symmetry above 90%, hop tests, and usually at least nine months after reconstruction.

Corticosteroid injection risk

Intra-articular or peritendinous corticosteroid gives short-term pain relief but may weaken tendon, so it is avoided in the Achilles tendon and used cautiously around weight-bearing tendons.

NICE knee osteoarthritis pathway

Core treatment is exercise and weight loss; then NSAIDs or topical NSAID, then intra-articular corticosteroid; joint replacement is considered for severe symptoms.

Blood flow restriction parameters

Low-load resistance training with cuff pressure commonly 60–80% of limb occlusion pressure improves strength and hypertrophy, useful when high loads are not tolerated.

PEACE and LOVE

Acute soft tissue injury guidance emphasising protection, elevation, avoiding anti-inflammatories, compression and education, followed by load, optimism, vascularisation and exercise.

Bone stress injury management

Management depends on site and grade; high-risk sites such as the femoral neck, anterior tibia and navicular require strict offloading and specialist review because of non-union risk.

2010 ACR/EULAR RA criteria

Rheumatoid arthritis is classified when a score of at least 6 of 10 is reached across joint involvement, serology, acute-phase reactants and symptom duration.

Anti-CCP antibody

Anti-cyclic citrullinated peptide has specificity around 95% for rheumatoid arthritis and may predate symptoms by years; it is more specific than rheumatoid factor.

Gout urate target

Urate-lowering therapy is titrated to a serum urate below 360 micromol/L, or below 300 micromol/L in severe disease, with allopurinol usually first line.

Giant cell arteritis

Age over 50 with new headache, jaw claudication or visual loss requires immediate high-dose glucocorticoid before temporal artery biopsy or ultrasound.

Polymyalgia rheumatica

Shoulder and hip girdle pain with morning stiffness in patients over 50, raised inflammatory markers, and prompt response to low-dose prednisolone (15–20 mg daily).

Central sensitisation

Amplified nociceptive processing in the central nervous system produces pain disproportionate to tissue damage, often with spread, fatigue and sensitivity to stimuli.

WHO physical activity guidelines

Adults should do 150–300 minutes of moderate, or 75–150 minutes of vigorous, aerobic activity weekly plus muscle-strengthening activities on at least two days.

Exercise-induced bronchoconstriction test

A fall in FEV1 of at least 10% after exercise challenge supports exercise-induced bronchoconstriction; eucapnic voluntary hyperpnoea is an alternative bronchial challenge.

SCAT6

The Sport Concussion Assessment Tool version 6 supports sideline and office assessment of concussion; same-day return to play is not permitted and graded return follows 24-hour steps.

RED-S

Relative energy deficiency in sport results from low energy availability and impairs bone health, menstrual function, immunity and performance; it affects male and female athletes.

Exertional heat stroke

Core temperature above 40°C with central nervous system dysfunction; immediate cold-water immersion is the priority treatment, with cooling started before transport.

StARRT return to play framework

Strategic Assessment of Risk and Treatment considers tissue health, sport demands and modifying factors, giving a shared estimate of return-to-play risk.

Number needed to treat

NNT is the reciprocal of the absolute risk reduction; for example, an absolute risk reduction of 0.1 gives an NNT of 10.

GRADE approach

Grades quality of evidence as high, moderate, low or very low and rates recommendations as strong or weak, considering values, preferences, costs and feasibility.

Absolute risk reduction formula

ARR equals the control group event rate minus the treatment group event rate; it reflects the actual benefit per patient better than relative risk.

Mental Capacity Act 2005

Adults are presumed to have capacity; capacity is decision- and time-specific, assessed by understanding, retention, weighing and communication, with best-interests decisions otherwise.

Duty of candour

A professional and statutory obligation to be open with patients when something goes wrong, including apologising, explaining what happened and offering remediation.

Publication bias

Studies with positive results are more likely to be published, inflating pooled effect sizes; funnel plots and trial registries help detect or prevent it.