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4. MSK Flashcards

1
Q

Flail Chest

Cause/PE/Tx/MC site

A
  • Cause: Blunt trauma (3 or more adjacent ribs broken)
  • PE
    • inspiration - flail segment contract
    • expiration - flail segment expands
  • Tx: Supportive care (NO CHEST WRAPPING)
    • 2 or more possible internal damage, should admission
  • MC rib fx - 4-9
    • Rib 1-2 - serious
    • Rib 9-12 - liver, spleen damage
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2
Q

Compartment syndrome

Cause/Sx/PE/Tx

A
  • Cause: tibial fx
  • Sx: out of proportion pain
  • PE
    • 6 p’s
      • Pallor
      • Pain
      • Pulselessness
      • Paralysis (muscle function is gone)
      • paresthesia (abnormal dermal sensation)
      • poikilothermia (unable to control body temp)
  • Dx: intracompartmental pressure >30-45 (normal 0-10), Delta pressure 30>, Lab: CK/Myoglobin
  • Tx: Emergent fasciotomy
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3
Q

Osteoarthritis

Cause/Sx/PE/Dx/Tx

A
  • Cause: Age related
  • Sx: Joint pain with activity
  • PE: PIP (Bouchard), DIP (heberden)
  • Dx: X-ray (joint narrowing)
  • Tx: NSAID, corticosteriod
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4
Q

Osteomyelitis

Cause/Sx/Dx/Tx

A
  • Cause: infection
    • General - Staph A
    • Sickle cell - salmonella
    • cat/dog - pasteurella multocida
    • Puncture wound - pseudoma
  • Sx: pain over bone, fever
  • Dx: X-ray (initial), MRI (best), Bone aspiration (Gold)
  • Tx: Abx (2-6 week) - IV for 2 weeks
    • Staph A - Nafcillin
    • MRSA - Vanco
    • Puncture - cipro
    • Sickle cell - cipro
    • Cat/dog - ampicillin, augmentin
  • Spread
    • hematogenous - children
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5
Q

Septic arthritis

Cause/Sx/Dx/Tx

A
  • Cause: Staph A infection
  • Sx: Fever, joint pain, swelling
  • Dx: Arthrocentesis (WBC 50,000 PMN)
  • Tx: Gram + - nafcillin, Gram - (Gonorrhea) - Ceftx
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6
Q

Rhabdomyolysis

Cause/Sx/Dx/Tx

A
  • Cause: injury muscle releave CK or myoglobin to blood stream -> kidney
  • Sx: edema
  • Dx: CK level(initial) , Urine Dark (myoglobin but NO RBC)
    • hypocalcemia, Hyperkalemia - ECG check
  • Tx: IVF, bicarbonate
  • Complications: DIC, ARF, compartment syndrome
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7
Q

Avascular necrosis

Cause/Common site/Dx

A
  • Cause: Corticosteriod use
  • Femoral head is common site
  • Dx: MRI
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8
Q

Develomental dysplasia of the hip

Cause/PE/Dx/Tx

A
  • Cause: decreased pressure of the femoral head against acetabulum
  • PE
    • Galeazzi - flex hip both knee not even (postivie)
    • Barlow - dislocation occur when adduction
    • Ortolani - dislocation occur when abduction
  • Dx: US
  • Tx: Pavlik harness
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9
Q

Hip dislocation

Cause/MC site/PE/Tx

A
  • Cause: MC MVA trauma
  • MC site: Posterior
  • PE: leg shorten internal rotated - sciatic nerve injury
  • Tx: Emergent reduction
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10
Q

Hip Fx

MC common site/PE/Dx/Tx

A
  • MC common site: Femoral neck
  • PE: leg shorten external rotated
  • Dx: MRI
  • Tx: ORIF
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11
Q

Prepatella bursitis

Cause/PE/Dx/Tx

A
  • Cause: chronic kneeling (house maids knee)
  • PE: Dome shape swelling
  • Dx: Aspiration to rule out septic, inflammation
  • Tx: NSAID, steriod injection
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12
Q

Patella dislocation

Cause/PE/Tx

A
  • Cause: twisting injury
  • MC common: lateral dislocation
  • PE: patella displaced, apprehension sign (push laterally patient contract qudriceps
  • Tx: Closed reduction and knee immobilizaer
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13
Q

Patella fx

Cause/Dx/Tx/Special comment

A
  • Cause: Direct Trauma
  • Dx: Sunrise view x-ray
  • Tx
    • Nondisplaced - knee immobilize x 6 weeks
    • Displaced - surgery
  • Special comment: bipartitie patella - if both broken part is not sharp and smooth the means not related to trauma
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14
Q

Knee dislocation

Cause/Dx/Tx

A
  • Cause
    • MC anterior - hyperextension
    • Posterior - knee flexed and anterior tibia blow
  • Dx: X-ray
    • Nerve - common peroneal
    • Artery - Popliteal artery
  • Tx: Emergent reduction
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15
Q

Meniscus injury

Cause/Sx/PE/Dx/Tx

A
  • Cause: Twisting
  • Sx: Knee locking, effusion after activity
  • PE: McMurray (tibia externally or internally rotate pop or click)
  • Dx: MRI
  • Tx: NSAID, PT
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16
Q

MCL vs LCL

PE/Tx

A
  • PE
    • MCL - vaLgus
    • LCL - vaRus
  • Tx: NSAID, complete tear - surgical
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17
Q

ACL vs PCL

Cause/Sx/PE/Tx

A

ACL

  • Cause: Sports related Pivoting injury (MC knee ligament injury)
  • Sx: audiable pop, swelling
  • PE: Lachman
  • Tx: Surgical

PCL

  • Cause: Dashboard injury (hit proximal anterior tibial when knee flexed)
  • Sx: dull aching pain and swelling
  • PE: Posterior drawer test
  • Tx: surgical
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18
Q

Ankle sparin

Cause/MC site/Sx/Dx/Tx

Ankle dislocation

MC type/Tx

A
  • Cause: foot inversion
  • MC site: ATFL (ankle talofibular ligament)
  • Sx: Swelling and tenderness
  • Dx: Ottawa ankle rule (x-ray)
    • Tenderness Posterior tip of lateral or medial malleoulus
    • Tenderness on navicular, fifth metasal (mid foot)
    • Inability to bear weight 4 step
  • Tx: PRICE (Protect, rest, ice, compress,elevation)
  • MC type: Posterior
  • Tx: close reduction
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19
Q

Type of fracture

SALTR

A
  • Type of fx
    • open - bone expose to outside
    • Closed - fx inside
  • SALTR
    • Slipped
    • Above
    • Low
    • Through
    • Rammed
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20
Q

Lisfranc injuries vs Jones and Psedo jones fx

PE/Tx

A

Lisfranc

  • PE: Pain tenderness at base of 2nd metatarsal (Malunion possible)
  • Tx: Surgical

Jones and Pseudo jones fx

  • PE: Fifth metatarsal diaphysis fx (Jone), Avulsion (pseudo jone)
  • Tx: Cast 6-8weeks (Jone), 2-3weeks (pseudo jone)
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21
Q

Morton’s neuroma

Cause/Sx/Dx/Tx

A
  • Cause: Painfull mass at 3rd metatarsal head
  • Sx: Pain with walking
  • Dx: MRI
  • Tx: Wide shoes, Glucocorticoid injection -> Surgical remove if failed 1st tx
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22
Q

Bunion vs Hammer

Joint involve/Tx

A
  • Bunioin
    • Location: 1st metatarsal deviation
    • Tx: Wide shoes, surgical if failed 1st tx
  • Hammer toe
    • Location: 2-4th metatarsal PIP flex DIP extend
    • Tx: Wide shoes, surgical if failed 1st tx
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23
Q

Tarsal tunnel syndrome

Cause/Sx/Tx

A
  • Cause: posterior tibial nerve compressed
  • Sx: Numbness at medial malleolus heel and sole
  • PE: Tinel sign
  • Tx: NSAID, corticosteriod inject
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24
Q

Plantar fasciitis

Cause/Sx/PE/Tx

Children with heal pain?

A
  • Cause: inflammation of plantar fascia
  • Sx: heel pain, tenderness worse at night
  • Dx: X-ray normal, flat foot
  • Tx: Rest, Ice, NSAID

Sever disease, 8-12yo, self limied

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25
Q

Foot Stress fx

Cause/Location/Dx/Tx

A
  • Cause: overuse foot (athletes & military)
  • Location: 3rd metatarsal
  • Dx: X-ray normal
  • Tx: Rest
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26
Q

Baker’s cyst

Cause/Sx/Tx

A
  • Cause: fluid effision is displaced with cyst formation
  • Sx: Painless cyst at knee
  • Tx: ICE, rest, NSAID
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27
Q

Osgood-Schlatter disease

Cause/Sx/PE/Tx

A
  • Cause: Rapid growth at tibial tuberosity 10-15 yo
  • Sx: Knee Pain when runs
  • PE: Tenderness over tibial tuberosity
  • Tx: ICE, Rest, NSAID
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28
Q

Patellofemoral syndrome

Sx/Dx/Tx

A
  • Sx: knee pain behind or around the patella (usually runner)
  • Dx: Apprehension sign
  • Tx: NSAID, rest
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29
Q

ITB syndrome

Sx/Dx/Tx

A
  • Sx: lateral knee pain (runner)
  • Dx: Ober test
  • Tx: NSAID, rest
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30
Q

Achilles tendon rupture

Sx/Risk/PE/Tx

A
  • Sx: sudden pop sound, sharp calf pain
  • Risk: hx of using FQ
  • PE: Thompson test (squeez calf to see plantar flextion)
  • Tx: Plantar flexed Splint (1st) -> surgical repair
31
Q

Legg-Calve-Perthes disease

Cause/Sx/Dx/Tx

A
  • Cause: Avascular necrosis of femoral head in children (4-10)
  • Sx: painless limping
  • Dx: X-ray
  • Tx: observation (usually revacularization at 2 yo)
    • Limit activity
32
Q

Slipped capital femoral epiphysis

Cause/Sx/Tx

A
  • Cause: femoral head epiphysis slips
  • MC patient: obese male 12-16 yo
  • Sx: hip, thigh or knee pain with limp
  • Dx: X-ray
  • Tx: non-weight bearing clutch
33
Q

Common peroneal neuropathy

Cause/PE/Tx

A
  • Cause: Fx of proximal fibula
  • PE: foot drop w/ numbness
  • Tx: ankle splint
34
Q

Benign Tumor

Name/Patient/Dx/Tx

A
  • Osteocondroma
  • Patient: 10-20y M
  • Dx: X-ray grows away from growth plate
  • Tx: Observation
35
Q

Maliganant tumor

3 type name/Patient/MC site/Dx/Tx

A
  • Osteosarcoma
    • Patient: adolescent (20yo>) or 50<
    • MC site: femur
    • Dx: X-ray sun burst appearance or hair on end
    • Tx: surgical, chemo
    • Special comment: MC bone malignancy (MET to lung)
  • Ewing sarcoma
    • Patient: children (5-25yo)
    • MC site: femur
    • Dx: X-ray onion skin
    • Tx: surgical, chemo
  • Chondrosarcoma
    • Patient: Adult (40-75yo)
    • Dx: X-ray punctate or ring & arc appearance
    • Tx: Surgical
36
Q

Fibromyalgia

Sx/Dx/Tx

A
  • Sx: wide spread muscle pain
  • Dx: diffuse pain 9 out of 18 site
    • All lab Normal
  • Tx: exercise (swimming), pregabalin (FDA approved)
37
Q

Gout vs pseudogout

Crystal type/Synovial Fluid/PE/Tx/Chroinc Tx/Special comment

A

Gout

  • Crystal type: Monosodium urate
  • Synovial Fluid: Negative needle shape
  • PE: First MTP (podogra)
  • Tx: NSAID (1st), colchicine, Corticosteroid
  • Chronic Tx(prevention): Allopurinol (Never use when gout attack occur)
  • Special comment: HCTZ,, Niacin makes worse

Pseudogout

  • Calcium pyrophosphate
  • Positive rhomboid shape
  • PE: Knee swelling
  • Tx: NSAID(1st), colchicine
38
Q

Juvenile idiopathic arthritis

3 type/Age/Sx/Tx

A
  • 3 type/Sx
    • Pauci articular - less than 5 joint but major joint
    • Systemic - Salmon colored rash
    • Polyarthicular - more than 5 joint but small joint
  • Age: less than 16 yo
  • Tx: NSAID, MTX
39
Q

Osteoporosis

Cause/Risk/Dx/Tx

A
  • Cause: decline in bone mass
  • Risk: Steriod use
  • Dx: Dexa scan -2.5 (osteoporosis) 2.5-1.0 (osteopenia)
  • Tx: Bisphosphonates
    • Complication: Osteonecrosis of the jaw, pillesophagitis
40
Q

Polyarteritis Nodosa

Cause/Age/Related/PE/Dx/Tx

A
  • Cause: Inflammation of vasculitis
  • Age: 40-50 yo
  • Related Dz: Hep B
  • PE
    • Tender lumps under the skin thigh and lower legs
    • Derm: Livedo reticularis (startburst livedo)
  • Dx: Bx (necrotizing arteritis) - definitive
    • Lab - ESR high
  • Tx: Steriods
41
Q

Polymyalgia Rheumatica

Cause/Sx/Hx/Dx/Tx

A
  • Cause: inflammation
  • Sx: stiffness hip shoulder neck in the morning
  • Hx: Giant cell artery
  • Dx: ESR high
  • Tx: Corticosteriod
42
Q

Dermatomyositis/Polymyositis

Cause/Sx/PE/Dx/Tx

A
  • Cause: inflammation
  • PE: purple rash on eyelid (heliotrope), progressive weakness of three month
  • Dx: CK, Aldolase high, Anti Jo
  • Tx: Steroid
43
Q

Reactive arthritis

Sx/Dx/Tx/Related dz

A
  • Sx: uveitis, arthritis, urethritis
  • Dx: HLA B27
  • Tx: NSAID
  • Related dz: chlamydia
44
Q

Rheumatoid arthritis vs Ostoarthritis (Main difference Only)

Sx/Dx/Tx

A
  • Main difference sx
    • RA - DIP spare, morning stiffness, Osteopenia, constitutional sx (fever, weakness, muscle pain)
      • PE: Boutonniere deformity, Mallet
    • OA - DIP involove, evening stiffness, Osteophytes
      • PE: heberden, bouchard
  • Dx: RF, Anti-CCP
  • Tx: DMARDs
    • monitor CBC
45
Q

Sjogren syndrome

Sx/Dx/Tx

A
  • Sx: Dry mouth, dry eye
  • Dx: Anti Ro, Anti La test Positive
    • Schirmer test (tear production low)
  • Tx: Pilocarpine, artificial tear
46
Q

SLE (systemic lupus erythematosus)

Sx/PE/Dx/Tx

A
  • Sx: Fever, Joint pain
  • PE: Malar rash
  • Dx: ANA (initial), Anti dsDNA(specific), Anti smith
  • Tx: NSAID, hydroxychloroquine, sun protection
47
Q

Scleroderma

Sx/Dx/Tx

A
  • Sx: Thicken skin, CREST (calinosis, raynaud, esophageal modility, Sclerodactyly, tenlangiectasia)
  • Dx: Anti-Centrome, Anti-Scl 70
  • Tx: DMARDs
48
Q

Ankylosing Spondylitis

Cause/Sx/Dx/Tx

A
  • Cause: HLA B27 positive
  • Sx: Worse in the morning, better with activity
  • Dx: ESR high, X-ray bamboo spine (spine fusion)
  • Tx: NSAID, PT
49
Q

Cauda equina syndrome

Cause/Sx/Dx/Tx

A
  • Cause: herniated disc
  • Sx: acute lower back pain with numbness
  • PE: saddle anesthesia, decreased rector tone
  • Dx: MRI
  • Tx: Emergency operative decompression
50
Q

Hernidated disk

Sx/Location/PE/Dx/Tx

A
  • Sx: back pain radiate to the thigh
  • Location - L4 (thigh), L5 (lateral thigh) S1 (calf, posterior of leg)
  • PE: Straight leg test positive
  • Dx: MRI
  • Tx: PT, surgical intervention
51
Q

Scoliosis

Type/Dx/Tx

A
  • Type
    • Scoliosis - left or right curve
    • Kyphosis - humpback
    • lordosis - sway back
  • Dx: Cobb angle on x-ray
  • Tx: Observe (if 0-10), brace (20-40), surgical (40<)
52
Q

Spinal stenosis

Cause/Sx/Dx/Tx

A
  • Cause: compression on spinal cord
  • Sx: leaning forward relieves pain with old age
  • Dx: MRI
  • Tx: Lumbar epidural injection of corticosteriod
53
Q

Back sprain/Strain

Cause/Hx/Sx/Tx

A
  • Cause: paraspinal muscle injury
  • Hx: lifting object
  • Sx: pain with activity but NO neurologic problem
  • Tx: NSAID, bad rest
  • Red flag of back pain for image test
    • Night pain and weight loss
    • fever, chill and sweats
    • Actue bony tenderness
    • Morning stiffness
54
Q

Toticollis

Cause/PE/Tx

A
  • Cause: Shorten neck muscle
  • PE: Contract sternocleidomastoid muscle
    • head tiltedtoward affected muscle and chin is away from affect muscle.
  • Tx: Daily stretch and PT
55
Q

Spinal Trauma

Sx/PE

A
  • Brown-sequard syndrome
    • Cause: Panetrating trauma damage spinal hemisection
    • PE
      • Ipsilateral - motor, position loss
      • Contralateral - Pain, temperature
  • Anterior cord syndrome
    • Cause: Flexion injury
    • PE: motor, pain, temp loss
      • propriception and vibratory intact
56
Q

Neck Fx

MOA/Dx/Tx

A

C1 Jefferson fx

  • MOA: Axial load (Football, diver)
  • Dx: Xray (odontoid)
  • Tx: halo collar

C2 hangman fx

  • MOA: MVA (hyperextension)
  • Dx: CT
  • Tx: Collar if 3mm less, operative more than 5mm

C6 or C7 fx (clay shoveler)

  • MOA: abrupt flexion
  • Dx: X-ray (avulsion fx)
  • Tx: immobilization
57
Q

Anterior vs posterior dislocation

Sx/Tx

A

Anterior

  • Sx: Externally abduct MC dislocation
  • Dx: X-ray Y view, (hill sachs lesion - humerous head, bankart lesion - glenoid inferior)
  • Tx: immobilization (axillary nerve check - pinprick sensation over the deltoid)

Posterior

  • Sx: Internally adduct
  • Dx: X-ray AP
  • Tx: immobilization
58
Q

AC joint seperation

Cause/Dx/Tx

A
  • Cause: Football direct blow
  • Dx: X-ray
  • Tx: sling immobilization
  • Grade
    • 1 - No rupture
    • 2 - AC rupture
    • 3 - AC, CC rupture
59
Q

Adhesive capsule

Sx/Tx

A
  • Sx: Progressive stiffness for 18-24 month
  • Tx: PT
60
Q

Rotator cuff injuries

Type/Muscle involve/Sx/PE/Tx

A
  • Type
    • Tendonitis - young <40
    • Tear - old 40<
  • Muslce involve: SITS
    • Supraspinatus MC
    • infraspinatus
    • Teres minor
    • Subscapularis
  • Sx: Can’t raise arm up
  • PE: Neer and hawk test
  • Tx: Wall climing exercise, Rest, ICE, NSAID
61
Q

Humeral fx

Other injuries/Tx

Clavical fx

Patient/Tx

Elbow fx (radial head or supracondyler)

PE/Dx

A

Humeral

  • Other injuries: Radial nerve
  • Tx: Sugar tong

Clavical

  • MC Children
  • Tx: mid 1/3 - sling, proximal 1/3 orthopedic surgery

Elbow

  • PE: can’t fully extend
  • Dx: X-ray Fat pad sign, Sail sign
    • Children - supracondyler
    • Adult - radial head
  • Tx: Sling or splint
62
Q

Flexor tenosynovitis

Pathogen/Cause/Sx/Dx/Tx

A
  • Pathogen: Staph A
  • Cause: infection
  • Sx
    • swelling finger (sausage like)
    • pain with extension
    • finger flexed
    • tenderness near tendon sheath
  • Dx: aspiration or Bx (definitive)
  • Tx: I&D + Abx
63
Q

Olecranon bursitis vs fx

Sx/Complication/Tx

A

Olecranon Fx

  • Sx: Swelling at elbow can’t full extend
  • Complication: Ulnar nerve
  • Tx: Reduction

Olecranon bursitis

  • Sx: Abrupt gooes egg (boggy, red elbow)
  • Complication: Septic bursitis
  • Tx: Rest, NSAID
64
Q

Scaphoid fx

Sx/Complication/Dx/Tx

A
  • Cause: FOOSH
  • PE: Anatomic snuff box tenderness
  • Complication: avascular necrosis
  • Tx: always Thumb spica splint
65
Q

Colles vs smith fx

Cause/Dx/Complication/Tx

A
  • Colles
    • Cause: fall w/ Wrist extension
    • Dx: dinner fork X-ray
    • Complication: EPL rupture
    • Tx: sugar tong splint
  • Smith
    • Cause: fall w/ wrist flexed
    • Dx: garden spade X-ray
    • Complication: medial nerve
    • Tx: sugar tong splint
66
Q

CRPS (Complex regional pain syndrome)

Hx/Sx/Tx

A
  • Hx: hx of fx or soft tissue injured and healed
  • Sx: Pain started after healed
  • Tx: NSAIDs (1st), Vitamin C prophylaxis
67
Q

Mallet vs boutonniere vs swan neck

PE/Tx

A
  • Mallet
    • DIP flexed
  • Boutonnier
    • PIP Flexed
  • Swan neck
    • PIP hyperextend
    • DIP flexed
  • Tx: Splint anormal part
68
Q

Game vs skier thumb

Ligament involve/Sx/Tx

A
  • Ligament - ulnar collateral
  • Sx
    • Game - chronic
    • Skier - acute
  • Tx: Thumb spica
69
Q

Boxer fx

Cause/Tx

A
  • Cause: fist fighting 4,5th finger broken
  • Tx: Ulnar gutter splint
    • Always check for bit wound
      • if bitten - augmentin
70
Q

Carpal tunnel syndrome

Sx/Dx/Tx/Other similar dz

A
  • Cause: median nerve compressed
  • Sx: night pain, 1-3 1/2 finger, thenar muscle wasting
  • Dx: Phalen test (best), tinel
  • Tx: Volar splint
  • Other similar dz: pronator dz (medial nerve compressed but NO night pain)
71
Q

Dypuytren contracture

Sx/Tx

A
  • Sx: Crease, nodule proximal phalanx
  • Tx: Corticosteriod injection
72
Q

de Quervain tenosynovitis

Cause/Sx/Dx/Tx

A
  • Cause: APL + EBP
  • Sx: Radial side pain
  • Dx: Finkelstein test (pain with ular deviation)
  • Tx: Thumbspica
73
Q
  1. night of heavy drinking and wrist drop?
  2. MUGR fx?
  3. Lateral vs medial epicondylitis
  4. Nursemaid elbow
  5. Spill teacup x-ray
  6. Most serious carpal fx (complication)
A
  1. Saturaday night palse
    • Radial nerve compress C6-8
    • Tx: PT, pain management
  2. MUGR
    • MU - monteggia - ulnar fx
    • GR - Galeazzi - Radial fx
    • Tx: ORIF
  3. Lateral epicondylitis
    • lateral - extension resist - ECRB
    • Medial - flexsion resist
    • Tx: RICE
  4. Nursemaid
    • Sx: Pulling with one hand, 5yo>
    • Tx: Manual reduction (supinate and flex)
  5. Lunate dislocation
  6. Lunate fx (avascular lunate - keinbock dz)

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