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step II > amboss 6/30 > Flashcards

amboss 6/30 Flashcards

1
Q

what is the presentation of malignant hyperthermia

A

muscle rigidity, perfuse.diaphoresis, hyperthermia, tachycardia, fever, high BP. increased end tidal CO2. there will be a mixed respiratory and metabolic acidosis

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2
Q

what is the cause of malignant hyperthermia

A

sudden increase in intracellular calcium in muscle fibers causes muscle contraction.

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3
Q

what is the treatment of choice for malignant hyperthermia

A

dantrolene

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4
Q

what is the earliest sign of malignant hyperthermia

A

increase in CO2

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5
Q

why does CO2 increase in malignant hyperthermia

A

because of increased muscle metabolism

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6
Q

what is the treatment for serotonin syndrome

A

cyproheptadine

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7
Q

what is the presentation of serotonin syndrome

A

present with hyperthermia, diaphoresis, and muscle hypertonia, it usually occurs after a recent increase in the dose or frequency of antidepressants. Neither were mentioned in this patient. The other typical features of serotonin syndrome are clonus and mydriasis,

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8
Q

what are the necessary steps in someone with vertebral osteomyelitis

A

in hemodynamically stable patients with no neurological symptoms, the first step is Xray and then MRI. After osteomyelitis is considered plausible, CT-guided biopsy is the next step. antibiotics are held off for specifics

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9
Q

what are the recommended empiric antibiotic regimens for osteomyelitis

A

Recommended regimens include a combination of vancomycin with either an antipseudomonal cephalosporin (e.g., ceftazidime, cefepime) or an antipseudomonal fluoroquinolone (e.g., ciprofloxacin, levofloxacin). Ciprofloxacin is effective against Pseudomonas, while vancomycin is effective against Staphylococci,

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10
Q

what is the next step if a septic joint is considered

A

synovial fluid drainage with empiric antibiotic

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11
Q

what often precedes septic arthritis in a child

A

URI/sore throat.

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12
Q

what is the most common cause of septic joint in child

A

staph aureus or streptococcus species

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13
Q

what is arthrocentesis

A

joint aspiration asshole

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14
Q

what is the most important general measure to relieve symptoms in someone with osteoarthritis

A

weight reduction

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15
Q

what is the most common joint disorder in the US

A

Osteoarthritis is the most common joint disorder in the US.

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16
Q

what is the most common joints affected by osteoarthritis

A

. The knee is the most commonly affected joint, followed by the hand and hip.

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17
Q

who gets osteoarthritis

A

Its incidence increases with age and it commonly affects female patients over the age of 50

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18
Q

what are the modifiable risk factors for osteoarthritis

A

There are only a few modifiable risk factors in patients with osteoarthritis, which include obesity and excessive joint loading or overuse; so causal treatment is limited and weight loss would be the most effective measure at this time.

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19
Q

what is legg-calves-perthes

A

essentially avascular necrosis

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20
Q

Conservative management with limited weight bearing and physical therapy is recommended for patients with Legg-Calvé-Perthes disease who

A

are younger than 6 years of age and have minimal or no damage to the femoral head on the initial x-ray.

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21
Q

what is the treatment for SCFE

A

surgical pinning of the femoral head

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22
Q

who gets SCFE

A

Older children who are obese

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23
Q

what is the treatment for developmental dysplasia of the hip

A

hip harness that keeps the hips abducted to 50° and flexed to 90–100° to achieve concentric reduction of the femoral head is the treatment of choice for DDH in infants who are less than 6 months old. The harness should be worn for at least 23 hours/day for 6–8 weeks. T

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24
Q

who gets SCFE

A

children between 10-16 who are obese

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25
Q

who gets transient synovitis

A

history of viral infection, which usually precedes the onset of this condition. most commonly affects children 4–10 years of age.

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26
Q

what is the most pronounced phenotype for osteogenesis imperfecta type one

A

This child presents with blue sclera, short stature, and growth retardation, recurrent fractures from minor falls, and decreased bone density – all classic symptoms of osteogenesis imperfecta.

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27
Q

what is the presentation of a scaphoid fracture

A

typically present following a fall on an outstretched hand. The patient exhibits several common symptoms including pain in the anatomical snuff box, between the tendons of the abductor pollicis longus, and decreased grip strength. When pain occurs in the anatomical snuff box after trauma, the injury should be treated as a scaphoid fracture until proven otherwise; initial x-rays may not reveal the fracture in up to 25% of cases.

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28
Q

what is the treatment for a suspected scaphoid fracture that does not show on x ray

A

spica cast and reimage in two weeks

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29
Q

what is a serious complication of embolectomy of the femoral artery

A

this can cause reperfusion injury and compartment syndrome. this is caused by tissue damage and inflammation from cross-clamping and femoral clotting throughout the procedure

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30
Q

what is the presentation of cholesterol emboli

A

mostly pain and skin changes such as lived reticulais, purpura and necrosis

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31
Q

what is the proper way to preserve a severed limp

A

gently rinsed with water, wrapped in damp gauze, placed in a water-tight bag, and then placed in another bag filled with ice water. An amputated limb should never be placed directly on ice due to risk of cold damage.

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32
Q

what is the most common complication of shoulder dislocation

A

axillary nerve palsy

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33
Q

what is the first thing to do for shoulder dislocation

A

test for sensation

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34
Q

what is the next step if suspected meniscal tear and not MRI possible

A

arthroscopy

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35
Q

what is gram positive, coagulase positive

A

staph aureus

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36
Q

what is gram positive, coagulase negative

A

strep epidermitiis

37
Q

what does an infected prosthetic joint look like

A

opaque, WBC>50K, with PMN > 75%

38
Q

If an infected prosthetic joint occurs with in less than 3 months what is the likely organism

A

staph aureus

39
Q

if an infected prosthetic occurs between 3-12 months what is the origanism

A

epidermis

40
Q

what is the presentation of de quervains

A

wrist pain, common in women with children, radial styloid pain and positive Finkelstein test.

41
Q

what is the treatment for de quervains

A

NSAIDs, rest, splinting and corticosteroid injections

42
Q

what is the difference between patellofemoral pain and patellar tendinitis

A

tendinitis is the anterior distal knee cap or the inferior aspect of the knee cap. while patellofemoral pain syndrome is the anterior knee when pressure is applied with extended knee

43
Q

where are the pain centers for fibromyalgia and what are the symptoms

A

neck, shoulders, biceps, forearms, thighs, anterior lower leg
dry mouth, palpitations, IBS, urge incontinence, muscle cramps. poor sleep and exhaustion.
migraines and tension headaches are common. depression or anxiety concentration difficulties

44
Q

what are some gout medications

A

NSAIDs, allopurinol, pegloticase, probincid, cholchicine

45
Q

when is colchicine used for gout

A

during acute gouty flares and when there are contraindication for NSAIDs or steroids

46
Q

is colchicine used for chronic gout management

A

NO. it is ineffective at preventing long term urate crystal formation

47
Q

what is the X ray description of metatarsal bone stress fracture

A

findings of cortical density loss and callus formation status-post abrupt onset of high-intensity exercise indicate a metatarsal stress fracture.

48
Q

what is the empiric treatment for a septic joint with a gram negative rod (with a PMH suggestive of e coli, not pseudomonas)

A

IV cefepime

49
Q

what is the pathophysiology of osteoporosis

A

reduced osteoblastic function (decreased blastic function in comparison to clastic)

50
Q

what are the risk factors for osteoporosis

A

increased age, daily alcohol consumption, female sex,

51
Q

is MRI used to diagnose impingement syndrome

A

no.

52
Q

what is MRI of the shoulder good for diagnosing

A

usually rotator cuff tears and labral injuries

53
Q

when do you use a FAST exam

A

if unreliable abdominal exam, hemodynamically unstable blunt abdominal trauma

54
Q

what are the two most common complications from humeral head fractures

A

brachial artery dissection is the most common.

radial nerve palsy (wrist drop) is another

55
Q

what is the presentation of Mortons neuroma

A

swelling and neuropathic pain in the ball of the foot that radiates into the toes. This pain is normally aggravated by activity and by wearing high-heeled shoes, which puts pressure on the area of the neuroma. Morton’s neuroma usually occurs in the third and fourth intermetatarsal spaces.

56
Q

what is the treatment for prepatellar bursitis

A

RICE

57
Q

rickets causes what in general and what is the presentation

A

cause the genu varum deformity, as seen in this patient, as well as the genu valgum deformity, the underlying vitamin D deficiency results in softening of all bones, which leads to delayed closing of the fontanelles, impaired growth (usually < 10th percentile for height), and further bone deformities

58
Q

what is the best test for bone mets to spine

A

MRI

59
Q

why is X ray not used for suspected spinal metastasis

A

because it is not sensitive enough to detect epidural or spinal cord involvement; it is used for extra spinal, boney mets however

60
Q

what is the treatment for acute musculoskeletal lower back pain

A

analgesia and regular activity

61
Q

what is a common finding in patients with ankylosing spondilitis

A

tenderness at the achilles insertion site. this is heel enthesitis 40-70% of patients will have this

62
Q

what are the characteristic findings for polymyositis

A

infrafascicular infiltration on muscle biopsy;Inflammatory cellular infiltrates of cytotoxic T cells within muscle fascicles are a characteristic finding on histological examination of muscle biopsies in patients with polymyositis (PM). As seen in this patient, the most common clinical feature of PM is slowly progressive, symmetric proximal muscle weakness, typically including the deltoids and the hip flexors. Dysphagia for solids may occur due to involvement of the upper esophageal striated muscles. Laboratory findings are typically nonspecific, with mildly elevated levels of inflammatory markers (e.g., CRP, ESR) and muscle enzymes (e.g., creatine kinase, lactate dehydrogenase, AST, and ALT), as found in this patient. Other possible laboratory findings include elevations of myoglobin and autoantibodies (e.g. antinuclear antibodies, myositis-specific antibodies)

63
Q

what are the characteristic findings for dermatomyositis

A

Inflammatory cellular infiltrates of B cells around muscle fascicles (perifascicular) and capillaries (perivascular) are a characteristic finding in muscle biopsies of patients with dermatomyositis. Dermatomyositis typically also presents with slowly progressive, symmetrical, proximal muscle weakness, mild muscle ache, and increased serum creatine kinase. However, patients would also have characteristic skin findings such as Gottron papules, a heliotrope rash, and/or a shawl sign.

64
Q

what is oligoarticular juvenile idiopathic arthritis

A

is the most common type of arthritis seen in children and adolescents. Girls between 2–4 years old are most affected. Oligoarticular JIA presents with asymmetrical arthritis of ≤ 4 large, weight-bearing joints (e.g., knees, ankles) within 6 months of disease onset. The affected joints are often stiff in the morning or after longer periods of inactivity (e.g., sitting), with mobility improving with activity throughout the day. Chronic anterior uveitis is another common symptom and may present with recurring episodes of ocular pain, redness, and photosensitivity. Most patients also have an elevated ESR and increased antinuclear antibody levels but negative rheumatoid factor.

65
Q

what is systemic juvenile arthritis

A

Systemic juvenile idiopathic arthritis is characterized by arthritis involving at least 1 joint and the occurrence of systemic symptoms. Joint involvement is most often polyarthritic (may also be oligoarthritic) and commonly affects the knees, ankles, and wrists. Systemic symptoms include intermittent fever and a transient, salmon-pink rash, which often occurs simultaneously to fever spikes. Spleno- or hepatomegaly, generalized lymphadenopathy, and serositis (e.g., pleuritis) can also occur.

66
Q

how do you know its systemic juvenile arthritis

A

look for salmon colored rash

67
Q

seronegative polyarticular juvenile arthritis

A

Seronegative polyarticular JIA is characterized by the involvement of ≥ 5 joints within 6 months of disease onset. Typical manifestations include symmetrical arthritis of the interphalangeal joints, as well as involvement of the cervical spine and the temporomandibular joint. Chronic anterior uveitis, as seen in this patient, is another common finding

68
Q

Osteoclastomas are

A

caused by a proliferation of osteoclastic giant cells (due to overactivity in the RANK signaling pathway). They have a peak incidence between the ages of 20 and 40 years and generally arise eccentrically in the epiphysis or metaphysis of long bones (usually distal femur or proximal tibia). They typically appear on x-ray as a well-defined osteolytic lesion with a soap-bubble appearance (due to trabecular remnants) and nonsclerotic margins, as seen in this patient. Despite the large size of the lesion, most lesions are benign, and the periosteal reaction is usually nonaggressive

69
Q

Chondrosarcomas

A

may also appear at the ends of long bones as an osteolytic lesion with cortical erosion, and can present with pain (particularly at night) and swelling. However, the lesion would be ill-defined with a moth-eaten appearance. Furthermore, spiculated, popcorn-like, or ring-and-arc calcifications are usually seen within the tumor. Moreover, chondrosarcomas occur in patients above the age of 50 years and more commonly affect the femur, pelvis, or proximal humerus; the tibia is not a typical site.

70
Q

Osteosarcomas

A

typically also occur in patients younger than 30 years, involve the ends of long bones, present with pain (particularly at night) and swelling, and may appear as an osteolytic lesion with cortical erosion on x-ray. However, the lesion would be ill-defined, with a wide transition zone between normal bone and the lesion, and an aggressive periosteal reaction (often with a sun-burst appearance and Codman’s triangle),

71
Q

Langerhans cell histiocytosis (LCH) is

A

a rare disorder that most commonly affects children 5–10 years of age. It presents as single or multiple osteolytic lesions that cause bone pain and swelling. The skull is the most commonly affected bone in children (as in this patient), but LCH can also involve the liver, spleen, and other organ systems. This patient’s anemia may be secondary to bone marrow involvement. Serum calcium levels are typically normal in patients with LCH.

72
Q

Traction apophysitis

A

of the tibial tubercle causes Osgood Schlatter disease, which typically affects adolescent athletes. Overuse (e.g., sports that involve running and jumping) leads to the patellar tendon exerting excessive strain on the tibial tuberosity, which is not yet fully ossified in adolescents and is thus susceptible to detachment. Patients typically present with anterior knee pain localized to the tibial tubercle that worsens with activity and is reproducible with extension against resistance.

73
Q

what is club foot and what is the treatment

A

in-toeing, an elevated hindfoot, and a cavus deformity of the midfoot bilaterally.
serial repositioning and casting is the corrective measure

74
Q

what is the treatment for Osgood-Schlatter

A

The first treatment measure in disease should always be a combination of rest, ice, and oral anti-inflammatory medication, like ketorolac. If this combination is not effective, cast immobilization can be attempted. Surgical excision of the fragmented tibial tubercle (and any other ossicles found in the area of the tendon) is reserved for refractory cases.

75
Q

A patient that presents with a short stature with average-sized torso, disproportionately short proximal limbs, macrocephaly, and frontal bossing, which suggests

A

achondroplasia.

76
Q

can achondroplasia be treated with growth hormone

A

it has not shown efficacy

77
Q

what should be done for people with achondroplasia

A

CT scan for foreman magnum stenosis

78
Q

Defective type V collagen is the cause of

A

Ehlers-Danlos syndrome type II (classic EDS), which is characterized by weakness of connective tissue that predominantly affects the joints and skin. Typical clinical features include joint hypermobility and subluxation (e.g., patella, temporomandibular, shoulder), skin hyperextensibility and fragility, and skeletal abnormalities (e.g., scoliosis). The fragile skin shows a tendency to bruise and break easily, leading to potentially severe lacerations from minor trauma. Cardiovascular features are seen less commonly in classic EDS, but may include heart valve defects and aneurysms/dissections of large arteries.

79
Q

Defective type III collagen is the cause of

A

vascular Ehlers-Danlos syndrome, which presents primarily with cardiovascular manifestations. These include heart valve defects (especially mitral valve prolapse), aneurysms or dissections of large arteries (e.g., aortic, iliac), and berry aneurysms of cerebral arteries. Features of other types of EDS may occur (e.g., skin is fragile, but not extensible), but are rare and are typically much less pronounced

80
Q

whaat is the treatment for torticolis/acute dystonic reaciton

A

benztropine is first line therapy

81
Q

what are the alternative therapies for treatment of acute dystonic reaction

A

Benadryl (diphenhydramine), benzodiazepine)

82
Q

what is raloxifene used for and what is a SE

A

used in osteoporosis. increases risk of DVT

83
Q

what is a well known SE of bisphosphonates

A

osteonecrosis of the jaw

84
Q

Chondrosarcoma typically affects which bones and in whom

A

the pelvis, proximal femur, or proximal humerus of individuals 50–70 years of age and presents with progressively worsening pain.

85
Q

what is the second most common non-hematological primary bone cancer

A

Chondrosarcoma

86
Q

how does chondrosarcoma appear on x ray

A

On x-ray, chondrosarcomas appear as osteolytic lesions with a moth-eaten or permeative pattern of bone destruction and spiculated, popcorn-like, or ring-and-arc sclerosis, which are characteristic of chondroid matrix calcification. Other radiological features include an aggressive periosteal reaction and endosteal scalloping.

87
Q

characteristics of Paget disease of the bone.

A

Skeletal changes (diffuse cortical thickening and multiple sclerotic lesions), grossly elevated alkaline phosphatase, and mixed hearing loss with normal serum calcium, parathyroid hormone, and vitamin D levels

88
Q

what is the treatment for pagets diseae

A

IV bisphosphonates

89
Q

what are the labs for pagets

A

Elevated serum ALP and normal Ca2+, phosphate, and PTH is most consistent with Paget disease of bone.

step II (22 decks)

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