Bone Flashcards
Osteoma
Osteoid osteoma
Osteoblastoma
Osteoma - facial bones
osteoid osteoma - diaphysis - resolves w/ aspirin
osteoblastoma - vertebral - no relief w/ aspirin
Vit D, Ca, PTH, alk phosph findings
Osteoporosis
Osteomalacia
Achondroplasia
osteopetrosis
pagets
Osteoporosis - Normal Ca, P, PTH, alk phosph
Osteomalacia - Vit D def, INC PTH, INC alk phosph
Achondroplasia - AD - FBGFr - blocks chondrocytes. Normal longevity/fertility.
osteopetrosis - carbonic anhydrase - defective osteoclasts. pancytopenia. CN palsy. Thick bones prone to fracture.
Pagets - INC clasts/blasts. Ca, P, PTH normal, INC alk phosph! osteosarcomma risk! INC urine hydroxyproline
CLavicular fracture work up?
Neurovasc ular exam
Angiogram if bruit or concern
Subacrombial bursitis presentation
Pain on internal rotation/flexion. No atrophy of deltoild
Adhesive capsulitis
DEC active AND passive ROM
Rotator cuff
Difficulty Abduction and externally rotating.
Falling on outstretched hand>
Lidoshot helps with rotator tendonitis but not tear
Glenohumeral osteA
Trauma - gradual onset
Bicepts rutpure/tendiopathy
Anterior shoulder pain
Suprachondylar fracture
brachial - median nerve (an terior interosseous) - > ulnar
voklmnass contraction
Lateral epicondylitis
Tennis elbow - pain w/ finger erxtenosion. Point tenderness.
Lumbosacral strain
vertebral fracture
Both have point tenderness that is acute onset.
basically only difference is demographic, risk factors
Anklyosing spondylitis
Anterior uveitis, enthesitis (inflam of ligaments)
Legg Cave Perthe
slipped capital femoral epyphysis
LC- 5-7 y.o idiopathic
Slipped capital femoral - 12-14 overweight adolescent- URGENT SURGICAL
osgood Schattler
Patellofemoral syndrome - dx?
Osgood - patella ripped off
patellofemoral syndrome - women young, runners, hurts with going up stairs. Tx - stretch.
dx w/ knee extension while applying pressure
Ansernine bursitis
Anteriomedial tibila
PMR
Fibromyalgia
Dermatomyositis
polymyositi s
MCTD lab finding
PMR - no weakness, temporal artritis. INC ESR. lwo dose steroids
Fibromyalgia - no weakness, exercise, ssri. younger than PMR
Dermatomyositis - CD4, weakness, perimysial. Molar, grotton, heliotrope
polymyositis - CD8, weakness
Later two have INC CK, ANA
Bone tumors
for each region
E
M
D
E - Giant Cell
M - osteochondroma
osteosarcoma
D Ewings
chondrosarcoma
Epiphyseal tumors
Giant cell - locally aggressuive, non malignant. Multinucleated giant, soap bubble.
Metaphyseal tumors
Osteochondroma - males
Osteosarcoma . Codman sunburst aggressive en block resection pagets rb inc risk
Diaphyseal tumor
Ewings 11:22 - Boys less than 15. Onion skinning. Chemo response
Chondrosarcoma - rare, malignant, Males 30-60, glistening mas
Osteo A
RA - tx algorithm
OsteoA - osteophytes, boney crepitus, eburnation. DIP+PIP
RA - pannus, baker cyst, anticitrullinated peptide. 2nd amyloidosis. Tx METHOTREXATE asap. If fail 6 mo -> TNF inhibitors. CERVICAL spinal involvement most common
Tx algorithsm - presentations
GOUT
Pseudogout
GOUT - monosodum urate - yellow in parallel light.
Punched out erosions.
Acute - NSAIDS, steroids, colchicine
Chronic - XO - allopurinol, febuxostat
Synovial fluid analysis shows WBC less than 50k.
Pseduo - CAPP, + birefriong. blue in parallel. Hemochromatosis. Chondrocalsinosis
Tx- Nsaids, steroids, colchicine.
Neurogenic arthropathy “Charcot joint”
Longstanding DM, B12 def - sig deformatlies of joints, fractures, effusions, osteophytes.
Infectious Arthritis
Seronegative
Infectious - S. Aureuas, Strep, GC, Migratory
Seronegative - Reactive (couple weeks after GI/viral/GU)
- conjuncitivits, urethritis, arthritis. Tx - NSAIDS (NOT ABX)
Metatarsal hairline fracture -
Mortons Neuroma
Hairline factuer Rest, analgesics, hard soled shoe
Mortons Neuroma - click in metatarsals when squeezed. Padded shoe.
Stress fracture
X ray may or may not show - Rest and heal. nsaids.
Avascualr necorsis rpesentation/.
X ray may not pick up initially. May or may not see point tendrness, full ROM early on.
Ankylosing spodnylitis - Inflam of what?
Dx?
Apophyseal joints (Facet joints). INC ESR, CRP.
Dx - Xray. B27 later.
Myasthenia crisis - tx
Intubatge if needed.
Steroids + plasmap-hx or IVIG.
Prostehsis infection - timecoruse bugs
Early onset - St. A> and GN anaerobes
3+ months - Staph Epi, propionibacterium, Enterococci
Spinal crod compression tx alg
Immedaite IV steroids + MRI + surgery consutl
Gout - what must you do?
Tap the joint to rule out infection.
Preventative measure for gout in pt w/ renal diseasE?
Allopurinol. Also colchiscine.
Probenecisd, NSAID contraindicated.
Lower back pain - Straight leg raise is positive. Is imaging needed?
If no sign neuro findings usually no.
SLR more specific than sensitive.
Hydroxychloroquine tox?
Retinal toxicity - dialted eye exam.
Anotehr DMARD second line to Methotrexate .
?APL sydrome - what should qualify for workup of in pregnant women ?
What tx to prevent this?
2 or more 1st trimester events, or A SINGLE SECOND TRIMESTESR EVENT.
Tx - heparin and aspirin
Ab associated with crest?
Most specific test for CREST?
Anti centromere (less specific but more sensitive)
Most specific - SCL70 - anti topoisomerase.
Sjogrens - best initial test. Most accurate test?
concerns?
Initial test - Schirmer test (filter paperagainst eye and look for tears)
Most accureate folowup - parotid/lip biopsy/.
Concerns- lymphoma
Best test for Wegeners?
Lung biopsy!!!
Better than renal >sinus.
Which complement is decreased in cryoglobulinemia
c4 (Hep C - 4 letters)
SLE (dec C3 - 3 letters)
presntation
Anterior shoudler dislocation
Posterior shoulder dislocation
Anterior - most common - - abducted and externally rotated - same as rotator cuff tear presentation
Posterior - flattened deltoid - adducted and internally rotated -
Otosclerosis - when deos this present? tx?
– common cause of conductive hearing loss in adults – esp in 20s and 30s. Female prepond. Tx – surgical stapedectomy or hearing amplification.
Ank spond presentation
– BETTER WITH EXERICSE, no improvement with rest. (worse at night)
Polymyosisit best way to diagnose?? Findings?
Muscle biopsy
DM - perimyseal cd4
Polymyositis - endomesial CD8
Low Threshold for What therapy in RA?
Bisphosphonates to prevent osteoporosis
Penetrating trauma vs blunt algorithm in unstable pt?
Penetrating with unstabl e-> lap. Blunt with inconclusive FAST and unstable vitals -> diagnostic peritoneal lavage.
Kid with no fever, URI, and externally rotated hip with pain what to do –
transient synovitis if no fever, no white count, and low ESR/CRP. Analgesics and followup.
Septic arthritis vs Osteomyelitis
septic is at JOINTS! Arthrocentesis. Whereas Osteo usu MRI?
Inheritance of muscular dystrophies
Duchennes, Becker Xr. Myotonic Muscular Dystrophy is AD! Of trinucleotide.
Asx pagets tx?
Bisphosphonates, NO OCTREOTIDE (that is acromegaly)
2 blastic maglinancies
prostate , breast, pagets
