Buzzwords Flashcards
narrowing of spinal canal
spinal stenosis
numbness/paresthesias radiating to bilateral buttocks and thighs
spinal stenosis
pain worse with extension
spinal stenosis
pain better with flexion
spinal stenosis
HLA-B27 positive
Akylosing Spondylitis
Reactive Arthritis aka Reiters syndrome
Psoriatic arthritis
IBD assoc arthritis
back pain/stiffness worse in AM
ankylosing spondylitis
polymyalgia rheumatica
back pain worse with rest
ankylosing spondylitis
uveitis
ankylosing spondylitis
increased ESR
ankylosing spondylitis
Xray shows sacroiliitis
ankylosing spondylitis
bamboo spine
ankylosing spondylitis
xray shows loss of normal lumbar curvature + squaring and fusion of the vertebrae
ankylosing spondylitis
unilateral radicular back pain radiating down leg in dermatomal pattern
Herniated disc
back pain increasing with coughing
herniated disc
back pain increasing with straining
herniated disc
back pain increasing with bending
herniated disc
back pain increasing with sitting
herniated disc
back pain increasing with valsalva
herniated disc
+ straight leg raise
herniated disc
xray of spine shows loss of disc height
herniated disc
anterior thigh pain
L4 herniated disc
weak ankle dorsiflexion
L4 herniated disc
loss of knee jerk + weak knee extension
L4 herniated disc
Lateral thigh/leg hip groin paresthesias + pain
L5 herniated disc
weakness in big toe extension aka big toe dorsiflexion
L5 hern disc
walking on heels more diff than walking on toes
L5 hern disc
posterior leg/calf and gluteus pain + Plantar surfaces of foot
S1 disc hern
weakness in plantar flexion
S1 disc herniation
walking on the toes is more difficult than walking on heels
S1 disc hern
Loss of ankle jerk
S1 disc hern
pain + numbness + weakness + swelling of arm/shoulder
thoracic outlet syndrome
(+) adson sign
thoracic outlet syndrome
goose egg
olecranon bursitis
snuffbox tenderness
scaphoid or navicular fx
DIP in flexion
mallet finger
PIP in flexion and DIP in hyperextension
Boutonniere deformity
PIP in hyperextension and DIP in flexion
swan neck deformity
inability to fully extend elbow
olecranon fx or elbow dislocation or radial head fx
MC sequelae of elbow dislocation
lost of terminal extension
neuro testing maneuvers
*peace sign against resistance
ulnar nerve
**elbow dislocation to check ulnar nerve
neuro testing maneuvers
*hitchhiker/thumbs up
radial nerve
**elbow dislocation to check radial nerve
neuro testing maneuvers
*power to the people aka closed fist
median nerve
**elbow dislocation to check median nerve
neuro testing maneuvers
*OK sign
Median nerve—anterior interosseous
**elbow dislocation to check median nerve
+ posterior fat pad sign
radial head fx
+ displaced anterior fat pad sign
radial head fx
mid-distal radial shaft fx with dislocation of the distal radioulnar joint
Galeazzi fx
Fx to proximal 1/3 of ulnar shaft + dislocation of radial head
Monteggia fx
MUGR
MU= monteggia fx is ULNA fx
GR=galeazzi RADIUS fx
MonteggiA (ENDS IN A)… A is proximal: bones affected proximally
GaleaZZi=Z is distal–bones affected distally
extensor carpi radialis brevis muscle inflammation
tennis elbow aka lateral epicondylitis
pain with wrist extension against resistance
tennis elbow aka lateral epicondylitis
pain with wrist flexion against resistance with elbow flexion
medial epicondylitis aka golfers elbow
pronator teres-flexor carpi radialis muscle inflamm
medial epicondylitis aka golfers elbow
+ tinel sign
- cubital tunnel syndrome
2. Tarsal tunnel syndrome
Paresthesia and pain along the ulnar nerve distribution
-worse with elbow flexion
cubital tunnel syndrome
+) Froment sign
cubital tunnel syndrome
FOOSH with extended wrist
scaphoid (navicular) fx
MC fx carpal bone
scaphoid/navicular
anatomical snuffbox tenderness
scaphoid/navicular fx
distal radius fx with dorsal angulation
colles fx
dinner fork deformity
colles fx
XR shows dorsally displaced or angulated fx on distal radius
colles fx
MC complication from colles fx
extensor pollicis longus tendon rupture
distal radius fx with ventral angulation of distal fragment
smith’s fx
FOOSH with wrist flexed
smith’s fx
garden spade deformity
smith’s fx
wrist pain worse with passive motion
smith’s fx
and
colles fx
“piece of pie” sign
lunate dislocation
“spilled teacup” sign
lunate dislocation
whats the most serious carpal fx and why
lunate fx
-occupies 2/3 of radial articular surface
lateral angle
scoliosis
posterior and anterior angles
kyphosis and lordosis
hump back
kyphosis
indentation on lower back
lordosis
back pain not assoc with radiation to leg or neuro symps
lumbosacral sprain or strain
when you see a compression fx– what must you r/o
CA *!! esp if pt is elderly
localized back pain
compression fx
xray shows loss of vertebral height
compression fx
pars interarticular defect
spondylolysis
MC at L5-S1
spondylolysis
scotty dog
spondylolysis
lateral radiolucent defect in pars
spondylolysis
scotty dog
MC at L4-L5
Spondylolisthesis
forward slipping of a vertebra on xray
spondylothisthesis
anterolisthesis of L5 over S1 with associated spondylolysis at that level
spondylolisthesis
bad thing we must always r/o with back pain
cauda equina
back pain + decr sensation to buttocks, perineum and inner surfaces of thigh
cauda equina syndrome
back pain + new onset urinary bowel retention or incontinence
cauda equina syndrome
back pain + bilat leg radiation of pain
cauda equina syndrome
fever + spinal pain + neuro deficits
spinal infection
RF for spinal infection
> 50 YO
IVDU
immunodef
recent instrument/procedure—EX: LP
what lab test determines early diagnosis of RA
Anti-citrullinated protein antibody (ACPA)
what lab test diagnoses RA
Rheumatoid factor
aggravation of pain with prolonged rest— morning stiffness and improves with use
- inflammatory arthritis—–RA, polyarthritis
- polymyalgia rheumatica
- ankylosing spondylitis
aggrivated by motion and relieved with rest
non-inflammatory arthritis
pain, limitation of motion, swelling and/or tenderness at a joint
arthritis in general
arthritis affecting single joint
monoarticular
arthritis affected several joints
oligoarticular
arthritis affecting many joints
polyarticular
rheum dz with age of onset 20-40 YO and is MC in W>M
RA
subcutaneous rheumatoid nodule over extensor surfaces
RA
extensor surfaces—lungs, pleura, pericardum**
symmetrical involvement of the joints of hands/feet
RA–typical presentation
HLA-DRA 1 & 4
RF for RA
Boutonniere deformities of PIP
RA
Swan-neck contractures of fingers
RA
ulnar deviation of metacarpophalangeal joints
RA
- elevated RF
- (+) Anticitrullinated peptide/protein antibodies
- elevated ESR
- elevated CRP
RA
which DMARD requires eye exam every 6 MO and why
hydroxychloroquine
*risk of visual loss due to retinopahty
what must you give with methotrexate
folic acid
DIP joint affected
osteoarthritis
MCP and PIP joints affected
RA (spares DIP)
conjunctivitis + urethritis + arthritis
reactive arthritis
cant see cant pee cant climb a tree
Reactive arthritis
arthritis + conjunctivitis + urethritis after an infection
reactive arthritis
hyperkeratinized lesions on palms and soles
keratoderma blennorrhagicum
finding in reactive arthritis
arthritis involves larger joints— esp knee
reactive arthritis
increased assoc with chronic hep B and C
Polyarteritis Nodosa
MC seen in men 40-60 YO
PAN
abd pain worse when eating
PAN— GI ischema
skin appears mottled/purplish
livdeo reticularis–seen with PAN
rosary sign on angiography
PAN
microaneurysms with abrupt cut off of small arteries
PAN
assoc with giant cell arteritis
Polymyalgia Rheumatica
sudden onset of bilateral hip and shoulder girdle ache +stiffness and fatigue in PT >50 YO
Polymyalgia Rheumatica
difficulty combing hair
polymyalgia rheumatica
polymyositis
difficulty getting up from chair
polymyalgia rheumatica
polymyositis
pain on movement and stiffness with periods of inactivity
Polymyalgia rheumatica
muscle inflammation of pharynx, limbs and neck
polymyositis
+ anti-signal recognition protein
most specific lab finding for polymyositis
what has a 25% association with CA
dermatomyositis
Anti-Jo 1 antibodies
Polymyositis
Dermatomyositis
Anti-Mi 2
Dermatomyositis
blue-purple discoloration of upper eyelid
pathognomonic for dermatomyositis (heliotrope rash)
raised violaceous scaly knuckle eruptions
pathognomonic for dermatomyositis (gottron’s papules)
MC in women 20-55 YO
Fibromyalgia
pain is worse in the cold or by weather changes
fibromyalgia
pain is allevaited with rest, warmth and mild exercise
fibromyalgia
pain is worse with sleep deprivation and worse in am
fibromyalgia
HLDA-DR52
Sjogren syndrome
assoc with other autoimmune dz—Hashimoto, SLE or RA
Secondary Sjogren syndrome
exocrine glands
Sjogren syndrome
associated with incr risk of non-Hodgkin lymphoma
Sjogren syndrome
anti-centromere antibodies
Systemic sclerosis— limited type (CREST)
anti-SCL-70 antibodies
systemic sclerosis–diffuse type–multiple organ involvement
*poor prognosis
proximal muscle weakness often painless + dermatologic manifestations
Dermatomyositis
proximal muscle weakness often painless
polymyositis
thickened skin + raynauds
scleroderma (CREST)
dry eyes dry mouth
Sjogren
malar rash
photosensitivity
fever
SLE
type III hypersensitivity
SLE
PAN
joint pain + fever + malar rash
SLE
anti-double stranded DNA
SLE
anti-Smith antibodies
SLE
antiphospholipid antibodies
SLE
*means incr risk of arterial and venous thrombosis
recurrent DVT or PE
Antiphospholipid syndrome
-can be assocc with SLE
recurrent miscarriages
antiphospholipid syndrome–can be assoc with SLE
anticardiolipin antibodies
antiphospholipid syndrome–can be assoc with SLE
**also assoc with false-positive testing for syphilis
+ lupus anticoagulant
Antiphospholipid syndrome
=incr PTT
*****positivty assoc with hypercoaguability
daily high fever + arthritis pain + salmon colored pink rash + lymphadenopathy in kid <16 YO
Jeuvenille RA— Systemic or Still’s DZ
<16 YO patient
- uveitis
- knee and/or ankle arthritis pain
Jeuvenille RA— Pauci (oligo) articular
<16 YO PT:
*small joints affected– many
*uveitis
+morning stiffness
Jeuvenille RA—polyarticular
***worse prognosis
which Jeuvenille (idiopathic) Rheumatoid Arthritis is assoc with (-) RF and ANA
Still’z dz
which Jeuvenille (idiopathic) Rheumatoid Arthritis is assoc with (+) ANA
oligoarticular
Skin thickening that begins as swelling of the fingers and hands associated with telangiectasia, dysphasia, and hypomotility of the GI tract is most likely…..
scleroderma
(+) ANA
SLE scleroderma RA Sjogrens dermatomyositis polymyositis
affected limb is ADDucted, internally rotated and shortened
hip dislocation posterior
affected limb is ABDucted, externally rotated and shortened
anterior hip dislocation
**hip fracture*
MC affeected nerve and artery in anterior hip dislocation
femoral
SCFE in kid before puberty what do you suspect
hormonal or systemic disorders— hypothyroidism**
14 YO obese male with hip/groin/thigh pain and painful limp worse with activity
SCFE
- obese
- male
- 8-16YO
ice cream cone fell off the cone
SCFE
frog leg lateral view
SCFE
child with PAINFUL limp
SCFE
child with painless limp
leg-calve-perthes dz
(+) crescent sign on xray
advanced Leg-calve-perthes dz
widening of cartilage space on xray with incr density of femoral epiphysis
early leg-calve-perthe dz
MC long bone fx?
tibial and fibular fx
what is the biggest and most stressed joint in the body
knee
Sudden and severe knee pain with hx of trauma sugests?
disruption of a ligament, meniscus or osseous structure
chronic knee pain suggests
degenerative condition
knee pain that is worse with weight bearing suggests
mechanical pathologies–>meniscus tear, ligament tear, fx
knee night pain + stiffness suggest
inflammatory pathology
hip and lumbar pathologies can cause ?
diffuse and poorly localized knee pain
Pain in the front of knee suggests
Chrondromalacia
patella tracking
bursitis
arthritis
pain above the knee suggests
quads tendon swelling
pain below the knee suggests
osgood schlatter
pain on inside or outside parts of knee suggest
meniscus or collateral ligament tears
arthritis
pain behind the knee
bakers cyst
child with quadricep atrophy suggests
legg calve perthes dz
list all the tests for ACL injury
Lachman test
Anterior drawer test
pivot shift test
pain behind knee
DVT
bakers cyst
noncontact injury to knee–what is MC affected
only ACL torn
lateral trauma to knee
MCL tear
aka valgus stress
MC knee ligament injury?
ACL
MOA is noncontact pivoting injury during sports
ACL
MVA + dashboard injury
PCL injury
Fall on flexed knee
PCL
Patellar fx
Direct blow to the knee
PCL
contact injuries to the knee MC affect which ligament
PCL
NOT ACL— most commonly non-contact pivoting injuries
popping of knee during ambulation
Mensical tear
cyclists or runners
Patellofemoral syndrome– chondromalacia
(+) apprehension sign
Patellofemoral syndrome (chondromalacia) Patellar dislocation
valgus stress after twisting injury, direct blow
patellar dislocation
(+) hemarthrosis of knee joint in context of trauma suggests
patellar fx
(+) drop foot finding on PE
- **peroneal nerve injury
- Femoral condyle fx
- tibial platea fx
- tibial/femoral dislocation if peroneal nerve injury present
this injury is MC seen in kids in MVAs
Tibial Plateau fx
MC complication from tibial plateau fx
soft tissue injury— MC lateral meniscal tears
what is a severe limb-threatenign emergency
knee (tibial/femoral) dislocations
MC in males 10-15 YO during ovruse activites
osgood-schlatter dz
prominence swelling and tenderness to anterior tibial tubercle
Osgood Schlatter
MC sprained ankle ligament
ATFL
anterior talofibular ligament
LATERAL LIGAMENT
mc tx for ankle sprain
Rest
Ice
Compression
Elevation
episodic atheletes
achilles tendon rupture
Fluoroquinolone (ex Cipro) use
achilles tendon rupture
(+) Thompson test
achilles tendon rupture
what drug has a BBW for achilles tendon rupture
Ciprofloxacin
what type of fx would be result of jumping out of a window
Pilon fx aka Plafond fx—- ankle fx— central portion of tibia fx
commonly missed ankle fx?
Maisonneue fx —– always alays alawys examine joints ABOVE AND BELOW injury
proximal fibula fx— what else do we want to look at?
Ankle xray— to r/o or r/i Maisonneuve fx
exam of which structure is imp to any suspected ankle fx or injury?
Fibular and lateral. malleolus
***maisonneuve fracture
localized tenderness at third metatarsal
march fx
foot pain incrs with dorsiflexion of toes
plantar fasciitis
pain incrs during the day–worse at night– and does not improve with rest
Tarsal Tunnel Syndrome
hx of wearing tight, pointed shoes
hallux valgus (bunion) (more so the pointed shoes) hammer toe (more so high heels) Morton's neuroma (more so high heels)
pain over great toe at MTP joint w/ a lateral deformty
Hallux Valgus
patient has 2nd toe (or 3rd or 4th) longer than the first
hammer toe
deformity of the PIP joint–>flexion of PIP joint w/ hyperextension of MTP and DIP joint
hammer toe
tertiary syphilis
Neuropathic (charcot) arthropathy
burning/lancinating foot pain
Morton’s neuroma
pain on 5th metatarsal
jones fx
(+) Fleck Sign
Lisfranc Injury
fx at the base of the second metatarsal pathognomonic for disruption of ligaments
xray shows irregularity and fragmentation of the joint space
avasc necrosis— can be assoc with legg-calve-perthes dz
blow to an abducted, externally rotated and extended shoulder causes
anterior shoulder dislocation
groove fx of shoulder
hill sachs lesions (ant dislocation)
Glenoid rim fx
bankart lesion– ant disloction
neurovascular compromise more common in ant or post shoulder dislocaiton
-which nerve
anterior— axillary nerve (runs in deltoid) MC nerve
this injury is assoc with seizures and electric shocks
post shoulder dislocation
shoulder has decr ROM esp with external rotation and pt has pain worse at night
adhesive capsulitis frozen shoulder
passive ROM of shoulder restricted
frozen shoulder
passive ROM greater than active in shoulder
rotator cuff tear
PE tests for rotator cuff injury
- Hawkins
- drop arm
- neer test
- supraspinatus strength test aka empty can test
which PE test do to to check for supraspinatus involvement
empty can test
common site for pathologic fxs in met BCA
proximal humerus—- humereal head fx
mets of BCA
patholgic fxs of humeral head
(+) wrist drop
radial nerve damage—- can be from humeral shaft fx
which nerve do we worry about with:
- humeral head fx
- humeral shaft fx
head=brachial plexus
shaft=radial nerve
severe vit D deficiency can cause
aka rickets
osteomalacia
blue tinted sclerae
Osteogenesis imperfecta
associated with deafness
osteogenesis imperfecta
puncture wound through shoe
osteomyelitis via pseudomonas aeruginosa
type of arthritis mc in weight bearing joints (knees, hips, spine, wrists)
OA
short (<60 mins) of morning stiffness
OA
RA is longer period of morning stiffness
Asymmetric joint narrowing
Marginal osteophytes
Subchondral bone sclerosis
Bone cysts
OA
Symmetric joint narrowing
Osteopenia, bone and joint erosions
Ulnar deviation in severe case
RA
OA is a ___ dz and RA is a ____ dz
OA=degenerative
RA=autoimmune
morning stiffness <30-60 mins
OA
morning stiffness >60 mins
RA
pain out of proportion to injury
comp syndrome
MC site for avasc necrosis
femoral head
pain starts in groin—>thigh—>buttock
avasc necrosis in femoral head
Avascular necrosis is a complication of which traumatic hip injuries?
hip dislocation or femoral neck fx
pt is on statin tx
RHABDO
muscle pain + weakness + dark tea colored urine
RHABDO
hyperuricemia
hallmark of gout—– but does not itself indicate gout
MC benign bone tumor
Osteochondroma
MC bone tumor in kids
osteochondroma
Xray shows pedunculated stalk that grows away from growth plate
Osteochondroma
nidus produces prostaglandins
osteoid osteoma
MC primary bone malignancy in kids + young adults
Osteosaroma
Second MC primary bone malignancy in kids + young adults
ewing’s sarcoa
onion skin apperance on xray
ewings
lytic lesions with moth eaten apperaence on xray
ewings
“hair on end” or “sunburst” apperance
osteosarcoma
xray shows lytic mass with a multi-laminated periosteal reaction involving the proximal anterior tibia (or another long bone)
ewing
**onoin skoin
xray shows round lucency surrounded by sclerotic bone
osteoid osteomao
opioid receptors
δ [delta],andκ [kappa
Leukocytosis and a low synovial glucose are indicative of
septic arthritis
best screening test to evaluate for SLE?
ANA
Cervical spondylosis occurs with
OA
associated with C1-C2 subluxation
RA
Hydroxychloroquine is associated with
macular damage—night vision impaired
rash
diarrhea
FOOSH then–>
- pain on the dorsal radial side of the wrist with minimal swelling
- pain is incr with dorsiflexion
- click with wrist movement
scapholunate dissociation
high energy injuries while the wrist is extended and ulnarly deviated
lunate dislocation
tenderness to palpation in shallow indentation on the mid-dorsum of the wrist
lunate fx
