Buzzwords - MSK & Rheum Flashcards
squared-off shoulder
anterior shoulder dislocation (MC type)
hill-sachs lesion
groove on humeral head
bankart lesion
glenoid inferior rim fracture
shoulder - abducted, externally rotated
anterior dislocation - MC type
shoulder - adducted, internally rotated
posterior dislocation
-mc associated with seizures, electric shock
mc rotator cuff muscle tear
supraspinatus (empty can test)
mc cause of shoulder pain >40
rotator cuff tear (50% trauma or chronic overuse)
mc cause of shoulder pain <40
tendonitis - associated with subacromial bursitis
-pain w/ abduction >90 suggest tendinopathy
hawkins test
drop arm test
neer test
impingement tests of subscapular nerve / supraspinatus
mc fractured bone in children, adolescents and newborns during birth
clavicle
adson sign
loss of radial pulse w/ head rotated to affected side
–> thoracic outlet syndrome
positive anterior/posterior fat pad on elbow xray
- supracondylar frx in children
- radial head frx in adults
positive fat pad (esp posterior) means
hemarthrosis
nerve (maybe) affected by olecranon frx
ulnar
abrupt “goose egg” swelling on elbow
olecranon bursitis
nightstick fracture
ulnar shaft
monteggia fracture
proximal ulnar shaft fracture w/ anterior radial head dislocation
-may cause radial nerve injury –> wrist drop
galeazzi fracture
mid-distal radial shaft fracture w/ dislocation of distal radial-ulnar junction
hutchinson fracture aka chauffer’s fracture
radial styloid fracture
tennis elbow vs. golfer’s elbow
lateral (tennis) epicondylitis
medial (golfers) epicondylitis
“piece of pie” sign or “spilled teacup” sign on xray
lunate dislocation –> emergent consult
“dinner fork deformity” on xray
colles fracture
kienbock’s disease
avascular necrosis of lunate bone
perineal ecchymosis
maybe pelvic fracture
legg-calve-perthes disease
idiopathic avascular osteonecrosis of femoral head in children (ischemia of capital femoral epiphysis)
-cresent sign w/ xray on advanced
greenstick fractures
-incomplete w/ cortical disruption and periosteal tearing on convex side (intact on concave side) BOWING
torus (buckle) fracture
incomplete frx with “wrinkling or bump” of metaphyseal-diaphyseal jx due to axial loading
unhappy (O’Donoghue’s) triad
injury to ACL, MCL and medial meniscus
lachman’s test
ACL injury (also anterior drawer)
segond fracture
avulsion of lateral tibial condyle w/ varus stress to the knee –> pathognomic for ACL tear
patella baja
quad tendon rupture
palpable defect below knee
patella alta
patellar tendon rupture
palpable defect above knee
apprehension sign
patellar dislocation or patellofemoral syndrome (chondromalacia)
pt anxious/forcefully contracts quad when examiner pushes laterally (after reduced)
sign of peroneal nerve injury
foot drop
ober test
pain or resistance to leg adduction
-IT band syndrome
thompson test
achilles tendon rupture
-weak, absent plantar flexion when gastrocneumius is squeezed
weber ankle fracture classification
level of fibular fracture (lateral malleolus)
-relative to the syndesmosis (tibia + talas)
Weber A - below syndesmosis
Weber B - level of syndesmosis
Weber C - above syndesmosis
fleck sign xray
lisfranc injury foot
-frx at base of 2nd metatarsal –> disrupts articulation of medial cuneiform (foot bone) and base of 2nd metatarsal
sciatica sx
back pain radiates to thigh/butt –> lower leg (below knee), down L5-S1 dermatome
-increases w/ valsalva
L4 herniated disc (sensory, weakness, reflex)
sensory: anterior thigh pain, sensory loss to medial ankle
weakness: ankle dorsiflexion
reflex: loss of knee jerk (weak knee extension / quads)
L5 herniated disc (sensory, weakness, reflex)
sensory: lateral thigh/leg, hip, groin paresthesias and pain; dorsum of foot esp btw 1st/2nd toes
weakness: big toe extension (dorsiflexion), walking on heels more difficult than toes
reflex: usually normal
S1 herniated disc (sensory, weakness, reflex)
sensory: posterior leg/calf, gluteus
weakness: plantar flexion, walking on toes harder than heels
reflex: loss of ankle jerk
no “anal wink”
cauda equina syndrome
-dec anal sphincter tone on rectal exam
scoliosis + cafe au lait spots, skin tags, axillary freckles
neurofibromatosis type 1
codman’s triangle
OSTEO SARCOMA or EWING SARCOMA
-ossification of raised periosteum
xray: “hair on end” or “sun ray / burst” appearance
osteosarcoma
xray: “onion skin”
ewing sarcoma
-layered periosteal rx appearance
xray: punctate or ring & arc appearance of calcification
chondrosarcoma
abnomal labs paget disease
increased alk phos
xray: “blade of grass/flame shaped” lucency; skull: cotton-wool appearance
paget disease
annular, red patches on face, scalp, heals w/ scarring
discoid lupus
triad: joint pain, fever, malar “butterfly rash”
SLE
heliotrope (blue/purple) upper eyelid discolor
gottron’s papules (raised, violaceous scaly eruptions on knuckles)
photosensitive poikiloderma “shawl or V sign”
diffuse alopecia
dermatomyositis
+ANTI-JO 1 AB
myositis-specific antibody - assoc w/ “mechanic hands”, GOTTRON’S PAPULES - raised violaceous scaly knuckle eruptions (DERMATOMYOSITIS)
+ANTI-SRP AB
signal recognition particle ab - almost exclusively seen with POLYMYOSITIS
+ANTI-MI-2-AB
DERMATOMYOSITIS
+ANA, esp antiSS-A (Ro) & antiSS-B (La)
sjogren’s
+ Schirmer test
decreased tear production -. sjogren’s
+ ANTI DOUBLE-STRANDED DNA & ANTI-SMITH AB
100% specific for SLE, not sensitive
purine rich foods
alcohol, liver, seafood, yeasts
arthritis in children <16yo
- less than 5 joints involved in 1st 6 mo
- Type 1 may be assoc w/ IRIDOCYCLITIS (ANT UVEITIS)
- Type 2 assoc w/ increased incidence of akylosing spond
juvenile idiopathic –> PAUCI-ARTICULAR oligoarticular)
arthritis in children <16yo
- daily arthritis, DIURNAL HIGH FEVER w/in 1st 6 mo
- SALMON-COLORED / PINK MIGRATORY RASH +/- koebner phenom
- assoc w/ hepatosplenomegaly, hepatitis, lymphadenopathy & serositis
juvenile idiopathic –> SYSTEMIC/ACUTE FEBRILE (STILL’S DZ)
arthritis in children <16yo
- ARTHRITIS > 5 SMALL JT in 1st 6 mo (usually symmetric); most similar to adult RA
- inc risk of IRIDOCYCLITIS
- RF neg assoc w/ better prognosis than RF pos
juvenile idiopathic –> POLYARTICULAR
HEBERDEN’S NODE
osteophytes @ DIP joints –> OA
bouchard’s node
osteophytes @ PIP joints –> OA
morning joint stiffness, better after some activity
RA
evening joint stiffness, better after rest
OA
triad: RA, splenomegaly & decreased WBC/repeated infx
Felty’s Syndrome (rare)
RA + pneumoconiosis
CAPLAN syndrome
boutonniere deformity, swan neck deformity, ulnar deviation at MCP
RA
boutonniere deformity
flex @ PIP
hyperextend @ DIP
swan neck deformity
flex @ DIP
hyperextend @ PIP
HA, scalp tenderness, jaw claudication, fever, vision changes
giant cell / temporal arteritis
RECURRENT, PAINFUL ORAL AND GENITAL ULCERS
Behcet’s Syndrome
reactive thrombocytosis
increased platelets
ASTHMA, HYPEREOSINOPHLIA, CHRONIC RHINOSINUSITIS
Churg-Strauss (eosinophilic granulomatosis w/ polyangiitis)
upper resp tract/nose sx (& saddle nose deform)
lower resp tract/lung sx
glomerulonephritis
Wegener’s (granulomatosis w/ polyangiitis
glomerulonephritis (rapidly progressing) + pulmonary hemorrhage (hemoptysis)
goodpasture’s disease
xray: “pencil in cup” deformity
psoriatic arthritis
xray: BAMBOO SPINE = SQUARING/BRIDGING OF VERTEBRAL BODIES
ankylosing spondylitis
+HLA-B27 gene
SERONEGATIVE SPONDYLOARTHROPATHIES
psoriatic arthritis
ankylosing spondylitis
reactive arthritis/reiter’s syndrome
-TRIAD: CONJUNCTIVITIS, URETHRITIS, ARTHRITIS (esp lower extremities)
+KERATODERMA BLENNORRHAGICUM - hyperkeratotic lesions on palms/soles
reactive arthritis
arthocentesis fluid WBC >50K (also positive cultures)
septic arthritis
-less than 50K in gout, pseudo gout, reactive arthritis (and negative cultures)
P-ANCA
MICROSCOPIC POLYANGITIS (MPA)
CHURG STAUSS
ULCERATIVE COLITIS
PRIMARY SCLEROSING CHOLANGITIS
-perinuclear antineutrophil cytoplasmic AB cause release of lytic enzymes from WBC, result in inflam of BV wall (vasculitis)
C-ANCA
WEGENER’S GRANULOMATOSIS (GPA)
-cytoplasmic antineutrophil AB
ESR (inc explained)
w/ inflam, high levels of fibrinogen causes RBC to stick together (rouleaux formation) causing them to settle faster
C-reactive protein (inc explained)
CRP released by liver in response to factors secreted by macrophages which help to activate complement (acute phase rx)
ANA (explained)
auto-AB against the nucleus
-present in low titers in gen pop, inc in autoimmune
TNF (explained)
group of cytokines that promote the inflammatory response, can cause cell death apoptosis (seen in tumor regression, septic shock and cachexia)
-elevated in: RA, ANKYLOSING SPONDYLITIS, PSORIASIS, CROHNS
IgA (explained)
CRITICAL ROLE IN MUCOSAL IMMUNITY - secreted in tears, saliva, resp epithelium, GI tract, GU tract
-seen in BERGER’S DZ (IgA nephropathy), HENOCH-SCHONLEIN PUPURA & CELIACS
+ ACETYCHOLINE RECEPTOR AB
MYASTHENIA GRAVIS
+ B-2 GLYCOPROTEIN 1 AB
ANTIPHOSPHOLIPID ANTIBODY SYNDROME (SLE)
+ CARDIOLIPIN AB
ANTIPHOSPHOLIPID ANTIBODY SYNDROME (SLE)
+ CENTROMERE AB
CREST SYNDROME
+ CYCLIC CITRULLINATED PEPTIDE PROTEIN
RA SPECIFIC
+ ENDOMYSIAL AB
CELIACS
+ GLOMERULAR BASEMENT MEMBRANE AB
GOODPASTURE’S SYNDROME
+ HISTONE AB
DRUG-INDUCED LUPUS
LUPUS ANTICOAGULANT AB
ANTIPHOSPHOLIPID ANTIBODY SYNDROME (SLE)
+ MITOCHONDRIAL AB
PRIMARY BILIARY CIRRHOSIS
+ MUSK AB
MYASTHENIA GRAVIS - MAY BE POS IN AChR-NEG PT W/ MG
+ RIBONUCLEOPROTEIN (RNP) AB
MIXED CONNECTIVE TISSUE DZ
SLE
+ SACCHAROMYCES CEREVISIAE AB
CROHN’S
+ SCL-70 (TOPOISOMERASE) AB
DIFFUSE SYSTEMIC SCLEROSIS (SCLERODERMA)
+ SIGNAL RECOGNITION PROTEIN (SRP) AB
POLYMYOSITIS
+ SMITH AB
SLE (specific, not sensitive)
+ SMOOTH MUSCLE AB
AUTOIMMUNE HEPAITTIS
+ THYROGLOBLIN AB
HASHIMOTO’S THYROIDITIS, AUTOIMM THYROIDITIS
+ THYROID PEROXIDASE (TPO) AB
HASHIMOTO’S THYROIDITIS, AUTOIMM THYROIDITIS
+ TRANSGLUTAMINASE AB
CELIACS
DERMATITIS HERPETIFORMIS
+ TSH (THYROTROPIN) RECEPTOR AB
GRAVES DZ
+ VOLTAGE-GATED CALCIUM CHANNEL AB
LAMBERT-EATON SYNDROME
