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Block 2 > Clin Med 2 > Flashcards

Clin Med 2 Flashcards

1
Q

STS epidemiology

A

peak onset at 15yo, male > female, rhabdomyosarcoma > osteosarcoma > Ewing’s sarcoma

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2
Q

is there screening for STS?

A

NO

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3
Q

STS ddx part 1

A

enchondroma (benign but can turn to chondrosarc), osteoid osteoma (prox femur –> NSAID), myositis ossificans (post traumatic)

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4
Q

STS ddx part 2

A

bone cyst, gout, brown tumors of hyperparathyroid (primary –> parathyroid adenoma, secondary –> chronic renal dz), osteomyelitis (Brodie’s abscess - hematogenous spread), Paget’s (endo dz)

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5
Q

STS risk factors

A

prior rad therapy, genetic ca syndromes

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6
Q

genetic ca syndromes: li fraumeni syndrome

A

germline mutation in TP53 tumor suppressor gene –> STS, osteosarc, RMS, fibrosarc, UPS; get whole body MRI

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7
Q

genetic ca syndromes: familial adenomatous polyposis (FAP)

A

auto dom colorectal ca syndrome, germline mutation in APC gene on chrm 5q21 –> adenomatous colon polyps –> CRC by 35-40yo

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8
Q

genetic ca syndromes: Gardner syndrome

A

variant of FAP w/ extracolonic manifestations like osteomas, skin cysts, hypertrophy of retinal epith, desmoid tumors/fibromatosis

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9
Q

genetic ca syndromes: Carney-Stratakis syndrome vs Hereditary retinoblastoma vs neurofibromatosis

A

auto dom –> GISTS, paragangliomas vs germline mutation in retinoblastoma tumor suppressor gene RB1 vs mutation in neurofibrin 1/2 gene (NF1/2) –> malig peripheral nerve sheath tumors

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10
Q

STS anatomic sites

A

extremities > visceral > retroperitoneum > trunk > head and neck

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11
Q

where are osteosarcs vs Ewing’s sarcs?

A

metaphyseal vs diaphyseal

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12
Q

STS diagnostic imging

A

XR (esp in children to min rad), MRI (gold standard), CT (sm cortical lesion, lung windows/metastases), angiogram (for vasc, resectability)

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13
Q

STS diagnostic bx

A

pre-tx core needle bx before diagnosis and grading; bx needs to be along future resection axis w/ minimal dissection and careful attn to hemostasis –> don’t do it yourself –> call the surgeon who’ll be operating to do bx; DON’T do needle aspiration/FNA

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14
Q

STS general tx

A

multidiscip care; spare limbs –> need good margins, neoadjuvant chemo +/- XRT if primary resection = difficult; allograft/rotationplasty/reconstruction; external beam rad, intraoperative RT, proton beam therapy

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15
Q

STS specific tx: osteosarc vs Ewing’s sarc vs chondrosarc

A

radio resistant, chemo sensitive –> neoadjuvant/preop chemo before surgery; recurrence in lung vs radio and chemo sensitive vs radio and chemo resistant

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16
Q

presentation: osteosarc vs Ewing’s sarc vs chondrosarc

A

painful swelling around knee/humerus, night pain and limping, firm/soft mass fixed to underlying bone, high ALP vs pain and constitutional sxs like osteomyelitis/sarc, can metastasize vs pain at lesion/mass (shoulder), can become high grade or de-differentiate

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17
Q

radiology: osteosarc vs Ewing’s sarc vs chondrosarc

A

Codman’s triangle vs onion skinning vs mass w/ matrix appearance

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18
Q

pathology: osteosarc vs Ewing’s sarc vs chondrosarc

A

osteoblasts secreting osteoid, cotton candy vs round and blue, no osteoid –> no cotton candy vs chondrocytes secreting cartilage

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19
Q

how does liposarcoma occur?

A

from adipocytes and has fatty tissue around sacromatous elements (spindle shaped sarcoma cells), develop from well-differentiated tumors in retroperitoneum then limbs

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20
Q

when does angiosarcoma occur?

A

can appear after rad therapy, assoc w/ chronic lymphedema; not good if >5cm or metastatic

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21
Q

GIST. tx?

A

GI stromal tumor that can occur anywhere in the GI tract, metastasize to liver. cKIT, PDGF, VEGF = inhibited by sm molec tyrosine kinases; adjuvant therapy for 3 y

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22
Q

Describe elbow

A

Links forearm and upper arm in concert w/ shoulder; uni-axial hinge joint

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23
Q

elbow stabilizers: static vs dynamic

A

bony structures vs muscles, ligaments, capsules

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24
Q

3 joints in elbow: humeroulnar vs humeroradial vs proximal radioulnar

A

True elbow joint, modified hinge joint for fl/ex vs combined hinge and pivot joint, some fl/ex and more rotation of radial head on capitulum of elbow vs rotation for supination and pronation

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25
Q

2 ligaments of elbow fxns: medial/ulnar collateral and lateral/radial collateral

A

Resists and prevents excessive ab/dduction; does not impede supination/pronation

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26
Q

what are the growth plates of elbow?

A

CRITOE/CRMTOL: Capitulum, radial head, internal/medial epicondyle, trochlea, olecranon, external/lateral epicondyle

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27
Q

Carrying angle. Cubitus valgus vs varus

A

Nmlly 15 degrees; female > male. >15 degrees d/t forearm deviating outwards vs <15 degrees d/t forearm deviating inwards

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28
Q

describe ulnar collateral ligament vs radial collateral ligament

A

has ant/post/transverse bundles, fan shaped ligament, impt stabilizer of valgus stress vs impt secondary stabilizer in fl/ex

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29
Q

Mechanism and sxs of lateral vs medial epicondylitis

A

overusing wrist extensor –> microtears of tendon at lat epicondyle —> tennis elbow; aches at region, difficulty wrist/mid finger extension and ADL vs overusing wrist flexors —> microtears of tendon at med epicondyle —> golfer’s elbow; tenderness at region, inc pain w/ resisted wrist flexion and forearm pronation, neg Tinnel’s at cubital tunnel

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30
Q

how to dx vs tx lat/med epicondylitis?

A

XR shows calcium deposits in extensors d/t microtears and chronicity of condition vs rest/ice, forearm splint/trap, OMM, rehab, acupuncture, steroid injection, surgery last resort

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31
Q

MCL/ulnar collateral sprain

A

repetitive valgus stress –> microtears or rupture –> gradual onset of pain, tenderness of humeroulnar joint, ulnar nerve irritation

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32
Q

how to dx vs tx MCL/ulnar collateral sprain

A

pain in valgus stress test and milking maneuver vs rest 2-4wks, NSAIDs, OMM/OT/PT, prolotherapy, surgery for persistent sxs

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33
Q

medial apophysitis

A

repetitive valgus stress –> microtears or rupture –> gradual or fast onset of pain at medial epicondyle w/ swelling or bruising, pain in late cocking or acceleration

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34
Q

how to dx vs tx vs prevent medial apophysitis

A

XR shows widening of apophyseal line –> partial or complete separation vs rest 2-3mo, NSAIDs, rehab vs pitch counts

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35
Q

primary injury vs secondary injury

A

trauma directly injuring cells vs body’s response to trauma (vasoconstriction –> dec blood flow and O2 –> cell death –> histamine release –> capillary permeability for fluid –> swelling and edema)

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36
Q

tissue injury and repair: phase I/days vs phase II/wks vs phase III/months

A

inflamm: red/heat/swell/pain/loss of fxn, neu/macs, vasodil/bleed, edema, phag; 2-4d vs fibroblastic repair: angiogenesis & type III collagen unorganized deposition –> weak scar tissue; day3-2wks vs maturation remodeling: wound contracture, type I collagen reorganization –> improve tensile strength to 80%; months

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37
Q

muscle injury vs tendon injury

A

ruptured myofibers ctx and gap filled w/ edema and scar tissue –> satellite cells/stem muscle cells prolif and regen –> new myofibers project into developing connective tissue scar vs tenocytes = reparative cells in tendons that activate collagen prod; tendons have less vascularity –> less O2 and nutrition supply –> slower to heal than muscles

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38
Q

goals of muscle rehab

A

dec pain, inflamm, effusion; return to full active & pain-free ROM, muscular strength/power/endurance, asx fxnal activities at preinjury lvl

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39
Q

acute vs subacute/intermediate vs chronic phase of muscle rehab

A

R (to manage inflamm), I (for vasoconstriction), C (limit edema), E (help lymphatic system move extracellular tissue away from injury site) vs emphasis on restoring fxn –> flexibility training, strengthening exer, re-est neuromuscular ctrl via proprioceptive exer vs healed connective tissue for tensile strength 80%, inc intensity strengthening exer

40
Q

what does anterior interosseous n. innervate?

A

flexor digitorum profundus, flexor pollicis longus, pron quadratus

41
Q

meds for pain/edema

A

analgesics, acetaminophen, NSAIDs (ibuprofen, naproxen), corticosteroids

42
Q

when/why use heat vs ice vs electrical stimulation

A

for vasodil –> bad in phase I vs for vasoconstriction –> good in phase I vs analgesic, anti-edema

43
Q

how does radial nerve split?

A

superficial branch => sensory; deep branch/posterior interosseous => motor, passes thru Arcade of Frohse where it’s most susceptible to injury

44
Q

how to regain motion?

A

passive ROM, involuntary; active assisted ROM (assistance w/ unaffected extremity or device); active ROM, voluntary

45
Q

osteochondritis dessicans of elbow

A

repetitive loading, limited blood supply –> subchondral fx, articular cartilage fx –> loose body formation from capitulum –> lat elbow pain, stiffness, locking, catching

46
Q

how to tx osteochondritis dessicans of elbow

A

activity restriction/mods, OT/PT, NSAIDs, elbow arthroscopy w/ removal of loose bodies

47
Q

valgus extension overload syndrome

A

medial laxity –> medial pain; lat compression near radial capitular joint –> lat pain; impingement posteriorly –> loss of extension and posterior pain, olecranon spurring

48
Q

how to regain strength: isometric vs concentric vs eccentric ctx

A

joint doesn’t move, load stays in place but still has muscle ctx vs muscle shortens against resistance, isotonic (constant load) & isokinetic (constant vel) vs muscle lengthens against resistance, isotonic & isokinetic; restores strength and fxn in athletes w/ tendonitis

49
Q

neuromuscular ctrl. goal?

A

for joint stability, not strength; requires afferent/proprioceptive input to produce efferent/muscle ctx output. counteract post-injury inhibition to allow more nml use of surround musculature

50
Q

neuromuscular ctrl exer: early vs late vs much later

A

AROM, wobble board vs rhythmic stabilization vs plyometrics

51
Q

when to use therapeutic modalities?

A

in adjunct to rehab; don’t use independently

52
Q

thermotherapy

A

using heat or cold –> arterial blood flow (inc blood flow/vasodil or dec blood flow/vasoconstrict) or collagen extensibility (inc tendon extensibility and collagenase activity or dec enzyme activity)

53
Q

what temp injures tissue?

A

<32 degrees F or >113-122 degrees F

54
Q

examples of conduction vs convection in cryotherapy

A

cold packs, ice massage, cold-compression device vs vapocoolant spray, cold water immersion

55
Q

factors determining heat-absorbing capacity of cold modalities

A

pt’s mass, size of contact area, diff in temp b/w modality and tissue (greater ability of cold modality to absorb heat –> greater potential for reducing tissue temp), distance across which heat = transferred

56
Q

indications vs precautions for cryotherapy

A

acute injuries to minimize inflamm, ctrl pain and neuromuscular inhibition vs cold intolerance/hypersensitivity, Raynaud’s dz, arterial insufficiency, impaired sensation, cog deficits/inability to communicate, cardiac/resp involvement b/c it raises bp

57
Q

which phase of injury&repair to do heat modalities? therapeutic effects?

A

after acute phase of inflamm/phase I. dec muscle spasm, pain, joint stiffness; inc circ

58
Q

conduction vs convection vs radiation of heat therapy w/ examples

A

transfer heat b/w 2 bodies at diff temps thru direct contact; hot pack, heating pad, parraffin bath vs transfer heat via fluid circ over surface of body; fluidotherapy (air), hydrotherapy (water, whirlpool) vs transfer heat thru conversion of electromagnetic radiation into heat energy; radiant heat

59
Q

indications vs precautions for heat therapy

A

arthritis, chronic pain vs ischemia, bleeding d/o, impaired sensations, cog deficits/inability to communicate, malignancy, edema

60
Q

superficial vs deep heat therapy

A

<2cm vs >2cm; US, nonthermal shortwave diathermy, microwave diathermy

61
Q

deep heat therapy: therapeutic vs thermal vs nonthermal US

A

use acoustic energy above hearing range –> 1-3MHz (medical US uses 1-10MHz); improve healing or alter fxn vs inc tissue temp to 40-45 degrees C; you’ll heat more bone > tendon > skin/muscle/fat; <40C –> no change, >45C –> tissue dmg vs repair/regen dmged tissue; acoustic cavitation: gas bubbles oscillate and burst –> disrupt tissue, acoustic streaming: unidirectional movement from US waves

62
Q

therapeutic US: phonophoresis

A

use sound waves to drive whole molec thru skin into underlying tissue; transport limited by stratum corneum (permeability depends on hydration, abrasions inc drug absorption, follicles primarily transport –> heat skin –> better drug absorption)

63
Q

electrotherapy

A

use electricity to generate AP –> alter sensory input or cause muscle ctx –> inc joint ROM, muscle strength, circ; dec muscle atrophy and spasm; release polypeptides & neurotransmitters; inhibit pain fibers; transport meds

64
Q

indications vs precautions of electrotherapy

A

pain, arthritis ROM, joint effusion, muscle stimulation/education, muscle disuse atrophy, meds delivery vs stimulation over carotid sinus & heart, preg, sz, acute fx, hemorrhage, impaired sensation, malignancy

65
Q

3 categories of nerve injuries: neurapraxia-focal vs axonotmesis vs neurotmesis

A

dmg of myelin sheaths around axon vs dmg to axon itself vs complete disruption of axon

66
Q

electrotherapy: iontophoresis

A

use electric current to transport meds thru skin; meds must dissociate into electrically charged ions in soln; tx lasts 10-20min

67
Q

indications vs precautions of axial/spinal traction

A

reduction of nerve or disc compression, pain/muscle spasm, loosening adhesions in dural sleeve vs congenital spine deformity, cervical spine (ligamentous instability, vertebrobasilar insufficiency), lumbar spine (preg, AAA), osteopenia/porosis, infxn

68
Q

electrotherapy: transcutaneous nerve stimulation (TENS)A

A

pulse, sensory lvl stimulation to interfere transmission of pain signals in spinal cord –> placebo, gateway theory, release of endogenous opioids; 30-60min for 8hrs/d

69
Q

electrotherapy: neuromuscular electrical stimulation (E-Stim). indications vs precautions

A

electrical stimulation above motor activation threshold to cause muscles ctx. strengthen muscle and maintain muscle mass, enhance voluntary muscle ctrl vs stimulation over heart & neck, pacemakers, preg, sz, impaired sensation, malignancy, infxn

70
Q

low lvl laser therapy. precautions?

A

use laser to tissues up to 36.5 degrees C => “cold laser”. w/in 6mo of rad therapy, preg, unfused epiphyseal plates/small children, over-cancerous areas, eyes, hemorrhage

71
Q

dry needling

A

thin filiform needle to penetrate skin and stimulate underlying myofascial trigger points, muscular and connective tissues for neuroMSK pain and movement impairments –> release tension

72
Q

adverse effects vs precautions of dry needling

A

pneumothorax vs local skin lesions/infxn, severe hyperalgesia, metal allergies, abnl bleeding, vasc dz, 1st trimester

73
Q

acupuncture

A

stimulate specific points/meridians to balanc emovemnt and restroe ehalth; for acute and chronic med problems

74
Q

massage. indications vs precautions

A

applying hands to soft tissue to improve circ and break down soft tissue adhesions. muscle cramps, stress/tension, edema vs local infxn, inflamm arthritis, open wounds, bleeding d/o, malignancy, entrapment neuropathy

75
Q

extracorporeal shockwave therapy. indications vs adverse effect

A

noninvasive high energy pulse thru skin to target tissue –> induc inflamm to initiate nml healing. plantar fasciitis, calcific tendinopathy of shoulder, Achilles’ tendinopathy, patellar tendinopathy vs discomfort

76
Q

bacteria causing osteomyelitis

A

s. aureus/epi, H. flu, salmonella in sickle cell, Pseudomonas in IVDU

77
Q

acute vs subacute vs chronic osteomyelitis

A

“great pretender”, direct contiguous (neg), hematogenous (50%), periosteal pus cx (75%); no fever, erythema, drainage vs Brodie’s abscess: round radiolucency w/ thick surrounding sclerosis; no fever, constitutional sxs; pus cx –> s. aureus vs sequestrum (necrotic bone), involucrum (thick bony collar to wall of infxn), cloaca (defect in involucrum)

78
Q

complications of osteomyelitis

A

pathologic fx, septic arthritis, growth disturbance, sq cell ca, amyloidosis

79
Q

bacteria causing acute vs chronic septic arthritis

A

pyogenic bacteria or virus vs non-Candida fungi, mycoTB, spirochetes

80
Q

toxins vs sxs vs dx vs tx of gonococcal septic arthritis

A

lack Opa proteins, protein 1A, antigenic LPS vs dermatitis, tenosynovitis, polyarthralgia, fever/chills vs NAAT, Thayer Martin, blood cx, synovial fluid cx, low glu vs ceftriaxone

81
Q

what kind of distribution does nongono arthritis affect? how does it spread?

A

bimodal (1-5yo and >60yo). from contiguous infected foci (epiphyseal osteomyelitis); from neighboring soft tissue infection (like skin infxn); Direct inoculation of bacteria through joint interventions or surgery (like prosthetic joints)

82
Q

toxins by nongono arthritis

A

s. aureus have fibrinogen binding protein and MSCRMMS, K. kingae have pili, s. agalactiae have fibrinogen binding adhesin

83
Q

which joints are infected in IVDU?

A

sternoclavicular and sternomanubrial joints

84
Q

pathology of nongono arthritis

A

purulent synovial fluid, ulceration of cartilage –> irreversible joint loss, inflamm of pannus, Exposure of subchondral bone, Obliteration of the joint space by fibrous ankylosis

85
Q

sx vs dx vs tx of nongono arthritis

A

fever, malaise, dec ROM vs synovial fluid cx, blood cx, leukocytosis w/ L shift, low glu vs parenteral abx therapy

86
Q

bacteria causing prosthetic joint infxn. how?

A

s. aureus/epi, gram neg bacilli. direct inoculation, biofilm

87
Q

early vs delayed vs late onset of prosthetic joint infxn

A

s. aureus –> acute fulm illness vs s. epi –> long indolent course vs dental (viridans), GI/U (E coli, Pseudomonas), pyogenic (s. aureus/epi)

88
Q

dx vs tx of prosthetic joint infxn

A

synovial fluid analysis (pathogen must be found in 2 periprosthetic samples), tissue bx vs device removal, 2-stage exchange arthroplasty

89
Q

early local vs early dis vs late dis vs PTLLS lyme dz

A

EM vs EM, acute meningitis w/ neck stiff and HA, facial palsy, transient AV block vs pauciarthralgia vs warm joints w/ large effusion, radiculoneuritis; late stage dz in txed pts, no bacteria found

90
Q

dx vs tx lyme dz

A

ELISA + West blot vs doxy, amox, cefuroxime

91
Q

polyarthritis w/ RF. dx vs tx

A

polyarticular, migratory. Synovial fluid analysis: sterile inflammatory fluid vs resolves its own

92
Q

clostridial vs strep myonec

A

C. septicum enter body via mucosal lining or bowel wall; ABCDE strain/toxin; purple skin, gas prod, fever/tachy; leukocytosis w/ L shift, hemolytic anemia, inc ESR/CK/aldolase/LDH/potassium, gas in tissue; surgical debride, piperacillin + clindamycin vs S. pyogenes enter prox muscles of LE; Spe pyrogenic toxins bind to both macrophages and CD4 T cells → high levels of cytokines; early (NVD, flu like sxs), intermediate (muscle pain/spasm), late (hypoTN, tachy, organ failure); leukocytosis w/ L shift, inc ESR/CK, abnl liver and renal fxn, CT/MRI: muscle thickening/edema/lymphadenopathy; penicillin + clindamycin

93
Q

complications of calcaneal fx

A

wound dehiscence, lost talar motion, dystrophy/CRPS, inc heel width

94
Q

Maison fx

A

prox 1/3 of fib, tear in syndesmosis/inteross mem, GET KNEE XR

95
Q

How to tx Charcot joint?

A

nonop: splint/cast/edema ctrl
op: fusion/osteotomies/amputation

96
Q

what does bone scan vs MRI show for LCP?

A

dec uptake w/ dec blood flow vs bone marrow changes

Block 2 (16 decks)

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