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Quarter 2 > Clin Med Exam 3 > Flashcards

Clin Med Exam 3 Flashcards

1
Q

FAI- Femoroacetabular Impingement

A

Groin and/or lateral hip pain

Bone overgrowth/abnormality tears labrum or destroys cartilage

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2
Q

FADIR and FABER tests are best for checking for

A

FAI- Femoroacetabular Impingement

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3
Q

Labral Tear of Hip

A

Groin pain, often radiates to lateral hip, anterior thigh, and buttocks

Catching and Clicking

MR ARthrogram best form of dx

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4
Q

Snapping Hip Syndrome

A

Snapping or popping with walking/ getting up from chair, or swinging leg

Muscle/tendon is sliding over bony prominence

External (IT band) vs Internal (Iliopsoas tendon)

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5
Q

Tx of Snapping Hip Syndrome

A

NSAIDs, avoid painful activity, Steroid Injection

PT, stretching, US, heat/ice, myofascial release

Iontophoresis- voltage current

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6
Q

Greater Trochanteric Pain Syndrome

“Trochanteric Bursitis”

A

most common cause lateral hip pain in adults

Repetitive overload tendinopathy, bursa inflamed

Pain worse when lying on side

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7
Q

Greater Trochanteric Pain Syndrome

A

Worse w lying on side, walking, staris, incline, prolonged standing

Trendelenburg Sign

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8
Q

Tx for Greater Trochanteric Pain Syndrome

A

Self limiting but can do NSAIDs, heating pad, sit differently, Steroid injection

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9
Q

MCL sprain

A

Often part of unhappy triad: MCL, ACL, and Medial meniscus

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10
Q

MOI for MCL Sprain

A

knee flexion, foot planted, and Lateral Impact causing valGUM stress and rotation

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11
Q

ACL injury

A

most common knee ligament to be injured

ACL prevents anterior movement of the tibia

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12
Q

MOI for ACL injury

A

Noncontact: quick change w pivoting
Contact: direct blow causing hyperextension and again valGUM stress w lateral impact

Feel a “POP” then pain and swelling

Pt reports feeling very unstable

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13
Q

ACL presentation

A

Joint effusion, guarding, able to bear wait w/laxity and feel very unstable

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14
Q

Test for ACL injury

A

Lachman, Anterior Drawer, Pivot shift

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15
Q

Imaging for ACL

A

MRI preferred

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16
Q

PCL

A

largest and strongest ligament of knee

MOI: high force trauma (MVA) vs low force (soccer)

least likely to be injured during sports

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17
Q

PCL injury

A

presentation varies. may be subtle or very unstable

General knee pain, pt says “something just isn’t right”

Limp

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18
Q

PCL tests

A

Posterior drawer sign and Posterior sag sign

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19
Q

Meniscus injury

A

Excessive rotational force
Medial meniscus is most vulnerable to injury

Joint line pain, unable to fully extend

knee “locking” or “catching”

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20
Q

Meniscus tests

A

McMurray, Apley Grind

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21
Q

Patellofemoral Pain Syndrome

A

“Runner’s knee”

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22
Q

Patellofemoral Pain Syndrome/ Runner’s Knee

A

Most common knee complaint
Malalignment!!
Anterior pain under patella, worse w stairs

Crepitus, popping, feeling unstable

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23
Q

Patellofemoral/Runner’s knee

Jenn

A

+theater or long car ride sign

Test: Patellar glide and Apprehension

Tx: Ice, NSAIDs, strengthen hip aBductors and quads, stretch hamstrings, core, taping, stabilizing brace

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24
Q

Baker’s/Popliteal cyst

A

often asymptomatic

foundon accident

pain/swelling w prolonged activity or standing

NSAIDs, Aspirate, Injection, Compressive neoprene brace

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25
Q

Patellar Tendonitis “jumper’s knee”

A

patellar tendon inflammation

repetitive trauma

Running, jumping, kicking sports

Worse w excessive foot pronation and running on hills

Ice, NSAIDs, brace, strap, modify activity, rest, PT

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26
Q

IT Band syndrome

A

overuse injury

Runners, cyclists

gradual onset of localized pain

localized tenderness that is reproducible with ROM and compression to ITB region

*Evaluate for LLD

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27
Q

Knee Bursitis

A

Prepatellar and Pes Ansarine regions are most common

Trauma vs Overuse

*Rule out infection!

NSAIDs, avoid irritating factors, Aspirate/steroid injection, padding/bracing

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28
Q

Osteochondritis Dissecans

A

Necrosis of subchondral bone
10-20 YO, Young
Repetitive loading in wt bearing joints- elbows, knees

Gymnasts, Throwing sports

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29
Q

Osteochondritis Dissecans

A

Trauma –> focal hypovascularity –> necrosis –> Chondromalacia –> Articular fragment

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30
Q

Osteochondritis Dissecans

A

intermittent swelling, popping, locking, catching in advanced disease

Pain, guarding possible

X Ray shows flattening of articular surface (Crater)

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31
Q

Tx of Osteochondritis Dissecans

A

Stage I-III: Conservative, avoid running/jumping, Immobilize for months and maybe PT

Stage IV: Surgery. Drill to promote new bone growth. Fixation if there is an unstable lesion and remove loose bony fragment

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32
Q

Lateral Ankle Sprain

A

Most commonly injured

Lateral Ligament Complex:
Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament

Inversion injury

Anterior drawer test

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33
Q

Medial ankle sprain

A

Deltoid ligament

Eversion injury

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34
Q

Syndesmotic ankle sprain

A

High ankle sprain:
Anterior and Posterior Talofibular, Transverse Tibiofibular, Interosseous membrane

Dosiflex/rotational injury

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35
Q

Test for Syndesmotic Ankle Sprain

A

Squeeze test

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36
Q

Tx for Ankle Sprains

A

RICE, NSAIDs, +/- short immobilizer for grade II-III to prevent repeat injury, brace/tape

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37
Q

Achilles tendon

A

Acute: tendinopathy, rupture

Peds: Calcaneal Apophysitis “Sever’s Disease”

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38
Q

Achilles tendon rupture

A

Sensation of violent hit or pop, maybe painless

Palpate in plantar and dorsiflexion

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39
Q

Test for Achilles Tendon

A

Thompson test- there should be plantar flexion movement when calf squeezed

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40
Q

Tx for Achilles Tendon

A

Equinus splinting, boot allowing for constant plantar flexion

Constant PLANTAR FLEXION

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41
Q

Plantar Fasciitis

A

First step in morning painful

can be d/t activity, heel spurs, pes planus, ankle pronation, poor shoe wear

Worse w/ROM that places fascia under sprain

Ortho or podiatry referral only for severe: Steroid injection, Splinting, Casting

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42
Q

Gout

A

Monosodium Urate Cyrstals

> 6.8 is Hyperuricemia

1st MTP Joint “Podagra”

X Ray: “punched out” “rat bite erosions”

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43
Q

Gout

A

Negatively birefringement and Needle shaped

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44
Q

Tx of Gout

A

Allopurinol: DOC
(Febuxostat is another option but has FDA cardiovascular warning)
Acute flare: NSAIDs (48hrs), Glucocorticoids, Colchicine (24hrs)

When starting meds, use NSAIDs or Colchicine to reduce risk of acute flare

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45
Q

Pseudogout

A

Calcium Pyrophosphate Crystal Disease

Older ages

Associated w/ Hemochromatosis and Hyperparathyroidism

Knee

Chondrocalcinosis

Positively bifringent and Rhomboid shaped

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46
Q

Tx for Pseudogout

A

Steroid, NSAIDs, or Colchicine

Prophlyactic if 3 or more attacks/year: Colchicine daily

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47
Q

Reactive Arthritis

A

1-4 wks after GI or GU infection

Young adults

“Cant see, cant pee, cant climb a tree”

HLA B27 Positive, RF negative

2/3 cases self-limiting, refer to Rheumo if needed

Treat arthritis: NSAIDs, then Steroids, then DMARDs (only progress to the next one if first doesn’t work)

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48
Q

Ankylosing Spondylitis

A

Axial

Starts at SI joints and progresses proximally

Young adults, <40

Ossification “Bambo Spine”

Labs show ESR, CRP elevated

X Ray shows Hallmark Sacroilliitis

Improves w/exercise

GREAT RESPONSE TO NSAIDs

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49
Q

Lupus SLE

A

Genetic, immunologic, hormonal, environmental factors –> Antinuclear Antibodies

Malar butterfly rash, Discoid rash

Increased risk MI

+ Anti- DNA, Anti-Sm Ab, and ANA

Daily Hydroychloro/ Plaquenil!!!! Optho f/u always

Based on severity, can add: NSAIDs, steroids, immunosupp

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50
Q

Drug induced Lupus

A

Procainamide, Isoniazid, Hydralazine

Will have + Antihistone antibody, but negative anti-dsDNA and anti-Sm Ab

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51
Q

Polymyositis/ Dermatomyositis

A

Proximal muscle weakness (groceries and getting up from chair is difficult)

Gradual

LUNG STUFF- interstitial lung disease and scarring of lung tissue

Cutaneous addition: Heliotrope rash, Gottron’s papules, Shawl sign

Tx: Glucocorticoids

may add immunosupp (MTX or Azathio)

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52
Q

Sjogrens Syndrome

A

Sicca comples -dry eyes and mouth

Schirmer test

Anti-Ro and Anti-La

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53
Q

Polyarteritis Nodosa PAN

A

only arteries affected-narrowing

Thrombosis, Ischemia, Infarct

Skin biopsy: Leukocytoclastic Vasculitis

Renal manifestation (kidney) most common!

ANCA negative lab

Steroids, may add Immunosupp if severe

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54
Q

Systemic Sclerosis

A

narrowing of small vessels

Limited Cutaneous vs Diffuse Fibrosis

limited: CREST
diffuse: rapid tightening of skin, organ damage risk

tx: none really, pt education and symptomatic

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55
Q

RA

A 
synovial joints
boggy
periphery--> proximal
Morning stiff >1hr
better w exercice
SPARES DIP
Trigger finger, Swan neck, Boutonniere, Ular drift

Cervical –> cervical myelopathy if sublux

X Ray: arrowhead, joint space narrowing, bony erosion

Anti CPP is more specific for RA

EARLY USE OF DMARDs

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56
Q

Felty’s syndrome is a triad of RA

A

Anemia
Splenomegaly
Neutropenia

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57
Q

Tx for RA

A

EARLY USE OF DMARDs

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58
Q

DMARDs

A

Traditional/synthetic
Biologic (TNF vs non)
JAK inhibitor

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59
Q

OA

A

Involves all joint tissues
OLD AGE
joint space narrows leading to bony changes
OSTEOPHYTES (bone spurs)

Relieved by rest- ZzzZzZ

Herberden’s, Bouchard’s nodes

First MCP joint “Squared Off”

NSAIDs, Cymbalta, Tramadol, Acetaminophen, Steroid

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60
Q

Polymyalgia Rheumatica

A

Old man
Proximal stiffness and aching

Assoc w/ Giant Cell Temporaritis

Rapid Improvement with LOW DOSE GLUCOCORTICOIDS!!!

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61
Q

Fibro

A

3 months or greater of sx

Female, 20-50s most common

Often occurs w Lupus or RA

Tricyclic antidepressants, Seretonin and NE reuptake inibitors (SNRIs)
Cymbalta
Savella
Anticonvulsants- Lyrica, Neurontin

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62
Q

Tests for Impingement

A

Neers, Hawkins

Tx: NO ARM SLING, Do physical therapy and f/u in 2-3 weeks

Possible steroid injection

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63
Q

Labral Tear of shoulder

A

can be acute or repetitive
Acute: FOOSH, sudden pull

Often accompanied by another shoulder issue

Bankar lesion- inferior tear assoc w dislocation
SLAP lesion- around the top rim

Biceps tendon pain, restricted rotation, scapula motion dysfx

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64
Q

Tests for Labral Tear

A

Anterior glide
Speed’s
O’Brien’s

Imaging: MRArthrography preferred

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65
Q

Frozen Shoulder

A

May develop adhesions
Reduced ROM in 2 OR MORE planes

Mechanical restriction

Apley Scratch Test

Physical Therapy ASAP rocky

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66
Q

AC Sprain/Separation

A

assoc w/ classic Football Fall

Fall onto tip of shoulder w/arm tucked

Worse @ bedtime

3 degrees depending on how many ligaments involved

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67
Q

Ligaments of AC Sprain/Separation

A

Coracoclavicular x2 (Trapezoid & Conoid)

Acromioclavicular

Coracoacromial

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68
Q

Test for AC injury

A

Cross Over (cross-body adduction)

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69
Q

AC injury tx

A

Reduce pressure and traction to allow ligaments to reform and strengthen

Shoulder immobilizer 3-4 wks

Steroid injections if not improving 2-4 wks, Surgery for grade 3

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70
Q

Clavicular fracture

A

Tenting of skin, Decreased ROM

Conservative for minimally displaced, non displaced, and ALL PEDS

Try Sling, Swathe vs Figure 8 Harness

Analgesics, Sleep upright, cosmetic

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71
Q

When to refer to Ortho for Clavicle fracture

A

All distal 1/3, All proximal 1/3, or displaced

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72
Q

Subacromial Bursitis (shoulder)

A

Inflammation or degeneration of bursa

Repetitive movement

May results from systemic disease- RA, gout, sepsis

R/o sepsis!! Fluid aspirate if needed

Can inject steroids if infection is ruled out

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73
Q

Biceps Tendonitis

A

inflammation of long head biceps tendon

Repetitive lifting

Pain on anterior shoulder w/aBduction and external rotation

Yergasons and Speeds

Reduce inflamm, swelling, and prevent rupture

Ice, NSAIDs, PT, steroid injection?, surgery

If rupture: POPEYE deformity

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74
Q

Myelopathy

A

damage to Spinal Cord

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75
Q

Radiculopathy

A

damage to Nerve Root

R & R

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76
Q

Myelopathy sx

A

BELOW THE LESION

Spasticity, up going plantar reflex (Babinski sign), Clonus (sustained), “Lhermitte sign” pain down spine/extremities with neck flexion

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77
Q

Radiculopathy sx

A

DERMATOMAL PATTERN

Hypotonia
Muscle atrophy, fasciculation

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78
Q

sTrain

A

muscle, tendon

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79
Q

sPrain

A

ligament (bone-bone)

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80
Q

Nexus Criteria: if all 5 are met, no need to image before assessing ROM or manipulation

A 
No posterior midline tenderness
Normal alertness
No intoxication
No abn neuro findings
No other painful inj
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81
Q

Reasons to get AP, lateral, AND Odontoid X Ray for Cervical

A

if Trauma or pt is OLDER

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82
Q

Opoids

A

No longer than 1-2 weeks

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83
Q

Resolution of Cervical sprain/strain

A

4-6 weeks

Whiplash may take longer

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84
Q

Cervical and Lumbar Radiculopathy

A

Onset can be abrupt or occur and worsen

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85
Q

Radiculopathy

A

follow nerve pattern!!!

86
Q

Cervical Radiculopathy

A

can include radicular pain/paresthesia with neck flexion

87
Q

Cervical Radiculopathy

A

Typically Unilateral

unless stenosis

88
Q

How to relieve Lumbar Radiculopathy

A

Lie on back with knees elevated or in fetal position

89
Q

Impingement b/w L1 and L4 can cause:

A

Anterior thigh pain

90
Q

Impingement from L4 and below:

A

Pain radiates down to foot

91
Q

Physical Exam for Radiculopathy

A

Motor, Sensory, and DTR dysfx should follow nerve distribution

92
Q

Cervical Radiculopathy

A

DROM, loss of cervical lordosis

93
Q

Lumbar Radiculopathy

A

Positive straight leg
Reverse straight leg raise for lesion above L4 (L1-L4)
Typically + low back pain/spasms

94
Q

What is the cutoff for whether radiculopathy pain is on anterior thigh or on the shin?

A

at about L4

L1-L4

L4 and below

95
Q

Order MRI for Radiculopathy IF:

A
  • Sx >4 weeks

- Immediately IF significant neuro deficit or if myelopathy is identified

96
Q

Tx of Radiculopathy

A

If nonprogressive Neuro sx:

NSAIDs, steroids, PT

97
Q

Tx of Radiculopathy

A

If confirmed and severee pain with worsening Neuro deficits:
Epidural Injections

Surgery Referral if no improvement after injections or concern for myelopathy
(2-3 injections then refer)

98
Q

Spinal Stenosis

A

can be Acquired or Congenital

99
Q

Acquired Spinal Stenosis

A

D/t: spondylosis (fracture), spondylolisthesis (anterior slippage), Herniated disc and lig flavum thickened, traumatic and post op fibrosis, skeletal disease (RA, ankylosing spondylitis)

100
Q

Congenital Spinal Stenosis

A

Dwarfism, Congenitally small spinal canal, Spina Bifida

101
Q

Lumbar Spinal Stenosis

A

Most common cause of neuro leg pain in Elderly

Neurogenic claudication: progressive leg pain worse w/ standing or walking

relieved by leaning forward “Shopping cart sign”

Radicular sx can be present without actual back pain

102
Q

Most common cause of Lumbar Stenosis

A

Spondylosis (fracture)

+/- Ligamentum Flavum Hypertrophy

103
Q

Cervical Stenosis

A

most common cause of myelopathy in elderly

d/t progressive spondylosis with Bone spur formation, disc herniate, and lig flavum hypertrophy

varying signs

104
Q

Cervical and Lumbar Stenosis Imaging

A

MRI preferred!!

CT myelogram is good but invasive

EMG/NCS if unclear to r/o other dx

105
Q

Stenosis tx

A

NSAIDs initially for pain
Cervical brace and activity restriction

Consider PT and Core strengthen for Lumbar Stenosis (aerobics for elderly)

Epidural steroid injections

Surgical decompression or fusion if sig stenosis or neuro changes/severe pain

106
Q

Cauda Equina

A

EMERGENCY
Compression of lumbar, sacral, coccygeal nerve roots

sx vary greatly

Hx very important, esp malignancy

107
Q

Causes of Cauda Equina

A

Intervertebral disc herniation, epidural abscess, tumor, lumbar stenosis, metastatic, infectious, autoimmune

108
Q

Cauda equina sx

A

LBP w radiation into 1 or both legs
Leg weakness multiple distributions L3-S1
Weak plantar flexion, loss of ankle reflex S1-2
Perineal sensory loss
“Saddle anesthesia” , urinary retention, incontinence fecal and urinary, sexual dysfx

109
Q

Tx of Cauda Equina

A

Dexamethasone 10 mg IV immediately!!

Emergent MRI WITH CONTRAST

if not avail, CT myelogram

110
Q

Tx Cauda Equina

A

Scan entire spine if concern for metastasis or unsure of cause
Tx depends on cause of cord compression

Surgical consult for decompression/radiation therapy if CA

Prognosis variable

111
Q

Red Flags for Malignancy

A 
Unexplained weight loss
Failure of pain to improve with tx
Pain > 1 month
Pain at night-wake frm sleep
PMHx CA
>50 YO
New onset spine pain w known malignancy is metastatic until proven otherwise
112
Q

Red Flags for Infection

A 
Pain at rest
BP with FEVER
Immunocomp
IV drug user
Recent hx of infection, i.e.: UTI, PNA, Cellulitis
113
Q

Thoracic Outlet Syndrome

A

compression of neurovascular bundle above 1st rib and behind the clavicle

Repetitive: pitching athletes
Cervical rib anomaly
Muscular anomaly
Injury (Trauma, fracture)

114
Q

Three types of Thoracic Outlet Syndrome:

A

Neurogenic (nTOS)- 95% brachial plexus compression

Arteriol (aTOS)- subclavian artery compression

Venous (vTOS)- subclavian vein compression

115
Q

nTOS presentation

A

compression in the scalene triangle

reproducible w elevation of arm

upper ext pain, dysesthesia, weakness/numbness

may not be specific nerve distribution

116
Q

nTOS presentation

A

progressive, unilateral weakness of Hypothenar muscle
Numbness in Ulnar OR Medial nerve distrib
Tenderness over Scalene Muscles

117
Q

aTOS presentation

A

sx develop spontaneously (not related to work/trauma)

almost always assoc with CERVICAL RIB

Thromboembolism to hand or arm

Arm/hand ischemia: pain, paresthesia, pallor, coolness
Pulse @ wrist may be diminished or absent

118
Q

vTOS

A

typically related to vigorous, repetitive UE activity
Upper ext venous thrombosis
SWELLING OF EXTREMITY- hallmark (paresthesia is secondary to swelling)

Cyanosis, ext pain, fatigue in forearm within minutes of use

119
Q

Dx of TOS

A

Electrodiagnostic testing - particularly with nTOS
Brachial Plexus Block- nTOS
US- initial for artery or vein
CXR- bony anomaly, good for artery one bc artery one is 90% assoc w bony anomaly
CT angiography/venography to appreciate UE vasculature

MRI w contract

120
Q

tx of nTOS

A

PT 4-6 wks
Steroid, Botulinim toxin type A
Decompression surgery for worsening sx, or if failed conservative

121
Q

tx of vTOS

A

Catheter directed thrombolysis (best w/in 2 wks of sx onset)

Decompressive surgery

122
Q

tx of aTOS

A

Decompressive surgery

Surgical Embolectomy- very dangerous and can result in further injury

123
Q

Elbow epicondylitis

medial- golf. wrist flexors
lateral- tennis. wrist extensors

A

sling, WRIST brace (even though prob is at elbow), ice (only right after activity), Anti-inflammatory

124
Q

Prevent elbow epicondylitis

A

Forearm strap, stop activity, correct technique

125
Q

Treat recurrent elbow epicondylitis

A

Steroid injection, surgery

usually do NOT inject on medial side d/t Ulnar nerve location

126
Q

Olecranon Bursitis

A

trauma, prolonged pressure

can become infected: warmth adn redness

127
Q

Treat olecranon bursitis

A

Ice, NSAIDs, Aspirate- gram stain and culture

Abx, +/- surgical intervention

128
Q

Cubital Tunnel

A

compression of ULNAR nerve
4th and 5th finger sx
decreased grip strength
chronic: muscle wasting

129
Q

Cubital tunnel tx

A

NSAIDs (if repetitive cause), brace, PT

Surgery- cubital tunnel release +/- ulnar nerve transposition (move the nerve)

130
Q

Carpal Tunnel Syndrome

A

1/2 loaf fingers
MEDIAN nerve compression
Swelling of synovium or thickening of transverse carpal ligament

131
Q

Carpal Tunnel synd

A 
Pregnant, typers, women: male 2:1
Usually gradual onset
early: dull ache
late: burning, numbness, tingling
Worse @ night bc wrist position during sleeping- often flexed

Thenar muscle atrophy

132
Q

Carpal Tunnel Syndrome

A

Tinel’s and Phalen’s test

X Ray, grip strength
Nerve Conduction study, Electromyogram

133
Q

Carpal Tunnel tx

A

Acute: immediate decompression
Chronic: NSAIDs, steroid injection, Brace, PT
Surgical release: endoscopic or open

134
Q

Ganglion cyst

A 
collection of synovial fluid
dorsal and volar wrist most common
Soft, mobile, can change often
often change size after activity
Size doesnt necessarily coorelate with pain
135
Q

Ganglion cyst tx

A

NSAIDs, Aspirate and Steroid, Surgery

“bible bump” not rec

136
Q

De Quervain Tenosynovitis

+Finkelstein test

A

Inflammation of 1st Dorsal Compartment
Sheath of aBductor pollicus LONGUS and extensor pollicis BREVIS

Overuse/repetitive gripping
Postpartum F>M
pain/sw along dorsal radial wrist

137
Q

De quervain tenosynovitis tx

A

Stop painful activity, Thumb spica splint, immobilization brace, NSAIDs, Steroid, Surgical referral to decompress 1st dorsal compartment

138
Q

Boutonniere

A

Flexion of PIP

Hyperextension of DIP

139
Q

Trigger Finger

A 
A1 Pulley
Nodule forms @ volar MCP joint
Mechanical impingement
Benign, idiopathic, spontaneous
Inflammatory nodule- PAINFUL

Will often come in for “catching, locking” of finger and pt has to pull open

Nodule is under sheath- palm of hand

140
Q

Tx of Trigger finger

A

NSAIDs, Steroid injection, Surgery to release A1 pulley (contracture will never come back after surgery)

141
Q

Concerning features on an X ray

A 
Indistinct margin
Abnormal Periosteal rxn
Soft tissue mass/invasion
Rapid growth
Pathologic fracture
142
Q

Unicameral Bone Cyst

A 
Simple bone cyst
fluid filled cavity in bone
Easily fractured
Younger pts
Long bones
Tx: "NO TOUCH LESION"
these can spontaneously improve
143
Q

Aneurysmal Bone Cyst

A 
Same as other but blood filled
Spine and extremities
Benign but AGGRESSIVE and RAPID GROWTH
Often treated since aggressive
Refer to Ortho (surgery)

will not improve on own

144
Q

Non-ossifying Fibroma

A

“MES” Metaphyseal (end of bone), Eccentric (on side of bone), Sclerotic border (bright white)

Tx: Observe, Ortho referral if lesion greater than 50% diameter of bone

145
Q

Giant Cell Tumor

A

Benign but aggressive
***Only one that CROSSES METAPHYSEAL/EPI region

Not good bc can affect joint space now

Localized pain and weakness

X Ray, *Usually followed by MRI

Need to r/o CA

146
Q

Giant Cell Tumor tx

A

Refer to Ortho, Radiation, Surgery, high recurrence rate

147
Q

Osteoid Osteoma

A

Small benign
Can see the reaction to the bone around it more than the tumor itself

NIDUS- dot in middle, releases other cells that cause pain

148
Q

Osteoid Osteoma

A

Dull aching pain, SEVERE at night

RELIEVED BY NSAIDs

149
Q

Osteoid Osteoma imaging

A

X Ray, CT, labs to r/o infection

Refer to ortho OR
Interventional Radiology
CT guided radiofrequency ablation- tx w/o big surgery!!

150
Q

Osteochondroma (exostosis)

A

Abnormal bone/cartilage growth along surface of bone

Pedunculated (stalk) or sessile

Grows in proportion with the patient!

May be painful w activity, depends on location

151
Q

Osteochondroma (exostosis) tx:

A

Observe, may have to treat for other secondary complications

152
Q

Osteosarcoma and Ewings Sarcoma

A

Malignant primary bone tumor

Asymptomatic becomes painful and swollen

X Ray, MRI, CT

Ortho and Oncology

153
Q

Chondrosarcoma

A

Males 60-80

Bone tumor made of cartilage producing cells

Hips, shoulder, pelvis (Radiates to hip/knee)

X Ray, MRI, Biopsy

Ortho, Radiation, Chemo

154
Q

Multiple Myeloma

A

Most common primary bone tumor in adulthood
Of the marrow

Entire skeleton

Radiation, Pesticide, HIV

Fatigue, fever, night sweats, DIFFUSE BONE TENDERNESS

155
Q

Multiple Myeloma

A

Labs, UA-Bence Jones Proteins
X Ray: Punched Out appearance

Radiation, Chemo, Supportive care

156
Q

Metastatic Bone CA

A

Prostate, Breast, Kidney, Thyroid, Lung

LUNGS most common spread

157
Q

Risk factors for Low BP

A

Poor ab muscles, Obesity, Pregnant

158
Q

Swimmer’s view X Ray

A

C7-T1

159
Q

Odontoid view

A

C1 and C2

160
Q

Cervical Spine Imaging Indications

A

Trauma, Infection, Atypical pain, Extremity pain, Osteoporosis, Degenerative change

161
Q

Lumbar Spine Imaging Indications

A

Fall from > 3 meters, Fall from standing if >60YO or frail, Ejection MVA, Sig trauma, Acute and severe BP, Neuro deficits, AMS, Postop fibrosis, Chronic condition and back pain, Hx of CA with back pain, BP at night or resting

162
Q

Oblique view Lumbar X Ray

A

to see Articular facets and Pars interarticularis

163
Q

Nerve Conduction Study

A

Can determine SPECIFIC SITE of nerve injury

164
Q

Lhermitte sign

A

Shock like sensation radiating into spine or arms with forward flexion of the neck

165
Q

NEXUS not applicable for

A

Direct blow to neck
Penetrate trauma to neck
Adults >60 YO

166
Q

Lumbar strain/sprain

A

usually axial, but can radiate to buttocks

may spasm

may not be able to stand without frequent change in position

167
Q

Lumbar strain/sprain treatment

A

No bedrest
NSAIDs, PT, TENS unit, trigger point injections

Core strength after pain improves

168
Q

Spondylosis

A

“Spinal Arthritis”

Osteophytes/ Bone spurs

Non spec degenerative changes

Can lead to spinal stenosis and/or neuroforaminal narrowing

169
Q

Spondylosis

A

ARTHRITIS

170
Q

Cervical Spondylosis

A

Osteophytes form
Thickening of ligamentum flavum
May cause stenosis or foraminal narrowing–> radiculopathy and/or myelopathy

171
Q

Most common cervical spondylosis (arthritis) sx

A

Decreased Cervical ROM

also: chronic neck pain, worse w/upright activity, may cause paraspinous muscle spasm, Occipital HA, radicular sx, advanced stenosis –> myelopathy

172
Q

Cervical Spondylosis (arthritis) physical exam

A

TTP along paraspinal muscles and posterior spinous process

Pain with “Facet loading” Spurling test
Extend and rotate to side of pain, downward pressure on head, postiive if pt has PAIN OR PARESTHESIA

pain alone is not positive test

173
Q

Cervical Spondlyosis (arthritis) tx

A

NSAIDs, PT, Surgery, Pain mgmt referral

174
Q

Lumbar Spondylosis (arthritis) sx

A

Hallmark: pain that radiates to one or both buttocks

other mechanical pain worsened by movement, pain releived by lying down, difficulty being in one position for too long,

175
Q

Lumbar Spondylosis imaging

A

Osteohpyte, disc space narrowing, MRI if warranted

176
Q

Tx of Lumbar Spondylosis (arthritis)

A

NSAIDs, PT, consider pain mgmt referral

177
Q

Spondylolisthesis

A

Anterior displacement

more common in LUMBAR spine

typically d/t Spondylolysis (Fracture) of pars interarticularis

178
Q

Listhesis sx

A

pain usually rotates whether in cervical or lumbar

cervical: shoulders, occipital HA
lumbar: posterior to knees worse w standing (spasms in hamstrings making it hard to bend forward)

179
Q

Findings for Spondyolisthesis

A

Diminished lumbar lordosis

180
Q

Spondylolisthesis

A

refer to Ortho Spine or Neurosurgeon

May require surgical fixation

181
Q

Spondylolysis (Fracture)

A

Scotty dog
90% time at L5
Rep. forced back extension- football player/gymnast

can be degenerative in older

often asymptomatic finding

Tx: bracing/ PT/ restrict activity

182
Q

Radiculopathy (ROOT)

Young ppl

A

lifting and twisting can increase spinal pressure resulting in herniation of intervertebral disc

183
Q

Radiculopathy (ROOT)

Older ppl

A

Degenerative changes can tear the annulus with disc prolapse and press on nerve ROOT

184
Q

Lumbar spine radiculopathy

A

L4-5, L5-S1

185
Q

Cervical spine radiculopathy

A

C6-7

186
Q

Radiculopathy sx

A

can be abrupt or worsen over time

SEVERE and worsened by activity

187
Q

Cervical Spine radiculopathy sx

A

Neck pain/possible occipital HA

Weakness, reduced grip strength

188
Q

Lumbar spine radiculoapthy

A

follow nerve pattern

L4 distinguishes

lying on back with knees elevated or in fetal position relieves pain

189
Q

Imaging for Radiculopathy

A

if sx persist >4 weeks

Immediately if significant neuro damage or myelopathy is identified

190
Q

Radiculopathy tx

If nonprogressive neuro deficits

A

NSAIDs, Steroids, PT

191
Q

Radiculopathy tx

If worsening or SEVERE PAIn

A 
Epidural injections (no more than 2-3)
Then surgery referral
192
Q

Spinal Stenosis

A

Narrowing

can be acquired or congenital

193
Q

Lumbar spinal stenosis

A

Most common neuro leg pain in elderly

progressive bilateral leg pain aggravated by standing or walking

relieved by leaning forward - shopping cart sign

194
Q

Neurogenic vs Claudication

A

Neurogenic pain:
Relieved walking flexed with cart YES
Takes a few minutes to relieve once sitting down

195
Q

Vascular/Claudication pain

A

Relieved by standing erect

Immediately relieved by sitting/lying

196
Q

Most common cause of Lumbar Spinal Stenosis

A

Spondylosis (Arthritis)

197
Q

Most common cause of myelopathy in elderly

A

Cervical Spinal Stenosis

d/t progressive spondylosis with osteophyte formation, disc herniation, and ligamentum flavum hypertrophy

198
Q

Test of choice for Cervical and Lumbar STENOSIS

A

MRI !!!

199
Q

Spinal STENOSIS treatment

A

NSAIDs, Cervical brace and activity restriction, PT for core strengthening - aquatics in elderly

Epidural steroid injections
Surgical decompression or fusion if significant stenosis

200
Q

Cauda equina

A

Surgical emergency

Compression of lumbar, sacral, coccygeal nerve ROOTS

201
Q

Tx for Cauda Equina syndrome

A

Dexamethasone 10 mg IV x 1 immediately

202
Q

Imaging for Cauda Equina

A

EMERGENT MRI w contrast

if not available : CT Myelogram

203
Q

Malignancy Red Flags with Back Pain

A

Unexplained wt loss, no imp with tx, pain >1 month, pain at night wake from sleep, PMHx of CA, older than 50YO

204
Q

Red Flags for Infection with Back Pain

A

Pain @ rest, fever, Immunocomp, IV drug use, recent hx of infection

205
Q

Causes of Thoracic Outlet Syndrome

A

Repetitive injury or athletic arm movement (pitching)
Cervical rib anomoly
Muscular anomoly
Fracture

206
Q

Neurogenic Thoracic outlet syndrome

A

Brachial plexus 95% of cases!!!

207
Q

Neurogenic Thorac outlet synd

A

Progressive unilateral weakness of Hypothenar muscle

numbness in Ulnar or Median distribution

Tenderness over scalene muscle

208
Q

Arterial Thoracic outlet synd

A

almost ALWAYS assoc with CERVICAL RIB 90%

209
Q

Venous Thorac outlet synd

A

related to vigorous, repetitive UE activities

HALLMARK: swelling of extremity

cyanosis, fatigue after short use

210
Q

Tx for nTOS

A

PT 4-6 wks
Steroid injection, Botulinum toxin type A
Decompression surgery if worsening sx or failed treatment

211
Q

vTOS

A

Catheter directed thrombolysis, decompressive surgery

212
Q

aTOS

A

Decompressive surgery

Surgical embolectomy- but very dangerous!!! can result in further injury

Quarter 2 (16 decks)

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