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PAM Semester 2 > Clinical Medicine Exam 1 MSK > Flashcards

Clinical Medicine Exam 1 MSK Flashcards

1
Q

Grades of sprains I,II,III

A

I = Partial tear but no instability of joint

II = Partial tear with some instability and laxity of joint

III = Complete Tear with laxity and instability of joint

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2
Q

Open fracture anitbiotics

A

IV antibiotics (Usually 1st-2nd generation cephalosporins and aminoglycosides should be administered 48 hours after fracture and for 48 hours after surgery.

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3
Q

Long bone ends are also known as

A

Proximal and distal

Epiphysis

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4
Q

Osteosarcoma

A

common malignant bone tumor
children & adolescents

Distal femur most common site, followed by proximal tibia and then proximal humerus.

pain before tumor is noticed

xray then MRI

Chemo, surgery (amputation is rare)

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5
Q

osteoarthritis

A

stiffness lasting less than an hour
crepitus
Females, age
asymmetry

Bouchards / Heberdens node

nsaids, rice, steroids, bracing, exercise

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6
Q

Rickets

A

Due to a lack of vitamin D or calcium and from inadequate sunlight exposure, which destroys normal bone growth.

This primarily occurs in children

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7
Q

Laminectomy –

A

most common, removal of lamina, bone spurs

Spinal stenosis

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8
Q

Juvenile RA

A

females 2 to 1
unknown cause
autoimmune

criteria = 
under 16
arthriris for 6 weeks
exclusion of other arthritis
5 joints or more

nsaids
methotrexate
PT/OT

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9
Q

torticollis

A

Neck tilt in infants (injury if adult)

can be from illness or injury

May be caused by sternocleidomastoid muscle contracture

Head will tilt toward side of contracture

May follow URI or mild trauma in children
Spinal cord tumor, RA other etiologies

stretching

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10
Q

Jones Fracture

A

junction of the metaphysis and diaphysis of the proximal end of the 5th metatarsal

Untreated risks Avascular necrosis

restand to preventmovementin the foot.

surgerymay be needed

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11
Q

Subluxation

A

Partial or incomplete misalignment of bones and joints

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12
Q

5 P’s of compartment syndrome

A

5 P’s
Pain

(late findings)
Pallor
Pulselessness
Parasthesia
Paralysis
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13
Q

Long bone shaft is also known as

A

Diaphysis

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14
Q

Pediatric bones (Fx)

A

Young skeletal bone is much more flexible than mature adult bone

The bones will bend, buckle before they break

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15
Q

Adhesive capitus

A

Frozen shoulder

Build up of scar tissue resistricts the movement inside the joint

(GH joint) (between humeral head and socket)

this results in pain and severe ROM decrease

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16
Q

Endosteum

A

inner layer of medullary cavity

also has layer of cells that breakdown and dissolve bone cells for reabsorption

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17
Q

Pediatric Fx

A

Greenstick (Surgeon for greater thatn 15 degrees)

Salter Harris types 1-5

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18
Q

Heberdens node

A

Bony lumps in the distal joint of phlange (DIP joint)

can cause pain and inflammation

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19
Q

Nutirent foramina

A

minute holes in bone surface that allows blood vessels to penetrate

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20
Q

Rhabdomyosarcoma

A

more than half of the soft tissue sarcomas in children

most typical in head and neck

Very uncommon in adults

Orbital RMS may present with pain in eye, orbital swelling, bulging of eye.

can mask as URI in nose and mouth

Surgery

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21
Q

Fibromyalgia

A

women 20-55
No specific tests.
all the problems!

Rule out Differential diagnosis (Hypothyroidism, Hep C, Vitamin D deficiency)

psych meds, ssri, gaba, meditation

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22
Q

Nerve conduction velocity test

A

Test to diagnose carpal tunnel syndrome

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23
Q

Osteoporosis

Primary vs secondary

A

Primary =
more common, age related
Type 1 = due to decrease in estrogen
type 2 = lack of Vitamin D3

Secondary = 
Result of other diseases that cause bone loss
medications
hyperparathyroidism
alcohol
smoking

Calcium, vitamin D phosphorus, fosamax

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24
Q

Nursemaids elbow

A

Radial head subluxation
“Pulled elbow”
Usually due to a pull and twist

Sudden acute pain
Child refuses to move arm
On exam, child will be holding arm in slight flexion and pronation
No swelling or tenderness to palpation
HOWEVER – significant tenderness elicited with pronation/supination of the forearm

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25
Q

Sprain

A

Stetched or torn ligament

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26
Q

Radial Neck Fracture

A

FOOSH
Typically unstable

This is a fracture that is best NOT immobilized
due to possible loss of ROM

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27
Q

Septic arthritis

A

Inflammation of a synovial membrane with purulent effusion into the joint capsule, due to infection

Knee mostly

IV drugs, bacterimia, diabetes, RA joint surgery, HIV

Infection symptoms

Antibiotics (vanc, cef)

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28
Q

olecranon bursitis

A

Students elbow

Enlarged bursa in elbow (point of elbow)

Swelling, pain
ROM not really affected
RICE

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29
Q

Outer layer of long bone is made up of

A

Compact bone (osteons)

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30
Q

Grade III Strain

A

III = Tear all muscle fibers, fascia still intact

Pain with weakness and loss of function

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31
Q

Low back pain

A

Usually prolapsed intervertebral disk and low back strain or Sciatica

Imaging not usual initially

nsaids, rest, PT/OT, fitness

surgery last resort

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32
Q

Fx complications

A 
Hemorrhage
DIC
Neurologic injury
Vascular injury
Compartment syndrome
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33
Q

RA Treatment

A 
PT/OT
nsaids
methotrexate
steroids
sulfa
antimalarials
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34
Q

Gout

A 
Podagra (big toe gout)
small joints (toes, ankles, wrist, fingers)
earlier in men, Rare in childhood
Meat seafood beer worsen
red, swollen, tophi

negatively birefridgerantly needle shaped crystals

RICE, nsaids, colchicine, steroids, indomethacine

no thiazides or ASA

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35
Q

Grade III Sprain

A

III = Complete Tear with laxity and instability of joint

Protected motion, possible, likely repair needed

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36
Q

Articular cartilage

A

layer of hyaline cartilage that covers joint surface
allows the joint to move moe freely
(at the ends of long bones) (covers the “head”)

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37
Q

Ortho Emergencies

A

Knee dislocation with vascular compromise (not patella)

Amputation

Spinal fracture

Open fractures

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38
Q

Foraminotomy -

A

decompression allowing room for nerve root exit

Spinal stenosis

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39
Q

Grade I Strain

A

I = Tear a few muscle fibers with fascia intact

Pain, very little weakness or loss of function

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40
Q

Bouchards node

A

Bony lumps in the second distal joint of phlange (middle joint or PIP)

can cause pain and inflammation

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41
Q

Common Type of ankle x ray

A

AP
Lateral
Mortise
Oblique

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42
Q

Kyphosis

A

Humpback, curve of spine

Congenital, traumatic or acquired

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43
Q

Fracture Blisters

A

Occur on overlying skin due to swelling

Appear as early as 6 hours post injury

Usually clear fluid – if hemorrhagic, worse prognoses

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44
Q

Femur Neck “surgical neck” (Hip Fx)

A 
Thinnest, most fragile part of the femur
Very common
(blood supply can be interuppeted)
avascular necrosis can occur
usually surgical
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45
Q

Cartilage injury treatments

A

Steroid injection
Glucosamine
Hyaluronic acid

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46
Q

Rheumatoid arthritis

A

is a chronic autoimmune disease characterized by an inflammatory polyarthritis that preferentially affects the small joints.

Anti-cyclic citrullinated peptide (anti-CCP or ACPA) is more specific and 95% of patients. Low in early disease.

Erythrocyte Sedimentation rate (ESR) and C-reactive protein are elevated.

RF is positive in 80 of patients but nonspecific

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47
Q

Multiple myeloma

A

Most common primary tumor of bone
45% of all bone tumors
over 40

Bone pain, increased protein, anemia, hypercalcemia, acute renal failure

“punched out” lesions on imaging

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48
Q

Hip Fx

A

2 types

Intertrochanteric Fracture
Area between the greater and lesser trochanters
(blood supply ususally intact)

Femur Neck “surgical neck”
Thinnest, most fragile part of the femur
Very common
(blood supply can be interuppeted)

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49
Q

Comminuted Fx

A

Comminutedfractures have > 2 bone fragments.

Comminuted fractures include segmental fractures (2 separate breaks in a bone).

i.e. shattered

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50
Q

Medial Epicondylitis

A

Medial = golfers elbow
Pain on inside of elbow

repetitive stress

MRI useful
surgery rare

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51
Q

osgood schlatter disease

A

inflammation and pain below patella
relieved by rest

patellar tendon pulls on growth plate of tibia repeatedly

imaging not necessary

self limiting once growth plate ossifies

Nsiads, RICE

pediatric disease

overuse injury

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52
Q

What accelerates the loss of bone mass in osteoporosis

A

gonadla steroid deficiency
estrogen deficiency in postmenopausal women
(lower bone mass than men)

Men can experience this too

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53
Q

Lewy bodies

A

Lewy bodies are a characteristic feature present in the brains of patients with Parkinson’s disease and Lewy body dementia.

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54
Q

Mechanisms of injury in musculoskeletal

Repetitive stress/injury

A

Stress fractures

ie shin spints

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55
Q

Anterior should dislocation

A

Most common joint dislocation,
95% of dislocations

loss of rounded appearance of shoulder

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56
Q

Segmented Fx

A

Segmental fractures are broken completely into seperate pieces

i.e. an island

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57
Q

Common Type of Hip x ray

A

AP hips

Frog Leg

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58
Q

Where is yellow bone marrow located

A

Medullary cavity on diaphysis or shaft of long bone

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59
Q

Spinal fusion –

A

reserved for patients with radicular pain, or unstable spine and other options have not been effective. Long recovery.

Spinal stenosis

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60
Q

Open Reduction Internal Fixation (ORIF)

A

Open Reduction Internal Fixation (ORIF) – surgical procedure with use of plates, rods, screws, pins, staples.

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61
Q

talipes equinovarus

A

club foot
internal rotation of foot

contracted achilles tendon (plantar flexion)

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62
Q

Osteoarthritis details

A

Osteoarthritis
Articular cartilage softens and degenrates

Bone spurs can develop
Cracking and crepitus

progressive loss of cartilage

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63
Q

Schleroderma clinical presentation

A

CREST

Calcinosis (Calcium deposits in skin)
Raynauds
Esophageal dysfunction
Sclerodactyly (thickend collagen on fingers)
Telangiectasias (dilation of capillaries on skin) (redness)

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64
Q

Oblique Fx

A

Obliquefractures occur at an angle.

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65
Q

Spondylolysis

A

fracture of the pars interarticularis

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66
Q

Schistocytes

A

Schistocytes are fragmented pieces of red blood cells. These are commonly found in patients with hemolytic anemia or microangiopathic diseases, such as disseminated intravascular coagulation.

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67
Q

Bone repair process

A

Osteoblasts seek out microcracks

They then secret RANKL

RANKL binds with monocytes

This causes them to form osteoclasts

Osteoclasts secrete enzymes (dissolves and creates holes in bone

This causes the hydroxyapatite to break down in calcium and phosphate releasing it into the blood

Osteoblasts then begin to secrete osteoprogenrin that deactivates RANKL

This slows the osteoclast activity

Calcium and phosphate deposit on the seams, some osteoblasts get trapped in the lacunae and turn into osteocytes

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68
Q

Avascular necrosis

A

Osteonecrosis
blood supply is cut off
Bone & tissue die

MRI without a contrast agent continues to be the “gold standard

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69
Q

4 Fracture repair steps

A

hematoma
fibrocartilaginous callus forms
Bony callus forms
Bone remodeling

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70
Q

Osteopenia

A

bone density has decreased but is not considered dangerous yet

precursor to osteoporosis

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71
Q

Laminoplasty –

A

lamina removed, plates and screws replace

Spinal stenosis

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72
Q

Spongy bone

A

At the ends of long bone
epiphysis
and metaphysis

lattice of bone
slivers of bone called spicules
thin plates of bone call trebeculae
spaces filled with red marrow

very few osteons (no central canals)
provides strength with minimal weight

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73
Q

How to counteract aging process

A

Exercise and stretching

much is the result of being sedintary and under use

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74
Q

Grade I Sprain

A

I = Partial tear but no instability of joint

Symptomatic treatment only

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75
Q

Polyarteritis nodosa (PAN)

A

Virus caused

Skin lesions-palpable purpura, and livedo reticularis

Fever, anorexia, weight loss, abd pain, peripheral neuropathy, arthralgias, HTN, edema, uremia, oliguria

HEp b antigen, ESR & CRP elevated, proteinuria

steroids, cytotoxic drugs

10-20% die (GI / CV issues)

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76
Q

Colles Fracture

A

distal end of radius with dorsal angulation

FOOSH Most common type

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77
Q

Pseudogout

A

large joints
not uric acid (calcium pyrophosphate crystals)

Painful, red, swollen but no tophi

Rhomboid shaped crytals positively birefridgerant

RICE, nsaids, colchicine, steroids, indomethacine

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78
Q

Impacted Fx

A

impactedfractures, bone fragments are driven into each other, shortening the bone;

these fractures may be visible as a focal abnormal density in trabeculae or irregularities in bone cortex.

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79
Q

Sarcopenia

A

Age related Muscle loss

Reduced satellite cells
loss of muscel mass
increased adipose tissue
fiber types transition from fast toslow twitch fibers
reduced number of mitochondria
calcium deficits/release
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80
Q

Boxers Fx

A

distal 3rd of the 5th metacarpal

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81
Q

Osteoporosis bone density measurements**

A

Standard deviations from the mean for young adults
DEXA Scan

Normal = 1 or less

Osteopenia = between 1 & 2.5

Osteoporosis = more than 2.5

Severe osteoporosis = more than 2.5 w/ Fx

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82
Q

Synovial joint accessory structures

A

Bursa
-fibrous sac filled with synovial fluid

Tendon sheath
-elongated cylindrical bura wrapped around a tendon

Meniscus
-moon shaped cartilage in the knee

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83
Q

Viewing imaging

Systematic Approach to Radiograph

A

ID patient and right/left

Bone and Joint Alignment

Joint spaces

Cortical outline

Bone texture

Soft tissues

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84
Q

Immobilization complications

A 
DVT
Infection 
PE
Muscle atrophy
Psychiatric disorders

Geriatrics are increased risk

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85
Q

4 stages of gout

A

1 High uric acid levels
2 Acute gout
3 intercritical gout (remission periods)
4 Chronic gout

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86
Q

Giant cell tumors of bone

A

Many types
females, 3rd decade
knee, distal radius, sacrum
large effusion, painful

surgery

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87
Q

Type A and B Cells in joints (osteoarthritis)

A

Type A = clears debris

Type B = produce components of synovial fluid

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88
Q

Fracture Healing Steps (4)

A

Hematoma formation
Soft callus forms
Hard callus forms
Bone Remodeling

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89
Q

Metabolic syndrome

A

Elevated
BP, Blood sugar, Chloesterol
increased body fat around waist

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90
Q

Ankylosing Spondylitis

A

Chronic inflammatory disease of the axial skeleton

human leukocyte antigen (HLA)- B27 surface antigen found in 88 to 96% of patients.

It is thought that the combo of this antigen and an exogenic component (Klebsiella or Chlamydia) trigger disease process

Imaging = bamboo spine

30 degree forward lean (posture)

nsaids, bracing, swiming PT for posture
may need surgery

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91
Q

What does the inorganic matter in bones do

A

it causes the bones to harden
in children this is called ricketts
in adults it can be osteomalcia

without it you end up with soft bones

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92
Q

reactive arthritis

A

Reiters syndrome (rare)

Can’t see, cant pee, cant climb a tree
vision (conjunctivitis), urinary issues, arthritis

STI of Chlamydia urethritis or gastroenteritis

HLA-b27 antigen 80% positive

PT, nsaids, antibiotics

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93
Q

7 types of fractures

A 
Stable
Open, compund
Transverse
Oblique
Comminuted
Compression
Stress
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94
Q

Structural Joint types

A

Fibrous
3 fibrous are suture, gomphosis, syndemosis

Cartilaginous
synchondroses (connected by hyaline cartilage) ribs and sternum
and
symphyses (connected by fibrocartilage) ie intervertebral discs

Synovial

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95
Q

Schirmers test

A

filter paper is placed inside lower eyelid
eyes closed for 5 mins
paper is then measured for moisture

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96
Q

Carpal Tunnel Syndrome

A

Median neuropathy

Compression of median nerve as it crosses under the flexor retinaculum at wrist

Tinel test, phalen sign

nsaids, splinting, may need surgery

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97
Q

Bruxism

A

Teeth grinding

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98
Q

Descriptions of fractures

A 
Location
Direction
Alignment
Open vs closed
Displaced
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99
Q

Russell bodies

A

Russell bodies are the accumulation of immunoglobulin in plasma cells: a characteristic finding in patients with multiple myeloma

100
Q

Spontaneous reduction of dislocation

A

Dislocations that reduce spontaneously require immobilization for 2-4 weeks then ROM activity then return to normal activity

101
Q

Rib Fractures

A

Excellent blood supply

Heal without immobilization

Think about a pneumothorax with high impact injury

(Sports, osteoporosis, cancer)

102
Q

Spiral Fx

A

Spiralfractures result from a rotatory mechanism;

on x-rays, they are differentiated from oblique fractures by a component parallel to the long axis of bone in at least 1 view

103
Q

Systemic lupus erythematosus

A

Autoimmune disorder characterized by inflammation, positive ANA level and involvement of multiple organs.

ANA 99%, also Anti-dsDNA, anti-Smith antibody

women, AA

unkown cause, maybe genetic, environmental, dietary

Malar rash, fatigue, fever, UV sensitivity, hair loss, joint issues

Sun protection, hydroxychloroquine

104
Q

Lateral Epicondylitis

A

Lateral = Tennis elbow
Pain on outside of elbow

Most common elbow injury
4th decade
surgery rare

105
Q

Name for the outer layer of long bone

A

Periosteum

106
Q

Osteoporosis

A

bone density decreases

age, postmenopausal women

107
Q

Compartment syndrome

A

Most common site – anterior compartment of lower leg

pain increases or seems out of proportion to known injury

5 P's
Pain
Pallor
Pulselessness
Parasthesia
Paralysis
108
Q

TMJ

A

Stress, teeth grinding

Restricted ROM, pain, click/pop

normal xray

109
Q

Compact Bone tissue make up

A

One third is organic matter
Osteoblasts synthesize
collagen, carbohydrate protein complexes,

two thirds is inorganic matter
85% hydroxyapatite (crystalized calcium salts)
10% calcium carbonate
other misc minerals

110
Q

Wolffs law

A

the ability to adapt to stress
(plasticity of bone)

Increase the stress to a bone, it will increase bone density

Decreasing the stress will reduce the density

111
Q

Spinal stenosis

A

Laminectomy – most common, removal of lamina, bone spurs

Laminoplasty – lamina removed, plates and screws replace

Foraminotomy - decompression allowing room for nerve root exit

Interspinous Process Spacers – spacers placed between spinous processes to create room, also involves a partial laminectomy

Spinal fusion – reserved for patients with radicular pain, or unstable spine and other options have not been effective. Long recovery.

112
Q

4 types of spinal fx

A

Compression 1pt
Burst 2pts
Translation / rotation 3pts
Distraction 4pts

113
Q

Hip fractures

A

90% are from falls
Women 2-3 times more likely

Types=
Subcapital neck fx (top of neck)
Transcervial neck fx (mid neck)
intertrochanteric fx (below neck)(through trochanter)
Subtrochanteric fx (top of shaft below trochanter)
Greater trochanter fx
lesser trochanter fx

114
Q

Benign bone tumors

A

Usually asymptomatic

x ray

115
Q

Distal Tibia Fractures

A

Notorious for having a poor blood supply, particularly at the junction of the middle and distal thirds

Very prone to nonunion

116
Q

Calcium needed daily

A

1200 for women
1000 for men

ages 51-70
1200 for all over 70

117
Q

Fat Pad (sail sign)

A

Signs of inflammation

Swelling around fracture site

118
Q

Functional joint types

A

Synarthroses (no movement) ie sutures in skull

Amphiarthroses (small amount of movement) ie pubic symphysis

Diarthroses (freely movable) ie regular joints

119
Q

Strains

A

Trauma to muscle or musclotendinous unit

120
Q

Tendons

A

Muscles to bone

121
Q

Hormones that cause bone to be broken down

A

Calcitirol

PTH (parathyroid hormone)

122
Q

Ligaments

A

Bone to bone

123
Q

Inner portions of long bone are mde up of

A

Spongy bone

filled with red bone marrow

124
Q

Rotator cuff syndrome

A

MRI is gold standard

Nsaids, rest, steroid injection, PT, strength exercises

Can need surgical repair

125
Q

Grades of Strains

A

I = Tear a few muscle fibers with fascia intact

II = Tear moderate amount of muscle fibers fascia is intact

III = Tear all muscle fibers, fascia still intact

IV = Tear all muscle fibers, Fascia is disrupted

126
Q

Strain

A

Musculotendinuos unit injury

pulled muscle

127
Q

Epiphyseal line

A

In an adult when the growth plate is closed (line of compact bone between the epiphysis and the metaphysis)

128
Q

Achilles tendon

A 
Tendonitis (inflammed)
Tendinosis (tiny tears, still intact)
Tendon rupture (tears)

NO STEROIDS INJECTIONS

Usual surgery for rupture

MRI

129
Q

Grade II Strain

A

II = Tear moderate amount of muscle fibers fascia is intact

Pain with weakness, no loss of function

130
Q

Compartment syndrome times

A

3-4 hours changes are reversible

6 hours muscle damage

8 hours irreversible muscle damage

131
Q

Fracture Mneumonic

A

OLD ACID

O Open or closed
L Location
D degree (Complete vs incomplete) (broken in 2 parts)

A Articular extenision (joint involvement)
C Comminuted (shattered?)
I Intrinstic bone quality (pathology)
D Displacement?

132
Q

Waddell Signs

A

Disc herniation

Assist in identifying patients most likely to benefit from surgery

The presence of 3 or more Waddell signs is associated with poor outcomes due to underlying psychosocial issues.

Signs are: superficial and non—atomic tenderness, axial loading and acetabular rotation simulation, distraction, regional sensory disturbance and weakness, overreaction

133
Q

Inner lining of medullary cavity

A

endosteum

134
Q

Polymyalgia rheumatica (PMR)

A

50% temporal arteritis
over 50
associated with Giant cell arteritis

ESR levels are markedly elevated. Temporal artery biopsy if suspected GCA

steroids long term (2 years)

135
Q

Sprains

A

Injuries to ligaments

136
Q

A “starry sky” pattern

A

A “starry sky” pattern is seen in patients with Burkitt’s lymphoma as a result of macrophages engulfing cellular debris.

137
Q

Minimum Xray views for fracture

A

AP
Lateral

Lower limbs might also add weight bearing and non
weight bearing

138
Q

What do perforating (sharpeys) do

A

They give the tendon (muscle) something to adhere to on the bone

139
Q

What runs through the central canal of the osteon

A

Nerve and vascular bundle

perforating canals branch off periodically to spread supply around to bone

140
Q

Hip fractures misnomer

A

Hip is a joint not a bone

Hip = Ball of the femur and acetabular socket of the pelvis

Irony –
neither a fracture of the ball of the femur (femoral head) or the acetabular socket is considered a “hip fracture”

141
Q

polymyositis

A

WBC attack muscles (auto immune)
unknown cause
Trunk and torso
higher in females

gradual skeletal muscle weakness (usually painless), 
Dysphagia
Malar skin rash
Polyarthralgias
Muscle atrophy

CPK and aldolase levels are elevated

steroids, methotrexate

5% die (usually due to cardiopulmonary complications)

142
Q

Spondylosis

A

a type of arthritis spurred by wear and tear to the spine.

It happens when discs and joints degenerate, when bone spurs grow on the vertebrae, or both.

Can also cause referred pain in the shoulder

143
Q

Spinal compression fx

A

Most spinal compression fractures are due to osteoporosis

no history of trauma
dowagers hump (loss of height and rounded back

vertebral body collapse

anlagesic, brace, possible surgery

red flag is neuro compromise, bladder dysfunction

144
Q

Osteoporosis

A

A state of Low bone mass

145
Q

Mechanisms of injury in musculoskeletal

Pathology/injury

A

Diseased and Weakened bone
ie osteoporosis

hip/tochanter fractures

microfractures in bones

146
Q

What is within the periosteum of long bones

A

Perforating (sharpeys) fibers (collagen fibers)

External sheath

147
Q

Neuro assessment of injury (Fx)

A

Assess neuro function of injured limb

Before and after every intervention
i.e. immobilization, patient movement, pre and post op, on daily rounds, while waiting for radiology etc.

148
Q

Swelling or effusion on Xray

A

Can be seen as a haze or shading around bone

149
Q

Ankylosing Spondylitis signs/symptoms

A

Insidious onset of pain in lower back, buttocks and heels

Symptoms improve with activity during the day, and return in the evening

Earliest changes – sacroiliac joints, proceeds up spine

Loss of motion

Lordosis of cervical and lumbar spine

Synovitis, progressive fibrosis and ankylosis of joints

Spinal kyphosis

150
Q

Greenstick Fx

A

greenstickfractures (cracks in only 1 side of the cortex) are childhood fractures.

151
Q

Things to do when first seeing patient with possible fracture

A 
Confirm Name and date
Search for old films for comparision
Identify bones and joints
Is skeleton mature?
Soft tissue injury or swelling
Fractures, dislocations, joint
152
Q

Best spinal cord injury imaging

A

MRI

153
Q

Scotty (or Scottie) Dog sign with collar

A

pars fracture or defect (seen on oblique view)

154
Q

Meniscus injury

A

Excess rotation of femur

Medial most comon

usually with other ligament injury

MRI gold standard

Mcmurray test

155
Q

Hand / Wrist pain

A

Mostly due to OA & RA

156
Q

Neck Pain

A

Spondylosis is the most common condition affecting the cervical spine.

157
Q

Growth plate fractures

A

Salter Harris Fx

158
Q

Mechanisms of injury in musculoskeletal

Fractures/injury

A

Direct
bone breaks at site of impact or force

indirect
force occurs at a distance from wear fracture occurs
ie twisting, spiral, bending, tension

159
Q

Disc Herniation

A

a disc herniation will have a clinical presentation based upon where the herniation occurs

L4/5 , L5/S1 most common

Age, genetic inheritance, occupational and recreational injury, smoking, obesity

Pain and symptoms worse in forward flexion, better in extension

MRI

Surgery not always required

90% spontaneous resolution in 12 weeks

nsaids PT rest, oral steroids

160
Q

Spinal stenosis

A

Etiology: hypertrophic degenerative processes and spondylolisthesis compressing the cord, cauda equina, individual nerve roots, arterioles and capillaries

No need for plain radiographs – lead to no change in treatment

CT and MRI are helpful to guide intervention via injection or surgery

nsaids, gaba, lyrica, PT, epidural, possible surgery

161
Q

Sjogren syndrome

A

Dry eyes, mouth

Autoimmune disorder that destroys the salivary and lacrimal glands

RF is present in over 70%
ANA in 60%
Anti-Ro (SS-A) antibodies in 60%
Anti-La (SS-B) antibodies in 40%

Artificial tears, hydration, cyclosporin

162
Q

Pseudo tumor

Cystic bone lesions

A

Simple Bone Cyst
usually from child hood fracture

aspiration with steroid injection

163
Q

Avascular necrosis sites from Fx

A

Femoral head
5th metatarsal (jones Fx)
Scaphoid Fx

164
Q

Long bone : Cavity in the diaphysis or shaft

A

Medullay cavity

filled with yellow bone marrow

165
Q

Morton neuroma

A

interdigital neuroma

pain in third web space between thrid and fourth metatarsals, radiating to third and fourth toes

Ice, massage, inserts, nsaids

166
Q

Aging Muscle loss

A

Sarcopenia
Loss of muscle mass over time and age

fibers decrease
water in tendons decreases
grip strength decreases
heart muscle declines
metabolism slows
lipids increase

Muscle replaced by adipose tissue

167
Q

Epiphyseal plate

A

In children this is where the bone is elongating

thin layer of hyaline cartilage between epiphysis and metaphysis

168
Q

Interspinous Process Spacers –

A

spacers placed between spinous processes to create room, also involves a partial laminectomy

Spinal stenosis

169
Q

Epiphysis

A

Enlarged ends of long bone

strengthen joint and anchor ligaments and tendons

170
Q

Epicondylitis (2 types)

A

Lateral = Tennis elbow
Pain on outside of elbow

Medial = golfers elbow
Pain on inside of elbow

171
Q

Schleroderma

A

excess thickened collagen
raynauds is symptom
females 4 to 1, 30-50

Chronic and rare autoimmune systemic vascular and connective tissue disease

localized or systemic

ANA is present in 90% with diffuse scleroderma

PPIs for GI, CCB for raynauds, immunosuppressive

172
Q

Malunion

A

Malunion – healing occurs but not in correct anatomical position

Factors contributing to malunion –

poor skill of clinician, inadequate blood flow, loss of reduction

173
Q

Pectus excavatum

A

Sunken chest

Fatigue
Shortness of breath/decreased exercise tolerance
Chest pain
Fast heart rate (tachycardia)

174
Q

Torus Fx

A

Torusfractures (buckling of the bone cortex)

Bulging

175
Q

Fat embolism

A

Long bone fractures

occur in 3 days from injury

Tachypnea
PE
Confusion
Petechial rash

176
Q

Most common form of arthritis

A

Osteoarthritis

177
Q

Caudal equina syndrome Classic findings

A

S P I N E

Saddle anaesthesia
Pain
incontinence
Numbness
Emergency

Emergent condition

178
Q

Grade IV Strain

A

IV = Tear all muscle fibers, Fascia is disrupted

Pain with weakness and loss of function

Complete rupture

179
Q

Cruciate ligmanet injury

A

Anterior and posterior

acl more common than pcl

women more affected

Lachman, anterior drawer test

MRI

180
Q

Transverse Fx

A

Transversefractures are perpendicular to the long axis of a bone.

181
Q

Four rotator cuff muscles

A 
SITS
Supraspinatis
Infraspinatie
Teres Minor
Subscapularis
182
Q

SCFE

A

Slipped capital femoral epiphysis

Males, AA, athletes, 12-14 years

pain, altered gait

obese teen, dull nonradiating aching pain in hip, groin, thigh or knee, no trauma

trendelenburg gait (pimp stroll)

Urgent ortho eval

Acute = under 2 weeks
Chronic over 2 weeks

will eventually progress to other side 30-60%

183
Q

Fracture terminology Classifications

A

displaced = bone is not in normal alignment

non displaced = bone is still in anatomical position

Angulated = i.e. broken “v” angle

Bayonetted = bone overlaps longitudinally

Distracted = Bones are seperated by a Gap between
Bones (segmented)

184
Q

Aging bone issues

A

Mineral content decreases
crush fractures of spine can occur
less water in cartilage
connective tissues lose elasticity

185
Q

Salter harris Fx’s undetectable on xray

A

Types I and II

186
Q

Psoriatic arthritis

A

Arthritis found in people with psoriasis

187
Q

Spinal stenosis

A

Narrowing of any part of
the lumbar spine – spinal canal, nerve root canal and intervertebral foramina

usually in 60’s, degenerative,

CT or MRI

Low back pain, pain in legs while walking
similar to claudication

RICE, nsaids, PT, steroid inection, possible surgery

188
Q

Osteoporosis

A

Bone density decrease

189
Q

Caudal equina syndrome

A

not a true spinal cord syndrome

instead it effects lumbar, sacral and coccygeal nerve roots

Numerous etiologies – trauma, degenerative changes, vascular, Iatrogenic, neoplastic

Diagnostic – high post-void residual, MRI

Emergent condition

190
Q

Fracture terminology Closed vs open

A

Closed = doesnt break skin

open =breaks skin

191
Q

Type I collagen and Type II Collagen in joints (osteoarthritis)

A

Type I collagen is found in bones and skin

Type II collagen is the main collagen in cartilage

192
Q

5 types of laceration

A 
Split
Stretch
Avulsion
Tear
Cut
193
Q

Diaphysis

A

Shaft of long bone (provides leverage)

194
Q

Distal Radial Head fracture

A

FOOSH

Most common type is Colles

195
Q

Fracture managment

A 
immobilize, reduce sweling
RICE
Nsaids
possible sedation, anesthesia, blocks
possible surgery
196
Q

C spine trauma

A

Stabalize neck

CT or MRI whichever is fast

perform neuro exam, get Neuro consult

197
Q

Fractures in elderly

A 
Hip Fx's
Ankle
Proximal humerus
Distal radius
Vertebral compresion Fx

all more common in women

198
Q

Osteoarthritis of the knee

A

Spurring femur bone
Degenerated articular cartilage
Spurring tibia bone

Females, age

199
Q

Non-union

A

Non-union – failure of the fractured ends to bond, heal back together

Factors influencing non-union –

smoking, venous stasis disease, atherosclerosis, malnutrition

200
Q

Common Type of shoulder x ray

A

AP shoulder view

True AP = shows GH joint

201
Q

Ankle strain and sprain

A

Strain is tendon

Sprain is ligament

Most common ankle injury
inversion on injury of the
Anterior Talofibular ligamnet (sprain) (ATL)

Anterior drawer test
RICE, PT, xray to r/o Fx

202
Q

Ordering imaging

General Basic Guidelines

A

Typically begin with plain radiograph
CT to see bone well
MRI to see tissue well
Lot’s of exceptions!

203
Q

Knee Fx

A

Probably the injury that is the worst of all of the possible knee injuries

4 bones meet at knee

204
Q

Imaging pearls

A

Fracture not involving a joint – plain X-ray

Fracture involving joint – plain X-ray if NO ligamentous injury on clinical exam, MRI if joint function impaired or suspected injury

Complex fractures requiring reconstruction – CT, spiral

CT – think tri-malleolar ankle fracture, pelvic crush injury.

Spine – typically MRI, especially if neurological deficit exists

Back pain – typically does not require X-ray in younger adult with no history of injury

205
Q

Dislocation

A

Complete misalignment of the bones and joint

206
Q

RA vs OA

A 
RA = 
women 3 to 1
20-40
weeks to months
symmetry
improves with usage
fatigue malaise
OA= older
years
asymmetry
Worse with use
no additional symptoms
207
Q

Reduction

A

Reduction – the action of re-aligning fractured pieces of bone or placing a dislocated joint back into correct anatomical position

208
Q

Osteomyelitis

A

Bone infection
Staph most common
salmonella, pseudomonas, strep, e.coli etc

Infection symptoms, fever, fatigue etc.

xray, ct, mri, ultrasound (MRI is best)

Woundcare, antibiotics (VANC)

209
Q

Ewing sarcoma

A

Second most common bone tumor

Aggressive malignancy with high rate of metastasis

5-25 y/o, males
femur, pelvis, tibia, humerus, scapula

“Hair on end” appearance, “onionskin”,

Chemo, surgery

210
Q

Pelvic Rami Fracture

A

Superior and inferior rami – non-weight-bearing areas

Typically occur in geriatric patients, trauma or demineralizing conditions

Do not require surgery, can not be immobilized

Curtail weight-bearing only for pain management

Get patient up and mobilizing as soon as pain is tolerable

Refer to Physical Therapy

211
Q

Fracture reduction

A

Can..
alleviate pain
relieve tension on nerves and vessels
eliminating risk of conversion to open restores circulation to pulseless ext.

212
Q

PARS Defect and Fracture

A

PARS defects are small stress fractures resulting from over-use, typically in a young athlete, results from repetitive hyperextension.

rest, strength, streching splint

Scotty dog sign with collar

213
Q

Hormones that cause bone genesis

A

Calcitonin

214
Q

6 features of synovial joints

A

Articular cartilage (hyaline cartilage)

Joint cavity

Articular capsule

Synovial fluid

3 possible reinforcing ligaments (capsular, intracapsular, extracapsular)

Rich nerve and blood supply

215
Q

Intertrochanteric Fracture (Hip Fx)

A

Area between the greater and lesser trochanters
(blood supply ususally intact)

surgical fixation is common

216
Q

Two joint classifications

A

Functional Joints

Structural Joints

217
Q

Scaphoid Fx

A

Common
Difficult ot see on film (might need MRI/Bone scan)
avascular necrosis possible if untreated
pain, swelling, bruising over snuff box

THumb psica csat

218
Q

Drug induced lupus drugs

A

I hate multiple meds causing queer problems
IHMMCQP

INH
Hydralazine
Minocycline
Methyldopa
Chlorpromazine
Quinidine
Procainamide
219
Q

Where is red bone marrow located

A

Spongy bone (long bone) epiphysis

220
Q

DDH

A

Developmental dysplasia of hip

ball of hip comes out of socket
can be due to shallow socket (acetabulum)

can be comletely dislocated or subluxed (partial,loose)

Tends to run in family
usually left hip
girls, first born, breech baby, low amniotic fluid (oligohydramnios)

Legs differnet lenghts, skin folds uneven,, limb,

Barlows test, ortalanis test

May need pavlik harness or spica cast
possible surgery

221
Q

Grade II Sprain

A

II = Partial tear with some instability and laxity of joint

Protected motion, full healing expected

222
Q

Avulsion Fx

A

Avulsionfractures are caused by a tendon or ligament dislodging a bone fragment.

223
Q

Disc herniation surgery

A

Persistent treatment in spite of a reasonable course of nonoperative treatment

Profound or progressive motor deficit

Cauda Equina Syndrome

Intractable pain

Patient preference

224
Q

Sprains in children

A

Sprains are uncommon in children with open growth plates.

This is because the physis is weaker than the ligaments and the physis may fail before the ligament does

Salter-Harris fractures & Avulsion fractures are more likely

225
Q

Fibromyalgia cardinal symptoms

A

Pain
stiffness
fatigue
non restorative sleep

226
Q

Mechanisms of injury in musculoskeletal

A

Injury
Repetitive stress
pathology

227
Q

Clavicle Fractures

A

Strong blood supply

Most managed conservatively with “figure 8” brace or sling of arm on fx side

Out of activity ~ 8 weeks – 4 in a sling, 4-6 out

Weight restriction to a few pounds

May return to full weight training/physical work at 3 months

Need radiographic confirmation of healing prior to returning to full activity

228
Q

Marfan Syndrome

A

A connective tissue disorder, which causes skeletal defects.

Is typically recognized by long limbs and ‘spider-like’ fingers, chest abnormalities and spine curvature

229
Q

Metaphysis

A

Below the ephyiseal line and above the diaphysis

230
Q

Salter Harris Fx (info)

A 
5 types
All involve growth plate
adult cannot have a SH Fx
Type II is most common
Worst prognosis is TYpe V
231
Q

Teardrop-shaped erythrocytes (dacrocytes)

A

Teardrop-shaped erythrocytes (dacrocytes) are commonly present in patients with myelofibrosis, myeloid metaplasia, and beta-thalassemia major.

232
Q

Plantar Fasciitis

A

Inflammation of the plantar fascia

heel pain, walking, weightbearing

middle age, women, lots of walking, runner, poor flexion

RICE, nsaids, stretches, inserts

233
Q

Dequervain syndrome

A

Inflammation of two tendons and the sheath that controls thumb movement

Women, 30-50, pregnancy
lifestyles with frequent wrist movement

Finklestein sign (thumb in fist, pain over thumb)

nsaids, spica, PT/OT, Steroid inj, surg decompression

234
Q

osteon

A

Tree trunk looking like bone cells (compact bone)

concentric rings of osseus tissue

Contain dark spots which are osteocytes

Parts include 
osteocytes,
lacuna (lake around dark spots or osteocytes), canalculi, 
central canal,
Lamella
235
Q

Spondylolisthesis

A

a vertebra shifts due to instability

can be degenerative or traumatic

236
Q

External fixation

A

External fixation – the use of an external brace to maintain alignment during healing

237
Q

Scoliosis

A

lateral curve of spine

idiopathic, cogenital, neuromuscular

admas test, forward bend test

25% is significant

Bracing, surgery

238
Q

Ankylosing Spondylitis Pearls

A

Associated with HLA-27 surface antigen

Progressive

First radiologic sign – increased SI joint space

Classic radiographic sign – “Bamboo Spine”

Multi – system disease

Hereditary component

Loss of Kyphotic curve, plantar fasciitis, inflamed costosternal joints – typical triad, though not all will be present in all patients

239
Q

Salter Harris Fx Types

A

Mneumonic

SALTR (in relation to growth plate)

Type =
I = Straight (parallel and inside growth plate)
II = Above
III = Lower
IV = Through (vertically through growth plate)
V = Rammed together (crushed)

240
Q

Ankylosing Spondylitis classic presentation

A

Young adult male

Late teens to late twenties

Better with activity, worse with rest

Pain fluctuates

Low back pain, SI pain, buttock pain

Morning stiffness

241
Q

Kyphoplasty vs vertebroplasty

A

both are used for compression fractures of spin

Kypho a ballon is used, then cement

Vertbro, imaging is used then cement (no ballon)

242
Q

Acromioclavicular Seperation

A

AC seperation, seperated shoulder

6 types

Type 1 Ligament stretched
Type 2 Partial rupture
Type 3 Complete rupture
Type 4 Clavicle is displaced over acromion process
Type 5 Clavicle is displaced up, just under skin
Type 6 Clavicle is displced uner acromion process(very rare)

243
Q

Sciatica

A

Caused by disc herniation

Compression of the L4 nerve
Pain from lower back down to knee

Compression of S1 nerve
pain can go all the way to ankle

Or can be caused by piriformis syndrome
swollen piriformis muscle compresses nerve

244
Q

Scotty (or Scottie) Dog sign

A

a NORMAL appearance of the lumbar spine when seen on oblique view

245
Q

Rotator cuff syndrome causes

A

Occurs with eccentric overload (Throwing objects),

underlying glenohumeral instability,

poor muscle strength and training errors.

impingement of the supraspinatus tendon as it passed beneath the subacromial arch.

PAM Semester 2 (22 decks)

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