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Clinical Medicine I > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

monosodium urate crystals
hyperuricemia (purine metabolism = uric acid)
95% underexcreters (mostly decrease renal function)

stage I - asymptomatic, no treatment needed
stage II - acute, severe attack of 1 joint
stage III - after 10+ years of acute attacks, chronic swelling and tophi

rapid onset pain, redness, warmth
PODAGRA - MTP joint of great toe
often recurrent

A

Gout

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2
Q

Gout diagnostics and treatment

A 
radiography = joint erosion
arthrocentesis = (-) BIREFRINGENT

Treatment: analgesia, NSAIDs (indomethacin or Naproxen)
Colchicine (diarrhea side effect)
glucocorticoids if can’t take NSAID or colchicine - sugar can rise in DM pts

*Urate-Lowering Therapy - goal to maintain serum uric acid of 6.0 or less
Probenecid - uricosuric agent
–> underexcreters only and avoid in pt with ASA (aspirin) use or nephrolithiasis (kidney stones)
Allopurinol (Zyloprim) and Febuxostat (Uloric) - xanthine oxidase inhibitors

Agent of Choice - Allopurinol - good for both over and underexcreters

Prophylaxis with colchicine or NSAID first, then initiate urate-lowering therapy
–> may precipitate an acute attack

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3
Q

calcium pyrophosphate dihydrate (CPP) crystals
comorbidities

acute, typically mono-articular - 50% knees
may mimic RA, OA or septic arthritis
self-limited

A

Pseudogout (chondrocalcinosis or CPPD deposition disease)

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4
Q

Pseudogout diagnostics and treatment

A

synovial fluid aspiration - (+) BIREFRINGENT

Treatment: NSAIDs or cholchicine
glucocorticoids (oral or systemic) if above doesn't work
remove crystals via joint aspiration
ice
joint immobilization

considered chronic if 3+ attacks in a year

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5
Q

autoantibodies to nuclear antigens (inflammatory autoimmune disorder)
multi system disease
more common in blacks and females

fever, fatigue, weight change
malar rash
photosensitivity
symmetric nonerosive arthritis
Raynaud's phenomenon (white - blue - red episodic vasospastic disease)
serositis (cardiopulmonary inflammation)
A

Systemic Lupus Erythematous (SLE)

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6
Q

Systemic Lupus Erythematous (SLE) diagnostics and treatment

A

ANA –> anti-dsDNA and anti-Sm subtypes
C3 and C4 - complement system
CBC, ESR (erythrocyte sedimentation rate/sed rate)
imaging if needed

Treatment: sun protection, diet, exercise, etc.
NSAIDs and rest for mild sxs
cytotoxic/immunosuppressive agents (ie. methotrexate) for severe sxs
systemic corticosteroids
antimalarials - hydroxychloroquine (Plaquenil) with ophthalmology f/u

drug-induced SLE (HIP drugs among others - hydralazine, isoniazid, procainamide)
–> (+) antihistone antibody

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7
Q

chronic, systemic autoimmune disorder
diminished exocrine gland function (salivary & lacrimal)
more common in females
common association with SLE, RA and systemic sclerosis

SICCA complex - dry eyes, dry mouth
--> keratoconjunctivitis, xerostomia
arthritis/arthralgia
parotid gland enlargement
fatigue
Raynaud's
A

Sjogren Syndrome (SS)

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8
Q

Sjogren Syndrome (SS) diagnostics and treatment

A

ANA –> anti-Ro.SSA and anti-La/SSB subtypes
Schemer’s test - tear production
salivary gland biopsy

Treatment: regular f/u with dentist and ophthalmologist
dry eyes –> artificial tears, cyclosporine drops
xerostomia - biotene OTC (saliva substitute)
steroids

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9
Q 
rare, chronic autoimmune disorder
diffuse FIBROSIS of skin and internal organs
skin appears taut and shiny
2 forms: limited (80%) diffuse (20%)
more common in females

arthralgia/arthritis
pericarditis
renal and pulmonary HTN

limited:
CREST syndrome
calcinosis cutis (calcification of subQ tissues)
Raynaud's
esophageal dysmotility
sclerodactyly (puffy hands)
telangiectasia

diffuse (worse prognosis):
rapid development of symmetric skin thickening on trunk and proximal extremities
more likely to have significant internal organ damage

A

Systemic Sclerosis (Scleroderma)

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10
Q

Systemic Sclerosis (Scleroderma) diagnostics and treatment

A

ANA –> anti-SCL-70
proteinuria (renal involvement)

Treatment: symptomatic and supportive
Raynaud’s - Nifedipine (Ca2+ channel blocker)
Esophageal - H2 blockers, H+ pump inhibitors, small more frequent meals

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11
Q

inflammatory arthritis triggered by antecedent GI/GU infection
HLA-B27 + (85%)
“can’t see, can’t pee, can’t climb a tree”
more common in men (post-GU infection)

acute, asymmetric oligoarthritis - often lower extremities
1-4 weeks post-GI/GU infection
diarrhea (GI) or urethritis (GI - “can’t pee”)
conjunctivitis (“can’t see”)
keratoderma blennorrhagicum on palms and soles

A

Reactive Arthritis (“Reiter’s Syndrome”)

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12
Q

Reactive Arthritis (“Reiter’s Syndrome”) treatment

A

NSAIDs - indomethacin
intra-articular/systemic glucocorticoids
methotrexate (MTX) or anti-TNF (cytotoxic/immunosuppressive) if above doesn’t work
sxs resolve 6-12 months

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13
Q

chronic, systemic, inflammatory autoimmune disorder
thickening of synovial membrane = inflammation (synovitis)
–> can lead to carpal tunnel over time
destruction of cartilage and bone
joint deformity and loss of fctn if not treated

gradual onset
symmetric polyarthritis
*morning stiffness for at least 1 hour
distal sites affected early - MCP and PIP joints

phys exam: ulnar deviation of MCP joints
Boutonniere deformity (PIP)
Swan neck deformity (DIP) - more severe disease
tenderness/swelling
*rheumatoid nodules = unfavorable sign (elbows)
A

Rheumatoid Arthritis (RA)

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14
Q

Rheumatoid Arthritis (RA) diagnostics and treatment

A 
radiography - preferred initial
--> soft tissue swelling around joint
--> periarticular osteopenia (thinning bones around joint)
--> narrowing joint space
--> subluxation/dislocation
--> bone erosion and joint obliteration
MRI and U/S to check for synovitis
joint aspiration if unsure

Lab: CBC/ESR
rheumatoid factor (RF) –> (+) early in course = more severe
anti-CCP antibodies (newer and more specific)
ANA (non-specific)

Treatment: control synovitis, prevent joint injury, preserve ADLs
NSAIDs + glucocorticoids
DMARDs (disease modifying anti-rheumatic drugs)
–> slows/halts disease progression
–> refer to Rheumatology
ex. methotrexate, sulfasalazine (synthetic)
ex. TNF inhibitors Enbrel, Remicaid, Humira (biologic) - risky
*CVD most common cause of death

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15
Q

degenerative joint/disk disease
risks: age, female, obesity, genetic, general wear/tear

pain exacerbated by activity and relieved by rest
morning stiffness typically resolves in less than 30 min
typically hands, knee, hip, pine

crepitus
bony enlargement
decreased ROM and malalignment
tenderness
Bouchard's nodes (PIP)
Heberden's nodes (DIP)
1st carpometacarpal joint (CMC)
osteophytes
effusions
pain around hip/groin referred to knee
cervical and lumbar spondylosis
A

Osteoarthritis (OA)

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16
Q

Osteoarthritis (OA) diagnostics and treatment

A

radiological: joint space narrowing
osteophytes
subchondral sclerosis and cysts

(-) RF and anti-CCP
no joint obliteration like RA

Treatment: pain control
minimize disability and pt education
NSAIDs (ie. diclofenac)
narcotics - sparingly if at all
intra-articular glucocorticoids
–> no more than 2-3 times per year - atrophy to cartilage
surgical = joint replacement or resurfacing

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17
Q

chronic inflammatory rheumatic condition
*association with giant cell (temporal) arteritis

gradual onset symmetric stiffness at least 30min
shoulder pain > hip and neck (proximal regions)
synovitis and bursitis
edema
decreased ROM
“gel” phenomenon = stiffness after periods of rest

A

Polymyalgia Rheumatica (PMR)

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18
Q

Polymyalgia Rheumatica (PMR) diagnostics and treatment

A

elevated ESR (>40)
(-) ANA, RF, anti-CCP
imaging - x-ray, MRI, U/S

*general rule of thumb:
male = age/2 = ESR
female = (age + 10)/2 = ESR

Treatment: RAPID RESOLUTION with low dose glucocorticoids (ie. prednisone)
MTX or TNF inhibitors for select pts
PT
NSAIDs

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19
Q

soft tissue pain disorder - muscles, tendons, ligaments
widespread, chronic
women 20-55yo = common complaint
no tissue inflammation

aching stiffness
fatigue
paresthesia
hard time explaining what hurts
headaches
insomnia
superficial pain in 11/18 tender points
A

Fibromyalgia

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20
Q

Fibromyalgia treatment

A

cyclobenzaprine - muscle relaxer
antidepressant - amitriptyline, cymbalta (SNRIs)
anticonvulsants - Lyrica, Neurontin (gabapentin)
psych referral
*avoid narcotics - addiction

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21
Q

non-displaced

A

fragments in anatomic alignment

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22
Q

displaced

A

fragments no longer in usual alignment

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23
Q

angulated

A

fragments maligned and angular

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24
Q

bayonetted

A

distal fragment longitudinally overlaps proximal fragment

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25
Q

distracted

A

distal fragment separated from proximal fragment by a gap

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26
Q

closed

A

skin over and near fracture intact

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27
Q

open

A

skin over and near fracture lacerated or abraded by the injury –> REFER

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28
Q

transverse

A

perpendicular to shaft of bone

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29
Q

comminuted

A

2+ fragments of fracture

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30
Q

oblique

A

angulated fracture line

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31
Q

segmental

A

type of comminuted fx in which a completely separate segment of bone is bordered by fx lines

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32
Q

spiral

A

multiplanar and complex fx line (common in ski injuries)

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33
Q

intra-articular

A

fx line crosses articular cartilage and enters the joint

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34
Q

torus

A

incomplete buckle fx of one cortex often seen in children

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35
Q

greenstick

A

incomplete fx with angular deformity seen in children

almost like it bends and one side breaks but the other doesn’t

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36
Q

impaction

A

one bone hits or “impacts” an adjacent bone

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37
Q

compression

A

type of impaction fx that occurs in vertebrae resulting in depression of end plates
often in older people with osteoporosis

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38
Q

depression

A

type of impaction fx that occurs in the knee when the femoral condyle strikes softer tibial plateau

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39
Q

stress (fatigue)

A

fx in normal bone that has been subjected to repeated or cyclical loads that in and of themselves are not sufficient to cause a fx

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40
Q

stress (insufficiency)

A

fx in weakened bone that has been subjected to a load insufficient to fx a normal bone

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41
Q

pathologic

A

fx through bone weaker by tumor, metabolic bone disease or osteoporosis

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42
Q

SITS muscles (SIT = ext rot & ABd, S = int rot)

pain over anterior and lateral aspects of shoulder that radiates to deltoid and progressively worsens
decreased ROM (inability to ABduct above shoulder)
shoulder may catch/click
subacromial tenderness

Drop arm and empty can tests

acute tear = often labral pathology
chronic tear = pain usually worse at night, gradual weakness does NOT improve with analgesics

A

Rotator Cuff Tear

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43
Q

Rotator Cuff Tear diagnostics and treatment

A

lidocaine injection test
radiograph - elevation of humeral head 1+cm
*MR ARTHROGRAM (good for labral pathology too)

Treatment: ice and NSAIDs
weighted pendulum stretching with some shoulder immobilization
PT
if persistent, subacromial steroid injection or surgery

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44
Q

*principle cause of rotator cuff tendonitis

subacromial (pinpoint) tenderness
gradual pain in lateral shoulder that radiates to deltoid
normal glenohumeral joint ROM
*preserved strength

Neer’s and Hawkin’s tests (flexion, int rot maneuvers)

A

Shoulder Impingement Syndrome

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45
Q

Shoulder Impingement Syndrome diagnostics and treatment

A

radiography - normal in 1st episode pts
MRI useful for chronic sxs

Treatment: ice, NSAIDs, activity modification
*NO arm sling recommended
PT referral with f/u
if persistent, corticosteroid injections or surgery

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46
Q

stiffened glenohumeral joint
secondary to injury, trauma, overuse, sling use, bursitis
may develop adhesions

chronic pain with limited ROM due to mechanical restriction

Apley Scratch test –> comparison is key
ABduction and ext rot

A

Adhesive Capsulitis (“frozen shoulder”)

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47
Q

Adhesive Capsulitis (“frozen shoulder”) treatment

A

imaging isn’t helpful

Treatment: PT consult - stretch lining of joint
treat underlying process

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48
Q

complains of bump on shoulder that is worse at bedtime

AC joint swelling, tenderness and possible deformity
pain aggravated by downward traction

Cross-Over test –> pain with passive cross-body ADduction

sprain, partial or complete tear

A

Acromioclavicular (AC) Injury

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49
Q

Acromioclavicular (AC) Injury grading

A

Grade I - AC joint intact, point tender SPRAIN without separation, normal radiographs

Grade II - separation of superior and inferior AC ligaments, decreased ROM, instability with stress testing of AC joint, radiographic evidence (PARTIAL TEAR)

Grade III - separation of superior and inferior AC ligaments AND coracoclavicular ligament, severe pain, decreased ROM and instability
radiograph shows inferior margin of distal clavicle at or above superior margin of acromion (COMPLETE TEAR)

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50
Q

Acromioclavicular (AC) Injury treatment

A

shoulder immobilizer 3-4 weeks for comfort
ice, rest, NSAIDs
corticosteroid injection if not improving
surgical for Grade III (recent studies do not support)

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51
Q 
tenderness to palpation over clavicle
visual deformity seen
decrease ROM
apprehension and guarding
single AP radiograph of clavicle

70-80% middle 1/3 - typically displaces superiorly

A

Clavicle Fracture

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52
Q

Clavicle Fracture treatment

A

sling/swathe or figure 8 harness
analgesics and muscle relaxers
sleep upright

ortho referral for all displace and proximal or distal fxs
–> surgery

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53
Q

inflammation or degeneration of sack-like structure
repetitive movement injury

pain to shoulder with ROM and rest
localized tenderness to palpation
warm, red, fever, malaise

*not often isolated and may cause impingement

A

Subacromial Bursitis

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54
Q

Subacromial Bursitis treatment

A

fluid aspiration if suspected sepsis, otherwise imaging provides little benefit

ice and NSAIDs
restriction of overuse
aspiration and corticosteroid injection

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55
Q

pain to anterior shoulder with ABduction and ext rot
popping sensation
weakness

Yergason’s and Speed’s tests

inflammation of long head of biceps tendon as it passes through bicipital groove

A

Biceps Tendonitis

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56
Q

Biceps Tendonitis treatment

A

U/S beneficial

NSAIDs and rest
PT
surgery

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57
Q

arm held in position of protection
–> SULCUS SIGN
apprehension and relocation tests

95% anterior –> SPECIAL CONSIDERATIONS
1. Bankart lesion
detachment of anterior inferior labrum from glenoid rim
2. Hill Sachs lesion
cortical depression of posterolateral humeral head when humeral head is impacted by anterior rim of glenoid
3. axillary n.
decreased sensation of lateral aspect of shoulder and decreased deltoid function

A

Glenohumeral Subluxation/Dislocation

58
Q

Glenohumeral Subluxation/Dislocation treatment

A

PT
ice, rest, NSAIDs
shoulder immobilizer –> sling and swathe 2-4wks
surgery for repeat dislocations

59
Q

localized pain and swelling
reproducible pain with wrist flexion (medial) or wrist extension (lateral) against resistance

overuse syndrome
Medial = Golfer’s elbow –> wrist flexor, pronator
Lateral = Tennis elbow –> wrist extensor, supinator

A

Elbow Epicondylitis

60
Q

Elbow Epicondylitis treatment

A 
acute = sling, wrist brace, ice and NSAIDs
recurrent = steroid injections and surgery for debridement
preventative = forearm strap and decreased repetitive activities
61
Q

swelling of the elbow
+/- pain
+/- ROM
infection = erythema and warmth

cause: trauma, infection, rheumatologic condition

A

Olecranon Bursitis

62
Q

Olecranon Bursitis treatment

A

ice and NSAIDs
aspiration
antibiotics +/- surgical intervention if infected

63
Q

decreased grip strength
RF and SF tingling and numbness
chronic = muscle wasting

ulnar n. compression

A

Cubital Tunnel

64
Q

Cubital Tunnel treatment

A

radiographs and nerve conduction studies

NSAIDs
bracing
PT
surgery

65
Q 
gradual, progressive pain
--> early = intermittent, late = burning, numbness, tingling
sxs worse at night
*thenar muscle atrophy
decreased grip strength
decreased sensory to thumb, IF, LF

Tinel’s and Phalen’s tests

swelling of synovium or thickening of transverse carpal ligament causing compression of median n.

A

Carpal Tunnel Syndrome

66
Q

Carpal Tunnel Syndrome diagnostics and treatment

A

nerve conduction study = delayed because demyelination
EMG = denervated muscle spontaneously fires

Treatment: acute = immediate decompression
chronic = NSAIDs, corticosteroid injection, brace, PT, surgery

67
Q

soft mobile mass
commonly on dorsal radial and solar aspects of wrist
fluctuates in size often with activity
may decrease ROM and become painful

collection of synovial fluid within a joint or tendon sheath

A

Ganglion Cyst

68
Q

Ganglion Cyst treatment

A

NSAIDs
aspiration and steroid injection
surgery for recurrence (50% come back)
may resolve spontaneously

69
Q

pain and swelling along dorsal radial wrist
pain aggravated by thumb and wrist motion

Finkelstein test

inflammation of 1st dorsal compartment due to overuse

A

De Quervain’s Tenosynovitis

70
Q

De Quervain’s Tenosynovitis treatment

A 
decreased repetitive activity
thumb spica immobilization
NSAIDs
steroid injections
surgery for decompression
71
Q

painless nodules that turn into palpable cords
extension loss of fingers (usually RF & SF)

Hueston Table Top test - ability to flatten hand on table

progressive fibrosis of palmar fascia
connective tissue disorder

A

Dupuytren’s Contracture

72
Q

Dupuytren’s Contracture treatment

A

observation
refer for surgery if progressive
glucocorticoid injection for pain or rapid growth of nodules

73
Q

nodule forms at solar aspect of MCP causing mechanical impingement and inflammation

digit snaps/catches/locks with passive and active ROM at IP/PIP joints
progressively painful
nodule unable to slide through A1 pulley

A

Trigger Thumb/Finger (Stenosing Flexor Tenosynovitis)

74
Q

Trigger Thumb/Finger (Stenosing Flexor Tenosynovitis) treatment

A

NSAIDs
local corticosteroid injection
surgery to release A1 pulley

75
Q 
gradual neck stiffness and soreness
muscle tightness
HA (tension) starting at base of skill
shoulder pain
decreased ROM due to pain
neuro exam normal
tenderness to palpation

usually 2-24 hrs post-injury (adrenaline)

A

Cervical Strain/Sprain

76
Q

Cervical Strain/Sprain treatment

A

radiograph - AP/ lateral/odontoid with flexion/extension views
MRI only if neuro deficit

“therapeutic trial” for 48 hours - rest, ice/heat, massage
NSAIDs, muscle relaxants - 48-72hrs around the clock, not PRN
narcotics for limited course if necessary
PT - TENS unit application
anti-depressants if chronic
majority recover in 4 wks

77
Q

ACUTE onset pain secondary to identifiable precipitating event
pain worsens with activity and radiates to butt
decreased ROM due to pain
neuro exam normal
tenderness to palpation

30-60% have had prior episodes

A

Lumbar Strain/Sprain

78
Q

Lumbar Strain/Sprain treatment

A

radiograph - AP/ lateral/odontoid with flexion/extension views
MRI only if neuro deficit

“therapeutic trial” for 48 hours - rest, ice/heat, massage
NSAIDs, muscle relaxants - 48-72hrs around the clock, not PRN
narcotics for limited course if necessary
PT - TENS unit application
anti-depressants if chronic
majority recover in 4 wks

79
Q

variable clinical presentation
1 level with unilateral, radicular sxs
multiple levels with bilateral sxs
may see signs consistent with myelopathy if central disc herniation causes cord compression

neck tenderness or muscle spasm
correlate plain films with MRI
–> narrowing disc space and bone spurs (osteophytes)

combo degenerative disc disease and hypertrophy of ligamentum flavum and facets

A

Cervical Spondylosis

80
Q

Myelopathy

A 
upper motor neuron (UMN)
hyperactive reflexes --> clonus
spasticity
upgoing toes (Babinski's sign)
late muscle atrophy
weakness in affected distribution
81
Q

Radiculopathy

A 
lower motor neuron (LMN)
hypoactive reflexes
flaccidity
fasciculations
muscle atrophy
weakness in affected distribution
82
Q

acute to severe pain
radiates from low back to legs (“sciatica”) in 95% of cases
pain aggravated by sitting, coughing, sneezing
may see trunk shift to one side

Straight Leg Raise test (SLR)
Achilles Tendon reflex if L5-S1 herniation (S1 nerve root)

most common at L4-5 and L5-S1
most posterolateral because posterior longitudinal ligament (PLL) is weakest

A

Herniated Lumbar Disk Disease

83
Q

Herniated Lumbar Disk Disease diagnostics and treatment

A

radiographs - decreased height of disc space and osteophytes
MRI = diagnostic

NSAIDs/analgesics (ibuprofen or naproxen)
muscle relaxants (cyclobenzaprine/flexeril)
NO narcotics
heat/cold
PT
urgent referral if neuro deficits –> surgery

84
Q

urinary retention in 90%
bilateral lower extremity muscle weakness
acute LBP with sciatica due to massive midline herniation
“SADDLE” anesthesia - numb wherever you sit
decreased anal sphincter tone –> rectal exam

*neurologic emergency = REFER

A

Cauda Equina Syndrome

85
Q

Cauda Equina Syndrome treatment

A

MRI is diagnostic

disc herniation or trauma = urgent surgical decompression
metastatic disease = urgent oncology consult for radiation

86
Q

back pain aggravated by bending, lifting, twisting
may have “step off” of spinal processes on exam
associated with degenerative disc disease

anterior displacement of one vertebrae on another
*graded by % –> less than 50% = asymptomatic

A

Spondylolithesis

87
Q

Spondylolithesis treatment

A

50% = spinal fusion to stabilize

any neuro impairment = REFER

88
Q

neurogenic claudication = progressive LBP and bilateral leg pain aggravated by standing and/or walking
relieved by leaning forward

congenital or acquired condition that narrows neural foramen causing compression

A

Lumbar Spinal Stenosis

89
Q

Lumbar Spinal Stenosis diagnostics and treatment

A

decreased height of intervertebral discs
facet hypertrophy
hypertrophy of ligamentum flavum
narrowing of intervertebral foramina

NSAIDs
PT
epidural steroid injections for pain

90
Q

Spinal Tumors

A

new onset LBP in patient with known malignancy is metastasis until proven otherwise

91
Q 
back pain
malaise
fever
sepsis
wound drainage

osteomyelitis (infection of bone) - rare and commonly associated with invasive procedures

A

Spinal Infections

92
Q

Spinal Infections treatment

A

antibiotics

surgical drainage

93
Q

aching LBP around SI joint that progresses proximally
persistent morning back stiffness 1+hr
–> exacerbated by inactivity and improves with activity
low grade fever, fatigue, weight loss, night sweats
*acute anterior uveitis/iritis (circumcorneal flush)
*limited spinal motion
tenderness over joint
loss of lumbar lordosis
accentuation of thoracic kyphosis

Shober test –> mark 10cm above an 5cm below intersection of iliac crest and spine
ask pt to forward flex as much as possible
re-measure distance –> should be 20+cm (5cm change)

A

Ankylosing Spondylitis

94
Q

Ankylosing Spondylitis diagnostics and treatment

A

radiograph = BAMBOO SPINE - fusion of vertebral bodies

1st line - NSAIDs - indomethacin, celecoxib (Celebrex)
2nd line - refer to Rheumatology - TNF antagonists (i.e. sulfasalazine)
intra-articular steroids no more than every 3-4mo
anti-depressants
refer to ophthalmology if uveitis
surgery
PT - supportive measures

95
Q

groin or lateral hip pain
sharp stabbing or dull ache
aggravated by turning, twisting, prolonged standing and squatting

*FADIR test (flexion, ADduction, internal rotation of hip)
FABER test (flexion, ABduction, external rotation of hip)

bone overgrowth or abnormality in bone development can change the function of the hip joint

2 types: pincer = acetabular involvement
Cam = femoral head involvement
could be combo of pincer and Cam lesions

A

Femoroacetabular Impingement (FAI)

96
Q

Femoroacetabular Impingement (FAI) diagnostics and treatment

A

x-rays initially
CT/MRI if needed

NSAIDs
PT
decrease aggravating activities
surgical eval if conservative tx fails

97
Q 
dull or sharp groin pain
catching/clicking
radiates to lateral hip, anterior thigh or butt
insidious onset vs. acute trauma
FADIR/FABER tests
ROM and strength testing
A

Labral Tear of the Hip

98
Q

Labral Tear of the Hip diagnostics and treatment

A

*MR Arthrogram (test of choice for labral tears)
x-rays
MRI

conservative vs. referral for surgical consultation

99
Q

painful or painless snapping/popping aggravated by activity
pseudosubluxation
external = passive internal/external rotation of hip while laying on side (IT band over g greater trochanter)
internal = FABER test then extend hip to check snapping (iliopsoas tendon over iliopectineal eminence or femoral head)

increased risk in adolescents and dancers

A

Snapping Hip Syndrome

100
Q

Snapping Hip Syndrome treatment

A

NSAIDs
+/- corticosteroid injection
PT - stretching and heat/ice
surgery rarely indicated

101
Q 
lateral hip pain localized to greater trochanter
pain with resisted abduction
Trendelenburg sign (hip drop on contralateral side)

repetitive overload tendinopathy (gluteus medius and minimus)

A

Greater Trochanteric Pain Syndrome (Trochanteric Bursitis)

102
Q

Greater Trochanteric Pain Syndrome (Trochanteric Bursitis) treatment

A 
self-limiting
NSAIDs
ice (acute) or heat (chronic)
adjust positioning
steroid injection into bursa
103
Q

most common MOI: knee flexion with foot planted
lateral impact with valgus stress and rotation

Valgus stress test = MCL
Varus stress test = LCL

Unhappy Triad (Triad of O’Donoghue)
ACL
MCL
Medial Meniscus

A

Medial Collateral Ligament (MCL) Sprain

104
Q

joint effusion (hemarthosis)
guarding
laxity
pt hears/feels a “pop” followed by immediate pain, swelling and instability

*Lachman’s test - stabilize distal femur and pull on tibia anteriorly
Anterior Drawer test
Pivot Shift test

more common in females (increased Q angle = increased values stress)
*prevents anterior translation of the tibia
>50% associated with meniscus injury

A

Anterior Cruciate Ligament (ACL) Injury

105
Q

Anterior Cruciate Ligament (ACL) Injury treatment

A 
RICE (rest, ice, compression, elevation)
refer to ortho
surgery for young patients and athletes
brace
PT - rehab
106
Q

mild to moderate knee effusion and hemarthrosis
generalized knee pain
limp

often missed because subtle or associate with high energy trauma

Posterior Drawer test
Posterior Sag sign

prevents posterior translation of tibia
largest and strongest ligament of the knee

A

Posterior Cruciate Ligament (PCL) Injury

107
Q

joint line pain
inability to fully extend knee - locking/catching
walking up and down stairs and squatting is painful

McMurray’s test - external rotation of heel, flex maximally, then slowly provide values stress while extending
Apley’s compression/distraction test

C-shaped cartilage that increases contact area for articulation –> aids in joint stability and shock absorption
can often result in arthritis later because bone on bone

A

Meniscus Injury

108
Q

Meniscus Injury treatment

A

consider location and extent of teat
conservative vs. surgical

MRI may help

109
Q

Knee “Sprains” Grading and Treatment

A

Grade I - mild stretch
RICE, WB as tol

Grade II - partial tear
RICE, brace immobilization, +/- crutches, PT, possible surgery

Grade III - complete tear
REFER –> surgical repair, crutches, brace, aggressive PT

110
Q

anterior pain under patella
pain worsens when going up and down stairs
+ theater/long car ride sign
crepitus, popping and instability

Patellar glide test
apprehension test

*most common knee complaint in primary care
malalignment, patellar tracking concerns

A

Patellofemoral Pain Syndrome

111
Q

Patellofemoral Pain Syndrome treatment

A

ice and NSAIDs
PT
brace PRN

no imaging needed

112
Q

often asymptomatic
pain/swelling may occur behind knee

accumulation of joint fluid in popliteal fossa

A

Baker’s Cyst (Popliteal Cyst)

113
Q

Baker’s Cyst (Popliteal Cyst) treatment

A

NSAID
aspiration/injection
compression brace

114
Q

pinpoint tenderness inferior to patella

inflammation from repetitive trauma

A

Patellar Tendonitis (“Jumper’s Knee”)

115
Q

Patellar Tendonitis (“Jumper’s Knee”) treatment

A

ice, NSAIDs, bracing/strapping
rest
PT

116
Q

gradual onset localized pain
initial sharp/burning during activity
develops into constant deep ache

overuse injury
evaluate for limb length discrepancy

A

Iliotibial Band Syndrome (ITBS)

117
Q

Iliotibial Band Syndrome (ITBS) treatment

A

RICE
NSAIDs
PT

118
Q

pain, swelling, tenderness to the knee
r/o infection

pre-patellar and pes anserine are most common site of inflammation

A

Knee Bursitis

119
Q

Knee Bursitis treatment

A

NSAIDs
aspiration/steroid injections
padding/bracing

120
Q

chronic pain usually in knee, ankle or elbow
catching.clicking if something is caught there

lesion of cartilage and underlying bone that results in necrosis and possible displacement

A

Osteochondritis Dissecans (OCD)

121
Q

Osteochondritis Dissecans (OCD) treatment

A

*MRI will pick it up

long term bracing
activity restrictions
PT
surgery

122
Q

swelling/pain at the ankle
ecchymosis
difficulty WB
eval for bone pain

lateral ligament complex (most commonly injured)
INVERSION with plantar flexion
Anterior Drawer test
medial = deltoid ligament complex
EVERSION
syndesmotic = high ankle sprain
Squeeze test
A

Ankle Sprains

123
Q

Ankle Sprains treatment

A

radiograph only to r/o fx

RICE
NSAIDs
+/- short immobilization for grade 2-3
PT

124
Q

recent increase in training resulting in burning pain
or
sudden pivoting or rapid acceleration
palpate along tendon for pain, edema or defect
have pt do active ROM first - plantar and dorsiflexion

Thompson test

peds = Sever’s disease (inflammation at growth plate)

A

Achilles Tendon

125
Q

Achilles Tendon treatment

A

ortho referral - conservative vs. surgery

immobilization - boot allowing for continuous plantar flex position

126
Q

pain with onset of walking (first step in the morning)
unilateral or bilateral
point tenderness aggravated by ROM
r/o S1 radiculopathy (SLR and achilles tendon reflex tests)

inflammation of fascia from activity, poor shoe wear, ankle pronation, heel spurs, etc.

A

Plantar Fasciitis

127
Q

Plantar Fasciitis treatment

A

ice, rest, NSAIDs
PT
improve shoe wear
if severe = steroid injection, splinting, casting

128
Q

progressive bone loss with increased risk of fx
prevent with Ca2+/Vitamin D and exercise
evaluate with DEXA scan for bone densitometry

A

Osteoporosis

129
Q

Osteoporosis treatment

A

estrogen replacement therapy - Raloxifine (Evista)
calcitonin
bisphosphates - alendronate (fosamax), risedronate (actonel), ibandronate (boniva)

130
Q 
increased pain in the joints
redness
warmth
inflammation
*Surgical emergency
A

Septic Arthritis

131
Q

Septic Arthritis diagnostics and treatment

A

joint aspiration - gram stain, fungi, crystals, etc.
CBC, ESR, CRP, cultures

IV antibiotics

132
Q

most common benign tumor
fluid-filled cavity in bone
cortex still intact

radiographs, MRI/CT if needed, bone scan

Treatment: may resolve spontaneously
consider surgery for recurrent pathologic fxs

A

Unicameral Bone Cyst (UBC)

133
Q

blood filled cyst in bone
spine and extremities most often affected
benign but aggressive

radiography, MRI, biopsy

Treatment: refer to ortho for surgery

A

Aneurysmal Bone Cyst (ABC)

134
Q

benign lesion
metaphyseal, eccentric (edge of bone), sclerotic borders
looks like bubbles
asymptomatic and typically incidental finding

Treatment: observe with serial radiographs
ortho referral is lesion is >50% diameter of bone

A

Non-ossifying Fibroma (NOF)

135
Q

benign aggressive tumor
may develop as growth plate closes
localized pain and weakness

radiographs, MRI, bone scan (hot spot)

Treatment: refer to ortho for radiation and surgery

A

Giant Cell Tumor (GCT)

136
Q

small benign tumor
*nidus-center of growing cells surrounded by thickening bone
severe pinpoint pain at night resolved immediately from taking NSAIDs

Treatment: refer to ortho or interventional radiology for radio frequency ablation

A

Osteoid Osteoma

137
Q

fixed, non-mobile mass near joints
pain with activity
tingling/numbness if near nerve

benign, abnormal growth of bone and cartilage along surface of bone

Treatment: observation and refer if painful

A

Osteochondroma (Exostosis)

138
Q

asymptomatic vs. pain/swelling
pathologic fx
malignant primary bone tumor - rapidly growing
*most common bone tumor in children

radiographs, MRI/CT

Treatment: refer to ortho and oncology

A

Osteosarcoma and Ewing’s Sarcoma

139
Q

pain and weakness
pelvic masses radiate pain to hip and bone

bone tumor of CARTILAGE-PRODUCING cells

Treatment: refer to ortho
+/- radiation and chemo

A

Chondrosarcoma

140
Q

fatigue, fever, sweats
diffuse bone tenderness
pathologic fxs

most common primary bone tumor –> malignant bone marrow
involves entire skeleton

*Bence-Jones proteins in UA
punched-out appearance on imaging

Treatment: chemo, radiation, supportive

A

Multiple Myeloma

141
Q

asymptomatic
anemia (labs)
bone scans

Lead Kettle (PB-KTL)
prostate, breast, kidney, thyroid, lungs
men = P and L
woman = B

*REFER

A

Metastatic Bone Cancer

Clinical Medicine I (4 decks)

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