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Clin Med > Exam 7 > Flashcards

Exam 7 Flashcards

1
Q

HLA common type

A

B27, usually class II MHC

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2
Q

Central tolerance

A

Cells expressing auto antibodies are marked and destroyed through apoptosis

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3
Q

Clonal anergy

A

Inactive T cells that have not encountered antigen

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4
Q

Immunological ignorance

A

Lack of antigen antibody encounter

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5
Q

Active regulation

A

Surveillance for self reacting antibodie

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6
Q

Rheumatoid arthritis definition

A

Chronic and systemic inflammatory dz affecting synovial tissues

Synovitis of multiple joints

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7
Q

Genetic risk factor for RA

A

HLA with shared epitope, 4x great risk of RA, but only present in 30% of population

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8
Q

How long are autoantibodies present in RA before onset of sx?

A

5-10 years

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9
Q

RA pathophysiology

A

Synovial fluid increases as synovial tissue proliferates, pannus develops

Pannus infiltrates adjacent structures and destroys them

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10
Q

RA joint symptoms

A

Early pain and stiffness

Symmetric swelling and pain of multiple joints

Worse with activity, worse in morning

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11
Q

Joint deformities in RA in the hands

A

Swan neck- hyperextension of PIP

Boutonnière- hyperflexion of PIP

Ulnar deviation of MCP

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12
Q

Other RA symptoms

A

*constitutional symptoms

Rheumatoid nodules (over bony prominences, bursae, tendons)

Dry eye, scleral nodules

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13
Q

Felty syndrome

A

Found in RA

RA, splenomegaly, neutropenia

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14
Q

RA diagnostics

A

Anti-CCP (most correlated and more specific)

RF (not as specific)

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15
Q

RA imaging

A

Early- soft tissue swelling of wrists and feet, juxta-articular demineralization

Late- joint space narrowing, bony erosions

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16
Q

What does RA have that OA doesn’t?

A 
MCP involvement
Systemic symptoms
Extra articular symptoms
Persistent morning stiffness
Symmetrical joint involvement
Erosions on x rays
Increased ESR, CRP, RF, and anti-CCP
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17
Q

What is more specific to OA vs. RA?

A

Asymmetrical joint involvement

Osteophytes on x ray

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18
Q

3 types of juvenile idiopathic arthritis

A

Oligoarticular

Polyarticular

Systemic onset

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19
Q

What is an ocular risk of all JIA patients?

A

Uveitis

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20
Q

JIA diagnosis

A

Effusion noticed acutely by parents

Pain and stiffness that restricts motion

Arthritis onset slow

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21
Q

JIA exam

A

Inflammation, erythema, tenderness, effusion

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22
Q

Still disease general

A

Related to chronic juvenile arthritis

Young adult onset

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23
Q

Still disease symptoms

A

High fevers
Sore throat
Evanescent rash
Destructive arthritis

Dramatic increased WBC, ferritin

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24
Q

What are the lupus criteria?

A
  1. Malar rash
  2. Discoid rash
  3. Photosensitivity
  4. Oral ulcers
  5. Arthritis
  6. Serositis
  7. Kidney disease
  8. Neurological disease
  9. Hematologic disorders
  10. Immunologic abnormalities
  11. Positive ANA
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25
Q

How many criteria does a patient need to be diagnosed with lupus?

A

Any 4 or more of the 11

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26
Q

Systemic sx of lupus

A

Fever, anorexia, malaise, weight loss

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27
Q

Malar rash

A

SLE

Butterfly rash, red/purple, mildly scaly, spares nasolabial folds

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28
Q

Discoid rash

A

SLE

Erythema, inflammation, scaling/crust. May scar

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29
Q

Photosensitivity of SLE

A

Rash in sun exposed areas

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30
Q

What may be the earliest sign of SLE?

A

Arthritis

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31
Q

Serositis in SLE

A

Inflammation of serous tissue

Pericarditis, pleural effusions common

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32
Q

Screening test of choice for SLE?

A

ANA!

If it is negative, need to consider other dx’s

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33
Q

Polymyositis

A

Insidious proximal muscle weakness and maybe pain

Dysphagia fairly common

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34
Q

Polymyositis diagnostic

A

Muscle biopsy

White blood cells attacking muscle cells

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35
Q

Dermatomyositis

A

Similar weakness to polymyositis

Heliotrope rash
Gottron papules
Shawl sign

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36
Q

Rhabdmyolysis

A

Acute necrosis of skeletal muscle

Very increased CK levels

Renal failure

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37
Q

Common causes of rhabdo

A

Crush injury

Cocaine, alcohol

Prolonged inactivity

Statins

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38
Q

Scleroderma types

A

Diffuse and limited

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39
Q

Scleroderma

A

Fibrosis of skin and internal organs

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40
Q

CREST syndrome

A

Aka limited scleroderma

Calcinosis cutis
Raynauds
Esophageal motility disorder
Sclerodactyly
Telangiectasia
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41
Q

Diffuse scleroderma manifestations

A

Tendon friction rubs over forearm, shins
Renal, cardiac dz
Interstitial lung dz
Tightening of skin

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42
Q

Tightening of skin with CREST

A

Just face and hands, greater risk of digital ischemia

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43
Q

What autoantibody marker does CREST have more commonly than diffuse scleroderma?

A

Anti-centromere

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44
Q

Sjogren syndrome

A

Dry eye, dry mouth

Usually females

Schirmer test to quantify tears

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45
Q

Polymyalgia rheumatica

A

Pain/stiffness in axial muscles (shoulders, hips/pelvis)

Associated with giant cell arteritis

Difficulty putting on coat, standing from chair

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46
Q

Behcet disease

A

Oral aphthae is the hallmark

Genital lesions, CNS involvement, vasculitis, arthritis

Uveitis- severe!

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47
Q

Behcet disease diagnosis

A

Recurrent oral ulcerations plus 2 more things, like…

Genital ulcerations
Eye lesions
Skin lesions
Positive pathergy test

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48
Q

Pathergy

A

Behcet diagnosis

Formation of a sterile pustule at the site of needle insertion

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49
Q

Polyarteritis nodosa

A

Medium vessel disease

Skin, nerves, mesenteric vessels, brain, etc.

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50
Q

Polyarteritis nodosa manifestations

A

Livedo reticularis

Digital gangrene

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51
Q

Primary angiitis of CNS

A

Rare vasculitis limited to brain and spinal cord

Brain bx is only way to make dx

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52
Q

Leukocytoclastic vasculitis

A

Small vessel vasculitis

Most commonly of skin, aka hypersensitivity vasculitis

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53
Q

Leukocytoclasatic vasculitis exam

A

Palpable purpura

Urticarial lesions- last greater than 24 hours, burning more than itching

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54
Q

Henoch schonlein purpura

A

Most common systemic vasculitis in kids

Palpable purpura, arthritis, hematuria and maybe abdominal pain

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55
Q

Essential cryoglobulinemia

A

Hep C is the most common cause

Cold precipitable immune complexes

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56
Q

Essential cryoglobulinemia findings

A

Palpable purpura
Peripheral neuropathy
Glomerulonephritis
Positive serum test for cryoglobulins

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57
Q

Osteoarthritis general

A

Most common joint disease

Degenerative dz due to cartilage breakdown in joints, bony and synovial changes

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58
Q

What joints does OA commonly affect?

A

Knee
Hip
Spine
Feet

Weight bearing joints!

Asymmetrical

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59
Q

OA pathophysiology

A

Edema of cartilage early

Progression- cartilage softens and loses elasticity
Loss of joint space
Bony degeneration and osteophyte/cyst formation

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60
Q

OA presentation

A

NO systemic sx

Slowly progressive joint pain
Deep and achy, tenderness
Worse with heavy use, better with rest

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61
Q

Gelling

A

Stiffness during rest with OA

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62
Q

Heberdens nodes

A

Palpable osteophytes and or cysts at DIP joint

OA

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63
Q

Bouchard’s nodes

A

Palpable osteophytes and or cysts at PIP joints

OA

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64
Q

Imaging findings of OA

A

Narrowed joint space
Osteophytes
Increased density of subchonral bone
Bony cysts

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65
Q

OA prevention

A

Weight loss

Correct any vitamin D deficiency

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66
Q

Joint fluid analysis general rule

A

RBC/WBC ratio in blood and normal fluid is 1000/1

More WBCs suggests infection or inflammation

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67
Q

Gout general

A

Associated with consumption of fish foods and alcohol

High purine foods are main trigger

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68
Q

Gout pathophysiology

A

Monosodium urate crystal formation

Often excess uric acid

Synovial fluid cooler than body temp, supersaturation and crystal aggregation

Inflammation via macrophage response

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69
Q

Podagra

A

Gout of the MTP joint (most common site)

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70
Q

Gout presentation

A

Sudden onset arthritis
Night onset common

Erythema, swelling, fever, warmth, TENDERNESS

Monoarticular usually

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71
Q

Tophi

A

Granulomataous inflammation around a deposit of MSU crystals

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72
Q

Chronic gouty arthritis

A

Persistent elevation in articular MSU

Chronic changes to bone, cartilage

“Rat bites” on X-RAYS

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73
Q

Gout diagnosis

A

Joint aspirate is key, especially for 1st diagnosis

Negatively birefringent needle like crystals

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74
Q

Chondrocalcinosis

A

Calcium salts in articular cartilage

Usually XR diagnosis

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75
Q

Pseudogout

A

Aka calcium pyrophosphate crystals

Gouty sx of large joints, knees and wrists common

Chondrocalcinosis of joint almost always seen

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76
Q

Diagnostic finding of pseudogout

A

Rhomboid, positively birefringent crystals under polarized light

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77
Q

Spondyloarthropathy general

A

Group of systemic inflammatory diseases

Musculoskeletal findings, extra articular manifestations, immunogenicity issues

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78
Q

Ankylosing spondylitis

A

Young adults

Chronic, inflammatory dz of axial skeleton

Low back pain that improves with activity

Ascending disease, lumbar curve flattens and cervical curvature exaggerated

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79
Q

Ankylosing spondylitis other findings

A

Peripheral arthritis

Uveitis

Entesthopathy (disordered tendon/ligament attachment)

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80
Q

Think of AS with…

A

Less than 30 years old, inflammatory pain that improves with activity

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81
Q

Reactive arthritis

A

Preceded by infection, but joints are not infected

Usually GI or STD pathogens

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82
Q

Reactive arthritis classic triad

A

Asymmetric arthritis, uveitis, and urethritis

“Can’t see, can’t pee can’t climb a tree”

Fever, weight loss, arthritis of large weight bearing joints

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83
Q

Septic arthritis definition, causes and pathogen

A

Bacterial joint infection
Hematogenous spread, direct inoculation, immunocompromise are the causes

Staph aureus most common!

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84
Q

Septic arthritis presentation

A

Acute pain, effusion, and warmth of joint

Fever, chills common

Knee most common site

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85
Q

Septic arthritis diagnostics

A

Synovial fluid analysis- increased WBCs

Often blood culture is positive

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86
Q

Prosthetic joint worries

A

Periprosthetic lucency!!

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87
Q

Gonoccoccal arthritis common patient populations

A

Menses, pregnancy, MSM

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88
Q

Gonococcal arthritis presentation

A

Migratory polyarthralgia, then EITHER

  • tenosynovitis of wrist, hands or feet
  • purulent monoarthritis
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89
Q

Osteomyelitis

A

Bony infection due to direct or hematogenous spread (always get blood cx)

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90
Q

Manifestations of osteomyelitis

A

Fever, chills, pain and elevated ESR/CRP

Wound that probes the bone is a clinical dx

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91
Q

Best imaging for osteomyelitis

A

MRI

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92
Q

Best way to obtain cultures for osteomyelitis?

A

Bone bx

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93
Q

Diskitis

Vertebral osteomyelitis

A

Insidious onset

Fever, back pain

Spinal/paraspinal tenderness
Elevated ESR, CRP, WBC
MRI best imaging

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94
Q

What do you see on an MRI for diskitis?

A

Disk collapse, irregular vertebral bodies

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95
Q

Epidural abscess

A

Can complicate diskitis

Increased neuro signs
-cord compression, so weakness, numbness, and radicular pain

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96
Q

Lemierre syndrome

A

Suppurrative thrombophlebitis of the jugular vein

Clot in setting of bacteremia

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97
Q

Typical bacteria for lemierre syndrome

A

Oral flora, usually fusobacterium

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98
Q

Osteomyelitis from Tb

A

Prolonged monoarticular arthritis

Send synovial fluid for AFB cx

Pott disease- spinal TB, months of back pain

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99
Q

Sickle cell disease with osteomyelitis

A

Salmonella is most common pathogen, microinfarcts in gut cause leakage, bony infarcts are setting for infection

Long bones

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100
Q

Osteosarcoma

A

Persistent bone pain, often epiphyseal

Rare, usually under 20 or over 65

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101
Q

Ewing sarcoma

A

1/3 of bony cancers effecting kids

Femur and pelvis most commonly

Fever and weight loss common here

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102
Q

Ewing sarcoma imaging

A

Moth eaten, finely destructive lesions

Onion skinning also seen

Soft tissue mass

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103
Q

Essential treatment for ewing sarcome

A

Radiation

104
Q

Scapular winging

A

Damage to long thoracic nerv

105
Q

Impingement syndrome definition

A

Inflamed subacromial bursa and related tendons

106
Q

Impingement syndrome presentation

A

Pain with overhead motion

Anterolateral pain, instability, decreased active ROM

107
Q

Impingement syndrome exam

A

Positive neer/hawkins test

Greater pain with at least 90 degrees abduction

108
Q

Best imaging for impingement syndrome

A

MRI

109
Q

Frozen shoulder phases

A

Inflammatory- very painful shoulder without trauma

freezing- pain decreases, joint stiffens

thawing- slow recovery of motion over a year

110
Q

Frozen shoulder related conditions

A

Endocrine disorders, especially diabetes

111
Q

Rotator cuff muscles

A

Subscapularis
Supraspinatus
Infraspinatus
Teres minor

112
Q

Rotator cuff tear presentation

A

Weakness, catching, grating, especially when raising arm overhead

Chronic shoulder pain for several months

113
Q

Rotator cuff tear physical exam

A

Back of shoulder appears sunken, indication atrophy of infraspinatus

Active ROM limited

Tenderness over greater tuberosity

114
Q

Special test for rotator cuff tears

A

Open can test- supraspinatus

Internal and external rotation

115
Q

Treatment for full thickness tears?

A

Surgery for formal repair

116
Q

Caution with steroid injections

A

Only short term relief, may weaken tendon or accelerate tears

117
Q

PT directed exercises

A

Light weight, high reps, don’t push it!

118
Q

Most common direction for shoulder dislocation

A

Anterior (fall or forceful throwing)

119
Q

Shoulder dislocation exam

A

Pain with movement

Joint hypermobility

Numb over deltoid- axillary

120
Q

Special tests for shoulder dislocation

A

Apprehension test

Sulcus sign

Jerk test

121
Q

Complication of clavicle fracture

A

Brachial plexus injury, paresthesias and loss of motor function distally

122
Q

Grade 1 clavicle fracture

A

Middle 1/3, 80% of fractures

123
Q

Floating shoulder

A

Disruption of clavicle and scapula

High energy trauma

Need surgery

124
Q

De quervain’s tenosynovitis

A

Repetitive motion of the tendons of the 1st dorsal compartment causing an inflamed tendon sheath

125
Q

Which tendons are involved in de quervain’s?

A

Extensor pollicis brevis

Abductor pollicis longus

126
Q

De quervain’s presentation

A

Pain in 1st dorsal compartment

Positive finkelstein’s

127
Q

Gamekeeper’s thumb aka skier’s thumb

A

Acute valgus force to the thumb, ruptured/sprained ulnar collateral ligament

Can be associated with an avulsion fracture

128
Q

Test with gamekeeper’s thumb

A

Laxity with stress test (stress on the UCL)

129
Q

Gamekeeper’s thumb treatment

A

Needs surgery asap!

130
Q

Ganglion cyst

A

Benign tumor near a joint or tendon sheath

Leaking out of synovial fluid

131
Q

Ganglion cyst presentation

A

Mass, usually asymptomatic

Rubbery and subq

Pain from compression on nearby nerve

132
Q

Carpal tunnel syndrome

A

Compression neuropathy of median nerve

133
Q

Positive exams for carpal tunnel syndrome

A 
Tinel's
Phalen
Median nerve compression
Thenar wasting
2 point discrimination
134
Q

What is the workup for carpal tunnel?

A

EMG to make sure there is not impingement higher up in the arm

135
Q

Treatment for carpal tunnel

A

Cock up wrist splint

Surgical release

136
Q

Nursemaids elbow

A

Most common elbow injury in kids less than 5

Slipping of radial head from annular ligament

137
Q

Nursemaid’s elbow presentation

A

Child doesn’t use affected arm

Hold their elbow flexed and close to body

No swelling or point tenderness

138
Q

What muscle types attach to the lateral epicondyle?

A

Extensors and supinators

139
Q

Which muscle types attach to the medial epicondyle?

A

Flexor and pronators

140
Q

Epicondylitis

A

Repetitive use of wrist extensors or flexor, tendinopathy at the numeral epicondyle

141
Q

Epicondylitis presentation

A

Pain just distal to the involved epicondyle

Pain with resisted muscle contraction

Normal elbow ROM

142
Q

Epicondylitis treatment

A

Cock up wrist splint

Steroid injection

Surgical release

143
Q

Metacarpal fracture

A

Loss of knuckle prominence

Axial load, distal fragment usually angulated volarly

144
Q

What kind of splint does a boxer’s fracture need?

A

Ulnar gutter splint

145
Q

Scaphoid fracture mechanism

A

Usually FOOSH

Most commonly fractured carpal bone

Blood supply enters distally, proximal fractures are more at risk for non-union or avascular necrosis

146
Q

Scaphoid fracture presentation

A

Tenderness in the anatomical snuffbox

147
Q

What kind of splint does a scaphoid fracture need?

A

Thumb spica splint

148
Q

Colles fracture

A

Type of distal radial fracture, extension of the distal portion of the fracture

149
Q

Smith’s fracture

A

Distal radial fracture, distal part of fracture flexes

150
Q

What kind of splint does a distal radial fracture need?

A

Sugar tong splint

151
Q

Supracondylar fracture presentation

A

Swelling with pain

As swelling decreases, may be confused with posterior elbow dislocation

Fat pad posteriorly! Highly suggestive

152
Q

De quervain’s tenosynovitis mechanism

A

Repetitive motion of the tendons in the 1st dorsal compartment

Inflamed tendon sheath

EPB and APL

153
Q

De quervain’s tenosynovitis presentation

A

Repetitive use of wrist or thumb

Swelling, pain, crepitus

Finkelsteins test

154
Q

Gamekeeper’s thumb mechanism

A

Acute valgus force to the thumb resulting in a ruptured ulnar collateral ligament

Can have associated avulsion fracture

155
Q

Gamekeeper’s thumb presentation

A

Pain, swelling, ecchymosis

Stress test, laxity in the UCL

**needs surgery asap

156
Q

Ganglion cysts mechanism

A

Benign tumor near a joint or tendon sheath

Leaking out of synovial fluid

157
Q

Ganglion cyst presentation

A

Mass, usually asymptomatic

Rubbery

Pain from compression on nearby nerve

158
Q

Carpal tunnel syndrome mechanism

A

Compression neuropathy of median nerve

Repetitive use, inflammation, ischemic injury to nerve

159
Q

Carpal tunnel syndrome presentation

A

Pain, paresthesias in median nerve distribution, hand weakness

Tinel sign, phalen sign, median nerve compression, thenar wasting, 2 point discrimination

160
Q

Nursemaid’s elbow

A

Traction on distal radius with elbow extended- slipping of the radial head from the annular ligament

161
Q

Nursemaid’s elbow presentation

A

Child doesn’t use affected arm

Hold elbow flexed, close to trunk

No swelling or point tenderness

162
Q

Extensors and supinators are…

A

Lateral

163
Q

Flexor and pronators are…

A

Medial

164
Q

Epicondylitis

A

Tendinopathy at the humeral epicondyles

165
Q

Epicondylitis presentation

A

Pain just distal to involved epicondyle

Pain with resisted muscle contraction

Normal elbow ROM

166
Q

Epicondylitis treatment

A

Cock up wrist splint

167
Q

Metacarpal fractures

A

Striking an object with a closed fist, axial load

Loss of knuckle prominence

168
Q

Treatment of metacarpal fracture

A

Ulnar gutter splint, splinted at 50 degrees of flexion to keep ROM

169
Q

Scaphoid fractures

A

Blood supply enters distally, proximal fractures are more at risk for non union or avascular nerosis

170
Q

Scaphoid fracture presentation

A

Tenderness in the anatomic snuffbox

171
Q

Scaphoid fracture traetment

A

Thumb spica splint

172
Q

Radial inclination

A

Angle formed between a line drawn through the tip of the radial styloid and the medial corner of the lunate facet, intersected with a line drawn perpendicular to the long axis of the radius

Normal is 22-23 degrees

173
Q

Smith’s fracture

A

Flexion fracture of the radius

174
Q

Colle’s fracture

A

Extension fracture of the radius

175
Q

Sugar tong splint

A

Colle’s fracture, forearm fracture

176
Q

Supracondylar fracture

A

Swelling, may be confused with dislocation

Posterior fat pad sign

177
Q

Acute back pain

A

< 6 weeks

178
Q

Chronic back pain

A

> 3 months

179
Q

Pain from the spine rarely goes…

A

Below the knee, without the radicular component

180
Q

Red flags

A 
Numbness
Weakness
Saddle anesthesia
Loss of anal sphincter tone
Bowel or bladder dysfunction

And way more!

181
Q

Testing L4

A

Heel walking

182
Q

Testing L5

A

Toe dorsiflexion

183
Q

Testing s1

A

Toe walking

184
Q

L4 dermatome

A

Medial calf/ankle

Patellar reflex

185
Q

L5 dermatome

A

Dorsal foot and 1st web space

186
Q

S1 dermatome

A

Plantar and lateral foot

Achilles reflex

187
Q

Straight leg raise test

A

Radiation past knee suggests l4-s1 nerve root irritation

188
Q

Crossed straight leg raise test

A

Opposite leg raise inducing pain on the affected side, more specific

189
Q

Upper motor neuron signs

A

Babinskis sign
Clonus
Hoffmann’s sign

190
Q

Lumbar strain

A

Injury to lunar intrinsic musculature

Mechanical overload

191
Q

Lumbar strain presentation

A

Acute onset of pain

No neuro complaints

Decreased ROM, sometimes sharp pain on movement but usually dull ache

Spasm

192
Q

Disc herniation f

A

Most common levels in lumbar- l4-s1
Cervical- c5-c7

Posterolateral is the mos common way for it to herniated

193
Q

Degenerative disc disease

A

Breakdown of intervertebral discs

Seen in conjuction with osteoarthritis

Back pain or radicular pain of impingement of nerve root

194
Q

Spinal stenosis

A

Narrowing of the spinal canal or foramen

Can lead to impingement/compression on the nerve or nerve root leading to back pain or radiculopathy

195
Q

Spinal stenosis presentation

A

Pain, numbness, tingling, often bilateral

Shopping cart sign (relieved by bending over)

196
Q

Neurogenic claudication

A

Symptoms with walking and standing

Variable walking distance

Relief with sitting and flexion

Pulses are all okay

197
Q

What is the most common ankle injury?

A

Sprain

198
Q

Strain

A

Stretching or tearing of muscle or tendon

199
Q

Sprain

A

Stretching or tearing of ligament

200
Q

What is the most common mechanism for an ankle sprain?

A

Inversion

201
Q

Most common ligament to be sprained in inversion?

A

Anterior talofibular ligament

202
Q

With a medial ankle sprain, what ligament is effected?

A

Medial deltoid ligament

Eversion

203
Q

Grade 1 sprain

A

Micro tear

Minimal swelling

No joint instability

Fully or partial weight bearing

204
Q

Hopkin’s test

A

Squeeze test

Help identify syndesmotic injury by compressing fibula against tibia at mid calf level

205
Q

Ottawa ankle rules

A

X ray an ankle if there is pain at:
Lateral of medial malleolus
Inability to bear weight

206
Q

Mortise x ray

A

Shows medial clear space

Between lateral border of medial malleolus and medial talus

<4mm is normal, greater than that is lateral talus shift

207
Q

High ankle sprain

A

Syndesmosis injury

Dorsiflexion and eversion injury with internal rotation of tibia

208
Q

Maisonneuve fracture

A

Proximal fibular fracture coexisting with a medial malleolus fracture or disruption of deltoid ligament

Associated with partial or complete disruption of the syndesmosis

209
Q

Trimalleolar fracture

A

Medial and lateral malleolus with posterior tibia involvement

210
Q

Weber A

A

At level of epiphyseal plate fibular fracture

211
Q

Weber B

A

Oblique fracture of fibula communicating distally with epiphyseal plate

212
Q

Weber C

A

Upper fibular fracture

213
Q

Pilon fracture

A

Tibial plafond fracture due to axial load

High velocity trauma

214
Q

Plantar fasciitis

A

Degenerative change of plantar fascia

Repetitive micotrauma. And collagen degeneration of plantar fascia

215
Q

Plantar fasciitis presentation

A

Pain worse with first few steps in the morning

Pain with excessive walking

Pain with dorsiflexion

216
Q

Morton’s neuroma

A

Benign neuroma of an intermetatarsal plantar nerve, most commonly 2nd and 3rd intermetatarsal spaces

Nerve entrapment of fibrous tissue around the nerve

217
Q

Morton’s neuroma presentation

A

Pain weight bearing

Complaint of walking on marble or rock

Numbness or tingling in the toes

218
Q

Calcaneal fractures

A

Compression fracture from high velocity

219
Q

Calcaneal fracture presentation

A

Pain, swelling, ecchymosis at bottom of heel aka mondor sign

220
Q

Mondor sign

A

Associated with calcaneal fracture, hematoma extending to sole of the foot

221
Q

Avascular necrosis risks

A

Hip fracture

Steroid use

Alcohol use

222
Q

Avascular necrosis manifestations

A

Groin or thigh pain, buttock pain

Weight bearing or movement pain

Pain at rest or at night

223
Q

Avascular necrosis imaging finding

A

Crescent sign

224
Q

Avascular necrosis treatment

A

Bed rest, partial weight bearing

Extracorporeal shock wave therapy

Hyperbaric oxygen

225
Q

Developmental dysplasia of the hip

A

Teratologic dyslocation (usually with neuromuscular disorder)

Typical dislocation, before or after birth

Associated with breech presentation, postnatal positioning, torticollis, matatarsus adductus, club foot

226
Q

DDH presentation

A

Ligament laxity that persists a few months into life

Asymmetrical skin folds

Galeazzi sign (shortened femur)

227
Q

Barlow and ortolani test

A

DDH

Barlow- displace unstable hip

Ortolani- relocate displaced hip

228
Q

Klisic test

A

DDH

Line drawn from greater trochanter through ASIS should point to umbilicus

229
Q

Imaging for DDH

A

Ultrasound

Femoral head doesn’t ossify for 4-6 months so an x ray will miss this

230
Q

DDH treatment

A

Pavlik harness providing flexion and limiting adduction

Hip spica cast with 6 months if pavlik fails

Surgery if all else fails

231
Q

Legg calve perthes disease

A

Idiopathic avascular necrosis of capital epiphysis of femoral head, leads to flattening of the bone

Associated with hypercoagulable state

232
Q

Legg calve perthes imaging

A

Radionucleotide bone scan better for early disease

233
Q

SCFE

A

Orthopedic emergency

Obesity is the biggest risk factor

234
Q

Stable SCFE

A

Antalgic gait

Limit time on affected leg to minimize pain, lurch of trunk

235
Q

Klein’s sign

A

Line along upserior edge of femoral neck, should pass through femoral head.

If it doesn’t, SCFE

236
Q

Trochanteric bursitis

A

Gait disturbance is most common cause

Lateral hip pain worse with pressure, patients rub their hip

Normal ROM

237
Q

Hip fracture

A

Increasing frequency in elderly

Significant mortality

Half of patients with fx cannot return to independent living

238
Q

Hip fracture presentation

A

Groin pain

Non wt bearing

Positive trendelenburg

239
Q

Discoid lateral meniscus

A

Meniscus are typically semilunar

Discoid meniscus is less mobile

Displaces with flexion

240
Q

Discoid lateral meniscus presentation

A

Pain, swelling

Widened joint space

241
Q

Osteochondritis dessicans

A

Vascular insult causes cartilage to separate from bone

Older pts usually need surgery

242
Q

Osgood. Schlatter disease

A

Common after growth spurt

Micro fx or avulsion of tibial tuberosity with quad contraction

Pain during or after activity, pain and swelling over tubercle

243
Q

Patellofemoral disorder

A

“Runner’s knee”

Anterior knee pain

Repetitive motion, pain worsens with activity or soreness after sitting for a long time

244
Q

Patellofemoral disorder diagnosis

A

Apprehension sign with lateral deviation of patella

Patellar grind test

Lateral deviation or tilting of patella on XR

245
Q

Most common patellar dislocation

A

Usually lateral

246
Q

Patellar fracture

A

Usually traumatic

Difficulty or inability to extend knee or ambulate

247
Q

Patellar tendon rupture.

A

Abrupt onset of severe pain

Athletes

Proximally displaced patella

Imcomplete extensor function

248
Q

Popliteal cyst

A

Baker’s cyst

Distension of bursae along posterior knee

May spontaneously resolve

Can precipitate DVT

249
Q

IT band syndrome

A

Bursitis caused by tightness of IT band and overuse

250
Q

Mesicus injury presentation

A

Catching or locking sensation due to meniscal fragment

Tenderness along joint line

251
Q

Meniscal tests

A

Mcmurray and. Thessaly

252
Q

Better test for ACL?

A

Lachman (over anterior drawer)

253
Q

Segond fracture

A

Pathognomonic for ACL tear

254
Q

Posterior cruciate ligament tear

A

Sag sign

Posterior drawer test

PCL injury generally from significant trauma, neurovascular exam is key

255
Q

Most common injured ligament of the knee? Mechanism?

A

MCL- valgus stress to flexed knee

256
Q

LCL tear

A

Medial blow to knee

Clin Med (7 decks)

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