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Differential Diagnosis/Imaging > Exam III > Flashcards

Exam III Flashcards

1
Q

Peptic ulcer referral pattern

A

right shoulder, lateral border, right scapula

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2
Q

Myocardial ischemia referral pattern

A

left or right shoulder and down arm (L>R)

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3
Q

Thoracic aorta aneurysm referral pattern

A

left shoulder or between shoulder blades

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4
Q

Hepatic /biliary: Acute cholecystitis referral pattern

A

right shoulder, in between scapula, right subscapular area

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5
Q

Gallbladder referral pattern

A

right upper trap, right shoulder

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6
Q

liver disease (hepatitis, cirrhosis, metastatic tumor, abscess) referral pattern

A

right shoulder, right subscapular

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7
Q

Pulmonary (pleurisy, pneumothorax, Pancoast tumor, pneumonia) referral pattern

A

Ipsilateral shoulder, upper trap

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8
Q

Kidney referral pattern

A

Ipsilateral shoulder

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9
Q

Gynecologic: Endometriosis referral pattern

A

Reported in right shoulder, possible in either shoulder depending on location of cysts

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10
Q

Internal bleeding: spleen rupture or trauma, post-op laparoscopy referral pattern

A

Left shoulder (Kehr’s sign)

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11
Q

Pancreas referral pattern

A

Left shoulder

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12
Q

infectious mononucleosis (hepatomegaly, splenomegaly) referral pattern

A

left shoulder/left upper trap

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13
Q

Gynecologic: Ectopic pregnancy

A

ipsilateral shoulder

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14
Q

Diaphragmatic Irritation

A

Irritation of the peritoneal (outside) or pleural (inside) surface of the diaphragm refers sharp pain

Central portion—upper trapezius, neck, supraclavicular fossa

Peripheral portion—costal margins and lumbar region

Pain is ipsilateral to area of irritation

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15
Q

Septic arthritis

A

Sudden/severe, warm with swelling and limited ROM, constitutional signs and symptoms

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16
Q

Polymyalgia rheumatica

A

Proximal MUSCLE pain, weight loss, elevated Erythrocyte Sedimentation Rate and C-Reactive Protein

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17
Q

Screening for Scaphoid Fracture

A

Clinical signs

Snuff box tenderness
Scaphoid tubercle tenderness
Longitudinal compression
All 3 present = 100% SN and 74% SP

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18
Q

Cervical ligamentous instabilities with possible cord compromise

A

Can be due to major trauma, history of RA or ankylosing spondylitis, or oral contraceptive use. Symptoms can include long tract neurological signs especially present in more than one extremity. Also can include dizziness, nystagmus, vertigo, clonus, or positive babinski’s sign.

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19
Q

Cervical and shoulder girdle peripheral entrapment neuropathies

A

Can present as paresthesias and pain present at rest and possibly with retrograde distribution. Muscles innervated can be tender to palpate and muscles and sensory distribution follow specific nerve patterns.

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20
Q

Spinal accessory nerve pathology

A

can be due to history of penetrating injury, direct blow, or stretching of nerve during fall or MVA. Present as asymmetry of the neck line and drooping of the shoulder. Also unable to shrug shoulders.

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21
Q

Axillary nerve pathology

A

Can be in patients >40yo with shoulder dislocation, history of traction or blunt force to shoulder, history of brachial neuritis or quadrilateral space syndrome. Presents with weakness in shoulder abd and flexion and lack of sensation on lateral aspect of upper arm

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22
Q

Long thoracic nerve pathology

A

Identified in players of many sports, serratus anterior weakness with scapular winging and demonstrates loss of scapulohumeral rhythm

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23
Q

Suprascapular nerve pathology

A

Deep and poor localized pain. Can be due to history of fracture of scap, traction injury, or direct compression on nerve by other pathology. Presentation is similar to RCT with wasting of supraspinatus and infraspinatus. Loss of abduction and ext rotation of shoulder

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24
Q

Pancoast’s Tumor

A

Can be in men >50yo with history of smoking. Presents as nagging type pain in the shoulder and along vertebral border of the scapula

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25
Hill-Sachs lesions 
posterolateral humeral head compression fracture, typically secondary to recurrent anterior shoulder dislocations, as the humeral head comes to rest against the anteroinferior part of the glenoid.
26
bankart lesion
* A Bankart lesion is an injury to the anterior-inferior part of the glenoid labrum, the cartilage surrounding the socket of the shoulder joint (glenoid). * It occurs when the shoulder dislocates anteriorly (forward), tearing this part of the labrum and sometimes involving the ligaments.
27
What does the fist view do on x-rays?
widening of the scapholunate interval
28
What does the scaphoid view look like?
Ulnar deviation for best view
29
Gilula 3 Carpal Arcs
1. Proximal curves of the scaphoid, lunate, triquetrum 2. Distal surfaces of the same bones 3. Proximal curves of the capitate and hamate
30
What is the Terry Thomas sign?
separation of scaphoid and lunate bones, >5mm seperation
31
What is a potential risk factor with scaphoid fractures?
Because no blood vessels enter the proximal pole of the scaphoid, a higher incidence of aseptic necrosis and nonunion is noted with fractures on this side of the scaphoid
32
Screening for Scaphoid Fracture
Clinical signs -Snuff box tenderness -Scaphoid tubercle tenderness -Longitudinal compression All 3 present = 100% SN and 74% SP
33
Radial inclination and ulnar variance
refers to the angle formed by the slope of the distal end of the radius as it tilts toward the ulna. Ulnar variance refers to the relative length of the ulna compared to the radius. Normal is considered 21-25 degrees. Neutral ulnar variance: when both bones are of similar length. Positive ulnar variance: when the ulna is slightly longer than the radius. Negative ulnar variance: when the ulna is shorter than the radius.
34
Gamekeeper's fracture
also known as a skier's thumb, is a specific injury to the ulnar collateral ligament (UCL) of the thumb, often associated with an avulsion fracture at the base of the proximal phalanx (thumb bone). It typically occurs when the thumb is forcefully abducted, such as when falling on an outstretched hand while gripping a ski pole (hence the name "skier's thumb").
35
Bennett Fracture
fracture of the base of the first metacarpal, typically occurs by blunt trauma or forceful axial load through the thumb
36
Rolando Fracture
 is a three-part or comminuted intra-articular fracture-dislocation of the base of the thumb (proximal first metacarpal). It can be thought of as a comminuted Bennett fracture.
37
Keinbock's disease
avascular necrosis of the lunate. usually found in the dominant wrist of males 20-40 yo. It can be due to repetitive microtrauma of the lunate and also linked to negative ulnar variance. MRI is most sensitive to see these changes.
38
Children ossification centers for wrist
Capitate: 1-3 months Hamate: 2-4 months Triquetral: 2-3 years Lunate: 2-4 years Scaphoid: 4-6 years Trapezium: 4-6 years Trapezoid: 4-6 years Pisiform: 8-12 years 2ndary ossification centers: Metacarpal heads fuse at 14-19 Phalangeal bases fuse at 14-19
39
Radial head fracture
Can be due to fall onto outsretched arm that is supinated. Presents as anterolateral pain and tenderness at the elbow, inability to supinate or pronate forearm.
40
Distal radius (colles) fracture
Can be due to fall on outstretched arm with forceful wrist extension, age >40 (women>men), history of osteoporosis. Wrist swelling and wrist extension is painful
41
Scaphoid fracture
Fall onto outstretched arm, wrist swelling, pain in anatomical snuff box
42
Lunate fracture or dislocation
fall onto outstretched arm, generalized wrist swelling and pain, decreased motion, and decreased grip strength (can be used to rule out capitate fracture)
43
TFCC tear
Traumatic fall on outstretched arm with forearm pronated, commonly associated with colles fracture, ulnar sided wrist pain, tenderness, and clicking. grip strength weakness
44
Long flexor tendon rupture
Histroy of RA, corticosteroid use, or trauma. Grade 1 and 2 presents with local tenderness, swelling, pain with motion. Grade 3 presents with total loss of motion and palpable defect in muscle
45
Space infection of the hand
Recent puncture of skin or insect bite. Presents as inflammation, swelling in palm, dorsum of hand, or finger tips
46
Raynaud's phenomenon
PMH of RA, occulsive vascular disease, smoking or betablockers. Presents as hands or feet that blanch, go cyanotic and then red when exposed to cold or emotional stress. Also can have pain or tingling
47
CRPS
Can be result of trauma or surgery, pain does not respond to typical analgesics. Presents as severe aching, stinging, cutting, or boring pain that is not typical of injury, hypersensitivity. Area swollen and warm and red
48
CRITOE of elbow
Capitulum: 1-3yo Radial head 5-7yo Internal (medial) Epicondyle: 5-7 yo Trochlea 9-11 yo Olecranon 9-11 yo External epicondyle 10-12yo
49
What is the T sign
indicative of a UCL tear, trauma to elbow should be screened with valgus stress test
50
Monteggia's fracture
fracture of the proximal third of the ulna with dislocation of the radial head, caused by foosh injury with forearm in hyperpronation
51
Osteochondritis Dissecans (OCD) of the capitulum
Injury to the joint surface, a seperation of a piece of cartilage and subchondral bone from the articular surface. Presents in adolescent athletes with open grwoth plates. Presents as dull pain, joint swelling, perhaps locking. Due to repetitive valgus compressive forces on the medial side of the joint.
52
Nightstick fracture
fracture to midportion of the ulna, usually from a direct blow
53
Galeazzi Fracture
fracture of distal radius and corresponding dislocation of the ulnar head from wrist
54
Colles fracture
Fracture of the distal radius, consists of fracture of the distal radial metaphyseal region with dorsal angulation and impaction (dinner fork), but without involvement of the articular surface. FOOSH injury
55
Smith's fracture
Also referred to ask reverse colles fracture, tends to be more unstable than colles fracture. Tends to displace towards palm
56
Coxa valga
Increased risk for hip dislocation
57
Coxa vara
increased risk for femoral neck fracture and SCFE
58
False-positive view
Anterior coverage of the femoral head can be assessed. It can diagnose CAM deformitity.
59
Dunn View
evaluates relationship of the femoral head and acetablum
60
FAI with labral tear
Mechanical pathology because of the abutment of the femoral neck with the acetablum. labrum is vulnerable due to altered joint arthrokinematics. Presents as snapping, clicking, limited hip ROM, and pain at end ranges of flexion or extension. Hip locking is associated with labral tears
61
The radiographic hallmarks of degenerative joint disease at the hip joint include the following
-Joint space narrowing -Sclerotic subchondral bone -Osteophyte formation at the joint margins -Cyst or pseudocyst formation -Migration of the femoral head
62
Avascular/Aseptic Necrosis: Radiographic Findings
Can be distinguished from OA by the normal preservation of the joint space, the crescent sign appears parallel to the superior rim of the femoral head. This represents the collapse of the necrotic subchondral bone of the femoral head
63
Aseptic Necrosis risk factors
Anemia Steroids Ethanol Pancreatitis Trauma Idiopathic Caisson’s Disease
64
Legg Calve Perthes Disease
Pediatric impairment. Necrosis of the epiphysis of the femoral head (7y/o), most common between 4-8 y, permanent deformity - OA Symptoms include limping, pain, stiffness, and decreased hip ROM
65
Slipped Capital Femoral Epiphysis
Most common adolescent hip disorder, weakening of the epiphyseal plate allows for displacement. Vague pain in hip and knee, limited motion especially in IR, antalgic gait, and limb length shortening. Onset is insidious and can coincide with growth spurts at puberty.
66
Developmental Dysplasia (DDH)
malformation of the hip in young children beginning to walk, usually affects left hip, more predomiant in girls, genetic and hormonal
67
Unstable pelvic fracture
Two or more articulation sites on the pelvic ring are disrupted.
68
In stable/alert trauma patient, a thorough clinical examination will detect pelvic fractures with nearly 100% sensitivity. What is the criteria?
Criteria: All must be present = initial radiograph unnecessary. Age: > 3 yrs No impairment of consciousness No other major distracting injuries No complaint of pelvic pain No signs of fracture on inspection Painless compression of iliac or pubic symphysis Pain free hip rotation and flexion

Differential Diagnosis/Imaging (4 decks)

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