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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
Q

Hill-Sachs lesions

A

posterolateral humeral head compression fracture, typically secondary to recurrentanterior shoulder dislocations, as the humeral head comes to rest against the anteroinferior part of the glenoid.

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26
Q

bankart lesion

A
  • 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.
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27
Q

What does the fist view do on x-rays?

A

widening of the scapholunate interval

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28
Q

What does the scaphoid view look like?

A

Ulnar deviation for best view

29
Q

Gilula 3 Carpal Arcs

A
  1. Proximal curves of the scaphoid, lunate, triquetrum
  2. Distal surfaces of the same bones
  3. Proximal curves of the capitate and hamate
30
Q

What is the Terry Thomas sign?

A

separation of scaphoid and lunate bones, >5mm seperation

31
Q

What is a potential risk factor with scaphoid fractures?

A

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
Q

Screening for Scaphoid Fracture

A

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

33
Q

Radial inclination and ulnar variance

A

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
Q

Gamekeeper’s fracture

A

also known as askier’s thumb, is a specific injury to theulnar 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
Q

Bennett Fracture

A

fracture of thebase of the first metacarpal, typically occurs by blunt trauma or forceful axial load through the thumb

36
Q

Rolando Fracture

A

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 comminutedBennett fracture.

37
Q

Keinbock’s disease

A

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
Q

Children ossification centers for wrist

A

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
Q

Radial head fracture

A

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
Q

Distal radius (colles) fracture

A

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
Q

Scaphoid fracture

A

Fall onto outstretched arm, wrist swelling, pain in anatomical snuff box

42
Q

Lunate fracture or dislocation

A

fall onto outstretched arm, generalized wrist swelling and pain, decreased motion, and decreased grip strength (can be used to rule out capitate fracture)

43
Q

TFCC tear

A

Traumatic fall on outstretched arm with forearm pronated, commonly associated with colles fracture, ulnar sided wrist pain, tenderness, and clicking. grip strength weakness

44
Q

Long flexor tendon rupture

A

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
Q

Space infection of the hand

A

Recent puncture of skin or insect bite. Presents as inflammation, swelling in palm, dorsum of hand, or finger tips

46
Q

Raynaud’s phenomenon

A

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
Q

CRPS

A

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
Q

CRITOE of elbow

A

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
Q

What is the T sign

A

indicative of a UCL tear, trauma to elbow should be screened with valgus stress test

50
Q

Monteggia’s fracture

A

fracture of the proximal third of the ulna with dislocation of the radial head, caused by foosh injury with forearm in hyperpronation

51
Q

Osteochondritis Dissecans (OCD) of the capitulum

A

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
Q

Nightstick fracture

A

fracture to midportion of the ulna, usually from a direct blow

53
Q

Galeazzi Fracture

A

fracture of distal radius and corresponding dislocation of the ulnar head from wrist

54
Q

Colles fracture

A

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
Q

Smith’s fracture

A

Also referred to ask reverse colles fracture, tends to be more unstable than colles fracture. Tends to displace towards palm

56
Q

Coxa valga

A

Increased risk for hip dislocation

57
Q

Coxa vara

A

increased risk for femoral neck fracture and SCFE

58
Q

False-positive view

A

Anterior coverage of the femoral head can be assessed. It can diagnose CAM deformitity.

59
Q

Dunn View

A

evaluates relationship of the femoral head and acetablum

60
Q

FAI with labral tear

A

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
Q

The radiographic hallmarks of degenerative joint disease at the hip joint include the following

A

-Joint space narrowing
-Sclerotic subchondral bone
-Osteophyte formation at the joint margins
-Cyst or pseudocyst formation
-Migration of the femoral head

62
Q

Avascular/Aseptic Necrosis: Radiographic Findings

A

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
Q

Aseptic Necrosis risk factors

A

Anemia
Steroids
Ethanol
Pancreatitis
Trauma
Idiopathic
Caisson’s Disease

64
Q

Legg Calve Perthes Disease

A

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
Q

Slipped Capital Femoral Epiphysis

A

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
Q

Developmental Dysplasia (DDH)

A

malformation of the hip in young children beginning to walk, usually affects left hip, more predomiant in girls, genetic and hormonal

67
Q

Unstable pelvic fracture

A

Two or more articulation sites on the pelvic ring are disrupted.

68
Q

In stable/alert trauma patient, a thorough clinical examination will detect pelvic fractures with nearly 100% sensitivity. What is the criteria?

A

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 (3 decks)

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