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Clin Med II - Exam 2 > Jaynstein - UE Topics in MSK > Flashcards

Jaynstein - UE Topics in MSK Flashcards

1
Q

what condition is caused by necrosis of bone dt interruption of blood supply

A

avascular necrosis

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2
Q

name 3 rf for avascular necrosis

A

etoh

coag d.o

steroids

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3
Q

what 3 bones are most commonly associated w. avascular necrosis

A
  1. head of femur or humerus
  2. scaphoid
  3. neck of talus
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4
Q

what is the 2 earliest sx of avascular necrosis

A
  1. pain w. activity/weight bearing
  2. decreased ROM
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5
Q

what is this sign and what is it associated with

A

crescent sign

avascular necrosis

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6
Q

what is the problem w. xrays in avascular necrosis

A

early xrays may be normal → late dx

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7
Q

what is the soc dx for avascular necrosis

A

advanced imaging → CT, MRI, bone scan

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8
Q

what is the first step in tx for avascular necrosis

A

ortho referral for all

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9
Q

what is the first step in suspected avascular necrosis if they have a negative work up

A

ortho referral for all!

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10
Q

you should treat all scaphoid avascular necrosis as if

A

it were broken

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11
Q

what is the tx for hip/shoulder avascular necrosis

A

almost all require replacement

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12
Q

what is the tx for scaphoid avascular necrosis

A

attempt to surgically restore blood flow →

debride and realign

OR

bone graft

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13
Q

__ accounts for 80-90% of osteomyelitis cases

A

s. aureus

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14
Q

what GI bacteria are associated w. osteomyelitis

A

e.coli

pseudomonas

klebsiella

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15
Q

what bacteria is associated w. osteomyelitis in ssa pt’s

A

salmonella

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16
Q

what 2 bacteria are associated w. osteomyelitis in neonates

A

h.flu

gbs

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17
Q

what lab values will be elevated in osteomyelitis

A

acute phase reactants

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18
Q

in osteomyelitis, ca, phos, and alk phos will usually be

A

normal

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19
Q

what will you see on xray of osteomyelitis (4)

A
  1. sts (soft tissue swelling)
  2. periosteal elevation
  3. cortical erosion
  4. lysis

→ bone necrosis

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20
Q

what is the problem w. xray for osteomyelitis

A

bone changes lag infxn by 14 days

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21
Q

__% of bone demineralization may have already occurred in osteomyelitis pt before it is seen on xray

A

30-50%

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22
Q

what is the first choice of imaging for osteomyelitis

A

MRI

CT is also helpful

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23
Q

what are 4 rf for osteomyelitis

A

kids

IVDU

DM

SSA

hardware

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24
Q

osteomyelitis is most common in

and >__ yo

A

<20

>50

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25
Q

what 2 bones are most commonly affected in osteomyelitis

A

long bones

vertebral bodies

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26
Q

what is the mc affected bone in dm w. osteomyelitis

A

toes/feet

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27
Q

what osteo condition do you think of when you see a pt who looks systemically ill w. malaise, f/c, leukocytosis, throbbing pain, and an open wound

A

osteomyelitis

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28
Q

what is the curative tx for osteomyelitis

A

abx + surgical drainage

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29
Q

what % of acute osteomyelitis infxns become chronic

A

5-25%

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30
Q

what 2 pt populations are at risk for chronic osteomyelitis

A

dm

immunocompromised

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31
Q

in osteomyelitis, ideally you begin abx tx after

A

c&s

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32
Q

what are 3 empiric abx choices for osteomyelitis

A
  1. Vanco + Ceftriaxone
  2. Cipro
  3. Cefepime
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33
Q

when should you tx a dm foot ulcer

A

if bone is visible

OR

if you can contact bone w. sterile probe

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34
Q

what are 4 complications of osteomyelitis

A
  1. pathologic fx
  2. endocarditis
  3. sepsis
  4. amputation
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35
Q

what is a benign bone lesion/slow growing tumor of little significance

A

osteoma

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36
Q

what are the 2 mc bones affected in osteoma

A

facial bones (nasal, ear)

skull

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37
Q

what do you think when you see exophytic growths attached to bone surface

A

osteoma

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38
Q

osteoomas are usually found

A

incidentally → xray or exam

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39
Q

what is the tx for osteoma

A

wait and see

vs

bx → if concern for malignancy

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40
Q

what do you call aggressive malignant, mesenchymal tumor of cancerous cells in the bone matrix

A

osteosarcoma

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41
Q

what is the mc bone cancer in kids

A

osteosarcoma

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42
Q

__% of osteosarcoma is in kids < 20 yo

A

75%

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43
Q

what are the 2 mc bones affected in osteosarcoma

A

long bones

jaw

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44
Q

what do you think when you see atraumatic bone pain and painful, progressively enlarging masses on the long bones or jaw

A

osteosarcoma

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45
Q

__% of osteosarcoma pt’s have mets at dx

A

20%

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46
Q

how do you describe the masses in osteosarcoma

A

endophilic

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47
Q

what imaging should you strongly consider when you dx osteosarcoma

A

CXR → evaluate for pulmonary mets

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48
Q

what is the tx for osteosarcoma (3)

A
  1. surgical excision
  2. XRT
  3. chemo
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49
Q

what is a hereditary condition that involves benign cartilage growth attached to underlying skeleton by a stalk

A

osteochondroma

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50
Q

what is the mc location for osteochondroma

A

metaphysis of long tubular bones

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51
Q

osteochondroma can be __

or __

A

solitary

multiple

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52
Q

osteochondromas are usually diagnosed

A

incidentally

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53
Q

what is the second mc malignancy in kids

A

ewing sarcoma

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54
Q

what are the 2 mc sites for ewing sarcoma

A

pelvis

proximal ends of long bones

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55
Q

what do you think when you see a kid with pain and inflammation around the head of the humerus, w. associated fever

A

ewing sarcoma

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56
Q

name 3 common lab findings in ewing sarcoma

A
  1. elevated ESR
  2. anemia
  3. leukocytosis
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57
Q

what do you think when you see onion peel appearance on xray

A

ewing sarcoma

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58
Q

any time you see an endothilic bone growth

A

do a cancer work up

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59
Q

what is the tx for ewing sarcoma

A

chemo + surgery

+/- XRT

60
Q

non uniform joint space narrowing and osteophytes are diagnostic xray findings of

A

osteoarthritis (DJD)

61
Q

osteoarthritis is same same

A

degenerative joint disease (djd)

62
Q

what imaging is necessary for dx of OA besides xray

A

none! → no advanced imaging necessary

63
Q

what is the mc joint dz and arthritis

A

OA (DJD)

64
Q

oa/djd is erosion of articular cartilage related to __

and __

more than __

A

chronic overuse and aging

inflammation

65
Q

what are 4 rf for OA/DJD

A
  1. obesity
  2. h.o trauma
  3. overuse
  4. female
66
Q

a majority of people > 40 yo will have what osteo condition

A

OA/DJD

67
Q

oa is a __ dz

whereas RA is __

A

oa: symmetric
ra: asymmetric

68
Q

what are the most common locations for oa/djd

A

wt bearing joints

spine

69
Q

oa is often described as a deep, achy pain that __ with use

and __ with rest

A

worsens

resolves

70
Q

what do you think of when you see morning stiffness lasting <30 min, crepitus, and limited rom

A

oa/djd

71
Q

tx for oa/djd is

A

symptomatic

72
Q

what is the tx for oa/djd (5)

A
  1. pt/exercise → 1st step
  2. RICE
  3. APAP
  4. NSAIDs
  5. wt loss
73
Q

there is no way to prevent or halt oa/djd, the only true fix is __

A

joint replacement

74
Q

what are heberden’s nodes

A

enlarged DIP → oa/djd

75
Q

what are bouchard’s nodes

A

enlarged PIP → oa/djd

76
Q

what osteo dz is characterized by abnormal type I collagen development

A

osteogenesis imperfecta → aka brittle bone dz

77
Q

how is osteogenesis imperfecta inherited

A

autosomal dominant

78
Q

severity of osteogenesis imperfecta ranges from __

to __

A

1-8

79
Q

what do you think when you see blue sclera, dental imperfections, and multiple bone fx

A

osteogenesis imperfecta

80
Q

is there a cure for osteogenesis imperfecta

A

no

81
Q

what is the tx for osteogenesis imperfecta (3)

A
  1. bisphosphonates → fx prevention
  2. surgery → rodding
  3. tx pain!
82
Q

what is the dx for osteogenesis imperfecta

A

DNA analysis

83
Q

what is primary osteoporosis

A

natural progression

84
Q

what is secondary osteoporosis

A

2/2 to another dz process → MM, pagets, hyperparathyroidism, thyroid dz, nutrition, chronic dz meds

85
Q

osteoporosis is usually asymptomatic; name 3 symptoms if it is not

A
  1. vertebral fx → may be presenting sign
  2. lumbar lordosis
  3. kyphoscoliosis
86
Q

name 6 labs for baseline in osteoporosis

A

CBC

CMP

Ca

phos

TSH

Vit D

87
Q

what is the standard of care dx test for OP

A

DXA w. T score

88
Q

a normal T score of 1 to -1 indicates

A

normal bones

89
Q

a T sore of -1 to -2.5 indicates

A

osteopenia

90
Q

a T score of -2.5 or lower indicates

A

osteoporosis

91
Q

x-rays should not be used for __ in osteoporosis

A

screening

92
Q

what is the problem w. xrays in osteoporosis

A

they do not detect OP until 30-40% loss of bone mass

93
Q

the USPSTF recommends osteoporosis screening with bone measurement testing for what pt populations

A
  1. all women > 65 yo
  2. postmenopausal women < 65 yo at increased risk for osteoporosis based on clinical risk assessment tool
94
Q

what is FRAX

A

Fracture Risk Assessment Tool to predict 10 year risk of fx

95
Q

tx for osteoporosis is recommended for what 5 pt populations

A
  1. FRAX risk for femoral neck fx >3%
  2. FRAX risk for other fx >20%
  3. s/p hip or vertebral fx
  4. T-score < -2.5
  5. osteopenia or femoral, hip, or spine (T-score -1 to -2.5
96
Q

what are 3 tx for osteoporosis

A
  1. address modifiable risk factors → ex smoking, falls, diet
  2. vit D/Ca
  3. bisphosphonates
97
Q

Actonel, Boniva, Fosamax, and Reclast are all

A

bisphosphonates

98
Q

is estrogen recommended as first line therapy for osteoporosis

A

no!

99
Q

what are 2 surgery options for osteoporosis

A

vertebroplasty

kyphoplasty

100
Q

what dz do you think when you see chronic breakdown in bone formation → disorganized bone remodeling → enlarged, misshapen, weak bones

A

paget dz

101
Q

what do you think when you see macrocephaly, bowing, and chalkstick type fx of the legs

A

paget dz

102
Q

when does paget dz typically manifest

A

middle adulthood

103
Q

what is the mc symptom of paget dz

A

pain

also deformity, HA, hearing loss, visual disturbance

104
Q

what are the 4 locations most commonly affected by paget dz

A
  1. skull
  2. spine
  3. pelvis
  4. long bone
105
Q

what lab is elevated in paget dz, and fractures

A

alk phos

106
Q

what are the 2 pharmaceutical tx for paget dz

A

bisphosphonates

calcitonin

107
Q

what dz is characterized by skeletal muscle breakdown and necrosis, and release of intra-cellular debris into the blood

A

rhabdomyolysis

108
Q

name 5 rf for rhabdomyolysis

A
  1. exertion
  2. crush injury
  3. statins!
  4. found down!
  5. hyperthermia
109
Q

always consider rhabdomyolysis in what 2 pt populations

A
  1. found down
  2. unable to get up for extended period of time
110
Q

what do you think when you see tea colored urine

A

rhabdomyolysis

111
Q

besides tea colored urine, what are some other symptoms of rhabdomyolysis

A
  1. muscle pain
  2. weakness/fatigue
  3. leg swelling
  4. low grade fever
  5. confusion
112
Q

what is a distinguishing lab value of rhabdomyolysis

A

creatinine phosphokinase (CPK) > 5x normal → 1,000

113
Q

besides CPK, what other lab values would you see in rhabdomyolysis

A

hyperkalemia

hyperphosphatemia

hypo → hypercalcemia

→ from release of intracellular debris into blood

114
Q

UA dip in rhabdomyolysis will be

A

positive for blood w.o RBC -> can’t distinguish myoglobin from hemoglobin

115
Q

what is the SOC for dx of rhabdomyolysis, but is never really done

A

muscle bx

116
Q

what is the goal of tx in rhabdomyolysis

A

treat shock and preserve kidney fxn

117
Q

what is the main tx for rhabdomyolysis

A

fluid resuscitation!

118
Q

what is the dosing for fluids for rhabdomyolysis

A

6-12 L / 24 hr

119
Q

what is the urine goal for fluid resuscitation in rhabdomyolysis

A

200-300 cc’s urine/hr

120
Q

what should you do if you are fluid resuscitating a rhabdo pt and they develop pulmonary edema

A

diurese them and continue fluids

121
Q

what is the most common soft tissue sarcoma

A

fibrosarcoma

122
Q

what do you think when you see a mass that arises from fat, muscle, bv, fibrous tissue, or any soft tissue

A

soft tissue sarcoma

123
Q

you should do a work up for a soft tissue sarcoma in what 2 instances

A
  1. >5 cm
  2. >4 weeks
124
Q

for soft tissue sarcoma:

SOC:

definitive dx:

CXR:

A

SOC: MRI

definitive dx: bx

CXR: evaluate for mets

125
Q

soft tissue masses can rapidly met to

A

lung

126
Q

fibrosarcomas are more common in

A

kids

127
Q

what is a benign synovial fluid out pouching that often arises post trauma

A

Baker’s cyst - aka popliteal cyst

128
Q

baker’s cysts arise between __

and __ muscles

A

gastric

semimembranous

129
Q

dx for baker’s cyst (popliteal cyst) is __

to rule out __

A

US

DVT

130
Q

what are 4 possible tx for baker’s/popliteal cyst

A
  1. RICE → most self resolve
  2. aspiration
  3. corticosteroid injxn
  4. surgical excision
131
Q

what is a benign synovial joint outpouching that most commonly occurs in the wrist, hands, and feet

A

ganglion cyst - aka bible cyst - aka bible bump

132
Q

what is the tx for ganglion cyst (bible cyst)

A

nothing vs surgical repair → cutoff is 5 cm

133
Q

what are the mc 2 locations for compartment syndrome

A
  1. forearm
  2. calf
134
Q

what is this picture showing

A

compartment syndrome

135
Q

what is the main symptom of compartment syndrome

A

pain out of proportion that is aggravated by passive stretching

→ ex pt on IV pain meds and still screaming in pain

136
Q

what are the 6 p’s of compartment syndrome

A
  1. pain out of proportion
  2. paresthesia
  3. pallor
  4. poikilothermia (cold/blue)
  5. paralysis (late finding)
  6. pulselessness (late finding)
137
Q

what are 5 rf for compartment syndrome

A
  1. trauma (esp lower leg and forearm)
  2. crush injury
  3. burns
  4. electrocution
  5. s/p cast placement
138
Q

compartment syndrome causes

A

ischemia distal to affected compartment

139
Q

what is the dx test for compartment syndrome

A

compartment pressure

140
Q

what is nl for compartment pressure

A

<10 mmHg

141
Q

10-20 mmHg for compartment pressure is

A

concerning

142
Q

what is the emergent value for compartment pressure

A

>30 mmHg

143
Q

what are the 2 steps in tx for compartment syndrome

A
  1. splint → need fully relaxed, low pressure
  2. fasciotomy
144
Q

for compartment syndrome, fasciotomy should be performed if compartment pressure is

A

>30 mmHg

145
Q

what tx should you avoid in compartment syndrome

A

ice! → do NOT want vasoconstriction

146
Q
A
147
Q

what is this xray showing

A

aseptic arthritis

Clin Med II - Exam 2 (14 decks)

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