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Natsumi - NPLEX video Questions > MSK > Flashcards

MSK Flashcards

1
Q

Ankylosing Spondylitis:

A
  • adolescent males

Bony ankylosis of SgI & vertebral processes with severe spinal immobility

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2
Q

Assessment for Achilles tendon injury

A

Ultrasound!

Look for ruptures, swelling, degenerative cysts, calcifications

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3
Q

Assessment for sesamoiditis

A

Sesamoid bone - X-rays and bone scan

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4
Q

Bennett’s Fracture:

A

Fracture through the base of the first (thumb) metacarpal

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5
Q

Bone Scan indication & advantages/disadcantages

A

Indication:
Osteomyelitis
Bony neoplasm or metastases
Occult vertebral Fracture

Advantage:
- Sensitive for bony neoplasm & infection

Disadvantages:
- Non-specific

False positives in 33% older patients (Osteoarthritis)

False negatives:

  • Diffuse bony metastases
  • Multiple Myeloma
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6
Q

Boxer’s Fracture:

A

Fracture of the 5th metacarpal.

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7
Q

Bursitis can be distinguished from an intra-articular process because of the location of pain and the fact that MOVEMENT OF THE JOINT (does/does not) cause discomfort.

A

DOES NOT

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8
Q

Chondrosarcoma:

A

Young or middle aged

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9
Q

Colles’ Fracture:

A

Distal radial fracture posteriorly displaced.

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10
Q

Common fracture seen in athletes at the base of the fifth metatarsal.

A

Jones Fracture

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11
Q

Diagnosis for ankle sprains

  • Imaging
  • Ortho
A

X-ray/stress X-ray → MRI (if inconclusive)

Orthos: Inversion stress, anterior drawer test

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12
Q

Duchenne’s Muscular Dystrophy:

A 
Most common MD of children,
Sex-linked, males,
Muscle replaced by fat / pseudo-hypertrophy of calves
Gower’s Sign+.  
Death by 20 yo commonly.
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13
Q

Effusion results from ??

A

inflammatory arthritis: infection, gout, rheumatoid arthritis.

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14
Q

Ewing’s Sarcoma:

A

Extreme bone pain in younger

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15
Q

Gallium 67 Citrate

A

Bone Scan

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16
Q

Gouty Arthritis

- characteristic

A

Hyperuricemia, uric acid in & around joints

1st MTP, tophi in olecranon, prepatellar, calcaneal tendon, pinna,

Genetic, heavy alcohol use.
(DDX: pseudo-gout: Sn/Sx without increased uric acid).

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17
Q

Grade 2 sprain involves? Grade 3?

A

2: complete tear of anterior talofibular ligament and some damage to the calcaneofibular ligament
3: uncommon, associated with fractures. SURGERY.

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18
Q

Myotonic Dystrophy

A

Most common in adults.

Presents in adolescence with facial atrophy

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19
Q

Osteoarthritis:

A

Tend to be over used joints

Progressive erosion of articular cartilage:

Subchondral cysts, osteophytes, hips, knees, lumbar, cervical,
Herberden’s nodes (osteophytes at DIP),
Bouchard’s nodes (at PIP)

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20
Q

Osteomyelitis:

A
  • Pyogenic dt staph, hematogenous seeding
  • Brodie’s abscess=walled off area of bacteria
    Sinus tracts develop, squamous carcinoma common at sinus tracts

RECURS again in lifetime

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21
Q

Paget’s/Osteitis Deformans

Key characteristics?

A

Paramyxovirus
Lytic mixed with sclerotic areas
Especially skull, bowing of femur/tibia, osteoarthritis,
Pathologic fracture common

Bowing of the long bones, thickening of the flat bones like sklukk = BIG head

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22
Q

Patient with pain under medial aspect of the heel, worse on tip-toeing, early in the morning, and going upstairs.

  • Supplement to help?
A

200,000 IU retinol daily for 2 months

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23
Q

Patient with pain under the medial aspect of the heel, worse on tip-toeing, early in the morning, and going upstairs.

  • Supplement to help?
A

200,000 IU retinol daily for 2 months

24
Q

RA tests

A

ANA, RA, CRP ERP

25
Q

Range of motion of the elbow is usually preserved with inflammatory (bursitis/arthritis)

A

inflammatory bursisitis - ROM is preserved

26
Q

Rheumatoid arthritis

  • which population
  • nodules at ___ joints
  • arthritis at __ or more joints
A

Can have negative RF but sitll have it

  • Collagen-vascular dz
  • females 25-50, RF positive
  • Nodules at the PIP joints
  • Arthritis in 3 or more joints, symmetric in the UE
27
Q

Salter-Harris Fractures applies to?

A

ONLY to children - physis is always involved

28
Q

Scaphoid Fracture:

A

Most common fractured carpal bone, may give rise to avascular necrosis.

Pain in the anatomical snuffbox!

29
Q

Smith’s Fracture:

A

Distal radial fracture anteriorly displaced.

30
Q

Subcapital fracture is a common fracture that may lead to _____. It is located at?

A

A common fracture under the head of the femur that may lead to avascular necrosis.

31
Q

Talus fracture requires __ treatment to avoid ___.

A

Surgery to avoid osteonecrosis

32
Q

Technetium Tc 99m Phosphate

A

Bone Scan

33
Q

Tx for grade 1 sprain

  • Med
  • physiotherapy
A

NSAID

Electrotherapy, strengthening exercises, propreoception (1 legged stand)

34
Q

What is ballotment for?

A

large effusion

Slightly flex the knee which is to be examined.
Place one hand on the supra-pateallar pouch, which is above the patella and communicates with the joint space.

Gently push down and towards the patella, forcing any fluid to accumulate in the central part of the joint.
Gently push down on the patella with your thumb.
If there is a sizable effusion, the patella will feel as if it’s floating and “bounce” back up when pushed down.

35
Q

What is milking for?

A

helpful for detecting small effusions

Gently stroke upwards along the medial aspect of the patella, pushing fluid towards the top and lateral aspects of the joint.

Gently push on the lateral aspect of the joint.
If there’s a small effusion, the fluid which was milked to the lateral aspect will be pushed back towards the medial area of the joint, causing the medial skin to bulge out slightly.

36
Q

Which is more common? ACL or PCL

A

ACL

37
Q

ZZZ: What do you always check for before proceeding to physical medicine?

A

Cancer & infection!

38
Q

Pain starts in the low back and radiates down the buttocks bilaterally, continuing along the backs of both legs.

Symptoms are usually worse with walking and improve when the patient bends forward.

You consider which 2 dx? how do you differentiate?

A

Spinal stenosis = pain resolves very quickly when a person stops walking and assumes an upright position. Peripheral pulses are normal.

True claudication does not

39
Q

Crepitus may be a sign of?

A

degenerative joint disease (DJD).

40
Q

degenerative joint disease (DJD) assessment?

A

X-ray

41
Q

Inflammatory arthropathy labs

A 
ANA + Reflex
ASO
Sed Rate / CRP
Uric Acid - gout 
RF
HLA-B27
Parvo B-19 - IF RA negative
Chlamydia
42
Q

Red flag signs of low back pain

A 
New pain > 50 yo
Fever
Unintentional weight loss
Severe nighttime pain
Worse in supine position
Cancer 
Bowel/bladder incontinence
Immunosuppression
MAJOR motor weakness
43
Q

ZZZ: If patient has significant trauma to the extremity should you order X-ray before proceeding to physical manipulation?

A

YES

44
Q

RF-, HLA B27+

This MSK condition is associated with Patients with UC / Crohn’s (more in UC), after Salmonella / Shigella or Yersinia infection.

Symmetric arthritis of
Knees, Ankles, Wrists, SI Joints.

A

Enteropathogenic Arthritis

45
Q

Heberden’s node is

A

DIP

46
Q

RF-, HLA B27+

A

Psoriatic Arthritis - DIP degeneration

Enteropathogenic Arthritis

Reactive arthritis

47
Q

This MSK condition is male dominant, POST-chlamydia infection. Usually with urethritis / conjunctivitis / asymmetric lower extremity arthritic

A

Reactive arthritis

48
Q

Bouchard’s node is

A

PIP

49
Q

ZZZ: Look for trauma. If not, then look for unilateral involvement and a lot of pain with motion. Then look for??

A

Signs of infection life fever

50
Q

ZZZ: If you have pain in MSK but without trauma, then think?

A

SIGNIFICANT PATHOLOGIES!

- infection, bone cancer

51
Q

Chondrosarcoma

- common population

A

Malignant tumor of cartilage

Pelvis of middle-aged men, shoulders, ribs, painful enlarging mass

Most common primary malignant bone tumor

Can metastasize!

52
Q

Ewing’s Sarcoma:

- common population

A

More common in the young.

Extremely malignant,
Viscous liquid like pus in marrow, sheets of round cells,

Metastatic!

53
Q

Osteosarcoma

- Secondary to which dz in elderly?

A

Primary bone cancer, adolescent males, familial

Secondary to Paget’s in elderly, knee, hip, humerus, jaw.

Destructive, mixed lytic & blastic, lifts periosteum (painful)

Hematogenous spread to lungs, bone, brain.

Second most common primary malignant bone CA.

54
Q

Unilateral joint pain?

Bilateral?

Paired – Wandering?

Mixed / Asymmetric?

A 
Unilateral: 
Infectious
Crystalline
Trauma
HIP: AVN + SCFE

B/L:
RA
Enteropathogenic
Psoriatic

Paired – Wandering:
Post strep (incr. ASO)

Mixed / Asymmetric:
OA (possibly)
Reactive Arthritis

55
Q

Single-Photon Emission Computed Tomography (SPECT)

A

3D bone scan - Lesions of vertebral pedicles suggest malignancy

56
Q

Spondylolysis vs spondylotisthesis

A

Thoracolumbar Spine

Defect in the pars interarticularis, appears as a collar on the “Scottie dog”. Best seen on oblique view.

Bilateral pars interarticularis defect.

Natsumi - NPLEX video Questions (2 decks)

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