MSK Flashcards
for a pectus chest deformity, ask about what PMH?
CT d/o
rib fxs are usually At site of impact or ____________
posterolateral bend
tx for rib broken in 2+ places
surgery
6Ps of compartment syndrome (list has 7)
Pain out of proportion to exam, pain w/ passive ROM, paresthesias, pallor, poikilothermia (limb unable to regulate temperature), pulselessness, paralysis.
MC joint d/o
osteoarthritis
is OA ASW OP?
no. lack of OP is a RF for OA
when does stiffness in OA occur (2)
Stiffness on awakening of <30 min and after inactivity
when does pain in OA occur (2)
w/ activity and after, ROM
4 MC locs for OA
Most common in DIPs and PIPs (Heberden and Bouchard nodes), then knees, then hips
node on DIP in OA
Heberden
crepitus in OA?
yes
earliest sign of hip OA
decreased internal ROM
test to confirm OA, if needed
weight bearing XR
Xray results: Loss of joint space / cartilage, subchondral sclerosis or cyst formation, osteophytes (bone spurs)
OA
pathogen MCC of osteomyleitis
S aureus
nonhematogenous osteomyelitis demographic
adults
MC loc for hematogenous osteomyelitis in adults; kids
adults: verbetral
kids: long bones
for suspected osteomyelitis w/ >2wks of sx in non-DM pt, order what test
xray
for a DM pt w/ foot ulcer >2x2cm, order ______ to r/o ________
MRI. osteomyelitis
empiric abx for osteomyelitis
IV vanc + 3rd/4th gen cephalosporin (cefepime, ceftazidime, ceftriaxone)
osteomyelitis post-debridement: how long to give abx if some infected bone remains
6 wks
osteomyelitis post-debridement: how long to give abx if NO infected bone remains and no soft tissue infx
5 days
is septic arthiritis more common in small or large joints?
large
MC joint affected in septic arthritis
knee
for suspected septic arhtiritis, draw joint fluid and order ____ on it
gram stain and culture. also crystals if still need to r/o gout
MCC of hip pain
Greater Trochanteric Bursitis
kid p/w fever + limp. Tx step?
refer to ortho/ED urgently
for poss Avascular necrosis hip
ask about what PMH
sickle cell
for poss Avascular necrosis hip
ask about what 2 meds
steroids, bisphosphonates
Ideopathic osteonecrosis of the hip
in kids
Legg-Calve-Perthes Disease
Legg-Calve-Perthes Disease: sudden or gradual usually?
Gradual (Long onset)
which test: hip adduction causes dislocation
barlow
which test: hip flexion and abduction with anterior pressure causes reduction of hip dislocation (CLICK auscultated)
ortolani
tx for congential hip dysplasia <6 mo
Pavlik harness
dx: pt presents after hip trauma. Physical exam: Hip is tender and pain is elicited with active and passive ROM. The hip will be shortened, abducted, and externally-rotated
hip fx (can be rare anterior dislocation)
most hip dislocations: ant or post
post
presentation of post hip dislocation
Hip pain with leg shortened, internally rotated, and adducted
post hip dislocation is ASW ______ nerve injury
sciatic
ant or post hip dislocation: femoral head smaller than the contralateral side and superior to the acetabulum.
post
tx for hip fx
“Open reduction and internal fixation (ORIF) - w/in 48 hours for best results
Most traumatic fractures will require surgical reduction”
head of the femur slips off the neck of the femur inferiorly and posteriorly, often due to mechanical overload
Slipped capital femoral epiphysis (SCFE)
12 y/o boy w/ groin to knee pain and limp
Slipped capital femoral epiphysis (SCFE)
tx for Slipped capital femoral epiphysis (SCFE)
Emergent referral to ortho ASAP for surgery. Make them non-weight bearing. Treat with surgical fixation with screw for all patients
torn meniscus will have tenderness to palpation where
joint line
meniscus tear is usually from ____ injury
twisting
MC cause of anterior knee pain
Patella-Femoral Tracking Syndrome
what is theater sign. which dx?
hurts when sitting for a long time. Patella-Femoral Tracking Syndrome
Prepatellar Bursitis (Housemaid’s Knee)
is common in which athletes?
wrestlers
what is Basset’s sign for Patellar Tendinitis (aka jumper’s knee)
Basset’s sign: tenderness to palpation at the distal pole of the patella in full extension and no tenderness to palpation at the distal pole of the patella in full flexion
___ metatarsal is most commonly fractured
3rd
if pain/injury to lateral foot, must order xray to r/o
jones fx
tx for jones fx
surgery
tx for lisfranc fx
urgent referral to ortho/ED
Proximal fibular fracture + medial ankle ligament sprain/rupture
Masionneuve fx
grade 2 sprain
partial tearing of ligaments
2nd MC site for stress fx
metatarsals (2nd is most common)
wrestler has dull ache over knee, aggravated by pressure and flexion of knee. Swelling over patella
dx?
Prepatellar Bursitis (Housemaid’s Knee)
PE test to distinguish between MTSS and stress fx
hop test. stress fx will have pain w/ 1 hop. mtss will be able to hop a few times w/o pain
Most common location for stress fracture in body
tibia
tx for Medial Tibial Stress Syndrome (MTSS) aka shin splints
” Relative rest 5-7d and symptomatic therapy. Moist heat, brace, taping. Ice NSAID, stretching
* Change running shoes
* Gradually return to training (soft surface first to prevent recurrence)
* Surgery – last resort”
difference in tenderness to palpation: shin splints vs tibial stress fx
shin splints will have zone of tenderness along anterolateral tibial shaft. stress fx has point tenderness over bone
demographic for osgood schlatter dz
13 y/o athlete going through growth spurt
pt in MVC, knee hit dashboard, now unable to extend, hemarthrosis, palpable patellar defect. test to order and view?
lateral XR
Next step for Knee (Tibiofemoral) Dislocations
emergency ortho consult
pittsburg knee rules (3)
Blunt trauma or fall as mechanism of injury + either of the following: Age <12 years or >50 years; Inability to walk 4 weight-bearing steps (2 weight transfers) in the ED
ottawa rules for knees (5)
X-ray indicated if….inability to bear weight both immediately after injury and in the exam room; >55 years old; isolated tenderness of the patella; tenderness over the head of the fibula; inability to flex to 90 degrees.
XR view to order for suspected patellar injury
sunrise
Ottawa Ankle Rules to r/o fx
(SnOUT – negative Ottawa effectively rules out fx)
1. Inability to bear weight (4 steps)
2. Bony tenderness along posterior edge of distal 6cm of medial or lateral malleolus
3. Tenderness over base of 5th metatarsal
4. Tender over midfoot (navicular)
most important xray view for poss ankle fx
mortise
MC loc for morton’s neuroma
Entrapment of interdigital nerve – 3rd and 4th web spaces most commonly used
+anterior drawer of the foot indicates injury to which ligament
ATFL
+Kleiger test indicates injury to what lig
deltoid
+talar tilt on lat foot when tilting medial indicates injury to which lig
calcaneofibular
MCC of heel pain in adults
plantar fasciitis
plantar fasciitis will have + _______test. how is it performed?
Windlass Test + (foot flat on ground and dorsiflex big toe)
to test for tarsal tunnel syndrome, ______
” Tinel’s Test over medial ankle
9 y/o soccer player w/ b/l pain over posterior heels
Sever’s Disease/Calcaneal Apophysitis
bone is the ____ MC location that metastases spread to
3rd
7 bone loving cancers
Bone-loving CA (“bone-zing ring”): MM PB KTL. Multiple myeloma. prostate, breast. Kidney, thyroid, lung.
classic sx of bone CA
worsening nighttime bone pain
MC malignant bone CA
Osteosarcoma
age for Osteosarcoma
10-14
age for Ewing sarcoma
5-25
which bone CA? X-ray: sunray/burst or hair on end appearance
Osteosarcoma
which bone CA is in adults >50
Chondrosarcoma
Osteochondroma: benign or malignant
benign
demographic MC in fibromyalgia
middle aged F
besides pain, ask about what key sx in fibromyalgia
sleep disturbance
difference in presentation of gout and CPPD
gout is more painful and shorter duration
ask about what drugs for suspected gout
If you put too much seafood on your plate, you’ll get gout.
PLATE = pyrazinamide, loop diuretics, aspirin/ACE/ARB, thiazides, ethambutol.