MSK Flashcards
1
Q
for a pectus chest deformity, ask about what PMH?
A
CT d/o
2
Q
rib fxs are usually At site of impact or ____________
A
posterolateral bend
3
Q
tx for rib broken in 2+ places
A
surgery
4
Q
6Ps of compartment syndrome (list has 7)
A
Pain out of proportion to exam, pain w/ passive ROM, paresthesias, pallor, poikilothermia (limb unable to regulate temperature), pulselessness, paralysis.
5
Q
MC joint d/o
A
osteoarthritis
6
Q
is OA ASW OP?
A
no. lack of OP is a RF for OA
7
Q
when does stiffness in OA occur (2)
A
Stiffness on awakening of <30 min and after inactivity
8
Q
when does pain in OA occur (2)
A
w/ activity and after, ROM
9
Q
4 MC locs for OA
A
Most common in DIPs and PIPs (Heberden and Bouchard nodes), then knees, then hips
10
Q
node on DIP in OA
A
Heberden
11
Q
crepitus in OA?
A
yes
12
Q
earliest sign of hip OA
A
decreased internal ROM
13
Q
test to confirm OA, if needed
A
weight bearing XR
14
Q
Xray results: Loss of joint space / cartilage, subchondral sclerosis or cyst formation, osteophytes (bone spurs)
A
OA
15
Q
pathogen MCC of osteomyleitis
A
S aureus
16
Q
nonhematogenous osteomyelitis demographic
A
adults
17
Q
MC loc for hematogenous osteomyelitis in adults; kids
A
adults: verbetral
kids: long bones
18
Q
for suspected osteomyelitis w/ >2wks of sx in non-DM pt, order what test
A
xray
19
Q
for a DM pt w/ foot ulcer >2x2cm, order ______ to r/o ________
A
MRI. osteomyelitis
20
Q
empiric abx for osteomyelitis
A
IV vanc + 3rd/4th gen cephalosporin (cefepime, ceftazidime, ceftriaxone)
21
Q
osteomyelitis post-debridement: how long to give abx if some infected bone remains
A
6 wks
22
Q
osteomyelitis post-debridement: how long to give abx if NO infected bone remains and no soft tissue infx
A
5 days
23
Q
is septic arthiritis more common in small or large joints?
A
large
24
Q
MC joint affected in septic arthritis
A
knee
25
for suspected septic arhtiritis, draw joint fluid and order ____ on it
gram stain and culture. also crystals if still need to r/o gout
26
MCC of hip pain
Greater Trochanteric Bursitis
27
kid p/w fever + limp. Tx step?
refer to ortho/ED urgently
28
for poss Avascular necrosis hip
ask about what PMH
sickle cell
29
for poss Avascular necrosis hip
ask about what 2 meds
steroids, bisphosphonates
30
Ideopathic osteonecrosis of the hip
in kids
Legg-Calve-Perthes Disease
31
Legg-Calve-Perthes Disease: sudden or gradual usually?
Gradual (Long onset)
32
which test: hip adduction causes dislocation
barlow
33
which test: hip flexion and abduction with anterior pressure causes reduction of hip dislocation (CLICK auscultated)
ortolani
34
tx for congential hip dysplasia <6 mo
Pavlik harness
35
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)
36
most hip dislocations: ant or post
post
37
presentation of post hip dislocation
Hip pain with leg shortened, internally rotated, and adducted
38
post hip dislocation is ASW ______ nerve injury
sciatic
39
ant or post hip dislocation: femoral head smaller than the contralateral side and superior to the acetabulum.
post
40
tx for hip fx
"Open reduction and internal fixation (ORIF) - w/in 48 hours for best results
Most traumatic fractures will require surgical reduction"
41
head of the femur slips off the neck of the femur inferiorly and posteriorly, often due to mechanical overload
Slipped capital femoral epiphysis (SCFE)
42
12 y/o boy w/ groin to knee pain and limp
Slipped capital femoral epiphysis (SCFE)
43
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
44
torn meniscus will have tenderness to palpation where
joint line
45
meniscus tear is usually from ____ injury
twisting
46
MC cause of anterior knee pain
Patella-Femoral Tracking Syndrome
47
what is theater sign. which dx?
hurts when sitting for a long time. Patella-Femoral Tracking Syndrome
48
Prepatellar Bursitis (Housemaid's Knee)
is common in which athletes?
wrestlers
49
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
50
___ metatarsal is most commonly fractured
3rd
51
if pain/injury to lateral foot, must order xray to r/o
jones fx
52
tx for jones fx
surgery
53
tx for lisfranc fx
urgent referral to ortho/ED
54
Proximal fibular fracture + medial ankle ligament sprain/rupture
Masionneuve fx
55
grade 2 sprain
partial tearing of ligaments
56
2nd MC site for stress fx
metatarsals (2nd is most common)
57
wrestler has dull ache over knee, aggravated by pressure and flexion of knee. Swelling over patella
dx?
Prepatellar Bursitis (Housemaid's Knee)
58
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
59
Most common location for stress fracture in body
tibia
60
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"
61
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
62
demographic for osgood schlatter dz
13 y/o athlete going through growth spurt
63
pt in MVC, knee hit dashboard, now unable to extend, hemarthrosis, palpable patellar defect. test to order and view?
lateral XR
64
Next step for Knee (Tibiofemoral) Dislocations
emergency ortho consult
65
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
66
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.
67
XR view to order for suspected patellar injury
sunrise
68
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)
69
most important xray view for poss ankle fx
mortise
70
MC loc for morton's neuroma
Entrapment of interdigital nerve -- 3rd and 4th web spaces most commonly used
71
+anterior drawer of the foot indicates injury to which ligament
ATFL
72
+Kleiger test indicates injury to what lig
deltoid
73
+talar tilt on lat foot when tilting medial indicates injury to which lig
calcaneofibular
74
MCC of heel pain in adults
plantar fasciitis
75
plantar fasciitis will have + _______test. how is it performed?
Windlass Test + (foot flat on ground and dorsiflex big toe)
76
to test for tarsal tunnel syndrome, ______
" Tinel’s Test over medial ankle
77
9 y/o soccer player w/ b/l pain over posterior heels
Sever’s Disease/Calcaneal Apophysitis
78
bone is the ____ MC location that metastases spread to
3rd
79
7 bone loving cancers
Bone-loving CA (“bone-zing ring”): MM PB KTL. Multiple myeloma. prostate, breast. Kidney, thyroid, lung.
80
classic sx of bone CA
worsening nighttime bone pain
81
MC malignant bone CA
Osteosarcoma
82
age for Osteosarcoma
10-14
83
age for Ewing sarcoma
5-25
84
which bone CA? X-ray: sunray/burst or hair on end appearance
Osteosarcoma
85
which bone CA is in adults >50
Chondrosarcoma
86
Osteochondroma: benign or malignant
benign
87
demographic MC in fibromyalgia
middle aged F
88
besides pain, ask about what key sx in fibromyalgia
sleep disturbance
89
difference in presentation of gout and CPPD
gout is more painful and shorter duration
90
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.
91
diet to ask about for suspected gout
diet high in purines: seafood, meat
92
when to measure uric acid levels in suspected gout
1-2 wks after flare resolves
93
joint aspiration results in gout
needle-shaped monosodium urate crystals w/ negative birefingent
94
joint aspiration results in CPPD
CPPD crystals (rhomboid, positive birefringent)
95
xray shows soft tissue calcification (streaking of soft tissue; chondrocalcinosis). dx?
CPPD
96
how long for gout flare to resolve
3-10 days
97
2 meds to consider rxing during acute gout flare
naproxen (NSAIDs), colchicine
98
1st line for prevention of gout flares
allopurinal
99
what to rx w/ allopurinol
NSAIDs or cochicine X 3-6 mo then d/c
100
what to tell pt when they start or increase allopurinol dose
When rxing allopurinol: tell pt to call asap and stop med if they dev rash or itching, esp w/in 2 mo.
101
1st line tx for CPPD
Injectable glucocorticoids (1st line if 2 or less joints involved)
102
JIA must show 6 wks of sx before age ___
16
103
MC type of JIA
oligoarticular
104
MC age range for JIA
1-5 y/o
105
fever in still's dz
diurnal, daily, for 2+ wks
106
most serious complication of JIA
Iridocyclitis not detected and treated, may lead to scarring of the lens and permanent visual damage including blindness.
107
ANA+ pt w/ JIA. what screening is required?
eye exam Q3 mo til 7 y/o, then Q6 mo
108
ANA- pt w/ JIA. what screening is required?
eye exam Q6 mo
109
when to start screening F for OP w/ DEXA
65
110
MC OP fx and loc
vertebral. T12, L1
111
vertebral fx is worse w/ ___ (2 positions, 1 action)
sitting, extension, valsalva
112
first labs to order for suspected OP (4)
CBC, CMP, vitamin D, phosporus
113
osteopenia + FRAX results of ______ = OP
10 year prob of hip fx 3+% and major osteoporotic fx 20+%
114
Ca and vit D amounts for OP
1200mg Ca, 800IU Vit D
115
if bisphosphonates are CI, rx _____ for OP pt
denosumab
116
med for OP pt w/ very high fx risk
teriparatide
117
demographic for polyarteritis nodosa
M 40-60
118
40 y/o M p/w painful subQ nodules and rapidly dev HTN. consider what rheum d/o?
polyarteritis nodosa
119
the NO in polyarteritis nodosa is what 2 things?
NOdosa: no lung involvement, no ANCA
120
1st line tx for PAN
prednisone
121
test for what concomitant dx in pt w/ PAN
hep B, C
122
Idiopathic inflammation of joints, bursae, and tendons
* Polymyalgia rheumatica
123
PMR is ASW what other dx
20% have giant cell arteritis
124
60 y/o F w/ Acute onset of Pain and stiffness in shoulders, hips. Normal muscle strength on PE, but difficulty w/ ADLs.
PMR
125
what sx is 100% sensitive for PMR
morning stiffness
126
tx for PMR
Low dose corticosteroids (prednisone) X 6mo - 1 yr, then taper off. Will have rapid response to prednisone. High dose if giant cell arteritis.
127
3 differences in presentation of PMR and polymiositis
PMR (no muscle weakness or tenderness; joint pain)
128
what 2 signs are pathognomonic for dematomyositis
Gottron’s papules (pathognomonic; raised violaceous scaly patches on extensor surfaces of fingers/elbows/knees), heliotrope rash (pathognomonic; around eyes)
129
most sensitive lab test for polymiositis
elevated CK
130
3 serum rheum tests for order for suspected polymiositis
ANA+ (60%), RF-
Anti-Jo-1: ASW myositis, is + in 20-30% of polymyositis
Anti-Mi2: ASW myositis, specific for dermatomyositis. think MiJositis.
131
which antibody is specific for dermatomyositis
anti-Mi2
132
1st line tx for polymiositis
prednisone
133
RA joints are stiff for how long in am?
>1 hr
134
RA joint stiffness is worse w/ ______ and better with _____
prolonged inactivity. activity
135
7 S's of RA
7 S's: symmetric, swollen, soft, small joints, spares DIPs and lumbar, 60min or more in the morning, swan neck deformity.
136
MCC of deaths in RA pts
CVD
137
4 comorbidities of RA
CVD (causes 50% of RA deaths), infx, malignancy, OP (from chronic steroid use)
138
xray shows bone erosions around joints, justaarticular osteopenia. dx?
RA
139
most specific test for RA
Anti-CCP antibodies
140
med class to start asap in RA
DMARDs
141
med to think of first when dxing RA
MTX
142
* Reactive arthritis (Reiter’s Syndrome)
preceeded by what 2 infx?
Dysentery caused by: Shigella, salmonella, yersinia, or campylobacter
STI w/: Chlamydia trachomatis or Ureaplasma urealyticum
143
is reactive arthritis from STI more common in M or F?
M
144
triad of reactive arthritis
Triad of arthritis, urethritis, and conjunctivitis (only 33% have full triad; can't see, can't pee, can't climb a tree)
145
order what test for suspected reactive arthritis
HLA-B27
146
tx for reactive arthritis. add _____ if d/t STI
NSAIDs are the mainstay of treatment. Tetracycline should be given if sexually transmitted disease is suspected.
147
pt w/ Xeropthalmia (dry eyes). Xerostomia (dry mouth). look for what on PE?
b/l parotid enlargement
148
special PE test for sjogren's
Positive Schirmer test: ↓ tear production (wetting <10mm of filter paper after 5 min)
149
labs to order for sjogren's (3)
labs: + ANA, +antiSS-A (Ro) & antiSS-B (La), +RF (none are specific)
150
class of med + example for sjogrens
Cholinergics (pilocarpine, Cevimeline)
151
40% of pts w/ SLE have what comorbidity affecting hands and feet?
Reynaud's
152
what makes SLE rash worse?
sunlight
153
pathognomonic finding on PE of limbs for SLE
palmar erythema mainly on fingertips
154
1st 3 tests to order for SLE
check urine, ANA, CBC first
155
2 specific antibodies in SLE
anti-double stranded DNA (very specific; use to Dx; high in renal impairment), anti-Sm (most specific)
156
which antibody is sensitive for drug-induced lupus?
anti-histone
157
rx high dose of _________ to achieve remission in SLE
Antimalarial therapy (hydroxychloroquine/ Plaquenil
158
which type of scleroderma is MC
CREST
159
what does CREST stand for in scleroderma
calcinosis cutis, Raynaud's, esophageal dysfunction, sclerodactyly, telangeictasia.
160
Scl-70 antibodies are specific for _____
Diffuse cutaneous systemic sclerosis (DCSS)
161
dx to order these:
Anti-centromere antibodies
Anti-RNA polymerase
Scl-70 antibodies
scleroderma
162
* Ankylosing spondylitis
is a type of _________
reactive arthritis
163
age of onset for ankylosing spondylitis
20-30 y/o
164
does the pain and stiffness in ankylosing spondylitis get better or worse w/ activity?
better
165
Bamboo spine (squaring of vertebral bodies). dx?
ankylosing spondylitis
166
test to order for cauda equina
MRI
167
2 MC locs for HNP
L4-5 and L5-S1 : 95% of cases
168
easy way to tell the difference between b/w cervical HNP and rotator cuff
HNP will ahve pain at rest. rotator cuff is only w/ movement
169
which nerve root is affected?
pain on ant upper arm, radial forearm, thumb; weak elbow flexion or shoulder external rotation; poss dec biceps / brachialis reflex
C6
170
when to start bracing scoliosis? when to refer to surgery
>25 degrees. >45 degrees
171
when to tell pt w/ back strain that they will feel better
some in 1 wk. most by 6 wks.
172
lumbar strain pt not improved in 6 wks of conservative mgmt. next step?
MRI
173
small piece of bone fractured off the ant inf glenoid after impaction of humeral head against glenoid.
Bankart lesion
174
(dent in the humeral head): compression chondral injury of the post superior humeral head following impaction against the glenoid
Hill-Sachs lesion
175
2 causes of post shoulder dislocation
seizures, electric shock
176
MC joint to be dislocated
shoulder
177
how will arm be held in ant shoulder dislocation?
Ant: arm is abducted and externally rotated
178
2 xray views to order for shoulder dislocation?
AP, axillary lateral OR scapular Y view
179
after reducing shoulder dislocation, must do what 2 things
neurovasc check, xray
180
zanca xray view is aka _____
clavicle
181
if clavicle fx is displaced, prox, distal, or shortened >______mm, refer to ortho surgery
15mm
182
most sensitive test for biceps tendinitis
speed's
183
pt has shoulder pain worse with overhead activity or at night when lying on arm. dx?
rotator cuff tendinopathy
184
MC rotator cuff injured
supraspinatus
185
difference b/w rotator cuff tendonitis and tear
tear has decreased AROM and strength
186
when to order xray for rotator cuff pain (2)
Xray first if atraumatic and >50 y/o OR traumatic
187
PE special test to distinguish between rotaator cuff tendinitis and tear
drop arm (specific)
188
do what PE special tests for labral tear )3)
positive O'Brien (most specific), Yergason, anterior apprehension (most specific for shoulder instability/labral tear), Jobe relocation
189
ask about what 3 things in PMH for adhesive capsulitis?
shoulder surgery, breast CA surgery, DM
190
PE to r/o adhesive capsulitis
ROM. Full range of motion on any plane suggests diagnosis other than adhesive capsulitis
191
pt has shoulder pain w/ motion. Painful crepitus with AROM, Decreased AROM/PROM, Intact strength. dx?
Glenohumeral joint Osteoarthritis
192
age for nursemaid's elbow
2-4 y/o
193
if radial head subluxation was >____ hrs ago, immoblise and consult ortho
12
194
how to check radial n function (sens and motor)
1st webspace sensation; finger extension
195
how to check median n function (sens and motor)
index finger sensation; finger flexion
196
how to check ulnar n function (sens and motor)
little finger sensation; interossei function
197
Ulnar Fracture with Radial Head Dislocation
Monteggia Fracture
198
Proximal radius fracture with distal ulna dislocation
Galeazzi Fx
199
most commonly fractured carpal bone
scaphoid
200
age range for supracondylar fx
5-8 y/o
201
Most common upper extremity fracture
colles
202
the more ______ the scaphoid fracture the more likely the non-union and avascular necrosis
proximal
203
displaced scaphoid fx tx
refer for surgery
204
age range for colles fx
Pediatric and senior citizens
205
Transverse distal radius fracture +/- ulnar involvement. NO articular involvement.
colles
206
refer metacarpal or phalange fx if ___ (3)
involves joint space, rotated, extensor lag
207
2 special PE tests to do for lateral epicondylitis
Cozen's, Mill's
208
tenderness 4-5 cm distal to the lateral epicondyle. +/- finger and wrist extensor weakness
Radial Tunnel Syndrome
209
pain and difficulty with resisted extension of the middle finger with the elbow in extension.
this is + for _______
Radial Tunnel Syndrome
210
consider what complication for Medial Epicondylitis (aka Golfer's elbow)
ASW Ulnar nerve entrapment (Cubital Tunnel Syndrome)
211
medial epicondylitis will have pain w/ resisted elbow ________
flexion
212
ulnar n entrapment/cubital tunnel syndrome will have paresthesias w/ prolonged elbow _________
flexion
213
complication of Olecranon Bursitis (aka student's elbow)
to r/o
infx
214
test for DeQuervain’s Syndrome
Finkelstein (Eichhoff) Test positive.
215
carpal tunnel affects what nerve
median
216
trigger finger PMH (3)
Reptititive trauma, RA, DM
217
Flexor Digitorum Profundus (Jersey finger)
MC affects what finger?
ring
218
tx for jersey finger
urgent surgery
219
Pain over ulnar aspect of 1st MCP; pincer strength decreased due to pain. Be suspicious of a Stener lesion if there is both pain and significant laxity with abduction stress test
Thumb Ulnar collateral ligament tear (Skier’s thumb)
220
how to test for hip OA
figure 4/faber (will have ant hip pain)
221
MCC (pathogen) of hematogenous osteomyelitis
S aureus
222
Diseases associated with HLA-B27: PAIR
Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis
223
Physical exam findings in a 4 year-old child that include blue sclerae and recurrent fractures indicates which of the following?
Ehlers-Danlos syndrome
Marfan syndrome
Achondroplasia
Osteogenesis imperfecta
Osteogenesis imperfecta
224
Which of the following groups is most likely to present with Duchenne's muscular dystrophy?
Adolescent females
Middle-aged males
Infant females
Toddler-aged males
toddler males
225
A patient presents with chronic back pain. On physical examination testing, the patient is found to have abnormalities of proprioception and vibration discrimination. Which of the following portions of the spinal column are most likely affected?
Lateral spinothalamic tract
Ventral spinothalamic tract
Posterior column
Transection of the cord
posterior column
226
An 80 year-old female presents with pain in her vertebral column. Radiography reveals compression fracture of T12 that is consistent with osteoporotic compression fracture. Which of the following treatment modalities has the potential to cause analgesia of the fracture site with its use?
Calcitonin (Miacalcin) nasal spray
Alendronate (Fosamax)
Raloxifene (Evista)
Combined estrogen and progesterone (Prempro) therapy
Calcitonin has the ability to cause analgesia when used for acute compression fracture of the vertebral body
227
A 35 year-old patient with lupus is being treated for mild arthralgias and rash with hydroxychloroquine. Which of the following clinical manifestations is the most common side effect of this medication?
impaired night vision
jaundice
mouth sores
proteinuria
Question 81 Explanation:
Hydroxychloroquine is associated with macular damage, rash and diarrhea
