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USMLE Step 2 - Top 5% > MSK 🦵🏼 > Flashcards

MSK 🦵🏼 Flashcards

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USMLE® Step 1 flashcards
1
Q

Identify the hip injury. Shortened and internally rotated leg

A

Posterior hip dislocation

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2
Q

Identify the hip injury. Lengthened and externally rotated leg

A

Anterior hip dislocation

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3
Q

Identify the hip injury.
Shortened and externally rotated leg

A

Hip fracture

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4
Q

Treatment for clavicle fracture

A

A sling if uncomplicated. Surgery required if open fracture, displaced with skin tenting, or neurovascular compromise

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5
Q

Nerve injury at risk in anterior shoulder dislocation

A

Axillary

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6
Q

Presenting differences between anterior and posterior shoulder dislocation

A

Anterior patient has abducted and externally rotated arm. Posterior patient has adopted an internally rotated arm

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7
Q

Treatment for shoulder dislocation

A

Sling and swath. Reduction would’ve been done first

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8
Q

Initial and confirmatory test to diagnose rotator cuff tears

A

Clinical diagnosis. But confirmed with MRI

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9
Q

Treatment for rotator cuff tears. Went to do surgery

A

Rest and NSAID. Surgery only if lost active range of motion with preserved passive range of motion

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10
Q

 Nerve affected if humeral fracture is proximal, mid shift, distal

A

Proximal would be axillary, mid shift would be radial, distal would be median

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11
Q

Humeral fracture treatment

A

coaptation splint un complicated. Surgery if open or displaced

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12
Q

Monteggia fracture

A

Proximal owner fracture and radial dislocation (may be called diaphyseal fracture of proximal owner with subluxed radial head)

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13
Q

Night stick fracture

A

Owner shaft fracture from direct trauma (often in self defence)

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14
Q

Galeazzi fracture 

A

Diaphyseal fracture of the radius with dislocation of distal ulnar.

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15
Q

Treatment of nightstick fracture

A

Conservative therapy if an complicated. Surgery if open or displaced

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16
Q

Monteggia fracture treatment

A

Open reduction and internal fixation of fracture And closed reduction of dislocated Radial head

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17
Q

Galeazzi fracture treatment

A

Open reduction internal fixation of radius and casting of fractured forum in supination to reduce the distal radio ulnar joint

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18
Q

Management of Colles fracture

A

Close reduction followed by short arm cast. Open reduction if fracture is open or displaced or intra-articular

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19
Q

Treatment of boxers fracture

A

Closed reduction and splint. Surgery if excessively angulated or unstable or if more than one metacarpal is fractured

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20
Q

Treatment of de quervain Tenosynovitis. And what to do if refractory

A

NSAIDs, ice, thumb splint. Steroid injection if refractory

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21
Q

Is a scaphoid fracture seen on an x-ray immediately. What’s the impact this has on the diagnosis

A

No, usually takes two weeks to show. So can assume a diagnosis if snuffboxes tender

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22
Q

Treatment for scaphoid fracture

A

Some cast (thumb spica splint), cereal x-ray monitoring, if displacement or non-union president must do ORIF (only really if more than 1 mm displacement,)

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23
Q

What nerves are impacted in posterior and anterior hip dislocation

A

Anterior is the obturator nerve. Posterior is the sciatic

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24
Q

Treatment for hip dislocation

A

Emergent closed reduction (unless there’s a pathology requiring open reduction). Do CT scan after reduction

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25
Q

Treatment for femoral fracture

A

0RIF. Irrigate and debride open fractures

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26
Q

If you suspect hip fracture, however x-ray is negative, what do you do

A

CT or MRI, because x-rays can be negative

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27
Q

Treatment for hip fracture. Consider DVT risk. And consider if heavily displaced

A

0RIF. Arthroplasty needed if there’s a high chance of displacement. Anticoagulation for DVT risk

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28
Q

Diagnostic test of choice for all knee ligament injuries

A

MRI

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29
Q

ACL tear when to Tx

A

Young symptomatic patients

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30
Q

Meniscus tear Tx

A

Younger patients, (repair or remove). Older patients (conservative remove)

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31
Q

Tibial stress fracture presentation

A

Point tenderness worsening with activity. Seen in misalignment, foot arch issues, female athlete triad

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32
Q

Non operative and operative Tx for tibial stress fracture

A

Active modification and casting. Or intramedullary nailing or ORIF

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33
Q

Thompson test is positive in what

A

Achilles’ tendon rupture

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34
Q

Who gets surgery for Achilles’ tendon rupture

A

Elite athletes. Everyone else should have conservative

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35
Q

What is Crescent sign in baker cyst rupture

A

And Ekhymosis at the medial malleolus

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36
Q

How to manage a patient with bakers cyst

A

NSAIDs and activity modification, surgery if symptomatic. Ultrasound to rule out DVT

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37
Q

What is used to determine if an x-ray is necessary for an ankle fracture suspicion

A

Ottawa ankle rules

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38
Q

Treatment for ankle fracture

A

ORIF if open displaced or unstable

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39
Q

Treatment for calcaneal stress fracture

A

Conservat

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40
Q

Treatment of metatarsal stress fracture

A

Usually Conservative. Fifth metatarsal involvement means we need treatment due to non-union risk (0RIF)

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41
Q

What is the Ottawa ankle rule

A

To know if somebody should get an x-ray for ankle pain. Do x-ray if patient cannot walk four steps four pain with palpation at the malleolus zone or specifically malleolus

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42
Q

Salter-Harris paediatric fracture classification type one

A

Fracture line is within growth plate (physis) straight across. But no compression

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43
Q

Salter-Harris paediatric fracture classification type 2

A

Fracture extends through both metaphysis and physis (most common)

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44
Q

Salter-Harris paediatric fracture classification type 3

A

Fracture extends through both physis and epithesis

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45
Q

Salter-Harris paediatric fracture classification type 4

A

Fracture extends through all three (metaphysis, physis, epithesis)

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46
Q

Salter-Harris paediatric fracture classification type 5

A

Physis is compressed or crushed (like one with compression). Worst Px

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47
Q

Pneumonic for Salter-Harris classification

A

Type one straight across, type two above growth plate, type three lower, type four through, type five erased growth plate

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48
Q

Long thoracic nerve findings

A

Cannot abduct the above 90°. Potential history of chest tube placement or stab wound to axilla. Winging seen on exam

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49
Q

Radial nerve palsy findings

A

Wrist drop and sensory deficit of proximal. Finger drop without sensory deficit if distal. Potential history of mid shaft humeral fracture, compression of humerus (Saturday night palsy), Radiohead subluxation

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50
Q

Median nerve palsy findings

A

Flat thinner eminence, weak wrist flexion, cannot oppose the thumb, weak finger flexion, potential history of supracondylar fracture or carpal tunnel syndrome. Recall median claw and Benediction sign

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51
Q

Ulnar nerve palsy findings

A

Ulnar claw (Recall distal proximal findings). Cannot abduct fingers. Potential history of guyon canal syndrome, Hi mate book fracture, medial epicondyle fracture

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52
Q

Musculocutaneous nerve palsy findings

A

Absent biceps reflex, weak elbow and shoulder flexion. Cannot supinate forearm. Potential history of shoulder dislocation or trauma to anterior bicep

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53
Q

Axillary nerve palsy findings

A

Cannot abduct arm above 15°. Deltoid is flat. Decrease sensation of a deltoid. Potential history of anterior shoulder dislocation, fracture of surgical neck of humorous

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54
Q

Common perineal nerve palsy findings

A

Foot drop, cannot dorsiflex or avert foot. Recall sensory deficit. Potential history of needles location prolonged mobilisation or trauma to fibula

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55
Q

Superior gluteal nerve palsy findings

A

Dropping of contra lateral pelvis due to horizontal walking (Trendelenburg). I.e. cannot hip abduct

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56
Q

Tibial nerve palsy findings

A

Cannot foot invert or plantarflex. Can be tarsal tunnel syndrome if distal. Since we lost soul of the foot. Look out for patient with trauma to the back of the knee or baker cyst

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57
Q

Obturator nerve palsy

A

Wide base gate, are you cannot see a doctor. Sensory loss to distal medial side. Look out for patient with pelvic lymph-node dissection or tumour

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58
Q

Femoral nerve palsy signs

A

Abnormal knee reflex, are you cannot flex and extend. Sensory loss to anterior medial side and medial side of lower leg (saphenous branch). Look out for patient with prolonged pressure on nerve or direct trauma

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59
Q

Lateral femoral cutaneous nerve palsy

A

Abnormal thigh sensation (lateral). Get meralgia Parasthetica. Causes include obesity or tight fitting clothes, or even surgeries and IVC filter

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60
Q

What is complex regional pain syndrome

A

Loss of function and autonomic dysfunction occurring after trauma (not a true nerve injury). Three phases development of pain (out of proportion) from trauma, soft tissue and oedema, atrophy and limitation of movement

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61
Q

Treatment of complex regional pain syndrome

A

Trial of NSAIDs for initial phase. Oral corticosteroids, low dose TCA, gabapentin, all for adjuvant mads. Refer to chronic pain specialist if complicated

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62
Q

Where does osteosarcoma occur in the bone

A

Metaphyseal region

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63
Q

Enchondroma usually found where

A

Hands or feet

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64
Q

Enchondroma, treatment

A

Serial x-rays

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65
Q

X-ray findings of giant cell tumours

A

Soap bubble Appearance

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66
Q

Medication for Giants of tumour of the bone

A

Denosumab

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67
Q

Location for osteoblastoma

A

In the back (blasted in the back)

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68
Q

Osteochondroma management

A

Monitor with cereal x-rays

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69
Q

Management for osteoid osteoma

A

Conservative, but can respect if patient cannot tolerate NSAIDs for pain

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70
Q

Management for osteosarcoma or ewing sarcoma or chondrosarcoma

A

Reception and chemotherapy. Chondro and ewing can use radiation to

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71
Q

Which bone tumour has a moth-eaten appearance on x-ray

A

Chondrosarcoma

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72
Q

Best initial test for osteosarcoma

A

X-ray (Sunburst and Codman triangle findings)

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73
Q

Onion skinning finding seen on x-ray for tumour

A

EWing sarcoma

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74
Q

Most accurate test for osteosarcoma

A

Bone biopsy

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75
Q

Intense pain with brief joint movement is pathognomic of which joint disease

A

Septic arthritis

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76
Q

In which joint disease is the synovial fluid viscosity low

A

Inflammatory arthritis is

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77
Q

Treatment for staphylococcus septic arthritis

A

Vancomycin

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78
Q

Treatment for neisseria Septic arthritis

A

Third gen Ceohalosporin

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79
Q

Treatment for salmonella and hemophilus septic arthritis

A

Third gen cephalosporin

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80
Q

General treatment of septic arthritis

A

Broad spec (ceph, vanco) until culture result comes back. Joint drain and debride

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81
Q

How does an osteoid osteoma present and what is the treatment

A

Adolescent, pain in upper thigh, x-ray showing small Lucent nidus. Pain relief with NSAID is needed surgery may be needed

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82
Q

I what pathogen do you think is responsible for these osteomyelitis patients:

No risk factor
IVDU
Sickle-cell disease
Hip replacement
Foot puncture
Diabetes

A

Staph aureus
Aureus or pseudomonas
Salmonella
Epidermidis
Pseudomonas
Polymicrobial


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83
Q

Osteomyelitis in a diabetic, antibiotics should be targeting what

A

Polymicrobial and gram-positive bacteria

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84
Q

Imaging test of choice for osteomyelitis

A

MRI

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85
Q

Treatment for osteomyelitis

A

Surgical department of necrosis, IV antibiotics for a month.

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86
Q

Consider antibiotics used for osteomyelitis:

If gram-negative, if MRSA, if methicillin sensitive,

A

If gram-negative do floxacin or Cephtriaxone. For methicillin sensitive stuff give floxacin or ampicillin or oxacillin, for MRSA give Vanco

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87
Q

Most accurate test to diagnose osteomyelitis

A

Bone Aspiration with culture and stain. But not always needed

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88
Q

What kind of cancer can come from osteomyelitis

A

Squeamish cell carcinoma can occur. This would be a marjolin ulcer 

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89
Q

Role of opioids in osteoarthritis

A

Only in severe refractory pain cases, and the patient is not able to take a surgical approach

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90
Q

Main imaging/diagnosis for osteoarthritis

A

X-ray

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91
Q

Best initial treatment for OA

A

Physical therapy, weight reduction and NSAIDs. CS injection for temporary relief

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92
Q

The most definitive treatment for osteoarthritis

A

Surgery (i.e. joint replacement)

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93
Q

Diagnostic criteria for rheumatoid arthritis

A

Six or more of the following points:

Rheumatoid factor or anti-CCP
High ESR or CRP
Duration more than six weeks
Exclusion of other differentials
Three or more joints involved (up to 5 points)

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94
Q

First line and second line medications for rheumatoid arthritis

A

DMARDS like methotrexate. Second lines are TNF inhibitor’s and rituximab all leflunomide

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95
Q

How to bridge rheumatoid arthritis treatment in flares

A

NSAIDs or glucocorticoids

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96
Q

Keratoderma blennorrhagica and circulate balanitis are both scene in which arthropathy

A

Reactive arthritis

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97
Q

Best initial test for ankylosing spondylitis

A

X-ray of sacroiliac joint and lumber

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98
Q

Best initial therapy for ankylosing spondylitis

A

NSAID for pain

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99
Q

The two best initial lab tests for dermatomyositis or Polymyositis

A

Creatine kinase and anti-Joe antibodies

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100
Q

Most accurate test for dermato and polymyositis

A

Muscle biopsy

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101
Q

Treatment for dermatomyositis and polymyositis

A

High-dose corticosteroids with taper after 4 to 6 weeks. Azathioprine or MTX for resistant cases

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102
Q

Treatment for TMJ disorders. Consider what pharmacology also could be given

A

Patient education and South Ken measures to avoid triggers. Incense and steroid injections can be given. Dental splints can be given for bruxism

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103
Q

What is myofascial pain syndrome

A

Similar to fibromyalgia, but has indurated regions which when palpated cause pain in another location. Trigger points are palpated, pain is in the target zone

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104
Q

Some ideas for treatment for myofascial pain syndrome

A

Sleep hygiene, low impact exercise, therapy, antidepressant, gabapentin, muscle relaxant

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105
Q

Which antibody in scleroderma is a risk factor for a Renal crisis

A

Anti RNA polymerase 3

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106
Q

Summarise the treatment for systemic sclerosis

A

Steroids for acute flares, methotrexate for limited type. CCB for Raynolds. ACEi for a Renal crisis

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107
Q

For SLE diagnostic criteria we have the pneumonic DOPAMINE RASH. What does that stand for and how many of these do we need

A

We need four or more. Discoid rash, oral ulcers, photo sensitivity, arthritis, Mallow rush, immune criteria, neuro symptoms, elevated ESR, renal disease, ANA, serositis, haematologic abnormalities

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108
Q

Discuss the treatment for SLE

A

NSAIDs for mild joint symptoms. Steroids for acute exacerbations. Hydroxychloroquine is good for progressive and refractory cases (also good for isolated skin and joint problems). Cyclo phosphide mid or mycophenolate is for severe cases especially lupus nephritis

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109
Q

What is Jaccoud arthropathy 

A

A pattern of arthritis in SLE. Similar to rheumatoid arthritis but is nondeforming

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110
Q

Serum sickness like reaction

A

Just a self-limited fever, at carrier, arthralgia, lymph nodes, proteinuria weeks after beta lactams or sulphurs

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111
Q

Best initial test and most accurate test for GCA

A

ESR. Then biopsy of the artery (don’t wait for results before giving steroids)

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112
Q

Which exact artery is affected in AION in GCA

A

Posterior ciliary artery

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113
Q

Discuss diagnostic approach to Takayasu

A

Clinical presentation and imaging. Imaging is usually MRA Or CTA

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114
Q

Treatment for Takayasu

A

High-dose steroids

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115
Q

Discuss treatment regime for Behcet syndrome

A

Topical steroids for ulcers, ophthalmic steroids for ocular involvement, colchicine for prevention

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116
Q

Myofascial pain syndrome versus fibromyalgia

A

Fibromyalgia does not have trigger points and target zones, and fibromyalgia has multiple painful areas

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117
Q

Diagnostic criteria for fibromyalgia

A

Multiple painful areas in autobody quadrants and axle skeleton for more than three

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118
Q

Treatment regime for fibromyalgia

A

Start nonpharmacologically. Good sleep, low impact exercise, psychotherapy, education. Then pharma including TCA, gabapentin, pre-Gabalin

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119
Q

Treatment for polymyalgia rheumatica

A

Low-dose steroid

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120
Q

When do you do imaging for lower back pain

A

If there are red flags present

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121
Q

What are the red flags for lower back pain that warrants further imaging

A

Constitutional symptoms (like fever), sensory or motor deficit, suspicion for infection, risk factors for fracture (glucocorticoids, old age), history of drug abuse, malignancy

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122
Q

If lower back pain is mechanical should we do Bedrest

A

No it is contra indicated

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123
Q

Imaging of choice for herniated disc

A

MRI. 100% necessary if you suspect cauda equina or rapidly progressive symptoms. But could also do x-ray if you suspect trauma, infections or compression fracture

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124
Q

Best initial treatment for herniated disc

A

NSAIDs, physical therapy, local heat. Not bedrest

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125
Q

If a patient doesn’t respond to the Conservative therapy for herniated disc pain, what can be given next

A

Epidural steroid injection or nerve block

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126
Q

What is the definitive treatment for herniated disc

A

Surgery. Indicated if focal neuro, cauda equina, six weeks of pain or more

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127
Q

Diagnose this:

Back pain radiating to the buttocks and legs bilaterally. Some leg weakness numbness. Worse when standing and walking, relieved when flexing the hip

A

Spinal stenosis

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128
Q

Main imaging for spinal stenosis

A

MRI

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129
Q

Mild to moderate spinal stenosis treatment

A

NSAIDs, weight loss and abdominal muscle strengthening

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130
Q

Advanced spinal stenosis treatment

A

Epidural corticosteroid injection

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131
Q

Treatment for refractory spinal stenosis

A

Surgical laminectomy

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132
Q

Main treatment and management of spondylosis/spondylolisthesis

A

Can prescribe two weeks of bedrest and symptom control. Due close follow-up. If there’s any neurological injury or of the bedrest doesn’t work do imaging. Spine surgery can be obtained

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133
Q

Diagnose the nerve root

Patient has absent plantar flexion and weak hip extension. Achilles reflex is negative. Lateral aspect of the foot in little toe have no sensation

A

S1

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134
Q

Diagnosed nerve root

Big toe cannot dorsiflex. Foot cannot advert. Patella an Achilles reflex are okay. Dorsum of the foot and lateral aspect of the lower leg has no sensation

A

L

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135
Q

Diagnose the nerve root

Week hip flexion and weak foot dorsi flexion. Absent patella Reflects. Anterior thigh and medial aspect of the lower leg has poor sensation

A

L2 - L4

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136
Q

Diagnose the nerve root lesion

Incontinence and impotence. Anocutaneous reflex absent. Posterior medial thigh and perianal Anastasia

A

S2 – S4

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137
Q

What is osteochondritis dissecans

A

An adolescent condition with subchondral bone detaches from underlying bone. Seen in heavily active voice. Presents with dough joint pain worsening with activity, stiffness, crepitus, swelling. Antalgic gate, catching unlocking sensation

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138
Q

Discuss the diagnosis of osteochondritis dissecans

A

X-ray, can see subchondral bone fragment. If radiograph as normal but still suspect do MRI

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139
Q

Treatment for osteochondritis dissecans

A

 Rest, physical therapy and surgery in severe cases

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140
Q

Thank Treatment for bursitis. Consider if septic or nonseptic

A

Nonseptic just do activity modification and NSAIDs. If septic then systemic antibiotics and surgical debridment maybe needed

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141
Q

What is pes anserinus pain syndrome

A

A bursitis. Located at the anterior medial tibia at the insertion of the Pes anserinus. Pain develops over weeks, worse at night, worse when in use, Valgus stress test doesn’t aggravate pain

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142
Q

Treatment for pes anserinus pain syndrome 

A

NSAIDs and strengthen the quadricep

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143
Q

Patient presents with boxers fracture and abrasions over the skin. How we manage

A

If skin is broken in boxers fracture have to do surgical debride meant and give IV antibiotics to cover Eikenella

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144
Q

Best initial treatment for patellofemoral syndrome. First line regime? And what is CI in septic bursitis

A

Rest, heat and ice, elevation and NSAIDs. Physical therapy to strengthen quadriceps. Intrabursal steroid injection potentially considered (contraindicated in septic bursitis)

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145
Q

What is Morton neuroma, what’s the Tx

A

Degeneration of the nerves between the toes due to compression of the metatarsals (walking on hard surfaces or high heels). Often have a clicking sensation palpating joint space, and get numbness and pain and paraesthesia. Treat with padded inserts in the shoes

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146
Q

Diagnostic procedure to confirm gout

A

Join aspiration an analysis of crystals

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147
Q

What can you see on x-ray for gout

A

Rat bite erosions. Which is punched out erosions with an overhanging cortical bone

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148
Q

Discuss treatment for a cute gout attack

A

Hide those incidents like indomethacin of first line. Steroids are used if NSAIDs are contraindicated or ineffective. Inject if one or two joints, systemic if multiple joints. Colchicine can also be used as well

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149
Q

When is maintenance therapy needed for gout patience

A

If you have two or more attacks annually, your presence of tophi or you have structural joint damage

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150
Q

 Probenecid is contraindicated in which cases 

A

Patience with tophi, nephrolithiasis or chronic kidney disease

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151
Q

What is adhesive capsulitis, how’s it diagnose how is it managed

A

Glenohumeral joint pathology, where it loses normal range of movement. Can be due to lots of things (such as fracture, rotator cuff injury, surgery, hypothyroidism, stroke, etc.) Presents with nagging shoulder pain and decrease range of movement. Clinically diagnosed, imaging only needed to rule out other pathology. Treatment includes exercises and therapy. NSAIDs and surgery needed if refractory

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152
Q

What are the Neer and Hawkins signs, and what are they related to

A

They are both signs of rotator cuff impingement (not tear). Hawkins is pain when internally rotating arm that is 90° and flexed. Neer Is pain when passively raising an internally rotated arm.

153
Q

What sign is usually indicative that the rotator cuff has torn and not just been impinged

A

Drop arm test. Positive if patient drops arm while lowering yet from 90° of abduction

154
Q

Diagnosis for rotator cuff impingement and then rotator cuff tear

A

Impingement do x-ray. If you suspect her MRI is best

155
Q

Volkmann contracture

A

Contracture of the wrist and fingers due to compartment syndrome following a supracondylar humeral fracture. Affecting the brachial artery and radial nerve

156
Q

Early signs and late signs of compartment syndrome

A

Early: pain out of proportion and paresthesia
Late: pallor and poikilothermia, then paralysis and pulselessness

157
Q

What is the delta pressure in compartment syndrome

A

Diastolic pressure minus compartment pressure. If pressure less than or equal to 30 then compartment syndrome is diagnosed

158
Q

Treatment for compartment syndrome

A

Fasciotomy

159
Q

Treatment of rhabdomyolysis

A

IV fluid resource and correct electrolytes. Three any aetiology

160
Q

What is the magic number of hours compartment syndrome can last before major complications occur

A

Six hours must do fasciotomy

161
Q

Best initial treatment for carpal tunnel

A

Splint of the wrist at night and day if possible

162
Q

Medical therapy that can be given in carpal tunnel

A

Steroid injection and NSAIDs

163
Q

Definitive treatment for carpal tunnel

A

Surgical decompression

164
Q

Discuss treatment regime for hand infections/bite wounds. Mention different sources of bite, if there is necrosis, if the septic arthritis

A

Broad spec antibiotics until culture is confirmed. If cat and dog cover Pasteurella and staphylococcus and streptococcus. If human cover eikenalla, and strep. Any necrosis requires surgical debride meant. Any septic arthritis requires joint aspiration and surgical debride to

165
Q

Other than clinical what other investigations can you do in hand infections/bite wounds

A

Usual lab studies, culture of the wound, X-ray is first line Imaging (to see if there is emphysema, foreign body, osteomyelitis et cetera

166
Q

Treatment of dupytrens contracture

A

Fasciotomy or fasciectomy. Percutaneous needle aponeurotomy is less invasive but less effective

167
Q

Diagnosis of avascular necrosis

A

X-ray first. MRI is good standard for negative x-ray and high suspicion. Recalled that scaffold fractures and AVN is associated with a negative x-ray for 2 to 6 weeks

168
Q

Treatment for femoral head AVN

A

Total hip replacement

169
Q

Scaphoid AVN treatment

A

Wrist splints after full and surgical referral if displaced or vascular compromise

170
Q

Patient 6mo after femoral neck fracture, presents with groin pain and inability to place weight on that side. What is the likely diagnosis

A

Avascular necrosis

171
Q

Femoroacetabular impingement syndrome…

A

Femoral head compresses the acetabular rim. Gradual onset of pain excaverbated by sitting/flexing the hip

172
Q

Patient has pain on lateral hip, especially when walking upstairs or generally flexing the hip. Palpating elicits pain on lateral hip. Dx?

A

Greater trochanteric PAin syndrome

173
Q

IVDU, 20-30 year old. With back pain, and tender spinous processes with light touch. No fever or high WBC. What’s the diagnosis

A

Vertebral osteomyelitis

174
Q

Main treatment for Meralgia paresthica

A

Conservative. Lose weight, loose clothes etc.
Nerve block or gabapentin if persitient

175
Q

Hook-like osteophytes is seen in which disease?

A

Hemochromatosis induced arthritis

176
Q

The Rat bite lesion seen on x ray is part of what disease

A

Gout. Where there is bone erosion and overhanging cortisone bone

177
Q

Dx this;
5 year old boy, with limp for few months. Initial X-rays were normal. BMI normal. No muscle pain, and hip pain is fairly stable. Cannot place weight on on leg. Limited abduction and internal rotation of hip.

A

Legg Calvé Perthens disease

178
Q

Contrast septic and overuse bursitis

A

Overuse: swollen and painful. History of overuse. Do RICE Mx

Septic: red and warm and painful. Aspirate to confirm. Abx given and even drain if persistent

179
Q

If some random person has posting antiphospholipid antibodies… what may this mean

A

A few people have transient positive APL Abs, so repeat the bloods a few months later

180
Q

Overview of Mx for Acute uncomplicated lower back pain

A

Heat pad and other non med stuff. NSAID is first line med. can add non benzo muscle relaxant

181
Q

What indicates that Genu Varum is physiological. How to Mx

A

No leg length discrepancy.
Symmetrical
Around 2 years old
Slightly short
Good ROM

Observe and reassure

182
Q

Giant cell tumour tx

A

Surgery (1st). Denosunab can shrink the tumour

183
Q

Moth eaten, onion skinning, codmans triangle.. seen in what Dx on X-RAY

A

Ewing Sarcoma

184
Q

Patient has signs of OA. very clear. Do we need to do further imaging?

A

No more invx needed. X-RAY NOT RECQUIRED

185
Q

Dx this:

5 year old boy. 3 mo Hx of on and off Thigh pains at night, and a little shin pain. Worse on active days. Whole exam and labs normal.

A

Growing pain. Aka idiopathic nocturnal pains of childhood

186
Q

Diagnose this;
Older patient, sudden back pain when doing light excersize.
Ain is midline, and point tender. Remains at night, worse when cough.
How to invx

A

Compression fracture, do X-ray and DEXA.

187
Q

What is complex regional,pain syndrome, and how is it Mx’d

A

Unknown pathophys, but occurs after trauma. Usually over weeks. Pain is burning or stinging, and not dermatomal. Can be red, warm, edematous, low ROM. But bloods will be normal and X-ray will show patchy osteopenia. Tx by educating P, and excersize. Can also do NSAID, gabapentin, TCA etc.

188
Q

Clavicle fracture risk to vessels? How to invx?

A

Yes can pierce the subclavian vessels. Give fluids (patient likely unstable). If they improve, do CT chest to check to issues. If they remain unstable do exploratory thoractomy.

189
Q

Dx this:
Patient with acheing hip. Externally rotated and flexed hip. Recently had a episode of diahrrea. No tenderness or gross issues.wbc normal, esr normal.

A

Transient synovitis (likely secondary to viral illness)

190
Q

Greater trochanteric pain syndrome

A

Overuse of glutes, that run over the greater trochanter, causing pain. Point tenderness over the lateral hip (burning feeling). Worse when active. Tx by excersize, NSAID, and injected CS if refractory

191
Q

What is adhesive capsulitis? How is it Tx

A

Glenohumeral joint capsule contracture, begins with pain, then more stiffness. No local tenderness, and no X-ray findings. Has Decreased ROM in multiple planes. Main RFs are TIIDM and hypothyroidism. Usual Tx, of NSAID, excersizes, and even injected GCs

192
Q

Myofascial pain syndrome versus fibromyalgia clinically

A

Myofascial pain syndrome has trigger points, that when palpated cause pain in the target zones. Fibromyalgia just has pain where you have paint

193
Q

Transient synovitis

A

Usually in younger children, following minor infx. Bloods roughly normal, X-ray normal, abducted and externally rotated, but can bear weight on leg. Give NSAID and rest

194
Q

Compare and contrast different causes of horn in lower back pain. Ie, infx, ca, mechanical, inflammatory etc.

A
195
Q

FOOSH FRACTURES

A
196
Q

Shoulder dislocation, reduced ok. Then paintient has pain and unable to abduct arm. No sensation issue

A

Rotator cuff tear.

197
Q

Difference in hammer and claw toe deformity…. At the joint level

A
198
Q

Deformities in the foot of diabetics

A

Claw toe and hammer toe deformities reflect an imbalance in strength and flexibility between the flexor and extensor muscle groups. In a patient with longstanding diabetes, these deformities may suggest underlying diabetic peripheral neuropathy. Other complications of diabetic neuropathy include callusing, ulceration, joint subluxation, and Charcot arthropathy.

199
Q

Fractures suggesting child abuse

A

Bruises/fractures at various stages of healing
• Femur fracture in nonambulatory infant
• Posterior rib fractures
• Metaphyseal corner fractures
• Retinal & subdural hemorrhages

200
Q

Colles fracture can compress which nerve

A

Median nerve

201
Q

Gout tophi appearance on X-ray

A

Bone erosion and overhanging edges of cortical bone

202
Q

Chronic bursitis vs tophi on palpating

A

Chronic bursitis (also caused by gout) is round and fluctaunt

203
Q

What is trigger thumb

A

Stenosing tenosynovitis (“trigger thumb”) results in pain over the palmar aspect of the first
metacarpophalangeal joint; the pain is associated with a catching sensation during movement or locking of the thumb in flexion.

204
Q

Tibial Stress fracture vs medial tibial stress syndrome (shin splints)

A

Tibial stress fracture often seen in our athletic female triad etc. and shows insidious point tenderness. shin splints usually seen on overweight casual runners, but not always, and had diffuse tenderness, not point .

205
Q

Tibial stress fracture details

A

High in athletic female triad, and in extreme exercises. Increase vit D. Insidious onset of point tender pain. And X-rays are negative until weeks after

206
Q

Discuss the clinical approach to transient synovitis patients. When to US, when to sus septic arthritis.

A

Acute, traumatic hip pain in children is typically caused by transient synovitis, which presents in well-
appearing children who are often febrile and able to ambulate. However, patients with features
concerning for septic arthritis (eg, inability to ambulate, leukocytosis) require bilateral hip ultrasound, with or without arthrocentesis, to distinguish between the conditions. If the ultrasound shows unilateral fluid, do arthrocentesis

207
Q

Causes and Mx of Charcot joint

A

DM, tabes d, syringomyelia, b12 def, SC injury. Do mechanical offloading and consider cast

208
Q

X-ray findings of Charcot joint

A

Bone loss, osteophytes and even bone fragments

209
Q

Chronic osteomyelitis findings on X-ray

A
210
Q

Calcaneal apophysitis vs plantar fasc

A

Former is what I had!! Literally carbon copy of me. It’s sort of the lagoon schaltter in the heal. Plantar fasciitis is unilateral usually and gets better throughout the day

211
Q

Extraadticular manifestations of RA

A

Lung fibrosis and nodules, effusions, pulmonary HTN, atheroscle, osteoP, anemia, fever, weight loss, fatigue, depression, scleritis and episcleritis, neuropathy

212
Q

High risk areas for stress fracture

A

Metatarsal, tibia

213
Q

Repetitive running, point tender bone, insidious onset

A

Stress fracture

214
Q

Pain in between third and fourth toes, with clicking and squeezing them together

A

Morton neuroma

215
Q

Pain at lateral epicondyle on passive flex and active extension on wrist. Tender at lateral distil humerus

A

Tennis elbow (lateral epicondylitis). Vice versa or golfers eblow

216
Q

What is radial tunnel syndrome

A

Radial tunnel syndrome is caused by compression of the radial nerve where it passes under
the supinator. Although it may cause lateral elbow pain resembling lateral epicondylitis, the tenderness is
typically greatest at the margin of the supinator several centimeters distal to the elbow, rather than at the
lateral epicondyle (eg, lateral distal humerus) as in this patient.

217
Q

Mixed connective tissues disorder mix of which three disorders. Which antibody seen

A

SLE, SysScl, Polymyositis

218
Q

What is the definition of chronic non specific lower back pain

A

Pain for more than 3 months with no specific etiollogy. All the scary stuff ruled out

219
Q

How to manage non specific lower back pain (consider if acute or chronic)

A

Acute, can do intermittent NSAIDs and moderate activity. If chronic do Normal activity, stretching and strengthening excersizes, heat and even CBT. Intermittent NSAIDs, SSRIs can also be tried in chronic when needed

220
Q

Hemochromatosis osteoarthropathy affects where the most

A

2nd and 3rd MCP. AND WRIST. like an OA but not in the DIP PIP, and in younger patients. Has chondrocalcinosis and hook like osteophytes

221
Q

Young Patient with diabetes, OA in the hands (MCP), and high LFTS

A

Hereditary hemochromatosis

222
Q

Mx of HH osteoarthopathy

A

NSAID, paracetamol. Or phlebotomy if severe

223
Q

Being vegetarian a risk factor for osteoporosis.?

A

No. Being vegan kinda is… but only really in the case of a low BMI vegan

224
Q

How can salter Harris III and IV fractures cause growth long term leg length discrep

A

The distal tibial growth plate typically closes around age 14 in boys (age 12 in girls), and fractures involving the maturing, partially fused, physis (eg, Salter-Harris type Ill and IV fractures) carry an increased risk for long-term complications. In particular, injury to the growth plate can cause growth arrest and lead to persistent limb-length discrepancy.

225
Q

Three main fractures to cause avasc necrosis

A

Post-fracture vascular necrosis is most common in areas of bone with limited blood supply
such as the scaphoid, femoral head, or metadiaphyseal junction of the fifth metatarsal

226
Q

Foot drop is a complication of which fracture

A

Traumatic foot drop is typically caused by injury to the common peroneal nerve where it wraps
around the lateral neck of the proximal fibula.

227
Q

Characteristics of physiologic gen varum include:

A

• Symmetric bowing
• Normal stature
• No leg length discrepancy
• No lateral thrust when walking

228
Q

What is lateral thrust in genu varum

A

Patient stands in one leg, and the bowing worsens

229
Q

How to treat radial head subluxation

A

While pressure is applied at the radial head, forearm hyperpronation or supination plus flexion usually reduces the annular ligament with an audible click. Either maneuver should restore full, normal use of the extremity. The response to reduction is diagnostic of this condition.

230
Q

Recap on Sever disease

A

Calcaneal apophysitis is a common cause of heel pain in children who play running or jumping sports.
Tenderness at the base of the heel and with calcaneal compression are diagnostic findings. Treatment is supportive.

231
Q

Last resort Tx for meralgia P

A

Patients with persistent symptoms may respond to anticonvulsants (eg, gabapentin) or local nerve block.

232
Q

Main two causes of myosotis ossificance. And the general Tx of it

A

Traumatic: muscle injury, fracture, orthopedic surgery (eg, arthroplasty)
Neurogenic: stroke, traumatic brain injury, spinal cord injury

Give NSAID, and do ROM excersizes, can do Sx removal

233
Q

When is pain worse in osteosarcoma? Or bone cancer generally

A

Neoplastic bone disorders (eg: osteosarcoma) classically present with deep pain that is worse
at night.

234
Q

Generally indications to do X-RAY or MRI in chronic lower back pain

A

X-RAY
Osteoporosis/compression fracture
• Suspected malignancy
Ankylosing spondylitis (eg, insidious onset, nocturnal pain, better
with movement)

MRI
• Sensory/motor deficits
• Cauda equina syndrome (eg, urine retention, saddle anesthesia)
Suspected epidural abscess/infection (eg, fever, intravenous
drug abuse, concurrent infection, hemodialysis)

235
Q

Causes of trendelenberg in younger patients, not nerve related. If groin pain present

A

conditions causing a Trendelenburg sign (eg, developmental
dysplasia of hip, avascular necrosis of femoral head, SCFE) also warrant bilateral hip x-rays.

236
Q

SCFE presentation

A

SCFE classically presents in adolescence with chronic, progressive pain of the hip, groin, or knee. Examination shows decreased abduction and internal rotation of the hip, as seen by this patient’s externally rotated foot. Opposite of Leg Calve perthers?

237
Q

Chronic osteomyelitis in setting of fracture. Signs, Dx and mx

A

Wound and sinus drainage, and lil pain. History of fracture in area. Non union. Do X-ray and bone biopsy. Sx debride and abx

238
Q

Radial subluxation vs fracture…,key signs

A

Fracture will have more pain, point tender, swell. Subluxation patient will hold arm in pronation

239
Q

Patient with potential radial subluxation… and is above 5 years old. Why do we need X-ray now?

A

Because subluxation is rare above 5… so could be a fracture

240
Q

Mx of Achilles tendinopathy

A

Acute: activity modification, ice, NSAIDs
Chronic: eccentric resistance exercises

241
Q

Contrast sever disease and Achilles tendinopathy and enthesitis

A

Sever is in adol who do jumping and extreme excersize. And is within 2cm on calcareous. Achilles tendinopathy is in excersizes, GCs, quinolones, and not so much in adol. It is more than 3 cm from calcaneous. Enthesitis is almost Always seen in HLA b27 arthrop

242
Q

Which knee ligament, when torn, causes significant effusion

A

ACL

243
Q

Rotator cuff impingement vs tear

A

Impinge
Pain with abduction, external rotation
Subacromial tenderness
Rotator cuff impingement or
tendinopathy
Normal range of motion with positive impingement tests
(eg, Neer, Hawkins)

Rotator cuff tear
• Similar to rotator cuff tendinopathy
• Weakness with abduction & external rotation
• Age >40

244
Q

In occult supracondylar fractures, what can be seen in xray

A

Fat pads

245
Q

Neer test

A

Thumb to ground (pronated arm) then raise arm in front on patient. Sign of rotator cuff tendinopathy

246
Q

Common causes of transient tenovosynovits

A

Post viral, extreme excersize and trauma

247
Q

Compare differences between SLE and DILE

A

Compared with systemic lupus erythematosus, drug-induced lupus erythematosus produces more abrupt symptom onset, is less likely to involve the skin, and affects men and women of any age.

248
Q

Causes of DILE

A

Most common: procainamide, hydralazine, penicillamine
• Others: minocycline, TNF-a inhibitors (eg, etanercept, infliximab), isoniazid

249
Q

How to diagnose sacroilititis. If this test is negative?

A

x-rays of the pelvis showing sacroiliitis can confirm the diagnosis of AS. However, ×-rays may be negative in early stages; MRI can confirm sacroiliitis in such cases.

250
Q

Diagnosis and Mx of fat emboli syndrome

A

FES is a
clinical diagnosis, and management is supportive.

251
Q

Asymmetrical thigh creases in child….

A

Dev dysplasia sign

252
Q

When does pseudogout usually occur in patients with chronic chondrocalcinosis

A

Attacks of pseudogout often occur in the setting of trauma/overuse, surgery, or medical
illness.

253
Q

Red flags and supportive findings for dev dysplasia of hip. Generally what should you do if there is a red flag, or supportive findings

A

Red flags
- Positive Ortolani test
• Dislocated hip
• Limited hip abduction
=refer to otho for sx

Supportive findings
• Limb length discrepancy
• Asymmetric gluteal/inguinal/thigh creases
= do US (less than 4mo) or X-ray (more than 4mo)

254
Q

Treatment for scleroderma renal crisis… how does it help?

A

ACEi. Since in renal crisis we see renal damage, increasing RAAS, which increases BP, then kidney damaged more

255
Q

Is hypothyroidism risk factor for SCFE

A

Yes, since there will be less ossification

256
Q

Shoulder pain how to differentiate

A

Rotator cuff tendinopathy
• Pain with abduction (overhead activities) or external rotation
- Strength preserved

Rotator cuff tear
- Similar to rotator cuff tendinopathy
• Weakness

Adhesive capsulitis
• Decreased passive & active range of shoulder motion
(frozen shoulder)
AC joint sprain
• Pain over AC joint
• Passive shoulder adduction provokes pain

Biceps tendinopathy
• Pain over bicipital groove

257
Q

We all know about drain till dry for septic arthritis. But how do we manage it if it’s deep and cannot aspirate

A

Surgical/arthroscopic irrigation

258
Q

Lyme disease clinical features early local, early dissem and late signs

A

Early localized
(days to 1 month)
• Erythema migrans
Fatique, headache
Myalgias, arthralgias
Multiple erythema migrans
Unilateral/bilateral CN palsy (eg, CN VIl)

Early disseminated
(weeks to months)
• Meningitis
• Carditis (eg, AV block)
Migratory arthralgias
• Arthritis

Late
(months to years)
• Encephalitis
• Peripheral neuropathy

259
Q

Features of mild Osteogenisis Imperfecta

A

Frequent fractures
• Blue sclera
• Conductive hearing loss
• Short to normal stature
• Dentinogenesis imperfecta
• Joint hypermobility

260
Q

Achondroplasia gene mutation

A

Achondroplasia is caused by a fibroblast growth factor receptor

261
Q

Urine hydroxyproline. What is it used to measure

A

Urine hydroxyproline is derived almost exclusively from the breakdown of collagen, so it’s high when there is resorp of bone

262
Q

Gout preventative measures (non pharma)

A

•Weight loss to achieve BMI <25 kg/m?
• Low-fat diet
• Decreased seafood & red meat intake
• Protein intake preferably from vegetable & low-fat dairy products
Avoidance of organ-rich foods (eg, liver & sweetbreads)
• Avoidance of beer & distilled spirits
• Avoidance of diuretics when possible

263
Q

Meds causing increase gout attacks

A

thiazide and loop diuretics, aspirin, and beta blockers, can increase the risk of gouty attacks.

264
Q

Dx
Pain at plantar aspect of heel & hindfoot
Worse with weight bearing (especially after prolonged rest). Worse in the morning and after long walks.
Pain with dorsiflexion of toes

A

Plantar fasciitis

265
Q

X-ray in plantar fasciitis may show calcifications in the proximal fascia (heel
spurs), is this sens, spec?

A

but this is neither sensitive nor specific.

266
Q

Compartment syndrome common and uncommon signs

A

Pain out of proportion to injury
• Pain 1 on passive stretch
• Rapidly increasing & tense swelling
• Paresthesia (early)

Uncommon
• Low Sensation
• Motor weakness (within hours)
• Paralysis (late)
• | Distal pulses (uncommon)

267
Q

Toe stress fracture Mx. If middle toes, or 5th toes

A

Middle toes just do rest and analgesia (since surrounding toes keep it in place)

5th toe needs casting or internal fixation

268
Q

Describe post amputation disorders. Acute stump pain, is medic pain, post traumatic neuroma, phantom limb pain

A

Acute stump pain
Tissue & nerve injury
• Severe pain lasting 1-3 weeks

Ischemic pain
• Swelling, skin discoloration
• Wound breakdown
• | Transcutaneous oxygen tension

Post-traumatic neuroma
• Weeks to months after amputation
• Focal tenderness, altered local sensation
• | Pain with anesthetic injection

Phantom limb pain
• Onset usually within 1 week
• Increased risk in patients with severe acute pain
• Intermittent cramping, burning felt in distal limb

269
Q

Minor criteria for rheum fever.? (recall need 2 major, or 1 minor and 2 major to Dx)

A

Fever
Minor
• Arthralgias
• Elevated ESR/CRP
• Prolonged PR interval

270
Q

Two main differences between acute rheum fever and JIA

A

Systemic juvenile idiopathic arthritis is diagnosed when arthritis is present for >6 weeks. And the arthritis is not migratory

271
Q

Triad of one type of disseminated gonoccocal infx. How to Dx

A

triad of pustular rash, migrating arthralgia, and tenosynovitis. Do urogen NAAT

Other type is just septic monoarthtiris

272
Q

Tx for acute non specific LBP. Consider two non pharma, first line pharma, and second line pharma

A
273
Q

Spinal issues in DMD

A

Scoliosis

274
Q

Aside from calcinosis, Pseudogout is also associated with ?
and ?.

A

Hemohromatosis and hypothyroidism

275
Q

Neck pain differential:

History of neck injury, and pain/stiffness with neck movement

A

Most likely a strain

276
Q

Neck pain differential:

Old patient, pain and stiffness in the neck which is worse with movement, I’m relieved by rest.

A

Likely facet osteoarthritis

277
Q

Neck pain:

Neck pain that radiates to the shoulder/arm, with a dermatomal sensory motor and reflex finding. Spurling test positive

A

Radiculopathy

278
Q

Neck pain differential:

Lhermitte sign, lower extremity weakness bilaterally, some bladder and bowel dysfunction, a bit of gait,

A

Cervical myelopathy

279
Q

Neck pain differential:

Pain is constant, and especially worse at night. Pain does not change when moving position.

Tender spinous processes

A

Spinal metastasis

280
Q

Neck pain differential:

Focal tenderness, fever and night sweats, IVDU, recent infection, immuno compromised

A

Vertebral osteomyelitis

281
Q

Name as many causes of carpal tunnel as you can

A

Idiopathic/overuse, hypothyroidism, diabetes, rheumatoid arthritis, pregnancy, renal disease, acromegaly, gout

282
Q

anterior shoulder pain radiating to the upper arm. partial weakness of shoulder flexion, abduction is not affected. noticeable bulge in the anterior arm. Dx?

A

Biceps tendinopathy

283
Q

Suprascaupular nerve injury signs and causes

A

Back packs, weights, baseball etc. compresses the nerve. Causing triad of shoulder pain, weak abd and external rotation of shoulder. May also increase pain when addict arm across body

284
Q

FetaL US: Foot in same plain as fibula and tibia

Means what?

A

Clubfoot (talipes equinovarus)

285
Q

Positional clubfoot vs proper clubfoot main different

A

Positional talipes foot can be easily moved and corrected. Proper clubfoot is fixed

286
Q

General Mx for humeral fracture . Not in Mx sheet

A

most cases treated nonsurgically (eg, closed reduction followed by arm immobilization with a coaptation or sugar-tong splint), open reduction and surgical exploration are indicated with open fractures, significant displacement (g, arm shortening, as in this patient), neurovascular compromise (eg, asymmetric radial pulses, as in this patient), polytrauma, and pathologic fractures.

287
Q

Patient has hip fracture and another potential issue (HF, Pneumonia etc.). What is thing to do? How long can we delay for

A

Delay up 72 hr and find cause and stabilise P.

288
Q

Intracapsular vs extracapsular hip fracture…. General Mx rules. Not details

A

Intracapsular higher risk of AVN…. Whereas extracapsular has higher need for nails and rods

289
Q

Spinal stenosis worse with spinal flexion or extension

A

Extension (shopping cart sign)

290
Q

Lumbar muscular pain signs

A

Lumbar muscle strain is the most common cause of low back pain; however, muscle strains
are usually worsened with activity, alleviated by rest, and associated with paraspinal tenderness (not focal vertebral tenderness).

291
Q

Why might plantarflexion be kept in Achilles’ tendon rupture

A

Because there are other muscles that do this movement. That’s why Thompson test is vital

292
Q

Imaging of choice for osteomyelitis

A

MRI

293
Q

Management overview for osteomyelitis. Mention if staph, MRSA, gram-negative

A

Once diagnosed, do surgical department and IV antibiotics for one month. If staff give either Cipro, ampicillin, nafcillin. If MRSA give vanco. If gram negative give foxy

294
Q

 Spinal stenosis management. Consider if mild, advanced, refractory

A

Mild to moderate you can just give NSAIDs and decrease weight. If advanced or more acute can do epidural corticosteroid injection. If refractory do laminectomy (above 75% stenosis)

295
Q

When do you normally do Sx for spondylosis or spondylolisthesis

A

If neuro injury. Otherwise do bed rest, symptom control, close follow up

296
Q

JIA has a risk to the eyes?

A

Risk of uveitis

297
Q

JIA and ankylosing spondylitis, first line therapy is what for both

A

NSAID

298
Q

Management of SLE. Consider main medication is prevalent joint, Reno, problems. Main medication for flare. Cornerstone medication for long-term

A

For joints give NSAIDs. For renal disorder consider cyclo phosphide or mycophenolate. For flare give steroids. For long-term management hydroxychloroquine is best

299
Q

For Behcets We know corticosteroids can be given topically. What can be given for recurrence prevention

A

Colchicine

300
Q

For polyarteritis nodosa, what’s the main imaging we do. What’s the gold standard diagnostic tool (not always needed

A

CT Angio is the best imaging. Biopsy is gold standard

301
Q

Clavicle fracture. The so-called soft and hard signs. How to manage in the presence of either one

A

Soft signs: decrease pulses, decrease blood pressure, minor haematoma. Do CTA

Hard signs: no pulse, bruit, large and expanding haematoma. Do surgery immediately

302
Q

Management of Colles’ fracture. Then what happens if it’s open? Or intra-articular or displaced?

A

Most of the time you do close reduction and put in a cast. If open fracture, intra-articular, displaced do open reduction

303
Q

When would you do ORIF in scaphoid fracture

A

If there is non-union or there is more than 1 mm displacement

304
Q

General rule with Salter-Harris fractures, regarding treatment

A

One two and three can do close reduction. Four usually needs open reduction. Five varies based on severity

305
Q

Meralgia paresthica doesn’t cause weakness, why?

A

Lat fem cut nerve doesn’t have motor element

306
Q

Dermatomal of the groin and upper leg revise

A
307
Q

Three-year-old child with right knee swelling and pain. Presentation is inflammatory (Wasim morning veteran day). Can bear weight, skin as normal, not that tender

A

Likely JIa oligo arthritis type

308
Q

If giving patient Vanco for septic arthritis, and it’s not getting better. What antibiotic do I add

A

Foxy

309
Q

Close toe and hammertoe can both be seen in what complication of diabetes

A

Neuropathy

310
Q

Hi suspicion of abuse (MSK question) what kind of investigation should we do

A

Skeletal survey, philosophy, head CT. Then of course the other stuff

311
Q

Three main side effects of methotrexate

A

Stomatitis, hepatotoxicity, cytopenia

312
Q

When does the anterior fontanelle close

A

1yr

313
Q

Which nerve is susceptible in Colles’ fracture

A

Median

314
Q

What is the onion skinning in ewing sarcoma

A

Cortical layering

315
Q

In charcot joint, What might we see

A

Bone loss, osteophytes, bone fragments

316
Q

Is plantar fasciitis usually unilateral or bilateral. Is calcaneal apophysitis usually unilateral or bilateral

A

Unilateral, bilateral respectively

317
Q

Just because you had a mind blip: morning stiffness of less than 30 minutes indicates what

A

Mechanical.

318
Q

If transient synovitis is a clear clinical picture, and as mild pain. And no red flags (yes as normal, white blood cell count is normal) how we manage next

A

Ibuprofen and follow up

319
Q

If a transient synovitis case has some alarm signs, (very bad pain, refuse to walk, high ESR, high WBC) and if the diagnosis is in 100% set. How do we manage next

A

US. If it is unilateral, we have to do an athro centesis

320
Q

If C osteoarthritis like signs in a younger patient. LFTs are elevated or patient has diabetes what are you thinking

A

Hereditary haemochromatosis

321
Q

What is the triad of diseases in mixed connective tissue

A

Lupus, scleroderma, polymyositis

322
Q

Other than viral infections, what is the other cause of transient Tenosynovitis

A

Trauma/exercise

323
Q

Haitian on hydralazine, suddenly get pleurisy or pericarditis

A

Considered DILE

324
Q

In calcaneal apophysitis, what manoeuvre will hurt

A

Dorsey flexion

325
Q

Myositis ossificans, name a couple of significant clinical findings. How do you manage

A

Mobile solid mass in an area that had trauma a few weeks ago. Often has pain when the muscle is stretched. NSAIDs are given, consider surgical excision

326
Q

Calcaneal apophysitis is within how many centimetres of the calcaneous (in terms of pain

A

2! If more than to consider Achilles tendinopathy

327
Q

Acute Achilles tendinopathy can just be treated with ice and NSAIDs. How can we tackle chronic tendinopathy

A

Resistance training

328
Q

We know patellofemoral is often seen in patience to do a lot of exercise. What deformity can be responsible

A

Angular deformities. So just check for this

329
Q

What is the compression test and is it positive in patellofemoral

A

Extend the knee and Press and the patella. It will be painful. And yes it is

330
Q

If in fracture, or dislocation. Arm or leg is swollen and pale, and it’s failing to have pain management with opioids. What’s the likely diagnosis

A

Compartment syndrome

331
Q

Management of fat Emboli syndrome

A

It is a clinical diagnosis and supportive management

332
Q

Sickle crisis before six months. Is it likely

A

No

333
Q

Call the Management for dev Dysplasia

A

Do you have any of the red flags (Ortolani for example) then Refer straight to ortho. If only support of findings to ultrasound of less than four months old, do x-ray if more than four months old

334
Q

Which disorder is hypothyroidism a risk for

A

SCFE

335
Q

Alcohol is a risk factor for which hip disorder

A

Avascular necrosis

336
Q

Nonlocalised knee pain, in a younger woman. Pain when contract quad muscle

A

Patellofemoral

337
Q

Recall our pes anserine bursitis management

A

Rest, NSAID, quad/hamstring management

338
Q

If have secondary Reynolds, what is a good lad to do first

A

ANA. Since many connective tissue disorder is actually have railroads, it’s good to do ANA first.

339
Q

Nephritic syndrome, low 3 and C4, palpable purpura on the legs.

A

Mixed cryoglobulinaemia. Wagners would not have low compliment. Polyarteritis nodosa would not cause low compliment or an nephritic

340
Q

How to confirm the presence of a painful traumatic neuroma

A

Can inject a local anaesthetic, if it helps, it’s probably the diagnosis

341
Q

As divine said. Tender paraspinal lumber acute onset is usually a sign of what

A

Muscle sprain. So given non-benzo muscle relaxant if NSAIDs didn’t work

342
Q

If a shoulder or arm pain is relieved when a patient puts their hand on the head what is this

A

Cervical radiculopathy

343
Q

Vertebral compression fracture versus sprain

A

Sprain will be relieved with rest, and will have tender or spasms of the paraspinal muscle. Fracture will have point tenderness usually at the spinous process. And will not be relieved with rest

344
Q

Once remission is induced by steroids in polymyositis, what do we go onto

A

Methotrexate or Azathioprine 

345
Q

Patient has pain on the lateral hip Describe does burning. Worse when active and tender on deep palpation.

A

Not meralgia paraesthetica. Greater trochanteric pain syndrome

346
Q

Some tests I have to do before putting a patient on methotrexate

A

Hepatitis and pregnancy for example

347
Q

Name two metabolic disorders that are risks for adhesive capsulitis

A

Hypothyroidism and diabetes

348
Q

The buzz term tender passive extension or flexion especially in the setting of swollen or tense compartment.

A

Compartment syndrome

349
Q

Do I need to do an x-ray in a clear clinical osteo arthritis

A

You world says no

350
Q

Lateral thigh pins and needles and numbness and pain. Works on Valsalva. Obese patient. No tenderness to the femoral epicondyle

A

Meralgia paraesthetica

351
Q

Radiotracer uptake in multiple myeloma versus Padgett

A

Myeloma it’s gonna have decrease uptake. Padgett is going to have increase

352
Q

Foot pain near here, worse when stands after sitting for a while.

Especially worth of patient runs barefoot.

A

Plantar fasciitis

353
Q

Dermato myositis patient…. Sudden weakness or stiffness of extension of arm

A

Maybe rotator cuff tear

354
Q

Risk factors for AVN in scaphoid fracture

A

Proximal, comminuted, displaced, fracture, smoker

355
Q

More than 1mm displacement of a scaphoid fracture

A

Consider ORIF

356
Q

Anterior hip dislocation… nerve damage

A

Obruator

357
Q

What medication to give in patient with hip fracture

A

Anticoag

358
Q

If high risk of displacement of femoral neck fracture… consider ??

A

Arthroplasty

359
Q

Injuries causing ACL injury

A

Hyper extension or landing on extended leg

360
Q

Casual excersize and overweight person. More shin splints or stress fracture

A

Shin splints. Tibial stress, is more female athletic triad, and foot misalignment

361
Q

Crescent sign 🌙

A

Bakers cyst rupture

362
Q

Other than unhappy triad… what year is most commonly seen with acute ACL

A

Lateral meniscus…. Even though triad is medial

363
Q

SCFE is what slater Harris

A

i

364
Q

Radial head subluxation can cause which nerve palsy

A

Radial nerve

365
Q

Crutches or Saturday night palsy

A

Radial nerve

366
Q

Distil radial nerve issue… patient loses motor or sensory

A

Motor (finger drop, not wrist drop)

367
Q

Just go through the whole distil or proximal claws (ulnar and median)

A
368
Q

Causes of long thoracic nerve palsy

A

Axillary lymphadenectomy. Chest tube placement or stab wound

369
Q

Hook of hamate fracture causes what nerve

A

Ulnar!! And guyons, recall

370
Q

Musculocutaneous nerve palsy. Which movement other than elbow flexion

A

No forearm supination. Pronation is our median nerve

371
Q

Baker cyst can cause which nerve palsy

A

Tibial

372
Q

Prolonged lithotomy position cause which nerve palsy

A

Femoral

373
Q

Other than anterior thigh, which lower leg area loses sense in femoral nerve palsy

A

Medial

374
Q

Wide based gait in which nerve palsy

A

Obruator

375
Q

Pelvic LN dissec causes which nerve damage

A

Obruator

376
Q

Ok sign test… for which nerve

A

Median

377
Q

Thumb extension against resistance which nerve

A

Radial nerve

378
Q

Most common bone tumour

A

Osteochrondroma

USMLE Step 2 - Top 5% (34 decks)

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