MSK Flashcards
1
Q
IBD is associated with what arthropathy?
A
Spondyloarthritis
2
Q
Pulmonary fibrosis is associated with what arthropathy?
A
Rheumatoid arthritis
3
Q
Lumbar stenosis pain worsens with what movement?
A
Lumbar extension
4
Q
Herniated disc pain worsens with what movement?
A
Lumbar flexion, sitting
5
Q
Compression fracture pain worsens with what movements?
A
Sitting and standing
6
Q
How is mild radiculopathy diagnosed and treated?
A
Clinically, no need for imaging
NSAIDs, glucocorticoids if severe pain
7
Q
Left diaphragm referred pain is where, and can be caused by what?
A
Left shoulder; contained splenic bleed
8
Q
Under what cases does alk phos represent bone metastases?
A
Osteoblastic, not osteolytic, metastases
MM and renal cell are osteolytic
9
Q
Ganglion cyst differential diagnosis
A
Ganglion cyst: round, rubbery, transilluminates - observation/needle aspiration/surgery
Epidermal cyst: painful, nontransilluminating, overlying punctum - use corticosteroids
RA nodule: hard, fixed, nontransilluminating
10
Q
How does treatment of clavicular injury depend on which part is fractured?
A
Middle third: closed reduction and figure-of-eight brace
Distal third: open reduction and internal fixation
11
Q
How does magnesium sulfate affect skeletal and cardiac muscle?
A
Skeletal muscle - decreased acetylcholine release
Cardiac muscle - prolonged conduction time
12
Q
What is more typically seen in electrical, rather than thermal, burns?
A
Direct injury to muscle tissue –> rhabdomyolysis
Vs circumferential constrictive eschar
13
Q
Which locations are high risk for malunion if stress fracture is suspected?
A
Fifth metatarsal, anterior tibial cortex; refer to orthopedic surgeon
14
Q
Stress fracture shows how on imaging?
A
Hairline lucency or periosteal thickening, but would not see in first 1-2 weeks on x-ray
15
Q
What does delta pressure on needle manometry correspond to with regards to compartment syndrome?
A
Delta pressure = diastolic BP - compartment pressure <=30 mm Hg reflects compromised perfusion pressure
16
Q
When can compartment syndrome be diagnosed clinically?
A
High risk: e.g. those with limb revascularization
17
Q
Superior pulmonary sulcus tumor would affect which nerves?
A
Brachial plexus –> shoulder pain
C8-T1 (ulnar) –> Weakness/atrophy of intrinsic hand muscles, pain/paresthesia of 4th/5th digits and medial arm/forearm
Paravertebral sympathetic chain/cervical ganglion –> Horner syndrome
18
Q
Superior pulmonary sulcus tumor causes which lymphadenopathy and is from which cancer?
A
Supraclavicular
Lung adenocarcinoma or squamous cell
19
Q
How can a spinal epidural abscess form?
A
Trauma –> hematoma
20
Q
Classic triad of spinal epidural abscess
A
- Spinal pain –> radiculopathic pain
- Neurologic deficits
- Fever
21
Q
In Peyronie disease, fibrous plaques form where?
A
In the tunica albuginea, reducing elasticity and expansion during erection –> pain, curvature
22
Q
Peyronie disease treatment
A
NSAIDs for pain
Pentoxifylline - reduce fibrosis
Intralesional injections of collagenase
Surgery if refractory
23
Q
Pelvic fracture signs, risks after
A
- Adducted, internally rotated lower extremity
- Perineal bruising
Risk for posterior urethral injury - abrupt upward motion of bladder and prostate can lead to urethral tearing at bulbomembranous junction
Also risk of bladder rupture
24
Q
Posterior urethral injury signs
A
- Blood at urethral meatus
- Inability to void
- Perineal bruising
- High-riding prostate
Perform retrograde urethrography (X-ray with injection of contrast)
25
Posterior cruciate ligament injury causes, Sx
Causes: Hyperextension or blow to anterior aspect of proximal tibia
Symptoms: Little pain or alteration in range of motion
26
Patellar dislocation signs
After quick, twisting motion around flexed knee
Lateral displacement with associated tear of medial patellofemoral ligament
Exam: lateral dislocation of patella, decreased extension, hemarthrosis and tenderness along medial patella
Often reduces spontaneously but may require closed reduction
Follow with X-ray to rule out additional injuries
27
Patellofemoral syndrome - signs
More common in women
Anterior pain worsened by squatting, climbing stairs, prolonged sitting
Pain and crepitus may be elicited by extending knee while compressing patella
28
Pes anserinus pain syndrome - signs
Localized pain over anteromedial tibia just below the joint line, often exacerbated by pressure from opposite knee while lying on the side
Absent swelling, erythema, induration
Pes anserinus is formed by conjoined tendons of gracilis, sartorius, and semitendinosus
Bursa located underneath pes anserinus but usually not truly inflamed
Caused by abnormal gait, overuse, or trauma
Treat with quadriceps exercises and NSAIDs
29
Test for complete supraspinatus tear
Drop arm test - drops rapidly around mid-descent (although it initiates the first 15 degrees of abduction)
MRI to confirm
30
Long thoracic nerve injury - cause, signs
Caused by penetrating trauma or procedures (e.g. chest tube insertion)
Weakness of serratus anterior with impairment at extreme abduction due to inability to rotate scapula upward
31
Which nerve injury causes claw hand deformity?
Lower (inferior) trunk of brachial plexus (C8, T1) - ulnar (e.g. intrinsic muscles of hand)
Injured by sudden upward traction on arm (Klumpke palsy)
32
Which collagen is Ehlers-Danlos?
Type V collagen
33
Stump hematoma - signs
Swelling
Ecchymosis
Skin breakdown
First several days following amputation
34
High-impact fall onto outstretched arm typically produces what injury?
Supracondylar humerus fractures (particularly children age 2-7)
35
Displaced supracondylar humerus fracture can affect which vessel and nerve?
Brachial artery and median nerve - pass anterior to humerus
36
How would an occult fracture present on X-ray?
Inflammation displaces synovial fat, leading to widened fat pads around the fracture site
37
Compartment syndrome 4 Ps
1. Pallor
2. Puleslessness
3. Paresthesia
4. Paralysis
38
What signs with penile fracture are concerning for concomitant urethral injury?
1. Blood at meatus
2. Hematuria
3. Dysuria
4. Urinary retention
39
What is the most common dislocation of the humerus? What nerve is injured?
Anteriorly from the glenohumeral joint; also the most commonly dislocated joint in the body
Anterior dislocation caused by blow to externally rotated and abducted arm
Axillary nerve is most commonly injured (teres minor, deltoid) --> weakened shoulder abduction; shoulder sensory innervation
40
Radial nerve innervation
Extensor muscles of wrist and digits
Sensory posterior arm, forearm, and dorsolateral hand
Commonly injured in humeral midshaft fractures
41
Biceps reflex - what nerves
C5, C6 - muscular innervation via musculocutaneous nerve (lateral cord of brachial plexus)
42
Ulnar nerve innervation
Intrinsic muscles of hand
Sensory loss of medial hand
Injured by fracture of medial epicondyle of humerus or deep laceration of anterior wrist
43
What damage causes scapular winging?
Long thoracic nerve - serratus anterior
Caused by deep lacerations to axillary region and axillary lymphadenectomy
44
What does a brown recluse spider bite do?
Ischemia leads to burning pain after a few hours
Small papule or in rarer cases blister with bluish discoloration and necrosis extending in gravity dependent manner
Treat with cold, which decreases venom phospholipase activity
Avoid debridement in early necrosis
Commonly when putting clothes on
Can be worse than papule: Forms ulcer —> necrosis, eschar
45
Growth plate fracture appears how?
Physeal fracture is suggested by growth plate widening on CT
46
When does the tibial growth plate close in boys/girls?
14/12 yo
47
Injury to growth plate can cause what complications?
1. Growth arrest and limb-length discrepancy
2. Physeal bars (bony bridges across growth plate)
3. Premature osteoarthritis
4. Decreased range of motion
48
Traumatic foot drop occurs due to damage to what nerve?
Common peroneal nerve as it wraps around lateral neck of proximal fibula
49
Arm anterior dislocation vs posterior dislocation positions
Anterior: arm held in abduction/external rotation
Posterior: arm held in adduction/internal rotation
50
When does myositis ossificans occur?
Following fracture or muscle contusion (e.g. quadriceps), typically in lower extremities
51
Complications of auricular hematoma
1. Infection in 2-3 days and abscess formation
2. Avascular necrosis (cartilage only blood supply is through perichondrium)
3. Cauliflower ear due to fibrocartilaginous overgrowth
52
Where is osteosarcoma most common?
Metaphysis of long bones: proximal humerus, distal femur, proximal tibia
Boys 13-16
Tender soft-tissue mass
53
Spiculated sunburst pattern is what cancer?
Osteosarcoma
Can also see periosteal elevation (Codman triangle)
54
Osteoid osteoma signs
1. Pain worse at night, relieved by NSAIDs
2. Central lucency with sclerotic margins
55
How do popliteal cysts form? How do ruptured cysts appear?
Synovial fluid from knee joint space to gastrocnemius or semimembranosus bursa
Can occur from synovial fluid excess (OA, RA) and knee extension
Arc of ecchymosis distal to medial malleolus; calf pain, erythema and warmth
56
Dinner fork deformity of wrist
Colles (Radial) fracture
Falling on outstretched hand
57
Radius fracture affects what structures?
Median nerve (dorsal displacement of radius)
Sensation: lateral 3.5 digits
Motor: thenar (opponens pollicis, abductor pollicis brevis)
Compression can causes acute carpal tunnel syndrome (including impaired thumb abduction)
If compression is proximal to tunnel, palmar cutaneous branch may also be affected
58
How can ulnar nerve be injured? What is affected?
Elbow: external compression (e.g. funny bone)
Wrist: hamate fracture or external compression (e.g. bicycle handlebar)
Sensation: medial 1.5 digits
Adduction of index, 4th, 5th digits towards 3rd digit (palmar interossei, innervated by deep branch of ulnar)
59
Radial nerve injury location and signs
Elbow - weakness of hand/finger extensor muscles
Sensory loss over posterior forearm/dorsolateral hand
Seen in supracondylar humerus fractures
60
Avascular necrosis of hip - atraumatic causes and x-ray features
Atraumatic: Alcohol, glucocorticoids
X-ray: Subchondral lucency, collapsed femoral head
61
Important components of rib fracture care
Analgesia to allow good tidal volume and prevent atelectasis, pneumonia
Incentive spirometer
62
Fat embolism signs
In 24-72h following fracture:
1. Hypoxemia
2. Neurological changes (>50% cases)
3. Rash (<50% cases)
63
How would a C5 lamina fracture occur?
Neck hyperextension (e.g. hitting airbag)
Can result in injury to adjacent facet, causing nerve root injury and radiculopathy
64
What do you do if there is a single vertebral fracture (especially cervical)?
Image entire cervical spine, 20% chance of noncontiguous vertebral fracture
65
How does osteonecrosis of femoral head appear on x-ray?
Flattening/collapse of femoral head
Patchy sclerosis
66
Primary screening for cervical spine injury
Start with CT without contrast
If NEXUS negative, then do basic neuro exam
67
SCFE leg position
Abduction and external rotation with passive hip flexion
Limited internal rotation so foot points laterally
68
Avascular necrosis of hip - pain, imaging
Pain on hip abduction and internal rotation
Groin pain on weight bearing
Crescent sign in advanced stage
MRI most sensitive
69
What arteries supply the femoral head?
1. Ascending arteries
2. Foveal artery within ligamentum teres - may become obliterated in older patients
70
What are the most common hip fractures in older adults, typically due to fall?
Femoral neck fracture
Intertrochanteric fracture
Shortening and external rotation of affected leg
71
What injury is likely if patient has leg shortened AND externally rotated?
Femoral neck or intertrochanteric fracture
Rarer: anterior hip dislocation (severe trauma)
Due to contraction of psoas and iliacus without normal acetabular counterforce
If just shortened, could be femoral shaft fracture (with angulation) or pubic ramus fracture
72
Intracapsular vs extracapsular fracture
Intracapsular - no significant ecchymoses, higher risk of AVN
Extracapsular - visible ecchymoses, higher risk for displacement
73
Anterior vs posterior dislocation positioning
Anterior dislocation - externally rotated
Posterior dislocation - internally rotated and adducted; may involve sciatic nerve
74
Scoliosis red flag features
1. Back pain
2. Neurologic symptoms
3. Rapidly progressing curve (>=10 deg per year)
4. Vertebral anomalies on x-ray
75
Scoliosis imaging
PA and lateral spine x-rays
MRI if pathologic etiology suspected
76
Rotator cuff impingement/tendinopathy vs acromioclavicular arthritis vs adhesive capsulitis
Rotator cuff tendinopathy: pain with abduction and external rotation, normal range of motion, impingement signs (Neer+)
Tear: same as above + weakness, age>40
Acromioclavicular arthritis: tenderness, swelling, or deformity in acromioclavicular space
Adhesive capsulitis: decreased passive + active range of motion
77
Foot eversion and inversion muscles
Eversion: peroneus - inserts onto lateral aspect of foot
Inversion: tibialis anterior and posterior - medial aspect of foot
78
How is meniscal tear diagnosed?
MRI or arthroscopy
79
Iliotibial band syndrome vs pes anserinus syndrome
Lateral (femoral condyle) vs medial (distal to joint line)
80
Shoulder abduction relief test
Improves radicular symptoms - can be both diagnostic and short-term therapeutic
81
Worsening limb pain and paresthesia with lateral neck flexion
Relatively specific for cervical radiculopathy
82
Osteosarcoma genetic links
RB1 (Retinoblastoma)
p53 (Li-Fraumeni; adrenocortical tumors)
Leukemia
Breast
Brain
83
What is a hinged unloader knee brace?
Hinged unloader (valgus) knee braces transfer load from medial to lateral joint compartment - useful for patients with medial unicompartmental OA associated with varus deformity
84
Decreased shoulder abduction with intact sensation following posterior glenohumeral dislocation
Rupture of supraspinatus tendon (rotator cuff injury)
As opposed to axillary nerve injury, which would mimic rotator cuff injury but also have sensory loss
85
Carpel tunnel syndrome would not affect sensation of which part?
Thenar eminence - palmar cutaneous branch of median nerve passes outside the carpal tunnel
86
Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS)
Myopathy with acute neurologic changes
Noninvasive workup - serum lactate/pyruvate, creatine kinase
Muscle biopsy confirms diagnosis
87
Which artery and nerve are associated with supracondylar fracture of humerus (posterior dislocation)?
Brachial artery - weak brachial + radial pulses
Median nerve - weak “ok” sign
Note: anterior displacement due to fall on flexed arm would injure ulnar nerve posterior to medial epicondyle
88
Position of nursemaid's elbow
Pronated and extended
Caused by pulling arm or lifting and swinging child by arm
89
Asymmetric oligoarthritis with mouth ulcers, conjunctivitis, or urethritis
Reactive arthritis
Can also have enthesitis
90
When is skeletal alk phos elevated?
Osteoblastic activity
91
Urine hydroxyproline
Seen with collagen breakdown - ex. Paget disease of bone
92
Common causes of acute viral arthritis
HIV
Hep B/C
Parvovirus B19
Rubella
93
Reactive vs viral arthritis
Reactive: seronegative spondyloarthropathy, chronic asymmetric arthritis, inflammatory back pain
94
Does scaphoid fracture typically cause nerve injury?
No, but lunate does
95
Causes of calcium pyrophosphate deposition
Elevated serum calcium:
Hyperparathyroidism
Hypothyroidism
Hemochromatosis - iron deposition in joint precipitates condition
Chronic arthritis
96
Meralgia paresthetica vs greater trochanteric pain syndrome
Meralgia: burning pain and tingling
GTPS: pain localized to lateral hip and worsened by direct pressure
97
Anterior shoulder pain
Biceps tendinopathy/rupture
98
Anterior vs posterior hip dislocation vs hip fracture
Anterior: leg lengthened and externally rotated
Posterior: leg shortened and internally rotated
Hip fracture: leg shortened and externally rotated
99
Ulnar wrist vs elbow symptoms
Wrist - small finger and medial 4th finger (superficial); intrinsic weakness (deep)
Elbow - medium dorsum of hand (dorsal cutaneous) and hypothenar eminence (palmar cutaneous) and weakness of grip and wrist flexion
100
Position of leg with SCFE or AVN of femoral head
Externally rotated and adducted (limited abduction)
101
Shin splint vs stress fracture of tibia
Shin splints (medial tibial stress syndrome) have diffuse pain, rather than point tenderness, along tibia shaft
Seen in obese or novice runners
102
Hook-like osteophytes on the 2nd and 3rd metacarpal heads of the hand
Hemochromatosis, resembling osteoarthritis
103
Pencil-in-cup deformity - narrowing of proximal phalanx with erosion of distal phalanx
Psoriatic arthritis
104
Joint mass with punched out lytic lesions and rim of overhanging bone, as well as soft tissue opacification
Gout - rat-bite lesion
105
Compression fracture vs disc degeneration
Compression fracture pain is worse with movement/cough/strain and may persist at night; vertebral point tenderness
Disc degeneration pain is chronic, worsens with activity, and relieved with rest; can lead to disc herniation with lumbosacral radiculopathy
106
de Quervain tendinopathy refers to which tendons?
Abductor pollicis longus and extensor pollicis brevis
107
Pain with flexion of thumb with wrist in ulnar deviation
Finkelstein/Eichhoff tests - de Quervain tendinopathy
108
Potential benign/malignancies from Paget disease
Benign giant cell tumor
Osteosarcoma
109
In part, how do glucocorticoids cause osteoporosis?
Apoptosis of osteoblasts
110
Exam findings of polymyalgia rheumatica
Normal strength but maybe limited range of motion in proximal joints, stiffness > pain
111
Does polymyositis have pain?
It is mild or absent
112
Odontoid process fracture
Often in MVA - causes spinal cord compression (myelopathy)
113
Supraspunatus vs infra function
Supra: shoulder abduction
Infra: external rotation
Both innervation by suprascapular nerve from brachial plexus
114
Posterior humerus dislocation on x-ray
Lightbulb sign, loss of overlap between humeral head and glenoid
115
Nonbenzo muscle relaxants (e.g. cyclobenzaprine, tizanidine) - side effects
Drowsiness
Anticholinergic
116
Difference between threatened and nonviable limb
Nonviable has severe sensory motor loss, absent capillary refill, and inaudible venous Doppler
117
In which shoulder condition does subacromial injection of anesthetic help pain but not range of motion?
Adhesive capsulitis
118
Tenderness at margin of supinator, several cm distal to elbow
Radial tunnel syndrome
119
Galeazzi fracture
Distal radial fracture with ulnar dislocation (opposite of Monteggia fracture)
ORIF and casting of the arm held in supination to reduce radioulnar joint
120
Distal radial nerve palsy vs proximal
Finger drop and no sensory loss (vs wrist drop and sensory loss of dorsal forearm and dorsal first 3.5 fingers
121
Obturator nerve motor and clinical findings
Thigh adduction, wide-based gait
122
Moth-eaten bone
Chondrosarcoma - malignant transformation of esteochondroma or enchondroma
123
Lytic lesion on hand/foot
Enchondroma - benign
124
Hip replacement osteomyelitis - most common bug
Staph epidermidis
125
Hip replacement osteomyelitis - most common bug
Staph epidermidis
