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MSK Flashcards

1
Q

Acute LBP 1st step?

A

Early mobilization & NSAIDs & muscle relaxants

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2
Q

LBP red flags

A

Neuromotor deficit, fever, >6wks, loss of bowel/bladder, CA, steroid use, >70

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3
Q

Fever, vertebral tenderness, IVDU + LBP dx

A

Osteomyelitis, septic discitis, abscess

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4
Q

Causes of spinal stenosis

A

Degen arthritis, spondylo, spina bifida, myelomeningocele

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5
Q

LBP, leg pain/weakness, psuedoclaudication, pain dec when bending forward, squatting, sitting

A

Spinal stenosis –> NSIADs, PT, epidural steroids

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6
Q

AcuteB/L pain after lifting, bending, coughing –> anterior abdomen

A

Compression fx –> X-ray

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7
Q

LBP radiating down thigh to toe, w/ straightleg raise and CL leg raise imaging, WORSE w/ cough, defecation

A

Disc herniation = no imaging, only >1mo –> MRI

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8
Q

Leg pain worse w/ standing, better lying down, normal pulses, neuro exam

A

Spinal stenosis –> MRI

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9
Q

1 cause of spinal stenosis

A

DJD

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10
Q

13 y/o girl, SOB, + Adam’s test

A

Scoliosis –> XR –> BRACE

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11
Q

Young male w/ morning stiffness, better w/ exercise, tender SI, heels, tibial tuberosities (enthesitis)

A

Ankylosing spondylitis –> XR SI joints, anterior uveitis

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12
Q

Diseases assoc w/ carpal tunnel

A

RA, sarcoid, amyloidosis, HYPOTHYROID (B/L, severe)

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13
Q

Periarticular osteopenia, joint margin erosions, stiffness >30min, WBC 2000-50000, warm

A

RA –> MTX, NSAIDs, steroids + test for HCV, HBV, TB –> + hydroxychloroquine

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14
Q

RA pts at increased risk of developing ?

A

Osteoporosis

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15
Q

Knee pain, bone spurs, no warmth, worse w/ activity, BMI 36 - best LT improvement tx?

A

OA = Weightloss

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16
Q

Older, morning stiffness <30min, worse w/ exercise, cool, crepitus, dec and painful ROM

A

OA –> acetaminophen

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17
Q

Punched out erosions of cortical bone (Rat bite lesion), WBC 2000-50000, warm

A

Gouty arthritis–> indomethacin, colchicine for acute & allopurinol, probenecid chronic

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18
Q

Asymmetric polyarthritis, skin rash, normal joint space w/ soft tissure swelling, WBC >50000

A

Septic arthritis

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19
Q

Acute onset painful, swollen joint, limited ROM, WBC 50,000-150,000, prosthetic joint

A

Septic arthritis = SA, strep #2

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20
Q

Nail pitting, skin plaques, morning stiffness for several hrs, dactylitis of DIP (sausage fingers)

A

Psoriatic arthritis –> NSAIDs, MTX - NO steroids

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21
Q

Spinous process tenderness, IVDU or sickle cell, normal WBC, high platelets, fever

A

Osteomyelitis = SA –> cultures, ESR, x-ray –> Inc ESR w/ normal XR = MRI

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22
Q

Arthritis, conjunctivitis, urethritis bug

A

Chlamydia

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23
Q

Acute onset symmetric arthritis, MCP, PIP, wrist ankle, contact with kids, past fatigue, diarrhea, stiff 15min

A

Parvovirus B19 - anti-B19 IgM Ab

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24
Q

Joint pain, recent urethral discharge, many PMNs but no organisms in joint, mouth ulcers

A

Reactive arthritis –> NSAIDs

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25
Q

Acute polyarticular, symmetric, swelling, daycare worker, fever resolves in <2mo, + /-RF, ANA

A

Viral arthritis - Parvo, Hepatitis, HIV, mumps, rubella

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26
Q

Rusty nail osteomyelitis bug adult

A

PA –> quinolone

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27
Q

Carpal tunnel pathological accumulation ?

A

Matrix substances

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28
Q

Dec sensation 1st 3 fingers, numbness, tingling, thenar waisting, worse w/ hyperflexion of hand

A

Carpal tunnel –> NSAIDs, splint, steroids, nerve velocity –> surgery

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29
Q

Mom’s carrying baby, prolonged thumb extension, pain, Finklestein’s test

A

Dequervain’s –> NSAIDs, spica splint, steroids

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30
Q

Torn ulnar collateral lig, forced thumb hyperextension, skiing

A

Gamekeeper’s thumb –> casting

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31
Q

Torn flexor tendon, unable to flex DIP

A

Jersey Finger –> splinting

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32
Q

Torn extensor tendon, unable to extend finger, Volleyball

A

Mallet Finger –> splinting

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33
Q

Unable to flex ONLY middle finger –> pop if extended

A

Trigger Finger –> steroids

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34
Q

etOH, Scandinavian men, palpable nodules

A

Duputyren’s –> surgery

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35
Q

Abscess of pulp of nail, extremely tender, penetrating injury, fever, throbbing pain

A

Felon –> I&D

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36
Q

Colles fx tx

A

Closed reduction & long arm cast

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37
Q

Protection for nightstick, fx proximal ulna, anterior radial head dislocation

A

Monteggia fx

Galeazzi if radial fx –> ORIF

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38
Q

FOOSH, wrist pain in snuff box, non-displaced fx

A

Scaphoid fx –> thumb spica splint; ORIF if angulated or displaced

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39
Q

Punched a wall, tender 4th, 5th digits

A

Metacarpal neck fx –> closed reduction + ulnar gutter splint OR Kirschner wire

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40
Q

1 fx in kids

A

Supracondylar humeral fx

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41
Q

FOOSH, inc pain despite meds, radial pulse intact, sensation intact

A

Supracondylar humeral fx –> compartment syndrome

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42
Q

Injury w/ supracondylar fx

A

Brachial artery –> no radial pulse

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43
Q

Crepitus, upper body fat accumulation, asymmetric moro reflex

A

Clavicular fx = DM mom –> dystocia, vacuum forceps

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44
Q

Tx for neonatal clavicular fx

A

Reassurance and gentle handling

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45
Q

Dec appetite, neck swelling, neck turned to left, resists flexion

A

Torticollis –> XR to r/o cervical spine fx, dislocation

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46
Q

Throwing sports, pain, crepitus, dec supination/pronation

A

Panner disease (osteochondrosis of captellum)

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47
Q

Erb-duchenne palsy - + grasp reflex, C5,6

A

Reassurance - 80% resolve 3-6mo

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48
Q

Supinated, wrist extended, MCP extended, ICP flexed, IL Horner syndrome, (-) grasp

A

Klumpke palsy = C8, T1 traction –> PT, usually resolves

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49
Q

Hold arm close to body, rotated outward, numb deltoid

A

Anterior shoulder dislocation (#1) –> XR

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50
Q

Block shot (Abduction, ER) –> pain, ER, no IR, prominent acromion

A

Anterior shoulder dislocation (#1) –> XR, Axillary nerve

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51
Q

Electrical burn, seizure, hold arm close to body, IR

A

Posterior shoulder dislocation –> axillary or scapular XR

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52
Q

Nerve injury w/ middle oblique or distal 3rd of humerus fx

A

Radial –> surgery on if paralysis develops

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53
Q

Mom pulled kids arm –> held in pronation, not moving

A

Nursemaid’s elbow –> passive flexion + supination

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54
Q

Newborn, Clunk/Click w/ Ortalani or Barlow, uneven gluteal folds

A

Congenital hip dysplasia –> US –> Pavlik harness

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55
Q

Asymmetric inguinal folds, soft-click, leg-length diff next step

A

Hip US <6mo otherwise XR

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56
Q

Developmental dysplasia of hip tx <6mo

A

Pavlik harness = abduction + flexion

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57
Q

7 y/o PainLESS limp, anterior thigh pain, AVN

A

Legg-Calves Perthes –> XR –> Cast

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58
Q

7 y/o boy, insidious limp, previous fever, pain >1mo, limited IR & Abduction

A

Legg-Calve-Perthes –> XR –> Cast, splint, surgery, limit weight

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59
Q

10 y/o, growth spurt, pain w/ hip movement, pain with IR, holding leg in ER

A

SCFE –> frog-legged XR –> immediate screw fixation

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60
Q

13 y/o w/ limp, insidious KNEE pain, obese adolescent

A

Slipped capital femoral epiphysis

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61
Q

2-3 y/o Fever, acute joint pain, NO weight bearing, hx of cellulitis, >100,000WBC, 90% PMNs

A

Septic arthritis –> surgical drainage/arthrocentesis, Vanco

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62
Q

Fever + severe localized bone pain

A

Osteomyelitis –> MRI and abx

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63
Q

2-6 y/o, painFUL limp, normal ESR, WBC

A

Transient synovitis –> B/L hip XR –> rest & NSAIDs

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64
Q

7 y/o, limp, previous URI <1mo, hip flexed, abducted, ER

A

Transient synovitis

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65
Q

14 y/o A.A male wks of limping, hx severe abd pain, Hct 22%, restricted ROM, tender

A

Sickle cell –> osteonecrosis of hip

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66
Q

Head on car collision, knees hit dashboard, hip pain

A

Posterior hip dislocation –> emergent reduction

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67
Q

13 y/o knee pain + swelling, worse after basketball

A

Osgood-Schlater = traction apophysitis –> work through or rest + cast

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68
Q

Point tenderness over inferior patella

A

Patellar tendonitis

69
Q

Fx in kids + growth plate tx

A

Closed reduction in 1 piece, displaced laterally; 2 pieces = ORIF

70
Q

Fx in kids (-) growth plate tx

71
Q

Fall –> short leg + ER on stretcher

72
Q

Tx femoral neck fx

A

Replace femoral head

73
Q

Tx intertrochanteric fx

74
Q

Tx femoral shaft fx

A

Intramedullary rod

75
Q

Isolated collateral ligament tear tx

A

Hinged cast –> surgical if mutliple torn

76
Q

Hyperextention, pivoting + popping, knee HEMARTHROSIS - rapid onset, joint instability, can’t bear weight

A

ACL tear –> MRI + RICE

77
Q

Tx ACL/PCL injury

A

Immobilization & rehab –> arthroscopy in athletes

78
Q

Popping + knee pain, swelling the NEXT DAY, joint line tenderness

A

Meniscal tear

79
Q

Twisting on planted foot, knee catching/locking, click when forcefully extended

A

Meniscal tear –> open repair

80
Q

Forced marches, very specific tenderness in lower leg, normal XR

A

Tibial stress fx –> Cast, crutches & repeat XR in 2 wks

81
Q

Pedestrian hit by car

A

Tib-Fib fx –> XR –> Casting +/- medullary nailing

82
Q

Excruciating pain w/ passive extension following tib-fib fx w/ CLOSED reduction

A

Compartment syndrome –> fasciotomy

83
Q

Posterior knee dislocation vascular injury

A

Popliteal artery –> Doppler or Ct angio & prompt reduction

84
Q

Open tib-fib fx –> dyspnea, confusion, fever, tachy, petechial rash

A

Fat embolism –> resp support, heparin, steroids

85
Q

Adducted anterior foot, overcorrects in abduction - metatarsals

A

Metatarsus adductus type I = reassurance

86
Q

Metatarsus adductus corrects in neutral position tx (type II)

87
Q

Metatarsus adductus rigid, do not correct tx (type III)

A

Immediate casting –> surgery if residual at 4 y/o

88
Q

Equinovarus calcaneum, midfoot, adduction forefoot, limited ROM

A

Clubfoot –> immediate stretching & serial casting

89
Q

Out of shape middle aged man, loud pop and fall to ground, pain swelling ankles and limping

A

Achilles rupture –> cast in equinus or surgery

90
Q

Marching, athletes, foot pain w activity –> rest, point tenderness

A

2nd metatarsal fx = rest and analgesics

91
Q

Sharp heel pain/burning, worse in mornings, tender, bone spur

A

Plantar fasciitis –> resolve 12-18mo

92
Q

Tender 3-4th interspace, palpable nodule + click, high-heels or runner

A

Morton neuroma –> analgesics, new shoes/insert, surgery

93
Q

Soap bubble, eccentrically lytic area, cystic + hemorrhagic regions

A

Giant cell tumor of bone –> surgery

94
Q

Subperiosteal resorption in phalanges, “salt and pepper,” bone pain, brown tumor

A

Osteitis fibrosa cystica - HPT from PT CA

95
Q

Sclerotic cortical lesion w/ central lucency, pain a night, better w/ NSAIDs

A

Osteoid Osteoma

96
Q

Fever, leukocytosis, anemia, 15 y/o, central lytic bone lesion, moth-eaten

A

Ewing sarcoma –> XR, Bx –> surgery –> radiation and chemo

97
Q

11;22, mid-shaft, onion skin, focal bone pain

A

Ewing sarcoma –> XR, Bx –> surgery

98
Q

Rb gene, sunburst, diaphysis, focal bone pain

A

Osteosarcoma –> XR, Bx –> excision –> chemo

99
Q

No constitutional sx, arm pain, metaphysis abn, tender soft tissue mass, sunburst, periosteal lift

A

Osteosarcoma –> XR, Bx –> excision –> chemo

100
Q

Fever, leukocytosis, central lytic lesion w/ surrounding sclerosis (Brodie’s abscess)

A

Osteomyelitis - #1 = SA

101
Q

Sclerotic cortical lesion w/ central nidus, pain worse @ night, relieved w/ NSAIDs

A

Osteoid osteoma

102
Q

B/L thigh and calf pain, worse at night, relieved w/ NSAIDs, no activity limit

A

Growing pain

103
Q

SINGLE lytic bone lesion of humerus + hyperCa, joint swelling

A

Langerhans Histiocytosis - eosinophilic granuloma = resolves

104
Q

Can’t stand or climb stairs, raise arms, weakness, elevated LDH, aldolase, creatnine kinase

A

Polymyositis –> muscle bx shows MO infiltrate surrounding necrotic & regen fibers

105
Q

Anti-Jo Abs

A

Polymositis

106
Q

SLE tx for skin and joints only

A

Hydroxychloroquine = check for retinopathy

107
Q

Fatigue, oral ulcers, ARTHRITIS of MCP, PIP, proteinuria in young A.A. female

108
Q

Young A.A. female, cough, hyperCa, elevated ACE, non-caseating granuloma

A

Sarcoidosis

109
Q

Proximal muscle weakness, rash on shoulders/back, scales on hands

A

Dermatomyositis

110
Q

Can’t rise from chair, dusky rash, periorbital edema (heliotrope), knuckles (grotton) assoc?

A

Dermatomyositis = Malignancies (Ovarian, breast)

111
Q

Poor sleep, fatigue, pain all over, trigger points, young female, pain worse after exercise

A

Fibromyalgia –> exericise, good sleep —> TCAs (amitriptyline)

112
Q

Extreme fatigue, no aches

A

Chronic fatigue syndrome

113
Q

Pain, STIFFNESS, aching in pelvic & shoulder girdle esp in AM, >50 y/o, no trigger points/muscle tenderness, elevated ESR

A

Polymyalgia rhuematica –> low dose steroid

  • assoc w/ temporal arteritis
114
Q

Difficulty combing hair, ptosis, dyaphagia, dysarthria, normal muscle tone, reflexes, stands-up normally

A

Myasthenia Gravis - Ab to ACH receptor

115
Q

Tx for hyperthermia/heat stroke

A

Evaporation coolin, IVFs

116
Q

1 site for ulnar nerve entrapment

117
Q

Abx for human bite

A

Augmentin OR cipro + clinda

118
Q

Popliteal mass cause

A

Baker’s cyst = inflammed synovium d/t RA, OA, meniscus

119
Q

Re-warm cold extremity

A

Rapid, warm water

120
Q

Paget’s disease path

A

Abnormal bone remodeling

121
Q

Mosaic pattern of lamellar bone

A

Paget’s Disease

122
Q

Inc deposition of unmineralized bone

A

Vit D deficiency

123
Q

Abundant mineralization of periosteum

A

Hypervitamin A

124
Q

Morning stiffness, <2000 neutrophils, splenomegaly

A

Felty syndrome (RA)

125
Q

Only inc Alk phos, thickened cortices in skull and tibia, mixed lytic/clastic lesions, b/L hearing loss

A

Paget’s disease –> bone scan –> bisphosphonates –> calcitonin

126
Q

Progressive hip pain w/o restriction in ROM, steroid use

A

AVN of femoral head

127
Q

High CPK, HLD, aches and pains

A

Statin induced muscle injury

128
Q

Risk factors for gout

A

etOH, high purine, pyrazidimide

129
Q

Diabetic foot ulcer tx order

A

Off-loading -> debridement -> dressings -> antibiotics -> revasc -> amupation

130
Q

RLS mech and tx

A

DA = pramipexole, ropinerole, levodopa

131
Q

Rotator cuff tear vs. impingement?

A

Impingement = better w/ lidocaine

132
Q

Pain w/ internal rotation and flexion, no muscle atrophy

A

Subacromial bursitis

133
Q

Difficulty swallowing, blue fingers in the cold, shiny MCP joints, “mat-like” patches on face

A

CREST syndrome

134
Q

Bugs for prosthetic implant infection 3mo

A

3mo = Staph epi, enterococci

135
Q

Osteoporosis path

A

Low bone MASS

136
Q

Z-score

A

1-2.5 = osteopenia, >2.5 = osteoporosis

137
Q

Osteomalacia path

A

Defect in MINERALIZATION, usually VitD deficiency or Ca deficiencies

138
Q

Bone pain, cramps, weak, colon resection, CKD, inc PTH, Alk phos, Dec Ca, VitD, Phos, psuedofractures

A

Osteomalacia

139
Q

Ca & VitD intake goals

A

1200mg & 800-100IU for all menopausal women

140
Q

Secondary causes of osteoporosis

A

Hyperthyroid, Primary HPT, Vit D deficiency, amenorrhea, steroid, smoking

141
Q

Labs for secondary osteo causes

A

CBC, BUN/Cr, TSH, VitD, Estradiol, testosterone, Ca, LFTs

142
Q

Bisphosphonate MOA

A

Inhibit clastic activity - empty stomach + water + upright for 30min

143
Q

Bisphosphonate SE

A

Osteonecrosis of jaw (mostly IV after dental work)

144
Q

SERM in osteo Tx

A

Raloxifene, also reduces breast CA but inc risk for thrombosis

145
Q

Nasal spray shown to reduces vertebral compression Fx, 2nd line

A

Calcitonin

146
Q

Recombinant human parathyroid hormone

A

Teriparatide - acts on Blasts = CI in @ risk for osteosarcoma (Paget disease)

147
Q

Denosumab MOA

A

Ab inhibits osteoclast differentiation

148
Q

Genu valgum, OSA, SIDS d/t foramen magnum stenosis

A

Achondroplasia

149
Q

Carpopedal spasm, laryngospasm, paresthesia, seizures

150
Q

HypoCa <4days old cause

A

Transient, IUGR, asphyxia, HypoMag

151
Q

HypoCa >4d neonatal cause

A

HypoPTH, maternal hyperPT, DiGeorge, hyperPhos

152
Q

High PTH, short, short MCPs, developmental delay

A

Parathyroid resistance

153
Q

Both Ca and Phos low

A

VitD deficiency

154
Q

Tx for hypoCa

A

<7.5-8.0, oral Ca

155
Q

Rickets, normalCa, low Phos, high alk phos, high PTH, Vit D no help

A

Familial hypophos rickets = #1 = renal phos leak

156
Q

Prominent costochondral junc, wrist metaphysis widened, CUPPED

157
Q

Bowlegs >3 y/o

A

Blount disease (medial proximal tibial GP) = surgery

158
Q

Knock-knees normal b/w what ages?

159
Q

<5 y/o, proximal weakness, 100x inc CPK, myopathic EMG, MR

A

DMD = no dystrophin

  • -> Genetic testing Xp21
  • -> muscle Bx showing fibrosis & fatty infiltration
160
Q

5-12 y/o, calf pain w/ exercise, cardiomyopathy, 50x inc CPK

161
Q

Weakness/wasting esp face, hands, ankle, myotonia, cataracts, delayed muscle relaxation, AD inheritance

A

Myotonic dystrophy (upper lip inverted V)

162
Q

Heel, metatarsal, toe tip ulcers, overweight person

A

Diabetic ulcer

163
Q

Pathogenesis of diabetic ulcer

A

Neuropathy –> wound –> microvascular disease prevents healing

164
Q

Tips of toes, dirty, no pulses, no granulation tissue ulcer

A

Arterial insufficiency –> Doppler –> angio for revascularization/stenting

165
Q

Medial malleolus, hyperpigmented skin, granulating bed, painless ulcer

A

Venous stasis ulcer –> support socks, ACE, unna boot

166
Q

Ulcer w/ many yrs of healing and breakdown (3rd d burns) –> deep dirty heaped-up ulcer

A

Marjoilin ulcer = SCC –> Bx, excision and grafting

167
Q

Fx 1st metacarpal bone

A

Bennet’s –> Rolando if comminuted

168
Q

Pain over lateral ankle + lateral proximal fibula playing soccer

A

ATFL sprain w/ possible proximal fibular fx (maisonneuve fx)

—> XR both knee and ankle

169
Q

Distal radial fracture name

  1. fx + dislocation of radial-ulnar joint
  2. Dorsal displacement of distal segment
A
  1. Galeazzi

2. Colles

Step 2 (20 decks)

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