MSK Flashcards
Pt 55yom p/w diffuse bone pain, increasing head size, frontal bossing, tibial bowing labs, dx, rx?
Paget’s dz (Osteitis Deformans); Elevated alkaline phosphatase with normal Ca, phosphate; rx bisphosphonates, calcitonin 2nd line
45yof p/w fatigue, myalgia, proximal muscle weakness, sluggish ankle reflex, normal ESR, elevated CK, dx?
Hypothyroid myalgia, check TSH
25yo p/w back pain, improves with use, afebrile, normal neuro exam, dx/wokup?
Ankylosing spondylitis involving apophyseal joints, check for uveitis, enthesitis, elevated ESR, CRP, HLAB27, spine xray
Acute back pain and point tenderness after strenous activity; dx/etilogy?
Vertebral compression fracture; Osteoperosis (most common), osteomalacia, malignancy, infection, hyperparathyroidism, trauma
65yo w/ b/l leg pain when standing (extension), better w/ sitting (flexion), lower back pain, ABI>1.1; dx?
Spinal canal narrowing/spinal stenosis (degenerative disks/spondylosis, hypertrophy of ligamentum flavum) causing Neurogenic claudications, get MRI for dx
Cauda equina syndrome
Urine retention/incontinence, saddle anesthesia, weakness; look for malignency
35yom on chronic steroids for sarcoid p/w hip pain, normal ESR, dx?
Osteonecrosis (avascular bone necrosis); MRI to confirm
13yo w/ pain over tibia at knee, tissue swelling, tibial tubercle irregularity or fracture (dissociation) from the shaft; dx?
Osgood-Schlatter traction apophysitis of the tibial tubercle
Twisting knee injury w/ pop, late joint effusion, pain with extension and knee locking, tibial torsion w/ fixed flexed knee produces pop; dx?
Medial meniscus tear w/ positive McMurray’s test
Abduction injury to knee, positive Valgus test?
Medial Collateral Ligament tear
Adduction injury to knee, positive Varus test?
Lateral Collateral Ligament tear
Hyperextension knee injury w/ immediate effusion and positive ant drawer test, Lachman test, pivot shift test?
Anterior Cruciate ligament tear
Forceful posterior hit to tibia w/ flexed knee, positive post drawer, reverse pivot shift and post sag tests?
Posterior Cruciate ligament tear
Tender mass in popliteal fossa, hx of RA, (or osteoarthritis, cartilage tear)
Bakers Cyst from excess fluid production from an inflamed synovium
Midshaft humerus fx, wrist drop?
Radial n injury
Tendons of rotator cuff?
SITS: Supraspinatus, Infraspinatus, Teres minor, Subscapularis
Arm passively abducted, upon lowerin rapidly falls once at 90 degrees, dx?
Rotator cuff tear, Supraspinatus
Hypothyroidism w/ median n compression signs of carpal tunnel sx; path?
Accumulation of matrix protein, mucupolysacharides, in the perineurium and endoneurium of the median nerve
Winged scapula, axillary lymphadenectomy, dx?
Long thoracic, serratus anterior
Sexually active young adult w/ polyarthritis, tender swollen purulent joint w/ 50k synovial WBC, may p/w polyarthalgia w/ tensynovitis or dermatitis; dx?
Septic joint via Neisseira Gonorrhea; rx IV Ceftriaxone then PO Cefexime, empiric chlamydia rx Azithromycin or Doxycycline
Diabetic p/w deformed feet on xray there’s joint effusion, osteophytes and extra-auricular joint fragments; dx?
Charcot joint (neurogenic arthropathy); a/w diabetes, B12 deficiency, Tabes dorsalis, spinal cord injuries
Periarticular osteopenia and joint margin erosions, with tendon damage and subluxation of cervical vertebrae?
Rheumatoid Arthritic joint
Calcification of cartilagenous joint structures / cynovial calcium deposits?
Pseudogout Calcium PyroPhosphate Dihydroate (CPPD) positive birefringent rhomboid
Punched out erosions w a rim of cortical bone?
Gouty arthritis
Narrowing of joint spaces, cartilage destruction and osteophyte formation?
Osteoarthritis, also w subchondral sclerosis/cysts
Distal phalangeal bone resorption, xray “pencil in cup”?
Arthritis mutilans variant of psoriatic arthritis
25yoF w/ weakness, mild fever, ESR, facial rash, joint pain?
SLE w/ Migratory lupus arthritis, non deforming
Passive arm raise above head causes shoulder pain, improves with lidocaine injection; dx?
Rotator cuff impingement from tendonitis, seen commonly in painters
Adolescent p/w several months of back pain, recent urinary incontinence and “step off” lesion at the lumbar sacral junction; dx?
Spondilolysthesis, slipped vertebrae usually L5 over S1
Suprachondylar fx of humerus (fall on outstretched hand); complications?
Injury to brachial artery and median nerve, cubitus varus malformation, compartment sx/Volkman’s ischemic contracture
25yo p/w pain in heel, iliac crests, tibial tuberosities, shoulder, limited spine movement; dx?
Enthesitis (pain at insertion of tendons), seen in HLAB27+ Ankylosing Spondylithis, psoriattic arthritis, reactive arthritis
Newborn w/ shoulder dystocia p/w “claw hand” extended wrist, no grasp reflex, ptosis, myosis, intact Moro and biceps reflex; dx?
Klumpke’s palsy w/ damage to C8 and T1 (p/w horner’s)
Newborn w/ shoulder dystocia p/w internally extended elbow, pronated forarm, flexed wrist and fingers, decreased moro and biceps reflex on affected side, entact grasp reflex; dx?
Erb-Duchenne’s palsy w/ waiter’s tip sign, damage to 5th and 6th cervical nerves
Benign tumor of osteoblasts at cortex of long bones, pain resolves with aspirin, xray shows mass
Osteoid osteoma
Metaphysis of long bones, often around knee. Codman triangle (from elevation of periosteum) or sunburst pattern on x-ray.
Osteosarcoma; Aggressive. Treat with surgical en bloc resection (with limb salvage) and chemotherapy
Boys
Ewings Sarcoma; Extremely aggressive with early metastases, but responsive to chemotherapy.
Men 30–60 years old. Malignant cartilaginous tumor. May be of 1° origin or from osteochondroma. Expansile glistening mass within the medullary cavity. Usually located in pelvis, spine, scapula, humerus, tibia, or femur.
Chondrosarcoma
Expansile eccentric lytic lesion (soup bubble appearance on xray) usually at distal epyphesis of long bones (femur tibia near knee), multinucleated giant cells
Giant Cell tumor, requires surgery
Mature bone with cartilaginous cap. Rarely transforms to chondrosarcoma. Most common benign tumor. Males
Osteochondroma (exostosis)
Tingling in pinky finger, discomfort on medial forarm and weak grip; dx/ nerve compression location?
Ulner nerve compression at elbow at epicondyle groove or cubital tunnel
Mid humerus fx, wrist drop; dx?
Radial N damage; traverses spiral goove of dorsal humerus; loss sensation dorsal hand, strength of finger and wrist extensors
Supracondylar humerus fx; nerve involved?
Median N
Urinary Hydroxyproline, hydroxypyridinoline, C or T -telopeptide
Urinary markers of bone degredation (ie. Pagets)
Chondrocalcinosis (usually at the knee); dx/ associations?
CPPD (Pseudogout); idiopathic or a/w hyperPTH, Hemochromatosis (look for diabetes, skin pigmentation, hepatomegaly, dilated cardiomyopathy), Hypomagnesia
Inability to anchor scapula to thoracic cage, cannot abduct arm above horizontal position, winged scapula?
Lesion of long thoracic nerve (Serratus anterior), Axillary node dissection after mastectomy
Supracondylar fracture of humerus (proximal lesion); carpal tunnel syndrome and wrist laceration (distal lesion)
Median (C5-T1) “Ape hand” and “Pope’s blessing”; Loss of wrist and lateral finger flexion, thumb opposition, lumbricals of 2nd and 3rd digits Loss of sensation over thenar eminence and dorsal and palmar aspects of lateral 3 1⁄2 fingers with proximal lesio; Tinel sign (tingling on percussion) in carpal tunnel syndrome
Fracture of medial epicondyle of humerus “funny bone” (proximal lesion); fractured hook of hamate (distal lesion)
Ulnar (C8-T1) “Ulnar claw” on digit extension; Radial deviation of wrist upon flexion (proximal lesion)Loss of flexion of wrist and medial fingers,abduction and adduction of fingers (interossei),actions of medial 2 lumbrical muscles Loss of sensation over medial 11/2 fingersincluding hypothenar eminence
Midshaft fracture of humerus; compression of axilla (e.g., due to crutches or sleeping with arm over chair (“Saturday night palsy”)
Radial (C5-T1) Wrist drop: loss of elbow, wrist, and finger extension grip strength (wrist extension necessary for maximal action of flexors) Loss of sensation over posterior arm/forearm and dorsal hand
Inability to curl toes and loss of sensation on sole of foot. In proximal lesions, foot everted at rest with loss of inversion and plantarflexion.
Tibial (L4–S3) via Knee trauma, Baker cyst (proximal lesion); tarsal tunnel syndrome (distal lesion)
Trendelenburg sign/gait—pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction (superior nervemedius and minimus). Lesion is contralateral to the side of the hip that drops, ipsilateral to extremity on which the patient stands.
Superior gluteal (L4–S1) via Posterior hip dislocation, polio
Foot drop—inverted and plantarflexed at rest, loss of eversion and dorsiflexion. “Steppage gait.” Loss of sensation on dorsum of foot.
Common peroneal (L4–S2) via Trauma or compression of lateral aspect of leg, fibular neck fracture
