MSK Flashcards
The most commonly fractured carpel bone? Dx?
Scaphiod
Dx: clinical, XR can take 2 weeks to show positive!
A guy presents with fracture of 5th metacarpal neck. What medication to give? Bug?
Abx for coverage of eikenella. Most likely from human mouth
Most common bone broken when defending yourself from cops?
Ulna (nightstick fracture)`
What is the unhappy triad?
Injury to ACL, MCL, and medial meniscus.
Lateral meniscus is more commonly seen in acute ACL injuries
Knee injury shows clicking and locking. Exam shows tenderness to joint line and a + Mcmurray’s test. Dx?
Meniscal tear
What will the compartment pressures look like in compartment syndrome?
> 30mmHg.
Delta pressure = diastolic pressure - compartment pressure. is + if it is
Lower back pain in middle aged man, made worse with coughing. Pain shoots down back of legs. Passive leg raise is +. Dz? What is the most common level?
Herniated disk. Most commonly at L5-S1
DO NOT STOP ACTIVITY, must keep moving. Take NSAIDs
What nerve root gives sensation to the:
medial aspect of lower leg?
dorsum of foot and lateral aspect of lower leg?
Plantar and lateral aspects of foot?
L4
L5
S1
Pt w/ lower bak pain complains of bowel/bladder dysfunction, impotence, saddle anesthesia. Dx?
Cauda Equina syndrome. emergency!
Lower back pain that radiates to buttocks and legs. Worse with standing and walking. Improves with flexion of hips and bending forward
Spinal Stenosis
Kid (10-20) with onion-skinning finding on xray in the diaphyseal region of the femur. Dx?
Ewings Sarcoma
Where are osteosarcomas located? Who gets them? Pathology? Where should I be concerned it metz to?
In the metaphyseal region of DISTAL FEMUR or PROXIMAL TIBIAL, aka around the knee.
Young people (men) 20-30
Path = codmans triangle (periosteal new bone at diaphyseal end of lesion) w/ a sunburst pattern
Commonly metz to the lungs
Where are giant cell tumors located?
Who gets them?
Pathology?
Epiphysieal/Metaphysieal region of long bones
people (females) 20-40
Path = soap bubble
How high is the WBC count in septic arthritis?
What do you tx with?
> 80k
empirically tx w/ cef and vanc until cultures of aspiration come back.
What does the synovial fluid analysis look like for RA?
Antic CCP Abs in the fluid
Child w/ gout and inexplicable injuries =
Lesch-Nyhan syndrome
What do gout crystals look like with condenser?
pseudogout?
needle shaped negative bifringence (yellow) w/ parallel light
rhomboid crystals with positive bifringence
What do lesions look like in bone with chronic gout?
Punched out lesions (rat bite erosions)
What is the MOA of Colchicine?
side effects?
it inhibits neutrophil chemotaxis, best used EARLY in gout flair
side effects = diarrhea and BM suppression (neutropenia)
Tx for an acute attack of gout?
maintenance therapy?
acute = NSAIDS (indomethacin) > colchicine > steroids (only use if other methods have failed or pt can’t take NSAIDs
maintenance = allopurinol (if pt is overproducer) or probenecid (if pt is underexcreter)
probenecid is contraindicated in pts with tophi, renal stones, or CKD!
Young man who complains of hip pain, LBP that worsens w/ inactivity and in the mornings. Dx?
What other (random) symptoms may occur?
What will xray look like?
Ankylosing Spondylitis
May also have uveitis and heart block!
xray = fused sacroiliac joints w/ bamboo spine
What will the xray of psoriatic arthritis look like?
“pencil in cup” deformity
Sx of polymyositis
Dermatomyositis?
Abs seen?
poly = symmetric, progressive proximal muscle weakness, pain, difficulty breathing/swallowing
dermato = same but with a heliotrope rash w/ “shawl sign” and gottron’s papules
Abs = serum CK and anti-Jo-1 Abs
What specific dz are antihistone Abs seen in?
anti-Ro abs?
Drug-induced SLE
Neonatal SLE
Pt has RA, splenomegaly, and neutropenia. What is the syndrome called?
Felty’s syndrome
What is the side effect of hydroxychloroquine (a drug used in RA tx)
Retinal toxicity
What types of collagen are deposited in Scleroderma?
Type 1 and 3
What Abs are specific for CREST syndrome?
What Abs indicate poor prognosis w/ diffuse disease?
What is the likely mode of death?
Anticentromere Abs
Anti-Scl-70 Abs mean poor prognosis
Pts will die from pulmonary HTN
What drug is used to tx reynaud’s syndrome?
CCBs
What Abs should be used for screening and confirmation in SLE?
What heart dz is common with SLE and APLS?
screen = anti-ANA (not specific, but highly sensitive) confirm = Anti-dsdNA, anti-Sm (highly specific)
Heart issue = Libman-Sacks endocarditis (noninfectious vegetations on the mitral valve)
Why is temporal arteritis also called giant cell arteritis?
Pt will have subacute granulomatous inflammation of large blood vessels (aorta, external carotid, and vertebral) as well as temporal artery issues
PTS WILL ALSO LIKELY HAVE POLYMYALGIA RHEUMATICA
What is the worst case scenario in temporal arteritis?
blindness due to occlusion of central retinal artery
Sx of temporal arteritis:
Labs:
Tx:
Sx = HA, jaw claudication, tender temple
labs = hi ESR, and also do a bx
Tx; CTSDs (prednisone) to prevent blindness
What are some differences between polymyalgia rheumatica and fibromyalgia?
All of these happen in PR, not fibro:
women >50, pain in pelvic girdle and shoulders (!!hard to get out of chair or raise arms above head!), +ESR, fever, temporal arteritis. Tx w/ prednisone, not anti depressants
Onset of DMD and what gene is effected?
cause of death?
Becker differences?
aages 3-5 - dystrophin gene is DEFICIENT
Death = pulmonary congestion by HOHF (due to cardiac fibrosis)
Becker = “milder” - later onset, later death, no MR, dystrophin is messed up, not absent
What is the most common pediatric elbow fracture?
Supracondylar humerus fracture
BEWARE OF BRACHIAL ARTERY ENTRAPMENT
How do you treat devvelopmental dysplasia before 6mo age? risks?
Put them in a Pavlik harness (hips flexed and abducted.)
Do not abduct more than 60* or risk of AVN of femoral head
Painless limp in boy 4-10 w/ limited abduction and internal rotation of hip?
Painfull limp in a fatty age 11-13, cant bear weight?
Legg-Calve-Perthes dz (AVN of femoral head) usually goes away on its own if still full ROM. UNILATERAL
SCFE (separation of proximal femoral epiphysis through the growth plate leading to inferior and posterior displacement of femoral head relative to femoral neck) fix with a screw. BILATERAL IN 50%
Tx for scoliosis?
50* = surgical correction
A nonmigratory mono or polyarthritis w/ bony destruction in a girl
Juvenile Idiopathic Arthritis
other sx: fever, rashes, PERICARDITIS
labs: +ESR, WBCs, platelets
Tx = NSAIDs or steroids. MTX is second line
Risk factors for osteoporosis?
White/asian, alcohol use, smoking, thin, menopause, malnutrition
Raloxifene does what?
It is a mixed agonist/antagonist of E receptors.
In the breast/vag it is an antagonist (ppl use it to prevent breast cancer)
In the bone it is an agonist (people use it for osteoporisis)
IT CAN CAUSE AN INCREASE IN THROMBOEMBOLISM
Tamoxifen can increase the risk for endometrial CA, but Raloxifene does not increase this risk
