Msk Flashcards
Compartment syndrome is due to what physiologically?
Soft tissue swelling
Can compartment syndrome follow a lower extremity embolectomy
Yes. It is a form of ischemia-reperfusion syndrome
Anterior shoulder dislocation increases risk of injury to what nerve
Axillary
___ nerve palsy may lead to wrist drop and loss of thumb extension
Radial
Humerus fracture may lead to __ nerve palsy
Radial
Weak wrist flexion and flat thenar eminence is due to injury of what nerve
Median
Claw hand is due to injury of what nerve
Ulnar
Decreased sensation over deltoid is due to what nerve injury
Axillary
Foot drop is due to damage of which nerve
Peroneal
___ nerve injury leads to benediction sign due to an inability to close first through third digits
Median
When is intrabursal corticosteroid injection contraindicated for bursitis
When septic bursitis is suspected
Volkmans contracture Of wrist and fingers is caused by ___ associated with —— fractures
Compartment syndrome
Supracondylar humerus fractures
____ epicondylitis worsens with resisted extension of the wrist, and __ epicondylitis worsens with resisted flexion If wrist
Lateral
Medial
Passive and crossed straight leg raise can ___ pain in herniated disc
Increase
In lumbar stenosis, leg cramping is ___ with standing and walking and ___ with flexion at the hips
Worse
Better
Tx of refractory spinal stenosis
Surgical laminectomy (though often have recurrence of sx)
What nerve root controls foot dorsiflexion
L4
What nerve root controls patellar reflex
L4
What nerve root controls sensory input to medial aspect of lower leg
L4
What nerve root controls foot eversion and big toe dorsiflexion
L5
What nerve root controls sensory input to dorsum of foot and lateral aspect of lower leg
L5
What nerve root controls plantar flexion and hip extension
S1
What nerve root controls Achilles reflex
S1
What nerve root controls sensory input to plantar and lateral aspects of the foot
S1
Bowel or bladder dysfunction, impotence and saddle area anesthesia are consistent with
Cauda equina syndrome
Where does osteosarcoma tend to occur
Metaphyseal regions of distal femur, proximal tibia and proximal humerus
Pain worsens at night in what bone cancer
Osteosarcoma
Link these terms to appropriate bone cancer:
- Sunburst pattern
- Onion skinning
- Soap bubble
- Osteosarcoma
- Ewing sarcoma
- Giant cell tumor
Most common benign bone tumor
Osteochondroma
First step in relieving spinal cord pressure in suspected metastasis (as you go to mri?)
Steroids
Describe osteoma
Benign bone forming tumor characterized by prostaglandin formation
Relief of pain with osteoma
NSAIDs
Wbc on septic arthritis is
> 80,000
Empirically treat septic arthritis with
Ceftriaxone and vanc
Other than abx how do you tx septic arthritis
Surgical debridement or serial aspirations
Pmn % on synovial fluid analysis in inflamed joint will be
> 50
Pmn % on synovial fluid analysis in septic joint will be
> 75
Glucose on synovial fluid analysis in septic joint will be
<25
Pmn % on synovial fluid analysis in inflammatory joint will be
> 25
Where does Ewing sarcoma usually present
Diaphyseal regions of the femur
Giant cell tumor of the bone usually presents in what demographic
Women aged 20-40
What antibodies do you find on synovial fluid analysis in ra
Anti ccp antibodies
In a child with gout and inexplicable injuries consider
Lesch-nyhan syndrome
How does colchicine work
Inhibits neutrophil chemotaxis
Side effects of colchicine
Diarrhea and bone marrow suppression
How do you choose between allopurinol and probenecid for maintenance therapy for gout
Allopurinol for overproducers
Probenecid for under secreters
Hla dr4 is a rf for
Ra
In gout, crystals are ___ shaped and ___ bifereringent
Needle
Negatively
In pseudogout, crystals are ___ shaped and ___ bifereringent
Rhomboid
Positively
In pseudogout what joints are affected
Wrists and knees
Dx of ra
Increased rf or presence of anti-ccp antibodies
Anklyosing spondylitis is associated with hla-
B27
Typical age of onset of anklyosing spondylitis
Late teens and early 20s
Pain in anklyosing spondylitis ___ with inactivity and in mornings
Worsens
Two complications of anklyosing spondylitis
Uveitis and heart block
Radiographs of anklyosing spondylitis May show ___ SI joints and ___ spine
Fused
Bamboo
Tx of anklyosing spondylitis
NSAIDs and tnf inhibitors for refractory cases
Heliotrope rash (periorbital) is associated with what msk dz
Dermatomyositis
___ syndrome is characterized by ra, splenomegaly, neutropenia
Felty
Hydroxychloroquine causes ___ toxicity
Retinal
Disease associated with this antibody: ana
Sle
Disease associated with this antibody: anti-ccp
Ra
Disease associated with this antibody: anticentromere
Crest syndrome
Disease associated with this antibody: anti dsdna
Sle
Disease associated with this antibody: antihistone
Drug induced sle
Disease associated with this antibody: anti jo 1
Polymyositis/dermatomyositis
Disease associated with this antibody: antimitochondrial
Primary biliary cirrhosis
Disease associated with this antibody: anti scl-70
Systemic sclerosis
Disease associated with this antibody: anti sm
Sle
Disease associated with this antibody: anti smooth muscle
Autoimmune hepatitis
Disease associated with this antibody: antitopoisomerase
Systemic sclerosis
Disease associated with this antibody: anti tshr
Graves
Disease associated with this antibody: c anca
Vasculitis esp wegner
Disease associated with this antibody: p anca
Vasculitis esp microscopic polyangiitis
Disease associated with this antibody: rf
Ra
Disease associated with this antibody: u1rnp antibody
Mixed connective tissue disease
Why should you discontinue aspirin in acute gout attack
Aspirin can decrease excretion of uric acid
Antihistone antibodies are seen in what kind of lupus
Drug induced
Tx of acute sle exacerbation
Steroids
Tx for isolated skin and joint involvement in sle
Hydroxychloroquine
Severe cases of lupus nephritis can be treated with ___. Be sure to get ___.
Cyclophosphamide
Renal biopsy
Monocular amaurosis fugax is associated with __. How to dx?
Giant cell (temporal artery) arteritis
Dx with temporal artery biopsy
In Giant cell (temporal artery) arteritis, esr is
Elevated over 50
Most commonly involved metatarsal in stress fractures
Second metarsal
Tx of stress fracture of 2nd, 3rd and 4th metarsals
Rest and analgesics
Burns in a child that spare flexor surfaces are concerning for
Child abuse by deliberate immersion injury
Arc of ecchymosis distal to the medial malleolus (crescent sign) is associated with
Ruptured popliteal cyst
Most common asymptomatic elevation of alk phos in an elderly pt is due to
Paget dz of the bone
X-ray of paget dz of the bone will show
Osteolytic or mixed lytic-sclerotic lesions
What happens to head in Paget’s disease of the bone
It grows
Tx of paget’s dz of the bone
Bisphosphates
Are thiazides a rf for gout flare
Yes
Etiology of paget dz of bone
Abnormal osteoclastic activity leading to increased bone turnover and disordered bone remodeling
Why can you get hearing loss with paget dz of the bone
Due to enlargement of the temporal bone
Tx of sciatica due to herniated disc
NSAIDs
Do you need to do an mri of herniated disc
No unless there are progressive nerve deficits
Most common complication of supracondylar fractures of the humerus
Entrapment of the brachial artery or median nerve
To dx ra sx have to be present for over
Six weeks
Sjogrens is most common in what demographic
Middle Aged women
Can sjogrens cause dysphasia
Yes
Which are associated with hemathrosis, acl or mcl
Acl
Low grade fever, bilateral periorbital edema, headache, papilledema, cranial nerve deficits. What am I?
Cavernous sinus thrombosis
Symmetric asymmetric muscle weakness and absent deep tendon reflexes after recent infection
Guillain barre syndrome
Is guillain barre associated with severe pain in back or extremities
Yes
Lp for guillain barre shows
Elevated csf protein with normal white blood cell count
Tx of Giullain barre
Supportive and ivig
Tx of myasthenia gravis
Cyclosporine and pyridostigmine
What degenerative joint disease can cause groin pain
Oa of the hip
Duchenne muscular dystrophy is transmitted via what gene thing
X linked recessive
dx of duchene muscular dystrophy
Deletion of dystrophin gene on xp21
Muscle biopsy in duchenne muscular dystrophy will show
Fibrosis and fatty infiltration
Triad of fat embolism syndrome
Resp distress, neuro dysfunction, petechial rash
Rule of 9s
Body surface area in adults
Head and each arm=9% Back and chest each=18% Each leg=18% Perineum=1% Palm=1%
Tenosynovitis largely affects which extremities
Hands and wrists