MSK Flashcards
What is the most common clinical manifestation of osteoporosis?
Vertebral fractures.
Who’s the most common patient for osteoporosis?
An elderly woman
What are some lifestyle issues associated with osteoporosis?
Alcohol and tobacco
How is osteoporosis diagnosis made?
By DEXA scan with a T-score ≤ -2.5
What is the first line treatment for osteoporosis?
Bisphosphonates
What is the most common fracture in osteoporosis?
Vertebral body compression fractures
What is an orthopedic, idiopathic avascular necrosis of the hip that affects children 3 to 12 years old?
Legg-Calvé-Perthes
What is the most common manifestation of late Lyme disease?
Arthritis.
What’s the most common cause of Legg-Calvé-Perthes?
Osteonecrosis of the proximal femoral head
What is the best initial treatment approach for carpal tunnel syndrome?
Wrist splinting
Which nerve injury causes the “claw hand,” which is the inability to open the fourth and fifth digits?
Ulnar nerve.
In which fingers would a patient with carpal tunnel syndrome complaining of pain and numbness?
In the first, second, and third digits, especially at night
What is the test for carpal tunnel symptoms that involves wrist hyperflexion?
Phalens sign
What is the test for carpal tunnel symptoms that involves percussion over the carpal tunnel?
Tinels sign
Which nerve is compressed in carpal tunnel?
Median nerve
What is the most appropriate treatment for giant cell arteritis (temporal arteritis)?
Prednisone
What are the classic symptoms of polymyalgia rheumatica?
Unexplained pain and stiffness in the shoulders, pelvic girdle, and hips.
What are the three major patient complaints seen in giant cell arteritis (temporal arteritis)?
Monocular visual loss, unilateral headache, jaw claudication
What is the typical patient with giant cell arteritis (temporal arteritis)?
woman > 50-years-old
What is the ESR with giant cell arteritis (temporal arteritis)?
> 50
How is the diagnosis of giant cell arteritis (temporal arteritis) made?
Temporal artery biopsy
Synovial fluid analysis showing crystals with a rhomboid shape is a diagnostic findings is suggestive of what?
Pseudogout
What is the first-line medication to prevent flares of acute gout arthritis?
Allopurinol.
What demographic is the typical patient with pseudogout?
A middle-aged man
What is the major complaint in a patient with pseudogout?
Monoarticular arthritis
What will labs show in Pseudogout?
Rhomboid-shaped crystals, weakly positive birefringence
What substance is most commonly present in synovial fluid with pseudogout?
Calcium pyrophosphate crystals
What is the first-line tx for pseudogout?
NSAIDS
A patients present with pain exacerbated by activity, especially running, jumping, squatting, and ascending or descending stairs. What do these symptoms describe?
Patellofemoral pain syndrome
What’s the tx for patellofemoral pain syndrome?
Exercise program for hip, knee, and core strengthening
When is surgery indicated to treat patellofemoral pain?
In patients with instability (recurrent subluxations or dislocations) or severe malalignment.
What will a physical exam show with patellofemoral pain syndrome?
Patellar crepitation
Diminished sensation over the dorsal foot is most characteristic of a herniated disk at what level?
L5
Compression of the L5 nerve root would cause weakness with which movement?
Great toe extension.
What is the Risser sign in scoliosis diagnosis?
The ossification and fusion of the iliac apophysis on X-rays of the pelvis
When is surgery is indicated for scoliotic curves?
When curves are greater than 50°.
What degree of Cobb angle means scoliosis?
Greater than or equal to 10 degrees
What pharmacologic therapy is generally a first-line treatment for osteoarthritis?
Naproxen
What is the most common side effect of topical capsaicin?
Local burning.
What will be present on an X-ray for a patient with osteoarthritis?
Subchondral sclerosis, joint-space narrowing, subchondral cysts, and osteophytes
What is the anatomical finding seen in patients with spondylolisthesis?
Vertebra slipping forward with respect to the vertebra below
Where is the most common site for degenerative spondylolisthesis?
L4
What is the term given to an injury of the extensor tendon at the distal interphalangeal joint, following a direct blow to the digit?
Mallet finger
What is an injury to the flexor digitorum profundus tendon resulting in a loss of the ability to fully flex the distal interphalangeal joint?
Jersey finger
What is an avulsion injury at the proximal interphalangeal joint?
Boutonniere deformity
What is the hyperflexion finger injury involving both the distal interphalangeal joint and proximal interphalangeal joint?
Swan-neck deformity
Which radiographic view of the digit is best for identifying avulsion fractures?
True lateral view.
What is the tx for Mallet finger?
Splint in extention for 6-8 weeks
What infiltrates the exocrine glands in Sjögren syndrome?
Lymphocytes
True or false: Atropinic drugs and decongestants should be avoided in patients with Sjögren syndrome?
True
What will be the chief patient complaint in Sjögren syndrome?
Dry eyes (Xerophthalmia) and dry mouth (Xerostomia)
What diagnostic test is performed in Sjögren syndrome?
Schirmer test
Bicycle vs automobile. Cyclist complains of right-sided chest pain and difficulty breathing. Visual inspection reveals that the posterior right side of his chest moves inward with inspiration and outward with expiration. Which of the following is the most likely diagnosis?
Flail chest
What is the treatment for tension pneumothorax?
14 gauge or higher) needle or thoracostomy tube. The preferred location for needle insertion is the second intercostal space at the mid-axillary line.
What types of fracture is usually involved in a flail chest?
≥ 3 adjacent ribs fractured at two different points
What’s the tx for flail chest?
Supportive care
A patient complains of pain when starting to walk or run after a period of rest or inactivity. This improves with activity but then can worsen again by the end of the day. What’s the likely condition?
Plantar fasciitis
What’s the likely diagnosis when a patient presents with pain in the posterior heel?
Achilles tendinitis
What is a “heel spur”? What is its association with plantar fasciitis?
a traction osteophyte on the plantar aspect of the calcaneus; most are seen incidentally on X-rays and there is no association with plantar fasciitis.
What is the most appropriate diagnostic test to confirm the diagnosis of Baker cyst?
Ultrasound
What are treatment options for Baker cysts resistant to initial therapy?
Ultrasound-guided cyst aspiration followed by glucocorticoid injection, surgery.
What is a a Baker’s cyst? How does it present?
A popliteal synovial cyst that presents as swelling in the posterior aspect of the knee.
A 13-year-old obese boy presents to the clinic with insidious left-sided hip pain and altered gait for the past three months. The hip pain is worse with activity. He reports no history of trauma. X-ray will show “scoop of ice cream slipping off an ice cream cone”. What is the most likely cause of this patient’s hip pain?
Slipped capital femoral epiphysis
In which position do patients with slipped capital femoral epiphysis often keep their hip?
An externally rotated position because internal rotation makes the pain worse.
What is the pathogenesis for the majority of cases of stenosing flexor tenosynovitis (trigger finger)?
Idiopathic
When does trigger finger typically present?
In the fifth or sixth decade of life.
A 45-year-old man presents to your office with a complaint of worsening asthma symptoms. He tells you that he has had asthma since he was a child and is compliant with his daily inhaled glucocorticoid that has controlled his asthma until recently. He also reports recent sinus pressure. Labwork results show eosinophilia of more than 10% in a peripheral blood smear. To confirm the diagnosis of eosinophilic granulomatosis with polyangiitis, which of the following also needs to be present?
Paranasal sinusitis
Patients with eosinophilic granulomatosis with polyangiitis are at increased risk of developing what condition?
Venous thromboembolism
A 25-year-old woman presents to the emergency department after she injured her right foot playing soccer. X-rays show a fracture of the fifth metatarsal. What piece of information is the most important piece of information to help you formulate a treatment plan?
Location of the fracture in the bone
What are the Ottawa rules for obtaining X-rays of the foot in the emergency department setting?
X-rays are required if there is any pain in the midfoot and one or more of the following: bone tenderness over the proximal fifth metatarsal, bone tenderness over the navicular, or inability to bear weight.
A 58-year-old woman with a history of diabetes mellitus presents to your office with a complaint of finger pain. She says that when she flexes her right third finger, it gets “stuck,” and then snaps open quickly with manual manipulation. After physical exam, she is diagnosed with trigger finger. What is the next best step?
Splinting
A 37-year-old woman presents to her primary care provider with complaints of left hip pain. She does not recall any recent injuries. A review of her current medications is concerning for avascular necrosis. What medication is associated with development of this problem?
Glucocorticoids
Which pathogen is the most common microbial cause of osteomyelitis?
Staphylococcus aureus
Which autosomal recessive genetic disease is associated with osteonecrosis?
Gaucher disease.
What is the name for osteomyelitis in the vertebrae caused by tuberculosis?
Pott disease.
Which of the following physical exam findings would be most consistent with an anterior cruciate ligament tear?
Positive anterior drawer test
Which three sports are most highly associated with anterior cruciate ligament injuries?
Soccer, basketball, and skiing.
A 48-year-old man presents to your office with a one-week history of right knee swelling. He works installing hardwood floors and finds it difficult to kneel. On physical examination, he has full range of motion of the knee. He has no effusion in the knee but has a 3-centimeter, well-circumscribed, subcutaneous, nontender fluid collection over the patellar tendon. What is the most likely diagnosis?
Prepatellar bursitis
When is surgical treatment indicated for prepatellar bursitis?
When the bursa cannot be adequately drained by aspiration, if adjacent tissues require debridement, or in an immunosuppressed patient in acute bursitis. In chronic bursitis, surgical excision of a large, thickened symptomatic bursa can be performed.
What medication is most appropriate to treat an acute lumbar strain without radiculopathy?
Ibuprofen
What are some lumbar strain “red flags” on history and physical that may prompt the clinician to order imaging tests?
Significant trauma, a history of bladder or bowel dysfunction, or a history of malignancy. Signs of infection and severe or progressive neurologic deficit. Urinary or fecal retention or incontinence by history or on examination should raise suspicion for cauda equina syndrome, which is a surgical emergency.
A 55-year-old woman presents with increasing weakness in her muscles that began in her legs and then progressed to her shoulders and neck for the past six months. Her physical exam reveals proximal muscle weakness of her hips, shoulders, and neck, which are non-tender to palpation. A blood test reveals an elevated creatine kinase and an elevated antinuclear antibody. A muscle biopsy is ordered to confirm diagnosis. What is the most likely diagnosis?
Polymyositis
What other inflammatory muscle disease is associated with polymyositis and is characterized by cutaneous lesions (in addition to proximal muscle weakness)?
Dermatomyositis.
What is the risk factors is most commonly associated with the development of Dupuytren contracture?
Genetic predisposition
Which digits are typically affected first with Dupuytren contracture?
The fourth and fifth digits.
A 25-year-old previously healthy woman presents to your office with a complaint of knee pain that started one week ago. She is an avid runner. Physical exam reveals pain with flexion when varus stress is applied to the joint. A diagnosis of iliotibial band syndrome is made. What is the most appropriate treatment?
Rest
Which muscle is affected in patients with torticollis?
Sternocleidomastoid
How is the diagnosis of congenital torticollis made in children?
History and physical exam.
A 34-year-old woman presents to the office for a fertility consult. She and her husband have been trying to get pregnant for over a year, and she has had four miscarriages, two in the first trimester and two during the second trimester. She has no other complaints and has not had any traumatic events or taken new medications in the past year. Physical exam is unremarkable. Laboratory testing reveals a low platelet count and high titers of several antibodies. What is the most likely diagnosis?
Antiphospholipid syndrome
What is livedo reticularis?
A skin finding characterized by a lacy, purplish discoloration of the skin in a reticulated pattern.
A 40-year-old woman presents to the emergency department after sustaining an injury in a basketball game. She thinks someone might have run into her ankle when she was going up for a jump. She is generally healthy and actively participates in sports, including a basketball team. She has had previous urinary tract infections treated with ciprofloxacin, the last occurrence was four months ago. On exam, calf squeeze is positive indicating likely Achilles tendon rupture. What is the most important risk factor for this patient’s injury?
Sports participation
Which muscles converge to form the Achilles tendon?
The soleus and the gastrocnemius.
What is the best initial diagnostic study for a suspected tarsometatarsal (Lisfranc) joint complex injury?
Plain, nonweight-bearing radiographs
What is a “fleck sign”?
An avulsion fracture at the origin or insertion of the Lisfranc ligament.
What lab tests provides the most specific diagnostic findings for rheumatoid arthritis?
Anti-citrullinated peptide/protein antibody and rheumatoid factor
Which joints in the hand are most commonly affected in patients with rheumatoid arthritis?
The metacarpophalangeal (MCP) joints.
What is the first-line pharmacologic therapy for osteoporosis in postmenopausal women?
Alendronate
When should a follow-up dual-energy X-ray absorptiometry (DXA) scan be done in patients started on pharmacotherapy for osteoporosis?
After one or two years.
A 45-year-old man presents to the emergency department with a spine injury after a motorcycle accident. He is alert and oriented and complains of severe pain in his lower back and both legs. On physical examination, he has decreased sensation over the perineum, weakness of plantar flexion and absent ankle jerk reflexes bilaterally, and fullness and tenderness in the suprapubic area. What is the most likely diagnosis?
Cauda equina syndrome
What are some causes of cauda equina syndrome other than trauma?
Any pathologic entity that affects the nerve roots, such as a large extruded disc herniation, epidural abscess, a tumor compressing the nerve roots, inflammatory conditions, and infections.
A 65-year-old woman presents to the emergency department after falling in her home. She complains of pain with breathing, especially inspiration. Physical exam reveals tenderness to palpation of the chest wall. The patient is not in distress. A chest X-ray is ordered and shows a single rib fracture. What is the most appropriate treatment?
Oral analgesics
What is the most appropriate treatment for an acute, closed, soft-tissue mallet injury of a finger?
Dorsal hyperextension splinting of the distal interphalangeal joint for six weeks
What is the best first test to confirm ankylosing spondylitis?
Pelvic X-ray
What are the characteristic findings of reactive arthritis, formerly known as Reiter syndrome?
Arthritis, uveitis, conjunctivitis, and urethritis; “can’t pee, can’t see, can’t climb a tree.”
An 11-year-old girl presents to your office with a six-week history of right knee pain. She plays soccer and field hockey nearly all year, and the pain has progressed to the point where she needs to sit out of practices and games. Physical examination reveals full range of motion of her knee and tenderness and swelling over the tibial tubercle. X-rays are normal. What is the most appropriate treatment for this patient?
Rest, ice, and ibuprofen as needed and activity as tolerated
What would you expect to see on ultrasound with de Quervain stenosing tenosynovitis?
Thickened abductor pollicis longus
What are some other causes of anterior knee pain in children and adolescents?
Patellar tendinopathy, bone tumors, trauma, painful synovial plica, and idiopathic anterior knee pain
What is the maneuver used to evaluate for pain with tendon stretch over the radial styloid?
Finkelstein maneuver.
What diagnostic studies is most effective for evaluating tumor size in a patient with chondrosarcoma?
Magnetic resonance imaging
Which bones are rarely involved in cases of chondrosarcoma?
The spine and the craniofacial bones.
Which ligaments is most commonly injured in an inversion ankle sprain?
Anterior talofibular ligament
What structure does a squeeze test assess injury to?
Syndesmosis.
Where do ganglion cysts most commonly occur?
Dorsal aspect of the wrist
What is the second most common location for ganglion cysts to occur?
The volar aspect of the wrist over the scaphotrapezoid joint.
