MSK Clib Lab Review Flashcards
1
Q
workup for monoarticular joint pain
A
- imaging
- arthrocentesis w/ synovial fluid analysis
+/- labs if needed - synovial biopsy - rare
2
Q
labs for hemarthrosis w/o trauma
A
PT/INR, PTT, CBC
3
Q
evidence of joint trauma w/o infection or cystals
A
ESR/CRP
testing for specific rheumatic disease
testing for lyme disease if suspicion is high
4
Q
monoarticular differential dx
A
OA
injury
septic arthritis
crystal induced
neoplasms
5
Q
workup of polyarticular w/ synovitis
A
- CBC, CMP, urinalysis
- arthocentesis w/ synovial fluid analysis
- Labs depending on clinical suspecion
- ESR/CRP
- suspected systemic illness
- viral antibodies
- imaging - rarely needed
- synovial biopsy - rare
6
Q
polyarticualar w/ synovitis differential dx
A
infection
reactive arthritis
psoriatic arthritis
rheumatoid arthritis
crystal induced
systemic rheumatoid illness
other systemic illness or malignancy
juvenile idiopathic arthritis
7
Q
workup for polyarthritis w/o synovitis
A
based on clinical suspicion
- CMP
- TSH/PTH
imaging - XR
screening for depression
8
Q
polyarthritis w/o synovitis differential dx
A
fibromyalgia
OA
neuropathic pain
depression
metabolic bone disorder
endocrine disorder
plasma cell myeloma
9
Q
normal synovial fluid analysis
A
viscosity-high
color - colorless/straw
clarity - translucent
WBC - <200
PNM - <10%
Culture - negative
protein - 1-2 g/dL
10
Q
noninflammatory synovial fluid analysis
A
viscosity - high
color - straw/yellow
clarity - translucent
WBC - 200-3K
PNM - <10%
culture - negative
Protein - 1-3 g/dL
11
Q
inflammatory synovial fluid analysis
A
viscosity - low
color - yellow
clarity - translucent/opaque
WBC - 2K - 50K
PMN - often >50%
culture - negative
protein - 3-5
12
Q
septic synovial fluid analysis
A
viscosity - variable
color - variable
clarity - opaque
WBC - >50K
PNM - >75%
culture - often positive
protein - 3-5 g/dL
13
Q
gout
A
age - 40+
sex - Male
s/sx - sudden monoarticular small joints
14
Q
pseudogout
A
age - older
s/sx - acute, subacute, chronic, mono or poly
15
Q
rheumatoid arthritis
A
age - 35-50
sex - Female
ulnar deviation, swan neck and boutinniere deformity
16
Q
labs for RA
A
RF +
ANTI-CCP +
ESR/CRP -elevated
17
Q
imaging for RA
A
XR - bony erosions deformities
18
Q
gout labs
A
labs - uric acid
arthrocentesis - yellow negative birefrigence
19
Q
psuedogout labs
A
arthrocentesis, blirefingence
20
Q
psoriatic arthritis
A
s/sx - small, med, large joint involvement
21
Q
psoriatic arthritis labs
A
RF - mild
anti-CCP - rare
imaging - XR pencil in cup
22
Q
juvenile idiopathic arthritis
A
age - <16
gender - varies
s/sx- vague joint pain, daily low grade fever
23
Q
juvenile idiopathic arthritis labs
A
CBC - WBC and PLTs ↑
ESR/CRP - ↑
Ferritin ↑↑↑’
RF and anti-CCP - negative
24
Q
reactive arthritis
A
age: GU: 20-40, GI - any
sex - GU M>F, GI: any
S/Sx - preceding infection, asymmetric large joint, reiter’s
25
reactive arthritis labs
ESR/CRP ↑
arthrocentesis - c/w inflammatory synovitis
26
SLE
age - any, usually >40
sex - Female
s/sx - malar rash
27
SLE labs
ANA +
Anti-dsDNA +
Anti-Sm +
Anti-chromatin +
Anti-histone + (drug induced)
28
sjogren's disease
age - 40-55
sex - female
s/sx - dry mouth/eyes/skin
29
sjogren's disease labs
Anti-Ro/SSA +
Anti-La/SSB +
ANA and RF often +
ESR +
CBC-Hgb & WBCs ↓
30
testing for sjogren's disease
Schirmer test
Sialometry
Salivary gland bx
31
systemic sclerosis
age - 20-50
sex - female
s/sx - skin tightening/thickening, systemic symptoms, CREST
32
systemic sclerosis labs
ANA +
Anti-centromere + (CREST)
Anti-Scl70 + (Diffuse)
Anti-RNA polymerase + (Diffuse)
Anti-topoisomerase
33
MCTD
age - adolescence
sex - female
s/sx - Raynaud's phenomenon, diffuse hand swelling, polyathrialgia, associated w/ lung disease
34
MCTD labs
ANA +
Anti-RNP +
RF +
Anti-SM and Anti-dsDNA -
35
Ankylosing spondylitis
age - 20s-30s
sex - male
s/sx - back pain
36
Ankylosing spondylitis labs
HLA-B27 +/-
XR or MRI - sacroilitis, bamboo spine
37
giant cell arteritis
age - 70s
sex - female
vessels involved - medium/large arteries off aortic arch
38
giant cell arteritis labs
ESR ↑
CRP ↑
MRI/CT
narrowing of subclavian
U/S temporal artery
temporal artery bx
39
polyarteritis nodosa
age - 50s-70s
vessels - medium arteries, spares the lungs
40
polyarteritis nodosa labs
ESR & CRP usually ↑
Screen for
Hep B&C
Bx sx site
41
granulomatosis w/ polyangiitis (GPA)
age - mean 40s
vessels - small to medium
+ granuloma formation
42
granulomatosis w/ polyangiitis (GPA) labs
c-ANCA PR3 +
ESR & CRP ↑
Hematuria
imaging - CT chest to assess lung involvement
bx of affected organ
43
eosinophilic GPA
age - 40s-50s
vessels - small to medium vessels
+ granuloma and eosinophilia
44
eosinophilic GPA labs
c-ANCA PR3 +
ESR & CRP ↑
Hematuria
CT chest - assess lung involvement
bx of affected organ
45
Microscopic polyangiitis
small vessels
no granuloma
46
microscopic polyangiitis labs
p-ANCA MPO +
ESR & CRP ↑
Hematuria
CT chest - assess lung involvment
bx of affected organ
47
Polymyositis
age - any (40s-60s)
sex - female
s/sx - progressive proximal muscle weakness
48
polymyositis labs
Anti-Jo +
CPK ↑
Aldolase ↑
ESR & CRP -
49
dermatomyositis
age - any (40s-60s)
sex - female
50
dermatomyositis signs and symptoms
Progressive proximal muscle weakness
Skin findings
-Heliotrope rash
-Gottron papules
-Shawl sign
Increased incidence ILD
51
dermatomyositis labs
Anti-Jo +
CPK ↑
Aldolase ↑
ESR & CRP -
CXR to r/o ILD
muscle biopsy
52
polymyalgia rheumatica
age - 50+
sex - female
s/sx - B pain and stiffness in neck, shoulders, and hip girdle
53
polymyalgia rheumatica labs
ESR & CRP ↑
ANA –
CPK nml
MRI - may see muscle edema
EMG - eval for GCA
54
long bone transverse fracture
55
long bone - oblique fracture
56
long bone - spiral fracture
57
long bone - comminuated fracture
58
long bone - avulsion fracture
59
long bone - greenstick fracture
60
long bone - impacted fracture
61
salter harris classification
pediatric specific fracture that center around the location of the fracture and the relation to the growth plate
62
salter fracture pneumonic
S - Type I - straight across
A- Type II - above
L - Type III - lower or beLow
T - Type IV - Two of through
ER - Type V - ERasure of growth plate/crush
63
fracture evaluation - displacement
loss of alignment of a long bone and its axis
- depends on the relationship of the distal and proximal portions
64
displacement - rotation
- broken end twists around the bones long axis
65
displacement - angulation
- the broken pieces tilt toward or away from each other creating an angle at the fracture sits
66
displacement - translation
- the broken ends shift sideways without rotating or angling
67
displacement - longitudinal
This happens along the length of the bone and can be either:
Impaction: The pieces are pushed into each other (compressed).
Distraction: The pieces are pulled apart (gap between fracture ends)
68
cervical spine
7 vertebrae
c1.- atlas
c2 - axis
69
odontoid view
- C1
- C2
alignment
70
a fracture of how many of the columns in the c spine is considered to be unstable?
two or more
71
Jefferson's Fracture
C1
mechanism - axial loading - diving
fracture type - burst
72
Odontoid fracture
C2
mechanism - extremem flexion/hyperextension plus shearing force
ex. MVC
fracture finding - transverse fx of odontoid process
73
Hangman's fracture
C2
mechanism - hyperextension w/ axial loading
ex. diving w/ neck bend; contact sports
fx finding - subluxation of C2 over C3 w/ BL pars interarticularis fx of C2
74
clay-shoveler fracture
C6-C7
mechanism - sudden pull or shearing force exerted by muscles of the back
fx finding - avulsion of C6/C7 spinous process
75
thoracic spine
12 vertebrae
76
thoracic vertebra
77
lumbar vertebra
5 vertebra
78
lumbar vertebra
79
compression fracture
any vertrbrae
mechanism - bending forward with downward pressure on spine
fx finding - wedge shape with loss of vertebral height
80
burst fracture
any vertebrae
mechanism - high energy axial loading
fx finding - loss of vertebral height with disruption of anterior/posterior alignment
81
flexion-distraction aka chance or seatbelt
any vertebra
mechanism - flexion of the anterior and middle columns with distraction of posterior column
fx feature - anterior vertebral body height loss with "tear" in spinous process/posterior of vertebrae
82
dislocation
any vertebrae
83
kyphosis
outward rounding of the spine
84
lordosis
inward rounding of spine
85
scoliosis
sideways curving of spine
86
kyphosis
87
lordosis
88
scoliosis
89
1. Clavicle
2. Acromion process
3. Greater tubercule
4. Coracoid process
5. Humeral head
6. Lesser tubercule
7. Glenoid fossa
8. Acromioclavicular joint
9. Scapula
10. Humerus
90
normal shoulder XR
ID - clavicle, scapula, acromion process, coracoid process, humerus
91
anterior shoulder dislocation
MOA - indirect force on arm while abducted and externally rotated
ex. hit while throwing a football/FOOSH
position of humerus - in and down
92
posterior shoulder dislocation
MOA - humeral head forced posterior while head is abducted and internally rotated
ex. seizure/electrocution
position - out and up
93
inferior shoulder dislocation
MOA - hyperabduction
ex. FOOSH that is also elevated
position of humerus - out with humerus pointed upward "luxatio erecta"
94
1. Olecranon Fossa
2. Medial Epicondyle
3. Olecranon
4. Lateral Epicondyle
5. Radial Head
6. Radial Tuberosity
7. Ulna
8. Radius
9. Humerus
95
Galeazzi fracture
radius fracture (distal)
ulna dislocation
GRUsome
96
Monteggia
Ulna fracture
radial head dislocation
MURder
97
1. phalanges
2. metacarpals
3. capitate
4. hamate
5. pisiform
6. triquetrum
7. lunate
8. scaphoid
9. trapezium
10. trapezoid
98
colles frature
most common distal fracture
MOA - FOOSH
99
smith fracture
<3% of radius/ulna fracture
MOA - fall on flexed wrist
young males and elderly females
100
1. Iliac crest
2. Ilium
3. Anterior sacral foramina
4. Sacroiliac joint
5. Anterior superior iliac spine
6. Anterior inferior iliac spine
7. Ischial spine
8. Superior pubic ramus
9. Obturator foramen
10. Inferior pubic ramus
11. Ischial tuberosity
1. Symphysis pubis
13. Coccyx
14. Femur
15. Lesser trochanter
16. Greater trochanter
17. Femoral neck
18. Femoral head
19. Acetabulum
101
unstable - lateral compression fracture -
- "wind swept"
102
unstable - anterior posterior compression
- "open book"
103
unstable - shear fracture
- ipsilateral fractures vertically aligned
104
1. femur
2. lateral condyle
3. medial condyle
4. tibia
5. fibula
6. tibial tuberosity
105
normal knee XR - AP
106
normal knee XR - lateral
107
1. tibia
2. medial malleolus
3. talus
4. lateral malleolus
5. syndesmosis joint
6. fibula
108
normal - AP view ankle XR
109
normal - Mortise view ankle XR
110
normal - lateral view ankle XR
111
normal foot XR - AP view
112
normal foot XR - oblique view
113
normal foot XR - lateral view
114
thoracic outlet obstruction
compression of nerve/vasculature as it passes through the thoracic outlet
115
bony abnormalities you may see with thoracic outlet obstruction
congenital cervical rib
bony abnormality of 1st rib or clavicle
elongated C7 transverse process
116
rib 1-3 fractures
generally high energy trauma
associated injuries
- brachial plexus
- subclavian and neck vessels
- head injury
- cardiac injury
117
rib 4-10 fractures
most common
associated with
- pneumothorax
- pulmonary laceration
118
rib 10-12 fractures
associated with injuries
- laceration of liver, kidney, or spleen
119
what is a "floating rib"
when the rib is fractured twice the free fracture is considered a floating rib
120
flail chest
when 3 or more contiguous floating ribs are present
121
multiple myeloma
malignant tumor
"punched out"
122
ostesarcoma
malignant tumor
"sunburst" and "codman triange"
123
ewing sarcoma
malignant tumor
"onion skin"
124
chondrosarcoma
malignant tumor
"popcorn calcifications"
125
giant cell tumor
benign tumor
126
osteoid osteoma
benign tumor
"bullseye" - nidus
127
unicameral bone cyst
benign tumor
128
when to suspect giant cell tumor vs unicameral bone cyst
age - 20s-30s
location
distal metaphyseal-epipyseal long bones
particulary the knee
129
when to suspect unicameral bone cyst vs giant cell tumor
age <20 years
location
metaphysis of long bone
proximal femur and humerus
