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Clin Med II > MSK Dx > Flashcards

MSK Dx Flashcards

1
Q

Worse pain in the AM
Pain lasts >45 min
Swelling, warmth, erythema

A

Inflammatory Arthritis

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2
Q

Worse pain at night

Pain lasts < 45 min

Swelling but less common than inflammatory

Bony hypertrophy

A

Non-inflammatory Artiritis

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3
Q

Typically symmetrical

Joint deformities if untreated
Ankylosis

Inflammation, joint pain, swelling, warnth, prolonged stiffness

Polyarticular disease w/ gradual onset

Hands mc involved- wrists, metacarpophalangeal (spares DIPJ)

A

Rheumatoid Arthritis

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4
Q

Skin and genital lesions

Eye and bowel inflammation

Association w/ preceding or ongoing infectious disorders

Inflam of axial joints

Asymmetrical oligoarthritis

Dactylitis

Enthesitis

Low back/inflam back pain usually at night and improves with exercise but NOT rest

A

Spondyloarthritis

SpA

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5
Q

MC affects DIPJ and PIPJ, hips and knees

Bony deformities
Bouchard’s nodes (PIPJ)
Heberden’s Nodes (DIPJ)
Squaring of thumb

Persistent use-related joint pain, morning stiffness ≤ 30 min

A

Osteoarthritis

DJD

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6
Q

Dull, aching pain over invovled area

Night pains “growing pains”

± fever, night sweats, weight loss

Tenderness to palpation of involved area, lim AROM of adj joint, limp, muscle atrophy, ± swelling, mass, deformity

± spontaneous fx

Pain from injury that doesn’t go away even after weeks

13-16 yo MC

A

Osteosarcome

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7
Q

Deep, dull, achy pain

MC in pelvis, ribs and hip

Pain at night

Chronic >1 yr

50-70 yo

A

Chondrosarcoma

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8
Q

Bone pain, tenderness on palpation, mass on exam

B sx (fever, night sweats, weight loss)

MC locations are pelvis, knee, prox humerus and femur disphysis

5-30 yo

A

Ewing Sarcoma

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9
Q

Dorsal surface of wrist at scapholunate joint

Joint instability, weakness, limited ROM

Normal overlying skin, compressible but firm movable mass

Transilluminates

May be adherent to bone, joint or tendon

A

Ganglion Cysts

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10
Q

What is the GS to diagnosis septic arthritis?

A

Arthrocentesis

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11
Q

MC affected bursa in adults

A

Olecranon

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12
Q

MC affected bursa in children

A

Prepatellar

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13
Q

GS to diagnose gout

A

Diagnostic Arthrocentesis

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14
Q

Monoarticular presentation (if pt comes in w/ monoarticular joint pain its septic arthritis until proven otherwise)

Abrupt swelling, warmth, and pain

Fever and chills

Antalgic gait (limp)
Guarding of limb
Extreme tenderness

Marked limitation in passive and active ROM

A

Septic Arthritis

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15
Q

Septic Arthritis etiology

A

S. aureus MC

Gonococcal

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16
Q

Infection of bone

A

Osteomyelitis

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17
Q

Osteomyelitis etiology

A

S. aureus

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18
Q

Tenosynovitis (inflammation of entire digit)

Dermatitis around palms and soles (pustules, hemorrhagic bullae)

Polyarthralgia starts in one joint and moves to another (migratory or additive)

GU sx

fevers/chills

A

Gonococcal Arthritis

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19
Q

Test of choice for gonococcal arthritis

A

(NAAT) of synovial fluid is preferred as more sensitive than culture

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20
Q

monoarticular or oligoarticular arthritis

Cold, large effusions Neurologic disease
Cutaneous involvement

A

Lyme Arthritis

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21
Q

Testing for Lyme arthritis

A

ELISA and confirm with Western blot due to high false ✚

Lyme IgM:1-2 wks
only 20- 40% ✚ at time of EM rash

Lyme IgG: 2-6 wks

Synovial fluid Lyme PCR

Most Lyme pts remain seropositive (including IgM) for yrs after successful tx with abx

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22
Q

Acute symmetric polyarthritis

Symmetric arthralgia or polyarthritis involving hands, wrists, knees, feet

Skin rash: lasts 2-4 days, face and trunk/limbs

A

Viral Arthritis

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23
Q

Septic Bursitis diagnostic test of choice

A

Aspiration and cx of bursitis = GS

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24
Q

Septic Bursitis etiology

A

s. aureus

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25
Q

MC site 1st MTP of foot= Podagra

Onset night or early morning

Pain, warmth, redness, swelling, fever (due to IL1), leukocytosis

Tenosynovial or bursal involvement

A

Acute Gout

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26
Q

Chronic Gout

A

Frequent attacks (≥2 per year)

Tophus

Erosive arthritis

CKD stage ≥2

Past urolithiasis (of any type)

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27
Q

Skeletal d/o characterized by compromised bone strength predisposing to inc risk of fx

A

Osteoporosis

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28
Q

Dx test of choice for Osteoporosis

A

Dual X-ray Absorptiometry (DXA) MC used

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29
Q

What pts should you use T score for?

A

used for dx of osteoporosis after menopause

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30
Q

What pts should you use Z score for?

A

used for dx of osteoporosis in children and YA

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31
Q

What fx requires greater force proximal humerus or humeral shaft?

A

humeral shaft

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32
Q

What should you look for on plain film if you suspect radial head fx

A

look for pulp findings (fat pad)

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33
Q

Anterior shoulder pain

Radiation down toward biceps

Tenderness over the bicipital groove

A

Biceps Tendinitis

34
Q

Period of shoulder immobilization

Loss of passive ROM and active

Pain w/ active and passive ROM, progressive loss of ROM

Shoulder stiffness

Rest pain and night pain

A

Adhesive Capsulitis

“frozen shoulder syndrome”

35
Q

Slowly progressive vague and diffuse shoulder pain

Pain is present at rest and exacerbated with activity

Progressive limitations on passive and active movement of shoulder (mostly due to pain)

Crepitus, ↓ ROM (w/ pain)

A

Glenohumeral Osteoarthritis

36
Q

Galeazzi Fracture

A

fracture of the distal 1/3 of the radius with dislocation of the distal radioulnar joint

37
Q

What is the mc type of metacarpal fx

A

Boxer’s Fracture

38
Q

What is mc type of metatarsal fx

A

Jones Fracture

39
Q

Jones Fracture

A

fx btwn the base and shaft of the fifth metatarsal bone

40
Q

Starts w/ painless nodule over MCP joint in 1 or more fingers

Nodule expands in proximal direction to form cord along tendon (over course of several mo-yr)

Cord and nodule begin to limit finger extension → persistent flexion of finger toward palm

A

Duuytren’s Contracture

41
Q

What is the most sensitive test for ACL tear?

A

Lachman’s

42
Q

Shoulder pain worse w/ overhead activity, lifting arm above shoulder level

Located sup and lat aspect of shoulder over deltoid

May be acute/burning (bursitis) or intermittent and dull (tendinopathy)

↓ active ROM due to pain but should have full passive ROM

A

Impingement Syndrome

Rotator Cuff Syndrome or Rotator Cuff Disease

43
Q

Pain in anterior lateral shoulder with radiation distally (but below elbow)

Weakness of the shoulder, especially with overhead movement

Night pain

Active ROM may show some weakness, esp with overhead reaching (above 90°)

Passive ROM is usually fine

A

Rotator Cuff Tears

44
Q

What is MC involved ligament in low ankle sprains

A

Anterior Talofibular Ligament (ATFL)

45
Q

c/o ”Walking on a Marble”

Pain & dysesthesias in the forefoot and
corresponding toes

Pain is described as sharp and burning

Toe numbness

Intermittent & episodic pain

Occasional night pain

A

MortonNeuroma

46
Q

Dull/sharp pain when first ge tout of bed in the AM

Pain after standing following long periods without weight-bearing

Pain improves with
walking

Greater pain after exercise or activity

Pain worsening through the day

A

Plantarfasciitis

47
Q

Pain worse after work or activities involving
repeated wrist extension and supination against resistance (think turning a screwdriver; painting a house; playing tennis)

Radiation of pain down posterior (dorsal) forearm

Pain reproduced with shaking hands,
opening/turning doorknob

Weakened grip, difficulty picking up heavy objects (bc tryin to avoid pain not bec inability)

ROM fully intact

A

Lateral Epicondylitis

tennis elbow

48
Q

50-60 yo

symmetric weakness

trouble climbing stairs

A

Polymyositis

49
Q

Pain after initial trauma but then dissipates
unless infected

Progressive formation of boggy swelling over
elbow

If infected → erythema, warmth, and pain

A

Olecranon Bursitis

50
Q

muscle pain, weakness, dark urine

A

Rhabdomyolysis

51
Q

Starts w/ painless nodule over MCP joint in 1 or more fingers

Nodule expands in proximal direction to form cord along tendon (over course of several mo-yr)

Cord and nodule begin to limit finger extension → persistent flexion of finger toward palm

A

Duuytren’s Contracture

52
Q

What is the most sensitive test for ACL tear?

A

Lachman’s

53
Q

> 3 months

Multifocal pain (above and below waist and on both sides of the body)

“tender points”

Cognitive problems/ Psychological distress

Fatigue, non-resorative sleep, arthralgias, cog dysfn, muscle spasm, parasthesias, depression/anxiety

Tension/migrain HA

Irritable bowel, restless legs, urinary infrequency, 1° dysmenorrhea/pelvic pain, temporomandibular pain, chem sensitivity

A

Fibromyalgia

54
Q

Tests for ACL tear

A

✚Lachman’s Test *most sensitive

✚ Pivot Shift

✚Anterior drawer test (not very sensitive)

✚Swelling

MRI is most sensitive test

55
Q

What is MC involved ligament in low ankle sprains

A

Anterior Talofibular Ligament (ATFL)

56
Q

c/o ”Walking on a Marble”

Pain & dysesthesias in the forefoot and
corresponding toes

Pain is described as sharp and burning

Toe numbness

Intermittent & episodic pain

Occasional night pain

A

MortonNeuroma

57
Q

Dull/sharp pain when first ge tout of bed in the AM

Pain after standing following long periods without weight-bearing

Pain improves with
walking

Greater pain after exercise or activity

Pain worsening through the day

A

Plantarfasciitis

58
Q

5-15 yo and 45-65 yo
Symmetric muscle weakness
trouble climbing stairs

Gottrons papules
Heliotrope rash
V-sign
Shawl sign
Holster sign
Mechanics hands
Nailfold changes
 Subcutaneous calcification
A

Dermatomyositis

59
Q

Motor disturbances are the earliest finding → triceps and hand intrinsic weakness

Clumnisess, can’t button shirt, dropping things, poor fine motor control

Spasticity in LE

Sensory sx can be minimal (can be stocking-glove dist)

Hyper-reflexive reflexes

Cord compression sx

A

Cervical Myelopathy

60
Q

Insidious- progressive over mo-yrs

Asymmetric, distal AND proximal muscle weakness (forearms and flexor fingers)

PAINLESS weakness

Ant thighs mc involved > arms

Atrophy is prominent

Neuropathy

A

Inclusion Body Myositis

61
Q

muscle pain, weakness, dark urine

A

Rhabdomyolysis

62
Q

Pain/stiffness of shoulder and/or pelvic girdles

Morning stiffness 45 min

Weakness/stiffness when brushing hair

Pain may wake up pt early morning/night

May have swelling

A

Polymyalgia Rheumatica

63
Q

Rapid decomp over mo

15% risk of blindness (mostly due to ischemic optic neuritis)

Jaw claudication is very specific

Constitutional sx

HA

Scalp tenderness

Abrupt field deficet (curtain coming down) - unilateral

Enlarged temporal arteries, absent temporal artery pulse, temporal artery tenderness

A

Giant Cell Arteritis

Temporal Arteritis

64
Q

> 3 months

Multifocal pain (above and below waist and on both sides of the body)

“tender points”

Cognitive problems/ Psychological distress

Fatigue, non-resorative sleep, arthralgias, cog dysfn, muscle spasm, parasthesias, depression/anxiety

Tension/migrain HA

Irritable bowel, restless legs, urinary infrequency, 1° dysmenorrhea/pelvic pain, temporomandibular pain, chem sensitivity

A

Fibromyalgia

65
Q

“My back hurts, and I peed my pants”

Urinary retention (or overflow incontinence)

Fecal incontinence

Saddle Anesthesia *mc sensory deficit (most sensitive)

Significant motor weakness

Sciatic pain – generally bilateral

Back pain

A

CaudaEquinaSyndrome

66
Q

neck pain, sore deltoids, trouble holding up arm due to weakness, pain/sensory sx and sensory lat shoulder

A

C4-5 disc herniation

compress C5 root

67
Q

neck pain, triceps, wrist drop (wrist extension), pain and sensory sx in upper arm 2nd-3rd fingers

A

C6-7 disc herniation (compress C7 root)

68
Q

Arthralgias, fatigue

Dry eyes, dry mouth, neuro problems

Skin disorders- raynaud’s, cutaneous vasculitis

Nutritional malabsorption

Dry throat, dysphagia, liver abnormalities

A

Sjogrens Syndrome

69
Q

Degenerative process that results in overall narrowing of spinal canal and neural foramen

A

Cervical Spondlyosis

70
Q

Motor disturbances are the earliest finding → triceps and hand intrinsic weakness

Clumnisess, can’t button shirt, dropping things, poor fine motor control

Spasticity in LE

Sensory sx can be minimal (can be stocking-glove dist)

Hyper-reflexive reflexes

Cord compression sx

A

Cervical Myelopathy

71
Q

pain post leg to hamstrings and to little toe side of the foot, motor weakness in plantar flexion, ↓ sensation in lat malleolus and lat foot

A

L5-S1 HLD (S1 nerve root

72
Q

pain to post leg wrapping to shin below knee, motor weakness in tibialis anterior (foot drop), ↓ sensation in top of foot to big toe

A

L4-5 HLD *MC (effects L5 nerve root)

73
Q

pain in ant thigh, motor weakness in quads, ↓ sensation in medial malleolus and medial foot

A

L3-4 HLD(effects L4 nerve root

74
Q

bilat pain or discomfort in buttocks, worse w/ walking

Releived w/ rest of Δ in posture

Back pain

Used to be able to walk 2 mi now can walk 2 block before rest (rest on shopping cart/lean over)

A

Lumbar Spinal Stenosis

75
Q

vertebral slip

A

Spondylolisthesis

76
Q

“My back hurts, and I peed my pants”

Urinary retention (or overflow incontinence)

Fecal incontinence

Saddle Anesthesia *mc sensory deficit (most sensitive)

Significant motor weakness

Sciatic pain – generally bilateral

Back pain

A

CaudaEquinaSyndrome

77
Q

Malar rash *spates nasolabial folds

Photosensitivity- rash in sun exposed areas

Oral or nasopharyngeal ulcers- usually painless

Arthritis- inflam, tenderness, swelling, non-erosive polyarthritis

A

SLE

78
Q

Thickened skin

Edema, tight puffy fingers, disffuse swelling

Contractures, skin ulcers, dignital tip ulcers (assoc w/ Raynaud’s)

Symmetric polyarthralgias- stiffness of fingers, wrists, knees and ankles

Lip thinning, ↓ oral aperature

A

Scleroderma

79
Q

Arthralgias, fatigue

Dry eyes, dry mouth, neuro problems

Skin disorders- raynaud’s, cutaneous vasculitis

Nutritional malabsorption

Dry throat, dysphagia, liver abnormalities

A

Sjogrens Syndrome

80
Q

Classically involved lungs but can also involve other organs (skin, joints, brain, liver)

Acute polyarthritis (usually ankles)

Erythema nodosum

Eyes popping out

A

Sarcoidosis

81
Q

Young pt w. Claudication or gangrene

A

Thromboangiitis Obliterans

Clin Med II (19 decks)

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