MSK/EENT Flashcards
Achilles tendon rupture clinical intervention
Non operative - serial splinting in mild plantar flexion with subsequent splinting w/ gradual dorsiflexion towards neutral
Operative - reattachment allowing for early range of motion
Acute compartment syndrome (FMLD)
MC after fxr of LONG BONES, crush injuries, tight casts/pressure dressings, thermal burns
Pain out of proportion to injury (persistent/deep/burning)
Increased compartmental pressure>30-45
Boxers fracture (scientific concepts)
Fx at neck of 5th metacarpal
Mechanism: punching with a clenched fist. If at base of thumb look at associated carap injuries
If bite wound - treat with AUGMENTIN
Cervical spine injury - 2 types
C1- Jefferson burst fracture vertical compression on atlas “ thomas jefferson was the first president and patted peopleon the head”
C2 - Hangmans - hyperextension then flexion axis pedicle
Complication of orthopedic device (clinical intervention)
Removal of hardware
Congenital talipes equinovarus (clinical intervention)
Ponseti method of serial manipulation and casting
Fingernail contusion dx and labs
Perform xray on finger with subungal hematoma if hematoma is >50% of nail to evaluate for phalanx fracture
Dermatomyositis (FMLD)
Progressive symmetric proximal muscle weakness + decreased muscle strength + GOTTRONS papules + helitrope rash
Anti-jo1 and AntiMi-2 antibodies
Joint effusion, knee (Hx and PE)
Bulge sign, ballottment (in increased patella waving motion or spongy joint feeling)
patellar tap test
Jones fracture (foot) FMLD
Transverse fracture through diaphysis of 5th Metatarsal @ metaphyseal diaphseal junction
Hip fracture (pharm therapeutics)
Prophylaxis = Ancef (first gen cephalosporin) + morphine + ketorlac
Radius wrist fracture clinical intervention
Closed reduction with sugar tong splint
Gout is a problem with what type of molecule?
Purine
Compound that precipitates into synovial fluid?
Sodium urate
When to do nail trephenation?
Evacuation via trephination or nail removal if >25% OR painful
Ankle dislocation clinical intervention
Closed reduction + posterior splint +/- ORIF in severe cases
Joint dislocation, shoulder (dx and labs)
Xray = X & Y axillary
Must r/o axillary nerve injury (pinprick sensation over deltoid)
Anterior shoulder joint dislocation (scientific concepts)
Mechanism = Blow to an abducted externally rotated arm that is extended
Anterior dislocation - MC shoulder dislocation
Lateral epicondylitis (scientific concepts)
Occurs at tendinous insertion of extensor carpi radialis brevis
Extra crispy red beautiful apples
Lumbar spondylosis with myelopathy (dx and labs)
Radiographs, CT scan, MRI used in events of complications
DEXA scan
Ensure no osteophytes
MCL injury (scientific conepts)
Mechanism = Blow to outside of knee
Femoral attachment is to medial epicondyle
Tibial attachment are semimembranosus muscle and posteromedial tibia
Meralgia paresthetica (clinical intervention)
Thigh tingling = lateral femoral nerve entrapment
Wt loss, loose clothing, focal nerve block at inguingal ligament with a combo of lido + steroids
Surgical decompression
C5 nerve injury (hx and PE)
Cervical radiculopathy with bone spurs or disc herniation
PE = weakness in deltoid (shoulder ABduction)
Bicep (elbow flexion)
Loss of bicep jerk reflex
Osteomyelitis (scientific concepts)
Inflammation/infection of bone
RF = Sickle cell = Salmonella
Hip = MC in children
Pagets dz of bone (FMLD)
Abnormal bone remodeling markedly elevated alk phos
Skull enlargement + COTTON WOOL appearance + deafness
Pes Anserine bursitis (FMLD)
Inflammation of bursa locate between shinbone (tibia) + 3 tendons of hamstring muscles at inside of knee
Pain occurs when arising from seated position at night or with ascending/descending stairs, local swelling
Posterior tibial tendon dysfunction (FMLD)
Player of high-impact sports
Pain + Swelling to medial foot and ankle; flattened arch “too many toes sign”
Pyogenic arthritis/Septic arthritis (Pharmaceutical tx)
Empiric abx therapy
G+ cocci = vanco
G - = Ceftriaxone
Rhabdo (pharm interventions)
IV saline, mannitol, bicarb, calcium gluconate
RA (pharm interventions)
Methotrexate = 1st line
Nsaids for pain control
Steroids if no relief with NSAIDS
What is the best view to assess SCFE and what is usually seen?
Best view = Frog leg lateral pevlis or lateral hio
Seen = Posterior and medial displacement of epiphysis
Spondylolisthesis
Forward slipping of vetebra on another on imaging from bilateral defect/fracture of pars
Synovial cyst (hx taking + PE)
MC in lumbar region of spine
+/- back/leg pain thats better with sitting, worse with standing/walking
Associated with age related degeneration (65+)
Thoracic outlet syndrome (FMLD)
Ulnar neuropathy + swelling/discoloration of arm with abduction of arm in affected side
ADSON sign = loss of radial pulse with head rotated to affected side
Torus fracture (FMLD)
Aka buckle fracture
Pediatric patient s/p fall with a “wrinkling/bump” on xray of distal radius
Open foot wound (Dx + Labs)
Labs - CBC, BMP, coag studies
Tissue culture
Dx - XR, CT, MRI
Vascular US = evaluate blood flow or occlusions
T99 = for osteo eval
Acoustic neuroma (Dx and labs)
MRI = Imaging of choice
Audiometry = Lab of choice
This is unilateral sensorineural hearing loss**
Acute narrow angle closure glaucoma (scientific concepts)
OPTHO EMERGENCY
Increased IOP = Optic nerve damage = Decrease in visual acuity
Decreased drainage of aquous humor via trabecular meshwork and canal of schlemm in patients with preexisting conditions
Leading cause of preventable BLINDNESS in the US
Factors: Dim lights, sympathomimetics, anticholinergics
Acute narrow angle closure glaucoma (Pharm tx)
Azetazolamide = first line to decrease IOP
Timolol reduces IOP without affecting vision
Acute sinusitis (dx and labs)
Mainly clinical sx (present less than 1 week(
CT w/o contrast = test of choice
Sinus radiographs = order WATERS view
Amarousis Fugax (FMLD)
Temporar MONOCULAR vision loss lasting minutes with complete resolution
Due to retinal emboli or ischemia; temporary “curtain” that resolves within 1 hr
Ambylopia (Hx and PE)
Hx of lazy eye and reduced vision in one eye caused by abnormal visual development early in life
Amblyopia (also called lazy eye) is a type of poor vision that usually happens in just 1 eye but less commonly in both eyes.
Barotrauma (pharm tx)
Abx only if tympanic membrane is rupture + middle ear contaminated = Cipro/Ofloxacin
NSAIDS for pain relief
No evidence that steroids speed recovery
BPPV (Hx + PE)
Recurrent episodes of sudden episodic peripheral vertigo <60sec. provoked with specific head movement
NO HEARING LOSS; tinnuts or ataxia; +/- NV
Central retinal artery occlusion (FMLD)
Acute, sudden monocular vision loss preceded by amaurosis fugas
Pale retina with cherry-red macula (red spot) “box car” appearance of retinal vessels
MC in 50-80yo with atherosclerotic dz
Cholesteatoma (scientific concepts)
Abnormal keritinized collection of desquamated squamous epithelium causing mastoid bony erosion
MC due to ET dysfunction = CONDUCTIVE hearing loss
Conductive hearing loss (FMLD)
Weber = Lateralized to affected ear
Rinee = Bone greater than Air
Etiologies: cerumen, foreign body, otitis, cholesteatoma
Conjunctivitis neonatal (scientific concepts)
Day 1 = Chemical due to silver nitrate
Day 2-5 = Gonococcal
Day 5-7 = Chlaymydia
Dacrocystitis (FML)D
Infection of lacrimal sac, tearing, tenderness, edema and redness to medial canthal side of lower lid (+/- purulent)
Diabetic retinopathy (scientific concepts)
MCC of new permanent vision loss/blindness in 25-74
1. Nonproliferative = Microaneurysms aka blot and dot hemorrhages, flame shaped hemorrhages, cotton wool spots, hard exudates
- Proliferative = Neovasculatization
- Maculopathy= macular edema or exudates, nblurred vision, central vision loss. Can occur at any stage
Diptheria (health maint + prevention)
Prophy = Erythromycin 7-10days or PCN G x 1 dose
Prevention = DTap at 2,4,6,15-18mo and 4-6yo booster
Diptheria (pharm tx)
Diptheria antitoxin (horse serum) + erythrymycin or pcn G for 2 weeks
Clinda or Rifampin are alternatives
PCNM + Aminoglycoside for endocarditis
Diptheria pharyngitis (scientific concepts)
Caused by Gram (+) rod Corynebacterium
rare due to vaccine
Transmission = resp secretions
Drug effect adverse from intranasal steroids
Rhinitis medicamentosa = MC = rebound congestion if used more than 3-5 days
Epidemic keratoconjunctivitis (scientific concepts)
MCC = Adenovirus types 8.19.37
Inflammatory response that involves conjunctiva + superficial cornea
Maxillary orbital fracture (FMLD)
Fx to orbital floor as result of trauma
Decreased visual acuity, diplopia with upward gaze if INFERIOR RECTUS MUSCLE ENTRAPMENT
Eyelid swelling after blowing nose
Glaucoma (Pharm tx)
First line = Prostaglandin analogs like Lantanoprost
Can use Brimonidine or carbonic anyhydrase inhibitors like acetazolamide
Hypertensive retinopathy (hx + pe)
Longstanding hx of HTN
Fundoscopic exam = Decreased cup to disc ratio
AV Nicking
Flame Hemorrhages
Papilledema = Seen at end stage = MALIGNANT HTN
Superficial keratitis (clinical intervention)
Topial abx; DO NOT patch eye
Larynx cancer (clinical intervention)
Surgical resection +/- chemo/radiation
Macular degeneration (scientific concepts)
MCC of PERMEANENT LEGAL BLINDNESS
Central vision loss = Seen on Amsler grid
Malignant otitis externa (Scientific concepts)
Invasive infection of external auditory canal and skull base (temporal bone, soft tissue)
COMPLICATION OF OTITIS EXTERNA
MCC = psuedomonase; MC in elderly +/- immunocompromised
Mastoiditis (clinical intervention)
Acute = Myringotomy and +/- tympanostomy
Refractor or complicated = Mastoidectomy
Nasal polyps (Pharm tx)
Intranasal steroids = Treatment of choice
Surgical removal if tx unsuccessful
Open angle glaucoma (hx + pe)
Slow progressive, painless bilateral peripheral vision loss
Asymptomatic until vision is loss - Tunnel vision progressing to central vision loss
PE = Increased IOP and cup/disc ratio
Optic neuritis (FMLD)
Loss of color vision, visual field defects, loss of vision over a few days (usually unilateral), associated with ocular PAIN WORSE WITH EYE MOVEMENT
Marcus Gunn Pupil = Relative afferent pupil defect
May need MRI; Usually clinical dx
Oral hairy leukoplakia (scientific concepts)
Caused by EBV virus
MC in immunocompromised
NOT considered cancerous
Orbital cellulitis (FMLD)
Usually secondary to sinus infection (ETHMOID)
MC in children 7-12
Decreased vision, pain with eye movements, proptosis, eyelid erythema and edema around orbit
Orbital cellulitis (dx + labs)
High resolution CT of orbits WITH IV contrast
Periorbital cellulitis (FMLD)
Infection of eyelid and periocular tissue; May have ocular pain and swelling; NO pain with ocular movements
Peritonsillar abscess (Dx +labs)
CT scan = 1st line to differentiate between cellulitis and abscess
MCC = Group A betahemolytic strep, staph, anaerobes
Peutz-Jerghens Syndrome (hx + pe)
Autosomal dominant
First presentation often from bowel obstruction secondary to intussusception from polyps
Dark blue, brown, black macules on lips, perioral areas, buccal mucosa, eyes, nostrils, fingertips, palms, perianal areas
Recurrent sinusitis (dx + labs)
Biopsy or histology is diagnostic rest of choice to identify organism and appropriate tx
Retinal detachment (scientific concepts)
- Rhegmatgenous = MC = Retinal tear - Retinal inner sensory layer detaches from choroid plexus
2.Traction = Adhesions separate from retina from its base
- Exudative = fluid accumulates beneath retina and deatement from HTN, CRVO, papillaedema
Retinal detachment (dx + labs)
Fundoscopy = Retinal tear/detached tissue flopping in vitreous humor
+Shafers sign
Retinal detachment, Spontaneous (hx + pe)
Curtain coming down over vision, flashing lights,floaters, NO pain or redness
Fundoscopy = Retinal tear/detached tissue flopping in vitreous humor
+Shafers sign (tobacco dust in anterior vitreous humor)
Retinitis (scientific concepts)
Threatens vision by damaging retina
REtinitis pigementosa = genetic
CMV retinitis = CMV herpes virus
Sialadenitis (scientific concepts)
Bacterial infection of parotid or submandibular salivary glands
May be due to dehydration or chronic illness
Staph = MC organism
Sialadenitis (Hx + PE)
Acute pain and swelling near gland with meals; local pain, dysphagia, trismus, May develop fever/chills if severe
Soft tissue traumatic injury (clinical intervention)
If contusion of the pinna or nasal fracture with septal hematoma = Blood requires drainage
Strep pharyngitis (pharm tx)
- PCN G or VK, Amox, Amox/Clauv
- Macrolides of PCN allergy
- Other alternatives = Clindamycin or Cephalosporins
Thyroglossal duct cyst (FMLD)
Mobile midline neck mass near hyoid bone ranging from asx to abscess w/ draining sinus
Elevates with tongue protrusion or swalloing
US = Ideal initial imaging of mass and thyroid
Torus palatines (clinical intervention)
Refer to maxofacial surgeon (Bony growth on the roof of the mouth)
Uveitis (hx + pe)
Hx of systemic inflammatory disease (HLA-B27, sarcoid etc)
Infectious CMV, toxoplasmosis, TB, Truama
PE = Ciliary injection (limbic flush), Consensual photophobia, vision changes
Uveitis (pharm tx)
- Anterior = Topical steroids
- Posterior = Systemic steroids
Uveitis (iritis) (FMLD)
Anterior = Inflammation of iris or ciliary body; unilateral ocular pain/redness/photophobia; Usually occurs w/ blunt trauma
Posterior = Choroid inflammation; blurred/decreased vision, floaters, absent sxs of anterior involvement; NO pain
Vasomotor rhinitis (pharm tx)
Oral antihistamines, decongestants, intranasal steroids, mast cell stabilizers, anticholinergics
Vitreous hemorrhage (hx and pe)
Blurred vision: floaters, faint cobweb like appearance through the visual vield
Reddish tint to vision, photopsia = brief flashes of light in peripheral
