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MSK/EENT Flashcards

1
Q

Achilles tendon rupture clinical intervention

A

Non operative - serial splinting in mild plantar flexion with subsequent splinting w/ gradual dorsiflexion towards neutral

Operative - reattachment allowing for early range of motion

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2
Q

Acute compartment syndrome (FMLD)

A

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

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3
Q

Boxers fracture (scientific concepts)

A

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

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4
Q

Cervical spine injury - 2 types

A

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

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5
Q

Complication of orthopedic device (clinical intervention)

A

Removal of hardware

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6
Q

Congenital talipes equinovarus (clinical intervention)

A

Ponseti method of serial manipulation and casting

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7
Q

Fingernail contusion dx and labs

A

Perform xray on finger with subungal hematoma if hematoma is >50% of nail to evaluate for phalanx fracture

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8
Q

Dermatomyositis (FMLD)

A

Progressive symmetric proximal muscle weakness + decreased muscle strength + GOTTRONS papules + helitrope rash

Anti-jo1 and AntiMi-2 antibodies

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9
Q

Joint effusion, knee (Hx and PE)

A

Bulge sign, ballottment (in increased patella waving motion or spongy joint feeling)

patellar tap test

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10
Q

Jones fracture (foot) FMLD

A

Transverse fracture through diaphysis of 5th Metatarsal @ metaphyseal diaphseal junction

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11
Q

Hip fracture (pharm therapeutics)

A

Prophylaxis = Ancef (first gen cephalosporin) + morphine + ketorlac

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12
Q

Radius wrist fracture clinical intervention

A

Closed reduction with sugar tong splint

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13
Q

Gout is a problem with what type of molecule?

A

Purine

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14
Q

Compound that precipitates into synovial fluid?

A

Sodium urate

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15
Q

When to do nail trephenation?

A

Evacuation via trephination or nail removal if >25% OR painful

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16
Q

Ankle dislocation clinical intervention

A

Closed reduction + posterior splint +/- ORIF in severe cases

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17
Q

Joint dislocation, shoulder (dx and labs)

A

Xray = X & Y axillary

Must r/o axillary nerve injury (pinprick sensation over deltoid)

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18
Q

Anterior shoulder joint dislocation (scientific concepts)

A

Mechanism = Blow to an abducted externally rotated arm that is extended

Anterior dislocation - MC shoulder dislocation

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19
Q

Lateral epicondylitis (scientific concepts)

A

Occurs at tendinous insertion of extensor carpi radialis brevis

Extra crispy red beautiful apples

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20
Q

Lumbar spondylosis with myelopathy (dx and labs)

A

Radiographs, CT scan, MRI used in events of complications

DEXA scan

Ensure no osteophytes

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21
Q

MCL injury (scientific conepts)

A

Mechanism = Blow to outside of knee

Femoral attachment is to medial epicondyle

Tibial attachment are semimembranosus muscle and posteromedial tibia

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22
Q

Meralgia paresthetica (clinical intervention)

A

Thigh tingling = lateral femoral nerve entrapment

Wt loss, loose clothing, focal nerve block at inguingal ligament with a combo of lido + steroids

Surgical decompression

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23
Q

C5 nerve injury (hx and PE)

A

Cervical radiculopathy with bone spurs or disc herniation

PE = weakness in deltoid (shoulder ABduction)
Bicep (elbow flexion)
Loss of bicep jerk reflex

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24
Q

Osteomyelitis (scientific concepts)

A

Inflammation/infection of bone

RF = Sickle cell = Salmonella
Hip = MC in children

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25
Pagets dz of bone (FMLD)
Abnormal bone remodeling markedly elevated alk phos Skull enlargement + COTTON WOOL appearance + deafness
26
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
27
Posterior tibial tendon dysfunction (FMLD)
Player of high-impact sports Pain + Swelling to medial foot and ankle; flattened arch "too many toes sign"
28
Pyogenic arthritis/Septic arthritis (Pharmaceutical tx)
Empiric abx therapy G+ cocci = vanco G - = Ceftriaxone
29
Rhabdo (pharm interventions)
IV saline, mannitol, bicarb, calcium gluconate
30
RA (pharm interventions)
Methotrexate = 1st line Nsaids for pain control Steroids if no relief with NSAIDS
31
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
32
Spondylolisthesis
Forward slipping of vetebra on another on imaging from bilateral defect/fracture of pars
33
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+)
34
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
35
Torus fracture (FMLD)
Aka buckle fracture Pediatric patient s/p fall with a "wrinkling/bump" on xray of distal radius
36
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
37
Acoustic neuroma (Dx and labs)
MRI = Imaging of choice Audiometry = Lab of choice This is unilateral sensorineural hearing loss**
38
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
39
Acute narrow angle closure glaucoma (Pharm tx)
Azetazolamide = first line to decrease IOP Timolol reduces IOP without affecting vision
40
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
41
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
42
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.
43
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
44
BPPV (Hx + PE)
Recurrent episodes of sudden episodic peripheral vertigo <60sec. provoked with specific head movement NO HEARING LOSS; tinnuts or ataxia; +/- NV
45
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
46
Cholesteatoma (scientific concepts)
Abnormal keritinized collection of desquamated squamous epithelium causing mastoid bony erosion MC due to ET dysfunction = CONDUCTIVE hearing loss
47
Conductive hearing loss (FMLD)
Weber = Lateralized to affected ear Rinee = Bone greater than Air Etiologies: cerumen, foreign body, otitis, cholesteatoma
48
Conjunctivitis neonatal (scientific concepts)
Day 1 = Chemical due to silver nitrate Day 2-5 = Gonococcal Day 5-7 = Chlaymydia
49
Dacrocystitis (FML)D
Infection of lacrimal sac, tearing, tenderness, edema and redness to medial canthal side of lower lid (+/- purulent)
50
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 2. Proliferative = Neovasculatization 3. Maculopathy= macular edema or exudates, nblurred vision, central vision loss. Can occur at any stage
51
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
52
Diptheria (pharm tx)
Diptheria antitoxin (horse serum) + erythrymycin or pcn G for 2 weeks Clinda or Rifampin are alternatives PCNM + Aminoglycoside for endocarditis
53
Diptheria pharyngitis (scientific concepts)
Caused by Gram (+) rod Corynebacterium rare due to vaccine Transmission = resp secretions
54
Drug effect adverse from intranasal steroids
Rhinitis medicamentosa = MC = rebound congestion if used more than 3-5 days
55
Epidemic keratoconjunctivitis (scientific concepts)
MCC = Adenovirus types 8.19.37 Inflammatory response that involves conjunctiva + superficial cornea
56
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
57
Glaucoma (Pharm tx)
First line = Prostaglandin analogs like Lantanoprost Can use Brimonidine or carbonic anyhydrase inhibitors like acetazolamide
58
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
59
Superficial keratitis (clinical intervention)
Topial abx; DO NOT patch eye
60
Larynx cancer (clinical intervention)
Surgical resection +/- chemo/radiation
61
Macular degeneration (scientific concepts)
MCC of PERMEANENT LEGAL BLINDNESS Central vision loss = Seen on Amsler grid
62
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
63
Mastoiditis (clinical intervention)
Acute = Myringotomy and +/- tympanostomy Refractor or complicated = Mastoidectomy
64
Nasal polyps (Pharm tx)
Intranasal steroids = Treatment of choice Surgical removal if tx unsuccessful
65
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
66
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
67
Oral hairy leukoplakia (scientific concepts)
Caused by EBV virus MC in immunocompromised NOT considered cancerous
68
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
69
Orbital cellulitis (dx + labs)
High resolution CT of orbits WITH IV contrast
70
Periorbital cellulitis (FMLD)
Infection of eyelid and periocular tissue; May have ocular pain and swelling; NO pain with ocular movements
71
Peritonsillar abscess (Dx +labs)
CT scan = 1st line to differentiate between cellulitis and abscess MCC = Group A betahemolytic strep, staph, anaerobes
72
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
73
Recurrent sinusitis (dx + labs)
Biopsy or histology is diagnostic rest of choice to identify organism and appropriate tx
74
Retinal detachment (scientific concepts)
1. Rhegmatgenous = MC = Retinal tear - Retinal inner sensory layer detaches from choroid plexus 2.Traction = Adhesions separate from retina from its base 3. Exudative = fluid accumulates beneath retina and deatement from HTN, CRVO, papillaedema
75
Retinal detachment (dx + labs)
Fundoscopy = Retinal tear/detached tissue flopping in vitreous humor +Shafers sign
76
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)
77
Retinitis (scientific concepts)
Threatens vision by damaging retina REtinitis pigementosa = genetic CMV retinitis = CMV herpes virus
78
Sialadenitis (scientific concepts)
Bacterial infection of parotid or submandibular salivary glands May be due to dehydration or chronic illness Staph = MC organism
79
Sialadenitis (Hx + PE)
Acute pain and swelling near gland with meals; local pain, dysphagia, trismus, May develop fever/chills if severe
80
Soft tissue traumatic injury (clinical intervention)
If contusion of the pinna or nasal fracture with septal hematoma = Blood requires drainage
81
Strep pharyngitis (pharm tx)
1. PCN G or VK, Amox, Amox/Clauv 2. Macrolides of PCN allergy 3. Other alternatives = Clindamycin or Cephalosporins
82
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
83
Torus palatines (clinical intervention)
Refer to maxofacial surgeon (Bony growth on the roof of the mouth)
84
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
85
Uveitis (pharm tx)
1. Anterior = Topical steroids 2. Posterior = Systemic steroids
86
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
87
Vasomotor rhinitis (pharm tx)
Oral antihistamines, decongestants, intranasal steroids, mast cell stabilizers, anticholinergics
88
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

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