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Clinical Medicine > MSK Quiz 2: Part 2 > Flashcards

MSK Quiz 2: Part 2 Flashcards

1
Q

What does diarthroses mean?

A

freely movable

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2
Q

Where is the synovial fluid secreted from?

A

synoviocytes

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3
Q

what’s the job of the synovial fluid?

A

nourishes the articular cartilage, shock absorber

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4
Q

What’s the most common of all joint diseases?

A

osteoarthritis

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5
Q

What is osteoarthritis?

A

progressive, irreversible loss of joint cartilage

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6
Q

Most commonly affected joints by osteoarthritis?

A

cervical and lumbosacral spine, hip, knee, 1st MTP joint, hands (DIP, PIP, 1st CMC joint)

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7
Q

Risk factors for osteoarthritis

A

joint vulnerability (systemic factors, intrinsic joint factors) and joint loading

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8
Q

Systemic risk factors for OA

A

increased age, female gender, racial/ethnic factors, genetics, nutrition

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9
Q

Intrinsic joint risk factors for OA

A

previous damage, muscle weakness, increasing bone density, malalignment, proprioceptive deficiencies

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10
Q

Does OA impact extra-articular organs?

A

No

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11
Q

Does OA impact men or women more?

A

women

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12
Q

Presentation of OA

A

pain (bone pain, aching to severe, localized to radiating, affects sleeping), stiffness lasting <30 minutes (worse with inactivity), swelling, joint instability, decreased ROM, locking and grinding

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13
Q

PE OA

A

TTP, joint effusion, possible deformity, crepitus, antalgic gait, decreased ROM, muscle atrophy

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14
Q

What are OA deformities you can see in the knees?

A

genu varum, genu valgum

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15
Q

what are OA deformities you can see in teh hands?

A

Heberden nodes (DIP) and Bouchard nodes (PIP)

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16
Q

Films for OA

A

Plain films (joint space narrowing, osteophytes, subchondral bone sclerosis/cysts), MRI (r/o if needed), US (not routinely used)

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17
Q

What labs are used for OA?

A

nothing specific, just r/o other causes

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18
Q

Treatment for OA?

A

RICE, unloader brace, injections, NSAIDS/tramadol/glcuosamine and chondroitin sulfate, physical therapy/aquatic therapy, patient education, CAM

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19
Q

Surgical options for OA?

A

arthroscopy is NOT indicated for OA, joint replacement

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20
Q

What’s the most common form of autoimmune arthritis?

A

Rheumatoid arthritis

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21
Q

What types of joints does RA typically impact?

A

synovial joints

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22
Q

What’s the cause of RA?

A

unknown triggers for immune response in synovial tissue

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23
Q

Which genetic marker determines both risk and severity of RA?

A

HLA-DR4

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24
Q

What are possible triggers of RA?

A

bacterial antigens (mycobacteria, strep, mycoplasma, e. coli, h. pylori), viral agents (EBV, rubella, parvovirus), smoking, hormonal changes

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25
Q

Risk factors for RA?

A

female sex, positive family history, older age, smoking, coffee consumption (>3 cups daily)

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26
Q

Who is impacted by RA more, men or women?

A

women

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27
Q

When does RA occur?

A

Any age; men <45 is uncommon, women it increases with age until 60 yo

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28
Q

Presentation of RA

A

insidious to sudden onset pain (affecting distal joints first), stiffness, swelling, possible systemic symptoms (Fatigue, low-grade fever, weight loss); symmetric polyarthritis, morning stiffness (gel phenomenon, lasting more than 1 hour, decreases with physical activity), swelling and tenderness, nodules

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29
Q

PE findings of OA

A

painful/loss of ROM, possible muscle pain, swelling, deformity, rheumatoid nodules

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30
Q

Affected joints for RA

A

MCP, PIP (flexor tendon tenosynovitis), MTP, wrist, knees, elbows, ankles, hips, shoulder, C1-C2 articulation, TMJ

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31
Q

When is the DIP joint involved in RA?

A

almost never

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32
Q

Hand/feet symptoms of RA?

A

MCP ulnar deviation, swan-neck deformity, boutonniere deformity, nodules, hammer toes

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33
Q

Exta-articular manifestations of RA

A

rheumatoid nodulosis, pulmonary nodules and fibrosis, vasculitis, pericarditis, musculoskeletal nodules, tenosynovitis, k. sicca, scleritis

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34
Q

Skin symptoms you may see in RA

A

subcutaenous nodules

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35
Q

Pulmonary symptoms you may see in RA

A

pleurisy, effusion

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36
Q

cardiovascular symptoms you may see in RA

A

digital infarcts, ischemic mononeuropathy

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37
Q

Musculoskeletal symptoms you may see in RA

A

carpal tunnel syndrome, tarsal tunne syndrome, trigger finger

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38
Q

Ocular symptoms you may see in RA

A

dry eyes, corneal ulcer, scleral injection

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39
Q

Felty’s syndrome is a combination of?

A

RA, splenomegaly, and neutropenia

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40
Q

Associated complication of Felty’s syndrome

A

hepatomegaly, thrombocytopenia, lymphandenopathy, fever

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41
Q

Diagnostic tests for RA

A

RF, ANA, CBC with diff (anemia, thrombocytosis, neutropenia), CRP, ESR, Anti-CCP

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42
Q

Imaging for RA

A

x-rays (joint erosions)

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43
Q

4 categories for RA criteria

A

joint involvement, serology, duration of synovitis, acute phase reactants

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44
Q

How many points do you need for criteria for RA?

A

6/10

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45
Q

Joint Involvement criteria (RA)

A

1 med/large joint (0), 2-10 med/large joints (1), 1-3 small joints (2), 4-10 small joints (3), >10 joints with at least one small (5)

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46
Q

Serology criteria (RA)

A

neither RF nor ACPA positive (0), at least one test low positive titre (2), at least one test high positive titre (3)

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47
Q

Duration of synovitis criteria (RA)

A

<6 weeks (0); >6 weeks (1)

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48
Q

Acute phase reactants criteria RA

A

neither CRP nor ESR abnormal (O), abnormal CRP or abnormal ESR (1)

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49
Q

Treatment of RA?

A

lifelong disease without cure; patient education, referral to rheumatologst, braces, splints, orthoses, medications

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50
Q

What’s the goal of RA treatment?

A

remission

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51
Q

Drug treatment options for RA?

A

NSAIDS or low-dose prednisolone, intra-articular steroid injection, disease modifying antirheumatic drugs (DMARDs), anti-TNF drugs

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52
Q

What do antirheumatic drugs (DMARDs) do?

A

target cytokines or receptors in inflammatory cascade, decrease monocolonal antibodies

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53
Q

Examples of antirheumatic drugs?

A

sulfasalazine, hydroxychloroquine, methotrexate, leflunomide, cyclophosphamide

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54
Q

Anti-TNF drug examples?

A

infliximab, etanercept, adalimumab, golimumab

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55
Q

RA surgical options?

A

joint replacement

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56
Q

Describe three components of RA?

A

inflamed joint capsule and synovial membrane; loss of space in synovial cavity; cartilage destruction

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57
Q

Describe three components of OA?

A

loose cartilage particles; bone spur; severe cartilage destruction

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58
Q

Fracture presentation

A

history of an injury with pain and edema, worse over first 1-3 days, TTP

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59
Q

4 phses of fracture healing

A

1) cellular callus–mesenchymoid cell proliferation, 2) mineralized callus–collagen to cartilage 3) bony callus-lamellar bone replaces mineralized callus 4) remodeling

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60
Q

Fracture complication

A

ARDS (fat embolism syndrome), atelectasis (early post-op fevers and hypoxemia), DVT, PE, compartment syndrome, nerve or blood vessel injury, failure of normal healing

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61
Q

Five Ps of compartment syndrome

A

pain out of proportion, paresthesia, pallor, paralysis, pulselessness

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62
Q

Malunion:

A

incomplete or faulty healing

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63
Q

Delayed union:

A

slower than normal healing

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64
Q

Non-union:

A

lack of bony reconstruction

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65
Q

How do you describe position on bone?

A

proximal, mid, distal

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66
Q

Closed fracture:

A

no break in the skin

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67
Q

Open fracture:

A

part of bone protrudes through skin

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68
Q

Complete fracture:

A

all cortical surfaces are disrupted

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69
Q

What are two types of incomplete fractures?

A

greenstick, buckle

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70
Q

What’s a greenstick fracture?

A

one side of bone breaks, the other side is still intact

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71
Q

What’s a buckle fracture?

A

crunches on one side of the bone

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72
Q

Simple fracture:

A

single fracture line in 2 bone fragments

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73
Q

Comminuted fracture:

A

2 or more fracture fragments

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74
Q

Butterfly fracture:

A

esults from two oblique fracture lines meeting to create a large triangular or wedge-shaped fragment located between the proximal and distal fracture fragments, and resembles a butterfly.

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75
Q

Give examples of fracture line direction

A

transverse, spiral, oblique

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76
Q

Term for a fracture that disrupts the joint?

A

intra-articular

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77
Q

Distraction:

A

a fracture resulting in increased overall bone length (bone fragments are pulled apart)

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78
Q

Impaction:

A

If there is shortening of bone without loss of alignment, the fracture is impacted. “over riding”

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79
Q

How to describe displacement?

A

anterior, posterior, lateral, medial (need 2-3 views!)

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80
Q

Angulation:

A

direction apex is pointing; location of distal fragment

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81
Q

Change in anatomic position in a circular motion is called?

A

rotation

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82
Q

Partial disruption/displacement of joint:

A

subluxation

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83
Q

Clavicle fracture MOI

A

direct blow, fall on outstretched arm

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84
Q

Presentation of clavicle fracture

A

pain, deformity, grinding at fracture site, sagging shoulder

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85
Q

Treatment of clavicle fracture

A

based on displacement; conservative (immobilize in sling figure-8 brace for 4-6 weeks) vs. surgery (open reduction internal fixation or intramedullary nail)

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86
Q

Proximal humerus MOI

A

high energy injury (Fall, MVA)

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87
Q

What classification system do you use for proximal humerus fracture?

A

Neer Classification

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88
Q

Treatment for proximal humerus fractures?

A

sling up to 6 weeks, passive ROM after 3 weeks vs. surgery (ORIF vs hemiarthroplasty)

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89
Q

With proximal humerus fractures, which nerve do we worry about?

A

Axillary

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90
Q

Humeral shaft fracture MOI

A

trauma, fall

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91
Q

What’s a common negative outcome with humeral shaft fractures?

A

mal-union

92
Q

What nerve do we worry about with humeral shaft fracture?

A

Radial (wrist drop)

93
Q

Elbow x-ray analysis

A

joint effusion, ossification centers, alignment, subtle fractures

94
Q

Fat pad sign

A

When there is a joint effusion, the anterior fat pad becomes elevated, likely intraarticular fracture.

95
Q

What’s the most common elbow fracture in kids?

A

supracondylar fractures

96
Q

supracondylar fractures MOI

A

fall with elbow extended

97
Q

Treatment of supracondylar fracture

A

typically surgery

98
Q

Complications of supracondylar fractures

A

brachial artery injury

99
Q

Epicondyle/condylar fracture MOI

A

FOOSH, valgus or varus force

100
Q

treatment of epicondyle/condylar fracture MOI

A

conservative (rest, splint, delayed ROM) vs surgical (percutaenous pinning vs ORIF)

101
Q

What’s the most common elbow fracture in adults?

A

radial head/neck fractures

102
Q

radial head/neck fracture MOI

A

fall with elbow extended

103
Q

treatment of radial head/neck fracture

A

long arm splint for 2-3 weeks (must go beyond wrist); rarely surgery; do not immobilize too long (need early PT)

104
Q

Olecranon fracture MOI

A

fall on posterior elbow or active triceps avulsion

105
Q

treatment of olecranon fracture

A

displacement and triceps guide treatment

106
Q

Describe the Monteggia fracture

A

ulnar fracture (proximal 1/3), radial head dislocation

107
Q

Describe the Galeazzi fracture

A

radial fracture, distal radioulnar joint dislocation

108
Q

Monteggia fracture MOI

A

FOOSH

109
Q

Monteggia fracture demographics

A

peds patients ages 4-10

110
Q

Monteggia fracture treatmetn

A

usually surgery

111
Q

Galeazzi fracture MOI

A

fall on outstretched hand with elbow flexed

112
Q

Galeazzi fracture demographics

A

adult males

113
Q

Galeazzi treatment

A

surgical fixation

114
Q

Radial shaft fracture usually occurs with?

A

ulnar shaft fractures or dislocation

115
Q

radial shaft fracture MOI

A

high energy injury (MVA)

116
Q

treatment of radial shaft fracture

A

often surgery

117
Q

ulnar shaft fracture AKA

A

nighstick

118
Q

ulnar shaft fracture MOI

A

usually a direct blow

119
Q

presentation of ulnar shaft fracture

A

medial forearm pain

120
Q

treatment of ulnar shaft fracture

A

splint, rarely needs surgery

121
Q

What’s the most common fracture of upper extremity?

A

distal radius fracture

122
Q

who commonly experiences distal radial fractures?

A

elderly (low energy FOOSH), younger patients (higher energy falls)

123
Q

presentation of distal radial fractures

A

deformity, swelling, ecchymosis, tenderness over fracture site

124
Q

Colles fracture MOI

A

FOOSH

125
Q

colles fracture (3 components)

A

dorsal angulation (apex volar), dorsal displacement, impaction/shortening

126
Q

Smith fracture AKA

A

reverse colles

127
Q

Which is more common colles or smith?

A

colles

128
Q

Smith fracture MOI

A

falling onto flexed wrist

129
Q

What’s the common anecdote for the smith fracture?

A

“i drank too much and fell down”

130
Q

Treatment of distal radius fracture (buckle or minimal displacement)

A

immobilize

131
Q

Treatment of distal radius fracture (other than buckle or minimal displacement)

A

colles, smith, or any angulation/displacment require referral

132
Q

treatment for adults with distal radius fracture (immobilization)

A

6 weeks immobilization (2 in splint, 4 in cast)

133
Q

treatment for adolescents with distal radius fracture (immobilization)

A

6 weeks immobilization

134
Q

Wrist reduction and splint procedure

A

analgesia to area or patient, hang in traps with counter-weight typically ten pounds, wait ten minutes, reduce and sugartong splint

135
Q

Chauffer fracture

A

radial styloid fracture

136
Q

chauffeur fracture MOI

A

direct blow to back of wrist, forced ulnar deviation and supination

137
Q

treatment of chauffeur fracture

A

surgery

138
Q

Most common carpal fracture?

A

scaphoid fracture

139
Q

presentation of scaphoid fracture

A

snuff box pain

140
Q

scaphoid fracture MOI

A

FOOSH

141
Q

scaphoid fractures are commonly diagnosed as?

A

sprains

142
Q

Scaphoid fractures have a % nonunion rate?

A

8-10

143
Q

Scaphoid fractures can result in?

A

AVN

144
Q

Treatment for scaphoid fracture

A

splint, cast for total of 12 weeks vs. surgery

145
Q

Are metacarpal fractures more common in men or women?

A

men

146
Q

Metacarpal fractures MOI

A

hitting an object with closed fist

147
Q

common metacarpal fracture locations

A

5th metacarpal (especially neck AKA boxer’s fracture)

148
Q

PE metacarpal fracture

A

pain, swelling, deformity, rotational deformity, depression knuckle; look for open wounds

149
Q

What do you need to assess with metacarpal fracture?

A

assess for rotational deformity

150
Q

What’s the most common metacarpal fracture?

A

boxers fracture

151
Q

Bennet fracture

A

intra-articular avulsion fracture at CMC joint

152
Q

Bennet fracture MOI

A

sublux/dislocation

153
Q

Rolando Fracture

A

Y or T shaped comminuted, intra articular fracture

154
Q

Rolando Fracture MOI

A

sublx/dislocation

155
Q

Metacarpal fracture treatment

A

treated by fracture type: angulation (10-20-30-40 rule) and rotational deformity (not accepted); conservative (ulnar gutter splint/cast–recheck in 1 week, 4-6 weeks immobilization); referral for unstable or rotational deformity fractures

156
Q

What’s the 10-20-30-40 rule

A

It’s how much angulation is acceptable in index through little metacarpal

157
Q

Complications of metacarpal fractures?

A

loss of grip strength, residual dorsal deformity, loss of knuckle prominence

158
Q

What’s the most common skeletal system injuries?

A

phalange fracures

159
Q

Which fragment phalange is most often fractured?

A

distal > middle and proximal

160
Q

PE for phalange fractures

A

pain, swelling, deformity, look for open wounds, nail bed injuries

161
Q

Phalange fractures treatment

A

buddy taping (except mallet finger…need extension splint); surgical if angulation or displacement or open

162
Q

complications of phalange fractures

A

loss of motion, malunion, nonunion

163
Q

Low energy pelvic fractures are common iN?

A

elderly after a fall

164
Q

PE for low energy pevlic fracture

A

pain in groin, lateral hip or buttock with ambulation

165
Q

tx of low energy pelvic fracture

A

conservative, PT/OT, possible rehab or SNF (skilled nursing facility)

166
Q

High energy pelvic fracture MOI

A

MVA–side impact and motorcycle account for most

167
Q

For high energy pelvic fracture you need to assess…

A

GU injuries (check bladder and prostate)

168
Q

treatment of high energy pelvic fracture

A

stabilize, most need surgical repair

169
Q

Hip fracture presentation

A

fall, unable to bear weight, leg is shortened and externally rotated

170
Q

Considerations with treatment of femoral neck fractures

A

displacement, patient activity level, patient/family wishes

171
Q

Treatment of femoral neck fracture with no/minimal displacement:

A

femoral neck with no/minimal displacement: hip pinning = cannulated screw fixation

172
Q

Treatment of femoral neck fracture with displacement

A

hip arthroplasty

173
Q

Intertrochanteric fracture surgical treatment

A

intramedullary nail gamma nail, dynamic hip screw

174
Q

Femur fractures (shaft) MOI

A

high energy, typically MVA; in elderly patients it could be fall with poor bone quality

175
Q

Femur fracture (shaft) treatment

A

non-displaced and patients with multiple co-morbidities = non-surgical; surgical if displaced/unstable

176
Q

Supracondylar fracture MOI

A

load to flexed knee (younger patients MVA), older patients (low energy fall)

177
Q

Associated injuries of supracondylar fracture

A

popliteal artery, ACL

178
Q

What else do you need to order with supracondylar fracture

A

arteriogram

179
Q

presentation of supracondylar fractures

A

pain, swelling, inability to flex/extend knee, posible deformity

180
Q

Supracondylar fracture tx

A

conservative vs. surgical

181
Q

Tibial plateau fracture MOI

A

extreme load or fall

182
Q

Where are tibial plateau fractures commonly located?

A

60% are lateral, often accompanying cartilage/ ligament injury

183
Q

Treatment of tibial plateau fracture

A

depends on displacement. Non-operative must be NWB with close follow-up; surgical is cannulated screen fixation or plate/screw with NWB

184
Q

Patella fracture MOI

A

direct trauma or forceful quadriceps contraction

185
Q

patella fracture presentation

A

deformity, swelling, can’t SLR

186
Q

treatment for patella fracture

A

surgery if displacement is >3 mm; non-operative is NWB for 6 weeks, gradually increase PROM

187
Q

What’s the most common long bone fractures?

A

tibial shaft fractures

188
Q

tibial shaft fractures MOI

A

high energy–associated with open fractures; twisting mechanism–spiral/oblique

189
Q

tibial fracture presentation

A

pain, deformity, wounds, fracture blisters, compartmetn syndrome

190
Q

tibia shaft fracture

A

conservative (LLC with progressive weight bearing) vs surgical for unstable, open fracture (IM nail)

191
Q

Fibula fracture MOI

A

direct blow, inversion or eversion injury

192
Q

Fibular fracture presentation

A

limping or unable to bear weight (due to pain), edema, ecchymosis

193
Q

Treatment of fibular fracture

A

dependent on severity of fracture and location

194
Q

Maisonneuve Fracture

A

Eversion injury; mortise widening and proximal 1/3 fibula fracture

195
Q

What do you worry about with a maisonneuve fracture?

A

superficial peroneal nerve palsy

196
Q

Treatment of maisonneuve fracture

A

surgery

197
Q

What’s the most common bone and join injury?

A

ankle fractures

198
Q

contributing factors to ankle fracture?

A

smoking and body habitus

199
Q

MOI of ankle fractures

A

twisting–inversion/eversion; MVA

200
Q

presentation of ankle fractures

A

pain, swelling, deformity, inability to ambulate

201
Q

Conservative treatment of ankle fractures

A

avulsion is treated like a severe ankle sprain, minimally or non-displaced fractures get posterior splint x 1 week; recheck (walking cast vs. walking boot for 4-5 weeks)

202
Q

Surgical treatment of ankle fractures if?

A

any mortise widening/suspicion of syndesmotic injury

203
Q

Medial malleolus fracture MOI

A

usually high-impact

204
Q

Considrations of medial malleolus fracture

A

displacement (<2 mm in joint is acceptable), joint involvement (<25% joint surface involvement), tenderness elsewhere

205
Q

Medial malleolus fracture treatmetn

A

surgery if ankle mortise widening and displacement; non-operative = NWB short leg splint x 1 week (recheck in 1 week); NWB vs. WBAT short leg cast x 6-7 weeks (recechk every 1-2 weeks)

206
Q

Bi-malleolar fracture tx

A

need referral, sx (ORIF)

207
Q

Tri-malleolar fracture tx

A

referral for surgery

208
Q

3 main types of fifth metatarsal fracture

A

stress, jones, avulsion

209
Q

Fifth metatarsal fracture: stress tx

A

NWB cast for 6-8 weeks

210
Q

Fifth metatarsal fracture: jones tx

A

surgery vs. short-leg walking cast vs. NWB cast for 6-8 weeks

211
Q

Fifth metatarsal fracture: avulsion tx

A

most common, short-leg walking cast/boot for 4-6 weeks

212
Q

What’s a common MOI for firth metatarsal fracture?

A

inversion ankle sprain

213
Q

What causes a stress fracture?

A

result of bone being exposed to repeated tensile or compressive stresses

214
Q

Where is the most likely place for stress fractures?

A

spine (pars interarticularis in lumbar spine), hip (femoral neck), lower leg (tibia), ankle and foot (talus and metacarpals)

215
Q

Stress fracture presentation

A

onset of insidious pain that progressively gets worse

216
Q

imaging for stress fracture

A

plain films, bone scan, MRI SCAN (looking for fluid/inflammatory response), Ct scan

217
Q

Treatment of stress fracture

A

Initial: eliminated stress; NWB 6-12 weeks; possible immobilization; activity modification; PT; pain control

218
Q

Risk factors for stress fractures

A

prior stress fracture, low fitness, sudden increase in exercise, female gender/menstrual irregularity, lower BMI, eating disorders, poor diet, poor bone health, poor biomechanics, workout environment

219
Q

What’s the assessment of physeal fractures called?

A

Salter-Harris classification

220
Q

SALTER:

A

straight across; above; lower and below; two or through; erasure of growth plate or crush

221
Q

Type I: S

A

fracture of the cartilage of the physis

222
Q

Type II: A

A

the fracture lies above the physis

223
Q

Type III: L

A

the fracture is below the physis in the epiphysis

224
Q

Type IV: T

A

through the metaphysis, physis, and epiphysis

225
Q

Type V: R

A

physis has been crushed

Clinical Medicine (13 decks)

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