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PANCE/EOC > MSK/Rheum #1 > Flashcards

MSK/Rheum #1 Flashcards

1
Q

Etiology of acute compartment syndrome

A
  • Trauma; fracture of the long bones

- Crush injuries, constriction (tight casts, splints, burns)

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2
Q

Pathophysiology of acute compartment syndrome

A

Muscle and nerve ischemia (decreased perfusion) when the closed muscle compartment pressure > perfusion pressure
- > 30-45 mmHg

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3
Q

Symptoms of acute compartment syndrome

A
  • Pain with passive stretching (earliest finding and most sensitive)
  • Tense compartment (firm or wood-like feeling)
  • Pulselessness, pallor, paresis
  • Capillary refill preserved
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4
Q

Diagnostics for acute compartment syndrome

A
  • Increased intracompartmental pressure > 30 mmHg

- Increased creatinine kinase and myoglobin

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5
Q

Treatment of acute compartment syndrome

A

Emergent Fasciotomy (Decompression)

  • Place limb at level of the heart
  • Remove constrictive dressings, IVF, oxygen
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6
Q

Adhesive Capsulitis is shoulder stiffness due to inflammation (especially _____ and _____). It is most common in people aged 40-60

A

Diabetes and Hypothyroidism

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7
Q

Symptoms of Adhesive Capsulitis

A
  • Shoulder pain/stiffness
  • Decreased ROM (External rotation)
  • Gradual return of ROM
  • Resistance of passive range of motion
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8
Q

Treatment for adhesive capsulitis

A
  • Rehab ROM therapy

- Anti-inflammatories, steroid injections, heat

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9
Q

What is the standard treatment for an amputated digit?

A
  • Wrap in gauze and soak in sterilized isotonic saline to prevent from drying
  • Placed in a plastic bag immersed in ice water
  • NEVER PLACE DIRECTLY IN ICE WATER
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10
Q

What is the MC knee ligamental injury

A

Anterior cruciate ligament (ACL)

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11
Q

Mechanism of action for ACL injury

A

-Noncontact pivoting injury, deceleration, changing direction, hyperextension, internal rotation

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12
Q

Clinical manifestations of an ACL injury

A
  • Associated with pop and swelling followed by hemarthrosis (intra-articular bleeding)
  • Knee buckling, inability to bear weight
  • Does not actively extend knee
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13
Q

What tests are performed for ACL tear?

A
  • Lachman Test (Most sensitive)
  • Pivot Shift Test
  • Anterior Drawer Test
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14
Q

What are some diagnostics for an ACL tear?

A
  • XR: done initially to rule out fracture

- MRI: best test

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15
Q

What is seen on a knee XR if the ACL is torn?

A

Segund Fracture (avulsion of lateral tibial condyle with varus stress of the knee)

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16
Q

What are the three parts of the Unhappy (O’Donoghue’s) Triad?

A
  • ACL Tear
  • MCL injury
  • Medial Meniscus injury
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17
Q

What is a basilar skull fracture?

A

Linear fracture at the base of the skull, associated with dural tear

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18
Q

Other symptoms of a basilar skull fracture

A
  • CSF Otorrhea
  • Raccoon eyes
  • Hemotympanum
  • Bruising over mastoid (Battle Sign)
  • Do a Glascow Coma Scale
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19
Q

What is a Boxer’s Fracture?

A

Fracture at the neck of the 5th metacarpal

-MOI: punching with a clenched fist

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20
Q

What should you check for and what is the treatment in a Boxer’s Fracture?

A

Check for bite wounds

-Treat with Augmentin

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21
Q

What should a Boxer Fracture go in?

A

Ulnar gutter splint

-ORIF if angulation > 40 degrees

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22
Q

What is the MC bone malignancy?

A

Osteosarcoma

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23
Q

MC site of osteosarcoma

A

Metaphysis of long bones (distal femur MC)

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24
Q

MC site of METS in bone cancer

A

-Lungs (MCC of death)

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25
Q

Symptoms of Osteosarcoma

A
  • Localized bone pain worse at night
  • Joint swelling without systemic symptoms
  • Palpable soft tissue mass
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26
Q

What do radiographs for an osteosarcoma show?

A

-“Hair on End” or “Sunburst” appearance

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27
Q

What is the definitive diagnostic for osteosarcoma?

A

Biopsy

28
Q

Treatment for Osteosarcoma

A

-Chemo + Surgical Removal with amputation or limb-sparing resection

29
Q

What is a C1 fracture called and what is the mechanism of injury?

A

Atlas

  • Jefferson (Burst) Fracture
  • Vertical compression
30
Q

What is a C2 fracture called and what is the mechanism of injury?

A
  • Axis pedicle
  • Hangman’s Fracture
  • Hyperextension then flexion
31
Q

What is a Colles Fracture?

A

Distal radius fracture with dorsal angulation

32
Q

MOA for Colles Fracture and what is seen on Physical Exam?

A
  • FOOSH

- Dinner fork deformity appearance to the wrist

33
Q

Treatment for Colles Fracture

A

Closed reduction followed by sugar tong splint or cast

-ORIF if > 20 degrees angulation

34
Q

What is the MC Complication of a Colles Fracture?

A

Extensor Pollicis Longus Tendon Rupture

-Others: Malunion, joint stiffness, median nerve compression, CRPS

35
Q

What is the treatment for Congenital Talipes Equinovarus (Clubfoot)?

A

Ponseti method of serial manipulation and casting

36
Q

When should you perform an xray of a finger with a subungal hematoma?

A

When hematoma is > 50% of nail to evaluate for phalanx fracture

37
Q

Dermatomyositis is associated with _____ in 25% of cases

A

Cancer

38
Q

Symptoms of Dermatomyositis

A
  • Progressive symmetric proximal muscle weakness (shoulders, hips)
  • Systemic symptoms: dysphagia, fever, fatigue, weight loss
  • Decreased muscle strength
  • Gottron’s Papules (scaly patches on PIP and MCP)
  • Heliotrope Rash (blue discoloration of eyelids)
  • Malar Rash: Shawl Sign (erythema of shoulder, chest, back)
39
Q

Diagnostics for Dermatomyositis

A
  • Increased muscle enzymes (CK and aldolase): best initial
  • Anti-Jo 1 and Anti-Mi-2 (most specific)
  • Muscle biopsy: definitive
40
Q

Treatment for Dermatomyositis

A

-High-dose glucocorticoids first-line

+/- Methotrexate, Azathioprine, IVIG

41
Q

Clinical Intervention for a distal radius fracture

A

Sugar Tong Splint

42
Q

Risk Factors for Dupuytren Contracture

A
  • Men > 40
  • Northern Europeans
  • ETOH
  • DM
  • Smoking
43
Q

Symptoms of Dupuytren Contracture

A
  • Visible or palpable nodules over the distal palmar crease along course of flexor tendons
  • Fixed flexion deformity at MCP joint
  • May have thickened skin or bands in the palmar fascia
44
Q

Treatment for Dupuytren Contracture

A
  • Intralesional injections
  • Physical therapy
  • Surgical correction (fasciotomy) for advanced stages
45
Q

Symptoms of a knee effusion

A
  • Bulge sign
  • Ballottement
  • Patellar Tap Tests
46
Q

What is a Bennett’s Fracture

A

Intraarticular fracture through the base of the 1st metacarpal (MCP) bone

47
Q

What is a Rolando Fracture?

A

Comminuted Bennett’s Fracture (Y sign)

48
Q

Treatment for Bennett or Rolando Fracture

A

Thumb Spica Splint

  • Bennett: Immobilization
  • Rolando: ORIF, external fixation
49
Q

What is a Galeazzi Fracture?

A

Mid-distal radial shaft fracture with dislocation of the distal radioulnar joint

(GRUesome)

50
Q

Treatment for Galeazzi Fracture

A
  • ORIF

- Long arm/sugar tong splint temporarily

51
Q

Triggers for Gout

A
  • Purine-Rich Foods (alcohol, liver, seafood)

- Thiazide & Loop Diuretics, ACEi, Pyrazinamide, Ethambutol, Aspirin

52
Q

What is the ONLY ACEi that decreases uric acid levels?

A

Losartan

53
Q

Symptoms of Gout

A
  • First MTP joint of great toe (Podagra)

- Joint pain, erythema, warmth, swelling, tenderness, fever

54
Q

What is the diagnostic of choice for gout?

A

Arthrocentesis: negatively birefringent, needle-shaped crystals

55
Q

On X-rays, what is seen for gout?

A

Mouse or rat bite lesions (punched out erosions with sclerotic and overhanging margins)

56
Q

Treatment for acute management of gout

A
  • NSAIDs (NOT Aspirin)

- Colchicine (if cannot use NSAIDs)

57
Q

Chronic Management for gout

A
  • Lifestyle: decrease alcohol consumption, weight loss, decrease meats/seafood
  • Allopurinol: Xanthine Oxidase Inhibitors (DO NOT START DURING ACUTE ATTACK)
58
Q

True or False: Allopurinol is safe in renal insufficiency

A

True

59
Q

Gout is a problem with metabolism of what type of molecule?

A

Purine

60
Q

In gout, what compound precipitates into the synovial fluid?

A

Sodium Urate

61
Q

Where is a herniated disc most common?

A

L5-S1

-Because it is the junction between the mobile and non-mobile spine)

62
Q

Symptoms of a herniated disc

A
  • Radicular back pain; unilateral in a dermatomal pattern

- Pain increases with coughing, straining, bending, sitting, Valsalva

63
Q

With a herniated L4, what are the symptoms?

A
  • Anterior Thigh Pain
  • Sensory loss to medial ankle
  • Weakness with ankle dorsiflexion
  • Loss of knee jerk
64
Q

With a herniated L5 disc, what are the symptoms?

A
  • Lateral thigh/leg, hip, groin pain
  • Weakness in big toe dorsiflexion/extension
  • Reflexes usually normal
65
Q

With a herniated S1 disc, what are the symptoms?

A
  • Posterior leg/calf/gluteus pain
  • Plantar surface of the foot sensory diminished
  • Weakness in plantarflexion
  • Loss of ankle jerk
66
Q

What is the diagnostic of choice for a herniated disc

A

-MRI

67
Q

Treatment for herniated lumbar disc

A
  • NSAIDs, short period of rest
  • Anti-inflammatories
  • Warm, moist heat
  • Resume activities as tolerated
  • Injections, Transcutaneous electrical nerve stimulation

PANCE/EOC (63 decks)

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