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Clinical Medicine I > MSK Tests/Signs > Flashcards

MSK Tests/Signs Flashcards

1
Q

Dermatomyositis

A

humeral attack of muscle capilaries and small arterioles - infarctions / proximal muscle weakness

  • Gottron’s papules
  • Anti-Mi2 & Anti-MDA5
  • muscle biopsy
  • Rx:
    • corticosteroids
    • Methotrexate
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2
Q

Polymyositis

A

T-cell mediated cytotoxic process against muscle antigens

proximal muscle weakness

  • Anti-Jo-1
  • elevated CK
  • muscle biopsy
  • Rx
    • corticosteroids
    • Methotrexate
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3
Q

Fibromyalgia

A
  • no specific tests - test for other causes of symptoms
  • Rx
    • symtom specific
      • pain: analgesics
        • acetaminophen
        • Tramadol
      • muscle relaxants
        • Cyclobenzaprine (Flexeril)
      • anxiety
        • Alprazolam (Xanax)
      • insomnia
        • Zolpidem (Ambien)
      • antidepressants
        • Duloxetine (Cymbalta), Venlafaxine (Effexor)
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4
Q

Chronic Fatigue Syndrome

A
  • no specific test - r/o other causes
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5
Q

Complex Regional Pain Syndrome

A

follows surgery or trauma

  • pain out of proportion
  • skin color changes, dryness, shiny, wrinkled
  • Rx
    • NSAIDs, corticosteroids
    • sympathetic nerve block
    • PT/OT
    • surgery
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6
Q

Marfan Syndrome

A

autosomal dominant connective tissue disorder

  • treat pathology
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7
Q

Ehlers-Danlos Syndrome

A

heterogeneous disorder of connective tissue affecting collagen - joint hypermobility

  • treat manifestations
  • B-blocker to protect vessels
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8
Q

Osteogenesis Imperfecta

A

hereditary defects in bony matrix

  • blue sclara
  • bony deformities
  • Rx
    • Risedronate (increases bone density)
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9
Q

Systemic Lupus Erythematous

(SLE)

A

multisystemic inflammatory autoimmune disease

  • non-erosive peripheral joint pain/stiffness out of proportion
  • Anti-Smith autoantibody
  • Anti-dsDNA
  • Rx
    • antimalarials
      • Hydroxychloroquine
    • NSAIDs, corticosteroids
      • supplement Ca & Vit D w/ long term steroid
    • DMARDs (immunosuppressants)
      • Methotrexate (Trexall) - arthritis
      • Cyclophosphamide - CNS
      • Azathioprine (Imuran) - nephritis
      • Mycophenolate (Cellcept) - nephritis
      • IV immunoglobulin for flare-ups
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10
Q

Sjorgren’s Syndrome

A

autoimmune attack of exocrine glands

  • SICCA
  • xerophthalmia (keratoconjunctivitis), xerostomia (mouth)
  • Anti-SS-A (Ro) -or- Anti-SS-B (La)
  • Rx
    • fluids, lotion, humidifiers, good oral hygiene, annual eye/dental exams
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11
Q

Polymyalgia Rheumatica

A

inflammatory condition of shoulders and pelvic girdle

  • sudden onset morning stiffness >45 min
  • ASSOCIATED w/ GIANT CELL arteritis
  • temporal artery biopsy (gold standard)
  • Rx
    • Prednisone
    • Ca/Vit D
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12
Q

Polyarteritis Nodosa

A

necrotizing inflammation of vessels at branches/bifurcatons

  • Livido reticularis
  • Rx
    • Prednisone
    • Methotrexate
    • Anti-viral if Hep B
    • treat HTN
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13
Q

tumor prefixes

  • osteo-
  • chondro-
  • fibro-
  • radiolucent
A
  • osteo - bone forming
    • osteoid osteoma
    • osteoblastoma
    • osteoma
  • chondro - cartilage forming
    • chondroma
    • osteochondroma
    • chondroblasoma
  • fibro - fibrous bone lesions
    • fibrous dysplasia
    • nonossifying fibroma
  • radiolucent
    • giant cell tumor
    • unicameral bone cyst
    • aneurysmal bone cyst
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14
Q

Osteoid Osteoma

A

benign ostoid forming tumor

  • night pain
  • <1cm cherry red lytic nidus
  • Rx
    • NSAIDs
    • curettage/burring
    • radiofrequency ablation
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15
Q

Osteoblastoma

A

large osteoid osteoma

  • >2cm and more aggressive
  • night pain
  • nidus not visible on x-rays
  • Rx
    • NOT responsive to NSAIDs
    • biopsy
    • curettage and bone grafting
    • tumor excision w/ bone reconstruction -or- internal fixation
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16
Q

Osteoma

A

benign deposit of new bone

  • associated w/ Gardner’s syndrome (colonic polyps)
  • firm w/ no pain
  • typically on skull, tibia, femur
  • Rx
    • observation vs. marginal resection
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17
Q

Encondroma

A

benign cartilage formation in medullary canal

  • associated with:
    • Ollier’s disease
    • Maffucci’s syndrome (+hemangiomas)
  • “scalloped”/thinning on x-ray
  • Rx
    • no tx if asymptomatic
    • biopsy
    • curettage w/ bone grafting
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18
Q

Periosteal Chondroma

A

benign hyaline cartilage formation on surface of bone

  • painful, sometime palpable mass
  • saucerization w/ sclerosis on x-ray
  • Rx
    • excision
    • need to r/o condrosarcoma
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19
Q

Osteochondroma

A

exostosis - growth on bone surface covered w/ benign cartilaginous cap

  • pedunculated vs. sessile stalk
  • Rx
    • asymptomatic - monitor
    • surgical excision
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20
Q

Chondroblasoma

A

cartilage forming tumor in epiphysis

  • radiographic finding - well circumscribed/defined lytic lesion
  • histology: “chickenwire calcification”
  • Rx
    • curettage and bone graft
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21
Q

Nonossifying Fibroma

(NOFs)

A

proliferation of fibrous tissue / fibrous cortical defect

  • children/adolescents
  • Jaffe-Campanacci Syndrome: multiple NOFs and cafe au lait spots
  • Rx
    • observation vs. curettage w/ bone graft
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22
Q

Fibrous Dysplasia

A

abnormal tissue formation in place of lamellar bone

  • pain
  • “ground glass” appearance on x-ray
  • Rx
    • surgery - rigid fixation
    • Bisphosphates
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23
Q

Giant Cell Tumor

A

aggressive benign proliferation of multinucleated giant cells

  • pain, swelling, deformity - can met to lungs
  • lucent and ecentrically located, bony destruction/cortical breakthrough on x-ray
  • Rx
    • curettage, ablation, bone grafting, fixation
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24
Q

Unicameral Bone Cyst

A

fluid filled cyst w/ fibrous lining

  • usually incidental finding or mild pain/swelling/stiffness
  • Rx
    • r/o sarcoma
    • interlesion aspiration w/ corticosteroid injection
    • curettage and bone graft
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25
Aneurysmal Bone Cyst
aggressive vascular lesion w/ blood filled cavities * Rx * curettage and bone grafting
26
Metatastic Disease
carcinomas of other organs spread to the bones most common bone tumor
27
Multiple Myeloma
proliferation of malignant interosseous plasma cells in bone marrow * "punched out" roundish lesion in x-ray * Rx * surgical fixation of pathologic fxs * chemo/radiation
28
**Osteosarcoma\***
most common malignant bone tumor * palpable mass, lymphadenopathy * +/- pain, swelling, night pain * types: * telangiectatic * multifocal * parosteal * periosteal - "star burst"/"sun burst" * Rx * resection to spare limb * amputation
29
Chondrosarcoma
malignant predominantly cartilage tumor * pain over time w/ or w/out mass * symptoms depend on tumor location * "ring and arc" pattern on x-ray, punctate calcifications, scalloping * Rx * excistion: wide resection vs. limb sparing * NO chemo/radiation
30
Secondary Chondrosarcoma
arises from enchondroma/osteochondroma * scattered irregular calcification on x-ray
31
**Ewing Sarcoma\***
malignant endothelioma - assoc w/ chromosomal translocation t(11:22) * young population * worsening pain, fever, warmth, incr sed rate, WBCs (mimics infection) * destructive lesion w/ poor borders on x-ray * Rx * chemo * Vincristine, Cyclophosphamide * radiation * surgical resectioning * limb sparing, amputation rare
32
osteocyte receptors/inhibitors regulating osteoclast production
RAKLE and OPG these determine rate of bone resorption
33
peak bone mass
18-20: proximal femur 25-30: spine more loss than formation after this
34
bone physiology vs. pathology longitudinal growth, mineralization, remodelling
growth - abnormal size mineralization - osteomalacia remodelling - osteoporosis
35
Osteoporosis
bone remodelling pathology * no S/s - seen with associated fracture * Kyphosis - **Dowager hump** * FRAX tool * **Dual-Energy X-ray Abosorbtiometry** (DEXA) - gold standard * T-score: value vs. control at peak BMD * 1 STD = normal * (-)1-2.5 STD = osteopenia * (-)2.5+ = osteoporosis * Z-score: value vs. age/sex * \>(-)2 = normal * _\<_(-)2 = below expected range * Rx * Ca (1000-1200mg/d) + Vit D (600-800 IU/d) * Bisphosphates - inhibit osteoclasts * oral * Alendronate (Fosamax) * Risedronate (Actonel) * Ibnadronate (Boniva) * parental * Zoledronic acid (Reclast) * Ibandronate (Boniva) * newer/expensive options * selective estrogen receptor modulators (SERMs) * Raloxifene (Evista) * recombinant human parathyroid hormone * Teriparatide (Forteo)- black box * human monoclonal antibody * Denosumab (Prolia)- RANKL Ab inhibits osteoclast
36
Osteomalacia
decreased mineralization (softening of bone/rickets-children) * **Vit D deficiency**, renal/liver disease, minerailzation inhibitors * +/-**Chvostek's sign**: tap on facial nerve elicits twitch * 25-hyroxyvitamin D (\<30 insufficient, \<15-20 dificient) * Rx * Vit D replacement 400-2000 IU/d
37
Paget Disease
_localized_ bone remodeling disorder * deformities, abnormal gait, skull: hearing loss/HA/tinitis/increased hat size * urinalysis: hyroxyproline, dexypyridinoline, C-telopeptide * NOT a Vit D disorder * Rx * Bisphosphates * Zoledronate acid (Reclast) * Alendronate (Fosamax) * Risedronate (Actonel)
38
The 4 Spondyloarthropathies
share genetic predisposing factors and clinical features * ankylosing spondylitis * reactive arthritis * psoriatric arthritis * enteropathic arthritis * joint ankyloses (new bone formation) * **occular inflammation** * **HLA-B27 gene**
39
Ankylosing Spondylitis
axial skeleton inflammation disorder * HLA-B27 * achilles tendon/heel pain * **Schober test**: measure mobility of spine 10cm/5cm * "bamboo spine" on x-ray, SI joint "missing" * Rx * NSAIDs, corticosteroid (injection/systemic) * Sulfasalazine * Methotrexate * DMARDs * anti-TNF therapy
40
Reactive Arthritis
_aseptic_ joint inflammation _after_ infection * salmonella, ersinia, shigella, chlamydia * **Reiter's syndrome**: "can't see, can't pee, can't climb tree" * conjunctivitis, urethritis, conjunctivitis * Mucocutaneous lesions/Papulosquamous eruptions * HLA-B27 * synovial fluid analysis * Rx * no cure - self limiting * NSAIDs +/- intra-articular injection
41
Psoriatric Arthritis
* onycholysis, subungual keratosis, pitting, oil staining * HLA-B27 * Rx * pain control, anti-TNF
42
Enteropathic Arthritis
non-erosive asymmetric polyarthritis * **associated w/ Crohn's and UC**
43
Scleroderma - Systemic Sclerosis
autoimmune thickening of skin/connective tissue w/ internal organ involvement * inflammation -\> **vascular obliteration** -\> fibrosis * limited * trunk spared * **CREST** syndrome * Calcinous cutis, Raynaud's, Esophageal thickening, Sclerodactyly, Telangiectasia * diffuse * proximal and trunk skin, rapid progression * mixed * overlap of SLE and systemic sclerosis (scleroderma) * localized * children - morphea (reddish/purple lesion) * Rx * no real tx - treat systems involved * corticosteroids, methotrexate, D-penicillamine, ACE inhibitor
44
Osteoarthritis
progressive irreversible loss of articular cartilage * changes to ALL components of joint: bone exposure, bony cysts, sclerosis of bony margins * **Heberden's nodes** (DIP) * **Bouchard's nodes** (PIP) * Rx * conservative * RICE, hyaluronic acid/corticosteroid injections * NSAIDs * PT, lifestyle modification * joint replacement
45
Rheumatoid Arthritis
immune response in synovial tissue * symmetric "moring stiffness" (gel phenomenon) * MCP/PIP, C1-C2 subluxation * deformities: * ulnar deviation, swan-neck, Boutonniere, nodules, hammer toe * **Felty's** syndrome: RA, splenomegaly, neutropenia * **+RF/anti-CCP** * Rx * no cure * NSAIDs or low dose Prednisone * DMARDs: methotrexate * Anti-TNF: infliximab, adalimumab, golimumab
46
RA vs. OA
47
Gout
monosodium urate crystals (MSU) * 1st metatarsophalangeal joint (Podegra) * subcutaneous tophus * synovial fluid analysis (gold standard) * **needle shaped crystals w/ negative birefringence** * **​**Rx * lifestyle * acute attacks: RICE, NSAIDs, Colchicine * Xanthine oxidase inhibitor * **Allopurinol** (Zyloprim, Aloprim) * Probenecid (under-excreters) * Pegloticase (Krystexxa) - rheumatologic, black box
48
Calcium Phyrophosphate Dihydrate Crystal Deposition Disease (CPPD Crystal Deposition Disease)
extracellular PPi accumulation around chondrocytes * synovial fluid analysis - gold standard * **square crystals w/ positive birefringence** * **​types** * pseudo gout (single knee) * chondrocalcinosis (incidental) * pyrophosphate arthropathy (OA+CPPD) * Rx * RICE, NSAIDs, corticosteroids
49
Hydroxyapatite Arthropathy | (3 manifestations)
species of basic phosphate crystals in joints, ligaments, tendons, bursa * **calcific tendinitis** - sudden onset pain w/out MOI, resolves, back during resorption phase * **Milwaukee shoulder** - crystals destroy RC and shoulder joint * **Diffuse idiopathic skeletal hyperostosis (DISH)** - bridging in spine
50
Septic Bursitis
infection of bursa * if infection of joint - pt will not want to move it! * aspiration to identify infection * Rx * outpatient * penicillin * tri/sulfa (Bactrim) if MRSA * Clindamycin -or- Linezolid if PCN allergy * inpatient * Nafcillin, Oxacillin, Cefazolin IV * MRSA: add Vanco, Daptomycin, Linezolid
51
Septic Arthritis
infection of _joint_ * damages articular cartilage and bone - DON'T MISS * hematogenous w/ UTIs, indwelling catheters * very painful, red, hot, swollen, +/- fever * **cervical/urethral cultures if +gonococcal** * Rx * surgery + IV antibiotics
52
Osteomyelitis
infection of _bone_ * biopsy or culture (gold standard) * Rx * abx spacer; reconstruction; amputation * IV abx * methylmethacrylate beads
53
Cervical Test
spurling * narrows foramen * will increase or reproduce radicular symptoms
54
Lumbar Tests
* straight-leg raise * herniated disk * lumbar spine of asymptomatic side * seated straight-leg raise * sciatic tenson, pt leans back * FABER * figure 4 * hip/SI joint pathology
55
non-organic pain signs
Waddell signs * nonorganic tenderness * axial stimulation/torso rotation * seated straight-leg raise * sensory examination
56
cervical strain
* Rx * NSAIDs, pain meds, muscle relaxers, corticosteroids
57
radiculopathy vs. myelopathy
* radiculopathy * nerve root * disk herniation, degeneration - spasms, weakness, HA * **relieved w/ hand over head** * myelopathy * spinal cord * long tract signs: palmar paresthesia, abnormal unrinary, vibration/position loss
58
myelopathy tests
* Babinski sign (toe's open) * Brudzinski-Kernig test (head lift / leg lift) * Ankle clonus (dorsiflex foot)
59
cervical radiculopathy
compressed nerve root * Spurling test * pain radiates PAST elbow * Rx * resolves in 2-8 weeks * NSAIDs, traction, NO MANIPULATION
60
cervical spondylosis
narrowing of neural foramen * **myelopathy** symptoms * Rx * decompression and fusion
61
cauda equina syndrome
compression of nerve roots distal to conus medullaris * bowel/bladder dysfunction * saddle anesthesia * weakness in lower extremities * Rx * IMMEDIATE decompression surgery
62
lumbar strain/sprain
* x-ray to r/o other * patellar tendon reflex (L4) * Rx * conservative * pain control, PT, education, back to work
63
chronic low back pain
* \>90 days / 3 months * LBP radiating to 1 or both buttocks * **relief when lying** * Rx * psychological testing * injections * education * detoxification
64
lumbar herniated disk
* L4/L5, L5/S1 most common (L5 and S1 nerves) * pain past knee to foot * Rx * NSAIDs, rest, PT * microdisection * laminectomy
65
spinal stenosis
narrowing of lumbar spinal canal * neurogenic claudication: weakness proximal to distal * **relief w/ sitting forward/leaning** * **Romberg test**: lose balance w/ eyes closed * Rx * pain control, PT, body mechanics * decompression vs. spinal fusion
66
SI joint dysfunction
* trauma, tight iliopsoas, scoliosis, hip OA, pregnancy * stabbing knife-like pain in butt or posterior leg(s) * wose w/ sitting/twisting * FABER test * pusth on ASIS and rock pt * Rx * conservative
67
coccydynia
tailbone pain * Rx * conservative * PT, change activity, nerve block * surgical * coccygectomy
68
spondylolysis / spondylolisthesis
* spondylolysis * scotty dog fracture - pars interarticularis defect * spondylolisthesis * forward translation of one vertebra to another * Rx * conservative (including wt. loss) * surgical * stabilize defect if skeletally immature
69
scoliosis
lateral curvature of the spine * Rx * immature * observation * bracing (25-45 deg): Milwaukee, Boston * fusion (\>45 deg) * mature * conservative * surgical if \>50-60 deg
70
metastatic spine disease
tumors of the spine * pain w/ weight bearing/night, radiculopathy, progresses * +/- constitutional
71
Jefferson Fracture
burst fracture of C1
72
Hangman's Fracture
hyperextension fracture of C2 pedicles
73
Clay-shoveler's fracture
spinous process avulsion C7 \> C6 \> T1
74
thoracic vertebral fracture
compression fx d/t osteoporosis more common
75
lumbar vertebral frature
76
spinal orthosis
* cervical * soft collar - short term cervical sprains * Philadelphia - rotational control for suspected fx * rigid - greater limitation * halo - immobilization * thoracic * corset * three-point - thoracic sprains or minimal compression fx * total contact - clamshell for fx, fusions * lumbar * elastic belt - support/strains * corset - sprain/herniation * rigid
77
Lower Extremety Measurements
* Q angle: ASIS to mid patella to mid tibia * F = 17 deg, M = 14 deg * leg length * ASIS to medial maleolus
78
femoral neck angles
coxa vara: \<125 deg coxa valga: \>125 deg
79
hip tests
* Trendelenburg test: hip tilts away from weak gluteus medius * Thomas test: psoas tightness, flexor contractor * log roll test: pain w/ internal rotation - acetabular/femoral neck pathology * FABER (Patrick) test: figure 4- SI joint/hip problem * Hamstring flexability: knee extension 5-15 deg of straight
80
hip sprain/strain
* pain and swelling * Rx * RICE, NSAIDs, pain relievers, PT * surgury for avulsion injuries
81
hip bursitis - trochanteric bursitis
pain w/ abduction * Rx * RICE, cortisone injection, NSAIDs, pain relievers, wt. loss * PT: stretch and strengthen gluteus medias and IT band
82
piriformis syndrome
piriformis muscle compressing sciatic nerve * **Lasegue sign**: pain w/ knee extension when hip 90 deg * **Piriformis sign** * Rx * NSAIDs, PT, +/- injection
83
femoral acetabular impingement (FAI)
osseous deformity of acetabular rim leads to articular cartilage damage * "C" sign * Rx * conservative vs. surgical
84
hip dislocation
obvious deformity * Rx * reduction ASAP
85
osteonecrosis
bone death * corticosteroid use * alocohol abuse * sickle cell * RA/SLE * trauma * Rx * w/out collapse: decompression, vacular grafting * arthroplasy (replacement)
86
lateral femoral cutaneous nerve entrapment
compression at ASIS * tight clothes, obesity, scar tissue, trauma * lateral thigh pain/dysesthesia * Rx * remove cause * cortisone injection * surgical release of nerve
87
knee tests
* Patella * apprehension - move patella laterally * J sign - shifts up and out w/ extesion * Meniscus * McMurry's test * lateral meniscus - knee abducted w/ foot in * medial meniscus - knee adducted w/ foot out * Ligaments * Lachman's/anterior drawer - ACL * Posterior drawer/sag sign - PCL * Valgus stress - MCL * Varus stress - LCL * positive w/ pain or laxity
88
patellar bursitis
pre-patellar (trauma/septic) vs. pes anserine (medial compartment OA) * apirate * Rx * NSAIDs, modify activity, compression * surgery rare
89
knee tendinitis
quadriceps tendon (above) vs. patellar (jumper's knee") * anterior knee pain w/ jumping, running, kicking * Rx * RICE, NSAIDs, PT * knee strap/sleeve
90
knee tendon ruptures
* pain, swelling, discoloration * Rx * surgery
91
patellofemoral syndrome
associated w/ **chondromalacia** - softening of cartilage * anterior knee pain worse w/ sitting, climbing, jumping, squatting * Q-angle, J sign, patellar apprehension * tight hamstrings and weak quadriceps * Rx * NSAIDs, bracing * PT
92
patellofemoral instability
lateral subluxation/dislocation * severe pain, inability to ambulate * Rx * RICE, +/- aspiration, braced in extension * NSAIDs, pain meds * PT * surgery if conservative tx fail
93
meniscus tears
* **McMurry test** * EMERGENCY if can't extend knee * Rx * RICE, pain control, PT * meniscectomy vs. meniscal repair
94
Baker's cyst
excessive joint fluid to popliteal bursa * Rx * conservative * surgery rare (fear of transecting popliteal nerve)
95
ACL tear
* pain, immediate joint effusion * **+ Lachman's exam** * **pivot shift test** * Rx * RICE, ROM * surgical reconstruction if younger, active
96
PCL tear
prevents posterior translation * force to tibia w/ flexed knee * **+ posterior drawer test, posterior sag** * Rx * depends on degree of instability
97
collateral ligament sprain
* evaluate instability at 0 and 30 degrees: more play 30 \> 0 * Rx * MCL - conservative * LCL - conservative if grade I-II, surgical grade III unhappy triad: ACL, MCL, medial meniscus
98
chondral / osteochondral defect (OCD)
articular cartilage injury * direct trauma * Rx * microfracture vs. OATS vs. implantation
99
foot ankle tests
* ankle * anterior drawer - pull heel forward * Thompson test - sqeeze calf to make foot move (achilles test) * inversion/eversion stress test * foot * interdigital neuroma test - squeeze inbetween toes
100
ankle sprain
* inversion * anterior and posterior talofibular ligament (ATFL/PTFL) * calcaneofibular ligament (CFL) * eversion * deltoid ligament * **PALPATE/ASSESS 5th metatarsal - Jones fracture** * anterior drawer, squeeze test, external rotation test * Rx * rehab * surgery rare
101
achilles tendon rupture
"someone kicked me in the ankle" * palpable tendon defect * Rx * tendon retraction - surgery * serial casting
102
tarsal tunnel syndrome
compression of tibial nerve * vague paresthesis or dysthesias on plantar foot * worse w/ walking/exercise; relieved w/ rest; night pain * **+ Tinel sign** * Rx * conservative; injection; orthotics * poor surgical outcomes
103
plantar faciitis
fascia of medial tuberosity of calcaneous to proximal phalanges * worse "start up" pain * Rx * orthotics, night splint, PT, NSAIDs, injections
104
pes planus (flat foot)
posterior tendon dysfunction * hindfoot valgus - "too many toes" * unable to toe raise * Rx * casting, orthotics, PT * tendon transfer/osteotomy
105
metatarsalgia
* forefoot pain d/t abnormal metatarsal length/toe deformities * bony prominences, avascular yellow candle wax callus * Rx * conservative * metatarsal pad/removal of callus, orthotics, PT * surgical * realign toes or metatarsal heads
106
interdigital (Morton) neuroma
perineural fibrosis of digital nerve b/t 3rd and 4th toes * like "walking on a marble" * **+ squeeze test** * Rx * metatarsal pad, shoe change, corticosteroid injection * surgical excision
107
hallux valgus (bunion)
lateral deviation of big toe at MTP joint * Rx * conservative * shoe wear, orthotics, PT- biomechanical evaluation * surgical
108
turf toe
1st MTP joint sprain / hyperextension * Rx * orthotics, stiff soled shoes * surgical only if avulsed or displaced fracture
109
toe deformities
* hammer toe * PIP flexion deformity * claw toe * MTP extension/PIP flextion (5th/4th toe) * mallet toe * DIP flexion
110
shoulder impingement
* inflammation in subacromial space: arms overhead, throwing, lifting, manual laborers * **Neer test** * **Hawkins-Kennedy test**
111
bicipital tendinitis
inflammaton of long head * **Speed's test** * **Yergason's test** * "Popeye" deformity * no surgery
112
rotator cuff tear
* night pain * tests * arm drop * empty can * Rx * RICE vs. arthroscopic / open repair
113
glenohumeral dislocation
* Nerve to test: CN XI (axillary) * **AXILLARY VIEW** * Rx * reduction * rest, ice, PT
114
recurrent instability
* tests * apprehension test * Sulcus sign (inferior) * Load and shift test * immobilize 2-3 weeks, maybe surgery
115
anterior dislocation
* Bankart - tear to glonoid labrum * Hill Sachs lesion - humeral head compression fx
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SLAP tear - superior labrum anterior to posterior
* overhead throwing athletes, fall on outstretched arm * **O'Brien test**: cross body arm * **Crank test:** manipulate humeral head * check for glenohumeral internal rotation deficit (GIRD) * Rx * conservative: rest, ice, PT, throwing protocol * surgical: arthroscopy for grade 3+
117
AC joint sprain/dislocation
* always trauma * Rx * conservative * immobilize ~2 days * rest, ice, NSAIDs, PT * surgery * rare - grade 4 and above
118
AC joint OA/osteolysis
* progressively worsening pain * pain w/ **across body adduction** * Rx * conservative * surgical * open vs. arthroscopic excision
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adhesive capsulitis
* freezing -\> plateau -\> thawing * plain x-ray to r/o other; NO MRI * Rx * rest, ice/heat, PT, GH injection, NSAIDs, pain meds * manipulation under anesthesia * arthroscopic lysis of adhesions
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shoulder joint injections
* subacromial space * 1cm below acromion, direct medial/anterior/superior * glenohumeral joint * 2 fingers medial/inferior acromion, direct anteriormedial * bicipital tendon sheath * at point of max tenderness, insert 30-45 deg into sheath - avoid tendon * AC joint * superior approach .5cm * SC joint * anterior approach .5cm
121
thoracic outlet syndrome
compression of brachial plexus/subclavian vessels * paresthesia, color changes, fatigue in arm * **Adson's maneuver** * **elevated arm stress (overhead makes symptoms worse)** * **​**Rx * rest, NSAIDs, muscle relaxers, PT * surgery rare
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epicondylitis (lateral & medial)
overuse injuries * lateral - extensors (tennis elbow) * medial - flexors (golfer's elbow) * Rx * rest, ice, NSAIDs, +/- cortisone injection, bracing * surgery no common - drill holes to advance healing
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collateral ligament injury (radial - LCL / ulnar - MCL)
* radial (LCL) rare and usually w/ fracture or dislocation * ulnar (MCL) repetative stress (overhead throwing) * ulnar paresthesia * tests * valgus stress test * **milking maneuer** * +/- Tinel's * Rx * rest, NSAIDs, PT, throwing mechanics * surgery * "Tommy John" - ulnar collateral ligament repair
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olecranon bursitis
* aspirate * Rx * abx for infection * NSAIDs, elbow pad, corticone injection if no infection * surgical excision not common
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cubital tunnel syndrome
compression of ulnar nerve * numbness, tingling, atrophy of hand * **claw hand** * + Tinel's sign * Rx * conservative * rest, avoid excessive flexion, night splint * surgery * ulnar nerve decompression vs. transposition
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distal bicep tendon rupture
* pain and defect in antecubital fossa * "reverse Popeye" * Rx * surgery w/in 2 weeks
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elbow dislocation
* extreme swelling, pain, inability to move elbow * Rx * reduction and splint under conscious sedation
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elbow injections
* olecranon bursa * elbow flexed, 1 cm distal to bursa, 18 ga needle, grasp bursa w/ opposite hand * elbow joint * 45 deg bend, center of lateral epicondyle/radial head/tip of olecranon triangle * lateral epicondylitis * elbow flexed 90 degrees, 1cm distal to epicondyle, point of max tenderness, 22 ga needle * medial epicondylitis * elbow extended 20 deg
129
carpal tunnel syndrome
* compression of median nerve - numbness in 1st, 2nd, 3rd fingers * worse at night * muscle weakness * tests * Tinel's sign * **Phalen's sign\* (reverse prayer)** * **​**Rx * NSAIDs, activity modification, bracing, injection * surgery * open vs. endoscopic
130
DeQuervain's Tenosynovitis
swelling/stenosis in abductor pollicis longus/extensor pollicis brevis tendon sheath * **+ Finkelstein test** * Rx * injection, bracing, PT * surgical release rare
131
ganglion cyst
fluid from joint capsule/tendon synovial sheath * dorsum of wrist, volar radial aspect, base of finger * can transilluminate * Rx * NSAIDs, rest, wrist splint * aspiration (caution: radial artery) * surgical w/ recurrent, painful cyst
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thumb/finger dislocation
* Rx * taping
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gamekeeper's (skiier's) thumb
torn ulnar collateral ligament (UCL) * Rx * conservative * surgical only if UCL ruptured
134
trigger finger
thickening of flexor tendon sheath * "feels locked" * palpable nodule
135
flexor tendon injury
Jersey finger * flexion weakness following injury * surgical repair **with every hand injury evaluate/document flexor tendons**
136
extensor tendon injuries
* Boutonniere deformity * PIP flexion and DIP extension * Mallet finger * rupture to extensor tendon at DIP * Rx * splint
137
swan neck deformity
hyperextension PIP and flexion DIP
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felon
finger pulp infection * severe pain and swelling * Rx * digital block with surgical drainage
139
paronychia
infection of soft tissue around fingernail * Rx * Cephalexin (Keflex) * TMP/SMZ (Bactrim) * Clindamycin (Cleocin)
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septic flexor tenosynovitis
infection in synovial sheath of flexor tendons "fight bite" * Kanaval's 4 Cardinal Signs: * intense pain (w/ extension) * flexion posture * fusiform swelling * tenderness along flexor tendon sheath * Rx * **SURGICAL EMERGENCY**
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herpetic whitlow
herpes simplex 1 or 2 infection * +/- antivirals * DO NOT DRAIN

Clinical Medicine I (8 decks)

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