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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
Q

Aneurysmal Bone Cyst

A

aggressive vascular lesion w/ blood filled cavities

  • Rx
    • curettage and bone grafting
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26
Q

Metatastic Disease

A

carcinomas of other organs spread to the bones

most common bone tumor

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27
Q

Multiple Myeloma

A

proliferation of malignant interosseous plasma cells

in bone marrow

  • “punched out” roundish lesion in x-ray
  • Rx
    • surgical fixation of pathologic fxs
    • chemo/radiation
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28
Q

Osteosarcoma*

A

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
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29
Q

Chondrosarcoma

A

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
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30
Q

Secondary Chondrosarcoma

A

arises from enchondroma/osteochondroma

  • scattered irregular calcification on x-ray
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31
Q

Ewing Sarcoma*

A

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
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32
Q

osteocyte receptors/inhibitors regulating osteoclast production

A

RAKLE and OPG

these determine rate of bone resorption

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33
Q

peak bone mass

A

18-20: proximal femur

25-30: spine

more loss than formation after this

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34
Q

bone physiology vs. pathology

longitudinal growth, mineralization, remodelling

A

growth - abnormal size

mineralization - osteomalacia

remodelling - osteoporosis

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35
Q

Osteoporosis

A

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
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36
Q

Osteomalacia

A

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
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37
Q

Paget Disease

A

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)
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38
Q

The 4 Spondyloarthropathies

A

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
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39
Q

Ankylosing Spondylitis

A

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
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40
Q

Reactive Arthritis

A

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
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41
Q

Psoriatric Arthritis

A
  • onycholysis, subungual keratosis, pitting, oil staining
  • HLA-B27
  • Rx
    • pain control, anti-TNF
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42
Q

Enteropathic Arthritis

A

non-erosive asymmetric polyarthritis

  • associated w/ Crohn’s and UC
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43
Q

Scleroderma - Systemic Sclerosis

A

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
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44
Q

Osteoarthritis

A

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
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45
Q

Rheumatoid Arthritis

A

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
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46
Q

RA vs. OA

A
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47
Q

Gout

A

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
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48
Q

Calcium Phyrophosphate Dihydrate Crystal Deposition Disease

(CPPD Crystal Deposition Disease)

A

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
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49
Q

Hydroxyapatite Arthropathy

(3 manifestations)

A

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
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50
Q

Septic Bursitis

A

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
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51
Q

Septic Arthritis

A

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
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52
Q

Osteomyelitis

A

infection of bone

  • biopsy or culture (gold standard)
  • Rx
    • abx spacer; reconstruction; amputation
    • IV abx
    • methylmethacrylate beads
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53
Q

Cervical Test

A

spurling

  • narrows foramen
  • will increase or reproduce radicular symptoms
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54
Q

Lumbar Tests

A
  • 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
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55
Q

non-organic pain signs

A

Waddell signs

  • nonorganic tenderness
  • axial stimulation/torso rotation
  • seated straight-leg raise
  • sensory examination
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56
Q

cervical strain

A
  • Rx
    • NSAIDs, pain meds, muscle relaxers, corticosteroids
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57
Q

radiculopathy vs. myelopathy

A
  • 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
Q

myelopathy tests

A
  • Babinski sign (toe’s open)
  • Brudzinski-Kernig test (head lift / leg lift)
  • Ankle clonus (dorsiflex foot)
59
Q

cervical radiculopathy

A

compressed nerve root

  • Spurling test
  • pain radiates PAST elbow
  • Rx
    • resolves in 2-8 weeks
    • NSAIDs, traction, NO MANIPULATION
60
Q

cervical spondylosis

A

narrowing of neural foramen

  • myelopathy symptoms
  • Rx
    • decompression and fusion
61
Q

cauda equina syndrome

A

compression of nerve roots distal to conus medullaris

  • bowel/bladder dysfunction
  • saddle anesthesia
  • weakness in lower extremities
  • Rx
    • IMMEDIATE decompression surgery
62
Q

lumbar strain/sprain

A
  • x-ray to r/o other
  • patellar tendon reflex (L4)
  • Rx
    • conservative
      • pain control, PT, education, back to work
63
Q

chronic low back pain

A
  • >90 days / 3 months
  • LBP radiating to 1 or both buttocks
  • relief when lying
  • Rx
    • psychological testing
    • injections
    • education
    • detoxification
64
Q

lumbar herniated disk

A
  • L4/L5, L5/S1 most common (L5 and S1 nerves)
  • pain past knee to foot
  • Rx
    • NSAIDs, rest, PT
    • microdisection
    • laminectomy
65
Q

spinal stenosis

A

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
Q

SI joint dysfunction

A
  • 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
Q

coccydynia

A

tailbone pain

  • Rx
    • conservative
      • PT, change activity, nerve block
    • surgical
      • coccygectomy
68
Q

spondylolysis / spondylolisthesis

A
  • 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
Q

scoliosis

A

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
Q

metastatic spine disease

A

tumors of the spine

  • pain w/ weight bearing/night, radiculopathy, progresses
  • +/- constitutional
71
Q

Jefferson Fracture

A

burst fracture of C1

72
Q

Hangman’s Fracture

A

hyperextension fracture of C2 pedicles

73
Q

Clay-shoveler’s fracture

A

spinous process avulsion C7 > C6 > T1

74
Q

thoracic vertebral fracture

A

compression fx d/t osteoporosis more common

75
Q

lumbar vertebral frature

A
76
Q

spinal orthosis

A
  • 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
Q

Lower Extremety Measurements

A
  • Q angle: ASIS to mid patella to mid tibia
    • F = 17 deg, M = 14 deg
  • leg length
    • ASIS to medial maleolus
78
Q

femoral neck angles

A

coxa vara: <125 deg

coxa valga: >125 deg

79
Q

hip tests

A
  • 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
Q

hip sprain/strain

A
  • pain and swelling
  • Rx
    • RICE, NSAIDs, pain relievers, PT
    • surgury for avulsion injuries
81
Q

hip bursitis - trochanteric bursitis

A

pain w/ abduction

  • Rx
    • RICE, cortisone injection, NSAIDs, pain relievers, wt. loss
    • PT: stretch and strengthen gluteus medias and IT band
82
Q

piriformis syndrome

A

piriformis muscle compressing sciatic nerve

  • Lasegue sign: pain w/ knee extension when hip 90 deg
  • Piriformis sign
  • Rx
    • NSAIDs, PT, +/- injection
83
Q

femoral acetabular impingement (FAI)

A

osseous deformity of acetabular rim leads to

articular cartilage damage

  • “C” sign
  • Rx
    • conservative vs. surgical
84
Q

hip dislocation

A

obvious deformity

  • Rx
    • reduction ASAP
85
Q

osteonecrosis

A

bone death

  • corticosteroid use
  • alocohol abuse
  • sickle cell
  • RA/SLE
  • trauma
  • Rx
    • w/out collapse: decompression, vacular grafting
    • arthroplasy (replacement)
86
Q

lateral femoral cutaneous nerve entrapment

A

compression at ASIS

  • tight clothes, obesity, scar tissue, trauma
  • lateral thigh pain/dysesthesia
  • Rx
    • remove cause
    • cortisone injection
    • surgical release of nerve
87
Q

knee tests

A
  • 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
Q

patellar bursitis

A

pre-patellar (trauma/septic) vs.

pes anserine (medial compartment OA)

  • apirate
  • Rx
    • NSAIDs, modify activity, compression
    • surgery rare
89
Q

knee tendinitis

A

quadriceps tendon (above) vs. patellar (jumper’s knee”)

  • anterior knee pain w/ jumping, running, kicking
  • Rx
    • RICE, NSAIDs, PT
    • knee strap/sleeve
90
Q

knee tendon ruptures

A
  • pain, swelling, discoloration
  • Rx
    • surgery
91
Q

patellofemoral syndrome

A

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
Q

patellofemoral instability

A

lateral subluxation/dislocation

  • severe pain, inability to ambulate
  • Rx
    • RICE, +/- aspiration, braced in extension
    • NSAIDs, pain meds
    • PT
    • surgery if conservative tx fail
93
Q

meniscus tears

A
  • McMurry test
  • EMERGENCY if can’t extend knee
  • Rx
    • RICE, pain control, PT
    • meniscectomy vs. meniscal repair
94
Q

Baker’s cyst

A

excessive joint fluid to popliteal bursa

  • Rx
    • conservative
    • surgery rare (fear of transecting popliteal nerve)
95
Q

ACL tear

A
  • pain, immediate joint effusion
  • + Lachman’s exam
  • pivot shift test
  • Rx
    • RICE, ROM
    • surgical reconstruction if younger, active
96
Q

PCL tear

A

prevents posterior translation

  • force to tibia w/ flexed knee
  • + posterior drawer test, posterior sag
  • Rx
    • depends on degree of instability
97
Q

collateral ligament sprain

A
  • 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
Q

chondral / osteochondral defect (OCD)

A

articular cartilage injury

  • direct trauma
  • Rx
    • microfracture vs. OATS vs. implantation
99
Q

foot ankle tests

A
  • 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
Q

ankle sprain

A
  • 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
Q

achilles tendon rupture

A

“someone kicked me in the ankle”

  • palpable tendon defect
  • Rx
    • tendon retraction - surgery
    • serial casting
102
Q

tarsal tunnel syndrome

A

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
Q

plantar faciitis

A

fascia of medial tuberosity of calcaneous to proximal phalanges

  • worse “start up” pain
  • Rx
    • orthotics, night splint, PT, NSAIDs, injections
104
Q

pes planus (flat foot)

A

posterior tendon dysfunction

  • hindfoot valgus - “too many toes”
  • unable to toe raise
  • Rx
    • casting, orthotics, PT
    • tendon transfer/osteotomy
105
Q

metatarsalgia

A
  • 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
Q

interdigital (Morton) neuroma

A

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
Q

hallux valgus (bunion)

A

lateral deviation of big toe at MTP joint

  • Rx
    • conservative
      • shoe wear, orthotics, PT- biomechanical evaluation
    • surgical
108
Q

turf toe

A

1st MTP joint sprain / hyperextension

  • Rx
    • orthotics, stiff soled shoes
    • surgical only if avulsed or displaced fracture
109
Q

toe deformities

A
  • hammer toe
    • PIP flexion deformity
  • claw toe
    • MTP extension/PIP flextion (5th/4th toe)
  • mallet toe
    • DIP flexion
110
Q

shoulder impingement

A
  • inflammation in subacromial space: arms overhead, throwing, lifting, manual laborers
  • Neer test
  • Hawkins-Kennedy test
111
Q

bicipital tendinitis

A

inflammaton of long head

  • Speed’s test
  • Yergason’s test
  • “Popeye” deformity
  • no surgery
112
Q

rotator cuff tear

A
  • night pain
  • tests
    • arm drop
    • empty can
  • Rx
    • RICE vs. arthroscopic / open repair
113
Q

glenohumeral dislocation

A
  • Nerve to test: CN XI (axillary)
  • AXILLARY VIEW
  • Rx
    • reduction
    • rest, ice, PT
114
Q

recurrent instability

A
  • tests
    • apprehension test
    • Sulcus sign (inferior)
    • Load and shift test
  • immobilize 2-3 weeks, maybe surgery
115
Q

anterior dislocation

A
  • Bankart - tear to glonoid labrum
  • Hill Sachs lesion - humeral head compression fx
116
Q

SLAP tear - superior labrum anterior to posterior

A
  • 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
Q

AC joint sprain/dislocation

A
  • always trauma
  • Rx
    • conservative
      • immobilize ~2 days
      • rest, ice, NSAIDs, PT
    • surgery
      • rare - grade 4 and above
118
Q

AC joint OA/osteolysis

A
  • progressively worsening pain
  • pain w/ across body adduction
  • Rx
    • conservative
    • surgical
      • open vs. arthroscopic excision
119
Q

adhesive capsulitis

A
  • 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
120
Q

shoulder joint injections

A
  • 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
Q

thoracic outlet syndrome

A

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
122
Q

epicondylitis (lateral & medial)

A

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
123
Q

collateral ligament injury (radial - LCL / ulnar - MCL)

A
  • 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
124
Q

olecranon bursitis

A
  • aspirate
  • Rx
    • abx for infection
    • NSAIDs, elbow pad, corticone injection if no infection
    • surgical excision not common
125
Q

cubital tunnel syndrome

A

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
126
Q

distal bicep tendon rupture

A
  • pain and defect in antecubital fossa
  • “reverse Popeye”
  • Rx
    • surgery w/in 2 weeks
127
Q

elbow dislocation

A
  • extreme swelling, pain, inability to move elbow
  • Rx
    • reduction and splint under conscious sedation
128
Q

elbow injections

A
  • 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
Q

carpal tunnel syndrome

A
  • 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
Q

DeQuervain’s Tenosynovitis

A

swelling/stenosis in abductor pollicis longus/extensor pollicis brevis tendon sheath

  • + Finkelstein test
  • Rx
    • injection, bracing, PT
    • surgical release rare
131
Q

ganglion cyst

A

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
132
Q

thumb/finger dislocation

A
  • Rx
    • taping
133
Q

gamekeeper’s (skiier’s) thumb

A

torn ulnar collateral ligament (UCL)

  • Rx
    • conservative
    • surgical only if UCL ruptured
134
Q

trigger finger

A

thickening of flexor tendon sheath

  • “feels locked”
  • palpable nodule
135
Q

flexor tendon injury

A

Jersey finger

  • flexion weakness following injury
  • surgical repair

with every hand injury evaluate/document flexor tendons

136
Q

extensor tendon injuries

A
  • Boutonniere deformity
    • PIP flexion and DIP extension
  • Mallet finger
    • rupture to extensor tendon at DIP
  • Rx
    • splint
137
Q

swan neck deformity

A

hyperextension PIP and flexion DIP

138
Q

felon

A

finger pulp infection

  • severe pain and swelling
  • Rx
    • digital block with surgical drainage
139
Q

paronychia

A

infection of soft tissue around fingernail

  • Rx
    • Cephalexin (Keflex)
    • TMP/SMZ (Bactrim)
    • Clindamycin (Cleocin)
140
Q

septic flexor tenosynovitis

A

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
141
Q

herpetic whitlow

A

herpes simplex 1 or 2 infection

  • +/- antivirals
  • DO NOT DRAIN

Clinical Medicine I (8 decks)

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