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Step 2 High Yield > MSK Tx And Tests > Flashcards

MSK Tx And Tests Flashcards

0
Q

What is the tx for hip dislocation?

A

Closed reduction followed by abduction pillow/bracing

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1
Q

What is the tx for shoulder dislocation?

A

Reduction

Swath and sling

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2
Q

What should be done after a reduction of a hip dislocation?

A

CT scan

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3
Q

What is the tx for a Colles fx that is intra-articular?

A

Open reduction.

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4
Q

What is the tx of a Colles fx?

A

Closed reduction with a long arm cast

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5
Q

What is the tx for scaphoid fx that is displaced or has nonunion?

A

Open reduction

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6
Q

What is the tx for a scaphoid fx?

A

Thumb spica cast

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7
Q

What is the tx for an excessively angulated boxer’s fx?

A

Percutaneous pinning

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8
Q

What is the tx for a boxer’s fx?

A

Closed reduction and ulnar gutter splint
Surgical debridement and irrigation if skin is broken +
IV antibiotics that will cover human pathogens such as eikenella

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9
Q

What is the tx for humerus fx?

A

Hanging arm cast vs. coaptation splint and sling

Fxnal bracing

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10
Q

What’s the tx for nightstick fx?

A

ORIF

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11
Q

What’s the tx for Monteggia’s fx?

A

ORIF with closed reduction of the radial head

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12
Q

What is the tx of Galeazzi’s fx?

A

ORIF of radius

Casting in supination to reduced the dislocated distal radio ulnar joint

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13
Q

What is the tx for a hip fx?

A

ORIF + anti coagulation

Hip hemiarthroplasty in old patients with displaced femoral neck

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14
Q

What is the tx of a femoral fx?

A

Intramedullary nailing of the femur

Irrigation and debridement if open

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15
Q

What is the tx for a tibial fx?

A

ORIF v. Intramedullary nailing vs casting

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16
Q

When should patients with an open fx be taken to the ER?

A

Within 8-24 h

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17
Q

What is the tx for an Achilles’ tendon rupture?

A

Surgery + long leg cast for 6 weeks

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18
Q

What is the diagnostic test of choice for knee injuries?

A

MRI

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19
Q

Which injuries of the knee can be treated conservatively?

A

MCL/LCL and meniscal

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20
Q

What is the tx of an ACL tear?

A

Surgical with graft from patellar or hamstring tendons

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21
Q

Who gets PCL reconstruction?

A

Highly competitive athletes with high grade injuries

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22
Q

Who gets meniscal repairs?

A

Younger patients with reparable tears

Older patients who don’t want conservative tx

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23
Q

How do you diagnose compartment syndrome?

A

Measure compartment pressures: positive if above 30 mmHg

Measure delta pressure (diastolic pressure - compartment pressure): positive if below 30

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24
Q

What can be done to confirm median nerve compression?

A

EMG

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25
Q

How do you diagnose carpal tunnel?

A

Positive Phalen and Tinel’s

Clinically

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26
Q

What’s the tx of carpal tunnel?

A

Splint wrist in neutral position at night and during the day if possible
NSAIDs
Corticosteroid injection
Surgical release (for fixed sensory loss, thenar weakness, intolerable sx)

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27
Q

What do you do if you suspect septic bursitis?

A

Needle aspiration

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28
Q

How do you tx septic bursitis?

A

7-10 days of antibiotics

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29
Q

What is contraindicated in septic bursitis?

A

Steroid injection

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30
Q

What is conservative tx of bursitis?

A

Rest
Ice
Heat
NSAID

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31
Q

How do you treat tendinitis?

A 
NSAID 
Rest 
Ice for 24-48 hours
Consider splinting or bracing
Strengthening exercises AFTER pain has subsided
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32
Q

What do you do is you suspect cauda equine syndrome?

A

Stat MRI

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33
Q

What do you do if symptoms of a herniated disk persist after conservative management?

A

order an MRI

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34
Q

What do you order to rule out other causes of the back pain?

A

ESR and XR

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35
Q

What is the tx for a herniated disk?

A

NSAIDs at scheduled doses
Physical therapy
Local heat

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36
Q

What test is specific but not sensitive for a herniated disk?

A

Crossed straight leg raise

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37
Q

What test is sensitive but not specific for herniated disk?

A

Straight leg raise test

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38
Q

How do you diagnose spinal stenosis?

A

MRI or CT

May see degenerative changes on XR

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39
Q

What is the tx for mild spinal stenosis?

A

NSAIDs

Abdominal muscle strengthening

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40
Q

What is the treatment of advanced spinal stenosis?

A

Epidural corticosteroid injections

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41
Q

What is the tx for severe spinal stenosis?

A

Surgical laminectomy

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42
Q

How do you diagnose osteosarcoma, Ewing’s, and giant cell tumor?

A

XR: codman’s triangle, sunburst pattern

Onion skinning of Ewing’s
Soap bubble of giant cell tumor

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43
Q

How do you stage osteosarcoma?

A

MRI and CT of the chest

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44
Q

What is the tx of osteosarcoma, Ewing’s and giant cell tumor?

A

Limb preserving surgery and chemo/radiation

Amputation

45
Q

How do you diagnose septic arthritis?

A

Joint aspiration

46
Q

What is the tx of septic arthritis?

A

Empirical tx with vanc and ceftriaxone until cultures come back
Surgical debridement or serial aspirations

47
Q

How do you diagnose OA?

A

XR

Synovial fluid aspiration

48
Q

What is the tx for OA?

A

Weight loss
Physical therapy
NSAIDs
Joint replacement

49
Q

How do you diagnose gout?

A

Joint fluid aspiration

Serum uric acid level may be above 7.5

50
Q

What is the first line tx for an acute gout attack?

A

NSAIDs

51
Q

What can be used if NSAIDs are ineffective?

A

Steroids

52
Q

What is used for maintenance of gout?

A

Allopurinol
Probenecid
Weight loss and avoidance of triggers

53
Q

What is the tx of anklyosing spondylitis?

A

NSAIDs
Exercise
TNF alpha inhibitors (etanercept, infliximab, adalimumab) Or Sulfalazine (refractory cases)

54
Q

How do you diagnose myosotis?

A

Anti-Jo abs and elevated serum CK

Muscle bx

55
Q

What is the tx of the myosotis?

A

High dose corticosteroids with taper after 4-6 weeks

Azathioprine and/or MTX

56
Q

What is the tx of RA?

A

NSAIDs then DMARDs

1st choice: MTX then hydroxychloroquine and sulfalazine

57
Q

What are the second line agents for tx RA?

A

TNF inhibitors
Rituximab
Leflunomide

58
Q

How do you diagnose scleroderma?

A

Anti-centromere abs

Anti-Scl 70 abs

59
Q

How do you treat skin changes in scleroderma?

A

Penicillamine

60
Q

How do you treat acute flares of scleroderma?

A

Corticosteroids

61
Q

How do you tx Raynaud’s?

A

CCB

62
Q

How do you treat renal disease in scleroderma?

A

ACEi

63
Q

How do you diagnose drug induced SLE?

A

Anti histone abs

64
Q

How do you diagnose neonatal SLE?

A

Anti-Ro Abs

65
Q

How do you diagnose SLE?

A

Anti-dsDNA
anti-Smith
Anti-snRP

66
Q

Whatis the tx for progressive SLE?

A

Hydroxychloroquine
Cyclophosphamide
Azathioprine

67
Q

What should you do if the patient has nephrotic sx?

A

Get a renal bx

68
Q

What drug should be used for lupus nephritis.

A

Cyclophosphamide

69
Q

What drug can be used for isolated skin and joint involvement in SLE?

A

Hydroxychloroquine

70
Q

How do you diagnose poly myalgia rheumatica?

A

Increased ESR and anemia

71
Q

What is the tx of polymyalgia rheumatica?

A

Low dose prednisone

72
Q

How do you diagnose temporal arteritis?

A

ESR
Opthalmic exam
Temporal artery bx

73
Q

What is the tx for temporal arteritis?

A

High dose prednisone

74
Q

What is the tx for regional pain syndrome?

A 
NSAIDs 
TCA 
Steroids
Gabapentin
Pregabalin 
Physical therapy
Chemical sympathetic blockade
75
Q

What is the diagnostic criteria for fibromyalgia?

A

11/18 tender points in all 4 body quadrants and the axial skeleton

76
Q

What is the tx for fibromyalgia?

A 
Antidepressants (TCA/SSRI combo or 2 SNRIs) 
Gabapentin
Pregabalin
Muscle relaxants 
Physical therapy
77
Q

How do you diagnose muscular dystrophy?

A

Immunostain for dystrophin (negative), elevated CK
Muscle bx
EMG : shows polyphasic potentials and increased recruitment
Can do western blot for dystrophin

78
Q

What is the tx for a clavicular fx?

A

Figure of eight sling vs arm sling

79
Q

How do you tx a free stick fx?

A

Reduction with casting

Get XR at 10-14 days

80
Q

What is the tx for nursemaid’s elbow?

A

Manual reduction by gentle supination of the elbow at 90 degrees of flexion to put radial head back in place

81
Q

What is the tx for a torus fx?

A

Cast immobilization for 3-5 weeks

82
Q

What is the tx for a supracondylar humerus fx?

A

Cast immobilization

Closed reduction with percutaneous pinning if significant displaced

83
Q

What is the tx for Osgood Schlatter disease?

A

Rest until asx

Neoprene brace

84
Q

What is the tx of a salter Harris fx?

A

Closed vs ORIF with immobilization

85
Q

How do you diagnose hip dysplasia?

A

Barthow’s and Ortolani’s maneuvers - dislocate hip posterior and then reduce
Allis/Galeazzi’s sign: unequal knee heights

US after 10 weeks of age
XR after 4 months of age

86
Q

What is the tx for hip dysplasia in a baby less than 6 months old?

A

Pavlov harness - keeps hips flexed and abducted

Do not flex hips more than 60 degrees

87
Q

What is the tx for hip dysplasia in a baby 6 -15 months old?

A

Spica cast

88
Q

What is the tx for hip dysplasia in a baby 15-24 months?

A

Open reduction then spica cast

89
Q

How do you diagnose Legg Calve Perthes?

A

Limited abduction and internal rotation

90
Q

How do you tx Legg calve Perthes?

A

Observation

If extensive - decrease ROM and brace with Petrie cast or osteotomy

91
Q

How do you diagnose SCFE?

A

Radiograph both hips in AP and frog leg lateral views

92
Q

What must you rule out with SCFE?

A

Hypothyroidism - get a TSH

93
Q

What is the tx for SCFE?

A

Percutaneous single screw fixation

94
Q

How do you diagnose scoliosis?

A

AP and full length XR

95
Q

What is the tx for scoliosis curves less than 20 degrees?

A

Observation

96
Q

What is the tx for scoliosis curves between 20-49 degrees?

A

Bracing

97
Q

What is the tx for scoliosis curves more than 50 degrees?

A

Surgery

98
Q

What is the tx for JIA?

A

NSAIDs

Corticosteroids

99
Q

What is second line tx of JIA?

A

MTX

100
Q

What is the diagnostic criteria for JIA?

A

Arthritis in patients less than 16 yo that lasts at least 6 weeks?

101
Q

What is pauciarticular JIA?

A

Asymmetric joints that involves less than 4

Iridocyclitis risk that can lead to blindness

102
Q

What labs are ordered to diagnose JIA?

A

ESR, CBC, ANA , RF

103
Q

What is the first step in evaluating for a scaphoid fx?

A

XR in full pronation with ulnar deviation

104
Q

What do you do if you get a positive Bartlow’s or Ortolani’s?

A

Positive bartlow’s or ortolani’s –> go to ortho

105
Q

What do you do if there is asymmetry of the hips in a child 2 weeks-6 months?

A

Hip US

106
Q

What do you do if there is asymmetry of the hips in a child 4-6 months?

A

Hip XR

107
Q

Who should be screened with a lumbosacral US?

A

Babies with a sacral simple or tuft of hair

108
Q

What should an abnormal lumbosacral US be followed by?

A

Spinal MRI

109
Q

What is the diagnostic test for anklyosing spondylitis?

A

X-RAY of the sacro iliac joints showing fusion or bamboo spine

110
Q

What is a good drug choice for SLE patients with isolated skin and joint problems?

A

Hydroxychloroquine

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