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PPC2 Exam 3 > Musculoskeletal 1 > Flashcards

Musculoskeletal 1 Flashcards

1
Q

What to expect with musculoskeletal types of limp pain (7)

A
  1. Acute and severe: trauma, infection, malignancy
  2. Gradually worsening: inflammation or mechanical
  3. Constant: tumor or infection
  4. Morning or inactivity pain: inflammatory
  5. Night time pain: growing pains or malignancy
  6. After activity pain: mechanical
  7. . Absence of pain: neuromuscular or metabolic
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2
Q

Antalgic Gait (3)

A

Gait that develops as a way to avoid pain while walking (antalgic = anti- + alge, “against pain”). It is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase.
*Indicates pain with weight bearing

  1. Directed by pain in affected limb
  2. Single limb support – shortened stance phase in affected painful extremity
  3. Cautious gait with diskitis
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3
Q

Myopathic Gait

A

Weakness of proximal muscles of pelvic girdle (may have gluteal weakness)

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4
Q

Circumduction gait (5)

A
  1. Shortens limb for foot clearance
  2. Excessive hip abduction
  3. Pelvic rotation
  4. Hiking
  5. Leg length discrepancy
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5
Q

Equinus Gait (4)

A
  1. Limited ankle dorsiflexion
  2. Gastroc soleus weakness
  3. Shortened Achilles tendon
  4. Should be in flat shoe with support
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6
Q

Trendelenburg Gait (2)

A
  1. Hip abductor weakness

2. Stance on involved side leans toward affected site as the contralateral pelvis drops

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7
Q

Neuropathic Gait (3)

A
  1. Ankle dorsiflexor weakness
  2. Seen in charcot-marie tooth
  3. Foot drop due to dorsiflexor weakness
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8
Q

Cautious Gait (3)

A
  1. To avoid jarring of back
  2. Gait is slow
  3. Due to painful spine or discitis
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9
Q

Grotesque limp pattern (2)

A
  1. Bizarre gait which is out of the normal range

2. Inconsistent with organic pathology

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10
Q

Plain film

A

= first line for abnormal gait’ soft tissue changes can be seen in 50%

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11
Q

What are bone scans good for? (7)

A
  1. Increased flow and osteoblastic activity
  2. Osteomyelitis
  3. Stress fracture
  4. Occult fracture
  5. Neoplasm
  6. Metastases
  7. Early bone infection
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12
Q

Musculoskeletal Ultrasounds (4)

A

a. Osteomyelitis
b. Inflammatory myositis
c. Hip effusions with 77-100% sensitivity
d. Not used if over 4 months or if very chubby; After 4 months can do frog leg or PA/later for hip dysplasia

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13
Q

Musculoskeletal CT (3)

A

a. Imaging cortical bone
b. Osteoid osteoma
c. Tarsal coalition

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14
Q

Musculoskeletal MRI (2)

A

a. Cartilage, joints, soft tissue, marrow

b. Will show infections

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15
Q

When to do lab tests for musculoskeletal problem?

A

Acute non-traumatic limp with fever, malaise, night pain or localized areas of complaint

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16
Q

Musculoskeletal ESR

A

If there is in issue, ESR will increase in 24-48 hours and persist for 3 weeks
*90% of osteomyelitis will have elevation

17
Q

Musculoskeletal CRP (2)

A
  1. Acute phase protein synthesis
  2. Increases in 6 hours but normalizes in 6-10 days
    * More sensitive because it goes up before ESR and it is more stable than ESR
18
Q

Musculoskeletal WBC

A

Can be normal in osteomyelitis

19
Q

Musculoskeletal CBC w/ Diff

A

65%-70% abnormal in osteomyelitis and septic arthritis

20
Q

Bone Cancer presentation and best test to do for it (5)

A
  1. Increasing pain above area of tumor
  2. Dull, achy pain
  3. Insidious onset that gets worse
  4. Febrile
  5. Best test to do = CBC w/ diff and sedimentation rate
21
Q

Where does pain occur w/ Osgood Schlatter?

A

below the knee

22
Q

Toxic Synovitis (8)

A
  1. Benign self-limiting
  2. Usually less than 4 year
  3. Boys 3-8 more common
  4. Afebrile or very low grade very
  5. Pain is mild
  6. Restricts of movement with leg held in external rotation
  7. WBC normal or very slight elevations of markers of inflammation; WBC > 12000, high sed. rate > 40, inability to bear weight
    (history of fever more likely to be septic arthritis)
  8. Diagnosis of exclusion
23
Q

Osteomyelitis patho (2)

A
  1. Hematogenous spread or by direct invasion of pathogens into bone; can be precipitated by trauma
  2. Osteomyelitis in a baby most commonly spreads hematologically, but in teenage years it can occur from external trauma or cellulitis
24
Q

Osteomyelitis Presentation (5)

A
  1. Fever and pain; usually occur together
  2. Erythema
  3. Swelling and pinpoint tenderness of affected bone
  4. Decreased ROM due to muscle splinting
  5. If lower extremities - can present with limp
25
Q

Osteomyelitis tests (3) and treatment (1)

A
  1. MRI = more specific
  2. Blood cultures may be positive
  3. X-ray may be normal for one week
  4. Treatment of 4-6 weeks of antibiotics
26
Q

Septic Arthritis Patho (3)

A
  1. Infection in joint following puncture injury, hematogenous spread of bacteria into the joint space or continuous spread from cellulitis or osteomyelitis
  2. Hematogenous spread is most common in neonates and infants due to a large network of blood vessels that cross from metaphysis to epiphysis.
    * More common in infants because of blood vessels that disappear at 1 year old
    * The vessels are obliterated by physis formation at one year.
  3. Can accompany osteomyelitis
27
Q

Septic Arthritis Clinical Presentation (4)

A
  1. Monoarticular arthritis with erythema and swelling
    * one hip may seem more swollen than the other
  2. Fever
  3. Limited motion due to pain
  4. Intensive synovitis
28
Q

Septic Arthritis Common Pathogens (5)

A
  1. Staphylococcus aureus #1 cause
  2. Non group A strep
  3. Haemophilus influenza type B
  4. Salmonella is more common is sickle cell disease
  5. Neisseria gonorrhoeae is possible in sexually active adolescent (purulent green discharge)
29
Q

Definitive Diagnosis of Septic Arthritis (6)

A
  1. Joint aspiration
  2. WBC elevated with shift to left
  3. Markers of inflammation are elevation
  4. Ultrasound detect joint effusions
  5. X-ray lag for 10 days
  6. MRI, CT and bone scan can be more helpful and demonstrate the abscess
    * MRI is more helpful in this case
30
Q

Septic Arthritis Tx (6)

A
  1. Admission for IV antibiotics
  2. Once improved, three weeks of oral antibiotics
  3. Neonate: Cloxacillin and gentamicin
  4. Infant 1-3 months of age: Cefuroxime; cefotaxime
  5. Child: cefazolin
  6. Adolescent: ceftriaxone or cefixime + azithromycin
31
Q

Lyme Disease (5)

A
  1. Borrelia burgdorferi by tick bites
  2. School age children
  3. Arthritis is second most common presentation with erythema migrans as most common
  4. Monoarticular arthritis months to years after infection
  5. Swelling out of proportion to pain **
32
Q

Growing Pains (8)

A
  1. Intermittent nonarticular pain in childhood
  2. Diagnosis of exclusion
  3. 3-10 year old
  4. Pain occurs at night
  5. Bilateral ***
  6. Relieved with heat massage and mild analgesics
  7. No limitation
  8. Does not usually bother child during the day
33
Q

Rheumatic Fever required criteria for dx

A

Evidence of strep infection (ex: increased titer of ASO); positive throat culture for group A; recent scarlet fever

34
Q

Rheumatic Fever Major (5) and Minor (5) Diagnostic Criteria

A

Dx requires the required criteria, two major criteria and zero minor criteria OR the required criteria, one major criteria and two minor criteria

Major:

  1. Carditis
  2. Polyarthritis
  3. Chorea
  4. Erythema marginatum
  5. Subq nodules

Minor:

  1. Fever
  2. Arthralgia
  3. Previous rheumatic fever or heart disease
  4. Acute phase reactions
  5. Prolonged PR interval
35
Q

4 Types of Overuse Injuries

A
  1. Stress fracture
  2. Osgood Schlatter
  3. Sinding-Larsen Johansson Disease
  4. Severs Disease
36
Q

Stress fractures: most common location and cause

A

Most common location: lower extremities (tibia, metatarsals, fibula, navicular bones) but also can occur in upper extremities and ribs

Cause: repetitive and submaximal loading of the bone, which eventually becomes fatigued and leads to a true fracture

37
Q

Stress fractures Clinical presentation (2)

A
  1. Increasing pain in lower extremity during exercise

2. Anything from knee down is usually where runners get it

38
Q

Stress fractures Patho (2) and Imaging (2)

A

Patho:

  1. Bone is brittle and eventually breaks
  2. Stress fracture of hip is rare but can disrupt blood supply leading to avascular necrosis of femoral head

Imaging:
1. Bone scan detects early stress fractures; look for periosteal reaction around the bone

  1. MRI is most sensitive, but is expensive

PPC2 Exam 3 (14 decks)

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