Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Medicine Final > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Progressive disease with genetic predisposition, loss of articular cartilage, & effects WB joints

A

Osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

OA has cartilage degeneration with __________ inflammation

A

Minimal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A key characteristic of OA is ________ formation which may be seen on xray

A

Osteophyte formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

OA is associated with what conditions/RFs

A

Age, hormones, genetics, obesity, lack of physical activity, & metabolic abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What metabolic abnormalities is OA associated with

A

Acromegaly
Gout
Hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

OA has abnormal joint mechanisms. What are the 2 groups?

A 
Congenital defects (SCFE & congenital hip dysplasia)
Acquired defects (epiphysis dysplasia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Condition where the protective cartilage on the ends of your bones wears down over time

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The primary symptom/complaint of OA is

A

Joint Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the joint pain of OA

A

Localized
Asymmetrical
Increases with use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the features of OA

A 
Herbeden's nodes at PIP
Bouchard's leg deformities
Fusiform swelling of joints
Loss of ROM
Brief morning stiffness
Effusions/Crepitus
Pain relieved with rest
Genu Valgum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is genu valgum

A

AKA knocked-knees

Severe lateral wear of the knee joint causing laxity of the medial ligament and knees jutting medially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the diagnostic of choice for OA

A

H&P is often sufficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

You believe you pt has OA and order some lab studies (fluid analysis) what might you find?

A

Synovial fluid debris
Absent of crystals
Absent of white cells/organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

You believe you pt has OA and order some lab studies (serum analysis) what might you find?

A

Normal uric acid, CBC, & rheumatic panel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

You believe you pt has OA and order some xrays what might you find?

A 
Narrowing of joint space
Osteophytes
Chondral irregularly
Boney cystic changes
Articular surface sclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are osteophytes? What condition are they associated with

A

They are bony growths at the edge/surface of the bone/joint that show the bone is trying to repair itself; associated with OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the proper medical management of OA

A 
Pt education
Exercise
Bracing of joint PRN
Cold therapy first followed by heat
Activity modification (periods of activity followed by rest)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the primary treatment of OA

A

Acetaminophen recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the 2nd line treatment of OA

A

NSAIDs; specifically COX-2

  • Celebrex
  • Mobic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why are NSAIDs 2nd line Tx for OA?

A

They are more effective but they have increased toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the 3rd line Tx for OA

A

Cortisone injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the 4th line Tx of OA

A

Hyaluronic acid injections (artificial synovial fluid to increase joint viscosity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is important to remember if you are considering giving a pt hyaluronic acid injections for OA

A

They can only be used for the knee joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the ultimate Tx of OA? When is it indicated?

A

Arthroplasty

Indicated when conservative measures have failed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the MC form of arthritis

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do NSAIDs work in the Tx of OA

A

Produce anti-inflammatory & analgesic effects by decreasing the production of prostaglandins & they inhibit both Cox-1 & 2 enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which NSAID is COX-2 specific

A

Celebrex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Systemic autoimmune disorder characterized by an inflammatory synovitis that erodes and ultimately destroys the articular cartilage

A

Rheumatoid arthritis (RA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What may also become involved in RA

A

Many non-articular organs b/c the same cytokines that drive synovial pathology are also responsible for generating extra-articular tissue pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Who is RA more prevalent in

A

Women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

In RA, what is associated with increased incidence and more severe disease (think genetic)

A

HLA-DR4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the features of RA (i.e. what might a pt present with)

A 
Malaise & fatigue
Stiffness
Pain & tenderness
Joint effusions
Symmetric arthritis/joint involvement
Rheumatoid nodules & deformatieis of the hands/fingers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the MC joint involved in RA

A

The wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the wrist findings of RA

A

Erosion, subluxation/drift of radius, tendon rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

SxS must be present for how long to Dx RA

A

At lest 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are “cock-up” deformaties in RA

A

Lateral drift of the toes & plantar subluxation d/t erosive damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

In order to Dx RA what must be present?

A

At least 4/7 of the RA criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the RA Dx criteria

A
  1. ) Morning stiffnes > 1hr for 6+ weeks
  2. ) Arthritis of 3+ joints for 6+ weeks
  3. ) Arthritis of hand joints for 6+ weeks
  4. ) Symmetric arthritis for 6+ weeks
  5. ) Rheumatoid subQ nodules
  6. ) Positive serum rheumatic factor
  7. ) Radiographic changes (including erosions, decalcifications, & narrowing joint space)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is diagnostic is most specific for RA

A

Radiographic findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What lab values will be elevated in RA

A

Acute phase ESR & CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the most specific lab value/finding for RA

A

Anti-CCP antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the Tx of RA directed towards?

A

Control of the synovitis and prevention of joint injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the primary (1st line, 1st choice) Tx of RA

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What if NSAIDs alone don’t work for Tx of RA

A

Must try more than 1 and and a second line agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is/are the 1st choice 2nd line agent(s) for Tx of RA

A

DMARDs:

  • Methotrextate best
  • Sulfasalazine next best
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is/are the 2nd choice 2nd line agent(s) for Tx of RA

A

Azathioprine, Infliximab, Gold Cyclosporine, low dose steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

If the pt’s RA is unresponsive to Methotrexate what can be used

A

Biologics such as Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, & Simponi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the appropriate Tx for moderate to severe RA

A

Methotrexate + sulfasalazine + hydroxycloriquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

If you are going to use hydroxycloroquine what must you do

A

Get a baseline eye exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What condition do you need to test for prior to starting treatment of RA?

A

Test for latent TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are extra-articular manifestations of RA in the heart

A

Pericarditis
Vasculitis
Valvular & valve ring nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are extra-articular manifestations of RA in the lungs

A

Pleural effusion

Bronchiolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are extra-articular manifestations of RA in the Skin

A

Fragility

Nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are neurological extra-articular manifestations of RA

A

Neuropathy
Cervical myelopathy
Peripheral neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are hematologic extra-articular manifestations of RA

A

Anemia

Thrombocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are extra-articular manifestations of RA in the bones

A

Osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are extra-articular manifestations of RA in the eyes

A

Sicca (Sjogren’s)
Episcleritis
Scleromalacia perforans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are extra-articular manifestations of RA in the kidney

A

Amyloidosis

Vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

RA carries a low prognosis if there is…

A

polyarticular involvement & systemic extra-articular manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the common “complications” or findings in RA

A

Boutonniere deformity
“Swan-neck” deformity
Valgus knee deformity
Volar suluxation of the MTP joints (ulnar deviation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Hyperextension of DIP with flexion of PIP

A

Boutonniere deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Flexion of DIP with extension of the PIP

A

“swan-neck” deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Name the arthritis…inflammation present

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Name the arthritis…involvement of the DIP & WB joints

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Name the arthritis…osteophyte formation

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Name the arthritis…ulnar deviation, swan-neck, & boutonneire deformities

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Name the arthritis…Tx goal = pain control

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Name the arthritis…positive lab finding include ESR & CRP

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Name the arthritis…heberden’s nodes

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Name the arthritis…involvement of MCP/PIP joints

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Name the arthritis…Tx goal = control inflammation

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Name the arthritis…normal lab findings

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Name the arthritis…periarticular osteoporosis and erosion

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the alarm SxS of CA

A 
Unexplained wt loss
Failure to improve with Tx
Pain > 6wks
Pain at night or at risk pt
Hx of CA
Age > 50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the alarm SxS for cauda equina

A 
Urinary retention/incontinence
Saddle anesthesia
Decreased anal sphincter tone/fecal incontinence
Bilateral LE weakness
Progressive neurological deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is the 2nd MC complaint in primary care

A

Lower back pain (LBP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

When examining a pt with lower back pain what do you need to make sure you do?

A

Rule out any red flags (such as those of CA or cauda equina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is the primary Tx for lower back pain

A

Rest! 80-90% of pts will improve within 1 month even without any treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are other treatments for lower back pain

A

Pt education, PT, or NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

If pt complains of lower back pain and has red flags what should you do?

A

Promptly get an MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is the MCC of disability in people under 45 y/o

A

Lower back pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Chronic inflammatory disease of the axial skeleton, peripheral joints, & non-articular structures

A

Ankylosing spondylitis (AS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

In what manner does AS affect the spine? (direction)

A

Affects it from the bottom up, starting at the SI joints and working up to cervical skeleton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What genetic predisposition do 90% of pts express

A

HLA-B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Who is AS more prevalent in

A

Men > women; generally young adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

AS is associated with chronic back pain that is worst when?

A

In the morning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Mid or entire spine stiffness in AS may improve with…

A

Activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Where might AS back pain refer to

A

Referred pain to the butt or back of the thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What condition is AS associated with

A

Anterior uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

AS rarely presents in pts < 18 y/o. If it does how might it present

A

Pain & swelling of the large limb joints (knee)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What are the necessary findings to Dx AS

A

Changes in the SI joints (early in disease may be seen on MRI, otherwise x-ray)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is the “shiny corner sign” associated with AS

A

X-ray finding due to inflammation where the annulus attaches (seen on the vertebral bodies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

When can plain films diagnose AS

A

Later in the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is the bamboo sign and what condition is it associated with

A

Late radiographic finding of AS where the vertebral bodies are fused by syndesmophytes and look like bamboo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What bloodwork will be positive in a pt with AS

A

Seronegative spondyloarthropathies

Negative anti-CCP antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is the 1st line Tx of AS

A

NSAIDs (empiric trials of several to find best result)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

If NSAIDs don’t work in the Tx of AS what should be done next

A

Add TNF inhibitors to the Tx (Entanercept, Adalimubab, Infliximab, Golimumab)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Why should corticosteroids not be given for AS

A

Can worsen osteopenia and minimal impact on arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What disease/condition is related to AS

A

Reiter’s Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Condition where ligaments and connective tissue of the back are stretched beyond normal

A

Back sprain/strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Quick tear, pull, or twist of muscle or tendon

A

Strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Trauma which displaces joint and stretches/tears a ligmante

A

Sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Compression of the spinal cord d/t a massive ruptured disc

A

Cauda equina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Where in the spine is cauda equina MC

A

MC at L4-L5 and usually occurs midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What are the main SxS of cauda equina

A

Urinary retention (may have overflow incontinence)
Diminished anal sphincter tone w/ fecal incontinence
Saddle anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What are other common SxS of cauda equina (but not major)

A

Motor weakness, LBP, absence of achilles reflex, sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

How do you Dx cauda equina

A

MRI is best

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is the Tx of cauda equina

A

URGENT surgical decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

How are the nerve roots numbered in the cervical spine

A

They are numbered C1-C8 and each is found about the vertebrae (ex: C6 nerve root is above C6 vertebrae)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

This is AKA a herniated disc

A

herniated nucleus pulposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Pt presents with painful limitation of neck motion, and pain that is aggravated with neck extension and relieved with forearm on top of the head. What is the likely Dx?

A

Cervical herniated nucleus pulposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What is Lhermitte’s sign? What condition is it seen in?

A

Electrical shock-like sensation radiating down the spine; seen with cervical herniated nucleus pulposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is Spurling’s sign? What condition is it seen in?

A

Pain when examiner exerts downward pressure on the vertex and tilting the head towards the symptomatic side; seen with cervical herniated nucleus pulposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is axial manual traction? What condition is it associated with?

A

10-15 kg traction is applied while the pt is supine & reduces or alleviates SxS is a (+) sign; associated with cervical herniated nucleus pulposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What is the diagnostic of choice for Cervical herniated nucleus pulposis

A

MRI is best

Plain films MAY be somewhat useful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

How do you treat Cervical herniated nucleus pulposis

A

NSAIDs, muscle relaxers, PT, chiropractic Tx, injections; analgesics & tricyclics may be helpful for reduction of neuropathic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

In what direction do LUMBAR discs usually herniate and why

A

Usually herniate to the side b/c the posterior longitudinal ligament is strongest in the midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What may relieve pain in lumbar herniated disc

A

Flexing knee and thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is the “cough effect” in lumbar herniated disc

A

Exacerbation of pain with coughing or straining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What do pts with lumbar herniated disc often do

A

Avoid excessive movements but don’t stay in one position for too long

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Pt presents with pain radiating down the LE, LE weakness, motor weakness, dermatomal sensory changes, and reflex changes. What might be the Dx?

A

Herniated lumbar disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is the diagnostic of choice for lumbar herniated disc

A

MRI is best

Plain films may help distinguish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is the Tx of lumbar herniated disc

A

NSAIDs, muscle relaxer, PT, chiropractic tx, injections; analgesics & tricyclics may help reduce neuropathic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Pt presents with exaggerated curvature of the thoracic spine. What may be the Dx?

A

Kyphosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What are the possible causes of kyphosis in adults

A

Degenerative disease of the spine
Fx by osteoporosis
Injury/trauma
Spondylolisthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What are common presenting SxS of kyphosis besides exagerated curvature of the thoracic spine

A 
Difficulty breathing (severe cases)
Fatigue
Mild back pain
Round back appearance
Tenderness
Spine stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

How do you diagnose kyphosis

A

Clinical may be sufficient but x-ray and MRI are tests of choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is kyphosis in adolescents called

A

Scheuermann’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

How is Scheuermann’s disease treated

A

Brace and PT

Sx if curve > 60 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is a common complication or finding of kyphosis

A

Multiple compression fractures of the thoracic spine d/t osteoporosis leading to worsening curvature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Sideways curvature of the spine most often seen during growth spurt just before puberty; causes of most cases unknown

A

Scoliosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What is the MC cause/type of scoliosis

A

MC = idiopathic scoliosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Who is scoliosis more prevalent in

A

Female > male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What are the common clinical findings or SxS of scoliosis

A

Uneven shoulders
Prominent shoulder blade
Uneven waist
Leaning to one side more than the other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

How is scoliosis often diagnosed

A

School screenings or exam & x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What is a Tx of scoliosis in adolescents? What does it do?

A

Braces for curves of 25-40 degrees will halt progression of curve but the curve will resume if bracing is discontinued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Where does sciatica/nerve root compression most commonly occur

A

95% occur at L4-L5 or L5-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What is the onset of sciatica

A

Usually abrupt but can be acute on chronic flare-up pains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What is the most common SxS or sciatica

A

Radicular pain that extends below the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What is the MC L5 finding in sciatica

A

Foot drop or loss of dorsiflexion of the great toe and pain in the great toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What is the radiation pattern of sciatica pain

A

Radiation in a radicular fashion along distribution of sciatic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What is the Tx of sciatica

A

Tx like a sprain/strain; activity as limited by pain, NSAIDs, possible opioid use for pain, possible epidural steroid injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Condition characterized by narrowing of the AP dimension of the spinal canal

A

Spinal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

In what direction does the spinal canal narrow in spinal stenosis

A

AP direction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Where is spinal stenosis MC

A

MC at L4-L5

2nd MC at L3-L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What are common SxS of spinal stenosis

A

Pain, paresthesias, LE weakness with walking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What is the MC SxS of spinal stenosis in the lumbar region? What is it?

A

Neurogenic claudication = pt tires with walking, require stopping & sitting & changes position of their back to relieve pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What is the diagnostic test of choice for spinal stenosis

A

MRI or CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What MRI type is best for spinal stenosis Dx

A

T2 images

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What is the Tx for spinal stenosis

A
  • Flexion based exercises by PT

- Spinal or facet joint corticosteroid injections to reduce pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Spinal TB is AKA….

Who is it primarily seen in?

A

Pott Disease

Seen in immigrants and immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What are the main SxS of spinal TB

A

Back pain
+/- radicular pain & LE weakness
+/- pulmonary disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

What is the diagnostic test of choice for spinal TB

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What are the radiographic findings of spinal TB

A

Lytic & sclerotic lesions & bony destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What is the Tx of spinal TB

A

Abx 6-9 months

- Isoniazid, rifampin, pyrazinamide, & ethambutol for 2 months then isoniazid & rifampin for additional 4-7 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What is the bad complication of spinal TB

A

Paraplegia d/t compression of the spinal cord -> cauda equina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Loss of conguency between the glenoid and humeral head

A

Shoulder dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

In which direction do most shoulder dislocations occur

A

95% are in the anterior direction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What is the mechanism of most shoulder dislocations

A

Usually d/t a fall on outstretched and abducted arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

How do posterior shoulder dislocations occur

A

Fall from high height, seizure, or electrocution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What is a bankart lesion

A

Anterior inferior labrum is torn in shoulder dislocation and leads to continuous instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What will a pt complain of with anterior shoulder dislocation

A

Pain & instability when shoulder is abducted and externally rotated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What are the diagnostic tests of choice for shoulder dislocation

A

X-rays with multiple views

MRI best if suspected soft tissue damage to labrum/rotator cuff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

What is the Tx for acute shoulder dislocations

A

Reduce immediately with gentle traction with internal rotation (1st inject with lidocaine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What is the Tx for traumatic shoulder dislocations

A

Bankart lesion is often present & surgical repair is often required, need to immobilize for 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What is the Tx for recurrent shoulder dislocations

A

Sx management (often arthroscopic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

How does AC injury most commonly occur

A

Occurs from a fall directly onto the shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

How might a pt present with an AC injury

A

Depends on extent of injury; may be in minimal pain to extreme unbearable pain with no arm movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What is the diagnostic test of choice for an AC injury

A

MRI best to access soft tissue & structural damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

What is the Tx for a mild AC injury

A

Sling for discomfort & mild pain meds for relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What is the Tx for a moderate AC injury

A

Stronger pain meds for relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What is the Tx for a severe AC injury

A

Surgical repair if it is a Type 4 or 5 injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Where is the MC location for a clavicular Fx

A

Mid-shaft MC

Distal is 2nd MC, proximal least common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

What is the mechanism of injury for most clavicular fractures

A

Direct blow or fall on point of the shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What is the diagnostic test of choice for clavicular fractures

A

X-ray is the gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What is the Tx for clavicular fractures

A

Most are treated non operatively with sling and swath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

When is operative Tx indicated for clavicle Fx

A

Indicated for open fxs, markedly displaced fxs, fxs associated with multiple traumas, & distal fxs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What is the mechanism of injury for a posterior dislocation sternoclavicular injury

A

Direct blow to the anterior chest wall, usually high energy blow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

What is the mechanism of injury for anterior dislocation sternoclavicular injury

A

Lateral blow to the shoulder when the arm is abducted/extended (usually low energy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

What is the main finding with sternoclavicular injury

A

Deformity, swelling, and tenderness of the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

What are secondary findings with sternoclavicular injuries

A

Stridor, dysphagia, venous distension, pulse deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What are the diagnostic tests that are done for sternoclavicular injuries

A 
X-ray
CT scan (can show structural damage better)
183
Q

What is the Tx for anterior dislocation sternoclavicular injuries

A

Treated without Sx (i.e. rest, pain meds, may sling)

184
Q

What is the Tx for posterior dislocation sternoclavicular injuries

A

Immediate closed reduction then sling and close followup

185
Q

What is the major complication/concern with posterior dislocation sternoclavicular injuries

A

Need to be careful b/c it can impinge on the aorta, other major vessels, & nerves

186
Q

What are the 4 muscles of the rotator cuff

A

Subscapularis
Supraspinatous
Infraspinatous
Teres minor

187
Q

Which rotator cuff muscle/tendon is most often injured

A

Supraspinatous

188
Q

What is the mechanism of injury for most rotator cuff injuries

A

Acute injuries like falls on an outstretched arm or pulling on the shoulder

189
Q

What may partial rotator cuff tears lead to

A

Impingement syndrome

190
Q

Pt presents to the office with difficulty lifting the arm & limited active range of motion. They report they had fallen on their outstretched arm while playing football. What might the Dx be

A

Rotator cuff injury

191
Q

How might a pt present with a complete rotator cuff tear

A

Weakness with resisted strength testing

192
Q

What are 2 tests that should be done with suspected rotator cuff injury

A

Neer & Hawkins tests

193
Q

Describe the Neer test

A

Depress the scapula while elevating the arm with the other

194
Q

Describe the Hawkins test

A

Have the shoulder at 90 degrees and the elbow flexed at 90 degrees then internally rotate the humerous & if it elicits pain it reinforces a positive Neer test

195
Q

What is the diagnostic test of choice to Dx a rotator cuff injury

A

MRI b/c it has best visualization of damage

196
Q

What is the Tx for rotator cuff injuries

A

NSAIDs
PT
Steroid injections
Activity precautions (no over head work, heavy lifting, pushing, or pulling)

197
Q

If the pt doesn’t see any improvement in their rotator cuff injury after 6 weeks what should you do

A

Get another MRI to reevaluate the tear

198
Q

What is the best Tx for a complete rotator cuff tear? Why?

A

Best Tx is Sx repair b/c complete tears often do not heal very well on their own

199
Q

True of False: injection of cortisone into the joint will help alleviate the pain in a rotator cuff injury?

A

FALSE, will NOT help alleviate pain

200
Q

What is the mechanism of injury for humeral fxs

A

Direct blow or FOOSH

201
Q

What are the diagnostic tests for humeral fxs

A

X-rays (best), CT, or CT with reconstruction

202
Q

What is the Tx for humeral fxs

A

Depends on type of fx, type of displacement, & number of fx parts; more complicated fxs often get ORIF

203
Q

What should you always check post-op with humeral fxs

A

Check NV, especially radial nerve

204
Q

What is the mechanism of injury for elbow dislocation

A

Fall with elbow locked in extension

205
Q

What are common SxS of elbow dislocation

A

Swelling, deformity, & tenderness of the elbow

206
Q

What is the diagnostic test for elbow dislocation

A

X-ray to check for coronoid or radial head fx

207
Q

What must you do following an elbow dislocation

A

NV check of ulnar nerver

208
Q

What is the Tx for elbow dislocation with no fx

A

Non-operative

209
Q

What is the Tx for elbow dislocation

A

Gentle closed reduction with axial traction

210
Q

In what direction do most elbow dislocations occur

A

80-90% occur in posterior or posteriolateral direction

211
Q

Condition with inflammation of the extensor muscles in the forearm that extends the wrist d/t overuse

A

Lateral epicondylitis

212
Q

What is lateral epicondylitis commonly known as

A

Tennis elbow

213
Q

What might a pt present with in lateral epicondylitis

A
  • Lifting anything in front of you or pulling door open causes pain
  • Tenderness over the lateral epicondyle
  • Possible tenderness over the ulnar nerve
214
Q

What is required to Dx lateral epicondylitis

A

Pain with resisted strength training and passive stretching

215
Q

What does the spurling test check for

A

Cervical radiculopathy

216
Q

What is the Tx of lateral epicondylitis

A

Rest, ice, NSAIDs, bracing, PT, cortisone shots, Sx last resport

217
Q

Condition with inflammation of the flexor muscles of the forearm d/t overuse

A

Medial epicondylitis

218
Q

What is medial epicondylitis commonly known as

A

Golfer’s elbow

219
Q

What might a pt present with in medial epicondylitis

A

Pain, tenderness of the medial aspect of the elbow, swelling, and numbness & tingling

220
Q

How is medial epicondylitis diagnosed

A

Clinically

221
Q

What is the Tx for medial epicondylitis

A

Rest, ice, NSAIDs, bracing, PT, cortisone shots, Sx last resport

222
Q

What must you be aware of with medial epicondylitis

A

Must be aware of ulnar nerve during cortisone injections

223
Q

What is the mechanism of injury for olecranon fxs

A

Direct blow to the flexed elbow

224
Q

What is the diagnostic test of choice for olecranon fxs

A

X-rays

225
Q

What is the Tx for most olecranon fxs

A

ORIF

226
Q

Inflammation of the olecranon bursa

A

Olecranon bursitis

227
Q

What is the mechanism of injury for olecranon bursitis

A

Single injury/blow to the elbow or repeated minor injuries

228
Q

What might a pt with olecranon bursitis present with

A

Pain, swelling, limited ROM, redness, possible infection

229
Q

How do you Dx olecranon bursitis

A

Clinically or with aspiration if suspected infection

230
Q

What is the Tx for olecranon bursitis

A

Oral or topical NSAIDs, aspiration of bursa, & injection of hydrocortisone
If infection Tx with Abx

231
Q

In what demographics is olecranon bursitis common

A

Prangant women & pts with DM or RA

232
Q

Fracture of the distal radius =

A

Colle’s Fx

233
Q

What is the mechanism of injury for Colle’s Fx

A

Usually via fall on outstretched hand

234
Q

What might a pt with a Colle’s Fx present with

A

Dorsal angulation
Loss of pronation & supination
Radial inclination (tilt & shortening)

235
Q

What is the diagnostic test of choice for Colle’s Fx

A

X-rays

236
Q

What is the Tx for Colle’s Fx

A

Closed reduction or ORIF

237
Q

This is the most common Fx…

A

Colle’s Fx

238
Q

What is the mechanism of injury for radial head fx

A

Direct blow to the radial head or fall with valgus force

239
Q

What might a pt with radial head fx present with

A

Decreased ROM
Pain at the wrist
Swelling over the wrist

240
Q

What is the diagnostic test of choice for radial head fracture

A

X-rays

241
Q

What is the Tx for radial head fx

A

Types 1 & 2 = simple ACE wrap soft splint, ice, pain meds,& early ROM
Type 3 = ORIF

242
Q

What are the 3 types of radial head fxs

A

Type 1 = no displacement
Type 2 = minimal displacement
Type 3 = communited

243
Q

What is the mechanism of injury in forearm fracture

A

Direct blow or fall

244
Q

What is the diagnostic test of choice for forearm fx

A

X-rays

245
Q

What is the Tx of forearm fx in adults

A

ORIF (plate across bone + pin)

246
Q

What is the Tx of forearm fx in children

A

Closed reduction with casting

247
Q

Fx of the middle to distal 1/3 of the ulna with anterior dislocation of the radial head

A

Monteggia Fx

248
Q

Fx of the distal to mid 1/3 of the radius with dislocation of radioulnar joint

A

Galeazzi Fx

249
Q

Fx of the 5th metacarpal head

A

Boxer’s Fx

250
Q

What is the diagnostic test for Boxer’s Fx

A

X-rays

251
Q

What is the Tx for Boxer’s Fx

A

Splinting with ulna gutter splint

252
Q

Hyperextension of the thumb causing disruption of the ulnar collateral ligament and MCP & DIP of the thumb

A

Gamekeeper’s Thumb

253
Q

What is the Tx of Gamekeeper’s thumb

A

Splinting for 6-8 weeks

254
Q

What is gamekeeper’s thumb AKA

A

Ski-pole injury

255
Q

What is the mechanism of injury for scaphoid fx

A

FOOSH

256
Q

What is important to remember when diagnosing a scaphoid fx

A

Fx may not always be seen/detected at first so may need to reevaluate in a week

257
Q

What is the MC SxS of scaphoid fx

A

Pain in the anatomical snuff box on palpation

258
Q

What is the diagnostic test of choice for scaphoid fx

A

X-ray

Repeat in 3-5 days if negative

259
Q

What is the Tx for scaphoid fx

A

Thumb spica splint; if severely displaced ORIF

260
Q

What must you watch for with scaphoid fx

A

Avascular necrosis

261
Q

You obtain an x-ray of your pts wrist and notice tearing of the scapholunate interosseous ligamnet and a “Terry Thomas” sign. What is the Dx?

A

Scapholunate Dislocation

262
Q

Slow progressive disease with thickening of the palmar fascia and shortening of the tendons

A

Dupuytren’s Contracture

263
Q

What conditions are associated with dupuytren’s contracture

A

Pregnancy, DM, & RA

264
Q

What is the Tx for dupuytren’s

A

PT/OT ASAP to prevent worsening

265
Q

Who is dupuytren’s more common in

A

Men > women until 80 y/o then even

266
Q

Swelling or stenosis of the sheath surrounding the APL & EPB, usually d/t repetitive motion

A

DeQuervain’s Tenosynovitis

267
Q

What is the diagnostic test of choice for DeQuervain’s

A

Finklestein test

268
Q

What is the Tx for DeQuervain’s

A

Splinting with thumb spica splint, cortisone, NSAIDs, & ice; Sx if those fail

269
Q

Who is DeQuervain’s more common in

A

Middle aged women

270
Q

What causes carpal tunnel syndrome

A

Increased fluid retention in the carpal tunnel

271
Q

What nerve is involved in carpal tunnel

A

Median nerve

272
Q

What ligament is involved in carpal tunnel

A

Transverse collateral ligament

273
Q

What conditions may precipitate carpal tunnel

A

Pregnancy, menopause, obesity, DM, thyroid disorders, & kidney failure

274
Q

With carpal tunnel, where in the hand may a pt experience pain, numbness, tingling, or burning

A

Thumb, index finger, middle finger, & middle half of the ring finger

275
Q

In severe carpal tunnel what finding may you see in the hand

A

Wasting of the thenar eminence

276
Q

What is the tinel sign & what condition does a positive test indicate

A

Tingling or shock-like pain on volar wrist percussion indicate carpal tunnel syndrome

277
Q

What is the phalen sign & what condition does a positive test indicate

A

Pain or paresthesias when flexing the wrists 90 degrees for 1 minute indicated carpal tunnel

278
Q

What is the carpal compression test and what does a positive test indicate

A

Numbness & tingling by direct pressure over the carpal tunnel indicates carpal tunnel syndrome

279
Q

What is the conservative Tx for carpal tunnel

A

Splinting at night, NSAIDs, cortisone shot into the carpal tunnel

280
Q

What is the BEST Tx for carpal tunnel

A

Surgical release

281
Q

Who is carpal tunnel more common in

A

Women > men

282
Q

Forced flexion of a distal phalanx causing disruption of the tendon leading to avulsion of the extensor tendon

A

Mallet finger

283
Q

Forceful blow to bent finger or arthritis leading to swelling and pain at the PIP

A

Boutonniere deformity

284
Q

What is the Tx of boutonniere deformity

A

Immediate splinting for 6-10 weeks

285
Q

What causes a swan neck deformity

A

Injury to finger, RA, or Ehler-Danlos Syndrome

286
Q

Flexor digitorum profundus avulsion; injury occurs during forceful DIP extension and results in inability to flex finger

A

Jersey finger

287
Q

What is the MC finger for jersey finger

A

Ring finger

288
Q

Infection of the flexor tendon sheath often occuring after penetrating injuries with inoculation of the tendon sheath

A

Tenosynovitis

289
Q

What is the Tx of tenosynovitis

A

Early IV Abx Cefazolin or Clindamycin; surgical drainage if no immediate relief

290
Q

What diseases/conditions are associated with tenosynovitis

A

DM and RA

291
Q

What is an intertrochanteric fx

A

When the fx goes from the greater to lesser trochanter

292
Q

What is the MC fx seen in the elderly

A

Intertrochanteric fx

293
Q

With hip fx pain in the groin is typical but where might it radiate to

A

Lateral hip, butt, & knee

294
Q

What is the diagnostic test of choice for hip fx

A

X-rays are usually sufficient

295
Q

What tests can you do to determine hip fx during the exam of the pt

A
  • Trendelenburg test looking for instability of the hip flexors
  • Internal rotation of hip is best provacative diagnostic maneuver
296
Q

What is the Tx for hip fx

A

Surgical repair (within 24hrs)

297
Q

How do femur fxs happen

A

From a fall or high velocity trauma (like car crash)

298
Q

What will be the main PE findings with femur fx

A

Severe pain, difficulty WB, & affected leg will be shortened and externally rotated

299
Q

What is the diagnostic of choice for femur fx

A

X-rays

300
Q

Who is SCFE most commonly seen in

A

Adolescent males (10-17 y/o)

301
Q

How will a pt with SCFE present

A

Pain in the hip, knee, or thigh

302
Q

What is the difference b/w stable and unstable SCFE

A

Stable can bear weight

303
Q

What is the main risk/complication in SCFE

A

Avascular necrosis of the hip

304
Q

What is the Patrick’s test?

A

AKA FABER & FADER test for SCFE

305
Q

What is the diagnostic of choice for SCFE

A

X-rays

306
Q

What is the Tx for SCFE

A

Surgical stabilization of joint

307
Q

Where does avascular necrosis most commonly affect

A

Proximal & distal femoral heads

308
Q

What is the ultimate outcome of many cases of avascular necrosis of the hip

A

Total hip replacement

309
Q

What are the common areas for bursitis in the knee

A

Pre-patellar busae and Baker cyst

310
Q

What is the MC infectious agent of knee bursitis

A

S. aureus

311
Q

Pt has bursitis on knee…what will they present with

A

Small focus of swelling over the knee cap

312
Q

What is the Tx of bursitis caused by trauma

A

Heat, rest, NSAIDs, & local corticosteroid injections

313
Q

What is the Tx of bursitis caused by infection

A

Aspiration of effusion & Abx

314
Q

What is the Tx of Baker cyst

A

Rest, leg elevation, Abx injection (triamcinolone)

315
Q

Hemarthrosis of the knee may indicate…

A

Ligament injuries or patellar dislocation/fx

316
Q

Common causes of medial knee pain

A

Medial compartment OA
MCL strain
Medial meniscus injury
Anserine bursitis

317
Q

Common causes of anterior knee pain

A 
Patellofemoral syndrome
OA
Prepatellar bursitis
"Jumper's Knee"
Septic arthritis
Gout/inflammatory disorder
318
Q

Common causes of lateral knee pain

A

Lateral meniscus injury
Iliotibial band syndrome
LCL sprain

319
Q

Common causes of posterior knee pain

A

Baker cyst
OA
Meniscal tear
Hamstring/calf tendinopathy

320
Q

Injury involving an audible pop when the knee buckles accompanied by immediate swelling & difficulty with motion

A

ACL injury

321
Q

This is the MC injury in sports

A

ACL injury

322
Q

ACL injuries are common with what kind of motion/activities

A

Common in skiing, soccer, football, & basketball; often during acceleration-deceleration movements

323
Q

What is the diagnostic test of choice for ACL injury

A

MRI

324
Q

What tests can you do during the PE to assess for an ACL injury

A

Lachman & Anterior Drawer tests

325
Q

What is the Tx for ACL injury

A

Surgical repair (autograft or cadacer graft)

326
Q

Knee injury caused by valgus blow/stress to the lateral aspect of the knee resulting in pain, instability, & limited ROM to the affected area

A

MCL Injury

327
Q

What is the MC finding with MCL injury

A

Pain along the course of the ligament

328
Q

Knee injury caused by varus blow/stress to the medial aspect of the knee resulting in pain, instability, & limited ROM to the affected area

A

LCL injury

329
Q

What is the most commonly injured ligament in the knee

A

MCL

330
Q

MCL & LCL injuries may not have any effusion because…

A

They are extra-articular

331
Q

What is the diagnostic test of choice for MCL/LCL injuries

A

MRI

332
Q

What tests can be done to access for MCL/LCL injuries

A

Varus/Valgus stress testing

333
Q

What is the Tx of MCL injury

A

Usually protected WB, PT, may use knee brace; if severe long leg brace for 6-8 weeks

334
Q

What is the Tx of LCL injury

A

Sx/reconstruction

335
Q

Knee injury usually following an anterior trauma to the tibia such as a dashboard injury

A

PCL injury

336
Q

What should you assess with PCL injury

A

NV status of LE

337
Q

What is the strongest ligament in the knee

A

PCL

338
Q

What will pt with PCL injury commonly complain of

A

“Looseness” and pain especially with bending

339
Q

What tests can you do to assess for PCL injury

A

Sag sign

Posterior drawer test

340
Q

What is the diagnostic test of choice for PCL injury

A

MRI

341
Q

What is the Tx of PCL injury

A

Immobilize with knee brace in extension, use crutches, PT

342
Q

Knee injury characterized by joint line pain and pain with deep squatting, often leading to pain, clicking, and locking sensation in the knee

A

Meniscus injury/tear

343
Q

What tests can be done to assess for meniscus injury

A

McMurray test
Modified McMurray test
Thessaly test

344
Q

What is the diagnostic test of choice for meniscus injuries

A

MRI

345
Q

What is the Tx for meniscus injury in older pt

A

Analgesics and PT for strengthening and core stability

346
Q

What is the Tx for meniscus injury in younger active pt

A

Arthroscopic repair & debridement

347
Q

Condition AKA “runners knee” where pt experiences pain with bending activities and has lateral deviation of the patella in relation to the femoral groove

A

Patellofemoral pain

348
Q

What are the tests you can do to assess patellofemoral pain

A

Patellar grind test

349
Q

What is the apprehension sign in patellofemoral pain

A

Suggests instability of the patellofemoral joint and is positive when the pt becomes apprehensive when the patella is deviated laterally

350
Q

What is the diagnostic test of choice for patellofemoral pain

A

X-ray shows lateral deviation of patella in relation to femoral groove

351
Q

Patella femoral injury is due to…

A

Rupture of the quads tendon

352
Q

Condition commonly referred to as “jumpers knee”

A

Patellar tendonitis

353
Q

What is the MOI for a proximal tibial fx

A

Most result from trauma but can be from stress or compromised bone

354
Q

What is the diagnostic test of choice for tib/fib fx

A

X-rays

355
Q

What is the primary Tx for tib/fib fx? What is the ultimate Tx?

A

Primary Tx = ORIF

Eventual Tx = total knee arthroplasty

356
Q

This is the MC injury seen in primary care

A

Foot injury

357
Q

What is a Jone’s Fx

A

Fx at the base of the 5th metatarsal

358
Q

Midfoot injury that occurs when the bones of the midfoot are broken or disrupted due to ligament damage

A

Lisfrac Fx

359
Q

What is the primary external finding with Lisfrac Fx

A

Bruising of the plantar side of the foot

360
Q

What is the diagnostic test of choice for Lisfranc Fx

A

X-ray

361
Q

What is the MC radiographic finding in Lisfranc Fx

A

Widening of the space b/w the 1st and 2nd metatarsals

362
Q

In which direction do most ankle sprains occur

A

Inversion

363
Q

What ligament is most commonly affected in ankle sprains

A

ATF ligament

364
Q

What is the Tx for ankle sprains

A

MICE (modified activity, ice, compression, elevation)

365
Q

What does SEADS stand for when inspecting the ankle

A

Swelling, Erythema, Atrophy, Deformity, Surgical Scars

366
Q

What is the MOI for a high ankle sprain

A

Eversion of the ankle

367
Q

What ligament is involved in high ankle sprains

A

Anterior tibiofibular ligament

368
Q

What SxS will a pt present with if they have a high ankle sprain

A

Severe, prolonged pain
Limited ROM
Mild swelling
Difficulty with WB

369
Q

What is a test to assess for high ankle sprain

A

External rotation stress test to reproduce MOI

370
Q

What is the Tx of a high ankle sprain

A

Cast or walking boot for 4-6 weeks, PT, crutches and WB protection

371
Q

What is the diagnostic test of choice for high ankle sprains

A

MRI best to visualize injury

372
Q

What is osteoporosis defined as by WHO

A

BMD of 2.5 SD or less below the young normal mean (T score < or = to -2.5)

373
Q

What are the unmodifiable RFs for osteoporosis

A 
Advanced age
Female
White or Asian
Hx of Fx
Hx of Fx in 1st degree relative
Dementia
374
Q

Severe form of osteoporosis caused by a major mutation in the gene encoding for Type 1 collagen

A

Osteogenesis Imperfecta

375
Q

What is “dowager’s hump”

A

Osteoporosis with fx; T-spine kyphotic deformity that occurs with multiple vertebral compression fxs

376
Q

What is the diagnostic study of choice for osteoporosis

A

Bone densitometry (DEXA Scan)

377
Q

Painful, softening of the bone =

A

Osteomalacia

378
Q

What is responsible for the uncoupling of bone resorption and bone formation

A

Estrogen deficiency

379
Q

When is estrogen deficiency and bone formation most pronounced

A

5-10 years after menopause

380
Q

What are the indications for DEXA scan in women

A 
65 y/o
Postmenopausal with RFs
Postmenopausal with Fx
Considering osteoporosis therapy
Receiving long term hormone replacement therapy
381
Q

What is a normal bone T score

A

-1.0

382
Q

What bone T score indicates osteopenia

A

-1.0 to -2.5

383
Q

What is osteopenia

A

Low bone density

384
Q

What bone T score indicates osteoporosis

A

< -2.5

385
Q

What is characterized as severe osteoporosis

A

T score < -2.5 with a Fx

386
Q

How much Ca2+ is needed for an adult < 50 y/o

A

1,000 mg

387
Q

How much Ca2+ is needed for an adult > 50 y/o

A

1,200 mg

388
Q

What vitamin is required for calcium absorption

A

Vitamin D

389
Q

At what age should a man get a DEXA scan (if needed)

A

Age 70

390
Q

What is the 1st line Tx for osteoporosis

A

Vitamin D + Calcium Supplements

391
Q

What is the 2nd line Tx for osteoporosis

A

Bisphosphonates (Alendronate, Ibandronate Boniva, Risedronate Actonel, Zoledronic Acid Reclast)

392
Q

What do bisphosphonates do for osteoporosis

A

Inhib osteoclast induced bone resorption, increase bone density, & reduce incidence of fxs

393
Q

What is 3rd line Tx for osteoporosis

A

Calcitonin

394
Q

What is the 4th line Tx for osteoporosis

A

Estrogen

395
Q

When is estrogen therapy for osteoporosis best

A

Best if started as soon after menopause as possible

396
Q

What is the 5th line Tx for osteoporosis

A

Selective Estrogen Receptor Modulators (SERMs)

397
Q

What is the 6th line Tx for osteoporosis

A

Parathyroid hormone

398
Q

What is the 7th line Tx for osteoporosis

A

RANK Ligand Inhibitors

399
Q

What is non-pharmacological Tx for osteoporosis

A

Exercise
Diet
PT

400
Q

With what HLA type is Reiter’s Syndrome associated

A

HLA-B27

401
Q

Who is more likely to get Reiter’s

A

Males (increased STDs)

402
Q

Reiter’s is remembered with “can’t pee, can’t see, can’t climb a tree” what conditions do these correlate to

A 
Pee = urethritis (chlamydial)
See = uvitis
Tree = Arthritis (ankles & knees)
403
Q

What are the dermatology findings in Reiter’s

A 
Circinate blantitis
Keratoderma biennorrhagicum (?spelling)
404
Q

What is the Tx of Reiter’s

A

Erythromycin + NSAIDs

405
Q

What are common PE findings with psoriatic arthritis

A

Nail pitting & DIP involvement

406
Q

What can cause seronegative arthritis

A

IBD

407
Q

Infection of the bone or bone marrow

A

Osteomyelitis

408
Q

What are the MC causative pathogens of osteomyelitis

A

S. aureus
Group B Strep
Salmonella (if hemoglobinopathy)

409
Q

What are 2 bedside clues that your pt has osteomyelitis

A
  • Ability to easily advance a needle through skin ulcer to bone
  • Ulcer area > 2 cm3
410
Q

What is the Tx for osteomyelitis

A

Quinolones (Cipro)

411
Q

What do you add to the Tx for osteomyelitis if the causative agent is S aureus

A

Add Rifampin to Cipro

412
Q

Inflammation of the joints secondary to infection =

A

Septic arthritis

413
Q

What is the MC organism associated with septic arthritis

A

Gonococcal species

414
Q

What are the MC gram-neg pathogens of septic arthritis

A

E coli

Pseudomonas

415
Q

Describe the joint pain of septic arthritis

A

Localized
Asymmetrical
Rapid onset
Erythema

416
Q

What is the affect of septic arthritis on ROM

A

Decreased active & passive ROM

417
Q

What is a common finding of septic arthritis upon PE

A

Pain with log roll

418
Q

What is the diagnostic test of choice for septic arthritis

A

MRI or CT

419
Q

What is the empiric Tx of septic arthritis

A

Vanco & zosyn or Ceftriaxone

420
Q

Which is more common in adults: primary or secondary bone cysts/tumors

A

Secondary (mets)

421
Q

Where are Ewings tumors primarily found

A

Pelvis, femur, humerus, ribs, clavicle

422
Q

Who is most likely to develop an Ewings tumor

A

Teenagers and young adults, men > women

423
Q

What is the Tx of Ewings tumor

A

Multi-agent chemo
External beam irradiation
Resection in select cases

424
Q

Malignancy of the plasma cells present in the bone marrow leading to destruction of bone and paraprotein formation

A

Multiple Myeloma

425
Q

What are pts with multiple myeloma at an increased risk of

A

Infections from encapsulated organisms (Step pneumoniae & H influenza)

426
Q

What is the chief complaint in multiple myeloma

A

Bone pain

427
Q

Where is pain MC in multiple myeloma

A

Ribs, back/spine, proximal long bones

428
Q

What is the diagnostic radiology finding in multiple myeloma

A

Lytic “punched out” lesion

429
Q

What is the Tx for multiple myeloma

A

No cure

Tx = dexamethasone + lenalidomide/thalidomide

430
Q

CA due to transformed cells that produce cartiage

A

Chondrosarcoma

431
Q

Where are chondrosarcomas MC

A

Femur, humerus, ribs, & surface of the pelvis

432
Q

What are the radiologic findings of chondrosarcomas

A

Large, fusiform, lucent defect with scalloping on the inner cortex of the bone

433
Q

What is the Tx for chondrosarcomas

A

Wide resection

434
Q

Remodeling disease with one or more bony lesions having high bone turnover and disorganized osteoid formation

A

Paget’s disease

435
Q

Why is paget’s disease difficult to Dx

A

Most pts are asymptomatic until late disease

436
Q

What is the 1st symptom of Paget’s disease

A

Bone pain

437
Q

What is a frequent complication in Paget’s disease

A

Frequent “chalkstick” fxs with slight trauma

438
Q

What will be the lab findings of Paget’s disease

A

Elevated alkaline phosphatase in the blood

439
Q

What is the Tx of choice for Paget’s disease

A

Bisphosphonates (Alendronate)

440
Q

Aggressive malignant neoplasm that arsies from osteoblastic CT

A

Osteosarcoma

441
Q

What is the MC malignancy of bone

A

Osteosarcoma

442
Q

Who are osteosarcomas most prevalent in

A

Adolescents

443
Q

How will a pt with an osteosarcoma present

A

Pain or swelling in a bone or joint, especially in or around the knee

444
Q

What is the x-ray finding with osteosarcoma

A

Codman’s triangle sign

445
Q

What is the Tx of osteosarcoma

A

Complete radical en-bloc resection

446
Q

What is the MC benign tumor in the hand or wrist

A

Ganglion cysts

447
Q

What are ganlion cysts d/t

A

Leakage of joint fluid along the synovial lining through the joint capsule

448
Q

What will you find on PE with ganglion cysts

A

Firm cystic masses adjacent to the joints that are usually painless

449
Q

What is the MC location for ganglion cysts

A

Dorsal wrist with origin at the scapholunate joint

450
Q

What is the 2nd MC location for ganglion cysts

A

Palmar aspect of wrist on radial side

451
Q

What is the Tx for ganglion cysts

A

Aspiration with wide-gauge needle

452
Q

A “punched out” lesion on x-ray indicates

A

Multiple myeloma

453
Q

A ‘sun ray’ lesion on x-ray indicates

A

Osteogenic sarcoma

454
Q

An ‘onion peel’ lesion/sign on x-ray indicates

A

Ewing sarcoma

Clinical Medicine Final (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions