Musculoskeletal Flashcards
1
Q
Progressive disease with genetic predisposition, loss of articular cartilage, & effects WB joints
A
Osteoarthritis
2
Q
OA has cartilage degeneration with __________ inflammation
A
Minimal inflammation
3
Q
A key characteristic of OA is ________ formation which may be seen on xray
A
Osteophyte formation
4
Q
OA is associated with what conditions/RFs
A
Age, hormones, genetics, obesity, lack of physical activity, & metabolic abnormalities
5
Q
What metabolic abnormalities is OA associated with
A
Acromegaly
Gout
Hyperthyroidism
6
Q
OA has abnormal joint mechanisms. What are the 2 groups?
A
Congenital defects (SCFE & congenital hip dysplasia) Acquired defects (epiphysis dysplasia)
7
Q
Condition where the protective cartilage on the ends of your bones wears down over time
A
OA
8
Q
The primary symptom/complaint of OA is
A
Joint Pain
9
Q
Describe the joint pain of OA
A
Localized
Asymmetrical
Increases with use
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
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
12
Q
What is the diagnostic of choice for OA
A
H&P is often sufficient
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
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
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
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
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)
18
Q
What is the primary treatment of OA
A
Acetaminophen recommended
19
Q
What is the 2nd line treatment of OA
A
NSAIDs; specifically COX-2
- Celebrex
- Mobic
20
Q
Why are NSAIDs 2nd line Tx for OA?
A
They are more effective but they have increased toxicity
21
Q
What is the 3rd line Tx for OA
A
Cortisone injections
22
Q
What is the 4th line Tx of OA
A
Hyaluronic acid injections (artificial synovial fluid to increase joint viscosity)
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
24
Q
What is the ultimate Tx of OA? When is it indicated?
A
Arthroplasty
Indicated when conservative measures have failed
25
What is the MC form of arthritis
OA
26
How do NSAIDs work in the Tx of OA
Produce anti-inflammatory & analgesic effects by decreasing the production of prostaglandins & they inhibit both Cox-1 & 2 enzymes
27
Which NSAID is COX-2 specific
Celebrex
28
Systemic autoimmune disorder characterized by an inflammatory synovitis that erodes and ultimately destroys the articular cartilage
Rheumatoid arthritis (RA)
29
What may also become involved in RA
Many non-articular organs b/c the same cytokines that drive synovial pathology are also responsible for generating extra-articular tissue pathology
30
Who is RA more prevalent in
Women
31
In RA, what is associated with increased incidence and more severe disease (think genetic)
HLA-DR4
32
What are the features of RA (i.e. what might a pt present with)
```
Malaise & fatigue
Stiffness
Pain & tenderness
Joint effusions
Symmetric arthritis/joint involvement
Rheumatoid nodules & deformatieis of the hands/fingers
```
33
What is the MC joint involved in RA
The wrist
34
What are the wrist findings of RA
Erosion, subluxation/drift of radius, tendon rupture
35
SxS must be present for how long to Dx RA
At lest 6 weeks
36
What are "cock-up" deformaties in RA
Lateral drift of the toes & plantar subluxation d/t erosive damage
37
In order to Dx RA what must be present?
At least 4/7 of the RA criteria
38
What is the RA Dx criteria
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)
39
What is diagnostic is most specific for RA
Radiographic findings
40
What lab values will be elevated in RA
Acute phase ESR & CRP
41
What is the most specific lab value/finding for RA
Anti-CCP antibodies
42
What is the Tx of RA directed towards?
Control of the synovitis and prevention of joint injury
43
What is the primary (1st line, 1st choice) Tx of RA
NSAIDs
44
What if NSAIDs alone don't work for Tx of RA
Must try more than 1 and and a second line agent
45
What is/are the 1st choice 2nd line agent(s) for Tx of RA
DMARDs:
- Methotrextate best
- Sulfasalazine next best
46
What is/are the 2nd choice 2nd line agent(s) for Tx of RA
Azathioprine, Infliximab, Gold Cyclosporine, low dose steroids
47
If the pt's RA is unresponsive to Methotrexate what can be used
Biologics such as Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, & Simponi
48
What is the appropriate Tx for moderate to severe RA
Methotrexate + sulfasalazine + hydroxycloriquine
49
If you are going to use hydroxycloroquine what must you do
Get a baseline eye exam
50
What condition do you need to test for prior to starting treatment of RA?
Test for latent TB
51
What are extra-articular manifestations of RA in the heart
Pericarditis
Vasculitis
Valvular & valve ring nodules
52
What are extra-articular manifestations of RA in the lungs
Pleural effusion
| Bronchiolitis
53
What are extra-articular manifestations of RA in the Skin
Fragility
| Nodules
54
What are neurological extra-articular manifestations of RA
Neuropathy
Cervical myelopathy
Peripheral neuropathy
55
What are hematologic extra-articular manifestations of RA
Anemia
| Thrombocytosis
56
What are extra-articular manifestations of RA in the bones
Osteopenia
57
What are extra-articular manifestations of RA in the eyes
Sicca (Sjogren's)
Episcleritis
Scleromalacia perforans
58
What are extra-articular manifestations of RA in the kidney
Amyloidosis
| Vasculitis
59
RA carries a low prognosis if there is...
polyarticular involvement & systemic extra-articular manifestations
60
What are the common "complications" or findings in RA
Boutonniere deformity
"Swan-neck" deformity
Valgus knee deformity
Volar suluxation of the MTP joints (ulnar deviation)
61
Hyperextension of DIP with flexion of PIP
Boutonniere deformity
62
Flexion of DIP with extension of the PIP
"swan-neck" deformity
63
Name the arthritis...inflammation present
RA
64
Name the arthritis...involvement of the DIP & WB joints
OA
65
Name the arthritis...osteophyte formation
OA
66
Name the arthritis...ulnar deviation, swan-neck, & boutonneire deformities
RA
67
Name the arthritis...Tx goal = pain control
OA
68
Name the arthritis...positive lab finding include ESR & CRP
RA
69
Name the arthritis...heberden's nodes
OA
70
Name the arthritis...involvement of MCP/PIP joints
RA
71
Name the arthritis...Tx goal = control inflammation
RA
72
Name the arthritis...normal lab findings
OA
73
Name the arthritis...periarticular osteoporosis and erosion
RA
74
What are the alarm SxS of CA
```
Unexplained wt loss
Failure to improve with Tx
Pain > 6wks
Pain at night or at risk pt
Hx of CA
Age > 50
```
75
What are the alarm SxS for cauda equina
```
Urinary retention/incontinence
Saddle anesthesia
Decreased anal sphincter tone/fecal incontinence
Bilateral LE weakness
Progressive neurological deficits
```
76
What is the 2nd MC complaint in primary care
Lower back pain (LBP)
77
When examining a pt with lower back pain what do you need to make sure you do?
Rule out any red flags (such as those of CA or cauda equina)
78
What is the primary Tx for lower back pain
Rest! 80-90% of pts will improve within 1 month even without any treatment
79
What are other treatments for lower back pain
Pt education, PT, or NSAIDs
80
If pt complains of lower back pain and has red flags what should you do?
Promptly get an MRI
81
What is the MCC of disability in people under 45 y/o
Lower back pain
82
Chronic inflammatory disease of the axial skeleton, peripheral joints, & non-articular structures
Ankylosing spondylitis (AS)
83
In what manner does AS affect the spine? (direction)
Affects it from the bottom up, starting at the SI joints and working up to cervical skeleton
84
What genetic predisposition do 90% of pts express
HLA-B27
85
Who is AS more prevalent in
Men > women; generally young adults
86
AS is associated with chronic back pain that is worst when?
In the morning
87
Mid or entire spine stiffness in AS may improve with...
Activity
88
Where might AS back pain refer to
Referred pain to the butt or back of the thigh
89
What condition is AS associated with
Anterior uveitis
90
AS rarely presents in pts < 18 y/o. If it does how might it present
Pain & swelling of the large limb joints (knee)
91
What are the necessary findings to Dx AS
Changes in the SI joints (early in disease may be seen on MRI, otherwise x-ray)
92
What is the "shiny corner sign" associated with AS
X-ray finding due to inflammation where the annulus attaches (seen on the vertebral bodies)
93
When can plain films diagnose AS
Later in the disease
94
What is the bamboo sign and what condition is it associated with
Late radiographic finding of AS where the vertebral bodies are fused by syndesmophytes and look like bamboo
95
What bloodwork will be positive in a pt with AS
Seronegative spondyloarthropathies
| Negative anti-CCP antibodies
96
What is the 1st line Tx of AS
NSAIDs (empiric trials of several to find best result)
97
If NSAIDs don't work in the Tx of AS what should be done next
Add TNF inhibitors to the Tx (Entanercept, Adalimubab, Infliximab, Golimumab)
98
Why should corticosteroids not be given for AS
Can worsen osteopenia and minimal impact on arthritis
99
What disease/condition is related to AS
Reiter's Syndrome
100
Condition where ligaments and connective tissue of the back are stretched beyond normal
Back sprain/strain
101
Quick tear, pull, or twist of muscle or tendon
Strain
102
Trauma which displaces joint and stretches/tears a ligmante
Sprain
103
Compression of the spinal cord d/t a massive ruptured disc
Cauda equina
104
Where in the spine is cauda equina MC
MC at L4-L5 and usually occurs midline
105
What are the main SxS of cauda equina
Urinary retention (may have overflow incontinence)
Diminished anal sphincter tone w/ fecal incontinence
Saddle anesthesia
106
What are other common SxS of cauda equina (but not major)
Motor weakness, LBP, absence of achilles reflex, sexual dysfunction
107
How do you Dx cauda equina
MRI is best
108
What is the Tx of cauda equina
URGENT surgical decompression
109
How are the nerve roots numbered in the cervical spine
They are numbered C1-C8 and each is found about the vertebrae (ex: C6 nerve root is above C6 vertebrae)
110
This is AKA a herniated disc
herniated nucleus pulposis
111
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?
Cervical herniated nucleus pulposis
112
What is Lhermitte's sign? What condition is it seen in?
Electrical shock-like sensation radiating down the spine; seen with cervical herniated nucleus pulposis
113
What is Spurling's sign? What condition is it seen in?
Pain when examiner exerts downward pressure on the vertex and tilting the head towards the symptomatic side; seen with cervical herniated nucleus pulposis
114
What is axial manual traction? What condition is it associated with?
10-15 kg traction is applied while the pt is supine & reduces or alleviates SxS is a (+) sign; associated with cervical herniated nucleus pulposis
115
What is the diagnostic of choice for Cervical herniated nucleus pulposis
MRI is best
| Plain films MAY be somewhat useful
116
How do you treat Cervical herniated nucleus pulposis
NSAIDs, muscle relaxers, PT, chiropractic Tx, injections; analgesics & tricyclics may be helpful for reduction of neuropathic pain
117
In what direction do LUMBAR discs usually herniate and why
Usually herniate to the side b/c the posterior longitudinal ligament is strongest in the midline
118
What may relieve pain in lumbar herniated disc
Flexing knee and thigh
119
What is the "cough effect" in lumbar herniated disc
Exacerbation of pain with coughing or straining
120
What do pts with lumbar herniated disc often do
Avoid excessive movements but don't stay in one position for too long
121
Pt presents with pain radiating down the LE, LE weakness, motor weakness, dermatomal sensory changes, and reflex changes. What might be the Dx?
Herniated lumbar disc
122
What is the diagnostic of choice for lumbar herniated disc
MRI is best
| Plain films may help distinguish
123
What is the Tx of lumbar herniated disc
NSAIDs, muscle relaxer, PT, chiropractic tx, injections; analgesics & tricyclics may help reduce neuropathic pain
124
Pt presents with exaggerated curvature of the thoracic spine. What may be the Dx?
Kyphosis
125
What are the possible causes of kyphosis in adults
Degenerative disease of the spine
Fx by osteoporosis
Injury/trauma
Spondylolisthesis
126
What are common presenting SxS of kyphosis besides exagerated curvature of the thoracic spine
```
Difficulty breathing (severe cases)
Fatigue
Mild back pain
Round back appearance
Tenderness
Spine stiffness
```
127
How do you diagnose kyphosis
Clinical may be sufficient but x-ray and MRI are tests of choice
128
What is kyphosis in adolescents called
Scheuermann's Disease
129
How is Scheuermann's disease treated
Brace and PT
| Sx if curve > 60 degrees
130
What is a common complication or finding of kyphosis
Multiple compression fractures of the thoracic spine d/t osteoporosis leading to worsening curvature
131
Sideways curvature of the spine most often seen during growth spurt just before puberty; causes of most cases unknown
Scoliosis
132
What is the MC cause/type of scoliosis
MC = idiopathic scoliosis
133
Who is scoliosis more prevalent in
Female > male
134
What are the common clinical findings or SxS of scoliosis
Uneven shoulders
Prominent shoulder blade
Uneven waist
Leaning to one side more than the other
135
How is scoliosis often diagnosed
School screenings or exam & x-ray
136
What is a Tx of scoliosis in adolescents? What does it do?
Braces for curves of 25-40 degrees will halt progression of curve but the curve will resume if bracing is discontinued
137
Where does sciatica/nerve root compression most commonly occur
95% occur at L4-L5 or L5-S1
138
What is the onset of sciatica
Usually abrupt but can be acute on chronic flare-up pains
139
What is the most common SxS or sciatica
Radicular pain that extends below the knee
140
What is the MC L5 finding in sciatica
Foot drop or loss of dorsiflexion of the great toe and pain in the great toe
141
What is the radiation pattern of sciatica pain
Radiation in a radicular fashion along distribution of sciatic nerve
142
What is the Tx of sciatica
Tx like a sprain/strain; activity as limited by pain, NSAIDs, possible opioid use for pain, possible epidural steroid injections
143
Condition characterized by narrowing of the AP dimension of the spinal canal
Spinal stenosis
144
In what direction does the spinal canal narrow in spinal stenosis
AP direction
145
Where is spinal stenosis MC
MC at L4-L5
| 2nd MC at L3-L4
146
What are common SxS of spinal stenosis
Pain, paresthesias, LE weakness with walking
147
What is the MC SxS of spinal stenosis in the lumbar region? What is it?
Neurogenic claudication = pt tires with walking, require stopping & sitting & changes position of their back to relieve pain
148
What is the diagnostic test of choice for spinal stenosis
MRI or CT
149
What MRI type is best for spinal stenosis Dx
T2 images
150
What is the Tx for spinal stenosis
- Flexion based exercises by PT
| - Spinal or facet joint corticosteroid injections to reduce pain
151
Spinal TB is AKA....
| Who is it primarily seen in?
Pott Disease
| Seen in immigrants and immunocompromised
152
What are the main SxS of spinal TB
Back pain
+/- radicular pain & LE weakness
+/- pulmonary disease
153
What is the diagnostic test of choice for spinal TB
MRI
154
What are the radiographic findings of spinal TB
Lytic & sclerotic lesions & bony destruction
155
What is the Tx of spinal TB
Abx 6-9 months
| - Isoniazid, rifampin, pyrazinamide, & ethambutol for 2 months then isoniazid & rifampin for additional 4-7 months
156
What is the bad complication of spinal TB
Paraplegia d/t compression of the spinal cord -> cauda equina
157
Loss of conguency between the glenoid and humeral head
Shoulder dislocation
158
In which direction do most shoulder dislocations occur
95% are in the anterior direction
159
What is the mechanism of most shoulder dislocations
Usually d/t a fall on outstretched and abducted arm
160
How do posterior shoulder dislocations occur
Fall from high height, seizure, or electrocution
161
What is a bankart lesion
Anterior inferior labrum is torn in shoulder dislocation and leads to continuous instability
162
What will a pt complain of with anterior shoulder dislocation
Pain & instability when shoulder is abducted and externally rotated
163
What are the diagnostic tests of choice for shoulder dislocation
X-rays with multiple views
| MRI best if suspected soft tissue damage to labrum/rotator cuff
164
What is the Tx for acute shoulder dislocations
Reduce immediately with gentle traction with internal rotation (1st inject with lidocaine)
165
What is the Tx for traumatic shoulder dislocations
Bankart lesion is often present & surgical repair is often required, need to immobilize for 6 weeks
166
What is the Tx for recurrent shoulder dislocations
Sx management (often arthroscopic)
167
How does AC injury most commonly occur
Occurs from a fall directly onto the shoulder
168
How might a pt present with an AC injury
Depends on extent of injury; may be in minimal pain to extreme unbearable pain with no arm movement
169
What is the diagnostic test of choice for an AC injury
MRI best to access soft tissue & structural damage
170
What is the Tx for a mild AC injury
Sling for discomfort & mild pain meds for relief
171
What is the Tx for a moderate AC injury
Stronger pain meds for relief
172
What is the Tx for a severe AC injury
Surgical repair if it is a Type 4 or 5 injury
173
Where is the MC location for a clavicular Fx
Mid-shaft MC
| Distal is 2nd MC, proximal least common
174
What is the mechanism of injury for most clavicular fractures
Direct blow or fall on point of the shoulder
175
What is the diagnostic test of choice for clavicular fractures
X-ray is the gold standard
176
What is the Tx for clavicular fractures
Most are treated non operatively with sling and swath
177
When is operative Tx indicated for clavicle Fx
Indicated for open fxs, markedly displaced fxs, fxs associated with multiple traumas, & distal fxs
178
What is the mechanism of injury for a posterior dislocation sternoclavicular injury
Direct blow to the anterior chest wall, usually high energy blow
179
What is the mechanism of injury for anterior dislocation sternoclavicular injury
Lateral blow to the shoulder when the arm is abducted/extended (usually low energy)
180
What is the main finding with sternoclavicular injury
Deformity, swelling, and tenderness of the joint
181
What are secondary findings with sternoclavicular injuries
Stridor, dysphagia, venous distension, pulse deficit
182
What are the diagnostic tests that are done for sternoclavicular injuries
```
X-ray
CT scan (can show structural damage better)
```
183
What is the Tx for anterior dislocation sternoclavicular injuries
Treated without Sx (i.e. rest, pain meds, may sling)
184
What is the Tx for posterior dislocation sternoclavicular injuries
Immediate closed reduction then sling and close followup
185
What is the major complication/concern with posterior dislocation sternoclavicular injuries
Need to be careful b/c it can impinge on the aorta, other major vessels, & nerves
186
What are the 4 muscles of the rotator cuff
Subscapularis
Supraspinatous
Infraspinatous
Teres minor
187
Which rotator cuff muscle/tendon is most often injured
Supraspinatous
188
What is the mechanism of injury for most rotator cuff injuries
Acute injuries like falls on an outstretched arm or pulling on the shoulder
189
What may partial rotator cuff tears lead to
Impingement syndrome
190
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
Rotator cuff injury
191
How might a pt present with a complete rotator cuff tear
Weakness with resisted strength testing
192
What are 2 tests that should be done with suspected rotator cuff injury
Neer & Hawkins tests
193
Describe the Neer test
Depress the scapula while elevating the arm with the other
194
Describe the Hawkins test
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
What is the diagnostic test of choice to Dx a rotator cuff injury
MRI b/c it has best visualization of damage
196
What is the Tx for rotator cuff injuries
NSAIDs
PT
Steroid injections
Activity precautions (no over head work, heavy lifting, pushing, or pulling)
197
If the pt doesn't see any improvement in their rotator cuff injury after 6 weeks what should you do
Get another MRI to reevaluate the tear
198
What is the best Tx for a complete rotator cuff tear? Why?
Best Tx is Sx repair b/c complete tears often do not heal very well on their own
199
True of False: injection of cortisone into the joint will help alleviate the pain in a rotator cuff injury?
FALSE, will NOT help alleviate pain
200
What is the mechanism of injury for humeral fxs
Direct blow or FOOSH
201
What are the diagnostic tests for humeral fxs
X-rays (best), CT, or CT with reconstruction
202
What is the Tx for humeral fxs
Depends on type of fx, type of displacement, & number of fx parts; more complicated fxs often get ORIF
203
What should you always check post-op with humeral fxs
Check NV, especially radial nerve
204
What is the mechanism of injury for elbow dislocation
Fall with elbow locked in extension
205
What are common SxS of elbow dislocation
Swelling, deformity, & tenderness of the elbow
206
What is the diagnostic test for elbow dislocation
X-ray to check for coronoid or radial head fx
207
What must you do following an elbow dislocation
NV check of ulnar nerver
208
What is the Tx for elbow dislocation with no fx
Non-operative
209
What is the Tx for elbow dislocation
Gentle closed reduction with axial traction
210
In what direction do most elbow dislocations occur
80-90% occur in posterior or posteriolateral direction
211
Condition with inflammation of the extensor muscles in the forearm that extends the wrist d/t overuse
Lateral epicondylitis
212
What is lateral epicondylitis commonly known as
Tennis elbow
213
What might a pt present with in lateral epicondylitis
- Lifting anything in front of you or pulling door open causes pain
- Tenderness over the lateral epicondyle
- Possible tenderness over the ulnar nerve
214
What is required to Dx lateral epicondylitis
Pain with resisted strength training and passive stretching
215
What does the spurling test check for
Cervical radiculopathy
216
What is the Tx of lateral epicondylitis
Rest, ice, NSAIDs, bracing, PT, cortisone shots, Sx last resport
217
Condition with inflammation of the flexor muscles of the forearm d/t overuse
Medial epicondylitis
218
What is medial epicondylitis commonly known as
Golfer's elbow
219
What might a pt present with in medial epicondylitis
Pain, tenderness of the medial aspect of the elbow, swelling, and numbness & tingling
220
How is medial epicondylitis diagnosed
Clinically
221
What is the Tx for medial epicondylitis
Rest, ice, NSAIDs, bracing, PT, cortisone shots, Sx last resport
222
What must you be aware of with medial epicondylitis
Must be aware of ulnar nerve during cortisone injections
223
What is the mechanism of injury for olecranon fxs
Direct blow to the flexed elbow
224
What is the diagnostic test of choice for olecranon fxs
X-rays
225
What is the Tx for most olecranon fxs
ORIF
226
Inflammation of the olecranon bursa
Olecranon bursitis
227
What is the mechanism of injury for olecranon bursitis
Single injury/blow to the elbow or repeated minor injuries
228
What might a pt with olecranon bursitis present with
Pain, swelling, limited ROM, redness, possible infection
229
How do you Dx olecranon bursitis
Clinically or with aspiration if suspected infection
230
What is the Tx for olecranon bursitis
Oral or topical NSAIDs, aspiration of bursa, & injection of hydrocortisone
If infection Tx with Abx
231
In what demographics is olecranon bursitis common
Prangant women & pts with DM or RA
232
Fracture of the distal radius =
Colle's Fx
233
What is the mechanism of injury for Colle's Fx
Usually via fall on outstretched hand
234
What might a pt with a Colle's Fx present with
Dorsal angulation
Loss of pronation & supination
Radial inclination (tilt & shortening)
235
What is the diagnostic test of choice for Colle's Fx
X-rays
236
What is the Tx for Colle's Fx
Closed reduction or ORIF
237
This is the most common Fx...
Colle's Fx
238
What is the mechanism of injury for radial head fx
Direct blow to the radial head or fall with valgus force
239
What might a pt with radial head fx present with
Decreased ROM
Pain at the wrist
Swelling over the wrist
240
What is the diagnostic test of choice for radial head fracture
X-rays
241
What is the Tx for radial head fx
Types 1 & 2 = simple ACE wrap soft splint, ice, pain meds,& early ROM
Type 3 = ORIF
242
What are the 3 types of radial head fxs
Type 1 = no displacement
Type 2 = minimal displacement
Type 3 = communited
243
What is the mechanism of injury in forearm fracture
Direct blow or fall
244
What is the diagnostic test of choice for forearm fx
X-rays
245
What is the Tx of forearm fx in adults
ORIF (plate across bone + pin)
246
What is the Tx of forearm fx in children
Closed reduction with casting
247
Fx of the middle to distal 1/3 of the ulna with anterior dislocation of the radial head
Monteggia Fx
248
Fx of the distal to mid 1/3 of the radius with dislocation of radioulnar joint
Galeazzi Fx
249
Fx of the 5th metacarpal head
Boxer's Fx
250
What is the diagnostic test for Boxer's Fx
X-rays
251
What is the Tx for Boxer's Fx
Splinting with ulna gutter splint
252
Hyperextension of the thumb causing disruption of the ulnar collateral ligament and MCP & DIP of the thumb
Gamekeeper's Thumb
253
What is the Tx of Gamekeeper's thumb
Splinting for 6-8 weeks
254
What is gamekeeper's thumb AKA
Ski-pole injury
255
What is the mechanism of injury for scaphoid fx
FOOSH
256
What is important to remember when diagnosing a scaphoid fx
Fx may not always be seen/detected at first so may need to reevaluate in a week
257
What is the MC SxS of scaphoid fx
Pain in the anatomical snuff box on palpation
258
What is the diagnostic test of choice for scaphoid fx
X-ray
| Repeat in 3-5 days if negative
259
What is the Tx for scaphoid fx
Thumb spica splint; if severely displaced ORIF
260
What must you watch for with scaphoid fx
Avascular necrosis
261
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?
Scapholunate Dislocation
262
Slow progressive disease with thickening of the palmar fascia and shortening of the tendons
Dupuytren's Contracture
263
What conditions are associated with dupuytren's contracture
Pregnancy, DM, & RA
264
What is the Tx for dupuytren's
PT/OT ASAP to prevent worsening
265
Who is dupuytren's more common in
Men > women until 80 y/o then even
266
Swelling or stenosis of the sheath surrounding the APL & EPB, usually d/t repetitive motion
DeQuervain's Tenosynovitis
267
What is the diagnostic test of choice for DeQuervain's
Finklestein test
268
What is the Tx for DeQuervain's
Splinting with thumb spica splint, cortisone, NSAIDs, & ice; Sx if those fail
269
Who is DeQuervain's more common in
Middle aged women
270
What causes carpal tunnel syndrome
Increased fluid retention in the carpal tunnel
271
What nerve is involved in carpal tunnel
Median nerve
272
What ligament is involved in carpal tunnel
Transverse collateral ligament
273
What conditions may precipitate carpal tunnel
Pregnancy, menopause, obesity, DM, thyroid disorders, & kidney failure
274
With carpal tunnel, where in the hand may a pt experience pain, numbness, tingling, or burning
Thumb, index finger, middle finger, & middle half of the ring finger
275
In severe carpal tunnel what finding may you see in the hand
Wasting of the thenar eminence
276
What is the tinel sign & what condition does a positive test indicate
Tingling or shock-like pain on volar wrist percussion indicate carpal tunnel syndrome
277
What is the phalen sign & what condition does a positive test indicate
Pain or paresthesias when flexing the wrists 90 degrees for 1 minute indicated carpal tunnel
278
What is the carpal compression test and what does a positive test indicate
Numbness & tingling by direct pressure over the carpal tunnel indicates carpal tunnel syndrome
279
What is the conservative Tx for carpal tunnel
Splinting at night, NSAIDs, cortisone shot into the carpal tunnel
280
What is the BEST Tx for carpal tunnel
Surgical release
281
Who is carpal tunnel more common in
Women > men
282
Forced flexion of a distal phalanx causing disruption of the tendon leading to avulsion of the extensor tendon
Mallet finger
283
Forceful blow to bent finger or arthritis leading to swelling and pain at the PIP
Boutonniere deformity
284
What is the Tx of boutonniere deformity
Immediate splinting for 6-10 weeks
285
What causes a swan neck deformity
Injury to finger, RA, or Ehler-Danlos Syndrome
286
Flexor digitorum profundus avulsion; injury occurs during forceful DIP extension and results in inability to flex finger
Jersey finger
287
What is the MC finger for jersey finger
Ring finger
288
Infection of the flexor tendon sheath often occuring after penetrating injuries with inoculation of the tendon sheath
Tenosynovitis
289
What is the Tx of tenosynovitis
Early IV Abx Cefazolin or Clindamycin; surgical drainage if no immediate relief
290
What diseases/conditions are associated with tenosynovitis
DM and RA
291
What is an intertrochanteric fx
When the fx goes from the greater to lesser trochanter
292
What is the MC fx seen in the elderly
Intertrochanteric fx
293
With hip fx pain in the groin is typical but where might it radiate to
Lateral hip, butt, & knee
294
What is the diagnostic test of choice for hip fx
X-rays are usually sufficient
295
What tests can you do to determine hip fx during the exam of the pt
- Trendelenburg test looking for instability of the hip flexors
- Internal rotation of hip is best provacative diagnostic maneuver
296
What is the Tx for hip fx
Surgical repair (within 24hrs)
297
How do femur fxs happen
From a fall or high velocity trauma (like car crash)
298
What will be the main PE findings with femur fx
Severe pain, difficulty WB, & affected leg will be shortened and externally rotated
299
What is the diagnostic of choice for femur fx
X-rays
300
Who is SCFE most commonly seen in
Adolescent males (10-17 y/o)
301
How will a pt with SCFE present
Pain in the hip, knee, or thigh
302
What is the difference b/w stable and unstable SCFE
Stable can bear weight
303
What is the main risk/complication in SCFE
Avascular necrosis of the hip
304
What is the Patrick's test?
AKA FABER & FADER test for SCFE
305
What is the diagnostic of choice for SCFE
X-rays
306
What is the Tx for SCFE
Surgical stabilization of joint
307
Where does avascular necrosis most commonly affect
Proximal & distal femoral heads
308
What is the ultimate outcome of many cases of avascular necrosis of the hip
Total hip replacement
309
What are the common areas for bursitis in the knee
Pre-patellar busae and Baker cyst
310
What is the MC infectious agent of knee bursitis
S. aureus
311
Pt has bursitis on knee...what will they present with
Small focus of swelling over the knee cap
312
What is the Tx of bursitis caused by trauma
Heat, rest, NSAIDs, & local corticosteroid injections
313
What is the Tx of bursitis caused by infection
Aspiration of effusion & Abx
314
What is the Tx of Baker cyst
Rest, leg elevation, Abx injection (triamcinolone)
315
Hemarthrosis of the knee may indicate...
Ligament injuries or patellar dislocation/fx
316
Common causes of medial knee pain
Medial compartment OA
MCL strain
Medial meniscus injury
Anserine bursitis
317
Common causes of anterior knee pain
```
Patellofemoral syndrome
OA
Prepatellar bursitis
"Jumper's Knee"
Septic arthritis
Gout/inflammatory disorder
```
318
Common causes of lateral knee pain
Lateral meniscus injury
Iliotibial band syndrome
LCL sprain
319
Common causes of posterior knee pain
Baker cyst
OA
Meniscal tear
Hamstring/calf tendinopathy
320
Injury involving an audible pop when the knee buckles accompanied by immediate swelling & difficulty with motion
ACL injury
321
This is the MC injury in sports
ACL injury
322
ACL injuries are common with what kind of motion/activities
Common in skiing, soccer, football, & basketball; often during acceleration-deceleration movements
323
What is the diagnostic test of choice for ACL injury
MRI
324
What tests can you do during the PE to assess for an ACL injury
Lachman & Anterior Drawer tests
325
What is the Tx for ACL injury
Surgical repair (autograft or cadacer graft)
326
Knee injury caused by valgus blow/stress to the lateral aspect of the knee resulting in pain, instability, & limited ROM to the affected area
MCL Injury
327
What is the MC finding with MCL injury
Pain along the course of the ligament
328
Knee injury caused by varus blow/stress to the medial aspect of the knee resulting in pain, instability, & limited ROM to the affected area
LCL injury
329
What is the most commonly injured ligament in the knee
MCL
330
MCL & LCL injuries may not have any effusion because...
They are extra-articular
331
What is the diagnostic test of choice for MCL/LCL injuries
MRI
332
What tests can be done to access for MCL/LCL injuries
Varus/Valgus stress testing
333
What is the Tx of MCL injury
Usually protected WB, PT, may use knee brace; if severe long leg brace for 6-8 weeks
334
What is the Tx of LCL injury
Sx/reconstruction
335
Knee injury usually following an anterior trauma to the tibia such as a dashboard injury
PCL injury
336
What should you assess with PCL injury
NV status of LE
337
What is the strongest ligament in the knee
PCL
338
What will pt with PCL injury commonly complain of
"Looseness" and pain especially with bending
339
What tests can you do to assess for PCL injury
Sag sign
| Posterior drawer test
340
What is the diagnostic test of choice for PCL injury
MRI
341
What is the Tx of PCL injury
Immobilize with knee brace in extension, use crutches, PT
342
Knee injury characterized by joint line pain and pain with deep squatting, often leading to pain, clicking, and locking sensation in the knee
Meniscus injury/tear
343
What tests can be done to assess for meniscus injury
McMurray test
Modified McMurray test
Thessaly test
344
What is the diagnostic test of choice for meniscus injuries
MRI
345
What is the Tx for meniscus injury in older pt
Analgesics and PT for strengthening and core stability
346
What is the Tx for meniscus injury in younger active pt
Arthroscopic repair & debridement
347
Condition AKA "runners knee" where pt experiences pain with bending activities and has lateral deviation of the patella in relation to the femoral groove
Patellofemoral pain
348
What are the tests you can do to assess patellofemoral pain
Patellar grind test
349
What is the apprehension sign in patellofemoral pain
Suggests instability of the patellofemoral joint and is positive when the pt becomes apprehensive when the patella is deviated laterally
350
What is the diagnostic test of choice for patellofemoral pain
X-ray shows lateral deviation of patella in relation to femoral groove
351
Patella femoral injury is due to...
Rupture of the quads tendon
352
Condition commonly referred to as "jumpers knee"
Patellar tendonitis
353
What is the MOI for a proximal tibial fx
Most result from trauma but can be from stress or compromised bone
354
What is the diagnostic test of choice for tib/fib fx
X-rays
355
What is the primary Tx for tib/fib fx? What is the ultimate Tx?
Primary Tx = ORIF
| Eventual Tx = total knee arthroplasty
356
This is the MC injury seen in primary care
Foot injury
357
What is a Jone's Fx
Fx at the base of the 5th metatarsal
358
Midfoot injury that occurs when the bones of the midfoot are broken or disrupted due to ligament damage
Lisfrac Fx
359
What is the primary external finding with Lisfrac Fx
Bruising of the plantar side of the foot
360
What is the diagnostic test of choice for Lisfranc Fx
X-ray
361
What is the MC radiographic finding in Lisfranc Fx
Widening of the space b/w the 1st and 2nd metatarsals
362
In which direction do most ankle sprains occur
Inversion
363
What ligament is most commonly affected in ankle sprains
ATF ligament
364
What is the Tx for ankle sprains
MICE (modified activity, ice, compression, elevation)
365
What does SEADS stand for when inspecting the ankle
Swelling, Erythema, Atrophy, Deformity, Surgical Scars
366
What is the MOI for a high ankle sprain
Eversion of the ankle
367
What ligament is involved in high ankle sprains
Anterior tibiofibular ligament
368
What SxS will a pt present with if they have a high ankle sprain
Severe, prolonged pain
Limited ROM
Mild swelling
Difficulty with WB
369
What is a test to assess for high ankle sprain
External rotation stress test to reproduce MOI
370
What is the Tx of a high ankle sprain
Cast or walking boot for 4-6 weeks, PT, crutches and WB protection
371
What is the diagnostic test of choice for high ankle sprains
MRI best to visualize injury
372
What is osteoporosis defined as by WHO
BMD of 2.5 SD or less below the young normal mean (T score < or = to -2.5)
373
What are the unmodifiable RFs for osteoporosis
```
Advanced age
Female
White or Asian
Hx of Fx
Hx of Fx in 1st degree relative
Dementia
```
374
Severe form of osteoporosis caused by a major mutation in the gene encoding for Type 1 collagen
Osteogenesis Imperfecta
375
What is "dowager's hump"
Osteoporosis with fx; T-spine kyphotic deformity that occurs with multiple vertebral compression fxs
376
What is the diagnostic study of choice for osteoporosis
Bone densitometry (DEXA Scan)
377
Painful, softening of the bone =
Osteomalacia
378
What is responsible for the uncoupling of bone resorption and bone formation
Estrogen deficiency
379
When is estrogen deficiency and bone formation most pronounced
5-10 years after menopause
380
What are the indications for DEXA scan in women
```
65 y/o
Postmenopausal with RFs
Postmenopausal with Fx
Considering osteoporosis therapy
Receiving long term hormone replacement therapy
```
381
What is a normal bone T score
-1.0
382
What bone T score indicates osteopenia
-1.0 to -2.5
383
What is osteopenia
Low bone density
384
What bone T score indicates osteoporosis
< -2.5
385
What is characterized as severe osteoporosis
T score < -2.5 with a Fx
386
How much Ca2+ is needed for an adult < 50 y/o
1,000 mg
387
How much Ca2+ is needed for an adult > 50 y/o
1,200 mg
388
What vitamin is required for calcium absorption
Vitamin D
389
At what age should a man get a DEXA scan (if needed)
Age 70
390
What is the 1st line Tx for osteoporosis
Vitamin D + Calcium Supplements
391
What is the 2nd line Tx for osteoporosis
Bisphosphonates (Alendronate, Ibandronate Boniva, Risedronate Actonel, Zoledronic Acid Reclast)
392
What do bisphosphonates do for osteoporosis
Inhib osteoclast induced bone resorption, increase bone density, & reduce incidence of fxs
393
What is 3rd line Tx for osteoporosis
Calcitonin
394
What is the 4th line Tx for osteoporosis
Estrogen
395
When is estrogen therapy for osteoporosis best
Best if started as soon after menopause as possible
396
What is the 5th line Tx for osteoporosis
Selective Estrogen Receptor Modulators (SERMs)
397
What is the 6th line Tx for osteoporosis
Parathyroid hormone
398
What is the 7th line Tx for osteoporosis
RANK Ligand Inhibitors
399
What is non-pharmacological Tx for osteoporosis
Exercise
Diet
PT
400
With what HLA type is Reiter's Syndrome associated
HLA-B27
401
Who is more likely to get Reiter's
Males (increased STDs)
402
Reiter's is remembered with "can't pee, can't see, can't climb a tree" what conditions do these correlate to
```
Pee = urethritis (chlamydial)
See = uvitis
Tree = Arthritis (ankles & knees)
```
403
What are the dermatology findings in Reiter's
```
Circinate blantitis
Keratoderma biennorrhagicum (?spelling)
```
404
What is the Tx of Reiter's
Erythromycin + NSAIDs
405
What are common PE findings with psoriatic arthritis
Nail pitting & DIP involvement
406
What can cause seronegative arthritis
IBD
407
Infection of the bone or bone marrow
Osteomyelitis
408
What are the MC causative pathogens of osteomyelitis
S. aureus
Group B Strep
Salmonella (if hemoglobinopathy)
409
What are 2 bedside clues that your pt has osteomyelitis
- Ability to easily advance a needle through skin ulcer to bone
- Ulcer area > 2 cm3
410
What is the Tx for osteomyelitis
Quinolones (Cipro)
411
What do you add to the Tx for osteomyelitis if the causative agent is S aureus
Add Rifampin to Cipro
412
Inflammation of the joints secondary to infection =
Septic arthritis
413
What is the MC organism associated with septic arthritis
Gonococcal species
414
What are the MC gram-neg pathogens of septic arthritis
E coli
| Pseudomonas
415
Describe the joint pain of septic arthritis
Localized
Asymmetrical
Rapid onset
Erythema
416
What is the affect of septic arthritis on ROM
Decreased active & passive ROM
417
What is a common finding of septic arthritis upon PE
Pain with log roll
418
What is the diagnostic test of choice for septic arthritis
MRI or CT
419
What is the empiric Tx of septic arthritis
Vanco & zosyn or Ceftriaxone
420
Which is more common in adults: primary or secondary bone cysts/tumors
Secondary (mets)
421
Where are Ewings tumors primarily found
Pelvis, femur, humerus, ribs, clavicle
422
Who is most likely to develop an Ewings tumor
Teenagers and young adults, men > women
423
What is the Tx of Ewings tumor
Multi-agent chemo
External beam irradiation
Resection in select cases
424
Malignancy of the plasma cells present in the bone marrow leading to destruction of bone and paraprotein formation
Multiple Myeloma
425
What are pts with multiple myeloma at an increased risk of
Infections from encapsulated organisms (Step pneumoniae & H influenza)
426
What is the chief complaint in multiple myeloma
Bone pain
427
Where is pain MC in multiple myeloma
Ribs, back/spine, proximal long bones
428
What is the diagnostic radiology finding in multiple myeloma
Lytic "punched out" lesion
429
What is the Tx for multiple myeloma
No cure
| Tx = dexamethasone + lenalidomide/thalidomide
430
CA due to transformed cells that produce cartiage
Chondrosarcoma
431
Where are chondrosarcomas MC
Femur, humerus, ribs, & surface of the pelvis
432
What are the radiologic findings of chondrosarcomas
Large, fusiform, lucent defect with scalloping on the inner cortex of the bone
433
What is the Tx for chondrosarcomas
Wide resection
434
Remodeling disease with one or more bony lesions having high bone turnover and disorganized osteoid formation
Paget's disease
435
Why is paget's disease difficult to Dx
Most pts are asymptomatic until late disease
436
What is the 1st symptom of Paget's disease
Bone pain
437
What is a frequent complication in Paget's disease
Frequent "chalkstick" fxs with slight trauma
438
What will be the lab findings of Paget's disease
Elevated alkaline phosphatase in the blood
439
What is the Tx of choice for Paget's disease
Bisphosphonates (Alendronate)
440
Aggressive malignant neoplasm that arsies from osteoblastic CT
Osteosarcoma
441
What is the MC malignancy of bone
Osteosarcoma
442
Who are osteosarcomas most prevalent in
Adolescents
443
How will a pt with an osteosarcoma present
Pain or swelling in a bone or joint, especially in or around the knee
444
What is the x-ray finding with osteosarcoma
Codman's triangle sign
445
What is the Tx of osteosarcoma
Complete radical en-bloc resection
446
What is the MC benign tumor in the hand or wrist
Ganglion cysts
447
What are ganlion cysts d/t
Leakage of joint fluid along the synovial lining through the joint capsule
448
What will you find on PE with ganglion cysts
Firm cystic masses adjacent to the joints that are usually painless
449
What is the MC location for ganglion cysts
Dorsal wrist with origin at the scapholunate joint
450
What is the 2nd MC location for ganglion cysts
Palmar aspect of wrist on radial side
451
What is the Tx for ganglion cysts
Aspiration with wide-gauge needle
452
A "punched out" lesion on x-ray indicates
Multiple myeloma
453
A 'sun ray' lesion on x-ray indicates
Osteogenic sarcoma
454
An 'onion peel' lesion/sign on x-ray indicates
Ewing sarcoma
