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PPC2 Exam 3 > Musculoskeletal 2 > Flashcards

Musculoskeletal 2 Flashcards

1
Q

Osgood Schlatter Syndrome Patho (4)

A

REPETITIVE USE INJURY CAUSING PAINFUL LIMP BELOW THE KNEE CAP

  1. Traction apophysitis of the tibial tubercle
  2. Chronic avulsion of secondary ossification center
  3. Repetitive strain of quadriceps produce cartilage to be pulled away leading ossification and enlargement
  4. Quadriceps inserts on to the tibia
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2
Q

Osgood Schlatter Syndrome Clinical Presentation and Dx (4)

A
  1. Pain over anterior tibial tuberosity
  2. Pain exacerbated with activity
  3. Chronic nature lasting 12-24 months
  4. Usually a non X-ray diagnosis but will be done to make sure it’s not a tumor
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3
Q

Treatment of OSS (5)

A
  1. Ice
  2. Rest
  3. NSAIDS
  4. Stretch hamstrings
  5. Quads strengthening exercises
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4
Q

Sinding-Larsen Johansson Disease (3)

A
  1. Inferior pole of patella; injury of tissue connecting kneecap to shin bone
  2. Patella periosteum can create same stress of apophysis of tibial tubercle
  3. X-ray irregular calcifications at end of patella
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5
Q

Severs Disease (7)

A
  1. Calcaneal apophysitis – injury/inflammation of the growth plate in the heel (apothesitis at the heel)
  2. Apophyseal insertion of the Achilles tend into the calcaneus
  3. 9-14, peak at 10-11
  4. Tends to be bilateral
  5. Shoe inserts will help
  6. Ice, NSAIDs and activity modification
    * Activity modification – stop when you get pain
  7. Common in male soccer players because soccer shoes are flat
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6
Q

Soft Tissue Injury (6)

A
  1. Be careful of salter harris fractures type I
  2. Significant swelling
  3. Acute trauma (ex: ankle sprain – lateral collateral ligaments; young children have open epiphysis so need to check for salter harris fracture)
  4. Anterior cruciate ligament injuries
  5. Can cause extreme pain/swelling even if child doesn’t have a fracture
  6. Injury to growth plate that doesn’t heal well == child won’t grow on that side
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7
Q

Slipped Capital Femoral Epiphysis: General (6)

A
  1. AN ORTHOPEDIC EMERGENCY
  2. Non-inflammatory
  3. Femoral head is displaced from femoral neck
  4. Lib is flexed and externally rotated
  5. Passive internal rotation of the hip
  6. Salter-Harris Type I fracture through the physeal plate of proximal femur resulting in displacement
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8
Q

SCFE Incidence (6)

A
  1. Overweight boys 10-14 years old; suspect in any adolescent who complains of hip or knee pain
  2. Twice as common in males (12-15) than females (10-13)
  3. More common in African Americans
  4. Occurs during growth spurt
  5. Most common hip disorder in adolescence
  6. Common w/ underlying endocrine disorders
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9
Q

SCFE Risk Factors (4)

A
  1. Obesity
  2. Renal osteodystrophy
  3. Endocrine disorders including hypothyroidism and hypopituitarism.
  4. Bilateral involvement of the hips can be seen in 20-30% of patients, but it is unusual to present at the same time
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10
Q

SCFE History (5)

A
  1. Acute, chronic or subacute
  2. Limp and pain in hip, groin, thigh, or knee
  3. Symptoms for greater than 2 weeks
  4. Progressive external rotation and limb shortening
  5. Gait antalgia is worse
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11
Q

SCFE Exam (4)

A
  1. External rotation and adduction
  2. Gait is painful
  3. Hip externally rotated
  4. Thigh muscle atrophies
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12
Q

SCFE Classification (3)

A
  1. Minimal: less than 1/3 of the upper metaphyseal width of femoral neck
  2. Moderate displacement: 1/3 to 1⁄2
  3. Severe: > ½
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13
Q

SCFE Imaging (3)

A
  1. Frogleg lateral views are often essential for diagnosis
  2. On frogleg views, a line drawn tangential to the lateral cortex of the metaphysis should bisect a portion of the ossified epiphysis.
    a. Ice cream falling off the cone appearance
    b. Femoral head can be mottled and flat
  3. If the epiphysis is medial to this tangential line, SCFE is the diagnosis.
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14
Q

SCFE Treatment and potential complication (2)

A

Treatment of SCFE: Surgically with pin fixation (done at current location) to prevent further slippage.

Potential complications: Avascular necrosis and chondrolysis

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15
Q

Benign Bone Tumors (6)

A

a. Osteochondroma (exostosis)
b. Endochondroma
c. Chondroblastoma
d. Chondromyxoid fibroma
e. Osteoid osteoma; 10% to 12% of all benign tumors
f. Osteoblastoma (1%)* 3% of all benign tumors

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16
Q

Malignant Bone Tumors (6)

A

a. Ewing’s
b. Osteosarcoma
c. Chondrosarcoma
d. Malignant fibrous histiocytoma
e. Small cell osteosarcoma
f. Adamantinoma

Pain is more common with malignant lesions, usually present at rest or at night, and nonresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs) or weak narcotics

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17
Q

Osteosarcoma: male to female ration, race and common site of origin

A

Male to Female: 1.5 to 1 (more common in males)

Race: All races

Common Site of Origin: metaphysis of long bones (80%-90%)
*Distal femur > proximal tibia > proximal humerus > middle and proximal femur > other bones

18
Q

Ewing’s Sarcoma: male to female ration, race and common site of origin

A

Male to Female: 1.3 to 1.5

Race: Primarily white

Common Site of Origin: long bones (30%)
*Femur > ilium > tibia > humerus > fibula > ribs
Metadiaphysis (59%), Diaphysis (35%), Pelvis (26%) Spine (11%)
*Occasionally soft bone

19
Q

Ewing’s Sarcoma radiographic findings (3)

A
  1. Onion skinning
  2. Primarily lytic
  3. Imaging shows lucency; smooth indentation (saucerization)
20
Q

Ewing’s Sarcoma Presentation (6)

A
  1. Localized, intermittent, and variable pain with a palpable mass
  2. Swelling in a bone or joint athletic injury may be implicated as the cause of pain, leading to a delay in diagnosis.

Systemic symptoms

  1. Fever
  2. Elevated inflammatory markers- ESR, WBC, and LDB
  3. Malaise
  4. Weight loss; in advanced disease
21
Q

Ewing’s Sarcoma average age

A

15 years old

22
Q

Osteosarcoma Radiology (3)

A
  1. Plain radiographs
  2. Sclerotic destruction with bone forming lesion
  3. Occasional mineralization often extending into the surrounding soft tissues, described as a classic “sunburst” appearance
23
Q

Osteosarcoma Lab Findings (3)

A
  1. Lactate dehydrogenase (LDH) concentrations elevation in 30%
  2. Alkaline phosphatase concentrations elevations in 40%
  3. Erythrocyte sedimentation rate (ESR) elevations
24
Q

Osteosarcoma Origin and common areas (4)

A
  1. Origin: osteoblasts (arise from either medullary cavity or bony cortex)
  2. Found in: humerus, distal femur, proximal tibia
  3. Most common in 10-25 years old
  4. More common in black than white children
25
Q

Osteosarcoma Risk factors (3)

A
  1. radiation exposure
  2. rapid bone growth
  3. genetics
26
Q

Osteosarcoma radiographic findings (4)

A
  1. Large, aggressive, eccentric lesion (can be either sclerotic, lucent, or both)
  2. Lesions usually do not cross the physis “moth-eaten” appearance with “sunburst” periosteal reaction or Classic Codman triangle
  3. Pathologic fractures at time of presentation
  4. Large soft tissue component
27
Q

Leukemia: General (4)

A
  1. Bone pain is the presenting feature of leukemia in 50% of newly diagnosed children
    * Must think of leukemia with bone pain
  2. Generalized and nonspecific pain rather than localized.
  3. Radiographs may appear normal; 25% of patients, have faint lines that look like growth arrest lines and are called leukemic lines
  4. Get CBC with diff and smear if you suspect this
28
Q

Arthropathy with Leukemia (3)

A
  1. Pain is severe
  2. Lab tests show anemia, leukopenia, thrombocytopenia, blasts
  3. X-rays show lucent metaphyseal bands with sclerotic densities
29
Q

Chondrosarcomas

A

locally aggressive intramedullary lesions; treated by removal

30
Q

Malignant Fibrous Histiocytomas (3)

A
  1. High-grade malignant pleomorphic bone tumors in individuals older than 40 years of age.
  2. Small cell osteosarcomas rare variant of osteosarcoma
  3. Poor prognosis
31
Q

Adamantinoma (3)

A
  1. Low-grade, slowly progressive lesions
  2. Exclusively in the diaphysis of the tibia
  3. Metastasize to lungs, lymph nodes, and bones, with a 20% risk of recurrence.
32
Q

Osteoid Osteoma Clinical Presentation (5)

A

BENIGN LESION

  1. Pain
  2. Acute, intense, unremitting, of sudden onset
  3. Not associated with exercise or trauma, worse at night and at rest
  4. Responsive to NSAIDs.
  5. Common sites are the femur and tibia
33
Q

Osteoid Osteoma on Plain Radiograph

A

Stalk or projection from the bone surface <2cm

34
Q

Osteoid Osteoma Management

A
  1. Are not removed (curettage/resection) unless the lesions cause pain or risk joint destruction.
  2. Orthopedist and radiographs annually
35
Q

Four Diagnostic Features of OO

A
  1. A sharp round or oval lesion
  2. Less than 2 cm in diameter
  3. Has a homogeneous dense center
  4. 1-2 mm peripheral radiolucent zone
36
Q

McCune-Albright Syndrome: Triad of Features

A
  1. Polyostotic, usually unilateral, fibrous dysplasia
    * BONE LESIONS
  2. Endocrine abnormalities (precocious puberty, hyperthyroidism)
  3. Cafe au lait spots
37
Q

Solitary Osteochondromas (4)

A
  1. 85% to 90% of all such lesions
  2. Nonhereditary
  3. Most are asymptomatic
  4. Developmental abnormality of bone
38
Q

Multiple Osteochondromas or Exostosis (3)

A
  1. 10% to 15% of osteochondromas
  2. Hereditary multiple osteochondromas or exostoses
  3. More likely to have pain due to irritation of adjacent structure or growth disturbance or fracture of pedicle
39
Q

Osteochondromas Patho (3)

A
  1. It occurs when part of the growth plate forms an outgrowth on the surface of the bone.
  2. Outgrowth may or may not have a stalk.
    * When a stalk is present, the structure is called pedunculated.
    * When no stalk is present, it is called sessile.
  3. An osteochondroma may grow in a child or adolescent; Its growth usually stops at maturity.
40
Q

Osteochondromas Management

A
  1. Observation
  2. Surgical management of curettage and excision may be needed for:
    a. Large lesions
    b. Lesions proximal to a joint
    c. Lesions with premalignant features
    d. Lesions involving more than 50% of the bone diameter may require curettage and bone grafting due to the risk of pathologic fracture.
41
Q

Multiple Hereditary Exostosis (6)

A
  1. Autosomal dominant disorder; Autosomal dominant disease characterized by multiple, usually sessile, osteochondromas.
  2. Knee, ankle and shoulder are simultaneously affected.
  3. Increased risk of joint deformity
  4. Limitations in range of motion
  5. Increased risk of malignant degeneration.
  6. These patients get referred; make sure they go for follow-up

PPC2 Exam 3 (14 decks)

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