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Musculoskeletal Flashcards

0
Q

Rotator cuff muscles

A

S- supraspinatus
I- infraspinatus
T- teres minor
S- subscapularis

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1
Q

SALTER

A 
Epiphyseal fractures
S-strait
A-above or away from joint
L- lower
T- through
R- rammed
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2
Q

Gout

A

Increased risk with thiazides and etoh consumption. Test of choice is inspiration of joint fluid.

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3
Q

Gout crystals

A

Negative bifringent crystals

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4
Q

What medication works well for anticoag in ortho surgery?

A

Low molecular weight heparin

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5
Q

Slipped capital femoral epiphysis (SCFE )

A

Ortho emergency, chubby teenager limping and can’t internally rotate with possible referred pain to knee or thigh

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6
Q

HLA-B27

A

Ankylosing spondylitis

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7
Q

To avoid what nerve do you give injections in the upper outer buttock

A

Sciatic

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8
Q

Rhomboid positive bifringent calcium pyrophosphate crystals

A

Pseudo gout

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9
Q

Fusion of the vertebrae, is joint involvement, am lower back pain better with exercise, seronegative, hLAB27

A

Ankylosing spondylitis

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10
Q

If you suspect ankylosing spondylitis what should you rule out first?

A

Chrones or ulcerative colitis…. 10-20% mimic AS

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11
Q

Increased age, obesity, decreased joint spaces on X-ray weight bearing joints, crepe dis on exam is?

A

Osteoarthritis

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12
Q

Monoarticular swelling and pain, fever, adult, with WBC over 50,000 think?

A

Septic arthitis and aspirated fluid. Could be gout could be ghonococcal disease.

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13
Q

ANA positive, rash on face, arthritic pain, oral ulcers, protein urea, painful discoid rash on fingers, what is the treatment?

A

SLE, treatment is methotrexate, NSAIDs, steroids.

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14
Q

First line of treatment for gout.

A

High dose NSAIDs

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15
Q

Inhibits formation of uric acid and therefore decreases it in the serum and ruin. Also decreases the size of tophi. Don’t use in acute attacks.

A

Allopurinol.

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16
Q

This med has no effect on uric acid levels and is given in acute attacks.

A

Colchicine

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17
Q

Prolonged ischemia followed by reperfusion, mc found in forearm or lower leg, pain with passive extension.

A

Compartment syndrome

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18
Q

Dx for adult with Monoarticular arthritis?

A

Arthrocentesis

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19
Q

What is the first line treatment for patients with symptomatic rheumatic arthritis?

A

DMARDS, methotrexate

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20
Q

Atlas

A

C1

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21
Q

Axis

A

C2, Odontoid process can break off after hyperextension and cause bony fragments that injure spinal cord.

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22
Q

MC fx of the wrist. Fx to the distal radius with DORSAL displacement, dinner fork deformity.

A

Colles fx, splint x 6 wks

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23
Q

Fx of distal radius with volar displacement.

A

Smith fx

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24
Q

Radial styloid fx, chauffeur fx.

A

Hutchensons fx, thumb spica or sugar tong splint

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25
Q

Origin of phrenic nerve

A

C3-c5. Injury below and the diaphragm works.

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26
Q

Which nerve

Is involved in carpal tunnel?

A

Median

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27
Q

A malignant bone tumor that produces osteoid and bone, sunburst appearance on X-ray, periosteal elevation that forms an angle with bone cortex

A

Osteosarcoma.

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28
Q

Excessive bone resorption replaced by soft matrix (osteoid), X-ray shows enlarged translucent bone, patient is usually over 40, bone fx, hearing loss, increased alk phos,

A

Padgets disease

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29
Q

Central cord syndrome

A

Hyperextension of neck and patient only has upper extremity deficits, lower extremities normal

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30
Q

All function lost except positional and vibratory

A

Anterior cord syndrome

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31
Q

Loss of only positional and vibratory sense, rare

A

Posterior cord syndrome

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32
Q

Non inflammatory joint dz with loss of articular cartilage, osteophytes, deep aching joint pain worse with use, relieved with rest. Obesity and increased age are risk factors.

A

Osteoarthritis

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33
Q

Autoimmune dz, joint pain in am, sx greater than 30 min, bony erosions on X-ray, joint pain, swelling, low grade fever, malaise, vasculitis, rheumatic nodules, scleritis, anemia.

A

Rheumatoid arthritis

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34
Q

Stress reaction of the insertion of the patellar tendon to the tibial tubercle.

A

Osgood schlater disease. Tx is stop offending activity.

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35
Q

A vascular necrosis of the femoral head. Limping patient with mild intermittent pain that may refer to thigh or knee. Normal née exam.

A

Legg calve perthes disease.

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36
Q

Nerve injured with foot drop

A

Deep peronial

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37
Q

Nerve injured with clawing of the toes

A

Tibial nerve

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38
Q

Young middle aged woman with rash on face, hair loss, fatigue, apples on fingers that are tender, and increased protein in urine?

A

SLE

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39
Q

Pos ANA

A

RA, SLE, scleroderma, polymyositis, dermatomyosis

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40
Q

Anti-ds DNA

A

SLE

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41
Q

RF

A

RA

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42
Q

Anti-Sm (ith)

A

SLE

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43
Q

Anti-ro, Anti-La

A

Sjogrens

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44
Q

Anti-SCL 70

A

Scleroderma

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45
Q

Anti-centomere

46
Q

ANCA

47
Q

Anti-histone

A

Drug induced lupus

48
Q

What drugs can cause lupus?

A

Procanamide, hydralazine

49
Q

Disease common 5-25 yrs, lower extremity and spine. Presents with pain at night and relieved with ASA/NSAIDs and X-ray shows sclerotic lesions with nidus. Tx is surgery.

A

Osteoid osteoma.

50
Q

Chronic localized bone abscess, treat with abx and/or surgery.

A

Brodie abscess.

51
Q

Malignant tumor of the bone arising in the medullary base. MC in cylindrical bones. Sx are pain, fever, leukocytosis. X ray shows onion skin appearance.

A

Ewing sarcoma

52
Q

Pathologic fracture- fx through weakened bone. What is the MC cause?

A

Metastatic cancer. Women breast, men lung.

53
Q

What is the unhappy triad that is injured from a lateral blow to the knee?

A

MAMM: MCL, ACL, medial meniscus.

54
Q

What is a risk after surgical repair of a long bone fracture?

A

Fat embolism.

55
Q

A patient has fatigue, swelling of the hands, raynauds syndrome, skin tightness, gerd, telangectasias, and pulmonary nodules. What is it?

A

Scleroderma.

56
Q

What causes scleroderma?

A

Over production of collagen

57
Q

Supplements for those on long term steroid tx?

A

Calcium and vitamin d

58
Q

What food to avoid with gout?

A

Nucleic acids, they make purine!

59
Q

What med can you give in marfans to slow down the MC vascular issue?

A

Aortic root dissection, give a beta blocker

60
Q

What is an infection that causes arthritis, conjunctivitis, urethritis?

A

Reiter syndrome

61
Q

Reiter syndrome is related to what marker?

62
Q

What med can you give for a benzo overdose? (Midazolam)

A

Flumazenil

63
Q

Oipeates overdose?

A

Give naloxone.

64
Q

What is the disease that causes a deformity in the synthesis of type 1 collagen?

A

Osteogenesis imperfecta.

65
Q

Sx of osteogenesis imperfecta?

A

Increase fractures in childhood, blue sclera, hearing loss and dental issues. Parents should have genetic counseling.

66
Q

Sx are waist down painful purpura, arthritis, abdominal pain in a child. Usually had a viral illness prior. Most common vasculitis in children.?

A

Henoch schoenlein purpura.

67
Q

Two areas affected in dequervians tensoynovitis.

A

Extensor pollicus brevis, abductor pollicus longus

68
Q

Fixed kyphosis at puberty, treat with brace and PT

A

Scheuermanns disease

69
Q

Scoliosis

A

Lateral curve of spine, right more common. 15-20% serial X-ray, 20-45% brace, 40 or more refer

70
Q

Fracture of C1

71
Q

Fracture of c6/c7?

A

Clay shovelers fracture

72
Q

Old person with fall, short leg with external rotation?

73
Q

Fx of the base of the 5th metatarsal…. Short leg cast 6-8 wks

74
Q

Osteomyelitis with sickle cell bug?

A

Salmonella

75
Q

Osteomyelitis with IV drug user?

A

S. Aureas or pseudomonas

76
Q

Osteomyelitis with in dwelling cath?

A

Think candida

77
Q

Osteomyelitis with diabetes?

A

Think corny bacterium or anaerobes.

78
Q

What is the median nerve responsible for?

A

Thumb strength, flexion of 2/3 digit at MCP. Sensation of 2/3 digits.

79
Q

What mess are contraindicated in a person with gout?

A

Thiazides and ASA. They increase uric acid levels.

80
Q

What nerve is injured with a winged scapula?

A

Long thoracic nerve

81
Q

If a patient abruptly stops long term steroids they can go into a?

A

Addisonian crisis.

82
Q

What is the most dislocated carpal bone?

83
Q

What is the most commonly fractured carpal bone?

A

Scaphoid. Look for avascular necrosis.

84
Q

Gout crystals?

A

Negatively bifringent crystals

85
Q

Pseudo gout crystals?

A

Positively bifringent calcium pyrophosphate crystals.

86
Q

Gout causes what kind of nodes?

87
Q

Osteoarthritis causes what nodes?

A

Herberdens and bouchardes

88
Q

Rheumatoid arthritis causes nodes where?

A

Sub q nodes on extensor surfaces.

89
Q

Describe a ruptured disk.

A

Weakened outer annulus fibrosis herniates the nuculus pulposis posterior lateral direction.

90
Q

A patient after seizure complains of shoulder pain?

A

Check for rare posterior dislocation, often missed on one view X-ray.

91
Q

MC cause of septic arthritis?

A

S. Aureus , hex of joint trauma or hematogenous spread.

92
Q

MC form of joint disease, non-inflammatory, pain worse in am and worse with activity. Improves with rest. Crepitus on exam and narrow joint space on X-ray. What is it?

A

Osteoarthritis

93
Q

Dx and treatment of fibromyalgia?

A

11/18 pos tender points, tricyclic antidepressants, exercise and education.

94
Q

Juvenile idiopathic arthritis…..

A

Chronic arthritis , 6-12 wks, one or more joints, swelling warmth and tenderness, morning stiffness and decreased ROM, if a high fever think stills disease.

95
Q

Tx for juvenile idiopathic arthritis?

A
  1. NSAIDs 2. Methotrexate MUST give folic acid
96
Q

Ulnar fx with radial head dislocation.

A

Monteggia fx

97
Q

Radial fx with ulnar dislocation

A

Galeazzi fx

98
Q

GRUM

A

Galeazzi/radial fx

Monteggia/ ulnar fracture

99
Q

Progressive fissuring of vertebrae and SI joint with bamboo spine on X-ray, SeroNegative, HLA-B27 pos, worse in am better with activity.

A

Ankylosing spondylitis

100
Q

Ankylosing spondylitis tx?

A
  1. NSAIDs

2. Tnf blockers

101
Q

Lumbar root for medial thigh?

102
Q

Lumbar root for knee reflex, quads, lateral thigh and medial calf?

103
Q

Lumbar root for lateral calf and dorsal foot?

104
Q

Lumbar root for Achilles reflex, lateral foot and ankle?

105
Q

What is polyarteritis nodosa and what are the s/s?

A

Vasculitis involving medium sized arteries. Palpable purpura, post prandial abdominal pain, with increased ESE and UA pos for blood and protein. Ex is tissue biopsy, tx with steroids.

106
Q

An idiopathic inflammatory myopathy affecting women 40-50 yrs, with a gradual progressive bilateral proximal muscle weakness (legs first) and complain of difficulty rising out of a chair. No facial involvement. Dx with muscle bx and tx with corticosteroids.

A

Polymyositis.

107
Q

An idiopathic inflammatory myopathy, women more than men, 40-50 yrs, with bilateral proximal weakness, a dusky rash on neck shoulders and upper chest and related to occult malignancy?

A

Dermatomyositis

108
Q

Scaly pink patches over dorsal PIP and MCP are what and related to what?

A

Gottron sign related to dermatomyositis. Check for malignancy!

109
Q

First step after dx of dermatomyositis?

A

Check for malignancy! Treat inflammation with steroids.

110
Q

45 year old female complains of an achy stiffness in shoulders and hips worse in the am, for over an hour, fatigue, weight loss, and low grade fever. Dx?

A

Poly myalgia rheumatica, linked to giant cell arteritis.

111
Q

This is a reactive arthritis in response to an infectious process elsewhere in the body. Patient is male and complains of sausage toes, eye pain, painless ulcers on hands and soles, knee pain, and pain with urination.

A

Reiters syndrome. Tx with abx, indocin, steroids.

112
Q

In this disease lymphocytes invade exocrine glands. It also has an increased relation to B cell lymphoma.

113
Q

S/s of Sjögren’s syndrome?

A

Dry eyes, dry mouth, dry skin, polyarthralgia, dysphasia, fever, malaise.

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