Musculoskeletal Flashcards
At what age should you begin ordering dexa scans for male patients? For female patients?
70 for males, 65 for females
Give the DEXA score for osteopenia and osteoporosis
Osteopenia = 1 to 2.4 standard deviations, osteoporosis = 2.5 standard deviations or greater
What fracture is the #1 cause of compartment syndrome?
Tibial shaft fracture
A patient’s lab work shows positive Smith antibody and positive double-stranded DNA antibodies. What is the most likely diagnosis?
Lupus
Where are Bouchard’s nodes found?
Proximal interphalangeal joint (PIP)
What will an xray show in acute osteomyelitis?
Nothing.
It will show bone destruction in chronic osteomyelitis
What is the best imaging to diagnose osteomyelitis?
Either a bone scan or an MRI will provide the diagnosis
A 22 year old male patient presents with what is clearly a septic knee. You also notice lesions on his hands and feet. What is the most likely pathogen?
Neisseria gonorrhoeae
What would you expect the WBC count to be in the joint fluid of an infected knee?
> 50,000 at a minimum and probably much higher
A patient presents with a painless mass in her right wrist. What is the most likely diagnosis?
Ganglion cyst
What is the age range for osteosarcoma? Where are they most typically found in the body?
Osteosarcoma usually occur in 15-25 year old males and are most commonly found around the knee
You think a patient may have an osteoid osteoma due to his complaints of severe night pain. You set him up for an xray. But in the meantime, what medication do you start him on?
If it is truly an osteoid osteoma, ibuprofen will resolve his pain.
Clicking or locking of the knee indicates what diagnosis?
Meniscal tear
A 65 year old presents complaining of severe pain in his great toe that began when he woke up this morning. It is swollen, red and very tender. What is the most likely diagnosis?
Gout would be number one bc of the location, but you might also think about an infection
What uric acid level helps to confirm a diagnosis of gout?
> 7.5
What is the medical treatment for gout?
Allopurinol, colchicine
A pathology report comes back with positive birefrigent crystals. What is the most likely diagnosis?
Pseudogout
A patient with a history of hepatitis B presents complaining of bilateral knee pain, fever, and weight loss. What is the most likely diagnosis?
Polyarteritis nodosa
You suspect a patient has polyarteritis nodosa. What is the test for a definitive diagnosis and what is the treatment?
Biposy, high dose steroids
On physical exam, you notice ulnar deviations and swan neck deformities. What is the most likely diagnosis?
Rheumatoid arthritis
A positive Neer’s test indicates what diagnosis?
Rotator cuff impingement
List three medications that may cause lupus
Procainamide, isoniazid, and Quinidine
What test do you do for Sjogren’s syndrome?
Schirmer test
A patient with rheumatoid arthritis is heading to the OR for an open reduction and internal fixation of the ankle. In addition to ankle films, what other xrays should you get?
C-spine. Anesthesia will want them due to concerns about instability of C1 and C2.
Which carpal bone has a high rate of nonunion and occult fracture?
Scaphoid
What medication is used for patients with lupus?
Systemic steroids
Scleroderma limited version has 5 main characteristics for which the CREST acronym is often used. What are those 5 things?
Calcinosis, Raynaud’s, Esophageal dysmotility, sclerodactyly, telangiectasia
This is a sunburst appearance on xray. What is the most likely diagnosis?
Osteosarcoma
Anatomically where are 80% of clavicle fractures located?
Middle third
A pathology report comes back showing negatively birifringent crystals. What is the most likely diagnosis?
Gout
What are the four muscles of the rotator cuff?
Commonly referred to as the SITS muscles - Supraspinatus, Infraspinatus, Teres minor, Subscapularis
Describe the characteristics of a lytic lesion on xray
Spiculated, elevated periosteum, bone destruction (think bad, very bad things)
What ligament is most commonly injured in an ankle sprain?
ATFL - anterior talofibular ligament
Vasculitis with a hepatitis B history should make you think of what diagnosis?
Polyarteritis nodosa
What is the most common fracture in children?
Clavicle
A fat pad sign on a lateral xray of the elbow has what significance?
It is blood in the joint indicating a fracture even if the fracture line cannot be seen.
A patient presents with progressive neck and proximal muscle muscle weakness. On physical exam, you see a reddish purple maculopapular rash. Her lab work shows an anti-Jo-1 antibodies. What is the most likely diagnosis?
Polymyositis
Which way does a Colles fracture angulate: dorsal or volar? What about a Smith fracure?
Colles = dorsal Smith = volar
Tenderness over the anatomical snuffbox is indicative of what fracture?
Scaphoid
What is the most common fracture in a patient with osteoporosis?
A compression fracture of a vertebral body followed by hip fractures
A 15 year old boy presents complaining of night pain in the pelvis. Since you have no idea what to do, you order an xray. The report comes back with a description of a mass with an “onion skin appearance.” What is the most likely diagnosis?
Ewing sarcoma
What is the name for the 4th and 5th metacarpal fractures that often result from throwing a punch?
Boxer’s fracture
A new mother presents with pain over the radial wrist. She has a positive Finkelstein’s test. What is the most likely dignosis?
de Quervain’s tenosynovitis
A positive McMurry indicates what diagnosis?
Meniscal tear
What is the first line treatment for carpal tunnel?
Night splint
What is the most common cause of C-Spine fractures?
Motor vehicles accidents
What is the medical term for hunchback?
Kyphosis
What is another term for podagra?
Gout in the toe
A patient presents to the ER with saddle anesthesia and loss of bowel and bladder function. What is the lost likely diagnosis?
Cauda equina
A patient with HIV presents with severe groin pain. What is the most likely diagnosis?
Avascular necrosis of the femporal head. Anti-retroviral medications put patients at an increased risk of AVN.
A 95 year old female presents to the ER after a fall in her home. Her leg is shortened and externally rotated. What is the most likely diagnosis?
Hip fracture
You recommend bisphosphonates for a patient with osteoporosis. What instruction do you give her for immediately after taking the medication?
Remain upright for 30 minutes
What is the most common cause of a hip dislocation? Is it usually anterior or posterior?
MVA, posterior
Which of the four rotator cuff muscles is most commonly injured?
Supraspinatus
What us the medical term for tennis elbow?
Lateral epicondylitis
What is the first line treatment for rhmeumatoid arthritis?
Methotrexate
A patient presents to the ER after taking a baseball bat to the knee. He is unable to actively extend his knee. What is the most likely diagnosis?
Patella fracture
Are most shoulder dislocations anterior or posterior?
Anterior
What is the most useful physical exam test for diagnosing an ACL tear?
Lachman’s, followed by anterior drawer
What is the most common knee injury?
Medial meniscal tear
Where are Heberden’s nodes found?
Distal Interphalangeal joint (DIP)
A patient presents with knee pain following a soccer game 2 days ago. He has joint line tenderness medially and feels a locking in the knee from time to time. What two physical exams should you do?
This is probably a medial meniscal tear.
McMurry and Apley tests would be appropriate.
A patient presents with conjunctivitis, urethritis, arthritis, and oral lesions. What is the most likely diagnosis? What other lab might you expect to be positive?
Reactive Arthritis
HLA B-27
A 46 year old male comes into the ER limping a little on the right side. He states that it felt as though he was kicked in the back of the leg during a soccer game, but clearly no one was behind him. What is the most likely diagnosis?
Achilles tendon rupture
Anti-Jo-1 antibodies should make you think of what diagnosis?
Polymyositis
A positive cross-over test indicates what diagnosis?
Acromioclavicular joint injury (AC joint)
A positive Hawkins test indicates what diagnosis?
Rotator cuff impingement
A positive Finkelstein’s test indicates what diagnosis?
de Quervain’s tenosynovitis
A positive Phalen and Tinnel’s sign indicates what diagnosis?
Carpal tunnel
A bamboo spine indicates what diagnosis?
Ankylosing spondylitis
A positive straight leg test indicates what diagnosis?
Herniated disc
An African American female presents with malar rash and a double-stranded DNA antibody. What is the most likely diagnosis?
Lupus
Carpal tunnel affects what nerve and what parts of the hand?
Median nerve
Thumb, pointer, and ring fingers. Thenar wasting is a sign of advanced disease
A patient has a silver-fork deformity on xray. What is the most likely diagnosis?
Colles fracture
A positive Apley test indicates what diagnosis?
Meniscal tear
