Musculoskeletal Flashcards
Injury to shoulder, holds arm in abducted, ext rotated: dx, tx, nerve injry
anterior dislocation, risk axillary nerve injury, reduction with sling
Post vs ant hip dislocation: nerve injury, tx
Ant: obturator
Post: sciatic nerve, AVN
Tx: closed reduction + abduction pillow
CT after reduction
Fall on outstretched hand leads to dorsally placed, dorsally angled fracture: dx, tx
Dx: colles fracture (distal radius
Tx: closed reduction + long arm cast (open if intra-articular fx)
Tenderness in anatomical snuff box: dx and tx
Scaphoid fracture
thumb spica cast; if displacement open reduction
Injury assoc with humerus fx
radial nerve palsy: wrist drop, loss of thumb extension
Tx of ulnar fx
ORIF if significantly displaced
Diaphyseal fx of proximal ulna with subluxation ulnar head: type and tx
monteggia’s fx
ORIF of shaft, closed reduction radial head
Galeazzi fx: diaphyseal fx of radius with dislocation distal radial-ulnar joint: cause and tx
direct blow to radius
ORIF of radius, casting with supination
Tx + complication of femoral fx
Fat emboli
intramedullary nailing, irrigate and debride if open
Common complication of tibila fx
compartment syndrome
limited plantar flexion and + Thompson test (pressure on gastrocnem absent foot plantar flexion): dx and tx
achilles tendon rupture
surgical + long leg cast for 6 weeks
herniate disc: common affected regions, tx
L5-S1
NSAID, PT, local heat, continue normal activity
neck pain, back pains that radiates to buttocks and legs, leg numbness/ weakness; leg cramping worsens with standing, improves with felxion at hips/ bending forward: dx and tx
spinal stenosis
NSAIDS/abd muscle strength
epidural corticosteroids (severe)
Laminectomy (refract)
“onion-skin” on diaphyseal region of femur
ewing sarcoma
soap bubble, on epiphyseal region long bones
giant cell tumor
progressive pain, worsen at night, sumburst pattern on xr: dx and common regions
osteosarcoma
distal femur, proximal tibia, proximal humerus
Empiric tx of septic arthritis
cetriaxone and vancomycin
anti-CCP antibodies
Rheumatoid arthritis
Joints affected: OA vs RA
OA: DIP (heberden) /PIP (Bouchard) / hips/ knees
RA: wrist, MCP, ankle, knee, shoulder, hip, elbo
Rhomboid vs needle shaped crystals: joint pain
Rhomboid: psudogout, + birefring (calcium pyrophosphate)
Needle: gout, neg biref
Acute and long term tx of gout
acute: NSAID > cochicine; steroids
Maintenance: allopurinol (overproducers); probenicid (undersecretors); weight loss + avoid ETOH
Back pain with Decr spine flexion, loss lumbar lordosis, worse with morning: dx and other risks
Ankylosing spondylitis; HLA B27
anterior uveitis and heart block
arthritis, uveitis, conjunctivits, urethritis in young man: dx and cause
reactive/ reiter arthritis
infx with campy, shigella, slamonella, chlamydia, ureaplasma
sausage-shaped digits, DIP joint: dx
psoriatic arthritis
asymmetric sacroilitis: dx and common assoc disease
enteropathic spondylitis, IBD
Symmetric proximal muscle weakness, heliotrope rash: dx and tx
polymyoisits/ dermatomyositis
high dose corticosteroids 4-6 wks
azathioprine/ MTX
Anticentromere Ab
CREST syndrome
Antihistone Ab
Drug-induced SLE
Antimitochondrial Ab
PBC
Anti-smooth muscle B
Autoimmune hepatitis
cANCA vs pANCA
cANCA: Wegener
pANCA: microscopic polyangitis
U1RNP ab
mixed connective tissue disease
RA, splenomegaly, neutropenia
Felty’s syndrome
RA tx
NSAIDs Disease modifying (1st line): MTX, hydroxychloroquine, sulfasalzine
symmetric thickening of skin of face or distal extr, pulm fibrosis: dx and tx
scleroderma Corticosteroids (acute) Penicillamine (skin) Ca Ch block (Raynaud's) ACEI (renal)
noninfectious vegetations on mitral valve: dx and assoc dis
Libman-sacks endocarditis; SLE and APLAS
pain accompanied by loss of function and autonomic dysfunction after trauma: dx and tx
Complex regional pain syndrome
NSAIDS, corticosteroids, low-dose TCAs, gabapent
Chemical sympathetic block
Fibromylagia vs polymyalgia rheumatica: joints involved and tx
Fibromylagia: various joints (>11 of 18, all 4 regions body); NSAIDs, Antidepr, rest, PT
Polymyalgia rheumatica: shoulder + pelvic girdle; low-dose prednisone
Muscle Bx: necrotic muscle fibers, variation in fiber size with fibrosis: Dx and tx
Neg dystrophin
Duchenne
PT, use of tendon release to maintain mobility
Cause of death: DMD
pulm congestion caused by high output cardiac failure
Refusal to bend elbow after being lifted by arm: dx and tx
nursemaid elbow (radial head subluxation) manual reduction by gentle supination of elbow at 90deg fexion; no immobilization
Supracondylar humerus fx: risk + tx
brachial artery entrapment, Volkmann contracture (compartment syndr)
cast immobilization
hip dysplasia: tx by age
Limited abduction and internal rotation, painless limp or groin pain: dx and tx
legg-calve-perthes
AVN femoral head
observation if nl ROM. pracing
pediatric acute groin or knee pain, painful , inability to bare weight, limited internal rotation and abduction: dx and tx
AP and frog leg laterals, TSH
Slipped capital femoral epiphysis
percutaneous single-screw fixaiton, no weight bearing until surgery
Arthritis, high-spiking fevers, maculopapular, evanescent salmon-colored rash (pediatric)
Still’s disease
