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A1 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Anterior dislocation of the shoulder risks injury to what nerve?

A

Axillary

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2
Q

Axillary nerve injury manifests how?

A

Abduction and external rotation of the arm

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3
Q

Posterior dislocation of the shoulder is associated with what sort of injury mechanism?

A

Seizures or electrocution

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4
Q

How does the arm hang with posterior dislocation of the shoulder?

A

Adduction and internal rotation

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5
Q

Humerus fractures risks injury to which nerve? How does this manifest?

A

Radial nerve

Wrist drop and loss of thumb extension

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6
Q

What is a nightstick fracture? Treatment?

A

Fracture of the ulnar shaft

ORIF

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7
Q

What is a monteggia fracture? treatment?

A

Diaphyseal fracture of the proximal ulna, with subluxation of the radial head

ORIF

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8
Q

What is a Galeazzi fracture? treatment?

A

Diaphyseal fracture of the radius with dislocation of the distal radioulnar joint.
ORIF

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9
Q

What is a colles fracture? Treatment?

A

fracture and dorsal displacement of the distal radius

Closed reduction and arm cast

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10
Q

What is the most commonly fractured carpal bone?

A

Scaphoid

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11
Q

What is the treatment for a scaphoid fracture?

A

Thumb spica cast

If displaced or scaphoid nonunion, then open reduction

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12
Q

What is a Boxer’s fracture? Treatment?

A

Fracture of the fifth metacarpal

Close reduction and ulnar gutter splint

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13
Q

What is the presentation of a posterior hip dislocation?

A

Internally rotated

Adducted

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14
Q

What nerve is at risk with a posterior dislocation of the hip? Anterior?

A 
Posterior = Sciatic
Anterior = obturator
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15
Q

What is the treatment of a hip dislocation?

A

Closed reduction followed by abduction pillow/bracing

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16
Q

How do hip fractures present?

A

Shortened and externally rotated leg

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17
Q

Displaced femoral neck fractures are associated with what condition?

A

Risk of AVN and DVTs

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18
Q

What is the treatment for a hip fracture?

A

ORIF, with anticoagulation after to reduce risk of DVTs

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19
Q

Fat emboli classically result from breakage of what bone?

A

Femur

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20
Q

What is the treatment for a femoral fracture?

A

Intramedullary nailing of the femur

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21
Q

What is the treatment for MCL/LCL tears?

A

Conservative management

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22
Q

How are ACL tears treated?

A

Treatment of ACL injuries in active patients is generally surgical with graft from the patellar or hamstring tendons.

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23
Q

When is PCL tear operated on?

A

Athletes

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24
Q

How do meniscal tears usually occur?

A

Acute twisting injury or a degenerative tears

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25
Q

What needs to be watched out for with tibial fractures?

A

Compartment syndrome

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26
Q

What is the treatment for tibial fractures?

A

Casting vs ORIF

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27
Q

What is the Thompson test?

A

Pressure on the gastrocnemius leading to absent foot plantar flexion

Indicates achilles tendon tear

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28
Q

What is the treatment for a achilles tendon tear?

A

Surgery followed by a long-leg cast for 6 weeks

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29
Q

What sort of burns are a concern for compartment syndrome?

A

Circumferential burns

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30
Q

What is the delta pressure for diagnosing compartment syndrome, and what indicates a positive test?

A

(diastolic pressure – compartment pressure); ⊕ if delta pressure ≤ 30 mm Hg).

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31
Q

How soon should patients with an open fracture be taken to the OR?

A

Within 8-24 hours

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32
Q

What is the motor and sensory deficit associated with injury to the radial nerve?

A 
Motor = loss of wrist extension
Sensory = Dorsal forearm and first three fingers
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33
Q

What is the motor and sensory deficit associated with injury to the median nerve?

A 
Motor = forearm pronation, thumb opposition
Sensory = Palmar surface of first three fingers
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34
Q

What is the motor and sensory deficit associated with injury to the Ulnar nerve?

A 
Motor = finger abduction
Sensory = Palmar and dorsal surface of the last 2 fingers
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35
Q

What is the motor and sensory deficit associated with injury to the Axillary nerve?

A

Arm abduction

Deltoid sensation

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36
Q

What is the motor and sensory deficit associated with injury to the Peroneal nerve?

A

Dorsiflexion, eversion

Dorsal foot and lateral leg

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37
Q

What is the common cause of radial nerve injury?

A

Humeral fracture or saturday night palsy

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38
Q

What is the clinical finding associated with radial nerve injury?

A

Wrist drop

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39
Q

What is the clinical finding associated with median nerve injury?

A

Weak wrist flexion, and flat thenar eminence

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40
Q

What is the common cause of ulnar nerve injury?

A

Elbow disolcation

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41
Q

What is the presentation of an ulnar nerve injury?

A

Claw hand

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42
Q

What is the common cause of axillary nerve injury?

A

Anterior shoulder dislocation

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43
Q

What is the common cause of peroneal nerve injury?

A

Knee dislocation

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44
Q

What is the clinical presentation of peroneal nerve injury?

A

Foot drop

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45
Q

What is the presentation of bursitis?

A

Localized TTP
Decreased ROM
Edema
Erythema

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46
Q

What needs to be r/o with bursitis?

A

Septic bursitis

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47
Q

What is the treatment for non-septic bursitis?

A

NSAIDs
RICE
Intrabursal corticosteroid injections

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48
Q

What is a Volkmann contracture?

A

Volkmann contracture of the wrist and fingers is caused by compartment syndrome, which is associated with supracondylar humerus fractures. Ischemia results in fibrosis of dead muscle.

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49
Q

What is the classic side effect of fluoroquinolones?

A

Tendon rupture

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50
Q

What causes tendinitis?

A

Repetitive stress and resisted strength testing

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51
Q

What is the treatment for tendinitis?

A

RICE, NSAIDs

Splinting and strengthening exercises once relieved

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52
Q

Why should the achilles tendon never be injected with corticosteroids?

A

Increased risk of rupture

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53
Q

What is the most common site for disc herniation?

A

L5-S1

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54
Q

is the SLR a highly sensitive / specific test?

A

Highly sensitive, not specific

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55
Q

Is the crossed SLR test a sensitive / specific test?

A

Specific, not sensitive

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56
Q

What are the s/sx of spinal stenosis?

A

Either neck pain with radiation to the arms, or back pain with radiation down the legs

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57
Q

What improves the pain with lumbar spinal stenosis?

A

Flexion of the back (like walking over a shopping cart)

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58
Q

What is the treatment for mild- moderate spinal stenosis?

A

NSAIDs, abdominal muscle strengthening

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59
Q

What is the treatment for advanced spinal stenosis?

A

Epidural corticosteroid injection

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60
Q

What is the treatment for refractory spinal stenosis?

A

Laminectomy

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61
Q

What is the bacteria that is commonly found in human bites?

A

Eikenella

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62
Q

How do you test the L4 reflex?

A

Patellar reflex

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63
Q

What motor function does L5 supply?

A

Big toe dorsiflexion

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64
Q

What motor function does S1 supply?

A

Plantar flexion and hip extension

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65
Q

What motor function does L4 supply?

A

Foot dorsiflexion

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66
Q

What is the level for the achilles tendon reflex?

A

S1

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67
Q

L4 supplies sensation where?

A

Medial aspect of the lower leg

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68
Q

L5 supplies sensation where?

A

Dorsum of the foot and lateral aspect of the lower leg

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69
Q

S1 supplies sensation where?

A

Plantar and lateral aspects of the foot

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70
Q

Over how many weeks of LBP is a red flag?

A

6

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71
Q

What is the most common benign bone tumor?

A

Osteochondroma

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72
Q

What is an osteosarcoma?

A

malignant Primary bone tumor that tends to occur at the metaphyseal region of the distal femur/proximal tibia

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73
Q

What are the s/sx of an osteosarcoma?

A

Pain that worsens at night

B symptoms

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74
Q

What are the classic x-ray findings associated with an osteosarcoma? (2)

A

Codman’s triangle (periosteal new-bone formation at the diaphyseal end of the lesion) or a “sunburst pattern”

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75
Q

Sunburst pattern of bone = ?

A

Osteosarcoma

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76
Q

Onion skinning bone malignancy = ?

A

Ewing’s sarcoma

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77
Q

Soap bubble bone malignancy = ?

A

Giant cell tumor of bone

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78
Q

What is the treatment for osteosarcoma, short of amputation?

A

radiation and chemo

79
Q

A WBC more than what level in a joint aspirate diagnoses septic arthritis?

A

80,000

80
Q

What are the two abx of choice for septic arthritis prior to bug specific therapy?

A

Ceftriaxone

Vancomycin

81
Q

What is the mnemonic for remembering the appearance of Ewing’s sarcoma on X-ray?

A

Eat WINGs and Onion rings (“onion skin appearance”)

82
Q

what is the color of joint aspirate in the following conditions:

  • normal
  • Noninflammatory
  • Inflammatory
  • Septic
A
  • normal = Clear
  • Noninflammatory = yellow
  • Inflammatory = yellow
  • Septic = yellow-green
83
Q

What is the viscosity of joint aspirate in the following conditions:

  • normal
  • Noninflammatory
  • Inflammatory
  • Septic
A
  • normal = High
  • Noninflammatory = high
  • Inflammatory = low
  • Septic = variable
84
Q

What is the WBC level of joint aspirate in the following conditions:

  • normal
  • Noninflammatory
  • Inflammatory
  • Septic
A
  • normal = less than 200
  • Noninflammatory = 0-1000
  • Inflammatory = 1,000-10,000
  • Septic = 10,000-100,000
85
Q

What is the PMN level of joint aspirate in the following conditions:

  • normal
  • Noninflammatory
  • Inflammatory
  • Septic
A
  • normal = less than 25
  • Noninflammatory = less than 25
  • Inflammatory = greater than 50
  • Septic = greater than 75
86
Q

What is the glucose level of joint aspirate in the following conditions:

  • normal
  • Noninflammatory
  • Inflammatory
  • Septic
A
  • normal = serum level
  • Noninflammatory = serum level
  • Inflammatory = More than 25
  • Septic = less than 25
87
Q

Which joints are classically affected in OA?

A

DIP and PIP

88
Q

Which joints are classically affected in RA?

A

wrists

MCP

89
Q

Which usually has a symmetric distribution of joint involvement: RA or OA

A

RA

90
Q

What are the antibodies that can be found in the synovial fluid in RA

A

Anti-CCP

91
Q

What is the usual presentation of Neisseria gonorrhoeae septic arthritis?

A

Asymmetric oligoarthritis
Tenosynovitis
Skin rash

92
Q

Child with gout and inexplicable injuries = ?

A

Lesch-nyhan syndrome

93
Q

Gout crystals appear what color when exposed to parallel light?

A

Yellow with parallel light

94
Q

What is the major risk factor for gout?

A

binge drinking

95
Q

What are the joint aspirate findings of gout?

A

Needle-shaped, negatively birefringent crystals

96
Q

What are the x-ray findings of advanced gout?

A

Punched put erosions with overhanging cortical bone

97
Q

What is the treatment for acute attacks of gout?

A
  • high dose NSAIDs

- Steroids if severe or if concurrent renal disease

98
Q

What is the drug of choice for overproducers of uric acid?

A

Allopurinol

99
Q

What is the drug of choice for under excretors of uric acid?

A

Probenecid

100
Q

What drug can decrease the incidence of acute urate nephropathy?

A

Allopurinol

101
Q

What is the long term treatment for gout?

A

Weight loss and alcohol avoidance

102
Q

What is the MOA of colchicine?

A

Inhibits PMN chemotaxis

103
Q

What HLA haplotype is associated with RA?

A

HLA-DR4

104
Q

What are the joints that are classically affected with pseudogout?

A

Wrists and knees

105
Q

What is the crystal shape with gout and pseudogout respectively?

A 
Gout = needle shaped
Pseudogout = rhomboid shaped
106
Q

Which has positively birefringent crystals: gout or pseudogout

A

Pseudogout

107
Q

What is the classic history of RA?

A

Morning stiffness for more than 1 hour with painful, warm swelling of multiple symmetric joints

108
Q

What is Rheumatoid factor?

A

IgM antibodies directed against Fc IgG

109
Q

What type of anemia is common with RA?

A

Anemia of chronic disease

110
Q

What will synovial fluid aspiration show with RA?

A

Turbid fluid with decreased viscosity, and an increased WBC

111
Q

What are the early and late radiographic findings of RA?

A 
Early = Soft tissue swelling and juxta-articular demineralization
Late = Symmetric joint space narrowing and erosions
112
Q

What is the treatment for RA?

A

NSAIDs

DMARDs

113
Q

What are the DMARDs? (3)

A

Methotrexate
Hydroxychloroquine
Sulfasalazine

114
Q

What is the MOA and use of rituximab?

A

Anti-CD20

RA

115
Q

What is the HLA haplotype associated with ankylosing spondylitis?

A

HLA-B27

116
Q

What is the typical history of ankylosing spondylitis?

A

LBP that worsens with inactivity, and in the mornings

117
Q

What are the PE findings of ankylosing spondylitis?

A

Decreased spine flexion and chest expansion

118
Q

What are the extra articular manifestations of ankylosing spondylitis?

A

Anterior uveitis

Heart block

119
Q

What is enthesitis?

A

Pain at insertion of tendons/ligaments

120
Q

What are the three classic symptoms of reactive arthritis (aka Reiter syndrome)?

A

Urethritis
Uveitis
Arthritis

121
Q

What are the infections that classically cause reactive arthritis? (5)

A 
Campylobacter
Shigella
Salmonella
Chlamydia
Ureaplasma
122
Q

What are the joints that are classically affected with psoriatic arthritis?

A

DIP joints

123
Q

Sausage digits = ?

A

Psoriatic arthritis (dactylitis)

124
Q

What is the classic radiographic finding of psoriatic arthritis?

A

Pencil in cup

125
Q

What is enteropathic spondylitis?

A

An ankylosing spondylitis–like disease characterized by sacroiliitis that is usually asymmetric and is associated with IBD.

126
Q

What are the radiographic findings of the spine with ankylosing spondylitis? (2)

A

Fused sacroiliac joints

Bamboo spine

127
Q

Which is positive in ankylosing spondylitis: RF or ANA

A

Neither

128
Q

What is polymyositis?

A

a progressive, systemic connective tissue disease characterized by immune-mediated striated muscle inflammation.

129
Q

What is the pathophysiology of polymyositis?

A

T cell mediated attack against muscle

130
Q

What is the pathophysiology of dermatomyositis?

A

Complement mediated microangiopathy

131
Q

What is the common ocular manifestation of RA?

A

Keratoconjunctivitis

132
Q

What is Felty syndrome?

A

RA
Splenomegaly
Neutropenia

133
Q

What are the two malignancies commonly associated with polymyositis and dermatomyositis?

A

lung and breast CA

134
Q

What is the classic side effect of hydroxychloroquine?

A

retinal toxicity

135
Q

What are the serological findings of polymyositis and dermatomyositis?

A

Increase serum CK

Anti-jo-1 antibodies

136
Q

What is the treatment for polymyositis and dermatomyositis?

A

high-dose corticosteroids with taper to maintenance dose

Azathioprine and/or methotrexate

137
Q

What are the s/sx of polymyositis?

A

Symmetric, progressive, proximal muscle weakness/pain

138
Q

Symmetric, progressive, proximal muscle weakness/pain = ?

A

polymyositis

139
Q

What is the heliotrope rash that is commonly seen in dermatomyositis?

A

A violaceous periorbital rash

140
Q

What is the Shaw’ sign seen with dermatomyositis?

A

A rash involving the shoulders, upper chest, and back

141
Q

What are gottron papules associated with dermatomyositis?

A

Papular rash with scales on the dorsa of the hands, over bony prominences.

142
Q

What types of collagen are deposited with systemic sclerosis?

A

I and III

143
Q

What disease is the following antibody associated with: ANA

A

SLE

144
Q

What disease is the following antibody associated with: Anti-CCP

A

RA

145
Q

What disease is the following antibody associated with: Anticentromere

A

CREST syndrome

146
Q

What disease is the following antibody associated with: anti-dsDNA

A

SLE

147
Q

What disease is the following antibody associated with: antihistone

A

Drug induced SLE

148
Q

What disease is the following antibody associated with: Anti-Jo-1

A

Polymyositis/dermatomyositis

149
Q

What disease is the following antibody associated with: anti-mitochondrial

A

Primary biliary cirrhosis

150
Q

What disease is the following antibody associated with: Anti-Scl-70

A

Systemic sclerosis

151
Q

What disease is the following antibody associated with: Anti-Sm

A

SLE

152
Q

What disease is the following antibody associated with: Anti-smooth muscle

A

Autoimmune hepatitis

153
Q

What disease is the following antibody associated with: Anti Topoisomerase I

A

Systemic sclerosis

154
Q

What disease is the following antibody associated with: Anti-TSHR

A

Graves disease

155
Q

What disease is the following antibody associated with: c-ANCA

A

Wegener’s granulomatosis

156
Q

What disease is the following antibody associated with: p-ANCA

A

Churg-struass

157
Q

What disease is the following antibody associated with: RF

A

RA

158
Q

What disease is the following antibody associated with: U1RNP antibody

A

MCTD

159
Q

What parts of the body are affected with limited cutaneous systemic sclerosis?

A

head
Neck
Distal UEs

160
Q

What parts of the body are affected with diffuse cutaneous systemic sclerosis?

A

Torso/abdomen

Proximal UEs

161
Q

What are the components of CREST syndrome?

A 
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasias
162
Q

What are the internal organs that are affected with diffuse systemic sclerosis? (3)

A

GI
Lungs
Kidneys

163
Q

What are the antibodies that are specific for CREST syndrome?

A

Anticentromere

164
Q

What antibodies are associated with diffuse systemic sclerosis?

A

Anti-Scl-70

165
Q

What is the treatment for systemic sclerosis? (2)

A

Corticosteroids for acute flares

Penicillamine for skin changes

166
Q

What is the treatment for raynaud’s?

A

CCBs

167
Q

What is the treatment for renal disease associated with systemic sclerosis?

A

ACEIs

168
Q

What is the most common cause of mortality 2/2 systemic sclerosis?

A

pHTN

169
Q

What are the antibodies that are implicated in neonatal SLE?

A

Anti-Ro

170
Q

What are the s/sx of SLE

A

Discoid rash
Arthritis
Serositis
hematologic abnormalities

171
Q

What is the treatment for the mild joint symptoms of SLE

A

NSAIDs

172
Q

What is the treatment for acute flares of SLE?

A

Corticosteroids

173
Q

What is the role of hydroxychloroquine in SLE?

A

Can be used to isolated skin and joint involvement

174
Q

What is the role of Cyclophosphamide in SLE?

A

Used for severe cases of lupus nephritis

175
Q

What are the s/sx of giant cell arteritis?

A

Temporal TTP

Jaw claudication

176
Q

What are the findings of temporal artery bx with giant cell arteritis?

A

thrombosis; necrosis of the media; and lymphocytes, plasma cells, and giant cells.

177
Q

What is complex regional pain syndrome?

A

A pain syndrome accompanied by loss of function and autonomic dysfunction, usually occurring after trauma.

178
Q

What are the three phases of complex regional pain syndrome?

A
  1. acute/traumatic
  2. Dystrophic
  3. Atrophic
179
Q

What are the symptoms of complex regional pain syndrome? (3)

A
  • -Diffuse pain out of proportion to injury in a non-anatomic distribution
  • loss of function
  • Sympathetic dysfunction
180
Q

What is Libman-sacks endocarditis?

A

Noninfectious vegetations often seen on the mitral valve in association with SLE and antiphospholipid syndrome.

181
Q

SLE and RA both affect the MCP and PIP joints; the difference is what?

A

SLE is non-deforming

182
Q

What infectious disease test may be positive in pts with SLE?

A

VDRL or RPR

183
Q

What is the pathophysiology of lupus anticoagulant?

A

IgM or IgG binds proteins and prolongs PTT

184
Q

What is the treatment for complex regional pain syndrome?

A

NSAIDs
Corticosteroids
TCAs
Pregabalin

185
Q

What is the interventional technique that can relieve pain with CRPS?

A

Chemical sympathetic blockade

186
Q

Who is usually affected with fibromyalgia?

A

women 30-50 years old

187
Q

How do you diagnose fibromyalgia?

A

Multiple (more than 11 of 18 TTPs)

188
Q

What is myofascial pain syndrome?

A

Less form of fibromyalgia (less than 11 of the 18 axial skeletal points)

189
Q

What is the treatment for fibromyalgia?

A

Antidepressants and PT

190
Q

Who is affected with polymyalgia rheumatica?

A

Women over 50

191
Q

Where is the pain with polymyalgia rheumatica?

A

Hip and shoulder girdle

192
Q

What happens to ESR with fibromyalgia

A

Normal

193
Q

Muscle bx with polymyalgia rheumatica reveals what?

A

Normal

A1 (32 decks)

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