Musculoskeletal Flashcards
1
Q
Anterior dislocation of the shoulder risks injury to what nerve?
A
Axillary
2
Q
Axillary nerve injury manifests how?
A
Abduction and external rotation of the arm
3
Q
Posterior dislocation of the shoulder is associated with what sort of injury mechanism?
A
Seizures or electrocution
4
Q
How does the arm hang with posterior dislocation of the shoulder?
A
Adduction and internal rotation
5
Q
Humerus fractures risks injury to which nerve? How does this manifest?
A
Radial nerve
Wrist drop and loss of thumb extension
6
Q
What is a nightstick fracture? Treatment?
A
Fracture of the ulnar shaft
ORIF
7
Q
What is a monteggia fracture? treatment?
A
Diaphyseal fracture of the proximal ulna, with subluxation of the radial head
ORIF
8
Q
What is a Galeazzi fracture? treatment?
A
Diaphyseal fracture of the radius with dislocation of the distal radioulnar joint.
ORIF
9
Q
What is a colles fracture? Treatment?
A
fracture and dorsal displacement of the distal radius
Closed reduction and arm cast
10
Q
What is the most commonly fractured carpal bone?
A
Scaphoid
11
Q
What is the treatment for a scaphoid fracture?
A
Thumb spica cast
If displaced or scaphoid nonunion, then open reduction
12
Q
What is a Boxer’s fracture? Treatment?
A
Fracture of the fifth metacarpal
Close reduction and ulnar gutter splint
13
Q
What is the presentation of a posterior hip dislocation?
A
Internally rotated
Adducted
14
Q
What nerve is at risk with a posterior dislocation of the hip? Anterior?
A
Posterior = Sciatic Anterior = obturator
15
Q
What is the treatment of a hip dislocation?
A
Closed reduction followed by abduction pillow/bracing
16
Q
How do hip fractures present?
A
Shortened and externally rotated leg
17
Q
Displaced femoral neck fractures are associated with what condition?
A
Risk of AVN and DVTs
18
Q
What is the treatment for a hip fracture?
A
ORIF, with anticoagulation after to reduce risk of DVTs
19
Q
Fat emboli classically result from breakage of what bone?
A
Femur
20
Q
What is the treatment for a femoral fracture?
A
Intramedullary nailing of the femur
21
Q
What is the treatment for MCL/LCL tears?
A
Conservative management
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.
23
Q
When is PCL tear operated on?
A
Athletes
24
Q
How do meniscal tears usually occur?
A
Acute twisting injury or a degenerative tears
25
What needs to be watched out for with tibial fractures?
Compartment syndrome
26
What is the treatment for tibial fractures?
Casting vs ORIF
27
What is the Thompson test?
Pressure on the gastrocnemius leading to absent foot plantar flexion
Indicates achilles tendon tear
28
What is the treatment for a achilles tendon tear?
Surgery followed by a long-leg cast for 6 weeks
29
What sort of burns are a concern for compartment syndrome?
Circumferential burns
30
What is the delta pressure for diagnosing compartment syndrome, and what indicates a positive test?
(diastolic pressure – compartment pressure); ⊕ if delta pressure ≤ 30 mm Hg).
31
How soon should patients with an open fracture be taken to the OR?
Within 8-24 hours
32
What is the motor and sensory deficit associated with injury to the radial nerve?
```
Motor = loss of wrist extension
Sensory = Dorsal forearm and first three fingers
```
33
What is the motor and sensory deficit associated with injury to the median nerve?
```
Motor = forearm pronation, thumb opposition
Sensory = Palmar surface of first three fingers
```
34
What is the motor and sensory deficit associated with injury to the Ulnar nerve?
```
Motor = finger abduction
Sensory = Palmar and dorsal surface of the last 2 fingers
```
35
What is the motor and sensory deficit associated with injury to the Axillary nerve?
Arm abduction
| Deltoid sensation
36
What is the motor and sensory deficit associated with injury to the Peroneal nerve?
Dorsiflexion, eversion
Dorsal foot and lateral leg
37
What is the common cause of radial nerve injury?
Humeral fracture or saturday night palsy
38
What is the clinical finding associated with radial nerve injury?
Wrist drop
39
What is the clinical finding associated with median nerve injury?
Weak wrist flexion, and flat thenar eminence
40
What is the common cause of ulnar nerve injury?
Elbow disolcation
41
What is the presentation of an ulnar nerve injury?
Claw hand
42
What is the common cause of axillary nerve injury?
*Anterior* shoulder dislocation
43
What is the common cause of peroneal nerve injury?
Knee dislocation
44
What is the clinical presentation of peroneal nerve injury?
Foot drop
45
What is the presentation of bursitis?
Localized TTP
Decreased ROM
Edema
Erythema
46
What needs to be r/o with bursitis?
Septic bursitis
47
What is the treatment for non-septic bursitis?
NSAIDs
RICE
Intrabursal corticosteroid injections
48
What is a Volkmann contracture?
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.
49
What is the classic side effect of fluoroquinolones?
Tendon rupture
50
What causes tendinitis?
Repetitive stress and resisted strength testing
51
What is the treatment for tendinitis?
RICE, NSAIDs
| Splinting and strengthening exercises once relieved
52
Why should the achilles tendon never be injected with corticosteroids?
Increased risk of rupture
53
What is the most common site for disc herniation?
L5-S1
54
is the SLR a highly sensitive / specific test?
Highly sensitive, not specific
55
Is the crossed SLR test a sensitive / specific test?
Specific, not sensitive
56
What are the s/sx of spinal stenosis?
Either neck pain with radiation to the arms, or back pain with radiation down the legs
57
What improves the pain with lumbar spinal stenosis?
Flexion of the back (like walking over a shopping cart)
58
What is the treatment for mild- moderate spinal stenosis?
NSAIDs, abdominal muscle strengthening
59
What is the treatment for advanced spinal stenosis?
Epidural corticosteroid injection
60
What is the treatment for refractory spinal stenosis?
Laminectomy
61
What is the bacteria that is commonly found in human bites?
Eikenella
62
How do you test the L4 reflex?
Patellar reflex
63
What motor function does L5 supply?
Big toe dorsiflexion
64
What motor function does S1 supply?
Plantar flexion and hip extension
65
What motor function does L4 supply?
Foot dorsiflexion
66
What is the level for the achilles tendon reflex?
S1
67
L4 supplies sensation where?
Medial aspect of the lower leg
68
L5 supplies sensation where?
Dorsum of the foot and lateral aspect of the lower leg
69
S1 supplies sensation where?
Plantar and lateral aspects of the foot
70
Over how many weeks of LBP is a red flag?
6
71
What is the most common benign bone tumor?
Osteochondroma
72
What is an osteosarcoma?
malignant Primary bone tumor that tends to occur at the metaphyseal region of the distal femur/proximal tibia
73
What are the s/sx of an osteosarcoma?
Pain that worsens at night
| B symptoms
74
What are the classic x-ray findings associated with an osteosarcoma? (2)
Codman's triangle (periosteal new-bone formation at the diaphyseal end of the lesion) or a “sunburst pattern”
75
Sunburst pattern of bone = ?
Osteosarcoma
76
Onion skinning bone malignancy = ?
Ewing's sarcoma
77
Soap bubble bone malignancy = ?
Giant cell tumor of bone
78
What is the treatment for osteosarcoma, short of amputation?
radiation and chemo
79
A WBC more than what level in a joint aspirate diagnoses septic arthritis?
80,000
80
What are the two abx of choice for septic arthritis prior to bug specific therapy?
Ceftriaxone
| Vancomycin
81
What is the mnemonic for remembering the appearance of Ewing's sarcoma on X-ray?
Eat WINGs and Onion rings ("onion skin appearance")
82
what is the color of joint aspirate in the following conditions:
- normal
- Noninflammatory
- Inflammatory
- Septic
- normal = Clear
- Noninflammatory = yellow
- Inflammatory = yellow
- Septic = yellow-green
83
What is the viscosity of joint aspirate in the following conditions:
- normal
- Noninflammatory
- Inflammatory
- Septic
- normal = High
- Noninflammatory = high
- Inflammatory = low
- Septic = variable
84
What is the WBC level of joint aspirate in the following conditions:
- normal
- Noninflammatory
- Inflammatory
- Septic
- normal = less than 200
- Noninflammatory = 0-1000
- Inflammatory = 1,000-10,000
- Septic = 10,000-100,000
85
What is the PMN level of joint aspirate in the following conditions:
- normal
- Noninflammatory
- Inflammatory
- Septic
- normal = less than 25
- Noninflammatory = less than 25
- Inflammatory = greater than 50
- Septic = greater than 75
86
What is the glucose level of joint aspirate in the following conditions:
- normal
- Noninflammatory
- Inflammatory
- Septic
- normal = serum level
- Noninflammatory = serum level
- Inflammatory = More than 25
- Septic = less than 25
87
Which joints are classically affected in OA?
DIP and PIP
88
Which joints are classically affected in RA?
wrists
| MCP
89
Which usually has a symmetric distribution of joint involvement: RA or OA
RA
90
What are the antibodies that can be found in the synovial fluid in RA
Anti-CCP
91
What is the usual presentation of Neisseria gonorrhoeae septic arthritis?
Asymmetric oligoarthritis
Tenosynovitis
Skin rash
92
Child with gout and inexplicable injuries = ?
Lesch-nyhan syndrome
93
Gout crystals appear what color when exposed to parallel light?
Ye*ll*ow with para*ll*el light
94
What is the major risk factor for gout?
binge drinking
95
What are the joint aspirate findings of gout?
Needle-shaped, negatively birefringent crystals
96
What are the x-ray findings of advanced gout?
Punched put erosions with overhanging cortical bone
97
What is the treatment for acute attacks of gout?
- high dose NSAIDs
| - Steroids if severe or if concurrent renal disease
98
What is the drug of choice for overproducers of uric acid?
Allopurinol
99
What is the drug of choice for under excretors of uric acid?
Probenecid
100
What drug can decrease the incidence of acute urate nephropathy?
Allopurinol
101
What is the long term treatment for gout?
Weight loss and alcohol avoidance
102
What is the MOA of colchicine?
Inhibits PMN chemotaxis
103
What HLA haplotype is associated with RA?
HLA-DR4
104
What are the joints that are classically affected with pseudogout?
Wrists and knees
105
What is the crystal shape with gout and pseudogout respectively?
```
Gout = needle shaped
Pseudogout = rhomboid shaped
```
106
Which has positively birefringent crystals: gout or pseudogout
Pseudogout
107
What is the classic history of RA?
Morning stiffness for more than 1 hour with painful, warm swelling of multiple symmetric joints
108
What is Rheumatoid factor?
IgM antibodies directed against Fc IgG
109
What type of anemia is common with RA?
Anemia of chronic disease
110
What will synovial fluid aspiration show with RA?
Turbid fluid with decreased viscosity, and an increased WBC
111
What are the early and late radiographic findings of RA?
```
Early = Soft tissue swelling and juxta-articular demineralization
Late = Symmetric joint space narrowing and erosions
```
112
What is the treatment for RA?
NSAIDs
| DMARDs
113
What are the DMARDs? (3)
Methotrexate
Hydroxychloroquine
Sulfasalazine
114
What is the MOA and use of rituximab?
Anti-CD20
| RA
115
What is the HLA haplotype associated with ankylosing spondylitis?
HLA-B27
116
What is the typical history of ankylosing spondylitis?
LBP that worsens with inactivity, and in the mornings
117
What are the PE findings of ankylosing spondylitis?
Decreased spine flexion and chest expansion
118
What are the extra articular manifestations of ankylosing spondylitis?
Anterior uveitis
| Heart block
119
What is enthesitis?
Pain at insertion of tendons/ligaments
120
What are the three classic symptoms of reactive arthritis (aka Reiter syndrome)?
Urethritis
Uveitis
Arthritis
121
What are the infections that classically cause reactive arthritis? (5)
```
Campylobacter
Shigella
Salmonella
Chlamydia
Ureaplasma
```
122
What are the joints that are classically affected with psoriatic arthritis?
DIP joints
123
Sausage digits = ?
Psoriatic arthritis (dactylitis)
124
What is the classic radiographic finding of psoriatic arthritis?
Pencil in cup
125
What is enteropathic spondylitis?
An ankylosing spondylitis–like disease characterized by sacroiliitis that is usually asymmetric and is associated with IBD.
126
What are the radiographic findings of the spine with ankylosing spondylitis? (2)
Fused sacroiliac joints
| Bamboo spine
127
Which is positive in ankylosing spondylitis: RF or ANA
Neither
128
What is polymyositis?
a progressive, systemic connective tissue disease characterized by immune-mediated striated muscle inflammation.
129
What is the pathophysiology of polymyositis?
T cell mediated attack against muscle
130
What is the pathophysiology of dermatomyositis?
Complement mediated microangiopathy
131
What is the common ocular manifestation of RA?
Keratoconjunctivitis
132
What is Felty syndrome?
RA
Splenomegaly
Neutropenia
133
What are the two malignancies commonly associated with polymyositis and dermatomyositis?
lung and breast CA
134
What is the classic side effect of hydroxychloroquine?
retinal toxicity
135
What are the serological findings of polymyositis and dermatomyositis?
Increase serum CK
| Anti-jo-1 antibodies
136
What is the treatment for polymyositis and dermatomyositis?
high-dose corticosteroids with taper to maintenance dose
| Azathioprine and/or methotrexate
137
What are the s/sx of polymyositis?
Symmetric, progressive, proximal muscle weakness/pain
138
Symmetric, progressive, proximal muscle weakness/pain = ?
polymyositis
139
What is the heliotrope rash that is commonly seen in dermatomyositis?
A violaceous periorbital rash
140
What is the Shaw' sign seen with dermatomyositis?
A rash involving the shoulders, upper chest, and back
141
What are gottron papules associated with dermatomyositis?
Papular rash with scales on the dorsa of the hands, over bony prominences.
142
What types of collagen are deposited with systemic sclerosis?
I and III
143
What disease is the following antibody associated with: ANA
SLE
144
What disease is the following antibody associated with: Anti-CCP
RA
145
What disease is the following antibody associated with: Anticentromere
CREST syndrome
146
What disease is the following antibody associated with: anti-dsDNA
SLE
147
What disease is the following antibody associated with: antihistone
Drug induced SLE
148
What disease is the following antibody associated with: Anti-Jo-1
Polymyositis/dermatomyositis
149
What disease is the following antibody associated with: anti-mitochondrial
Primary biliary cirrhosis
150
What disease is the following antibody associated with: Anti-Scl-70
Systemic sclerosis
151
What disease is the following antibody associated with: Anti-Sm
SLE
152
What disease is the following antibody associated with: Anti-smooth muscle
Autoimmune hepatitis
153
What disease is the following antibody associated with: Anti Topoisomerase I
Systemic sclerosis
154
What disease is the following antibody associated with: Anti-TSHR
Graves disease
155
What disease is the following antibody associated with: c-ANCA
Wegener's granulomatosis
156
What disease is the following antibody associated with: p-ANCA
Churg-struass
157
What disease is the following antibody associated with: RF
RA
158
What disease is the following antibody associated with: U1RNP antibody
MCTD
159
What parts of the body are affected with limited cutaneous systemic sclerosis?
head
Neck
Distal UEs
160
What parts of the body are affected with diffuse cutaneous systemic sclerosis?
Torso/abdomen
| Proximal UEs
161
What are the components of CREST syndrome?
```
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasias
```
162
What are the internal organs that are affected with diffuse systemic sclerosis? (3)
GI
Lungs
Kidneys
163
What are the antibodies that are specific for CREST syndrome?
Anticentromere
164
What antibodies are associated with diffuse systemic sclerosis?
Anti-Scl-70
165
What is the treatment for systemic sclerosis? (2)
Corticosteroids for acute flares
| Penicillamine for skin changes
166
What is the treatment for raynaud's?
CCBs
167
What is the treatment for renal disease associated with systemic sclerosis?
ACEIs
168
What is the most common cause of mortality 2/2 systemic sclerosis?
pHTN
169
What are the antibodies that are implicated in neonatal SLE?
Anti-Ro
170
What are the s/sx of SLE
Discoid rash
Arthritis
Serositis
hematologic abnormalities
171
What is the treatment for the mild joint symptoms of SLE
NSAIDs
172
What is the treatment for acute flares of SLE?
Corticosteroids
173
What is the role of hydroxychloroquine in SLE?
Can be used to isolated skin and joint involvement
174
What is the role of Cyclophosphamide in SLE?
Used for severe cases of lupus nephritis
175
What are the s/sx of giant cell arteritis?
Temporal TTP
| Jaw claudication
176
What are the findings of temporal artery bx with giant cell arteritis?
thrombosis; necrosis of the media; and lymphocytes, plasma cells, and giant cells.
177
What is complex regional pain syndrome?
A pain syndrome accompanied by loss of function and autonomic dysfunction, usually occurring after trauma.
178
What are the three phases of complex regional pain syndrome?
1. acute/traumatic
2. Dystrophic
3. Atrophic
179
What are the symptoms of complex regional pain syndrome? (3)
- -Diffuse pain out of proportion to injury in a non-anatomic distribution
- loss of function
- Sympathetic dysfunction
180
What is Libman-sacks endocarditis?
Noninfectious vegetations often seen on the mitral valve in association with SLE and antiphospholipid syndrome.
181
SLE and RA both affect the MCP and PIP joints; the difference is what?
SLE is non-deforming
182
What infectious disease test may be positive in pts with SLE?
VDRL or RPR
183
What is the pathophysiology of lupus anticoagulant?
IgM or IgG binds proteins and prolongs PTT
184
What is the treatment for complex regional pain syndrome?
NSAIDs
Corticosteroids
TCAs
Pregabalin
185
What is the interventional technique that can relieve pain with CRPS?
Chemical sympathetic blockade
186
Who is usually affected with fibromyalgia?
women 30-50 years old
187
How do you diagnose fibromyalgia?
Multiple (more than 11 of 18 TTPs)
188
What is myofascial pain syndrome?
Less form of fibromyalgia (less than 11 of the 18 axial skeletal points)
189
What is the treatment for fibromyalgia?
Antidepressants and PT
190
Who is affected with polymyalgia rheumatica?
Women over 50
191
Where is the pain with polymyalgia rheumatica?
Hip and shoulder girdle
192
What happens to ESR with fibromyalgia
Normal
193
Muscle bx with polymyalgia rheumatica reveals what?
Normal
