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Casey: Panre > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

At what age should you begin ordering DEXA scans for male pts? For female patients?

A

70 for males, 65 for females

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2
Q

Give the DEXA score for osteopenia and osteoporosis

A

Penia 1-2.4 standard deviations

Porosis 2.5 SD or greater

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3
Q

1 cause of compartment syndrome

A

Tibial shaft fracture

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4
Q

Pt’s lab work shows positive Smith antibodies and positive double-stranded DNA antibodies. What is most likely dx?

A

Lupus

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5
Q

Where are Bouchard’s nodes found?

A

Proximal interphalangeal joint (PIP)–RA

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6
Q

What will an X-ray show in acute osteomyelitis?

A

Nothing. It will show bone destruction in chronic osteomyelitis.

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7
Q

What is the best imaging to dx osteomyelitis?

A

Either a bone scan or MRI

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8
Q

22yo male pt presents with what is clearly a septic knee. You also notice lesions on his hands & feet. What is the most likely pathogen?

A

Neisseria gonorrhoeae

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9
Q

What would you expect the WBC count to be in the joint fluid of an infected knee?

A

> 50,000 at a minimum and probably much higher

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10
Q

A pt presents with a painless mass in her right wrist. What is the most likely dx?

A

Ganglion cyst

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11
Q

What is the age range for osteosarcoma ? Where are they most typically found in the body?

A

Usu occur in 15-25yo males

Most commonly found in knee

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12
Q

You think a pt may have an osteoid due to his complaints of severe night pain. You set him up for an X-ray; but in the meantime what med do you start him on?

A

Ibuprofen will resolve his pain if it is truly an osteoid osteoma.

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13
Q

Clicking or locking of the knee indicates what dx

A

Meniscal tear

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14
Q

A 65 yo presents c/o 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 dx?

A

Gout would be number one because of the location, but you might also think about an infection.

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15
Q

What Uric acid level helps to confirm a diagnosis of gout?

A

> 7.5

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16
Q

What is the medical tx for gout?

A

Allopurinol

Colchicine

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17
Q

A path report comes back w/ positive birefringent crystals. What is the most likely dx?

A

Pseudogout

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18
Q

Pt w/ a hx of hep B presents c/o bilateral knee pain, fever & wt loss. What is most likely dx?

A

Polyarteritis nodosa

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19
Q

You suspect a pt has polyarteritis nodosa. What is the test for a definitive dx and what is the tx?

A

Biopsy

High dose steroids

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20
Q

On PE you notice ulnar deviations and swan neck deformities. What is the most likely dx?

A

Rheumatoid arthritis

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21
Q

A positive Neer’s test indicates what dx

A

Rotator cuff impingement

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22
Q

3 meds that may cause lupus

A

Procainamide
Isoniazid
Quinidine

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23
Q

What test do you do for Sjögren’s syndrome

A

Schrimer test

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24
Q

A pt w/ RA is heading to the OR for open reduction & internal fixation of the ankle. In addition to ankle films, what other X-rays should you get?

A

C-spine: anesthesia will want them due to concerns about instability of C1&C2.

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25
Q

Which carpal bone has a high rate of nonunion and occult fracture?

A

Scaphoid

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26
Q

What medication is used for patients with systemic lupus?

A

Systemic steroids

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27
Q

Scleroderma limited version has five main characteristics for which the CREST acronym is used. What are they?

A 
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasis
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28
Q

There is a sunburst appearance on X-ray. What is most likely dx?

A

Osteosarcoma

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29
Q

Anatomically where are 80% of clavicle fractures located?

A

Middle third

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30
Q

A path report comes back showing negatively birefringent crystals. What is most likely dx?

A

Gout

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31
Q

What are the 4 muscles of the rotator cuff?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

32
Q

Describe the characteristics of a lytic lesion on X-ray

A

Spiculated
Elevated periosteum
Bone destruction (think bad, very bad things)

33
Q

What ligament is most commonly injured in an ankle sprain

A

Anterior talofibular ligament (ATFL)

34
Q

Vasculitis w/ a hx of hep B should make you think of what dx

A

Polyarteritis nodosa

35
Q

What is the most common fx in children

A

Clavicle

36
Q

A fat pad sign on a lateral X-ray of the elbow has what sig?

A

It is blood in the joint indicating a fx even if the fx line cannot be seen

37
Q

A pt presents w/ progressive neck and proximal muscle weakness. On PE, you see a reddish purple maculopapular rash. Her lab work shows anti-Jo-1 antibodies. What is the most likely dx?

A

Polymyositis

38
Q

Which way does a Cooles fx angulate dorsal or volar? What about a Smith fx?

A 
Colles= dorsal
Smith= volar
39
Q

Tenderness over the anatomical snuffbox is indicative of what fx?

A

Scaphoid

40
Q

What is the most common fx in a pt w/ osteoporosis?

A

A compression fx of a vertebral body followed by hip fx.

41
Q

A 15yo boy presents c/o night pain in the pelvis. Since you have no idea what to do, you order an X-ray. The report comes back with a description of a mass with an “onion skin appearance.” What is the most likely dx?

A

Ewing sarcoma

42
Q

What is the name for the 4th and 5th metacarpal fxs that often result from throwing a punch?

A

Boxer’s fx

43
Q

A new mom presents with pain over the radial wrist. She has a positive Finklestein’s test. What is the most likely dx?

A

de Quervain’s tenosynovitis

44
Q

A positive McMurry indicates what dx?

A

Meniscal tear

45
Q

First line tx for carpal tunnel

A

Night splint

46
Q

Most common cause of C-spine fractures

A

MVA

47
Q

Medical term for hunchback

A

Kyphosis

48
Q

Another term for podagra

A

Gout

49
Q

A pt presents to ED with saddle anesthesia and loss of bowel & bladder fxn. What is most likely dx?

A

Cauda equina

50
Q

A pt with HIV presents with severe groin pain. What is the most likely dx?

A

AVN

Antiretroviral meds put pts at an increased risk of AVN

51
Q

A 95y female presents to the ED after a fall in her home. Her left leg is shortened and externally rotated. What is the most likely dx?

A

Hip fx

52
Q

You recommend biphosphonates for a pt c osteoporosis. What instruction do you give her for immediately after taking the med?

A

Remain upright for :30

53
Q

What is the most common cause of a hip dislocation? Is it usually anterior or posterior?

A

MVA, posterior

54
Q

Which of the 4 rotator cuff muscles is most commonly injured?

A

Supraspinatus

55
Q

What is the medical term for tennis elbow?

A

Lateral epicondylitis

56
Q

What is the first line tx for rheumatoid arthritis?

A

Methotrexate

57
Q

A pt presents to the ED after taking a baseball bat to the knee. He is unable to actively extend his knee. What is the most likely dx?

A

Patella fx

58
Q

Are most shoulder dislocations anterior or posterior?

A

Anterior

59
Q

What is the most useful physical exam test for diagnosing an ACL tear?

A

Lachman’s, followed by anterior drawer

60
Q

What is the most common knee injury?

A

Medial meniscal tear

61
Q

Where are Heberden’s nodes found?

A

DIP

62
Q

A pt 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 2 PE tests should you do?

A

Probably a medial meniscal tear. Mcmurry & apply tests would be appropriate.

63
Q

A pt presents with conjunctivitis, urethritis, arthritis and oral lesions. What is the most likely dx? What other lab might you expect to be positive?

A

Reactive arthritis

HLA B-27

64
Q

A 46 yo male comes into the ED 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 dx?

A

Achilles’ tendon rupture

65
Q

Anti-Jo antibodies should make you think of what dx?

A

Polymyositis

66
Q

A positive crossover test indicates what dx?

A

Acromioclavicular joint injury (AC joint)

67
Q

A positive Hawkins test indicates what dx?

A

Rotator cuff impingement

68
Q

A positive Finklestein’s test indicates what dx?

A

de Quervain’s tenosynovitis

69
Q

A positive Phalen and Tinel’s sign indicates what dx?

A

Carpal tunnel

70
Q

A bamboo spine indicates what dx?

A

Ankylosing spondylitis

71
Q

A positive straight leg test indicates what dx?

A

Herniated disc

72
Q

An African American female presents with malar rash and a positive double-stranded DNA antibody. What is the most likely dx?

A

Lupus

73
Q

Carpal tunnel affects what nerve and what parts of the hand?

A

Median nerve. Thumb, pointer and ring fingers. Thenar wasting is sign of advanced disease.

74
Q

A pt has a silver fork deformity on X-ray. What is the most likely dx?

A

Colles fx

75
Q

A positive Apley indicates what dx

A

Meniscal tear

Casey: Panre (12 decks)

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