Musculoskeletal

Question 1

Paget’s disease of bone labs

Answer 1

Urine hydroxy-proline UP
Blood alkaline phosphatase UP
Calcium NORMAL
Phosphate NORMAL

Question 2

Fibromyalgia treatment

Answer 2

TCA 1st line

SNRI 2nd line

Question 3

Rotator cuff impingement tests

Answer 3

Neer and Hawkins

Question 4

Giant cell arteritis

Answer 4

Also called temporal arteritis
Highly associated with polymyalgia rheumatica
Predominantly whites women in 80s

Segmental involvement so could have negative artery biopsy
Blindness caused by ischemic optic beuritis

Question 5

Gout attack characteristics

Answer 5

Can cause low grade fever

Typically have abrupt onset hitting max at 12-24 hrs

Question 6

Ankylosing spondylitis exam findings

Answer 6

Dactylitis
Uveitis
Sacroiliitis
Enthesitis
Reduced spinal mobility

Question 7

Subacute pain reproduced by stretching the wrist extensors

Answer 7

Lateral epicondylitis (tennis elbow)

Question 8

Dermatomyositis can be paraneoplastic

Answer 8

Gottron papules and heliotrope rash

Question 9

Lambert Eaton myasthenic syndrome (LEMS)

Answer 9

proximal muscle weakness
autonomic dysfunction (erectile, dry mouth)
loss of deep tendon reflexes (that return with repeated use of muscle groups)

Question 10

most common cause of back pain after lifting

Answer 10

lumbosacral strain

Question 11

Pseudogout association

Answer 11

hemochromatosis

Question 12

de quervain tenosynovitis

Answer 12

classically affects new mothers
inflammation of the abductor pollicis longus and extensor pollicis brevis
Finkelstein test positive (grasping flexed thumb into fingers produces the pain)

Question 13

scaphoid fracture

Answer 13

usually occurs due to FOOSH

pain localized to the anatomical snuff box

Question 14

trigger thumb

Answer 14

pain at thumb MCP, causing thumb to be locked in flexion

Question 15

osteoarthritis knee exam

Answer 15

crepitus
some swelling and warmth
new bony growths
baker cysts (highly associated)

Question 16

pes anserinus syndrome

Answer 16

anteromedial tibia pain

highly associated with female and diabetics

Question 17

causes of chronic low back pain

Answer 17

1) mechanical
2) cancer
3) infection
4) inflammation
5) radicular
6) stenosis (relieved by leaning forward)
>12 weeks *encourage PT
<12 weeks *use NSAIDs and tylenol

Question 18

atlanto-axial dislocation

Answer 18

often trauma or RA

can cause quadriplegia

Question 19

Spondylolysis

Answer 19

genetics or gymnasts
Usually L5 pain
Can progress to spondylolithesis and dislocation
Best seen on lateral film

Question 20

Pain from ankylosing spondylitis

Answer 20

Stiffness

Pain that CAN awaken from sleep

Question 21

Humerus greater tuberosity fracture

Answer 21

Rotator cuff tendon injury

supraspinatus (most common), infraspinatus, teres minor, subscapularis

Question 22

Humerus surgical neck fracture

Answer 22

axillary nerve damage

Question 23

Humerus shaft fracture

Answer 23

Radial nerve damage (radial spiral groove)

Question 24

Humerus supracondylar fracture (just above the elbow)

Answer 24

median nerve and brachial artery
Volkmann's ischemic contracture
(damage and flexion of the arm and hands)
1) no flexion of digits 1-3
2) no wrist flexion
3) no pronation 
makes "hand of benediction"

Question 25

humerus medial epicondylar fracture

Answer 25

``` ulnar nerve damage 1) no flexion of digits 4-5 2) no wrist flexion on ulnar side 3) no interosseos "claw hand deformity" CAN ALSO OCCUR WITH FRACTURE AT HOOK OF HAMATE ```

Question 26

Distal radius fracture (Colles)

Answer 26

Occurs after FOOSH Often has ulnar styloid process fracture as well Dinner fork deformity

Question 27

Scaphoid fracture

Answer 27

Pain localized to the anatomical snuffbox Often missed on XRAY Can lead to avascular necrosis Repeat Xray in 10 days to see

Question 28

Femoral neck fracture

Answer 28

mostly in women with osteoporosis Can damage medial circumflex femoral artery Leads to avascular necrosis Leg shorter and turned out

Question 29

Pott fracture

Answer 29

extreme foot eversion | Medial ligament very strong so pulls off piece of malleolus

Question 30

Fracture of the fifth metatarsal

Answer 30

Extreme foot inversion | Breaks lateral malleolus and fibular head

Question 31

Legg-Calve-Perthes disease

Answer 31

Avascular necrosis of the capital femoral epiphysis Usually in male children 3-12 yo Self resolving but can lead to OA

Question 32

How to reduce radial head subluxation

Answer 32

elbow flexed -> supination

Question 33

lateral impact force on the knee

Answer 33

Injury to medial collateral ligament | BUT ALSO medial meniscus because of attachment to MCL

Question 34

ACL course

Answer 34

anterior tibia to postero-lateral femur

Question 35

Gluteal muscle innervation and functions

Answer 35

Glut maximus - inferior gluteal nerve - abduct Glut medius - superior gluteal - abduct and medially rotate Glut minimus - superior gluteal - abduct and medially rotate Other butt muscles laterally rotate

Question 36

anterior compartment of forearm function

Answer 36

wrist flexion AND arm pronation

Question 37

Piriformis syndrome

Answer 37

sciatic nerve usually comes out under piriformis If comes out through it, then hypertrophy of muscle will cause pain Common in bikers, climbers, skaters

Question 38

Sign of damaged superior gluteal nerve

Answer 38

Trendelenburg sign | Lift left leg up, if hip drops to left, then right is damage

Question 39

Common fibular (peroneal) nerve damage

Answer 39

takes out anterior and lateral compartment | Cannot dorsiflex foot, or evert

Question 40

Innervation for diaphragm

Answer 40

C3-4-5

Question 41

Cancers that met to bone

Answer 41

``` BLT w/ Cool Kosher Pickle Breast Lung Thyroid Colon Kidney Prostate Preferred site is vertebrae, proximal femur, pelvis ```

Question 42

predisposition for osteoma

Answer 42

FAP

Question 43

predisposition to osteosarcoma

Answer 43

Pagets Radiation Familial retinoblastoma

Question 44

Enchondroma

Answer 44

usually in small bones of hands Can be multiple looks like popcorn with calcified stippling

Question 45

reactive bone in OA

Answer 45

Subchondral sclerosis (eburnation)

Question 46

RA vs OA

Answer 46

``` OA also morning stiffness but resolves in <30 min RA usually >60 min OA affects C/T/L spine; RA only C spine RA associated with HLA-DR4 OA gives bone cysts RA gives baker cysts RA gives pannus (thickened synovium) RA can lead to other serositis like pleural or carditis ```