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English 2 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

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1
Q

Shoulder dislocation (anterior vs posterior)

A

Ant: axillary N injury; arm abduct + ext rotat*
Post: rare; seiz/electroc; arm adduct + int rotat*

ttt: reduction then sling/swathe
If recurr, surg

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2
Q

Humerus fracture

A

Radial N palsy → wrist drop + loss thumb extens*

ttt: cast vs sling; functional bracing

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3
Q

“Nightstick fracture”

A

Ulnar shaft fx (trauma in self-defense ag blunt obj)

ttt: ORIF

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4
Q

Monteggia fracture

A

Diaphys fx of prox ulna + subluxat* radial head
Fall on pronated + outstretch arm

ttt: ORIF of fx + reduct* of radius

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5
Q

Galeazzi fracture

A

Diaphys fx of radius + disloc of distal radioulnar joint
Direct blow to radius

ttt: ORIF of radius + cast in supination

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6
Q

Colles fracture

A

Distal radius; dorsally displaced
Fall to outstretched hand
Esp child or elder (osteop)

ttt: closed reduct* + long-arm cast; open reduct if intraartic

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7
Q

Scaphoid fracture

A

1 fractured carpal bone

Fall to outstretch hand
Tendern in anatom snuffbox w/ axial loading
Xray: 2wks to appear

ttt: thumb spica cast +/- open reduct*
!! AVN if disrupt* of bld flow

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8
Q

Boxer’s fracture

A

5th metacarpal neck
Forward trauma to closed fist

ttt: closed reduct*, ulnar gutter splint; +/- pinning

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9
Q

Hip dislocation (anterior vs posterior)

A

Post: >90%; post force on an internally rotated flexed adducted hip; sciatic N injury + AVN
Ant: obturator N

ttt: closed reduct* then abduct* pillow/bracing then CT

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10
Q

Hip fracture

A

Short + ext rotat leg
If Xray⊖ and clinic ⊕, do CT/MRI
-Displaced femor neck fx: ↑R AVN
Ass w/ DVTs

ttt: ORIF; if displaced fem neck fx in elder, arthroplasty
+ Anticoag

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11
Q

Femoral fracture

A

!! fat emboli: fev, chang ment status, dyspn, hypox, petech, ↓plts

ttt: intramedull nailing

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12
Q

ACL vs PCL knee injuries

A

ACL: noncontact twist, forced hyperextens* or impact to extended knee
⊕ ant drawer
R/o meniscal or MCL injury

PCL: post force on flexed knee
⊕ post drawer

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13
Q

Meniscal tears of knee

A

Acute twist or degenerative tear in elder
Click/lock
Joint line tendern; ⊕McMurray

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14
Q

Knee injuries (ttt)

A

MRI (#1)
MCL/LCL/Meniscal tears: conserv ttt

ACL: surg
PCL: surg if highly competitive athlete
Meniscal: surg: if young or old refractory to conserv ttt

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15
Q

Tibial fracture

A

!! compartment sd

ttt: casting vs intramedull nailing vs ORIF

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16
Q

Achilles tendon rupture

A

Sudden “pop” w/ ↓activ (plantar flex*)
⊕ Thompson test
ttt: surg then long-leg cast x6wks

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17
Q

Radial nerve injury

A

Motor def: wrist extens*
Sens def: dorsal forearm + first 3 fingers
Cause: hum fx, prolong compr of hum
Clinic: wrist drop

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18
Q

Median nerve injury

A

Motor def: forearm pronat* + thumb oppos
Sens def: palmar first 3 fingers
Cause: carpal tunnel
Clinic: weak wrist flex* + flat thenar eminence

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19
Q

Ulnar nerve injury

A

Motor def: finger abduct*
Sens def: palmar + dorsal (last 2 fingers)
Cause: elbow dislocat*
Clinic: claw hand

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20
Q

Axillary nerve injury

A

Motor def: arm abduct*
Sens def: over deltoid
Cause: ant should dislocat*

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21
Q

Peroneal nerve injury

A

Motor def: dorsiflex, evers
Sens def: dorsal foot + lateral leg
Cause: knee dislocat*, trauma to fibula
Clinic: foot drop

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22
Q

Compartment syndrome (etiologies, PE)

A

↑pressure in confined space; compromise N/M/perfus*
Ant comp of lower leg; forearm
After fx, muscl injury, surg

Pain out of prop; pain w/ passive mot* of fing/toe; paresthesia; pallor; poikiloth; pulseless; paralysis

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23
Q

Compartment syndrome (dg, ttt)

A

Dg: Hx, clinic, ⊕ delta pressure (≤30)
Delta P* = DBP - compartment P*

ttt: immediate fasciotomy

24
Q

Carpal tunnel syndrome (RF, PE)

A

Entrapment of median N at wrist
By overuse of wrist flex*; ass w/ DM, thyroid dysf
Pgnt and middle-aged W

Pain in thenar area + prox forearm; paresth in palmar of first 3 fingers; worse at night
Phalen/Tinel ⊕

25
Q

Carpal tunnel syndrome (dg, complications, ttt)

A

Dg: clinic; EMG to confirm
Complic: permanent loss sensat*/strength/fine motor

ttt: splint wrist in neutral (night + day); CS inject*
Surg if refract or advanced

26
Q

Bursitis

A

Infl by repetitive use/trauma/inf/system infl ds/microcristall
Esp subacromial, olecranon, trochanteric, pre/infrapatellar

Local tendern, ↓motion, edema, eryth
Dg: if septic or crystal suspic, needle aspir
ttt: rest, heat+ice, elevat, NSAIDs
Intrabursal CS inj (but CI in septic); Septic ttt w/ 7-10d AB

27
Q

Tendinitis (PE)

A

From overuse
Esp supraspinatus, biceps, wrist extensor, patellar, iliotibial band, post tibial, Achilles

Pain at tendon insert, swell, impair fct; worse w/ repetiive stress + resist strength
Lat epicondyl ↑w/ resist extens of wrist vs Med w/ resist flex*

28
Q

Tendinitis (dg, ttt)

A

Dg: clinic; radio if trauma; MRI/US in tendon tear

ttt: rest + NSAIDs + ice first 24-48h
Splint, brace, immobil
Once pain stops, strengthen exo
If all fail, CS inject (CI in Achilles)

29
Q

Herniated disk (PE)

A 
Degen, trauma, strain/sprain
Esp lumbar (L5-S1; L4-L5); middle-aged+older men

Sudden severe (w/ valsalva), electr-like LBP, preceded by months of pain
Ass w/ sciatica, paresth, weakness, atrophy, contract*
Passive straight-leg raise ↑pain
If midline, cauda equina sd

30
Q

Herniated disk (dg, ttt)

A

Dg: ESR/Xray (if susp of inf, trauma, fx)
Stat MRI: cauda equina sd or sev progress neuro def
MRI: if sympt refract to conservative ttt

ttt: NSAIDs + physical therapy + local heat: resolut* 4wks
No bed rest; +/- inject* or nerve block
Sev or rapid progr and cauda equina: surg

31
Q

Spinal stenosis (PE)

A

Narrow lumbar or cervical spinal canal
Compr of sp cord and nerv roots
Esp degen joint ds; middle-aged or elder

Neck/back pain radiates to arms/buttocks/legs
Leg numb/weak; leg cramp worse w/ stand/walk
Improv w/ flex* of hip + bend forw/

32
Q

Spinal stenosis (dg, ttt)

A

Dg: radio (degen, narrow); MRI/CT (spinal stenos)

ttt: mild to mod: NSAIDs + abdo muscl strength
Adv: epidural CS inj
Refract: surg laminectomy (!recurr)

33
Q

Osteosarcoma (PE)

A

Child/ado: #1 bone malign
Adult: benign (Paget) transfo to malign
Metaph of distal femur, prox tibia, prox hum

Progr intractable pain, worse at night
+/- fev, ↓weight, night swt, eryth, enlarg

34
Q

Osteosarcoma (dg, ttt)

A

Dg: radio (Codman triangle, sunburst); biopsy
(# onion skin of Ewing sarc; #soap bubble of giant cell tumor)
MRI/CT of chest (stage + plan surg)

ttt: limb-sparing surg, pre and post chemoth; amputation

35
Q

Septic arthritis

A

After open injury or bacteremia
RF: prosthetic joint; RA; osteoarthritis; bacteremia; IVDA

Warm, red, immobile joint, effus*, fev/chill
Dg: joint aspir (WBCs>80K, ⊕ Gram/Cx)
Esp staph/strep/GNRs

ttt: empir cetriax + vanco then change; surg debrid or several aspir

36
Q

Osteoarthritis (RF, PE)

A

Chronic, noninfl arthritis of synov joint
RF: ⊕fam Hx, obes, Hx of joint trauma

Crepitus, ↓ROM, pain ↑w/ activ + weight and ↓rest
Morning stiffness <30min

37
Q

Osteoarthritis (dg, ttt)

A

Dg: radio (joint spac narrow; osteophyte; subchond scler + bone cyst); fluid (yellow, Nl viscos, WBC<2K); labs Nl

ttt: physical therapy, ↓weight, NSAIDs; intra-art CS
Joint replac if adv

38
Q

Causes of hyperuricemia

A 
↑cell turnover (hemolys, blast crisis, tumor crisis, pso, myelodyspl)
Cyclosporine
Dehydration
Diabetes insipidus
Diet (red meat, alcoh)
Diuretics
Lead poisoning
Lesch-Nyhan sd
Salicylates (low dose)
Starvation
39
Q

Gout (RF, PE)

A

Recurr attac; acute monoart arthritis
Monosod urate cryst
RF: male, obes, postmenop, binge drink

Excruc sudden pain; 1st MTP (podagra), other joints
Erythem, swoll, tender; +/- tophi and kidn stones if chron

40
Q

Gout (dg, ttt)

A

Dg: fluid aspir (needle cryst, ⊖ birefr); ↑/Nl serum uric ac

Acute: high-dose NSAIDs (#1); steroids (if 1 is ineff/CI); colchicine
Mainten: allopurin (over-producer; CI to proben; refract); probenecid (under-secret)
↓weight; avoid trigg (alcoh, …)

41
Q

Rheumatoid arthritis (RF, PE)

A

Autoimm ds; chron destruct symmetr infl arthritis
Synov hypertr; pannus; eros* of cartil/bone/tendon
RF: female, 35-50yo, HLA-DR4

Morning stiff >1h, pain, warm, swell, multi symm joints
Esp wrist, MCP, …; ulnar deviat*
Tendon deform; vasculitis; atlantoaxial sublux

42
Q

Rheumatoid arthritis (dg, ttt)

A 
Dg: ↑RF (IgM ag Fc IgG) or anti-CCP Ab; ↑ESR/CRP
≥3 joints for >6wks; exclude acute/cryst cause
Fluid aspir (turbid, ↓viscos, ↑WBCs 3K-50K)
Radio: joint space narrow + eros*

ttt: NSAIDs (↓ or d/c after success ttt w/ DMARDs)
DMARDs: start early w/ methotrexate; or hydroxychlor, sulfasalazine; #2 TNF inh, rituximab, leflunomide

43
Q

Ankylosing spondylitis (RF, PE, dg)

A

Chron infl of spine + pelvis
RF: male, early 20s, ⊕fam Hx
Fatig, interm hip pain, LBP worse w/ rest+morning
⊕ Schober, no lumbar lordosis
Ant uveitis, heart block, enthesitis of heel

Dg: ⊕HLA-B27; radio (fused sacroiliac j, bamboo spine); ↑ESR/CRP; ⊖RF; ⊖ANA

44
Q

Ankylosing spondylitis (r/o, ttt)

A

R/o other sero⊖ spondylarth:

  • Reactive arthritis (Reiter; arthr/uveit/urethr aft campylo/shigel/salmo/chlam/ureapl)
  • Psoriatic arthritis (oligoarth, also DIP, dactylitis)
  • Enteropathic spondylitis (sacroiliitis asymm, IBD)

ttt: NSAIDs + exo (improve posture + breath)
TNF inh or sulfasalazine (if refract)

45
Q

Polymyositis and dermatomyositis (PE)

A

50-70yo; W>M; bla>whi
Progr syst connect T. ds; immune-med infl of striated M.

Polym: symm progr prox M. weak/pain
Dermatom: same + rash; heliotr (violac periorb); Shawl sign (should/chest/back); Gottron papul (dors hands)

+/- diff breath/swall; myocarditis; card conduc def
Ass w/ malign (lung/breast)

46
Q

Polymyositis and dermatomyositis (dg, ttt)

A

Dg: clinic+lab; ↑CK; ↑anti-Jo-1 Ab

ttt: high-dose CS x4-6wks then taper
Azathioprine +/- methotrexate if no CS

47
Q

Systemic sclerosis / Scleroderma (RF, PE)

A

Infl → progr T. fibrosis by excess depos collag I+III
RF: female, 35-50yo

Symm thick skin: limited (head, neck, dist upp extrem); diffuse (chest, abdo, prox upp extrem)
CREST: Calcinosis, Raynaud, Esoph dysmot, Sclerodact, Telangiect
Diff: GI dysmot, pulm fibros, cor pulm, acute renal fail, malign HTN (Morta from pulm/card/renal complic)

48
Q

Systemic sclerosis / Scleroderma (dg, ttt)

A

Dg: Anticentrom Ab in CREST; Anti-Scl-70 Ab (antitopoiso 1) in diffuse (poor pg)
May have: eosino; RF/ANA ⊕

ttt: organ-based; CS (acute flares); penicilliamine (skin chang); CCB (Raynaud); ACEIs (renal + prevent ren crisis)

49
Q

Systemic lupus erythematosus (RF, PE)

A

Autoimm; Ab-mediat cellular attack + deposit Ab-Ag compl
RF: black women; child-bear age

Fev, anorex, ↓weight, symm joint pain
≥4 criteria of DOPAMINE RASH (Discoid rash; Oral ulc; Photosens; Arthritis; Malar rash; Immuno (dsDNA, Sm, anti-phospholi); Neuro (seiz, cerebritis); ↑ESR; Renal; ANA⊕; Serositis (pleur/peric eff); Hemato abNl)

50
Q

Systemic lupus erythematosus (dg, ttt)

A

Dg: ⊕ANA; anti-dsDNA Ab; anti-Sm Ab
+/- antiphosph Ab; An; leukop; thrombocytop; proteinur/casts
⊕antihistone Ab (drug-ind); ⊕anti-Ro Ab (neonat)

ttt: NSAIDs (mild joint); CS (acute exac)
Progr/Refrac: CS, hydroxychlo, cycloph, azathiop
Hydroxychl (only skin/joint ds); Cycloph (sev nephritis)

51
Q

Giant cell arteritis / Temporal arteritis (RF, PE)

A

Subacute granulom infl of large Vx (Ao, caroti, verteb)
RF: polym rheum, >50yo, female

New headac (uni/bil), tempor tendern, jaw claudic
Fev, monoc blind, ↓weight, myalg/arthralg (should/hip)
52
Q

Giant cell arteritis / Temporal arteritis (dg, ttt, complications)

A

Dg: tempor art biops (defin; thromb, media necros, lymphoc, plasma C, giant C); ↑ESR, ophth eval

ttt: high-dose prednisone immed; ophth follow-up

Complic: blindness (by occl of central retin art)

53
Q

Complex regional pain syndrome (PE)

A

3 phases: acute/traum → dystrophic → atrophic
No true nerve injury

Diffuse pain out of prop; non-anatom distrib
Loss of fct of limb
Sympathetic (autonom) dysfct: changes of skin (temp, hair, nail growth), tiss, bld flow

54
Q

Complex regional pain syndrome (dg, ttt)

A

Dg: clinical

ttt: NSAIDs, CS, low-dose TCA, gabapentin, pregabalin
Physical therapy; chemical sympathetic blockade

55
Q

Fibromyalgia (PE)

A

Chron soft T and axial skeletal pain
No joint pain; No infl

Women 30-50yo; ass w/ depress, anxiet, sleep disord, IBS, cognit disord

56
Q

Fibromyalgia (dg, ttt)

A

Dg: ≥11 of 18 painful areas over all body
If <11 then myofascial pain syndrome

ttt: antidepress (SSRI+TCA or 2 SNRIs), gabapentin, pregabalin, muscle relax, physical therapy
Multidisciplinary

57
Q

Polymyalgia rheumatica

A

Inflamm; ass w/ temporal arteritis
RF: female, >50yo

Pain+stiff in should/hip/neck; diffic standing or lifting arms
Fev, mal, ↓weight
Dg: ↑ESR, anemia
ttt: low-dose prednisone (10-20mg/d)

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