MUSCULOSKELETAL/RHEUM Flashcards
Mechanism in anterior shoulder dislocation
Posteriorly directed force on distal humerus or forearm during abduction drives humeral head forward and tears anterior shoulder capsule
Most common mechanisms in posterior shoulder dislocation
Seizures and electrical shock
Unhappy triad
Medial meniscus tear
MCL
ACL
Emergent fasciotomy for compartment pressures at what level?
> 30 mm Hg or within 20 mm Hg of DBP
Distal radius is displaced in what direction in a smith fracture
Anteriorly
What is a montage fracture
Dislocation of radial head and ulnar diaphysial fracture – “nightstick injury”
Galeazzi fracture
Distal radio-ulnar joint dislocation and radial diaphyseal fracture
Which fx has high risk for compartment syndrome
Tibial
Complication of pelvic fx
High risk of major blood loss
MOA of teriparatide
Recombinant human parathyroid hormone. Used in pulsatile fashion it stimulates osteoblasts and bone remodeling.
Increased bone density caused by impaired osteoclast activity
Osteopetrosis
Labs in osteopetrosis
Decreased H&H due to narrowing of marrow cavities
Increased acid phosphatase
Increased CK
Labs in Pagets
Increased alk phos and urine hydroxyproline
Normal calcium and phosphorous
What kind of lesions caused by pages disease
OsteoLYTIC
What kind of lesions in prostate cancer bone mets
OsteoBLASTIC
MOA of allopurinol
Inhibits uric acid formation
MOA of probenecid
Inhibits kidney uric acid resorption
Xray shows chonedrocalcinosis in knee and wrist
PSeudogout!
Tx of pseudogout
NSAIDs and colchicine
Joint aspiration shows 5000-50000 leukocytes
Inflammatory arthrpathies like RA, gout, or pseudo gout
Tx for lyme
Doxy or amoxicillin in early disease
Cefuroxime for advanced disease
Bouchard nods
PIP
Heberden nodes
DIP joint
DIP joints are spared in OA or RA?
RA
Flexed DIP plus hyperextended PIP
Swan neck deformity (RA)
Flexed PIP
Boutonnniere deformities seen in RA
Anticitrulline-containing protein IgM antibodies
RA
Anti-Jo-1 antibodies
Polymyositis or dermatomyositis
Anti-scl-70, ANA
Scleroerma
Anti-centromere antibodies
CREST syndrome
Anti-RNP ANA
Mixed connective tissue disease
PTs still symptomatic following NSAId use in RA may be started on what meds?
Sulfasalazine
Hydroxychloroquine
Analgesics
Common drugs that cause drug-induced lupus
Hydralazine Procainamide INH Methyldopa Quinidine Chlorpromazine
Anti-Sm antiodies
Very specific for SLE
Complement in SLE
Decreased C3 and C4
Weakness is a symptom of polymyositis or polymyalgia rheumatic?
Polymyositis
Muscle biopsy in pts with polymyositis
Inflammatory cells WITHIN muscle fascicles and muscle degeneration
Muscle biopsy in pts with dermatomyositis
Inflammatory cells SURROUNDING muscle fascicles, muscle degeneration
EMG in polymyositis/dermatomyositis
Spontaneous fibrillations
Extra-organ involvement in polymyositis and dermatomyositis
Possible interstitial lung disease (especially if anti-Jo-1 antibodies)
Next step once polymyalgia rheumatic diagnosed
Workup for temporal arteritis.
Pencil in cup deformities
Psoriatic arhtritis
Tx for Raynaud in Scleroderma
CCB and avoidance of caffeine, nicotine, and decongestants
Malignant renal HTN in scleroderma is treated with?
ACE-I
Mixed connective tissue disease is a combo of what 3 disorders
SLE + scleroderma + [polymyositis
What is sicca syndrome
Sjogren without a secondary autoimmune association
Fractures following minor trauma in a middle aged patient?
Bone mets
Risk factors for osteosarcoma
Paget disease of bone p53 genetic mutations Familial retinoblastoma Radiation exposure Bone infarcts
Sunburst pattern an dCodman triangle
Osteosarcoma
Tumors that mets to bone
Prostate Renal Thyroid Lung Lymphoma Breast
(Permanently Relocated Tumors Like Long Bones)
Most commonn benign bone tumor in metaphysics of long bones
Osteochondroma
Female delivered breech presentation should be worked up for?
Devlopmental dysplasia of the hip
Most commonly used method of imaging hip congruity (in infants)
Ultrasound. Xrays aren’t helpful until after 4 months of age
Tx of devo dysplasia of hip
Pavlik harness
X-rays may demonstrate osteopenia and subchondral sclerosis around INVOLVED JOINTS?
Juvenila idiopathic arthritis
Tx of juvenile idiopathic arhritis
Usually NSAIDS, methotrexate, or corticosteroids
Complications of pauciarticular juvenile RA
Blindness from iridocyclitis
Amyloidosis is a complication of which form of JRA?
Systemic
Which JRA has worst prognosis
Polyarticular. Worse with older onset.
Type 1 salter-harris physeal fracture
Physeal separation without extension into adjacent bone
Salter Harris II
Partial physeal separation with pro extension into metaphysis
Salter Harris III
Partial physeal separation with distal extension into epihpysis
Salter Harris Type IV
Fracture extends through metaphysics, physics, and epihpysis
Salter Harris Classification type V
Crush injury. High likelihood of partial growth arrest :(
Tx of nursemaid’s elbow
Manual reduction via supination of arm with flexion of elbow from 0-90 degrees
X ray shows asymmetric hips; affected femoral head appears small with sclerotic bone and widened joint space
Legg Calve Perthes
Death in Duchenne MD occurs due to?
Respiratory issues
What is a second fracture
Avulsion fx at proximal lateral tibia, associated with ACL tear.
Grade 1 Lachman test
Up to 5 mm of translation
Grade II lachman
6-10 mm translation
Grade III lachman
11-15 mm translation
Grade IV Lachman
More than 15 mm translation
ACL tear type A
Firm end point
ACL tear type B
Soft end point
What is a pivot shift test
Evaluates knee for ACL tear. Performed with patient supine and physician places a VALGUS stress while INTERNALLY rotating the tibia, then flexing and extending the knee. In its resting position, an ACL deficient knee will be in a sublimed position, where the tibia is sublimed anteriorly on the femur. When performing the shift test the physician recreates the giving way event then reduces the anteriorly sublimed tibia, pushing it posteriorly under the femur A palpable clunk is felt, indicating a positive pivot shift test.
What is Friedbergs infraction
Osteochondrosis of the 2nd metatarsal head
Most frequently encountered in adolescent females
What is severs disease
Traction apophysitis at the insertion of the Achiles on the calcaneus and is most common during periods of rapid physical growth.
What is Sinding Larsen Johansson syndrome
Traction apophysitis at the inferior pole of the patella
Osgood Schlatter affects what area of the knee?
Tibial tuberosity.
What is a Lisfranc joint
Articulation between midst and forefoot and involves all five taros-metatarsal joints.
Wahat is a Le Fort I fracture
Separation of palate from maxilla, also known as a low septal fracture. It results from force directed low on the maxillary alveolar rim with a downward direction and the fracture extends from the nasal septum, travels horizontally above the teeth apices crosses below the zygomaticomaxillary junction and traverses the pterygomaxillary junction to interrupt the pterygoid plates.
What is a Le Fort II fracture
Blow to the lower or mid maxilla and has a pyramidal shape with extension from the nasal bridge at or below the nasofrontal suture through the frontal process of the maxilla, inferolaterally through the lacrimal bones and inferior orbital floor and rim through the inferior orbital foramen and inferiorly through the anterior wall of the maxillary sinus. It goes under the zygoma, across the pterygomaxillary fissure and through the pterygoid plates.
What is a Type III Le Fort fracture
Complete craniofacial dysfunction with extension posteriorly tthrough the ethmoid bones and laterally through the orbit below the optic foramen and through the pterygomaxillary suture into the sphenopalatine fossa. It results in a face that appears long and flat.
Describe Hawkins test
Tests for shoulder impingement or rotator cuff tendinous.
The shoulder is flexed forward, elevated to 90 degrees, then forcibly internally rotated bringing the greater tuberosity of the humeral head toward the accordion.
Describe Jobe’s test
This is also known as the empty can test.
The patient actively abducts the arms to 90 degrees, flexes forward 30 degrees, and internally rotates pointing the thumb toward the floor. The patient the resists a downward force applied by the doc. This test isolates the supraspinatus muscle.
Speeds test assesses for .. ?
Biceps tendinopathy
What is Wright maneuver
Assesses thoracic outlet.
Physician passively and progressively hyperabducts and externally rotates patients arm. Head and chin are in neutral. If it reproduces sx or causes a diminished radial pulse, it is considered positive.
What is the cross arm test
Evaluates AC joint. Painful arm is flexed to 90 and adducted across the body. Pain at AC joint indicates OA or separation of the joint.
What is the Neer test
Patient places the hand of the affected shoulder on the unaffected shoulder and then forward flexes (raises the elbow) which narrows the space around the rotator cuff and recreates their sx. The Neer test uses lidocaine injection into the subacromial space which provides pain relief for the patient for up to several months. Highy sensitive for rotator cuff pathology.
MCC of impetigo
Staph areas followed by Strep pyo
What causes bullous impetigo
Strain of S. aureus that produces exfoliative toxin A which targets desmoglein.
3 things that increase risk of Legg Calve Perthes
Positive family hx
Exposure to cigarette smke
Low birth weight
Tx of legg calve perthes
Bracing with the use of a Petri cast keeps the hips in abduction and holds the femoral head in concentric alignment with the acetabulum. Pt also placed on crutches to limit amy of weight transferred through the hip which helps relieve symptoms.
Injury to thoracodorsal nerve causes what muscular dysfunctions
Loss of adduction, internal rotation, and extension.
What nerve is responsible for forearm pronation
Median
What nerve is responsible for ab or adduction fingers
ulnar (interosseus mm)
Unable to raise arm above horizontal indicates what nerve injury
LTN, also CN XI
What nerve is at risk of injury to supracondyle of humerus
median
What types of fx would prompt you to search for a ruptured aorta
1st or 2nd rib
Scapula
Sternum
Abx ppx in grade I or II open fracture
Cefazolin
Abx ppx in Grade III open fx (extensive tissue damage and/or high contemn)
Cefazolin + aminoglycoside
Abx ppx in farm injury causing open fx
Cefazolin + aminoglycoside + PCN
Dashboard knee injury
PCL
What imaging study is best for detecting spinal cord compression
CT
What imaging study is best for detecting spinal cord lesions
MRI
What imaging study is best for visualizing brachial plexus
MRI
Tx for compartment syndrome
fasciotomy of ALL COMPARTMENTS in extremity!
Arthropathhy of PIP and MCP
RA
ARthropathy of DIP and PIP
OA
Isolated MCP arthropathy with squared off bone ends and hook like osteophytes of the MCPs
hemochromatosis
How do you treat pseudogout
NSAIDs or colchicine
What is tripartite used for
Pulsatile PTH used in tx of osteoporosis
This bone dz results in narrowing of the marrow cavity and low H&H
osteopetrosis
What should you always do before starting a TNF inhibitor?
Check a PPD!
anti U1 RNP
CREST
Obtain a hip sonogram at 8 weeks if ..
female newborn was born breech or theres a family hx.
Tx of JRA
NSAIDS but if unresponsive to a trial of 2 DIFFERENT NSAIDS over at LEAST 6 weeks, second line is MTX or corticosteroids.
Tx in SCFE
Surgical pinning.
IF HYPOTHYROID PIN OTHER SIDE
