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PANCE Study Guide > Musculoskeletal/Rheumatologic > Flashcards

Musculoskeletal/Rheumatologic Flashcards

1
Q

Indications to aspirate a bursa

A
  1. Rule out INFECTION

2. Aid in diagnosis of GOUT (or other microcrystalline disorder)

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2
Q

Sprain vs Strain

A 
Sprain = Ligaments
Strain = Tendons (s"T"rain - "T"endon)
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3
Q

Untreated wrist strain

A

“SLAC” wrist: Scapho-Lunate Advanced Collapse

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4
Q

Impingement tests for shoulder

A

Neer

Hawkins

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5
Q

Most common injury of the wrist

A

Colle’s Fracture

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6
Q

Rotator Cuff Muscles

A

SItS:

  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
  4. Subscapularis
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7
Q

Most commonly injured rotator cuff mm

A

Supraspinatus

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8
Q

MC cause of shoulder pain >40

A

Rotator cuff TEAR

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9
Q

Shoulder pain <40

A

Rotator cuff TENDINITIS

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10
Q

Test for rotator cuff

A

Drop arm test

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11
Q

Distinguishing rotator cuff tear from tendinitis

A

Lidocaine injection (improves tendinitis)

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12
Q

PASSIVE ROM limited

A

Adhesive capsulitis

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13
Q

MC demographic for adhesive capsulitis

A

Women and Diabetics

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14
Q

“Tennis elbow”

A

Lateral epicondylitis

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15
Q

“Golfer’s (baseball) elbow”

A

Medial epicondylitis

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16
Q

Most common overuse injury of elbow

A

Lateral epicondylitis

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17
Q

Which muscles attach to lateral epicondyle

A

EXTENSOR muscles

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18
Q

Which muscles attach to medial epicondyle

A

FLEXOR muscles

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19
Q

Treatment for lateral epicondylitis

A
  • Rest (at least 6 weeks), ice, NSAIDs
  • Counter force strap
  • Steroid injection +/- surgery
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20
Q

Red, swollen, painful elbow with PRESERVED ROM

A

Olecranon bursitis

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21
Q

Cause of INFECTIOUS olecranon bursitis

A

S. aureus

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22
Q

Small, soft, fluid-filled painLESS mass typically at the wrist

A

Ganglion cyst

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23
Q

Treatment for painful/disabling ganglion cyst

A

Aspiration +/- surgery

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24
Q

Most common mass/lump of hand

A

Ganglion cyst

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25
Q
  • 30-50 YO Woman with children +/- diabetic

- c/o pain/tenderness near base of thumb radiating up the forearm

A

DeQuervain’s Tenosynovitis

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26
Q

Most common tendonitis of the wrist

A

DeQuervain’s

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27
Q

Test for DeQuervain’s

A

Finkelstein

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28
Q

1st line treatment for DeQuervain’s

A

Brace/thumb splint and NSAIDs

+/- cortisone injection/surgery

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29
Q
  • Paresthesias of the 1st, 2nd, 3rd, and lateral 4th digit

- Thenar atrophy

A

Carpal tunnel syndrome

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30
Q

Carpal tunnel nerve

A

Median

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31
Q

Tests for carpal tunnel

A
  • Phalen’s sign
  • Tinel’s sign
  • Others: Durkan’s, Flick
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32
Q

Phalen’s sign

A

Reproduction of carpal tunnel symptoms with wrist hyperflexion

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33
Q

Tinel’s sign

A

Reproduction of carpal tunnel symptoms with percussion over carpal tunnel

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34
Q

Treatment for carpal tunnel

A

VOLAR SPLINT in neutral position
NSAIDs
+/- surgery (99% curative)

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35
Q

Most common mononeuropathy

A

Carpal Tunnel Syndrome

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36
Q

Sprain (or tear) of the ulnar collateral ligament of the thumb

A

Gamekeeper’s Thumb

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37
Q

Stenner lesion

A

Slippage of the UCL associated with Gamekeeper’s Thumb

ABSOLUTE indication for surgery

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38
Q

Most common shoulder dislocation

A

Anterior

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39
Q

Nerve involved with shoulder dislocation

A

Axillary nerve: check deltoid sensation

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40
Q

Management of shoulder dislocation

A

Manual reduction

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41
Q

MOI Scapula Fx

A

Direct VIOLENT trauma

Will likely have other injuries/fx

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42
Q

Management of scapula fx

A

Immobilization with sling and swathe

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43
Q

Common elbow fx in children

A

Supracondylar Fracture

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44
Q

Artery that may be damaged with supracondylar fx

A

Brachial –> Check radial pulses!!!

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45
Q

X-ray findings of supracondylar fx

A

Posterior sail sign

Anterior humeral line will NOT bisect the capitate

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46
Q

“Dinner fork deformity”

A

Colles Fracture

POSTERIOR displacement of the wrist

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47
Q

Treatment for colles fx

A
  1. Nondisplaced: casting alone
  2. Slight displacement: Closed reduction + casting
  3. A lot of displacement: ORIF + casting
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48
Q

Opposite of colles fx

A

Smith Fracture

MOI: Fall on back of hand

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49
Q

Shoulder slumped downward, forward and inward

A

Clavicle Fracture

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50
Q

Management of clavicle fx

A

Figure 8 dressing

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51
Q

Common arm fx of elderly pt

A

Humeral SHAFT fx

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52
Q

Nerve damaged with humeral shaft fx

A

Radial nerve

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53
Q

Radial nerve damage findings

A

Wrist drop

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54
Q

Displacement of fat bad and elbow effusion on xray

A

Radial head fx

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55
Q

Pain in the anatomical snuffbox

A

Scaphoid Fx

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56
Q

X-ray findings of scaphoid fx

A

Often negative (repeat in 10-14 days)

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57
Q

Fx of the distal 5th metacarpal

A

Boxer’s fracture

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58
Q

MC ligament injured in ankle sprain

A

Anterior talofibular ligament (ATFL)

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59
Q

Name of criteria for imaging on ankle sprains

A

Ottawa Rules

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60
Q

Ottawa Rules

A
  • ANKLE imaging if tenderness in MALLEOLAR region
  • FOOT imaging if tenderness in MID-FOOT region
  • Image BOTH if unable to bear weight for at least 4 steps
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61
Q

Ankle Sprain Classifications

A

Grade 1 - minimal tenderness/swelling; normal weight bearing
Grade 2 - moderate tenderness/swelling, decreased ROM; +/- instability
Grade 3 - significant tenderness/swelling, INSTABILITY

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62
Q

Grade 1 ankle sprain management

A

Weight bear as tolerated

PT

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63
Q

Grade 2 ankle sprain management

A

Immobilize with air splint

PT

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64
Q

Grade 3 ankle sprain management

A

Immobilize
PT
Possible SURGICAL reconstruction

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65
Q

Most common knee injury

A

Meniscal injuries

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66
Q

MC meniscus injury

A

Medial meniscus

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67
Q

Meniscus MOI

A

Excessive ROTATIONAL force

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68
Q

Meniscus special tests

A

McMurray

Apley

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69
Q

Fractures specific to peds population

A

Bowing

Greenstick

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70
Q

Classifying pediatric growth plate fxs

A

Salter-Harris

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71
Q

Salter-Harris classifications

A 
I - (S)lipped
II - (A)bove 
III - (L)ower
IV - (T)hrough
V - (ER)asure - crush
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72
Q

Metaphysis vs Epiphysis vs Diaphysis

A 
(M)etaphysis = (M)iddle
(E)piphysis = (E)nd
Diaphysis = Body/Shaft
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73
Q

Population for hip fx

A

Elderly females

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74
Q

Hip fx at risk of avascular necrosis

A

INTRAcapsular - affects blood supply to femoral head

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75
Q

Extracapsular hip fx treatment

A

Internal fixation

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76
Q

Intracapsular hip fx treatment

A

Hemiarthroplasty due to high risk of avascular necrosis

Internal fixation if non-displaced

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77
Q

Hemarthrosis with fat globules (knee aspiration)

A

Knee Fracture (patella/tibial plateau)

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78
Q

Obese male 12-16 YO c/o:
Progressive limp and knee pain
Knee turned (unable to internally rotate hip)

A

Slipped Capital Femoral Epiphysis

79
Q

Scoop of ice cream slipping off ice cream

A

Slipped capital femoral epiphysis

80
Q

SCFE management

A

Orthopedic EMERGENCY - Surgical repair

81
Q

MC cause of heel pain

A

Plantar fasciitis

82
Q

Pain with first steps in the morning that improves

A

Plantar fasciitis

83
Q

Fractures associated with child abuse

A
  • Metaphyseal corner fx
  • Posterior rib fx
  • LE fx of non-ambulatory child
  • Multiple fx in various stages of healing
  • Sternal or scapular fx without high impact mechanism
  • Any fx in child <1 YO
  • Spinous process fx
84
Q

MC complications of fx

A

DVT or PE

85
Q

Tenderness over the tibial tuberosity

A

Osgood-Schlatter Disease

86
Q

Male age 10-15 c/o:

  • Anterior knee pain worse with kneeling, jumping, stairs
  • Relieved by rest
  • Normal x-ray
A

Osgood-Schlatter Disease

87
Q

Osgood-Schlatter Disease treatment

A

Rest & NSAIDs

88
Q

Young child presenting with:

-Conjunctivitis, rash, adenopathy, strawberry tongue, hand/feet edema, high fever (>5 days)

A

Kawasaki Disease

89
Q

MC cause of pediatric acquired heart disease

A

Kawasaki Disease

90
Q

Cardiac complication of Kawasaki Disease

A

Coronary Artery Aneurysm

91
Q

Kawasaki Mnemonic

A 
CRASH and burn:
(C)onjunctivitis
(R)ash
(A)denopathy
(S)trawberry tongue
(H)and/feet edema
\+ Fever (>5 days)
92
Q

Medium-sized artery inflammation

A

Kawaski Disease

93
Q

Treatment for Kawasaki

A

IVIG (lowers risk of coronary artery complications)

Aspirin (continued low dose for months after)

94
Q

MC cause of costochondritis

A

Idiopathic

95
Q

Small vessel vasculitis caused by deposition of IgA

A

Henoch-Schonlein Purpura

96
Q

Child 4-12 YO presenting following URI with:

  • Arthritis
  • Palpable purpura
  • GI sxs
A

HSP

97
Q

Complications of HSP

A

Nephropathy

Intussusception

98
Q

Treatment for HSP

A

Supportive

99
Q

MC fx associated with osteoporosis

A

Vertebral body compression fx

100
Q

Screening test for osteoporosis

A

DEXA

101
Q

When to screen for osteoporosis

A

Average risk: Women >65 YO
Screen younger with risk factors
If osteopenia (-1.0 to -2.5), screen again in 1-5 years

102
Q

Osteoporosis diagnosis

A

T-score < -2.5

103
Q

Osteoporosis treatment

A
  1. Bisphosphonates (Alendronate, resideronate, ibandronate)
  2. Vitamin D: 800-1000 IU daily
  3. Calcium: 500-600 mg BID
104
Q

Important Bisphosphonate instuctions

A

Take on EMPTY stomach and
Sitting UPRIGHT (remain upright for 30 min)
HYPOcalcemia
Osteonecrosis of the jaw in cancer patients

105
Q

Chronic tendon thickening with localized tendon pain

no inflammation

A

Overuse syndrome

106
Q

Disruption or laceration of the extensor tendon at the DIP

A

Mallet Finger

107
Q

Distal radial shaft fx with

Associated distal radioulnar joint dislocation

A

Galeazzi Fracture

108
Q

Fracture of proximal 1/3 of ulna

+ Dislocation of radial head

A

Monteggia Fracture

109
Q

5th metatarsal transverse fx (proximal)

A

Jones Fracture

110
Q

Midfoot fracture of metatarsal bones

A

Lisfranc Fracture

111
Q

Lisfranc Fx treatment

A

ORIF

112
Q

Stress fracture of pars interarticularis (usually L5)

A

Spondylolysis

113
Q

Scotty Dog with collar (lumbar x-ray)

A

Spondylolysis

114
Q

MC location of Gout

A

First MTP (Podagra)

115
Q

MC Gout crystals

A

Uric Acid

116
Q

Gout light microscopy

A

Needle-shaped

Negative birefringence

117
Q

Acute gout treatment

A

NSAIDs (indomethacin)

118
Q

Chronic gout treatment

A

Allopurinol

Colchicine

119
Q

Gout triggers

A

Red meats, alcohol

Meds: Thiazide and Loop Diuretics

120
Q

MC location for pseudogout

A

Knee

121
Q

Pseudogout light microscopy

A

Positively birefringent

Prism (rhomboid) shaped crystals

122
Q

MC pseudogout crystal

A

Calcium pyrophosphate crystals

123
Q

Pseudogout treatment

A

NSAIDs

124
Q

Morning stiffness lasting >30 min

A

RA

125
Q

Ulnar deviation of MCP

A

RA

126
Q

Associated with Baker’s cyst,
Swan neck deformity,
Boutonniere deformity

A

RA

127
Q

Symmetrical bone erosions and joint space narrowing

A

RA

128
Q

RA labs

A

RF
ESR
CRP
(Consider PMR if +ESR, +CRP, -RF)

129
Q

RA treatment

A

NSAIDs
Glucocorticoids
DMARDS (Methotrexate)
TNF Inhibitor

130
Q

Affects MCP and PIP joints

A

RA

131
Q

Widespread muscle pain >3 months
PE shows tenderness at >9/18 trigger points
Labs are normal

A

Fibromyalgia

132
Q

Fibromyalgia treatment

A

Education
Antidepressants
NO opioids

133
Q

Proximal WEAKNESS of the skeletal muscles

A

Polymyositis

134
Q

Patient presenting with insidious onset of muscle weakness

Reports difficulty getting up from chair, muscle atrophy

A

Polymyositis

135
Q

Polymyositis Treatment

A

HIGH dose steroid taper

DMARDS if unresponsive to steroids

136
Q

Pt with hx of lupus

c/o REPEATED SPONTANEOUS ABORTIONS

A

Antiphospholipid Antibody Syndrome

137
Q

Antiphospholipid Antibody Syndrome Lab Finding

A

Thrombocytopenia

138
Q

Treatment of antiphospholipid antibody syndrome

A

Anticoagulation

139
Q

Malar rash
Photosensitivity
Arthritis
Hemolytic anemia

A

SLE

140
Q

SLE antibodies

A

Anti-dsDNA: High specificity, poor prognosis
Anti-Smith: High specificity, not prognostic
ANA: High sensitivity, non-specific

141
Q

Drugs that induce SLE

A

HIPPS:

  • Hydralazine
  • Isonazid
  • Procainamide
  • Phenytoin
  • Sulfonamides
142
Q

Drug induced SLE antibodies

A

Antihistone

143
Q

SLE treatment

A

NSAIDs
Steroids
Immunosuppressants
HYDROXYCHLOROQUINE

144
Q

Disease of excessive collagen deposition

A

Scleroderma

145
Q

Scleroderma manifestations

A

CREST + Pulmonary fibrosis/HTN, Renal artery stenosis, GI dysmotility

146
Q

CREST Syndrome

A 
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasias
147
Q

Scleroderma antibodies

A

Anti-SCL-70 (systemic only)
Anti-centromere
ANA

148
Q

CREST antibodies

A

Anti-centromere

ANA

149
Q

Pain/stiffness in shoulders and hips w/out weakness

A

PMR

150
Q

What is PMR associated with

A

Temporal (giant cell) arteritis

151
Q

PMR labs

A

(+)ESR/CRP

(-)RF

152
Q

PMR treatment

A

Steroids (prednisone)

153
Q

Middle aged female presenting with:

dry eyes, dry mouth, parotid enlargement

A

Sjogren’s

154
Q

What rheum conditioin is Sjogren’s associated with

A

RA

155
Q

What cancer is Sjogren’s associated with

A

B-Cell Lymphoma (44x the risk!!!)

156
Q

Sjogren’s antibodies

A

Anti-Ro
Anti-La
ANA, RF

157
Q

Stiffness that is worse w/ activity, improved with rest

A

OA

158
Q

Joints affected by OA

A

DIP, CMC of thumbs

159
Q

Osteophytes on x-ray

A

OA

160
Q

OA labs

A

Normal ESR & RF

161
Q

Heberden and Bouchard nodes

A

OA

162
Q

Heberden VS Bouchard nodes

A

Heberden - DIP

Bouchard - PIP

163
Q

MC cause of septic arthritis <35 YO

A

Gonorrhea

164
Q

MC cause of septic arthritis overall

A

S. aureus

165
Q

Patient presenting with fever, joint pain, dec ROM

A

Septic arthritis

166
Q

MC site for septic arthritis

A

Knee

167
Q

Septic arthritis synovial fluid analysis

A

WBC >50,000 with >75% PMNs
Yellow, purulent
Variable viscosity

168
Q

HLA-B27

A

Ankylosing Spondylitis

Reactive Arthritis

169
Q

Low back pain that is worse in the morning, improves with exercise

A

Ankylosing spondylitis

170
Q

Bamboo spine

A

Ankylosing spondylitis

171
Q

Ankylosing spondylitis labs

A

(+) ESR

(+) HLA-B27

172
Q

Ankylosing spondylitis treatment

A

NSAIDs
Methotrexate
PT
Spinal fusion

173
Q

Pt with recent GI or chlamydia infection

c/o ASYMMETRIC arthritis, conjunctivitis, urethritis

A

Reactive Arthritis (Reiter’s)

174
Q

Reactive arthritis labs

A

HLA-B27

175
Q

Treatment for reactive arthritis

A

NSAIDs

176
Q

MC primary malignancy of the bone

A

Osteosarcoma

177
Q

Sunburst x-ray pattern

A

Osteosarcoma

178
Q

MC location for osteosarcoma

A

LONG bones: Femur > tibia > humerus

179
Q

MC cause of avascular necrosis

A

Corticosteroids

180
Q

MC site for avascular necrosis

A

Femoral head

181
Q

Hypercalcemia
Renal insufficiency
Anemia
Bone lesions/Back pain

A

Multiple Myeloma

182
Q

Lytic bone lesions

A

Multiple Myeloma

183
Q

Multiple Myeloma mnemonic

A 
CRAB:
hyperCalcemia
Renal insufficiency
Anemia
Bone lesions/Back pain
184
Q

Monoclonal antibody spike (M spike)

A

Multiple myeloma

185
Q

Bence-Jones proteins

A

Multiple myeloma

186
Q

Rouleaux formations

A

Multiple myeloma

187
Q

Proximal myalgias and weakness
Skin ulcers
Nephritis
Mesenteric ischemia

A

Polyarteritis nodosa

188
Q

MC type of ischial tuberosity avulsion

A

Pelvic avulsion fracture

189
Q

Brittle bone disease

A

Osteogenesis imperfecta

190
Q

Infant with hearing loss, easy bruisability, and multiple fractures

A

Osteogenesis imperfecta

191
Q 
Blue sclera
Increased laxity of joints
Short stature
Scoliosis
Basilar skull deformities
A

Osteogenesis imperfecta

192
Q

Osteogenesis imperfecta inheritance pattern

A

Autosomal dominant mutation of the collagen

193
Q

Fleck sign

A

Avulsion fx of the medial aspect of the base of the 2nd metatarsal
Pathognomonic for Lisfranc fx

PANCE Study Guide (2 decks)

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