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Natsumi - NPLEX 2 > Natsumi MSK conditions > Flashcards

Natsumi MSK conditions Flashcards

1
Q 
Localized tenderness, pain with movement
Decreased ROM
Erythema
Edema
Hx of repetitive movement
Alleviated by rest, worsened by exercise
A

Bursitis

Test:

  • fluid aspiration → monosodium urate crystal (DDX: gout) , cell count, gram stain
  • MRI

Tx: RICE, NSAID (celecoxib, ibuprofen) , hydrocortisone, bursal aspiration

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2
Q

Men > 40 yo
Diet with seafood and meat
Hx of renal failure

Clinical conditions associated with gout: hypertension, obesity, DM, chemo

Acute Gouty Arthritis
• Most commonly involve the first metatarsophalangeal joint (podagra), ankle and knee
- Joint is hot, red and swollen; limited mobility
- Will subside spontaneously within several days to weeks; may recur
Tophi
- Uric acid crystal accumulate in the joint to produce tophus
© Deposited on cartilage, tendons, bursae, soft tissues, synovial membranes
© Common sites are first MTP joint, ear helix, olecranon bursae, tendons (particularly
the Achilles tendon).
Kidney
• Gouty nephropathy
• Uric acid calculi
Investigations
• Joint aspirate is confirmatory: >90% show monosodium rate crystals
• X-ray may show the tophi as punched out lesions, erosion with “over-hanging”
• Laboratory findings
• Increased serum uric acid (hyperuricemia)
- May have absolute neutrophilic leukocytosis in acute gouty arth

A

Gout

Investigations
• Joint aspirate is confirmatory: >90% show monosodium rate crystals
• X-ray may show the tophi as punched out lesions, erosion with
“over-hanging”
• Laboratory findings
- Increased serum uric acid (hyperuricemia)
• May have absolute neutrophilic leukocytosis in acute gouty arthritis
allopurinol
Colchicine
Harpagophe
Treatment
Eupatorium pù
• Acute gout: high dose NSAIDs, then taper as symptoms improve; corticosteroids, Colchicine
Smi
• Chronic gout:
- Modify diet to eliminate high purines (organ meats, meat, sardines, shellfish, beans, peas)
- Avoid drugs with hyperuricemic effect (thiazide e.g. Hydrochlorothiazide, alcohol)

LYME DISEASE

Herbs:

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3
Q

Stage 1 (7-14 days) - “bull’s eye” lesion with malaise, fatigue, headache, myalgia

Stage 2 (weeks after infection) - Bilateral Bell’s palsy (CN VIl), peripheral neuritis, Transient heart block or myocarditis

Stage 3 (months to years after infection) - disabling arthritis, encephalopathy, meningitis, neuropathy

A

Labs:
- ELISA (enzyme-linked immunosorbent assay) testing
Highly sensitive
- Western Blot assay: High specificity (96%)

Prevention and Treatment:

  • Preventative measure
  • Doxycycline prophylaxis within 72 h of removal of Ixodes scapulars tick in hyperendemic areas (only for ages 8 and up, no preg, no lactation)

Stage 1: Doxycycline/Amoxicillin/Cefuroxime

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4
Q
  • HLA-B27
  • Sausage-shaped DIP, < 10 yo, nail pitting
  • Asymmetric oligoarthritis
  • Skin: psoriasis (Scales on EXTENSOR)

CASPAR
evidence psoriatic nail, negative RF, dactylitis, radiological evidence

A

Psoriatic Arthritis

PSORIATIC ARTHRITIS
• Psoriasis appears before the onset of psoriatic arthritis in 60-80% of patients, usually <10 years
Etiology and Pathophysiology
• Unclear but many genetic associations have been identified like HLA-B27

Investigations: ESR, CRP

DMARDS:Methotrexate, sulfasalazine, cyclosporine

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5
Q
  • Most commonly caused by S. aureus and has a history of damaged joints
  • Monoarticular joint, warm, swollen joint, erythema; pain on active or passive ROM
  • Fever, leukocytosis,
  • MC joint: Knee > hip > shoulder > ankle, wrist
A

Septic Arthritis

nvestigations
• Joint aspirate: cloudy yellow fluid, WBC >50,000 with >90% neutrophils, protein level >4.4 mg/
dL, joint glucose level < 60% blood glucose level, no crystals, positive Gram stain result.
• X-ray may show erosion of cartilage, osteoporosis, and to rule out tumor and fracture
• Listen for heart murmur to reduce suspicion of infective endocarditis

Treatment
• IV antibiotics and adjust dosage and medication based on joint aspirate C&S results
• Therapeutic joint aspiration (if early diagnosis and joint superficial)
• Arthroscopic/open irrigation and drainage ‡ decompression

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6
Q

Investigation and Treatment for tendinitis

A

Tendinitis

Investigations
• Ultrasonography
• MRI is also accurate in accessing tendon pathology
• MRI can also assess cartilage injuries, bony abnormalities, and ligamentous injury

Treatment
• Rest, decrease activity level
• Ice for the first 24-48 hours
• NSAIDs may reduce pain, but most tendonitis conditions are non-inflammatory in nature
- Unknown if it will work compared to other analgesics

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7
Q
  • Male > 50yo
  • Mainly pelvis > femur > skull (enlarged) > tibia
  • Usually asymptomatic
  • Severe bone pain is the most common complaint
  • Skeletal deformities: bowed tibias, kyphosis, frequent fractures
  • Increased hat size with skull involvement causing headaches, hearing loss
  • Increased vascularity creates a complaint of warmth over affected bones
A

Paget Disease of Bone (Osteitis Deformans) = excessive bone destruction and repair (thick, fragile bone)

**BiG HEAD BENDY, THICC, WEAK BONES*

Labs:
X-ray: lytic lesions
- HIGH ALP, normal calcium and phosphorus

Treatment
• Weight bearing exercise
• Adequate calcium and vitamin D intake to prevent development of secondary hyperparathyroidism
• Treat medically if ALP >3x normal
• Bisphosphonates (e.g. Alendronate)
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8
Q

Asetic necrosis of ossification centers in children

“Legg-Calve-Perthes dz”

A

Osteochondrosis

Investigations

  • ESR, CRP, CBC (leukocytosis), aspirate culture/bone biopsy, blood culture
  • X-Ray shows soft tissue swelling and lytic bone destruction (seen after 12 days post-infection)
  • MRI = high sensitivity

Tx:

  • IV antibiotics for 4-6 weeks and adjust based on blood and aspirate cultures
  • Send to ER because of the potential of bacterial spread resulting in amputation
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9
Q
  • Recent trauma/surgery, immunocompromised patient with S. aureus infection in the vertebra (adults) and tibia and fibula (children)
  • EXTREME PAIN, fever, redness, swelling 1-2 weeks after URI
A

Osteomyelitis

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10
Q

women > 65 yo

primary osteoporosis = post menopausa (low estrogen)
vs secondary osteo

Dowager’s hump

A

Osteoporosis

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11
Q

T score -2.5 to -1 is?

T score less than -2.5 is?

A

Osteopoenia

Osteoporosis

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12
Q
  • gradual onset of decreased AROM PROM
  • pain worse at night, can’t sleep on side of pain
  • Inc stiffness 6-12 month after pain gone
A

Adhesive capsulitis “frozen shoulder”

Test:

  • MRI to r/o tear (6 weeks to 3 months)
  • X-ray: demineralization or normal

Tx:
- NSAID, strech

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13
Q
  • pain and tenderness in the region of biceps tendon
  • overuse/too much lifting

which orthos

A

Biceps tendinopathy

Lippman, speed’s yergason
MRI to r/o
US

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14
Q

inflammation of the extensor tendon or flexor tendon

A

epicondylitis

extensor = lateral - cozen's & mill's 
flexor = medial

Tx
RICE, physiotherapy, stretch
NSAID corticosteroids
Surgery

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15
Q

electric shooting pain down forearm to the 4th and 5th digit

weakness of the muscle

A

Ulnar nerve entrapment

Tinel’s

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16
Q

flexor retinaculum
median nerve entrapment
repetitice trauma wrist flexion
more common in female
numbness an tingling 3rd and half of 4th digit
decreased light touch and 2 point discrimination at fingertip
loss of grip[, dropping things

A

Carpal tunnel syndrome
clinical diagnosis
nerve condution
electromyography to confirm

phalen’s test and tinel’s

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17
Q

tenosynovitis of the first dorsal compcomprment of the rest abductp pollicis longus

A

de Quervain tenosynovitis

Finkelstein’s tst
pain localized to 1st extensor comporment

NSAID

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18
Q

mst commonly 4th, sometimes 5th and 3rd

- nodules can be felt in the palmar fascia of the affected finger

A

Dupuytren

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19
Q

fluid filled synovial lined cyst that protrudes between carpal bones or from tendon sheath of the wrist

more common in women
scapholunate ligamental junction is most common
pea sized

A

Ganglion cyst

watch and wait, aspirate, excision by arthroscopy

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20
Q

Intervertebral disc herniation at C6-C7 (most commonly), less commonly C5-C6

  • Trapezius and shoulder pain that radiates down
  • Woese with neck extension, ipsilateral rotation and lateral flexion
  • Paralysis, weakness
A

Cervical discopathy

Test:

  • X-ray, CT, MRI
  • cervical orthos

Tx:
- PT, analgesic, surgery if no better 3 month

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21
Q

Progerssive degeneratice process of cervical spine leading to canal stenosis C5-C6
- more men 40-50

  • gradual neck pain, worse with motion, radiculopathy cervical, hyperredlexia, weakness, lacking motor control
A

Cervical spondylosis

Test:

  • X-ray, CT, MRI**
  • cervical orthos

Tx:

  • Don’t move! givy
  • Surgery
22
Q

Kyphosis

A

XX-ray is essential to diagnosis kyphsiss

23
Q

Scoliosis

A

Adam;s test
X-ray

TX:
>20 bracing
>45 surgerical correction

24
Q

Lordosis

A

inward curvature of a [prtion of the lu,bar and cervai; vertebral colu,m causing anterior pelvic tilt

X-ray

PT

25
Q

Thoracic outlet syndrome

A

C8/T1 compression
nubmess, parasthesias

Wright’s test, adson’s test, shoulder depression, east test (Roo’s test)

Tx:
Physiotherapy, massage, rest

26
Q

sciatica

A

L4-S3
herniated disk
radiculopathy

Bechtrew’s
SLE
Braggard

27
Q 
foward slip
L5-S2, L4-L5
lower back pain radiating to btuttick ti relieve with sitting
tight hamsterins
pain on hyperextension
A

sponfylolusthesis

X-ray, MRI

activity restriction, bracing, NSAIDs

28
Q

This condition is most commonly caused by knee pain in runners. Localized pain is usually the lateral knee, worse with activity, better at rest.

A

IT Band syndrome

  • Varus stress test with knee flexion 30 degrees

Tx: PT & NSAIDs

29
Q

This condition is often caused by femoral neck fracture. It can also be due to Legg-Calve-Perthes, RA, or SLE. It is Painless in the beginning, then pain is worsened by weight bearing, better with rest. PROM (internal rotation) of hip is limited and painful.

A

Avascular necrosis of the femoral head

Test: X-ray, MRI***

Tx: Surgery, NSAIDS

30
Q

Most common mass in the popliteal fossa, located between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles. They are posterior to the medial femoral condyle. Usually due to arthritis of the knee or cartilage tear that causes fluid distention of the gastrocnemio-semimembranosus bursa.

A

Baker’s Cyst

Test: US, X-ray, MRI

Tx: aspiration, elevate/rest, surgery

31
Q

Softening, erosion of articular cartilage, mostly along the medial aspect of the patella seen in young females. Knee pain worse with going upstairs and squatting. PE is palpable for crepitus without swelling. Pain with compression of patella with knee ROM or resisted knee extension.

A

Chondromalacia patella

Tests:

  • Patellar-femoral grinding test and bounce home test
  • X-ray, MRI

Tx: NSAIDs, PT

32
Q

This condition has instant pain, swelling and inflammation. Knee feels locked, when shaken it will click and unlock. Pain with squatting and twisting. Tender on palpation of the knee medially or laterally.

A

Meniscal and ligament disorders (medial tear is more common)

Test:

  • MRI, athroscopy, McMurray test - Menisucus
  • Lachman, AP drawer test, Apley, medial and lateral collateral ACL/PCL tear

Tx: NSAIDs

33
Q

Softening, erosion of articular cartilage, mostly along the medial aspect of the patella seen in young females. Knee pain worse with going upstairs and squatting. PE is palpable for crepitus without swelling. Pain with compression of patella with knee ROM or resisted knee extension.

A

Chondromalacia patella

Tests:

  • Patellar-femoral grinding test
  • X-ray, MRI

Tx: NSAIDs, PT

34
Q

Knee pain: Rapid swelling, intense knee pain, and difficulty with any knee flexion. Inability to extend leg without pain is often recurrent, and self-reducing.

A

Patellofemoral disorders

MRI > CT > X-ray
Patellar apprehension test

Tx: NSAIDS, acetominophen, PT

35
Q

shin splints

A

Medial tibial stress syndrome

36
Q

Painful bursa over medial side of 1st metatarsal, head, pronation of grat tow, valgus displacement of the great to overriding 2nd tow.

A

Bunion (Halluc valgus)

X-ray

Tx: proper foot wear & surgery

37
Q

This condition is common in runners and dancers. Stiffness after rest and intense pain in the morning upon walking that subsides with more activities. Worse at the end of the day with prolonged standing. Swelling and tenderness over sole. Greatest at medical calcaneal tubercle and 1-2 cm distal along plnatar fascia.Pain with tow dorsiflection.

A

Plantar fascitis

X-ray r/o fracture
bone spit detct

RICE

achielles tendon, plantar fascia streitching, us therapy
NSAIDS steroids

38
Q

“Pain is greater than injury”

Stage 1 (Acute)

  • Pain: intense burning or aching pain that is disproportionate to injury
  • Sensitive to touch/cold
  • Edema and altered temperature

Stage 2 (Dystrophic)

  • Hypersensitivity to affected area
  • Osteoporosis, hair loss, increasing edema
  • Excessive sweating

Stage 3 (atrophic)

  • Paroxysmal spread of pain
  • Thin, shiny skin, thickened fascia with contractures
  • Demineralization of bone
A

Complex regional pain syndrome

Test: clinical, bone scan, X-rays, MRI

Tx: PT, NSAIDs, topical capsaicin

39
Q

CT disorder with widespread MSK pain, tender points that is chronic in nature (>3 months). More women.

Signs and Symptoms
• Diffuse, widespread aching, stiffness and reproducible tender points
• Fatigue with unrefreshed sleep, easy fatigability
• Difficulty falling asleep, frequent waking
• Patients say joints are swollen however physical exam shows normal appearance
• Neurologic symptoms of hyperalgesia, paresthesias
• Associated with irritable bowel or bladder syndrome, migraines, tension headaches, restless legs
syndrome, obesity, depression, and anxiety

A

Fibromyalgia

Test: TSH, ESR, CBC, sleep study

DO not run ANA or RF unless suspicion

Tx:

  • exercise, acupunture, massage, stretch good posture
  • NSAIDS, amitriptyline, gabapentin
40
Q

This is an inherited MSK condition.
symptoms occur by 3
weakness and wasting of pelvic muscles causing waddling gait. Child must place hands on knees for help standing up. Hpertrophy of the calf muscles and wasting thigh muscles. Low intellecural skill, cardiac weakness

A

Muscular dystrophy (Duchenne & Becker’s)

Investigations
• Serum creatine kinase (CK) is elevated at birth
• Muscle biopsy
• DNA testing through Western blot
• Electromyography

Becker’s more serious - death in 4th decade due to Resp. failure

41
Q

Bilateral back and leg pain with neurologic claudication. Normal back flexion, but difficulty with back extension. Positive SLR, no pain with valsalva.

A

Spinal stenosis

CT/MRI
gold standard = CT myelogram

Tx: PT, decompression surgery

42
Q

This condition has benign tumors composed of mature hyaline cartilage that affect young people, 10-20 years old. This condition is incidentally discovered by X-ray

A

Chondromas

X-ray = stippled or popcorn calcifications

43
Q

This condition has benign tumors composed of mature hyaline cartilage that affect young people, 10-20 years old. This condition is incidentally discovered by X-ray

A

Chondromas

X-ray = stippled or popcorn calcifications

44
Q

This is the most common benign bone tumors that occurs in 2nd and 3rd decade Located adjacent to growth plates and are affected by growth factors and hormones. Located on the metaphysics of long bone. Osteochondroma stops growing once the bones ar mature. Usually seen in X-ray incidentally.

A

osteochondromas

X-ray is sufficient to daignose, biopsy

45
Q

This condition is benign bone tumor that occur in the shade of long bones. Femur, tibia, and humerus typical. More man. 10-20’s

Deep, aching, intense pain with varying intensity that is typically localized to the are. Pain is worse at night and diminishes in the morning. Pain is alleviated by aspirin

A

osteoma

X-ray
CT - cicumscrized annuar lesion

Tx: NSAID for night pain, surcail

46
Q

This condition has pain and abnormal sensation in the forefoot. There’s a painful mass between heads of third and fourth metatarsal bones. Numbness in the toes adjacent to the mass with episodes of pain. Narrow shoes worsen symptoms

A

Morton’s neuroma

Test

  • Morton’s forefoot squeeze test
  • MRI (specificity 100%, sensitivity 87%)
  • X-ray is normal

Tx: PT & ice

47
Q

Stippled or popcorn calcifications on x-ray

A

Chondromas

48
Q

Highly malignant bone tumor that metastases to the lung
30’s
previous radiation tx
femur > prox tibia > prox humerus

Palpable hard mass with bone pain and inflammation over tumor, more often near joint. destructive lesion of metaphysis

A

Osteosarcoma

biopdy
x-ray
elevated serum Alkaline posphatase

Tx: complete rescrtion with chemo
prognosis : 75% 5 yr survival rate

49
Q

Malignant tumor of cartilgr, can arise secondary to wnchondroma
over ag 40,
processing bone pain in arm, leg, spine
hard palpable tumor

A

Chondrosarcoma

• X-ray, chondrosarcomas are usually large (> 5 cm)
- MRI is the investigation of choice, helps delineate the extent of soft-tissue involvement
• CT may be useful for detecting subtle calcifications in the matrix to help diagnose
cartilaginous tumors.
- Biopsy

Tx: chemo, radiation, surgery

50
Q

Most common between 5-20 years of age
• Bone tumor thought to be derived from mesenchymal stem cells of the bone marrow
• Metastases frequent without treatment
Clinical Features
- Pain, palpable mass, erythema
• Systemic symptoms of fever and weight loss are indicative of metastatic disease

A

Ewings sarcoma

Investigations
- Blood tests show anemia, increased WBC, ESR, and lactate dehydrogenase
- X-ray show moth-eaten appearance and ‘onion-like skinning’ of the periosteal bone
- MRI is the gold standard that can help determine extent of disease
• CT scanning is helpful in delineating any extraosseous extent of the tumor

Tx: chemo, radiation, surgery

Prognosis: 70%, worse if there is distant metastases

Natsumi - NPLEX 2 (37 decks)

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