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EOR Family med > Ortho > Flashcards

Ortho Flashcards

1
Q

red flags for back pain

A

night pain and weight loss (tumor)
fevers, chills, sweats (bone or disc infection)
acute bony tenderness (fracture)
morning stiffness > 30 min in young adult (seronegative spondyloarthropathy)
urinary/bowel retention, saddle anesthesia (cauda equina)
recent spinal instrumentation (spinal epidural abscess or hematoma)
immunodeficiency (bone or disc infection)
extremes of age
coagulopathy (spinal epidural hematoma)

others - failure to improve w tx, pain for > 6 weeks

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2
Q

sx herniated disc (nucleus pulposus)

A

radicular back pain usually unilateral may radiate down leg w paresthesias or numbness in a dermatomal pattern

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3
Q

where is herniated disc MC

A

L5-S1

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4
Q

MC cauda equina

A

massive lumbar disc herniation

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5
Q

Sx cauda equina

A

back pain
bilateral leg radiation of pain
weakness
saddle anesthesia - decreased sensation in butt, perineum, inner surface of thigh, erectile dysfunction
urinary/bowel dysfunction new onset
decreased anal sphincter tone (decreased anal wink test)****

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6
Q

dx cauda equina

A

immediate MRI
CT myelography if pacemaker

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7
Q

tx cauda equina

A

emergency decompression + corticosteroids

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8
Q

sx spinal stenosis

A

back pain, numbness, paresthesias worsened w extension
relieved w flexion - sitting, bending forward, leaning over shopping cart, walking uphill, cycling

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9
Q

dx spinal stenosis

A

MRI

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10
Q

sx lombosacral sprain/strain

A

back pain and spasms that are activity-related
DOES NOT RADIATE TO LEGS
no neurologic sx

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11
Q

PE lumbosacral sprain/strain

A

paraspinal muscle tenderness
no neurological changes

may be normal exam

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12
Q

MC cause spinal epidural abscess

A

staph aureus

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13
Q

classic triad for spinal epidural abscess

A

fever + spinal pain + progressive neurologic deficits

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14
Q

dx spinal epidural abscess

A

MRI w gadolinium

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15
Q

tx spinal epidural abscess

A

aspiration, drainage, abx (Vancomycin plus either Cefotaxime or Ceftriaxone)

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16
Q

Cobb angle to dx scoliosis

A

> /= 10 degrees

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17
Q

tx scoliosis

A

observation if < 25 degrees
bracing 25-39 degrees
surgical correction if > 40 degrees

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18
Q

spondylosis

A

pars interarticularis defect due to failure of fusion or stress fracture

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19
Q

MC location spondylosis

A

L5-S1

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20
Q

sx spondylosis

A

low back pain w activity
most asx

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21
Q

dx spondylosis

A

lateral radiographs - radiolucent defect in pars
oblique radiographs - scotty dog

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22
Q

spondylolisthesis

A

forward slipping (subluxation) or a vertebra on another due to b/l fracture or defect of pars interarticularis

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23
Q

MC cause septic bursitis

A

staph aureus

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24
Q

pts w limitation of joint movement should be evaluated for

A

septic arthritis

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25
Q

gold standard bursitis

A

bursa fluid culture

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26
Q

tx MSSA bursitis

A

cephalexin or dicloxacillin

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27
Q

tx MRSA bursitis

A

trimethoprim-sulfamethoxazole or IV vancomycin and Cefazolin

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28
Q

MC locations septic bursitis

A

olecranon
infrapatellar
pre patellar bursa

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29
Q

difference btwn costochondritis and Tietze syndrome

A

costochondritis - pleuritic chest pain that may be worse w inspiration, coughing, certain body movements; reproducible point wall tenderness + absence of palpable edema; more than one area of reproducible tenderness
age < 40
can be caused by carrying book-bag over one shoulder***

Tietze syndrome - pleuritic chest pain that may be worse w inspiration, coughing, certain body movements; reproducible point chest wall tenderness w palpable edema
age > 40

30
Q

in what population is fibromyalgia MC

A

women 20-50

31
Q

sx fibromyalgia

A

multiple tender points (>/= 11 out of 18)
fatigue
chronic headache
sleep disorders
subjective numbness
more prominent in the morning and aggravated by minor exertion

32
Q

American college of rheumatology criteria for dx of fibromyalgia

A

widespread pain index > 7
symptom severity scale > 5
OR
widespread pain index 3-6
symptom severity scale > 9
sx present for at least 3 mos

33
Q

conservative tx fibromyalgia

A

sleep hygiene
low impact aerobic exercise (swimming, walking, biking)
CBT

34
Q

pharm therapy for fibromyalgia

A

TCA (amitriptyline)
SSRI (fluoxetine)
SNRI (duloxetine, Milnacipran)
cyclobenzaprine
pregabalin
gabapentin

35
Q

MC soft tissue tumor of the hand

A

ganglion cyst

36
Q

MC location ganglion cyst

A

dorsal aspect of wrist over scapholunate joint

37
Q

will ganglion cysts transilluminate

A

yes
solid tumors will not

38
Q

tx asx ganglion cyst

A

observation and reassurance

39
Q

tx sx ganglion cyst

A

brace
needle aspiration
surgical excision - definitive; if needle aspiration ineffective

40
Q

a ganglion cyst is associated w

A

a degenerated joint capsule or synovial tendon sheath that contains gelatinous fluid

41
Q

is gout more common in men or women

A

men

42
Q

meds that trigger gout attack

A

thiazide and loop diuretics
ACEI
pyrazinamide
ethambutol
aspirin
ARBS (losartan is exception)

43
Q

sx gout

A

intermittent, acute mono or oligoarthritis esp of the first metatarsophalangeal joint
flares usually occur overnight and early morning
flares reach max intensity in 12-24 h
resolution 2 weeks

may have fever, chills, malaise, fatigue

44
Q

dx gout

A

arthrocentesis - negatively birefringent needle shaped crystals

radiographs - mout or rate bite lesions (punched out erosions w sclerotic and overhanging margins)

45
Q

tx acute gout

A

NSAIDs
glucocorticoids
colchicine

46
Q

MC joint in PSEUDOgout

A

knee

47
Q

pseudogout

A

calcium pyrophosphate dihydrate deposition in joints and soft tissues

48
Q

dx pseudogout

A

arthrocentesis - positive birefringent, rhomboid-shaped calcium pyrophosphate crystals

radiographs - linear calcification of cartilage (chonedrocalcinosis)

49
Q

tx pseudogout

A

corticosteroids
NSAIDS
colchicine

50
Q

PE osteoarthritis

A

hard body joint
crepitus
audible grating sound
Heberden node (DIP enlargement)
Bouchard node (PIP enlargement)

51
Q

dx osteoarthritis

A

asymmetric joint space narrowing
marginal osteophytes (bone spurs)
subchondral bone sclerosis or cysts

52
Q

normal DEXA

A

1 or greater

53
Q

DEXA osteopenia

A

T score -1 to -2.5

54
Q

DEXA osteoporosis

A

T score -2.5 or less

55
Q

bisphosphonates

A

alendronate
ibandronate
pamidronate
risedronate
zoledronate

56
Q

sx plantar fasciitis

A

pain in the plantar region of the foot (inferior and medial heel, sole of the foot), often sharp, usually worse AFTER period of rest when initiating walking

pain decreases after further ambulation, massage, stretching

57
Q

PE plantar fasciitis

A

local point tenderness of plantar fascia and plantar medial calcanea tuberosity

pain can be reproduced w passive dorsiflexion of foot and toes

58
Q

sx psoriatic arthritis

A

asymmetric inflammatory oligoarthritis
DIP involvement
dactylitis - uniform swelling of fingers/toes (sausage digits)
sacroiliitis and spondylitis
enthesitis - Achilles tendon, plantar fasciitis, medial and lateral epicondyles
psoriasis - erythematous plaques w thick silvery-white scales and nail pitting

59
Q

dx psoriatic arthritis

A

pencil in a cup deformities

60
Q

tx psoriatic arthritis

A

NSAIDs

61
Q

risk ankylosing spondylitis

A

young males 15-30
HLA-B27 positive

62
Q

sx ankylosing spondylitis

A

low back pain and neck pain - insidious onset, stiffness, decreased ROM worse at night and in morning, not improved w rest
improves w exercise and activity
sacroiliitis and arthritis
enthesopathy
dactylitis

63
Q

dx ankylosing spondylitis

A

bamboo spine - loss of normal lumbar curvature + bridging syndesmophwytes

64
Q

tx ankylosing spondylitis

A

NSAIDs

65
Q

MC cause reactive arthritis

A

chlamydia trachomatis

66
Q

sx reactive arthritis

A

arthritis + conjunctivitis/uveitis + urethritis/cervicitis/balanitis

keratoderma blennorrhagicum - hyperkeratotic lesions on palms and soles

circinate balanitis - painless erythematous lesions w small shallow ulcers on glans penis and urethral meatus

67
Q

tx reactive arthritis

A

NSAIDS

68
Q

sx rheumatoid arthritis

A

joint pain, stiffness, swelling worse in morning w morning stiffness > 1 hour after initiating movement, improves later in the day
spares the DIP

69
Q

PE rheumatoid arthritis

A

symmetric inflamed joints - warm, erythematous, soft “boggy”
ulnar deviation
rheumatoid nodules

70
Q

dx rheumatoid arthritis

A

rheumatoid factor
Anti-CCP more specific

radiographs - symmetric joint narrowing, osteopenia, bone and joint erosions

may have C1-C2 subluxation

71
Q

tx rheumatoid arthritis

A

DMARD - Methotrexate or Leflunomide + NSAIDs or glucocorticoids

EOR Family med (25 decks)

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