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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
gold standard bursitis
bursa fluid culture
26
tx MSSA bursitis
cephalexin or dicloxacillin
27
tx MRSA bursitis
trimethoprim-sulfamethoxazole or IV vancomycin and Cefazolin
28
MC locations septic bursitis
olecranon infrapatellar pre patellar bursa
29
difference btwn costochondritis and Tietze syndrome
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
in what population is fibromyalgia MC
women 20-50
31
sx fibromyalgia
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
American college of rheumatology criteria for dx of fibromyalgia
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
conservative tx fibromyalgia
sleep hygiene low impact aerobic exercise (swimming, walking, biking) CBT
34
pharm therapy for fibromyalgia
TCA (amitriptyline) SSRI (fluoxetine) SNRI (duloxetine, Milnacipran) cyclobenzaprine pregabalin gabapentin
35
MC soft tissue tumor of the hand
ganglion cyst
36
MC location ganglion cyst
dorsal aspect of wrist over scapholunate joint
37
will ganglion cysts transilluminate
yes solid tumors will not
38
tx asx ganglion cyst
observation and reassurance
39
tx sx ganglion cyst
brace needle aspiration surgical excision - definitive; if needle aspiration ineffective
40
a ganglion cyst is associated w
a degenerated joint capsule or synovial tendon sheath that contains gelatinous fluid
41
is gout more common in men or women
men
42
meds that trigger gout attack
thiazide and loop diuretics ACEI pyrazinamide ethambutol aspirin ARBS (losartan is exception)
43
sx gout
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
dx gout
arthrocentesis - negatively birefringent needle shaped crystals radiographs - mout or rate bite lesions (punched out erosions w sclerotic and overhanging margins)
45
tx acute gout
NSAIDs glucocorticoids colchicine
46
MC joint in PSEUDOgout
knee
47
pseudogout
calcium pyrophosphate dihydrate deposition in joints and soft tissues
48
dx pseudogout
arthrocentesis - positive birefringent, rhomboid-shaped calcium pyrophosphate crystals radiographs - linear calcification of cartilage (chonedrocalcinosis)
49
tx pseudogout
corticosteroids NSAIDS colchicine
50
PE osteoarthritis
hard body joint crepitus audible grating sound Heberden node (DIP enlargement) Bouchard node (PIP enlargement)
51
dx osteoarthritis
asymmetric joint space narrowing marginal osteophytes (bone spurs) subchondral bone sclerosis or cysts
52
normal DEXA
1 or greater
53
DEXA osteopenia
T score -1 to -2.5
54
DEXA osteoporosis
T score -2.5 or less
55
bisphosphonates
alendronate ibandronate pamidronate risedronate zoledronate
56
sx plantar fasciitis
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
PE plantar fasciitis
local point tenderness of plantar fascia and plantar medial calcanea tuberosity pain can be reproduced w passive dorsiflexion of foot and toes
58
sx psoriatic arthritis
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
dx psoriatic arthritis
pencil in a cup deformities
60
tx psoriatic arthritis
NSAIDs
61
risk ankylosing spondylitis
young males 15-30 HLA-B27 positive
62
sx ankylosing spondylitis
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
dx ankylosing spondylitis
bamboo spine - loss of normal lumbar curvature + bridging syndesmophwytes
64
tx ankylosing spondylitis
NSAIDs
65
MC cause reactive arthritis
chlamydia trachomatis
66
sx reactive arthritis
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
tx reactive arthritis
NSAIDS
68
sx rheumatoid arthritis
joint pain, stiffness, swelling worse in morning w morning stiffness > 1 hour after initiating movement, improves later in the day spares the DIP
69
PE rheumatoid arthritis
symmetric inflamed joints - warm, erythematous, soft "boggy" ulnar deviation rheumatoid nodules
70
dx rheumatoid arthritis
rheumatoid factor Anti-CCP more specific radiographs - symmetric joint narrowing, osteopenia, bone and joint erosions may have C1-C2 subluxation
71
tx rheumatoid arthritis
DMARD - Methotrexate or Leflunomide + NSAIDs or glucocorticoids

EOR Family med (25 decks)

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