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MSK/Rheum Exam- Clin Med > Ortho-lower > Flashcards

Ortho-lower Flashcards

1
Q

Degeneration of articular cartilage
Thickening of subchondral bone
Periarticular osteophyte formation
Synovial inflammation

A

Osteoarthritis of hip

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2
Q

Percentage of adults over 70 w OA

A

80%

Leading cause of disability in elderly

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3
Q

Predisposing factors to OA

A

Advanced age
Increased BMI
Possible genetic
Increased external forces..running, weight lifting

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4
Q

Systemic secondary predisposing factors to OA

A 
Gout
Hemachromatosis
Hyperparathyroidism
Pagets
Hypothyroidism
Acromegaly
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5
Q

Localized secondary predisposing factors to OA

A 
Congenital deformity
Trauma
Perthes dz
RA
Septic arthritis
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6
Q 
Progressive hip or groin pain
Increased pain w activity 
AM pain>PM pain
Crunching noises
Decreased ROM
A

OA in hip

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7
Q 
PE shows..
Limp w ambulation
Decreased AROM and PROM (int and ext rotation)
Palpable/audible crepitus w motion
Possible tenderness over groin 
Possible decreased MMT
A

Hip OA

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8
Q

X rays in hip OA

A 
AP pelvis, lateral hip
Looking for...
Osteophyte formation
Decreased joint space 
Subchondral sclerosis and cysts
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9
Q

Hip OA conservative treatment

A 
NSAIDs / acetaminophen 
Activity modification
Weight reduction 
PT
Cortisone injection
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10
Q

Hip OA surgical tx

A

Total hip arthroplasty
Arthroscopic debridement
Femoral head resurfacing..younger patients

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11
Q

Osteonecrosis
Bone death due to disruption of blood supply to bone/femoral head
Osteocytes, osteoblasts, osteoclasts die within 24-48 hrs of oxygen deprivation
Reperfusion may occur to regenerate bone growth

A

Avascular necrosis

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12
Q

Avascular necrosis epidemiology

A

Male>female
30-50 yo
Up to 60% bilateral
Kids age 5-9… Legg Calves Perthes dz

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13
Q

Causes of avascular necrosis

A 
ETOH
Steroid use
Chemo
HTN
Vasculitis
Thrombosis
Sickle cell anemia
Deep sea diving 
Radiation
Smoking 
Trauma
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14
Q 
Pain in groin, buttock, thigh
Unknown MOI
Usual gradual onset
Decreased activity due to pain
Pain typically decrease w rest
A

Avascular necrosis

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15
Q

Hip normal ROM

A 
Flexion 120
Extension 10
Abduction 30
Adduction 30
Internal rotation 40
External rotation 60
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16
Q

PE shows…
Limp
Painful AROM/PROM
Groin tenderness

A

Avascular necrosis

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17
Q

Avascular necrosis x ray

A

Early disease may not show bone collapse

**“Crescent sign” =collapsing subchondral bone

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18
Q

Avascular necrosis MRI

A

Better at showing early changes

Most specific and sensitive for diagnosis

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19
Q

Bone scan in avascular necrosis

A

Helpful in determining increased bone activity

Non specific

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20
Q

Avascular necrosis conservative tx

A 
NSAIDs
Anticoags (heparin, Coumadin)
Exercise/PT
Rest
Statins
Bisphosphonates
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21
Q

Avascular necrosis surgical tx

A

Hip resurfacing
Core decompression
Fibular bone grafting
Total hip arthroplasty

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22
Q

Causes of greater trochanteric bursitis

A 
Overuse
Trauma
ITB syndrome 
Weak abductors
Prior surgery 
Unequal leg length
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23
Q

No MOI, gradual onset
Pain w laying on affected side
Pain w repetitive motions (running, cycling, walking)

A

Greater trochanteric bursitis

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24
Q 
PE shows...
Possible limp
No swelling, erythema, ecchymosis
Pain w resisted abduction/passive adduction 
Point tender over Great trochanter
A

Greater trochanteric bursitis

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25
Q

Conservative tx of great trochanteric bursitis

A 
NSAIDs
Ice/heat
Physical therapy
Activity modification 
Cortisone injection
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26
Q

Surgical tx of greater trochanteric bursitis

A

Excision of Bursa

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27
Q

Grade 1 quad/hamstring strain

A

Mild stretch injury to muscle or tendon

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28
Q

Grade 2 quad hamstring strain

A

Partial tear but functionally in tact

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29
Q

Grade 3 quad hamstring strain

A

Complete tear or rupture of structure

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30
Q

Predisposing factors of quad or hamstring strain

A

Inflexibility
Overtraining
Poor bio mechanics
Muscle imbalance

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31
Q 
Known moi/ identifiable injury 
Sudden onset
Pain w activity 
Possible muscle spasm
Muscle weakness
A

Quad or hamstring strain

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32
Q 
PE shows...
Limp
Swelling
Ecchymosis
Palpable hematoma in muscle belly
Decreased ROM in hip and or knee
Decreased strength
A

Quad or hamstring strain

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33
Q

Conservative tx of quad or hamstring strain

A

RICE
PT, stretching, strengthening
Gradual return to activity
May take several months to regain fxn

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34
Q

Surgical repair of quad or hamstring strain

A

Repair complete disruption of muscle/tendon
Evacuate hematoma
Fasciotomy for compartment syndrome

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35
Q

Extensor mechanism is made up of..

A

Quadriceps
Quadriceps tendon
Patella
Patella tendon

(Acts to extend knee)

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36
Q

“I tore my knee”
“I felt a pop”
Generalized pain
Inability to bear weight

A

Extensor mechanism rupture

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37
Q

Chronic inflammation/degeneration
Cortisone injections in/around patella tendon
Weakening of tendons

Can cause…

A

Extensor mechanism rupture

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38
Q

Extensor mechanism rupture conservative treatment

A

Only for pts that are too sick for surgical repair

Treat in immobilized for 6-8 weeks, then gradual ROM progression

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39
Q

Extensor mechanism rupture surgical repair

A

Repair w sutures/hardware
Can wt bear as tolerated w immobilizer
PT

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40
Q

Causes of knee OA

A 
Genetic 
Trauma
Over use 
Joint instability
Obesity 
Ligament insufficiency 
Biomechanical deformity (varus valgus)
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41
Q 
Knee pain worse in am 
Swelling
Stiffness
Giving away or locking 
Gradual onset
A

Knee OA

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42
Q 
PE shows...
Knee joint hypertrophy
Tenderness at joint line
Effusion 
Decreased ROM
Quad atrophy
Crepitus
A

Knee OA

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43
Q

X-rays with knee OA

A 
**gold standard*
Osteophyte formation 
Decreased joint space 
Subchondral sclerosis
Cyst formation
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44
Q

Conservative tx for knee OA

A 
NSAIDs/acetaminophen 
Ice and or heat 
Activity modification
Decreased weight
Cortisone injections 
Hyaluronic acid injections
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45
Q

Surgical tx for knee OA

A

Knee arthroscopy
Tibial/femoral osteotomy
Total knee arthroplasty

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46
Q

Anterior knee pain

Most common and frequent complaint with teens

A

Patellofemoral pain syndrome

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47
Q

Causes of patellofemoral pain syndrome

A

Biomechanical
Muscular
Trauma
Over use

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48
Q 
Increased Q angle 
Pes planus/pes cavus feet (pronation)
Tibial internal rotation 
Patella instability 
Shape of femoral sulcus and or patella
Angle of flexed knee
A

Biomechanics that can cause patellofemoral syndrome

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49
Q

Quadriceps weakness
Hip flexor weakness

Can cause..

A

Patellofemoral pain

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50
Q

Tight hamstrings, IT band, gastrocs can cause…

A

Patellofemoral pain

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51
Q

Pain with squatting, kneeling, going down stairs, sitting for long periods of time
Stiffness, sometimes swelling

A

Patellofemoral pain

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52
Q 
PE shows..
Possible effusion
Mild peri-patella tenderness 
Quadriceps weakness
Pain w resisted knee extension
A

Patellofemoral pain

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53
Q

Special tests for patellofemoral pain

A

Patella apprehension

J sign

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54
Q

X ray for patellofemoral syndrome

A

A/P, Lateral, sunrise
Abnormal bone morphology…
…shallow femoral sulcus
…tilted patella

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55
Q

Conservative tx of patellofemoral pain

A 
NSAIDs/acetaminophen
Ice or heat
PT (quad strength)
Patella support base
Foot orthotics 
Activity modification
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56
Q

Surgical fx for patellofemoral

A

Medial patellofemoral ligament reconstruction
Lateral release
Tibial tubercle osteotomy

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57
Q

Sprain is an injury to….

A

Ligament

58
Q

Most often injure ligament of knee

A

MCL

59
Q

Provides lateral stability
Prevents valgus deformity
Associated w medial meniscus injury

A

MCL

60
Q 
Known MOI
Loose knee
Giving away sensation 
Stiffness swelling
Decreased ROM due to pain swelling 
Ecchymosis possible
A

MCL

61
Q 
PE shows...
Limp, inability to wt bear
Medial femoral condyle tenderness
Decreased ROM
Pain w valgus stress 
Variable laxity w valgus stress
A

MCL

62
Q

Provides lateral stability
Prevents varus deformity
Associated w fibular head fx

A

LCL

63
Q

PE shows…
Point tender over fibular head
Ligament is palpable in figure 4 position
Pain and laxity on varus stress

A

LCL

64
Q

PCL injury

A

Provides posterior and rotational stability
MOI is anterior to posterior force on tibia
Ex dash board injury, total knee dislocation
Associated w multi ligament injuries

65
Q

Posterior or popliteal pain
Stiffness, decreased ROM
Swelling
Knee is “un hinged”

A

PCL

66
Q

PE shows..
Swelling, effusion, ecchymosis
Decreased rom due to swelling
Possible hyperextension on PROM

A

PCL

67
Q

Special tests for PCL

A

Posterior drawer

Sag sign

68
Q

MOI is combination of medial tibial rotation and anterior tibial translation
80% non contact

A

ACL injury

69
Q

Reasons females tear ACL more than males

A 
Hormone cycles
Increased Q angle
Strength
Proprioception
Skill, technique
70
Q

Special tests for ACL

A

Quad inhibition
Lachmans
Anterior drawer
Pivot shift test

71
Q

X-ray w ACL injury

A

Possible associated fxs

  • medial femoral condyle avulsion
  • lateral tibial fx
  • tibial spine/eminence fx
72
Q

Definitive test for determining ligament damage

A

MRI

73
Q

Fibrocartilage made up of 70% type I collagen

A

Meniscus

74
Q 
Fxn:
Lubrication of joint
Nutrition
Diffused forced from femur on tibia
Decreases hyalin cartilage wear
Shock absorption
A

Meniscus

75
Q

Medial meniscus

A

C shaped
Firmly attached to tibia, joint capsule, MCL
2 mm of motion at knee flexes

76
Q

Lateral meniscus

A

O shaped
Loosely attached
10mm motion allowed as knee flexes

77
Q

Meniscus tears in elderly due to..

A

OA

Degenerative tear

78
Q

Meniscus tears in younger..

A

Associated w trauma

Rotational injury

79
Q 
Persistent swelling 
Pain w rotation and squatting 
Giving away or locking knee
Decreased ROM 
Fullness behind knee
A

Meniscus tear

80
Q

Joint line tenderness
Swelling
Decreased ROM

A

Meniscus tear

81
Q

Special tests for meniscus

A

McMurrys test

Appleys compression test

82
Q

Definitive test to dx meniscus

A

MRI

83
Q

White zone meniscus

A

Inner avascular portion of meniscus

84
Q

Red zone of meniscus

A

Outer vascularized area near joint capsule

85
Q

What is considered when deciding repair vs menisectomy

A 
Age of patient
Type of tear 
Zone of tear (red or white)
Associated injuries 
Activity demands
86
Q

Housemaids knee

Inflammation of pre patella bursa (lies between patella and skin)

A

Pre patella bursitis

87
Q

Frequent in roofers, floorers, carpenters

Injury due to repetitive kneeling

A

Pre patella bursitis

88
Q

“Water on knee”
Mild erythema
Decreased ROM due to swelling
No drainage

A

Pre patella bursitis

89
Q 
PE shows...
No effusion 
Palpable fluid over patella 
Full ROM
Mild tenderness on palpation
A

Pre patella bursitis

90
Q

Symptoms in an infected/septic pre patella bursitis

A 
Moderate to severe erythema 
Moderate pain w ROM
Drainage
Fever and or chills 
Pain on palpation
91
Q

When to aspirate in pre patella bursitis?

A

If question of sepsis

Send fluid for gram stain, cell count and culture

92
Q

Pre patella bursitis treatment

A 
NSAIDs
Compression wrap 
Ice/heat
Activity modification 
Knee pad
Therapeutic aspiration 
Cortisone (IF 100% NO SEPSIS)
93
Q

Shin pain related to load bearing activity

Disruption of tibial cortex as a result of repetitive stress

A

Shin splints

94
Q

15% of all runner complaints

A

Shin splints
More common in women
Women 3x more likely to progress to stress fx

95
Q 
No MOI
Gradual onset
Dull ache in middle 1/3 of tibia 
Pain w load bearing 
Decreased pain w rest
A

Shin splints

96
Q

Pain with passive dorsiflexion/toe extension

A

Shin splints

97
Q

Shin splints treatment

A 
NSAIDs 
Rest
PT, strengthening, stretching 
Footwear, orthotics
Crutches if stress fx present
98
Q

Risks for Achilles’ tendon rupture

A

Prolonged immobilization/atrophy
Medications (Fluoroquinolones)
Corticosteroid injections
Prior injury

99
Q 
PE shows...
Ecchymosis
Palpable defect in tendon
Decreased plantar flexion strength if partially torn
Swelling and fullness
A

Achilles’ tendon rupture

100
Q

Special test for Achilles rupture

A

Thompson test

101
Q

Best diagnostic test for Achilles rupture

A

MRI

102
Q

Conservative tx for Achilles’ tendon rupture

A

For partial or non retracted tears…

Cast up to 12 weeks
Change cast every 2 weeks, progressively increase DF to neutral position

103
Q

Surgical tx for Achilles’ tendon tears

A

Preferred method in healthy patient
Cast for up to 8 weeks, decreasing DF to neutral
PT
*up to 6 months before full activity

104
Q

Ligament involved in a high ankle sprain

A

Syndesmotic ligaments

105
Q

Grade I, II, III ankle sprains

A

I: stretch of Ligament
II: partial tear of ligament
III: complete disruption of ligament

106
Q

Special test for ankle sprains

A

Anterior drawer test

107
Q

Ottowa ankle rules

A

Bone tenderness over distal 6cm of posterior edge of tibia (medial malleolus)

Bone tenderness over distal 6cm of posterior edge of fibula (lateral malleolus)

Inability to walk/weight bear for 4 steps

108
Q

Inflammation of plantar fascia
Pain in AM..”stepping on a knife”
Limp w ambulation
Gradual onset

A

Plantar fasciitis

109
Q

Risks for plantar fasciitis

A

Overweight
Poor footwear
Weight bearing activities

110
Q

Tight fascia on palpation
Tenderness over medial calcaneus
Pain with passive toe extension/dorsiflexion

A

Plantar fasciitis

111
Q

Plantar fasciitis treatment

A 
NSAIDs
Ice/heat
Activity modification
Stretching
Arch support/orthotics/foot wear 
Night splints 
Cortisone injection
112
Q

Mid foot pain generated from the metatarsals and associated structures
Most commonly at head of 1st metatarsal
Stress fracture develops at 2nd and 3rd metatarsal shafts

A

Metatarsalgia

113
Q

Characterized by joint dislocations, pathologic fxs and anatomical deformities In foot

A

Charcot foot

114
Q

Acute arthritis caused by sudden increase and deposition of uric acid crystals in s joint
Most common form of inflammatory arthritis in men and women over age 40

A

Gout

115
Q

Hyperuricemia

A

Can cause gout

Renal under excretion of uric acid (90% of cases)
Over production of uric acid..10% cases

116
Q

Risks for gout

A 
Etoh
Fructose
Meat
Seafood
(Purines)
117
Q

Sudden onset..usually at night
Very tender joint
Pain with motion, weight bearing
Painless nodules at joint (tophi)

A

Gout

118
Q

Needle like, uric acid crystals

A

Gout

119
Q

Acute gout treatment

A 
NSAIDs 
Colchicine
Steroids 
Elevation 
Ice
120
Q

Chronic gout treatment

A

Xanthine oxidase inhibitor

    - allopurinol 
    - blocks uric acid production
121
Q

Rod shaped calcium pyrophosphate crystals

A

Pseudo gout

122
Q

Most common joint affected in pseudo gout

A

Knees

123
Q

Infection of the bone (bacterial, fungal)

A

Osteomyelitis

124
Q

Inoculation in osteomyelitis

A

Blood stream (sepsis)
Through local infection (cellulitis)
Trauma (wounds/surgery)

125
Q

Most common bones in adults involved in osteomyelitis

A

Vertebrae
Maxilla
Pelvis

126
Q

Most common bones in osteomyelitis in children

A

Femur
Tibia
Humerus

127
Q

Osteomyelitis pathology

A

Leukocytes attack pathogens resulting in enzymes release causing bone lysis
Pus formation impedes blood flow in bone causing tissue necrosis
Bacteria can enter into bone cells

128
Q

Pathogens causing osteomyelitis in children

A

S. Aureus in 90%

129
Q

Pathogens in osteomyelitis for adults

A

S aureus 80%

130
Q 
PE shows...
Swelling 
Erythema 
Point tender over bone 
May have superficial wound/ulcer over area
A

Osteomyelitis

131
Q

What is needed for accurate diagnosis of osteomyelitis

A

Bone biopsy

132
Q

X ray of osteomyelitis

A

May show bone destruction/lysis

May show heterotopic bone formation

133
Q

Conservative tx for osteomyelitis

A

Antibiotics..at least 6 weeks
Monitor lab values
Symptomatic treatment
Hyperbaric treatment

134
Q

Surgical treatment osteomyelitis

A

Aggressive debridement required in most cases
Removal of foreign bodies (surgical hardware)
May require multiple wash outs
Amputation for persistent infections

135
Q

Infection of a joint caused by a number of different pathogens

  • bacterial
  • viral
  • fungal
  • mycobacterial
A

Septic arthritis

136
Q

Common septic joint sites

A

Hips and knees most common

Elbow, ankle, shoulder

137
Q

Pathogens involved in septic arthritis

A

S. Aureus*****
Streptococcus
H. Influenzae (common in children)

138
Q 
No MOI
Sudden onset of joint pain 
Swelling
Erythema
Pain w joint motion
Fever/chills 
Malaise
A

Septic joint

139
Q

Labs in septic joint

A

Elevated ESR
High WBC count
Elevate CRP

140
Q

Appearance of joint fluid in septic joint

A

Cloudy, turbid, purulent appearance

**must send for gram stain, culture/sensitivity and crystals

141
Q

Conservative treatment of septic joint

A

Not indicated!

oral antibiotics will not irradiate pathogens***

142
Q

Surgical treatment in septic joint

A

Aggressive incision an drainage
Remove prosthesis if applicable
IV abx for up to 6 weeks

MSK/Rheum Exam- Clin Med (7 decks)

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