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Clin med sem 2 > Ortho- MSK > Flashcards

Ortho- MSK Flashcards

1
Q

Avascular Necrosis- pathophysiology

A

Necrosis of bone secondary to an interruption of blood supply

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2
Q

Avascular Necrosis- cause

A 
Immunosuppression
Alcoholism
Long-term steroid use
Trauma
IVDU
Indwelling catheters
Sickle Cell
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3
Q

Avascular Necrosis- S/S & PE

A

Any bone - Head of femur or humerus, scaphoid, neck of talus

Progressive pain - weeks to mons

  • early - pain w/ acitiv or weight bearing, dec ROM
  • Late - pain at rest w/sig dec ROM
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4
Q

Avascular Necrosis- diagnosis

A

Early xrays - nl
- if neg, move on to CT/MRI to get diagnosis
Later xray - bone destruction/collapse

CT, MRI, bone scan - reveal AVN

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5
Q

Avascular Necrosis- treatment

A

Refer Ortho!!

Directed at bone involved

  • Hip - replacement
  • Scaphoid - maybe surgery or bone graft
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6
Q

Osteomyelitis- pathophysiology

A

Inflammation of bone and marrow

Long bones and vertebral bodies

Toes/feet - DM

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7
Q

Osteomyelitis- cause

A 
Most common: 
Staph aureus 
E. coli, pseudomonas, Klebsiella - GU tract infections or IV drug users
H flu, Group B strep - neonatal
Salmonella - sickle cell
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8
Q

Osteomyelitis- epidemiology

A 
<20, > 50 y 
Children
IVDU
DM
Sickle cell 
Open wounds
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9
Q

Osteomyelitis- S/S & PE

A 
Malaise
Fever
Chills
Leukocytosis
Throbbing pain - on site
Skin - may show infection
Pain w/ active and passive ROM
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10
Q

Osteomyelitis- diagnosis

A

MRI - gold

Bone scan, CT

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11
Q

Osteomyelitis- labs & imaging

A 
CBC
ESR
CRP
Lactate
Blood culture
Wound culture
Bone bio

Ca, phos, alk phos - NL

Xray - STS, periosteal elevation, cortical erosion/lysis -> necrotic bone

  • seen by 10-14days - lag behind infection
  • 30-50% gone by time shows up
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12
Q

Osteomyelitis- treatment

A

Abx and surgical drainage

  • wait for culture sensitivites
  • IV 6w -> PO - Vanco+Ceftriaxone or Cipro or Cefepime

Chronic:

  • sinus tract breaks through skin - drains externally
  • abx vs open debridement
  • DM infected foot ulcer - consider osteomyelitis
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13
Q

Osteoma- pathophysiology

A

Benign lesions of bone - developmental or reactive growths

Exophytic growths - attached to bone surface

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14
Q

Osteoma- epidemiology

A

40-50yo

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15
Q

Osteoma- S/S & PE

A

Facial bones - nasal, ears
Skull

Found incidentally

Resemble nl bone

Slow growing tumors - little clinical significance
- obstruction or cosmetic problem

NO Malignant change

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16
Q

Osteoma- treatment

A

Refer Ortho!

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17
Q

Osteosarcoma- pathophysiology

A

Aggressive malignant mesenchymal tumor

- cancerous cells produce bone matrix

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18
Q

Osteosarcoma- epidemiology

A

MOST COMMON IN CHILDREN

<20y

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19
Q

Osteosarcoma- S/S & PE

A

Long bones and jaw

Painful and progressively enlarging masses

Pathologic fracture - 1st symptom

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20
Q

Osteosarcoma- labs & imaging

A 
CBC
ESR/CRP
Xray
CT/MRI/PET
- 20% will have mets at dx
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21
Q

Osteosarcoma- treatment

A

Surgery
radiation
Chemo

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22
Q

Osteochondroma- pathophysiology

A

Benign cartilage growth - attached to underlying skeleton by a stalk
- single or multiple

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23
Q

Osteochondroma- cause

A

Hereditary

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24
Q

Osteochondroma- epidemiology

A

10-30 y - Metaphysis of long tubular bones

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25
Q

Osteochondroma- S/S & PE

A

Slow-growing masses
Painful - if impinge nerve

Stop growing at time of growth plate closure

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26
Q

Osteochondroma- diagnosis

A

Biopsy - benign vs malignant

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27
Q

Ewing Sarcoma- pathophysiology

A

Malignant neoplasm of bone

Chromosomal translocation

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28
Q

Ewing Sarcoma- epidemiology

A

Children - sec most common

M=F

10-20 y

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29
Q

Ewing Sarcoma- S/S & PE

A

Pelvis and proximal ends of long bones
pain w/ local inflammation
Swelling/mass
Fever

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30
Q

Ewing Sarcoma- diagnosis

A

Xray - onion peel appearance

Biopsy - definitive

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31
Q

Ewing Sarcoma- labs & imaging

A

ESR
Anemia
Leukocytosis

CT, MRI, bone scan

32
Q

Ewing Sarcoma- treatment

A

Chemo and surgery

Radiation

33
Q

Osteoarthritis- pathophysiology

A

Most common joint disease and arthritis

Progressive erosion of articular cartilage

34
Q

Osteoarthritis- cause

35
Q

Osteoarthritis- epidemiology

A

> 40
65

Obesity
H/o trauma
Overuse

36
Q

Osteoarthritis- S/S & PE

A

Weight bearing joints and spine

Deep, achy pain - worse w/ use
Morning stiffness <30min
Crepitus
Limited ROM

No systemic symptoms

Joints - effusion, repitus, instability dec ROM

  • Heberden’s nodes - DIP
  • Bouchard’s nodes - PIP
37
Q

Osteoarthritis- diagnosis

A

Clinical

Xray - nonuniform joint space narrowing, osteophytes

38
Q

Osteoarthritis- treatment

A

Symptomatic - RICE, APAP, NSAIDs, weight loss, PT, exercise

Surgery - joint replacement

39
Q

Osteoarthritis- prevention

40
Q

Osteogenesis imperfecta- pathophysiology

A

Brittle bone disease

Hereditary conditions - abnormal development of type 1 collagen

  • 8 types
  • most - autosomal dominant
41
Q

Osteogenesis imperfecta- S/S & PE

A 
Multiple bone fractures - in utero
Blue sclerae 
Hearing loss
Dental imperfections
Debilitating
42
Q

Osteogenesis imperfecta- diagnosis

A

Clinical

- DNA analysis

43
Q

Osteogenesis imperfecta- treatment

A 
No cure
Fracture prevention
Bisphosphonates
Surgery 
Treat pain
44
Q

Osteoporosis- pathophysiology

A

Inc porosity of skeleton -> reduction of bone mass -> inc fracture

  1. Age - bone-forming cells dimmish capacity to make bone
  2. Reduced physical activity - mechanical forces import stimuli for bone remodeling
  3. Genetic - Vit D receptors
  4. Ca Nutrional state - insuff Ca intake puts them at a later risk
  5. Hormonal - postmenopausal - hormone dependent acceleration of bone loss
    - estrogen protects
45
Q

Osteoporosis- cause

A 
Primary - natural 
Secondary - 2nd to another disease
- MM
- Pagets
- Hyperparathyroidism
- Graves/ hyperthryoidism
- Nutritional - vit D, alcoholism, anorexia, malnutrition
- Chronic disease
- Meds- steroids, anticonvulsants, PPIs, loop diuretics
46
Q

Osteoporosis- epidemiology

A

Peak bone mas achieved during young adulthood

Modifiable - alcoholism, tobacco, low body mass, sedentary lifestyle, low vit D and Ca intake, chronic corticosteroid use

47
Q

Osteoporosis- S/S & PE

A

Vertebral fractures, lumbar lordosis, kyphoscoliosis

48
Q

Osteoporosis- diagnosis

A 
Screening:
All women >65, men > 70
Postmenopausal women 60-65 w/ 1 risk: 
- fracture after age 45
- Hip fracture
- Tobacoo
- BMI
- Extended glucocorticoid 
Indications in Men over age 50 and postmenopausal women at any age
- Non trauma fracture
- incidental findings of osteopenia on Xray
- Glucocorticoid use
- hyperparathyroidism
- Multiple osteoporosis risk factors
49
Q

Osteoporosis- labs & imaging

A 
CBC
CMP
Ca
Phos
TSH
Vit D

Xray - pathologic fractures, loss of density

  • not used for screening!
  • doesn’t detect until 30-40%

DEXA
1 to -1 - normal
-1 - -2.5 - Osteopenia
>-2.5 - osteoporosis

50
Q

Osteoporosis- treatment

A

Treat- hip or vertebral fx, osteoporosis of femoral neck, hip or spine (T-1–2.5), Osteoporosis >-2.5

Modify factors
Vit D and Ca - 1st line!!
- inc bone density, dec bone loss
Bisphosphonates - inc bone density and prevent loss
- actonel, boniva, fosamax, reclast
Calcitonin - inhibits osteoclastic bone reabsorption

Estrogen - not great, but provides protection
- contra- w/ risk of breast or endometrial ca

F/U
Repeat Dexa: 
- nl or mild osteopenia - 15 y
- mod osteopenia - 5 y
- severe osteopenia - 1 y
- Osteoporosis - 2y
51
Q

Paget Disease (Osteitis Deformans)- pathophysiology

A

Excessive breakdown and formation of bone

-> disorganized bone remolding -> enlarged, misshapen, weak bones

52
Q

Paget Disease (Osteitis Deformans)- epidemiology

A

Middle adult

Genetic

53
Q

Paget Disease (Osteitis Deformans)- S/S & PE

A

Skull, spine, pelvis, long bones

Asymptomatic
-> pain, deformity

HA, hearing & visual disturbances, enlargement of head, bowing and chalk stick-type fractures of legs

54
Q

Paget Disease (Osteitis Deformans)- labs & imaging

A

Alk phos - inc

55
Q

Paget Disease (Osteitis Deformans)- treatment

A

Bisphosphonates

Calcitonin

56
Q

Rhabdomyolysis- pathophysiology

A

Skeletal muscle cell breaks down and necrosis -> release intracellular debris in blood stream
–> inc Ca, K, Myoglobin

57
Q

Rhabdomyolysis- epidemiology

A 
Exertional
Crush injury - compartment syndrome
Seizures
Hyperthermia
Drugs - STATIN
Infection
Genetics
Found down
58
Q

Rhabdomyolysis- S/S & PE

A 
None
Muscle pain
Weakness/fatigue
Swelling
Low-grade fever
Nausea & Vomiting
Confusion
Cardiac Dysfunction
Tea colored urine 
Dec urine output
59
Q

Rhabdomyolysis- diagnosis

A

Muscle biopsy - don’t wait to treat

60
Q

Rhabdomyolysis- labs & imaging

A 
CPK - inc
Hyperkalemia, hyperphosphatemia, hypocalcemia (early), hypercalcemia (late)
UA - pos blood w/out RBC
LFT - inc
AKI labs
EKG
61
Q

Rhabdomyolysis- treatment

A 
Treat shock and preserve kidney function 
IV FLUIDS!!!! 
- 6-12L/24hr
- 200-300ccs urine per hour
- Cautin - overload syndromes - CHF
- Furosemid - Lasix

Manage electrolyte imbalances - K, albuterol, insulin, Va

Kidney management - hemodialysis?

62
Q

Rhabdomyolysis- prognosis

A

w/ trauma - 20%
ICU admit w/o renal impairment - 20%
ICU admit w/ renal impairment - 60%

Survive - near full renal recov

63
Q

Rhabdomyolysis- complications

A 
Kidney failure
Compartment syndrome
Volume depletion shock
Disseminated intravascular coag
CV dysrhythmia
64
Q

Soft Tissue Sarcomas- pathophysiology

A

Arise from muscle, fat, tendon blood vessels, fibrous tissue
- anything bone

Many types:
- fibrosarcoma, leiomyosarcoma, liposarcoma, kaposi sarcoma

65
Q

Soft Tissue Sarcomas- S/S & PE

A

Soft tissue mass - 1/3 w/pain

66
Q

Soft Tissue Sarcomas- diagnosis

A

MRI

Biopsy - definitive

67
Q

Soft Tissue Sarcomas- labs & imaging

A

W/Up required for: symptomatic, progressing in size, >5cm, or present >4w

68
Q

Soft Tissue Sarcomas- treatment

A

Type directed

Eval for mets - lung and liver!!

69
Q

Baker’s Cysts- pathophysiology

A

Synovial fluid out-pouching
b/t gastric and semimembranosus muscles

Benign - after trauma

70
Q

Baker’s Cysts- S/S & PE

A

Tenderness and bump

Palpable mass

71
Q

Baker’s Cysts- diagnosis

72
Q

Baker’s Cysts- treatment

A

RICE
Aspirate - larg
Corticosteroid injections
Surgical

73
Q

Compartment Syndrome- pathophysiology

A

Life/limb threatening emergency

Insufficient blood supply to muscles and nerves due to inc pressure w/in one of body’s compartments

74
Q

Compartment Syndrome- cause

A 
Trauma
Crush injury
Burns
Electrocution 
Cast
75
Q

Compartment Syndrome- S/S & PE

A

Forearm and calf

6ps: 
Pain out of proportion
Paresthesia
Paralysis
Poikilothermia
Pallor
Pulselessness
76
Q

Compartment Syndrome- diagnosis

A 
Clinical 
Compartment pressure
- 10 = nl
- 10-20 = concerning
- >30 = emergent

Xray - hx suggestive

77
Q

Compartment Syndrome- treatment

A

Splint
Elevate
Fasciotomy - <6hr
NO ICE!!!

Clin med sem 2 (30 decks)

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