Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > Orthopedics/Rheumatology > Flashcards

Orthopedics/Rheumatology Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

What are signs of an Anterior Glenohumeral Shoulder Dislocation

A

Arm Abducted, Externally Rotated
Can palpate humeral head inferiorly
Squared off shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dx of Anterior Glenohumeral Shoulder Dislocation

A

Axillary and “Y” view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Tx of Anterior Glenohumeral Shoulder Dislocation

A

Reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are signs of a Posterior Glenohumeral Shoulder Dislocation

A

Arm Adducted, Internally Rotationed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does a Posterior Glenohumeral Shoulder Dislocation occur

A

Forced Adduction

Usually associated with seizures or direct trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tx of Posterior Glenohumeral Shoulder Dislocation

A

Reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an Acromioclavicular Joint Dislocation

A

Shoulder Separation

Usually due to direct blow to adducted shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sx of Acromioclavicular Joint Dislocation

A

Pain with lifting arm, unable to lift arm past the shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx of Acromioclavicular Joint Dislocation

A

Brief sling immobiliczation, ice, analgesia, and ortho f/u

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do Rotator Cuff Injuries Occur

A

Chronic Erosion or trauma
Tendonitis
Rotato Cuff Tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 4 muscles that make up the Rotator Cuff

A

SITS

Supraspinatus, Infraspinatus, Teres Minor, Subscapularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sx of Rotator Cuff Injuries

A

Anterior Deltoid Pain with reduced ROM especially with overhead activities, external rotation or abduction
Weakness, atrophy, and continuous pain most commonly seen with tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you note on physical exam of a rotator cuff injury

A

Passive ROM is better than active ROM
Pain with abduction >90 degrees suggests tendinopathy
Supraspinatus strength test: Empty can test
Hawkin’s Test: Elbow flexed at 90 degrees with sharp anteiror shoulder pain with internal rotation
Drop Arm Test: Pain with inability to lift arm above shoulder
Neer Test: Arm fully pronated (thumb’s down) with pain during forward flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx of Rotator Cuff Injury

A

Tendinitis: Shoulder pendulum/wall climbing exercises, Ice, NSAIDS, physical activity
Tear: Rehab, NSAIDS, Steroid Injections, ROM preservation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a Clavicle Fracture

A

The most common fracture in kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sx of Clavicle Fractures

A

Pain with ROM, deformity at site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are complications of Clavicle Fractures

A

Pneumothora, Hemothorax, Coraclavicular Ligament Disruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tx of Clavicle Fractures

A

Arm sling for 4-6 weeks in adults

Ortho consult if within proximal 1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Adhesive Capsulitis

A

Frozen Shoulder

Shoulder Stiffness due to Inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Sx of Adhesive Capsulitis

A

Shoulder pain/stiffness that lasts for 18-24 months
Reduced ROM especially with external rotation
Resistance on passive ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx of Adhesive Capsulitis

A

Rehab ROM therapy
Anti-inflammatories
Intraarticular steroid injection, heat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Thoracic Outlet Syndrome

A

Idiopathic compression of the brachial plexus, subclavian vein, or subclavian artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Sx of Thoracic Outlet Syndrome

A

Nerve Compression: Pain/Parasthesias to the forearm, ulnar side of hand
Vascular Compression: Swelling/discoloration fo the arm especially with abduction of arm
Los of radial pulse with head rotated to affected side (Adson)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Dx of Thoracic Outlet Syndrome

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tx of Thoracic Outlet Syndrome

A

Physical Therapy
Avoid strenuous activity
Ortho consult, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does a Supracondylar Fracture Occur

A

Fall on outstretched hand with hyperextended elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Sx of supracondylar fracture

A

Swelling, tenderness at elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Dx of supracondylar fracture

A

Abnormal anterior humeral line on lateral view if displaced

If non-displaced, anterior fat pad sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are complications that can occur from Supracondylar Fracture

A

Median Nerve and Brachial Artery Injury
Volkmann’s Ischemic Contractures (claw hand)
Radial Nerve Injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Tx of Supracondylar Fracture

A

Non-Displaced: Splint
Displaced: Open Reduction Internal Fixation
Immediate ortho consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does a Radial Head Fracture occur

A

Fall on outstretched hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Sx of Radial Head Fracture

A

Lateral elbow pain

Inability to fully extend elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Dx of Radial Head Fracture

A

Fat Pad Sign: Posterior or Increased Anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Tx of Radial Head Fracture

A

Non-Displaced: Sling, long arm splint at 90 degrees

Displaced: Open Reduction Internal Fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does an Olecranon Fracture occur

A

Direct Blow (fall on flexed elbow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Sx of Olecranon Fracture

A

Pain, Swelling, Inability to Extend Elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are complications that can occur with Olecranon Fractures

A

Ulnar Nerve Dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Tx of Olecranon Fractures

A

Non-Displaced: Splint with 90 degree flexion

Displaced: Open Reduction Internal Fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is Olecranon Bursitis

A

Inflammation of the bursa over bony prominences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What does an Olecranon Bursitis

A

Gout, Inflammation, Direct Trauma, Infectious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Sx of Olecranon Bursitis

A

Abrupt “goose egg” swelling (boggy, tender, red elbow)
Painless or tender
Limited ROM with flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are signs of septic bursitis

A

Bursar aspiration shows WBC >5,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Tx of Olecranon Bursitis

A

rest, NSAIDS, local steroid injection, padding, avoid repetitive movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is an Ulnar Shaft Fracture

A

Nightstickk

Direct blow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Tx of Ulnar Shaft Fracture

A

Non-Displaced distal 1/3: Short arm cast
Non-Displaced mid-prox 1/3: Long arm cast
Displaced: Open Reduction Internal Fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is a Monteggia Fracture

A

Proximal Ulnar shaft fracture with anterior radial head dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Sx of Monteggia Fracture

A

Elbow Pain, Parasthesias to thumb

Radial Nerve Injury (wrist drop)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Tx of Monteggia Fracture

A

Open Reduction Internal Fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is a Galeazzi Fracture

A

Mid-Distal Radial Shaft fraction with dislocation of distal radio-ulnar joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Sx of Galeazzi Fracture

A

Deformity on the radial surface of the wirst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Tx of Galeazzi Fracture

A

Needs Open Reduction with Internal Fixation
Long Arm Splint
Sugar Tong Splint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Wha is a Nursemaid’s Elbow

A

Radial Head Subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How does a Nursemaid’s Elbow occur

A

Lifting, swinging, pulling a child usually 2-5 years old while forearm is pronated and extended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Sx of Nursemaid’s Elbow

A

Children present with arm slightly flexed, refuses to use arm
Tenderness to palpation of radial head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Tx of Nursemaid’s Elbow

A

Reduction (pressure on radial head with supination and flexion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is Tennis Elbow

A

Inflammation of the tendon insertion of ECRB (Extensor Carpi Radialis Brevis Muscle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Sx of Tennis Elbow

A

Lateral elbow pain with gripping, forearm pronation and wrist extension against resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Tx of Tennis Elbow

A 
RICE
NSAIDS
Physiotherapy
Brace
Steroid Injections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is Golfer’s Elbow

A

Medial Epicondylitis
Inflammation of the pronator teres-flexor carpi radialis due to repetitive stress at the tendon insertion of the flexor forearm muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Sx of Golfer’s Elbow

A

Tenderness over the medial epicondyle worse with pulling activities
Reproduced by forcefully extending elbow vs. resistance with forearm supinated and wrist flexion against resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Tx of Golfer’s Elbow

A

RICE, NSAIDS, Physiotherapy, Brace

Steroid Injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How does an elbow dislocation occur

A

Fall on outstretched hand with hyperextension
High energy insults
Posterior is most common type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Sx of Elbow Dislocation

A

Presents with flexed elbow with marked prominence of olecranon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Tx of Elbow Dislocation

A

Emergency reduction

Posterior splint at 90 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is a complication that can occur with Elbow Dislocation

A

Brachial, Median, Ulnar, or Radial Nerve Injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is Cubital Tunnel Syndrome

A

Ulnar Nerve Compression at the cubital tunnel along the medial elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Sx of Cubital Tunnel Syndrome

A

Parasthesias/Pain along the ulnar nerve
Positive Tinel’s Sign
Positive Froment’s Sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Tx of Cubital Tunnel Syndrome

A

Wrist immobilization especially with sleep
NSAIDS
Steroid injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How does a Scaphoid (Navicular) Fracture occur

A

Fall on outstretched hand with extended wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Sx of Scaphoid Fracture

A

Pain along the radial surface of the wrst with anatomical snuffbox tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Dx of Scaphoid Fracture

A

May be asymptomatic for up to 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Tx of Scaphoid Fracture

A

Thumb Spica if non-displaced or snuffbox tenderness

Open Reduction and Internal Fixation if displaced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is a Scapholunate Dissociation

A

Pain on the dorsal radial side of the wirst

Positive Terry Thomas Sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Tx of Scapholunate Dissociation

A

Radial gutter splint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is a Colles Fracture

A

Distal radial fracture with dorsal angulation (posterior)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is a Perilunate Dislocation

A

Lunate doesn’t artiulate with capitate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is a Lunate Dislocation

A

Lunate doesn’t articulate with capitate or radius

This is an emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Dx of Lunate Dislocation

A

AP view “piece of pie” sign

“spilled teacup sign” with lunate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Tx of Lunate Dislocation

A

Open Reduction and Internal Fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is a Lunate Fracture

A

Most serious carpal fracture since the lunate occupies 2/3 of the radial articular surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Tx of Lunate Fracture

A

Thumb Spica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is Complex Regional Pain Syndrome

A

Autonomic dysfunction following bone or soft tissue injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Sx of Complex Regional Pain Syndrome

A

Pain out of proportion to injury
Stage I: Swelling, extremity color changes, increased nail and hair growth
Stage II: Waxy, pale skin, brittle nails, loss of hair
Stage III: Joint atrophy and contractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Tx of Complex Regional Pain Syndrome

A 
Anesthetic Blocks
Physical Therapy
Oral Steroids
NSAIDS
TCA's
Vitamin C prophylaxis after fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is Mallet Finger

A

A avulsion of extensor tendon with sudden blow to the tip of extended finger with forced flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Sx of Mallet Finger

A

Patient unable to straighten distal finger (flexed at DIP joint)
Commonly associated with avulsion fracture of stial phalanx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Tx of Mallet Finger

A

Splint DIP uninterrupted extension for 6 weeks vs. surgical pinning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

With is outonniere Deformity

A

Sharp force against the tip of partially extended digit leads to hyperflexion of middle joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Tx of Boutonniere Deformity

A

Splint PIP in extension for 4-6 weeks with hand surgeon f/u

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is a Gamekeeper’s Thumb

A

Ulnar Collateral Ligament injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Sx of Gamekeeper’s Thumb

A

Thumb far away from other digits, MCP tenderness, weakness in pinch strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Tx of Gamekeeper’s Thumb

A

Thumb Spica and referral to hand surgeon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is a Boxer’s Fracture

A

Fracture at the neck of the 5th metacarpal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

How does a Boxer’s Fracture occur

A

Punch with clenched fist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Tx of Boxer’s Fracture

A

Ulnar Gutter Splint with joints in at least 60 degree flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is a Bennett Fracture

A

Intraarticular fracture through the base of the 1st metacrpal bone with large sital framgent dislocation radially and dorsally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Tx of Bennet Fracture

A

Open Reduction and Internal Fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is a Type I Salter Harris Fracture

A

Isolated growth plate fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is a Type II Salter Harris Fracture

A

Growth plate + Metaphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is a Type III Salter Harris Fracture

A

Growth Plate + Epiphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is a Type IV Salter Harris Fracture

A

Growth Plate + Metaphysis + Epiphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is a Type V Salter Harris Fracture

A

Growth Plate Compression - Worst type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

what is Dequervain’s Tenosynovitis

A

Stenosing tenosynovitis of abductor pollicus longus and Extnsor pollicus Brevus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

How does a Dequervain’s Tenosynovitis occur

A

Excessive thumb use with repetitive action

Seen in golfers, clerical workers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Sx of Dequervain’s Tenosynovitis

A

Pain along radial aspect of wrist radiating to forearm especially with thumb extension or gripping, radial styloid pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Dx of Dequervain’s Tenosynovitis

A

Finkelstein Test: Pain with ulnar deviation or thumb extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Tx of Dequervain’s Tenosynovitis

A

Thumb Spica Splint for 3 weeks
NSAIDS for 10-14 days
Steroid injections
Physical Therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is Carpal Tunnel Syndrome

A

Median Nerve Entrapment/Compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Sx of Carpal Tunnel Syndrome

A

Parasthesias and pain of palmar 1st 3 digits especially at night
Increased Pin that is worse at night
Decreased pain with shaking hands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Dx of Carpal Tunnel Syndrome

A

Tinel’s Sign: Percussion of Media Nerve

Phalen’s Sign: Flex both wrists for 30-60 seconds reproduces symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Tx of Carpal Tunnel Syndrome

A

Volar Splint
NSAIDS
Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What is a Dupuytren Contracture

A

Contractures of the palmar fascia due to nodules/cords that lead to a fixed flexion deformity at the MCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Sx of Dupuytren Contractures

A

Nodules over distal palmar crease or proximal phalynx

Fixed flexion deformity at the MCP joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Tx of Dupuytren Contractures

A

Intr-lesional steroid injection
Collagenase injection
Physical therapy
Surgical correction if >30 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What is a Hip Dislocation

A

Usually due to trauma

It’s an emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What are complications with Hip Dislocation

A

Avascular Necrosis

Sciatic nerve injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Sx of Hip Dislocation

A

Hip pain with leg shortened, internally rotated and adducted with hip/knee slightly flexd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is a Hip Fracture

A

Common in elderly patients with decreased bone mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Sx of Hip Fractures

A

Hip pain with leg shortened and externally rotated, abducted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Tx of Hip Fracture

A

Open Reduction with Internal Fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is Legg-Calve Perthes Disease

A

Idiopathic avascular necrosis of the femoral head in kids due to ischemia of the capital femoral epiphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What age group is at risk for Legg-Calve Perthes Disease

A

8-10 year old boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Sx of Legg-Calve Perthes Disease

A

Painless limping
Worse with continued activity especially at the end of the day
Hip pain that radiates to the thigh, knee, or groin
loss of abduction and internal rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Dx of Legg-Calve Perthes Disease

A

Xray: Increased density of femoral head, widening of cartilage space, crescent sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Tx of Legg-Calve Perthes Disease

A

Observation in kids <5 yrs old
NSAIDS, Bed Rest
Abduction bracing in kids >5 yrs old or significant loss of abduction
Pelvic Osteotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is Slipped Capital Femoral Eiphysis

A

The femoral head (epiphysis) slips posterior and inferior at the growth plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What age/demographic is most at risk for SCFE

A

7-16 year old, obese, African America/Latino Boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Sx of SCFE

A

Hip, thigh or knee pain with a limpExternal rotation of affected leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Tx of SCFE

A

Open Reduction with Internal Fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is a Greenstick Fracture

A

Incomplete fracture with cortical disruption and periosteal tearing on the convex side of the fracture
Bowing

131
Q

What is a Torus (Buckle) Fracture

A

Incomplete fracture with wrinkling or bump of the metaphyseal-diaphyseal junction due to axial loading

132
Q

How does a Medial Collateral Ligament Injury Occur. How does a Lateral Collateral Ligament Injury Occur

A

MCL: Valgus stress with rotation
LCL: Varus stress after rotation

133
Q

Sx of MCL/LCL injury

A

Localized pain, swelling, ecchymosis, stiffness

134
Q

Tx of MCL/LCL injury

A

Sprains or incomplete tears: Pain control, Physical Therapy, RICE, NSAIDS, Knee Immobilizer
Complete Tears: Surgical Repari

135
Q

How does an ACL injury occur

A

Noncontact pivoting injury, usually during deceleration, hyperextension, internal rotation

136
Q

Sx of ACL injury

A

Hear a “pop” followed by swelling, hemarthrosis

Knee bucling

137
Q

How can you test for an ACL injury

A

Lachman’s Test is most sensitive (stabilize the femur and pull the tibia back and froth)
Anterior Drawer Test (stabilize the foot, pull tibia forward)

138
Q

How does a PCL injury occur

A

Associated with anterior force to proximal tibia with knees flexed or direct blow injury
Fall on flexed knee

139
Q

Sx of PCL injury

A

Anterior bruising especially anteromedial aspect of proximal tibia
Large effusion

140
Q

How can you test for a PCL injury

A

Pivot Shift Test

Posterior Drawer Test

141
Q

Tx of PCL injury

A

Surgery

142
Q

How does a meniscal tear occur

A

Squatting, twisting, compression or trauma with rotation and axial loading
Medial is more common than lateral

143
Q

Sx of Meniscal Tear

A

Locking, Popping, Giving way, Effusion after Activities

144
Q

What is a way you can test for a Meniscal Tear

A

Mcmurray’s sign (pop or click while tibia is externally and internally rotated

145
Q

Tx of Meniscal Tear

A

NSAIDS
Partial weight bearing until ortho f/u
Arthroscopy

146
Q

How does a Patellar Fracture occur

A

Direct blow

Fall on flexed knee with forceful quadriceps contraction

147
Q

Sx of Patellar Fracture

A

Pain, Swelling, Defmority

Limited knee extension with pain

148
Q

Dx of Patellar Fracture

A

See Sunrise view Xray

149
Q

Tx of Patellar Fracture

A

If non-displaced, use a knee immobilizer
6 weeks cast
If displaced, needs surgery

150
Q

How does a Patellar and Quadriceps Tendon Rupture occur

A

Forceful quadriceps contractions

Fall on flexed knee, walking up/down stairs

151
Q

Sx of Patellar and Quadriceps Tendon Ruptures

A

Sharp proximal knee pain with ambulation, inability to extend knee (straight leg raise)
Quadriceps Tendon Rupture: Patella Baja - Palpable defect above the knee
Patellar Tendon Rupture: Paella Alta - Palpable defect below the knee

152
Q

Tx of Patellar and Quadriceps Tendon Rupture

A

Knee Immobilizer

Surgical Repair within 7-10 days

153
Q

How does a Patellar Dislocation occur

A

Valgus stress after twisting injury

Direct Blow

154
Q

How can you test for a Patellar Dislocation

A

Apprehension Sign: Anxiety when force is applied laterally

155
Q

Tx of Patellar Dislocation

A

Closed Reduction: Push anteromedially on patella while gently extending leg
Knee immobilizer for 3-6 weeks

156
Q

How does a Knee (Tibial-Femoral) Dislocation occur

A

High velocity trauma

Often assocaited with multiple traumas

157
Q

Sx of Knee Dislocation

A

Gross deformity

158
Q

What are complications that can occur with Knee Dislocation

A

Popliteal artery injury in 1/3 of patients
Arteriography needed
peroneal or tibial nerve injury

159
Q

Tx of Knee Dislocation

A

Immediate ortho consult

Prompt reduction via longitudinal traction

160
Q

How does a Femoral Condyle Fracture occur

A

Axial loading
Fall from height
Direct blow to femur

161
Q

Sx of Femoral Condyle Fracture

A

Pain, Swelling, Inability to Bear Weight

162
Q

What are complications that can occur with a Femoral Condyle Fracture

A

Peroneal Nerve Injuries (check 1st web space)

Popliteal artery injuries

163
Q

Tx of Femoral Condyle Fracture

A

Immediate ortho consult

164
Q

How does a Tibial Plateau Fracture occur

A

Axial loading/rotation/direct trauma

165
Q

Sx of Tibial Plateau Fracture

A

Pain, swelling, hemarthrosis

If displaced, check peroneal nerve function (foot drop)

166
Q

Tx of Tibial Plateau Fracture

A

Non-Displaced: Cast for 6-8 weeks

Displaced: Open Reduction and Internal Fixation

167
Q

What is Osgood Schlatter Disease

A

Osteochondritis of patellar tendon at tibial tuberosity from overuse (repetitive stress) or small avulsions due to quadriceps contraction on patellar tendon insertion into tibia
Most common cause of chronic knee pain in children

168
Q

Who is at risk for Osgood Schlatter Disease

A

Males 10-15 years old, athletes with “growth spurts”

169
Q

Sx of Osgood Schlatter Disease

A

Activity related knee pain/swelling
Painful lump below the knee
Tenderness to the atnerior tibial tubercle

170
Q

Dx of Osgood Schlatter Disease

A

Xray shows prominence or heterotropic ossification at tibial tuberosity

171
Q

Tx of Osgood Schlatter Disease

A

RICE, NSAIDS, quadriceps stretching

172
Q

What is a Baker’s Cyst

A

Synovial fluid effusion that is displaced into formation of cyst

173
Q

Sx of Baker’s Cyst

A

Popliteal mass, aching, knee effusions, clicking, buckling, locking of knee
Ruptured cyst may ook like DVT

174
Q

Dx of Baker’s Cyst

A

Ultrasound to r/o DVT

175
Q

Tx of Baker’s Cyst

A

Ice
Assisted weight bearing
NSAIDS
Steroid injections

176
Q

What is an Ankle Sprain

A

Usually due to collateral ligament injury
Anterior Talofibular
Calcaneofibular

177
Q

Sx of Ankle Sprain

A

Pop followed by swelling, pain, inability to bear weight

178
Q

Tx of Ankle Sprain

A

RICE, NSAIDS

179
Q

What are the Ottawa Ankle Rules

A

Ankle Films: Pain along Lateral Malleolus, Pain along Medial Malleolus
Foot Films: Midfoot pain, 5th metatarsal or navicular pain
Unable to walk >4 steps at time of injury and in the ER

180
Q

How does an Achilles Tendon Rupture occur

A

Mechanical overload from eccentric contraction of gastrocsoleus complex

181
Q

Sx of Achilles Tendon Rupture

A

Sudden heel pain after push-off movement
Pop, sudden sharp calf pain
Positive Thompson Test: Weak, Absent plantar flexion

182
Q

Tx of Achilles Tendon Rupture

A

Surgical repair allows for early ROM

Splint with gradual dorsiflexion

183
Q

What is a Stress Fracture

A

Common in athletes, military due to overuse

Most common in the 3rd metatarsal

184
Q

Sx of Stress Fracture

A

Insidious onset of localized aching pain, swelling, and tenderness at the end of activity

185
Q

Dx of Stress Fracture

A

50% of xrays will be normal

Bone scan or MRI may show it

186
Q

Tx of Stress Fracture

A

Rest, avoid high impact activities

Splint or post-op shoe

187
Q

What is Plantar Fasciitis

A

Inflammation of plantar aponeurosis due to overuse, especially with flat fee/heel spur

188
Q

Sx of Plantar Fasciitis

A

Heel pain
Tender plantar fascia at medial foot
Pain worse after periods of rest, decreases throughout the day
Worse with the 1st step in the morning

189
Q

Dx of Plantar Fasciitis

A

Xray may show flat foot deformity or heel spur

MRI

190
Q

Tx of Plantar Fasciitis

A

Rest, Ice, NSAIDS, heel/arch support

Plantar stretching exercises

191
Q

What is Tarsal Tunnel Syndrome

A

Post Tibial nerve compression from overuse, restrictive footwear, edematous states

192
Q

Sx of Tarsal Tunnel Syndrome

A

Pain/numbness at medial malleolus, heel and sole
Can mimic plantar fasciitis
Pain increases throughout the day
Pain worse at night and with activity (as opposed to plantar fasciitis which is worse in the morning and gets better with activity and throughout the day)

193
Q

Dx of Tarsal Tunnel Syndrome

A

Tinel’s Sign
Sx worse with dorsiflexion
Nerve conduction tests

194
Q

Tx of Tarsal Tunnel Syndrome

A

Avoid exacerbating activities
NSAIDS
Steroid injections if no improvement

195
Q

What is a Bunion

A

Hallux Valgus deformity of bursa over the 1st metatarsal

History of poorly fitting shoes

196
Q

Sx of Bunions

A

Medial eminence pain with 1st metatarsal lateral deviation

197
Q

Tx of Bunions

A

Comfortable, wide-toed shoes

Surgery

198
Q

What is a Hammer Toe

A

Deformity of the PIP joint with flexion of PIP joint and hyperextension of MTP and DIP joint
Seen if the 2nd toe is longer than the 1st

199
Q

Sx of Hammer Toe

A

Pain at PIP

200
Q

What is Charcot’s Joint (Diabetic Foot)

A

Joint damage and destruction as a result fo peripheral neuropathy from DM
Repetitive microtrauma to the foot with no sensation and autonomic dysfunction leads to bone resorption and weakening
Usually seen at the mid-foot

201
Q

Sx of Charcot’s Joint

A

Pain, swelling, alteration of shape of the foot

Ulcer or skin changes

202
Q

Dx of Charcot’s Joint

A

Xray: Obliteration of joint space
Scattered osteophytes in fibrous tissue
Increased ESR

203
Q

Tx of Charcot’s Joint

A

Rest
Non-bearing
Surgery

204
Q

What is a Jones Fracture

A

Transverse fracture through diaphysis of the 5th metatarsal

205
Q

Tx of Jones Fracture

A

Non-weight bearing for 6-8 weeks followed by repeat xrays

Often needs Open Reduction and Internal Fixation/pinning

206
Q

What is a Pseudojones Fracture

A

Transverse avulsion fracture at the base (tuberosity) of the 5th metatarsal due to plantar flexion with inversion

207
Q

Tx of Pseudojones Fracture

A

Walking cast for 2-3 weeks

Open Reduction and Internal Fixation if displaced

208
Q

What is a Herniated Disk

A

Pain in a dermatomal pattern

Increased pain with coughing, straining, bending, sitting

209
Q

What are the common locations of a Herniated Disk

A

L5-S1

L4-L5

210
Q

Sx of Herniated Disk

A

Back pain that radiates through the thigh/buttocks
Pain with straight leg raise, crossover test
Strength, reflex and sensibility deficits

211
Q

What is Cauda Equina Syndrome

A

Serious complication of herniated lumbar disk

This is a neurosurgical emergency

212
Q

Sx of Cauda Equina Syndrome

A

New onset of urinary or bowel retention/incontinence with saddle anesthesia
Uni/bilateral leg radiation
Decreased anal sphincter tone on rectal exam (no “anal wink)

213
Q

Tx of Cauda Equina Syndrome

A

Emergency Surgery

Corticosteroids

214
Q

What is Spinal Stenosis

A

Narrowing of the spinal canal with impingement of the nerve roots and cauda equina
Usually seen in >60 yrs old

215
Q

Sx of Spinal Stenosis

A

Back pain with parasthesias in one or both extremities
Worse with extension, prolonged standing, walking
Relieved with flexion, sitting, walking uphill
Lumbar flexion increases the canal volume

216
Q

Tx of Spinal Stenosis

A

Lumbar Epidural steroid injections

Decompression laminectomy

217
Q

What is a Lumbosacral Sprain/Strain

A

Acute strain or tear of paraspinal muscles specially after twisting or lifting

218
Q

Sx of Lumbosacral Sprain/Strain

A

Back muscle spasms
Loss of lordotic curve
Decreased ROM
No neurological changes (no pain below knee)

219
Q

Tx of Lumbosacral Sprain/Strain

A

Brief bed rest (2 days)
NSAIDS, Analgesics
Muscle Relaxers

220
Q

What is a Spinal Compression Fracture

A

A burst fracture that usually occurs in children from jumping, falling from a height
Lumbar compression fracture typically seen in elderly due to osteoporosis

221
Q

Sx of Spinal Compression Fracture

A

Pain and point tenderness at the level of compression

222
Q

Tx of Spinal Compression Fracture

A

Ortho and Neurosurgery consult
Analgesics
Kyphoplasty/vertebroplasty

223
Q

What is Scoliosis

A

Lateral curvature of the spine >10 degrees

Typically assocaited with Kyphosis (humpback) or lordosis (sway back)

224
Q

What age and demographics are noted with Scoliosis

A

8-10 year old girls

225
Q

Sx of Scoliosis

A

See cafe au lait spots, skin tages or axillary freckles

226
Q

Dx of Scoliosis

A

Adams forward bending test is most sensitive

Cobb’s Angle measured on AP/Lateral films

227
Q

Tx of Scoliosis

A

Observation
Bracing if 20-40 degrees
Surgery if >40 degrees

228
Q

What is Spondylolysis

A

Defect in pars interarticularis from either failure of fusion or stress fracture

229
Q

What is Spondylolisthesis

A

Forward slipping of vertebrae on another

230
Q

Sx of Spondylolysis and Spondylolisthesis

A

Lower back pain
Sciatica symptoms
Spondylolisthesis may cause bowel or bladder dysfunction

231
Q

Tx of Spondylolysis and Spondylolisthesis

A

Spondylolysis: Symptomatic relief, activity restriction, physical therapy, bracin
Spondylolisthesis: Low grade treat like spondylolysis
High grade needs surgery

232
Q

What is Osteomyelitis

A

Inflammation/Infection of bone by pyogenic organisms

Usually seen in young adults or older people

233
Q

What are risk factors for Osteomyelitis

A

DM, immunocompromised, preexisting joint disease

URI’s in children

234
Q

What organism are associated with Acute Osteomyelitis in children

A

Staph. Aureus, GABHS

Sickle Cell Disease: Salmonella

235
Q

What organisms are associated with Chronic Osteomyelitis in adults

A

Staph Aureus, Staph Epidermis

Gram Negatives: Pseudomonas, Serratia, E. Coli

236
Q

What are the common sources of Chronic Osteomyelitis

A

Acute Hematogenous: Most common, especially kids
Direct Inoculation: Infection close to bone usually after trauma surgery
Contiguous Spread with vascular insufficiency: DM, peripheral vascular disease

237
Q

Sx of Osteomyelitis

A

Gradual onset of sx, signs of bacteremia (fever, chills, malaise)
Local inflammation, pain over involved bone, reduced ROM
Inability to bear weight

238
Q

Dx of Osteomyelitis

Gold Standard

A

Bone Aspiration is gold standard
Increased WBC, Increased ESR
MRI: most sensitive in early disease
Xray: Soft tissue swelling and periosteal reaction, lucent areas of cortical destruction, in advanced/chronic see sequestrum - segments of necrotic bone separated from living bone by granulation tissue

239
Q

Tx of Osteomyelitis

A

Chronic: Surgical debridement and abx specific to organism involved

240
Q

What antibiotics are used in Osteomyelitis
Newborn
>4 months

A

Newborn: Nafcillin or Oxacillin + 3rd Gen Cephalosporin
>4 months: Nafcillin or Oxacillin (Clindamycin or Vanco if PCN allergy)
If MRSA: Vancomycin
Sickle Cell Disease: 3rd gen Cephalosporin or Fluroquinolone (Ciprofloxacin or Levofloxacin)
Pseudomonas (puncture wound): Cipro

241
Q

What is Septic Arthritis

A

Infection in the joint cavity

This is an emergency

242
Q

What are the common ways Septic Arthritis spreads

A

Hematogenous, Direct Inoculation (trauma, puncture), Contiguous

243
Q

What are the pathogens involved in Septic Arthritis

A 
Staph. Aureus
Neisseria Gonorrhea
Streptococci
Gram Negatives
Staph Epidermis
244
Q

Sx of Septic Arthritis

A

Joint Involvement: single swollen, warm, painful joint, tender to palpation
Knee is most common
Constitutional sx: fevers, chills, night sweats, myalgias, malaise, pain

245
Q

Dx of Septic Arthritis

A

Arthrocentesis: WBC >50,000 primarily PMN, Gram Stain and Cultures

246
Q

Tx of Septic Arthritis

A

Based on Gram Stain
Gram Positive Cocci: Nafcillin, Vanco if PCN allergy or MRSA
Gram Negative Cocci: Ceftriaxone, Cipro if PCN allergy
Gram Negative Rods: Ceftriaxone + Gentamicin

247
Q

What is Compartment Syndrome

A

Muscle/Nerve Ischemia when closed muscle compartment pressure is greater than perfusion pressure

248
Q

What causes Compartment Syndrome

A

Trauma, crush injuries, thermal burns, tight casts or pressure dressings

249
Q

Sx of Compartment Syndrome

A

Pain out of proportion to injury (persistent deep burning)

Pain on passive stretching, tense extremitis (firm/wooden feeling), parasthesias, pulselessness, paresis (late finding)

250
Q

Dx of Compartment Syndrome

A

Increased intracompartmental pressure >35-40 mm Hg

251
Q

Tx of Compartment Syndrome

A

Fasciotomy (decompression of pressure)

252
Q

What is Osteosarcoma

A

Most common bone malignancy

Usually in adolescents and peaks again at 50’s

253
Q

Where does Osteosarcoma metastasize to

A

Lungs

254
Q

Sx of Osteosarcoma

A

Bone pain/joint swelling

Palpable soft tissue mass

255
Q

Dx of Osteosarcoma

A

Hair on end or Sun ray/bursts
Appearance of soft tissue mass
Mixed sclerotic/lytic lesions
Periosteal bone reactions

256
Q

Tx of Osteosarcoma

A

Limb-sparing resection
Radical aputation
Chemo

257
Q

What is Ewing’s Sarcoma

A

Giant cell tumor usually seen in children

Femur and Pelvis are common locations

258
Q

Sx of Ewing’s Sarcoma

A

Bone pain, palpable mass, may have joint swelling, fever

259
Q

Dx of Ewing’s Sarcoma

A

Lytic Lesions with layered periosteal reaction “inion peel” appearance on Xray

260
Q

Tx of Ewing’s Sarcoma

A

Chemo

Surgery and Radiation

261
Q

What is Chondrosarcoma

A

Cancer of the cartilage

262
Q

Dx of Chondrosarcoma

A

Mineralized chondroid matrix punctate or ring and arc appearance pattern of calcification

263
Q

What is Paget’s Disease (Osteitis Deformans)

A

Abnormal bone remodeling and disorganized osteoid formation

Usually in the elderly and people of Western European descent

264
Q

How does Paget’s Disease occur

A

Disordered bone remodeling occurs by increase in osteoclast bone resporption and increase in abnormal trabecular bone formation which in turn leads to larger, weaker, less compact bones more vascular and prone to fractures
The Lytic phase involves increased osteoclast activity

265
Q

Sx of Paget’s Disease

A

Asymtpomatic - Usually incidental findings on Xray
Bone pain, stress fractures or increased warmth due to hyper vascularity
Soft bones: bowed tibias, kyphosis, frequent fractures
Skull involvement: Deafness

266
Q

Dx of Paget’s Disease

A

Labs: Increased Alkaline Phosphatase, Normal Calcium and Phosphate
Xrays: Lytic Phase: Blade of grass/flame shaped luceny
Sclerotic Phase: Coarsened Trabeculae
Skull: Cotton Wool Apperance

267
Q

Tx of Paget’s Disease

A

Bisphosphonates (Alendronate, Risedronate). These inhibit osteoclast activity
Calcitonin: Leads to decreased osteoclast activity

268
Q

What is Systemic Lupus Erythematosus (SLE)

A

Chronic systemic, multi organ autoimmune disorder of connective tissue
Seen in young females, increased incidence in AA, Hispanics, Native Americans

269
Q

Sx of Lupus

A

Triad of joint pain, fever, and malar “butterfly” rash (erythematous rash on cheeks and bridge of nose sparing nasolabial folds)
Discoid Lupus: Annular, erythematous patches on face and scalp, which heals with scarring
Systemic: CNS, cardiovascular, glomerulonephritis, retinitis, oral ulcers, alopecia

270
Q

Dx of Lupus

A

Positive ANA, though not specific
Positive Anti-Double Stranded DNA: 100% specific
Positive Anti-Smith antibodies: 100% specific
Antiphospholipid antibody syndrome

271
Q

Tx of Lupus

A

Sun Protection
Hydroxychloroquine (for skin lesions)
NSAIDS or Acetaminophen for arthritis

272
Q

What is Scleroderma (Systemic Sclerosis)

A

Systemic connective tissue disorder

See Thickened Skin (Sclerodactyl), lung, heart, kidney, GI tract

273
Q

Sx of Scleroderma

A 
Tight, shiny, thickened skin
Limited cutaneous systemic sclerosis "crest syndrome" -Calcinosis cutis
-Raynaud's Phenomenon
-Esophageal motility disorder, 
-Sclerodactyl (claw hand), Telangectasis
274
Q

Dx of Scleroderma

A

Positive Anti-Centromere Antibodies

Positive Anti-SCL 70 Antibodies

275
Q

Tx of Scleroderma

A

DMARDS, Steroids

For Raynaud’s: CCB, Prostacyclin

276
Q

What is Sjogren’s Syndrome

A

Autoimmune disorder attacking the exocrine glands
Salivary glands: Xerostoma
Lacrimal Glands: Keratoconjnctivitis
Parotid Enlargement

277
Q

Sx of Sjogren’s Syndrome

A

Dry mouth, Dry eyes, Parotid Enlargement

278
Q

Dx of Sjogren’s Syndrome

A

ANA
AntiSS-A (Ro)
Positive RF
Schirmer Test (decreased tear production)

279
Q

Tx of Sjogren’s Syndrome

A

Artificial Tears

Pilocarpine for Xerostoma: Cholinergic that increases lacrimation and salivation

280
Q

What is Fibromyalgia

A

Widespread muscular pain, fatigue, muscle tenderness, headache, poor sleep/memory problems, increased pain perception

281
Q

Sx of Fibromyalgia

A

Diffuse pain
Extreme fatigue, stiffness, painful, tender joints
Sleep Disturbances, haziness

282
Q

Dx of Fibromyalgia

A

Diffuse pain in 11/18 trigger points for > 3 months

Biopsy: Moth eaten appearance of type I muscle fibers

283
Q

Tx of Fibromyalgia

A

TCA’s
Cymbalta, SSRIs, Neurontin, Exercise
Pregabalin only FDA approved tx

284
Q

What is Polymyalgia Rhuematica

A

Idiopathic inflammatory condition causing synovitis, bursitis, and tenosynovitis
Aching/Stiffness of proximal joints

285
Q

What is closely related to Polymyalgia Rehumatica

A

Giant Cell Arteritis

286
Q

Sx of Polymalgia Rheumatica

A

Bilateral proximal joint pain/stiffness
Morning stiffness > 30 minutes of pelvic and shoulder girdle
No severe muscle weakness

287
Q

Dx of Polymalgia Rheumatica

A

Clinical
Increased ESR
Anemia

288
Q

Tx of Polymalgia Rheumatica

A

Corticosteroids

Methotrexate

289
Q

What is Polymyositis and Dermatomyositis

A

Idiopathic inflammatory muscle disease of proximal limbs, neck, pharynx

290
Q

Sx of Polymositis and Dermatomyositis

A

Progressive symmetrical proximal muscle weakness

Dysphagia, Skin Rash, Polyarthralgias, Muscle Atrophy

291
Q

What is a sx of Dermatomyositis

A

Heliotrope (blue-purple) upper eyelid discoloration
Gottron’s Papules: Raised violaceous scaly eruptions on the knuckles
Malar rash wih erythema

292
Q

Dx of Polymositis and Dermatomyositis

A

Increased Aldolase and Creatine Kinase
Positive Anti-Jo 1 Antibody: Myositis
Positive Anti-SRP antibody: Polymositis
Positive Anti-Mi-2-Antibody: Dermatomyositis
Muscle Biopsy: See edomysial involvement with Polymositis

293
Q

Tx of Polymositis and Dermatomyositis

A

Corticosteroids

Methotrexate, Azathioprine, IVIG

294
Q

What is Gout

A

Uric acid deposition in soft tissue, joints, and bones

295
Q

How do Gout attacks happen

A

Purine-Rich foods (Alcohol, Liver, Oily Fish, Yeast)
These cause rapid change sin uric acid concentrations
Diuretics, Ace-I, Pyrazinamide, Ethambutol, ASA

296
Q

Sx of Gout

A

Joint erythema, swelling, and stiffness
Podagra: 1st MTP joint is most common
Knees, Feet, Ankles are also common
Tophi Deposition: Collection of solid uric acid in sofit tissue, such as helix of ear, eyelids, achilles tendon
Uric Acid Nephrolithiasis and Nephropathy

297
Q

Dx of Gout

A

Arthrocentesis: Negatively birefringent needle-shaped urate crystals
Xrays: Mouse/Rat bite, punched out resosions

298
Q

Tx of Gout

A

Acute: NSAIDS (Indomethacin, Naprosyn)
Colchicine is 2nd line
Chronic: Allopurinol which reduces uric acid production

299
Q

What is Pseudogout

A

Calcium pyrophosphate deposition in the joints and soft tissue

300
Q

Sx of Pseudogout

A

Red, Swollen, Tender Joints, Usually of the knee

301
Q

Dx of Psuedogout

A

Arthrocentesis: Positively birefringent, Rhomboid-Shaped CPP crystals

302
Q

Tx of Pseudogout

A

Acute: Steroids, NSAIDS, Colchicine
Chronic: NSAIDS, Colchicine

303
Q

What is Rheumatoid Arthritis

A

Chronic inflammatory disease with persistent symmetric polyarthritis with bone erosion, cartilage destruction and joint structure loss

304
Q

Sx of Rheuatoid Arthritis

A 
Symmetric arthritis
-Boggy joints, Boutonniere Deformity
-Swan Neck Deformity (flexion at DIP)
-Ulnar deviation at MCP
-Rheumatoid Nodules
Small Joint Stiffness worse with rest, Morning joint stiffness lasts > 60 minutes after initiating movement, improves as the day progresses
305
Q

Dx of Rheumatoid Arthritis

A

Positive RF
Positive Anti-Citrullinated Peptide AB (Anti-CPP)
Xray: Nrarowed joint space, Subluxation, Deformities, Ulnar Deviation of hand

306
Q

Tx of Rheumatoid Arthritis

A

DMARDS (Methotrexate, Hydroxychloroquine

NSAIDS for pain and low dose steroids

307
Q

What is Osteoarthritis

A

Chronic disease due to articular cartilage damage and degeneration

308
Q

What is the largest risk factor for Osteoarthritis

A

Obesity

309
Q

Sx of Osteoarthritis

A

Evening joint stiffness
-Decreases with rest, worst throughout the day
Seen in weight bearing joints (hips, knees, cervical/lumbar spine)
Heberden’s Nodes, Bouchard’s Nodes

310
Q

Dx of Osteoarthritis

A

Clinical
Xray: Joint space arrowing
Osteophytes
Subchondral bone cysts/sclerosis

311
Q

Tx of Osteoarthritis

A

Acetaminophen first then NSAIDS

Steroid injections

312
Q

What is Reactive Arthritis (Reiter’s Syndrome

A

Autoimmune response to infection in another part of the body

313
Q

What pathogen is most commonly involved in Reactive Arthritis

A

Chlamydia
Gonorrhea
GI: Salmonella, Shigella, Campylobacter, yersinia

314
Q

Sx of Reactive Arthritis

A

Can’t see, can’t bee, can’t climb a tree

Conjunctivitis, Urethritis, Arthritis

315
Q

Dx of Reactive Arthritis

A

Positive HLA-B27
Increased WBC
Synovial Fluid: WBC 1,000-8,000
Negative synovial fluid bacterial culture

316
Q

Tx of Reactive Arthritis

A

NSAIDS
Antibiotics to treat infection that triggered reaction
Anti-TNF agents

317
Q

What is Ankylosing Spondylitis

A

Chronic inflammatory arthropathy of the axial skeleton and sacroiliac joints with progressive stiffness

318
Q

Sx of Ankylosing Spondylitis

A

Chronic low back pain, morning stiffness, decreased ROM
Back pain decreases with exercise
Peripheral arthritis

319
Q

Dx of Ankylosing Spondylitis

A

Increased ESR
Positive HLA-B27
Bamboo Spine: Squaring of vertebral bodies

320
Q

Tx of Ankylosing Spondylitis

A 
NSAIDS
Rest
Physical Therapy
TNF-Alpha Inhibitors
Steroids
321
Q

What is Psoriatic Arthritis

A

Psoriasis usually precedes the development of psoriatic arthritis

322
Q

Sx of Psoriatic Arthritis

A

Asymmetric arthritis dactylitis
Sausage Digits of fingers and toes
Scaroiliac Arthritis
Pitting of the nails, psoriasis, Chronic Uveitis

323
Q

Dx of Psoriatic Arthritis

A

Xray: Pencil in cup deformity

Positive HLA-B27

324
Q

Tx of Psoriatic Arthritis

A

NSAIDS (Methotrexate after NSAID)

TNF-Inhibitors

Emergency Medicine (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions