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Clinical Medicine > Rheum/musculoskeletal > Flashcards

Rheum/musculoskeletal Flashcards

1
Q

Deposition of Monosodium urate crystals in joints

A

gout

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2
Q

Hyperuricemia

A

uric acid greater than 6.8. Treatment only indicated in those undergoing cytotoxic treatment.

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3
Q

Primary Overproducers

A

idiopathic, genetic

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4
Q

Secondary Over producers

A

increased purine consumption, malignancy, psoriasis, enzyme defects.

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5
Q

Primary underexcreters

A

idiopathic

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6
Q

secondary underexcreters

A

Most common. decreased renal function, metabolic acidosis, dehydration, meds, lead nephropathy.

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7
Q

Stage 1 gout

A

elevated uric acid levels with no symptoms.

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8
Q

Stage 2 gout

A

acute attack of arthritis

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9
Q

stage 3 gout

A

10 or more acute attacks. chronic swelling and tophi

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10
Q

Podagra

A

gout affecting the first MTP

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11
Q

Tophi

A

large aggregated crystals in the joint

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12
Q

Gout presentation

A

rapid onset, severe pain, redness, warmth and swelling. Usually monoarticular (big toe).

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13
Q

Gout triggers

A

ETOH, trauma, any medications that change uric acid levels, high purine consumption.

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14
Q

Xray of gout

A

Joint erosion. “rat bite”

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15
Q

Arthrocentesis of gout

A

gold standard. needle shaped and NEGATIVE birefringent crystals

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16
Q

24 urine uric acid

A

overproducers with have more than 800mg on a normal diet.

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17
Q

Acute Gout Attack Treatment

A

1st line: NSAIDS, indomethacin 50mg TID or naproxen 500mg BID
2nd line: colchicine 1.2mg followed by 0.6mg an hour later then 0.6mg BID.
3rd line: Glucocorticoids

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18
Q

Gout prevention

A

avoid high purine foods, prophylactic treatment and urate lowering therapy.

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19
Q

Chronic gout treatment indications

A

frequent attacks, polyarticular, tophi, renal stones.

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20
Q

Gout treatment goals

A

SUA of 6.0mg or less.

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21
Q

Probenecid

A

Gout. For underexcreters. Enhances renal excretion. 250mg BID. Avoid with nephrolithiasis and aspirin.

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22
Q

Allopurinol (Xanthine oxidase inhibitor)

A

Agent of choice for gout. Decreases uric acid synthesis. 300mg a day. renal dosing.

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23
Q

Febuxostat (xanthine oxidase inhibitor)

A

similar to allopurinol. safe with mild-moderate renal insufficiency.

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24
Q

Chronic gout treatment

A

urate lowering therapy should be started 2 weeks after an acute attack. need to have prohpylaxis of NSAIDS/colchicine before starting.

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25
Q

Calcium pyrophosphate dihydrate depostion disease

A

Pseudogout

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26
Q

chondrocalcinosis

A

radiographic evidence of calcification. punctate and linear.

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27
Q

psuedogout presentation

A

acute, monoarticular inflammatory arthritis. usually effects the knees, wrists or shoulder.

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28
Q

Pseudogout arthrocentesis

A

POSITIVELY birefringent. rhomboid shaped CPPD crystals.

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29
Q

Psuedogout acute treatment

A

NSAIDS, colchicine, glucocorticoids. Joint aspiration. intrarticular glucocorticoids. immobilization and ice.

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30
Q

Pseudogout prophylaxis

A

if greater than 3 attacks per year. Cochicine 0.6mg BID

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31
Q

Systemic Lupus Erythematosus (SLE) Etiology

A

Autoimmune disorder with autoantibodies to nuclear antigens. Genes, environment, hormones.

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32
Q

SLE pathogenesis

A

ANA then antibody/antigen complexes then deposit in tissues which activate complement causing inflammation.

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33
Q

SLE presentation

A

Fever, Fatigue, weight change, photosensitivity, alopecia, malar/discoid rash, arthritis, serositis, lupus nephritis, seizures, Raynaods phenomenon, peritonitis, vasculitis, ophthalmologic involvement, recurrent fetal loss.

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34
Q

SLE Diagnosis

A

ANA is cardinal feature but is not specific. immunofluorecence shows anti-dsDNA and anti-sm antibodies.

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35
Q

SLE treatment

A

Step wise approach. NSAIDS. Antimalarials (hydroxychloroquine with ophthalmologic follow up). systemic corticosteroids. cytotoxic/immunosuppressive agents (methotrexate, azathioprine). Belimumab (monoclonal antibody).

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36
Q

Drug induced SLE

A

Constitutional symptoms, pleuropericardial symptoms. Positive antihistone antibody.

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37
Q

Drug induced SLE treatment

A

stop the offending drug

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38
Q

Sjogren Syndrome etiology

A

Chronic, autoimmune. Diminished exocrine gland function.

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39
Q

Sicca complex

A

dry eyes and mouth

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40
Q

sjogren syndrome presentation

A

fatigue, keratoconjunctivitis (dry eyes), xerostoma, parotid gland enlargement, mucous membrane dryness, arthritis, Raynaud’s, lymphadenopathy, pulomary disease, vasculitis, nephritis, lymphoma.

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41
Q

Raynaud’s phenomenon

A

episodic vasospastic disease. white then blue then red fingers.

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42
Q

Sjogren syndrome diagnosis

A

ANA. Anti-Ro/ssa and anti-La/ssB. elevated RF.

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43
Q

Sjogren syndrome treatment

A

Dentist and optomotrist follow up. cyclosporine eye drops (restasis), biotene. Steroids/immunosuppressants.

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44
Q

Systemic sclerosis (scleroderma) etiology

A

Rare, chronic autoimmune disorder causing diffuse fibrosis of skin and organs.

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45
Q

Systemic sclerosis pathogenesis

A

immunologic mechanisms lead to vascular endothelial damage and activation of fibroblasts.

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46
Q

Systemic sclerosis presentation

A

arthritis, pulmonary fibrosis, pericarditis, renal failure, cutaneous symptoms.

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47
Q

Limited cutaneous systemic sclerosis

A

CREST. Calcinosis cutis, Raynaud’s, Esophageal dysmotility, Sclerodactyly (puffy hands), Telengiectasia.

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48
Q

Diffuse cutaneous Systemic sclerosis

A

rapid symmetric skin thickening of trunk and proximal extremities.

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49
Q

Systemic Sclerosis Diagnosis

A

ANA. anti-SCL-70 and anti-centromere antibodies.

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50
Q

Systemic Sclerosis Treatment

A

Supportive. Raynauds: nifedipine. Esophageal dysmotility: H2 blockers. HTN: ace inhibitors.

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51
Q

Reactive Arthritis etiology

A

inflammatory arthritis triggered by a GI/GU infection (diarrhea or urethritis). shigella, salmonella, yersinis and campylobacter. chlamydia.

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52
Q

Reactive Arthritis Presentation

A

asymmetric oligoarthritis (can’t climb a tree), conjunctivits (can’t see), urethritis (can’t pee). ulcers, keratoderma blennorrhagicum (hyperpigmentation of soles/palms), circinate balanitis (on penis), nail changes.

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53
Q

Reactive Arthritis Diagnosis

A

HLA-B27 antigen. Synovial fluid: inflammation but non infection.

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54
Q

Reactive arthritis treatment

A

NSAIDS: indomethacine 25-50mg TID.

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55
Q

Rhuematoid Arthritis (RA) etiology

A

autoimmune, chronic, inflammatory disorder.

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56
Q

RA pathogenesis

A

Interluekins effect the T cells, increasing TNF, leading to inflammation and osteoclastogenesis causing bone erosion.

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57
Q

RA Presentation

A

symmetric polyarthritis. Morning sitffness >1 hour. Pain, swelling, MCP and DIP joints. Ulnar deviation. Boutonniere, swan-neck, interosseous hypertrophy. Adhesive capsulitis, baker’s cyst, metatarsal head subluxation.

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58
Q

RA Extraarticular manifestations

A

constitutional symptoms, rheumatoid nodules, episceleritis/scleritis, pericarditis, plueritis, sicca, hematologic. Cardiovascular disease is most common cause of death.

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59
Q

Felty Syndrome

A

RA, Splenomegaly, neutropenia.

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60
Q

RA radiology

A

soft-tissue swelling, osteopenia, narrowing of the joint, subluxation, bone erosion/joint obliteration.

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61
Q

RA Labs

A

Rheumatoid Factor. Anti-CCP, ANA (30%). Inflammatory markers (ESR and CRP).

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62
Q

RA Treatment

A

Exercise with rest periods. NSAIDS, glucocorticoids, Disease Modifying Antirhuematic Drugs (DMARD)

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63
Q

Synthetic DMARDs

A

Methotrexate, sulfasalazine, hydroxycholoraquine.

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64
Q

Biological DMARDs

A

Inhibit inflammatory cytokines (TNF-alpha). High risk of infection, myelosuppression and malignancy. Etanercept (enbrel), Infliximab (remicaid), Adalmumab (humira).

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65
Q

Osteoarthritis (OA) Pathogenesis

A

damage leads to chondrocytes then degradative enzyems causing thinning of articular cartilage and bone remodeling (bone spurs and joint space narrowing).

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66
Q

OA Symptoms

A

pain that is exacerbated by activity and relieved by rest. Morning stiffness that last for less than 30 minutes.

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67
Q

OA General Signs

A

crepitus, bony enlargements, decreased ROM, malalignment, tenderness.

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68
Q

OA of the hands

A

Heberden’s nodes ( DIP), bouchard’s nodes (PIP), oftern in first CMC joint.

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69
Q

OA of the knees

A

Osteophytes, effusions, crepitus, decreased ROM.

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70
Q

OA of the hip

A

decreased internal rotation, pain in hip/groin, pain that radiates to the knee.

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71
Q

OA radiology

A

joint narrowing, osteophytes, subchondral sclerosis, subchondral cysts.

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72
Q

OA Treatment

A

Weight loss, PT, tylenol, NSAIDS, narcotics (sparingly), topical NSIADS (diclofenac or capsaicin), intraarticular glucocorticoids or hyaluronic acid.

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73
Q

Polymyalgia Rheumatica Etiology

A

Chronic, inflammatory rhuematic condition associated with giant cell temporal arteritis. women > 50 years old.

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74
Q

Polymyalgia presentation

A

morning stiffness, symmetric, shoulder>hip/neck pain, synovitis/bursitis, edema, decreased ROM, subjective weakness, systemic symptoms.

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75
Q

Polymyalgia Labs

A

elevated ESR > 40.

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76
Q

Polymyalgia diagnosis

A

Proximal bilateral aching with morning stiffness for > 30 mins for > 2 weeks. Rapid resolution with low-dose glucocorticoids.

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77
Q

Polymyalgia Treatment

A

NSAIDS, PT, glucocorticoids (15-20mg/day).

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78
Q

Fibromyalgia etiology

A

idiopathic. Soft tissue pain disorder with widespread, chronic pain. No inflammaiton.

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79
Q

Fibromyalgia presentation

A

aching, stiffness, paresthesias, HA, fatigue, mood disturbances (anxiety and depression), disturbed sleep, pelvic pain, IBS, painful bladder syndrome.

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80
Q

Fibromyalgia diagnosis

A

All labs are negative. Symptoms of widespread pain that is above/below the waist and on right/left sides of the body with at least 11/18 tender spots.

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81
Q

Fibromyalgia Treatment

A

NSAIDS, Cyclobenzapine (muscle relaxer), antidepresants (amitriptyline, duloxetine, milnacipran), anticonvulsants (pregabalin, gabapentin). Avoid narcotics.

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82
Q

Rotator Cuff Muscles in order

A

Supraspinatus, infraspinatus, teres minor (external rotation and abduction), subscapularis (internal rotation).

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83
Q

Most common rotator cuff tear

A

supraspinatus

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84
Q

General Rotator Cuff symptoms

A

Pain over anterior/lateral shoulder. Radiates to deltoid. Occurs with overhead activities. Decreased abduction.

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85
Q

Rotator Cuff tests

A

drop arm (complete tear), empty can, neer’s, hawkins.

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86
Q

Tendinosis

A

Degeneration of muscles typically due to age

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87
Q

Tendonitis

A

Inflammation due to repetitive trauma

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88
Q

Chronic rotator cuff tear causes

A

Degeneration, impingement and overload. Overhead occupations. Anatomical variations that cause narrowing. Men >40.

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89
Q

Acute rotator cuff tear causes

A

Traums. acute pain with negative radiographs. Labral pathology.

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90
Q

Chronic rotator cuff symptoms

A

Pain worse at night. gradual weakness. Does NOT improve with analgesics. positive drop arm and empty can tests.

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91
Q

Rotator cuff radiography

A

elevation of humeral head suggests tear.

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92
Q

MRI of rotator cuff

A

if full thickness is suspected of labral pathology.

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93
Q

Acute Rotator cuff tear treatment

A

Ice, NSAIDs, weighted pendulum stretch BID, restrict overhead movement, immobilization for a short time, PT after initial rest.

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94
Q

Chronic Rotator Cuff tear treatment

A

subacromial steroid injection (3-4 times per year). Surgery either arthroscopic or joint arthroplasty.

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95
Q

Shoulder impingement Syndrome Presentation

A

subacromial tenderness, normal ROM but pain at >90 degrees. Deep ache. Preserved strength. Pain with flexion and internal rotation. Positive neer’s and hawkins tests. Improves with analgesics.

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96
Q

Shoulder impingement syndrome treatment

A

Ice, NSAIDs, activity modification, PT. Steroid injections if persistent. Surgery if anatomical variation can be fixed.

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97
Q

Adhesive capsulitis etiology

A

trauma, overuse, bursitis, sling use.

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98
Q

Adhesive capsulitis Presentation

A

chronic pain, decreased ROM due to mechanical restirction. usually effects abduction and external rotation. positive apley’s scratch test.

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99
Q

Adhesive capsulitis treatment

A

PT

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100
Q

Acromioclavicular Injury MOI

A

fall onto the tip of the shoulder with the arm tucked into the side.

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101
Q

Acromioclavicular Injury Presentation

A

AC joint swelling/deformity/tenderness. Pain worse at bedtime. Pain worse with downward traction and cross-over test.

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102
Q

AC injury grade I

A

Sprain. Radiographs are normal.

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103
Q

AC injury Grade II

A

speration of the superior/inferior AC ligaments. Instability, decreased ROM. Radiograph shows inferior margin of clavicle lies above the inferior margin of the acromion.

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104
Q

AC injury Grade III

A

Seperation of superior/inferior AC and coracoclavicular ligament. Clinical deformity. Severe pain. Radiograph shoes the inferior margin of the clavicle above the superior margin or the acromion.

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105
Q

AC injury treatment

A

Ice, rest, NSAIDs, shoulder immobilizer (3-4 weeks), corticosteroid injection .

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106
Q

AC injury surgery

A

Grade III with fixation, ligament reconstruction and distal clavicle resection.

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107
Q

Typical Clavicle fracture

A

occurs in the middle and displaces superiorly.

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108
Q

Clavicle fracture presentation

A

visual deformity, tenderness, decreased ROM with apprehension.

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109
Q

Clavicle fracture treatment

A

sling/swathe or figure 8 harness. analgesics, muscle relaxers.

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110
Q

Clavicle fracture ortho referral if…

A

displaced mid clavicle and all proximal/distal fractures.

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111
Q

Subacromial bursitis etiology

A

inflammation or degeneration of the bursa due to repetitive movement or a systemic disease. Can be associated with rotator cuff tendonitis/impingement.

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112
Q

Subacromial bursitis presentation

A

pain with ROM and at rest. localized tenderness of subacromial area.

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113
Q

Subacromial bursitis treatment

A

ice, NSAIDs, rest, aspiration and corticosteriod injections

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114
Q

Carpal Tunnel syndrome (CTS) pathogenesis

A

Repetitive activities that cause swelling of the synovium and thickening of the transverse carpal ligament.

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115
Q

CTS presentation

A

Chronic intermittent pain (dull ache) leading to burning pain, numbness, tingling and weakness. worse at night.

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116
Q

CTS Tests

A

Phalens and tinels

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117
Q

CTS signs

A

Thenar atrophy, decreased sensory and and strength in median nerve distribution.

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118
Q

CTS Diagnostics

A

Grip strength test, nerve conduction tests, electromyogram.

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119
Q

CTS Treatement

A

NSAIDs, steroid injuections, brace, PT, surger.

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120
Q

Acute CTS treatment

A

Immediate decompression.

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121
Q

Ganglion cysts Etiology

A

collection of synovial fluid within a joint or tendon sheath.

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122
Q

Ganglion cyst presentation

A

dorsal/volar aspect of wrist. Soft mobile mass that fluctuates in size.

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123
Q

Ganglion cyst treatment

A

NSAIDs, aspiration with steroid injection. Often resolve on their own.

124
Q

De Quervain’s tendosynovitis etiology

A

Inflammation of the first dorsal compartment involving abductor pollicis longus and extensor pollicis brevi due to overuse (repetitive gripping).

125
Q

De Q’s Presentation

A

pain/swelling along dorsal wrist. positive finkelstein’s test. Pain aggravated by gripping.

126
Q

De Q’s Treatment

A

rest, thumb spica immobilization, NSAIDs, steroid injections.

127
Q

Boutonniere deformity

A

PIP flexion, DIP hyperextension.

128
Q

Swan neck deformity

A

PIP Hyperextension, DIP flexion.

129
Q

Biceps tendonitis etiology

A

Inflammation of the long head of the bicep as it passes through the bicepetal groove. Due to repetitive lifting.

130
Q

Biceps tendonitis presentation

A

pain in anterior shoulder (bicipetal groove), pain with abduction and external rotation, popping, weakness.

131
Q

Biceps tendonitis tests

A

Yergason’s and speeds.

132
Q

Biceps tendonitis treatment

A

NSAIDs, rest, PT to strengthen the bicep.

133
Q

Glenohumeral dislocation/subluxation Presentation

A

Sulcus sign, usually dislocates anteriorly, apprehension/relocation test.

134
Q

Multi-axial instability treatment

A

PT, analgesics, ice and rest.

135
Q

Glenohumeral dislocation treatment

A

immediate reducation, should immobilizer (2-4 weeks), analgesics, PT. Consider axillary nerve damage (numbness over deltoid).

136
Q

Bankart lesion

A

detachment of anterior/inferior labrum from glenoid rim

137
Q

Hills-Sachs lesion

A

cortical depression of posterolateral humeral head.

138
Q

Elbow epicondylitis etiology

A

over use.

139
Q

Elbow epicondylitis presentation

A

localized pain/swelling. Reproducible pain with wrist flexion (medial) or wrist extension (lateral).

140
Q

Medial elbow epicondylitis

A

golfer’s elbow. Wrist flexors and protonators.

141
Q

Lateral elbow epicondylitis

A

tennis elbow. wrist extensors and supinators.

142
Q

Elbow epicondylitis acute treatment

A

sling, wrist brace, ice, NSAIDs.

143
Q

Elbow epicondylitis prevention

A

forearm strap, correct technique, minimize repetitive injury.

144
Q

Elbow epicondylitis chronic treatment

A

steroid injections and surgery.

145
Q

Olecranon bursitis etiology

A

trauma, prolonged pressure, infection, rhematological conditions.

146
Q

Olecranon bursitis presentation

A

swelling, +/- pain, +/- decreased ROM

147
Q

Olecranon bursitis treatment

A

Ice, NSAIDs, aspiration.

148
Q

Olecranon bursitis Prevention

A

elbow pads, change activity.

149
Q

Cubital tunnel Etiology

A

Compression of the ulnar nerve due to repetitive motion, pressure, fluid or trauma.

150
Q

Cubital tunnel presentation

A

ulnar nerve neuropathy, decreased grip strength, muscle wasting.

151
Q

Cubital tunnel treatment

A

NSAIDS, bracing, PT, surgery (cubital tunnel release or ulnar nerve transposition).

152
Q

Dupuytren’s contracture etiology

A

connective tissue disorder. progressive fibrosis of the palmar fascia.

153
Q

Dup’s contracture presentation

A

painless nodules that become palpable cords along the palmer surface. Loss of finger extension.

154
Q

Dup’s contracture Test

A

hueston table top test

155
Q

Dup’s contracture treatment

A

stretching, splinting, massage, glucocorticoid injections, surger if contracture is >30 degrees.

156
Q

Trigger thumb/finger etiology

A

nodule on volar aspect of the MCP

157
Q

Trigger thumb/finger presentation

A

digit snaps/catches at IP or PIP joint. Becomes painful.

158
Q

Trigger thumb/finger treatment

A

NSAIDs, steroid injections, surgery to release the A1 pulley.

159
Q

Strain

A

muscle/tendon injury

160
Q

Sprain

A

ligamentous injury

161
Q

Radiculopathy

A

Lower motor neuron dysfunction. Dermatomal distribution. hypoactive reflexes. Flaccidity. Fasciculations.

162
Q

Myelopathy

A

Upper motor neuron dysfunction. Hyperactive reflexes. clonus. upgoing toes (babinski). spasticity.

163
Q

C5 Sensory

A

Lateral/upper arm and shoulder.

164
Q

C5 Motor

A

deltoid and some bicep (abduction)

165
Q

C5 DTR

A

Biceps or brachioradialis

166
Q

C6 sensory

A

dorsolateral arm, forearm and thumb

167
Q

C6 motor

A

biceps, brachioradialis and wrist extensors.

168
Q

C6 DTR

A

biceps or brachioradialis

169
Q

C7 sensory

A

mid-dorsal forearm and middle finger.

170
Q

C7 Motor

A

triceps, wrist flexors and finger extensors.

171
Q

C7 DTR

A

Triceps

172
Q

C8 sensory

A

medial forearm, ring finger, small finger.

173
Q

C8 motor

A

thenar eminence and interossei.

174
Q

L3 sensory

A

anterior thigh

175
Q

L3 motor

A

iliopsoas.

176
Q

L3 DTR

A

knee jerk

177
Q

L4 sensory

A

anteromedial thigh and medial leg.

178
Q

L4 motor

A

quads

179
Q

L4 DTR

A

knee jerk

180
Q

L5 sensory

A

lateral thigh and anterior calf.

181
Q

L5 motor

A

foot dorsiflexion, anterior tibialis and extensor hallucis longus.

182
Q

S1 sensory

A

Posterior calf and heel.

183
Q

S1 motor

A

gastrocnemius.

184
Q

S1 DTR

A

achilles

185
Q

X-ray films indications

A

trauma, degenerative diseases.

186
Q

CT indications

A

bony detail

187
Q

MRI indications

A

soft tissue structures and neural compression

188
Q

Bone scan indications

A

infectious or metastatic diseases

189
Q

Electromyogram (EMG)

A

differentiates root vs. peripheral vs. plexus problem

190
Q

Nerve conduction study

A

problem with the axon vs. myelin. determines the amplitude and speed of response.

191
Q

Cervical sprain etiology

A

rapid deceleration injury that causes hyperextension then flexion. inflammatory response that presents 2-24 hours after trauma.

192
Q

Cervical Sprain Presentation

A

gradual onset of stiffness/soreness. HA at base of skull. shoulder pain.

193
Q

Lumbar Sprain etiology

A

lifting and twisting

194
Q

Lumbar sprain presentation

A

worsens with activity and resolves with rest. radiates to the buttocks. common to have reoccuring episodes.

195
Q

Signs of spinal strains/sprains

A

tenderness, decreased ROM due to pain, muscle spasms.

196
Q

Spinal strain/sprain imaging

A

plain films

197
Q

Spinal strain/sprain treatment

A

Rest (no more than 48 hours), RICE, NSAIDS (for 72 hours not PRN), PT, usually resolves withing 4 weeks.

198
Q

Herniated lumbar disk etiology

A

Repetitive movements or acute injury usually L4/5 or L5/S1 posterolateral. Often associated with lumbar strain.

199
Q

Herniated Lumbar disk Presentation

A

Pain radiating down the back of the legs. Aggravated by coughing/sneezing. Hard to get comfortable. Trunk shifted to one side for compensation.

200
Q

Herniated Lumbar disk Diagnostics

A

Straight leg raise test (gold standard). MRI.

201
Q

Herniated Lumbar disk treatment

A

Best rest (1-2 days), NSAIDs, muscle relaxants (cyclobenzaprine), heat or ice, PT. Urgent referral for any neuro deficits. Surgery if intractable or neuro deficits.

202
Q

Cervical Spondylosis etiology

A

degenerative disk disease and hypertropy of ligamentum flavum and facets.

203
Q

Cervical Spondylosis Presentation

A

unilateral radicular symptoms or bilateral myelopathy. tenderness, muscle spasms.

204
Q

Cervical spondylosis treatment

A

Best rest (1-2 days), NSAIDs, muscle relaxants (cyclobenzaprine), heat or ice, PT. Urgent referral for any neuro deficits. Surgery if intractable or neuro deficits.

205
Q

Cauda Equina Syndrome etiology

A

Massive midline herniation. Neuro Emergency.

206
Q

Cauda Equina Presentation

A

acute onset of low back pain, sciatica, urinary retention, decreased anal sphincter tone, “saddle” anesthesia.

207
Q

Cauda Equina Imaging

A

MRI

208
Q

Cauda equina treatment

A

urgent surgical decompression or oncology referral for metastatic disease.

209
Q

Spondylolysis

A

Defect in the pars interarticularis (collar on the scottie dog) due to repetitive hyperextension of the back. common in adolescents. treated with NSAIDs and rest.

210
Q

Spondylolisthesis etiology

A

degenerative disk disease causing anterior displacement of one vertebra on another.

211
Q

Spondylolisthesis Presentation

A

back pain that is aggravated by lifting/twisting. Can have step offs.

212
Q

Spondylolisthesis treatment

A

50% or neuro deficits: Refer to ortho or neuro.

213
Q

Lumbar spinal stenosis etiology

A

congentical or degenerative disk disease with hypertrophy of the ligamentum flavum causing narrowing of the neural foramen creating compression.

214
Q

Nerogenic claudication

A

Seen with lumbar stenosis. progressive low back pain and bilateral leg pain aggravated by standing/walking and relieved by leaning forward.

215
Q

Lumbar stenosis treatment

A

conservative treatment, epidural steroid injections. Surgery if intractable or neuro deficits.

216
Q

osteomyelitis

A

infection usually associated with invasive procedues. back pain, malaise, fever, sepsis, wound drainage, elevated EST. Treated with IV antibiotics and surgical drainage.

217
Q

Spinal tumors (secondary)

A

90%. New onset of low back pain with known malignancy is metastasis until proven otherwise.

218
Q

Femoroacetabular Impingement (FAI) etiology

A

Progressive bone overgrowth or abnormality that changes the function of the hip. Can lead to labral tears and OA.

219
Q

FAI Pincer

A

acetabular involvement

220
Q

FAI Cam

A

Femoral head involvement

221
Q

FAI Presntation

A

groin and/or lateral hip pain. Sharp throbbing to dull achy. Aggravated with turning/twisting/standing/squatting.

222
Q

FAI test

A

Impingement Test. FADIT and FABER

223
Q

FADIR test

A

flexion, adduction then internal rotation

224
Q

FABIR test

A

figure of four. flexion abduction then external rotation.

225
Q

FAI treatment

A

decrease aggravation, conservative therapy, surgery if that doesn’t work

226
Q

Labral Tear of the hip presentation

A

dull to sharp groin pain that can radiate to the lateral hip, anterior thigh and/or buttock. catching/clicking.

227
Q

Labral tear of hip Diagnositcs

A

ROM, strength, FADIR and FABER. MR anthrogram is gold standard.

228
Q

Labral Tear of hip treatment

A

conservative then refer.

229
Q

Snapping hip syndorme etiology

A

muscle/tendon sliding over a bony prominence. Can lead to bursitis.

230
Q

Snapping hip external

A

IT band over greater trochanter.

231
Q

Snapping hip internal

A

Iliopsoas tendon over the iliopectineal eminence of the femoral head.

232
Q

Snapping hip presentation

A

snapping/popping sensation, +/- pain, aggravated with activity, pseudosubluxation, difficulty with stairs, rising from seated position.

233
Q

External snapping hip tests

A

Passive internal/external rotation while on side.

234
Q

Internal snapping hip tests

A

FABER then extending the hip.

235
Q

Snapping hip treatment

A

Conservative treatment, steroid injection, PT.

236
Q

Greater Trochanteric Pain syndrome etiology

A

Most common cause of lateral hip pain. Due to repetitive overload tendinopathy leading to an inflammed bursa.

237
Q

Greater Troch pain Presentation

A

Lateral hip pain, pinpoint tenderness on greater trochanter, pain with activity.

238
Q

Greater troch pain tests

A

pain with resisted abduction. Trendelenburg sign.

239
Q

Trendelenburg sign

A

Can’t stabilize the pelvis. The contralateral side dips due to weak pelvic stabilizers.

240
Q

MCL MOI

A

knee flexed, foot planted with a lateral impact that causes valgus stress and rotation.

241
Q

Triad of O’Donoghue

A

ACl, MCL, and medial meniscus.

242
Q

ACL MOI

A

quick position change with valgus stress (pivoting/cutting). or a direct blow that causes hyperextension and valgus stress.

243
Q

ACL function

A

Most important for knee stability. prevents posterior movement or the tibia as well as rotation.

244
Q

ACL Presentation

A

“pop” followed by immediate swelling/pain. Feeling of instability. Joint effusion, guarding, usually able to bear weight, laxity.

245
Q

ACL tests

A

Lachman, anterior drawer test and pivot shift. MRI.

246
Q

ACL Treatment

A

Conservative. Surgery for younger people and athletes.

247
Q

PCL function

A

Prevents posterior movement of the tibia and external rotation.

248
Q

PCL MOI

A

high energy trauma (MVA), low energy trauma (soccer).

249
Q

PCL presentation

A

gross instability, mild-moderate effusion, generalized knee pain.

250
Q

PCL tests

A

posterior drawer test and posterior sag sign.

251
Q

Meniscus injury MOI

A

Usually medial meniscus. Occurs due to excessive rotational force.

252
Q

Meniscus injury presentation

A

joint line pain, inability to fully extend knee, locking/catching, difficulty with stairs and squatting.

253
Q

meniscus injury tests

A

mcmurray’s, apley’s compression/distraction. MRI.

254
Q

Knee sprain Grade I treatment

A

mild stretch. Conservative treatment.

255
Q

Knee sprain Grade II treatment

A

partial tear. RICE, brace, crutches, PT, possible surgery.

256
Q

Knee sprain grade III treatment

A

full tear. surgery, crutches, brace, aggressive PT.

257
Q

Patellofemoral pain syndrome etiology

A

Malalignment and patellar tracking concerns. Most common knee complaint.

258
Q

Patellofemoral pain presentation

A

pain behind the patella, worse with stairs, and after sitting for a long time. crepitus, popping, feeling of unstable.

259
Q

patellofemoral pain tests

A

patellar glide and apprehension test.

260
Q

patellofemoral pain treatment

A

conservative. PT. brace PRN for comfort.

261
Q

Baker’s cyst etiology

A

accumulation of synovial fluid in the popliteal fossa.

262
Q

Baker’s cyst presentation

A

oftern asymptomatic. pain/swelling with prolonged activity.

263
Q

Baker’s cyst treatment

A

NSAIDS, aspiration/injection, compressive knee brace.

264
Q

Patellar tendonitis etiology

A

tendon inflammation due to repetitive trauma often from jumping.

265
Q

Patellar tendonitis treatment

A

Conservative. NO steroid injection.

266
Q

patellar tendonitis presnentation

A

pinpoint tenderness just inferior to the patella.

267
Q

Iliotibial band syndrome (ITBS) etiology

A

overuse syndrome usually in runners.

268
Q

ITBS presentation

A

gradual onset of localized pain and tenderness. reproducible pain with ROM and compression of the ITB. Evaluate for any leg length discrepancies.

269
Q

ITBS treatment

A

Conservative.

270
Q

Knee bursitis etiology

A

inflammatory disorder of the bursa usually prepatellar or pes anserine. Caused by trauma or overuse.

271
Q

Knee bursitis presentation

A

pain/swelling, tenderness. Need to rule out infection.

272
Q

Knee bursitis treatment

A

NSAIDS, aspiration/injection, padding/brace.

273
Q

Osteochondritis Dissecans (OCD) etiology

A

lesion of cartilage and underlying bone that results in necrosis and possible displacement.

274
Q

OCD treatment

A

long-term bracing, activity restrictions, PT.

275
Q

Lateral ankle sprain MOI

A

inversion with plantar flexion

276
Q

Lateral ankle sprain tests

A

anterior drawer test.

277
Q

Lateral ligament complex

A

anterior talofibular, calcaneofibular, and posterior talofibular ligaments.

278
Q

Medial ankle sprain

A

eversion injury. deltoid ligament complex.

279
Q

Syndesmotic sprain

A

high ankle sprain. Due to dorsiflexion +/- rotation.

280
Q

Achilles tendinopathy

A

recent incrase in training regimen, burning pain with activity.

281
Q

Achilles rupture MOI

A

sudden pivoting or rapid acceleration. violent pop, often pain is absent.

282
Q

Achilles injury test

A

Thompson test.

283
Q

Achilles injury treatment

A

refer to ortho. equinos splint with continuous plantar flexion.

284
Q

Plantar fasciitis etiology

A

inflammation of the fascia due to activity, heel spurs, pes planus/cavus, ankle pronaiton, poor shoe wear.

285
Q

Plantar fasciitis presentation

A

Pain on plantar aspect of heel. Pain with onset of walking in the morning. uni or bilateral. aggravated with dorsiflexion.

286
Q

Plantar fasciitis treatment

A

conservative. PT and massage.

287
Q

Osteoporosis treatment

A

Calcium supplements, estrogen replacement, calcitonin and bisphosphonates.

288
Q

Septic arthritis presentation

A

increasing pain, redness, warmth, inflammation. surgical emergency.

289
Q

septic arthritis diagnosis

A

aspiration with culture. CBC, EST, CRP, blood cultures.

290
Q

septic arthritis treatment

A

IV antibiotics and I/D

291
Q

Unicameral Bone Cyst

A

common, benign fluid filled cavity in the bone. Surgery if recurrent or pathological fractures.

292
Q

Aneurysmal bone cyst

A

blood filled cyst in the bone. benign but aggressive. refer to ortho.

293
Q

Non-ossifying fibroma

A

benign lesion usually found incidentally. MES: metaphysial, eccentric, sclerotic borders. Observe and refer is >50% of diameter.

294
Q

Giant Cell tumor

A

benign but aggressive. develop as the growth plate closes. localized pain and weakness. refer to ortho for radiation and surgery.

295
Q

Osteoid Osteoma

A

small, benign tumor. Nidus: center of growing cells surrounded by thick bone. severe night time pain that is resolved with NSAIDS. Refer to ortho.

296
Q

Osteochondroma

A

exostosis. abnormal growth of bone or cartilage along the bone surface. Most common and bengin tumor. Fixed, non-mobile mass near joints. Some pain with activity. If painful refer to ortho.

297
Q

Osteosarcome/ewings sarcoma

A

malignant primary bone tumor common in children. Can be aymptomatic until pathological fracture. pain/swelling. Refer to ortho/onc immediately. Fast growing.

298
Q

Chondrosarcoma

A

Bone tumor composed of cartilage-producing cells. >40 years of age. pain and weakness. refer to ortho.

299
Q

Multiple myeloma

A

most common primary bone tumor. > 40 years of age, black people. Involves the entire skeleton.

300
Q

Multiple myeloma presentation

A

fatigue, fever, night sweats, diffuse bone tenderness, pathological fractures.

301
Q

Multiple myeloma diagnosis

A

UA with bence jones proteins. radiograph that shows punched out appearance.

302
Q

Most common cause of metastatic bone cancer in men

A

prostate and lung

303
Q

most common cause of metatstatic bone cancer in women

A

breast.

304
Q

Causes of metastatic bone cancer

A

prostate, lung, breast, kidney and thyroid cancer.

305
Q

Metastatic bone cancer presentation

A

asymptomatic until pathological fracture. anemia. osteolytic bone destruction and osteoblastic formation.

Clinical Medicine (7 decks)

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