Step 2 MSK Flashcards
Back pain exacerbated by standing and walking and relieved with sitting and hyperflexion of hips
Spinal stenosis
Joints in the hand affected by RA
MCP and PIPs
Joint pain and stiffness that worsens over course of day and is relieved by rest
OA
Genetic disorder characterized by multiple fractures & blue sclera
OI
Hip & back pain + stiffness that improves w activity and worsens w rest. Diagnostic test?
Ankylosing spondylitis. check HLA-B27
Arthritis, conjunctivits, and urethritis in young men. Assc’d bugs?
Reactive arthridis. Most commonly assc’d w Chlamydia, Campylobacter, Shigella, Salmonella, and Ureaplasma
55 yo w sudden, excruciating first MTP joint pain after a night of drinking wine. Dx, w/up and acute/chronic tx?
Gout. Needle-shaped negatively birefringent crystals are seen on joint fluid aspirate. Acute tx: NSAIDS #1, colchicine or steroids. Chronic treatment w allopurinol or prebenecid.
Elder w stiff shoulders and hips a dn pain. Cannot lift her arms above her head. Labs show anemia and elevated ESR.
Polymyalgia rheumatica
Bone fractured due to fall on outstreched hand. What bone?
Distal radius/Colles fx.
Complication of scaphoid fx
AVN
Signs suggesting radial nerve dmg w humerus fx
Wrist drop. Loss of thumb ABduction.
Most common primary malignant tumor or bone?
Multiple myeloma
HA, soreness in jaw, pain on scalp, transient monocular blindness?
Giant cell arteritis
Anterior shoulder dislocation. Presentation and treatment?
Most common type of shoulder dislocation. Patients hold arm in slight abduction and external rotation. Risk of axillary nerve injury. Tx: reduction followed by sling and swath. Recurrent dislocations may need surg.
Posterior shoulder dislocation. Presentation and treatment?
Rare. Assc’d w seizure and electrocution. Patients hold arm in adduction and internal rotation. Tx: reduction followed by sling and swath.
Humerus fx. Presentation and treatment?
Direct trauma. Risk of radial nerve palsy which may lead to wrist drop and loss of thumb extension/abduction. Tx: hanging-arm cast vs. coaptation splint and sling. Functional bracing.
“Nightstick fracture” / Ulnar fracture. Presentation and treatment?
P: Direct trauma often self defense. T: ORIF if significantly displaced
Monteggia fracture. Presentation and treatment?
Diaphyseal fracture of proximal ulna with subluxation of the radial head. Results from fall on pronated and outstretched arm. T: ORIF of the shaft and closed reduction of the radial head
Galeazzi fracture. Presentation and treatment?
Diaphyseal fx of the radius with dislocation of the distal radioulnar joint. Results from direct blow to radius. T: ORIF of the radius and casting of the fractured forearm in supination to reduce the distal radioulnar joint
Colles fracture involves distal ??? Presentation and treatment?
Distal radius. Dorsally displaced, dorsally angulated fracture. Commonly seen in kids and old folx. Tx: Closed reduction followed by long arm cast. ORIF if intra-articular fx.
Most commonly fractured carpal bone?
Scaphoid. Results from fall on outstretched hand . May take 2 weeks for XR to show FX. Assume fx if tenderness in anatomic snuffbox w axial loading. Tx: Thumb spica cast. If displacement or scaphoid nonunion is present, treat with open reduction. With proximal-third fx, AVN is a risk.
Boxers Fx? Presentation and treatment?
Fx of fifth metacarpal neck. Closed reduction and ulnar gutter splint. Percutaenous pins if fx is excessively angulated
What is the unhappy triad knee injury?
MCL, ACL, and medial meniscus.
Median nerve injury results from what classic sign? what can the patient not do?
Median nerve injury leads to “benediction sign” where patient cannot close the first-third digits.
Ulnar nerve injury causes inability to do what with fingers?
Ulnar nerve injury prevents patient from opening the 4th and 5th digits “claw hand”
RED flags for LBP
age >50, >=6 weeks of pain, previous cancer history, severe pain, consititutional sx, neurologic deficits, loss of anal sphincter tone.
L4 nerve root motor sensory and reflex innervation
Motor: foot dorsiflexion
reflex: patellar
sensory: : medial aspect of lower leg
L5 nerve root motor sensory and reflex innervation
Motor: big toe dorsiflexion (extensor hallucis longus), foot eversion (peroneus muscles)
Reflex: nonte
Sensory: dorsum of foot and lateral aspect of lower leg
S1 nerve root motor sensory and reflex innervation
Motor: plantar flexion (gastrocnemus and soleus), hip extension (gluteus max)
Reflex: achilles
Sensory: plantar and lateral aspects of the foot
Joint aspirate with WBC 500: inflammatory or noninflammatory?
inflammatory starts @ WBC of 1000.
30 yo woman w knee pain and mass, with “soap bubble” appearance along eipphyseal/metaphyseal region of long bone. Dx?
giant cell tumor
labs for RA?
RF & anti-CCP
Causes of hyperuricemia?
Increased cell turnover (as in hemolysis, blast crisis, tumor lysis, myelodysplasia, psoriais) cyclosporine dehydration DI increased meat and alchol Diuretics lead poisoning lesch-Nyhan Salicyalates starvation
Gout: acute tx and chronic maintenance?
Acute: high-dose NSAIDS (indomethacin) Colchicine (which inhibits neutrophil chemcotaxis and is most effective when used early in flare, can also cause diarrhea and neutropenia)
Cx:Allopurinol for overproducers or those with contraindications to probenecid (tophi, renal stones, CKD).
Probenecid for under-secreters
Compare polymyositis and dermatomyositis
Polymyositis: symmetric, progressive proximal muscle weakness and/or pain. Difficulty breathing or swallowing in severe disease. Anti-Jo Ab. Increased serum CK
Dermatomyositis: Sx as above + rash. Heliotrope, shawl rash or gottron papules. Anti-Jo Ab. Increased serum CK
Anti-centromere Ab +. Dx?
CREST: Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telanciectasias
Anti-dsDNA Ab +. Dx?
SLE
Anti-histone Ab +. Dx?
Drug-induced SLE
Antimitochondrial Ab +. Dx?
primary biliary cirrhosis
Anti-Scl-70 Ab +. Dx?
Systemic sclerosis
Anti-Sm Ab +. Dx?
SLE
Anti-smooth muscle Ab +. Dx?
Autoimmune hepatitis
Antitopoisomerase I Ab +. Dx?
Systemic sclerosis
Anti-TSH-R Ab +. Dx?
Graves Dz
c-ANCA Ab +. Dx?
vasculitis, esp. granulomatosis w polyangitis
p-ANCA Ab +. Dx?
vasculitis, esp. microscopic polyangitis
U1RNP Ab +. Dx?
Mixed connective tissue dz
Criteria for SLE: DOPAMINE RASH
Discoid rash Oral ulcers Photosensitivity Arthritis Malar rash Immunologic criteria: anti-dsDNA, anti-Sm, anti-phospholipids Neurologic sx (lupus cerebritis ESR (elevated) Renal dz ANA Serositis: pleural or pericardial effusions Hematologic abnormalities
numbness in pinky and 1/2 ring finger. Dx?
Numbness of the pinkie and half of the ring finger is ulnar entrapment (cubital tunnel syndrome, which happens at the elbow)
