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Clinical Medicine > Test 6 MSK > Flashcards

Test 6 MSK Flashcards

1
Q

What type of shoulder location is more common?

A

Anterior

usually from external rotation & abduction

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2
Q

Fix shoulder dislocation

A
  1. Distal traction & internal rotation
  2. Immobilize for 6 wks
  3. Physical therapy

Arthroscopic surgery if doesn’t work

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3
Q

Tx clavicle Fx

A

Sling

Surgery if:

  1. Open Fx
  2. Markedly displaced Fx
  3. Fxs w/ multi trauma
  4. Distal Fx
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4
Q

Sx w/ posterior sternoclavicular dislocations

A
  1. Stridor
  2. Dysphagia
  3. Venous distention
  4. Pulse defecit
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5
Q

Tx anterior sternoclavicular dislocation

A

no surgery

Sling

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6
Q

Tx posterior sternoclavicular dislocation

A

Immediate close reduction

Might need open reduction surgery
Sling

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7
Q

Sx of rotator cuff impingement

A
  1. Gradual onset of anterior, lateral shoulder pain
  2. Night pain & difficulty sleeping on affected side
  3. Pain in forward flexion & abduction
  4. Atrophy of muscles in chronic disease
  5. Pain w/ Neers & Hawkens
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8
Q

Tx rotator cuff impingement

A
  1. NSAIDS
  2. PT
  3. Give cortisone shot - if it’s cured then it was tendonitis
    If there is still pain then you need an MRI
  4. No overhead work, no heavy lifting, no pushing or pulling
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9
Q

How does a proximal humerus Fx usually occur?

A

Direct blow or fall onto outstretched hand

Assoc w/ dislocations of greater tuberosity

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10
Q

What type of proximal humerus Fx need a shoulder replacement?

A

Hemiarthroplasty

4 part Fx

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11
Q

How is an elbow broken?

A

Fall w/ elbow locked in extension

Check neurovascular b/c ulnar nerve runs along medial condyle

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12
Q

Tx elbow Fx

A
  1. Closed reduction w/ axial traction

2. Put affected extremity in long arm posterior splint

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13
Q

Most common elbow dislocations?

A

Posterior/posteriolateral

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14
Q

What is tennis elbow & Tx?

A 
Lateral epicondylitis
Inflammation of the extensor muscles in the forearm
1. Rest 
2. Ice 
3. NSAID
4. Bracing
5. PT
6. Cortisone
If all else fails - surgery
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15
Q

What is medial epicondylitis?

A

Inflammation of flexor muscles of forearm
Pain & tenderness on medial aspect of elbow, swelling, weakness, numbness & tingling

Swinging golf club, racket, pitching a ball, turning a doorknob, picking up something w/ the palm down will cause pain
Same Tx as tennis elbow

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16
Q

Tx olecranon Fx

A

ORIF

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17
Q

Tx olecranon bursitis

A
  1. NSAIDS
  2. Aspiration of bursa
  3. Hydrocortisone
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18
Q

Classifications of radial head Fx

A

1 - non-displace
2 - minimal displacement
3 - comminute
Usually Types 1-2

3 needs ORIF

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19
Q

What is a Monteggia Fx?

A

Fx of middle to distal 1/3 of ulna w/ anterior dislocation of radial head

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20
Q

What is a Galeazzi Fx?

A

Fx of distal to middle third of radius w/ dislocation of radioulnar joint

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21
Q

What is a Colles fx?

A

Distal radius Fx from fall on outstretch hand

Close reduction or ORIF

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22
Q

What is a smith Fx?

A

Distal radius Fx from fall w/ wrist flexed

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23
Q

Normal radial inclination

A

22-23 degrees

Loss of this will inc. load across the lunate

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24
Q

What do Pts experience w/ shortened radial length?

A

Loss of pronation & supination

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25
Q

What is normal radial tilt?

A

11mm
2-20mm
Measured on lateral view

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26
Q

What is a boxer’s Fx & Tx?

A

head of 5th metacarpal

1. Splinting w/ ulna gutter splint & refer

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27
Q

How many bones are in the wrist & hand?

A

27

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28
Q

What Fx shows pain in anatomical snuff box & Tx?

A

Scaphoid Fx

Repeat Xray in 3-5 days

Thumb spica splint & ortho referral

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29
Q

What is the Terry Thomas/David Letterman sign?

A

Scapholunate dissociation

Splint

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30
Q

Who usually gets carpal tunnel?

A

Women

  1. Pregnancy
  2. Menopause
  3. Obesity
  4. Diabetes
  5. Thyroid disorders
  6. Kidney failure
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31
Q

Sx of Carpal tunnel

A

Pain, numbness, tingling, burning in the hand, thumb, index , middle & 1/2 of ring finger
Weakness in hand & not being able to hold things, hand falls asleep
Wasting of thenar eminence

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32
Q

Tx carpal tunnel

A
  1. Splinting at night
  2. NSAIDS
  3. Cortisone shot into carpal tunnel

Surgery

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33
Q

What is Dupuytren contracture?

A

Slow, progressive thickening of palmar fascia & shortening of the tendon
More common in men
Northern European descent

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34
Q

Tx Dupuytren contracture

A
  1. Occupational therapy

2. Surgery

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35
Q

What is DeQuervain’s syndrome?

A

Swelling or stenosis of the sheath that surrounds the adductor pollicus longus & extensor pollicus brevis
Usually from repetitive motion
Most common in middle aged women

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36
Q

Sx DeQuervain’s syndrome

A

Pain & swelling over radial syloid
Might squeek
Test - Finklestein test

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37
Q

What is the Finklestein test?

A

To see if you have DeQuervain’s syndrome

Full extension of thumb followed by ulnar deviation of the wrist = pain

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38
Q

Tx DeQuervain’s syndrome

A
  1. RICE
  2. Splint w/ thumb spica splint
  3. Cortisone

Surgery if doesn’t work

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39
Q

What is gameskeeper’s thumb & Tx

A

aka ski pole injury
Hyperextension of thumb causing disruption to ulnar collateral ligament

Splint 6-8 wks

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40
Q

What is mallet finger & Tx?

A

MAO - forced flexion of distal phalanx (trying to catch a ball)

Splint 6-10 wks, Pt education

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41
Q

What is Boutonniere deformity & Tx?

A

MOA - forceful blow to the bent finger - unable to extend finger
May be caused by arthritis

Swelling & pain at PIP
Deformity can develop immediately or 1-3wks after injury

Tx - splint & stretch exercises

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42
Q

What is swan neck deformity & Tx?

A

Causes:

  1. Injury
  2. RA
  3. Ehler’s Danlos Syndrome

Splint, exercises

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43
Q

What is Jersey finger & Tx?

A

Flexor digitorum profundus avulsion contraction at DIP extension
-from grabbing a jersey
Unable to flex finger

Surgery, DIP arthrodesis

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44
Q

Tx fight bite

A

Augmentin

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45
Q

What is felon?

A

Infection of fingertip pukp
Thumb & index fingers most common

Staph aureus most common

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46
Q

What is paronychia?

A

Infection of soft tissue around fingernail
Painful, purulent drainage
Staph most common

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47
Q

What is Herpetic whitlow?

A

Very painful infection of hand
Usually on terminal phalanx
HSV1 most common

May use acyclovir

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48
Q

S/S Flexor tenosynovitis

A
  1. Finger held in slight flexion
  2. Fusiform swelling
  3. Tenderness along the flexor tendon sheath
  4. Pain w/ passive extension of digit
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49
Q

Who commonly gets flexor tenosynovitis & Tx?

A
  1. RA
  2. DM

Tx:

  1. Cefazolin
  2. Surgical drainage maybe
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50
Q

Risk factors of osteoarthritis

A
  1. Age
  2. Obesity
  3. Previous trauma
  4. Metabolic abnormalities (Acromegaly, gout, hyperparathyroidism)
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51
Q

S/S Osteoarthritis

A
  1. Herbeden’s nodes at PIP
  2. Fusiform swelling of joints
  3. Loss of ROM
  4. Effusions
  5. Crepitus
  6. Pain
  7. Genu Valgum (knock knees)
  8. Genu Varum (bow leg)
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52
Q

Dx osteoarthritis

A
  1. Labs
  2. Narrowing of joint spaces
  3. Osteophytes, chondral irregularity, boney cystic changes, articular surface sclerosis
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53
Q

Tx osteoarthritis

A
  1. Pt education
  2. Exercise
  3. Cold therapy 1st then heat
  4. NSAID
  5. COX2 - Celebrex
  6. Cortisone injections
  7. Hyaluronic acid injections
  8. Arthroplasty
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54
Q

What joints can have a total arthroplasty?

A
  1. Knee
  2. Hip
  3. Shoulder
  4. Elbow
  5. Ankle
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55
Q

Criteria for Dx Rheumatoid Arthritis

A

Must have 4/7

  1. Morning stiffness
  2. Arthritis of 3or+ joints for at least 6 weeks
  3. Arthritis of hand joints for at least 6 weeks
  4. Symmetric arthritis for at least 6 weeks
  5. Rheumatoid nodules
  6. Positive serum rheumatic factor
  7. Radiographic changes
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56
Q

Risk factors for RA

A
  1. Female
  2. 35-50
  3. RA is men <45 is rare
  4. 1st degree relative
  5. HLA-DR4
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57
Q

S/S RA

A
  1. Malaise & fatigue
  2. Stiffness
  3. Pain & tenderness
  4. Effusion
  5. Symmetric arthritis
  6. Rheumatoid nodules
  7. Deformity of hand & finger
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58
Q

Extra-articular manifestations of RA

A
  1. Heart - pericarditis, vasculitis, valvular & valve ring nodules
  2. Lung - effusions & bronchiolitis
  3. Skin - fragility & nodules
  4. Neuro - neuropathy, cervical myelopathy, peripheral neuropathy
  5. Hematology - anemia, thrombocytosis
  6. Bone - osteopenia
  7. Eye - Sjorgen’s, episcleritis, scleromalacia perforans
  8. Kidney - amyloidosis, vasculitis
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59
Q

Labs RA

A
  1. ESR
  2. CRP
  3. Platelets
  4. Anemia
  5. Rheumatoid factor
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60
Q

Tx RA

A
  1. NSAIDS
  2. Plaquenil, methotrexate
    If doesn’t work:
  3. Azathioprine, Infliximab, gold cyclosporine, low dose steroids
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61
Q

Dx septic arthritis & Tx

A
  1. CBC
  2. ESR
  3. CRP
  4. Xrays
  5. Blood cultures
  6. Joint aspiration & culture
  7. Gram stain & culture

Tx w/ abx & drainage

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62
Q

Where does gout usually occur?

A

Big tootsie

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63
Q

What is pseudogout & who is at risk?

A

Calcium pyrophosphate crystals

  1. Age
  2. Joint trauma
  3. Genetic disorder
  4. Mineral imbalances
  5. Underactive thyroid/overactive parathyroid
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64
Q

Tx gout

A
  1. Colchicine
  2. Indomethacin
  3. NSAIDS
  4. Ice
  5. Allopurinol to dec. uric acid production
  6. Peobenecid to inc. uric acid excretion

Eat dark cherries

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65
Q

What is the most common Fx from an old lady falling?

A

Intertrochanteric of femur - from greater to lesser trochanter

Tx - ORIF

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66
Q

Tx femur Fx

A

Intermedullary nailing

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67
Q

Who gets slipped capital femoral epiphysis?

A 
Males 10-17
Females 8-15 
Pain in hip, knee or thigh
1. Fat
2. Blacks
3. Hypothroidism
L hip more effected
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68
Q

S/S & Dx slipped capital femoral epiphysis

A
  1. Antalgic gait
  2. Limited internal rotation
  3. Pain on abduction w/ extreme motion
  4. Hip held in flexion & external rotation

Dx - Patricks test or FABER/FADIR

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69
Q

What is FABER/FIDIR test?

A

Tests for SCFE
Flexion, abduction, external rotation
Flexion, adduction, internal rotation

70
Q

Tx SCFE

A
  1. Crutches NWB

Refer

71
Q

Who commonly ruptures their quadraceps tendon?

A

Males 60-70 yo

  1. Cortisone injections
  2. Diabetes
  3. Chronic renal failure
  4. Hyperthyroidism
  5. Gout

Tear usually central & extends peripherally tearing the retinaculum

72
Q

What is jumper’s knees?

A 
Patellar tendonitis 
1. RICE
2. Stretching
3. NSAIDS
4. Chopat straps
Resolves in wks/months
73
Q

What is the most common injury in sports?

A

ACL

Girls more common due to smaller intercondylar notch

74
Q

Dx ACL tear

A
  1. Lachman’s test
  2. Anterior drawer sign & pivot shift
  3. McMurray test for meniscal injury
  4. Xray
  5. MRI
75
Q

What is Segond sign?

A

pathognomonic for ACL tear
Avulsion Fx of proximal lateral tibia

Reverse segond is an avulsion Fx of MCL in assoc w/ a PCL tear

76
Q

What is the most common injury seen?

A

Foot injury

Fx of base of 5th metatarsal from rolling ankle

77
Q

What is Lisfranc injury?

A

Midfoot injury
Commonly seen w/ football & soccer players
Twist & fall w/ top of foot flexed downwards

S/S:

  1. Top of foot swollen & painful
  2. Bruising on dorsal & plantar side of foot
  3. Pain w/ wt

RICE, nonwt bearing for 6 wks

78
Q

Common organisms of osteomyelitis

A
  1. S aureus
  2. Group B strep
  3. Throat, tonsils, teeth
  4. Skin infections
  5. UTIs
  6. GI source
  7. Lung infection
79
Q

S/S osteomyelitis

A
  1. Bone pain
  2. Fever
  3. General discomfort
  4. Local swelling & redness
  5. Chills
  6. Excessive sweating
80
Q

Dx osteomyelitis

A
  1. Blood cultures
  2. CBC
  3. CRP & ESR
  4. Xray
  5. Bone scan
  6. MRI
  7. Needle aspiration & cultures
81
Q

Tx osteomyelitis

A

Abx - often vanco

Surgical debridement

82
Q

What is multiple myeloma?

A

CA of plasma cells in bone marrow causing destruction of bone & antibody formation

Dx

  1. Clonal cells/Kappa/Lambda light chain
  2. Lytic - punch out lesions
  3. Osteopenia

2x as common in blacks
Uncommon <40yo

83
Q

S/S multiple myeloma

A
  1. Sudden onset bone pain
  2. Rib/back pain
  3. Fx - ribs, vertebral bodies, femur or humerus
  4. Weakness & fatigue
  5. Epistaxis
  6. Herpes zoster
  7. Bacterial infection
  8. Fever maybe
84
Q

Tx multiple myeloma

A
  1. Watch & wait if not severe
  2. Velcade, thalidomde, Revlimid
  3. Chemo
  4. Corticosteroids
  5. Stem cell transplant
85
Q

Classifications of Primary Lymphoma of Bone

A
  1. Single primary bone site w/ or w/o regional nodes
  2. Multiple bone sites w/o visceral involvement
  3. Bone lesion & multiple visceral involvement or lymph node site
  4. Soft tissue lymphoma w/ bone involvement detected by bone Bx
86
Q

Who gets Primary Lymphoma of Bone?

A

4-6 decade

Femur, ilium, spine & humerus usually affected

87
Q

PLB Xray

A
  1. Mixture of lysis & new bone growth

2. Maybe cortical thickening

88
Q

Tx PLB

A
  1. Chemo & radiation
  2. Cyclophosphamide, Adriamycim, Vincristine, Predisone (CHOP)
  3. Surgery maybe
89
Q

Who typically gets chondrosarcoma?

A

From cartilage cells
30-70 yo
Males more common

Most common in femur, humerus, ribs & surface of pelvis

90
Q

Xray chondrosarcoma & Tx

A

Large lucent defects w/ scalloping on inner cortex of bone

Cut it out!

91
Q

What is Paget’s disease?

A

Remodeling bone disease
Common in Europe, NAmerica, Australia, New Zealand

Causes?

  1. Virus
  2. Genetic
92
Q

Dx Paget’s & Tx

A

May be confused for another disease

  1. Inc. ALP
  2. Bone pain
  3. Loss of hearing
  4. Maybe vision loss

Tx - meds that slow breakdown of bone

93
Q

What is osteosarcoma & who gets it?

A

Aggressive cancer - proliferating cells producing osteoid
Often have night pain & ASA & NSAIDS don’t work
More common in males in 20s
8th most common childhood cancer

  1. Cortical bone destruction
  2. Soft tissue mass
  3. Necrosis, cyst formation, hemorrhage
  4. Codman’s sign on Xray

Tx - cut it out

94
Q

What is Ewings tumor & who gets it?

A 
Small round cell sarcoma 
Maybe from neuroectdodermal origin
Found in pelvis, femur, humerus, ribs & clavicle
Males more common
10-20 yo
95
Q

S/S & Tx Ewings tumor

A
  1. Fever
  2. Anemia
  3. Leukocytosis
  4. Inc. ESR
  5. Localized pain & swelling

Tx - Chemo, radiation & cut it out

96
Q

Back Pain Red flagged for CA

A
  1. 50
  2. Hx of CA
  3. Wt loss
  4. Failure to improve after 1 mo therapy
  5. Back pain not improved w/ rest
97
Q

Back Pain Red flagged for infection

A
  1. Immunosuppression
  2. UTI, IVDU
  3. Fever/chills
  4. Back pain not improved w/ rest
98
Q

Emergent Red Flags for back pain

A
  1. Urinary retention or overflow incontinence
  2. Fecal incontinence or loss of anal sphincter tone
  3. Saddle anesthesia
  4. Global/progressive weakness in lower extremities
99
Q

Strain vs sprain

A

Strain - occurs in response to a quick tear, pull or twist of a muscle or tendon

Sprain - Occurs from trauma that displaces the joint beyond its normal alignment, stretching or tearing the ligament

100
Q

What ligament covers the spinal cord?

A

Posterior longitudinal ligament

101
Q

Tx back sprain/strain

A
  1. Muscle relaxes/NSAIDS
  2. PT
  3. Injections for pain control & relieve muscle spasm
102
Q

What does degenerative disc disease lead to?

A

Spinal stenosis

Weaking of annulus

103
Q

What is spinal stenosis & S/S?

A

Narrowing of AP diameter of spinal canal

Lumbar - neurogenic claudication
Cervical - cervial myelopathy & ataxia

104
Q

Where is lumbar spinal stenosis most common & common causes?

A

L4-5 then L3-4

  1. Facet hypertrophy
  2. Hypertrophy of ligamentum flavum
  3. Protruding intervertebral discs
  4. Spondylolithesis
105
Q

S/S trochanteric bursitis?

A
  1. Intermittent aching over lateral aspect of hip
  2. Usually chronic
  3. Cannot lay on affected side
106
Q

S/S cervical radiculopathy

A
  1. Pain & limited neck motion
  2. Pain w/ extension
  3. Relief w/ cupping back of head w/ hand
  4. Lhermitte’s sign - electrical shock radiating down spine
  5. Spurling’s sign - pain when pushing down on head & tilt towards symptomatic side
  6. Reduction of pain w/ axial manual traction
107
Q

S/S lumbar herniated nucelus pulposus

A
  1. Pain radiating down LE
  2. Motor weakness
  3. Dermatomal sensory changes
  4. Reflex changes
    • nerve root tension
  6. Rain relief w/ flexing knee & thigh
  7. Cough effect - pain on cough
  8. Reduced bladder sensation, urgency, frequency, inc. post-void residual
108
Q

Tx HLD

A
  1. NSAIDS
  2. Muscle relaxants
  3. PT
  4. Chiropractor
  5. Injections
  6. Surgery if above doesn’t work
109
Q

What is Scheuermann’s disease?

A

Kyphosis in kids
Caused by wedging together of vertebrae
Unknown cause

Treated w/ brace & PT
Surgery if >60 degrees

110
Q

Causes of kyphosis in adults

A

Exaggerated curvature of thoracic spine

  1. Degenerative diseases of spine
  2. Osteoporotic compression Fx
  3. Injury
  4. Spondylolisthesis
111
Q

S/S kyphosis

A
  1. Difficulty breathing in severe cases
  2. Fatigue
  3. Back pain
  4. Round back appearance
  5. Tenderness & stiffness in spine

Tx needed if persistent pain/neurological symptoms

112
Q

Types of scoliosis

A
  1. Congenital
  2. Neuromuscular - abnormal muscles/nerves (spina bifida or cerebral palsy)
  3. Degenerative - trauma, surgery, osteoporosis
  4. Idiopathic

Girls more affected than boys

113
Q

Dx scoliosis

A
  1. School screening exams
  2. Uneven shoulders
  3. Prominent shoulder blade
  4. Uneven waist
  5. Leaning to one side
  6. X-ray
114
Q

Do all people with HLA B27 have ankylosing spondylitis?

A

No, only 5% do

But 90% of people w/ AS have HLA B27

115
Q

S/S ankylosing spondylitis

A

23 yo

  1. Chronic pain & stiffness in spine
  2. Pain referred to butts of back of thigh
  3. Uveitis
  4. Fatigue, nausea

Seronegative spondyloarthropathies

Dx - Imaging & blood work

116
Q

What can cause cauda equina syndrome?

A
  1. Compression of L4-5
  2. Tumor
  3. Trauma
  4. Spinal epidural hematoma
  5. Free fat graft following discectomy
117
Q

S/S cauda equina

A
  1. Sphincter disturbance
  2. Urinary retention
  3. Urinary/fecal incontinence
  4. Saddle anesthesia
  5. Motor weakness
  6. Low back pain/sciatica
  7. Bilat absence of achilles reflex
  8. Sexual dysfunction

EMERGENT surgical decompression

118
Q

Polyarticular joint pain

A
  1. Rhematic fever
  2. Gonococcal arthritis
  3. Rheumatoid arthritis
119
Q

Common causes of septic arthritis

A
  1. Staph
  2. Strep
  3. Trauma
  4. Prosthetic joints

Osteomyelitis, cellulitis, abscess, tenosynovitis, septic bursitis, fungal, viral

120
Q

Risk factors for gout

A
  1. Obesity
  2. Metabolic syndrome
  3. DM
  4. HTN
  5. Heart attack
  6. Angina
  7. Stroke
  8. Peripheral vascular disease
  9. Hyperlipidemia
  10. Psoriasis
  11. Kidney disease
121
Q

Risk factors of osteoporosis

A
  1. Age, female, white/asian
  2. Hx of Fx
  3. Dementia
  4. Hypogonadism
  5. Smoking
  6. Excessive alcohol/caffiene intake
  7. Low Ca2+ intake
  8. Low body wt <127 lbs
  9. Low physical activity
  10. Visual impairment
  11. Steroid/anticonvulsant use
  12. Thyrotoxicosis
  13. Recurrent falls
  14. Poor health/frailty
122
Q

What is Dowager’s hump?

A

T spine kyphosis from multiple vertebral compression Fx seen w/ osteoporosis

123
Q

Indications for DEXA

A

Women - 65, postmenopausal w/ risk factors/Fx, receiving long-term hormone replacement therapy

Men - 70, low trauma Fx, hypogonadism, prevalent vertebral deformities, radiographic osteopenia

Hyperparathyroidism, chronic steroid therapy

124
Q

How much Ca2+ & vitamin D should you get per day?

A

50 - 1200 Ca, 800-1000 D

125
Q

When should you start osteoporosis Tx?

A
  1. Prior vertebral/hip Fx
  2. Dexa 3%
  3. Osteoporosis FX FRAX >20
126
Q

Tx Osteoporosis

A
  1. Bisphosphenates
  2. Calcitonin
  3. Estrogen
  4. SERM
  5. PTH
  6. RANK inhibitor
127
Q

What is polymyalgia rheumatica?

A

Inflmmatory rheumatic condition
Aching & morning stiffness in shoulders, hip & neck
Assoc. w/ Giant Cell Arteritis
>50 yo women

128
Q

What is Giant Cell Arteritis?

A

Granulomatous inflammation of artery
60-80 yo Scandinavian women

Inc. risk of aortic aneurysm

129
Q

S/S GCA

A
  1. HA…scalp tenderness
  2. Constitutional symptoms
  3. Polymyalgia syndrome
  4. Visual disturbances
  5. Intermittent claudication of jaw & tongue on mastication
  6. Dec. pulsation & nodulation of temporal arteries
  7. Diminished/absent pulses in upper extremities
130
Q

Dx GCA

A
  1. Inc. ESR & CRP
  2. Temporal artery Bx w. granulomatous changes

Risk of blindness!!!

131
Q

Tx GCA

A
  1. IV prednisone

2. Oral prednisone for a long time

132
Q

Schober’s test

A

Mark iliac spine 5cm below & 10 cm above
Pt bends over & measure distance

Normal - inc. to >20 cm
Abnormal - doesn’t inc to >20 cm
Suggests ankylosing spondylitis

133
Q

Gaenslen test

A

Stresses sacroiliac joints

Inc. pain suggests ankylosing spondylitis

134
Q

Tx ankylosing spondylitis

A
  1. NSAID
  2. Analgesics
  3. Anti-TnF inhibitors
  4. Tumor necrosis factors
  5. Steroids
135
Q

Lupus Risk Factors

A
  1. Women
  2. Blacks
  3. 15-45 yo
  4. FH
136
Q

S/S Drug-induced Lupus erythematosus & common drugs

A
  1. Pleuropericardial inflammation
  2. Pleuritic chest pain
  3. Pericarditis
  4. Fever, rash & arthritis
  5. Blood changes
  6. Isoniazid
  7. Hydralazine
  8. Procainamide
  9. Minocycline
  10. Anti-TnF biologics
137
Q

S/S SLE

A
  1. Malar rash
  2. Discoud rash
  3. Pleurisy
  4. Pericarditis
  5. Oral ulcers
  6. Arthritis
  7. Hemolytic anemia
  8. Leukopenia
  9. Lymphopenia
  10. Thrombocytopenia
  11. Photosensitivity
  12. ANA +
  13. Anti-smith
  14. Antiphospholipid Ab
138
Q

Tx lupus

A
  1. Methotrexate
  2. Cyclophosphamide
  3. Azathioprine
  4. Mycophenolate
  5. Rituximab
139
Q

What is Sjogren’s usually associated with?.

A

Rheumatoid arthritis

140
Q

Dx Scleraderma

A

Skin induration + 1or+ of:

  1. Heartburn dysphagia or new onset
  2. Acute onset of HTN & renal insufficiency
  3. DOE assoc. w/ interstitial pulm changes on Xray
  4. Pulm HTN
  5. Diarrhea w/ malabsorption
  6. Mucocutaneous telangiectasia on face, lips, oral cavity or hands
  7. Digital infarctions or digital tip pitting
  8. Erectile dysfunction

Often get Raynauds

141
Q

Tx Scleraderma

A

Tx if get Raynauds

  1. Steroids
  2. Methotrexate
  3. Thalidomide
  4. UV light
142
Q

Tx Raynauds

A
  1. CCBs - Norvasc
  2. Alpha blockers - Cardura
  3. Vasodilators
143
Q

S/S Fibromyalgia

A
  1. Female 20-65
  2. Chronic, generalized pain
  3. Fatigue
  4. Sleep & mood disturbances
  5. HA
  6. IBS
  7. Chronic, widespread MSK pain >3mo
144
Q

S/S Lyme

A
  1. Erythema migrans
  2. Constitutional
  3. Arthritis
  4. Carditis
  5. Neurologic
  6. LAD
  7. Eye involvement
  8. Liver involvement

Tx - Doxycylcine

145
Q

Ganglion cyst

A

Benign cyst in hand or wrist
Usually painless
Aspirate but might come back

146
Q

Complex regional pain syndrome

A

Rare disorder characterized by autonomic and vasomotor instability
Intense, burning pain; often greatly worsened by minimal stimuli, such as light touch
Usually caused by minor trauma

  1. NSAIDS
  2. Nortiptylline
  3. Steroids if severe
147
Q

Causes & S/S plantar fasciitis

A
  1. Obesity
  2. Pes planus
  3. Pes cavus
  4. Limited dorsiflexion of the ankle
  5. Prolonged standing
  6. Walking on hard surfaces
  7. Faulty shoes

Worse in morning & w/ limited activity or a lot of activity
Pain in heel

148
Q

MCC septic arthritis

A

S aureus

149
Q

CREST

A

Seen w/ scleroderma

Calcinosis
Raynaud's
Esophageal dysfunction
Sclerodactyly
Telangiectasias
150
Q

What type of osteomyelitis do sickle cell people usually get?

A

Salmonella

151
Q

What type of Fx does CT help best see?

A
  1. Pelvic
  2. Facial
  3. Intra-articular
152
Q

What type of Fx does MRI help best see?

A

Occult hip Fx

153
Q

What ligament is most commonly injured w/ ankle sprain?

A

ATL - anterior talofibular ligament

154
Q

What is the MCC of shoulder dislocation?

A

FOOSH in abduction & extension

anterior dislocations more common

155
Q

What is a common cause of rotator cuff impingement?

A

Impingement of supraspinatous tendon as it passes beneath the subacromial arch

156
Q

What is the MCC of clavicle Fx?

A

FOOSH

most common Fx in kiddos

157
Q

What is the MCC or acromioclavicular dislocations?

A

Fall on or impact to tip of shoulder

Tearing of acromioclavicular &/or coracoclavicular ligaments

158
Q

What is the MCC of proximal humerus Fx?

A

older Pts w/ osteoporosis

159
Q

What is the MCC of humeral shaft Fx?

A

Motor vehicle accidents, FOOSH, penetrating injuries

160
Q

What is the MCC of supracondylar humerus Fx?

A

FOOSH w/ hyperextension of elbow

161
Q

What is Tinel’s sign?

A

tingling w/ percussion over the volar aspect of the wrist

–carpal tunnel

162
Q

What is Phalen’s test?

A

Sx w/ full flexion of wrist

-Carpal tunnel

163
Q

What is the most common injury of the wrist & MOI?

A

Colle’s Fx - distal radius Fx w/ dorsal angulation

Fall onto dorsiflexed hand
Silver neck deformity

164
Q

What is the most common elbow Fx?

A

Radial head injust

FOOSH

165
Q

What is the most commonly Fx carpal bone?

A

Scaphoid

166
Q

Aseptic necrosis of hip

A

Loss of blood supply to the trabecular bone that causes a collapse of the femoral head
Usually bilateral

Risk factors

  1. Trauma
  2. Steroid use
  3. Alcohol abuse
  4. RA
  5. Radiation therapy
  6. SLE

Dx - MRI

167
Q

Dx ACL injury

A

Lachman’s test

168
Q

Dx achilles tendon rupture

A

Thompson’s test

169
Q

Pain w/ resisted wrist flexion?

A

Medial epicondylitis

aka Golfer’s elbow

170
Q

Pain w/ resisted wrist extension?

A

Lateral epicondylitis

aka Tennis elbow

171
Q

Where does pseudogout usually occur?

A

Knees

Clinical Medicine (11 decks)

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