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CM2 Exam 2 > Topics in MSK- Jaynstein > Flashcards

Topics in MSK- Jaynstein Flashcards

1
Q

Necrosis of bone secondary to an interruption of blood supply

A

AVN (Avascular Necrosis)

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2
Q

What is a big RF for AVN?

A

Alcoholism (fat embooli)

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3
Q

What bones is AVN mc seen in?

A
  • Head of the femur or humerus
  • Scaphoid
  • Neck of the talus
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4
Q

What bones do you have to be reallllyyyy concerned about with AVN and other injuries because they are so important?

A

Scaphoid (hands)

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5
Q

Crescent sign

A

AVN

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6
Q

What are the sxs for AVN?

A

Progressive main over weeks to months with concerning history “and now I can’t tolerate it at all”

  • Early pain with activity/wt bearing, decreased ROM
  • Late pain at rest with sig. decreased ROM
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7
Q

What is the diagnostic test for AVN that you would do first? Is this a good test?

A

Xray

Dx is too late if seen on xray

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8
Q

What is a better test if you suspect AVN?

A

CT, MRI and bone scan

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9
Q

What is the tx for AVN?

A

Refer to ortho! Even the pts you suspect of having AVN with an initial neg work-up!

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10
Q

Tx for Hip/Shoulder AVN?

A

replacement

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11
Q

Tx for Scaphoid AVN?

A

Depends on degree – may attempt to surgically restore blood supply (debride and re-align) or bone graft

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12
Q

_________ denotes inflammation of bone and marrow and the common use of the term virtually always implies infection

A

Osteomyelitis

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13
Q

Mc organism involved in osteomyelitis?

A

S. aureus

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14
Q

Mc organism involved in osteomyelitis in elderly, drug users or those with GU tract infections?

A

E. coli, Pseudomonas, Klebsiella

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15
Q

What organism is salmonella and osteomyelitis?

A

Sickle cell

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16
Q

What does the workup for osteomyelitis include?

A

Labs – CBC, ESR, CRP, Lactate, blood cultures, wound culture, bone biopsy
• Ca, phos, alk phos are usually normal

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17
Q

What is the test of choice to dx osteomyelitis?

A

Bone bx

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18
Q

What is the preferred imaging for osteomyelitis?

A

MRI (or CT or bone scan) first if possible because bone changes lag infection by 10-14 days so Xray not the best

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19
Q

What is the treatment for osteomyelitis?

A

Surgical drainage + abx

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20
Q

How long do we give abx in patients with osteomyelitis?

A

6 weeks IV then PO

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21
Q

__________ osteomyelitis can

develop–usually in the immunocompromised and those with vascular insufficiency (DM)

A

Chronic

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22
Q

In diabetics with an infected foot ulcer, __________ should be considered and treated whenever bone is visible or you are able to contact bone with a sterile probe

A

Osteomyelitis

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23
Q

__________ are benign lesions of bone that in many cases represent developmental or reactive growths rather than true neoplasms

A

Osteomas

Most are exophytic growths attached to the bone surface

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24
Q

What is the most common location of osteomas?

A

Facial bones (nasal, ears) and skull

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25
Q

T/F: Osteomas undergo malignant change?

A

F

they are outgrowths of normal bone itself

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26
Q

__________ is an aggressive malignant mesenchymal tumor in which the cancerous cells produce bone matrix

A

Osteosarcoma

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27
Q

Common sites of osteosarcoma?

A

Knee is mc, also long bones and jaw

“kid comes in with atraumatic knee pain for weeks”

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28
Q

Work up for osteosarcoma?

A

CBC,ESR,CRP,xrays,CT/MRI/PET scans

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29
Q

Tx for osteosarcoma?

A

Surgical resection, radiation, chemo

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30
Q

_________ is a benign cartilage growth that is attached to the underlying skeleton by a stalk

A

Osteochondroma

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31
Q

What is the way you dx Osteochondroma?

A

bone bx

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32
Q

Is a malignant neoplasm of bone that occurs predominantly in children - second most common malignancy after osteosarcoma

A

Ewing sarcoma

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33
Q

_____________ is a highly aggressive neoplasm which has been associated with a chromosomal translocation

A

Ewing sarcoma

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34
Q

Common sites of Ewing sarcoma

A

Pelvis and long bone

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35
Q

This disease classically presents with pain often accompanied by local inflammation, swelling/mass; fever is fairly common along with elevated ESR, anemia and leukocytosis

A

Ewing sarcoma

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36
Q

What imaging should you get for ewing sarcoma?

A

Xray

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37
Q

Xray of this disease shows onion peel appearance and a destructive lytic tumor

A

Ewing sarcoma

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38
Q

What is the definitive dx modality of ewing sarcoma>

A

bx

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39
Q

What is the tx for ewing’s sarcoma?

A

chemo and surgery with/without radiation

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40
Q

____________ is the most common type of joint disease and arthritis

A

Osteoarthritis

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41
Q

________ is characterized by the progressive erosion of articular
cartilage

A

Osteoarthritis

42
Q

Osteoarthritis is typically __________ & __________

A

Unilateral and asymmertric

43
Q

Where is osteoarthritis mc located?

A

Weight bearing joints and spine

44
Q

A patient comes in with deep, achy pain that worsens with use and resolves with rest, morning stiffness < 30 mins, crepitus, and limitation of range of movement. What dx are you thinking of?

A

Osteoarthritis

45
Q

On a joint exam for osteoarthritis, what may you find?

A

Effusion, crepitus, instability, decreased ROM also Heberden’s nodes & Bouchard’s nodes

46
Q

Heberden’s nodes make you think of what joints?

47
Q

Bouchard’s nodes make you think of what joints?

48
Q

How do you diagnose osteoarthritis?

49
Q

What is the treatment for asymptomatic pt with osteoarthritis?

What is the treatment for symptomatic pt with osteoarthritis?

A

Symptomatic – RICE, APAP, NSAIDs, wt loss, PT/exercise program

Surgery – joint replacement

50
Q

___________ or “brittle bone disease”is a group of hereditary conditions characterized by abnormal development of type I collagen

A

Osteogenesis imperfecta

Characterized by multiple bone fractures which may occur in utero in the severe forms

51
Q

This disease has 8 different types based on severity

A

Osteogenesis imperfecta

52
Q

A patient presents with blue sclerae; hearing loss, and dental imperfections what disease is the most likely associated with?

A

Osteogenesis imperfecta

53
Q

How do you confirm a dx of Osteogenesis imperfecta?

A

DNA analysis

54
Q

Tx for Osteogenesis imperfecta?

A
  • No cure
  • Aimed at fracture prevention
  • Bisphosphonates
  • Surgery – rodding
  • Treat pain!
55
Q

____________ Is a term that denotes increased porosity of the skeleton resulting from a reduction in bone mass and increasing the risk of fracture

A

Osteoporosis

56
Q

This disease is mc after menopause

A

Osteoporosis

57
Q

What are some RFs or things that contribute to Osteoporosis?

A

Age, reduced physical activity, genetic, calcium/nutritional state, hormonal influences

58
Q

Natural progression of osteoporosis refers to primary or secondary?

59
Q

Bone loss secondary to another disease process refers to primary or secondary?

60
Q

Women over the age of _____ should be screened for osteoporosis

61
Q

Postmenopausal women age ________ years with _____ risk should be screened for osteoporosis

A

60-65 with 1 risk

62
Q

What are the risks of postmenopausal women and osteoporosis?

A
  • Fracture after age 45years
  • Hip Fracture in a parent
  • Tobacco Abuse
  • BodyMassIndex<22
  • Extended glucocorticoid use(>3months)

**these patient should be screened earlier if they have an RF

63
Q

What is the screening of choice for osteoporosis and what should not be used for screening?

A

DEXA Scan should be used and an xray shouldnt because you cant detect osteoporosis until 30-40% of bone mass is lost

64
Q

What is the normal Bone range T score?

65
Q

What is the T score for osteopenia?

A

-1 to -2.5

66
Q

What is the T score for osteoporosis

A

-2.5 or lower

67
Q

When would we treat osteoporosis?

A
  • s/p hip or vertebral fx
  • Osteopenia of femoral neck, hip, or spine (1-2.5)
  • Osteoporosis (2.5 or lower)
68
Q

What is the tx for osteoporosis?

A
  • Adress modifiable factors
  • Vit D and Ca
  • Bisphosphinates
  • Calcatonin
69
Q

What treatment is not an intial therapy for osteoporosis and is contraindicated in pts with risk of breast or endometrial ca?

A

Estrogen therapy

70
Q

WHat is the follow up for patients with osteoporosis?

A

Repeat DEXA
• Nl or mild osteopenia every 15 years
• Moderate osteopenia every 5 years
• Severe osteopenia and osteoporosis every 2 years

71
Q

____________ is a chronic disorder caused by the excessive breakdown and formation of bone, followed by disorganized bone remodeling that can result in enlarged, misshapen, and weak bones

A

Paget disease

72
Q

This disease causes disorganized bone remodeling and happens midadulthood and becomes progressive thereafter

A

Paget disease

73
Q

A patient with pagets disease may have elevated ________

A

serum alkaline phosphastase levels

74
Q

What is the treatment of paget disease?

A

Bisphosphonates and calcitonin

75
Q

This disease causes skeletal muscle cell break down and necrosis that leads to the release intra-cellular debris into the blood stream

A

Rhabdomyolysis

76
Q

What electrolytes and protein are released into blood stream from Rhabdo?

A

Electrolytes (Ca2+ & K+)

Proteins (myoglobin)

77
Q

In an old patient who fell and has been there for 6 hours, what disease should we be concerned about?

A

Rhabdomyolysis

78
Q

“tea” colored urine is in which disease

A

Rhabdomyolysis

79
Q

What is the test of choice in Rhabdomyolysis?

A
  • CPK will be elevated 5x normal
  • Electrolyte abnormalities - hyperkalemia, hyperphosphatemia, hypercalcemia (early) to hypercalcemia (late)
  • LFTs may be elevated
  • AKI labs
  • EKG
80
Q

What is the definitive dx test for RHabdomyolysis

81
Q

UA dip will be ____________ for blood without RBCs in what condition?

A

Postitive, rhabdo

82
Q

What is the tx for rhabdo?

A
  • Goals to TX shock and preserve kidney function
  • IV fluids around 6-12/hr
  • Manage electrolyte imbalances (K- albuterol, insulin, Ca++)
83
Q

What are the sxs for soft tissue sarcoma?

A

Soft tissue mass- only 1/3 complain of pain

84
Q

When would you do a workup for a soft tissue sarcoma?

A

required for ST masses that are symptomatic, progressing in size, larger than 5cm, or present for more than 4 weeks

85
Q

What is the initial diagnostic test for soft tissue sarcoma if you don’t know where else to go and to see if its something solid or fluid?

86
Q

What is the imaging modality of choice for a soft tissue sarcoma?

A

MRI and bx is definitive

87
Q

What is the tx for soft tissue sarcoma?

A

type directed (make sure you eval for metastatic disease- lung & liver)

88
Q

A synovial out-pouching of fluid behind the knee that is benign but usually occurs after trauma

A

Baker’s cyst

89
Q

What are the sxs and exam finding of a baker’s cyst?

A

Tenderness and “bump” and exam reveals palpable mass

90
Q

How do you dx a baker’s cyst?

A

with an U/S

91
Q

How do you tx a baker’s cyst?

A
  • RICE
  • May aspirate large collections
  • Corticosteroid injections
  • Surgical excision
92
Q

Benign synovial fluid collection that can occur from any joint but usually in the dorsum of the hand/wrist, or feet

A

Ganglion cyst

93
Q

Tx for a ganglion cyst?

A

Nothing or surgical. Cut off is usually 5cm

94
Q

This is a life/limb threatening emergency due to sufficient blood supply to muscles and nerves due to increased pressure within one of the body’s compartments

A

Compartment syndrome

95
Q

SHould you cast acute illness injuries?

A

NO because it needs to swell and cast prevents this

96
Q

What are the 6 P’s of compartment syndrome?

A
  • Pain out of proportion - aggravated by passively stretching
  • Paresthesia - altered sensation, “pins & needles”
  • Pallor – decreased circulation, delayed cap refill
  • Poikilothermia – cold, blue
  • Paralysis – late finding
  • Pulselessness – late finding
97
Q

WHat is a normal compatment pressure?

A

• NL < 10mmHg

98
Q

What is a concerning compartment pressure?

A

• 10-20mmHg concerning

99
Q

What is an emergent compartment pressure?

A

• > 30 mmHg emergent

100
Q

Treatment for compartment syndrome?

A
  • Splint
  • Elevate
  • Fasciotomy (<6hrs)
  • NO ICE!

CM2 Exam 2 (8 decks)

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