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Clin Med Exam 3 > UE > Flashcards

UE Flashcards

1
Q

Rotator cuff action

A

Stabilize shoulder by depressing the humeral head against glenoid

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2
Q

Rotator cuff muscles and their actions

A

Supraspinatus, Infraspinatus, Teres Minor- External rotation and abduction

Subscapularis- internal rotation

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3
Q

Most common cause of rotator cuff tears

A

repetitive micro-trauma (overuse)

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4
Q

Most common rotator cuff tear

A

supraspinatus (tear in order)

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5
Q

Sx of rotator cuff injury

A

pain over anterior & lateral aspects of should (radiates to deltoid, occurs initially with overhead activity then progresses to sx at rest); ROM decreased (abduction past shoulder level), should may catch

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6
Q

Tests for rotator cuff

A

(+): Drop arm (complete tear), empty can, neers impingement, hawkpin

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7
Q

Weakness tests for rotator

A

drop arm, empty can

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8
Q

Pain test for rotator

A

neers, hawkins

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9
Q

Types of rotator cuff injuries

A

tendonosis, tendonitis, tear (chronic/acute)

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10
Q

Tendonosis

A

Chronic degneration of the muscles typically with AGE (weakness)

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11
Q

Tendonitis

A

INFLAMMATION associated with repetitive trauma associated with everyday movement of the shoulder (pain)

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12
Q

Chronic rotator tear

A

degeneration, impingement due to overload; overhead occupation
variations in should structure causing narrowing under outer edge of clavicle
majority start as partial tear of suprapsinatus and progress to complete (involving SITS) and biceps tendon

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13
Q

Acute rotator tear

A

TRAUMA;
Suspicion with acute should pain and negative radiograph
Significant force if person <30 yo
Often seen with labral pathology

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14
Q

Acute rotator tear is usually seen with

A

labral pathology

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15
Q

Major risk of tendonitis/impingement

A

Repetitive overhead activity

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16
Q

Sx of tendonitis/impingement of rotator

A

pain comes on GRADUALLY
deep ache in lateral shoulder that radiate to deltoid
POINT TENDERNESS
ROM painful >90 degrees, improves with analgestics
may lead to chronic tear

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17
Q

Tests for impingement of rotator

A

Hawkins, neer

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18
Q

Who is most likely to have a chronic tear

A

men older than 40

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19
Q

Sx of chronic tear

A

pain worse with overhead activities and at night;
worsening pain followed by weakness
subacromial tenderness/bursitis
decrease in ability to move arm, especially abduction
Restricted ADL’s >90

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20
Q

PE for tear

A

weakness of abduction and external rotation
loss of smoothness of overhead reaching and ability to lift 2-5 lb weights overhead
atrophy may be present in large tears
weakness does not improve with anlagesics

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21
Q

Apleys scratch test

A

loss of range of motion; rotator cuff problem

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22
Q

Neer’s

A

subacromial impingement

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23
Q

Hawkin’s

A

supraspinatus impingement

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24
Q

Drop-arm

A

rotator cuff tear

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25
Q

Cross-arm test

A

acromioclavicular joint arthritis

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26
Q

Spurlings test

A

spine extended with head rotated to affected should: cervical nerve root disorder

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27
Q

Apprehension test

A

anterior pressure with external rotation; anterior glenohumeral instability

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28
Q

Relocation test

A

posterior force on humurus while externally rotating the arm: anterior glenohumeral instability

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29
Q

Sulcus sign

A

inferior glenohumeral instability

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30
Q

Yergason

A

biceps tendon instability or tendonitis

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31
Q

Speed’s

A

biceps tendon instability or tendonitis

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32
Q

Clunk sign

A

rotation from extension to forward flexion; labral disorder

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33
Q

Dx for rotator cuff

A

Lidocaine injuection test (10 mL to subacromial space- Neer’s test)
Radiographs (elevation of humeral head >1 cm - tear)
U/S: limited use
MRI: STUDY OF CHOICE when full thickness tear is suspected or pt has failed conservative tx
MR Arthrography PREFERRED and can also evaluate labral pathology

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34
Q

Rotator cuff test of choice

A

MR arthrograph, or MRI

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35
Q

Acute therapy for rotator cuff

A

ice, NSAIDs, weighted pendulum stretching (5 min BID), restrict overhead positioning, shoulder immobilizer for SHORT TIME,, after rest consider PT

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36
Q

Tx for persistent rotator cuff sx

A

Subacromial steroid injection (rest several days after, no more than 3-4/year)

Surgery: arthroplasty or joint arthroplasty (pain vs. mobility trade off)

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37
Q

Shoulder impingement syndrome

A

compression causing pain and dysfunction: compression of rotator cuff tendons and subacromial bursa between humeral head and lateral edge of acromion process

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38
Q

Risk for shoulder impingement syndrom

A

anatomical variance (osteophytic changes) or previous injuries (clavicle fracture, AC separation)

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39
Q

Impingement can lead to

A

bursitis, rotator cuff tendonitis, degenerative changes

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40
Q

Principle cause of rotator cuff tendonitis

A

Shoulder impingement syndrome

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41
Q

Degree of impingement

A

pain reproduced by flexion-internal rotation maneuvers (neer’s hawkins);

Pain at 90 degrees: mild
Pain at 60-70: moderate
Main 45 or below: severe

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42
Q

Imaging for impingement

A

Radiography (anatomical variance)
MSK U/S
MRI: rule out cuff tear

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43
Q

Tx for impingement

A

Ice, NSAIDS, activity modification (no sling)

PT referall: F/U after 2-3 weeks to confirm improvement

Possible corticosteroi; surgery if sx are severe and anatomic variant could be improved

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44
Q

Labral tear MOI

A

acute (FOOSH, sudden pull); repetitive overuse (throwing athletes, laborer)

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45
Q

Presentation of labral tear

A

acute: pain
Chronic: clicking/catching
frequently associated with other should pathology
Bankhart vs. SLAP tear

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46
Q

Bankart lesion

A

inferior tear of rim often associated with dislocation

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47
Q

SLAP lesion

A

superior labrum anterior posterior; curved fashion

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48
Q

PE for labral tear

A

biceps tendon: Pain
glenohumeral joint: restricted internal/external rotation
Scapula: motion dysfunction
Specialized: Anterior glide test, speeds, o’brien’s

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49
Q

Specialized tests for labral tear

A

anterior glide test, speed’s test, O’briens

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50
Q

Imaging for labral tear

A
  1. Radiograph
  2. MRA>MRI: preferred (more beneficial in pts <35 yo)
  3. Arthoscopy (DEFINITIVE FOR DX)
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51
Q

Definitive dx for labral tear

A

Arhtroscopy

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52
Q

Tx for labral tears

A

nonsurgical preferred; NSAIDs or acetaminophen and PT

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53
Q

Adhesive capsulitis (frozen shoulder)

A

chronic shoulder pain with gradual global limitation in ROM (stiffened glenohumeral joint, may develop adhesion)

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54
Q

Etiology of adhesive capsulitis

A

idiopathic

secondary to injury, trauma, overuse, bursitis or sling use

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55
Q

Dx of adhesive capsulitis

A

ROM testing (decreased in 2+ planes- passive and actie)
Severe shoulder pain
Mechanical restriction
Abduction and external rotation most commonly affected
Apley’s scratch test (T8-T10 is normal)
Injection test: won’t help

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56
Q

Imaging for adhesive capsulitis

A

Radiography- most are normal but routinely ordered

MRI or MRA: not needed but may be helpful; thickening of joint capsule and ligaments

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57
Q

Tx for adhesive capsulitis

A

treat underlying process, stretch, restore ROM, CONSULT PT

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58
Q

Acromioclavicular injury MOI

A

fall onto the tip of the shoulder with arm tucked into side (football)

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59
Q

Sx of acromioclavicular injury

A

bump on shoulder that is worse at bedtime

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60
Q

Ligaments in acromioclavicular joint

A

Coracoclavicular ligament (trapezoid + Conoid), coracoacromial ligament, acromioclavicular ligament

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61
Q

PE of AC joint injury

A 
swelling/deformity (3rd degree)
AC joint tenderness
Pain aggravated by downward traction (test for instability)
(+) cross over test
Dx confirmed with radiographs
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62
Q

Dx of AC joint injury

A

radiographs

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63
Q

AC sprain/separation degrees

A

Grade 1: ac joint intact, capsular distension, ligament stretch (sprain) without separation, point tenderness;
NORMAL RADIOGRAPHS

Grade 2: Separation of superior and inferior AC ligaments, instability with stress testing at AC joint, decreased ROM, CORACOCLAVICULAR LIGAMENTS INTACT with only partial tear or sprain; radiographs: inferior margin of distal clavicle lies above inferior margin of acromion, but below superior margin

Grade 3: separation of superior and inferior AC ligaments AND coracoclavicular ligaments, clinical deformity, instability, decreased ROM, severe pain; Radiographs: inferior margin of clavicle at or above superior margin of acromion

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64
Q

Dx of AC sprain

A

PE and plain radiograph

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65
Q

Goals of AC tx

A

reduce direct pressure and traction at AC joint to allow reattachment of ligaments

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66
Q

Tx for AC Injury

A

shoulder immobilizer for 3-4 weeks
Ice, rest, NSAIDS, and corticosteroid injection if not improving after 2-4 weeks
Surgical: grade III with fixation, ligament reconstruction, distal clavicle resection (not usually needed/supported)

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67
Q

Clavicle fracture location

A

Most: middle 1/3 (displaces superiorly and may be comminuted)
Some: distal 1/3 (may look like AC separation)
Few: proximal 1/3 (internal organ evaluation is essential, R/O sternoclavicular dislocation or physeal fx in peds pts)

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68
Q

What must you evaluate for in proximal clavicle fx

A

Internal organs (lungs)

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69
Q

Sx of clavicle fracture

A 
visual deformity (evaluate for open fx or tenting)
TTP
Decreased ROM (apprehensive and guarded)
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70
Q

Imagining for clavicle fracture

A

single AP radiograph of clavicle

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71
Q

Tx for clavicle fracture

A

Conservative for non-displace or minimally displaced; conservative for nearly all pediatric patients (sling, figure 8 harness, analgesics, muscle relaxers, sleep upright, discuss cosmetic concerns)

Ortho referral: displaced mid clavicle fx and all proximal and distal 1/3 fxs, surfery

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72
Q

Muscle relaxers may be good tx for

A

Clavicle fracture

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73
Q

Subacromial bursitis

A

inflammation or degeneration of the sack-ike structure due to repetitive movement injury; may result from systemic disease (RA, gout, sepsis)

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74
Q

Sx of subacromial busitis

A 
pain with ROM and at rest
Occasional decreased ROM due to pain
Localized TTP 
Not usually isolated finding (rotator cuff tendonitis)
May cause impingement syndrome
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75
Q

Dx of subacromial bursitis

A

CLINICAL
Radiographs-limited benefit
U/S for injections
Fluid aspiration - C&S if sepsis suspected

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76
Q

Tx for subacromial bursitis

A

ICE AND NSAIDS
restrict overhead use
aspiration and corticosteroid injection

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77
Q

Biceps tendonitis

A

inflammation of the long head of the biceps tendone as it passes through bicipital groove

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78
Q

Cause of biceps tendonitis

A

repetitive lifting

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79
Q

Sx of biceps tendonitis

A

pain anterior should with abduction and ext. rotation
maximal point of tenderness at biciptal groove
popping sensation
weakness
“popeye” deformity with rupture

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80
Q

Tests for biceps tendonitis

A

Speed’s, yergason’s

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81
Q

Dx of biceps tendonitis

A

CLINCIAL
U/S beneficial
(radiographs and MRI only rule out underlying pathology or concerns)

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82
Q

Goals for biceps tendonitis treatment

A

reduce tendon inflammation and swelling
strength biceps
prevent rupture

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83
Q

Tx for biceps rupture

A

surgery rarely indicated unless younger patient who are laborers or athletes

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84
Q

Tx of biceps tendonitis

A

NSAIDs, Rest, PT, steroid?, surgery

85
Q

Glenohumeral subluxation/dislocation

A

shoulder instability can be in one direction or multidirectional (usually ANTERIOR)

86
Q

Sx of shoulder dislocation

A

arm held in position of protection, sulcus sign, apprehension and relocation test

87
Q

Dx of shoulder dislocation

A

radiograph and MRI if needed (AP, Y, and axillary); suclus sign, apprehnsion test

88
Q

Tx for shoulder dislocation

A

Multi-axial instability required PT and education, analgesics, ice and rest needed episodically

Immediate reduction if needed
Shoulder immobilizer: sling and swatch x 2-4 weeks
Analgesics
PT
Surgical intervention with repeat dislocations

89
Q

What requires shoulder immobilizer

A

Glenohumeral dislocaiton, rotator cuff, AC injury

90
Q

Special considerations for shoulder dislocation

A

Bankart lesion
Hills Sachs lesion
Axillary nerve

91
Q

Bankart lesion

A

detachment of anterior inferior labrum from glenoid rim

92
Q

Hill sach’s lesion

A

cortical depression of posterolateral humeral head when humeral head is impacted by anterior rim of glenoid (fracture of humeral head)

93
Q

Axillary nerve test

A

decreased sensory to lateral should (mid deltoid) and decreased deltoid function

94
Q

Elbow epicondylitis sx

A

overuse syndrome; localized pain and swelling

95
Q

Two types of elbow epicondylitis

A
  1. Medial: Golfer’s elbow: wrist flexors, pronator muscle group
  2. Lateral: tennis elbow: wrist extensors, supinator muscle group
96
Q

Most common elbow epicondylitis

A

Lateral tennis elbow

97
Q

Effects wrist extensors

A

Lateral epicondylitis

98
Q

Effects wrist flexors

A

medial epicondylitis

99
Q

Imaging to elbow epicondylitis

A

x-ray if concerned for loose bodies, fracture, exostosis

100
Q

Tx for elbow epicondylitis

A

Acute: sling, wrist brace, ice, anti-inflammatory
Preventative: forearm strap, minimize repetitive activity and correct technique
Reccurent: steroid, surgery for debridement

101
Q

Olecranon bursitis cause

A

trauma, prolonged pressure (occupation), infection (pus), rheumatologic

102
Q

Sx of olecranon bursitis

A

swelling, +/- pain, +/- restricted ROM

Infection: erythema, warmth

103
Q

Tx for olecranon bursitis

A

ice, NSAIDs, aspiration (C&S), abx +/- surgery for infection

104
Q

Prevention of olecranon bursitis

A

elbow pads/sleeve;

activity changes

105
Q

Cubital tunnel syndrome

A

compression of the ulnar nerve caused by repetivie motion, constant pressure, fluid or trauma

106
Q

Where does the ulnar nerve run

A

behind medial epicondyle

107
Q

Sx of cubital tunnel syndrome

A

ulnar neuropathy (RF/LF tingling or numbness)
decreased grip strength
Chronic: muscle wasting

108
Q

Dx of cubital tunnel

A

Radiograph, nerve conduction studies

109
Q

Tx of cubital tunnel

A

NSAIDs, Bracing, PT, Surgery: cubital tunnel release +/- ulnar nerve transposition

110
Q

Carpal tunnel syndrome (CTS)

A

pain, parasthesia and weakness in median nerve distribution of the hand; pain WORSE AT NIGHT (2-3 hours after falling asleep)

111
Q

Pathogenesis of CTS

A

repetitive activities result in swelling of synovium or thickening of transverse carpal ligament leading to compression of the nerve

112
Q

Most likely to get CTS

A

typer/computer use
Congenital smaller tunnel
Females 2:1

113
Q

Most common neuropathy in UE

A

CTS

114
Q

Other potential causes of CTS

A 
direct pressure (osteophytes, anomalous muscle bodies, tumors, hypertrophic synovium, infection)
CT disorders (lupus, gout, scleroderma, polymyalgia rheumatica)
trauma
Pregnancy, long-term renal failure, hypothyroidism
115
Q

Chronic progression of CTS

A

Early: pain intermittent and described as dull ache at risk during and shortly after use

Late: burning pain, numbness, and tingling

116
Q

Pain in UE that often wakes you up at night

A

CTS

117
Q

PE for CTS

A

compare color, temp and texture BL
evaluate for thenar muscle atrophy
decreased sensory along median nerve distribution
Decreased gril strength

118
Q

Testing for CTS

A

Tinels and Phalen’s

119
Q

Dx of CTS

A

wrist x-ray in trauma or rheumatologic disease
grip strength testing
Nerve conduction study (NCS)
Electromyogram

120
Q

NCS

A

can test both sensory and motor nerves; records time from stimulus to response; delayed in CTS because of demyelination of median nerve fibers

121
Q

Electromyogram (EMG)

A

needle inserted into muscle to measure electrical activity with muscle relaxed and fully contracted; denervated muscle spontaneously fires during relaxation and produces fibrillation

122
Q

Tx of CTS

A

Acute (traumatic): require immediate decompression
Chronic: NSAIDS, local steroid injection, brace (working and/or night), PT

Surgery (endoscopic or open)

123
Q

Ganglion cysts

A

collection of synovial fluid within a joint or tendon sheath; herniation of synovial tissue from capsule or tendon sheath

124
Q

Sx of ganglion cysts

A

soft mobile mass; fluctuates in size, often with activity; may restrict motion or become painful with repetitive activity

125
Q

Common locations of ganglion cysts:

A

dorsal radial and volar aspects of wrist

126
Q

Tx for ganglion cysts

A

NSAIDs - may resolve spontaneously
Aspiration and steroid injection
Surgery for recurrence

127
Q

De Quervain’s Tenosynovitis

A

inflammation of the 1st dorsal compartment of the hand involving the sheath of the abductor pollicis longus and extensor pollicis brevis

128
Q

Cause of De Quervain’s

A

overuse/repetitive gripping

129
Q

Who is at increased risk for De Quervain’s?

A 
Hormonal changes (postpartum)
W>M, 30-50
130
Q

Sx of De Quervain’s

A

pain/swelling along dorsal radial wrist; pain aggravated by thumb and wrist motion (gripping)

131
Q

Test for De Quervain’s

A

Finkelstein

132
Q

Tx for De Quervain’s

A 
diminish repetitive activity
Thumb spica immbolization
NSAID's
Steroid injection
Surgical referral: decompress 1st dosral compartment
133
Q

Boutonniere Deformity

A

Flexion of PIP
Hyperextension of DIP
Ruptured central slip extensor tendon mechanism

134
Q

Swan neck

A

Hyperextension of PIP
Flexion of DIP
Volar plate attenuation of PIP joint

135
Q

Dupuytren’s Contracture

A

CT disorder; progressive fibrosis of the palmar fascia

136
Q

Dupuytren risk factors

A

Males, Northern European descent, >40-50

Risks: EtOH abuse, smoking, diabetes

137
Q

Sx of Dupuytren’s

A

painless nodules develop into palpable cords along palmar surface (irreversible contractures);
extension loss of fingers (RF and SF most often

138
Q

Dx of Dupuytren’s

A

CLINICAL, no imaging

severity based on amount of contracture

139
Q

Test for Dupuytren’s

A

Hueston table top test: test ability to flatten hand on table

140
Q

Tx for Dupuytren’s

A

observation
Stretching, splinting, massage do not help progression
Glucocorticoid injection if it becomes painful (tenosynovitis) or for rapid growth of nodules
Surgical referral: progressive presenetation (flexion contraction of >30 degrees at MCP or any PIP flexion is noted; inability to perform Hueston)
Collagenase injections: milder presentation w/ mixed results and high risk of recurrence

141
Q

When to refer for surgery with Dupuytren’s

A

Flexion contracture >30 degrees at PIP
Any DIP involvement
Inability to perform Hueston Table Top Test

142
Q

Stenosing Flexor Tenosynovitis

A

Trigger thumb/finger

143
Q

Resembles deputyrens

A

Stenosing flexor tenosynovitis (trigger finger)

144
Q

At risk for trigger finger

A

W>M, affects both adults and children

145
Q

Trigger finger

A

idiopathic, benign, and OCCURS SPONTANEOUSLY;

nodule forms at volar aspect of MCP (mechanical impingement, flexor tendon irritation and inflammation)

146
Q

Sx of trigger finger

A

digit snaps, catches, or locks with passive/active ROM at IP/PIP- nodule is unable to easily glide through A1 pulley, pt. may need to forcefully unlock digit; progressively becomes painful; concern for contracture if tx not provided

147
Q

Dx of trigger finger

A

Clinical, no imaging

148
Q

Tx of trigger finger

A

NSAIDs
Local corticosteroid injection
Surgery to release A1 puller

149
Q

Local glucocorticoid tx used with

A

CTS, Deputyren’s, Stenosing flexor tenosynovitis (trigger finger)

150
Q

Bone tumor/lesion concerning features on radiography

A 
Indistinct margin
Abnormal periosteal reaction
Soft tissue mass/invasion
Rapid growth
Pathologic Fx
151
Q

Lesions >30

A 
Metastasis Myeloma Lymphoma
Metastasis Myeloma HPT
Encondroma Chondrosarcoma
Giant CT
Geode
152
Q

Benign lesions

A 
Unicameral bone cyst (UBC)
Aneurysmal bone cyst (ABC)
Non-ossifying fibroma (NOF)
Giant Cell Tumor (GCT)
Osteoid Osteoma (OO)
Osteochondroma (exostosis)
153
Q

Unicameral bone cyst aka

A

Simple bone cyst

154
Q

Most common benign tumor

A

UBC

155
Q

UBC qualities

A

fluid filled cavity in the bone;

long bones: upper humerus & femur

156
Q

Imaging for UBC

A

plain radiograph and MRI or CT if needed

Bone scan occasionally: evaluate for more cysts

157
Q

Tx for UBC

A

may resolve spontaneously, observation

Surgery: recurrent pathologic fractures

158
Q

When not to do surgery for UBC

A

pediatrics: avoid tx if near physis until older, high recurrence rate

159
Q

Aneurysmal Bone Cyst (ABC)

A

Blood filled cyst in the bone;
Location: spine and extremities
Benign but aggressive

160
Q

Dx for ABC

A

Radiographs
MRI: fluid-fluid levels
Bx

161
Q

Tx for ABC

A

refer to ortho for surgery

162
Q

Non-ossifying fibroma (NOF)

A

benign lesion
MES: metaphyseal, eccentric (on side), sclerotic borders (dense around)
asymptomatic or pain associated with pathologic fx

163
Q

NOF is a MES

A

Metaphyseal
eccentric (on side of bone)
Sclerotic borders

164
Q

Imaging for NOF

A

radiograph (usually incidental)

may have patho fx

165
Q

Tx for NOF

A

observation with serial radiographs

Ortho referral: lesion >50% diameter of the bone

166
Q

When to refer to ortho for NOF

A

lesion >50% diameter of bone

167
Q

Giant Cell Tumor (GCT)

A

benign, aggressive tumor
May develop as growth plate closes: metaphyseal/epiphyseal;
localized pain and possible weakness

168
Q

Aggressive benign tumors

A

ABC, GCT

169
Q

Painful bone lesions

A

GCT
Osteoid osteoma (worse at night, NSAIDs relieve)
Osteochondroma (painful with activity, tingling near nerve)

Osteosarcoma/Ewings (sometimes)
Chondrosarcoma (w/ weakness)

170
Q

Imaging for GCT

A

plain radiograph, MRI, bone scan (hot spot)

171
Q

Osteoid Osteoma

A

small benign bone tumor: children and adults

Nidus-center (dot inside) of growing cells surrounded by thickened bone

172
Q

Sx of osteoid osteoma

A

dull aching pain
Severe night pain*
NSAIDs relieve pain*

173
Q

Imagine for OO

A

plain radiographs, CT scan

labs to r/o infection

174
Q

Tx of OO

A

Refer to ortho or interventional radiology

CT guided radiofrequency ablation

175
Q

Osteochondroma aka

A

Exostosis

176
Q

Osteochondroma

A

abnormal growth of bone and cartilage along surface of the bone

177
Q

Most common benign bone tumor

A

Osteochondroma (pedunculated or sessile)

178
Q

Sx of Osteochondroma

A

fixed, non-mobile mass near joints; may be painful with activity;
tingling or numbness if near nerve

179
Q

Tx for osteochondroma

A

observation; refer if painful

180
Q

Malignant Tumors

A

Osteosarcoma and Ewing’s Sarcoma

Chondrosarcoma

181
Q

Osteosarcoma & Ewing’s sarcom

A

malignant primary bone tumors;

osteosarcoma most common bone tumor in children

182
Q

Most common bone tumor in children

A

Osteosarcoma

183
Q

Sx of osteosarcoma

A

Asymptomatic vs. pain and swelling

pathological fracture

184
Q

Tumor most common in kids

A

Osteosarcoma & Ewing’s sarcoma

185
Q

Dx for osteosarcoma/ewing’s

A

radiographs, MRI, CT, bx

186
Q

Tx for osteosarcoma/ewing’s

A

refer to ortho and oncology

187
Q

Chondrosarcoma

A

bone tumor composed of carilage-producing cells

188
Q

prevalence of chondrosarcoma

A

> 40 yo (most often males 60-80)

189
Q

Location of chrondrosarcoma

A

hips, shoulder, pelvis

190
Q

Sx of chondrosarcoma

A

pain, weakness;

pelvic masses radiate pain to hip/knee

191
Q

Dx of chondrosarcoma

A

plain radiograph, MRI, BIOPSY (speckling appearance)

192
Q

Tx for chondrosarcoma

A

refer to ortho;

+/- radiation, chemo

193
Q

Similar appearance to condrosarcoma

A

Chondroblastoma/Enchondroma

194
Q

Most common primary bone tumor (malignant)

A

Multiple myeloma

195
Q

Prevalence of Multiple Myeloma (MM)

A

> 40 yo, M>F, African americans

196
Q

Multiple Myeloma cause

A

involves entire skeletons; may be associated with radiation or pesticide exposure/HIV

197
Q

Sx of multiple myeloma

A

Fatigue, fever, nigh sweats, diffuse bone tenderness, pathologic fx

198
Q

Dx of multiple myeloma

A

Labs, U/A, and imaging (punched out appearance)

199
Q

What does a U/A show in multiple myeloma

A

Bence-Jones Proteins

200
Q

Punched out appearance on radiograph

A

multiple myeloma

201
Q

Tx for multiple myeloma

A

Chemo, Radiation

Supportive care

202
Q

Metastatic Bone Cancer most common causes

A 
(PB KTL)
Prostate (most common in M)
Breast (most common in F)
Kidney
Thyroid
Lung (most common in M)
203
Q

Sx of metastatic bone cancer

A

asymptomatic with pathological fx or painful at presentation

204
Q

Dx of metastatic bone cancer

A

Labs: anemia
Radiographs: patho fx (osteolytic bone destruction (KTL), osteoblastic formation (P), or mixed (B)
BONE SCAN

205
Q

Causes osteolytic bone destruction

A

KTL

206
Q

Causes osteoblastic formation

A

P

207
Q

Mixed osteolytic bone destruction and osteoblastic formation

A

B

208
Q

Tx for metastatic bone cancer

A

refer to ortho and oncology

Clin Med Exam 3 (7 decks)

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