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USMLE Step 2 > USMLE Step 2: MSK > Flashcards

USMLE Step 2: MSK Flashcards

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USMLE® Step 1 flashcards
1
Q

What nerve is at risk wtih anterior shoulder dislocation?

A

Axillary nerve

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2
Q

How does someone hold their arm with an anterior dislocation?

A

Slight abduction and external rotation

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3
Q

What nerve can be injured in anterior hip dislocation?

A

obturator nerve

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4
Q

What is the most common type of shoulder dislocation?

A

Anterior (posterior is rare and from seizure)

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5
Q

What is the most common hip dislocation

A

Posterior (“dashboard injury)

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6
Q

Colles Fracture

A

Distal radius- fall onto an outstretched hand

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7
Q

Scaphoid Fracture

A

Takes 2 weeks to show up on x-ray. Assume there is a fracture if there is tenderness in the anatomical snuff box

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8
Q

What nerve is at risk with humerus fracture

A

radial nerve (wrist drop and loss of thumb extension)

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9
Q

Monteggia’s Fracture

A

diaphyseal fracture of the proximal ulna with subluxation of the radial head

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10
Q

Galeazzi’s fracture

A

Diaphyseal fracture of the radius with dislocation of the distal radioulnar join

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11
Q

What causes Galeazzi’s fracture?

A

Direct blow to the radius

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12
Q

Achilles Tendon Rupture

A

Presents with a sudden “pop” like a rifle shot

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13
Q

What is the mechanism of ACL injury

A

Noncontact twisting (+ anterior drawer sign)

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14
Q

What is the mechanism of PCL tear

A

Posteriorly directed forced on a flexed knee (+ posterior drawer sign)

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15
Q

Radial Nerve Injury

A

Wrist extension, loss of dorsal forearm and hand (1st 3 fingers). wrist drop

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16
Q

Median Nerve

A

Loss of pronation/thumb opposition, sensory on palmar surface **weak wrist flexion and flat thenar eminence)

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17
Q

Ulnar nerve injury

A

Loss of finger abduction, palmar and dorsal sensory claw hand

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18
Q

Axillary nerve

A

Loss of abduction, sensory over lateral shoulder

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19
Q

Peroneal nerve injury

A

Loss of dorsiflexion/eversion, sensory over dorsal foot and lateral leg foot drop

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20
Q

Herniated Disk & Passive Straight leg pain

A

Pain increases (high sensitivity but not specific)

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21
Q

Herniated disk and straight-leg raise

A

Increased pain (highly specific but not sensitive)

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22
Q

Cauda Equina Syndrome

A

Bowel or bladder dysfunction, impotence, and saddle area anesthesia surgical emergency

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23
Q

S/sx of herniated disk

A

Presents with sudden onset of severe, electricity-like LBP, usually preceded by several months of aching “discogenic” pain

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24
Q

L4 nerve root

A

Foot dorsiflexion (tibialis anterior), patellar reflex, sensory for medial aspect of lower leg

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25
Q

L5 nerve root

A

Big toe dorsiflexion (EHL), foot eversion (peroneus muscles), sensory to dorsum of the foot and lateral aspect of lower leg

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26
Q

S1

A

Plantar flexion (gastrocs/soleus), hip extension (glut max), achilles reflex, sensory to plantar and lateral aspect of the foot

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27
Q

Presentation of spinal stenosis

A

Neck pain, back pain that radiates to the arms or but/legs, leg numbness/weakness

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28
Q

Presentation of lumbar stensosi

A

Leg cramping is worse with standing and walking, but symptoms improve with flexion at the hips and bending forward (relieves pressure on the nerves)

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29
Q

Where does osteosarcoma occur?

A

Metaphyseal regions of the distal femur, prox tibia, and prox humerus

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30
Q

Presentation of osteosarcoma

A

Progressive and eventually intractable pain that worsens at night, constitutional symptoms

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31
Q

Radiographs for osteosarcoma

A

Codman’s triangle or sunburst pattern

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32
Q

Classic finding of Ewing Sarcoma

A

child 10-20 yo with a multilayered “onion-skinning” finding on xray is the diaphyseal regions of femur

33
Q

Classic findings of a giant cell tumor of bone

A

female 20-40 yo presenting with knee pain and a mass, a “soap bubble” appearance

34
Q

Diagnosis of septic arthritis (WBC count)

A

WBC count > 80,000

35
Q

Most common organisms of septic arthritis

A

Staph (#1), strep, gram negative rods

36
Q

Treatment of septic arthritis

A

Empirically with ceftriaxone and vancomycin until cultures come back

37
Q

Heberden’s nodes

A

DIP enlargement

38
Q

Bouchard’s Nodes

A

PIP enlargement

39
Q

How long does stiffness last in the morning with osteoarthritis?

A

<30 min

40
Q

X-ray findings in osteoarthritis

A

Joint space narrowing, osteophytes, subchondral sclerosis, and subchondral bone cysts

41
Q

What diagnosis do you consider in a child with gout and inexplicable injuries?

A

Lesch-Nyhan syndrome

42
Q

What do gout crystals look like?

A

YeLLow when paraLLel to the condensor; needle-shaped, negatively birefringent crystals

43
Q

Treatment of acute gout

A

High dose NSAIDs (indomethacin) + colchicine

44
Q

Maintenance of gout

A

Allopurinol for overproducers; probenecid for undersecreters

45
Q

Crystals in pseudogout

A

Rhomboid + crystal birefringence

46
Q

Reactive Arthritis

A

Arthritis, uveitis, conjunctivits, urethritis;

47
Q

Bugs in reactive arthritis

A

usually following campylobacter, shigella, salmonella, chlamydia, or ureaplasma infection

48
Q

Pencil in cup deformity

A

Psoriatic arthritis

49
Q

Polymyositis

A

symmetric, progressive, proximal muscle weakness, pain, and difficulty breathing or swallowing

50
Q

Dermatomyositis

A

Heliotrope rash, shawl sign, gottron’s papules

51
Q

HLA associated with RA

A

HLA-DR4

52
Q

How long does morning stiffness last for RA?

A

> 1 hour

53
Q

Best initial DMARD

A

methotrexate

54
Q

Other DMARD

A

hydroxychloroquine and sulfasalazine

55
Q

Second line agents for RA

A

TNF inhibitors, rituximab, leflunomide

56
Q

CREST Syndrome

A

Calcinosis, Raynaud’s, Esophageal Dysmotility, Sclerodactyly, Telangiectasias

57
Q

What can diffuse scleroderma lead to?

A

Pulmonary fibrosis, cor pulmonale, acute renal fialure, and malignant hypertension

58
Q

What is mortality due to in scleroderma?

A

pulmonary hypertension and complications of pulmonary hypertensions

59
Q

Libman-Sacks endocarditis

A

Noninfectious vegetations often seen on the mitral valve in association wtih SLE and antiphospholipid syndrome

60
Q

Polymyalgia Rheumatica

A

Pain and stiffness of the shoulder and pelvic girdle (difficulty getting out of a chair or lifting the arms above the head). Increased ESR. Females >50yo

61
Q

Inheritance of Duchenne Muscular Dystrophy

A

X-linked recessive

62
Q

Greenstick Fracture

A

Incomplete fracture involving the cortex of only 1 side (tension side) of the bone

63
Q

Nursemaid’s Elbow

A

Radial head subluxation that typically occurs as a result of being pulled or lifted by the hand presents with pain and refusal to bend the elbow

64
Q

Torus Fracture

A

Buckling of the compression side of the cortex of a long bone secondary to trauma. Usually occurs in the distal radius or ulna

65
Q

Osgood-Schlatter Disease

A

Overuse apophysitis of the tibial tubercle. Causes localized pain, especially with quds contraction

66
Q

Salter-Harris Fracture

A

Fractures of the growth plate in children

67
Q

Salter-Harris I

A

Physis (growth plate)

68
Q

Salter-Harris II

A

Metaphysis and physis

69
Q

Salter-Harris III

A

Epiphysis & physis

70
Q

Salter-Harris IV

A

Epiphysis, metaphysis, and physis

71
Q

Salter-Harris V

A

Crush injury of the physis

72
Q

Congenital Dislocation of the hip- who is it most common in?

A

First-born females born in the breech position

73
Q

Barlow’s Maneuver

A

Posterior pressure is places on the inner aspect of the abducted thigh and the hip is then adducted, leading to an audible “clunk” as the femoral head dislocates posteriorly [in congenital hip dislocation)

74
Q

Ortolani’s Maneuver

A

The thighs are gently abducted from the midline with anterior pressure on the greater trochanter. A soft click signifies reduction of the femoral head into the acetabulum [congenital hip dislocation]

75
Q

Allis’ (Galeazzi’s sign)

A

The knees are at unequal heights when the hips and knees are flexed (dislocated side is lower) [in congenital hip dislocation]

76
Q

How is congenital dislocation of the hip diagnosed?

A

ultrasound

77
Q

Legg-Calve-Perthes Disease

A

Idiopathic AVN of femoral head

78
Q

Slipped capital femoral epihpysis

A

separation of the proximal femoral epiphysis through the growth plate (leading to inferior and posterior displacement of the femoral head relative to the femoral neck) epiphysis remains within the acetabulum while the metaphysis moves anteriorly and superiorly

USMLE Step 2 (10 decks)

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