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USMLE Step 2: MSK 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
L5 nerve root
Big toe dorsiflexion (EHL), foot eversion (peroneus muscles), sensory to dorsum of the foot and lateral aspect of lower leg
26
S1
Plantar flexion (gastrocs/soleus), hip extension (glut max), achilles reflex, sensory to plantar and lateral aspect of the foot
27
Presentation of spinal stenosis
Neck pain, back pain that radiates to the arms or but/legs, leg numbness/weakness
28
Presentation of lumbar stensosi
Leg cramping is worse with standing and walking, but symptoms improve with flexion at the hips and bending forward (relieves pressure on the nerves)
29
Where does osteosarcoma occur?
Metaphyseal regions of the distal femur, prox tibia, and prox humerus
30
Presentation of osteosarcoma
Progressive and eventually intractable pain that worsens at night, constitutional symptoms
31
Radiographs for osteosarcoma
Codman's triangle or sunburst pattern
32
Classic finding of Ewing Sarcoma
child 10-20 yo with a multilayered "onion-skinning" finding on xray is the diaphyseal regions of femur
33
Classic findings of a giant cell tumor of bone
female 20-40 yo presenting with knee pain and a mass, a "soap bubble" appearance
34
Diagnosis of septic arthritis (WBC count)
WBC count > 80,000
35
Most common organisms of septic arthritis
Staph (#1), strep, gram negative rods
36
Treatment of septic arthritis
Empirically with ceftriaxone and vancomycin until cultures come back
37
Heberden's nodes
DIP enlargement
38
Bouchard's Nodes
PIP enlargement
39
How long does stiffness last in the morning with osteoarthritis?
<30 min
40
X-ray findings in osteoarthritis
Joint space narrowing, osteophytes, subchondral sclerosis, and subchondral bone cysts
41
What diagnosis do you consider in a child with gout and inexplicable injuries?
Lesch-Nyhan syndrome
42
What do gout crystals look like?
YeLLow when paraLLel to the condensor; needle-shaped, negatively birefringent crystals
43
Treatment of acute gout
High dose NSAIDs (indomethacin) + colchicine
44
Maintenance of gout
Allopurinol for overproducers; probenecid for undersecreters
45
Crystals in pseudogout
Rhomboid + crystal birefringence
46
Reactive Arthritis
Arthritis, uveitis, conjunctivits, urethritis;
47
Bugs in reactive arthritis
usually following campylobacter, shigella, salmonella, chlamydia, or ureaplasma infection
48
Pencil in cup deformity
Psoriatic arthritis
49
Polymyositis
symmetric, progressive, proximal muscle weakness, pain, and difficulty breathing or swallowing
50
Dermatomyositis
Heliotrope rash, shawl sign, gottron's papules
51
HLA associated with RA
HLA-DR4
52
How long does morning stiffness last for RA?
>1 hour
53
Best initial DMARD
methotrexate
54
Other DMARD
hydroxychloroquine and sulfasalazine
55
Second line agents for RA
TNF inhibitors, rituximab, leflunomide
56
CREST Syndrome
Calcinosis, Raynaud's, Esophageal Dysmotility, Sclerodactyly, Telangiectasias
57
What can diffuse scleroderma lead to?
Pulmonary fibrosis, cor pulmonale, acute renal fialure, and malignant hypertension
58
What is mortality due to in scleroderma?
pulmonary hypertension and complications of pulmonary hypertensions
59
Libman-Sacks endocarditis
Noninfectious vegetations often seen on the mitral valve in association wtih SLE and antiphospholipid syndrome
60
Polymyalgia Rheumatica
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
Inheritance of Duchenne Muscular Dystrophy
X-linked recessive
62
Greenstick Fracture
Incomplete fracture involving the cortex of only 1 side (tension side) of the bone
63
Nursemaid's Elbow
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
Torus Fracture
Buckling of the compression side of the cortex of a long bone secondary to trauma. Usually occurs in the distal radius or ulna
65
Osgood-Schlatter Disease
Overuse apophysitis of the tibial tubercle. Causes localized pain, especially with quds contraction
66
Salter-Harris Fracture
Fractures of the growth plate in children
67
Salter-Harris I
Physis (growth plate)
68
Salter-Harris II
Metaphysis and physis
69
Salter-Harris III
Epiphysis & physis
70
Salter-Harris IV
Epiphysis, metaphysis, and physis
71
Salter-Harris V
Crush injury of the physis
72
Congenital Dislocation of the hip- who is it most common in?
First-born females born in the breech position
73
Barlow's Maneuver
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
Ortolani's Maneuver
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
Allis' (Galeazzi's sign)
The knees are at unequal heights when the hips and knees are flexed (dislocated side is lower) [in congenital hip dislocation]
76
How is congenital dislocation of the hip diagnosed?
ultrasound
77
Legg-Calve-Perthes Disease
Idiopathic AVN of femoral head
78
Slipped capital femoral epihpysis
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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