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Musculoskeletal and Connective Tissue > UW 2 > Flashcards

UW 2 Flashcards

1
Q

Overview of running injuries of the foot and ankle - ddx

A
  1. stress fracture
  2. plantar fascitis
  3. achilles tendinopathy
  4. motor neuroma
  5. tarsal tunnel syndrome
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2
Q

stress fracture - RF

A
  1. repetitive activities (running, gymnastics)
  2. abrupt increase in physical activity
  3. inadequate calcium + vit D intake
  4. decreased caloric intake
  5. female athelte triad: low caloric, hypomenorrhea/amenorrhea, low bone density
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3
Q

stress fracture - presentation

A

insidious onset of localized pain
point tenderness at fracture site
possible negative x-ray in the first 6 wks

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4
Q

stress fracture - x-ray

A

possible negative for the 1st 6 wks

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5
Q

stress fracture - management

A

reduced weight bearing for 4-6 wks

referral to orthopedic surgeon for fracture at high risk for maluntion (anterior tibial cortex, 5th metatarsal)

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6
Q

medial tibial stress syndrome (shin splints)

A

anteror leg pain resembling that of stress fractrure –> usually seen in casual runners and is characterized by diffuse area of tnederness (not point tenderness vs stress fracture) –> common in overweight (vs stress

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7
Q

when to treat a stress fracture with casting or internal fixation

A

if increased risk for nonunion: 5th metatarsal or anterior tibial cortex

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8
Q

MC metatarsal with stress fracture

A

2nd

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9
Q

shin splints vs stress fracture

A

shin: obesity, no tender
fracture: low BMI, tender

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10
Q

plantar fascitis - definition

A

inflammation of plantar aponeurosis characterized by eel pain (worse with first step in the morning or after period of inactivity) and tenderness

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11
Q

achilles tnedinopathy - clinical features

A

burning pain or stifness 2-6 cm above the posterior calcaneus

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12
Q

motor neuroma - clinical features

A
  • numbness or pain between the 3rd and 4th toes

- clicking sensation when palating space between 3rd and 4th toes while squeezing the metatarsal joints (Mulder’s sign)

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13
Q

tarsal tunnel syndrome - clinical features

A
  • compression of the tibial nerve at the ankle

- burning, numbness + aching of the distal plantar surface of the foot/toes

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14
Q

common causes of shoulder pain

A
  1. Rotator cuff impingement or tendinopathy
  2. rotator cuff tear
  3. Adhesive capsulitis (frozen shoulder)
  4. Biceps tenindopathy rupture
  5. Gienohumeral osteoarthritis
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15
Q

Rotator cuff impingement or tendinopathy

A
  • pain with abduction, external rotation
    subacrosomial tenderness
  • normal range of motion with positive impigement tests
  • NEAR TEST: with the patient’s shoulder internally roated and forearm pronated, the examiner stabilizes the scapula and flexes the humerus -> reproduction of the pain
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16
Q

Rotator cuff tear

A

similar to rotator cuff tendinopathy

  • weakness with abduction + external rotation
  • older than 40
  • usually after a fall on an outstrected ar
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17
Q

adhensive capsulitis (frozen shoulder)

A

decreaed passive + active range of motion
more stiffness than pain
FIBROSIS

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18
Q

biceps tendinoapthy / rupture

A

anterior shoulder pain
pain with lifting carrying or overhead reaching
weakness less common

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19
Q

glenohumeral osteoarthritis

A

uncommon + usually due to trauma
gradual onset of anterior or deep shoulder pain
decreased active + passive abduction + external

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20
Q

anterior knee pain in young patient - DDX (typical patient)

A
  1. patelloferomal syndrome –> young female athletes
  2. patellar tendonitis –> 1ry athletes (jumper’s knee)
  3. Osgood-Schlatter disease –> preadolescent/adolescent, recent growth spurt
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21
Q

patellofemoral syndrome - test

A
  • pain elicited by extending the knee while compressing the patella
  • reproduction of pain with squatting
  • -> if doubt –> x-ray or f
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22
Q

patellofemoral syndrome - initial management

A

activity modification, NSAID and stretchig and strengthening exercises
- if fails after 1 year –> surgery

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23
Q

patellofemoral syndrome - clinical features

A

sabactue chronic pain increased with squatting, running, prolonged sitting and using stairs

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24
Q

patellar tendonitis - clinical features

A

episodic pain + tenderness at inferior patella

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25
Q

osgood schlatter - clinical features

A

anterior knee pain / reproduce pain when extend the knee against resistance / tenderness and edema on tubercle
- anterior soft tissue swelling, lifting of tubercle from the shaft, irregularity or fragmentation of the tubercle

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26
Q

iliotibial band syndrome

A

overuse injury of lateral knee that occurs primarily in runners

  • 2ry to friction of iliotibial band against LATERAL femoral epicondyle
  • tenderness at the lateral femoral condyle during flexion and extension
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27
Q

motor neuroma syndrome - treatment

A

conservative, with metatarsal support or padded shoe internts

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28
Q

pes anserinus pain syndrome

A

sharp, localized pain and tenderness over the anteromedial part of the tibial plateau just below the joint line of the knee
- normal x-ray
valgus stress will not aggravate pain

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29
Q

DDX of myopathy (also ESR and CK)

A
  1. Glucocrticoid-induced myopathy - both normal
  2. Polymyalgia rhematica - increased ESR
  3. Infl myopathies: both increased
  4. statin induced myopathy: CK elevated, normal ESR
  5. hypothyroid myopathy: CK elevated, normal ESR
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30
Q

myopathies with normal ESR and high CK

A
  1. statin induced

2. hypothyorid

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31
Q

Glocorticoid induced myopathy - features

A
  • progressive proximal muscle weakness + atrophy
  • NO PAIN OR TENDERNESS
  • Lower ext are more involved
  • normal ESR + CK
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32
Q

infl myopathies - features

A
  1. muscle pain, tenderness + proximal muscle weakness
  2. skin rash + infl arthritis may present
  3. high esr + CK
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33
Q

statin induced myopathy - features

A
  • prominent muscle pain/tenderness with or without weakness
  • rare rhabdomyolysis
  • normal ESR, high CK
34
Q

hypothyroid myopathy - features

A
  1. muscle pain, cramps, weakness involving the proximal muscles
  2. delayed tendon reflexes, myoedema
  3. casional rhabdomyolysis
  4. normal ESR, high CK
35
Q

rotator cuff tears - etiology / how to confirm diagnosis

A
  • after fall on outstrectehd arm

- MRI

36
Q

rotator cuff tear - treatment

A

surgery with best results if first 6 wks

37
Q

olecranon bursitis

A

due to repetitive pressure or friction on the elbows –> posterior wlbow pain and is usually associated with visible swelling of teh bursal sac

38
Q

De Quervain tenosynovitis

A

classically affects new mothers who hold theri infants with thumb outstreched (abducted/extended). The abductor pollicis longus and extensor pollicis brevis tendons are affected
- passive stretch of these tendons elicits pains (Finkelstein test)

39
Q

causes of chronic low back pain

A
  1. mechanical
  2. radiculopathy
  3. spinal stenosis
  4. inflammatory
  5. metastatic
  6. infectious
40
Q

mechanical back pain - mechanism

A

muscle strain, spasm. degenerative arthritis

41
Q

mechanical back pain - clinical clues

A
  1. normal neurologic examination
  2. negative straight leg raise
  3. possible paraspinal tenderness
42
Q

herniated nucleus pulposus/disc disease - clinical clues

A
  1. radiculopathy (usually L4-L5)
  2. possible (+) straight leg raise
  3. possible neurologic findings
43
Q

spinal stenosis - clinical clues

A
  • pseudoclaudication
  • better with spine flexion / worse with extension
  • older age
44
Q

compression fracture - clinical clues

A
  1. older
  2. More common in women
  3. trauma/fall (may be minor)
45
Q

inflammatory - low back pain - examples

A

ankylosing spondylitis, reactive arthritis, psoriatic arthritis, IBD

46
Q

inflammatory - low back pain - clinical clues

A
  1. better with activity
  2. no improvement with rest
  3. gradual onset
  4. HLA-B27
47
Q

malignancy - low back pain - clinical clues

A
  1. history or malignancy
  2. older than 50
  3. worse at night
  4. unintentional weight loss
  5. cauda equina syndrome
48
Q

infectious low back pain - clinical clues

A
  1. Recent infection
  2. IV drugs
  3. DM
  4. Fever exquisite point tenderness
49
Q

Disseminated gonococcal infection - clinical presentation

A

Purulent moroarhtirtis AND/OR

TRIAD of tenosynovitis, dermatitis (erythematous papules + pustules) asymmetric migratory polyarthralgias

50
Q

Disseminated gonococcal infection - diagnosis

A
  1. blood culture (may be (-)
  2. synovial fluid analysis: infl effusion with neutrophil predominance, gram stain + culture or NAAT
  3. Culture or NAAT of urethral, cerivx, pharynx, rectum
51
Q

Disseminated gnococcal infection - treatment

A
  1. IV ceftriaxone, swtich to oral (cefixime) when clinically improved)
  2. empiric azithromycin OR doxycycline for concomitant chlamydial infection
  3. Joint drainage for purulent arthritis
52
Q

Management of low back pain

A
  • acute pain 1. maintain moderate activity 2. NSAID or acetaminophen 3. consider muscle relaxants, spinal manipulation, brief course of opioids
  • chronic: intermittent use of NSAID, exercise therapy, consider duloxetine / TCA
  • 2ry prevention: exercise therapy, education
53
Q

Bechet - manifestations beside the triad

A 
skin lesions (erytema nodosum, acneiform lesions)
2, thrombosis
54
Q

Bechet - evaluation

A

Pathergy: exaggerated skin ulceration with minor truama (eg. needlestick)
2. biopsy: nonspecific vasculitis of different sized vessels

55
Q

characteristic of SLE oral ulcers

A

PAINLESS

56
Q

typical age of onset of RA

A

30-50

57
Q

RA - future complication

A

osteoporosis

58
Q

part of spine affected by RA

A

only cervical

59
Q

before initiation of MTX - check for

A

HBV, HCV, TB

60
Q

fibromyalgia - treatment

A

exercise is the foundation

- medication (TCA, SNRI) if fails initially

61
Q

giant cell arteritis vs polymyaglia rhematica regarding steroids dose

A

giant cells: high dose

polymyalgia: low dose

62
Q

cryoglobulinemia - types and disease association

A

type 1: lymphoproliferative or hematoogic (eg. MM)

mixed: chronic HCV, HIV, SLE

63
Q

cryoglobulinemia - types and complement levels

A

type 1: normal

mixed: Low C4

64
Q

cryoglobulinemia type 1 - clinical findings

A

asymptomatic
hyperviscosity (blurry vision) thrombosis (Raynaud)
Livedo reticularis, purpura

65
Q

mixed cryoglobulinemia - clinical manifestations

A
  1. fatique, arthralgia
  2. glumerulonephritisis
  3. HTN
  4. dyspnea, pleuristy
  5. Palpable purpura, leukocytoclastic vasculitis
66
Q

disease-modifying antirhematic drugs - agents and SE

A

methotrexate: liver tox, stomatitis, cytopenias (macro anemia)
2. leflunamide: liver tox, cytpoenias
3. Hydroxychloroquine: retinopathy
4. sulfasalazine: liver tox, stomatitis, hemolytic anemia
5. TNF inhibitors: infection ,demyelination , malignancy, CHF

67
Q

another difference of 1ry vs 2ry raynaud

A

1ry: symmetric

68
Q

flexion in lumbar herniation

A

makes it worse

69
Q

Giant cell - clinical sign if there is upper arm claudication

A

bruits in subclavian or axillary areas

70
Q

Giant cell arteritis - treatment

A
  1. polymialgia rheumatic only: low dose oral steroids
  2. giant cell arteritis: intermediate to high dose oral steroids (prednsisone 40-60mg/d)
  3. with vision loss: high dose steroids (methylpredinisolone 1000 mg/d) for 3 days and then intermediate to high dose oral steroids
71
Q

herniated disc vs vertebrae fracture - a clinical sign

A

hernaited disc has sciatical pain

72
Q

Dupuytren contracture

A

progressive fibrosis of the palmar fascia and presents with a palmar nodule or thickening (usually 4th and 5th digits) with possible nodule formation along the flexor tendons near the distal palmar crease –> decreased extension

73
Q

MCC of asymptomatic ALP elevation

A

Paget

74
Q

other extramuscular manifestations of dermatomyositisi

A
  1. interstitial lung disease
  2. dysphagia
  3. myocarditis
75
Q

joint fluid characteristics

A
  1. normal: clear, less than 200 WBC, les than 25% OMNs
  2. noninflammatory (OA): clear, 200-2000, 25% PMNs
  3. inflammatory (crystals, RA etc): translucent or opaque, 2000-100, often more than 0% PMNs
  4. septic joint: opaque, 50.000-150, more than 80-90%
76
Q

Felty syndrome

A
  1. RA (vasculitis, rhematoid nodules, severe erosive joint disease + deformity)
  2. neutropenia (ANC less than 1500)
  3. splenomegaly
    IN 10 YEARS RA
77
Q

enthesitis as isolated disorder?

A

plantar fascitis

78
Q

indications for imaging in low back pain - x-ray

A
  1. osteoporosis, compression fracture
  2. suspected malignancy
  3. anklylosing spondylitis (eg. insidious onset, nocturnal pain, better with movement)
79
Q

indications for MRI in low back pain

A
  1. sensroy/motor deficits
  2. cauda equina
  3. suspected epidrual absecess/infection
80
Q

indications for radionuclide bone scan or CTn low back pain

A

indications for but not able to have MRI

81
Q

Baker cyst - complications

A
  1. venous compression (leg/ankle swelling)
  2. dissection into calf (erythema, edema, positie Homan sign)
  3. Cyst rupture (acute calf pain, warmth, erytema, ecchymosis)
    - crescent sign distal to medial malleus

Musculoskeletal and Connective Tissue (19 decks)

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