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CM 4 > MSK Diagnosis > Flashcards

MSK Diagnosis Flashcards

1
Q

Spinal stenosis?

A

MRI

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2
Q

Ankylosing spondylitis?

A

Labs: Increased ESR and Negative RA and ANA.
Xray: Bamboo Spine and Sacroilitis.

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3
Q

Herniated disc?

A

Definitive Diagnosis: MRI.

Xray shows loss of disc height.

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4
Q

Compression fracture?

A

Xray: Loss of vertebral height.

MRI or CT if neuro symptoms.

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5
Q

Spondylolysis?

A

Lateral xray: radiolucent defect in pars; oblique: “scotty dog” w/ collar which shows a break in the pars interarticularis.
CT
Bone scan.

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6
Q

Spondylothisthesis?

A

Xray: Forward slipping on vertebra. Lateral views to measure slip angle and grade; flex/extension views can help eval stability.
MRI if neuro symptoms.

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7
Q

RA?

A

Labs: RF and ACPA + and elevated ESR and C-reactive protein.
Xray: Loss of junta articular bone mass. Narrowing of joint space. Boney erosions at margins of joint.

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8
Q

RA diagnosis criteria?

A

Inflammatory arthritis of three or more joints
Symptoms lasting at least 6 weeks
Elevated CRP and ESR
Positive serum RF or ACPA
Radiographic changes consistent with RA (erosions and periarticular decalcification)

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9
Q

Reactive arthritis/Reiter Syndrome?

A

Synovial fluid for analysis.

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10
Q

Polyarteritis nodosa?

A

Increased ESR, proteinuria. ANCA -. Renal and mesenteric angiography: microaneurysms “beading”/strung together “rosary sign”.
Definitive: Biopsy shows necrotizing medium vessel vasculitis & no granulomas.

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11
Q

Polymyalgia rheumatica?

A

ESR elevated. Normal CK and aldolase.

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12
Q

Polymyositis and Dermatomyositis?

A 
Best Initial: Elevated CK and Aldolase.
\+ anti JO 1 and ANA.
Increased ESR & CRP, RF.
Definitive Diagnosis: Muscle biopsy 
Abnml EMG.
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13
Q

Fibromyalgia?

A

Multiple trigger points. Symmetrical.
Criteria:
1. Widespread pain including axial pain for at least 3 months.
2. Pain in at least 11/18 tender point sites.

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14
Q

Sjogren Syndrome?

A

Best Initial: ANA + & AntiSS-A and -B.
Schirmer test: decreased tear production (wetting of < 5mm
of the filter paper placed in the lower eyelid for 5 minutes.
Definitive: salivary gland (lip or parotid) biopsy

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15
Q

Scleroderma?

A

Anti-centromere antibodies.
Anti-SCL-70 antibodies - associated with diffuse disease & multiple organ involvement.
ANA+.

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16
Q

Lupus?

A

Positive ANA.
Anti-double stranded DNA and anti-Smith antibodies - the presence of either is diagnostic of SLE.
Antiphospholipid antibodies = increased risk of arterial & venous thrombosis.
Pancytopenia: anemia of chronic disease, leukopenia, lymphopenia, thrombocytopenia.
Decreased compliment levels (C3, C4).

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17
Q

Antiphospholipid syndrome?

A

Anticardiolipin antibodies; lupus anticoagulant = increased PTT.

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18
Q

Juvenile (Idiopathic) RA?

A

Clinical, but with increased ESR, CRP; positive ANA if oligoarticular; 15% are RF positive. Still’s is often associated with negative RF and ANA.

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19
Q

Pelvic Fracture?

A

X-ray

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20
Q

Hip dislocation?

A

X-ray of pelvis and hip.

CT scan to further evaluate associated fractures.

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21
Q

Hip fracture?

A

X-ray.

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22
Q

Trochanteric bursitis?

A

Clinical as x-rays are unremarkable.

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23
Q

Slipped capital femoral epiphysis (SCFE)?

A

X-ray- frog leg or lateral (posterior displacement of femoral epiphysis - ICE CREAM fell off the cone).

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24
Q

Legg-Calve-Perthes Disease?

A

Early: Increased density of femoral epiphysis, widening of cartilage space.
Advanced: Deformity, + crescent sign (microfractures w/ collapse of bone)

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25
Q

Femoral Shaft fracture?

A

X-ray.

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26
Q

Tibial and fibular fractures?

A

X-ray.

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27
Q

Popliteal (Baker’s) Cyst?

A

Doppler to r/o DVT and identifies cyst.

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28
Q

LCL and MCL?

A

MRI.

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29
Q

ACL PE?

A

Lachman Test=Most sensitive.
Pivot Shift Test.
Anterior Drawer Test.

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30
Q

ACL?

A

X-ray to r/o fracture.

MRI.

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31
Q

PCL?

A

MRI.

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32
Q

Meniscal tear PE?

A

Positive McMurray sign = pop/click

Apley test with joint line tenderness, effusion, swelling.

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33
Q

Meniscal tear?

A

MRI.

34
Q

Patellar dislocation?

A

Apprehension sign: when pushing laterally after reducing.

X-rays.

35
Q

Patellar fracture?

A

Xrays: Sunrise and cross table lateral views.

36
Q

Tibial plateau fracture?

A

CT scan for pre surgical planning.

37
Q

Osgood-Schlatter Disease?

A

Clinical.

X-rays if not classic presentation.

38
Q

How to tell if an ankle is sprained or fractured?

A

Ottawa Ankle Rules

39
Q

When should you get ankle radiograph?

A

Pain in malleolar region w/:
Bone tenderness at lateral malleolus.
Bone tenderness at medial malleolus.
Inability to bear weight for at least 4 steps both immediate after injury and at time of evaluation.

40
Q

When should you get a foot radiograph?

A

Pain in midfoot w/:
Bone tenderness at navicular bone.
Bone tenderness at base of fifth metatarsal.
Inability to bear weight for at least 4 steps both immediate after injury and at time of evaluation.

41
Q

Achilles Tendon Rupture PE?

A

Positive Thompson test = squeeze the gastrocnemius and if weak or absent plantar flexion, it is a POSITIVE test and indicates tendon rupture.

42
Q

Achilles Tendon Rupture?

A

X-ray to r/o fracture.

MRI is best test.

43
Q

Maisonneuve Fracture?

A

X-ray may or may not show fracture or instability since actual bone fracture is well above the ankle.
MRI for ligament injuries.

44
Q

Stress/March Fracture?

A

Clinical as 50% of x-rays are negative in first 2 wks.

If high risk area and refractory: MRI

45
Q

Plantar fasciitis PE?

A

Pain is reproducible on palpation over the heel pad. Pain increases with dorsiflexion of the toes.

46
Q

Plantar fasciitis?

A

Clinical.

47
Q

Tarsal Tunnel Syndrome PE?

A

Positive Tinel sign (tapping at posterior medial malleolus reproduces the sx).

48
Q

Tarsal Tunnel Syndrome?

A

Clinical w/ Tinel sign.

Electromyography confirmative.

49
Q

Charcot Joint/ Neuropathic arthropathy?

A

X-rays: Obliteration of joint space, fragmentation of bone, increased bone density, and disorganization of the joint.

50
Q

Morton’s Neuroma PE?

A

Reproducible pain on palpation or squeezing the foot. Check for numbness or paresthesia in the toes or plantar aspect of the web spaces. May have a palpable, painful mass.

51
Q

Morton’s Neuroma?

A

Clinical, but can get a sonogram to confirm.

52
Q

Jones Fracture?

A

X-ray.

53
Q

Lisfranc Injury?

A

x-ray -> big space between two metatarsals

FLECK sign = fracture at the base of the second metatarsal ligament is PATHOGNOMONIC for disruption of the ligaments.

54
Q

Anterior glenohumeral dislocation PE?

A

While abduction & external rotation; humeral head is palpable with loss of deltoid contour “squared off”.

55
Q

Anterior glenohumeral dislocation?

A

Axillary & scapular Y view (helps distinguish anterior from posterior dislocation) x-rays.

56
Q

Posterior glenohumeral dislocation PE?

A

While adducted and internally rotated, shoulder appears flat with prominent humeral head

57
Q

Posterior glenohumeral dislocation?

A

Axillary & scapular Y view (helps distinguish anterior from posterior dislocation) x-rays; AP view may show “light bulb” sign.

58
Q

Acromioclavicular joint dislocation/seperation?

A

X-ray w/ weights to help see displacement.

59
Q

Acromioclavicular joint dislocation/seperation PE?

A

Step-off (deformity) at AC joint.

60
Q

Adhesive capsulitis PE?

A

Resistance on passive ROM only on affected side.

61
Q

Rotator Cuff Injury PE?

A 
Passive ROM greater than active.
Supraspinatus strength test (“empty can” test) = 90% specificity for assessing supraspinatus involvement
Impingement tests (positive = pain with)
Hawkins
Drop arm test
Neer test
62
Q

Rotator Cuff Injury?

A

X-ray: nml

MRI: Gold Standard.

63
Q

Humeral Head Fracture?

A 
Shoulder radiographs.
CT scan (preop planning).
64
Q

Thoracic Outlet Syndrome PE?

A

+ Adson Sign: loss of radial pulse w/ deep breath, head rotated toward affected side.

65
Q

Thoracic Outlet Syndrome?

A

Confirmative: MRI.

Doppler and EMG/NCV.

66
Q

Olecranon bursitis?

A

Clinical: Aspiration of bursa if suspected septic bursitis or gout (WBC > 2,000 = septic).

67
Q

Peace sign against resistance?

A

Ulnar Nerve

68
Q

“Hitchhiker”/ Thumbs up?

A

Radial Nerve

69
Q

“Power To The People”

A

Median Nerve

70
Q

OK Sign?

A

Median Nerve

71
Q

Radial Head Fracture?

A

Positive posterior or displaced anterior fat pad sign (hemarthrosis) may be the only radiologic evidence.

72
Q

Cubital Tunnel Syndrome PE?

A

Positive Tinel’s sign at the elbow.

Decreased sensation to the fifth and the ulnar side of the fourth finger.

73
Q

Scaphoid (navicular) fracture?

A

Radiographs: fracture may NOT be evident for up to 2 weeks.
If snuffbox tenderness, treat as a fracture because of the high incidence of avascular necrosis or nonunion (since the blood supply to scaphoid is distal to proximal).

74
Q

Scapholunate Dissociation?

A

Widened scapholunate spaces > 3mm.

75
Q

Colles Fracture?

A

Lateral view with dorsally displaced or angulated extraarticular fracture of the distal radius. Lateral view needed to distinguish Colles vs. Smith fracture.

76
Q

Smith Fracture?

A

Lateral view with ventrally displaced or angulated fracture of the distal radius. Lateral view needed to distinguish Colles vs. Smith fracture.

77
Q

Lunate Dislocation?

A

AP view: lunate appears triangular “piece of pie”

Lateral view: volar displacement & tilt of the lunate “spilled teacup” sign.

78
Q

Mallet (baseball) Finger?

A

X-ray: Normal or avulsion fracture of the distal phalanx at the tendon insertion site.

79
Q

De Quervain Syndrome?

A

Finkelstein test: positive means -> first dorsal compartment pain with ulnar deviation while the thumb is flexed in the palm or pain with thumb extension.

80
Q

Carpal Tunnel Syndrome?

A

Tinel Test: positive if percussion of the median nerve produces symptoms
Phalen test: positive if flexion of both wrists for 30-60 seconds reproduces symptoms.

81
Q

Boxer’s Fracture?

A

X-ray.

82
Q

Radial Head Subluxation?

A

Clinical. X-rays normal.

CM 4 (9 decks)

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