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Internal Medicine > MSK > Flashcards

MSK Flashcards

1
Q

IBD is associated with what arthropathy?

A

Spondyloarthritis

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2
Q

Pulmonary fibrosis is associated with what arthropathy?

A

Rheumatoid arthritis

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3
Q

Lumbar stenosis pain worsens with what movement?

A

Lumbar extension

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4
Q

Herniated disc pain worsens with what movement?

A

Lumbar flexion, sitting

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5
Q

Compression fracture pain worsens with what movements?

A

Sitting and standing

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6
Q

How is mild radiculopathy diagnosed and treated?

A

Clinically, no need for imaging

NSAIDs, glucocorticoids if severe pain

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7
Q

Left diaphragm referred pain is where, and can be caused by what?

A

Left shoulder; contained splenic bleed

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8
Q

Under what cases does alk phos represent bone metastases?

A

Osteoblastic, not osteolytic, metastases

MM and renal cell are osteolytic

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9
Q

Ganglion cyst differential diagnosis

A

Ganglion cyst: round, rubbery, transilluminates - observation/needle aspiration/surgery
Epidermal cyst: painful, nontransilluminating, overlying punctum - use corticosteroids
RA nodule: hard, fixed, nontransilluminating

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10
Q

How does treatment of clavicular injury depend on which part is fractured?

A

Middle third: closed reduction and figure-of-eight brace
Distal third: open reduction and internal fixation

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11
Q

How does magnesium sulfate affect skeletal and cardiac muscle?

A

Skeletal muscle - decreased acetylcholine release
Cardiac muscle - prolonged conduction time

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12
Q

What is more typically seen in electrical, rather than thermal, burns?

A

Direct injury to muscle tissue –> rhabdomyolysis

Vs circumferential constrictive eschar

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13
Q

Which locations are high risk for malunion if stress fracture is suspected?

A

Fifth metatarsal, anterior tibial cortex; refer to orthopedic surgeon

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14
Q

Stress fracture shows how on imaging?

A

Hairline lucency or periosteal thickening, but would not see in first 1-2 weeks on x-ray

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15
Q

What does delta pressure on needle manometry correspond to with regards to compartment syndrome?

A

Delta pressure = diastolic BP - compartment pressure <=30 mm Hg reflects compromised perfusion pressure

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16
Q

When can compartment syndrome be diagnosed clinically?

A

High risk: e.g. those with limb revascularization

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17
Q

Superior pulmonary sulcus tumor would affect which nerves?

A

Brachial plexus –> shoulder pain
C8-T1 (ulnar) –> Weakness/atrophy of intrinsic hand muscles, pain/paresthesia of 4th/5th digits and medial arm/forearm
Paravertebral sympathetic chain/cervical ganglion –> Horner syndrome

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18
Q

Superior pulmonary sulcus tumor causes which lymphadenopathy and is from which cancer?

A

Supraclavicular

Lung adenocarcinoma or squamous cell

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19
Q

How can a spinal epidural abscess form?

A

Trauma –> hematoma

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20
Q

Classic triad of spinal epidural abscess

A
  1. Spinal pain –> radiculopathic pain
  2. Neurologic deficits
  3. Fever
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21
Q

In Peyronie disease, fibrous plaques form where?

A

In the tunica albuginea, reducing elasticity and expansion during erection –> pain, curvature

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22
Q

Peyronie disease treatment

A

NSAIDs for pain
Pentoxifylline - reduce fibrosis
Intralesional injections of collagenase
Surgery if refractory

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23
Q

Pelvic fracture signs, risks after

A
  1. Adducted, internally rotated lower extremity
  2. Perineal bruising

Risk for posterior urethral injury - abrupt upward motion of bladder and prostate can lead to urethral tearing at bulbomembranous junction
Also risk of bladder rupture

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24
Q

Posterior urethral injury signs

A
  1. Blood at urethral meatus
  2. Inability to void
  3. Perineal bruising
  4. High-riding prostate

Perform retrograde urethrography (X-ray with injection of contrast)

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25
Q

Posterior cruciate ligament injury causes, Sx

A

Causes: Hyperextension or blow to anterior aspect of proximal tibia

Symptoms: Little pain or alteration in range of motion

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26
Q

Patellar dislocation signs

A

After quick, twisting motion around flexed knee
Lateral displacement with associated tear of medial patellofemoral ligament

Exam: lateral dislocation of patella, decreased extension, hemarthrosis and tenderness along medial patella

Often reduces spontaneously but may require closed reduction
Follow with X-ray to rule out additional injuries

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27
Q

Patellofemoral syndrome - signs

A

More common in women
Anterior pain worsened by squatting, climbing stairs, prolonged sitting
Pain and crepitus may be elicited by extending knee while compressing patella

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28
Q

Pes anserinus pain syndrome - signs

A

Localized pain over anteromedial tibia just below the joint line, often exacerbated by pressure from opposite knee while lying on the side
Absent swelling, erythema, induration

Pes anserinus is formed by conjoined tendons of gracilis, sartorius, and semitendinosus
Bursa located underneath pes anserinus but usually not truly inflamed

Caused by abnormal gait, overuse, or trauma

Treat with quadriceps exercises and NSAIDs

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29
Q

Test for complete supraspinatus tear

A

Drop arm test - drops rapidly around mid-descent (although it initiates the first 15 degrees of abduction)

MRI to confirm

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30
Q

Long thoracic nerve injury - cause, signs

A

Caused by penetrating trauma or procedures (e.g. chest tube insertion)
Weakness of serratus anterior with impairment at extreme abduction due to inability to rotate scapula upward

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31
Q

Which nerve injury causes claw hand deformity?

A

Lower (inferior) trunk of brachial plexus (C8, T1) - ulnar (e.g. intrinsic muscles of hand)

Injured by sudden upward traction on arm (Klumpke palsy)

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32
Q

Which collagen is Ehlers-Danlos?

A

Type V collagen

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33
Q

Stump hematoma - signs

A

Swelling
Ecchymosis
Skin breakdown

First several days following amputation

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34
Q

High-impact fall onto outstretched arm typically produces what injury?

A

Supracondylar humerus fractures (particularly children age 2-7)

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35
Q

Displaced supracondylar humerus fracture can affect which vessel and nerve?

A

Brachial artery and median nerve - pass anterior to humerus

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36
Q

How would an occult fracture present on X-ray?

A

Inflammation displaces synovial fat, leading to widened fat pads around the fracture site

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37
Q

Compartment syndrome 4 Ps

A
  1. Pallor
  2. Puleslessness
  3. Paresthesia
  4. Paralysis
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38
Q

What signs with penile fracture are concerning for concomitant urethral injury?

A
  1. Blood at meatus
  2. Hematuria
  3. Dysuria
  4. Urinary retention
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39
Q

What is the most common dislocation of the humerus? What nerve is injured?

A

Anteriorly from the glenohumeral joint; also the most commonly dislocated joint in the body

Anterior dislocation caused by blow to externally rotated and abducted arm

Axillary nerve is most commonly injured (teres minor, deltoid) –> weakened shoulder abduction; shoulder sensory innervation

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40
Q

Radial nerve innervation

A

Extensor muscles of wrist and digits
Sensory posterior arm, forearm, and dorsolateral hand

Commonly injured in humeral midshaft fractures

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41
Q

Biceps reflex - what nerves

A

C5, C6 - muscular innervation via musculocutaneous nerve (lateral cord of brachial plexus)

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42
Q

Ulnar nerve innervation

A

Intrinsic muscles of hand
Sensory loss of medial hand

Injured by fracture of medial epicondyle of humerus or deep laceration of anterior wrist

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43
Q

What damage causes scapular winging?

A

Long thoracic nerve - serratus anterior

Caused by deep lacerations to axillary region and axillary lymphadenectomy

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44
Q

What does a brown recluse spider bite do?

A

Ischemia leads to burning pain after a few hours
Small papule or in rarer cases blister with bluish discoloration and necrosis extending in gravity dependent manner
Treat with cold, which decreases venom phospholipase activity
Avoid debridement in early necrosis

Commonly when putting clothes on
Can be worse than papule: Forms ulcer —> necrosis, eschar

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45
Q

Growth plate fracture appears how?

A

Physeal fracture is suggested by growth plate widening on CT

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46
Q

When does the tibial growth plate close in boys/girls?

A

14/12 yo

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47
Q

Injury to growth plate can cause what complications?

A
  1. Growth arrest and limb-length discrepancy
  2. Physeal bars (bony bridges across growth plate)
  3. Premature osteoarthritis
  4. Decreased range of motion
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48
Q

Traumatic foot drop occurs due to damage to what nerve?

A

Common peroneal nerve as it wraps around lateral neck of proximal fibula

49
Q

Arm anterior dislocation vs posterior dislocation positions

A

Anterior: arm held in abduction/external rotation
Posterior: arm held in adduction/internal rotation

50
Q

When does myositis ossificans occur?

A

Following fracture or muscle contusion (e.g. quadriceps), typically in lower extremities

51
Q

Complications of auricular hematoma

A
  1. Infection in 2-3 days and abscess formation
  2. Avascular necrosis (cartilage only blood supply is through perichondrium)
  3. Cauliflower ear due to fibrocartilaginous overgrowth
52
Q

Where is osteosarcoma most common?

A

Metaphysis of long bones: proximal humerus, distal femur, proximal tibia
Boys 13-16

Tender soft-tissue mass

53
Q

Spiculated sunburst pattern is what cancer?

A

Osteosarcoma

Can also see periosteal elevation (Codman triangle)

54
Q

Osteoid osteoma signs

A
  1. Pain worse at night, relieved by NSAIDs
  2. Central lucency with sclerotic margins
55
Q

How do popliteal cysts form? How do ruptured cysts appear?

A

Synovial fluid from knee joint space to gastrocnemius or semimembranosus bursa
Can occur from synovial fluid excess (OA, RA) and knee extension

Arc of ecchymosis distal to medial malleolus; calf pain, erythema and warmth

56
Q

Dinner fork deformity of wrist

A

Colles (Radial) fracture
Falling on outstretched hand

57
Q

Radius fracture affects what structures?

A

Median nerve (dorsal displacement of radius)
Sensation: lateral 3.5 digits
Motor: thenar (opponens pollicis, abductor pollicis brevis)

Compression can causes acute carpal tunnel syndrome (including impaired thumb abduction)

If compression is proximal to tunnel, palmar cutaneous branch may also be affected

58
Q

How can ulnar nerve be injured? What is affected?

A

Elbow: external compression (e.g. funny bone)
Wrist: hamate fracture or external compression (e.g. bicycle handlebar)

Sensation: medial 1.5 digits
Adduction of index, 4th, 5th digits towards 3rd digit (palmar interossei, innervated by deep branch of ulnar)

59
Q

Radial nerve injury location and signs

A

Elbow - weakness of hand/finger extensor muscles
Sensory loss over posterior forearm/dorsolateral hand

Seen in supracondylar humerus fractures

60
Q

Avascular necrosis of hip - atraumatic causes and x-ray features

A

Atraumatic: Alcohol, glucocorticoids

X-ray: Subchondral lucency, collapsed femoral head

61
Q

Important components of rib fracture care

A

Analgesia to allow good tidal volume and prevent atelectasis, pneumonia
Incentive spirometer

62
Q

Fat embolism signs

A

In 24-72h following fracture:
1. Hypoxemia
2. Neurological changes (>50% cases)
3. Rash (<50% cases)

63
Q

How would a C5 lamina fracture occur?

A

Neck hyperextension (e.g. hitting airbag)
Can result in injury to adjacent facet, causing nerve root injury and radiculopathy

64
Q

What do you do if there is a single vertebral fracture (especially cervical)?

A

Image entire cervical spine, 20% chance of noncontiguous vertebral fracture

65
Q

How does osteonecrosis of femoral head appear on x-ray?

A

Flattening/collapse of femoral head
Patchy sclerosis

66
Q

Primary screening for cervical spine injury

A

Start with CT without contrast

If NEXUS negative, then do basic neuro exam

67
Q

SCFE leg position

A

Abduction and external rotation with passive hip flexion
Limited internal rotation so foot points laterally

68
Q

Avascular necrosis of hip - pain, imaging

A

Pain on hip abduction and internal rotation
Groin pain on weight bearing

Crescent sign in advanced stage
MRI most sensitive

69
Q

What arteries supply the femoral head?

A
  1. Ascending arteries
  2. Foveal artery within ligamentum teres - may become obliterated in older patients
70
Q

What are the most common hip fractures in older adults, typically due to fall?

A

Femoral neck fracture
Intertrochanteric fracture

Shortening and external rotation of affected leg

71
Q

What injury is likely if patient has leg shortened AND externally rotated?

A

Femoral neck or intertrochanteric fracture
Rarer: anterior hip dislocation (severe trauma)

Due to contraction of psoas and iliacus without normal acetabular counterforce

If just shortened, could be femoral shaft fracture (with angulation) or pubic ramus fracture

72
Q

Intracapsular vs extracapsular fracture

A

Intracapsular - no significant ecchymoses, higher risk of AVN
Extracapsular - visible ecchymoses, higher risk for displacement

73
Q

Anterior vs posterior dislocation positioning

A

Anterior dislocation - externally rotated
Posterior dislocation - internally rotated and adducted; may involve sciatic nerve

74
Q

Scoliosis red flag features

A
  1. Back pain
  2. Neurologic symptoms
  3. Rapidly progressing curve (>=10 deg per year)
  4. Vertebral anomalies on x-ray
75
Q

Scoliosis imaging

A

PA and lateral spine x-rays
MRI if pathologic etiology suspected

76
Q

Rotator cuff impingement/tendinopathy vs acromioclavicular arthritis vs adhesive capsulitis

A

Rotator cuff tendinopathy: pain with abduction and external rotation, normal range of motion, impingement signs (Neer+)

Tear: same as above + weakness, age>40

Acromioclavicular arthritis: tenderness, swelling, or deformity in acromioclavicular space

Adhesive capsulitis: decreased passive + active range of motion

77
Q

Foot eversion and inversion muscles

A

Eversion: peroneus - inserts onto lateral aspect of foot

Inversion: tibialis anterior and posterior - medial aspect of foot

78
Q

How is meniscal tear diagnosed?

A

MRI or arthroscopy

79
Q

Iliotibial band syndrome vs pes anserinus syndrome

A

Lateral (femoral condyle) vs medial (distal to joint line)

80
Q

Shoulder abduction relief test

A

Improves radicular symptoms - can be both diagnostic and short-term therapeutic

81
Q

Worsening limb pain and paresthesia with lateral neck flexion

A

Relatively specific for cervical radiculopathy

82
Q

Osteosarcoma genetic links

A

RB1 (Retinoblastoma)
p53 (Li-Fraumeni; adrenocortical tumors)
Leukemia
Breast
Brain

83
Q

What is a hinged unloader knee brace?

A

Hinged unloader (valgus) knee braces transfer load from medial to lateral joint compartment - useful for patients with medial unicompartmental OA associated with varus deformity

84
Q

Decreased shoulder abduction with intact sensation following posterior glenohumeral dislocation

A

Rupture of supraspinatus tendon (rotator cuff injury)

As opposed to axillary nerve injury, which would mimic rotator cuff injury but also have sensory loss

85
Q

Carpel tunnel syndrome would not affect sensation of which part?

A

Thenar eminence - palmar cutaneous branch of median nerve passes outside the carpal tunnel

86
Q

Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS)

A

Myopathy with acute neurologic changes

Noninvasive workup - serum lactate/pyruvate, creatine kinase
Muscle biopsy confirms diagnosis

87
Q

Which artery and nerve are associated with supracondylar fracture of humerus (posterior dislocation)?

A

Brachial artery - weak brachial + radial pulses
Median nerve - weak “ok” sign

Note: anterior displacement due to fall on flexed arm would injure ulnar nerve posterior to medial epicondyle

88
Q

Position of nursemaid’s elbow

A

Pronated and extended

Caused by pulling arm or lifting and swinging child by arm

89
Q

Asymmetric oligoarthritis with mouth ulcers, conjunctivitis, or urethritis

A

Reactive arthritis

Can also have enthesitis

90
Q

When is skeletal alk phos elevated?

A

Osteoblastic activity

91
Q

Urine hydroxyproline

A

Seen with collagen breakdown - ex. Paget disease of bone

92
Q

Common causes of acute viral arthritis

A

HIV
Hep B/C
Parvovirus B19
Rubella

93
Q

Reactive vs viral arthritis

A

Reactive: seronegative spondyloarthropathy, chronic asymmetric arthritis, inflammatory back pain

94
Q

Does scaphoid fracture typically cause nerve injury?

A

No, but lunate does

95
Q

Causes of calcium pyrophosphate deposition

A

Elevated serum calcium:
Hyperparathyroidism

Hypothyroidism

Hemochromatosis - iron deposition in joint precipitates condition
Chronic arthritis

96
Q

Meralgia paresthetica vs greater trochanteric pain syndrome

A

Meralgia: burning pain and tingling
GTPS: pain localized to lateral hip and worsened by direct pressure

97
Q

Anterior shoulder pain

A

Biceps tendinopathy/rupture

98
Q

Anterior vs posterior hip dislocation vs hip fracture

A

Anterior: leg lengthened and externally rotated
Posterior: leg shortened and internally rotated
Hip fracture: leg shortened and externally rotated

99
Q

Ulnar wrist vs elbow symptoms

A

Wrist - small finger and medial 4th finger (superficial); intrinsic weakness (deep)

Elbow - medium dorsum of hand (dorsal cutaneous) and hypothenar eminence (palmar cutaneous) and weakness of grip and wrist flexion

100
Q

Position of leg with SCFE or AVN of femoral head

A

Externally rotated and adducted (limited abduction)

101
Q

Shin splint vs stress fracture of tibia

A

Shin splints (medial tibial stress syndrome) have diffuse pain, rather than point tenderness, along tibia shaft

Seen in obese or novice runners

102
Q

Hook-like osteophytes on the 2nd and 3rd metacarpal heads of the hand

A

Hemochromatosis, resembling osteoarthritis

103
Q

Pencil-in-cup deformity - narrowing of proximal phalanx with erosion of distal phalanx

A

Psoriatic arthritis

104
Q

Joint mass with punched out lytic lesions and rim of overhanging bone, as well as soft tissue opacification

A

Gout - rat-bite lesion

105
Q

Compression fracture vs disc degeneration

A

Compression fracture pain is worse with movement/cough/strain and may persist at night; vertebral point tenderness

Disc degeneration pain is chronic, worsens with activity, and relieved with rest; can lead to disc herniation with lumbosacral radiculopathy

106
Q

de Quervain tendinopathy refers to which tendons?

A

Abductor pollicis longus and extensor pollicis brevis

107
Q

Pain with flexion of thumb with wrist in ulnar deviation

A

Finkelstein/Eichhoff tests - de Quervain tendinopathy

108
Q

Potential benign/malignancies from Paget disease

A

Benign giant cell tumor
Osteosarcoma

109
Q

In part, how do glucocorticoids cause osteoporosis?

A

Apoptosis of osteoblasts

110
Q

Exam findings of polymyalgia rheumatica

A

Normal strength but maybe limited range of motion in proximal joints, stiffness > pain

111
Q

Does polymyositis have pain?

A

It is mild or absent

112
Q

Odontoid process fracture

A

Often in MVA - causes spinal cord compression (myelopathy)

113
Q

Supraspunatus vs infra function

A

Supra: shoulder abduction
Infra: external rotation

Both innervation by suprascapular nerve from brachial plexus

114
Q

Posterior humerus dislocation on x-ray

A

Lightbulb sign, loss of overlap between humeral head and glenoid

115
Q

Nonbenzo muscle relaxants (e.g. cyclobenzaprine, tizanidine) - side effects

A

Drowsiness
Anticholinergic

116
Q

Difference between threatened and nonviable limb

A

Nonviable has severe sensory motor loss, absent capillary refill, and inaudible venous Doppler

117
Q

In which shoulder condition does subacromial injection of anesthetic help pain but not range of motion?

A

Adhesive capsulitis

118
Q

Tenderness at margin of supinator, several cm distal to elbow

A

Radial tunnel syndrome

Internal Medicine (23 decks)

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