3, 4, 5 Star topics 3 Flashcards Preview

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Flashcards in 3, 4, 5 Star topics 3 Deck (111):
1

Sx of carpal tunnel syndrome (4)

Wrist pain that radiates up arm and worsens w/ flexion and grasping
Numbness/tingling in thumb, index, middle and radial side of 4th finger
Decreased grasp strength
Thenar atrophy long term

2

Signs of carpal tunnel syndrome (4)

Tinel and Phalen signs

3

Treatment carpal tunnel syndrome (4)

Activity modification, wrist splints
NSAIDs, steroid injections
Surgical release of ligament

4

Nerve affected in carpal tunnel syndrome (4)

Median nerve

5

MC shoulder dislocation (3.5)

Anterior

6

MC hip dislocation (3.5)

Posterior

7

Shoulder dislocation w/ external rotation and slight abduction (3.5)

Anterior

8

Shoulder dislocation w/ internal rotation (unable to externally rotate) and adduction (3.5)

Posterior

9

Shoulder rotation w/ possible axillary nerve damage (3.5)

Anterior

10

Nerve damage w/ claw hand (3)

Ulnar

11

Nerve damage w/ ape hand (3)

Median

12

Nerve damage w/ wrist drop (3)

Radial

13

Nerve damage w/ scapular winging (3)

Long thoracic

14

Nerve damage w/ inability to wipe bottom (3)

Thoracodorsal

15

Nerve damage w/ loss of forearm pronation (3)

Median

16

Nerve damage w/ inability to abduct or adduct fingers (3)

Ulnar

17

Nerve damage w/ loss of shoulder abduction (3)

Axillary

18

Nerve damage w/ weak external rotation of arm (3)

Suprascapular / Axillary

19

Nerve damage w/ loss of elbow flexion and forearm supination (3)

Musculocutaneous

20

Nerve damage w/ loss of wrist extension (3)

Radial

21

Nerve damage w/ trouble initiating shoulder abduction (3)

Suprascapular

22

Nerve damage w/ inability to abduct arm >10 degrees (3)

Axillary

23

Nerve damage w/ inability to raise arm above horizontal (3)

Long thoracic, spinal accessory

24

Nerve damage w/ fx of shaft of humerus (3)

Radial

25

Nerve damage w/ fx of surgical neck of humerus (3)

Axillary

26

Nerve damage w/ supracondylar humerus fx (3)

Median

27

Nerve damage w/ fx of medial epicondyle (3)

Ulnar

28

Nerve damage w/ anterior shoulder dislocation (3)

Axillary

29

Nerve damage w/ carpal tunnel injury (3)

Median

30

Back pain w/ radiation to epigastrum (5)

PUD, GERD, gastritis
Pancreatitis
AAA

31

Back pain w/ radiation to pelvis (5)

Nephrolithiasis, pyelonephritis

32

Back pain along paraspinal area only (5)

Muscle strain

33

Back pain w/ osteoporotic patient (5)

Compression fx

34

Back pain w/ back asymmetry (5)

Scoliosis

35

Back pain w/ abnormal gait (knees/hips flexed) (5)

Spondylolisthesis

36

Back pain w/ systemic symptoms (5)

Meningitis, discitis, osteomyelitis

37

Back pain worse w/ exertion, +straight leg raise (5)

Disk herniation

38

Back pain w/ walking, standing, better in supermarket (5)

Spinal stenosis

39

Back pain worse at rest, better w/ activity (5)

Ankylosing spondylitis (esp 20-30 yo men)

40

Back pain 24 hrs including night or at rest (5)

R/o cancer

41

Back pain w/ bowel or bladder dysfunction (5)

Cauda equina

42

Back pain w/ saddle anesthesia (5)

Cauda equina

43

Treatment spinal stenosis (4)

Analgesics (NSAIDs), PT, epidural injections
Surgical decompression

44

Treatment cauda equina syndrome (3.5)

Emergency surgical decomression

45

Waiter's tip (3.5)

Erb-Duchenne palsy (superior trunk)

46

Deltoid paralysis (3.5)

Axillary nerve damage (assoc w/ anterior shoulder dislocation)

47

Claw hand + thenar/hypothenar eminence + possible Horner's syndrome (3.5)

Klumpke palsy (C8-T1)

48

Paget disease of bone s/sx (3.5)

Possibly asymptomatic
"Hat no longer fits," bone pain, increased fx, tibial bowing, deafness, kyphosis
Increased alk phos, normal other labs

49

Paget disease of bone diagnostic radiology (3.5)

Bone scan for "hot spots"

50

Paget disease of bone treatment (3.5)

Bisphosphonates
Calcitonin (SC)
No treatment if asymptomatic

51

Asymmetric arthritis (possibly only one joint) w/ PIP, DIP involvement (3)

Osteoarthritis

52

Symmetric arthritis w/ DIP sparing w/ PIP, MCP (3)

Rheumatoid arthritis

53

Insidious joint stiffness and pain that worsens w/ activity and weight bearing and is relieved by rest (3)

Osteoarthritis

54

Pannus formation (3)

Rheumatoid arthritis

55

Swan neck, boutonniere deformities; ulnar deviation of fingers (3)

Rheumatoid arthritis (S = flexed DIP, B = flexed PIP)

56

Insidious joint stiffness and pain w/ 30+ min morning stiffness, worse w/ rest, better w/ activity (3)

Rheumatoid arthritis

57

Rheumatoid arthritis treatment (3)

Start DMARDs early (sulfasalazine, hydroxychloroquine, MTX for moderate)
Also anti-TNFa
Steroids, NSAIDs as adjuncts

58

Drug induced lupus causes (3)

SHIPP
Sulfa drugs (esp sulfasalazine)
Hydralazine
Isoniazid
Phenytoin
Procainamide
(Methyldopa, quinidine, chlorpromazine)

59

Skin symptoms of SLE (3)

Malar rash
Discoid rash
Photosensitivity
Painless oral ulcers

60

Inflammatory symptoms of SLE (3)

Arthritis (symmetric, non-erosive, 2+ joints)
serositis (pleuritis, pneumonitis, pericarditis)
++ANA

61

Organ system symptoms of SLE (3)

Renal
Neurologic (seizures, psychosis, stroke, neuropathy)
Hematologic
Immunologic (dsDNA, Smith, phospholipid Abs)

62

Major causes of death of SLE (3)

Renal disease
Infection

63

Treatment of SLE (3)

Avoid sun
NSAIDs, steroids
Hydroxychloroquine
Anticoagulation if needed

64

Proximal muscle weakness (legs first) (3)

Polymyositis

65

Proximal muscle weakness + rash (3)

Dermatomyositis

66

Dermatomyositis skin signs (3)

Purple/red heliotropic rash (periorbital)
Shawl sign
Gottron's papules
Mechanic's hands

67

Pain and stiffness in hips and shoulders (trouble raising arms and getting out of bed) with NO weakness (3)

Polymyalgia rheumatica

68

PMR patients should be worked up for what? (3)

Temporal arteritis

69

Muscle pain and tenderness in multiple distinct locations (trigger points) (3)

Fibromyalgia

70

Young man w/ low back pain that is worse in morning and improves w/ exercise (3)

Ankylosing spondylitis

71

Pencil-in-cup deformities of PIP and DIP joints (3)

Psoriatic arthritis

72

Bamboo spine on x-ray (3)

Ankylosing spondylitis

73

Asymmetric arthritis worse in morning, improves w/ activity (3)

Psoriatic arthritis

74

CREST scleroderma (3)

Calcinosis cutis (SQ calcifications, often in fingers)
Raynaud phenomenon
Esophageal dysmotility
Sclerodactyly (skin thickening of fingers, hands, face)
Telangectasias (lip, hand, face)

75

Dry eyes, dry mouth, arthritis (3)

Sjogren syndrome

76

Adolescent, obese male w/ thigh/knee/hip pain (4)

Slipped capital femoral epiphysis (SCFE)

77

SCFE treatment (4)

Surgical pinning, weight-bearing restriction

78

SCFE complications (4)

AVN, premature OA

79

AVN of capital femoral epiphysis btwn 3-8 years old (4)

Legg-Calve-Perthe's disease

80

Legg-Calve-Perthe's disease treatment (4)

Non-weight bearing
Observation or bracing, Petrie cast, osteotomy
Surgical correction rare
50% untreated cases recover fully

81

Pediatric limp + x-ray shows femoral head sclerosis (4)

Legg-Calve-Perthe's disease

82

Pediatric limp + x-ray shows "ice cream scoop falling off cone" (4)

SCFE

83

Pediatric limp + acute onset tibial pain, fever, malaise, elevated ESR, no joint pain (4)

Osteomyelitis

84

Pediatric limp + acute onset knee pain, fever, elevated ESR, +WBC (4)

Septic arthritis

85

Pediatric limp + obese, male adolescent with dull hip pain and inability to bear weight (4)

SCFE

86

Pediatric limp + 7 yr old with growth delay and inner thigh pain (4)

Legg-Calve-Perthe's disease

87

Pediatric limp + 13 yr old boy w/ pain and swelling at tibial tuberosity (4)

Osgood-Schlatter

88

Erythematous papule w/ rough, yellow-brown scales, <5 mm in diameter, in sun-exposed area (4)

Actinic keratosis (pre-SCC)

89

Painless, erythematous, irregular-looking papule w/ scaling or keratinized growths in sun-exposed areas; may become painful, bleed, or ulcerate (4)

Squamous cell carcinoma

90

Pearly papule w/ telangiectasias or rolled edges around ulceration (4)

Basal cell carcinoma

91

Irregular borders, multiple colors, large or rapidly growing moles (4)

Melanoma

92

Metastatic risk of skin cancers (4)

BCC <0.1%
SCC 5-10%
Melanoma MC

93

MCC skin cancer (4)

BCC

94

Most important prognostic factor for melanoma (4)

Thickness (always need punch or excisional biopsy)
>0.76 mm associated w/ increased risk metastasis

95

Follow what characteristics of moles? (4)

ABCDE
Asymmetry
Border (irregular)
Color (variable)
Diameter (>6 mm)
Enlargement

96

MC type of melanoma (4)

Superficial spreading

97

Non-pigmented melanoma (4)

Amelanotic

98

Dark papule on legs or trunk that bleeds w/ minor trauma, melanoma type (4)

Nodular (only grows vertically, rapidly invasive)

99

occurs on palms, soles or beneath nail plate in patients w/ dark skin, melanoma type (4)

Acral lentiginous

100

Dark lesion larger than 6 mm w/ irregular, asymmetric borders (4)

Superficial spreading melanoma

101

Long-lasting in situ melanoma before vertical growth (4)

Lentigo maligma

102

Treatment of actinic keratosis (4)

Topical 5-fluorouracil or imiquimod, cryotherapy

103

Treatment of squamous cell carcinoma (4)

Surgical/Mohs excision, radiation for large lesions

104

Treatment of basal cell carcinoma (4)

Surgical/Mohs excition, radiation or cryotherapy

105

Treatment of melanoma (4)

Surgical excision w/ 0.5 cm margin (in situ), 1 cm margin (2 mm thick)
Possible LN dissection
Chemo and radiation if metastatic

106

Purple-red lesion on face that does not regress with age (3)

Port-wine stain (Sturge Weber syndrome if in ophthalamic area)

107

Infant w/ bright-red lesion that regresses over months-years (3)

Strawberry hemangioma

108

Benign, small red papule that appears on skin w/ age (3)

Cherry hemangioma

109

Bright red papule w/ radiating blanching vessels (3)

Spider hemangioma (assoc w/ liver disease)

110

Blue or red compressible mass that does not regress (3)

Cavernous hemangioma

111

Red-pink nodule on a child often confused w/ melanoma (3)

Spitz nevus