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DIT STEP 2 > MUSCULOSKELETAL/RHEUM > Flashcards

MUSCULOSKELETAL/RHEUM Flashcards

1
Q

Mechanism in anterior shoulder dislocation

A

Posteriorly directed force on distal humerus or forearm during abduction drives humeral head forward and tears anterior shoulder capsule

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2
Q

Most common mechanisms in posterior shoulder dislocation

A

Seizures and electrical shock

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3
Q

Unhappy triad

A

Medial meniscus tear
MCL
ACL

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4
Q

Emergent fasciotomy for compartment pressures at what level?

A

> 30 mm Hg or within 20 mm Hg of DBP

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5
Q

Distal radius is displaced in what direction in a smith fracture

A

Anteriorly

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6
Q

What is a montage fracture

A

Dislocation of radial head and ulnar diaphysial fracture – “nightstick injury”

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7
Q

Galeazzi fracture

A

Distal radio-ulnar joint dislocation and radial diaphyseal fracture

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8
Q

Which fx has high risk for compartment syndrome

A

Tibial

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9
Q

Complication of pelvic fx

A

High risk of major blood loss

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10
Q

MOA of teriparatide

A

Recombinant human parathyroid hormone. Used in pulsatile fashion it stimulates osteoblasts and bone remodeling.

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11
Q

Increased bone density caused by impaired osteoclast activity

A

Osteopetrosis

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12
Q

Labs in osteopetrosis

A

Decreased H&H due to narrowing of marrow cavities
Increased acid phosphatase
Increased CK

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13
Q

Labs in Pagets

A

Increased alk phos and urine hydroxyproline

Normal calcium and phosphorous

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14
Q

What kind of lesions caused by pages disease

A

OsteoLYTIC

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15
Q

What kind of lesions in prostate cancer bone mets

A

OsteoBLASTIC

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16
Q

MOA of allopurinol

A

Inhibits uric acid formation

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17
Q

MOA of probenecid

A

Inhibits kidney uric acid resorption

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18
Q

Xray shows chonedrocalcinosis in knee and wrist

A

PSeudogout!

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19
Q

Tx of pseudogout

A

NSAIDs and colchicine

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20
Q

Joint aspiration shows 5000-50000 leukocytes

A

Inflammatory arthrpathies like RA, gout, or pseudo gout

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21
Q

Tx for lyme

A

Doxy or amoxicillin in early disease

Cefuroxime for advanced disease

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22
Q

Bouchard nods

A

PIP

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23
Q

Heberden nodes

A

DIP joint

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24
Q

DIP joints are spared in OA or RA?

A

RA

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25
Q

Flexed DIP plus hyperextended PIP

A

Swan neck deformity (RA)

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26
Q

Flexed PIP

A

Boutonnniere deformities seen in RA

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27
Q

Anticitrulline-containing protein IgM antibodies

A

RA

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28
Q

Anti-Jo-1 antibodies

A

Polymyositis or dermatomyositis

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29
Q

Anti-scl-70, ANA

A

Scleroerma

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30
Q

Anti-centromere antibodies

A

CREST syndrome

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31
Q

Anti-RNP ANA

A

Mixed connective tissue disease

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32
Q

PTs still symptomatic following NSAId use in RA may be started on what meds?

A

Sulfasalazine
Hydroxychloroquine
Analgesics

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33
Q

Common drugs that cause drug-induced lupus

A 
Hydralazine
Procainamide
INH
Methyldopa
Quinidine
Chlorpromazine
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34
Q

Anti-Sm antiodies

A

Very specific for SLE

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35
Q

Complement in SLE

A

Decreased C3 and C4

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36
Q

Weakness is a symptom of polymyositis or polymyalgia rheumatic?

A

Polymyositis

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37
Q

Muscle biopsy in pts with polymyositis

A

Inflammatory cells WITHIN muscle fascicles and muscle degeneration

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38
Q

Muscle biopsy in pts with dermatomyositis

A

Inflammatory cells SURROUNDING muscle fascicles, muscle degeneration

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39
Q

EMG in polymyositis/dermatomyositis

A

Spontaneous fibrillations

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40
Q

Extra-organ involvement in polymyositis and dermatomyositis

A

Possible interstitial lung disease (especially if anti-Jo-1 antibodies)

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41
Q

Next step once polymyalgia rheumatic diagnosed

A

Workup for temporal arteritis.

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42
Q

Pencil in cup deformities

A

Psoriatic arhtritis

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43
Q

Tx for Raynaud in Scleroderma

A

CCB and avoidance of caffeine, nicotine, and decongestants

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44
Q

Malignant renal HTN in scleroderma is treated with?

A

ACE-I

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45
Q

Mixed connective tissue disease is a combo of what 3 disorders

A

SLE + scleroderma + [polymyositis

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46
Q

What is sicca syndrome

A

Sjogren without a secondary autoimmune association

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47
Q

Fractures following minor trauma in a middle aged patient?

A

Bone mets

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48
Q

Risk factors for osteosarcoma

A 
Paget disease of bone
p53 genetic mutations
Familial retinoblastoma
Radiation exposure
Bone infarcts
49
Q

Sunburst pattern an dCodman triangle

A

Osteosarcoma

50
Q

Tumors that mets to bone

A 
Prostate
Renal
Thyroid
Lung
Lymphoma
Breast

(Permanently Relocated Tumors Like Long Bones)

51
Q

Most commonn benign bone tumor in metaphysics of long bones

A

Osteochondroma

52
Q

Female delivered breech presentation should be worked up for?

A

Devlopmental dysplasia of the hip

53
Q

Most commonly used method of imaging hip congruity (in infants)

A

Ultrasound. Xrays aren’t helpful until after 4 months of age

54
Q

Tx of devo dysplasia of hip

A

Pavlik harness

55
Q

X-rays may demonstrate osteopenia and subchondral sclerosis around INVOLVED JOINTS?

A

Juvenila idiopathic arthritis

56
Q

Tx of juvenile idiopathic arhritis

A

Usually NSAIDS, methotrexate, or corticosteroids

57
Q

Complications of pauciarticular juvenile RA

A

Blindness from iridocyclitis

58
Q

Amyloidosis is a complication of which form of JRA?

A

Systemic

59
Q

Which JRA has worst prognosis

A

Polyarticular. Worse with older onset.

60
Q

Type 1 salter-harris physeal fracture

A

Physeal separation without extension into adjacent bone

61
Q

Salter Harris II

A

Partial physeal separation with pro extension into metaphysis

62
Q

Salter Harris III

A

Partial physeal separation with distal extension into epihpysis

63
Q

Salter Harris Type IV

A

Fracture extends through metaphysics, physics, and epihpysis

64
Q

Salter Harris Classification type V

A

Crush injury. High likelihood of partial growth arrest :(

65
Q

Tx of nursemaid’s elbow

A

Manual reduction via supination of arm with flexion of elbow from 0-90 degrees

66
Q

X ray shows asymmetric hips; affected femoral head appears small with sclerotic bone and widened joint space

A

Legg Calve Perthes

67
Q

Death in Duchenne MD occurs due to?

A

Respiratory issues

68
Q

What is a second fracture

A

Avulsion fx at proximal lateral tibia, associated with ACL tear.

69
Q

Grade 1 Lachman test

A

Up to 5 mm of translation

70
Q

Grade II lachman

A

6-10 mm translation

71
Q

Grade III lachman

A

11-15 mm translation

72
Q

Grade IV Lachman

A

More than 15 mm translation

73
Q

ACL tear type A

A

Firm end point

74
Q

ACL tear type B

A

Soft end point

75
Q

What is a pivot shift test

A

Evaluates knee for ACL tear. Performed with patient supine and physician places a VALGUS stress while INTERNALLY rotating the tibia, then flexing and extending the knee. In its resting position, an ACL deficient knee will be in a sublimed position, where the tibia is sublimed anteriorly on the femur. When performing the shift test the physician recreates the giving way event then reduces the anteriorly sublimed tibia, pushing it posteriorly under the femur A palpable clunk is felt, indicating a positive pivot shift test.

76
Q

What is Friedbergs infraction

A

Osteochondrosis of the 2nd metatarsal head

Most frequently encountered in adolescent females

77
Q

What is severs disease

A

Traction apophysitis at the insertion of the Achiles on the calcaneus and is most common during periods of rapid physical growth.

78
Q

What is Sinding Larsen Johansson syndrome

A

Traction apophysitis at the inferior pole of the patella

79
Q

Osgood Schlatter affects what area of the knee?

A

Tibial tuberosity.

80
Q

What is a Lisfranc joint

A

Articulation between midst and forefoot and involves all five taros-metatarsal joints.

81
Q

Wahat is a Le Fort I fracture

A

Separation of palate from maxilla, also known as a low septal fracture. It results from force directed low on the maxillary alveolar rim with a downward direction and the fracture extends from the nasal septum, travels horizontally above the teeth apices crosses below the zygomaticomaxillary junction and traverses the pterygomaxillary junction to interrupt the pterygoid plates.

82
Q

What is a Le Fort II fracture

A

Blow to the lower or mid maxilla and has a pyramidal shape with extension from the nasal bridge at or below the nasofrontal suture through the frontal process of the maxilla, inferolaterally through the lacrimal bones and inferior orbital floor and rim through the inferior orbital foramen and inferiorly through the anterior wall of the maxillary sinus. It goes under the zygoma, across the pterygomaxillary fissure and through the pterygoid plates.

83
Q

What is a Type III Le Fort fracture

A

Complete craniofacial dysfunction with extension posteriorly tthrough the ethmoid bones and laterally through the orbit below the optic foramen and through the pterygomaxillary suture into the sphenopalatine fossa. It results in a face that appears long and flat.

84
Q

Describe Hawkins test

A

Tests for shoulder impingement or rotator cuff tendinous.
The shoulder is flexed forward, elevated to 90 degrees, then forcibly internally rotated bringing the greater tuberosity of the humeral head toward the accordion.

85
Q

Describe Jobe’s test

A

This is also known as the empty can test.
The patient actively abducts the arms to 90 degrees, flexes forward 30 degrees, and internally rotates pointing the thumb toward the floor. The patient the resists a downward force applied by the doc. This test isolates the supraspinatus muscle.

86
Q

Speeds test assesses for .. ?

A

Biceps tendinopathy

87
Q

What is Wright maneuver

A

Assesses thoracic outlet.
Physician passively and progressively hyperabducts and externally rotates patients arm. Head and chin are in neutral. If it reproduces sx or causes a diminished radial pulse, it is considered positive.

88
Q

What is the cross arm test

A

Evaluates AC joint. Painful arm is flexed to 90 and adducted across the body. Pain at AC joint indicates OA or separation of the joint.

89
Q

What is the Neer test

A

Patient places the hand of the affected shoulder on the unaffected shoulder and then forward flexes (raises the elbow) which narrows the space around the rotator cuff and recreates their sx. The Neer test uses lidocaine injection into the subacromial space which provides pain relief for the patient for up to several months. Highy sensitive for rotator cuff pathology.

90
Q

MCC of impetigo

A

Staph areas followed by Strep pyo

91
Q

What causes bullous impetigo

A

Strain of S. aureus that produces exfoliative toxin A which targets desmoglein.

92
Q

3 things that increase risk of Legg Calve Perthes

A

Positive family hx
Exposure to cigarette smke
Low birth weight

93
Q

Tx of legg calve perthes

A

Bracing with the use of a Petri cast keeps the hips in abduction and holds the femoral head in concentric alignment with the acetabulum. Pt also placed on crutches to limit amy of weight transferred through the hip which helps relieve symptoms.

94
Q

Injury to thoracodorsal nerve causes what muscular dysfunctions

A

Loss of adduction, internal rotation, and extension.

95
Q

What nerve is responsible for forearm pronation

A

Median

96
Q

What nerve is responsible for ab or adduction fingers

A

ulnar (interosseus mm)

97
Q

Unable to raise arm above horizontal indicates what nerve injury

A

LTN, also CN XI

98
Q

What nerve is at risk of injury to supracondyle of humerus

A

median

99
Q

What types of fx would prompt you to search for a ruptured aorta

A

1st or 2nd rib
Scapula
Sternum

100
Q

Abx ppx in grade I or II open fracture

A

Cefazolin

101
Q

Abx ppx in Grade III open fx (extensive tissue damage and/or high contemn)

A

Cefazolin + aminoglycoside

102
Q

Abx ppx in farm injury causing open fx

A

Cefazolin + aminoglycoside + PCN

103
Q

Dashboard knee injury

A

PCL

104
Q

What imaging study is best for detecting spinal cord compression

A

CT

105
Q

What imaging study is best for detecting spinal cord lesions

A

MRI

106
Q

What imaging study is best for visualizing brachial plexus

A

MRI

107
Q

Tx for compartment syndrome

A

fasciotomy of ALL COMPARTMENTS in extremity!

108
Q

Arthropathhy of PIP and MCP

A

RA

109
Q

ARthropathy of DIP and PIP

A

OA

110
Q

Isolated MCP arthropathy with squared off bone ends and hook like osteophytes of the MCPs

A

hemochromatosis

111
Q

How do you treat pseudogout

A

NSAIDs or colchicine

112
Q

What is tripartite used for

A

Pulsatile PTH used in tx of osteoporosis

113
Q

This bone dz results in narrowing of the marrow cavity and low H&H

A

osteopetrosis

114
Q

What should you always do before starting a TNF inhibitor?

A

Check a PPD!

115
Q

anti U1 RNP

A

CREST

116
Q

Obtain a hip sonogram at 8 weeks if ..

A

female newborn was born breech or theres a family hx.

117
Q

Tx of JRA

A

NSAIDS but if unresponsive to a trial of 2 DIFFERENT NSAIDS over at LEAST 6 weeks, second line is MTX or corticosteroids.

118
Q

Tx in SCFE

A

Surgical pinning.

IF HYPOTHYROID PIN OTHER SIDE

DIT STEP 2 (17 decks)

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