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4. MSK Flashcards

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1
Q

Flail Chest

Cause/PE/Tx/MC site

A
  • Cause: Blunt trauma (3 or more adjacent ribs broken)
  • PE
    • inspiration - flail segment contract
    • expiration - flail segment expands
  • Tx: Supportive care (NO CHEST WRAPPING)
    • 2 or more possible internal damage, should admission
  • MC rib fx - 4-9
    • Rib 1-2 - serious
    • Rib 9-12 - liver, spleen damage
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2
Q

Compartment syndrome

Cause/Sx/PE/Tx

A
  • Cause: tibial fx
  • Sx: out of proportion pain
  • PE
    • 6 p’s
      • Pallor
      • Pain
      • Pulselessness
      • Paralysis (muscle function is gone)
      • paresthesia (abnormal dermal sensation)
      • poikilothermia (unable to control body temp)
  • Dx: intracompartmental pressure >30-45 (normal 0-10), Delta pressure 30>, Lab: CK/Myoglobin
  • Tx: Emergent fasciotomy
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3
Q

Osteoarthritis

Cause/Sx/PE/Dx/Tx

A
  • Cause: Age related
  • Sx: Joint pain with activity
  • PE: PIP (Bouchard), DIP (heberden)
  • Dx: X-ray (joint narrowing)
  • Tx: NSAID, corticosteriod
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4
Q

Osteomyelitis

Cause/Sx/Dx/Tx

A
  • Cause: infection
    • General - Staph A
    • Sickle cell - salmonella
    • cat/dog - pasteurella multocida
    • Puncture wound - pseudoma
  • Sx: pain over bone, fever
  • Dx: X-ray (initial), MRI (best), Bone aspiration (Gold)
  • Tx: Abx (2-6 week) - IV for 2 weeks
    • Staph A - Nafcillin
    • MRSA - Vanco
    • Puncture - cipro
    • Sickle cell - cipro
    • Cat/dog - ampicillin, augmentin
  • Spread
    • hematogenous - children
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5
Q

Septic arthritis

Cause/Sx/Dx/Tx

A
  • Cause: Staph A infection
  • Sx: Fever, joint pain, swelling
  • Dx: Arthrocentesis (WBC 50,000 PMN)
  • Tx: Gram + - nafcillin, Gram - (Gonorrhea) - Ceftx
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6
Q

Rhabdomyolysis

Cause/Sx/Dx/Tx

A
  • Cause: injury muscle releave CK or myoglobin to blood stream -> kidney
  • Sx: edema
  • Dx: CK level(initial) , Urine Dark (myoglobin but NO RBC)
    • hypocalcemia, Hyperkalemia - ECG check
  • Tx: IVF, bicarbonate
  • Complications: DIC, ARF, compartment syndrome
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7
Q

Avascular necrosis

Cause/Common site/Dx

A
  • Cause: Corticosteriod use
  • Femoral head is common site
  • Dx: MRI
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8
Q

Develomental dysplasia of the hip

Cause/PE/Dx/Tx

A
  • Cause: decreased pressure of the femoral head against acetabulum
  • PE
    • Galeazzi - flex hip both knee not even (postivie)
    • Barlow - dislocation occur when adduction
    • Ortolani - dislocation occur when abduction
  • Dx: US
  • Tx: Pavlik harness
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9
Q

Hip dislocation

Cause/MC site/PE/Tx

A
  • Cause: MC MVA trauma
  • MC site: Posterior
  • PE: leg shorten internal rotated - sciatic nerve injury
  • Tx: Emergent reduction
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10
Q

Hip Fx

MC common site/PE/Dx/Tx

A
  • MC common site: Femoral neck
  • PE: leg shorten external rotated
  • Dx: MRI
  • Tx: ORIF
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11
Q

Prepatella bursitis

Cause/PE/Dx/Tx

A
  • Cause: chronic kneeling (house maids knee)
  • PE: Dome shape swelling
  • Dx: Aspiration to rule out septic, inflammation
  • Tx: NSAID, steriod injection
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12
Q

Patella dislocation

Cause/PE/Tx

A
  • Cause: twisting injury
  • MC common: lateral dislocation
  • PE: patella displaced, apprehension sign (push laterally patient contract qudriceps
  • Tx: Closed reduction and knee immobilizaer
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13
Q

Patella fx

Cause/Dx/Tx/Special comment

A
  • Cause: Direct Trauma
  • Dx: Sunrise view x-ray
  • Tx
    • Nondisplaced - knee immobilize x 6 weeks
    • Displaced - surgery
  • Special comment: bipartitie patella - if both broken part is not sharp and smooth the means not related to trauma
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14
Q

Knee dislocation

Cause/Dx/Tx

A
  • Cause
    • MC anterior - hyperextension
    • Posterior - knee flexed and anterior tibia blow
  • Dx: X-ray
    • Nerve - common peroneal
    • Artery - Popliteal artery
  • Tx: Emergent reduction
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15
Q

Meniscus injury

Cause/Sx/PE/Dx/Tx

A
  • Cause: Twisting
  • Sx: Knee locking, effusion after activity
  • PE: McMurray (tibia externally or internally rotate pop or click)
  • Dx: MRI
  • Tx: NSAID, PT
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16
Q

MCL vs LCL

PE/Tx

A
  • PE
    • MCL - vaLgus
    • LCL - vaRus
  • Tx: NSAID, complete tear - surgical
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17
Q

ACL vs PCL

Cause/Sx/PE/Tx

A

ACL

  • Cause: Sports related Pivoting injury (MC knee ligament injury)
  • Sx: audiable pop, swelling
  • PE: Lachman
  • Tx: Surgical

PCL

  • Cause: Dashboard injury (hit proximal anterior tibial when knee flexed)
  • Sx: dull aching pain and swelling
  • PE: Posterior drawer test
  • Tx: surgical
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18
Q

Ankle sparin

Cause/MC site/Sx/Dx/Tx

Ankle dislocation

MC type/Tx

A
  • Cause: foot inversion
  • MC site: ATFL (ankle talofibular ligament)
  • Sx: Swelling and tenderness
  • Dx: Ottawa ankle rule (x-ray)
    • Tenderness Posterior tip of lateral or medial malleoulus
    • Tenderness on navicular, fifth metasal (mid foot)
    • Inability to bear weight 4 step
  • Tx: PRICE (Protect, rest, ice, compress,elevation)
  • MC type: Posterior
  • Tx: close reduction
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19
Q

Type of fracture

SALTR

A
  • Type of fx
    • open - bone expose to outside
    • Closed - fx inside
  • SALTR
    • Slipped
    • Above
    • Low
    • Through
    • Rammed
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20
Q

Lisfranc injuries vs Jones and Psedo jones fx

PE/Tx

A

Lisfranc

  • PE: Pain tenderness at base of 2nd metatarsal (Malunion possible)
  • Tx: Surgical

Jones and Pseudo jones fx

  • PE: Fifth metatarsal diaphysis fx (Jone), Avulsion (pseudo jone)
  • Tx: Cast 6-8weeks (Jone), 2-3weeks (pseudo jone)
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21
Q

Morton’s neuroma

Cause/Sx/Dx/Tx

A
  • Cause: Painfull mass at 3rd metatarsal head
  • Sx: Pain with walking
  • Dx: MRI
  • Tx: Wide shoes, Glucocorticoid injection -> Surgical remove if failed 1st tx
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22
Q

Bunion vs Hammer

Joint involve/Tx

A
  • Bunioin
    • Location: 1st metatarsal deviation
    • Tx: Wide shoes, surgical if failed 1st tx
  • Hammer toe
    • Location: 2-4th metatarsal PIP flex DIP extend
    • Tx: Wide shoes, surgical if failed 1st tx
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23
Q

Tarsal tunnel syndrome

Cause/Sx/Tx

A
  • Cause: posterior tibial nerve compressed
  • Sx: Numbness at medial malleolus heel and sole
  • PE: Tinel sign
  • Tx: NSAID, corticosteriod inject
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24
Q

Plantar fasciitis

Cause/Sx/PE/Tx

Children with heal pain?

A
  • Cause: inflammation of plantar fascia
  • Sx: heel pain, tenderness worse at night
  • Dx: X-ray normal, flat foot
  • Tx: Rest, Ice, NSAID

Sever disease, 8-12yo, self limied

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25
Foot Stress fx Cause/Location/Dx/Tx
* Cause: overuse foot (athletes & military) * Location: 3rd metatarsal * Dx: X-ray normal * Tx: Rest
26
Baker's cyst Cause/Sx/Tx
* Cause: fluid effision is displaced with cyst formation * Sx: Painless cyst at knee * Tx: ICE, rest, NSAID
27
Osgood-Schlatter disease Cause/Sx/PE/Tx
* Cause: Rapid growth at tibial tuberosity 10-15 yo * Sx: Knee Pain when runs * PE: Tenderness over tibial tuberosity * Tx: ICE, Rest, NSAID
28
Patellofemoral syndrome Sx/Dx/Tx
* Sx: knee pain behind or around the patella (usually runner) * Dx: Apprehension sign * Tx: NSAID, rest
29
ITB syndrome Sx/Dx/Tx
* Sx: lateral knee pain (runner) * Dx: Ober test * Tx: NSAID, rest
30
Achilles tendon rupture Sx/Risk/PE/Tx
* Sx: sudden pop sound, sharp calf pain * Risk: hx of using FQ * PE: Thompson test (squeez calf to see plantar flextion) * Tx: Plantar flexed Splint (1st) -\> surgical repair
31
Legg-Calve-Perthes disease Cause/Sx/Dx/Tx
* Cause: Avascular necrosis of femoral head in children (4-10) * Sx: painless limping * Dx: X-ray * Tx: observation (usually revacularization at 2 yo) * Limit activity
32
Slipped capital femoral epiphysis Cause/Sx/Tx
* Cause: femoral head epiphysis slips * MC patient: obese male 12-16 yo * Sx: hip, thigh or knee pain with limp * Dx: X-ray * Tx: non-weight bearing clutch
33
Common peroneal neuropathy Cause/PE/Tx
* Cause: Fx of proximal fibula * PE: foot drop w/ numbness * Tx: ankle splint
34
Benign Tumor Name/Patient/Dx/Tx
* Osteocondroma * Patient: 10-20y M * Dx: X-ray grows away from growth plate * Tx: Observation
35
Maliganant tumor 3 type name/Patient/MC site/Dx/Tx
* Osteosarcoma * Patient: adolescent (20yo\>) or 50\< * MC site: femur * Dx: X-ray **sun burst** appearance or hair on end * Tx: surgical, chemo * Special comment: MC bone malignancy (MET to lung) * Ewing sarcoma * Patient: children (5-25yo) * MC site: femur * Dx: X-ray **onion** skin * Tx: surgical, chemo * Chondrosarcoma * Patient: Adult (40-75yo) * Dx: X-ray punctate or ring & arc appearance * Tx: Surgical
36
Fibromyalgia Sx/Dx/Tx
* Sx: wide spread muscle pain * Dx: diffuse pain 9 out of 18 site * All lab Normal * Tx: exercise (swimming), pregabalin (FDA approved)
37
Gout vs pseudogout Crystal type/Synovial Fluid/PE/Tx/Chroinc Tx/Special comment
Gout * Crystal type: Monosodium urate * Synovial Fluid: Negative needle shape * PE: First MTP (podogra) * Tx: NSAID (1st), colchicine, Corticosteroid * Chronic Tx(prevention): Allopurinol (Never use when gout attack occur) * Special comment: HCTZ,, Niacin makes worse Pseudogout * Calcium pyrophosphate * Positive rhomboid shape * PE: Knee swelling * Tx: NSAID(1st), colchicine
38
Juvenile idiopathic arthritis 3 type/Age/Sx/Tx
* 3 type/Sx * Pauci articular - less than 5 joint but major joint * Systemic - Salmon colored rash * Polyarthicular - more than 5 joint but small joint * Age: less than 16 yo * Tx: NSAID, MTX
39
Osteoporosis Cause/Risk/Dx/Tx
* Cause: decline in bone mass * Risk: Steriod use * Dx: Dexa scan -2.5 (osteoporosis) 2.5-1.0 (osteopenia) * Tx: Bisphosphonates * Complication: Osteonecrosis of the jaw, pillesophagitis
40
Polyarteritis Nodosa Cause/Age/Related/PE/Dx/Tx
* Cause: Inflammation of vasculitis * Age: 40-50 yo * Related Dz: Hep B * PE * **Tender lumps under the skin thigh and lower legs** * Derm: **Livedo reticularis (startburst livedo)** * Dx: Bx (necrotizing arteritis) - definitive * Lab - ESR high * Tx: Steriods
41
Polymyalgia Rheumatica Cause/Sx/Hx/Dx/Tx
* Cause: inflammation * Sx: stiffness **hip shoulder neck** in the morning * Hx: Giant cell artery * Dx: ESR high * Tx: Corticosteriod
42
Dermatomyositis/Polymyositis Cause/Sx/PE/Dx/Tx
* Cause: inflammation * PE: purple rash on eyelid (heliotrope), **progressive weakness of three month** * Dx: CK, Aldolase high, Anti Jo * Tx: Steroid
43
Reactive arthritis Sx/Dx/Tx/Related dz
* Sx: uveitis, arthritis, urethritis * Dx: HLA B27 * Tx: NSAID * Related dz: chlamydia
44
Rheumatoid arthritis vs Ostoarthritis (Main difference Only) Sx/Dx/Tx
* Main difference sx * RA - DIP spare, morning stiffness, Osteopenia, **constitutional sx (fever, weakness, muscle pain)** * PE: Boutonniere deformity, Mallet * OA - DIP involove, evening stiffness, Osteophytes * PE: heberden, bouchard * Dx: RF, Anti-CCP * Tx: DMARDs * monitor CBC
45
Sjogren syndrome Sx/Dx/Tx
* Sx: Dry mouth, dry eye * Dx: Anti Ro, Anti La test Positive * Schirmer test (tear production low) * Tx: Pilocarpine, artificial tear
46
SLE (systemic lupus erythematosus) Sx/PE/Dx/Tx
* Sx: Fever, Joint pain * PE: Malar rash * Dx: ANA (initial), Anti dsDNA(specific), Anti smith * Tx: NSAID, hydroxychloroquine, sun protection
47
Scleroderma Sx/Dx/Tx
* Sx: Thicken skin, CREST (calinosis, raynaud, esophageal modility, Sclerodactyly, tenlangiectasia) * Dx: Anti-Centrome, Anti-Scl 70 * Tx: DMARDs
48
Ankylosing Spondylitis Cause/Sx/Dx/Tx
* Cause: HLA B27 positive * Sx: Worse in the morning, better with activity * Dx: ESR high, X-ray bamboo spine (spine fusion) * Tx: NSAID, PT
49
Cauda equina syndrome Cause/Sx/Dx/Tx
* Cause: herniated disc * Sx: acute lower back pain with numbness * PE: saddle anesthesia, decreased rector tone * Dx: MRI * Tx: Emergency operative decompression
50
Hernidated disk Sx/Location/PE/Dx/Tx
* Sx: back pain radiate to the thigh * Location - L4 (thigh), L5 (lateral thigh) S1 (calf, posterior of leg) * PE: Straight leg test positive * Dx: MRI * Tx: PT, surgical intervention
51
Scoliosis Type/Dx/Tx
* Type * Scoliosis - left or right curve * Kyphosis - humpback * lordosis - sway back * Dx: Cobb angle on x-ray * Tx: Observe (if 0-10), brace (20-40), surgical (40\<)
52
Spinal stenosis Cause/Sx/Dx/Tx
* Cause: compression on spinal cord * Sx: leaning forward relieves pain with old age * Dx: MRI * Tx: Lumbar epidural injection of corticosteriod
53
Back sprain/Strain Cause/Hx/Sx/Tx
* Cause: paraspinal muscle injury * Hx: lifting object * Sx: pain with activity but NO neurologic problem * Tx: NSAID, bad rest * Red flag of back pain for image test * Night pain and weight loss * fever, chill and sweats * Actue bony tenderness * Morning stiffness
54
Toticollis Cause/PE/Tx
* Cause: Shorten neck muscle * PE: Contract sternocleidomastoid muscle * head tiltedtoward affected muscle and chin is away from affect muscle. * Tx: Daily stretch and PT
55
Spinal Trauma Sx/PE
* Brown-sequard syndrome * Cause: Panetrating trauma damage spinal hemisection * PE * Ipsilateral - motor, position loss * Contralateral - Pain, temperature * Anterior cord syndrome * Cause: Flexion injury * PE: motor, pain, temp loss * **propriception and vibratory intact**
56
Neck Fx MOA/Dx/Tx
C1 Jefferson fx * MOA: Axial load (Football, diver) * Dx: Xray (odontoid) * Tx: halo collar C2 hangman fx * MOA: MVA (hyperextension) * Dx: CT * Tx: Collar if 3mm less, operative more than 5mm C6 or C7 fx (clay shoveler) * MOA: abrupt flexion * Dx: X-ray (avulsion fx) * Tx: immobilization
57
Anterior vs posterior dislocation Sx/Tx
Anterior * Sx: Externally abduct MC dislocation * Dx: X-ray Y view, (hill sachs lesion - humerous head, bankart lesion - glenoid inferior) * Tx: immobilization (axillary nerve check - pinprick sensation over the deltoid) Posterior * Sx: Internally adduct * Dx: X-ray AP * Tx: immobilization
58
AC joint seperation Cause/Dx/Tx
* Cause: Football direct blow * Dx: X-ray * Tx: sling immobilization * Grade * 1 - No rupture * 2 - AC rupture * 3 - AC, CC rupture
59
Adhesive capsule Sx/Tx
* Sx: Progressive stiffness for 18-24 month * Tx: PT
60
Rotator cuff injuries Type/Muscle involve/Sx/PE/Tx
* Type * Tendonitis - young \<40 * Tear - old 40\< * Muslce involve: SITS * **Supraspinatus MC** * infraspinatus * Teres minor * Subscapularis * Sx: Can't raise arm up * PE: Neer and hawk test * Tx: Wall climing exercise, Rest, ICE, NSAID
61
**Humeral fx** Other injuries/Tx **Clavical fx** Patient/Tx **Elbow fx (radial head or supracondyler)** PE/Dx
Humeral * Other injuries: Radial nerve * Tx: Sugar tong Clavical * MC Children * Tx: mid 1/3 - sling, proximal 1/3 orthopedic surgery Elbow * PE: can't fully extend * Dx: X-ray Fat pad sign, Sail sign * Children - supracondyler * Adult - radial head * Tx: Sling or splint
62
Flexor tenosynovitis Pathogen/Cause/Sx/Dx/Tx
* Pathogen: Staph A * Cause: infection * Sx * swelling finger (sausage like) * pain with extension * finger flexed * tenderness near tendon sheath * Dx: aspiration or Bx (definitive) * Tx: I&D + Abx
63
Olecranon bursitis vs fx Sx/Complication/Tx
Olecranon Fx * Sx: Swelling at elbow can't full extend * Complication: Ulnar nerve * Tx: Reduction Olecranon bursitis * Sx: Abrupt gooes egg (boggy, red elbow) * Complication: Septic bursitis * Tx: Rest, NSAID
64
Scaphoid fx Sx/Complication/Dx/Tx
* Cause: FOOSH * PE: Anatomic snuff box tenderness * Complication: avascular necrosis * Tx: always Thumb spica splint
65
Colles vs smith fx Cause/Dx/Complication/Tx
* Colles * Cause: fall w/ Wrist extension * Dx: dinner fork X-ray * Complication: EPL rupture * Tx: sugar tong splint * Smith * Cause: fall w/ wrist flexed * Dx: garden spade X-ray * Complication: medial nerve * Tx: sugar tong splint
66
CRPS (Complex regional pain syndrome) Hx/Sx/Tx
* Hx: hx of fx or soft tissue injured and healed * Sx: Pain started after healed * Tx: NSAIDs (1st), Vitamin C prophylaxis
67
Mallet vs boutonniere vs swan neck PE/Tx
* Mallet * DIP flexed * Boutonnier * PIP Flexed * Swan neck * PIP hyperextend * DIP flexed * Tx: Splint anormal part
68
Game vs skier thumb Ligament involve/Sx/Tx
* Ligament - ulnar collateral * Sx * Game - chronic * Skier - acute * Tx: Thumb spica
69
Boxer fx Cause/Tx
* Cause: fist fighting 4,5th finger broken * Tx: Ulnar gutter splint * Always check for bit wound * if bitten - augmentin
70
Carpal tunnel syndrome Sx/Dx/Tx/Other similar dz
* Cause: median nerve compressed * Sx: night pain, 1-3 1/2 finger, thenar muscle wasting * Dx: Phalen test (best), tinel * Tx: Volar splint * Other similar dz: pronator dz (medial nerve compressed but **NO night pain**)
71
Dypuytren contracture Sx/Tx
* Sx: Crease, nodule proximal phalanx * Tx: Corticosteriod injection
72
de Quervain tenosynovitis Cause/Sx/Dx/Tx
* Cause: APL + EBP * Sx: Radial side pain * Dx: Finkelstein test (pain with ular deviation) * Tx: Thumbspica
73
1. night of heavy drinking and wrist drop? 2. MUGR fx? 3. Lateral vs medial epicondylitis 4. Nursemaid elbow 5. Spill teacup x-ray 6. Most serious carpal fx (complication)
1. Saturaday night palse * Radial nerve compress C6-8 * Tx: PT, pain management 2. MUGR * MU - monteggia - ulnar fx * GR - Galeazzi - Radial fx * Tx: ORIF 3. Lateral epicondylitis * lateral - extension resist - ECRB * Medial - flexsion resist * Tx: RICE 4. Nursemaid * Sx: Pulling with one hand, 5yo\> * Tx: Manual reduction (supinate and flex) 5. Lunate dislocation 6. Lunate fx (avascular lunate - keinbock dz)

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