Bone Flashcards by Eric Lee

Osteoma
Osteoid osteoma
Osteoblastoma

Osteoma - facial bones

osteoid osteoma - diaphysis - resolves w/ aspirin

osteoblastoma - vertebral - no relief w/ aspirin

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Vit D, Ca, PTH, alk phosph findings

Osteoporosis

Osteomalacia

Achondroplasia

osteopetrosis

pagets

Osteoporosis - Normal Ca, P, PTH, alk phosph

Osteomalacia - Vit D def, INC PTH, INC alk phosph

Achondroplasia - AD - FBGFr - blocks chondrocytes. Normal longevity/fertility.

osteopetrosis - carbonic anhydrase - defective osteoclasts. pancytopenia. CN palsy. Thick bones prone to fracture.

Pagets - INC clasts/blasts. Ca, P, PTH normal, INC alk phosph! osteosarcomma risk! INC urine hydroxyproline

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CLavicular fracture work up?

Neurovasc ular exam

Angiogram if bruit or concern

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Subacrombial bursitis presentation

Pain on internal rotation/flexion. No atrophy of deltoild

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Adhesive capsulitis

DEC active AND passive ROM

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Rotator cuff

Difficulty Abduction and externally rotating.

Falling on outstretched hand>

Lidoshot helps with rotator tendonitis but not tear

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Glenohumeral osteA

Trauma - gradual onset

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Bicepts rutpure/tendiopathy

Anterior shoulder pain

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Suprachondylar fracture

brachial - median nerve (an terior interosseous) - > ulnar

voklmnass contraction

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Lateral epicondylitis

Tennis elbow - pain w/ finger erxtenosion. Point tenderness.

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Lumbosacral strain

vertebral fracture

Both have point tenderness that is acute onset.

basically only difference is demographic, risk factors

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Anklyosing spondylitis

Anterior uveitis, enthesitis (inflam of ligaments)

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Legg Cave Perthe

slipped capital femoral epyphysis

LC- 5-7 y.o idiopathic

Slipped capital femoral - 12-14 overweight adolescent- URGENT SURGICAL

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osgood Schattler

Patellofemoral syndrome - dx?

Osgood - patella ripped off

patellofemoral syndrome - women young, runners, hurts with going up stairs. Tx - stretch.

dx w/ knee extension while applying pressure

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Ansernine bursitis

Anteriomedial tibila

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PMR

Fibromyalgia

Dermatomyositis

polymyositi s

MCTD lab finding

PMR - no weakness, temporal artritis. INC ESR. lwo dose steroids

Fibromyalgia - no weakness, exercise, ssri. younger than PMR

Dermatomyositis - CD4, weakness, perimysial. Molar, grotton, heliotrope

polymyositis - CD8, weakness

Later two have INC CK, ANA

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Bone tumors

for each region
E
M
D

E - Giant Cell

M - osteochondroma
osteosarcoma

D Ewings
chondrosarcoma

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Epiphyseal tumors

Giant cell - locally aggressuive, non malignant. Multinucleated giant, soap bubble.

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Metaphyseal tumors

Osteochondroma - males

Osteosarcoma . Codman sunburst aggressive en block resection pagets rb inc risk

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Diaphyseal tumor

Ewings 11:22 - Boys less than 15. Onion skinning. Chemo response

Chondrosarcoma - rare, malignant, Males 30-60, glistening mas

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Osteo A

RA - tx algorithm

OsteoA - osteophytes, boney crepitus, eburnation. DIP+PIP

RA - pannus, baker cyst, anticitrullinated peptide. 2nd amyloidosis. Tx METHOTREXATE asap. If fail 6 mo -> TNF inhibitors. CERVICAL spinal involvement most common

Tx algorithsm - presentations
GOUT

Pseudogout

GOUT - monosodum urate - yellow in parallel light.
Punched out erosions.
Acute - NSAIDS, steroids, colchicine
Chronic - XO - allopurinol, febuxostat
Synovial fluid analysis shows WBC less than 50k.

Pseduo - CAPP, + birefriong. blue in parallel. Hemochromatosis. Chondrocalsinosis
Tx- Nsaids, steroids, colchicine.

Neurogenic arthropathy “Charcot joint”

Longstanding DM, B12 def - sig deformatlies of joints, fractures, effusions, osteophytes.

Infectious Arthritis

Seronegative

Infectious - S. Aureuas, Strep, GC, Migratory

Seronegative - Reactive (couple weeks after GI/viral/GU)
- conjuncitivits, urethritis, arthritis. Tx - NSAIDS (NOT ABX)

Metatarsal hairline fracture - Mortons Neuroma

Hairline factuer Rest, analgesics, hard soled shoe Mortons Neuroma - click in metatarsals when squeezed. Padded shoe.

Stress fracture

X ray may or may not show - Rest and heal. nsaids.

Avascualr necorsis rpesentation/.

X ray may not pick up initially. May or may not see point tendrness, full ROM early on.

Ankylosing spodnylitis - Inflam of what? Dx?

Apophyseal joints (Facet joints). INC ESR, CRP. Dx - Xray. B27 later.

Myasthenia crisis - tx

Intubatge if needed. Steroids + plasmap-hx or IVIG.

Prostehsis infection - timecoruse bugs

Early onset - St. A> and GN anaerobes 3+ months - Staph Epi, propionibacterium, Enterococci

Spinal crod compression tx alg

Immedaite IV steroids + MRI + surgery consutl

Gout - what must you do?

Tap the joint to rule out infection.

Preventative measure for gout in pt w/ renal diseasE?

Allopurinol. Also colchiscine. Probenecisd, NSAID contraindicated.

Lower back pain - Straight leg raise is positive. Is imaging needed?

If no sign neuro findings usually no. SLR more specific than sensitive.

Hydroxychloroquine tox?

Retinal toxicity - dialted eye exam. Anotehr DMARD second line to Methotrexate .

?APL sydrome - what should qualify for workup of in pregnant women ? What tx to prevent this?

2 or more 1st trimester events, or A SINGLE SECOND TRIMESTESR EVENT. Tx - heparin and aspirin

Ab associated with crest? Most specific test for CREST?

Anti centromere (less specific but more sensitive) Most specific - SCL70 - anti topoisomerase.

Sjogrens - best initial test. Most accurate test? concerns?

Initial test - Schirmer test (filter paperagainst eye and look for tears) Most accureate folowup - parotid/lip biopsy/. Concerns- lymphoma

Best test for Wegeners?

Lung biopsy!!! Better than renal >sinus.

Which complement is decreased in cryoglobulinemia

c4 (Hep C - 4 letters) SLE (dec C3 - 3 letters)

presntation Anterior shoudler dislocation Posterior shoulder dislocation

Anterior - most common - - abducted and externally rotated - same as rotator cuff tear presentation Posterior - flattened deltoid - adducted and internally rotated -

Otosclerosis - when deos this present? tx?

– common cause of conductive hearing loss in adults – esp in 20s and 30s. Female prepond. Tx – surgical stapedectomy or hearing amplification.

Ank spond presentation

– BETTER WITH EXERICSE, no improvement with rest. (worse at night)

Polymyosisit best way to diagnose?? Findings?

Muscle biopsy DM - perimyseal cd4 Polymyositis - endomesial CD8

Low Threshold for What therapy in RA?

Bisphosphonates to prevent osteoporosis

Penetrating trauma vs blunt algorithm in unstable pt?

Penetrating with unstabl e-> lap. Blunt with inconclusive FAST and unstable vitals -> diagnostic peritoneal lavage.

Kid with no fever, URI, and externally rotated hip with pain what to do –

transient synovitis if no fever, no white count, and low ESR/CRP. Analgesics and followup.

Septic arthritis vs Osteomyelitis

septic is at JOINTS! Arthrocentesis. Whereas Osteo usu MRI?

Inheritance of muscular dystrophies

Duchennes, Becker Xr. Myotonic Muscular Dystrophy is AD! Of trinucleotide.

Asx pagets tx?

Bisphosphonates, NO OCTREOTIDE (that is acromegaly)

2 blastic maglinancies

prostate , breast, pagets