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Clin Med > Exam 7 > Flashcards

Exam 7 Flashcards

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1
Q

HLA common type

A

B27, usually class II MHC

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2
Q

Central tolerance

A

Cells expressing auto antibodies are marked and destroyed through apoptosis

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3
Q

Clonal anergy

A

Inactive T cells that have not encountered antigen

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4
Q

Immunological ignorance

A

Lack of antigen antibody encounter

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5
Q

Active regulation

A

Surveillance for self reacting antibodie

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6
Q

Rheumatoid arthritis definition

A

Chronic and systemic inflammatory dz affecting synovial tissues

Synovitis of multiple joints

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7
Q

Genetic risk factor for RA

A

HLA with shared epitope, 4x great risk of RA, but only present in 30% of population

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8
Q

How long are autoantibodies present in RA before onset of sx?

A

5-10 years

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9
Q

RA pathophysiology

A

Synovial fluid increases as synovial tissue proliferates, pannus develops

Pannus infiltrates adjacent structures and destroys them

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10
Q

RA joint symptoms

A

Early pain and stiffness

Symmetric swelling and pain of multiple joints

Worse with activity, worse in morning

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11
Q

Joint deformities in RA in the hands

A

Swan neck- hyperextension of PIP

Boutonnière- hyperflexion of PIP

Ulnar deviation of MCP

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12
Q

Other RA symptoms

A

*constitutional symptoms

Rheumatoid nodules (over bony prominences, bursae, tendons)

Dry eye, scleral nodules

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13
Q

Felty syndrome

A

Found in RA

RA, splenomegaly, neutropenia

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14
Q

RA diagnostics

A

Anti-CCP (most correlated and more specific)

RF (not as specific)

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15
Q

RA imaging

A

Early- soft tissue swelling of wrists and feet, juxta-articular demineralization

Late- joint space narrowing, bony erosions

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16
Q

What does RA have that OA doesn’t?

A 
MCP involvement
Systemic symptoms
Extra articular symptoms
Persistent morning stiffness
Symmetrical joint involvement
Erosions on x rays
Increased ESR, CRP, RF, and anti-CCP
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17
Q

What is more specific to OA vs. RA?

A

Asymmetrical joint involvement

Osteophytes on x ray

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18
Q

3 types of juvenile idiopathic arthritis

A

Oligoarticular

Polyarticular

Systemic onset

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19
Q

What is an ocular risk of all JIA patients?

A

Uveitis

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20
Q

JIA diagnosis

A

Effusion noticed acutely by parents

Pain and stiffness that restricts motion

Arthritis onset slow

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21
Q

JIA exam

A

Inflammation, erythema, tenderness, effusion

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22
Q

Still disease general

A

Related to chronic juvenile arthritis

Young adult onset

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23
Q

Still disease symptoms

A

High fevers
Sore throat
Evanescent rash
Destructive arthritis

Dramatic increased WBC, ferritin

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24
Q

What are the lupus criteria?

A
  1. Malar rash
  2. Discoid rash
  3. Photosensitivity
  4. Oral ulcers
  5. Arthritis
  6. Serositis
  7. Kidney disease
  8. Neurological disease
  9. Hematologic disorders
  10. Immunologic abnormalities
  11. Positive ANA
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25
How many criteria does a patient need to be diagnosed with lupus?
Any 4 or more of the 11
26
Systemic sx of lupus
Fever, anorexia, malaise, weight loss
27
Malar rash
SLE Butterfly rash, red/purple, mildly scaly, spares nasolabial folds
28
Discoid rash
SLE Erythema, inflammation, scaling/crust. May scar
29
Photosensitivity of SLE
Rash in sun exposed areas
30
What may be the earliest sign of SLE?
Arthritis
31
Serositis in SLE
Inflammation of serous tissue Pericarditis, pleural effusions common
32
Screening test of choice for SLE?
ANA! If it is negative, need to consider other dx's
33
Polymyositis
Insidious proximal muscle weakness and maybe pain Dysphagia fairly common
34
Polymyositis diagnostic
Muscle biopsy White blood cells attacking muscle cells
35
Dermatomyositis
Similar weakness to polymyositis Heliotrope rash Gottron papules Shawl sign
36
Rhabdmyolysis
Acute necrosis of skeletal muscle Very increased CK levels Renal failure
37
Common causes of rhabdo
Crush injury Cocaine, alcohol Prolonged inactivity Statins
38
Scleroderma types
Diffuse and limited
39
Scleroderma
Fibrosis of skin and internal organs
40
CREST syndrome
Aka limited scleroderma ``` Calcinosis cutis Raynauds Esophageal motility disorder Sclerodactyly Telangiectasia ```
41
Diffuse scleroderma manifestations
Tendon friction rubs over forearm, shins Renal, cardiac dz Interstitial lung dz Tightening of skin
42
Tightening of skin with CREST
Just face and hands, greater risk of digital ischemia
43
What autoantibody marker does CREST have more commonly than diffuse scleroderma?
Anti-centromere
44
Sjogren syndrome
Dry eye, dry mouth Usually females Schirmer test to quantify tears
45
Polymyalgia rheumatica
Pain/stiffness in axial muscles (shoulders, hips/pelvis) Associated with giant cell arteritis Difficulty putting on coat, standing from chair
46
Behcet disease
Oral aphthae is the hallmark Genital lesions, CNS involvement, vasculitis, arthritis Uveitis- severe!
47
Behcet disease diagnosis
Recurrent oral ulcerations plus 2 more things, like... Genital ulcerations Eye lesions Skin lesions Positive pathergy test
48
Pathergy
Behcet diagnosis Formation of a sterile pustule at the site of needle insertion
49
Polyarteritis nodosa
Medium vessel disease Skin, nerves, mesenteric vessels, brain, etc.
50
Polyarteritis nodosa manifestations
Livedo reticularis | Digital gangrene
51
Primary angiitis of CNS
Rare vasculitis limited to brain and spinal cord Brain bx is only way to make dx
52
Leukocytoclastic vasculitis
Small vessel vasculitis Most commonly of skin, aka hypersensitivity vasculitis
53
Leukocytoclasatic vasculitis exam
Palpable purpura | Urticarial lesions- last greater than 24 hours, burning more than itching
54
Henoch schonlein purpura
Most common systemic vasculitis in kids Palpable purpura, arthritis, hematuria and maybe abdominal pain
55
Essential cryoglobulinemia
Hep C is the most common cause Cold precipitable immune complexes
56
Essential cryoglobulinemia findings
Palpable purpura Peripheral neuropathy Glomerulonephritis Positive serum test for cryoglobulins
57
Osteoarthritis general
Most common joint disease Degenerative dz due to cartilage breakdown in joints, bony and synovial changes
58
What joints does OA commonly affect?
Knee Hip Spine Feet Weight bearing joints! Asymmetrical
59
OA pathophysiology
Edema of cartilage early Progression- cartilage softens and loses elasticity Loss of joint space Bony degeneration and osteophyte/cyst formation
60
OA presentation
NO systemic sx Slowly progressive joint pain Deep and achy, tenderness Worse with heavy use, better with rest
61
Gelling
Stiffness during rest with OA
62
Heberdens nodes
Palpable osteophytes and or cysts at DIP joint OA
63
Bouchard's nodes
Palpable osteophytes and or cysts at PIP joints OA
64
Imaging findings of OA
Narrowed joint space Osteophytes Increased density of subchonral bone Bony cysts
65
OA prevention
Weight loss Correct any vitamin D deficiency
66
Joint fluid analysis general rule
RBC/WBC ratio in blood and normal fluid is 1000/1 More WBCs suggests infection or inflammation
67
Gout general
Associated with consumption of fish foods and alcohol High purine foods are main trigger
68
Gout pathophysiology
Monosodium urate crystal formation Often excess uric acid Synovial fluid cooler than body temp, supersaturation and crystal aggregation Inflammation via macrophage response
69
Podagra
Gout of the MTP joint (most common site)
70
Gout presentation
Sudden onset arthritis Night onset common Erythema, swelling, fever, warmth, TENDERNESS Monoarticular usually
71
Tophi
Granulomataous inflammation around a deposit of MSU crystals
72
Chronic gouty arthritis
Persistent elevation in articular MSU Chronic changes to bone, cartilage "Rat bites" on X-RAYS
73
Gout diagnosis
Joint aspirate is key, especially for 1st diagnosis Negatively birefringent needle like crystals
74
Chondrocalcinosis
Calcium salts in articular cartilage Usually XR diagnosis
75
Pseudogout
Aka calcium pyrophosphate crystals Gouty sx of large joints, knees and wrists common Chondrocalcinosis of joint almost always seen
76
Diagnostic finding of pseudogout
Rhomboid, positively birefringent crystals under polarized light
77
Spondyloarthropathy general
Group of systemic inflammatory diseases Musculoskeletal findings, extra articular manifestations, immunogenicity issues
78
Ankylosing spondylitis
Young adults Chronic, inflammatory dz of axial skeleton Low back pain that improves with activity Ascending disease, lumbar curve flattens and cervical curvature exaggerated
79
Ankylosing spondylitis other findings
Peripheral arthritis Uveitis Entesthopathy (disordered tendon/ligament attachment)
80
Think of AS with...
Less than 30 years old, inflammatory pain that improves with activity
81
Reactive arthritis
Preceded by infection, but joints are not infected Usually GI or STD pathogens
82
Reactive arthritis classic triad
Asymmetric arthritis, uveitis, and urethritis "Can't see, can't pee can't climb a tree" Fever, weight loss, arthritis of large weight bearing joints
83
Septic arthritis definition, causes and pathogen
Bacterial joint infection Hematogenous spread, direct inoculation, immunocompromise are the causes Staph aureus most common!
84
Septic arthritis presentation
Acute pain, effusion, and warmth of joint Fever, chills common Knee most common site
85
Septic arthritis diagnostics
Synovial fluid analysis- increased WBCs Often blood culture is positive
86
Prosthetic joint worries
Periprosthetic lucency!!
87
Gonoccoccal arthritis common patient populations
Menses, pregnancy, MSM
88
Gonococcal arthritis presentation
Migratory polyarthralgia, then EITHER - tenosynovitis of wrist, hands or feet - purulent monoarthritis
89
Osteomyelitis
Bony infection due to direct or hematogenous spread (always get blood cx)
90
Manifestations of osteomyelitis
Fever, chills, pain and elevated ESR/CRP Wound that probes the bone is a clinical dx
91
Best imaging for osteomyelitis
MRI
92
Best way to obtain cultures for osteomyelitis?
Bone bx
93
Diskitis | Vertebral osteomyelitis
Insidious onset Fever, back pain Spinal/paraspinal tenderness Elevated ESR, CRP, WBC MRI best imaging
94
What do you see on an MRI for diskitis?
Disk collapse, irregular vertebral bodies
95
Epidural abscess
Can complicate diskitis Increased neuro signs -cord compression, so weakness, numbness, and radicular pain
96
Lemierre syndrome
Suppurrative thrombophlebitis of the jugular vein Clot in setting of bacteremia
97
Typical bacteria for lemierre syndrome
Oral flora, usually fusobacterium
98
Osteomyelitis from Tb
Prolonged monoarticular arthritis Send synovial fluid for AFB cx Pott disease- spinal TB, months of back pain
99
Sickle cell disease with osteomyelitis
Salmonella is most common pathogen, microinfarcts in gut cause leakage, bony infarcts are setting for infection Long bones
100
Osteosarcoma
Persistent bone pain, often epiphyseal Rare, usually under 20 or over 65
101
Ewing sarcoma
1/3 of bony cancers effecting kids Femur and pelvis most commonly Fever and weight loss common here
102
Ewing sarcoma imaging
Moth eaten, finely destructive lesions Onion skinning also seen Soft tissue mass
103
Essential treatment for ewing sarcome
Radiation
104
Scapular winging
Damage to long thoracic nerv
105
Impingement syndrome definition
Inflamed subacromial bursa and related tendons
106
Impingement syndrome presentation
Pain with overhead motion Anterolateral pain, instability, decreased active ROM
107
Impingement syndrome exam
Positive neer/hawkins test Greater pain with at least 90 degrees abduction
108
Best imaging for impingement syndrome
MRI
109
Frozen shoulder phases
Inflammatory- very painful shoulder without trauma freezing- pain decreases, joint stiffens thawing- slow recovery of motion over a year
110
Frozen shoulder related conditions
Endocrine disorders, especially diabetes
111
Rotator cuff muscles
Subscapularis Supraspinatus Infraspinatus Teres minor
112
Rotator cuff tear presentation
Weakness, catching, grating, especially when raising arm overhead Chronic shoulder pain for several months
113
Rotator cuff tear physical exam
Back of shoulder appears sunken, indication atrophy of infraspinatus Active ROM limited Tenderness over greater tuberosity
114
Special test for rotator cuff tears
Open can test- supraspinatus Internal and external rotation
115
Treatment for full thickness tears?
Surgery for formal repair
116
Caution with steroid injections
Only short term relief, may weaken tendon or accelerate tears
117
PT directed exercises
Light weight, high reps, don't push it!
118
Most common direction for shoulder dislocation
Anterior (fall or forceful throwing)
119
Shoulder dislocation exam
Pain with movement Joint hypermobility Numb over deltoid- axillary
120
Special tests for shoulder dislocation
Apprehension test Sulcus sign Jerk test
121
Complication of clavicle fracture
Brachial plexus injury, paresthesias and loss of motor function distally
122
Grade 1 clavicle fracture
Middle 1/3, 80% of fractures
123
Floating shoulder
Disruption of clavicle and scapula High energy trauma Need surgery
124
De quervain's tenosynovitis
Repetitive motion of the tendons of the 1st dorsal compartment causing an inflamed tendon sheath
125
Which tendons are involved in de quervain's?
Extensor pollicis brevis Abductor pollicis longus
126
De quervain's presentation
Pain in 1st dorsal compartment Positive finkelstein's
127
Gamekeeper's thumb aka skier's thumb
Acute valgus force to the thumb, ruptured/sprained ulnar collateral ligament Can be associated with an avulsion fracture
128
Test with gamekeeper's thumb
Laxity with stress test (stress on the UCL)
129
Gamekeeper's thumb treatment
Needs surgery asap!
130
Ganglion cyst
Benign tumor near a joint or tendon sheath Leaking out of synovial fluid
131
Ganglion cyst presentation
Mass, usually asymptomatic Rubbery and subq Pain from compression on nearby nerve
132
Carpal tunnel syndrome
Compression neuropathy of median nerve
133
Positive exams for carpal tunnel syndrome
``` Tinel's Phalen Median nerve compression Thenar wasting 2 point discrimination ```
134
What is the workup for carpal tunnel?
EMG to make sure there is not impingement higher up in the arm
135
Treatment for carpal tunnel
Cock up wrist splint Surgical release
136
Nursemaids elbow
Most common elbow injury in kids less than 5 Slipping of radial head from annular ligament
137
Nursemaid's elbow presentation
Child doesn't use affected arm Hold their elbow flexed and close to body No swelling or point tenderness
138
What muscle types attach to the lateral epicondyle?
Extensors and supinators
139
Which muscle types attach to the medial epicondyle?
Flexor and pronators
140
Epicondylitis
Repetitive use of wrist extensors or flexor, tendinopathy at the numeral epicondyle
141
Epicondylitis presentation
Pain just distal to the involved epicondyle Pain with resisted muscle contraction Normal elbow ROM
142
Epicondylitis treatment
Cock up wrist splint Steroid injection Surgical release
143
Metacarpal fracture
Loss of knuckle prominence Axial load, distal fragment usually angulated volarly
144
What kind of splint does a boxer's fracture need?
Ulnar gutter splint
145
Scaphoid fracture mechanism
Usually FOOSH Most commonly fractured carpal bone Blood supply enters distally, proximal fractures are more at risk for non-union or avascular necrosis
146
Scaphoid fracture presentation
Tenderness in the anatomical snuffbox
147
What kind of splint does a scaphoid fracture need?
Thumb spica splint
148
Colles fracture
Type of distal radial fracture, extension of the distal portion of the fracture
149
Smith's fracture
Distal radial fracture, distal part of fracture flexes
150
What kind of splint does a distal radial fracture need?
Sugar tong splint
151
Supracondylar fracture presentation
Swelling with pain As swelling decreases, may be confused with posterior elbow dislocation Fat pad posteriorly! Highly suggestive
152
De quervain's tenosynovitis mechanism
Repetitive motion of the tendons in the 1st dorsal compartment Inflamed tendon sheath EPB and APL
153
De quervain's tenosynovitis presentation
Repetitive use of wrist or thumb Swelling, pain, crepitus Finkelsteins test
154
Gamekeeper's thumb mechanism
Acute valgus force to the thumb resulting in a ruptured ulnar collateral ligament Can have associated avulsion fracture
155
Gamekeeper's thumb presentation
Pain, swelling, ecchymosis Stress test, laxity in the UCL **needs surgery asap
156
Ganglion cysts mechanism
Benign tumor near a joint or tendon sheath Leaking out of synovial fluid
157
Ganglion cyst presentation
Mass, usually asymptomatic Rubbery Pain from compression on nearby nerve
158
Carpal tunnel syndrome mechanism
Compression neuropathy of median nerve Repetitive use, inflammation, ischemic injury to nerve
159
Carpal tunnel syndrome presentation
Pain, paresthesias in median nerve distribution, hand weakness Tinel sign, phalen sign, median nerve compression, thenar wasting, 2 point discrimination
160
Nursemaid's elbow
Traction on distal radius with elbow extended- slipping of the radial head from the annular ligament
161
Nursemaid's elbow presentation
Child doesn't use affected arm Hold elbow flexed, close to trunk No swelling or point tenderness
162
Extensors and supinators are...
Lateral
163
Flexor and pronators are...
Medial
164
Epicondylitis
Tendinopathy at the humeral epicondyles
165
Epicondylitis presentation
Pain just distal to involved epicondyle Pain with resisted muscle contraction Normal elbow ROM
166
Epicondylitis treatment
Cock up wrist splint
167
Metacarpal fractures
Striking an object with a closed fist, axial load Loss of knuckle prominence
168
Treatment of metacarpal fracture
Ulnar gutter splint, splinted at 50 degrees of flexion to keep ROM
169
Scaphoid fractures
Blood supply enters distally, proximal fractures are more at risk for non union or avascular nerosis
170
Scaphoid fracture presentation
Tenderness in the anatomic snuffbox
171
Scaphoid fracture traetment
Thumb spica splint
172
Radial inclination
Angle formed between a line drawn through the tip of the radial styloid and the medial corner of the lunate facet, intersected with a line drawn perpendicular to the long axis of the radius Normal is 22-23 degrees
173
Smith's fracture
Flexion fracture of the radius
174
Colle's fracture
Extension fracture of the radius
175
Sugar tong splint
Colle's fracture, forearm fracture
176
Supracondylar fracture
Swelling, may be confused with dislocation Posterior fat pad sign
177
Acute back pain
< 6 weeks
178
Chronic back pain
> 3 months
179
Pain from the spine rarely goes...
Below the knee, without the radicular component
180
Red flags
``` Numbness Weakness Saddle anesthesia Loss of anal sphincter tone Bowel or bladder dysfunction ``` And way more!
181
Testing L4
Heel walking
182
Testing L5
Toe dorsiflexion
183
Testing s1
Toe walking
184
L4 dermatome
Medial calf/ankle Patellar reflex
185
L5 dermatome
Dorsal foot and 1st web space
186
S1 dermatome
Plantar and lateral foot Achilles reflex
187
Straight leg raise test
Radiation past knee suggests l4-s1 nerve root irritation
188
Crossed straight leg raise test
Opposite leg raise inducing pain on the affected side, more specific
189
Upper motor neuron signs
Babinskis sign Clonus Hoffmann's sign
190
Lumbar strain
Injury to lunar intrinsic musculature Mechanical overload
191
Lumbar strain presentation
Acute onset of pain No neuro complaints Decreased ROM, sometimes sharp pain on movement but usually dull ache Spasm
192
Disc herniation f
Most common levels in lumbar- l4-s1 Cervical- c5-c7 Posterolateral is the mos common way for it to herniated
193
Degenerative disc disease
Breakdown of intervertebral discs Seen in conjuction with osteoarthritis Back pain or radicular pain of impingement of nerve root
194
Spinal stenosis
Narrowing of the spinal canal or foramen Can lead to impingement/compression on the nerve or nerve root leading to back pain or radiculopathy
195
Spinal stenosis presentation
Pain, numbness, tingling, often bilateral Shopping cart sign (relieved by bending over)
196
Neurogenic claudication
Symptoms with walking and standing Variable walking distance Relief with sitting and flexion Pulses are all okay
197
What is the most common ankle injury?
Sprain
198
Strain
Stretching or tearing of muscle or tendon
199
Sprain
Stretching or tearing of ligament
200
What is the most common mechanism for an ankle sprain?
Inversion
201
Most common ligament to be sprained in inversion?
Anterior talofibular ligament
202
With a medial ankle sprain, what ligament is effected?
Medial deltoid ligament Eversion
203
Grade 1 sprain
Micro tear Minimal swelling No joint instability Fully or partial weight bearing
204
Hopkin's test
Squeeze test Help identify syndesmotic injury by compressing fibula against tibia at mid calf level
205
Ottawa ankle rules
X ray an ankle if there is pain at: Lateral of medial malleolus Inability to bear weight
206
Mortise x ray
Shows medial clear space Between lateral border of medial malleolus and medial talus <4mm is normal, greater than that is lateral talus shift
207
High ankle sprain
Syndesmosis injury Dorsiflexion and eversion injury with internal rotation of tibia
208
Maisonneuve fracture
Proximal fibular fracture coexisting with a medial malleolus fracture or disruption of deltoid ligament Associated with partial or complete disruption of the syndesmosis
209
Trimalleolar fracture
Medial and lateral malleolus with posterior tibia involvement
210
Weber A
At level of epiphyseal plate fibular fracture
211
Weber B
Oblique fracture of fibula communicating distally with epiphyseal plate
212
Weber C
Upper fibular fracture
213
Pilon fracture
Tibial plafond fracture due to axial load High velocity trauma
214
Plantar fasciitis
Degenerative change of plantar fascia Repetitive micotrauma. And collagen degeneration of plantar fascia
215
Plantar fasciitis presentation
Pain worse with first few steps in the morning Pain with excessive walking Pain with dorsiflexion
216
Morton's neuroma
Benign neuroma of an intermetatarsal plantar nerve, most commonly 2nd and 3rd intermetatarsal spaces Nerve entrapment of fibrous tissue around the nerve
217
Morton's neuroma presentation
Pain weight bearing Complaint of walking on marble or rock Numbness or tingling in the toes
218
Calcaneal fractures
Compression fracture from high velocity
219
Calcaneal fracture presentation
Pain, swelling, ecchymosis at bottom of heel aka mondor sign
220
Mondor sign
Associated with calcaneal fracture, hematoma extending to sole of the foot
221
Avascular necrosis risks
Hip fracture Steroid use Alcohol use
222
Avascular necrosis manifestations
Groin or thigh pain, buttock pain Weight bearing or movement pain Pain at rest or at night
223
Avascular necrosis imaging finding
Crescent sign
224
Avascular necrosis treatment
Bed rest, partial weight bearing Extracorporeal shock wave therapy Hyperbaric oxygen
225
Developmental dysplasia of the hip
Teratologic dyslocation (usually with neuromuscular disorder) Typical dislocation, before or after birth Associated with breech presentation, postnatal positioning, torticollis, matatarsus adductus, club foot
226
DDH presentation
Ligament laxity that persists a few months into life Asymmetrical skin folds Galeazzi sign (shortened femur)
227
Barlow and ortolani test
DDH Barlow- displace unstable hip Ortolani- relocate displaced hip
228
Klisic test
DDH Line drawn from greater trochanter through ASIS should point to umbilicus
229
Imaging for DDH
Ultrasound Femoral head doesn't ossify for 4-6 months so an x ray will miss this
230
DDH treatment
Pavlik harness providing flexion and limiting adduction Hip spica cast with 6 months if pavlik fails Surgery if all else fails
231
Legg calve perthes disease
Idiopathic avascular necrosis of capital epiphysis of femoral head, leads to flattening of the bone Associated with hypercoagulable state
232
Legg calve perthes imaging
Radionucleotide bone scan better for early disease
233
SCFE
Orthopedic emergency Obesity is the biggest risk factor
234
Stable SCFE
Antalgic gait Limit time on affected leg to minimize pain, lurch of trunk
235
Klein's sign
Line along upserior edge of femoral neck, should pass through femoral head. If it doesn't, SCFE
236
Trochanteric bursitis
Gait disturbance is most common cause Lateral hip pain worse with pressure, patients rub their hip Normal ROM
237
Hip fracture
Increasing frequency in elderly Significant mortality Half of patients with fx cannot return to independent living
238
Hip fracture presentation
Groin pain Non wt bearing Positive trendelenburg
239
Discoid lateral meniscus
Meniscus are typically semilunar Discoid meniscus is less mobile Displaces with flexion
240
Discoid lateral meniscus presentation
Pain, swelling Widened joint space
241
Osteochondritis dessicans
Vascular insult causes cartilage to separate from bone Older pts usually need surgery
242
Osgood. Schlatter disease
Common after growth spurt Micro fx or avulsion of tibial tuberosity with quad contraction Pain during or after activity, pain and swelling over tubercle
243
Patellofemoral disorder
"Runner's knee" Anterior knee pain Repetitive motion, pain worsens with activity or soreness after sitting for a long time
244
Patellofemoral disorder diagnosis
Apprehension sign with lateral deviation of patella Patellar grind test Lateral deviation or tilting of patella on XR
245
Most common patellar dislocation
Usually lateral
246
Patellar fracture
Usually traumatic Difficulty or inability to extend knee or ambulate
247
Patellar tendon rupture.
Abrupt onset of severe pain Athletes Proximally displaced patella Imcomplete extensor function
248
Popliteal cyst
Baker's cyst Distension of bursae along posterior knee May spontaneously resolve Can precipitate DVT
249
IT band syndrome
Bursitis caused by tightness of IT band and overuse
250
Mesicus injury presentation
Catching or locking sensation due to meniscal fragment Tenderness along joint line
251
Meniscal tests
Mcmurray and. Thessaly
252
Better test for ACL?
Lachman (over anterior drawer)
253
Segond fracture
Pathognomonic for ACL tear
254
Posterior cruciate ligament tear
Sag sign Posterior drawer test PCL injury generally from significant trauma, neurovascular exam is key
255
Most common injured ligament of the knee? Mechanism?
MCL- valgus stress to flexed knee
256
LCL tear
Medial blow to knee

Clin Med (7 decks)

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