MSK Flashcards
(252 cards)
1
Q
tietze syndrome
A
costochondritis + local edema
2
Q
costochondritis tx
A
self limiting
responds well to NSAIDS
3
Q
flail chest sx
A
3+ ribs w/ segmental fx
paradoxical respiration (area of injury sinks in w/ inspiration)
crepitus
4
Q
flail chest tx
A
nonoperative (no respiratory compromise): pain control, positive pressure ventilation
operative (displaced fx, open fx): ORIF
5
Q
MCC rib fx
A
blunt trauma
6
Q
rib fx test
A
CXR AP lat view
7
Q
compartment syndrome MC fx
A
long bone fx
8
Q
compartment syndrome sx
A
6 Ps: pulselessness, pallor, paresthesia, paralysis, pain out of proportion, poikilothermia
tight wood like muscles
9
Q
compartment syndrome tests
A
pressure >30
elevated CK d/t muscle injury
10
Q
compartment syndrome tx
A
emergent fasciotomy of >30
11
Q
compartment syndrome complication
A
volkmann contracture: permanent nerve/muscle damage “claw like deformity”
12
Q
osteoarthritis sx
A
evening joint stiffness, worse throughout the day
heberdens nodes: DIP
Bouchard nodes: PIP
13
Q
osteoarthritis test
A
Xray: joint space narrowing, joint mice, osteophytes, subchondral sclerosis
14
Q
osteoarthritis tx
A
acetaminophen 1st line for elderly w/ bleed risk and mild/mod
NSAIDS
intraairticular glucocorticoid injections
surgery: end-prosthesis (joint replacement)
15
Q
MCC osteomyelitis
A
S. aureus
salmonella: sickle cell
16
Q
osteomyelitis sx
A
point tenderness, pain to site, sinus connecting to abscess
F
children: long bones
17
Q
osteomyelitis homogenous vs exogenous
A
homogenous: indirect, children
exogenous: direct inoculation, adults
18
Q
osteomyelitis test
A
inc WBC
CT: codmans triangle = agressive
MRI: edema, cortical loss
inc ESR and CRP
gold: bone aspiration
19
Q
osteomyelitis tx
A
long term IV abx: ampicillin sulbactam
surgical removal of dead bone
amputation
20
Q
acute osteomyelitis <4mo etiology and tx
A
GBS
nafcillin or oxacillin + 3rd gen cef
21
Q
acute osteomyelitis >4mo etiology and tx
A
MSSA: nafcillin or oxacillin or cefazolin (clinda or vanco if penicillin allergic)
MRSA: vancomycin or linezolid
22
Q
acute osteomyelitis sickle cell etiology and tx
A
salmonella
3rd gen Cef or FQ (cipro or levo)
23
Q
acute osteomyelitis puncture wound etiology or tx
A
pseudomonas
ciprofloxacin or levofloxacin
24
Q
septic arthritis etiology
A
MCC: S aureus
sexually active: S. gonorrheaeoe
25
septic arthritis sx
MC joint knee, unilateral
dec ROM, edema, warm to touch
F
26
septic arthritis dx
leukocytosis
XR
arthrocentesis: >50k WBC, neutrophils, low glucose
27
septic arthritis tx
arthrotomy w/ joint drainage
IV Vanco + 3rd gen ceph
28
avascular necrosis sx
hx of steroid use
pain w/ internal/external rotation of hip
29
avascular necrosis test
hip xray AP and frog: joint space narrowing, subchondral sclerosis
30
avascular necrosis tx
protective weight bearing until dx established
hip arthroplasty if + for femoral head collapse
31
developmental dysplasia sx
ortolani +: clunk hip in
Barlow +: hip adduction out of place
galeazzi +: knee level asymmetric
trendelenburg +: stand of affected leg, dip in pelvis opposite side
waddling gait
32
developmental dysplasia test
US reliable if <4mo
xray not useful, better if >6wks
33
developmental dysplasia tx
reversible w/in 1st, can spontaneously correct by 2-6wk
pavlik harness
forced abduction or reduction is CI d/t avascular necrosis
if >2yo: surgery
34
femoral neck fx sx
acutely shortened
externally rotated
due to posts and iliacus
35
femoral neck fx tx
surgery
36
patella fx sx
acute swelling w/ effusion
inability to extend knee against gravity
quads can't contract
37
patellar vs biparte fx
biparte fx has rounded edges
patellar fx has sharp edges
38
jones fx sx
transverse fx 5th metatarsal at metadiaphyseal junction
pain in lateral mid foot
tenderness at base of 5th metatarsal
39
jones fx MOA
twisting foot wearing heels
40
1st metatarsal fx
dancers fx
ortho referral
41
jones fx tx
non weight bearing
posterior splint then immobilization in short leg cast
surgery
42
Osgood schlatter dz sx
osteochondritis at tibial tuberosity from overuse
tenderness to anterior tibial tubercle
43
MCC chronic knee pain in young active adolescents
Osgood schlatter dz
44
Osgood schlatter test
xray: irregular ossification of tibial tubercle
45
Osgood schlatter tx
spontaneously resolves at skeletal maturity
conservative: ice, NSAIDs, PT
surgery if refractory
46
SCFE sx
adolescent obese boys
limited internal rotation of hip
pain and limp
pain referred to thigh or medial knee
47
SCFE tx
crutches, referral
48
pes anserinus pain syndrome muscles
gracilis
sartorius
semitendinous
49
pes anserinus pain syndrome sx
pain medial knee below joint line
pain over medial tibial condyle, exacerbated by pressure from opposite knee while lying on side
swelling, erythema, and induration typically absent
50
pes anserinus pain syndrome tx
quad strengthening exercise
NSAIDs
51
medial ankle injury sx
tibiofibular ligament
+ external rotation stress test
52
medial ankle injury test
MRI best test
53
medial ankle injury tx
conservative: cast/boot and crutches
PT
refer if tibiotalar joint space is widened/asymmetrical
gold: screw fixation
54
lateral ankle injury sx
inward inversion of foot, anterior taolfibular ligament
anterior drawer test
55
lateral ankle injury test
Ottawa ankle rules
plain radiograph
56
lateral ankle injury tx
uncomplicated: conservative or ortho if bony fx is present
ortho if open fx and neuromuscular impairment
57
osteochondroma
10-20yo
pedunculate grows away from growth plate
observe, resect
58
chondrosarcoma
cartilage based tumor
malignant
punctate ring and arc appearance
35-50yo
tx w/ surgery
59
pages dz of bone
elderly, inc ALP
blade of grass, flame shaped
skull: cotton wool appearance
bisphosphonates TOC
calcitonin
60
osteosarcoma sx
adolescent and <30yo
MC mets to lungs
metaphysics of long bones
61
MC bone malignancy that produces immature or osteoid bone
osteosarcoma
62
osteosarcoma test
xray: hair on end, starry or sunburnt appearance
Rodman's triangle (also seen in Ewings sarcoma)
63
osteosarcoma tx
limb sparing resection if not neovascular
amputation if neovascular
chemo adjunct
high dose IV drugs: MTX, doxirubicon, cisplatin
64
Ewing sarcoma sx
children, femur/pelvis
long bone diaphysis and axial skeleton
palpable mass
fever
65
Ewing sarcoma x ray
lytic lesion
onion peel
moth eaten appearance
periosteal elevation: codman's triangle
66
fibromyalgia associations
MDD
GAD
IBS
67
fibromyalgia ACR criteria
11/18 symmetrical characteristic trigger points
sx >3mo
68
fibromyalgia bx
moth eaten appearance
69
fibromyalgia tx
low dose TCA (amitryptiline)
SNRI (duloxetine)
anticonvulsants (pregabalin)
70
gout gold standard test
arthrocentesis of synovial fluid
biferingent negative needle shaped
71
gout tx
NSAIDS acute first line (indomethacin, naproxen, ibuprofen)
colchicine 2nd line and glucocorticoids
72
gout prophylaxis
low dose colchicine or NSAIDS or low dose steroid
73
gout 1st line chronic tx
allopurinol
CI in acute gout
avoid ASA
74
gout NSAID CI
CKD
PUD
75
pseudo gout test
gold: arthrocentesis: rhomboid positive birefringent
XR: chonedrocalcinosis (linear radiodensities)
76
pseudo gout tx
initial: NSAIDs (naproxen)
alt: colchicine and steroids
77
juvenile RA
1+ joints involved >6wks <16yo
inc CRP/ESR, +ANA
78
juvenile RA tx
opthalmologic exam
NSAIDS
DMARDS
steroid injection to inflamed joint
79
first line tx osteoporosis
bisphosphonates (alendronate)
80
behcets dz
autoimmune recurrent painful oral/genital ulcers
tx w/ CS
81
osteogenesis imperfecta sx
blue tinted sclera
presentile deafness
82
polyarteritis nodosa association
hep B
83
polyarteritis nodes sx
necrotizing vasculitis of medium sized muscular arteries
skin ulcers, subq nodules on lower legs
starburst lived (lived reticularis)
nononeuritis multiplex
HTN, fever
84
polyarteritis nodes test
inc ESR/CRP
definitive: deep wedge bx of nodules
anca -
85
polyarteritis nodosa tx
systemic steroids (prednisone) + cyclophosphamide
86
polyarteritis nodosa complications
cardiac
bowel infarction or perforation
renal failure
87
polymyalgia rheumatica assoc w/
giant cell arteritis
88
polymyalgia rheumatica sx
pain/morning stiffness of shoulder/hip/neck
better thru the day, worse in morning
F
89
polymyalgia rheumatica test
high ESR >50
inc CRP
neg CK, RF, and autoab
90
polymyalgia rheumatica tx
low dose prednisone w/ taper
91
eosinophilic granulomatosis w/ polyangitis triad
asthma
hypereosinophilia
chronic rhino sinusitis
92
eosinophilic granulomatosis w/ polyangitis labs
eosinophilia hallmark
+ PANCA, + RF
inc ESR/CRP, inc BUN/Cr
inc IgE
93
eosinophilic granulomatosis w/ polyangitis tx
CS
94
polymyositis sx
painless progressive weakness
pain of proximal muscles
95
polymyositis test
anti-jo-1
inc aldolase
96
polymyositis tx
high dose prednisone
97
dermatomyositis sx
heliotrope: blue purple upper eyelid discoloration
gottrons papules: raised violicious scaly eruptions on knuckles
shawl or V sign: photosensitive poikiloderma
98
dermatomyositis dx
anti MI 2 ab
99
reactive arthritis MC pathogens
hx of recent GI or chlamydia infx
chlamydia, salmonella, campy, shigella
100
reactive arthritis sx
arthritis, urethritis, conjunctivitis (can't see, can't pee, can't climb a tree)
brown red hyperkeratotic macules on palms and soles (keratoderma blemmoragium)
101
reactive arthritis test
+ HLAB27
102
reactive arthritis tx
self limiting 3-12mo
supportive: NSAIDS
103
granulomatosis w/ polyangiitis
URI sx, saddle nose deformity, lower respiratory tract sx
glomerulonephritis
+ CANCA
tx w/ CS
104
RA sx
improves during day, morning stiffness >30m
swan neck deformity
boutonniere deformity
bow string sign
105
felty syndrome
triad: RA + splenomegaly + dec WBCr/repeat infx
106
Caplan syndrome
pneumoconiosis + RA
107
RA labs
+ RF, anti-CCP (most specific)
108
RA tx
DMARDS: MTX, hydroxychloroquine in pregnancy
NSAIDs first line for acute pain
109
supplement w/ MTX
folic acid
110
sjogrens syndrome tests
+ ANA, + RF, + schemer test
rose bengal test: devitalized epithelium of conjunctiva
anti SS-A (ro), anti SSB (La)
bx: increased infiltration of lymphoblasmacytic
111
sjrogens syndrome tx
pilocarpine
clevimeline
112
SLE can be induced by which meds
methyldopa
INH
procainamide
hydralazine
quinidine
113
SLE sx
triad: joint pain, fever, butterfly rash
discoid rash: annular dry patches on face and scalp
glomerulonephritis, retinitis, oral ulcers, alopecia
114
SLE test
BIT: +ANA
+anti dsDNA, anti smith
+RF, antihistone ab
antiphhospholipid ab syndrome
+ anti cardiolipin
115
SLE tx
hydroxychloroquine
decrease time in sun
116
hydroxychloroquine monitor
do eye exam
117
scleroderma limited
MC: CREST (calcinosis cutis, Raynaud, esophageal dysmotility, sclerodactyly, telangiectasia)
118
CREST
Calcinosis cutis: ca deposits on elbow, knee, finger
Raynaud
esophageal dysmotility (GERD/dysphasia)
sclerodacytyly: red/blue edema, fibrosis
telangiectasia
119
diffuse scleroderma
widespread trunk
pigmentation
more aggressive
cardiac, lung, kidney dz present
120
generalized sx scleroderma
skin thickening/tightning, appears smooth/shiny
digital pitting, depigmentation
121
scleroderma dx
>3/5 crest sx
+ anti scl 70
+ANA
122
limited scleroderma tests
anti SCL70
anticentromere antibodies
ANA
123
scleroderma tx
supportive
MTX
nifedipine CCB for raynauds
124
hence schlonlien purpura
IgA
hematuria, palpable purpura, abd pain, synovial
normal coags
supportive tx
125
ankylosing spondylitis tx
NSAIDs, PT
if doesn't work, TNF inh (infliximab)
126
psoriatic arthritis
asymmetric arthritis, dactyliitis
sausage fingers
xray: pencil in cup
HLAB27, inc ESR
NSAID 1st line
127
cauda equina MCC
herniated disk
128
cauda equina sx
acute onset, low back pain, numbness
urinary retention, saddle anesthesia
dec rectal tone/ fecal incontinence
dec DTR
129
cauda equina dx
MRI study of choice
CT pyelogram if unable to do MRI
130
cauda equina tx
emergent surgery decompression
131
MC locations of herniated disk
L5/S1
L4/L5
132
herniated disk test
MRI best method
133
herniated disk L4 sx
anterior thigh pain
sensory loss to medial ankle
ankle dorsiflexion weakness
loss of knee jerk
weak knee extension- quads
134
herniated disk L5 sx
lateral thigh/leg, hip groin paresthesias and pain
dorsum of foot, esp between 1st and 2nd toes
big toe extension/dorsiflexion weakness
walking on heels harder than on toes
reflexes usually normal
135
herniated disk S1 sx
posterior leg/calf gluteus
plantar surface of foot
plantar flexion weakness
walk on toes harder than heels
loss of ankle jerk reflex
136
kyphosis sx
hunchback
137
scheuermanns juvenile kyphosis
genetic
shmorls nodes on xray
138
kyphosis test
later xray of spine
Cobb angle >40 degrees
anterior wedging of >3 vertebral bodies
139
kyphosis tx
PT
NSAIDs
>75: surgery
>60: brace/cast
140
cafe au lait spots
skin tags
axillary freckles
scoliosis
neurofibromatosis type I
141
scoliosis MC pattern
right thoracic curve
142
scoliosis test
Adams forward bending test
confirm: xray
Cobb method
143
scoliosis tx
brace if 20-40 degrees
observation if <25 degrees, repeat imaging
surgery if >40
144
scoliosis left sided curve
higher incidence of intraspinal pathology (syrinx or tumor)
145
spinal stenosis sx
load dependent low back pain, worse w/ extension, standing, walking
shopping cart test
146
spinal stenosis due to
osteoarthritis (DJD) of lumbar spine or large disk herniation
147
spinal stenosis test
initial: XR
confirm: MRI
148
spinal stenosis tx
conservative: NSAIDs, PT, CS inj
laminectomy
149
thoracic outlet syndrome compression of
brachial plexus
vascular compression w/ abduction of arm
150
thoracic outlet syndrome sx
neck pain, paresthesias to fingers, hand atrophy
dec BP in affected arm
151
thoracic outlet syndrome compression of
brachial plexus
subclavian artery
subclavian vein
152
thoracic outlet syndrome test
arterial TOS = MRA
venous TOS = duplex us
neurogenic TOS = EMG study
+ adson: dec radial pulse if head toward affected side
153
thoracic outlet syndrome tx
mild: PT, NSAIDs, thrombolytics if venous
acute: surgical decompression
154
torticollis which muscle
sternocleidomastoid
155
torticollis tx
congenital: PT, surgery at 12mo if not corrected
wry neck: self limiting
156
brown sequard syndrome
ipsilateral hemiplegia, increased muscle tone.
ipsilateral loss of motor, vibratory, and proprioception
contralateral loss of pain and temp sensation
157
brown sequard syndrome tx
supportive, rehab
CS
158
anterior cord syndrome sx
complete loss of motor, pain, and temp below injury
retains proprioception and vibratory
159
MC shoulder dislocation
anterior
160
anterior arm dislocation sx
abducted and externally rotated arm
axillary nerve damage: dec sensation in shoulder badge description
161
bankart lesion
detaching of anterior inferior labrum from glenoid rim
162
hills Sachs lesion
defect of postiolateral humeral head d/t abrasions of anterior rum of glenoid
163
posterior shoulder dislocation causes
electric shock
seizures
164
posterior shoulder dislocation sx
arm adduction and internal rotation
165
posterior shoulder dislocation tx
closed reduction
166
posterior shoulder dislocation complications
labral injuries
tears to SITS
+neer and + Hawkins
167
clavicle fx MC location
middle 1/3
168
clavicle fx test
CT angio dx TOC
169
clavicle fx complication
middle 3rd of clavicle has brachial plexus and subclavian artery/vein
170
clavicle fx tx
figure 8 sling
neonatal: reassurance
prox 1/3: ortho
171
colles fx
fx distal radius w/ dorsal and radial displacement
tx w/ sugar tong splint
from FOOSH
172
smiths fx
distal radius
garden spade deformity
volar angulation
173
torus fx
Peds, buckle fx
174
humeral head fx MOA
FOOSH
175
humeral head fx neuro eval
watch for axillary nerve and brachial plexus
176
humeral head fx tx
immobilization in sling
177
MC complication humeral head fx
frozen shoulder
178
humeral shaft fx tx
r/o radial nerve injury (wrist drop)
tx sugar tong splint
179
radial head fx xray
fat pad sail sign
180
radial head fx sx
FOOSH
cannot fully extend elbow
181
radial head fx tx
sling
displaced ORIF
182
fat pad sail sign in child
supracondylar fx
183
boxers fx
5th metacarpal neck
ulnar gutter cast
184
galeazze fx dislocation
FOOSH
distal radius rx, radioulnar joint (DRUJ) dislocation
185
monteggia fx
proximal/mid ulna fx
radial head dislocation
186
conteggia fx complication
radial nerve injury (wrist drop)
187
dupuytrens contracture association
diabetes
188
dupuytrens contracture (trigger finger) tx
injection
surgery
189
orbital blowout fx sx
inferior rectus entrapment CN3
upward gaze
infraorbital anesthesia
190
MC area mandibular fx
body
condyle
191
legg calve perthes sx
child 4-8yo
painless limp
192
legg calve perthes tx
self limiting
pain reduction
193
unhappy triad
ACL
MCL
medial meniscus
194
tenosynovitis sx
Finger in flexion
Length of tendon sheath tender
Enlarged finger
Xtension of finger causes pain
195
meds that can cause gout
pyrazinamide
loop diuretics
low dose aspirin
thiazides
ethambutol
196
colchicine AE
diarrhea
197
NSAID gout caution/CI
renal insufficiency
active duodenal/gastric ulcer
cardiovascular dz
198
allopurinol AE
SJS
199
meds that can cause SJS
allopurinol
phenytoin
phenobarbital
lamotrigine
ethosuximinde
penicillins
carbamazepines
sulfonamides
200
MC joint involved in pseudo gout
knee
201
pseudo gout tx
intraairticular injection (1-2 joints) first line
NSAIDS, steroids, colchicine
202
juvenile idiopathic arthritis criteria
<16yo
arthritis for at least 6 weeks
203
juvenile idiopathic arthritis sx
Fever at least 2 wks (quotidian pattern: F spikes and disappears daily)
arthritis at least 6 weeks
salmon colored rash
uveitis
204
juvenile idiopathic arthritis tx
NSAIDS
205
MC type of fx in osteoporosis
vertebral compression fx
206
bisphosphonates AE
pill induced esophagitis
jaw osteonecrosis
atypical femur fx
207
polyarteritis nodosa sx
hx of hepatitis
renal dz (HTN)
dermatologic
mononeuropathy multiplex
tends to spare the lungs
208
polyarteritis nodosa dx and tx
- ANCA
glucocorticoids
209
polymyalgia rheumatica sx
stiffness and pain in shoulders, hip girdle, and neck, worse in AM
Female > 50yo
giant cell arteritis
210
polymyalgia rheumatica test
inc ESR/CRP
211
polymyositis and dermatomyositis sx
muscle weakness (proximal, progressive, symmetric)
dermatomyositis: gottron papules, shawl sign/ v sign (photo distributed koikiloderma), heliotrope rash,
212
polymyositis and dermatomyositis test
elevated CK, aldolase
anti-jo-1, anti-mi-2 (dermtomyositis)
213
causes of reactive arthritis
chlamydia
preceding GI/GU infx
214
sjogrens test
anti ro SSA
anti la SSB
schirmer test
215
limited scleroderma test
anti centromere ab
216
diffuse scleroderma test
anti scl 70
217
lupus tests
anti smith ab
anti dsDNA ab
antiphospholipid ab `
218
lupus tx
hydroxychloroquine
219
MC type of dislocation
anterior glenohumeral dislocation
220
anterior glenohumeral dislocation presentation
abducted externally rotated arm
221
axillary nerve injury
common in pts with glenohumeral dislocation
lose feeling around shoulder badge distribution
222
associated injuries w/ anterior shoulder dislocation
hill-sachs lesion
bankart lesion
axillary nerve injury
223
posterior shoulder dislocation xray
light bulb sign
224
adhesive capsulitis RF
diabetes
hypothyroidism
225
supracondylar humerus fx presentation
2-7yo
FOOSH w/ elbow hyperextendedn
226
supracondylar humerus fx test
xray: fat pads
227
supracondylar humerus fx complications
volkmann ischemic contracture
228
cubital tunnel syndrome test
tinel sign
229
scaphoid fx tx
thumb spicca splint
230
colles fx xray
dorsal displacement of the distal radius fragment
231
smith fx xray
volar/ palmar displacement of the distal radius fragment
232
lunate fx xray
spilled tea cup sign
233
lunate fx complications
avascular necrosis (kienbocks disease)
234
de quervain tenosynovitis tendons
abductor pollicis longus
extensor pollicis brevis
235
type of femur fx associated w/ avascular necrosis
femoral neck fx
236
hip fx presentation
externally rotated, shortened leg
237
hip dislocation presentation
internally rotated, shortened leg
238
MC Hip dislocation
posterior
239
SCFE presentation
12-13yo obese
painful limp
240
SCFE gold standard tx
surgical pinning
241
legg calve perthes presentation
painless limp
5-8yo
242
legg calve perthes presentation
painless limp
5-8yo
243
ACL test
lachman most sensitive
244
PCL test
posterior drawer test
245
meniscal injury test
Mcmurray
joint line tenderness
246
meniscal injury sx
pop
lock
knee gives out (drop)
247
tibiofemoral dislocation complication
popliteal artery injury: can lose limb
peroneal nerve injury
248
patellofemoral syndrome sx
anterior knee pain
249
patellofemoral syndrome RF
runners
women
250
IT band syndrome sx
lateral knee pain
251
achilles tendon rupture RF
FQ
252
achilles tendon rupture test
thompson test
