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PANCE 2024 > MSK > Flashcards

MSK Flashcards

1
Q

2 COMMON locations for compartment syndrome

A

Anterior compartment of lower leg

Volar compartment of forearm

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2
Q

Don’t forget that what can be a cause of compartment syndrome

A

Circumferential burn

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3
Q

What pressure is positive for compartment syndrome

A

Delta pressure over 30

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4
Q

Muscle breakdown causes what two things

A

Release of myoglobin leading to myoglobinuria

Kidney dysfunction = hyperkalemia // increased phosphate // LOW CALCIUM

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5
Q

MC complication of compartment syndrome

A

Rhabdomyolysis

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6
Q

BMI greater than what can cause osteoarthritis

A

25

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7
Q

5 things to remember about osteoarthritis

A

LOSS

Loss of joint space
Osteopphytes
Subchondral cysts
Sclerosis

And

Pip-E Bouchard Nodules with Heberden Nodules at the DIP Joint

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8
Q

4 management options for osteoarthritis

A

Oral or topical NSAIDS
Topical capsaicin
Duloxetine
CC Injections

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9
Q

With HLA B27 think ?

A

Ankloysing Spondylitis

Axial spine and Sacroiliac joints

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10
Q

Risk factors for AK

A

Male under age 45

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11
Q

Pain is what with AK

A

Worse in the morning and improves with activity

Just like osteoarthritis

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12
Q

1 extra articulate manifestation of AK

A

Anterior uveitis

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13
Q

1 st line for AK

A

NSAIDs and PT

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14
Q

Nerve distro effected by cauda equina

A

L2 - S1

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15
Q

Post void residual volume = + for urinary retention in cauda equina

A

Greater 100

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16
Q

Lateral upper arm

Lateral forearm and thumb

Posterior forearm and middle finger

Fifth finger

Nerve Roots.

A

C5

C6

C7

C8

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17
Q

Root associated with loss of

Brachioradialis reflex

Biceps reflex

Triceps reflex

A

C5

C6

C7

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18
Q

How does the leg get its innervation

A

S1 the butt

L5

L4

L3 wraps around the groin

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19
Q

What is a positive straight leg test

A

Hold the knee

Raise the leg

Pain shoots from back PAST the knee

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20
Q

Knee extension vs. Knee Flexion roots

A

Extension = L3/L4 —> KICK THE FLOOR

Flexion = L5/S1 —> RIDE ONE, FLEX.

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21
Q

In spinal stenosis sxs improve with

A

Flexion

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22
Q
A
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23
Q

What red flag is significant from seronegative splodylarthropathy

A

Morning stiffness in a greater than 30 yr old adult

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24
Q

When is a good time to X-rays for low back pain

A

Persists longer than 6 weeks despite conservative treatment or if ALARM sxs

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25
Q

Most shoulder dislocations are

A

Anterior

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26
Q

Mechanism for posterior shoulder dislocation

A

Seizure or electric shock

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27
Q

Special tests for shoulder instability

A

Apprehension and O’Brien Test

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28
Q

What movements aggravate each RTC muscle

A

Supraspinatus = abduction

Infraspinatus = ER

Tree Minor = ER

Subscapularis = IR

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29
Q

What are good tests for shoulder impingement?

A

Anterior = Hawkins Kennedy

Posterior = Neers Test

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30
Q

Shoulder lift off and belly press test what

A

Internal rotation of the shoulder

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31
Q

Shoulder impingement gets surgery for what

A

Full thickness tears

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32
Q

2 diseases associated with frozen shoulder

A

Diabetes

Hypothyroidism

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33
Q

Movement most effected in frozen shoulder

A

External rotation and abduction

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34
Q

Lateral epicondylitis is what?

A

Tennis Elbow

Lateral tendonidopathy of the Extensor carpi radilais brevis

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35
Q

Medial epicondylitis is?

A

Golfers elbow

Medial tendonopathy of the pronator teres

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36
Q

Lateral epicondylitis vs medial epicondylitis = PAIN WITH WHAT MOTIONS?

A

Lateral = activities where the arm and wrist are extended

Medial = activities that involve wrist Flexion and Pronation

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37
Q

Pain with resisted what in LATERAL VS. MEDIAL EPICOND

A

LATERAL = extension

MEDIAL = Flexion

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38
Q

Two tests if you suspect scaphoid tenderness

A

Ulnar wrist deviation PAIN

Exist compression of the thumb PAIN

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39
Q

When do you have surgery in scaphoid fracture

A

Displaced fractures

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40
Q

Type of splint for boxer fracture

A

Ulnar gutter splint

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41
Q

Colles vs. Smith fracture

A

Colles = volar displacement of wrist = R/o Schaphiod injury!

Smith = distal displacement

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42
Q

Colles vs. Smith Fracture

A

Colles = volar

Smith = distal

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43
Q

If you are gonna do surgery on Colles or smith what is the surgery / splint

A

ORIF = unstable or communited

Splint = sugar tong splint

Colles = Eat something sweeet with that FORK = Sugar Tong

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44
Q

Mallet finger is what?

A

Disruption of finger extensor tendon mechanism at the DIP.

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45
Q

Treatment mallet finger

A

Maintain the DIP joint in full extension for 6-8 weeks

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46
Q

Mallet finger can lead to what

A

Swan neck deformity

DIP in Flexion
PIP in hyperextension

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47
Q

Skiers game keeper thumb is a disruption of what ligament

A

Ulnar collateral ligament avulsion fracture by forced ABDUCTION

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48
Q

Posterior hip dislocation is described as

A

Leg shortened with hip flexed ; adducted ; internally rotated
FADIR

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49
Q

Anterior hip dislocation is defined as

A

Hip extended , abducted, and externally rotated

FABER

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50
Q

How does the femoral head appear in anterior vs. posterior hip dislocation

A

Anterior = larger and medial or inferior to the acetabulum

Posterior = smaller and superimposes on the roof of the acetabulum

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51
Q

Time frame for closed reduction in hip dislocation

A

6hours

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52
Q

Most common type of hip fx

A

Intertrochaneteric

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53
Q

What is the story for ACL tear

A

Pop sensation with effusion and instability

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54
Q

What would a plain film show in knee ligament injury

A

Segond fracture

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55
Q

What artery is injured in PCL tear

A

Popliteal artery injury

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56
Q

MCL vs LCL stress

A

MCL = Valgus

LCL = VARUS

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57
Q

What is the story for meniscal tear

A

Twisting motion of a flexed knee on a planted foot

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58
Q

Meniscus makes you think?

A

Mechanical symptoms

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59
Q

Ankle INVERSION injury is most common and effects what ligament

A

Anterior talofibular ligament

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60
Q

Ankle eversion is uncommon and effects what ligament

A

Deltoid

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61
Q

High ankle sprain effects what location

A

Distal tibiofibular syndesmosis

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62
Q

Brief explanation of Ottawa ankle rules

A

Pain in the malleolar region :
-Bone tenderness posterior edge of medial mall. or lateral mall. [6cm]
-Pain in the same area when walking [ 4 steps ]

Pain in the midfoot region :
-TTP at the Navicular
-Base of 5th metatarsal pain
-Pain in the same area when walking [ 4 steps ]

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63
Q

Maisoneueve fracture combination ? 2 things.

A

1st. Medial Malleolous fracture

2nd. Spiral fracture of proximal tibia

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64
Q

JONES VS. PSUEDOJONES definition

A

Jones = transverse fracture of the proximal diaphysis of the fifth metatarsal

PSUEDOJONES = avulsion fracture of the 5th metatarsal tuberosity

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65
Q

Jones vs. Pseudojones management

A

Jones = Non weight bearing 6-8 weeks

PSUEDOJONES = walking boot 2-3 weeks

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66
Q

What three ligaments are involved in the lesfranc fracture

A

Plantar
Lesfranc
Dorsal ligament

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67
Q

Lesfranc management

A

ORIF non weight bearing cast 6-12 weeks

Non weight bearing case and repeat X-ray every 2 weeks = no dislocation

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68
Q

Puncture wound from nail what pathogens

A

Staph A

Psuedomonas = shoe de Mona’s

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69
Q

Most sensitive study for osteomyelitis

A

MRI

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70
Q

Osteomyelitis treatment if

Psuedomonas

GBS

MSSA

A

Pseudomonas = Cefepime ; Ceftazidime

GBS = Vancomycin

MSSA = nafcilin oxacilin

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71
Q

If something looks like septic arthritis dont forget to think about

A

N. Gonnorhea

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72
Q

Antibiotics of choice for septic arthritis

A

Vancomycin + Ceftriaxone

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73
Q

What part of the bone is effected in Ewing sarcoma

A

Diaphysis of long bones

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74
Q

Biopsy of Ewing sarcoma looks like

A

Small round blue cells

Psuedorossetes

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75
Q

What age is effected by osteosarcoma

A

13-16 and greater than 65

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76
Q

Osteosarcoma think what

A

Sunburst

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77
Q

Osteosarcoma think what

A

Sunburst

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78
Q

5 PLATE, medications that can cause gout

A

Pyrazinamide
Loop diuretics
ASA
Thiazides
Ethambutol

“Too much seafood on your plate”

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79
Q

Gout arthrocentesis shows what

A

Negative birefringent crystals

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80
Q

Psuedomonas gout shows what

A

Positive birefrigent crystals

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81
Q

Mainstay treatment gout

A

Indomethacin
Colchicine for ATTACKS

MX = allupurinol

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82
Q

Allupurinol is what type of medication and what side effects

Probenacid

A

Xanthine oxidase inhibitor

probenacid = urate reputake inhibitor

Hematuria
Bleeding gums
Blue/pale skin

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83
Q

4 disease states assoc with pseudo gout

A

Hyper PTH

hypothyriodism

Hemochromatosis

Thiazides diuretics

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84
Q

X-RAY for pseudogout shows what

A

Chondrocalcinosis

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85
Q

Shape of crystals gout vs. psuedogout

A

Gout = sharp

Psuedogout = rhomboids

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86
Q

MC primary cause of osteoporosis

A

Post menopause loss of estrogen
Loss of zinc / ca2+

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87
Q

What is the defintion of osteoporosis

A

Less than -2.5 with fragility fracture

88
Q

Osteoporosis treatment of choice

A

Dronates! Bisphosphonates

89
Q

Screening for osteoporosis [5]

A

Age over 65 women

Hx of fragility fracture
BMI less 21= LOW
Current smoker or drinker
Rheumatoid Arthritis
Medication cause of bone loss

90
Q

Polymaylagia rhuematica is associated with ?

A

Giant Cell Arteritis

91
Q

Pain in PMR is what?

A

Symmetric with prolonged morning stiffness greater 30 mins ; impacts ability to do daily activities.

PROXIMAL JOINTS

92
Q

Lab findings associated with Reuters syndrome

A

HLA B27

93
Q

Rheumatoid affects what joints? And what deformity is associated

A

MCP and PIP

Swan neck and Bouteniere deformities ; ulnar finger deviation

94
Q

Lab studies positive in rheumatoid arthritis

A

Rheumatic factor

Anti cyclic citrullinated peptide

95
Q

1st line RA and what do you also give

A

Methotrexate

Folic acid supplements

96
Q

SLE think what meds? HIMP

A

Hydralazine

Isoniazid

Minocycline

Procainamide

97
Q

SLE affects who?

A

Young women age 16-55

98
Q

What is the eye involvement in SLE

A

Kerratoconjunctivitis sicca

99
Q

SLE Lab antibodies

A

Anti double stranded DNA
Anti smith antibodies

100
Q

SLE management

A

Hydroxycloroquine or chloroquine

101
Q

Limited scleroderma is what?

A

CREST

Calcinosis

Raynauds

Esophageal dysmotitility

Telangiectasias

102
Q

Lab testing in scleroderma is positive for

A

Diffuse = ANA -SCl-70

Limited = anticentromere antibodies

103
Q

3 complications of systemic scleroderma

A

Interstitial lung disease
Pulmonary hypertension
Cardio renal complications

104
Q

Sjorgen syndrome causes destruction of what two glands

A

Salivary and lacrimal [exocrine glands]

105
Q

Antibodies positive in Sjogrens

A

Anti ss A Rho

Anti ss B LA

106
Q

How to combat dryness in Sjogrens

A

Cholinergic agonists // artificial tears

107
Q

2 complications of Sjogrens

A

Dental caries

MALT // lymphoid tissue lymphoma

108
Q

2 things lost in osteoporosis

A

Bone matrix and mineral

RF : ETOH, smoking ; steroid use=2ndary

109
Q

Osteopenia vs. osteoporosis

A

Penis = 1.0 -2.4

2.5 or more

Females = screen at 65 yrs

Males = 75 yrs

110
Q

Teaching points for Bisphosphonates

A

Take it in the AM ; while sitting up

ADE’s = esophagitis ; Jaw necrosis ; femoral shaft fx

STOP after 3 yrs that the condition has resolved

111
Q

If advanced renal dz w osteoporosis what treatment

A

Denosomab

112
Q

Last line for osteoporosis

A

Raloxifene = sERM

Given to pts with increased risk of breast cancer ; to decrease hormone receptors responsible in cancer development

113
Q

What is an effective analgesic after acute vertebral fx

A

Miacalcin nasal spray

114
Q

Paget’s bone disease [4]

A

Osteoclastic then osteoblastic activity = weak bone formation —> CORTICAL THICKENING SKULL AND PELVIS

Highly vascular ; high ALK PHOS

Deformed ; Multiple bones involved

TXMN = IV zolendronate -single dose

115
Q

Pagets of the skull

A

Would show mod severe cortical thickening

116
Q

Compartment syndrome has pain with

A

Passive stretch

117
Q

Osteoarthritis is a

A

Non inflammatory arthritis

Pain in the AM > moving makes it better

Crepitus

Heberden -DIP

Bouchard-PIP

118
Q

Normal dexa scan =

A

-1.0 or greater

119
Q

In adults osteomyelitis affects the

A

Spine - diabetics

120
Q

Chronic osteomyelitis [4]

A

Weeks to months with mild incr ESR/CRP

Localized inflammation or cellulitis

X-ray —> bone destruction // CT for bone bx ; MRI best view

TXM = Lon term IV abx ; Surgical debridement

121
Q

Septic arthritis is commonly what kind of spread

A

Hematogenous

122
Q

DIG infection may have lesions where with septic arthritis

A

Palms and Soles of feet

123
Q

Non gonnococcal arthritis TXM

A

Vanco + 3rd gen ceph

4-6 weeks

124
Q

Gonnocoal arthritis TXM

A

Doxy PO + IV Ceftriaxone

125
Q

Do ganglion cysts transilluminate

A

YES

126
Q

Benign vs. Malignant bone tumor

A

Benign = defined sclerotic margins and SLOW growth

Malignant = permeative lesion with Lytic destruction poor margins = RAPID growth

127
Q

Primary tumors that often Metz to the bone : Lettuce tomatoes pickles ketchup bacon

A

Prostate
Breast
Lung
Kidney
Thyroid

128
Q

How can you manage bone cysts

A

Bx=Dx

Watch and Wait

Asp/inj w/ steriods

Curettage and bone graft

129
Q

Osteoid osteoma = FULL OF BONE

A

Aching night pain ; better w/ NSAIDS —> surgery —-> ablation

MC : benign bone tumor M>F ; young adults

130
Q

osteosarcoma [4]

A

KNEE ; Males ; non traumatic

Ages 15-25 y/o

Destructive sun burst appearance —> get bone bx

ALK PHOS [2-3xnml] TXM = CHEMO

131
Q

Fibromyalgia

A

20-50 y/o F

Pain on trigger points in several different areas

Non progressive sxs ; but life long

TXM = moderate exercise ; CBT ; TCAs ; SSRI’s SSNRIs best analgesic = ultram/APAP

132
Q

Gout medications 4

A

Thiazide

Loop diuretics

Beer

Beta blockers

133
Q

Acute cases of gout have increased what

A

WBC

134
Q

What type of crystals in out

A

Positive sodium urate +

Negatively birefringent

135
Q

Must r/o what if giving CC for acute gout

A

Septic arthritis

136
Q

Undersecretion vs. overproduction meds for chronic gout mgmt

A

Undersecretion = probenecid or uricosuric agent URI —> STOPS URATE UPTAKE, PROMOTES SECRETION

Overproduction = allopurinol/febuxostat ; XOI —> STOPS THE PRODUCTION

137
Q

Increase what type of dietary component in gout mgmt

A

Dairy

138
Q

Pseudogout affects what joint

A

Large joints !

Like knee and wrists

+rhomboid crystals + birefringent

139
Q

Allopurinol or probencid in psuedogout mgmt ?

A

NO ; not a problem of uric acid.

Just; = acute NSAIDs // CC //

colchicine or NSAIDs = chronic

140
Q

Juvenile idiopathic arthritis [4]

A

Greater 6 weeks of sxs ; less than 16 years old.

Fever ; rash that will come and go ; Oligo —-> anterior uveitis [optho x4/yr]

25% = poly articular +RF; +AntiCCP [RA] +ANA = more severe disease

TXM = NSAIDs —> DMARDS [Methotrexate]

141
Q

Poly arteritis nodosa [4]

A

“Necrotizing Arteritis” ; medium sized vessels 10% CAUSE : HEP B

Libido Reticularis // skin ulcers // digital gangrene // fever // malaise

Dx : tissue bx / Angio of aneurysms ; if renal vessels —> HTN

TXM = high dose CC // HTN = ACE // Hep B = Prednisone + lamivudine + plasmaphoresis

142
Q

Poly/dermatomyositis

A

20% = malignant ; can raise hand up neck and proximal muscle weakeness UE & LE

Heliotrope rash-eyelids // Gotttron papules -hands = skin rash common

Dx = muscle bx ; + ANA +ANTI-JO 1 antibodies

TXM = CC ; methotrexate ; IVIG

143
Q

Reactive arthritis [5]

A

Post shigella ; salmonella ; yersenia ; campy ; chlamydia infection

Tetrad : conjunctives ; urethritis ; aseptic arthritis ; oral lesions

Keratoderma blennorhagica = feet nodules

HLA B27 + dx : joint destruction after 6 mos = permanent

TXM = NSAIDs ; PT ; less likely to develop if early TXM

144
Q

RA [4]

A

Inflammatory synovial membrane pannus erodes cartilage

Boggy tissue ; symmetrical poly arthritis ; nodules on elbows
—> ulnar deviation of fingers
-Boutonnier/Swan neck deformities
-C1-2 joint prone to subluxation

60% = Sjorgens ; + RF and +Anti-CCP
Usually lasts longer than 6 weeks

TXM = Methotrexate ; NSAIDs ; etanercept ; TNF inhibitors

145
Q

SLE [4]

A

Medications : procainamide ; isoniazid ; quinidine ; anti-TNF agents ; chlorpromazine; hydralazine; minocyclin]

Fever anorexia ; Arthralgia ; Raynard’s syndrome MALAR or DISCOID rash

+anti dx DNA ; + anti-smith ab

TXM = joint/skin—> hydroxuchloroquine

Minor —> NSIADs

GMN / pericarditis / hemolytic anemia —> CC

146
Q

SE w steriods and SLE

A

Accelerate atherosclerosis

Osteoporosis and AVN of bone

147
Q

Scleroderma

A

Diffuse fibrosis of skin and internal organs

Limited = CREST
Diffuse = skin hardening of face ; hands ; trunck ; limbs ORGANS = SEVERE

90% have Raynauds // Esoph motility —> lungs ; heart ; kidney

+AntiSCL 70 ; +Anitcentromere AB +AntiRNA polymerase Ab

TXM = rainouts = CCBs
HTN crisis —> ACE inhibitors

148
Q

Sjorgens dysfunction TREATMENT AND ANTIBODIES

A

Exocrine ; + SSA [ro] + SSB [La]

+lymphs on lip bx

Anemia leukopenia eosinophilia

TXM = avoidance ; pilocarpine —> dry mouth

Topical cyclosporine —-> dry eyes

149
Q

AC injury

A

Direct fall onto the shoulder ; over the handle bars

Pain at top os shoulder —> up towards the neck

+crossover test

TXM = ice sling 2-4 weeks ; grades 4-6 —> ortho surgery

150
Q

MC bone fx in children

A

Clavicle

151
Q

Most clavicle fx at the

A

Middle 1/3

Closer to the chest —> more concerned for organ damage medially

152
Q

TXM of clavicle fx

A

Sling or fig of 8 splint [3-4 weeks]

Good ROM encouraged

153
Q

MC injured RC muscle

A

Supraspinatus

154
Q

RTC INJURY is mostly a

A

Chronic disorder —> inflammation causes pinching —-> tear

Pain over greater tuberosity ; lateral shoulder pain that radiates downward

+Neer and Hawkins

TXM = RICE ; steriods ; PT ; surgery

155
Q

Biceps tendinopathy [4]

A

Overuse of biceps

Bicipital groove tenderness

Resisted supination of forearm pain

TXM = Rest ; sling ; NSaIDs

156
Q

Elderly women with osteoporosis likely fx where

A

Proximal humerus fx

157
Q

TXM proximal humerus fx

A

Mild / impacted = sling and swath 4 weeks

Dislocation / fx = surgical

158
Q

Shoulder dislocation =

A

Fall on externally rotated abducted arm = trying to catch self while falling

Presents with arm ABDUCTED
Squared off
97% anterior

TXM = immediate closed reduction w post reduction X-ray

Sling swath 4 weeks ; start ROM at 2 weeks

159
Q

Elbow joint is what type of joint

A

Hinge

160
Q

Lateral epicondylitis

A

Tennis elbow ; overuse with supination and wrist extension

Pain on resisted wrist extension +point tenderness over lateral epicondyle

TXM = Rest ice ; NSAIDS

161
Q

Medial epicondylitis

A

Golfers elbow

Point tenderness over medial epicondyle +pain on resisted wrist Flexion

TXM = stretching / REST / ice

162
Q

Supracondylar fx think positive what on X-ray

A

Posterior fat pad

163
Q

Radial head fx = fall

A

On an outstretched hand

Diffuse lateral elbow pain over radial head + posterior fat pad

TXM = sling 2-4 weeks

164
Q

Colles fx

A

Distal radius fx

FOOSH

Silver fork deformity

TXM = closed reduction and cast 6-8 weeks

Intraarticular or comminited = surgery

165
Q

Gamekeepers thumb

A

Them forced into radial deviation

Stretched ulnar collateral ligament

X-RAY r/o avulsion fx

TXM = thumb spica cast —> ORIF surgery

166
Q

What dx test can confirm scaphoid fx best

A

Bone scan or MRI

167
Q

Schapoid fx

A

Thumb spica cast 6-20 weeks

Repeat X-ray in 1 week

HIGH NON UNION RATE

168
Q

Boxers fx TXM ; 4th and 5th metacarpal fx with volar angulation :

A

TXM = ulnar gutter splint with closed reduction

Close follow up

OR + IV abx if break in skin

169
Q

De Quervains tenosynovitis TXM

A

Thumb spica splint for rest ; NSAIDs and steroid injection if non improvement

170
Q

Trigger finger

A

Stenosis tenosynovitis @ flexor tendon

+snap with Flexion and extensions // pain

TXM = splinting NAIDs steriods surgery

171
Q

Fingers of carpal tunnel compression

A

Them index and middle finger ; some radial aspect of ring finger

172
Q

Thoacolumbar fx TXM

A

+wedge shaped or chance fx = pulled wide open

If fx is non displaced and no deficit —> brace for 6 weeks and PT

Fx or displaced with neuro deficit —> surgery

173
Q

Monitor what 2 things for rib fx

A

Adequate ventilation

PNA

—consider nerve block for pain mgmt // ventilation assistance

174
Q

AK

A

Chronic inflammatory disease ; starts in the pelvis SI joint

M>F ; +HLA B27 = 90% ; ESR elevated

Progresses to dec spine mobility and limited chest expansion

TXM = NSAIDs or TNF Inhibitors PT for flexibility or pt. Education

175
Q

Thoracic outlet syndrome

A

Compression of brachial plexus and subcalvian artery and vein

Pain can come and go ; vague ; get an X-ray ; EMG ; Doppler of neck structures

TXM = posture exercise

Surgery = anatomic obstruction

176
Q

Torticollis TXM

A

TXM = child = cervical collar

Adults = pain mgmt and PT

177
Q

What muscle is affected by torticollis commonly

A

SCM +/- a mass on SCM

178
Q

Pectus carinatum =

Pectus excavatum =

A

PC = protrusion of sternum

PE = extrusion of sternum

*both assoc : CHDz

179
Q

Kyphosis [4]

A

Increase in dorsa curve of T spine —> collapse of vertebrae

Pain = acute Fx ; de conditioned back muscles

ANTERIOR BEND

TXM = PT for strengthening ; pain control ; surgery = kyphoplasty

180
Q

scoliosis [4]

A

Idio LATERAL curve greater 10degrees

Hips/shoudler sit at diff levels

Dx : Cobb angle = greater 20 degrees

TXM = Over 20 = surgery and brace ; less 20 observe
consider closeness to puberty

181
Q

TXM of LBP

A

Relative rest ; ice/heat ; NSAIDs ;

-PT after each episode-

Muscle relaxants ; narcotics no longer 3 days

182
Q

Herniated disc pain is worse when

A

Flexion or valsava

+cross and straight leg raise

183
Q

L4

L5

S1

Motor //

A

L4 —> dorsoflexion of foot

L5 —> dorsiflexion of great toe

S1 —> eversion of foot

184
Q

L4

L5

S1

Reflex //

A

L4 —> knee jerk

L5 —> none

S1 —> ankle jerk

185
Q

L4

L5

S1

// Sensory Pain

A

L4–> medial calf and foot

L5–> lateral calf and dorsal foot

S1 —> lateral foot and plantar foot

186
Q

Herniated disc initial image

A

MRI

187
Q

Cauda equina compression

A

L2 -S4 nerve root ; saddle anesthesia ; bowel bladder dysfunction

MRI

SURGICAL EMERGENCY

188
Q

Spinal stenosis

A

Pt over 60 y/o male + Arthritis

Inflamed ligamentum flavum hypertrophy ; sponylolisthesis

Butt and leg pain chronic —> better when lean fwd and walk

Spaghetti legs mild LE weakness

MRI best ;

TXM = rest ; PT ; NSAIDS ; weight reduction ; nerve blocks ; surgery

189
Q

Pt lifts heavy objects on a daily basis pain on the lateral leg and foot +SLR ; dx

A

Herniated disk

190
Q

AVN

A

Loss of blood supply ; think : steriods or ETOH ; peds: dvd ; SCFE

Dull IR / ER pain decreased ROM

MRI best Dx

TXM = non eight bearing refer to ortho!

191
Q

Hip fx think what kind of leg

A

Shortened

Then —> ER or IR

192
Q

Hip dislocation think

A

MC : posterior dislocation ; knee contact with dashboard —> ACL

Posterior : short and internally rotated

TXM = immediate reduction with post reduction film

193
Q

Tibial plateau fx think

A

Axial load injury = jump from high place and land

+/- weight bearing ;

X-ray —> CT ; tibial depression r/o

TXM = immobilize and non weight bearing —> surgical

194
Q

Patellar fx

A

Direct blow or forced Flexion of the quadriceps muscle

Pain with knee EXTENSION

TXM = mild = immobilization

Displacement more 3mm = surgical

195
Q

MCL vs LCL

A

MCL = valgus

LCL = varus

196
Q

Associated nerve injury with LCL injury

A

Peroneal nerve

197
Q

Grade 3 MCL and LCL injury TXM

A

= surgery ; due to buckle and insecurity of knee

198
Q

PCL MOI commonly

A

Anterior tibia or dashboard injury in MVA

199
Q

PCL nerve and artery that could be injured

A

Peroneal nerve

Popiliteal artery

200
Q

Joint line pain + effusion + locking or clicking

A

+mcmurray and apley

201
Q

Prepatellar bursitis

A

Excessive kneeling or trauma to the knee

202
Q

3 ligaments commonly hurt in ankle injury

A

ATF = anterior talofibular [MC]
PTF = posterior talfobular
CF = calcaneaofibular

203
Q

Ligament ankle injury =

A

Sprain

204
Q

Ottawa ankle rules

A

Bone TTP along with—> distal post edge of tibia // tip of medial mall

Bone TTP along distal post edge of fibula or tip of // lateral mall

Inability to bear weight

205
Q

Ottawa foot rules

A

Bone TTP at base of 5th MT
Bone TTO at navicular bone

Inability bear weight

206
Q

MC ligament injured in ankle fx

A

Deltoid ligament

207
Q

Positive Peroneal nerve damage =

A

Foot drop

208
Q

Charcot mgmt

A

Walking correction ; wide toe box shoe

209
Q

MC location of avulsion fx

A

5th base of MT

TXM = hard shoe return to activity as comfort

210
Q

How long does it take for X-ray evidence in stress fx ; what can confirm early

A

X-ray

Early = MRI or bone scan

211
Q

Large muscle groups affected think

A

Polymyositis

212
Q

OGS disease of the tibial tubercle improved with what

A

Quad and hamstring strengthening

213
Q

First line for AK txm

A

NSAIDs

214
Q

JIA TXM of choice [severe]

A

CC

215
Q

JIA mild TXM

A

Naproxen first

216
Q

2 equal first line TXMs for de quarvains

A

Splinting and Steriod injections

217
Q

Most sensitive pain ROM with hip intrarticualr pathology is pain with

A

Internal rotation

PANCE 2024 (15 decks)

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