MSK Flashcards
(169 cards)
1
Q
Acute LBP 1st step?
A
Early mobilization & NSAIDs & muscle relaxants
2
Q
LBP red flags
A
Neuromotor deficit, fever, >6wks, loss of bowel/bladder, CA, steroid use, >70
3
Q
Fever, vertebral tenderness, IVDU + LBP dx
A
Osteomyelitis, septic discitis, abscess
4
Q
Causes of spinal stenosis
A
Degen arthritis, spondylo, spina bifida, myelomeningocele
5
Q
LBP, leg pain/weakness, psuedoclaudication, pain dec when bending forward, squatting, sitting
A
Spinal stenosis –> NSIADs, PT, epidural steroids
6
Q
AcuteB/L pain after lifting, bending, coughing –> anterior abdomen
A
Compression fx –> X-ray
7
Q
LBP radiating down thigh to toe, w/ straightleg raise and CL leg raise imaging, WORSE w/ cough, defecation
A
Disc herniation = no imaging, only >1mo –> MRI
8
Q
Leg pain worse w/ standing, better lying down, normal pulses, neuro exam
A
Spinal stenosis –> MRI
9
Q
1 cause of spinal stenosis
A
DJD
10
Q
13 y/o girl, SOB, + Adam’s test
A
Scoliosis –> XR –> BRACE
11
Q
Young male w/ morning stiffness, better w/ exercise, tender SI, heels, tibial tuberosities (enthesitis)
A
Ankylosing spondylitis –> XR SI joints, anterior uveitis
12
Q
Diseases assoc w/ carpal tunnel
A
RA, sarcoid, amyloidosis, HYPOTHYROID (B/L, severe)
13
Q
Periarticular osteopenia, joint margin erosions, stiffness >30min, WBC 2000-50000, warm
A
RA –> MTX, NSAIDs, steroids + test for HCV, HBV, TB –> + hydroxychloroquine
14
Q
RA pts at increased risk of developing ?
A
Osteoporosis
15
Q
Knee pain, bone spurs, no warmth, worse w/ activity, BMI 36 - best LT improvement tx?
A
OA = Weightloss
16
Q
Older, morning stiffness <30min, worse w/ exercise, cool, crepitus, dec and painful ROM
A
OA –> acetaminophen
17
Q
Punched out erosions of cortical bone (Rat bite lesion), WBC 2000-50000, warm
A
Gouty arthritis–> indomethacin, colchicine for acute & allopurinol, probenecid chronic
18
Q
Asymmetric polyarthritis, skin rash, normal joint space w/ soft tissure swelling, WBC >50000
A
Septic arthritis
19
Q
Acute onset painful, swollen joint, limited ROM, WBC 50,000-150,000, prosthetic joint
A
Septic arthritis = SA, strep #2
20
Q
Nail pitting, skin plaques, morning stiffness for several hrs, dactylitis of DIP (sausage fingers)
A
Psoriatic arthritis –> NSAIDs, MTX - NO steroids
21
Q
Spinous process tenderness, IVDU or sickle cell, normal WBC, high platelets, fever
A
Osteomyelitis = SA –> cultures, ESR, x-ray –> Inc ESR w/ normal XR = MRI
22
Q
Arthritis, conjunctivitis, urethritis bug
A
Chlamydia
23
Q
Acute onset symmetric arthritis, MCP, PIP, wrist ankle, contact with kids, past fatigue, diarrhea, stiff 15min
A
Parvovirus B19 - anti-B19 IgM Ab
24
Q
Joint pain, recent urethral discharge, many PMNs but no organisms in joint, mouth ulcers
A
Reactive arthritis –> NSAIDs
25
Acute polyarticular, symmetric, swelling, daycare worker, fever resolves in <2mo, + /-RF, ANA
Viral arthritis - Parvo, Hepatitis, HIV, mumps, rubella
26
Rusty nail osteomyelitis bug adult
PA --> quinolone
27
Carpal tunnel pathological accumulation ?
Matrix substances
28
Dec sensation 1st 3 fingers, numbness, tingling, thenar waisting, worse w/ hyperflexion of hand
Carpal tunnel --> NSAIDs, splint, steroids, nerve velocity --> surgery
29
Mom's carrying baby, prolonged thumb extension, pain, Finklestein's test
Dequervain's --> NSAIDs, spica splint, steroids
30
Torn ulnar collateral lig, forced thumb hyperextension, skiing
Gamekeeper's thumb --> casting
31
Torn flexor tendon, unable to flex DIP
Jersey Finger --> splinting
32
Torn extensor tendon, unable to extend finger, Volleyball
Mallet Finger --> splinting
33
Unable to flex ONLY middle finger --> pop if extended
Trigger Finger --> steroids
34
etOH, Scandinavian men, palpable nodules
Duputyren's --> surgery
35
Abscess of pulp of nail, extremely tender, penetrating injury, fever, throbbing pain
Felon --> I&D
36
Colles fx tx
Closed reduction & long arm cast
37
Protection for nightstick, fx proximal ulna, anterior radial head dislocation
Monteggia fx
Galeazzi if radial fx --> ORIF
38
FOOSH, wrist pain in snuff box, non-displaced fx
Scaphoid fx --> thumb spica splint; ORIF if angulated or displaced
39
Punched a wall, tender 4th, 5th digits
Metacarpal neck fx --> closed reduction + ulnar gutter splint OR Kirschner wire
40
#1 fx in kids
Supracondylar humeral fx
41
FOOSH, inc pain despite meds, radial pulse intact, sensation intact
Supracondylar humeral fx --> compartment syndrome
42
Injury w/ supracondylar fx
Brachial artery --> no radial pulse
43
Crepitus, upper body fat accumulation, asymmetric moro reflex
Clavicular fx = DM mom --> dystocia, vacuum forceps
44
Tx for neonatal clavicular fx
Reassurance and gentle handling
45
Dec appetite, neck swelling, neck turned to left, resists flexion
Torticollis --> XR to r/o cervical spine fx, dislocation
46
Throwing sports, pain, crepitus, dec supination/pronation
Panner disease (osteochondrosis of captellum)
47
Erb-duchenne palsy - + grasp reflex, C5,6
Reassurance - 80% resolve 3-6mo
48
Supinated, wrist extended, MCP extended, ICP flexed, IL Horner syndrome, (-) grasp
Klumpke palsy = C8, T1 traction --> PT, usually resolves
49
Hold arm close to body, rotated outward, numb deltoid
Anterior shoulder dislocation (#1) --> XR
50
Block shot (Abduction, ER) --> pain, ER, no IR, prominent acromion
Anterior shoulder dislocation (#1) --> XR, Axillary nerve
51
Electrical burn, seizure, hold arm close to body, IR
Posterior shoulder dislocation --> axillary or scapular XR
52
Nerve injury w/ middle oblique or distal 3rd of humerus fx
Radial --> surgery on if paralysis develops
53
Mom pulled kids arm --> held in pronation, not moving
Nursemaid's elbow --> passive flexion + supination
54
Newborn, Clunk/Click w/ Ortalani or Barlow, uneven gluteal folds
Congenital hip dysplasia --> US --> Pavlik harness
55
Asymmetric inguinal folds, soft-click, leg-length diff next step
Hip US <6mo otherwise XR
56
Developmental dysplasia of hip tx <6mo
Pavlik harness = abduction + flexion
57
7 y/o PainLESS limp, anterior thigh pain, AVN
Legg-Calves Perthes --> XR --> Cast
58
7 y/o boy, insidious limp, previous fever, pain >1mo, limited IR & Abduction
Legg-Calve-Perthes --> XR --> Cast, splint, surgery, limit weight
59
10 y/o, growth spurt, pain w/ hip movement, pain with IR, holding leg in ER
SCFE --> frog-legged XR --> immediate screw fixation
60
13 y/o w/ limp, insidious KNEE pain, obese adolescent
Slipped capital femoral epiphysis
61
2-3 y/o Fever, acute joint pain, NO weight bearing, hx of cellulitis, >100,000WBC, 90% PMNs
Septic arthritis --> surgical drainage/arthrocentesis, Vanco
62
Fever + severe localized bone pain
Osteomyelitis --> MRI and abx
63
2-6 y/o, painFUL limp, normal ESR, WBC
Transient synovitis --> B/L hip XR --> rest & NSAIDs
64
7 y/o, limp, previous URI <1mo, hip flexed, abducted, ER
Transient synovitis
65
14 y/o A.A male wks of limping, hx severe abd pain, Hct 22%, restricted ROM, tender
Sickle cell --> osteonecrosis of hip
66
Head on car collision, knees hit dashboard, hip pain
Posterior hip dislocation --> emergent reduction
67
13 y/o knee pain + swelling, worse after basketball
Osgood-Schlater = traction apophysitis --> work through or rest + cast
68
Point tenderness over inferior patella
Patellar tendonitis
69
Fx in kids + growth plate tx
Closed reduction in 1 piece, displaced laterally; 2 pieces = ORIF
70
Fx in kids (-) growth plate tx
Casting
71
Fall --> short leg + ER on stretcher
Hip fx
72
Tx femoral neck fx
Replace femoral head
73
Tx intertrochanteric fx
ORIF
74
Tx femoral shaft fx
Intramedullary rod
75
Isolated collateral ligament tear tx
Hinged cast --> surgical if mutliple torn
76
Hyperextention, pivoting + popping, knee HEMARTHROSIS - rapid onset, joint instability, can't bear weight
ACL tear --> MRI + RICE
77
Tx ACL/PCL injury
Immobilization & rehab --> arthroscopy in athletes
78
Popping + knee pain, swelling the NEXT DAY, joint line tenderness
Meniscal tear
79
Twisting on planted foot, knee catching/locking, click when forcefully extended
Meniscal tear --> open repair
80
Forced marches, very specific tenderness in lower leg, normal XR
Tibial stress fx --> Cast, crutches & repeat XR in 2 wks
81
Pedestrian hit by car
Tib-Fib fx --> XR --> Casting +/- medullary nailing
82
Excruciating pain w/ passive extension following tib-fib fx w/ CLOSED reduction
Compartment syndrome --> fasciotomy
83
Posterior knee dislocation vascular injury
Popliteal artery --> Doppler or Ct angio & prompt reduction
84
Open tib-fib fx --> dyspnea, confusion, fever, tachy, petechial rash
Fat embolism --> resp support, heparin, steroids
85
Adducted anterior foot, overcorrects in abduction - metatarsals
Metatarsus adductus type I = reassurance
86
Metatarsus adductus corrects in neutral position tx (type II)
Orthoses
87
Metatarsus adductus rigid, do not correct tx (type III)
Immediate casting --> surgery if residual at 4 y/o
88
Equinovarus calcaneum, midfoot, adduction forefoot, limited ROM
Clubfoot --> immediate stretching & serial casting
89
Out of shape middle aged man, loud pop and fall to ground, pain swelling ankles and limping
Achilles rupture --> cast in equinus or surgery
90
Marching, athletes, foot pain w activity --> rest, point tenderness
2nd metatarsal fx = rest and analgesics
91
Sharp heel pain/burning, worse in mornings, tender, bone spur
Plantar fasciitis --> resolve 12-18mo
92
Tender 3-4th interspace, palpable nodule + click, high-heels or runner
Morton neuroma --> analgesics, new shoes/insert, surgery
93
Soap bubble, eccentrically lytic area, cystic + hemorrhagic regions
Giant cell tumor of bone --> surgery
94
Subperiosteal resorption in phalanges, "salt and pepper," bone pain, brown tumor
Osteitis fibrosa cystica - HPT from PT CA
95
Sclerotic cortical lesion w/ central lucency, pain a night, better w/ NSAIDs
Osteoid Osteoma
96
Fever, leukocytosis, anemia, 15 y/o, central lytic bone lesion, moth-eaten
Ewing sarcoma --> XR, Bx --> surgery --> radiation and chemo
97
11;22, mid-shaft, onion skin, focal bone pain
Ewing sarcoma --> XR, Bx --> surgery
98
Rb gene, sunburst, diaphysis, focal bone pain
Osteosarcoma --> XR, Bx --> excision --> chemo
99
No constitutional sx, arm pain, metaphysis abn, tender soft tissue mass, sunburst, periosteal lift
Osteosarcoma --> XR, Bx --> excision --> chemo
100
Fever, leukocytosis, central lytic lesion w/ surrounding sclerosis (Brodie's abscess)
Osteomyelitis - #1 = SA
101
Sclerotic cortical lesion w/ central nidus, pain worse @ night, relieved w/ NSAIDs
Osteoid osteoma
102
B/L thigh and calf pain, worse at night, relieved w/ NSAIDs, no activity limit
Growing pain
103
SINGLE lytic bone lesion of humerus + hyperCa, joint swelling
Langerhans Histiocytosis - eosinophilic granuloma = resolves
104
Can't stand or climb stairs, raise arms, weakness, elevated LDH, aldolase, creatnine kinase
Polymyositis --> muscle bx shows MO infiltrate surrounding necrotic & regen fibers
105
Anti-Jo Abs
Polymositis
106
SLE tx for skin and joints only
Hydroxychloroquine = check for retinopathy
107
Fatigue, oral ulcers, ARTHRITIS of MCP, PIP, proteinuria in young A.A. female
SLE
108
Young A.A. female, cough, hyperCa, elevated ACE, non-caseating granuloma
Sarcoidosis
109
Proximal muscle weakness, rash on shoulders/back, scales on hands
Dermatomyositis
110
Can't rise from chair, dusky rash, periorbital edema (heliotrope), knuckles (grotton) assoc?
Dermatomyositis = Malignancies (Ovarian, breast)
111
Poor sleep, fatigue, pain all over, trigger points, young female, pain worse after exercise
Fibromyalgia --> exericise, good sleep ---> TCAs (amitriptyline)
112
Extreme fatigue, no aches
Chronic fatigue syndrome
113
Pain, STIFFNESS, aching in pelvic & shoulder girdle esp in AM, >50 y/o, no trigger points/muscle tenderness, elevated ESR
Polymyalgia rhuematica --> low dose steroid
- assoc w/ temporal arteritis
114
Difficulty combing hair, ptosis, dyaphagia, dysarthria, normal muscle tone, reflexes, stands-up normally
Myasthenia Gravis - Ab to ACH receptor
115
Tx for hyperthermia/heat stroke
Evaporation coolin, IVFs
116
#1 site for ulnar nerve entrapment
Elbow
117
Abx for human bite
Augmentin OR cipro + clinda
118
Popliteal mass cause
Baker's cyst = inflammed synovium d/t RA, OA, meniscus
119
Re-warm cold extremity
Rapid, warm water
120
Paget's disease path
Abnormal bone remodeling
121
Mosaic pattern of lamellar bone
Paget's Disease
122
Inc deposition of unmineralized bone
Vit D deficiency
123
Abundant mineralization of periosteum
Hypervitamin A
124
Morning stiffness, <2000 neutrophils, splenomegaly
Felty syndrome (RA)
125
Only inc Alk phos, thickened cortices in skull and tibia, mixed lytic/clastic lesions, b/L hearing loss
Paget's disease --> bone scan --> bisphosphonates --> calcitonin
126
Progressive hip pain w/o restriction in ROM, steroid use
AVN of femoral head
127
High CPK, HLD, aches and pains
Statin induced muscle injury
128
Risk factors for gout
etOH, high purine, pyrazidimide
129
Diabetic foot ulcer tx order
Off-loading -> debridement -> dressings -> antibiotics -> revasc -> amupation
130
RLS mech and tx
DA = pramipexole, ropinerole, levodopa
131
Rotator cuff tear vs. impingement?
Impingement = better w/ lidocaine
132
Pain w/ internal rotation and flexion, no muscle atrophy
Subacromial bursitis
133
Difficulty swallowing, blue fingers in the cold, shiny MCP joints, "mat-like" patches on face
CREST syndrome
134
Bugs for prosthetic implant infection 3mo
3mo = Staph epi, enterococci
135
Osteoporosis path
Low bone MASS
136
Z-score
1-2.5 = osteopenia, >2.5 = osteoporosis
137
Osteomalacia path
Defect in MINERALIZATION, usually VitD deficiency or Ca deficiencies
138
Bone pain, cramps, weak, colon resection, CKD, inc PTH, Alk phos, Dec Ca, VitD, Phos, psuedofractures
Osteomalacia
139
Ca & VitD intake goals
1200mg & 800-100IU for all menopausal women
140
Secondary causes of osteoporosis
Hyperthyroid, Primary HPT, Vit D deficiency, amenorrhea, steroid, smoking
141
Labs for secondary osteo causes
CBC, BUN/Cr, TSH, VitD, Estradiol, testosterone, Ca, LFTs
142
Bisphosphonate MOA
Inhibit clastic activity - empty stomach + water + upright for 30min
143
Bisphosphonate SE
Osteonecrosis of jaw (mostly IV after dental work)
144
SERM in osteo Tx
Raloxifene, also reduces breast CA but inc risk for thrombosis
145
Nasal spray shown to reduces vertebral compression Fx, 2nd line
Calcitonin
146
Recombinant human parathyroid hormone
Teriparatide - acts on Blasts = CI in @ risk for osteosarcoma (Paget disease)
147
Denosumab MOA
Ab inhibits osteoclast differentiation
148
Genu valgum, OSA, SIDS d/t foramen magnum stenosis
Achondroplasia
149
Carpopedal spasm, laryngospasm, paresthesia, seizures
HypoCa
150
HypoCa <4days old cause
Transient, IUGR, asphyxia, HypoMag
151
HypoCa >4d neonatal cause
HypoPTH, maternal hyperPT, DiGeorge, hyperPhos
152
High PTH, short, short MCPs, developmental delay
Parathyroid resistance
153
Both Ca and Phos low
VitD deficiency
154
Tx for hypoCa
<7.5-8.0, oral Ca
155
Rickets, normalCa, low Phos, high alk phos, high PTH, Vit D no help
Familial hypophos rickets = #1 = renal phos leak
156
Prominent costochondral junc, wrist metaphysis widened, CUPPED
Rickets
157
Bowlegs >3 y/o
Blount disease (medial proximal tibial GP) = surgery
158
Knock-knees normal b/w what ages?
4-8yrs
159
<5 y/o, proximal weakness, 100x inc CPK, myopathic EMG, MR
DMD = no dystrophin
- -> Genetic testing Xp21
- -> muscle Bx showing fibrosis & fatty infiltration
160
5-12 y/o, calf pain w/ exercise, cardiomyopathy, 50x inc CPK
Becker MD
161
Weakness/wasting esp face, hands, ankle, myotonia, cataracts, delayed muscle relaxation, AD inheritance
Myotonic dystrophy (upper lip inverted V)
162
Heel, metatarsal, toe tip ulcers, overweight person
Diabetic ulcer
163
Pathogenesis of diabetic ulcer
Neuropathy --> wound --> microvascular disease prevents healing
164
Tips of toes, dirty, no pulses, no granulation tissue ulcer
Arterial insufficiency --> Doppler --> angio for revascularization/stenting
165
Medial malleolus, hyperpigmented skin, granulating bed, painless ulcer
Venous stasis ulcer --> support socks, ACE, unna boot
166
Ulcer w/ many yrs of healing and breakdown (3rd d burns) --> deep dirty heaped-up ulcer
Marjoilin ulcer = SCC --> Bx, excision and grafting
167
Fx 1st metacarpal bone
Bennet's --> Rolando if comminuted
168
Pain over lateral ankle + lateral proximal fibula playing soccer
ATFL sprain w/ possible proximal fibular fx (maisonneuve fx)
| ---> XR both knee and ankle
169
Distal radial fracture name
1. fx + dislocation of radial-ulnar joint
2. Dorsal displacement of distal segment
1. Galeazzi
| 2. Colles
