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Flashcards in MSK Deck (24):
1

osteoporosis

loss of bone matrix and mineral

rf: white, asian, small build, smoking, ETOH hx

primary causes: post menopausal women, senile osteoporosis ( lack of calcium)

secondary : corticosteroid use, hyperthyroidism,

dx: DEXA scan,

2

compartment syndrome

incr. pressure in limited space

causes: bleeding/ swelling in closed compartment caused by trauma or crush injury ( tibial shaft fx)
s/s: severe pain , paresthesia, paresis, pallor, pain with passive stretch

dx: measure compartment pressure if dx is unclear

tx: urgent fasciotomy

3

OA- DJD

idiopathic, non-inflammatory

s/s: stiffness in AM - better with rest, crepitus, joint swelling, dec. ROM, Heberdens DIP nodes ( most common)Bouchard PIP

dx: xray- narrow joint place, osteophytes

tx: Tylenol ( 1s), NSAIDS, topical diclofenac, steroid injections, capsaicin, viscosupplemenation, surgery when QOL is diminished

4

Acute osteomyelitis

hematagenous speed of bacteria ( s. aureus)
often affects long bones of children

adults> 50 y/o
s/s: fever, chills, warmth/ swelling
refuse to use limp in kids

dx: cbc, sed rate, + bc, bone tx
bone scan, MRI

tx: IV abx 4-6 weeks, then oral abx 6-8 weeks
oxacillin, cefazolin
MRSA- vancomycin

debride

5

chronic osteomyelitis

untreated blood infection or exogenous untreated trauma/ infection > 2 weeks

s/s: mild fever, mild elevated ESR and CRP
persistent drainage,

dx: X-rays show bone destruction
confirm with bone scan,

tx: long-term abx, surgical I and D , possible amputation

6

septic arthritis

bacteria to joint

N. gonorrhea, s. aureus
MRSA and group b strep

s/s: joint swelling, redness, limited ROM
with gonorrhea - have lesions o palms and fee

dx; confirm with blood, take from synovial
joint fluid-elevated WBC, and decrease glucose

tx: rest, ice, elevation, arthroscopic I and D, IV abx 4-6 weeks

if no better in 48 hours, open I and D

7

ganglion cysts

being tumor or wrist

fluid-filled mass

dx: clinical

tx: wrist splinting, aspiration with steroid injection, surgical excision

8

bone tumors on X-ray

bening- asymptomatic, well -defined with sclerotic margins

malignant: pt have pain, X-ray show lesion with lytic destruction and poor margins

9

bone cysts

s/s: usually asymptomatic

dx: found on X-ray and confirm of b

tx: asp/ ink with steroids or bone marrow

10

osteoid osteoma

most common being bone tumor, M> F

s/s: aching, night pain relieved with NSAIDS

dx: xray

tx: symptomatic, if fails surgical removal
radio frequency ablation

11

osteosarcoma

most common malignancy of bone in knee

happe in men 15-25
h/o with retinoblastoma

s/s: persistent night pain and palpable mass

dx: xray- destructive lesions
sun ray, sun burst appearance
get bone /soft tissue for dx
mRI -- used for stating
high all phase

tx: chemo and surgicall resection

12

ewing sarcoma

seen in pelvis, distal femur,
increased LDH

10-20

dx: lytic lesion of bone "onion skin appearance"
bone bx

tx: surgical resection, chemo and rad tx

13

fibromyalgia

females ( 20-50)
s/s: msk pain around neck, shoulders, low back hips. fatigue,
trigger points

tx: patient ed, mod. exercise, CBT, SSRI, SNRI, lyrics/ neuron tin, ultra, trigger pt injections

14

gout

under excretion or overproduction of uric acid

RF: thiazide/ loop diuretic, ETOH ( beer), MM, hypothyroid, pacific islanders

s/s: fever and sudden onset of monarticualr joint swelling/ pain
may develop top on ears, hands, elbows, and feet

dx: uric acid> 7.5, incr ESR and WBC, synovial fluid ( + sodium urate crystals)
negative bifringent and needle-like

tx: acute: NSAIDs 7-10 days

chronic: colchicine

chronic management: weight loss, increase dirty, limit ETOH intact, red meats, lentils, oatmeal,

15

pseudogaout

recurrent arthritis affecting large joints

s/s: similar to gout

dx: normal uric acid levels and synovial fluid
positive for birefringement

tx: saids and intraarticurlar steroids
colchicine

16

juvenile RA

affects females> males
two peaks 1-3 and then 8-12 years

may develop RA as adults

systemic- severe

polyarticular- 5 or more of joints with fever

oligo articular- 1-4 joints,ritis

dx: fevers, morning stiffness/ rash

elevated WBC and ESR and CRP

50% + ANA, RF negative

tx: NSAIDS, methotrexate, nighttime splinting, exams with slit lamp 2-4 X /yr

17

polyarteritis nodosa

necrotizing arteritis of medium sized vessels, affects 30 in 1 million
30% cases caused by hep b

s/ss: fever, malaise, wt loss, extremity pain, monneuritis, SQ nodules, skin ulcers, abd pain, n/v

dx: tissue bx or angiogram

tx; high dose corticosteroids, IV steroids,hep B, prednisone,

18

polymyositis

systemic disorder of unknown cause, peaks in 5-6%

s/s: progressive neck and proximal mm weakness of UE and LE
25% have dysphagia

reddish purple maculopapular rash in shawl distribution

dx: mm bx
increase in CPK, aldolase

tx: steroids, methotrexate
look for malignancy

19

reactive arthritis

tetrad of conjunctitivey, urethritis, aseptic arthritis and oral lesions

s/s: fever, arthritis in knee/ ankel, conductivity, and much mucocutaneous lesions

dx: X-rays shows joint destruction

tx; NSAiDS, PT
less likely to develop if original infection treated

20

RA

idiopathic, chronic inflame dz, affects synovial membranes,

s/s: malaise, wt loss, fever, SQ nodules, Sjogren's syndrome,
late: ulnar deviation, boutonnière and swan neck deformities

dx: elevated ESR and CRP,anemia jt fluid
Anti-Ccl
X-rays show soft issue swelling
prone to C1-2 subluxation ( don't ignore neck complaints)

21

RA tx

decrease inflamm/pain and avoid deformity

tx: NSAIDS,DMARDS ( when dx is made)
methotrexate, etanercept, TNF inhibitors, antimalarials

22

lupus

inflamm/autoimmune affects all organs

caused by meds ( procainima, quinidine, INH

affects females, blacks

s/s: fever, malaise, rash, raynads, arthalgias)
late: pleurite, pneumonititis

must have 4/1 1 criteria to dx

dx: positive ANA, RF, pos anti ds DNA, make sure not drug induced

tx: steroids, NSAIDS

23

scleroderma

diffuse fibrosis of the skin

affects 3-50 y/o

CREST-calcinosis, raynauds, esophageal motility, sclerdoderma,

s/s: polyarthalgia, fever, malaise, skin folds are abn,

lat: pulmonary fibrosis, pericarditis,

tx: ACE to protect kidneys

dx: anemia, protein in urine, positive ANA, anti topoisomerase and anti-centromere antibody

tx; symptomatic and supportive
CCB for Raynauds
ACE

24

sjorgen's syndrome

dry eyes and dry mouth
autoimmune

40-66
F> M
dental caries

dx: anemia, leukopenia, positive for RF, positive anti ss-A, SS-B,
Shcirmer's test- how much tears

tx: symptomatic an supportive