MSK PANCE Flashcards

Question

Herniated Disk Lumbar L2-L4

Answer 1

Spinal stenosis anterior aspect of thigh Diminished reflexes, knee jerk

Answer 2

Lateral aspect of thigh Reduced foot dorsiflexion, toe extension Normal reflexes (only one with normal)

Answer 3

Ankle jerk Black Swan Posterior thigh Loss of sensory of plantar foot

Answer 4

Neurosurg emergency Retention more common Herniated disc, Tumor, Abscess L4-L5 Disc Herniation MC Saddle anesthesia, Sphincter tone MRI Surg Emergent

Answer 5

Radial Nerve

Answer 6

Axillary Nerve

Answer 7

Anterior interosseous nerve Radial Nerve

Answer 8

Posterior interosseous nerve

Answer 9

Radial head subluxation Tx Supination and flexion or Hyper pronation Normal xray

Answer 10

Ulna GRUM (Radila Dislocation)

Answer 11

Radial GRUM (Ulnar dislocation)

Answer 12

Short Adduction Internal rotation Posterior

Answer 13

Short Abduction External rotation Femoral Neck Blood supply (Medial Circumflex femoral artery) ORIF

Answer 14

Pain at Lateral malleolus Medial Malleolus Navicular Pain pain at 5th meta tarsal cant walk 4 steps on exam Gets Xray

Answer 15

Weber Normal A, B, or C

Answer 16

Fx of diaphysis of 5th metatarsal pain at Base of 5th meta tarsal usually with weight bearing non weight bearing short leg cast 6-8 weeks Non weight bearing

Answer 17

Purines, ETOH, HCTZ Rat bite lesions on imaging Tx Acute - NSAIDS, Colchicine Chronic - Allopurinol (urate lowering) Contraindicated Loop, HCTZ, ASA

Answer 18

Pasteurella Bartonella henselae Augmentin

Answer 19

Rule out septic arthritis Joint aspiration

Answer 20

Avulsion of extensor tenson Unable to extend DIP joint DIP Tear, small avulsion fx Splint for 6 weeks

Answer 21

PIP tear Splint 4-6 weeks Jammed finger Swan shaped

Answer 22

Axillary nerve

Answer 23

Common peroneal Nerve (Popliteal Artery)

Answer 24

Small get Ancef Large gets Ancef and genta

Answer 25

Anti histone

Answer 26

cobb angle >10 on Xray

Answer 27

Intussuseption

Answer 28

pain on passive extension

Answer 29

McMurray Apley

Answer 30

All labs are normal

Answer 31

ESR/CRP Blood cultures 50% X-ray - Periosteal

Answer 32

Knee MC, Hip MC in peds S.Aureus - MCC N. Gonorrhea - Sex Strep pneumo - Kids GBS - neonates WBC >50000, Mostly Neutrophils ESR/CRP IV ABX - Ceftriaxone, Vanc, Nafcillian Drain joint, debridement

Answer 33

Risks Breech delivery First born child Females Family history

Answer 34

Dislocates the hip Adduct fully flexed hip without downward pressure

Answer 35

Reduces and puts hip back in Abduction and elevation

Answer 36

ortolani and barlow Done at every well check until walking (9months) Can us US under 4 months under 6 months - pavlik harness over 6 months - surgery

Answer 37

Idiopathic avascular osteonecrosis of femoral head Ages 4-10, Males, obesity (rare in AA) Painless limp for weeks, worsens with activity Loss of Abduction and internal rotation Widening cartilage space Positive crescent sign on x ray Observation restrict activity PT Surgical

Answer 38

Displacement of the femoral head from femoral neck (through growth plate) age 8-16, obese, AA, commonly seen during puberty Painful Limp worse with activity Hip, groin, knee pain Externally rotated leg x-ray - posterior displacement of femoral epiphysis (ice cream slipping off a cone) Frog leg lateral pelvis view Non weight bearing crutches then surgery

Answer 39

Lachman - most sensitive Anterior drawer - less useful Hemarthrosis MRI RICE Surgery

Answer 40

Commonly associated with hitting the dashboard Posterior drawer test MRI RICE, Surgery

Answer 41

Medial 3 times more likely than lateral Popping, Locking Mcmurray test Apley test MRI RICE SURGERY

Answer 42

Direct trauma limited knee extension Sunrise view, cross table lateral view Non displaced = immobilize, cast displaced = surgery

Answer 43

Inflammation of the patellar tendon at the tibial tubercle due to overuse and repetitive knee extension and quad contraction Males, ages 10-15, athletes Pain during activity, knee pain and swelling (swelling at anterior tibial tubercle) (Jumping) Imaging not usually helpful RICE (surgery rare, but for refractory cases after growth plate is closed)

Answer 44

Patella is pulled down

Answer 45

pulled up by quad tendon

Answer 46

Valgus stress after twisting injury Females Apprehension sign (anxiety before quad contracts when pushed laterally) Reduce while gently extending the leg Immbolize

Answer 47

Isolated fracture of mid ulnar shaft Short or long arm cast (depends on location)

Answer 48

Emergency Common peroneal nerve (foot drop) Popliteal artery

Answer 49

Peroneal nerve (foot drop) Popliteal artery Ortho, surg

Answer 50

Peroneal nerve (foot drop) x-ray may not show CT is best

Answer 51

Runners, cyclists overuse injury knee pain around and behind patella worse with hyperflexion, prolonged sitting standing, jumping etc NSAIDS, RICE PT

Answer 52

Runners, cyclists overuse injury Lateral knee pain tender over lateral condyle Worse with stairs, climbing Positive Noble compression test, or Ober test RICE PT Steroid injections

Answer 53

Fluoroquinolones Thompson test MRI Splint in mid plantar flexion Surgery

Answer 54

Ankle fractures Normal, A, B, or C A is stable B maybe stable or unstable Surg yes or no C is unstable ORIF

Answer 55

spiral fracture of proximal third of fibula with distal medial maleolar fracture

Answer 56

Fracture of distal tibia Surg

Answer 57

flat feet or high arches Pain with dorsiflexion Worse in morning RICE NSAIDS

Answer 58

Posterior tibial nerve compression Pain and numbness in medial malleolus, heel and sole Worsens throughout the day does not improve with rest Positive tinel sign (tapping on nerve at medial malleolus RICE Surg

Answer 59

Joint damage and destruction as a result of peripheral neuropathy decreased sensation, weakness Joint and foot deformity, ulcer, skin changes x ray - obliteration of joint space RICE, special shoes Surgery rare

Answer 60

Interdigital neuroma Compression of interdigital nerve women 25-50 Tight shoes, heels, flat feet Burning pain between 3rd and 4th digits Numbness paresthesia RICE Steroid injection SUrgery

Answer 61

More common than true jones fx Fx through base of 5th metatarsal Walking cast 2-3 weeks If displaced ORIF

Answer 62

Displaced metatarsal bones Fleck sign ORIF

Answer 63

Type 1 straight Type 2 Above Type 3 Lower Type 4 Through Type 5 cRush

Answer 64

Straight Best

Answer 65

Above Most common

Answer 66

Through Needs reduction

Answer 67

Crush Worst, can affect growth

Answer 68

Malignant tumor Most common bone malignancy in children 90% are long bone (distal femur) MC is METS to lungs (MC cause of Death) Bone pain, worse at night X-ray = Sunburst, Hair on end Biopsy is definitive Chemo, SUrgery and amputation

Answer 69

Cancer of cartilage age 40-75 pain swelling, fx's x-ray = punctate or ring/arc appearance Surg, Chemo

Answer 70

Narrowing of spinal canal (nerve impingement) Pain walking down hill Relieved with flexion or leaning over (worse with extension) No change with valsalva (unlike herniated disc) Over 60 MRI Steroid injection Surgery

Answer 71

Males ages 5-25 Lung mets Femur and pelvis X ray - Onion skin, Lytic Chemo, radiation

Answer 72

Benign Cartilage cap on bone cancer Most common type of benign bone tumor. Age 10-20, Males X ray - Pedunculated Observation

Answer 73

Benign Nidus Increasing pain worse at night CT/MRI NSAIDS relieve pain

Answer 74

Women 20-50 All Labs normal Must have 11 out of 18 Trigger points TCA is first line Duloxetine (SNRI) Pregabalin

Answer 75

give folic acid (methotrexate) Methotrexate affects liver Test for HIV, Hep, TB (all DMARDS)

Answer 76

Gracilis Sartorius Semitendinosus

Answer 77

Reduced active ROM Normal Passive ROM Pain with Abduction of shoulder Shoulder

Answer 78

Reduced active and passive ROM

Answer 79

Neer Hawkins

Answer 80

Most common cause of limp in child ages 3-10 Usually Post URI Non traumatic Rule out septic joint, Legg calve, SCFE

Answer 81

Most common cause of bow legs in children

Answer 82

Under 2 children can have bow legs

Answer 83

Inferior Anterior Under

Answer 84

Superior Posterior On top

Answer 85

Keflex and Genta (+/- MRSA)

Answer 86

Flexor Tenosynovitis Pain with passive extension Tender Flexed finger posture Fat finger

Answer 87

Supraspinatus

Answer 88

Supraspinatus Infraspinatus Subscapularis Teres Minor

Answer 89

Straight leg, Crossed leg test (L2-L5)

Answer 90

Ankalosing spondylitis Reiters Syndrome

Answer 91

Median nerve (thumb, index, middle fingers) Fork deformity Sugar tong splint Extensor pollicis longus tendon rupture

Answer 92

Median nerve Diabetics, Women, pregnant first 3 digits, worse at night NSAIDS Steroids Surgery Volar Splint

Answer 93

Think Cancer

Answer 94

Cancer affecting plasma cells of bone IgG, IgM, IgA are affected Most common bone cancer in adults over 65 Black males >65 Increased Calcium Increased Protein Vertebral Fx Renal issues Rouleaux Punched out lesions Stem Cell transplant, Chemo

Answer 95

Inflammation of Joints, Bursa, Tendons GIANT CELL ARTERITIS Pain and stiffness Shoulder and pelvic girdle Increased ESR/CRP Steroids

Answer 96

Trauma, Statins Cocaine, seizure etc Leads to Acute tubular necrosis Muscle pain, weakness Dark Urine ECG - Hyperkalemia UA, Dipstick CK > 5 x times limit of normal Hyperkalemia, Hypocalcemia IV fluids lots Sodium bicarb Mannitol Calcium gluconate for Hyper K

Answer 97

Muscle inflammation WEAKNESS (no pain) Shoulders and pelvis CK/Aldolase is best initial test Anti Jo, Anti SRP Steroids

Answer 98

Polymyositis is weakness Polymyalgia rheumatica is normal strength (pain and stiffness)

Answer 99

Derm issues with muscle inflammation Associated with cancer 25% Shoulder and hip weakness Gottron's papules (mechanics hands) (violaceous papules on dorsum of hand) Heliotrope rash - Edema and blue color on upper eyelids Shawl sign and Malar rash Ck/Aldolase best initial test ANTI Jo, Anti MI2 Biopsy is definitive Steroids first line Hydroxychloroquine for skin lesions DMARDS

Answer 100

Females 20-40, AA Joints, Malar rash, Antiphospholipid syndrome, Multiple system issues ANA Screening Anti DS DNA and Anti Smith specific for SLE Pancytopenia Antiphospholipid syndrome Avoid UV, Hydroxychloroquine Steroids, Pulse therapy IV steroids DMARDS, Immunosuppresants

Answer 101

HIPPS Q - Hydralazine, isoniazid, Procainamide, phenytoin, Sulfas, Quinidine SLE symptoms Anti HIstone Antibodies

Answer 102

SLE Risk of arterial and venous thrombosis (recurrent DVT/PE) Livedo Reticularis Anticardiolipin Antibodies Increased PTT Warfarin or anticoags if recurrent thrombosis LMWH if pregnant

Answer 103

Painful oral and genital ulcers Erythema Nodosum Uveitis Asian/Middle eastern 20-40 Biopsy is definitive Steroids

Answer 104

Aorta and branches (large vessel arteritis) Women, Asian, 10-40 Lower extremity claudication, vascular issues Bruits, low pulses, pulse difference in arms Angiography Steroids Dmards Revascularization

Answer 105

Small medium vessel arteritis Boys under 5, asian CRASH & Burn Conjunctivitis Rash Adenopathy Strawberry Tongue Hand and foot edema (swelling) Burn - Fever for 5 days ECG, Coronary artery Aneurysm IVIG + ASA

Answer 106

Small medium Vessel vasculitis This vasculitis does not involve lung vessels HEP B/C HTN (renal artery stenosis) Ulcers, purpura, raynauds Livedo reticularis (Starburst pattern) ANCA is negative Renal/Mesenteric angiography Biopsy is definitive Steroids Cyclophosphamide

Answer 107

Eosinophilic Granulomatosis with Polyangiitis Lungs MC affected Asthma and eosinophilia (chronic Sinusitis) P-ANCA positive with eosinophils Steroids, Cyclophosphamide

Answer 108

Granulomatosis with Polyangiitis (no eosinophils) Triad - Nose, lungs, kidneys URI, LRI, Glomerulonephritis C-ANCA positive biopsy is definitive, (large necrotizing granulomas) Steroids, Cyclophosphamide

Answer 109

Capillary vasculitis Palpable purpura Similar to Wegeners but no URI symptoms Biopsy is definitive, non granulomatous inflammation Steroids, Cyclophosphamide

Answer 110

90% ages 3-15 After URI GABHS, Parvovirus 4 cardinal symptoms Hematuria, Arthralgia, Palpable purpura, Abdominal pain Purpura on butt and legs Normal platelets, PT, PTT Mesangial IgA Supportive

Answer 111

Anti GBM Antibody (type 2 sensitivity, type 4 collagen)) Lungs and kidneys Hemoptysis, hematuria UA RBC Casts Anti Glomerular basement membrane antibodies Steroids + Cyclophosphamide + Plasmapheresis

Answer 112

Arthritis with Psoriasis Looks like RA but includes DIP joint (symmetrical or unilateral) Pencil in cup deformity (bony erosions) NSAIDS 1st line Methotrexate, TNF, Interleukin antagonists

Answer 113

HLA B27 Men 15-30 Back pain, stiffness Worse in morning Uveitis ESR (neg RF and ANA) Narrowing sacral joint Bamboo spine (squaring and fusion of vertebrae) MRI NSAIDS, exercise, PT Anti TNF (infliximab)

Answer 114

Reiter's syndrome Cant see, can't pee, cant climb a tree Arthritis, Conjunctivitis/uveitis, Urethritis Lesions on palms and soles Rule out septic arthritis ESR, IgG NSAIDS 1st line Methotrexate sulfasalazine

Answer 115

Liver cancer testicular cancer Decreased in down syndrome

Answer 116

Testicular cancer Choriocarcinoma Teratoma Trophoblastic tumor

Answer 117

Ovarian cnacer

Answer 118

Pancreatic cancer

Answer 119

Medullary Thyroid cancer

Answer 120

Colon cancer Rectal cancer

Answer 121

Prostate cancer

Answer 122

Urate lowering

Answer 123

calcium deposits in joints Positive birefringent rhomboid crystals Large joints - Knee MC, Elbow, wrist, MCP joint Rule out Septic joint, gout Steroid injection NSAIDS Colchicine

Answer 124

Children under 16 must last over 6 weeks Stills disease (fever, Salmon colored rash, Anterior uveitis Large joints - Knee, ankle etc ESR/CRP NSAIDS Steroids

Answer 125

MC L5-S1 Positive straight leg raise, Crossed leg raise MRI best NSAIDS, continue normal activity Steroid injection Surgery

Answer 126

Staph A MC IV drug use, immunodeficiency Fever, Spinal pain, Neurodeficits MRI Aspirate, drain ABX - Vanc Plus Cefotaxime or rochepi

Answer 127

Lateral curve of spine Girls, family history, age 10 Adams forward bend test Scoliometer - 7 degree Xray - cobb angle of >10 Under 25 on Cobb = Observation Over 25 bracing Surg if over 40

Answer 128

compression of brachial plexus women 20-50 Pain paraesthesia in forearm Swelling discoloration with raising of arm Positive adson sign (loss of radial pulse with rotation of head to affected side Conservative, PT, Ortho consult

Answer 129

Scottie dog Pars interarticularis failure to fue, stress fx Low back pain with activity

Answer 130

Forward slipping of vertebrae Low back pain

Answer 131

SITS, Supraspinatus MC Tendonitis MC under 40 Tear MC over 40 Hawkins, Neer, Drop arm,

Answer 132

Frozen shoulder DM and hypothyroid Shoulder pain/stiffness Decreased ROM (external rotation) Worse at night PT NSAIDS

Answer 133

Anterior or posterior fat pad sign Hemarthrosis Median nerve and brachial artery injury can lead to volkmann contracture Radial nerve injury Long arm splint then long arm cast

Answer 134

Infection of finger sheath Staph A MC Penetrating trauma Kanavel Sign Pain with passive extension Tender Flexed finger posture Fat finger I & D ABX

Answer 135

Trauma Rule out septic bursitis Pad area, NSAIDS, Ace wrap if Septic, drain + ABX

Answer 136

Posterior MC Emergent Reduction with posterior splint

Answer 137

Ulnar nerve compression Paraesthesia and pain along ulnar nerve worse with flexion +tineal elbow sign

Answer 138

Non displaced Thumb spica Displaced surg if xray neg - treat as fx splint and reeval or refer

Answer 139

Distal radius fx Spoon shovel deformity Stable - closed reduction Sugar tong ORIF

Answer 140

Complex regional pain syndrome 30% have no injury Upper extremities, females, over 30 Pain out of proportion, edema, dysfunction NSAIDS PT, Nerve block, steroids, TCA Vitamin C prophylaxis to reduce fx risk

Answer 141

Ulnar collateral ligament of thumb sprain Thumb spread wide Thumb spica

Answer 142

5th metacarpal fx Ulnar gutter splint Augmentin for bite wound

Answer 143

Metacarpal fx at base of thumb Comminuted = rolando (shattered) (Y sign) Thumb spica

Answer 144

Men, over 40, white Progressive Fibrosis of palmar fascia leading to contracture Palpable nodule over palmar crease Deformity of MCP joint Steroid or collagen injection Surgery

MSK PANCE Flashcards

(177 cards)