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MSK Pathophys Flashcards

1
Q

Spinal Pathologies

lower spine vertebral column anatomy

A
  • lumbar: 5 vertebral bodies; L1-L5
  • sacrum: 5 segements (fused w/out discs)
  • coccyx: 3-4 fused segments
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2
Q

Spinal Pathologies

label anatomy of vertebrae

A

okay

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3
Q

Spinal Pathologies

ligaments of spine

A
  • anterior longitudinal ligament: connects vertebral bodies anteriorly
  • posterior longitudinal ligament: connects vertebral bodies posteriorly
  • ligamentum flavum: yellow ligament; connects lamina posteriorly
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4
Q

Spinal Pathologies

anatomy of lumbar discs

A
  • purpose: cushioning between vertebral bodes
  • named by vertebral body above/below (L4-5 disc is between L4/L5)
  • Annulus Fibrosis: fibrous outer ring of disc
  • Nucleous Pulposus: soft inside of disc
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5
Q

Spinal Pathologies

anatomy/phys of spinal cord

A
  • purpose is to transmit information to and from rest of body
  • begins at craniocervical junction and ends between T12-L2
  • end of sinal cord: conus medullaris (conus)
  • cauda equina: end of conus there are spinal nerves that go to LE and bowel/bladder
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6
Q

Spinal Pathologies

nerve roots of spinal cord numbering

A
  • cervical: nerve roots exiting are name based on vertebral body below foramen (except C8 which exits in C7-T1 forament)
  • Thoracic/Sacral: named for vertebral body above foramen
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7
Q

Spinal Pathologies

describe spurling test of cervical spine

A
  • dx cervical HNP or spondylosis
  • pt seated, laterally flex head, apply pressure downward to increase axial load & cause pain down ipsilateral arm
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8
Q

Spinal Pathologies

describe hoffman reflex for cervical spine

A
  • tests for long tract spinal cord involvement in neck
  • pathologic reflex (indicates abnormality w/in cervical spinal cord or higher like UMN lesion or pyramidal sign) for ALS< MS, spinal cord compression
  • pos reflex: flexion and adducting the thumb/index finger after flicking the middle finger
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9
Q

Spinal Pathologies

lumbar spine tests

A
  • gait (barefoot) look at Trendelenburg (pelvis level on one foot = normal hip abductor)
  • heel-toe walking (tests L4-5, S1 innervated muscles)
  • calf/thigh circumfrence/atrophy (asymmetric or atrophy = weakness)
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10
Q

Spinal Pathologies

lumbar SLR tests

A
  • seated SLR: pos test causes pt to lean back
  • Supine SLR (lesegue): pos test is radicular pain in leg, not back (HNP or compression) sx at 20deg or less is suggestive of sx amplification
  • Slump test: seated, hands behind back, then slump in relaxed position w/ chin to chest; extend leg, dorsiflex fully. examiner gives slight pressure to back of head. pos test is impingement on dura, spinal cord, nerve roots
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11
Q

Spinal Pathologies

red flags in HPI/PE

8

A
  • fever/chills/wt loss (malignancy)
  • hx of IV drug use
  • progressive weakness; decreasing pain in face of increasing deficit; paraparesis
  • bowel/bladder dysfunction; distended/palpable bladder
  • trauma
  • increasing pain not controlled by simple analgesia
  • saddle anesthesia
  • unexplained neuro deficits
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12
Q

distended/palpable bladder

lordosis vs kyphosis vs scoliosis

A
  • lordosis: increased lumbar curvature
  • kyphosis: increased thoracic curvature
  • scoliosis: abnormal sideways curves
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13
Q

Spinal Pathologies

myelopathy vs radiculopathy vs stenosis

A
  • myel: injury/compression of spinal cord
  • radi: injury/compression of nerve root
  • stenosis: narrowing of passage for spinal cord/nerve root
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14
Q

Compartment Syndrome

causes of compartment syndrome

4

A
  • long bone fractures (tibia or humerus)
  • severe contusion/crash injuries
  • reperfusion injury after vascular repair
  • restrictive cast/dressing
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15
Q

Compartment Syndrome

compartments of LE

A
  • anterior
  • lateral
  • superficial posterior
  • deep posterior

Contents
* each compartment covered by fascia (resistant to expansion and stretch)
* each compartment contains muscles, blood vessels, nerves

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16
Q

Compartment Syndrome

pathogenesis

A
  • interruption of hemostatic pressure gradient causes a disruption in flow and capillary perfusion pressure
  • build up of fluid outside of the capillaries increases pressure w/in myofascial compartment
  • distribution of oxygen/nutrients and CO2 removal disrupted leading to muscle ischemia and necrosis
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17
Q

Compartment Syndrome

reversibility of sx based on duration?

A
  • < 4 hrs: reversible muscle injury
  • > 8 hrs: irreversible muscle injury
  • nerve conduction loss: 2 hrs
  • irreversible nerve injury: > 8 hrs
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18
Q

Compartment Syndrome

describe procedure of emergency fasciotomy

A
  • long incision to release pressure in affected compartment and adjacent compartments
  • wounds are left open and a 2nd procedure for debridement is performed w/in 48-72 hrs
  • wound closure w/in 7-10d +/- skin grafting
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19
Q

Osteomyelitis

common bacteria of non-hematogenous vs hematogenous

A
  • Non-Hematogenous Polymicrobial (S. aureus, S.epidermidis, streptococcus spp, gram neg, anaerobes)
  • Hematogenous monomicrobial (S. aureus, streptococcus, gram neg, p. aeruginosa, serratia, candida)
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20
Q

Osteomyelitis

bacterial causes due to specific risk factors

A
  • no risk factors: s. aureus
  • sexually active: n. gonorrhoeae
  • cat/dog bites: p. multocida
  • IVDU: p. aeruginosa, s. aureus, candida
  • sickle cell: salmonella
  • neonates: group b strep
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21
Q

Osteomyelitis

pathophys

A
  • overall poorly understood
  • several factors: host immune status, underlying disease, virulence of organisms, vascularity and location of bone
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22
Q

Osteomyelitis

which part of bone most commonly affected in hematogenous spread?

A
  • metaphysis
  • due to rich vascular supply of growth plates
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23
Q

Osteomyelitis

XR findings/limitations

A
  • 1st line imaginge, but may not show chagnes in the first 2wks (so normal XR cannot r/o dz)
  • disease must extend at least 1 cm and compromise 30-50% of bone mineral content to produce noticeable changes in plain radiographs
  • findings: regional osteopenia, loss of trabecular architecture, bone destruction, soft tissue gas, new bone apposition (cortical thickening; increase in diameter of bone)
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24
Q

Septic Arthritis

bacteria associated w/ infection

A
  • S. aureus most common overall
  • s. epidermidis
  • streps: pyogenes, pneumoniae, agalactiae)
  • gram neg: p. aeruginosa, e. coli, k. kingae, n. gonorhoeae (sexually active young pt), h. flu, salmonella (sickle cell)
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25
Q

DeQuervain’s Tenosynovitis

Finkelstein tests

A

place thumb into palm and ulnar deviate
pain is pos result (expected w/ DeQuervain’s)

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26
Q

Arthritis

purpose of articular cartilage

A

lings bones, allows for protection and gliding movement

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27
Q

Arthritis- Wrist

what bones are removed w/ proximal row carpectomy

A

scaphoid, lunate, triquetrum

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28
Q

Trigger Finger

why don’t you release A1 pulley in RA

A

can cause further ulnar drift

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29
Q

Common Fractures

metacarpal fractures- describe when rotational deformity may be present

A
  • most common in oblique and spiral fracture types
  • PIP joints at 90deg flexion normally converage at a point in the proximal carpal bones (scaphoid)
  • deviation of 1+ lines suggests a metacarpal fracture
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30
Q

Common Fractures

components of neurovascular for fractures

A
  • repetitively evaluate motor + sensory nerve function and assess for vascular insufficiency
  • neuro exam: assess median nerve, AIN, and radial nerve
  • vascular exam: temp, color, cap refill
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31
Q

Common Fractures

specifics of neuro exams

A
  • Median: assess for abduction of thumb or flexion of distal phalanx of thumb
  • Ant. Interosseous Nerve (AIN): assess for flexion of distal phalanx (OK sign)
  • Radial: extension of wirst
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32
Q

Common Fractures

specifics of vascular exam

A
  • eval for color, warmth, cap refill
  • eval both radial and ulnar arteries
  • emergent surg if: cold, pale, pulseless
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33
Q

Common Fractures

Weber Classification

A
  • describe fibular fracture relative to syndemosis
  • A: below syndesmosis
  • B: level of syndesmosis
  • C: above level of syndesmosis
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34
Q

Common Fractures

Bohler Angle (calcaneal)

A
  • formed by intersection of 2 lines
  • Line 1: drawn from superior aspect of post calcaneal tuberosity to the superior subtalar articular surface
  • Line 2: drawn from the superior subtalar articular surface to the superior aspect of anterior calcaneal process
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35
Q

Shoulder Disorders

types of shoulder separations

6

A
  • Type I: ligament stretched
  • Type II: partial rupture of AC ligaments
  • Type III: complete rupture of AC/CC ligaments
  • Type IV: clavicle displaced posteriorly over acromion
  • Type V: clavicle displaced up (just under skin)
  • Type VI: clavicle underneath coracoid (rare, but serious)
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36
Q

Shoulder Disorders

Subacromial impingement/bursitis: describe Neer and Hawkins tests

A
  • Neer Impingement Sign: arm up to ear and rotate, pain w/ flexion and pronation. subacromial impingement or rotator cuff tear.
  • Hawkin Impingement Test: to test for subacromial impingement or rotator cuff tendonitis abduct the shoulder to 90 deg, forward flex to 30 deg, and forcibly internally rotate (induced pain!)
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37
Q

Shoulder Disorders

rotator cuff muscles & their jobs

A
  • supraspinatus: abduction
  • infraspinatus: external rotation
  • teres minor: external rotation
  • subscapularis: internal rotation
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38
Q

Shoulder Disorders

Pos PE tests for rotator cuff tears + describe them all

4

A
  • Neer Impingement Sign: arm up to ear and rotate, pain w/ flexion and pronation. subacromial impingement or rotator cuff tear.
  • Hawkin Impingement Test: to test for subacromial impingement or rotator cuff tendonitis abduct the shoulder to 90 deg, forward flex to 30 deg, and forcibly internally rotate (induced pain!)
  • Drop Arm Test: from fully abducted position, slowly lower the arm to the side, noting pain starting at approx 90deg followed up sudden drop of arm.
  • Empty Can Test: supraspinatus muscle isolation; with arm straight and shoulder abducted to 90deg and forward flexed 30deg, point thumb at ground and lift arm against resistance
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39
Q

Shoulder Disorders

Pos PE tests for labral tear

A
  • Apprehension Test: shoulder abducted to 90 deg and elbow flexed to 90 deg, examiner then externally rotates the shoulder and looks for signs of apprehension on pt’s face
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40
Q

Shoulder Disorders

Pos PE tests for shoulder dislocation

A
  • Apprehension Test: shoulder abducted to 90 deg and elbow flexed to 90 deg, examiner then externally rotates the shoulder and looks for signs of apprehension on pt’s face
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41
Q

Shoulder Disorders

dislocated shoulder appearances on XR

A
  • posterior: humeral head appears superior to glenoid cavity on AP film
  • anterior: humeral head appears inferior to glenoid cavity on AP film (MUCH MORE COMMON)
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42
Q

Shoulder Disorders

posterior approach for shoulder joint aspiration

A
  • palpate posteior lateral edge of acromion process
  • mark spot 2cm inferior to edge
  • inject shoulder w/ 10mL of anestetic targeting coracoid process
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43
Q

Shoulder Disorders

ways to reduce anterior shoulder dislocations

A
  • Stimson
  • Scapular Manipulation
  • Leidelmeyer
  • Milch
  • Traction-counter traction
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44
Q

Shoulder Disorders

describe Stimson reduction

A
  • Prone position
  • Arm hanging
  • Traction in forward flexion using 5, 10 or 15 pound weight (15-30 min)
  • Use with scapular manipulation
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45
Q

Shoulder Disorders

describe scapular manipulation

A
  • Stimson technique
  • Scapular tip medially
  • Slight dorsal displacement of scapular tip
  • Reduction may be subtle
46
Q

Shoudler Disorders

describe Leidelmeyer reduction

A
  • Supine
  • Arm adducted
  • Elbow flexed 90°
  • Gentle external rotation
47
Q

Shoulder Disorders

describe Milch reductions

A
  • Forward flexion or abduction until arm is directly overhead
  • Longitudinal traction
  • Slight external rotation
  • Manipulate humeral head upward into glenoid fossa
48
Q

Shoulder Disorders

Traction- Countertraction Reduction

A
  • Supine
  • Bed sheets tied
  • Slight abduction of arm
  • Continuous traction
  • Gentle external rotation
  • Gentle lateral force to humerus
  • Change degree of abd
49
Q

Shoulder Disorder

Pos PE test for Bicepital Tendonitis

A
  • speed’s test: with elbow fully extended and palm forward, flex shoulder against resistance
50
Q

Knee Disorders

most common location for OCD of the knee?

PPP

A

70% in the posterior lateral aspect of the medial femoral condyle

51
Q

Knee Disorders

PE differences for patellar and quad tendon ruptures

A
  • patellar: difficulty w/ knee flexion, patella alta)
  • quad: difficulty w/ SLR, can’t extend knee, patella baja
52
Q

Knee Disorders

bursa of the knee

A
  1. suprapatellar
  2. pre-patellar
  3. infrapatellar
  4. pes anserine
53
Q

Knee Disorders

location of pes anserine bursa

A

deep to the gracilis, sartorius, and semitendinosus tendons at the lower medial knee

54
Q

Knee Disorders

pos special tests for ACL tear

A
  • Anterior Drawer Test: for ACL tear; flex knee to 90 deg and sit on pt’s foot; attempt to pull tibia anteriorly toward you (ACL tear = anterior tibia shift); and then repeat with the tibia in internal rotation to test posteriolateral joint capsule and in external rotation to test posteriomedial joint capsule
  • Lachman Test: for ACL tear; flex knee to approx 20 deg; grasp lower leg, with one hand, use other hand to grasp thight; pull tibia foward while pushing femur back
55
Q

Knee Disorders

pos special tests for PCL tear

A
  • Posterior Drawer Test: for PCL tear- flex knee to 90 deg and sit on pt’s foot; attempt to push tibia posteriorly away you (PCL tear = posteior tibia shift)
  • Sag Sign for PCL tear: inspect if tibia sags posteriorly when knee is relaxed at 90 deg flexion
56
Q

Knee Disorders

pos special tests for meniscus tears

A
  • Medial McMurray Test: fully flex knee, then hold foot in external rotation and apply valgus force to knee while extended knee
  • Lateral McMurray Test: fully flex knee, hold foot in internal rotation and apply varus force to knee while extending knee
  • Apley’s Meniscal Compression Test: with patient prone, grind tibia against femur in rotating motion to see if it elicits meniscal pain
  • Apley’s Meniscal Distraction Test: same as above, except tibia is pulled away from femur; pain may indicate ligamentous injury or malingering rather than meniscal injury.
57
Q

Scoliosis

differentiate dextroscoliosis and levoscoliosis

A
  • Dextro: spinal curvature to R
  • Levo: spinal curvature to L
58
Q

Scoliosis

describe purpose of and technique for scholiometer

A
  • measures angulation of spine while individual bends forward to determine degree of truncal rotation
  • pt bend forward, deviation of teh ball from center is measured
  • measurements of >5deg is abnormal, f/u with spinal XR
59
Q

Raynaud’s

pathophys of each phase

A
  • Ischemic: arterial vasospasm causing distal blanching and transient numbness
  • Hypoxic: dilation of capillaries and venules containing deoxygenated blood causing cyanosis
  • Hyperemic: rewarming and resolution of vasospasm leading to oxygenated blood being delivered to dilated capillaries and venules leading to erythema
60
Q

Raynaud’s

clinical presentation primary vs secondary

A
  • Primary: mild cuase, middle 3 fingers most commonly affected, episodic < 20 min
  • Secondary: more severe, asymmetric or unilateral, trophic changes (scarring, ulceration, gangrene), sclerodactyly (puffy digits w/ skin tightening)
61
Q

Raynaud’s

normal vs abnormal nailfold capillary microscopy

A
  • Normal: vessels thin, uniform, evenly spaced, symmetric; capillary loops have hairpin appearance
  • Abnormal: absent (dropout areas) or dilated capillary loops; vessels are irregular, tortuous, elongated, bizarre, bushy, engorged, corkscrew in appearance; spacing between loops may be uneven
62
Q

Raynaud’s

vasoconstrictive meds to avoid

A
  • nasal decongestants
  • amphetamines
  • methylphenidate sumatriptan
63
Q

Radial Head Subluxation

supination/flexion technique

A
  • Warn caregivers that the maneuver will hurt and the child will likely cry
  • Child can be seated in parent’s or caregiver’s lap
  • Fully extend and supinate elbow and then take elbow intoflexion
  • This procedure is done while maintaining slight pressure over the radial head; often, the provider will feel a “click” in the elbow
  • Typically, the child will be moving thearmnormally within 15 minutes
  • Immobilizationis unnecessary after first episode
64
Q

Radial Head Subluxation

hyperpronation reduction technique

A
  • Warn caregivers that the maneuver will hurt and the child will likely cry
  • Child can be seated in parent’s or caregiver’s lap
  • While applying mild pressure over the radial head, the provider holds the elbow in a flexed position and hyperpronates theforearm
  • A click may be felt whendisplacementis reduced
  • Typically, the child will be moving thearmnormally within 15 minutes
65
Q

anatomy of apophysis

A
  • normal secondary ossifications center
  • located in NWB part of bone
  • site of tendon or ligament attachment
  • AKA traction epiphysis
  • eveentually fuses w/ major portion of bone in 2nd decade of life
66
Q

Ankle Sprain

sprain vs strain

A
  • sprain: injury to ligament caused my tearing of the fibers of a ligament
  • strain: injury in which the muscle is stretched too much and tears
67
Q

Ankle Sprain

ligaments of the ankle

A
  • deltoid (strong, medial ligament)
  • anterior/posterior talofibular (lateral ligaments)
  • calcaneofibular (lateral ligament)
68
Q

Ankle Sprain

grading ankle sprains

A

1st degree – mild ankle sprain
* Minimal pain and swelling
* Ankle is weakened and prone to reinjury
* Healing: 1-2 wks

2nd degree – moderate to severe ankle sprain
* Swelling often associated with ecchymosis
* Walking produces pain and is often difficult
* Healing: 2-3 wks

3rd degree – severe ankle sprain
* Diffuse swelling and ecchymosis
* Unable to bear weight
* Ankle instability
* +/-nerve damage
* Healing: 6-8 wks

69
Q

Ankle Sprain

Ottawa Ankle Rules- ankle vs foot imaging

A

An ANKLE radiograph should be performed if there is pain in the malleolar region with any of the following:
* Bone tenderness at the posterior edge of the distal 6 cm or tip of the lateral malleolus
* Bone tenderness at the posterior edge of the distal 6 cm or the tip of the medial malleolus
* Inability to bear weight for at least 4 steps both immediately after injury and at the time of evaluation

A FOOT radiograph should be performed if there is pain in the midfoot region with any of the following:
* Bone tenderness at the navicular bone
* Bone tenderness at the base of the 5th metatarsal
* Inability to bear weight for at least 4 steps both immediately after injury and at the time of evaluation

70
Q

Ankle Sprains

Ankle Anterior Drawer Test

A
  • Performed to evaluate the stability of the anterior talofibular ligament (differentiate between 2nd and 3rd degree lateral ankle sprains)
  • Positive test: anterior movement of the foot = 3rd degree tear

Performing the Test
* place the pt’s ankle into 20deg plantar flexion
* with one hand, stabilize the anterior aspect of the distal leg
* cup the calcaneous and attempt to displace it anteriorly detecting the total amount of anterior translation in the lateral part of the ankle

71
Q

Ankle Sprains

proper use of posterior leg splint

A
  • use with grade 2-3 ankle sprains, isolated fractures of tibia or fibula, lisfranc, or metatarsal fractures
  • origin: posterior surface of leg, 2 in below fibular head to avoid common peroneal nerve compression
  • insertion: plantar aspect of metatarsal heads
  • position: ankle in 90deg dorsiflexion, pt in prone position to prevent shortening of Achilles
72
Q

Metatarsal Fractures

types of fractures

A
  • Pseudojones/Dancer’s fracture: occurs in zone I; fracture through base (tuberosity) of 5th metatarsal due to plantar flexion/inversion
  • Jones Fracture: occurs in zone II; fracture at metaphyseal-diaphyseal junction that occurs w/ ankle sprains; high risk for non-union due to zone being avascular
  • Stress Fracture: zone III
73
Q

Bursitis

define bursa

A
  • synovium lined, sac like structure containing small amount of fluid
  • found throughout the body
  • acts as a cushion and gliding surface to reduce friction
  • located near bony prominences or between bones, muscles, tendons, or ligaments
74
Q

Bursitis

describe olecranon bursitis

A
  • caused by injury or repetitive pressure on elbow
  • pain w/ flexion
75
Q

Bursitis

describe trochanteric bursitis

A
  • caused by injury, overuse, arthritis, surgery
  • pain w/ lying or sleeping on affected side
  • most common in middle age/older women
76
Q

Bursitis

describe pre-patellar bursitis

A
  • caused by repetitive pressure on knees
77
Q

Bursitis

describe retrocalcaneal bursitis

A
  • caused by uphill running or wearing tight fitting shoes
78
Q

Foot Disorders

anatomy of the foot

A
  • tarsals, metatarsals, phalanges
  • arches function to distribute/absorb body wt, provide foot w/ elasticity and resilience, adapt to uneven surfaces, and protect neurovasculature
79
Q

Elbow Disorders

Elbow anatomy

A
  • synovial hinge joint
  • 3 joints which form functional unite w/in single articular capsule: humeroulnar joint, humeroradial joint, proximal radioulnar joint
  • motions of elbow: extenion/flexion; pronation/supination
80
Q

Elbow Disorders

define Cozen and Maudsley tests

A
  • Cozen: resisted wrist extension with elbow extended and forearm pronated
  • Maudsley: resisted extension of middle finger
81
Q

Elbow Disorders

5 muscles that form the common flexor tendor + their innervations

A

Innervated by Median Nerve
* pronator teres
* flexor carpi radialis
* palmaris longus
* flexor digitorum superficialis

Innervated by Ulnar Nerve
* flexor carpi ulnaris

82
Q

Bone Tumors

children vs adult

A
  • peds: most are benign; if malignant suspect osteosarcoma, Ewing sarcoma
  • adults: metastatic 100x more common; metastases commonly from breast, lung, thyroid, prostate, or renal cancers
83
Q

Bone Tumors

proto-onco genes

A
  • genes that promote normal cell growth
  • with mutations, proto-oncogenes become oncogenes which overstimulate cell growth
84
Q

Bone Tumors

tumor suppressor genes

A

help balance cell growth by promoting apoptosis of mutated cells

85
Q

Bone Tumors

primary malignant bone tumors

4

A
  • multiple myeloma
  • chondrosarcoma
  • ewing sarcoma
  • osteosarcoma
86
Q

Bone Tumors

how multiple myeloma destroys bone

A
  • Lytic Lesions: plasma cells activate osteoclasts which promote bone destruction
  • Hypercalcemia: increased bone destruction leads to increased serum calcium
87
Q

Bone Tumors

osteoma vs osteoblastoma

A
  • osteoma: < 1.5 cm
  • osteoblastoma: > 1.5 cm
88
Q

Osteoporosis

pathophys

A
  • bone is continually being formed and resorbed (formation = resoprtion)
  • peak bone mass around age 30 and plateaus for 10 yrs
  • bone loss then occurs at a rate of 0.3-0.5% each year until menopause then there is a 3-5% loss in bone density for 5-7 yrs
  • osteoporotic bone loss affects cortical and spongy/trabecular bone leading to a fragile/porous bone
89
Q

Osteoporosis

describe fragility fractures

A
  • occur after less trauma than might be expected to fracture a bone (ex: fall while standing, falling out of bed, coughing)
  • common sites: distal radius, spine, femoral neck, proximal humerus, pelvis
90
Q

Osteoporosis

types of primary osteoporosiss

A
  • overall: 95% of post-menopausal women; 80% of male cases
  • Type 1: estrogen deficiency (increased osteoclasts, reduced osteoblasts)
  • Type 2: age-related loss of bone mineral density
91
Q

Osteoporosis

secondary osteoporosis

A
  • overall: 5% of female cases; 20% of male cases
  • can be caused by disease (bone marrow/endocrine disorders), deficiency (malabsorption, vit D), drugs
92
Q

Osteoporosis

biggest med risks for secondary osteoporosis

3

A

steroids, PPIs, aromatase inhibitors (block estrogen)

93
Q

Osteoporosis

purpose of DEXA scans

A
  • define osteopenia and osteoporosis by providing a quantitative measure of bone loss
  • predicts risk of fracture
  • monitors patients undergoing tx
94
Q

Osteoporosis

DEXA T vs Z score

A
  • T score: standard deviation differenec between the patient’s BMD and reference BMD of younger population of same sex/ethnicity/race
  • Z Score: standard deviation difference between pt’s BMD and that of an age-matched population of the same sex/race/ethnicity
95
Q

Osteoporosis

interpreting T vs Z scores

A

T: if -1 to -2.5 SD: osteopenia; if <-2.5 SD: osteoporosis
Z: <-2.0 SD: osteoporosis

96
Q

Osteoporosis

FRAX Score

A
  • Fracture Risk Assessment Score which predicts the 10 yr probability of major osteoporotic fractures
  • Based on: age, gender, race, hx of fragility fracture, RA, family hx hip fracture, low BMI, hx steroid use, EtOH, current smoker, BMD of femoral neck
  • Screen all pt >50 w/ FRAX

do not memorize, just be familiar

97
Q

Osteoporosis

indications for pharmacotherapy in women and men

3 each

A
  • women: hx fragility fracture, T score <-1, elevated 10 yr risk via FRAX
  • men: fragility fracutres, FRAX estimations, BMD measurements
98
Q

Osteoporosis

bisphosphonates overview

A
  • end in “dronate” or “dronic acid”
  • bind to hydroxyapatite binding sites on bone (areas w/ active resorption by osteoclasts)
  • bone turnover reduced at 3 mo and reduced fx risk at 1 yr
  • take on empty stomach w/ 8oz water (can cause esophageal irritation)
99
Q

Osteoporosis

Hormonal replacement overview

A
  • Estrogen + progesterone: not always given due to risk of thromboembolism, endometrial cancer, CAD, breast cancer
  • Testosterone: replace in hypogonadal men
100
Q

Osteoporosis

Misc Therapies

A
  • Raloxifene: estrogen-agonistic effect on bone leading to increased bone mineral density and mass by decreasing bone resorption
  • Denosumab: monoclonal ab against receptor activator of RANKL which is secreted by osteoblasts
  • Calcitonin: opposes action of PTH leading to inhibited osteoclast activity and reduced bone resorption
101
Q

Osteoarthritis

characteristics of synovial joints

A
  • Articular Cartilage: made of hyaline, covers ends of bones, provides shock absorption/stability/lubrication
  • Synovial Membrane: loose/vascularized connective tissue, secretes synovial fluid into joint cavity for lubrication
  • Joint/Articular Capsule: fibrous connective tissue that surrounds the bony ends forming the joint
102
Q

Osteoarthritis

primary vs secondary

A
  • Primary: idiopathic
  • Secondary: due to obesity, repeated trauma/surgery, infection, congenital abnormalities, metabolic disorders, bone disorders
103
Q

Osteoarthritis

XR/PE evidence of osteophytes

A
  • DIPs: Heberden’s nodes
  • PIPs: Bouchard’s nodes
  • 1st CMC: thumb squaring
104
Q

Osteoarthritis

Stages of Osteoarthritis

A
  • Stage 0: normal joint
  • Stage 1: 10% cartilage loss
  • Stage 2: joint space narrowing + osteophyte formation
  • Stage 3: moderate joint space narrowing (crepitus) + continued osteophyte formation
  • Stage 4: > 60% cartilage loss + severe joint space narrowing + large osteophytes
105
Q

Pediatric Hip Disorders

describe being breech as a risk factor for DDH

A
  • Frank Breech highest risk: both knees extended (i.e. bent in half)
  • if a female baby is born breech, they should ALL undergo US screening for DDH
106
Q

Pediatric Hip Disorders

DDH hip XR H line

A
  • drawn horizontally through the inferior portion of the iliac bones at the triradiate cartilages
107
Q

Pediatric Hip Disorders

DDH PE tests as newborn & describe

A
  • Barlow: dislocation of hips at rest; child’s hips adducted while applying posterior force –> positive when femoral head is felt slipping (posteriorly) our of the acetabulum
  • Ortolani: reduction of the hips at rest; from an adducted position, the child’s hip is abducted while the trochanter is pushed anteriorly –> positive when “hip clunk” is felt or if the hip is reduced
108
Q

Pediatric Hip Disorders

DDH PE tests as infants age & describe

A
  • Galeazzi: child lays supine w/ hips flexed to 45deg and knees at 90deg; pos if one knee is higher than the other (indicates possible posterior displacement of the femur)
  • Klisic: place a finger on the greater trochanter and the ASIS –> draw “line” through both fingertips –> if the line is below the umbilicus, the test is pos
109
Q

Pediatric Hip Disorders

endocrine & renal work up for who? includes what?

A
  • children < 10 yrs and wt < 50th percentile
  • TSH, free T4, BUN, creatinine
110
Q

Pediatric Hip Disorders

SCFE Drehmann sign

A

external rotation w/ passive hip flexion to 90deg

CMT (72 decks)

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