MSK review deck Flashcards
(166 cards)
1
Q
What is the initial diagnostic, after imaging, for monoarticular workup?
A
Arthrocentesis with synovial fluid analysis
+/- Labs if needed
2
Q
What labs are needed for hemarthrosis without trauma?
A
PT/INR, PTT, CBC
Evidence of joint inflammation without infection or crystals
3
Q
What tests are used for evidence of joint inflammation?
A
ESR/CRP, CBC, CMP
4
Q
When should you test for systemic rheumatic disease?
A
If there is suspicion for that disease
5
Q
When should you test for Lyme disease?
A
If suspicion is high
6
Q
What is the role of synovial biopsy in monoarticular workup?
A
Rarely performed
7
Q
What conditions are considered in the workup for polyarticular with synovitis?
A
RA, Lupus, Other systemic disease
8
Q
What labs are included in the polyarticular workup?
A
CBC, CMP, urinalysis, ESR/CRP
9
Q
What viral antibodies should be tested in polyarticular workup?
A
Hepatitis B, Hepatitis C, Parvovirus B19
10
Q
What imaging is needed for polyarticular workup?
A
Rarely needed
11
Q
What is the approach for polyarthritis without synovitis?
A
Workup based on clinical suspicion
12
Q
What labs are included in the polyarthritis without synovitis workup?
A
CMP, TSH / PTH
13
Q
What imaging is used for polyarthritis without synovitis?
A
X-ray
14
Q
What screening should be done for polyarthritis without synovitis?
A
Screening for depression
15
Q
What is the normal color of synovial fluid?
A
Clear, sometimes straw colored
16
Q
Why is differential cell type important in synovial fluid analysis?
A
It can provide important diagnostic information
17
Q
What do negative birefringent yellow crystals indicate?
A
They are associated with gout
18
Q
Long bone Fractures
A
19
Q
What is the pathology?
A
bisphosphates induced transverse femur fracture
20
Q
What is the pathology?
A
oblique fracture of the tibial shaft
21
Q
What is the pathology?
A
spiral fracture of the femur
22
Q
What is the pathology?
A
highly comminuted fracture-gun shot injury
23
Q
What is the pathology?
A
normal
24
Q
What is the pathology?
A
calcaneal tuberosity avulsion of the fracture
25
What is the pathology?
impacted femoral neck fracture
26
What is this pathology?
greenstick fracture
27
what are the pediatric specific fractures?
Salter-Harris Classification: centers around location of fracture in relation to growth plate
Torus (aka buckle fracture)
28
What is this pathology?
normal pediatric fracture series-5 years
29
What is this pathology?
incomplete radial fracture
30
Displacement
loss of alignment of a long bones along its axis
31
What is the relationship of the distal portion to the proximal portion?
Rotation
Angulation
Translation
Impaction
Distraction
32
What does the atlas look like?
33
What does the axis look like?
34
What is a superior view of the cervical vertebrae look like?
35
What is this pathology?
normal cervical spine radiographs
36
What is this pathology?
normal cervical spine radiographs
37
What is this pathology?
normal cervical spine radiographs with swimmer's view
38
Structures you should be able to identify:
C2
Dens/Odontoid Process
Body
C3-C4
Body
C5-C6
Body
Transverse Process
Spinous Process
C7 (larger downward pointing transverse processes)
Body
Transverse Process
Spinous Process
T1
Body
Transverse Process
Spinous Process
39
Structures you should be able to identify:
C1 (Atlas)
C2 (Axis)
Body
Lamina
General location for Dens/Odontoid Process (vertical)
C3-C7
Body
Lamina
Spinous Process
T1
Body
40
Lines you should be able to identify:
Anterior Vertebral Line
Posterior Vertebral Line
Spinolaminar Line
Posterior Spinous Line
Anterior Vertebral Line: Front of the vertebral bodies
Posterior Vertebral Line: Back of the vertebral bodies
Spinolaminar Line: “Dividing line” between the lamina and spinous process
Posterior Spinous Line: Posterior to spinous processes
41
What is this pathology?
normal cervical spine soft tissues
42
Structures you should be able to identify:
C1
Lateral Masses
C2
Lateral Masses
Dens/Odontoid Process
Lamina
43
What is this pathology?
normal thoracic spine
44
What is this pathology?
normal thoracic spine
45
Structures you should be able to identify:
T1-T12
Body
Transverse Processes
Spinous Processes
Pedicles
Ribs
Clavicle
46
Structures you should be able to identify:
T1-T12
Body
Spinous Processes
Intervertebral Discs
47
Structures you should be able to identify:
L1-L5
Body
Transverse Processes
Spinous Processes
Pedicles (little circles seen on the right side of the image)
48
Structures you should be able to identify:
L1-L5
Body
Spinous Processes
49
What is this pathology?
compression fracture
50
What is this pathology?
burst fracture
51
What are the anterior soft tissue measurements for the nasopharyngeal and retropharyngeal spaces?
C1-C4 should be < ½ the width of the vertebral body.
52
What is the measurement for the retrotracheal space?
C5-C7 should be < the width of the vertebral body.
53
What is the first alignment check for the cervical spine?
Make sure lateral masses of C1 do not overhang those of C2.
54
What is the second alignment check for the cervical spine?
Make sure no asymmetry of the articular spaces between the lateral masses of C1 and the body of C2.
55
What is the third alignment check for the cervical spine?
Make sure no asymmetry between lateral masses of C1 and dens.
56
What defines an unstable cervical spine fracture?
A fracture through 2 or more of the columns is considered unstable.
57
What is this pathology?
Flexion-Distraction
aka Chance or Seatbelt
58
What is this pathology?
dislocation
59
kyphosis
Outward rounding of spine
60
Lordosis
inward rounding of the spine
61
Scoliosis
sideways curving of the spine
62
What is this pathology?
kyphosis
63
What is this pathology?
Lordosis
64
What is this pathology?
scoliosis
65
Label these structures
1.Clavicle
2. Acromion process
3. Greater tubercule
4. Coracoid process
5. Humeral head
6. Lesser tubercule
7. Glenoid fossa
8. Acromioclavicular joint
9. Scapula
10. Humerus
66
Structures you should be able to identify:
Clavicle
Scapula
Acromion Process
Coracoid Process
Humerus
- Head
- Greater Tubercle
- Lesser Tubercle
- Shaft
67
Structures you should be able to identify on this right "Y" view:
Clavicle
Scapula
Humerus
- Head
- Shaft
68
What is this pathology?
anterior shoulder dislocation
69
What is this pathology?
inferior shoulder dislocation
70
What is this pathology?
posterior shoulder dislocation
71
Label these structures
Olecranon Fossa
Medial Epicondyle
Olecranon
Lateral Epicondyle
Radial Head
Radial Tuberosity
Ulna
Radius
Humerus
72
Label these structures
Olecranon Fossa
Medial Epicondyle
Olecranon
Lateral Epicondyle
Radial Head
Radial Tuberosity
Ulna
Radius
Humerus
73
What does a normal elbow series look like?
74
Should be able to identify:
Humerus
- Medial Epicondyle
- Lateral Epicondyle
- Olecranon Fossa
Radius
- Radial Head
-Radial Tuberosity
Ulna
- Olecranon
75
What is this pathology?
Galeazzi
Radius fracture (distal)
Ulna dislocation
76
What is this pathology?
Monteggia
Ulna fracture
Radial head dislocation
77
What does a normal hand series look like?
78
Should be able to identify:
Radius
Ulna
Styloid Process
Carpals
Scaphoid
Lunate
Triquetral
Pisiform
Hamate
Capitate
Trapezoid
Trapezium
Metacarpals
Pisiform is the round structure that seems to lay on top and the triquetal is underneath it
79
What are the bones of the hand?
80
Should be able to identify:
Radius
Ulna
- Styloid Process
Carpals
-Scaphoid
- Trapezium
Metacarpals
81
Should be able to identify:
Radius
Carpals
Lunate
Trapezium
Metacarpals
82
Should be able to identify:
Radius
Ulna
- Styloid Process
Carpals
- Scaphoid
-Lunate
-Triquetral
-Pisiform
-Hamate
-Capitate
-Trapezoid
-Trapezium
Metacarpals
Phalanges
-Proximal
-Middle
-Distal
83
Should be able to identify:
Radius
Ulna
- Styloid Process
Carpals
-Scaphoid
-Trapezium
Metacarpals
Phalanges
-Proximal
-Middle
-Distal
84
What is this pathology?
Colles
Most common distal radial fracture
Mechanism: FOOSH
85
What is this pathology?
Smith
< 3% of radius/ulna fractures
Mechanism: Fall on flexed wrist
Young males and elderly females
86
Iliac crest
Ilium
Anterior sacral foramina
Sacroiliac joint
Anterior superior iliac spine
Anterior inferior iliac spine
Ischial spine
Superior pubic ramus
Obturator foramen
Inferior pubic ramus
Ischial tuberosity
Symphysis pubis
Coccyx
Femur
Lesser trochanter
Greater trochanter
Femoral neck
Femoral head
Acetabulum
87
Things you should be able to identify:
Sacrum
Sacroiliac joint
Ilium
- Anterior superior iliac spine
- Anterior inferior iliac spine
Ischium
- Ischial spine
Pubic bone
- Superior pubic ramus
- Inferior pubic ramus
Pubic symphysis
Acetabulum
Femur
- Head
- Neck
- Greater trochanter
- Lesser trochanter
- Shaft
88
What is this pathology?
lateral compression
"wind swept"
fractures occur in two places
89
What is this pathology?
anterior posterior compression
"open book"
compression in the front
90
What is this pathology?
vertical shear
ipsatleteral fractures vertically aligned
91
Femur
Lateral and Medial Condyles
Patella
Tibia
Fibula
Tibial Plateau
Tibial Tuberosity
92
Should be able to identify:
Femur
- Shaft
- Medial Condyle
- Lateral Condyle
Tibia
- Tibial Plateau
- Shaft
Fibula
- Head
-Shaft
Patella
93
Should be able to identify:
Femur
- Shaft
- Condyles
Tibia
- Tibial Plateau
-Shaft
Fibula
- Head
- Shaft
Patella
Area of the Quadriceps Tendon
Area of the Patellar Ligament
94
Should be able to identify:
Tibia: Medial malleolus
Fibula: Lateral malleolus
Talus
95
Should be able to identify on this mortise view:
Tibia
Medial malleolus
Fibula
Lateral malleolus
Talus
96
Should be able to identify on this lateral view of the ankle:
Tibia
Fibula
Talus
Calcaneus
Navicular
Cuboid
Base of 5th metatarsal
97
What does an ankle series look like?
98
Should be able to identify:
Lateral malleolus
Medial malleolus
Talus
Calcaneus
Navicular
Cuboid
Cuneiforms
- Lateral
- Intermediate
- Medial
Metatarsals
Phalanges
99
Should be able to identify:
Lateral malleolus
Talus
Calcaneus
Navicular
Cuboid
Cuneiforms
- Lateral
- Intermediate
- Medial
Metatarsals
Phalanges
100
Should be able to identify:
Talus
Calcaneus
Navicular
Medial Cuneiform
Metatarsals
- Base of 5th
Phalanges
101
What is thoracic outlet obstruction?
Compression of nerve/vascular structures as they pass through the thoracic outlet.
102
What are the multiple variants of thoracic outlet obstruction?
Congenital cervical rib, bony abnormality of 1st rib or clavicle (congenital anomaly, malunited fracture, callus, Paget disease, tumor), elongated C7 transverse process.
103
What imaging is useful for evaluating thoracic outlet obstruction?
Imaging is useful for evaluating bony abnormality as the source.
104
What are the characteristics of rib fractures 1-3?
Generally associated with high energy trauma and injuries to brachial plexus, subclavian and neck vessels, head injury, and cardiac injury.
105
What are the characteristics of rib fractures 4-10?
Most common rib fractures associated with injuries such as pneumothorax and pulmonary laceration.
106
What are the characteristics of rib fractures 10-12?
Associated with injuries such as laceration of liver, kidney, or spleen.
107
What is a floating rib?
When a rib is fractured twice, the free fracture fragment is called a floating rib.
108
What is a flail chest?
When 3 or more contiguous floating ribs are present, this is called a flail chest.
109
What are the malignant cancer tumors?
Multiple myeloma, osteosarcoma, Ewing sarcoma, and chondrosarcoma.
110
What are the benign cancer tumors?
Giant cell tumor, osteoid osteoma, unicameral bone cyst.
111
What is this pathology?
"sunburst" and "codman triangle"
112
What is this pathology?
"onion skin"
Ewing sarcoma
113
What is this pathology?
"popcorn calcifications"
114
What is this pathology?
Giant cell tumor
115
What is this pathology?
"bulleye" nidus
osteoid osteoma
116
What is this pathology?
unicameral bone cyst
117
What is this pathology?
unicameral bone cyst in the head of the left femur
118
Where is Giant cell arteritis commonly located?
Distal metaphyseal-epiphyseal long bones, particularly the knee
119
Where is unicameral bone cyst commonly located?
Metaphysis of long bones, specifically in the proximal femur and humerus
120
Describe the following fracture
right humeral midshaft spiral fracture w/ 25-50% translation
121
Describe the following fracture
distal femur fracture with rotation and impaction
122
Describe the following fracture
scaphoid fracture
123
Identify the bones
third left proximal phalanax
lunate
capitate
trapezoid
124
identify the bones
intermediate cuneiform
navicular
cuboid
distal 1st phalanx
125
Identify the structure
medial epicondyle
radial tuberosity
126
identify the bones/structures
greater trocanter
obturator foramen
ischium
127
Identify the bones/structures
right ilium
sacrum
pubic symphysis
left sacroiliac
L5 left transverse process
128
identify the bones/structures
left clavicle
AC joint
acromion
left humerus
129
Identify the pathology on x-ray
scoliosis
130
identify the structures
C5 lamina
C5
C7 spinous process
131
Identify the structures
C2 right lateral mass
odontoid process C1
C2 body
132
Identify the structures
L1 spinous process
L1/L2 intervertebral disc space
L3 pedicle
Sacrum
133
What type of salter-harris fracture is this?
Type 4
134
What salter harris fracture is this?
type 1
135
Describe the following structure?
right femur midshaft comminuted fracture with rotation and impaction
136
Name the pathology on the x-ray
odontoid fracture of C2
137
Name the pathology on the x-ray
T12 compression fracture
138
Name the pathology
chance fracture/ flexion-distraction fracture
139
Name the pathology
left anterior sholder dislocation
140
Name the pathology
right AC joint dislocation
141
Name the pathology
"sail" sign and posterior fat pad
occult radial head fracture
142
Name the pathology
fracture of the medial epicondyle of the left arm
avulsion or shearing fracture
143
Name the pathology
right colles fracture
144
Name the pathology
boxers fracture of the right 5th distal metacarpal
145
Name the pathology
Monteggia fracture
146
Name the pathology
left pubic rami fracture
147
Name the pathology
right femoral neck fracture
148
Name the pathology
left posterior hip dislocation
149
Name the pathology
patella fracture
150
Name the pathology
right tibial plateua fracture
151
Name the pathology
right 5th metatarsal fracture or Jones fracture
152
Name the pathology
Lisfranc fracture of the right foot
153
Name the pathology
left distal phalanx chronic osteomyelitis
154
Name the pathology
osteoporosis of the right wrist and forearm
155
What are the characteristics of Synovial Fluid Findings?
156
How can we summarize the different rheumatologic disorders like Gout, Pseudogout, RA, Psoriatic Arthrirtis, and JRA?
157
How can we summarize the different rheumatologic disordes like reactive arthirtis, SLE, Sjorgren's, and Systemic Scleorsis?
158
How can we summarize the different rheumatologic disordes like MTCD and Ankylosing Spondylitis?
159
How can we summarize the different inflammatory myopathies like polymyositis, dermatomyositis, and polymyalgia rheumatics?
160
How can we classify the differnet vasculitidies like Giant cell arteritis, polyarteritis nodosa, Granulomatosis w/
Polyangiitis (GPA), Eosinophilic GPA, and Microscopic
Polyangiitis?
161
How can we descreibe a Jefferson's fracture, odontoid fracture, hangman's fracture, and clay shovelers fracture?
162
How can we summarize a compression fracture, burst fracture, Flexion-Distraction
aka Chance or Seatbelt fracture, and dislocation
163
Hoe can we summarize shoulder dislocations?
164
How can we summarize the malignant tumors?
165
How can we summarize the benign tumors?
166
What is this pathology?
multiple myeloma and "punched out" lesions
