Flashcards in MSK/Rheum Deck (55):
What is the most common dislocated joint in the body?
A shoulder dislocation is the most common.
What nerve needs special attention when examining an anterior shoulder disloca- tion?
The Axillary nerve needs to be assessed when examining an anterior shoulder dislocation.
What are the four SITS muscles?
3. Teres Minor
What is the treatment of choice for the majority of clavicle fractures?
A simple arm sling is the treatment of choice. A figure 8 splint is not indicated or recommended anymore.
When does a clavicle fracture require surgical correction?
Most will heal well without surgical correction. Surgery is indicated when there is complete displacement.
What signs on X-ray suggest supracondylar fracture?
An anterior sail or posterior fat pad can be seen on X-ray. This might be the only finding seen on X-ray. Look for it!
A five year old child presents with arm pain after the mother yanked her child. The child’s arm is in pronation. What is the most likely diagnosis?
Nurse maid elbow. Reduction will cause immediate pain relief.
What is the most common mechanism for schaphoid fractures?
FOOSH: Fall on outstretched hand.
What anatomical location needs to be palpated when evaluating a schaphoid frac- ture?
The anatomic snuffbox will elicit pain when palpated. Generalized wrist pain will be noted. Swelling may or may not be present.
What is the major complication associated with an untreated scaphoid fracture?
The main worry is avascular necrosis. Patients with a suspicion for fracture should be kept in a thumb spica splint until this can reliably be excluded.
What is the treatment of choice for epicondylitis?
NSAIDs and rest! This is simply an overuse syndrome. Stop using it and the symptoms resolve.
What digits are affected in patients with carpal tunnel syndrome?
The first 3 digits and the radial half of the 4th digit will be affected.
When is surgery indicated for a boxers fracture?
Surgery is indicated if there is any degree of rotation. Surgery is also indicated if neurovascular impairment or an open fracture is seen. Psuedoclawing can occur at 30 degrees of angulation and these should be reduced and placed in an ulnar gutter splint.
What is a finklestein test and when will it yield a positive result?
Have the patient wrap their thumb in the remaining four fingers. Pain with ulnar devia- tion is a positive test and suggests dequervaine tenosynovitis.
A 20 year old patient is presenting with chronic back pain. A bamboo spine is seen on X-ray. What is the most likely diagnosis?
Ankylosing spondylitis. This has an association with HLA-B27.
After what time period is it reasonable to order an X-ray in a patient presenting with unresolved back pain?
Most patients with back pain will resolve after 4 weeks. If pain continues after 4-6 weeks, then an x-ray is indicated.
When is an MRI indicated in the evaluation of back pain?
MRI is indicated if pain persists >3 months or if there are any neurological deficits.
A patient is presenting with back pain, incontinence, and absent lower extremity reflexes. What is the treatment of choice?
This is cauda equina sydrome. Patients should receive steroids, followed by surgical de- compression.
After what degree of rotation puts a scoliosis patient at risk for cardiopulmonary compromise?
Those with >70 degrees of rotation are at risk.
A cobb angle of what will require surgery for scoliosis?
A cobb angle >50 will require surgery. Those >30 will require a brace. Those
Patients with spinal stenosis will notice relief of symptoms with what type of position?
They will present with the shopping cart sign: relief with forward bending.
What X-ray views are needed when evaluating avascular necrosis?
All patients should be evaluated with a frog leg lateral view.
Patients slipped capital femoral epiphysis will often have referred pain to what body part?
Children will usually have referred pain to their knee. It is for this reason that any child with knee pain should also have a hip examination.
What are the two physical exam maneuvers used to look for developmental hip dysplasia?
1. Ortolani - Abduct the hip and lift the trochanter anteriorly.
2. Barlow - Adduct the hip and push the trochanter posteriorly. A palpable clunk or click is a positive result.
A displaced femoral neck fracture will present in what anatomical position?
Patients will have external rotation and shortening of the leg.
What is the most accurate physical exam test for an ACL tear?
The lachman test is most specific.
A McMurray and Apley test are used to diagnose what condition?
What is the thomas compression test?
Have the patient lie on their abdomen with their feet hanging off the bed. If plantar flex- ion isn’t noted with squeezing of the calf, then we have a positive test; this indicates an achilles ankle rupture.
What is the most common etiology in osteomyelitis?
What is the best initial test when evaluating osteomyelitis?
An X-ray is the initial test ordered, however, it may be negative initially. If suspicion is high with a negative x-ray, the next step is MRI.
What will the aspirated fluid in a septic joint demonstrate?
A septic joint will have a leukocytosis >100,000.
A sunburst pattern on X-ray signifies what disease?
What are bouchard and heberdens nodes?
These physical exam findings are seen in osteoarthritis.
Bouchard - PIP enlargement
Heberdens - DIP enlargement
What is first line treatment of osteoporosis?
Bisphosphonates. Make sure patients drink a full glass of water as this can cause pill induced esophagitis.
What are the classic findings noted in compartment syndrome?
What is felty syndrome?
1. Rheumatoid Arthritis
Which patients require DMARD therapy in RA?
Every patient! This is a progressive disease.
Compare the morning stiffness of OA vs RA.
OA = Morning stiffness 1 hour
What is the first line treatment in fibromyalgia?
All patients should have an exercise program and CBT. First line medication is a tricyc- lic antidepressant.
What is the most accurate way of diagnosing gout?
Arthrocentesis = needle shaped crystals with birefringence under polarized light
What medications can exacerbate a gouty attack?
Aspirin and thiazide diuretics can increase uric acid levels.
What is the uric acid goal for patients with gout?
All patients should have a uric acid level
What is first line treatment for an attack of gout and pseudogout?
NSAIDs are first line.
A 15 year old male is presenting with multiple joint pains for 8 weeks and an intermittent fever. A salmon colored rash is noted over the trunk. What is the most likely diag-nosis.
This is a classic presentation for juvenile rheumatoid arthritis
Polyarteritis nodosum is associated with which hepatitis?
Hepatitis B and C. Hepatitis B has a stronger association.
Which antibodies are present in patients with polymyositis?
Polymyalgia rheumatica is associated with what vasculitis?
Giant Cell Arteritis
What is the classic triad seen in reactive arthritis?
2. Post infectious arthritis
What is the most sensitive test in the evaluation of lupus?
ANA - All patients will have a positive ANA.
Which antibodies are the most specific in diagnosing lupus?
1. Double stranded DNA 2. Anti-smith
What is the relationship with a lupus flare and complement levels?
Patients will have a decreased complement level with an acute flare.
What is CREST syndrome?
2. Reynaud phenomenon
3. Esophogeal dysmotility
What is the first line treatment for hypertension in patients with scleroderma?
Sjogren syndrome will have what antibodies?
1. Anti-ro (SS-A)
2. Anti-la (SS-B)