MSK/Rheum #5

Question 1

A Morton’s Neuroma is

Answer 1

Compressive neuropathy of the interdigital nerve (MC involves the second or third interdigital nerve between the metatarsal heads)

Question 2

Risk factors for a Morton’s Neuroma

Answer 2

• Women 25-50 years old
• Tight-fitting shoes
• High feels
• Flat feet

Question 3

What is a Jones Fracture?

Answer 3

-Transverse fracture through the diaphysis of the fifth metatarsal at the metaphysical-diaphyseal junction

Question 4

Treatment for Jones Fracture

Answer 4

-Non weight bearing in short leg cast for 6-8 weeks

Frequently requires ORIF/pinning

Question 5

What is a LisFranc Injury?

Answer 5

One or more of the metatarsal bones are displaced from the tarsus

Question 6

What is the treatment for a LisFranc injury?

Answer 6

ORIF

Question 7

On a radiograph for a LisFranc fracture, a Fleck Sign may be seen. What is this?

Answer 7

Fracture at the base of the second metatarsal

Question 8

A Ewing Sarcoma is the 2nd MC primary bone malignancy in children and young adults (after Osteosarcoma). Which location is the MC for this type of bone cancer?

Answer 8

Femur (diaphysis of long bones)

-Then pelvis

Question 9

Symptoms of a Ewing Sarcoma

Answer 9

• Localized bone pain and swelling with systemic symptoms (fever, malaise, weight loss)
• Palpable mass, local tenderness, or joint swelling

Question 10

A Ewing Sarcoma occurs due to a translocation between chromosomes ___ and ___

Answer 10

11 and 22

Question 11

On radiographs for a Ewing Sarcoma, what is seen?

Answer 11

Layered periosteal reaction (Onion Skin Appearance), “Moth-eaten appearance.”

Question 12

Treatment for Ewing Sarcoma

Answer 12

• Chemotherapy followed by limb-sparing resection when possible
• Radiation when you cannot excise

Question 13

Treatment for Fibromyalgia

Answer 13

• Conservative measures: low impact aerobic exercise, swimming, water aerobics
• TCA (Amitriptyline) is the first line
• Pregabalin is approved by the FDA for treatment though

Question 14

What is Polyarteritis Nodosa (PAN)

Answer 14

• Systemic vasculitis of medium-sized vessels

- Pulmonary vessels (lung) not involved

Question 15

PAN has an increased association with

Answer 15

Chronic Hepatitis B and C

Question 16

Symptoms of PAN

Answer 16

-Hypertension, Abdominal pain worse with eating, Livedo Reticularis, Raynaud’s, Myalgias, Fever, Peroneal foot drop

Question 17

Diagnostics for PAN

Answer 17

• Classic PAN is ANCA negative

- Renal or Mesenteric Angiography: micro aneurysms or beading of small arteries

Question 18

Treatment for PAN

Answer 18

Glucocorticoids

Question 19

Risk factors for ALS

Answer 19

• Young males 15-30 years old

- HLA-B27 positivity

Question 20

Symptoms of ALS

Answer 20

• Back pain, stiffness and decreased ROM worse in morning
• Pain decreases with exercise and activity
• Sacroilitis
• Uveitis

Question 21

What do radiographs of ALS show?

Answer 21

Sacroilitis (narrowing of the joint)

-Bamboo spine = straightening of the spine + squaring and fusion of the vertebrae

Question 22

Treatment for ALS

Answer 22

NSAIDs are first line

Anti-TNF drugs if no response to NSAIDs

Question 23

Symptoms of Cauda Equina Syndrome

Answer 23

• Bilateral leg radiation of pain
• Saddle anesthesia (S2-S4 nerve roots)
• Urinary or bowel retention or incontinence
• Decreased anal sphincter tone

Question 24

Study of choice for Cauda Equina Syndrome

Answer 24

MRI

Question 25

Medial Epicondylitis (Golfer's Elbow) is inflammation of which muscles due to repetitive overuse?

Answer 25

Pronator Teres & Flexor Carpi Radialis

Question 26

Exam findings of a patient with medial epicondylitis

Answer 26

- Pain with wrist flexion against resistance with elbow fully extended - Tenderness over medial epicondyle

Question 27

Cubital Tunnel Syndrome is compression of which nerve?

Answer 27

Ulnar Nerve

Question 28

Symptoms of a patient with Osteogenesis Imperfecta

Answer 28

- Blue-tinted sclera - Brown teeth - Severe premature osteoporosis - Presenile deafness

Question 29

A Boxer's Fracture is put in a

Answer 29

Ulnar Gutter Splint | -Always check for bite wounds

Question 30

A Gamekeeper's Thumb is put in a

Answer 30

Thumb Spica Splint and referred to hand surgeon

Question 31

What can be given after fractures as prophylaxis to reduce incidence of CRPS

Answer 31

Vitamin C

Question 32

When a patient has pain along the radial aspect of the wrist and base of thumb radiating to the forearm, what is the diagnosis?

Answer 32

DeQuervain Tenosynovitis

Question 33

What is the treatment for DeQuervain's?

Answer 33

Thumb spica splint, NSAIDs, PT

Question 34

Risk factors for DeQuervain's?

Answer 34

Clerical workers - Women PostPartum (from lifting newborn) - diabetics - Posttraumatic

Question 35

What tendons are entrapped in DeQuervain's?

Answer 35

APL and EBP - Abductor pollicis longus - Extensor Pollicis Brevis

Question 36

What nerve is entrapped and compressed in carpal tunnel syndrome?

Answer 36

Median nerve

Question 37

What area(s) does the median nerve cover?

Answer 37

First 3 and radial half of the fourth digits

Question 38

What two tests are positive in Carpal Tunnel Syndrome?

Answer 38

Tinel and Phalen

Question 39

What is the difference between carpal tunnel syndrome and Pronator Teres Syndrome?

Answer 39

Pronator Teres Syndrome does not have pain at night, whereas carpal tunnel has severe pain at night