Musculoskeletal Flashcards Preview

Clinical Medicine Final > Musculoskeletal > Flashcards

Flashcards in Musculoskeletal Deck (454):
1

Progressive disease with genetic predisposition, loss of articular cartilage, & effects WB joints

Osteoarthritis

2

OA has cartilage degeneration with __________ inflammation

Minimal inflammation

3

A key characteristic of OA is ________ formation which may be seen on xray

Osteophyte formation

4

OA is associated with what conditions/RFs

Age, hormones, genetics, obesity, lack of physical activity, & metabolic abnormalities

5

What metabolic abnormalities is OA associated with

Acromegaly
Gout
Hyperthyroidism

6

OA has abnormal joint mechanisms. What are the 2 groups?

Congenital defects (SCFE & congenital hip dysplasia)
Acquired defects (epiphysis dysplasia)

7

Condition where the protective cartilage on the ends of your bones wears down over time

OA

8

The primary symptom/complaint of OA is

Joint Pain

9

Describe the joint pain of OA

Localized
Asymmetrical
Increases with use

10

What are the features of OA

Herbeden's nodes at PIP
Bouchard's leg deformities
Fusiform swelling of joints
Loss of ROM
Brief morning stiffness
Effusions/Crepitus
Pain relieved with rest
Genu Valgum

11

What is genu valgum

AKA knocked-knees
Severe lateral wear of the knee joint causing laxity of the medial ligament and knees jutting medially

12

What is the diagnostic of choice for OA

H&P is often sufficient

13

You believe you pt has OA and order some lab studies (fluid analysis) what might you find?

Synovial fluid debris
Absent of crystals
Absent of white cells/organisms

14

You believe you pt has OA and order some lab studies (serum analysis) what might you find?

Normal uric acid, CBC, & rheumatic panel

15

You believe you pt has OA and order some xrays what might you find?

Narrowing of joint space
Osteophytes
Chondral irregularly
Boney cystic changes
Articular surface sclerosis

16

What are osteophytes? What condition are they associated with

They are bony growths at the edge/surface of the bone/joint that show the bone is trying to repair itself; associated with OA

17

What is the proper medical management of OA

Pt education
Exercise
Bracing of joint PRN
Cold therapy first followed by heat
Activity modification (periods of activity followed by rest)

18

What is the primary treatment of OA

Acetaminophen recommended

19

What is the 2nd line treatment of OA

NSAIDs; specifically COX-2
- Celebrex
- Mobic

20

Why are NSAIDs 2nd line Tx for OA?

They are more effective but they have increased toxicity

21

What is the 3rd line Tx for OA

Cortisone injections

22

What is the 4th line Tx of OA

Hyaluronic acid injections (artificial synovial fluid to increase joint viscosity)

23

What is important to remember if you are considering giving a pt hyaluronic acid injections for OA

They can only be used for the knee joints

24

What is the ultimate Tx of OA? When is it indicated?

Arthroplasty
Indicated when conservative measures have failed

25

What is the MC form of arthritis

OA

26

How do NSAIDs work in the Tx of OA

Produce anti-inflammatory & analgesic effects by decreasing the production of prostaglandins & they inhibit both Cox-1 & 2 enzymes

27

Which NSAID is COX-2 specific

Celebrex

28

Systemic autoimmune disorder characterized by an inflammatory synovitis that erodes and ultimately destroys the articular cartilage

Rheumatoid arthritis (RA)

29

What may also become involved in RA

Many non-articular organs b/c the same cytokines that drive synovial pathology are also responsible for generating extra-articular tissue pathology

30

Who is RA more prevalent in

Women

31

In RA, what is associated with increased incidence and more severe disease (think genetic)

HLA-DR4

32

What are the features of RA (i.e. what might a pt present with)

Malaise & fatigue
Stiffness
Pain & tenderness
Joint effusions
Symmetric arthritis/joint involvement
Rheumatoid nodules & deformatieis of the hands/fingers

33

What is the MC joint involved in RA

The wrist

34

What are the wrist findings of RA

Erosion, subluxation/drift of radius, tendon rupture

35

SxS must be present for how long to Dx RA

At lest 6 weeks

36

What are "cock-up" deformaties in RA

Lateral drift of the toes & plantar subluxation d/t erosive damage

37

In order to Dx RA what must be present?

At least 4/7 of the RA criteria

38

What is the RA Dx criteria

1.) Morning stiffnes > 1hr for 6+ weeks
2.) Arthritis of 3+ joints for 6+ weeks
3.) Arthritis of hand joints for 6+ weeks
4.) Symmetric arthritis for 6+ weeks
5.) Rheumatoid subQ nodules
6.) Positive serum rheumatic factor
7.) Radiographic changes (including erosions, decalcifications, & narrowing joint space)

39

What is diagnostic is most specific for RA

Radiographic findings

40

What lab values will be elevated in RA

Acute phase ESR & CRP

41

What is the most specific lab value/finding for RA

Anti-CCP antibodies

42

What is the Tx of RA directed towards?

Control of the synovitis and prevention of joint injury

43

What is the primary (1st line, 1st choice) Tx of RA

NSAIDs

44

What if NSAIDs alone don't work for Tx of RA

Must try more than 1 and and a second line agent

45

What is/are the 1st choice 2nd line agent(s) for Tx of RA

DMARDs:
- Methotrextate best
- Sulfasalazine next best

46

What is/are the 2nd choice 2nd line agent(s) for Tx of RA

Azathioprine, Infliximab, Gold Cyclosporine, low dose steroids

47

If the pt's RA is unresponsive to Methotrexate what can be used

Biologics such as Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, & Simponi

48

What is the appropriate Tx for moderate to severe RA

Methotrexate + sulfasalazine + hydroxycloriquine

49

If you are going to use hydroxycloroquine what must you do

Get a baseline eye exam

50

What condition do you need to test for prior to starting treatment of RA?

Test for latent TB

51

What are extra-articular manifestations of RA in the heart

Pericarditis
Vasculitis
Valvular & valve ring nodules

52

What are extra-articular manifestations of RA in the lungs

Pleural effusion
Bronchiolitis

53

What are extra-articular manifestations of RA in the Skin

Fragility
Nodules

54

What are neurological extra-articular manifestations of RA

Neuropathy
Cervical myelopathy
Peripheral neuropathy

55

What are hematologic extra-articular manifestations of RA

Anemia
Thrombocytosis

56

What are extra-articular manifestations of RA in the bones

Osteopenia

57

What are extra-articular manifestations of RA in the eyes

Sicca (Sjogren's)
Episcleritis
Scleromalacia perforans

58

What are extra-articular manifestations of RA in the kidney

Amyloidosis
Vasculitis

59

RA carries a low prognosis if there is...

polyarticular involvement & systemic extra-articular manifestations

60

What are the common "complications" or findings in RA

Boutonniere deformity
"Swan-neck" deformity
Valgus knee deformity
Volar suluxation of the MTP joints (ulnar deviation)

61

Hyperextension of DIP with flexion of PIP

Boutonniere deformity

62

Flexion of DIP with extension of the PIP

"swan-neck" deformity

63

Name the arthritis...inflammation present

RA

64

Name the arthritis...involvement of the DIP & WB joints

OA

65

Name the arthritis...osteophyte formation

OA

66

Name the arthritis...ulnar deviation, swan-neck, & boutonneire deformities

RA

67

Name the arthritis...Tx goal = pain control

OA

68

Name the arthritis...positive lab finding include ESR & CRP

RA

69

Name the arthritis...heberden's nodes

OA

70

Name the arthritis...involvement of MCP/PIP joints

RA

71

Name the arthritis...Tx goal = control inflammation

RA

72

Name the arthritis...normal lab findings

OA

73

Name the arthritis...periarticular osteoporosis and erosion

RA

74

What are the alarm SxS of CA

Unexplained wt loss
Failure to improve with Tx
Pain > 6wks
Pain at night or at risk pt
Hx of CA
Age > 50

75

What are the alarm SxS for cauda equina

Urinary retention/incontinence
Saddle anesthesia
Decreased anal sphincter tone/fecal incontinence
Bilateral LE weakness
Progressive neurological deficits

76

What is the 2nd MC complaint in primary care

Lower back pain (LBP)

77

When examining a pt with lower back pain what do you need to make sure you do?

Rule out any red flags (such as those of CA or cauda equina)

78

What is the primary Tx for lower back pain

Rest! 80-90% of pts will improve within 1 month even without any treatment

79

What are other treatments for lower back pain

Pt education, PT, or NSAIDs

80

If pt complains of lower back pain and has red flags what should you do?

Promptly get an MRI

81

What is the MCC of disability in people under 45 y/o

Lower back pain

82

Chronic inflammatory disease of the axial skeleton, peripheral joints, & non-articular structures

Ankylosing spondylitis (AS)

83

In what manner does AS affect the spine? (direction)

Affects it from the bottom up, starting at the SI joints and working up to cervical skeleton

84

What genetic predisposition do 90% of pts express

HLA-B27

85

Who is AS more prevalent in

Men > women; generally young adults

86

AS is associated with chronic back pain that is worst when?

In the morning

87

Mid or entire spine stiffness in AS may improve with...

Activity

88

Where might AS back pain refer to

Referred pain to the butt or back of the thigh

89

What condition is AS associated with

Anterior uveitis

90

AS rarely presents in pts < 18 y/o. If it does how might it present

Pain & swelling of the large limb joints (knee)

91

What are the necessary findings to Dx AS

Changes in the SI joints (early in disease may be seen on MRI, otherwise x-ray)

92

What is the "shiny corner sign" associated with AS

X-ray finding due to inflammation where the annulus attaches (seen on the vertebral bodies)

93

When can plain films diagnose AS

Later in the disease

94

What is the bamboo sign and what condition is it associated with

Late radiographic finding of AS where the vertebral bodies are fused by syndesmophytes and look like bamboo

95

What bloodwork will be positive in a pt with AS

Seronegative spondyloarthropathies
Negative anti-CCP antibodies

96

What is the 1st line Tx of AS

NSAIDs (empiric trials of several to find best result)

97

If NSAIDs don't work in the Tx of AS what should be done next

Add TNF inhibitors to the Tx (Entanercept, Adalimubab, Infliximab, Golimumab)

98

Why should corticosteroids not be given for AS

Can worsen osteopenia and minimal impact on arthritis

99

What disease/condition is related to AS

Reiter's Syndrome

100

Condition where ligaments and connective tissue of the back are stretched beyond normal

Back sprain/strain

101

Quick tear, pull, or twist of muscle or tendon

Strain

102

Trauma which displaces joint and stretches/tears a ligmante

Sprain

103

Compression of the spinal cord d/t a massive ruptured disc

Cauda equina

104

Where in the spine is cauda equina MC

MC at L4-L5 and usually occurs midline

105

What are the main SxS of cauda equina

Urinary retention (may have overflow incontinence)
Diminished anal sphincter tone w/ fecal incontinence
Saddle anesthesia

106

What are other common SxS of cauda equina (but not major)

Motor weakness, LBP, absence of achilles reflex, sexual dysfunction

107

How do you Dx cauda equina

MRI is best

108

What is the Tx of cauda equina

URGENT surgical decompression

109

How are the nerve roots numbered in the cervical spine

They are numbered C1-C8 and each is found about the vertebrae (ex: C6 nerve root is above C6 vertebrae)

110

This is AKA a herniated disc

herniated nucleus pulposis

111

Pt presents with painful limitation of neck motion, and pain that is aggravated with neck extension and relieved with forearm on top of the head. What is the likely Dx?

Cervical herniated nucleus pulposis

112

What is Lhermitte's sign? What condition is it seen in?

Electrical shock-like sensation radiating down the spine; seen with cervical herniated nucleus pulposis

113

What is Spurling's sign? What condition is it seen in?

Pain when examiner exerts downward pressure on the vertex and tilting the head towards the symptomatic side; seen with cervical herniated nucleus pulposis

114

What is axial manual traction? What condition is it associated with?

10-15 kg traction is applied while the pt is supine & reduces or alleviates SxS is a (+) sign; associated with cervical herniated nucleus pulposis

115

What is the diagnostic of choice for Cervical herniated nucleus pulposis

MRI is best
Plain films MAY be somewhat useful

116

How do you treat Cervical herniated nucleus pulposis

NSAIDs, muscle relaxers, PT, chiropractic Tx, injections; analgesics & tricyclics may be helpful for reduction of neuropathic pain

117

In what direction do LUMBAR discs usually herniate and why

Usually herniate to the side b/c the posterior longitudinal ligament is strongest in the midline

118

What may relieve pain in lumbar herniated disc

Flexing knee and thigh

119

What is the "cough effect" in lumbar herniated disc

Exacerbation of pain with coughing or straining

120

What do pts with lumbar herniated disc often do

Avoid excessive movements but don't stay in one position for too long

121

Pt presents with pain radiating down the LE, LE weakness, motor weakness, dermatomal sensory changes, and reflex changes. What might be the Dx?

Herniated lumbar disc

122

What is the diagnostic of choice for lumbar herniated disc

MRI is best
Plain films may help distinguish

123

What is the Tx of lumbar herniated disc

NSAIDs, muscle relaxer, PT, chiropractic tx, injections; analgesics & tricyclics may help reduce neuropathic pain

124

Pt presents with exaggerated curvature of the thoracic spine. What may be the Dx?

Kyphosis

125

What are the possible causes of kyphosis in adults

Degenerative disease of the spine
Fx by osteoporosis
Injury/trauma
Spondylolisthesis

126

What are common presenting SxS of kyphosis besides exagerated curvature of the thoracic spine

Difficulty breathing (severe cases)
Fatigue
Mild back pain
Round back appearance
Tenderness
Spine stiffness

127

How do you diagnose kyphosis

Clinical may be sufficient but x-ray and MRI are tests of choice

128

What is kyphosis in adolescents called

Scheuermann's Disease

129

How is Scheuermann's disease treated

Brace and PT
Sx if curve > 60 degrees

130

What is a common complication or finding of kyphosis

Multiple compression fractures of the thoracic spine d/t osteoporosis leading to worsening curvature

131

Sideways curvature of the spine most often seen during growth spurt just before puberty; causes of most cases unknown

Scoliosis

132

What is the MC cause/type of scoliosis

MC = idiopathic scoliosis

133

Who is scoliosis more prevalent in

Female > male

134

What are the common clinical findings or SxS of scoliosis

Uneven shoulders
Prominent shoulder blade
Uneven waist
Leaning to one side more than the other

135

How is scoliosis often diagnosed

School screenings or exam & x-ray

136

What is a Tx of scoliosis in adolescents? What does it do?

Braces for curves of 25-40 degrees will halt progression of curve but the curve will resume if bracing is discontinued

137

Where does sciatica/nerve root compression most commonly occur

95% occur at L4-L5 or L5-S1

138

What is the onset of sciatica

Usually abrupt but can be acute on chronic flare-up pains

139

What is the most common SxS or sciatica

Radicular pain that extends below the knee

140

What is the MC L5 finding in sciatica

Foot drop or loss of dorsiflexion of the great toe and pain in the great toe

141

What is the radiation pattern of sciatica pain

Radiation in a radicular fashion along distribution of sciatic nerve

142

What is the Tx of sciatica

Tx like a sprain/strain; activity as limited by pain, NSAIDs, possible opioid use for pain, possible epidural steroid injections

143

Condition characterized by narrowing of the AP dimension of the spinal canal

Spinal stenosis

144

In what direction does the spinal canal narrow in spinal stenosis

AP direction

145

Where is spinal stenosis MC

MC at L4-L5
2nd MC at L3-L4

146

What are common SxS of spinal stenosis

Pain, paresthesias, LE weakness with walking

147

What is the MC SxS of spinal stenosis in the lumbar region? What is it?

Neurogenic claudication = pt tires with walking, require stopping & sitting & changes position of their back to relieve pain

148

What is the diagnostic test of choice for spinal stenosis

MRI or CT

149

What MRI type is best for spinal stenosis Dx

T2 images

150

What is the Tx for spinal stenosis

- Flexion based exercises by PT
- Spinal or facet joint corticosteroid injections to reduce pain

151

Spinal TB is AKA....
Who is it primarily seen in?

Pott Disease
Seen in immigrants and immunocompromised

152

What are the main SxS of spinal TB

Back pain
+/- radicular pain & LE weakness
+/- pulmonary disease

153

What is the diagnostic test of choice for spinal TB

MRI

154

What are the radiographic findings of spinal TB

Lytic & sclerotic lesions & bony destruction

155

What is the Tx of spinal TB

Abx 6-9 months
- Isoniazid, rifampin, pyrazinamide, & ethambutol for 2 months then isoniazid & rifampin for additional 4-7 months

156

What is the bad complication of spinal TB

Paraplegia d/t compression of the spinal cord -> cauda equina

157

Loss of conguency between the glenoid and humeral head

Shoulder dislocation

158

In which direction do most shoulder dislocations occur

95% are in the anterior direction

159

What is the mechanism of most shoulder dislocations

Usually d/t a fall on outstretched and abducted arm

160

How do posterior shoulder dislocations occur

Fall from high height, seizure, or electrocution

161

What is a bankart lesion

Anterior inferior labrum is torn in shoulder dislocation and leads to continuous instability

162

What will a pt complain of with anterior shoulder dislocation

Pain & instability when shoulder is abducted and externally rotated

163

What are the diagnostic tests of choice for shoulder dislocation

X-rays with multiple views
MRI best if suspected soft tissue damage to labrum/rotator cuff

164

What is the Tx for acute shoulder dislocations

Reduce immediately with gentle traction with internal rotation (1st inject with lidocaine)

165

What is the Tx for traumatic shoulder dislocations

Bankart lesion is often present & surgical repair is often required, need to immobilize for 6 weeks

166

What is the Tx for recurrent shoulder dislocations

Sx management (often arthroscopic)

167

How does AC injury most commonly occur

Occurs from a fall directly onto the shoulder

168

How might a pt present with an AC injury

Depends on extent of injury; may be in minimal pain to extreme unbearable pain with no arm movement

169

What is the diagnostic test of choice for an AC injury

MRI best to access soft tissue & structural damage

170

What is the Tx for a mild AC injury

Sling for discomfort & mild pain meds for relief

171

What is the Tx for a moderate AC injury

Stronger pain meds for relief

172

What is the Tx for a severe AC injury

Surgical repair if it is a Type 4 or 5 injury

173

Where is the MC location for a clavicular Fx

Mid-shaft MC
Distal is 2nd MC, proximal least common

174

What is the mechanism of injury for most clavicular fractures

Direct blow or fall on point of the shoulder

175

What is the diagnostic test of choice for clavicular fractures

X-ray is the gold standard

176

What is the Tx for clavicular fractures

Most are treated non operatively with sling and swath

177

When is operative Tx indicated for clavicle Fx

Indicated for open fxs, markedly displaced fxs, fxs associated with multiple traumas, & distal fxs

178

What is the mechanism of injury for a posterior dislocation sternoclavicular injury

Direct blow to the anterior chest wall, usually high energy blow

179

What is the mechanism of injury for anterior dislocation sternoclavicular injury

Lateral blow to the shoulder when the arm is abducted/extended (usually low energy)

180

What is the main finding with sternoclavicular injury

Deformity, swelling, and tenderness of the joint

181

What are secondary findings with sternoclavicular injuries

Stridor, dysphagia, venous distension, pulse deficit

182

What are the diagnostic tests that are done for sternoclavicular injuries

X-ray
CT scan (can show structural damage better)

183

What is the Tx for anterior dislocation sternoclavicular injuries

Treated without Sx (i.e. rest, pain meds, may sling)

184

What is the Tx for posterior dislocation sternoclavicular injuries

Immediate closed reduction then sling and close followup

185

What is the major complication/concern with posterior dislocation sternoclavicular injuries

Need to be careful b/c it can impinge on the aorta, other major vessels, & nerves

186

What are the 4 muscles of the rotator cuff

Subscapularis
Supraspinatous
Infraspinatous
Teres minor

187

Which rotator cuff muscle/tendon is most often injured

Supraspinatous

188

What is the mechanism of injury for most rotator cuff injuries

Acute injuries like falls on an outstretched arm or pulling on the shoulder

189

What may partial rotator cuff tears lead to

Impingement syndrome

190

Pt presents to the office with difficulty lifting the arm & limited active range of motion. They report they had fallen on their outstretched arm while playing football. What might the Dx be

Rotator cuff injury

191

How might a pt present with a complete rotator cuff tear

Weakness with resisted strength testing

192

What are 2 tests that should be done with suspected rotator cuff injury

Neer & Hawkins tests

193

Describe the Neer test

Depress the scapula while elevating the arm with the other

194

Describe the Hawkins test

Have the shoulder at 90 degrees and the elbow flexed at 90 degrees then internally rotate the humerous & if it elicits pain it reinforces a positive Neer test

195

What is the diagnostic test of choice to Dx a rotator cuff injury

MRI b/c it has best visualization of damage

196

What is the Tx for rotator cuff injuries

NSAIDs
PT
Steroid injections
Activity precautions (no over head work, heavy lifting, pushing, or pulling)

197

If the pt doesn't see any improvement in their rotator cuff injury after 6 weeks what should you do

Get another MRI to reevaluate the tear

198

What is the best Tx for a complete rotator cuff tear? Why?

Best Tx is Sx repair b/c complete tears often do not heal very well on their own

199

True of False: injection of cortisone into the joint will help alleviate the pain in a rotator cuff injury?

FALSE, will NOT help alleviate pain

200

What is the mechanism of injury for humeral fxs

Direct blow or FOOSH

201

What are the diagnostic tests for humeral fxs

X-rays (best), CT, or CT with reconstruction

202

What is the Tx for humeral fxs

Depends on type of fx, type of displacement, & number of fx parts; more complicated fxs often get ORIF

203

What should you always check post-op with humeral fxs

Check NV, especially radial nerve

204

What is the mechanism of injury for elbow dislocation

Fall with elbow locked in extension

205

What are common SxS of elbow dislocation

Swelling, deformity, & tenderness of the elbow

206

What is the diagnostic test for elbow dislocation

X-ray to check for coronoid or radial head fx

207

What must you do following an elbow dislocation

NV check of ulnar nerver

208

What is the Tx for elbow dislocation with no fx

Non-operative

209

What is the Tx for elbow dislocation

Gentle closed reduction with axial traction

210

In what direction do most elbow dislocations occur

80-90% occur in posterior or posteriolateral direction

211

Condition with inflammation of the extensor muscles in the forearm that extends the wrist d/t overuse

Lateral epicondylitis

212

What is lateral epicondylitis commonly known as

Tennis elbow

213

What might a pt present with in lateral epicondylitis

- Lifting anything in front of you or pulling door open causes pain
- Tenderness over the lateral epicondyle
- Possible tenderness over the ulnar nerve

214

What is required to Dx lateral epicondylitis

Pain with resisted strength training and passive stretching

215

What does the spurling test check for

Cervical radiculopathy

216

What is the Tx of lateral epicondylitis

Rest, ice, NSAIDs, bracing, PT, cortisone shots, Sx last resport

217

Condition with inflammation of the flexor muscles of the forearm d/t overuse

Medial epicondylitis

218

What is medial epicondylitis commonly known as

Golfer's elbow

219

What might a pt present with in medial epicondylitis

Pain, tenderness of the medial aspect of the elbow, swelling, and numbness & tingling

220

How is medial epicondylitis diagnosed

Clinically

221

What is the Tx for medial epicondylitis

Rest, ice, NSAIDs, bracing, PT, cortisone shots, Sx last resport

222

What must you be aware of with medial epicondylitis

Must be aware of ulnar nerve during cortisone injections

223

What is the mechanism of injury for olecranon fxs

Direct blow to the flexed elbow

224

What is the diagnostic test of choice for olecranon fxs

X-rays

225

What is the Tx for most olecranon fxs

ORIF

226

Inflammation of the olecranon bursa

Olecranon bursitis

227

What is the mechanism of injury for olecranon bursitis

Single injury/blow to the elbow or repeated minor injuries

228

What might a pt with olecranon bursitis present with

Pain, swelling, limited ROM, redness, possible infection

229

How do you Dx olecranon bursitis

Clinically or with aspiration if suspected infection

230

What is the Tx for olecranon bursitis

Oral or topical NSAIDs, aspiration of bursa, & injection of hydrocortisone
If infection Tx with Abx

231

In what demographics is olecranon bursitis common

Prangant women & pts with DM or RA

232

Fracture of the distal radius =

Colle's Fx

233

What is the mechanism of injury for Colle's Fx

Usually via fall on outstretched hand

234

What might a pt with a Colle's Fx present with

Dorsal angulation
Loss of pronation & supination
Radial inclination (tilt & shortening)

235

What is the diagnostic test of choice for Colle's Fx

X-rays

236

What is the Tx for Colle's Fx

Closed reduction or ORIF

237

This is the most common Fx...

Colle's Fx

238

What is the mechanism of injury for radial head fx

Direct blow to the radial head or fall with valgus force

239

What might a pt with radial head fx present with

Decreased ROM
Pain at the wrist
Swelling over the wrist

240

What is the diagnostic test of choice for radial head fracture

X-rays

241

What is the Tx for radial head fx

Types 1 & 2 = simple ACE wrap soft splint, ice, pain meds,& early ROM
Type 3 = ORIF

242

What are the 3 types of radial head fxs

Type 1 = no displacement
Type 2 = minimal displacement
Type 3 = communited

243

What is the mechanism of injury in forearm fracture

Direct blow or fall

244

What is the diagnostic test of choice for forearm fx

X-rays

245

What is the Tx of forearm fx in adults

ORIF (plate across bone + pin)

246

What is the Tx of forearm fx in children

Closed reduction with casting

247

Fx of the middle to distal 1/3 of the ulna with anterior dislocation of the radial head

Monteggia Fx

248

Fx of the distal to mid 1/3 of the radius with dislocation of radioulnar joint

Galeazzi Fx

249

Fx of the 5th metacarpal head

Boxer's Fx

250

What is the diagnostic test for Boxer's Fx

X-rays

251

What is the Tx for Boxer's Fx

Splinting with ulna gutter splint

252

Hyperextension of the thumb causing disruption of the ulnar collateral ligament and MCP & DIP of the thumb

Gamekeeper's Thumb

253

What is the Tx of Gamekeeper's thumb

Splinting for 6-8 weeks

254

What is gamekeeper's thumb AKA

Ski-pole injury

255

What is the mechanism of injury for scaphoid fx

FOOSH

256

What is important to remember when diagnosing a scaphoid fx

Fx may not always be seen/detected at first so may need to reevaluate in a week

257

What is the MC SxS of scaphoid fx

Pain in the anatomical snuff box on palpation

258

What is the diagnostic test of choice for scaphoid fx

X-ray
Repeat in 3-5 days if negative

259

What is the Tx for scaphoid fx

Thumb spica splint; if severely displaced ORIF

260

What must you watch for with scaphoid fx

Avascular necrosis

261

You obtain an x-ray of your pts wrist and notice tearing of the scapholunate interosseous ligamnet and a "Terry Thomas" sign. What is the Dx?

Scapholunate Dislocation

262

Slow progressive disease with thickening of the palmar fascia and shortening of the tendons

Dupuytren's Contracture

263

What conditions are associated with dupuytren's contracture

Pregnancy, DM, & RA

264

What is the Tx for dupuytren's

PT/OT ASAP to prevent worsening

265

Who is dupuytren's more common in

Men > women until 80 y/o then even

266

Swelling or stenosis of the sheath surrounding the APL & EPB, usually d/t repetitive motion

DeQuervain's Tenosynovitis

267

What is the diagnostic test of choice for DeQuervain's

Finklestein test

268

What is the Tx for DeQuervain's

Splinting with thumb spica splint, cortisone, NSAIDs, & ice; Sx if those fail

269

Who is DeQuervain's more common in

Middle aged women

270

What causes carpal tunnel syndrome

Increased fluid retention in the carpal tunnel

271

What nerve is involved in carpal tunnel

Median nerve

272

What ligament is involved in carpal tunnel

Transverse collateral ligament

273

What conditions may precipitate carpal tunnel

Pregnancy, menopause, obesity, DM, thyroid disorders, & kidney failure

274

With carpal tunnel, where in the hand may a pt experience pain, numbness, tingling, or burning

Thumb, index finger, middle finger, & middle half of the ring finger

275

In severe carpal tunnel what finding may you see in the hand

Wasting of the thenar eminence

276

What is the tinel sign & what condition does a positive test indicate

Tingling or shock-like pain on volar wrist percussion indicate carpal tunnel syndrome

277

What is the phalen sign & what condition does a positive test indicate

Pain or paresthesias when flexing the wrists 90 degrees for 1 minute indicated carpal tunnel

278

What is the carpal compression test and what does a positive test indicate

Numbness & tingling by direct pressure over the carpal tunnel indicates carpal tunnel syndrome

279

What is the conservative Tx for carpal tunnel

Splinting at night, NSAIDs, cortisone shot into the carpal tunnel

280

What is the BEST Tx for carpal tunnel

Surgical release

281

Who is carpal tunnel more common in

Women > men

282

Forced flexion of a distal phalanx causing disruption of the tendon leading to avulsion of the extensor tendon

Mallet finger

283

Forceful blow to bent finger or arthritis leading to swelling and pain at the PIP

Boutonniere deformity

284

What is the Tx of boutonniere deformity

Immediate splinting for 6-10 weeks

285

What causes a swan neck deformity

Injury to finger, RA, or Ehler-Danlos Syndrome

286

Flexor digitorum profundus avulsion; injury occurs during forceful DIP extension and results in inability to flex finger

Jersey finger

287

What is the MC finger for jersey finger

Ring finger

288

Infection of the flexor tendon sheath often occuring after penetrating injuries with inoculation of the tendon sheath

Tenosynovitis

289

What is the Tx of tenosynovitis

Early IV Abx Cefazolin or Clindamycin; surgical drainage if no immediate relief

290

What diseases/conditions are associated with tenosynovitis

DM and RA

291

What is an intertrochanteric fx

When the fx goes from the greater to lesser trochanter

292

What is the MC fx seen in the elderly

Intertrochanteric fx

293

With hip fx pain in the groin is typical but where might it radiate to

Lateral hip, butt, & knee

294

What is the diagnostic test of choice for hip fx

X-rays are usually sufficient

295

What tests can you do to determine hip fx during the exam of the pt

- Trendelenburg test looking for instability of the hip flexors
- Internal rotation of hip is best provacative diagnostic maneuver

296

What is the Tx for hip fx

Surgical repair (within 24hrs)

297

How do femur fxs happen

From a fall or high velocity trauma (like car crash)

298

What will be the main PE findings with femur fx

Severe pain, difficulty WB, & affected leg will be shortened and externally rotated

299

What is the diagnostic of choice for femur fx

X-rays

300

Who is SCFE most commonly seen in

Adolescent males (10-17 y/o)

301

How will a pt with SCFE present

Pain in the hip, knee, or thigh

302

What is the difference b/w stable and unstable SCFE

Stable can bear weight

303

What is the main risk/complication in SCFE

Avascular necrosis of the hip

304

What is the Patrick's test?

AKA FABER & FADER test for SCFE

305

What is the diagnostic of choice for SCFE

X-rays

306

What is the Tx for SCFE

Surgical stabilization of joint

307

Where does avascular necrosis most commonly affect

Proximal & distal femoral heads

308

What is the ultimate outcome of many cases of avascular necrosis of the hip

Total hip replacement

309

What are the common areas for bursitis in the knee

Pre-patellar busae and Baker cyst

310

What is the MC infectious agent of knee bursitis

S. aureus

311

Pt has bursitis on knee...what will they present with

Small focus of swelling over the knee cap

312

What is the Tx of bursitis caused by trauma

Heat, rest, NSAIDs, & local corticosteroid injections

313

What is the Tx of bursitis caused by infection

Aspiration of effusion & Abx

314

What is the Tx of Baker cyst

Rest, leg elevation, Abx injection (triamcinolone)

315

Hemarthrosis of the knee may indicate...

Ligament injuries or patellar dislocation/fx

316

Common causes of medial knee pain

Medial compartment OA
MCL strain
Medial meniscus injury
Anserine bursitis

317

Common causes of anterior knee pain

Patellofemoral syndrome
OA
Prepatellar bursitis
"Jumper's Knee"
Septic arthritis
Gout/inflammatory disorder

318

Common causes of lateral knee pain

Lateral meniscus injury
Iliotibial band syndrome
LCL sprain

319

Common causes of posterior knee pain

Baker cyst
OA
Meniscal tear
Hamstring/calf tendinopathy

320

Injury involving an audible pop when the knee buckles accompanied by immediate swelling & difficulty with motion

ACL injury

321

This is the MC injury in sports

ACL injury

322

ACL injuries are common with what kind of motion/activities

Common in skiing, soccer, football, & basketball; often during acceleration-deceleration movements

323

What is the diagnostic test of choice for ACL injury

MRI

324

What tests can you do during the PE to assess for an ACL injury

Lachman & Anterior Drawer tests

325

What is the Tx for ACL injury

Surgical repair (autograft or cadacer graft)

326

Knee injury caused by valgus blow/stress to the lateral aspect of the knee resulting in pain, instability, & limited ROM to the affected area

MCL Injury

327

What is the MC finding with MCL injury

Pain along the course of the ligament

328

Knee injury caused by varus blow/stress to the medial aspect of the knee resulting in pain, instability, & limited ROM to the affected area

LCL injury

329

What is the most commonly injured ligament in the knee

MCL

330

MCL & LCL injuries may not have any effusion because...

They are extra-articular

331

What is the diagnostic test of choice for MCL/LCL injuries

MRI

332

What tests can be done to access for MCL/LCL injuries

Varus/Valgus stress testing

333

What is the Tx of MCL injury

Usually protected WB, PT, may use knee brace; if severe long leg brace for 6-8 weeks

334

What is the Tx of LCL injury

Sx/reconstruction

335

Knee injury usually following an anterior trauma to the tibia such as a dashboard injury

PCL injury

336

What should you assess with PCL injury

NV status of LE

337

What is the strongest ligament in the knee

PCL

338

What will pt with PCL injury commonly complain of

"Looseness" and pain especially with bending

339

What tests can you do to assess for PCL injury

Sag sign
Posterior drawer test

340

What is the diagnostic test of choice for PCL injury

MRI

341

What is the Tx of PCL injury

Immobilize with knee brace in extension, use crutches, PT

342

Knee injury characterized by joint line pain and pain with deep squatting, often leading to pain, clicking, and locking sensation in the knee

Meniscus injury/tear

343

What tests can be done to assess for meniscus injury

McMurray test
Modified McMurray test
Thessaly test

344

What is the diagnostic test of choice for meniscus injuries

MRI

345

What is the Tx for meniscus injury in older pt

Analgesics and PT for strengthening and core stability

346

What is the Tx for meniscus injury in younger active pt

Arthroscopic repair & debridement

347

Condition AKA "runners knee" where pt experiences pain with bending activities and has lateral deviation of the patella in relation to the femoral groove

Patellofemoral pain

348

What are the tests you can do to assess patellofemoral pain

Patellar grind test

349

What is the apprehension sign in patellofemoral pain

Suggests instability of the patellofemoral joint and is positive when the pt becomes apprehensive when the patella is deviated laterally

350

What is the diagnostic test of choice for patellofemoral pain

X-ray shows lateral deviation of patella in relation to femoral groove

351

Patella femoral injury is due to...

Rupture of the quads tendon

352

Condition commonly referred to as "jumpers knee"

Patellar tendonitis

353

What is the MOI for a proximal tibial fx

Most result from trauma but can be from stress or compromised bone

354

What is the diagnostic test of choice for tib/fib fx

X-rays

355

What is the primary Tx for tib/fib fx? What is the ultimate Tx?

Primary Tx = ORIF
Eventual Tx = total knee arthroplasty

356

This is the MC injury seen in primary care

Foot injury

357

What is a Jone's Fx

Fx at the base of the 5th metatarsal

358

Midfoot injury that occurs when the bones of the midfoot are broken or disrupted due to ligament damage

Lisfrac Fx

359

What is the primary external finding with Lisfrac Fx

Bruising of the plantar side of the foot

360

What is the diagnostic test of choice for Lisfranc Fx

X-ray

361

What is the MC radiographic finding in Lisfranc Fx

Widening of the space b/w the 1st and 2nd metatarsals

362

In which direction do most ankle sprains occur

Inversion

363

What ligament is most commonly affected in ankle sprains

ATF ligament

364

What is the Tx for ankle sprains

MICE (modified activity, ice, compression, elevation)

365

What does SEADS stand for when inspecting the ankle

Swelling, Erythema, Atrophy, Deformity, Surgical Scars

366

What is the MOI for a high ankle sprain

Eversion of the ankle

367

What ligament is involved in high ankle sprains

Anterior tibiofibular ligament

368

What SxS will a pt present with if they have a high ankle sprain

Severe, prolonged pain
Limited ROM
Mild swelling
Difficulty with WB

369

What is a test to assess for high ankle sprain

External rotation stress test to reproduce MOI

370

What is the Tx of a high ankle sprain

Cast or walking boot for 4-6 weeks, PT, crutches and WB protection

371

What is the diagnostic test of choice for high ankle sprains

MRI best to visualize injury

372

What is osteoporosis defined as by WHO

BMD of 2.5 SD or less below the young normal mean (T score < or = to -2.5)

373

What are the unmodifiable RFs for osteoporosis

Advanced age
Female
White or Asian
Hx of Fx
Hx of Fx in 1st degree relative
Dementia

374

Severe form of osteoporosis caused by a major mutation in the gene encoding for Type 1 collagen

Osteogenesis Imperfecta

375

What is "dowager's hump"

Osteoporosis with fx; T-spine kyphotic deformity that occurs with multiple vertebral compression fxs

376

What is the diagnostic study of choice for osteoporosis

Bone densitometry (DEXA Scan)

377

Painful, softening of the bone =

Osteomalacia

378

What is responsible for the uncoupling of bone resorption and bone formation

Estrogen deficiency

379

When is estrogen deficiency and bone formation most pronounced

5-10 years after menopause

380

What are the indications for DEXA scan in women

65 y/o
Postmenopausal with RFs
Postmenopausal with Fx
Considering osteoporosis therapy
Receiving long term hormone replacement therapy

381

What is a normal bone T score

-1.0

382

What bone T score indicates osteopenia

-1.0 to -2.5

383

What is osteopenia

Low bone density

384

What bone T score indicates osteoporosis

< -2.5

385

What is characterized as severe osteoporosis

T score < -2.5 with a Fx

386

How much Ca2+ is needed for an adult < 50 y/o

1,000 mg

387

How much Ca2+ is needed for an adult > 50 y/o

1,200 mg

388

What vitamin is required for calcium absorption

Vitamin D

389

At what age should a man get a DEXA scan (if needed)

Age 70

390

What is the 1st line Tx for osteoporosis

Vitamin D + Calcium Supplements

391

What is the 2nd line Tx for osteoporosis

Bisphosphonates (Alendronate, Ibandronate Boniva, Risedronate Actonel, Zoledronic Acid Reclast)

392

What do bisphosphonates do for osteoporosis

Inhib osteoclast induced bone resorption, increase bone density, & reduce incidence of fxs

393

What is 3rd line Tx for osteoporosis

Calcitonin

394

What is the 4th line Tx for osteoporosis

Estrogen

395

When is estrogen therapy for osteoporosis best

Best if started as soon after menopause as possible

396

What is the 5th line Tx for osteoporosis

Selective Estrogen Receptor Modulators (SERMs)

397

What is the 6th line Tx for osteoporosis

Parathyroid hormone

398

What is the 7th line Tx for osteoporosis

RANK Ligand Inhibitors

399

What is non-pharmacological Tx for osteoporosis

Exercise
Diet
PT

400

With what HLA type is Reiter's Syndrome associated

HLA-B27

401

Who is more likely to get Reiter's

Males (increased STDs)

402

Reiter's is remembered with "can't pee, can't see, can't climb a tree" what conditions do these correlate to

Pee = urethritis (chlamydial)
See = uvitis
Tree = Arthritis (ankles & knees)

403

What are the dermatology findings in Reiter's

Circinate blantitis
Keratoderma biennorrhagicum (?spelling)

404

What is the Tx of Reiter's

Erythromycin + NSAIDs

405

What are common PE findings with psoriatic arthritis

Nail pitting & DIP involvement

406

What can cause seronegative arthritis

IBD

407

Infection of the bone or bone marrow

Osteomyelitis

408

What are the MC causative pathogens of osteomyelitis

S. aureus
Group B Strep
Salmonella (if hemoglobinopathy)

409

What are 2 bedside clues that your pt has osteomyelitis

- Ability to easily advance a needle through skin ulcer to bone
- Ulcer area > 2 cm3

410

What is the Tx for osteomyelitis

Quinolones (Cipro)

411

What do you add to the Tx for osteomyelitis if the causative agent is S aureus

Add Rifampin to Cipro

412

Inflammation of the joints secondary to infection =

Septic arthritis

413

What is the MC organism associated with septic arthritis

Gonococcal species

414

What are the MC gram-neg pathogens of septic arthritis

E coli
Pseudomonas

415

Describe the joint pain of septic arthritis

Localized
Asymmetrical
Rapid onset
Erythema

416

What is the affect of septic arthritis on ROM

Decreased active & passive ROM

417

What is a common finding of septic arthritis upon PE

Pain with log roll

418

What is the diagnostic test of choice for septic arthritis

MRI or CT

419

What is the empiric Tx of septic arthritis

Vanco & zosyn or Ceftriaxone

420

Which is more common in adults: primary or secondary bone cysts/tumors

Secondary (mets)

421

Where are Ewings tumors primarily found

Pelvis, femur, humerus, ribs, clavicle

422

Who is most likely to develop an Ewings tumor

Teenagers and young adults, men > women

423

What is the Tx of Ewings tumor

Multi-agent chemo
External beam irradiation
Resection in select cases

424

Malignancy of the plasma cells present in the bone marrow leading to destruction of bone and paraprotein formation

Multiple Myeloma

425

What are pts with multiple myeloma at an increased risk of

Infections from encapsulated organisms (Step pneumoniae & H influenza)

426

What is the chief complaint in multiple myeloma

Bone pain

427

Where is pain MC in multiple myeloma

Ribs, back/spine, proximal long bones

428

What is the diagnostic radiology finding in multiple myeloma

Lytic "punched out" lesion

429

What is the Tx for multiple myeloma

No cure
Tx = dexamethasone + lenalidomide/thalidomide

430

CA due to transformed cells that produce cartiage

Chondrosarcoma

431

Where are chondrosarcomas MC

Femur, humerus, ribs, & surface of the pelvis

432

What are the radiologic findings of chondrosarcomas

Large, fusiform, lucent defect with scalloping on the inner cortex of the bone

433

What is the Tx for chondrosarcomas

Wide resection

434

Remodeling disease with one or more bony lesions having high bone turnover and disorganized osteoid formation

Paget's disease

435

Why is paget's disease difficult to Dx

Most pts are asymptomatic until late disease

436

What is the 1st symptom of Paget's disease

Bone pain

437

What is a frequent complication in Paget's disease

Frequent "chalkstick" fxs with slight trauma

438

What will be the lab findings of Paget's disease

Elevated alkaline phosphatase in the blood

439

What is the Tx of choice for Paget's disease

Bisphosphonates (Alendronate)

440

Aggressive malignant neoplasm that arsies from osteoblastic CT

Osteosarcoma

441

What is the MC malignancy of bone

Osteosarcoma

442

Who are osteosarcomas most prevalent in

Adolescents

443

How will a pt with an osteosarcoma present

Pain or swelling in a bone or joint, especially in or around the knee

444

What is the x-ray finding with osteosarcoma

Codman's triangle sign

445

What is the Tx of osteosarcoma

Complete radical en-bloc resection

446

What is the MC benign tumor in the hand or wrist

Ganglion cysts

447

What are ganlion cysts d/t

Leakage of joint fluid along the synovial lining through the joint capsule

448

What will you find on PE with ganglion cysts

Firm cystic masses adjacent to the joints that are usually painless

449

What is the MC location for ganglion cysts

Dorsal wrist with origin at the scapholunate joint

450

What is the 2nd MC location for ganglion cysts

Palmar aspect of wrist on radial side

451

What is the Tx for ganglion cysts

Aspiration with wide-gauge needle

452

A "punched out" lesion on x-ray indicates

Multiple myeloma

453

A 'sun ray' lesion on x-ray indicates

Osteogenic sarcoma

454

An 'onion peel' lesion/sign on x-ray indicates

Ewing sarcoma