Musculoskeletal Flashcards
(114 cards)
0
Q
Rotator cuff muscles
A
S- supraspinatus
I- infraspinatus
T- teres minor
S- subscapularis
1
Q
SALTER
A
Epiphyseal fractures S-strait A-above or away from joint L- lower T- through R- rammed
2
Q
Gout
A
Increased risk with thiazides and etoh consumption. Test of choice is inspiration of joint fluid.
3
Q
Gout crystals
A
Negative bifringent crystals
4
Q
What medication works well for anticoag in ortho surgery?
A
Low molecular weight heparin
5
Q
Slipped capital femoral epiphysis (SCFE )
A
Ortho emergency, chubby teenager limping and can’t internally rotate with possible referred pain to knee or thigh
6
Q
HLA-B27
A
Ankylosing spondylitis
7
Q
To avoid what nerve do you give injections in the upper outer buttock
A
Sciatic
8
Q
Rhomboid positive bifringent calcium pyrophosphate crystals
A
Pseudo gout
9
Q
Fusion of the vertebrae, is joint involvement, am lower back pain better with exercise, seronegative, hLAB27
A
Ankylosing spondylitis
10
Q
If you suspect ankylosing spondylitis what should you rule out first?
A
Chrones or ulcerative colitis…. 10-20% mimic AS
11
Q
Increased age, obesity, decreased joint spaces on X-ray weight bearing joints, crepe dis on exam is?
A
Osteoarthritis
12
Q
Monoarticular swelling and pain, fever, adult, with WBC over 50,000 think?
A
Septic arthitis and aspirated fluid. Could be gout could be ghonococcal disease.
13
Q
ANA positive, rash on face, arthritic pain, oral ulcers, protein urea, painful discoid rash on fingers, what is the treatment?
A
SLE, treatment is methotrexate, NSAIDs, steroids.
14
Q
First line of treatment for gout.
A
High dose NSAIDs
15
Q
Inhibits formation of uric acid and therefore decreases it in the serum and ruin. Also decreases the size of tophi. Don’t use in acute attacks.
A
Allopurinol.
16
Q
This med has no effect on uric acid levels and is given in acute attacks.
A
Colchicine
17
Q
Prolonged ischemia followed by reperfusion, mc found in forearm or lower leg, pain with passive extension.
A
Compartment syndrome
18
Q
Dx for adult with Monoarticular arthritis?
A
Arthrocentesis
19
Q
What is the first line treatment for patients with symptomatic rheumatic arthritis?
A
DMARDS, methotrexate
20
Q
Atlas
A
C1
21
Q
Axis
A
C2, Odontoid process can break off after hyperextension and cause bony fragments that injure spinal cord.
22
Q
MC fx of the wrist. Fx to the distal radius with DORSAL displacement, dinner fork deformity.
A
Colles fx, splint x 6 wks
23
Q
Fx of distal radius with volar displacement.
A
Smith fx
24
Radial styloid fx, chauffeur fx.
Hutchensons fx, thumb spica or sugar tong splint
25
Origin of phrenic nerve
C3-c5. Injury below and the diaphragm works.
26
Which nerve
| Is involved in carpal tunnel?
Median
27
A malignant bone tumor that produces osteoid and bone, sunburst appearance on X-ray, periosteal elevation that forms an angle with bone cortex
Osteosarcoma.
28
Excessive bone resorption replaced by soft matrix (osteoid), X-ray shows enlarged translucent bone, patient is usually over 40, bone fx, hearing loss, increased alk phos,
Padgets disease
29
Central cord syndrome
Hyperextension of neck and patient only has upper extremity deficits, lower extremities normal
30
All function lost except positional and vibratory
Anterior cord syndrome
31
Loss of only positional and vibratory sense, rare
Posterior cord syndrome
32
Non inflammatory joint dz with loss of articular cartilage, osteophytes, deep aching joint pain worse with use, relieved with rest. Obesity and increased age are risk factors.
Osteoarthritis
33
Autoimmune dz, joint pain in am, sx greater than 30 min, bony erosions on X-ray, joint pain, swelling, low grade fever, malaise, vasculitis, rheumatic nodules, scleritis, anemia.
Rheumatoid arthritis
34
Stress reaction of the insertion of the patellar tendon to the tibial tubercle.
Osgood schlater disease. Tx is stop offending activity.
35
A vascular necrosis of the femoral head. Limping patient with mild intermittent pain that may refer to thigh or knee. Normal née exam.
Legg calve perthes disease.
36
Nerve injured with foot drop
Deep peronial
37
Nerve injured with clawing of the toes
Tibial nerve
38
Young middle aged woman with rash on face, hair loss, fatigue, apples on fingers that are tender, and increased protein in urine?
SLE
39
Pos ANA
RA, SLE, scleroderma, polymyositis, dermatomyosis
40
Anti-ds DNA
SLE
41
RF
RA
42
Anti-Sm (ith)
SLE
43
Anti-ro, Anti-La
Sjogrens
44
Anti-SCL 70
Scleroderma
45
Anti-centomere
CREST
46
ANCA
Wegners
47
Anti-histone
Drug induced lupus
48
What drugs can cause lupus?
Procanamide, hydralazine
49
Disease common 5-25 yrs, lower extremity and spine. Presents with pain at night and relieved with ASA/NSAIDs and X-ray shows sclerotic lesions with nidus. Tx is surgery.
Osteoid osteoma.
50
Chronic localized bone abscess, treat with abx and/or surgery.
Brodie abscess.
51
Malignant tumor of the bone arising in the medullary base. MC in cylindrical bones. Sx are pain, fever, leukocytosis. X ray shows onion skin appearance.
Ewing sarcoma
52
Pathologic fracture- fx through weakened bone. What is the MC cause?
Metastatic cancer. Women breast, men lung.
53
What is the unhappy triad that is injured from a lateral blow to the knee?
MAMM: MCL, ACL, medial meniscus.
54
What is a risk after surgical repair of a long bone fracture?
Fat embolism.
55
A patient has fatigue, swelling of the hands, raynauds syndrome, skin tightness, gerd, telangectasias, and pulmonary nodules. What is it?
Scleroderma.
56
What causes scleroderma?
Over production of collagen
57
Supplements for those on long term steroid tx?
Calcium and vitamin d
58
What food to avoid with gout?
Nucleic acids, they make purine!
59
What med can you give in marfans to slow down the MC vascular issue?
Aortic root dissection, give a beta blocker
60
What is an infection that causes arthritis, conjunctivitis, urethritis?
Reiter syndrome
61
Reiter syndrome is related to what marker?
HLA-b27
62
What med can you give for a benzo overdose? (Midazolam)
Flumazenil
63
Oipeates overdose?
Give naloxone.
64
What is the disease that causes a deformity in the synthesis of type 1 collagen?
Osteogenesis imperfecta.
65
Sx of osteogenesis imperfecta?
Increase fractures in childhood, blue sclera, hearing loss and dental issues. Parents should have genetic counseling.
66
Sx are waist down painful purpura, arthritis, abdominal pain in a child. Usually had a viral illness prior. Most common vasculitis in children.?
Henoch schoenlein purpura.
67
Two areas affected in dequervians tensoynovitis.
Extensor pollicus brevis, abductor pollicus longus
68
Fixed kyphosis at puberty, treat with brace and PT
Scheuermanns disease
69
Scoliosis
Lateral curve of spine, right more common. 15-20% serial X-ray, 20-45% brace, 40 or more refer
70
Fracture of C1
Jefferson
71
Fracture of c6/c7?
Clay shovelers fracture
72
Old person with fall, short leg with external rotation?
Hip fx
73
Fx of the base of the 5th metatarsal.... Short leg cast 6-8 wks
Jones fx
74
Osteomyelitis with sickle cell bug?
Salmonella
75
Osteomyelitis with IV drug user?
S. Aureas or pseudomonas
76
Osteomyelitis with in dwelling cath?
Think candida
77
Osteomyelitis with diabetes?
Think corny bacterium or anaerobes.
78
What is the median nerve responsible for?
Thumb strength, flexion of 2/3 digit at MCP. Sensation of 2/3 digits.
79
What mess are contraindicated in a person with gout?
Thiazides and ASA. They increase uric acid levels.
80
What nerve is injured with a winged scapula?
Long thoracic nerve
81
If a patient abruptly stops long term steroids they can go into a?
Addisonian crisis.
82
What is the most dislocated carpal bone?
Lunate.
83
What is the most commonly fractured carpal bone?
Scaphoid. Look for avascular necrosis.
84
Gout crystals?
Negatively bifringent crystals
85
Pseudo gout crystals?
Positively bifringent calcium pyrophosphate crystals.
86
Gout causes what kind of nodes?
Tophi
87
Osteoarthritis causes what nodes?
Herberdens and bouchardes
88
Rheumatoid arthritis causes nodes where?
Sub q nodes on extensor surfaces.
89
Describe a ruptured disk.
Weakened outer annulus fibrosis herniates the nuculus pulposis posterior lateral direction.
90
A patient after seizure complains of shoulder pain?
Check for rare posterior dislocation, often missed on one view X-ray.
91
MC cause of septic arthritis?
S. Aureus , hex of joint trauma or hematogenous spread.
92
MC form of joint disease, non-inflammatory, pain worse in am and worse with activity. Improves with rest. Crepitus on exam and narrow joint space on X-ray. What is it?
Osteoarthritis
93
Dx and treatment of fibromyalgia?
11/18 pos tender points, tricyclic antidepressants, exercise and education.
94
Juvenile idiopathic arthritis.....
Chronic arthritis , 6-12 wks, one or more joints, swelling warmth and tenderness, morning stiffness and decreased ROM, if a high fever think stills disease.
95
Tx for juvenile idiopathic arthritis?
1. NSAIDs 2. Methotrexate MUST give folic acid
96
Ulnar fx with radial head dislocation.
Monteggia fx
97
Radial fx with ulnar dislocation
Galeazzi fx
98
GRUM
Galeazzi/radial fx
| Monteggia/ ulnar fracture
99
Progressive fissuring of vertebrae and SI joint with bamboo spine on X-ray, SeroNegative, HLA-B27 pos, worse in am better with activity.
Ankylosing spondylitis
100
Ankylosing spondylitis tx?
1. NSAIDs
| 2. Tnf blockers
101
Lumbar root for medial thigh?
L3
102
Lumbar root for knee reflex, quads, lateral thigh and medial calf?
L4
103
Lumbar root for lateral calf and dorsal foot?
L5
104
Lumbar root for Achilles reflex, lateral foot and ankle?
S1
105
What is polyarteritis nodosa and what are the s/s?
Vasculitis involving medium sized arteries. Palpable purpura, post prandial abdominal pain, with increased ESE and UA pos for blood and protein. Ex is tissue biopsy, tx with steroids.
106
An idiopathic inflammatory myopathy affecting women 40-50 yrs, with a gradual progressive bilateral proximal muscle weakness (legs first) and complain of difficulty rising out of a chair. No facial involvement. Dx with muscle bx and tx with corticosteroids.
Polymyositis.
107
An idiopathic inflammatory myopathy, women more than men, 40-50 yrs, with bilateral proximal weakness, a dusky rash on neck shoulders and upper chest and related to occult malignancy?
Dermatomyositis
108
Scaly pink patches over dorsal PIP and MCP are what and related to what?
Gottron sign related to dermatomyositis. Check for malignancy!
109
First step after dx of dermatomyositis?
Check for malignancy! Treat inflammation with steroids.
110
45 year old female complains of an achy stiffness in shoulders and hips worse in the am, for over an hour, fatigue, weight loss, and low grade fever. Dx?
Poly myalgia rheumatica, linked to giant cell arteritis.
111
This is a reactive arthritis in response to an infectious process elsewhere in the body. Patient is male and complains of sausage toes, eye pain, painless ulcers on hands and soles, knee pain, and pain with urination.
Reiters syndrome. Tx with abx, indocin, steroids.
112
In this disease lymphocytes invade exocrine glands. It also has an increased relation to B cell lymphoma.
Sjogrens
113
S/s of Sjögren's syndrome?
Dry eyes, dry mouth, dry skin, polyarthralgia, dysphasia, fever, malaise.
