Musculoskeletal Flashcards
(88 cards)
1
Q
cause of osteoporosis
A
loss of bone matrix and mineral
2
Q
risk factors for osteoporosis
A
- white or asian women
- small thin build
- smoking hx
- excessive ETOH
- sedentary lifestyle
- low calcium intake
3
Q
primary osteoporosis
A
- post-menopausal (due to loss of estrogen)
- senile (calcium deficiency and decreased vit D intake)
4
Q
secondary osteoporosis
A
- steroid use
- hyper or hypothyroidism
- hyperparathyroidism
- DM
- Cushing’s ds
5
Q
age to get DEXA scan in women? men?
A
65 for women, 70 for men
6
Q
nl for DEXA scan
A
t score within 1 SD of young adult reference
7
Q
osteopenia
A
1 - 2.4 SD
8
Q
osteoporosis
A
2.5 or more SD
9
Q
when to do DEXA scan again
A
1 - 1.5 = q 5 yrs
- 5 - 2 = q 2 yrs
- 5 or greater = yearly
10
Q
common fx with h/o osteoporosis
A
vertebral bodies
-also hip, pelvis, distal radius
11
Q
non-med tx of osteoporosis
A
lifestyle modifications like:
- wt bearing exercise
- take calcium and vit D
- use walker/cane
- stop smoking, ETOH
- balanced diet
12
Q
tx of osteoporosis
A
BISPHOSPHANATES (fosamax, boniva)
-can also use Raloxifene, HRT, Teriparatide (forteo, parathar), Miacalcin nasal spray
13
Q
how do pt’s need to take bisphosphanates
A
take in AM on empty stomach and remain upright for 30 mins
14
Q
increased pressure within a limited space that comprises circulation and function
A
compartment syndrome
15
Q
cause of compartment syndrome
A
bleeding or edema into a closed compartment usually caused by trauma or crush injury
16
Q
most common injury to cause compartment syndrome
A
tibial shaft fx
17
Q
severe pain out of proportion to injury, paresthesia, paresis and pallor, pain with passive stretch, decreased sensation/strength/pulses
A
compartment sydrome
18
Q
tx of compartment syndrome
A
urgent fasciotomy
19
Q
ideopathic non-inflam arthritis
A
osteoarthritis
20
Q
symptoms of OA
A
- morning joint stiffness relieved with activity
- pain with wt bearing, relief with rest
- crepitus
- joint swelling
- decreased ROM
21
Q
Heberden’s nodes
A
on DIP joints
22
Q
Bouchard’s nodes
A
on PIP joints
23
Q
xray findings of OA
A
joint space narrowing. osteophytes, sclerosis of bone and bone cyst formation
24
Q
tx of OA
A
first line = acetominophen
then NSAIDS, topical diclofenac, steroid injections, capsaicin, viscosupplementation
-surgery when QOL diminished
25
most common cause of acute osteomyelitis
s. aureus
26
common areas for acute osteomyelitis
kids - long bones
| adults > 50 - spinne (DM pts)
27
dx of acute osteomyelitis
- increased WBC, ESR, CRP
- + blood cx
- bone bx to confirm
- bone scan and MRI may help early
28
tx of acute osteomyletis
IV antibiotics for 4-6 weeks then oral for 6-8 weeks
- oxacillin/cefazolin/vanco if MRSA
- surgical debridement if no improvement of if spine involved
29
chronic osteomyelitis tx
- long term IV antibiotics (bacteria specific)
- surgical I & D
- possible amputation
30
cause of inflamed joint in pt younger than 30
septic arthritis - n. gonorrhea
31
in septic arthritis what is seen in joint fluid
WBC > 50K
polys > 80%
decreased glucose
32
tx of septic arthritis
rest, ice, elevation - admit to hospital
arthroscopic I & D
IV antibiotics 4-6 weeks (ceftriaxone if gonorrhea)
if no better in 2 days open I&D
33
most common benign tumor of wrist
ganglion cyst
34
tx of ganglion cyst
wrist splinting, aspiration with steroid inject, surgical excision
35
asymptomatic lesion, xray shows well defined lesion with sclerotic margins
benign bone tumor
36
pain and palp mass, xray shows permeatic lesion with lytic destruction and poorly defined margins
malignant bone tumor
37
cavity in bone filled with something other than bone
bone cyst
38
symptoms of bone cysts
usually asymptomatic until pathologic fx
39
tx of bone cyst
aspirate/inject with steroids or bone marrow
| curettage and bone grafting
40
most common benign bone tumor
osteoid osteoma
41
where are osteoid osteomas found?
spine or long bones
42
symptoms of osteoid osteoma
night pain relieved by NSAIDS - usually young adults
43
tx of osteoid osteoma
symptomatic - will burn itself out over time
| can remove surgically
44
most common primary malignant tumor of bone (other than multiple myeloma)
osterosarcoma
45
location of osteosarcoma
around the knee - distal femur or proximal tibia
46
what part of bone for osteosarcoma and what pt population?
metaphyseal - young men 15-25
47
what medical condition puts pt at higher risk for osterosarcoma
retinoblastoma
48
symptoms of osteosarcoma
persistent night pain and swelling
| palpable mass
49
xray findings of osteosarcoma
destructive lesion with periosteal elevation and SUN RAY/SUNBURST appearance
50
tx of osteosarcoma
chemo and surgical resection
51
location of Ewings sarcoma
pelvis,distal femur and proximal tibia
52
what part of bone for Ewings sarcoma and what population
diaphysis (shaft) of bone - men 10-20
53
symptoms and labs for Ewings sarcoma
pain, mass, fever
increased ESR and WBC
increased LDH
54
what is seen on xray for Ewings
lytic lesion ONION SKIN APPEARANCE
55
tx of Ewings
surgical resection, chemo and radiation
56
fibromyalgia is associated with what other conditions?
hypothyroidism, RA, or sleep apnea in men
57
musculoskeletal pain around neck, shoulders, low back and hips with fatigue, numbness and h/as
positive trigger points
fibromyalgia
58
tx of fibromyalgia
PT eval
moderate exercise
meds: TCAs, SSRIs like Cymbalta, SSNRIs, Lyrica/neurontin, ultram/APAP, trigger point injections
59
fever, sudden onset of monoarticular joint swelling with exquisite pain and tense warm dusky red skin with uric acid > 7.5
Gout
60
fluid finding in Gout
+ sodium urate crystals that are negatively birefringent and needle like
61
tx of acute Gout
NSAIDS or intraarticular/IV/PO steroids
62
tx of chronic Gout
colchicine
63
tx of Gout if undersecretion?
| tx if overprodutction?
```
under = probenicid or uricosuric agent
over = allopurinol/febuxostat
```
64
fluid findings in Pseudogout
normal uric acid levels and rhomboid shaped crystals that are positively pirefringent
65
tx of Pseudogout
NSAIDS and intraarticular steroids if acute
| colchciine for prophylaxis
66
fever, rash, lymphadenopathy, carditis, splenomegaly, arthritis in a pediatric pt
Still's ds (systemic Juvenile PA)
67
types of JRA
systemic, polyarticular, oligo/pauciarticular
68
JRA with low grade fever and synovitis/arthritis in 5 or more joints
polyarticular JRA
69
JRA with synovitis in 1-4 joints with NO systemic symptoms
oligo/pauciarticular JRA
70
with oligo/pauciarticular JRA higher risk for what other conditions?
iridocyclitis/anterior uveitis
71
pediatric pt with intermittent fevers and stiffness and rash
JRA
72
what test has a high specificity for JRA?
anti-CCP
73
classification criteria of JRA
- age 6 weeks
| - other causes excluded
74
tx of JRA
NSAIDS then methotrexate, night time splinting, exam with slit lamp q 2-4 yrs
75
JRA and RF
if + RF then more severe the ds and more likely to have it continue into adulthood
76
necrotizing arteritis of medium sized vessels
Polyarteritis Nodosa
77
polyarteritis nodosa can be caused by what virus?
Hep B
78
fever, malaise, wt loss, extremity pain, foot drop (mononeuritis multiplex), livedo reticularis,SQ nodules,
skin ulcers, digital gangrene, abdominal pain, N/V
polyarteritis nodosa
79
dx polyarteritis nodosa
tissue bx or angiogram
80
what has to be ruled out it pt has polyarteritis nodosa
Hep B
81
tx of polyateritis nodosa
high dose steroids
| if Hep B + : prednisone, lamivudine, plasmaphoresis
82
progressive neck and proximal muscle weakness of UE and LE and reddish purple maculopapular rash or shoulders (like shawl) or heliotrope
polymyositis
83
dx of polymyositis
muscle bx
increased CPK and aldolase
may have + ANA and anti-Jo 1 antibodies
84
tx of polymyositis
steroids - oral and topical
methotrexate, azathioprine, IVIG
LOOK FOR MALIGNANCY
85
reactive arthritis was known as
Reiter's syndrome
86
conjunctivitis, urethritis, septic arthritis and oral lesions,
may have enteritis or STD
Reactive Arthritis
87
symptoms of Reactive Arthritis
fever, arthritis (knee/ankle), urethral discharge, conjunctivitis, mucocutaneous lesions
88
seropositive test for Reactive Arthritis and tx
HLA-B27
NSAIDS and PT
less likely to develop if original infx tx'ed with antibiotics
