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English 2 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

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1
Q

Shoulder dislocation (anterior vs posterior)

A

Ant: axillary N injury; arm abduct + ext rotat*
Post: rare; seiz/electroc; arm adduct + int rotat*

ttt: reduction then sling/swathe
If recurr, surg

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2
Q

Humerus fracture

A

Radial N palsy → wrist drop + loss thumb extens*

ttt: cast vs sling; functional bracing

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3
Q

“Nightstick fracture”

A

Ulnar shaft fx (trauma in self-defense ag blunt obj)

ttt: ORIF

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4
Q

Monteggia fracture

A

Diaphys fx of prox ulna + subluxat* radial head
Fall on pronated + outstretch arm

ttt: ORIF of fx + reduct* of radius

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5
Q

Galeazzi fracture

A

Diaphys fx of radius + disloc of distal radioulnar joint
Direct blow to radius

ttt: ORIF of radius + cast in supination

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6
Q

Colles fracture

A

Distal radius; dorsally displaced
Fall to outstretched hand
Esp child or elder (osteop)

ttt: closed reduct* + long-arm cast; open reduct if intraartic

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7
Q

Scaphoid fracture

A

1 fractured carpal bone

Fall to outstretch hand
Tendern in anatom snuffbox w/ axial loading
Xray: 2wks to appear

ttt: thumb spica cast +/- open reduct*
!! AVN if disrupt* of bld flow

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8
Q

Boxer’s fracture

A

5th metacarpal neck
Forward trauma to closed fist

ttt: closed reduct*, ulnar gutter splint; +/- pinning

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9
Q

Hip dislocation (anterior vs posterior)

A

Post: >90%; post force on an internally rotated flexed adducted hip; sciatic N injury + AVN
Ant: obturator N

ttt: closed reduct* then abduct* pillow/bracing then CT

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10
Q

Hip fracture

A

Short + ext rotat leg
If Xray⊖ and clinic ⊕, do CT/MRI
-Displaced femor neck fx: ↑R AVN
Ass w/ DVTs

ttt: ORIF; if displaced fem neck fx in elder, arthroplasty
+ Anticoag

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11
Q

Femoral fracture

A

!! fat emboli: fev, chang ment status, dyspn, hypox, petech, ↓plts

ttt: intramedull nailing

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12
Q

ACL vs PCL knee injuries

A

ACL: noncontact twist, forced hyperextens* or impact to extended knee
⊕ ant drawer
R/o meniscal or MCL injury

PCL: post force on flexed knee
⊕ post drawer

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13
Q

Meniscal tears of knee

A

Acute twist or degenerative tear in elder
Click/lock
Joint line tendern; ⊕McMurray

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14
Q

Knee injuries (ttt)

A

MRI (#1)
MCL/LCL/Meniscal tears: conserv ttt

ACL: surg
PCL: surg if highly competitive athlete
Meniscal: surg: if young or old refractory to conserv ttt

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15
Q

Tibial fracture

A

!! compartment sd

ttt: casting vs intramedull nailing vs ORIF

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16
Q

Achilles tendon rupture

A

Sudden “pop” w/ ↓activ (plantar flex*)
⊕ Thompson test
ttt: surg then long-leg cast x6wks

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17
Q

Radial nerve injury

A

Motor def: wrist extens*
Sens def: dorsal forearm + first 3 fingers
Cause: hum fx, prolong compr of hum
Clinic: wrist drop

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18
Q

Median nerve injury

A

Motor def: forearm pronat* + thumb oppos
Sens def: palmar first 3 fingers
Cause: carpal tunnel
Clinic: weak wrist flex* + flat thenar eminence

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19
Q

Ulnar nerve injury

A

Motor def: finger abduct*
Sens def: palmar + dorsal (last 2 fingers)
Cause: elbow dislocat*
Clinic: claw hand

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20
Q

Axillary nerve injury

A

Motor def: arm abduct*
Sens def: over deltoid
Cause: ant should dislocat*

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21
Q

Peroneal nerve injury

A

Motor def: dorsiflex, evers
Sens def: dorsal foot + lateral leg
Cause: knee dislocat*, trauma to fibula
Clinic: foot drop

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22
Q

Compartment syndrome (etiologies, PE)

A

↑pressure in confined space; compromise N/M/perfus*
Ant comp of lower leg; forearm
After fx, muscl injury, surg

Pain out of prop; pain w/ passive mot* of fing/toe; paresthesia; pallor; poikiloth; pulseless; paralysis

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23
Q

Compartment syndrome (dg, ttt)

Study These Flashcards
A

Dg: Hx, clinic, ⊕ delta pressure (≤30)
Delta P* = DBP - compartment P*

ttt: immediate fasciotomy

24
Q

Carpal tunnel syndrome (RF, PE)

Study These Flashcards
A

Entrapment of median N at wrist
By overuse of wrist flex*; ass w/ DM, thyroid dysf
Pgnt and middle-aged W

Pain in thenar area + prox forearm; paresth in palmar of first 3 fingers; worse at night
Phalen/Tinel ⊕

25
Carpal tunnel syndrome (dg, complications, ttt)
Dg: clinic; EMG to confirm Complic: permanent loss sensat*/strength/fine motor ttt: splint wrist in neutral (night + day); CS inject* Surg if refract or advanced
26
Bursitis
Infl by repetitive use/trauma/inf/system infl ds/microcristall Esp subacromial, olecranon, trochanteric, pre/infrapatellar Local tendern, ↓motion, edema, eryth Dg: if septic or crystal suspic*, needle aspir ttt: rest, heat+ice, elevat*, NSAIDs Intrabursal CS inj (but CI in septic); Septic ttt w/ 7-10d AB
27
Tendinitis (PE)
From overuse Esp supraspinatus, biceps, wrist extensor, patellar, iliotibial band, post tibial, Achilles Pain at tendon insert*, swell, impair fct; worse w/ repetiive stress + resist strength Lat epicondyl ↑w/ resist extens* of wrist vs Med w/ resist flex*
28
Tendinitis (dg, ttt)
Dg: clinic; radio if trauma; MRI/US in tendon tear ttt: rest + NSAIDs + ice first 24-48h Splint, brace, immobil Once pain stops, strengthen exo If all fail, CS inject (CI in Achilles)
29
Herniated disk (PE)
``` Degen, trauma, strain/sprain Esp lumbar (L5-S1; L4-L5); middle-aged+older men ``` Sudden severe (w/ valsalva), electr-like LBP, preceded by months of pain Ass w/ sciatica, paresth, weakness, atrophy, contract* Passive straight-leg raise ↑pain If midline, cauda equina sd
30
Herniated disk (dg, ttt)
Dg: ESR/Xray (if susp of inf, trauma, fx) Stat MRI: cauda equina sd or sev progress neuro def MRI: if sympt refract to conservative ttt ttt: NSAIDs + physical therapy + local heat: resolut* 4wks No bed rest; +/- inject* or nerve block Sev or rapid progr and cauda equina: surg
31
Spinal stenosis (PE)
Narrow lumbar or cervical spinal canal Compr of sp cord and nerv roots Esp degen joint ds; middle-aged or elder Neck/back pain radiates to arms/buttocks/legs Leg numb/weak; leg cramp worse w/ stand/walk Improv w/ flex* of hip + bend forw/
32
Spinal stenosis (dg, ttt)
Dg: radio (degen, narrow); MRI/CT (spinal stenos) ttt: mild to mod: NSAIDs + abdo muscl strength Adv: epidural CS inj Refract: surg laminectomy (!recurr)
33
Osteosarcoma (PE)
Child/ado: #1 bone malign Adult: benign (Paget) transfo to malign Metaph of distal femur, prox tibia, prox hum Progr intractable pain, worse at night +/- fev, ↓weight, night swt, eryth, enlarg
34
Osteosarcoma (dg, ttt)
Dg: radio (Codman triangle, sunburst); biopsy (# onion skin of Ewing sarc; #soap bubble of giant cell tumor) MRI/CT of chest (stage + plan surg) ttt: limb-sparing surg, pre and post chemoth; amputation
35
Septic arthritis
After open injury or bacteremia RF: prosthetic joint; RA; osteoarthritis; bacteremia; IVDA Warm, red, immobile joint, effus*, fev/chill Dg: joint aspir (WBCs>80K, ⊕ Gram/Cx) Esp staph/strep/GNRs ttt: empir cetriax + vanco then change; surg debrid or several aspir
36
Osteoarthritis (RF, PE)
Chronic, noninfl arthritis of synov joint RF: ⊕fam Hx, obes, Hx of joint trauma Crepitus, ↓ROM, pain ↑w/ activ + weight and ↓rest Morning stiffness <30min
37
Osteoarthritis (dg, ttt)
Dg: radio (joint spac narrow; osteophyte; subchond scler + bone cyst); fluid (yellow, Nl viscos, WBC<2K); labs Nl ttt: physical therapy, ↓weight, NSAIDs; intra-art CS Joint replac if adv
38
Causes of hyperuricemia
``` ↑cell turnover (hemolys, blast crisis, tumor crisis, pso, myelodyspl) Cyclosporine Dehydration Diabetes insipidus Diet (red meat, alcoh) Diuretics Lead poisoning Lesch-Nyhan sd Salicylates (low dose) Starvation ```
39
Gout (RF, PE)
Recurr attac; acute monoart arthritis Monosod urate cryst RF: male, obes, postmenop, binge drink Excruc sudden pain; 1st MTP (podagra), other joints Erythem, swoll, tender; +/- tophi and kidn stones if chron
40
Gout (dg, ttt)
Dg: fluid aspir (needle cryst, ⊖ birefr); ↑/Nl serum uric ac Acute: high-dose NSAIDs (#1); steroids (if 1 is ineff/CI); colchicine Mainten: allopurin (over-producer; CI to proben; refract); probenecid (under-secret) ↓weight; avoid trigg (alcoh, ...)
41
Rheumatoid arthritis (RF, PE)
Autoimm ds; chron destruct symmetr infl arthritis Synov hypertr; pannus; eros* of cartil/bone/tendon RF: female, 35-50yo, HLA-DR4 Morning stiff >1h, pain, warm, swell, multi symm joints Esp wrist, MCP, ...; ulnar deviat* Tendon deform; vasculitis; atlantoaxial sublux
42
Rheumatoid arthritis (dg, ttt)
``` Dg: ↑RF (IgM ag Fc IgG) or anti-CCP Ab; ↑ESR/CRP ≥3 joints for >6wks; exclude acute/cryst cause Fluid aspir (turbid, ↓viscos, ↑WBCs 3K-50K) Radio: joint space narrow + eros* ``` ttt: NSAIDs (↓ or d/c after success ttt w/ DMARDs) DMARDs: start early w/ methotrexate; or hydroxychlor, sulfasalazine; #2 TNF inh, rituximab, leflunomide
43
Ankylosing spondylitis (RF, PE, dg)
Chron infl of spine + pelvis RF: male, early 20s, ⊕fam Hx Fatig, interm hip pain, LBP worse w/ rest+morning ⊕ Schober, no lumbar lordosis Ant uveitis, heart block, enthesitis of heel Dg: ⊕HLA-B27; radio (fused sacroiliac j, bamboo spine); ↑ESR/CRP; ⊖RF; ⊖ANA
44
Ankylosing spondylitis (r/o, ttt)
R/o other sero⊖ spondylarth: - Reactive arthritis (Reiter; arthr/uveit/urethr aft campylo/shigel/salmo/chlam/ureapl) - Psoriatic arthritis (oligoarth, also DIP, dactylitis) - Enteropathic spondylitis (sacroiliitis asymm, IBD) ttt: NSAIDs + exo (improve posture + breath) TNF inh or sulfasalazine (if refract)
45
Polymyositis and dermatomyositis (PE)
50-70yo; W>M; bla>whi Progr syst connect T. ds; immune-med infl of striated M. Polym: symm progr prox M. weak/pain Dermatom: same + rash; heliotr (violac periorb); Shawl sign (should/chest/back); Gottron papul (dors hands) +/- diff breath/swall; myocarditis; card conduc def Ass w/ malign (lung/breast)
46
Polymyositis and dermatomyositis (dg, ttt)
Dg: clinic+lab; ↑CK; ↑anti-Jo-1 Ab ttt: high-dose CS x4-6wks then taper Azathioprine +/- methotrexate if no CS
47
Systemic sclerosis / Scleroderma (RF, PE)
Infl → progr T. fibrosis by excess depos collag I+III RF: female, 35-50yo Symm thick skin: limited (head, neck, dist upp extrem); diffuse (chest, abdo, prox upp extrem) CREST: Calcinosis, Raynaud, Esoph dysmot, Sclerodact, Telangiect Diff: GI dysmot, pulm fibros, cor pulm, acute renal fail, malign HTN (Morta from pulm/card/renal complic)
48
Systemic sclerosis / Scleroderma (dg, ttt)
Dg: Anticentrom Ab in CREST; Anti-Scl-70 Ab (antitopoiso 1) in diffuse (poor pg) May have: eosino; RF/ANA ⊕ ttt: organ-based; CS (acute flares); penicilliamine (skin chang); CCB (Raynaud); ACEIs (renal + prevent ren crisis)
49
Systemic lupus erythematosus (RF, PE)
Autoimm; Ab-mediat cellular attack + deposit Ab-Ag compl RF: black women; child-bear age Fev, anorex, ↓weight, symm joint pain ≥4 criteria of DOPAMINE RASH (Discoid rash; Oral ulc; Photosens; Arthritis; Malar rash; Immuno (dsDNA, Sm, anti-phospholi); Neuro (seiz, cerebritis); ↑ESR; Renal; ANA⊕; Serositis (pleur/peric eff); Hemato abNl)
50
Systemic lupus erythematosus (dg, ttt)
Dg: ⊕ANA; anti-dsDNA Ab; anti-Sm Ab +/- antiphosph Ab; An; leukop; thrombocytop; proteinur/casts ⊕antihistone Ab (drug-ind); ⊕anti-Ro Ab (neonat) ttt: NSAIDs (mild joint); CS (acute exac) Progr/Refrac: CS, hydroxychlo, cycloph, azathiop Hydroxychl (only skin/joint ds); Cycloph (sev nephritis)
51
Giant cell arteritis / Temporal arteritis (RF, PE)
Subacute granulom infl of large Vx (Ao, caroti, verteb) RF: polym rheum, >50yo, female ``` New headac (uni/bil), tempor tendern, jaw claudic Fev, monoc blind, ↓weight, myalg/arthralg (should/hip) ```
52
Giant cell arteritis / Temporal arteritis (dg, ttt, complications)
Dg: tempor art biops (defin; thromb, media necros, lymphoc, plasma C, giant C); ↑ESR, ophth eval ttt: high-dose prednisone immed; ophth follow-up Complic: blindness (by occl of central retin art)
53
Complex regional pain syndrome (PE)
3 phases: acute/traum → dystrophic → atrophic No true nerve injury Diffuse pain out of prop; non-anatom distrib Loss of fct of limb Sympathetic (autonom) dysfct: changes of skin (temp, hair, nail growth), tiss, bld flow
54
Complex regional pain syndrome (dg, ttt)
Dg: clinical ttt: NSAIDs, CS, low-dose TCA, gabapentin, pregabalin Physical therapy; chemical sympathetic blockade
55
Fibromyalgia (PE)
Chron soft T and axial skeletal pain No joint pain; No infl Women 30-50yo; ass w/ depress, anxiet, sleep disord, IBS, cognit disord
56
Fibromyalgia (dg, ttt)
Dg: ≥11 of 18 painful areas over all body If <11 then myofascial pain syndrome ttt: antidepress (SSRI+TCA or 2 SNRIs), gabapentin, pregabalin, muscle relax, physical therapy Multidisciplinary
57
Polymyalgia rheumatica
Inflamm; ass w/ temporal arteritis RF: female, >50yo Pain+stiff in should/hip/neck; diffic standing or lifting arms Fev, mal, ↓weight Dg: ↑ESR, anemia ttt: low-dose prednisone (10-20mg/d)

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