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Rosh Review > Musculoskeletal Disorders > Flashcards

Musculoskeletal Disorders Flashcards

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1
Q

What is a complication of plantar fasciitis?

A

Plantar fascial rupture, which occurs during push-off phase of gait

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2
Q

Best type of I&D for felon infection

A

Single lateral incision along ulnar aspect of digits 2-4 and radial aspect of digits 1 and 5

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3
Q

Complications of felon infections

A
  • Ischemic necrosis
  • Osteomyelitis
  • Flexor tenosynovitis
  • Septic arthritis
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4
Q

Most commonly injured ligament of the knee?

A

ACL

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5
Q

Most likely cause of disk herniation symptoms?

A

Repetitive flexion

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6
Q

Difference between herniated vs. bulging disk?

A

Herniated disk - rupture of nucleus pulposus beyond annulus fibrosus of the vertebral body

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7
Q

Symptoms suggesting meniscal tear

A
  • Joint line pain
  • Joint effusion
  • Locking
  • Giving way of knee
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8
Q

Most common injury associated with traumatic hemarthrosis of knee joint?

A

ACL rupture

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9
Q

Maneuvers to test for meniscal tear

A
  • McMurray test
  • Thessaly test
  • Apley test
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10
Q

McMurray Test

A

lateral meniscus: knee fully flexed, rotate tibia medially and bring knee into extension

medial meniscus: knee fully flexed rotate tibia laterally and bring knee into extension

Positive = clicking, locking, pain

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11
Q

Apley test

A

Patient in prone position
Bring knee into 90 degree
Lateral and medial rotation of tibia

Excessive rotation or discomfort as compared with other side - ligamentous

Repeat procedure while pressing down on heel - decreased rotation or discomfort - meniscal damage

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12
Q

Thessaly Test

A

Most accurate for meniscal tests

Patient stand on injured leg flexed at 20 degrees
Rotate over tibia 3x on each side
Positive if patient complains of pain in joint line

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13
Q

Most serious complication associated with juvenile idiopathic arthritis, particularly during initiation of treatment

A

Macrophage activation syndrome

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14
Q

Presentation of juvenile idiopathic arthritis

A
  • High fevers for minimum of 2 weeks
  • Polyarticular arthritis
  • Erythematous, macular rash involving trunk, palms, and soles
  • May develop hepatosplenomegaly, lymphadenopathy, pleuritis, or pericarditis
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15
Q

Complications of juvenile idiopathic arthritis

A
  • Interstitial lung disease
  • Pulmonary hypertension
  • Lipoid pneumonia
  • Macrophage activation syndrome
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16
Q

What is macrophage activation syndrome

A
  • Massive T-cell up-regulation
  • Increased macrophage function
  • Release of proinflammatory cytokines
  • Hemophagocytosis
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17
Q

Clinical picture of macrophage activation syndrome

A
  • High fever
  • Hepatosplenomegaly
  • Lymphadenopathy
  • Pancytopenia
  • Liver dysfunction
  • DIC
  • Low ESR
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18
Q

Tx of macrophage activation syndrome

A

High-dose glucocorticoids

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19
Q

What treatments besides disease-modifying antirheumatic drugs have helped decrease incidence of growth retardation and osteoporosis in patients with juvenile idiopathic arthritis?

A

Recombinant growth hormone and vitamin supplementation, particularly with calcium

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20
Q

Which imaging modality may be an effective tool in the diagnosis of tendinopathy?

A

Ultrasound

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21
Q

The shoulder is most vulnerable to an anterior glenohumeral dislocation in which of the following positions?

A

Abduction and external rotation

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22
Q

What is the most common type of major joint dislocation?

A

Glenohumeral joint

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23
Q

What is most sensitive for the diagnosis of cauda equina?

A

Urinary retention (90%)

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24
Q

What is the tx for cauda equina syndrome 2/2 malignancy?

A

Emergent radiation therapy

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25
What organism makes up majority of septic bursitis cases?
Staph aureus (80%)
26
Mechanism of infection in septic bursitis
Percutaneous inoculation of skin organisms from trauma, prolonged pressure on the elbow such as from leaning on a hard surface, or from an overlying cellulitis
27
What is a Pott puffy tumor?
Subperiosteal abscess or osteomyelitis of the frontal bone that results from contiguous spread of frontal sinusitis - tender, boggy protuberance overlying the frontal bone and frontal sinus - rare, most often presents in children and adolescents
28
Presentation of a Pott puffy tumor
- Fever - Headache - Photophobia - Vomiting - AMS/lethargy - Periorbital or forehead swelling - Purulent rhinorrhea - Meningismus - Cranial nerve deficits
29
Complications of a Pott puffy tumor
- Cerebral abscess - Meningitis - Cavernous sinus or dural venous thrombosis - Epidural abscess
30
What organisms are most responsible for a Pott puffy tumor?
Staphylococcus, Streptococcus, and anaerobes
31
Physical exam maneuvers that aid in diagnosing rotator cuff injury
1. Painful arc test: patient abducts arm and if pain beyond 90 degrees = positive 2. Empty can test: downward pressure on arm while patient abducts to 90 degrees and internally rotates arm pointing thumbs down 3. Drop arm test: patient slowly lowers arm to side after abducting 90 degrees 4. Weakness with external rotation
32
Rotator cuff muscles and their movements
``` Supraspinatus (abduction) Infraspinatus (external rotation) Teres minor (external rotation) Subscapularis (internal rotation) ```
33
What is Hawkins test?
Pain in shoulder with forced internal rotation with the arm parallel to the floor and elbow flexed at 90 degrees -> shoulder impingement syndrome (sort of rotator cuff)
34
What is Neer’s test
Pain with passive elevation of arm above the head | -> shoulder impingement syndrome (sort of rotator cuff too)
35
Most common organism of felon
Staph aureus
36
Pressures indicative of compartment syndrome
Compartment pressure >30-40mm Hg | Delta pressure = diastolic blood pressure - direct pressure <30 (more reliable than direct pressures)
37
Compartments of forearm and legs
Look this up***
38
Drugs that can increase urate levels
Low-dose Aspirin Diuretic Cyclosporine Tacrolimus
39
Upper Extremity Dermatomes
Q571252
40
What is a Segond fracture?
Avulsion injury of lateral tibial plateau
41
What ligamentous injury is highly associated with Segond fracture?
ACL
42
Most common ligamentous injury of the knee?
ACL
43
Most sensitive test for ACL tear
Lachman’s
44
What is a gamekeeper’s/skier’s thumb injury?
Acute forced abduction of the thumb at the MCP joint causing Ulnar collateral ligament injury Weak pincer grasp
45
Tx for gamekeeper’s/skier’s thumb?
Thumb spica splint; could require operative repair
46
What is more common, injury to ulnar or radial collateral ligament?
Ulnar is 10x more common
47
Radiculopathies
Q138263
48
What is the most common bony tumor in children?
Osteosarcoma
49
Most common sites of involvement with osteosarcoma
1. Distal femur 2. Proximal tibia 3. Proximal humerus 4. Middle and proximal femur
50
Radiographical finding of osteosarcoma
``` Sunburst pattern (periosteal reaction) Codman triangle ```
51
Radiographical and path finding of Ewing Sarcoma
Onion skinning periosteal reaction | Blue cell tumor
52
Which tends to have systemic symptoms, osteosarcoma or ewing sarcoma?
Ewing sarcoma
53
Kanavel Criteria for Flexor Tenosynovitis
1. Tenderness along course of flexor tendon 2. Fusiform or symmetrical swelling of the finger 3. Pain with passive extension (often first finding) 4. Finger held in flexed posture
54
Causes of rhabdomyolysis
1. Trauma 2. Infection 3. Drugs 4. Medications 5. Heat 6. Exercise 7. NMS
55
Electrolyte abnormalities in rhabdomyolysis
Early: hypocalcemia (results from deposition of calcium salts in necrotic muscle, binding with phosphorus, and sequestration by the sarcoplasmic reticulum) Others: hyperkalemia, hyperphosphatemia
56
Most common extra-articular manifestation of ankylosing spondylitis?
Uveitis
57
What is first-line pharmacologic tx of ankylosing spondylitis?
NSAIDs
58
Ottawa ankle rules
Pain in malleolar region with any of the following: - Bone tenderness at posterior edge of distal 6cm or the tip of lateral malleolus - Bone tenderness at posterior edge of the distal 6cm or the tip of medial malleolus - Inability to bear weight for at least 4 steps both immediately after injury and at time of evaluation
59
When to add a foot x-ray when evaluating ankle injury
Pain in midfoot region and one of the following: - Bone tenderness at navicular bone - Bone tenderness at base of fifth metatarsal - Inability to bear weight for at least 4 steps both immediately after injury and at time of evaluation
60
What fracture of proximal fibula is associated with a medial ankle disruption
Maisonneuve fracture

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