Flashcards in Musculoskeletal Review Deck (75)
At what age should you begin ordering dexa scans for male patients? What about female patients?
70 for males, 65 for females
Give the dexa score for osteopenia? Osteoporosis?
Osteopenia = 1 to 2.4 standard deviations, osteoporosis = 2.5 standard deviations or greater.
What fracture is the #1 cause of compartment syndrome?
Tibial shaft fracture
A patient's lab work shows positive smith antibody and positive double stranded DNA antibodies. What is the most likely diagnosis?
Where are Bouchard's nodes found?
Proximal interphalangeal joint (PIP)
What will an x-ray show in acute osteomyelitis?
Nothing - it will show bone destruction in chronic osteomyelitis.
What is the best imaging to diagnose osteomyelitis?
Either a bone scan or an MRI will provide the diagnosis.
A 22 year old male patient presents with what is clearly a septic knee. You also notice lesions on his hands and feet. What is the most likely pathogen?
What would you expect the WBC count to be in the joint fluid of an infected knee?
>50,000 at a minimum and probably much higher.
A patient presents with a painless mass in her right wrist. What is the most likely diagnosis?
What is the age range for osteosarcoma? Where are they most typically found in the body?
Osteosarcoma usually occur in 15-25 year old males and are most commonly found around the knee.
You think a patient may have an osteoid osteoma due to his complaints of severe night pain. You set him up for an x-ray, but in the meantime what medication do you start him on?
If it is truly an osteoid osteoma ibuprofen will resolve his pain.
Clicking or locking of the knee indicates what diagnosis?
A 65 year old presents complaining of severe pain in his great toe that began when he woke up this morning. It is swollen, red and very tender. What is the most likely diagnosis?
Gout would be number one because of the location, but you might also think about an infection.
What uric acid level helps to confirm a diagnosis of gout?
What is the medical treatment for gout?
A pathology report comes back with positive birefringent crystals. What is the most likely diagnosis?
A patient with a history of hepatitis B presents complaning of bilateral knee pain, fever and weight loss. What is the most likely diagnosis?
You suspect a patient has polyarteritis nodosa. What is the test for a definitive diagnosis and what is the treatment?
Biopsy, high dose steroids
On physical exam you notice ulnar deviations and swan neck deformities. What is the most likely diagnosis?
A positive Neer's test indicates what diagnosis?
Rotator cuff impingement
List three medication that may cause lupus.
Procainamide, Isoniazid and Quinidine.
What test do you do for Sjogren's syndrome?
A patient with rheumatoid arthritis is heading to the OR for open reduction and internal fixation of the ankle. In addition to ankle films what other x-rays should you get?
C-spine, anesthesia will want them due to concerns about instability of C1 & C2.
What carpal bone has a high rate of nonunion and occult fracture?
What medication is used for patients with lupus?
Scleroderma limited version has five main characteristics for which the CREST acronym is often used. What are those five things?
Calcinosis, Raynaud's, Esophageal motility, Sclerodactyly, Telangiectasia
There is a sunburst appearance on x-ray. What is the most likely diagnosis?
Anatomically where are 80% of clavicle fractures located?
A pathology report comes back showing negatively birefringent crystals. What is the most likely diagnosis?
What are the four muscles of the rotator cuff?
Commonly referred to as the SITS muscles they are Supraspinatus, Infraspinatus, Teres minor, Subscapularis.
Describe the characteristics of a lytic lesion on x-ray.
Spiculated, elevated periosteum, bone destruction (think bad, very bad things).
What ligament is most commonly injured in an ankle sprain?
Anterior talofibular ligament (ATF)
Vasculitis with a hepatits B history should make you think of what diagnosis?
What is the most common fracture in children?
A fat pad sign on a lateral x-ray of the elbow has what significance?
It is blood in the joint indicating a fracture even if the fracture line cannot be seen.
A patient presents with progressive neck and proximal muscle weakness. On physical exam you see a reddish purple maculopapular rash. Her lab work shows an anti Jo 1 antibodies. What is the most likely diagnosis?
Which way does a Colles fracture angulate dorsal or volar? What about a Smith fracture?
Colles = Dorsal, Smith = Volar
Tenderness over the anatomical snuffbox is indicative of what fracture?
What is the most common fracture in a patient with osteoporosis?
A compression fracture of a vertebral body followed by hip fractures.
A 15 year old boy presents complaining of night pain in the pelvis. Since you have no idea what to do you order an x-ray. The report comes back with a description of a mass with an "onion skin appearance." What is the most likely diagnosis?
What is the name for a 4th and 5th metacarpal fractures that often result from throwing a punch?
A new mother presents with pain over the radial wrist. She has a positive Finkelstein's test. What is the most likely diagnosis?
de Quervain's tenosynovitis
A positive Mcmurry indicates what diagnosis?
What is the first line treatment for carpal tunnel?
What is the most common cause of C-spine fractures?
Motor vehicle accidents
What is the medical term for hunchback?
What is another term for podagra?
A patient presents to the ER with saddle anesthesia and loss of bowel and bladder function. What is the most likely diagnosis?
A patient with HIV presents with severe groin pain. What is the most likely diagnosis?
Avascular necrosis of the femoral head. Antiretroviral medications put patients at an increased risk of AVN.
A 95 year old female presents to ER after a fall in her home. Her left leg is shortened and externally rotated. What is the most likely diagnosis?
You recommend bisphosphonates for a patient with osteoporosis. What instruction do you give her for immediately after taking the medication?
Remain upright for 30 minutes.
What is the most common cause of a hip dislocation? Is it usually anterior or posterior?
Which of the four rotator cuff muscles is most commonly injured?
What is the medical term for tennis elbow?
What is a first line treatment for rheumatoid arthritis?
A patient presents to the ER after taking a baseball bat to the knee. He is unable to actively extend his knee. What is the most likely diagnosis?
Are most shoulder dislocations anterior or posterior?
What is the most useful physical exam test for diagnosing an ACL tear?
Lachman's, followed by anterior drawer.
What is the most common knee injury?
Medial meniscal tear
Where are Heberden's nodes found?
Distal interphalangeal joint (DIP)
A patient presents with knee pain following a soccer game two days ago. He has joint line tenderness medially and feels a locking in the knee from time to time. What two physical exam tests should you do?
This is probably a medial meniscal tear. Mcmurry and Apply tests would be appropriate.
A patient presents with conjunctivitis, urethritis, arthritis and oral lesions. What is the most likely diagnosis? What other lab might you expect to be positive?
Reactive arthritis, HLA B-27
A 46 year old male comes into ER limping a little on the right side. He states that it felt as though he was kicked in the back of the leg during a soccer game, but clearly no one was behind him. What is the most likely diagnosis?
Achilles tendon rupture
Anti jo antibodies should make you think of what diagnosis?
A positive cross over test indicates what diagnosis?
Acromioclavicular joint injury (AC joint).
A positive Hawkin's test indicates what diagnosis?
Rotator cuff impingement
A positive Finkelstein's test indicates what diagnosis?
de Quervain's tenosynovitis
A positive Phalen and Tinel's sign indicates what diagnosis?
A bamboo spine indicates what diagnosis?
A positive straight leg test indicates what diagnosis?
An African American female presents with malar rash and a positive double stranded DNA antibody. What is the most likely diagnosis?
Carpal tunnel affects what nerve and what parts of the hand?
Median nerve. Thumb, pointer and ring fingers. Thenar wasting is sign of advanced disease.
A patient has a silver fork deformity on x-ray. What is the most likely diagnosis?