Musculoskeletal/Rheumatologic Flashcards
(193 cards)
1
Q
Indications to aspirate a bursa
A
- Rule out INFECTION
2. Aid in diagnosis of GOUT (or other microcrystalline disorder)
2
Q
Sprain vs Strain
A
Sprain = Ligaments Strain = Tendons (s"T"rain - "T"endon)
3
Q
Untreated wrist strain
A
“SLAC” wrist: Scapho-Lunate Advanced Collapse
4
Q
Impingement tests for shoulder
A
Neer
Hawkins
5
Q
Most common injury of the wrist
A
Colle’s Fracture
6
Q
Rotator Cuff Muscles
A
SItS:
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
7
Q
Most commonly injured rotator cuff mm
A
Supraspinatus
8
Q
MC cause of shoulder pain >40
A
Rotator cuff TEAR
9
Q
Shoulder pain <40
A
Rotator cuff TENDINITIS
10
Q
Test for rotator cuff
A
Drop arm test
11
Q
Distinguishing rotator cuff tear from tendinitis
A
Lidocaine injection (improves tendinitis)
12
Q
PASSIVE ROM limited
A
Adhesive capsulitis
13
Q
MC demographic for adhesive capsulitis
A
Women and Diabetics
14
Q
“Tennis elbow”
A
Lateral epicondylitis
15
Q
“Golfer’s (baseball) elbow”
A
Medial epicondylitis
16
Q
Most common overuse injury of elbow
A
Lateral epicondylitis
17
Q
Which muscles attach to lateral epicondyle
A
EXTENSOR muscles
18
Q
Which muscles attach to medial epicondyle
A
FLEXOR muscles
19
Q
Treatment for lateral epicondylitis
A
- Rest (at least 6 weeks), ice, NSAIDs
- Counter force strap
- Steroid injection +/- surgery
20
Q
Red, swollen, painful elbow with PRESERVED ROM
A
Olecranon bursitis
21
Q
Cause of INFECTIOUS olecranon bursitis
A
S. aureus
22
Q
Small, soft, fluid-filled painLESS mass typically at the wrist
A
Ganglion cyst
23
Q
Treatment for painful/disabling ganglion cyst
A
Aspiration +/- surgery
24
Q
Most common mass/lump of hand
A
Ganglion cyst
25
- 30-50 YO Woman with children +/- diabetic
| - c/o pain/tenderness near base of thumb radiating up the forearm
DeQuervain's Tenosynovitis
26
Most common tendonitis of the wrist
DeQuervain's
27
Test for DeQuervain's
Finkelstein
28
1st line treatment for DeQuervain's
Brace/thumb splint and NSAIDs
| +/- cortisone injection/surgery
29
- Paresthesias of the 1st, 2nd, 3rd, and lateral 4th digit
| - Thenar atrophy
Carpal tunnel syndrome
30
Carpal tunnel nerve
Median
31
Tests for carpal tunnel
- Phalen's sign
- Tinel's sign
- Others: Durkan's, Flick
32
Phalen's sign
Reproduction of carpal tunnel symptoms with wrist hyperflexion
33
Tinel's sign
Reproduction of carpal tunnel symptoms with percussion over carpal tunnel
34
Treatment for carpal tunnel
VOLAR SPLINT in neutral position
NSAIDs
+/- surgery (99% curative)
35
Most common mononeuropathy
Carpal Tunnel Syndrome
36
Sprain (or tear) of the ulnar collateral ligament of the thumb
Gamekeeper's Thumb
37
Stenner lesion
Slippage of the UCL associated with Gamekeeper's Thumb
| ABSOLUTE indication for surgery
38
Most common shoulder dislocation
Anterior
39
Nerve involved with shoulder dislocation
Axillary nerve: check deltoid sensation
40
Management of shoulder dislocation
Manual reduction
41
MOI Scapula Fx
Direct VIOLENT trauma
| Will likely have other injuries/fx
42
Management of scapula fx
Immobilization with sling and swathe
43
Common elbow fx in children
Supracondylar Fracture
44
Artery that may be damaged with supracondylar fx
Brachial --> Check radial pulses!!!
45
X-ray findings of supracondylar fx
Posterior sail sign
| Anterior humeral line will NOT bisect the capitate
46
"Dinner fork deformity"
Colles Fracture
| POSTERIOR displacement of the wrist
47
Treatment for colles fx
1. Nondisplaced: casting alone
2. Slight displacement: Closed reduction + casting
3. A lot of displacement: ORIF + casting
48
Opposite of colles fx
Smith Fracture
| MOI: Fall on back of hand
49
Shoulder slumped downward, forward and inward
Clavicle Fracture
50
Management of clavicle fx
Figure 8 dressing
51
Common arm fx of elderly pt
Humeral SHAFT fx
52
Nerve damaged with humeral shaft fx
Radial nerve
53
Radial nerve damage findings
Wrist drop
54
Displacement of fat bad and elbow effusion on xray
Radial head fx
55
Pain in the anatomical snuffbox
Scaphoid Fx
56
X-ray findings of scaphoid fx
Often negative (repeat in 10-14 days)
57
Fx of the distal 5th metacarpal
Boxer's fracture
58
MC ligament injured in ankle sprain
Anterior talofibular ligament (ATFL)
59
Name of criteria for imaging on ankle sprains
Ottawa Rules
60
Ottawa Rules
- ANKLE imaging if tenderness in MALLEOLAR region
- FOOT imaging if tenderness in MID-FOOT region
- Image BOTH if unable to bear weight for at least 4 steps
61
Ankle Sprain Classifications
Grade 1 - minimal tenderness/swelling; normal weight bearing
Grade 2 - moderate tenderness/swelling, decreased ROM; +/- instability
Grade 3 - significant tenderness/swelling, INSTABILITY
62
Grade 1 ankle sprain management
Weight bear as tolerated
| PT
63
Grade 2 ankle sprain management
Immobilize with air splint
| PT
64
Grade 3 ankle sprain management
Immobilize
PT
Possible SURGICAL reconstruction
65
Most common knee injury
Meniscal injuries
66
MC meniscus injury
Medial meniscus
67
Meniscus MOI
Excessive ROTATIONAL force
68
Meniscus special tests
McMurray
| Apley
69
Fractures specific to peds population
Bowing
| Greenstick
70
Classifying pediatric growth plate fxs
Salter-Harris
71
Salter-Harris classifications
```
I - (S)lipped
II - (A)bove
III - (L)ower
IV - (T)hrough
V - (ER)asure - crush
```
72
Metaphysis vs Epiphysis vs Diaphysis
```
(M)etaphysis = (M)iddle
(E)piphysis = (E)nd
Diaphysis = Body/Shaft
```
73
Population for hip fx
Elderly females
74
Hip fx at risk of avascular necrosis
INTRAcapsular - affects blood supply to femoral head
75
Extracapsular hip fx treatment
Internal fixation
76
Intracapsular hip fx treatment
Hemiarthroplasty due to high risk of avascular necrosis
| Internal fixation if non-displaced
77
Hemarthrosis with fat globules (knee aspiration)
Knee Fracture (patella/tibial plateau)
78
Obese male 12-16 YO c/o:
Progressive limp and knee pain
Knee turned (unable to internally rotate hip)
Slipped Capital Femoral Epiphysis
79
Scoop of ice cream slipping off ice cream
Slipped capital femoral epiphysis
80
SCFE management
Orthopedic EMERGENCY - Surgical repair
81
MC cause of heel pain
Plantar fasciitis
82
Pain with first steps in the morning that improves
Plantar fasciitis
83
Fractures associated with child abuse
- Metaphyseal corner fx
- Posterior rib fx
- LE fx of non-ambulatory child
- Multiple fx in various stages of healing
- Sternal or scapular fx without high impact mechanism
- Any fx in child <1 YO
- Spinous process fx
84
MC complications of fx
DVT or PE
85
Tenderness over the tibial tuberosity
Osgood-Schlatter Disease
86
Male age 10-15 c/o:
- Anterior knee pain worse with kneeling, jumping, stairs
- Relieved by rest
- Normal x-ray
Osgood-Schlatter Disease
87
Osgood-Schlatter Disease treatment
Rest & NSAIDs
88
Young child presenting with:
| -Conjunctivitis, rash, adenopathy, strawberry tongue, hand/feet edema, high fever (>5 days)
Kawasaki Disease
89
MC cause of pediatric acquired heart disease
Kawasaki Disease
90
Cardiac complication of Kawasaki Disease
Coronary Artery Aneurysm
91
Kawasaki Mnemonic
```
CRASH and burn:
(C)onjunctivitis
(R)ash
(A)denopathy
(S)trawberry tongue
(H)and/feet edema
+ Fever (>5 days)
```
92
Medium-sized artery inflammation
Kawaski Disease
93
Treatment for Kawasaki
IVIG (lowers risk of coronary artery complications)
| Aspirin (continued low dose for months after)
94
MC cause of costochondritis
Idiopathic
95
Small vessel vasculitis caused by deposition of IgA
Henoch-Schonlein Purpura
96
Child 4-12 YO presenting following URI with:
- Arthritis
- Palpable purpura
- GI sxs
HSP
97
Complications of HSP
Nephropathy
| Intussusception
98
Treatment for HSP
Supportive
99
MC fx associated with osteoporosis
Vertebral body compression fx
100
Screening test for osteoporosis
DEXA
101
When to screen for osteoporosis
Average risk: Women >65 YO
Screen younger with risk factors
If osteopenia (-1.0 to -2.5), screen again in 1-5 years
102
Osteoporosis diagnosis
T-score < -2.5
103
Osteoporosis treatment
1. Bisphosphonates (Alendronate, resideronate, ibandronate)
2. Vitamin D: 800-1000 IU daily
3. Calcium: 500-600 mg BID
104
Important Bisphosphonate instuctions
Take on EMPTY stomach and
Sitting UPRIGHT (remain upright for 30 min)
HYPOcalcemia
Osteonecrosis of the jaw in cancer patients
105
Chronic tendon thickening with localized tendon pain
| no inflammation
Overuse syndrome
106
Disruption or laceration of the extensor tendon at the DIP
Mallet Finger
107
Distal radial shaft fx with
| Associated distal radioulnar joint dislocation
Galeazzi Fracture
108
Fracture of proximal 1/3 of ulna
| + Dislocation of radial head
Monteggia Fracture
109
5th metatarsal transverse fx (proximal)
Jones Fracture
110
Midfoot fracture of metatarsal bones
Lisfranc Fracture
111
Lisfranc Fx treatment
ORIF
112
Stress fracture of pars interarticularis (usually L5)
Spondylolysis
113
Scotty Dog with collar (lumbar x-ray)
Spondylolysis
114
MC location of Gout
First MTP (Podagra)
115
MC Gout crystals
Uric Acid
116
Gout light microscopy
Needle-shaped
| Negative birefringence
117
Acute gout treatment
NSAIDs (indomethacin)
118
Chronic gout treatment
Allopurinol
| Colchicine
119
Gout triggers
Red meats, alcohol
| Meds: Thiazide and Loop Diuretics
120
MC location for pseudogout
Knee
121
Pseudogout light microscopy
Positively birefringent
| Prism (rhomboid) shaped crystals
122
MC pseudogout crystal
Calcium pyrophosphate crystals
123
Pseudogout treatment
NSAIDs
124
Morning stiffness lasting >30 min
RA
125
Ulnar deviation of MCP
RA
126
Associated with Baker's cyst,
Swan neck deformity,
Boutonniere deformity
RA
127
Symmetrical bone erosions and joint space narrowing
RA
128
RA labs
RF
ESR
CRP
(Consider PMR if +ESR, +CRP, -RF)
129
RA treatment
NSAIDs
Glucocorticoids
DMARDS (Methotrexate)
TNF Inhibitor
130
Affects MCP and PIP joints
RA
131
Widespread muscle pain >3 months
PE shows tenderness at >9/18 trigger points
Labs are normal
Fibromyalgia
132
Fibromyalgia treatment
Education
Antidepressants
NO opioids
133
Proximal WEAKNESS of the skeletal muscles
Polymyositis
134
Patient presenting with insidious onset of muscle weakness
| Reports difficulty getting up from chair, muscle atrophy
Polymyositis
135
Polymyositis Treatment
HIGH dose steroid taper
| DMARDS if unresponsive to steroids
136
Pt with hx of lupus
| c/o REPEATED SPONTANEOUS ABORTIONS
Antiphospholipid Antibody Syndrome
137
Antiphospholipid Antibody Syndrome Lab Finding
Thrombocytopenia
138
Treatment of antiphospholipid antibody syndrome
Anticoagulation
139
Malar rash
Photosensitivity
Arthritis
Hemolytic anemia
SLE
140
SLE antibodies
Anti-dsDNA: High specificity, poor prognosis
Anti-Smith: High specificity, not prognostic
ANA: High sensitivity, non-specific
141
Drugs that induce SLE
HIPPS:
- Hydralazine
- Isonazid
- Procainamide
- Phenytoin
- Sulfonamides
142
Drug induced SLE antibodies
Antihistone
143
SLE treatment
NSAIDs
Steroids
Immunosuppressants
HYDROXYCHLOROQUINE
144
Disease of excessive collagen deposition
Scleroderma
145
Scleroderma manifestations
CREST + Pulmonary fibrosis/HTN, Renal artery stenosis, GI dysmotility
146
CREST Syndrome
```
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasias
```
147
Scleroderma antibodies
Anti-SCL-70 (systemic only)
Anti-centromere
ANA
148
CREST antibodies
Anti-centromere
| ANA
149
Pain/stiffness in shoulders and hips w/out weakness
PMR
150
What is PMR associated with
Temporal (giant cell) arteritis
151
PMR labs
(+)ESR/CRP
| (-)RF
152
PMR treatment
Steroids (prednisone)
153
Middle aged female presenting with:
| dry eyes, dry mouth, parotid enlargement
Sjogren's
154
What rheum conditioin is Sjogren's associated with
RA
155
What cancer is Sjogren's associated with
B-Cell Lymphoma (44x the risk!!!)
156
Sjogren's antibodies
Anti-Ro
Anti-La
ANA, RF
157
Stiffness that is worse w/ activity, improved with rest
OA
158
Joints affected by OA
DIP, CMC of thumbs
159
Osteophytes on x-ray
OA
160
OA labs
Normal ESR & RF
161
Heberden and Bouchard nodes
OA
162
Heberden VS Bouchard nodes
Heberden - DIP
| Bouchard - PIP
163
MC cause of septic arthritis <35 YO
Gonorrhea
164
MC cause of septic arthritis overall
S. aureus
165
Patient presenting with fever, joint pain, dec ROM
Septic arthritis
166
MC site for septic arthritis
Knee
167
Septic arthritis synovial fluid analysis
WBC >50,000 with >75% PMNs
Yellow, purulent
Variable viscosity
168
HLA-B27
Ankylosing Spondylitis
| Reactive Arthritis
169
Low back pain that is worse in the morning, improves with exercise
Ankylosing spondylitis
170
Bamboo spine
Ankylosing spondylitis
171
Ankylosing spondylitis labs
(+) ESR
| (+) HLA-B27
172
Ankylosing spondylitis treatment
NSAIDs
Methotrexate
PT
Spinal fusion
173
Pt with recent GI or chlamydia infection
| c/o ASYMMETRIC arthritis, conjunctivitis, urethritis
Reactive Arthritis (Reiter's)
174
Reactive arthritis labs
HLA-B27
175
Treatment for reactive arthritis
NSAIDs
176
MC primary malignancy of the bone
Osteosarcoma
177
Sunburst x-ray pattern
Osteosarcoma
178
MC location for osteosarcoma
LONG bones: Femur > tibia > humerus
179
MC cause of avascular necrosis
Corticosteroids
180
MC site for avascular necrosis
Femoral head
181
Hypercalcemia
Renal insufficiency
Anemia
Bone lesions/Back pain
Multiple Myeloma
182
Lytic bone lesions
Multiple Myeloma
183
Multiple Myeloma mnemonic
```
CRAB:
hyperCalcemia
Renal insufficiency
Anemia
Bone lesions/Back pain
```
184
Monoclonal antibody spike (M spike)
Multiple myeloma
185
Bence-Jones proteins
Multiple myeloma
186
Rouleaux formations
Multiple myeloma
187
Proximal myalgias and weakness
Skin ulcers
Nephritis
Mesenteric ischemia
Polyarteritis nodosa
188
MC type of ischial tuberosity avulsion
Pelvic avulsion fracture
189
Brittle bone disease
Osteogenesis imperfecta
190
Infant with hearing loss, easy bruisability, and multiple fractures
Osteogenesis imperfecta
191
```
Blue sclera
Increased laxity of joints
Short stature
Scoliosis
Basilar skull deformities
```
Osteogenesis imperfecta
192
Osteogenesis imperfecta inheritance pattern
Autosomal dominant mutation of the collagen
193
Fleck sign
Avulsion fx of the medial aspect of the base of the 2nd metatarsal
Pathognomonic for Lisfranc fx
