Ortho- MSK Flashcards
(77 cards)
1
Q
Avascular Necrosis- pathophysiology
A
Necrosis of bone secondary to an interruption of blood supply
2
Q
Avascular Necrosis- cause
A
Immunosuppression Alcoholism Long-term steroid use Trauma IVDU Indwelling catheters Sickle Cell
3
Q
Avascular Necrosis- S/S & PE
A
Any bone - Head of femur or humerus, scaphoid, neck of talus
Progressive pain - weeks to mons
- early - pain w/ acitiv or weight bearing, dec ROM
- Late - pain at rest w/sig dec ROM
4
Q
Avascular Necrosis- diagnosis
A
Early xrays - nl
- if neg, move on to CT/MRI to get diagnosis
Later xray - bone destruction/collapse
CT, MRI, bone scan - reveal AVN
5
Q
Avascular Necrosis- treatment
A
Refer Ortho!!
Directed at bone involved
- Hip - replacement
- Scaphoid - maybe surgery or bone graft
6
Q
Osteomyelitis- pathophysiology
A
Inflammation of bone and marrow
Long bones and vertebral bodies
Toes/feet - DM
7
Q
Osteomyelitis- cause
A
Most common: Staph aureus E. coli, pseudomonas, Klebsiella - GU tract infections or IV drug users H flu, Group B strep - neonatal Salmonella - sickle cell
8
Q
Osteomyelitis- epidemiology
A
<20, > 50 y Children IVDU DM Sickle cell Open wounds
9
Q
Osteomyelitis- S/S & PE
A
Malaise Fever Chills Leukocytosis Throbbing pain - on site Skin - may show infection Pain w/ active and passive ROM
10
Q
Osteomyelitis- diagnosis
A
MRI - gold
Bone scan, CT
11
Q
Osteomyelitis- labs & imaging
A
CBC ESR CRP Lactate Blood culture Wound culture Bone bio
Ca, phos, alk phos - NL
Xray - STS, periosteal elevation, cortical erosion/lysis -> necrotic bone
- seen by 10-14days - lag behind infection
- 30-50% gone by time shows up
12
Q
Osteomyelitis- treatment
A
Abx and surgical drainage
- wait for culture sensitivites
- IV 6w -> PO - Vanco+Ceftriaxone or Cipro or Cefepime
Chronic:
- sinus tract breaks through skin - drains externally
- abx vs open debridement
- DM infected foot ulcer - consider osteomyelitis
13
Q
Osteoma- pathophysiology
A
Benign lesions of bone - developmental or reactive growths
Exophytic growths - attached to bone surface
14
Q
Osteoma- epidemiology
A
40-50yo
15
Q
Osteoma- S/S & PE
A
Facial bones - nasal, ears
Skull
Found incidentally
Resemble nl bone
Slow growing tumors - little clinical significance
- obstruction or cosmetic problem
NO Malignant change
16
Q
Osteoma- treatment
A
Refer Ortho!
17
Q
Osteosarcoma- pathophysiology
A
Aggressive malignant mesenchymal tumor
- cancerous cells produce bone matrix
18
Q
Osteosarcoma- epidemiology
A
MOST COMMON IN CHILDREN
<20y
19
Q
Osteosarcoma- S/S & PE
A
Long bones and jaw
Painful and progressively enlarging masses
Pathologic fracture - 1st symptom
20
Q
Osteosarcoma- labs & imaging
A
CBC ESR/CRP Xray CT/MRI/PET - 20% will have mets at dx
21
Q
Osteosarcoma- treatment
A
Surgery
radiation
Chemo
22
Q
Osteochondroma- pathophysiology
A
Benign cartilage growth - attached to underlying skeleton by a stalk
- single or multiple
23
Q
Osteochondroma- cause
A
Hereditary
24
Q
Osteochondroma- epidemiology
A
10-30 y - Metaphysis of long tubular bones
25
Osteochondroma- S/S & PE
Slow-growing masses
Painful - if impinge nerve
Stop growing at time of growth plate closure
26
Osteochondroma- diagnosis
Biopsy - benign vs malignant
27
Ewing Sarcoma- pathophysiology
Malignant neoplasm of bone
Chromosomal translocation
28
Ewing Sarcoma- epidemiology
Children - sec most common
M=F
10-20 y
29
Ewing Sarcoma- S/S & PE
Pelvis and proximal ends of long bones
pain w/ local inflammation
Swelling/mass
Fever
30
Ewing Sarcoma- diagnosis
Xray - onion peel appearance
| Biopsy - definitive
31
Ewing Sarcoma- labs & imaging
ESR
Anemia
Leukocytosis
CT, MRI, bone scan
32
Ewing Sarcoma- treatment
Chemo and surgery
| Radiation
33
Osteoarthritis- pathophysiology
Most common joint disease and arthritis
Progressive erosion of articular cartilage
34
Osteoarthritis- cause
No cause
35
Osteoarthritis- epidemiology
>40
>65
Obesity
H/o trauma
Overuse
36
Osteoarthritis- S/S & PE
Weight bearing joints and spine
Deep, achy pain - worse w/ use
Morning stiffness <30min
Crepitus
Limited ROM
No systemic symptoms
Joints - effusion, repitus, instability dec ROM
- Heberden's nodes - DIP
- Bouchard's nodes - PIP
37
Osteoarthritis- diagnosis
Clinical
| Xray - nonuniform joint space narrowing, osteophytes
38
Osteoarthritis- treatment
Symptomatic - RICE, APAP, NSAIDs, weight loss, PT, exercise
| Surgery - joint replacement
39
Osteoarthritis- prevention
None
40
Osteogenesis imperfecta- pathophysiology
Brittle bone disease
Hereditary conditions - abnormal development of type 1 collagen
- 8 types
- most - autosomal dominant
41
Osteogenesis imperfecta- S/S & PE
```
Multiple bone fractures - in utero
Blue sclerae
Hearing loss
Dental imperfections
Debilitating
```
42
Osteogenesis imperfecta- diagnosis
Clinical
| - DNA analysis
43
Osteogenesis imperfecta- treatment
```
No cure
Fracture prevention
Bisphosphonates
Surgery
Treat pain
```
44
Osteoporosis- pathophysiology
Inc porosity of skeleton -> reduction of bone mass -> inc fracture
1. Age - bone-forming cells dimmish capacity to make bone
2. Reduced physical activity - mechanical forces import stimuli for bone remodeling
3. Genetic - Vit D receptors
4. Ca Nutrional state - insuff Ca intake puts them at a later risk
5. Hormonal - postmenopausal - hormone dependent acceleration of bone loss
- estrogen protects
45
Osteoporosis- cause
```
Primary - natural
Secondary - 2nd to another disease
- MM
- Pagets
- Hyperparathyroidism
- Graves/ hyperthryoidism
- Nutritional - vit D, alcoholism, anorexia, malnutrition
- Chronic disease
- Meds- steroids, anticonvulsants, PPIs, loop diuretics
```
46
Osteoporosis- epidemiology
Peak bone mas achieved during young adulthood
Modifiable - alcoholism, tobacco, low body mass, sedentary lifestyle, low vit D and Ca intake, chronic corticosteroid use
47
Osteoporosis- S/S & PE
Vertebral fractures, lumbar lordosis, kyphoscoliosis
48
Osteoporosis- diagnosis
```
Screening:
All women >65, men > 70
Postmenopausal women 60-65 w/ 1 risk:
- fracture after age 45
- Hip fracture
- Tobacoo
- BMI
- Extended glucocorticoid
Indications in Men over age 50 and postmenopausal women at any age
- Non trauma fracture
- incidental findings of osteopenia on Xray
- Glucocorticoid use
- hyperparathyroidism
- Multiple osteoporosis risk factors
```
49
Osteoporosis- labs & imaging
```
CBC
CMP
Ca
Phos
TSH
Vit D
```
Xray - pathologic fractures, loss of density
- not used for screening!
- doesn't detect until 30-40%
DEXA
1 to -1 - normal
-1 - -2.5 - Osteopenia
>-2.5 - osteoporosis
50
Osteoporosis- treatment
Treat- hip or vertebral fx, osteoporosis of femoral neck, hip or spine (T-1--2.5), Osteoporosis >-2.5
Modify factors
Vit D and Ca - 1st line!!
- inc bone density, dec bone loss
Bisphosphonates - inc bone density and prevent loss
- actonel, boniva, fosamax, reclast
Calcitonin - inhibits osteoclastic bone reabsorption
Estrogen - not great, but provides protection
- contra- w/ risk of breast or endometrial ca
```
F/U
Repeat Dexa:
- nl or mild osteopenia - 15 y
- mod osteopenia - 5 y
- severe osteopenia - 1 y
- Osteoporosis - 2y
```
51
Paget Disease (Osteitis Deformans)- pathophysiology
Excessive breakdown and formation of bone
| -> disorganized bone remolding -> enlarged, misshapen, weak bones
52
Paget Disease (Osteitis Deformans)- epidemiology
Middle adult
| Genetic
53
Paget Disease (Osteitis Deformans)- S/S & PE
Skull, spine, pelvis, long bones
Asymptomatic
-> pain, deformity
HA, hearing & visual disturbances, enlargement of head, bowing and chalk stick-type fractures of legs
54
Paget Disease (Osteitis Deformans)- labs & imaging
Alk phos - inc
55
Paget Disease (Osteitis Deformans)- treatment
Bisphosphonates
| Calcitonin
56
Rhabdomyolysis- pathophysiology
Skeletal muscle cell breaks down and necrosis -> release intracellular debris in blood stream
--> inc Ca, K, Myoglobin
57
Rhabdomyolysis- epidemiology
```
Exertional
Crush injury - compartment syndrome
Seizures
Hyperthermia
Drugs - STATIN
Infection
Genetics
Found down
```
58
Rhabdomyolysis- S/S & PE
```
None
Muscle pain
Weakness/fatigue
Swelling
Low-grade fever
Nausea & Vomiting
Confusion
Cardiac Dysfunction
Tea colored urine
Dec urine output
```
59
Rhabdomyolysis- diagnosis
Muscle biopsy - don’t wait to treat
60
Rhabdomyolysis- labs & imaging
```
CPK - inc
Hyperkalemia, hyperphosphatemia, hypocalcemia (early), hypercalcemia (late)
UA - pos blood w/out RBC
LFT - inc
AKI labs
EKG
```
61
Rhabdomyolysis- treatment
```
Treat shock and preserve kidney function
IV FLUIDS!!!!
- 6-12L/24hr
- 200-300ccs urine per hour
- Cautin - overload syndromes - CHF
- Furosemid - Lasix
```
Manage electrolyte imbalances - K, albuterol, insulin, Va
Kidney management - hemodialysis?
62
Rhabdomyolysis- prognosis
w/ trauma - 20%
ICU admit w/o renal impairment - 20%
ICU admit w/ renal impairment - 60%
Survive - near full renal recov
63
Rhabdomyolysis- complications
```
Kidney failure
Compartment syndrome
Volume depletion shock
Disseminated intravascular coag
CV dysrhythmia
```
64
Soft Tissue Sarcomas- pathophysiology
Arise from muscle, fat, tendon blood vessels, fibrous tissue
- anything bone
Many types:
- fibrosarcoma, leiomyosarcoma, liposarcoma, kaposi sarcoma
65
Soft Tissue Sarcomas- S/S & PE
Soft tissue mass - 1/3 w/pain
66
Soft Tissue Sarcomas- diagnosis
MRI
| Biopsy - definitive
67
Soft Tissue Sarcomas- labs & imaging
W/Up required for: symptomatic, progressing in size, >5cm, or present >4w
68
Soft Tissue Sarcomas- treatment
Type directed
| Eval for mets - lung and liver!!
69
Baker's Cysts- pathophysiology
Synovial fluid out-pouching
b/t gastric and semimembranosus muscles
Benign - after trauma
70
Baker's Cysts- S/S & PE
Tenderness and bump
Palpable mass
71
Baker's Cysts- diagnosis
U/S
72
Baker's Cysts- treatment
RICE
Aspirate - larg
Corticosteroid injections
Surgical
73
Compartment Syndrome- pathophysiology
Life/limb threatening emergency
| Insufficient blood supply to muscles and nerves due to inc pressure w/in one of body's compartments
74
Compartment Syndrome- cause
```
Trauma
Crush injury
Burns
Electrocution
Cast
```
75
Compartment Syndrome- S/S & PE
Forearm and calf
```
6ps:
Pain out of proportion
Paresthesia
Paralysis
Poikilothermia
Pallor
Pulselessness
```
76
Compartment Syndrome- diagnosis
```
Clinical
Compartment pressure
- 10 = nl
- 10-20 = concerning
- >30 = emergent
```
Xray - hx suggestive
77
Compartment Syndrome- treatment
Splint
Elevate
Fasciotomy - <6hr
NO ICE!!!
