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CM2 Exam 2 > Topics in MSK- Jaynstein > Flashcards

Topics in MSK- Jaynstein Flashcards

(100 cards)

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1
Q

Necrosis of bone secondary to an interruption of blood supply

A

AVN (Avascular Necrosis)

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2
Q

What is a big RF for AVN?

A

Alcoholism (fat embooli)

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3
Q

What bones is AVN mc seen in?

A
  • Head of the femur or humerus
  • Scaphoid
  • Neck of the talus
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4
Q

What bones do you have to be reallllyyyy concerned about with AVN and other injuries because they are so important?

A

Scaphoid (hands)

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5
Q

Crescent sign

A

AVN

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6
Q

What are the sxs for AVN?

A

Progressive main over weeks to months with concerning history “and now I can’t tolerate it at all”

  • Early pain with activity/wt bearing, decreased ROM
  • Late pain at rest with sig. decreased ROM
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7
Q

What is the diagnostic test for AVN that you would do first? Is this a good test?

A

Xray

Dx is too late if seen on xray

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8
Q

What is a better test if you suspect AVN?

A

CT, MRI and bone scan

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9
Q

What is the tx for AVN?

A

Refer to ortho! Even the pts you suspect of having AVN with an initial neg work-up!

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10
Q

Tx for Hip/Shoulder AVN?

A

replacement

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11
Q

Tx for Scaphoid AVN?

A

Depends on degree – may attempt to surgically restore blood supply (debride and re-align) or bone graft

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12
Q

_________ denotes inflammation of bone and marrow and the common use of the term virtually always implies infection

A

Osteomyelitis

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13
Q

Mc organism involved in osteomyelitis?

A

S. aureus

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14
Q

Mc organism involved in osteomyelitis in elderly, drug users or those with GU tract infections?

A

E. coli, Pseudomonas, Klebsiella

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15
Q

What organism is salmonella and osteomyelitis?

A

Sickle cell

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16
Q

What does the workup for osteomyelitis include?

A

Labs – CBC, ESR, CRP, Lactate, blood cultures, wound culture, bone biopsy
• Ca, phos, alk phos are usually normal

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17
Q

What is the test of choice to dx osteomyelitis?

A

Bone bx

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18
Q

What is the preferred imaging for osteomyelitis?

A

MRI (or CT or bone scan) first if possible because bone changes lag infection by 10-14 days so Xray not the best

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19
Q

What is the treatment for osteomyelitis?

A

Surgical drainage + abx

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20
Q

How long do we give abx in patients with osteomyelitis?

A

6 weeks IV then PO

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21
Q

__________ osteomyelitis can

develop–usually in the immunocompromised and those with vascular insufficiency (DM)

A

Chronic

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22
Q

In diabetics with an infected foot ulcer, __________ should be considered and treated whenever bone is visible or you are able to contact bone with a sterile probe

A

Osteomyelitis

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23
Q

__________ are benign lesions of bone that in many cases represent developmental or reactive growths rather than true neoplasms

A

Osteomas

Most are exophytic growths attached to the bone surface

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24
Q

What is the most common location of osteomas?

A

Facial bones (nasal, ears) and skull

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25
T/F: Osteomas undergo malignant change?
F they are outgrowths of normal bone itself
26
__________ is an aggressive malignant mesenchymal tumor in which the cancerous cells produce bone matrix
Osteosarcoma
27
Common sites of osteosarcoma?
Knee is mc, also long bones and jaw "kid comes in with atraumatic knee pain for weeks"
28
Work up for osteosarcoma?
CBC,ESR,CRP,xrays,CT/MRI/PET scans
29
Tx for osteosarcoma?
Surgical resection, radiation, chemo
30
_________ is a benign cartilage growth that is attached to the underlying skeleton by a stalk
Osteochondroma
31
What is the way you dx Osteochondroma?
bone bx
32
Is a malignant neoplasm of bone that occurs predominantly in children - second most common malignancy after osteosarcoma
Ewing sarcoma
33
_____________ is a highly aggressive neoplasm which has been associated with a chromosomal translocation
Ewing sarcoma
34
Common sites of Ewing sarcoma
Pelvis and long bone
35
This disease classically presents with pain often accompanied by local inflammation, swelling/mass; fever is fairly common along with elevated ESR, anemia and leukocytosis
Ewing sarcoma
36
What imaging should you get for ewing sarcoma?
Xray
37
Xray of this disease shows onion peel appearance and a destructive lytic tumor
Ewing sarcoma
38
What is the definitive dx modality of ewing sarcoma>
bx
39
What is the tx for ewing's sarcoma?
chemo and surgery with/without radiation
40
____________ is the most common type of joint disease and arthritis
Osteoarthritis
41
________ is characterized by the progressive erosion of articular cartilage
Osteoarthritis
42
Osteoarthritis is typically __________ & __________
Unilateral and asymmertric
43
Where is osteoarthritis mc located?
Weight bearing joints and spine
44
A patient comes in with deep, achy pain that worsens with use and resolves with rest, morning stiffness < 30 mins, crepitus, and limitation of range of movement. What dx are you thinking of?
Osteoarthritis
45
On a joint exam for osteoarthritis, what may you find?
Effusion, crepitus, instability, decreased ROM also Heberden's nodes & Bouchard's nodes
46
Heberden's nodes make you think of what joints?
DIP
47
Bouchard's nodes make you think of what joints?
PIP
48
How do you diagnose osteoarthritis?
xray
49
What is the treatment for asymptomatic pt with osteoarthritis? What is the treatment for symptomatic pt with osteoarthritis?
Symptomatic – RICE, APAP, NSAIDs, wt loss, PT/exercise program Surgery – joint replacement
50
___________ or “brittle bone disease”is a group of hereditary conditions characterized by abnormal development of type I collagen
Osteogenesis imperfecta Characterized by multiple bone fractures which may occur in utero in the severe forms
51
This disease has 8 different types based on severity
Osteogenesis imperfecta
52
A patient presents with blue sclerae; hearing loss, and dental imperfections what disease is the most likely associated with?
Osteogenesis imperfecta
53
How do you confirm a dx of Osteogenesis imperfecta?
DNA analysis
54
Tx for Osteogenesis imperfecta?
* No cure * Aimed at fracture prevention * Bisphosphonates * Surgery – rodding * Treat pain!
55
____________ Is a term that denotes increased porosity of the skeleton resulting from a reduction in bone mass and increasing the risk of fracture
Osteoporosis
56
This disease is mc after menopause
Osteoporosis
57
What are some RFs or things that contribute to Osteoporosis?
Age, reduced physical activity, genetic, calcium/nutritional state, hormonal influences
58
Natural progression of osteoporosis refers to primary or secondary?
Primary
59
Bone loss secondary to another disease process refers to primary or secondary?
Secondary
60
Women over the age of _____ should be screened for osteoporosis
65
61
Postmenopausal women age ________ years with _____ risk should be screened for osteoporosis
60-65 with 1 risk
62
What are the risks of postmenopausal women and osteoporosis?
* Fracture after age 45years * Hip Fracture in a parent * Tobacco Abuse * BodyMassIndex<22 * Extended glucocorticoid use(>3months) **these patient should be screened earlier if they have an RF
63
What is the screening of choice for osteoporosis and what should not be used for screening?
DEXA Scan should be used and an xray shouldnt because you cant detect osteoporosis until 30-40% of bone mass is lost
64
What is the normal Bone range T score?
+1 to -1
65
What is the T score for osteopenia?
-1 to -2.5
66
What is the T score for osteoporosis
-2.5 or lower
67
When would we treat osteoporosis?
* s/p hip or vertebral fx * Osteopenia of femoral neck, hip, or spine (1-2.5) * Osteoporosis (2.5 or lower)
68
What is the tx for osteoporosis?
- Adress modifiable factors - Vit D and Ca - Bisphosphinates - Calcatonin
69
What treatment is not an intial therapy for osteoporosis and is contraindicated in pts with risk of breast or endometrial ca?
Estrogen therapy
70
WHat is the follow up for patients with osteoporosis?
Repeat DEXA • Nl or mild osteopenia every 15 years • Moderate osteopenia every 5 years • Severe osteopenia and osteoporosis every 2 years
71
____________ is a chronic disorder caused by the excessive breakdown and formation of bone, followed by disorganized bone remodeling that can result in enlarged, misshapen, and weak bones
Paget disease
72
This disease causes disorganized bone remodeling and happens midadulthood and becomes progressive thereafter
Paget disease
73
A patient with pagets disease may have elevated ________
serum alkaline phosphastase levels
74
What is the treatment of paget disease?
Bisphosphonates and calcitonin
75
This disease causes skeletal muscle cell break down and necrosis that leads to the release intra-cellular debris into the blood stream
Rhabdomyolysis
76
What electrolytes and protein are released into blood stream from Rhabdo?
Electrolytes (Ca2+ & K+) Proteins (myoglobin)
77
In an old patient who fell and has been there for 6 hours, what disease should we be concerned about?
Rhabdomyolysis
78
"tea" colored urine is in which disease
Rhabdomyolysis
79
What is the test of choice in Rhabdomyolysis?
- CPK will be elevated 5x normal - Electrolyte abnormalities - hyperkalemia, hyperphosphatemia, hypercalcemia (early) to hypercalcemia (late) - LFTs may be elevated - AKI labs - EKG
80
What is the definitive dx test for RHabdomyolysis
muscle bx
81
UA dip will be ____________ for blood without RBCs in what condition?
Postitive, rhabdo
82
What is the tx for rhabdo?
- Goals to TX shock and preserve kidney function - IV fluids around 6-12/hr - Manage electrolyte imbalances (K- albuterol, insulin, Ca++)
83
What are the sxs for soft tissue sarcoma?
Soft tissue mass- only 1/3 complain of pain
84
When would you do a workup for a soft tissue sarcoma?
required for ST masses that are symptomatic, progressing in size, larger than 5cm, or present for more than 4 weeks
85
What is the initial diagnostic test for soft tissue sarcoma if you don't know where else to go and to see if its something solid or fluid?
U/S
86
What is the imaging modality of choice for a soft tissue sarcoma?
MRI and bx is definitive
87
What is the tx for soft tissue sarcoma?
type directed (make sure you eval for metastatic disease- lung & liver)
88
A synovial out-pouching of fluid behind the knee that is benign but usually occurs after trauma
Baker's cyst
89
What are the sxs and exam finding of a baker's cyst?
Tenderness and "bump" and exam reveals palpable mass
90
How do you dx a baker's cyst?
with an U/S
91
How do you tx a baker's cyst?
* RICE * May aspirate large collections * Corticosteroid injections * Surgical excision
92
Benign synovial fluid collection that can occur from any joint but usually in the dorsum of the hand/wrist, or feet
Ganglion cyst
93
Tx for a ganglion cyst?
Nothing or surgical. Cut off is usually 5cm
94
This is a life/limb threatening emergency due to sufficient blood supply to muscles and nerves due to increased pressure within one of the body's compartments
Compartment syndrome
95
SHould you cast acute illness injuries?
NO because it needs to swell and cast prevents this
96
What are the 6 P's of compartment syndrome?
* Pain out of proportion - aggravated by passively stretching * Paresthesia - altered sensation, “pins & needles” * Pallor – decreased circulation, delayed cap refill * Poikilothermia – cold, blue * Paralysis – late finding * Pulselessness – late finding
97
WHat is a normal compatment pressure?
• NL < 10mmHg
98
What is a concerning compartment pressure?
• 10-20mmHg concerning
99
What is an emergent compartment pressure?
• > 30 mmHg emergent
100
Treatment for compartment syndrome?
* Splint * Elevate * Fasciotomy (<6hrs) * NO ICE!

CM2 Exam 2 (8 decks)

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