D\'s Musculosketal Step 2

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JCremer
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D\'s Musculosketal Step 2
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2010-08-08 13:55:01
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Musculoskeletal
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  1. Thenar mm atrophy
    Carpel Tunnel
  2. Risk factors for carpal tunnel
    • Pregnancy
    • Overuse
    • RA
    • DM
    • Acromegaly
    • Hypothyroidism
  3. Ant dislocation of the shoulder damages
    Axillary nerve
  4. Causes of posterior dislocation of the shoulder
    Seizures & lightening & electrical shock
  5. Unable to extend arm & shoulder numbness following shoulder dislocation.
    • Deltoid malfxn
    • Axillary N injury
  6. + Lachman's test
    ACL tear
  7. Unhappy triad
    • MCL
    • ACL
    • Medial meniscus
  8. Meniscus injuries are commonly associated with
    ACL injury
  9. Pain, pallor, poikilothermia, pulselessness, paresthesia, paralysis
    Compartment Syndrome
  10. Emergent fasciotomy for compartment syndrome if
    • Pressures  30 mmHg
    • Pressures within 20mmHg of diastolic BP
  11. Fall on outstretched hand, "dinner fork" appearance
    Colles fx
  12. Bones involved in a Colles fx
    Distal radius +/- distal ulna
  13. Treatment of Colles fx
    • Closed reduction
    • Long arm cast
    • Possible sx
  14. Snuffbox tenderness, fall on radially deviated outstretched hand
    Scaphoid fx
  15. Treatment of a scaphoid fx
    • Thumb spica cast
    • Possible sx
  16. Punching hard obj or surface with strong force
    Boxer's fx
  17. Treatment of Boxer's fx. Bones involved.
    5th metacarpal neck

    • Closed reduction
    • Ulnar gutter splint*
    • Surgical pinning
  18. Nerve involved with trauma to humerus
    Radial nerve injury
  19. Monteggia fx
    • Ulnar diaphyseal fx
    • Dislocation of radial head
  20. Treatment of monteggia fx
    • Surgical repair of Ulna
    • Closed redxn of radial head
  21. Galeazzi fx
    • Radial diaphyseal fx
    • Distal radial ulnar joint dislocation (druj)
  22. Treatment of Galeazzi fx
    • Sx
    • Cast forearm in supination to maintain reduction of druj
  23. Bones involved in hip fx
    Femoral head or neck
  24. MC wrist fx, particularly in osteoporotic bone
    Colles fx
  25. Fx associated with increased risk of AVN
    • Scaphoid fx
    • Hip fx
  26. Fx not seen on xray for 1-2 wks after injury
    Scaphoid fx
  27. MC carpal fx
    Caphoid fx
  28. Fight bite, open teeth wound requiring sx exploration to r/o tendon involvement
    Boxer's fx
  29. Fx with wrist drop, weakened thumb abduction
    Humerus fx damaging radial n
  30. This fx has high risk of AVN & DVT, pts should be anticoagulated!
    Hip fx
  31. Fx with increased risk of fat embolism
    Femur
  32. Fx with increased risk of compartment syndrome
    Tibial fx
  33. Fx with high risk of major blood loss
    Pelvic fx
  34. 1st step in suspected pelvic fx
    Close pelvis ASAP via binder!
  35. After pelvic binder in pelvis fx next step?
    US
  36. US of pelvic fx shows fluid. Next step
    DPL
  37. DPL of pelvic fx shows blood
    Take to OR immediately for laparotomy!
  38. DPL of pelvic fx shows urine. Next step
    OR when available
  39. DPL of pelvic fx shows nothing. Next step.
    Angiogram for r/o of retroperitoneal hematoma
  40. Suspect ruptured thoracic aorta in fx of what?
    • Rib 1-2s fx
    • Scapular fx
    • Sternal fx
  41. Back pain that radiates. Worse with walking and standing.
    Spinal stenosis
  42. Back pain that radiates worse at rest, better with activity
    Ankylosing spondyloitis
  43. Backpain with urinary retention, saddle anesthesia, decreased rectal tone. Dx? Tx?
    Cauda Equina syndrome

    • Emergency sx decompression!
    • IV corticosteriods
    • Radiation if neoplasm
  44. Sensory deficit of lateral foot
    S1 root

    Achilles reflex
  45. Sensory deficit of lateral lower leg, first web space
    L5
  46. Sensory deficit of medial leg
    L4

    Patellar reflex
  47. Sensory deficit of axilla
    T1
  48. Sensory deficit of 4th & 5th fingers, medial forearm
    C8
  49. Sensory deficit posterior forearm
    C7

    Triceps reflex
  50. Sensory deficit of lateral forearm
    C6

    Brachioradialis reflex
  51. Sensory deficit of anterior shoulder
    C5

    Biceps reflex
  52. Motor deficit of biceps & deltoid
    C5

    Biceps reflex
  53. Motor deficit of biceps & wrist extensors
    C6

    Brachioradialis reflex
  54. Motor deficit of triceps, wrist flexors, finger extensors
    C7

    Triceps reflex
  55. Motor deficit of finger flexors
    C8
  56. Motor deficit interossei of fingers
    T1
  57. Motor deficit of tibalis anterior (foot dorsiflexion)
    L4

    Patellar Reflex
  58. Motor deficit of extensor hallucis longus (first toe dorsiflexion)
    L5
  59. Motor deficit of peroneus longus & brevis (foot eversion) gastrocnemius (foot plantarflexion)
    S1

    Achilles reflex
  60. Define osteoporosis
    • Decreased bone density
    • Normal mineralization.

    Decreased bone formation or increased resorption of bone
  61. Endocrine Risks for osteoporosis
    • Hyperparathyroidism
    • Hyperthyroidism
    • Cushing
    • Hypogonadism
  62. Treatment for osteoporosis
    • Bisphosphonates: clastic,  bone density,  fx risk
    • SERM:  bone density
    • Pulsatile PTH (teraperatide): build bones
    • Prevention!
  63. Define gout
    Peripheral monoarthritis caused by sodium urate crystals in joints
  64. Needle shaped, negatively birefringent crysts
    Gout
  65. Acute gout treatment
    • Colchicine
    • Corticosteriods
    • Indomethacin (NSAIDs)
  66. Chronic Gout tx
    • Probenecid
    • Allopurinol
  67. Define pseudogout
    Calcium pyrophosphate dihydrate deposition in joints
  68. Positively birefringent, rhomboid crystals
    Pseudogout
  69. Treatment of pseudogout
    NSAIDs & colchicine
  70. Xray of pseudogout
    Chondrocalcinosis
  71. Define pagers
    Overactive osteoclasts & osteoblasts

    Excessive bone turnovee & disorganized bony architecture
  72. Fx, tibial bowing, kyphosis, increased cranial diameter, deafness
    Pagets dz
  73. Labs of Pagets dz
    •  ALP
    •  urine hydroxyproline
    • Normal calcium & phosphorus
  74. Treatment of Pagets dz
    • Bisphosphonates
    • Calcitonin

    Only tx if symptomatic!!
  75. Define osteogenesis imperfecta
    Defective production of type I collagen
  76. Freq fx from minimal trauma, blue sclera, joint hypermobility, possible deafness
    Osteogenesis imperfecta
  77. Treatment of osteogenesis imperfect
    • Sx
    • Bisphosponates
  78. Define osteopetrosis
    Increased bone density caused by impaired osteoclast activity
  79. Fx, blindness, deafness, neuro sx, impaired fx hearing
    • Osteopetrosis
    • "rocklike"
  80. Lab in osteopetrosis
    hgb & hct

    "sandwich vertebrae"
  81. My hat no longer fits
    • Pagets
    • Osteopetrosis
  82. Waiter's tip
    Erb Duchenne

    Superior trunk injury
  83. Cause of Erb Duchenne
    • Birth
    • Shoulder dystocia
  84. Claw hand, lumbrical weakness
    Ulnar nerve
  85. Wrist drop
    Posterior cord or radial nerve
  86. Claw hand, horner's
    Klumpke's

    Posterior or medial cords
  87. MCC septic arthritis in young adults
    N. Gonorrhea
  88. If you suspect septic joint
    Aspirate!
  89. MCC septic joint overall
    Staph aureus
  90. Sudden onset of joint pain, several days of migratory polyarthralgia, red, tender swollen joint
    Septic joint
  91. Joint aspiration of septic joint
    •  50,000 leukocytes
    • High neutrophils
    • Low glucose
    • Positive cx
  92. Joint aspirate of osteoarthritis/trauma
    2,000 leukocytes

    If trauma may see hemarthrosis
  93. Joint aspirate of inflammatory arthropathies
    5-50,000 leukocytes

    • Gout: needle, negatively birefringent
    • Pseudgout: rhomboid, positiely birefringent
  94. Labs for septic joint
     ESR,  CRP,  WBC
  95. Treatment for septic joint
    I & D (unless N. Gonorrhea)
  96. N. Gonorrhea Septic joint tx
    IV ceftriaxone & doxycycline
  97. MRSA septic joint tx
    • Bactrim & rifampin
    • Clinda & rifampin
    • Linezolid
  98. MC cause of osteomyelitis
    Staph Aureus
  99. Labs of osteomyelitis
    •  WBC, ESR, CRP
    • Cx
  100. 3 tests for osteomyelitis
    • MRI: bone edema
    • Bone Scan:  uptake after 72 hrs
    • Tagged WBC scan: most sensitive!

    Xray not helpful initially (show signs of infxn after 10 days)
  101. Treatment for osteomyelitis
    • IV antibiotics 4-6wks- vanc
    • I & D abscess
  102. Cause of Lyme dz
    Borrelia Burgdorferi via ixodes tick
  103. Early stage of Lyme dz
    Chills, fatigue, arthralgia, ha, erythema chronicum migrans, fever
  104. Early disseminated stage of Lyme dz
    • Myocarditis (wks-mos after infxn)
    • Cardiac arrythmias
    • Heart block
    • Bell's palsy
    • Sensory motor neuropathy
    • Asepyic meningitis
    • Meningoencephalitis
  105. Late disseminated stage of Lyme (mo's-yrs)
    • Chronic synovitis
    • Monoarthritis
    • Oligoarthritis
    • Subacute encephalopathy
    • Polyneuropathy
  106. Tests for Lyme dz
    • ELISA
    • Western Blot
  107. Treatment for Lyme dz
    • Doxycycline
    • Amoxicillin
    • Ceftriaxone
  108. define OA
    Chronic, noninflammatory joint degeneration involving articular cartilage deterioration
  109. Joint creptius. Joint stiffeness & pain worse with activity & wt bearing. Relieved with rest
    OA
  110. Heberden nodes
    Bony protuberance of DIP
  111. Bouchard nodes
    Bony protuberance of PIP
  112. Xray of OA
    • Ostephyte
    • Joint space narrowing
    • Subchondral bone sclerosis
    • Subchondral bone cyst
  113. Treatment of OA
    • Heat
    • Analgesics-NSAIDs
    • Steriod or hyalyronan injxn
    • Schefuled tylenol
    • Joint replacement
    • Activity modification
    • Wt loss
    • PT
  114. Bone on bone radiograph
    OA
  115. Define RA
    Chronic inflammatory disorder with infiltration of synovial joints by inflammatory cells & progressive erosion of cartilage & bone
  116. HLA type with RA
    HLA DR4
  117. Synovial hypertrophy with panes formation
    RA
  118. Symmetric polyarthropathy
    RA
  119. Assymmmetric polyarthropathy
    OA
  120. Morning stiffness with pain
    • RA
    • AS
  121. Swan neck deformities
    • RA
    • Flexed DIP & hyperextended PIP
  122. Boutonnière deformities
    • RA
    • Flexed PIP
  123. Best test for RA
    Anti-CCP
  124. Antibodies + in RA
    • RF
    • ANA
    • anti-CCP
    • HLA DR4
    • ESR
  125. Soft tissue swelling, joint space narrowing, marginal bony erosions, subluxation
    RA
  126. Treatment of RA
    • Initial: NSAIDs, PT
    • Mild: sulfasalazine, hydroxychloroquine, analgesic
    • Moderate: mtx, anti-TNF, steriods
    • Severe: anti-TNF, steriods
  127. Anti-Jo 1 antibodies
    • PM
    • DM
  128. Anti-scl 70 ANA
    Scleroderma
  129. Anti centromere antibodies
    CREST syndrome
  130. Anti RNP ANA
    MCTD
  131. Anti Ro (SSA)
    Sjogrens
  132. Anti La (SSB)
    Sjogrens
  133. HLA B27 & seronegative (RF)
    • P: Psoriatic Arthritis
    • A: Ankylosing Spondylitis
    • I: IBD
    • R: Reiter's
  134. Anti-histone ab
    Drug induced lupus
  135. Anti- dsDNA
    SLE with renal dz
  136. Anti-sm antibodies
    SLE
  137. False Positive RPR
    SLE
  138. Drugs causing SLE
    • Hydralazine
    • Procainamide
    • INH
    • Methyldopa
    • Quinidine
    • Chlorpromazine

    Symptoms resolve when drug dc!
  139. SLE symptoms
    • D: Discoid rash
    • O: Oral Ulcers
    • P: Photosensitivity
    • A: Arthritis
    • M: Malar Rash
    • I: Immuno (sm,DNA,ro,la,histone)
    • N: Neuro changes
    • E: Elevated ESR

    • R: Renal
    • A: ANA +
    • S: Serositis-pleural, pericard
    • H: Heme- hemolytic anemia, thrombocytopenia, leukopenia
  140. Treatment if SLE
    • Avoid sun
    • NSAIDs
    • Hydroxychloroquine
    • Corticosteriods
    • Immunosuppresants
    • Anticoagulants
  141. What SLE antibodies increase risk of miscarriage and fetal death?
    • Lupus anticoagulant
    • Anticardiolipin antibodies
  142. Define Polymyositis
    Progressive sytemic dx with skeletal mm inflammation
  143. Define dermatomyositis
    PM + skin manifestations
  144. Symmetric progressive mm weakness in legs first, myalgia, atrophy,
    PM
  145. Skin manifestations of DM
    • Red heliotrophic rash
    • Shawl sign
    • Gottron's papules
  146. Labs for DM/PM
     CK, aldolase, LDH, AST, ALT, creatinine

    Anti Jo 1
  147. Mm biopsy for DM/PM show
    DM: inflammatory cella surrounding mm fasicles

    PM: Inflammatory cells within mm fascicles
  148. EMG of PM & DM
    Spontaneous fibrillations
  149. Treatment of DM & PM
    • High dose corticosteriods
    • Mtx or azathioprine (4-6wks)
    • IVIG other immunosuppresants if needes
  150. Complications of DM & PM
    • Interstitial Lung dz
    •  risk of malignancy 
  151. PMR define
    Rheumatic dz with multiple sites of mm pain

    Shoulder & Pelvic girdle
  152. Difficult to get out of bed, malaise, unexpected wt loss, mm strength maintained
    PMR
  153. PMR associated with
    GCA
  154. Labs of PMR
     ESR
  155. MRI of PMR
     signal at tendon sheaths & synovial tissues outside of joints
  156. Treatment of PMR
    • Low dose corticosteriods
    • Tapered!
  157. Chronic pain in mm without apparent inflammation. Associated with depression, anxiety, IBD
    Fibromylagia
  158. Treatment for fibromylagia
    • Pregabalin
    • Duloxetine
    • Minacipram
    • Stretching
    • Antidepressants
    • PT
  159. AS define
    Chronic inflammatory dz of spine & pelvis

    • Worse in am & with inactivity
    • Better as day progresses
  160. Bamboo spine
    AS
  161. Treatment of AS
    • PT
    • NSAIDs
    • Exercise
    • Sulfasalazine
    • Mtx
    • Anti-TNF
  162. Assymetric joint pain & stiffness, worse in am, better with activity, pencil in cup deformity
    Psoriatic Arthritis
  163. Treatment of psoriatic arthritis
    • NSAIDs
    • Mtx
    • Sulfasalazine
    • Anti TNF
  164. Scleroderma defined
    Chronic multisystem sclerosis with accumulation of connective tissue, skin thickening, visceral involvement
  165. CREST syndrome
    • C: Calcinosis, anti Centro ab
    • R: Raynaud's
    • E: Esophageal dysmotility
    • S: Sclerodactyl
    • T: Telangiectasia
  166. Treat Raynaud's
    • Avoid exposure
    • Nefedipine
    • ASA
  167. + anti ribonucleoprotein (RNP) ANA
    MCTD
  168. MCTD
    Overlapping features SLE, scleroderma, PM
  169. Sjogren's syndrome defined
    AI disorder with lymphocytic infiltration of exocrine glands

    Dry  Dry 
  170. Sjogren's syndrome antibodies
    • Anti SSA Ro
    • Anti SSB La
  171. MC primary malignant bone tumor
    Osteosarcoma
  172. Risk factors for Osteosarcoma
    • Pagets
    • P53 gene mutation
    • Familial retinoblastoma
    • Radiation
    • Bone infarcts
  173. What denotes a poor prognosis in Osteosarcoma
     LDH
  174. Sunburst pattern & codman's triangle
    Osteosarcoma
  175. MC bone tumor in adults
    Mets
  176. Mets to bone from?
    • Lung
    • Breast
    • Prostate
    • Renal
    • Lymphoma
    • Thyroid
  177. What finding suggests mets on h&p
    • Deep bone pain
    • Fx following minor trauma
  178. Malignant cartilage tumor in kids with codman's triangle & onion skinning on radiograph
    Ewing's sarcoma
  179. Dactomycin is used to treat what kind of children's malignancy
    • Wilms
    • Ewings
  180. MC adult bone tumor
    Multiple myeloma
  181. MC benign bone tumor
    In metaphysis of long bones
    Osteochondroma
  182. DDH defined:
    Perinatal displacement of femoral head from acetabulum
  183. Risk factors for DDH
    • Female
    • 1st born
    • Breech
    • Oligohydramnios
  184. Signs of DDH
    • + Barlow's
    • + Ortolani's
    • Galeazzi's
    • + Trendenlenburg
    • Asymetric skin folds
  185. Galeazzi's sign
    Knees at unequal heights when hips amd knees flexed

    For DDH
  186. MC method of imaging for DDH
    Ultrasound
  187. Treatment DDH
    Pavlik harness
  188. SCFE
    Separation through growth plate of femoral epiphysis from metaphysis
  189. Risk factors for SCFE
    • Adolescent
    • Obese
    • Black
    • Hypothyroid
  190. Xray show "scoop of ice cream falling off cone"
    SCFE

    (posterior & medial displacement of femoral head from femoral metaphysis)
  191. Obese black kid with limp
    SCFE
  192. Treatment of SCFE
    • Sx pinning
    • Wt bearing restrictions

     risk of AVN
  193. Define rickets
    Impaired calcifaction of bone in kids bc of deficient vit D intake, absorption or metabolism or impaires phosphate absorption
  194. Rickets aka what in adults
    Osteomalacia
  195. Bowed legs, bone pain, delayed walking, soft skull bones
    Rickets
  196. Labs in rickets
    • ALP, PTH
    •  Phosp, Ca,
  197. Translucent lines in bones, widening of phases, flat skull, enlarged costal cartilage on xray
    Rickets
  198. Treatment of rickets
    • Phosph
    • Vit D
    • 1, 25 dihydroxycholecalciferol- impaired vitamin absorption
  199. JRA subtypes
    • Pauciarticular
    • Polyarticular
    • Systemic
  200. JRA with blindness from uveitis or iridocyclitis
    Pauciarticular
  201. JRA with symmetric joint involvement, growth retardation
    Polyarticular
  202. Osgood Sclatter defined
    Inflammation of bone cartilage interface of the tibial tubercle
  203. Mc fx in kids. Tx.
    Clavicle

    • No treatment needed
    • Evaluate for brachial plexus injury
    • PT
  204. Mid 1/3 clavicle fx treatment
    • Figure of 8 strap or
    • Sling arm
  205. Define nursemaids elbow
    Radial head subluxation

    (pulling & lifting on hand)
  206. Treatment for nursemaids elbow
    Manual reduction via supination of arm & dlexion of elbow
  207. 2 causes of limp in kids
    • SCFE- sx!
    • Legg Calve Perthes- nonsx!
  208. Define Legg Calve Perthes (LCP)
    AVN of capital femoral epiphysis
  209. Xray with asymmetric hips, affected femoral head appears small with sclerotic bone & widened joint space
    LCP
  210. Treatment of LCP
    Contain hip within acetabulum via bracing
  211. Treatment of club foot
    • Serial casting
    • Sx to relieve contractures
  212. Treatment of scoliosis
    • Small: observe
    • Moderate: bracing
    • Severe: surgery
  213. Duchenne's muscular dystrophy defined:
    • X linked
    • Deficency of dystrophin
  214. Becker's muscular dystrophy
    Symptoms less severe & progresduon is slower
  215. Gower's maneuver, difficulty standing up & walking, pseudohypertrophy in calf
    Duchenne's
  216. Definite dx of duchenne's
    Mm biopsy!!

    Mm fiber degeneration & fibrosis & basophilic fibers
  217. EMG of duchenne's
    • Polyphasic potentials
    • Increased fiber recruitment
  218. Spondylolisthesis
    Forward anterior slip of vertebrae
  219. Palpable step of on physical exam
    Spondylolisthesis

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