-
Thenar mm atrophy
Carpel Tunnel
-
Risk factors for carpal tunnel
- Pregnancy
- Overuse
- RA
- DM
- Acromegaly
- Hypothyroidism
-
Ant dislocation of the shoulder damages
Axillary nerve
-
Causes of posterior dislocation of the shoulder
Seizures & lightening & electrical shock
-
Unable to extend arm & shoulder numbness following shoulder dislocation.
- Deltoid malfxn
- Axillary N injury
-
+ Lachman's test
ACL tear
-
-
Meniscus injuries are commonly associated with
ACL injury
-
Pain, pallor, poikilothermia, pulselessness, paresthesia, paralysis
Compartment Syndrome
-
Emergent fasciotomy for compartment syndrome if
- Pressures 30 mmHg
- Pressures within 20mmHg of diastolic BP
-
Fall on outstretched hand, "dinner fork" appearance
Colles fx
-
Bones involved in a Colles fx
Distal radius +/- distal ulna
-
Treatment of Colles fx
- Closed reduction
- Long arm cast
- Possible sx
-
Snuffbox tenderness, fall on radially deviated outstretched hand
Scaphoid fx
-
Treatment of a scaphoid fx
- Thumb spica cast
- Possible sx
-
Punching hard obj or surface with strong force
Boxer's fx
-
Treatment of Boxer's fx. Bones involved.
5th metacarpal neck
- Closed reduction
- Ulnar gutter splint*
- Surgical pinning
-
Nerve involved with trauma to humerus
Radial nerve injury
-
Monteggia fx
- Ulnar diaphyseal fx
- Dislocation of radial head
-
Treatment of monteggia fx
- Surgical repair of Ulna
- Closed redxn of radial head
-
Galeazzi fx
- Radial diaphyseal fx
- Distal radial ulnar joint dislocation (druj)
-
Treatment of Galeazzi fx
- Sx
- Cast forearm in supination to maintain reduction of druj
-
Bones involved in hip fx
Femoral head or neck
-
MC wrist fx, particularly in osteoporotic bone
Colles fx
-
Fx associated with increased risk of AVN
-
Fx not seen on xray for 1-2 wks after injury
Scaphoid fx
-
-
Fight bite, open teeth wound requiring sx exploration to r/o tendon involvement
Boxer's fx
-
Fx with wrist drop, weakened thumb abduction
Humerus fx damaging radial n
-
This fx has high risk of AVN & DVT, pts should be anticoagulated!
Hip fx
-
Fx with increased risk of fat embolism
Femur
-
Fx with increased risk of compartment syndrome
Tibial fx
-
Fx with high risk of major blood loss
Pelvic fx
-
1st step in suspected pelvic fx
Close pelvis ASAP via binder!
-
After pelvic binder in pelvis fx next step?
US
-
US of pelvic fx shows fluid. Next step
DPL
-
DPL of pelvic fx shows blood
Take to OR immediately for laparotomy!
-
DPL of pelvic fx shows urine. Next step
OR when available
-
DPL of pelvic fx shows nothing. Next step.
Angiogram for r/o of retroperitoneal hematoma
-
Suspect ruptured thoracic aorta in fx of what?
- Rib 1-2s fx
- Scapular fx
- Sternal fx
-
Back pain that radiates. Worse with walking and standing.
Spinal stenosis
-
Back pain that radiates worse at rest, better with activity
Ankylosing spondyloitis
-
Backpain with urinary retention, saddle anesthesia, decreased rectal tone. Dx? Tx?
Cauda Equina syndrome
- Emergency sx decompression!
- IV corticosteriods
- Radiation if neoplasm
-
Sensory deficit of lateral foot
S1 root
Achilles reflex
-
Sensory deficit of lateral lower leg, first web space
L5
-
Sensory deficit of medial leg
L4
Patellar reflex
-
Sensory deficit of axilla
T1
-
Sensory deficit of 4th & 5th fingers, medial forearm
C8
-
Sensory deficit posterior forearm
C7
Triceps reflex
-
Sensory deficit of lateral forearm
C6
Brachioradialis reflex
-
Sensory deficit of anterior shoulder
C5
Biceps reflex
-
Motor deficit of biceps & deltoid
C5
Biceps reflex
-
Motor deficit of biceps & wrist extensors
C6
Brachioradialis reflex
-
Motor deficit of triceps, wrist flexors, finger extensors
C7
Triceps reflex
-
Motor deficit of finger flexors
C8
-
Motor deficit interossei of fingers
T1
-
Motor deficit of tibalis anterior (foot dorsiflexion)
L4
Patellar Reflex
-
Motor deficit of extensor hallucis longus (first toe dorsiflexion)
L5
-
Motor deficit of peroneus longus & brevis (foot eversion) gastrocnemius (foot plantarflexion)
S1
Achilles reflex
-
Define osteoporosis
- Decreased bone density
- Normal mineralization.
Decreased bone formation or increased resorption of bone
-
Endocrine Risks for osteoporosis
- Hyperparathyroidism
- Hyperthyroidism
- Cushing
- Hypogonadism
-
Treatment for osteoporosis
- Bisphosphonates: clastic, bone density, fx risk
- SERM: bone density
- Pulsatile PTH (teraperatide): build bones
- Prevention!
-
Define gout
Peripheral monoarthritis caused by sodium urate crystals in joints
-
Needle shaped, negatively birefringent crysts
Gout
-
Acute gout treatment
- Colchicine
- Corticosteriods
- Indomethacin (NSAIDs)
-
-
Define pseudogout
Calcium pyrophosphate dihydrate deposition in joints
-
Positively birefringent, rhomboid crystals
Pseudogout
-
Treatment of pseudogout
NSAIDs & colchicine
-
Xray of pseudogout
Chondrocalcinosis
-
Define pagers
Overactive osteoclasts & osteoblasts
Excessive bone turnovee & disorganized bony architecture
-
Fx, tibial bowing, kyphosis, increased cranial diameter, deafness
Pagets dz
-
Labs of Pagets dz
- ALP
- urine hydroxyproline
- Normal calcium & phosphorus
-
Treatment of Pagets dz
- Bisphosphonates
- Calcitonin
Only tx if symptomatic!!
-
Define osteogenesis imperfecta
Defective production of type I collagen
-
Freq fx from minimal trauma, blue sclera, joint hypermobility, possible deafness
Osteogenesis imperfecta
-
Treatment of osteogenesis imperfect
-
Define osteopetrosis
Increased bone density caused by impaired osteoclast activity
-
Fx, blindness, deafness, neuro sx, impaired fx hearing
-
Lab in osteopetrosis
hgb & hct
"sandwich vertebrae"
-
-
Waiter's tip
Erb Duchenne
Superior trunk injury
-
-
Claw hand, lumbrical weakness
Ulnar nerve
-
Wrist drop
Posterior cord or radial nerve
-
Claw hand, horner's
Klumpke's
Posterior or medial cords
-
MCC septic arthritis in young adults
N. Gonorrhea
-
If you suspect septic joint
Aspirate!
-
MCC septic joint overall
Staph aureus
-
Sudden onset of joint pain, several days of migratory polyarthralgia, red, tender swollen joint
Septic joint
-
Joint aspiration of septic joint
- 50,000 leukocytes
- High neutrophils
- Low glucose
- Positive cx
-
Joint aspirate of osteoarthritis/trauma
2,000 leukocytes
If trauma may see hemarthrosis
-
Joint aspirate of inflammatory arthropathies
5-50,000 leukocytes
- Gout: needle, negatively birefringent
- Pseudgout: rhomboid, positiely birefringent
-
Labs for septic joint
ESR, CRP, WBC
-
Treatment for septic joint
I & D (unless N. Gonorrhea)
-
N. Gonorrhea Septic joint tx
IV ceftriaxone & doxycycline
-
MRSA septic joint tx
- Bactrim & rifampin
- Clinda & rifampin
- Linezolid
-
MC cause of osteomyelitis
Staph Aureus
-
-
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)
-
Treatment for osteomyelitis
- IV antibiotics 4-6wks- vanc
- I & D abscess
-
Cause of Lyme dz
Borrelia Burgdorferi via ixodes tick
-
Early stage of Lyme dz
Chills, fatigue, arthralgia, ha, erythema chronicum migrans, fever
-
Early disseminated stage of Lyme dz
- Myocarditis (wks-mos after infxn)
- Cardiac arrythmias
- Heart block
- Bell's palsy
- Sensory motor neuropathy
- Asepyic meningitis
- Meningoencephalitis
-
Late disseminated stage of Lyme (mo's-yrs)
- Chronic synovitis
- Monoarthritis
- Oligoarthritis
- Subacute encephalopathy
- Polyneuropathy
-
-
Treatment for Lyme dz
- Doxycycline
- Amoxicillin
- Ceftriaxone
-
define OA
Chronic, noninflammatory joint degeneration involving articular cartilage deterioration
-
Joint creptius. Joint stiffeness & pain worse with activity & wt bearing. Relieved with rest
OA
-
Heberden nodes
Bony protuberance of DIP
-
Bouchard nodes
Bony protuberance of PIP
-
Xray of OA
- Ostephyte
- Joint space narrowing
- Subchondral bone sclerosis
- Subchondral bone cyst
-
Treatment of OA
- Heat
- Analgesics-NSAIDs
- Steriod or hyalyronan injxn
- Schefuled tylenol
- Joint replacement
- Activity modification
- Wt loss
- PT
-
Bone on bone radiograph
OA
-
Define RA
Chronic inflammatory disorder with infiltration of synovial joints by inflammatory cells & progressive erosion of cartilage & bone
-
-
Synovial hypertrophy with panes formation
RA
-
Symmetric polyarthropathy
RA
-
Assymmmetric polyarthropathy
OA
-
Morning stiffness with pain
-
Swan neck deformities
- RA
- Flexed DIP & hyperextended PIP
-
-
Best test for RA
Anti-CCP
-
-
Soft tissue swelling, joint space narrowing, marginal bony erosions, subluxation
RA
-
Treatment of RA
- Initial: NSAIDs, PT
- Mild: sulfasalazine, hydroxychloroquine, analgesic
- Moderate: mtx, anti-TNF, steriods
- Severe: anti-TNF, steriods
-
-
Anti-scl 70 ANA
Scleroderma
-
Anti centromere antibodies
CREST syndrome
-
-
-
-
HLA B27 & seronegative (RF)
- P: Psoriatic Arthritis
- A: Ankylosing Spondylitis
- I: IBD
- R: Reiter's
-
Anti-histone ab
Drug induced lupus
-
Anti- dsDNA
SLE with renal dz
-
-
-
Drugs causing SLE
- Hydralazine
- Procainamide
- INH
- Methyldopa
- Quinidine
- Chlorpromazine
Symptoms resolve when drug dc!
-
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
-
Treatment if SLE
- Avoid sun
- NSAIDs
- Hydroxychloroquine
- Corticosteriods
- Immunosuppresants
- Anticoagulants
-
What SLE antibodies increase risk of miscarriage and fetal death?
- Lupus anticoagulant
- Anticardiolipin antibodies
-
Define Polymyositis
Progressive sytemic dx with skeletal mm inflammation
-
Define dermatomyositis
PM + skin manifestations
-
Symmetric progressive mm weakness in legs first, myalgia, atrophy,
PM
-
Skin manifestations of DM
- Red heliotrophic rash
- Shawl sign
- Gottron's papules
-
Labs for DM/PM
CK, aldolase, LDH, AST, ALT, creatinine
Anti Jo 1
-
Mm biopsy for DM/PM show
DM: inflammatory cella surrounding mm fasicles
PM: Inflammatory cells within mm fascicles
-
EMG of PM & DM
Spontaneous fibrillations
-
Treatment of DM & PM
- High dose corticosteriods
- Mtx or azathioprine (4-6wks)
- IVIG other immunosuppresants if needes
-
Complications of DM & PM
- Interstitial Lung dz
- risk of malignancy
-
PMR define
Rheumatic dz with multiple sites of mm pain
Shoulder & Pelvic girdle
-
Difficult to get out of bed, malaise, unexpected wt loss, mm strength maintained
PMR
-
-
-
MRI of PMR
signal at tendon sheaths & synovial tissues outside of joints
-
Treatment of PMR
- Low dose corticosteriods
- Tapered!
-
Chronic pain in mm without apparent inflammation. Associated with depression, anxiety, IBD
Fibromylagia
-
Treatment for fibromylagia
- Pregabalin
- Duloxetine
- Minacipram
- Stretching
- Antidepressants
- PT
-
AS define
Chronic inflammatory dz of spine & pelvis
- Worse in am & with inactivity
- Better as day progresses
-
-
Treatment of AS
- PT
- NSAIDs
- Exercise
- Sulfasalazine
- Mtx
- Anti-TNF
-
Assymetric joint pain & stiffness, worse in am, better with activity, pencil in cup deformity
Psoriatic Arthritis
-
Treatment of psoriatic arthritis
- NSAIDs
- Mtx
- Sulfasalazine
- Anti TNF
-
Scleroderma defined
Chronic multisystem sclerosis with accumulation of connective tissue, skin thickening, visceral involvement
-
CREST syndrome
- C: Calcinosis, anti Centro ab
- R: Raynaud's
- E: Esophageal dysmotility
- S: Sclerodactyl
- T: Telangiectasia
-
Treat Raynaud's
- Avoid exposure
- Nefedipine
- ASA
-
+ anti ribonucleoprotein (RNP) ANA
MCTD
-
MCTD
Overlapping features SLE, scleroderma, PM
-
Sjogren's syndrome defined
AI disorder with lymphocytic infiltration of exocrine glands
Dry Dry
-
Sjogren's syndrome antibodies
-
MC primary malignant bone tumor
Osteosarcoma
-
Risk factors for Osteosarcoma
- Pagets
- P53 gene mutation
- Familial retinoblastoma
- Radiation
- Bone infarcts
-
What denotes a poor prognosis in Osteosarcoma
LDH
-
Sunburst pattern & codman's triangle
Osteosarcoma
-
MC bone tumor in adults
Mets
-
Mets to bone from?
- Lung
- Breast
- Prostate
- Renal
- Lymphoma
- Thyroid
-
What finding suggests mets on h&p
- Deep bone pain
- Fx following minor trauma
-
Malignant cartilage tumor in kids with codman's triangle & onion skinning on radiograph
Ewing's sarcoma
-
Dactomycin is used to treat what kind of children's malignancy
-
MC adult bone tumor
Multiple myeloma
-
MC benign bone tumor
In metaphysis of long bones
Osteochondroma
-
DDH defined:
Perinatal displacement of femoral head from acetabulum
-
Risk factors for DDH
- Female
- 1st born
- Breech
- Oligohydramnios
-
Signs of DDH
- + Barlow's
- + Ortolani's
- Galeazzi's
- + Trendenlenburg
- Asymetric skin folds
-
Galeazzi's sign
Knees at unequal heights when hips amd knees flexed
For DDH
-
MC method of imaging for DDH
Ultrasound
-
Treatment DDH
Pavlik harness
-
SCFE
Separation through growth plate of femoral epiphysis from metaphysis
-
Risk factors for SCFE
- Adolescent
- Obese
- Black
- Hypothyroid
-
Xray show "scoop of ice cream falling off cone"
SCFE
(posterior & medial displacement of femoral head from femoral metaphysis)
-
Obese black kid with limp
SCFE
-
Treatment of SCFE
- Sx pinning
- Wt bearing restrictions
risk of AVN
-
Define rickets
Impaired calcifaction of bone in kids bc of deficient vit D intake, absorption or metabolism or impaires phosphate absorption
-
Rickets aka what in adults
Osteomalacia
-
Bowed legs, bone pain, delayed walking, soft skull bones
Rickets
-
-
Translucent lines in bones, widening of phases, flat skull, enlarged costal cartilage on xray
Rickets
-
Treatment of rickets
- Phosph
- Vit D
- 1, 25 dihydroxycholecalciferol- impaired vitamin absorption
-
JRA subtypes
- Pauciarticular
- Polyarticular
- Systemic
-
JRA with blindness from uveitis or iridocyclitis
Pauciarticular
-
JRA with symmetric joint involvement, growth retardation
Polyarticular
-
Osgood Sclatter defined
Inflammation of bone cartilage interface of the tibial tubercle
-
Mc fx in kids. Tx.
Clavicle
- No treatment needed
- Evaluate for brachial plexus injury
- PT
-
Mid 1/3 clavicle fx treatment
- Figure of 8 strap or
- Sling arm
-
Define nursemaids elbow
Radial head subluxation
(pulling & lifting on hand)
-
Treatment for nursemaids elbow
Manual reduction via supination of arm & dlexion of elbow
-
2 causes of limp in kids
- SCFE- sx!
- Legg Calve Perthes- nonsx!
-
Define Legg Calve Perthes (LCP)
AVN of capital femoral epiphysis
-
Xray with asymmetric hips, affected femoral head appears small with sclerotic bone & widened joint space
LCP
-
Treatment of LCP
Contain hip within acetabulum via bracing
-
Treatment of club foot
- Serial casting
- Sx to relieve contractures
-
Treatment of scoliosis
- Small: observe
- Moderate: bracing
- Severe: surgery
-
Duchenne's muscular dystrophy defined:
- X linked
- Deficency of dystrophin
-
Becker's muscular dystrophy
Symptoms less severe & progresduon is slower
-
Gower's maneuver, difficulty standing up & walking, pseudohypertrophy in calf
Duchenne's
-
Definite dx of duchenne's
Mm biopsy!!
Mm fiber degeneration & fibrosis & basophilic fibers
-
EMG of duchenne's
- Polyphasic potentials
- Increased fiber recruitment
-
Spondylolisthesis
Forward anterior slip of vertebrae
-
Palpable step of on physical exam
Spondylolisthesis
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