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246 Cards in this Set
- Front
- Back
This complication of "supracondylar" humerus fracture is 2/2 radial nerve injury complicated by compartment syndrome. |
Volkmann's contracture (flexion of wrist and fingers)
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6 Ps of compartment syndrome
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Pain
Pallor Paresthesias Poikilothermia Paralysis (late finding) Pulselessness (rare finding) |
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2 most common locations of compartment syndrome
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forearm (most common) and anterior lower leg
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Forearm pain increases with passive motion of fingers. Diagnosis?
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compartment syndrome
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Diagnostic test for compartment syndrome
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measure compartment pressures compared to diastolic pressure
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Treatment of compartment syndrome.
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Immediate fasciotomy
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Phalen's maneuver.
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In Carpal Tunnel: flexion of wrists reproduces aching/numbness in under 60 seconds
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Tinel's Sign
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In carpal tunnel: tapping over median nerve elicits tingling in median n. distribution
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Entrapment of the median nerve. Diagnosis?
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Carpal Tunnel
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Why are symptoms of Carpal Tunnel worse at night at times?
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Wrist may be positioned inadvertently in extension or flexion
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Patient acknowledges increased frequency of dropping things and difficulty opening jars. Most common diagnosis?
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Carpal Tunnel
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If Carpal Tunnel is a clinical diagnosis, why are some diagnosed by EMG?
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work-up for atypical presentation or incindental finding
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first line treatment for carpal tunnel (2).
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Splinting into neutral position
NSAIDS |
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Carpal tunnel continues despite splinting and NSAIDS. 2 options for management
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Corticosteroids or Surgery
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When to do surgery for Carpal Tunnel.
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indicated if fixed sensory loss or weakness, but you can do surgery if patient wants it basically
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Most common bone to be fractured.
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clavicle
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Most common LOCATION of a fracture?
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wrist (8 bones)
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Most common bone to be fractured in adults (especially over 50 years); also very common in children.
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distal radius
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Most common shoulder dislocation.
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Anterior (posterior is rare)
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Anterior shoulder dislocation: worry about damage to this artery and to this nerve.
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Axillary
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Treatment for Shoulder Disloation
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expedient reduction, then sling/swath
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What is a sling and what is a swath?
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sling holds forearm up (elbow flexed) |
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Dashboard injury
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posterior hip dislocation
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Treatment for Hip dislocation
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closed reduction, then pillow bracing
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F/U test after hip dislocation surgery
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CT scan
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Most common radius fracture.
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colles fracture (distal radius)
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Mechanism of injury causing colles fracure (distal radius)?
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fall onto outstretched hand
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Most common wrist bone fracture.
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Scaphoid
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Tenderness in anatomical snuff box. Diagnosis?
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Scaphoid fracture
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What is closed reduction?
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push bones back in place with your hands (without opening the skin)
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Treatment of colles fracture (distal radius)?
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closed reduction, then cast
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What cast for a scaphoid fracture?
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thumb spica cast (thumb and wrist)
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Where exactly is a boxer's fracture?
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5th metacarpal neck
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Punched a wall. What is the classic fracture?
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boxer's fracture (5th metacarpal neck)
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What bacteria is common hand infection after a patient punched someone in the mouth?
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Eikenella
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Treatment for boxer's fracture
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closed reduction and ulnar gutter splint (ulna to pinky)
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Radial nerve pasly. What classical fracture?
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Humerus
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Homeless man found in alley and brought to ER. He has an ulnar shaft fracture with bruises on both forearms and . Cause?
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self defence from blunt trauma ("nightstick fracture")
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A "nightstick" ulnar fracture WITH radial head deviation is called what?
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monteggia's fracture
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Treatment of monteggia's fracture
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Open Reduction and Internal Fixation (ORIF)
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Fracture of the radius and dislocation of the radioulnar joint is called what?
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Galeazzi's fracture; remember "G-azz plays on the Radio (radius)"
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Femoral fracture. What classic complication?
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Fat emboli
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Elderly (i.e. osteoporosis) patient presents after fall. What classic fractures (2)?
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Hip fracture or Colles Fracture (distal radius)
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These complications of a Hip Fracture are more common if there is displacement of the femoral neck. (2)
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Avascular necrosis and DVT
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This type of fracture is ALWAYS an O.R. emergency.
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open fracture
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Open fractures have subsantially increasing risk of infection after this many hours.
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6 hours (get to OR)
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While heading to the OR, what to give a patient with an open fracture?
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Antibiotics and Tetanus booster
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Hip fractures require Open Reduction and Internal Fixation. What treatment afterward?
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anticoagulation to prevent DVTs
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Treatment of Galeazzi's fracture of the radius.
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Open reduction and Internal Fixation (ORIF) and then supinated arm cast
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Treatmenf of a Hip Fracture
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Open Reduction and Internal Fixation (ORIF)
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Treatment of Femoral Fracture
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Intramedullary nailing (aka intramedullary rod) +/- traction; early mobilization
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Tibial Fracture. What is the feared complication?
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Compartment Syndrome
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Treatment of Tibially Fracture
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Intramedullary nailing (aka intramedullary rod); casting
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What is the Thompson Test?
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Squeeze the gastrocnemius: if no plantar flexion, test is positive for Achilles Tendon Rupture
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Which knee ligament tear almost always requires surgical correction.
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ACL
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When might surgery be done on an isolated PCL tear?
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on a competitive athlete
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Tibia moves forward too far on exam. Name the test and the ligament torn.
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Positive Anterior Drawer = ACL tear
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Tibia is displaced too far back on exam. Name the test and the ligament torn.
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Positive Posterior Drawer = PCL tear
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5 most common knee injuries.
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ACL, PCL, MCL, LCL, meniscus
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Clicking or locking on knee exam. Which of the 5 common knee injuries is most likely?
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Meniscal tear
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These 3 of the 5 common knee injuries almost never get surgery
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MCL, LCL, meniscus
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Valgus vs. Varus
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ValGus: feet Go, knees together like Gum
VaRus: feet Return, knees like a bowlegged horse rider ("Vhere is my horse?") |
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McMurray's Test is positive. Suspect what?
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Meniscal tear with click/pop on McMurrays (very specific)
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McMurray's Test?
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you trap the meniscus between tibia and femur and then rotate knee while feeling and listening for pop/click
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Treatment of Bursitis (along with rest, heat&ice, elevation)
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NSAIDS +/- corticosteroids
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What is contrindicated treatment if bursitis is suspected to be septic?
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corticosteroids
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Treatment of septic bursitis.
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7-10 days
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Pain at lateral epicondyle worse on wrist extension. Diagnosis?
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tendinitis: lateral epicondylitis (aka Tennis Elbow)
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Rule about treatment of Achilles Tendonitis.
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never inject the achilles tendon (risk of rupture)
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3 levels of therapy for Tendonitis. Name them in the correct order.
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1) NSAIDS and ice
2) splinting/immobilization 3) lidocaine or corticosteroid injection |
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Which reflex tests L4?
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patellar (knee = down on all "4"s)
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Which reflex tests S1?
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Achilles
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Dermatome of L4.
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medial lower leg and foot
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Dermatome of L5.
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dorsum and plantar surfaces of foot
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Dermatome of S1.
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Lateral foot
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Where is the herniated disc: absent foot dorsiflexion (tibialis anterior).
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L4
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Where is the herniated disc: absent big toe dorsiflextion
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L5
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Where is the herniated disc: absent plantar flexion
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S1
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Sudden electricity like lower back pain. Diagnosis.
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Disc Herniation
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Test for Disc Herniation.
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Straight leg raise (passive and crossed)
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When to order MRI if Disc Herniation symptoms.
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if not resonding to conservative treatment NSAIDS and PT
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80% of cases of Disc Herniation will resolve in this amount of time with just conservative treatment (NSAIDS).
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4 weeks
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Treatment to consider if NSAIDS fail.
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Epidural or nerve block
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Treatment for cauda equina or rapid neuro deficits due to disc herniation?
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discectomy (surgical emergency)
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cauda equINA symptoms (3).
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Impotence
iNcontinence (bowel or bladder) saddle-area Anesthesia |
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Bone cancer's classic pain description?
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worse at rest or worse at night
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Lower back pain relieved by rest. Most likely diagnosis?
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lumbar strain
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lower back pain in paitient with osteoporosis. Diagnosis?
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vertebral decompression
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Lower back pain worse with Lumber Extension; improves with hip and lumber flexion (bending forward). Diagnosis?
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lumbar stenosis
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PBKTL ("lead kettle") cancers which often metastasize to the bone.
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Prostate
Breast Kidney Thyroid Lung (most common) |
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Most common primary bone malignancy.
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Multiple Myeloma
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Cancer in the metaphyseal regions at distal femur and proximal tibia. Diagnosis?
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Osteosarcoma
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Most common benign tumor of the bone.
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osteochondroma
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Sunburst pattern on XR of leg. Diagnosis?
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Osteosarcoma
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Onion skinning on XR of leg. Diagnosis?
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Ewing's Sarcoma
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Morning stiffness under 30 min. Diagnosis?
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Osteoarthritis
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Osteoarthritis dilemma about resting.
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pain decreases with rest
stiffness increases with rest |
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Joint space narrowing on XR in osteoarthritis. Mechanism of narrowing?
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deterioration of articular cartilage
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Why delay joint replacement in patients with osteoarthritis?
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the artificial joint will likely fail before the patient dies (e.g. 15 years with knee replacement)
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Biggest risk factor for osteoarthritis other than age.
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obesity
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Reduction in risk of osteoarthritis in the knee with the loss of 10 lbs.
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50%
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1st line therapy for osteoarthritis.
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Tylenol
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Why are NSAIDS 2nd line (after Tylenol) for treatment of osteoarthritis if they work so well.
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GI symptoms (e.g. GIB)
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Heberden's nodes on DIPs. Diagnosis?
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Osteoarthritis
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Bouchard's nodes on PIPs. Diagnosis.
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Rheumatoid Arthritis
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Swan Neck or Boutonniere deformities. Diagnosis?
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Rheumatoid Arthritis
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After limb trauma, some kind of neurofeedback creates this weird syndrome:
1) out-of-proportion chronic pain 2) loss of function of affected limb 3) sympathetic dysfunction and increased skin and hair growth with edema and warmth Diagnosis? |
Complex Regional Pain Syndrome (reflex sympathetic dsystrophy); aka causalgia or sudecks atrophy
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Chronic pain syndrome most common in women; no joint pain or inflammation. Diagnosis?
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Fibromyalgia
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Treatment of Fibromyalgia (2)
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Antidepressants (e.g. SSRI/TCA combo)
Physical Therapy |
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less than 11 of 18 tender points on the fibromyalgia map. Called what?
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myofascial pain syndrome
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Undiagnosed monarticular joint pain. Test?
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Joint aspiration (arthrocentesis)
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Recurrent monarticular arthritis. Most likely Diagnosis?
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Gout
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3 D's as a part of Gout treatment.
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Dehydration (drink water)
Diet (lose weight!; avoid EtOH and red meat) Diuretics (avoid) |
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Advanced gout appearance on XR.
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rat-bite erosions (punched out lesions)
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Medical therapy options for gout maintenance.
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Probenecid (1st line)
Allopurinol |
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Gout crystals
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Needle shaped
Negative birefringence |
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Psuedogout crystals
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"P" for psuedogout:
Positive birefringent Polygon shaped crystals (rhomboid) calcium Pyrophosphate |
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Treatment for acute attacks of Gout (3)
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NSAIDS, Colchicine, Steroids
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What is Tophi?
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urate crystal deoposits in soft tissue (complicaiton of chronic gout)
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What cell marker is associated with Ankylosing Spondylitis?
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HLA-B27
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Onset of symptoms (age) in Ankylosing Spondylitis?
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late teens to early 20s
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Pos HLA-B27, Elevated ESR, Negative RF. Diagnosis?
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Ankylosing Spondylitis
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What does Spondylo refer to?
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Spine (greek for vertebra)
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5 bacteria associated with Reactive Arthritis (aka Reiter's Syndrome).
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Chlamydia
Campylobacter Shigella Salmonella Ureoplasma |
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Sausage shaped digits (dactylitis). Diagnosis?
|
psoriatic arthritis
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What gastrointestinal diagnosis is associated with Ankylosing Spondylitis?
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IBD
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Spine shape in Ankylosing Spondylititis.
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loss of Lumbar Lordosis, decreased flexion
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fused sacroiliac joints. Diagnosis?
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Ankylosing Spondylitis
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Morbidity (besides arthritic pain) in Ankylosing Spondylititis.
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decreased chest expansion
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medical treatment for Ankylosing Spondylitis symptoms (2)
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1) NSAIDS for pain control
2) TNF inhibitors for refractory cases |
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polymyositis: describe the weakness
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Symmetric progressive proximal muscles
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heliotrope rash and rash on shoulders, upper chest, and back ("shawl sign"). Diagnosis?
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Dermatomyositis
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New proximal weakness and rash. Diagnosis?
|
Dermatomyositis
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10% of Dermatomyositis is associated with this (classic association).
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neoplasm
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Gottron's papules (papular rash over nuckles). Diagnosis?
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Dermatomyositis
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elevated CK and presence of anti-Jo-1. Diagnosis?
|
Polymyositis or Dermatomyositis
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Confirmatory test for polymyositis.
|
muscle bx
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Treatment for polymyositis
|
high dose corticosteroid then taper to maintenance does
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SLE: associated antibody test (3)
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ANA (sensitive), Anti-Smith (specific), and Anti-dsDNA (specific)
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Rheumatoid Arthritis: associated antibody test (2)
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Rheumatoid factor (classic) and Anti-CCP (more specific)
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CREST syndreom: associated antibody test
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Anticentromere
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Drug-Induced SLE: associated antibody test
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Antihistone (100% sensitive; not specific)
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Primary Biliary Cirrhosis: associated antibody test.
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Antimitochondrial
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Scleroderma: associated antibody test
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AntiScl70
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Grave's disease: associated antibody test
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Anti-TSHR
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Wegener's Vascultis: associated antibody test
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c-ANCA
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Microscopic Polyangiitis: associated antibody test
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p-ANCA
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Dermatitis Herpetiformis (extra-intestinal IBD): associated antibody test.
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Anti-endomesial
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Common ocular manifestation of Rheumatoid arthritis.
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Sjogren's syndrome (keratoconjuctivitis sicca)
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HLA-DR4 positive. Diagnosis?
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Rheumatoid Arthritis
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Morning stiffness for over an hour. Diagnosis?
|
Rheumatoid Arthritis
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Symmetric polyarthritis with swelling and warmth. Diagnosis?
|
Rheumatoid Arthritis
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When gout crystals line up with the condensor, what color are they?
|
yeLLow when paraLLel
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mechanism of colchicine
|
inhibits neutophil chemotaxis
|
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2 limiting factors in treatment of acute gout with Colchicine.
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1) efficacious if used early in acute attack
2) narrow therapeutic window |
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Rheumatoid Arthritis, Splenomegaly, and Neutropenia. What syndrome?
|
Fetty's Syndrome
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Ulnar deviation of the fingers bilaterally. Diagnosis?
|
Rheumatoid Arthritis
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Common anemia in Rheumatoid Arthritis.
|
Anemia of Chronic Disease
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When to reduce or discontinue NSAIDS in treatment of Rheumatoid Arthritis.
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once DMARDs effective
|
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2 popular DMARDs for Rheumatoid Arthritis
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Methotrexate or Sulfasalazine
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CREST syndrome
|
Calcinosis
Raynauds Esophageal dysmotility Sclerodactyly Telangiectasias |
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AntiScl70 antibodies indicate what about Scleroderma?
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poor prognosis
|
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Common cause of death in Scleroderma
|
pulmonary hypertension
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Excessive collegen I and III deposition. What is the disease?
|
Scleroderma
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Treatment for acute flares of Scleroderma.
|
Corticosteroids
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Treatment for skin changes in Scleroderma.
|
Penicillamine
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Treatment of Raynaud's Phenomenon.
|
Calcium Channel Blockers
|
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Prevention of renal crisis in Scleroderma.
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ACEI
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What medicine often used in Scleroderma can cause a lupus like syndrome?
|
Penicillamine
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DOPAMINERASH criteria for SLE.
|
Discoid Rash
Oral ulcers Photosensitivity Arthritis Malar rash Immunologic stuff Neuro sx ESR elevated Renal disease ANA Serositis Hematologic abnls |
|
Malar rash. What is the disease?
|
Systemic Lupus Erythematosus (SLE)
|
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Libman Sacks endocarditis: associated conditions (2)
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SLE and antiphospholipid syndrome
|
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Treatment of joint pain in SLE
|
NSAIDS
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Treatment for acute exacerbations of Lupus
|
Corticosteroids
|
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Vasodilating Hypertension med known to cause lupus like syndrome.
|
Hydralazine
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Another name for Temporal Arteritis.
|
Giant Cell Arteritis
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Most feared manifestation of Temporal Arteritis.
|
Blindness (usually monocular)
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Half of temporal arteritis patients also have this joint disease.
|
Polymyalgia Rheumatica
|
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Trigeminal Neuralgia and Temporal Arteritis can appear similar on Step 2 questions. What are the differences in pain characteristics?
|
Trigem: episodes of recurrent attacks of severe dermatomal skin pain that lasts seconds to minutes
TA: new temporal headache that is constant |
|
How high of ESR is criteria for Temporal Arteritis and how high does it usually get?
|
higher than most rheumatologic diseases: over 50 for criteria; usually over 100
|
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Treatment for Temporal Arteritis
|
High dose prednisone immediately
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Confirmatory test for Temporal Arteritis?
|
Temporal Artery biopsy
|
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Why get serial CXRs after an episode of Temporal Arteritis?
|
TA is associated with aortic aneurisms
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3 areas of pain in Polymyalgia Rheumatica.
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Neck, Shoulders, Hips
|
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2 labs associated with polymyalgia rheumatica.
|
increased ESR and anemia
|
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Treatment for Polymyalgia Rheumatica.
|
daily low dose prednisone
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Usual age of onset of Polymyalgia Rheumatica
|
50
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Usual age of onset of Temporal Arteritis?
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50
|
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Usual age of onset of Scleroderma?
|
35
|
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Usual age of onset in Rheumatoid Arthritis.
|
35
|
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Most common age and gender in SLE
|
child-bearing age (women)
|
|
dystrophin mutation. Diagnosis?
|
Muscular Dystrophy (DMD or BMD)
|
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Whats the difference between Becker's (BMD) and Duchenne Muscular Dystrophy (DMD)?
|
BMD has more mild phenotype because the mutation still creates a partially functional protein
|
|
inheritance pattern in Duchenne Muscular Dystrophy (DMD)
|
x-linked recessive
|
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Gowers' maneuver: what is it and what is the diagnosis?
|
walks hands up body to help stand up = Duchenne Muscular Dystrophy (DMD)
|
|
psuedohypertrophy of the gastrocnemius. Diagnosis?
|
Duchenne Muscular Dystrophy (DMD)
|
|
Waddling gait (hip drop) in a child. Diagnosis?
|
Duchenne Muscular Dystrophy (DMD)
|
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Diagnosing Duchenne Muscular Dystrophy (DMD).
|
DNA sequencing
|
|
Old diagnostic test for Duchenne Muscular Dystrophy (DMD) now only used as a second option.
|
muscle biopsy +/- immunostaining
|
|
What medication will prolong time to wheel chair in Duchenne Muscular Dystrophy?
|
prednisone
|
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Prognosis of DMD.
|
death by 20
|
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Why use Physical Therapy to ambulate DMD patient if they will never be able to regain self-ambulatory function?
|
prevent contractures
|
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What causes death in most DMD patients?
|
pulmonary congestion due to cardiac failure
|
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Common bone fractured during birth.
|
clavicle
|
|
What is a greenstick fracture?
|
incomplete fracture involving only cortex (only one side of bone)
|
|
Treatment for nursemaid's elbow?
|
manual reduction:
1) extend elbow with gentle distal traction 2) supinate hand while flexing elbow |
|
What joint is effected in nursemaid's elbow?
|
radial head (subluxation)
|
|
Young child with arm pain after being lifted by one arm. Diagnosis?
|
Nursemaid's Elbow
|
|
Describe arm position at presentation of nursemaid's elbow.
|
elbow flexed to near 90; refuses to move arm
|
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Treatment of a partial fracture (greenstick).
|
cast
|
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Buckling of the cortex of a long bone secondary to trauma. Fracture?
|
Torus Fracture
|
|
Most common age of Suracondylar humerus fracture (risk of volkmann's contracture secondary to compartment syndrome)?
|
5-8 y/o
|
|
Treatment for Supracondylar humerus fracture?
|
cast usually all that is needed; closed reduction if needed
|
|
Treatment of torus fracture (a long bone fracture).
|
cast
|
|
12 year old boy hits growth spurt and develops knee pain worse with resisted flexion (active extension). Diagnosis?
|
Osgood-Schlatter Disease (aka traction apophysitis)
|
|
What is a Salter Harris fracture?
|
fracture in the growth plate
|
|
Rule for conservative vs surgical repair of Growth Plate fracture (Salter Harris fracture).
|
if it involves the epiphysis, do surgery
|
|
Hip abnormality that can be seen in babies who spent a long time in the breech position?
|
Developmental Dysplasia of the Hip (aka Congenital Hip Dislocation)
|
|
Prognosis of BMD.
|
Death by 40
|
|
Describe Barlow and Ortolani procedures in evaluation of the newborn hip.
|
Barlow: posterior pressure with knees together (femoral head may CLUNK out)
Ortolani: medial pressure on hip as thighs are abducted (femoral head may CLICK in) |
|
Asymetric skin folds (fat creases) in newborn groin. Diagnosis?
|
Developmental Dysplasia of the Hip (aka Congenital Hip Dislocation)
|
|
First line treatment of Developmental Dysplasia of the Hip.
|
Pavlik Harness (maintains hip flexed and abducted)
|
|
Most common gender for Developmental Dysplasia of the Hip
|
female
|
|
Developmental Dysplasia of the Hip not caught until after 6 months of age. What is treatment?
|
Spica Cast (maintains hip flexed and abducted)
|
|
Developmental Dysplasia of the Hip not caught until after 15 months of age. What is treatment?
|
open reduction followed by Spica Cast
|
|
Idiopathic Avascular Necrosis (AVN) of the femoral head. What is the disease?
|
Legg-Calve-Perthes Disease
|
|
Painless unilateral limp in child under 10. Diagnosis?
|
Legg-Calve-Perthes Disease
|
|
Treatment for Legg-Calve-Perthes Disease
|
observation usually sufficient
|
|
Painful bilateral (50%) limp in and obese 12 year old child. Diagnosis?
|
Slipped Capital Femoral Epiphysis (SCFE)
|
|
Treatment for Slipped Capital Femoral Epiphysis.
|
Open reduction and pinning
|
|
Is Slipped Capital Femoral Epiphysis acute or chronic.
|
Chronic
|
|
What lab to order in child with Slipped Capital Femoral Epiphysis? Ruling out what?
|
TSH (r/o hypothyroidism)
|
|
Insidious thigh, knee, groin pain, and limp in 12 year old. What test to order to dx Slipped Capital Femoral Epiphysis?
|
XR sufficient (AP and frog-leg lateral)
|
|
Separation of the femoral epiphysis from the growth plate in child. What is the disease called?
|
Slipped Capital Femoral Epiphysis (SCFE)
|
|
STARTSS HOTT differential for a child with a limp.
|
Septic joint
Tumor Avascular necrosis (L-C-Perthes) Rheumatoid arthritis (JIA) Tuberculosis Sickle Cell disease SCFE Henoch-Schonlein prupura Osteomyelitis Trauma Toxic synovitis |
|
Degree of curvature for criteria of scoliosis.
|
more than 10 degrees
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Clinically significant scoliosis is most common in males or females?
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females (7:1)
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Diagnostic test for scoliosis (as well as exam).
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XR spine
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Degree of curvature of scoliosis that is threshold for at least bracing.
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over 20 degrees
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Degree of curvature of scoliosis that is threshold for surgery?
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over 50 degrees
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Most common complication of scoliosis (besides back pain).
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restrictive lung disease
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Prognosis in Juvenile Idiopathic Arthritis?
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90% resolve by puberty
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Treatment for Juvenile Idiopathic Arthritis (JIA) (3).
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1. NSAIDS
2. Corticosteroids 3. Immunosuppression (Methotrexate) |
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Usual RF and ANA results in Juvenile Arthritis.
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RF negative, ANA positive
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Morning Stiffness for over six weeks in patient under 16 years old. Meets criteria for this diagnosis?
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Juvenile Idiopathic Arthritis (JIA) - formerly JRA
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Child with recurrent high fever, hepatosplenomegaly, rash, and Morning Stiffness in joints. Diagnosis?
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Still's Disease (Systemic Onset Arthritis)
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