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184 Cards in this Set
- Front
- Back
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What lab changes would you see in the following diseases?
HUS/TTP, Hemophilia, vWB disease, DIC, Warfarin use, Aspirin use, end stage liver disease |
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Compare the serum iron, ferritin, and transferrin levels in iron deficiency anemia to anemia of chronic disease:
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What medications are necessary in pts with end stage renal disease? (SU pg 96)
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Vit D, Phosphate binders, aspirin, erythropoietin, statin
BP control, glucose control, ACE inhibitor |
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What is the treatment for hyperkalemia?
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Calcium gluconate
D50 with insulin NaHCO3 Albuterol Kayexalate Furosemide (Lasix) |
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What are the 4 Potassium sparing diuretics?
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Spironolactone (Aldactone)
Eplerenone (Inspra) Amiloride (Midamor, Moduretic) Triamterene (Dyrenium) |
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What findings do the following signs describe, and with what diseases are they associated?
Murphy's, Reynold's pentad, Psoas sign, Obturator sign, Kerr's sign, Grey Turner's sign, Cullen's sign |
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What xray finding is indicative of croup? What xray finding is indicative of epiglottitis?
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Croup → steeple sign
Epiglottitis → thumb sign |
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What is the treatment for RSV bronchiolitis?
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Albuterol or Racemic Epinephrine
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What is Beck’s triad?
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Hypotension
Distant heart sounds Distended neck veins for cardiac tamponade |
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What is the typical initial post-op fever workup?
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CBC with differential
Urinalysis Blood & urine cx CXR |
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label
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labeled
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What nerve is injured?
How would you injury this nerve? What physical exam findings would the patient have? |
Long Thoracic Nerve (C5,6,7) Serratus Anterior muscle
can be injured in mastectomy PE: winged scapula (when patient pushes hands against wall the scapula protrudes posteriorly) |
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This event (sudden upward stretching on the arm at the shoulder) injures what part of the brachial plexus?
What are the consequences of this injury? |
Lower trunk injury
This trunk carries nerves from the C8, T1 spinal levels that ultimately form the median & ulnar nerves These nerves innervate all the intrinsic muscles of the hand results in hand clumsiness or palaysis (klumpke's palsy/ thoracic outlet syndrome) atrophy of thenar & hypothenar eminences, atrophy of interosseous muscles, sensory deficits on medial side of forearm & hand, disappearnce of the radial pulse upon moving the head toward the ipsilateral side |
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What part of the brachial plexus is injured?
What are the consequences? |
inferior trunk injury (C8, T1, median/ ulnar nerves, subclavian artery can also be compressed)
Thoracic outlet syndrome/ Klumpkes palsy Lower trunk injury atrophy of thenar & hypothenar eminences, atrophy of interosseous muscles, sensory deficits on medial side of forearm & hand, disappearnce of the radial pulse upon moving the head toward the ipsilateral side |
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This injures what part of the brachial plexus?
What S/S result? |
Upper Trunk injury (C5, C6 roots - Axillary n, Supraspinatus n, Musculocutaneous n)
S/S: Erb's Palsy/ Waiter's tip Limb hangs by side, medially rotated & pronated |
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What S/S result from this injury?
How would this injury occur? |
Tear of UPPER trunk, any situation that stretches neck - ie motorcycle injury, pulling baby by head during birth
S/S: Erb's palsy - waiter's tip |
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What part of the brachial plexus is injured?
What S/S result? |
UPPER trunk (C5, C6 - axillary, musculocutaneous, supraspinatus)
Erb's Palsy - "Waiter's Tip" Limb hangs by side, medially rotated & in pronation |
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What part of the brachial plexus was injured?
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Upper trunk
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This claw hand demonstrates a patient that has difficulty making a fist & spreading his fingers
What nerve is damaged? How do damage this nerve? |
Ulnar nerve
medial half of flexor digitorum profundus is denervated + loss of interosseus muscles (cannot abduct or adduct fingers) - interosseus atrophy can be seen too injury of the ulnar nerve at the medial epicondyle |
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Explain this sensory loss - what nerve is damaged? What is a likely cause of damage?
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Ulnar nerve
"Handle Bar Palsy" - hook of hamate compresses ulnar nerve |
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what nerve is at risk of injury with a fracture of the medial epicondyle?
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ulnar nerve
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What nerve is most at risk with a fracture of the surgical neck of the humerus?
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axillary nerve (deltoid muscle)
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What nerve is most at risk with a fracture of the shaft of the humerus?
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Radial nerve
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What nerve is most at risk of an injury to the supracondyle of the humerus?
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median nerve
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What nerve is damaged when a pt presents with:
Claw hand |
Ulnar n
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What nerve is damaged when a pt presents with:
Ape hand |
Median n
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What nerve is damaged when a pt presents with:
Wrist drop |
Radial n
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What nerve is damaged when a pt presents with:
Scapular winging |
Long thoracic n
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What nerve is damaged when a pt presents with:
Unable to wipe bottom |
Thoracodorsal n
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What nerve is damaged when a pt presents with:
Loss of forearm pronation |
Median n
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What nerve is damaged when a pt presents with:
Cannot abduct or adduct fingers |
Ulnar n
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What nerve is damaged when a pt presents with:
Loss of arm (shoulder) abduction |
Axillary n
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What nerve is damaged when a pt presents with:
Weak lateral (external) rotation of arm |
Suprascapular or Axillary n
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What nerve is damaged when a pt presents with:
Loss of arm (elbow) and forearm (wrist) flexion |
Musculocutaneous
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What nerve is damaged when a pt presents with:
Loss of forearm (wrist) extension |
Radial n
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What nerve is damaged when a pt presents with:
Trouble initiating arm (shoulder) abduction |
Suprascapular n
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What nerve is damaged when a pt presents with:
Unable to abduct arm beyond 10° |
Axillary n
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What nerve is damaged when a pt presents with:
Unable to raise arm above horizontal |
Long Thoracic n &
Spinal Accessory n |
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What nerve is injured in carpal tunnel syndrome?
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Median nerve
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What scenarios favor a posterior shoulder dislocation?
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Seizures & electrical shock
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When are wrist splints most effective in treating carpal tunnel syndrome?
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At night
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Why are pelvic binders used on trauma pts with pelvic fractures?
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To prevent blood loss & hypovolemic shock
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A young man comes in s/p MVA. His car was T-boned and his left arm trapped. He is unable to abduct his thumb. What bone do you suspect is broken & what nerve do you suspect to be involved?
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Radial nerve – due to fracture of the humerus
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What are the general steps of management of an open fracture?
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Irrigation
Pressure dressing Prophylactic antibiotics To OR w/in 6 hrs for debridement, ORIF, delayed primary closure |
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A pt comes to the ER with c/o wrist pain after a fall. What findings lead to believe there is a scaphoid fracture?
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Any time there is tenderness in the anatomical snuffbox assoc with traumatic wrist/hand pain, a scaphoid fracture should be suspected regardless of the presence/absence of a visible fracture on xray. Splinting is indicated until definitive diagnosis can be made with bone scan, MRI, or repeat xray at a later date
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What is the treatment for a scaphoid fracture?
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Short arm thumb spica splint case for
4-6 wks in distal fracture 10-12 wks in middle fracture 12-20 wks in proximal fracture (least vascularization and highest risk of avascular necrosis) if displaced, open-reduction and long arm thumb spica splint |
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What types of fractures would prompt you to search for a ruptured thoracic aorta?
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1st & 2nd rib fractures, scapular, sternum
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What are the general recommendations in the treatment of an open fracture in the ER?
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Address wound hemorrhage with direct pressure
Obtain xrays Antibiotic coverage: see above Apply saline-soaked sterile dressing to wound Provisional fracture reduction and splint application Operative intervention w/in 8hrs to ↓ infection & osteomyelitis If surgical delay is anticipated, then remove obvious foreign bodies and irrigate gently. Avoid probing and pressure irrigation which may force debris deeper into the wound. Do not remove any bone fragments in the ER Tetanus prophylaxis |
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What is the treatment for a sprained ankle?
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A pt comes to the ER s/p MVA with a suspected tib/fib fracture. The pt’s lower leg is pale, dorsalis pedis pulse is absent, and the pt has pain with passive motion of the leg. What is the tx?
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Dx: Compartment syndrome
Tx: emergent fasciotomy for pressures > 30mmHg or w/in 20mmHg of diastolic pressure |
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How is compartment syndrome diagnosed?
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Needle attached to a manometer is placed into the compartment & pressure is measured
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For what grade sprains should a lace-up ankle support be used rather than semi-rigid ankle supports?
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Grades I & II
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What is an important short-term complication of immobilization due to hip fracture?
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DVT
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What is an important long-term complication of a hip fracture?
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↑ risk of avascular necrosis of the hip
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What is the most commonly injured knee ligament?
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MCL
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Which type of knee injury will you find (+) Lachman test?
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ACL
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in which type of knee injury does (+) McMurray test aid in diagnosis?
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Meninscus tear
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what is the common dashboard knee injury in an MVA?
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PCL
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What are the characteristic features of compartment syndromes?
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Earliest sign: pain in excess of what is expected and occurs even with passive motion
6Ps: Pain Pallor Poikilothermia Pulselessness Paresthesia Paralysis measured compartment pressures >30mmHg most common compartments: volar compartment of forearm, anterior compartment of leg most commonly due to fractures (supracondylar humerus, both-bone forearm, proximal tibia) |
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What imaging study is best for detecting spinal cord compression? Which is best for detecting spinal cord lesions as in multiple sclerosis (MS)?
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Spinal cord compression → CT scan
Spinal cord lesion (ie MS) → MRI scan |
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What is the best imaging study for visualizing the brachial plexus?
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MRI
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What imaging study is preferred for imaging soft tissue in joint injuries, such as ligamentous tears? What about bone?
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Soft tissue → MRI
Bone → CT scan |
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At what level is disc herniation most common? What imaging modality is used to confirm disc herniation?
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L4-L5 or L5-S1
MRI |
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How long should a pt rest after a back muscle strain?
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Remain active NOT bed rest!
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A young woman thrown from a horse presents with low back pain, urinary retention, saddle anesthesia, and decreased rectal tone. What is the tx for her condition?
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Dx: Cauda Equina Syndrome
Tx: emergency surgical decompression, IV steroids |
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What is the organization of the brachial plexus?
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From proximal → distal: roots, trunks, divisions, cords, branches
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what nerve root level is injured if patient c/o:
Paresthesia to the lateral foot |
S1
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what nerve root level is injured if patient c/o:
Loss of foot dorsiflexion |
L4
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what nerve root level is injured if patient c/o:
Anterior shoulder numbness |
C5
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what nerve root level is injured if patient c/o:
Loss of the ability to spread the fingers |
T1
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what nerve root level is injured if patient c/o:
Parasthesia to the posterior forearm |
C7
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What are the classic symptoms of carpal tunnel syndrome?
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Wrist pain radiating up the arm
Pain gets worse with hand flexion & grasping ↓ hand strength numbness in the first 3 digits (+) Tinel’s test & Phalen’s test Thenar atrophy |
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What is the difference btw a Monteggia fracture & Galeazzi fracture?
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Monteggia: prox ulnar fracture with anterior dislocation of the radial head
Galeazzi: radial fracture with dislocation of distal ulnar – radial joint |
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What complications should you look for with the following types of fracture/injury:
Fall on outstretched hand → snuffbox tenderness |
Risk of avascular necrosis
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What complications should you look for with the following types of fracture/injury:
Anterior shoulder dislocation |
Axillary nerve injury
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What complications should you look for with the following types of fracture/injury:
Fracture of the 5th metacarpal neck (aka Boxer’s fracture) |
Abscess from a bite wound
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What complications should you look for with the following types of fracture/injury:
Humerus fracture |
Radial nerve injury
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What complications should you look for with the following types of fracture/injury:
Hip Fracture |
DVT, avascular necrosis
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What complications should you look for with the following types of fracture/injury:
Femur fracture |
Severe blood loss,
fat embolus |
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What complications should you look for with the following types of fracture/injury:
Tibial fracture |
Compartment syndrome
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What complications should you look for with the following types of fracture/injury:
Pelvic fracture |
Hypovolemic shock
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What is the cause of low back pain given the following presentation?
↑ Pain with passive straight leg raise |
Herniated disc
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What is the cause of low back pain given the following presentation?
↓ Pain with flexion at the hips (ie bending over shopping cart) |
Spinal stenosis
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What is the cause of low back pain given the following presentation?
Elderly, weight loss, pain constant but worse when supine |
Spinal tumor
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What is the cause of low back pain given the following presentation?
Acute urinary retention |
Cauda Equina
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What is the cause of low back pain given the following presentation?
Pain made worse by walking and standing (aka pseudoclaudication) |
Lumbar spinal stenosis
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What is the cause of low back pain given the following presentation?
Loss of foot dorsiflexion and pain on crossed straight leg raise |
Disc herniation
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What is the cause of low back pain given the following presentation?
Pain limited to the paraspinal region |
Muscular strain
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What is the treatment for compartment syndrome?
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Emergent fasciotomy of all compartments
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What scenarios favor a posterior shoulder dislocation?
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Seizure, electrocution
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What common drug will cause osteoporosis if used long term?
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Corticosteroids
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What should be seen in the joint aspirate of a pt with gouty arthritis? Pseudogout arthritis?
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Gout: needle shaped negatively birefringent crystals
Pseudogout: (+) birefringent, crystals that are rhomboid in shape |
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What are the treatment options available for gout?
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Anti-inflammatories: NSAIDs, Indomethacin, Colchicine, Corticosteroids
↓ intake of alcohol, red meat, foods high in purines reduce diuretics tx of acute attacks: Probenacid, Allopurinol |
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Which joints are more likely affected in gout? In pseudgout?
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Gout: Podagra (1st MTP joint), ankle, knee, other lower extremity joints
Gouty tophi: Achilles tendon, external ear Pseudogout: knee, wrist & elbow |
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6yo girl is brought to children’s ER for suspected broken bone in the forearm after a fall while running around the backyard. The parents tell you that this is pt’s 3rd fracture. The pt doesn’t seem to respond to questioning, to which the parents inform you that she is hard of hearing. With this clue, you check the pt’s eyes to help confirm your diagnosis. What are you looking for? If this diagnosis is correct, how can it be treated?
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Finding: blue sclera of osteogenesis imperfecta (OI)
Tx: bisphosphonates |
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60 yo M in clinic for as new pt. You notice that his legs are bowed out. He also is bent forward with kyphosis and is hard of hearing. He has no complaints besides his favorite hat not seeming to fit anymore. He claims that is feels smaller. What imaging is most sensitive to diagnose this process?
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Dx: Paget’s Disease of Bone
Diagnostic tx: Radionucleotide bone scan |
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What is the classic presentation & clinical course of Lyme Dz?
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What is the treatment for Lyme Disease? What is the tx for Rocky Mountain Spotted Fever?
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22yo M in clinic c/o new-onset pain in left elbow. On exam, his left elbow is mildly swollen, painful with movement, and has some overlying erythema. He also has a fever and an elevated WBC ct. His history is unremarkable except for having multiple sexual partners recently. What is the treatment for this pt?
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Dx: gonococcal arthritis
Tx: IV Ceftriaxone until symptoms resolve, then oral cephalosporins for 1 wk Doxycycline for Chlamydia |
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What is the most common organism in osteomyelitis overall? For sickle cell pts? IV drug users?
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Mc overall: Staph aureus
Sickle cell: salmonella IVDU: Pseudomonas |
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What is the initial radiologic study that would be ordered for a pt suspected of having osteomyelitis? In case of the initial study being negative, but the diagnosis of osteomyelitis still being likely, what is the nest best radiologic study to order?
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Next step: MRI
Next best: bone scan (ie if pt has metal implant) |
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56yo outdoors man in Connecticut goes to the local clinic for evaluation. He has a fever, chills, malaise, arthralgia, and bilateral facial weakness. He is slurring somewhat b/c of the facial problem. He says that the whole left side of the face became weak first and now is worse than the right at this point. PE is remarkable for a bulls-eye shaped rash on his right thigh. What is the organism and vector responsible for this disease? What is the primary treatment?
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Suspected dx: Lyme disease, borrelia burgdorferi, Ixodes tick
Tx: Doxycycline |
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What are the differences in location on the bone & radiologic findings btw the primary bone tumors (osteosarcoma, Ewing's sarcoma, Osteochondroma)?
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In cases of an unhelpful xray and unavailable MRI, what 3 studies can be used to make the dx of osteomyelitis?
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Ct scan, Bone scan, tagged WBC scan
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What disease should you include in your differential with arthropathy of the following joints
DIP & PIP |
Osteoarthritis (OA)
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What disease should you include in your differential with arthropathy of the following joints:
PIP & MCP (but not DIP) |
Rheumatoid Arthritis (RA)
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What disease should you include in your differential with arthropathy of the following joints:
Isolated MCP (squared off bone ends & hook-like osteophytes of the MCPs) |
Hemochromatosis
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What are the most common causes of bony metastasis?
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Breast, lung, prostate, renal cell carcinoma, thyroid cancer, lymphoma
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What is the classic radiologic appearance of osteosarcoma? Ewing’s sarcoma?
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Osteosarcoma: sunburst pattern & Codman’s triangle
Ewing Sarcoma: large destructive lesion with periosteal rxn & Codman’s triangle |
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What is the tx for Lyme Disease? Rocky Mtn Spotted Fever?
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Early Lyme Dz: Doxycycline, Amoxicillin, Cefuroxime
Late Lyme Dz: Ceftriaxone x 2-4 wks Rocky Mtn Spotted Fever: Doxycyline, Chloramphenicol |
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What meds are used in the tx of acute gout? Pseudogout?
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Acute Gout: NSAIDs, Colchicine, Steroids
Pseudogout: NSAIDs, colchicine |
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What tx options are available to pts with osteoporosis?
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Optimize Ca2+ & Vit D
Weight bearing exercise Stop steroids if possible Estrogen/testosterone replacement Bisphosphonates (pulsatile, teriparatide) |
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What are some of the endocrine causes of osteoporosis?
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Hyperthyroidism, hyperparathyroidism, hypOgonadism, Cushing’s Disease
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What disease matches the following description:
Knee xray reveals calcification of the menisci |
Pseudogout
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Hats no longer fit + deafness
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Paget’s Dz, osteopetrosis
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Needle-shaped, negatively birefringent crystals
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Gout
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Bone pain/ tenderness with
↑ WBC, ↑ CRP, ↑ ESR |
Osteomyelitis
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Child with low-trauma fractures
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Osteogenesis Imperfecta (OI)
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Narrowing of the marrow cavity results in low H/H
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Osteopetrosis
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55yo F that trip and sustains distal radial fx
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Osteoporosis
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What is the empiric tx for septic arthritis?
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Presumed S. aureus → IV Vancomycin
Suspect Gonococcal → IV Ceftriaxone + 10 days doxycycline |
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What are the diagnostic criteria for rheumatoid arthritis?
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4 or 7 criteria required
1. Morning stiffness lasting at least 1 hr (for more than 6 wks) 2. Symmetrical peripheral polyarthritis (for more than 6 wks) 3. MCP, PIP or wrist involvement (for more than 6 wks) 4. More than 3 joints involved with soft tissue swelling or fluid (for more than 6 wks) 5. Rheumatoid nodules – subQ nodules over bony prominences extensor surfaces, or juxtaarticular regions (in 30% of pts) 6. ↑ serum RF (seen in 70-80% RA, 70% Sjogrens, 20-30% SLE, 5-10% of healthy elderly) adding anti-cyclic citrinullated peptide (anti-CCP) antibody titers greatly improves diagnostic accuracy esp early in the disease 7. radiographic erosions of cartilage or bony decalcification (hands, wrists, or feet) |
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What medications are considered first line for rheumatoid arthritis?
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What is the treatment for fibromyalgia?
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How is the diagnosis of CREST Scleroderma (aka limited cutaneous systemic sclerosis) made?
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The diagnosis is primarily clinical, but lab studies can support the clinical diagnosis
Calcinosis cutis – subQ calcifications often in the fingers, not always present Raynaud’s phenomenon – cyanotic vasoconstriction esp in the fingers Esophageal dysmotility – due to lower esophageal sphincter sclerosis → reflux, dysphagia Sclerodactyly – skin fibrosis esp in fingers, hands, and face Telangiectasias – on the lip, hand, or face; not always present Labs: anti-Scl-70, anti-RNA, anti-U1 RNP, anti-centromere Lab work can support the dx but cannot r/o scleroderma |
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What are the deformities of the hand a/w RA?
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Ulnar deviation of the fingers, MCP hypertrophy
Swan neck deformity, Boutonniere deformity |
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Compare rheumatoid arthritis (RA) and osteoarthritis (OA)
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What are the seronegative HLA-B27 spondyloarthropathies?
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“PAIR”
Psoriatic arthritis Ankylosing spondylitis IBD arthritis Reiter’s syndrome |
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What disease is a/w :
Anti-Scl-70 |
Scleroderma
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What disease is a/w :
Anti-Ro (anti-SSA) Anti-La (anti-SSB) |
Sjogren’s
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What disease is a/w :
Anti-histone antibodies |
Drug-induced Lupus
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What disease is a/w :
Anti-Jo1 antibodies |
Polymyositis or Dermatomyositis
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What disease is a/w :
Rheumatic Factor (RF) |
Rheumatoid Arthritis (RA)
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What disease is a/w :
Anti-dsDNA antibodies |
SLE
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What disease is a/w :
Anti-Sm antibodies |
SLE
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What disease is a/w :
HLA-DR4 |
Rheumatoid Arthritis
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What disease is a/w :
Anti-RNP |
Mixed Connective Tissue Disease
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What disease is a/w :
Anti-mitochondrial antibodies |
Primary Biliary Cirrhosis
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A 65 yo AA woman is evaluated for weakness. The pt has been an active person but now has weakness in her lower extremities. On exam both are equally weak. She also has a rash on her chest. What labs would be helpful to order initially?
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Dx: Dermatomyositis
Labs: CK, AST/ALT, LDH, Anti-Jo1 antibodies, ANA, BMP, CBC |
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A 35 yo Caucasian male comes to the clinic as a new patient. As you enter the room, you notice that he seems to have bad posture. But he tells you that bending forward relieves the pain he feels in his lower back. He goes on to tell you that the pain is worse in the morning but improves with use. What would you expect to see on an X-RAY of his spine?
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Suspect: Ankylosing spondylitis
XRAY: Bamboo Spine |
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A 67yo F c/o pain in her extremities, esp in the shoulders & hips. It is hard for her to even get out of bed. ESR is markedly elevated. What is the treatment?
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Dx: Polymyalgia Rheumatica
Tx: Low dose steroids |
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What serious disease must you look out for in patients with polymyalgia rheumatica?
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Temporal arteritis (tx with high dose steroids)
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What are the characteristics of CREST syndrome, and with what immunologic marker is it associated with?
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Calcinosis
Raynaud’s phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias Marker: anticentromere antibodies |
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A 40yo F with a malar rash, myalgias, pleuritic chest pain, and neuropathy also c/o dry eyes and dry mouth. Labs are (+) for anti-dsDNA antibodies, SSA, and anti-Sm antibodies. What is the diagnosis?
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Dx: Lupus & Sjogren’s Syndrome
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What are the comorbidities a/w fibromyalgia?
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Depression, Anxiety, Irritable Bowel Syndrome (IBS)
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Which infants should be screened for developmental dysplasia of the hip?
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Obtain hip sonogram at 6 weeks if:
Breech female (+/- male breech) Female with fam hx of DDH |
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What is the treatment for slipped capital femoral epiphysis?
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Avoid weight bearing with bedrest, crutches, and/or wheelchair until surgically repaired
Prompt surgical pinning of the head of the femur (single screw to center of the epiphysis) If acute/unstable → admit to hospital for surgical tx If chronic/stable → urgent outpt evaluation (closed reduction of acute slips prior to pinning is controversial) |
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Which infants should receive Vit D supplementation?
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The American Academy of Pediatrics recommends that all children (including breastfed infants) should receive Vit D supplementation of 400IU daily starting the first few days of life (Oct 2008). About 32 ounces of regular formula (1 quart) is required to obtain this amt of Vit D on a daily basis. This recommendation is particularly important if Vit D generated from sunlight exposure is limited due to environmental limitations of darker skin
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What is the treatment for juvenile rheumatoid arthritis?
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NSAIDs are the drugs of choice, but if unresponsive to a trial of 2 different NSAIDs over at least 6 weeks then second line is Methotrexate or Corticosteroids
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What are the characteristic features & treatment of Osgood-Schlatter disease?
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Most common symptom is anterior knee pain that increases over time and is worsened by quadriceps contraction (running, jumping)
Signs at the tibial tuberosity may include soft tissue swelling, a palpable bony mass, and/or pain upon quadriceps flexion Treatment: It is ok to continue sports despite pain; Typically resolves in 6 – 18 months Rehab including stretching the hamstrings and quadriceps and strengthening the quadriceps Protective pad over the tibial tuberosity (aka Osgood-Schlatter pad) Ice to the affected area after activities, NSAIDs for pain (knee immobilizers are contraindicated) |
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What is the treatment for a clavicle fracture in a newborn?
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Occurs in 0.2 – 3.5% of SVDs
No tx is needed (not necessary to immobilize by pinning the shirt) ; Evaluate for brachial plexus injury |
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What is the treatment for a mid-third clavicle fracture in older kids/ adults?
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A child presenting to the ER with his parents is unable to bend his elbow after his father jerked him out of the street an hour prior to presentation. What is the treatment?
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Dx: Nursemaid’s elbow – reduce by gently flexing & supinating the arm with one hand while supporting the elbow & applying gentle pressure to the radial head with the other → give the child a popsicle that they can eat only by using the recently reduced arm to encourage movement and confirm successful treatment (no need to immbolize)
Note: don’t need to obtain xrays of elbow Note: to remember “supination” think of carrying a bowl of “soup” – turns hands into that position |
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What is the treatment for Legg-Calvé-Perthes Disease?
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Non-weight bearing on the affected side for an extended period of time
If limited femoral head involvement and full ROM → observation If extensive femoral head involvement or limited ROM → options include bracing, hip abduction with a petrie cast, or an osteotomy |
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What is the classic presentation of childhood spondylolisthesis?
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Forward (anterior) slip of a vertebrae resulting in a palpable “step-off” on PE (usually L5 over S1
Subacute back pain exacerbated by hyperextension of spine Knee-flexed, hip-flexed gait in cases where the sacrum becomes relatively more vertical & hip extension is impaired Possible neurological dysfunction including urinary incontinence (very rare) |
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A 13yo overweight African American boy is seen with the c/o right knee pain. He denies injuring himself in sports or by some other means. What would be seen on x-ray? What will happen if this condition isn’t corrected promptly?
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Dx: Slipped Capital Femoral Epiphysis
XRAY: posterior & medial displacement of epiphysis in rotation to metaphysis Complications: avascular necrosis of femoral head & premature osteoarthritis |
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On a scheduled health exam of a 3 mo old infant, the doctor notices that the child has asymmetric inguinal skin folds. Wht maneuvers can help determine whether this child has developmental dysplasia of the hip?
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Barlow’s maneuver
Ortolani’s maneuver |
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A concerned mother brings in her 6yo son b/c he “runs funny”. She says that it’s hard to explain, but he doesn’t run with the same gait as the other boys in his age group. Also, he is slower than all of them when they race. You notice the boy stand up from sitting on the ground by using his hands to push against his legs & thighs. He also has larger calves than expected. What protein is deficient in this boy & on what chr is it located?
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Dx: Duchenne Muscular Dystrophy
Genetics: x-linked, Dystrophin protein |
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A female toddler is brought to urgent care clinic b/c the child refuses to use her left arm. On exam, it is obvious the child is anxious as she supports the left forearm with the right one. The left elbow is slightly bent and the forearm is pronated. The patient will not move the arm, and screams when you try to passively flex the affected elbow. What is the pathophysiology of this diagnosis?
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Dx: Nursemaid’s elbow
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What is the treatment for Nursemaid’s elbow?
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Forces supination & flexion by examiner
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What is the treatment for slipped capital femoral epiphysis?
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Non-weight bearing, surgical pinning
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What is the treatment for juvenile rheumatoid arthritis?
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1st line: NSAIDs
2nd line: different NSAID 3rd line: Methotrexate or corticosteroids |
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What is the treatment for Osgood-Schlatter disease?
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Stretching, ice, NSAIDs, do NOT limit sports/ activity, do not immobilize
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What disease is responsible for a painful limb in a child in each of the following scenarios:
X-ray reveals femoral head sclerosis |
Avascular necrosis seen with Legg-Calvé-Perthes Dz
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What disease is responsible for a painful limb in a child in each of the following scenarios:
X-ray reveals ice-cream scoop (femoral head) falling off of cone (femur) |
Slipped Capital Femoral Epiphysis
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What disease is responsible for a painful limb in a child in each of the following scenarios:
Obese, male adolescent with dull hip pain and inability to bear weight |
Slipped Capital Femoral Epiphysis
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What disease is responsible for a painful limb in a child in each of the following scenarios:
Acute onset of tibial pain, fever, malaise, ↑ ESR, no joint pain |
Osteomyelitis
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What disease is responsible for a painful limb in a child in each of the following scenarios:
Acute onset of knee pain, fever, ↑ ESR, leukocytosis |
Septic arthritis
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What disease is responsible for a painful limb in a child in each of the following scenarios:
7yo with growth delay and inner thigh pain |
Legg-Calvé-Perthes Disease
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What disease is responsible for a painful limb in a child in each of the following scenarios:
6yo with unilateral hip pain for 5 days, low-grade fever, spontaneous resolution |
Toxic synovitis
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What disease is responsible for a painful limb in a child in each of the following scenarios:
13yo male with pain & swelling at the tibial tuberosity |
Osgood-Schlatter disease
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What is the treatment for developmental dysplasia of the hip in children younger than 6 months of age?
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Pavlik harness
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Which medications are FDA-approved for the treatment of fibromyalgia?
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Pregabalin, Duloxetine (Cymbalta), Milnacipran
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Describe the rash of dermatomyositis:
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Heliotropic periorbital rash
Shawl sign, Malar rash Gottron’s papules, Mechanic’s hands |
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Which rheumatologic disease matches the following description:
Proximal muscle weakness, facial rash |
Dermatomyositis
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Which rheumatologic disease matches the following description:
Pain & stiffness in the hips & shoulders |
Polymyalgia Rheumatica
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Which rheumatologic disease matches the following description:
Muscle pain & tenderness in multiple distinct points |
Fibromyalgia
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Which rheumatologic disease matches the following description:
Male in his 20’s with low back pain that improves with exercise |
Ankylosing Spondylitis
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Which rheumatologic disease matches the following description:
Jaw claudication & difficulty standing from a chair |
PMR & Temporal Arteritis
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Which rheumatologic disease matches the following description:
Pencil in cup deformities of DIP PIP joints |
Psoriatic Arthritis
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Which rheumatologic disease matches the following description:
Bamboo spine on x-ray |
Ankylosing Spondylitis
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Which rheumatologic disease matches the following description:
Arthritis + oral ulcers + proteinuria |
Lupus
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Which rheumatologic disease matches the following description:
Flexed DIP & hyperextended PIP |
Swan neck deformity of Rheumatoid Arthritis
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WTQ: 15yo boy is brought to the physician b/c 15day h/o painful swelling of the right knee. The swelling & redness were immediate after hitting his knee on the door, but have not subsided after 15 days of ibuprofen. He states that the pain is increasing. He has no other complaints. T 98.9, BP 110/75, P 80, R 22. Labs show a normal ESR and elevated serum alkaline phosphatase. Exam shows the skin is warm & nontender. An x-ray film of the femur and the knee joint shows an osteolytic lesion of the distal femur along with periosteal inflammation. What's the most likely dx?
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Dx: osteosarcoma - the most common primary malignancy of bone
it most commonly affects males in their second decade, preferentially in the metaphysis of long bones. Pts present with bone pain but do not have systemic symptoms |
