Pathologic Conditions

Question 1

Signs and symptoms of a dissecting thoracic aneurysm?(2)

Answer 1

1. Chest pain that can radiate to the back

2. Sudden onset of pain, that is unrelenting, not relieve by positional changes

Question 2

Signs and symptoms of myocardial ischemia?

Answer 2

1. Anterior chest pain or heaviness
2. Occasional nausea
3. Pain radiating to back

Question 3

Signs and symptoms of peptic ulcer?

Answer 3

1. Boring pain from the epigastric area to the middle thoracic spine
2. Thoracic pain triggered or relieved by eating
3. History of extensive NSAID use should increase suspicion for Peptic ulcer

Question 4

What are clusters of finding to diagnose cervical spine myelopathy?(4)

Answer 4

1. Gait Deviations
2. Pos Hoffmanns test
3. Inverted supinator sign
4. Pos Babinski test
5. Age >45 y.o

3 of 5 sensitivity .19 specificity .99
4 of 5 sensitivity .09 specificity 1.0

Question 5

Signs and symptoms of inflamed gallbladder(cholecystitis)?

Answer 5

1. Right upper quadrant and right infrascapular region
2. Pain with moderate fever, nausea, and vomiting
3. Symptoms occur 1 to 2 hours after ingestion of a heavy meal

Question 6

What are the most common forms of cancer that are secondary spinal metastasis to the thoracic spine?(3)

Answer 6

1. Breast
2. Lung
3. Colon cancer

Question 7

Signs and symptoms of Ankylosing Sponsylitis?(5)

Answer 7

1. Definition of >30 minute duration
2. Improvement in back pain with exercise but not rest
3. Awakening because of back pain during the second half of the night
4. Alternating buttock pain
5. Limited chest expansion-Normal 5cm, pathological 2.5cm

Question 8

What is Parsonage-Turner Syndrome? (5)

Answer 8

1. rare syndrome that may occur in otherwise normal healthy individuals
2. Sudden, rather abrupt, unilateral shoulder pain that may begin rather insidiously but quickly amplifies in severity and intensity.
3. progressive weakness, reflex changes, and sensory abnormalities
4. AKA neuralgic amyotrophy or brachial neuritis
5. May be surgical, infectious, traumatic, or even therapeutic, such as cases involving vaccinations or antibiotic treatments

Question 9

What is a Hangsman’s Fracture?

Answer 9

1. Traumatic spondylolisthesis of the
   axis, C2 pedicle fracture of C2 and dislocation
2. Hyperextension-Distraction injury

Question 10

What nerve has highest incident of injury w/ mid humerus fracture?

Answer 10

1. Radial N
2. Seen in 8-15% of fractures
3. Increased incidence in distal 1/3 of fractures (22%)

Question 11

What is a 5th metacarpal fracture? (5)

Answer 11

1. AKA Boxer fracture
2. 10% of all hand fractures
3. MOI: Punching-axial pressure applied to clinched hand; also direct blow to dorsum of hand
4. ORIF if angulation greater then 30deg
5. Treated w/ immobilized with an ulnar gutter splint

Question 12

What is Sinding Larsen Johansson Syndrome (SLJ)? (4)

Answer 12

1. Juvenile osteochondrosis and traction epiphysitis affecting the extensor mechanism of the knee
2. TTP to inferior pole of the patella
   3.Typically young active boys aged 10 to 13 years.
   4.Symptoms
   -Worse with exercise, stair climbing, squatting,
   kneeling, jumping and running.
   -May report that they limp after exercise.
   -May be unilateral or bilateral.
   -Is relieved by rest

Question 13

What is Exophthalmos?(4)

Answer 13

1. A condition where the eyeball protrudes from the eye socket, making it appear to bulge. It can affect one or both eyes.
2. Can signal a problem with the thyroid gland.
3. Graves’ disease is the most common cause of exophthalmos

Question 14

What is the odd facet?

Answer 14

1. Extreme medial edge of the patella

2. Which is in contact with the femur in deep angles of knee flexion

Question 15

What are types of Distal radial fractures? (3)

Answer 15

1. Colles fracture-< 90% of distal radius fractures Colles’ fractures
2. Smith fracture-reverse Colles’
3. Barton’s Fracture- intra-articular fracture with subluxation or dislocation of the carpus bone

Question 16

What is Gaucher disease?

Answer 16

Gaucher (go-SHAY) disease is the result of a buildup of certain fatty substances in certain organs, particularly your spleen and liver. This causes these organs to enlarge and can affect their function.

The fatty substances also can build up in bone tissue, weakening the bone and increasing the risk of fractures.

Question 17

What is Ehlers-Danlos?(4)

Answer 17

1. Cause joint hyper mobility-hyper extensive joints
2. hyperexistence skin
3. Fragile skin
4. Bruising may be sever

Question 18

What is Marfan syndrome?(5)

Answer 18

1. Long arms, legs, and fingers
2. Tall and thin body type
3. thumb sign-DIP sticks out
4. Wrist sign-cross over by one digit
5. Pectus Carinatum or pectus excavatum

Question 19

What is a oeteosarcoma?

Answer 19

1.Malignant tumor often in proximal tibia
2.Common in young boys during growth spurts
3.Presentation
-significant night pain
—insidious onset of deep ache
—-gait deviation
——redness in the joint
4.May require amputation

Question 20

What is a Slipped capital femoral epiphysis?(6)

Answer 20

1. Hip Condition in adolescence
2. Fracture in the growth plate allows the femur to slip off the neck
3. May refer pain to groin or knee(Due to operator N distribution)
4. Patient limbs
5. loss of hip IR, Abd, and flexion
6. Commonly seen in adolescent obese males

Question 21

What is Tripe hand/palm?

Answer 21

1. Thicken velvety palms
2. Palms have appearance of tripe
3. 90% associated w/ internal malignancy in GI tract and lungs

Question 22

What are Bouchard and Henerden nodes?

Answer 22

1. Bony swelling of PIP’s-Bouchard
2. Bony swelling of DIP’s-Heberden
3. Sign of OA

Question 23

What is Erb’s palsy? (4)

Answer 23

1. Injury to the brachial plexus at birth,most common 50-60-%
2. Lesion of C5 and C6 nerve roots, sometimes C7
3. Erb’s point is site of upper trunk
4. Affected nerves axillary, musculocutaneous, supeascapular N.

Question 24

What is Klumpke paralysis?

Answer 24

1.neuropathy of the lower brachial plexus
2.C8 and T1 are injured
3.MOI hyper abduction traction
4.Main signs:
-Claw hand
—weakness and loss of movement of arm and hand
—-Decrease sensation C8-T1 dermatoma
——Infant with injury hold the arm supinated, with the elbow bent, and the wrist extended

Question 25

What is a green stick fracture?(3)

Answer 25

1. A fracture that occurs when the bones bend and cracks instead of breaking completely separating into two pieces 2. Occur in younger children less than 10 years old 3. Most common occur with a fall, and arm fractures more common than leg fractures.

Question 26

What is nursemaids elbow?(2)

Answer 26

1. Common injury early childhood | 2. Results in subluxation of the annular ligament due to a sudden longitudinal action applied to the hand

Question 27

AVN risk factors?(5)

Answer 27

1. Joint injury like dislocating joint, fracture, cancer treatment with radiation we can weaken bone and blood vessels 2. Heavy drinking 3. Steroid abuse 4. Obesity 5. Medical conditions like sickle cell anemia or Lupus

Question 28

What is Legg-Calve-Perthes Disease?

Answer 28

1.AVN of the proximal femoral epiphysis in children 2.4-8 years is most common age 3.male to female ratio is 5:1 4.Symptoms insidious onset intermittent hip, knee, groin or thigh pain 5.Physical exam hip stiffness loss of IR and ABD gait disturbance(Trendelenburg gait), antalgic limp, may cause painless limp

Question 29

What is Reiter disease?(3)

Answer 29

1. Joint pain and swelling triggered by an infection in another part of the body. 2. Symptoms include joint pain and stiffness, most commonly in the knees, ankles, and feet. 3. there may be discomfort during urination as well as eye inflammation.

Question 30

What is Apophysitis?(2)

Answer 30

1. Traction injury to the cartilage and bony attachment of tendons in children and adolescents 2. Most often an overuse injury in children

Question 31

Common sites for apophysitis? (6)

Answer 31

1. Hip apophysitis-ischial tuberosity, anterosuperior and anteroinferior iliac spines, iliac crest 2. Iselin disease-over base of 5th metatarsal head 3. Larsen-Johansson disease-Inferior patella 4. Medial epicondyle apophysitis-Thrower elbow 5. Osgood-Schlatter disease-anterior tibial tubercle 6. Sever disease-Posterior heel

Question 32

What is Osteochondrosis?

Answer 32

1.Degenerative changes in the epiphyseal ossification centers of growing bones

Question 33

Common sites for Osteochondrosis?(4)

Answer 33

1. 2nd metatarsal head (i.e., Freiberg disease) 2. Navicular bone (i.e., Köhler bone disease) 3. Femoral head (i.e., Legg-Calvé-Perthes disease) 4. Capitellum (i.e., Panner disease).

Question 34

What is Scheuermann disease?(4)

Answer 34

1. juvenile kyphosis or juvenile discogenic disease 2. condition involving an abnormal, excessive curvature of the spine 3. involves both the vertebral bodies and discs of the spine 4. characterized by anterior wedging of greater than or equal to 5 degrees in 3 or more adjacent vertebral bodies

Question 35

What is Klippel Feil syndrome?(4)

Answer 35

1. affecting the development of the bones in the spine. 2. PT are fused at least two spinal bones (vertebrae) in the neck. 3. Common features may include a short neck, low hairline at the back of the head, and restricted movement of the upper spine.

Question 36

What is Kehr’s sign?

Answer 36

1. Acute LEFT shoulder pain at tip | 2. Ruptured SPLEEN

Question 37

What is Lhermitte's Sign?(3)

Answer 37

1. electric shock-like sensation that occurs on flexion of the neck 2. sensation radiates down the spine, often into the legs, arms, and sometimes to the trunk 3. Caused by multiple sclerosis, cervical spondylotic myelopathy