Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fitzgerald Review > ch 16 Common MK problems > Flashcards

ch 16 Common MK problems Flashcards

1
Q

when conducting an orthopedic exam, assess..

A

the entire person not just the MK problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 ortho q’s to ask…

A
  1. is the pt otherwise well? if no, condition limited to bone and/or joints (OA, osteoporosis)
  2. systemic systems and signs (fever, weight loss, anemia, rash, joint swelling)? yes think RA, lupus, PMR etc
  3. pt’s risk factors/predisposing factors? trauma, age, gender, obesity, autoimmune (RA), job (OA), sports, meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

monoarticular pain

A

affecting 1 joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

2 most common places to have gout

A

-metacarpophalangeal joint of
the great toe
-wrist

distal from body since uric acid need lower temp to ‘settle’ compared to internal body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when to start preventative therapy for gout with allopurinol?

A

6 months AFTER tx of acute gouty attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

avoid what type of foods to prevent future gout attacks?

A

purine rich foods = forms uric acid when metabolized like organ meats
-seafood
-alcohol
-fructose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

risk factors for gout

A

-Obesity
-diabetes mellitus
-family history of gout
thiazide, niacin, aspirin, alcohol use, purine-rich diet (organ meats, seafood (sardines and anchovies, spinach, oatmeal),
-CKD(offloading uric acid isn’t as sufficient), renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

gout causes

A

-10% uric acid overproduction
-90% urate UNDER excretion esp with risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

prevention of acute gouty athritis attack (urate lowering therapy)

A

1st line: Allopurinol (Aloprim) - xanthine oxidase inhibitor (XOI) therapy OR
febuxostat (Uloric)

start 6 months after start of NSAID/colchicine treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

knee pain after a twisting-type injury; has reduced ROM and reports the knee locks

& what test?

A

meniscus tear
Mc Murray test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

history of multiple ankle sprains; feels ankle rolls inward more easily, ankle pain

& what test?

A

ankle instability
talar tilt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

repeititve hand motions, who constantly uses a soldering iron throughout day; feels numbness,
tingling, weakness in dominant hand

& what test?

A

carpel tunnel syndrome (hand repeititve movements)
Tinel’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

18 year old soccer player experiences
sudden knee pain and swelling after changing direction rapidly, heard a “popping” noise, has reduced ROM

& what test?

A

ACL tear
lachmman test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A 62-year-old with history of spondylolisthesis and experiences low back pain that radiates to the legs and feet, with numbness and muscle
weakness

& what test?

A

lumbar nerve root compression/lumbar spinal stenosis (lower back pain)

straight leg raise test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A 32-year-old with neck pain following a motor vehicle accident; tingling and numbness runs down shoulder, arm, and to the thumb

& what test?

A

cervical nerve root compression
Splurling test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A 14-year-old baseball pitcher complaining of
pain and swelling on his throwing arm, clicking
sound heard when arm is raised, pain triggered
by raising or lowering arm

& what test?

A

rotator cuff evaluation
drop arm test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A 44-year-old drummer who complains of pain
and swelling at base of thumb, feels a “sticking”
sensation when trying to move thumb

& what test?

A

De quervains tenosynovitis
Finkelstein test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

differential diagnosises of MK depends on

A

if it’s systemic issue or localized issue
-pay attention if the joints are affected are smaller joints (hands, wrist) or big joints (shoulders, hips)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

rheumatoid arthritis vs polymyalgia rheumatica

A

both elevate ESR
RA affects smaller joints (fingers, wrists)
PMR affects larger joints (hips, shoulders)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

polymyalgia rheumatica (PMR) etiology

A

> 50 years (white)
-unknown etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PMR clinical presentation

A

aches in shoulder (1st sx seen), neck, upper arms, lower back, hips, thighs
-worse in morning, better during day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PMR intervention

A

50% will have giant cell arteriitis so get rid of inflammation! give low dose corticosteroids (10-15 mg QD prednisone) until sx’s are relieved (2-3 wks) then taper dose to find lowest dose to suppress sx
tx up to 2-3 years
supplement with Ca & Vitamin D
-NSAIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PMR diagnosis

A

-no specific test
-CRP, ESR are elevated = inflammation
-MRI, U/S = inflammation
-CBC = mild anemia of chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

RA, lupus, or both?
More common in women?
An autoimmune disorder?
Classic presentation of fever, joint pain, and
rash?
Anemia of chronic disease common at
diagnosis?
Elevation in ESR and CRP?
Treated with biologic and/or non-biologic
DMARDs?
Can present with subcutaneous nodules?

A

More common in women: both
An autoimmune disorder: both
Classic presentation of fever, joint pain, and butterfly rash: lupus
Anemia of chronic disease common at diagnosis: both (multip system and inflammatory condition)
Elevation in ESR and CRP: both
Treated with biologic and/or non-biologic
DMARDs: both
Can present with subcutaneous nodules: RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

osgood-schlatter disease affects mostly

A

adolescent during growth spurts in running/jumping sports

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

pain and/or swelling of knees, ankles, heels, toes or fingers
low back pain
conjunctivitis
urinary problems can also be present

A

reactive arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

reactive arthritis etiology

A

painful inflammatory arthritis seen days or weeks after acute bacterial diarrhea or STI

most common in men 20-50 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

reactive arthritis diagnosis

A

blood test for infection/inflammation (ESR/CRP)
-HLA-B27 genetic test
-xray
-test for chlamydia

29
Q

lumbar sacral strain

A

back spasmsss, ache, stiffness
-positon, activity impacts pain
(ask how do u feel walking? better when walking? worse when sitting for awhile. laying flat is best)

30
Q

lumbar sacral strain PE

A

Paraspinal muscle tenderness and spasm
LS curve straightening
decrease LS flexion (bend over)
**NORMAL NEURO EXAM

31
Q

lumbar sacral strain intervention

A

-pain can last 1-2 weeks (>90% recover in 1 month)
-analegisa (NSAID)
-stay active
-PT/condition
-heat or ice
-skeletal muscle relaxers (SMR/ Soma) abuse potential but can be helpful

32
Q

lumbar radiculopathy and sx’s

A

“pinched nerve”/sciatica
-irritation damage of neural structures (L4-L5, L5-S1) most common site of bulge
-sharp burning electric shock down leg
-decreased sensory, DTR
-worse when increase spinal fluid pressure (sneezing, straining like sit on toilet) = sharp pain

33
Q

lumbar radiculopathy PE

A

Signs of LS strain
**ABNORMAL neurological exam including
-abnormal straight-leg raising
-sensory loss
-altered DTRs

34
Q

lumbar radiculopathy intervention

A

70% improve in 2 weeks
-conservative tx (heat, ice, NSAID, SMR, PT)
-if 4-6 weeks no improvement in persistent neuro defect, refer
-only 10-15% require surgery

35
Q

neuro testing in what lumbar vertebrals?

A

L4, L5, S1

36
Q

lumbar radiculopathy innervations

A

L4-L5 or L5-S1

37
Q

what does the L4 move/motor? causes what reflex? sensory?

A

foot dorsiflexion
patellar reflex
medial calf

38
Q

what does the L5 move/motor? causes what reflex? sensory?

A

great toe dorsiflexion
no reflex
medial foot

39
Q

what does the S1 move/motor? causes what reflex? sensory?

A

foot eversion
ankle jerk
lateral foot

40
Q

imaging for low back pain criteria

A

NO criteria for immediate imaging (Xray, MRI, CT) without first 1-2 month trial of conservative back pain therapy ESP with normal neuro exam, NO significant trauma, low risk for vertebral compressure fracture or osteoporosis

41
Q

when consider MRI for low back pain?

A

-signs of radiculopathy persisting AFTERRR trying conservative therapy (4-6 wks) who are candidates for surgery or epidural corticosteroid injection
-risk factors for or symptoms of spinal stenosis in patients who are candidates for surgery

42
Q

lumbar spinal stenosis clinical presentation

A

-50 and older, RA, ankylosing spondylitis [autoimmune]
-standing causes discomfort, bending slightly forward feels BETTER (opens spinal canal and relieve leg pain)
-Pseudoclaudication (leg pain that worsens with
activity and improves with rest)
-Bilateral lower-extremity numbness, weakness in
the majority

43
Q

lumbar spinal stenosis diagnostics

A

none for 1 month, if persists >1 month, consider x-ray, CT, MRI, eletromyelogram (EMG), nerve conduction velocity, somatosenory evoked potentials & refer to spine specialist

44
Q

lumbar spinal stenosis intervention

A

-Conservative: PT, NSAIDs, last: epidural corticosteroid injection
-Surgical (with significant myelopathy,
radiculopathy, and/or neurogenic claudication):
-Consider decompressive surgery if no improvement with conservative

45
Q

osteoporosis

A

based on bone mass deviation (BMD) at spine, hip, or forearm by Dexa scan device, within 1 standard deviation of a “young normal” adult
T score at -2.5 and lower

46
Q

osteopenia (low bone mass)

A

BMD between 1 and 2.5 SD
T score -1 and -2.5

47
Q

osteoporosis guidelines

A

BMD 2.5 SD or below
T score -2.5 or below
if pt has had 1 or more fractures, they have severe or “established” OP
OR
low trauma spine or hip fracture (regardless of BMD)
OR
T score -1 and -2.5, and fragility fracture of proximal humerus, pelvis, or distal forearm
OR
T score -1 and -2.5 and high FRAX probability

48
Q

osteoporosis: who should undergo BMD/Dexa scan?

A

women age 65 and older, men 70 and older regardless of risk factors
-younger post menopausal women, meno transition, men 50-69 with fracture risk factors
-women/men 50+ who has broken a bone
-adults with RA or med (long term steroid) a/s with low bone mass/loss
risk factors:
- sedenatary, low Ca intake, alcohol abuse, CF, gauchers disease, hyperprolactinemia, DM, adrenal insuff, celiac dz, IBD, multiple myeloma, leukemia, autoimmune (RA, lupus), epilepsy, MS, AIDS, CHF, anticonvuls, thyroid hormones

49
Q

Osteoporosis: who should be treated?

A

Postmenopausal women and men age 50 years and older with:
* DXA testing that reveals BMD T-scores of less than –2.5
* Low bone mass/osteopenia of T-score of –1 to –2.5 and a 10-year hip fracture probability of 3% or more or a 10-year
all major osteoporosis-related fracture probability of 20
* History of hip or vertebral fracture

50
Q

Osteoporosis treatment

A

1st line: Bisphosphonates (alendronate [Fosamax]
ibandronate [Boniva], risedronate [Actonel], and
zoledronic acid [Reclast]), calcitonin (Miacalcin),

-Also give ALL vitamin D and calcium for age ≥50 years
-For calcium, men age 50 to 70 years should consume 1000 mg/d, and women age ≥51 years and men age ≥71 years should consume 1200 mg/d of calcium.
- diet Ca: spinach, sardines, tofu, select nuts including almonds,

51
Q

Osteoarthritis of knee assessment

A

Pain, tenderness, and stiffness (more prominent in the morning) in thejoint
reduced range of motion and crepitus
NO erythema and warmth are usually absent (but effusion might be present)

52
Q

OA of knee treatment

A

-Tai chi, yoga,
-Weight loss if BMI≥25 kg/m2
-cane
-NSAID, intraarticular glucocorticoid, topical capsaicin, acetaminophen, duloxetine, tramadol

53
Q

OA & knee replacement surgery

A

arthroplasty considered if all fail, when osteotomy not appropriate, and can’t do ADL’s

54
Q

A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Osteoarthritis

A 44-year-old woman with a
normocytic, normochromic, nonevolving anemia

A

A & B
anemia of chronic disease

55
Q

A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Osteoarthritis

A 34-year-old woman with elevated
C-reactive protein

A

A & B

56
Q

A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Osteoarthritis

A 57-year-old man with BMI of 39 kg/m2 and knee pain associated with joint-space narrowing on x-ray

A

C. older adult with high BMI
not systemic dz, but localized dz

57
Q

A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Osteoarthritis

A 51-year-old woman with morning stiffness in her hands and a positive antinuclear antibody titer

A

A & B
ANA will be + in RA 60% of the time and 99% in Lupus

58
Q
A

A. Herberden nodes
B. Bourchard nodes

Osteoarthritis

59
Q

FOOSH (snuff box)

A

“fall on an outstretched hand” / scaphoid fracture
-fracture with risk of union and avascular necrosis

60
Q

scaphoid fracture sx’s and dx

A

Pain radial aspect of wrist proximal to thumb (snuff box),
decreased grip and strength

Xray - (PA, lateral, oblique) plus scaphoid view may miss this fracture; consider repeat radiographs within 7‒10 days; CT, MRI, and bone scan

61
Q

when it involves hand/wrist injuries, when in doubt

A

ortho refer!

62
Q

scaphoid fracture intervention

A

even if x-ray negative, give thumb spica splint, analgesia, ortho referral

63
Q
A

“Scared Lovers Try Positions That They Can’t Handle”

A= Scaphoid
B= Lunate
C= Triquetrum
D= Pisiform
E= Trapezium
F= Trapezoid
G= Capitate
G= Hamate

1= Radius
2= Ulna
3= Metacarpus

64
Q

*Grade 1 sprain

A

mild ligament stretched with small tears
Minimal swelling, can bear weight

RICE, analgesia, PT, compression bandage for swelling

65
Q

*Grade 2 sprain

A

BRUISES, swelling
mild to mod joint instability, decreased ROM
can weight bearing and walking but painful

immobilization with walking boot (Aircast) or splint for few weeks(4-6 wks recovery)

66
Q

Grade 3 sprain

A

-complete tear of ligament
-complete ankle isntability, lots of swelling and brusing
-loss of function, can’t bear weight and walk ankle flopping back and forth
-ortho referral!!!! cast, splint, boot

67
Q

ottawa knee rules

A

get x ray to r/o fracture if have any of these:
1. 55 yrs or older
2. Isolated tenderness of the patella (kneecap)
3. Tenderness at the head of the fibula
4. Inability to flex the knee to 90 degrees
5. Inability to bear weight both immediately and in the emergency department for four steps.

68
Q

ottawa ankle rules

A

get x ray to r/o fracture if have any of these:
1. pain in malleolar zone AND tenderness lower tip of fibula or tibia and can’t bear weight for 4 steps
2. pain midfoot zone AND tenderness at 5th toe or navicular bone, or can’t walk 4 steps

Fitzgerald Review (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions