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From Flashcardlet > AGNP (AANP) MSK Systems Review > Flashcards

AGNP (AANP) MSK Systems Review Flashcards

Abby and Alice

0
Q

Bursitis: Most common affected

A

subdeltoid, olecranon (elbow), ischial, trochanter, and prepatellar.

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1
Q

Bursitis

A

Inflammation of the fluid filled sacs that act as cushions between tendons and bones. From overuse of joints, trauma, infection, RA, OA

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2
Q

Bursitis: S&S

A

ROM FULL, but limited by pain. Typically localized pain and swelling at site.

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3
Q

Bursitis: Tx

A

In prepateller first line aspiration. Others first line minimizing or eliminating offending activity, and ice qid, and NSAIDS. If in 4-6 wks no improvement intrabursal corticosteroid injection

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4
Q

Epicondylitis

A

Injury to extensor tendon at the lateral epicondyle (tennis elbow), medial epicondyle (golfers elbow)

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5
Q

Medial Epicondylitis

A

pain over medial aspect of lower humerus, tenderness, pain, weakness, pain with wrist flexion and pronation. Golfers elbow. From sports involving tight grip

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6
Q

Lateral epicondylitis

A

pain over lateral aspect of lower humerus. With wrist extension. Hand grip weak. Tennis elbow

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7
Q

Lateral epicondylitis Tx:

A

avoid aggravating activity. NSAIDS, cast to limit movement, if persist 6-8 wks then corticosteroid injection.

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8
Q

Gouty Arthritis

A

Uric acid accumulation in joints bones, and subQ tissue. Accumulation usually due to kidneys inability to excrete it. 90% men.

Deposition of uric acid or monosodium urate crystals in supersaturated extracellular fluids (particularly in and around joints and tendons)

Three stages - asymptomatic hyperuricemia, acute intermittent gout, chronic tophaceous gout

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9
Q

Gouty Arthritis: Risk factors

A

obesity, DMII, family hx. OR use of medications: TZD diuretics, niacin, aspirin, and cyclosporin. ALCOHOL possible precipitant.

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10
Q

Gouty Arthritis: S&S

A

Sudden onset and significant distress. Extremely painful, can’t even stand bed sheet on effected joint. Joint reddened and enlarged. Can get nodules called tophi in external ear, nasal cartilage, hands, feet, and elbow.

Sudden onset red, hot, swollen, tender joint

Typically presents in great toe.when occurs in the first MTP joint - is ‘podagra’

More common - chronic joint pain in more than one joint

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11
Q

Gouty Arthritis: Diagnostics

A

Joint aspiration = urate crystals on polarized light microscopy

↑ CRP

↑ WBC

↑ ESR

serum uric acid > 7.0 mg/dL

xray = punched-out lesions in subchondral bone

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12
Q

Gouty Arthritis: Non-pharm Tx

A

Acute - rest; local application of cold (caution in pts with PVD or p/neuropathy)

Chronic - dietary modification (avoid purines/ETOH), ≥ 3L/d, wt loss

Avoid foods with purine: scallops, mussels, organ and game meat, beans, spinach, asparagus, bakers and brewers yeast

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13
Q

OA

A

Degenerative condition manifests withOUT systemic manifestations or acute inflammation.

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14
Q

OA: Most common joints affected

A

hip and knees and distal interphalangeal joints

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15
Q

OA: Patho

A

Articular cartilage becomes rough and wears away. Bone spurs may form and synovial thickening. Joint space narrows. Non-inflammatory disease. Can get bouchard nodes on finger joints

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16
Q

OA: S&S

A

Minimal morning stiffness, pain increases as day goes on as the joint is uses more.

Pain cause by activity and relieved by rest within 15 mins.

PE: cool joints with crepitus. Can be joint effusion in knee. Cannot achiev full flexion in effused joints.

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17
Q

OA: Risk factors

A

family and sports hx, obesity

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18
Q

OA: Dx

A

Radiography: xray (osteophytes, asymmetric narrowing of joint space)

Labs: ESR and CRP normal since it is non inflammatory

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19
Q

OA: Pharm Tx

A

Acetaminophen - 3000mg daily for pain

Topical analgesic creams (Diclofenac sodium/Voltaren 1% gel; Lidocaine 5% patches)

NSAIDs - risks may outweigh benefits; may use COX-2 inhibitor celecoxib

(Celebrex) cautiously when no risk for cardiac disease

Intra-articular corticosteroid or hyaluronic acid injections may be helpful

Glucosamine is an amino acid which is first line in European nations.

Joint replacement when: pain uncontrolled, function severely impaired, or when more than 80% of articular cartilage gone.

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20
Q

RA

A

Disease causing chronic systemic inflammation involving synovial membranes. More common in women. Onset 20-40. Family hx.

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21
Q

RA: S&S

A

slowly progressing malaise, wgt loss, and stiffness. Hands (sparing distal intraphalangeal joints), wrists, ankles, and toes. Morning stiffness for hr, stiffness after inactivity.

22
Q

RA: Diagnostics

A

Radiographs: juxta articular osteopenia, joint erosion, loss of joint space

ESR, CRP higher than normal indicating inflammation.

Rheumatoid factor (immunoglobulin M antibody)- present. Most specific test

23
Q

RA: Tx

A

goal to reduce pain and inflammation. Reduce stress

Water exercise beneficial

NSAIDS and DMARDs (methotrexate, infliximab etc)

If above does not help THEN, intraarticual corticosteroid injections, or systemic steroids.

24
Q

Meniscal tear

A

Disruption of the C-shaped fibrocartilage pad located between the femoral codyles and the tibial plateaus.

Often seen in athletes from hyperextension or twist injury. Often seen in older adults from degenerative changes.

25
Q

Meniscal tear: S&S

A

Report knee locking, pooping sound, or “gives out”. Effusion common. Tightness, stiffness. ROM limited due to discomfort.

26
Q

Meniscal tear: Dx

A

McMurray test: palpable popping of the joint line

Radiograph- meniscus not visible, so have to use MRI if sxs don’t improve over 2-4 wks.

27
Q

Meniscal tear: Tx

A

RICE

Aspiration if joint effusion doesn’t resolve within 2-4 wks.

Use of crutch

Arthroscopy for debridement after 4-6 wks with no improvement.

28
Q

Carpal Tunnel Syndrome:

A

Painful syndrome caused by compression of median nerve between carpal ligaments and other structures within carpal tunnel.

29
Q

Carpal Tunnel Syndrome: Risk factors

A

repetitive movements, keyboard, cake decorators etc.

30
Q

Carpal Tunnel Syndrome: S&S

A

due to nerve ischemia NOT nerve damage

Burning, aching, tingling, pain radiating to forearm and occasionally shoulder, acroparethesia. Awakening at night with numbness and burning in fingers.

31
Q

Carpal Tunnel Syndrome: Dx

A

positive Tinel and Phalen test, and carpal compression test.

32
Q

Normal changes of aging: Body composition

A

Fat mass ↑
Bone, muscle mass and strength ↓
↓water →tendon, ligament AND cartilage STIFFNESS

33
Q

Normal changes of aging: Endocrine changes affecting bone and muscle

A

Adrenopause - ↓ DHEA levels may ↑ adiposity and ↓ muscle mass

Andropause
↓ of total and free testosterone in men
↓ testosterone in postmenopausal women → ↑ fracture risk

Menopause
↑ bone resorption → ↑ risk of osteopenia and osteoporosis

Growth hormone (GH) and insulin-like growth factor ↓ → ↑ fat and ↓lean muscle mass and strength

34
Q

Osteoporosis

A

Bone resorption > bone formation → ↑ bone porosity in trabecular bone (larger marrow spaces) & thinning of cortical bone

35
Q

Bone mineral density (BMD)

A

at least 2.5 standard deviations below peak bone density; represented as

Osteoporosis: T-score of -2.5 or lower

Osteopenia - BMD T score of -1 to -2.4

36
Q

Osteoporosis: Prevention / screening

A

Nutritional diet - adequate Calcium and Vit D intake
Regular weight bearing exercise / resistance exercise
Bone densitometry or dual energy x-ray absorptiometry (DXA) scan of axial skeleton for all women 65yo and older; and for 60yo with increased risk

37
Q

Osteoporosis: Assessment

A

Hx - any fx after 50yo, ↓ height, back pain, articular stiffness → pain with motion; relieved by rest

Phy - fx most common presenting sign; documented decreased ht over time; kyphosis with bulging abdomen common in more advanced case

Dx - bone densitometry; show on x-rays after more than 30% bone lost

38
Q

Nonpharmacologic tx

A

exercise, fall prevention, smoking cessation, no more than 1-2 alcoholic drinks daily

39
Q

Osteoporosis: Pharmacologic tx

A

> Calcium 1200-1500mg daily
Vitamin D 800U daily
Bisphosphonates
Zoledronic acid (Reclast)
Parathyroid hormone teriparatide (Forteo)
Selective estrogen receptor modulators (SERM) - raloxifene (Evista)
Calcitonin nasal spray

40
Q

Bisphosphonates

A

Alendronate (Fosamax) 70mg weekly or 150mg monthly or

Risedronate (Actonel) 35mg weekly or 75mg on 2 consecutive days per month,

Ibandronate (Boniva) 150mg orally monthly OR 3mg IV every 3 months

Must take on empty stomach in am and remain sitting or standing for 30 minutes (60 minutes for Ibandronate) before eating or it will not be absorbed or will cause severe esophagitis

41
Q

Calcitonin nasal spray

A

Miacalcin) 200units daily intranasal, alternating nostrils for those unable to take bisphosphonates due to GI distress

not as effective as bis….; also used as analgesic for compression fractures

42
Q

OA: Prevention and screening

A

Moderate physical activity; mtn IBW, avoid obesity

43
Q

OA: Assessment

A

Weather changes may affect symptoms

Joint instability - especially knees

Localized…not systemic disease

Bony hypertrophy of joint

  • -Distal interphalangeal (DIP) joint swelling - Heberden’s node
  • -Proximal interphalangeal (PIP) joint swelling - Bouchard’s node
44
Q

OA: Non-pharm Tx

A

Physical activity: PT/OT
Heat/cold to affected joint
Non-wt bearing exercise - water aquatics

Wt loss

Heat to minimize pain and stiffness, heat before activity and ice after.

45
Q

Acute Gout: Pharm Tx

A

Treat inflammation THEN hyperuricemia.

Use all gout meds with caution - renal insufficiency or dehydration

Acute:
NSAIDs or Clochicine = tx of choice

NSAID:
»Indomethacin not recommended for use in gero pts (CNS Ses)
»Tx until pain resolved; COX-2 inhibitors not FDA approved for Gout

Colchicine:
0.6mgPO q 2 hrs until pain relieved or nausea or diarrhea occur; total dose not to exceed 8mg/d; usually relief in 3-14 days (Used when NSAIDs contraindicated for pts with HF or on anticoag)

Corticosteroids PO or inj NOT aspirin as contraindicated.

46
Q

Chronic Gout: Pharm Tx

A

Goal - keep uric acid level WNL; minimize urate deposition in tissues

Avoid or decrease diuretics
Colchicine 0.6mg PO 1-2/day

Allopurinol - for chronic gout only
100mg-300mg daily depending on creatinine clearance
 Adverse events - fatal skin rx, 
 hypersensitivity rx, renal and
 hepatotoxicity
47
Q

Neck pain: Incidence

A

50% > 50yo; 80% > 55yo = degenerative disk disease on cervical spine x-rays

48
Q

Neck pain: Management

A

Nonpharmacologic tx
Heat, soft cervical collar, neck strengthening as tol

Pharmacologic tx
See clinical implications for pain management
Muscle relaxants with caution in older adult
Refer for corticosteroid injection if indicated
Refer for physical therapy

49
Q

Lower back pain: Causes

A

Sciatica - symptom of pain radiating down 1 or both buttocks/legs; often but not always caused by herniated disk

Herniated disk - rupture of nucleus pulposus through annulus fibrosis of intervertebral disk; compresses spinal cord or irritates associated nerve root; more often unilateral

Spinal stenosis - narrowing of spinal canal, usually from osteoarthritis

50
Q

Lower back pain: Hx/S&S

A

onset, precipitating factors, impact on function,

  • -stiffness (usually associated with muscular injury)
  • -paresthesia or sciatica (burning pain buttock/leg) associated with herniated disk or radiculopathy
  • -gait disturbance with pain associated with spinal stenosis
  • -pain at night unrelieved by rest suggests tumor, infection, compression fx, ankylosing spondylitis or malignancy,
  • -bilateral leg weakness, saddle area anesthesia, or B/Bl incontinence indicate cauda equina process from tumor, epidural abscess, or massive disk herniation
51
Q

Lower back pain: PE

A

with pt on back, raise 1 leg with knee absolutely straight until pain experienced in thigh, buttock and calf - record angle when pain occurred (normal pain free 70-90 degrees, higher in people with lax ligaments)

…then perform sciatic stretch test…dorsiflex foot at point of discomfort; test is positive if additional pain occurs

flexing the knee will relieve the buttock pain, but this is restored by pressing on the lateral popliteal nerve

Severe root irritation is indicated when straight raising leg on unaffected side produces pain on affected side

52
Q

Lower back pain: Tx

A

Nonpharmacological
Relieve pain to facilitate function and mtn activity
Avoid bed rest - deconditioning
Ice/heat/massage

Pharmacological
Short term…acetaminophen, NSAIDs, lidocaine patch 5% (Lidoderm)
Long term…pain management g/lines, TENS unit

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