CA rheum/MSK Flashcards
(137 cards)
1
Q
SHOULDER
Neer’s impingement sign
A
press on the scapula to prevent it from moving and with one hand, raise patients arm with the other
compresses the greater tuberosity of humerous against acromion causing rotator cuff tendons to press against the acromion
2
Q
SHOULDER
hawkins impingement sign
A
flex the shoulder and elbow to 90, internally rotate arm
compresses greater tuberosity against the acromion
3
Q
SHOULDER
empty can test
what specific muscle does it test?
A
flex arm at shoulder to 90 and internall rotate so thumbs are pointing down (like emptying a can, duh)
have the patient resist against downward pressure on the arm
tests supraspinatus muscle
4
Q
SHOULDER
infraspinatus and teres minor test
how is this test performed?
A
flex at elbows 90 in front of the body with thumbs up
provide resistance against patient externally rotating
5
Q
SHOULDER
Lift off test
what muscle does this test?
A
subscapularis
place arm behind back with palm facing out and lift off against restistance
6
Q
SHOUDLER
drop-arm test
A
abduct the arm so it is over the head and ask the patient to slowly lower it
if supraspinatus is torn, then at 90* it will fall
7
Q
ELBOW
lateral epicondylitis
A
feel the lateral epidcondyl of the humerus and 2 cm distal to it
apply resistance as the patient extends and soupinates their wrist
since the muscles that do this attach to the lateral epidcondyl, this will cause pain which can indicate inflammation
8
Q
ELBOW
medial epicondylitis
A
apply resistance as the patient flexes and pronates
the flexor and pronation muscles attach here so if pain could indicate inflammation
9
Q
WRIST
finkelsteins test
what two muscles does this specifically test?
A
place thumb inside of formed fist, deviate towards the ulna
stretches extensor pollics brevis and abductor pollicis longus over radial styloid
10
Q
WRIST
tinel’s sign
A
lightly tap over the median nerve in the carpal tunnel on the volar aspect of the wrist
aching and numbness is a positive test
11
Q
WRISTS
phalen’s sign
A
press dorsal aspects of the hands together to form right angles
this compresses the median nerve
numbness and tingling for 60 seconds is a positive test
12
Q
Spine
spurlings test
A
passively laterally flex and extend the neck with downward compression
radiating symptoms down neck and shoulder is positive for cervical nerve impingement
13
Q
SPINE
cervical unload
A
in neutral position, put one hand under the occiput and one hand under the chin and lift head
positive test is reduction where symptoms are eliminated suggesting cervical nerve inpingement
14
Q
SPINE
cervical load
A
press on the top of the skull in neutral position
positive test is reproduction of symptoms indicating cervical nerve inpingement
15
Q
SPINE
FABER TEST
A
make a 4 shape and press hands on ASIS and knee at the same time
positive test: pain in the SIJT
if pain is in the groin, could be hip involvement too
16
Q
SPINE
hoffman test
A
flick the middle nail of middle finger and look for index and thum flexion
indicates upper motor neuron disease
(eg proximal central cord compression)
17
Q
SPINE
waddells test
what is it and what are four benign maneuvers to stimulate pain?
A
SLR placing hands on heels, if no pressure than person not exhibiting true effort
benign maneuvers to stimulate pain
- skin roll
- twist at hips
- head compression of 5 pounds
- SLR, standing and seated, should cause radiating pain
18
Q
Knee
bulge test
A
with leg extended place pressure on the suprapatellar pouch
apply medial pressure, and tap latterally with right hand to watch for fluid wave
positive test: bulge on the medial side between the patella and the femur
19
Q
knee
balloon sign
A
basically: grab either side of the patella, squeeze with the left hand and look for any fluid displacement to under the right hand
20
Q
knee
valgus stress test
A
flex thigh to 30*, push medially at the knee and pull laterally at the ankle
tests medial collateral lig
21
Q
knee
varus stress test
A
tests lateral collateral lig
lateral force at knee medial force at ankle
22
Q
knee
anterior drawer sign
A
tests ACL
patient lays supine, flex knee to 90*, cups hands around the knee and pull tibia forward compare with opposite knee for amount of forward motion
forward jerking motion shows positive test and suggests ACL tear!
NOT THE FOOTBALL PLAYERS! Fantasy sports!
23
Q
knee
lachman’s test!
A
ACL
place knee in 15* flexion and external rotation, pull tibia forward and push distal femur backwards at the same time, suggests ACL tear
24
Q
knee
posterior knee test
A
PCL
patient supine knee at 90, push back on the tibia
25
knee
McMurray test
flex knee holding knee and foot
then...
**externally rotate: stresses medial meniscus**
**interally rotate: stresses lateral meniscus**
in _click_ is felt or heard or pain at the joint line then this is suggestive of a meniscus tear
26
foot and ankle
Thompson's test
with patient lying prone (on stomache) with feet hanging off table
squeeze the calf of **affected** side
test is positive if foot remails in the **neutral** position or there is **minimal plantar flexion**
**aka, it doesn't move!**
27
ottowa ankle and foot rules
what are the 3 locations that warrent a xray film?
**malleolar zone:**
posterior edge 6cm
**Midfoot zone**:
tendernous at base of 5th metatarsal
navicular bone
28
flexor tenosynovitis-Kanavel criteria
tenderness along the course of **flexor tendon**
## Footnote
**fusiform symmetrical swelling of finger**
**flexed posture of finger**
29
dequervain's disease
- tenosynovitis
- repetitive strain injury
- decreased grip strength, pain on radial surface that increases with **thumb or ulnar deviation**
**Finkelstein's test**
30
carpel tunnel syndrome
median neuropathy from compression of the flexor retinaculum
**tinel test**
nerve conduction or velocity test
31
scaphoid fracture
**fall on outstretched hand**
pain at anatomical snuffbox
immobalize the thumb 6-12 weeks
**complication: osteonecrosis since has minimal blood supply**
start with Xray, go to MRI if necrosis is suspected
32
spinal epidural abscess
also, what are four risk factors?
what are three major indications?
what must you cover for when treating?
classic triad: **back pain, fevers, neurologic defects**
must cover for methylcillin resistant staph aureus
RF: immunosuppression, renal failure, IV drug abuse, ETOH
33
cauda equina syndrome
compression of the nerves at the end of the spinal cord within the canal
back pain
**urinary retention, incontinence of bladded/bowel**
**numbness or tingling in buttocks, lower extremities**
**EMERGENCY!!** usually requires surgical decompression
34
what are the symptoms associated with cauda equina syndrome?
**motor and sensory loss**
**hyperactive reflexes**
**saddled anesthesia pattern**
confirm with CT/MRI
35
development dysplasia
congenital dyplasia of the **hip**
shallow socket, so femor can slip out
**exam: leg length discrepancy, outward rotation, folds on buttock skin uneven**
wider space between legs
_galeazi sign,_ ortolani test, barlows test
36
what is this test and what is it used to diagnose?
(assuming somone was holding the legs)
ortolini's test (this is on porth 1103)
developmental dysplasia where the hip socket is shallow and the femor can slip out
37
avascular necrosis
where does the pain present? where is it most common? and what are 3 risk factors?
**most common in femur head**
RF: chronic ETOH, corticosteroid use, sickle cell
can be a complication from dislocation or fracture
**painful hip, buttock, thigh or knee in setting with no trauma**
38
legg-calve-perthes disease
avascular necrosis of the femoral head usually seen in young children
early hip pain with limp
**unilateral in 85%**
39
**slipped capital femoral epiphysis (SCFE)**
what type of fracture do you see? how is the femor head displaced? what age and what type of child? what type of measurement are you looking for on a xray?
**salter-harris type 1 fracture on femoral capital epiphysis**
**posterior and inferior displacement of head of femor**
common in children \>10 years old
_mildly obese kids with hip pain and limp_
URGENT ORTHOPEDIC EVAL
klein line
40
**meniscus tear**
what are the two common feelings you can have with this? where do you find tenderness? what two tests do you want to do to help diagnose this? what image testing do you want to do for this? is it an emergency?
nagging non specific pain medial or lateral
can **lock up which is orthopedic emergency**
"**giving away"** is URGENT
fullness behind the knee
_joint line tendernous_
Mcmurray test and Apley's comrpession test
MRI: check for joint space, if no space then there is a tear
41
patellofemoral pain syndrome
**most common cause of knee pain**
anterior pain made worse with climbing, kneeling, jumping or sittitng
Exam: patellar crepitus possible
Tx: strengthen
42
patellofemoral instability
which way does the patella usually deviate? why?
displacement usually laterally of the patella
AP, lateral, tunnel, and axial (sunrise) views
if untreated may lead to **quadriceps weakness and patellar arthrosis**
43
chondromalacia patella
achy knee pain, "stiffness"
Exam: place hand on patella, flex and extend knee to observe crepitus
44
dislocated knee
one of the few true orthopedic emergencies
## Footnote
**limb threatening 2\* to vascular comprimise**
45
Osgood Schlatter Disease
**rupture of the growth plate at the tibial tuberosity**
stresses the patellar tendon
**rapidly growing adolescents**
46
osteochondritis Dissecans
what is this common from? where does this happen the most? when does this start and become symptomatic?
repetitive stress
**most common, medial femoral condyle**
starts in childhood may not become symptomatic till adolescene or adulthood
surgery or nonweightbearing treatment
is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hinder joint motion
47
osteosarcoma
solitary lesions
"starburst" or "sunburst" on xray
**appear in long bones of children,** most commonly distal femur, proximal tibia, and proximal humerus
**bimodal age**
**1st-early adolescence**
**2nd- 6th decade**
48
anterior curciate ligament tear (ACL)
most common sports injury
**postive drawer test, lachman** (be careful because there can be a lot of fluid that makes this difficult to see)
MRI is diagnostic
49
achilles rupture
what test? what two things increase the risk of this happening?
common men 30-50
sport related usually
risk goes up with **chronic corticosteroid and fluoroquinolones**
testing: **Thompson's squeeze**, squeeze the back of the calf should get plantar flexion
50
ankle injury
what are the most common types (percentages) ? what is the most commonly injured ligament?
**inversion is most common 90%**
only 10% eversion
most common injured ligament is: anterior talofibular
follow Ottawa rules for xray.
51
explain the grading for ligament injury
1: stretch
2. Partial tear
3. complete disruption of ligament
52
Ottawa Ankle rules
What are the two regions of the foot that are concerning? what needs to be present in each of these regions for a xray to be indicated? (3 things in each region)
malleolar zone and midfoot zone
53
ankle fracture
HERES SOME PICS!
54
ankle dislocation
what do you want to do ASAP? what 3 things should you be concerned about?
severe fractures can cause dislocations
reduce ASAP
be concerned about **neuro, sensory, vascular**
55
what do you always want to do with a traumatic fracture or dislocation of the ankle?
always xray top of fibula with traumatic fracture or ankle dislocation
check for: _maisonneuve fracture_
56
foot fractures
given anatomy, fractures can easily hide and allow for ambulation
get xray!! stress fractures may not show up early so whole fracture is missed
57
what is a jones fracture?
fracture of proximal 5th metatarsal, common in athletes
comes from **inversion**
58
hallux valgus
"bunion"
lateral deviation of big toe
59
mortons neuroma
**most common neuroma of the foot**
**between _third and fourth toes_**
burning or sharp stabbing, worse with ambulation, tight shoes
TX: steroid injection, roomier shoes, surgery
60
Hammer toe
what happens in this? what is the most common cause?
toe deviates
distal portion goes down, middle hunches upwards
**2nd toe most common**
_most common cause, poorly fitting shoes, high heels with narrow toe boxes_
61
what is there always for a focused visit? what doesn't it include?
chief complaint and HPI
rarely includes ALL subjective and objective components (unless for billing)
62
where are you likely to see focused visits?
urgent care
ed
clinic visits
hospital rounding
63
what two factors do documentation influence?
qualitiy of care
reimbursement
64
what are 3 things the effect the reimbursement?
1. new or established patient
2. time required for evaluation
3. complexity of the visit
65
what are problem focused visits?
presenting problem are self limiting
~10 mins for visit
low complexity of medical decision
aka plantar wart
66
what are the characteristics of a expanded, detailed visti?
presentation are low to moderately severe
provider spends 20-30 mins
low to moderate complexity
ex pneumonia
67
what are the characteristics of a comprehensive visit?
presentation is moderate to severe
45-60 mins
high complexity of medical decision making
CF with biabetes with pneumonia, etc
68
what is a tip about the buinsness of medicine?
observe preceptors documentation technique from start to finish
69
what do you need to include for the subjective portion of a focused visit?
some but not all,
only stuff that is relevant to chief complaint
70
what are the 6 things that need to be included in the first sentence of HPI
name
age
race/ethnicity
sex
present/absence or pertinent pos/neg
presenting symptoms
71
how does the HPI relate to the CC?
amplifies chief complaint, describes how symptoms developed
can pull in pertinent pos/neg from ROS
72
what does the OPQRST pneumonic stand for HPI?
onset
pallidating and provoking
quality of pain
radiation
severity of pain
timing
associated things
73
what should be included in the past medical history?
medical (always psych and obstetric)
surigcal
hospitalizations
74
what are 3 things you want to include as part of the health maitenance portion?
immunizations
screenings
advance directives
75
what are two things you always want to do even in a focused visit?
cardiac and respiratory
76
what should guide your focused visit?
differential diagnosis
77
where do the laboratory and dianostic tests fit on the SOAP note?
**last part of objective portion** before A and P
78
pimary assesment
related to chief complaint
79
secondary assesment
related to chronic disease or new disease that was secondarily discovered during disease
80
what are 5 things you want to make sure you do during your focused visit to inolve patient?
1. share impression
2. address any concerns
3. make sure she agrees to steps ahead
4. provide written information
5. include health promotion and disease prevention
81
what 3 things does a successful plan take into consideration?
patients goal/ preference
economic means
family structure/dynamics
82
explain tendinitis
1. what does it mean?
2. what signs would be present
3. what is the treatment?
literally means "inflammation of the tendon"
all the normal signs seen with inflammation, red, hot swollen, painful
treatment: RICE NSAIDS
83
explain what tendinosis is? how is it different than tendonitis?
describes long term pathophysiology of tendons
under a microscope see "bowl of spaghetti" rather than "box of spaghetti" like in tendonitis
this is what happens after the inflammatory process passes, so if someone has long term tendonitis, it is more likely it has become tendonosis
**not warm or red like tendonitis**, but decreased ROM and strength
Treatment: PT with eccentric exercises, which **strengthen and stretch tendon**
84
calcific tendonitis
what is deposited in the joint? what symptoms are typically present? what imagine do you want to do to diagnose this? what are 4 treatment options?
tendons develop **calcium deposits**, commonly in rotator cuff
early on causes pain and mechanical symtpms or blockage, similiar symtpms to impingement or tendonitis
Dx: xray or MRI, see a little piece of bone floating in the joint, generally self limiting
TX: PT, dry needling, shock therapy wave to break it down, surgical removal
85
bicipital tendonitis
## Footnote
what tendon is involved here? what two motions will the patient have a difficult time performing?
**tendonitis along the long head of the bicep tendon**
painful when flexing the shoulder or the elbow
runs through the tubercles on the head of the humerus
86
acromioclavicular arthritis
what joint degrades here? what is it caused by? what syndrome can this lead to? what image study do you want to do? what is the treatment?
degeneration of the acromioclavicular joint
osteoarthritis
can lead to impingement syndrome because arthritis will narrow the subacromial space
decrease shoulder ROM, pain
Xray: will see degredation
Tx: RICE, NSAIDs, can also do surgery to clean out the mess
87
thenar atrophy
what is this commonly associated with?
thenar eminence atrophy
seen with carpal syndrome
need to treat carpal syndrome
88
felon finger
infection of the finger tip possibly due to splinter or cut
most common: staph aureus
89
ganglion
what is this? where does it commonly develop? what is the really stange thing people used to do to get rid of it? what do they do now with it?
cyst that develops randomly
often seen on the back of the wrist
used to treat with "bible therapy"....have person put their hand face down on the table and smash the cyst
aspiration or surgical removal if symptomatic
90
**legg-calve-perthes disease**
congenital problem of the hips in **childhood**
bloos supply to femoral head is disrupted and it begins to misform as a result of necrosis
91
**chondromalacia patellae**
what happens in this? what does this feel like? what are your two treatment options?
**sandpapery wear** and tear of the **cartilage on the back of the patella**
presents like patellofemoral pain
"grinding" feeling
TX: PT or surgery to clean out damaged cartilage
92
**osteochrondritis desiccans**
joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hinder joint motion. Osteochondritis dissecans occurs most often in children and adolescents
- most common in the knee but can occure in other joints as well
- PT and surgery for treatment
93
Lis Franc Fracture
where does this fracture take place? where does this most commonly take place within that region? how does this injury occur? what is important to do when getting an xray?!
fracture of the **mid-foot**
needs to be splinted in walking boot or casted
**commonly first and second metatarsal and nacicular**
**forced plantar flexion**"like riding a horse and you fall off and your foot gets stuck in the stirrup, or football player tackled in plantar flexion"
*need to get a non weight bearing and weight bearing xray to see how the bones change between the two*
94
Jones fracture
where does this injury occur? why is this injury improtant? what motion does this injury commonly occur with? imaging options?
acute or stress fracture at the base of the **5th metarsal, often seen with inversion of the ankle**
* important because of the blood supply, they don't heal well so you want to want to identify early to prevent necrosis*
* 1st: xray*
* 2nd: MRI if xray is negative and high clinical suspiscion*
95
when do you use a volar splint? (4 things)
wrist sprains/strains
carpal tunnel
lacerations
night slints
96
what are the four splinting wetting techniques?
1. water bottle
2. open sling cover technique (peel back one side of backing to get the water in)
3. water bottle/faucet technique (put under running water and then ring)
4. dipping in bucket technique (immerse in water ring out excess water)
97
what would you use to look at someone's appendix?
ultrasound
98
radiodensitiy
physical qualities of an object that determines how much radiation it absorbs from the X-Ray beam
determined by composition and thickness
99
radiopaque
**Does not permit** the passage of x-rays. Representative areas **appear light or white** on the x-ray film. Usually the property of denser materials, such as **bone**.
100
radiolucent
**darker gray** but not white or black
Permits the **passage of x-rays while offering some resistance** (depending on the density of the material). Representative areas are **dark on exposed film, such as air**.
101
on an xray how would you expect these to appeare:
gas:
soft tissue (fat):
water (organs/blood):
bone:
metal/barium:
102
what acronym should you use when looking at the different densities on a xray?
how do the boarders apear if the densities are similar or different?
BIL
B=boarder
I=interface
L=line
if there is a sharp contrast between densities, you will see crisp line
if they are similar than the board will be fuzzy
103
if closer to the film you use _____ and get ____ image
if closer to the film you use **less magnification** and get **sharper** image
104
if farther from the film you use _____ and get ____ image
if farther from the film you use more magnification and get fuzzier image
105
to tell the different between a AP and PA....
look at the heart!!
106
what view is this?
sunrise view
107
what view is this?
lordoctic view
108
what view is this?
water's view
109
shape distortion can happen with what?
unequal magnification
110
mammogram, Dexa, and fluoroscopt are types of what imaging?
xray
111
Dexa scan is a screening for...
bone densitiy aka osteoporosis
bone absorbes the xray, determines the density
112
what are the reading for a dexa scane?
\<1 is normal
1-2.5 osteopenia
\<2.5 osteoporosis
113
Xray: fluroscopy
what does this testing allow you to do? what are two examples?
continuous beam passes through the patient and allows you to see what they are doing in real time
swallow studies, heart angiograms
114
computerized tomography (CT-Scan)
focused radiographic images for one slice of the patient
10-90 seconds
need to know the relative densities between organs to interpret
**view from the FEET UP, making the left on the right!**
115
how many times more is a chest CT than a xray!?!
100-400X xray dose greater!!!
WOW
116
what can metal cause on a CT scan?
artifact!!
117
what is the benefit of a reformatted CT?
YOU GET 3D IMAGE! formatted in multiple planes
ex: CT angiogram (tell because it is colored and looks generated)
118
magnetic resonance imaging
how do they work and what do you use?
Uses powerful magnets
Imaging of H+ atoms in fat and water
H+ align in magnetic field, pulsed waves of scanning knock the atoms out of alignment.
H+ atoms emit radiofrequency waves which produce the image during re-alignment (relaxation time)
119
On MRI
## Footnote
High signal strength items appear\_\_\_\_\_
Low signal strength items appear\_\_\_\_\_
High signal strength items appear white
Low signal strength items appear dark (blood and bone)
signal strength refers the H+ atom ability to move, so if more dense they don't move and you get darker color.
120
what is the name of the contrast you use in MRI? If indicated, what must you check for the patient?
gadolidium
KIDNEY FUNCTION!!
121
in T1 weighted images on MRI, fats appeare\_\_\_
bright
122
in T2 weighted images on MRI, inflammation, tumors, and fluids appear\_\_\_\_\_
bright
123
When should you not use a MRI? what two things are ok to use?
metal or programmable things like pacemaker, icd
if the patient can't lay still for 35-45 mins
**can use with titanium and stainless steel**
124
explain how sound waves are used in Ultrasound?
**hyperechoic/echoic** if solid: they bounch back creating a light image
**hypoechoic/hypoechoic** if fluid filled: light passes through, produces dark image
ex: normal tissue vs fluid filled
125
radioisotope (nuclear) scanning
nuclear isotope is attached to a normal compound used in organ metabolism so it lights up
usually two part study
126
technetium 99
radioactive isotop used in radioactive scanning
half life 6 hours useful use in **thyroid scanning, pulmonary scans, and bone scans**
127
thallium 201
radioactive isoptope used in radioactive scans
half life 73 hours for myocardial blood flow
128
conventional arteriogram
Small tipped catheter advanced under fluoroscopy into an artery (usually the femoral)
take xrays to see the vessels
129
digital subtraction angiography
same as conventional but digitally saved so you can subract parts
130
chromatography angiogram
Patient injected with bolus of contrast material to opacify the blood vessels while CT is performed
BVs and bone are white, and bones can be subtracted out with 3D reconstruction
131
magnetic resonance angiogram
Stack of contiguous MR images converted into 3D vascular images
Safer for patients in renal failure, but contrast can enhance images
132
image? view? whats it mean?
xray
lateral
**sail sign=radial head fracture**
133
salter harris frature classification
134
image? view? what is it?
xray
AP view
**cresant sign on femoral head means _avascular necrosis_**
135
imagine? view? weight? what does it show?
MRI
saggital
T1 weight since not as bright as T2 would look
compression fracture
136
image? view? what is this?
CT
axial
liver metasticist
\*don't forget looking from patients feet up!\*
137
image? what does it show?
MRA (since reconstructed and 3D)
shows artery stenosis (narrowing)!
