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AANP Study Cards > MSK > Flashcards

MSK Flashcards

1
Q

What is the presentation of a navicular fracture?

A
  • wrist pain on palpation of the anatomical snuffbox
  • pain on axial loading of the thumb
  • history of a FOOSH
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2
Q

Initial x-ray of a suspected navicular or scaphoid fracture may be ____ in the event that it is what is advised?

A

normal; repeat in 2 weeks

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3
Q

What is the management of a navicular fracture

A
  • thumb spica splint

- refer

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4
Q

What is the risk with a navicular fracture

A

-high risk for avascular necrosis

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5
Q

What is a colles fracture

A

-fracture of the distal radius +/- ulnar fracture of the forearm with dorsal displacement

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6
Q

What is the presentation of a colles fracture

A
  • history of FOOSH

- also known as the dinner fork fracture

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7
Q

What is the most common type of risk fracture

A

Colles

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8
Q

What is the presentation of osteomyelitis

A
  • localized bone pain
  • swelling
  • redness
  • tenderness of the affected area
  • fever
  • if weight bearing joint, may refuse to walk or bear weight
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9
Q

What is osteomyelitis

A

-infection of the bone that causes inflammation and destruction

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10
Q

What are the causes of osteomyelitis

A
  • contagious spread from a nearby infected wound to the bone
  • hematogenous spread from a bloodstream infection
  • direct trauma
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11
Q

The most common bacteria that causes osteomyelitis is

A

Staphylococcus aureus

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12
Q

What are labs indicated in suspected osteomyelitits

A
  • CBC
  • ESR
  • CRP
  • blood cultures
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13
Q

What is the presentation of hip fracture

A
  • sudden onset 1 sided hip pain
  • unable to walk or bear weight weight on affected hip
  • may have pain with external rotation
  • leg shortening (if dispalced)
  • Usually a history of a fall
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14
Q

What is the presentation of pelvic fracture

A
  • history of significant trauma or high impact injury
  • sx depend on the degree of injury to the pelvic bones and structures
  • ecchymosis
  • lower abdominal, hip, groin or scrotal swelling
  • bladder or fecal incontinence
  • vaginal or rectal bleeding
  • hematuria
  • numbness
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15
Q

What is the presentation of cauda equina

A
  • acute onset of saddle anesthesia
  • bladder incontinence
  • fecal incontinence
  • bilateral leg numbness and weakness
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16
Q

Acute onset of “tearing” severe low back pain/abdominal pain with presence of abdominal bruit or pulsation

A

Dissecting AAA

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17
Q

Bone metastases presents like

A
  • achy, sharp well localizied or neuropathic pain
  • can be severe at night
  • pain with weight bearing
  • can be associated with night sweats, fatigue, fever, malaise, weight loss
  • can be constant or intermittent and get exacerbated by movement of the joint/bone
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18
Q

Genu valgum

Genu varum

A

valgum: knock knee
varum: bow leged

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19
Q

If a patient experiences an exercise injury, what is the management in the 1st 48 hours

A

RICE

  • Rest: avoid use
  • Ice: 20 minutes on 10 off for 24-48 hrs
  • Compression: Elastic bandage over joints ot decrease swelling and support the joint (usually ankles and knees)
  • Elevation:
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20
Q

Drawer sign tests for

A

knee stability

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21
Q

+ Anterior drawer is indicative of _____ while + posterior drawer is indicative of _____

A

ACL tear

PCL tear

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22
Q

What does the a + finkelstein’s test suggest

A

De Quervain’s (which is inflammation of the tendon sheath located at the base of the thumb)

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23
Q

+ Lachman’s suggests

A

ACL damage

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24
Q

+ McMurrays suggests

A

meniscus, (+ if knee pain and click)

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25
Q

Valgus stress test of the knee tests

A

MCL

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26
Q

Varus stress test of the knee tests

A

LCL

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27
Q

What are complications of steroid joint injections

A
  • tendon rupture
  • nerve damage
  • infection
  • bleeding
  • HPA suppression
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28
Q

What is gold standard imaging for dx injuries of cartilage, menisci, tendons, ligaments or any joint

A

MRI

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29
Q

What is medial tibia stress syndrome

A

-lower extremity injury caused by overuse, resulting in microtears and inflammation fo the muscles, tendons and bone tissue of the tibia

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30
Q

What are risk factors for medial tibia stress syndrome

A
  • runners
  • flat feet
  • females
  • female athlete triad
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31
Q

What is the presentation of medial tibia stress syndrome

A
  • Pain on inner edge of the tibia
  • pain may be sharp, stabbing or dull and throbbing
  • aggravated during and after exercise
  • focal area tenderness
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32
Q

What is the management of medial tibia stress syndrome

A
  • RICE
  • NSAIDs PRN
  • When pain is gone wait ~2 weeks before resuming exercise, avoid hills and hard surfaces
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33
Q

What is the imaging of choice in a suspected stress fracture

A

-MRI or bone scan

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34
Q

What is the presentation of plantar fasciitis

A
  • pain on the bottom of the feet
  • aggravated by walking and weight bearing
  • complains that foot pain is worse during first few steps in the am and worsens with prolonged walking
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35
Q

What are risk factors for plantar fasciitis

A
  • obesity
  • DM
  • Aerobic exercise
  • flat feet
  • prolonged standing
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36
Q

What is a morton’s neuroma

A

-inflammation of the digital nerve of the foot between the 3rd and 4th metatarsals

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37
Q

What are risk factors for morton’s neuroma

A
  • high heels
  • dancers
  • obesity
  • runners
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38
Q

This test is done by grasping the 1st and 5th metatarsals and squeezing the forefoot. A + test is hearing a click along with patient reporting pain during compression.

A

Mulder test for Morton’s Neuroma

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39
Q

What are risk factors for DJD or OA

A
  • older age
  • overuse of joints
  • family hx
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40
Q

What is the presentation of DJD or OA

A
  • Gradual onset
  • Early morning stiffness with inactivity
  • Shorter duration of joint stiffness (<15 minutes) when compared with RA
  • Pain aggravated by overuse of the join
  • Can be unilateral
  • No systemic sx
  • HeberDen’s Nodes: DIP
  • Bouchards: PIP
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41
Q

What is the non-pharmacological mgmt of DJD or OA

A
  • Exercise 3x/wk
  • weight loss
  • smoking cessation
  • isometric exercises
  • weight bearing exercises
  • avoid aggravating activities
42
Q

What is the first line medication for DJD or OA

A

Acetaminophen 325 to 650mg q4-6 hours to a max of 4g/daily

43
Q

What NSAIDs have the highest risk of GI bleed

A

-toradol and piroxicam

44
Q

What NSAIDs have the lowest risk of gi bleed

A

-Ibuprofen and celebrex

45
Q

What NSAIDs have the highest risk for CV events

A

Diclofenac and celebrex

46
Q

What NSAIDs have lowest risk of CV events

A

Naproxen

47
Q

Toradol should be limited to ___ days of use and the 1st dose is give

A

5 days; IM/IV

48
Q

Heberden’s node appear ____ and are associated with

A

DIP; OA

49
Q

Bouchards nodes appear ____ and are associated with

A

PIP; OA or RA

50
Q

What are types of pharmacology treatments in DJD or OA

A

-Acetaminophen, NSAIDs (oral/topical), steriod injections, surgery

51
Q

What organs are affected by lupus

A

-skin, kidney, heart, blood vessels

52
Q

What is the classic presentation of lupus

A
  • maculopapular butterfly rash on middle of face (malar rash), nonpruritic thick scaly red rashes on sun exposed areas (discoid rash)
  • proteinuria on UA
53
Q

What education should you provide to pts with lupus

A
  • avoid sun between 10-4
  • sun protection
  • use nonflourescent lights
54
Q

What is the presentation of RA

A
  • gradual onset of
  • daily fatigue
  • low grade fever
  • generalized body aches
  • myalgia
  • generalized joint pain
  • early morning stiffness
  • pain, warmth, tender joints
  • joint involvement is symmetrical
  • Swan neck or boutonniers present
55
Q

What is swan neck deformity

A

-flexion of the DIP with hyperextension of the PIP

56
Q

Boutonniere deformity

A

-hyperextension of the DIP with flexion of the PIP

57
Q

What labs are indicated in RA

A
  • ESR
  • CRP
  • CBC
  • RF
  • Radiographs
  • Serology/antibodies: Anti-CCP
58
Q

What joints are most commonly affected in RA

A

-fingers, hands, wrist, shoulders, elbows, ankles and feet

59
Q

What medications are indicated in RA management

A
  • NSAIDs
  • Steroids
  • DMARDs
  • Biologics
60
Q

RA increases the risk of:

A

-uveitis, scleritis, vasculitis, pericarditis, certain malignancies (lymphoma)

61
Q

Before starting plaquenil what do all patients need

A

an eye exam

62
Q

Plaquenil is an

A

antimalarial

63
Q

Methotrexate is an example of a _____ it is contraindicated during ____ and so what precautions should be taken

A

DMARD
Pregnancy
Contraception is in place

64
Q

NSAIDs injure GI tract by blocking ____ resulting in

A

COX-1 and 2 resulting in lower levels of systemic prostaglandins

65
Q

Aspiring affects platelets and clotting ______. It resolves when the therapy is stopped and platelet dies which is ____ days

A

Permanent

10 days

66
Q

What is gout

A

deposit of uric acid crystals inside joints and tendons r/t genetic excess production or low excretion of purine crystals (a by-product of protein metabolism)

67
Q

What is the gold standard for dx gout

A

-joint aspiration of the synovial fluid

68
Q

The most common way to dx gout is

A

recurrent flares with elevated serum uric acid level >6.8mg/dL

69
Q

The joints most commonly affected by gout are

A
  • MTP
  • Ankles
  • Hands
  • Wrists
70
Q

What is the classic presentation of gout

A
  • painful, hot red and swollen MTP joint

- often precipitated by ingestion of ETOH, meats or seafoot

71
Q

What are lab finding sin gout

A
  • Uric acid level: elevated >6.8mg/dL *Note uric acid doesn’t rise until after the acute phase
  • CBC: WBC level elevated
  • ESR elevated
  • CRP: Elevated
72
Q

Medications for gout flares

A

NSAIDS, steroids, colchicine

73
Q

In a patient taking urate lowering therapies with a gout flare do you D/C the med?

A

No

74
Q

What are common side effects of colchicine

A
  • diarrhea
  • abdo pain
  • cramps
  • nausea
  • vomiting
75
Q

What are drug interactions of colchicine

A
  • Macrodlides
  • Azoles
  • Anti virals
  • CCBs
  • Cyclosporines
  • Tacrolimus
76
Q

What is the presentation of ankylosing spondylitis

A
  • chronic back pain starting at neck and progressing down
  • impaired spinal mobility
  • joint pain at night
  • generalized sx such as low grade fever, fatigue
  • costochondritis
  • stiffness improves with activity
  • marked loss of ROM of the spin
  • uveitis
  • +HLA-B27
77
Q

What are classic lab/imaging findings of Ankylosing spondylitis

A
  • ESR/CRP: Elevated

- Spinal X-ray: Classic bamboo spine

78
Q

What are complications of ankylosing spondlyitis

A
  • anterior uveitis
  • aortitis
  • fusing of the spine with significant loss of ROM
  • spinal stenosis, hyperkyphosis
79
Q

What is the management of ankylosing spondylitis

A

-refer to rheum
-smoking cessation
-PT
-Exercise therapy and hydrotherapy
-First line pharm is NSAIDs
for sever cases same as RA

80
Q

Red flags back pain

A
  • significant trauma
  • cancer
  • suspected infection
  • suspected spinal/vertebral fracture
  • age >50 new onset back pain or waking pt from sleep
  • radiculopathy
  • fever, night sweats, weight loss
81
Q

What is the presentation of piriformis syndrome

A
  • sciatic symptoms
  • pain, numbness of the buttocks with radiation
  • pain worse with prolonged sitting
  • episodic
82
Q

What ist he cast for wrist fractures

A

thumb spica cast

83
Q

What are signs of cauda equina

A
  • incontinence
  • saddle anesthesia
  • bilateral sciatic sx
84
Q

Microtears on a tendon causing inflammation and pain

A

Tendinitis

85
Q

Rotator cuff pathology presentation

A
  • repetitive overhead activity
  • complains of shoulder pain with over head movements
  • local point tenderness over the anterior shoulder
86
Q

Jobes test or empty can tests teh

A

supraspinatus
-+ without weakness (tendiopathy)
+ with weakness suggests a tear

87
Q

Painful arc test is positive when

A

shoulder pain occurs between 60-120 degrees

88
Q

Lateral epicondylitis

A
  • tennis elbow
  • gradual onset of pain on the outside of elbow with radiation to forearm
  • pain is worse with twisting and grasping movements
  • pain on palpation of lateral epicondyle
89
Q

Medial epicondylitis

A
  • golfers elbow
  • aching pain on the medial area of elbow
  • localized tenderness
90
Q

a complication of epicondylitis is

A

ulnar nerver neuropathy

91
Q

What are the best imaging methods for hamstring injuries

A
  • US

- MRI

92
Q

What is the presentation of a a hamstring injury

A
  • acute, popping noise
  • sudden onset of posterior thigh pain while performing activities
  • swelling, bruising, tenderness on posterior thigh
93
Q

What is the most common mechanism of injury for a lateral ankle sprain

A

-inversion with plantar flexed foot

94
Q

What is the most common mechanism of injury for a medial ankle sprain

A

-eversion of the ankle

95
Q

Grade II sprain

A
  • moderate swelling
  • pain
  • joint tenderness
  • ambulation and weight bearing are painful
96
Q

Classic presentation of a meniscus tear includes

A
  • clicking, locking. buckling of the kees
  • unable to extend the knee
  • knee pain
  • joint line tenderness
  • decreased ROM
  • swelling
97
Q

What does McMurrays test for

A

meniscal tears + is pain, clicking or knee locks

98
Q

Apleys test for

A

Meniscal tears

+ if pain occurs with compression of the knee

99
Q

What is the presentation of a ruptured bakers cyst

A
  • ball like mass behind knee that is soft and smooth
  • mass softens when knee is at 45 degrees (fouchers sign)
  • may be asymptomatic or have pressure, pain or stiffness in posterior knee
100
Q

Ankle series is required if

A
  • inability to bear weight immediately after injury
  • inability to ambulate 4 steps
  • bone tenderness over the posterior tip of medial malleolus
  • bone tenderness over posterior tip of lateral malleolus

AANP Study Cards (20 decks)

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