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
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
3
Q
What is the management of a navicular fracture
A
- thumb spica splint
- refer
4
Q
What is the risk with a navicular fracture
A
-high risk for avascular necrosis
5
Q
What is a colles fracture
A
-fracture of the distal radius +/- ulnar fracture of the forearm with dorsal displacement
6
Q
What is the presentation of a colles fracture
A
- history of FOOSH
- also known as the dinner fork fracture
7
Q
What is the most common type of risk fracture
A
Colles
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
9
Q
What is osteomyelitis
A
-infection of the bone that causes inflammation and destruction
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
11
Q
The most common bacteria that causes osteomyelitis is
A
Staphylococcus aureus
12
Q
What are labs indicated in suspected osteomyelitits
A
- CBC
- ESR
- CRP
- blood cultures
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
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
15
Q
What is the presentation of cauda equina
A
- acute onset of saddle anesthesia
- bladder incontinence
- fecal incontinence
- bilateral leg numbness and weakness
16
Q
Acute onset of “tearing” severe low back pain/abdominal pain with presence of abdominal bruit or pulsation
A
Dissecting AAA
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
18
Q
Genu valgum
Genu varum
A
valgum: knock knee
varum: bow leged
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:
20
Q
Drawer sign tests for
A
knee stability
21
Q
+ Anterior drawer is indicative of _____ while + posterior drawer is indicative of _____
A
ACL tear
PCL tear
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)
23
Q
+ Lachman’s suggests
A
ACL damage
24
Q
+ McMurrays suggests
A
meniscus, (+ if knee pain and click)
25
Valgus stress test of the knee tests
MCL
26
Varus stress test of the knee tests
LCL
27
What are complications of steroid joint injections
- tendon rupture
- nerve damage
- infection
- bleeding
- HPA suppression
28
What is gold standard imaging for dx injuries of cartilage, menisci, tendons, ligaments or any joint
MRI
29
What is medial tibia stress syndrome
-lower extremity injury caused by overuse, resulting in microtears and inflammation fo the muscles, tendons and bone tissue of the tibia
30
What are risk factors for medial tibia stress syndrome
- runners
- flat feet
- females
- female athlete triad
31
What is the presentation of medial tibia stress syndrome
- Pain on inner edge of the tibia
- pain may be sharp, stabbing or dull and throbbing
- aggravated during and after exercise
- focal area tenderness
32
What is the management of medial tibia stress syndrome
- RICE
- NSAIDs PRN
- When pain is gone wait ~2 weeks before resuming exercise, avoid hills and hard surfaces
33
What is the imaging of choice in a suspected stress fracture
-MRI or bone scan
34
What is the presentation of plantar fasciitis
- 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
35
What are risk factors for plantar fasciitis
- obesity
- DM
- Aerobic exercise
- flat feet
- prolonged standing
36
What is a morton's neuroma
-inflammation of the digital nerve of the foot between the 3rd and 4th metatarsals
37
What are risk factors for morton's neuroma
- high heels
- dancers
- obesity
- runners
38
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.
Mulder test for Morton's Neuroma
39
What are risk factors for DJD or OA
- older age
- overuse of joints
- family hx
40
What is the presentation of DJD or OA
- 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
41
What is the non-pharmacological mgmt of DJD or OA
- Exercise 3x/wk
- weight loss
- smoking cessation
- isometric exercises
- weight bearing exercises
- avoid aggravating activities
42
What is the first line medication for DJD or OA
Acetaminophen 325 to 650mg q4-6 hours to a max of 4g/daily
43
What NSAIDs have the highest risk of GI bleed
-toradol and piroxicam
44
What NSAIDs have the lowest risk of gi bleed
-Ibuprofen and celebrex
45
What NSAIDs have the highest risk for CV events
Diclofenac and celebrex
46
What NSAIDs have lowest risk of CV events
Naproxen
47
Toradol should be limited to ___ days of use and the 1st dose is give
5 days; IM/IV
48
Heberden's node appear ____ and are associated with
DIP; OA
49
Bouchards nodes appear ____ and are associated with
PIP; OA or RA
50
What are types of pharmacology treatments in DJD or OA
-Acetaminophen, NSAIDs (oral/topical), steriod injections, surgery
51
What organs are affected by lupus
-skin, kidney, heart, blood vessels
52
What is the classic presentation of lupus
- maculopapular butterfly rash on middle of face (malar rash), nonpruritic thick scaly red rashes on sun exposed areas (discoid rash)
- proteinuria on UA
53
What education should you provide to pts with lupus
- avoid sun between 10-4
- sun protection
- use nonflourescent lights
54
What is the presentation of RA
- 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
What is swan neck deformity
-flexion of the DIP with hyperextension of the PIP
56
Boutonniere deformity
-hyperextension of the DIP with flexion of the PIP
57
What labs are indicated in RA
- ESR
- CRP
- CBC
- RF
- Radiographs
- Serology/antibodies: Anti-CCP
58
What joints are most commonly affected in RA
-fingers, hands, wrist, shoulders, elbows, ankles and feet
59
What medications are indicated in RA management
- NSAIDs
- Steroids
- DMARDs
- Biologics
60
RA increases the risk of:
-uveitis, scleritis, vasculitis, pericarditis, certain malignancies (lymphoma)
61
Before starting plaquenil what do all patients need
an eye exam
62
Plaquenil is an
antimalarial
63
Methotrexate is an example of a _____ it is contraindicated during ____ and so what precautions should be taken
DMARD
Pregnancy
Contraception is in place
64
NSAIDs injure GI tract by blocking ____ resulting in
COX-1 and 2 resulting in lower levels of systemic prostaglandins
65
Aspiring affects platelets and clotting ______. It resolves when the therapy is stopped and platelet dies which is ____ days
Permanent
| 10 days
66
What is gout
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
What is the gold standard for dx gout
-joint aspiration of the synovial fluid
68
The most common way to dx gout is
recurrent flares with elevated serum uric acid level >6.8mg/dL
69
The joints most commonly affected by gout are
- MTP
- Ankles
- Hands
- Wrists
70
What is the classic presentation of gout
- painful, hot red and swollen MTP joint
| - often precipitated by ingestion of ETOH, meats or seafoot
71
What are lab finding sin gout
- 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
Medications for gout flares
NSAIDS, steroids, colchicine
73
In a patient taking urate lowering therapies with a gout flare do you D/C the med?
No
74
What are common side effects of colchicine
- diarrhea
- abdo pain
- cramps
- nausea
- vomiting
75
What are drug interactions of colchicine
- Macrodlides
- Azoles
- Anti virals
- CCBs
- Cyclosporines
- Tacrolimus
76
What is the presentation of ankylosing spondylitis
- 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
What are classic lab/imaging findings of Ankylosing spondylitis
- ESR/CRP: Elevated
| - Spinal X-ray: Classic bamboo spine
78
What are complications of ankylosing spondlyitis
- anterior uveitis
- aortitis
- fusing of the spine with significant loss of ROM
- spinal stenosis, hyperkyphosis
79
What is the management of ankylosing spondylitis
-refer to rheum
-smoking cessation
-PT
-Exercise therapy and hydrotherapy
-First line pharm is NSAIDs
for sever cases same as RA
80
Red flags back pain
- 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
What is the presentation of piriformis syndrome
- sciatic symptoms
- pain, numbness of the buttocks with radiation
- pain worse with prolonged sitting
- episodic
82
What ist he cast for wrist fractures
thumb spica cast
83
What are signs of cauda equina
- incontinence
- saddle anesthesia
- bilateral sciatic sx
84
Microtears on a tendon causing inflammation and pain
Tendinitis
85
Rotator cuff pathology presentation
- repetitive overhead activity
- complains of shoulder pain with over head movements
- local point tenderness over the anterior shoulder
86
Jobes test or empty can tests teh
supraspinatus
-+ without weakness (tendiopathy)
+ with weakness suggests a tear
87
Painful arc test is positive when
shoulder pain occurs between 60-120 degrees
88
Lateral epicondylitis
- 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
Medial epicondylitis
- golfers elbow
- aching pain on the medial area of elbow
- localized tenderness
90
a complication of epicondylitis is
ulnar nerver neuropathy
91
What are the best imaging methods for hamstring injuries
- US
| - MRI
92
What is the presentation of a a hamstring injury
- acute, popping noise
- sudden onset of posterior thigh pain while performing activities
- swelling, bruising, tenderness on posterior thigh
93
What is the most common mechanism of injury for a lateral ankle sprain
-inversion with plantar flexed foot
94
What is the most common mechanism of injury for a medial ankle sprain
-eversion of the ankle
95
Grade II sprain
- moderate swelling
- pain
- joint tenderness
- ambulation and weight bearing are painful
96
Classic presentation of a meniscus tear includes
- clicking, locking. buckling of the kees
- unable to extend the knee
- knee pain
- joint line tenderness
- decreased ROM
- swelling
97
What does McMurrays test for
meniscal tears + is pain, clicking or knee locks
98
Apleys test for
Meniscal tears
| + if pain occurs with compression of the knee
99
What is the presentation of a ruptured bakers cyst
- 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
Ankle series is required if
- 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
