MSK

Question 1

Which wrist ligament stabilizes the ulna? How do you test if it is injured?

Answer 1

TFCC - triangular ligament that stabilizes ulnar

Test - Supination lift off table

Question 2

PE for MSK Inury

Answer 2

Neuro - reflexes, sensation, 2 pt discrimination, strength compared to healthy wrist

Cardio - pulses, cap refill

Examine joints more proximal

I-PASS

• Idenitfy abnormalities
• Palpate - ea carpal, anatomic snuffbox, Lister’s tubercle, scaphoid-lunate joint
• Active ROM + passive ROM
• Sensation
• Special Tests

Question 3

Finkelstein Test

Answer 3

reproducing pain w/ ulnar deviation of lateral fist means De Quervains tenosynovitis

Question 4

Phalen v Tinnel

Answer 4

Carpal Tunnel

Phalen’s (flex wrists) & Tinnel’s (tap)

Question 5

Common FOOSH Injuries (3)

Answer 5

scaphoid (avascular)

growth plate damage in kids (can stunt growth)

Collese in elderly women

Question 6

Direct Palmar Injury

Answer 6

worry about hook of hamate (ulnar branch)

Question 7

Trigger Finger

Answer 7

overuse inflammation –> nodule that prevents full extension of finger

Question 8

Ganglion

Answer 8

aspiration drainage w/ needle or observation or surgical removal

Question 9

Dupuytren’s Contracture

Answer 9

• skin thickening and fibrosis –> hand surgery (seen in Swedish population)

Question 10

Mallet v Jersey Finger

Answer 10

Mallet Finger - forced flexion; splint 8 wks

Jersey Finger - forced extension

Question 11

RA Dx Criteria

Answer 11

synovitis in 1+ joints

r/o other diagnoses

score 6/10+
pts for # joints, duration > 6 wks, +RF/anti-CCP, inc ESR or CRP

Question 12

Gout Risk Factors

Answer 12

inc purines (red meat or seafood) & HCTZ/loops/chemo

Question 13

Common Septic Joint Organisms

Answer 13

RA - staph aureus

HIV - pneumo, H flu, Salmonella

IV drug use - strep, staph, gram neg, Pseudomonas

Question 14

Ankle Sprain Grades

Answer 14

1- stretch one ligament w/ minor swelling, no instability or sig loss of function

2- partial ligament tear w/ more severe swelling, pain and bruising; mild instability; some loss of ROM; pain when bearing wt

3- complete ligament tear so very unstable and cannot bear wt

Question 15

Ottowa Ankle Rules

Answer 15

1- pain on palp of posterior or distal tip eithermalleolus
2- pt tenderness over mid foot / navicular or 5th metatarsal area
3- cannot bear wt immediately after or at appointment

** 2 perpendicular views if any 1 criteria (100% sensitive)

Question 16

Ottowa Knee Rules

Answer 16

1- 55 yo +
2- isolated patella tenderness
3- tenderness at head of fibula
4- cannot flex knee to 90 degrees
5- cannot bear wt for 4 steps immediately after or at appointment 

** 2 perpendicular views if any 1 criteria (100% sensitive)

Question 17

Most Common Ankle Injury

Answer 17

Lateral more often injured b/c weaker ligaments - ATFL, PTFL, CFL

ATFL most commonly injured

inversion plantar injuries

Question 18

3 Ankle Tests

Answer 18

Anterior Drawer - pull heal forward while lower leg steady; unstable ATL

Inversion stress test - invert ankle while holding lower leg steady; CFL

Squeeze test - squeeze mid calf; if pain at anterior ankle then high ankle syndesmotic injury

Question 19

Ankle Sprain Tx

Answer 19

PRICE (protection, rest, ice, compression, elevation)

+ NSAIDs

+ early mobilization to dec stiffness
(ROM exercises in first 48-72 hrs)

Question 20

5 Rotator Cuff Tests

Answer 20

Empty can - abducted and thumbs point down; supraspinatous

External rotation w/ elbow by side - infraspinatous/teres minor

Internal rotation w/ elbow by side - subscapularis

Hawkins Supacromial Impingement - pain when arm flexed, elbow bent and internal rotation

Drop arm - unable to lower arm slowly from raised position

Question 21

4 Knee Injury Tests

Answer 21

Lachman - 20 degree flexion

Ant/Post Drawer - 90 degree flexion

Valgus - medial force to knee and lateral to ankle (for MCL)

Varus - lat force to knee and medial to ankle (for LCL)

Question 22

Gout v Pseudo Gout Crystals

Answer 22

MSU - neg bifringe needles

CPPD - rhomboid, weak pos bifringe

Question 23

Synovial Fluid in Septic v. Gout Joint

Answer 23

Septic - 100,000 WBCs
> 90% neutrophils in synovial fluid

Gout - 2-60,000 WBCs
< 90% neutrophils

**Still get cx even if see crystals

Question 24

Acute v. Chronic Gout Tx

Answer 24

Acute - colchicine (inhibits microtubule polymerization of neutrophils) , steroid, NSAIDs for acute

Maint w/ probenacid (inc excretion) & allopurinol (dec prod)

Question 25

RA Tx

Answer 25

Tx - sulfasalazine, methotrexate, NSAIDs, steroids, anti-cytokines (entarecept, infliximab)

Question 26

Injuries Suspicious for Abuse

Answer 26

* Corner or "bucket handle" fractures of metaphysis of long bones * Spiral fracture of femur or humerus (not tibia) * Rib fracture (esp posterior or medial) * Vert or spinal process fractures * Digital fractures * Sternal or scapular fractures

Question 27

Toddler Fracture

Answer 27

spiral fracture of tibia from twisting on planted foot

Question 28

Slipped Capital Femoral Epiphysis

Answer 28

* sep of growth plate b/n femoral head and shaft --> head medially and posteriorlly displaced --> dec internal rotation and obligatory external rotation w/ flexing * Often in obese adolescent males * Surgical pinning of femoral head

Question 29

4 Factors that Determine if Septic Arthritis in Kid

Answer 29

* Fever > 38.5 * Not bearing wt * WBC > 12,000 * ESR > 40

Question 30

3 Tests for Cong Hip Problems

Answer 30

* Barlow - flex knee and hip and try to displace * Ortolani - guided abduction * Galeazzi - lay and flex knees so ankle near butt to Meas discrepancy in knee ht

Question 31

Acute Low Back Pain Red Flags (14)

Answer 31

* Night pain or pain at rest * Unexplained fever * Neuro deficits * > 6 wks duration * Age > 70 * Loss of bowel or bladder control * Suspect ankylosing spondylitis * Trauma * Hx or suspicion of cancer * Osteoporosis * Chronic steroid use * Immunosuppression * Alcohol abuse * IV drug use

Question 32

Diff for Acute Low Back Pain

Answer 32

* Cauda Equina - leg weakness, incontinence, numbness or pain in saddle distribution, pos straight leg and dec anal tone / dec ankle reflexes - get MRI * Infectious - fevers, pt tenderness, recent infection, IV drug use * Osteomyelitis, discitis, paraspinal or epidural abscess * CBC, ESR, CSF tap, MRI, IV abx and drainage * Herniated Disc /Sciatica - esp in L4-L5 and L5-S1 vert, better w/ laying and worse w/ Valsalva , pos straight leg test - conservative; MRI if symptoms persist > 1 mo * Spinal stenosis - pseudoclaudication symptoms w/ activity but vascular supply good; worse w/ anything that dec canal space * NSAIDs, musc relaxants, PT, epidural steroids * Vert Compression Fracture - osteoporosis or steroid use; w/ little or no trauma; Xrays and treat osteoporosis * Lumbosacral Strain -COMMON; conservative * Cancer - mets from prostate, heme, breast, lung (wt loss and other signs)