MSK

Question 1

Navicular/ Scaphoid bone fracture presentation/ PE/ Xray

Answer 1

hx of falling forward with hyperextension if the wrist. wrist pain is below the thumb area. may report difficulty gripping objects

PE: tenderness to palpation of the anatomic snuff box. pain with resisted pronation

Xray: may NOT show fracture as it take 14-21 days to show callus formation

MRI: is the most sensitive dx in < 24 hours

Question 2

Navicular/ Scaphoid bone fracture TX for non and displaced

Answer 2

refer to hand speclaist

non: thumb spica case
displaced: surgery w/ screws

Question 3

Colles fracture

Answer 3

distal radius fracture w/ radius tilting upward. MOST common wrist fracture

will need sugery if displaced

Question 4

What are the emergent cases of LBP

Answer 4

progressive loss of bladder resulting in retention or incontinence ( caude equina)

progressive numbness in pelvic area (saddle anesthesia)

Impending rupture of AAA (severe abd pain w/ low BP in elderly smokers)

night pain, fever, sweat, wgt loss ( cancer)

Osteoporosis ( check if on steroids)

Osteomyletisis

Question 5

Classic presentation of mechanical LBP

Answer 5

dull pain that persist for weeks, NO nuero sympt

Question 6

Sciatica

Answer 6

Impingement of L4-L5 nerve root causing ( type of radiculopathy). Sharp pain located midline and runs down leg to top of foot. May have weakness

Question 7

what does the SLR check for?

Answer 7

sciatica pain
lumbrosacral ner root irritiation

SLR is a passive move

Question 8

LBP tx

Answer 8

Pt education
NSAIDS
XRAYs not reccomended unless hx of trauma or red flag
MRI w/ people with nuero defs
No blood work
for muscle spasms - can use muscle relaxant (flexeril or Skelaxin) or valium

Question 9

Ankylosing Spondylitis what/presentation/PE/ complications / TX

Answer 9

Progressive seronegative arthitis (HLA B 27 pos)

Chronic inflammation of the spine

Men from puberty to 40’s

young male, w/ progressive back pain w/ stiffness (most of spine), may have generalized fever, fatigue

PE: lumbar spine loss of lateral flexsion ( early finding)*

comp: anterior uveitis, cauda equina, increase in CRP and ESR

TX first line: high dose NSAIDS ( indomethacin)

Question 10

When to use cold therapy?

Answer 10

first 48 hours to decrease swelling

Question 11

isometric exercises

Answer 11

spares joint, helps build muscle ( resistance bands)

Question 12

aerobic exercises

Answer 12

swimming, walking , biking

Question 13

when to get MRI?

Answer 13

for soft tissue injuries such as cartilage, tendons

Question 14

what is EMG?

Answer 14

electomyogram to evaluate nerve function

Question 15

When can you get joint injections?

Answer 15

3/4 times per year. No in same joint more than once every 3 months.

watch out for : tendon rupture, infection, bleeding, DM, cushing syndrome

Question 16

McMurray test

Answer 16

M = Meniscus assess for a “click” - also assess for joint line for tenderness on palpation

Question 17

Anterior Drawer test

Answer 17

ACL test + = if laxity/glide when tibia is pulled forward ( anteriorly)

Question 18

Posterior Drawer test

Answer 18

PCL test + = if laxity/glide when tibia is pulled backwards (posteriorly)

Question 19

lachman test

Answer 19

Most sensitive test for ACL

+ = excessive motion of the knee = laxity

Question 20

Valgus stress test

Answer 20

MCL test + = laxity when medial stress applied ot the knee

putting stress on the actual medial ligament ( abduction)

Question 21

Vargus stress test

Answer 21

LCL : + = laxity when lateral or vargus stress applied to the knee

Question 22

Rotator Cuff tendinitis / shoulder impingement / supraspinatus tendinitis is most common in who?

Answer 22

common in young athletes ( swimmer, tennis, baseball) and middle-aged

Question 23

supraspinatus tendinitis what/ presentation/ tx

Answer 23

inflammation of rotator cuff

gradual or acute onset of pain w/ over head movements (hyperextension). Pain in front of shoulder (anteriorly) and radiates to the side of arm. Lifting and reaching cause pain.

TX: Nsaids, PT, avoid over head activity during acute phase

MRI is gold standard

Question 24

Lateral epicondylitis presentation, risk, tx

Answer 24

tennis elbow : overuse of forearm muscles ( flexors/extensors)

people at risk : painting, using screwdriver, tennis player

gradual onset of pain on the outside of the elbow that sometimes radiates to forearm. Pain worsens with twisting and grasping movements ( shaking hands, opening jars)

tx: RICE, can use tennis elbow strap

refractory cases ; cortisone injection

Question 25

Medial Epcondyitis presentation, risk, complication, pe

Answer 25

golf elbow/ baseball pitcher complains of aching pain over the inside part of the elbow PE: tenderness to palpation over the inner aspect of the elbow Risk : golfing, baseball, bowling, weight-lifters complication: ulnar nerve neuropathy

Question 26

DeQuervain Tenosynovitis / Tendonitis : what/s/s, PE, TX, test

Answer 26

inflammation of the tendon sheath causing entrapment of the thumb tendons s/s: wrist pain over the thumb side, pain with grasping PE: tenderness/swelling over the thumb tendon TX: wear a wrist splint 4-6 weeks, NSAIDs + Finklestein test ( fingers over thumb w/ ulnar deviation) = pain

Question 27

Carpal Tunnel Syndrome : what, presentation, tests, late sign, tx

Answer 27

Compression of the median nerve due to ( repetitive motion, hypothyriodism, preg) on palmer side gradual onset of parathesias on the thumb, index, middle, half of ring finger nocturnal awakening + Flick sign = shaking hand for releif + Phalen = full wrist flexion for 60 sec + tinels = tap anterior wrist briskly x 60 sec Late sign : atrophy of the thenar eminence TX: modify/limit motion night splint NSAIDS

Question 28

Classic presentation of Morton Neuroma and what

Answer 28

scarring of the common digital nerve ( ganglion) due to chronic pressure from wearing hight heels and tight-fitting shoes complains of pebble-like mass and pain in the interspace area + Mulder sign

Question 29

Plantar Fasciitis

Answer 29

inflammation of pantar facia due to over use stretching to help complains of severe pain in am, on the heel of foot

Question 30

Chondromalacia Patella

Answer 30

Patellopfemoral syndrome | damage to the cartilage behind knee cap

Question 31

OA / DJD

Answer 31

most common joint dx in world affects weight bearing joints morning stiffness for less than 30 min pain worse with cold weather, prolonged or overuse joint PE: joint crepitus, joint deformity, swelling Will have Herberdeen's DIP nodes and Bouchards TX : tylenol ASA #1 then NSAIDS

Question 32

Herberdeen nodes

Answer 32

DIP - only seen in OA/DJD

Question 33

Bouchard nodes

Answer 33

PIP - seen in both RA and OA

Question 34

TX for OA

Answer 34

1. rest/ restriction of weight bearing on affected joint 2. Tylenol 3. if inflammation = NSAIDS 4. hight risk stomach ulcers = COX 2 ( celebrex) 5. if severe glucocosteroid intraarticular

Question 35

RA : what, late signs, signs, presentation, Pe, labs

Answer 35

systemic autoimmune dx symmetrical arthitis that involves multiple joint will NOT effect HIPS Late sign: swan-neck deformity, boutonniere deformity ( on PIP) will see bouchards nodes presentation: middle aged women complains of new onset of swollen, painful and stiff joints especially on hand and wrist. Joint stiffness for hours in am. Pain NOT relieved by rest. Maay have low grade fever, normocytic anemia PE: multiple joints, swollen, red, tender to palpation. IF rheumatoid nodules = chronic dx Labs: + RH, ANA +, normocytic anemia,ESR and CRP + Imaging: xrays Complications : uveitis , vasculitis , need eye exam TX : NSAIDS or ASA

Question 36

What are examples of DMARDS ( disease modifying agent for Rheumatoid disease)

Answer 36

Methotrexate and sulfaslazine Plaquinil Prednisone ( systemic)

Question 37

Biologics TNF

Answer 37

Humera, Enebrel = PPD adn CBC adverse : lymphoma

Question 38

Fibrimyalgia

Answer 38

Soft tissue pain chronic condition (last more than 3 months) generalize MSK pain with fatigue, cognitive imparment Need 11 out of 18 tender point to dx occuring everywhere

Question 39

Gout what, presentation, joint, DX criteria

Answer 39

deposit of urate acid crytals ( monosodium urate ) on distal joints and tendons middle age male with acute exacerbation of gout. pain ful ankle. knee wrist. recent increase alcohol intake, seafood, or meat. Serum uric acid level is increased MTP joint of great toe swollen, red, hot, painful Intake: alcohol, red meat, seafood, diurtics DX: elevated uric level and clinical findings untx gout: joint destruction and kidney damage

Question 40

Tophi

Answer 40

small white nodules filled with urates ( in ears and joints)

Question 41

Podagra

Answer 41

the classic red/swollen/painful toe of gout

Question 42

Gout management: acute

Answer 42

acute : provide pain relief. if pt is on allopurinol continue and add pain med start pain med ASAP w/ 12 hours of onset = indomethacin, naproxen, motrin Low-dose colchine can shorten episode

Question 43

Colchicine dose

Answer 43

inital 1.2 mg followed by .6 mg in one hour | drink lots of water

Question 44

Gout Maintinance

Answer 44

use 4-6 wks after attac check CBC prior to starting allopurinol Probenecid

Question 45

Marfan's syndrome

Answer 45

genetic disorder affects connective tissue production concern about aortic anuresym / dissection

Question 46

Medial Tibia Stress Syndrome

Answer 46

(shins splints) can lead to stress fracture F>M complains of pain on the inner edge of the tibia. TX: 1. stop activity for weeks 2. cold packs first 24-48 hours 3. NSAIDs 4. Once pain is gone Wait 2 weeks before resuming activity 5. stretch 6. if suspect a fracture get bone scan and MRI