MSK CIS

Question 1

Be able to dx RA

Answer 1

(need at least 4 of these)

• morning stiffness
• arthritis in 3 or more joints
• arthritis of hand joints
• symmetric arthritis
• rheumatoid nodules
• serum RF
• radiographic changes

Question 2

physical examination findings in RA

Answer 2

• joint swelling

- rheumatoid nodules (firm, non-tender, moveable)

Question 3

joint swelling

Answer 3

• swelling due to synovial hypertrophy or effusion

- synovial thickening detected by a “boggy” feel to a swollen joint and effusion by demonstrating fluctuance

Question 4

presenting signs and sx’s

Answer 4

• morning joint stiffness for at least 1 hr b/f improving
• joint swelling
• possible systemic sx’s (myalgia, fatigue, low grade fever, wt loss, depression)

Question 5

diff b/w RA (vs osteoarthritis)

Answer 5

• MCP and PIP
• soft, warm, tender joints
• stiffness worst AFTER resting
• RF, anti-CPP Ab, inc ESR and CRP

Question 6

diff bw OA (vs RA)

Answer 6

• DIP, carpometacarpal
• heberden’s nodes
• hard and bony joints
• stiffness worse after effort

Question 7

tx of RA- aimed to do what?

Answer 7

maintain tight control of the dz, and not to control sx’s only!!!

• DMARD
• anti-infl agents, including glucocorticoids, only as adjunctive agents
• pt education, preventative therapy (PT/OT)
• early care by a rheumatologist- better outcomes

Question 8

osteoarthritis- tx?

Answer 8

• first line- acetaminophen!!!!!

- NSAIDs may help sx’s more, but may have adverse effects on gastric lining and renal fxn

Question 9

osteopathic considerations in RA

Answer 9

• restriction in UE’s, thoracic, cervical
• MFR, CS- dec joint and extremity SD and fluid accum in joint- start with indirect techniques
• Direct techniques (ME, MFR)

Question 10

OMT contraindications

Answer 10

-HVLA of cervical spine due to laxity of ligaments surrounding the dens or erosion of dens from infl

Question 11

neurological- viscerosomatic reflexes of UE’s

Answer 11

• symp- T2-8

- parasymp- OA/AA

Question 12

OMT- lymphatics

Answer 12

help lymph drainage

• thoracic inlet
• thoracic diaphragm
• tentorium cerebelli
• effleurage and petrissage

Question 13

drainage of lymph

Answer 13

• right duct- right head and neck, right UE, all lung lobes except upper left
• thoracic duct- rest of body
• thoracic inlet- pelvic diaphragm- thoracic area- abd area= UE or LE- head and neck- thoracic inlet