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Flashcards in MSK Clinical Manifestations/Pt scenarios Deck (84)
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1
Q

Pt w/ back pain with numbness and parenthesis radiating to buttocks and thighs bilaterally. Pain worse with extension (standing) but better with flexion (leaning forward).

A

Spinal Stenosis

2
Q

Pt w/ severe morning back pain. Pain gets better with exercise and activity. Pt w/ decreased ROM. Labs show elevated ESR and shows pt is + HLA-B27.

A

Ankylosing Spondylitis

3
Q

Pt presents with back pain radiating down only the left leg with parasthesias or numbness. Pain increases with coughing, straining, bending, or sitting. Pt has positive straight leg test.

A

Herniated disc

4
Q

Pt w/ + straight leg test has anterior thigh pain, weak ankle dorsiflexion, and loss of ankle jerk.

A

L4 herniated disc

5
Q

Pt w/ + straight leg test has lateral thigh/leg and dorsal foot pain. Pt w/ weak big toe extension and walking on heels is harder than on toes. Reflexes are normal.

A

L5 herniated disc

6
Q

Pt w/ + straight leg test has posterior thigh/leg and plantar foot pain. Pt has weak plantar flexion and walking on toes is more difficult than on heels. Pt w/ loss of ankle jerk.

A

S1 herniated disc

7
Q

Pt w/ localized back pain.

A

Compression fracture

8
Q

Pt w/ low back pain w/ activity. Xray shows scotty dog sign.

A

Spondylolysis

9
Q

Pt w/ low back pain. Pt w/ history of sciatica. Also has bowel/bladder dysfunction and neuro defects.

A

Spondylothisthesis

10
Q

Pt w/ back pain that radiates down only the left leg. Also has saddle anesthesia, decreased LE sensation/weakness/strength, and urinary & bladder retention/incontinence. On exam, pt has decreased anal sphincter tone.

A

Cauda equina

11
Q

Pt w/ malaise, paresthesias and pain in bilateral hands. Pain is worse in the morning and improves throughout the day. There is bogginess and slight swelling in both wrists and multiple MCP joints. No DIP joint swelling. RF and ACPA are +.

A

RA

12
Q

Pt w/ recent GI/GU infection has asymmetric joint pain with effusions and lack of mobility. Pt also with conjunctivitis and pain with urination. Assx of fatigue, malaise, and fever.

A

Reactive arthritis/Reiter Syndrome

13
Q

Pt w/ abdominal pain worse w/ eating. Also has mottled/purplish skin. Assx of numbness, tingling, and weakness. BP is elevated. Creatinine, ESR, and C-reactive protein are also elevated. ANCA -. Protein in urine.

A

Polyarteritis nodosa

14
Q

Pt w/ abrupt bilateral hip and shoulder (or neck and pelvic girdle) pain and weakness. Reports that in the AM shoulder feels to stiff to even brush hair. Pt has trouble rising out of exam room chair., Normal strength and ROM. Assx of fever, malaise, depression, weight loss, joint swelling and fatigue. Assx w/ temporal arteritis. ESR is elevated.

A

Polymyalgia rheumatica

15
Q

Pt w/ symmetrical proximal muscle weakness in neck flexors, shoulder girdle, and pelvic girdle muscles. Developed sub acutely over several weeks/months. Assx of myalgia and dysphagia. W/ decreased strength. Elevated CK, + ANA and anti JO 1 abs.

A

Polymyositis

16
Q

Pt w/ edema & blue or purple discoloration of upper eyelids. Also w/ – raised violacous scaly patches over the knuckles and photosensitive erythematous rash on the face, neck, and anterior chest. Also has rash on shoulders, upper back.

A

Dermatomyositis

17
Q

Pt w/ history of anxiety and depression has a 1-year history of “aching and hurting all over.” Pain is constant and aching. When questioned carefully, she describes “muscle areas tender to touch.” Although the pain is worse in the back, there really is no place free of pain. Pain is aggravated by weather change, stress, sleep deprivation, and cold temperature and worse in the AM. Sleep is an issue.

A

Fibromyalgia

18
Q

Pt w/ dry MM. Complains fo dry mouth and eyes. Also with vaginal dryness. oil parotid gland enlargement and dental carries.

A

Sjogren Syndrome

19
Q

Pt w/ tight, shiny, thickened skin involving the face, neck as well as distal to the elbows and knees. Spares the trunk. Red-white-blue vasospastic changes of the digits. Also w/ localized thickness and tightness of the skin of the fingers and toes and telangiectasias on her left cheek. Has feeling of heartburn and sometimes feels she has to vomit.

A

Localized scleroderma

20
Q

Acronym for localized scleroderma?

A
C = Calcinosis cutis (calcium deposits in the skin) 
R = Raynaud phenomenon (red-white-blue vasospastic changes of the digits 
E = Esophageal motility disorder 
S = Sclerodactyly (claw hand - localized thickness and tightness of the skin of the fingers and toes) 
T = Telangiectasias (small widened blood vessels in the skin)
21
Q

Pt w/ tight, shiny, thickened skin involving the trunk & proximal extremities. Associated with greater internal organ involvement (restrictive lung disease to to pulmonary fibrosis, myocardial fibrosis)?

A

Diffuse scleroderma

22
Q

Pt w/ intermittent joint pain. The joint pain began about 13 months ago affecting primarily the joints in her hands, wrists, and feet. She expresses concern regarding worsening fatigue, muscle aches, malaise fever, weight loss and feelings of depression. The physical exam reveals tender, edematous bilateral wrists; painless oral ulcers; and erythematous maculopapular lesions on her face.

A

Lupus

23
Q

Pt w/ daily high fevers and arthritis pain. Has salmon colored pink migratory rash. Assx. w/ lymphadenopathy.

A

Systemic (Still’s Dz) RA

24
Q

Pt w/ knee/ankle pain and less than 5 joints are involved. Has uveitis.

A

Pauci (oligo) articular RA - MC.

25
Q

Pt w/ morning stiffness. 5 or more small joints on bilateral sides. Has uveitis.

A

Polyarticular RA

26
Q

Pt s/p MVA w/ inability to ambulate. Pt actively bleeding.

A

Pelvic fracture

27
Q

Pt w/ left hip pain s/p sitting in passenger seat and being hit head on by a truck. Pt w/ severe pain upon ambulation and deformity of left hip. Unable to move hip or bear weight. Left hip is adducted, internally rotated and shortened. Also w/ motor weakness behind the thigh and around the leg and foot.

A

Hip dislocation (Posterior)

28
Q

Pt w/ hx of osteoporosis w/ pain in right leg. Was reaching for a box of cereal when he fell from a small stool. Pain also felt in groin. When the pt is supine, right leg is abducted, externally rotated, and shortened.

A

Hip fracture

29
Q

Pt w/ pain to lateral side of hip (just over greater trochanter). Pain worse w/ walking or by direct pressure over greater trochanter.

A

Trochanteric bursitis

30
Q

Obese 16 year old boy w/ dull, achy left groin, hip and thigh (or knee). Mom notices limp when he walks. Pain worse w/ activity. Left leg externally rotated and pt w/ altered gait.

A

Slipped capital femoral epiphysis (SCFE)

31
Q

10 y/o male w/ limping for past few weeks w/ intermittent hip, thigh, knee, or groin pain. Pt w/ restricted ROM and wasting of thigh muscles.

A

Legg-Calve-Perthes Disease

32
Q

Pt w/ right leg pain and inability to bear weight. Pt w/ obvious deformity.

A

Tibial and fibular fractures

33
Q

Pt w/ posterior knee pain and stiffness. Also feels a mass behind his knee.

A

Popliteal (Baker’s) Cyst

34
Q

Pt w/ posterior knee pain and stiffness. Also has tenderness, warmth and erythema to the calf.

A

Ruptured Popliteal (Baker’s) Cyst

35
Q

Pt s/p being hit on lateral side of knee. Heard a pop and now in severe pain, ecchymosis, and stiffness. On exam, there is swelling over medial aspect of knee and pain/laxity when valgus stress test done. Lachman and McMurray are negative.

A

MCL Tear

36
Q

Pt s/p colliding w/ other soccer player. Now w/ pain, ecchymosis, and severe pain to right knee. Lachman is weakly positive. Laxity/pain to various stress.

A

LCL tear

37
Q

Pt s/p being hit on lateral side of knee. Heard a pop and his knee buckled and now he has an inability to bear weight. On exam, there is swelling, hemarthrosis, and anterior translation of the proximal tibia when pulled as the patient has the knee flexed at 90° and supine.

A

ACL injury

38
Q

Pt s/p a right knee injury 6 months ago. He has been treated with rest and rehabilitation but is unable to play at his previous level due to his knee “giving way.” Pt w/ bruising on anterior aspect and swelling. Physical exam reveals 10° varus alignment when standing and a varus thrust with walking. Ligamentous exam reveals a stable ACL and MCL but opens to a varus stress and a 3+ posterior drawer and positive dial test at both 30° and 90° degrees of flexion.

A

PCL

39
Q

Pt w/ swelling and pain in the left knee s/p twisting injury three days ago. The injury did not take him out of the game; he was able to continue participating with minimal difficulty. Over the last 2 days, the pain has progressed. He often feels a “popping” or “giving away” when walking or climbing or descending stairs. Also inability to fully extend knee. On physical examination, the patient is found to have tenderness over the medial joint line and limited range of motion. Forced flexion and circumduction of the joint cause a painful click.

A

Meniscal tear

40
Q

Pt w/ ache over his right knee, which had seemed to be aggravated hyperflexion of the knee such as sitting, jumping or climbing. On exam, compression of the patella during knee extension worsens symptoms and positive apprehension sign.

A

Patellofemoral syndrome (Chondromalacia)

41
Q

Pt w/ fall on flexed knees now with pain swelling and deformity to right knee. On exam, pt has limited extension with pain.

A

Patellar fracture

42
Q

Pt s/p fall from tree. Pt has pain and swelling to right knee. Pt unable to bear weight. On exam, foot drop and decreased sensation to posterior first web space of foot.

A

Femoral condyle artery

43
Q

5 y/o s/p MVA w/ right knee pain and swelling. Possible foot drop.

A

Tibial plateau fracture

44
Q

10 y/o male w/ anterior knee pain and swelling during running/jumping. No trauma. Pain relieved with rest. On exam, knee with swelling & tenderness to anterior tibial tubercle and it is pronounced.

A

Osgood-Schlatter Disease

45
Q

Pt w/ sudden heel pain after pushing off the ground. He heard a pop a developed sudden sharp calf pain. Pt unable to bear weight. On exam, pt w/ weak plantar flexion when squeezing gastrocnemius.

A

Achilles Tendon Rupture

46
Q

Pt w/ insidious onset of localized aching pain, swelling, and tenderness to 3rd metatarsal that is increased w/ activity. Pain w/ weight bearing. Pain better with rest. On physical exam, there is pain upon palpation of the second and third metatarsal bone of the right foot.

A

Stress/March Fracture

47
Q

Pt w/ sharp inferior heel pain. States first few steps after resting are the worst pain. Pain gets better throughout the day but then returns at night. On exam, pt w.o reproducible pain on palpation over heel pad and pain increases w/ dorsiflexion of toes.

A

Plantar fasciitis

48
Q

Pt w/ burning, numbness and tingling on the plantar aspect of the right foot. Pain increases during the day and is worse at night and w/ dorsiflexion. Pain not better w/ rest. The area has reduced sensitivity to light touch. Tinel sign is present at the posterior tibial nerve adjacent to the medial malleolus.

A

Tarsal Tunnel Syndrome

49
Q

Pt w/ bilateral painful forefeet especially pain over great toe at MTP joint that is exacerbated by the dress shoes she wears for work. Physical examination reveals bursal inflammation and calluses at the medial eminence of the first metatarsal with a 1st metatarsophalangeal (MTP) joint deformity that passively corrects.

A

Hallux Valgus (Bunion)

50
Q

Pt w/ PIP pain and deformity. Due to contact w/ shoe.

A

Hammer Toe

51
Q

Pt w/ nontender, swollen, warm and erythematous joint. Also w/ joint or foot deformity.

A

Charcot Joint/ Neuropathic arthropathy

52
Q

Pt w/ flight attendant complaining of worsening foot pain for 3 weeks. The pain is located on the plantar surface of her forefoot and is described as severe, “burning” pain especially w/ weight bearing. The pain also radiates into her third and fourth toes. The patient states that, at first, she thought she had a pebble in her shoe, but when she removed her shoe, she could not find any obvious offending agent in her shoe. On physical examination, you are able to reproduce the pain by grasping the medial and lateral aspect of the foot in your hand and squeezing the metatarsal heads together. There is no tenderness with palpation of the metatarsal shafts. There is a palpable painful mass.

A

Morton’s Neuroma

53
Q

Pt falls and sustains an injury to her left foot. She has pain and inability to bear weight on her injured foot. She has no plantar ecchymosis but does have tenderness over her 5th metatarsal area and lateral foot.

A

Jones Fracture

54
Q

Pt w/ severe pain and tenderness over tarsometatarsal joint. Pt unable to bear weight and w/ swelling and bruising. X-ray shows fracture at base of second metatarsal ligament.

A

Lisfranc Injury

55
Q

Pt fell off his bicycle four days ago and injured his left non-dominant shoulder. He has pain and unable to lift the arm. There is an abnormal contour of the left shoulder with an elevation of the clavicle, AC joint tenderness, step-off of AC joint and pain with cross-chest testing.

A

Acromioclavicular joint dislocation/seperation

56
Q

Pt w/ insidious onset of left shoulder pain that is exacerbated by overhead activities and while lifting objects away from his body. He is a retired mechanic of 35 years. The patient reports that over the last several months he has been having difficulty sleeping because of the pain. On physical examination, there is notable tenderness over the left anterolateral shoulder and passive forward flexion >90° causes severe pain. An x-ray reveals proximal migration of the humeral head and calcification of the coracoacromial ligament.

A

Impingement Syndrome

57
Q

Pt w/ past medical history of diabetes mellitus complaining of prolonged shoulder pain and stiffness for 6 months. For the past few months, she reports persistent left shoulder pain that also occurs worse at night. She denies history of traumatic injury. On physical exam, she has decreased active and passive range of motion. She is also unable to reach 90° with passive abduction. Resisted shoulder passive ROM on left side. Gradual return of ROM in 18-24 months.

A

Adhesive capsulitis

58
Q

Pt w/ with right shoulder pain for the past several months. He reports that he cannot reach above his head without severe pain. As a retired carpenter, he reports that this has significantly impacted his quality of life. Additionally, he is unable to lie on his left side at night due to shoulder pain. On physical exam, there is focal tenderness over the left anterolateral shoulder. Passive ROM is greater than active. Pain w/ Hawkins, Drop arm, empty can, and neer test.

A

Rotator Cuff Injury

59
Q

Pt w/ right arm pain, swelling & ecchymosis. Arm held in adducted position w. decreased ROM.

A

Humeral Head Fracture

60
Q

Pt w/ difficulty grasping his golf club. The patient reports difficulty with maintaining a strong grip in various situations. This symptom is accompanied by numbness, weakness, pain, and swelling. Pallor of fingers upon arm elevation w/ edema and cyanosis. On physical exam, there is atrophy of his intrinsic hand muscles and loss of radial pulse w/ deep breath and head rotated to affected side.

A

Thoracic Outlet Syndrome

61
Q

Pt w/ with right-sided elbow pain. He describes the pain as sharp and worsens when performing arm curls or playing golf. He reports repetitive trauma w. mild discomfort on full flexion. On physical exam, there is tenderness upon palpation of the medial elbow w/ “goose egg” boggy swelling to posterior olecranon process. Area w/ erythema, warmth, tenderness w/ painful, limited ROM.

A

Olecranon bursitis

62
Q

Pt s/p fall on flexed elbow w/ right elbow pain and swelling. Unable to fully extend elbow.

A

Olecranon Fracture

63
Q

Pt w/ elbow pain. Elbow is flexed w/ marked olecranon prominence & inability to extend elbow.

A

Elbow dislocation.

64
Q

Pt w/ lateral elbow pain. Pt unable to fully extend elbow. X-ray shows posterior fat pain and displaced anterior fat pad.

A

Radial Head Fracture

65
Q

Pt w/ left forearm injury as a result of a fall from a 15-foot ladder. Initial examination in the emergency room reveals a clean 2-centimeter laceration over the volar forearm, pain and swelling of the affected arm along with decreased active and passive range of motion. Radial and ulnar pulses are intact.

A

Nightstick Fracture

66
Q

Pt w/ severe right elbow and forearm pain after sustaining a blunt injury to his right arm. Also thumb tingling. On examination, the affected arm is swollen and tender around his elbow. Radiographs demonstrate a displaced fracture of the proximal ulnar diaphysis and radial head dislocation.

A

Monteggia Fracture

67
Q

Pt w/ pain and deformity of radial side of wrist. On exam, ulnar head is prominent.

A

Galeazzi Fracture

68
Q

Pt w/ elbow pain. She reports that the pain began a few weeks ago and affects the lateral aspect of the left elbow. The pain improves with rest and is aggravated while playing tennis or holding a cup of coffee. It radiates down the forearm and worsens when lifting objects. On physical exam, there is tenderness upon palpation of the lateral epicondyle. Pain is elicited with resisted wrist extension and forearm pronation while the elbow is fully extended.

A

Lateral epicondylitis (tennis elbow)

69
Q

Pt w/ right-sided elbow pain. He describes the pain as sharp and worsens when performing arm curls or playing golf. He denies any direct trauma to the elbow. On physical exam, there is tenderness upon palpation of the medial elbow. Pain is elicited with resisted wrist flexion while the elbow is fully extended.

A

Medial epicondylitis (Golfer’s elbow)

70
Q

Pt w/ weakened grip along with pain and numbness over the small finger and ulnar half of 4th finger and ulnar dorsum of the hand. Her symptoms often wake her at night and are exacerbated when she talks on her cell phone.

A

Cubital Tunnel Syndrome

71
Q

Pt w/ pain along radial surface of the wrist w/ anatomical snuffbox.

A

Scaphoid (navicular) fracture

72
Q

Pt w/ pain on dorsal radial side of the wrist w/ minimal swelling. Pain is increased w/ dorsiflexion. Click w/ wrist movement.

A

Scapholunate Dissociation

73
Q

Pt s/p tripping while getting out of the car and fell onto her outstretched right hand. She experiences immediate pain and swelling over her right wrist. On exam, the patient has a dinner-fork deformity of the wrist and exquisite pain with passive motion. A radiograph is shown, which reveals a dorsally angulated distal radius fracture.

A

Colles Fracture

74
Q

Pt s/p tripping over a throw rug, falling forward, and landing with her arms extended and hands flexed. She presents complaining of left wrist pain. Pain worse w/ passive ROM. On x-ray, you note an extra-articular metaphysical fracture of the radius with volar angulation and displacement. Garden Spade Deformity.

A

Smith Fracture

75
Q

Pt w/ Acute wrist swelling and pain. Also median nerve symptoms.

A

Lunate Dislocation

76
Q

Pt w/ tenderness to palpation in shallow indentation on mid dorsum of wrist.

A

Lunate Fracture

77
Q

Pt sustained a left finger injury while attempting to catch a baseball for his son. He presents with left, long finger pain and an inability to extend his middle finger at the distal interphalangeal joint.

A

Mallet (baseball) Finger

78
Q

Pt w/ pain over the radial side of her right wrist and base of thumb radiating to the forearm especially w/ thumb extension or gripping. She denies any history of wrist trauma. Her pain is aggravated by carrying her 3-month-old son. She is swollen and tender over the radial styloid. Finkelstein test is positive. Radiographs are normal without signs of osseous abnormalities.

A

De Quervain Syndrome

79
Q

Pt w/ pain and numbness in her hand. The patient reports that the pain is most severe during hours of sleep and that the pain can sometimes wake her up at night and she feels as if her thumb is falling asleep. To relieve the pain she shakes her hand or places it under warm running water. She says her symptoms mainly affect the first 3 digits of her hand. She denies any recent injury to or pain in the hand or neck. On physical exam, she has normal range of motion of the neck and arm. She has 2+ bilateral biceps, triceps, and brachioradialis reflexes. She has a positive Phalen and Tinel test.

A

Carpal Tunnel Syndrome

80
Q

Pt w/ visible or palpable nodules over the distal palmar crease or proximal phalanx along the course of the flexor tendons. On exam, pt w/ fixed flexion deformity at the MCP joint with limited extension of the MCP or PIP.

A

Dupuytren Contracture

81
Q

Pt who arrives at the emergency department with a swollen right hand. According to the patient’s girlfriend, he punched a wall after having an argument. On physical exam, there is marked swelling over the ulnar side of his right hand with limited movement of the 5th metacarpophalangeal joint due to pain. Radiographs reveal a fracture of the 5th metacarpal neck of the right hand.

A

Boxer’s Fracture

82
Q

Pt w/ arm slightly flexed & child refuses to use the arm.

A

Radial Head Subluxation

83
Q

Pt w/ pain with ROM, deformity at site; holds arm against chest.

A

Clavicle Fracture

84
Q

Pt w/ cortex broken on one side, bent bowed on other.

A

Greenstick Fracture