MSK MDT

Question 1

What is a major cause of chest pain in the ambulatory setting?

Answer 1

Costochondritis

Question 2

Chest pain from costochondritis is said to be what?

Answer 2

Reproducible

Question 3

What dx should you r/o before considering costochondritis

Answer 3

Myocardial ischemia
Infarction
Pulmonary embolism
Aortic dissection
Pneumothorax

Question 4

Treatment for costochondritis

Answer 4

NSAIDS, HEP, Activity mods

Question 5

Risk factors for osteoarthritis

Answer 5

Age: >50
Gender: greater risk in females
Joint injuries, chronic inflammation
Obesity, occupation
Heavy work load

Question 6

What percentage of knee joints account for osteoarthritis cases

Answer 6

80%

Question 7

Common sites of osteoarthritis

Answer 7

Hips, knees, spine and hands

Question 8

Pt presents with:
-Pain exacerbated with use, alleviated with rest
-Pain is aching, deep in later stages
-Sharp pain in beginning stages

Answer 8

osteoarthritis

Question 9

Rads for osteoarthritis

Answer 9

Plain films reveal: joint space narrowing, osteophytes, subchondral sclerosis, cysts

Question 10

Treatment of osteoarthritis

Answer 10

Pain control
Activity/lifestyle modifications
Weight reduction

Question 11

Examples of inflammatory arthroses

Answer 11

Rheumatoid arthritis, reactive arthritis, psoriatic arthritis, ankylosing spondylitis

Question 12

Which joints are commonly effected by RA

Answer 12

Small and bilateral joints: hands, finger, wrists, feet, ankle

Question 13

Pt presents with:

4 of 7 criteria
Morning stiffness
Arthritis
Swelling of hand joints
Symmetrical joint swelling
Rheumatoid nodules
Positive RF factor
Erosions or osteopenia in hand XR
Myelopathy with C1-C2

Answer 13

Rheumatoid arthritis

Question 14

Labs for RA

Answer 14

RF
Antibody cyclic citrullinated peptide (anti-CCP)
C-reactive protein (CRP)
Erythrocyte sedimentation rate

Question 15

Rads for RA

Answer 15

Plain films: may show osteopenia and mild soft tissue swelling along with erosions

Question 16

Treatment for RA

Answer 16

MED ADVICE
NSAID/Tylenol
DMARD (Disease-modifying anti-rheumatic drug)
- Ab, etanercept, methotrexate, hydroxycholoquine, cyclosporine
PT/surgery

Question 17

What causes reactive arthritis

Answer 17

UTI
Diarrheal
STI

Question 18

Pt presents with:

-Acute onset of joint pain 1-4weeks after infection
-Sausage digits
-Lower back pain
-Nail changes, conjunctivitis, anterior uveitis, oral lesions

Answer 18

reactive arthritis

Question 19

Treatment of reactive arthritis

Answer 19

Treat infection
Self limiting (may be up to 6 months)
NSAIDS for pain

Question 20

What is psoriatic arthritis

Answer 20

Inflammatory arthritis associated with psoriasis

Question 21

What is ankylosing spondylitis

Answer 21

Inflammatory arthritis of the spine

Question 22

Sx of ankylosing spondylitis

Answer 22

“bamboo spine”

Question 23

What is gout

Answer 23

Monosodium urate crystal deposition in joints and tissues

Question 24

Common sites of gout

Answer 24

1st toe, ankle, wrist, fingers, elbow

Question 25

Labs for gout

Answer 25

Uric acid, chem panel, TSH, iron panel, WBC

Question 26

Rads for gout

Answer 26

Plain films: erosions and peripheral spurs, soft tissue swelling

Question 27

Treatment for gout

Answer 27

NSAID (indomethacin) Colchicine Steroids

Question 28

Prophylaxis of gout

Answer 28

Allopurinol (overproducer) Probenecid (underexcreter)

Question 29

What should patients with gout avoid eating

Answer 29

Meat, seafood, alcohol, high fructose corn syrup

Question 30

How is pseudogout and gout differentiated

Answer 30

Labs

Question 31

What will uric acid levels be in pseudogout

Answer 31

Normal

Question 32

Pathophysiology of pseudogout is

Answer 32

Based on pyrophosphate deposition

Question 33

What is septic arthritis

Answer 33

Infection of joint space

Question 34

What is the most common cause of septic arthritis

Answer 34

Staphylococcus aureus

Question 35

Labs for septic arthritis

Answer 35

CBC, ESR, CRP

Question 36

Rads for septic arthritis

Answer 36

Plain films MRI

Question 37

Treatment for septic arthritis

Answer 37

Supportive if having shock IV antibiotics MEDEVAC

Question 38

What is virchow’s triad

Answer 38

Hypercoagulability Venous stasis Endothelial damage

Question 39

DVT will often become what in most cases?

Answer 39

Pulmonary embolism

Question 40

Pt presents with: -Pain in limb -Edema (unilateral) -Erythema

Answer 40

Deep vein thrombosis

Question 41

What is a special test for DVT?

Answer 41

Homan’s sign (pain w/dorsiflexion)

Question 42

What is a fracture

Answer 42

Disruption in the bone from repetitive or forceful trauma

Question 43

Pt presents with: -Severe pain, swelling, decreased mobility -Limited weight bearing -Numbness, tingling, pallor, ecchymosis, deformity

Answer 43

Fracture

Question 44

What is the difference between an open and closed fracture

Answer 44

Open: bone through skin or break in skin Closed: Intact skin

Question 45

What is a non-displaced fracture?

Answer 45

Anatomic alignment

Question 46

What is a displaced fracture?

Answer 46

Not in anatomic alignment, described as a percentage

Question 47

What is a bayonetted fracture?

Answer 47

Distal fragment overlaps proximal fragment

Question 48

What is a distracted fracture?

Answer 48

Fragments are separated

Question 49

What is angulation fracture?

Answer 49

Deviation at an angle

Question 50

Rads for fracture

Answer 50

Plain films (AP, lateral, oblique) above and below joint Consider CT, MRI, US, bone scan

Question 51

Treatment for fractures

Answer 51

Recognition Reduction Retention of reduction Rehabilitation

Question 52

What do you check before and after splinting

Answer 52

Pulses and sensations

Question 53

How do you splint femoral fractures

Answer 53

Traction

Question 54

How do you splint spine fractures

Answer 54

Spine board/C-collar

Question 55

How do you splint clavicular fractures

Answer 55

Sling

Question 56

How do you splint pelvic fractures

Answer 56

Pelvic binder

Question 57

What factors increase healing of fractures

Answer 57

Skeletal immaturity Transverse fractures Prescence of adjacent bone for support Anatomic alignment

Question 58

Factors that decrease healing

Answer 58

Smoking Skeletal maturity Oblique/comminuted/segmental fractures Marked displacement Interarticular fracture