Musculoskeletal

Question 1

how do you definitively scan for osteoporosis?

Answer 1

DEXA
-2.5 or less

Question 2

What meds to treat osteoporosis?

Answer 2

Bisphosphonates
-Fosamax

Question 3

What med should we use to tx htn in those that have osteoporosis?

Answer 3

HCTZ
thiazides

Question 4

What meds are you going to prescribe for rheumatoid arthritis?

Answer 4

DMARDS
-Methotrexate

Question 5

What deficiency is methotrexate notorious for?

Answer 5

Folic acid deficiency

Question 6

When would we see bouchard’s nodes?
Where are they?

Answer 6

B=both
RA and osteo

PIP

Question 7

When would you see Heberden’s nodes?
Where are they?

Answer 7

osteoarthritis
DIP

Question 8

What might you see on exam with Rheumatoid arthritis?

Answer 8

Boutonniere
swan neck deformity

Question 9

Where does the pain start in ankylosing spondylitis?

Answer 9

lower back
then works its way up to the nect

Question 10

What diagnostic test for ankylosing spondylitis?

Answer 10

xray “bamboo spine”

Question 11

When does a navicular/scaphoid fx usually show up on xray?

Answer 11

2 weeks later

Question 12

Why is it important to treat a navicular/scaphoid fx?

Answer 12

prevent osteonecrosis in the wrist

Question 13

What are 2 signs of carpel tunnel syndrome and describe

Answer 13

Phalen’s = backwards prayer hands

Tinels = tap median nerve on inner wrist “tinel tap”

Question 14

What tests do you use to evaluate the meniscus?

Answer 14

mcmurray
Apley test

Question 15

What does the valgus maneuver look at?

Answer 15

ligaments

Question 16

When we have continued popping of hte knee…what type of injury is that?

Answer 16

Meniscal

Question 17

What maneuver determines if it’s the L4 that’s causing sciatica?

Answer 17

squat and rise
diminished knee jerk

Question 18

what maneuver if it’s the L5 causing sciatica?

Answer 18

heel walking = numbness at great toe

Question 19

what manuever if it’s S1 causing sciatica?

Answer 19

walk on toes
dim or absent ankle jerk

Question 20

What is the drop arm test?

Answer 20

abduct arm away from body then lower back down to the waist slowly
…if there is a rotator cuff tear the arm will suddenly drop to the side

Question 21

how do you assess a supraspinatus tear?

Answer 21

empty can test

Question 22

What medication can be used as prevention to decrease uric acid levels?

Answer 22

allopurinol

Question 23

What’s a big side effect of allopurinol?
What do we want to monitor?

Answer 23

bone marrow suppression

CBC

Question 24

What is a treatment for a gout attack?
what about a severe attack?

Answer 24

NSAID ex Indocin
Steroids

Colcrys

Question 25

Diagnosis criteria for fibromyalgia

Answer 25

pain fatigue wake up feeling unrefreshed cognitive problems ...for 3+ months ...and symptoms can't be explained for any other reason

Question 26

Fibromyalgia treatment?

Answer 26

Cymbalta Elavil Lyrica Flexeril Regular exercise

Question 27

What is hallux valgus? What joint is affected? Dx? Tx

Answer 27

bunion 1st metatarsal phalangeal joint dx: Xray tx: braces -if severe, refer surgery

Question 28

What is De Quervain's tenosynovitis? Dx

Answer 28

pain in lower thumb/wrist dx: Finkelstein test

Question 29

What is the finkelstein test

Answer 29

tests for De Quervain's tenosynovitis grab thumb and perform ulnar deviation...positive test if pain occurs

Question 30

What labs are going to be elevated for gout

Answer 30

ESR CRP WBC

Question 31

What are you going to prescribe during a gout attack?

Answer 31

NSAID: Indocin steroids Severe: Colchicine

Question 32

What lab do you want to monitor for a patient on Allopurinol?

Answer 32

CBC look for bone marrow suppression

Question 33

What is the main drug tx for osteoporosis?

Answer 33

bisphosphonates..."-dronate"

Question 34

How do you take bisphosphonates? why?

Answer 34

Need to be taken alone before food need to remain upright for 30 mins to minimize acid reflux

Question 35

What are signs someone has an ACL injury

Answer 35

sudden POP with PIVOTing and IMMEDIATE swelling

Question 36

If someone has a positive Lachman or anterior drawer test...what do you do next?

Answer 36

refer to ortho

Question 37

What are some distinguishing features of a meniscal injury? how to tx

Answer 37

maybe feel a pop then joint "locks up" going to still be able to finish the game DELAYED swelling McMurray's test shows "clicking" or pain RICE and refer to ortho

Question 38

osteoarthritis symptoms 3

Answer 38

pain worse with activity but relieved with rest morning stiffness <1hr asymmetrical no warmth or redness

Question 39

what deficiency can DMARDs (methotrexate) cause?

Answer 39

folic acid deficiency

Question 40

What are treatment options for fibromyalgia

Answer 40

1st line: physical exercise 2nd: Duloxetine (Cymbalta) SSNRI Amitriptyline (Elavil) Flexeril Pregabalin (Lyrica) GABA analogue

Question 41

What is the Hep B vaccination series?

Answer 41

24 hours after birth 1 month after 1st dose 6 months

Question 42

What is Hep B treatment for: post exposure prophylaxis in unvaccinated? post exposure prophylaxis vaccinated previouslyl?

Answer 42

unvaccinated: hep B vaccine AND hep B immunoglobulin within 24 hours vaccinated: hep b immunoglobulin within 24 hours

Question 43

What are the 3 main stages of HIV?

Answer 43

1st: flu symptoms for 1st week 2nd: viral load decreases = latency stage lasts for years 3rd: return of symptoms

Question 44

How do you diagnose HIV?

Answer 44

HIV1/HIV2 antigen/antibody immunoassay it can detect acute infection and previous infection during latent phase

Question 45

What CD4 count to do we want to start antiretroviral drug therapy?

Answer 45

CD4 <350

Question 46

How should patients take their iron supplement?

Answer 46

with an acidic drink and on an empty stomach

Question 47

What exists in the stomach and small intestine to help absorb vitamin b12?

Answer 47

intrinsic factor