Family Nurse Practitioner (FNP) > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

Identify, assess, and manage common musculoskeletal disorders and injuries across the lifespan. (87 cards)

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1
Q

What characterizes osteoporosis?

A
  • Low bone mass
  • Structure disruption
  • Increased skeletal fragility
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2
Q

List the risk factors for osteoporosis.

A
  • Elderly
  • History of fracture
  • Caucasian and Asian patients
  • Long-term use of steroids
  • Cigarette smoking
  • Excessive alcohol use
  • Low body weight
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3
Q

What T-score indicates osteoporosis?

A

≤-2.5

A T-score measures a person’s bone density and compares it to a healthy adult of the same gender.

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4
Q

What is the first-line pharmacotherapy for osteoporosis?

A

Bisphosphonates

(alendronate and risedronate)

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5
Q

Fill in the blank:

A T-score of ______ indicates osteopenia.

A

-1.0 to -2.5

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6
Q

What are the most common sites for fragility fractures?

A
  • Spine
  • Hip
  • Wrist
  • Humerus
  • Pelvis
  • Rib
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7
Q

True or False:

Smoking cessation is a recommended lifestyle measure for osteoporosis management.

A

True

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8
Q

What is the recommended daily intake of calcium for osteoporosis prevention?

A

Approximately 1200 mg/day

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9
Q

Which condition is characterized by joint pain, stiffness, and locomotor restriction?

A

Osteoarthritis

(OA)

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10
Q

List the common joints affected by osteoarthritis.

A
  • Knees
  • Hips
  • Interphalangeal joints
  • First CMC joints
  • First MTP joints
  • Joints of the lower cervical and lower lumbar spine

CMC: carpometacarpal joints (where the thumb meets the hand); MTP: metatarsophalangeal joints (where the toe meets the foot)

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11
Q

What is the primary non-pharmacological treatment for knee osteoarthritis in obese patients?

A

Weight management

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12
Q

What is the first-line pharmacological treatment for osteoarthritis affecting one or few joints?

A

Topical NSAIDs

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13
Q

What is the most common type of ankle sprain?

A

Lateral sprain

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14
Q

What ligament is usually affected in a lateral ankle sprain?

A

Anterior talofibular ligament

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15
Q

What is the treatment for a Grade I ankle sprain?

A
  • Ace bandage
  • RICE (rest, ice, compression, elevation)
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16
Q

Fill in the blank:

A Grade III ankle sprain involves a ______ tear of a ligament.

A

complete

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17
Q

What are the Ottawa Ankle Rules for when to x-ray an ankle?

A

Pain and tenderness in the malleolar zone, or unable to bear weight both immediately after the injury and for four steps on exam.

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18
Q

What causes carpal tunnel syndrome?

A

Compression of the median nerve.

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19
Q

What are Tinel and Phalen signs used to diagnose?

A

Carpal tunnel syndrome

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20
Q

What is the treatment for mild to moderate carpal tunnel syndrome?

A

Night time splinting in the neutral position, or glucocorticoid injections.

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21
Q

What is de Quervain tendinopathy?

A

Entrapment tendonitis of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons.

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22
Q

What maneuver supports the diagnosis of de Quervain tendinopathy?

A

Finkelstein maneuver

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23
Q

What are the red flags with orthopedic injuries?

A
  • Any open fracture
  • Neurovascular compromise
  • Acute compartment syndrome
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24
Q

What is the general rule for examining orthopedic injuries?

A

Examine the entire area involved, adjacent bones, and at least one joint above and below the site of injury.

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25
What is the recommended follow-up for **metacarpal fractures**?
Follow up in 3 to 5 days, where splint may be replaced with a cast if needed.
26
What is the common cause of **wrist fractures**?
FOOSH (falling on outstretched hand) injury
27
What is the treatment for a **non-displaced wrist fracture**?
Sugar tong, reverse sugar tong or double sugar tong splint with the arm placed in a neutral position.
28
What is the most common type of carpal bone fracture?
Scaphoid fracture
29
What is the common presentation of a **scaphoid fracture**?
* Snuff box tenderness * Often not visible on initial X-rays ## Footnote Scaphoid fractures are common in the upper extremity and can be difficult to diagnose without significant fracture.
30
What are the indications for **orthopedic consult** in scaphoid fractures?
* Proximal pole affected * Fracture is displaced * Delayed presentation for treatment
31
What is the most common location for **clavicle fractures**?
Middle third of the clavicle
32
What type of imaging is indicated for diagnosing a clavicle fracture?
Anteroposterior (AP) x-ray
33
What are the indications for **ER or surgical referral** in clavicle fractures?
* Proximal third clavicle fractures * Respiratory compromise * Hemodynamic instability * Neurovascular compromise * Open fracture * Tenting present
34
What supports a clinical diagnosis for **lateral epicondylitis**?
Pain with resisted wrist extension and passive wrist flexion
35
What are the treatment options for **elbow tendinopathy**?
* Activity modification * Bracing * Analgesics * Physical therapy * Icing
36
# Fill in the blank: The most commonly injured ligament of the knee is the \_\_\_\_\_\_.
anterior cruciate ligament | (ACL)
37
What is a **positive Lachman test** indicative of?
Increased anterior translation of the tibia relative to the femur ## Footnote Often used to support a diagnosis of an ACL tear
38
What is the preferred imaging for diagnosing an **ACL tear**?
MRI ## Footnote Ultrasound can detect complete tears, and positive Lachman and Anterior Drawer tests can support diagnosis.
39
What are the symptoms of a **meniscus tear**?
* Pain, worse with twisting movements * Knee locking * Knee effusion * Loss of ability to fully extend or flex knee * Unable to squat
40
What is the **definitive method** for diagnosing and treating a meniscus tear?
Arthroscopy
41
What is the common presentation of **Osgood-Schlatter disease**?
* Anterior knee pain that worsens with use * Pain relieved by rest
42
What is the most common **long bone fracture**?
Tibial shaft fracture
43
What are the **red flags** associated with neck pain?
* Neck pain with extremity weakness, or gait abnormalities * Shock sensation with neck flexion * Neck pain with fever or systemic symptoms * Neck pain with unexplained weight loss * Anterior neck pain
44
What are the **first-line pharmacological options** for neck pain?
* NSAIDs * Acetaminophen
45
What are the **red flags** for back pain that indicate the need for imaging?
* Concern for spinal infection * Risk factors for metastatic cancer * Concern for vertebral compression fracture * Neurologic deficits present * Symptoms of spinal cord compression (e.g. saddle anesthesia, bowel, bladder, or sexual dysfunction)
46
What is **cauda equina syndrome**?
A rare complication of lumbar spinal stenosis affecting the nerve roots from L1 to L5 and S1 to S5
47
What are the **symptoms** of cauda equina syndrome?
* Bladder incontinence or retention * Fecal incontinence * Saddle paresthesia * Weakness or bilateral leg numbness
48
What is the treatment for patients with **progressive neurologic deficits or bladder dysfunction** due to cauda equina syndrome?
Urgent surgery
49
What is a **buckle fracture**?
Occurs after compression injury or falling on outstretched hand (FOOSH) injury and generally considered to be a stable fracture.
50
How should a **greenstick fracture** be managed?
Immobilize with a short arm cast or splint for 4 to 6 weeks. Refer to orthopedic.
51
What are the types of **Salter-Harris fractures**?
* Type I: straight across the growth plate * Type II: above the growth plate * Type III: lower or below the growth plate * Type IV: through the growth plate * Type V: erasure of the growth plate or crush injury
52
Which fractures are associated with **child abuse**?
* Long bone fractures in non-ambulatory children * Metaphyseal corner and bucket-handle fractures * Rib fractures * Fractures of the sternum, scapula, or spinous processes * Multiple fractures in various stages of healing * Bilateral acute long-bone fractures * Vertebral body fractures and subluxations in the absence of a history of high force trauma * Digital fractures in children younger than 36 months of age or without a corresponding history * Displaced physeal fractures, especially transphyseal distal humerus fractures, in nonambulatory children * Complex skull fractures in children
53
# Fill in the blank: Gout is a chronic disease of \_\_\_\_\_\_ crystal deposition.
Monosodium Urate | (MSU)
54
What are the common symptoms of a **gout flare**?
* Intense joint pain, often affecting the first metatarsophalangeal (MTP) joint * Inflammation: red, swollen, tender, and warm joint * Limited range of motion * Tophi in chronic gout
55
What is the optimal time to draw **serum urate levels** in a gout patient?
2 weeks after a flare
56
What are the **clinical diagnosis variables** for gout?
* Male sex (2 points) * Previous patient-reported arthritis flare (2 points) * Onset within one day (0.5 points) * Joint redness (1 point) * First MTP joint involvement (2.5 points) * Hypertension or at least one cardiovascular disease (1.5 points) * Serum urate level greater than 5.88 mg/dL (3.5 points) ## Footnote Score: low (≤4 points), intermediate (>4 to <8 points), and high (≥8 points) probability of gout
57
What **treatments** are used for gout flares?
* Systemic glucocorticoids (e.g., prednisone, methylprednisolone) * Intraarticular glucocorticoids (e.g., triamcinolone acetonide) * NSAIDs (e.g., naproxen, ibuprofen) * Colchicine
58
Which gout treatment is preferred for patients on **anticoagulation**?
Colchicine or oral glucocorticoids
59
# True or False: Intraarticular glucocorticoids are recommended for patients with end-stage kidney disease and transplantation.
True
60
What defines a **fragility fracture**?
A fracture that occurs either spontaneously or from minor trauma
61
What is the **FRAX 10-year probability** threshold for a major fracture indicating osteoporosis?
≥20%
62
What are the **contraindications** for bisphosphonates?
* Esophageal disorders * Unable to sit upright for at least 30 mins * Severe kidney issues
63
What is the **most common form** of arthritis?
Osteoarthritis
64
What are **Heberden** and **Bouchard** nodes associated with?
Osteoarthritis
65
What are the **criteria** for diagnosing osteoarthritis clinically?
* Persistent usage-related joint pain in one or a few joints * Age 45 years or older * Morning stiffness for 30 minutes or less
66
What is **rheumatoid arthritis**?
A chronic, systemic, autoimmune, inflammatory disorder that primarily affects the synovial joints
67
What **joints** are most commonly affected by rheumatoid arthritis?
* Metacarpophalangeal (MCP) joints * Proximal interphalangeal (PIP) joints * Interphalangeal joints of the thumbs * Wrists * Metatarsophalangeal (MTP) joints
68
What is the **preferred treatment** for rheumatoid arthritis?
Disease modifying antirheumatic drug therapy
69
What score on the **rheumatoid arthritis classification criteria** indicates RA is extremely likely?
A score of at least 6
70
What is a **Grade I sprain**?
Mild stretching of a ligament with microscopic tears
71
What is the treatment for a **Grade II sprain**?
Joint immobilization, RICE, non-weight bearing until follow up with orthopedic
72
What is the presentation of **lateral epicondylitis**?
Localized tenderness over the lateral epicondyle
73
What is the presentation of **medial epicondylitis**?
Localized tenderness at the medial epicondyle
74
What are the indications for an x-ray in cases of **decreased elbow mobility**?
* Decreased elbow mobility * Bony abnormalities * Other signs consistent with injury
75
# Fill in the blank: The treatment for an anterior cruciate ligament tear includes referral to \_\_\_\_\_\_.
orthopedics ## Footnote RICE and non-weight bearing until follow up with ortho.
76
Which test can support the diagnosis of a **meniscus tear**?
Positive McMurray test can support diagnosis.
77
What is the **preferred imaging method** for diagnosing a meniscus tear?
MRI ## Footnote Ultrasound can detect complete tears.
78
# True or False: Less than 1% of back pain cases have severe causes or etiologies.
True
79
# Fill in the blank: Patients with back pain who do not improve after \_\_\_\_\_\_ weeks of conservative management often require imaging.
4 to 6
80
What are some components of **conservative management** for back pain?
* Heat * Massage * Acupuncture * Spinal manipulation * Short term NSAIDs ## Footnote Bed rest is not advised.
81
What is a rare complication of **lumbar spinal stenosis** affecting the nerve roots from L1 to S5?
Cauda equina syndrome
82
What **diagnostic tool** is required for cauda equina syndrome?
emergent MRI
83
What are the **directional terms** used in anatomy?
* Superior: Above * Inferior: Below * Medial: Toward the midline * Lateral: Away from the midline * Proximal: Closer to a point of reference * Distal: Farther from a point of reference
84
What are the **types of bones** in the musculoskeletal system?
* Long Bones: Femur, humerus; support weight and facilitate movement. * Short Bones: Carpals and tarsals; provide stability and some movement. * Flat Bones: Skull, sternum; protect internal organs and provide surfaces for muscle attachment. * Irregular Bones: Vertebrae; varied shapes for specific functions.
85
What are the **characteristics** of synovial joints?
Most common type; allow significant movement (knee, shoulder). Features include synovial fluid, cartilage, and a joint capsule.
86
What is the **function** of tendons?
Connective tissue that attaches muscles to bones, facilitating movement.
87
Which **activities** help maintain musculoskeletal health?
* Regular Exercise * Balanced Diet * Proper Posture * Injury Prevention
Family Nurse Practitioner (FNP)
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