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Flashcards in Musculoskeletal Deck (60):
1

How often does lower back pain resolve?

90% in 6-12 weeks

2

DD for lower back pain?

Lumbar strain, disc buldge, Degenerative disc disease, spinal stenosis, spondyloarthropathy, spondylosis, sacroiliac dysfunction

3

What do you do to test for spondylosis?

HLA-B27

4

When do you do radiographic tests?

Hx trauma, 55 years with persistent pain, noted spinal deformity, S&S of spondyloarthropathy, suspicion for tumor or infection, failure of conservative treatment after 6 weeks.

5

When is lower back pain an emergency?

Cauda Equina syndrome

6

Treatment for lower back pain?

NSAIDs, steroids, non-narcotics, muscle relaxers, narcotics rarely indicated, Physcial terapy, surgery

7

What is herniated disc?

Nucleus pulpus is forced through a weakened part of the disc;

8

Symptoms of herniated disc

Low back pain with associated leg symptoms

9

How successful is conservative treatment with herniated disc?

90% symptom management with non operative management

10

What is a tendon?

Attach muscle to bone

11

Common sites of tendonitis?

Rotator cuff, insertion of wrist extensors and flexors at elbow, tibial tenon at leg, patellar and poplital, illiotibial, achilles tendons

12

Symptoms of Tendonitis?

Pain under pressure, restricted movement, burning sensation, swollen, red, warm

13

Treatment of tendonitis?

Radiology is rarely indicated, PRICE, brace area, anti-inflammatory agents

14

Treatment for DeQuervian's Tendonitis?

Base of thumb, occurs over snuff box, point for 3-6 weeks, NSAIDS for two weeks

15

What is bursitis?

Painful inflammation of bursa

16

Risk factors for bursitis?

Over use, not stretching, rheumatoid disease, staphylococcal or other bacterial infections

17

Symptoms of bursitis

Pain that increases with movement of joint, joint tenderness, with swelling and redness in affected area

18

Treatment of bursitis?

Anti-inflammatory drugs, injection of corticosteroids, may need surgical intervention

19

Three types of femoral neck fractures?

Femoral neck (high risk for avascular necrosis), intertrochanteric, and subtrocanteric

20

Diagnosis and S&S of hip fracture?

Pain, inability to bear weight, shortened leg, externally rotated, tenderness over groin, hip motion painful, XR of hip. If negative, do MRI

21

What is carpel tunnel syndrome?

repetitive stress injury due to inflammation of the tissues around the median nerve

22

S&S of Carpal tunnel?

Pain in wrist and hand, nubness, pain that wakes you up at night, all but pinky and side of ring fever

23

DD of carpel tunnel syndrome?

Arthritis, cervical radiculopahty, (C6 thumb and index finger only), DM with neuropathy, cubism, wrist arthritis

24

Exam for carpel tunnel?

Tunnel's sign, phalen's sign, hypothenar atrophy

25

Diagnostic test for carpel tunnel?

Electromyography, XR to r/o fractured bones

26

Conservative tx for carpel tunnel?

RICE, NSAIDs, srugery, B6, acupuncture, electromagnetic fields

27

When do you refer for carpel tunnel?

Thenar atrophy or failure of conventional treatment

28

What is plantar fasciitis?

Inflammation of plantar fascial tissue, adjacent to its insertion into heel.

29

Etiology of plantar fasciitis?

strucutral abnormlaitis, flat foot, high arch, runners

30

Symptoms of plantar fasciitis?

Foot pain with worst pain in morning, sharp, dull,

31

Treatment for Plantar Fasciitis?

NSAIDs, night splints, ice the sore area, supporting splints, weight loss

32

Lumbar stenosis pathology

Narrowing of the canal with compression of the nerve roots

33

Symptoms of lumbar stenosis?

Pseudoclaudication causing radiuclar complaints, unlike claudication, does not get better with rest. May bend over to reduce pain, may have atrophy, incontenence

34

Treatment of lumbar stenosis?

PT, NSAIDS, injections, refer to neurosurgery for bad pain

35

What about Paget's disease?

Second most common disease after osteoarthritis, leading to weaker bones

36

When does pain occur with paget's disease?

Occurs at night

37

Test for Paget's disease?

Radionucleotide test

38

Differential diagnosis for Paget's disease?

Cancer/ metastasis

39

Treatment for Paget's disease?

Biphosphinates, calcitonin for patients that can't handle biphosphanates

40

Path of multiple sclerosis?

Demyelinating disease of CNS and usually begins in young adulthood and frequently associated with vision changes, weakness, numbness, loss of balance

41

Four types of multiple sclerosis?

1. Replasing remitting
2. Primary Progressive
3. Secondary Progressive
4. Progressive relpasing

42

Subjective complaints of MS?

Sensory disturbances, spasticity, ataxic gait, paresthesias, fatigue, optic neuritis, trigeminal neuralgia

43

Diagnosis of MS?

Done by neurologist, two or more parts of the CNS must be involved

44

Treatment of MS?

Glucocorticoids are mainstay of treatment, with new medications prescribed by neurologist. May need plasma exchange for patients refractory to glucocorticoids

45

Symptoms of polymyalgia rheumatica

usually older than 50 y.o., involves shoulders, hip girdle, neck, and torso, decreased ROM, subjective weakness

46

Other condition that occurs with polymyalgia rheumatica?

Occurs with GCA- jaw claudication, new headache, scalp tenderness.

47

Diagnosis of PM?

ESR >40, the rest of the labs should be normal for rheumatoid diseases. Should resolve quickly with steroids

48

Differential diagnosis for PM?

rheumatoid arthritis, bone disease, drug induced myalgia, inflammatory myopathy, fibromyalgia

49

Fibromyalgia symptoms and chronic fatigue syndrome?

Post exercise malaise, fatigue, multiple joint pains, headaches, impaired memory and concentration, depressed mood, cognitive disturbances, sore throat, restless and disordered sleep, vague symptoms

50

What should you rule out for fibromyalgia symptoms?

sleep apnea

51

Objective assessment for FM?

Widespread apin, at least 11/18 trigger points.

52

Treatment for FM?

CBT and graded exercise has best outcomes. May use amitriptyline, lyrics, and SSRI.

53

What two diseases are associated with carpel tunnel syndrome?

Hypothyroidism and pregnancy because of swelling

54

Most common cause of bursitis?

Joint overuse

55

Most symptoms of low back pain are caused by?

Muscle or ligamentous strain.

56

Primary prevention for CTS includes?

Stretching and toning exercises

57

Straight leg tests compression of which roots?

L5 S1

58

First line bursitis treatment includes?

NSAIDS

59

Red Flags for back pain?

Unexplained fever or wt loss, immunospression, >70 y.o., osteoporosis, duration >6 weeks, indwelling catheter, recent UTI or cellulitis, bowel/bladder incontenece, trauma/heavy lifting > 50 y.o., Hx malignancy or IVDU, prolonged steroid use, focal neuro deficit, new back pain >50 y.o., pain at night, urinary retention.

60

Four muscles of the rotator cuff?

1 supraspinatus
2 infraspinatus
3 teres minor
4 subscapularis