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Flashcards in Musculoskeletal Deck (122):
1

Patient has hx of falling forward with outstretched hand to break the fall. Check for

scaphoid bone fracture

2

Xray diagnostic for scaphoid wrist fracture

May be initially normal but repeat in 2 weeks will show fracture

3

Patient presents with dorsal displacement of wrist. Suspect for

Colles fracture (fx of distal radius)

4

s/s of hip fracture

inability to bear weight, severe hip pain with external rotation of hip, leg shortening

5

Acute onset of saddle anesthesia (less of sensation in buttocks and inner thighs), bladder/fecal incontinence

cauda equina syndrome

6

Caused by pressure by a bulging disc on a sacral nerve root. A surgical emergency

cauda equina syndrome

7

The cartilage lining the open surfaces of bones in a joint

articular cartilage

8

tendons connect

muscle to bone

9

sac-like structures located on anterior and posterior areas of a joint that act as padding

bursae

10

Genu recurvatum

hyperextension or backward curvature of knees

11

Genu valgum

knock knees ("GUM" stuck between knees)

12

Genu varum

Bow legs

13

Within the first 48 hours of an injury, do NOT

exercise, perform active ROM, or apply heat

14

Weight bearing exercises are only good for:

osteoporosis

15

test for ACL injury

anterior drawer (ACL injury), posterior drawer (PCL injury); Lachman's sign shows knee laxity

16

Finkelstein's test is used to dx for

DeQuervain's tenosynovitis

17

inflammation of the tendon and it's sheath

DeQuervain's tenosynovitis

18

how to perform Finkelstein's test

pain on thumb side of wrist upon ulnar deviation

19

test for meniscal injury

McMurray's test

20

increase in laxity during the valgus stress test of knee indicates

damage to MCL ("GUM" push knee in and ankle out)

21

increase in laxity during the varus stress test of knee indicates

damage to LCL

22

varus is known as

abduction; movement going away from body ("RUN")

23

valgus is known as

adduction; movement going towards body ("GUM" stick inward)

24

refers to bones of hand and wrist

carpal

25

refer to finger and toes

phalanges (singular: phalanx)

26

pain with plantar fasciitis is aggravated by

walking

27

caused by microtears in the plantar fascia d/t tightness in achilles tendon

plantar fasciitis

28

risk factors for plantar fasciitis

obesity, diabetic, aerobic exercise, flat feet, prolong standing

29

nonpharm trx for plantar fasciitis

orthotic foot appliance at night x few weeks; ice; rolling a golf ball

30

pharm trx for plantar fasciitis

NSAIDs (oral or diclofenac gel to soles of feet bid).

31

inflammation of the digital nerve of the foot between the 3rd and 4th metatarsals.

morton's neuroma

32

risk factors for morton's neuroma

high-heeled shoes, obesity, dancer, runner

33

s/s of morton's neuroma

burning/numbness to space between 3rd-4th toes, small nodule b/t 3-4th toe.

34

Mulder test

for morton's neuroma: squeeze forefoot, positive if there is a click or pain

35

degenerative, chronic damage to articular surface of joints

osteoarthritis

36

s/s of osteoarthritis

transient joint stiffness for less than 60 minutes; worse with activity, better with rest; crepitus

37

nodes to DIP in osteoarthritis

Heberden's

38

nodes to PIP in osteoarthritis

Bouchards

39

nonpharm trx for OA

nonweight bearing (walking, swimming, biking, resistance);
Patellar taping by physical therapist;
Glucosamine supplements

40

first line trx for osteoarthritis

Tylenol 325-650 mg q4-6 hours or Tylenol extra strength 500-1000 mg every 6 hours

41

second line trx for osteoarthritis

short to medium acting NSAIDs

42

Complications of long term NSAID

GI and CV disease, decreased renal perfusion, liver damage.

43

topical trx for osteoarthritis

diclofenac gel (Voltaren) apply and massage BID;
capsaicin cream apply QID

44

NSAIDs with highest risk for GI bleed

diclofenac (ketorolac)

45

NSAIDs with lowest risk for GI bleed

ibuprofen, celecoxib (Celebrex)

46

NSAIDs with highest risk for CV events

diclofenac and celecoxib (Celebrex)

47

NSAIDs with lowest risk for CV event

naproxen

48

autoimmune disease that affects skin, kidneys, heart, and blood vessels. Common in black and hispanic women

SLE (lupus)

49

management of SLE

- rheumatologist
- avoid sun 10-4 pm
- wear SPF sunblock; wide brim hats

50

s/s of rheumatoid arthritis

weight loss, anorexia, morning stiffness for more than an hour; symmetrical bone pain, warmth, and tenderness

51

progressive inflammation and thickening of synovial membrane

rheumatoid arthritis

52

flexion of the DIP joint with hyperextension of the PIP joint

Swan neck deformity in RA

53

Hyperextension of the DIP joint with flexion of the PIP joint

Boutonniere deformity in RA

54

Diagnostic for RA

normocytic anemia, ESR and RF elevated

55

meds for RA

NSAIDs, DMARDs

56

swelling of the uvea, the middle layer of the eye that supplies blood to the retina

Uveitis (refer to ophthalmologist STAT)

57

complication of RA

uveitis

58

Plaquenil

antimalarial; can be used for RA

59

Methotrexate

DMARD used for RA

60

deposition or uric acid crystals inside joints and tendons

gout

61

podagra

pain in great big toe

62

meds for gout

only indomethacin or naproxen sodium (Anaprox DS) work well;
Colchicine 0.5 mg

63

when to start maintenance uric lowering therapy after acute gout attack

wait 4-6 weeks

64

education about allopurinol

stop during acute gout phase; restart 4-6 after it is resolved

65

when initiating allopurinol, check baseline

CBC, LFT, renal status

66

uric acid lowering therapy

allopurinol

67

chronic inflammatory disorder that is more common in young males

ankylosing spondylitis

68

ankylosing spondylitis most commonly affects

spine and sacroiliac joints

69

s/s of ankylosing spondylitis

chronic back pain that improves with activity; marked loss of ROM in spine

70

s/s of uveitis

eye irritation, photosensitivity, eye pain, blurred vision

71

diagnostic for ankylosing spondylitis

ESR and CRP elevated;
xray shows "bamboo spine"

72

trx for ankylosing spondylitis

refer to rheumatologist;
NSAIDs

73

s/s of supraspinatus tendinitis

shoulder pain with movement, elevation, and abduction (reaching for back pocket); tenderness over anterior shoulder

74

lateral epicondylitis

tennis elbow

75

medial epicondylitis

golfer's elbow

76

Grade II sprain

incomplete tear; painful weight bearing

77

Grade III sprain

completely torn ligament.
Positive Ottawa rules: inability to bear weight, inability to take 4 steps, tenderness over medial or lateral malleolus

78

s/s of ruptured Baker's cysts

similar to cellulitis (redness, swelling, tenderness to calf)

79

trx for Baker's cysts

RICE, NSAIDS;
large bursae can be drained (if cloudy, r/o septic arthritis)

80

diagnostic criteria for RA

morning stiffness more than 1 hour, swelling of more than 3 joints for more than 6 weeks, at least one joint has to be in the hand or wrist

81

patients with rotator cuff tear may show weakness with

abduction and external rotation

82

disorders of the flexor tendons of the fingers or thumb; caused by a nodule or thickening in the tendon and impedes tendon movement

stenosing tenosynovitis (trigger finger)

83

diagnostic for trigger finger

pain when patient tries to extend finger

84

referral to orthopedist if pain in trigger finger or tenosynovitis does not resolve in

2 weeks

85

In palmer fibrosis (Dupuytren's contracture), referral for surgery should be done for a contracture of more than

30 degrees

86

risk factor of carpal tunnel

pregnancy, menopause, DM, arthritis, HTN, hypothyroidism

87

can be a possible complication of corticosteroids

avascular necrosis

88

s/s of patellofemoral pain syndrome

"runners knee", pain to the anterior portion of the knee; worse when walking up stairs

89

nonpharm trx for low back pain

modify activities for 3-6 weeks; limit bedrest to 2-4 days

90

result from a tearing of the ligaments that bind the joint.

sprain

91

result from an overstretching or overuse of muscles.

strain

92

Unilateral or bilateral tibial pain, exacerbated by exercise, pain with squatting or crouching.

Osgood-Schlatter disease

93

common in adolescent boys and girls who play sports

Osgood-Schlatter disease

94

Avascular necrosis of the femoral head found in preadolescent boys that causes hip/knee pain with a limp

Legg-Calve-Perthes disease

95

Severe hip or knee pain associated with a limp; common in adolescent boys

Slipped capital femoral epiphysis

96

s/s of fibromyalgia

widespread musculoskeletal pain for more than 3 months, fatigue, sleep disorder, depression, IBS

97

patient with polymyalgia rheumatica is at high risk for

temporal arteritis

98

labs for RA

RF, ESR, CRP, Anti-CCP antibodies

99

trx for fibromyalgia

amitryptyline, duloxetine (Cymbalta), pregabalin (Lyrica)

100

Empty can test

abduct shoulder 90 degrees, internally rotate where thumb is pointing to floor. Pain or weakness while pressing down is positive test.

101

s/s of rotator cuff tendinopathy (impingement syndrome)

pain with reaching overhead, positive empty can test, normal passive ROM

102

Difference between rotator cuff impingement and tear

impingement has pain only with testing; tear has pain AND weakness with testing

103

Adhesive capsulitis is associated with

DM

104

If shoulder pain is not reproducible, then consider

CV cause

105

suspect scaphoid fracture when there is tenderness in

anatomic snuffbox (right under thumb)

106

clues on when to get xray for back pain

age greater than 50, hx of cancer, unexplained weight loss, nighttime pain, pain for more than 4 weeks

107

sciatica is nerve root irritation on

L5-S1

108

lateral hip pain aggravated by direct pressure

trochanter bursitis

109

constant hip pain, especially at night

infectious, inflammatory, neoplastic cause

110

hallmark sign of plantar fasciitis

local heel point tenderness

111

how to diagnose hip pain in children

Trendelenburg's test: ask child to stand on affected leg; abnormal if unaffected hip sits lower "dip in the hip".

112

diagnostics for SCFE and Legg-Calve Perthes

xray of hip AP and frog-leg

113

difference between SCFE and Legg-Calve Perthes

SCFE is common in adolescents; Legg-Calve Perthes is common in preadolescents

114

s/s of transient synovitis of the hip in children (irritable hip)

acute limp and hip pain; negative Trendelenburg test; hx of URI 7-14 days prior

115

trx for transient synovitis of the hip in children (irritable hip)

self-limited

116

s/s of osteogenesis imperfecta

triangular face, blue sclera, bones that fracture easily, hearing loss

117

s/s of Prader-Willi syndrome

craving for food and rapid weight gain

118

meds that increase uric acid excretion

colchicine, probenecid

119

first line trx for osteoarthritis

exercise

120

other diseases that can be confused with RA

lupus, scleroderma, Fifth's disease

121

Diagnostic test for RA

no specific diagnostic test; based on symptoms. RF can be false negative or positive.

122

test for impingement syndrome

Hawkin's Kennedy test