Musculoskeletal Flashcards
(122 cards)
1
Q
Patient has hx of falling forward with outstretched hand to break the fall. Check for
A
scaphoid bone fracture
2
Q
Xray diagnostic for scaphoid wrist fracture
A
May be initially normal but repeat in 2 weeks will show fracture
3
Q
Patient presents with dorsal displacement of wrist. Suspect for
A
Colles fracture (fx of distal radius)
4
Q
s/s of hip fracture
A
inability to bear weight, severe hip pain with external rotation of hip, leg shortening
5
Q
Acute onset of saddle anesthesia (less of sensation in buttocks and inner thighs), bladder/fecal incontinence
A
cauda equina syndrome
6
Q
Caused by pressure by a bulging disc on a sacral nerve root. A surgical emergency
A
cauda equina syndrome
7
Q
The cartilage lining the open surfaces of bones in a joint
A
articular cartilage
8
Q
tendons connect
A
muscle to bone
9
Q
sac-like structures located on anterior and posterior areas of a joint that act as padding
A
bursae
10
Q
Genu recurvatum
A
hyperextension or backward curvature of knees
11
Q
Genu valgum
A
knock knees (“GUM” stuck between knees)
12
Q
Genu varum
A
Bow legs
13
Q
Within the first 48 hours of an injury, do NOT
A
exercise, perform active ROM, or apply heat
14
Q
Weight bearing exercises are only good for:
A
osteoporosis
15
Q
test for ACL injury
A
anterior drawer (ACL injury), posterior drawer (PCL injury); Lachman’s sign shows knee laxity
16
Q
Finkelstein’s test is used to dx for
A
DeQuervain’s tenosynovitis
17
Q
inflammation of the tendon and it’s sheath
A
DeQuervain’s tenosynovitis
18
Q
how to perform Finkelstein’s test
A
pain on thumb side of wrist upon ulnar deviation
19
Q
test for meniscal injury
A
McMurray’s test
20
Q
increase in laxity during the valgus stress test of knee indicates
A
damage to MCL (“GUM” push knee in and ankle out)
21
Q
increase in laxity during the varus stress test of knee indicates
A
damage to LCL
22
Q
varus is known as
A
abduction; movement going away from body (“RUN”)
23
Q
valgus is known as
A
adduction; movement going towards body (“GUM” stick inward)
24
Q
refers to bones of hand and wrist
A
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
