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N507 Exam 3 > (16) Musculoskeletal Reds > Flashcards

(16) Musculoskeletal Reds Flashcards

1
Q

Articular disease

A

typically involves:

  • swelling and tenderness of the entire joint
  • crepitus
  • instability
  • “locking”
  • deformity

limits both active and passive ROM d/t stiffness or pain

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2
Q

Extra-articular disease

A

typically involves:
- point of focal tenderness in regions adjacent to articular structure

limits active ROM

rarely causes: swelling, instability, joint deformity

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3
Q

Pain in a single joint suggests:

A
  • injury
  • monoarticular arthritis
  • extra-articular causes like tendonitis or bursitis
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4
Q

lateral hip pain w/ focal tenderness over the greater trochanter suggests ?

A

trochanteric bursitis

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5
Q

pattern of joint pain spread:

rheumatic fever vs rheumatoid arthritis

A

RF: migratory pattern

RA: additive and progressive w/ symmetric involvement

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6
Q

extra-articular joint pain occurs in:

A

inflammation of:

  • bursae (bursitis)
  • tendons (tendonitis)
  • tendon sheaths (tenosynovitis)

sprains from stretching or tearing of ligaments

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7
Q

severe pain of rapid onset in a red swollen joint suggests ?

A

acute septic arthritis or crystalline arthritis (gout, CPPD)

  • in kids consider osteomyelitis in a bone contiguous to a joint
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8
Q

Joint pain w/ butterfly (malar) rash =

A

systemic lupus erthythematous

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9
Q

Joint pain w/ Scaly plaques, especially on extensor surfaces, and pitted nails =

A

Psoriatic arthritis

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10
Q

Joint Pain w/ Heliotrope rash on the upper eyelid

A

Dermatomyositis

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11
Q

Joint Pain w/ Papules, pustules, or vesicles with reddened bases on the distal extremities

A

Gonococcal arthritis

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12
Q

Joint Pain w/ Expanding erythematous “target” or “bull’s eye” patch early in an illness

A 
Lyme disease (erythema chronicum
migrans)
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13
Q

Joint Pain w/ Painful subcutaneous nodules especially in pretibial area

A

Sarcoidosis, Behçet disease (erythema

nodosum)

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14
Q

Joint Pain w/ palpable purpura

A

vasculitis

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15
Q

Joint Pain w/ hives

A

serum sickness, drug reaction

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16
Q

Joint Pain w/ Erosions or scaling on the penis and crusted scaling papules on the soles and palms

A

Reactive (Reiter) arthritis (with urethritis, uveitis)

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17
Q

Joint Pain w/ The maculopapular rash of rubella

A

Arthritis of rubella

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18
Q

Joint Pain w/ Nailfold capillary changes

A

Dermatomyositis

systemic sclerosis

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19
Q

Joint Pain w/ Clubbing of the fingernails

A

Hypertrophic osteoarthropathy

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20
Q

Joint Pain w/Red, burning, and itchy eyes (conjunctivitis), eye pain and blurred vision (uveitis)

A

Reactive (Reiter) arthritis
Behçet syndrome
ankylosing spondylitis

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21
Q

Joint Pain w/ Scleritis

A

RA, IBD, vasculitis

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22
Q

Joint Pain w/ preceding sore throat

A

Acute rheumatic fever or gonococcal arthritis

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23
Q

Joint Pain w/ Oral ulcerations

A

RA (usually painless); Behçet disease

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24
Q

Joint Pain w/ Pneumonitis; interstitial lung disease

A

RA; systemic sclerosis

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25
Q

Joint Pain w/ Diarrhea, abdominal pain, cramping

A

IBD, reactive arthritis from Salmonella,
Shigella, Yersinia, Campylobacter;
scleroderma

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26
Q

Joint Pain w/ Urethritis

A

Reactive (Reiter) arthritis, gonococcal

arthritis

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27
Q

Joint Pain w/ Mental status change, facial or other weakness, stiff neck

A

Lyme disease with central nervous

system involvement

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28
Q

Maneuvers for Examining the Shoulder:

Acromioclavicular Joint

A

Crossover or crossed body adduction test.
- Adduct patient’s arm across the chest.

Pain with adduction is a positive test

Acromioclavicular joint tenderness and compression
tenderness have low LRs so are not diagnostically helpful

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29
Q

Maneuvers for Examining the Shoulder:

Overall Shoulder Rotation

A

Apley scratch test.

  • Ask the patient to touch the opposite scapula using two motions
  • tests abduction and external rotation
  • tests adduction and internal rotation

Pain during these maneuvers suggests a rotator cuff disorder or adhesive capsulitis

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30
Q

Maneuvers for Examining the Shoulder:

Rotator Cuff (pain provocation tests)

A

Painful arc test

  • Fully adduct the patient’s arm from 0° to 180
  • Shoulder pain from 60° to 120° is a positive test for a subacromial impingement/rotator cuff tendinitis disorder

Neer impingement sign

  • Press on the scapula to prevent scapular motion with one hand, and raise the patient’s arm with the other.
  • This compresses the greater tuberosity of the humerus against the acromion.
  • Pain during this maneuver is a positive test for a subacromial impingement/rotator cuff tendinitis disorder

Hawkins impingement sign
- Flex the patient’s shoulder and elbow to 90° with the palm facing down
- with one hand on the forearm and one on the arm, rotate the arm internally
- This compresses the greater tuberosity against the
supraspinatus tendon and coracoacromial ligament.
- Pain during this maneuver is a positive test for supraspinatus impingement/rotator cuff tendinitis

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31
Q

Maneuvers for Examining the Shoulder: Strength Tests

A

External rotation lag test

  • With the patient’s arm flexed to 90° with palm up, rotate the arm into full external rotation
  • Inability of the patient to maintain external rotation is a positive test for supraspinatus and infraspinatus disorders

Internal rotation lag test

  • Ask the patient to place the dorsum of the hand on the low back with the elbow flexed to 90°
  • Then you lift the hand off the back, which further internally rotates the shoulder
  • Ask the patient to keep the hand in this position
  • 90º flexion
  • Inability of the patient to hold the hand in this position is positive test for a subscapularis disorder

Drop-arm test
- Ask the patient to fully abduct the arm to shoulder
level, up to 90°, and lower it slowly
- Note that abduction above shoulder level, from 90° to 120°, reflects action of the deltoid muscle.
- Weakness during this maneuver is a positive test for a supraspinatus rotator cuff tear or bicipital tendinitis

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32
Q

Maneuvers for Examining the Shoulder:

Composite Tests

A 
External rotation resistance
test. Ask the
patient to adduct and
flex the arm to 90°,
with the thumbs
turned up. Stabilize
the elbow with one
hand and apply pressure
proximal to the
patient’s wrist as the
patient presses the
wrist outward in external
rotation.
- Pain or weakness during this maneuver
is a positive test for an infraspinatus
disorder, with a positive LR of 2.6
and negative LR of 0.49. Limited
external rotation points to glenohumeral
disease or adhesive capsulitis
Empty can test. Elevate
the arms to 90° and
internally rotate the
arms with the thumbs
pointing down, as if
emptying a can. Ask
the patient to resist as
you place downward
pressure on the arms.
- Inability of the patient to hold the arm
fully abducted at shoulder level or
control lowering the arm is a positive
test for a suprasinatus rotator cuff
tear, with a positive LR of 1.3.
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33
Q

articular joint pain

A
  • decreased active and passive ROM

- morning stiffness or “gelling”

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34
Q

nonarticular joint pain

A
  • periarticular tenderness

- only passive ROM remains intact

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35
Q

Severe pain of rapid onset in a red

swollen joint suggests

A
  • acute septic arthritis
  • crystalline arthritis (gout; CPPD)

In children, consider osteomyelitis
in a bone contiguous to a joint

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36
Q

Inflammatory joint disorders have many

causes:

A
  • infectious (Neisseria gonorrhoeae
    or Mycobacterium tuberculosis)
  • crystal-induced (gout, pseudogout)
  • immune-related (RA, systemic lupus erythematous)
  • reactive (rheumatic fever, reactive arthritis)
  • idiopathic.
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37
Q

In noninflammatory joint disorders,

consider ?

A
  • trauma (rotator cuff tear),\
  • repetitive use (bursitis, tendinitis)
  • degenerative changes (OA)
  • fibromyalgia
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38
Q

Joint inflammation with fever and chills is

seen in ?

A
  • septic arthritis

- also consider crystalline arthritis

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39
Q

Morning joint stiffness that gradually
improves with activity is more common
in ?

intermittent stiffness & gelling are seen in ?

A

inflammatory disorders like RA
and PMR

OA

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40
Q

Monoarticular arthritis can be:

A

traumatic, crystalline, or septic

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41
Q

Oligoarticular arthritis occurs in:

A

infection from gonorrhea or rheumatic fever, connective tissue disease, and OA

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42
Q

Polyarthritis may be:

A

viral or inflammatory from RA, SLE, or psoriasis

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43
Q

Joint involvement is usually symmetric in:

asymmetric in:
.

A

symmetric:
RA
SLE
ankylosing spondylitis

asymmetric:
psoriatic, reactive (Reiter), and IBD-associated arthritis.

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44
Q

Joints: Constitutional symptoms are common
in:

A

RA, SLE, PMR, and other inflammatory arthritides

High fever and chills suggest an infectious cause.

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45
Q

Leukemia & joints

A

can infiltrate the synovium;
chemotherapy can also cause joint
pain

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46
Q

2 ways to assess for C spine injury:

A 
The NEXUS criteria are normal alertness,
no posterior midline cervical
spine tenderness, no focal neurologic
deficits, no evidence of intoxication,
and no painful distracting injury.

The Canadian C-Spine Rule includes age,
mechanism of injury, low risk factors
allowing assessment of range of
motion, and testing of neck rotation.

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47
Q

Radicular pain signals

A 
spinal nerve
compression and/or irritation, most
commonly at C7 or C6. Unlike low
back pain, the principal cause is
foraminal impingement from
degenerative joint changes (70% to
75%), rather than disc herniation
(20% to 25%).
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48
Q

Nonspecific low back pain is usually from

A

musculoligamentous injuries

and age-related degenerative processes of the intervertebral discs and facet joints

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49
Q

For midline back pain, diagnoses include:

For pain off the midline,
assess for:

A

musculoligamentous injury;
disc herniation; vertebral collapse; spinal cord metastases; and, rarely, epidural abscess.

assess:
muscle strain, sacroiliitis,
trochanteric bursitis, sciatica, and hip arthritis as well as for renal conditions like pyelonephritis or stones

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50
Q

Sciatica

A

radicular gluteal and posterior
leg pain in the S1 distribution that increases with cough or Valsalva
- 85% of cases are associated
with a disc disorder, usually at L4–L5 or L5–S1
- Leg pain that resolves with
rest and/or lumbar forward flexion occurs in spinal stenosis

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51
Q

Consider cauda equina syndrome from

an S2–S4 midline disc or tumor if

A 
there is bowel or bladder dysfunction
(usually urinary retention with overflow
incontinence), especially if there
is saddle anesthesia or perineal
numbness. Pursue immediate imaging
and surgical evaluation
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52
Q

In cases of low back pain plus another indicator, there is a pretest probability
of

A

serious systemic disease of ∼10%.

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53
Q

low back pain “yellow flags”

A

Ask about anxiety, depression,
and work stress. Assess any maladaptive
coping, inappropriate fears or
beliefs, or tendency to somatization

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54
Q

Bone mass peaks by:

A

age 30

Bone loss from age-related declines in
estrogen and testosterone is initially
rapid, then slows and becomes continuous

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55
Q

A previous low-impact fracture from standing height or lower is the greatest risk factor for

A

subsequent fracture

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56
Q

Once injured, articular cartilage is replaced by

A

less resilient fibrocartilage, increasing risk of pain and OA

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57
Q

Acute involvement of only one joint

suggests

A

trauma, septic arthritis, or
crystalline arthritis.

(RA is typically polyarticular and symmetrical)

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58
Q

Malalignment occurs in

A

Dupuytren contracture
bow-legs (genu varum)
knock-knees (genu valgum)

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59
Q

Look for:

subcutaneous nodules in ?

effusion in ?

crepitus over inflamed joints in ?

A

RA or rheumatic fever

trauma

OA or over the inflamed tendon sheaths of tenosynovitis

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60
Q

Decreased range of motion is present in ?

Anterior cruciate ligament (ACL) laxity occurs in ?

A

arthritis, joints with tissue inflammation or surrounding fibrosis, or bony fixation (ankylosis)

knee trauma; muscle atrophy and weakness is seen in RA

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61
Q

Palpable bogginess or doughiness of the synovial membrane indicates ?

Palpable joint fluid is present in ?

A

synovitis, which is often accompanied by effusion

effusion, tenderness over the tendon sheaths in tendinitis

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62
Q

Increased warmth is seen in

A

arthritis
tendinitis
bursitis
osteomyelitis

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63
Q

Redness over a tender joint suggests

A

septic or crystalline arthritis, or possibly

RA.

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64
Q

Diffuse tenderness and warmth over a
thickened synovium suggest ?

focal tenderness suggests ?

A

arthritis or infection

injury and trauma

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65
Q

Facial asymmetry is seen in ?

A

TMJ disorders
(a category of orofacial pain with multifactorial etiologies; typically, there is unilateral chronic pain with chewing, jaw clenching, or teeth grinding, often associated with stress and accompanied by headache)

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66
Q

Swelling, tenderness, and decreased

range of motion signal

A

TMJ inflammation

or arthritis.

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67
Q

TMJ dislocation can be caused by

A

trauma

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68
Q

Palpable crepitus or clicking is present in

A

poor occlusion, meniscus injury, or synovial swelling from trauma

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69
Q

In TMJ syndrome, there is pain and

tenderness with palpation.

A

a

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70
Q

This muscular meshwork can make it
difficult to distinguish shoulder from
neck disorders.

A

646

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71
Q

? may cause elevation of one
shoulder.
With ? of the shoulder, the rounded lateral aspect of the shoulder appears flattened

A

Scoliosis

anterior dislocation

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72
Q 
Atrophy of the supraspinatus and
infraspinatus with increased
prominence of scapular spine can
appear within 2 to 3 weeks of a rotator
cuff tear; infraspinatus atrophy has a
positive likelihood ratio (LR) of 2 for
rotator cuff disease
A

a

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73
Q 
Swelling from synovial fluid accumulation
is rare and must be significant
before the glenohumeral joint capsule
appears distended. Swelling in
the acromioclavicular joint is easier to
detect as the joint is more superficial
A

a

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74
Q 
Localized tenderness points to subacromial
or subdeltoid bursitis, degenerative
changes, or calcific deposits in
the rotator cuff. Swelling suggests a
bursal tear that communicates with
the articular cavity.
A

a

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75
Q 
Tenderness over the SITS muscle
insertions and inability to abduct the
arm above shoulder level occurs in
sprains, tears, and tendon rupture of
the rotator cuff, most commonly the
supraspinatus
A

a

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76
Q

Tenderness and effusion suggest glenohumeral
joint synovitis. If the margins
of the capsule and synovial membrane
are palpable, a moderate to large effusion
is present; minimal synovitis cannot
be detected on palpation.

A

a

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77
Q

Restricted range of motion occurs in
bursitis, capsulitis, rotator cuff tears or
sprains, and tendinitis

A

a

78
Q

test pure glenohumeral motion:

test scapulothoracic motion:

The final 30° tests: combined glenohumeral and scapulothoracic
motion.

A

patient should raise the arms to shoulder level at 90°, with palms facing down

patient should turn the palms up and raise the arms an additional 60°

combined glenohumeral and scapulothoracic motion

79
Q

An age of ≥60 years and a positive
drop-arm test are the findings most
likely to identify a degenerative rotator
cuff tear, with positive LRs of 3.2
and 2.9 to 5.0, respectively. The combined
findings of supraspinatus weakness,
infraspinatus weakness, and a
positive impingement sign increase
the LR of a tear to 48.0; when all three
are absent, the LR falls to 0.02, virtually
ruling out the diagnosis.

A

a

80
Q

Swelling over the olecranon process is
suspicious for olecranon bursitis (see
p. 702); inflammation or synovial fluid
suggests arthritis

A

a

81
Q 
Tenderness distal to the epicondyle is
common in lateral epicondylitis (tennis
elbow) and less common in medial
epicondylitis (pitcher’s or golfer’s
elbow).
A

a

82
Q 
After injury, preservation of active
range of motion and full elbow extension
makes fracture highly unlikely. Full
elbow extension has a sensitivity of
84% to >98% and specificity of 48% to
>97% for absence of fracture.62,63 Tenderness
over the radial head, olecranon,
or medial epicondyle and bruising, plus
absent elbow extension, may improve
these test characteristics.64 Full elbow
extension also makes intra-articular
effusion or hemarthrosis unlikely
A

a

83
Q

Degenerative changes at the first carpometacarpal
joint of the thumb are
more common in women

A

a

84
Q

Guarded movement suggests injury.
Flexor tendon damage causes abnormal
finger alignment

A

a

85
Q

Diffuse swelling is common in arthritis or
infection; local swelling suggests a ganglion.
Laceration, puncture, injection
marks, burn, or erythema result from
trauma.

A

a

86
Q 
Heberden nodes (DIP joints) and
Bouchard nodes (PIP joints) are common
findings in OA. In RA, inspect for
symmetric deformity in the PIP, MCP,
and wrist joints; later, there is MCP
subluxation and ulnar deviation
A

a

87
Q

Thenar atrophy occurs in

in ulnar nerve compression, there is

A

median nerve compression from carpal tunnel syndrome

hypothenar atrophy

88
Q 
Dupuytren flexion contractures in the
third, ring, and fifth fingers, arise from
thickening of the palmar fascia (see
p. 704). Trigger digits are caused by
stenosing tenosynovitis
A

a

89
Q

Tenderness over the distal radius after a fall is suspicious for:

Bony step-offs also suggest:

A

Colles fracture

fracture

90
Q

In RA, there is persisting bilateral

swelling and/or tenderness

A

a

91
Q

Tenderness over the extensor and
abductor tendons of the thumb at the
radial styloid occurs in de Quervain
tenosynovitis and gonococcal tenosynovitis.

A

a

92
Q

“Snuffbox” tenderness with the wrist in ulnar deviation and pain at the scaphoid tubercle are suspicious for:

Poor blood supply increases risk of:

A

occult scaphoid fracture (a common injury)

scaphoid bone avascular necrosis

93
Q

The MCPs are often boggy or tender
in RA, but are rarely involved in OA.
Pain with compression also occurs in
posttraumatic arthritis.

A

a

94
Q

There are PIP changes in RA; Bouchard
nodes in OA. Pain at the base of the
thumb occurs in carpometacarpal
arthritis.

A

a

95
Q

Hard dorsolateral nodules on the DIP
joints, or Heberden nodes are common in

the DIP joints are also involved in

A

OA

psoriatic arthritis

96
Q 
Tenderness and swelling occur in
tenosynovitis, or inflammation of the
tendon sheaths. De Quervain tenosynovitis
involves the extensor and
abductor tendons of the thumb as
they cross the radial styloid.
A

a

97
Q

Arthritis, tenosynovitis, and Dupuytren

contracture all impair range of motion

A

a

98
Q 
Forceful repetitive handwork with
wrist flexion such as keyboarding or
mail sorting, vibration, cold environments,
wrist anatomy, pregnancy, RA,
diabetes, and hypothyroidism are risk
factors for carpal tunnel syndrome
A

a

99
Q 
Decreased sensation in the median
nerve territory is a common sign of
carpal tunnel syndrome (sensitivity to
pinprick and two-point discrimination
<50%; specificity >85%; positive LR of
hypalgesia is 3.1).
A

a

100
Q 
Decreased grip strength is a positive
test for weakness of the finger flexors
and/or intrinsic muscles of the hand.
It also results from inflammatory or
degenerative arthritis, carpal tunnel
syndrome, epicondylitis, and cervical
radiculopathy. Grip weakness plus
wrist pain are often present in de
Quervain tenosynovitis.
A

a

101
Q

Weakness on thumb abduction is a
positive test. The abductor pollicis
longus is innervated only by the
median nerve

A

a

102
Q 
Combined use of a hand symptom
diagram, median nerve territory
hypalgesia, and thumb abduction
weakness are most consistent with
nerve conduction diagnoses of carpal
tunnel syndrome
A

a

103
Q

Aching and numbness in the median
nerve distribution is a positive test
(sensitivity 23% to 60%; specificity
64% to 91%; LR ≤1.5)

A

a

104
Q 
Numbness and tingling in the median
nerve distribution within 60 seconds
is a positive test (sensitivity 10% to
91%; specificity 33% to 86%; LR
≤1.5).68
A

a

105
Q

Tinel and Phalen signs do not reliably
predict positive electrodiagnosis of
carpal tunnel disease

A

a

106
Q

Inspect for impaired hand movement

in

A

arthritis
trigger finger
Dupuytren contracture

107
Q

Neck stiffness signals arthritis, muscle
strain, or other underlying pathology
that should be pursued; headache may
be present.

A

a

108
Q

Lateral deviation and rotation of the
head are seen in torticollis, from contraction
of the sternocleidomastoid
muscle.

A

a

109
Q

Vertebral tenderness raises concerns
for fracture, dislocation, underlying
infection, or arthritis

A

a

110
Q

Tenderness occurs in arthritis, especially
at the facet joints between C5
and C6.

A

a

111
Q

Step-offs occur in spondylolisthesis,
or forward slippage of one vertebra,
which may compress the spinal cord

A

a

112
Q

Tenderness over the sacroiliac joint is
common in sacroiliitis and ankylosing
spondylitis

A

a

113
Q

Pain with percussion occurs in vertebral
osteoporotic fractures, infection,
and malignancy

A

a

114
Q

Increased thoracic kyphosis occurs

with aging

A

a

115
Q 
In scoliosis, lateral and rotatory curvature
of the spine brings the head back
to midline. Scoliosis often becomes
evident during adolescence, before
symptoms appear
A

a

116
Q 
Unequal shoulder heights occur in scoliosis,
the Sprengel deformity of the
scapula from the attachment of an
extra bone or band between the
upper scapula and C7, “winging” of
the scapula from loss of long thoracic
nerve innervation to the serratus
anterior muscle, and contralateral
weakness of the trapezius
A

a

117
Q 
Unequal heights of the iliac crests, or
pelvic tilt, occur in unequal leg
lengths, scoliosis, and hip abduction
or adduction. Check if unequal leg
lengths disappear when a block is
placed under the shorter limb. “Listing”
of the trunk to one side is seen
with a herniated lumbar disc
A

a

118
Q

Birthmarks, port-wine stains, hairy
patches, and lipomas often overlie
bony defects such as spina bifida

A

a

119
Q

Café-au-lait spots (discolored patches
of skin), skin tags, and fibrous tumors
are common in neurofibromatosis

A

a

120
Q

Spasm occurs in degenerative and
inflammatory muscle disorders, overuse,
prolonged contraction from
abnormal posture, and anxiety

A

a

121
Q

Sciatic nerve tenderness is seen with a
herniated disc or nerve root impingement
from a mass lesion.

A

a

122
Q 
Herniated intervertebral discs, most
common at L5–S1 or L4–L5, may
cause tenderness of the spinous processes,
intervertebral joints, paravertebral
muscles, sacrosciatic notch, and
sciatic nerve
A

a

123
Q

Limited range of motion is caused by
stiffness from arthritis, pain from
trauma, overuse, and muscle spasm
from torticollis

A

a

124
Q

Assess any complaints or findings of
neck, shoulder, or arm pain, numbness,
or weakness for possible cervical
cord or nerve root compression

A

a

125
Q

Tenderness at C1–C2 in RA is suspicious
for possible subluxation and high cervical
cord compression and warrants
prompt additional assessment

A

a

126
Q

Deformity of the thorax on forward
bending, especially when the height
of the scapulae is unequal, suggests
scoliosis

A

a

127
Q

Persistence of lumbar lordosis suggests
muscle spasm or ankylosing
spondylitis

A

a

128
Q

Decreased spinal mobility is common

in OA and ankylosing spondylitis

A

a

129
Q

Consider lumbosacral cord or nerve
root compression; arthritis, mass
lesion, or infection in the hip, rectum,
or pelvis may also cause symptoms.

A

a

130
Q

Most hip problems appear during the

weight-bearing stance phase

A

a

131
Q 
A wide base suggests cerebellar disease
or foot problems. Pain during
weight bearing or examiner strike on
the heel occurs in femoral neck stress
fractures
A

a

132
Q

Hip dislocation, arthritis, unequal leg
lengths, or abductor weakness can
cause the pelvis to drop on the opposite
side, producing a waddling gait

A

a

133
Q 
Lack of knee flexion, which makes the
leg functionally longer, interrupts the
smooth pattern of gait, causing circumduction
(swinging the leg out to
the side
A

a

134
Q

Loss of lordosis occurs with paravertebral
spasm; excess lordosis suggests a
flexion deformity of the hip

A

a

135
Q 
Disparities in leg length occur in
abduction or adduction deformities
and scoliosis. Leg shortening and
external rotation are common in
hip fracture
A

a

136
Q

Sacroiliac joint tenderness suggests ?

A

sacroiliitis

137
Q

Bulges along the ligament suggest
an inguinal hernia or, at times, an
aneurysm

A

a

138
Q

Enlarged lymph nodes point to infection

in the pelvis or lower extremity

A

a

139
Q

Causes of groin tenderness are

A

synovitis of the hip joint, arthritis; bursitis; or

possible psoas abscess.

140
Q

Focal tenderness over the trochanter confirms

Tenderness over the posterolateral surface of the greater trochanter occurs in

A

trochanteric bursitis

localized tendinitis, muscle spasm from referred hip pain, and iliotibial band tendinitis.

141
Q 
Intra-articular causes include OA,
osteonecrosis of the femoral head,
acetabular labral tears, and femoral
neck stress fracture. Extra-articular
causes include trochanteric bursitis,
muscle strain, sacroiliac disorders,
and lumbar radiculopathy
A

??

142
Q

Look for tenderness in ischiogluteal bursitis or “weaver’s bottom”; because of the adjacent sciatic nerve, this may
mimic

A

sciatica

143
Q

In flexion deformity of the hip, as the opposite hip is ?

the affected hip:

A

flexed (with the thigh against the chest)

does not allow full hip extension and the affected thigh appears flexed

144
Q

Flexion deformity may be masked by an increase, rather than flattening, in

A

lumbar lordosis and an anterior pelvic tilt

145
Q

Restricted abduction and internal and external rotation are common in

A

hip OA

146
Q

Pain with maximal flexion and adduction and internal rotation or with abduction and external rotation with
full extension signals

A

acetabular labral tear

147
Q

Problems with patellar tracking, for example, in patients with shallower grooves, especially women, can lead to

A

arthritis, anterior knee pain, and

patellar dislocation

148
Q

In women, quadriceps contraction often exerts a more lateral pull (Q angle) that alters patellar tracking, contributing to

A

anterior knee pain

149
Q

Stumbling or “giving way” of the knee during heel strike suggests

A

quadriceps weakness or abnormal patellar tracking

150
Q

Quadriceps atrophy signals

A

hip girdle weakness in older adults

151
Q

Swelling over the patella occurs in ?

Swelling over the tibial tubercle suggests ? or, if more medial, ?

A

prepatellar bursitis (housemaid’s knee)

infrapatellar bursitis; anserine bursitis

152
Q

Bony enlargement at the joint margins, genu varum deformity, and stiffness lasting ≤30 minutes are typical findings in ?. Crepitus is also common.

A

OA

153
Q

A ? with joint line point tenderness is common after

trauma and requires prompt further evaluation.

A

medial meniscus tear

154
Q

MCL tenderness after injury is suspicious for

A

an MCL tear

- LCL injuries are less frequent

155
Q

Tenderness over the tendon or inability to extend the knee suggests

A

partial or complete tear of the patellar tendon

156
Q

Pain with compression and patellar
movement during quadriceps contraction
occurs in ?

Two of three findings are most diagnostic
of the patellofemoral pain
syndrome:

A

chondromalacia

  1. pain with quadriceps contraction; pain with squatting
  2. pain with palpation of the posteromedial/ or lateral patellar border
157
Q

Swelling around the patella points to

A

synovial thickening or effusion of the knee joint

158
Q

Thickening, bogginess, or warmth occurs with (joints)

A

synovitis and nontender effusions from OA

159
Q

? is triggered by excessive kneeling

? from running, valgus knee deformity,
or OA

? from distention of the gastrocnemius semimembranosus bursa from underlying arthritis or trauma

A

Prepatellar bursitis

anserine bursitis

popliteal or “Baker” cyst

160
Q

A fluid wave or bulge on the medial side between the patella and the femur is a positive test for

A

effusion

161
Q

A palpable fluid wave is a positive test or “balloon sign.” A palpable returning fluid wave into the suprapatellar pouch
further confirms

A

a major effusion, present in knee fractures

162
Q

A palpable fluid wave returning into the pouch is also a positive test for

A

major effusion

163
Q

A defect in the muscles, tenderness, and swelling signal a ?

Tenderness and thickening of the tendon, at times with a protuberant posterolateral bony process of the calcaneus, suggests ?

A

ruptured Achilles tendon

Achilles tendinitis

164
Q

Absent plantar flexion is a positive test for ?

A

Achilles tendon rupture
- Sudden severe pain “like a gunshot,” an ecchymosis from the calf into the heel, and a flat-footed gait with absent “toe-off” may also be present

165
Q

Crepitus with flexion and extension signals

A

patellofemoral OA, a probable precursor of knee OA

166
Q

ACL tears are notably more frequent in ?, attributed to ?

A

women

ligamentous laxity related to estrogen cycling and
to differences in anatomy and neuromuscular control

167
Q

A palpable click or pop along the medial or lateral joint line is a positive test for

A

a tear of the posterior portion of the medial meniscus

- The tear may displace meniscal tissue, causing “locking” on full knee extension

168
Q

Pain or a gap in the medial joint line is a positive test for

A

an MCL injury

169
Q

Pain or a gap in the lateral joint line points is a positive test for

A

LCL injury (less common than MCL injuries)

170
Q

A few degrees of forward movement
are normal if equally present on the
opposite side.

A

690

171
Q

A forward jerk showing the contours
of the upper tibia is a positive test, or
anterior drawer sign, with a positive LR
of 11.5 for an ACL tear

A

690

172
Q

ACL injuries result from knee hyperextension,
direct blows to the knee, and
twisting or landing on an extended
hip or knee

A

690

173
Q

Significant forward excursion is a positive
test for an ACL tear (positive LR
of 17.0).

A

690

174
Q

If the proximal tibia falls back, this is a
positive test for PCL injury (positive LR
of 97.8).

A

690

175
Q

Isolated PCL tears are less common,
usually resulting from a direct blow to
the proximal tibia.

A

690

176
Q

Localized tenderness is often present in

A

arthritis
ligamentous injury
infection

177
Q

Check for rheumatoid nodules and tenderness, commonly found in

A

Achilles tendinitis, bursitis, or partial tear from trauma

178
Q

Focal heel tenderness at the attachment site of the plantar fascia is typical of ?

risk factors are:

A

plantar fasciitis

anatomic (overpronation, flat feet)
improper footwear
excessive use
overtraining with prolonged heel-strike exercise

Presence or absence of a heel spur does not change the diagnosis.

179
Q

Most ankle sprains involve

A

foot inversion and injury to the weaker lateral ligaments (anterior talofibular and
calcaneofibular), with overlying tenderness, swelling, and ecchymosis

180
Q

After trauma, pain in the malleolar zone plus either bone tenderness over the posterior aspects of either malleolus
(or over the navicular or base of the fifth metatarsal) or an inability to bear weight for four steps is suspicious
for

A

ankle fracture and warrants radiography (known as the Ottawa ankle and foot rules)

181
Q

Tenderness on compression is an early sign of ?

Acute inflammation of the first MTP joint is common in ?

A

RA

gout

182
Q

Tenderness along the posterior medial malleolus is seen in

A

posterior tibial tendinitis.

183
Q

Pain and tenderness, called metatarsalgia,

occurs in

A

trauma
arthritis
vascular compromise

184
Q

Tenderness over the third and fourth metatarsal heads on the plantar surface is suspicious for

A

Morton neuroma

185
Q

Forefoot abnormalities like hallux valgus, metatarsalgia, and Morton neuroma are more common with

A

wear of high heeled shoes with narrow toe boxes.

186
Q

Pain during movements of the ankle and the foot helps to localize possible

A

arthritis

187
Q

An arthritic joint frequently causes pain when ?, whereas

a ligamentous sprain produces pain when ?.

A

moved in any direction

the ligament is stretched

For example, often, ankle sprain inversion with plantar flexion of the foot causes pain, whereas eversion with plantar flexion is relatively pain free

188
Q

Pain suggests ?

Instability occurs in?

A

acute synovitis

chronic synovitis and claw-toe deformity.

189
Q

Measured leg length is the same in

A

scoliosis

190
Q

Pain with chewing also occurs in

A

TMJ disorders
trigeminal neuralgia
temporal arteritis

N507 Exam 3 (12 decks)

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