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kelly's fam med AQ cases > 2 > Flashcards

2 Flashcards

1
Q

You ask the patient to lift his thigh while you push down on his thigh. What are you testing?

A

Hip Flexion (L 2, 3, 4)

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2
Q

Which motion test L 2, 3, 4?

A

Hip flexion and adduction, and knee extension

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3
Q

You ask the patient to push his legs apart while you push them together. What are you testing?

A

Hip Abduction (L 4, 5, S1)

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4
Q

Which nerve fibers are tested with hip adduction?

A

L 2, 3, 4

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5
Q

You ask the patient to flex his knee while you push against it. What are you testing?

A

Knee Flexion (L 5, S1, S2)

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6
Q

Which fibers do Ankle Dorsiflexion involve?

A

L4,5

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7
Q

Which dermatome is big toe?

A

L 5

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8
Q

Back pain largely originates from impingement of which nerve roots?

A

L 4, 5 and S 1

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9
Q

Which physical exam maneuvers can test dermatome and firing of L 4, 5 and S1?

A

Strength of hip abduction (L4,5 and S1), ankle dorsiflexion (L4,5), sensation big toe (L5), sensation poteriorlateral foot (S1)``

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10
Q

SLR test

A

Neurologic pain which is reproduced in the leg and low back between 30-70 degrees of hip flexion is suggestive of lumbar disc herniation at the L4-S1 nerve roots.

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11
Q

Crossed leg raise

A

Test is positive if pain is increased in the contralateral leg; this correlates with the degree of disc herniation. Such results imply a large central herniation.

Cross SLR test is much less sensitive (0.25) but is highly specific (about 0.90). Thus, a negative test is nonspecific, but a positive test is virtually diagnostic of disc herniation.

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12
Q

FABER test

A

Looks for pathology of the hip joint or sacrum. The test is performed by flexing the hip and placing the foot of the tested leg on the opposite knee. Pressure is then placed on the tested knee while stabilizing the opposite hip.
The test is positive if there is pain at the hip or sacral joint or if the leg cannot lower to the point of being parallel to the opposite leg from pathology of the hip, sacrum or sacroiliac joint.

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13
Q

What test do you do if suspect SI joint pathology?

A

FABER

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14
Q

Symptoms with disc herniation

A

1) pain exacerbated when sitting and bending
2) increased pain with coughing and sneezing
3) pain radiating down the leg and sometimes the foot
paresthesias
4) muscle weakness, such as foot drop

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15
Q

Does disc herniation self-resolve? How long does it last?

A

Yes. 2-4 weeks.

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16
Q

Symptoms of Cauda Equina Syndrome

A

1) Urinary incontinence or retention
2) Saddle anesthesia
3) Anal sphincter tone decreased or fecal incontinence
4) Bilateral lower extremity weakness or numbness
5) Progressive neurologic deficits

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17
Q

Signs/clues of infectious etiology of back pain

A

1) Persistent fever (temperature over 100.4 F)
2) History of intravenous drug abuse
3) Recent bacterial infection, particularly bacteremia (UTI, cellulitis, pneumonia)
4) Immunocompromised states (chronic steroid use, diabetes, HIV)

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18
Q

Foot drop in back pain think ___

A

herniated disk

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19
Q

Settings in which to consider xray for back pain

A

1) History of trauma
2) Strenuous lifting in patient with osteoporosis
3) Prolonged steroid use
4) Osteoporosis
5) Age <20 and >70
6) History of cancer
7) Fever/chills/weight loss
8) Pain worse when supine or severe at night
9) Spinal fracture, tumor, or infection

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20
Q

how can you tell lumbar vertebra on xray?

A

non rib bearing

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21
Q

treatment for disc herniation with radiculopathy?

A

moist heat, physical therapy, NSAIDS and muscle relaxant

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22
Q

What’s characteristic of gout arthrocentesis?

A

Negatively birefringent rods

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23
Q

Positively birefringent rhomboids are found in arthrocentesis of what?

A

pseudogout

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24
Q

Septic arthritis diagnostic findings?

A

Turbid synovial fluid
Leukocytosis
ESR > 50

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25
Q

Resulting from traumatic varus stress

A

LCL strain

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26
Q

Lateral knee pain aggravated with activity

A

iliotibial band tendonitis

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27
Q

What does the Lachman test evaluate?

A

Assesses the stability of the anterior cruciate ligament

28
Q

How can you assess functioning of the medial and lateral collateral ligaments?

A

Varus and valgus stress tests

29
Q

What’s the role of the mcmurray test?

A

Can assess the medial and lateral menisci, though it has low sensitivity and specificity for diagnosing meniscal tears

30
Q

How is ACL injured?

A

Noncontact Deceleration Force

31
Q

How is MCL injured?

A

Misstep or collision that causes valgus stress

32
Q

What is patellofemoral syndrome

A

a clinical diagnosis of exclusion for anterior knee pain; worse after sitting a long while; “cinema knee”

33
Q

What test can help detect patellar subluxation?

A

A patellar apprehension test. The test is positive if there is pain or a giving-way sensation when attempting to translate the patella laterally.

34
Q

What is tibial apophysitis (Osgood-Schlatter lesion)?

A

Inflammation of the tibial tubercle at the site of the patellar tendon attachment. It is typically seen in adolescents who recently went through a growth spurt. They present complaining of anterior knee pain localized to the tibial tuberosity.

35
Q

What is the clinical finding in something with a Baker’s cyst?

A

palpable fullness in the popliteal fossa

36
Q

Syndrome that includes joint pain, including fever, skin rashes, Raynaud’s phenomenon, pleuritis, or chest pain.?

A

SLE

37
Q

Person comes in with knee pain and it is warm and red. What is your first step?

A

Arthrocentesis to rule out septic arthritis! Time is knee!

38
Q

When to order xray for knee?

A

Ottawa guidelines.

1) Age 55 or older
2) Isolated tenderness of the patella (that is, no bone tenderness of the knee other than the patella).
3) Tenderness at the head of the fibula.
4) Inability to flex to 90 degrees.
5) Inability to bear weight both immediately and in the emergency department (4 steps; unable to transfer weight twice onto each lower limb regardless of limping).

39
Q

What medication is first line for osteoarthritis?

A

Paracetamol, or acetaminophen because good side effect profile (second choice would be NSAIDS like diclofenac, more affective than acetaminophen but bad side effect profile with GI irritation and bleeding)

40
Q

What about intra-articular joint injections for osteoarthritis?

A

No more than three injections per year, and no more frequent than one injection per month.
Long-acting triamcinolone is typically preferred over methylprednisolone, and 1 ml of steroid should be combined with 3-4 ml local anesthetic.

41
Q

A patient is started on a TCA for chronic pain management. What are common side effects?

A

anticholinergic side effects, including dry mouth, constipation, urinary retention, blurred vision and paralytic ileus

42
Q

3 side effects of NSAIDs?

A

gastrointestinal upset
decreasing the effectiveness of hypertension medications
increasing the effect of sulfonylureas

43
Q

age range for screening mammography?

A

50-74

44
Q

How far into an illness before monospot test can detect virus?

A

one week

45
Q

What makes up the Modified Centor Score for GAS?

A

Give one point for each positive response:

Tonsillar exudate or erythema
Anterior cervical adenopathy
Cough absent
Fever present:
Age 3 to 14 years: +1 point
Age 15 to 45 years: 0 points
Age over 45 years: -1 point
46
Q

What is the role of the Centor criteria?

A

has a good negative predictive value, but a relatively poor positive predictive value. Thus it is useful in figuring out which patients likely do not have strep pharyngitis and therefore do not need further testing.

47
Q

When to complete swab with Centor criteria?

A

2+

48
Q

What medications can be used for strep treatment?

A

1) Macrolides
2) Penicillin V
3) Penicillin G IM
4) Amoxicillin
5) First generation cephalosporin

49
Q

What are two rare complications of GABHS?

A

Rheumatic fever and PSGN

50
Q

Which vaccines are required for school admission?

A 
Two MMR
Two varicella
Three hepatitis B
Four polio
Five DTaP
51
Q

Common causes of chronic cough

A

1) postnasal drip
2) vocal cord dysfunction
3) asthma
4) gastroesophageal reflux disease (GERD)
5) medications such as angiotensin-converting enzyme inhibitors (ACE-inhibitors)
6) tobacco-related cough
7) post-infectious cough
8) chronic obstructive pulmonary disease (especially the chronic bronchitis type)
9) non-asthmatic eosinophilic bronchitis.

52
Q

Can post nasal drip and PE cause wheezing?

A

Yes

53
Q

GERD and obesity are co-morbid conditions of asthma. Can you list 3 more?

A

obstructive sleep apnea
rhinitis or sinusitis
stress and depression

54
Q

Symptoms and time course of chronic sinusitis?

A 
> 12 weeks + 2 of the following: 
nasal obstruction or congestion
mucopurulent drainage (anterior, posterior or both)
facial pain, pressure or fullness
decreased sense of smell
55
Q

What are some physical exam findings of allergic rhinitis?

A

swollen nasal turbinates and pallor of the nasal mucosa and clear d/c from nares

56
Q

Medications for allergic rhinitis management

A

Oral antihistamine

Nasal corticosteroid

57
Q

Medications for cough due to asthma

A

Inhaled corticosteroid

Inhaled bronchodilator

58
Q

What are the 3 main components of spirometry?

A

FEV1, FVC, and FEV1/FVC

59
Q

Spirometry diagnostic of obstructive lung disease

A

FEV1/FVC < 70%

60
Q

What is different in spirometry of asthma vs COPD?

A

Reversability/improvement of FEV1 by 12% with bronchodilator

61
Q

What part of spirometry helps determine severity of COPD

A

percent predicted of FEV1

62
Q

Classify asthma severity: 1x week nightly awakenings

A

moderate

63
Q

Classify asthma severity: several time per day use of SABA

A

severe

64
Q

Classify asthma severity: symptoms <2x a week

A

mild

65
Q

Classify asthma severity: night time awakenings < 2x/month

A

mild

kelly's fam med AQ cases (10 decks)

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