AS, CTS et al

Question 0

ankylosing spondylitis pathophysiology

Answer 0

inflammation at tendon/ligament insertion site onto bone —>
ossification happens over time —>
development of syndesmophytes –>
fusion of vertebral bodies

Question 1

inflammatory disease of the axial skeleton characterized by symmetric sacroiliitis & progressive inflammatory arthritis

Answer 1

Ankylosing spondylitis

Question 2

presentation: LBP around SI joint area, radiating upwards. Stiffness exacerbated by inactivity, improved w/ moderate activity. Morning back stiffness > 1 hr. Acute anterior uveitis

Answer 2

ankylosing spondylitis

Question 3

circumcorneal, unilateral uveitis
eye pain, photophobia, blurred vision

associated with which musculoskeletal condition?

Answer 3

ankylosing spondylitis

Question 4

Shober test (for what and how?)

Answer 4

for ankylosing spondylitis

mark 10 cm above and 5 cm below where iliac crest meets the spine. Pt fwd flexes. Measure distance- should be > 20 cm between the marks

Question 5

lab findings for ankylosing spondylitis (3)

Answer 5

elevated ESR, CRP
Anemia on CBC for anemia of chronic disease
Increased alkaline phosphatase in 50& due to increased ossification

Question 6

ankylosing spondylitis tx (primary care) (4)

Answer 6

NSAIDs- Indomethacin (Indocin), Celecoxib (Celebrex)
intra-articular steroids every 3-4 mo.
antidepressants/hypnotics
refer to opthalmology for uveitis

Question 7

advanced ankylosing spondylitis tx (post-rheumatology referral) (3 groups)

Answer 7

Tumor necrosis factor a-antagonists (Etanercept, infliximab, adalimumab)
Sulfasalazine (Azulfidine) for peripheral arthritis
Biologic agents: MTX, azathioprine

Question 8

pain, paresthesias, & weakness in the distribution of the median n. in the hand

Answer 8

carpal tunnel syndrome

Question 9

carpal tunnel syndrome pathophysiology/cause

Answer 9

commonly caused by repetitive overuse

swelling of the synovium and/or thickening of the transverse ligament, leading to nerve compression

Question 10

concern with acute carpal tunnel?

Answer 10

carpal canal compartment syndrome

Question 11

chronic carpal tunnel syndrome tx (5)

Answer 11

NSAIDs, corticosteroid injection, splint, PT, surgical release

Question 12

inflammation of extensor pollicis brevis & abductor pollicus longus tendons of the thumb

Answer 12

DeQuervain Tenosynovitis

Question 13

either sharp or aching pain at the dorsal aspect of the wrist with referred pain to the thumb and lateral forearm, caused by overuse, repetitive gripping. Weakness of the thumb extension and abduction

Answer 13

DeQuervain Tenosynovitis

Question 14

how to perform the Finklestein test?

Answer 14

make a fist with the thumb inside, put it into ulnar deviation –> sharp pain indicates DeQuervain’s tenosynovitis

Question 15

DeQuervain’s tenosynovitis tx (4)

Answer 15

rest & ice, NSAIDs, PT/OT, thumb spica cast

Question 16

purpose of the thumb spica cast in DeQuervain’s Tenosynovitis treatment?

Answer 16

inhibit flexion and extension of the thumb

Question 17

inflammation due to repetitive strain and standing on hard floors. Pain is most common on the plantar aspect of the heel- may see heel spur

Answer 17

Plantar fasciitis

Question 18

bilateral plantar fasciitis can be…

Answer 18

early symptom of other inflammatory disorders

Question 19

heel pain directly beneath the calcaneus or in an area of the medial arch
pain is worst in the morning, after weight bearing or “1st step” out of bed. Worse when dorsiflexing the toes and ankle

Answer 19

Plantar fasciitis

Question 20

plantar fasciitis imaging

Answer 20

X-rays for stress fx of the calcaneus

to rule in a heel spur

Question 21

nonpharmacologic tx for plantar fasciitis (4)

Answer 21

heel pads, cups, orthotics to provide arch support
heel cord stretching
ice/heat after standing or strain
taping/casting/splinting

Question 22

pharmacologic tx for plantar fasciitis

Answer 22

NSAIDs

local injection of steroid/anesthetic mixture (marcaine, lidocaine, kenalog), no more than 3/year