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Module 1: Mali Rheum/MSK > CA rheum/MSK > Flashcards

CA rheum/MSK Flashcards

1
Q

SHOULDER

Neer’s impingement sign

A

press on the scapula to prevent it from moving and with one hand, raise patients arm with the other

compresses the greater tuberosity of humerous against acromion causing rotator cuff tendons to press against the acromion

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2
Q

SHOULDER

hawkins impingement sign

A

flex the shoulder and elbow to 90, internally rotate arm

compresses greater tuberosity against the acromion

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3
Q

SHOULDER

empty can test

what specific muscle does it test?

A

flex arm at shoulder to 90 and internall rotate so thumbs are pointing down (like emptying a can, duh)

have the patient resist against downward pressure on the arm

tests supraspinatus muscle

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4
Q

SHOULDER

infraspinatus and teres minor test

how is this test performed?

A

flex at elbows 90 in front of the body with thumbs up

provide resistance against patient externally rotating

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5
Q

SHOULDER

Lift off test

what muscle does this test?

A

subscapularis

place arm behind back with palm facing out and lift off against restistance

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6
Q

SHOUDLER

drop-arm test

A

abduct the arm so it is over the head and ask the patient to slowly lower it

if supraspinatus is torn, then at 90* it will fall

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7
Q

ELBOW

lateral epicondylitis

A

feel the lateral epidcondyl of the humerus and 2 cm distal to it

apply resistance as the patient extends and soupinates their wrist

since the muscles that do this attach to the lateral epidcondyl, this will cause pain which can indicate inflammation

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8
Q

ELBOW

medial epicondylitis

A

apply resistance as the patient flexes and pronates

the flexor and pronation muscles attach here so if pain could indicate inflammation

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9
Q

WRIST

finkelsteins test

what two muscles does this specifically test?

A

place thumb inside of formed fist, deviate towards the ulna

stretches extensor pollics brevis and abductor pollicis longus over radial styloid

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10
Q

WRIST

tinel’s sign

A

lightly tap over the median nerve in the carpal tunnel on the volar aspect of the wrist

aching and numbness is a positive test

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11
Q

WRISTS

phalen’s sign

A

press dorsal aspects of the hands together to form right angles

this compresses the median nerve

numbness and tingling for 60 seconds is a positive test

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12
Q

Spine

spurlings test

A

passively laterally flex and extend the neck with downward compression

radiating symptoms down neck and shoulder is positive for cervical nerve impingement

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13
Q

SPINE

cervical unload

A

in neutral position, put one hand under the occiput and one hand under the chin and lift head

positive test is reduction where symptoms are eliminated suggesting cervical nerve inpingement

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14
Q

SPINE

cervical load

A

press on the top of the skull in neutral position

positive test is reproduction of symptoms indicating cervical nerve inpingement

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15
Q

SPINE

FABER TEST

A

make a 4 shape and press hands on ASIS and knee at the same time

positive test: pain in the SIJT

if pain is in the groin, could be hip involvement too

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16
Q

SPINE

hoffman test

A

flick the middle nail of middle finger and look for index and thum flexion

indicates upper motor neuron disease

(eg proximal central cord compression)

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17
Q

SPINE

waddells test

what is it and what are four benign maneuvers to stimulate pain?

A

SLR placing hands on heels, if no pressure than person not exhibiting true effort

benign maneuvers to stimulate pain

  1. skin roll
  2. twist at hips
  3. head compression of 5 pounds
  4. SLR, standing and seated, should cause radiating pain
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18
Q

Knee

bulge test

A

with leg extended place pressure on the suprapatellar pouch

apply medial pressure, and tap latterally with right hand to watch for fluid wave

positive test: bulge on the medial side between the patella and the femur

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19
Q

knee

balloon sign

A

basically: grab either side of the patella, squeeze with the left hand and look for any fluid displacement to under the right hand

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20
Q

knee

valgus stress test

A

flex thigh to 30*, push medially at the knee and pull laterally at the ankle

tests medial collateral lig

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21
Q

knee

varus stress test

A

tests lateral collateral lig

lateral force at knee medial force at ankle

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22
Q

knee

anterior drawer sign

A

tests ACL

patient lays supine, flex knee to 90*, cups hands around the knee and pull tibia forward compare with opposite knee for amount of forward motion

forward jerking motion shows positive test and suggests ACL tear!

NOT THE FOOTBALL PLAYERS! Fantasy sports!

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23
Q

knee

lachman’s test!

A

ACL

place knee in 15* flexion and external rotation, pull tibia forward and push distal femur backwards at the same time, suggests ACL tear

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24
Q

knee

posterior knee test

A

PCL

patient supine knee at 90, push back on the tibia

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25
Q

knee

McMurray test

A

flex knee holding knee and foot

then…

externally rotate: stresses medial meniscus

interally rotate: stresses lateral meniscus

in click is felt or heard or pain at the joint line then this is suggestive of a meniscus tear

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26
Q

foot and ankle

Thompson’s test

A

with patient lying prone (on stomache) with feet hanging off table

squeeze the calf of affected side

test is positive if foot remails in the neutral position or there is minimal plantar flexion

aka, it doesn’t move!

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27
Q

ottowa ankle and foot rules

what are the 3 locations that warrent a xray film?

A

malleolar zone:

posterior edge 6cm

Midfoot zone:

tendernous at base of 5th metatarsal

navicular bone

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28
Q

flexor tenosynovitis-Kanavel criteria

A

tenderness along the course of flexor tendon

fusiform symmetrical swelling of finger

flexed posture of finger

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29
Q

dequervain’s disease

A
  • tenosynovitis
  • repetitive strain injury
  • decreased grip strength, pain on radial surface that increases with thumb or ulnar deviation

Finkelstein’s test

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30
Q

carpel tunnel syndrome

A

median neuropathy from compression of the flexor retinaculum

tinel test

nerve conduction or velocity test

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31
Q

scaphoid fracture

A

fall on outstretched hand

pain at anatomical snuffbox

immobalize the thumb 6-12 weeks

complication: osteonecrosis since has minimal blood supply

start with Xray, go to MRI if necrosis is suspected

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32
Q

spinal epidural abscess

also, what are four risk factors?

what are three major indications?

what must you cover for when treating?

A

classic triad: back pain, fevers, neurologic defects

must cover for methylcillin resistant staph aureus

RF: immunosuppression, renal failure, IV drug abuse, ETOH

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33
Q

cauda equina syndrome

A

compression of the nerves at the end of the spinal cord within the canal

back pain

urinary retention, incontinence of bladded/bowel

numbness or tingling in buttocks, lower extremities

EMERGENCY!! usually requires surgical decompression

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34
Q

what are the symptoms associated with cauda equina syndrome?

A

motor and sensory loss

hyperactive reflexes

saddled anesthesia pattern

confirm with CT/MRI

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35
Q

development dysplasia

A

congenital dyplasia of the hip

shallow socket, so femor can slip out

exam: leg length discrepancy, outward rotation, folds on buttock skin uneven

wider space between legs

galeazi sign, ortolani test, barlows test

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36
Q

what is this test and what is it used to diagnose?

(assuming somone was holding the legs)

A

ortolini’s test (this is on porth 1103)

developmental dysplasia where the hip socket is shallow and the femor can slip out

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37
Q

avascular necrosis

where does the pain present? where is it most common? and what are 3 risk factors?

A

most common in femur head

RF: chronic ETOH, corticosteroid use, sickle cell

can be a complication from dislocation or fracture

painful hip, buttock, thigh or knee in setting with no trauma

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38
Q

legg-calve-perthes disease

A

avascular necrosis of the femoral head usually seen in young children

early hip pain with limp

unilateral in 85%

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39
Q

slipped capital femoral epiphysis (SCFE)

what type of fracture do you see? how is the femor head displaced? what age and what type of child? what type of measurement are you looking for on a xray?

A

salter-harris type 1 fracture on femoral capital epiphysis

posterior and inferior displacement of head of femor

common in children >10 years old

mildly obese kids with hip pain and limp

URGENT ORTHOPEDIC EVAL

klein line

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40
Q

meniscus tear

what are the two common feelings you can have with this? where do you find tenderness? what two tests do you want to do to help diagnose this? what image testing do you want to do for this? is it an emergency?

A

nagging non specific pain medial or lateral

can lock up which is orthopedic emergency

“giving away” is URGENT

fullness behind the knee

joint line tendernous

Mcmurray test and Apley’s comrpession test

MRI: check for joint space, if no space then there is a tear

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41
Q

patellofemoral pain syndrome

A

most common cause of knee pain

anterior pain made worse with climbing, kneeling, jumping or sittitng

Exam: patellar crepitus possible

Tx: strengthen

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42
Q

patellofemoral instability

which way does the patella usually deviate? why?

A

displacement usually laterally of the patella

AP, lateral, tunnel, and axial (sunrise) views

if untreated may lead to quadriceps weakness and patellar arthrosis

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43
Q

chondromalacia patella

A

achy knee pain, “stiffness”

Exam: place hand on patella, flex and extend knee to observe crepitus

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44
Q

dislocated knee

A

one of the few true orthopedic emergencies

limb threatening 2* to vascular comprimise

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45
Q

Osgood Schlatter Disease

A

rupture of the growth plate at the tibial tuberosity

stresses the patellar tendon

rapidly growing adolescents

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46
Q

osteochondritis Dissecans

what is this common from? where does this happen the most? when does this start and become symptomatic?

A

repetitive stress

most common, medial femoral condyle

starts in childhood may not become symptomatic till adolescene or adulthood

surgery or nonweightbearing treatment

is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hinder joint motion

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47
Q

osteosarcoma

A

solitary lesions

“starburst” or “sunburst” on xray

appear in long bones of children, most commonly distal femur, proximal tibia, and proximal humerus

bimodal age

1st-early adolescence

2nd- 6th decade

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48
Q

anterior curciate ligament tear (ACL)

A

most common sports injury

postive drawer test, lachman (be careful because there can be a lot of fluid that makes this difficult to see)

MRI is diagnostic

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49
Q

achilles rupture

what test? what two things increase the risk of this happening?

A

common men 30-50

sport related usually

risk goes up with chronic corticosteroid and fluoroquinolones

testing: Thompson’s squeeze, squeeze the back of the calf should get plantar flexion

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50
Q

ankle injury

what are the most common types (percentages) ? what is the most commonly injured ligament?

A

inversion is most common 90%

only 10% eversion

most common injured ligament is: anterior talofibular

follow Ottawa rules for xray.

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51
Q

explain the grading for ligament injury

A

1: stretch
2. Partial tear
3. complete disruption of ligament

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52
Q

Ottawa Ankle rules

What are the two regions of the foot that are concerning? what needs to be present in each of these regions for a xray to be indicated? (3 things in each region)

A

malleolar zone and midfoot zone

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53
Q

ankle fracture

HERES SOME PICS!

A
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54
Q

ankle dislocation

what do you want to do ASAP? what 3 things should you be concerned about?

A

severe fractures can cause dislocations

reduce ASAP

be concerned about neuro, sensory, vascular

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55
Q

what do you always want to do with a traumatic fracture or dislocation of the ankle?

A

always xray top of fibula with traumatic fracture or ankle dislocation

check for: maisonneuve fracture

56
Q

foot fractures

A

given anatomy, fractures can easily hide and allow for ambulation

get xray!! stress fractures may not show up early so whole fracture is missed

57
Q

what is a jones fracture?

A

fracture of proximal 5th metatarsal, common in athletes

comes from inversion

58
Q

hallux valgus

A

“bunion”

lateral deviation of big toe

59
Q

mortons neuroma

A

most common neuroma of the foot

between third and fourth toes

burning or sharp stabbing, worse with ambulation, tight shoes

TX: steroid injection, roomier shoes, surgery

60
Q

Hammer toe

what happens in this? what is the most common cause?

A

toe deviates

distal portion goes down, middle hunches upwards

2nd toe most common

most common cause, poorly fitting shoes, high heels with narrow toe boxes

61
Q

what is there always for a focused visit? what doesn’t it include?

A

chief complaint and HPI

rarely includes ALL subjective and objective components (unless for billing)

62
Q

where are you likely to see focused visits?

A

urgent care

ed

clinic visits

hospital rounding

63
Q

what two factors do documentation influence?

A

qualitiy of care

reimbursement

64
Q

what are 3 things the effect the reimbursement?

A
  1. new or established patient
  2. time required for evaluation
  3. complexity of the visit
65
Q

what are problem focused visits?

A

presenting problem are self limiting

~10 mins for visit

low complexity of medical decision

aka plantar wart

66
Q

what are the characteristics of a expanded, detailed visti?

A

presentation are low to moderately severe

provider spends 20-30 mins

low to moderate complexity

ex pneumonia

67
Q

what are the characteristics of a comprehensive visit?

A

presentation is moderate to severe

45-60 mins

high complexity of medical decision making

CF with biabetes with pneumonia, etc

68
Q

what is a tip about the buinsness of medicine?

A

observe preceptors documentation technique from start to finish

69
Q

what do you need to include for the subjective portion of a focused visit?

A

some but not all,

only stuff that is relevant to chief complaint

70
Q

what are the 6 things that need to be included in the first sentence of HPI

A

name

age

race/ethnicity

sex

present/absence or pertinent pos/neg

presenting symptoms

71
Q

how does the HPI relate to the CC?

A

amplifies chief complaint, describes how symptoms developed

can pull in pertinent pos/neg from ROS

72
Q

what does the OPQRST pneumonic stand for HPI?

A

onset

pallidating and provoking

quality of pain

radiation

severity of pain

timing

associated things

73
Q

what should be included in the past medical history?

A

medical (always psych and obstetric)

surigcal

hospitalizations

74
Q

what are 3 things you want to include as part of the health maitenance portion?

A

immunizations

screenings

advance directives

75
Q

what are two things you always want to do even in a focused visit?

A

cardiac and respiratory

76
Q

what should guide your focused visit?

A

differential diagnosis

77
Q

where do the laboratory and dianostic tests fit on the SOAP note?

A

last part of objective portion before A and P

78
Q

pimary assesment

A

related to chief complaint

79
Q

secondary assesment

A

related to chronic disease or new disease that was secondarily discovered during disease

80
Q

what are 5 things you want to make sure you do during your focused visit to inolve patient?

A
  1. share impression
  2. address any concerns
  3. make sure she agrees to steps ahead
  4. provide written information
  5. include health promotion and disease prevention
81
Q

what 3 things does a successful plan take into consideration?

A

patients goal/ preference

economic means

family structure/dynamics

82
Q

explain tendinitis

  1. what does it mean?
  2. what signs would be present
  3. what is the treatment?
A

literally means “inflammation of the tendon”

all the normal signs seen with inflammation, red, hot swollen, painful

treatment: RICE NSAIDS

83
Q

explain what tendinosis is? how is it different than tendonitis?

A

describes long term pathophysiology of tendons

under a microscope see “bowl of spaghetti” rather than “box of spaghetti” like in tendonitis

this is what happens after the inflammatory process passes, so if someone has long term tendonitis, it is more likely it has become tendonosis

not warm or red like tendonitis, but decreased ROM and strength

Treatment: PT with eccentric exercises, which strengthen and stretch tendon

84
Q

calcific tendonitis

what is deposited in the joint? what symptoms are typically present? what imagine do you want to do to diagnose this? what are 4 treatment options?

A

tendons develop calcium deposits, commonly in rotator cuff

early on causes pain and mechanical symtpms or blockage, similiar symtpms to impingement or tendonitis

Dx: xray or MRI, see a little piece of bone floating in the joint, generally self limiting

TX: PT, dry needling, shock therapy wave to break it down, surgical removal

85
Q

bicipital tendonitis

what tendon is involved here? what two motions will the patient have a difficult time performing?

A

tendonitis along the long head of the bicep tendon

painful when flexing the shoulder or the elbow

runs through the tubercles on the head of the humerus

86
Q

acromioclavicular arthritis

what joint degrades here? what is it caused by? what syndrome can this lead to? what image study do you want to do? what is the treatment?

A

degeneration of the acromioclavicular joint

osteoarthritis

can lead to impingement syndrome because arthritis will narrow the subacromial space

decrease shoulder ROM, pain

Xray: will see degredation

Tx: RICE, NSAIDs, can also do surgery to clean out the mess

87
Q

thenar atrophy

what is this commonly associated with?

A

thenar eminence atrophy

seen with carpal syndrome

need to treat carpal syndrome

88
Q

felon finger

A

infection of the finger tip possibly due to splinter or cut

most common: staph aureus

89
Q

ganglion

what is this? where does it commonly develop? what is the really stange thing people used to do to get rid of it? what do they do now with it?

A

cyst that develops randomly

often seen on the back of the wrist

used to treat with “bible therapy”….have person put their hand face down on the table and smash the cyst

aspiration or surgical removal if symptomatic

90
Q

legg-calve-perthes disease

A

congenital problem of the hips in childhood

bloos supply to femoral head is disrupted and it begins to misform as a result of necrosis

91
Q

chondromalacia patellae

what happens in this? what does this feel like? what are your two treatment options?

A

sandpapery wear and tear of the cartilage on the back of the patella

presents like patellofemoral pain

“grinding” feeling

TX: PT or surgery to clean out damaged cartilage

92
Q

osteochrondritis desiccans

A

joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hinder joint motion. Osteochondritis dissecans occurs most often in children and adolescents

  • most common in the knee but can occure in other joints as well
  • PT and surgery for treatment
93
Q

Lis Franc Fracture

where does this fracture take place? where does this most commonly take place within that region? how does this injury occur? what is important to do when getting an xray?!

A

fracture of the mid-foot

needs to be splinted in walking boot or casted

commonly first and second metatarsal and nacicular

forced plantar flexion“like riding a horse and you fall off and your foot gets stuck in the stirrup, or football player tackled in plantar flexion”

need to get a non weight bearing and weight bearing xray to see how the bones change between the two

94
Q

Jones fracture

where does this injury occur? why is this injury improtant? what motion does this injury commonly occur with? imaging options?

A

acute or stress fracture at the base of the 5th metarsal, often seen with inversion of the ankle

  • important because of the blood supply, they don’t heal well so you want to want to identify early to prevent necrosis*
  • 1st: xray*
  • 2nd: MRI if xray is negative and high clinical suspiscion*
95
Q

when do you use a volar splint? (4 things)

A

wrist sprains/strains

carpal tunnel

lacerations

night slints

96
Q

what are the four splinting wetting techniques?

A
  1. water bottle
  2. open sling cover technique (peel back one side of backing to get the water in)
  3. water bottle/faucet technique (put under running water and then ring)
  4. dipping in bucket technique (immerse in water ring out excess water)
97
Q

what would you use to look at someone’s appendix?

A

ultrasound

98
Q

radiodensitiy

A

physical qualities of an object that determines how much radiation it absorbs from the X-Ray beam

determined by composition and thickness

99
Q

radiopaque

A

Does not permit the passage of x-rays. Representative areas appear light or white on the x-ray film. Usually the property of denser materials, such as bone.

100
Q

radiolucent

A

darker gray but not white or black

Permits the passage of x-rays while offering some resistance (depending on the density of the material). Representative areas are dark on exposed film, such as air.

101
Q

on an xray how would you expect these to appeare:

gas:

soft tissue (fat):

water (organs/blood):

bone:

metal/barium:

A
102
Q

what acronym should you use when looking at the different densities on a xray?

how do the boarders apear if the densities are similar or different?

A

BIL

B=boarder

I=interface

L=line

if there is a sharp contrast between densities, you will see crisp line

if they are similar than the board will be fuzzy

103
Q

if closer to the film you use _____ and get ____ image

A

if closer to the film you use less magnification and get sharper image

104
Q

if farther from the film you use _____ and get ____ image

A

if farther from the film you use more magnification and get fuzzier image

105
Q

to tell the different between a AP and PA….

A

look at the heart!!

106
Q

what view is this?

A

sunrise view

107
Q

what view is this?

A

lordoctic view

108
Q

what view is this?

A

water’s view

109
Q

shape distortion can happen with what?

A

unequal magnification

110
Q

mammogram, Dexa, and fluoroscopt are types of what imaging?

A

xray

111
Q

Dexa scan is a screening for…

A

bone densitiy aka osteoporosis

bone absorbes the xray, determines the density

112
Q

what are the reading for a dexa scane?

A

<1 is normal

1-2.5 osteopenia

<2.5 osteoporosis

113
Q

Xray: fluroscopy

what does this testing allow you to do? what are two examples?

A

continuous beam passes through the patient and allows you to see what they are doing in real time

swallow studies, heart angiograms

114
Q

computerized tomography (CT-Scan)

A

focused radiographic images for one slice of the patient

10-90 seconds

need to know the relative densities between organs to interpret

view from the FEET UP, making the left on the right!

115
Q

how many times more is a chest CT than a xray!?!

A

100-400X xray dose greater!!!

WOW

116
Q

what can metal cause on a CT scan?

A

artifact!!

117
Q

what is the benefit of a reformatted CT?

A

YOU GET 3D IMAGE! formatted in multiple planes

ex: CT angiogram (tell because it is colored and looks generated)

118
Q

magnetic resonance imaging

how do they work and what do you use?

A

Uses powerful magnets

Imaging of H+ atoms in fat and water

H+ align in magnetic field, pulsed waves of scanning knock the atoms out of alignment.

H+ atoms emit radiofrequency waves which produce the image during re-alignment (relaxation time)

119
Q

On MRI

High signal strength items appear_____

Low signal strength items appear_____

A

High signal strength items appear white

Low signal strength items appear dark (blood and bone)

signal strength refers the H+ atom ability to move, so if more dense they don’t move and you get darker color.

120
Q

what is the name of the contrast you use in MRI? If indicated, what must you check for the patient?

A

gadolidium

KIDNEY FUNCTION!!

121
Q

in T1 weighted images on MRI, fats appeare___

A

bright

122
Q

in T2 weighted images on MRI, inflammation, tumors, and fluids appear_____

A

bright

123
Q

When should you not use a MRI? what two things are ok to use?

A

metal or programmable things like pacemaker, icd

if the patient can’t lay still for 35-45 mins

can use with titanium and stainless steel

124
Q

explain how sound waves are used in Ultrasound?

A

hyperechoic/echoic if solid: they bounch back creating a light image

hypoechoic/hypoechoic if fluid filled: light passes through, produces dark image

ex: normal tissue vs fluid filled

125
Q

radioisotope (nuclear) scanning

A

nuclear isotope is attached to a normal compound used in organ metabolism so it lights up

usually two part study

126
Q

technetium 99

A

radioactive isotop used in radioactive scanning

half life 6 hours useful use in thyroid scanning, pulmonary scans, and bone scans

127
Q

thallium 201

A

radioactive isoptope used in radioactive scans

half life 73 hours for myocardial blood flow

128
Q

conventional arteriogram

A

Small tipped catheter advanced under fluoroscopy into an artery (usually the femoral)

take xrays to see the vessels

129
Q

digital subtraction angiography

A

same as conventional but digitally saved so you can subract parts

130
Q

chromatography angiogram

A

Patient injected with bolus of contrast material to opacify the blood vessels while CT is performed

BVs and bone are white, and bones can be subtracted out with 3D reconstruction

131
Q

magnetic resonance angiogram

A

Stack of contiguous MR images converted into 3D vascular images

Safer for patients in renal failure, but contrast can enhance images

132
Q

image? view? whats it mean?

A

xray

lateral

sail sign=radial head fracture

133
Q

salter harris frature classification

A
134
Q

image? view? what is it?

A

xray

AP view

cresant sign on femoral head means avascular necrosis

135
Q

imagine? view? weight? what does it show?

A

MRI

saggital

T1 weight since not as bright as T2 would look

compression fracture

136
Q

image? view? what is this?

A

CT

axial

liver metasticist

*don’t forget looking from patients feet up!*

137
Q

image? what does it show?

A

MRA (since reconstructed and 3D)

shows artery stenosis (narrowing)!

Module 1: Mali Rheum/MSK (4 decks)

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