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MSK > Ch 13 MDT Musculoskeletal System > Flashcards

Ch 13 MDT Musculoskeletal System Flashcards

1
Q

Chest pain is “reproducible”

Able to exacerbate pain with palpation on physical exam

Likely secondary to viral illness and other causes of inflammation
-Other rheumatic diseases such as fibromyalgia a common cause of chest wall pain

A

Costochondritis

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2
Q

Diagnostic tests for Costochondritis

A

Clinically

-Rads/Labs used to rule out other sources of chest pain

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3
Q

Treatment for Costochondritis

A

Improves in the course of 2 weeks

  • NSAIDS
  • Home Stretching
  • Activity modification
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4
Q

Osteoarthritis

Affects an Estimated ____ million people

A

30 million

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5
Q

Osteoarthritis

Knee joint accounts for ___% cases

A

80%

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6
Q

Risk factors for Osteoarthritis

A

Age (>50)

Female (1.7x more likely than males)

Family history

Joint injuries

Chronic inflammation

Obesity

Occupation

Heavy workload

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7
Q

Common sites of Osteoarthritis

A

Hips

Knees

Spine

Hands

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8
Q

Joint Pain that is exacerbated with use, alleviated with rest

Pain is aching, deep in later stages

Sharp pain in beginning stages

  • Bony swelling
  • Joint line tenderness, crepitus
  • Limited ROM on affected joint
A

Osteoarthritis

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9
Q

Diagnostic tests for Osteoarthritis

A

Plain films

-Joint space narrowing, osteophytes, subchondral sclerosis, cysts

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10
Q

Treatment for Osteoarthritis

A

NSAIDs/Tylenol

Activity/Lifestyle modification (weight loss)

Rehabilitation

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11
Q

Osteoarthritis

Loss of 10% of body weight is associated with __% reduction in pain over 18 months

A

50%

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12
Q

Includes rheumatoid arthritis, reactive arthritis, psoriatic arthritis, ankylosing spondylitis

A

Inflammatory Arthroses

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13
Q

Autoimmune disorder

Mostly small joints and bilateral: hands, finger, wrist, feet, ankle

Insidious onset, distal joints first (DIP of hands are spared)

Extra-articular manifestations (pulmonary, CV, eyes)

A

Rheumatoid Arthritis (RA)

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14
Q

Rheumatoid Arthritis (RA)

Diagnosed if they meet 4 of the 7 ACR criteria which involves:

A

Morning stiffness (1 hour for 6 weeks)

Arthritis (>/= 3 joints for 6 weeks)

Swelling of hand joints (6 weeks)

Symmetrical joint swelling (6 weeks)

Rheumatoid nodules

Positive Rheumatoid factor

Erosions or osteopenia in hand X-Ray

May have myelopathy with C1-C2 involvement

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15
Q

Nodules (elbow mostly)

Swelling/hypertrophy

Swan neck deformity

Lateral drift of toes

  • Boggy sensation
  • ROM diminished and painful
  • Reduced grip strength
  • Numbness and tingling in affected nerve
A

Rheumatoid Arthritis (RA)

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16
Q

Lab tests for Rheumatoid Arthritis (RA)

A

Rheumatoid Factor (RF)

Antibody to cyclic citrullinated peptide (Anti-CCP)

C-reactive Protein (CRP)

Erythrocyte Sedimentation Rate (ESR)

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17
Q

Radiologic studies for Rheumatoid Arthritis (RA) that can show osteopenia and mild soft tissue swelling along with erosions

A

Plain films

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18
Q

Treatment for Rheumatoid Arthritis (RA)

A

MEDADVICE

NSAIDs/Tylenol

-Disease-Modifying Anti-Rheumatic Drug (DMARD)

Physical Therapy/Surgery

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19
Q

Disease-Modifying Anti-Rheumatic Drug (DMARD)

A

Etanercept

Methotrexate

Hydroxychloroquine

Cyclosporine

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20
Q

Spondylarthropathy that is preceded and precipitated by infection in the body
-Urinary Tract Infection, Diarrheal illness, STIs

Incidence 10 per 1,000

Interval of days to weeks between infection and onset of pain

A

Reactive Arthritis

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21
Q

Clinical manifestations 1-4 weeks after infection, include:

  • Peripheral arthritis
  • Enthesitis
  • Dactylitis
  • Lower Back pain
  • Extra articular manifestations (nail changes, conjunctivitis, uveitis, oral lesions
A

Reactive Arthritis

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22
Q

Diagnosis of Reactive Arthritis

A

Exclude other etiologies
-Lyme, Septic joint, RA, Psoriatic arthritis

Test for:

  • Arthrocentesis (joint effusion)
  • Stool cultures (diarrhea)
  • UA and STD panel (GU symptoms)
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23
Q

Treatment for Reactive Arthritis

A

Treat active infection

Self limited symptoms (up to 6 months)

NSAIDs for pain

Refer to specialist in severe cases

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24
Q

Inflammatory arthritis associated with psoriasis

Common inflammatory skin disease

Most common manifestation: well demarcated erythematous plagues with silver scale

1-2 per 1,000

A

Psoriatic Arthritis

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25
Q

Joint stiffness sometimes alleviated by physical activity

SI joint, large joints (knee), small joints (DIP)

Pain may precede lesions

Soft tissue inflammation: Enthesitis, dactylitis, tenosynovitis

Nail Lesions

Ocular involvement

A

Psoriatic Arthritis

26
Q

Diagnosis and Treatment for Psoriatic Arthritis

A

Made clinically in a patient who has both psoriasis and classic arthritis

Refer to rheumatology and dermatology

NSAIDs

DMARDs

27
Q

Inflammatory arthritis of the spine

More common in men

Back pain in almost all patients

A

Ankylosing spondylitis

28
Q

Back pain. “Bamboo spine”: Severe restriction in back mobility seen in about half of patients in later stages.

Large joints involved: Sacroiliac joint, spine, hip shoulder
-Peripheral arthritis common, chest wall inflammation, enthesitis, dactylitis

A

Ankylosing spondylitis

29
Q

Treatment for Ankylosing spondylitis

A

Recognize and refer

NSAIDs

DMARDs after rheumatology referral

Minimize damage to spine and other manifestages

Psychological screening and surveillance

30
Q

Monosodium urate crystal deposition in joints and tissues (tophi)
-Uric acid deposition

Most patients have hyperuricemia

Monoarticular 80% of the time

Common sites:
-1st toe, ankle, knee, wrist, fingers, elbow

Intense pain, redness, swelling

Occurs in hours to days

A

Gout

31
Q

Swelling, erythema, tophi

Severe tenderness even to light touch

ROM: Limited and guarded

1st toe, ankle, knee, wrist, fingers, elbow

A

Gout

32
Q

Lab tests for Gout

A

Uric acid

Chem panel

TSH, Iron panel

WBC

33
Q

Rads for Gout, look for:

A

Erosion and peripheral spurs; soft tissue swelling

34
Q

Treatment for acute episode of Gout

A

NSAID (Indomethacin)

Colchicine (N/V/D, bone marrow suppression, neuropathy

Steroids

35
Q

Prophylaxis of Gout

A

Allopurinol (overproducers)

Probenecid (underexcreters; UA <600mg/day)

36
Q

Diet modification for Gout

A

Avoid: Meat, seafood, alcohol, high-fructose corn syrup

37
Q

Referral consideration for a Gout patient if:

A

Joint deformity or destruction

Large tophaceous masses

Metabolic problems

All patients should see MO for consideration of prophylaxis

38
Q

Similar clinical presentation to gout

  • Intensely painful, joint swelling, erythema
  • Large joints such as the knee often affect

URIC ACID levels are NORMAL

Pathophysiology is based on calcium pyrophosphate deposition (CPPD)

A

Pseudogout

39
Q

Pseudogout is differentiated from gout by lab, which show:

A

Analysis of joint aspiration reveals rhomboid shaped crystals

40
Q

Treatment for Pseudogout

A

NSAIDs

-No preventive treatment

41
Q

Infection of the joint space
-Direct inoculation, hematogenous spread, or from a bone infection

Staph aureus is the most common cause
Severe, pain, swelling, decreased mobility

Difficulty bearing weight

Fever, tachycardia

-Post surgical patients, history of STI

A

Septic Arthritis

42
Q

Erythema, effusion, discharge, skin changes, wound

Warm and tender to touch

Restricted passive ROM, Guarded active ROM

A

Septic Arthritis

43
Q

Diagnostic tests for Septic Arthritis

A

CBC, ESR, CRP

Joint fluid aspirate (Gram stain, Culture, Crystal Analysis)

Plain films

MRI

44
Q

Treatment for Septic Arthritis

A

Supportive if having shock (IV, monitors, O2, VS, Bolus of IVF)

IV Antibiotics (Ceftriaxone, Vancomycin)

MEDEVAC

45
Q

Venous clot formation, often in lower extremities

Virchow’s Triad:
-Hypercoagulability, Venous stasis, Endothelial Damage

A

Deep Vein Thrombosis

46
Q

Risk factors for Deep Vein Thrombosis

A

MSK Surgery

Polytrauma

Spinal cord injuries

History of blood clots

Immobilization

Cancer history

Certain genetic conditions predisposing for clots

Estrogen use

Smoking

Diabetes

Obesity

Age

47
Q

Venous thrombosis will become a ________ in most cases

A

Pulmonary embolism

48
Q

Used as a clinical assessment to evaluate risk of PE

A

Wells Criteria

49
Q

Pain in the limb, edema, erythema

Palpable veins, fever

Homans sign

A

PE

50
Q

Disruption in the bone from repetitive or forceful trauma

Severe pain, swelling, decreased mobility

Limited weight bearing

Numbness, tingling, pallor, ecchymosis, deformity

Tenderness, crepitus, palpable deformity

ROM: Limited or Guarded

A

Fracture

51
Q

Fracture

In anatomic alignment

A

Non-displaced

52
Q

Fracture

Not in anatomic alignment; described as a percentage

A

Displaced

53
Q

Fracture

Distal fragment overlaps proximal fragment

A

Bayonetted

54
Q

Fracture

Fragments are separated

A

Distracted

55
Q

Fracture

Deviation at an angle

A

Angulation

56
Q

Diagnostic tests for a Fracture

A 
Plain films (AP, Lat, Oblique) above and below joint
-Repeat if suspicion is high but image is normal

Consider CT, MRI, U/S, or Bone Scan

57
Q

Adverse outcomes of a fracture

A

Delayed union

Nonunion

Malunion

Joint contractures

Osteonecrosis

Osteomyelitis or infection

Neurovascular injury

Compartment syndrome

58
Q

Treatment for Fracture revolves around what four R’s?

A

Recognition

Reduction

Retention of reduction while achieving union

Rehabilitation

59
Q

Fracture

Factors that increase healing

A

Skeletal immaturity

Transverse fractures

Presence of adjacent bone for support

Anatomic alignment

60
Q

Fracture

Factors that decrease healing

A

Smoking

Skeletal maturity

Oblique/Comminuted/Segmental Fractures

Marked displacement

Intraarticular fracture

61
Q

Spondylarthropathy that is preceded and precipitated by infection in the body
-Urinary Tract Infection, Diarrheal illness, STIs

Incidence 10 per 1,000

Interval of days to weeks between infection and onset of pain

A

Reactive Arthritis

MSK (14 decks)

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