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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
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
Psoriatic Arthritis
26
Diagnosis and Treatment for Psoriatic Arthritis
Made clinically in a patient who has both psoriasis and classic arthritis Refer to rheumatology and dermatology NSAIDs DMARDs
27
Inflammatory arthritis of the spine More common in men Back pain in almost all patients
Ankylosing spondylitis
28
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
Ankylosing spondylitis
29
Treatment for Ankylosing spondylitis
Recognize and refer NSAIDs DMARDs after rheumatology referral Minimize damage to spine and other manifestages Psychological screening and surveillance
30
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
Gout
31
Swelling, erythema, tophi Severe tenderness even to light touch ROM: Limited and guarded 1st toe, ankle, knee, wrist, fingers, elbow
Gout
32
Lab tests for Gout
Uric acid Chem panel TSH, Iron panel WBC
33
Rads for Gout, look for:
Erosion and peripheral spurs; soft tissue swelling
34
Treatment for acute episode of Gout
NSAID (Indomethacin) Colchicine (N/V/D, bone marrow suppression, neuropathy Steroids
35
Prophylaxis of Gout
Allopurinol (overproducers) Probenecid (underexcreters; UA <600mg/day)
36
Diet modification for Gout
Avoid: Meat, seafood, alcohol, high-fructose corn syrup
37
Referral consideration for a Gout patient if:
Joint deformity or destruction Large tophaceous masses Metabolic problems All patients should see MO for consideration of prophylaxis
38
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)
Pseudogout
39
Pseudogout is differentiated from gout by lab, which show:
Analysis of joint aspiration reveals rhomboid shaped crystals
40
Treatment for Pseudogout
NSAIDs -No preventive treatment
41
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
Septic Arthritis
42
Erythema, effusion, discharge, skin changes, wound Warm and tender to touch Restricted passive ROM, Guarded active ROM
Septic Arthritis
43
Diagnostic tests for Septic Arthritis
CBC, ESR, CRP Joint fluid aspirate (Gram stain, Culture, Crystal Analysis) Plain films MRI
44
Treatment for Septic Arthritis
Supportive if having shock (IV, monitors, O2, VS, Bolus of IVF) IV Antibiotics (Ceftriaxone, Vancomycin) MEDEVAC
45
Venous clot formation, often in lower extremities Virchow's Triad: -Hypercoagulability, Venous stasis, Endothelial Damage
Deep Vein Thrombosis
46
Risk factors for Deep Vein Thrombosis
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
Venous thrombosis will become a ________ in most cases
Pulmonary embolism
48
Used as a clinical assessment to evaluate risk of PE
Wells Criteria
49
Pain in the limb, edema, erythema Palpable veins, fever Homans sign
PE
50
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
Fracture
51
Fracture In anatomic alignment
Non-displaced
52
Fracture Not in anatomic alignment; described as a percentage
Displaced
53
Fracture Distal fragment overlaps proximal fragment
Bayonetted
54
Fracture Fragments are separated
Distracted
55
Fracture Deviation at an angle
Angulation
56
Diagnostic tests for a Fracture
``` 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
Adverse outcomes of a fracture
Delayed union Nonunion Malunion Joint contractures Osteonecrosis Osteomyelitis or infection Neurovascular injury Compartment syndrome
58
Treatment for Fracture revolves around what four R's?
Recognition Reduction Retention of reduction while achieving union Rehabilitation
59
Fracture Factors that increase healing
Skeletal immaturity Transverse fractures Presence of adjacent bone for support Anatomic alignment
60
Fracture Factors that decrease healing
Smoking Skeletal maturity Oblique/Comminuted/Segmental Fractures Marked displacement Intraarticular fracture
61
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
Reactive Arthritis

MSK (14 decks)

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