Chapter 22, module 6; LE Limb Pain Flashcards
1
Q
Repetitive trauma activities;pain with movement
A
Tenosynovitis (tendinitis)
2
Q
Swelling over tendon, crepitus
A
Tenosynovitis (tendinitis)
3
Q
DIAGNOSTIC STUDIES FOR Tenosynovitis (tendinitis)?
A
None
4
Q
History of overuse; aching pain over affected bursae that radiates along limb
A
Bursitis
5
Q
Local tenderness, swelling; limited joint motion; muscle weakness
A
Bursitis
6
Q
DIAGNOSTIC STUDIES FOR Bursitis?
A
None
7
Q
Presentation depends on age, location of infection; history of infection, trauma, penetration, invasive procedure; refusal to bear weight (hip); constant pain
A
Osteomyelitis
8
Q
Fever, chills, vomiting; pain localized over affected area but progressively worsens; soft tissue injury or abscess
A
Osteomyelitis
9
Q
DIAGNOSTIC STUDIES FOR Osteomyelitis?
A
Increased WBCs, ESR, C-reactive protein; radiographs
10
Q
Older adults; asymmetrical joint pain and stiffness that improves throughout day; history of repetitive joint trauma; obesity
A
Osteoarthritis
11
Q
DIP, PIP joints enlarged; Heberden nodes; limited cervical spine ROM
A
Osteoarthritis
12
Q
DIAGNOSTIC STUDIES FOR Osteoarthritis?
A
ESR; radiograph may reveal osteophytes, loss of joint space
13
Q
Morning stiffness of small joints; symmetrical involvement; anorexia, weight loss
A
Rheumatoid arthritis
14
Q
Fever, rheumatoid nodules, ulnar deviation of wrists
A
Rheumatoid arthritis
15
Q
DIAGNOSTIC STUDIES FOR Rheumatoid arthritis?
A
Increased ESR, positive rheumatoid factor, anemia on CBC; radiograph shows bony erosion
16
Q
Fatigue, weight loss, failure to thrive, refusal to walk, joint pain and stiffness
A
Juvenile rheumatoid arthritis
17
Q
Fever, rash, guarding of joints, limited ROM; joint swelling, nodules
A
Juvenile rheumatoid arthritis
18
Q
DIAGNOSTIC STUDIES FOR Juvenile rheumatoid arthritis?
A
Elevated WBCs, ESR; positive rheumatoid factor and antinuclear antibody
19
Q
History of systemic infection, malaise, diaphoresis, refusal to bear weight (hip), acute joint pain
A
Septic arthritis
20
Q
Fever; red, swollen joint; limited range of motion
A
Septic arthritis
21
Q
DIAGNOSTIC STUDIES FOR Septic arthritis?
A
WBCs, culture of joint aspirate, ESR, C-reactive protein, ultrasound of joint
22
Q
Acute pain of large joint, asymmetrical; males over 30 yr, history of gout
A
Gout
23
Q
Inflamed, swollen joint; tophi; sodium urate crystals
A
Gout
24
Q
DIAGNOSTIC STUDIES FOR Gout?
A
Increased serum uric acid level, ESR, WBCs
25
Older adults; asymmetrical joint pain and stiffness that improves throughout day; history of repetitive joint trauma; obesity
Osteoarthritis
26
DIP, PIP joints enlarged; Heberden nodes; limited cervical spine ROM
Osteoarthritis
27
DIAGNOSTIC STUDIES FOR Osteoarthritis?
ESR; radiograph may reveal osteophytes, loss of joint space
28
Morning stiffness of small joints; symmetrical involvement; anorexia, weight loss
Rheumatoid arthritis
29
Fever, rheumatoid nodules, ulnar deviation of wrists
Rheumatoid arthritis
30
DIAGNOSTIC STUDIES FOR Rheumatoid arthritis?
Increased ESR, positive rheumatoid factor, anemia on CBC; radiograph shows bony erosion
31
Fatigue, weight loss, failure to thrive, refusal to walk, joint pain and stiffness
Juvenile rheumatoid arthritis
32
Fever, rash, guarding of joints, limited ROM; joint swelling, nodules
Juvenile rheumatoid arthritis
33
DIAGNOSTIC STUDIES FOR Juvenile rheumatoid arthritis?
Elevated WBCs, ESR; positive rheumatoid factor and antinuclear antibody
34
History of systemic infection, malaise, diaphoresis, refusal to bear weight (hip), acute joint pain
Septic arthritis
35
Fever; red, swollen joint; limited range of motion
Septic arthritis
36
DIAGNOSTIC STUDIES FOR Septic arthritis?
WBCs, culture of joint aspirate, ESR, C-reactive protein, ultrasound of joint
37
Acute pain of large joint, asymmetrical; males over 30 yr, history of gout
Gout
38
Inflamed, swollen joint; tophi; sodium urate crystals
Gout
39
DIAGNOSTIC STUDIES FOR Gout?
Increased serum uric acid level, ESR, WBCs
40
Children: During rapid growth spurts; knee pain worse with activity
Slipped capital femoral epiphysis
41
Limitation of medial hip rotation, limp
Slipped capital femoral epiphysis
42
DIAGNOSTIC STUDIES FOR Slipped capital femoral epiphysis?
Radiograph of epiphyseal plate
43
Children less than 10 yr; history of upper respiratory tract infection; limp, pain in anteromedial thigh and knee
Transient synovitis of hip
44
Tenderness on palpation over anterior hip; hip movement increases pain and is limited; low-grade fever
Transient synovitis of hip
45
DIAGNOSTIC STUDIES FOR Transient synovitis of hip?
Ultrasound, ESR
46
Boys age 3-11 yr; groin or medial thigh pain, limp
Legg-Calve-Perthes disease (LCPD)
47
Decreased hip ROM
Legg-Calve-Perthes disease (LCPD)
48
DIAGNOSTIC STUDIES FOR Legg-Calve-Perthes disease (LCPD)
AP and frog lateral radiographs of hip; LCPD may show increased density of femoral head
49
History of repetitive flexion of hip; pain worse with movement
Iliopsoas tendinitis
50
With patient sitting, place heel of affected leg on knee of other; test is positive if pain is elicited
Iliopsoas tendinitis
51
DIAGNOSTIC STUDIES FOR Iliopsoas tendinitis?
None
52
History of direct trauma to the fibula or ankle
Proximal fibular fracture
53
Pain on weight bearing, edema and tenderness to palpation over fracture
Proximal fibular fracture
54
DIAGNOSTIC STUDIES FOR Proximal fibular fracture?
Radiography, CT if soft tissue injury is suspected
55
Younger age, history of overuse of lower extremities
Stress fracture
56
Pain with activity
Stress fracture
57
DIAGNOSTIC STUDIES FOR Stress fracture?
Radiography, MRI
58
Adolescent females; history of knee trauma or misalignment, knee pain worse with activity
Chondromalacia patellae
59
Tenderness to palpation over knee
Chondromalacia patellae
60
DIAGNOSTIC STUDIES FOR Chondromalacia patellae?
Four-view radiographs of knees to rule out arthritis
61
History of overuse, especially running or jumping; dull, achy knee pain; click
Patellar tendinitis
62
Q angle >10 degrees in males, 15 degrees in females; clicking or popping with knee movement
Patellar tendinitis
63
DIAGNOSTIC STUDIES FOR Patellar tendinitis?
None
64
History of valgus stress to knee; limp; pain
Medial collateral liga¬ ment sprain
65
Effusion and point tenderness over knee; valgus and varus pressure to assess instability
Medial collateral liga¬ ment sprain
66
DIAGNOSTIC STUDIES FOR Medial collateral ligament sprain?
AP and lateral radiographs may reveal a ligament avulsion of femoral origin
67
History of twisting injury to the knee, pain, difficulty flexing, bearing weight, clicking or catching of knee with movement
Medial meniscus tear
68
Positive McMurray test, click¬ ing or locking during joint movement
Medial meniscus tear
69
DIAGNOSTIC STUDIES FOR Medial meniscus tear?
Four-knee view radio¬ graphs to rule out bony abnormality; MRI
70
History of twisting or extension knee injury; audible “pop”
Anterior cruciate ligament tear
71
Swelling; positive Lachman test
Anterior cruciate ligament tear
72
DIAGNOSTIC STUDIES FOR
| Anterior cruciate ligament tear?
Radiograph to rule out fracture; MRI
73
Adolescent males; knee pain and swelling aggravated by activity, limp
Osgood-Schlatter disease
74
Tenderness, warmth, swelling over anterior tibial tubercle
Osgood-Schlatter disease
75
DIAGNOSTIC STUDIES FOR Osgood-Schlatter disease?
Radiograph with knee rotated inward may show soft tissue swelling
76
Fullness or swelling of posterior knee, aggravated by walking
Baker cyst
77
Negative Foucher sign; normal joint examination; positive Homans sign in ruptured cyst
Baker cyst
78
DIAGNOSTIC STUDIES FOR Baker cyst?
none
79
History of inversion stress with audible “pop,” immediate swelling
Ankle sprain
80
Swelling, soft tissue trauma, able to perform active ROM with ligament sprain
Ankle sprain
81
DIAGNOSTIC STUDIES FOR Ankle sprain?
Radiograph needed only with tenderness over the lateral malleolus to rule out fracture
82
Ache or pain over medial tibia that is worse with exercise, history of running
Shin splints
83
Tenderness over medial tibia
Shin splints
84
DIAGNOSTIC STUDIES FOR Shin splints?
AP and lateral radiographs may show a stress fracture; a bone scan will be positive with increased uptake along the medial tibia
85
Pain and tightness over Achilles tendon, especially with walking or running
Achilles tendinitis
86
Tenderness over Achilles tendon; pain worse with dorsiflexion ankle; calf weakness
Achilles tendinitis
87
DIAGNOSTIC STUDIES FOR Achilles tendinitis?
Lateral ankle radiograph reveals enlarged posterosuperior tuberosity of the calcaneus
88
History of chronic weight bearing; aching feet, muscle spasms, obesity
Plantar fasciitis
89
Misalignment of foot structures, especially talus, calcaneus, and plantar ligaments
Plantar fasciitis
90
DIAGNOSTIC STUDIES FOR Plantar fasciitis?
None
91
History of upper respiratory tract infection; malaise, chills, cold symptoms, general muscle aches
Viral infections
92
Fever, ill-appearing adult or child
Viral infections
93
DIAGNOSTIC STUDIES FOR Viral infections?
Viral serum titer
94
Pain is diffuse; varies in pattern of activity, setting; history of depression or anxiety
Psychogenic
95
Normal examination or patient response to examination maneuvers disproportionate to physical findings or subjective complaints
Psychogenic
96
DIAGNOSTIC STUDIES FOR Psychogenic?
none
97
Female 20-50 yr; history of depression, sleep disturbance, chronic fatigue, general muscle and joint aches
Fibromyalgia
98
Palpation of trigger points will produce pain; normal physical examination
Fibromyalgia
99
DIAGNOSTIC STUDIES FOR Fibromyalgia?
none
100
Hip pain in children, refusal to walk
Acute leukemia
101
Fever, hepatosplenomegaly, bruising
Acute leukemia
102
DIAGNOSTIC STUDIES FOR Acute leukemia?
CBC
103
African American, family history; appears after 6 mo of age; acute pain with swelling of hands and feet, abdominal pain, decreased appetite, malaise
Sickle cell disease
104
Normal examination
Sickle cell disease
105
DIAGNOSTIC STUDIES FOR Sickle cell disease?
Hemoglobin S genotype
106
Female; transient arthritis of small joints, malar rash
Systemic lupus erythmatosus
107
Normal examination may have joint tenderness on palpation
Systemic lupus erythematosus
108
DIAGNOSTIC STUDIES FOR Systemic lupus erythematosus?
Kidney function tests, antinuclear antibody, CBC
109
History of exposure to endemic areas of deer tick; chills, diffuse joint pain and swelling; often knee is affected
Lyme arthritis
110
Asymmetrical swelling, warmth of joint; erythema migrans; may have myocardial involvement
Lyme arthritis
111
DIAGNOSTIC STUDIES FOR Lyme arthritis?
Serum IgM and IgG antibodies, ESR
112
Under age 5 yr; pain in bones
Neuroblastoma
113
Unexplained fever
Neuroblastoma
114
DIAGNOSTIC STUDIES FOR Neuroblastoma?
Urine for vanillylmandelic or homovanillic acid; CT scan
115
Age 10-25 yr; intermittent pain of lower femur, upper tibia; limp
Osteogenic sarcoma
116
Tenderness over affected area
Osteogenic sarcoma
117
DIAGNOSTIC STUDIES FOR Osteogenic sarcoma?
Radiograph, serum alkaline phosphatase
118
History of pressure to knee from a cast, sports injury, or trauma; pain over head of fibula; clumsy gait
Peroneal compression
119
Unilateral footdrop
Peroneal compression
120
DIAGNOSTIC STUDIES FOR Peroneal compression?
none
121
Pain in ankle and proximal foot; weakness of toe flexors; ill-fitting shoes
Tarsal tunnel syndrome
122
Tapping posterior tibial nerve elicits pain
Tarsal tunnel syndrome
123
DIAGNOSTIC STUDIES FOR Tarsal tunnel syndrome?
none
124
Pain and sensory loss, usually of lower extremities; history of alcohol ingestion, diabetes mellitus
Neuritis
125
Decreased sensory and pain sensation
Neuritis
126
DIAGNOSTIC STUDIES FOR Neuritis?
Liver function tests, hemoglobin A1C to rule out diabetes mellitus
