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NMSK-A II > Clinical > Flashcards

Clinical Flashcards

1
Q

What is the major complaint by individuals who have arthritis?

A

joint pain

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2
Q

What is the easiest way to differentiate articular form non-articular joint pain?

A

passive joint motion preserved in non-articular injury without pain

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3
Q

Who is most at risk of infectious arthritis?

A

immunocompromised

[also, diabetes, IV drug use]

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4
Q

What joints are usually affected by infectious arthritis?

A

1) hip
2) knee
3) ankle
4) wrist

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5
Q

What are the components of synovial fluid analysis?

A

1) cell count
2) gram stain
3) culture
4) crystal identification

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6
Q

Which pathology is typical of crystal formation?

A

Gout

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7
Q

Which lab tests suggest gout?

A

1) crystal identification in synovial fluid analysis

2) uric acid level elevated in blood tests

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8
Q

Are heat and swelling more typical of articular or non-articular injuries?

A

articular; joint effusion

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9
Q

What is the gold standard of diagnosing Rheumatoid arthritis?

A

greater than 1 hour of morning stiffness in the affected joints

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10
Q

What are the key signs of osteoarthritis?

A

1) non-inflammatory
2) pain after use
3) improvement after rest
4) no systemic symptoms

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11
Q

What is the most common form of arthritis?

A

osteoarthritis; “wear and tear arthritis”

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12
Q

What are the risk factors of Rheumatoid arthritis?

A

1) age
2) obesity
3) manual labor
4) female
5) trauma

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13
Q

What are bouchard nodes?

A

bony proliferation of proximal IP joints in OA

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14
Q

What are heberden nodes?

A

bony proliferation at distal IP joints in OA

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15
Q

What are the causes of septic arthritis?

A

1) trauma
2) hematogenous spread
3) spread of osteomyelitis

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16
Q

The lump or mass scheme offers us which two ways to begin the investigation?

A

1) Visible or palpable

2) Non-visible, non-palpable (i.e., “occult”)

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17
Q

When you encounter a lump or mass, what is the essential part of the patient’s history?

A

examine old medical records

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18
Q

What is the most common cause of a Virchow’s node of the neck?

A 
GI cancer
breast cancer (women)
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19
Q

What are the types of biopsies?

A

1) brush (cheek)
2) leather punches (skin)
3) cotton brush (tongue)

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20
Q

What should first be done with malignancies of the head and neck, associated with or without adenopathy (“swollen” lymph nodes), sbefore an incisional or excisional lymph node biopsy?

A

panendoscopy (Complete physical examination of the head and neck by pharyngoscopy, laryngoscopy, and upper GI endoscopy “EGD”)

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21
Q

What is the purpose of completing a panendoscopy?

A

Find the primary tumor of a malignancy of the head and neck

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22
Q

What are the major complication of biopsies?

A

1) bleeding
2) infection
3) hematoma
4) bruising
5) poor cosmosis (scarring)

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23
Q

Are imaging and biopsy necessary for a mass or lump on his arm?

A

NO

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24
Q

What is the treatment for an elderly man with a mass or lump on his arm

A

sling, rest, no surgery

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25
Q

What is Prune-Belly Syndrome?

A

congenital disorder aka “Eagle-Barret Syndrome” which shows a triad of symptoms:

1) Partial or complete lack of abdominal muscles (wrinkled skin, abdominal distention)
2) Undescended testes (males)
3) Urinary tract abnormalities

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26
Q

What is an inguinal hernia & treatment?

A

Defect in fascia where piece of intestine slips into inguinal region; best diagnosed by physical examination

treatment: Truss/support or surgical repair

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27
Q

What is an Umbilical Hernia & treatment?

A

looks like an “outie” belly-button from intestines herniating

treatment: mostly surgical, some close by 2 yo

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28
Q

What is an Incisional Hernia & treatment?

A

Fascial defect or weakness from prior operation causes intestines/colon to herniate

treatment: repair with mesh

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29
Q

What is Diastasis Recti & treatment?

A

Presents as a “lump” or “bulge” in the midline of the abdomen; asymptomatic, NO fascial defect

treatment: no repair indicated

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30
Q

What is a Lumbar Hernia?

A

Grynfeltt-Lesshaft Hernia; rare

Grynfeltt-Lesshaft Hernia: superior lumbar triangle
Petit’s Hernia: inferior lumbar triangle

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31
Q

What is a Spigelian Hernia?

A

special type of ventral hernia (hernia on ventral abdomen); occurs at semi-lunar line and lateral to rectus musculaturea umbilicus level or below

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32
Q

What is treatment of a sarcoma?

A

wide surgical excision, radiation, and chemotherapy after diagnosis by MUSCLE BIOPSY

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33
Q

What is the treatment of an osteoma?

A

local excision

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34
Q

What is the treatment of an osteosarcoma?

A

amputation, radiation, chemotherapy

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35
Q

What is a Rectus Sheath Hematoma & treatment?

A

Results from trauma to anterior abdomen and bleeding into rectus muscle (imaging to rule out intra-abdominal injuries with trauma etiology)

treatment: abdominal binder and bed-rest

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36
Q

What can happen with patients on blood thinners in regards to Rectus Sheath Hematomas?

A

bleed spontaneous into rectus sheath or retro-peritoneum (retro-peritoneal hematoma)

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37
Q

What is a Gastrointestinal Stromal Tumor (GIST) & treatment?

A

A tumor of the GI tract derived from mesenchymal tissue surrounding the organs (stomach, intestine, etc.); genetic: c-kit pathway gene

treatment: treat symptoms

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38
Q

What is an Endometriosis of Rectus Muscle & treatment?

A

Pain and Lump in a scar; Mass within an abdominal muscle; Derived from endometrium of uterus [gets worse during menstruation and subdues]

treatment: Hormonal manipulation or surgical excision

39
Q

What is a Leiomyoma & treatment?

A

fibroid tumor; muscular wall of uterus

treatment:

1) Ablation
2) Hysterectomy
3) Embolization
4) Myomectomy
5) Hormonal control

40
Q

What is the treatment for psoas muscle abcess?

A

percutaneous drainage and antibiotics

aspiration will reveal puss

41
Q

What are infectious red flags of acute cervical neck pain?

A

1) fever and chills
2) nights sweats
3) recent bacterial infection
4) unremitting pain despite rest and analgesics
5) night pain
6) IV drug use, immunocompromised

possible infection

42
Q

Why might a person with an infection causing acute neck pain not cause a fever?

A

immunocompromised

43
Q

What are acute neurologic red flags of cervical neck pain?

A

1) bowel or bladder incontinence
2) saddle anasthesia
etc.

**nerve damage

44
Q

What are pathologies which can cause an acute neurologic cervical neck pain?

A

Occipital-Atlantal Dislocation (OAD)
-paresis and apnea of CN VI, X, XII

Herniated Cervical Disc (not very common; usually trauma)

Cervical Radiculopathy and Stenosis
-osteophytes (bone spurs)

45
Q

What are pathologies which can cause an acute musculoskeletal cervical neck pain?

A

somatic dysfunction

  • computer use
  • rigorous workout
  • sleep funny

cervical fracture (trauma)

46
Q

What are pathologies which can cause an acute vascular cervical neck pain?

A

vertebral artery insufficiency

  • check cranial nerve palsies
  • bruit on PE (plaque buildup in vessels)

Whiplash
-ligament destruction

47
Q

What are pathologies which can cause an chronic musculoskeletalcervical neck pain?

A 
Cervical spondylosis (aka "lipping")
Myelopathy

Red Flags:
tenderness and restricted ROM

48
Q

What if thoracic pain doesn’t go away after the fever, chills, night sweats and rest?

A

chronic infectious
bacterial tonsillitis
cervical discitis

49
Q

How can abdominal disease cause thoracic pain?

A

neurologic; organs innervated by nerves

50
Q

If you see these symptoms, what is the likely cause and what should you do? acute thoracic pain and low blood pressure

A

thoracic aortic aneurism rupture; perform bedside echocardiogram

51
Q

What is the most common type of dysfunction which causes back pain?

A

musculoskeletal dysfunction

52
Q

What are the two types of thoracic fractures and how are they diagnosed?

A

compression
burst

pain with motion

53
Q

When a patient is experiencing pain in both the thoracic vertebrae and the ribs, which should be treated first?

A

thoracic vertebrae; ribs are secondary (structurally) to the vertebrae

54
Q

What are red flags of lumbar pain?

A

hx of cancer
nights sweats, fever
weight loss

aka cancer risk factors

also, corticosteroid use

55
Q

What is commonly confused as groin pain?

A

Abdominal Aortic Aneurysm

56
Q

What is Spondylolisthesis?

A

chronic lower back pain; vertebrae is slipping forward due to fracture of spondylolysis between spines of connecting vertebrase

57
Q

What does anisotropic mean?

A

material which has mechanical properties different in different directions; 3 types: rolling, spinning, gliding

58
Q

What is the relationship between glide and roll in joint movement?

A

glide direction is opposite of the roll

59
Q

What is Reiter Syndrome?

A

reactive arthritis

60
Q

What is the classic triad of symptoms of reactive arthritis?

A

arthritis
conjunctivitis
urethritis

61
Q

What is the genetic predisposition for Reither syndrome ankylosing spondylitis, and psoriasis?

A

HLA-B27

62
Q

Which form of arthritis presents as low back pain in male teens and early 20s?

A

ankylosing spondylitis

63
Q

What is psoriasis?

A

skin grows too fast and forms lesions; t-cell mediated disease

64
Q

What are the clear signs of psoriasis?

A

nail discoloration

nail pitting

65
Q

Which ethnic group does inflammatory bowel disease most commonly effect?

A

jewish

66
Q

How is erosive inflammatory osteoarthritis differentiated from rheumatoid arthritis?

A

EIO:
RA serologic markers (-)
ESR and CRP (normal)
swelling of soft tissue

67
Q

What are the common causes of neck pain?

A

postural imbalances

ergonomic factors

68
Q

What are examples of acute infections of the cervical and thoracic vertebrae and what are red flags?

A

1) meningitis
2) osteomyelitis
3) discitis
4) epidural abscess
5) fasciitis

**signs of inflammation

69
Q

What is the main red flag for a deep neck infection?

A

pain out of proportion to physical findings and “advanced airway signs”

70
Q

What are examples of acute neurologic of the cervical vertebrae and what are red flags?

A

occipito-atlanto dislocation
herniated nucleus pulposus
cervical myelopathy

**trauma, bowel/bladder incontinence

71
Q

What is the main clinical presentation of occipito-atlantal dislocation (OAD)?

A

cranio-cervical ligamentous instability

72
Q

What is radiculopathy?

A

nerve root compression at neck with resultant pain, tingling, and numbness

73
Q

What are the common causes of radiculopathy?

A

1) nerural foraminal narowing from cervical arthritis

2) cervical disc lesion

74
Q

What do strenght, sensory, and reflex testing differentiate between?

A

radicular pain
peripheral nerve damage
global deficits

75
Q

How is a neurologic exam typically done for checking nerve deficits?

A

tapping brachioradialis tendon; hypoactive wrist and hyperactive finger flexion = inverted radial reflex (spinal cord compression)

76
Q

What are examples of acute musculoskeletal damage of the cervical vertebrae?

A

whiplash (w/ no neurologic or lab findings)

77
Q

What is the imaging used to view and diagnose whiplash?

A

nothing confirms; X-ray done to rule out bony fracture

78
Q

What are examples of acute vascular damages to the cervical vertebrae?

A

vertebral artery insufficiency

arterial dissection

79
Q

When should individuals be examined for chronic neck pain?

A

1) w/ or w/o hx of remote trauma
2) w/ hx of malignancy
or
3) w/ hx of neck surgery in remote past

80
Q

What are examples of chronic infections of the cervical vertebrae?

A

cervical discitis

81
Q

What are examples of chronic musculoskeletal damages and infections to the cervical vertebrae?

A

spondylosis
cervical myelopathy
cervical radiculopathy

82
Q

What is the most common spinal cord disorder?

A

spondylosis

83
Q

What is the hallmark symptom of cervical spondylotic myelopathy?

A

weakness or stiffness in the legs

84
Q

What does the neurologic exam show for a patient with cervical spondylotic myelopathy?

A

hyperreflexia

85
Q

What are examples of chronic vascular damage to cervical vertebrae?

A

carotidynia

86
Q

What is carotidynia?

A

vascular change occurs in coratid artery of neck with hx of migraines

87
Q

What are examples of acute neurologic of the thoracic vertebrae and what are red flags?

A

1) stomach or duodenal ulcers
2) pancreatitis
3) angina (cardiac)
4) gastro-esophageal disease (GERD)
5) asthma
6) pneumonia

88
Q

Which abdominal diseases cause thoracic pain?

A

1) tumors of stomach or duodenum
2) biliary disease
3) pancreatic disease
4) pyelonephritis

89
Q

What are examples of acute musculoskeletal damages to the thoracic vertebrae?

A

fracture
somatic dysfunction
thoracic strain

90
Q

What is the most relevant finding during the history for a thoracic fracture?

A

moderate to severe pain related to a traumatic event

91
Q

How does a patient present with a thoracic aortic aneurysm?

A

acute pain usually harbinger of rupture
hypotension

**bedside echocardiogram

92
Q

What is osteomyelitis?

A

bone infection which can lead to destruction of tissue

93
Q

What part of a patient’s past medical history suggest that the thoracic spine will be more susceptible to injury?

A

1) osteoporosis

2) steroid use

94
Q

What is “stress posture”?

A

functional thoracic kyphosis

NMSK-A II (10 decks)

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