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CLASS 22010 MSK > CLINICAL CARE OF THE MUSCULOSKELETAL SYSTEM > Flashcards

CLINICAL CARE OF THE MUSCULOSKELETAL SYSTEM Flashcards

1
Q

What is a major cause of chest pain in the ambulatory setting that is said to be reproducible?

A

Costochondritis

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2
Q

In what are you able to exacerbate the chest pain with palpation on physical exam and is likely secondary to a viral illness and other causes of inflammation?

A

Costochondritis

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3
Q

True or False

Costochondritis

Rheumatic diseases such as fibromyalgia a common cause of chest wall pain

A

True

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4
Q

Most cases of costochondritis improve over the course of a few weeks with additional treatments such as what?

A
  1. NSAIDS
  2. Home stretching program
  3. Activity modification

*refer all patients in which the diagnosis is unclear

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5
Q

It is estimated that what affects an estimated 30 million people in the US?

A

Osteoarthritis

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6
Q

Osteoarthritis

Knee joint accounts for approximately ___% of cases

A

80%

also affects:
Hand
Spine
Hip

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7
Q

Is age an important risk factor in osteoarthritis?

A

Yes, more common in older population

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8
Q

In general what age group will see osteoarthritis?

A

Over 50

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9
Q

True or False

Females are at greater risk for osteoarthritis than males

A

True

1.7 times more likely

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10
Q

Other risk factors for osteoarthritis include what?

A
  1. Family history
  2. Joint injuries
  3. Chronic inflammation
  4. Obesity
  5. Occupation
  6. Heavy workload
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11
Q

True or False

Osteoarthritis can be due to the destruction of the joint cartilage due to “wear and tear”

A

True

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12
Q

The following are symptoms associated with what?

  1. Pain that is exacerbated with use, alleviated with rest
  2. Pain is aching, deep in later stages
  3. Sharp pain at beginning stages
A

Osteoarthritis

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13
Q

What will you see on plain films in a patient with osteoarthritis?

A
  1. Joint space narrowing
  2. Osteophytes
  3. Subchondral sclerosis
  4. Cysts
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14
Q

What is the treatment for osteoarthritis?

A
  1. Control pain
    a. NSAIDS
    b. Tylenol
  2. Stop insult to cartilage
    a. activity/lifestyle mod
    b. weight reduction
  3. Rehab
    a. aerobic and strengthening exercises
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15
Q

A loss of ___% in body weight is associated with a 50% reduction in pain associated with osteoarthritis over ___ months

A
  1. 10%

2. 18 Months

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16
Q

These are some common examples of what?

  1. Rheumatoid arthritis
  2. Reactive arthritis
  3. Psoriatic arthritis
  4. Ankylosing spondylitis
A

Inflammatory Arthroses

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17
Q

What is an autoimmune disorder of unknown etiology that mostly affects small joints bilaterally?

Hands, fingers, wrists, feet, ankles

A

Rheumatoid arthritis

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18
Q

What inflammatory arthroses has an insidious onset with the distal joints? (DIPJ of the hands are spared)

A

Rheumatoid arthritis

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19
Q

The following may be symptoms of what inflammatory arthroses?

  1. Morning stiffness (1 hour for 6 weeks)
  2. Arthritis (>/= 3 joints for 6 weeks)
  3. Swelling of hand joints (6 weeks)
  4. Symmetrical joint swelling (6 weeks)
  5. Rheumatoid nodules
  6. Positive RE factor
  7. Hand X-ray shows erosions or osteopenia
A

Rheumatoid arthritis

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20
Q

Patients with the following findings on physical exam may have what?

  1. Elbow nodules
  2. Swelling/hypertrophy (especially in PIP early sign)
  3. Swan neck deformity
  4. Lateral drift of the toes
A

Rheumatoid arthritis

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21
Q

What lab tests should be ordered for a patient with possible rheumatoid arthritis?

A
  1. RF
  2. Anti-CCP
  3. CRP
  4. ESR
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22
Q

True or False

Rheumatoid arthritis

Plain films may show osteopenia and mild soft tissue swelling along with erosions

A

True

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23
Q

What is the treatment for RA?

A
  1. MEDADVICE with MO or refer to internal medicine
  2. NSAIDS/Tylenol
  3. DMARD (disease-modifying anti-rheumatic drug)
  4. PT/Surgery
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24
Q

What is a spondylarthopathy that is preceded and precipitated by infection in the body such as:

  1. UTI
  2. Diarrheal illness
  3. STIs
A

Reactive arthritis

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25
Q

True or False

The incidence of reactive arthritis is estimated around 10 per 1,000 people

A

True

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26
Q

The acute onset of joint pain with reactive arthritis is usually ____ to ____ weeks after infection

A

1 to 4 weeks

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27
Q

A patient presents with peripheral arthritis in his knees and enthesitis (inflammation of the insertion sites of ligaments, tendons, and fascia), dactylitis, and lower back pain. He mentions a recent diarrheal illness 2 weeks ago. What is the most likely diagnosis?

A

Reactive arthritis

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28
Q

True or False

You need to exclude other etiologies for joint paint for a patient with possible reactive arthritis

A

True

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29
Q

What are some differential diagnosis for reactive arthritis?

A
  1. Lyme disease
  2. Septic joint
  3. RA
  4. Psoriatic arthritis
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30
Q

What is the treatment for Reactive Arthritis?

A
  1. Treat infection if active
  2. Usually self-limited
    a. may last up to 6 months
  3. NSAIDS
  4. Severe cases
    a. Refer to specialist
    b. DMARDS/steroid considered
31
Q

What is the inflammatory arthritis that is associated with psoriasis ?

A

Psoriatic arthritis

32
Q

This is the most common manifestation of what inflammatory arthritis?

Well demarcated erythematous plaques with silver scales

A

Psoriatic arthritis

33
Q

True or False

Psoriatic arthritis affects men more than women

A

False

Affects both genders equally

34
Q

Can the stiffness associated with psoriatic arthritis be sometimes alleviated with physical activity?

A

Yes

35
Q

True or False

There is usually an asymmetric distribution of joint pain in psoriatic arthritis

A

True

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

36
Q

Does pain usually precede lesions in psoriatic arthritis?

A

Yes

37
Q

True or False

The diagnosis for psoriatic arthritis does not require diagnostic testing, but is rather a diagnosis based on a patient presenting with both psoriasis and a classic arthritis pattern

A

True

38
Q

Should the IDC attempt to manage a patient with Psoriatic arthritis?

A

No, refer to rheumatology and dermatology

  1. Treat symptoms in the interim
  2. NSAIDS
  3. DMARDS to be considered by specialist
39
Q

What is known as inflammatory arthritis of the spine?

A

Ankylosing Spondylitis

40
Q

Who is ankylosing spondylitis more common in?

A

Men

41
Q

The estimated prevalence of ankylosing spondylitis in North America is ____ per 10,000

A

31.9

42
Q

What are some periarticular features of ankylosing spondylitis?

A
  1. Uveitis
  2. Psoriasis
  3. IBD
43
Q

“Bamboo spine”, a severe restriction in back mobility is seen in about half of patients in later stages of what disease progression?

A

Ankylosing spondylitis

44
Q

These are all large joints and symptoms associated with what inflammatory arthritis?

  1. Sacroiliac joint, spine, hip, shoulder
  2. Peripheral arthritis is common
  3. Chest wall inflammation
  4. Enthesitis
  5. Dactylitis
A

Ankylosing spondylitis

45
Q

What is it called when there is a monosodium urate crystal deposition in the joints and tissues?

A

Gout

46
Q

True or False

Most patients with gout have hyperuricemia (elevated uric acid) but not all with hyperuricemia develop gout

A

True

47
Q

Gout is mostly monoarticular in about what percentage of the time?

A

80%

48
Q

What are the common sites of involvement with gout?

A
  1. Big toe
  2. Ankle
  3. Knee
  4. Wrist
  5. Fingers
  6. Elbow
49
Q

Will patients with gout usually have intense pain, redness, and swelling around the affected joint?

A

Yes

50
Q

What labs should be run for a patient with gout?

A
  1. Uric acid
  2. Chem panel
  3. TSH
  4. Iron panel
  5. WBC
51
Q

What will the uric acid crystals look like under a microscope?

A

Needle shaped

52
Q

What is the treatment for an acute episode of gout?

A
  1. NSAIDS (indomethacin)
  2. Colchicine
  3. Steroids
53
Q

What is the prophylaxis for gout?

A
  1. Allopurinol (overproducers)

2. Probenecid (under excreters)

54
Q

Patients with gout should avoid what kinds of food?

A
  1. Meat
  2. Seafood
  3. Alcohol
  4. High fructose corn syrup
55
Q

True or False

All patients with gout should see the MO for consideration of prophylaxis

A

True

56
Q

What has clinical presentation similar to gout but affects more large joints such as the knee?

A

Pseudogout

57
Q

Patients with what have normal uric acid levels and symptoms similar to gout?

A

Pseudogout

58
Q

The pathophysiology of Pseudogout is base on what?

A

Calcium pyrophosphate deposition (CPPD)

59
Q

What is known as an infection of the joint space?

A

Septic Arthritis

60
Q

The following can be causes of what?

  1. Direct inoculation (wound)
  2. Hematogenous spread
  3. Bone infection
A

Septic arthritis

61
Q

What is the most common bacteria that causes septic arthritis?

A

Staph

62
Q

The following symptoms may be associated with what?

  1. Severe pain, swelling, decreased mobility in affected joint
  2. Difficulty bearing weight
  3. Fever, tachycardia
  4. Post-surgical patients
  5. Previous STI
A

Septic arthritis

63
Q

What are some lab tests that need to be ran for a patient with possible septic arthritis ?

A
  1. CBC, ESR, CRP
  2. Joint Fluid Aspirate
    a. Gram stain
    b. culture
    c. crystal analysis
  3. Plain films
  4. MRI
64
Q

What is the treatment for septic arthritis?

A
  1. Supportive care if in shock
  2. IV antibiotics (vancomycin, ceftriaxone)
  3. MEDEVAC
65
Q

What is the disruption in the bone from repetitive or forceful trauma?

A

Fracture

66
Q

True or False

Fractures are classified by location, orientation, extent of fracture line, displacement, and skin integrity

A

True

67
Q

What kind of fracture displacement is when the bone is in anatomic alignment?

A

Non-displaced

68
Q

What kind of fracture displacement is when the bone is not in anatomic alignment?

A

Displaced

69
Q

What kind of fracture displacement is when the distal fragments of the bone overlaps the proximal fragment?

A

Bayonetted

70
Q

What kind of fracture displacement is when the bone fragments are separated?

A

Distracted

71
Q

What kind of fracture displacement is when the deviation of the bone is at an angle?

A

Angulation

72
Q

Treatment for fractures is based on the Four R’s, what are they?

A
  1. Recognition
  2. Reduction
  3. Retention of reduction while achieving union
  4. Rehab
73
Q

What are some factors that increase the healing of fractures?

A
  1. Skeletal immaturity
  2. Transverse fractures
  3. Presence of adjacent bone for support
  4. Anatomic alignment
74
Q

What are some factors that can decrease the healing of fractures?

A
  1. Smoking
  2. Skeletal maturity (old)
  3. Oblique/comminuted/segmental fractures
  4. Marked displacement
  5. Intraarticular fracture

CLASS 22010 MSK (12 decks)

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