deck 8 Flashcards
USPSTF aspirin primary prevention recommendation
Low-dose recommended for individuals 50-59 who have a 10% or greater 10 year CVD risk + are not at increased risk for bleeding + life expectancy of 10 years.
Interpreting PPD
1) 5 or more induration positive in HIV, recent contact w/ TB, imaging evidence of prior TB, organ transplant, immunosuppressed for other reason
2) 10 or more positive if recent immigrant from high prevalence country, injection drug use, employee of high risk setting, lab personnel, children under 4, exposed to adults in high-risk categories
3) 15 or more for normal people
rapid effusion post knee injury suggests…
ACL or tibial fracture
indications for arthrocentesis
1) unexplained mono arthritis
2) suspected infection
3) unexplained effusion
4) suspected crystal-induced arthritis
5) suspected hemarthrosis
6) symptomatic relief from large painful effusion
most common cause of knee pain in people younger than 45
patellofemoral syndrome
patellofemoral syndrome presentation
1) peripatellar pain
2) exacerbated by overuse
confirming patellofemoral syndrome
compress patella against femur and move it up and down along groove, reproducing pain or crepitation
patellofemoral syndrome treatment
NSAIDS
minimize high-impact activity
pre patellar bursitis presentation
1) anterior knee pain
2) swelling anterior to the patella
Ottawa knee rules for obtaining knee radiograph
Get film if 1 or more is satisfied…
1) Age >55 years
2) isolated tenderness of the patella
3) tenderness at the head of the fibula
4) inability to flex knee to 90 degrees
5) inability to bear weight immediately after injury or in the ED
MOA of ACL injury
twisting resulting in valgus stress
hyperextension
MOA of PCL injury
trauma to flexed knee
arthroscopic surgery for non-OA related knee pain?
Not been shown to improve outcomes as compared with medicine + physical therapy
rotator cuff tendonitis presentation
- Lateral shoulder pain aggravated by reaching, raising the arm overhead, or lying on the side.
- Subacromial pain to palpation and with passive/resisted abduction.
rotator cuff tear presentation
- Shouldr weakness, loss of function, tendonitis symptoms, and nocturnal pain.
- similar to tendonitis exam + weakness with abduction and external rotation
- positive drop arm test
Exam finding specific for rotator cuff tear
- Inability to lower the affected arm smoothly
bicipital tendonitis/rupture presentation
Anterior shoulder pain with lifting, overhead reaching, and flexion; reduced pain after rupture. Bicipital groove tenderness and pain with resisted elbow flexion.
Adhesive capsulitis
Progressive decrease in range of motion, more from stiffness than from pain.
Loss of external rotation and abduction (unable to scratch lower back or fully lift arm straight overhead)
AC syndromers
- anterior shoulder pain and deformity, usually from trauma or overuse.
- localized joint tenderness and deformity (osteophytes, separation); pain with adduction.
Glenohumeral arthritis
- gradual onset of anterior pain and stiffness.
- anterior joint-line tenderness, decreased range of motion, and crepitation
shoulder asymmetry suggests
dislocation
radiography for shoulder pain?
limited usefulness. primary indication is rotator cuff tear (MRI)
initial management of shoulder tenditis or bursitis
- 2-week trial of an NSAID + rest
- if no improvement with 4-6 weeks, PT, subacrominal glucocorticoid injection or (rarely) surgery
- no response to conservative therapy in 6-12 weeks, then consultation with rheumatologist or orthopedist
other exam findings in asthma
- chest hyper expansion, prolonged expiratory phase, nasal mucosal thickening, nasal polyps, rhinitis manifested by cobblestoning of the oropharynx
