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Primary Care 2 > Exam 3: Musculoskeletal > Flashcards

Exam 3: Musculoskeletal Flashcards

1
Q

Adduction

A

the movement of a limb or other part toward the midline of the body or toward another part.

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2
Q

abduction

A

the movement of a limb or other part away from the midline of the body, or from another part

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3
Q

Flexion

A

the action of bending or the condition of being bent, especially the bending of a limb or joint.

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4
Q

Extension

A

It occurs when muscles contract and bones move the joint from a bent position to a straight position. It is a posterior movement for joints that move backward or forward, such as the neck

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5
Q

Pronation

A

person shifts their weight from the heel to the forefoot, it is termed pronation

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6
Q

Suppination

A

weight is placed on the outside of the foot while walking or running

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7
Q

3 major bones of ankle

A

Tibia, fibula, talus

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8
Q

Weight bearing bone of ankle

A

Talus

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9
Q

Sprain

A 
Ligament injury (bone to bone)
Occurs due to abnormal rotation such as a sudden change in direction or a misstep on an uneven surface
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10
Q

Clinical presentation of ankle sprain

A

Swollen and painful joint, ecchymosis and decreased ROM. weight bearing causes pain

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11
Q

Immediate swelling or ecchymosis is suspicious for

A

Fracture

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12
Q

Treatment of sprain

A

RICE
Rest, ice, compression elevation
NSAIDs
Passive and active exercises

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13
Q

Achilles tendon

A

Responsible for flexion and extension of the ankle

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14
Q

Clinical presentation of achilles tendinopathy

A

Intermittent symptoms, pain that subsides during exercise but increases while at rest
Can be local at heel or along th elength of tendon
Severe pain climbing stairs
Abnormal gait

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15
Q

Haglund deformity

A

Bony prominence at the heel

Achilles tendinopathy

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16
Q

Gold standard for achilles tendinopathy

A

MRI

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17
Q

Tx of achilles tendinopathy

A

Cessation of sports, tendon rest, NSAIDs, ice massage

May take 8 weeks to heal

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18
Q

Achilles tendon rupture

A

Sudden event; feel like you were shot in the calf; sudden weakness in the ankle and inability to rise up on toes; pain not common

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19
Q

PE of achilles tendon rupture

A

Visible and palpable gap overlying the tendon where the rupture occurred

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20
Q

Thompson test

A

Achilles tendon is in tact if th efoot plantar flexes when the calf is squeezed

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21
Q

Tx of achilles tendon rupture

A

Long leg cast with foot in plantar-flexed position for 6 weeks or surgical repair

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22
Q

Plantar fasciitis

A

Pain in the bottom of the foot and along the arch and in the heel
Due to high impact running/jumping or shoes with inadequate support
Pain with weight bearing first thing in the morning and point tenderness

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23
Q

Morton neuroma

A

Result of perineural fibrosis of the plantar nerve at the point where the medial and lateral branches of the plantar nerve converge
Usually due to high heeled shoes
severe pain and burning in the region of the third web space; barefoot and foot massages relieves discomfort; elevation of foot aggravates

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24
Q

Tx of morton neuroma

A

Wide toe shoes, NSAIDs, separation of toes with pad

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25
Q

Sarcoma

A

Malignant tumor of mesenchymal or neuroectodermal origin

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26
Q

Most common malignant tumor that originates in bone

A

Multiple myeloma

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27
Q

Pain management for bone tumors

A

Biphosphanates

Gabapentin, amitriptyline, benzos

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28
Q

Bursa

A

Sac lined with synovial fluid, which provides lubrication and facilitates smooth movement between tissues of an extremity

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29
Q

Clinical features of bursitis

A

Pain at motion and rest, regional loss of ROM, visible swelling, tenderness to palpation

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30
Q

Shoulder bursitis

A

Anterior/lateral shoulder pain exacerbated by overhead activities
Deep aching interrupts sleep
Tenderness below the acromion

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31
Q

Signs for shoulder bursitis

A

NEER and Hawkins

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32
Q

Olecranon bursitis

A

Elbow
Visible posterior elbow swelling
1/3 cases are septic–antibiotics should cover S Aureus

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33
Q

Ballottement test

A

For knee effusion

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34
Q

Valgus stress

A

Force on medial elbow from throwing or axial compression

Golf

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35
Q

Varus stress

A

Force on lateral elbow

Tennis

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36
Q

Tx of fibromyalgia

A

Amitriptyline, cyclobenzaprine, SSRI, gabapentin, trazadone, zolpidem, lidocaine IM

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37
Q

4 stages of gout

A

Asymptomatic hyperuricemia
Acute gouty flare
Intercritical gout
Chronic tophaceous gout

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38
Q

Most common inflammatory arthritis in adults

A

gout

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39
Q

Predominant cause of hyperuricemia

A

Undersecretion of urate by the kidneys

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40
Q

Definitive dx of gout achieved by

A

Needle aspiration of inflamed joint

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41
Q

Tx of acute gout flare

A

NSAIDs, colchicine, steroids

higher doses of NSAIDs in first 24-48 hours

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42
Q

Urate lowering therapy

A

Start 6-8 weeks after acute flare has resolved
Start at low dose and increase slowly every 4-6 weeks
Allopurinol, prebencid, pegloticase

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43
Q

Tinnel sign

A

For carpal tunnel syndrome

Push down on radial nerve

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44
Q

Phalen test

A

For carpal tunnel syndrome

Back of hands pressed together

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45
Q

What should always be ruled out for hip pain caused by trauma

A

Avascular necrosis

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46
Q

Primary fx of hip

A

locomotion and weight bearing

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47
Q

Leg-Calve-Perthes

A

Avascular necrosis of the femoral head found in 4-8 year old boys

48
Q

Pain at rest in hip indicates

A

inflammatory, infection or neoplasm

49
Q

OA clinical presentation

A

Worsening pain with activity and improvement with rest

Stiffness on first rising and after long eperiods of inactivity

50
Q

2 tests of hip function

A

gait and ROM

51
Q

Most common cause of acute bacterial arthritis

A

Staph aureus

52
Q

Triad of sx in gonococcal arthritis

A

dermatitis, tenosynovitis, migratory polyarthritis

53
Q

Most important dx exam for infectious arthritis

A

Synovial fluid aspiration

54
Q

Tx of infectious arthritis

A

Older children + adults: nafcillin, oxacillin, cefazolin
Elderly/immuno compromised: cefepime
Gonococcal: ceftriaxone IM
MRSA: Vanco

55
Q

Cartilage of knee

A

Meniscus

56
Q

Medial collateral ligament injury

A

Externally rotating wrenching motion of the knee or a blow to the lateral side of the knee with a firmly planted foot
Valgus stress

57
Q

Lateral collateral ligament injury

A

Internal rotation or a blow to the medial side of the knee with a firmly planted foot
Varus stress

58
Q

Anterior cruciate ligament injury

A

Typically injured in sports during rapid deceleration or quickly changing direction
Usually occurs with ruptures of MCL and medial meniscus
Hear a pop or feel snap
Lachman test, anterior drawer test

59
Q

Medial meniscus injury

A

When weight bearing knee is twisted while in flexed position; femur compresses against the tibia and grinds against the meniscus
McMurray test
Activity modification for 6-12 weeks

60
Q

Lumbar spinal stenosis

A

Back pain and neurogenic claudication; feel as though legs are heavy or wooden
Walk with shopping cart helps

61
Q

Cauda equina

A

Saddle anesthesia, urinary retention or incontinence, lower extremity weakness, recent onset ED
Due to compression of multiple lumbosacral nerve roots below the termination of the spinal cord

62
Q

Straight leg test

A

For herniated disk

63
Q

Osteoporosis

A

Increased bone fragility and susceptible to fracture due to decrease in bone mass due to estrogen deficiency and aging
Most common metabolic bone disease
Bone mineral density of 2.5 below mean

64
Q

Bone formation

A

Osteoblasts

65
Q

Most common cause of secondary osteoporosis

A

Steroids

Causes osteoblast death, prolongs life of osteoclast and decreases estrogen levels

66
Q

Indication for DEXA scan

A

women >65, men >70

67
Q

Prevention of osteoporosis

A

Calcium 1000-1200mg, vitamin D 800-1000IU daily, weight bearing exercise, normal body weight, avoid smoking and alcohol

68
Q

Biphosphanates

A

Alendronate, zoledronic acid

Reduce bone resorption and bone loss by binding to bone and poisoning osteoclasts

69
Q

Biphosphanates CI in

A

esophageal dismotility, active GI bleeding, renal disease

70
Q

Denosumab

A

Monoclonal antibody that inhibits RANK ligant and potently reduces bone resorption
Given SC every 6 months
For osteoporosis

71
Q

Calcitonin

A

Decreases osteoclastic activity

72
Q

Paget disease

A

Localized increase in bone turnover and blood flow; osteoclasts increased in number and size; osteoblasts try to keep up but the newly formed bone is disorganized and lacks integrity
Result is mechanically weak, highly vascular bone prone to deformity and fractures

73
Q

Clinical presentation of paget disease

A

Bone pain most common

Painful at rest and motion; deep ache pain and becomes worse with weight bearing and warmed

74
Q

PE in paget disease

A

Affected area tender to touch and warm; may have increased pulsatility and enlarged

75
Q

Dx tests for paget disease

A

serum alkaline phosphatase, urinary n-telopeptide cross links level

76
Q

How to take biphosphanates

A

Empty stomach at least 30 mins before a meal

77
Q

Muscle relaxants

A

Tizanidine, cyclobenzaprine, baclofen

78
Q

Most common pathogen of osteomyelitis

A

staph aureus

79
Q

Rotator cuff consists of attachments of 4 muscles

A

supraspinatus, infraspinatus, teres minor, subscapularis muscles

80
Q

PE for shoulder pain

A

Palpate for any tenderness

Active ROM: forward flexion, extension, external rotation, internal rotation, abduction, adduction

81
Q

Apprehension test

A

abduct to 90 degrees and slowly externally rotate patient’s arm to position where it might dislocate

82
Q

Drop arm test

A

have patient hold arm in fully abducted position, then ask patient to slowly lower arm to side

83
Q

Empty can test

A

hold affected arm as if offering examiner can of soda (abduct to 90 degrees), then have patient turn arm to empty contents

84
Q

Impingement test

A

have patient elevate arm slowly into overhead position

85
Q

Hawkin test

A

forward flex the shoulder and elbow to 90 degrees, apply force to the forearm to internally rotate the shoulder

86
Q

Spurling test

A

have patient flex cervical spine laterally toward the ipsilateral shoulder; apply downward axial force on the head

87
Q

Most commonly injured tendon in rotator cuff tear

A

Supraspinatus tendon

88
Q

Labral tear

A

o Deep shoulder pain with specific shoulder positions, pain during overhead maneuvers

89
Q

Subacromial impingement syndrome

A

Edema, hemorrhage, inflammation and fibrosis occur

90
Q

Grade 1 sprain

A

: involves minimal injury with stretched fibers or a few microscopic tears of a ligament resulting from overstretching; causes pain and edema
Tx: RICE, non-weight bearing activity, return to sports in 2-3 weeks

91
Q

Grade 2 sprain

A

incomplete tear of a ligament and includes some functional impairment, ecchymosis, discomfort or pain with weight bearing
Tx: RICE, partial weight bearing, return to sports in 4-8 weeks

92
Q

Grade 3 sprain

A

full or complete tear of the ligament with loss of ligament integrity
May have swelling, discoloration and pain with movement
Tx: referral to orthopedics, cast for 10-14 days, rehab before returning to sports

93
Q

Strain

A

Overstretching or overuse o muscles and/or tendons (muscle to bone)
No actual muscle damage occurs

94
Q

Most common site for bursitis

A

subacromial (shoulder)

95
Q

CI to aspiration and injection in bursitis

A

cellulitis at the injection site, primary coagulopathy or uncontrolled anticoagulant therapy, septic effusion of a bursa or periarticular structure, more than three previous injections at the same site in the previous 12 months or lack of improvement after two prior injections, suspected bacteremia from another site, unstable joints (for corticosteroid injection), tumors, fractures, joint prosthesis, and inaccessible joints.

96
Q

Primary weight bearing bone of ankle

A

talus

97
Q

Risk factors for osteoporosis

A

alcohol, RA, menopause

98
Q

Typical sites of fracture in osteoporosis

A

vertebrae, distal wrist, proximal femur, ribs

99
Q

If osteoporosis is present in premenopausal or men

A

Should consider secondary cause–hyper parathyroidism or hyperthryoidism

100
Q

Dx labs for osteoporosis

A

Serum electrolyte levels, fasting serum calcium and phosphorus, serum glucose, BUN, Cr, PTH, TSH, vit D

101
Q

Most common sites of Pagets disease

A

pelvis, femur, tibia, spine, skull

102
Q

Labs for bone tumors (multiple myeloma)

A

Calcium, alkaline phosphatase, Bence jones protein, ESR and CRP, WBC,

103
Q

NEER impingement sign

A

Raise and pull on straightened arm forcibly from the side to full abduction above the head.
• The maneuver causes pain in patients with impingement.

104
Q

Hawkins impingement sign

A

Flex the elbow to 90 degrees and raise the upper arm to 90 degrees of abduction (parallel to the floor). Then rotate the arm internally across the front of the body, causing compression of the rotator cuff and subacromial bursa between the head of the humerus and coracoacromial ligament.
• The maneuver causes pain in patients with impingement

105
Q

Neuropathic agents for fibromyalgia pain

A

Gabapentin (neurontin), pregabalin (lyrica), amitriptyline (elavil)

106
Q

Increasing prevalence of gout due to

A

Greater use of diuretics and low dose aspirin

107
Q

Podagra

A

Acute synovitis of the first MTP joint of the big toe

108
Q

Risk factor for avascular necrosis

A

Chronic steroid use

109
Q

Ballotment

A

Push down on patella

Patella springs upward suggesting large effusion

110
Q

McMurray test

A

Foot everted, knee varus position, flex/extend while palpating medial joint line, then invert fot, knee valgus, palpate lateral joint line
Pain or palpable click with hand on joint line suggests meniscal injury

111
Q

Appley grind test

A

Patient supine, knee flexed 90 degrees, examiner rotates foot while providing downard pressure
Pain suggests meniscal injury along side being palpated

112
Q

Lachman test

A

Stabilize femur with one hand and pull anteriorly on tibia with other
Excessive laxity suggests ACL tear

113
Q

Posterior drawer test

A

Knee 90 degrees, examiner sits in patient’s foot and pushes posteriorly on tibia
Excessive laxity suggests PCL tear

114
Q

Subacromial palpation pain

A

Suggests bursitis or impingement

115
Q

Hawkins test

A

Elbow 90 degrees, arm forward flexed 90 degrees, examiner internally rotates
Pain suggests bursitis/impingement

116
Q

Neers test

A

Thumb down, elbow straight, examiner raises arm through forward flexion
Pain suggests bursitis/impingement

Primary Care 2 (5 decks)

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