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NR511 - Differential Diagnosis > Final exam - Musculoskeletal > Flashcards

Final exam - Musculoskeletal Flashcards

1
Q

Carpal tunnel syndrome

A

Inflammation of the Median Nerve

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2
Q

Symptoms of carpal tunnel syndrome

A

wrist achiness that radiates to the base of the thumb on the palm of the hand;

may be awakened at night with pain and numbness in the area

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3
Q

Treatment for carpal tunnel syndrome

A

Wrist splint and NSAIDS

Surgery

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4
Q

Shoulder pain in over 55s

A

More likely to have rotator cuff tears and degenerative arthritis.

Fractures and dislocations with falls more prevalent

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5
Q

Shoulder pain in under 30s

A

Glenohumeral dislocation

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6
Q

Shoulder pain in middle age

A

Impingement syndrome more likely

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7
Q

Differential diagnoses for shoulder pain

A
  • fractures
  • dislocations
  • acute tendon rupture
  • chronic or repetitive injuries (impingement syndromes, most rotator cuff tears and biceps tendon ruptures)
  • degenerative conditions
  • inflammatory conditions
  • idiopathic conditions (glenohumeral and AC arthritis, frozen shoulder)
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8
Q

Dislocated shoulder

A

Dislocates due to excessive pressure on the joint.

Pain noted when shrugging shoulders

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9
Q

Shoulder pain - Musculoskeletal Differential Diagnoses

A

Adhesive capsulitis (frozen shoulder)

Rotator cuff syndrome

Impingement

Calcific tendinitis

Subacromial bursitis

Degenerative arthritis: glenohumeral, acromioclavicular

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10
Q

Shoulder pain - Trauma Differential Diagnoses

A

Fractures: humerus, clavicle, acromion

Acromioclavicular joint sprains

Rotator cuff tear

Dislocation: glenohumeral

Nerve injuries: compression

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11
Q

Shoulder pain - Neurovascular Differential Diagnoses

A

Reflex sympathetic dystrophy (shoulder–hand syndrome)

Thoracic outlet syndrome

Cervical root compression

Brachial plexus injury

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12
Q

Shoulder pain - Systemic Disease Differential Diagnoses

A

Inflammatory disease

Cancer

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13
Q

Herniated disc - Risk factors

A
  • age-related degenerative changes (it is often difficult to distinguish between normal aging of the spine and pathological changes)
  • cigarette smoking
  • a narrowed lumbar vertebral canal
  • obesity
  • osteoporosis
  • stress
  • muscle tension.
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14
Q

Causes of herniated disc

A

Trauma (sudden or over time), frequent lifting without proper utilization of body mechanics, and vibration, such as driving and/or riding in a motor vehicle for prolonged periods of time.

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15
Q

What is the most common herniated disc?

A

L4-L5 (weakness in the great toe)

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16
Q

Evaluating a herniated disc - diagnostics

A

MRI should also be considered for patients with neurologic symptoms, specifically weakness, loss of deep tendon reflex, or bilateral symptoms.

Xray for patients with trauma

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17
Q

Evaluating herniated disc - physical exam

A
  • Range of motion
  • Sensory function
  • Numbness/tingling
  • Straight leg raise test
  • patient unable to walk on toes or heels
18
Q

Preventing recurrence of herniated disc

A
  • smoking cessation
  • weight reduction
  • good posture and body mechanics
  • adherence to an exercise regimen
19
Q

Patellofemoral dysfunction

A

continuum of disorders due to overuse of the knee

20
Q

Management of knee pain

A

NSAIDS and quadriceps strengthening exercises

21
Q

How to evaluate for meniscus tears?

A

the McMurray test

22
Q

Phalen’s test

A

involves flexing the wrist for 60 seconds, leads to painor paraesthesia in the median nerve

23
Q

Anterior drawer test

A

used in initial clinical assessment of suspected rupture of the cruciate ligaments in the knee

24
Q

Low back pain workup

A

Focus on HPI:

1.Mode of onset (abrupt or insidious?)

2.Characteristics
*Provoking factors
*Aggravating factors
*Relieving factors

3.Effects of activities
*Posture
*Coughing, sneezing, straining
*Exercise, exertion, rest
*Sleep

4.History
*Similar or different pains
*Course (progressive, decreasing, increasing, fluctuating, episodic?)
*Associated limb and/or neurologic symptoms (pain, paresthesias, numbness, weakness, atrophy, cramps, fasciculations?)

5.Associated symptoms
*Urinary problems (frequency, urgency, retention, incontinence?)
*Bowel problems (incontinence or constipation?)

6.Previous back pain history and treatment (medications, types of surgery, nonpharmacologic management, lifestyle and work modifications, litigation or compensation issues?)

25
Q

Differential diagnoses for low back pain

A
  • ovarian cyst
  • ankylosing spondylitis
  • infection
26
Q

Lumbar spinal stenosis

A
  • often radicular pain down the legs
  • symptoms progress proximal to distal
  • walking or prolonged standing causes pain and weakness in the legs and buttocks
  • Patients report short term relief with leaning forward and often lean on counters when standing or grocery carts when shopping
27
Q

Spinal fracture

A
  • Can present as low back pain

-Consider red flags from the patient history that alerts you to a potential spinal fracture that may include a fall history, prolonged steroid use, osteopenia, osteoporosis

28
Q

Cervical spondylosis

A

AKA degenerative arthritis

Blanket term for the chronic degenerative processes that affect the vertebrae and facet joints; causes pain, stiffness and disability

29
Q

Cervical myelopathy

A

(compression-like a pinched nerve) symptoms would include radicular symptoms of the upper extremities and weakness.

In severe cases, leg weakness, gait disturbances, and loss of bowel and bladder control may occur.

30
Q

Symptoms of nerve root involvement

A

Radiculopathy includes weakness, numbness, and tingling that typically occur along the distribution of the affected nerve root.

Paresthesia over the anterior thigh just above the knee indicates L4 involvement.

31
Q

Vertebral Fractures

A

Osteoporosis is most commonly associated with vertebral fractures in susceptible individuals

32
Q

Assessing for peripheral neuropathy

A
  • medical history
  • neuro exam
  • sensation
  • EEG, EMG (electrical condition)
  • MRI/CT (nerve pinch)
  • Deep tendon reflexes

Characterized by is “stocking-glove” or distal sensorimotor paresthesia, with diminished or variable deep tendon reflexes

33
Q

First degree muscle strain

A

ligaments are stretched but not torn

34
Q

Second degree muscle strain

A

most common; partial tearing of the ligament

35
Q

Third degree muscle strain

A

most severe; ligament is torn completely

36
Q

What can cause muscle strain

A

Strain-can be due to not warming up prior to exercise; Teachable moment when the patient presents with a strain is just to suggest stretching and warm-up exercises prior to the full exercise routine

37
Q

How do you identify a strain?

A

Look for location; e.g. acute low back strain; low back pain that is not associated with sciatica;

Is aggravated by sitting, standing, and certain movements; alleviated with rest; pain locally on palpation and muscle spasms are felt.

38
Q

How to treat strains

A
  • NSAID
  • low back strengthening exercises (type and intensity of the strengthening exercises depends on the patient’s pain tolerance). Be careful to not add insult to injury!
39
Q

What is the most common presenting symptom for neck strain?

A

Pain. Associated complaints of headache, usually occipital, which may persist for months, is not unusual.

40
Q

Signs and symptoms of ankle sprain

A
  1. injury
  2. swelling
  3. decreased ROM
  4. discoloration

NR511 - Differential Diagnosis (8 decks)

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