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Family Medicine Cases > Knee Pain > Flashcards

Knee Pain Flashcards

1
Q

Common knee conditions in children

A 
Patellar subluxation
Tibial apophysitis (Osgood-Schlatter)
Patellar tendonitis
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2
Q

Common knee conditions for adults

A 
Patellofemoral syndrome
- Dx of exclusion for anterior knee pain
Overuse syndromes
Trauma 
Inflammatory arthropaties
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3
Q

Hx of trauma

A

Increased risk of injury to ligaments and meniscal tears

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4
Q

Impair ability to squat

A

Effusion
Arthritis
Ligament damage

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5
Q

Ability to duck waddle

A

Rules out

  • ligament instability
  • Effusion
  • Significant damage to meniscal cartilage
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6
Q

Work-up for septic arthritis

A 
CBC w/ differential
ESR
Arthrocentesis 
- Cell count w/ differential
- Glucose
- Protein
- Culture
- Polarized light microscopy
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7
Q

Clear, straw-colored transudate

A

Simple joint effusion

  • Osteoarthritis
  • Degenerative meniscal injuries
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8
Q

Bloddy knee aspirate

A

Hemarthrosis

  • Ligament tear
  • Fracture
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9
Q

Hemarthrosis with fat goblets

A

Osteochondral fracture

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10
Q

Work-up for RA

A

RF

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11
Q

Side effects of NSAIDs

A

GI upset
Worsens HTN
Increases the effect of sulfonylureas

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12
Q

Can NSAIDs and ASA contribute to hepatictoxicity

A

yes

- They also contribute to coagulopathy

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13
Q

Screening for 74 year old women

A 
Colonoscopy to 75
Mammograms to 74
Depression
HTN
Lipids
- This is only if they are at risk of CAD
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14
Q

Immunization for 74 year-old

A

Tdapt: q10 yrs
Pneumococcal- > 65 gets a one time dose
Flu: Annual
Zoster: > 60

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15
Q

Knee exam

A

Inspection
Palpation
ROM
Assess tenderness and ROM of hip

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16
Q

Points of palpation

A

Patella
Tibial tubercle
All tendons
Joint lines (Anterior, Medial, and lateral)

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17
Q

Stability of the ACL only

A

Lachmann’s test

  • Flex to 30
  • Stabilize distal femur
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18
Q

Stability of ACL and PCL

A

Drawer testing

  • Flex knee to 90 degrees
  • Stabilize foot
  • Thumbs on tibial tubercle
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19
Q

Stability of MCL and LCL

A

Valgus and Varus Stress tests

  • Do with leg in full extension and knee flexed to 30
  • Place hands on medial/lateral knee
  • Apply pressure to distal tibia
20
Q

Assess the medial and lateral menisci

  • Sens and Spec for tears
  • Positive test is pain, click, or clunk
A

McMuray Test

  • Flex the knee as far as possible
  • Rotate tibia either internal or external
  • Bring knee to 90
  • Apply a varus or a valgus stress to knee while extending
21
Q

Tap median nerve of wrist

A

Tinel’s sign

22
Q

Flex wrists and press dorsal surface together

Hold for 30 to 60 seconds

A

Phalen’s test

23
Q

Anterior knee pain

A

Patellofemoral pain syndrome

  • Overuse
  • Typical in women as “theater sign”
24
Q

Lateral knee

A 
IT band tendonitis
- Overuse
LCL sprain
- Varus stress
- Immediate onset
Meniscal tear
- Twisting injury
- Mild effusion
- Catching and locking
25
Q

General knee pain

A 
ACL
- Deceleration forces
- Effusion and swelling
Septic arthritis
- Swelling
- Turbid synovial fluid
OA
- Aggrevated by weight-bearing activity
- Chronic stiffness
- Crepitus
26
Q

Medial pain

A 
MCL
- Misstep or collision
- Swelling
Meniscus
-Meniscal tear
- Twisting injury
- Mild effusion
- Catching and locking
27
Q

Posterior pain

A

Popliteal cyst

  • insidious onset
  • Pain in the popliteal area
28
Q

Extreme pain with any movement

A

Gout/Psuedogout

  • Clear or cloudy synovial fluid
  • (-) birefringent rod = gout
  • (+) birefringent rhomboid = pseudogout
29
Q

Top differential for chronic knee pain

A 
Sprain
OA
RA
Gout/pesudogout
Psoriatic arthritis
30
Q

Subcutaneous nodules that are firm and tender
Joint stiffness in morning lasting for more than 30 minutes
Bilateral joint pain involving 3 or more joints

A

RA

31
Q

Psoriatic plaques on extensor surface

Oligo (2 to 4) or poly (5+)

A

Psoriatic arthritis

  • Plaques are required for diagnosis
  • Arthritis often presents first
32
Q

Acute monoarticular joint pain
Exposure to tick bite
History of rash

A

Lyme disease

33
Q

HLA-B27 association

Chronic back pain and progressive loss of motion of the spine

A

Ankylosing spondylitis

34
Q

Fever, skind rashes, raynauds phenomenon, pleuritis, or chest pain
Butterfly rash
Discoid lesions
Migratory

A

SLE

35
Q

When to get an x-ray for OA

A

Questionable diagnosis
Assess severity and location
No improvement with conservative therapy

36
Q

When to get an MRI

A

Locking
Popping
Joint instability
- Unless X-ray shows significant joint space narrowing

37
Q

X-ray features of OA

A

Joint space narrowing
Subchondral sclerosis
Osteophytes
Subchondral cysts

38
Q

What corrolates the best with pain? What corrolates best with disease severity?

A

Patellofemoral or tibiofemoral joint osteophytes = pain

Joint space narrowing = disease progression

39
Q

Diagnositc test of choice for carpel tunnel

A

Nerve conduction studies

  • Expensive
  • Often unnecessary
40
Q

When are nerve conduction tests necessary

A

Symptoms do not improve with treatment
Motor dysfunction
Thenar atrophy

41
Q

Most helpful findings to dx carpel tunnel

A 
hand symptom diagrams
- Digits 1, 2, or 3 (need 2)
Hypalgesia
- Decreased sensitivity to pain 
Weak thumb abduction
42
Q

Pain management for OA

A 
Exercise
Acetaminophen
- First line agent
NSAIDs
- Second line agent
Intra-articular injection
- Only when inflammed
Acupuncture
Glucosamine
SAM-e
Tramadol
43
Q

Opiods for chronic pain

A

Oxycodone or morphine

44
Q

Other options for chronic pain

A

TCAs
Anticonvulsants
- Good for neuropathic pain

45
Q

OA pain management when conservative management fails

A

Tramadol
Long-acting opiod with short acting for break through
TCAs

Family Medicine Cases (13 decks)

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