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6030 Primary Care Test 3 COMPLETE ☑️ > Module 9: Musculoskeletal (a) > Flashcards

Module 9: Musculoskeletal (a) Flashcards

1
Q

Osteoarthritis (OA)

-Info/Stats

A
  1. Most common type of arthritis — accounts for 30% of primary care visits
    —Most COMMON musculoskeletal problem of adults >45 yrs
    —Most COMMON cause of disability in elderly — OA of the knee is leading cause of chronic disability in US
  2. Also called Degenerative Joint Disease
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2
Q

Osteoarthritis (OA)

-Patho

A
  1. Changes in cartilage cellular matrix — earliest manifestations of OA are superficial erosions of the cartilage
    —Loss of articular cartilage
    —Thickening of sub-chondral bone
    —Development of osteophytes
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3
Q

Osteoarthritis (OA)

-Contributing Factors

A
  1. Aging
  2. Genetic Factors
  3. Obesity
  4. Muscle weakness
  5. Trauma
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4
Q

Osteoarthritis (OA)

-Clinical Presentation

A
  1. Joint pain — deep aching pain aggravated by motion & weight bearing — Worse at night s/p vigorous activity
  2. Joint Stiffness — esp after inactivity — morning stiffness usually <30 minutes
  3. Joint Enlargement — Osteophyte formation
  4. Crepitus on movement w/ joint
  5. Later stages — Pain on motion and at rest; limitation of motion; mal-alignment; body protuberances from spurs

NO SYSTEMIC SYMPTOMS

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5
Q

Osteoarthritis (OA)

-Joint Involvement

A
  1. Knees and Hips
  2. Hands — Distal inter phalange all joint (DIP) & Proximal inter phalange all joint (PIP)
  3. Spine
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6
Q

Osteoarthritis (OA)

-Major Radiographic Features

A
  1. Joint space narrowing
  2. Osteophyte formation
  3. Subchondral bone cysts — periarticular ossicles
  4. Subchondral sclerosis
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7
Q

Osteoarthritis (OA)

-Management

A
  1. Control Pain
  2. Maximize functional independence — encourage movement
  3. Minimize disability
  4. Preserve quality of life
  5. Non-Pharm
    - Weight loss, proper body mechanics
    - Warm, moist heat or Ice
    - PT — Good for quad development for knee pain
  6. Pharm
    - Acetaminophen & NSAIDS
    - Capsaicin cream (Topical)
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8
Q

Osteoarthritis (OA)

-When to Refer?

A
  1. Severe, disabling OA
  2. Mal-alignment
  3. Instability
  4. Bone spurs

Follow up Q3-6 months

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9
Q

Rheumatoid Arthritis

-Info/Stats

A
  1. Autoimmune disorder — immunologically mediated chronic inflammatory disease
  2. Higher incidence in females
  3. Peaks at 20-30 yrs and has familiar component
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10
Q 
Rheumatoid Arthritis (RA)
-Presentation
A
  1. Synovitis and destructive arthritis of the diarthroidal joints — fingers (MCP, PIP), wrist, shoulders, knees

2Affected joints are painful to pressure (tender), swollen, and partially immobile

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11
Q 
Rheumatoid Arthritis (RA)
-Extra-articular involvement
A
  1. Cardiovascular system
  2. Pulmonary visceral pleura
  3. Sclera
  4. Spleen
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12
Q 
Rheumatoid Arthritis (RA)
-S/S
A
  1. Peripheral Symmetric poly arthritis & Morning stiffness > 1 hr ***
  2. Pain, tenderness, warmth, swelling
  3. Fatigue, depression, malaise, anorexia
  4. Chest pain w/ deep inspiration
  5. Low grade fever
  6. Painful eyes
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13
Q 
Rheumatoid Arthritis (RA)
-Diagnostic Tips?
A
  1. Persistent symmetric** poly-arthritis
  2. Presence of systemic features
  3. Presence of rheumatoid nodules
  4. Exclusion of other systemic disorders (Ex: Lupus)
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14
Q 
Rheumatoid Arthritis (RA)
-American Rheumatism Association Diagnostic Criteria
A
  1. Morning stiffness for >6 wks
  2. Arthritis involving 3 or more joints for > 6 wks
  3. Arthritis of hand joints >6 wks
  4. Rheumatoid nodules
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15
Q 
Rheumatoid Arthritis (RA)
-Treatment
A
  1. Non-Pharm — Rest, splints, regular supervised exercise (PT, OT), Support groups, community resources
  2. Pharm
    - NSAIDS, methotrexate, low dose corticosteroids, antimalarials, sulfasalazine, Gold Salts
    - Rheumatologist REFERRAL
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16
Q

Gout

-Info/Stats

A
  1. Metabolic disorder influenced by dietary factors — Overeating, obesity, ETOH abuse, Hyperlipidemia & insulin resistance syndrome
  2. Male to female ration 9:1
  3. Peak age of 1st attack — Males 50 yrs; females 60 yrs
17
Q

Gout

-Primary & Secondary?

A
  1. Develops when uric acid crystals collect in synovial fluid
  2. PRIMARY Gout — Inborn error in production or excretion of uric acid
  3. SECONDARY Gout — d/t other factors/disorders that cause hyperuricemia through over production of uric acid or decreased excretion of uric acid
18
Q

Gout

-Risk Factors for Acute Gout Attack

A
  1. Family Hx
  2. Obesity
  3. Lead exposure
  4. Purine rich diet
  5. Diuretics
  6. Recent Surgery
  7. ETOH abuse
  8. Chronic renal disease
  9. Rapid weight loss
  10. Infection or Trauma
19
Q

Gout

-Purine Rich foods?

A
  1. Organ meats and other meats
  2. Anchovies
  3. Sardines
  4. Meat extracts — gravy, broth, bouillon

High intake of low fat dairy products can reduce risk of gout

20
Q

Gout

-S/S

A
  1. Sudden onset of intense pain
  2. Usually monoarticular
  3. Inflammation increases within hours & lasts a few days to weeks
  4. Erythema
  5. Peak w/in 24-36 hrs
  6. MOST COMMON affected joint — 1st metatarsophalangeal joint 90%** (Big Toe) — other joints as well
21
Q

Gout

-Treatment

A
  1. Non-Pharm
    — ETOH in moderation
    —Diet if there is an association w/ symptoms
    —2 L water per day
  2. Pharm
    - DOC is — Indocin (Indomethacin)**
    - Alternative Drug — is naproxen or ibuprofen

-Chronic Gout
—Colchicine or Allopurinol

22
Q

Gout

-Drug of Choice?

A
  1. Indocin (Indomethacin)
23
Q

Gout

-Alternative Drugs

A
  1. Naproxen or Ibuprofen
24
Q

Gout

-Chronic Gout Drugs

A
  1. Colchicine

2. Allopurinol

25
Q

Gout

-Patient Education

A
  1. Lifestyle modification — weight reduction if obese; Reduce ETOH
  2. Medications — start w/ first sign of attack
  3. Ice pack may be helpful w/ NSAID use
  4. Follow-up PRN on individual basis
26
Q

Costochondritis

-Info/Stats

A
  1. Inflammation of the costochondral junction
  2. Most common cause of non-cardiac chest pain
  3. Pain is reproducible/increased w/ palpation
27
Q

Costochondritis

-Presentation

A
  1. Sharp, dull, or gnawing pain; fleeting or intermittent
  2. 2nd to 5th upper costal cartilage spaces
  3. Increased pain w/ movement, deep breathing or coughing
  4. May have Hx of URI, heavy lifting, or hard exercise
  5. NO objective PE findings other than localized tenderness
  6. Pain is reproducible
    - Diagnosis is made solely on ability to reproduce pain by palpation of tender area**
28
Q

Carpel Tunnel Syndrome

-Info/Stats

A
  1. Median nerve compression neuropathy
  2. Genetic predisposition
  3. Females > males
  4. Bilateral or unilateral
29
Q

Carpal Tunnel Syndrome

-Presentation

A
  1. Most cases are idiopathic — Some may be seen w/ RA, connective tissue dz, pregnancy, fracture of carpal tunnel bones, acromegaly, hypothyroidism, and DM
  2. Repetitive hand/wrist use and workplace factors in the development of CTS is controversial
30
Q

Carpal Tunnel Syndrome

-Physical Exam Signs

A
  1. Tinel’s Sign — tap palmer surface of the wrist — Positive = tingling sharp sensation following along medial nerve
  2. Phalen’s maneuver — Press back of hands together

LOOK UP in BOOK**

31
Q

Carpal Tunnel Syndrome

-Treatment

A
  1. Splinting is 1st line therapy — Especially when sleeping; IDEALLY 24 hrs, 7days/wk for 6 wks
  2. NSAIDS
32
Q

Tendinitis (Tenosynovitis)

-Info/Stats

A
  1. Common cause of localized soft tissue pain
  2. Seen w/ occupations that require REPETITIVE wrist and thumb movements
  3. Pain noted on ulnar deviation under stress
    - Caused by OVER USE & Direct or microtraumatic INJURY
  4. Refer to Orthopedist if unresolved in 2 wks
33
Q

Ganglion Cyst

-Info/Stats

A
  1. Develops on or in a tendon sheath
  2. Thick, gel-like material leaks from the joint into weakened tendon sheath and forms a cyst sac
  3. Cause — Frequent strains and contusions
  4. Common sites — dorsum of wrist over radiocarpal joint or volar surface of wrist
  5. May be Asymptomatic or associated w/ dull aching pain and weakness
  6. Treatment includes ASPIRATION or SURGICAL removal
    —Refer to General Surgery

6030 Primary Care Test 3 COMPLETE ☑️ (7 decks)

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