MSK Flashcards
Big risk factor for osteoporosis:
Smoking
Diagnosis of osteoporosis?
DEXA scan with t-score less than -2.5
What medication should be used in a patient with osteoporosis and HTN?
Thiazides bc they stimulate osteoblasts and decrease Ca excretion.
First line treatment for RA?
DMARDS- methotrexate and plaquenil- slow the progression on RA.
Risk associated with DMARDS?
Suppression of immune function
What does methotrexate deplete?
Folic acid so patient must supplement
This presents as joint pain and AM stiffness that resolved in less than 1 hour.
OA
What will patient with OA present with?
Heberden and Bouchard’s nodes.
Where are Heberden nodes located?
DIP and only in OA
Where are Bouchard’s node located?
PIP- both RA and OA
What would an X-ray show in a patient with OA?
Joint space narrowing
What is treatment for OA?
Tylenol and exercise
This is a systemic issue that presents with bouchards nodes, warm, tender and swollen fingers (sausage fingers), boutonniere deformity, and swan neck deformity.
RA
This is Hyper-extension of the DIP and flexion of the PIP?
Boutonniere’s deformity
This is flexion of the DIP and hyper-extension of the PIP?
Swan neck deformity
Another type of arthritis that typically begins in the lower back and works it way to upper back. It is autoimmune and a chronic inflammatory condition.
Ankylosing Spondylitis
How do we diagnose ankylosing spondylitis?
X-ray first then MRI
This presents with snuff box tenderness and patient may say “ I fell with arms out to catch me”.
Scaphoid fracture
How do we treat scaphoid fracture?
Thumb spica cast because this does not show up immediately on X-ray.
This is backward prayer hands to diagnose carpal tunnel?
Phalen’s
This is we you tap on the inner wrist to diagnose carpal tunnel?
Tinnel’s
This is caused by a thickening of the tissue around the nerve leading to the toes that is common in females that wear heals and patient may say “it feels like a pebble is in my shoe”.
Morton’s neuroma
McMurray tests for:
Meniscal injury
Lachman tests for:
ACL injury
Valgus tests for:
Ligaments
This is knock knees?
Gene Valgum
This is Row legged/bow legged?
Gene varum
When is the pain relieved with a herniated disk/spinal stenosis?
When sitting
What test do we use to evaluate sciatica?
Straight leg test
Describe the straight leg test:
This is positive when reproduction of symptoms occur between 30-70 degrees of elevation.
Sciatica pain is worsen when?
Sitting
Which nerve is the root of the patient’s sciatica when they have a diminished knee jerk with squat and rise exam?
L4
Which nerve is the root of the patient’s sciatica when they have a numbness at the great toe with the heel walking test?
L5
Which nerve is the root of the patient’s sciatica when they have a diminished or absent ankle jerk when walking on toes?
S1
What tests can be used to test for a rotator cuff injury?
Drop arm, empty can test, and apprehension test
The apprehension test may also show?
Posterior impingement of rotator cuff
What would diagnose a distal biceps tendon rupture?
Hook test- use the index finger to hook the biceps tendon from the lateral side of the elbow.
Gout prevention?
Allopurinol and lifestyle modifications
Side effect of Allopurinol?
Bone marrow suppression
Lifestyle modifications of gout?
Low purine diet, no alcohol, avoiding diuretics, no thiazide
How do we diagnose Gout?
Uric acid greater then 6.5
Treatment of acute gout attack?
Potent NSAIDs such as Indomethacin or steroids if severe colchicine
This is when the ball at the head of the femur slips off the neck of the bone in a backwards directions. The patient will walk with a limp and there will be a dip in the hip (positive trendelenburg). Seen in adolescents.
SCFE
This is lack of blood supply to the femur head that is seen in babies?
Legg-Calves-Perthes disease
