MSK

Question 1

McMurray’s test

Answer 1

• audible/palpable click when the knee is raised slowly with one foot externally rotated
• positive test for meniscal tears

Question 2

Lachman’s test

Answer 2

• Drawer test, graded 1-3 degree of displacement
• assess for ACL/PCL tear
• place knee in 20-30 degree flexion, grasp leg with one hand and apply anterior force; opposite hand stabilizes the thigh

Question 3

Apley’s grind test

Answer 3

• flex knee 90 degrees with patient prone; put pressure on heel with one hand while rotating lower leg internally and externally
• positive shows pain or click
• indicates MCL or LCL damage and/or meniscus injury

Question 4

Ankle sprain

Answer 4

• Lateral ankle sprain is the most frequent sports-related injury
• “I fell of my high heels”
• Grades 1-3
• X-ray to rule out fracture based on Ottowa Ankle Rule
• RICE, NWB, NSAIDs, refer grade 3

Question 5

Bursitis

Answer 5

• Inflammation of the bursa from trauma, sepsis/infection
• pain, especially with movement, swelling, tenderness, erythema
• Dx: aspiration with gram stain, C&S, WBC, plain x-rays
• Tx: splinting, RICE, heat, NSAIDs, steroid injections (max 3/year)

Question 6

Osteoarthritis: Sx, Dx, Tx

Answer 6

Sx: asymmetrical, better in the morning and worse as the day progresses, aggravated by activity, crepitus possible, limited ROM, DIPs and PIPs commonly affected
Dx: synovial aspirate normal (clear/yellow), Osteophytes and joint space narrowing on X-ray
Tx: NSAIDs, COX-2 inhibitors, weight loss, Use cane on opposite side, moist heat, physical therapy, refer for joint replacement

Question 7

Rheumatoid arthritis: Sx, Dx, Tx

Answer 7

Sx: symmetrical, redness/”heat” complaints to joints, ulnar deviation, MCPs and PIPs commonly affected, worse in morning and better as day progresses
Dx: ESR elevated, ANA+ in 1/5 patients, synovial aspirate with inflammatory changes and WBCs, X-ray shows Osteopenia and joint space narrowing
Tx: NSAIDs, antirheumatic drugs (DMARDS), corticosteroids, methotrexate (check LFTs), gold salt injections, early Rheumatology referral, rest, physical therapy

Question 8

Heberden’s nodes

Answer 8

DIPs

found in OA

Question 9

Bouchard’s nodes

Answer 9

PIPs

found in OA

Question 10

Carpal tunnel syndrome

Answer 10

• from repeated (often job-related) wrist flexion
• Sx: numbness, tingling, burning along median nerve; nocturnal pain (awakens at night), positive Tinel’s sign, positive Phalen’s test, positive carpal compression test
• Tx: Elevate, cock-up wrist splint, NSAIDs, steroid injection, refer for surgery

Question 11

Tinel’s sign

Answer 11

tapping over median nerve on flexor surface of the wrist produces tingling sensation
carpal tunnel syndrome

Question 12

Phalen’s sign

Answer 12

“Pharoah” hands
reproduction of symptoms after 1 minute of flexion
carpal tunnel syndrome

Question 13

Carpal tunnel compression test

Answer 13

pressure with examiner’s thumb over carpal tunnel for 30 seconds illicit symptoms
carpal tunnel syndrome

Question 14

straight leg raise test

Answer 14

patient’s legs elevated off exam table causes radiating or sciatic pain

Question 15

Pelvic rock test

Answer 15

screens for sacroiliac joint dysfunction
hands on anterior iliac spines and attempt to “open and close” pelvis
test is positive if pain is felt in either or both sacroiliac joints

Question 16

Lumbar nerve root findings: L3-L4 pathology

Answer 16

• quadriceps muscles weak/atrophic
• pain radiating into medial malleolus, numb along same path especially medial aspect of knee
• diminished or absent patellar reflexes
• screening exam: have patient squat and rise

Question 17

Lumbar nerve root pathology: L4-L5 pathology

Answer 17

• weakness of dorsiflexion mechanism of great toe and foot
• pain radiating into lateral calf, numbness of dorsum of foot and lateral calf
• screening exam: have patient walk on heels of feet

Question 18

Lumbar nerve root findings: L5-S1 pathology

Answer 18

• weakness of plantar flexion of great toe and foot
• pain along buttocks, lateral leg, and lateral malleolus; numb to lateral aspect of foot and in posterior calf
• diminished or absent Achilles reflex
• screening exam: have patient walk on toes

Question 19

Morton’s neuroma: pathology, sx, dx, tx

Answer 19

• compression neuropathy of an intermetatarsal plantar nerve, most commonly of 3rd or 4th intermetatarsal spaces
• high heel shoe injury
• Sx: “standing on a pebble”; numbness/tingling in toes
• Dx: ultrasound
• Tx: orthotics, steroid injections, refer

Question 20

Plantar fasciitis: pathology, sx, dx, tx

Answer 20

• inflammation of plantar fascia
• Sx: foot arch/heel pain, obesity, runners, men 40-70, worse in morning
• Dx: physical exam, x-rays to r/o other problems
• Tx: NSAIDs, corticosteroids, orthotics, night splints, PT, refer for surgery

Question 21

Osgood-Schlatter: pathology, incidence, sx, dx, tx

Answer 21

• pathology: rupture of growth plate at tibial tuberosity
• incidence: adolescent, athletic boys
• sx: pain below knee cap in one or both legs; swelling mild to severe
• dx: x-ray to r/o other conditions
• tx: RICE, NSAID, refer for surgery in rare cases

Question 22

Costochondritis

Answer 22

pathology: inflamm of cartilage that connects rib to sternum
causes: injury to chest, physical strain, URI, infection, fibromyalgia
sx: pain/tenderness where ribs connect to sternum, pain w/C&DB
dx: x-ray to r/o other conditions
tx: usually resolves on its own, local ice/heat, NSAIDs

Question 23

Polymyalgia rheumatica

Answer 23

• pathology: inflammatory dz involving pain/stiffness in shoulder and hip
• incidence: cause unknown, people over 50 years old, may be associated with temporal arteritis
• sx: stiff neck shoulders and hips, loss of ROM in affected areas, fatigue, anemia, mild fever, “hard to get out of bed in the AM”
• dx: ESR, x-rays to r/o other conditions
• tx: steroids, symptom management

Question 24

Hallmarks of meniscal tears

Answer 24

locking, immediate swelling (grapefruit)