MSK

Question 1

Physical exam findings indicative of disc pathology/herniation

Answer 1

Diminished/absent Achilles- L5-S1 = weak plantar flexion

’ ‘ Patellar- L3-L4; weak quads so assess squat/stand,

Trouble holding up great toe while walking on heels- L4-L5 = weak dorsiflexion

Straight leg raise to assess for pain r/t sciatica

Question 2

Apley’s Grind Test

Answer 2

Medial or lateral ligament damage,

McMurrays test = meniscal injury, audible/palpable clicking

Question 3

Sprain Classifications

Answer 3

Grade I: point tenderness, full ROM

Grade II: moderate to severe pain c weight bearing

Grade III: egg shaped swelling & NWB

Question 4

Medial epicondylitis

Lateral ‘ ‘

Tendonopathy

Answer 4

Golfers elbow, strain to medial aspect, pain is medial/inner aspect of elbow

Tennis elbow, strain to lateral aspect, pain on outside or lateral elbow

Inflammation & micro tears

Question 5

Meds to prevent GOUT FLARE

S/s of gout

Risk factors

Answer 5

Allopurinol (xanthine oxidase inhibitor)

Colchicine

Febuxostat (xanthine oxidase inhibitor)

Probenecid (increases excretion of uric acid in urine)

RFs: obesity, LDA, higher beer consumption, M>W,

Question 6

Cauda Equina Syndrome

Lumbar Nerve Root Compression/sciatica

Answer 6

Medical emergency due to compression of spinal nerve roots

New onset bowel bladder complaints think Cauda Equina

Pain radiates along the sciatic nerve down the leg from lower back

Question 7

Osteoarthritis

Answer 7

Herberden’s (DIP) & Bouchard’s (PIP) nodes may both be swollen in OA

Tx: NSAIDs (acetaminophen & aspirin), corticosteroids,

M=W are affected, not symmetrical inflammation,

X-ray +for joint space narrowing early in disease process (unlike RA)

Question 8

Rheumatoid arthritis

Answer 8

Bouchard’s nodes (PIP), metacarpophalangeal joints & wrists may be swollen in RA

Tx: DMARDs (methotrexate), corticosteroids,

W>M, symmetrical inflammation, 35- 50yo, redness over joints, WBCs in aspirated synovial fluid, elevated sed rate,

Question 9

bursitis

Answer 9

Caused by joint overuse

S/s: pain c movement, swelling & tenderness

Tx: RICE (as c strains), reduce pain/inflammation (NSAIDS), heat/ice, steroid injections (if deep tissue bursitis)

Trochanter bursitis =Common in runners

Olecranon bursitis= pain behind elbow

Retrocalcaneal busitis =pain behind ankle, worse with climbing stairs, common in hikers

Question 10

Ligaments
Vs
Tendons

Answer 10

Ligaments attach bone to bone
*hold structure together, stabilize

Tendons attach muscle to bone or other soft tissue structures
*help to move bone or structure

Question 11

Muscle strain
Vs
Joint strain

Answer 11

S/s: acute onset of pain, limited ROM, swelling, stiffness, bruising, spasms

S/s joint strain: #1 sports injury,

Lateral ankle sprain is #1 sports injury

Question 12

Carpal tunnel syndrome

Answer 12

Tx: NSAIDs, corticosteroids, splint/brace,

Goal: decrease inflammation around compressed nerves

Question 13

Rotator cuff injury

Answer 13

Drop arm test

Question 14

Ligament tear/damage

Answer 14

Lachmans test (pressure placed against tibia while knee is flexed) indicative of AP cruciate ligament tear

Question 15

Tx for herniated disc

Answer 15

NSAIDS, ice/heat, brace, transcutaneous electric nerve stimulation, PT

Question 16

Gout

Answer 16

S/s

Diagnosis: cultures of synovial fluid or blood

If gout suspected serum uric acid levels can guide tx

Tx = NSAIDS

• low dose colchicine may be used if NSAIDS are contraindicated (kidney disease, active PUD or NSAID intolerance)
• if both NSAIDS and colchicine are contraindicated PO or parenteral glucocorticoids may be used

Prevention: allopurinol, febuxostat (xanthine oxidase inhibitors), probenecid (increases uric acid excretion in the urine)

Wait 2-3w after flare to start using urate lowering agents

Question 17

Lumbosacral strain

Answer 17

S/s decreased or painful ROM especially with flexion

neuro exam should be intact. S/s numbness, weakness or incontinentinence indicative of disc prolapse, spinal canal stenosis or nerve root impingement

Question 18

Radiculopathy

Answer 18

S/s low back pain with nerve involvement such as referred pain down buttock to ankle

Radiculopathy L1-L3 s/s referred pain down front of thigh to knee

Question 19

Antinuclear antibody test

Answer 19

Is the primary test used to evaluate for auto immune disorder