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Family Med > MSK > Flashcards

MSK Flashcards

1
Q

Which wrist ligament stabilizes the ulna? How do you test if it is injured?

A

TFCC - triangular ligament that stabilizes ulnar

Test - Supination lift off table

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2
Q

PE for MSK Inury

A

Neuro - reflexes, sensation, 2 pt discrimination, strength compared to healthy wrist

Cardio - pulses, cap refill

Examine joints more proximal

I-PASS

  • Idenitfy abnormalities
  • Palpate - ea carpal, anatomic snuffbox, Lister’s tubercle, scaphoid-lunate joint
  • Active ROM + passive ROM
  • Sensation
  • Special Tests
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3
Q

Finkelstein Test

A

reproducing pain w/ ulnar deviation of lateral fist means De Quervains tenosynovitis

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4
Q

Phalen v Tinnel

A

Carpal Tunnel

Phalen’s (flex wrists) & Tinnel’s (tap)

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5
Q

Common FOOSH Injuries (3)

A

scaphoid (avascular)

growth plate damage in kids (can stunt growth)

Collese in elderly women

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6
Q

Direct Palmar Injury

A

worry about hook of hamate (ulnar branch)

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7
Q

Trigger Finger

A

overuse inflammation –> nodule that prevents full extension of finger

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8
Q

Ganglion

A

aspiration drainage w/ needle or observation or surgical removal

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9
Q

Dupuytren’s Contracture

A
  • skin thickening and fibrosis –> hand surgery (seen in Swedish population)
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10
Q

Mallet v Jersey Finger

A

Mallet Finger - forced flexion; splint 8 wks

Jersey Finger - forced extension

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11
Q

RA Dx Criteria

A

synovitis in 1+ joints

r/o other diagnoses

score 6/10+
pts for # joints, duration > 6 wks, +RF/anti-CCP, inc ESR or CRP

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12
Q

Gout Risk Factors

A

inc purines (red meat or seafood) & HCTZ/loops/chemo

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13
Q

Common Septic Joint Organisms

A

RA - staph aureus

HIV - pneumo, H flu, Salmonella

IV drug use - strep, staph, gram neg, Pseudomonas

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14
Q

Ankle Sprain Grades

A

1- stretch one ligament w/ minor swelling, no instability or sig loss of function

2- partial ligament tear w/ more severe swelling, pain and bruising; mild instability; some loss of ROM; pain when bearing wt

3- complete ligament tear so very unstable and cannot bear wt

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15
Q

Ottowa Ankle Rules

A

1- pain on palp of posterior or distal tip eithermalleolus
2- pt tenderness over mid foot / navicular or 5th metatarsal area
3- cannot bear wt immediately after or at appointment

** 2 perpendicular views if any 1 criteria (100% sensitive)

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16
Q

Ottowa Knee Rules

A 
1- 55 yo +
2- isolated patella tenderness
3- tenderness at head of fibula
4- cannot flex knee to 90 degrees
5- cannot bear wt for 4 steps immediately after or at appointment

** 2 perpendicular views if any 1 criteria (100% sensitive)

17
Q

Most Common Ankle Injury

A

Lateral more often injured b/c weaker ligaments - ATFL, PTFL, CFL

ATFL most commonly injured

inversion plantar injuries

18
Q

3 Ankle Tests

A

Anterior Drawer - pull heal forward while lower leg steady; unstable ATL

Inversion stress test - invert ankle while holding lower leg steady; CFL

Squeeze test - squeeze mid calf; if pain at anterior ankle then high ankle syndesmotic injury

19
Q

Ankle Sprain Tx

A

PRICE (protection, rest, ice, compression, elevation)

+ NSAIDs

+ early mobilization to dec stiffness
(ROM exercises in first 48-72 hrs)

20
Q

5 Rotator Cuff Tests

A

Empty can - abducted and thumbs point down; supraspinatous

External rotation w/ elbow by side - infraspinatous/teres minor

Internal rotation w/ elbow by side - subscapularis

Hawkins Supacromial Impingement - pain when arm flexed, elbow bent and internal rotation

Drop arm - unable to lower arm slowly from raised position

21
Q

4 Knee Injury Tests

A

Lachman - 20 degree flexion

Ant/Post Drawer - 90 degree flexion

Valgus - medial force to knee and lateral to ankle (for MCL)

Varus - lat force to knee and medial to ankle (for LCL)

22
Q

Gout v Pseudo Gout Crystals

A

MSU - neg bifringe needles

CPPD - rhomboid, weak pos bifringe

23
Q

Synovial Fluid in Septic v. Gout Joint

A

Septic - 100,000 WBCs
> 90% neutrophils in synovial fluid

Gout - 2-60,000 WBCs
< 90% neutrophils

**Still get cx even if see crystals

24
Q

Acute v. Chronic Gout Tx

A

Acute - colchicine (inhibits microtubule polymerization of neutrophils) , steroid, NSAIDs for acute

Maint w/ probenacid (inc excretion) & allopurinol (dec prod)

25
Q

RA Tx

A

Tx - sulfasalazine, methotrexate, NSAIDs, steroids, anti-cytokines (entarecept, infliximab)

26
Q

Injuries Suspicious for Abuse

A
  • Corner or “bucket handle” fractures of metaphysis of long bones
  • Spiral fracture of femur or humerus (not tibia)
  • Rib fracture (esp posterior or medial)
  • Vert or spinal process fractures
  • Digital fractures
  • Sternal or scapular fractures
27
Q

Toddler Fracture

A

spiral fracture of tibia from twisting on planted foot

28
Q

Slipped Capital Femoral Epiphysis

A
  • sep of growth plate b/n femoral head and shaft –> head medially and posteriorlly displaced –> dec internal rotation and obligatory external rotation w/ flexing
  • Often in obese adolescent males
  • Surgical pinning of femoral head
29
Q

4 Factors that Determine if Septic Arthritis in Kid

A
  • Fever > 38.5
  • Not bearing wt
  • WBC > 12,000
  • ESR > 40
30
Q

3 Tests for Cong Hip Problems

A
  • Barlow - flex knee and hip and try to displace
  • Ortolani - guided abduction
  • Galeazzi - lay and flex knees so ankle near butt to Meas discrepancy in knee ht
31
Q

Acute Low Back Pain Red Flags (14)

A
  • Night pain or pain at rest
  • Unexplained fever
  • Neuro deficits
  • > 6 wks duration
  • Age > 70
  • Loss of bowel or bladder control
  • Suspect ankylosing spondylitis
  • Trauma
  • Hx or suspicion of cancer
  • Osteoporosis
  • Chronic steroid use
  • Immunosuppression
  • Alcohol abuse
  • IV drug use
32
Q

Diff for Acute Low Back Pain

A
  • Cauda Equina - leg weakness, incontinence, numbness or pain in saddle distribution, pos straight leg and dec anal tone / dec ankle reflexes - get MRI
  • Infectious - fevers, pt tenderness, recent infection, IV drug use
    • Osteomyelitis, discitis, paraspinal or epidural abscess
    • CBC, ESR, CSF tap, MRI, IV abx and drainage
  • Herniated Disc /Sciatica - esp in L4-L5 and L5-S1 vert, better w/ laying and worse w/ Valsalva , pos straight leg test - conservative; MRI if symptoms persist > 1 mo
  • Spinal stenosis - pseudoclaudication symptoms w/ activity but vascular supply good; worse w/ anything that dec canal space
    • NSAIDs, musc relaxants, PT, epidural steroids
  • Vert Compression Fracture - osteoporosis or steroid use; w/ little or no trauma; Xrays and treat osteoporosis
  • Lumbosacral Strain -COMMON; conservative
  • Cancer - mets from prostate, heme, breast, lung (wt loss and other signs)

Family Med (8 decks)

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