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AGNP AANC Boards > MSK > Flashcards

MSK Flashcards

1
Q

Navicular/ Scaphoid bone fracture presentation/ PE/ Xray

A

hx of falling forward with hyperextension if the wrist. wrist pain is below the thumb area. may report difficulty gripping objects

PE: tenderness to palpation of the anatomic snuff box. pain with resisted pronation

Xray: may NOT show fracture as it take 14-21 days to show callus formation

MRI: is the most sensitive dx in < 24 hours

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2
Q

Navicular/ Scaphoid bone fracture TX for non and displaced

A

refer to hand speclaist

non: thumb spica case
displaced: surgery w/ screws

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3
Q

Colles fracture

A

distal radius fracture w/ radius tilting upward. MOST common wrist fracture

will need sugery if displaced

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4
Q

What are the emergent cases of LBP

A

progressive loss of bladder resulting in retention or incontinence ( caude equina)

progressive numbness in pelvic area (saddle anesthesia)

Impending rupture of AAA (severe abd pain w/ low BP in elderly smokers)

night pain, fever, sweat, wgt loss ( cancer)

Osteoporosis ( check if on steroids)

Osteomyletisis

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5
Q

Classic presentation of mechanical LBP

A

dull pain that persist for weeks, NO nuero sympt

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6
Q

Sciatica

A

Impingement of L4-L5 nerve root causing ( type of radiculopathy). Sharp pain located midline and runs down leg to top of foot. May have weakness

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7
Q

what does the SLR check for?

A

sciatica pain
lumbrosacral ner root irritiation

SLR is a passive move

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8
Q

LBP tx

A

Pt education
NSAIDS
XRAYs not reccomended unless hx of trauma or red flag
MRI w/ people with nuero defs
No blood work
for muscle spasms - can use muscle relaxant (flexeril or Skelaxin) or valium

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9
Q

Ankylosing Spondylitis what/presentation/PE/ complications / TX

A

Progressive seronegative arthitis (HLA B 27 pos)

Chronic inflammation of the spine

Men from puberty to 40’s

young male, w/ progressive back pain w/ stiffness (most of spine), may have generalized fever, fatigue

PE: lumbar spine loss of lateral flexsion ( early finding)*

comp: anterior uveitis, cauda equina, increase in CRP and ESR

TX first line: high dose NSAIDS ( indomethacin)

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10
Q

When to use cold therapy?

A

first 48 hours to decrease swelling

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11
Q

isometric exercises

A

spares joint, helps build muscle ( resistance bands)

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12
Q

aerobic exercises

A

swimming, walking , biking

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13
Q

when to get MRI?

A

for soft tissue injuries such as cartilage, tendons

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14
Q

what is EMG?

A

electomyogram to evaluate nerve function

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15
Q

When can you get joint injections?

A

3/4 times per year. No in same joint more than once every 3 months.

watch out for : tendon rupture, infection, bleeding, DM, cushing syndrome

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16
Q

McMurray test

A

M = Meniscus assess for a “click” - also assess for joint line for tenderness on palpation

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17
Q

Anterior Drawer test

A

ACL test + = if laxity/glide when tibia is pulled forward ( anteriorly)

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18
Q

Posterior Drawer test

A

PCL test + = if laxity/glide when tibia is pulled backwards (posteriorly)

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19
Q

lachman test

A

Most sensitive test for ACL

+ = excessive motion of the knee = laxity

20
Q

Valgus stress test

A

MCL test + = laxity when medial stress applied ot the knee

putting stress on the actual medial ligament ( abduction)

21
Q

Vargus stress test

A

LCL : + = laxity when lateral or vargus stress applied to the knee

22
Q

Rotator Cuff tendinitis / shoulder impingement / supraspinatus tendinitis is most common in who?

A

common in young athletes ( swimmer, tennis, baseball) and middle-aged

23
Q

supraspinatus tendinitis what/ presentation/ tx

A

inflammation of rotator cuff

gradual or acute onset of pain w/ over head movements (hyperextension). Pain in front of shoulder (anteriorly) and radiates to the side of arm. Lifting and reaching cause pain.

TX: Nsaids, PT, avoid over head activity during acute phase

MRI is gold standard

24
Q

Lateral epicondylitis presentation, risk, tx

A

tennis elbow : overuse of forearm muscles ( flexors/extensors)

people at risk : painting, using screwdriver, tennis player

gradual onset of pain on the outside of the elbow that sometimes radiates to forearm. Pain worsens with twisting and grasping movements ( shaking hands, opening jars)

tx: RICE, can use tennis elbow strap

refractory cases ; cortisone injection

25
Q

Medial Epcondyitis presentation, risk, complication, pe

A

golf elbow/ baseball pitcher complains of aching pain over the inside part of the elbow

PE: tenderness to palpation over the inner aspect of the elbow

Risk : golfing, baseball, bowling, weight-lifters

complication: ulnar nerve neuropathy

26
Q

DeQuervain Tenosynovitis / Tendonitis : what/s/s, PE, TX, test

A

inflammation of the tendon sheath causing entrapment of the thumb tendons

s/s: wrist pain over the thumb side, pain with grasping

PE: tenderness/swelling over the thumb tendon

TX: wear a wrist splint 4-6 weeks, NSAIDs

+ Finklestein test ( fingers over thumb w/ ulnar deviation) = pain

27
Q

Carpal Tunnel Syndrome : what, presentation, tests, late sign, tx

A

Compression of the median nerve due to ( repetitive motion, hypothyriodism, preg) on palmer side

gradual onset of parathesias on the thumb, index, middle, half of ring finger

nocturnal awakening

+ Flick sign = shaking hand for releif
+ Phalen = full wrist flexion for 60 sec
+ tinels = tap anterior wrist briskly x 60 sec

Late sign : atrophy of the thenar eminence

TX: modify/limit motion
night splint
NSAIDS

28
Q

Classic presentation of Morton Neuroma and what

A

scarring of the common digital nerve ( ganglion) due to chronic pressure from wearing hight heels and tight-fitting shoes

complains of pebble-like mass and pain in the interspace area

+ Mulder sign

29
Q

Plantar Fasciitis

A

inflammation of pantar facia due to over use
stretching to help
complains of severe pain in am, on the heel of foot

30
Q

Chondromalacia Patella

A

Patellopfemoral syndrome

damage to the cartilage behind knee cap

31
Q

OA / DJD

A

most common joint dx in world
affects weight bearing joints
morning stiffness for less than 30 min
pain worse with cold weather, prolonged or overuse joint

PE: joint crepitus, joint deformity, swelling

Will have Herberdeen’s DIP nodes and Bouchards

TX : tylenol ASA #1 then NSAIDS

32
Q

Herberdeen nodes

A

DIP - only seen in OA/DJD

33
Q

Bouchard nodes

A

PIP - seen in both RA and OA

34
Q

TX for OA

A
  1. rest/ restriction of weight bearing on affected joint
  2. Tylenol
  3. if inflammation = NSAIDS
  4. hight risk stomach ulcers = COX 2 ( celebrex)
  5. if severe glucocosteroid intraarticular
35
Q

RA : what, late signs, signs, presentation, Pe, labs

A

systemic autoimmune dx
symmetrical arthitis that involves multiple joint

will NOT effect HIPS

Late sign: swan-neck deformity, boutonniere deformity ( on PIP)

will see bouchards nodes

presentation: middle aged women complains of new onset of swollen, painful and stiff joints especially on hand and wrist. Joint stiffness for hours in am. Pain NOT relieved by rest. Maay have low grade fever, normocytic anemia

PE: multiple joints, swollen, red, tender to palpation. IF rheumatoid nodules = chronic dx

Labs: + RH, ANA +, normocytic anemia,ESR and CRP +

Imaging: xrays

Complications : uveitis , vasculitis , need eye exam

TX : NSAIDS or ASA

36
Q

What are examples of DMARDS ( disease modifying agent for Rheumatoid disease)

A

Methotrexate and sulfaslazine
Plaquinil
Prednisone ( systemic)

37
Q

Biologics TNF

A

Humera, Enebrel = PPD adn CBC

adverse : lymphoma

38
Q

Fibrimyalgia

A

Soft tissue pain
chronic condition (last more than 3 months)
generalize MSK pain with fatigue, cognitive imparment

Need 11 out of 18 tender point to dx

occuring everywhere

39
Q

Gout what, presentation, joint, DX criteria

A

deposit of urate acid crytals ( monosodium urate ) on distal joints and tendons

middle age male with acute exacerbation of gout. pain ful ankle. knee wrist. recent increase alcohol intake, seafood, or meat. Serum uric acid level is increased

MTP joint of great toe swollen, red, hot, painful

Intake: alcohol, red meat, seafood, diurtics

DX: elevated uric level and clinical findings

untx gout: joint destruction and kidney damage

40
Q

Tophi

A

small white nodules filled with urates ( in ears and joints)

41
Q

Podagra

A

the classic red/swollen/painful toe of gout

42
Q

Gout management: acute

A

acute : provide pain relief.

if pt is on allopurinol continue and add pain med

start pain med ASAP w/ 12 hours of onset = indomethacin, naproxen, motrin

Low-dose colchine can shorten episode

43
Q

Colchicine dose

A

inital 1.2 mg followed by .6 mg in one hour

drink lots of water

44
Q

Gout Maintinance

A

use 4-6 wks after attac
check CBC prior to starting allopurinol
Probenecid

45
Q

Marfan’s syndrome

A

genetic disorder affects connective tissue production

concern about aortic anuresym / dissection

46
Q

Medial Tibia Stress Syndrome

A

(shins splints) can lead to stress fracture

F>M

complains of pain on the inner edge of the tibia.

TX:

  1. stop activity for weeks
  2. cold packs first 24-48 hours
  3. NSAIDs
  4. Once pain is gone Wait 2 weeks before resuming activity
  5. stretch
  6. if suspect a fracture get bone scan and MRI

AGNP AANC Boards (27 decks)

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