MSK geriatrics

Question 1

in what population is scoliosis most common

Answer 1

girls
FHx

Question 2

more sensitive screening test for scoliosis

Answer 2

Adams forward bend test

Question 3

XR scoliosis

Answer 3

Cobb’s angle >/= 10 degrees

Question 4

tx scoliosis

Answer 4

Cobb angle < 25 - observe

surgery if > 40

can do bracing otherwise to stop progression

Question 5

kyphosis vs lordosis

Answer 5

kyphosis - humpback
lordosis - swayback

Question 6

normal curvatures of the spine

Answer 6

cervical - lordosis
thoracic - kyphosis
lumbar - lordosis

Question 7

risks for ankylosis spondylitis

Answer 7

young males 15-30
HLA-b27

Question 8

sx ankylosis spondylitis

Answer 8

low back pain and neck pain
decreased ROM in the night and morning, not improved with rest
improves with exercise and activity

dactylitis - uniform swelling of the fingers and toes (sausage digits)

may have anterior uveitis
!!!

Question 9

dx ankylosis spondylitis

Answer 9

increased ESR, HLAB27 positivity

XR - bamboo spine - straightening of spine; loss of lordotic lumbar curvature + fusing of vertebrae

Question 10

tx ankylosis spondylitis

Answer 10

NSAIDs first line

anti-TNF drugs if no response after 2 weeks

Question 11

at what level is herniated disc MC

Answer 11

L5-S1

Question 12

sx herniated disc

Answer 12

RADICULAR BACK PAIN!!!

POSITIVE SLR, crossover

Question 13

dx herniated disc

Answer 13

XR
MRI

Question 14

tx herniated disc

Answer 14

conservative

injections

laminectomy vs discectomy

Question 15

MCC cauda equina

Answer 15

massive lumbar disc herniation

Question 16

sx cauda equina

Answer 16

back pain
leg pain
saddle anesthesia
urinary or bowel dysfunction

DECREASED ANAL SPHINCTER TONE

Question 17

dx cauda equina

Answer 17

MRI!!!!

Question 18

tx cauda equina

Answer 18

emergency decompression

Question 19

dx spinal stenosis

Answer 19

MRI preferred

Question 20

which hip fractures are associated with AVN

Answer 20

fractures of the femoral head and neck

Question 21

PE hip fracture

Answer 21

shortened, abducted, externally rotated (opposite for dislocation)

Question 22

dx hip fracture

Answer 22

XR - traction-internal rotation AP hip

Question 23

first line for osteoporosis

Answer 23

1200 Ca+
800 Vit D

Question 24

DEXA screening

Answer 24

65 F or older

Question 25

what is poly myalgia rheumatica associated with

Answer 25

giant cell arteritis

Question 26

sx polymyalgia rheumatica

Answer 26

pain and stiffness in the proximal joints and muscles - shoulder and hip girdles!!! worse after inactivity (worse in the AM > 45 min)

Question 27

PE polymyalgia rheumatica

Answer 27

normal muscle strength may have decreased ROM

Question 28

dx polymyalgia rheumatica

Answer 28

clinical increased ESR and CRP

Question 29

tx polymyalgia rheumatica

Answer 29

low dose steroids is associated with rapid response!!!

Question 30

what is polymyositis

Answer 30

muscle inflammation due to CD8+ lymphocytes

Question 31

sx polymyositis

Answer 31

progressive symmetric proximal muscle weakness (shoulder, hips) decreased muscle strength!!

Question 32

dx polymyositis

Answer 32

elevated muscle enzymes - CK, aldolase, AST, ALT, LDH Anti-jo-1 anti-signal recognition protein muscle biopsy - definitive

Question 33

tx polymyositis

Answer 33

high dose steroids

Question 34

sx RA

Answer 34

joint pain, stiffness, swelling worse inn the morning with morning stiffness > 1 hour after initiating movement improves later in the day wrist, MCP, PIP

Question 35

PE RA

Answer 35

symmetric inflamed joints - warm, erythematous, soft "boggy" ulnar deviation

Question 36

dx RA

Answer 36

RF - best initial anti-CCP most specific XR - symmetric joint narrowing, osteopenia, bone and joint erosions C1-2 subluxation

Question 37

tx RA

Answer 37

DMARDs (methotrexate, leflunomide) + NSAIDs or steroids (for sx)

Question 38

most important modifiable RF for OA

Answer 38

obesity

Question 39

sx OA

Answer 39

usage-related joint pain, stiffness, restriction of movement evening joint stiffness - worse throughout the day; morning stiffness is short in duration

Question 40

PE OA

Answer 40

asymmetric joint space narrowing marginal osteophytes

Question 41

tx OA

Answer 41

acetaminophen, NSAIDs, steroids