MSK Injuries in the ER

Question 1

What could snuff box tenderness indicate?

Answer 1

A scaphoid fx

Question 2

What is treatment for a scaphoid fx?

Answer 2

Hand f/u
Immobilization for up to 12 weeks
Thumb Spica Splint

Question 3

Diagnostics & Imaging used in Joint Pain?

Answer 3

X-ray
US
CT Scan
MRI

Question 4

Laboratory Blood Studies to order for Joint Pain?

Answer 4

CBC
BMP
ESR
CRP
RF
ANA
ANCA
Complement

Question 5

Laboratory Arthrocentesis Studies to order for Joint Pain?

Answer 5

Gram Stain
Culture
Cell Count (WBC, PMN)
Crystals

Question 6

DDx for Pain in front of knee at level of the patella

Answer 6

Chondromalacia patella
Patella Tracking
Bursitis
Arthritis

Question 7

DDx for pain above the patella

Answer 7

Quadriceps tendon injury
Quadriceps tendon swelling

Question 8

DDx for pain behind the patella

Answer 8

Baker’s cyst
arthritis

Question 9

DDx for pain on inside or outside of the knee at level of patella

Answer 9

meniscus or collateral ligament tears
arthritis

Question 10

DDx for pain below the patella

Answer 10

Osgood-Schlatter disease

Question 11

Synovial fluid findings (normal)
Color
Clarity
Viscosity
WBC per mm3
PMNs
Mucin Clot

Answer 11

Clear
Transparent
High
<200
<25%
Good

Question 12

Synovial fluid findings (Non-inflammatory)
Color
Clarity
Viscosity
WBC per mm3
PMNs
Mucin Clot

Answer 12

Yellow
Transparent
High
200-2,000
<25%
Good

Question 13

Synovial fluid findings (Inflammatory)
Color
Clarity
Viscosity
WBC per mm3
PMNs
Mucin Clot

Answer 13

Yellow to green
Opaque
Low
2,000-15,000
>50%
Good to poor

Question 14

Synovial fluid findings (Septic)
Color
Clarity
Viscosity
WBC per mm3
PMNs
Mucin Clot

Answer 14

Yellow
Opaque
Variable
15,000-200,000
>75%
Poor

Question 15

Diagnostics Imaging for suspicion of Gout?

Answer 15

x-ray the joint

Question 16

Labs for suspicion of Gout?

Answer 16

WBC
BMP
ESR
CSRP
Uric Acid
BC

Question 17

Labs for suspicion of Gout from arthroscopy?

Answer 17

Gram stain
routine culture
cell count
crystals

Question 18

Underlying disease processes that lead to Psudo-gout?

Answer 18

Hyperparathyroidism
Phosphorous
TSH
Magnesium
Ferritin
Iron
Alkaline Phosphate

Question 19

Pseudo-Gout
Birefringence
Shape
Color parallel to polarizer

Answer 19

Strong
Needle-like, sharp edges
Yellow

Question 20

Gout
Birefringence
Shape
Color parallel to polarizer

Answer 20

Weak
Rhomboid, rod-like
Blue

Question 21

Criteria that indicates Septic Arthritis?

Answer 21

Krocher Criteria

Question 22

Kocher Criteria for Septic Arthritis

Answer 22

Non-weight bearing
Temp > 38.5*C
ESR > 40mm/hr
WBC > 12,000 cells/mm3

Question 23

Risk Factors for Septic Arthritis?

Answer 23

Prosthetic Joint
Skin infection
Joint Surgery
RA
> 80 years of age
DM
IVDA
STD

Question 24

Precipitating Causes of Septic Arthritis

Answer 24

Artificial Joint implants
Bacterial infection somewhere else in your body
Chronic illness or disease (such as DM, RA, Sickle Cell Disease)
IV drug use
Medications that suppress your immune system
Recent joint injury
Recent joint arthroscopy or surgery
-

Question 25

Diagnostic Imaging for Septic Arthritis

Answer 25

X-ray the joint

Question 26

Blood Labs to order for suspicion of septic arthritis?

Answer 26

WBC
BMP
ESR
CRP
Uric Acid
BC

Question 27

Diagnostic Labs for Arthroscopy of joint?

Answer 27

Gram stain
routine culture
cell count
crystals

Question 28

Diagnostic Exams for septic arthritis?

Answer 28

weight bearing status
ROM (active vs passive)

Question 29

Diagnostic Workup for Low Back Pain
Cancer
Key features on hx or PE (imaging for associated features)
Additional Studies

Answer 29

Hx of CA w/ new onset LBP (MRI)
Unexplained weight loss (Lumbrosacral plain radiograph)
Failure to improve after 1 mo (Lumbrosacral plain radiograph
Age > 50 years (Lumbrosacral plain radiograph
Multiple risk factors present ( Plain Radiograph or MRI)

ESR

Question 30

Diagnostic Workup for Low Back Pain
Vertebral Infection
Key features on hx or PE?
Imaging?
Additional Studies?

Answer 30

Fever, IV drug use, Recent infection
MRI
ESR and/or CRP

Question 31

Diagnostic Workup for Low Back Pain
Cauda Equina Syndrome
Key features on hx or PE?
Imaging?
Additional Studies?

Answer 31

Urinary retention, motor deficits at multiple levels, fecal incontinence, saddle anesthesia
MRI
None

Question 32

Diagnostic Workup for Low Back Pain
Ankylosing Spondylitis
Key features on hx or PE?
Imaging?
Additional Studies?

Answer 32

Morning stiffness, improvement w/ exercise, Alternating buttock pain, Awakening d/t back pain during the second part of the night, younger age
Anterior-posterior pelvis plain radiography
ESR and/or CRP, HLA-B27

Question 33

Diagnostic Workup for Low Back Pain
Severe / Progressive neurologic deficits
Key features on hx or PE?
Imaging?
Additional Studies?

Answer 33

Progressive motor weakness
MRI
Consider EMG/NCV

Question 34

Diagnostic Workup for Low Back Pain
Herniated Disc Symptoms present <1 mo
Key features on hx or PE?
Imaging?
Additional Studies?

Answer 34

Back pain with leg pain in an L4, L5, or S1 nerve root distribution, Positive Straight-leg-raise test or crossed leg straight-leg-raise test
None
None

Question 35

Diagnostic Workup for Low Back Pain
Herniated Disc Symptoms Present > 1mo
Key features on hx or PE?
Imaging?
Additional Studies?

Answer 35

Back pain with leg pain in an L4, L5, or S1 nerve root distribution, Positive Straight-leg-raise test or crossed leg straight-leg-raise test
MRI
Consider EMG/NCV

Question 36

Diagnostic Workup for Low Back Pain
Spinal Stenosis Symptoms present for <1mo
Key features on hx or PE?
Imaging?
Additional Studies?

Answer 36

Radiating leg pain, Older age (pseudoclaudication a weak predictor)
none
none

Question 37

Diagnostic Workup for Low Back Pain
Spinal Stenosis Symptoms present for >1mo
Key features on hx or PE?
Imaging?
Additional Studies?

Answer 37

Radiating leg pain, Older age (pseudoclaudication a weak predictor)
MRI
Consider EMG/NCV