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Clin Med I Disease Key Notes > MSK/Rheum (Exam 3) > Flashcards

MSK/Rheum (Exam 3) Flashcards

1
Q

What condition involves bone overgrowth/bone abnormality during bone development that changes function of hip joint?

A

FAI (Femoroacetabular Impingement)

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2
Q

What condition AND specific subtype has acetabular involvement; extra bone extends over normal rim of acetabulum?

A

FAI (Femoroacetabular Impingement)

- Pincer

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3
Q

What condition AND specific subtype has femoral head involvement; femoral head not round so does not run smoothly inside acetabulum

A

FAI (Femoroacetabular Impingement)

- Cam

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4
Q

What condition involves pain aggravated with turning, twisting, prolonged standing/squatting?

A

FAI (Femoroacetabular Impingement)

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5
Q

What is the best physical exam test for evaluating FAI (Femoroacetabular Impingement)? What other test may be considered?

A

FADIR is best test

- Also FABER

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6
Q

What condition involves dull or sharp groin pain that may radiate; catching, clicking that may cause pain?

A

Labral Tear of hip

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7
Q

What is the best radiology test for a Labral Tear of hip?

A

MR Arthrogram is best test

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8
Q

What LE condition is most common in dancers?

A

Snapping Hip Syndrome

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9
Q

What LE condition involves tendon sliding over bone at top of femur (involves IT band and greater trochanter)?

A

EXternal Snapping Hip Syndrome

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10
Q

What LE condition involves tendon sliding over bone structures anteriorly (involves iliopsoas tendon over femoral head)

A

INternal Snapping Hip Syndrome

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11
Q

What LE condition involves snapping/popping sensation worse with activity (painless or painful); pseudosubluxation?

A

Snapping Hip Syndrome

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12
Q

With Snapping Hip Syndrome, what is often possible on physical exam?

A

Snapping often reproducible by patient

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13
Q

What PE exam is used to test internal Snapping Hip Syndrome? What PE exam is used to test external Snapping Hip Syndrome?

A
  • Internal: FABER

- External: passive internal and external rotation of hip

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14
Q

What condition involves PAIN, lateral hip pain with localized pain to greater trochanter?

A

Greater Trochanter Pain Syndrome

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15
Q

What is the most common cause of lateral hip pain in adults?

A

Greater Trochanter Pain Syndrome

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16
Q

What LE condition can present with positive Trendelenburg Test on physical exam?

A

Greater Trochanter Pain Syndrome

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17
Q

With what LE condition are steroid injections VERY effective?

A

Greater Trochanter Pain Syndrome

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18
Q

What is the Unhappy Triad? What is another name for this?

A

Unhappy Triad = Triad of O’Donoghue

- MCL, ACL and medial meniscus

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19
Q

What LE condition has an MOI that most commonly involves knee flexion + foot planted AND lateral impact causing valgus stress?

A

Medial Collateral Ligament (MCL) Sprain

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20
Q

What is the least common knee ligament injury?

A

Lateral Collateral Ligament (LCL) Sprain

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21
Q

What type of physical exam is performed for an MCL or LCL sprain?

A

Varus (medial force applied) or valgus (lateral force applied)

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22
Q

What is the most common knee ligament injury?

A

Anterior Cruciate Ligament (ACL) Injury

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23
Q

What injury are 50% of Anterior Cruciate Ligament (ACL) Injury associated with?

A

50% associated with meniscus injury

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24
Q

Which type of knee ligament injury requires contact on MOI? Which one classically does not require contact?

A
  • Medial Collateral Ligament (MCL) Sprain: contact required

- Anterior Cruciate Ligament (ACL) Injury: NON-contact

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25
Q

What LE condition involves feeling/hearing “pop” → immediate pain and swelling with feeling of instability?

A

Anterior Cruciate Ligament (ACL) Injury

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26
Q

What three physical exam tests are performed for an Anterior Cruciate Ligament (ACL) Injury?

A

Lachman test

- Also Anterior Drawer, and Pivot Shift

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27
Q

Most LE injuries involve supportive care as treatment. Which injury is an exception that often requires surgery?

A

Anterior Cruciate Ligament (ACL) Injury

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28
Q

What MOI is most common with a Posterior Cruciate Ligament (PCL) Injury?

A

Most likely MVA trauma injury

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29
Q

What type of knee ligament injury is least likely to be injured in athletics?

A

Posterior Cruciate Ligament (PCL) Injury

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30
Q

Which meniscus is more susceptible to injury?

A

Medial

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31
Q

What LE condition involves joint line pain; “locking” or “catching” of knee?

A

Medial Meniscus Injury

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32
Q

What physical exam test is performed to test for a Medial Meniscus Injury? Describe this.

A

McMurray Test

- Medial: hand on medial meniscus and other on foot, ext. rotate foot and apply valgus stress at knee

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33
Q

What physical exam test is performed to test for a Lateral Meniscus Injury? Describe this.

A

McMurray Test

- Lateral: hand on lateral meniscus and other on foot, int. rotate foot and apply varus stress at knee

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34
Q

What are the three grades of knee sprains? Describe each, AND the recommended treatment for each.

A
  • Grade I (mild stretch): supportive (RICE, weight-bearing as tolerated)
  • Grade II (partial tear): supportive +/- surgery (RICE, brace immobilization, PT, possible surgery)
  • Grade III (complete tear): surgery (then supportive with crutches, brace, PT)
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35
Q

What LE conditions involves deep knee pain anteriorly?

A

Patellofemoral Pain Syndrome (Runner’s Knee)

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36
Q

What is the most common knee complaint in primary care medicine?

A

Patellofemoral Pain Syndrome (Runner’s Knee)

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37
Q

What LE condition involves positive theater sign/long car ride sign; often see crepitus, popping, feeling of instability?

A

Patellofemoral Pain Syndrome (Runner’s Knee)

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38
Q

What two physical exam tests are performed to test for Patellofemoral Pain Syndrome (Runner’s Knee)?

A

Patellar Glide

- Also Apprehension Test

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39
Q

What LE condition involves accumulation of fluid in popliteal fossa behind knee?

A

Baker’s Cyst (Popliteal Cyst)

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40
Q

What LE condition is often asymptomatic, or found incidentally; potential pain with prolonged standing or activity?

A

Baker’s Cyst (Popliteal Cyst)

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41
Q

What LE condition often occurs after skeletal maturity in adulthood?

A

Patellar Tendonitis (Jumper’s Knee)

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42
Q

What population is Patellar Tendonitis (Jumper’s Knee) most common in?

A

Athletes

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43
Q

What treatment is not recommended for Patellar Tendonitis (Jumper’s Knee)?

A

Steroid injection NOT recommended

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44
Q

What LE condition involves : progressive localized pain to lateral thigh?

A

Iliotibial Band Syndrome (ITBS)

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45
Q

What population is Iliotibial Band Syndrome (ITBS) most common in?

A

Overuse injury more common in runners/cyclists

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46
Q

What LE condition has a physical exam finding significant for localized tenderness that is reproducible with ROM/compression?

A

Iliotibial Band Syndrome (ITBS)

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47
Q

What are the three subtypes of Knee Bursitis?

A
  • Prepatellar
  • Pes anserinus
  • Suprapatellar
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48
Q

For which LE condition should you consider aspirating to rule out infection? What treatment should not be done if there is infection?

A

Knee Bursitis

- Do NOT perform injections if infected

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49
Q

What LE condition involves idiopathic osteonecrosis of subchondral bone? What is the most common location for this to occur?

A 
Osteochondritis Dissecans (OCD)
- Most common in the knee joint
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50
Q

If Osteochondritis Dissecans (OCD) is in the elbow, what is the most likely location?

A

Capitellum (laterally)

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51
Q

If Osteochondritis Dissecans (OCD) is in the knee, what is the most likely location?

A

Lateral portion of medial femoral condyle from repetitive actions

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52
Q

What age range is most commonly affected by Osteochondritis Dissecans (OCD)?

A

10-20 years old

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53
Q

What LE condition involves ague symptoms like progressive, deep, poorly localized pain; decreased ROM in elbow but not knee; can include popping, clicking, catching with advanced disease, may have intermittent swelling?

A

Osteochondritis Dissecans (OCD)

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54
Q

What type of radiology is recommended for Osteochondritis Dissecans (OCD)? What would be seen on imaging?

A

X-ray

- Would show flattening of articular surface (crater)

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55
Q

What five conditions should be considered if a patient presents with ANTERIOR knee pain?

A
  • Injury of quadriceps/patellar tendons
  • Patellofemoral pain syndrome
  • Knee bursitis
  • Patellar fracture/dislocation
  • Osgood-Schlatter disease
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56
Q

What three conditions should be considered if a patient presents with MEDIAL knee pain?

A
  • MCL injury
  • Medial meniscus injury
  • Pes anserine bursitis
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57
Q

What three conditions should be considered if a patient presents with LATERAL knee pain?

A
  • LCL injury
  • IT band syndrome
  • Lateral meniscus
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58
Q

What two conditions should be considered if a patient presents with POSTERIOR knee pain?

A
  • Baker’s Cyst

- DVT

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59
Q

Which ankle location is most commonly injured? What specific ligament complex is injured most?

A

Lateral most commonly injured
- Lateral Ligament Complex (anterior talofibular ligament, calcaneofibular ligament (CFL) and posterior talofibular ligament)

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60
Q

What are the three types of ankle sprains (think location)? What is the MOI for each?

A
  • Lateral: inversion injury
  • Medial: eversion injury
  • Syndesmotic: rotational injury
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61
Q

What is the physical exam test performed for a lateral ankle sprain?

A

Anterior Drawer Test

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62
Q

What is the physical exam test performed for a syndesmotic ankle sprain?

A

Squeeze Test

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63
Q

What is the most important treatment for ankle sprain?

A

PT

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64
Q

What LE condition is due to increased activity and involves burning pain worse with activity?

A

Achilles Tendinopathy

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65
Q

What LE condition often involves a sensation of violent “hit or pop” due to sudden pivot or rapid acceleration?

A

Achilles Tendon Rupture

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66
Q

What Achilles Tendon injury is common in pediatrics?

A

Calcaneal Apophysitis (Sever’s Disease)

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67
Q

What is the physical exam test performed for an Achilles Tendon Rupture? Describe this.

A

Thompson Test (+ if squeeze calf of affected Achilles Tendon with no movement of foot)

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68
Q

If an Achilles Tendon Rupture is suspected, what position should the foot be kept in (think for splinting)?

A

Keeping foot in continued plantar flexed position

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69
Q

What LE condition involves pain with onset of walking (first step in the morning)?

A

Plantar Fasciitis

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70
Q

What is one of the most common causes of foot pain?

A

Plantar Fasciitis

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71
Q

With Plantar Fasciitis, what should be ruled out? How do you rule it out (think exams)?

A

Rule out S1 radiculopathy (weakness with great toe dorsiflexion) with SLR and Achilles DTR

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72
Q

What is an inflammatory arthritis involving hyperuricemia?

A

Gout

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73
Q

What level is considered hyperuricemia (think exceeds what value)?

A

Serum uric acid level exceeds 6.8 mg/dL

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74
Q

With Gout, what does uric acid accumulate into?

A

Uric acid accumulates into monosodium urate (MSU) crystals

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75
Q

What is uric acid? What types of food is it found in?

A

Uric acid: breakdown product of purine metabolism

- Found in red meat, seafood

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76
Q

What are the two population groups for Gout (think reasons for getting gout)? Which is more common? Describe each

A
  • Underexcretors (90%): more common; due to kidney disease or fluid abnormalities
  • Overproducers: due to high cell turnover
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77
Q

What are four non-modifiable risk factors associated with Gout?

A
  • Male
  • Older
  • Pacific Islanders
  • Genetic variants
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78
Q

What are eight modifiable risk factors associated with Gout?

A
  • Obesity
  • HTN
  • Hyperlipidemia
  • CKD
  • Type II DM
  • Diet
  • EtOH
  • Certain medications
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79
Q

What is white chalky material consisting of dense concentrations of MSU crystals? What condition are they associated with?

A

Tophi

- Seen with chronic Gout

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80
Q

What conditions involves rapid onset of severe pain at night?

A

Acute Gout Flare

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81
Q

What condition is often recurrent, monoarticular, affecting the 1st MTP joint? What is this location site specifically called?

A

Acute Gout Flare

- 1st MTP joint = “Podagra”

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82
Q

What condition is triggered by acute increase OR decrease in uric acid levels? What two types of medications might cause this?

A

Acute Gout Flare

  • Thiazide loop diuretics
  • Urate-lowering medications
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83
Q

What condition shows bony erosions like “punched out” or “rat bite erosions”? What stage of the disease does this occur?

A

Advanced disease of Gout

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84
Q

What diagnostic test will provide a definitive diagnosis for Gout OR Pseudogout?

A

Arthrocentesis/synovial fluid analysis

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85
Q

What condition would show + for MSU crystals that are needle-shaped and negatively birefringent on polarized light microscopy?

A

Gout

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86
Q

What are the three recommended treatments for Acute Gout Flare OR Pseudogout?

A
  • NSAIDs (Indomethacin or Naproxen)
  • Steroids
  • Colchicine
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87
Q

What is ULT (Urate-Lowering Therapy)? How does it work, and what condition is it used to treat?

A

ULT treat Gout
- Lowers serum uric acid levels to avoid future attacks by preventing new crystal formation and dissolving those already formed

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88
Q

What prophylactic treatment should be considered when starting ULTs?

A

Adding NSAIDs or Colchicine

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89
Q

What are Xanthine Oxidase Inhibitors (XOIs) an example of, and what condition do they treat?

A

XOIs are a type of ULT

- Used to treat Gout

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90
Q

What population group of Gout do XOIs work for?

A

Underexcretors AND overproducers

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91
Q

What is the DOC for XOIs to treat Gout? What type of dosing should be considered? What are possible side effects of this DOC?

A

Allopurinol

  • Consider renal dosing (low and slow)
  • Side effect: SJS
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92
Q

What population group of Gout do Uricosuric Agents work for?

A

Underexcretors only

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93
Q

When should ULTs NOT be considered for the treatment of Gout? When is the appropriate time to use ULTs?

A

Acute Gout Flare

- Wait 2 weeks

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94
Q

Why is long-term management of ULTs important?

A

Non-optimal sUA levels can increase risk for premature mortality

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95
Q

What two metabolic/endocrine disorders are often associated with Pseudogout?

A
  • Hemochromatosis

- Hyperparathyroidism

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96
Q

What are three possible causes/triggers of Acute Pseudogout?

A
  • Trauma
  • Surgery
  • Severe medical illness
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97
Q

What condition involves severe acute joint inflammation with possible associated systemic findings?

A

Pseudogout

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98
Q

If an x-ray is performed for Pseudogout, what would be seen on imaging?

A

Chondrocalcinosis, or “cartilage calcification”

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99
Q

What condition would show + for CPP crystals that are rhomboid-shaped and positively birefringent on polarized light microscopy?

A

Pseudogout

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100
Q

What are the two subtypes of Axial Spondyloarthritis?

A
  • Ankylosing Spondylitis

- Non-radiographic axial SpA

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101
Q

What are the four subtypes of Peripheral Spondyloarthritis?

A
  • Reactive arthritis
  • Psoriatic arthritis
  • Arthritis associated with IBD
  • Peripheral SpA without any associated illness aka “undifferentiated SpA”
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102
Q

What group of diseases involve a strong association with HLA-B27?

A

Spondyloarthropathies (SpA)

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103
Q

What group of diseases are generally seronegative (rheumatoid factor (RF) is negative)?

A

Spondyloarthropathies (SpA)

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104
Q

What subtype of SpA involves inflammation/swelling of LEs, asymmetrical; affects 1-3 joints (oligoarthritis)?

A

Peripheral SpA

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105
Q

What condition involves inflammation/swelling of entheses, particularly at Achilles tendon?

A

Enthesitis (“heel pain”)

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106
Q

What subtype of SpA involves acute, non-septic inflammatory arthritis that is asymmetrical oligoarthritis?

A

Reactive Arthritis (ReA)

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107
Q

Which subtype of SpA is triggered by preceding GI or GU/STD infection 1-4 weeks prior?

A

Reactive Arthritis (ReA)

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108
Q

What subtype of SpA involves “can’t see, can’t pee, can’t climb a tree”? What does each mean symptomatically?

A

Reactive Arthritis (ReA)

  • “Can’t see”: conjunctivitis, uveitis
  • “Can’t pee”: urethritis
  • “Can’t climb a tree”: peripheral and/or axial symptoms of peripheral arthritis
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109
Q

What subtype of SpA involves conjunctivitis/uveitis, urethritis and peripheral arthritis?

A 
Reactive Arthritis (ReA)
- “Can’t see, can’t pee, can’t climb a tree”
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110
Q

What is the initial treatment for Reactive Arthritis (ReA)? If this doesn’t work, what type of medication should be considered?

A

NSAIDs with rheumatology referral

- DMARDs can be started

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111
Q

What subtype of SpA involves chronic inflammatory disease of axial skeleton, particularly SI joints and spine?

A

Ankylosing Spondylitis (AS)

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112
Q

What subtype of SpA involves a STRONG hereditary component?

A

Ankylosing Spondylitis (AS)

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113
Q

What subtype of SpA involves inflammatory back pain and progressive stiffness of spine?

A

Ankylosing Spondylitis (AS)

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114
Q

What subtype of SpA progresses proximally?

A 
Ankylosing Spondylitis (AS)
- SI joints to outer fibers of annulus fibrosus
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115
Q

What subtype of SpA shows “bamboo spine” appearance with late disease on imaging?

A

Ankylosing Spondylitis (AS)

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116
Q

What subtype of SpA involves enthesitis with chronic inflammation → structural damage that is attempted to be repaired by new bone formation (ossification) → leads to fusion

A

Ankylosing Spondylitis (AS)

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117
Q

What subtype of SpA involves limited spine mobility and chest expansion on physical exam?

A

Ankylosing Spondylitis (AS)

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118
Q

What is the initial treatment for Ankylosing Spondylitis (AS)?

A

First line is NSAIDs (Indomethacin or Naproxen)

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119
Q

When considering referral to rheumatology, what are the two required requirements for SpA, as well as the list of seven other conditions that 1+ must be present?

Lol sorry this question sucks ass

A

Patients with >3 months back pain + age onset <45 years + 1 or more of these…

  • Positive family history of SpA
  • Inflammatory back pain
  • HLA-B27 positivity
  • Sacroiliitis on imaging
  • Extraarticular manifestations
  • Good response with NSAIDs
  • Elevated acute phase reactants
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120
Q

What condition is a chronic multi-organ autoimmune disorder?

A

Systemic Lupus Erythematosus (SLE)

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121
Q

What general symptom is often associated with Systemic Lupus Erythematosus (SLE)?

A

Fatigue

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122
Q

What four skin symptoms are often associated with Systemic Lupus Erythematosus (SLE)?

A
  • Malar rash (“butterfly rash”)
  • Discoid
  • Painless oral/nasal ulcers
  • Raynaud Phenomenon
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123
Q

What cardiac symptom is often associated with Systemic Lupus Erythematosus (SLE)?

A

At increased risk for MI due to accelerated atherosclerosis

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124
Q

What two renal symptoms are often associated with Systemic Lupus Erythematosus (SLE)?

A

Nephritis with proteinuria

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125
Q

What condition involves joint pain/joint effusions that tend to be migratory, polyarticular and symmetrical?

A

Systemic Lupus Erythematosus (SLE)

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126
Q

What condition involves positive ANA (with titer and staining – homogenous and speckled) + subtypes (positive anti-dsDNA, anti-Sm and antiphospholipid antibodies)?

A

Systemic Lupus Erythematosus (SLE)

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127
Q

What is the first line pharmacologic treatement for Systemic Lupus Erythematosus (SLE)? What referral MUST be made before starting this medication, and why?

A

Antimalarials (Plaquenil)

- Regular ophthalmology follow-up for Plaquenil and possible retinal toxicity

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128
Q

What three co-morbid disease worsen prognosis for Systemic Lupus Erythematosus (SLE)?

A
  • Active renal disease/infection
  • Active CNS disease/infection
  • CV disease
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129
Q

What three medications can caused Drug-Induced Lupus?

A
  • Isoniazid
  • Procainamide
  • Hydralazine
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130
Q

What condition has similar symptoms to Systemic Lupus Erythematosus (SLE)?

A

Drug-Induced Lupus

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131
Q

What condition involves positive antihistone antibody test; negative anti-dsDNA and anti-Sm antibody?

A

Drug-Induced Lupus

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132
Q

What condition involves progressive, symmetric proximal muscle weakness most often in deltoids and hip flexors?

A

Polymyositis

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133
Q

What other systems may be affected by Polymyositis, and which is most important to consider/why?

A

Lungs: cough/SOB due to interstitial lung disease

- Also Raynaud Phenomenon, esophageal disease, cardiac disease, myocarditis and skin

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134
Q

What is Dermatomyositis?

A

Polymyositis + cutaneous eruptions

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135
Q

What condition involves increased risk of occult malignancy?

A

Dermatomyositis

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136
Q

What is an erythematous/violaceous rash on upper eyelids? What condition is it associated with?

A

Heliotrope rash

- Associated with Dermatomyositis

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137
Q

What is an erythematous/violaceous papules on dorsal aspect of MCP, PIP and DIP joints? What condition is it associated with?

A

Gottron’s papules

- Associated with Dermatomyositis

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138
Q

What is redness at top of shoulders called? What condition is it associated with?

A

Shawl sign

- Associated with Dermatomyositis

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139
Q

What two conditions show elevated CK and aldolase on labs?

A
  • Polymyositis

- Dermatomyositis

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140
Q

What is the first line treatment for both Polymyositis and Dermatomyositis?

A

Steroids

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141
Q

What condition involves systemic, chronic autoimmune inflammatory disorder of exocrine glands/extraglandular features?

A

Sjögren’s Syndrome

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142
Q

What condition involves “sicca complex”? What are the two symptoms of this complex?

A

Sjögren’s Syndrome

  • Xerophthalmia (dry eyes)
  • Xerostomia (dry mouth)
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143
Q

What condition will have a positive Schirmer Test?

A

Sjögren’s Syndrome

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144
Q

What condition involves +ANA with positive Anti-Ro/SSA and Anti-La/SSB?

A

Sjögren’s Syndrome

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145
Q

What three specialty referrals are recommended for follow up with Sjögren’s Syndrome?

A
  • Dentist
  • Ophthalmologist
  • Rheumatologist
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146
Q

What condition involves inflammation of muscular arteries resulting in thrombosis, ischemia, infarct?

A

Polyarteritis Nodosa (PAN)

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147
Q

What population is more commonly affected by Polyarteritis Nodosa (PAN)?

A

Most common in males

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148
Q

What condition involves leukocytoclastic vasculitis mostly in LE?

A

Polyarteritis Nodosa (PAN)

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149
Q

What other two diseases are often associated with Polyarteritis Nodosa (PAN)?

A
  • Renal disease

- HTN

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150
Q

What condition has a negative ANCA (antineutrophil cytoplasmic antibodies)?

A

Polyarteritis Nodosa (PAN)

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151
Q

What is the first line treatment for Polyarteritis Nodosa (PAN)?

A

Steroids +/- immunosuppressants

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152
Q

What rare condition involves autoimmune disorder causing diffuse fibrosis (thickening/tightening) of skin/internal organs?

A

Systemic Sclerosis (SSc)

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153
Q

What are the two subtypes of Systemic Sclerosis (SSc)?

A
  • Limited Cutaneous SSc

- Diffuse Cutaneous SSc

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154
Q

What condition involves CREST? What does each letter stand for (aka what are the symptoms)?

A

Limited Cutaneous SSc

  • Calcinosis
  • Raynaud syndrome
  • Esophageal dysfunction
  • Sclerodactyly
  • Telangiectasias
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155
Q

What condition has a +ANA; positive ACA (anti-centromere antibodies)?

A

Limited Cutaneous SSc

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156
Q

Does Limited Cutaneous SSc or Diffuse Cutaneous SSc have a better prognosis?

A

Limited Cutaneous SSc has a better prognosis

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157
Q

What condition involves CREST + trunk and proximal extremities involved?

A

Diffuse Cutaneous SSc

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158
Q

What condition has a +ANA; positive Anti-Scl-70 (Antitopoisomerase I antibodies); or positive Anti-RNA Polymerase III antibody?

A

Diffuse Cutaneous SSc

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159
Q

What is the recommended treatment for Raynaud Phenomenon?

A

Nifedipine

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160
Q

What is the most common inflammatory arthritis?

A

Rheumatoid Arthritis (RA)

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161
Q

What condition involves primarily synovial joints with possible extraarticular manifestations?

A

Rheumatoid Arthritis (RA)

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162
Q

What condition involves synovial hypertrophy and chronic joint inflammation?

A

Rheumatoid Arthritis (RA)

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163
Q

What condition progresses from periphery to proximal symmetrical pain, stiffness, with swelling of many joints?

A

Rheumatoid Arthritis (RA)

164
Q

What condition affects the MCP and PIP joints but NOT the DIP joints?

A

Rheumatoid Arthritis (RA)

165
Q

Typically, the axial skeleton is spared with Rheumatoid Arthritis (RA), except for which level?

A

Cervical spine with advanced disease

166
Q

What two conditions involve LONG morning stiffness more than 1 hour?

A
  • Rheumatoid Arthritis (RA)

- Polymyalgia Rheumatica (PMR)

167
Q

What two conditions are WORSE WITH REST, better with activity?

A
  • Rheumatoid Arthritis (RA)

- Polymyalgia Rheumatica (PMR)

168
Q

What type of arthritis involves accelerated cardiovascular disease?

A

Rheumatoid Arthritis (RA)

169
Q

What is Felty’s Syndrome, and what condition is it associated with?

A

Felty’s Syndrome: triad of RA, splenomegaly and neutropenia

- Associated with Rheumatoid Arthritis (RA)

170
Q

What condition has soft, warm, tender joints on physical exam?

A

Rheumatoid Arthritis (RA)

171
Q

What condition has that “boggy” and fluctuant joints on physical exam?

A

Rheumatoid Arthritis (RA)

172
Q

What condition has “trigger” finger from flexor tendon tenosynovitis on physical exam?

A

Rheumatoid Arthritis (RA)

173
Q

What condition has “ulnar drift” on physical exam?

A

Rheumatoid Arthritis (RA)

174
Q

What condition has swan-neck and boutonniere deformities on physical exam?

A

Rheumatoid Arthritis (RA)

175
Q

What condition is associated with carpal tunnel syndrome and ulnar nerve compression on physical exam?

A

Rheumatoid Arthritis (RA)

176
Q

What condition presents with rheumatoid nodules on physical exam?

A

Rheumatoid Arthritis (RA)

177
Q

What condition has hammer toes; hallux valgus (bunions) on physical exam?

A

Rheumatoid Arthritis (RA)

178
Q

What condition has associated Baker’s cyst with effusion and limited knee ROM on physical exam?

A

Rheumatoid Arthritis (RA)

179
Q

What condition involves joint instability at C1-C2? What can this progress to?

A 
Rheumatoid Arthritis (RA)
- Can progress to cervical myelopathy
180
Q

What is the preferred radiology test for Rheumatoid Arthritis (RA)? What might be seen on imaging?

A

X-ray preferred

- Evidence of soft tissue swelling around joint, bony erosions

181
Q

What condition has positive RF AND positive Anti-CCP (Anti-Cyclic Citrullinated Peptide) antibodies?

A

Rheumatoid Arthritis (RA)

182
Q

What test can show as seronegative for Rheumatoid Arthritis (RA), but should still be referred if suspected?

A

RF may be seronegative

183
Q

What is the first line treatment for Rheumatoid Arthritis (RA)?

A

DMARDs + NSAIDs/steroids

184
Q

How do DMARDs work (2)?

A
  • Slow/halt disease progression

- Preserve joint function

185
Q

What are the two risks associated with DMARDs?

A
  • Infection

- Malignancy

186
Q

What are four non-pharmacologic treatments for Rheumatoid Arthritis (RA), and what is the primary goal?

A

Preserve ADLs

  • Rest/exercise/PT/OT
  • Nutrition/diet
  • Psychosocial help
  • Stop smoking
187
Q

What is a major risk factor associated with Rheumatoid Arthritis (RA)?

A

SMOKING

188
Q

What is the most common form of general arthritis?

A

Osteoarthritis (OA)

189
Q

What condition involves joint pain and functional impairment, leading to disability?

A

Osteoarthritis (OA)

190
Q

What condition involves synovitis + bony changes (osteophytes) + soft tissue involvement?

A

Osteoarthritis (OA)

191
Q

What arthritic condition involves cartilage loss and which tissues are involved?

A

Osteoarthritis (OA)

- ALL joint tissues involved

192
Q

What condition involves any joint changes trigger proinflammatory mediators?

A

Osteoarthritis (OA)

193
Q

What condition involves single OR multiple joints; asymmetrical pain of hands WITH DIPs?

A

Osteoarthritis (OA)

194
Q

What condition affects the 1st CMC joint of wrist and 1st MTP joints of feet?

A

Osteoarthritis (OA)

195
Q

Which arthritic condition does NOT involve extraarticular manifestations?

A

Osteoarthritis (OA)

196
Q

What arthritic condition involves the knees, hips, cervical and lumbar spine?

A

Osteoarthritis (OA)

197
Q

What condition has SHORT morning stiffness less than 30 minutes?

A

Osteoarthritis (OA)

198
Q

What condition has hard, bony joints on physical exam?

A

Osteoarthritis (OA)

199
Q

What condition has Heberden’s nodes and Bouchard’s nodes on physical exam? What joint does each type of node affect?

A

Osteoarthritis (OA)

  • Heberden’s nodes: DIP joints
  • Bouchard’s nodes: PIP joints
200
Q

What condition has the 1st CMC “squared off” on physical exam?

A

Osteoarthritis (OA)

201
Q

What condition has UNIlateral hip pain with decreased ROM and hip/groin pain? What body part might show referred pain?

A

Osteoarthritis (OA)

- Referred pain to knee possible

202
Q

What type of radiology is recommended for Osteoarthritis (OA), AND HOW should it be obtained? What would be seen on imaging?

A

X-rays WITH weight bearing

- Shows joint space narrowing and osteophyte formation

203
Q

How is Osteoarthritis (OA) diagnosed?

A

Clinical

- Labs often normal

204
Q

What are the four recommended treatments for Osteoarthritis (OA) ?

A
  • NSAIDs/Tylenol
  • Tramadol
  • Steroid injections
  • SNRIs
205
Q

What two conditions are often associated with Osteoarthritis (OA)?

A
  • Depression

- Sleep issues

206
Q

What age group is most affected by Polymyalgia Rheumatica (PMR)?

A

50+ years

207
Q

What condition involves discrete bilateral, proximal aching and stiffness (affects shoulders, neck, pelvis)?

A

Polymyalgia Rheumatica (PMR)

208
Q

What condition has symptoms due to synovitis, tenosynovitis and bursitis?

A

Polymyalgia Rheumatica (PMR)

209
Q

What condition has limited ROM with subjective weakness but normal muscle strength on physical exam?

A

Polymyalgia Rheumatica (PMR)

210
Q

What condition has VERY elevated ESR/CRP? What is the level numerically?

A 
Polymyalgia Rheumatica (PMR)
- >40 mm/hr
211
Q

What is the recommended treatment for Polymyalgia Rheumatica (PMR)?

A

STEROIDS

- ALWAYS WORK!

212
Q

Which condition uses steroids as the first line treatment AND they always work? What is the recommended dose/course?

A 
Polymyalgia Rheumatica (PMR)
- Begin at 10-20 mg/day and slowly taper over 1 year
213
Q

What condition is very common, chronic WIDESPREAD musculoskeletal pain?

A

Fibromyalgia (FM)

214
Q

What condition often occurs in conjunction with RA and SLE?

A

Fibromyalgia (FM)

215
Q

What condition is considered a disorder of central pain processing?

A

Fibromyalgia (FM)

216
Q

What condition has a strong genetic component and must be present for >3 months?

A

Fibromyalgia (FM)

217
Q

What condition has vague symptoms of widespread muscle pain with associated fatigue, poor sleep, depression/anxiety and psych/cognitive issues?

A

Fibromyalgia (FM)

218
Q

What condition has vague symptoms with associated headaches and IBS?

A

Fibromyalgia (FM)

219
Q

What condition has widespread soft tissue tenderness but NO soft tissue swelling or redness on physical exam?

A

Fibromyalgia (FM)

220
Q

What is the first line treatment for Fibromyalgia (FM)? What other two medications may be considered?

A

Tricyclic antidepressants

- Also SNRIs or anticonvulsants

221
Q

What non-pharmacologic treatment is recommended for Fibromyalgia (FM)?

A

Exercise (aquatic therapy)

222
Q

What type of approach is VITAL to treating Fibromyalgia (FM)?

A

Interprofessional team approach (PCP, rheum, pain management, psych, sleep specialist)

223
Q

What two actions do the SIT muscles perform?

A

External rotation and abduction

224
Q

What action does the Subscapularis perform?

A

Internal rotation

225
Q

What group of injuries involves pain over anterior and lateral aspects of shoulder with radiation to deltoid?

A

Rotator Cuff Injuries

226
Q

What are Drop Arm and Empty Can testing for?

A

Weakness

227
Q

What are Neer’s Impingement and Hawkins testing for?

A

Pain

228
Q

Which RC injury involves chronic degeneration with age?

A

Tendinosis

229
Q

Which RC injury involves gradual onset of inflammation with repetitive, everyday activities?

A

Tendonitis

230
Q

Which RC injury involves degeneration, impingement, overload? How does this initially present, and how does it progress?

A

Chronic RC Tear

- Partial tear of Supraspinatus initially → Progresses to complete tear with SITS + Biceps tendon

231
Q

Which RC injury involves acute shoulder pain with neg. radiographs; often due to FOOSH?

A

Acute RC Tear

232
Q

What condition has gradual onset of deep achy pain with subacromial point tenderness?

A

Tendonitis/Impingement

233
Q

What two tests will be positive when testing for Tendonitis/Impingement on physical exam?

A

+ Neer’s and Hawkins’s

- PAIN

234
Q

What is the recommended treatment for Tendonitis/Impingement?

A

Analgesics

- Pain WILL improve

235
Q

What condition involves accumulation of impingement + degeneration; with risk factor being male and over age 40?

A

Chronic RC Tear

236
Q

What condition has pain that progresses with eventual associated weakness that does NOT relate to the pain?

A

Chronic RC Tear

237
Q

What two tests will be positive when testing for Chronic RC Tear on physical exam?

A

+ Drop Arm, Empty Can

- WEAKNESS

238
Q

What treatment will not work for a Chronic RC Tear?

A

Analgesics will have NO affect

239
Q

What are the three conditions that differentiate between tendinopathy and an RC tear?

A

TEAR IF…

  • Lidocaine injection test: inject lido, but weakness persists on Neer’s test with pain removal
  • Elevation of humeral head over 1 cm on x-ray
  • MRI proves tear is present
240
Q

What type of radiography can be used to test for labral pathology?

A

MRI arthrography for labral pathology

241
Q

What are the three primary goals to treating an RC tear?

A
  • Recover lost strength
  • Improve function (remove pain)
  • Treat concurrent tendonitis
242
Q

Typically, supportive care is used to treat an RC tear but if symptoms persist, what two treatments can be considered?

A
  • Steroid injections (3-4 per year)

- Surgery (arthroscopic repair, joint arthroplasty (replacement))

243
Q

What condition is very similar to RC tendonitis and involves subacromial point tenderness with normal ROM and strength?

A

Shoulder Impingement Syndrome

244
Q

What three tests will be positive when testing for Shoulder Impingement Syndrome on physical exam?

A

+ Painful Arc (pain)

- Also, + Neer’s and Hawkins’s (pain)

245
Q

What type of tests will often be negative with Shoulder Impingement Syndrome?

A

All radiology is often normal

- Can consider an MRI to rule out RC tear

246
Q

What is the recommended treatment for Shoulder Impingement Syndrome?

A

PT referral

247
Q

What condition involves shoulder pain acutely and clicking/catching chronically?

A

Labral Tear

248
Q

What is a Bankart lesion, and what condition is it associated with? Is it acute or chronic?

A

Bankart lesion: acute inferior tear of rim associated with shoulder dislocation – acute
- Associated with Labral Tear

249
Q

What is a SLAP tear, and what condition is it associated with? Is it acute or chronic?

A

SLAP tear: Superior Labral Anterior Posterior (anterior to posterior tear) – chronic
- Associated with Labral Tear

250
Q

What is the MOI for a Labral Tear (think acute AND chronic)?

A
  • Acute (FOOSH, sudden pull)

- Chronic (repetitive overuse like throwing athletes, laborer)

251
Q

What three tests will be positive when testing for a Labral Tear on physical exam?

A

+ Anterior Glide Test, Speed’s Test and O’Brien’s Test

252
Q

What type of radiography is recommended for a Labral Tear? What is another type of diagnostic test that can be definitive?

A
  • MRA

- Arthroscopy is also definitive diagnosis

253
Q

What condition involves shoulder stiffness with limited ROM unilaterally?

A

Adhesive Capsulitis (Frozen Shoulder)

254
Q

What is a potential risk factor that providers should consider when using slings?

A

Extended sling use can lead to Adhesive Capsulitis (Frozen Shoulder)

255
Q

What condition involves reduced ROM in 2+ planes passive AND active (due to mechanical restriction, not pain)?

A

Adhesive Capsulitis (Frozen Shoulder)

256
Q

What test will be positive when testing for Adhesive Capsulitis (Frozen Shoulder) on physical exam?

A

+ Apley Scratch Test with comparison

257
Q

What is the recommended treatment for Adhesive Capsulitis (Frozen Shoulder)?

A

PT referral

- Will NOT improve without treatment

258
Q

What condition has AC joint tenderness worse with downward traction?

A

Acromioclavicular (AC) Injury

259
Q

What are the three grades of shoulder sprain? Describe each, and describe what imaging might show.

A
  • Sprain (Grade 1): stretch, but no ligament separation = normal imaging
  • Sprain with partial separation (Grade 2): AC ligament torn but coracoclavicular ligaments intact; slight offset seen on imaging
  • Sprain with complete separation (Grade 3): AC ligament torn AND coracoclavicular ligaments torn; dramatic offset seen on imaging
260
Q

What is the MOI for an Acromioclavicular (AC) Injury?

A

Fall onto tip of shoulder with arm tucked to side

261
Q

What test will be positive when testing for Acromioclavicular (AC) Injury on physical exam?

A

+ Cross-Over Test

262
Q

What is the recommended treatment for Acromioclavicular (AC) Injury?

A

Immobilization for 3-4 weeks, also supportive care

- Surgery if grade 3+

263
Q

What type of Clavicle Fracture is most common? What is second most common?

A

Middle 1/3

- Then distal 1/3 then proximal 1/3

264
Q

What type of Clavicle Fracture is most dangerous and why?

A

Proximal 1/3 because of possible involvement of internal organs

265
Q

What condition shows patient apprehension and guarding, may see tenting of skin on physical exam?

A

Clavicle Fracture

266
Q

If a Clavicle Fracture is middle 1/3 and non-displaced, what is the recommended treatment?

A

Supportive (muscle relaxants) and Sling/Swathe vs. Figure 8 Harness

267
Q

If a Clavicle Fracture is distal or proximal 1/3 and/or displaced, what is the recommended treatment?

A

Surgery (ortho referral)

268
Q

What condition is often associated with RC tendonitis or impingement syndrome?

A

Subacromial Bursitis

269
Q

What condition may be caused by systemic disease like RA, gout, sepsis?

A

Subacromial Bursitis

270
Q

What condition involves point tenderness over bicipital groove?

A

Biceps Tendonitis

271
Q

What is the common cause for Biceps Tendonitis?

A

Due to repetitive lifting

272
Q

What two tests will be positive for Biceps Tendonitis on physical exam? Which one tests for the “popping” noise?

A

+ Yergason’s Test (for “popping” noise), also Speed’s Test

273
Q

What condition is associated with “Popeye Deformity”?

A

Biceps tendon rupture

274
Q

What are the two primary goals when treating Biceps Tendonitis?

A
  • Prevent recurrence

- Prevent rupture

275
Q

When is surgery indicated for Biceps Tendonitis?

A

Young and/or laborer/athlete

276
Q

What condition includes “golfer’s elbow” and “tennis elbow”? At what location does each occur on the elbow?

A

Elbow Epicondylitis

  • Medial = golfer’s elbow
  • Lateral = tennis elbow
277
Q

What two muscle groups (actions) should be tested with Medial Epicondylitis (golfer’s elbow)?

A
  • Wrist flexors

- Pronators

278
Q

What two muscle groups (actions) should be tested with Lateral Epicondylitis (tennis elbow)?

A
  • Wrist extensors

- Supinators

279
Q

What is the treatment for ACUTE Elbow Epicondylitis (4)?

A
  • Sling
  • Wrist brace
  • Ice
  • NSAIDs
280
Q

What is the treatment for PREVENTATIVE Elbow Epicondylitis (3)?

A
  • Forearm strap
  • Correct technique
  • Minimize aggravating activities
281
Q

What is the treatment for RECURRENT Elbow Epicondylitis (2)?

A
  • Steroid injections

- Surgery

282
Q

What is the primary recommended treatment for Olecranon Bursitis?

A

Aspiration

- Can be clinical and diagnostic

283
Q

What condition involves ulnar n. compression?

A

Cubital Tunnel Syndrome

284
Q

What condition involves ulnar n. neuropathy; decreased grip strength? How does ulnar n. neuropathy present (distribution)?

A

Cubital Tunnel Syndrome

- Ulnar n. distribution: 4th, 5th digits

285
Q

What is the recommended diagnostic test for Cubital Tunnel Syndrome?

A

EMG/NCS

286
Q

What condition can be caused by a congenitally smaller tunnel or occupational problem?

A

Carpal Tunnel Syndrome

287
Q

What condition involves median n. compression?

A

Carpal Tunnel Syndrome

288
Q

What condition involves median n. neuropathy; decreased grip strength? How does median n. neuropathy present (distribution)?

A

Carpal Tunnel Syndrome

- Median n. distribution: 1st, 2nd, 3rd, 1/2 4th digits

289
Q

What condition involves symptoms worse at night → sleep disturbances; initially presents as dull ache that progresses to burning pain/paresthesias?

A

Carpal Tunnel Syndrome

290
Q

What two tests will be position on physical exam with Carpal Tunnel Syndrome? What other finding will be seen with this condition?

A
  • Tinel’s
  • Phalen’s

Also, decreased grip strength

291
Q

What is the recommended diagnostic test for Carpal Tunnel Syndrome?

A

EMG/NCS

292
Q

If Carpal Tunnel Syndrome presents acutely, what is the recommended treatment?

A

Surgery (carpal tunnel release)

293
Q

What condition involves collection of synovial fluid within wrist joint or tendon sheath?

A

Ganglion Cyst

294
Q

What condition involves a soft mobile mass that fluctuates in size, often with activity?

A

Ganglion Cyst

295
Q

What condition involves inflammation of 1st dorsal compartment?

A

De Quervain’s Tenosynovitis

296
Q

What condition involves pain, swelling along dorsal radial wrist; pain worse with gripping?

A

De Quervain’s Tenosynovitis

297
Q

What test will be positive with De Quervain’s Tenosynovitis on physical exam?

A

Finkelstein’s

298
Q

What condition is classically seen in males, northern European descent, >40-50 years? What are three other possible associated risk factors?

A

Dupuytren’s Contracture

  • EtOH use
  • Tobacco use
  • DM
299
Q

What condition involves nodules → irreversible contractures?

A

Dupuytren’s Contracture

300
Q

What condition is often painless because due to gradual, NON-retractable fibrosis?

A

Dupuytren’s Contracture

301
Q

What test will be positive with Dupuytren’s Contracture on physical exam?

A

Hueston Table Top test

302
Q

What condition involves nodules → catching/locking sensation?

A

Trigger Thumb/Finger (Stenosing Flexor Tenosynovitis)

303
Q

What condition is progressively painful because due to inflammation of A1 pulley?

A

Trigger Thumb/Finger (Stenosing Flexor Tenosynovitis)

304
Q

What four factors are considered concerning for bone tumor or lesions?

A
  • Indistinct margins
  • Abnormal periosteal reaction (formation of new bone in response to injury/other stimuli)
  • Soft tissue mass/invasion
  • Rapid growth
305
Q

Generally, what is the recommended treatment for a benign bone tumor/lesion if it is NOT aggressive?

A

Observe with serial scans

306
Q

Generally, what is the recommended treatment for a benign bone tumor/lesion if it IS aggressive?

A

Ortho/neurosurgery referral

+/- surgery

307
Q

What bone lesion/tumor condition is also called a “simple bone cyst” and is fluid-filled?

A

Unicameral Bone Cyst (UBC)

308
Q

What bone lesion/tumor condition is NOT aggressive and often seen in long bones of younger patients?

A

Unicameral Bone Cyst (UBC)

309
Q

What bone tumor/lesion condition can improve spontaneously by adulthood?

A

Unicameral Bone Cyst (UBC)

310
Q

What bone lesion/tumor condition involves blood-filled cyst that is AGGRESSIVE/rapid growth? Where two locations of the body are these often seen?

A

Aneurysmal Bone Cyst (ABC)

- Spine and extremities

311
Q

What bone lesion/tumor condition involves MES, and what does this stand for?

A

Non-Ossifying Fibroma (NOF)

- MES: metaphyseal, eccentric, sclerotic borders

312
Q

What bone lesion/tumor condition is AGGRESSIVE; involves metaphyseal/epiphyseal?

A

Giant Cell Tumor (GCT)

313
Q

What two symptoms are associated with Giant Cell Tumor (GCT)?

A

Localized pain and possible weakness

314
Q

Which type of benign bone lesion/tumor condition has a high recurrence rate?

A

Giant Cell Tumor (GCT)

315
Q

What bone lesion/tumor condition involves severe night pain; NSAIDs relieve pain?

A

Osteoid Osteoma

316
Q

What bone lesion/tumor condition contains nidus center of growing cells that release prostaglandins, surrounded by thickened bone?

A

Osteoid Osteoma

317
Q

What is the most common benign bone tumor?

A

Osteochondroma (Exostosis)

318
Q

What bone lesion/tumor condition involves a fixed, non-mobile mass that can be painful with activity?

A

Osteochondroma (Exostosis)

319
Q

What is ALWAYS the recommended treatment for a malignant bone lesion/tumor?

A

REFER TO ORTHO OR NEUROSURGERY

320
Q

What is the most common bone tumor in children?

A

Osteosarcoma

321
Q

Which two primary bone lesion/tumor conditions can be symptomatic OR present with pain/swelling?

A
  • Osteosarcoma

- Ewing’s Sarcoma

322
Q

What is a primary bone tumor of cartilage-producing cells (epiphysis); occurs in hips, shoulder, pelvis?

A

Chondrosarcoma

323
Q

What is the most common primary bone tumor? What part of the bone is associated with this condition?

A

Multiple Myeloma

- Malignant bone marrow

324
Q

What condition involves entire skeleton; can be associated with radiation, pesticide exposure, HIV/immunocompromised?

A

Multiple Myeloma

325
Q

What does Multiple Myeloma appear like on imaging?

A

Punched out appearance (lytic lesions)

326
Q

What type of proteins will be seen on UA for Multiple Myeloma?

A

Bence-Jones proteins

327
Q

What five primary cancers are most associated with Metastatic Bone Cancer?

A

Lead Kettle aka PB-KTL

  • Prostate
  • Breast
  • Kidney
  • Thyroid
  • Lung
328
Q

What finding is always seen on imaging with Metastatic Bone Cancer?

A

Pathologic fracture

329
Q

What three primary cancers present with osteolytic bone destruction on imaging for Metastatic Bone Cancer?

A

KTL

  • Kidney CA
  • Thyroid CA
  • Lung CA
330
Q

Which primary cancer presents with osteoblastic formation on imaging for Metastatic Bone Cancer?

A

Prostate CA

331
Q

Which primary cancer presents with mixed (osteolytic bone destruction and osteoblastic formation) on imaging for Metastatic Bone Cancer?

A

Breast CA

332
Q

Which two benign bone lesion/tumor conditions are aggressive?

A
  • Aneurysmal Bone Cyst (ABC)

- Giant Cell Tumor (GCT)

333
Q

Which two benign bone lesion/tumor conditions have metaphyseal involvement?

A
  • Non-Ossifying Fibroma (NOF)

- Giant Cell Tumor (GCT)

334
Q

What three risk factors are often associated with back pain?

A
  • Pregnancy
  • Poor core strength
  • Obesity
335
Q

What are the two most significant indication for lumbar spine imaging? What are six other important reasons?

This card sucks lol

A

Pain at night or pain at rest

  • Fall from height >3 meters,
  • Fall in age >60 years/frail
  • MVA ejection
  • Trauma
  • Neuro deficit
  • History of cancer with back pain
336
Q

Why would you order a CT to evaluate the spine? Why would you order an MRI to evaluate the spine?

A
  • CT: bony (fracture)

- MRI: soft tissue structures, nerve compression

337
Q

What does an EMG test for?

A

muscle

338
Q

What does a NCS test for?

A

nerve

339
Q

Where are Upper Motor Neurons located? Are they more associated with myelopathy or radiculopathy?

A

Brainstem

- Myelopathy

340
Q

Where are Lower Motor Neurons located? Are they more associated with myelopathy or radiculopathy?

A

Spinal cord

- Radiculopathy

341
Q

What is the primary cause for myelopathy? What part of the nervous system is affected?

A

Caused by spinal stenosis

- Affects spinal cord

342
Q

What is the primary cause for radiculopathy? What part of the nervous system is affected?

A

Caused by neuroforaminal narrowing

- Affects nerve roots

343
Q

Is myelopathy or radiculopathy more associated with weakness/loss of sensation, increased muscle tone (spasticity), hyperreflexia, Babinski sign, clonus, Lhermitte’s sign?

A

Myelopathy

344
Q

Is myelopathy or radiculopathy more associated with hypotonia, hyporeflexia, weakness/loss of sensation, muscle atrophy, fasciculations?

A

Radiculopathy

345
Q

Differentiate between strain and sprain (think associated tissue).

A
  • Strain = ligaments

- Sprain = muscles, tendons

346
Q

What type of spinal condition is associated with whiplash?

A

Cervical Strain/Sprain

347
Q

What condition involves neck pain at any point skull base to cervical/thoracic junction; pain worse with motion; +/- spasms, normal neuro exam?

A

Cervical Strain/Sprain

348
Q

What spinal condition involves the NEXUS criteria? What is this criteria?

A

Cervical Strain/Sprain
NEXUS Criteria (ALL must be met; if all 5 are present, imaging is not necessary before exam)
- Absence of posterior midline tenderness
- Normal level of alertness
- No evidence of intoxication/substance use
- No abnormal neurologic findings
- No other painful distracting injuries

349
Q

Under what three conditions is NEXUS criteria NOT considered (aka imaging is done first always)?

A
  • Direct blow to neck
  • Trauma
  • Adults >60 years
350
Q

What spinal condition typically resolves in 4-6 weeks spontaneously, and does NOT recommend manipulation as treatment?

A

Cervical Strain/Sprain

351
Q

What condition involves axial back pain +/- buttock radiation; spasms with TTP in low back or SI; limited low back flexion; neuro exam normal?

A

Lumbar Strain/Sprain

352
Q

For what condition is bedrest NOT recommended?

A

Lumbar Sprain/Strain

353
Q

What are Waddell’s signs (4)? What do they pertain to?

A

Used to identify secondary gain motivation

  • Simulation sign
  • Distraction sign
  • Reported regional sensory/motor disturbance (no dermatomal pattern)
  • Overreaction
354
Q

What condition involves “spinal arthritis” with osteophytes?

A

Spondylosis

355
Q

What condition involves decreased cervical spine ROM; occipital headaches; chronic neck pain +/- muscle spasms?

A

Cervical Spondylosis

356
Q

What test will be positive on physical exam with Cervical Spondylosis?

A

Spurling test

357
Q

What condition involves LBP radiating to one/both buttocks; pain relieved with lying downs, with often axial back pain; normal motor/sensory/DTRs; +/- decreased ROM?

A

Lumbar Spondylosis

358
Q

What spinal condition involves anterior displacement of vertebra often due to uni/bilateral fracture of pars interarticularis?

A

Spondylolisthesis

359
Q

What condition involves neck pain that radiates to shoulders, pain with ROM; occipital headaches

A

Cervical Spondylolisthesis

360
Q

What lumbar spinal condition often involves often L3-4 or L4-5?

A

Lumbar Spondylolisthesis

361
Q

What spinal condition involves flat back; +/- step-off deformity on physical exam?

A

Spondylolisthesis

362
Q

What spinal condition involves unilateral or bilateral fracture of pars interarticularis (“scotty dog fracture”)?

A

Spondylolysis

363
Q

Differentiate between spondylolysis and spondylolisthesis.

A

Spondylolysis: fracture at pars interarticularis (“scotty dog fracture”)

Spondylolisthesis: anterior displacement of vertebra often due to uni/bilateral fracture of pars interarticularis

364
Q

What condition involves unilateral radicular pain/paresthesias that follow dermatome; weakness; reduced grip strength?

A

Cervical Radiculopathy

365
Q

At what spinal level is Cervical Radiculopathy most common?

A

C6-7

366
Q

What is considered an aggravating factor for radiculopathy?

A

Activity

367
Q

At what two spinal levels are Lumbar Radiculopathy most common?

A
  • L4-L5

- L5-S1

368
Q

What levels of the lumbar spine have a dermatomal distribution of anterior thigh pain?

A

L1-4

369
Q

What levels of the lumbar spine have a dermatomal distribution of pain can radiate down leg into foot?

A

L4 and below

370
Q

What level of the cervical spine has a dermatomal distribution of lateral arm, thumb?

A

C6

371
Q

What level of the cervical spine has a dermatomal distribution of 2nd and 3rd fingers?

A

C7

372
Q

What level of the cervical spine has a dermatomal distribution of 4th and 5th fingers?

A

C8

373
Q

What is the first line imaging recommended for radiculopathy?

A

MRI

374
Q

What two tests will be positive on physical exam if L1-4 radiculopathy is present?

A

+ SLR

+ reverse SLR

375
Q

What is the recommended treatment for radiculopathy if radicular symptoms but no progressive neuro deficits?

A

Supportive (NSAIDs, steroids, PT)

376
Q

What is the recommended treatment for radiculopathy if no improvement/worsening radicular symptoms OR concerns for myelopathy?

A

Surgery

377
Q

What is the recommended treatment for radiculopathy if radicular symptoms, severe pain OR worsening neuro deficits

A

Epidural injections

378
Q

What is the most common cause of acquired Spinal Stenosis?

A

Spondylosis

379
Q

What is the most common cause of myelopathy in elderly?

A

Cervical Spinal Stenosis

380
Q

What is the most common cause of neurogenic leg pain in elderly?

A

Lumbar Spinal Stenosis

381
Q

What condition involves progressive bilateral leg pain worse with standing and/or walking (neurogenic claudication)

A

Lumbar Spinal Stenosis

382
Q

Can radicular pain present without back pain?

A

YES IT CAN

383
Q

With what condition might you expect to see diminished DTRs, wide-based gait on physical exam?

A

Lumbar Spinal Stenosis

384
Q

How can you differentiate neurogenic claudication from vascular leg pain?

A

Neurogenic: relieved with walking flexed with cart (“shopping cart sign”), NOT relieved with standing erect, relieved within minutes of sitting/lying down

Vascular: NOT relieved with “shopping cart sign”, relieved with standing erect, relieved IMMEDIATELY with sitting/lying down

385
Q

What is the recommended diagnostic testing for both Cervical and Lumbar Spinal Stenosis (2)?

A

MRI with EMG/NCS

386
Q

What specific treatment is recommended for the elderly with Lumbar Spinal Stenosis?

A

Water exercise

387
Q

What condition involves perineal sensory loss at S2-4 (“saddle anesthesia”); bladder or bowel incontinence?

A

Cauda Equina Syndrome

388
Q

What spinal condition did we learn about that is an EMERGENCY (@Hannah)?

A

Cauda Equina Syndrome

389
Q

What is the recommended empirical treatment for Cauda Equina Syndrome?

A

Dexamethasone 10 mg IV

390
Q

What is the recommended diagnostic testing for Cauda Equina Syndrome?

A

Emergent MRI with contrast or CT myelogram

391
Q

What four conditions are considered red flags for back pain MALIGNANCY?

A
  • Unexplained weight loss
  • Failure of pain to improve with treatment; chronic
  • Pain at night +/- sleep disturbances
  • History of cancer
392
Q

What five conditions are considered red flags for back pain INFECTION?

A
  • Pain at rest
  • Spinal pain with fever
  • Immunocompromised
  • IV drug user
  • Recent history of infection (UTI, pneumonia, cellulitis
393
Q

What condition involves pain that can be associated with chest pain (dermatomal “band-like” pain)?

A

Thoracic Spine Pain

394
Q

What condition involves compression of upper extremity neurovascular bundle above first rib/behind clavicle?

A

Thoracic Outlet Syndrome

395
Q

What are the three types of Thoracic Outlet Syndrome? Which is most common?

A
  • Neurogenic (nTOS)
  • Arterial (aTOS)
  • Venous (vTOS)
396
Q

What is the most common cause for Neurogenic (nTOS) Thoracic Outlet Syndrome?

A

Brachial plexus compression in scalene triangle

397
Q

What is the most common cause for Arterial (aTOS) Thoracic Outlet Syndrome?

A

Subclavian artery compression due to cervical rib anomaly

398
Q

What is the hallmark symptom/sign associated with Venous (vTOS) Thoracic Outlet Syndrome?

A

Swelling of extremity

399
Q

Which type of Thoracic Outlet Syndrome involves thromboembolism in hand/arm with ischemia causing pain/paresthesias, pallor?

A

Arterial (aTOS)

400
Q

Which type of Thoracic Outlet Syndrome involves progressive unilateral hand/arm/shoulder with weakness and paresthesias (reproducible/may not be in a specific distribution)?

A

Neurogenic (nTOS)

401
Q

What two diagnostic tests are recommended for Neurogenic (nTOS) Thoracic Outlet Syndrome?

A
  • Electrodiagnostic testing

- + brachial plexus block

402
Q

What is the recommended diagnostic testing for both aTOS and vTOS?

A

US

403
Q

For which type of Thoracic Outlet Syndrome is catheter directed thrombolysis recommended as treatment?

A

vTOS

404
Q

For which type of Thoracic Outlet Syndrome is surgical embolectomy recommended as treatment?

A

aTOS

405
Q

What is the recommended treatment for all types of Thoracic Outlet Syndrome if severe or failed treatment?

A

Decompressive surgery

Clin Med I Disease Key Notes (4 decks)

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