Musculo

Question 1

What test or sign is associated with a Meniscal tear?

Answer 1

McMurray test

Question 2

What test or sign is associated with ankle instability?

Answer 2

Talar tilt

Question 3

What test or sign is associated with carpal tunnel syndrome?

Answer 3

Tinel’s sign or Phalen’s sign

Question 4

What test or sign is associated with an anterior cruciate ligament tear?

Answer 4

Lachman test

Question 5

What test or sign is associated with a lumbar nerve root compression?

Answer 5

Straight-leg raising test

Question 6

What test or sign is associated with a Cervical nerve root compression?

Answer 6

Spurling test

Question 7

What test or sign is associated with a rotator cuff evaluation?

Answer 7

Drop arm test

Question 8

What test or sign is associated with De Quervains tenosynovitis?

Answer 8

Finkelstein test

Question 9

What are the potential acute gouty arthritis triggers?

Answer 9

Renal insuffiency, alcohol abuse, use of loop or thiazides diuretics, ASA, other medications, and purine rich foods (including organ meats, forms of seafood including sardines and anchovies, spinach, oatmeal, & others)

Question 10

What is the etiology of polymyalgia rhemautica (PMR)?

Answer 10

Inflammation of unknown origin that effects muscles and joints.

Generally impacts people older than 50 years.

Question 11

What is the clinical presentation of polymyalgia rheumatica (PMR)?

Answer 11

Symptoms often include aches in the shoulder (often the first symptom), neck, upper arms, lower back, hips, and thighs.

Symptoms come quickly (over a few days or weeks) and are worse in the morning with improvement during the day.

Question 12

How do you diagnose polymyalgia rheumatica (PMR)?

Answer 12

So there is no specific test to diagnose PMR, CRP and ESR are typically elevated indicating inflammation.

MRI or ultrasound imaging of shoulder and hip joints can detect inflammation in these joints to support the diagnosis.

Question 13

What is the intervention for Polymyalgia rheumatica (PMR)?

Answer 13

Low-dose corticosteroids (10-15 mg per day of prednisone) until symptoms are relieved (typically within 2-3 weeks) followed by tapering the low dose to find the lowest those necessary to suppress symptoms.

Treatment can take up to 2 to 3 years.

Question 14

What are the clinical presentations of lumbar spinal stenosis?

Answer 14

Older age (>50 years)

Standing discomfort with improvement in symptoms with bending forward nearly universal.

Pseudoclaudication (like pain that worsens with activity and improves with rest).

Bilateral lower extremity numbness, weakness in the majority.

Question 15

What is the intervention for lumbar spine stenosis?

Answer 15

Physical therapy

NSAIDs

Epidural corticosteroid injection

Perhaps surgery

Question 16

What is the etiology of Osgood-Schlatter disease?

Answer 16

Patellar swelling and pain in Adolescents who participate in sports involving running and jumping.

Repeated stress causes inflammation below the patellar tendon where it attaches to the tibia.

New bone growth can occur where the tendon pulls away from the tibia, resulting in a bony lump.

Question 17

What is the clinical presentation of Osgood-Schlatter disease?

Answer 17

Pain, swelling, and tenderness and one or both knees that can vary from mild to debilitating.

Pain ranges from constant to only when performing certain activities such as running or jumping.

Question 18

What is the treatment for Osgood-Schlatter disease?

Answer 18

Treatment is primarily aimed to reduce pain and swelling.

Mild pain relievers (e.g., NSAIDS) may help alleviate symptoms

Strengthening exercises for the quadriceps can help stabilize the knee joint.

Symptoms typically resolve at the completion of the adolescent growth spurt.

Question 19

What etiology for prepatellar bursitis?

Answer 19

Thickening of synovial tissue along with excessive fluid within the bursa resulting in knee swelling and pain.

Condition is caused by joint overuse, trauma, infection, or arthritis conditions.

Question 20

What are the clinical presentations of prepatellar bursitis?

Answer 20

Abrupt onset of knee pain with focal tenderness and swelling.

Range of motion is really full but often limited by pain.

Question 21

What is the treatment for prepatellar bursitis?

Answer 21

Bursar aspiration is first-line therapy.

Alternatives can include minimizing or illuminating the offending activity, applying ice to the area for 15 minutes at least four times a day, and the use of NSAIDs.

If no improvement after 4 to 8 weeks, and traversal corticosteroid injection should be performed

Question 22

What is the etiology of meniscal tear?

Answer 22

Disruption of them is a c-shape fibrocartilage pad located between the femoral condyles and the tibial plateau.

Often found an athlete due to the twist type injury to the knee.

Question 23

What are the clinical manifestation of meniscal tear?

Answer 23

Effusion with knee tightness and stiffness. Range of motion is limited by discomfort. Those with larger tears after report that the knee locks, makes a popping sound or gives out.

Question 24

What can be used to diagnose a meniscal tear?

Answer 24

MRI can be used to identify the type and extent of the tear.

McMurray’s test and Apley grinding test are highly specific for a meniscal tear but not sensitive.

Question 25

What is the treatment of an meniscal tear?

Answer 25

Rest, elevation, ice application and analgesia our initial treatment options.

Aspiration can be considered if there is no improvement after 2 to 4 weeks.

arthroscopic for debridement and repair should be consider at 4-6 weeks with no improvement or earlier if joint locking or effusion are problematic.

Question 26

What is the etiology of reactive arthritis?

Answer 26

Painful and inflammatory arthritis typically seen days or weeks after an episode of acute bacterial diarrhea or sexually transmitted infection.

Question 27

What are the clinical presentations of reactive arthritis?

Answer 27

Pain and or swelling of the knees ankles, heels, toes or fingers.

Persistent low back pain.

Conjunctivitis and urinary problems (e.g., urethritis) can be also present.

Question 28

What can be used to diagnose reactive arthritis?

Answer 28

Diagnoses can ball blood test to check for infection and inflammation (I.e., ESR and CRP).

A genetic tests can be checked for the presence of HLA-B27 gene.

X-rays can be used to indicate the presence of characteristic signs of reactive arthritis.

A test for the presence of chlamydia trachomatis should be performed.

Question 29

What is the treatment for reactive arthritis?

Answer 29

Treatment involves the use of anti-inflammatory drugs such as NSAIDs, corticosteroid injection’s in the affected joints can be considered to reduce inflammation.

Antimicrobial therapy is generally not beneficial, though the use in documented infection helps shorten the duration of symptoms when urethritis is also present

Question 30

What is the etiology of a lumbar sacral strain?

Answer 30

Spasm, irritation of LS spine-supporting muscles, most common reason for low back pain

Question 31

What are the discomfort characteristics of lumbar-sacral (LS) strain?

Answer 31

Spasms, ache, stiffness

Position, activity, rest typically impacts pain

Question 32

How do you perform a physical examination in a person with a lumbar/sacral strain ?

Answer 32

Paraspinal muscle tenderness and spasm

LS curve straightening

Decreased LS flexion

Neurological exam WNL

Question 33

How do you treat a lumbar sacral strain?

Answer 33

Analgesia

Physical conditioning and therapy

Limiting physical activity potentially harmful

Heat or ice as indicated by pain response

Muscle relaxer’s can be helpful but also dating, some with abuse potential

Question 34

What is the etiology of lumbar radiculopathy?

Answer 34

Irritation or death match of neural structures such as disks; L4-L5, L5-S1 most common sites of disc bulge

Question 35

What are the discomfort characteristics of lumbar radiculopathy?

Answer 35

Sharp, burning, Electric-shock sensation

Worse when increase spinal fluid pressure, thus pressure on nerve root.

Nice, cough, straining evokes sharp pain

Question 36

What are the positive physical examination signs of lumbar radiculopathy?

Answer 36

Signs of LS strain

Altered neurological exam including abnormal straight leg raising, sensory loss, altered DTRs

Question 37

What is the treatment for a person with lumbar Radiculopathy?

Answer 37

Conservative treatment as with LS strain

Specialty evaluation/intervention indicated for rapid involving defect, persistent neurological defects without real resolution after 4 to 6 weeks of conservative therapy.

Question 38

How do you test the nerve root L4?

Answer 38

Motor: foot dorsiflexion

Reflex: knee jerk

Sensory area: medial calf

Question 39

How do you test L5?

Answer 39

Motor: great toe dorsiflexion

reflex: none

Sensory area: medial foot

Question 40

How do you test S1?

Answer 40

Motor: foot Eversion

Reflex: ankle jerk

Sensory area: lateral foot

Question 41

What is considered a normal bone density level?

Answer 41

Bone density is within 1 SD (+1 or -1) of the young adult mean.

Question 42

What is considered a low bone mass on a bone density level?

Answer 42

Bone density is between 1 and 2.5 SD below the young adult mean (-1 to 2.5 SD).

Question 43

What is consider osteoporosis on bone density levels?

Answer 43

Bone density is 2.5 ST or more below the young adult mean (-2.5 SD or below).

Question 44

What is considered severe (established) osteoporosis on a bone density level?

Answer 44

Bone density is more than 2.5 SD below the young adult mean, and there have been one or more osteoporotic fractures.

Question 45

Who should undergo BMD testing?

Answer 45

Women age 65 and older and men age 70 years and older regardless of risk factors.

Younger post menopausal woman, women in menopausal transition, and men age 5269 years with clinical risk factors for fracture.

A woman or man older than 50 years old who has broken a bone.

Adults with a condition(e.g., rheumatoid arthritis) or taking a medication (e.g., mom term glucocorticoid) associated with low bone mass or bone loss.

Question 46

Who should be treated for osteoporosis?

Answer 46

Postmenopausal women and men age 50 years and older presenting with the following should be considered for treatment:

TXA testing that reveals a BMD T-scores of less than -2.5 at femoral neck, total hip, or spine.

Post menopausal woman and in men age 50 and greater years who have low bone mass or osteopenia as indicated by a T score of -12 -2.5 at the for moral neck, total hip, or spine and a 10 year hip fracture possibility of 3% or more or a 10 year old major osteoporosis related fracture probability of 20% or more based on the US adapted WHO Absolute fracture risk model.

History of hip or vertebral fracture (clinically apparent or found on vertebral imaging).

Question 47

what are the treatment options for osteoporosis?

Answer 47

Biophosphonates (alendronate (fosamax), ibandronate (boniva), risedronate (Actonel), and zolefronic acid (Reclast), calcitonin (miacalcin), estrogens or hormone therapy, raloxifene (evils ya), parathyroid hormone (PTH 1-34 Teriparatide (Forteo)), receptor activator of nuclear factor kappa-B ligand (Rank)/RANKL inhibitor (denosumab (prolia))

All should be given with an appropriate dose of vitamin D and calcium, generally recommended for adults age 50 or greater of age (male & female), vitamin Dequal or greater 800 -1000 IU/d (treat vitamin D deficiency with higher doses). For calcium, men age 50 to 70 years old should consume 1000 MG/D, and women age 51 or older years and men age 71 or older yearsshould consume 1200 MG/D of calcium. Dietary calcium should be the primary source of calcium from dairy and from nondairy options (spinach, sardines, tofu, select nuts including almonds, others).

Question 48

Where is the location of Heberden’s nodes?

Answer 48

Distal interphalangeal joints

Question 49

Where is the location of the Bouchard’s nodes?

Answer 49

Proximal interphalangeal joints