Musculoskeletal Flashcards
Navicular (scaphoid bone) fracture is often found with falls landing on outstretched hand. Although X-rays may be negative, what test suggest navicular fracture and what is the treatment?
Pain w/ axial loading of thumb, palpation of “snuffbox”. Apply thumb-spica splint and repeat X-ray in 2 weeks.
This fracture to the distal radial may also include the ulna?
Collies fracture
Severe bone pain with localized tenderness, swelling, redness with systemic findings of fever in patient with a wound infection is suggestive of what disorder?
Osteomylitis
What lab findings would you suspect with osteomyelitis?
Leukocytosis, elevated ESR and CRP
What organism a causative agent for osteomyelitis?
Staph Aureus
Acute onset of saddle anesthesia is suspicious for what emergency disorder?
Cauda Equina Sydrome
What other symptoms accompany saddle anesthesia increasing the concern?
Bowel/bladder incontinence (or retention) and bilateral leg pain, numbness and/or weakness
Patient presents with back and leg pain with standing, typically worse at night. He is undergoing treatment for prostate cancer. He also has night sweats, malaise, fever and weight loss. What is a top differential diagnosis?
Bone metastasis.
What lab findings might be elevated in a patient with bone metastasis?
Alkaline phosphatase and serum calcium
Which cancers have higher occurrence of bone metastasis?
Prostate, breast, lung, thyroid and kidney
T/F Tendons connect bone to bone?
False, ligaments connect bone to bone. Tendons connect muscle to bone
Knock-knees is also called?
Genu Valgum
Bow-legged is also known as?
Genu Varum
Genu recurvatum is commonly known as?
Hyperextension or backward curvature of the knees
How do you perform an anterior drawer sign test and what does it mean?
Pt is supine, hip flexed 45 degrees and knee 90 degrees. Sitting on the foot to stabilize, pulling tibia anteriorlaterally (drawer open).
+ indicates ACL damage or tear.
How do you perform a posterior drawer sign test?
Pt is supine, hip flexed 45 degrees and knee 90 degrees. Sitting on the foot to stabilize, pulling tibia posterior (drawer close).
+ indicates PCL damage or tear.
Inflammation of the thumb tendon sheath is known as?
DeQuervain’s tenosynovitis
What test screens for DeQuervain’s tenosynovitis and how is it performed?
Finklestein’s Test: Thumb is flexed downward into palm, fingers surround thumb to make a fist encasing thumb. Pt flexes wrist downward (ulnar side). Pain is wrist is a positive sign.
What test is performed to assess damage to the meniscus and what are the findings?
McMurray test: Supine, hip and knee flexed. Holding heel with one hand and the other knee joint line. Knee is flex maximally w/ abducted (valgus stress) to assess medial meniscus and addiction (varus stress) for lateral meniscus. A click and knee pain with manipulation of the knee suggestive of meniscus injury or tear.
What other test assess for damage to the ACL and how is it performed?
Lachman’s sign: Pt is supine, hip flexed 45 degrees and knee 90 degrees. Knee is pulled forward with a sudden jerk.
+ indicates ACL damage or tear- more sensitive than drawer.
Abduction is?
Varus movement- away from the body
Adduction is?
Valgum- towards the body
Female runners with eating disorders and osteoporosis are at higher risk for this disorder?
“Shin Splints” (Medial Tibia Stress Syndrome) which can result in tibial stress fracture
Plantar foot pain that is made worse by walking and weight bearing, worse upon walking is suggestive of?
Plantar fasciitis
What is the treatment for plantar fasciitis?
NSAIDS (oral and topical), orthotic foot appliance, stretching/rolling exercises, lifestyle (weight loss)
Frequent wearing of high heels increases risk for this disorder and how does it present?
Morton’s Neuroma- C/O of feeling like walking on a pebble, plantar pain/numbness/burning in forefoot between 3rd and 5th metatarsals.
How is the Mudler test is performed, what does it indicate and what is the treatment?
Grabbing 1st and 5th metatarsal and squeezing the forefoot. Audible click and patient’s report of pain is a positive finding for Morton’s Neuroma. Treatment- Well-padded shoes, avoid wearing heels/narrow shoes. Podiatry referral.
What is the cornerstone treatment for osteoarthritis?
Acetaminophen
NSAIDS- consider risk profile
What rashes are commonly found with Lupus (SLE)?
Malar rash: Macupapular butterfly
Discoid rash: nonpruritic thick scaly red rash on sun exposed area
What joints are most commonly affected in RA?
Smaller non-weight bearing: Hands, wrists, elbows, ankles, feet and shoulders
What deformities are commonly found with RA?
Swan neck: Flexion DIP with hyperextension PIP
Boutonnières (hyperextension of DIP and flex ion PIP)
What is the progression of treatment medications in RA?
NSAIDS- oral steroids for flares
Steroid joint injections
Disease-modifying drugs (DMARDS): methotrexate, cyclosporine, sulfasalazine, and hydroxychloroquine
Anti-TNF biologist: Humira, Enbrel, Remicade
When starting a patient on plaquniel (hydroxychloroquine), what exam should be performed prior and every 6 months while on the therapy?
Eye examination due to risk of retinal damage
T/F Bouchard nodules are only seen with OA?
False, can be present in RA but herberdness are only found with OA
Patient with RA (as well as other autoimmune diseases) are at risk for this eye complication?
Uveitis: swelling of the urea, the middle layer of the eye that supplies blood to the retina
What are the expected diagnostic findings with RA?
Labs: Elevated sed rate, positive RF, and anti-CCP. Anemia may be present
X-ray: bony erosions, narrowed joint spaces and subluxations
Uric acid >____ suggest gout?
6.8 mg/dl
Normal should be under 6
What drugs interact with colchicine?
Macrolide, azole antifungals, some antivirals, CCBs, cyclosporine, and tacroliums
Patient with gout with history of CKD on routine medications presents with fever, rash and hepatits, what is the likely problem
Allopurinol hypersensitivity. Stop allopurinol.
What joints are affective with ankylosing spondylitis?
Axial skeleton (spine), SI joints, shoulders, hips, knees and sternoclavicular joints.
T/F females are at higher risk for ankylosis spondylitis?
False, males are
25 year old male presents with eye irritation/pain, photosensitivity and progressive back and chest wall pain. What is the likely condition and what tests would be ordered?
Ankylosis spondylitis: ESP/CRP- elevated, RF- negative
Spine X-ray: Bamoo spine (straightened leaning)
Patient complains of Low back pain w/ leg radiation and numbness that is worsened by sitting or driving. Pain is elicited by flexion, adduction, and internal rotation maneuvers. What is the likely diagnosis?
Piriformis syndrome
What NSAID has the lowest cardiac risk profile?
Naproxen
Shoulder pain that is produced when arms extend above shoulders, is worse at night and can be localized is suspicious for what condition?
Supraspinatus tendinitis (rotator cuff disease)
With Arc test, what findings would suggest what pathology?
Pain at 60 to 120 degrees- subacromial painful arc
Pain 45-120- glenohumeral painful arc
Pain 170-acromioclavicular painful arc
How is Jobe test performed and what do findings indicate?
-It evaluates the supraspinatus muscle:
Perform: 90 degree extension in scapular plane (30 degrees forward) with thumbs pointed up. Apply downward pressure asking patient to hold against.
Findings:
Positive if pain w/o weakness (tendinopathy)
Positive if pain w/ weakness (tear)
Tennis elbow (lateral epicondylitis) presents how?
Reproducible and pinpoint pain in lateral epicondyle area that is made worse by twisting and grasping movements like opening jars, shaking hands.
Gradual onset of aching pain on medial epicondyle with or without decreased grasp strength is what condition?
Golfer’s elbow (medial epicondylitis)
What are the OTTAWA Sprain Rules?
Grade 1- able to bear weight and ambulated. Caused by slight stretching of ligament- stable joint. Mild compression support for a few days (ACE).
Grade 2- Ecchymosis, moderate swelling, pain to palpation, able to bear weight but painful. Mild to moderate joint instability. Consider X-ray. Require support and compression (ACE, Aircast)
Grade 3: Severe swelling, ecchymosis and pain to posterior malleolus. Resists foot motion. Inability to bear weight after injury, unable to take more than 4 steps. Fracture and/or complete rupture of ligaments and unstable joint. X-ray required. Require referral and splinting
Apley’s knee test for what injury and is performed how?
Meniscus damage. Pt is in prone position, knee 90 degrees, holding ankle rotate laterally and medially. Repeat same movement with compression on foot. Decreased rotation or discomfort w/o compression is ligamental.
Rotation & compression is meniscus
Patient presents with large lump in the back of the knees that is painless but annoying. A soft, compressible mass is palpated. What is the likely condition?
Bakers Cyst
What tests are done to assess for Carpal Tunnel Disorder and how are the performed?
Phalen’s test: wrists are flexed downward 90degress and held against each other for 60 seconds
Tinels- examiner taps over transverse carpal ligament
Tests are positive is pain, anesthesia or parenthesias are produced
What are the recommended treatments for an acute gouty flare?
Steroids: taper dose
NSAIDS: Indomethacin, naproxen are an option for those who cannot take steroids.
Colchicine 2 tablets (1.2mg) at onset followed by 1 tab (0.6mg) in 1 hour. No more than 3 tabs during a gouty flare.
What are the medications that can be used to prevent gouty flare?
Xanthine oxides inhibitors: Allopurinal or Uloric (high risk of CVD death in those with heart disease).
Urisosoric agents: Probenecid
T/F Pes planus is a high-arched foot?
False, pes cavus is a high arch, pes planus is flat footed
What are some anti-TNF drugs indicated as second line in RA?7
Humira, Cimzia, Embrel and Remicade
Sudden onset tibial pain w/ point tenderness over the tibial tuberosity that is worsened with contraction of the quadriceps against traction in an adolescent is suspicious for what disorder?
Osgood-Schlatter Disease
T/F slipped capitol femoral epiphysis (SCFE) is a condition most commonly found in adolescents where the femoral head is displaced causing by weakness in the growth plate?
True
T/F manual reduction of nurse maid’s elbow (subluxation of the radial head) is recommended?
True
Unlike SCFE, this condition is more common in children 3-10 years old and is a self-limiting inflammation of the hip and what is the presentation?
Transient synovitis of the hip- sudden onset limp, hip pain to palpation and avoidance in hip flexion and abduction w/ restriction in adduction and internal rotation.
Shoulder injury that limits abduction is likely which of the SITS muscles?
Supraspinatus
Shoulder injury that limits external rotation is likely which of the SITS muscles?
Infraspinatus and/or trees minor
Shoulder injury that limits internal rotation is likely which of the SITS muscles?
Subscapularis
When a patient reaches arm across their chest and touches the opposite shoulder Acromium, what movement is that?
Abduction and external roation
When the patient reaches over their opposite shoulder to touch the top of the scapula, that is what motion?
Abduction and external rotation
A positive empty can test indicates what injury?
Supraspinatus reputed/dysfunction
What test is done to illicit ACL injury?
Anterior drawer test
A posterior drawer test elicits injury of what structure in the knee?
PCL
To test the MCL, what movement procedure is done?
Valgus stress test
Varus stress test examines what knee structure?
LCL
What tests are done to evaluate the meniscus?
Apley’s Grinding
McMurray’s Test
What is commonly found in someone with a medial meniscus injury?
Pain or clicking with external rotation and valgus stress that finishes with knee extension (McMurray test)
What finding is common with someone who has injury to the lateral meniscus?
Pain or clicking with internally rotation and apply varus stress that finishes with knee extension (McMurray test)
