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