Musculoskeletal

Question 1

Lachman’s test

Answer 1

Drawer test
Positive = Ligament
Graded 1+-3+
Most sensitive with swollen / painful knee

Question 2

McMurray’s test

Answer 2

Positive = Meniscus injury
Medial meniscus injuries
Knee flexed and then quickly straightened - click / pop = positive

Question 3

Apley’s Grind test

Answer 3

Positive = medial / lateral ligament or meniscus injury
Not as specific
PRONE position for test

Question 4

Strain

Answer 4

muscle injury

Question 5

Sprain

Answer 5

Joint injury

Question 6

Bursitis

Answer 6

Inflammation of bursa (sac lined with synovial like membrane in area of friction or pressure)
cause: trauma or sepsis
Pain, swelling, tenderness, erythema
dx: aspiration, WBC, plain X-rays FIRST r/o other conditions
TX: splint, heat, NSAIDS, steroid injections, septic = I/D, aspiration or parenteral antibx
MAX STEROID INJECTION PER YEAR = THREE ALL TOGETHER

Question 7

STEROID INJECTION

Answer 7

max = 3 per year
adverse = soft tissue breakdown
adrenal effects / endocrine
Permanent skin discoloration

Question 8

OSTEOARTHRITIS

Answer 8

NON symmetrical
Degenerative join disease, w/ destruction of articular cartilage
weight bearing joints
HEBERDENS (distal) + BOUCHARDS (proximal) NODES
Aggravates as day goes = short rest periods
genetic predisposition, age
DX: synovial aspirate is normal, Xray = NARROWING OF JOINT SPACE, osteophytes
TX: NSAIDS, ASPIRIN, ACETOMIN.
cane = opposite side of injury

Question 9

RHEUMATOID ARTHRITIS

Answer 9

SYMMETRICAL
systemic autoimmune disease w/ inflammation of connective tissue
women more common
PIPs (middle finger joint), MIPs (knuckles), Wrists, ulnar deviation
WORSE in am
DX: ESR, ANA
aspiration = WBCs and inflammatory changes
DMARDs = methotrexate (Monitor LFT), hydrochloroquine, corticos

Question 10

CARPAL TUNNEL SYNDROME

Answer 10

Median nerve compression of wrist
Repeated wrist flexion
c/o numbness, tingling, BURNING
increase pain w/ dorsiflexion (wrist up)
PHALENS = reproduce symptoms following 1 min of wrist flexion

Question 11

Low Back Pain

Answer 11

pain perceived in lumbosacral region
Leading cause of missed work in america 2nd to headache
Positive straight leg test: reproduced pain w/ legs elevated off exam table
Positive pelvic rock test: sacroiliac joint dysfunction, “open/close” pelvis, positive = pain in either sacroiliac joints
DX: lease invasive to MRI
Tx: TENS, NSAIDS, EDUCATION, REFERAL AS NEEDED

Question 12

MORTONS NEUROMA

Answer 12

benign neuroma causing compression neuropathy of intermetatarsal plantar nerve
flat feet, bunions, hammertoes can contribute
standing on pebble, shooting pain, tingling/ numbness of toes
DX: US, MRI
orthotics referral
cryogenic neuroablation or neurectomy

Question 13

PLANTAR FASCIITIS

Answer 13

inflammation of plantar fascia
cause: arch problem, runners, obesity, men more common
s/s: pain / stiffness in heel, dull or sharp, worse in morning
Dx: PE, xray to r/o
NSAIDs, orthotic, PT, surgery ?

Question 14

Osgood- Schlatter Disease

Answer 14

rupture of growth plate @ tibial tuberosity from stress of patellar tendon
s/s: painful limp, may be both legs, inc. w/ running, jumping, stairs
Dx: PE, x-ray for r/o
Management: RICE, NSAIDs. rarely = surgery

Question 15

COSTOCHONDRITIS

Answer 15

cartilage inflammation at the rib to sternal connection
cause - unknown mostly
s/s = pain/ tenderness where ribs attach to breastbone, pain with DEEP breath or coughing
dx: PE, x-ray to r/o
Tx: resolve independently, ice, NSAIDs

Question 16

POLYMYALGIA RHEUMATICA

Answer 16

Inflammatory disorder that involves pain and stiffness in shoulder, also USUALLY the hip
Unknown etiology
>50 years of age
s/s- pain/ stiffness, fatigue, anemia, fever
dx: ESR, x-rays r/o
Tx: CORTICOS, symptom management