Musculoskeletal

Question 1

What is the most common joint disease in the US?

Answer 1

Osteoarthritis (OA)

Question 2

Asymmetric joint pain with morning stiffness <1 hour then gets better but resumes after periods of activity. What is this?

Answer 2

OA

Question 3

Clinical findings of OA

Answer 3

Asymmetric joint

cool
possible crepitus
Limited ROM
bony enlargements (herberdens/bouchards nodes)

Question 4

Where do herberdens nodes occur?

Answer 4

DIP joint - joint closest to the nail

Question 5

where do bouchards nodes develop?

Answer 5

PIP joint - 2nd knuckle from nail

Question 6

Number 1 non pharm management for OA

Answer 6

WEIGHT LOSS

10% reduction can improve symptoms

Question 7

Pharm management for OA

Answer 7

Short acting NSAIDs

-concomitant use of misoprostol (Cytotec) to prevent gastric ulcer

or

Cox-2 inhibitor for GI protection
(Celebrex)

or topical NSAIDs

Question 8

what is the most common immune mediated inflammatory arthritis

Answer 8

Rheumatoid Arthritis

Question 9

what type of arthritis is inflammatory with bone loss, worn cartilage and thickened synovial membranes.

Answer 9

RA

Question 10

Tx for RA

Answer 10

goal: reduce rate of bone loss & improve QOL

Analgesics/NSAIDs
glucocorticoids - short term
Nonbiologic DMARDS (methotrexate)
biologics “mab’s” (rituximab)

Question 11

What occurs in gout?

Answer 11

Deposition of monosodium urate crystal in joint and causes joint inflammation and pain

Question 12

assessment findings for gout

Answer 12

acute joint pain
swelling
warmth
erythema

usually single joint- often big toe

Question 13

what can develop in advanced gout

Answer 13

tophi and MSU depositis in subcutaneous tissues of antihelix of ears and extensor aspects of elbow occur

tophi can involve eyes - conjunctival nodues, blurred vision

fever
kidney stones

Question 14

Can you diagnosis gout with a serum uric acid level?

Answer 14

eh. Normal levels are common during acute attack. should diagnosis with clinical presentation in conjunction with diagnostic studies

Question 15

gold standard for Gout diagnosis

Answer 15

synovial fluid aspiration - not typically performed but gold standard

presence of monosodium urate crystals is diagnostic

Question 16

what medication do we use for acute gout attacks

Answer 16

Colchinice - best within 36 hours of flare onset
Steroids
NSAIDs

Question 17

what are the 3 main urate lowering agents we give to prevent gout flare ups?

Answer 17

Allopurinol
Febuxostat
Probenecid

Question 18

what do you need to monitor when patients are on urate lowering drugs such as allopurinol

when do we monitor?

Answer 18

CBC (bone marrow suppression)
Renal fx
Liver fx

Draw labs: 1 week, 6 weeks, Q3 months while on allopurinol

Question 19

what is plantar fasciitis?

Answer 19

painful, inflammatory/degenerative injury of the planter surface - bottom - part of your foot fascia

Question 20

what muscle allows for abduction of arm?

Answer 20

Supraspinatus

Question 21

what synovial joint has the greatest ROM?

Answer 21

Shoulder

Question 22

What is tinels sign?

Answer 22

test for carpal tunnel

tap on median nerve, if symptoms occur = positive

Question 23

what is phalens sign

Answer 23

push hands together for 60 seconds, occluding medial nerve

symptoms = positive

Question 24

what is the nerve distribution for the medial nerve?

Answer 24

palmer thumb + 2.5 fingers

dorsal = tip of same fingers to first joint from nail

Question 25

what is the nerve distribution of the ulnar nerve in the hand.

Answer 25

palmer/dorsal coverage of pinky + .5 of ring finger

Question 26

what is the nerve distribution for radial nerve in hand

Answer 26

dorsal part of hand for thumb, index, middle, and half of ring finger up to the 1st joint (PIP joint)

Question 27

what does McMurrary test look for?

Answer 27

Meniscal injury/ Joint line pain

Question 28

what happens in cauda equina syndrome?

Answer 28

loss of sensation/ function of legs with loss of bowel d/t cord compression

EMERGENCY –> lead to permanent paralysis

Question 29

how do you grade DTRs

Answer 29

DTR responses are graded as follows 
			 0= no response 
			\+1 = 1 diminished response
			\+2+ = Normal response 
			\+3 = Increased response 
                        \+4 = Hyperactive response