Musculoskeletal Flashcards
how do you definitively scan for osteoporosis?
DEXA
-2.5 or less
What meds to treat osteoporosis?
Bisphosphonates
-Fosamax
What med should we use to tx htn in those that have osteoporosis?
HCTZ
thiazides
What meds are you going to prescribe for rheumatoid arthritis?
DMARDS
-Methotrexate
What deficiency is methotrexate notorious for?
Folic acid deficiency
When would we see bouchard’s nodes?
Where are they?
B=both
RA and osteo
PIP
When would you see Heberden’s nodes?
Where are they?
osteoarthritis
DIP
What might you see on exam with Rheumatoid arthritis?
Boutonniere
swan neck deformity
Where does the pain start in ankylosing spondylitis?
lower back
then works its way up to the nect
What diagnostic test for ankylosing spondylitis?
xray “bamboo spine”
When does a navicular/scaphoid fx usually show up on xray?
2 weeks later
Why is it important to treat a navicular/scaphoid fx?
prevent osteonecrosis in the wrist
What are 2 signs of carpel tunnel syndrome and describe
Phalen’s = backwards prayer hands
Tinels = tap median nerve on inner wrist “tinel tap”
What tests do you use to evaluate the meniscus?
mcmurray
Apley test
What does the valgus maneuver look at?
ligaments
When we have continued popping of hte knee…what type of injury is that?
Meniscal
What maneuver determines if it’s the L4 that’s causing sciatica?
squat and rise
diminished knee jerk
what maneuver if it’s the L5 causing sciatica?
heel walking = numbness at great toe
what manuever if it’s S1 causing sciatica?
walk on toes
dim or absent ankle jerk
What is the drop arm test?
abduct arm away from body then lower back down to the waist slowly
…if there is a rotator cuff tear the arm will suddenly drop to the side
how do you assess a supraspinatus tear?
empty can test
What medication can be used as prevention to decrease uric acid levels?
allopurinol
What’s a big side effect of allopurinol?
What do we want to monitor?
bone marrow suppression
CBC
What is a treatment for a gout attack?
what about a severe attack?
NSAID ex Indocin
Steroids
Colcrys
Diagnosis criteria for fibromyalgia
pain
fatigue
wake up feeling unrefreshed
cognitive problems
…for 3+ months
…and symptoms can’t be explained for any other reason
Fibromyalgia treatment?
Cymbalta
Elavil
Lyrica
Flexeril
Regular exercise
What is hallux valgus?
What joint is affected?
Dx?
Tx
bunion
1st metatarsal phalangeal joint
dx: Xray
tx: braces
-if severe, refer surgery
What is De Quervain’s tenosynovitis?
Dx
pain in lower thumb/wrist
dx: Finkelstein test
What is the finkelstein test
tests for De Quervain’s tenosynovitis
grab thumb and perform ulnar deviation…positive test if pain occurs
What labs are going to be elevated for gout
ESR
CRP
WBC
What are you going to prescribe during a gout attack?
NSAID: Indocin
steroids
Severe: Colchicine
What lab do you want to monitor for a patient on Allopurinol?
CBC
look for bone marrow suppression
What is the main drug tx for osteoporosis?
bisphosphonates…“-dronate”
How do you take bisphosphonates?
why?
Need to be taken alone before food
need to remain upright for 30 mins to minimize acid reflux
What are signs someone has an ACL injury
sudden POP with PIVOTing and IMMEDIATE swelling
If someone has a positive Lachman or anterior drawer test…what do you do next?
refer to ortho
What are some distinguishing features of a meniscal injury?
how to tx
maybe feel a pop then joint “locks up”
going to still be able to finish the game
DELAYED swelling
McMurray’s test shows “clicking” or pain
RICE and refer to ortho
osteoarthritis symptoms 3
pain worse with activity but relieved with rest
morning stiffness <1hr
asymmetrical
no warmth or redness
what deficiency can DMARDs (methotrexate) cause?
folic acid deficiency
What are treatment options for fibromyalgia
1st line: physical exercise
2nd:
Duloxetine (Cymbalta) SSNRI
Amitriptyline (Elavil)
Flexeril
Pregabalin (Lyrica) GABA analogue
What is the Hep B vaccination series?
24 hours after birth
1 month after 1st dose
6 months
What is Hep B treatment for:
post exposure prophylaxis in unvaccinated?
post exposure prophylaxis vaccinated previouslyl?
unvaccinated: hep B vaccine AND hep B immunoglobulin within 24 hours
vaccinated:
hep b immunoglobulin within 24 hours
What are the 3 main stages of HIV?
1st: flu symptoms for 1st week
2nd: viral load decreases = latency stage lasts for years
3rd: return of symptoms
How do you diagnose HIV?
HIV1/HIV2 antigen/antibody immunoassay
it can detect acute infection and previous infection during latent phase
What CD4 count to do we want to start antiretroviral drug therapy?
CD4 <350
How should patients take their iron supplement?
with an acidic drink and on an empty stomach
What exists in the stomach and small intestine to help absorb vitamin b12?
intrinsic factor
