musculoskeletal

Question 1

functional assessment tools

Answer 1

tinetti balance & gait evaluation
performance-oriented mobility assessment
berg balance scale

Question 2

arthritis vs periarthritis process

Answer 2

arthritis - complete ROM pain
periarthritis (ligament, tendon) - partial ROM pain

Question 3

arthritis diagnostic

Answer 3

arthrocentesis

Question 4

RA epidemiology

Answer 4

females>males
onset for females - 40-50
onset for males - 60-80

Question 5

key characteristics of RA

Answer 5

insidious onset w/ morning stiffness & joint pain
symmetric inflammatory polyarthritis
extra-articular manifestations (rheumatoid nodules, pulm fibrosis, serositis, vasculitis)
serum rheumatoid factor & ACPA

Question 6

RA imaging

Answer 6

uniform joint space narrowing & juxta-articular erosion on XRAY

Question 7

characteristics of OA

Answer 7

deep, achy joint pain
no systemic manifestations
pain exacerbated by activity, relieved by rest

Question 8

heberden nodes

Answer 8

DIP

distal interphalangeal joint

Question 9

Bouchard nodes

Answer 9

PIP

proximal interphalangeal joint

Question 10

OA imaging

Answer 10

unequal joint space narrowing

Question 11

OA meds

Answer 11

acetaminophen
NSAIDs
capsaicin
opioids
intra-articular injections

also use non-pharm methods!

Question 12

gout diagnostics

Answer 12

serum uric acid >6.8
WBC elevated in acute attack
check acute phase reactants maybe

Question 13

gout meds

Answer 13

NSAIDs (indomethacin)
colchicine
corticosteroids
xanthine oxidase inhibitors (allopurinol)
uric acid lowering agents

Question 14

gonocococcal vs non-gonococcal septic arthritis epidemiology

Answer 14

gonococcal - otherwise healthy adults

non-gonococcal - usually immunocomp., or bacteremic patients

Question 15

non-gonococcal septic arthritis pathogen

Answer 15

staphylococcus aureus

Question 16

key characteristics of septic arthritis

Answer 16

acute onset (hours)
inflammatory, monoarticular
large weight bearing joints
large joint effusions

Question 17

ankylosing spondylitis characteristics

Answer 17

chronic low back pain
worse in morning
improves with exercise

Question 18

neurogenic arthropathy management

Answer 18

control DM!!! or primary disease

Question 19

neurogenic arthropathy characteristics

Answer 19

enlarged, boggy, painless joint

joint dislocations & fractures common

foot and ankle most common

Question 20

normal T score

Answer 20

> -1.0

Question 21

abnormal T scores

Answer 21

-1 to -2.5 SD - osteopenia
< -2.5 SD - osteoporosis
< -2.5 SD with fragility - severe osteoporosis

Question 22

RA deformities

Answer 22

ulnar deviation
boutonniere
swan neck
hammer toe

common in MCP, PIP, wrist, ankles, MTP, knees

Question 23

RA treatment

Answer 23

DMARDS!!! AEs significant - screen for TB first

steroids - bridge before DMARDs effective
NSAIDs

methotrexate - first line
sulfasalazine

Question 24

ankylosing spondylitis diagnostic

Answer 24

xray - bamboo spine

Question 25

ankylosing spondylitis treatment

Answer 25

PT, exercise

NSAIDs!, sulfasalazine (DMARD), TNF inhibitors

surgery, referral - rheum, optho, surgery, cards

Question 26

osteoporosis risk factors

Answer 26

estrogen deficiency, Ca/Vit D deficiency, cushings, steroids, hyperparathyroidism

aging, immobilization, ETOH, smoking, malignancy

Question 27

osteoporosis screening & diagnostics

Answer 27

DEXA (women 65+, or younger w RF)

xray for fractures

Question 28

osteoporosis management

Answer 28

non-pharm - exercise, diet, smoking cessation, safety

bisphosphonates - “-dronates” (no use in CKD; can cause jaw necrosis) for DEXA <2.5

SERMs

Question 29

types of OM

Answer 29

hematogenous - d/t chronic disease
contiguous - post-traumatic, wounds
vascular - DM

Question 30

OM s/s

Answer 30

hematogenous - fever, chills, pain ->sepsis
contiguous - local s/s of info
vascular - no pain/fever, visible bone

Question 31

OM s/s

Answer 31

hematogenous - fever, chills, pain ->sepsis
contiguous - local s/s of info
vascular - no pain/fever, visible bone

Question 32

OM diagnostics

Answer 32

leukocytosis - acute
BC +

bone biopsy - definitive

MRI - late

Question 33

low back pain red flags

Answer 33

cauda equina syndrome

leg pain > back pain - nerve impingement
unexplained weight loss
failure to improve w treatment
severe pain > 6 weeks
night/rest pain - malignancy
bowel/bladder symptoms - cauda equina

Question 34

when to order MRI for low back pain

Answer 34

red flag symptoms
symptoms persisting >6 weeks

Question 35

ortho general management

Answer 35

control pain & inflammation!, improve ROM & strength

non-pharm

APAP, NSAIDs
topical opioids
opioids - short term
muscle relaxants
steroids
injections

Question 36

most commonly injured knee ligament

Answer 36

MCL

Question 37

ligaments connect

Answer 37

bones

Question 38

tendons connect

Answer 38

muscles

Question 39

knee injury management

Answer 39

protected weight bearing (brace)
pain management
PT
CT/MRI post-acute

ortho referral: if internal derangement, neurovascular compromise, gross instability, failed conservative treatment

Question 40

shoulder injury tear mgmt

Answer 40

ortho referral
shoulder immobilization & ROM
PT
pain mgmt

reduction for dislocation

Question 41

frozen shoulder

Answer 41

adhesive capsulitis

pain out of proportion to clinical findings

Question 42

important H&P components for fractures

Answer 42

mechanism of injury

sensation, circulation, motion

Question 43

compartment syndrome

Answer 43

pain
pallor
paresthesia
pulselessness
paralysis
poikolothermia

Question 44

fractures mgmt

Answer 44

immobilization
PT/OT

pain mgmt, muscle relaxants

referral - may need surgery

abx if open fractures

Question 45

Ottawa ankle rules

Answer 45

used to determine when to xray ankle injury

if not ankle to bear weight for 4 steps, then:
check for bony tenderness

bony tenderness ->xray

no bony tendernes ->no xray

Question 46

who needs an ankle boot?

Answer 46

CAM boot

eversion