Musculoskeletal Flashcards
1
Q
Neer test also called what?
Tests for what?
A
Painful arc test
Shoulder impingement
2
Q
Hawkins test - for what?
A
Shoulder impingement
3
Q
How much calcium should post menopausal women take?
A
1200mg daily
4
Q
Apley scratch test
A
Reach hand behind to opposing shoulder blade
Positive with pain indicating rotator cuff issue
5
Q
T score indicative of OP
Osteopenia?
Normal?
A
- -2.5 and below (-3, -4)
- -1 to -2.5
- Normal: -1 and higher
6
Q
Who gets a DEXA scan?
A
- All women 65+
- Younger patients with low trauma fractures
7
Q
Drugs that increase risk for OP? (3)
A
- Steroids
- PPI
- Depo
*Think OP = SPD
8
Q
Biggest risk factor for OP?
A
- Smoking
9
Q
Common first symptom of OP?
A
Fracture
10
Q
What do DEXA scans specifically look at? (3)
A
- Hip, femoral neck, lumbar spine
11
Q
HTN med great for OP?
DM med that’s helpful?
Psych med that’s helpful?
A
- Thiazides
- GLP 1
- Wellbutrin
12
Q
How do bisphosphonates work?
A
- Inhibits reabsorption of bone by osteoclasts
- Increases bone density
13
Q
How to take bisphosphonates?
A
- Upright 30 min to avoid serious erosion
- Take alone with full glass of water
14
Q
Long term risk factors of bisphosphonates?
How long should we take these?
A
- Femur fracture
- Osteonecrosis of the jaw
- 3-5 years
15
Q
Morning Stiffness in RA vs. OA
A
- OA: goes away within an hour
- RA: doesn’t go away
16
Q
Pain in RA vs. OA
A
- RA: not relived with rest
- OA: worse with activity, better with rest
17
Q
Where are the Bouchard’s nodes?
Where are the Heberden’s nodes?
A
- Bouchard’s: PIP
- Heberden’s: DIP
18
Q
What do you see on XRs in OA? (2)
Typical sites? (5)
A
- Joint space narrowing, bone spurs
- Hand
- Spine
- Hip, Knee, Foot
19
Q
Risk factors for OA? (4)
A
- Age
- Trauma
- Obesity
- Overuse
20
Q
Tx for OA? (3)
A
- NSAIDs
- Tylenol
- Exercise – non-weightbearing
21
Q
What is a FRAX score?
Need treatment when what?
A
- Likelihood of a patient to experience a fracture
- FRAX > 7.5% or osteopenia
22
Q
How to DMARDs work in RA?
May use what until the DMARDs kick in?
A
- Slow the disease process and preserve joint function
- Steroids
23
Q
Side effect of methotrexate? (2)
A
- Immunosuppression
- Folic Acid deficiency
24
Q
Risk factors for OP (5)
Race?
A
- Smoking
- Low body weight
- Anorexia
- Alcohol
- Early menopause
- White and Asian
25
OA vs. RA
Which one is bilateral?
Which one has warmth and redness?
- RA
- RA
26
OA vs. RA – which one has a slow onset?
Which one has weight loss?
- Slow: OA
- Weight loss: RA
27
What lab is most specific to RA?
Other labs?
- Anti CCP antibodies 98% specific
- RF factor
28
ESR in RA vs. OA
- + RA
- - OA
29
What is the max dose of Tylenol?
3g
30
What is indomethacin good for?
What is Celebrex good for?
- Indomethacin: Gout
- Celebrex: Bursitis
31
Contraindications to NSAIDs (6)
- Heart failure, HTN
- Ulcers, GI bleed
- On blood thinners
- Pregnancy
- Renal issues
- Steroids
32
What is Ankylosing Spondylitis?
XR findings?
- Autoimmune and chronic inflammatory disease that starts in the lower back and creeps up the spine
- Bamboo spine on spinal/sacroiliac XR
33
How to diagnose Ankylosing Spondylitis?
Key symptoms? (2)
Commonly occurs with what?
- sacroiliac XR first, then MRI
- Loss of ROM, lordosis
- Uveitis
34
Management for ankylosing spondylitis? (2)
Meds? (2)
- Refer to rheumatology
- Postural training
- NSAIDs or DMARDs
35
Treatment of navicular/scaphoid fx?
- Thumb spica cast
36
What is DeQuervain’s Tenosynovitis?
- Pain in the lower thumb and wrist
37
Test for DeQuervain’s Tenosynovitis
How to do it?
- Finkelstein’s test
- Patient grabs thumb and preforms ulnar deviation
- Positive if pain
38
How is carpal tunnel treated?
- Splint or brace
- Sometimes steroids
39
Symptoms of ulnar nerve palsy?
Test?
- Numbness in fingers 4&5
- Froment’s sign – thumb is bent when holding paper
40
Symptoms of Morton’s neuroma
- Feels like a pebble in their shoe between toes 3&4
- Numbness and tingling
- Positive Mulder's Sign
41
What is metatarsalgia?
- pain on the ball of the foot
42
Where does a ganglion cyst occur?
- Over a joint (not a space)
43
What is metatarsal phalangeal (MTP) joint synovitis?
- Pain and swelling on both the dorsal and plantar parts of the foot
44
Symptoms of epicondylitis? (2)
- Burning pain worsened with activity
- Pain with palpation
45
Other names for lateral epicondylitis vs. medial epicondylitis?
- Lateral: tennis elbow
- Medial: Golfers elbow
46
What is a test for lateral epicondylitis?
Cozen test - Extend wrist against resistance
47
Treatment for epicondylitis? (3)
- RICE
- NSAIDs
- Possible PT
48
Causes of Gout (5)
- Diuretics (dehydration, avoid thiazides)
- Renal issues
- Obesity
- ETOH*
- Purine foods
49
Foods high in purines?
- Alcohol, liver
- Red meat, shellfish,
- High fructose corn syrup
50
Foods low in purine?
- Coffee, milk, vitamin C
51
Med to avoid in gout?
- Aspirin
- HCTZ
52
How to diagnose gout flare?
- Aspiration of synovial fluid to see crystals
53
What are tophi?
- Stone-like deposits in the joints
- Look like a bulge
54
Is uric acid always high during a flare?
What is high during an attack?
- No
- ESR/CRP, WBC
55
Go to treatment for gout flat? (2)
Not working? (1)
- Indomethacin
- Steroids
- Severe: Colchicine
56
Side effects of colchicine?
- N/V/D, cramping
- Take at onset of symptoms
57
Side effect of allopurinol
What labs to monitor?
- Bone marrow suppression
- Monitor CBC, LFTs, RFP
58
More expensive options for gout prevention
- Colchicine
- Probalan
- Uloric
59
What is gout of the big toe called?
- Podogra
60
Typical scenario of meniscus injury?
During injury?
- Twisting maneuvers – can finish game
- Pop then lock
- Painful extension
61
Swelling ACL vs. Meniscus
- Meniscus: up to 24hr
- ACL: immediate < 1 hr
62
Most sensitive test for meniscus injury?
- Thessaly test
63
How to diagnose meniscus injury?
MRI
64
Treatment for meniscus injury
- RICE, NSAIDs
- Refer to ortho
65
Meniscus tests?
Positive with what?
- Apleys
- McMurrays
- Clicking or pain
66
Typical scenario of ACL injury?
Characteristics?
- Pivoting, not contact
- Sudden pop and knee gave way
67
How to perform Lachmans?
Less specific test?
- Supine, bend knee 20 degrees, pull calf to you
- Too much ROM
- Anterior drawer
68
Treatment for ACL injury?
- Refer to ortho
- NSAIDs, RICE, PT
69
MCL injury
Pain is where?
Feels like what?
- Medial side of knee pain
- Feels like it’s giving out
70
MCL injury test
- Valgus
- *Think push knees to middle like Gum to the Middle
71
LCL pain is where?
- Lateral side of knee
72
LCL test?
- Varus
- Think vaRus – lateral
73
Symptoms of fibromyalgia (5)
- Widespread pain
- Tenderness
- Overall sensitivity
- Fatigue
- Cognitive problems
74
Population commonly affected by fibro?
- Middle aged women
75
Diagnostic criteria for Fibro? (4)
3 months or more of what?
- >/= 3 months of
- Fatigue
- Waking up not feeling refreshed
- Pain -WPI >/= 7 out of 19
- Cognitive problems
76
What are we no longer looking at to diagnose fibro?
- Tender points
77
First line treatment for fibro?
- Regular exercise
78
What is the name for bunion?
How to diagnose?
Treatment?
- Hallux valgus
- >20 degree curve on XR
- Braces or surgery
79
Risk factors for plantar fasciitis?
Common symptom?
- Runners
- Sharp heel pain worse in the morning
80
Plantar fasciitis treatment? (5)
- NSAIDs, rest ice
- Stretch arches
- Supportive shoes
- Changing sports
81
Symptoms of bursitis
- Generalized pain and swelling over the whole joint
82
Treatment of bursitis?
- Celebrex
- Rest, ice
- Injections to hip/shoulder, not elbows
83
What is Wadells sign?
- Eval for psychogenic LOW back pain
84
What is another name for empty can test?
What does it test for?
- Jobe test
- supraspinatous tear
85
Which tests are for shoulder impingement?
- Hawkins and Neer (painful arc)
86
Test for sciatica? (3)
- Straight leg raise
- Yeoman - prone
- piriformis test
87
L4 nerve root
- Squat and rise
- Diminished knee jerk
- Think L4 squat on the floor
88
L5 nerve root
- Heel walking
- Numbness on big toe
- Think5/5 numbness on big toes
89
S1 nerve root
- Walk on toes
- Diminished or absent ankle jerk and weakness with walking
90
What is the speed test?
- Evals for SLAP superior labrum tear
91
What is the hook test?
What to do if positive?
- Eval for bicep tear/rupture
- Send to ortho
92
How to diagnose rotator cuff tear?
MRI
93
Most common mechanism of a sprain?
- Ankle inversion
94
What is Ottawa rule?
- Determine if patient needs radiographs of ankle
95
Grade 1 sprain
- Mild
- Can bear weight and ambulate
96
Grade 2 sprain
- Partial tearing of ligament
- Bruising, swelling, pain with palpation
- Painful to bear weight
- Consider XR
97
Grade 3 sprain
- Complete rupture of ligaments
- Can’t bear weight or walk 4 steps
- Refer to ED
98
How to diagnose shin splints?
MRI
99
Bursitis behind the knee
Called what?
- Baker’s cyst
- Ball behind knee
100
Name for shin splints?
Classic case (4)
- Medial tibial stress syndrome
- Pain on inner edge of tibia
- Worse with exercise
- Anterior aspect of shin
- May develop into stress fx
101
Shin splints tx? (3)
- Stop and rest for several weeks
- Cold packs BID 24-48hr
- When pain is gone, wait 2 weeks after to resume exercise
102
Gold standard test for any joint damage
MRI
103
What do NSAIDs increase? (3)
- Heart disease
- Kidney problems
- GI bleeding
104
What may help diagnose ankylosing spondylitis?
- Dramatic response to NSAIDs
105
Which NSAID has the least cardiovascular effects?
- Naproxen
106
Rotator cuff injuries that need surgical intervention? (4)
- Full thickness in young patients
- >50% partial with significant pain
- Full thickness not responding to non-op measures
- Any degree that results in loss of function
107
What is the lever test?
What does it test for?
- Thumb arthritis
- Grasping base of thumb and moving it radially and ulnarly
108
What does the O’Brien test test for?
- Superior labrum tears following dislocation
109
What is the apprehension test?
- Used to assess pain and instability after shoulder dislocation
110
First line meds for RLS (3)
- Pramipexole
- Requip
- Rotigotine
111
First line treatment for paronychia without abscess?
Symptoms not improved?
- CHG soaks and Bactroban
- Augmentin
112
What does the Watson test look at?
Other name?
- Wrist instability
- Scaphoid shift test
113
What does the Ege test look at?
- Meniscus injuries
114
What is the Fajersztajn test?
- Straight leg raise with contralateral leg of symptoms
115
Test most specific for rotator cuff test?
Drop arm test
116
What condition involves weakness in the femoral growth plate allowing the femoral head to “slip” or move out of place in relation to the rest of the femur?
Slipped capital femoral epiphysis (SCFE)
117
Risk Factors for SCFE
Adolescent males
Growth spurts, trauma, obesity
118
Symptoms of SCFE
Hip stiffness/pain, limp, difficulty bearing weight, unequal leg lengths
119
Positive test in SCFE?
Management?
Positive trendelenburg sign
Refer to ortho
120
What is Legg Calve Perthes disease?
Temporary loss of blood supply to the femoral head causing necrosis and loss of bone mineral density in the hip joint
121
Who is affected by legg calve perthes disease?
It’s a pediatric condition, commonly affecting ages 4-9 years
122
Symptoms of Legg Calve perthes disease
Hip pain, joint pain, limited range of motion, and walking with a limp
123
How dot diagnose Legg calve perthes
XR of hip
124
What curve in scoliosis warrants referral to ortho?
>20%
