Musculoskeletal

Question 1

three types of joints

Answer 1

synovial - freely movable joint, such as for knee or shoulder
cartilaginous - slightly movable, ex vertebral bodies
fibrous - immovable, ex skull sutures

Question 2

synovial joints

Answer 2

the bones do not touch each other, the articulations are freely movable. Bones are covered by articular cartilage and separated by a synovial cavity which cushions movements. A synovial membrane lines the cavity and secretes a small amount of synovial fluid, which is viscous and lubricates. a joint capsule surrounds the synovial memberne.

Question 3

cartaliginous joints

Answer 3

slightly movable joints where bony surfaces are separate by fibrocartilaginous discs. at the center of each disc is the nucleus pulposa. a fibrocartilagionus material that serves as cushion or shock absorber.

Question 4

fibrous joints

Answer 4

the bones are held together by intervening layers of fibrous tissue or cartilage. The bones are almost in direct contact which allos no appreciable movement

Question 5

bursae

Answer 5

roughly disc-shaped synovial sacs that allow adjacent muscles or muscles and tendons to glide over each other during movement.

Question 6

three joints of the shoulder

Answer 6

glenohumeral joint -head of humerus articulates with the glenoid fossa of scapula. ball and socket joint
sternoclavicular joint - convex medial end of the clavicle articulating with the concave hollow int he upper sternum
acromioclavicular joint - the lateral end of the clavicle articulates with the acromion process of the scapula

Question 7

muscle groups of the shoulder

Answer 7

the scapulohumeral, axioscapular and axiohumeral groups

Question 8

scapulohumeral muscle group

Answer 8

extends from scapula to humerusincludes deltoid, teres major and SITS muscles (Supraspinitus, Infraspinitus, Teres minor, Subscapularis) which insert directly on the humerus (rotator cuff muscles)..

Question 9

axioscapular muscles group

Answer 9

attach to teh trunk of the scapula and includes trapezius, rhomboids, serratus anterior and levator scapulae. rotate and fix the sapula adn pull shoulder back

Question 10

axiohumeral muscle group

Answer 10

attaches the trunk to the humerus, includes pectoralis major, pectoralis minor, and latismus dorsi. responsible for internal rotation of shoulder

Question 11

principle bursa of shoulder

Answer 11

subacromonial bursa

Question 12

joints of the elbow

Answer 12

jumeroulnar, radiojumeral and radioulnar joints

Question 13

muscles groups of the elbow

Answer 13

biceps and brachioradialis (flexion)
the triceps (extension)
pronator teres (pronation)
supinator (supination)

Question 14

olecranon bursa

Answer 14

between olecranon process and the skin

Question 15

ulnar nerve

Answer 15

runs posteriorly between the medial epicondyle and the olecranon process

Question 16

effects of aging

Answer 16

tendons less elastic, decrease ROM, increase bone resporption, decrease bone density, deterioration of cartilage around joints

Question 17

common systemic MS problems

Answer 17

RA, lupus, polymyositis, lyme disease, SSA

Question 18

common local MS problems

Answer 18

lumbar strain, tennis elbow

Question 19

Joint point with inflammation

Answer 19

RA, SLE, scleroderma

Question 20

joint pain without inflammation

Answer 20

osteoartritis

Question 21

monoarticluar joint invovlement

Answer 21

gout, trauma, septic arthritis, lyme disease

Question 22

polyarticular joint involvement

Answer 22

RA
SLE - can affect mulitsystems
scleroderma- CREST syndrome (Caclinsis Raynauds pehnomenon, esophageal dysfuntionc, sclerodyctle, and telangiectasisias)

Question 23

neck range of motion

Answer 23

Chin to chest (flexion)
“look at ceiling” (extension)
Chin to each shoulder (lateral rotation)
Ear to each shoulder (lateral flexion, i.e., head tilt)

Question 24

components of the shoulder exam

Answer 24

Inspection
Palpation
Passive Range of Motion
Active Range of Motion
Appley scratch test for internal/external rotation
Impingement Signs
Bicep Tendonitis/Crossarm adduction/apprehension
Neck exam: compression test
Adson’s manuever

Question 25

osteoarthritis

Answer 25

Affects ¼ of population—over age 50
Degeneration of articular cartilage
Wt bearing & distal finger joints
Pain worsens with exercise
Morning stiffness or immobility
Heberdon’s nodes
Usually + family hx, obesity, hx of trauma

Question 26

rheumatoid arthritis

Answer 26

Chronic inflammatory condition
Insidious onset over wks. to months
Fatigue, malaise, morning stiffness
Swelling of joints, polyarticular, PIP, MCP joints commonly affected, symmetrical movement
ROM may be limited, tenderness of joints

Question 27

SLE

Answer 27

The ‘great imitator’
10 x more common in women than men
Mainly affects joints, kidneys and skin
Can present with oral lesion, rash, hair loss urinary symptoms (blood or foamy urine), etc…
Best managed by rheumatologist

Question 28

lower back pain differential dx

Answer 28

Acute lumbar-sacral sprain
Postural backache
Lumbar disk syndrome
Osteoarthritis
IBS

Question 29

risk factors LBP

Answer 29

Repetitive lifting
Exposure to vibration
Cig smoking
Osteoporosis-spinal stenosis
Obesity
Lack of exercise
Increased age
Urinary disorders
Gyn disorders
Ankylosing spondylitis
Tumors

Question 30

lumbar disc syndrome

Answer 30

With repetitive trauma: progressive degeneration of nucleus pulposus leading to protrusion or complete extrusion of portion of disc contents into neural canal
95% at 4 & 5 spaces
Most common between 3 & 4 decades
LBP, Restriction ROM, Radicular pain, Paresthesias and Local tenderness

Question 31

acute lumbar sacral strain

Answer 31

Related to muscular, ligament strain 2nd to specific trauma or continuous mechanical stress
Most common in age 20-40
Obesity & lack of exercise
features LBP, Muscle spasm, Local tenderness or swelling, Neurol exam negative

Question 32

Cauda equina syndrome

Answer 32

Massive midline protrusion
Medical emergency
Presentation: weakness to legs, urinary changes, impotence, loss of sphincter tone & saddle anesthesia
From trauma, lumbar spinal stenosis, or chronic inflammatory conditions (like Paget’s disease or ankylosing spondylitis)

Question 33

knee exam

Answer 33

Lachman’s test
Ballottement
Bulge sign
Post drawer
Valgus & varus stress
Apley’s Sign
McMurray’s Sign
Patellar apprehension test

Question 34

meniscus injury clinical features

Answer 34

Walking up and down stairs difficult
Joint effusion
Limited ROM
Positive McMurray
Nl xray

Question 35

Osgood-Schlatter disease

Answer 35

Involves the growing tibial tuberosity, occurs in Adolescents 8-15 yrs, Bilateral, Males > females, Self-limited
Features Local pain & swelling over tibial tuberosity
Pain with stair walking, exercise, squatting on knee
Lat xray may reveal variable degrees of separation & fragmentation of tibial epiphysis

Question 36

gout

Answer 36

common in older men. Involvement of monoarticular, usually proximal phalanx of great toe. Exquisite tenderness of jt, marked edema, swelling, warmth, Topi or urate crystals can occur on the ears and joints.