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AHA > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Joint Pain: Leading complaint for seeking health care
Duration may be? Location may be?

A

Acute vs chronic
Localized vs diffuse

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2
Q

Joint Pain: Leading complaint for seeking health care
May be associated with?

A

constitutional symptoms and systemic manifestations from other organ systems, injury, previous surgery or repetitive motion

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3
Q

Joint Pain: Leading complaint for seeking health care
Common complaint areas are?

A

Neck
Low back

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4
Q

MSK Overview:
Symptoms can be ___ vs ___ joints

A

single vs multiple

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5
Q

MSK Overview:
If there is injury, what do you ask?

A

What was the Mechanism of Injury

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6
Q

MSK Overview:
Additional questions?

A

Were there prior issues with specific areas?
Systemic symptoms?

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7
Q

Joint Pain
Ask the patient to?
joint pain may be?
One joint = ?

A

“point to the pain”
Articular or extra-articular
monoarticular

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8
Q

Joint Pain
Hands and feet tend to be more?
Multiple joints = ?
Pattern of involvement:?

A

localized than in larger joints
polyarticular, typically four or more
migrating, steadily spreading, symmetric, affecting similar joints on both sides of the body?

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9
Q

Joint Pain
Extraarticular means?
Myalgia means?
Arthralgia means?

A

joint pain w/ involvement of bones, muscles, and tissues around the joint (tendon, bursae, or even overlying skin)
Generalizes “aches and pains” if muscular in origin
joint pain is present, and no evidence of arthritis

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10
Q

Joint Pain
Decreased or limited movement - ask about?

A

any changes in activity related to the involved joint, especially ADLs

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11
Q

Joint Pain
Musculoskeletal stiffness is?

A

tightness or resistance to movement

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12
Q

Joint Pain
Acute joint pain lasts up to?
Chronic pain?

A

6 weeks
>12 weeks

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13
Q

Joint pain
Assess what of the joint symptom?

A

site
onset
duration
quality
severity

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14
Q

Joint Pain
Check for sings of inflammation?

A

swelling
warmth
redness

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15
Q

Joint Pain
Patterns of stiffness questions

A

worse in Am?
better with activity?
worse with activity?

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16
Q

Joint Pain
Localized or diffuse:

A

Which joints are painful?
Monoarticular vs Oligoarticular vs Poly articular?
Axial?

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17
Q

Joint Pain
Pain in more than one joint, is it?

A

Symmetric vs asymmetric

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18
Q

What is axial joint pain?

A

Spine is primarily affected

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19
Q

Joint Pain
If patient is < 60 y/o consider what?

A

repetitive strain or overuse syndromes (tendinitis or bursitis)
Crystalline arthritis (gout)
RA
Psoriatic arthritis
Infectious arthritis from gonorrhea, Lyme disease or viral or bacterial infections

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20
Q

Joint Pain
What type of arthritis is considered for patients < 60 with IBD?

A

Reactive (Reiter)

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21
Q

Joint Pain
If patient is >60 y/o consider what?

A

OA
gout
pseudo gout
polymyalgia rheumatica
osteoporotic fracture
septic bacterial arthritis

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22
Q

Four Cardinal Features of Inflammation

A

Swelling
Warmth
Redness
Pain

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23
Q

Associated Constitutional Symptoms/Systemic Manifestations from Other Organ Systems:
Skin Conditions: Butterfly (malar) rash on the cheeks is a sign of?

A

SLE

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24
Q

Associated Constitutional Symptoms/Systemic Manifestations from Other Organ Systems:
Papules, pustules or vesicles with reddened bases on the distal extremities are a sign of?

A

Gonococcal arthritis

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25
Q

Associated Constitutional Symptoms/Systemic Manifestations from Other Organ Systems:
Expanding erythematous “target” or “bulls eye” patch early in an illness is a sign of?

A

Lyme’s disease

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26
Q

Neck Pain
Rarity?
Always ask if what was a precursor?
Ask about radiation into the?
is the arm feeling what?

A

Common
trauma
arm, scapular area
weakness, numbness, or parasthesia

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27
Q

Neck Pain
Nexus Criteria:

A

Normal alertness
no posterior midline cervical spine tenderness
no focal neurologic deficits
no evidence of intoxication
no painful distracting injury

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28
Q

Low Back Pain
Three groups
Nonspecific accounts for ___% of cases
Nerve root entrapment with radiculopathy or spinal stenosis ____%
Pain from a specific underlying disease ___%

A

90
5
1-2

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29
Q

Low Back Pain
Ask what about the location?

A

Is the pain on the midline, over the vertebrae, or off the midline?

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30
Q

Low Back Pain
If there is radiation into the buttock or lower extremity ask about?

A

is there associated numbness or parasthesia?

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31
Q

Low Back Pain
If there is any associated bladder or bowel dysfunction, what does this indicate?
What should you immediately do?

A

Cauda equina
pursue immediate imaging and surgical evaluation

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32
Q

Red Flags for Lower Back Pain from underlying systemic disease

A

Age <20 years to >50 years
Hx of CA
Unexplained weight loss, fever, or decline in general health
Pain lasting more than 1 month and not responding to treatment

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33
Q

Red Flags for Lower Back Pain from underlying systemic disease
Part 2

A

Pain at night or present at rest
Hx of IV drug use, addiction, or immunosuppression
Presence of active infection or HIV infection
Long-term steroid use
Saddle anesthesia, bladder or bowel incontinence
Neurologic symptoms or progressive neurologic deficit

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34
Q

Health Promotion
Nutrition?
Healthy weight does what for joints?

A

Calcium intake
reduced mechanical stress on weight-bearing joints (hips and knees)

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35
Q

Health Promotion
Physical Activity helps with?

A

Improved sleep quality
cognitive function
risk reduction of early death
CV disease
HTN
DMT2
Breast and Colon CA
Obesity
Osteoporosis
falls
depression

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36
Q

When should women be screened for osteoporosis?

A

age >/= 65 years w/o previous known fxs or secondary causes of osteoporosis
age </=65 years whose 10 year fx risk is >/= a 65 y/o white woman w/o additional risk factors

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37
Q

How much Calcium should men and women 19-50 yrs old intake?
Vitamin D?

A

1000mg/d
600 IU/d

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38
Q

How much Calcium should women 51-70 yrs old intake?
Vitamin D?

A

1200mg/d
600 IU/d

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39
Q

How much Calcium should men 51-70yrs old intake?
Vitamin D?

A

1000mg/d
600 IU/d

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40
Q

How much calcium should men and women >71 yrs old intake?
Vitamin D?

A

1200mg/d
800 IU/d

41
Q

Examination of the MSK system
Inspect the joint for?

A

symmetry
alignment
bony deformities
swelling

42
Q

Examination of the MSK system
Inspect and palpate what?

A

surrounding tissue

43
Q

Examination of Specific Joints
What are you looking for in the temporomandibular joint?

A

looking for pain and tenderness with palpation

44
Q

Shoulder
Inspection should be looking at?

A

Shoulder and shoulder girdle anteriorly
Scapulae and related muscles posteriorly

45
Q

Shoulder
Palpation should feel for?

A

bony contours
palpate any areas of pain

46
Q

Shoulder
ROM in what movements?

A

flexion
extension
abduction
adduction
internal rotation
external rotation

47
Q

Shoulder
What are the most common disorders?

A

Rotator cuff

48
Q

Shoulder
What is the cross-chest adduction test?

A

Push AC joint
Adduct shoulder
Patient pushes elbow up against resistance
Pain in AC = + test

49
Q

Shoulder
What is a false positive in the cross-chest adduction test?

A

RC Pathology

50
Q

Shoulder
What is the Apley Scratch test?

A

A series of movements that tests the patients ROM, flexion, extension, internal and external rotations, flexibility and strength

51
Q

Shoulder
Painful arc test is positive if?
A positive test shows?

A

shoulder pain from 60* to 120*
subacromial impingement / rotator cuff tendonitis

52
Q

Elbow
Palpate where?

A

the olecranon process and over the epicondyles

53
Q

Elbow
ROM in what movements?

A

flexion
extension
supination
pronation

54
Q

Elbow
What is medial epicondylitis?

A

Pitcher’s elbow

55
Q

Elbow
What is lateral epicondylitis?

A

Tennis elbow

56
Q

Elbow
What is Olecranon bursitis?

A

inflammation of the olecranon bursa
causes a golf ball sized area of swelling over the olecranon

57
Q

Hands
Heberden nodes occur where?

A

on the distal interphalangeal joint

58
Q

Hands
Bouchard’s nodes occur where?

A

In the proximal interphalangeal joint

59
Q

Hands
What is a Tinel sign?

A

Tapping the skin on the anterior wrist
A positive sign is paresthesia in the distal fingers

60
Q

Hands
What is Phalen’s Sign?

A

Pushing the posterior hands together to increase pressure in the carpal tunnel which increases pressure on the median nerve. A positive test occurs when the patient experiences pain or tingling in the thumb, index finger, middle finger, and sometimes the lateral half of the ring finger

61
Q

Spine
Assess all low back pain for?
This happens most commonly at? increases risk for?

A

Potential herniated intervertebral disks
L4-L5 or L5-S1; bladder bowel dysfunction

62
Q

Spine
ROM for these movements
When is neurological testing advised with these maneuvers?

A

flexion, extension, rotation, lateral bending
pain or tenderness, especially with radiation

63
Q

Spine
Inspection checking for?

A

Alignment overall
alignment of shoulders
alignment of iliac crests
alignment of gluteal folds

64
Q

Spine
How to correctly palpate the spine?

A

Palpate the spinous process of each vertebrae with your thumbs

65
Q

Hip
Observe what?

A

Patient’s gait
Heelstrike
foot flat
midstance
push off

66
Q

Hip
Palpation of bony landmarks includes what?

A

iliac spine
greater trochanter
ischial tuberosity
sacroiliac joint

67
Q

Hip
ROM of what movements?

A

flexion
extension
abduction
adduction
external and internal rotation

68
Q

Hip
What is the FABER test?

A

AKA Patrick’s test
Patient lays ankle across opposite knee
Examiner applies downward pressure at the flexed knee while stabilizing the opposite hip

69
Q

Hip
What is a positive FABER test show?

A

The presence of hip or sacroiliac joint pathology

70
Q

Knee
Inspect the gait for?

A

smooth rhythmic flow
any loss of hollow space around the patella

71
Q

Knee
Palpate the knee in what postion?
Feeling for what?

A

while sitting on the edge of the exam table
the tibiofemoral joint

72
Q

Knee
Bony enlargement at the tibiofemoral joint margins, genu varum deformity, and stiffness lasting <30 min are typical findings in what?

A

Osteoarthritis

73
Q

Knee
Inspect which bursa for effusion?

A

suprapatellar pouch
prepatellar bursa
anserine bursa

74
Q

Knee
Bulge sign present in?
How to test for it?

A

Minor effusions
Milk downward on medial and lateral sides of patella
apply medial pressure
tap and watch for fluid wave

75
Q

Knee
Balloon sign present in?
How to test for it?

A

Major effusions
Compress the suprapatellar pouch against the femur with the fingers and thumb
pressing the raised patella downward against the femur

76
Q

Knee
What is a positive balloon sign?

A

if there is a lot of space between the kneecap and the femur, and swelling pushes off to both sides the test is positive.

77
Q

Knee
How to perform McMurray Test

A

Examiner applies one hand at knee along medial meniscus
Examiners other hand holds the foot and ankle
Externally rotate the foot and apply valgus stress at the knee
Slowly extend the knee

78
Q

Knee
What is a positive test for the McMurray Test?

A

a palpable click or pop along the medial or lateral joint line is a positive test for a tear of the posterior portion of the medial meniscus

79
Q

Knee
What is Valgus Stress Test?

A

Abduction
Perform maneuver at 0* and 30*
Examiner applies inward pressure at lateral thigh with one hand
Examiner applies outward pressure from medial ankle with other hand

80
Q

Knee
What is Varus Stress Test?

A

Adduction
Perform maneuver at 0* and 30*
Examiner applies outward pressure at medial thigh with one hand
Examiner applies inward pressure at lateral ankle with the other hand

81
Q

Knee
What does a positive Valgus Stress test show?

A

MCL injury

82
Q

Knee
What does a positive Varus Test Show?

A

LCL injury

83
Q

Knee
What is the anterior drawer signs?

A

Examiner grasps upper calf with both hands.
Fingers clasped behind the calf.
Both thumbs on the tibial plateau region
Examiner pulls the tibia anteriorly in a sudden firm forward motion.
Assess for laxity (>6-8mm shift)
Compare to laxity with the opposite knee.

84
Q

Knee
What does a positive anterior drawer sign show?

A

Anterior cruciate ligament injury

85
Q

Knee
What is the Lachman Test?

A

Examiner grasps upper calf with the dominant hand, thumb over the anterior joint line.
The other hand stabilizes the distal femur
Examiner pulls the tibia anteriorly in a sudden firm forward motion.
Assess for laxity (>6-8mm shift)
Compare to laxity with the opposite knee.

86
Q

Knee
What does a positive Lachman Test show?

A

Anterior cruciate ligament injury

87
Q

Knee
What is a posterior drawer sign?

A

Have the patient lie on their back with their hip flexed to 45* and their foot flat on the bed (knee angle should be 90*)
Lean lightly on the patient’s foot to stabilize the leg
Wrap you hands around the knee’s joint line and gently apply a firm force to move the tibia backward
Assess for Laxity (>6-8mm shift)
Compare to laxity with the opposite knee

88
Q

Knee What does a positive posterior drawer sign show?

A

Posterior Cruciate Ligament injury

89
Q

Ankle and Foot
Localized tenderness often presents with?

A

arthritis
ligamentous injury
infection

90
Q

Ankle and Foot
Plantar fasciitis is?

A

focal heel tenderness

91
Q

Ankle and Foot
Acute inflammation of the first MTP joint is common in?

A

Gout

92
Q

Ankle and Foot
Palpate what joints for what?

A

anterior aspect of each ankle joint
metatarsophalangeal (MTP) joints
Metatarsal heads

tenderness

93
Q

Ankle and Foot
ROM of what movements?

A

Flexion
extension
inversion
eversion

94
Q

Pain in and around the joints
Which disease tends to have pain more in the PICP and MCP joints, feet (MTP) joints, wrists, knees, elbows, and ankles?

A

Rheumatoid arthritis

95
Q

Pain in and around the joints
Which disease tends to have pain in knees, hips, hands (usually distal), cervical and lumbar spine, and wrists, also previously injured or diseased joints?

A

Osteoarthritis

96
Q

Pain in and around the joints
Which disease tends to have pain in the base of the big toe (first MTP joint), instep or dorsa of feet, the ankles, knees, and elbows?

A

Gouty arthritis

97
Q

Pain in and around the joints
Which disease tends to have pain in the feet, ankles, wrists, fingers, and elbows?

A

Chronic tophaceous gout

98
Q

Gouty Arthritis
What are the bumps called?

A

tophi

AHA (2 decks)

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