Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Board Review > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Finkelstein’s Test

A

De Quervain’s tenosynovitis is caused by an inflammation of the tendon sheath, which is located at the base of the thumb. The screening test is Finkelstein’s (lesson “Figure 14.2 Finkelstein’s test”), which is positive if there is pain and tenderness on the wrist on the thumb side (abductor pollicis longus and extensor pollicis brevis tendons).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anterior Drawer Sign

A

A positive anterior drawer sign is indicative of a damaged or torn anterior cruciate ligament (ACL).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Posterior Drawer Sign

A

hen examiner grasps the lower leg by the joint line and pushes it posteriorly. A positive posterior drawer sign is indicative of a damaged or torn posterior cruciate ligament (PCL).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lachman’s Sign

A

With the patient’s knee in 30 degrees of flexion, the femur is stabilized with one hand, and the other hand is used to apply force to the tibia to displace the tibia forward on the femur (Figure 14.4). Positive result is suggestive of a tear to the ACL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Collateral Ligament Tests

A

Valgus stress test of the knee: Test for the medial collateral ligament (MCL)

Varus stress test of the knee: Test for the lateral collateral ligament (LCL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ankylosing Spondylitis

A

Chronic inflammatory disorder (seronegative arthritis) that affects mainly the spine (axial skeleton) and the sacroiliac joints (axial spondylarthritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

S/S Ankylosing spondylitis

A
  • neck pain that progresses down the spine
  • impaired spinal mobility
  • joint pain that keeps you awake at night
  • fatigue
  • low grade fever
  • costochondritis and costovertebral tenderness
  • stiffness that resolves with activity
  • decreased ROM
  • hyperkyphosis (hunchback)
  • lordosis (exaggerated inward curve of the spine, usually in the lower back)
  • bamboo spine on xray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment for ankylosing spondylitis

A
  • refer to rheumatology
  • exercise therapy
  • NSAIDS first line (then TNF inhibitors, DMARDS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lateral Epicondylitis

A

Tennis elbow.

Gradual onset of pain on the outside of the elbow that sometimes radiates to the forearms. Pain worse with twisting or grasping movements (opening jars, shaking hands). Physical exam will show local tenderness over the lateral epicondyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Medial Epicondylitis

A

Golfer’s elbow

Gradual onset of aching pain on the medial area of the elbow (the side of the elbow that is touching the body), which can last a few weeks to months. Pain can be mild to severe. More common in women age 45 to 64 years. Occurs over the medial aspect of the elbow (ulnar nerve). Physical exam will show localized tenderness over the medial epicondyle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gout

A

Deposit of uric acid crystals in the joints. Can be due to overproduction or reduced excretion of purine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Gold standard for gout diagnosis

A

joint fluid aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

S/s Gout

A
  • warm, painful, tender swollen joint
  • rapid onset usually at night
  • precipitated by ingestion of alcohol, meats, or seafood

Chronic gout has tophi (small white nodules full of urates on ears and joints)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

uric acid levels during gout flare

A

During the acute phase, uric acid level is normal; uric acid level does not begin to rise until after the acute phase.

Elevated level may support diagnosis but is not diagnostic.

Most accurate measurement is 2 weeks after gout flare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Labs for gout

A

WBC is often elevated.
ESR is elevated.
CRP is elevated.

Uric acid will be normal, increases 2 weeks after flare. Elevation may support diagnosis but its not diagnostic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment for gout

A

Pain relief - NSAIDS

Inflammation - steriors, prednisone or medrol taper

Colchicine - Two tablets (1.2 mg) at the onset of pain and then one tablet (0.6 mg) in 1 hour

Patient may continue daily dose of urate lowering therapy during flares (allopurinol, febuxostat….). Or may start new 2 weeks after flare.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Dietary modifications for patients with gout

A

Avoid/minimize alcohol (<2 servings for males/<1 serving for females).

Avoid fructose- or corn syrup–sweetened beverages, which increase uric acid.

Remain well hydrated.

(DASH) or Mediterranean diet.

Advise dietary moderation in purine intake.

Potential benefit in consumption of cherries, vitamin C, fish, and omega-3 fatty acids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Red flags for cauda equina syndrome

A
  • Bladder and bowel incontinence
  • Sensory loss in the distribution of the affected nerve roots; may cause saddle anesthesia
  • Low back pain accompanied by pain radiating into one or both legs
  • Bilateral leg weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tibial stress fracture s/s

A

Pain that’s more focal and in one specific area of the leg.

Pain that worsens over time and increases with impact activity.

Pain that doesn’t get better after stopping activity.

Pain that’s more noticeable when resting.

There may also be tenderness to even a light touch on or near the affected bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Shin splints vs. tibial stress fracture

A

Pain at affected bone with fracture, more generalized with shin splints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Treatment for shin splints

A

RICE

Cushioned sneakers for daily use

After pain stops wait 2 weeks prior to resuming activities

Stretch before and after activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment for suspected tibial stress fracture

A

Same as for shin splints however..

If suspect stress fracture, plain radiographs are often the first imaging study; however, they are often normal initially. MRI is highly sensitive and specific. Refer to orthopedic specialist.

Recommend lower-impact exercises (e.g., swimming, stationary bike, elliptical trainer).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Meniscus tear

A

The two menisci are crescent-shaped pads of fibrocartilage located within the knee joint. Tears in the meniscus result from trauma and/or overuse. Sports with higher risk are soccer, basketball, and football.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Meniscus tear s/s

A
  • clicking, locking, or buckling of the knee
  • may be unable to fully extend affected knee.
  • Patient may limp.
  • Complains of knee pain and difficulty walking and bending the knee.
  • joint line pain.
  • Decreased ROM.

Certain movements aggravate symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PE findings for meniscal tear

A
  • Assess for joint line tenderness and knee ROM
  • Look for locking or inability to fully extend or straighten the leg, squat, or kneel.
  • Will be unable to squat or kneel. -
  • Knee may be swollen (joint effusion)
26
Q

Steinman’s test

A

Flex the knee joint and palpate the joint line. Pain over the posterior joint line with flexion is positive for meniscus tear.

27
Q

Apley’s test

A

Patient is prone with affected knee flexed at 90 degrees. Stabilize patient’s thigh (with examiner’s knee or hand). Press the patient’s heel downward (push heel toward the floor) while the foot is internally and externally rotated. The examiner is compressing the meniscus between the tibia and femur while twisting the foot. Positive sign is pain elicited with compression of the knee.

28
Q

Treatment for meniscal tear

A
  • RICE
  • may need crutches
  • NSAIDS for pain
  • When the pain and swelling are resolved, start quadriceps-strengthening exercises. The quadriceps are the largest muscles of the body; they will help to stabilize the knees. Swimming, water aerobics, and light jogging are possible exercises.
  • Locking or unstable knees should be referred to orthopedist; many need arthroscopy to repair menisci.
  • MRI is most sensitive imaging for tear
29
Q

Morton’s neuroma

A

Inflammation of the digital nerve of the foot between the third and fourth metatarsals. Increased risk with high-heeled shoes, tight shoes, obesity, dancers, runners.

30
Q

Morton’s neuroma s/s

A

Pain, burning or numbness with walking especially in heels or tight shoes.

May have small nodule between 3rd and 4th toes

31
Q

Mulder Test

A

This test for Morton’s neuroma is done by grasping the first and fifth metatarsals and squeezing the forefoot (Figure 14.6). Positive test is hearing a click along with a patient report of pain during compression. Pain is relieved when the compression is stopped.

32
Q

Treatment for morton’s neuroma

A

Avoid wearing tight, narrow shoes and high heels.
Use forefoot pad.
Wear well-padded shoes.
Diagnosed by clinical presentation and history.
Refer to podiatrist.

33
Q

Osteoarthritis

A

Inflammatory process with altered joint function that is associated with characteristic pathologic changes in the joint tissue and destruction of the articular cartilage.

Large weight-bearing joints (hips and knees) and the hands (Bouchard’s and Heberden’s nodes) are most commonly affected. It can affect one side or bilaterally.

Risk factors include older age, overuse of joints, and positive family history.

34
Q

S/s of OA

A
  • insidious onset over years
  • early morning joint pain stiffness or pain and stiffness with inactivity. usually lasts les than 30 minutes
  • pain worse with joint overuse
  • usually asymmetrical
  • Deformities such as Heberden’s and/or Bouchard’s
  • crepitus
  • decreased ROM
35
Q

Heberden’s nodes

A

Found in OA.

Bony nodules on the distal interphalangeal (DIP) joints

36
Q

Bouchard’s nodes

A

Found in OA

Bony nodules on the proximal interphalangeal (PIP) joints

37
Q

OA managment

A
  • exercise with weight bearing
  • warm or cold packs
  • thai chi, acupuncture,
  • NSAIDs (start with topical)
  • duloxetine for patients where NSAIDS are contraindicated
  • r/o osteoporosis
38
Q

Piriformis syndrome

A

Piriformis muscle, located in the buttocks, can compress, irritate, and entrap the sciatic nerve between its muscle layers

39
Q

Piriformis syndrome s/s

A
  • pain and numbness of the buttocks- may radiate down the leg. - - pain is worse with prolonged sitting/driving
  • Pain may be episodic.

History of running, lifting heavy objects, falls, or excessive stair climbing.

There are maneuvers that can be done to irritate the piriformis muscle, such as FAIR (flexion, adduction, internal rotation) maneuvers.

40
Q

Freiburg test

A

Evaluates for piriformis syndrome

positive when pain or sciatic symptoms are caused by placing the hip in extension and internal rotation, and then resisting external rotation.

41
Q

Pace sign

A

Evaluates for piriformis syndrome

Pain elicited when the seated patient resists abduction and external rotation.

42
Q

Imaging for piriformis syndrome

A

Radiograph (x-ray): Consider if limited hip ROM or chronic groin pain. Can help diagnose OA of hip.

Ultrasound: Can help diagnose tendon and soft-tissue injury around the hip and groin.

MRI: Can help diagnose sciatic nerve compression, stress fracture of femoral neck, cartilage tears, tendon ruptures.

43
Q

Treatment for piriformis syndrome

A
  • Avoid positions that trigger pain
  • RICE (rest, ice, compression, elevation) guide; cold packs or heat can be used.
  • Warm up and stretch before sports or exercises. .
  • NSAIDs and muscle relaxants are the most common method of treatment.

Refer for physical therapy for stretching and exercises.

44
Q

Plantar Fasciitis

A

cAute or recurrent pain in the plantar region of the foot that is aggravated by walking.

Caused by microtears in the plantar fascia due to tightness of the Achilles tendon.

45
Q

Treatment for plantar fascitis

A
  • NSAIDS - PO or topical
  • Orthotic foot appliance: Used at night for a few weeks; it will help to stretch the Achilles tendon.
  • Stretching and massaging of the foot: Roll a golf ball with sole of foot several times a day.

Lose weight: If overweight.

Shoes: Well-padded soles and/or a heel cup on affected foot.

46
Q

Popliteal (Baker’s) Cyst

A

Type of bursitis that is located behind the knee (popliteal fossa).

The bursae are protective, fluid-filled synovial sacs located on the joints that act as a cushion and protect the bones, tendons, joints, and muscles. Sometimes when a joint is damaged and/or inflamed, synovial fluid production increases, causing the bursa to enlarge.

47
Q

Treatment for baker’s cyst

A
  • RICE
  • NSAIDS

Large bursa can be drained with syringe using 18-gauge needle if causing pain. Synovial fluid is a clear, golden color. If cloudy synovial fluid is present and the joint is red, swollen, and hot, order a C&S to rule out a septic joint infection. After it is drained, an intraarticular injection of a glucocorticoid (triamcinolone acetonide) can decrease inflammation.

Warn patient that the cyst can recur in the future. Most popliteal cysts are asymptomatic and do not require intervention.

48
Q

The best imaging test for suspected stress fractures is …

A

MRI. Plain radiographs do not show stress fractures initially after injury.

49
Q

Rheumatoid arthritis

A

Chronic, systemic autoimmune and inflammatory disorder. Mainly manifested through systemic inflammation of multiple joints and other parts (skin, heart, blood vessels, kidneys, GI, brain/nerves, eyes

50
Q

RA s/s

A
  • fatigue
  • low-grade fever
  • generalized body aches
  • myalgia
  • joint pain, stiffness, and swelling
    -early-morning stiffness/pain and warm, tender, and swollen fingers in the DIP/PIP joints

Swan neck deformity and boutonniere deformity are signs of late and/or severe RA disease.

51
Q

RA treatment

A
  • refer to rheumatology
  • PT/OT
  • DMARDS
52
Q

Ottawa Rules (of the Ankle)

A

Plain radiographs of the ankle are only indicated if there is pain in the malleolar zone and
- Bone tenderness over the posterior edge or tip of the medial or lateral malleolus or
- Inability to bear weight both immediately after the injury and for four steps into the ED or provider’s office.

Plain radiographs of the foot are only indicated if there is pain in the midfoot zone and
- Bone tenderness at the base of the fifth metatarsal or at the navicular or
- Inability to bear weight both immediately after the injury and for four steps into the ED or doctor’s office.

In regard to the Ottawa ankle rules:
Bearing weight includes the ability to transfer weight twice to each foot (even if limping).

Assess for bone tenderness by palpating the distal 6 cm of the posterior edge of the fibula.

53
Q

Grade I Sprain

A

Mild sprain (slight stretching and some damage to ligament fibers); patient is able to bear weight and ambulate. There is no joint instability present during the ankle evaluation.

54
Q

Grade II Sprain

A

Moderate sprain (partial tearing of ligament); ecchymoses, moderate swelling, and pain are present. Joint tender to palpation. Ambulation and weight bearing are painful. Mild-to-moderate joint instability occurs. Consider x-ray, referral.

55
Q

Grade III Sprain

A

Complete Rupture of Ligaments

Severe pain, swelling, tenderness, and ecchymosis. Significant mechanical ankle instability and significant loss of function and motion. Unable to bear weight or ambulate. Refer to ED for ankle fracture.

56
Q

Treatment for sprains

A

Grade I sprains (mild sprains) do not require immobilization. Use elastic wrap (ACE bandage) for a few days.

Grade II sprains (moderate sprain) may need more support. Use ACE and an Aircast or similar splint for a few weeks. May require brief period of immobilization and non-weight bearing.

Grade III sprains are often managed by an orthopedic or sports specialist. Non-weight bearing and immobilization for brief period (about 10 days). May require surgery and functional rehabilitation.

57
Q

Systemic Lupus Erythematosus

A

Multisystem autoimmune disease characterized by remissions and exacerbations affecting the skin, kidneys, heart, and blood vessels.

58
Q

S/S SLE

A
  • fever
  • fatigue
  • weight loss
  • arthralgias
  • maculopapular butterfly-shaped - - rash on the middle of the face - - - nonpruritic thick scaly red rashes on sun-exposed areas
  • Photosensitivity,
  • ocular manifestations,
  • abdominal pains
  • joint symptoms.

May have cardiac symptoms, vascular abnormalities (e.g., Raynaud’s phenomenon), pleuritis, pulmonary hypertension, cognitive dysfunction, anemia, and leukopenia. Urinalysis (UA) may be positive for proteinuria with kidney involvement. Antinuclear antibodies (ANA) are positive in virtually all patients

59
Q

Treatment for SLE

A

NSAIDs, analgesics, steroids, antimalarial [Plaquenil], immune modulators [methotrexate, biologics], monoclonal antibodies).
For mild symptoms: Bedrest, naps, avoidance of fatigue

60
Q
A

Board Review (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions