Musculoskeletal

Question 1

Most likely presentation for gout

Answer 1

redness at first metatarsophalangeal joint

Question 2

How would you tx a gout attack

Answer 2

intraarticular corticosteroid injection
naproxen
colchicine

allopurinol and febuxostate for prevention not tx of attack

Question 3

potential triggers for gout

Answer 3

thiazide diuretic
sardines and anchovies
alcohol

Question 4

etiology of gout

Answer 4

can be from an overproduction of uric acid, but an urate under-excretion is more common

made worse by renal insufficiency, alcohol, diuretics, aspirin and purine rich foods

Question 5

purine rich foods

Answer 5

organ meats
seafood
spinach
oatmeal

Question 6

Test used for meniscal tear

Answer 6

McMurray test

Question 7

Test used for ankle instability

Answer 7

Talar tilt

Question 8

Test used for Carpal tunnel

Answer 8

Tinel’s sign

Question 9

Test used to eval ACL tear

Answer 9

Lachman test

Question 10

Test for lumbar nerve root compression

Answer 10

Straight leg raising test

Question 11

Test for rotator cuff tear

Answer 11

Drop arm test

Question 12

Test for De Quervain’s tenosynovitis

Answer 12

Finkelstein test

Question 13

What are some system signs of musculoskeletal issues

Answer 13

fever
weight loss
anemia
rash
joint swelling

Question 14

woman complains of fatigue and aching of her hips and shoulders x 2 months and struggles to get dressed. Her grip strength is normal but decreased active range of motion. Her joints are cool and smooth. Has a Hgb of 10.8 and increased set rate. What is her dx?

Answer 14

Polymyalgia rheumatica

She has anemia of chronic disease as well which helps you rule out fibromyalgia and osteoarthritis

Question 15

Tx for polymyalgia rheumatica

Answer 15

corticosteroids

Question 16

Expected findings with lumbar stenosis

Answer 16

back pain worse with standing (psudoclaudication)
bilateral leg numbness
pain improvement with flexion forward
age >50

Question 17

Dx for lumbar stenosis

Answer 17

MRI or EMG if symptoms last longer than 1 month

Question 18

Tx lumbar stenosis

Answer 18

PT
NSAIDS
epidural
surgery

Question 19

Reiter’s syndrome presentation

Answer 19

can’t see
can’t pee
can’t climb a tree

Question 20

Test if you suspect reiter’s syndrome

Answer 20

Urinary test for gonorrhoeae and trachomatis

Question 21

Clinical presentation of Osgood-Schlatter disease

Answer 21

anterior knee pain worse with squatting and walking up or down stairs and better with rest.

tender swollen tibial tuberosity

Question 22

Tx for Osgood Schlatter

Answer 22

rest

Question 23

Appropriate sport for someone with bleeding disorder

Answer 23

swimming

Question 24

Lumbar sacral strain

Answer 24

most common reason for low back pain
it can spasm, ache, stiffness
may have paraspinal muscle tenderness but normal neuro

Question 25

Lumbar rediculopathy

Answer 25

irritation or damage of the neural structures L4-L5, L5-S1 most common sharp, burn worse with increased pressure from sneezing or coughing abnormal straight let raise and altered DTRs try conservative therapy first

Question 26

Motor testing for L4 nerve root

Answer 26

Foot dorsiflexion

Question 27

Reflex testing for L4 nerve root

Answer 27

knee jerk

Question 28

Sensory area for L4 nerve root

Answer 28

medial calf

Question 29

Motor testing for L5 nerve root

Answer 29

great toe dorsiflexion

Question 30

Reflex testing for L5 nerve root

Answer 30

none

Question 31

sensory area for L5 nerve root

Answer 31

medial foot

Question 32

Motor testing for S1 nerve root

Answer 32

foot eversion

Question 33

Reflex testing for S1 nerve root

Answer 33

ankle jerk

Question 34

Sensory area for S1 nerve root

Answer 34

lateral foot

Question 35

When is imaging indicated for low back pain

Answer 35

after 2 months of conservative therapy and signs of radicular pain that persists

Question 36

What areas does a Dexa scan look at

Answer 36

spine hip forearm

Question 37

Normal bone mineral density

Answer 37

BMD within 1 SD of a younger normal adults | T score at -1.0 or greater

Question 38

osteopenia defined

Answer 38

BMD between 1.0 and 2.5 SD below that of normal | T score between -1.0 and -2.5

Question 39

osteoporosis defined

Answer 39

BMD 2.5 or more SD below normal | T score > -2.5

Question 40

Who should have BMD testing

Answer 40

women 65 and older men 70 and older younger postmenomausal women anyone older than 50 who has broken a bone taking meds that can cause bone loss (steroids)

Question 41

Risk factors for osteoporosis and fractures

Answer 41

``` limited physical activity alcohol low calcium cystic fibrosis hyperprolactinemia celiac disease inflammatory bowel disease myeloma lupus RA epilepsy AIDS/HIV ```

Question 42

Meds to tx osteoporosis

Answer 42

bisphosphonates: alendronate, ibandronate, zoledronic acit Vit D 800-1000 u/day Calcium intake 1200mg/d

Question 43

What can be found with rheumatoid arthritis

Answer 43

anemia | elevated C-reactive protein

Question 44

What can be found with systemic lupus erythematosus

Answer 44

positive antinuclear antibody titer anemia elevated C-reactive protein

Question 45

What can be found with Osteoarthritis

Answer 45

joint space narrowing | no increase in CRP or set rate

Question 46

Where are Heberden's nodes located

Answer 46

Distal phalangeal joints

Question 47

Where are Bouchard's nodes located

Answer 47

medial phalangeal joints

Question 48

characteristics of osteoarthritis

Answer 48

more you use the worse it gets

Question 49

what could help symptomatic osteoarthritis of knee

Answer 49

strengthening and low impact aerobic exercise weight loss corticosteroids