Musculoskeletal

Question 1

33 yo female complaining of knee pain. 1. What questions to ask? 2. DDx? 3. Test?

Answer 1

1. OLDCARTS Swelling, Reddness, Trauma, Other joint pain, Morning stiffness, photosensitivity, rashes, oral ulcers, fatigue, fever/chills, hair loss, cold temp fingers change colors, heart, pulmonary, abdominal, neuro complaints, tick bite, sexual hx/hx of STDs. 2. Gout, Pseudogout, SLE, RA, Gonoccoal Athritis, Nongonoccoal septic athritis, osteoathritis. 3. Pelvic exam and cultures, CBC, Blood Cultures, RF, ANA, Anti-smith, Anti-dsDNA, Xray, Knee aspiration and synovial fluid analysis.

Question 2

51 yo male complaining of back pain. 1. What questions to ask? 2. Physical Exam manuevars 3. DDx? 4. Test?

Answer 2

1. OLDCARTS , Weakness/Numbness, Urinary or Fecal incontinence, Fevers/Chills, Night sweats, weightloss, Standing or leaning forward helps/worsens. Hx of back pain 2. Back: Inspection, Palpation, Range of motion, Extremities: Inspection, palpation of peripheral pulses, hip exam, Neuro Exam 3. Disk Herniation, Lumbar muscle strain, Degenerative arthritis, Lumbar Spinal Stenosis, Metastatic prostate cancer, Multiple Myeloma, Malingering 4. Rectal exam, XR-Spine, MRI-Spine, PSA, CBC, Ca, BUN/Cr, Serum and urine protein electrophoresis.

Question 3

35 yo female complaining of R calf pain. 1. What questions to ask? 2. Physical Exam maneuvers 3. DDx? 4. Test?

Answer 3

1. OLDCARTS, Injury, Swelling, Erythema, Pus, Varicose, Veins, SOB, CP, Palpitations, Breathing fast, Recent Imobilization/Travel/Surgery, Fevers, LMP, Contraceptives,, Obstetric Hx, Last pap smear. 2. Pulses, joint (hip/knee/ankle,) Homans sign, Sensation, Reflexes. 3. DVT, Cellulitis/Myositits, Rupture of Baker’s Cyst, Hematoma, Rupture of medial head of the gastronemius, Spasm due to injury or sprain. 4. Doppler US, CTA, D-dimer, Hypercoagulability Testing (Factor 5, Protein C and S deficiency, Lupus, APAS, CBC with diff, CPK and Myoglobin, MRI.

Question 4

31 yo male complaining of heel pain. 1. What questions to ask? 2. Physical exam maneuvers 3. DDx? 4. Test?

Answer 4

1. OLDCARTS, Injury, When does it hurt in the morning, Radiation to leg or back, Quality, NWT, Other joint pain, previous episodes of similar pain/injury, Past hx of diabetes, rheumatologic disorders and cancer, Fm Hx of diabetes, rheumatologic disorders and cancer. 2. Pulses, Inspect both feet weight bearing and non weight bearing, palpate medical calcaneal tuberosity, Achilles tendon, plantar fascia, retrocalcaneal bursae, passive range of motion and general strength of ipsilateral knee and hip, ankle dorsiflexion and great toe extension and passive range of motion, strength testing of ankle dorsiflexion and plantar flexion. 3. Plantar fascitis, Calcalneal stress fracture, Achilles tendinitis, Retrocalcaneal bursitis, Tarsal tunnel syndrome, Foreign body and ankle sprain. 4. XR-right ankle, Bone Scan, MRI.