Musculoskeletal Flashcards
What are the ottawa ankle rules for X-ray?
- Bony tenderness on posterior edge of malleoli (laterally)
- Navicular tenderness
- 5th Metatarsal tenderness
- Inability to bear weight for 4 steps in the ED
What is the squeeze test used to diagnose?
High ankle sprain – syndesmosis tear
How is the thompson test performed and test for?
Patient laying prone and feet extended over the edge of the table, squeeze the calf (gastrocnemius/soleus) are compressed flexing achilles – plantar flexion
What is the best test for ruling in/out an ACL tear?
Lachman Test – knee flexed to 30 degrees while supine
If a patient has a positive sag sign, what should you do and be suspicious of?
PCL tear, should perform posterior drawer test
What is the McMurray test used for in diagnosing?
Meniscal damage
What are the Ottawa knee rules for x-rays?
- Age 55+
- Tenderness over the proximal fibular head
- Isolated patella tenderness
- Inability to flex to 90
- Inability to bear weight for 4 steps
What are the most effective treatment options for Degenerative joint disease?
– Glucosamine or Corticosteriod joint injections
What are the big differences between osteoarthritis and rheumatoid arthritis?
OA – M>F, chronic, includes DIP joints and big joints, stiffness only lasts short amount of time
RA – F»M, chronic flare ups, 40-60, inflammatory features, 45-1hr stiffness time
What is commonly associated with RA?
- Other autoimmune disorders
- Systemic symptoms
- pulmonary nodules
- fibrosis pericarditis
How can you test for and diagnose RA?
- Arthritis in symmetric joints lasting 6weeks+
- Positive Rheumatoid Factor
- Radiologic damage of joints present
Does a high uric acid level in the blood correlate to acute exacerbation of gout?
False
What are the best medications for acute symptomatic relieve of gout pain?
- NSAIDS
- Intra-articular steroids
- Colchicine
What should not be used in an acute gout attack?
ASA
Allopurinol
Febuxostat
What is the best treatment for chronic gout?
– Reduce red meat, beer/liquor, increase liquid intake (not soft drinks), Vitamin C, and take Allopurinol/Febuxostat
If a patient is an over producer of urate, what is the best pharmocologic agent?
- Allopurinol
- Febuxostat
If a patient is an under secretor of uric acid?
Probenecid – increase secretion
– contraindicated in nephrolithiasis
What are the nerve root for knee extension?
L4
- Medial Foot Sensation
- if deficit unable to squat and rise
- DEFECTIVE PETELLAR REFLEX
If there is a lesion at L5, where would you find abnormalities?
Weakness in Dorsiflexion ankle/Great Toe
Dorsal Foot sensory loss
– Unable to Heel Walk
– No reflex changes
If there is a herniated disc at S1, what might you expect to find?
- Lateral Foot loss sensation/shooting pains
- Weak/Loss Achilles relfex
- Plantarflexion ankle/toes weakness
- Unable to Walk on toes
When is the only time you should get imaging of the spine?
Worried about fracture
If a patient has dorsiflexion weakness, positive straight leg raise, and lower back pain. What is the most likely diagnosis?
Herniated Disc
If a patient has improved pain with sitting down and pain in their legs when walking down stairs and when on feet for periods of time?
Spinal Stenosis
What two exam tests can be performed to evaluate neck pain?
- -Spurling Test – bend side to side toward painful side
- - Arm Abduction test – reduces pressure on nerve outlet
