musculoskeletal Flashcards
navicular fracture
wrist pain at snuffbox (loading of thumb)
splint write (thumb spica spling) and refer to hand surgeon usually from a fall
colles fracture
most common WRIST fracture
distal radius
hip fracture
“sudden” one sided hip pain.
elderly have 1 year mortality rate increased after
leg shortening with displacement
pelvic fracture
ecchymosis and swelling of lower abdomen, hips, groin, scrotum.
bladder/fecal incontinence
check ABC for internal hemorrhage
cauda equina syndrome
sudden bladder incontinence LEG NUMBNESS (due to pressure o a sacral nerve root)
Surgical emergency, needs spinal decompression
low back pain from dissecting abdominal aneurysm
“tearing” of low back pain/abdominal pain.
ABDOMINAL BRUIT
s/s of shock
most common in elder, white male, smoker
tendon
connects muscle to bone
ligament
bone to bone
finklestein test
test for de quervain’s tenosynovitis (base of thumb)
test is thumb in wrist and flex downwards
mc murray’s
medial meniscus
knee pain and “click”
medial mensicus= valgus pressure (knee in), foot out
lateral meniscus= varUS stress (knee out, feet in)
gold standard is MRI
lachman’s
ACL tear
knee joint laxity, more sensitive than drawer test
The examiner should place one hand behind the tibia and the other on the patient’s thigh. It is important that the examiner’s thumb be on the tibial tuberosity. On pulling anteriorly on the tibia, an intact ACL should prevent forward translational movement of the tibia on the femur (“firm endpoint”).
soft endpoint= tear
test for “MEDIAL collateral ligament. which stress test.
valgus
test for “LATERAL collateral ligament. which stress test.
varus
morton’s neuroma
inflammation of the digital nerve of the foot between the 3rd and 4th metatarsal, > risk with high heels, tight shoes, dancers
“pebble sensation”
mulder test
test for morton’s neuroma.
positive is click and pain when squeezing the forefoot
herberden’s nodes
nodes of the DISTAL interphalangeal joint
bouchard’s nodes
bondy nodules of the proximal interphalangeal joint
RA versus OA
RA: symmetrical, > pain/stiffness, systemic systems (fever)
NORMACYTIC anema
TREatement of RA
systemic steroids ( NOT for OA)
antimalarials (plaquenil)
antimetabolites (methotrexate)
biologics (HUMIRA, Enbrel)
lupus
> women (9:1)
AA, hispanic
affects skin, kidneys, heart, blood vessels
MACULOPAPULAR butterfly rash (malar rash)
DISCOID RASH ( non itchy rash)
PROTEINURIA
tx for lupus
refer to rhemuatologist; plaquenil, methotrexate, biologics ( same as RA)
RA S/S
“sausage” joints
swan’s neck deformity (50%), flexion of dip joint, hyperextension PIP joint
boutonnier deformity- hyperextion of the DIP with flexion of the PIP joint
rx for RA
DMARD- disease modifying agent for rheumatoid disease;
methotrexate, sulfasalazine, cyclosproine, hydroxychloroquine (antimalarial drug)
Gold salt compounds IM injections anti TNF (humira, enbrel, remidade)
plaqunil (antimalarial)
Gout
uric acid crystals inside joint and tendons due to genetic excess or low excretion of purine crystals (by product of protein metabolism).
LARGE JOINT OF FIRST TOE common, middle age males common
worse with alcohol, meat, seafood
Chronic gout has tophi (small white nodules full of urates on ears and joints)
rx for gout
nsaids (indocin, anaprox)
colchicine
ankylosing spondylitis
early 20’s, > males
inflammation of seronegative arthritis effects spine (upper thoracic)
best for dsg herniated disc
MRI
cauda quina syndrome
acute pressure on the SACRAL nerve root (anal and bladder
bowel/bladder incontinence
Sprains grade (ottawa) to determine needs for radiographs
1- mild sprain, able to bear weight
2-partial tearing of ligament. painful ablution
3- complete rupture of ligaments. Can’t ambulate 4 steps
baker’s cyst
bursitis behind the knee (bursae are synovial sacs located o certain joints)
if cyst ruptures, will cause reaction like celulitis (calf redness, swelling)
ankylosing spondilytis presentation
upper back pain >3 months,
