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Boards > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Patient has hx of falling forward with outstretched hand to break the fall. Check for

A

scaphoid bone fracture

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2
Q

Xray diagnostic for scaphoid wrist fracture

A

May be initially normal but repeat in 2 weeks will show fracture

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3
Q

Patient presents with dorsal displacement of wrist. Suspect for

A

Colles fracture (fx of distal radius)

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4
Q

s/s of hip fracture

A

inability to bear weight, severe hip pain with external rotation of hip, leg shortening

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5
Q

Acute onset of saddle anesthesia (less of sensation in buttocks and inner thighs), bladder/fecal incontinence

A

cauda equina syndrome

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6
Q

Caused by pressure by a bulging disc on a sacral nerve root. A surgical emergency

A

cauda equina syndrome

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7
Q

The cartilage lining the open surfaces of bones in a joint

A

articular cartilage

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8
Q

tendons connect

A

muscle to bone

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9
Q

sac-like structures located on anterior and posterior areas of a joint that act as padding

A

bursae

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10
Q

Genu recurvatum

A

hyperextension or backward curvature of knees

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11
Q

Genu valgum

A

knock knees (“GUM” stuck between knees)

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12
Q

Genu varum

A

Bow legs

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13
Q

Within the first 48 hours of an injury, do NOT

A

exercise, perform active ROM, or apply heat

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14
Q

Weight bearing exercises are only good for:

A

osteoporosis

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15
Q

test for ACL injury

A

anterior drawer (ACL injury), posterior drawer (PCL injury); Lachman’s sign shows knee laxity

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16
Q

Finkelstein’s test is used to dx for

A

DeQuervain’s tenosynovitis

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17
Q

inflammation of the tendon and it’s sheath

A

DeQuervain’s tenosynovitis

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18
Q

how to perform Finkelstein’s test

A

pain on thumb side of wrist upon ulnar deviation

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19
Q

test for meniscal injury

A

McMurray’s test

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20
Q

increase in laxity during the valgus stress test of knee indicates

A

damage to MCL (“GUM” push knee in and ankle out)

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21
Q

increase in laxity during the varus stress test of knee indicates

A

damage to LCL

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22
Q

varus is known as

A

abduction; movement going away from body (“RUN”)

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23
Q

valgus is known as

A

adduction; movement going towards body (“GUM” stick inward)

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24
Q

refers to bones of hand and wrist

A

carpal

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25
Q

refer to finger and toes

A

phalanges (singular: phalanx)

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26
Q

pain with plantar fasciitis is aggravated by

A

walking

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27
Q

caused by microtears in the plantar fascia d/t tightness in achilles tendon

A

plantar fasciitis

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28
Q

risk factors for plantar fasciitis

A

obesity, diabetic, aerobic exercise, flat feet, prolong standing

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29
Q

nonpharm trx for plantar fasciitis

A

orthotic foot appliance at night x few weeks; ice; rolling a golf ball

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30
Q

pharm trx for plantar fasciitis

A

NSAIDs (oral or diclofenac gel to soles of feet bid).

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31
Q

inflammation of the digital nerve of the foot between the 3rd and 4th metatarsals.

A

morton’s neuroma

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32
Q

risk factors for morton’s neuroma

A

high-heeled shoes, obesity, dancer, runner

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33
Q

s/s of morton’s neuroma

A

burning/numbness to space between 3rd-4th toes, small nodule b/t 3-4th toe.

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34
Q

Mulder test

A

for morton’s neuroma: squeeze forefoot, positive if there is a click or pain

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35
Q

degenerative, chronic damage to articular surface of joints

A

osteoarthritis

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36
Q

s/s of osteoarthritis

A

transient joint stiffness for less than 60 minutes; worse with activity, better with rest; crepitus

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37
Q

nodes to DIP in osteoarthritis

A

Heberden’s

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38
Q

nodes to PIP in osteoarthritis

A

Bouchards

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39
Q

nonpharm trx for OA

A

nonweight bearing (walking, swimming, biking, resistance);
Patellar taping by physical therapist;
Glucosamine supplements

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40
Q

first line trx for osteoarthritis

A

Tylenol 325-650 mg q4-6 hours or Tylenol extra strength 500-1000 mg every 6 hours

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41
Q

second line trx for osteoarthritis

A

short to medium acting NSAIDs

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42
Q

Complications of long term NSAID

A

GI and CV disease, decreased renal perfusion, liver damage.

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43
Q

topical trx for osteoarthritis

A 
diclofenac gel (Voltaren) apply and massage BID;
capsaicin cream apply QID
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44
Q

NSAIDs with highest risk for GI bleed

A

diclofenac (ketorolac)

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45
Q

NSAIDs with lowest risk for GI bleed

A

ibuprofen, celecoxib (Celebrex)

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46
Q

NSAIDs with highest risk for CV events

A

diclofenac and celecoxib (Celebrex)

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47
Q

NSAIDs with lowest risk for CV event

A

naproxen

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48
Q

autoimmune disease that affects skin, kidneys, heart, and blood vessels. Common in black and hispanic women

A

SLE (lupus)

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49
Q

management of SLE

A
  • rheumatologist
  • avoid sun 10-4 pm
  • wear SPF sunblock; wide brim hats
50
Q

s/s of rheumatoid arthritis

A

weight loss, anorexia, morning stiffness for more than an hour; symmetrical bone pain, warmth, and tenderness

51
Q

progressive inflammation and thickening of synovial membrane

A

rheumatoid arthritis

52
Q

flexion of the DIP joint with hyperextension of the PIP joint

A

Swan neck deformity in RA

53
Q

Hyperextension of the DIP joint with flexion of the PIP joint

A

Boutonniere deformity in RA

54
Q

Diagnostic for RA

A

normocytic anemia, ESR and RF elevated

55
Q

meds for RA

A

NSAIDs, DMARDs

56
Q

swelling of the uvea, the middle layer of the eye that supplies blood to the retina

A

Uveitis (refer to ophthalmologist STAT)

57
Q

complication of RA

A

uveitis

58
Q

Plaquenil

A

antimalarial; can be used for RA

59
Q

Methotrexate

A

DMARD used for RA

60
Q

deposition or uric acid crystals inside joints and tendons

A

gout

61
Q

podagra

A

pain in great big toe

62
Q

meds for gout

A

only indomethacin or naproxen sodium (Anaprox DS) work well;

Colchicine 0.5 mg

63
Q

when to start maintenance uric lowering therapy after acute gout attack

A

wait 4-6 weeks

64
Q

education about allopurinol

A

stop during acute gout phase; restart 4-6 after it is resolved

65
Q

when initiating allopurinol, check baseline

A

CBC, LFT, renal status

66
Q

uric acid lowering therapy

A

allopurinol

67
Q

chronic inflammatory disorder that is more common in young males

A

ankylosing spondylitis

68
Q

ankylosing spondylitis most commonly affects

A

spine and sacroiliac joints

69
Q

s/s of ankylosing spondylitis

A

chronic back pain that improves with activity; marked loss of ROM in spine

70
Q

s/s of uveitis

A

eye irritation, photosensitivity, eye pain, blurred vision

71
Q

diagnostic for ankylosing spondylitis

A

ESR and CRP elevated;

xray shows “bamboo spine”

72
Q

trx for ankylosing spondylitis

A

refer to rheumatologist;

NSAIDs

73
Q

s/s of supraspinatus tendinitis

A

shoulder pain with movement, elevation, and abduction (reaching for back pocket); tenderness over anterior shoulder

74
Q

lateral epicondylitis

A

tennis elbow

75
Q

medial epicondylitis

A

golfer’s elbow

76
Q

Grade II sprain

A

incomplete tear; painful weight bearing

77
Q

Grade III sprain

A

completely torn ligament.

Positive Ottawa rules: inability to bear weight, inability to take 4 steps, tenderness over medial or lateral malleolus

78
Q

s/s of ruptured Baker’s cysts

A

similar to cellulitis (redness, swelling, tenderness to calf)

79
Q

trx for Baker’s cysts

A

RICE, NSAIDS;

large bursae can be drained (if cloudy, r/o septic arthritis)

80
Q

diagnostic criteria for RA

A

morning stiffness more than 1 hour, swelling of more than 3 joints for more than 6 weeks, at least one joint has to be in the hand or wrist

81
Q

patients with rotator cuff tear may show weakness with

A

abduction and external rotation

82
Q

disorders of the flexor tendons of the fingers or thumb; caused by a nodule or thickening in the tendon and impedes tendon movement

A

stenosing tenosynovitis (trigger finger)

83
Q

diagnostic for trigger finger

A

pain when patient tries to extend finger

84
Q

referral to orthopedist if pain in trigger finger or tenosynovitis does not resolve in

A

2 weeks

85
Q

In palmer fibrosis (Dupuytren’s contracture), referral for surgery should be done for a contracture of more than

A

30 degrees

86
Q

risk factor of carpal tunnel

A

pregnancy, menopause, DM, arthritis, HTN, hypothyroidism

87
Q

can be a possible complication of corticosteroids

A

avascular necrosis

88
Q

s/s of patellofemoral pain syndrome

A

“runners knee”, pain to the anterior portion of the knee; worse when walking up stairs

89
Q

nonpharm trx for low back pain

A

modify activities for 3-6 weeks; limit bedrest to 2-4 days

90
Q

result from a tearing of the ligaments that bind the joint.

A

sprain

91
Q

result from an overstretching or overuse of muscles.

A

strain

92
Q

Unilateral or bilateral tibial pain, exacerbated by exercise, pain with squatting or crouching.

A

Osgood-Schlatter disease

93
Q

common in adolescent boys and girls who play sports

A

Osgood-Schlatter disease

94
Q

Avascular necrosis of the femoral head found in preadolescent boys that causes hip/knee pain with a limp

A

Legg-Calve-Perthes disease

95
Q

Severe hip or knee pain associated with a limp; common in adolescent boys

A

Slipped capital femoral epiphysis

96
Q

s/s of fibromyalgia

A

widespread musculoskeletal pain for more than 3 months, fatigue, sleep disorder, depression, IBS

97
Q

patient with polymyalgia rheumatica is at high risk for

A

temporal arteritis

98
Q

labs for RA

A

RF, ESR, CRP, Anti-CCP antibodies

99
Q

trx for fibromyalgia

A

amitryptyline, duloxetine (Cymbalta), pregabalin (Lyrica)

100
Q

Empty can test

A

abduct shoulder 90 degrees, internally rotate where thumb is pointing to floor. Pain or weakness while pressing down is positive test.

101
Q

s/s of rotator cuff tendinopathy (impingement syndrome)

A

pain with reaching overhead, positive empty can test, normal passive ROM

102
Q

Difference between rotator cuff impingement and tear

A

impingement has pain only with testing; tear has pain AND weakness with testing

103
Q

Adhesive capsulitis is associated with

A

DM

104
Q

If shoulder pain is not reproducible, then consider

A

CV cause

105
Q

suspect scaphoid fracture when there is tenderness in

A

anatomic snuffbox (right under thumb)

106
Q

clues on when to get xray for back pain

A

age greater than 50, hx of cancer, unexplained weight loss, nighttime pain, pain for more than 4 weeks

107
Q

sciatica is nerve root irritation on

A

L5-S1

108
Q

lateral hip pain aggravated by direct pressure

A

trochanter bursitis

109
Q

constant hip pain, especially at night

A

infectious, inflammatory, neoplastic cause

110
Q

hallmark sign of plantar fasciitis

A

local heel point tenderness

111
Q

how to diagnose hip pain in children

A

Trendelenburg’s test: ask child to stand on affected leg; abnormal if unaffected hip sits lower “dip in the hip”.

112
Q

diagnostics for SCFE and Legg-Calve Perthes

A

xray of hip AP and frog-leg

113
Q

difference between SCFE and Legg-Calve Perthes

A

SCFE is common in adolescents; Legg-Calve Perthes is common in preadolescents

114
Q

s/s of transient synovitis of the hip in children (irritable hip)

A

acute limp and hip pain; negative Trendelenburg test; hx of URI 7-14 days prior

115
Q

trx for transient synovitis of the hip in children (irritable hip)

A

self-limited

116
Q

s/s of osteogenesis imperfecta

A

triangular face, blue sclera, bones that fracture easily, hearing loss

117
Q

s/s of Prader-Willi syndrome

A

craving for food and rapid weight gain

118
Q

meds that increase uric acid excretion

A

colchicine, probenecid

119
Q

first line trx for osteoarthritis

A

exercise

120
Q

other diseases that can be confused with RA

A

lupus, scleroderma, Fifth’s disease

121
Q

Diagnostic test for RA

A

no specific diagnostic test; based on symptoms. RF can be false negative or positive.

122
Q

test for impingement syndrome

A

Hawkin’s Kennedy test

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