Musculoskeletal

Question 1

Polymyalgia rheumatica PMR definition and sx

Answer 1

Inflammation of unknown origin that affects muscles and joints.
Sx- aches in the shoulders (usually 1st symptom), neck, upper arm, lower back, hips, back and thigh pain. Quick onset worse in am improvement during the day.

Question 2

Treatment of polymyalgia rheumatica

Answer 2

Low dose steroids (10-15mg per day) until sx are relieved, then tapering dose to find lowest effective dose to suppress symptoms.

Question 3

Osgood-Schlatter disease etiology and presentation

Answer 3

Patellar swelling and pain in adolescents who participate in running/jumping. Repeated stress causes inflammation and avulsion below the patellar tendon where it attaches to the tibia.
Sx- pain, swelling, tenderness in one or both knees that ranges from mild to debilitating.

Question 4

Osgood-Schlatter treatment

Answer 4

Aimed to reduce pain and swelling. NSAIDS, PT, strengthening exercises

Question 5

Meniscal tear etiology and presentation

Answer 5

Tear of meniscus (c-shaped fibrocartilage pad) between femoral condyles and tibial plateaus. Found with twist-type injury to knee.
Sx- effusion of knee, tightness/stiffness, ROM limited by discomfort. Some report lock knee, popping, or knee “gives out”

Question 6

Treatment of meniscal tear

Answer 6

RICE, analgesics, aspiration if no improvement after 2-4 weeks. Arthroscopy for debridement and repair considered at 4-6 weeks if no improvement

Question 7

Reactive arthritis etiology and presentation

Answer 7

Painful inflammatory arthritis typically seen days or weeks after an acute bacterial diarrhea or STI infection.
Sx- pain/swelling of the knees, ankles, heels, toes or fingers, persistent low back pain. Conjunctivitis and urinary problems can also be present
“Can’t see, can’t per, can’t climb a tree”

Question 8

Treatment of reactive arthritis

Answer 8

Anti-inflammatory meds- NSAIDS, steroids. Steroid injections into joints, Antimicrobial meds for urethritis

Question 9

Normal bone mass on DEXA

Answer 9

T-score at -1.0 and above

Question 10

Low bone mass (Osteopenia) on DEXA

Answer 10

T-score between -1.0 and -2.5

Question 11

Osteoporosis on DEXA

Answer 11

T-score at or below -2.5 (-2.5 or “more negative” on number line)

Question 12

Treatment for osteoporosis

Answer 12

Bisphosphonates- alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel)
Calcitonin (Miacalcin) 
Estrogen or hormone therapy
Parathyroid hormone 
RANK inhibitor (denosumab-Prolia)

Question 13

Distal joint involvement with Osterarthritis

Answer 13

Mid-Finger joint= Bouchards nodes

Last distal finger joint= Heberdens nodes