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Adult Primary Care > Musculoskeletal Conditions > Flashcards

Musculoskeletal Conditions Flashcards

1
Q

(4) axes on which to consider MSK conditions

A

duration (acute vs. chronic), origin (articular vs. non-articular), nature (inflammatory vs. non-inflammatory), distribution (localized vs. systemic)

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2
Q

OLDCARTS acronym for HPI

A

Onset, Location, Duration, Character, Aggravating/Alleviating, Radiation, Timing, Severity

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3
Q

Reserve imaging studies for cases with “red flags” or persistent symptoms longer than…..

A

4-6 weeks

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4
Q

MSK “red flags” (6)

A

radicular symptoms >4-6 weeks, increasing symptoms, osteomyelitis, cauda equina, disc herniation, epidural abscess

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5
Q

Your 1 week postpartum pt who received epidural anesthesia in labor calls clinic reporting low back pain. Suspect….

A

Epidural abscess

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6
Q

Radicular pain

A

radiating

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7
Q

Lifetime risk for osteoarthritis

A

~50%

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8
Q

Medical term for bone spurs

A

osteophytes

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9
Q

pathogenesis of OA (3)

A

loss of articular cartilage, thickening of the subchrondral bone, development of osteophytes

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10
Q

DIAGNOSE: Pt presents with joint pain and stiffness, swelling, crepitus, low-grade synovitis, and loss of mobility to one hand

A

osteoarthritis

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11
Q

Causes of secondary OA, generally (3)

A

mechanical (i.e., joint out of alignment), metabolic, endocrine

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12
Q

Common medication that is risk factor for OA

A

prednisone

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13
Q

Characteristics of OA

A

Slow insidious onset, affecting one or a few joints, pain is “achey” and poorly localized, morning stiffness lasts <30 minutes, pain is relieved by rest, there is NO systemic symptoms

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14
Q

Why is it important to assess risk for GI bleed in clients with OA?

A

NSAIDs is usual treatment, may require modification

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15
Q

Key differentiations between OA and RA (3)

A 
OA = one or a few joints, morning stiffness <30 minutes, no systemic symptoms
RA = multiple joints bilaterally, morning stiffness >30 minutes, systemic symptoms present
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16
Q

OA characteristics seen on radiographic imaging (5)

A

joint space narrowing, osteophyte formation, periarticular ossicles, subchondral bone cysts, altered shape of bone end

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17
Q

Heberden’s nodes are found at the …..

A

DIP joints of the hand

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18
Q

Bouchard’s nodes are found at the ….

A

PIP joints of the hand

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19
Q

Hopkins Pearl: True hip joint pain will ofetn be felt…

A

in the groin

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20
Q

Patient self-management of OA

A

physical activity is key, including ROM, aerobic and strength exercises. Weight-bearing exercise like running can put stress on the joints. Strengthening the muscles around the joint can help and develop stability in the joint. Proper body mechanics, aids and braces. Importance of rest and warm heat or cool ice pack. If limiting function, consider referral to PT or OT

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21
Q

Pharmacologic recommendation for OA in one or a small few joints

A

topical NSAIDs

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22
Q

OA patients with history of GI bleed should not be taking….

A

NSAIDs or a COX-2

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23
Q

Maximum dose of NSAIDs per day

A

2400mg in 24 hours

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24
Q

When might you refer your OA pt to a specialist (4)

A

severe or disabling, malalignment, instability, or bone spurs

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25
Q

Hopkin’s (2) things to remember about RA

A

it is a systemic disease, it has a variable course

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26
Q

Condition characterized as a symmetric, inflammatory, peripheral polyarthritis

A

rheumatoid arthritis

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27
Q

RA affects how many joints

A

3-5+

28
Q

RA symptom duration

A

> 6 weeks

29
Q

(3) possible disease courses of RA

A

monocyclic, polycyclic, progressive

30
Q

monocyclic RA

A

only one episode that ends within 2-5 years of initial diagnosis. This may result from early diagnosis or aggressive treatment

31
Q

polycyclic RA

A

levels of disease activity fluctuate over the course of the condition

32
Q

progressive RA

A

continues to increase in severity over time and does not go away

33
Q

Characteristics of RA

A

slow insidious onset with symmetric joint involvement, morning stiffness lasting several hours, pain, tenderness, warmth, and swelling with systemic symptoms

34
Q

Systemic symptoms in RA (4)

A

fatigue, depression, malaise, anorexia

35
Q

Diagnostic criteria for RA

A

persistent, symmetric polyarthritis lasting >3 months with the presence of systemic features

36
Q

RA workup: comprehensive vs. focused visit?

A

comprehensive (complete history, extensive ROS)

37
Q

Boutonniere deformity

A

tendons of the hand are shortened and drawn up

38
Q

Lab test fairly specific to lupus

A

ANA (anti-nuclear antibody)

39
Q

Lab work-up for RA

A

CBC (r/o anemia), CMP (LFTs, kidney function), ESR and CRP (inflammatory markers), ANA (r/o SLE), uric acid (r/o gout), RF and anti-CCP antibody (specific to RA)

40
Q

DMARDS

A

disease modifying antirheumatic drugs

41
Q

Gold standard for diagnosis of RA

A

intra-articular aspiration of synovial fluid

42
Q

Primary care non-pharm treatment for RA

A

Recommend rest, splints to prevent deformities, regular exercise (warm water exercise particularly useful), occupational therapy referral can provide TENS units and parafin wax baths.

43
Q

Primary care pharm-treatment for RA

A

NSAIDs or ASA. Beyond this, refer to a specialist for DMARDs, biologics, antimalarials, and low-dose steroids

44
Q

Gout is a type of ______ arthritis

A

inflammatory

45
Q

Primary gout

A

inborn error in the production of, or excretion of, uric acid. 90% male incidence. Majority of gout cases are primary

46
Q

Secondary gout

A

gout due to other disorders that cause hyperuricemia through over production or impaired excretion

47
Q

Gout is strongly associated with what other condition….

A

metabolic syndrome

48
Q

Purine rich diet places someone at increased risk for…

A

gout

49
Q

purine-rich food examples (6)

A

organ meats, anchovies, sardines, meat extracts, hard cheeses, red wine

50
Q

DIAGNOSE: Sudden onset of intense pain in one joint with inflammation, redness, and the pain is not relieved by rest.

A

Gout

51
Q

Characteristics of gout

A

sudden onset, intense pain, usually monoarticular, inflammation and erythema, pain peaks in 24-36 hours, not relieved by rest. Tophi may be seen with chronic gout

52
Q

Medical term for crystal deposits in chronic gout

A

tophi

53
Q

Most common joint affected by gout

A

big toe (first metatarsophalangeal joint)

54
Q

Medical term for gout of the big toe

A

podogra

55
Q

Hopkins Pearl: Monoarticular, sudden onset knee pain in sexually active pt, keep this rare complication on our radar….

A

gonhorrhea causing systemic infection of the knee

56
Q

Gold standard test for diagnosing gout

A

synovial fluid exam for uric acid crystals

57
Q

Lab workup for gout

A

Gold standard will be a synovial fluid exam for uric acid crystals. Otherwise, serum uric acid, CBC (WBCs), ESR, potentially an xray in chronic gout

58
Q

An alcohol binge can precipitate this MSK condition….

A

gout

59
Q

Avoid this common medication in gout

A

low dose ASA

60
Q

Prophylactic pharm treatment for chronic gout

A

colchicine

61
Q

Pharm management of acute gout

A

NSAIDs (loading dose, then 10-15 days), occasionally oral steroids

62
Q

Most common etiology of both tendinitis and bursitis

A

overuse

63
Q

DIAGNOSE: Pain with movement and ROM, with swelling, warmth, point tenderness with palpation, and erythema

A

Tendinitis or bursitis

64
Q

Non pharm management of tendinitis

A

gentle exercise, support bracing (but not immobilization), ice. Ultrasound can also be palliative!

65
Q

When would you get imaging in tendinitis?

A

Not necessary in mild cases, but get an MRI if you suspect tear or r/t traumatic injury, or if you’re treating it and its not improving

Adult Primary Care (6 decks)

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