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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
Hopkin's (2) things to remember about RA
it is a systemic disease, it has a variable course
26
Condition characterized as a symmetric, inflammatory, peripheral polyarthritis
rheumatoid arthritis
27
RA affects how many joints
3-5+
28
RA symptom duration
>6 weeks
29
(3) possible disease courses of RA
monocyclic, polycyclic, progressive
30
monocyclic RA
only one episode that ends within 2-5 years of initial diagnosis. This may result from early diagnosis or aggressive treatment
31
polycyclic RA
levels of disease activity fluctuate over the course of the condition
32
progressive RA
continues to increase in severity over time and does not go away
33
Characteristics of RA
slow insidious onset with symmetric joint involvement, morning stiffness lasting several hours, pain, tenderness, warmth, and swelling with systemic symptoms
34
Systemic symptoms in RA (4)
fatigue, depression, malaise, anorexia
35
Diagnostic criteria for RA
persistent, symmetric polyarthritis lasting >3 months with the presence of systemic features
36
RA workup: comprehensive vs. focused visit?
comprehensive (complete history, extensive ROS)
37
Boutonniere deformity
tendons of the hand are shortened and drawn up
38
Lab test fairly specific to lupus
ANA (anti-nuclear antibody)
39
Lab work-up for RA
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
DMARDS
disease modifying antirheumatic drugs
41
Gold standard for diagnosis of RA
intra-articular aspiration of synovial fluid
42
Primary care non-pharm treatment for RA
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
Primary care pharm-treatment for RA
NSAIDs or ASA. Beyond this, refer to a specialist for DMARDs, biologics, antimalarials, and low-dose steroids
44
Gout is a type of ______ arthritis
inflammatory
45
Primary gout
inborn error in the production of, or excretion of, uric acid. 90% male incidence. Majority of gout cases are primary
46
Secondary gout
gout due to other disorders that cause hyperuricemia through over production or impaired excretion
47
Gout is strongly associated with what other condition....
metabolic syndrome
48
Purine rich diet places someone at increased risk for...
gout
49
purine-rich food examples (6)
organ meats, anchovies, sardines, meat extracts, hard cheeses, red wine
50
DIAGNOSE: Sudden onset of intense pain in one joint with inflammation, redness, and the pain is not relieved by rest.
Gout
51
Characteristics of gout
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
Medical term for crystal deposits in chronic gout
tophi
53
Most common joint affected by gout
big toe (first metatarsophalangeal joint)
54
Medical term for gout of the big toe
podogra
55
Hopkins Pearl: Monoarticular, sudden onset knee pain in sexually active pt, keep this rare complication on our radar....
gonhorrhea causing systemic infection of the knee
56
Gold standard test for diagnosing gout
synovial fluid exam for uric acid crystals
57
Lab workup for gout
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
An alcohol binge can precipitate this MSK condition....
gout
59
Avoid this common medication in gout
low dose ASA
60
Prophylactic pharm treatment for chronic gout
colchicine
61
Pharm management of acute gout
NSAIDs (loading dose, then 10-15 days), occasionally oral steroids
62
Most common etiology of both tendinitis and bursitis
overuse
63
DIAGNOSE: Pain with movement and ROM, with swelling, warmth, point tenderness with palpation, and erythema
Tendinitis or bursitis
64
Non pharm management of tendinitis
gentle exercise, support bracing (but not immobilization), ice. Ultrasound can also be palliative!
65
When would you get imaging in tendinitis?
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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