Orthopedics Flashcards

1
Q

What is the first line treatment for osteoarthritis?

A

Exercise, ROM, and strengthening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are heberdens nodes associated with?

A

Osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of arthritis affects the metacarpal joints?

A

Rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the test for impingement syndrome (shoulder pain)

A

Painful arc test & Hawkins-Kennedy test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the McMurray’s test for?

A

Torn meniscus (knee)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is the lateral epicondyle?

A

Elbow

Lateral epicondylitis is tennis elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where is the scaphoid?

A

Inner aspect of wrist bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Common injury to wrist during fall?

A

Scaphoid fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the diagnostic test for a scaphoid fracture?

A

Snuffbox tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the lower back pain test that is positive for radiculopathy?

A

Straight leg raise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an overreaction during physical exam with inappropriate physical signs?

A

Waddell’s signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What type of lower back pain is from L5-S1 and radiates down leg, foot, or ankle?

A

Sciatica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the diagnostic test for sciatica?

A

Straight leg raise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the hip bone?

A

Trochanter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Osteoarthritis in a patient causes what type of hip joint pain?

A

Anterior hip/groin pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When a patient complains of heel pain or tenderness, they have…

A

Plantar fasciitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What test is for an acl in knee?

A

Anterior draw test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What condition is associates with a positive MTP squeeze test?

A

Mortons neuroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What condition is associated with a positive finkelstein test?

A

DeQuervain’s tensosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Burning pain between the 3rd and 4th toes.

A

Morton’s neuroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Positive tinel’s test & positive Phalen’s test

A

Carpal Tunnel Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Type of fracture secondary to systemic disease?

A

Pathologic fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Common cause of posterior knee pain

A

Bakers cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Overuse injury of a bone

A

Stress fracture/ takes 4-6 weeks to heal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dorsal thumb pain is a classic symptom of

A

DeQuervains tenosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Injury to a bone that does not result in a fracture

A

Contusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Injury to a muscle is a

A

Strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Injury to a ligament is a

A

Sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the nodes on the PIP nodes secondary to arthritis?

A

Bouchnard’s nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Joint stiffness lasts <60 minutes usually

A

Osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

RICE is acronym for treatment for

A

Sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Term that describes compression of the spinal cord

A

Cauda equine syndrome

Loss of bowel/bladder function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

The Lachman maneuver is used to detect what

A

Knee instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Heberden’s node’s are commonly seen in

A

Degenerative joint disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

The drawer sign is performed on the knee or ankle to assess for

A

Instability of the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What test is used to identify inflammation of the median nerve as seen with carpal tunnel syndrome

A

Phelan test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Wrist pain on palpation of the anatomic snuffbox. Pain on axial loading of the thumb. History of falling forward with outstretched hand to break the fall. Initial x-ray of the wrist may be normal, but a repeat x-ray in two weeks will show the scaphoid fracture. High-risk of a vascular necrosis and non-union. Splint rest and referred to a hand surgeon.

A

Navicular fracture (scaphoid bone fracture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is an important stabilizer of the metacarpal joint

A

Scaphoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

An injury to bone is a

A

Contusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

If a patient has a positive snuff box tenderness test, what should be done

A

Treat as a fracture until proven otherwise. If x-ray is negative, consider MRI or CT as definitive exams. Splint thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Fracture of the distal radius of the forearm along with dorsal displacement of wrist. History of falling forward with outstretched hand. This fracture is also known as the dinner fork fracture due to the appearance of arm and wrist after the fracture. The most common type of wrist fracture.

A

Colles fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

History of slipping or falling. Sudden onset of one sided hip pain. Unable to walk and bear weight on affected hip. If mild fracture, may bear weight on affected hip. If displaced fracture, presence of severe hip pain with external rotation of the hip/leg and leg shortening. More common in elderly. Elderly have a one year mortality rate from 12% to 37%.

A

Hip fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

If a patient has hip pain, at night, what must be ruled out

A

Malignancy, inflammatory process, osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

If a patient has lateral hip pain that is aggravated by direct pressure what is a diagnostic consideration

A

Trochanteric bursitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

If a patient has hip pain with use, that is better with rest what diagnostic consideration

A

Structural joint problem or Osseo arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

If a patient has constant hip pain, especially at night what must be considered

A

Infectious, inflammatory, neoplastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

If a patient has anterior hip/groin pain, what diagnosis should be considered

A

Hip joints,osteo arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

If a patient complains of posterior hip pain what diagnosis should be considered

A

S I joint, LBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

History of significant or high energy trauma such as a motor vehicle or motorcycle accident. Signs and symptoms depend on degree of injury to the pelvic bones and other pelvic structures such as nerves, blood vessels, and pelvic organs. Look for ecchymosis and swelling in the lower abdomen, the hips, groin, and/or scrotum. May have bladder and/or fecal incontinence, vaginal or rectal bleeding, hematuria, numbness etc. may cause internal hemorrhage, which can be life threatening. Check airway, breathing, and circulation first

A

Pelvic fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Acute onset of saddle anesthesia, bladder incontinence, fecal incontinence. Accompanied by bilateral leg numbness and weakness. Pressure on a sacral nerve root results in inflammatory and ischemic changes to the nerves. A surgical emergency. Need spinal decompression. Refer to ED.

A

Cauda Equina Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Acute and sudden onset of tearing severe low back/abdominal pain. Presence of abdominal bruit with abdominal pulsation. Patient with signs and symptoms of shock. More common in elderly males atherosclerosis, white rice, and smokers.

A

Low back pain from a dissecting abdominal aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What conditions outside of the spine can cause back pain

A

Pancreatitis, nephrolithiasis, prostatitis, Pyelonephritis , AAA, herpes zoster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

When a patient presents with lower back pain what are some clues to systemic disease

A

History of cancer i.e. breasts, prostate, lung, fibroid, kidney. Age over 50 years old. Unexplained weight loss. Duration of pain greater than four weeks. Nighttime pain. Only get lumbar x-ray in these situations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What test do you perform for a patient that presents with lower back pain

A

Straight leg raise is positive it is radiculopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Inappropriate physical signs on physical exam, faking illness or pain, overreaction during exam

A

Waddell’s signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Nerve root irritation at L5 through S1. Sharp or burning pain radiating down the leg to foot or ankle. May occur as numbness or tingling.

A

Sciatica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Examiner raises patients extended leg with the ankle Dorsiflexed. Positive if sciatica is reproduced between 10 and 60° in the affected leg. May confirm radiculopathy

A

Straight leg raise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What imaging is done for a patient that complains with lower back pain

A

Plain radiographs AP and lateral of lumbar spine; trauma, suspected malignancy, infection add ESR and CRP he.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

When is an MRI indicated in a patient that presents with lower back pain

A

It is the gold standard test for disc disease. Demonstrates discs, ligaments, nerve roots, epidural that, shape and size of the spinal canal. Looks at soft tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

If cloudy synovial fluid is found what must be done

A

Order culture and sensitivity because this can be indicative of an infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Damage to what joint may cause locking of the knees and knee instability

A

Meniscus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Connects muscle to the bone.

A

Tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Connects bone to bone

A

Ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Saclike structures located on the anterior and posterior areas of the joints that act as padding. Filled with synovial fluid when inflamed.

A

Bursae

When bursae is filled with synovial fluid and is inflamed it os bursitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the gold standard imaging study for injuries of the cartilage, meniscus, tendons, ligaments, or any joints of the body

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What imaging study and emits radiation and detects bleeding, aneurysms, masses, pelvic and bone trauma and fractures

A

CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Metal implants, pacemakers, aneurysm clips, and metallic joints are contraindicated in what diagnostic imaging study

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is Venus recurvatum

A

Hyper extension or backward curvature of the knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is genu valgum

A

Knock knees

Think of “gum stuck between the knees”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is genu varum

A

Bow legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

When should RICE be initiated after musculoskeletal trauma

A

48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

When should isometric exercise be introduced after musculoskeletal trauma

A

It is useful during the early phase of recovery before regular active exercises performed. Defined as the controlled and sustained contraction and relaxation of a muscle group. Less stressful on joints than regular exercise. Usually done first before exercise post injury. Nonweightbearing exercises.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is a test for knee stability

A

Drawer test. And diagnostic sign of a torn or ruptured ligament.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What causes DeQuervain’s tensovitis and where is it located in my hand

A

It is caused by inflammation of the tendon and it’s sheath and is located at the base of the thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the screening test for DeQuervain’s tendinitis

A

Finkelstein’s test

Which is positive if there is pain and tenderness on the wrist upon ulnar deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Knee pain and the click sound upon manipulation of the knee is positive. Suggests injury to the medial meniscus.

A

McMurray’s test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is the gold standard test for joint damage

78
Q

What test is for knee laxity and is suggestive of ACL damage of the knee and more sensitive than the anterior drawer test for ACL damage

A

Lachman’s sign

79
Q

Acute or recurrent pain on the bottom of the feet that is aggravated by walking. Caused by micro tears in the plantar fascia due to tightness of the Achilles tendon. Higher risk with obesity, diabetics, aerobic exercise, flat feet, prolonged standing

A

Plantar fasciitis

80
Q

What is the treatment plan for plantar fasciitis

A

NSAIDs. Use orthotic foot appliance at night times a few weeks. Ice pack to affected foot. Stretching and massaging of the foot: rolling a golf ball with soles of foot several times a week. Lose weight. Consider x-ray to rule out fracture, heel spurs, complicated case. Refer to podiatry as needed.

81
Q

Inflammation of the digital nerve of the foot between the third and fourth metatarsal’s. Increased risk with high-heeled shoes, tight shoes, obesity, dancers, runners.

A

Morton’s neuroma

82
Q

What condition can cause a small nodule on the space between the third and fourth toes on physical exam

A

Morton’s neuroma

83
Q

What is the screening test for Morton’s Neuroma

A

Mulder rest
Grasp 1st & 5th metatarsals and squeeze the forefoot. + if hearing a click along with a pt report of pain during compression. Pain is relieved when the compression is stopped.

84
Q

What is the treatment plan for Morton’s neuroma

A

Avoid wearing tight narrow shoes and high heels. Use for front foot pad. Where well padded shoes. Diagnosed by clinical presentation and history. Refer to podiatrist.

85
Q

Pain exacerbated by activity; relieved by rest, sometimes occurring at night. A.m. stiffness resulting in less than or equal to 60 minutes. Tenderness to palpation of infected joints. Crepitus is audible. Joint effusion may be present. Osteophytes and joint space narrowing are present

A

Osteoarthritis or degenerative joint Disease

86
Q

What is the first line treatment for osteoarthritis

A

Exercise and range of motion and strengthening.

Weight loss if appropriate, patient education, heat and ultrasound

87
Q

What is the pharmacologic treatment for osteoarthritis

A

Acetaminophen PRN first then scheduled up to 3 g daily. If this doesn’t work then NSAIDs PRN 2-four week trial at high dose is no relief. If there is no release on three different NSAIDs, steroid injection, consider referral

88
Q

Can you reprice an NSAID to a patient that had an MI

A

No. Use with caution in patients with cardiac problems.

89
Q

A patient who has osteoarthritis takes NSAIDs almost daily. Which lab tests should be done annually

A

CBC, BUN/CR, ALT

90
Q

What joints are mostly affected by osteoarthritis

A

Hips, knees, and the hands.

91
Q

What risk factors are there for osteoarthritis

A

Older age, overuse of joints, and positive family history

92
Q

Bony nodules on the distal interphalangeal joint’s associated with osteoarthritis

A

Heberden’s nodes

93
Q

Bony nodules on the proximal interphalangeal joints associated with osteoarthritis

A

Bouchnard’s nodes

94
Q

Age greater than 75 years old what pharmacologic treatment should be used for osteoarthritis

A

Topical NSAIDs vs. oral form

95
Q

When a patient presents with osteoarthritis symptoms what must be ruled out

A

Osteoporosis

96
Q

If a patient has a history of uncomplicated ulcer, aspirin, Coumadin, PUD, and platelet disorder, can they be on an NSAID

97
Q

What type of arthritis causes joint stiffness to last longer, involves multiple joints, and has symmetrical distribution. It is also accompanied by systemic symptoms like fatigue, fever, normocytic anemia, etc.

A

Rheumatoid arthritis

98
Q

What nobody is located at the DIP joint

A

Heberden’s

- the den ending on the word is the letter D for DIP joint

99
Q

What is the treatment for rheumatoid arthritis

A

All of the treatments for osteoarthritis plus systemic steroids, antimalarial’s such as plaquenil, anti-metabolite such as methotrexate, and Biologics such as Humira or Enbrel

100
Q

A woman of age 20 to 35 years old presents with a classic rash in a maculopapular Butterfly shaped rash on the middle of the face or Malar rash. May have non pruritus thick scaly red rashes on sun exposed areas called discoid rash. Urinanalysis is positive for protein urea.

A

Systemic lupus erythematosus

101
Q

How do you manage lupus

A

Referral to rheumatologist

102
Q

What is pertinence patient education for lupus

A

Avoid sun between 10 AM to 4 PM because it causes rashes to break out. Cover skin with high SPF sunblock. Sun protective clothing such as hats with wide Rams, long sleeved shirts. More sensitive to indoor fluorescent lighting. Use non-fluorescent lightbulbs.

103
Q

Adult to middle-aged female complains of gradual onset of symptoms over months with daily fatigue, low-grade fever, generalized bodyaches, and myalgia. Complains of generalized aching joints, which usually involves the fingers/hands and wrist. Morning stiffness lasts longer than osteoarthritis with painful, warm, and swollen joints. Swollen fingers with warm tender joints (PIP & DIP). Also called sausage joints

A

Rheumatoid arthritis

104
Q

Systemic autoimmune disorder that is more common in women. Mainly manifested through multiple joint inflammation and damage. Patients are at higher risk for other autoimmune diseases, graves disease, pernicious anemia, and others.

A

Rheumatoid arthritis

105
Q

What conditions have poly arthritis

A

Lupus, rheumatoid arthritis, scleroderma, fitz disease

106
Q

Morning joint stiffness lasts greater than 60 minutes, affected joints swell, symptoms present at least six weeks

A

Rheumatoid arthritis

107
Q

What is the work up for rheumatoid arthritis

A

Rheumatoid factor, anti-– CCP antibody’s, ESR, CRP, ANA, CBC, BUN, LFT, CR, uric acid level, urinalysis

108
Q

Heberden’s nodes are solely associated with

A

Osteoarthritis

109
Q

The primary joint that is affected Are the hands and wrists, metacarpophalangeal, absent heberden’s nodes, joint is soft warm & tender, + RF, CCP, ESR, CRP

A

Rheumatoid arthritis

110
Q

Hips and knees are the primary joint affected, carpometacarpal, DIO, + heberden’s nodes, joint is bony and hard, -RF, CCP, ESR, CRP

A

osteoarthritis

111
Q

How do you manage rheumatoid arthritis

A

Early referral to rheumatology
patients aware prescribed biologics such as infliximab -mab
And nonbiologics such as methotrexate

112
Q

Swan’s neck deformity is found in

A

Rheumatoid arthritis. It is found in 50% of patients. Flexion of the DIP joint with hyperextension of the PIP joints

113
Q

Boutonnière deformity is found in

A

Rheumatoid arthritis. Hyper extension of the DIP with flexion of the PIP joint

114
Q

If an x-ray shows bony erosion, joint space narrowing, and subluxations i.e. dislocation what must be considered

A

Rheumatoid arthritis

115
Q

Can A patient with rheumatoid arthritis continue to take a biologic drug if they have signs and symptoms of infection such as fever or sore throat

116
Q

Uveitis, scleritis, vasculitis, pericarditis, are all associated with

A

Rheumatoid arthritis

Uveitis needs an opthomologist STAT

117
Q

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

A

Uveitis. Refer to ophthalmologist immediately. Patient treated with high dosed steroid for several weeks.

118
Q

What kind of drug is Plaquenil

A

Antimalarial

119
Q

What type of drug is methotrexate

120
Q

Middle-aged male presents with painful, hot, red, and swollen metatarsal phalangeal joint of greater toe i.e. Podagra. Patient is limping due to severe pain from weight bearing on affected toe. History of previous attacks on the same site. Precipitated by alcohol, meets, or seafood.

121
Q

What condition has tophi

A

Chronic gout.

Tophi are small white modules full of urates on ears and joints

122
Q

What will the labs show in gout

A

Uric acid level will be elevated more than 7 mg.

123
Q

What is the treatment for an acute presentation of gout

A

Indomethacin (Indocin) BID or naproxen sodium BID PRN.
If no relief, combine with colchicine 0.5mg 1 tan every hour until relief or diarrhea occurs. After acute phase is over, wait at least 4-6 weeks before initiating maintenance treatment.
Stop allopurinol during acute phase. Restart 4-6 weeks after resolved.

124
Q

What is the maintenance medication for gout

A

Allopurinol (Zyloprim) daily for years to lifetime. Check CBC as it affects bone marrow.
Probenecid lowers uric acid
Colchicine has anti-inflammatory effects and can be used during acute phase with NSAIDs and for maintenance phase.

125
Q

Can gout cause joint destruction

126
Q

More common in males and HLA-B27+. Average age of onset is the early 20s. Chronic inflammatory disorder that affects mainly the spinal region and the sacroiliac joint. Some other joints affected are the shoulders and hips.

A

Ankylosing Spondylitis

127
Q

Young adult male complains of a chronic case of back pain for more than three months that is worse in the upper back. Joint pain keeps him awake at night. Associated with generalized symptoms like low-grade fever and fatigue. May have chest pain with respiration. Long-term stiffness that improves with activity. Some have buttocks pain.

A

Ankylosing Spondylitis

128
Q

Objective findings include marked loss of range of motion of the spine such as forward bending, rotation, and lateral bending. Decreased respiratory excursion down to less than 2.5 cm. Some have lordosis. Uveitis: complains of Eye irritation, photosensitivity, and Eye pain. Scleral injection and blurred vision. Refer to opthalmologist ASAP to be treated with steroids.

A

Ankylosing Spondylitis

129
Q

What labs are ordered for ankylosing Spondylitis

A

Sedimentation rate and see reactive proteins which will be slightly elevated. RF will be negative. Spinal radiograph will show classic bamboo sign.

130
Q

What is the treatment plan for ankylosing spondylitis

A

Referral to rheumatologist. Buy mattress with good support. Postural training.
First line treatment is NSAIDs
If high risk of bleeding, prescribe PPI with NSAIDs or COX-2 inhibitors (celecoxib or Celebrex)
For severe treatment DMARDs, biologics, and spinal fusion

131
Q

What are complications of Ankylosing Spondylitis

A

Anterior uveitis
Aoritis (inflammation of the aorta)
Fusing of the spine with significant loss of range of motion. Spinal stenosis.

132
Q

Patient greater than 50 years old with a new onset of back pain what should be ruled out

133
Q

If a patient presents with symptoms of spinal stenosis what must be ruled out

A

Ankylosing Spondylitis

134
Q

What is the best imaging study for diagnosing a herniated disc

135
Q

Acute pressure on a sacral nerve root results in inflammatory and ischemic changes to the nerve. Sacral nerves innovate pelvic structures such as the sphincters (anal and bladder). Considered a surgical emergency. Needs decompression. Referred to ED.

A

Cauda Equina syndrome

136
Q

Bowel incontinence, bladder incontinence, & saddle anesthesia are all signs of

A

Cauda Equina Syndrome

137
Q

Common cause of shoulder pain. Also called cuff tendinitis.

A

Supraspinatus Tendonitis

138
Q

What test is for impingement syndrome

A

Hawkins-Kennedy Test

Painful arc test

139
Q

Which condition would be consistent with the patient that has a history of diabetes, history of immobilizing condition of the shoulder, and diminished shoulder range of motion

A

Adhesive capsulitis

140
Q

Forearm muscles attach to the

A

Lateral epicondyle

141
Q

How do you manage lateral epicondylitis or tennis elbow

A

Rest is very important. Keep joints moving. Ice/heat is helpful. NSAIDs. Steroid injections. Physical therapy. Isometric resistance or wrist extension.

142
Q

How is epicondylitis treated

A

If chronic neuropathy, it can be treated with TCAs, gabapentin, phenytoin and pain medications.

143
Q

What grade of ankle sprain is a minimally torn ligament, stable joint

144
Q

What grade of ankle sprain is an incomplete tear painful weight bearing

145
Q

What grade of ankle sprain is completely torn ligament, severe pain, swelling, tenderness.

146
Q

How do you manage an ankle sprain

A

RICE for 2-3 days
Early mobility with splints, braces
Analgesics: acetaminophen, NSAIDs

147
Q

What scale is used to determine whether a patient needs radiographs of an injured ankle in the emergency room

A

Ottawa rules of the ankle

148
Q

What do you consider x-ray and referral for a grade 2 sprain

149
Q

Twisting injury with the foot fixed. Degenerative tears in the middle/older adults, maybe as a result of minor trauma.

A

Meniscal tear

150
Q

This condition is almost always secondary to trauma, swelling after injury, laxity of ligaments on exam.

A

Torn ligaments

151
Q

What tests should you perform on a patient that presents with acute knee pain

A

Anterior drawer test, posterior drawer test, Lachman test, McMurray’s test

152
Q

Patient complains of locking of the knee or knees. Some patients are unable to fully extend affected knee. Patient may limp. Complains of knee pain and difficulty walking and bending the knee. Some complain of joint line pain. Decreased range of motion.

A

Meniscus tear of the knees

153
Q

What is the best imaging study for a torn meniscus

A

MRI. Referred to orthopedic specialist for repair.

154
Q

A type of bursitis that is located behind the knee i.e. popliteal fossa. Sometimes when a joint is damaged and or inflamed, synovial fluid production increases, causing the bursa to enlarge. Bursae are the protective synovial sacs that are located on certain joints.

A

Ruptured Baker’s cyst or bursitis

155
Q

Physically active patient complains of a ball like mass behind one knee that is soft and smooth. Pressure pain or asymptomatic. If cyst ruptures, will cause an inflammatory reaction resembling cellulitis on the surrounding area i.e. the calf such as redness, swelling, tenderness.

A

Ruptured Baker’s cyst

156
Q

How do you diagnose a ruptured Baker’s cyst

A

Diagnosed by clinical presentation and history. MRI if diagnosis is uncertain. Rule out plain bursitis from bursitis with infection i.e. septic joint.

157
Q

What is the treatment plan for a ruptured Baker’s cyst

A

RICE
NSAIDS
Large bursa can be drained with syringe, 18 gauge needle if causing pain. Synovial fluid is a clear golden color. If cloudy synovial fluid and red, swollen, and hot joint, order C& S to rule out septic joint infection.

158
Q

Anterior uveitis is a complication of

A

Rheumatoid arthritis and ankle losing spondylitis

159
Q

Does an x-ray of the knee show meniscal injury or any joint cartilage

160
Q

What is the gold standard test for assessing joint damage

161
Q

Chronic widespread musculoskeletal pain greater than three months accompanied by fatigue, psych symptoms, and multiple somatic complaints. Ideology and pathophysiology are unknown. No evidence of tissue inflammation. Labs, and radiology are within normal limits. Physical exam is normal except for tenderness in nine pairs of specific fibromyalgia points on exam in the neck. ACR has diagnostic Criteria

A

Fibromyalgia

162
Q

How do you treat fibromyalgia

A

Patient education, sleep hygiene, treat comorbid i.e. mood and sleep disorders, exercise: aerobic conditioning, stretching, strengthening, medications for pain: amitriptyline, duloxetine (cymbalta), pregabalin

163
Q

Positive is point tenderness at heel

A

Plantar fasciitis

164
Q

Positive MTP squeeze test

A

Morton’s neuroma

165
Q

Associated with High purine diet

166
Q

Nodes on the DIP joint secondary to arthritis

A

Heberden’s nodes

167
Q

Positive Finkelstein test

A

DeQuervains tensosynovitis

168
Q

Burning pain between third and fourth toes

A

Morton’s neuroma

169
Q

Positive Tinel’s test and positive Phalen’s test

A

Carpal tunnel syndrome

170
Q

Type of fracture secondary to a systemic disease

A

Pathologic fracture

171
Q

Common cause of posterior knee pain

A

Baker’s cyst

172
Q

Overuse injury of a bone

A

Stress fracture takes 4-6 weeks to heal

173
Q

Dorsal thumb pain is a classic symptom

A

DeQuervains tensosynovitis

174
Q

Injury to a bone that does not result in a fracture

175
Q

Injury to a muscle

176
Q

Injury to a ligament

177
Q

Caused by deposition of urate crystals in joints

178
Q

Nodes on PIP joints secondary to arthritis

A

Bouchnard’s nodes

179
Q

Joint stiffness lasts less than 60 minutes usually

A

Osteoarthritis

180
Q

RICE is the acronym for treatment for this

181
Q

Term that describes compression of the spinal cord

A

Cauda Equina Syndrome

182
Q

Rupture of the biceps tendon

A

Popeyes disease

183
Q

A 7 year old male presents with a painless with limp, antalgic gait, muscle spasm, mildly restricted hip abduction and internal rotation, proximal thigh atrophy, and slightly short stature. The most likely diagnosis is

A

Legg-Calve-Perthes Disease

184
Q

What physical modalities recommended for treatment of rheumatoid arthritis provides the most effective long-term pain relief?

185
Q

Is osteo arthritis associated with chronic renal failure, long time anticonvulsant to use, and long-term steroid use

186
Q

The most effective treatment for a noninfective bursitis includes

A

Rest, and intra-articular corticosteroid injection, and a concomitant oral NSAID

187
Q

Radiographic evaluation of talipes equinovarus must be performed

A

While weight bearing

188
Q

What disease process are Bouchard’s node’s most commonly associated with

A

Osteoarthritis

189
Q

What is subluxation of the Radial Head

A

Nurses elbow

190
Q

The complete resolution of symptoms of Osgood Schlatter disease through physiologic healing takes how long

A

12 to 24 month