TBL Dec 6 MSK part 2

Question 1

Sciatica is classic sign of what?

Answer 1

Herniated disc

Question 2

Herniated disc gets better with?

Answer 2

Lying down

Question 3

Herniated disc gets worse with?

Answer 3

Valsalva, cough, sneeze

Question 4

Treat Herniated Disc w/ big 3
 - NSAIDs
 - muscle relaxant
 - acetaminophen
Plus what possibly?

Answer 4

Short course oral steroids

Question 5

When consider surgery in herniated disc?

Answer 5

Disabling pain > 6 weeks

Progressive neuro deficits

Question 6

Signs and treatment of spinal stenosis?

Answer 6

Pseudoclaudication after walking (only w/ activity)
MRI to confirm
NSAIDs, muscle relaxants, PT, epidural corticosteroid injections

Question 7

3 groups worry about vertebral compression fractures?

Answer 7

Elderly
Long-term steroid use
Osteoporosis

Question 8

To where does compression fracture (vertebral) radiate?

Answer 8

Girdle pain
- bilaterally to abdomen
(often low impact or no trauma)

Question 9

Snap or pop w/ ankle pain?

Answer 9

Ligament rupture

Question 10

If posterior ankle pain worry about?

Answer 10

Achilles tendon injury

- squeeze gastroc if foot plantar flexes = achilles is fine

Question 11

Ottowa ankle rules for imaging?

Answer 11

Tip/edge malleoli
Navicular
5th metatarsal
can’t walk 4 steps

Question 12

MVC w/ flexed knee hits dashboard, think what injury?

Answer 12

PCL

- otherwise rare injury

Question 13

If knee locks think?

Answer 13

Meniscus injury

Loose cartilage

Question 14

Stiffness w/ inactivity
Improves after few minutes of activity
Pain w/ weight bearing

Answer 14

Degenerative joint disease

Question 15

If hemarthrosis?

Answer 15

Significant knee injury

Possible ACL

Question 16

Ottowa knee rules?

Answer 16

> 55
Head of fibula
Patella
Can't flex to 90 degrees
Can't do 4 weight transfers

Question 17

What is osteoarthritis?

Answer 17

Non-inflammatory arthritis

• immune damage
• mechanical damage

Question 18

OA

• joint
• morning
• systemic?
• inflammatory?

Answer 18

DIP joints of fingers
Morning stiffness gone in 15-30 mins
No systemic, no inflammatory
OA = Older = Farther
Risks: obesity, injury, occupation

Question 19

RA

• joint
• morning
• systemic?
• inflammatory?

Answer 19

Any age, F>>M
PIP and MCP joints
Inflammatory & systemic = yes
Morning stiffness lasts 45-60 minutes +
Risks: genetic, smoking

Question 20

HA, loss vision, scalp tenderness

Jaw claudication

Answer 20

Giant cell (temporal) arteritis

Question 21

When do X-ray for OA/RA?

Answer 21

NOT for diagnosis; not for asymptomatic

Do if surgery is being contemplated

Question 22

Diagnosing RA

Answer 22

1 hour morning stiff
3 joints involved, one is wrist/MCP/PIP
Symmetric
Nodules over bony points
Rh factor + (but weeks/months after onset)
Erosions/decalcification in hand/wrist

Question 23

Drugs for RA?

Answer 23

Methotrexate (but NOT for preggers)
TNF receptor blockers
- etanercept, infliximab/adalimumab
NSAIDs

Question 24

Three antibodies in SLE?

Answer 24

anti-Smith
anti-dsDNA
ANA - but non-specific

Question 25

Treating SLE

Answer 25

NSAIDs are recommended with hydroxychloroquine, low to high dose steroids, methotrexate, or azathioprine also being used for disease suppression