TBL Dec 6 MSK part 3

Question 1

Gout

Answer 1

1st MTP joint
Unilateral
Hyperuricemia
Subcortical cysts
Urate crystals in joint fluid
Joint fluid culture is NEGATIVE

Question 2

Why gout? who?

Answer 2

Deposition of monosodium rate crystals in joints

Males > 40, AA, Family hx

Question 3

What see in polarized light?

Answer 3

Negatively birefringent

Question 4

Treat acute gout?

Answer 4

NSAIDs
Indomethacin
Colchicine
Intra-articular steroids

Question 5

How treat chronic gout? Non-meds?

Answer 5

Allopurinal, febuxostat (OX inhibitors) - OVER producers
- reduce purine rich foods (red meat, seafood)

Under-excretors
- use probenecid

Question 6

Stiffness in cervical spine - elderly/women
Stiffness in shoulder/hip
Systemic inflammation: low grade fever, wt loss

Answer 6

Polymyalgia Rheumatica
- give low dose steroids
Assoc: Giant cell arteritis - give high dose steroids

Question 7

Organisms in septic joint

• young sex active
• common
• prosthetic

Answer 7

Neisseria gonorrhea
Staph aureus, Streptococcus
Staph epidermidis

Question 8

Viral cause septic joint?

Answer 8

Parvovirus B19

• slapped cheeks in kid
• adult poly arthritis

Symptoms resolve in 4-6 weeks

Question 9

How diagnose Lyme?

Answer 9

ELISA, erythema migrant (bulls eye rash)

Question 10

How treat Lyme?

Answer 10

Doxycycline - curative + prevent progression

Question 11

What is reactive arthritis?

Answer 11

Rheumatic presentation after GI/GU infection

• Campylobacter, Salmonella, Shigella
• Chlamydia

HLA B27 + more likely

Question 12

What is common triad of reactive arthritis?

Answer 12

Arthritis
Urethritis
Conjunctivitis

Question 13

When do straight leg raise? Better?

Answer 13

Provoke sciatics – to diagnose for Herniated Disk

Greatest risk = 30-55 y/o – older disk gets firmer

Better = crossed SLR test (lift opposing leg)

Question 14

Smoking is risk for what back problem?

Answer 14

Vertebral compression fracture

- cigarette = compress

Question 15

3 big symptoms of caudal equina?

Answer 15

Acute neuro impairment
Bowel/bladder dysfunction
Saddle anesthesia

Question 16

Sensory/motor loss L3-4
L4-5
L5-S1

Answer 16

Medial foot - knee extension - squat & rise
Dorsal foot - dorsiflex - heel walk
Lateral foot - plantar - walk on toes

Question 17

If fail conservative treatment or red flag symptoms for acute LBP, do what?

Answer 17

Plain films, 2 views
May then do advanced imaging and lab tests
If pathology detected, surgical eval

Question 18

4 Drugs and 1 thing to do to manage acute LBP?

Answer 18

NSAIDs
Muscle relaxants - cyclobenzaprine, baclofen
Mild opioids
Acetaminophen
and stay ACTIVE !!

Question 19

When do imaging or refer to surgery for herniated disc / radiculopathy?

Answer 19

Severe/intractable pain
Progressive neuro symptoms
> 6 weeks
- MRI, surgical consult

Question 20

Three things to do if red flag symptoms for acute LBP?

Answer 20

Plain radiograph, two views
ESR
CBC

Question 21

When use back belt?

When use lumbar supports?

Answer 21

Not recommended for chronic lower back pain

Question 22

Acceleration-deceleration neck injury w/ radiculopathy requires:

Answer 22

imaging and possible consult

Question 23

Instability following sublaxation?

Answer 23

Labrum injury

Sublaxation = partial dislocation

Question 24

Numbness, tingling, radiating pain past the elbow

Answer 24

C-spine radiculopathy

Question 25

Woman 40-60+, stiff shoulder

- pain w/ AROM, PROM or both?

Answer 25

Adhesive capsulitis

- both

Question 26

Repetitive overhead activity (painting)

Throwing sports

Answer 26

Rotator cuff injury

Question 27

Red flags - shoulder pain

Answer 27

Fever, chills, wt loss, IV drug, IS, fall, trauma
Shoulder weakness
Multiple joint involvement w/ effusion
Numbness, tingling, radiation past elbow
Muscle atrophy

Question 28

Hawkins test for?

Answer 28

Impingement/rotator cuff disorder

Have patient look at hand, then internally rotate humerus