Walden

Question 1

Wrist pain palpation Hx of falling, 2nd x-ray will show fx, hi risk necrosis and nonunion, - TX splint wrist refer to hand surgeon

Answer 1

Navicular fracture

Question 2

Cast for wrist fractures (scaphoid bone in wrist),

Answer 2

Thumb Spica cast

Question 3

Fracture of distal radius of the forearm, DINNER FORK fracture, most common type wrist fracture

Answer 3

Colles fracture

Question 4

high energy trauma, ecchymosis and swelling, lower abdomen, hips, groin, scrotum, may have bladder or bowel incontinence, hematuria, may cause internal hemorrhage life threatening - TX check ABC’s

Answer 4

Pelvic fracture

Question 5

Sudden onset of one side pain, elderly have one-year mortality rate,

Answer 5

Hip fracture

Question 6

Tennis/golfers elbow, pharm TX =nsaids, anti-inflammatory cream, intraarticular corticosteroid injection, nonpharm TX= rest, ice, brace, physical therapy, referral- ortho, PT/OT

Answer 6

Lateral epicondylitis

Question 7

Used to determine when a patient needs radiographs of injured ankle in ED, 1,2,3, Grades, 2 needs x-ray, 3 referrals to ER for ankle fracture

Answer 7

Ottawa rule (ankle)

Question 8

Injury of overuse of the muscles tendons and bone tissue of the tibia, shin splints, pain of overuse of the large front bone in lower leg, - Dx bone scan or MRI, - TX RICE, stretching, massage, nsaids,

Answer 8

Medial tibial stress syndrome/fracture

Question 9

Acute or recurrent pain, bottom of foot, aggravated by walking, caused by micro tears in the plantar fascia due to tightness of the Achilles tendon, elevated risk factors BMI>30, diabetes, aerobic exercise, pes planus (flat feet), prolonged standing – TX Nasid, orthotic foot appliance, ice pack, stretching with golf ball sole of feet, x-ray to rule out fracture

Answer 9

Plantar fasciitis

Question 10

• TX brace, stretching arch support

Answer 10

Pes planus (flat feet)

Question 11

crystal deposits in joints, elevated uric acid, caused by excess dietary purines (beef, pork, lamb, seafood, beer, bread, gravy, alcohol) - Dx gold standard is joint aspiration of synovial fluid Labs- uric acid level, CBC, ESR - TXNSAIDs Indocin), colchicine for flare up, corticosteroids Podagra means gout of the foot

Answer 11

Gout exacerbations

Question 12

Occurs during growth spurt and affects superior tibia, when quadriceps exert stress on the patellar tendon (tibial tubercle), anterior knee pain increases over time

Answer 12

Osgood-Schlatter

Question 13

Small round projection on bone or surface

Answer 13

Tubercle

Question 14

Typical in osteoarthritis, enlargement of proximal interphalangeal joint

Answer 14

Bouchards node

Question 15

inflammatory arthritis affecting spine and large joints, pain improves with exercise not rest, low grade fever, fatigue, marked loss of ROM, humpback, uveitis, - Dx labs sed rate, C reactive protein, spinal radiograph bamboo spine, - TX refer to rheumatologist, first line is NSAIDS, postural training

Answer 15

Ankylosing spondylitis (Bechterews disease)

Question 16

medical emergency, spinal cord compression, B/B dysfunction, - TX refer to ED, needs decompression

Answer 16

Cauda equina syndrome

Question 17

painful condition hurts the ball of your foot, between third and fourth toe, involves thickening of tissue around nerves leading to your toe, toe may sting, burn or feel numb, DX with clinical presentation and history, small nodule between third and fourth toe, linked to tight fitting shoes and high heels, - TX with corticosteroid or surgery, avoid tight shoes,

Answer 17

Morton’s neuroma

Question 18

TX- Tylenol first line, nsaids- Celebrex, topical nsaids

Answer 18

Arthritis

Question 19

cartilage covering surface of joints becomes damage from overuse, obesity, affects distal interphalangeal joints, early morning stiffness<15 minutes, swollen tender joints, ASYMMETRIC symptoms, Bouchards nodes (Proximal) and Heberden’s nodes (Distal) - DX physical exam or radiographs, - TX first line treatment is Tylenol, nsaids, steroidal injections only, no oral steroids, glucosamine sulfate supplement

Answer 19

Degenerative joint disease/OSTEOARTHRITIS

Question 20

autoimmune disorder inflammation of multiple joints plan is to prevent the joint damage, presents with bilateral pain and swelling of proximal interphalangeal joinst, SYMMETRICAL DISTRUBUTION, signs of fatigue, low grade fever, body aches, myalgia, GENERALIZED joint pain, early morning stiffness >1 hour, weight loss, anorexia, neurophathic pain in the extremities or eyes, chest pain upon inspiration, warm and tender swollen fingers “sausage joints” - Dx intital test is sed rate, Creactive protein, CBC, rheumatoid factor, - TX refer to rheumatologist, surgery, NSAIDS, steroids, Humira Anti TNF biologics, antimalarial- Plaquenil, can cause uveitis

Answer 20

Rheumatoid arthritis Severe RA go swimming

Question 21

Deterioration of bone tissue caused by hormonal changes, calcium vitamin d deficiency, risk factors- patients on PPI, patients with anorexia/bulimia females, family history, age; estrogen and testosterone deficiency, kyphosis, Caucasians and Orientals, small frame people, cigarette, alcohol, caffeine, medication- steroids anticonvulsants, thyroid supplements, eating disorder, sedentary life, - Dx bone mineral density >-2.5 osteoporosis - TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise

Answer 21

Osteoporosis

Question 22

increase calcium dark green vegetables, salmon, sardines, soy and OJ

Answer 22

Osteopenia

Question 23

slippage of the overlying end of the femur (epiphysis).SCFE happen to teens who have specific stuff going on with their health, such as: obesity (carrying extra weight puts increased pressure on the growth plate) endocrine disorders like diabetes, thyroid disease, or growth hormone problems. kidney disease. - TX in situ fixation. This is the procedure used most often for patients with stable or mild SCFE. The doctor makes a small incision near the hip, then inserts a metal screw across the growth plate to maintain the position of the femoral head and prevent any further slippage. Non- wt bearing, referral to ortho for pinning

Answer 23

Slipped capital femoral epiphysis

Question 24

Also known as metatarsus varus, is a common foot deformity noted at birth that causes the front half of the foot, or forefoot, to turn inward. TX teach parent to perform passive stretching into straighten position several times a day, serial casting every 1-2 weeks or surgery for correction

Answer 24

Metatarsus adductus- (pigeon toe)

Question 25

Involve lower extremity and foot, TX brace, stretching, casting, surgery

Answer 25

Club foot- talipes equinovarus

Question 26

Injury in 1-4-year-old, - TX reduction to put back in place, or device wearing splint

Answer 26

Nursemaids elbow

Question 27

Inflammatory disorder causing muscle and joint pain and stiffness (shoulders/hips), aching stiffness about the upper arms, neck, lower back and thighs, symptoms develop quickly, and worse in the morning, - DX elevated sed rate, Creactive protein, 1st line - TX oral prednisone

Answer 27

Polymyalgia rheumatic

Question 28

depression, dysrhythmias or anxiety disorders, malaise fatigue, multiple joint pain, headaches, impaired memory, and concentration, sore throat, restless sleep, muscular pain for 3 months, - DX - TX cognitive based therapy CBT.

Answer 28

Fibromyalgia/chronic fatigue syndrome

Question 29

Arthritis that causes inflammation, pain, and stiffness, mainly in the spinal joints.

Answer 29

Ankylosing spondylitis (AS)

Question 30

Involves joints and arteries. It is associated with a high risk of giant cell arteritis (GCA) or temporal arteritis (15%-30%). New onset of vision loss and the location of the pain (neck, both shoulders/hips)

Answer 30

Polymyalgia rheumatica (PMR)

Question 31

Enlargement of the middle joint of a finger

Answer 31

Bouchard’s node

Question 32

(bony overgrowths) are classic signs of OA

Answer 32

Heberden’s nodes

Question 33

A diagnostic test for carpal tunnel syndrome

Answer 33

Phalen test