Fm: Musculoskeletal

Front 1

pain stiff joints, fatigue, malaise, weight loss

Back 1

RA

Front 2

pain better over course of day: RA or OA

Back 2

rheumatoid.

Front 3

4 of what criteria required for RA diagnosis

Back 3

morning stiffness > 1 hr > 6 w, swelling in 3 jts, symmetric, joint erosions on xray, rheumatoid nodules

Front 4

RA spares which joint?

Back 4

DIP. (does involve PIP, MCP and wrists)

Front 5

endotracheal intubation is dangerous in RA why?

Back 5

effect on cervical vertebrae

Front 6

heberden's nodes

Back 6

DIP [not in RA]

Front 7

bouchard's nodes

Back 7

PIP [these nodes not in RA, it's an osteophyte]

Front 8

Hand abnormalities in RA

Back 8

Swan neck deformity & ulnar deviation

Front 9

Iron study findings in RA

Back 9

Classic Anemia of Chronic Disease [normal MCV, normal Pllt, low iron, high ferritin low TIBC]

Front 10

Low MCV normal iron studies

Back 10

thalassemia

Front 11

high iron in what type of anemia

Back 11

sideroblastic anemia usu caused by alcohol

Front 12

most specific test for dx of RA

Back 12

anti CCP

Front 13

RA patient already on NSAIDs, wrist splints, & physical therapy. What should you add?

Back 13

methotrexate

Front 14

DMARDs are used when??

Back 14

1) can't tolerate metothrexate 2) don't repsond to MTX

Front 15

Perform what screen before administering hydroxychloroquine?

Back 15

check eyes. It causes retinal lesions

Front 16

RA patient already on NSAIDs, wrist splints, & physical therapy AND methotrexate & DMARDs. What should you add?

Back 16

Adalimumab [Humera] (or etancercept, or infliximab ) TNF alpha inhibitors!!!

Front 17

check what before giving TNF alpha inhibitor

Back 17

PPD test don’t reactivate TB

Front 18

Acute vs chronic LBP

Back 18

<4 weeks, subacute 4-12, chronic >12 weeks

Front 19

When do you MRI a complaint of LBP

Back 19

Severe pain, objective weakness, progressive neurologic deficits, osteoporosis or prolonged steroid use, constitutional symptoms, history of malignancy, recent trauma, IV drug use. Failed conservative treatment for at least 3 months

Front 20

Leg pain on back extension, pain worsens with standing or walking, neurogenic claudication

Back 20

spinal stenosis

Front 21

bladder dysfunction, saddle anesthesia,

Back 21

cauda equina syndrome. Surgical emergency

Front 22

tx of spinal stenosis

Back 22

epidural steroid injections. Surgery if this fails

Front 23

Shoulder impingement syndrome vs cervical radiculopathy of C5

Back 23

inject subacromial space with cortisone to see if symptoms resolve (radiculopathy)

Front 24

cervical myelopathy 1) define 2) sx 3) tx

Back 24

1) neuro dysfxn secondary to spinal cord compression 2) gait disturbance, loss of hand dexterity, bowel and bladder late findings 3) surgery to decompress.

Front 25

anterior knee pain

Back 25

osteoarthritis, ptaellofemoral pain,

Front 26

plica syndrome

Back 26

diagnosis of exclusion, seen in athletes or overuse, MEDIAL PATELLA pain, feel of snapping with walking

Front 27

McMurray and Apley test

Back 27

valgus & varus stress tests.

Front 28

Ottawa Ankle Rules state xray is unnecessary if:

Back 28

1) patient can walk four steps at time of injury and at time of evaluation 2) no BONY tenderness over the distal 6 cm of either malleolus

Front 29

Shoulder impingement syndrome 1) caused by 2) sx 3) tx

Back 29

1) impingement of greater tuberosity on acromion leading to supraspinatus tendinitis 2) pain with overhead activity/abduction: lateral deltoid, lateral shoulder, subacromially 3) acromioplasty

Front 30

Grading ankle sprain

Back 30

1) partial rupture of ATFL 2) complete rupture ATFL & partial CFL 3) complete rupture of ATFL & CFL

Front 31

Managing ankle sprain

Back 31

PRICE: Protection, Rest, Ice, Compression, Elevation

Front 32

FINKELSTEIN'S TEST

Back 32

For dequervain's tenosenovitis (clench thumb under fingers, deviate wrist ulnarly)

Front 33

Osteoarthritis of hip vs tronchanteric bursitis

Back 33

primarily groin pain with osteoarthritis. Lateral hip pain over the greater trochanter or in buttock region is NOT osteoarthritis.

Front 34

Differential dx for hand numbness

Back 34

carpal tunnel, cervical radiculopathy peripheral neuropathy or median nerve compression in forearm

Front 35

Tinel's sign

Back 35

tap over median nerve at wrist crease, paresthesias in nerve distribution

Front 36

Phalen's test

Back 36

palmar flexion of wrist for 1 minute

Front 37

Definitive diagnosis of carpal tunnel

Back 37

electromyography and nerve conduction velocity studies

Front 38

Findings in osteoarthritis

Back 38

joint space narrowing, osteophytes, sclerosis of subchondral bony end plates adjacent to diseased cartilage, subchondral cysts.

Front 39

Tx of osteoarthritis

Back 39

avoid activities weight loss, PT, swimming. Pharmacologic: acetaminophen is FIRST LINE AGENT. Steroid injections, viscosupplementation, total joint replacement if needed.

Front 40

DEXA scan 1) start what age 2) repeat how often if normal

Back 40

1) women 65 plus (or postmenopause less than 65 with a RF) 2) every 3-5 yrs if normal

Front 41

T score 1) Normal 2) osteopenia 3) osteoporosis

Back 41

1) 1.0 or greater 2) Between -1.0 and -2.5 3) less than or equal to -2.5

Front 42

Tx of osteoporosis 1) nonpharm 2) pharm

Back 42

1) diet (calories, calcium, vit D), Wt bearing exercise 30 min 3x/w, no smoking 2) Bisphosphonates (alendronate, risedronate), PTCH, Calcitonin short term

Front 43

Primary vs secondary osteoporosis

Back 43

secondary due to an obvious cause such as excess steroids/cushings, immobilization, hyperthyroidism, long term heparin use, hypogonadism in men, vit d deficiency

Front 44

PROOF trial showed what regarding calcitonin

Back 44

no effect at hip, decreases vert fracture risk by 40%, slight lumbar vert bone density increase

Front 45

RFs for osteoporosis

Back 45

estrogen depletion, female, calcium vit d def, decreased peak bone mass, genetics, immobility, endocrine, smoking, meds