CA rheum/MSK Flashcards Preview

Module 1: Mali Rheum/MSK > CA rheum/MSK > Flashcards

Flashcards in CA rheum/MSK Deck (137)
1

SHOULDER

Neer's impingement sign

press on the scapula to prevent it from moving and with one hand, raise patients arm with the other

 

compresses the greater tuberosity of humerous against acromion causing rotator cuff tendons to press against the acromion

2

SHOULDER

hawkins impingement sign

flex the shoulder and elbow to 90, internally rotate arm

compresses greater tuberosity against the acromion

3

SHOULDER

empty can test

what specific muscle does it test?

flex arm at shoulder to 90 and internall rotate so thumbs are pointing down (like emptying a can, duh)

 

have the patient resist against downward pressure on the arm

 

 tests supraspinatus muscle

4

SHOULDER

infraspinatus and teres minor test

how is this test performed?

flex at elbows 90 in front of the body with thumbs up

provide resistance against patient externally rotating

5

SHOULDER

Lift off test

what muscle does this test?

subscapularis

place arm behind back with palm facing out and lift off against restistance

6

SHOUDLER

drop-arm test

abduct the arm so it is over the head and ask the patient to slowly lower it

 

if supraspinatus is torn, then at 90* it will fall

7

ELBOW

lateral epicondylitis

feel the lateral epidcondyl of the humerus and 2 cm distal to it

apply resistance as the patient extends and soupinates their wrist

 

since the muscles that do this attach to the lateral epidcondyl, this will cause pain which can indicate inflammation

8

ELBOW

medial epicondylitis

apply resistance as the patient flexes and pronates

the flexor and pronation muscles attach here so if pain could indicate inflammation

9

WRIST

finkelsteins test

what two muscles does this specifically test?

place thumb inside of formed fist, deviate towards the ulna

stretches extensor pollics brevis and abductor pollicis longus over radial styloid

10

WRIST

tinel's sign

lightly tap over the median nerve in the carpal tunnel on the volar aspect of the wrist

aching and numbness is a positive test

11

WRISTS

phalen's sign

press dorsal aspects of the hands together to form right angles

this compresses the median nerve

numbness and tingling for 60 seconds is a positive test

12

Spine

spurlings test

passively laterally flex and extend the neck with downward compression

radiating symptoms down neck and shoulder is positive for cervical nerve impingement

13

SPINE

cervical unload

in neutral position, put one hand under the occiput and one hand under the chin and lift head

positive test is reduction where symptoms are eliminated suggesting cervical nerve inpingement

14

SPINE

cervical load

press on the top of the skull in neutral position

positive test is reproduction of symptoms indicating cervical nerve inpingement

15

SPINE

FABER TEST

make a 4 shape and press hands on ASIS and knee at the same time

positive test: pain in the SIJT

if pain is in the groin, could be hip involvement too

16

SPINE

hoffman test

flick the middle nail of middle finger and look for index and thum flexion

indicates upper motor neuron disease

(eg proximal central cord compression)

17

SPINE

waddells test

what is it and what are four benign maneuvers to stimulate pain?

SLR placing hands on heels, if no pressure than person not exhibiting true effort

 

 

benign maneuvers to stimulate pain

1. skin roll

2. twist at hips

3. head compression of 5 pounds

4. SLR, standing and seated, should cause radiating pain

18

Knee

bulge test

with leg extended place pressure on the suprapatellar pouch

apply medial pressure, and tap latterally with right hand to watch for fluid wave

 

positive test: bulge on the medial side between the patella and the femur

19

knee

balloon sign

basically: grab either side of the patella, squeeze with the left hand and look for any fluid displacement to under the right hand

20

knee

valgus stress test

flex thigh to 30*, push medially at the knee and pull laterally at the ankle

tests medial collateral lig

21

knee

varus stress test

 

tests lateral collateral lig

lateral force at knee medial force at ankle

22

knee

anterior drawer sign

tests ACL

patient lays supine, flex knee to 90*, cups hands around the knee and pull tibia forward compare with opposite knee for amount of forward motion

forward jerking motion shows positive test and suggests ACL tear!

 

NOT THE FOOTBALL PLAYERS! Fantasy sports!

23

knee

lachman's test!

ACL

place knee in 15* flexion and external rotation, pull tibia forward and push distal femur backwards at the same time, suggests ACL tear

24

knee

posterior knee test

PCL

patient supine knee at 90, push back on the tibia

 

25

knee

McMurray test

flex knee holding knee and foot

then...

externally rotate: stresses medial meniscus

interally rotate: stresses lateral meniscus

in click is felt or heard or pain at the joint line then this is suggestive of a meniscus tear

26

foot and ankle

Thompson's test

with patient lying prone (on stomache) with feet hanging off table

squeeze the calf of affected side

test is positive if foot remails in the neutral position or there is minimal plantar flexion

 

aka, it doesn't move!

27

ottowa ankle and foot rules

what are the 3 locations that warrent a xray film?

malleolar zone:

posterior edge 6cm

 

Midfoot zone:

tendernous at base of 5th metatarsal

navicular bone

28

flexor tenosynovitis-Kanavel criteria

tenderness along the course of flexor tendon

fusiform symmetrical swelling of finger

flexed posture of finger

29

dequervain's disease

-tenosynovitis

-repetitive strain injury

-decreased grip strength, pain on radial surface that increases with thumb or ulnar deviation

Finkelstein's test

30

carpel tunnel syndrome

median neuropathy from compression of the flexor retinaculum

tinel test

nerve conduction or velocity test

31

scaphoid fracture

fall on outstretched hand

pain at anatomical snuffbox

immobalize the thumb 6-12 weeks

complication: osteonecrosis since has minimal blood supply

start with Xray, go to MRI if necrosis is suspected

32

spinal epidural abscess

also, what are four risk factors?

what are three major indications?

what must you cover for when treating?

classic triad: back pain, fevers, neurologic defects

must cover for methylcillin resistant staph aureus

RF: immunosuppression, renal failure, IV drug abuse, ETOH

33

cauda equina syndrome

compression of the nerves at the end of the spinal cord within the canal

back pain

urinary retention, incontinence of bladded/bowel

numbness or tingling in buttocks, lower extremities

EMERGENCY!! usually requires surgical decompression

34

what are the symptoms associated with cauda equina syndrome?

motor and sensory loss

hyperactive reflexes

saddled anesthesia pattern

confirm with CT/MRI

35

development dysplasia

congenital dyplasia of the hip

shallow socket, so femor can slip out

exam: leg length discrepancy, outward rotation, folds on buttock skin uneven

wider space between legs

galeazi sign, ortolani test, barlows test

36

what is this test and what is it used to diagnose?

 (assuming somone was holding the legs)

ortolini's test (this is on porth 1103)

developmental dysplasia where the hip socket is shallow and the femor can slip out

37

avascular necrosis

where does the pain present? where is it most common? and what are 3 risk factors?

most common in femur head

RF: chronic ETOH, corticosteroid use, sickle cell

can be a complication from dislocation or fracture

painful hip, buttock, thigh or knee in setting with no trauma

38

legg-calve-perthes disease

avascular necrosis of the femoral head usually seen in young children

early hip pain with limp

unilateral in 85%

39

slipped capital femoral epiphysis (SCFE)

what type of fracture do you see? how is the femor head displaced? what age and what type of child? what type of measurement are you looking for on a xray?

 

salter-harris type 1 fracture on femoral capital epiphysis

posterior and inferior displacement of head of femor

common in children >10 years old

mildly obese kids with hip pain and limp

URGENT ORTHOPEDIC EVAL

klein line

40

meniscus tear

what are the two common feelings you can have with this? where do you find tenderness? what two tests do you want to do to help diagnose this? what image testing do you want to do for this? is it an emergency?

nagging non specific pain medial or lateral

can lock up which is orthopedic emergency

"giving away" is URGENT

fullness behind the knee

joint line tendernous

Mcmurray test and Apley's comrpession test

MRI: check for joint space, if no space then there is a tear

41

patellofemoral pain syndrome

most common cause of knee pain

anterior pain made worse with climbing, kneeling, jumping or sittitng

Exam: patellar crepitus possible

Tx: strengthen

42

patellofemoral instability

which way does the patella usually deviate? why?

displacement usually laterally of the patella

AP, lateral, tunnel, and axial (sunrise) views

if untreated may lead to quadriceps weakness and patellar arthrosis

43

chondromalacia patella

achy knee pain, "stiffness"

Exam: place hand on patella, flex and extend knee to observe crepitus

44

dislocated knee

one of the few true orthopedic emergencies

limb threatening 2* to vascular comprimise

45

Osgood Schlatter Disease

rupture of the growth plate at the tibial tuberosity

stresses the patellar tendon

rapidly growing adolescents

 

46

osteochondritis Dissecans

what is this common from? where does this happen the most? when does this start and become symptomatic?

repetitive stress

most common, medial femoral condyle

starts in childhood may not become symptomatic till adolescene or adulthood

surgery or nonweightbearing treatment

is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hinder joint motion

47

osteosarcoma

solitary lesions

"starburst" or "sunburst" on xray

appear in long bones of children, most commonly distal femur, proximal tibia, and proximal humerus

bimodal age

1st-early adolescence

2nd- 6th decade

48

anterior curciate ligament tear (ACL)

most common sports injury

postive drawer test, lachman (be careful because there can be a lot of fluid that makes this difficult to see)

MRI is diagnostic

49

achilles rupture

what test? what two things increase the risk of this happening?

common men 30-50

sport related usually

risk goes up with chronic corticosteroid and fluoroquinolones

testing: Thompson's squeeze, squeeze the back of the calf should get plantar flexion

50

ankle injury

what are the most common types (percentages) ? what is the most commonly injured ligament?

inversion is most common 90%

only 10% eversion

most common injured ligament is: anterior talofibular

follow Ottawa rules for xray.

51

explain the grading for ligament injury

1: stretch

2. Partial tear

3. complete disruption of ligament

52

Ottawa Ankle rules

What are the two regions of the foot that are concerning? what needs to be present in each of these regions for a xray to be indicated? (3 things in each region)

malleolar zone and midfoot zone

53

ankle fracture

HERES SOME PICS!

54

ankle dislocation

what do you want to do ASAP? what 3 things should you be concerned about?

severe fractures can cause dislocations

reduce ASAP

be concerned about neuro, sensory, vascular

55

what do you always want to do with a traumatic fracture or dislocation of the ankle?

always xray top of fibula with traumatic fracture or ankle dislocation

check for: maisonneuve fracture

56

foot fractures

 

given anatomy, fractures can easily hide and allow for ambulation

get xray!! stress fractures may not show up early so whole fracture is missed

57

what is a jones fracture?

fracture of proximal 5th metatarsal, common in athletes

comes from inversion

58

hallux valgus

"bunion"

lateral deviation of big toe

59

mortons neuroma

most common neuroma of the foot

between third and fourth toes

burning or sharp stabbing, worse with ambulation, tight shoes

 

TX: steroid injection, roomier shoes, surgery

60

Hammer toe

what happens in this? what is the most common cause?

toe deviates

distal portion goes down, middle hunches upwards

2nd toe most common

most common cause, poorly fitting shoes, high heels with narrow toe boxes

61

what is there always for a focused visit? what doesn't it include?

chief complaint and HPI

rarely includes ALL subjective and objective components (unless for billing)

62

where are you likely to see focused visits?

urgent care

ed

clinic visits

hospital rounding

63

what two factors do documentation influence?

qualitiy of care

reimbursement

64

what are 3 things the effect the reimbursement?

1. new or established patient

2. time required for evaluation

3. complexity of the visit

65

what are problem focused visits?

presenting problem are self limiting

~10 mins for visit

low complexity of medical decision

 

 

aka plantar wart

66

what are the characteristics of a expanded, detailed visti?

presentation are low to moderately severe

provider spends 20-30 mins

low to moderate complexity

 

ex pneumonia

67

what are the characteristics of a comprehensive visit?

presentation is moderate to severe

45-60 mins

high complexity of medical decision making

 

CF with biabetes with pneumonia, etc

68

what is a tip about the buinsness of medicine?

observe preceptors documentation technique from start to finish

69

what do you need to include for the subjective portion of a focused visit?

some but not all,

only stuff that is relevant to chief complaint

70

what are the 6 things that need to be included in the first sentence of HPI

name

age

race/ethnicity

sex

present/absence or pertinent pos/neg

presenting symptoms

71

how does the HPI relate to the CC?

amplifies chief complaint, describes how symptoms developed

can pull in pertinent pos/neg from ROS

72

what does the OPQRST pneumonic stand for HPI?

onset

pallidating and provoking

quality of pain

radiation

severity of pain

timing

associated things

73

what should be included in the past medical history?

medical (always psych and obstetric)

surigcal

hospitalizations

74

what are 3 things you want to include as part of the health maitenance portion?

immunizations

screenings

advance directives

75

what are two things you always want to do even in a focused visit?

 

cardiac and respiratory

76

what should guide your focused visit?

differential diagnosis

77

where do the laboratory and dianostic tests fit on the SOAP note?

last part of objective portion before A and P

78

pimary assesment

related to chief complaint

79

secondary assesment

related to chronic disease or new disease that was secondarily discovered during disease

80

what are 5 things you want to make sure you do during your focused visit to inolve patient?

1. share impression

2. address any concerns

3. make sure she agrees to steps ahead

4. provide written information

5. include health promotion and disease prevention

81

what 3 things does a successful plan take into consideration?

patients goal/ preference

economic means

family structure/dynamics

82

explain tendinitis

1. what does it mean?

2. what signs would be present

3. what is the treatment?

literally means "inflammation of the tendon"

all the normal signs seen with inflammation, red, hot swollen, painful

treatment: RICE NSAIDS

83

explain what tendinosis is? how is it different than tendonitis?

describes long term pathophysiology of tendons

under a microscope see "bowl of spaghetti" rather than "box of spaghetti" like in tendonitis

this is what happens after the inflammatory process passes, so if someone has long term tendonitis, it is more likely it has become tendonosis

not warm or red like tendonitis, but decreased ROM and strength

Treatment: PT with eccentric exercises, which strengthen and stretch tendon

84

calcific tendonitis

what is deposited in the joint? what symptoms are typically present? what imagine do you want to do to diagnose this? what are 4 treatment options?

tendons develop calcium deposits, commonly in rotator cuff

early on causes pain and mechanical symtpms or blockage, similiar symtpms to impingement or tendonitis

 

Dx: xray or MRI, see a little piece of bone floating in the joint, generally self limiting

TX: PT, dry needling, shock therapy wave to break it down, surgical removal

85

bicipital tendonitis

what tendon is involved here? what two motions will the patient have a difficult time performing?

tendonitis along the long head of the bicep tendon

painful when flexing the shoulder or the elbow

runs through the tubercles on the head of the humerus

86

acromioclavicular arthritis

what joint degrades here? what is it caused by? what syndrome can this lead to? what image study do you want to do? what is the treatment?

degeneration of the acromioclavicular joint

osteoarthritis

can lead to impingement syndrome because arthritis will narrow the subacromial space

decrease shoulder ROM, pain

 

Xray: will see degredation

Tx: RICE, NSAIDs, can also do surgery to clean out the mess

87

thenar atrophy

what is this commonly associated with?

thenar eminence atrophy

seen with carpal syndrome

need to treat carpal syndrome

88

felon finger

infection of the finger tip possibly due to splinter or cut

most common: staph aureus

 

89

ganglion

what is this? where does it commonly develop? what is the really stange thing people used to do to get rid of it? what do they do now with it?

cyst that develops randomly

often seen on the back of the wrist

used to treat with "bible therapy"....have person put their hand face down on the table and smash the cyst

aspiration or surgical removal if symptomatic

90

legg-calve-perthes disease

congenital problem of the hips in childhood

bloos supply to femoral head is disrupted and it begins to misform as a result of necrosis

91

chondromalacia patellae

what happens in this? what does this feel like? what are your two treatment options?

sandpapery wear and tear of the cartilage on the back of the patella

presents like patellofemoral pain

"grinding" feeling

 

TX: PT or surgery to clean out damaged cartilage

92

osteochrondritis desiccans

joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hinder joint motion. Osteochondritis dissecans occurs most often in children and adolescents

-most common in the knee but can occure in other joints as well

 

-PT and surgery for treatment

93

Lis Franc Fracture

where does this fracture take place? where does this most commonly take place within that region? how does this injury occur? what is important to do when getting an xray?!

fracture of the mid-foot

needs to be splinted in walking boot or casted

commonly first and second metatarsal and nacicular

forced plantar flexion "like riding a horse and you fall off and your foot gets stuck in the stirrup, or football player tackled in plantar flexion"

need to get a non weight bearing and weight bearing xray to see how the bones change between the two

94

Jones fracture

 

where does this injury occur? why is this injury improtant? what motion does this injury commonly occur with? imaging options?

acute or stress fracture at the base of the 5th metarsal, often seen with inversion of the ankle

important because of the blood supply, they don't heal well so you want to want to identify early to prevent necrosis

 

 

1st: xray

2nd: MRI if xray is negative and high clinical suspiscion

95

when do you use a volar splint? (4 things)

wrist sprains/strains

carpal tunnel

lacerations

night slints

96

what are the four splinting wetting techniques?

1. water bottle

2. open sling cover technique (peel back one side of backing to get the water in)

3. water bottle/faucet technique (put under running water and then ring)

4. dipping in bucket technique (immerse in water ring out excess water)

97

what would you use to look at someone's appendix?

ultrasound

98

radiodensitiy

physical qualities of an object that determines how much radiation it absorbs from the X-Ray beam

 

determined by composition and thickness

99

radiopaque

Does not permit the passage of x-rays.  Representative areas appear light or white on the x-ray film.  Usually the property of denser materials, such as bone.

100

radiolucent

darker gray but not white or black

Permits the passage of x-rays while offering some resistance (depending on the density of the material).  Representative areas are dark on exposed film, such as air.

101

on an xray how would you expect these to appeare:

gas:

soft tissue (fat):

water (organs/blood):

bone:

metal/barium:

102

what acronym should you use when looking at the different densities on a xray?

how do the boarders apear if the densities are similar or different?

BIL

B=boarder

I=interface

L=line

 

if there is a sharp contrast between densities, you will see crisp line

if they are similar than the board will be fuzzy

103

if closer to the film you use _____ and get ____ image

if closer to the film you use less magnification and get sharper image

104

if farther from the film you use _____ and get ____ image

if farther from the film you use more magnification and get fuzzier image

105

to tell the different between a AP and PA....

look at the heart!!

106

what view is this?

sunrise view

107

what view is this?

lordoctic view

108

what view is this?

water's view

109

shape distortion can happen with what?

unequal magnification

110

mammogram, Dexa, and fluoroscopt are types of what imaging?

xray

111

Dexa scan is a screening for...

bone densitiy aka osteoporosis

bone absorbes the xray, determines the density

112

what are the reading for a dexa scane?

<1 is normal

1-2.5 osteopenia

<2.5 osteoporosis

113

Xray: fluroscopy

what does this testing allow you to do? what are two examples?

continuous beam passes through the patient and allows you to see what they are doing in real time

 

swallow studies, heart angiograms

114

computerized tomography (CT-Scan)

focused radiographic images for one slice of the patient

10-90 seconds

need to know the relative densities between organs to interpret

view from the FEET UP, making the left on the right!

115

how many times more is a chest CT than a xray!?!

 

100-400X xray dose greater!!!

WOW

116

what can metal cause on a CT scan?

artifact!!

117

what is the benefit of a reformatted CT?

YOU GET 3D IMAGE! formatted in multiple planes

 

 

 

ex: CT angiogram (tell because it is colored and looks generated)

118

magnetic resonance imaging

how do they work and what do you use?

Uses powerful magnets

Imaging of H+ atoms in fat and water

H+ align in magnetic field, pulsed waves of scanning knock the atoms out of alignment.

H+ atoms emit radiofrequency waves which produce the image during re-alignment (relaxation time)

119

On MRI

High signal strength items appear_____

Low signal strength items appear_____

High signal strength items appear white

Low signal strength items appear dark (blood and bone)

 

signal strength refers the H+ atom ability to move, so if more dense they don't move and you get darker color.

120

what is the name of the contrast you use in MRI? If indicated, what must you check for the patient?

gadolidium

KIDNEY FUNCTION!!

121

in T1 weighted images on MRI, fats appeare___

bright

122

in T2 weighted images on MRI, inflammation, tumors, and fluids appear_____

bright

123

When should you not use a MRI? what two things are ok to use?

metal or programmable things like pacemaker, icd

if the patient can't lay still for 35-45 mins

can use with titanium and stainless steel

124

explain how sound waves are used in Ultrasound?

hyperechoic/echoic if solid: they bounch back creating a light image

hypoechoic/hypoechoic if fluid filled: light passes through, produces dark image

 

 

ex: normal tissue vs fluid filled

125

radioisotope (nuclear) scanning

nuclear isotope is attached to a normal compound used in organ metabolism so it lights up

usually two part study

126

technetium 99

radioactive isotop used in radioactive scanning

half life 6 hours useful use in thyroid scanning, pulmonary scans, and bone scans

127

thallium 201

radioactive isoptope used in radioactive scans

half life 73 hours for myocardial blood flow

128

conventional arteriogram

Small tipped catheter advanced under fluoroscopy into an artery (usually the femoral)

take xrays to see the vessels

129

digital subtraction angiography

same as conventional but digitally saved so you can subract parts

130

chromatography angiogram

Patient injected with bolus of contrast material to opacify the blood vessels while CT is performed

BVs and bone are white, and bones can be subtracted out with 3D reconstruction

131

magnetic resonance angiogram

Stack of contiguous MR images converted into 3D vascular images

Safer for patients in renal failure, but contrast can enhance images

132

image? view? whats it mean?

xray

lateral

sail sign=radial head fracture

133

salter harris frature classification

134

image? view? what is it?

xray

AP view

cresant sign on femoral head means avascular necrosis

135

imagine? view? weight? what does it show?

MRI

saggital

T1 weight since not as bright as T2 would look

compression fracture

136

image? view? what is this?

CT

axial

liver metasticist

 

*don't forget looking from patients feet up!*

137

image? what does it show?

MRA (since reconstructed and 3D)

shows artery stenosis (narrowing)!