boards- msk

Reactive arthritis

"Can't see, can't pee, can't climb a tree"

Retrocalcaneal Bursitis

"pump bumps" Caused by inflammation of Achilles bursa worsened by wearing high heels

how long do you wait to get an MRI for a patient w lumbar spinal stenosis symptoms?

1 mo

approximately what percentage of patients w radiogolical findings of osteoarthritis of the knee will report having symptoms? 25% 50% 70% 95%

25%

a woman or a man >___? y.o. who has broken a bone should be tested for osteoperosis?

50 y.o.

up to what percentage of patients with medial epicondylitis recover w/ o surgery? 35% 50% 70% 95%

95%

Mrs. Garcia is a 78-year-old woman who presents with a chief complaint of progressively increasing aches, limited to her hands and fingers, particularly after doing yard work. Otherwise, she denies musculoskeletal problems. Physical examination reveals bilateral Heberden's and Bouchard's nodes. Identify the location of the Heberden's nodes

A

strain

A condition resulting from damaging a muscle or tendon

Which of the following is unlikely to be noted in Tom, a 62-year-old man with lumbar spinal stenosis? Report of back pain worsening with standing Bilateral leg numbness Pain improvement with flexed forward position Absent pedal pulses

Absent pedal pulses

Rheumatoid arthritis

Anemia of chronic disease Elevated C-reactive protein Positive antinuclear antibody titer

Systemic lupus erythematosus

Anemia of chronic disease Elevated C-reactive protein Positive antinuclear antibody titer

Ms. Hannigan is a 70-year-old woman with well-controlled hypertension, dyslipidemia, and hypothyroidism. Her current medications include a statin, ACE inhibitor, a thiazide diuretic, and levothyroxine replacement. She presents today with a chief complaint of a 2-month history of fatigue and aching sensation accompanied by morning stiffness in her hips and shoulders. During this time, she has lost 8 lb (3.6 kg) "without even trying" and reports struggling to get dressed, especially when putting on a shirt or pants. Physical exam reveals full limb strength, decreased active range of motion in the hips and shoulders, cool, smooth joints, and no excessive muscle tenderness. Laboratory test results include:Hb=10.8 g/dL (108 g/L)Hct=32% (0.32 proportion)MCV=86 fLRDW=12.2% (0.122 proportion)ESR=112 mm/h (ULN=20 mm/h) The result of her hemogram reveals: Iron deficiency anemia. Pernicious anemia. Anemia of chronic disease. Age-relative normative findings.

Anemia of chronic disease.

Patients with a Grade II ankle sprain should be advised that recovery is likely to require which of the following? Choose two that apply. Application of an air cast or splint 4 to 6 weeks of recovery Surgical intervention Many months of non-weightbearing

Application of an air cast or splint 4 to 6 weeks of recovery

A 21-year-old man presents approximately 48 hours after a non-syncopal fall on outstretched right hand (FOOSH) during a pick-up soccer game with friends. He relates that since the fall, he has pain in the anatomic snuff box region that worsens with hand grasp. Physical examination reveals tenderness in the anatomic snuff box with minimal swelling without additional abnormalities. He adds that he visited a local urgent care center immediately after the fall and reports an x-ray done there failed to reveal "any broken bones" and he was told to apply ice to the area.Choosing two that apply, your next best action is to: Apply a spica thumb splint. Refer to orthopedics. Provide a sling for the affected limb. Refer to physical therapy. Advise wearing protective gloves while playing soccer.

Apply a spica thumb splint. Refer to orthopedics.

Josh is a 14-year-old basketball player who presents with anterior knee pain that has occurred intermittently over the past 3 months. The pain worsens with squatting and walking up or down stairs, and is better with rest. He denies fever, weight loss, joint redness, or skin rash. Physical examination reveals a Tanner 3 male in no acute distress with a tender, swollen tibial tuberosity in the affected knee. Pain can be reproduced with resisted active extension and passive hyperflexion of the knee. No effusion is present. Intervention for Josh should include information about: Curtailing his participation in sporting activities. Avoiding sports that involve heavy quadriceps loading or deep knee bending. The benefit of intraarticular corticosteroid injection for the control of discomfort. The likely need for surgical correction of the defect.

Avoiding sports that involve heavy quadriceps loading or deep knee bending.

Mrs. Garcia is a 78-year-old woman who presents with a chief complaint of progressively increasing aches, limited to her hands and fingers, particularly after doing yard work. Otherwise, she denies musculoskeletal problems. Physical examination reveals bilateral Heberden's and Bouchard's nodes. Identify the location of the Bouchard's nodes

B

A person with a Grade III ankle sprain presents with: Minor swelling and minimal joint instability. Moderate joint instability without swelling or ecchymosis. Moderate swelling, mild to moderate ecchymosis, and moderate joint instability. Complete ankle instability, significant swelling, and moderate to severe ecchymosis.

Complete ankle instability, significant swelling, and moderate to severe ecchymosis.

Rotator cuff evaluation

Drop arm test

Joe is a 54-year-old man with COPD who presents with an 18-hour history of sudden-onset monoarticular pain consistent with acute gouty arthritis. He denies trauma to the area and has taken acetaminophen 1 g × 2 doses with little effect. Which of the following medications would be ineffective in treating Joe's episode of acute gouty arthritis? Intraarticular corticosteroid injection Naproxen sodium (Aleve®, Anaprox®) Febuxostat (Uloric®) Colchicine (Colcrys®)

Febuxostat (Uloric®)

De Quervain's tenosynovitis

Finkelstein test

Ms. Hannigan is a 70-year-old woman with well-controlled hypertension, dyslipidemia, and hypothyroidism. Her current medications include a statin, ACE inhibitor, a thiazide diuretic, and levothyroxine replacement. She presents today with a chief complaint of a 2-month history of fatigue and aching sensation accompanied by morning stiffness in her hips and shoulders. During this time, she has lost 8 lb (3.6 kg) "without even trying" and reports struggling to get dressed, especially when putting on a shirt or pants. Physical exam reveals full limb strength, decreased active range of motion in the hips and shoulders, cool, smooth joints, and no excessive muscle tenderness. Laboratory test results include:Hb=10.8 g/dL (108 g/L)Hct=32% (0.32 proportion)MCV=86 fLRDW=12.2% (0.122 proportion)ESR=112 mm/h (ULN=20 mm/h) The most appropriate next step in Ms. Hannigan's plan of care is: Referral to physical therapy. Rest and ice to the affected areas. Initiating a course of systemic corticosteroids. Prescribing oral low-dose bisphosphonate therapy.

Initiating a course of systemic corticosteroids.

metacarpophalangeal joint

Is the knuckle between the hand and the finger

Osteoarthritis

Joint-space narrowing on x-ray

Anterior cruciate ligament tear

Lachman test

You are evaluating Karen, a 48-year-old African American woman who is a nonsmoker and drinks 2 glasses of wine per week. She has a longstanding intermittent lumbosacral strain that she attributes in part to her work, which requires her to be physically active. Today she presents with a 2-week history of shooting pain down the right leg and occasional "dragging" of the right foot with walking. Karen denies any recent trauma or precipitating event. Examination reveals abnormal straight-leg raising, diminished right patellar reflex, and difficulty performing heel walking. She relates, "I am really uncomfortable. This is different than my usual back pain." Her presentation is most consistent with: Lumbar radiculopathy. Exacerbation of chronic lumbar-sacral strain. Vertebral compression fracture. Spondyloarthropathy.

Lumbar radiculopathy.

Meniscal tear

McMurray test

Herberden's nodes (DIP nodes)

OA

Josh is a 14-year-old basketball player who presents with anterior knee pain that has occurred intermittently over the past 3 months. The pain worsens with squatting and walking up or down stairs, and is better with rest. He denies fever, weight loss, joint redness, or skin rash. Physical examination reveals a Tanner 3 male in no acute distress with a tender, swollen tibial tuberosity in the affected knee. Pain can be reproduced with resisted active extension and passive hyperflexion of the knee. No effusion is present. Josh's presentation is most consistent with: Osgood-Schlatter disease. Prepatellar bursitis. Meniscal tear. Reactive arthritis.

Osgood-Schlatter disease.

Bouchard's nodes

Osteoarthritis (PIP)

Mrs. Garcia is a 78-year-old woman who presents with a chief complaint of progressively increasing aches, limited to her hands and fingers, particularly after doing yard work. Otherwise, she denies musculoskeletal problems. Physical examination reveals bilateral Heberden's and Bouchard's nodes. Mrs. Garcia's most likely diagnosis is: Systemic lupus erythematosus. Rheumatoid arthritis. Osteoarthritis. Reactive arthritis.

Osteoarthritis.

Ms. Hannigan is a 70-year-old woman with well-controlled hypertension, dyslipidemia, and hypothyroidism. Her current medications include a statin, ACE inhibitor, a thiazide diuretic, and levothyroxine replacement. She presents today with a chief complaint of a 2-month history of fatigue and aching sensation accompanied by morning stiffness in her hips and shoulders. During this time, she has lost 8 lb (3.6 kg) "without even trying" and reports struggling to get dressed, especially when putting on a shirt or pants. Physical exam reveals full limb strength, decreased active range of motion in the hips and shoulders, cool, smooth joints, and no excessive muscle tenderness. Laboratory test results include:Hb=10.8 g/dL (108 g/L)Hct=32% (0.32 proportion)MCV=86 fLRDW=12.2% (0.122 proportion)ESR=112 mm/h (ULN=20 mm/h) Ms. Hannigan's clinical presentation is most consistent with: Rheumatoid arthritis. Fibromyalgia. Osteoarthritis. Polymyalgia rheumatica.

Polymyalgia rheumatica.

Richard is a 28-year-old man who presents with a chief complaint of left knee pain and swelling for the past month, as well as redness and tearing in the left eye for the past week. He also has had intermittent dysuria and 2-3 loose stools per day for the past 2 weeks. He denies weight loss, skin rash, or fever. Physical exam reveals a smooth, swollen, red, warm left knee with decreased range of motion, pupils equal and reactive to light with marked unilateral conjunctival redness. The urinary meatus is reddened. Richard's clinical presentation is most consistent with: Systemic lupus erythematosus. Polymyalgia rheumatica. Reactive arthritis (Reiter's syndrome). Psoriatic arthritis.

Reactive arthritis (Reiter's syndrome).

Pegloticase (Krystexxa)

Recombinant, stabilized uricase Converts uric acid to allantoin Chronic tophaceous gout

You are counseling a 56-year-old woman who asks about increasing her dietary calcium intake with nondairy foods. You counsel about adding all of the following foods that are calcium-rich except for: Spinach. Tofu. Almonds. Red grapes.

Red grapes.

Joe is a 54-year-old man with COPD who presents with an 18-hour history of sudden-onset monoarticular pain consistent with acute gouty arthritis. He denies trauma to the area and has taken acetaminophen 1 g × 2 doses with little effect. Swelling at the third distal interphalangeal joint. Redness at the first metatarsophalangeal. Firm, white 4 mm nodular auricular lesion. Effusion in the right knee.

Redness at the first metatarsophalangeal.

You are evaluating Karen, a 48-year-old African American woman who is a nonsmoker and drinks 2 glasses of wine per week. She has a longstanding intermittent lumbosacral strain that she attributes in part to her work, which requires her to be physically active. Today she presents with a 2-week history of shooting pain down the right leg and occasional "dragging" of the right foot with walking. Karen denies any recent trauma or precipitating event. Examination reveals abnormal straight-leg raising, diminished right patellar reflex, and difficulty performing heel walking. She relates, "I am really uncomfortable. This is different than my usual back pain." Which of the following represents the most appropriate next step in Karen's plan of care? Advise a 3-day course of bedrest Refer to physical therapy Order a lumbosacral MRI Obtain a standing lumbosacral x-ray

Refer to physical therapy

Which of the following is not a potential acute gouty arthritis trigger? Use of a thiazide diuretic Consumption of organ meats Alcohol consumption Report of recently increased intake of acidic foods

Report of recently increased intake of acidic foods

Tophi

Small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric acid crystals and are a sign of gout.

Cervical nerve root compression

Spurling test

Lumbar nerve root compression

Straight-leg raising test

Ankle instability

Talar tilt

Carpal tunnel syndrome

Tinel's Sign

Richard is a 28-year-old man who presents with a chief complaint of left knee pain and swelling for the past month, as well as redness and tearing in the left eye for the past week. He also has had intermittent dysuria and 2-3 loose stools per day for the past 2 weeks. He denies weight loss, skin rash, or fever. Physical exam reveals a smooth, swollen, red, warm left knee with decreased range of motion, pupils equal and reactive to light with marked unilateral conjunctival redness. The urinary meatus is reddened. In evaluating Richard, the next most appropriate test to obtain is: Serum antinuclear antibodies. Serum rheumatoid factor. Urinary PCR testing for N. gonorrhoeae and C. trachomatis. Stool for ova and parasites.

Urinary PCR testing for N. gonorrhoeae and C. trachomatis.

Probenecid (Benemid)

Used to prevent recurrence of gouty arthritis 2. Administer with food or antacid to minimize gastric irritation. MOA: renal excretion of acid

osteoperosis

a condition in which the bones become fragile and break easily -2.5

first line pharmacological intervention for milder oa should be a trial of: acetaminophen tramadol celecoxib intr-articular corticosteroid injection

acetaminophen

the american academy of orthopedic surgeons favors all of the following in the management of symptomatic oa of the knee except: low impact aerobic exercises wt. loss for those w a bmi >/= 25 acupuncture strengthening exercises.

acupuncture

treatment of psuedogout can include all of the following except: nsaids colchicine allopurinol oral corticosteroids

allopurinol

The most helpful diagnostic test to perform during acute gouty arthritis is: A. measurement of erythrocyte sedimentation rate (ESR). B. measurement of serum uric acid. C. analysis of aspirate from the affected joint. D. joint radiography

analysis of aspirate from the affected joint.

what are 2 hypogonadal states that put people at risk for osteoporosis?

androgen insensitivity hyperpolactinemia

Neuro testing in lumbar vertebral problems: nerve root: S1 = ? reflex

ankle jerk

Secondary gout can be caused by all of the following conditions except: A. psoriasis. B. hemolytic anemia. C. bacterial cellulitis. D. renal failure.

bacterial cellulitis.

Deformity of the proximal interphalangeal (PIP) joints found in an elderly patient with OA is known as:

bouchard nodes

which of the following supplements is associated w an increased risk for gout? vit. a gingko biloba brewer's yeast glucosamine

brewer's yeast

an adverse effect associated w the use of glucosamine is: elevated alt and ast bronchospasm increased bleeding risk qt prolongation

bronchospasm

pseudogout is caused by the formation of what type of crystals in joints? uric acid ca oxalate sruvite ca pyrophosphate dihydrate

ca pyrophosphate dihydrate

wat are 2 gi disorders that put people at risk for osteoporosis?

celiac dx ibd

what are 2 genetic factors that put people at risk for osteoperosis?

cf gaucher's dx

a 72 y.o. man presents at an early stage of osteoarthritis in his left knee. he mentions that he heard about the benefits of using glucosamine and chondroitin for treating joint problems. in consulting the patient you mention all of the following except: any benefit can take at least 3 months of consistent use before observed glucosamine is not associate with any drug interactions clinical studies have consistently shown benefit of long term use of glucosamine and chondroitin for treating oa of the knee chondroitin should be used w caution because of its antiplatelet effect.

clinical studies have consistently shown benefit of long term use of glucosamine and chondroitin for treating oa of the knee

pegloticase (krystexxa) reduces serum uric acid levels by: reducing the production of urea converting uric acid to allantoin blocking conversion of urea to uric acid binding to uric acid and facilitating elimination through the GI system.

converting uric acid to allantoin

initial treatment of lateral epicondylitis includes all of the following except: rest and activity modifications corticosteroid injections topical or oral NSAIDs counterforce bracing

corticosteroid injections

what are long term meds that put people at risk for osteoporosis?

corticosteroids anticonvulsants thyroid

patients with medial and lateral epicondylitis typically present w: electric pain over median nerve reduces joint rom pain that is worst w elbow flexion decreased hand grip strength

decreased hand grip strength

spondyloarthropathy

disease of the joints of the spine

which of the following joints is most likely to be affected by osteoarthritis? wrists elbows metacarpophalangeal joint distal interphalangeal joint

distal interphalangeal joint

what are 2 endocrine disorders that put people at risk for osteoporosis?

dm adrenal insufficiency

what are 2 cns dx that put people at risk for osteoporosis?

epilepsy ms

Neuro testing in lumbar vertebral problems: nerve root: L4 = ? motor

foot dorsiflexion

Neuro testing in lumbar vertebral problems: nerve root: S1 = ? motor

foot eversion

Neuro testing in lumbar vertebral problems: nerve root: L5 = ? motor

great toe dorsiflexion

what is the recommended treatment for lumbar radiculpathy

ice rest if no resolution after 4-6 weeks specialty eval

sprain

injury to a ligament

lumbar radiculopathy (sciatica)

irritation or damage of neural structures such as disks: L4-5 L5-S1 most common sites of disk bulge sneezing/ coughing/ straining can provoke sharp pain d/t inc. pressure (also inc. spinal fluid) -radiculopathy of the lower back -commonly includes pain radiating down the leg

Neuro testing in lumbar vertebral problems: nerve root: L4 = ? relfex

knee jerk

the moa of glucosamine and chondroitin is: via increased production of synovial fluid through improved cartilage repair via inhibition of the inflammatory response in the joint largely unknown

largely unknown

Neuro testing in lumbar vertebral problems: nerve root: S1 = ? sensory

lateral foot

what is the most common reason for low back pain?

lumbar sacral strain

Neuro testing in lumbar vertebral problems: nerve root: L4 = ? sensory area

medial calf

Neuro testing in lumbar vertebral problems: nerve root: L5 = ? sensory area

medial foot

what are 2 hematological dx that put people at risk for osteoporosis?

multiple myeloma leukemia

first line therapy for treating patients w acute gouty arthritis usually includes: ASPIRIN naproxen sodium allopurinol probenecid

naproxen sodium

is decreased ROM usually correlated w bursitis?

no- pain/ redness/ swelling

Neuro testing in lumbar vertebral problems: nerve root: L5 = ? relfex

none

is imaging recommended for lumbar radiculpathy

not for 1-2 mo w conservative tx w no other concerns and then a mri (unless trying to rule in/ out vertebral facture)

risk factors for acute gouty arthritis include: obesity female gender rheumatoid arthritis joint trauma

obesity

indicate whether each medication is used for prevention (p) or treatment (t) of gout: allopurinol (aloprim)

p

psuedogout has been linked to abnormal activity of the: liver kidneys parathyroid adrenal gland

parathyroid

what are 2 rheumatological and autoimmunological dx that put people at risk for osteoporosis?

ra lupus

the most common locations for tophi are all except: auricles elbows extensor surfaces of hands shoulders

shoulders

What are non-dairy sources of calcium?

spinach sardines tofu nuts: almonds

The use of all of the following medications can trigger gout except: A. aspirin. B. statins. C. diuretics. D. niacin.

statins.

indicate whether each medication is used for prevention (p) or treatment (t) of gout: colchine

t

indicate whether each medication is used for prevention (p) or treatment (t) of gout: febuxostat (uloric)

t

osteopenia

thinner than average bone density -1.0-2.5

clinical findings of the knee in a patient w oa include all of the following except: coarse crepitus joint effusion warm joint knee often locks or pop is heard

warm joint

who should be tested for osteopetrosis regardless of risk factors?

woman > 65 men >70

differention between gout and psuedogout can involve all of the following diagnostic approaches except: analysis of minerals in the blood analysis of joint fluid xray of the affected foot measuring thyroid function

xray of the affected foot

should adults w conditions such as RA or taking meds associated w low bone mass be tested for osteoporosis?

yes

should men aged 50-69 y.o. w clinic risks for fracture be tested for osteoperosis?

yes

should women 50- 65 y.o. be tested for osteoperosis if they are postmenopausal or are in menopausal transition?

yes