have a disease - ortho
In order to diagnose a ruptured Achilles tendon, what test would you perform? A) Thompson's Test B) Rhomberg Test C) McMurray's Test D) Thessaly's Test
a
-?will present with stiffness and decreased active and passive range of motion -Three phases to ?: Freezing phase = painful stiffness Frozen phase = stiffness Thawing phase = ROM improves -Avoid immobilization with ?
adhesive capsulitis
-Majority of patients suffering from an ?are young and active adults - Patient will complain specifically of pain of the superior part of the shoulder and may also have restricted shoulder mobility -The most common mechanism for an ?injury is a fall directly onto the acromion -A ? is diagnosed through history, physical exam, and an X-ray (with a minimum of 2 radiographic views)
AC separation
-Rates of ? are substantially higher in women -Meniscal Tears (usually Lateral Meniscus) are associated with ~50% of ? -Patients will typically report that their knee "gave out" or hearing a "pop"
ACL tear
-? occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers 1-3 and half of 4th digit. - Women are three times more likely than men to develop ?, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. -Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay.
CTS
-? is primarily a medium and small vessel disease most commonly affecting the GI tract but can also affect the kidneys, nerves, skin, heart, eye, and genitals. -The American College of Rheumatology requires 3 of 10criteria to be met for a diagnosis of ? -Immunosuppressive drugs such as cyclophosphamide and corticosteroids such as prednisone are the mainstay of treatment for ?
PAN
- ? can mimic RA and other connective tissue diseases and so need laboratory testing to differentiate the disease: Antinuclear antibodies (ANA) and anti-double stranded (ds) DNA , anti-smith antibodies, CMP (creatinine), ESR (inflammation), CBC - ? arthralgia or arthritis typically target the fingers, hands, wrists, knees Knowing the diagnostic criteria is helpful in recognizing SLE symptoms; practice the mnemonic SOAP BRAIN MD
SLE
.What type of fracture describes the most common type of distal radial fracture that is most likely secondary to a fall on an out-stretched hand with a pronated forearm in dorsiflexion when one tries to break a forward fall. a. Colles' fracture Barton's fracture Chauffeur's fracture Ulnar styloid process fracture Greenstick fracture
a
1. The control areas to palpate for the trigger points in fibromyalgia are: a. mid forehead and anterior thigh b. fingers and toes c. teeth and ear lobes d. deltoid and dorsum of foot
a
1. The scaphoid bone is located: A. Proximal row of wrist bones, radial side B. Proximal row of wrist bones, ulnar side C. Distal row of wrist bones, radial side D. Distal row of wrist bones, ulnar side
a
1. What is the new name of Pseudogout? a. CPPD - Calcium Pyrophosphate Deposition b. Faker Gout c. False Gout d. Faux Gout
a
2. Patients with a scaphoid fracture may present with: A. Snuffbox tenderness B. Swelling C. Reduced ROM D. All of the above
a
2. Systemic lupus erythematous is an autoimmune reaction involving which cells? a. B cells b. TNF alpha c. T cells d. Macrophages
a
2. The best FIRST imaging study for a patient suspected to have gamekeeper's thumb is: A. Plain 3-view radiograph of the thumb B. Ultrasound C. MRI D. CT E. TEE with bubble
a
2. What two tests are typically performed to diagnose pseudogout? a. Synovial fluid aspiration and X ray b. MRI and CT c. DEXA and Bod Pod Bodyfat measurement d. Weber and Rinne
a
2: Osgood-Schlatters Disease is caused by: A. repetitive quadriceps contraction which pulls on the patellar tendon where it inserts on the tibial tubercle B. Falling down the stairs and spraining an ankle C. Lifting heavy objects and injuring the muscles in the lower back D. Tight hip flexors pulling on the muscles of the lower back E. None of the above
a
3. A positive test may indicate De Quervain tenosynovitis A. Finkelstein B. Tinel C. Chandelier D. Pickle jar
a
3. In what age group is this disease more prevalent. a. Over 50 b. 20-30 c. 0-5 d. 10-11
a
3. Septic Arthritis presents in which of the following ways A. Red, warm, swollen and painful B. Tender but not swollen C. Normal and usually found incidentally D. None of the above
a
3. What classic triad of symptoms is most suggestive of systemic lupus erythematous? a. Fever, joint pain, malar rash Urethritis, conjunctivitis, arthritis Neurologic, incontinence, ataxia Fever, RUQ, jaundice Hypercoagulability, stasis, endothelial injury
a
3.) Subacromial bursitis causes pain at rest and with movement, it may be felt in the deltoid muscle and the pain is between the acromion bone and the top of the humerus. It is often associated with the following condition: A.) supraspinatus tendinitis B.) Scapulothoracic bursitis C.) Anserine bursitis D.) None of the above
a
A 25 yr old UPS deliveryman presents with a 2 day history of lower back pain, which began while he was lifting boxes at work. He describes as unilateral, sharp, intense and does not radiate. He has not been able to do his delivery routes due to the pain. He denies fever as well as urinary & bladder incontinence. The diagnosis is most likely: Low back strain Cauda equina syndrome Pancreatic cancer Spinal stenosis
a
A 45 years old woman comes into your office complaining of stiffness and pain in her shoulder. You suspect that she is in the freezing phase of adhesive capsulitis. What would be the best coarse of treatment for her? NSAID, ice and heat alternative and physical therapy when she can tolerate it Consultation to an orthopaedic surgeon Anticoagulant for 3 weeks Hospitalize and surgical correction
a
A 70-year-old postmenopausal woman with a 30-pack-year smoking history presents for a routine office visit. You notice a kyphotic posture on physical exam and order AP and lateral spine radiographs. Because you are a maximal PA you are quickly able to recognize the classic ____________ on the lateral radiograph which is consistent with a diagnosis of compression fracture. a. Wedging of the anterior vertebral body b."Winking owl" sign c.Fracture line d.None of the above are correct
a
A nursemaid's elbow is a. subluxation of the radial head out of the annular ligament. b. a fracture of the radial head. c. rupture of the medial collateral ligament of the elbow. d. entrapment of the ulnar nerve at the medial epicondyle.
a
All of the following may be used to treat shoulder impingement syndrome EXCEPT: a. Use of a sling to prevent overhead movement b. Subacromial steroid injections c. Ibuprofen d. Physical therapy e. All of the above
a
Aside from injury, one of the most common causes of AVN is the: a. use of corticosteroid medications such as prednisone. b. Increased use of NSAIDs c. Lung cancer d. Multiple sclerosis
a
Because evidence of osteomyelitis typically takes greater than 2 weeks to appear on x-rays, which imaging modality would be better at finding evidence of osteomyelitis earlier on in the course of the disease? MRI Bone scan Wait 2 weeks before getting any imaging Imaging is not beneficial in diagnosing osteomyelitis
a
Diagnosis and treatment for nursemaid's elbow consists of a a. History, PE, A/P, M/L & oblique radiographs, reduction/splinting b. History, PE, MRI and long-term casting c. History, PE, no imaging, and reduction and splinting d. History, MRI/CT scan, and reduction and splinting
a
Garth Brooks presents to your office for care, complaining that he is having trouble holding up his golden guitar, climbing the stairs up from the Low Places where his friends reside, and recently, is noticing it's getting significantly more physically difficult for him to sing. When you ask him to stand up from the chair he's sitting in, he finds it very difficult, and not just because of the spurs on his rattlesnake boots. What should you do? a. Give him some corticosteroids - sounds like polymyositis b. Give him a copy of "Sweating to the Oldies-" probably too many Texas fried steaks c. Give him a referral to neuro - it's probably Guillain Barré d. Give him a full workup - sounds like late stage scleroderma
a
Kanye West is diagnosed with polymyositis, as he is no longer able to pick up what other rappers are laying down. Knowing the etiology of polymyositis, you think it's best to also screen him for the following: a. Other autoimmune diseases b. Other polyneuropathies incited by viral infections c. Other x-linked genetic diseases d. Depression, since it's now apparent Jay Z is the best rapper alive
a
Mrs. SS is a 48 y/o professional guitar player who is currently on tour. She presented to the clinic today with sharp pain at the base of her fingers on her right hand (she is right handed). Whenever she bends them they get stuck and make a loud "pop" when they are straightened back out. What condition does she most likely have? Trigger Finger Gouty Arthritis Osteoarthritis Rheumatoid Arthritis
a
Scleroderma involves which organ the most? a. Skin b. Bone c. Heart d. Kidneys
a
Standard imaging for Charcot foot should include: X-Ray PET scan DEXA scan Ultra sound
a
Symptoms of Avascular Necrosis of the hip include: a. Pain that is localized to the groin area b. Pain that is localized to the outer thick area c. Pain that radiates to the ankle d. None of the above
a
The most common complaint of those who have suffered an acromioclavicular joint separation is: a. Pain at the superior part of the shoulder and limited range of motion b. Stabbing pains that start at the shoulder and radiate to the scapula c. Complete loss of shoulder movement and the worst pain ever imagined d. No pain and just muscle tightness in the shoulder and neck
a
Treatment for acromioclavicular joint separation will likely include: a. Arm sling, ice, NSAIDS, physical therapy referral b. A cast, narcotics, muscle relaxers, NSAIDS c. Emergency surgery and a long road to recovery d. No treatment is necessary, rest and limited the use of the shoulder will allow for healing
a
What is a Carpal Tunnel Release Procedure? A) An arthroscopic surgery that involves severing the band of tissue around the wrist to reduce pressure on the median nerve. B) Wearing a splint to release the pressure on wrist C) Muscle Relaxers D) Massaging the muscles of the hand, wrist, and forearm until the pain goes away.
a
What is a surgical emergency that can happen from having Spinal Stenosis? Cauda Equina Sciatic nerve pain Numb foot Radicular arthropathy pain syndrome
a
What is polymyalgia rheumatica? a. A chronic inflammatory disease that causes muscle weakness, pain, and stiffness in proximal muscles b. A chronic inflammatory disease that typically affects small joints and classically spares the DIP joints. c. A neurological disorder that causes gait disturbances and radiating pain. d. A rheumatologic disorder that occurs after a Strep infection.
a
What is the best treatment for cauda equina syndrome? a. Surgical decompression b. Do nothing it will resolve on its own c. Preform a lumbar tap
a
What is the main underlying cause of pes anserine bursitis? a. Tight hamstrings b. Tight quadriceps c. Tight gastrocnemius d. Tight iliopsoas
a
What is the most common tumor of the wrist and hand? Ganglion Cyst Baker's cyst Tumor of metastatic breast cancer Warts
a
What is the pathophysiology of a herniated nucleus pulposus? A gradual deterioration of these intervertebral discs over time as part of the natural aging process Swelling of a disc caused by an autoimmune inflammatory process Trauma accidents severing the spinal cord None of the above
a
What is the treatment of choice for a herniated nucleus pulposus? Conservative treatment with analgesics and physical therapy Surgery ASAP Biopsy of infected nerve root Bed rest for 4-6 weeks
a
What kind of crystals are found in the synovial fluid of gout patients? Monosodium urate monohydrate Carbonic acid Calcium pyrophosphate Iron
a
What nerve is commonly affected in carpal tunnel syndrome and what are the associated digits that are affected generally? A) Median Nerve - affecting digits 1-4 B) Ulnar Nerve - affecting digits 1-4 C) Radial Nerve - affecting digits 1-2 D) Median Nerve - affecting digits 1 and 5.
a
Which genetic test is found in 90% of patients with AS? a. HLA-B27 G6PD CFTR TPMT
a
Which joints are typically affected by systemic lupus erythematous? a. Fingers, hands, wrists, knee b. Anything but the elbows, ankle, and 1-4 MCP c. Anything but the DIP d. Typically the hip and knee e. Femur, tibia, humerus
a
Which of the following is an important risk factor for development of osteosarcoma? Paget's Disease Vitamin D deficiency Lactose Intolerance Osteoporosis
a
Which of these patients is more likely to have an Achilles tendon rupture? A) 35 y/o male marathon runner B) 22 y/o female cyclist C) 65 y/o male swimmer D) 14 y/o female gymnast
a
You see a chart that has a problem list with Spinal Stenosis as a diagnosis, what can you guess is the patient's age: 75 y/o 7 y/o 25 y/o 6 m/o
a
f a patient has pain that is exacerbated by standing/walking and relieved by sitting or lying down, they might have the following: Spinal Stenosis Cervical spine claudication Sciatic nerve palsy Systemic Lupus
a
---- typically occurs in middle-aged males who are athletes, especially runners.1,2,3 Use the Thompson's Test for diagnosis of a ruptured ----. 6 If your patient describes feeling a pop or snap or the sensation of being struck on the posterior leg with associated onset of pain, suspect an ----.
achilles tendon
-The lateral stabilizing ligaments of the ankle, which include the anterior talofibular, calcaneofibular and posterior talofibular ligaments, are most often damaged.1,7 -The anterior drawer test determines the integrity of anterior talofibular ligament1,7; the talar tilt test or inversion stress test determines the integrity of cacaneofibular ligament1,7 -Treatment of an acute ankle sprain includes RICE therapy: RICE therapy: R - rest, I - ice, C - compression, E - elevation1,6 Ottawa Ankle and Foot Rules are highly accurate for ruling out fractures of ankle and mid-foot and reduce unnecessary radiography.
ankle aprain
-?typically presents with back pain, morning stiffness that is improved with exercise. -Diagnostically pelvis, c-spine, t-spine and l-spine XRAYs as well as an HLA-B27 tests are indicated. -Treatment approach includes physical therapy, NSAID's, intra-articular corticosteroid injections, disease-modifying antirheumatic drugs and tumor necrosis factor-alpha inhibitors.
ankylosing spondylitis
-If not remedied in time, ? can lead to eventual collapse of bone structure. -? is seen in children and young adults as the result of injuries and various genetic bone disorders, and it may occur later in life as the result of abuse of drugs (i.e. corticosteroids and alcohol) and secondary to chronic diseases (i.e. systemic lupus) that affect the vascular system. -Surgical replacement of the femoral head is the primary therapy. -MRI is the most sensitive and specific means of diagnosing ?
avn of hip
1) The most common cause(s) of olecranon bursitis is/are: A) Falls B) Repetitive microtrauma/Overuse C) Infectious D) Complication due to Diabetes E) None of the above
b
1. What is/are the most common joints to be affected by individuals with septic arthritis? A. Small joints such as fingers and toes B. Large joint such as knees and hips. C. Any joint because it is an infection within the bloodstream so it is non-specific. D. None, it only affects the bones not the joints.
b
1. Which of the following joints are not affected by rheumatoid arthritis?2 a. MCP joints b. DIP joints c. Hip joints d. PIP joints e. MTP joints
b
2. First line treatment for plantar fasciitis includes all of the following EXCEPT a. Steroid injections b. Open surgical plantar fascia release c. Stretching regimen d. Orthotic inserts or silicone heel cups
b
2. Which clinical presentation is NOT consistent with fibromyalgia? a. Sleep disorders b. Fever c. Fatigue d. Stiffness
b
3. If initial radiographs do not show fracture, follow-up imaging should be occur: A. in 3 days B. in 7-14 days C. in 1 month D. follow-up imaging is not required
b
3: The age group most commonly affected by Osgood-Schlatters Disease is A. 5-10 B. 10-15 C. 18-23 D. 55-60 E. all age groups
b
A 16 year old male presents to your primary care office with sudden-onset, severe pain in the area of his distal femur. He denies any recent injury. What primary bone tumor do you most strongly suspect? Chondrosarcoma Osteosarcoma Multiple Myeloma Osteoma
b
A boxer's fracture is a fracture of the... a. Subluxation of the 5th carpal bone b. A fracture of the 5th metacarpal neck c. Rupture of the medial collateral ligament of the elbow. d. Entrapment of the
b
Along with excessively dry eyes and mouth, what other physical finding might you expect to see in a patient with Sjögren syndrome? Moist skin with sufficient turgor Bilateral parotitis Gottron's papules A fixed, dilated right pupil
b
Boxer's fracture can occur from... a. Hugging a boxer with excessive force b. Punching a hard object with a clenched fist c. Rough play or wrestling d. Attempting to put on boxers (briefs are much better) e. All of the above
b
Charcot foot is initially treated by: Trepanation to let out the bad spirits Joint immobilization Emergency amputation Administering leaches
b
Clubfoot is twice as common in what population? a. Girls b. Boys c. The elderly d. Middle aged women
b
Ganglion cysts MOST commonly occur on the: Palmar surface of MCPs Dorsal wrist Posterior shoulder Popliteal fossa behind the knee
b
Gout presents with what classic set of symtoms? Nausea, vomiting, diarrhea, loss of appetite Pain, swelling, and erythema of a single joint Fever, swelling, and erythema of bilateral joints Swelling, fever, and pain of entire limbs
b
Plantar fasciitis... a. Is an acute rupture of the plantar fascia b. Has a gradual onset, usually as a result of increasing level of activity or change in footwear c. Is a local infection of the plantar fascia d. Is a genetic condition associated with several other seronegative spondyloarthropathies
b
What is one major difference in Adhesive capsulitis and rotator cuff teat? Adhesive capsulitis presents with limb weakness Adhesive capsulitis presents with stiffness Rotator cuff tears presents with stiffness Rotator cuff tears presents with SOB
b
What is the most common causative organism seen in hematogenous osteomyelitis? Escherichia coli Staphylococcus aureus Proteus sp. Pseudomonas sp.
b
What is the most common location for biceps tendon rupture? a. Short head of the biceps b. Long head of the biceps c. Distally at the insertion at the radial tuberosity d. All of the above are equally common
b
What is the most common location for biceps tendon rupture? a. Short head of the biceps b. Long head of the biceps c. Distally at the insertion at the radial tuberosity d. All of the above are equally common
b
What is the second most common upper extremity compression neuropathy? A. Carpal Tunnel Syndrome B. Cubital Tunnel Syndrome C. Epicondyle Hypertrophy Syndrome D. Scaphoid Palsy Syndrome
b
What is the treatment for biceps tendon rupture? a. Steroid injections b. Surgical repair or conservative treatment depending on the patient and the degree of injury c. Acetaminophen d. Time is the only treatment
b
When conducting a neurovascular assessment on a patient with a suspected radial head fracture, what motor findings would you expect to see if the median nerve is damaged?3 a. Inability to abduct the fingers b. Inability to flex fingers and make the "OK" sign c. Inability to extend the wrist d. Inability to extend the thumb
b
Where will pain present with pes anserine bursitis? a. Lateral knee b. Medial knee c. Anterior knee d. Posterior knee
b
Which of the following does NOT describe a reasonable treatment for ganglion cysts? Splinting of affected joint with behavioral modification. Surgical amputation of affected joint and everything distal to it. Cyst aspiration with or without corticosteroid injection. No treatment, if presentation is cosmetically based. Surgical resection if weakness, paresthesia, or vascular insufficiency is present.
b
Which of the following is NOT a typical conservative treatment for Cubital Tunnel Syndrome? A. NSAIDs B. Long Arm Cast x 6 weeks C. Night splint or Elbow pad D. Rest and Avoiding aggravating factors such as repetitive/prolonged elbow flexion
b
Which of the following is the LEAST LIKELY sign/symptom of Cubital Tunnel Syndrome? A. Weakness B. Paresthesia in the index finger C. Pain and tenderness in advanced stages D. Decreased strength/grip
b
Which of the following presentations is not typically found in Akylosing Spondylitis? a. Back pain, often times waking the patient up early in the morning b. Urinary incontinence c. Morning stiffness d. Stiffness improved with exercise
b
You diagnose your patient with trochanteric bursitis - how are you going to manage this patient? Empiric antibiotics Activity modification and adjunct therapy (NSAIDs) Emergent surgery Admit to nursing home DMARDs
b
1. ---- commonly occurs in children and adults with previous degenerative joint disease from osteoarthritis or torn meniscus2,3. 2. Diagnosis is commonly made by physical exam and confirmed with ultrasound, but MRI is the gold standard diagnostic2,3,4. 3. Treatment of the underlying disease in adults or surgery are the only definitive treatments for ----
backers cyst
-The most common clinical finding with ----- is a visual deformity of the muscle anteriorly ("Popeye deformity") where the muscle and tendon retract toward their distal attachment at the elbow. -Ask about traumatic events! Usually results from extension forces being placed on a flexed elbow e.g. Weightlifting -Treatment for ----- is either surgical repair or conservative treatment with anti inflammatories, rest, ice, physical therapy etc. and this is determined on a case-by-case basis.
biceps tendon rupture
-? is a fracture of the 5th metacarpal neck, likely resulting from a forceful punch. -Diagnosis of a ? is typically made from the history and physical exam with a positive history of aggression or frustration, edema, pain at the base of the 5th finger. Radiographic studies (AP, lateral and oblique views) are required for diagnosis and to evaluate the extent of injury. Treatment for ? depends on the degree of angulation and rotation, involves splinting for less extensive injuries, closed reduction, and open reduction/surgery for greatly angulated and/or rotated fractures.
boxers fx
16 year-old female soccer player presents to the ED with difficulty walking, and a painful, swollen left knee. She said she heard a 'pop' during her soccer game last night and the pain and swelling have gotten progressively worse. What is the most likely diagnosis? Femoral fracture Knee dislocation ACL tear Stress Fracture
c
2. Dosed once per week, what is the gold standard in treating rheumatoid arthritis?2 a. Plaquenil b. Arava c. Methotrexate d. TNF-alpha blockers e. Corticosteroids
c
2. Popliteal ecchymosis with severe knee pain after a diagnosis of Baker's cyst usually indicates: A. Osteoarthritis B. Osgood-Schlatter disease C. Ruptured Baker's Cyst D. Ankylosing Spondylitis
c
3. Diagnosis of chondromalacia is made by: a. clinical picture with PE b. exclusion of other diagnosis c. all of the above d. none of the above
c
3. The difference between a primary (type 1) and a secondary (type 2) Baker's cyst is: A. Primary Baker's cyst only occurs in the young population B. Secondary Baker's cyst is a blood filled pseudocyst C. Secondary Baker's cyst maintains free communication with the knee joint capsule D. Primary Baker's cyst maintains free communication with the knee joint capsule
c
3. What is a complication that might occur from unsuccessful reduction of a Colles' fracture. a. spoon deformity b. spork deformity c. dinner fork deformity d. dinner knife deformity e. dessert knife deformity
c
3. Which is the first step in the treatment of fibromyalgia? a. Corticosteroids b. Intense exercise program c. Correct sleep disruption d. Caffeine for fatigue
c
3. Which of the following patients is least at risk for plantar fasciitis a. A 17 year old on the high school football team b. A 45 year old man who just began training for a half marathon c. A 55 year old laboratory research technician
c
A 35-year-old women presents to her primary care physician complaining of right lateral hip pain. Her pain is constant and radiates into her right thigh and stops above the knee. She has not tried anything to make it better and laying on her right side makes it worse. The rest of her ROS is negative. She admits that her husband wants to run a half marathon so they have been training vigorously for that. Her physical exam is non-contributory except for pain to palpation over the lateral aspect of her right hip and pain with abduction of the right hip. X-ray did not show any pathology. What is the most likely diagnosis? Osteoarthritis Osteosarcoma Trochanteric Bursitis Sciatica Hip sprain
c
A 60 year-old male presents with a painless fibrous cord in the palmer aspect of his hand that is causing his 4th and 5th digit to be partially flexed. What is the most likely diagnosis? Trigger Finger Cancer Dupuytren's contracture Fractured 4th and 5th digit
c
All of the following are TRUE regarding shoulder impingement syndrome EXCEPT: a. Shoulder pain is worse with overhead lifting or reaching b. Shoulder pain can radiate to the lateral upper arm (deltoid) c. Patients will exhibit a drop arm sign
c
An 18-year-old high school Football player has just torn his ACL. He is a coveted prospect with Scholarship offers from 10 different Universities. He knows he will have to undergo ACL surgical reconstruction and asks you how long until he can start training again. Assuming there are no surgical complications and he adheres to the physical therapy routine, he should be able to start training in how long? 2-3 months 4-6 months 6-9 months 1-2 months
c
Charcot foot is caused by an underlying neuropathy cause by: Monkey Pox Crimean-Congo hemorrhagic fever Diabetes HIV
c
Majority of patients suffering from an acromioclavicular joint separation are: a. Older patients suffering from arthritis b. Women taking birth control c. Young and active adults d. AC joint separation occurs commonly in all age groups and types
c
Patient presents with knee pain exacerbated with walking up and down. Patient is 30 y/o female with no swelling, redness, or heat on PE and full ROM. There is tenderness on palpation on patellar retinaculum. You are suspecting: a. ACL tear b. Osteoarthritis c. chondromalacia d. none of the above
c
What are the lab findings seen in polymyalgia rheumatica? a. RF and anti-CCP positive b. Elevated BUN and LFTs c. Elevated ESR and CRP d. No abnormal lab findings
c
What are the three phases of adhesive capsulitis? Stiffness, weakness and painful phases Weakness, numbness and erythematous phases Freezing, frozen and thawing phases Frozen, thawing and raw phases
c
What are the two most common primary symptoms of Sjögren syndrome? Sore throat and dry eyes Dry mouth and unilateral headaches Dry eyes and dry mouth Urinary frequency and scrotal edema
c
What is the first line diagnostic modality for suspected C-spine herniation with radiculopathy? a. CT scan w contrast b. MRI c. X-ray d. CBC/CMP
c
What is the first line treatment for clubfoot? a. Radical amputation followed by prosthetic replacement b. Surgical repositioning of the cuneiforms c. The Ponseti method of serial recasting and bracing d. No treatment is currently available
c
What is the most common etiology of trochanteric bursitis? Trauma Sepsis Overuse Congenital Autoimmune
c
What medication should be avoided for long periods of time? a. NSAID b. Prednisone c.Narcotics d. Both b & c
c
Which of the following is NOT a 1st line treatment option for low back strain? 3 NSAIDs Ice & heat regimens Opioids Bed rest & light activity without causing significant pain
c
Which of the following is not a sign or symptom of cauda equina syndrome a. Sexual dysfunction b. Saddle anesthesia c. Headaches
c
Which of the following is the first line therapy for a patient with AS? a. Surgery b. IV Steroids c. Physical therapy and NSAID's
c
Which of the following is the most common cause of radial head fracture?5 a. Blunt force trauma directly to the elbow b. Genetic factors c. Bracing arm to catch self in a fall d. Wrestling
c
Which of the following symptoms might a person with tennis elbow NOT complain of? a.) Holding a coffee mug b.) Painting a house c.) Kicking a ball d.) Turning a doorknob
c
While performing a musculoskeletal exam on a patient presenting with shoulder pain, the patient produces a positive drop arm test. This test is used to further strengthen the diagnosis of which shoulder condition? a. Dislocation of the shoulder b. Fracture of the distal humerus c. Rotator Cuff Tear d. Deep Sternoclavicular bruising
c
Who is most likely to present today to a primary care clinic with Dupuytren's contracture? An 8 year old boy with epilepsy and a history of hand fracture A 25 year old female who smokes and has type 1 diabetes A 60 year old male who smokes, has diabetes, works in construction where he frequently uses a jack hammer, and whose father had Dupuytren's contractures A healthy 75 year-old female
c
You suspect osteosarcoma based on history and physical exam in a 17 year old male in your family practice. What should be your next step? Order an MRI of the affected area. Prescribe calcium supplements and refer patient to a nutritionist. Order plain radiographs and refer to orthopedic oncology. Osteosarcoma is a self-limiting disease of adolescence. Supportive care is all that is necessary.
c
pproximately half of all patients with an ACL tear will also have PCL tear MCL tear Meniscal tear Femoral fracture
c
Most common cause of cauda equina syndrome is compression of lumbosacral nerve roots caused by trauma, vertebral compression fractures, herniation, primary or metastatic spinal tumor or infection. Cauda Equina Syndrome patients will present with low back pain, sciatica/radicular pain, sexual dysfunction, saddle anesthesia, bowel dysfunction and bladder dysfunction. The best treatment is prompt diagnosis and surgical decompression to prevent permanent neurological deficits.
cauda ewuina
Joint destruction will be out of proportion to pain reported Patient will have underlying diabetic neuropathy Immobilize the affected joint.
charcot foot related to diabetes
1. Most common symptom is knee pain that increases with walking up or downstairs. 2. Patellar tilt test, Q angle great than 15 percent, or patellar tracking test positive. 3. Pain on palpation of Patellar retinaculum.
chondromalacia
Ganglion cysts are most commonly diagnosed clinically, but the diagnosis can be confirmed by MRI or US- and by cyst aspiration revealing: Blood Jelly-like, purulent fluid CSF Clear, thick, jelly-like fluid
d
2) If aspiration of olecranon bursiitis reveals cloudy fluid, which of the following labs should be ordered: A) Gram stain B) Leukocyte count C) Cultures D) Antibiotic Sensitivity E) All of the above
e
?is one of the most common birth defects affecting 1/1000 live births. Boys are twice as likely to be affected by clubfoot then girls. First line treatment for ? is the nonsurgical Ponseti method of serial casting and bracing.
clubfoot
1. A ? is the most common type of distal radial fracture that is most likely secondary to a fall on an out-stretched hand with a pronated forearm in dorsiflexion when one tries to break a forward fall, [iv]. 2. The gold standard of ? diagnosis is an AP and Lateral wrist plain film, [ii]. 3. A "dinner fork" deformity is a complication that might occur from unsuccessful reduction of a ?
colles' fx
- ? is the second most common upper extremity compressive neuropathy which affects men 3-8 times more than women - ? typically occurs due to increased pressure at the elbow, causing ulnar nerve entrapment/compression. - ? is characterized by weakness, and paresthesia in the distribution of the ulnar nerve, including the little and ring finger. Advanced stages of disease may be complicated with pain and tenderness (radiating proximally to distally), increased muscle atrophy, hand contractures, and possible loss of function.
cubital tunnel syndrome
1. 26-year-old presents to your office with intermittent knee pain. She states that it feels like her knee catches on something and she can not fully bend or straighten it. Because 70% of diagnosis comes form history you place what diagnosis at the top of your differential? a. Patellofemoral pain syndrome b. Sciatica c. Grade 3 high ankle sprain d. Menical tear e. None of the above
d
1. A 14 year old male presents in a primary care office complaining of knee pain. Upon examination you palpate a 2-3cm medial popliteal mass. The remainder of the knee exam is unremarkable. What is the next step in the workup? A. Refer to orthopedic surgery B. MRI C. Plain films of the affected knee D. Ultrasound
d
1. De Quervain tenosynovitis is A. An aggressive sepsis endemic to France B. An inflammatory tendonitis due to fascial sclerosis and entrapment of thumb tendons C. A result of overuse or acute trauma D. B and C are correct
d
2. Gold standard imaging modality for diagnosing a meniscal injury is a. 3-D Imax b. Plain film AP and lateral views of knee c. CT-with or without contrast d. MRI
d
2. Infection of the joint is due to an organism entering the body/blood via: A. Small cut or puncture B. Orifices such as the urinary tract or GI tract C. Respiratory tract D. All of the above
d
2. You are suspecting chondromalacia in a patient. What is a PE test you can do? a. Q angle measurement b. lateral tilt test c. hypermobility of patella d. all of the above
d
2.) What diagnostic test should be ordered to rule out nerve compression? a.) MRI b.) X-rays c.) CT Scan d.) Electromyography e.) EKG
d
A contributory history of a patient with shoulder bursitis includes all of the following EXCEPT A.) History of inflammatory disease B.) Localized tenderness C.) History of trauma D.) Increased range of motion
d
According to the Ottawa ankle and foot rules, imaging is indicated if: a. The patient has peripheral neuropathy b. The patient has lateral or medial malleolar tenderness c. The patient was unable to bear weight both immediately and in the emergency department d. B & C e. All of the above
d
An ankle sprain involving the lateral ligaments: a. Is the most common type of ankle sprain (85%) b. May involve the anterior talofibular ligament and/or posterior talofibular ligament c. May involve the calcaneofibular ligament d. All of the above
d
As carpal tunnel syndrome progresses - what is the patient likely to experience? A) Decreased Grip and Decreased hand strength. B) Burning, cramping, weakness, and wasting of the affected hand C) Shooting pains in the forearm. D) All of the above
d
DJD on X-ray may exhibit which of the following? a. Joint space narrowing b. Subchondral sclerosis and/or subchondral cysts c. Osteophyte formation d. X-ray of DJD may exhibit all of the above
d
Diagnosis and treatment for nursemaid's elbow consists of a a. history, physical exam, A/P and M/L radiographs and manual reduction of the radial head. b. history, physical exam, MRI and surgical reduction of the joint. c. history, physical exam and splinting of the elbow at 90 degrees for 6-8 weeks. d. history, physical exam and manual reduction of the radial head.
d
1. Gamekeeper's thumb is best described as an injury to the: A. 1st digit B. 2nd digit C. Hypothenar muscle group D. Thenar muscle group E. Ulnar collateral ligament of the thumb
e
In order to diagnose new onset, acute (<4weeks), low back pain (unilateral, sharp, intense and non-radiating) in an otherwise young, healthy individual which of the following sets of diagnostic tests is most appropriate? 1 Lumbar spine MRI & muscle biopsy Lumbar puncture & blood cultures Lumbar spine x-ray & electromyelography No imaging is required unless pain persists > 4weeks with treatment or develops other associated red flag symptoms
d
Ozzy Osbourne is referred to you after his PCP decides there's a high suspicion the Rock God is developing polymyositis. Which of the following is NOT considered a good diagnostic test for this disease? a. CK enzymes b. An EMG c. A muscle biopsy d. KMFDM enzymes
d
Polyarteritis nodosa most commonly affects which size of vasculature? Small vessels only Medium vessels only Large vessels only Medium and small vasculature All of the above
d
Scleroderma is most common in which age population? a. Children b.Adolescents c.Young adults d.Middle age to elderly
d
Treatment for Avascular Necrosis of the hip includes: a. Reduction in weight bearing activities b. Core decompression surgery c. Arthroplasty/Joint replacement surgery d. All of the Above
d
Treatment of an acute ankle sprain involves RICE therapy which is which of the following: a. R - reclining, I - ice, C - cold calorics, E - erythromycin b. R - rest, I - imaging, C - cephalosporin, E - ergonomic splinting c. R - rovsing's sign, I - isotonic solution, C - corticosteroids, E - elevation d. R - rest, I - ice, C - compression, E - elevation
d
What is the diagnostic test for gout? CBC Serum uric acid level MRI Synovial fluid analysis
d
What is the first diagnostic test you would do when assessing for radial head fracture?2 a. CT with contrast b. MRI c. Ultrasound d. Plain film radiograph
d
What is the gold standard of treatment for polymyalgia rheumatica? a. Antibiotics b. Cognitive-behavioral therapy c. Supportive treatment only d. Long-term low-dose steroids
d
What is the typical presentation in someone with a herniated nucleus pulposus? Most are atypical and incidental findings Impingement of a nerve root Segmental radiculopathy with paresthesias and weakness in the distribution of the affected root All of the above
d
What most likely contributes to Mr. Brown's symptoms of dry eyes and mouth? 3 first degree relatives with "dryness" Smoking- 20-yr pack hx A1C of 8.9% Doxepan (Sinequan) for his depression
d
What should the provider be most concerned about when assessing a pt. with cervical radiculopathy in an acute setting? a. Mechanism of injury b. Gradual pain c.Sensory and motor deficits d. C-spine precautions
d
What type of deformity is found in newborns with clubfoot? a. Equinus deformity b. Hind foot in varus and adducted c. Forefoot adducted d. All of the above
d
Which conditions can cause trigger finger? Overuse Diabetes Rheumatoid arthritis All of the above
d
Which fingers do not get trigger finger: The index finger Middle finger Thumb All fingers can get Trigger finger
d
Which of the following are known risk factors for DJD? a. Older age b. Female gender c. Obesity d. All of the above
d
You recently diagnosed a patient with acute hematogenous osteomyelitis. What is the best initial treatment for this patient? Supportive measures only Gentamicin 80mg IM once Ciprofloxacin 500mg BID for 7 days Penicillinase-resistant synthetic penicillin (oxacillin 2g IV q 4h) and cephalosporin (ceftazidime 2g IV q 8h).
d
1. ? is inflammatory tendonitis due to fascial sclerosis and entrapment of extensor tendons of the thumb. 2. ? presents with pain in the radial wrist during thumb motion, may present with tender swelling and hardening of the 1st dorsal compartment of the wrist, and is usually found in mothers or caretakers of infants and middle-aged women. 3. The positive Finkelstein test, consisting of sharp pain on thumb flexion across the palm and ulnar deviation, may indicate ?.
de quervain tenosynovitis
-?is the most common form of arthritis. It occurs when the cartilage within the joint deteriorates. Without this smooth surface, which permits a frictionless motion with movement, the joint is rough and the interaction causes increased pain and breakdown until eventually the joint consists of bone rubbing on bone. -Joints that are commonly affected by ? are the joints of the hands, neck, lower back, knees and hips -Some common signs and symptoms include: pain during or after movement, tenderness even with light pressure, stiffness most noticeable when you wake up or after a period of inactivity, loss of ROM, crepitus and/or bone spurs around affected joint -Risk Factors for ?: older age, female gender, bone deformities, joint injuries, obesity and other diseases that affect the bones such as diabetes, hypothyroid, gout and Paget's disease.
djd
-? is a slowly progressing disease where the formation of fibrous nodules, bands and/or cords form in the palmar surface of the hand that cause the finger(s) to have limited extension/flexion contractures. It most commonly affects the 4th and 5th digit, but may affect any finger and is commonly bilateral. -Risk factors include smoking, alcohol use, hand trauma, hand surgery, epilepsy, diabetes, HIV, adhesive capsulitis of the shoulder, cancer, hyperlipidemia and occupations that can cause trauma or overuse of the hands such as manual labor and exposure to vibration23. Anticonvulsant use may also be a risk factor2. It frequently runs in families as well. -treatment includes expectant management, steroid injections, collagenase injections, radiation and surgery. Recurrence is common. Surgery is reserved for severe progressive disease.
dupuytren's contracture
) Which of the following are considered treatment modalities for tennis elbow? a.) Corticosteroid Injections b.) Brace c.) NSAIDS d.) Physical Therapy e.) All of the Above
e
. Extra-articular manifestations of rheumatoid arthritis include2 a. Serositis b. Vasculitis c. Sicca complex d. Corneal melts e. All of the above
e
2. De Quervain tenosynovitis may present with A. Pain in radial wrist during thumb motion B. Increased pain with motion against resistance C. Tender swelling and hardening of the 1st dorsal compartment of the wrist D. Often found in mothers of infants E. All of the above
e
2.What is the gold standard of Colles' fracture diagnosis? a. AP wrist x-ray b. Lateral wrist x-ray c. CT of wrist d. MRI of wrist e. A and B
e
3) Olecranon bursitis is most commonly treated in the following way(s): A) NSAIDS for pain B) Corticosteroids for inflammation C) R.I.C.E. (Rest, Ice, Compression, Elevation) D) Aspiration of fluid on joint E) All of the above
e
3. Joints commonly affected by DJD/Osteoarthritis include all of the following except: a. Hand b. Neck c. Knees d. Hips e. Elbows
e
3. Which of the following can be seen in a patient with gamekeeper's thumb? A. Arthritis of the MCP joint of the affected thumb B. UCL joint laxity of the opposite (non-injured) thumb. C. Subluxation of the MCP joint of the affected thumb D. Fracture of the affected thumb. E. All of the above can be seen in a patient with gamekeeper's thumb.
e
3. Which provocative maneuvers are associated with meniscal injuries? a. Lachmans test b. Anterior drawers test c. Apley grind test d. McMurray test e. Both C and D
e
45-year-old male patient with history of rheumatoid arthritis comes in with complaints of pain in his axilla area. On physical exam you note tenderness, redness, and warmth of the area. Patient presents with reduced active range of motion and weakness of muscles of the shoulder. Your differential diagnoses includes all of the following except: A.) Supraspinatus tendinitis B.) Subacromial bursitis C.) Rotator cuff injury D.) Shoulder Bursitis E.) All of the above are possible ddx
e
: What are the best treatments for Osgood-Schlatters Disease? A. Ice B. A brace C. NSAID'S D. A and B E. All of the above
e
A patient with shoulder impingement syndrome may exhibit which of the following physical exam finding: a. Drop Arm Sign b. Neer Sign c. Sulcus Sign d. Hawkins Sign e. Both B and D
e
Cauda Equina syndrome is compression of which nerve roots. a. Cervical b. Thoracic c. Lumbar d. Sacral e. Both C&D
e
If you suspect a ruptured Achilles tendon in your patient, what imaging tests would be helpful? A) X-Ray B) MRI C) Ultrasound D) A and B E) All of the Above
e
Nursemaid's elbow can occur a. by swinging a toddler by the arms or wrists. b. yanking or dragging a child by the arm. c. during rough play or wrestling. d. while attempting to dress a child (e.g. pulling on a sweater or jacket). e. all of the above
e
Risk factors for osteoporotic spinal compression fractures include all of the following EXCEPT: Older age (>50 years for women and >65 years for men) Previous osteoporotic vertebral compression fracture Smoking Corticosteroid use All of the above are risk factors for osteoporotic spinal compression fractures
e
Rotator cuff injury treatment include all of the following except: a. NSAIDs b. Stabilization with a shoulder sling c. Corticosteroid injections d. Surgery e. All of the above are possible treatments of rotator cuff injury
e
Skin manifestation of polyarteritis nodosa include... Livedo reticularis Punched out ulceration Digital gangrene Raynaud's Phenomenon All of the above
e
Treatment for Dupuytren's contracture include which of the following Expectant management/watchful waiting Steroid injections with triamcinolone acetonide Collagenase injections Surgery in severe progressive disease All of the above
e
What diagnostic tool(s) is/are used to diagnose scleroderma? a. CBC b. Antinuclear antibody (ANA) c. Biopsy of skin d. CT scan of lungs e. All of the above
e
What infection(s) are commonly associated with polyarteritis nodosa? HBV HCV HAV EBV A and B
e
Which of the following are considered first line treatment for pes anserine bursitis? a. Ice b. NSAIDs c. Quadriceps strengthening d. Hamstring stretching e. All of the above
e
Which of the following muscle tendons is not a muscle tendon comprising the rotator cuff? a. Teres Minor b. Infraspinatus c. Supraspinatus d. Subscapularis e. All of the above are muscles comprising the rotator cuff.
e
reatment of a patient with osteoporosis after a thoraco-lumbar compression fracture may include all of the following EXCEPT: Spine radiographs at 6-week intervals for 3 months from injury Daily exercise regimen Calcium and vitamin D supplementation Analgesics All of the above are treatment options
e
1. ?occurs more often in women and age of onset is 20-60. 2. Main diagnostic criteria include positive 11 out of 18 trigger points throughout the body. 3. There is no cure for ?just managing the symptoms.
fibromyalgia
1.Suspect ---- in a patient who plays any sport with direct ball-to-hand contact OR in a skier.1 2.----is very rare in sports that involve gripping an object (tennis, lacrosse, etc.).3 3. Plain radiograph is the best first test for a patient suspected to have ----. An ortho consult should be ordered—in the meantime, the patient can be placed in a temporary sicca splint (thumb only or short arm sicca with thumb) until they are evaluated by a specialist.4
gamekeeper's thumb
-? is a benign, soft, smooth 0.5-3 cm cystic lesion formed from an out-pouching of the joint capsule/synovial membrane, most commonly occurring on the dorsal wrist. They less commonly occur around the hand/finger joints, top of the foot, and outside of the ankle or knee. -? are most commonly diagnosed clinically with physical exam revealing a smooth, soft, mobile, cystic, non-pulsatile lesion on or around a joint. The diagnosis can be confirmed by MRI or US showing a fluid filled cystic lesion and/or by cystic aspiration revealing clear, thick, jelly-like fluid. -Because patients most commonly present with ? for cosmetic reasons, treatment is very conservative, most commonly employing behavior/activity modification, splinting, and NSAIDS if there is mild aching involved. Cyst aspiration and surgical resection are utilized in ganglion cysts causing weakness, paresthesia, or vascular insufficiency
ganglion cyst
1. ? is caused by monosodium urate monohydrate crystals in the joint that cause an immune response with large amounts of inflammatory cells and cytokines (5). 2. ? risks include diet high in meat and seafood, high alcohol consumption, meds such as HCTZ, renal insufficiency, and psoriasis (5). 3. ? treatment is 3-fold: treat the acute flare (NSAIDS, corticosteroids, colchicine), prophylaxis against future flares(colchicine, NSAIDS, lifestyle changes), and lower excess stores of urate (allopurinol)(1). 4. It is important to differentiate ? from septic arthritis, and in order to do so, you must get a synovial fluid analysis (1).
gout
-? is a prolapse of an intervertebral disc through a tear in the surrounding annulus fibrosis. -The tear causes pain; when the disk impinges on an adjacent nerve root, a segmental radiculopathy with paresthesias and weakness in the distribution of the affected root results. -Recommend analgesics, light activity as tolerated, and exercises to improve posture and strength; however, if pain or deficits are severe or worsening, consider invasive procedures.
herniated nucleus pulposus
-STRAIN specifically refers to stretched or damaged MUSCLE or TENDON. While a SPRAIN involves a LIGAMENT. -? can takes up to 4-6 weeks to improve3, so prepare patients & help them have realistic expectations about their recovery. Additionally it is a diagnosis of exclusion and most cases are non-specific so patients may be frustrated by the course of treatment chosen. -Pain which accompanies ? is usually UNILATERAL, SHARP, INTENSE, aggravated by movement, alleviated by rest, sometimes accompanied by muscle spasm, and non-radiating1. Most patients can trace the onset of pain back to a particular activity or movement.
low back strain
1. Common complaints of meniscal injuries include catching, locking, buckling, pain, instability or any combination of these symptoms 2. MRI scan is the most accurate and noninvasive method of diagnosis 3. McMurray's test and Apley's compression test are indicative of meniscal injury
meniscal injury
-? is a prolapse of an intervertebral disc through a tear in the surrounding annulus fibrosis. -The tear causes pain; when the disk impinges on an adjacent nerve root, a segmental radiculopathy with paresthesias and weakness in the distribution of the affected root results. - Recommend analgesics, light activity as tolerated, and exercises to improve posture and strength; however, if pain or deficits are severe or worsening, consider invasive procedures.
nerniated nucleus pulposus
-?typically occurs between the ages of 1 and 3 due to excessive longitudinal traction (e.g. pulling) on the child's forearm. -The diagnosis of ? is typically made from the history and physical exam with a negative history of trauma and the child's unwillingness to move the upper extremity being the most prominent features. Radiographic studies are typically not warranted. Treatment for ? involves manual traction using either the hyperpronation or supination-flexion technique. Pain typically resolves with the reduction and no further treatment is necessary.
nursemaids elbow aka subluxation of radial head
-Common causes of ? are elbow injuries that involve direct or repetitive minor trauma to the posterior elbow or other activities cause repetitive microtrauma (i.e. leaning on a desk, rubbing the elbow against something, etc) -Common treatment of ? is aspiration of the joint, NSAIDS for pain, and corticosteroids for inflammation. -If aspiration of the ? reveals cloudy fluid, it should be sent for additional testing, such as Gram stain, leukocyte count, cultures, and antibiotic sensitivity. Also, corticosteroid injections are contraindicated, in this case.
olecranon bursitis
-?disease occurs in adolescents 10-15 years old and is a common cause of knee pain in this age group. -It is cause by repetitive quadriceps contraction, which pulls on the patellar tendon where it inserts on the tibial tubercle. -It is self limiting and usually will resolve within one year using conservative therapy: NSAID'S, ice, and possible short term immobilization to improve compliance
osgood schlatter disease
-The most common type of primary bone tumor is ? -? has a bimodal distribution, peaking in adolescents and in the elderly.1 It is most common in males.2 -? should be suspected in a patient presenting with acute-onset severe and localized bone pain, especially in long bones.
osteosarcoma
-? is an inflammatory condition of the medial knee - main cause is underlying tight hamstrings. -? is typically found in patients who are predisposed to knee conditions: those with degenerative joint disease, obesity, knee deformities, pes planus (flat foot), rapid side to side movements, local trauma, tendon tightness, and/or diabetes -This condition is self-limited and can be managed with conservative treatments - NSAIDs, ice, quadriceps strengthening, hamstring stretching. Intrabursal injection of local anesthetics, corticosteroids, or both represents a second-line treatment option to be considered only for refractory cases that don't respond to physical therapy, rest, ice, and NSAIDs.
pes anerine bursitis
?is a self-limited condition that will resolve within 10 months in 80-90% of cases [3]. ? is the most common cause of plantar heel pain [3]. Presence of calcaneal bone spur on x-ray is not specific for ?
plantar fascitis
olymyalgia rheumatica (PMR) is a chronic inflammatory disease that causes the body to experience muscle weakness, pain, and stiffness especially in the neck, shoulders, and hips.1,2,3,4 Often PMR related to giant cell arteritis1 Diagnosis of PMR is made off patient history (>50, morning stiffness), physical examination (proximal muscle pain and weakness), and elevated ESR (>40mm/hour) and CRP. Other rheumatologic serology (ex: RF, anti-CCP, CPK, dsDNA) factors should be normal/negative. No universal diagnostic criteria exist for PMR. 1,2,4 The gold standard of treatment for PMR is long-term low-dose steroids (such as Prednisone 15mg/day). Methotrexate can work as an add on treatment benefiting the patient by reducing the duration of steroids
polymyalgia rheumatica
----, if left untreated, can progress to respiratory depression, and ultimately, death. • ---- presents with with proximal muscle weakness, and tenderness of the affected areas. • The best tx option for --- is high dose oral corticosteroids.
polymyositis
? is a systemic autoimmune disease that is the most common inflammatory arthritis and second most common form of arthritis.2 ? is characterized by systemic inflammation, morning joint stiffness, and symmetric distribution of affected joints.2 ? affects many joints of the feet, wrists and hands, but the DIP joints are spared.
ra
-? is the fracture around the elbow joint that is most commonly found in adults, while children more often present with radial neck fracture.4 - ? most commonly occur as a result of falling on an outstretched arm, with elbow fully extended. Direct trauma rarely results in radial head fracture.5 -In approximately 20% of cases of elbow trauma, the?is fractured, and injury to the radial head and/or neck is present in about 33% of elbow fractures and dislocations.2 -It is vital to perform a neurovascular assessment on a patient with an elbow injury because the brachial artery and the ulnar, median, and radial nerves cross the elbow.
radial head fx
-? injuries are a common cause of shoulder pain in people of all age groups, athletic and nonathletic -Repetitive microtrauma and anatomic variations lead to most rotator cuff injuries. -?initial treatments include stabilization, NSAIDS and physical Therapy for 6 weeks.
rotator uff tear
1. A ? is the most common injury of the carpal/wrist bones. 2. The scaphoid and lunate are the only bones to articulate with the radius; therefore, these two bones receive the full force of a fall on the hand. 3. Poor blood supply and delayed diagnosis/treatment puts the scaphoid bone at risk for avascular necrosis.
scaphoid fx
- ? commonly presents with tightening of the skin, especially in the hands.1 -The etiology and pathophysiology of ? is unknown, but it is an autoimmune disorder.1,3 -There is no specific treatment for ?; however, treatment uses different medications to reduce the severity of the progression of the disease.
scleroderma
1. People most often affected with ? are young children and older adults. 2. Knees and hips are the most common infected joints and usually the infection is strep aureus 3. The best test to determine the infection organism in to drain and culture the synovial fluid. However if you have concern that there might be joint damage an MRI is the best follow up to the draining.
septic arthritis
1.) ? is inflammation of the rotator cuff tendons and the bursa that surrounds these tendons. 2.)The set of symptoms related to ? is called "impingement syndrome". Inflammation cases a pinching of the tendons and the bursa of the rotator cuff, hence why the condition is called impingement syndrome. 3.) 3.)Common treatment options for ----- include RICE (rest, ice, compression, elevation), anti-inflammatory medications, physical therapy, and ultrasound guided injection of local anesthetics.
shoulder bursitis
-? will have a positive Hawkins and/or Neer sign. -?occurs from overuse/repetitive activity. -Shoulder pain from ? is typically worse with overhead lifting or reaching and can radiate to the lateral upper arm (deltoid region).
shoulder impingement syndrome
? is a multisystem disorder that must be comanaged with a variety of medical specialists. Always stress regular dental and rheumatological care. -? exist as a primary condition or as a secondary condition with sicca symptoms (dry mouth and eyes)/signs in association with other well defined autoimmune disorders such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), polymyositis (PM) or primary biliary cirrhosis (PBC). -Diffuse infiltrative lymphocytosis syndrome (DILS) is a disorder that mimics ? and is seen in HIV patients.
sjogrens syndrome
1.) ? is most common in non-tennis players. 2.) ? is the not caused by the inflammation of the epicondyle but rather the hypoxic degeneration of the tendon. 3.) Rehabilitation of ?can take anywhere from 9-18 months.
tennis elbow
-The possibility of a spinal compression fracture should always be considered in patients at risk of osteoporotic bone disease, particularly older people and those taking long-term corticosteroid therapy. -Most osteoporotic spinal compression fractures are identified as an incidental finding on chest and abdominal x-rays taken for other indications, as patients are frequently asymptomatic by the time of diagnosis. -Initial investigation involves radiographic evaluation with AP and lateral spine x-rays, which often reveal the classic wedge fracture with loss of anterior vertebral height and relative preservation of posterior body height.
thoracolumbar compression fx
?is caused by inflammation of the tenosynovium of the phalanges, which gets stuck in the sheath of the phalanges causing the finger to get stuck in a bent position. When and if the finger is straightened back to the neutral position, a popping sound will be made when the inflamed portion of the tenosynovium shoots out of the narrow tendon sheath. ? can occur in all digits, including the thumb. Besides consistent overuse of the fingers, ? can also be caused by diabetes, rheumatoid arthritis, and gout.
trigger finger
-Inflammation of the bursa over the greater trochanter. Most commonly an overuse injury. Typically seen in women, runners, and those between 30-50. -Always x-ray a painful hip - in ? it will typically be negative but it's good to rule out other differentials. -Start management with activity modifications (rest, ice, stretching) and adjunct with NSAIDs or steroid injections. Refer to PT
trochanteric bursitis
