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Musculoskeletal

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jennifer12345's version from 2018-10-30 02:05

Section 1

Question Answer
Occupational risk factors: low back painlifting, pulling, prolonged sitting, vibration
Patient risk factors: low back painobesity, tall stature, work dissatisfaction, smoking, weak abs/spinal muscles, over age 65
Psychological risk factors: low back painanxiety, depression, alcoholism
Risk factors for cervical radiculopathyheavy manual labor, driving/operating vibrating equipment, smoking, disk degeneration
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Section 2

Question Answer
pain straight leg raise at 30-70 degrees indicatessciatic nerve root irritation
pain straight leg raise beyond 70 degrees indicateship issue
pain straight leg raise less than 30 degreesbuttock, sacral, malingering, multiple causes
pain when walking on heel indicatesL4-5 injury
pain when walking on toesL5-S1 injury
cervical radiculopathy commonly involvesC6-C7 injury
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Section 3

Question Answer
xray is indicated for trauma, cancer, osteoporosis, long term steroid use, constitution or neuro symptoms
MRI is indicated forsevere or progressive neuro deficits, infections, tumor, fracture, surgical candidates
secondary causes of osteoporosisthyrotoxicosis, cushing's disease, hyperparathyroidism, celiac disease
red flags for low back paininfection, fracture, refractory pain, cauda equina syndrome, malignancy
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Section 4

Section 5

Question Answer
Symptoms of herniated nucleus pulposusunilateral radiculopathy, SLR with pain in affected leg when opposite leg raised
Symptoms of gouterythemtous swollen and painful joint, usually affects just one joint
symptoms of degenerative joint disease (osteoarthritis)tenderness, swelling, loss of motion in weight bearing joints. Pain with activity relieved with rest.
symptoms of fibromyalgia syndromechronic pain, fatigue, tenderness in soft tissue for > 3 months. Joints are spared
symptoms of sclerodermacalcinosis, raynauds, esophageal dysmotility, sclerodactyl, telangiectasis
symptoms of sarcoidosiscough, SOB, fatigue, fever, night sweats, nodules/papules skin, occular symptoms, acute arthritis
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Section 6

Question Answer
Treatment of herniated nucleus pulposusNSAIDs, muscle relaxants, limit prolonged sitting,standing, or walking
Treatment of goutNSAIDS x 5-10 days, colchrys (colchicine) give within 48hr, corticosteroids last resort
Long term management goutallopurinol 300mg daily, colchrys 0.6mg daily, low purine diet (red meat, seafood, yeast, beer)
Treatment of osteoarthritistylenol/NSAIDs, 2nd line cox-2 inhibitor, OTC meds glucosamine/chondrotin/capsaicin
Treatment of osteoporosiscalcium 1,200mg/day, vit D 800IU, fosamax/actonel/boniva, hormone replacement selective cases
Treatment of fibromyalgia syndromeexercise, weight loss, cognitive behavior therapy, low dose pain and sleep medicine
treatment of rheumatoid arthritishydroxychloroquine, leflunomide, methotrexate, sulfasalazine, minocycline (DMARDS)
treatment of lupusif end organ involvement use methotrexate, avoid bactrim (can exacerbate symptoms)
treatment of sarcoidosisnot standardized, NSAIDs for joint pain, corticosteroids to control symptoms not improved NSAIDs
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Section 7

Question Answer
Nerve root L4foot dorsiflexion, knee jerk reflex, medial calf sensory
Nerve root L5great toe dorsiflexion, no reflex, medial forefoot sensory
Nerve root S1foot eversion, ankle jerk reflex, lateral foot sensory
Nerve root C4sensory change only, pain, cape distribution
Nerve root C5deltoid and bicep weakness, bicep reflex, shoulder pain, small area numbness
Nerve root C6weakness in biceps and wrist extensors, brachio-radialis reflex, pain and numbness arm to finger
Nerve root C7triceps weakness, triceps reflex, pain and numbness down arm to finger
Nerve root C8hand difficulty and fine motor function, weakness DIP of middle/index finger, sensory loss 5th digits
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Section 8

Question Answer
Diagnosis of gouturic acid >7.5, joint aspiration, soft tissue swelling on xray early-- then tophi later on
Diagnosis of osteoarthritislook to rule out other diseases, x-ray. Non-systemic disease
Diagnosis of osteoporosist score greater than -2.5 SD
Diagnosis of fibromyalgia syndromepain in 11/18 trigger points, diagnosis of exclusion
Diagnosis of rheumatoid arthritismorning stiffness, pain with motion in 1 joint, swelling joint, findings fluid/nodule bx, > 6 weeks
Diagnosis of lupus4 of 11: malar or discoid rash, photosensitivity, oral ulcers, arthritis, renal/neuro/hem issues
Diagnosis of sarcoidosisno single test, CXR for lymphagenopathy, infiltrates, fibrosis. PFTs for restriction, bronch granulomas
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Section 9

Question Answer
risk factors goutenzyme defects, obesity, etoh abuse, high purine diet, thiazide diuretics, ethambutol
risk factors degenerative joint disease (osteoarthritis)family history, increased age, inactivity, obesity, low vit D levels
risk factors osteoporosissmoking, alcohol, vitD calcium deficiency, family history
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Section 10

Question Answer
Osteoporosis screening indications for womenall > 65 years old, 60-64 if fracture risk
Osteoporosis screening indications for menno routinely recommended
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